Efficacy of photodynamic therapy on candida colonization and clinical symptoms in denture stomatitis: a systematic review and meta-analysis.

BACKGROUND: Photodynamic therapy (PDT) has been recently proposed as a promising alternative therapy for Denture Stomatitis (DS). The present systematic review and meta-analysis investigated the current available evidence regarding the efficacy of PDT in the management of DS. MATERIALS AND METHODS: PubMed, Scopus, Web of Science, Google Scholar, and ProQuest were searched up to June 7, 2023. All relevant clinical trials were included. RevMan software was used for the statistical analyses. RESULTS: Elven randomized clinical trials (460 DS patients) were included. Eight studies assessed the efficacy of PDT vs. topical antifungal therapy, while three studies assessed the adjunctive use of PDT (PDT + antifungal therapy) vs. topical antifungal therapy alone. The results revealed comparable efficacy of PDT and conventional antifungal therapy on candida colonization at 15 days (MD: 0.95, 95% CI: -0.28, 2.19, p = 0.13) and at the end of follow-up (MD: -0.17, 95% CI: -1.33, 0.98, p = 0.77). The pooled two studies revealed relatively better efficacy of adjunctive use of PDT with antifungal therapy on candida colonization compared to antifungal therapy alone at 15 days (MD: -6.67, 95% CI: -15.15, 1.82, p = 0.12), and at the end of follow-up (MD: -7.14, 95% CI: -19.78, 5.50, p = 0.27). Additionally, the results revealed comparable efficacy of PDT and topical antifungal therapy on the clinical outcomes. CONCLUSIONS: PDT might be considered a viable option for DS either as an adjunct or as an alternative to the topical antifungal medications. Further studies with adequate sample sizes and standardized PDT parameters are warranted.

Efficacy of hyaluronic acid for recurrent aphthous stomatitis: a systematic review of clinical trials.

OBJECTIVES: Recurrent aphthous stomatitis (RAS) is a very common oral mucosal disease, and its management is quite challenging with no definitive cure being available so far. Many studies have tried hyaluronic acid (HA) for alleviating signs and symptoms of RAS. The present systematic review sought to assess the available evidence regarding the efficacy of HA in management of RAS. METHODS: Two reviewers independently conducted extensive search in four online databases (PubMed, Scopus, Web of Science, and Google Scholar) and the gray literature, with no restriction to date or language of the publication. All clinical trials that assessed the efficacy of HA in reducing signs and symptoms of RAS were included. Risk of bias was assessed by two reviewers independently, using the Cochrane assessment tool. Due to substantial heterogeneity, no meta-analysis was feasible. RESULTS: Out of the 75 identified articles, nine clinical trials involving 538 RAS patients (259 in HA group) were included. The risk of bias was high in five studies, low in one study, and unclear in three studies. The comparative groups varied greatly across the included studies: triamcinolone (in three studies), chlorhexidine mouthwash, lidocaine, placebo, iodine glycerin, diclofenac, and laser therapy. Overall, the results revealed a good efficacy of HA in alleviating pain and shortening the healing time of RAS, without any reported side effects. Compared to triamcinolone, HA showed superior results in one study, and comparable results in two studies. CONCLUSIONS: The available evidence suggests that HA is a promising treatment option for RAS. However, given the huge heterogeneity of the included studies and high risk of bias in some of these studies, the evidence is inconclusive. Further well-designed clinical trials with standardized methodologies and adequate sample sizes are warranted to discern the efficacy of HA for RAS. CLINICAL RELEVANCE: Hyaluronic acid might be a viable alternative therapeutic option for patients with RAS.

The association between Epstein-Barr virus and oral lichen planus: A systematic review and meta-analysis.

