Emerging pharmacotherapy trends in preventing and managing oral mucositis induced by chemoradiotherapy and targeted agents.

INTRODUCTION: The introduction of targeted therapy and immunotherapy has tremendously changed the clinical outcomes and prognosis of cancer patients. Despite innovative pharmacological therapies and improved radiotherapy (RT) techniques, patients continue to suffer from side effects, of which oral mucositis (OM) is still the most impactful, especially for quality of life. AREAS COVERED: We provide an overview of current advances in cancer pharmacotherapy and RT, in relation to their potential to cause OM, and of the less explored and more recent literature reports related to the best management of OM. We have analyzed natural/antioxidant agents, probiotics, mucosal protectants and healing coadjuvants, pharmacotherapies, immunomodulatory and anticancer agents, photobiomodulation and the impact of technology. EXPERT OPINION: The discovery of more precise pathophysiologic mechanisms of CT and RT-induced OM has outlined that OM has a multifactorial origin, including direct effects, oxidative damage, upregulation of immunologic factors, and effects on oral flora. A persistent upregulated immune response, associated with factors related to patients' characteristics, may contribute to more severe and long-lasting OM. The goal is strategies to conjugate individual patient, disease, and therapy-related factors to guide OM prevention or treatment. Despite further high-quality research is warranted, the issue of prevention is paramount in future strategies.

Dietary intake effects on severity of cancer treatment-induced mucositis: A cross-sectional study.

Background and Aims: Oral mucositis is one of the most serious complications due to chemotherapy and radiotherapy in head and neck cancer treatment. Oral mucositis causes a wide range of clinical signs and symptoms, such as ulcers, pain, and dysphagia. Additionally, because of speech limitations, patients' self-esteem will decrease, ultimately causing reduced quality of life. The primary objective of this study was to investigate the role of diet in the onset and progress of mucositis induced by chemotherapy and radiation therapy in patients with cancers. Methods: In this study, 121 patients with a mean age of 51.43 ± 13.08 years were selected randomly and referred to the cancer institute, where they underwent their first phase of chemotherapy. In this step, patients were examined and their severity of oral mucositis was graded according to the World Health Organization criteria. They completed a 3-day allergen food recall and dietary recommendations were met. After completing the forms, four questionnaires were filled out for each patient, the patient's nutrition was analyzed using the N4 software, and the amount of macro- and micronutrients was measured. Results: Micronutrients such as aspartic acid, glycine, serine, proline, alanine, arginine, glutamic acid, and vitamin B12 and macronutrients such as rose water, sausage, beverages, coffee, and lamb meat were examined, and a significant difference was observed between groups (grade 1 and 2 mucositis) (p < 0.005). In patients with grade 2 mucositis, a lower level of vitamin B12 was reported (p < 0.005). There is a negative correlation between amounts of macro- and micronutrients and grades of oral mucositis. Conclusion: It can be concluded that diet plays a considerable role in the severity of oral mucositis caused by cancer treatment.

Comparison of diagnostic effects of infrared imaging, visual inspection, and bitewing radiography in primary occlusal caries of permanent teeth.

Background: This study compared the diagnostic efficacy of VistaCam iX infrared camera, visual inspection, and bitewing-radiographs for the detection of primary occlusal caries of permanent teeth. Materials and Methods: In this in vitro experimental study, 80 extracted human premolars were evaluated. The occlusal surfaces of these teeth were demineralized by immersion in a demineralizing agent. Then, the International Caries Detection and Assessment System (ICDAS II), bitewing-radiography, and Proxi head of VistaCam iX were used to inspect them. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each diagnostic modality. Data were analyzed using SPSS. Twenty-five at P < 0.05 level of significance with one-way analysis of variance and Games-Howell test. Results: Bitewing-radiography had significantly lower sensitivity than ICDAS II and VistaCam (P < 0.05). ICDAS II was comparable to VistaCam, with no significant difference in sensitivity (P > 0.05). ICDAS II had a significantly higher PPV than bitewing-radiography and VistaCam (P < 0.05). The sensitivity of bitewing radiography was significantly lower than that of ICDAS II and VistaCam (P < 0.05). ICDAS II was comparable to that of VistaCam with no significant differences in sensitivity (P > 0.05). ICDAS II had a considerably higher PPV than bitewing-radiography and VistaCam (P < 0.05). The NPV of ICDAS II visual inspection was significantly higher than that of bitewing-radiography and VistaCam (P < 0.05). The ICDASS II and VistaCam had a repeatability coefficient of 47.4%. For bitewing-radiography and VistaCam, this value was 44.2% and 83.4% for ICDAS II and bitewing-radiography. Conclusion: Visual inspection seems to be superior to bitewing-radiography and VistaCam in detecting primary occlusal caries of permanent teeth.

