Gingival crevicular fluid alkaline phosphate activity during the retention phase of maxillary expansion in prepubertal subjects: A split-mouth longitudinal study

NTRODUCTION: The aim of this study was to monitor the alveolar bone formation at the tension sites of teeth supporting the appliances for rapid maxillary expansion (RME) during the retention phase according to the local gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity. METHODS: This split-mouth prospective study included 23 prepubertal subjects (15 girls, 8 boys; mean age, 9.0 \ub1 1.4 years) who had a constricted maxillary arch and were undergoing RME. Periodontal parameters, including probing depth, were recorded at 3 and 6 months after RME. Furthermore, the GCF ALP activity was measured at the tension sites of the supporting test teeth (TT) and at the antagonist control teeth (CT) sites. RESULTS: Periodontal parameters were generally similar between the TT and CT sites during the study, with the exception that probing depth underwent a slight increase at the TT sites. At baseline, the GCF ALP activity was similar between the TT and CT sites; however, at both 3 and 6 months, significantly greater enzymatic activity was seen at the TT sites. The overall probing depth changes were not significantly correlated with the corresponding GCF ALP activity changes for either the TT or the CT sites. CONCLUSIONS: Alveolar bone formation at the tension sites would last up to 6 months of retention after RME. These results warrant more comprehensive studies to assess whether the GCF ALP activity has potential as a diagnostic tool for bone formation during the retention phase of RME

MULTIDISCIPLINARY APPROACH TO MEDICATION-RELATED OSTEONECROSIS OF THE JAW: REPORT OF A CASE

Nowadays the multidisciplinary team (MDT) plays a critical role in the treatment of patients with osteonecrosis of the oral cavity, in particular for the reconstructive-rehabilitation phase of complex cases. Among the objectives of the MDT we find the improvement of the quality of life of patients, the restoration of the anatomical defect following surgery, as well as the planning of an aesthetic-functional rehabilitation. The experience of the MDT composed of professionals belonging to the Medicine and Oral Pathology Outpatient Clinic of the Maggiore Hospital of Trieste and to the Department of Otolaryngology of the S. Maria degli Angeli Hospital in Pordenone is presented in relation to surgical-prosthetic rehabilitation in a patient with drug-induced osteonecrosis. The patient, suffering from right maxillary osteonecrosis induced by therapy with Zoledronic Acid, underwent a demolitive surgical intervention of right maxillectomy. At the same time, reconstruction was carried out using a microvascularized fibula flap and insertion of 5 implants. Subsequently, the patient was rehabilitated with a fixed prosthesis on implants. The rehabilitation of the treated patient allowed the resumption of functional activities such as chewing and phonation, guaranteeing the patient a good quality of life. Last but not least, it has allowed us to obtain a good result also from an aesthetic point of view. There are numerous studies in literature which confirm the success of planning by the MDT in treating MRONJ hat demonstrate how an effective and dynamic MDT positively influences the patient's therapeutic and rehabilitative path. The MDT must therefore be able to formulate a personalized therapeutic and rehabilitation plan for the individual patient

Changes in mandibular radiomorphometric indices in osteoporosis patients treated with denosumab: a retrospective case-control study

