Diagnosis and rehabilitation of an infant with palatal mucormycosis: A clinical report and systematic literature review.

STATEMENT OF PROBLEM: Oral mucormycosis is uncommon in pediatric patients with hematolymphoid diseases. Prosthetic rehabilitation is challenging, and protocols are scarce in the literature. PURPOSE: The purpose of this clinical report and systematic literature review of case reports and case series was to describe the clinicopathologic aspects of oral mucormycosis and the interim prosthetic rehabilitation of an affected infant. MATERIAL AND METHODS: The clinical lesions were ulcerative and necrotic with underlying bone exposure that affected the hard palate. The affected area underwent surgical debridement, and histopathologic analysis was performed. A literature search in PubMed/MEDLINE, Embase, Scopus, and Web of Science up to October 2023 was performed. RESULTS: The histopathological features were consistent with mucormycosis. Topical and systemic antifungals were prescribed. Tooth eruption was insufficient, and an acetate plate without clasp retention, but still with adequate retention, was fabricated. Articulatory, masticatory, and swallowing functions were restored, preventing the passage of food and fluids into the oroantral cavities. Twenty-five articles describing 26 patients with oral mucormycosis related to hematolymphoid disorders affecting the pediatric population were identified. None of the authors of these articles provided information about oral rehabilitation. CONCLUSIONS: Early diagnosis and treatment are essential to increasing the chances of survival for infants affected by oral mucormycosis. Custom-made rehabilitation should be provided to restore oral function and improve the patient's general health.

Clinical, immunological, and microbiological analysis of the association between periodontitis and COVID-19: a case-control study.

PURPOSE: Periodontitis and coronavirus disease (COVID-19) share risk factors and activate similar immunopathological pathways, intensifying systemic inflammation. This study investigated the clinical, immunological and microbiological parameters in individuals with COVID-19 and controls, exploring whether periodontitis-driven inflammation contributes to worsening COVID-19 endpoints. METHODS: Case (positive RT-PCR for SARS-CoV-2) and control (negative RT-PCR) individuals underwent clinical and periodontal assessments. Salivary levels of TNF-α, IL-6, IL-1ß, IL-10, OPG, RANKL, neutrophil extracellular traps, and subgingival biofilm were analyzed at two timepoints. Data on COVID-19-related outcomes and comorbidity information were evaluated from medical records. RESULTS: Ninety-nine cases of COVID-19 and 182 controls were included for analysis. Periodontitis was associated with more hospitalization (p = 0.009), more days in the intensive care unit (ICU) (p = 0.042), admission to the semi-ICU (p = 0.047), and greater need for oxygen therapy (p = 0.042). After adjustment for confounders, periodontitis resulted in a 1.13-fold increase in the chance of hospitalization. Salivary IL-6 levels (p = 0.010) were increased in individuals with COVID-19 and periodontitis. Periodontitis was associated with increased RANKL and IL-1ß after COVID-19. No significant changes were observed in the bacterial loads of the periodontopathogens Porphyromona gingivalis, Aggregatibacter actinomycetemcomitans, Tanerella forsythia, and Treponema denticola. CONCLUSIONS: Periodontitis was associated with worse COVID-19 outcomes, suggesting the relevance of periodontal care to reduce the burden of overall inflammation. Understanding the crosstalk between SARS-CoV-2 infection and chronic conditions such as periodontitis that can influence disease outcome is important to potentially prevent complications of COVID-19.

Neutrophil extracellular traps in rheumatoid arthritis and periodontitis: Contribution of PADI4 gene polymorphisms.

AIM: We sought to investigate the release of neutrophil extracellular traps (NETs) in neutrophils from individuals with rheumatoid arthritis (RA) and controls and compare the presence of NETs in gingival tissues according to periodontal status. Also, the association between single nucleotide polymorphisms (SNPs) of the peptidyl arginine deaminase type 4 (PADI4) gene and the GTG haplotype with RA, periodontitis and NETs was evaluated in vitro. MATERIALS AND METHODS: Peripheral neutrophils were isolated by density gradient, and NET concentration was determined by the PicoGreen method. Immunofluorescence was studied to identify NETs by co-localization of myeloperoxidase (MPO)-citrullinated histone H3 (H3Cit). Genotyping for SNPs (PADI4_89; PADI4_90; PADI4_92; and PADI4_104) was performed in 87 individuals with RA and 111 controls. RESULTS: The release of NETs in vitro was significantly higher in individuals with RA and periodontitis and when stimulated with Porphyromonas gingivalis. Gingival tissues from subjects with RA and periodontitis revealed increased numbers of MPO-H3Cit-positive cells. Individuals with the GTG haplotype showed a higher release of NETs in vitro and worse periodontal parameters. CONCLUSIONS: The release of NETs by circulating neutrophils is associated with RA and periodontitis and is influenced by the presence of the GTG haplotype.

Leukemia/lymphoma oral infiltration and its impact on disease outcomes: A Brazilian study.

