COVID-19 and Oral Mucosal Lesions: a Systematic Review.

Introduction: COVID-19 disease is caused by a mutated strain of the coronavirus family "SARS-CoV-2". It affects especially the respiratory system, but many clinical manifestations outside this system have been reported. Oral manifestations are uncommon, however, with the absence of common signs, they may represent the onset of COVID-19 disease. The aim of this systematic review is to observe if there is a correlation between SARS-CoV-2 infection and oral manifestations. Methods: The research was conducted on PubMed, Scopus, Google Scholars and Cochrane Library from March 2020 to May 2023. Each study was subjected to data extraction; including authors, year and month of publication, study type, patients' average age, type and localization of oral lesions, the positivity of the SARS-CoV-2 virus test, and comorbidities. Results: A total of 43 studies met the inclusion criteria and a total of 507 COVID-19 patients with 496 oral lesions were included. The most frequent was ulceration and the most common localization was the tongue. Conclusions: The results of our systematic review show a possible correlation between COVID-19 infection and oral manifestations. Further studies are required to determine if the lesions are directly connected to the virus.

The effects of low level laser irradiation on proliferation of human dental pulp: a narrative review.

Mesenchymal stem cells (MSCs) have the capability for self-renewal, proliferation, and differentiation in various types of specialized cells, so they are very important in cellular therapies. MSC from dental pulp are simply obtainable and have high proliferative capability. Among the therapies that can stimulate the proliferation of certain cell types, low-level laser therapy (LLLT) stands out. The target of this study is to perform a literature review to investigate these effects of low-level laser irradiation on proliferation of human dental pulp.The electronic search of scientific papers was conducted in the Lilacs, Scielo, Medline and PubMed databases through scientific articles published in national and international journals in the past 20 years.The results of this review suggest that LLLT may be a useful and important tool for future advances in cell therapy and tissue engineering associated to stem cells. Studies on cell therapy for regenerating dental tissues has already been done, and shows promising results.

Er:YAG laser for brackets bonding: a SEM study after debonding.

BACKGROUND: The introduction of Er:YAG laser in dentistry for ablation of hard tissues advocated an alternative method of enamel etching for orthodontics purpose. MATERIALS AND METHODS: 55 extracted human third molars were inserted in acrylic resin blocks and divided into five groups of 11 teeth. Group 1 was treated with 37% orthophosphoric acid for 30 seconds. Group 2 was treated with laser irradiation (Er:YAG Fidelius III, Fotona, Slovenia) at 80 mJ and 4 Hz. Group 3 underwent laser treatment (80 mJ, 4 Hz), followed by 37% orthophosphoric acid for 30 seconds. The teeth in Group 4 were treated with laser at 40 mJ and 10 Hz. The teeth in Group 5 were treated with laser (40 mJ, 10 Hz), followed by 37% orthophosphoric acid for 30 seconds. The adhesive remnant index was determined after debonding. RESULTS: Kruskas-Wallis test showed that location parameters (median and mean) are significantly different between Groups 2 and 4 when compared with control group; on the contrary no significant difference was detected between Groups 3 and 5 with the controls. CONCLUSION: The use of Er:YAG laser alone, as in Groups 2 and 4, showed no significant advantages over phosphoric acid in the bonding procedure for orthodontics brackets.

Shaping outcomes using two Ni-Ti rotary instruments in simulated canals.

AIM: The aim of this study was to compare the shaping ability of Mtwo and ProTaper instruments in simulated curved root canals in resin blocks. METHODS: The study was carried out using 40 simulated canals in resin blocks, all of which had the same canal diameter (0.70 mm>D>0.20 mm), length (16 mm), and angle of curvature (40 degrees). These 40 canals were divided into 2 groups of 20 specimens. Both before and after instrumentation, all the resin specimens were photographed, and all the canals examined were measured at 4 different points of reference. Using a computer image analysis program, the photographs of corresponding sections were superimposed on one another. In this way we sought to evaluate the shaping ability of these 2 systems in relation to specific portions of the root canal, also with regard to maintenance of original canal curvature. The results were analysed using Student's t-test. RESULTS: Both rotary systems were found to respect the original root canal curvature, particularly in the areas most at risk of modification, namely the outer aspect of the curve in the apical third of the canal. The Mtwo instruments caused less transportation of the apex than the ProTaper instruments, but this difference was not statistically significant (P>0.05). CONCLUSION: According to the results of this study, both these instruments respected the original canal curvature, particularly in the areas at most risk of modification, and they also showed good shaping ability in curved canals, with minimum transportation of the apex.

