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Ozdogan MS, Gungormus M. Salivary opiorphin levels in denture-related traumatic ulcers. Oral Dis 2024; 30:3136-3141. [PMID: 37793134 DOI: 10.1111/odi.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Opiorphin is a pentapeptide secreted in saliva and has a strong analgesic effect. Salivary opiorphin has been shown to increase in orofacial pain and may act as a pain reliever in pain caused by denture-related ulcers. The current study aimed to evaluate the salivary opiorphin levels in traumatic ulcers caused by ill-fitting dentures and demonstrate whether there is any correlation between trauma-related pain levels and salivary opiorphin levels. MATERIALS AND METHODS Twenty-two individuals with new full dentures and a complaint of pain due to ill-fitting were included in this study. Patients were asked to rate their level of pain on a visual analog scale (VAS). Then, saliva specimens were collected at the first visit with the complaint of pain and 7 days following the denture adjustment. RESULTS The average saliva opiorphin level before and after denture adjustment were 19.29 ± 5.44 and 15.78 ± 3.95 ng/mL, respectively. A dependent (paired) t-test determined that the mean salivary opiorphin level differed statistically significantly before and after the adjustment of the dentures. CONCLUSIONS The findings show that salivary opiorphin levels increase in pain associated with denture-related traumatic ulcers. Adjusting the dentures resulted in pain relief and a statistically significant reduction in opiorphin levels.
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Affiliation(s)
- Mahmut Sertac Ozdogan
- Department of Prosthodontics, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkiye
| | - Mustafa Gungormus
- Department of Basic Sciences, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkiye
- Central Research Laboratory Application and Research Center, Ankara Yildirim Beyazit University, Ankara, Turkiye
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2
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Wang J, Liu X, Gou J, Deng J, Li M, Zhu Y, Wu Z. Role of neuropeptides in orofacial pain: A literature review. J Oral Rehabil 2024; 51:898-908. [PMID: 38213060 DOI: 10.1111/joor.13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/19/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Neuropeptides play a critical role in regulating pain and inflammation. Despite accumulating evidence has further uncovered the novel functions and mechanisms of different neuropeptides in orofacial pain sensation and transmission, there is deficient systematic description of neuropeptides' pain modulation in the orofacial region, especially in the trigeminal system. OBJECTIVES The present review aims to summarise several key neuropeptides and gain a better understanding of their major regulatory roles in orofacial inflammation and pain. METHODS We review and summarise current studies related to calcitonin gene-related peptide (CGRP), substance P (SP), opioid peptide (OP), galanin (GAL) and other neuropeptides' functions and mechanisms as well as promising targets for orofacial pain control. RESULTS A number of neuropeptides are clearly expressed in the trigeminal sensory system and have critical functions in the transduction and pathogenesis of orofacial pain. The functions, possible cellular and molecular mechanisms have been introduced and discussed. Neuropeptides and their agonists or antagonists which are widely studied to be potential treatment options of orofacial pain has been evaluated. CONCLUSIONS Various neuropeptides play important but distinct (pro-nociceptive or analgesic) roles in orofacial pain with different mechanisms. In summary, CGRP, SP, NPY, NKA, HK-1, VIP mainly play proinflammatory and pro-nociceptive effects while OP, GAL, OXT, OrxA mainly have inhibitory effects on orofacial pain.
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Affiliation(s)
- Jian Wang
- Department of Pediatric Dentistry, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Xiangtao Liu
- Department of Pediatric Dentistry, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Junzhuo Gou
- Department of Pediatric Dentistry, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jing Deng
- Department of Pediatric Dentistry, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Mujia Li
- Department of Pediatric Dentistry, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Yafen Zhu
- Department of Pediatric Dentistry, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Zhifang Wu
- Department of Pediatric Dentistry, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
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3
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Giannaccare G, Vaccaro S, Borselli M, Rossi C, Carnovale Scalzo G, Scalia G, Di Cesare Mannelli L, Ghelardini C, Zerillo L, Polvere I, Vito P, Zotti T, Stilo R, Scorcia V. A Novel Ophthalmic Solution Containing Glicopro ® Complex for the Treatment of Patients with Dry Eye Disease: Results from a Pilot Study. J Clin Med 2024; 13:1447. [PMID: 38592312 PMCID: PMC10932378 DOI: 10.3390/jcm13051447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/17/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Dry eye disease (DED) is a multifactorial ocular surface disease characterized by an imbalance in ocular surface homeostasis, and tear substitutes constitute the first line of treatment. The present study aimed to evaluate the changes in the signs and symptoms of patients with DED treated with a novel tear substitute containing the GlicoPro® complex. (2) Methods: Patients with DED not successfully responding to other tear substitutes were enrolled and treated with a novel ophthalmic solution (two drops four times daily). Patients were examined before starting the study treatment (T0) and after 30 (T1) and 60 (T2) days of treatment by means of Keratograph for the evaluation of the following: (i) tear meniscus height (TMH); (ii) noninvasive Keratograph break-up time (NIKBUT); (iii) bulbar redness; and (iv) infrared meibography. The SANDE questionnaire was administered to assess ocular discomfort symptoms. Analysis of the tear content of proenkephalin and Met/Leu-enkephalin was also performed. (3) Results: At T2, a significant improvement in NIKBUT first, average, and class, TMH, and SANDE score was found. The tear content of proenkephalins was significantly higher at T1, whereas processed active Met/Leu-enkephalins increased at both T1 and T2. (4) Conclusions: Our novel tear substitute based on GlicoPro® resulted in a significant improvement in ocular discomfort symptoms, tear volume, and stability in the patients treated. The increase in active peptides processed in tears may represent the pathophysiological substrate underlying this finding.
