Advancements and Trends in Electrochemical Biosensors for Saliva-Based Diagnosis of Oral Diseases: A Bibliometric Analysis (2000-2023)

BACKGROUND

Oral diseases, such as dental caries, periodontal diseases, and oral cancers, represent significant global public health challenges. With the COVID-19 pandemic, traditional diagnostic methods have limitations, thus highlighting the need for innovative, early, and non-invasive diagnostic approaches. Analyse and summarise publications globally through a comprehensive bibliometric study to help researchers suggest possible directions for future research.

OBJECTIVE

The purpose of the study was to evaluate global academic productivity, impact, and collaboration of electrochemical biosensors for oral diseases utilising bibliometrics based on annual number of publications, countries and regions, institution, authors, journals, citations and co-occurrences of author keywords over the last 20 years.

METHODS

This study employs bibliometric analysis to assess the research of electrochemical biosensors for oral diseases in the Web of Science from 2000 to 2023. Utilising VOSviewer, CiteSpace software, and Microsoft Excel, we conducted a bibliometric and visualised analysis of electrochemical biosensors for oral diseases.

RESULTS

The quantity of pertinent publications in this research domain displays a fluctuating but overall upward trend. In aggregate, there are 341 articles and 82 reviews, encompassing research contributions from 55 countries, 649 institutions, and involving 2068 authors. Among these publications, China, the USA, and India emerged as the predominant contributing nations. Predominantly, articles found their publication venue in "Biosensors & Bioelectronics." Notably, the author with the highest number of publications and most influence is Wang, Joseph S. The top 3 keywords include "biosensor,""sensor,""saliva."

CONCLUSION

In this investigation, statistical analysis and network visualisation were conducted to reveal the research progress, trends, and trending topics on electrochemical biosensors for oral diseases via a thorough bibliometric analysis. We found that Despite these challenges, electrochemical biosensors hold significant promise for transforming oral disease diagnostics. Overcoming current technical barriers will improve both oral and systemic health outcomes.

Oral Ulceration with Bone Sequestration: Key Insights for Clinicians and Their Relevance in Contemporary Clinical Practice-A Narrative Systematic Review

Background: Oral ulceration with bone sequestration (OUBS) is an uncommon clinical lesion characterized by painful mucosal ulceration associated with exposed and necrotic bone in the oral cavity, often without known factors inducing osteonecrosis. Despite its potential for diagnostic confusion with more serious lesions, such as medication-related osteonecrosis, OUBS remains poorly understood and underreported. Objectives: To systematically review the literature on OUBS and identify its main clinical and radiographic characteristics to assist in early diagnosis and appropriate management. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in the PubMed, Scopus, and Web of Science databases on 27 January 2024, to identify case reports, case series, and observational studies that described OUBS. Data extraction focused on demographic information, lesion location, clinical features, radiographic findings, possible etiological factors, management, and outcomes. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized to assess the quality of the case reports and series. Data were synthesized narratively due to heterogeneity among studies. Results: Fifty-seven patients from 22 studies were included. The male-to-female ratio was 2.5:1, with most cases (71.9%) occurring in males. The mean age was 50.22 ± 11.49 years, with the highest incidence in patients aged 50-59 years (64.9%). Most cases were localized to the mandible (94.7%). Clinically, lesions were shallow ulcers (mean size: 0.75 ± 0.85 cm). Pain was the most common symptom (88.9%). Radiographs revealed no significant maxillary abnormalities, but some cases showed radiopaque areas in the mandible. Surgical interventions were most common (40.4%), with complete healing in 67.7% of cases within 4 weeks. Limitations include the predominance of case reports and series, which limits the strength of evidence. Conclusions: Recognizing OUBS can prevent misdiagnosis and unnecessary interventions. Further studies are needed to clarify its etiology and natural history. Registration: This review was registered on the PROSPERO database (registration number CRD42024541416).

Somatic Symptoms as Idioms of Distress in East Asian Patients With Differing Temporomandibular Disorder Diagnostic Subtypes

OBJECTIVE

This cross-sectional study investigated the prevalence/severity of somatic symptoms, their relationship with psychological distress and oral behaviors in different temporomandibular disorder (TMD) diagnostic subtypes, and identified biopsychosocial factors associated with depression, anxiety, and jaw overuse behavior among East Asian patients.

METHODS

Anonymized data from consecutive new TMD patients at a tertiary oral medicine clinic were evaluated. TMD diagnoses were determined using the DC/TMD methodology, while somatic symptoms, depression, anxiety, and oral behaviors were assessed with the Patient Health Questionnaire (PHQ)-15, PHQ-9, Generalized Anxiety Disorder Scale-7, and Oral Behavior Checklist. Data were examined using the Chi-square/non-parametric tests and multivariate linear regression analysis (α = 0.05).

RESULTS

Among the 699 patients, somatic symptoms were present in 36.8%, 54.0%, and 48.2% of individuals with intra-articular (IT), pain-related (PT), and combined (CT) TMDs respectively. Significant differences in somatic symptom burden/depression (PT, CT > IT) and anxiety (CT > IT) were observed. For all TMD subtypes, patients with somatic symptoms showed significantly greater depression, anxiety, and jaw overuse behavior compared to those without somatic symptoms. Somatic symptoms were moderately correlated with depression and anxiety (rs = 0.51-0.65).

CONCLUSION

Somatic symptom burden was linked to depression and anxiety, supporting the phenomenon of somatization across different TMD subtypes.

Unexploited opportunities in oral disease biosensors and digital health integration

Oral pathologies such as oral cancer, oral potentially malignant disorders (OPMDs), oral squamous cell carcinoma (OSCC), represent significant global health challenges owing to their prevalence, complex management, and impact on patient quality of life. Traditional diagnostic approaches, though effective, are often limited by their invasiveness, lack of sensitivity, and inability to provide real-time monitoring. Biosensors, particularly colorimetric and electrochemical types, offer promising alternatives by enabling rapid, non-invasive detection of disease-related biomarkers in saliva or breath. However, current biosensor applications in oral health are predominantly designed for single-time measurements, with limited capabilities for continuous monitoring and integration with digital health platforms. This narrative review synthesizes literature published in the last 10 years from major databases, focusing on recent advances in salivary biosensors for oral disease monitoring, with emphasis on OSCC and OPMDs. The review also explores the emerging role of artificial intelligence and digital platforms in transforming biosensor data into clinically meaningful insights. Addressing these areas could enhance the practicality and accessibility of biosensors, offering a proactive approach to oral healthcare and improving patient outcomes. This paper underscores the need for interdisciplinary collaboration to bridge current technological gaps, paving the way for a future where personalized, preventative care in oral pathology becomes standard practice.

Clinical Characteristics and Risk Factors of Geographic Tongue: A Retrospective Analysis of 100 Polish Patients

Background/Objectives: We aimed to evaluate the clinical course, demographic characteristics, and risk factors in Polish patients with geographic tongue (GT). Methods: The analysis was based on medical records of 100 patients with GT referred to the outpatient clinic of Poznań University of Medical Sciences (PUMS) from 2013 to 2023. Data regarding age, gender, medical history, habits, subjective complaints, clinical features, localization, histology, and treatment were considered. Results: Patients with GT constituted 11.3% of 887 individuals admitted to the outpatient clinic in the analyzed period. The female-to-male ratio was 52:48. The average age at diagnosis was 51.6 years. Thirteen patients reported smoking, and 2.0% admitted to consuming alcohol excessively. Subjective complaints were reported by 85.0% of patients and mainly included a burning sensation (57.0%), pain (39.0%), xerostomia (22.0%), bleeding (4.0%), and taste disturbance (3.0%), while 15.0% of GT patients were asymptomatic. Comorbidities were found in 76.0% of subjects with GT, and included cardiovascular disorders (37.0%), gastrointestinal and thyroid gland diseases (24.0% and 18.0%), and type II diabetes (15.0%). Psoriasis was observed in one case only. Conclusions: The frequency of GT in a Polish cohort of patients was high and comparable in both genders. The majority of participants reported subjective complaints, and most of the patients were non-smokers. Comorbidities were found in 76.0% of subjects with GT and mainly included cardiovascular and gastrointestinal diseases. GT was often accompanied by other oral conditions, like candidiasis, recurrent aphthous stomatitis, and lichen planus. GT screening should include cardiovascular and gastrointestinal evaluation.