Background: Radiomorphometric indices measured on Dental Panoramic Radiography (DPR) can reflect Bone Mineral Density (BMD). The aim of our study is to evaluate changes in DPR radiographic markers in patients undergoing antiresorptive therapy with denosumab and correlate them to BMD and serum bone turnover markers (BTM). Methods: We evaluated two radiomorphometric indices: Mandibular Cortical Width (MCW) and Panoramic Mandibular Index (PMI), in patients undergoing antiresorptive therapy with denosumab at T0 (before starting the therapy) and at T1 (after 12 months), comparing results with a control group of healthy patients who performed two DPRs at a one-year time distance. Correlation analysis was performed in the denosumab group, as well as ROC curves were obtained for both indices. Results: The study included 18 patients and 21 controls according to specific inclusion and exclusion criteria, matched by gender and age. Both MCW and PMI were significantly lower at T0 in the denosumab group, consistently with lower BMD. MCW showed significant correlation with femoral and lumbar DEXA and was significantly lower in patients with osteoporosis compared to osteopenia. Only PMI index increased significantly in the denosumab group from T0 to T1. After one year (T1), there weren't any differences between patients and controls for both indices. No significant correlations were found with BTMs. Sensitivity and specificity for MCW and PMI were also calculated. Conclusions: Our results show how CMW shows sufficient sensitivity and specificity to be used as a radiographic marker to screen and intercept patients with osteoporosis. PMI seems to be able to reflect changes in response to antiresorptive therapy with denosumab. Further studies are needed to confirm our hypothesis

Dental Treatment in Special Needs Patients and Uncooperative Young Children: A Retrospective Study

Background and Objectives: Special Needs Patients (SNPs) and young non-collaborative children are more predisposed to develop oral pathologies due to poor collaboration and scarce access to dental treatment. The aim of this retrospective study was to analyze a sample of SNPs who received dental treatments either under general anesthesia (GA) or deep sedation (DS) over a period of 6 years. The number and type of procedure were analyzed. Materials and Methods: In total, 131 patients were included and mostly (>90%) treated under GA. Patients were either uncooperative and phobic (Group 1) or affected by mental, behavioral, and neurological disorders (Group 2), diseases of the nervous system (Group 3), or developmental anomalies (Group 4). Results: Patients in Group 2 required more invasive dental treatments than those in the other groups. Therapies were mainly preventive and restorative, except in Groups 3 and 4, where extractions were more frequent. The type of dental treatment significantly varied according to age and systemic condition. Only 5.3% of the patients needed a second intervention, despite only 17.6% of patients respecting the scheduled follow-up. Conclusions: Treatment under GA is effective, but the poor adherence to follow-ups and the risk of reintervention should be contrasted by improving the perception by parents/guardians of the importance of oral hygiene and periodic visits

Knowledge and awareness of oral cancer: A cross-sectional survey in Trieste, Italy

The aim of the study was to verify the knowledge on oral cancer and to assess possible differences in awareness and information basing on different demographic and subject-related factors. An anonymous survey was provided to 750 random subjects using online-based questionnaires. Statistical analysis was performed in order to evaluate the influence of demographic variables (gender, age, education) on knowledge of oral cancer and its risk factors. 68.4% of individuals knew about the existence of oral cancer, mostly from media and family/friends. Awareness was significantly influenced by gender and higher education, but not by age. Most participants recognized smoking as a risk factor, but alcohol abuse and sunlight exposure are less known, especially among less educated subjects. On the contrary, our study shows a diffusion of false information: more than 30% of the participants indicated the possible role of amalgam fillings in oral cancer onset, independently of gender, age or education. The results of our study suggest the need for oral cancer awareness campaigns, where school and healthcare professionals should be actively involved in promoting, organizing and finding methods to monitor the medium and long-term efficacy with proper methodological quality

Oral Problems in Oncology Patients Undergoing Chemotherapy for Solid Tumors: A Prospective Observational Study