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Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (S.V.); (M.B.); (C.R.); (G.C.S.); (G.S.); (V.S.)
- Eye Clinic, Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy
| | - Sabrina Vaccaro
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (S.V.); (M.B.); (C.R.); (G.C.S.); (G.S.); (V.S.)
| | - Massimiliano Borselli
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (S.V.); (M.B.); (C.R.); (G.C.S.); (G.S.); (V.S.)
| | - Costanza Rossi
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (S.V.); (M.B.); (C.R.); (G.C.S.); (G.S.); (V.S.)
| | - Giovanna Carnovale Scalzo
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (S.V.); (M.B.); (C.R.); (G.C.S.); (G.S.); (V.S.)
| | - Giovanni Scalia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (S.V.); (M.B.); (C.R.); (G.C.S.); (G.S.); (V.S.)
| | - Lorenzo Di Cesare Mannelli
- Department of Neuroscience, Psychology, Drug Research and Child Health-NEUROFARBA-Pharmacology and Toxicology Section, University of Florence, 50139 Florence, Italy; (L.D.C.M.); (C.G.)
| | - Carla Ghelardini
- Department of Neuroscience, Psychology, Drug Research and Child Health-NEUROFARBA-Pharmacology and Toxicology Section, University of Florence, 50139 Florence, Italy; (L.D.C.M.); (C.G.)
| | - Lucrezia Zerillo
- Department of Science and Technologies, University of Sannio, 82100 Benevento, Italy; (L.Z.); (I.P.); (P.V.); (T.Z.); (R.S.)
- Genus Biotech Srls, University of Sannio, 82100 Benevento, Italy
| | - Immacolata Polvere
- Department of Science and Technologies, University of Sannio, 82100 Benevento, Italy; (L.Z.); (I.P.); (P.V.); (T.Z.); (R.S.)
- Genus Biotech Srls, University of Sannio, 82100 Benevento, Italy
| | - Pasquale Vito
- Department of Science and Technologies, University of Sannio, 82100 Benevento, Italy; (L.Z.); (I.P.); (P.V.); (T.Z.); (R.S.)
- Genus Biotech Srls, University of Sannio, 82100 Benevento, Italy
| | - Tiziana Zotti
- Department of Science and Technologies, University of Sannio, 82100 Benevento, Italy; (L.Z.); (I.P.); (P.V.); (T.Z.); (R.S.)
- Genus Biotech Srls, University of Sannio, 82100 Benevento, Italy
| | - Romania Stilo
- Department of Science and Technologies, University of Sannio, 82100 Benevento, Italy; (L.Z.); (I.P.); (P.V.); (T.Z.); (R.S.)
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (S.V.); (M.B.); (C.R.); (G.C.S.); (G.S.); (V.S.)
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Porporatti AL, de Oliveira Machado CA, Alajbeg I, Alajbeg IZ, Paszynska E, Dmitrzak-Weglarz M, Braud A, Boucher Y. Opiorphin as a biomarker of orofacial conditions: a meta-analysis. Sci Rep 2023; 13:15533. [PMID: 37726305 PMCID: PMC10509258 DOI: 10.1038/s41598-023-42051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/05/2023] [Indexed: 09/21/2023] Open
Abstract
The aim of this meta-analysis was to answer the following question: "Are there any differences in opiorphin biomarker concentrations between different orofacial conditions and controls?". Two reviewers searched for observational studies that evaluated the levels of opiorphin in orofacial conditions, annotated in seven main databases and three that compile gray literature. Of the 443 articles obtained initially, 8 met the inclusion criteria for quantitative analyses. Relative percentages showed a mean 24.1% higher opiorphin concentration in chronic conditions (Burning Mouth Syndrome, Oral Potentially Malignant Diseases and Temporomandibular Disorder) compared to controls; 33.2% higher opiorphin in sustained pain (Symptomatic Irreversible Pulpitis, Symptomatic Apical Periodontitis, Painful Oral Soft-tissue conditions); and 21.7% higher opiorphin after stimuli (Corneal Foreign Body, Capsaicin). Meta-analysis revealed a standardized mean difference of 0.62 [0.02, 1.22] in the absolute concentration of opiorphin in saliva for the chronic group compared to the control. The analogous values for the sustained group and the stimulated group were 2.24 [0.34, 4.14] and 0.43 [0.00, 0.85], respectively. No differences in opiorphin levels were found for 'after Local Anesthesia before Tooth Extraction' or for apicoectomy. Based on the available evidence, in general, a statistically higher level of opiorphin is found in orofacial conditions. Salivary opiorphin levels are elevated in chronic, persisted and acute pain conditions, presumably reflecting a physiological homeostatic adaptative response to different conditions such as stress or pain. Salivary opiorphin might therefore be used as a valuable biomarker in several oral disorders.