BACKGROUND: Oral lichen planus (OLP) is a relatively common inflammatory disease, with unclear etiology. A number of studies have linked Epstein-Barr virus (EBV) with OLP. The present systematic review and meta-analysis aimed to evaluate the available evidence regarding the potential association between EBV and OLP. METHODS: Online databases (PubMed, Scopus, Web of Science, ProQuest, and Google Scholar) were searched from date of inception till May 2020. Studies were included if they met the following criteria: 1) observational studies that assessed the relationship between EBV and OLP, 2) the study comprised OLP patients and control subjects, 3) diagnosis of OLP was confirmed histopathologically, and 4) articles were in English. Studies without control groups, experimental studies, case reports, and reviews were excluded. The fixed-effects model was performed for meta-analyses using RevMan 5.3 software. RESULTS: A total of 10 studies comprising 386 OLP cases and 304 controls were included. Of these, only 8 studies were eligible for the meta-analysis. The results of the quality assessment showed that only 2 studies were of high quality, while the remaining studies were of moderate quality. The results of the pooled eight studies revealed a significant positive association between EBV and OLP (OR = 4.41, 95% CI: [2.74, 7.11], P < .0001). CONCLUSION: The results of the present systematic review suggest that EBV infection is statistically associated with increased risk of OLP. However, these results are preliminary, and high-quality, large-scale studies are warranted to further explore the potential role of EBV in the pathogenesis of OLP.

Single application of topical doxycycline in management of recurrent aphthous stomatitis: a systematic review and meta-analysis of the available evidence.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a highly prevalent oral mucosal disease. The management of RAS is quite challenging, and as yet, there is no definitive cure. The present systematic review and meta-analysis assessed the efficacy of a single application of topical doxycycline for the management of RAS. METHODS: A comprehensive online search of PubMed, Scopus, Embase, and Web of Science databases was conducted to identify all relevant studies published up to March 31, 2019. All randomized clinical trials that assessed the efficacy of a single application of topical doxycycline in the management of RAS were included. Primary outcome measures were pain scores and/or healing time, while secondary outcomes included the associated side effects. RevMan 5.3 software was used for data analysis. RESULTS: Five clinical trials fulfilled the eligibility criteria, three of which were included in the meta-analysis. All of the included studies found doxycycline effective in alleviating signs and symptoms of RAS. The results of the pooled 3 studies revealed a statistically significant decrease in the healing time in favor of the doxycycline group as compared to the control groups (I2 = 51%; MD: -1.77, 95% CI: - 2.11, - 1.42, P <0.00001); however, the results showed no significant differences between doxycycline and control groups with regard to pain reduction (I2 = 96%; MD: -1.28, 95% CI: - 2.83, 0.27; P = 0.11). CONCLUSION: Although still inconclusive, the available evidence suggests that a single application of topical doxycycline might be effective for reducing signs and symptoms of RAS. However, owing to the limited number of the included studies, further well-designed clinical trials with adequate sample sizes are required to discern the clinical efficacy of topical doxycycline in patients with RAS.

Aloe vera in treatment of oral submucous fibrosis: A systematic review and meta-analysis.

The management of oral submucous fibrosis (OSF) is quite challenging, and as yet, no effective therapy is available for its management. The present systematic review and meta-analysis sought to assess the effectiveness of aloe vera in alleviating pain and clinical signs of OSF. A comprehensive search in PubMed/Medline, Scopus, and Web of Science databases was conducted to identify the relevant randomized clinical trials. RevMan 5.3 software was used for data analysis. Six randomized controlled trials fulfilled the inclusion criteria. The results of meta-analysis showed statistically significant differences between aloe vera and control groups in alleviating pain/burning sensation at the end of the first and second month, in favor of aloe vera, but no significant differences were found at the end of the third month. With regard to objective clinical outcomes, no statistically significant differences were found between the groups. Aloe vera has a promising effect in reducing pain/burning sensation and clinical improvement in patients with OSF. However, owing to the marked heterogeneity of the included studies, conducting well-designed trials with long follow-up periods, standardized outcome measures and adequate sample sizes are warranted.

Efficacy of photodynamic therapy in the treatment of symptomatic oral lichen planus: A systematic review.

