Challenges in providing special care dentistry during COVID-19 pandemic: a survey of public dental care services in Italy.

BACKGROUND: The aim of this paper was to assess COVID-19 pandemic impact over the public health care services (HCS) involved in special care dentistry (SCD). METHODS: Customized questionnaire was sent to 45 HCS involved in SCD. Healthcare personnel (HP) on duty, safety of HCS, time of suspension and reduction of routine dental practice in special needs patients (SNP), kind of SNP mostly penalized during pre-COVID period/T1, lockdown (phase 1/T2) and post pandemic reopening (phase 2/T3) were analyzed by statistical means (P<0.05). RESULTS: 21 questionnaires were returned. A significant decrease of median number of HP during T2 was observed. Prevalence of COVID-19 infection among HP was not significantly different between T2 vs. T3. Medical surveillance of HP during T2 was significantly lower than during T3. Patients with lack of cooperation were the most disadvantaged during both phases dental procedures were significantly lower between T1 and T2 and between T1 and T3 as well. Patients with lack of cooperation and/or living in residential care homes were the most disadvantaged in relation to access to dental care during both phases. CONCLUSIONS: COVID-19 pandemic determined significant restrictions in daily access to routine oral care resulting in reduction of preventive evaluations and decline of oral health in a population which is already at a higher risk of oral pathologies. Our data reveal that reduction of dental procedures, healthcare professionals and days of suspension of clinical activity were still considerable also in T3 with respect to T1 and in some cases not significantly different from T2.

A multicenter observational study on Medication-Related Osteonecrosis of the Jaw (MRONJ) in advanced cancer and myeloma patients of a cancer network in North-Western Italy / Un estudio observacional multicéntrico sobre osteonecrosis relacionada con medicamentos de la mandíbula (MRONJ) en pacientes con cáncer avanzado y mieloma de una red contra el cáncer en el noroeste de Italia

Background: Incidence of Medication-Related Osteonecrosis of the Jaw (MRONJ) related to cancer and myelomatreatments is undetermined, with scarce data varying from 2 to 7.8/million/year in limited investigated popula-tions. A 9-years [2009-2018] regional-wide survey was conducted, deploying the North-Western Italy Cancer Net-work (“Rete Oncologica Piemonte e Valle d’Aosta”), to assess number and main characteristics of MRONJ casesamong myeloma/cancer patients, within a population of 4.5 million inhabitants.Material and Methods: MRONJ cases were collected retrospectively from January 2009 to June 2015; from July2015 to December 2018, data were collected prospectively. Number of new MRONJ cases per year, underlyingdisorder, drug(s) administered, treatment duration, site and onset timing of MRONJ were detailed.Results: 459 MRONJ cases were identified. Primary diseases were breast cancer (46%), prostate cancer (21%),myeloma (19%), and other types of carcinoma (14%). Patients received antiresorptive treatment either alone (399;88.47%) or in combination with biological agents (52; 11.53%); 8 patients (1.7%) received only antiangiogenicdrugs. Zoledronic acid [388] and denosumab [59] were the most frequently administered drugs. Mandible was involved in 296 (64,5%) cases. Number of new MRONJ cases was stable from 2009 to 2015, with a mean of 51.3 casesper year (raw incidence: 11.6/million/year), declining in the 2016-2018 years to 33.3 cases per year (raw incidence:7.5/million/year).Conclusions: With such discrepancy of cases overtime being partially explicable, number of new MRONJ cases peryear are consistent with those observed in a previous study [2003-2008] in the same region, being instead higher thanthose reported in other populations.(AU)

Numb chin syndrome as first symptom of diffuse large B-cell lymphoma.

Numb chin syndrome is a rare sensory neuropathy of the mental nerve characterized by numbness, hypoesthesia, paraesthesia, and very rarely pain. Dental causes, especially iatrogenic ones, maxillofacial trauma, or malignant neoplasm are etiologic factors for this rare syndrome. Many malignant and metastatic neoplasms are causing this syndrome, like primary osteosarcoma, squamous cell carcinoma, and mandibular metastasis of primary carcinoma of breast, lung, thyroid, kidney, prostate, and nasopharynx. Haematological malignancies like acute lymphocytic leukaemia, Hodgkin and non-Hodgkin lymphoma, and myeloma can cause this neuropathy. The authors report a case of a 71-year-old woman in which the numb chin syndrome was the first symptom of the diffuse large B-cell lymphoma, which caused infiltration and reabsorption of the alveolar ridge and lower mandibular cortex. A biopsy of the mass was performed on fragments of tissue collected from the mandibular periosteum, medullary and cortical mandibular bone, and inferior alveolar nerve.