Oral Complications Research Articles

Evaluation of parotid and submandibular salivary glands with ultrasonography in diabetic patients.

The main symptom of diabetes mellitus (DM) is hyperglycaemia, and patients with DM often have microvascular complications, such as retinopathy, neuropathy, and nephropathy; macrovascular complications, such as coronary heart disease, peripheral arterial disease and cerebrovascular disease; and oral complications, such as xerostomia, hyposalivation and periodontal disease. The main aim of this study was to evaluate the submandibular and parotid glands in type 2 DM patients and healthy individuals and to determine the changes in the salivary glands caused by diabetes. In this study, the salivary glands of 100 patients (50 individuals with type 2 DM and 50 healthy individuals) were evaluated by ultrasonography (US). Echogenicity, parenchymal homogeneity, hypoechogenic and hyperechogenic areas, margin characteristics, and vascularity of the glands were analysed. The anteroposterior, superoinferior, and mediolateral lengths and volumes of the submandibular glands were measured. Statistically significant differences in submandibular gland echogenicity, parotid gland vascularity, and hyperechogenic reflections of the parotid glands were observed between the groups (p < 0.05). In addition, the volume and dimensions of the submandibular glands were significantly greater in the type 2 DM group. DM leads to changes in the salivary glands. US, which has many advantages for salivary gland imaging, is a highly effective method for investigating these changes in individuals with diabetes. US, which is well tolerated by patients and does not involve ionizing radiation, can be used for long-term monitoring of the effects of diabetes mellitus on the salivary glands.

Not Enough Dentistry

This Viewpoint discusses the gap in dental insurance coverage for patients with head and neck cancer, many of whom forego dental care to treat or prevent oral complications of head and neck cancer therapy due to financial hardship.

Marked Gingival Overgrowth Protruding from the Oral Cavity Due to Sodium Valproate.

Drug-induced gingival overgrowth is associated with various systemic diseases, including epilepsy. Among antiepileptic medications, phenytoin is commonly reported to cause this condition. In contrast, sodium valproate (VPA), another widely used antiepileptic drug, rarely induces gingival overgrowth. This difference in side effects highlights the variability in drug-induced oral complications among different antiepileptic medications. This case study presents a patient who developed significant gingival overgrowth after using VPA for over 10 years. The study aims to identify VPA as the causative agent and observe changes during long-term administration and after dose reduction. Our findings demonstrate that even long-standing gingival overgrowth can improve rapidly following discontinuation of the causative medication, providing valuable insights for managing similar cases in the future.

Oral Health and Quality of Life in Type 2 Diabetic Patients: Key Findings from a Romanian Study.

Background: Diabetes mellitus is associated with various oral health complications that can negatively impact quality of life. Despite evidence of the relationship between diabetes and oral health issues, limited research exists on the perceptions, behaviors, and oral health-related quality of life (OHRQoL) of diabetic patients in Romania. This study aims to evaluate self-reported oral health, knowledge, behaviors, and OHRQoL among diabetic patients in western Romania. Methods: A cross-sectional study was conducted in early 2024 at Pius Brinzeu County Emergency Hospital, Timisoara, involving 121 patients with type 2 diabetes. Data were collected using self-administered questionnaires that assessed oral health status, behaviors, and OHRQoL, with the OHIP-14 instrument employed for quality-of-life measurement. Statistical analyses included descriptive statistics, multiple linear regression, and correlation analyses to identify the predictors of oral health knowledge and OHRQoL. Results: Participants (mean age: 63.24 years; 52.1% female; 60.5% urban residents) reported significant oral health challenges. Over half (56.2%) did not visit a dentist regularly, with financial constraints identified as the primary barrier (23.5%). Oral hygiene practices were suboptimal: only 38.0% brushed twice daily, while 78.5% used fluoride toothpaste. Auxiliary hygiene tools, such as mouthwash and toothpicks, were rarely used (13.22% and 11.57%, respectively). Regression analyses identified the significant predictors of oral health knowledge, including tooth mobility (β = 0.33, p < 0.01) and brushing frequency (β = -0.18, p < 0.05). The mean OHIP-14 score (0.55) indicated a moderate impact on OHRQoL, with domains such as psychological discomfort and social disability revealing nuanced challenges. Conclusions: Diabetic patients in Romania face oral health challenges and care barriers, emphasizing the need for preventive strategies, oral health education, and integrated diabetes care. Addressing these gaps can improve oral health outcomes and overall quality of life in this vulnerable population.

A Retrospective Study of Stabilizing Bridges in Patients With Stages III and IV Periodontitis: Up to 35 Years of Clinical Audit.

