Crosstalk between oral and general health status in e-smokers

Electronic Nicotine Delivery Systems Use and Periodontal Health-Findings from the Population Assessment of Tobacco and Health Study

(1) Background: Electronic nicotine delivery systems (ENDSs) are rapidly increasing in the U.S., however, information about their long-term risks and benefits remains limited. This study examined the relationship between ENDS use and periodontal health among U.S. adults. (2) Methods: Data came from 33,822 adults who participated in the 2016-2018 wave of the Population Assessment of Tobacco and Health (PATH) study. Inclusion criteria were adults without a history of cigarette smoking or diabetes. Logistic regression analysis was performed to estimate the associations between ENDS use and a history of periodontal disease, with multivariable logistic regression adjusting for factors associated with poor oral health. (3) Results: Of the study participants, 2321 were never ENDS users, 38 were regular ENDS users, and 512 were non-regular ENDS users. Compared to never ENDS users, regular ENDS users had higher odds of poor periodontal health including bone loss around teeth. Regular ENDS use was also independently associated with higher odds of poor oral health compared to non-regular ENDS users. (4) Conclusions: This study suggests an association between ENDS use and increased risk of periodontal health issues in the United States. These findings align with previous research linking ENDS use to poor oral health.

The impact of electronic and conventional cigarettes on periodontal health-a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis examined the effects of electronic cigarettes on periodontal health compared to conventional cigarette smoke and a non-smoking population.

MATERIALS AND METHODS

MEDLINE, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov were screened for literature. Eligibility criteria included clinical studies published between 2006 and 2022 that compare e-cigarettes and conventional cigarettes on periodontal health (bleeding on probing (BoP), plaque index (PI), probing depth (PD), attachment loss (AL), marginal bone loss (MBL), tooth loss, molecular inflammation markers, salivary flow rate). Meta-regression analysis was used to examine the influence of moderator variables.

RESULTS

Sixteen studies were found to be eligible for qualitative synthesis. Individual analyses showed that cigarette smokers had significantly higher PI, PD, AL, and MBL and increased concentrations of proinflammatory mediators than e-cigarette users and non-smokers. Meta-analysis revealed a 0.33-fold lower chance for BoP in e-cigarette users compared to smokers (p = 0.03), whereby meta-regression failed to detect any effects regarding the age of users and frequency of smoking. A 0.01-fold decreased chance for positive BoP in e-cigarette users compared with non-smokers was seen (p < 0.01).

CONCLUSIONS

The current findings suggest that that e-cigarette use might be considered a healthier alternative to cigarette smoking concerning periodontal health. Even so, harmful effects of electronic nicotine delivery system (ENDS) usage on periodontal health were seen as well. However, a definitive decision on this research question remains elusive due to the absence of randomized controlled trials.

CLINICAL RELEVANCE

Electronic cigarettes, marketed as a safer alternative to traditional cigarettes, are becoming increasingly popular. Evidence on the use of electronic cigarettes as a cessation aid and its beneficial impact compared to cigarette smoke remains inconclusive, so the analysis conducted in this review addresses a recent question of high clinical relevance.

The Potential Impact of E-cigarettes on the Life-Years Lost from Conventional Smoking in the Russian Federation

This study analyses the potential impact of e-cigarettes on the death toll of cigarette smoking in the Russian Federation by working under a variety of assumptions pertaining to how much vaping might affect smoking cessation and initiation, and its adverse impacts on health in comparison to conventional smoking. Within this study, each combination of these assumptions generates a single vaping scenario (210 in total). A dynamic population simulation model, specifically for the Russian Federation, that is tailoured to tobacco control policy analysis, is built for estimation purposes. Considering the toll of smoking on cumulative life-years saved via the inclusion of vaping across a period of 80 years, the simulation analysis produces positive results in 88.1% of e-cigarette scenarios, ranging from - 3.3 million to 38.5 million life-years saved. In relative terms, the estimated life-years saved from vaping varies from - 1.6 to 18.6% of the predicted life-years lost from smoking. Most of the model scenarios involve a significant number of individuals who stopped smoking in favour of vaping. These results suggest that vaping has great potential to reduce the prevalence of smoking and the related death toll in the Russian Federation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10603-023-09540-z.

Periodontal and Peri-Implant Health Status in Traditional vs. Heat-Not-Burn Tobacco and Electronic Cigarettes Smokers: A Systematic Review

The aim of the present systematic review was to evaluate and possibly differentiate the effects of traditional cigarettes, heat-not-burn tobacco, and electronic cigarettes on periodontal and peri-implant health status. Electronic cigarettes and heat-not-burn tobacco have become very popular in recent years and have been proposed to consumers as a safer alternative to conventional tobacco smoke, although their effect on periodontal and peri-implant health remains unclear. The study protocol was developed according to PRISMA guidelines, and the focus question was formulated according to the PICO strategy. A literature search was conducted across PubMed/MEDLINE and the COCHRANE library from 2003 to April 2022. From the 1935 titles initially identified, 18 articles were finally included in the study and extracted data were qualitatively synthesized. It may be carefully concluded that e-cigarettes may cause attenuated clinical inflammatory signs of periodontitis and, hypothetically, of peri-implantitis when compared to conventional tobacco smoke. Both alternative smoking products, containing nicotine, may likewise exert negative effects on periodontal and peri-implant health, as demonstrated by in vitro studies. Further investigations are needed to assess the impact of electronic cigarettes and heat-not-burn tobacco products on periodontal and peri-implant health status.

The World of Oral Cancer and Its Risk Factors Viewed from the Aspect of MicroRNA Expression Patterns

Oral cancer is one of the leading causes of death worldwide, with a reported 5-year survival rate of around 50% after treatment. Epigenetic modifications are considered to have a key role in oral carcinogenesis due to histone modifications, aberrant DNA methylation, and altered expression of miRNAs. MicroRNAs (miRNAs) are small non-coding RNAs that have a key role in cancer development by regulating signaling pathways involved in carcinogenesis. MiRNA deregulation identified in oral cancer has led to the idea of using them as potential biomarkers for early diagnosis, prognosis, and the development of novel therapeutic strategies. In recent years, a key role has been observed for risk factors in preventing and treating this malignancy. The purpose of this review is to summarize the recent knowledge about the altered mechanisms of oral cancer due to risk factors and the role of miRNAs in these mechanisms.

