Negative excess oral and pharyngeal cancer mortality in Europe during the early pandemic years.

OBJECTIVE: The COVID-19 pandemic had direct and indirect effects on oral and pharyngeal cancer (OPC) mortality due to high COVID-19 mortality risk among cancer patients, and to the COVID-19 response that caused treatment delays and reduced routine visits. This study investigated the excess OPC mortality in Europe during the early pandemic years. METHODS: Mortality and population data were gathered from the Eurostat database. The 2011-2019 mortality rates were used to estimate the 2020-2021 expected rates through joinpoint trend analysis. The excess mortality rates (observed minus expected mortality) with 95% confidence intervals (95 CIs) were assessed. RESULTS: Statistically significant negative excess age-standardized and crude (age strata <65 and ≥65 years) OPC mortality rates in males and females, in the European Union (EU, 27 countries) and Europe were reported. The estimated OPC missing deaths in EU were 831 (95 CI, 630-985) and 1240 (95 CI, 1039-1394) in 2020 and 2021, respectively, with differences between sexes, age strata, and countries. The OPC deaths in the EU and Europe were 3.6% and 3.5% lower than expected. CONCLUSION: Missing OPC deaths reported in Europe in 2020-2021 could be explained by changes in death certification of OPC patients who developed COVID-19, rather than a real OPC mortality decline.

Herpes simplex virus type 1 in periapical pathoses: Systematic review and meta-analysis.

OBJECTIVES: The objective of this systematic review and meta-analysis of observational studies was to assess whether herpes simplex virus type 1 (HSV-1) can infect endodontic periapical lesions. MATERIALS AND METHODS: Studies with cross-sectional design investigating HSV-1 in periapical tissues of patients with symptomatic and asymptomatic acute and chronic apical periodontitis were searched through MEDLINE, Scopus, Embase, Web of Science, and Google Scholar. Pooled HSV-1 prevalence proportion with 95% confidence interval (95CI) in periapical lesions was assessed with both fixed-effect and random-effects models, with/without adjustment for study quality and publication bias. Result robustness was investigated through sensitivity and subgroup analyses. RESULTS: Literature search, performed twice, provided 84 items, and eight remained for the meta-analysis; globally, there were 194 patients mostly adults. The pooled HSV-1 prevalence proportions, assessed with various methods, were 6.9% (95CI, 3.8-11.3%, fixed-effect); 6.8% (95CI, 3.6-11.0%, random-effects); 8.1% (95CI, 4.4-14.5%, quality-adjusted); and 4.8% (95CI, 2.0-11.4%; adjusted for small-study effect). CONCLUSIONS: The results indicated that HSV-1 can colonize the periapical tissues of 3%-11% patients with periapical diseases. Such data do not imply a causative role of HSV-1 in disease development and advancement. Well-designed and large-sized prospective cohort studies should be added in the literature panorama.

Oral cancer and precancer in Oral Pathology and Medicine curricula of Mexican dental schools.

OBJECTIVE: To identify the teaching-learning process characteristics of Oral Pathology and Medicine (OP&M) related to oral potentially malignant disorders (OPMDs) and oral cancer (OC), in the dental schools' curricula in Mexico, to analyze the approach given to this topic worldwide, and to provide the possible solution strategies. MATERIALS AND METHODS: Questionnaires were sent to OP&M deans and professors from public Mexican Universities to explore the curriculum and academic profile of the dental schools. The recommendations gathered from a workshop with expert professors on the challenges in OPMD/OC teaching were reported. RESULTS: Twenty-two dental schools participated (22 deans, 30 professors). The most widely used strategies were clinical-case resolving (86%) and presentations (73%). Although 77.3% of the programs included maxillofacial lesions, only 40.9% contemplated OPMD/OC. Only 45% of the programs developed community activities for early OC detection. The workshop recommendations were (i) multidisciplinary approach to OPMD/OC teaching, involving OP&M professors in other dental and nondental courses; (ii) implementation of the most effective teaching techniques (currently, problem-based learning and clinical-case presentation) in OP&M curricula; (iii) education of OP&M professors on teaching-learning processes. CONCLUSIONS: These recommendations from the Mexican context, integrated with similar experiences from other countries could contribute to develop a unique, internationally acknowledged OP&M curriculum.

