Cross-Bite and Oral-Health-Related Quality of Life (OHRQoL) in Preadolescents Aged 11 to 14 Years Old: A Pilot Case-Control Study

INTRODUCTION

Malocclusions have a negative impact on oral-health-related quality of life (OHRQoL). Posterior cross-bite is one of the most prevalent malocclusions in the preadolescent population. This study investigated the influence of posterior cross-bites (unilateral or bilateral) on OHRQoL in an 11- to 14-year-old population.

MATERIALS AND METHODS

A pilot case-control study was carried out at the Dental Clinic of the University of Salamanca between 2021 and 2023. A consecutive sample of 120 preadolescent patients aged 11 to 14 years old was recruited. Three groups were analyzed: a control group (no posterior cross-bite) (n = 40), a group with unilateral posterior cross-bite (n = 40), and a group with bilateral posterior cross-bite (n = 40). To analyze the OHRQoL, the Spanish version of the Child Perception Questionnaire (CPQ-Esp11-14) was used.

RESULTS

The mean age of the sample was 12.2 years old (±0.96 years). The group of patients with a bilateral posterior cross-bite was shown to have higher scores in all dimensions of the CPQ-Esp11-14, as well as a higher total score. Sex only influenced the oral symptom dimension of the CPQ-Esp11-14 questionnaire; in this dimension, the girls described a greater impact. Age did not influence OHRQoL.

CONCLUSION

The presence of a posterior cross-bite had a negative impact on OHRQoL in the preadolescent population that was studied.

RET Fusion Testing in Patients With NSCLC: The RETING Study

Introduction

RET inhibitors with impressive overall response rates are now available for patients with NSCLC, yet the identification of RET fusions remains a difficult challenge. Most guidelines encourage the upfront use of next-generation sequencing (NGS), or alternatively, fluorescence in situ hybridization (FISH) or reverse transcriptase-polymerase chain reaction (RT-PCR) when NGS is not possible or available. Taken together, the suboptimal performance of single-analyte assays to detect RET fusions, although consistent with the notion of encouraging universal NGS, is currently widening some of the clinical practice gaps in the implementation of predictive biomarkers in patients with advanced NSCLC.

Methods

This situation prompted us to evaluate several RET assays in a large multicenter cohort of RET fusion-positive NSCLC (n = 38) to obtain real-world data. In addition to RNA-based NGS (the criterion standard method), all positive specimens underwent break-apart RET FISH with two different assays and were also tested by an RT-PCR assay.

Results

The most common RET partners were KIF5B (78.9%), followed by CCDC6 (15.8%). The two RET NGS-positive but FISH-negative samples contained a KIF5B(15)-RET(12) fusion. The three RET fusions not identified with RT-PCR were AKAP13(35)-RET(12), KIF5B(24)-RET(9) and KIF5B(24)-RET(11). All three false-negative RT-PCR cases were FISH-positive, exhibited a typical break-apart pattern, and contained a very high number of positive tumor cells with both FISH assays. Signet ring cells, psammoma bodies, and pleomorphic features were frequently observed (in 34.2%, 39.5%, and 39.5% of tumors, respectively).

Conclusions

In-depth knowledge of the advantages and disadvantages of the different RET testing methodologies could help clinical and molecular tumor boards implement and maintain sensible algorithms for the rapid and effective detection of RET fusions in patients with NSCLC. The likelihood of RET false-negative results with both FISH and RT-PCR reinforces the need for upfront NGS in patients with NSCLC.

Influence of orthodontic archwire (nickel-titanium versus copper-nickel-titanium) on pain in adult patients in the aligning phase of treatment with self-ligating brackets (two months of follow-up): a prospective observational pilot study

BACKGROUND

The aim of this pilot study was to analyze the influence of a nickel-titanium archwire (NiTi) and a copper-nickel-titanium archwire (Cu-NiTi) on pain levels in adult patients during the first two months of orthodontic treatment with self-ligating brackets.

METHODS

This prospective observational pilot study was carried out at the Dental Clinic of the University of Salamanca between 2023 and 2024. This study analyzed 30 adult orthodontic patients who began treatment with self-ligating brackets. The participants were distributed into two study groups (n = 15) for treatment with initial NiTi and Cu-NiTi archwires. At the beginning, a 0.014-inch archwire was used, and a 0.016-inch archwire was used after a month. The level of pain was measured using a visual analog scale (VAS) at the beginning of treatment (T0), at one month (T1), and at two months (T2). At each time point (T0, T1, and T2), pain was measured at baseline and at 4, 24, and 48 h after archwire placement or replacement. The data were analyzed using Spearman's correlation coefficient and the Mann-Whitney test (p < 0.05).

