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ObjectivesTo investigate the relationship between sleep disorders, morning hyposalivation, and subjective feeling of dry mouth.Materials and methodsA cross-sectional, observational, clinical study was carried out in a homogenous population sample which consists of Greek male soldiers without any medical history. After the application of oral modified Schirmer test, the sample was divided into a study group (n = 63) (MST < 25 mm/3 min) and a control group (n = 110) (MST ≥ 25 mm/3 min). In order to assess daytime sleepiness, risk of obstructive sleep apnea (OSA), sleep quality, sleep bruxism (SB), and subjective feeling of dry mouth, all the participants filled in the following scales in Greek version: Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Berlin Questionnaire (BQ), a SB questionnaire, and Xerostomia Inventory (XI) respectively. In every subgroup that came of ESS, PSQI, BQ, and SB questionnaire scoring, subjective feeling of dry mouth was evaluated, based on XI values.ResultsStatistically significant difference (p < 0.001) through PSQI scores was found between the study and control group. In contrast, a statistically significant difference was not obtained for the scores of ESS (p = 0.293), BQ (p = 0.089), and SB questionnaire (p = 0.730). XI scores introduced statistically significant difference between the subgroups of PSQI (p < 0.001), BQ (p = 0.001), SB questionnaire (p = 0.004) and statistically weak between the subgroups of ESS (p = 0.049).ConclusionsThis is the first research study so far suggesting that patients with morning hyposalivation exhibit poor sleep quality using an objective method. The present results have, also, shown that subjective feeling of dry mouth is related to excessive daytime sleepiness, poor sleep quality, high risk of obstructive sleep apnea, and sleep bruxism, but larger-scale studies are still needed.Clinical RelevanceThese findings should keep dentists aware of a possible association between xerostomia and sleep disorders and support larger-scale studies.

Background Latest evidence suggests that periodontitis is prevalent among patients with chronic obstructive pulmonary disease (COPD), while recent studies have also reported a potential benefit of periodontal treatment on several COPD outcomes. This systematic review aims to determine the impact of periodontal treatment on exacerbation rate, lung function and quality of life of COPD patients. Methods A systematic search of electronic databases of PubMed, Scopus, Virtual Health Library, ScienceDirect, Wiley Online Library, Web of Science, ProQuest Dissertation and Theses Global and Google Scholar was conducted. Search restricted to studies involving human subjects which were published from January 2000 to March 2020 in English language. Distiller Systematic Review software was used for data management. Risk of bias was assessed using Risk of Bias 2 (RoB2) and Risk of Bias for non-randomized studies of intervention (ROBINS-I) tools. Overall quality of evidence was judged based on Grading of Recommendations Assessment, Development and Evaluation working group methodology. Results Out of 1442 articles retrieved, 7 full text articles were included in the review. Limited evidence suggests that periodontal treatment in patients with COPD and periodontitis is associated with reduced exacerbation frequency and a slower lung function decline rate, while its effects on quality of life remain unclear. In addition, periodontal treatment in COPD is associated with lower hospitalization rates and reduced all-cause mortality. Significant methodological differences were noted amongst included studies, while very low-to-moderate overall quality of evidence was demonstrated. Conclusions Although it is reasonable to advise COPD patients not to neglect their dental health, further studies are warranted to determine the role of periodontal therapy on COPD clinical outcomes. Trial Registration : PROSPERO 2020 (CRD42020158481). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158481

Effective pharmacotherapy during glaucoma treatment depends on interventions that reduce intraocular pressure (IOP) and retain the IOP lowering effect for sufficient time so as to reduce dosing frequency and enhance patient adherence. Combination anti-glaucoma therapy and dosage forms that increase precorneal residence time could therefore constitute a promising therapeutic intervention. The in-situ gel forming self-assembling peptide ac-(RADA)4-CONH2 was evaluated as carrier for the ocular co-delivery of timolol maleate (TM) and brimonidine tartrate (BR). The hydrogel’s microstructure and mechanical properties were assessed with atomic force microscopy and rheology, respectively. Drug diffusion from the hydrogel was evaluated in vitro in simulated tear fluid and ex vivo across porcine corneas and its effect on the treated corneas was assessed through physicochemical characterization and histological analysis. Results indicated that TM and BR co-delivery affected hydrogel’s microstructure resulting in shorter nanofibers and a less rigid hydrogel matrix. Rapid and complete release of both drugs was achieved within 8 h, while a 2.8-fold and 5.4-fold higher corneal permeability was achieved for TM and BR, respectively. No significant alterations were induced in the structural integrity of the corneas treated with the hydrogel formulation, suggesting that self-assembling peptide hydrogels might serve as promising systems for combination anti-glaucoma therapy.

