Intraoral Environment Research Articles

Regular Smoking Accelerates the Decline in Masticatory Performance in Japanese Men: The Suita Study.

Smoking is presumed to cause a decline in masticatory performance by worsening the intraoral environment in various ways. However, no longitudinal study has examined the relationship between smoking and masticatory performance. To clarify how smoking affects future decline in masticatory performance through a 5-year follow-up study of a general urban population. The study participants were 494 men (mean age at baseline: 65.8 years) who participated in baseline and follow-up dental examinations in the Suita Study. The masticatory performance of the participants was evaluated using a test gummy jelly. The rate of change in masticatory performance during the follow-up period was calculated by subtracting the masticatory performance at baseline from the masticatory performance at follow-up and dividing this by the masticatory performance at baseline. Logistic regression analysis was performed, with the presence or absence of a decline in masticatory performance as the objective variable and age at baseline, number of functional teeth, periodontal status, salivary flow rate, maximum bite force, smoking status, utilisation of dental services, and follow-up years as the explanatory variables. The rate of change in masticatory performance during the follow-up period was significantly higher in smokers than in non-smokers. Logistic regression analysis showed that age, maximum bite force, and smoking were significant explanatory variables for a decline in masticatory performance. A 5-year follow-up study showed that smoking causes a decline in masticatory performance in men, even after adjusting for confounding factors.

Dynamic Reconstruction of the Nickel Ions' Behavior in Different Orthodontic Archwires Following Clinical Application in an Intraoral Environment.

Rationale: Orthodontic archwires undergo chemical and structural changes in the complex intraoral environment. The present work aims to investigate the safe duration for intraoral use (related to the nickel release hypothesis) of different types of nickel-containing wires. By analyzing how the nickel content (NC) varies over time, we aim to provide practical recommendations for the optimal use of said archwires. Materials and Methods: Our analysis focuses on the following nickel-containing archwires: stainless steel, Ni-Ti superelastic, heat-activated NiTi and CuNiTi, and multi-force archwires. The studied archwires of each type were divided into three groups: group 1, as received; group 2, retrieved after intraoral exposure for less than 6 weeks; group 3, used for more than 8 weeks. To assess NC, measurements using scanning electron microscopy (SEM), energy-dispersive X-ray (EDX), and laser-induced breakdown spectroscopy (LIBS) were performed in multiple regions of each wire. Statistical analysis of the measured values using one-way ANOVA and multiple group comparisons showed significant differences in nickel content between groups. The dynamic behavior of the statistical results for NC was then modeled using logistic regression and fitted with cubic splines. Conclusions: The proposed behavior model, with further refinement, could enable orthodontists to make informed, patient-specific decisions regarding the safe and effective use of orthodontic floss. The overall conclusion of the study is that due to stability, SS-CrNi, HA-Ni-Ti with Cu, and TriTaniumTM are suitable for long-term use, and due to higher nickel release, Ni-Ti-Superelastic, HA-Ni-Ti without Cu, and Bio-ActiveTM are better for short- to medium-term use.

Influence of thermal-cycling or staining medium on the surface properties and color stability of conventional, milled, and 3D-printed base materials

The study of denture base resin fabricated by digital technology with surface properties or color stability remains limited. In this study, thermal cycling and staining media (distilled water, artificial saliva, green tea, and Coca-Cola) immersion were used to simulate the intraoral environment to assess the surface properties and color stability of CAD/CAM (milled) and 3D-printed base resin materials, the conventionally polymerized base served as the control group. After thermal cycling, all groups showed increased surface roughness, contact angle (i.e. hydrophilicity) and color difference (∆E), the 3D-printed group had the most significant increase among the 3 groups (P<0.001). While there were no significant difference (or the difference is very small) between the conventional and milled groups. After 7 and 30 days of immersion in four staining media, the ∆E values remained highest in the 3D-printed group (∆E ≥ 3.34) (P<0.001), exceeding the clinically acceptable threshold (∆E = 2.7) at 30 days. Additionally, all groups showed significantly higher ∆E values after 30 days compared to 7 days (P<0.05). The 3D-printed group exhibited a rougher surface, poorer hydrophilicity, and reduced color stability compared to the conventional or milled groups, indicating that further improvements are needed before clinical application.