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Affiliation(s)
- André Luís Porporatti
- Laboratoire de Neurobiologie OroFaciale (LabNOF, EA7543), Service Odontologie, Université Paris Cité, Groupe Hospitalier Pitié Salpêtrière-APHP, 47-83 Bd de l'Hôpital, 75651, Paris Cedex 13, France.
- GHPS Assistance Publique Hôpitaux de Paris, Paris, France.
| | | | - Ivan Alajbeg
- Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Iva Z Alajbeg
- Prosthetic Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Elzbieta Paszynska
- Department of Integrated Dentistry, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Dmitrzak-Weglarz
- Department of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Adeline Braud
- Laboratoire de Neurobiologie OroFaciale (LabNOF, EA7543), Service Odontologie, Université Paris Cité, Groupe Hospitalier Pitié Salpêtrière-APHP, 47-83 Bd de l'Hôpital, 75651, Paris Cedex 13, France
- GHPS Assistance Publique Hôpitaux de Paris, Paris, France
| | - Yves Boucher
- Laboratoire de Neurobiologie OroFaciale (LabNOF, EA7543), Service Odontologie, Université Paris Cité, Groupe Hospitalier Pitié Salpêtrière-APHP, 47-83 Bd de l'Hôpital, 75651, Paris Cedex 13, France
- GHPS Assistance Publique Hôpitaux de Paris, Paris, France
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5
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Borșa RM, Toma V, Onaciu A, Moldovan CS, Mărginean R, Cenariu D, Știufiuc GF, Dinu CM, Bran S, Opriș HO, Văcăraș S, Onișor-Gligor F, Sentea D, Băciuț MF, Iuga CA, Știufiuc RI. Developing New Diagnostic Tools Based on SERS Analysis of Filtered Salivary Samples for Oral Cancer Detection. Int J Mol Sci 2023; 24:12125. [PMID: 37569501 PMCID: PMC10418512 DOI: 10.3390/ijms241512125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Cancer still represents one of the biggest challenges in current medical practice. Among different types of cancer, oral cancer has a huge impact on patients due to its great visibility, which is more likely to create social stigma and increased anxiety. New early diagnose methods are still needed to improve treatment efficiency and patients' life quality. Raman/SERS (Surface Enhanced Raman Spectroscopy) spectroscopy has a unique and powerful potential for detecting specific molecules that can become priceless biomarkers in different pathologies, such as oral cancer. In this study, a batch of saliva samples obtained from a group of 17 patients with oro-maxillofacial pathologies compared with saliva samples from 18 healthy donors using the aforementioned methods were evaluated. At the same time, opiorphin, potassium thiocyanate and uric acid were evaluated as potential specific biomarkers for oro-maxillofacial pathologies using multivariate analysis. A careful examination of SERS spectra collected on saliva samples showed that the spectra are dominated by the vibrational bands of opiorphin, potassium thiocyanate and uric acid. Given the fact that all these small molecules are found in very small amounts, we filtrated all the samples to get rid of large molecules and to improve our analysis. By using solid plasmonic substrates, we were able to gain information about molecular concentration and geometry of interaction. On the other hand, the multivariate analysis of the salivary spectra contributed to developing a new detection method for oral cancer.
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Affiliation(s)
- Rareș-Mario Borșa
- Dental Medicine Faculty, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4, 400349 Cluj-Napoca, Romania; (R.-M.B.); (C.-M.D.); (S.B.); (H.-O.O.); (S.V.); (F.O.-G.); (M.-F.B.)
