Microbiota of the Tongue and Systemic Connections: The Examination of the Tongue as an Integrated Approach in Oral Medicine

The tongue is able to quickly reflect the state of health or disease of the human body. Tongue inspection is an important diagnostic approach. It is a unique method that allows to explore the pathogenesis of diseases based on the guiding principles of the holistic concept that involves the observation of changes in the lining of the tongue in order to understand the physiological functions and pathological changes of the body. It is a potential method of screening and early detection of cancer. However, the subjective inspection of the tongue has a low reliability index, and therefore computerized systems of acquisition of diagnostic bioinformation have been developed to analyze the lining of the tongue. Next-generation sequencing technology is used to determine the V2–V4 hypervariable regions of 16S rRNA to study the microbiota. A lot of neoplasms are identified only at an advanced phase, while in the early stages, many subjects remain in an asymptomatic form. On the contrary, the early diagnosis is able to increase the prognosis of cancer and improve the survival rates of subjects. Evidently, it is necessary to develop new strategies in oral medicine for the early diagnosis of diseases, and the diagnosis of the tongue as a minimally invasive method is certainly one of them

EFFICACY OF ADJUNCTIVE PDT IN THE TREATMENT OF A PARTICULAR PRESENTATION OF MRONJ: A CASE REPORT

Background. Drug-related osteonecrosis of the jaw (MRONJ) is an adverse event in patients with osteometabolic and/or oncological disease treated with antiresorptive (pAR) drugs including anti-RANKL antibodies (e.g., denosumab) and nitrogen-containing bisphosphonates (N- BP; e.g., zoledronic acid), or angiogenesis inhibitors (AgI). We present a case of MRONJ in a patient suffering from systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) which resolved thanks to antibiotic therapy (AT) and photodynamic therapy (PDT). Patients and methods. A 48-year-old patient comes to our attention with history of SLE and RA from several years treated with monoclonal antibodies (Tolicizumab) since 2015 and bisphosphonate for 24 months. The patient has been taking deltacortene 25 mg per day for 25 years. He has never undergone radiation therapy. On intraoral physical examination, a bony exposure of approximately 1,5 cm in diameter is found in the upper right hemimaxillary bone. In the lower arch, white reticular lesions attributable to SLE are observed. In addition, the patient is suffering from periodontitis. The patient underwent AT according to ministerial guidelines (amoxicillin + clavulanic acid and metronidazole), for 4 weeks during which the elements with a poor prognosis (mobility 3) were extracted. Results. During the first week of AT, the bone exposure area was treated with PDT based on Curcumin + 3% hydrogen peroxide, activated by a diode lamp at 460 nm wavelength and 7 watts of power. 2 sessions of 5 minutes were performed. 1 week after PDT and 3 weeks after the start of AT there is a total re-epithelialization of the osteonecrotic area with a significant reduction in pain revealed by the patient. Conclusions. In the literature, emerges that PDT is increasingly performed in combination with other therapeutic options with excellent clinical outcomes. The most important aspect at a clinical level is the absence of adverse effects, due to the ability of the photosensitizer to bind and induce apoptosis of only damaged cells. This is important in immunosuppressed patients who are undergoing other drug therapies, thus improving their lifestyle. Randomized clinical trials should be conducted so that the benefit of PDT in the treatment of MRONJ can be demonstrated with a greater scientific basis

Host Microbiota Balance in Teenagers with Gum Hypertrophy Concomitant with Acne Vulgaris: Role of Oral Hygiene Associated with Topical Probiotics

Gum hypertrophy is a very frequent condition linked to orthodontic treatment, especially in teenagers, and the same time, about 80% of young adults are affected by acne vulgaris, a chronic inflammatory skin disease, typically treated with antibacterial therapy. The use of probiotics has gained popularity in the medical field, and many studies have demonstrated its effectiveness, such as the positive effects of some bacterial strains belonging to Lactobacillus species. The aim of this study is to document the effect of Lactobacillus reuteri (L. reuteri) on facial skin that was randomly observed in two orthodontic patients. We present two case reports of a 14-year-old female patient and a 15-year-old male patient suffering from acne vulgaris who, during fixed orthodontic treatment, showed clinical signs of gingivitis with high values of Full Mouth Plaque Score (FMPS) and Bleeding on Probing (BOP). The patients were treated first with professional oral hygiene sessions and Scaling and Root Planing (SRP) procedures, and then with the administration of a formulate containing L. reuteri as a probiotic. The follow-up was made at four weeks. During the follow-up analysis, both patients showed a significant clinical remission for gum hypertrophy and skin acne vulgaris

Oral Health and Caries Prevention: How Tongue Hygiene Helps Maintain Balance of Microbiota and Overall Health in Pediatric Patients

Background/Objectives: The tongue harbors about two-thirds of the microorganisms present in the mouth; the stable bacterial population consists mainly of aerobic and facultative anaerobic streptococci. These bacterial colonies, found more frequently on the tongue than on the outside of the hard part of the dental enamel in children younger than 18 months, suggest that the tongue is a potential bacterial reservoir. The aim of this review is to examine the scientific literature to clarify whether the mechanical removal of bacterial biofilm on the tongue can have a positive effect on caries prevention, with the reduction in colony-forming unit (CFU) of salivary streptococcus and the whole-mouth plaque index (FMPS). Methods: An open literature search was conducted by using PubMed (MEDLINE), Cochrane Library and Google Scholar. The most studied age range was 9 to 12 years, with groups of children with no caries and groups with a minimum number of two teeth that were reconstructed, decayed and/or missing (DMFS/dmfs > 2) who experienced different tongue hygiene methods for the first time. Results: Four randomized trials met the search criteria and were included in this review. Conclusions: The results obtained suggest that specific tongue hygiene protocols, combined with a healthy diet and lifestyle, could be considered the gold standard to enable more effective primary prevention and improve the health of pediatric patients. This review improves the understanding of the impact of tongue hygiene in controlling the bacteria responsible for the onset of carious disease and its systemic correlates; however, further research with more data is needed to further confirm the findings of this research