Digital Simulation and Designing of a Novel Osteotomy Guide for Autotransplantation in the Anterior Region.

Autotransplantation of teeth (ATT) is a viable treatment option for replacing teeth lost due to various reasons. Periodontal ligament (PDL) on the donor tooth is one of the most crucial factors determining the success of ATT. To preserve the PDL during surgery and improve the success rate of ATT, digital dentistry has been applied to ATT. In this article, a digital workflow including surgical simulation, a three-dimensional (3D) replica fabrication, and a novel osteotomy guide design is introduced. Digital simulation of ATT on a patient's integrated model enables visualization of anatomical structures and the 3D position of the donor tooth prior to the actual surgery. The 3D-printed osteotomy guide allows the transfer of the direction and depth of the planned osteotomy into the intraoral environment. The 3D replica helps prepare the recipient site before the actual transplantation, which minimizes the extra-alveolar time of the donor tooth and decreases trauma during the try-in process. The proposed virtual planning and the use of the guide and the 3D replica can facilitate the surgical procedures while minimizing complications.

A scanning electron microscope evaluation of surface roughness of different clear aligners – A comparative in-Vitro study

Clear aligner are thermoplastic polyurethane materials which produces small increments of tooth movements by each aligner tray. Clinical effectiveness of the treatment largely depend on the mechanical properties of the material. The use of scanning electron microscopy (SEM) in invitro environment allows to evaluate the surface morphology of the aligners The aim of the study is to compare the surface roughness of different types of clear aligners after thermoforming and after invitro aging. A sample of 15 aligners from Group A (DURAN), Group B (ERKODUR), Group C (MONOFLEX) were taken for this study. After screening the subjects were scanned by intraoral scanner and STL file were imported to Maestero 3D software. Then resin models were printed and aligners were fabricated in the models by thermoforming machine. The first set of aligners were scanned by Scanning Electron Microscope and another set of aligners were placed in chewing simulator for simulating intraoral environment. Then the second set of aligners were sent for SEM evaluation. Mean comparison of surface roughness and root mean square surface roughness was compared by paired t test and comparison among the groups was done by one way ANOVA test. The surface roughness of both aligners increased after thermoforming. This could be due to thermoforming process which could be due to temperature variation. After the ageing of the aligners in the invitro environment, there is homogenous and smooth layer of the aligner surfaces which could be due to adhesion of biofilm and polishing effect by chewing strokes.

Molecular Genetic Analysis of Perioperative Colonization by Infection-Related Microorganisms in Patients Receiving Intraoral Microvascular Grafts.

Background/Objectives: In oral and maxillofacial surgery, the reconstruction of defects often involves the transfer of skin tissue into the oral cavity utilizing microvascular grafts. This study investigates postoperative changes in microbial colonization following intraoral microvascular transplantation, as well as potential influencing factors. Methods: In 37 patients undergoing intraoral reconstructions, pre- and postoperative swabs were taken from the donor and recipient regions to quantify the seven selected marker bacteria using TaqMan PCRs. Patient-specific factors and clinical data were also recorded. Results: The infection-associated Acinetobacter baumannii tended to decrease postoperatively, while the infectious pathogens Pseudomonas aeruginosa, Enterococcus faecalis and the family of Enterobacteriaceae showed a postoperative increase without being directly associated with a clinical infection. Streptococcus mitis showed a significant postoperative decrease on buccal mucosa and increase on the graft surface (oral dysbiosis) and was significantly reduced or displaced by other bacteria (e.g., Mycoplasma salivarium, positive selection) when treated with ampicillin/sulbactam. Conclusions: The cutaneous microbiome of the graft adapts to the local intraoral environment. Postoperative shifts in oral bacterial colonization and an increase in infection-relevant bacteria were observed. These perioperative changes in colonization are also influenced by the administration of ampicillin/sulbactam. Consequently, single doses of antibiotics appear to be more beneficial compared to longer-term preventive use.

