Clinical Oral Investigations最新文献

Objectives: Although superficial fungal infections of the oral and maxillofacial region are common, deep fungal infections remain unfamiliar. We investigated the prevalence of fungal infections in this location in Thailand from specimens examined in the Department of Oral and Maxillofacial Pathology over a 50-year period.

Materials and methods: Cases diagnosed as fungal infections in our archive were selected. Demographic data, risk factors, clinical and radiographic features, clinical differential diagnoses and treatments were analyzed.

Results: Of 22,070 biopsied specimens, 41 cases (0.19%) were fungal infections in this location. The prevalence increased in the last decade. Approximately 71% were candidiasis, while 29% constituted deep infections including mucormycosis, aspergillosis and histoplasmosis. Fungal infections predominantly affected elderly individuals (mean age: 62.1 years). Both superficial and deep types exhibited a female predominance with a ratio of 1:3.8 and 1:3, respectively. About 60% of patients were associated with risk factors, namely, betel quid chewing, diabetes mellitus and human immunodeficiency virus infection. Clinically misdiagnosed chronic hyperplastic candidiasis as erythroleukoplakia/lichen planus, and deep fungal infections as osteomyelitis/oral squamous cell carcinoma were frequently observed. All candidiasis were treated with topical antifungal drugs, while mucormycosis and histoplasmosis required systemic antifungal therapy.

Conclusions: Fungal infections constituted less than 1% among biopsied specimens. The majority of fungal infections were clinically misdiagnosed. Currently, histopathologic examinations using proper special stains play a vital role to achieve a definite diagnosis.

Clinical relevance: Unfamiliarity with deep fungal infections in the oral and maxillofacial region among oral healthcare personnel may lead to misdiagnosis and inappropriate treatment. Awareness of fungal infections in this area must be encouraged.

Objectives: To explore correlation between ability of dentists and dental students to recognise the clinical presentation of oral cancer and their self-rated confidence.

Methods: A cross-sectional, analytical design was used for this study. A validated oral disease recognition scale (ODRS) encompassing a range of benign, premalignant, and malignant oral conditions was used for data collection. For each of the seven patient cases, the participants were asked to provide a diagnosis and rate their self-perceived confidence. Confidence ratings were used as a predictor in a logistic regression model to determine its value as a predictor of diagnosis accuracy, controlling for other factors.

Results: A total of 252 participants completed the online survey. All correlations between pairs of Cases are positive and statistically significant (p < 0.001). An ordinal logistic regression model predicting Correct vs. Incorrect based on Confidence, Case, participant status, participant gender, and participant age group (and a random effect for participant) suggests that each unit increase in confidence results in a 0.235 unit increase in log-odds of a correct response (an Odds Ratio of 1.265, p < 0.001).

Conclusions: Overall, confidence ratings appear to predict diagnosis accuracy, after controlling for case and participant characteristics. Notwithstanding the limitations of the current study, the oral disease recognition scale may serve as a useful tool to assess clinicians' ability to recognize oral cancer and identify potential cognitive biases in their clinical assessment skills.

Clinical relevance: This study highlights the correlations between diagnostic accuracy and confidence of dentists and dental students in identifying oral cancer, which is crucial for timely referral and improved patient outcomes. By identifying gaps in diagnostic confidence and potential cognitive biases, the findings can inform targeted educational interventions for reliable oral cancer screening in general dental practice.

Objective: Obesity and periodontitis are recognized as a major public health problem. The aim of this study was to investigate the response of different body mass index(BMI) groups to non-surgical periodontal treatment(NSPT).

Methods: We retrospectively reviewed the medical records, including baseline medical information and BMI, of patients with periodontal disease. We also analyzed periodontal indices, including periodontal pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), before and after NSPT to assess the correlation between BMI and the effectiveness of NSPT.

Results: A total of 147 patients participated in this study, including 88 individuals in the normal BMI group with an average age of 49.02 ± 10.05 years and 59 individuals in the high BMI group with an average age of 48.15 ± 8.78 years. The results showed that the periodontal index of the abnormal BMI group was higher than that of the normal BMI group both before and after NSPT. NSPT had significant effects on patients with periodontitis in both the normal and abnormal BMI groups. The abnormal BMI group exhibited a significantly higher change in the percentage of PD ≧ 4 mm compared to the normal BMI group (p = 0.019).

