Healthy lifestyles are associated with a better response to periodontal therapy: A prospective cohort study.

AIM: To evaluate the association between lifestyle behaviours and clinical periodontal outcomes following Steps 1/2 of periodontal therapy. METHODS: A total of 120 subjects with untreated Stage II/III periodontitis participated in this study. At baseline, questionnaires were administered to assess the following lifestyle behaviours: adherence to Mediterranean diet (MD), physical activity (PA) and stress levels, sleep quality, smoking and alcohol use. Participants received Steps 1/2 of periodontal therapy and were re-evaluated after 3 months. A composite outcome of the endpoint of therapy (i.e., no sites with probing pocket depth [PPD] ≥4 mm with bleeding on probing, and no sites with PPD ≥ 6 mm) was regarded as the primary outcome. Simple and multiple regression analyses were used to evaluate the association between lifestyle behaviours and clinical periodontal outcomes. Disease severity at baseline, body mass index, diabetes, household disposable income and plaque control were considered as confounders. RESULTS: Multiple regression analyses showed significantly lower odds of achieving the endpoint of therapy in subjects with poor sleep quality (odds ratio [OR] = 0.13; 95% confidence interval [CI]: 0.03-0.47; p < .01), smoking (OR = 0.18; 95% CI: 0.06-0.52; p < .05) and alcohol use above the suggested intake (OR = 0.21; 95% CI: 0.07-0.63; p < .01). Subjects with a combination of 'unhealthy lifestyles' (low adherence to MD and low PA levels and high levels of stress and poor sleep quality) showed higher proportions of residual PPD≥6 mm (MD = 1.51; 95% CI: 0.23-2.80; p < .05) and lower odds of achieving the endpoint of therapy (OR = 0.85; 95% CI: 0.33-0.99; p < .05) at re-evaluation. CONCLUSIONS: Subjects with unhealthy lifestyle behaviours showed worse clinical outcomes 3 months after Steps 1/2 of periodontal therapy.

The impact of COVID-19 pandemic in patients with a diagnosis of Oral Lichen Planus: Pain perception and psychological profile analysis.

OBJECTIVES: To assess the impact of COVID-19 in patients affected by OLP, in terms of level of pain, stress, depression and anxiety and their impact on the clinical manifestation of the disease. MATERIAL AND METHODS: A longitudinal design was employed. Psychometric evaluations of anxiety, stress, and depression were conducted using the DASS21 scale, while pain levels were measured using the VAS scale. Clinical diagnosis and phenotype evaluation were performed. RESULTS: The study included 24 patients with an average age of 62.9 years, with 70.8% presenting erosive OLP. Results revealed a significant worsening of anxiety, stress, and depression scores during the pandemic. Pain level (1.5 ± 1.2 pre-pandemic VS 3.8 ± 1.1 during the pandemic, p < 0.0001) was also negatively affected. CONCLUSIONS: These findings highlight the potential interplay between psychological stress and oral health conditions, emphasizing the need for a comprehensive understanding of OLP's complex etiology and its response to external stressors. CLINICAL RELEVANCE: Multidisciplinary care strategies to address both physical and psychological aspects of OLP patients is recommended following the present findings. Further research is warranted to confirm these observations in larger multicenter studies and to guide tailored guidance approaches for OLP patients during challenging times.

Oroantral Communications: Clinical Efficacy of a Double-layered Technique With/Without the Palatal Connective Tissue Flap: A Superiority, Single-center, University-based Randomized Clinical Trial.

