Aberrant immunoexpression of p53 tumour-suppressor and Bcl-2 family proteins (Bcl-2 and Bax) in ameloblastomas and odontogenic keratocysts.

Background: The growth of ameloblastomas (odontogenic tumours) and odontogenic keratocyst (OKC) (developmental cyst) is associated with the expression of proteins related to cell survival and apoptosis. Bcl-2-associated protein X (Bax) and the tumour suppressor protein p53 collectively promote p53-mediated apoptosis. This study aimed to assess the immunohistochemical expression of p53, Bcl-2 and Bax in conventional ameloblastoma (CA), unicystic ameloblastoma (UA) types, and OKC sporadic (OKC-NS/S) and syndromic (OKC-NBSCC). Material and Methods: Paraffinized blocks of CA (n=18), UA (n=15), OKC-NS/S (n=18) and OKC-NBSCC (n=15) fixed in 10% formalin were used. After diagnosis, tissue specimens were stained by immunohistochemistry for p53, Bcl-2 and Bax marker. Stained cells were randomly counted in five high power fields. The data analysis was performed via Shapiro-Wilk test, ANOVA with Tukey's multiple comparisons or Kruskal-Wallis with Dunn's multiple comparisons. Statistical significance was defined as p<0.05. Results: We did not observe differences between p53 expression in CA, mural UA (MUA), intraluminal/luminal UA (I/LUA), OKC-NS/S, and OKC-NBSCC (19.69%, 18.74%, 16.76%, 12.35% and 9.04%, respectively). Similar results were recognized for Bax expression in CA, MUA, I/LUA, OKC-NS/S, and OKC-NBSCC (33.72%, 34.95%, 22.94, 21.58% and 20.76%, respectively). However, we recognized significant differences between Bcl-2 expression in OKC-NS/S vs MUA, OKC-NS/S vs I/LUA, OKC-NS/S vs CA, OKC-NBSCC vs MUA, OKC-NBSCC vs I/LUA, and I/LUA vs CA. P53, Bcl-2 and Bax levels were higher in mural morphological areas versus intraluminal and luminal morphological areas in UA. Conclusions: There is a tendency for an increased expression of p53, Bcl-2, and Bax proteins in CA, and mural proliferation of UA, compared to lesions with a cystic morphology, which could be associated with a local aggressive behaviour. Key words:p53, Bcl-2, Bax protein, apoptosis, odontogenic tumour, odontogenic cyst.

Moderate and Severe Dental Fluorosis in the Rural Population of Anantapur, India: Change in Their Biological Susceptibility?

Dental fluorosis affects the quality of life. A cross-sectional, observational study was conducted in a community affected by endemic fluorosis for several generations with a conserved biological and social environment. The study included patients from the rural population of Anantapur, India. The Dean index (DI) and the Thylstrup and Fejerskov Index (TFI) were used for fluorosis classification. Additionally, water samples were collected for fluoride analysis, taken from the patients' living areas. The statistical association between the variables was analyzed. In total, 785 patients between 10 and 60 years old were included in the study (58.7% women and 41.3% men). Fluorosis signs were found in 94.6% of patients examined using the DI and 94.4% using the TFI. Moderate-severe dental fluorosis was observed in 62.8% by DI and 73.1% by TFI consuming untreated water with up to 2.9 ppm of fluoride. Furthermore, moderate-severe dental fluorosis was observed in 33.2% by DI and 39.9% by TFI consuming water with ≤1.5 ppm of fluoride. The high prevalence of moderate-severe dental fluorosis in patients consuming water with a low fluoride concentration suggests that other factors are involved. Biological susceptibility change could play an essential role in the severity of dental fluorosis in populations exposed for several generations, affecting its actual and future quality of life.

Compromised Teeth Preserve or Extract: A Review of the Literature.

Multiple systems and associated factors have been described in the literature to assess the prognosis of teeth with periodontal disease. Nowadays there is a tendency among clinicians to consider implants as the best solution after tooth extraction, in cases of teeth with a questionable prognosis. However, the value of the natural tooth must be considered, as the proprioception of the periodontal ligament is preserved, and it adapts to stress during functional loads. We first review the literature focusing on analyzing the factors that should guide decision-making to maintain or extract a tooth with a compromised periodontium. Then, we propose a schematic diagram of prognostic indicators to reflect the main factors to consider and the survival rate that each one represents when preserving or extracting a tooth.

