Role of Extracellular Heat Shock Protein 90 Alpha in the Metastasis of Oral Squamous Cell Carcinoma: A Systematic Review

Heat shock proteins (HSPs) are expressed in a variety of cancers in human beings and are correlated with differentiation, proliferation, and metastasis. Head and neck squamous cell carcinomas, like other tumors, are exposed to environmental stress, and lack of oxygen and nutrients, and in such situations, hypoxic inducible factor (HIF) initiates the expression of genes causing angiogenesis, invasion, and metastasis. Extracellular heat shock proteins 90 alpha (eHSP90α) are overexpressed in cancers leading to tumor progression and metastasis. Hence, this review will focus on the role of eHSP90α in the metastasis of oral squamous cell carcinomas (OSCC). Different online databases were scoured for relevant articles from October 2000 to October 2022. A total of 342 articles along with duplicates were excluded. The retrieved 45 articles were studied and 39 of them were found to be not eligible as they lacked intervention and their outcome measures did not match with the present review. The final qualitative evaluation included four articles that fulfilled the eligibility criterion. A definitive expression of HSP90 was implicated, as seen in three studies, suggesting its probable role as a prognostic marker for OSCC, but no conclusive evidence was found. The present review suggests that eHSP90α plays a significant role in OSCC. Though a positive association was found between HSP90 expression and its possible correlation with metastasis, affirmative evidence can only be derived with the conduction of many more research studies and their subsequent synthesis of results.

The Association of Helicobacter pylori in the Oral Cavity With Dental Caries in Patients With and Without Gastric Infection: A Systematic Review

Helicobacter pylori (H. pylori) organisms are well-recognized pathogens responsible for many GI diseases. Streptococcus mutans-related caries and H. pylori infection share similar risk factors such as early childhood occurrence and low socioeconomic status. Therefore, it is possible for these two bacterial diseases to co-exist in the same environment. The present review evaluates the association of H. pylori with dental caries in patients with and without gastric infection, with the objective of comparing the association of H. pylori with dental caries in patients with and without gastric infection. A computerized literature search was performed in online databases from September 2000 to September 2022 using both electronic and manual searches for scientific databases. The research question was framed following the patient/population, intervention, comparison, and outcomes (PICO) statement. A thorough literature search identified a total of 200 manuscripts. Out of which, 100 were duplicate records and 100 were screened for eligibility, and about 78 articles were excluded, as they were not following PICO and the eligibility criterion. The retrieved 22 articles were sought for retrieval, only 17 were retrieved, and two studies did not fulfill the requirement. A total of 15 studies were recorded as eligible for the present review. There is a close association between the presence of infection of H. pylori in the oral cavity and the increased number of dental caries incidence in patients, even without a gastric infection. This suggests that the oral cavity is another niche for H. Pylori and may be the source of infection, re-infection, and transmission into the stomach.

The effectiveness of electronic pulsed soft tissue vibration compared with topical anaesthesia in reducing the pain of injection of local anaesthetics in adults: a randomized controlled split-mouth clinical trial

The purpose of this study was to evaluate the effectiveness of an electronic hand-held pulsed vibration device on the pain of local analgesia (LA) injection and physiologic changes. A prospective randomized controlled clinical trial using split-mouth (crossover) design was implemented. The control-side injection was performed after using topical anaesthesia. The experimental side injection was carried out without topical anaesthesia, but with the aid of a switched-on vibration device. Overall, 332 dental LA injections were given to 166 patients for routine exodontia. The pain at penetration and pain during injection were significantly lower in the experimental sides (vibrations sides) compared with those of the controls (P<0.001). Similarly, the heart rate changes at penetration and during injections were significantly lower in the experimental sides (P<0.001). The vibration device was clinically and statistically more effective than topical anaesthesia in the reduction of dental injection pain in adults, measured subjectively and objectively, regardless of the gender, injection technique (infiltration or block) or anxiety level.

Vital signs changes during different dental procedures: A prospective longitudinal cross-over clinical trial

OBJECTIVES

The purpose of this study was to evaluate the magnitude of vital signs changes during 3 different dental treatments.

STUDY DESIGN

A prospective longitudinal multiarm cross-over clinical trial was conducted. Three dental procedures were performed on each participant: supragingival scaling, dental restoration under local anesthesia (LA), and exodontia under LA. The following parameters were recorded for in each dental procedure: body temperature (BT), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO₂). Three repeated measurements of each parameter were recorded at 3 phases of each procedure.

RESULTS

A total of 150 dental interventions were performed on 50 patients. Scaling caused a statistically significant rise in BT, RR, and SpO₂, and a reduction in HR. Restorative treatment caused a statistically significant rise in SpO₂ during LA. Exodontia caused a statistically significant rise in BT, RR, SBP (during the procedure), and SpO₂ (during LA).

CONCLUSIONS

Scaling and restorative treatment did not significantly impact heart rate. The respiratory rate may temporarily rise during LA injection and some dental procedures, especially exodontia. Increase in systolic blood pressure and heart rate during exodontia was tolerated by healthy patients.

Operative time, blood loss, hemoglobin drop, blood transfusion, and hospital stay in orthognathic surgery

PURPOSE

This study was conducted to evaluate the operative time, blood loss, hemoglobin drop, blood transfusion, and length of hospital stay in orthognathic surgery.

METHODS

A 10-year retrospective analysis was performed on patients who underwent bilateral sagittal split osteotomy (with or without genioplasty), Le Fort I osteotomy (with or without genioplasty), or any combination of these procedures. A total of 271 patients were included.

RESULTS

The age range was 17 to 49 years, with a mean age of 24.13 ± 4.51 years. Approximately 62% of patients underwent double-jaw surgery. The most common procedure was bilateral sagittal split with Le Fort I (37%). The average operative time was 3.96 ± 1.25 h. The mean estimated blood loss was 345.2 ± 149.74 mL. Approximately 9% of patients received intraoperative blood transfusion. The mean hemoglobin drop in the non-transfusion cases was 2.38 ± 0.89 g/dL. The mean postoperative hospital stay was 1.85 ± 0.83 days. Only one patient was admitted to the ICU for one night.

CONCLUSIONS

In orthognathic surgery, blood loss is relatively minor, blood transfusion is frequent, and ICU admission is unlikely. Operative time, blood loss, blood transfusion, and the complexity of the surgical procedure can significantly increase the length of hospital stay. Males may bleed more than females in orthognathic surgery. Hemoglobin drop can be overestimated due to hemodilution in orthognathic surgery, which may influence the decision to use blood transfusion.