Studies on large cross-arch bridges in patients with severe periodontitis show that such bridges can stabilize the periodontal condition. However, it is not known if these bridges will reduce long-term tooth loss and what factors are important for their long-term survival. The aim of the study was to study all patients with Stages III/IV periodontitis who received cross-arch bridges for up 35 years in a private practice. All patients referred for periodontal treatment from 1986 who received cross-arch bridges with observation period of minimum 7 years were assessed. All dropouts were accounted for. Ninety-eight patients (1.7% of the patient population) with 111 bridges were observed (57 females and 37 males). Age at bridge construction was 55.4 years (SD = 7.1, range 39-79). Failure rate was 14.4% at 16.1 years (SD = 4.0 range 10-22). Reasons for failure were poor oral hygiene (p = 0.0093) and complications such as caries, endontics, porcelain fractures and gingival retractions during maintenance therapy (p = 0.0059). Fewer abutment teeth were lost from the bridges than teeth from the same and opposing arches (8.8% vs. 34.4% and 25.4%) (p < 0.0001). Cross-arch bridges constructed for patients with Stages III and IV periodontitis were successful in terms of longevity, low failure rates, tooth preservation and patient satisfaction.

Lower Serum IL-10 Linked to Oral Manifestations in Diabetes Patients.

Diabetes mellitus (DM) is a chronic disease that remains a global health problem with increasing prevalence, particularly in Indonesia. The presence of oral manifestations in patients with DM is influenced by changes in immune system function. Interleukin-10 (IL-10) is an inflammatory marker implicated in DM. However, no studies have investigated the differences in IL-10 levels between non-DM and DM patients with and without oral manifestations. This study aimed to compare the serum levels of IL-10 between non-DM and DM patients with and without oral manifestations at Dr. Hasan Sadikin Hospital Bandung. This observational study used a cross-sectional design. A total of 88 serum samples that met the inclusion criteria were selected, consisting of 37 (42%) samples from non-DM patients, 35 (39.8%) samples from DM patients with oral manifestations, and 16 (18.2%) samples from DM patients without oral manifestations. Serum levels of IL-10 were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Among the 35 DM patients with oral manifestations, xerostomia was the most common (80%). The mean serum IL-10 level was 0.93 pg/mL in non-DM patients, 0.80 pg/mL in DM patients with oral manifestations, and 1.08 pg/mL in DM patients without oral manifestations. Statistical analysis using the Kruskal-Wallis test showed a p-value of 0.008 (p ≤ 0.05), indicating a significant difference in serum levels of IL-10 between non-DM and DM patients with and without oral manifestations. DM patients with oral manifestations had lower IL-10 serum levels compared to non-DM patients and DM patients without oral manifestations. These findings suggest that monitoring IL-10 levels could help identify diabetic patients at higher risk for oral complications.

Mitochondrial Dysfunction in Diabetic Periodontitis: Mechanisms and Therapeutic Potential.

Diabetic periodontitis is a common oral complication of diabetes characterized by progressive destruction of periodontal tissues. Recent evidence suggests that mitochondrial dysfunction plays a crucial role in the pathogenesis and progression of this condition. This review aims to systematically summarize the role and potential mechanisms of mitochondrial dysfunction in diabetic periodontitis. We first explore the relationship between diabetes and mitochondrial dysfunction, then analyze the specific manifestations of mitochondrial dysfunction in diabetic periodontitis, including morphological changes, energy metabolism disorders, increased oxidative stress, and enhanced apoptosis. We further delve into the connections between mitochondrial dysfunction and the pathogenic mechanisms of diabetic periodontitis, such as exacerbated inflammatory responses, decreased tissue repair capacity, and autophagy dysregulation. Finally, we discuss potential therapeutic targets based on mitochondrial function, including antioxidant strategies, mitochondria-targeted drugs, and autophagy regulators. We also propose future research directions, emphasizing the need for in-depth exploration of molecular mechanisms, development of new diagnostic markers and therapeutic strategies, and personalized treatment approaches. This review provides new insights into understanding the pathogenic mechanisms of diabetic periodontitis and offers a theoretical basis for developing targeted prevention and treatment strategies to improve oral health in diabetic patients.

Combined Phototherapies (aPDT and PBM Therapy) Protocol for Medication-Related Osteonecrosis of the Jaw (MRONJ) in a Cancer Patient: Scope Literature Review and A Case Report

