Oral manifestations of monkeypox and potential tools for their management

Since May 2022, cases of monkeypox have been reported in around 70 countries where the disease is not endemic. The World Health Organization (WHO) has declared the 2022 monkeypox outbreak a Public Health Emergency of International Concern. The monkey poxvirus, like that of smallpox, is a member of the Orthopoxvirus group. There are two distinct strains (or clades, i.e., groups of similar microorganisms that are descended from a common ancestor) of monkeypox: the West African strain and the Congo Basin strain [1]. Particularly, all cases associated with the 2022 global outbreak are caused by the West African strain. Despite the name, nonhuman primates are not a reservoir for the virus. Although the reservoir is unknown, the main candidates are small rodents (eg, squirrels) of African rainforests, mainly in western and central Africa. Dentists and oral pathologists should be aware of the clinical manifestations of the new monkeypox virus. Even if this last is transmitted through large respiratory droplets and typically requires prolonged close contact (in contrast to the current SARS-CoV-2 infection), the possibility of transmission through saliva splashes during dental procedures is concret

Oral and maxillofacial metastasis of breast cancer: a case report and literature review

Objective: Oral metastases are relatively rare. In women, the most common oral metastases originate from breast cancer, most diagnosed malignancy and the second leading cause of death. The aim of this study was to review the literature regarding oral metastases from breast cancer with the help of a case report, with a focus on clinical and radiographical features and differential diagnosis. Materials and Methods: The English-language literature between 1980 and 2020 was searched for cases of metastatic lesions to the oral cavity, including bone and soft tissue. Clinical and histopathological data were collected from selected articles. Results: 81 studies were included in the analysis, with a total of 191 affected patients. 97% were women (mean age 54.6) and the remaining 3% were men (mean age 65.2). Adenocarcinoma was the most frequent histotype (33%) followed by ductal carcinoma (17%). In 102 patients (51.5 %), oral metastases were intra-osseous and the remaining 96 patients (48.5%) showed metastases to soft tissues. The primary breast tumor was already known before the onset of the oral metastatic lesion (76.4%). The average time between primary tumor diagnosis and appearance of the oral metastases was 3.8 years. 73% of the patients died, the mean survival time from oral metastasis diagnosis was 21.6 months. Conclusions: Oral metastases can present both clinically and radiographically very similar to other benign lesions frequently encountered in clinical dental practice. In most cases, the patient has developed the primary neoplasm before oral metastasis, therefore, a complete anamnesis is decisive. Once the diagnostic hypothesis and the differential diagnosis have been established, the histopathological examination is fundamental; therefore, it must always be performed

Extended erosive oral lichen planus treated with a very low-level laser therapy: A case report

Background: Oral lichen planus is a chronic idiopathic inflammatory disease that affects the skin and mucous membrane and involves about 1-2% of the population. The management of this pathology aims to control symptoms. Clinically, it can appear as a plaque, in reticular form, or an erythematous/atrophic form. The treatment options include different classes of drugs and non-drug therapies such as a laser. In addition, most drug treatments include numerous side effects. Objective: The aim of this work is to evaluate the clinical effectiveness of a particular type of very Low-Level-Laser Therapy for the management of an erosive oral lichen planus case. Methods: An extensive form of erosive Oral Lichen Planus was treated using a Low-Level Laser Therapy with a 660 nm diode laser. The treatment was performed once per week for two sessions of five minutes each. Different outcome variables were examined: the size of lesions, evolution of pain symptoms, and presence of side effects and stability of the therapeutic results in the follow-up period. Results: After a week, the lesion appeared more homogenous, and the erythematous areas underwent a reduction with a simultaneous decrease in symptoms. After two weeks, the lesion seemed completely healed with the disappearance of pain. The follow-up continued for the other four months, and no relapse was reported. No adverse effects were observed during the study. Conclusion: This study suggests that Low-Level Laser Therapy with very low power parameters could be a safe and successful treatment for extended oral erosive lichen planus lesions

Photodynamic therapy for the successful management of cyclosporine-related gum hypertrophy: A novel therapeutic option