Endodontic treatment of a fused tooth. Report of a case.

Dental fusion, a rare developmental anomaly present in 0.2% of the general population, consists of the union of two teeth originating from two different tooth germs. The irregular coronal morphology and the complex endodontic anatomy, characterized by the partial or total union of the pulp chambers, together with the peculiarity of the root canal systems, make diagnosis, therapy and rehabilitation difficult. The authors describe the endodontic treatment of a permanent lower second molar fused with a third molar and having four root canals.

Bond strength to deep coronal dentin: effect of bonding strategies.

AIM: The aim of this study was to evaluate bond strength at the composite-adhesive-deep dentin interface following pre-treatment with sodium hypochlorite using 4 different types of enamel-dentin adhesive and a composite for the core. METHODS: From 60 healthy human molars, cylindrical samples (3 mm high) were obtained using a special slow-speed saw. Cavities with 2-5-mm diameters were made in all the samples. Samples were assigned to 8 groups, 4 groups were designated as experimental groups and were irrigated with NaOCl and the other 4 groups designated as control groups were irrigated with distilled water. Adhesive systems were applied to the samples and then restored using a core build-up composite. Samples were subjected to shear stress test using an electronic dynamometer. RESULTS: The data were analyzed using one-way ANOVA and the Tukey test (P<0.05). The results, in terms of bond strength, demonstrate that the two-step self-etch adhesive systems generate a stronger bond than the other systems considered in the study (P<0.05). The results also show that pre-treatment with hypochlorite does not seem to influence the bond strength of self-etch adhesive systems. CONCLUSIONS: This in vitro study demonstrates that there exist differences in bond strength between self-etch and etch & rinse adhesive systems on deep dentin pretreated with sodium hypochlorite to simulate endodontic treatment.

[Treatment of curved canals: from stainless steel to nickel titanium]. / Trattamento dei canali curvi: dall'acciaio inossidabile al nichel-titanio.

Endodontic treatment of curved canals is always more difficult than straight canals, especially for the apical zone preparation: root canals may present several curvatures in different space directions. From an anatomical point of view root canals with accentuated curvatures are a very frequent event (more than we might think); radiological exams, in fact, give us only a 2D image, and we can observe mesial or distal curvatures but not those in the oral or buccal direction. However, all root canals have curvatures of some degrees; even those that appear straight. Because of this, endodontitis have made many attempts to overcome these problems and manage to have a good preparation in curve canal. The authors analyse all endodontic techniques (step back, step down, crown down, balanced forces) codified in the course of the years, to prepare curved canals; they both in shape or in materials. It's fundamental for the endodontist to have a specific technique to treat curved canals to allow a good, wide preparation; in this way it's possible to make a better and tridimensional filling of the endodontic space above all in the tipical zone.

[Dental management of patients with cardiovascular disease]. / Trattamento odontoiatrico nei pazienti a rischio cardiovascolare.

Authors present the management of patients affected by cardiovascular disease undergoing oral surgical treatment. Oral surgery may influence the health of these patients because of three factors: psychological stress, anesthesia and daily pharmacological therapy. Dentists have to know and apply preventive rules to avoid the risks of medical complications during surgical treatment, they also have to be able to manage cardiological emergencies wherever they occur.

[Posterior vertical dimension and condylo-discal non-coordination of the temporomandibular joint. Hypothesis on correlation]. / Dimensione verticale posteriore e incoordinazione condilo-discale dell'ATM. Ipotesi di correlazione.

