Platelet-rich fibrin in the management of oral mucosal lesions: a scoping review.

OBJECTIVES: Oral mucosal lesions are prevalent and often cause pain, thus impacting patients' quality of life. Platelet-rich fibrin (PRF) has emerged as a promising autologous biomaterial for wound healing, yet comprehensive evidence regarding its efficacy in treating oral mucosal lesions is limited. This study aims to update the current evidence on the effectiveness of PRF in treating various types of oral mucosal lesions. MATERIALS AND METHODS: We conducted a literature search in PubMed, Scopus, Embase, and Web of Science databases until April 2024. The search included studies that investigated the use of PRF in treating oral mucosal lesions. Twelve studies met the inclusion criteria, comprising three case reports, three randomized controlled trials, two animal studies, three split-mouth trials, and one retrospective study. We performed data extraction according to a predefined form. RESULTS: PRF was applied in two forms-membranes and injectable gels-to treat a range of oral mucosal lesions, including ulcerative, red and white, pigmented, and potentially malignant or malignant lesions. Compared to control groups or conventional treatments, PRF generally demonstrated superior outcomes regarding faster healing, lesion size reduction, symptom relief, and lower recurrence rates. Histological and molecular analyses from some studies also indicated PRF's regenerative and anti-inflammatory effects. CONCLUSION: PRF shows promise as an effective and safe alternative to current treatments for oral mucosal lesions due to its autologous nature, ease of preparation, and wound-healing capabilities. However, further research is needed to standardize PRF preparation protocols and confirm its long-term efficacy across different lesion types.

A novel chitosan-based doxepin nano-formulation for chemotherapy-induced oral mucositis: a randomized, double-blinded, placebo-controlled clinical trial.

OBJECTIVES: Considering the prevalence of oral mucositis, we aimed to use the analgesic effects of doxepin with chitosan's antimicrobial and bio-adhesive nature to fabricate a nano-formulation for treating chemotherapy-induced oral mucositis. MATERIALS AND METHODS: Nanogel was fabricated via ionic gelation and characterized. Sixty patients were randomly divided and received four different treatments for 14 days: diphenhydramine + aluminum-magnesium mouthwash (control), doxepin mouthwash (DOX MW), chitosan nanogel (CN), and doxepin/chitosan nanogel (CN + DOX). Lesions were assessed with four indices, National Cancer Institute (NCI), World Health Organization (WHO), World Conference on Clinical and Research in Nursing (WCCNR) and visual analog scale (VAS) before and 3, 7, and 14 days after interventions. Kruskal-Wallis test was used for pairwise comparison. RESULTS: CN had semisolid consistency, uniform spherical shape, an average size of 47.93 ± 21.69 nm, and a zeta potential of + 1.02 ± 0.16 mV. CN + DOX reduced WHO, WCCNR, and VAS scores significantly more than the control three days after the intervention. Seven days after the intervention, CN + DOX reduced NCI and WCCNR considerably more than the control; it reduced WCCNR significantly more than CN. Fourteen days after the intervention, CN + DOX decreased NCI markedly more than the control. CONCLUSION: Chitosan-based doxepin nano-formulation might be a promising alternative for routine treatments of oral mucositis.

Effect of lactobacillus reuteri-derived probiotic nano-formulation on recurrent aphthous stomatitis: a double-blinded randomized clinical trial.

OBJECTIVES: We aimed to assess the therapeutic effects of a topical probiotic nano-formulation derived from Lactobacillus reuteri on treating recurrent aphthous stomatitis. MATERIALS AND METHODS: 60 participants were randomly allocated into two groups (control and probiotic). Probiotic group administered topical probiotic nano-formulation three times a day for seven days. The control group administered a standard analgesic oral rinse. The size of ulcer(s) and pain severity were recorded on days 0, 3, 5, and 7 after intervention. RESULTS: Before the intervention, the groups had no significant differences in terms of pain severity (P-value = 0.28) and lesion size (P-value = 0.24). Both groups exhibited significant reductions in pain severity and lesion size over the course of the intervention. After one week, the probiotic group had a notably larger lesion size reduction than the control group (P-value = 0.01). The probiotic group also showed a significantly greater reduction in pain severity than the control group (P-value = 0.04). CONCLUSIONS: Applying topical probiotic nano-formulation derived from Lactobacillus reuteri three times a day decreased lesion size and pain severity in RAS patients faster than the local analgesic oral rinse. CLINICAL RELEVANCE: Lactobacillus reuteri-derived probiotic nano-formulation might be a promising treatment option for RAS.