Conclusion: Despite the fact that Taiwan individuals have lower BMI groupings, those with abnormal BMI exhibit less favorable periodontal indices compared to those with normal BMI. However, NSPT has shown promising results in improving periodontal disease among individuals with abnormal BMI. Encouragement should be given to individuals with generalized severe periodontitis and a high BMI to actively consider receiving periodontal treatment.

Clinical relevance: Despite generally lower BMI in Taiwan, individuals with abnormal BMI exhibit less favorable periodontal health. NSPT shows promise in improving their periodontal condition. Tailored interventions may enhance periodontal outcomes.

Objectives: This study aimed to investigate the microbial spectrum and resistance patterns in surgically treated odontogenic infections and to assess the clinical impact of resistance, including systemic complications and hospitalization. Resistance rates were additionally evaluated in relation to reported penicillin hypersensitivity.

Methods: A total of 740 inpatient cases with microbiological testing from surgically treated odontogenic infections at the Jena University Hospital from January 1, 2012, to December 31, 2023, were analyzed. Resistance rates were assessed at infection level. Time trends were analyzed using Poisson regression. Associations between resistance rates and clinical variables were evaluated using binary logistic regression.

Results: Clindamycin resistance was observed in 38.9% of infections, while amoxicillin/clavulanate (6.9%) and moxifloxacin (4.5%) showed lower resistance rates. No statistically significant trends in resistance rates were observed. Moxifloxacin resistance increased the risk of systemic complications (OR: 10.875; 95%-CI: 2.364-50.017; p = 0.002), while no significant associations were found between antibiotic resistance and prolonged hospitalization. A history of penicillin hypersensitivity was associated with increased clindamycin resistance (OR: 2.156; 95%-CI: 1.038-4.480; p = 0.04).

Conclusions: Clindamycin exhibits high resistance rates in odontogenic infections and should be critically re-evaluated as empirical therapy, especially in patients with penicillin hypersensitivity. Given the overall low resistance rates to moxifloxacin, resistance to this agent indicated highly resistant infections and was associated with an increased risk of systemic complications.

Clinical relevance: Continuous resistance surveillance and adaptation of empirical therapy are essential for managing severe odontogenic infections and reducing life-threatening infection-related complications, emphasizing the need for antimicrobial stewardship.

Objectives: Vitamin D has been extensively studied in dentistry in the modern past. However, its impact on caries progression and arrest remains unclear. This narrative review aims to provide a critical overview of the relationship between vitamin D and caries, with a focus on the historical development of the topic, current scientific understanding, and potential future perspectives.

Materials and methods: A literature review and screening of historical periodicals was performed to outline the role of vitamin D in caries prevention in the past and in the future. Articles focusing on the historic use of vitamin D in cariology and vitamin D in cariology were included and evaluated.

Results: Literature showed that vitamin D was described as one of the central caries preventive agents in the 1930s and 1940s until systemic and topical fluoridation became more prominent. Possible mechanisms described by current science include effects on tooth development and immune modulation via saliva.

Conclusions: The emergence of fluoride as the leading preventive measure in cariology shifted the focus away from vitamin D research. However, recent studies have renewed interest in the potential causal role of vitamin D in caries prevention.

Clinical relevance: Further research is needed to examine the role of vitamin D in the proteome of saliva, pellicle and initial caries lesions, as well as to visualize its presumed arresting effect at the ultrastructural level. Additionally, prospective studies on the influence of vitamin D on caries progression in permanent teeth are necessary.

Objectives: This study aimed to evaluate the effects of different irrigation protocols on the removal of mono- and multispecies biofilms, as well as on chemical alterations induced in superficial dentin.

Materials and methods: Specimens were divided into two groups according to the irrigating solution used: sodium hypochlorite (NaOCl 2.5%) or saline solution (SS 0.9%), and were subjected to agitation using either passive ultrasonic irrigation or EasyClean. The chemical composition of dentin discs was assessed by attenuated total reflectance Fourier-transform infrared spectroscopy (ATR-FTIR), based on the Amide III/Phosphate and Carbonate/Phosphate ratios at three time points: baseline, after conventional irrigation, and after agitation. In parallel, E. faecalis, E. faecalis + S. oralis, and E. faecalis + C. albicans biofilms were grown on bovine dentin blocks and subjected to the same irrigation protocols. Cell viability was quantified by confocal laser scanning microscopy following Live/Dead staining. Data were analyzed using Kruskal-Wallis, Dunn, and Wilcoxon tests (α < 0.05).

