PREVALENCE OF ORAL LESIONS MODULATED BY PATIENT’S AGE: THE YOUNG VERSUS THE ELDERLY

The aim of this study was to compare the prevalence of oral lesions and conditions in young and elderly population. The authors analyzed a number of 1324 patiens, treated in our clinic, between 2011-2017, divided into 4 subgroups. Prevalence of one or several oral lesions was of 51,29% patients. We identified a wide range of oral heterogeneous lesions, the first place being held by burning mouth syndrome and chronic candidiasis in the elderly, and by aphtous stomatitis and acute candidiasis in the young. The results of our study may provide important information on the types and incidence of oral mucosal lesions in the northern region of Romania and seems to be similar to the level predicted for young and elderly patients in our country

The Complex Relationship of Periodontal Disease and Rheumatoid Arthritis

The relationship between periodontitis and systemic diseases is an important part of clinical periodontal research, which has been growing steadily. Even though the etiologies of periodontal disease and rheumatoid arthritis (RA) differ, these pathologies have many common features, both being multifactorial diseases characterized by localized chronic inflammatory reactions, which are fuelled by an analogous set of cytokines (among many, the most prominent being Tumour Necrosis Factor (TNF), Interleukin (IL) 6 and 17), leading to high systemic circulating concentrations of inflammatory markers such as C-reactive protein (CRP). It was not until the discovery of peptidylarginine deiminase (PAD) mediated citrullination of proteins by Porphyromonas gingivalis that the link between the two diseases was purely speculative. This citrullination initiates a series of events which culminate in the production of anti-citrullinated protein antibodies (ACPA) and, finally, in the clinical manifestation of rheumatoid arthritis. Another common denominator is the bone destruction caused by proinflammatory cytokines secreted by T 17 helper cells (TH17) which is the pathological hallmark of both diseases. Other notable common areas are shared risk factors such as environmental and genetic risk factors. Regarding treatment, neither pathologies have a definitive cure, however, several strategies are employed, some of which are common, such as diet and lifestyle changes, and immunomodulating medication applied locally or systemically

IMPLICATIONS AND CONSTRAINTS OF PERIODONTAL IMPLANTATION FOR ORTHODONTIC PURPOSES IN THE CONTEXT OF DIABETES AND OTHER ASSOCIATED COMORBIDITIES. REVIEW.

Diabetes mellitus and periodontal disease are among the most common chronic diseases of mankind and, remarkably, they share many common features. The most common forms of periodontal diseases, gingivitis and periodontitis, are characterized by a microbially driven series of host responses that lead to periodontal tissue damage.The host response is central to the development of periodontitis, as it is to the development and progression of several human chronic diseases, including diabetes mellitus. In the next sections we will review the main features of diabetes mellitus, with the main focus being the association between type 2 diabetes mellitus and periodontitis. Peri-implant diseases are infectious conditions affecting dental implants, ranging from peri-implant mucositis, which is an inflammatory lesion of the peri-implant mucosa, to peri-implantitis, which also affects the supporting bone. As well as potentially sharing some similar risk factors, diabetes mellitus and periodontal disease patients have exceptionally similar tendencies to develop comorbidities that tend to cluster in the same individuals. Attention to the patient’s medical history is one of the cornerstones for efforts in the prevention of periodontal and peri-implant diseases

Odontogenic Sinusitis: From Diagnosis to Treatment Possibilities—A Narrative Review of Recent Data

The maxillary sinus is a structure at the border of specialties: otorhinolaryngology and maxillofacial surgery. Due to this fact, regarding etiology, it can be affected by both the rhinogenic and odontogenic path and can impose diagnostic difficulties. The etiopathogenic mechanisms that can affect the Schneiderian membrane are mainly inflammatory, iatrogenic, traumatic, and tumorous in nature. From a microbiological point of view, the bacteriology is polymorphic, including both aerobic and anaerobic species in acute OS, the predominating species in acute OS being aerobic, and in chronic anaerobic germs. The role of fungi in the determination of this pathology and in the production of the biofilm that leads to resistance to antibiotic treatment is also discussed. The present paper aims to present the etiopathogenesis, bacteriology, clinical manifestations, as well as treatment of odontogenic sinusitis (OS) from an updated perspective through reviewing the literature. If unilateral maxillary sinusitis is usually due to odontogenic causes, this does not clinically exclude the possibility of strictly rhinogenic causes in the occurrence of sinusitis. This underlines the important role of complex oral and rhinological clinical examination as well as the role of preclinical examinations in specifying the certainty diagnosis. Simple radiography, orthopantomography, CT, and CBCT are compared in terms of diagnostic accuracy. The treatment of OS is complex, involving medication, dental, and surgical measures. The value of endoscopic surgery is emphasized, comparing its advantages over the classic Caldwell-Luc technique