RESULTS

The mean age of the participants (n = 30) was 31.34 (± 6.05) years. The maximum pain peak was in the first 48 h after placing the initial archwire (5.57 ± 1.72). The age and sex of the participants did not influence the pain levels in the sample studied. The composition of the orthodontic archwire only influenced the pain levels at the beginning of treatment (T0) (p < 0.05); in this case, the NiTi group (1.73 ± 1.53) described a higher level of pain than that of the Cu-NiTi group (1.07 ± 1.36); in the rest of the follow-up period, no significant differences were observed.

CONCLUSIONS

Within the limitations of this study, we observed that the orthodontic archwire material (nickel-titanium versus copper-nickel-titanium) only influenced pain levels at the beginning of orthodontic treatment.

Influence of the metabolic control in patients with type 1 diabetes on their oral health status and the need for orthodontic treatment in a group of Spanish children (aged 6-12 years): a cross-sectional study

BACKGROUND

The aim of this study was to analyze the influence of good metabolic control, based on glycosylated hemoglobin (HbA1c) levels, on oral health status and the need for orthodontic treatment in children.

METHODS

This cross-sectional study was carried out at the Dental Clinic of the University of Salamanca (Spain) during the years 2020 and 2024. A total of 260 children with type 1 diabetes (aged between 6 and 12 years) participated. The sample was divided into two study groups based on their metabolic control: good metabolic control (HbA1c < 7%) (n = 130) and poor metabolic control (HbA1c > 7%) (n = 130). Oral health status was assessed using the Decayed, Missing, and Filled Teeth index for permanent teeth (DMF-T) and the need for orthodontic treatment using the Dental Health Component of the Index of Orthodontic Treatment Need (DHC-IOTN).

RESULTS

The mean age was 9.2 ± 1.9 years old. The total sample (n = 260) consisted of 53.8% boys and 46.2% girls. In the group of patients with poor metabolic control, a significant increase was observed in the number of decayed teeth (1.83 ± 1.36), filled teeth (1.05 ± 0.84), and DMF-T score (3.14 ± 1.87) compared to patients with good metabolic control (1.38 ± 1.20 decayed teeth; 0.88 ± 0.86 filled teeth; DMF-T score 2.46 ± 1.87). However, no significant differences were observed in relation to the influence of metabolic control on the need for orthodontic treatment.

CONCLUSIONS

In the sample studied, metabolic control had a negative influence on caries rates in children with type 1 diabetes, but not on the need for orthodontic treatment.

An Assessment of Oral-Health-Related Quality of Life and Anxiety in Early Adolescents (11-14 Years) at Their First Dental Visit: A Cross-Sectional Study

Background: Knowing the oral-health-related quality of life (OHRQoL) status of pediatric patients would be helpful in analyzing their level of dental anxiety before their first visit to a pediatric dentist. However, few studies have analyzed OHRQoL and anxiety in early adolescent patients. The aim of this study was to describe the OHRQoL and anxiety levels of early adolescents, according to age and sex, at their first dental examination. Methods: A cross-sectional study was conducted on early adolescents (11-14 years old) attending their first dental examination in 2023-2024. OHRQoL was assessed using the Spanish version of the Child Perceptions Questionnaire 11-14 (CPQ-Esp11-14) and anxiety using the State-Trait Anxiety Inventory in Children (STAIC). Results: A total of 130 early adolescents were assessed, with an average age of 12.6 years (±1.06) and an equal sex distribution (65 boys and 65 girls). Among the analyzed sample, the OHRQoL dimension with the highest score was social well-being (15.01 ± 10.7), whereas the oral symptoms dimension (8.6 ± 4.25) had the lowest impact. There were no statistically significant differences between female and male early adolescents in the anxiety state or anxiety-trait dimensions or in the dimension of OHRQoL, except for oral symptoms, which were higher in boys (9.48 ± 4.51 versus 7.72 ± 3.81). Similarly, no significant differences were found based on age regarding anxiety or OHRQoL. Conclusions: Considering the limitations of this study, it can be concluded that higher levels of anxiety negatively impacted the OHRQoL of the early adolescent population studied.