Results: The Amide III/Phosphate ratio was significantly reduced in the NaOCl groups after agitation (p < 0.05), while changes in the Carbonate/Phosphate ratio were observed only in the SS groups when compared to NaOCl (p < 0.05). From a microbiological perspective, both activation methods with NaOCl significantly reduced cell viability, particularly ultrasonic activation in monospecies biofilms and EasyClean in multispecies biofilms (p < 0.05).

Conclusion: Based on the results and the methodology applied, it can be concluded that NaOCl activation with either ultrasonic irrigation or EasyClean is effective for disinfection, although it promotes chemical changes in dentin.

Clinical relevance: This study analyzes the impact of irrigation protocols on biofilm removal and dentin composition. NaOCl activation was effective in reducing microbial viability but promoted chemical changes in dentin, highlighting the need to balance disinfection and structural preservation in endodontic practice.

Aim: The Nuclear Receptor Coactivator 4 (NCOA4)-mediated ferritinophagy and the Acyl-CoA synthetase long-chain family member 4 (ACSL4)-mediated lipid peroxidation promote ferroptosis. Nuclear factor erythroid-2 related factor-2 (Nrf2), a transcription factor, controls antioxidants, detoxifying enzymes, and ferroptosis. The concerted activity of NCOA4, ACSL4, and Nrf2 in periodontitis associated with or without T2DM needs exploration.

Materials and methods: Forty-two patients were recruited and categorized into 3 groups: Group I: systemically and periodontally healthy (PH, n = 14); Group II: Stage III/IV Periodontitis (PD, n = 14); Group III: Stage III/IV Periodontitis with uncontrolled Type 2 Diabetes mellitus (T2DM + DM, n = 14). The site-specific periodontal clinical parameters were recorded. Gingival tissue biopsies were evaluated for gene expression of NCOA4, Nrf2, and ACSL4 by real time -PCR.

Results: In groups II and III, NCOA4 expression increased by 10.07 ± 9.15 and 9.40 ± 6.29-fold, respectively, whereas ACSL4 expression increased by 3.23 ± 2.53 and 2.03 ± 2.22-fold, respectively, compared to group I (P < 0.05). Nrf2 expression decreased in groups II (0.36 ± 0.39) and III (0.83 ± 0.89) compared to group I, with the least expression in group II. In the total sample analysis, NCOA4 FC and Nrf2 CT showed a significant positive correlation with all clinical parameters and with each other (P < 0.05). There was a significant positive correlation (P < 0.05) between NCOA4 FC and ACSL4 CT (P < 0.05). In group II, NCOA4 CT had significant positive and negative correlations with Nrf2 FC and ACSL4 FC values, respectively (P < 0.05). The diagnostic accuracy of NCOA4 and Nrf2 in differentiating between periodontal health and periodontitis was 89% (AUC = 0.96) and 71% (AUC = 0.60), respectively. Likewise, NCOA4 and Nrf2 demonstrated diagnostic accuracy of 67.8% (AUC = 0.73) and 78.5% (AUC = 0.85) in differentiating between diabetic periodontitis and periodontal health, respectively.

Conclusions: Ferroptosis in the progression of periodontitis and diabetes-associated periodontitis may be linked to dysregulated expressions of the NCOA4, ACSL4, and Nrf2 genes. However, additional investigation is required to fully comprehend the findings.

Objectives: This prospective controlled clinical trial aimed to evaluate the periodontal status of posterior indirect resin composite (IRC) restorations followed by proximal box elevation (PBE), based on clinical and radiographic parameters. Additionally, the study investigated the influence of restoration depth and supracrestal tissue attachment (STA) violation on periodontal outcomes.

Materials and methods: A total of 80 molars with deep cervical margins were restored using IRC (SR Nexco) with PBE (Tetric-N Flow and Tetric-N Ceram). Of these, 42 restorations with PBE on one proximal surface (mesial or distal) in 39 patients were included. The test group consisted of the proximal surfaces restored with PBE due to subgingival margin placement, whereas the control group comprised the opposite proximal surfaces of the same teeth without restoration. Periodontal parameters including plaque index (PI), gingival index (GI), probing pocket depth (PPD), and bleeding on probing (BoP) were assessed at baseline (15 days after cementation), and at 6, 12, 24, and 36 months. Standardized periapical radiographs were used to monitor alveolar bone levels at designated follow-ups. Test and control sides were compared using the Robust Mixed ANOVA test (PI, GI, PPD) and McNemar's test (BoP).

