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.

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.

Patient perception after oral biopsies: an observational outpatient study.

OBJECTIVE: The aim of this study was to evaluate the postoperative course in patients undergoing oral mucosal biopsies, considering clinical and patient's perception variables potentially correlated to poor healing. SUBJECTS AND METHODS: Eighty patients underwent oral biopsies. All the variables connected with the surgery were recorded, and the harvested volume was calculated through image software (ImageJ, NIH, Betesda, USA). To evaluate the postoperative discomfort, the OHIP-14 and the numeric rating scale of pain (NRS) were administered at 6 h, 7 days and 21 days after biopsy. RESULTS: Six hours after the biopsy, 22 (OHIP-14 ≥ 20) and 24 (NRS ≥ 4) patients experienced a troublesome or painful healing, respectively. A significant statistical correlation between poor healing and high scores of NRS and OHIP was detected (Pearson's correlation test p < 0.05). Higher values of OHIP-14 were correlated to the type of lesion (OR = 1.165; p < 0.05), whereas high values of NRS were correlated to the use of systemic drugs (p < 0.05). No surgical variable had a significant statistical correlation with any of the outcomes. CONCLUSIONS: The clinical evaluation was correlated with the patient's perception of pain and discomfort. This finding could be suggestive of the fact that wound healing can be reliably monitored with the help of these tools. CLINICAL RELEVANCE: Patient perception can be a predictor of the healing of biopsied tissues.

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.

Implant placement in oral squamous cells carcinoma patients treated with chemoradiotherapy: "Sapienza Head and Neck Unit" clinical recommendations.

OBJECTIVE: To date, the treatment of patients affected by head and neck squamous cell carcinoma (HNSCC) is highly challenging for clinicians. Possible therapies are surgical resection of the tumor mass, radiotherapy, chemotherapy or, more often, a combined treatment that inevitably affects both normal and tumor cells. Consequently, patients' anatomy and functions become reduced or altered. Nowadays the functional restoration is significantly improved thanks to the innovation in prosthetic rehabilitation and in radiotherapy. The current IMRT (Intensity Modulated Radiation Therapy) allows planning adequate treatments evaluating different tissues' involvement and radiation dosage. It is possible to define the most suitable sites for implant insertion, using data provided by dose-volume histogram (DVH). This study aims to illustrate the idea of obtaining a unique CT image by blending radiation-planning CT and Cone Beam CT. PATIENTS AND METHODS: Five patients among 54 candidates were selected for this study. Selection criteria were: good general health (PS0-1), age between 18 and 72 years, absence of metastatic disease or local recurrence, disease-free interval of at least 18 months. Radiation planning CT scan and maxillo-facial CT Cone Beam of every patient were overlapped and merged. Only one CT for every evaluated patient was obtained in order to plan the most suitable areas for implant placement. RESULTS: The placement of 10 implants in 5 patients was programmed using the explained method. Patients (all male) were aged between 48 and 72 years old, with a median age of 64.4 years. In every case of this study, a modification of the initial program of implant placement was necessary. The new imaging method we are proposing was able to provide information about radiation isodoses received in the planned osseointegrated implants' positions. CONCLUSIONS: This new method allows operators to correct their own therapy plans and choices, customizing the treatment plan on the actual condition of the patient. Moreover, it makes all the rehabilitation process safer and can reduce the risk of failure, side effects and inconveniences for the patients.

Delayed Eruption of Permanent Dentition and Maxillary Contraction in Patients with Cleidocranial Dysplasia: Review and Report of a Family.

INTRODUCTION: Cleidocranial dysplasia (CCD) is an inherited disease caused by mutations in the RUNX2 gene on chromosome 6p21. This pathology, autosomal dominant or caused by a spontaneous genetic mutation, is present in one in one million individuals, with complete penetrance and widely variable expressivity. AIM: To identify the incidence of these clinical findings in the report of the literature by means of PubMed interface from 2002 to 2015, with the related keywords. The report of local patients presents a clinical example, related to the therapeutic approach. RESULTS AND DISCUSSIONS: The PubMed research resulted in 122 articles. All the typical signs were reported in all presented cases. The maxilla was hypoplastic in 94% of the patients. Missing of permanent teeth was found in two cases: one case presented a class II jaw relationship, instead of class III malocclusion. Similar findings were present in our cohort. CONCLUSION: CCD is challenging for both the dental team and the patient. The treatment requires a multidisciplinary approach. Further studies are required to better understand the cause of this disease. According to this review, a multistep approach enhances the possibilities to achieve the recovery of the most possible number of teeth, as such to obtain a good occlusion and a better aesthetic.

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.

Medication-related osteonecrosis of the jaws (MRONJ) and quality of life evaluation: a pilot study.

BACKGROUND: MRONJ (medication related osteonecrosis of the jaws) is a well-known side effect of certain drugs, which are used to influence bone metabolism for the cure of osteo-metabolic or cancer diseases. The aim of this study is to assess the quality of life (QOL) under a physical and mental point of view in patients affected by MRONJ compared with the general population. METHODS: The study has been accomplished through the administration of the SF-12 questionnaire: 30 patients of the MRONJ group were evaluated. RESULTS: Significant differences based on the level of education and age of the subjects, on the location and finally on the stage of necrosis of the jaw have been identified. In this pilot study the test sample shows how MRONJ can aggravate the conditions of patients, above all under a physical point of view. CONCLUSIONS: Prevention of MRONJ and its symptoms as dysphagia, oral pain, immunological compromission and the need of frequent antibiotic therapies is a crucial part of modern oral pathology and dentistry, above all for oncologic patients who already have a general decrease of physical and mental activities, leading to a poor quality of life.