OBJECTIVE: Oral malignant infiltrations (OMI) are relevant for the diagnosis and prognosis of leukemia/lymphoma. This study analysed the oral health status and OMI of individuals with leukemia/lymphoma. MATERIALS AND METHODS: A retrospective analysis (2010-2021) of data from individuals seen at a specialized hospital-based dental service in Brazil. RESULTS: A total of 781 cases of leukemia/lymphoma were surveyed. Acute lymphoblastic leukemia (30.1%), acute myeloid leukemia (AML; 26.0%), and non-Hodgkin lymphoma (22.2%) were the most common diagnoses. The first (21.3%) and second (19.3%) decades of life were the most affected. Overall, dental caries (36.7%) and periodontal changes (34.6%) were the most frequent oral conditions. OMI occurred in 25 (3.2%) individuals. Lesions mainly involved the gingiva (80%) and patients diagnosed with AML (64%). Death (p < 0.001) and worse periodontal condition (p = 0.036) were more frequent among adults with OMI than among those without OMI. Death (p = 0.002) was more frequent among paediatric individuals with OMI than among those without OMI. When controlling for underlying disease, no association was observed between OMI and these outcomes. CONCLUSION: Oral status of individuals with leukemia, particularly those with acute leukemia or lymphoma, should be closely monitored since one or multiple conditions may occur, including OMI, which may influence disease outcomes.

Biosafety in Dental Health Care During the COVID-19 Pandemic: A Longitudinal Study.

Background: The coronavirus disease 2019 (COVID-19) pandemic had quite an impact on dental health care. Concerns about the risk of SARS-CoV-2 transmission through contaminant fluids and droplet formation during several dental procedures highly impacted dental health care, drastically reducing the number of dental practices worldwide. To monitor SARS-CoV-2 contamination in dental clinics, a longitudinal study was carried out during the return of dental practice at university. Methods: Dental health care professionals [(DHCPs); teachers, undergraduate dental students, and dental assistants] and patients were screened for SARS-CoV-2 RNA in a dental school clinic environment from 11th January to 12th March 2021 (9 weeks). Serological testing was performed on DHCPs in two-time points. Additionally, samples with low Ct values were sequenced to identify the circulating SARS-CoV-2 variant and possible transmission clusters. Results: We found a low number of dental staff (5.8%), patients (0.9%), and environment sites (0.8%) positive for SARS-CoV-2. Most positive cases had asymptomatic to mild symptoms, and two asymptomatic DHCPs presented prolonged infection. In the first week after previous exposure to COVID-19, 16.2% of DHCPs had IgM or IgG antibodies against SARS-CoV-2, and 1/3 of them had undetected antibodies in the last weeks. The variant zeta (P.2) could be detected. No cross-infection was observed between participants. Conclusion: Our study suggests that dental practice can be safely executed when adequate control measures and biosafety protocols are applied. DHCP and patient testing, patient telemonitoring, proper use of personal protection equipment, and sanitization of surfaces are essential to avoid SARS-CoV-2 cross-infection in dental practice.

Orofacial Manifestations of Fetal Alcohol Syndrome: Two Case Reports and a Scoping Review.

Purpose: Fetal alcohol syndrome (FAS) results from the teratogenic effects of alcohol on the fetus. Oral manifestations are commonly found in FAS and contribute to the diagnosis. The purpose of this study was to provide a review of the literature and describe two cases of FAS.
Methods: Electronic searches were conducted in August 2021 in multiple databases. The cases of two children with FAS are reported.
Results: One hundred sixty-six articles were included. The oral features frequently reported were micrognathia, cleft palate, high arched palate, maxillary hypoplasia, prognathia and crowding. The first patient had systemic and orofacial changes, such as delayed physical and cognitive development, micrognathia, tooth impaction, malocclusion and enamel hypoplasia. The second child had cognitive, and speech and behavioral deficits, but no oral and dental abnormalities.
Conclusion: Dentists should be aware of clinical findings since they may take part in the diagnosis and management of FAS.

Análise clínica, imunológica e microbiológica da associação entre periodontite e COVID- 19: um estudo caso-controle / Clinical, immunological, and microbiological analysis of the association between periodontitis and COVID-19: a case-control study