Different scoring methods of the VARK questionnaire to evaluate dentistry Students' learning styles.

INTRODUCTION: The way students process and organise information to facilitate learning is known as learning style. Knowing one's learning style can improve learning and help teachers choose their teaching methods more effectively. This study was conducted to investigate different scoring methods of the VARK questionnaire and compare different learning styles in different stages of dental school. MATERIALS AND METHODS: Students in three stages of the dental school participated in this study: basic sciences, preclinical and clinical. The validated reliable Persian VARK questionnaire was utilised. Collected data were computed and analysed in three ways: raw, normalised and weighted scoring by ANOVA and chi-squared tests (α = .05). RESULT: The most favoured learning style was auditory; however, the prevalence of other learning styles varied through stages. On analyses of visual and auditory learning styles by all methods of scoring, no significant difference was seen in different stages (study time). The kinetic learning style, using normalised scoring method, was used more significantly when the grade increased (p-value = .028). However, in the weighted method, this effect was not significant. The read-write learning style using all three scoring methods showed an inverse relationship with the level of education (p-value <.05), which means the tendency to use this style of learning decreased when the level of education increased. CONCLUSION: As the educational level increases, students are more inclined to use kinetic and less likely to employ read-write learning style. There was not a significant difference in the use of visual and aural learning styles in any stages of dental school.

Effects of COVID-19 epidemic on mental health of dental students of Tehran University of Medical Sciences in 2020.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) pandemic has imposed panic and fear among people in the community, and has endangered the mental health of people, including students. The purpose of this study was to determine the psychological effects of COVID-19 outbreak on dental students of our university in 2020. METHODS AND MATERIALS: The present cross-sectional and descriptive-analytical study was conducted on 133 dental students from the fifth and 11th semesters in our University. Data collection tools included the Demographic Information Questionnaire, the 28-item Goldberg General Health Questionnaire (GHQ-28) to measure the psychological aspects, the BarOn Emotional Quotient-Inventory (BarOn EQ-i) to determine emotional intelligence, and the COVID-19 Anxiety Scale (CAS) of students during the epidemic. The reliability and validity of the questionnaires had already been reviewed and confirmed. The correlation of the scores of the questionnaires was evaluated by Pearson correlation coefficient and the effects of different variables in predicting the scores of the questionnaires by regression model. RESULTS: Among the tested students, the mean GHQ-28 score was 35.73%, the mean BarOn EQ-i score was 59.94%, and the mean CAS score was 25.27%. There was a significant and direct correlation between GHQ-28 and BarOn EQ-i scores and also a significant and negative correlation between GHQ-28 and CAS scores and between BarOn EQ-i and CAS scores. CONCLUSION: Despite limited CAS scores and high BarOn EQ-i scores, psychological disorders were observed in a significant number of students during the COVID-19 pandemic period; there is a need for therapeutic and counseling interventions to mitigate the effects of these disorders.

Oral focal mucinosis in an adolescent: A rare entity.

Oral focal mucinosis (OFM) is an extremely rare benign lesion of the oral cavity with unknown etiology, considered the oral counterpart of cutaneous focal mucinosis. It occurs mainly in women in the fourth and fifth decades of life. It has no characteristic features, and diagnosis depends on histological evaluation. Its pathogenesis is related to the excessive production of hyaluronic acid by fibroblasts during collagen production, which leads to focal myxoid degeneration. To date, ten documented cases have been reported in the literature in adolescents. This paper reports a rare case of OFM with a narrative review of the available literature.