The aim of this study was to compare the clinical results of combining a pedicle connective palatal flap coupled with the trapezoid buccal flap against the buccal flap alone in the closure of the oroantral fistula. Individuals with oroantral communication were consecutively included and eventually randomly allocated into 2 groups. In the group test, oroantral fistula was treated with the association of a buccal flap with a pedicle palatal connective tissue flap; in group control, a classic buccal sliding flap was performed. Patients' outcomes were recorded at 48 hours, 1 week, 2 weeks, and 1 month after surgery for assessment of primary (success rate) and secondary endpoints, such as experienced pain, discomfort, and complications. The success rate was 96.6% for the test group and 86.6% for the control group. No significant difference between the 2 groups could be observed regarding discomfort and pain. More pronounced pain was detected in the test group during the early healing period. This surgical procedure was demonstrated to be successful, with a high success rate and low patient discomfort.

The Role of Cyanoacrylate after Mandibular Third Molar Surgery: A Single Center Study.

BACKGROUND: The management of the surgical wound of partially impacted mandibular third molar surgery has a great impact on recovery as well as on food impact retention. The present study used clinical parameters and health-related quality of life (HRQL) to compare outcomes of cyanoacrylate application versus traditional suture of third molar impaction surgery. METHODS: This was a retrospective observational study of subjects scheduled for outpatient third molar surgery. Each participant signed an informed consent agreement. Inclusion criteria were as follows: presence of at least one partially impacted mandibular third molar, confirmed with a preoperative panoramic radiograph. Exclusion criteria were the following: smoking, diagnosed diabetes mellitus. Between June 2020 and September 2023, a total of 78 patients of mean age 31.14 years old (range 21-40 years, standard deviation 9.14), were included in this study-38 patients were male, 40 patients were female. A group of patients received traditional silk suture (G1 = 41 patients), while the second group (G2 = 37 patients) received hemostasis performed with fibrin sponge and, after complete soaking of the sponge, the application of cyanoacrylate gel on the blood clot and suture with one 2/0 stitch in order for recovery for secondary closure. The following parameters were measured: HRQL, average pain (AP), maximum pain (MP), complication score (CS), facial swelling (FS), and erythema. RESULTS: For HRQL parameters, oral disability was found to be significantly higher in G1 while AP was significantly higher in G2 (p < 0.05). AP was higher in G2 (p = 0.0098), as well as MP (p = 0.001). No differences were found with regards to CS (p = 0.0759). FS and erythema were higher in G1 (p < 0.0001 for facial swelling, and p = 0.0001 for erythema). CONCLUSIONS: on the basis of this study, the use of cyanoacrylate after mandibular third molar surgery appears to be useful in order to reduce postoperative oral disability, facial swelling, and erythema after tooth extraction, with increased average and medium pain: clinicians may consider its use in selected cases.

Multiplicative effect of stress and poor sleep quality on periodontitis: A university-based cross-sectional study.

BACKGROUND: The aim of this study was to evaluate the association of perceived stress and poor sleep quality with periodontitis in a university-based cohort of individuals. METHODS: A total of 235 individuals were included in this cross-sectional study. Perceived stress and sleep quality were evaluated through validated questionnaires, while periodontitis was identified with a full-mouth periodontal examination protocol using both European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) and Centers for Disease Control and Prevention (CDC)/AAP case definitions. Simple and multiple linear and ordinal logistic regression analyses were performed to evaluate the association between perceived stress and sleep quality with periodontitis prevalence and severity. RESULTS: Stage III/IV periodontitis resulted associated with both moderate/high perceived stress (odds ratio [OR] = 5.4; 95% confidence interval [CI]: 2.2-13.5; p < 0.001) and poor sleep quality (OR = 3.0; 95% CI: 1.2-7.4; p < 0.05). The interaction between moderate/high perceived stress and poor sleep quality presented a multiplicative association with stage III/IV periodontitis (EFP/AAP; OR = 5.8; 95% CI: 1.6-21.3; p < 0.001). Multiple linear regression analyses indicated a similar trend of association also with linear periodontal parameters, that is, mean clinical attachment level (CAL) and mean probing pocket depth (PPD). CONCLUSIONS: The findings from the present study suggest that stress and poor sleep quality may exert a multiplicative effect on periodontitis prevalence and severity.