Are probiotics a possible treatment of periodontitis? Probiotics against periodontal disease: a systematic review.

Introduction Periodontal disease is one of the most prevalent oral diseases. Until now, periodontal disease treatments offer good results but periodontal pockets can be immediately recolonised by pathogenic bacteria. The limitations of these treatments have led to the need to find more effective alternatives that reinforce the periodontal treatments.Aim To evaluate the clinical effect of probiotics as an adjuvant treatment to scaling and root planing in patients with periodontitis.Materials and methods An electronic search in Medline (via PubMed) of randomised clinical trials published in the last ten years that include the effects of using probiotics in periodontal disease was performed.Results In total, ten trials were included and in seven of them the evaluated clinical parameters were significantly improved in the test group compared to the placebo group. In five trials, a significant reduction of the main periodontal pathogens was reported. No side effects were observed in any trial.Conclusions The administration of probiotics as an adjuvant treatment to periodontal treatment helps improve the clinical parameters, significantly decreases the concentration of the main periodontal pathogens and does not cause any side effects.

Cyclooxygenase-2 protein expression modulates cell proliferation and apoptosis in solid ameloblastoma and odontogenic keratocyst. An immunohistochemical study.

BACKGROUND: Cyclooxygenase-2 protein is a critically important mediator in inflammation that influences proliferation, apoptosis, angiogenesis and metastasis. Previous works showed a relationship between cyclooxygenase-2 and tumourigenesis in humans and animal models. In epithelial odontogenic tumours and cysts, increased cell proliferation and survival have been linked to its pathogenesis and tumour development. The aim of the present study was to analyse the immunohistochemical expression of cyclooxygenase-2 in solid ameloblastoma and odontogenic keratocyst and its association with proteins related to cell proliferation and apoptosis. METHODS: This study was conducted on 40 cases from the Pathological Anatomy Service, University of Chile. The cases were diagnosed as solid ameloblastoma (n = 21) and odontogenic keratocyst (n = 19) according to WHO 2017. Slides prepared from paraffin-embedded sections were immunohistochemically stained for cyclooxygenase-2, cyclin D1, Ki-67, p63 and Bcl-2. Statistical evaluation was performed by the Shapiro-Wilk test, ANOVA Mann-Whitney test and Spearman's correlation coefficient (p < 0.05). RESULTS: There were significant differences in the immunoexpression of cyclin D1, Ki-67 and Bcl-2 between solid ameloblastoma and odontogenic keratocyst. Likewise, there was a significant difference in the immunoexpression of p63 between follicular and plexiform histological types/subtypes of solid ameloblastoma. Lastly, there were statistical associations between cyclooxygenase-2 and Ki-67 for solid ameloblastoma and between cyclooxygenase-2 and p63 for odontogenic keratocyst. CONCLUSION: A high level of cyclooxygenase-2 is related to increased cell survival and proliferative activity in solid ameloblastoma and odontogenic keratocyst. This event might contribute to tumoural progression and local invasiveness in these lesions.

Effect of probiotics as a complement to non-surgical periodontal therapy in chronic periodontitis: a systematic review

BACKGROUND: To improve the results of the classic periodontal treatment, probiotics have been suggested recently to decrease the number of bacteria and the expression of mediators of inflammation. This systematic review aimed to assess the literature for the effectiveness of different probiotic strains as adjuvants to non-surgical periodontal therapy. MATERIAL AND METHODS: The electronic database of MEDLINE (via Pubmed) was searched up to December 2017 for randomised clinical trials in English comparing non-surgical periodontal treatment and probiotics versus periodontal treatment and placebo. The primary outcome investigated was reduction in pocket probing depth. Secondary outcomes were bleeding on probing, plaque index reduction and bacteria counts. RESULTS: Nine trials were included. A narrative data synthesis did not result in any major improvement of overall pocket probing depth but moderate pockets from 4 to 6 mm showed larger reductions in study groups, which could decrease the need for surgery. Sites with bleeding on probing and presence of plaque decreased after treatment. For periimplant mucositis, there was a small tendency to better results in the study group. CONCLUSIONS: With the available data, it is concluded that probiotics may provide an additional benefit to manual debridement in chronic periodontitis. More studies are required on dose, route of administration and strains of probiotics used

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Human papillomavirus in premalignant oral lesions: No evidence of association in a Spanish cohort.