Investigating the Relationship between Fingerprint Pattern and Development of Oral Squamous Cell Carcinoma.

Statement of the Problem: Oral squamous cell carcinoma (OSCC) constitutes more than 90% of oral malignancies. The main risk factors of OSCC include cigarette smoking and alcohol. However, since not all smokers or alcohol drinkers develop this disease, other factors have also been suggested including genetic characteristics of every person to be implicated in the probability of developing OSCC. Purpose: Our aim in this study is to investigate the possible relationship between fingerprint patterns and the probability of developing OSCC. Materials and Method: In a cross sectional study, we had 140 patients in 2 groups as OSCC and cancer free. Fingerprints were recorded by fingerprint scanner device. The fingerprint patterns were categorized into three major groups and four subgroups. Groups were tested by chi-square. Results: The relationship between the main fingerprint patterns and incidence of OSCC became significant (p= 0.037). The frequency of the main pattern of Arch was significantly higher in the experimental group than in the control group (p< 0.05). Considering the main patterns of Loop and Whorl, no significant difference existed between the two groups. Furthermore, the frequency of subtype patterns of Double Whorl and Central Pocket Whorl was significantly higher in the control group than in the experimental group (p< 0.05). Conclusion: Since dermatoglyphics is contingent upon genetic variations, fingerprint can be used for investigating the susceptibility of people in developing different diseases, though further studies are required in this regard. This method is in no way a substitute for gold standard methods for diagnosis.

MASCC/ISOO expert opinion on the management of oral problems in patients with advanced cancer.

PURPOSE: The Palliative Care Study Group in conjunction with the Oral Care Study Group of the Multinational Association for Supportive Care in Cancer (MASCC) formed a sub-group to develop evidence-based guidance on the management of common oral problems in patients with advanced cancer. METHODS: This guidance was developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews and trials, respectively. Guidance was categorised by the level of evidence, and "category of guideline" (i.e., "recommendation", "suggestion" or "no guideline possible"). RESULTS: Twelve generic suggestions (level of evidence - 5), three problem-specific recommendations and 14 problem-specific suggestions were generated. The generic suggestions relate to oral hygiene measures, assessment of problems, principles of management, re-assessment of problems and the role of dental/oral medicine professionals. CONCLUSIONS: This guidance provides a framework for the management of common oral problems in patients with advanced cancer, although every patient requires individualised management.

"Oral Manifestations of Patients with Inherited Defect in Phagocyte Number or Function" a systematic review.

INTRODUCTION: Inherited phagocyte defects are one of the subgroups of primary immunodeficiency diseases (PIDs) with various clinical manifestations. As oral manifestations are common at the early ages, oral practitioners can have a special role in the early diagnosis. MATERIALS AND METHODS: A comprehensive search was conducted in this systematic review study and data of included studies were categorized into four subgroups of phagocyte defects, including congenital neutropenia, defects of motility, defects of respiratory burst, and other non-lymphoid defects. RESULTS: Among all phagocyte defects, 12 disorders had reported data for oral manifestations in published articles. A total of 987 cases were included in this study. Periodontitis is one of the most common oral manifestations. CONCLUSION: There is a need to organize better collaboration between medical doctors and dentists to diagnose and treat patients with phagocyte defects. Regular dental visits and professional oral health care are recommended from the time of the first primary teeth eruption in newborns.

Impact of COVID-19 on Dentistry.

The coronavirus disease 2019 (COVID-19) pandemic has affected the health-care system drastically, including dental care practice. COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is thought to spread via close contact through respiratory droplets and aerosols. Owing to specific characteristics of dental care such as aerosol generation as well as close proximity to patients, dentistry is thought to be associated with the nosocomial spread of infection. The risk of bidirectional spread of infection between patient and dental care providers makes it critical to take additional precautionary measures to mitigate the spread of COVID-19. It is essential to understand that the guidelines for providing dental treatment during the COVID-19 pandemic will vary across the globe, and dental practices should be in compliance with their regional guidelines. This chapter aims to present an overview of the dynamics of COVID-19 transmission and its impact on dentistry and discuss measures to provide dental care during the time of the COVID-19 outbreak effectively.