BACKGROUND: The aim of this study was to systematically review the efficacy of photodynamic therapy (PDT) in the management of symptomatic oral lichen planus (OLP). MATERIALS AND METHODS: PubMed/MEDLINE, Scopus, and ISI Web of knowledge were searched until July 2017, using the following keywords: OLP, erosive lichen planus, lichen planus, and PDT. RESULTS: Five clinical studies were included. The risk of bias was considered high in 4 studies and moderate in 1 study. The efficacy of PDT was compared with topical corticosteroids in all included studies. Laser wavelengths, duration of irradiation, and power density ranged between 420-660 nm, 30 seconds to 10 minutes, and 10-500 mW/cm2 , respectively. All studies reported PDT to be effective in the management of symptomatic OLP. Two studies reported PDT to be as effective as corticosteroids, 1 study reported a better efficacy of PDT compared to corticosteroids, whereas 2 studies found PDT to be inferior to corticosteroids. CONCLUSIONS: The limited available evidence suggests that PDT is an effective treatment option for the management of OLP. However, due to the limited number of studies included in this review and heterogeneity among these studies, more well-designed clinical trials with adequate sample sizes are highly warranted.

Efficacy of low-level laser therapy in management of recurrent herpes labialis: a systematic review.

Recurrent herpes labialis (RHL) is a highly prevalent viral infection that affects the oro-facial region. Current treatment options have limited efficacy in reducing healing time and recurrence rate of the disease. Recently, low-level laser therapy has been proposed as a potential treatment alternative for the management of RHL with no side effects. This systematic review aims to evaluate the effectiveness of laser therapy in the management and prevention of RHL. A comprehensive search of Medline/PubMed, Scopus, and Web of Science was carried out to identify published clinical trials comparing laser intervention to active and/or non-active controls for the treatment of RHL. Due to marked heterogeneity of available data, studies were assessed qualitatively, and no statistical analysis was performed. Of the retrieved 227 articles, six clinical trials met the eligibility criteria. The wavelengths, the power output, and energy density ranged between 632.5-870 nm, 5-80 W, and 2.04-48 J/cm2, respectively. All included studies found laser to be effective in the management and prevention of RHL, without any side effects. The findings of this review suggest that laser is potentially a safe and effective treatment alternative for the management of RHL. However, due to high variability in study designs and inconsistency in laser parameters among the included studies, more well-designed randomized clinical trials with standardized laser parameters are highly warranted.

Antibiotic Prescription During Endodontic Treatment: Knowledge and Practices of Dental Interns in Saudi Arabia.

Background: Antibiotics are widely used in dental practice, especially for endodontic infections. The present survey aimed to investigate the knowledge and practices of dental interns in Saudi Arabia regarding antibiotic prescription for endodontic treatment. Methods: The present online questionnaire-based, cross-sectional study involved dental interns in private and public dental schools, Saudi Arabia. A pre-validated questionnaire was distributed to 900 dental interns via different social media platforms. The questionnaire consisted of 16 close-ended questions related to participants' demographic data and knowledge and practices of antibiotic prescription in context of endodontic treatments. Data were managed and analyzed using IBM-SPSS version 25, and Chi-square test was used to compare between the groups. Results: A total of 555 dental interns completed the questionnaire, giving a response rate of 61.1%. Overall, the surveyed participants revealed inadequate knowledge and unnecessary use of antibiotics during endodontic procedures. While majority of the participants (75.3%) correctly identified the first choice of antibiotics during endodontic treatments, a considerable proportion of the participants did not recognize the clinical indications of antibiotics in endodontic patients. Additionally, around one-fifth (18.9%) of the participants were unaware of the potential side effects of the prescribed antibiotics. Conclusion: The present survey revealed unsatisfactory knowledge and practices of antibiotic prescription in context of endodontic therapy among Saudi dental interns. Therefore, dental schools in Saudi Arabia should address such a gap through updating the curriculum and integrating real-world clinical scenarios using problem-based learning. Additionally, periodic continuous education courses aiming at improving dental professionals' knowledge about antibiotics and their clinical uses for endodontic therapy are highly encouraged.

Xerostomia, Salivary Flow, and Oral Health Status Among Saudi Diabetic Patients: A Comparative Cross-Sectional Study.