BACKGROUND: Human papillomavirus (HPV) is the cause of a fraction of head and neck squamous cell carcinoma. Although this relation is well-known, it is still not clear the role of HPV in premalignant oral lesions such as oral lichen planus (OLP) and dysplasia. We aimed to evaluate the HPV-DNA prevalence and type distribution in a set of oral biopsies obtained from patients diagnosed with OLP and dysplasia, as well as the role of HPV in these lesions. METHODS: A retrospective cohort of all premalignant oral lesions consecutively diagnosed from March 30th 1995 to May 21st 2014 at Hospital of Bellvitge and Odontological University Hospital of Bellvitge was identified and classified in four groups: OLP (groups 1 and 2) and dysplasias (groups 3 and 4) that progressed or not to invasive cancer during follow-up. A random selection targeting 25 cases was aimed to be performed for each group. All selected cases were subjected to pathological evaluation, DNA quality control and HPV-DNA detection. HPV-DNA positive samples were further subject to p16INK4a analysis. RESULTS: A total of 83 cases yielded a valid HPV-DNA result. From those, 7 and 34 cases were OLP that progressed or not to invasive cancer during follow-up, whereas 24 and 18 cases were displasias that progressed or not to invasive cancer during follow-up, respectively. HPV-DNA was detected in 4 samples (3 dysplastic lesions and 1 OLP). Two samples were HPV16 positive (2%), 1 sample HPV18 positive (1%) and 1 sample (1%) was HPV indeterminate. Two out of four HPV-DNA positive cases had high p16INK4a expression and none of the HPV positive cases progressed to invasive cancer during long-term follow-up. CONCLUSIONS: We found a low HPV-DNA attributable fraction in premalignant lesions of the oral cavity, suggesting that HPV is unlikely to play a significant role in oral carcinogenesis in our setting.

Halitosis Assessment and Changes in Volatile Sulfur Compounds After Chewing Gum: A Study Performed on Dentistry Students.

OBJECTIVE: The objective of this study is to estimate the prevalence of halitosis (with subjective and objective methods), evaluate the immediate effect of chewing gum on volatile sulfur compounds (VSCs), assess the perception of halitosis by dentistry students, and estimate the distribution of positive and negative frequencies, when comparing objective and subjective methods for the diagnosis of halitosis. METHODS: The study was performed on a sample of dentistry students attending the Faculty of Medicine and Health Sciences at the University of Barcelona. A questionnaire about halitosis perception was provided and a clinical examination, organoleptic test (OT), and gas chromatography were performed to determine the presence of halitosis. The subjects were also given chewing gum to modify their breath, and gas chromatography was carried out to evaluate possible changes in VSCs. RESULTS: The sample comprised 80 individuals. Twenty-seven (33.75%) self-perceived halitosis during the period of evaluation; the OT was positive in 38 subjects (47.5%); and individuals positive for halitosis on gas chromatography were distributed as follows: H2S in 25 (31.25%), CH3SH in 28 (35%), and (CH3)2S in 70 individuals (87.5%). A statistical difference before and after chewing gum (P < .05) was found for each VSC; a difference in frequencies was observed between the variable OT and H2S (P < .05) and between the OT and (CH3)2S (P < .001). There was no significant difference (P > .05) between the positive and negative frequencies retrieved between the variable OT and CH3SH and between the OT and the student's halitosis perception. CONCLUSION: Prevalence of halitosis in the studied sample is high, considering that it comprised healthy individuals. The relationship between the OT and gas chromatography is not completely established. Chewing gum could be considered a therapeutic alternative to decrease or neutralize the amount of VSCs present in oral breath.