In vitro and in vivo anticancer activity of nickel (II) tetraazamacrocyclic diperchlorate complex, [(Ni-Me8[14]diene)(ClO4)2] against ehrlich ascites carcinoma (EAC) and MCF7 cells

Cancer remains a global health burden, with a pressing need for more effective treatments. This study uses a novel compound, Nickel (II) diperchlorate complex of the ligand (L): 3,10-C-meso-3,5,7,7,10,12,14,14-octamethyl-1,4,8,11-tetraazacyclotetradeca-4,11-diene, Me8[14]diene, designated as [Ni(II)L](ClO4)2, to explore its potential as an anticancer agent. Its efficacy was evaluated against Ehrlich Ascites Carcinoma (EAC)-bearing Swiss albino mice by monitoring tumor cell growth inhibition, survival time, tumor mass reduction, and hematological profiles. Additionally, cytotoxicity was investigated in vitro using MCF7 breast cancer cells. The apoptotic potential was evaluated through Hoechst staining, with changes in apoptosis-related gene expression (p53, BCL2, BAX, PARP1, CASP3, CASP8, and CASP9) using RT-qPCR. The test compound's toxicity was evaluated by monitoring hematological, biochemical, and histological changes. The compound exhibited dose-dependent growth inhibition of EAC cells with 88.45% inhibition at a dose of 200 µg/kg (p < 0.01), extended lifespan by 52.63%, reduced tumor weight by 47.83%, and restored hematological parameters in EAC-bearing mice. Cytotoxicity assays yielded LC50 and IC50 values of 23.73 µg/mL and 71.52 µg/mL, respectively. Apoptosis induction was evidenced by cell membrane blebbing, apoptotic body formation, chromosomal condensation, and nuclear fragmentation in MCF7 cells. Significant upregulation of pro-apoptotic genes such as p53, BAX, PARP1, CASP3, CASP8, and CASP9, alongside downregulation of anti-apoptotic gene BCL2, implied activation of the apoptotic pathway in cancer cells, followed by compound treatment. Moreover, no long-term negative impacts on tissue levels or hematological or biochemical markers were noted in the mice. Altogether, [Ni(II)L](ClO4)2 demonstrates promising anticancer activity and could serve as a potential chemotherapeutic agent, pending further studies.

The impact of electronic cigarette smoking on periodontal status and proinflammatory cytokine levels: a cross-sectional study

BACKGROUND

E-cigs(E-cigs) use is increasing worldwide. Recent studies suggest that E-cigs contain harmful elements that could lead to adverse oral health outcomes. Therefore, the aim of this study was to evaluate the impact of E-cigs smoking on periodontal health among current male smokers in Al-Kharj city in Saudi Arabia by assessing periodontal parameters and proinflammatory cytokine levels.

METHODS

Fifty-three male individuals (25 E-smokers and 28 non-smokers) participated in the study. This study compared periodontal parameters, including the plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment loss (CAL), and marginal bone loss (MBL), as well as levels of unstimulated whole saliva (UWS), interleukin IL-1B, and IL-6, between E-smokers and non-smokers.

RESULTS

The E-cigs users consumed approximately 432.6 ± 425.22 puffs on average daily, with a nicotine content of approximately 45.2 ± 11.23 mg on average. There was no statistically significant difference between the groups in terms of BOP and PI. A statistically significant difference was detected in PPD and CAL (p < 0.05) between the two groups, in which the PPD (4.10 ± 1.87) and CAL (2.72 ± 0.89) were greater in E-smokers. The mean MBL was also higher among E-smokers, which was statistically significant (p < 0.05). The mean cytokine IL-1B level was found to be (640.75 ± 138.78) among non-smokers and (889.05 ± 540.56) among E-smokers, and this difference was statistically significant (p < 0.05). However, while IL-1B had shown a significant difference between groups in the bivariate analysis (t-test), its association with E-cigs use became non-significant in the multivariate model (OR = 1.01, 95% CI: 1.00-1.02, p = 0.194). The mean IL-6 level among non-smokers was (19.49 ± 11.90) and among E-smokers, it was (17.07 ± 8.21). And, this difference was not statistically significant (p > 0.05).

CONCLUSIONS

This study revealed that E-cigs smoking had a negative effect on periodontal status (especially PPD, CAL and MBL). These results may contribute to the pathogenesis of periodontal diseases and tissue destruction. Efforts must be made to educate and create awareness among patients and the general community regarding the risks associated with E-cigs usage especially in young populations.

Serial Changes in Vitamin D Status in Patients During Severe Acute Respiratory Distress Syndrome and Extracorporeal Membrane Oxygenation

Background and Objectives: Therapeutic interventions, such as extracorporeal membrane oxygenation (ECMO) therapy, in patients suffering from severe acute respiratory distress syndrome (ARDS) may reduce their vitamin D levels. Many observational studies have shown associations between poor outcomes and low vitamin D levels in critically ill patients. This retrospective study primarily aimed to investigate the time-dependent changes in vitamin D levels and the correlation of vitamin D levels with disease severity and inflammatory markers in patients suffering from ARDS receiving ECMO therapy. Materials and Methods: This study used a longitudinal approach to assess the serial changes and the correlations of vitamin D levels (25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D)) with disease severity and inflammatory markers in 24 invasively mechanically ventilated (IMV) patients treated using ECMO over a period of 17 days. Most of the patients in this study were suffering from severe coronavirus disease 2019 (COVID-19) (n = 19; 79%). Serial blood samples collected during routine blood draws were retrospectively analyzed to assess the dynamics of their vitamin D levels over 17 days of ICU therapy. Results: Hypovitaminosis D (25(OH)D ≤ 50 nmol/L) was prevalent in 18 (75%) patients, while values of 25(OH)D lower than 30 nmol/L were measured in 5 patients (21%), indicating severe deficiency. Additionally, 1,25(OH)2D showed a significant decrease within the first 11 days of intensive care unit (ICU) treatment (these levels dropped by 28%; p = 0.03) and then remained at similar levels throughout the observational period; 25(OH)D levels remained largely unchanged during the observation period. We observed that 25(OH)D showed a significant negative correlation with C-reactive protein (CRP) (p = 0.04), and that 25(OH)D and 1,25(OH)2D levels did not show correlations with disease severity. Conclusions: Patients suffering from severe COVID-19 ARDS showed a significant decrease in their 1,25(OH)2D levels from day 0 to day 11 in the ICU. Therefore, routine vitamin D substitution and monitoring in critically ill patients, especially for patients suffering from ARDS treated with ECMO, should be carried out to prevent hypovitaminosis D. In addition, vitamin D may be associated with inflammation. Further studies are necessary to elucidate the mechanisms behind these retrospective observations.

Vitamin D status in children with mild, moderate, or severe confirmed COVID-19: systematic-review and meta-analysis

Background

Vitamin D acts as a pro-hormone with a wide range of beneficial effects. It is reported that vitamin D deficiency is a risk factor for COVID-19 severity in children. In the present study, we decided to assess 25 hydroxy (OH) vitamin D status in children with mild, moderate, or severe confirmed COVID-19 and also compare them with those of a healthy control group using existing data.

Methods

Relevant studies were extracted using online international databases including Scopus, Science Direct, PubMed, Web of Science, ProQuest, and Google Scholar search engine between Jan 2019 and 2024. The quality of all papers is determined by the NOS checklist. Heterogeneity between the results of primary studies was evaluated with the I-square index. Egger's test, funnel plot, and sensitivity analysis were applied. The statistical analysis was done using Stata version 17.

Results

In 12 documents, the status of vitamin D was examined between case and control groups. By combining the results of these studies using random effect model, the standardized mean difference (SMD) vitamin D level in the COVID-19 children compared to the control group was estimated to be -0.88 (98% CI: -1.24, -0.51), which was statistically significant. In the present study, the odd ratio of vitamin D deficiency and vitamin D disorder (insufficiency and deficiency) in children with moderate COVID-19 compared to asymptomatic children with COVID-19 were estimated to be 3.58 (1.10, 11.63) and 2.52 (0.99, 6.41) respectively which was higher than in asymptomatic children with COVID-19. In addition, vitamin D deficiency and vitamin D disorder in children with moderate COVID-19 compared to the children with mild COVID-19 were estimated to be 2.12 (0.90, 4.98) and 1.82 (0.78, 4.22) respectively, which was higher than in children with mild COVID-19. Also, vitamin D deficiency and vitamin D disorder in children with mild COVID-19 compared to asymptomatic children with COVID-19 were estimated to be 2.02 (0.60, 6.78) and 1.64 (0.53, 5.07) respectively, which was higher than in asymptomatic children.

Conclusions

Combining the results of these studies, the effect size of the relationship between vitamin D and COVID-19 in children is significant. During the COVID-19 pandemic (except for the Omicron peak), children were less affected by the severity of COVID-19. The standardized mean difference (SMD) vitamin D level in children with COVID-19 was significantly 0.88 units lower than the control group. Also, the odds ratio of moderate COVID-19 in children with vitamin D deficiency was significantly 3.58 times higher than in asymptomatic children with COVID-19.

Carcinogenetic mechanisms employed by the oral microbiome: A narrative review

Cancers of the oral cavity, lip, salivary gland, and oropharynx cause substantial global disease burden. While tobacco-use and alcohol use are highly associated with oral cancers, the rising incidence of disease in patients who do not use tobacco or alcohol points to additional carcinogenic risk factors. Chronic inflammation, disruption of the oral microbiome, and dysbiosis are becoming more widely implicated in the pathogenesis of oral cancer. Several studies have identified specific bacterial species enriched in patients with oral cancer, including Porphyromonas gingivalis and Fusobacterium nucleatum. In this narrative review, we describe potential carcinogenic mechanisms exhibited by these species and other microbes in the development of oral cancer.

The Relationship of HbA1c Serum Levels with the Severity of Periodontal Disease in Patients with Type 1 Diabetes Mellitus: A Cross-Sectional Study

OBJECTIVE

 According to the evidence, the level of glycemic control is of key importance in determining the increased risk of periodontal disease (PD). The aim of the study was to evaluate the role of metabolic control as a key factor leading to the development and severity of periodontitis and compare the periodontal and oral hygiene status with the glycated hemoglobin levels.