PURPOSE: Diabetes mellitus (DM) is associated with numerous oral complications, including frequent oral infections, periodontal diseases, hyposalivation, and xerostomia. The present study aimed to investigate salivary flow rate, xerostomia, and oral health status among a group of Saudi diabetic patients as compared to healthy controls. PATIENTS AND METHODS: This comparative cross-sectional study involved 50 diabetic patients (aged between 15 and 70 years) and 53 age- and gender-matched healthy controls. Data collection was carried out using a structured questionnaire and clinical examination of oral health status, which included salivary flow rates, saliva pH, tooth loss, plaque accumulation, and gingival health. Independent t-tests, one-way analysis of variance (ANOVA), and chi-square tests were performed to compare between groups. RESULTS: The results revealed a statistically significant lower salivary flow (0.33 ± 0.16 vs 0.59 ± 0.54; p = 0.002) and lower saliva pH (6.36 ± 0.49 vs 6.58 ± 0.39; p = 0.014) in diabetic patients than in the control group. A higher proportion of diabetic subjects (60%) self-reported having xerostomia compared to controls (52%), but the findings were statistically non-significant. Additionally, the results revealed slightly poorer oral health and greater tooth loss among DM patients, although the results did not attain a significant difference (P > 0.05). CONCLUSION: The findings of the present study demonstrate poor oral health and a high prevalence of xerostomia among Saudi diabetic patients. Oral health education should therefore be promoted in this group of patients.

Velar morphological variants in oral submucous fibrosis: A comparative digital cephalometric study.

CONTEXT: Soft palate (velar) plays a significant role in various important functions in the head and neck region. Its diverse morphology is implicated in a variety of diseases. Knowledge about the varied morphological pattern of soft palate in oral submucous fibrosis (OSMF) patients can give us a clear understanding about disease progress in the oropharyngeal region for a proper diagnosis and also help the maxillofacial surgeon in successful structural and functional corrections associated with this disorder. AIM: (1) To evaluate the morphological variations of soft palate in OSMF patients using digital lateral cephalogram. (2) To assess the morphological variations of soft palate with respect to the different clinical stages of OSMF patients. SUBJECTS AND METHODS: A total number of 300 patients were included in the study (150 participants each in study and control group), evaluated clinically, and subjected for digital lateral cephalogram for evaluating velar morphological variants. STATISTICAL ANALYSIS: The data were statistically evaluated using SPSS 11.5 software with Student's t-test, Chi-square test, and ANOVA. RESULTS: Among Group I, 34 participants had Stage I OSMF, 90 participants had Stage II OSMF, and 26 participants had Stage III OSMF. Type I velar was commonly seen in Stage I OSMF, Type VI velar in Stage II OSMF, and Type III velar in Stage III OSMF. There was statistically highly significant decrease in anterior-posterior (AP) length and increase in width of superior-inferior (SI) measurement, as compared to the Group II. CONCLUSION: There was diminution in AP length and increase in SI measurement as the OSMF disease progressed.

Evaluation of serum uric acid levels in patients with oral squamous cell carcinoma.

BACKGROUND: Worldwide, oral carcinoma is one of the most prevalent cancers and is one of the most common causes of death. Toxicity by oxygen radicals has been suggested as an important cause of cancer. Several researchers have reported an association of plasma/serum uric acid with different cancers. AIM: The aim was to determine the serum uric acid level in patients with newly diagnosed oral squamous cell carcinoma (OSCC) and then to compare and correlate it with those of normal subjects and also to determine the role of uric acid in the etiology of OSCC. MATERIALS AND METHODS: The study group included 41 OSCC patients and 40 age- and sex- matched healthy subjects as a control group. Estimation of serum urate concentration was determined enzymatically with a commercially available reagent. The data were statistically evaluated with Student's t-test and Chi-square test using SPSS 11.5 software. RESULTS: The mean serum uric acid levels were very low with the study group as compared to control group and were very highly significant (t = 4.14, P < 0.001). It was also found that risk of OSCC was more in a study group with low serum uric acid levels with tobacco intake. CONCLUSION: This study showed that serum uric acid was lower in oral cancer patients compared with healthy volunteers and low serum uric acid was associated with increased risk of oral cancer development.