BACKGROUND: On the basis of clinical evidence, an analytic study has been carried out to verify the hypothetic correlation between reduction of the posterior vertical overlap and internal derangements. METHODS: 58 patients with temporomandibular disorders have been observed; they presented clinically a reduction of the posterior vertical dimension (RPVD) due either to the loss of molar teeth or to the molar occlusal surface abrasion or to a wrong prosthetic rehabilitation. A cephalometric exam showed a significative correspondence between the RPVD and the retruded condylar position in the glenoidae fossa with a reduction of posterior joint space in comparison with the standard values purposed by Farrar. RESULTS: The results obtained showed a possible relation between occlusal alterations and the TMJ pathology. CONCLUSIONS: The conclusion is drawn that the clinical evaluation brings to consider occlusal factors, and in particular the reduction of posterior vertical dimension may be considered as possible etiologic factors of TMJ disorders.

Short-term effect of exercise on platelet factor 4 in normal subjects and in patients with coronary artery disease.

BACKGROUND: The aim of this study was to evaluate the plasma concentration of a platelet-derived protein, platelet factor 4 (PF4), before and after exercise in coronary artery disease. METHODS: We enrolled 60 patients with documented ischemic heart disease. The subjects were divided into two groups: Group 1 patients with previous myocardial infarction (n = 20, 13 males, 7 females, mean age 51.6 +/- 7.5 years, range 38-62 years); Group 2 patients with exercise-induced angina (n = 40, 22 males, 18 females, mean age 52.6 +/- 8.0 years, range 38-65 years). Patients with hypertension, hyperlipidemia and diabetes were excluded. Patients with angina or ST segment depression during the stress test were included in a subgroup (n = 33, 21 males, 12 females, mean age 50.3 +/- 6.3 years, range 40-65 years). Twenty healthy subjects without coronary risk factors (13 males, 7 females, mean age 53.2 +/- 7.1 years, range 38-65 years) served as controls. PF4 was measured in all patients at baseline and 5 min after a bicycle exercise test. Plasma PF4 levels were measured performed by radioimmunoassay (ng/ml, normal range 0-10). RESULTS: Patients with ischemic heart disease showed a high basal concentration of PF4 compared with controls. PF4 levels at baseline vs after stress test were 4.1 +/- 2.5 vs 5.3 +/- 2.6 ng/ml in healthy subjects; 33.4 +/- 15.8 vs 56.2 +/- 28.2 ng/ml (p < 0.001) in Group 1; 22.4 +/- 15.8 vs 44.6 +/- 28.4 ng/ml (p < 0.001) in Group 2; 29.9 +/- 15.5 vs 67.7 +/- 26.1 ng/ml in the subgroup with angina or ST segment depression (p < 0.001), and 23.1 +/- 16.5 vs 26.0 +/- 18.1 ng/ml in those without angina or ST segment depression (NS). CONCLUSIONS: These findings support the hypothesis that a significant increase in PF4 levels after exercise is associated with clinically significant coronary artery disease.

Effects of angiotensin-converting enzyme inhibition on left ventricular geometric patterns in patients with essential hypertension.

Although angiotensin-converting enzyme inhibitors have been shown to affect left ventricular (LV) remodeling favorably in several conditions, it remains unclear whether they can influence LV geometric pattern in hypertension. To address this issue, 122 patients (71 men and 51 women; mean age = 51 +/- 10 years) with mild to moderate hypertension were studied prospectively. All underwent clinical evaluation and Doppler echocardiography at entry and more than 2 years of quinapril therapy (10-40 mg/day). According to either LV mass (normal if < 131 g/m2 for men or < 100 g/m2 for women) or the ratio of LV posterior wall thickness to diastolic diameter (RWT; normal if < 0.45) at baseline, 58 patients had normal mass and RWT, 18 patients had concentric remodelling (i.e., normal mass but increased RWT), 24 patients had eccentric hypertrophy (i.e., increased mass but normal RWT), and 22 patients had concentric hypertrophy (i.e., increase in both mass and RWT). After 6 months of quinapril therapy, all patients with normal left ventricles showed the maintenance of mass and RWT within normal limits. Patients with concentric remodeling showed no increase in mass but had a significant decrease in RWT. Patients with eccentric hypertrophy exhibited a significant reduction in mass with no substantial change in RWT. Patients with concentric hypertrophy had a significant reduction in both mass and RWT. Changes in LV mass and geometry were maintained during the 2-year period of treatment and were paralleled by improvements in Doppler indices of LV diastolic function in each group. It is concluded that quinapril, with its well-known effects on LV hypertrophy, modifies the LV geometric pattern of hypertensive patients favorably, regardless of the presence of an abnormal LV mass or RWT.

