Accidentally Swallowing a Toothbrush in a Patient during a Vomiting Attempt: Literature Review and Case Report

Swallowing a whole toothbrush is a rare event. As of today, no case described has documented that the foreign body has passed through the entire gastrointestinal tract and has been spontaneously eliminated. Places where it is most frequently retained have been described. Only in one single case described did the foreign body reach the colon. We describe the main injuries caused by this foreign body, and the most common correct therapeutic approach for solving the problem. The third case in the literature is presented, with diagnosis and treatment of a woman who, in an attempt to induce vomiting, swallowed a toothbrush which became lodged in her stomach. The patient, at the time of the examination, only showed abdominal pain and anxiety

Hiperplasia gingival inducida por Ciclosporina A en transplantes renales : estudio clínico, morfométrico inmunohistoquímico y ultraestructural

El aumento en el tamaño de la encia es uno de los principales signos de enfermedad gingival, y la hiperplasia iatrogénica es de las causas más frecuentes. La CSA es un farmaco introducido por Borel en terapeútica en 1976 y actualmente con un uso más multidisciplinario (en transplantes, enfermedades autoinmunes, patología tumoral). En el presente trabajo de investigación hacemos un estudio clínico histopatológico y con análisis digital de imagen de 30 paciente transplantados de riñón de ls provincias de Granada y Málaga, y que tomaban de forma crónica la droga. Para ello hacemos una cuantificación de la salud oral de los pacientes. Establecemos un índice que valora de forma objetiva el grado de hiperplasia. Estudiamos mediante determinación de la dosis serica de CSA, CSA "in situ", y dosis total de CSA ingerida desde el trasplante. El posible papel que tiene este farmaco en la incidencia de esta patología oral, tipificamos y cuantificamos el inflitrado inflamatorio en la submucosa gingival mediante un panel de anticuerpos monoclopales y como hemos dicho para el índice creado, aplicamos en odontología una metodología original y fácil de realizar para cuantificar el agrandamiento que es el análisis digital de imagen. Con el trabajo concluimos que, la hiperplasia cuando se relaciona con los índices de salud, aunque no de forma exclusiva, la población de células inflamatorias son parecidas a las que aparecen en la enfermedad periodontal no iatrogénica, se encuentran unos depositos intralesionales que pudiera tratarse del farmaco. El mecanismo de inducción es multifactorial, aportando un modelo patogénico de inducción.Tesis Univ. Granada. Facultad de Medicin

Composite Alloplastic Biomaterial vs. Autologous Platelet-Rich Fibrin in Ridge Preservation

Aim: The aim of this study was to examine the clinical and histological differences of using a combination of alloplastic beta triphasic calcium phosphate (_ β-TCP) and a cross-linked collagen membrane versus autologous platelet-rich fibrin (PRF-L) in ridge preservation after dental extraction. Material and methods: Fifty-one patients were included in this observational case-series study. Dental extractions were performed, after which 25 patients were grafted with _-TCP and 26 with PRF-L. After four months of healing, clinical, radiological, histomorphometric and histological evaluations were performed. Results: A significantly higher percentage of mineralized tissue was observed in samples from the PRF-L grafted areas. Cellularity was higher in PRF-L grafted areas (osteocytes in newly formed bone per mm2 = 123.25 (5.12) vs. 84.02 (26.53) for PRF-L and β-TCP, respectively, p = 0.01). However, sockets grafted with PRF-L showed a higher reduction in the bucco-lingual dimension after four months of healing (2.19 (0.80) vs. 1.16 (0.55) mm, p < 0.001), as well as a higher alteration in the final position of the mid muco-gingival junction (1.73 (1.34) vs. 0.88 (0.88) mm, p < 0.01). Conclusion: PRF-L concentrate accelerates wound healing in post-extraction sockets in terms of new mineralized tissue component. However, the use of β-TCP biomaterial appears to be superior to maintain bucco-lingual volume and the final position of the muco-gingival junction.The authors of this manuscript were partially supported by Research Groups #CTS-138 (FO) and #CTS-1028 (PGM, MPM) (Junta de Andalucía, Spain). Grafting materials were generously provided by Dentium Co., Ltd., Seoul, Korea