Comparison of the Accuracy of Age Estimation Methods on Saudi Arabian Population - A Cross Sectional Study

Identity and legal culpability hinges on age estimation in modern society. There are several biometric methods for accurate age determination that have validity in medico-legal proceedings globally. The accuracy of conventional methods should be reassessed periodically to ascertain validity in differing global societies. This study aims to evaluate the comparative accuracy of three age determination methods based on non-invasive radiographic odontometric data when applied to a sample of Saudi population. MethodsThis cross-sectional study is done on 350 subjects of Saudi Arabian population, aged between 4 and 16 years. The same set of radiographs is used in all three methods and the dental age estimation is done by trained examiners who determine the age using Demirjian’s, Willem’s and the London Atlas Method. Statistical analysis is done using the IBM SPSS (Statistical Package for Social Science) software (version 19). Significance of differences between the chronological age and the estimated dental age was calculated using paired ‘t’ test (P value of < 0.05 was considered significant. ResultsThe chronological age was above estimated age by all three methods used to assess male samples. Significant difference was seen with William's method (p=0.000) and the the London Atlas Method (p=0.000), and no significant difference was seen with Demirjian's method (p=0.102). Demirjian's method estimated the age above chronological age for females while the other two methods were below in their estimates. There were significant differences only between the London Atlas estimates and chronological age in females (p = 0.020). ConclusionsAge estimated by Demirjian’s method on Saudi population is most accurate among the methods tested. Boys showed more variations than girls when the ages were measured. Changing diet and socioeconomic factors influence growth and development of children, and this can alter the anticipated outcomes of age determination by mathematical methods.

Correlation of habits and clinical findings with histopathological diagnosis in oral submucosal fibrosis patients.

BACKGROUND: Oral submucosal fibrosis (OSMF) is one of the most prevalent premalignant conditions in India which is easy to diagnose but difficult to manage. At present it is considered as irreversible and incurable. It has also been referred to as an epidemic in India. AIMS AND OBJECTIVES: To correlate the frequency and duration of habits with clinical staging, functional staging and histopathological grading and to correlate the clinical and functional staging with histopathological grading. MATERIALS AND METHODS: The study included a total of 90 subjects, 80 with OSMF in the experimental group and 10 patients in the control group. Patient personal history was recorded with chewing habits, including frequency and duration of chewing. The site of keeping the quid, time duration and whether he/she swallows it or spits it were also noted. Clinical staging was done on the presence of palpable fibrous bands. Functional staging was accomplished by measuring mouth opening. Incisional biopsy was done for all the patients for histopathological examination. Histopathological grading was according to Pindborg and Sirsat. RESULTS: The experimental group comprised 71 males and 9 females, the majority of which were in the age group of 21-30 years. Correlation of habits with clinical staging, functional staging and histopathological grading were significant (p<0.05). Clinical and functional staging did not correlate with histopathological grading, but the correlation of clinical and functional staging was highly significant (p<0.01). CONCLUSIONS: The widespread habit of chewing gutkha is a major risk factor for OSMF, especially in the younger age group. In this study, it was found that with increase in the duration and frequency of the habit the severity of the disease increased.

Evaluation of serum uric acid levels in patients with oral squamous cell carcinoma.

Background: Worldwide, oral carcinoma is one of the most prevalent cancers and is one of the most common causes of death. Toxicity by oxygen radicals has been suggested as an important cause of cancer. Several researchers have reported an association of plasma/serum uric acid with different cancers. Aim: The aim was to determine the serum uric acid level in patients with newly diagnosed oral squamous cell carcinoma (OSCC) and then to compare and correlate it with those of normal subjects and also to determine the role of uric acid in the etiology of OSCC. Materials and Methods: The study group included 41 OSCC patients and 40 age‑ and sex‑ matched healthy subjects as a control group. Estimation of serum urate concentration was determined enzymatically with a commercially available reagent. The data were statistically evaluated with Student’s t‑test and Chi‑square test using SPSS 11.5 software. Results: The mean serum uric acid levels were very low with the study group as compared to control group and were very highly significant (t = 4.14, P < 0.001). It was also found that risk of OSCC was more in a study group with low serum uric acid levels with tobacco intake. Conclusion: This study showed that serum uric acid was lower in oral cancer patients compared with healthy volunteers and low serum uric acid was associated with increased risk of oral cancer development.