Herpes simplex virus type 1 in subgingival plaque and periodontal diseases. Meta-analysis of observational studies.

BACKGROUND AND OBJECTIVES: This meta-analysis of observational studies (PROSPERO registration number CRD42021236054) sought to investigate strength and generalizability of the association of herpes simplex virus type 1 (HSV-1) in subjects with plaque-induced gingivitis and periodontitis, since the data from literature are contrasting. MATERIAL AND METHODS: Case-control and cross-sectional studies, investigating HSV-1 in subgingival plaque/crevicular fluid and periodontal status, were searched through MEDLINE via PubMed, Scopus, Web of Science and Google Scholar. From each study the crude odds ratio (OR) with 95% confidence interval (95CI) was extracted, and the pooled OR was assessed for periodontitis, chronic and aggressive, and gingivitis. The meta-analytic method was chosen based on the level of heterogeneity. The generalizability of results, determined by the meta-analysis bias, was investigated through secondary analyses including sensitivity analyses for study quality, publication bias, and study inclusion, and subgroup analyses for quality of scientific journals that published the primary studies, world Region, subgingival plaque sampling method and study design. RESULTS: Twelve studies were included (738 cases, 551 controls). The pooled ORs were 4.4 (95CI, 1.9-10.2) for any periodontitis; specifically, 2.8 (95CI, 1.0-8.3) for chronic periodontitis, 11.8 (95CI, 5.4-25.8) for aggressive periodontitis and 4.8 (95CI, 2.1-11.0) for gingivitis. These estimates were statistically significant, excluding for chronic periodontitis, resulting marginally significant (p = .05). Secondary analyses on any and aggressive periodontitis, and, partly, chronic periodontitis corroborated the results, while the material was insufficient for secondary analyses on gingivitis. CONCLUSIONS: The results obtained indicated that HSV-1 is associated with periodontitis, while data about gingivitis are inconclusive. HSV-1 investigation in subgingival plaque could help assess periodontitis risk and severity and, if causal association were confirmed, could contribute to its control.

Occupational COVID-19 risk to dental staff working in a public dental unit in the outbreak epicenter.

OBJECTIVE: The management of the COVID-19 outbreak occurred in Lombardy (Italy) implied that non-COVID-19 health care was remodeled, limiting adequate resources in non-hospital public dental healthcare settings. This situation offered the opportunity to investigate the occupational COVID-19 risk to dental staff in public non-hospital dental units. METHODS: An infection control protocol was designed for dental health care in the Territorial Health and Social Services Authority (ASST) "Melegnano and Martesana" (Milan). Since specific guidance from central authorities was lacking, information was gathered from international public health organizations. The probability to visit asymptomatic COVID-19-infected patients was estimated, and the occupational risk to dental staff was calculated. RESULTS: The probability to visit asymptomatic patients passed from 1.2% (95% confidence interval -95 CI, 0.6%-2.5%) in the first period (20 February-15 March 2020) to 11.1% (95 CI, 5.8%-23.6%) in the second period (16 March-30 April). Dentists and dental assistants did not develop COVID-19, while one nurse did, the nature of her occupational risk was unclear, as nurses provided prevalently non-dental health care. The probabilities of developing COVID-19 per worked hour per person excluding and including this uncertain situation were 0.0% (95 CI, 0.0%-3.2%) and 0.9% (95 CI, 0.1%-4.7%). CONCLUSION: Relatively simple infection control procedures were enough to control occupational COVID-19 risk during the outbreak.

NA0D - The new Traumatic Dental Injury classification of the World Health Organization.