- Research Center for Advanced Medicine—MedFuture, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4-6, 400337 Cluj-Napoca, Romania; (V.T.); (A.O.); (C.-S.M.); (R.M.); (D.C.); (C.-A.I.)
| | - Valentin Toma
- Research Center for Advanced Medicine—MedFuture, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4-6, 400337 Cluj-Napoca, Romania; (V.T.); (A.O.); (C.-S.M.); (R.M.); (D.C.); (C.-A.I.)
| | - Anca Onaciu
- Research Center for Advanced Medicine—MedFuture, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4-6, 400337 Cluj-Napoca, Romania; (V.T.); (A.O.); (C.-S.M.); (R.M.); (D.C.); (C.-A.I.)
| | - Cristian-Silviu Moldovan
- Research Center for Advanced Medicine—MedFuture, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4-6, 400337 Cluj-Napoca, Romania; (V.T.); (A.O.); (C.-S.M.); (R.M.); (D.C.); (C.-A.I.)
| | - Radu Mărginean
- Research Center for Advanced Medicine—MedFuture, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4-6, 400337 Cluj-Napoca, Romania; (V.T.); (A.O.); (C.-S.M.); (R.M.); (D.C.); (C.-A.I.)
| | - Diana Cenariu
- Research Center for Advanced Medicine—MedFuture, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4-6, 400337 Cluj-Napoca, Romania; (V.T.); (A.O.); (C.-S.M.); (R.M.); (D.C.); (C.-A.I.)
| | | | - Cristian-Mihail Dinu
- Dental Medicine Faculty, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4, 400349 Cluj-Napoca, Romania; (R.-M.B.); (C.-M.D.); (S.B.); (H.-O.O.); (S.V.); (F.O.-G.); (M.-F.B.)
- Department of Maxillofacial Surgery and Implantology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Iuliu Hossu 37, 400029 Cluj-Napoca, Romania
- County Emergency Hospital Cluj, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Simion Bran
- Dental Medicine Faculty, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4, 400349 Cluj-Napoca, Romania; (R.-M.B.); (C.-M.D.); (S.B.); (H.-O.O.); (S.V.); (F.O.-G.); (M.-F.B.)
- Department of Maxillofacial Surgery and Implantology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Iuliu Hossu 37, 400029 Cluj-Napoca, Romania
- County Emergency Hospital Cluj, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Horia-Octavian Opriș
- Dental Medicine Faculty, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4, 400349 Cluj-Napoca, Romania; (R.-M.B.); (C.-M.D.); (S.B.); (H.-O.O.); (S.V.); (F.O.-G.); (M.-F.B.)
- Department of Maxillofacial Surgery and Implantology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Iuliu Hossu 37, 400029 Cluj-Napoca, Romania
- County Emergency Hospital Cluj, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Sergiu Văcăraș
- Dental Medicine Faculty, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4, 400349 Cluj-Napoca, Romania; (R.-M.B.); (C.-M.D.); (S.B.); (H.-O.O.); (S.V.); (F.O.-G.); (M.-F.B.)
- Department of Maxillofacial Surgery and Implantology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Iuliu Hossu 37, 400029 Cluj-Napoca, Romania
- County Emergency Hospital Cluj, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Florin Onișor-Gligor
- Dental Medicine Faculty, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4, 400349 Cluj-Napoca, Romania; (R.-M.B.); (C.-M.D.); (S.B.); (H.-O.O.); (S.V.); (F.O.-G.); (M.-F.B.)
- Department of Maxillofacial Surgery and Implantology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Iuliu Hossu 37, 400029 Cluj-Napoca, Romania
- County Emergency Hospital Cluj, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Dorin Sentea
- County Emergency Hospital Cluj, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Mihaela-Felicia Băciuț
- Dental Medicine Faculty, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4, 400349 Cluj-Napoca, Romania; (R.-M.B.); (C.-M.D.); (S.B.); (H.-O.O.); (S.V.); (F.O.-G.); (M.-F.B.)
- Department of Maxillofacial Surgery and Implantology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Iuliu Hossu 37, 400029 Cluj-Napoca, Romania
- County Emergency Hospital Cluj, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Cristina-Adela Iuga
- Research Center for Advanced Medicine—MedFuture, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4-6, 400337 Cluj-Napoca, Romania; (V.T.); (A.O.); (C.-S.M.); (R.M.); (D.C.); (C.-A.I.)
- Department of Pharmaceutical Analysis, Faculty of Pharmacy, “Iuliu Hațieganu” University of Medicine and Pharmacy, Pasteur 6, 400349 Cluj-Napoca, Romania
| | - Rareș-Ionuț Știufiuc
- Research Center for Advanced Medicine—MedFuture, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 4-6, 400337 Cluj-Napoca, Romania; (V.T.); (A.O.); (C.-S.M.); (R.M.); (D.C.); (C.-A.I.)