Background: Drug-induced gingival overgrowth is associated with the intake of three classes of drugs: anticonvulsants, immunosuppressants, and calcium channel blockers. It is clinically characterized by hyperplasia of the gingival connective tissue which appears edematous, bloody, and purplish-red in color. In more severe cases, drug-induced gingival hyperplasia negatively affects the patient’s quality of life, making it difficult to eat and practice good oral hygiene. Drug-induced gingival overgrowth therapy is controversial and, in fact, no studies in the literature highlight a well-defined therapeutic protocol. The therapies that are described provide primarily for non-surgical periodontal treatment and second-line surgical treatment. The aim of this work is to highlight a case of drug-induced gingival hyperplasia which was completely resolved thanks to photodynamic therapy which is completely free from side effects. Design and Methods: Photodynamic therapy was performed on an 18year-old female patient with LEDs at a power of 450–470nm and 5500mW/cm2+7500mW/cm2, combined with a Curcuma longa-based photosensitizer. A single session was performed, with applications of approximately 30s for each interdental papilla. Results: The patient improved markedly after only one cycle of PDT. There was an absence of clinically detectable inflammation, edema, and rubor of the involved dental papillae. At the 4, 6, and 12week follow-ups there were no recurrences. Conclusions: This case report highlights the first case of drug-induced gingival hypertrophy entirely treated with photodynamic therapy to be described in the literature. Therefore, although it is only a case report, this therapy which is free from side effects should be investigated as an alternative to current therapies

Oral HSV Infections: Molecular biology and photodynamic therapy as new diagnostic and therapeutic tools

Globally, it has been estimated that 3.7 billion people are Herpes simplex 1 (HSV) seropositive. In addition, numerous studies highlight the presence of HSV-1 and 2 (HSV-2) in the oral cavity of asymptomatic patients. The rate of asymptomatic shedding of both HSV-1 and HSV-2, the re-exacerbation following dental treatments and finally the professional risk, and new techniques to improve the diagnosis and treatment of this widespread pathology, will discussed. In particular the effectiveness of photodynamic therapy (PDT) in combination with molecular biology (Polymerase Chain reaction, PCR) tested on a cohort of patients will presented. PDT was performed by diode laser light at 660 nm and 100 mWatt of power (Helbo, Bredent Medical, Senden, Germany), combined with photosensitizer phenothiazine chloride at 1%. The results show that the main HSV spread mode is asymptomatic. Particularly, HSV-1 is statistically more detectable in HIV positive and oncological patients than in immunocompetent ones (p<0,01) but not in transplant patients (p>0,01). HSV-2 is more detectable in HIV positive patients than healthy ones (p<0,01) but not in cancer and transplant patients (p>0,01). Regarding the exacerbation of HVS-1 after dental treatments, studies in the literature are discordant. Finally, for the occupational risk, dentistry team appears to be more exposed than the general population. Extremely interesting data emerged from PDT applied in patients with herpetic lesion. The PCR in fact, besides being decisive in some doubtful clinical cases, has shown a statistically significant reduction of the viral load 100 and 150 times the first and the second cycle of PDT. Clinically PDT has proven effective in immediately reducing symptoms and healing, also increasing the recurrence interval. Therefore, it could be a powerful aid in patients with herpetic manifestations to be applied before carrying out any treatments in order to decrease the viral spread

Melkersson–Rosenthal syndrome: A case report

Melkersson–Rosenthal syndrome (MRS) is a rare disorder with a still unknown etiology. It is defined by three main symptoms, which are orofacial granulomatosis (OFG), facial palsy, and fissured tongue. It generally presents in young people, during the second or third decade, and its incidence in the entire population is about 1%. We focus our attention on a 69-year-old man who came to us with an important swelling of the upper lip. His anamnesis revealed that he suffered from a facial palsy four times in his life and at the physical examination we attested the presence of scrotal tongue. We suspected a misdiagnosed MRS and we searched the web in order to give him a diagnosis and a therapy. We found that OFG is the most common symptom of MRS and that it can show as a non complete form, where the three main symptoms cannot occur simultaneously. We also prescribed a therapy based on the use of topic steroids and antiviral, according to literature. After the positive response to the therapy and according to data found in the most recent literature, we can assume that our patient suffers from a misdiagnosed MRS for about 40 years

A Retrospective Cohort Study of Traumatic Root Fractures in Primary Dentition: Can Splinting Type Improve Therapeutic Outcomes?