An accurate, clear, and easy-to-use traumatic dental injury (TDI) classification and definition system is a prerequisite for proper diagnosis, study, and treatment. However, more than 50 classifications have been used in the past. The ideal solution would be that TDIs are adequately classified within the International Classification of Diseases (ICD), endorsed by the World Health Organization (WHO). TDI classification provided by the 11th Revision of the ICD (ICD-11), released in 2018, and previous Revisions, failed to classify TDIs satisfactorily. Therefore, in December 2018, a proposal was submitted by Dr's Stefano Petti, Jens Ove Andreasen, Ulf Glendor, and Lars Andersson, to the ICD-11, asking for a change of the existing TDI classification. Proposal #2130 highlighted the TDI paradox, the fifth most frequent disease/condition neglected by most public health agencies in the world, and the limits of ICD-11 classification. Namely, injuries of teeth and periodontal tissues were located in two separate blocks that did not mention dental/periodontal tissues; infraction, concussion, and subluxation were not coded; most TDIs lacked description; and tooth fractures were described through bone fracture descriptions (e.g., comminuted, compression, and fissured fractures). These limitations led to TDI mis-reporting, under-reporting, and non-specific reporting by untrained non-dental healthcare providers. In addition, no scientific articles on TDIs, present in PubMed, Scopus, and Web-of-Science, used the ICD classification. Proposal #2130 suggested to adopt the Andreasen classification, the most widely acknowledged classification used in dental traumatology. The Proposal was reviewed by two WHO teams, two scientific Committees, one WHO Collaborating Center, and the Department of Non-Communicable Disease Prevention at WHO headquarters, and it underwent two voting sessions. In March 2022, the Andreasen classification was accepted integrally. A new entity was generated, called NA0D, "Injury of teeth or supporting structures" (https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1413338122). Hopefully, this will contribute to increasing the public awareness, and the dental profession's management, of TDIs.

Covid-19, non-Covid-19 and excess mortality rates not comparable across countries.

Evidence that more people in some countries and fewer in others are dying because of the pandemic, than is reflected by reported coronavirus disease 2019 (Covid-19) mortality rates, is derived from mortality data. Using publicly available databases, deaths attributed to Covid-19 in 2020 and all deaths for the years 2015-2020 were tabulated for 35 countries together with economic, health, demographic and government response stringency index variables. Residual mortality rates (RMR) in 2020 were calculated as excess mortality minus reported mortality rates due to Covid-19 where excess deaths were observed deaths in 2020 minus the average for 2015-2019. Differences in RMR are differences not attributed to reported Covid-19. For about half the countries, RMR's were negative and for half, positive. The absolute rates in some countries were double those in others. In a regression analysis, population density and proportion of female smokers were positively associated with both Covid-19 and excess mortality while the human development index and proportion of male smokers were negatively associated with both. RMR was not associated with any of the investigated variables. The results show that published data on mortality from Covid-19 cannot be directly comparable across countries. This may be due to differences in Covid-19 death reporting and in addition, the unprecedented public health measures implemented to control the pandemic may have produced either increased or reduced excess deaths due to other diseases. Further data on cause-specific mortality is required to determine the extent to which residual mortality represents non-Covid-19 deaths and to explain differences between countries.

The controversial natural history of oral herpes simplex virus type 1 infection.

The natural history of oral herpes simplex virus type 1 (HSV-1) infection in the immunocompetent host is complex and rich in controversial phenomena, namely the role of unapparent transmission in primary infection acquisition, the high frequency of asymptomatic primary and recurrent infections, the lack of immunogenicity of HSV-1 internalized in the soma (cell body) of the sensory neurons of the trigeminal ganglion, the lytic activity of HSV-1 in the soma of neurons that is inhibited in the sensory neurons of the trigeminal ganglion and often uncontrolled in the other neurons, the role of keratin in promoting the development of recurrence episodes in immunocompetent hosts, the virus-host Nash equilibrium, the paradoxical HSV-1-seronegative individuals who shed HSV-1 through saliva, the limited efficacy of anti-HSV vaccines, and why the oral route of infection is the least likely to produce severe complications. The natural history of oral HSV-1 infection is also a history of symbiosis between humans and virus that may switch from mutualism to parasitism and vice versa. This balance is typical of microorganisms that are highly coevolved with humans, and its knowledge is essential to oral healthcare providers to perform adequate diagnosis and provide proper individual-based HSV-1 infection therapy.

World traumatic dental injury prevalence and incidence, a meta-analysis-One billion living people have had traumatic dental injuries.

