Relevance of Epstein–Barr virus infection in the oral squamous cell carcinoma: A meta-analysis

Objectives: The objectives of the study were to assess the main risk factors related to Epstein–Barr virus (EBV) infection on oral squamous cell carcinoma (OSCC) and the influence on its biological behavior. Methodology: A search for articles on EBV infection and mouth neoplasms was performed in the next electronic databases: PubMed (MEDLINE, Cochrane Library), Web of Science, and Spanish Medical Index (IME). From 600 potentially eligible articles, 575 were excluded for several reasons: Articles without full-text availability (201), studies on hairy leukoplakia (256), studies in patients without OSCC (42), studies on malignant salivary gland neoplasms (19), studies in HIV+ or immunocompromised patients (14), and studies with non-usable data (43). Finally, 25 studies were included in this meta-analysis. The statistical software RevMan 5.3 (The Cochrane Collaboration, Oxford, UK) was used to analyze the data. For dichotomous outcomes, the estimates of effects of an intervention were expressed as odds ratio (OR) using the Mantel-Haenszel method with 95% confidence intervals. Results: About 46.3% of oral cancers were infected with EBV. Oral cancer patients had more than triple the risk of being infected with EBV than controls (OR: 3.48, P = 0.01). In contrast, age (>60 years), gender (women), tumor location (tongue-floor of the mouth), tumor differentiation degree (well differentiated), or tumor stage (III and IV) were parameters without significant influence (P > 0.05) in oral cancers infected with EBV. Conclusion: EBV infection may be an important risk factor in oral cancer. Clinical Significance: Specific treatment of EBV infection can improve the biological behavior of oral cancers toward less aggressive tumors

Clinicopathological Parameters Related to Malignant Transformation of Oral Leukoplakia: A Meta-Analysis

Objective. To assess the clinical-pathological factors related to the malignant transformation of oral leukoplakia. Materials and Methods. A search for articles on malignant transformation factors related to oral leukoplakia was conducted in the following electronic databases: PubMed (MEDLINE, Cochrane Library), Web of Science (WoS) and Google Scholar. Thirty-seven articles with a low-moderate risk of bias according to the Newcastle-Ottawa methodological quality scale were included in this meta-analysis. The data were analyzed using the statistical programs RevMan 5.4 (The Cochrane Collaboration, Oxford, UK) and MedCalc Statistical Software version 16.4.3 (MedCalc Software Ltd. Ostend, Belgium) programs. The estimated prevalence was calculated according to DerSimonian and Laird random method. For dichotomous outcomes, the estimates of effects of an intervention were expressed as odds ratios (OR) using the Mantel-Haenszel (M-H) method with 95% confidence intervals. Results. The estimated global prevalence of malignant transformation of oral leukoplakia was 9.15%. The factors with the highest malignant transformation risk of oral leukoplakia were: non-homogeneous clinical types (OR: 5.41; p<0.001); leukoplakias with moderate-severe dysplasia (OR: 3.43; p<0.001); lesions located on the tongue and/or the floor of the mouth (OR: 3.19; p<0.001); leukoplakias in non-smokers (OR: 2.08; p<0.001) and lesions in women (OR: 1.73; p<0.001). In contrast, older age or regular alcohol intake were factors without significant influence (p>0.05).Conclusions. Non-homogenous oral leukoplakias and with moderate-severe dysplasia are those with the highest probability of malignant transformation

Revisiting peri-implant soft tissue - histopathological study of the peri-implant soft tissue

Released by the publisher under the “Creative Commons Attribution Non-Commercial License”, enabling the unrestricted non-commercial use, distribution, and reproduction of the published article in any medium, provided that the original work is properly cited."Peri-implant soft tissues are essential for osseointegration. The peri-implant mucosa may lack vascular supply, and histological observation, even without plaque, shows the presence of inflammatory cells. The objectives of this study were to assess the histopathological changes of the epithelium and connective tissue around the implant. Twenty patients of both genders were studied. Twelve weeks after implant placement, fragments of peri-implant gingival sulcus were harvested and processed for light microscopy. Group I (10): without clinical inflammatory signs (control); Group II (10): with clinical inflammatory signs. Histopathological parameters were analyzed and classified in 3 grades: mild, moderate or severe (grade 1, 2 or 3). Control group showed only slight changes, grade 1. In group II we found edema with moderate to severe cellular and nuclear changes. There are more women than men with all grades of inflammation. All patients with moderate edema are male and all patients with severe edema are female. A significant association (p=0.007) exists between these two variables. Significant differences were found when comparing the degree of inflammation with nuclear alterations (p=0.001) and the same results when comparing the degree of edema and nuclear changes (p<0.001). This study demonstrates that clinical examination can be used, with a small margin of error, to monitor and control the state of the peri-implant mucosa. In clinics the predisposition of female patients to greater degree of edema and inflammation should be accounted for.

Is menopause associated with an increased risk of tooth loss in patients with chronic periodontitis?