Accuracy and Completeness of ChatGPT-Generated Information on Interceptive Orthodontics: A Multicenter Collaborative Study.

Background: this study aims to investigate the accuracy and completeness of ChatGPT in answering questions and solving clinical scenarios of interceptive orthodontics. Materials and Methods: ten specialized orthodontists from ten Italian postgraduate orthodontics schools developed 21 clinical open-ended questions encompassing all of the subspecialities of interceptive orthodontics and 7 comprehensive clinical cases. Questions and scenarios were inputted into ChatGPT4, and the resulting answers were evaluated by the researchers using predefined accuracy (range 1-6) and completeness (range 1-3) Likert scales. Results: For the open-ended questions, the overall median score was 4.9/6 for the accuracy and 2.4/3 for completeness. In addition, the reviewers rated the accuracy of open-ended answers as entirely correct (score 6 on Likert scale) in 40.5% of cases and completeness as entirely correct (score 3 n Likert scale) in 50.5% of cases. As for the clinical cases, the overall median score was 4.9/6 for accuracy and 2.5/3 for completeness. Overall, the reviewers rated the accuracy of clinical case answers as entirely correct in 46% of cases and the completeness of clinical case answers as entirely correct in 54.3% of cases. Conclusions: The results showed a high level of accuracy and completeness in AI responses and a great ability to solve difficult clinical cases, but the answers were not 100% accurate and complete. ChatGPT is not yet sophisticated enough to replace the intellectual work of human beings.

Microbiological Retention on PTFE versus Silk Suture: A Quantitative Pilot Study in Third Molar Surgery.

Background: Mandibular third molar (M3M) removal and management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. This potential quantitative study assessed the ability of two types of surgical sutures, Silk and polytetrafluoroethylene polymer (PTFE), to carry aerobic and anaerobic bacteria on wounds after mandibular third molar surgery, with a collection of the stitches at the suture removal and study in the laboratory on the basis of colony-forming units. Methods: This prospective quantitative study sampled a total of 10 consecutive healthy patients for mandibular third molar surgery at the Oral Surgery School, Dentistry and Dental Prosthodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy. The mean age of the patients was 31 years (range 25-40 years), seven patients were male and three patients were female. Inclusion criteria were: presence of a partially impacted mandibular third molar. Exclusion criteria were: smoking and diabetes mellitus. Extraction of the mandibular third molar was performed under local anesthesia: after the third molar surgery, two sutures were applied on the surgical site distally to the second mandibular molar: one single 3/0 silk stitch; one single 3/0 PTFE stitch. No sutures were applied on the release incision. Sutures were removed after 7 days and were immediately conserved and sent to the laboratory to be rated on the basis of colony-forming units (CFUs). CFUs were evaluated and reported on GraphPad Prism and transformed into its base 10 logarithm. Data were analyzed with a non-parametric Wilcoxon test, and p-values < 0.05 were evaluated as statistically significant. Results: All the patients attended the suture removal date, and all the sutures were present in the site. None of the surgical sites presented dehiscence. No stitch loss was reported, and no patient reported mouth washing or tooth brushing in the surgery site. All interventions were uneventful and no major complications were reported after M3M surgery. Bacterial retention resulted as statistically greater in silk sutures rather than PTFE sutures, both in Brain Heart Infusion samples (p = 0.003) and Wilkins-Chalgren anaerobe samples (p = 0.002). Conclusions: We found the PTFE suture to be superior to the silk suture in a reduction in the bacterial biofilm in both aerobic and anaerobic evaluations after M3M surgery.

The role of oral bromelain on "bad outcome" in mandibular third molar surgery. A split-mouth comparative study.