MATERIALS AND METHODS

 The evaluation was undertaken with diabetic patients (59 uncontrolled diabetics and 36 controlled diabetics) from a patient cohort of the Hospitalar Center of Tâmega e Sousa and subjects without diabetes (n = 95).

STATISTICAL ANALYSIS

 The data were analyzed using IBM SPSS Statistics software (Statistical Program for Social Sciences), version 29.0 for Windows. In the logistic regression analysis, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The significance level was set at 0.05.

RESULTS

 Periodontal parameters were increased in systemically compromised individuals especially those who were poorly controlled as compared with their healthy counterparts, which are important indicators of PD progression. Furthermore, uncontrolled type 1 diabetic mellitus (T1DM) patients showed increased plaque index (PI), which predisposes these individuals to a greater degree of periodontal destruction and tooth loss. Using a binary logistic regression, we observe a significant relation of the risk of severe periodontitis in T1DM subjects with family history of T1DM (p = 0.019; OR: 3.36; 95% CI: 1.22-9.21), alcohol consumption (p = 0.02; OR: 3.78; 95% CI: 1.23-11.63), periodontal probing depth (PPD) (p < 0.001; OR: 3.64; 95% CI: 14.74-90.34), and clinical attachment loss (p = 0.033; OR: 4.71; 95% CI: 1.13-19.59).

CONCLUSION

 Increased glycated hemoglobin levels were positively related with periodontal status. Uncontrolled systemically compromised individuals showed an increased Plaque index (PI), which predisposes to greater periodontal inflammation and tooth loss. Increased clinical attachment level, Periodontal probing depth (PPD) and family history of T1DM, and alcohol consumption were identified as potential risk factors for severe periodontitis in subjects with T1DM.

Temporomandibular disorder: A previously unreported complication of chronic suppurative otitis media

OBJECTIVE

The aim of the current clinical study was to test the hypothesis that chronic suppurative otitis media (CSOM) might be significantly associated with signs of temporomandibular joint (TMJ) internal derangement.

METHODS

The study involved 79 patients with CSOM and 79 control subjects. The TMJ was clinically examined in both groups.

RESULTS

Signs of internal derangement of the TMJ(s) were found in 67.1% of CSOM patients versus 26.6% of control subjects (p = .001).

CONCLUSION

CSOM may be associated with the extension of the inflammatory process into the TMJ, thereby predisposing to internal derangement of the joint.

Intratumoral microbiota: a new force in the development and treatment of esophageal cancer

Esophageal cancer (EC) ranks among the most prevalent cancers worldwide, with a particularly high incidence in the Asian population. Due to the inconspicuous nature of early symptoms, patients with esophageal cancer are typically diagnosed in the middle to late stages, resulting in suboptimal overall treatment outcomes. Consequently, there is an urgent need to explore and refine therapeutic strategies. Microorganisms have been identified in numerous tumor tissues, including EC, and these microorganisms are referred to as the intratumoral microbiome. Intratumoral microbiota and their metabolic byproducts can influence the progression and treatment of esophageal cancer through various mechanisms, such as modulating tumor cell metabolism and local immune responses. Therefore, the intratumoral microbiota may potentially serve as a target for the treatment of esophageal cancer. This review delineates the composition, origin, and diagnostic significance of intratumoral microbiota in esophageal cancer tissue, and discusses the mechanisms by which intratumoral microbiota contribute to the onset of esophageal cancer. In addition, the impact of intratumoral microbiota on the treatment of esophageal cancer and its intervention measures are also addressed.

Salivary biomarkers: a promising approach for predicting immunotherapy response in head and neck cancers

Head and neck cancers, including cancers of the mouth, throat, voice box, salivary glands, and nose, are a significant global health issue. Radiotherapy and surgery are commonly used treatments. However, due to treatment resistance and disease recurrence, new approaches such as immunotherapy are being explored. Immune checkpoint inhibitors (ICIs) have shown promise, but patient responses vary, necessitating predictive markers to guide appropriate treatment selection. This study investigates the potential of non-invasive biomarkers found in saliva, oral rinses, and tumor-derived exosomes to predict ICI response in head and neck cancer patients. The tumor microenvironment significantly impacts immunotherapy efficacy. Oral biomarkers can provide valuable information on composition, such as immune cell presence and checkpoint expression. Elevated tumor mutation load is also associated with heightened immunogenicity and ICI responsiveness. Furthermore, the oral microbiota may influence treatment outcomes. Current research aims to identify predictive salivary biomarkers. Initial studies indicate that tumor-derived exosomes and miRNAs present in saliva could identify immunosuppressive pathways and predict ICI response. While tissue-based markers like PD-L1 have limitations, combining multiple oral fluid biomarkers could create a robust panel to guide treatment decisions and advance personalized immunotherapy for head and neck cancer patients.

Burning Mouth Syndrome Following Covid Vaccination: A Case Report

This is the first reported case of burning mouth syndrome resulting from the Pfizer-BioNTech COVID-19 vaccine. It highlights the efficacy of a unique multimodal treatment regimen, including zinc supplementation, acupuncture, and topical capsaicin.

Association between Apical Periodontitis and Autoimmune Diseases: A Systematic Review with Meta-analysis

OBJECTIVES

The aim of this study was to perform a qualitative and quantitative synthesis of the available studies evaluating the possible relationship between apical periodontitis and autoimmune diseases.

METHODS

The literature search was conducted across 6 electronic databases (PubMed/MEDLINE, Embase, SciELO, Web of Science, Cochrane Library, and Scopus). The search covered articles published up to September 2023. There was no disagreement between the 2 reviewers. The RevMan software (V5.3) (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) was used for the meta-analysis. A dichotomized analysis was performed using the Mantel-Haenszel statistical method with a fixed-effect model and the risk ratio as the effect measure. A 95% confidence interval was adopted, and the significance level was set at P < .05. The presence of apical periodontitis was predefined as the event, with the experimental group consisting of patients with autoimmune disease and the control group consisting of patients without autoimmune disease (healthy individuals). The data used included the number of individuals presenting the event vs the total number of study participants.

RESULTS

Nine studies were included and considered eligible. The methodological quality of the studies was classified as moderate in 5 of the 9 included studies, while 2 were rated as low, and 2 were rated as high-quality. The relative risk was 1.24 with a 95% confidence interval (1.08-1.62), in which the prevalence of apical periodontitis in comparing patients with autoimmune diseases and healthy patients yielded statistically significant results (P < .0001). Thus, patients with autoimmune diseases had a 24% higher relative risk of developing apical periodontitis compared to the healthy/control group.

CONCLUSIONS

The analysis of the studies included in this review suggests a potential association between apical periodontitis and autoimmune diseases. However, it is important to consider that the selected studies have limitations, primarily because they are observational studies.

Chronic craniomandibular pain after craniotomy: A long-term clinical study

OBJECTIVE

Chronic craniomandibular/cervical pain and temporomandibular disorders have not been studied in patients who had a craniotomy several years previously. The aim of the current clinical work was to address these issues.

METHODS

A total group of 150 ambulant patients who had a previous craniotomy was subclassified according to whether or not the temporalis muscle was manipulated.

RESULTS

The average incidence of multiple subsite regional head and neck pain was 69.3% a number of years after a craniotomy. Evidence of internal derangement of the temporomandibular joint was significantly higher in the group that required manipulation of the temporalis muscle during the procedure.

CONCLUSION

The pattern of chronic craniomandibular/cervical pain experienced years after a craniotomy supports the brain neuromatrix theory of pain.

Vitamin D and COVID-19: Clinical Evidence and Immunological Insights

Vitamin D has emerged as a potential modulator of immune responses, sparking interest in its role in COVID-19 susceptibility and clinical outcomes. This review synthesizes current clinical evidence and explores immunological insights into the relationship between vitamin D levels and COVID-19 infection severity. Epidemiological studies indicate an inverse correlation between vitamin D deficiency and an increased risk of severe disease, hospitalization, and mortality in COVID-19 patients. Immunologically, vitamin D exerts regulatory effects on both innate and adaptive immunity, enhancing antimicrobial defense mechanisms, reducing excessive inflammatory responses, and potentially mitigating cytokine storm events observed in severe COVID-19 cases. Despite promising observational data, clinical trials evaluating vitamin D supplementation have shown mixed results, underscoring the need for standardized dosing regimens and patient stratification. Future research should focus on large-scale randomized controlled trials to conclusively determine the therapeutic potential and optimal supplementation strategies for vitamin D in managing COVID-19.

Porphyromonas gingivalis and Human Cytomegalovirus Co-Infection: A Potential Link Between Periodontal Disease and Oral Cancer Development

Periodontal disease (PD) is an inflammatory condition that can contribute to the development of oral cancer. Chronic inflammation from PD can lead to the release of inflammatory mediators and growth factors that promote tumorigenesis. Porphyromonas gingivalis (P. gingivalis) is one of several pathogens implicated in PD and its potential link to oral cancer. However, other viral infections, such as human cytomegalovirus (HCMV), can also contribute to chronic inflammation, creating a favorable environment for oral cancer development.