A CASE OF BILATERAL IMPACTION OF MAXILLARY INCISORS IN AN INTELLECTUALLY CHALLENGED PATIENT

Maxillary incisors usually erupt in the early mixed dentition stage but eruption anomalies can arise and are frequently caused by local factors. A failure of eruption affects the developing occlusion and has the potential to influence the psychological development of the child. Furthermore, impaction of frontal teeth can result in esthetic, functional and phonetic problems in addition to causing root resorption and chronic or acute infections. As general guidelines of managing the delayed eruption or impaction of these teeth, it is recommended for the clinician to ensure the existence of enough space in the dental arch and remove any impediment in the path of eruption. In addition to this, the eruption should further be aided through surgical exposure, with or without subsequent orthodontic traction. In order to appoint the appropriate treatment plan, various factors – such as patient age, medical history, associated systemic diseases or conditions, compliance, etiology and position of the un-erupted tooth, can influence the decision-making process,. Thorough clinical appraisal associated to appropriate paraclinical investigation is a prerequisite, but also an interdisciplinary approach is advised, in order to enhance the treatment outcome

MIGRATORY STOMATITIS – CASE PRESENTATION

Migratory stomatitis is a rare recurring condition of unknown etiology that mainly involves lingual mucosa, with a typical appearance of geographic tongue. Factors such as heredity, nutritional deficiencies or stress may be the contributing factors to the appearance of lesions. Clinically, they appear as circular, multiple, erythematous lesions with red spots surrounded by a white, narrow, hyperkeratotic aspect with irregular, slightly elevated appearance modifying its form in 24 hours.The condition may have spectacular clinical signs when the lesions are localised on the tongue, and may involve other areas of oral mucosa, such as labial or floor of mouth mucosa. The aim of this study is to present a clinical case of a patient with two localisations of lesions corresponding clinically to migratory stomatitis. The anatomopathological examination confirmed the migratory stomatitis diagnosis, so we could begin the specific treatment, to which the patient responded positively

Customized 3D-Printed Titanium Mesh Developed for an Aesthetic Zone to Regenerate a Complex Bone Defect Resulting after a Deficient Odontectomy: A Case Report

Background and Objectives: Alveolar ridge augmentation in the complex bone defect is a popular topic in implantology. Guided bone regeneration (GBR) is one of the most commonly applied methods to reconstruct alveolar bone. The application of a membrane is the fundamental principle of GBR. There are many membrane types used in oral surgery, but the advantage of the titanium mesh is the rigidity which provides space maintenance and prevents contour collapse. The smooth surface also reduces bacterial contamination. Using computer-aided design (CAD) and computer-aided manufacturing (CAM) in dentistry allows us to obtain the perfect architecture form of the mesh, which covers and protects the bone reconstruction. Case presentation: We present a surgical case of a 27-year-old female patient with severe aesthetic bone atrophy after a deficient odontectomy. Based on the GBR clinical applications, the technique consists of bone reconstruction and a customized titanium mesh application. Using mesh titanium in this case presentation was a reliable alternative to perform a lateral alveolar bone augmentation and reconstruct ridge deformities before reaching an ideal implant placement. Conclusions: According to our case report, the customized titanium mesh could be a valuable option for guided bone regeneration in aesthetic maxillary defects