Biocompatibility profile of aged pigmented and non-pigmented silicone elastomer for combined maxillofacial defects.

To assess the biocompatibility of platinum silicone elastomer A-2000 used in combined maxillofacial defects prosthesis, after being deteriorated by an accelerated aging process resembling both the extra and intraoral environment. This assessment was done indirectly on human-derived dermal and gingival tissues. One hundred eight samples of room-temperature vulcanized A-2000 platinum silicone were equally divided into extrinsically pigmented and non-pigmented groups to replicate combined maxillofacial defects. Accelerated aging was applied to pigmented samples to mimic extra- and intra-oral conditions, while non-aged counterparts served as controls. After isolating human cell lineages, dermal and gingival fibroblasts were indirectly exposed to silicone sample media. Cytotoxicity to cultured fibroblasts was assessed via MTT assay. Statistical significance was determined by repeated measures of one-way ANOVA (p < 0.01), evaluating cytotoxicity on dermal and gingival fibroblasts. MTT assay showed increased cytotoxicity in pigmented silicon samples subjected to extraoral aging compared to non-aged counterparts (p < 0.01). Non-pigmented silicon, modeling intraoral conditions, exhibited cytotoxicity after 48h (p < 0.05). Both aged and non-aged silicon extracts equally sensitized gingival fibroblasts at 72h (p < 0.001). Negative correlations between pigmented and non-pigmented silicon were observed in dermal cell growth (p > 0.05, except at 24h, r = 0.2), with accelerated aging showing minimal impact on the pigmentation effect (p > 0.05). The retrieved diminished cellular metabolic activity of platinum silicone elastomer was in an acceptable clinical range, pointing out the importance of periodic assessments of the maxillofacial prosthesis for replacement depending on aging and cytotoxic harmful cellular responses.

Analysing the mechanical behaviour of thermoformed dental clear aligners using acoustic emission technique

Clear aligners have been widely preferred in recent years for aesthetically pleasant orthodontic treatments. However, their efficacy in treating dental malposition and malocclusion is yet to be studied extensively. Clear aligners are mostly made from thermoplastic materials that guarantee sufficient elasticity while lowering the plastic deformations during their use. This is to guarantee a stable level of forces acting on teeth to be repositioned. This work aims to get insight into the mechanical behaviour of these devices during their period of use, by comparing aligners produced from two different thermoplastic materials: polyethylene terephthalate-glycol modified (PET-G) and polyurethane (PU) supplied by Dooris and Ghost Aligners, respectively. The aligners were subjected to cyclic compression loading, to simulate the swallowing act throughout 15 days of use. Tests were conducted by surrounding the aligners with artificial saliva to simulate the intraoral environment. The Acoustic Emission (AE) technique was used to analyse the damage progression in the aligners during the loading. Furthermore, the AE results were compared with the energy absorbed and the stiffness changes in the aligners. Finally, the damage evolution in the aligners post-loading was validated using optical microscopy. The AE results revealed a good correlation with mechanical and optical microscopy data, thus contributing to the understanding of the mechanical behaviour of the clear aligners.

