The Oral Microbiota Changes in Orthodontic Patients and Effects on Oral Health: An Overview

Nowadays, there is a considerable interest to study the biological and microbiological changes that accompany orthodontic treatment. Growing knowledge on oral microbiota allows, day after day, to identify and characterize the microbial arrangements specifically associated with oral and extra-oral conditions. The aim of the present work is to highlight any further correlations between orthodontic appliances and the qualitative and quantitative modifications of the oral microbiota, such as predisposing factors for the onset of caries, periodontal diseases, and other infections, which can impact the oral and systemic health of the orthodontic patients. When compared with subjects without orthodontic appliances, orthodontic patients reported significant qualitative and quantitative differences in supra- and subgingival plaque during the entire treatment period. Certain components of fixed appliances (mainly bonded molar brackets, ceramic brackets, and elastomeric ligatures) showed high risks of periodontal disease and tooth decay for patients. An unclear prevalence of Candida spp. and the paucity of studies on viruses and protozoas in the oral microbiota of orthodontic patients need to be further investigated. The evidence emerging from this study could guide clinicians in modulating the timing of controls and enhance patient motivation to prevent the formation of mature plaque, thus reducing the risks of oral-plaque-related diseases

Efficacy of three different irrigation techniques in the removal of smear layer and organic debris from root canal wall: A scanning electron microscope study

Abstract Aim Aim of this study was to compare the removal of smear layer and organic debris within the tooth canal among conventional needle irrigation, EndoVac and Endoactivator. Methodology Eighty single-rooted extracted human teeth were prepared with rotary NiTi instrumentation and randomly separated into 4 groups. Twenty teeth were used as positive control (Group 1), irrigated with only saline. Teeth assigned to Group 2 ( n = 20) received irrigation with a conventional syringe and a 30-gauge needle (NaviTip, Ultradent, South Jordan, UT); samples in Group 3 ( n = 20) were rinsed with an irrigation device based on apical negative pressure (EndoVac, Discus Dental, Culver City, CA) and teeth in Group 4 ( n = 20) were treated with a sonic irrigation system (EndoActivator, Dentsply Tulsa Dental, Tulsa, OK, USA). The amount of residual smear layer and debris was evaluated under a scanning electron microscope, and a semi-quantitative score was assigned to each root at the coronal, middle and apical thirds; the chi-square test was used to compare the results of the S.E.M. analysis. Results EndoActivator performed the best cleansing for both smear layer and organic debris in all root canal thirds, followed by EndoVac and conventional irrigation ( p > 0.001). EndoVac and conventional irrigation showed better cleaning in the coronal area, whereas EndoActivator performed an homogeneous cleansing at all levels. Conclusions The EndoVac system and the EndoActivator system demonstrated significantly more efficacy in cleansing root canal walls than conventional needle irrigation

Noninvasive Imaging Methods to Improve the Diagnosis of Oral Carcinoma and Its Precursors: State of the Art and Proposal of a Three-Step Diagnostic Process

Abstract: Oral squamous cell carcinoma (OSCC) is the most prevalent form of cancer of lips and oral cavity, and its diagnostic delay, caused by misdiagnosis at the early stages, is responsible for high mortality ratios. Biopsy and histopathological assessment are the gold standards for OSCC diagnosis, but they are time-consuming, invasive, and do not always enable the patient’s compliance, mainly in cases of follow-up with the need for more biopsies. The use of adjunctive noninvasive imaging techniques improves the diagnostic approach, making it faster and better accepted by patients. The present review aims to focus on the most consolidated diagnostic techniques, such as vital staining and tissue autofluorescence, and to report the potential role of some of the most promising innovative techniques, such as narrow-band imaging, high-frequency ultrasounds, optical coherence tomography, and in vivo confocal microscopy. According to their contribution to OSCC diagnosis, an ideal three-step diagnostic procedure is proposed, to make the diagnostic path faster, better, and more accurate

Correlation between Oral Lichen Planus and Viral Infections Other Than HCV: A Systematic Review.

OBJECTIVES This review aimed to evaluate the correlation between viral infections (HPV, EBV, HSV-1, CMV) other than HCV and oral lichen planus to assess if there is sufficient evidence to establish if these viruses can play a role in the etiopathogenesis of the disease. MATERIALS AND METHODS We reviewed the literature using different search engines (PubMed, ISI Web of Science, and the Cochrane Library), employing MeSH terms such as "oral lichen planus" and "OLP" in conjunction with other terms. We utilized the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) method to define our study eligibility criteria. RESULTS A total of 43 articles of the 1219 results initially screened were included in the study. We allocated the 43 selected items into four groups, according to each related virus: HPV, EBV, HSV-1, and CMV. CONCLUSIONS Heterogeneous results neither confirm nor exclude a direct correlation between the investigated viral infections and oral lichen planus etiopathogenesis and its feasible malignant transformation. Many viral agents can cause oral lesions and act as cancerizing agents. Future studies could be desirable to produce comparable statistical analyses and enhance the quantity and quality of the outcomes to promote the translation of research into clinical practice