Disbiosis como factor determinante de enfermedad oral y sistémica: importancia del microbioma / Dysbiosis as a determinant factor of systemic and oral pathology: importance of microbiome

Los avances en los estudios de genética y epigenética modifican algunos conceptos de salud y enfermedad que se habían mantenido intactos durante décadas. En este sentido, en los últimos años se está otorgando un protagonismo creciente a microorganismos que han acompañado durante millones de años de evolución a los seres vivos superiores. Los genes de estos y de su microbiota constituyen un microbioma que interviene en el mantenimiento de la salud. La boca es lugar de asiento de gran variedad de microorganismos, cuyo control ayuda a estabilizar la enfermedad oral y sistémica. El objetivo del presente artículo es actualizar algunos conceptos relativos al microbioma oral y de su vinculación con la salud oral y general (AU)

Advances in genetic and epigenetic studies modified some concepts of health and disease that had been kept intact for decades. In this respect, in the last few years, microorganisms that have evolved with superior life forms for millions of years have taken an increased prominence. The genes of organisms and their microbiota constitute a microbiome that intervenes in health maintenance. The oral cavity is inhabited by a variety of microorganisms, their control aids in stabilising oral and systemic disease. The objective of this article is to update some concepts related to oral microbiome and its correlation with general and oral health (AU)

Dysbiosis as a determinant factor of systemic and oral pathology: importance of microbiome. / Disbiosis como factor determinante de enfermedad oral y sistémica: importancia del microbioma.

Advances in genetic and epigenetic studies modified some concepts of health and disease that had been kept intact for decades. In this respect, in the last few years, microorganisms that have evolved with superior life forms for millions of years have taken an increased prominence. The genes of organisms and their microbiota constitute a microbiome that intervenes in health maintenance. The oral cavity is inhabited by a variety of microorganisms, their control aids in stabilising oral and systemic disease. The objective of this article is to update some concepts related to oral microbiome and its correlation with general and oral health.

Letter to Editor: Support to the Spanish language, from Oral Medicine

In the form of a letter to the director, the author provides linguistic comments related to Spanish. He draws attention to some often misused words and suggests some expressions that may improve the use of the Spanish language in scientific texts (AU)

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Dental pigmentation and hemochromatosis: A case report.

The causes of dental pigmentation are diverse. It can be classified in intrinsic or extrinsic depending on the origin and location of the stain in the affected tooth. This report presents an unusual case of dental pigmentation and enamel loss where the diagnosis of its origin revealed an underlying systemic pathology, unknown to the patient, which could have affected the development of the pigmentation.

Burning mouth syndrome and associated factors: A case-control retrospective study. / Síndrome de boca ardiente y factores asociados: estudio retrospectivo de casos y controles.

BACKGROUND AND OBJECTIVE: Burning mouth syndrome (BMS) can be defined as burning pain or dysesthesia on the tongue and/or other sites of the oral mucosa without a causative identifiable lesion. The discomfort is usually of daily recurrence, with a higher incidence among people aged 50 to 60 years, affecting mostly the female sex and diminishing their quality of life. The aim of this study was to evaluate the association between several pathogenic factors and burning mouth syndrome. PATIENTS AND METHODS: 736 medical records of patients diagnosed of burning mouth syndrome and 132 medical records for the control group were studied retrospectively. The study time span was from January 1990 to December 2014. The protocol included: sex, age, type of oral discomfort and location, among other factors. RESULTS: Analysis of the association between pathogenic factors and BMS diagnosis revealed that only 3 factors showed a statistically significant association: triggers (P=.003), parafunctional habits (P=.006), and oral hygiene (P=.012). There were neither statistically significant differences in BMS incidence between sex groups (P=.408) nor association of BMS with the pathogenic factors of substance abuse (P=.915), systemic pathology (P=.685), and dietary habits (P=.904). CONCLUSIONS: Parafunctional habits like bruxism and abnormal movements of tongue and lips can explain the BMS main symptomatology. Psychological aspects and systemic factors should be always considered. As a multifactorial disorder, the treatment of BMS should be executed in a holistic way.

Effectiveness of dentist's intervention in smoking cessation: A review.

INTRODUCTION: Smoking is one of the main public health problems in developed countries. Despite extensive evidence on the effects of smoking on both oral and general health, the rate of smoking cessation is not promising. MATERIAL AND METHODS: To review the evidence on knowledge and programs for smoking cessation developed by dentists, a literature review was carried out on programs for smoking cessation from the dentist's perspective, as well as a review of behavioral guidelines that have been recently proposed for these interventions. We used the keywords "Tobacco", "Smoking Prevention", "Public Health" AND "Dentistry", to identify controlled studies, systematic reviews and meta-analyses published between 1999 and 2014, in Google Scholar, SCOPUS and PubMed. RESULTS: Out of 177 studies found, 35 were considered, and these were divided into 2 groups of 20 and 15 articles respectively, according to type of study and inclusion criteria. CONCLUSIONS: There is considerable scientific evidence describing the programs for smoking cessation used in dentistry, which support their effectiveness. Overall, these are brief behavioral interventions complemented by pharmacological treatment, with the participation of the entire dental team. KEY WORDS: Dentistry, nicotine, smoking cessation, tobacco.

