Tooth Abnormalities and Their Age-Dependent Occurrence in Leukemia Survivors

The multidrug nature of anticancer treatment and different treatment protocols used in the studies are likely to be a major limitation in establishing real risk factors determining the occurrence of dental abnormalities. The authors aimed to establish a relationship between the duration and the dose of chemotherapy and the number of tooth adverse effects in the group receiving the same treatment. Of the 40 anticancer therapy recipients who attended the outpatient dental clinic, 7 leukemia survivors receiving the treatment according to the ALL IC-BFM 2002 protocol were selected. The study group consisted of four females and three males aged 92 to 207 months at the time of dental examination and 29 to 91 months at leukemia diagnosis. As a result of the clinical and radiological examination, dental abnormalities such as agenesis, tooth size reduction, root abnormalities, and taurodontia were identified, and the medical records of all survivors were reviewed in terms of drugs administered, their doses, and treatment schedules. No correlation was observed between the treatment duration of an intensive therapy, the entire therapy, and the number of tooth abnormalities. No relationship was also found between the number of dental abnormalities and the cumulative dose of vincristine, L-asparaginase, methotrexate, cyclophosphamide, cytarabine, and 6-mercaptopurine. The age at the onset of antineoplastic therapy is likely to be the strongest risk factor for toxic injury during tooth development.

Molar incisor hypomineralisation – aetiological factors and clinical manifestation

Molar incisor hypomineralisation is described as enamel hypomineralisation of systemic origin involving the first permanent molars. It is also often associated with damage to permanent incisors, which undoubtedly have an important function during developmental age. It is estimated that permanent incisors are involved in approximately 30% of patients with molar incisor hypomineralisation. Early diagnosis of molar incisor hypomineralisation, implementation of appropriate treatment and knowledge of the factors that may contribute to this disorder can reduce the risk of loss of the affected teeth. The aetiology of the disorder has not been fully established. Many studies have shown correlations between molar incisor hypomineralisation and a particular aetiological factor. Research is underway to narrow down this area of consideration, as the aetiology identified to date is very extensive and multifactorial. Both genetic, epigenetic and environmental factors influence the onset of molar incisor hypomineralisation. In the large latter group, a particular role in the aetiology of the disorder is attributed to maternal viral infections during pregnancy, as well as chronic maternal diseases such as hypertension or diabetes, maternal use of certain medications during pregnancy, perinatal complications and diseases of early childhood. Many studies indicate that genetic factors and endocrine disturbances are the most important predisposing factors for molar incisor hypomineralisation. This paper discusses the diagnostic challenges and the most likely aetiological factors of molar incisor hypomineralisation investigated to date.

Systemic Anticancer Therapy Details and Dental Adverse Effects in Children

An idea of therapy intensification in order to make anticancer treatment more effective is still being investigated. The study aimed to estimate the impact of the chemotherapy dose levels and treatment duration on the risk for dental development disturbance. The clinical examination and OPG analysis were carried out in 37 cancer survivors and germ agenesis, microdontia, size reduction, taurodontism, root and enamel abnormalities were identified. An analysis of anticancer treatment was carried out separately for vincristine (VCR), doxorubicin (DXR), cyclophosphamide (CP), etoposide (VP-16), carboplatin (CBDCA) and actinomycin D (ACTD) recipients in terms of treatment duration and drug doses administered. Individuals aged between three years and ten months, and seven years and four months, at diagnosis presented with no severe dental abnormalities, regardless of treatment duration and increasing cytotoxic drug doses. The largest number of abnormalities per one person was noted in the survivors treated with the highest single doses of VCR, DXR, CP and ACTD. No similar observation was made in the cases of cumulative and weekly doses analyzed. Moreover, there were no significant differences between the mean number of abnormalities across all the drug groups.

Duration and dose of chemotherapy and dental development

BACKGROUND

Given the susceptibility of developing tissues to drugs, even small doses of anticancer drugs may affect odontogenesis. Although any toxic effect is transient, the treatment regimens are based on repeated drug administration.

OBJECTIVES

The study aimed to establish the impact of antineoplastic therapy on the occurrence of longterm adverse dental effects in a dose-dependent manner in young survivors treated for cancer before 10 years of age.

MATERIAL AND METHODS

In total, 37 cancer survivors treated with antineoplastic therapy before 10 years of age underwent a dental examination with a thorough analysis of panoramic radiographs. A total of 236 teeth with 243 different developmental abnormalities were revealed in 28 survivors. Agenesis, tooth size reduction, taurodontia, and enamel and root abnormalities were diagnosed. All survivors received multi-agent chemotherapy, with the most frequently used drugs being vincristine (VCR), doxorubicin (DXR), cyclophosphamide (CP), ifosfamide (IF), etoposide (VP-16), carboplatin (CBDCA), cisplatin (CDDP), and actinomycin-D (ActD). A detailed analysis of medical records was also performed to assess the relationship between the treatment duration as well as the cumulative drug dose administered and the occurrence of particular disturbances.