Frequency of development of acute global left ventricular dysfunction in human immunodeficiency virus infection.

OBJECTIVES: This study evaluated prospectively the frequency, clinical outcome and pathologic findings of acute global left ventricular dysfunction in human immunodeficiency virus (HIV) infection during the various stages of the disease. BACKGROUND: Acute global left ventricular dysfunction in the course of HIV infection is still a poorly defined clinical entity, and little is known about the outcome after the acute onset. METHODS: Between January 1988 and June 1992, 136 HIV-positive (HIV+) patients without clinical, electrocardiographic or echocardiographic evidence of cardiovascular dysfunction on admission were prospectively studied with serial echocardiograms. Patients were assigned to three groups: 1) anti-HIV+ asymptomatic (17 patients, 12.5%); 2) acquired immunodeficiency syndrome (AIDS)-related complex (26 patients, 19.1%); 3) AIDS (93 patients, 68.4%). RESULTS: During a mean follow-up period of 415 +/- 220 days, seven patients, all in the AIDS subgroup, developed clinical and echocardiographic findings of acute global left ventricular dysfunction; of these, six (85%) died of congestive heart failure. Mean survival time from symptom onset was 41 +/- 13 days. Necropsy findings in five patients revealed acute lymphocytic myocarditis in three, cryptococcal myocarditis in one and interstitial edema and fibrosis in one. In only one patient was left ventricular dysfunction reversible with treatment. CONCLUSIONS: Although infrequent, acute global left ventricular dysfunction is not rare in the course of HIV infection. It seems to occur exclusively during the AIDS stage. Acute global left ventricular dysfunction is often fatal but may be reversible and is mainly associated with the pathologic findings of acute myocarditis.

[Transesophageal echocardiography in patients with ischemic stroke with and without clinical evidence of heart disease]. / L'ecocardiografia transesofagea nei pazienti con ictus ischemico con e senza evidenza clinica di cardiopatia.

Transesophageal echocardiography (TEE) is useful in the assessment of potential cardiac sources of emboli in patients with ischemic stroke and clinical history of heart disease. Aim of our study was to assess the utility of TEE in stroke patients with and without clinical evidence of cardiac disease. In addition, we evaluated if multiplane TEE, versus mono and biplane TEE, provides additional information about potential cardiac sources of emboli. A total of 89 ischemic stroke patients were studied: 30 patients with a history and clinical evidence of cardiac disease (Group A) and 59 patients without evidence of cardiac disease (Group B). All patients had a documented ischemic lesion of the brain. Patients who had an extracardiac potential source of emboli were excluded from the study. In all patients, transthoracic (TTE) and biplane TEE were performed, whereas omniplane TEE was performed in 40 patients only. In Group A, sources of emboli were disclosed by TTE in 33% of the patients. When TEE was performed the percentage of positive cases raised to 83% (p < 0.001). In Group B, TTE was positive in only 10% of the patients as opposed to 43% with TEE (p < 0.001). Omniplane TEE revealed a potential source of emboli in 23 out of 40 (57%) patients versus 16/40 (40%) and 20/40 (50%) with monoplane and biplane, respectively. TEE is useful in patients with cardiovascular disease in whom clinical evaluation and TTE are negative for sources of emboli. TEE is of great value in stroke patients without clinical evidence of cardiovascular disease in whom an extracardiac potential source of emboli has been excluded.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart involvement in AIDS: a prospective study during various stages of the disease.