Traumatic dental injuries (TDIs) account for a considerable proportion of bodily injuries. Nevertheless, global TDI frequency is unknown, probably because TDI diagnosis is not standardized. This study estimated world TDI frequency. A literature search (publication years 1996-2016) was aimed at covering as many countries, communities, ethnic groups as possible, thus achieving high generalizability. In particular, non-specific keywords, no language restrictions, and large databanks were used. Observational studies reporting proportions of individuals with at least one TDI (prevalence) and who developed TDI (incidence rate) were considered. Prevalence rates to permanent dentition, primary dentition and in 12-year-olds, incidence rate to any tooth for any age, male-to-female prevalence ratio (PR) in 12-year-olds, with 95% confidence intervals (95 CIs), were extracted/calculated. Study quality, Z-score distribution, funnel plot symmetry analysis, between-study heterogeneity, sensitivity, and subgroup analyses were performed. Selected primary studies were 102 (permanent dentition; 268 755 individuals; median age, 13.8 years), 46 (primary dentition; 59 436 individuals; median age, 3.4 years), 42 (12-year-olds; 33 829 individuals), 11 (incidence rate; 233 480 person-years; median age, 7.8 years), and 31 (PR; 16 003 males, 16 006 females). World TDI frequency resulted as follows: permanent dentition prevalence 15.2% (95 CI, 13.0%-17.4%); primary dentition prevalence 22.7% (95 CI, 17.3%-28.7%); 12-year-olds prevalence 18.1% (95 CI, 15.3%-21.0%); incidence rate, 2.82 (95 CI, 2.28%-3.42%) per 100 person-years; PR, 1.43 (95 CI, 1.34%-1.52%). Differences between WHO Regions were found. This study shows that more than one billion living people have had TDI. TDI is a neglected condition which could rank fifth if it was included in the list of the world's most frequent acute/chronic diseases and injuries.

The face of Ebola: changing frequency of haemorrhage in the West African compared with Eastern-Central African outbreaks.

BACKGROUND: The West-African (WA) Zaire Ebolavirus disease (EVD) outbreak was characterized by an exceptionally high number of cases and deaths as compared with the Eastern-Central African (ECA) outbreaks. Despite the Zaire Ebolavirus being the most lethal for humans, case-fatality rate, close to 80 % in ECA outbreaks, almost halved to 47 % in Guinea-Liberia-Sierra Leone (WA). Such an improvement was due to the remarkable implementation of international humanitarian aids. Some studies also suggested that the long human-to-human transmission cycle occurred in WA, gave rise to human adaptation and consequent immune escape. Haemorrhage, the main feature in seriously infected EVD patients, is due to the immune system that triggers the infected endothelial cells which expose the spike-like glycoprotein (GP) of the virion on their surface. If the human adaptation hypothesis holds true, the proportion of EVD patients with haemorrhage in the WA outbreak should be lower than in the ECA outbreaks due to immune escape. Therefore, the aim of this meta-analysis was to compare the relative frequencies of three typical haemorrhagic symptoms (conjunctival -CB, nasal -NB, gingival -GB- bleedings) in the ECA and WA outbreaks. METHODS: Literature searches were performed through PubMed and Scopus using generic keywords; surveys including at least ten patients reporting CB, NB, GB relative frequencies were extracted and split into ECA and WA. The meta-analytical methods chosen were based on the levels of between-study heterogeneity and publication bias. Pooled CB, NB, GB relative frequencies in ECA and WA were estimated and compared. Subgroup analysis including only studies on Zaire Ebolavirus also was performed. RESULTS: Fifteen studies (10 ECA, 5 WA) were located with 4,867 (CB), 3,859 (NB), 4,278 (GB) EVD patients overall. GB pooled relative frequency was 45.3 % (95 % confidence interval -95 CI, 34.7-56.1 %) and 18.0 % (95 CI, 6.0-34.5 %), in ECA and WA; NB was 10.6 % (95 CI, 5.7-16.8 %) and 1.3 % (1.0-1.8 %); GB was 24.2 % (95 CI, 11.9-39.2 %) and 1.9 % (95 CI, 1.4-2.4 %). Subgroup analysis confirmed these results. CONCLUSIONS: During the WA outbreak the relative frequency of GB decreased by two thirds, while NB and GB almost disappeared, suggesting that the Zaire Ebolavirus human adaptation hypothesis is plausible.