Pilot study to determine differences in breath odour between cigarette and e-cigarette consumers

Cigarette smoke is known to influence breath odour, but the effect of e-cigarettes is unknown. In this pilot study, we aimed to determine differences in breath odour between cigarette smokers (CSs) and e-cigarette consumers (ECs) in 33 healthy subjects: 11 CSs, 11 ECs and 11 non-smokers (NSs). Breath was sampled at baseline and following product use (CSs and ECs) or a waiting period (NSs) by eight trained odour judges using a six-point smoke intensity scale and a nine-point hedonic scale. We observed a statistically significant difference between CSs and ECs. Smoke intensity values were significantly higher in CSs than ECs and NSs, which were comparable both at baseline and after product use. In addition, hedonic values for CSs were significantly lower than both NSs and ECs after product use. These acute results indicate that cigarette and e-cigarette use results in significantly different breath. ECs breath has a reduced smoke odour and more pleasant aroma than CSs, and is comparable to NSs. This suggests there may be cosmetic benefits for CSs who quit smoking or switch to exclusive use of ECs. Further studies are required to understand the long-term effects of e-cigarette use on breath odour.

Early Diagnosis of Oral Mucosal Alterations in Smokers and E-Cigarette Users Based on Micronuclei Count: A Cross-Sectional Study among Dental Students

The presence of micronuclei in oral epithelial cells is considered a marker of genotoxicity, which can be identified using exfoliative cytology. The aim of this study was to investigate cytotoxic damage through the evaluation of micronuclei in the oral mucosa of smokers and e-cigarette users compared to nonsmokers. We obtained smears from the buccal mucosa of 68 participants divided in 3 groups (smokers, e-cigarette users and nonsmokers), which were further processed with Papanicolaou stain. The frequencies of micronuclei and micronucleated cells were recorded and statistically analyzed at a level of significance of p < 0.05. The mean micronuclei values per 1000 cells were 3.6 ± 1.08 for smokers, 3.21 ± 1.12 for e-cigarette users and 1.95 ± 1.05 for nonsmokers. The mean values of micronucleated cells per 1000 cells were 2.48 ± 0.91 for smokers, 2.39 ± 1.07 for e-cigarette users and 1.4 ± 0.68 for nonsmokers. Smokers and e-cigarette users had significantly higher values of micronuclei and micronucleated cells compared to nonsmokers, but there were no significant differences between smokers and e-cigarette users. We concluded that the micronuclei count can be used as an early indicator for alterations of oral mucosa and exfoliative cytology represents an accessible tool which could be applied for mass screening.

Impact of tobacco and/or nicotine products on health and functioning: a scoping review and findings from the preparatory phase of the development of a new self-report measure

BACKGROUND

Measuring self-reported experience of health and functioning is important for understanding the changes in the health status of individuals switching from cigarettes to less harmful tobacco and/or nicotine products (TNP) or reduced-risk products (RRP) and for supporting tobacco harm reduction strategies.

METHODS

This paper presents insights from three research activities from the preparatory phase of the development of a new self-report health and functioning measure. A scoping literature review was conducted to identify the positive and negative impact of TNP use on health and functioning. Focus groups (n = 29) on risk perception and individual interviews (n = 40) on perceived dependence in people who use TNPs were reanalyzed in the context of health and functioning, and expert opinion was gathered from five key opinion leaders and five technical consultants.

RESULTS

Triangulating the findings of the review of 97 articles, qualitative input from people who use TNPs, and expert feedback helped generate a preliminary conceptual framework including health and functioning and conceptually-related domains impacted by TNP use. Domains related to the future health and functioning measurement model include physical health signs and symptoms, general physical appearance, functioning (physical, sexual, cognitive, emotional, and social), and general health perceptions.

CONCLUSIONS

This preliminary conceptual framework can inform future research on development and validation of new measures for assessment of overall health and functioning impact of TNPs from the consumers' perspective.

The Emergence and Evolution of Borophene

Neighboring carbon and sandwiched between non-metals and metals in the periodic table of the elements, boron is one of the most chemically and physically versatile elements, and can be manipulated to form dimensionally low planar structures (borophene) with intriguing properties. Herein, the theoretical research and experimental developments in the synthesis of borophene, as well as its excellent properties and application in many fields, are reviewed. The decade-long effort toward understanding the size-dependent structures of boron clusters and the theory-directed synthesis of borophene, including bottom-up approaches based on different foundations, as well as up-down approaches with different exfoliation modes, and the key factors influencing the synthetic effects, are comprehensively summarized. Owing to its excellent chemical, electronic, mechanical, and thermal properties, borophene has shown great promise in supercapacitor, battery, hydrogen-storage, and biomedical applications. Furthermore, borophene nanoplatforms used in various biomedical applications, such as bioimaging, drug delivery, and photonic therapy, are highlighted. Finally, research progress, challenges, and perspectives for the future development of borophene in large-scale production and other prospective applications are discussed.

Effect of e-cigarettes on nasal epithelial cell growth, Ki67 expression, and pro-inflammatory cytokine secretion

OBJECTIVE

Upon use, e-cigarette aerosol comes in contact with various mucosal tissues, including the nasal epithelium, which may lead to nasal pathologies. We therefore assessed the effect of e-cigarettes on nasal epithelial cell and tissue behaviours.

METHODS

Human primary nasal epithelial cells and engineered 3D nasal mucosa tissues were exposed or not to either e-cigarette aerosol or standard cigarette smoke. We then evaluated cell viability and lactate dehydrogenase (LDH) activity. With the tissues analysed tissue structure, the expression of Ki67 proliferating marker, and the secretion of pro-inflammatory cytokines by the engineered nasal mucosa.

