The Performance of GPT-3.5, GPT-4, and Bard on the Japanese National Dentist Examination: A Comparison Study.

Purpose This study aims to evaluate the performance of three large language models (LLMs), the Generative Pre-trained Transformer (GPT)-3.5, GPT-4, and Google Bard, on the 2023 Japanese National Dentist Examination (JNDE) and assess their potential clinical applications in Japan. Methods A total of 185 questions from the 2023 JNDE were used. These questions were categorized by question type and category. McNemar's test compared the correct response rates between two LLMs, while Fisher's exact test evaluated the performance of LLMs in each question category. Results The overall correct response rates were 73.5% for GPT-4, 66.5% for Bard, and 51.9% for GPT-3.5. GPT-4 showed a significantly higher correct response rate than Bard and GPT-3.5. In the category of essential questions, Bard achieved a correct response rate of 80.5%, surpassing the passing criterion of 80%. In contrast, both GPT-4 and GPT-3.5 fell short of this benchmark, with GPT-4 attaining 77.6% and GPT-3.5 only 52.5%. The scores of GPT-4 and Bard were significantly higher than that of GPT-3.5 (p<0.01). For general questions, the correct response rates were 71.2% for GPT-4, 58.5% for Bard, and 52.5% for GPT-3.5. GPT-4 outperformed GPT-3.5 and Bard (p<0.01). The correct response rates for professional dental questions were 51.6% for GPT-4, 45.3% for Bard, and 35.9% for GPT-3.5. The differences among the models were not statistically significant. All LLMs demonstrated significantly lower accuracy for dentistry questions compared to other types of questions (p<0.01). Conclusions GPT-4 achieved the highest overall score in the JNDE, followed by Bard and GPT-3.5. However, only Bard surpassed the passing score for essential questions. To further understand the application of LLMs in clinical dentistry worldwide, more research on their performance in dental examinations across different languages is required.

Squamous Cell Carcinoma of the Gingiva.

A 77-year-old woman presented with a 2-year history of denture sores at the left mandibular gingiva. She had no smoking history or alcohol use. Intraoral examination showed a cauliflower-like, 28 × 20 mm mass on the left mandibular gingiva without induration. The edentulous ridge was extensively resorbed. Extraoral examination showed no numbness of lower lip and cervical lymphadenopathy. Computed tomography (CT) showed superficial cortical bone erosion beneath the mass and proximity to the inferior alveolar canal. 18 F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) showed increased uptake in the left mandibular region and left submandibular lymph nodes. An incisional biopsy was performed, and she was diagnosed with squamous cell carcinoma (SCC)(cT2N1M0, stage 2). She underwent segmental mandibulectomy, selective neck dissection, and immediate reconstruction under general anesthesia. At the 2 years follow-up, she remained free of disease.

Adenoid cystic carcinoma of the sublingual gland developing lung metastasis 20 years after primary treatment: A case report and literature review.

RATIONALE: Adenoid cystic carcinoma (ACC) is a rare malignant tumor that primarily occurs in the salivary glands. Distant metastases can develop despite favorable local control. Moreover, distant metastasis of ACC can occur after a long time interval without local recurrence. We report the first case of ACC of the sublingual gland that developed lung metastasis 20 years after primary treatment. PATIENT CONCERNS: A 52-year-old man was referred to our department with a 1-year history of painful swelling on the right oral floor. DIAGNOSIS: An incisional biopsy was performed, and histopathological examination revealed malignancy. INTERVENTIONS: Surgical excision of the right oral floor and right supra-omohyoid neck dissection with postoperative chemoradiation therapy were performed, and ACC of the sublingual gland was diagnosed. Left pulmonary metastasis was detected 20 years after the primary treatment. Metastasectomy was performed; however, subsequently, skin and bone metastases developed. OUTCOMES: After receiving palliative care, the patient died of multiple organ failure. LESSONS: As late distant metastasis of salivary ACC can develop, patients who undergo primary treatment need a long-term, strict follow-up plan even if locoregional control is favorable.

Intraoral hemorrhage caused by dental calculus: two case reports.

Intraoral hemorrhage is an undesirable and emergency condition, and it can also occur spontaneously. Clinicians sometimes face difficulty in identifying the hemorrhage points and the causes of hemorrhage, as well as difficulty in the hemostatic procedures. Here, the authors present two rare cases of spontaneous intraoral hemorrhage related to dental calculus. The hemorrhage points and causes of hemorrhage were determined after removing the removable intraoral components, including the dental calculus.

Oral liposarcoma in elderly: Case report and literature analysis.

RATIONALE: Oral liposarcoma is an extremely rare lesion that is often clinically misdiagnosed as a benign lesion because of its asymptomatic and indolent clinical course. we report a case of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) of buccal mucosa, provisionally diagnosed as lipoma. PATIENT CONCERNS: A 97-year-old female was referred to dentistry and oral surgery department with an asymptomatic mass on the right buccal mucosa which had been present for an unknown period of time. DIAGNOSIS: Magnetic resonance imaging demonstrated a well-circumscribed lesion at the right buccal mucosa, and a lipoma was suspected. INTERVENTIONS: Surgical removal was performed, and a diagnosis of ALT/WDL was made. She and her family refused additional treatment due to her age. OUTCOMES: At the 10 months follow-up, the patient remained free of disease. LESSONS: The indolent clinical course and small size of oral liposarcoma can lead to provisional clinical diagnosis of benign lesion.

Celecoxib suppresses lipopolysaccharide-stimulated oral squamous cell carcinoma proliferation in vitro and in vivo.

Periodontitis is one of the most common chronic oral inflammatory conditions worldwide and is associated with a risk of developing oral squamous cell carcinoma (OSCC). Porphyromonas gingivalis is a major pathogen in periodontitis, and its lipopolysaccharide (LPS) promotes the expression of cyclooxygenase-2 (COX-2) in OSCC both in vivo and in vitro. Celecoxib is a selective COX-2 inhibitor; however, its antitumor effects on P. gingivalis LPS-stimulated OSCC and the underlying molecular mechanism remain unclear. To elucidate the association between periodontitis and OSCC, the effect of P. gingivalis-derived LPS on OSCC cell proliferation was examined both in vitro and in vivo in the present study. The expression levels of COX-2 and p53 in OSCC cells with/without celecoxib treatment were determined via western blotting. The therapeutic potential of celecoxib in LPS-stimulated OSCC was evaluated by staining for Ki-67 and p21, as well as with terminal deoxynucleotidyl-transferase-mediated dUTP nick end labeling staining. LPS treatment significantly increased OSCC cell proliferation in vitro, and celecoxib significantly inhibited cell proliferation with/without LPS treatment. Celecoxib treatment of OSCC cells downregulated the protein expression levels of COX-2 compared with untreated cells, but there was little change in p53 expression. In the mouse xenograft model, oral administration of celecoxib significantly suppressed tumor growth, reduced the expression of Ki-67, increased the apoptosis index and induced p21 expression with/without LPS treatment. The results from the present study demonstrate that P. gingivalis' LPS can stimulate tumor growth by interacting with OSCC cells. In conclusion, these results suggest that celecoxib could be used for the effective prevention and treatment of LPS-stimulated OSCC.