Oral lichen planus (OLP) is a common skin disease of indeterminate etiology that can affect the oral mucosa. Epithelial-mesenchymal transition (EMT) is a critical biological event that plays an essential role in several functions, such as development, tissue repair, and stem cell dynamics, but also in cancer progression. Claudin-10, an EMT-related protein, is encoded by the CLDN10 gene in humans. In the present work, we studied the immunohistological expression of Claudin-10 in OLP compared to normal oral mucosa. Fifty-one formalin-fixed, paraffin-embedded samples diagnosed as OLP from patients who did not receive any medications for the treatment of OLP until the initial biopsy and ten formalin-fixed, paraffin-embedded samples diagnosed as comprising histologically normal oral mucosa tissue from resection margins of fibromas were immunohistochemically stained and analyzed for Claudin-10. The expression of Claudin-10 was evaluated as significantly enhanced in OLP epithelium compared to controls ( <0.001). In the superficial epithelial layer, the staining was markedly higher in OLP than in the controls ( =0.008), and in the stroma, the staining was significantly stronger in OLP ( =0.027). In the intermediate epithelial layer, the staining was significantly weaker in OLP than in the controls ( =0.001), and in the basal layer, the staining was markedly reduced in OLP ( <0.001). The immunohistological expression of Claudin-10 has been described and analyzed in oral mucosal disease for the first time. Our findings indicate that the expression of Claudin-10 is dysregulated in OLP, possibly showing an interaction between the epithelium and the underlying tissue.

Oral squamous cell carcinoma (OSCC) may arise in the the alveolar ridge (in a minority of cases). Smoking, chronic mucosal injuries, and poor oral hygiene are involved in its pathogenesis. It mostly occurs to men instead of women and affects the mandible on a 3:2 ratio to the maxilla. The objective of the current study is to present an interesting case of an OSCC of the alveolar ridge mimicking jaw osteonecrosis due to denosumab, resulting in differential diagnostic dilemmas. A 78-year-old female patient, edentulous and bearing total dentures, was referred with a persistent (four months), severely painful, ulcerative lesion in the anterior lateral (right) region of the residual alveolar ridge of the mandible. Medical history referred to a long-term systemic steroid use due to sarcoidosis as well as the subcutaneous use of denosumab for osteoporosis one/month for one year. Cone-beam CT (CBCT) examination was performed where bone resorption was detected and a differential diagnosis of osteonecrosis of the jaws (ONJs) from denosumab or neoplasia was made. A biopsy was carried out, and the histological examination showed that soft tissues and underlying bone were infiltrated by abnormal, confluent, compact islands of malignant squamous cells with intense atypia and numerous mitoses indicating a moderately differentiated OSCC. Denosumab inhibits the binding of receptor activator of nuclear factor ligand (RANKL) to receptor activator of nuclear factor-kappa (RANK); this decreases bone resorption and results in increased bone density. However, denosumab may induce ONJ. The area of exposed bone and abnormal soft tissue alterations may resemble both benign and malignant diseases. Osteonecrosis may mimic OSCC or may even provide the suitable substrate for the development of OSCC. Biopsy as well as bone imaging examination are required to accurately determine the possibility of neoplastic formation and its boundaries in cases of osteonecrosis especially in patients under treatment with denosumab or bisphosphonate-related ONJ (BRONJ).

Sjögren's syndrome is a chronic, inflammatory autoimmune disorder characterized by lymphocyte infiltration of the exocrine glands. Notably, the rehabilitation of partially edentulous patients with Sjögren's syndrome is limited by the scarce availability of studies that could inform therapeutic modalities and potential challenges during clinical procedures. This case report aimed to present the oral rehabilitation of a patient with Sjögren's syndrome who received fixed partial dentures (FPDs). A 28-year-old female patient sought treatment to restore her missing teeth. She was diagnosed with Sjögren's syndrome by a rheumatologist adhering to the revised version of the European criteria proposed by the American-European Consensus Group and was on a medication regimen including prednisolone, hydroxychloroquine, pantoprazole, pilocarpine, and tear substitutes to manage her condition. The final treatment plan consisted of extractions, management of gingivitis, post-and-core restorations, and a 2 mm vertical dimension increase with the placement of 15 porcelain-fused-to-metal (PFM) crowns and 4 short-span bridges. The patient underwent regular clinical and radiographic evaluations every 3 months since June 2020. Throughout this period, the fixed prostheses, teeth, and periodontal tissues demonstrated remarkable stability and exhibited no complications. This three-year case study provides evidence that meticulous planning and clinical execution can facilitate successful oral rehabilitation in young edentulous patients with Sjögren's syndrome. Tooth-supported fixed prostheses can effectively restore oral function and aesthetic appeal in these individuals, provided they undergo more frequent dental examinations than the general population and maintain a cooperative attitude throughout the treatment process.

