Oral dysbiosis in pancreatic cancer and liver cirrhosis: A review of the literature

The human body is naturally colonized by a huge number of different commensal microbial species, in a relatively stable equilibrium. When this microbial community undergoes dysbiosis at any part of the body, it interacts with the innate immune system and results in a poor health status, locally or systemically. Research studies show that bacteria are capable of significantly influencing specific cells of the immune system, resulting in many diseases, including a neoplastic response. Amongst the multiple different types of diseases, pancreatic cancer and liver cirrhosis were significantly considered in this paper, as they are major fatal diseases. Recently, these two diseases were shown to be associated with increased or decreased numbers of certain oral bacterial species. These findings open the way for a broader perception and more specific investigative studies, to better understand the possible future treatment and prevention. This review aims to describe the correlation between oral dysbiosis and both pancreatic cancer and liver cirrhotic diseases, as well as demonstrating the possible diagnostic and treatment modalities, relying on the oral microbiota, itself, as prospective, simple, applicable non-invasive approaches to patients, by focusing on the state of the art. PubMed was electronically searched, using the following key words: "oral microbiota" and "pancreatic cancer" (PC), "liver cirrhosis", "systemic involvement", and "inflammatory mediators". Oral dysbiosis is a common problem related to poor oral or systemic health conditions. Oral pathogens can disseminate to distant body organs via the local, oral blood circulation, or pass through the gastrointestinal tract and enter into the systemic circulation. Once oral pathogens reach an organ, they modify the immune response and stimulate the release of the inflammatory mediators, this results in a disease. Recent studies have reported a correlation between oral dysbiosis and the increased risk of pancreatic and liver diseases and provided evidence of the presence of oral pathogens in diseased organs. The profound impact that microbial communities have on human health, provides a wide domain towards precisely investigating and clearly understanding the mechanism of many diseases, including cancer. Oral microbiota is an essential contributor to health status and imbalance in this community was correlated to oral and systemic diseases. The presence of elevated numbers of certain oral bacteria, particularly P. gingivalis, as well as elevated levels of blood serum antibodies, against this bacterial species, was associated with a higher risk of pancreatic cancer and liver cirrhosis incidence. Attempts are increasingly directed towards investigating the composition of oral microbiome as a simple diagnostic approach in multiple diseases, including pancreatic and liver pathosis. Moreover, treatment efforts are concerned in the recruitment of microbiota, for remedial purposes of the aforementioned and other different diseases. Further investigation is required to confirm and clarify the role of oral microbiota in enhancing pancreatic and liver diseases. Improving the treatment modalities requires an exertion of more effort, especially, concerning the microbiome engineering and oral microbiota transplantation

Orthodontic treatment of class three malocclusion using clear aligners: A case report

Class III malocclusion is a growth-related challenging condition for orthodontists. We present a case of a 11-year-old girl with a skeletal class III malocclusion with bilateral cross bite, and a functional shift of the lower dental midline. A multiphase clear aligners' treatment was scheduled with the aim of removing all dental interferences which involved an anterior displacement of the mandible. At one-year follow-up, clear aligners\u2019 therapy resulted in skeletal and dental improvements. Clear aligners therapy represents a valid alternative to fixed appliance therapy in the early interception of class III malocclusion. The present manuscript was prepared following the CARE guidelines

Analysis of the Changes in Occlusal Plane Inclination in a Class II Deep Bite “Teen” Patient Treated with Clear Aligners: A Case Report

Background: Optimal management of hypodivergent growing patients demands a strict control of vertical dimension and to exploit the growth potential. If a deep bite malocclusion causes a traumatic contact between the upper and lower incisors and affects the facial appearance, an early interceptive treatment is recommended. The aim of this case report is to outline the clinical management of the occlusal plane of a growing Class II division 1 deep bite patient treated with aligners and Class II elastics. Methods: The treatment lasted 11 months and was divided into two phases. Treatment goals included improvement of the soft tissue profile and basal bone relationships through an increase in the mandibular third of the face and a sagittal advancement of the mandible. The correction of the curve of Spee involved intrusion of the mandibular incisors and extrusion of the mandibular premolars. Results: The cephalometric analysis at the end of the treatment displayed significant differences in the skeletal and occlusal pattern along with aesthetic improvements. Conclusion: The final cephalogram showed a consistency between the planned tooth movement and the clinical results. Although definitive recommendations must be withheld until longer follow-up is available, the patient presented here shows that the treatment protocol yielded positive mandibular growth