PURPOSE: Oral problems in a group of oncological patients undergoing chemotherapy (CT) for solid tumors have been examined. Incidence and severity of patients’ self-reported oral problems have been evaluated along their interaction with age, gender, tumor diagnosis and stage, presence of mestastasis, CT agent type, and number of CT cycle. We also analyzed the presence of paraesthesia and anaesthesia and their predisposing factors associated with clinical and treatment-related variables. METHODS: Patients were asked to fill in a questionnaire to evaluate the onset and the intensity of oral and perioral pain, oral mucositis, salivary gland hypofunction, dysgeusia, dysphagia, dysphonia, and sensitivity neuropathy (paraesthesia or dysaesthesia) since the last CT infusion. We also investigated which types of medications have possibly been used and who recommended it, as well as patients’ degree of awareness about the possibility of oral problems arising during CT. RESULTS: We recruited 194 patients and obtained 491 questionnaires. We found that a metastatic disease was a risk factor for OM (OR 2.02, p = 0.026) and salivary gland hypofunction (OR 1.66, p = 0.042) and that platinum agents, compared to mitotic inhibitors, increased the risk of developing salivary gland hypofunction (OR 2.16, p = 0.013), dysphagia (OR 3.26, p = 0.001), and anaesthesia (OR 5.16, p = 0.041). Young age was a slight protective factor for most symptoms. The 80% of enrolled patients were informed by the oncologist about possible oral problems arising during CT. CONCLUSIONS: Our study highlighted the importance of collecting observational data from the patients’ perspective on oral problems arising during the routine oncology practice, across a range of solid tumors and CT regimens. The relevance of these findings focused on the key role of the multidisciplinary team in advising the patients on the possible occurrence of oral problems, also by recommending their management

Advancements in Understanding and Classifying Chronic Orofacial Pain: Key Insights from Biopsychosocial Models and International Classifications (ICHD-3, ICD-11, ICOP)

In exploring chronic orofacial pain (COFP), this review highlights its global impact on life quality and critiques current diagnostic systems, including the ICD-11, ICOP, and ICHD-3, for their limitations in addressing COFP's complexity. Firstly, this study outlines the global burden of chronic pain and the importance of distinguishing between different pain types for effective treatment. It then delves into the specific challenges of diagnosing COFP, emphasizing the need for a more nuanced approach that incorporates the biopsychosocial model. This review critically examines existing classification systems, highlighting their limitations in fully capturing COFP's multifaceted nature. It advocates for the integration of these systems with the DSM-5's Somatic Symptom Disorder code, proposing a unified, multidisciplinary diagnostic approach. This recommendation aims to improve chronic pain coding standardization and acknowledge the complex interplay of biological, psychological, and social factors in COFP. In conclusion, here, we highlight the need for a comprehensive, universally applicable classification system for COFP. Such a system would enable accurate diagnosis, streamline treatment strategies, and enhance communication among healthcare professionals. This advancement holds potential for significant contributions to research and patient care in this challenging field, offering a broader perspective for scientists across disciplines

Photobiomodulation at Multiple Wavelengths Differentially Modulates Oxidative Stress In Vitro and In Vivo

Photobiomodulation (PBM) is emerging as an effective strategy for the management of multiple inflammatory conditions, including oral mucositis (OM) in cancer patients who receive chemotherapy or radiotherapy. Still, the poor understanding of the mechanisms by which the light interacts with biological tissues and the heterogeneity of light sources and protocols employed worldwide significantly limits its applicability. Reactive oxygen species (ROS) are massively generated during the early phases of OM and play a major role in the pathogenesis of inflammation in general. Here, we report the results of a clinical and experimental study, aimed at evaluating the effect of laser light at different wavelengths on oxidative stress in vivo in oncologic patients suffering from OM and in vitro in two cell types abundantly present within the inflamed oral mucosa, neutrophil polymorphonuclear (PMN) granulocytes, and keratinocytes. In addition to standard ROS detection methods, we exploited a roGFP2-Orp1 genetically encoded sensor, allowing specific, quantitative, and dynamic imaging of redox events in living cells in response to oxidative stress and PBM. We found that the various wavelengths differentially modulate ROS production. In particular, the 660\u2009nm laser light increases ROS production when applied either before or after an oxidative stimulus. In contrast, the 970\u2009nm laser light exerted a moderate antioxidant activity both in the saliva of OM patients and in both cell types. The most marked reduction in the levels of ROS was detected in cells exposed either to the 800\u2009nm laser light or to the combination of the three wavelengths. Overall, our study demonstrates that PBM exerts different effects on the redox state of both PMNs and keratinocytes depending on the used wavelength and prompts the validation of a multiwavelength protocol in the clinical settings