AIM: to evaluate evidence of therapeutic efficacy of 9.6 g bromelain after mandibular third molar surgery. MATERIAL OF STUDY: This study is a prospective split-mouth clinical study of 49 patients, 22 male and 27 female, mean age 25.4 years old (range from 18-30 years). Each patient received two interventions in two different dates with 1 month of distance: the first third molar to be removed was chosen with a coin; at the second date of surgery bromelain was administered, one packet (9.6 g) every 12 hours for seven days. The evaluation of postoperative facial swelling was measured through specific measurements at every date on the side of the surgery. RESULTS: A total of 98 third molars were extracted. No major complications occurred after the surgery. Regarding the comparison between the results of the measurements made after surgery with the use of bromelain a statistically significant difference (p = 0,0078) resulted between the interventions that provided the use of bromelain (10.56 average value) and interventions in which bromelain was not provided (12.59 average value). CONCLUSIONS: The usefulness of this clinical trial is to provide a bromelain dosage and reduce the bad outcome after mandibular third molar surgery. KEY WORDS: Bromelain, Swelling, Third Molar.

Patterns of Third-Molar-Pericoronitis-Related Pain: A Morphometrical Observational Retrospective Study.

BACKGROUND: Mandibular third molar (M3M) removal and the management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. Pain represents a great symptom for patients affected by pericoronitis and it is the most common indication for third molar removal. The aim of the present article is to search for patterns of pre-operative pain in patients before undergoing third molar surgery and to test for a relation between some patterns of symptoms, such as pain intensity, site of symptomatic tooth, and referred area of pain. METHODS: This retrospective observational study enrolled a total of 86 patients, aged (mean ± SD) 34.54 ± 13.62 years (range 17-78 years), scheduled for outpatient third molar extraction at the Oral Surgery School, Department of Medical Biotechnologies, Policlinico "Le Scotte", University of Siena. Pericoronitis and pain were the symptoms of the patients and the indication of extraction. Inclusion criteria were the presence of partially impacted third molars, confirmed with a preoperative panoramic radiograph, and preoperative pain. Exclusion criteria were known neurological disease (such as previous trigeminal or facial nerve injuries), impaired communicative or cognitive disease, diagnosed diabetes mellitus, and oral surgical intervention within 30 days before data collection. Patients were visited and asked to answer a morphometric analytic questionnaire about their perception of pain referred to the third molar. Analyses were performed on statistical evaluation on age, age ranges, patient gender, prior third molar extraction, site of pericoronitis, pain score (1-10), and pain area. Two-tailed p values of less than 0.05 were considered significant if not otherwise specified. RESULTS: No correlations were found between age, gender, previous extraction, tooth site (maxillar on mandible), pain score, and pain area. Patterns of third molar pericoronitis pain among 86 patients were reported. A significant correlation was found between pain score and pain area (p = 0.0111, rs = 0.3131). CONCLUSIONS: Pain intensity has indeed some kind of responsibility in determining the orofacial distribution of pain. The pain area referral patterns of the present article could be considered as a pain model resulting from the pericoronitis of maxillar and mandibular third molars.

Adherence to Mediterranean diet, physical activity level, and severity of periodontitis: Results from a university-based cross-sectional study.

BACKGROUND: The aim of this study was to evaluate the association between adherence to Mediterranean diet (MD) and physical activity (PA) level with the periodontal status of a University-based cohort of individuals. METHODS: A total of 235 individuals were included in the study. MD adherence and PA level were registered through validated questionnaires, together with a full periodontal examination. Crude and adjusted odds ratios (ORs) [95% confidence interval] were calculated to evaluate the association between MD adherence, PA level, and periodontitis severity. A final logistic multivariate regression model was built to evaluate the impact of the combination between low MD adherence and low PA level on the prevalence of Stage III/IV periodontitis. RESULTS: The adjusted ORs for Stage III/IV periodontitis were 1.65 [0.84 to 3.28; P = 0.42] for low PA and 5.63 [3.21 to 9.84; P = 0.00] for low MD adherence. The final logistic multivariate regression model resulted in OR = 10.23 [4.01, 26.09; P = 0.00] of having Stage III/IV periodontitis in individuals with low MD adherence and low PA. CONCLUSIONS: Individuals conducting a lifestyle characterized by the combination of low MD adherence and lack of regular exercise had 10 times the odds to have severe forms of periodontitis.