Endodontic treatment of patient with cleidocranial dysostosis: a case report

Aim: Cleidocranial dysostosis (CCD) is a rare congenital bone disorder with an autosomal dominant hereditary inheritance pattern. This disorder can be caused by mutation in the transcription factor CBFA1 (RUNX2). The CBFA1 gene is essential for membranous as well as endochondral bone formation. The estimated prevalence of CCD is one per million, but it is most likely underdiagnosed because of the relative lack of medical complications in comparison to other skeletal dysplasias. CCD is reported in all ethnic groups, and there is no sex predilection. Clinically, CCD is characterized by hypoplastic/aplastic clavicles, brachycephalic skull, midface hypoplasia, delayed closure of fontanelles and moderately short stature. The most common dentoalveolar characteristics of CCD are: over-retained deciduous teeth with unresorbed roots, supernumerary teeth, retarded eruption, reduced height of the lower third of the face and a skeletal Class III tendency due to an underdevelopment of the maxilla and to an upward and forward mandibular rotation, seriously delayed root development of the permanent teeth. The multidisciplinary treatment procedure consists of a surgical phase followed by an orthodontic treatment, in which extrusion forces are applied. Methods: A 18-years-old male student presented at Gemelli Hospital in June 2016 because of pain in the upper right back-molar region. Clinical and radiographic examinations revealed an extensive cavity in the upper right first molar and impactation of numerous teeth. In addition, supernumerary teeth were evident at orthopantomography. During treatment, an accidental pulp exposure occurred, so an interim medication with calcium hydroxide was performed. After 1 week, the patient keep on being symptomatic and returned for a recall evaluation, reporting pain and sensitivity. After local anesthesia (3% mepivacaine with noradrenaline 1:100.000) and rubber dam isolation, the pulp chamber was accessed using a spherical diamond bur and further refined with Endo Z bur. The working length was established with a Root ZX apex locator. The root canals were instrumented with NiTi rotary files, using copious irrigation with 2.5 % sodium hypochlorite. The MB2 canal was deeply calcified, so an interim root canal medication was performed with a pellet embedded with 17% EDTA and calcium oxide cement. The next appointment, under 2,5x loop magnification, the MB2 canal was rinsed by copious irrigation with 17% EDTA and instrumented until working length. The root canal was dried with sterilized paper points and then filled with Thermafil gutta-percha cones and AH Plus sealer. After 5 days, coronal restoration was performed with composite resin. Results: Our follow up plan consisted in a clinical visit and a control radiography of the tooth. After 9 months of follow up, the patient reports the complete remission of symptomatology attributable to the tooth treated. Conclusions: As seen, there are many dental implications of this pathology. Therefore, it is very important to approach it with a correct multidisciplinary protocol. Since these patients have a great number of impacted teeth, it is fundamental to preserve their erupted teeth. In fact, keeping permanent teeth as much healthy as possible, enables to choose among different treatment possibilities in order to improve everyday life of our patients. In our case, an erupted tooth can be very important for the orthodontic treatment, since it may help during the orthodontic traction of impacted teeth after surgical exposure. In conclusion, the dental condition of these patients has to be analyzed carefully, because even a single tooth can give us the opportunity to improve oral condition of our patients

Ossifying epulis in pseudohypo-parathyroidism: a case-based therapeutic approach

BACKGROUND: The term Pseudohypoparathiroidism indicates a group of rare conditions characterised by end-organ resistance to the action of parathyroid hormone (PTH). Ossifying epulis (OE) is a exophytic gingival lesion characterised by spontaneous bone formation beneath the mucosa, which may affect children and adults: the exophytic, calcified outgrowths can occur in any bone and generally have favorable prognosis. Drug therapy may normalise calcium serum levels, but not completely avoid the occurrence of peripheral ossifying epulis. CASE REPORT: We report a representative case of a peripheral ossifying epulis in the mouth of a patient following a drug treatment protocol for her pseudohypoparathyroidism and to optimise serum markers. An 11-year-old girl was referred to our department, showing a bulky neoformation on the gingival margin of 0.6 mm diameter with sharp margins. The mass was completely excised. Histological analysis revealed distinctive features of a chronic and acute inflammatory microenvironment with plasma cells (positivity for CD38, MUM1, Lambda and Kappa chains) and bone tissue fragments with remodeling aspects referable to flogistic osteolysis. The biopsy result leads to hypothese a change in the patient's drug therapy. Multidisciplinary screening and individualised pharmacological treatment are strongly recommended in the clinical practice in order to improve the therapeutic result