Purpose: Medication-Related Osteonecrosis of the Jaw (MRONJ) is an oral complication in patients on ongoing or previous treatment with antiresorptive or antiangiogenic drugs. Many treatments have been proposed, but the management of MRONJ lesions is still challenging. The objective of this article is to present a literature review on aPDT and PBM in the management of MRONJ. Accompanying the review, a protocol and its outcome, for treating MRONJ in a cancer patient, where the association of photobiomodulation (PBM) therapy and antimicrobial photodynamic therapy (aPDT) was applied is presented. Methods: This is the clinical case report of a 58-year-old male patient, with prostate cancer presenting a bone metastasis that was treated with chemotherapy and intravenous antiresorptive Zometa®. On intraoral clinical examination, in the region of the lower alveolar ridge, a lesion with necrotic bone exposed was observed. After clinical and radiographic evaluation of the lesion, it was diagnosed as MRONJ. The association of PBM and aPDT was applied at pre, trans and post-surgery. The pre-surgical phase lasted about two months. The post-surgical protocol was implemented 48 hours after surgery and lasted two months. Results: The search included articles in the databases MEDLINE/Pubmed and Scopus. Nine studies were included 6 of combined aPDT and PBM and 3 studies investigated isolated aPDT published in English from 2016 to 2023. The proposed protocol resulted in the complete closure of the lesion. The patient was undergoing clinical follow-up for 3 years without recurrences. Conclusion: Based on the positive outcome of the proposed phototherapy protocol, one can infer that the combination of PBM and aPDT in the pre, trans and post-surgery showed to be efficient in the treatment of MRONJ lesion.

Frequency and factors associated with oral Candida growth in patients with chronic kidney disease

Introduction: Yeasts of the genus Candida, especially Candida albicans, are responsible for oral infections, particularly in immunocompromised individuals. Candida colonization can lead to oral candidiasis and, in severe cases, to esophageal or systemic candidiasis. In patients with chronic kidney disease (CKD), dialysis and immunosuppression increase the risk of oral infections, such as candidiasis. CKD is a highly prevalent pathology, and patients undergoing peritoneal dialysis are more prone to suffer oral complications due to alterations in oral health habits and defense mechanisms. Objective: To relate risk factors and clinical characteristics of patients with chronic kidney disease to the frequency of oral Candida.Methods: This study is framed within a cross-sectional and analytical design, including a total of 21 patients over 18 years of age who were undergoing peritoneal dialysis treatment at the HIGA “Presidente Perón”. Samples of biofilm from the gingival sulcus and buccal mucosa were collected from each participant using standardized sampling techniques.Results: A predominance of C. albicans (46%) and C. parapsilosis (40%) was observed. The variables that showed a statistically significant association (p &lt; 0.05) were: age (p = 0.002), smoking (p = 0.032), time on peritoneal dialysis (p = 0.005), oral hygiene (p = 0.003), oral health (p = 0.003) and maximum probing depth (p = 0.011).Conclusions: We were able to demonstrate a relationship between oral Candida and CKD, in addition to its association with various risk factors. C. albicans and C. parapsilosis species were the most frequent, especially in women and smokers with prolonged peritoneal dialysis treatment.

Modern Radiation Therapy for Head and Neck Cancer and the Management of Radiation-Induced Oral Complications

Background: The management of head and neck cancers is a unique crossroads between the dental and oncology disciplines. In the following manuscript, a summary of the modern advances in radiation treatment of head and neck cancers as well as a brief overview of some of the most common adverse effects will be reviewed with special emphasis on osteoradionecrosis. Types of Studies Reviewed: We reviewed the literature regarding major dental events after head and neck radiotherapy, which include 4 major categories including: 1) osteoradionecrosis, 2) gingival recession, 3) caries, extractions, tooth loss and 4) oral mucositis. Results: We summarized herein the literature behind the pathophysiology, risk factors and management options for major dental events after head and neck radiotherapy. We also have organized the major guidelines published for dental management before, during and after head and neck radiotherapy. Practical Implication: The cooperation between dentistry and oncology is paramount considering the advancements regarding overall survival and outcomes in cancer patients. Patients are expected to deal with the sequalae of the long-term, post-treatment effects of radiation therapy. Younger, healthier individuals are being diagnosed with head and neck cancers given the rise of HPV infections, which portends longer survival and the greater need to improve long-term dental health in this group. We hope that this review will be a resource to dental providers to help provide excellent care for head and neck cancer radiotherapy patients.

Enhancing oral health for patients on chronic medications at Al-Kaaban health center

The project's primary goal was to enhance dental and oral health services for patients on chronic medications, which are known to cause adverse effects on oral health. The initiative required to establish a referral system that would guarantee that 100% of these patients underwent comprehensive oral health screening assessments by the dentist within a six-month timeframe. Family physicians were responsible for referring patients who were taking medications for chronic conditions such as diabetes, hypertension, asthma, and epilepsy to the dental clinic for evaluations. Identified oral health issues, including gingival hyperplasia and gingivitis, were managed through direct treatment, consultations with physicians for potential medication modifications, or referrals to specialized clinics when necessary. Among the 40 patients assessed, 10% exhibited oral health problems, which included one instance of phenytoin-induced gingival hyperplasia and four cases of diabetes-related gingivitis. This collaborative effort facilitated the early identification and management of oral health complications, reduced the risk of further complications, and improved patient outcomes. Important insights gained from this initiative included the significance of interdisciplinary collaboration, the necessity of early intervention, and the importance of patient education. To ensure the sustainability of the program, recommendations include the establishment of a permanent referral system, training family physicians to recognize the oral side effects of medications and conducting regular audits of the program. This quality improvement initiative underscores the potential benefits of integrating dental care into the management of chronic diseases to enhance patient care across various healthcare systems.