Self-Assembled Nanomicelles as Curcumin Drug Delivery Vehicles: Impact on Solitary Fibrous Tumor Cell Protein Expression and Viability

Solitary fibrous tumors (SFTs) are rare soft tissue sarcomas that rely on several epithelial-mesenchymal transition (EMT) protein regulators for invasion/metastatic progression. Curcumin (CUR) has several pharmacological activities, including anticancer activity and the ability to suppress the EMT process. However, poor absorption, rapid metabolism, and side effects at high doses limit the clinical applications of CUR. Here we present the results obtained by treating SFT cells with free CUR and three different CUR-loaded nanomicelles (NMs), each of which has its surface decorated with different ligands. All CUR-loaded NMs were more efficient in suppressing SFT cell viability and expression of EMT markers than CUR alone. Combined treatments with the pan-histone deacetylase dual inhibitor SAHA revealed a differential ability in inhibiting EMT markers expression and SFT cell invasiveness, depending on the NM-ligand type. Finally, combinations of photodynamic therapy and CUR-loaded NM administrations resulted in almost complete SFT cell viability abrogation 24 h after laser irradiation

CHARACTERIZATION OF THE ANTIMICROBIAL EFFECT OF BLUE LASER ON PSEUDOMONAS AERUGINOSA IN VITRO AND IN VIVO

Lo sviluppo di nuove strategie antimicrobiche \ue8 un argomento che \ue8 tornato di vivo interesse nella comunit\ue0 scientifica, a causa dell\u2019aumento costante della resistenza agli agenti antimicrobici convenzionali. L\u2019effetto antimicrobico della luce blu \ue8 stato descritto in diversi recenti lavori scientifici, tuttavia necessita di ulteriori validazioni prima di poter essere applicato nella pratica clinica e per trovare degli ambiti di utilizzo appropriati. Gli obiettivi di questo studio sono stati la valutazione dell\u2019effetto antimicrobico del laser blu su Pseudomonas aeruginosa (PAO), la caratterizzazione dei meccanismi antimicrobici coinvolti, la valutazione di possibili tossicit\ue0 su cellule epiteliali umane, la validazione di tale effetto in vivo in un modello murino di abrasione infetta e il possibile utilizzo della luca laser blu in terapia fotodinamica utilizzando come fotosensitizzante la curcumina libera, e la curcumina incapsulata in tre tipi di nanomicelle anfifiliche. I risultati del nostro studio hanno dimostrato come la sola irradiazione di PAO con luce laser blu \ue8 stata sufficiente ad esercitare un effetto antimicrobico in diverse condizioni (PAO cresciuto in sospensione planktonica o su piastra), e abbiamo identificato diversi protocolli efficaci. In aggiunta, abbiamo caratterizzato anche un effetto sia su biofilm maturo cresciuto con diverse modalit\ue0, che sull\u2019inibizione dello sviluppo del biofilm stesso. Sebbene ulteriori caratterizzazioni a livello molecolare saranno necessarie, i nostri risultati confermano un ruolo dello stress ossidativo nel meccanismo di azione antimicrobica. Comparando l\u2019effetto della luce blu laser e LED, abbiamo rilevato un\u2019efficacia significativamente maggiore della luce laser. Valutando lapossibile tossicit\ue0 su cheratinociti umani, abbiamo rilevato effetti leggermente diversi nelle due linee cellulari utilizzate in termini di vitalit\ue0 e metabolismo cellulare. Abbiamo inoltre identificato diversi protocolli che possiedono sia efficacia antimicrobica che scarsa tossicit\ue0 nei confronti dei cheratinociti umani. Inoltre, abbiamo evidenziato una stimolazione dell\u2019espressione di molecole relative all\u2019inflammosoma come ci aspettavamo, ma anche un aumento nell\u2019espressione genica di peptidi antimicrobici (defensine), che persiste fino a 6 ore dall\u2019esposizione alla luce laser blu (soprattutto per quanto riguarda le defensine b3 e b4). Applicando cos\uec il protocollo con lunghezza d\u2019onda 445nm, potenza 0,3W, irradianza 0,105W/cm2 e fluenza 60J/cm2 in un modello