Is preexisting inflamed jaw marrow a "hidden" co-morbidity affecting outcomes of COVID-19 infections? - Clinical comparative study.

Introduction: Exceedingly high levels of the chemokine CCL5/RANTES have been found in fatty degenerated osteonecrotic alveolar bone cavities (FDOJ) and aseptic ischemic osteolysis of the jaw (AIOJ) from toothless regions. Because CCL5/RANTES seems to have a prominent role in creating the COVID-19 "cytokine storm", some researchers have used the monoclonal antibody Leronlimab to block the CCR5 on inflammatory cells.Objective: Is preexisting FDOJ/AIOJ jaw marrow pathology a "hidden" co-morbidity affecting some COVID-19 infections? To what extent does the chronic CCL5/RANTES expression from preexisting FDOJ/AIOJ areas contribute to the progression of the acute cytokine storm in COVID-19 patients?Methods: Authors report on reducing the COVID-19 "cytokine storm" by treating infected patients through targeting the chemokine receptor 5 (CCR5) with Leronlimab and interrupting the activation of CCR5 by high CCL5/RANTES signaling, thus dysregulating the inflammatory phase of the viremia. Surgical removal of FDOJ/AIOJ lesions with high CCL5/RANTES from patients with inflammatory diseases may be classified as a co-morbid disease.Results: Both multiplex analysis of 249 FDOJ/AIOJ bone tissue samples as well as serum levels of CCL5/RANTES displayed exceedingly high levels in both specimens.Discussion: By the results the authors hypothesize that chronic CCL5/RANTES induction from FDOJ/AIOJ areas may sensitize CCR5 throughout the immune system, thus, enabling it to amplify its response when confronted with the virus. As conventional intraoral radiography does little to assess the quality of the alveolar bone, ultrasonography units are available to help dentists locate the FDOJ/AIOJ lesions in an office setting.Conclusion: The authors propose a new approach to containment of the COVID-19 cytokine storm by a prophylactic focus for future viral-related pandemics, which may be early surgical clean-up of CCL5/RANTES expression sources in the FDOJ/AIOJ areas, thus diminishing a possible pre-sensitization of CCR5. A more complete dental examination includes trans-alveolar ultrasono-graphy (TAU) for hidden FDOJ/AIOJ lesions.

Oral health related-quality of life before and during the COVID-19 pandemic in patients with non-alcoholic fatty liver disease

Background: Since the beginning of the COVID-19 pandemic, the number of medical appointments and the offer and use of oral health services have decreased sharply with the lockdown period. Restriction to regular dental care can increase the risk of oral diseases, capable of affecting general health and oral health-related quality of life, particularly among medically compromised patients. This study aimed to assess health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) of patients with non-alcoholic liver disease (NAFLD) before and during the COVID-19 pandemic. Material and methods: Prospective cohort of 58 patients with NAFLD followed up from March 2020 (before the pandemic) to December 2021 (during the pandemic). RAND 36-Item Health Survey and Oral Health Impact Profile 14 (OHIP-14) questionnaires were used to assess HRQoL and OHRQoL, respectively, in the two points of time. Results: The scores of all scales HRQoL and of the question about health change in the last year decreased substantially with the advent of the pandemic. Large (>0.50) effect sizes were estimated for the scales Role functioning/physical, Pain, General health, and Energy/fatigue. Patients who had COVID-19 presented better HRQoL and OHIP-14 mean scores than those who did not have the disease. The OHIP-14 total score increased 3.6 points with the advent of the pandemic, representing a large effect size (0.62). Patients presented high probability (84.3%) of increasing OHIP14 score during the pandemic. Conclusions: The HRQoL and the OHRQoL scores of NAFLD patients decreased substantially with the advent of the pandemic. However, these decreases were not associated with the COVID-19 disease by itself, but probably to other factors related to the deep social changes brought by the social isolation measures to combat the pandemic. (AU)

Thirteen Synchronous Multifocal Calcifying Epithelial Odontogenic Tumors (CEOT): Case Report and Review of the Literature.

BACKGROUND: Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor) is a rare, benign, locally aggressive neoplasm of the jaws that accounts for approximately 1% of all odontogenic tumors. It was first defined by Pindborg in 1955 and has been reported approximately 350 times in the literature; 7 reported multiple (up to 4) synchronous lesions. MATERIALS AND METHODS: We report an individual with the largest number of CEOTs reported to date and provide a literature review of multifocal CEOT cases. RESULTS: A 30-year-old male presented to the Oral and Maxillofacial Surgery Department of the West Virginia University School of Dentistry (WVU SoD) to extract multiple impacted teeth previous to construction of a complete denture. A pantograph showed 15 impacted teeth, almost all associated with well-demarcated cyst-like radiolucencies, some with small, ill-defined radiopaque flecks. Microscopically, the lesions showed sheets and strands of polygonal epithelial cells with eosinophilic cytoplasm. Spread throughout the epithelium and connective tissue were small, spherical, amorphous, pale purplish calcifications. Each lesion was similar and consistent with a diagnosis of CEOT. CONCLUSION: We report a patient with 13 independent CEOTs scattered throughout all quadrants. This case represents the largest number of Pindborg tumors or any other type of odontogenic tumor yet reported in a single individual.