NOTICE: this is the author’s version of a work that was accepted for publication in Revista Portuguesa de Estomatologia Medicina Dentária e Cirurgia Maxilofacial. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Revista Portuguesa de Estomatologia Medicina Dentária e Cirurgia Maxilofacial, Vol. 54, Issue 4, (November 2013). DOI: 10.1016/j.rpemd.2013.09.005."Objetivos: Analisar o possível efeito da menopausa sobre a perda dentária em mulheres com periodontite crónica. Materiais e Métodos: 102 mulheres entre os 35 e 80 anos com periodontite crónica e pelo menos seis dentes foram divididas em dois grupos: grupo de estudo (GE) constituído por 68 mulheres na menopausa e grupo controle (GC) constituído por 34 mulheres pré-menopáusicas. Foi aplicado um questionário onde se recolheram diversos dados sociodemográficos, história clínica geral e oral, antecedentes ginecológicos e hábitos. Adicionalmente, foram avaliados diversos parâmetros orais e periodontais incluindo: número de dentes, índice de placa, presença de tártaro, profundidade de sondagem, hemorragia à sondagem, recessão gengival e perda de inserção. Na análise estatística foram utilizados os testes de Chi-Quadrado, Fisher, teste-t para amostras independentes, teste não-paramétrico de Wilcoxon-Mann-Whitney y ANCOVA. Resultados: 98% das mulheres estudadas apresentam pelo menos um dente ausente. Ao comparar o grupo de mulheres pré e pós-menopáusicas, o número de dentes é significativamente menor nas mulheres na menopausa (GE 10,83±5,90;GC 6,79±4,66), no entanto, depois de ajustado o efeito da idade esta diferença deixa de ser estatisticamente significativa (p<0,05). Conclusões: Na população estudada a menopausa não parece influenciar significativamente a perda dentária.

Serologic control against hepatitis B virus among dental students of the University of Granada, Spain

Background: To evaluate the immunological situation against hepatitis B virus (HBV) of a cohort of dentistry students, to analyze the behavior of the levels of hepatitis B surface antigen (anti-HBs) after the administration of one or three vaccine doses, and to determine the influence of age and sex on the immune response. Material and Methods: This retrospective cohort study included students attending the School of Dentistry of the institution where the study was performed from 2005 to 2012 who had completed the public health vaccination calendar for HBV at the age of 12-13. Data on age, sex, basal anti-HBs levels, post-vaccination anti-HBs results and final anti-HBs levels were collected. Comparisons of the basal and final levels, as well as associations regarding age and sex, were performed by means of the Student t and Chi-square tests. Results: Of the 359 students, 97 (27.02%) had basal antibody concentrations <10 mIU/ml, whereas in 262 the levels of anti-HBs were ≥10 mIU/ml (72.98%). Of the 288 participating students who completed the School ́s protocol for immunization, 287 (99.65%) attained a level of protection ≥10 mIU/ml. Globally, there were statistically significant differences between the basal antibody levels and those achieved after administration of the vaccine and booster, but no association with age or sex was observed. Conclusions: About 70% of dental students vaccinated as preadolescents had serologic evidence of protection against HBV. Administering a booster is associated with the presence of an excellent immune memory. There is clearly a need to reinforce control of the antibody levels in groups at risk, such as Dentistry student

Dental extraction in patients rece iving dual antiplatelet therapy

Background: Dual antiplatelet therapy consists of administering antiplatelet (antiaggregant) drugs (clopidogrel and aspirin) to prevent thrombotic processes, as a preventative measure in patients with acute coronary disease, or in patients subjected to percutaneous coronary intervention. Objective: The purpose of this study was to evaluate the efficacy of a protocol for performing dental extraction in patients receiving dual antiplatelet therapy. Material and Methods: Thirty-two patients undergoing dental extractions were included in the study. The variables evaluated were: collagen-epinephrine fraction, collagen- adenosine diphosphate fraction, surgical surface, post-surgical measures, and adverse effects. Alveolar sutures and gauzes impregnated with an antifibrinolytic agent (tranexamic acid), which the patient pressed in place for 30 minutes, were applied to all patients as post- surgical measures. Descriptive statistics were calculated and analyzed with Student’s t-test to compare pairs of quantitative variables; simple regression analysis was performed using Pearson’s correlation coefficient. Statistical significance was set at p <0.05. Results: Collagen/epinephrine fraction was 264.53±55.624 seconds with a range of 135 to 300 seconds, and collagen/ADP fraction was 119.41±44.216 seconds, both values being higher than normal. As a result of the postsurgical measures taken, no patients presented post-operative bleeding, hematoma or infection. Conclusions: Dental extraction was safe for patients receiving dual anti-platelet therapy when using sutures and gauze impregnated with tranexamic acid, which the patient pressed in place for 30 minutes

Candida species detection in potentially malignant and malignant disorders of the oral mucosa: A meta-analysis

Background: Candida species, mainly Candida albicans, have been related to dysplastic changes and malignant transformation of different oral mucosal lesions. Objective: The objective was to assess the possible influence of Candida detection in oral leukoplakia (OL), oral lichen planus (OLP), and oral cancerous lesions. Search Methods: A PubMed search through February 2018, using the following MESH terms, was performed: “Candida,” “precancerous conditions,” “mouth,” and “mouth neoplasms.” Selection Criteria: The selection criteria included studies with findings on Candida detection in premalignant and malignant oral lesions. Data Collection and Analysis: For continuous outcomes, the estimates of effects of an intervention were expressed as mean differences using the inverse variance method and for dichotomous outcomes, the estimates of effects of an intervention were expressed as odds ratios using Haenszel—Mantel method, both with 95% confidence intervals. Results: Fifteen studies on Candida detection in premalignant and malignant oral lesions were included in this meta-analysis. Nearly 61.5% of oral cancers, 32.2% of OLs, and 29.1% of OLP lesions were infected by Candida species. Candida infection does not increase the risk for developing OL (P = 0.32) or OLP (P = 0.31). A higher mean age, male gender, tobacco consumption, and location of the lesions on tongue or floor of the mouth were factors that did not have a significant influence on developing Candida-infected OL. Dysplastic OLs were 10.62 times more likely to be Candida-infected lesions. A greater number of OL lesions infected by Candida species than OLP lesions were found (P < 0.01). Having oral cancer increased 4.92-fold risk of Candida infection. No statistically significant association between Candida-infected oral cancer lesions and Candida-infected OL lesions was observed (P = 0.21). Conclusions: Candida infection worsens the biological behavior of potentially malignant and malignant lesions of the oral cavity