Minimally invasive approach to eliminate pyogenic granuloma using Er, Cr: YSGG laser

Backgroung. PG or granuloma pyogenicum is a common tumor like growth of the oral cavity that is considered to be of non-neoplastic nature, arising commonly as a result of constant low grade trauma and poor oral hygiene and in few instances because of hormonal disturbances. Since it is a benign lesion, choice of treatment is surgical excision with removal of underlying cause if any. A newer treatment modality using laser has been reported. Case report. A 16-year-old male patient reported to our sector of oral medicine with the chief complaint of intra-oral painless growth since four months. Past history and medical history did not reveal any relevant information. He was taking no medication and had no history of known drug allergy. On intra-oral examination smooth surfaced and lobulated growth of approximately 1.5 × 1 × 0.5 cm in size was present in the palate. The lesion was pedunculated and was freely movable over peduncle. The surface of the lesion showed non-omogenous red color whereas in certain area was covered by yellowish plaque like material. On palpation, growth was non-tender, nonfluctuant, hard and fibrous in consistency. Treatment plan comprising of excisional biopsy of the lesion using an Er, Cr: YSGG laser. An elliptical incision was made around the peduncle, the lesion was lifted along with the underlying periosteum from the bone surface and removed. Hemostasis was achieved with the same laser and healing was obtained for second intention. Excised specimen was preserved and sent for histopathological examination. At 7 days recall, the gingival tissues were healthy with successful healing. Conclusion. Excisional surgery is the treatment of choice for PG. The use of laser may be a valid approach for the excision of this lesion, as it is minimally invasive and offers many clinical advantages (minimal intra-operative bleeding,hemostasis, reduced times of healing)

Diode laser treatment of a large oral hemangioma

Background. Several options can be taken into account to treat hemangiomas; the most considered is the surgical excision, although total removal is not always possible, especially for large lesions, since vital structures can be involved. Another treatment includes the diode laser therapy. Objectives. The aim of this study was to report a clinical case of micro-invasive treatment of a large oral hemangioma in the buccal mucosa using a 900 nm diode laser. Case report. A 49-year-old female patient was referred to our sector of oral medicine reporting difficult chewing, swelling, and occasionally bleeding, from a congenital neoformation. Clinical examination revealed a dark blue and multiglobular (size 5x3 cm) lesion of the right buccal mucosa. After diascopy, loss of normal coloration in the place of the lesion was observed. After the eco-doppler evaluation, a diagnosis of congenital haemangioma was formulated, and the patient was treated by photocoagulation by diode laser at 900 nm wavelenght, and 2.5 W of power, in continuous wave mode for 90 s. Irradiation was delivered by means of a flexible quartz fiber that was kept 2-3 mm away from the lesion. Treatment was performed without topical, local, or general anesthesia, in six-monthly-sessions. All stages of treatment and healing were photographically documented. After the treatment, the lesion was blanched and visibile shrinkaged. No adverse effects (atrophy, scars, hyper- or hypopigmentation) were observed after the treatment. No intra and postoperative pain was reported by the patients. On 3-months follow-up, no recurrence was observed. Conclusions. Likewise reported by other studies, diode laser photocoagulation treatment proved to be an useful method for the treatment of oral hemangiomas. For the safety of use and the absence of intra and postoperative discomfort for patients, it would be considered a valuable tool in the treatment of large hemangiomas

The combination of laser-assisted surgery with PRP for the treatment of BRONJ in cancer patient. A pilot study