Over two hundred million injuries to anterior teeth attributable to large overjet: a meta-analysis.

BACKGROUND/AIM: The association between large overjet and traumatic dental injuries (TDIs) to anterior teeth is documented. However, observational studies are discrepant and generalizability (i.e. external validity) of meta-analyses is limited. Therefore, this meta-analysis sought to reconcile such discrepancies seeking to provide reliable risk estimates which could be generalizable at global level. MATERIAL AND METHODS: Literature search (years 1990-2014) was performed (Scopus, GOOGLE Scholar, Medline). Selected primary studies were divided into subsets: 'primary teeth, overjet threshold 3-4 mm' (Primary3); 'permanent teeth, overjet threshold 3-4 mm' (Permanent3); 'permanent teeth, overjet threshold 6 ± 1 mm' (Permanent6). The adjusted odds ratios (ORs) were extracted. To obtain the highest level of reliability (i.e. internal validity), the pooled OR estimates were assessed accounting for between-study heterogeneity, publication bias and confounding. Result robustness was investigated with sensitivity and subgroup analyses. RESULTS: Fifty-four primary studies from Africa, America, Asia and Europe were included. The sampled individuals were children, adolescents and adults. Overall, there were >10 000 patients with TDI. The pooled OR estimates resulted 2.31 (95% confidence interval - 95CI, 1.01-5.27), 2.01 (95CI, 1.39-2.91) and 2.24 (95CI, 1.56-3.21) for Primary3, Permanent3 and Permant6, respectively. Sensitivity and subgroup analyses corroborated these estimates. CONCLUSIONS: Reliability and generalizability of pooled ORs were high enough and made it possible to assess that the fraction of global TDIs attributable to large overjet is 21.8% (95CI, 9.7-34.5%) and that large overjet is co-responsible for 235 008 000 global TDI cases (95CI, 104,760,000-372,168,000). This high global burden of TDI suggests that preventive measures must be implemented in patients with large overjet.

Are overweight/obese children at risk of traumatic dental injuries? A meta-analysis of observational studies.

BACKGROUND/AIM: Observational studies which investigated the association between overweight/obesity and traumatic dental injuries (TDI) reported contrasting results. Thus, this meta-analysis was designed to investigate such an association with the highest possible levels of internal and external validities. MATERIAL AND METHODS: A comprehensive literature search was performed through PubMed, ISI Web of Science, Cochrane Library, Scopus, Google scholar to ensure generalizability. Eligible studies reported clear case and control definitions, exposure assessment. Where possible, odds ratio (OR) adjusted for covariates was extracted. Study quality was assessed through Newcastle-Ottawa Scale (NOS). Only fair-to-good quality studies with NOS scores ≥4 were selected. The method to assess the pooled OR was based on the level of between-study heterogeneity, estimated through the Cochran's Q. Reliability of the pooled OR was improved by controlling for publication bias, sensitivity analysis to study inclusion, and subgroup analyses according to tooth type (permanent vs primary teeth) and country where the study was performed (Brazilian studies vs studies from other countries). RESULTS: Seventeen studies were selected from America, Asia, and Europe, their NOS scores ranged between 4 and 8. Overall, there were almost 28,000 patients, 7400 of them with TDI. The level of publication bias was minimal, and no adjustment was necessary. Between-study heterogeneity was high, and the random-effects method was used to assess the pooled OR, which resulted 1.30 (95% confidence interval, 1.11-1.53; P < 0.05). Sensitivity and subgroup analyses corroborated this estimate. CONCLUSION: The choice to increase internal and external validity levels decreased the precision of the pooled OR (i.e., confidence intervals were relatively wide). The statistically significant overweight/obesity-TDI association, together with the so-called counterfactual condition (i.e., TDI prevalence was higher among overweight/obese children than among lean children), suggests that causal association between these two conditions is plausible.

Intensity and duration of in-vitro antibacterial activity of different adhesives used in orthodontics.