RESULTS

The nasal epithelial cells exposed to e-cigarettes displayed a larger cell size and a faint nucleus following exposure to e-cigarettes. This is supported by the increased levels of LDH activity following exposure to e-cigarettes, compared to that observed in the control. Tissues exposed to e-cigarette aerosol displayed a structural deregulation, with more large-sized cells, fewer Ki67-positive cells, and a reduced proliferation rate, compared to that observed in the non-exposed tissues. Cytokine measurements showed high levels of IL-6, IL-8, TNFα, and MCP-1, demonstrating that e-cigarettes activated pro-inflammatory cytokine responses.

CONCLUSION

E-cigarette aerosol showed adverse effects on nasal epithelial cells and nasal engineered mucosa tissue. These findings indicate that e-cigarettes could be a threat to nasal tissues and may impair the innate immune function of nasal epithelial cells.

Association of e-cigarette use with oral health: a population-based cross-sectional questionnaire study

BACKGROUND

The impact of daily or intermittent electronic cigarette (e-cigarette) use on oral health is unknown.

METHODS

We performed a cross-sectional analysis using the 2016 Behavioral Risk Factor Surveillance System data. Poor oral health was determined by the number of permanent teeth removed due to non-traumatic causes, and e-cigarette use determined by daily or intermittent use within 30 days prior to survey administration. We performed logistic regression analysis to test associations between e-cigarette use and oral health with adjustment for factors associated with poor oral health, survey clustering, strata and weight.

RESULTS

We included survey responses from 456 343 adults. Over half of respondents (51.5%) reported having at least one permanent tooth removed because of tooth decay or gum disease in their lifetime. Daily e-cigarette use was reported by 4957 (1.1%) of respondents. In multivariable analysis, daily e-cigarette use, was independently associated with a 78% higher odds of poor oral health (adjusted OR = 1.78, 95% CI: 1.39-2.30; P < 0.001).

CONCLUSIONS

In a population-based health survey of US adults, self-reported health behavior and outcomes, daily use, but not intermittent use of e-cigarettes was independently associated with poor oral health. Care must be exercised in seeking 'healthier' cigarette alternatives.

Harmful chemicals emitted from electronic cigarettes and potential deleterious effects in the oral cavity

Use of electronic nicotine delivery systems (ENDS), such as electronic cigarettes (e-cigs), is increasing across the US population and is particularly troubling due to their adoption by adolescents, teens, and young adults. The industry’s marketing approach for these instruments of addiction has been to promote them as a safer alternative to tobacco, a behavioral choice supporting smoking cessation, and as the ‘cool’ appearance of vaping with flavored products (e.g. tutti frutti, bubble gum, and buttered popcorn etc.). Thus, there is a clear need to better document the health outcomes of e-cig use in the oral cavity of the addicted chronic user. There appears to be an array of environmental toxins in the vapors, including reactive aldehydes and carbonyls resulting from the heating elements action on fluid components, as well as from the composition of chemical flavoring agents. The chemistry of these systems shows that the released vapors from the e-cigs frequently contain levels of environmental toxins that considerably exceed federal occupational exposure limits. Additionally, the toxicants in the vapors appear to be retained in the host fluids/tissues at levels often approximating 90% of the levels in the e-cig vapors. These water-soluble reactive toxins can challenge the oral cavity constituents, potentially contributing to alterations in the autochthonous microbiome and host cells critical for maintaining oral homeostasis. This review updates the existing chemistry/environmental aspects of e-cigs, as well as providing an overview of the somewhat limited data on potential oral health effects that could occur across the lifetime of daily e-cig users.

Oral Cancer: A Historical Review

Aim: This historical medical literature review aims at understanding the evolution of the medical existence of oral cancer over times, particularly better comprehending if the apparent lower prevalence of this type of cancer in antiquity is a real value due to the absence of modern environmental and lifestyle factors or it is linked to a misinterpretation of ancient foreign terms found in ancient medical texts regarding oral neoplasms. Methods: The databases MedLne, PubMed, Web of Science, Elsevier's EMBASE.com, Cochrane Review, National Library of Greece (Stavros Niarchos Foundation, Athens) and the Library of the School of Health Sciences of the National and Kapodistrian University of Athens (Greece) were extensively searched&nbsp;for relevant studies published during the past century on the history of oral cancer and its treatment from antiquity to modern times, in addition to the WHO website to analyse the latest epidemiological data. In addition, we included historical books on the topic of interest and original sources. Results: Historical references reveal that the cradle of the oral oncology was in ancient Egypt, the Asian continent and Greece and cancer management was confined to an approximate surgical practice, in order to remove abnormal masses and avoid bleeding with cauterization. In the Medieval Age, little progress occurred in medicine in general, oral cancers management included. It is only from the Renaissance to modern times that knowledge about its pathophysiological mechanisms and histopathology and its surgical and pharmacological treatment approaches became increasingly deep all over the world, evolving to the actual integrated treatment. Despite the abundant literature exploring oncology in past civilizations, the real prevalence of oral cancer in antiquity is much less known; but a literature analysis cannot exclude a consistent prevalence of this cancer in past populations, probably with a likely lower incidence than today, because many descriptions of its aggressiveness were found in ancient medical texts, but it is still difficult to be sure that each single description of oral masses could be associated to cancer, particularly for what concerns the period before the Middle Ages. Conclusions: Modern oncologists and oral surgeons must learn a lot from their historic counterparts in order to avoid past unsuccessful efforts to treatment oral malignancies. Several descriptions of oral cancers in the antiquity that we found let us think that this disease might be linked to mechanisms not strictly dependent on environmental risk factors, and this might guide future research on oral cavity treatments towards strategical cellular and molecular techniques.

Efficacy of Fluorescence Technology vs Conventional Oral Examination for the Early Detection of Oral Pre-Malignant Lesions. A Clinical Comparative Study

BACKGROUND AND OBJECTIVE

Oral cancer is one of the most common malignancies that affect human beings across the world and early detection of oral cancer is believed to reduce the morbidity significantly. Fluorescence diagnosis is emerging as a promising method in the differentiation of cancerous lesions and thus helping in the determination of resolution for the surgical resection of affected area of malignancy very accurately. The aim of this study was to evaluate the usefulness of an autofluorescence hand held device (OralID) to detect oral premalignant lesions.