Zirconia Translucency and Cement Systems as Factors Influencing the Zirconia-Titanium and Zirconia-Zirconia Shear Bond Strength.

PURPOSE: To evaluate the bonding ability of self-adhesive and dual-cure resin cement systems applied to zirconia materials of different translucency in combination with each other and with titanium. MATERIALS AND METHODS: Computer-aided design/computer-assisted manufacture (CAD/CAM) disks of three different zirconia materials (Zenostar MO 0 [medium opacity], MT 0 [medium translucency], and T 1 [translucent], Wieland Dental) were milled and hard sintered in order to obtain cylindrical samples of either 12 mm high × 12 mm diameter (used as a substrate) or 12 mm high × 8 mm diameter (to be bonded to the substrate). CAD/CAM disks of titanium (Starbond Ti4 Disc, S&S Scheftner) were milled in order to obtain a cylinder shape (12 mm high × 8 mm diameter to be bonded to the zirconia substrate). The bonding surfaces were sandblasted with alumina particles (70 µm/2 ATM). Two resin cement systems were tested in this study: a self-adhesive resin cement (SpeedCEM Plus, Ivoclar Vivadent) and a dual-cure resin cement (Variolink Esthetic DC, Ivoclar Vivadent) in combination with a primer (Monobond Plus, Ivoclar Vivadent). The smaller cylinders were bonded to the substrate following the manufacturer's instructions. After 24 hours at 37°C storage, each specimen was subjected to shear bond strength testing in a universal testing machine. The substrate was fixed to the machine, and shear force was applied to the small cylinder close to the bonding interface. Shear bond strength data were statistically analyzed by a three-way analysis of variance (ANOVA) followed by the Tukey test for post hoc comparison (P < .05). RESULTS: No significant differences were found between substrates in the shear bond strength test (P = .078). Variolink Esthetic DC showed a statistically significantly higher bond strength compared with the SpeedCEM Plus (P = .001) with the exception of Zenostar MT substrate (P = .014). CONCLUSION: The resin cement systems showed high shear bond strength values when zirconia was resin bonded to either titanium or the corresponding zirconia substrate. Different zirconia translucencies did not affect the bond strength. The use of MDP primer and a dual-cure cement showed statistically significantly higher strength compared with the self-adhesive resin cement system with the only exception being the bonding of the translucent zirconia Zenostar MT.

Blastic plasmacytoid dendritic cell neoplasm: a rare case of gingival lesion with leukaemic presentation.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare haematological malignancy with an aggressive clinical course. It has been recognised as a distinct entity in the WHO 2008 classification of haematolymphoid neoplasm. This disease usually presents with cutaneous involvement as the first manifestation, with subsequent or simultaneous spread to bone marrow and peripheral blood with leukaemic dissemination. Gingival lesion as the first manifestation, in the absence of a cutaneous lesion, is an uncommon presentation of this rare disease. We report a case of an elderly woman, aged 84 years, who presented with a lump on the mandibular gingiva and ipsilateral otalgia without any cutaneous lesion and associated with an highly aggressive and rapid leukaemia. This case is an addition to the handful of those cases of BPDCN which presents without cutaneous involvement, but it is exceedingly rare for clinical features that make it a unique case in the literature.

Correlation Between Dysphagia and Malocclusion in Rett Syndrome: A preliminary study.