- Department of Pharmaceutical Physics-Biophysics, Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur 6, 400349 Cluj-Napoca, Romania
- TRANSCEND Research Center, Regional Institute of Oncology, 700483 Iasi, Romania
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Stendelyte L, Malinauskas M, Grinkeviciute DE, Jankauskaite L. Exploring Non-Invasive Salivary Biomarkers for Acute Pain Diagnostics: A Comprehensive Review. Diagnostics (Basel) 2023; 13:diagnostics13111929. [PMID: 37296781 DOI: 10.3390/diagnostics13111929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Pain is one of the most common complaints leading to a pediatric emergency department visit and is associated with various painful procedures, leading to increased anxiety and stress. Assessing and treating pain in children can be challenging, so it is crucial to investigate new methods for pain diagnosis. The review aims to summarize the literature on non-invasive salivary biomarkers, such as proteins and hormones, for pain assessment in urgent pediatric care settings. Eligible studies were those that included novel protein and hormone biomarkers in acute pain diagnostics and were not older than 10 years. Chronic pain studies were excluded. Further, articles were divided into two groups: studies in adults and studies in children (<18 years). The following characteristics were extracted and summarized: study author, enrollment date, study location, patient age, study type, number of cases and groups, as well as tested biomarkers. Salivary biomarkers, such as cortisol, salivary α-amylase, and immunoglobulins, among others, could be appropriate for children as saliva collection is painless. However, hormonal levels can differ among children in different developmental stages and with various health conditions, with no predetermined levels of saliva. Thus, further exploration of biomarkers in pain diagnostics is still necessary.
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Affiliation(s)
- Laura Stendelyte
- Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Mantas Malinauskas
- Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Dovile Evalda Grinkeviciute
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Lina Jankauskaite
- Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
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7
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Dalirsani Z, Amirchaghmaghi M, Ghazi A, Hashemy SI, Taherizadeh M. Assessment of salivary opiorphin in oral lichen planus. BRAZILIAN JOURNAL OF ORAL SCIENCES 2023. [DOI: 10.20396/bjos.v22i00.8667270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Opiorphin is a pentapeptide, which could be isolated from human fluids and has a decreasing effect on pain. Aim: Since lichen planus is a chronic mucocutaneous disease, which causes pain or burning feeling in the oral mucosa, this study aimed to compare salivary opiorphin levels of oral lichen planus (OLP) patients with healthy subjects. Methods: This case-control study, was performed on 24 patients with OLP lesions and 21 healthy subjects. After collecting unstimulated saliva, opiorphin levels were compared between two groups through statistical analyses. Results: There was not any significant difference between OLP patients and healthy subjects according to salivary opiorphin concentration (p=0.378). Also, in the OLP group, opiorphin concentration was not significantly different between males and females (p=0.601). Analytical analysis could not show any remarkable difference between various severity of OLP lesions regarding to salivary opiorphin levels (p=0.653). Conclusion: In this study, salivary opiorphin levels was not significantly different between patients with OLP and healthy subjects; however, more studies are suggested for better assessment of salivary opiorphin levels in various types of OLP lesions and its correlation with pain severity.
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Paszynska E, Hernik A, Slopien A, Boucher Y, Tyszkiewicz-Nwafor M, Roszak M, Bilska K, Dmitrzak-Weglarz M. Expression of salivary immunoglobulins and their association with analgesic neuropeptide opiorphin in anorexia nervosa during adolescence. J Eat Disord 2022; 10:118. [PMID: 35953876 PMCID: PMC9367138 DOI: 10.1186/s40337-022-00637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients who suffer from anorexia nervosa (AN) are characterized by exceedingly lower body weight, micro- and macro-nutrient deficiencies, and hyposalivation as compared to healthy subjects. In addition, AN may predispose to difficulties in oral health maintenance. However, little is known about the relationship between stress-dependent salivary neuro/immunopeptidergic biomarkers such as opiorphin and immunoglobulins (Ig) and AN.The aim of this case-control study was to evaluate salivary opiorphin and immunoglobulins in female children and adolescents diagnosed with AN compared to healthy controls. METHODS Adolescent patients with clinically-confirmed severe restrictive subtype AN (Body Mass Index BMI < 15 kg/m2, mean age 15.0 ± 1.8, n = 83) were examined in the first week of hospital admission and compared to healthy matched controls (n = 79). Measurements of salivary opiorphin, IgA, IgG, IgM (ELISA technique), and oral hygiene levels (Plaque Control Record index-PCR) were performed. RESULTS In the AN group, a significantly higher concentration of opiorphin was evidenced (3.1 ± 4.1 ng/ml) compared to the control group (1.1 ± 1.2 ng/ml), (p < 0.001), contrary to IgM, which was significantly lower (311.0 ± 185.3 ng/ml) than in the control group (421.2 ± 168.1 ng/ml), (p < 0.001). There were no significant differences in the levels of IgA and IgG, despite a higher concentration of IgA in the AN group vs. controls (p = 0.14). Spearman analysis revealed a correlation between opiorphin and age (p < 0.05), but also with all immunoglobulins IgA, IgG, IgM (p = 0.006, p < 0.001, p < 0.001). Similarly a correlation was found between PCR index and immunoglobulins IgG, IgM (respectively p = 0.028, p < 0.001), and between body mass, BMI, IBW% and IgA, IgM (all p < 0.05). CONCLUSIONS In the acute phase of AN, salivary changes in opiorphin and immunoglobulins related to dental plaque suggest an essential role in oral health balance. Changes related to AN may affect the anti-inflammatory and analgesic components of saliva and suggest their use as neurobiological markers in severe malnutrition.