Managing patients taking edoxaban in dentistry

Background

Anticoagulation therapy is used in several conditions to prevent or treat thromboembolism. A new group of oral anticoagulants with clear advantages over classic dicoumarin oral anticoagulants (warfarin and acenocoumarol) has been developed in recent years. The Food and Drug Administration has approved edoxaban, dabigatran, rivaroxaban and apixaban. Their advantages include: predictable pharmacokinetics, drug interactions and limited food, rapid onset of action and short half-life. However, they lack a specific reversal agent.

Material and Methods

This paper examines the available evidence regarding rivaroxaban and sets out proposals for clinical guidance of dental practitioners treating these patients in primary dental care. A literature search was conducted through July 2016 for publications in PubMed and Cochrane Library using the keywords “edoxaban”, “dabigatran”, “rivaroxaban”, “apixaban”, “new oral anticoagulants”, “novel oral anticoagulants”, “bleeding” and “dental treatment” with the “and” boolean operator in the last 10 years.

Results

The number of patients taking edoxaban is increasing. There is no need for regular coagulation monitoring of patients on edoxaban therapy. For patients requiring minor oral surgery procedures, interruption of edoxaban is not generally necessary. Management of patients on anticoagulation therapy requires that dentists can accurately assess the patient prior to dental treatments.

Conclusions

Their increased use means that oral care clinicians should have a sound understanding of the mechanism of action, pharmacology, reversal strategies and management of bleeding in patients taking edoxaban. There is a need for further clinical studies in order to establish more evidence-based guidelines for dental patients requiring edoxaban.

Key words:Edoxaban, dabigatran, rivaroxaban, apixaban, novel oral anticoagulants, bleeding.

Concordance in the estimation of tumor percentage in non-small cell lung cancer using digital pathology

The incorporation of digital pathology in clinical practice will require the training of pathologists in digital skills. Our study aimed to assess the reliability among pathologists in determining tumor percentage in whole slide images (WSI) of non-small cell lung cancer (NSCLC) using digital image analysis, and study how the results correlate with the molecular findings. Pathologists from nine centers were trained to quantify epithelial tumor cells, tumor-associated stromal cells, and non-neoplastic cells from NSCLC WSI using QuPath. Then, we conducted two consecutive ring trials. In the first trial, analyzing four WSI, reliability between pathologists in the assessment of tumor cell percentage was poor (intraclass correlation coefficient (ICC) 0.09). After performing the first ring trial pathologists received feedback. The second trial, comprising 10 WSI with paired next-generation sequencing results, also showed poor reliability (ICC 0.24). Cases near the recommended 20% visual threshold for molecular techniques exhibited higher values with digital analysis. In the second ring trial reliability slightly improved and human errors were reduced from 5.6% to 1.25%. Most discrepancies arose from subjective tasks, such as the annotation process, suggesting potential improvement with future artificial intelligence solutions.

Assessment of PD-L1 expression and tumour infiltrating lymphocytes in early-stage non-small cell lung carcinoma with artificial intelligence algorithms

AIMS

To study programmed death ligand 1 (PD-L1) expression and tumour infiltrating lymphocytes (TILs) in patients with early-stage non-small cell lung carcinoma (NSCLC) with artificial intelligence (AI) algorithms.

METHODS

The study included samples from 50 early-stage NSCLCs. PD-L1 immunohistochemistry (IHC) stained slides (clone SP263) were scored manually and with two different AI tools (PathAI and Navify Digital Pathology) by three pathologists. TILs were digitally assessed on H&E and CD8 IHC stained sections with two different algorithms (PathAI and Navify Digital Pathology, respectively). The agreement between observers and methods for each biomarker was analysed. For PD-L1, the turn-around time (TAT) for manual versus AI-assisted scoring was recorded.

RESULTS

Agreement was higher in tumours with low PD-L1 expression regardless of the approach. Both AI-powered tools identified a significantly higher number of cases equal or above 1% PD-L1 tumour proportion score as compared with manual scoring (p=0.00015), a finding with potential therapeutic implications. Regarding TAT, there were significant differences between manual scoring and AI use (p value <0.0001 for all comparisons). The total TILs density with the PathAI algorithm and the total density of CD8+ cells with the Navify Digital Pathology software were significantly correlated (τ=0.49 (95% CI 0.37, 0.61), p value<0.0001).