Background and objective Cancer stem cells (CSCs) initiate carcinogenesis. This study aimed to examine them via immunohistochemistry in oral potentially malignant disorders (OPMDs). Methods The study involved 54 samples of OPMDs, which were compared with five cases of normal oral epithelium. The study was approved by the Ethics Committee of the School of Dentistry, Aristotle University of Thessaloniki, Greece (protocol number: 8/03.07.2019). The CSC-related proteins octamer-binding transcription factor (OCT)3-4 and SRY-related HMG-box (SOX)2 were examined with immunohistochemical methods. In the case of SOX2 and OCT3-4, the samples were evaluated through a scale of 1 to 3 depending on the presence of positive cells, and this scale was further multiplied by the intensity of staining (multipliers 1 and 2). The statistical analysis was performed with Fisher's exact test, and the significance level was set at ≤0.05.  Results The nuclear staining of OCT3-4 was not expressed in any of the samples. The nuclear staining of SOX2 was observed mostly in the basal and parabasal layer of the epithelium. Statistically significantly higher expression of SOX2 was observed in the erosive oral lichen planus (EOLP) group than in the reticular OLP (ROLP) group ( =0.05) and the mild and non-dysplastic leukoplakia group than in the reticular OLP group ( =0.024). Conclusions The characteristic expression of SOX2 in OLP suggests the presence of CSCs and might imply oral tumorigenesis even in lichenoid lesions. Erosive lichen planus outperformed the mild and non-dysplastic leukoplakia, regarding the expression of CSC biomarkers.

Early identification and adequate treatment of actinic cheilitis (AC), which affects the lower lip vermillion and is considered a precursor of squamous cell carcinoma, is mandatory. Photodynamic therapy (PDT) has been successfully used in AC. PDT with the use of daylight (DLPDT) is equally effective and more convenient than the conventional PDT. Data on short and long-term efficacy of DLPDT in AC are limited. Our primary purpose was to assess efficacy of DLPDT in AC as well as safety and tolerance. Twenty-two individuals with histologically confirmed AC received 2 MAL (5-aminolevulinic acid)-DLPDT sessions 1 week apart. Patients were evaluated clinically 3, 6, and 12 months after treatment. Non-complete responders were biopsied and excluded from the study if histological alterations were indicative of AC. Adverse events were recorded from baseline to the end of the 12-month follow-up period. Twenty patients completed the study. Overall, complete clinical response 12 months after treatment was 80% (16/20), while an association between treatment response and grade of dysplasia was observed ( p  = 0.016). With respect to response by grade, complete clinical response achieved in grade I AC was 100% (12/12) and 50% (4/8) in grade II AC. Main adverse events included mild erythema, oedema, and scaling, with no pain associated with DLPDT. According to our results, DLPDT seems to be of significant benefit for the treatment of grade I AC. Combination with the other treatment modalities could improve the efficacy in grade II AC. Further studies are needed for the assessment of late recurrences.

Standard treatment options for rheumatoid arthritis (RA) often fail to deliver a long-term therapeutic outcome and in many cases cause intractable adverse events leading to treatment discontinuation or readjustment. Treatment with mesenchymal stem cells (MSCs) has been recently studied in RA due to its immunomodulatory and anti-inflammatory capacities. Thus, this study aims at systematically search and review the literature for randomized or non-randomized clinical trials comparing interventions of MSCs with placebo in RA patients. Electronic searches were conducted on PubMed, SCOPUS, Cochrane-CENTRAL, registries of clinical trials and grey literature. Selected studies were estimated for risk of bias with the Cochrane RoB tool 2 or the ROBINS-I tool. Four trials met the eligibility criteria and entered the review process. Identified MSCs treatments varied from allogeneic to autologous or umbilical cord-derived cells. Enrolled patients had an active RA and had poor responses to previous standard medications. In general, the safety evaluation revealed that treatment with MSCs was safe and well tolerated. Regarding the efficacy measurements, modest improvements were found in RA symptoms and RA-related indices. Significant decreases were found in inflammatory molecules such as C-reactive protein, tumor necrosis factor alpha and interleukin 6. However, clinical response criteria related to RA were achieved by a low-to-moderate percentage of patients. In conclusion, treatment of RA with MSCs appears to have a short-term therapeutic effect. Better-designed randomized trials with sufficient follow-up periods are needed so that the long-term safety and efficacy interventions with MSCs would be elucidated.