Aim. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-known potential complication of bisphosphonates (BPs) therapy and its treatment could reckon on different approaches. Recently, encouraging results for BRONJ were showed from some clinical studies using Er, Cr: YSGG laser-assisted surgery. Platelet-Rich Plasma (PRP), a new approach to promote tissue regeneration and healing, may be a promising complementary therapy. The aim of this pilot study is to study the effectiveness, in terms of clinical healing, of a combined treatment (laserassisted surgery and topical PRP) for BRONJ in a group of cancer patients. Methods. Ten oncological patients (3 males, 7 females; aged 69-89 years, mean age 76.2±5.8) with BRONJ were consecutively recruited. BRONJ was classified (T0) according to. All patients underwent pre- and peri-operatory antibiotic prophylaxis, and preparation of autologous PRP; the following combined surgical protocol was applied: i) exposure of the surgical area, through the creation of surgical edges; ii) courettage of the necrotic bone and, if present, sequestrectomy, by using a Er, Cr: YSGG laser; iii) application of autologous PRP over the entire bone cavity; iiii) suture of surgical flaps. All patients performed a CT after 3 months from surgery (T1) in order to re-stage of the disease. Successful treatments were considered the complete healing and the radiological improvement (transition from a higher stage to a lower one). Results. At T0 6/10 patients were stage IB, 2/10 were stage IIA and 2/10 were stage IIB. At T1, 3/10 (30%) cases (2 cases IB and 1 case IIB) showed no clinical and radiological signs of BRONJ relapse; 5/10 (50%) cases (4 cases IB and 1 case IIB) showed clinical improvement, whereas 2/10 (20%) (both IIA) showed no-improvement. Conclusion. The association of laser-assisted surgery and topical PRP, firstly investigated in this study, seems useful in BRONJ healing among cancer patients. Further investigation is necessary in order to validate these preliminary result

Conservative Surgical Treatment of Bisphosphonate-Related Osteonecrosis of the Jaw with Er,Cr:YSGG Laser and Platelet-Rich Plasma: A Longitudinal Study

Abstract Introduction: The management of bisphosphonate-related osteonecrosis of the jaw (BRONJ), with no evidence-based guidelines, remains controversial. We aimed to evaluate the efficiency of a conservative surgical treatment combining Er,Cr:YSGG laser and platelet-rich plasma (PRP) for the treatment of BRONJ in cancer patients.Methods:We performed a longitudinal cohort study. Inclusion criteria were (1) age 65 18 years; (2) cancer diagnosis; (3) treatment with NBP because of the underlying cancer. Results:We consecutively recruited ten patients diagnosed with BRONJ in stage I or II. These patients underwent a surgical laser-assisted therapy together with autologous PRP. At the latest follow-up at 12 months, clinical improvement was observed in eight patients. Registration Number is IRCT20180329039159N1. Conclusion:We could successfully manage the BRONJ utilizing this combined protocol to heal the 30% of surgically treated sites and to improve the 50% of patients' lesions clinically. Our findings suggest that a surgical approach combined with Er,Cr:YSGG laser and PRP benefit cancer patients with general health issues

POSSIBLE ROLE OF CRY1 AND CRY2 IN ORAL CARCINOGENESIS

Aim. Dysfunction of the circadian clock is involved in tumorigenesis, and altered expression of some clock genes has been found in cancer patients. It has been shown recently that the occurrence, development, prognosis, and treatment of cancer are closely related to the abnormal expression of certain circadian-clock genes. CRY1 and CRY2 circadian-clock gene plays an important role in the regulation of many normal hysiological rhythms. This proteins act as light-independent inhibitors of CLOCK-BMAL1 components of the circadian clock. It has been revealed recently that abnormal expression of CRY1 and CRY2 correlate closely with the occurrence and development of many cancers. However, the expression and significance of this proteins in oral squamous cell carcinoma (OSCC) remains unknown. The aim of this study was to evaluate the expression levels of CRY1 and CRY2 in oral cancer. Materials and methods. CRY1 and CRY2 expression in cancerous and peritumoral tissues (when it was present) from 27 patients with OSCC was detected by immunohistochemistry techniques. Of all samples were received medical records (age, sex, grading, TNM, site of localization of the tumor). Immunohistochemistry was then performed on two sections for each of 27 sample mounted on poly-Llysine-coated glass slides to evaluate respectively the expression of CRY1 and CRY2.Results. In this study, out of the 27 cases, 11 were +/- positive in tumor area for CRY1 (most of which are well (differentiated), while out of 23 cases in which we evaluated the peritumoral tissue present in the section, 18 were positive. Also in the cases of positive tumor, almost always cytoplasmic, the CRY1 appears to be more strongly positive in dysplastic areas or even more in healthy epithelium, with a negative regulation in the areas most undifferentiated. As for the CRY2, out of the 27 cases analyzed, 17 were positive in the tumor area while about 23 cases in which we evaluated in peritumoral tissue present in the sections, 20 cases were positive. In tumor epithelium were found positivity also medium / high, present in tumors of different degree of differentiation, in some cases in other nuclear or cytoplasmic and nuclear/cytoplasmic, but when present the CRY2 is expressed, in most cases, in a manner similar or more intensely in peritumoral dysplastic epithelium. In the case of CRY2, there were no positivity in healthy epithelium (when present), but only in dysplastic epithelium. In addition, the positivity observed especially in peritumoral epithelium were present in states intermediate/surface. Conclusions. In conclusion, abnormal expression levels of CRY1 and CRY2 in OSCC tissue compared to healthy or dysplastic tissue may be related to the process of tumorigenesis. Further research focusing on these genes may, from the perspective of biological rhythms, provide novel ideas and methods for a better understanding of the occurrence and development of tumors, and for treatment of oral cancer