Evaluation of Inhibitory Effects of Caffeine on Human Carcinoma Cells.

One of the world's most consumed medications is caffeine which is available in the vast majority of beverages. Previously, some effects of caffeine have been evaluated including its inhibitory effect on cancer cells. But, the influence of caffeine on esophagus carcinoma squamous cells (CSC) and head and neck carcinoma cells still has not well understood. Herein, the relation between different amounts of caffeine with the proliferation rate of human esophagus carcinoma squamous cell line KYSE-30 as well as human head and neck carcinoma cell line HN5 was evaluated. Furthermore, concentrations of caffeine were adjusted and their effect on cells were studied. The inhibitory effects of caffeine on cells were measured using the conventional colorimetric MTT assay after 3 and 7 day of incubation. Our findings are suggested that caffeine has a significant inhibitory effect on both cell lines at the concentrations of 20, 50, and 70 milli-mol (mmol). The result shows that caffeine can prevent the proliferation of carcinoma cells and it is a perfect candidate for therapeutic applications.

Comparison of diagnostic effects of infrared imaging and bitewing radiography in proximal caries of permanent teeth.

This study aimed to compare the diagnostic efficacy of VistaCam iX intraoral camera system using infrared light and bitewing radiography for detection of proximal caries in permanent teeth. This in vitro study was performed on 108 teeth. The proximal surfaces of the teeth were examined for caries using ICDAS II criteria, bitewing radiography, and the Proxi head of VistaCam iX. The teeth were then sectioned and histologically analyzed (gold standard). Data were analyzed using SPSS version 25 via the correlation test at P < 0.05 level of significance. The overall and segmental sensitivity and specificity values were calculated for (1) the contact area and higher regions, (2) below the contact area to the cementoenamel junction (CEJ), and (3) below the CEJ. Radiography had the highest specificity. VistaCam had the highest overall and segmental sensitivity for enamel caries. Radiography had the highest segmental sensitivity for dentin. In region 1, VistaCam had the highest sensitivity and lowest specificity, and radiography and ICDAS II had the highest specificity and lowest sensitivity. In region 2, radiography showed the highest sensitivity and specificity. VistaCam had the lowest sensitivity and ICDAS II had the lowest specificity in this region. In region 3, VistaCam did not detect any caries and radiography had a better performance than ICDAS II. The specificity value was equal for both methods. VistaCam had the highest diagnostic efficacy among the three methods for caries in region 1; however, bitewing radiography had a superior efficacy in regions 2 and 3.

Preventing and Therapeutic Effect of Propolis in Radiotherapy Induced Mucositis of Head and Neck Cancers: A Triple-Blind, Randomized, Placebo-Controlled Trial.

BACKGROUND: Mucositis is one of the acute complications of radiotherapy which can ulcerate oral mucosa and cause severe pain and discomfort which can affect oral normal function. Propolis is a natural source of flavenoid which has antiulcer, antibacterial, antifungal, healing and anti-inflammatory effects. Using such an affordable compound without any bad smell or taste that has reasonable price can help the radiotherapy undergoing patients. OBJECTIVES: Our goal is assessing the preventing and therapeutic effect of propolis in radiotherapy induced mucositis in patients with head and neck cancer. PATIENTS AND METHODS: In a randomized triple blind clinical trial, 20 patient were selected randomly to swish and swallow 15 ml of water based extract of propolis mouth wash 3 times a day in the case group (n = 10) and 15 ml placebo mouth wash in control group (n = 10). we use NIC-CTC scale for determining mucositis grading. RESULTS: We use T-test, Man-Whitney, Chi-square, and Friedman as analyzing tests. Case group had significantly (P < 0.05) lower grade of mucositis in all of the follow-ups, but xerostomia is not significantly different in two groups (P > 0.05). CONCLUSIONS: This is a pilot study which shows water based extract of propolis efficiently prevents and heals radiotherapy induced mucositis.