Biomimetic Scaffolds for Regeneration of Temporomandibular Joint Disc: A Narrative Review.

Defects and dysfunctions of temporomandibular joint (TMJ) disc are responsible for the majority of TMJ diseases. Current treatments in this matter are usually short-term and only palliative, thus an alternative treatment that offers long-lasting repair is in great demand. In recent years great attempts have been made to prepare an ideal scaffold, which best resembles the native TMJ disc in characteristics such as mechanical, physical and biological properties. This narrative review focuses on developments of the recent ten years in fabrication of scaffolds using decellularized tissues, natural and synthetic biomaterials for regeneration of TMJ disc and compared their properties. PubMed and Google Scholar databases were searched using the following keywords ("TMJ" OR "temporomandibular joint" OR "TMD" OR "temporomandibular disease") AND ("scaffold" OR "hydrogels"). Randomized controlled trials, randomized clinical trials, case-controls, case reports, and animal studies were included. Comments, systematic reviews, meta-analyses, and non-English papers were excluded. The study concluded that hybrid scaffolds have exhibited favorable cell attachment and proliferation. Synthetic scaffolds have shown promise in providing better control over structural properties; however, additional processes are often required to provide biomimetic cell signaling. While there is still much to learn about the ideal scaffold for TMJ disc regeneration, both natural and synthetic scaffolds have shown promise in achieving the functional, structural, biological, and mechanical properties of a native TMJ disc.

Stimuli-responsive hydrogel based on natural polymers for breast cancer.

Aims: Breast cancer is the most common malignancy among women in both high- and low-resource settings. Conventional breast cancer therapies were inefficient and had low patient compliance. Stimuli-responsive hydrogels possessing similar physicochemical features as soft tissue facilitate diagnostic and therapeutic approaches for breast cancer subtypes. Scope: Polysaccharides and polypeptides are major natural polymers with unique biocompatibility, biodegradability, and feasible modification approaches utilized frequently for hydrogel fabrication. Alternating the natural polymer-based hydrogel properties in response to external stimuli such as pH, temperature, light, ultrasonic, enzyme, glucose, magnetic, redox, and electric have provided great potential for the evolution of novel drug delivery systems (DDSs) and various advanced technologies in medical applications. Stimuli-responsive hydrogels are triggered by specific cancer tissue features, promote target delivery techniques, and modify release therapeutic agents at localized sites. This narrative review presented innovation in preparing and characterizing the most common stimuli-responsive natural polymer-based hydrogels for diagnostic and therapeutic applications in the breast cancer area. Conclusion: Stimuli-responsive hydrogels display bioinspiration products as DDSs for breast cancer subtypes, protect the shape of breast tissue, provide modified drug release, enhance therapeutic efficacy, and minimize chemotherapy agents' side effects. The potential benefits of smart natural polymer-based hydrogels make them an exciting area of practice for breast cancer diagnosis and treatment.

Trinitroglycerin-loaded chitosan nanogels: Shedding light on cytotoxicity, antioxidativity, and antibacterial activities.

AIM AND BACKGROUND: Trinitroglycerin (TNG) is a remarkable NO-releasing agent. Here, we synthesized TNG based on chitosan Nanogels (Ngs) for ameliorating complications associated with high-dose TNG administration. METHOD: TNG-Ngs fabricated through ionic-gelation technique. Fourier-transformed infrared (FT-IR), zeta-potential, dynamic light scattering (DLS), and electron microscopy techniques evaluated the physicochemical properties of TNG-Ngs. MTT was used to assess the biocompatibility of TNG-Ngs, as the antioxidative properties were determined via lactate dehydrogenase (LDH), reactive oxygen species (ROS), and lipid peroxide (LPO) assays. The antibacterial activity was evaluated against Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE). RESULTS: Physicochemical characterization reveals that TNG-Ngs with size diameter (96.2 ± 29 nm), polydispersity index (PDI, 0.732), and negative zeta potential (-1.1 mv) were fabricated. The encapsulation efficacy (EE) and loading capacity (LC) were obtained at 71.1 % and 2.3 %, respectively, with no considerable effect on particle size and morphology. The cytotoxicity assay demonstrated that HepG2 cells exposed to TNG-Ngs showed relative cell viability (RCV) of >80 % for 70 µg/ml compared to the TNG-free drug at the same concentration (P < 0.05). TNG-Ngs showed significant differences with the TNG-free drug for LDH, LPO, and ROS formation at the same concentration (P < 0.001). The antibacterial activity of the TNG-Ngs against S. aureus, E. coli, VRE, and MRSA was higher than the TNG-free drug and Ngs (P < 0.05). CONCLUSION: TNG-Ngs with enhanced antibacterial and antioxidative activity and no obvious cytotoxicity might be afforded as novel nanoformulation for promoting NO-dependent diseases.

