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.

Evaluation of dental demands and needs of people experiencing homelessness in the city of Rome, Italy.

OBJECTIVE: Poor oral health and oral diseases are common among people experiencing homelessness. The aim of this study was to evaluate the dental demands and needs of a population of homeless persons in the city of Rome, Italy. PATIENTS AND METHODS: The clinical records of 165 homeless patients admitted between October 2020 and October 2021 to the dental service of the Primary Care Services of the Eleemosynaria Apostolica, Vatican City, were retrospectively reviewed. The service employed dentists to evaluate dental needs and oral conditions in patients experiencing homelessness. The main dental and oral pathological conditions were noted. RESULTS: One hundred and sixty-five records of homeless patients were included in the study. The sample consisted in 138 males (76.97%) and 27 females (23.03%) with a mean age of 46.9 years (range 7-85 years). Acute tooth pain was reported by 132 (80%) patients, 42 (25.45%) had edentulism or missing teeth and 18 (10.91%) patients had oral lesions. Both dental and oral pathologies were intercepted and managed in secondary healthcare facilities. CONCLUSIONS: Given the specific peculiarities of this vulnerable population, it is important to implement strategies that facilitate the access of persons experiencing homelessness to dental evaluation with a preventive and curative perspective.

Effects of laser photobiomodulation in the management of oral lichen planus: a literature review.

Objectives: This review aims to understand whether Photobio-modulation (PBM) therapy is a valid aid in the management of Oral Lichen Planus (OLP) and its symptoms. Moreover, an analysis to determine whether it is a valid replacement for conventional therapies and whether standardized protocols can be used in PBM sessions or whether these should be changed depending on the type of injury has been made. Finally, an evaluation to determine whether PBM may induce transformation of dysplastic oral keratinocytes into squamous cell carcinoma has been made. Materials and Methods: Searches were conducted on two search databases for relevant publications released between 1992 and 2019. The databases used were: Pubmed "Medline", and Google Scholar. Forty-four articles complied with the inclusion criteria and were included for quality assessment and data extraction. Results: All the studies reported positive effects of PBM; how-ever, there was wide heterogeneity in the laser parameters used in the management of the OLP. The effective dose ranges from 2 to 3 J/cm2, in order to see the desired biological effects. Conclusions: PBM is useful in controlling algal sensation and can be used in cases of OLP lesions that are not responsive to conventional therapies or when corticosteroid doses are too high for the patient, resulting in possible side effects. Standardized biostimulation protocols with further scientific insights are therefore required.

CO2 laser ablation of oral leukoplakia: with or without extension of margins?

PURPOSE: The purpose is to determine the sufficient extension of margins during laser ablation of oral leukoplakia and observe its short-term recurrence rate. MATERIALS AND METHODS: The study was designed as a randomized controlled clinical trial was conducted on 33 oral leukoplakia lesions diagnosed in 30 patients (16 Females and 14 Males) with an age range between 39 and 79 years. The lesions were divided into three groups; Group A: 11 lesions in 11 patients, in which the laser ablation was done for the entire lesion without extension of margins; Group B: 11 lesions in 8 patients, in which the laser ablation was done for the lesion adding at least 3mm extension of margins; and finally the Group Control: consists of 11 untreated lesions in 11 patients, in which only "wait and see" approach was done. RESULTS: Complete healing of 13 lesions occurred in both groups A and B. Complete regression of 3 lesions occurred in Group Control. After 6 months of follow-up, 6 of 9 lesions in both groups A and B that showed the recurrence, had shown an initial recurrence after 3 weeks of the laser ablation. Patients with no history of smoking habits showed complete healing of 87.5%, while in ex-smokers complete healing was 42.8%. The statistical analysis was performed, and the averages of all groups are significantly different (p <0.00001). DISCUSSION: The primary treatment focuses on the elimination of associated risk factors (smoking, alcohol, and local irritating factors). In the literature, the recurrence rate varies between 13.6% and 40.7%, while in our study, it was 45.5% in Group A and 36.4% in Group B. CONCLUSION: The recommended extension of margins should be at least 3mm in width. Further research can be performed to evaluate the immediate re-ablation of the lesions which showed an initial recurrence after 3 weeks of laser ablation.

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.

Frequent detection of high human papillomavirus DNA loads in oral potentially malignant disorders.