OBJECTIVES

The present literature review tries to investigate the possible influence of P. gingivalis and HCMV co-infection in fostering the development of oral cancer and chronic periodontitis.

METHODS

A comprehensive search was conducted in PubMed and Google Scholar, focusing on the relevance and significance of articles that examine the role of P. gingivalis and HCMV in periodontal disease and oral cancer.

RESULTS

The evidence suggests that P. gingivalis and HCMV may act synergistically to modulate host immunity, disrupt epithelial integrity, and interfere with key cellular pathways. These interactions may enhance tissue destruction and foster a microenvironment conducive to malignant transformation. However, most of these findings stem from in vitro models and small-scale clinical studies, limiting the generalizability and clinical relevance of current conclusions.

CONCLUSIONS

Although the proposed interaction between P. gingivalis and HCMV provides a compelling framework for understanding how microbial co-infections may influence oral cancer, the evidence remains preliminary and largely associative. To support these mechanistic hypotheses, future studies should give top priority to in vivo models, bigger patient cohorts, and longitudinal clinical studies.

Glycemic Control, Inflammatory Mediators, and Periodontal Health: A Cross-Sectional Study in Patients with Diabetes

Background/Objectives: The bidirectional relationship between diabetes mellitus (DM) and periodontal disease (PD) has garnered increasing attention due to shared inflammatory mechanisms and mutual disease exacerbation. In Romania, despite a high prevalence of diabetes and PD, integration of oral health into diabetes care remains limited. This study aimed to investigate the association between glycemic control, salivary inflammatory biomarkers (IL-1β, IL-6, MMP-8), and periodontal status in diabetic patients. Additionally, it evaluated patients' awareness of oral health risks and their communication with healthcare providers regarding periodontal care. Methods: A cross-sectional, observational study was conducted between May and December 2024, involving 79 adult patients with confirmed type 1 or type 2 DM. Periodontal examinations assessed probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Salivary samples were collected to quantify IL-1β, IL-6, and MMP-8. Participants also completed a structured questionnaire on oral symptoms, hygiene practices, and awareness of the diabetes-periodontitis link. Correlation and t-test analyses were used to explore associations between clinical, biochemical, and self-reported variables. Results: Most participants had advanced periodontitis (65.8% Stage IV; 72.2% Grade C). IL-1β and IL-6 were positively correlated (r = 0.34, p < 0.01), while MMP-8 correlated with PI (r = 0.28) and BOP (r = 0.26). Inflammatory markers showed weak correlation with HbA1c. Notably, patients with higher oral health knowledge reported worse clinical indices, suggesting increased symptom awareness rather than preventive effectiveness. Conclusions: This study reinforces the inflammatory link between DM and PD and highlights the need for integrated care models. Periodontal screening and education should be embedded within diabetes management, particularly in high-risk populations.

Association between oral health and bowel habits: a cross-sectional study

BACKGROUND

Oral diseases affect approximately 3.5 billion people worldwide, disproportionately burdening populations in developing countries. Chronic diarrhea and constipation, as common intestinal disorders, may interact bidirectionally with oral health, though their population-level associations remain unexamined.

METHODS

We analyzed data from the National Health and Nutrition Examination Surveys (NHANES) 2005-2008, selecting participants based on inclusion criteria. Chronic diarrhea and constipation were defined based on the bowel health questionnaire. Oral health indicators (teeth condition and oral pain frequency) were derived from the oral health questionnaire. Covariates selected by Lasso regression were analyzed through adjusted logistic regression to examine associations between bowel habits and oral health. Restricted cubic splines (RCS), subgroup stratification, and sensitivity analyses were also used.

RESULTS

A total of 7512 participants aged ≥ 20 with complete information were included. Multivariable logistic regression revealed a significant association between chronic constipation and poor teeth condition (OR:1.45, 95% CI: 1.05-2.01, P = 0.029). A U-shaped dose-response relationship was observed between stool frequency and poor teeth condition (nonlinear P-value = 0.002) using RCS analysis, with both abnormally low and high bowel frequencies correlating with increased oral health risks. No significant association was identified between oral pain frequency and abnormal bowel habits after full covariate adjustment. Stratified analyses indicated that daily dietary fiber intake ≥ 25 g was associated with reduced risks of poor teeth condition (chronic diarrhea OR: 0.40, 95% CI: 0.12-0.98; chronic constipation OR: 0.44, 95% CI: 0.13-1.09), whereas higher income (PIR > 3.5) correlated with elevated risks (chronic diarrhea OR: 2.38, 95% CI: 1.35-3.98; chronic constipation OR: 2.18, 95% CI: 1.22-3.70). Sensitivity analyses supported the stability of associations between abnormal bowel habits and poor teeth condition.

CONCLUSIONS

Both chronic constipation and diarrhea were associated with higher risk of poor teeth condition. In the general population and subgroup analyses, individuals with stool frequency around 8-10 times per week demonstrated the lowest risk of poor teeth condition. Stratified analysis indicates that dietary fiber intake and PIR might modify the observed relationship between abnormal bowel habits and teeth condition.

Patients with vasculitis present a poor oral health: results of the online cross-sectional survey from Canada (VASC-TOOTH Survey)

To describe oral health complications and related quality of life in patients with vasculitis. Survey to assess clinical variables, pertinent to oral and dental health in patients with vasculitis and using the Oral Health Impact Profile 14 (OHIP14) questionnaire. 226 patients answered the survey. Globally, 179 (79.2%) patients reported good oral and dental health before the vasculitis diagnosis, while 92 (40.7%) patients reported a worsening since the diagnosis of vasculitis. Patients with a worsened oral health had a longer disease duration (10.0 (1.0) vs. 7.4 (0.7) years; p < 0.05), and had more relapses in the previous 2 years (34.8% vs. 16.4%; p < 0.005). The median OHIP14 score was 4 (IQR: 0-10); 97 (48.7%) patients scored > 4 points. Patients with Takayasu arteritis and Behçet disease showed worse OHIP14 scores, had a longer disease course but were younger than those with better scores or other vasculitis diagnoses. A high proportion of patients with vasculitis, especially those with Takayasu arteritis or Behçet disease, reported oral or dental complications, with subsequent impaired oral health-related quality of life.

An Overview of the Etiopathogenic Mechanisms Involved in the Expression of the Oral Microbiota

Background/Objectives: The diversity of the oral microbiota exerts its effects in maintaining dental and overall health. The unique genetic profile of each individual influences the composition of the oral microbiota, determining susceptibility to certain diseases. The aim is to observe its role by highlighting the pathogenic mechanisms involved in oral dysbiosis and identify genetic determinism's influence in maintaining balance. Methods: This study was designed as a narrative review of the oral microbiota, utilizing some of the principles and guidelines of systematic review to increase methodological rigor. We examined 121 articles such as reviews, meta-analyses, editorials, and observational studies, which met the inclusion and exclusion criteria. The inclusion criteria for studies were as follows: (1) studies that evaluated the impact of the microbiota in oral or/and systemic diseases; (2) studies that observed pathogenic mechanisms in the oral microbiota; (3) studies that evaluated the interaction of the microbiota with the immune system (4); studies that evaluated genetic implications in the microbiota. Results: Host genes regulate inflammatory and immunological reactions that play a role in microbiological balance. This explains the increased resistance of some to diseases, including gingivitis or periodontitis. Also, the implications of oral dysbiosis are reflected not only locally, but also generally, being associated with various systemic conditions. Conclusions: Understanding the pathogenic mechanisms and genetic determinants involved in oral dysbiosis may help create individualized therapies for preventing and managing oral and systemic disorders. A healthy lifestyle and adequate oral hygiene can facilitate a diverse and balanced microbiome, crucial for overall health.

Granulomatosis with polyangiitis presenting with isolated external genital and urethral manifestations: a case-based review

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis primarily affecting the respiratory tract and kidneys, with external genital and urethral lesions (EGUL) being exceedingly rare. We present a case of a middle-aged man with relapsing proteinase 3-antineutrophil antibody-positive GPA who developed isolated granulomatous, ulcerative balanitis, and urethritis. His condition abruptly worsened after a prolonged indolent course, requiring treatment with glucocorticoids and rituximab, leading to successful remission. To better characterize EGUL in GPA, a systematic literature search was performed in PubMed, Scopus, and the NPO Japanese Society of Medical Abstracts databases using keywords related to GPA and EGUL. Cases meeting the American College of Rheumatology or Japanese Ministry of Health, Labor, and Welfare criteria for GPA and the 2012 Chapel Hill Consensus Conference definitions were included for analysis. Our review identified that EGUL often presents as an initial symptom and can be classified by the presence or absence of preceding urethritis. Cases with preceding urethritis had a higher risk of severe complications with extensive penile or urethral involvement. In contrast, penile lesions without preceding urethritis typically presented as characteristic mucosal lesions localized around the glans. In females, GPA-associated urethritis frequently led to periurethral mass formation, vaginal involvement, and significant sequelae. Given the potential for delayed diagnosis and serious complications, clinicians should be vigilant for EGUL in patients with suspected or diagnosed GPA. Future prospective studies with larger cohorts are needed to elucidate the prevalence, clinical spectrum, and optimal management of these rare but significant manifestations of GPA.