Three-dimensional stereophotogrammetric analysis of nasolabial soft tissue effects of rapid maxillary expansion: a systematic review of clinical trials

Analisi tridimensionale degli effetti dell\u2019espansione mascellare rapida sui tessuti molli nasolabiali mediante stereofotogrammetria: revisione sistematica degli studi clinici. RIASSUNTO: In questa revisione sistematica, \ue8 stata analizzata la letteratura per analizzare i cambiamenti tridimensionali dell\u2019area nasolabiale indotti dall\u2019espansione rapida del mascellare (RME) misurati attraverso la stereofotogrammetria. La presente revisione \ue8 strutturata secondo lo schema PRISMA-P ed \ue8 stata registrata sul portale PROSPERO con il seguente ID: CRD42017079875. I database Pubmed, Cochrane, EBSCO, Scopus, Web of Sciences sono stati consultati senza nessuna restrizione di anno o di status della pubblicazione. 652 articoli sono risultati dalla ricerca iniziale. A seguito del processo di revisione, 11 articoli sono risultati conformi ai criteri di inclusione. Dopo la lettura in extenso dei lavori, 4 pubblicazioni sono state incluse nella seguente revisione. I criteri di selezione sono stati: studi clinici randomizzati e controllati, studi di coorte, studi caso-controllo su pazienti con crossbite uni/bilaterale o deficit trasversale del mascellare o affollamento dentale, pazienti che hanno eseguito espansione rapida del mascellare superiore e che sono stati monitorati mediante stereofotogrammetria. La metodologia eterogenea dei lavori ha reso una meta-analisi impossibile; di conseguenza, \ue8 stata eseguita un\u2019accurata analisi degli studi ed una puntuale schematizzazione dei risultati ai fini di rispondere al quesito clinico. La massima distensione della cartilagine alare \ue8 stata di 1,41 \ub1 0,95 mm, la cui rilevanza clinica \ue8 questionabile. L\u2019effetto dell\u2019espansione mascellare sull\u2019ampiezza della bocca rimane controverso. In Altindis et al., l\u2019incremento di ampiezza del cavo orale post-trattamento (1,80 mm nel gruppo con RME su bande) \ue8 considerato statisticamente significativo, mentre in Baysal et al. il valore di 1,86 mm non risulta un cambiamento statisticamente significativo. Inconsistenze e limitazioni nella popolazione degli studi e nei protocolli di misurazione sono stati individuati all\u2019interno degli articoli. I dati emersi dovrebbero essere confermati con un protocollo metodologicamente conforme, evitando bias di selezione e di misurazione.The aim of this systematic review is to analyse the quality and clinical evidence in the literature analysing, through 3D stereophotogrammetry, the nasolabial soft tissue modifications that may occur after rapid maxillary expansion (RME). This systematic literature review was based on the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: CRD42017079875. Pubmed, Cochrane, EBSCO, Scopus, Web of Science databases were searched with no restriction of year or publication status. Selection criteria were: randomised clinical trials, controlled clinical trials, cohort studies, cross-sectional studies, case-control studies on patients with unilateral/bilateral crossbite, transverse maxillary deficiency and crowding, treated with RME and monitored by 3D stereophotogrammetry. 652 articles were retrieved in the initial search. After the review process, 11 full-text articles met inclusion criteria. After the evaluation process, 4 publications were included for the present literature review. Due to the heterogeneous methodology meta-analysis was not possible; consequently, a systematic assessment of the studies and summary of the findings from the available evidence were used to answer the research question. The maximum widening of the alar cartilage is 1.41 \ub1 0.95 mm, whose clinical significance is open to question. The effect of RME on the mouth width remains controversial. In Altindis et al., the difference between pre-treatment and post-treatment mouth width (1.80 mm increment in the banded RME group) was statistically significant, while in Baysal 1.86 mm was considered a non-significant value. Inconsistencies and limitations in the study population and measurement protocols were detected between studies. These data underline the necessity for updated guidelines that allow to standardise, for this type of study, sample selection, measurement methods and collection of results

Prevalence of signs and symptoms of temporo-mandibular disorder in patients with sleep apnea