The pararadicular radiolucency with vital pulp: Clinicopathologic features of 21 cemental tears.

OBJECTIVE: The investigation was conducted to better characterize the clinical, radiographic, and histopathologic features of cemental tears from a review of 21 cases. STUDY DESIGN: This was a retrospective review of consecutive cases collected from patient records of the investigators. RESULTS: Twenty-one cases were identified during an 8-year period. Maxillary incisors were most often affected (47.6%). All lesions presented with pain. They occurred as radiolucencies along the root of a vital or endodontically treated tooth and were classified as D-shaped (38.1%), thin-vertical-line (23.8%), thick-vertical-line (14.3%), J-shaped (19.0%), or periapical radiolucencies (4.8%). All lesions showed focal destruction of the lamina dura, with 66.7% exhibiting extension into the medullary bone. Histopathologic diagnoses included intramedullary fibrous scar (28.6%) and chronic fibrosing osteomyelitis (71.4%), all associated with embedded cemental fragments. Five associated teeth were also examined: All showed tears beneath the remaining cementum. Four cases were successfully treated with curettage without tooth extraction; endodontic therapy was performed, probably mistakenly, in 8 cases. CONCLUSIONS: Cemental tears produced symptomatic, localized chronic inflammation characterized usually by a vertical radiolucency adjacent to a root. These lesions may not be as rare as previously thought and extraction may not be the best treatment.

Symmetrical palatal fibromatosis: Five new cases and a review of the literature.

OBJECTIVE: To present five cases of symmetrical palatal fibromatosis (SPF), a lesion reported very rarely in the English language literature, under more than a dozen different names, and to recommend the most appropriate name. METHODS: Five SPF cases are characterized with a literature review. RESULTS: Three females and two males, aged 20-39 years, presented with bilateral, symmetrical, asymptomatic, sessile, moderately firm, or soft (n = 2) masses of the lateral posterior hard palate; two were isolated to the tuberosities. All masses were normal in color, with smooth, non-ulcerated surfaces and occasional surface nodularity. Underlying bone was radiographically normal, and adjacent teeth were asymptomatic. All masses originated from supra-periosteal tissues over palatal bone, only secondarily extending to gingivae and/or crestal tuberosity. Cases were present between 4 months and 15 years, with no familial or environmental etiologies identified. Histopathologically, masses were comprised of dense, avascular fibrous tissue with scattered thick bands of collagen. Surface epithelium showed occasional long, thin, sometimes pointed rete processes, and subepithelial stroma contained scattered large, angular fibroblasts. Conservative surgical excision appeared curative in all cases. CONCLUSIONS: The present investigators propose SPF as the most accurate name for this rare entity.

Chronic lingual papulosis: new, independent entity or "mature" form of transient lingual papillitis?

OBJECTIVE: Several acute, usually pediatric variants of edematous, symptomatic fungiform lingual papillitis have been reported since the 1990s, most notably transient lingual papillitis (TLP); but no chronic forms have been mentioned. Is there a chronic counterpart, akin to the older palatal examples of inflammatory papillary hyperplasia? The objective of this study was to clinicopathologically characterize a previously unreported entity with clustered, chronic fibrous papules (nonsyndromic) of the tongue. METHODS: Cases were collected from clinics in 2 dental schools. RESULTS: Five women and 4 men were identified with multiple, moderately firm, slightly pedunculated, normally colored masses clustered at the tip of the tongue (n = 4), covering the dorsal surface (n = 4) or on the lateral border (n = 1); 2 showed several erythematous or edematous papules (similar to TLP) admixed with fibrous papules. Patient ages ranged from 31 to 62 years (average 49) and all lesions had been present for many years. All lesions were asymptomatic except for the lateral border lesion, which presented with a burning sensation and mild tenderness (disappeared with antifungal medication). Five cases were associated with mouth breathing or a tongue-thrust habit; 4 were associated with geographic tongue or fissured tongue. Four papules were biopsied. All were composed of dense, avascular fibrous tissue with no or very few inflammatory cells; one showed focal mild neovascularity and edema. The lesion appeared to represent altered filiform papillae, more so than fungiform papillae. CONCLUSIONS: Chronic lingual papulosis (CLP) is an innocuous entity represented by focal or diffuse enlargement of numerous lingual papillae, primarily the filiform papillae. It appears to usually have an adult onset and most likely represents papillary reaction to very low-grade, chronic irritation or desiccation. Some cases with childhood onset, however, seem to be variations of normal anatomy. No treatment or biopsy is required, but a number of systemic disorders and syndromes must be ruled out before applying the CLP diagnosis.