Cone Beam Computed Tomography Evaluation of Stafne Bone Defect: A Case Series and Review of Radiographic Features

Background: Stafne's bone defects (SBDs) are rare, intraosseous lesions not only localized in the mandible but also asymptomatic by default and found occasionally at radiographically investigations. The size and location of these defects can vary, although most are located in the posterior mandible. Since anterior variants are less frequently reported, diagnostic imaging is crucial for distinguishing SBDs from other diseases. This case series documents both familiar and unusual appearances, highlighting the diagnostic value of cone beam computed tomography (CBCT) in the evaluation of SBDs. Case Presentation: This study evaluated four instances of SBDs using CBCT. In Case 1, a 48-year-old man without any clinical symptoms had a characteristic posterior SBD located beneath the inferior alveolar canal. Case 2 described a 28-year-old woman's unusual anterior mandibular SBD, which was accompanied with scalloping and tooth diversion. In Case 3, a 59-year-old woman had a unique case of bilateral SBDs with combined buccal and lingual depressions. In Case 4, a 47-year-old man had a large anterior SBD with partial root exposure and fenestration. In all cases, CBCT interpreted detailed three-dimensional imaging, assessing diagnosis and effective differentiation from other mandibular pathologies. Conclusions: CBCT proved to be essential in accurately diagnosing SBDs in every instance, particularly when it came to spotting unusual signs like anterior and bilateral lesions. The findings confirmed that SBDs are benign and typically do not require treatment. The improved radiographic capabilities of CBCT support the argument for conservative management strategies and improve diagnostic accuracy.

Prevention and control of HPV-related cancers in people living with HIV

The advent of effective antiretroviral therapy (ART) has increased the lifespan of many people living with HIV. As a result, cancers driven by high-risk human papillomavirus (HPV) infection have emerged as an increasingly important cause of mortality in this population. The complex interplay between HIV and HPV necessitates a deep understanding of the HPV-related cancer burden in people living with HIV and the integration of effective prevention strategies into their care. Although cervical cancer is a global concern, anal cancer is more important among people living with HIV in settings where HIV is more concentrated among men who have sex with men. High HPV prevalence, coupled with resource constraints, particularly in sub-Saharan Africa, where the majority of people living with HIV reside, creates substantial barriers to successful prevention and management of HPV-related malignancies. Implementing preventive measures, such as HPV vaccination and comprehensive screening programmes, is crucial and will require addressing existing health inequities and developing tailored interventions for people living with HIV. The development of enhanced secondary prevention tools and innovative treatment modalities is essential to mitigate the burden of HPV-associated cancers and improve the overall health outcomes for this vulnerable population.

Oral Extraintestinal Manifestations of Inflammatory Bowel Disease: The Temporal Relationship Between Oral and Intestinal Symptoms

Objectives

Oral extraintestinal manifestations (OEIMs) of inflammatory bowel disease (IBD) may impact IBD treatment. The aims of this study were to: (1) determine which OEIMs are most prevalent among patients with IBD, (2) investigate the presence of a temporal association between GI luminal disease activity and OEIMs, and (3) determine how often changes in therapeutic management of IBD are needed in the presence of OEIMs.

Study Design

A retrospective cohort study was performed for adult patients with IBD evaluated between January 2017 and November 2021 with at least 1 oral complaint. Demographic data were collected from the charts of these patients. Kruskal-Wallis test for continuous measures and Fisher's Exact test for categorical measures were used.

Results

A total of 116 patients with IBD who had presented with at least 1 oral finding during the study time period were identified. Aphthous ulcers were the most common oral presentation in both Crohn's disease (CD) (85.1%) and ulcerative colitis (UC) (75.0%). OEIMs were associated with CD activity in the small intestine (P = .004) and colon (P < .001). UC pancolitis was associated with OEIMs (P = .002). In 32.7% of patients, OEIMs led to either an increase in dose or frequency of IBD therapy. In an additional 16.4% of patients, new systemic agents were started because of the OEIMs.

Conclusions

This study provides evidence that patients with IBD may develop OEIMs synchronous with IBD flares and may require escalation of IBD therapy when OEIMs occur.

Uses of soybean isoflavonoids in dentistry: A literature review

Soybean isoflavones including genistein, daidzein and glycitein have excellent therapeutic and health properties. In this article, we reviewed soy isoflavones with a specific focus on the role they play in dentistry. In the present article, we reviewed English published articles up to December 2020 and summarized their effectiveness in inflammation, bone effects, disease prevention, and treatment of periodontal tissue and its related diseases, as well as their anti-microbial activity against oral bacteria, oral, head and neck cancers. This study shows that the anti-inflammatory effect of soy isoflavones in periodontal disease is through its inhibitory effect on the production of inflammatory cytokines and inhibition of mitogen-activated protein kinase (MAPK) activity. It has been observed that isoflavones can stop cell division in Staphylococcus aureus and may be helpful to treat salivary gland disorders caused by estrogen deficiency. Genistein and daidzein increase mineral content in bones and protect against bone loss and genistein may be beneficial as preventive chemical agents for head and neck cancers.

Impact of HPV status on oropharyngeal cancer detection via gastrointestinal endoscopy: a retrospective study

BACKGROUND

Gastrointestinal endoscopy (GIE) performed by gastroenterologists is essential for the early detection of pharyngeal cancer. Human papillomavirus (HPV) is a significant cause of oropharyngeal squamous cell carcinoma (OPSCC). However, the prevalence of HPV-related OPSCC detected by GIE remains unclear.

AIM

This study aims to evaluate the differences in detection rates, patient characteristics, and treatment approaches between HPV-positive and HPV-negative OPSCCs, with a focus on the role of GIE in early diagnosis.

METHODS

We retrospectively analyzed 207 OPSCCs from 2018 to 2022, where HPV infection was diagnosed by p16 immunohistochemistry. We compared detection modalities and evaluated the proportion of lesions detected by GIE in both p16-positive and p16-negative cases.

RESULTS

Out of the 207 patients, 92 (44.4%) were p16-positive. p16-positive cases had significantly lower rates of alcohol use, smoking, and history of esophageal or head/neck squamous cell carcinoma (all p < 0.001). Only 4.3% of p16-positive cases were detected by GIE, compared to 44.3% of p16-negative cases (p < 0.001). In addition, p16-positive patients were often diagnosed at advanced stages and underwent transoral resection less frequently (2.2% vs. 31.3%, p < 0.001). In cT1 cases, GIE and laryngoscopy revealed that p16-positive lesions were typically protruding and white to normal-colored, while p16-negative lesions were predominantly flat and erythematous.

CONCLUSIONS

HPV-related OPSCC cases are rarely detected by GIE, and few cases are treated with minimally invasive transoral resection. These findings highlight the need for enhanced detection strategies for HPV-positive OPSCC.

Multi-active phlorotannins boost antimicrobial peptide LL-37 to promote periodontal tissue regeneration in diabetic periodontitis

The bidirectional correlation between diabetes and periodontitis positions the latter as the most prevalent complication of the former. Rehabilitation of the periodontal tissues damaged by diabetic periodontitis presents a significant clinical challenge. The multifaceted nature of the pathogenesis of diabetic periodontitis necessitates a comprehensive approach in its treatment to mitigate its adverse effects. To address this, a temperature-sensitive hydrogel containing phlorotannins (PL) and antimicrobial peptide LL-37 was developed to shift the microenvironment of diabetic periodontitis from an exacerbated high-glycemic inflammatory state to a regenerative one. The addition of PL significantly enhanced the antimicrobial properties, stability, and safety of LL-37. Vitro experiments confirmed that PL/LL-37 had good biocompatibility and promoted osteogenic differentiation of bone. PL/LL-37 demonstrated antioxidant properties by scavenging DPPH free radicals and inhibiting NO production. Furthermore, PL/LL-37 effectively modulated macrophage polarization from a M1 phenotype to an M2 phenotype through NF-κB P-p65 inflammatory pathway, thereby reducing the release of pro-inflammatory cytokines and promoting the secretion of anti-inflammatory cytokines. Interestingly, it could downregulate the AGE-RAGE signaling pathway, exerting a protective effect against diabetes. In addition, PL/LL-37 could attenuate inflammation levels, inhibit osteoclast production, promote bone regeneration, inhibit apoptosis and decrease RAGE levels in a rat model of diabetic periodontitis. These combined features synergistically accelerate diabetic periodontal bone regeneration. Consequently, PL/LL-37 emerges as a promising candidate for clinical treatment of diabetic periodontitis.

Macrophage-Hosted Porphyromonas gingivalis Is a Risk Factor for Cataract Development

Purpose

We studied the regulatory association of Porphyromonas gingivalis (PG) and cataracts.

Methods

PCR and FISH assays were used for detecting PG 16s ribosomal RNA genome, Immunofluorescence was for expression of RpgA in anterior capsular epithelium and fibrosis markers in anterior subcapsular cataract (ASC) model. Flow cytometry was for reactive oxygen species and apoptosis. RNA deep sequencing is for differential gene expression analysis.