RESULTS

When analyzing the treatment duration and the drug doses in the affected and non-affected participants, there were no statistically significant differences between the survivors with different disturbances within most of the specific drug groups. In some groups, the mean cumulative treatment dose was significantly higher in the non-affected patients. According to Spearman's rho, no significant relationships were observed.

CONCLUSIONS

In the present study, no significant differences in terms of treatment duration or drug doses were observed between the patients with particular abnormalities. The developmental stage of tooth formation during chemotherapy is likely the most important factor influencing dental changes. For future research with respect to different treatment protocols, an analysis of a more homogenous group of survivors is warranted.

Intramuscular Injections and Dry Needling within Masticatory Muscles in Management of Myofascial Pain. Systematic Review of Clinical Trials

Background: Myofascial pain is an important cause of disability among the whole population, and it is a common symptom of temporomandibular joint disorders (TMDs). Its management techniques vary widely; however, in recent years, there has been a growing interest especially in needling therapies within masticatory muscles, due to their simplicity and effectiveness in pain reduction. Methods: The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was conducted based on the PubMed and BASE search engines. Searching the abovementioned databases yielded a total of 367 articles. The screening procedure and analysis of full texts resulted in the inclusion of 28 articles for detailed analysis. Results: According to analyzed data, clinicians manage myofascial pain either with wet or dry needling therapies. The most thoroughly studied approach that prevails significantly within the clinical trials is injecting the botulinum toxin into the masseter and temporalis. Other common methods are the application of local anesthetics or dry needling; however, we notice the introduction of entirely new substances, such as platelet-rich plasma or collagen. In the analyzed articles, the target muscles for the needling therapies are most commonly localized by manual palpation although there are a variety of navigational support systems described: EMG, MRI or EIP electrotherapy equipment, which often aid the access to located deeper lateral and medial pterygoid muscle. Conclusions: Needling therapies within masticatory muscles provide satisfactory effects while being simple, safe and accessible procedures although there still is a need for high quality clinical trials investigating especially injections of non-Botox substances and needling within lateral and medial pterygoid muscles.

Sleep Bruxism in Children: Etiology, Diagnosis, and Treatment-A Literature Review

(1) Background: Bruxism, a condition characterized by grinding and involuntary clenching of the teeth, is a risk factor for the development of masticatory dysfunction. It can occur together with sleep disturbances and may be associated with abnormal body movements, breathing difficulties, increased muscle activity, and heart rate disturbances. This disorder is becoming an important dental concern in children. (2) Methods: A literature review was carried out based on a search in PubMed and Google Scholar databases for articles on bruxism in children, published between 2014 and 2021. The etiology, diagnosis, and treatment of bruxism in children were of particular interest in the study. (3) Results: A total of 40 articles were included in the review. The analyzed studies indicated that the prevalence rates of bruxism in children vary widely from 13% to 49%. The etiology of bruxism is complex and incomprehensible, and the main diagnostic criteria for this condition in children are subjective observation, clinical history, and clinical examination. The recommended therapy for sleep bruxism in children is physiotherapy and psychotherapy. (4) Conclusions: Dentists and primary care physicians should correctly diagnose bruxism in children, educate parents, prevent potential consequences for oral health, and identify possible comorbidities. Appropriate clinical guidelines for the treatment and prophylaxis of bruxism in children should also be developed.

The effect of simulated erosive conditions on the frictional behavior of different orthodontic bracket-wire combinations

BACKGROUND

Frictional resistance is an important parameter in orthodontics that influences the effectiveness of archwire-guided tooth movement. Since the consumption of dietary acids has increased considerably over the last 2 decades, there is a rationale for investigating the process of degradation of orthodontic materials in an acidic environment and its effect on clinical efficiency.

OBJECTIVES

The aim of this study was to evaluate the effect of simulated erosive conditions on the frictional behavior between the brackets of 3 different materials and 3 different wire alloys.

MATERIAL AND METHODS

Three types of twin orthodontic brackets (stainless steel (SS), monocrystalline ceramic and titanium) and 3 types of archwires of the same dimension (SS, nickel-titanium (Ni-Ti) and beta-titanium (titanium-molybdenum alloy - TMA) were tested in 9 different combinations under simulated erosive and non-erosive conditions (18 groups, n = 10). Bracket-wire specimens in the erosivecondition groups were subjected to a pH cycling regimen with 1% citric acid and artificial saliva for 5 consecutive days. Bracket-wire specimens from the non-erosive-condition groups were incubated only in artificial saliva for 5 days. Static and kinetic friction were determined by measuring the force needed to move the wire through the bracket. A three-way analysis of variance and pairwise comparisons with the Student-Newman-Keuls test were performed.