METHODS

98 potentially high-risk oral cancer patients were divided into two groups (n=49/group). Both the groups were first examined by conventional oral examination under white light and oral findings were noted. Subjects under group B were further examined under fluorescence light through hand held device, i.e. OralID. After the examinations, a surgical biopsy sample was taken from the suspected lesions under local anaesthesia from both the groups to confirm the diagnosis through histopathological analysis.

RESULTS

The positive potential malignant lesions (PMLs) observed in Group A when compared with biopsy reporting was 89.47% true positive while in Group B was 95.24%. The sensitivity reported of Group A was 89.47% and Group B was 97.56%. We observed 8.09% more sensitivity and 11.36% more specificity when we incorporate adjunctive the fluorescence examination using OralID.

CONCLUSION

Results from this study suggests that OralID is a true adjunct to conventional oral examination in detecting early potential malignant changes in subjects visiting for regular dental check-up.

The oral health impact of electronic cigarette use: a systematic review

Introduction: Electronic cigarette (e-cigarette) use is becoming more prevalent and is particularly popular among adolescents and conventional smokers. While the oral health sequelae of conventional smoking are well-established, the impact of e-cigarettes on oral health is still unknown. This study aims to systematically review the available research evidence on the oral health impact of e-cigarette use.Methods: This systematic review was conducted according to PRISMA guidelines and used the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence. Three electronic databases (PubMed, Web of Science, and Embase) were systematically searched for studies including case reports. Two independent reviewers extracted data and synthesized the findings.Results: Ninety-nine articles were included in this systematic review. Analyses of the articles yielded seven categories based on symptom similarity and/or focus: mouth effects, throat effects, periodontal effects, dental effects, cytotoxic/genotoxic/oncologic effects, oral microbiome effects, and traumatic/accidental injury. The majority of mouth and throat symptoms experienced by e-cigarette users were relatively minor and temporary, with some evidence that conventional smokers who switched to e-cigarettes experienced mitigation of these symptoms. E-cigarette exposure increased the risk for deteriorating periodontal, dental and gingival health as well as changes to the oral microbiome. Extensive dental damage as a result of e-cigarette explosions were described in case reports. Components of e-cigarette vapor have known cytotoxic, genotoxic, and carcinogenic properties.Conclusions: Although switching to e-cigarettes may mitigate oral symptomatology for conventional smokers, findings from this review suggest that a wide range of oral health sequelae may be associated with e-cigarette use. Well-designed studies to investigate oral health outcomes of e-cigarette use are needed.

Utility of High-Intensity Laser Therapy Combined with Photobiomodulation Therapy for Socket Preservation After Tooth Extraction

Objective: High-intensity laser therapy (HILT) combined with photobiomodulation therapy (PBMT) using a diode or CO₂ laser was administered after extraction of the left first molar in rats. Effects on socket preservation (preservation of the alveolar bone and healing time after extraction) were evaluated histopathologically.

Background: Irradiation using a diode or CO₂ laser has been shown to hasten wound healing, but the effects remain controversial.

Methods: Five-week-old male Wistar rats that underwent extraction of the left maxillary first molar were divided into three groups: diode laser irradiation (diode group), CO₂ laser irradiation (CO₂ group), and no laser irradiation (control group). HILT (27 J) was performed immediately after tooth extraction to enhance blood coagulation, followed by PBMT (0.7 J) 1 day later to enhance healing. Tissues, including the extraction socket, were removed en bloc 3, 5, 7, 10, and 21 days postextraction to determine the morphological characteristics of wound healing and the distribution of myofibroblasts involved in scar formation.

Results: In the diode and CO₂ groups, new bone formation and cancellous bone maturation were observed at an early stage of wound healing. The number of myofibroblasts was significantly lower in the laser treatment groups than the control (p < 0.001), and both treatment groups had a significantly higher alveolar crest height (p < 0.01), with almost no concavity in the mucosa of the extraction wound.

Conclusions: Combined HILT and PBMT following tooth extraction hastened wound healing and preserved alveolar crest height, suggesting a role in socket preservation.

Electronic Nicotine Delivery Systems (ENDS) and Their Relevance in Oral Health

The number and popularity of electronic nicotine delivery systems (ENDS) and especially e-cigarettes (e-cigs) have been increasing in the last decade. Although ENDS owe their popularity to excluding the harmful chemicals that are present in tobacco smoke, there is a debate whether they are safe, regulated, and as harmless as they are assumed to be and have potential unknown long-term effects. Involvement of cigarette smoking to the progression of periodontal diseases, other adverse oral health outcomes, and its detrimental effects to oral health are well-described. ENDS producer companies claim that these products can improve oral health by providing alternatives to smoking. However, the effect of e-cigs on oral health is not fully understood and is still debated among many scientists and clinicians. The number of studies addressing the potential toxic effect of ENDS or e-cig aerosol on oral cells is limited along with the clinical studies which are still preliminary, and their sample size is limited. The long-term effects of inhaled aerosols and the potential synergistic effect of the e-cigs components are not known. It is essential and of utmost importance to determine whether exposure to ENDS aerosol contributes to the progression of periodontal diseases and how it affects periodontal ligament and gingival cells which are believed to be its first targets. This review briefly summarizes the available evidence about the effects of e-cigs on periodontal health including several pathophysiological events, such as oxidative stress, DNA damage, inflammation, cellular senescence, dysregulated repair, and periodontal diseases.

Probiotics Efficacy on Oxidative Stress Values in Inflammatory Bowel Disease: A Randomized Double-Blinded Placebo-Controlled Pilot Study

BACKGROUND

Inflammatory bowel diseases (IBD), which include Crohn's disease (CD) and ulcerative colitis (UC), are described as a chronic inflammation of the small intestine and colon, caused by a dysregulated immune response to host intestinal microbiota in genetically susceptible subjects.

OBJECTIVE

The aim of this study was to compare probiotic therapy versus placebo in Oxidative Stress Values and clinical features in patients affected by IBD.