Results

PG's 16s ribosomal RNA gene is positively in 43.3% (101/233 cases) of aqueous humor (AH) samples of patients with cataracts, which differs from 4.7% (6/127) of PG-positive AH in patients with glaucoma. Diabetic and high myopia cataracts increase PG-positive AH compared with age-related cataracts. No PG is observed in AH of congenital cataracts. PG is positive in 82% to 94% of the cataractous anterior capsule tissues from high myopia and age-related, congenital, and diabetic cataracts. The PG-positive cells in the cataractous anterior capsular epithelium are CD68+/CD14+ macrophages, but not anterior epithelial cells. In rat ASC models, PG injected via the tail vein or PG-carried bone marrow monocytes can migrate into the equatorial lens epithelium in form of PG-positive macrophages, which promote ASC progression with upregulation of collagen, fibronectin and α smooth muscle actin (α-SMA) expression, and increase 8-OHdG levels and α-SMA expression in the surrounding lens epithelial cells. Kyoto Encyclopedia of Genes and Genomes and Gene Ontology analysis of the RNA sequencing dataset of ASC tissues shows that signaling pathways related to epithelial-mesenchymal transition, oxidative stress, and cell death are up-regulated in PG + ASC compared with that in ASC alone. Co-culture of supernatants of Raw264.7/PG+ cells with rat primary lens epithelial cells increases the 8-OHdG levels, mitochondrial fission, apoptosis, and expression of α-SMA.

Conclusions

Chronic infection with PG can access the lens epithelium via macrophages during stress conditions, which promotes cataract development by possibly elevating oxidative stress, apoptosis, and epithelial-mesenchymal transition in lens tissues. PG infection is a novel a risk factor for cataract development.

A systematic review and network meta-analysis of the association between periodontitis and inflammatory bowel diseases

OBJECTIVES

Several earlier studies have shown that IBD (including its two subtypes, ulcerative colitis (UC) and Crohn's disease (CD)) increases the risk of periodontal disease. This study aimed to evaluate the relevance among periodontitis and IBD subcategories.

METHODS

This study was conducted based on PRISMA guidelines. The Web of Science, PubMed, Google Scholar, and Scopus databases were searched up to February 2024 using pertinent keywords. Case series, review articles, and animal studies were excluded. The risk of bias in this research was evaluated through the Joanna Briggs Institute (JBI) criteria. The meta-analysis was conducted using R statistical software.

RESULTS

A total of 9134 patients within 13 studies after the screening process were evaluated. Our study has shown that periodontitis is significantly more prevalent among IBD patients (UC and CD). According to prior meta-analyses, PD morbidity was found to be significantly high among CD patients (OR: 4.30; 95% CI: 3.72-4.98; I2 = 0%). Similarly, UC elevated PD risk (OR: 4.55; 95% CI: 3.76-5.50; I2 = 0%). The risk of periodontitis was not significantly different between CD and UC patients (OR: 0.96; 95% CI: 0.65-1.43; I2 = 34%).

CONCLUSIONS

UC and CD patients were more likely to develop periodontitis, with low heterogeneity between studies, while the prevalence of periodontitis among UC and CD patients was not meaningfully different.

CLINICAL RELEVANCE

The higher risk of periodontitis in patients with IBD indicates the necessity of screening for periodontitis. Considering the various oral manifestations and poor quality of life associated with IBD, it is important to be aware of the symptoms of periodontitis.

Omega-3 attenuates the severity of medication-related osteonecrosis of the jaws in rats treated with zoledronate

This study aimed to evaluate the ability of ω-3 to modulate the tissue response in rats with MRONJ, focusing on histopathological and immunohistochemical parameters. Forty Wistar rats were subjected to bilateral ovariectomy and, three months later, the medication regimen with ZOL (100μg/kg; groups ZOL and ZOL-ω3) of vehicle (VEH and VEH-ω3) was initiated. Following 3 weeks of ZOL or VEH, experimental periodontitis was induced around the mandibular left first molars of all animals. Then, 14 days later (one day before tooth extraction), daily dietary supplementation with ω-3 was given to animals belonging to groups VEH-ω3 or ZOL-ω3. Euthanasia was performed 21 days after tooth extraction. Histologic, histometric (newly-formed bone tissue [NFBT] and non-vital bone tissue [NVBT]), and immunohistochemical (TNF-α, α-SMA, ALP, IL-1β, VEGF, OCN, and TRAP) analyses were performed. Dietary supplementation with ω-3 reduced the amount of NVBT and controlled the intensity and extension of the inflammatory infiltrate in ZOL-ω3, as compared with ZOL. Osteoclast and osteoblast activity were not statistically different between groups ZOL and ZOL-ω3. The structure of the epithelium and the underlining connective tissue were improved by the supplementation with ω-3 in animals under ZOL therapy. Oral supplementation with omega-3 controlled the inflammation and reduced the amount of non-vital bone at the tooth extraction site of ovariectomized rats treated with ZOL and attenuating the severity of MRONJ.

Intestinal flora was associated with occurrence risk of chronic non-communicable diseases

BACKGROUND

The intestinal flora (IF) has been linked to risks of non-communicable diseases, especially various cancers, stroke, and Alzheimer's disease. However, many uncertainties of these associations during different stages of growth, development, and aging still exist. Therefore, further in-depth explorations are warranted.

AIM

To explore the associations of the human IF with disease risks during different stages of growth, development, and aging to achieve more accurate and convincing conclusions.

METHODS

Cohort, cross-sectional, case-control, and Mendelian randomization studies published in the PubMed and Web of Science databases until December 31, 2023 were systematically reviewed to clarify the associations of the IF at the genus level with the risks of various non-communicable diseases, which were grouped in accordance with the 10th revision of the International Classification of Diseases.

RESULTS

In total, 57 studies were included to quantitatively examine the influence of the IF on the risks of 30 non-communicable diseases during different stages of growth, development, and aging. Population studies and Mendelian randomization studies confirmed positive associations of the abundances of Bifidobacterium and Ruminococcus with multiple sclerosis.

CONCLUSION

These findings contribute to a deeper understanding of the roles of the IF and provide novel evidence for effective strategies for the prevention and treatment of non-communicable diseases. In the future, it will be necessary to explore a greater variety of research techniques to uncover the specific mechanisms by which gut microbiota trigger diseases and conduct in-depth studies on the temporal relationship between microbiota alterations and diseases, so as to clarify the causal relationship more accurately.

Chronic Inflammation to Cancer: The Impact of Oxidative Stress on DNA Methylation

The genomic landscape of cancer cells is complex and heterogeneous, with aberrant DNA methylation being a common observation. Growing evidence indicates that oxidants produced from immune cells may interact with epigenetic processes, and this may represent a mechanism for the initiation of altered epigenetic patterns observed in both precancerous and cancerous cells. Around 20% of cancers are linked to chronic inflammatory conditions, yet the precise mechanisms connecting inflammation with cancer progression remain unclear. During chronic inflammation, immune cells release oxidants in response to stimuli, which, in high concentrations, can cause cytotoxic effects. Oxidants are known to damage DNA and proteins and disrupt normal signalling pathways, potentially initiating a sequence of events that drives carcinogenesis. While research on the impact of immune cell-derived oxidants on DNA methylation remains limited, this mechanism may represent a crucial link between chronic inflammation and cancer development. This review examines current evidence on inflammation-associated DNA methylation changes in cancers related to chronic inflammation.

Correlation of the oral health and biochemical profile in hemodialysis patients with end-stage renal diseases

The current study aims to investigate the oral health of end-stage renal diseases (ESRD) patients undergoing hemodialysis and to correlate it with the biochemical profile of the patients. The current study included 43 ESRD patients on regular hemodialysis. The oral hygiene status, dental, and periodontal health were measured by the following indices: decayed, missed, and filled teeth (DMFT) index, visible plaque index (VPI), and Russell periodontal index (RPI). Several biochemical, hormonal, and hematological parameters were evaluated for each patient. The correlation of the oral health status with the biochemical profile of the patients was measured. The mean age of the participants in the current study was (51.67 ± 14.7) years. About 81% of the participants were hypertensive (35), 19% were diabetic (8), and 28% showed HCV positivity (12). VPI showed 30% of patients had fair oral hygiene and 44% had poor oral hygiene. According to RPI, periodontitis was detected in more than 95% of patients. It was significantly correlated with the age and body mass index (BMI) of the patients. DMFT index was significantly positively correlated to RPI and serum transferrin saturation. RPI scores showed a significant correlation between the ages of the patients and their BMI. VPI significantly correlated with serum calcium, but not with other biochemical variables. ESRD patients treated with hemodialysis showed several oral health concerns. Most of these patients had periodontitis, which was more frequent in diabetics and elderly patients. Advanced grades of periodontitis were associated with older age and increased BMI.