Periodontitis is associated with higher subclinical atherosclerosis in patients with systemic lupus erythematosus

We would like to thank the patients from the Unit of Autoimmune Diseases of the “Virgen de las Nieves” University Hospital. This investigation has not received funds from any private entity. All procedures in this were performed from the regular care, with resources of the Spanish National Health System. All authors declare no conflicts of interest, and all authors have approved the final article.Aim: To determine periodontitis prevalence in patients with systemic lupus erythematosus (SLE) and to assess whether periodontitis in SLE patients is associated with a greater subclinical atherosclerosis. Methods: An observational case–control study was conducted in SLE (cases) and patients without any rheumatic diseases (controls), matched for sex. Sociodemographic and cardiometabolic variables were gathered, and SLE activity was assessed through several indexes. Periodontal examination registered probing pocket depth, clinical attachment level, bleeding on probing, plaque index, and tooth loss. Subclinical atherosclerosis was assessed by measuring the carotid–femoral pulse wave velocity (PWV) by Doppler velocimetry, homocysteine levels, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Bivariate analyses and logistic regression were used to assess the association of any of the studied variables with SLE. Results: Seventy-one cases and 72 controls were included in the study. Thirty-nine SLE patients (54.9%) were diagnosed with periodontitis, compared with 16 controls (22.2%). High levels of PWV (≥7.7 m/s, 75th percentile) were shown by 44.3% of the cases vs. 22.4% of the controls (p = .011). Among SLE patients, those with periodontitis showed higher PWV values (8.1 ± 1.52 vs. 7.16 ± 1.11 m/s, p = .006) and higher homeostasis model assessment index (indicative of insulin resistance) (1.7 ± 0.73 vs. 2.92 ± 3.05, p = .028) compared to those with periodontal health. Logistic regression showed that waist circumference (OR 1.06, 95% CI 1.01–1.12, p = .015); ESR (OR 1.09, 95% CI 1.03–1.16, p = .003); and bleeding on probing (OR 1.1, 95% CI 1.01–1.19, p = .018) were associated with the risk of SLE. Conclusion: Systemic lupus erythematosus patients showed a higher periodontitis percentage than controls. Higher PWV values were found in SLE patients with periodontitis, indicating a higher prevalence of subclinical atherosclerosis. Patients with higher gingival bleeding showed a higher risk of SLE

Randomized clinical trial on the clinical effects of a toothpaste containing extra virgin olive oil, xylitol, and betaine in gingivitis

To determine the effects on gingival bleeding, dental biofilm, and salivary flow and pH in patients with gingivitis of using toothpaste with extra-virgin olive oil (EVOO), xylitol, and betaine in comparison to a placebo or commercial toothpaste. This controlled, double blinded, and multicenter randomized clinical trial included patients with gingivitis randomly assigned to one of three groups: test group (EVOO, xylitol, and betaine toothpaste), control group 1 (placebo toothpaste), or control group 2 (commercial toothpaste). Percentage supragingival biofilm and gingival bleeding were evaluated at baseline (T0), 2 months (T2), and 4 months (T4), measuring non-stimulated salivary flow and salivary pH. Comparisons were performed between and within groups. The final study sample comprised 20 in the test group, 21 in control group 1, and 20 in control group 2. In comparison to control group 1, the test group showed significantly greater decreases in gingival bleeding between T4 and T0 (p = 0.02) and in biofilm between T2 and T0 (p = 0.02) and between T4 and T0 (p = 0.01). In the test group, salivary flow significantly increased between T2 and T0 (p = 0.01), while pH alkalization was significantly greater between T4 and T0 versus control group 2 (p = 0.01) and close-to-significantly greater versus control group 1 (p = 0.06). The toothpaste with EVOO, xylitol, and betaine obtained the best outcomes in patients with gingivitis, who showed reductions in gingival bleeding and supragingival biofilm and an increase in pH at 4 months in comparison to a commercial toothpaste.(STOP ORAL DYSBIOSIS) - University of Granada OTRI-4907Mucosal Innovations S.L. (Madrid