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Affiliation(s)
- Elzbieta Paszynska
- Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), Bukowska St. 70, 60-812, Poznan, Poland.
| | - Amadeusz Hernik
- Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), Bukowska St. 70, 60-812, Poznan, Poland
| | | | - Yves Boucher
- Université de Paris, LabNOF, 75013, Paris, France.,Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | | | - Magdalena Roszak
- Department of Computer Science and Statistics, PUMS, Poznan, Poland
| | - Karolina Bilska
- Department of Psychiatric Genetics, Department of Psychiatry, PUMS, Poznan, Poland
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Biomarcadores salivares na avaliação da dor: revisão integrativa. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ar03203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Salivary Biomarkers (Opiorphin, Cortisol, Amylase, and IgA) Related to Age, Sex, and Stress Perception in a Prospective Cohort of Healthy Schoolchildren. Mediators Inflamm 2022; 2021:3639441. [PMID: 35110971 PMCID: PMC8801773 DOI: 10.1155/2021/3639441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background The use of easily accessible biomarkers for assessing young patients' health is weighty. This cohort study is aimed at measuring stress/immune biomarkers in the saliva of healthy school-age children and comparing subgroups according to age, sex, and stress perception. Material and Methods. 503 children under 12 years old (8.7 ± 1.3) were included with anthropometric evaluation (height, waist, hip circumference, body weight, and body mass index (BMI)). Levels of opiorphin (OPI), free cortisol, alpha-amylase (sAA), and secreted immunoglobulin (sIgA) were determined by quantitative assays (ELISA) in unstimulated saliva. Unpaired t-test, Welch test, and Mann-Whitney U test were applied for appropriate group comparisons, and the correlation between variables was analyzed with Spearman's rank coefficient. Results were considered significant at p < 0.05. Results sIgA and sAA exhibited significant differences depending on age and sex: IgA (ng/mL): 86 ± 68.6 vs. 104.9 ± 72.1 for (6-7 y.o.) and (8-11 y.o.), respectively, and 108.1 ± 80.1 vs. 94.6 ± 62.2 for male and females, respectively; sAA (U/mL): 78.9 ± 54.4 vs. 100.5 ± 81.2 for (6-7 y.o.) and (8-11 y.o.). No difference related to age or sex between groups was observed for cortisol and OPI. However, OPI levels were higher and correlated to prior stress exposure in children (0.31 ± 0.4 vs. 0.26 ± 0.5 ng/mL, p = 0.031). sAA was negatively correlated to low mood self-declaration in children in the last two weeks (r = -0.10, p = 0.045). Conclusions sIgA and sAA can be used as sex- and age-related biomarkers in children 6-12 y.o., which is not the case for free cortisol and opiorphin. However, OPI reflected previous exposure to stress, suggesting its use for evaluating stress-related changes in children.
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Yilmaz N, Baygin O, Tuzuner T, Mentese A, Demir S. Determination of the effect of two different methods of dental anesthesia on pain level in pediatric patients: A cross-over, randomized trial. Niger J Clin Pract 2022; 25:1853-1863. [DOI: 10.4103/njcp.njcp_289_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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New Perspectives in the Pathophysiology and Treatment of Pain in Patients with Dry Eye Disease. J Clin Med 2021; 11:jcm11010108. [PMID: 35011849 PMCID: PMC8745516 DOI: 10.3390/jcm11010108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/13/2022] Open
Abstract
Ocular discomfort and eye pain are frequently reported by patients with dry eye disease (DED), and their management remains a real therapeutic challenge for the Ophthalmologist. In DED patients, injury at the level of each structure of the ocular surface can determine variable symptoms, ranging from mild ocular discomfort up to an intolerable pain evoked by innocuous stimuli. In refractory cases, the persistence of this harmful signal is able to evoke a mechanism of maladaptive plasticity of the nervous system that leads to increased pain responsiveness. Peripheral and, subsequently, central sensitization cause nociceptor hyperexcitability and persistent pain perception that can culminate in the paradoxical situation of perceiving eye pain even in the absence of ocular surface abnormalities. Effective therapeutic strategies of these cases are challenging, and new options are desirable. Recently, a theoretical novel therapeutic approach concerns enkephalins thanks to the evidence that eye pain sensations are modulated by endogenous opioid peptides (enkephalins, endorphins and dynorphins). In this regard, new topical agents open up a new theoretical scenario in the treatment of ocular discomfort and eye pain in the setting of DED, such as, for example, a multimolecular complex based on proteins and glycosaminoglycans also containing opiorphin that may assist the physiological pain-relieving mechanism of the eye.