Results: Data were available from 42, 39, 33, and 30 teeth at baseline, 6, 12, 24, and 36 months. No significant differences were found at any time point (p > 0.05) for none of the periodontal parameters. PPD values showed a significant change over time (p = 0.001), with pairwise differences observed between baseline and 12-, 24-, and 36-month measurements, as well as between 6- and 36-month, 12- and 36-month, and 24- and 36-month time points. Within the test group, no significant differences in BoP were found among STA grades (p > 0.05).

Conclusions: PBE appears to be biologically safe and clinically acceptable, even when the restorative margin is located close to or slightly within the STA, without leading to severe periodontal response resulting in alveolar bone resorption.

Clinical relevance: PBE facilitates the adhesive restoration of deep proximal cavities without surgical intervention. The findings support the clinical use of PBE in anatomically challenging cases where subgingival margin elevation is required.

Trial registration: ClinicalTrials.gov identifier: NCT03832829.

Objectives: To evaluate the presence of SARS-CoV-2 RNA in the subgingival biofilm of COVID-19 individuals and its association with generalized gingivitis.

Materials and methods: A pool of subgingival biofilm samples was collected from 80 individuals, 59 with and 21 without COVID-19, after periodontal diagnosis (classified as periodontally healthy or generalized gingivitis). Samples were tested for SARS-CoV-2 RNA by qRT-PCR. Binary logistic regression and Mann-Whitney test were applied to evaluate associations between the presence and amount of SARS-CoV-2 RNA in the biofilm and the presence of gingivitis (p < 0.05).

Results: SARS-CoV-2 RNA was detected in the subgingival biofilm of 35.6% (n = 21) of individuals with COVID-19 but not in individuals without COVID-19. In the COVID-19 group, SARS-CoV-2 RNA was detected in periodontally healthy individuals (47.6%) and those with gingivitis (52.4%). After adjusting for covariates, SARS-CoV-2 in dental biofilm was associated with 7.25-fold higher odds of generalized gingivitis (OR = 7.25; 95% CI: 1.41-37.33; p = 0.02).

Conclusion: SARS-CoV-2 was detected in subgingival biofilms of COVID-19-positive individuals and was associated with an increased chance of gingivitis, providing preliminary evidence of a potential role of the virus in gingival inflammation. However, a bidirectional relationship may be present, as gingival inflammation could also create a more favorable environment for viral colonization of the subgingival biofilm.

Clinical relevance: Maintaining periodontal health during and after COVID-19 infection may be important not only for oral well-being but also for mitigating viral persistence and its inflammatory effects.

Objective: To evaluate the effects of concentrated growth factors (CGFs) combined with Bio-Oss bone substitute on the periodontal healing of adjacent teeth following impacted tooth extraction.

Methods: This single-centre prospective controlled study enrolled 60 patients requiring bilateral impacted mandibular third molar extraction. Patients were randomly allocated to a test group (n = 30; extraction socket filled with CGFs + Bio-Oss and covered with a CGF membrane) or control group (n = 30; natural healing). Primary outcomes included periodontal probing depth (PD) and distal bone height measured by cone beam computed tomography at baseline and 3 and 6 months. Secondary outcomes comprised the visual analogue scale (VAS) pain scores, swelling assessment and dry socket incidence. Statistical analysis was performed using SPSS 26.0, with significance set at P < 0.05.

Results: A total of 60 patients were enrolled in this randomised single-blind clinical trial. The test group showed significantly greater PD reduction (2.41 ± 0.89 vs. 1.52 ± 0.73 mm, P < 0.001) and bone height gain (2.87 ± 1.12 vs. 1.63 ± 0.91 mm, P < 0.001) at 6 months than the control group. The VAS pain scores were significantly lower in the test group at days 3 and 7 (P < 0.001). No cases of dry socket occurred in the test group, compared with three cases (11.1%) in the control group. Multivariate analysis revealed that CGFs + Bio-Oss application was the strongest predictor of bone gain ≥ 2 mm (β = 0.412, P < 0.001).

Conclusion: Concentrated growth factors combined with Bio-Oss significantly enhance periodontal healing and bone regeneration at adjacent teeth following impacted tooth extraction while reducing postoperative complications. This combined approach represents a promising strategy for clinical practice.