Technetium-99mTc MDP imaging of 293 quadrants of idiopathic facial pain: 79% show increased radioisotope uptake.

OBJECTIVE: To evaluate the association between facial pain and maxillofacial scintigraphy. METHODS: A total of 117 patients with idiopathic facial pain (IFP) (88% females; average age = 46.7 years) underwent 99mTc-MDP scans, as did 32 age-matched controls. Pearson χ(2) analysis was used to determine associations. RESULTS: Of subject quadrants, 63% were painful (average duration: 5.4 years); 79% of painful quadrants had positive 99mTc-MDP scans, i.e., "hot spots," significantly different from 13% in nonpainful quadrants (P < .0001). Five percent of controls had quadrants with hot spots; the proportion of hot spots in subjects versus controls was significantly different (P < .0001). No difference was found between pain-free quadrants in subjects and controls (P = .0688). CONCLUSIONS: A positive 99mTc-MDP scan is strongly correlated with the location of pain in IFP, and patients with IFP have significantly more hot spots than controls, suggesting that pain in some IFP is associated with or caused by cancellous bone disease.

Bone healing in critical-size defects treated with new bioactive glass/calcium sulfate: a histologic and histometric study in rat calvaria.

This study analyzed histologically the influence of new spherical bioactive glass (NBG) particles with or without a calcium sulfate (CS) barrier on bone healing in surgically created critical-size defects (CSD) in rat calvaria. A CSD was made in each calvarium of 60 rats, which were divided into three groups: C (control): the defect was filled with blood clot only; NBG: the defect was filled with NBG only; and NBG/CS: the defect was filled with NBG covered by CS barrier. Subgroups were euthanized at 4 or 12 weeks. Amounts of new bone and remnants of implanted materials were calculated as percentages of total area of the original defect. Data were statistically analyzed. In contrast to Group C, thickness throughout defects in Groups NBG and NBG/CS was similar to the original calvarium. At 4 weeks, Group C had significantly more bone formation than Group NBG/CS. No significant differences were found between Group NBG and either Group C or Group NBG/CS. At 12 weeks, Group C had significantly more bone formation than Group NBG or NBG/CS. NBG particles, used with or without a CS barrier, maintained volume and contour of area grafted in CSD. Presence of remaining NBG particles might have accounted for smaller amount of new bone in Groups NBG and NBG/CS at 12 weeks post-operative.

T-786C polymorphism of the endothelial nitric oxide synthase gene and neuralgia-inducing cavitational osteonecrosis of the jaws.

OBJECTIVE: We hypothesized that, similar to idiopathic hip osteonecrosis, the T-786C mutation of the endothelial nitric oxide synthase (eNOS) gene affecting nitric oxide (NO) production was associated with neuralgia-inducing cavitational osteonecrosis of the jaws (NICO). DESIGN: In 22 NICO patients, not having taken bisphosphonates, mutations affecting NO production (eNOS T-786C, stromelysin 5A6A) were measured by polymerase chain reaction. Two healthy normal control subjects were matched per case by race and gender. RESULTS: Homozygosity for the mutant eNOS allele (TT) was present in 6 out of 22 patients (27%) with NICO compared with 0 out of 44 (0%) race and gender-matched control subjects; heterozygosity (TC) was present in 8 patients (36%) versus 15 control subjects (34%); and the wild-type normal genotype (CC) was present in 9 patients (36%) versus 29 controls (66%) (P = .0008). The mutant eNOS T-786C allele was more common in cases (20 out of 44 [45%]) than in control subjects (15 out of 88 [17%]) (P = .0005). The distribution of the stromelysin 5A6A genotype in cases did not differ from control subjects (P = .13). CONCLUSIONS: The eNOS T-786C polymorphism affecting NO production is associated with NICO, may contribute to the pathogenesis of NICO, and may open therapeutic medical approaches to treatment of NICO through provision of L-arginine, the amino-acid precursor of NO.

The use of digital volume tomography in imaging an unusually large composite odontoma in the mandible.

The odontoma is the most common of all odontogenic tumors. Digital volume tomography (DVT) provides a major advantage of decreased radiation and cost-effectiveness, as compared to a conventional computed tomography. There is no known published report utilizing this DVT analysis for assessing and localizing on odontomo. The purpose of this case report was to document the use of digital volume tomography to assess an unusually large composite odontoma in the mondible. Tomographic sections revealed expansion of the buccol cortex and occasional thinning of both the buccol and lingual cortical plates, although there was no pronounced clinically detectable cortical expansion. The sections further demonstrated enomel ond dentin in on irregular mass bearing no morphologic similority to rudimentary teeth. This case highlights the importance of early diagnosis and intervention for treating on odontoma while demonstrating the value of tomographic imaging as on aid to diagnosis.