Clinical and Spectrophotometric Evaluation of LED and Laser Activated Teeth Bleaching.

BACKGROUND: Auxiliary power sources (LED and laser) are used in in-office teeth bleaching techniques to accelerate the redox reaction of the whitening gel to increase ease of use, to improve comfort and safety, and to decrease the procedure time. OBJECTIVE: The aim this study is to evaluate the efficiency of the teeth whitening procedures performed with hydrogen peroxide and carbamide peroxide, LED or Laser activated. METHOD: 18 patients, affected by exogenous dyschromia, were treated with a bleaching agent composed by 35% hydrogen peroxide and 10% carbamide peroxide. They were divided into two groups: in the first group the bleaching agent was activated by a LED lamp; in the second group it was activated by a Laser diode lamp. Both groups were subjected to 3 bleaching cycle of 15' each. The chromatic evaluations were performed before and after one week from the treatment, using a chromatic scale and a spectrophotometer. The mean value of pre, post bleaching and follow-up were analyzed using a T-test, with results statistically significant for P<0,05. RESULTS: Results showed that the variations in brightness, chroma and hue are significantly influenced by the interaction between the whitening agent and the original colour of the teeth. Laser-activation has marginally improved the bleaching effectiveness. All patients treated with laser activation complained an increase in dental sensitivity. CONCLUSION: The use of laser-activating systems did not improve the efficacy of bleaching.

Psychological disorders and oral lichen planus: matched case-control study and literature review.

OBJECTIVE: Oral lichen planus (OLP) may be linked to psychological disorders. This study investigated psychological factors associated with OLP. METHODS: A case-control study with incident OLP case patients and age-gender-socio-economic status-matched controls, recruited from among relatives, accompanying persons, and departmental staff, investigated psychological traits using the Psychological General Well-Being Index-Short form. Common factor analysis was used to generate a set of psychological dimensions. The association between these dimensions and OLP adjusted for confounders (education, number of lifetime sexual partners, drinking-smoking) and interactions was assessed through conditional logistic regression and odds ratios (OR) were estimated. RESULTS: A total of 67 case-control pairs were recruited. Psychological dimensions generated were: dimension-1 (anxiety, low vitality), dimension-2 (negative well-being, low vitality), dimension-3 (depressed mood, low self-control). The ORs for OLP were, dimension-1, 1.0 (95% confidence interval -95CI, 0.3-2.6); dimension-2, 0.5 (95CI, 0.2-1.2); dimension-3, 4.8 (95CI, 1.8-12.9). Dimension-3 was highly associated with mild, but not associated with severe, OLP. Literature searching provided 21 studies, with anxiety and depression principally associated with OLP. CONCLUSIONS: Depressed mood and low self-control were highly associated with OLP, particularly the reticular-papular forms. These traits could have a causative role in OLP development-progression, but further investigations are necessary.

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.

[Root-end filling materials. Proposal for a meta-analysis study]. / Materiali da otturazione retrograda. Proposta di studio metanalitico.

BACKGROUND: The purpose of this study is to identify a first choice Root-end Filling Material (RFM) as regards the apical sealing ability. METHODS: The method we have used is the so called Metanalysis. It consists of the selection of all experimental studies already existing in literature and of the statistical processing of their results, so that it is possible to achieve a wider statistical sample which could lead to the most conclusive results. In this study we have tried to apply the above mentioned method to scientific articles investigating apical sealing ability through two different experimental methods: the dye penetration method and the fluid filtration method. RESULTS: This study shows that it is not possible to perform all the steps required for the realisation of a metanalytic study. This situation is consequential on the lack of well overlapped studies concerning the experimental protocol. We have tried, however, to outline the characteristics of main Root-end Filling Materials, on the basis of what we had achieved by consulting the single studies found in literature. CONCLUSIONS: It is necessary to carryout experiments consisting of more similar research protocols both to realise their metanalytic comparison and to respect one of the main foundations in scientific research, that is the effective repetition rather than a mere theoretical one.

[Bad habits and dysgnathia: epidemiological study]. / Abitudini viziate e disgnazie: indagine epidemiologica.

The authors refer about an epidemiological survey in 651 children in the school-age. The aim of study is to investigate about the frequency of the bad habits and the pathogenetic relations between these and the development of the dento-maxillo-facial deformities. They point out an incidence of these bad habits in the 35,48% with a predominance of mouth breathers (45,45%). After they discuss the necessity of an early detection of anomalous neuromuscular attitudes.

[Epidemiological study of the frequency of caries and malocclusion in school-age children]. / Studio epidemiologico sulla frequenza della carie e delle malocclusioni in eta' scolare.

The authors have made an epidemiological survey on a population in the school-age group, with the aim to evaluate the right incidence of the decay and dysgnathias and about the possible ethiopatogenetic relationship between these two pathologies. The results are very close to other similar researches.