Oral Surgery Oral Medicine Oral Pathology Oral Radiology最新文献

Introduction: Medication-related osteonecrosis of the jaws (MRONJ) is a complex oral condition for which no global consensus on management currently exists, underscoring the need to establish internationally accepted therapeutic protocols. The use of platelet-rich fibrin (PRF) and the adjunctive administration of pentoxifylline and tocopherol (PenTo) have shown promising preliminary results in the clinical management of MRONJ; however, robust data remain limited. The aim of this study is to analyze the outcomes of surgically treated patients with stage I and II MRONJ, incorporating PenTo as an adjuvant to platelet concentrate therapy. Furthermore, the study seeks to evaluate both clinical and radiographic outcome variables throughout the follow-up period.

Methods: A controlled pharmacological clinical trial was conducted, using a standard drug regimen as the comparator. Total 20 patients diagnosed with stage I or II MRONJ were allocated into 2 groups: one group received surgical treatment combined with PRF, while the other underwent the same protocol supplemented with an adjuvant therapeutic regimen based on PenTo. Participants were recruited from the Oral Medicine Department, School of Dentistry, Universidad Católica de Córdoba.

Results: Statistically significant differences were observed in the mean duration of antiresorptive therapy, which was notably longer in patients with osteoporosis (P = .01). Zoledronic acid was the most frequently associated drug (P = .0019). The addition of PenTo to the treatment protocol was associated with improved clinical and radiographic outcomes, with statistically significant differences (P = .0138 and P = .0046, respectively). Furthermore, the diagnostic stage (I or II) showed a significant correlation with clinical improvement following treatment (P = .0294). The healing index at 15, 90, and 180 days was higher in the group receiving PenTo, with statistically significant differences at each time point (P = .0441; P = .0001; P = .0018, respectively). In oncological patients, the healing index was also higher at all follow-up stages, with clear statistical significance (P = .0294; P = .0004; P = .0042).

Conclusions: This study contributes with patient-based evidence to support the interdisciplinary management of MRONJ. The combination of surgical treatment, PRF, and PenTo may serve to optimize and enhance clinical strategies for this condition.

Objective: To evaluate the epidemiological characteristics, comorbidity patterns, and economic burden of temporomandibular disorder (TMD)-related hospital emergency department (ED) visits in the United States using a nationally representative database.

Study design: A retrospective cross-sectional analysis of 2021-2022 National Emergency Department Samples data identified TMD-related ED visits using ICD-10 codes. Descriptive statistics summarized demographics, hospital characteristics, payer status, and comorbidities. Multivariable linear regression model determined associations between patient- and system-level factors and ED charges.

Results: A total of 52,412 TMD-related ED visits were identified. Most patients were female (67.5%) with a mean age of 39.5 years. Black (19.1%) and Hispanic (18.7%) patients were overrepresented. The mean ED charge per visit was $2,827. Common comorbidities included hypertension (12.9%) and depression (2.5%). Regression analysis showed that older age, higher income, and Western U.S. location were associated with higher ED charges. Medicaid and self-pay status predicted lower charges, while hypertension increased ED charges.

Conclusions: More than 52,000 TMD-related ED visits resulting in $147 million in ED charges highlight a major public health issue disproportionately affecting women, minorities, and low-income groups. Many visits may be preventable with improved outpatient care. Integrated, cost-effective, multidisciplinary strategies are needed to reduce emergency use and long-term complications.

Objective: Oral lichen planus (OLP) is a T-cell-mediated mucosal disorder with malignant potential and ∼1% prevalence. Its associations with autoimmune diseases and oral squamous cell carcinoma (OSCC), especially among smokers, remain unclear. This study quantified OLP prevalence across 17 autoimmune disorders and evaluated OSCC risk in these cohorts.

Methods: Data from TriNetX research network were analyzed in a retrospective cohort of adults ≥18 years. Patients with one of 17 autoimmune diseases were identified via ICD-10 codes and compared to nonautoimmune controls. OLP prevalence and risk were estimated using 1:1 age- and sex-matched propensity score matching. OSCC risk in autoimmune and OLP patients was assessed via ICD-O/ICD-10 codes, and tobacco impact was evaluated.

Results: In 4,480,330 patients with autoimmune disorders, OLP prevalence was 2.04%, ranging from 1.19% in multiple sclerosis to 4.57% in Sjögren's. OLP risk was significantly elevated in 13 conditions (OR = 1.06-2.44; P < .05), nonsignificant for scleroderma, myasthenia gravis, and Hashimoto, and inversely associated with multiple sclerosis (OR = 0.78; P < .0001). OSCC risk was 1.39%, with ORs of 15.93 overall and 23.6 in smokers with autoimmune disorders and OLP (P < .0001).

Conclusions: Autoimmune interactions in OLP are complex, with robust associations in Sjögren's, vasculitis, Addison's, and intriguing multiple sclerosis protection. The markedly elevated risk of OSCC in patients with autoimmune disease and OLP highlights the need for integrated screening protocols and patient education.

Objective: Inherited cancer predisposition syndromes (ICPS) are rare genetic disorders associated with an elevated cancer risk. This study evaluates oral squamous cell carcinoma (OSCC) prevalence across selected ICPS, including Fanconi anemia (FA), Plummer-Vinson syndrome, Cowden syndrome, Li-Fraumeni syndrome, dyskeratosis congenita, and xeroderma pigmentosum, quantifies risk magnitude, examines age at diagnosis, and assesses tobacco's modifying effect on OSCC risk in these populations.

Study design: We conducted a retrospective cohort study using the TriNetX Research Network, including patients with or without ICPS identified by ICD‑10 codes over a 20‑year period. OSCC cases were matched 1:1 by age and sex to controls. The analyses assessed prevalence, odds ratios, age at diagnosis, and the impact of tobacco use. Statistical significance was set at P < .05.