CONCLUSIONS

This preliminary study supports the use of AI algorithms for the scoring of PD-L1 and TILs in patients with NSCLC.

Oral Rehabilitation as Part of a Multidisciplinary Treatment in a Case Study of Pigmentary Incontinence

We present the clinical course of a 9-year-old female patient with Bloch-Sulzberger syndrome and severe neurological deficit that met the major (classic cutaneous signs) and minor (dental anomalies and retinal pathology) diagnostic criteria of Landy and Donnai. Longitudinal multidisciplinary follow-up was carried out from birth to adulthood. Neurological involvement was assessed with electroencephalographic (EEG) and neuroimaging tests at different times during the patient's life. Cranio-maxillofacial involvement was evaluated using lateral skeletal facial and cephalometric analyses. The right and left facial widths were measured through frontal face analysis and using the vertical zygomatic-midline distance. Oral rehabilitation was performed through orthodontic treatment and major dental reconstruction using composite resins. This treatment aimed to improve the occlusion and masticatory function, relieve the transversal compression of the maxilla, and reconstruct the fractured teeth. We believe that, due to significant neurological and cognitive impairment, orthognathic surgery was not the best option for restoring function and improving oral health-related quality of life.

Influence of maternal health status during pregnancy and the child´s medical history on molar-incisor hypomineralization in a group of Spanish children (aged 6-14 years): a retrospective case-control study

BACKGROUND

Molar-incisor hypomineralization (MIH) is a qualitative enamel defect that is highly prevalent in children. It has been reported that patients with MIH have higher caries occurrence with an increased need and frequency of dental treatment compared to patients without MIH. The objective of this study was to analyze the association between MIH and a series of factors related to maternal health status during pregnancy and children´s medical history in early childhood.

METHODS

A retrospective study of cases (patients with MIH) and controls (patients without MIH) was designed between 2023 and 2024. A total of 280 children (cases = 140; controls = 140) aged 6 to 14 years (138 boys and 142 girls) were examined according to the European Academy of Pediatric Dentistry (EAPD) criteria for MIH. A survey was carried out with mothers regarding the potential exposure of their children to etiological factors of MIH. Possible prenatal and postnatal etiological factors were obtained through a personal interview with the patients' mothers. The statistical analysis was carried out with the contrast test and the chi-square test.

RESULTS

During pregnancy, folic acid consumption, alcohol intake, systemic viral and/or bacterial infections, and gestational diabetes were statistically significantly related to MIH, as were breastfeeding, asthma, and corticosteroid consumption during childhood.

CONCLUSIONS

Although there are different factors that may have statistically significant relationships with MIH, they cannot be predicted. Therefore, longitudinal studies, with a large sample size, are needed to determine the influence of prenatal and postnatal factors on the prevalence and severity of MIH in children.

Assessment of Orthodontic Treatment Need and Oral Health-Related Quality of Life in Asthmatic Children Aged 11 to 14 Years Old: A Cross-Sectional Study

This study investigated the need for orthodontic treatment in asthmatic children aged 11 to 14 years and how the treatment affected their oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

This cross-sectional study was conducted at the dental clinic of the University of Salamanca in 2020-2022. The study selected a consecutive sample of 140 children with asthma (52.1% girls; 47.9% boys). This study used the Orthodontic Treatment Needs Index (OTN) to analyze the need for orthodontic treatment and the Children's Perception Questionnaire (CPQ11-14) to assess OHRQoL.

RESULTS

Sex and age did not significantly influence the need for orthodontic treatment, although age may be considered influential for OHRQoL concerning oral symptoms (p < 0.01), functional limitations (p < 0.05), and total score on the CPQ_11-14 questionnaire (p < 0.05): the younger the age, the greater the effect of the need for orthodontic treatment on OHRQoL. The social well-being of the patients was much more significantly impacted by the need for orthodontic treatment (15.7 ± 1.91) than by oral symptoms (7.64 ± 1.39), which were the least impacted. In all parts of the CPQ_11-14 questionnaire and in the patients' total scores, we observed significant agreement (p < 0.01) that treatment influenced OHRQoL.

CONCLUSION

An inverse relationship exists between the severity of the treatment needed and OHRQoL.