The goal of our study was to evaluate the incidence of heart involvement in AIDS patients during various stages of the disease. Between January 1988 to September 1991, we conducted a prospective study in 114 anti-HIV positive patients. The patients, whose mean age (+/- SD) was 34.6 +/- 5.4 years (range 20 to 54), were divided into three groups: anti-HIV positive asymptomatic (n = 31; 27%), AIDS related complex (ARC) group IV-A (n = 11; 10%), and AIDS subgroups IV-C1 (n = 62; 54%) and IV-D (n = 10; 9%). Overall, 84 patients (74%) were i.v. drug abusers, 24 (21%) were homosexuals, and six (5%) were partners at risk. Zidovudine (AZT) was administered to 94 patients (82%). Opportunistic infections and/or secondary malignancies were detected in 72 patients (63%). Electrocardiographic changes were of little clinical relevance. Of 72 AIDS patients, 47 (65.2%) presented a cardiac involvement: 12 subjects (16.6%) were affected by a dilated cardiomyopathy, 13 (18%) by pericardial effusion, three (4.1%) by mitral valve prolapse, four (5.5%) by myocarditis, five (6.9%) by valvular bacterial endocarditis, and 10 (13.8%) by alterations of left ventricle regional contractility. During a mean follow-up period of 44 months, 29 AIDS patients (40.2%) died. Death was attributed to a cardiac event in four patients; autopsy could be performed in 24 of the 29 patients who died. Our results demonstrate that heart involvement is present in 45.6% of HIV-infected patients, but only in the end-stage of the disease (AIDS) and it is presumably due to opportunistic infections and/or secondary malignancies.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of noninvasive diagnosis in cardiac echinococcosis: pulmonary embolization from right atrial localization]. / Ruolo della diagnostica non invasiva nella echinococcosi cardiaca: embolizzazione polmonare da localizzazione atriale destra.

We report the case of a young woman died of pulmonary embolism from a hydatid cyst of the right atrium. Cardiac involvement in hydatid disease is rare, particularly when it is intracavitary and not intramyocardial. The role of invasive and noninvasive techniques, such as echocardiography, computed tomography and nuclear magnetic resonance, is discussed.

[Noninvasive evaluation of left ventricular function in alcoholics before and after suspension of ethanol abuse]. / Valutazione non invasiva della funzione ventricolare sinistra in etilisti, prima e dopo sospensione dell'abuso di etanolo.

It is known that chronic alcoholism causes morphological changes of the myocardium before the development of a specific dilated cardiomyopathy. We studied a group of chronic alcoholics, with normal arterial pressure and without clinical evidence of liver cirrhosis, to evaluate left ventricular function, both before and after withdrawal of ethanol. A M-B mode echo recording of the left ventricle and left ventricular inflow Doppler velocimetry with carotid pulse tracing was performed in each patient within 24 hours of the last alcohol consumption and after a period of abstinence at least 3 weeks. We analysed parameters of left ventricular systolic and diastolic functions, in comparison with a group of normal subjects well matched for age, body surface area and heart rate. The results showed that, in the group of alcoholics, a cardiac hypertrophy exists with increased left ventricular mass and normal parameters of left systolic ventricular function, but with altered ratio PEP/LVET. This last result is the consequence of an abnormal left diastolic ventricular function, as demonstrated from the analysis of the Doppler indexes of left ventricular filling (lower ratio E/A). Left ventricular inflow Doppler velocimetry showed different results in alcoholics and control subjects in the early diastolic flow velocity peak (61 +/- 12 vs 84 +/- 8) and in the peak flow velocity in the atrial contraction phase (62 +/- 10 vs 40 +/- 5.6). We have not observed any change of the echocardiographic parameters after the short period of alcohol withdrawal. We advance the hypothesis that there is an altered diastolic function depending, not only on the hypertrophy of the myocardium, but also on the myocardial interstitial involvement caused by ethanol.(ABSTRACT TRUNCATED AT 250 WORDS)

Early experience with Telehealth during sport activities.

In order to verify the usefulness of a system designed to provide participants of sport competitions with a cardiological emergency service, the authors utilized a cardiotelephone apparatus during a "24-hour Marathon race" in which 1008 subjects took part. In 18 cases, an ECG was transmitted owing to various symptoms after exertion. One case of pseudoischaemia and one of complete A-V block were registered. The authors emphasize the importance of a telephone ECG transmission system as a special aid able to cut down the intervention time without moving the patients.