Neutrophil Extracellular Traps in Periodontitis

Neutrophils are key cells of the immune system and have a decisive role in fighting foreign pathogens in infectious diseases. Neutrophil extracellular traps (NETs) consist of a mesh of DNA enclosing antimicrobial peptides and histones that are released into extracellular space following neutrophil response to a wide range of stimuli, such as pathogens, host-derived mediators and drugs. Neutrophils can remain functional after NET formation and are important for periodontal homeostasis. Periodontitis is an inflammatory multifactorial disease caused by a dysbiosis state between the gingival microbiome and the immune response of the host. The pathogenesis of periodontitis includes an immune-inflammatory component in which impaired NET formation and/or elimination can be involved, contributing to an exacerbated inflammatory reaction and to the destruction of gingival tissue. In this review, we summarize the current knowledge about the role of NETs in the pathogenesis of periodontitis

Clinical Application of Mesenchymal Stem Cells and Novel Supportive Therapies for Oral Bone Regeneration

This work has been also recommended by the PACT (Platelet and Advanced Cell Therapies) Forum Civitatis of the POSEIDO Academic Consortium (Periodontology, Oral Surgery, Esthetic and Implant Dentistry Organization).Bone regeneration is often needed prior to dental implant treatment due to the lack of adequate quantity and quality of the bone after infectious diseases, trauma, tumor, or congenital conditions. In these situations, cell transplantation technologies may help to overcome the limitations of autografts, xenografts, allografts, and alloplastic materials. A database search was conducted to include human clinical trials (randomized or controlled) and case reports/series describing the clinical use of mesenchymal stem cells (MSCs) in the oral cavity for bone regeneration only specifically excluding periodontal regeneration. Additionally, novel advances in related technologies are also described. 190 records were identified. 51 articles were selected for full-text assessment, and only 28 met the inclusion criteria: 9 case series, 10 case reports, and 9 randomized controlled clinical trials. Collectively, they evaluate the use of MSCs in a total of 290 patients in 342 interventions. The current published literature is very diverse in methodology and measurement of outcomes. Moreover, the clinical significance is limited. Therefore, the use of these techniques should be further studied in more challenging clinical scenarios with well-designed and standardized RCTs, potentially in combination with new scaffolding techniques and bioactive molecules to improve the final outcomes.The authors of this paper were partially supported by the Talentia Scholarship Program (Junta de Andalucía, Spain) (MPM), the International Team for Implantology through the ITI Scholarship Program (AL), and the Research Groups #CTS-138 and #CTS-583 (Junta de Andalucía, Spain) (All)

Short-term effects of hyaluronic acid on the subgingival microbiome in peri-implantitis: A randomized controlled clinical trial

