Could salivary biomarkers be useful in the early detection of oral cancer and oral potentially malignant disorders, and is there a relationship between these biomarkers and risk factors?

Data sources Four electronic databases were searched: Medline (OVID), Web of Science, Embase and Scopus. An initial search was carried out in May 2018, and this was updated in September 2020. There was no time restriction on the studies included, and the final data consisted of studies published from 2004-2020.Study selection The electronic database search yielded 2,764 abstracts, and following de-duplication, 1,873 articles were screened in accordance with the exclusion criteria. In total, 346 articles were selected for full-text screening by four pairs of blinded reviewers and 295 articles were included in the final study. The main objectives of this study were to investigate a suitable biomarker for early detection of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs), and to assess the relationships between salivary biomarkers and risk factors for OSCC and OPMD. The Newcastle-Ottawa Scale was used for quality assessment. Most studies were considered to have a moderate risk of bias. The publications included fulfilled the following criteria: original research, human subjects with oral cavity cancer, OSCC or OPMD, aged 18 years or over, studies analysing biomarkers in saliva or salivary rinse, and studies published in English.Data extraction and synthesis Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline process. The following data parameters were included in the studies chosen for assessment: study design, first author, year of publication, country of study population, age, sample size, gender, salivary biomarkers, method used to analyse the biomarkers, relationships between risk factors and salivary biomarkers, and conclusions.Results Following evaluation of 295 articles and selection of suitable salivary biomarkers, 28 articles were chosen to further assess interleukins as potential biomarkers and 33 studies were found to report a relationship between salivary biomarkers and risk factors. From the data reported, IL1ß, IL6 and IL8 were identified as being statistically significant and most suitable for early identification of OSCC and OPMDs. In smokers, there were significant differences found in certain biomarkers compared to controls. There were statistically non-significant relationships found between biomarkers and alcohol, as well as other risk factors.Conclusion The authors proposed that a proteomic salivary biomarker panel, including a combination of IL1ß, IL6 and IL8, would be suitable for clinical validation for the early detection and screening of OPMDs and OSCC. They have also highlighted the presence of research gaps in the relationship between salivary biomarkers and risk factors for OPMDs and OSCC, and the need for further research to understand the role of biomarkers in disease initiation and progression.

Evaluation of the information provided by UK dental practice websites regarding complications of dental implants.

Introduction Dental implants are a popular option for replacing missing teeth. When searching for information regarding dental implants, patients may first look to their dental practice website. The aim of this study was to assess the variance of patient information provided regarding implant complications on dental implant practice websites.Materials and methods Inclusion criteria for this study were dental practices within the Greater Glasgow & Clyde health board and practices with an active website. Completeness was assessed using a six-point score based on the British Association of Oral Surgeons 'Information for patients' leaflet and Association of Dental Implantology 'Considering dental implants? - A patient's guide to dental implant treatment' leaflet.Results In total, 90.7% (n = 107) of practices provided accessible implant information on their websites. However, only 37.3% (n = 44) mentioned one or more specified dental implant complications. Pain/discomfort was the most frequently stated complication (n = 41/118); implant failure was only mentioned by 19 practices (16%). The mean number of complications mentioned by the 118 practices offering dental implants was 1.1.Discussion As implant dentistry grows, there may be concerns over patient expectations. To overcome lack of quality assurance on the internet, dentists can provide factual information on their websites. They should be aware of their duty to provide material that is accurate, honest, informative and not potentially misleading.

Could dentists be the first to diagnose COVID-19 due to oral manifestations?

Data sources A search of electronic databases (PubMed and Google Scholar) was carried out, with publication being set from 2019 to October 2020.Study selection Titles and abstracts from the original search were reviewed by two reviewers independently. Overall, 17 studies were included in the final analysis.Data extraction and synthesis Data extraction was conducted independently by two reviewers. Studies that were chosen were examined and the following data parameters were included: age and gender, COVID-19 polymerase chain reaction (PCR) test, COVID-19 manifestations, treatment for COVID-19, cutaneous lesions, oral manifestations, days after COVID-19 diagnosis, treat/healing or oral symptoms.Results Seventeen studies were included; 14 articles were case reports, two case series and one systematic review. The results showed that dry mouth, dysgeusia, oral ulcerations and opportunistic infections were among the most common oral manifestations expressed in COVID-19-positive patients.Conclusion The authors recommended carrying out careful clinical intraoral examinations on both COVID-19-positive patients or any patients requiring dental care, as oral symptoms can still be the only or initial symptom of COVID-19.

Could certain mouthwashes reduce transmissibility of COVID-19?

Data sources Six electronic databases were searched including PubMed/Medline, Embase, Web of Science, Scopus, Cochrane, and Latin American and Caribbean Literature in Health Science (LILACS). Grey literature was also examined. There were no restrictions with regards to language, time of publication or participant demographics including gender, age and ethnicity.Study selection Both clinical and in vitro studies were included in the data search. Inclusion and exclusion criteria were clearly identified. Study selection was carried out in two phases by two independent reviewers. The studies included fitted the following criteria: studies that hypothesised the use of mouthwashes as a form of intervention to decrease the viral load in saliva contaminated with coronavirus. Two other studies were included in this review and both were conducted in Germany, performed in vitro, which tested povidone-iodine (PVP-I) mouthwash at two different concentrations: 1% and 7%. Both studies used the same culture mediums for clean and dirty conditions, and the evaluated outcome was the viral titre of MERS-CoV and SARS-CoV. The studies were published in 2015 and 2018. Neither study evaluated the action of this mouthwash on SARS-CoV-2 infection.Data extraction and synthesis The extraction of data followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline process. Studies chosen for analysis included assessment of the following data parameters for risk of bias: cell origin and cell type used, duration of exposure, frequency of exposure, magnetic flux density of exposure, environmental background magnetic field, use of control treatment, temperature control, blinding of exposure, randomisation of exposure, measurement of cell vitality, identical methods for control and exposure groups, randomisation of data measurements and potential industry sponsorship.Results One study assessed the effect of the mouthwash on MERS-CoV and the other on both MERS-CoV and SARS-CoV. In both studies, following 15 seconds of exposure to the mouthwash, a reduction in viral load of >99.99% was seen. There was a measurable reduction in viral titre in the samples, with one study reporting a reduction to 4.30 log10 TCID50/ml from 6.00-6.50 log10 TCID50/ml. Other mouthwashes such as hydrogen peroxide and chlorhexidine were not assessed in these studies.Conclusions The study concludes that PVP-I mouthwash at concentrations of 1% and 7% for 15 seconds may be effective at reducing the viral load of COVID-19 in human saliva. The level of scientific evidence, however, is low.