Oral leukoplakia treatment with the carbon dioxide laser: A systematic review of the literature.

We conducted a systematic review of the literature to evaluate treatment of oral leukoplakia with the carbon dioxide (CO2) laser. A comprehensive search of studies published between 1981 and 2015 and listed in the PubMed (National Library of Medicine, NCBI) database yielded 378 articles which were screened in detail. Relevant studies were selected according to predetermined inclusion and exclusion criteria. A total of 33 articles met the final inclusion criteria and were analysed in detail in accordance with the PRISMA-P statement. These full-text papers were classified as synopses (n = 7), recurrence and malignant transformation studies (n = 17), comparative studies between CO2 laser and cold knife surgery (n = 3) and studies evaluating the efficacy of CO2, Nd:YAG and KTP lasers. According to the literature the CO2 laser is the workhorse of oral leukoplakia treatment due to its effectiveness and low associated morbidity. However, randomized clinical trials are needed to compare CO2 laser with other lasers. The results of our systematic review showed that there is no consensus regarding the factors involved in higher recurrence and malignization rates, so further studies are needed.

Úlceras orales: diagnóstico diferencial y tratamiento / Oral ulcers: Differential diagnosis and treatment

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The treatment of oral leukoplakia with the CO2 laser: A retrospective study of 65 patients.

The use of CO2 laser has become a routine procedure for the treatment of oral leukoplakia. In this retrospective study, we evaluated 65 patients with oral leukoplakia treated with CO2 laser vaporization. The main location was the tongue (n = 21/65, 32.3%). The initial biopsy showed mild/moderate dysplasia in almost half the patients (n = 29, 44.6%) and hyperplasia without dysplasia in around a third of the patients (n = 21, 32.3%). The recurrence and malignant transformation rates were 33.8% (n = 22) and 15.4% (n = 10), respectively. The follow-up mean (standard deviation) was 15.0 (10.6) months. The procedure-related complications rate was 7.7% (n = 5). The Kaplan-Meier curves for time to recurrence showed differences only for gingiva lesions compared to tongue lesions (log rank, p = 0.032). Malignant leukoplakia transformation is independent of treatment, although it seems advisable to treat leukoplakia with or without dysplasia.

Efecto de masticar chicle sobre la halitosis / Effect of chewing gum on halitosis

Fundamento y objetivo: Este estudio pretende estimar la prevalencia de halitosis oral en una población joven y mostrar el efecto del chicle sobre el aliento. Pacientes y método: Estudio prospectivo de campo descriptivo correlacional, de corte transversal. Se seleccionaron a conveniencia 121 jóvenes, de los que 98 concluyeron el estudio, el cual se realizó en el Hospital Odontológico Universitario-Universidad de Barcelona. El protocolo consistió en: cuestionario, evaluación clínica oral, prueba organoléptica (PO) y medición de compuestos volátiles sulfurados (CVS) con monitor de sulfuros, antes y después de masticar chicle durante 15 min, con 2 investigadores calibrados. Resultados: Un 87,8% tenían higiene oral adecuada, el 17,3% refirieron mal aliento, y un 29,6%, xerostomía. En la PO 44 sujetos tenían un grado 2; la concordancia de examinadores fue del 75%. La determinación de CVS en 53 individuos fue 100 partes por billón (ppb) y en 45 sujetos > 100 ppb. Se obtuvo una reducción de CVS post de 17,34%, con una media de disminución de 1,8-9,0 ppb (p = 0,003). Conclusiones: La prevalencia de halitosis fue del 36,7%. El uso de chicle como adyuvante en casos de halitosis disminuye los CVS, mejorando la percepción de terceros y del propio paciente (AU)