In vitro evaluation of shape-memory hydrogels for removable dental prostheses and optimization of phase-transition temperature for intraoral use

Removable dental prostheses require periodic relining with the loss of intaglio surface fit because of mucosal shape changes over time. Therefore, a new material with high adaptability to tissue changes over time would be beneficial. This study focused on a shape-memory gel (SMG) that softens when heated, retains its shape when cooled, and returns to its original shape when reheated. The purpose was to optimize SMG for intraoral use by controlling the ratio of 2 acrylate monomers and to evaluate the changes in the shape memory and physical properties of SMG with temperature and to evaluate biocompatibility. SMG specimens were synthesized using the following mixing ratios of 2 monomers, docosyl acrylate (DA) and stearyl acrylate (SA): 0:100, 25:75, 50:50, 75:25, and 100:0. SMG specimens were photopolymerized using a fluorescent light-polymerizing unit. To evaluate shape memory as a function of temperature, permanent deformation was measured based on the standardized compression set test for thermoplastic rubber. For evaluation of the physical properties and cytotoxicity, a 3-dimensionally printed denture base material was used as the control material. All assessments were compared between the groups by using 1-way analysis of variance followed by the Tukey-Kramer multiple comparison test (α=.05). SMGs with a higher amount of DA maintained their compressed shape at room and intraoral temperatures. However, the SMG matrices softened and recovered their original shapes above 60°C. SMGs showed Shore A hardness equivalent to that of the denture-base polymer material at intraoral temperatures because of the high phase-transition temperature. The low water solubility of SMGs supported the biocompatibility test results. SMG, in which the phase-transition temperature was controlled by mixing acrylate monomers with different melting points, exhibited shape memory in the intraoral environment. The results indicate the feasibility of applying SMG for the fabrication of removable dental prostheses because of its high adaptability to tissue changes over time and biocompatibility.

Evaluation of Color Stability for Two Types of Denture Base Materials: Heat Cured Acrylic and Flexible Resin.

Commonly consumed beverages used by human being daily (Tea &amp; Cola) caused external staining. This study is done to evaluate the color stability for two different types of denture base materials against this external staining caused by (Tea &amp; Cola). Sixty (60) samples were prepared, divided into two groups, 30 samples of heat cure acrylic material &amp; 30 samples of flexible resin material (Valplast). Each group divided into three subgroups 10 samples in each, according to the type of staining solution that immersed in it, (synthetic saliva &amp; tea), (synthetic saliva &amp; Cola), and (synthetic saliva alone as a control). Tea &amp; Cola were mixed with synthetic saliva in order to create intraoral environment to certain extent. Color measurement was made at Baghdad University, Collage of Engineering, using reflected spectrophotometer before immersion (at baseline) &amp; after immersion, at intervals of (24 hours) &amp; (1 week) respectively. The result was a highly significant difference between, heat cure acrylic &amp; flexible resin a t baseline &amp; the (flexible samples) were the higher value in discol oration than (heat cure acrylic samples) regardless the type of s taining solution. Maximum discoloration was seen in (synthetic sal iva &amp; tea) solution for both denture base materials. Followed by (synthetic saliva &amp; Cola) &amp; (synthetic saliva alone) respectively . Both denture base mater ials had a color changes after immersion in staining solution (tea , Cola &amp; synthetic saliva). The color changes, for two materi als, were increased with the increase of immersion time.

A real-time interactive restoration system for intraoral digital videos using segment anything model.

Poor conditions in the intraoral environment often lead to low-quality photos and videos, hindering further clinical diagnosis. To restore these digital records, this study proposes a real-time interactive restoration system using segment anything model. Intraoral digital videos, obtained from the vident-lab dataset through an intraoral camera, serve as the input for interactive restoration system. The initial phase employs an interactive segmentation module leveraging segment anything model. Subsequently, a real-time intraframe restoration module and a video enhancement module were designed. A series of ablation studies were systematically conducted to illustrate the superior design of interactive restoration system. Our quantitative evaluation criteria contain restoration quality, segmentation accuracy, and processing speed. Furthermore, the clinical applicability of the processed videos was evaluated by experts. Extensive experiments demonstrated its performance on segmentation with a mean intersection-over-union of 0.977. On video restoration, it leads to reliable performances with peak signal-to-noise ratio of 37.09 and structural similarity index measure of 0.961, respectively. More visualization results are shown on the https://yogurtsam.github.io/iveproject page. Interactive restoration system demonstrates its potential to serve patients and dentists with reliable and controllable intraoral video restoration.