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

The use of Human Allogenic Graft (HBA) for Maxillary Bone Regeneration: Review of Literature and Case Reports

The use of graft materials is developed from the strong demand to support the complete bone regeneration of the empty socket and to increase the bone volume in treating the atrophies of sites already consolidated and with adverse alveolar bone conditions. A number of graft materials with different origin and mechanism of bone regeneration are available. Autologous graft materials, coming from the same patient, are defined as the gold-standard. The need of a second surgical site and the risk of morbidity and complications may make their use difficult. Human bone allografts (HBA) have been recently introduced, in order to offer an alternative to the autologous grafts. They have demonstrated to be effective in bone regeneration. Recent studies have proved the ability of HBA in bone regenerating process as they guarantee a three-dimensional structure for the re-growth of the new bone and the maintenance of inductive stimuli. In the present manuscript, Authors reviewed the evidence supporting the use of HBA in the management of the localized ridge atrophies, in the preservation of the extracted socket and in the sinus augmentation surgery, and illustrated some original case reports

Tobacco use by adolescents and young adults: oral health effects and cessation strategies

Background: The use of smoking and smokeless tobacco worldwide has greatly increased in recent years, especially among adolescent boys and young men. Tobacco use can produce a wide range of negative effects on oral tissues, including periodontal tissue destruction and the onset of oral pre-malignant lesions. In the United States, major gains have been made to reduce smoking among adults. Similar gains, however, have not been realized with adolescents. In recent years, substantial interest has been directed to tobacco cessation studies with adolescents. The previously limited interest in adolescent cessation programs was attributable in large part to the mistaken assumptions that: (1) adolescent tobacco users were not dependent on nicotine and could stop at any time; (2) adolescents did not want to quit; and (3) adult tobacco cessation programs would be effective with adolescents. Oral health professionals should prevent tobacco use by adolescents and provide cessation counseling services or referral for appropriate treatment. Objective: To review the epidemiology, health effects and cessation programs of tobacco use among adolescents and young adults. Methods: Original papers, reviews and current guidelines on this subject, published in English from 2002 to 2007, were located in the MEDLINE/Pubmed database. Additional publications were obtained by searching the reference lists of retrieved studies. Contents: 1) Tobacco use by adolescents and young adults: epidemiology 2) Effects of tobacco use (smoking and smokeless) on the oral health status of adolescents and young adults: incipient periodontitis, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis, oral pre-malignant lesions, gingival recessions; 3) Tobacco cessation programs for adolescents and young adults: the role of oral health professionals; 4) Future directions in research

Traumatic dental injuries: preventive and public health approaches

Dental trauma can involve injuries to hard tissues and pulp, to periodontal tissues, to bone tissue, and to gingiva and oral mucosa. The aetiology of dental injuries is multi-factorial as they are caused by a complex array of individual clinical factors and social/environmental determinants. Traumatic dental injuries are mainly sustained during sports, through accidents and as a direct result of violence. The prevalence of traumatic dental injuries is not high but there is evidence that the incidence in children’s teeth is increasing. Primary prevention of traumatic dental injuries addresses the control of preventable risk factors through the early treatment of large overjet, the provision of safe playground surfaces and mouth protection in sports. Secondary prevention includes prompt, accurate diagnosis and appropriate initial management in order to improve the prognosis of traumatic dental injuries. Available evidence indicates that traumatic dental injury is a significant public health problem. Therefore, a treatment approach is unlikely to be successful unless a complementary public health strategy is adopted. Effective public health action should provide high quality clinical care with staff specialized in traumatic dental injuries treatment. Healthy public policies should provide a legislative framework for environmental change in playground layout and for the promotion of mouthguard use in high-risk sports. Health education should be expanded in schools and sport organizations in order to promote the use of mouthguards and improve first-aid treatment by lay peopl