Anxiety and depression in keratotic oral lichen planus: a multicentric study from the SIPMO

Objectives: Oral lichen planus with exclusive keratotic reticular, papular, and/or plaque-like lesions (K-OLP) is a clinical pattern of OLP that may be associated with a complex symptomatology and psychological alteration. The aim of the study was to evaluate the prevalence of anxiety (A) and depression (D) in patients with K-OLP, analyzing the potential predictors which can affect mental health status. Methods: Three hundred K-OLP patients versus 300 healthy controls (HC) were recruited in 15 Italian universities. The Numeric Rating Scale (NRS), Total Pain Rating Index (T-PRI), and Hamilton Rating Scales for Depression and for Anxiety (HAM-D and HAM-A) were administered. Results: The K-OLP patients showed statistically higher scores in the NRS, T-PRI, HAM-D, and HAM-A compared with the HC (p-value < 0.001**). A and D were found in 158 (52.7%) and 148 (49.3%) K-OLP patients. Strong linear correlations were identified between HAM-A, HAM-D, NRS, T-PRI, and employment status and between HAM-D, HAM-A, NRS, T-PRI, employment status, and female gender. Multivariate logistic regression revealed that HAM-D and HAM-A showed the greatest increase in the R2 value for A and D in the K-OLP patients, respectively (DR2 = 55.5% p-value < 0.001**; DR2 = 56.5% p-value < 0.001**). Conclusions: The prevalence of A and D is higher in the K-OLP patients compared with the HC, also found in K-OLP subjects without pain, suggesting that the processing of pain may be in a certain way independent of the processing of mood. Clinical relevance: Mood disorders and pain assessment should be carefully performed in relation to K-OLP to obtain a complete analysis of the patients

Oral Candidiasis and Novel Therapeutic Strategies: Antifungals, Phytotherapy, Probiotics, and Photodynamic Therapy

Oral candidiasis is an opportunistic infection of the oral mucosa sustained by fungi of the genus Candida. Various Candida species, with a predominance of C. albicans, normally a saprophyte of the oral cavity, may become virulent and infect the oral mucosa with variegated clinical presentation, in case of imbalance of the oral microbiota, the presence of local predisposing factors and systemic conditions that weaken the immune system. Conventionally, oral candidiasis eradication is done with the help of antifungal drugs. However, the growing phenomena of drug resistance and the increase in infections sustained by non-albicans species being less responsive to common antifungals have orientied researches towards the experimentation of alternative therapies. The present review considered the most promising alternative therapeutic proposals. The use of plant derivatives with phytotherapy is a promising option, such as probiotics, to rebalance the oral microbiota in case of dysbiosis. Finally, antimicrobial photodynamic therapy (aPDT), with highly selective fungicidal activity and free of side effects, is also being studied as a powerful alternative to drug administration. All these therapies are alternatives or supportive to the conventional treatment of recurrent and non-drug-responsive forms of oral candidiasis. However, further studies are needed to define the most active compounds, the efficacy of the therapies compared with the conventional ones, and the planning of regulated and standardized protocols

A new technique to make transparent teeth without decalcifying: description of the methodology and micro-hardness assessment

Diaphanisation and other in vitro endodontic models (i.e., plastic blocks, micro-CT reconstruction, computerised models) do not recreate real root canal working conditions: a more realistic endodontic model is essential for testing endodontic devices and teaching purposes. The aim of this study was to describe a new technique to construct transparent teeth without decalcifying and evaluate the micro-hardness of so treated teeth. Thirty freshly extracted teeth were randomly divided into three groups as follows: 10 non-treated teeth (4 molars, 3 premolars, 3 incisors; control group - G1), 10 teeth were diaphanised (4 molars, 4 premolars, 2 incisors - G2) and 10 teeth were treated with the new proposed technique (2 molars, 6 premolars, 2 incisors - G3). Vickers hardness tester (MHT-4 and AxioVision microscope, Carl Zeiss, 37030 Gottingen, Germany - load=50 g, dwell time=20s, slope=5, 50× magnification) was used to determine microhardness (Vickers Hardness Number - VHN). Statistical analysis was performed using the Intercooled Stata 8.0 software (Stata Corporation, College Station, TX, USA). Only groups 1 and 3 could be tested for hardness because diaphanised teeth were too tender and elastic. Differences in enamel VHN were observed between G1 (mean 304.29; DS=10.44; range 283-321) and G3 (mean 318.51; DS=14.36; range 295.5-339.2) - (p<0.05); differences in dentine VHN were observed between G1 (mean 74.73; DS=6.62; range 63.9-88.1) and G3 (mean 64.54; DS=5.55; range 51.2-72.3) - (p<0.05). G3 teeth presented a slightly lower VHN compared to G1, probably due to some little structural differences among groups, and were dramatically harder than the diaphanised teeth. The described technique, thus, can be considered ideal for testing endodontic instruments and for teaching purposes