Dentin bond strength of resin luting agents under a simulated intra-oral environment

Dentin bond strength of resin luting agents under a simulated intra-oral environment

Bio-inspired nanocomposite coatings on orthodontic archwires with corrosion resistant and antibacterial properties.

The corrosion resistance and antibacterial properties of fixed orthodontic devices are insufficient in the complex oral cavity, which delays tooth movement and causes enamel demineralization. To overcome the challenges, this research constructs a series of polydopamine-graphene oxide (PDA-GO) nanocoatings on representative NiTi archwires via self-assembly. The morphology, chemical structure, and multifunctional properties of coatings showed tunability dependent on the PDA/GO ratio. Optimized PDA-GO coatings with uniform and dense characteristics prolonged the diffusion path for the corrosive medium and reduced Ni dissolution in NiTi alloys. Meanwhile, the applied coatings endowed NiTi alloys with antibacterial activity against Streptococcus mutans due to the surface structures and inherent properties of PDA-GO. In vitro cytotoxicity tests further verified their good biocompatibility. This bio-inspired nanocomposite coating provides a practical reference for modification of dental metal surfaces to better behave in the intraoral environment.

The effect of aging on the mechanical properties of 3-dimensional printed biocompatible resin materials used in dental applications: An in vitro study

The mechanical properties of biocompatible printable resin materials in an intraoral environment is still being investigated. This study aimed to assess the effect of the aging process on the mechanical properties of resin samples produced by stereolithography appearance (SLA) and digital light processing (DLP) 3-dimensional printer systems. The cylindrical sample (4.00 × 20.00 mm) was designed by software, and the data were transformed into digital format. A DLP printer (n= 40) and an SLA printer (n= 40) carried out the printing process. The aging procedure was applied to 20 samples from each group using a thermocycling device. After the aging procedure, the samples were placed in the universal testing device for the 3-point bending test. This study showed that the aging procedure decreased maximum load, bending stress, and Young's modulus values and increased maximum deflection values of the DLP group (P<0.01). However, no statistical difference was detected in the parameters compared with the SLA group except for the maximum deflection values. Furthermore, statistically significant differences were found between maximum deflection and Young's module values of SLA and DLP control and study groups (P<0.05). This invitro study revealed that the biocompatible printable resin materials produced by DLP and SLA printers had the mechanical strength to resist the values resembling the physiological occlusal forces even after the aging procedure and could produce intraoral appliances.

Fracture Characteristics of Commercial PEEK Dental Crowns: Combining the Effects of Aging Time and TiO2 Content.

Polyetheretherketone (PEEK) is an emerging thermoplastic polymer with good mechanical properties and an elastic modulus similar to that of alveolar bone. PEEK dental prostheses for computer-aided design/computer-aided manufacturing (CAD/CAM) systems on the market often have additives of titanium dioxide (TiO2) to strengthen their mechanical properties. However, the effects of combining aging, simulating a long-term intraoral environment, and TiO2 content on the fracture characteristics of PEEK dental prostheses have rarely been investigated. In this study, two types of commercially available PEEK blocks, containing 20% and 30% TiO2, were used to fabricate dental crowns by CAD/CAM systems and were aged for 5 and 10 h based on the ISO 13356 specifications. The compressive fracture load values of PEEK dental crowns were measured using a universal test machine. The morphology and crystallinity of the fracture surface were analyzed by scanning electron microscopy and an X-ray diffractometer, respectively. Statistical analysis was performed using the paired t-test (α = 0.05). Results showed no significant difference in the fracture load value of the test PEEK crowns with 20% and 30% TiO2 after 5 or 10 h of aging treatment; all test PEEK crowns have satisfactory fracture properties for clinical applications. Fracture surface analysis revealed that all test crowns fractured from the lingual side of the occlusal surface, with the fracture extending along the lingual sulcus to the lingual edge, showing a feather shape at the middle part of the fracture extension path and a coral shape at the end of the fracture. Crystalline analysis showed that PEEK crowns, regardless of aging time and TiO2 content, remained predominantly PEEK matrix and rutile phase TiO2. We would conclude that adding 20% or 30% TiO2 to PEEK crowns may have been sufficient to improve the fracture properties of PEEK crowns after 5 or 10 h of aging. Aging times below 10 h may still be safe for reducing the fracture properties of TiO2-containing PEEK crowns.