OBJECTIVES: Rett syndrome (RS) is a severe neurological developmental disorder characterised by stereotypical hand movements, epileptic seizures, craniofacial dysmorphism and digestive dysfunction. This study aimed to examine the correlation between the severity of malocclusion and dysphagia in patients with RS. METHODS: This preliminary study was conducted at the Ear, Nose & Throat Clinic of the University Hospital of Siena, Siena, Italy, from January 2014 to December 2017. A total of 56 patients with RS were examined and grouped according to the severity of dysphagia (absent, mild, moderate or severe) and malocclusion (<2 mm, 2-3 mm, 3-4 mm or >4 mm). RESULTS: All of the patients were female and the mean age was 11.3 years. Eight (14.3%) patients had mild, 18 (32.1%) had moderate and 30 (53.6%) had severe dysphagia. Four (7.1%) patients had <2 mm occlusion, 10 (17.9%) had 2-3 mm occlusion, 26 (46.4%) had 3-4 mm occlusion and 16 (28.6%) had >4 mm occlusion. Mild dysphagia was observed in 100% and 40% of patients with <2 and 2-3 mm malocclusion, respectively, while moderate dysphagia was present in 60% and 38.5% of patients with 2-3 and 3-4 mm malocclusion, respectively. Severe dysphagia was observed in 28.6% and 87.5% of patients with 3-4 and >4 mm malocclusion, respectively. There was a significant correlation between dysphagia and malocclusion severity (P <0.001). CONCLUSION: A higher degree of malocclusion was associated with more severe dysphagia among a cohort of patients with RS.

Unusual complications caused by lipoma of the tongue.

Lipoma is the most common, benign, soft tissue, mesenchymal tumour and is composed of mature adipose tissue. It is infrequent in the oral cavity (approximately 0.3% of all tongue neoplasias). We describe the case of a 68-year-old man with a swelling at the tongue edge and tongue dysesthesia. Medical history, clinical assessment, radiographic images, and cytological analysis enabled specialists to classify this neoplasia as a lipoma. The patient recovered fully after surgical excision of the affected area, and the neuralgic symptoms regressed. Surgical excision is an elective treatment; however, accurate differential diagnosis, histological examination, and follow-up are required.

Abnormal oral mucosal light reflectance in bronchopulmonary dysplasia.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is an important cause of mortality and morbidity in preterm infants. A disordered vascular development and a decreased production of angiogenic factors have been recently reported in the condition. Extracellular matrix (ECM) is known to play an important role on angiogenesis and blood vessel geometry and changes in ECM components have been previously reported in experimental models and patients with BPD. Here, we aimed to assess the potential value of light reflectance on the oral mucosa in detecting infants who will develop BPD. METHODS: A total of 75 preterm newborns (gestational age: 27.7 +/- 2.8 weeks, birth weight: 870 +/- 145 g) were recruited to the study, of whom 25 developed BPD (gestational age: 26.9 +/- 3.0 weeks, birth weight: 855 +/- 150 g). Reflectance was measured on the postnatal days 1 and 28, using high-resolution photographs of the lower gingival and vestibular oral mucosa, using imaging spectrophotometry in the 400-700 nm wavelength electromagnetic spectral range. The median of artefact- and vessel-free areas was n = 78 (interquartile range: 59-88). Median range values were comparable for both groups: BPD-positive infants, median 77 (interquartile: 60-90) vs. control infants, median 74 (interquartile: 62-92). The predictive accuracy of oral spectrophotometry was calculated using receiver operating characteristic curve analysis. RESULTS: BPD patients showed significantly lower light reflectance values in the red (610-700 nm, P < 0.0001), with higher values in the violet (400 nm, P = 0.0056; 430 nm, P=0.014), and blue-green (480-500 nm, P < or = 0.024) sections of the spectrum already on the first day of life. A low reflectance value in the 640-700 nm wavelengths interval was found to identify BPD patients with 100% sensitivity and 100% specificity (640 nm: cutoff < or = 44.91%; 650 nm: < or = 45.64%; 660 nm: < or = 46.56%; 670 nm: < or = 47.14%; 680 nm: < or = 47.56%; 690 nm: < or = 48.95%; 700 nm: < or = 50.81%). CONCLUSIONS: These findings indicate the presence of previously unrecognised, early abnormalities in the average optical properties of the oral mucosa from infants developing BPD.