Using chitosan, hyaluronic acid, alginate, and gelatin-based smart biological hydrogels for drug delivery in oral mucosal lesions: A review.

AIMS: Oral mucosal diseases can lead to pain, difficulty speaking and eating, psychological distress, and cancer. Topical drug delivery using biological macromolecules, specifically hydrogels, is gaining interest due to the drawbacks of conventional treatments for oral mucosal lesions. SCOPE: Biological hydrogels made from natural polymers and their derivatives, such as chitosan, hyaluronic acid, alginate, and gelatin, represent promising alternatives to conventional oral medication delivery methods. Topical drug delivery is beneficial for oral mucosal lesions as it can directly target the affected area, especially with the development of smart stimuli-responsive hydrogels, which allow for more controlled drug release. Biological hydrogels have already been used to deliver drugs like lidocaine and nystatin. This review summarizes the current research on applying smart natural polymer-based hydrogels for drug delivery in oral mucosal lesions. CONCLUSION: Smart biological hydrogels show great promise as topical drug delivery systems for oral mucosal lesions, offering sustained drug release, increased therapeutic efficacy, and minimized systemic complications. Technological advancement is expected to lead to the development of more effective and safer drug delivery systems. The potential benefits of biological polymer-based hydrogels make them an exciting area of research for oral mucosal lesion treatment.

The Effect of Photobiomodulation on Temporomandibular Pain and Functions in Patients With Temporomandibular Disorders: An Updated Systematic Review of the Current Randomized Controlled Trials.

Introduction: Temporomandibular disorders (TMDs) are the most prevalent non-dental origin orofacial pain conditions affecting the temporomandibular joints (TMJs) and/or orofacial muscles. Photobiomodulation therapy (PBMT) is a conservative way to improve function and reduce symptoms in TMD patients. This systematic review was conducted to update evidence about the effects of PBMT on pain intensity, TMJ movements, electromyography (EMG) activity, pressure pain threshold (PPT), and TMJ sound in patients with TMDs. Methods: A systematic literature search was conducted in Web of Science, PubMed/Medline, and Scopus databases using appropriate keywords and specific strategies from January 2000 to September 2022. Data extraction was done based on the inclusion/exclusion criteria. Results: A total of 40 studies were included. All included studies except one provided information on pain intensity; 27 studies showed a reduction in pain intensity in PBMT groups compared to control groups. Seven out of 15 studies, which reported maximum mouth opening (MMO), showed a greater MMO in PBMT groups than in placebo groups. In addition, the figures for passive maximum mouth opening (PMMO) and active maximum mouth opening (AMMO) in all the studies reporting PMMO and AMMO were higher in PBMT groups. In eight out of ten studies, lateral movement (LM) was greater in PBMT groups. Moreover, in three studies out of four, protrusive movement (PM) was reported to be greater in the PBMT group. Four out of nine studies showed a greater PPT in the PBMT group. Reduced TMJ sounds in the PBMT group were reported in two out of five studies. In addition, in most studies, no difference in EMG activity was detected between the two groups. Conclusion: This updated systematic review showed the promising effects of PBMT on the alleviation of pain and improvement in MMO. Using the infrared diode laser with a wavelength ranging between 780-980 nm, an energy density of<100 J/ cm2, and an output power of≤500 mW for at least six sessions of treatment seems to be a promising option for treating mentioned TMDs signs and symptoms based on the previously reported findings.