Porphyromonas gingivalis outer membrane vesicles alter cortical neurons and Tau phosphorylation in the embryonic mouse brain

Porphyromonas gingivalis (Pg) is an oral bacterial pathogen that has been associated with systemic inflammation and adverse pregnancy outcomes such as low birth weight and pre-term birth. Pg drives these sequelae through virulence factors decorating the outer membrane that are present on non-replicative outer membrane vesicles (OMV) that are suspected to be transmitted systemically. Given that Pg abundance can increase during pregnancy, it is not well known whether Pg-OMV can have deleterious effects on the brain of the developing fetus. We tested this possibility by treating pregnant C57/Bl6 mice with PBS (control) and OMV from ATCC 33277 by tail vein injection every other day from gestational age 3 to 17. At gestational age 18.5, we measured dam and pup weights and collected pup brains to quantify changes in inflammation, cortical neuron density, and Tau phosphorylated at Thr231. Dam and pup weights were not altered by Pg-OMV exposure, but pup brain weight was significantly decreased in the Pg-OMV treatment group. We found a significant increase of Iba-1, indicative of microglia activation, although the overall levels of IL-1β, IL-6, TNFα, IL-4, IL-10, and TGFβ mRNA transcripts were not different between the treatment groups. Differences in IL-1β, IL-6, and TNFα concentrations by ELISA showed IL-6 was significantly lower in Pg-OMV brains. Cortical neuron density was modified by treatment with Pg-OMV as immunofluorescence showed significant decreases in Cux1 and SatB2. Overall p-Tau Thr231 was increased in the brains of pups whose mothers were exposed to Pg-OMV. Together these results demonstrate that Pg-OMV can significantly modify the embryonic brain and suggests that Pg may impact offspring development via multiple mechanisms.

Evaluation of salivary Ki-67 in health and periodontitis

BACKGROUND

Ki-67, a nuclear protein is found in cells undergoing proliferation during the cell cycle. It has been established as an important tumor proliferation and prognostic marker. An increased expression of Ki-67 is observed in inflammation. Periodontitis tissue biopsy specimens have shown Ki-67 expression. Saliva has become popular as a non-invasive source of biomarkers that may have a clinical utility. Ki-67 has not been examined in the saliva of patients having periodontitis. This cross-sectional study aimed to detect and make a comparative estimation of salivary Ki-67 in health and periodontitis.

METHODS

Fifty-two participants were divided equally into two groups: Health [systemically and periodontally healthy (n = 26)] and Periodontitis [systemically healthy periodontitis patients (n = 26)]. Study volunteers were recruited based on the selection criteria. Plaque index, modified gingival index, bleeding on probing, probing pocket depth and clinical attachment loss were recorded. Saliva was obtained and Ki-67 was estimated with a commercially available ELISA kit.

RESULTS

The periodontitis group had significantly higher levels of Ki-67 than the healthy group. Overall, except with plaque index, there were significant positive weak correlations between Ki-67 and modified gingival index, bleeding on probing, probing pocket depth, and significant positive strong correlation with clinical attachment loss. Receiver operating characteristic analysis of the diagnostic accuracy of Ki-67 in periodontitis showed that the area under the curve was statistically significant, and the cutoff value was > 787.67 pg/ml.

CONCLUSION

Ki-67 can be detected in saliva and has a role in periodontitis. This implies that saliva can be a non-invasive source for Ki-67 as a potential biomarker in periodontitis.

A Potential Link Between Oral Microbiota and Female Reproductive Health

Oral cavity dysbiosis is associated with numerous inflammatory diseases, including diabetes, inflammatory bowel diseases, and periodontal disease. Changes in the oral microenvironment lead to bidirectional interactions between pathogens and individual host systems, which may induce systemic inflammation. There is increasing evidence linking the condition of the oral cavity with the most common causes of female infertility, such as polycystic ovary syndrome and endometriosis, as well as gestational complications, e.g., low birth weight, preterm delivery, and miscarriages. This review highlights the composition of the female oral microbiome in relation to infertility-related disorders, such as endometriosis and polycystic ovary syndrome, and provides a comprehensive overview of the current state of knowledge on the relationship between a dysbiotic oral microbiome, pregnancy, and its impact on the female reproductive tract.

The Silent Epidemic: Unveiling Herpetic Uveitis in the Elderly

In aging societies, uveitis-a leading cause of vision loss due to ocular inflammation-is increasingly prevalent, especially among older people. This study aimed to determine the trends and contributing factors of herpetic uveitis in older people, reflecting the broader impact of demographic shifts on ocular health. A retrospective study at the Institute of Science Tokyo reviewed uveitis cases in patients aged ≥ 65 years between 2012 and 2022. Among the 1095 older patients diagnosed with uveitis, 65 (5.9%) had herpesvirus uveitis, predominantly manifesting as unilateral anterior uveitis, with cytomegalovirus as the most common virus. Male predominance in herpetic uveitis cases was identified. The study also noted a significantly higher incidence of unilateral onset in herpetic cases compared to non-herpetic ones (p < 0.05). There was a trend toward a higher rate of secondary glaucoma in herpetic cases. Post-2020, an upsurge in herpetic uveitis diagnoses was recorded, potentially linked to the immunosuppressive effects of the coronavirus disease 2019 pandemic. Additionally, rare and severe acute retinal necrosis was identified in the study cohort. These findings highlight the growing trend of herpetic uveitis in older people in Japan and emphasize the necessity for advanced monitoring, diagnostic accuracy, and treatment strategies for herpes uveitis in aging populations globally.

Strawberry gingivitis as an initial presentation of granulomatosis with polyangiitis in an older adult

OBJECTIVE

To describe a rare case of granulomatosis with polyangiitis (GPA) in an older adult in light of the existing literature.

BACKGROUND

GPA is a potentially life-threatening multisystem necrotising vasculitis, characterised by a spectrum of oral mucosal lesions that present diagnostic challenges.

MATERIALS AND METHODS

A 76-year-old female patient presented with asymptomatic granular and haemorrhage swelling ("strawberry" gingivitis) affecting the upper and lower anterior and posterior gingivae. Cytoplasmic antineutrophil cytoplasmic antibody (ANCA) was positive. Concurrent kidney lesions were diagnosed.

RESULTS

Histopathological examination revealed a pseudoepitheliomatous proliferation with perivascular inflammation and a dense eosinophilic infiltrate. After a 5-year follow-up, the patient showed no signs of recurrence. A literature review performed using PubMed, Web of Science and Scopus identified 22 documented cases of GPA-related oral lesions in older adults, with equal sex distribution and 63.6% occurring in the seventh decade of life.

CONCLUSION

Early recognition and diagnosis of "strawberry" gingivitis in older adults with GPA are crucial, as these oral manifestations may be the initial presentation of the disease.

Current Status of Dental Examinations During Pregnancy Term in Matsudo City, Japan

AIM

Poor oral hygiene during pregnancy is associated with pre-term birth, low birth weight, and pregnancy-induced hypertension, suggesting its significant effects on both maternal and fetal health. However, global guidelines indicate that oral care during pregnancy remains an underdeveloped field, and no large-scale reports on dental studies conducted during pregnancy exist in Japan. Therefore, we assessed the key factors that contribute to maintaining oral health during pregnancy in a cohort of Japanese women.

METHODS

We conducted dental examinations on 907 pregnant women in Matsudo City, Japan, and investigated the key factors for maintaining 379 women (41.7%) had untreated cavities. An increase in the frequency of toothbrushing was associated with a higher number of treated teeth (r=0.315, p < 0.001). However, periodontal disease-related factors such as gingival bleeding (71.2%) and the condition of periodontal pockets showed little correlation with brushing frequency(r=-0.139, p > 0.05 for untreated teeth and brushing frequency).

CONCLUSIONS

While brushing teeth three times a day, including during pregnancy, is ideal, attention should also be directed to other aspects, such as brushing technique and thoroughness, which may require further consideration. This report serves as a foundation for obstetricians and dentists to recognize the importance of oral hygiene management during pregnancy and advocate for dental checkups during pregnancy, providing valuable opportunities to increase awareness regarding this issue.

Erianin serves as an NFATc1 inhibitor to prevent breast cancer-induced osteoclastogenesis and bone destruction

INTRODUCTION

Breast cancer-related bone metastasis can lead to skeletal-related events (SREs), which decrease patient quality of life. Inhibition of osteoclastogenesis is a key treatment for SREs; however, the availability of clinical drugs remains limited, and all existing ones disrupt physiological bone formation, while exhibiting no effect on patient survival time.

OBJECTIVES

This study aimed to identify a novel osteoclast inhibitor for the treatment of breast cancer-induced SREs.

METHODS

The MDA-MB-231 breast cancer cell-induced bone loss model was used to investigate the therapeutic effects of erianin in vivo. Then, we evaluated the inhibitory effects of erianin on osteoclastogenesis and signalling in bone marrow-derived macrophages (BMMs) induced by conditioned medium from MDA-MB-231 breast cancer cells (231 CM) and receptor activator of nuclear factor-κB ligand (RANKL) in vitro. Next, a Cellular Thermal Shift Assay and siRNA-mediate knockdown were performed, to investigate the target of erianin during osteoclast formation. The effects of erianin on human osteoclastogenesis were evaluated using CD14+ monocytes obtained from patients with breast cancer.