(1) Introduction: Deciduous traumatic dental injuries pose a serious global health concern. Root fractures show an incidence rate of approximately 2%; however, the literature is limited regarding the appropriate treatment and prognosis of affected teeth. This retrospective study aims to analyze the long-term outcomes of orthodontic splinting using brackets compared with composite resin-only splinting in two homogeneous samples affected by root fractures. The study also examines the onset and patterns of root resorption. (2) Methods: The first group included 25 patients with 27 deciduous upper incisors affected by root fracture; Group 2 consisted of 35 patients with 38 root fractures of maxillary deciduous teeth. The categorical data for both groups were analyzed using the chi-squared homogeneity test. Age groups were compared using the Mann–Whitney U test; p < 0.005 was considered statistically significant. (3) Results: In both groups, the male gender predominated similarly. In Group 1, early decidual loss occurred in 16% of cases, whereas in Group 2 it occurred in 51% of cases. Pulp canal obliteration was observed in 68% of deciduous teeth in Group 1, compared with 30% in Group 2. No complications affecting permanent teeth were noted in Group 1; in Group 2, 29% developed enamel dysplasia and 26% experienced delayed eruption, with statistically significant differences in these proportions. Apical fragment resorption was observed in 92% of cases in Group 1 and 30% in Group 2. (4) Conclusions: The treatment of deciduous tooth root fractures using orthodontic splints can yield significant benefits, such as reduction of early tooth loss. Furthermore, the study confirms that early resorption of the distal fragment of fractured roots is a common physiological phenomenon in primary teeth and typically occurs within a year following trauma

Morphological Changes in Dental Surfaces Suggest Health Status and Alimentary Habits in the Subjects Belonging to the Copper Age in Sardinia Island (III Millennium BC)

The aim of this multidisciplinary study, which involved a team of archaeologists, odontologists, biologists, is to examine a set of dental health indicators, including caries, tooth wear, and enamel hypoplasia of a III millennium BC sample from the burial site of Scaba ’e Arriu (Siddi, South Sardinia), in order to evaluate the dental health status and the diet. Our purpose is to depict a timeline of dental health in Sardinia from prehistory to the present day, starting with a focus on a Copper Age population. Caries, dental wear, and enamel hypoplasia of 259 permanent teeth were evaluated. It was not possible to assign sex and age of each tooth because of the lack of bony support, lost due to taphonomy factors. 14,7% of Scaba‘e Arriu’s samples were affected by carious lesions, with greater involvement of the posterior teeth (12,7% against 1,9% of anterior ones). Interproximal caries was the most frequent. Dental wear affected 77,8% of the teeth, and its presence is preponderant over caries’ rate. The high percentage of dental wear suggests a diet based on abrasive foods. Further studies are necessary to delineate more accurately the modus vivendi, the nutrition, and, consequently, the health status of this sample

New Enzymatic Gel as Adjuvant Treatment for Wound Healing Processes in Oral Surgery, A Mini-Review and A Case Report

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B.P.F.C Pure Growth Factor, PDT and LLLT for the Treatment of Severe MRONJ Non-responsive to Prolonged Antibiotic Therapy

Drug-related osteonecrosis of the jaw (MRONJ) is a potentially serious and debilitating drug-related complication. In the literature, there are many studies that evaluate therapeutic treatments to support those already existing for MRONJ. The aim of this work was to report a case of severe osteonecrosis, related to bisphosphonates treated with Photodynamic therapy (PDT), Low level laser therapy (LLLT) and a surgery with new platelet-rich plasma preparation. The main biological effects of LLLT are wound healing, collagen synthesis, nerve regeneration, stimulation of endorphin release and immune system modulation. PDT is a new technique for the treatment of inflammatory, infectious, ulcerative, tumor and pre-tumor lesions, able to selectively destroy the altered cells. The preparation of Bio-Plasma® with Pure Growth Factors, associated with the use of fibrin enriched with poor Plasma is able to provide a perfect healing. The excellent results obtained, combined with the absence of short- and long-term complications, constitute a good perspective for the outpatient use of Bio-Plasma® with Pure Growth Factors. Therefore, LLLT and PDT associated with the use of fibrin enriched with poor Plasma, are important tools to contribute to healing and improvement of patient's quality of life