Human papillomavirus (HPV) is estimated to be the cause of 40--80% of the squamous cell carcinoma of the oropharynx but only of a small fraction of the oral cavity cancers. The prevalence of oral HPV infection has significantly increased in the last decade, raising concerns about the role of HPV in progression of oral potentially malignant disorders (OPMD) toward squamous cell carcinomas. We sought to study HPV infection in patients with oral lesions, and in control individuals, using non-invasive and site-specific oral brushing and sensitive molecular methods. HPV DNA positivity and viral loads were evaluated in relation to patient data and clinical diagnosis. We enrolled 116 individuals attending Dental Clinics: 62 patients with benign oral lesions (e.g. fibromas, papillomatosis, ulcers) or OPMD (e.g. lichen, leukoplakia) and 54 controls. Oral cells were collected with Cytobrush and HPV-DNA was detected with quantitative real-time PCR for the more common high-risk (HR) and low-risk (LR) genotypes. HPV detection rate, percentage of HR HPVs and HPV-DNA loads (namely HPV16 and in particular, HPV18) were significantly higher in patients than in controls. Lichen planus cases had the highest HPV-positive rate (75.0%), hairy leukoplakia the lowest (33.3%). This study detected unexpectedly high rates of HPV infection in cells of the oral mucosa. The elevated HR HPV loads found in OPMD suggest the effectiveness of quantitative PCR in testing oral lesions. Prospective studies are needed to establish whether elevated viral loads represent a clinically useful marker of the risk of malignant progression.

Cleidocranial dysplasia: maxillary alterations on the transverse plane. Presence of crown-radicular anomalies and multidisciplinary approach of a clinical case.

INTRODUCTION: Cleidocranial Dysplasia (CCD) is a rare inherited autosomal dominant congenital syndrome that occurs in approximately one out of every one million individuals worldwide; it primarily affects bones that undergo intra-membranous ossification, generally the skull and clavicles. Other bones may be affected such as the long bones, spine, pelvis, bones of hands and feet showing hypoplasia of distal phalanges. Indispensable is the role of the gene Runx2, necessary for the differentiation of odontoblasts and osteoblasts; it regulates the expression of many genes related to the development of dental hard tissues. The aim of this study was to appraise the connection between the Cleidocranial Dysplasia and the appearance of skeletal and dental anomalies not much deepen to this day. With particular emphasis, it wants to describe the multidisciplinary therapeutic approach. CASE REPORT: The patient showed multiple skeletal features of CCD. A distinctive feature was the failed or delayed exfoliation of deciduous dentition and a delayed eruption of permanent teeth. The goal of the treatment is the improvement of both aesthetic and functional aspects. This objective can be achieved through an appropriate multidisciplinary treatment plan that arranges the orthodontic and surgical measures. RESULTS AND DISCUSSIONS: Because of the involvement of facial bones, the altered mode of tooth eruption and the presence of numerous included supernumerary teeth, CCD is a pathology that all dentists should be familiar with. The patients have small faces compared to the skull and the hypoplasia of maxillary, tear, nasal and zygomatic bones. The orthodontic approach in literature seems to be reduced to the guided eruption of bad-positioned and impacted teeth. Knowledge of the clinical features of CCD allows for the early planning of the procedures necessary to resolve the dental pathologies observed in CCD patients.

Histological ex vivo evaluation of peri-incisional thermal effect created by a new-generation CO2 superpulsed laser.

The purpose of this study is the evaluation of the histological effects of a new-generation superpulsed CO2 laser through an "ex vivo" study. A CO2 ( λ = 10,600 nm) ultra-speed laser (SmartUS20D, DEKA, Florence, Italy) has been used at different parameters from 2 to 4 watt in Continuous Wave (CW) and Pulsed Wave (PW, 50 Hz) to obtain 30 samples from pig cadaver tongues. All the specimens have been subdivided into 6 groups (from A to F) and each group consisted of 5 samples. A final specimen has been taken by scalpel and used as control group. Histological analysis has been performed using an optical microscope (Leica DM 2000) at a magnification of × 40. Results showed that histological readability was optimal in all the samples. The thermal damage has been negligible in all the groups. Furthermore, the average of thermal damage was 0,095 mm in the epithelial, while it was 0.245 mm in the connective tissue. Statistical analysis using Graphpad Prism 5 software showed no significant differences among the groups. CO2 laser demonstrated a good surgical effectiveness provoking little peripheral damage onto the cut edges and allowing a safe histological diagnosis.