RESULTS

Irrespective of the conditions, SS brackets with SS wire demonstrated significantly lower mean static and kinetic frictional resistance than other bracket-wire combinations (p < 0.01). Ceramic and titanium brackets generated high frictional forces with all 3 types of wire tested. Erosive conditions did not significantly influence static and kinetic frictional resistance in all bracket-wire groups.

CONCLUSIONS

Erosive conditions do not affect the frictional behavior of SS, Ni-Ti and TMA orthodontic archwires at a clinically significant level.

Systemic sclerosis and its oral health implications

Systemic sclerosis (SSc) is a chronic, generalized disorder of the connective tissue. It is characterized by immune disorders, abnormalities of morphology and functions of small blood vessels, and the presence of inflammatory process. The pathogenesis of this disorder has not yet been fully understood. The classification criteria were established by The American College of Rheumatology (ACR). A number of clinical types are distinguished due to the diversity of the clinical picture. These types are characterized by a different course, presence of organ complications and prognosis. Connective tissue disorders are interdisciplinary conditions and, therefore, the subject of interest of different medical specialties, including dentistry. The oral cavity may be the place of pathological manifestations within soft and hard tissues. Such manifestations are the results or the primary symptom of systemic diseases. The relationship between the health of the oral cavity and systemic diseases has been frequently reported in the literature. Lesions in the oral cavity in patients with SSc are discussed in detail in the present paper. Management includes the administration of drugs that prevent tissue ischemia and post-ischemic consequences as well as drugs that inhibit inflammatory-immune processes and excessive collagen production.

Diseases of the oral cavity in light of the newest epigenetic research: Possible implications for stomatology

Epigenetics is the study of inheritable changes in gene expression without changes in the underlying deoxyribonucleic acid (DNA) sequence. The main mechanisms of epigenetic regulation include DNA methylation, modifications in histones, and micro-ribonucleic acids (miRNA). Recent research evidence has shown that environmental and lifestyle factors dynamically interact with the genome, influencing epigenetic changes, from development to the later stages of life. This happens across a spectrum, from physiological to pathological conditions, such as genetic defects, developmental disorders, infectious or inflammatory processes, cancers, mental disorders, and substance abuse. Epigenetic studies have been conducted in various medical disciplines (e.g., oncology, internal medicine or psychiatry), adding valuable insight to standard medical approaches. However, in stomatology, epigenetic research is still in its infancy; thus, this review is aimed at presenting the role of epigenetic mechanisms in diseases of the oral cavity, including periodontal diseases, caries, developmental anomalies, and oral carcinoma. In addition, this paper reveals new insights into epigenetic biomarkers that can be helpful in the detection, early diagnosis, prognosis, and treatment of different oral diseases. Moreover, this review is focused on the possible clinical implications (diagnostic and therapeutic) of epigenetics, in the form of some noninvasive methods that can possibly be used in the future for the screening, work-up, outcome prediction and novel treatments of some dental diseases. Finally, this paper highlights that an epigenetic approach can be useful for designing novel interventions that will improve the management of oral malignancies or developmental abnormalities.

Microdontia after chemotherapy in a patient treated for neuroblastoma: Histopathological findings

Microdontia is one of the late effects of antineoplastic therapy in children. This study is based on the comparative histological examination of abnormal, peg-shaped premolars, erupted in a patient treated for neuroblastoma, and of non-affected teeth, extracted in a healthy child. Apart from the size, the teeth vary in tissue morphology. The number of dentinal tubules, dependent on the number of odontoblasts, is smaller in the microdontal sample when observation in the same-sized field of view is conducted. Moreover, the youngest, more than 100-micrometer-thick layer of the microdontal dentin seems to be the secondary dentin, with crispy-shaped tubules and empty spaces between them. No irregular dentin is deposited in the samples of physiologically developed teeth. The structure of cementum is different as well. Unlike regularly shaped premolars, in which typical 2-layer tissue is seen, in sections of microdontal teeth, only acellular tissue with cementoblasts overlying its surface is present. Thorough analysis of drug administration effects, which are visible in microscopic sections, and of time of anticancer treatment could provide insight into the developmental mechanisms of tooth germ formation.

TEGDMA and UDMA monomers released from composite dental material polymerized with diode and halogen lamps

BACKGROUND

More than 35 substances released from composite fillings have been identified. Among these, basic monomers and the so-called co-monomers are most often reported. The substances released from polymer-based materials demonstrate allergenic, cytotoxic, genotoxic, mutagenic, embryotoxic, teratogenic, and estrogenic properties.