METHOD

Forty (40) patients previously diagnosed for IBD were recruited and randomized to receive probiotics (test group, n=20) or placebo (control group, n=20) administered for 90 days. Subjects in both the groups were assessed for overall oxidant ability (d-ROMs test) and for the antioxidant response (BAP test): data were reported at baseline, after 1 and 3 months. Additional data from anamnesis and haematological investigation were also reported during the study.

RESULTS

d-ROM assay clearly showed that the values observed in the test group were significantly improved, leading to oxidative stress values which are not pathological. The test group showed increasing BAP values, thus confirming the overall improvements of patients 'health following administration of probiotics.

CONCLUSION

Oral administration of the specific probiotics demonstrated its efficacy and safety on patients affected by IBD.

Borophene Is a Promising 2D Allotropic Material for Biomedical Devices

Allotropic 2D materials are the new frontier of materials science, due to their unique strategic properties and application within several sciences. Allotropic 2D materials have shown tunable physical, chemical, biochemical, and optical characteristics, and among the allotropic materials, graphene has been widely investigated for its interesting properties, which are highly required in biomedical applications. Recently, the synthesis of thin 2D boron sheets, developed on Ag(111) substrates, was able to create a 2D triangular structure called borophene (BO). Borophene has consistently shown anisotropic behavior similar to graphene. In this topical review, we will describe the main properties and latest applications of borophene. This review will critically describe the most interesting uses of borophene as part of electronic and optical circuits. Moreover, we will report how borophene can be an innovative component of sensors within biomedical devices, and we will discuss its use in nanotechnologies and theranostic applications. The conclusions will provide insight into the latest frontiers of translational medicine involving this novel and strategic 2D allotropic material.

Effects of an Er,Cr:YSGG Laser on Bone Regeneration in Critical-Sized Calvarial Defects of Rats Exposed to Inhalation of Cigarette Smoke

Objective: To evaluate the effect of the Er,Cr:YSGG laser on healing of critical-sized calvarial defects (CSDs) in rats submitted to inhalation of cigarette smoke. Background: Smoking has been implicated with the delay in the bone healing after osteotomy procedures, then the use of the Er,Cr:YSGG laser for osteotomy in smokers could be an alternative to the conventional drills. Methods: One hundred animals were randomly allocated into four groups: trephine-the CSDs were made with a trephine drill in healthy rats; Er,Cr:YSGG-the CSDs were made with the Er,Cr:YSGG laser in healthy rats; Trephine-S-the CSDs were made with a trephine drill in rats exposed to cigarette smoke; and Er,Cr:YSGG-S-the CSDs were made with the Er,Cr:YSGG laser in rats exposed to cigarette smoke. The inhalation of cigarette smoke started 7 days before the surgical procedure until euthanasia (immediately, 7, 15, 30, or 60 days after the surgical procedure). A histometric analysis and a histological description were performed to evaluate (1) the residual linear lengths and bone formation in the CSDs; (2) the quality of bone healing. Results: The use of Er,Cr:YSGG laser induces more bone formation compared with the trephine in smokers; however, the closure of the CSD was only superior in the Er,Cr:YSGG-S group compared to the Trephine-S group at the 60-day period. Conclusions: The use of the Er,Cr:YSGG laser stimulated the bone repair process after osteotomy procedures in animals submitted to exposure of inhalation of cigarette smoke.

Should we reconsider the apoptosis as a strategic player in tissue regeneration?

Apoptosis plays a central role in organs development and homeostasis. Impaired regulation of this process is often associated with the onset of several human diseases, such as developmental disorders and cancer. The last scientific investigations have discovered interesting connections between apoptosis, stem cells, tissue regeneration and cancer. The role of "programmed cell death" in stem cells and tissue engineering is extremely promising; in fact, it holds great potential for regenerative purposes. However, several questions still remain unsolved: do we really know all the main molecular actors able to switch ON/OFF the apoptosis? Is it possible to modulate these players, to obtain a predictable regeneration of tissues and organs? But primarily: should we reconsider the apoptosis as a strategic player in tissue regeneration? In this topical review, we have carefully examined the most recent discoveries about the role of apoptosis in stem cells and, specifically, in mesenchymal stem cells. The pivotal molecules involved in the activation and inhibition of the apoptotic pathways will be carefully described, with the aim to shed an overall light on the complex scenario of stem cell life and death, and on a novel strategy for tissue regeneration.

Awareness and use of e-cigarettes among urban residents in China

INTRODUCTION

The long-term health effects of e-cigarettes are uncertain, and data on e-cigarette use among Chinese adults are limited. This study examined the prevalence and correlates of e-cigarette awareness and use among urban residents in China. Data came from the China City Adult Tobacco Survey (CCATS), a city-representative household survey conducted using electronic tablets during 2013–2014 in 14 major Chinese cities.

METHODS

CCATS used multistage geographically clustered samples with standardized survey protocols and questionnaire to ensure data comparability. Overall, 31151 adults completed the survey, with sample size varying from 1977 to 3838 across cities, and survey response rates ranging from 79.8% to 97.5%. Respondents were considered current e-cigarette users if they self-reported using e-cigarettes ‘daily’ or ‘less than daily’ at the time of the survey. Descriptive statistics and multivariate logistic regression were conducted. Assessed correlates included: age, education, quit attempts in past 12 months, cigarettes smoked per day, and monthly expenditures on cigarettes.

RESULTS

Overall, 46.7% of respondents were aware of e-cigarettes, 2.9% ever used, and 0.8% currently used. Most current e-cigarette users (93.0%) also currently smoked tobacco. Among male current tobacco smokers, adjusted odds ratio (AOR) of current e-cigarette use was higher among those aged 15–29 (AOR=2.5; 95% CI: 1.5–4.3) or 30–49 (AOR=1.9; 95% CI: 1.0–3.4) than those ≥50 years; those who attempted to quit in the past 12 months than those who did not (AOR=4.7; 95% CI: 2.2–10.1); those with a college degree (AOR=3.4; 95% CI: 1.9–6.2) or just finished high school (AOR=2.2; 95% CI: 1.2–4.2) than those who did not finish high school; and those who smoked ≥15 cigarettes per day (AOR=2.8; 95% CI: 1.4–5.6) than those who smoked fewer.