Dental conditions in patients with medically unexplained oral symptoms

Background/purpose: Dentists sometimes struggle with treating patients with unexplained symptoms, known as oral psychosomatic disorders, that do not improve with conventional treatment. Oral psychosomatic disorders do not fit the definition of psychosomatic diseases in internal medicine. To ensure appropriate dental treatment, it is important for general dentists to distinguish between oral psychosomatic disorders and psychosomatic diseases. However, relevant evaluation methods have not yet been developed. The DMFT index is widely used as an indicator of the caries status. The purpose of this study was to compare the DMFT index scores of patients with oral psychosomatic. Materials and methodsThe DMFT scores of 2202 patients with oral psychosomatic disorders, 145 psychiatric inpatients, and 3940 general dental patients were statistically compared. The DMFT of patients with oral psychosomatic disorders was further compared based on the presence or absence of psychiatric history and disease. ResultsThe median DMFT scores of oral psychosomatic disorder patients, psychiatric inpatients, and general dental patients were 16, 22, and 10, respectively, showing a significant difference. No significant differences were found in the DMFT scores based on the presence or absence of psychiatric history in oral psychosomatic disorder patients. ConclusionThe intraoral environment of patients with oral psychosomatic disorders was worse than that of general dental patients but better than that of psychiatric inpatients. General dentists could suspect psychiatric and oral psychosomatic disorders based on the state of patients’ oral environment.

Bridging the Gap with Nanoparticles: A Novel Approach

Two-piece implants unavoidably present a microgap between the implant and the abutment interface. Although numerous modalities have been attempted to overcome this situation, the implant abutment interface still remains a critical point for microbial colonization, which starts an inflammatory cascade of events eventually compromising the implants. Throughout our life, cells in all biological systems are unprotected to oxidative stress leading to the formation of Reactive oxygen species which is of concern when it comes to placing implants in patients who are periodontally compromised. This necessitates the development of alternative therapeutic modalities, which could counteract as well as prevent the microbial overload and ROS generation thereby improving the longevity of implants. To evaluate and assess the antibacterial, antioxidant and anti inflammatory effectiveness of quercetin-loaded titanium nanocomposites as coatings over healing abutments. Quercetin-loaded titanium nanocomposites were synthesized using green synthesis and confirmation was done using UV spectroscopy. Healing abutments were coated with the formulated nanocomposites, an intra-oral environment was simulated by thermocycling. Their antibacterial, antioxidant, anti-inflammatory, and cytotoxicity were assessed using standard tests. Healing abutments were coated with the formulated nanocomposites, an intra-oral environment was simulated by thermocycling. They showed potent antibacterial, antioxidant, and anti-inflammatory properties, which could prove beneficial in a variety of clinical scenarios in which there is a high risk for implant failure during early osseointegration.