OBJECTIVES

The aim of this study was to measure the amounts of triethylene glycol dimethacrylate (TEGDMA) and urethane dimethacrylate (UDMA) monomers released from composite dental fillings to citrate-phosphate buffer with the pH of 4, 6, 8 after 24 h and 6 months from the polymerization.

MATERIAL AND METHODS

Ten samples for each polymerization method had been made from the composite material (Filtek Supreme XT, 3M ESPE, St. Paul, USA), which underwent polymerization using the following lamps: halogen lamp (Translux CL, Heraeus Kulzer, Hanau, Germany) (sample H) and diode lamp (Elipar Freelight 2, 3M ESPE), with soft start function (group DS) and without that function (group DWS).

RESULTS

It has been demonstrated that the type of light-curing units has a significant impact on the amount of TEGDMA and UDMA released. The amount of UDMA and TEGDMA monomers released from composite fillings differed significantly depending on the source of polymerization applied, as well as the pH of the solution and sample storage time.

CONCLUSIONS

Elution of the monomers from composite material polymerized using halogen lamp was significantly greater as compared to curing with diode lamps.

Factors affecting the outcomes of direct pulp capping using Biodentine

Introduction

This study aimed to evaluate the prognostic value of factors with regard to the treatment outcome of direct pulp capping using Biodentine (Septodont, Saint-Maur-des-Fossés, France), in permanent teeth in which the pulps were exposed during caries removal.

Methods

Between 2010 and 2014, 112 teeth with deep carious lesions underwent direct pulp capping. The patients were followed up at 2–3 months and 1–1.5 years with a routine examination on both recall visits. Periapical radiographs were taken at 1–1.5 years. Lack of patient complaints, positive reactions to cold and electric testing, no sensitivity to percussion, and no widening of the periapical ligament indicated success. The Fisher exact test was used for statistical analysis. The significance level was P = .05.

Results

Eighty-six teeth were available for 1–1.5 years follow-up. The overall success rate was 82.6%. Only age had a significant effect on the pulpal survival rate: the success rate was 90.9% in patients younger than 40 years and 73.8% in patients 40 years or older (P = .0480). Sex, initial or secondary caries treatment, occlusal or cervical/proximal caries, delayed placement of permanent filling, tooth position, and arch type did not influence the outcome.

Conclusions

A patient’s age influenced the outcome of direct pulp capping using this new calcium silicate cement.

Clinical relevance

Asymptomatic vital permanent teeth with cariously exposed pulp can be treated successfully by direct pulp capping using Biodentine.

Possible ways of reducing dental erosive potential of acidic beverages

Frequent consumption of acidic beverages is related to excessive tooth wear, namely dental erosion. Preventive measures may involve reduction or elimination of acidic drink consumption. However, the success of this approach is difficult to achieve as it is highly dependent on patient compliance. Therefore, a practical way of minimizing the erosive potential of popular acidic drinks may be their chemical modification. The aim of this article was to review the different methods of modification and their shortcomings. The available literature demonstrates that the erosive potential of most acidic beverages could be reduced. To date, the effectiveness of soluble calcium salts supplementation is the best established. However, modification can reduce the sensorial quality of the drink and shorten its shelf-life. There is also a need to evaluate the lowest effective and safe dose of the additive.

[The association between oral diseases and stroke]

In recent years there have been many studies concerning the effect of periodontal disease on the vascular system, including the development of stroke, either ischemic or hemorrhagic. The aim of this study was to present the relationship between periodontal disease and stroke based on the available literature. As it is evident from studies, patients with periodontal disease are predisposed to the formation of chronic systemic inflammation, which in turn is a risk facto for cardiovascular diseases, particularly diseases of the large vessels, including atherosclerosis, as well as chronic inflammation in the atherosclerotic plaque Atherosclerosis is a recognized risk factor for stroke. Current knowledge indicates the relationship between periodontal inflammation and stroke. Periodonta diseases are considered as an independent risk factor for vascular disease of the brain. Therefore, the prevention of periodontal disease is important, also early detection and treatment. Dental care should be an essential element of primary and secondary prevention of vascular events of central nervous system.

Concentrations of metals in maxilla and mandible deciduous and permanent human teeth

The study shows the results of research on the concentrations of metals (Cd, Pb, Mn, Cu, Cr, Fe, Zn, Na, K, Mg, and Ca) in deciduous and permanent teeth with respect to their location in the oral cavity (maxilla, mandible). It has been found that the concentrations of metals were significantly higher in the deciduous teeth than in permanent ones. Regression analysis and principal component analysis revealed an increased dynamics of the processes of binding the elements by the hydroxyapatite of deciduous teeth. Higher concentrations of the metals were found in the maxilla permanent and deciduous teeth than in the mandible ones.