Background and objective: This study aims to estimate the prevalence of oral halitosis in a young population and show the effect of chewing gum on their breath. Patients and method: Prospective, descriptive correlational cross section study. We selected a convenience sample of 121 young individuals and 98 completed the study. It was carried out at the University Dental Hospital-University of Barcelona. The protocol consisted of: questionnaire, oral clinical evaluation, organoleptic tests (OT) and measurement of volatile sulfur compounds (VSC) with sulphide monitoring before and after chewing gum during 15 min, with 2 calibrated investigators. Results: A percentage of 87.8 had adequate oral hygiene, 17.3% reported bad breath and 29.6% had xerostomia. Forty-four subjects had a OT grade 2 ; the agreement of examiners was 75%. The VSC in 53 individuals were 100 parts per billion (ppb) and in 45 subjects, it was > 100 ppb. A post-reduction of VSC of 17.34% was obtained with a mean decrease of 1.8-9.0 ppb (P = .003). Conclusions: The prevalence of halitosis was 36.7%. The use of chewing gum as an adjunct in cases of halitosis decreases the VSC, improving the perception of others and the patient (AU)

Boca seca, mal aliento y síndrome de boca ardiente. Actualización / Dry mouth, breath malodour and burning mouth syndrome. Update

La xerostomía o boca seca como síntoma y la hiposialia como signo, afecta a la calidad de vida de muchos pacientes y no siempre es diagnostica y tratada de manera adecuada. Sabemos que el síndrome de boca seca es muy frecuente en la población adulta. En recientes estudios, se afirma que el 30% de la población mayor de 65 años la sufre, y en nuestro país esta cifra supone más de 1,5 millones de personas afectadas con un crecimiento casi exponencial en las próximas décadas. Puede estar producido, entre otras causas, por enfermedades sistémicas y tratamientos oncológicos, destacando de manera especial el consumo de medicamentos. La disminución de saliva se encuentra íntimamente relacionada con dos cuadros frecuentes en patología oral, la halitosis y el síndrome de boca ardiente. En el presente monográfico que refleja los resultados de un seminario realizado en la universidad de Barcelona con la colaboración de la empresa Biocosmetics, se actualizan, en primer lugar, los aspectos más relevantes de la boca seca y de la boca ardiente. Después se incide de manera detallada en la etiopatogenia y diagnóstico de la boca seca, la patología oral asociada a la xerostomía y finalmente se actualiza su tratamiento. A continuación se revisa el tratamiento del síndrome de boca ardiente. En una tercera etapa se repasa la etiopatogenia de la halitosis haciendo especial hincapié en la importancia de los compuestos sulfurados y de la cubierta lingual y se actualizan los aspectos terapéuticos. Finalmente se presenta por la doctora Margarita Martín un trabajo que nos repasa de manera específica la xerostomía postradioterapia y nos presenta los resultados de un ensayo clínico en pacientes irradiados que tiene como base el tratamiento con un producto a base aceite de oliva, betaína y xilitol (AU)

Xerostomia or dry mouth as a symptom and hyposalivation as a sign affects the quality of life of many patients and it is not always diagnosed and treated adequately. We know that the dry mouth syndrome is very frequent in the adult population. in recent studies it has been shown that 30% of the population over 65 years suffers from it, and in our country this figure represents more than 1.5 million affected people, with an almost exponential growth in the coming decades. It can be produced, among other causes, due to systemic diseases and cancer treatments, emphasizing especially on the consumption of medicines. The decrease in saliva is found closely related to two common forms in oral pathology, halitosis and the burning mouth syndrome. In the present monographic which reflects the results of a seminar held at the university of Barcelona in collaboration with the company Biocosmetics, the most relevant aspects of dry mouth and burning mouth were updated first of all. Afterwards, a detailed account of the etiopathogenesis and diagnosis of dry mouth, oral pathology associated with xerostomia and finally its treatment, were updated. In continuation, the treatment of the burning mouth syndrome was reviewed. In a third stage, the etiopathogenesis of halitosis with particular emphasis on the importance of sulphur compounds and of the lingual cover were reviewed and the therapeutic aspects were updated. Finally Dr. Margarita Martín presented her work specifically reviewing xerostomia post-radiotherapy and presented the results of a clinical trial in irradiated patients which is based on treatment with a product containing olive oil, betaine and xylitol (AU)