Purpose: The aim of the present study was to detect the prevalence of temporomandibular disorders (TMD) in patients with untreated obstructive sleep apnea (OSA) and to compare the results with healthy controls, matched for sex and age. Methods: Forty-one consecutive patients with OSA were prospectively recruited from the Department of Otorhinolaryngology at the A. Gemelli Hospital prior to undergoing any treatment for OSA and independently of OSA severity. All patients underwent a complete TMD examination according to the diagnostic criteria for temporomandibular disorders (DC/TMD) protocol. The same examination was performed on 41 healthy controls matched for sex and age. Chi-squared test was used to compare results between the two groups. Results: Of the 41 patients with OSA, 21 (51%) presented signs and/or symptoms of TMD compared to 13 of 41 subjects (32%) from the control group. Headache attributed to TMD and disc displacement with reduction were the most common diagnoses, with a statistically significant difference between the two groups (p<0.05). Conclusions: The prevalence of TMD signs and symptoms is significantly higher in untreated patients with OSA compared to healthy controls

Proteomic analysis of salivary inflammatory biomarkers of developmental gingival enlargements in patients with West and Noonan syndromes: a preliminary pilot single-center retrospective study

OBJECTIVE: The aim of the preliminary pilot single-center retrospective cross-sectional study was to analyze and compare the presence of non-secretory salivary inflammatory biomarkers in pediatric patients with West syndrome, Noonan syndrome, and a healthy control group. PATIENTS AND METHODS: A total of 60 saliva samples were collected during dental check-ups. The saliva samples collected were analyzed by liquid chromatography. The results were analyzed with a t-test, and the statistical significance was given by a p-value lower than 0.05. RESULTS: We found statistical significance for defensin α1 (p=0.006) and thymosin β4 (p=0.025) in the Noonan syndrome. In the West syndrome, only the defensin α1 had a statistically significant difference with the other groups (p=0.022). Proteomic analysis revealed an overexpression of peptides related to the innate (thymosin β4) and acquired (defensin α1, α3) immunity. CONCLUSIONS: West and Noonan's syndromes showed the overexpression of molecular biomarkers involved in the pathogenesis of chronic periodontitis. The inflammatory status is triggered and amplified by the abnormal overgrowth of gingival tissues, the amplified release of proinflammatory cytokines from the immune cells, and the poor cooperation in maintaining adequate oral hygiene

Indication of clear aligners in the early treatment of anterior crossbite: A case series

Introduction: Anterior crossbite (AC) is defined as a reverse sagittal relationship between maxillary and mandibular incisors. According to an evidence-based orthodontic triage, the treatment need of AC is indicated if any occlusal interference is forcing the mandible towards a Class III growth pattern. Removable and fixed appliances have been suggested to correct AC. Objective: The present report aims at presenting the benefits of an alternative therapy for the early treatment of anterior crossbite using clear aligners. Methods: Two cases of anterior crossbite corrected using clear aligners in 8-years-old children are presented. Results: In both cases, AC was successfully corrected within 5 months. At the end of the treatment, overjet and overbite were corrected. No major discomfort or speech impairment was noticed by the parents. Conclusions: Due to the perceived shortcomings of alternative approaches, the use of clear aligners for correcting AC in mixed dentition should be considered as a comfortable and well tolerated appliance for young patients

Dental anaesthesia for children \u2013 effects of a computer-controlled delivery system on pain and heart rate: a randomised clinical trial

Local anaesthesia in dentistry is usually given by conventional injection through a syringe. In this randomised, single-blind, split-mouth clinical study we evaluated the perception of pain and changes in heart rate in children being given dental local anaesthesia using a computer-controlled device compared with that given using a traditional syringe. Participants were in good general health with no contraindications to local anaesthetics. One half of each maxilla was anaesthetised using each technique, the order having been randomly selected according to a computer-generated sequence. The hypothesis was that the controlled anaesthetic flow rate results in virtually imperceptible injections. The outcomes were the perception of pain and the heart rate. Seventy-six children aged from 5\u201312 years old participated in this study. The mean (SD) pain score of the conventional injection was 5.51 (2.46) and the mean (SD) heart rate was 2.72 (6.76), which were significantly higher than those of the computerised delivery system, which were 4.74 (2.8) and 0.34 (7.3) (p = 0.04). More patients anaesthetised with the traditional syringe technique required a second injection (n = 21). These results suggest that dental anaesthesia given to children with a computer-controlled delivery system reduced pain better than that given with a conventional syringe