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GlicoPro, Novel Standardized and Sterile Snail Mucus Extract for Multi-Modulative Ocular Formulations: New Perspective in Dry Eye Disease Management. Pharmaceutics 2021; 13:pharmaceutics13122139. [PMID: 34959420 PMCID: PMC8708832 DOI: 10.3390/pharmaceutics13122139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
This study aimed to evaluate the mucoadhesive and regenerative properties of a novel lubricating multimolecular ophthalmic solution (GlicoPro®) extracted from snail mucus and its potential anti-inflammatory and analgesic role in the management of dry eye disease (DED). GlicoPro bio-adhesive efficacy was assessed using a lectin-based assay, and its regenerative properties were studied in a human corneal epithelial cell line. In vitro DED was induced in human corneal tissues; the histology and mRNA expression of selected genes of inflammatory and corneal damage biomarkers were analyzed in DED tissues treated with GlicoPro. A higher percentage of bio-adhesivity was observed in corneal cells treated with GlicoPro than with sodium hyaluronate-based compounds. In the scratch test GlicoPro improved in vitro corneal wound healing. Histo-morphological analysis revealed restoration of cellular organization of the corneal epithelium, microvilli, and mucin network in DED corneal tissues treated with GlicoPro. A significant reduction in inflammatory and ocular damage biomarkers was observed. High-performance liquid chromatography-mass spectrometry analysis identified an endogenous opioid, opiorphin, in the peptide fraction of GlicoPro. In conclusion, GlicoPro induced regeneration and bio-adhesivity in corneal cells; moreover, considering its anti-inflammatory and analgesic properties, this novel ophthalmic lubricating solution may be an innovative approach for the management of DED.
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Abstract
PURPOSE Opiorphin is an endogenous inhibitor of enkephalin-degrading enzymes. It has a strong analgesic effect in chemical and mechanical pain models. We aimed to evaluate the tear opiorphin levels in ocular pain caused by corneal foreign bodies and demonstrate whether there is any correlation with pain levels obtained from the Visual Analog Scale (VAS) score and tear opiorphin level. METHODS Thirty-two healthy individuals and 34 individuals diagnosed with corneal foreign bodies were included in this study. Tear opiorphin levels were measured by the ELISA method using a commercially available kit. The difference in tear opiorphin levels between the patient and control groups were evaluated using the Mann-Whitney U test. The correlation between VAS scores and tear opiorphin levels was evaluated using the Spearman rank correlation coefficient. RESULTS The median values of tear opiorphin levels of the patient and control groups were 134 pg/mL (86.86-296.25) and 109.80 pg/mL (66.15-191.49), respectively. The Mann-Whitney U test showed a statistically significant difference in tear opiorphin levels between patient and control groups (P < 0.05). No ocular pain was reported in the control group. The median VAS score of the patient group was 6 points (1-9). No correlation was found between VAS scores and tear opiorphin levels in the patient group. CONCLUSIONS The cornea is the most densely innervated tissue, and the highest opiorphin concentrations have been observed in tear. It is, therefore, expected that the stimulation or damage to the nerve endings in cornea would cause an increase in opiorphin secretion as a pain relief mechanism.
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Mukherjee A, Park A, Wang L, Davies KP. Role of opiorphin genes in prostate cancer growth and progression. Future Oncol 2021; 17:2209-2223. [PMID: 33593085 PMCID: PMC8293029 DOI: 10.2217/fon-2020-1299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/04/2021] [Indexed: 01/02/2023] Open
Abstract
Background: We describe the first studies investigating a role for opiorphin genes (PROL1, SMR3A and SMR3B) in prostate cancer (PrCa). Materials & methods: Databases and PrCa tissue arrays were screened for opiorphin expression. Xenografted tumor growth of human PrCa cells overexpressing PROL1 was compared with controls in nude mice. Modulated gene expression by overexpression of PROL1 was determined by RNA sequencing. Results: PrCa is associated with overexpression of opiorphin genes. Xenografted androgen-sensitive PrCa cells overexpressing PROL1 developed into tumors in castrated male mice (in contrast to parental cells). PROL1 overexpression modulates expression of genes in angiogenesis, steroid and hypoxic response pathways. Conclusions: Opiorphins promote the development of androgen-insensitive PrCa and activate pathways that potentially overcome the hypoxic barrier generated during tumor growth.