Results: The prevalence of OSCC among ICPS patients ranged from 0.11% to 4.66%, with the highest in patients with FA. Among ICPS, only FA showed a markedly increased OSCC risk (OR = 40.63, P < .01), while Plummer-Vinson syndrome and dyskeratosis congenita were inversely associated. Patients with ICPS developed OSCC at younger ages (P < .0001). Smoking increased OSCC risk within ICPS (OR = 1.47), whereas nonsmokers with ICPS had a reduced risk (OR = 0.78).

Conclusions: FA is strongly associated with OSCC; OSCC also occurs in Li-Fraumeni syndrome and Cowden syndrome. Patients with ICPS present with OSCC at a younger age, supporting targeted screening for high‑risk ICPS populations.

Objective: To investigate the association between self-reported race and ethnicity with oral potentially malignant disorders and oral cancer, considering environmental and genetic influences.

Study design: This was a case-control study including clinical information and DNA samples from 792 subjects from the University of Pittsburgh dental clinics. The cases were 264 subjects diagnosed with oral potential malignant disorders or oral squamous cell carcinoma. Controls were matched by sex and age in a 1:2 ratio. χ² tests detected differences between groups regarding ethnicity, race, and covariates. A Post-hoc test with Bonferroni and Holm corrections accounted for multiple comparisons between groups. A standard χ² residual test was used to investigate which ethnicity category contributed most to the association. Multiple logistic regression models were used to obtain the unadjusted and adjusted odds ratios (ORs) and to detect the association between single-nucleotide variants and outcomes, stratified by ethnicity and race.

Results: The risk of having the outcomes was 78% greater in those patients who self-reported as African American (OR, 1.78; P = .002; 95% confidence interval, 1.225-2.592). Minor allele G (rs9879992-GSK3B) increased the risk for the outcomes in patients who self-reported as African American (OR, 1.85; P = .002; 95% confidence interval, 1.236-2.772).

Conclusions: Self-reported race and ethnicity were associated with oral potential malignant disorder/oral cancer. Future studies using ancestry informative markers can confirm these findings.

Introduction: Matrix metalloproteinase 14 (MMP-14) is crucial in extracellular matrix remodeling and tumor progression. This study evaluated MMP-14 expression in oral squamous cell carcinoma (OSCC) and its correlations with clinical, histopathological, and sociodemographic factors.

Methods: Manual tissue microarrays were constructed from 39 OSCC and 22 healthy mucosa samples from a Colombian cohort (2015-2022). MMP-14 detection was performed via immunohistochemistry using a combined histological score. Nonparametric tests and ROC analysis assessed their prognostic value.

Results: MMP-14 was significantly overexpressed in OSCC relative to healthy mucosa (P < .05), with cytoplasmic and membranous localization. Elevated levels were observed in patients aged ≥50 (P = .05), in cases with perineural invasion (P = .01), and in tongue tumors (P = .03). ROC analysis yielded an area under the curve of 0.90, indicating diagnostic potential.

Conclusions: The findings confirm MMP-14 overexpression in OSCC and its association with perineural invasion, underscoring its role in tumor progression. No significant correlations were found with lymph node metastasis, clinical stage, or histological grade. Limitations include MMP-14's ubiquitous expression, reducing biomarker specificity. Further research incorporating additional molecular markers is warranted to refine prognostic accuracy.

Objective: To summarize contemporary evidence for intra-articular therapies in synovial joint dysfunction-emphasizing temporomandibular joint (TMJ) osteoarthritis-across regenerative (platelet-rich plasma [PRP]/ injectable platelet-rich fibrin [i-PRF], mesenchymal stem cells), lubricating (hyaluronic acid [HA]), anti-inflammatory (corticosteroids), and selected adjunctive/combination approaches.

Study design: An integrative narrative review (2020-2025) was performed of randomized trials, systematic reviews/meta-analyses, and high-quality mechanistic/preclinical studies (PubMed/Scopus/Web of Science/SciELO; English/Portuguese/Spanish). Quality considerations followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidance, Mixed Methods Appraisal Tool, and Cochrane/risk of bias paradigms; TMJ-specific data were prioritized with biologically justified extrapolation from other synovial joints.

Results: Mesenchymal stem cells yield visual analog scale reductions ≈30%-50% and Western Ontario and McMaster Universities Arthritis Index gains ≈20%-40% with reassuring 2-year safety and synergy when paired with HA/PRP. PRP improves symptoms ≈3-6 months but is preparation-sensitive; i-PRF's fibrin matrix sustains bioactive release (7-14 days), shifts synovial cytokines (interleukin [IL]-1β ↓58%, IL-6 ↓63%, IL-17 ↓51%, IL-10 ↑3-5×), and is associated with magnetic resonance imaging chondral preservation and larger clinical effects in TMJ/temporomandibular disorders. HA (especially high-molecular weight or cross-linked, bacterial-derived) consistently reduces pain 25%-45% with outstanding safety. Corticosteroids offer 50%-70% short-term relief but carry dose-dependent chondrotoxicity. Adjuncts (botulinum toxin type A, dextrose, ozone) and combinations (i-PRF+HA/ozone) are promising.

Conclusions: Intra-articular therapy has advanced from palliation to mechanism-driven modulation. i-PRF and mesenchymal stem cells show the strongest disease-modifying signals; HA remains a safe backbone and carrier. Standardized preparation/ reporting and TMJ-focused randomized trials are priority needs. (Oral Surg Oral Med Oral Pathol Oral Radiol 2026;XXX:xxx-xxx).