Esse estudo avaliou os parâmetros clínicos, imunológicos e microbiológicos em indivíduos com COVID-19 e controles, explorando se a inflamação causada pela periodontite contribui para ocorrência e gravidade de desfechos adversos da COVID19. Indivíduos do grupo caso [exame de transcriptase reversa da reação em cadeia da polimerase (RT-PCR) positivo para coronavírus da síndrome respiratória aguda grave-2 (SARS-CoV-2)] e controles (RT-PCR negativo para SARS-CoV-2) foram submetidos à avaliação clínica e periodontal. Níveis salivares de fator de necrose tumoral alfa, interleucina (IL)-6, IL-1ß, IL-10, osteoprotegerina, ativador de receptor do fator nuclear Kappa-B ligante (RANKL), armadilhas extracelulares de neutrófilos (NET) e biofilme dental foram analisadas em dois tempos. Dados de desfechos relacionados à COVID-19 e comorbidades foram extraídos dos prontuários clínicos. Noventa e nove casos de COVID-19 e 182 controles foram incluídos para análise. Periodontite foi associada com maior número de hospitalizações (p=0.009), maior número de dias na unidade de terapia intensiva (UTI) (p=0.042), maior admissão na unidade de terapia semi-intensiva (UTSI) (p=0.047), e elevada necessidade de uso de oxigenação suplementar (p=0.042). Após ajuste das variáveis de confusão, periodontite resultou em 1.13 vezes mais chance de hospitalização. Níveis salivares de IL-6 (p=0.010) estavam aumentados em indivíduos com COVID-19 e periodontite. Periodontite foi associada com elevados níveis RANKL e IL-1ß após o fim da infecção por COVID-19. Não foram observadas alterações significativas nas cargas bacterianas dos periodontopatógenos Porphyromona gingivalis, Aggregatibacter actinomycetemcomitans, Tanerella forsythia, e Treponema denticola durante e após a infecção. Periodontite foi associada à piores desfechos da COVID-19 (hospitalização, uso de oxigênio suplementar, dias na UTI e admissão na UTSI), sugerindo a relevância do cuidado periodontal para reduzir a carga sistêmica de inflamação. Entender a relação entre a infecção por SARS-CoV-2 e condições crônicas que podem influenciar os desfechos da doença, como a periodontite, é importante para potencialmente prevenir complicações da COVID-19.

This study investigated the clinical, immunological, and microbiological parameters in individuals with coronavirus disease (COVID-19) and controls, exploring if periodontitis-driven inflammation contributes to the occurrence and severity of COVID19 endpoints. Case [positive reverse transcriptase- polymerase chain reaction (RTPCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)] and control (negative RT-PCR for SARS-CoV-2) individuals underwent clinical and periodontal assessment. Salivary levels of tumoral necrosis factor alpha, interleukin (IL)-6, IL-1ß, IL-10, osteoprotegerin, receptor activator of nuclear factor Kappa-B (RANKL), neutrophil extracellular traps, and subgingival biofilm were analysed at two time-points. Data on COVID-19-related outcomes and comorbidity information were assessed from medical records. Ninety-nine cases of COVID-19 and 182 controls were included for analysis. Periodontitis was associated with more hospitalization (p=0.009), more days in the intensive care unit (ICU) (p=0.042), admission to the semi-ICU (p=0.047), and greater need for oxygen therapy (p=0.042). After adjustment for confounders, periodontitis resulted in a 1.13-fold increase in the chance of hospitalization. Salivary IL-6 levels (p=0.010) were increased in individuals with COVID-19 and periodontitis. Periodontitis was associated with increased RANKL and IL-1ß after the end of COVID19 infection. No significant changes were observed in bacterial loads of the periodontopathogens Porphyromona gingivalis, Aggregatibacter actinomycetemcomitans, Tanerella forsythia, and Treponema denticola during and after the infection. Periodontitis was associated with worse outcomes from COVID-19 (hospitalization, use of oxygen, days at ICU and admission to semi-ICU), suggesting the relevance of periodontal care to reduce the burden of overall inflammation. Understanding the crosstalk between SARS-CoV-2 infection and chronic conditions such as periodontitis that can influence the disease outcome is important to potentially prevent complications of COVID-19.

Safety protocols for dental care during the COVID-19 pandemic: the experience of a Brazilian hospital service.

The coronavirus disease (COVID-19) has been prioritized in relation to other illnesses considered critical, such as cancer, cardiovascular diseases/stroke, diabetes, and autoimmune diseases. The management of patients with these diseases involves dental care to reduce systemic complications caused by odontogenic infections, and/or to treat oral manifestations of systemic comorbidities. In this regard, the dental care of these individuals must be guaranteed during the pandemic. Although a high risk of exposure to and catching of COVID-19 is expected to befall dental professionals, biosafety guidelines reduce the likelihood of infection. Thus, the current scenario poses challenges, and offers decision-making approaches and tools that facilitate the management of individuals with oral manifestations of chronic and/or critical diseases, using hospital-based services. This article presents an overview for hospital service providers who are at the forefront of COVID-19 care, including a secure protocol, and clinical guidelines based on the experience of the Hospital das Clínicas in Belo Horizonte, a public referral service, supported by the Brazilian National Health System.

Safety protocols for dental care during the COVID-19 pandemic: the experience of a Brazilian hospital service

Abstract The coronavirus disease (COVID-19) has been prioritized in relation to other illnesses considered critical, such as cancer, cardiovascular diseases/stroke, diabetes, and autoimmune diseases. The management of patients with these diseases involves dental care to reduce systemic complications caused by odontogenic infections, and/or to treat oral manifestations of systemic comorbidities. In this regard, the dental care of these individuals must be guaranteed during the pandemic. Although a high risk of exposure to and catching of COVID-19 is expected to befall dental professionals, biosafety guidelines reduce the likelihood of infection. Thus, the current scenario poses challenges, and offers decision-making approaches and tools that facilitate the management of individuals with oral manifestations of chronic and/or critical diseases, using hospital-based services. This article presents an overview for hospital service providers who are at the forefront of COVID-19 care, including a secure protocol, and clinical guidelines based on the experience of the Hospital das Clínicas in Belo Horizonte, a public referral service, supported by the Brazilian National Health System.