This study was supported by Ricerfarma srl (Milan, Italy) in collaboration with Research Groups #CTS 583 and #BIO-344 (Junta de Andalucía, Spain) (reference: OTRI-3300). Ana Soriano-Lerma was supported by a fellowship from the Ministry of Education, Culture and Sport (FPU 17/05413). José A. García-Salcedo was supported by “Programa Estatal de Inves-tigación, Desarrollo e Innovación Orientada a los Retos de la Sociedad” (grant SAF-SAF2015-71714-RMINECO/FEDER) and The Network of Tropical Diseases Research—RICET (Instituto de Salud Carlos III).Background: The aim of our study was to evaluate the effects of a hyaluronic acid gel at 45 days on the microbiome of implants with peri-implantitis with at least one year of loading. Methods: A randomized controlled trial was conducted in peri-implantitis patients. Swabs containing the samples were collected both at baseline and after 45 days of treatment. 16S rRNA sequencing techniques were used to investigate the effect of hyaluronic acid gel on the subgingival microbiome. Results: 108 samples of 54 patients were analyzed at baseline and after follow-up at 45 days. Three strata with different microbial composition were obtained in the samples at baseline, representing three main microbial consortia associated with peri-implantitis. Stratum 1 did not show any difference for any variable after treatment with hyaluronic acid, whereas in stratum 2, Streptococcus, Veillonella, Rothia and Granulicatella did decrease (p<0.05). Similarly, Prevotella and Campylobacter (p< 0.05) decreased in stratum 3 after treatment with hyaluronic acid. Microbial diversity was found to be decreased in stratum 3 (p<0.05) after treatment with hyaluronic acid compared to the control group, in which an increase was found (p<0.05). Conclusions: Hyaluronic acid reduced the relative abundance of peri-implantitis-related microorganisms, especially the early colonizing bacteria, suggesting a specific action during the first stages in the development of the disease. Hyaluronic acid did not alter relative abundances of non-oral genera. The use of hyaluronic acid in advanced stages of peri-implantitis resulted in a decrease in microbial alpha diversity, suggesting a protective action of the peri-implant site against bacteria colonization.Ricerfarma srl (Milan, Italy)Junta de Andalucía, Spain Research Groups OTRI-3300: #CTS 583, #BIO-344Ministry of Education, Culture and Sport (FPU 17/05413)SAF-SAF2015-71714-RMINECO/FEDERInstituto de Salud Carlos II

Patients with periodontitis and erectile dysfunction suffer a greater incidence of major adverse cardiovascular events: A prospective study in a Spanish population

DATA AVAILABILITY STATEMENT The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available because of privacy or ethical restrictions.Background Periodontitis and erectile dysfunction (ED) have been linked with cardiovascular disease. The association of periodontitis and ED with the occurrence of major adverse cardiovascular events has not been previously assessed. The aim of this study was to determine if the presence of periodontitis and ED has any effect on the incidence of major adverse cardiovascular events. Methods Male patients that attended the Urology service were enrolled in a prospective study. Erectile dysfunction was diagnosed according to the International Index of Erectile Function. Sociodemographic data and periodontal clinical parameters were gathered (pocket probing depth, clinical attachment loss, bleeding on probing (BoP), plaque index and number of teeth) at baseline. Major adverse cardiovascular events occurred both before and during the follow-up time were registered. Bivariate analyses, as well as a multivariate analysis were performed, adjusting for potential confounders. Results A total of 158 patients were included, with a mean follow-up of 4.2 years. A greater number of major adverse cardiovascular events occurred in the group that presented periodontitis and ED (P = 0.038). After adjusting by age and previous cardiovascular disease in the multivariate analysis, the annual major adverse cardiovascular event rate was estimated to be 3.7 times higher in the same group (P = 0.049). Other periodontal clinical variables together with ED supported these results and were close to statistical significance. Conclusions Patients with periodontitis and ED, adjusted by age and a cardiovascular disease, showed 3.7 times more risk of suffering major adverse cardiovascular events after mean follow-up of 4.2 years.Research Group #CTS-583 (Junta de Andalucía, Granada, Spain

An Ex Vivo Model in Human Femoral Heads for Histopathological Study and Resonance Frequency Analysis of Dental Implant Primary Stability

Objective. This study was designed to explore relationships of resonance frequency analysis (RFA)—assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. Material and Methods. This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) ( ) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) ( ). Sixty  mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. Results. As expected, the analysis yielded significant effects of femoral head type (OA versus OA) ( ), but not of the implants ( ) or of the interaction of the two factors ( ). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified ( ) heads than in fresh ( ) or fixated ( ) heads (both ). The ISQ score (fresh) was significantly higher for those in OA ( ) versus OP ( ) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results ( in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both ). Conclusion. Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies.This investigation was partially supported by Research Group no. CTS-138 (Junta de Andalucía, Spain)