murino di abrasione infetta, abbiamo ottenuto una riduzione significativa della carica batterica, ma non un\u2019eradicazione completa come ci saremmo aspettati considerando i risultati precedenti. D\u2019altra parte, osservando i campioni dal punto di vista istologico per valutare possibili danni termici, abbiamo rilevato una grande differenza tra i due gruppi: mentre i campioni non trattati presentavano un grande livello di infiammazione attraverso tutto lo strato dermico ed epidermico, i campioni trattati con il laser presentavano un danno termico minimo insieme ad un modesto infiltrato infiammatorio omogeneo. Infine, abbiamo valutato l\u2019utilizzo di un protocollo subletale di laser blu in terapia fotodinamica su tre tipi di nanomicelle anfifiliche con curcumina, ottenendo la concentrazione minima inibente antimicrobica pi\uf9 bassa di nanoparticelle di curcumina descritta finora, che si \ue8 abbassata ulteriormente con l\u2019aggiunta della luce laser blu.The development of novel antimicrobial strategies has returned of crucial importance due to increasing resistance to conventional antibiotics. The antimicrobial effect of blue light has been recently described in several research works, but it needs further validation to be safely used in clinical practice and to find appropriate fields of application. The aims of this study were to evaluate the antimicrobial properties of blue laser light on Pseudomonas aeruginosa (PAO), to explore the mechanisms underlying the antimicrobial acttivity, to evaluate possible toxicity on human keratinocytes, to validate this effect in vivo and to evaluate the use of blue laser in antimicrobial photodynamic therapy (PDT) using free curcumin and curcumin embedded in three types of amphiphilic nanomicelles. The results of our study demonstrated how blue laser irradiation alone is able to exert antimicrobial effects towards PAO grown in different conditions (PAO grown in planktonic state and on solid surfaces) and we identified several effective irradiation parameters. Furthermore, we described also an antibiofilm activity both in disrupting a mature biofilm and in inhibiting biofilm formation. Although further and more molecular-based investigation is warranted, our results suggest, according with literature, a possible role of oxidative stress stimulation for the explanation of bacterial inhibition/death. Comparing blue laser source with LED, laser was significantly more effective. When investigating the possible toxic effects on keratinocytes, we observed slightly different effects on two keratinocyte cell lines in terms of cell viability and metabolic activity after irradiation, and identified several protocols which proved both antimicrobial efficacy and safety towards human cells. Furthermore, we highlighted a stimulation of inflammosome molecules expression as expected, but also an overexpression of highly active antimicrobial peptides (defensins), which persists hours after irradiation (especially defensin b3 and b4). When applying the protocol with wavelength 445nm, power 0,3W, irradiance 0,105W/cm2 and fluence 60J/cm2 in vivo on a mouse model of infected abrasion, we obtained a significant reduction in bacterial load in laser treated mice, but not the complete eradication as we were expecting basing on our previous results. 7 But on the other hand, when observing histological samples to evaluate possible thermal damage, we noticed a huge difference among samples: while non treated displayed a high inflammation rate permeating epidermal and dermal layers, the laser treated ones had minimum epidermal damage and were almost free of inflammatory infiltrate. Finally, we explored the possible potentiating effect of blue laser sublethal irradiation on three types of amphiphilic nanomicelles loaded with curcumin. We obtained the lowest MIC of curcumin nanoparticles described so far, which further decreased after sublethal blue laser irradiation