CONCLUSIONS

These findings reveal that during 2013–2014, many urban Chinese adults were aware of e-cigarettes, while use was relatively low and most current users also smoked tobacco. Continued monitoring of e-cigarettes could help inform public health policy, planning, and practice.

Association between Regular Electronic Nicotine Product Use and Self-reported Periodontal Disease Status: Population Assessment of Tobacco and Health Survey

Electronic nicotine product use is increasing in the U.S., but few studies have addressed its effects on oral health. The goal of this work was to determine the association between electronic nicotine product use and periodontal disease. Population Assessment of Tobacco and Health adult survey data from 2013⁻2016 (waves 1, 2 and 3) was used for the analysis. Longitudinal electronic nicotine product users used electronic nicotine products regularly every day or somedays in all three waves. Participants with new cases of gum disease reported no history of gum disease in wave 1 but reported being diagnosed with gum disease in waves 2 or 3. Odds ratios (OR) were calculated to determine the association between electronic nicotine product use and new cases of gum disease after controlling for potential cofounders. Compared to never users, longitudinal electronic nicotine product users had increased odds of being diagnosed with gum disease (OR 1.76, 95% Confidence Interval (CI) 1.12⁻2.76) and bone loss around teeth (OR 1.67, 95% CI 1.06⁻2.63). These odds were higher for participants with a history of marijuana and a history of illicit or non-prescribed drug use. Our findings show that e-cigarettes may be harmful to oral health.

Effectiveness of Platelet-Rich Fibrin as an Adjunctive Material to Bone Graft in Maxillary Sinus Augmentation: A Meta-Analysis of Randomized Controlled Trails

Purpose

To date, it remains unknown whether the addition of platelet-rich fibrin (PRF) to bone grafts actually improves the effectiveness of maxillary sinus augmentation. This study aimed to perform a meta-analysis to evaluate the efficacy of PRF in sinus lift.

Materials and Methods

PubMed, Embase, and the Cochrane Library were searched. Randomized controlled studies were identified. The risk of bias was evaluated using the Cochrane Collaboration tool.

Results

Five RCTs were included in our meta-analysis. Clinical, radiographic, and histomorphometric outcomes were considered. No implant failure or graft failure was detected in all included studies within the follow-up period. The percentage of contact length between newly formed bone substitute and bone in the PRF group was lower but lacked statistical significance (3.90%, 95% CI, -2.91% to 10.71%). The percentages of new bone formation (-1.59%, 95% CI, -5.36% to 2.18%) and soft-tissue area (-3.73%, 95% CI, -10.11% to 2.66%) were higher in the PRF group but were not significantly different. The percentage of residual bone graft was not significant in either group (4.57%, 95% CI, 0% to 9.14%).

Conclusions

Within the limitations of this review, it was concluded that there were no statistical differences in survival rate, new bone formation, contact between newly formed bone and bone substitute, percentage of residual bone graft (BSV/TV), and soft-tissue area between the non-PRF and PRF groups. Current evidence supporting the necessity of adding PRF to bone graft in sinus augmentation is limited.

Perceived health effects of vaping among Hungarian adult e-cigarette-only and dual users: a cross-sectional internet survey

BACKGROUND

Knowledge about the health effects of e-cigarette use (or vaping) among past and current combustible cigarette users is limited. Several studies have assessed vaping-related adverse events (AEs) and beneficial health effects, however, most studies focused on AEs in general and examined only a few physiological changes that vapers experience. This study aims to explore self-reported AEs and perceived health changes due to e-cigarette use among Hungarian adult e-cigarette-only users (former smokers who switched completely to e-cigarette use) and dual users (smokers who use e-cigarettes and combustible tobacco cigarettes concomitantly).

METHODS

A cross-sectional, web-based survey of 1042 adult Hungarian e-cigarette users was conducted in 2015. Participants reported AEs and changes in physiological functions since they switched from smoking to e-cigarette use or while dually using e-cigarettes and combustible cigarettes. Confirmatory factor analysis with covariates was applied to explain perceived health changes due to e-cigarette-only use and dual use.

RESULTS

Dual users (17.6%) were significantly more likely to report AEs of vaping than e-cigarette-only users (26.2% vs. 11.8%, p < 0.001). Experiencing health improvements were significantly more likely among e-cigarette-only users than for dual users for all surveyed physiological functions. E-cigarette-only users reported larger effects of vaping on sensory, physical functioning, and mental health factors compared to dual users. Self-reported changes in sensory and physical functioning were significantly higher among individuals using e-cigarettes more than a year and people who were past heavy smokers (smoked ≥20 cigarettes per day). Gender was related to sensory improvement only; males reported greater improvement than females.

CONCLUSIONS

The majority of e-cigarette-only users reported more perceived beneficial changes in physiological functions and fewer AEs than dual users. Perceived short-term benefits of e-cigarette use may reinforce users despite the uncertainty of long-term health consequences. Health professionals should provide balanced information regarding the possible short- and long-term positive and negative health effects of e-cigarette use during consultations with patients.

Management of Central Giant Cell Granulomas of the Jaws: An Unusual Case Report with Critical Appraisal of Existing Literature

Central giant cell granuloma (CGCG) is an uncommon, benign but aggressive osteolytic neoplasm of the craniomaxillofacial region, histologically characterized by an abundance of evenly distributed multinucleated giant cells within a sea of spindle-shaped mesenchymal stromal cells, scattered throughout the fibrovascular connective tissue stroma containing areas of hemorrhage. A rapid diagnostic assessment, together with an adequate histopathologic verification, is essential to improve the management and the prognosis of this locally destructive lesion. A rare case of a large destructive CGCG involving the entire right angle of mandible, causing extensive bony resorption, and buccal, medial as well as inferior border cortical expansion with multiple perforations, in a young child is presented. It was treated successfully by enucleation and aggressive curettage followed by peripheral ostectomy preserving the continuity of the mandible. Two adjunctive measures were employed; first, chemical cauterization of the residual bony walls to prevent possible recurrence, for which this tumor is notorious, and second, placement of fresh autologous platelet-rich fibrin within the bony defect to hasten bone fill and reossification, thus obviating the need for a bone graft.

