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

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

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

Chirurgia di salvataggio nelle lesioni metastatiche del cavo orale: caso clinico

OBIETTIVI: Si riporta il caso di una rara metastasi orale da adenocarcinoma del colon retto gestita chirurgicamente con l\u2019ausilio della tecnica Narrow Band Imaging (NBI) e con la successiva riabilitazione protesica. MATERIALI E METODI: Un paziente di 81 anni si presentava con una lesione esofitica gengivale che, alla biopsia incisionale, \ue8 risultata essere compatibile con una metastasi da adenocarcinoma del colon retto. \uc8 stata eseguita un\u2019escissione completa della lesione NBI guidata. RISULTATI E CONCLUSIONI: Il decorso post-operatorio non ha presentato alcuna complicanza e i margini di resezione risultavano liberi da neoplasia. Nei pazienti con una bassa aspettativa di vita la \u201cchirurgia di salvataggio\u201d pu\uf2 rappresentare la migliore soluzione per eradicare lesioni metastatiche locali e di modeste dimensioni che, come in questo caso, limitano la possibilit\ue0 di ottenere un\u2019adeguata funzione masticatoria

MRONJ ONSET AFTER PRELIMINARY EVALUATION AND PREVENTIVE INTERVENTIONS - A SINGLE CENTER STUDY

Are preventive dental interventions potential triggers for MRONJ onset? The aim of the present study was to retrospectively analyze clinical charts of subjects candidate for medical therapies with ascertained risk of MRONJ observed at the Dental Unit of the Hospital of Gorizia from 2011 to 2019. Patients who underwent a preliminary dental evaluation and preventive interventions (n = 214) were assigned to a preventive protocol group basing on the therapies performed (Complete, Partial, Not necessary). Demographical and clinical data were recorded, alongside with the interventions performed and the possible onset of MRONJ and its treatment. The obtained data were then compared with the characteristics of patients who were evaluated and treated for MRONJ (n = 34), who didn't perform a preliminary oral and dental evaluation before. Our results indicate that strict preventive protocols including single or multiple dental extractions of non maintainable teeth may represent triggers for MRONJ onset

Effect of Laser Therapy on Defensins' Gene Expression in TR146 Epithelial Cell Line

Laser therapy (LT) has been employed for treatment of oral mucositis (OM)due to its anti-inflammatory, analgesic and bio-stimulatory effects. This pilot study investigated the effect of LT in TR146 epithelial cell line, used to mimic oral mucosa,aimed at evaluating the expression of DEFB1, DEFB4, DEFB103 genes encoding for the human \u3b2-defensins 1, 2 and 3. In this cellular model LT decreased mRNA defensins' expression 30 minutes after irradiation but not 24 hours later, suggesting that LT is able to influence \u3b2-defensins production immediately after treatment, while its efficacy decreases over time

Ozone treatment combined with sodium fluoride for the treatment of dentin hypersensitivity: an exploratory study

Background: Dentin hypersensitivity is one of the most common complains faced by dental professionals, and there is still lack of consensus for the most effective treatment approaches. The aim of the present study was to evaluate the efficacy of ozone therapy combined with sodium fluoride in reducing pain associated with dental hypersensitivity, compared to a paint-on adhesive desensitizing agent. Methods: The study included 20 patients (131 teeth), selected according to specific inclusion criteria and divided into two groups according to the type of desensitizing therapy (ozone with sodium fluoride or paint-on adhesive). The efficacy of both treatments were evaluated recording pain for each treated tooth immediately after treatment, after 1 month and after 6 months using a Numeric Rating Scale (NRS). Subjective parameters were also recorded: patients were asked to report whether they experienced pain caused by air, teeth brushing, cold and hot topical stimuli (present/absent). Results: In both groups, pain values significantly decreased over time. Six months after treatment we registered significantly lower pain values in the ozone-treated group compared with the adhesive group and the mean percentage of NRS reduction from was significantly higher in the ozone-treated group. We did not register significant differences in subjective pain-related parameters between groups. Conclusions: The results of this exploratory study were aimed at exploring the combined effect of ozone with natrium fluoride, which was before described only in vitro. With the limitation of the sample size, our results suggest that this approach provides a pain reduction that was comparable to the paint-on adhesive

Efficacy of ultramicronized palmitoylethanolamide in burning mouth syndrome-affected patients: a preliminary randomized double-blind controlled trial

OBJECTIVES: This preliminary randomized double-blind controlled trial was performed to test the efficacy of ultramicronized palmitoylethanolamide treatment in the burning mouth syndrome. MATERIALS AND METHODS: Patients with referred burning mouth intensity greater than 4, according to the Numeric Rating Scale, were included in the study according to established inclusion and exclusion criteria. Patients were randomized into two groups and received either placebo or ultramicronized palmitoylethanolamide 600 mg twice daily for 60 days. Patients were assessed at baseline, 30 and 60 days after treatment start, and 4 months after treatment discontinuation. In order to evaluate the change in the burning mouth sensation over time, the generalized linear mixed model was employed. RESULTS: A total of 35 patients were considered eligible, among which 6 withdrew prior to the end of treatment. A statistically significant reduction of burning mouth sensation (p\u2009<\u20090.0132) was registered at the end of the active treatment in the ultramicronized palmitoylethanolamide group compared to the placebo one. Any side effect related to the active treatment was neither observed nor reported both by patients and by physicians. CONCLUSIONS: The significant decrease of burning sensation in the ultramicronized palmitoylethanolamide group compared to the placebo group suggests to consider this naturally occurring molecule as a viable therapy in the management of burning mouth syndrome. CLINICAL RELEVANCE: The use of an effective compound to manage the burning mouth syndrome, devoid of adverse effects for the patient and that does not interfere with other pharmacological therapies, could find wide employability from clinicians

Photobiomodulation modulates inflammation and oral microbiome : a pilot study

Introduction: Oral mucositis (OM) is a severe side effect in patients undergoing anticancer therapies, which negatively impacts on their quality of life often leading to either the interruption of the therapy. Photobiomodulation (PBM) is emerging as an effective strategy allowing a faster wound healing. Objectives: This pilot study aims at verifying whether PBM modulates the inflammatory response in patients and its effect on the oral microbiome composition. Materials and methods: Buccal swabs were collected from four patients affected by OM, both on ulcerated and clinically healthy areas, before and on the last day of PBM therapy, as well as on the first day after treatment discontinuation. The concentration of 38 cytokines and the composition of oral microbiome were measured. Results: Most of the pro-inflammatory cytokines were reduced, whereas anti-inflammatory cytokines resulted up-regulated by PBM. In addition, PBM influenced the composition of oral microbiome, by decreasing the amount of pathogenic species and promoting the growth of commensal bacteria. These changes were even more evident when separately analysing patients who clinically responded to PBM and the only patient who did not respond. Conclusions: PBM reduces inflammatory burden in patients affected by OM and positively influences the composition of the oral microbiome