This work investigated the antibacterial activity of 14 bonding agents to predict their ability to inhibit white-spot development during orthodontic treatment. Standardized, sterilized disks of each material were continuously rinsed (for up to 180 d) in a flow of sterile saline. At predetermined time points, the residual ability of each material to inhibit bacterial growth (determined by measuring the size of inhibition halos around disks placed onto appropriate culture media seeded with Streptococcus gordonii DSM6777, Streptococcus sanguinis DSM20567, Streptococcus mutans DSM20523, or Lactobacillus acidophilus DSM20079) and biofilm formation (determined by measuring the numbers of bacteria adherent to disks following incubation in appropriate broths) was tested in triplicate and compared with the baseline activities of freshly prepared materials. Overall antibacterial and anti-biofilm activities, adjusted for exposure time and strain of bacteria, were assessed. The decrease of antibacterial activity was faster (30-60 d) and complete for fluoride-enriched materials, but slower (90 d) and partial for antimicrobial-containing materials (benzalkonium chloride, zinc oxide, chlorexidine, or MDPB). Materials enriched with benzalkonium chloride, chlorexidine, or MDPB showed the highest antibacterial activities. Anti-biofilm assays yielded similar results. These data could be helpful for clinicians in the choice of the best performing bonding agent also in light of duration of the clinical application.

High salivary Staphylococcus aureus carriage rate among healthy paedodontic patients.

Staphylococcus aureus can be responsible for oral and dental healthcare-associated infections. Patients with high salivary S. aureus levels are potential sources of infection, because saliva is spread in the environment during dental therapy. This study assessed the salivary S. aureus carriage rate in 97 children (6-12 years) in good general health, attending a paedodontic department. Samples of unstimulated saliva were collected, S. aureus was presumptively identified. The salivary carriage rate was 43% (95% confidence interval, 33%-53%). 6.2% children harboured levels >103 colony forming units/mL. These data suggest that the risk for environmental contamination and infection in dental healthcare settings could be high.

Effect of recombinant human thyroid stimulating hormone on long-term salivary gland dysfunction in thyroid cancer patients treated with radioactive iodine. A systematic review.

Adjuvant radioactive iodine (RAI) is administered to thyroid cancer patients following thyroidectomy for remnant tissue ablation and metastatic disease management. Patients are prepared with thyroid hormone withdrawal (THW) or recombinant human thyroid stimulating hormone (rhTSH). Long-term salivary gland dysfunction (LT-SGD) is a common, dosage-dependent, RAI adverse effect. Although rhTSH preparation seems to reduce LT-SGD, this effect could be due to lower RAI activity generally used in rhTSH-prepared patients. Therefore, this meta-analysis investigated the effect of preparation type on LT-SGD development. Literature search (PubMed, Medline, EmBase, Cochrane, Web of Science, LILACS, Google Scholar) was performed four times (January-November 2022) and studies reporting LT-SGD incidence ≥1 year after RAI in patients prepared with rhTSH/THW were identified. The LT-SGD risk ratio (RR) was estimated with various models considered for sensitivity analysis (fixed-effect, random-effects, study-quality adjusted, publication-bias adjusted, individual-patient-data meta-analysis adjusted for RAI). Subgroup analysis according to RAI activity (<3.7/≥3.7 GBq) also was performed. Literature search resulted in five studies (321 rhTSH, 632 THW patients). The pooled RRs according to various models were 0.65 (95% confidence interval -95CI, 0.49-0.86; fixed-effect); 0.62 (95CI, 0.38-1.02; random-effects); 0.72 (95CI, 0.54-0.96; quality adjusted); 0.76 (95CI, 0.58-0.99; publication-bias adjusted); 0.0.80 (95CI, 0.55-1.14; individual-patient-data meta-analysis). The pooled RRs stratified for RAI activity were 0.26 (95CI, 0.05-1.30) for <3.7 GBq; 0.75 (95CI, 0.57-0.98) for ≥3.7 GBq. The number of patients needed to be prepared with rhTSH to prevent one case of LT-SGD ranged between seven and thirty-seven. There is moderate-quality scientific evidence that rhTSH preparation may consistently protect salivary gland function.