From Mouth to Brain: Neuroendocrine Markers Play as a Crosstalk Among Oral and Neurodegenerative Diseases

The neuroendocrine system consists of various cells distributed in non-endocrine functional structures, able to synthesize amines and peptides with both local (paracrine) and systemic (endocrine) effects. The presence of such cells, belonging to the neuroendocrine system, is highlighted by the presence of neuroendocrine markers: the most suggestive are chromogranin A, synaptophysin, S-100B protein and glial fibrillary acidic protein. The presence of neuroendocrine markers is commonly associated to the occurrence of neuroendocrine cancers, currently representing the 0.5 percent of all malignant tumors. Nevertheless, neuroendocrine markers have been found to be overexpressed in rare oral neuroendocrine tumors, but also in quite common inflammatory conditions, such as severe periodontitis. The monitoring of neuroendocrine markers is, thus, a common factor of interest among dentistry and neurology: the analysis of neuroendocrine markers in oral diseases may be predictive and prognostic about the severity of neurological diseases, such as lateral amyotrophic sclerosis and traumatic brain injuries. The aim of this mini-review is to highlight the role of neuroendocrine molecules as advantageous diagnostic and prognostic markers for both oral diseases and neurodegenerative disorders.

Effect of Platelet-rich Plasma on Implant Bone Defects in Rabbits Through the FAK/PI3K/AKT Signaling Pathway

Platelet-rich plasma (PRP) has been shown to be a beneficial growth factor for bone tissue healing and is used in implantology. The aim of this study was to investigate the effects of PRP on bone defects in rabbits. Twenty rabbits were used to establish the implant bone defect model in this study. An intrabony defect (5mm × 5mm × 3mm) was created in alveolar bone in the lower jar of each rabbit. The wound was treated with PRP. The expression of platelet-derived growth factor BB (PDGFBB) was assessed by enzyme-linked immunosorbent assay (ELISA). Focal adhesion kinase (FAK) and related phosphatidylinositol 3-kinase (PI3K)/AKT (protein kinase B) levels were measured by Western blot. The results show that PRP could significantly improve the bone healing process when compared with control, and 10% PRP could markedly increase fibroblast proliferation 48-h post treatment. PDGFBB was higher in the PRP group than that in the control group. PRP treatment also could elevate the phosphorylation of FAK and PI3K/AKT, although the inhibitor of PDGFR could reverse this trend. These results suggest that PRP treatment improves the bone healing process through the FAK/PI3K/AKT pathway.

Concentric Ring Probe for Bioimpedance Spectroscopic Measurements: Design and Ex Vivo Feasibility Testing on Pork Oral Tissues

Many oral diseases, such as oral leukoplakia and erythroplakia, which have a high potential for malignant transformations, cause abnormal structural changes in the oral mucosa. These changes are clinically assessed by visual inspection and palpation despite their poor accuracy and subjective nature. We hypothesized that non-invasive bioimpedance spectroscopy (BIS) might be a viable option to improve the diagnostics of potentially malignant lesions. In this study, we aimed to design and optimize the measurement setup and to conduct feasibility testing on pork oral tissues. The contact pressure between a custom-made concentric ring probe and tissue was experimentally optimized. The effects of loading time and inter-electrode spacing on BIS spectra were also clarified. Tissue differentiation testing was performed for ex vivo pork oral tissues including palatinum, buccal mucosa, fat, and muscle tissue samples. We observed that the most reproducible results were obtained by using a loading weight of 200 g and a fixed time period under press, which was necessary to allow meaningful quantitative comparison. All studied tissues showed their own unique spectra, accompanied by significant differences in both impedance magnitude and phase (p ≤ 0.014, Kruskal-Wallis test). BIS shows promise, and further studies are warranted to clarify its potential to detect specific pathological tissue alterations.

Regulation of PKCβ levels and autophagy by PML is essential for high-glucose-dependent mesenchymal stem cell adipogenesis

BACKGROUND/OBJECTIVES

Obesity is a complex disease characterized by the accumulation of excess body fat, which is caused by an increase in adipose cell size and number. The major source of adipocytes comes from mesenchymal stem cells (MSCs), although their roles in obesity remain unclear. An understanding of the mechanisms, regulation, and outcomes of adipogenesis is crucial for the development of new treatments for obesity-related diseases. Recently an unexpected role for the tumor suppressor promyelocytic leukemia protein (PML) in hematopoietic stem cell biology and metabolism regulation has come to light, but its role in MSC biology remains unknown. Here, we investigated the molecular pathway underlying the role of PML in the control of adipogenic MSC differentiation.

SUBJECTS/METHODS

Muscle-derived stem cells (MDSCs) and adipose-derived stem cells (ADSCs) obtained from mice and voluntary patients (as a source of MSCs) were cultured in the presence of high glucose (HG) concentration, a nutrient stress condition known to promote MSCs differentiation into mature adipocytes and the adipogenic potential of PML was assessed.

RESULTS

PML is essential for a correct HG-dependent adipogenic differentiation, and the enhancement of PML levels is fundamental during adipogenesis. Increased PML expression enables the upregulation of protein kinase Cβ (PKCβ), which, in turn, by controlling autophagy levels permits an increase in peroxisome proliferator-activated receptor γ (PPARγ) that leads the adipogenic differentiation. Therefore, genetic and pharmacological depletion of PML prevents PKCβ expression, and by increasing autophagy levels, impairs the MSCs adipogenic differentiation. Human ADSCs isolated from overweight patients displayed increased PML and PKCβ levels compared to those found in normal weight individuals, indicating that the PML-PKCβ pathway is directly involved in the enhancement of adipogenesis and human metabolism.

CONCLUSIONS

The new link found among PML, PKCβ, and autophagy opens new therapeutic avenues for diseases characterized by an imbalance in the MSCs differentiation process, such as metabolic syndromes and cancer.