Effect of thermocycling-induced stress on properties of orthodontic NiTi wires

Background/purposeIn orthodontic applications, NiTi wires are under continuous bending stress and exposed to fluctuations in temperature over long durations. The sensitivity of NiTi to temperature can have a considerable influence on its mechanical properties. This study investigated the effects of deflected NiTi wire, presented in stress-induced (detwinned) martensite microstructure, combined with thermal cycle on the microstructure and mechanical properties.Materials and methodsWe tested four types of as-received orthodontic NiTi: (1) Nitinol Classic (3 M Unitek), (2) Sentalloy (Tomy), (3) 27 °C CuNiTi (Ormco) and (4) 40 °C CuNiTi (Ormco). Each group of specimens was subjected to three different testing conditions: (1) temperature fluctuations (5000 cycles) between 5 and 55 °C, (2) continuous three-point bending force and (3) combination of thermal cycling and bending stress.ResultsThe specimens that underwent thermocycling as well as loading exhibited a substantial narrowing in stress hysteresis, which may be attributed to crystallinity lower than that of as-received NiTi wires. Reduced crystallinity can manifest in a number of imperfections, such as dislocations and internal stress, as well as a less-organized structure. Micro X-ray diffraction (XRD) analysis revealed the existence of martensite phase in Sentalloy wires subject to thermal and stress conditions. Under loading conditions, stress-induced martensite of NiTi wires exposed to temperature fluctuations of 5–55 °C also induced cyclic changes in bending stress. In a simulated intra-oral environment, the stability of austenite↔martensite transformation decreased.ConclusionThis study determined that bending stress in conjunction with repeated temperature fluctuations can greatly affect the microstructure and mechanical properties of NiTi wires.

Anti-Swelling, Robust, and Adhesive Extracellular Matrix-Mimicking Hydrogel Used as Intraoral Dressing.

Due to the wet and dynamic environment of the oral cavity, the healing of intraoral wounds, such as tooth extraction wounds, requires stable and firm wound dressings. In clinical practice, cotton balls and gauzes, sponge plugs, or sutures are used to treat extraction wounds, but none of these means can continuously isolate the wound from the intraoral environment and facilitate ideal healing conditions. Herein, inspired by the natural extracellular matrix, a family of wound dressings is developed for intraoral wound repair. Infiltrating a ductile long-chain hydrogel network into a prefabricated, sturdy macromolecular meshwork and in situ crosslinking endowed the composite hydrogel with controllable swelling behaviors and robust mechanical properties. The macromolecular meshwork functioned as the backbone to support the composite and restricts the swelling of the long-chain hydrogel network. In vitro tests verified that this wound dressing can provide durable protection for intraoral wounds against complex irritations. Furthermore, accelerated wound healing occurred when the wound dressing is applied in vivo on a canine tooth extraction model, due to the effective reduction of acute inflammation. These results suggest that this family of bioinspired hydrogels has great potential for application as intraoral wound dressing.

Periodontal inflamed surface area in oral cavity associated with febrile neutropenia in patients with hematologic malignancy undergoing chemotherapy

Febrile neutropenia (FN) is an infectious complication that develops during chemotherapy. Although the oral cavity can be an important infection route, it is unknown whether the oral environment is associated with FN. The present study examined the relationship between the oral environment using periodontal inflamed surface area (PISA), a new periodontal disease parameter, and FN in hematologic cancer patients undergoing chemotherapy. In this retrospective cohort study, 157 patients were divided into FN onset during chemotherapy (n = 75) and the FN negative groups (n = 82). The associations of risk factors related to the intraoral environment were assessed. Logistic regression analysis showed that types of blood cancer (odds ratio 1.98; P < 0.01), use of a high-risk regimen (odds ratio 4.44; P < 0.05), prophylaxis treatment with human granulocyte colony-stimulating factor (G-CSF) (odds ratio 4.15; P < 0.01) and PISA (odds ratio 1.02; P < 0.01) were independent factors associated with FN onset. Finally, propensity score matching was performed between two groups; 37 matched pairs were generated. PISA was significantly higher in the FN group than the FN negative group. There was a significant relationship between PISA and FN onset (P = 0.035). The present findings indicate that periodontitis treatment before starting cancer treatment is recommended as supportive care for preventing FN onset during chemotherapy.