EVALUATION OF MICROBIOLOGICAL MARKERS IN PATIENTS WITH PERIODONTAL DISEASE AND DEPRESSION

Clinical research documents causal relationships between periodontitis and depression. Furthermore, it has been revealed that clinical depression can also negatively affect periodontal treatment outcomes. The present study aimed to analyze subgingival microbial profiles in patients with periodontal disease and those with depression by qualitative and quantitative determination of 4 periodontal pathogens. Material and method. The study was carried out on a number of 40 patients between the ages of 20 and 48 within the Periodontology Clinic of the Faculty of Dental Medicine, within the “Grigore T. Popa” University of Medicine and Pharmacy Iași or in an office with private practice within the radius of the city of Iași. Analyzing the obtained results, it can be seen that the average age is significantly lower for the group of patients with periodontal disease compared to the average age of patients with periodontal disease and depression (p=0.02). Regardless of which method, the individualized determination of periodontal pathogens helps guide targeted systemic antibiotic therapy (individualization of the treatment plan). It limits self-medication or the possibility of developing bacterial resistance

Correlations between Salivary Immuno-Biochemical Markers and HbA1c in Type 2 Diabetes Subjects before and after Dental Extraction

Dental extraction can trigger certain sequences of complex processes that involve both hard (alveolar bone) and soft tissue (periodontal ligament, gingiva) remodeling. Type 2 diabetes is a serious risk factor for many oral pathologies, both in terms of progression and severity, but also regarding subsequent rehabilitation possibilities. The aim of this study was to establish whether certain molecules: osteoprotegerin (OPG), kappa B nuclear factor receptor activator ligand (RANKL), hepatocyte growth factor (HGF), tumor necrosis factor-α (TNF-α), interleukin 18 (IL-18), matrix metalloproteinase 9 (MMP-9) and oxidative stress markers—total oxidant status (TOS), total antioxidant capacity (TAC)—evaluated in saliva are modified post-extraction in type 2 diabetes mellitus subjects and whether there is a correlation with HbA1c levels. The aforementioned markers plus HbA1c were investigated in a group of systemically healthy subjects (n = 45) and in a type 2 diabetes mellitus group (n = 41) before and three months after a tooth extraction. Diabetes patients’ recorded increased levels of OPG, RANKL, TNF-α, MMP-9, IL-18 and TOS compared to controls both pre- and post-extraction. In both study groups, the average OPG, HGF and TAC level recorded an upward trend three months post-extraction. TNF-α registered a statistically significant decrease only in the diabetes group after dental extraction, together with a decrement of mean HbA1c levels in the diabetes group. By plotting the ROC (receiver operating characteristic) curve, at baseline RANKL, TNF-α, IL-18, MMP-9, TOS and OPG were good predictors of HbA1c levels. Post-extraction, there was a significant correlation between HbA1c and oxidative status biomarkers, however the linear regression model indicated the influence of all studied salivary markers in HbA1c determinism, in a considerable proportion. In conclusion, our study demonstrated that several oxidative status markers and proinflammatory biomarkers are modified in the saliva of diabetic patients and they correlate to HbA1c levels, thus being potential indicators of the post-extraction healing status in the oral cavity

HOST RESPONSE CHANGES FOLLOWING NON-SURGICAL SUBGINGIVAL INSTRUMENTATION. REVIEW

There is ample literature evidence to support that periodontal therapy has an impact on the local and systemic host immune responses, despite contradicting data from the literature reporting both a decrease and increase in systemic antibody levels following treatment. The clinical guidelines for the treatment of patients with periodontitis stages I–III published from the European Federation of after the patient has been informed about his/her condition, the first step in the treatment process is directed toward motivation, targeting behavioral changes to achieve adequate self-performed oral hygiene practices and controlling local and systemic modifiable risk factors. A systematic review indicates positive associations across patient-reported experiences, self-rated and objectively measured health outcomes in relation to a wide range of areas and settings. Despite patient-reported experiences and patient-reported outcomes of therapy being closely related, there are differences between the two concepts. Frequent re-evaluation of oral hygiene reinforcement outcomes is suggested, aiming to reinforce a patient’s motivation and keep the patient up to date with any changes that might occur in the periodontal status, enabling the patient to actively participate in the progress of the treatment plan. In conclusion, short-term perturbations of antibody responses occur during the active phase of periodontal therapy