Optimal Load for Bone Tissue Scaffolds with an Assigned Geometry

Thanks to the recent advances of three-dimensional printing technologies the design and the fabrication of a large variety of scaffold geometries was made possible. The surgeon has the availability of a wide number of scaffold micro-architectures thus needing adequate guidelines for the choice of the best one to be implanted in a patient-specific anatomic region. We propose a mechanobiology-based optimization algorithm capable of determining, for bone tissue scaffolds with an assigned geometry, the optimal value L_opt of the compression load to which they should be subjected, i.e. the load value for which the formation of the largest amounts of bone is favoured and hence the successful outcome of the scaffold implantation procedure is guaranteed. Scaffolds based on hexahedron unit cells were investigated including pores differently dimensioned and with different shapes such as elliptic or rectangular. The algorithm predicted decreasing values of the optimal load for scaffolds with pores with increasing dimensions. The optimal values predicted for the scaffolds with elliptic pores were found higher than those with rectangular ones. The proposed algorithm can be utilized to properly guide the surgeon in the choice of the best scaffold type/geometry that better satisfies the specific patient requirements.

About stem cell research in dentistry: many doubts and too many pitfalls still affect the regenerative dentistry

Stem cells (SCs) research is one of the most promising approaches to regenerative medicine. Our understanding of SCs biology and their potential role in tissue repairing has notably increased during the last few years. Mesenchymal stem cells (MSCs) are present in almost all human tissues, including oral and dental tissues (dental-derived stem cells or DDSCs). Despite many doubts and too many pitfalls still affect regenerative dentistry; however, it represents an exciting challenge for the next generations of young dentists. Educating and training in regenerative medicine the new generation of researchers is of utmost importance, albeit often underestimated: regenerative dentistry represents a big opportunity for the next generations of researchers and clinicians, and this review report underlines that dental schools should pay more attention to teachings of strategic subjects, such as cell biology, molecular biology and tissue engineering.

Treatment of diabetic foot ulcers with Therapeutic Magnetic Resonance (TMR®) improves the quality of granulation tissue

Diabetic foot ulcers (DFUs) often result in severely adverse outcomes, such as serious infections, hospitalization, and lower extremity amputations. In last few years, to improve the outcome of DFUs, clinicians and researchers put their attention on the application of low intensity pulsating electro-magnetic fields through Therapeutic Magnetic Resonance (TMR®). In our study, patients with DFUs have been divided into two groups: The Sham Group treated with non-functioning TMR® device, and the Active Group treated with a functioning device. Biopsies were recovered from ulcers before and after a 15-day treatment with both kind of TMR® device. To recognize signs of inflammation or healing process, the harvested biopsies were subjected to histological and molecular analyses. The histological analysis showed a change in cell population after treatment with TMR®: an increase of fibroblasts and endothelial cells with a reduction of inflammatory cells. After TMR® application, the gene expression profile analysis revealed an improvement in extracellular matrix components such as matrix metalloproteinases, collagens and integrins, a reduction in pro-inflammatory interleukins, and an increase in growth factors expression. In conclusion, our research has identified histological and molecular features of reduced inflammation and increased cell proliferation during the wound healing process in response to TMR® application.

Retrospective Analysis of the Correlation Between the Facial Biotype and the Inclination of the Upper Canine Cusp Axis to the Occlusal Plane

Permanent maxillary canines are the second most frequently impacted teeth and the prevalence of this clinical condition is estimated to be 1-2% in the general population. The diagnosis of maxillary canine impaction should be based on both clinical and radiographic examinations. The aim of this study was to evaluate the presence of a correlation between the facial biotype and the inclination of the upper cusp axis. A correlation between the total radicular length of the lateral incisors was also evaluated, by comparing the side of impaction with the healthy side. Twenty three patients with a diagnosis of unilateral upper cusp impaction were recruited. For each patient, dental casts and radiographic material (panoramic radiographs and lateral cephalograms) were examined. Statistical analyses were done with Spearman's rank correlation coefficient or Spearman's rho (ρ). X-ray examinations demonstrated that canine impaction was associated to other dental anomalies (32% of the sample). The mean α angle measurements were 22.9° ± 4.1°, and mean values of the β angle were 34.7°± 4.0°. The mean distance "d" value was 14.6 mm ± 1.2 mm. The mean values of the angle between the upper cusp axis and the perpendicular-to-Fh plane were 20.8° ± 2.6°. Among the 23 subjects recruited, 5 showed values included in the range 25°-45° and 1 an inclination > 45°. The results obtained in the present study demonstrate a significant inverse correlation between the MM angle and the inclination of the upper cusp axis to the perpendicular-to-Fh plane.

Influence of legislations and news on Indian internet search query patterns of e-cigarettes

BACKGROUND

There is a paucity of data on the use of electronic nicotine delivery systems (ENDS) in India. In addition, the Indian internet search pattern for ENDS has not been studied. We aimed to address this lacuna. Moreover, the influence of the tobacco legislations and news pieces on such search volume is not known. Given the fact that ENDS could cause oral lesions, these data are pertinent to dentists.

METHODS

Using a time series analysis, we examined the effect of tobacco-related legislations and news pieces on total search volume (TSV) from September 1, 2012, to August 31, 2016. TSV data were seasonally adjusted and analyzed using time series modeling. The TSV clocked during the month of legislations and news pieces were analyzed for their influence on search pattern of ENDS.

RESULTS

The overall mean ± standard deviation (range) TSV was 22273.75 ± 6784.01 (12310-40510) during the study with seasonal variations. Individually, the best model for TSV-legislation and news pieces was autoregressive integrated moving average model, and when influence of legislations and news events were combined, it was the Winter's additive model. In the legislation alone model, the pre-event, event and post-event month TSV was not a better indicator of the effect, barring for post-event month of 2^nd legislation, which involved pictorial warnings on packages in the study period. Similarly, a news piece on Pan-India ban on ENDS influenced the model in the news piece model. When combined, no "events" emerged significant.

CONCLUSIONS

These findings suggest that search for information on ENDS is increasing and that these tobacco control policies and news items, targeting tobacco usage reduction, have only a short-term effect on the rate of searching for information on ENDS.