RESULTS

Erianin effectively improved breast cancer cells-induced bone destruction at doses of 2 and 20 mg/kg/day in vivo, while suppressing osteoclastogenesis and the upregulation of SRC-NFATc1, INTEGRIN β3-MMP9 signals induced by 231 CM and RANKL in vitro. Furthermore, erianin interacted with NFATc1 but not SRC, and Nfatc1 knockdown eliminated the inhibitory effects of erianin on osteoclastogenesis. Notably, lower expression of NFATc1 positively correlated with longer survival in patients with cancer and a high risk of bone metastasis. We further revealed that 62.5-250 nM erianin suppresses NFATc1 and excessive osteoclastogenesis in CD14+ monocytes from patients with breast cancer.

CONCLUSION

Erianin acts as an NFATc1 inhibitor that attenuates breast cancer-induced osteoclastogenesis and bone destruction.

Real-world study of medication-related osteonecrosis of the jaw from 2010 to 2023 based on Food and Drug Administration Adverse Event Reporting System

Medication-related osteonecrosis of the jaw (MRONJ) is a rare and severe adverse drug reaction (ADR) commonly seen in people taking drugs prescribed for metastatic cancer and osteoporosis. Prior studies only analyzed this ADR utilizing the public database Food and Drug Administration Adverse Event Reporting System (FAERS) by different stages (2010-2014, 2015-2021); a more comprehensive study is needed to analyze the MRONJ cases and the associated drugs from a longer time span. We conducted a retrospective pharmacovigilance analysis for all reported MRONJ cases between 2010 and 2023 in FAERS, using preferred terms and the primary suspect drug as searching conditions. Thus, this study aimed to analyze the MRONJ cases and the associated drugs more comprehensively. The reporting odds ratios (RORs) and 95% CIs were calculated for each queried drug. To distinguish the signal levels, we calculated the expected information component (EIC) and its 95% CI, using the Bayesian confidence propagation neural network (BCPNN) methods. We identified 22 846 MRONJ cases. A total of 15 drug classes including 30 suspect drugs showed different positive signal levels; among these drugs, 8, 5, and 17 had strong, medium, and weak intensity signals (+++, ++, and +), respectively. Drug classes involved bisphosphonate, RANKL inhibitor, radiotherapy drug, monoclonal antibody for cancer, corticosteroid, tyrosine kinase inhibitor, mammalian target of rapamycin inhibitor, aromatase inhibitor, cyclin-dependent kinase 4/6 inhibitor, immunomodulator, microtubule inhibitor, selective estrogen receptor modulator, sclerostin monoclonal antibody, estrogen receptor antagonist, and cytotoxic drug. Bisphosphonate, RANKL inhibitor, and radiotherapy drug exhibited higher risk than other classes with higher ROR or EIC 95% CI lower limit. Females had higher MRONJ incidence than males, and the mean age was 67.33 ± 11.71 yr. Compared with previous research, this study identified more drug classes and more novel medications with positive MRONJ signals that warrant further attention.

Reduction of masseter muscle prominence after treatment with onabotulinumtoxinA: Primary results from a randomized phase 2 study

BACKGROUND

OnabotA is used to treat masseter muscle prominence (MMP).

OBJECTIVE

To assess the safety and efficacy of OnabotA for MMP in a randomized study.

METHODS

This 12-month, multicenter, double-blind, placebo-controlled, phase 2 study randomized adults (18-50 years of age) with marked/very marked bilateral MMP (≥4 on the Masseter Muscle Prominence Scale [MMPS]) to OnabotA (24, 48, 72, or 96 U) or placebo; retreatment occurred at day 180 if MMPS ≥4. Lower facial volume at day 90 was measured using Vectra 3-dimensional photography. Safety assessments included computed tomography and dental exams. Evaluations occurred monthly through day 360.

RESULTS

Among 187 randomized subjects, significant lower facial volume reductions and percentage of responders (MMPS grade ≤3) were greater with OnabotA versus placebo at day 90 (P < .001 and ≤.008, respectively). Similar efficacy was observed with retreatment. No dose-related safety trends or clinically relevant changes in the mandible or teeth occurred. Localized impact on smile was reported with 96 U OnabotA (n = 4).

LIMITATIONS

Limited sample size per individual treatment group.

CONCLUSION

OnabotA administered in 1 or 2 treatments over 1 year was associated with significant reductions in masseter muscle volume and MMP severity, with an acceptable safety profile.

Elevated Serum Presepsin Identifies Herpes Simplex Virus-1 Reactivation in COVID-19 Patients

Presepsin, a cleaved peptide of soluble CD14, may become a promising biomarker for assessing disease severity and mortality in coronavirus disease 2019 (COVID-19). Patients with severe COVID-19 frequently develop bacterial and fungal superinfections, as well as herpes simplex virus-1 (HSV-1) reactivation, which may exacerbate disease progression. This study aimed to evaluate the impact of concomitant infections on serum presepsin levels. Serum presepsin levels were measured using an enzyme-linked immunosorbent assay (ELISA) in 63 patients with moderate COVID-19, 60 patients with severe disease, and 49 healthy controls. Correlations with procalcitonin and the presence of superinfections or HSV-1 reactivation were assessed. Consistent with previous studies, serum presepsin levels were the highest in patients with severe COVID-19 (p = 0.002 compared to patients with moderate disease). Within this group, non-survivors exhibited significantly elevated presepsin levels (p = 0.027). A positive correlation between presepsin and procalcitonin was observed in both moderate and severe COVID-19 cases. Patients with bacterial or fungal superinfections showed presepsin levels comparable to those without secondary infections. However, presepsin levels were markedly elevated in patients with HSV-1 reactivation (p = 0.002). After excluding patients with HSV-1 reactivation, presepsin levels no longer differed between moderate and severe COVID-19 cases, though they remained higher than in healthy controls (p < 0.001 for both comparisons). In conclusion, these findings suggest that elevated serum presepsin levels in severe COVID-19 are primarily driven by HSV-1 reactivation rather than bacterial or fungal superinfections.

"Evaluation of the effect of nutrition and oral hygiene on Dmft index of patients applying to restorative dentistry clinic"

OBJECTIVES

The aim of this study was to investigate the effects of diet, oral hygiene, visits to the dentist, and body mass index (BMI) on the risk of dental decay.

METHODS

240 patients aged 18-50 were included in the study. Participants completed a questionnaire that included demographic information and oral hygiene habits. They were also required to submit dietary analysis forms, which asked about the foods and amounts consumed at breakfast, lunch, dinner, and during two snacks. Intraoral and radiographic examinations of the patients were performed, and the values for DMFT, plaque index, dental calculus index, and oral hygiene index (OHI-S) were recorded. Statistical analysis, including Chi-square tests, independent samples t-tests, and one-way ANOVA, was conducted on the data (p < 0.05).

RESULTS

The oral hygiene index(OHI-S) was determined to be good in 58.3% of the study participants and poor in 10%. No statistical difference was found between BMI and DMFT index (p > 0,005). When the relationship between food consumption frequencies and DMFT was evaluated, it was determined that there was no statistically significant relationship between bread, rice, milk, legumes, and DMFT values (p > 0,005), but there was a statistically significant relationship between fruit, vegetables, yoghurt, cheese, meat/chicken/fish, eggs, honey, sugar, glutens, acidic drinks, tae/coffee consumption and DMFT indices (p < 0,005 ).

CONCLUSION

The types of food consumed by patients and the frequency of consumption affect the risk of caries.

Perspectives on the Application of Biosensors for the Early Detection of Oral Cancer

Oral cancer continues to cause profound suffering and is associated with high mortality rates. Early detection techniques are crucial in enhancing patient outcomes. This review paper thoroughly evaluates the significance of biomarkers and recent advancements in oral cancer detection, emphasizing cutting-edge electrochemical methods. The paper provides an epidemiological and etiological overview, outlining its clinical importance and reviewing the current state of the art in detection methods. Despite considerable progress, conventional methods exhibit limitations such as invasiveness, long wait times, and a lack of accuracy, creating a critical need for more robust technologies. This review emphasizes the significance of oral cancer biomarkers, which are considered promising cues for early detection, facilitating the development of innovative biosensing technologies. This review seeks to illuminate the recent advances in early detection and precision diagnostics, along with the usage of artificial intelligence strategies, ultimately contributing to significant progress in the battle against oral cancer.

Age-Related Oral and Para-Oral Tissue Disorders: The Evolving Therapeutic and Diagnostic Potential of Exosomes

This review highlights the key molecular and cellular mechanisms contributing to aging, such as DNA damage, mitochondrial dysfunction, telomere shortening, protein dysfunction, and defective autophagy. These biological mechanisms are involved in various oral health conditions prevalent in the elderly, including periodontal disease, oral cancer, xerostomia, dental caries, and temporomandibular joint disorders. Exosomes generated by mesenchymal stem cells possess substantial therapeutic potential. These exosomes are nanosized extracellular vesicles derived from cells and are involved in essential intercellular communication and tissue homeostasis. The exosome-based therapies proved superior to traditional cell-based approaches, due to lower immunogenicity, ease of storage, and avoidance of complications associated with cell transplantation. Furthermore, the diagnostic potential of exosomes as non-invasive biomarkers for aging processes and age-related oral diseases offers insights into disease diagnosis, staging, and monitoring. Among the challenges and future perspectives of translating exosome research from preclinical studies to clinical applications is the need for standardized procedures to fully harness the therapeutic and diagnostic capabilities of exosomes.