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Affiliation(s)
- Amarnath Mukherjee
- Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, NY 10461, USA
| | - Augene Park
- Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, NY 10461, USA
| | - Li Wang
- Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, NY 10461, USA
| | - Kelvin P Davies
- Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, NY 10461, USA
- Department of Physiology & Biophysics, Albert Einstein College of Medicine/Montefiore Medical Center, NY 10461, USA
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Accioni F, García-Gómez D, Rubio S. Exploring polar hydrophobicity in organized media for extracting oligopeptides: application to the extraction of opiorphin in human saliva. J Chromatogr A 2020; 1635:461777. [PMID: 33302140 DOI: 10.1016/j.chroma.2020.461777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 01/17/2023]
Abstract
Supramolecular solvents (dubbed SUPRAS) are gaining momentum as extractants of compounds of interest from complex matrixes such as foodstuff and biological and environmental samples. However, their powerful extraction mechanism, based on multiligand ability for solute binding, fails when applied to very polar compounds, hindering their applicability to the extraction of highly polar metabolites. In this work, we introduce the synthesis, characterization, and application of a new kind of SUPRAS formed by heptafluorobutyric acid (HFBA). The polar hydrophobicity of this perfluorinated acid results in a SUPRAS, which coacervates at acidic pHs, that shows a great capability to extract amino acids and oligopeptides (recoveries in the range 81-105%) with nonpolar alkyl, cyclic or aromatic side chain substituents (with log D > -3.62). To further demonstrate the potential of this novel SUPRAS, an analytical methodology for the determination of opiorphin in real saliva samples was developed and fully validated. The HFBA-based SUPRAS was synthetized in situ from 950 µL of stabilized saliva, by the addition of 150 µL of HFBA and 400 µL of HCl 37% (v/v). The resulting SUPRAS was directly injected into a LC-MS/MS system for further quantification. Quantitative recoveries in the range of 87-110% were obtained with relative standard deviations below 20%. The HFBA-based SUPRAS is, therefore, capable of efficiently extracting opiorphin from saliva samples and shows a high potential for the determination of several amino acids and oligopeptides from biological samples.
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Affiliation(s)
- Francesca Accioni
- Department of Analytical Chemistry, Institute of Fine Chemistry and Nanochemistry, Universidad de Córdoba, Spain.; Department of Chemistry and Pharmacy, University of Sassari, Italy
| | - Diego García-Gómez
- Department of Analytical Chemistry, Institute of Fine Chemistry and Nanochemistry, Universidad de Córdoba, Spain..
| | - Soledad Rubio
- Department of Analytical Chemistry, Institute of Fine Chemistry and Nanochemistry, Universidad de Córdoba, Spain
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Paszynska E, Roszak M, Slopien A, Boucher Y, Dutkiewicz A, Tyszkiewicz-Nwafor M, Gawriolek M, Otulakowska-Skrzynska J, Rzatowski S, Dmitrzak-Weglarz M. Is there a link between stress and immune biomarkers and salivary opiorphin in patients with a restrictive-type of anorexia nervosa? World J Biol Psychiatry 2020; 21:220-229. [PMID: 30880537 DOI: 10.1080/15622975.2019.1593502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives: Opiorphin is a salivary peptide with analgesic and antidepressant properties. Its relationship with the hypothalamic-pituitary-adrenal, autonomic nervous and immune systems may provide understanding of chronic stress, especially in anorexia nervosa (AN). This study investigated a possible correlation between opiorphin and stress/immune biomarkers, cortisol, salivary alpha-amylase (sAA) and secretory immunoglobulin A (sIgA), in saliva of patients with restrictive-type AN.Methods: A case-control clinical trial was conducted in 92 AN patients (+75 healthy controls). Unstimulated salivary samples were taken during the acute stage of AN, measurements of cortisol, sAA, sIgA and opiorphin were performed with a quantitative assay (enzyme-linked immunosorbent assay, P < 0.05).Results: AN patients displayed an increase in cortisol (P < 0.001) and sIgA (P < 0.001) but not in sAA (P = 0.279) levels. Distinct correlation between these two parameters and body-weight indexes were observed. Opiorphin levels were neither correlated to stress and immune biomarkers, nor to salivary flow rate.Conclusions: The effect of stress responses can be reliably assessed in saliva in AN patients. The difference between sIgA and cortisol indicate that they can both be used for mental stress assessment in saliva. Modulation of opiorphin by chronic stress was not confirmed. Unchanged sAA indicates a partial adaptation of human organism to severe condition during malnutrition.
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Affiliation(s)
- Elzbieta Paszynska
- Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), Poznań, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, PUMS, Poznań, Poland
| | | | - Yves Boucher
- Groupe Hospitalier Pitié Salpêtrière, UFR Odontologie Université Paris Diderot, Paris, France
| | - Agata Dutkiewicz
- Department of Child and Adolescent Psychiatry, PUMS, Poznań, Poland
| | | | - Maria Gawriolek
- Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), Poznań, Poland
| | | | - Szymon Rzatowski
- Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), Poznań, Poland
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