Exploring Salivary Biomarkers and Health Parameters in Type 2 Diabetic and Non-diabetic Patients

1.Background/Objectives: Diabetes mellitus (DM) is a chronic, non-communicable disease with significant systemic and oral health complications. Early, non-invasive diagnostic approaches, such as salivary biomarker analysis, could improve management and reduce associated complications. Salivary alpha-amylase has emerged as a promising biomarker due to its role in glycemic control and stress-related sympathetic activation. This study aims to evaluate salivary alpha-amylase levels as potential biomarkers for type 2 diabetes mellitus (T2DM) and explore their correlation with clinical parameters.2. Methods: A cross-sectional study was conducted involving 40 participants (20 T2DM patients and 20 controls). Saliva samples were collected and analyzed for alpha-amylase using ELISA. Data on oral health, body mass index (BMI), glycated hemoglobin (HbA1c), and total cholesterol were also collected.3. Results: Salivary alpha-amylase levels were significantly higher in T2DM patients (mean: 177.86 μ/L) compared to controls (mean: 90.98 μ/L, p = 0.001). Poorer oral health, higher BMI, and increased cholesterol levels were observed in diabetic participants. HbA1c levels revealed suboptimal glycemic control in a subset of patients.4. Conclusions: Salivary alpha-amylase shows potential as a non-invasive biomarker for T2DM diagnosis and monitoring. The findings emphasize the need for integrated medical and dental management to address systemic and oral health challenges in diabetes. Further research is needed to validate and standardize salivary diagnostic methodologies.

Awareness of Radiation Oncologists Regarding Oral Evaluation of Patients before Radiotherapy: Survey Study

Radiotherapy is one of the most preferred methods in head and neck cancers. Many oral complications develop in patients during and after radiation from the head and neck region. While these complications affect the comfort of life in patients, they also cause many problems in the treatment process for physicians. The aim of this study is to evaluate the knowledge, opinions and attitudes of physicians who perform radiotherapy about dentistry and multidisciplinary approach before or during radiotherapy. A total of 120 physicians who applied radiotherapy participated in the study. The questionnaire consists of 14 questions which were sent online to practitioners working in many centres. The results were entered into the statistics data package system. 78.6% of the physicians answered yes to the question of simultaneous dentistry and multidisciplinary approach during radiotherapy. While 82.1% answered yes as the level of knowledge in terms of complications, 79.5% answered yes to the question of supportive treatments, and 29.9% answered yes to the question of applying protective appliances. While the level of knowledge of the physicians participating in this study was sufficient in terms of complications, a lower rate was found in terms of dental consultation and dentistry, as well as multidisciplinary approach and protective appliances.

HUBUNGAN PERILAKU PENDERITA DIABETES MELLITUS DENGAN STATUS KEBERSIHAN GIGI DAN MULUT

The background of this research is that oral hygiene is an important aspect of healthcare, especially for diabetes mellitus patients who are prone to oral complications. Diabetes mellitus, characterized by high blood sugar levels, can trigger bacterial growth and worsen oral hygiene. The problem is that the behavior of diabetes mellitus patients greatly affects their oral hygiene status, yet many diabetes mellitus patients exhibit inadequate oral care behaviors. This study aims to determine the relationship between the behavior of diabetes mellitus patients and their oral hygiene status at Puskesmas Mutiara Barat, Pidie District. The research methodology employs a cross-sectional design with a sample of 40 diabetes mellitus patients visiting the Mutiara Barat Health Center in Pidie District. Data collection was conducted through interviews using a questionnaire and assessment of oral and dental hygiene status using the OHIS index. The research took place from March 8 to May 2 2024. The results showed that of the 40 respondents, 62.5% had poor behavior and 62.5% had poor oral and dental hygiene status. Bivariate analysis using the Chi-Square test indicated a significant relationship between the behavior of diabetes mellitus patients and their oral and dental hygiene status (p = 0.000). Poor behavior, such as not regularly maintaining oral hygiene, contributes to poor oral conditions in diabetes mellitus patients. The study concludes that there is a significant relationship between the behavior of diabetes mellitus patients and their oral and dental hygiene status. It is recommended that diabetes mellitus patients improve their oral hygiene habits, control blood sugar levels well, and regularly check their teeth. Health workers are expected to provide comprehensive and ongoing education on the importance of maintaining oral and dental hygiene for diabetes mellitus patients.

THE INFLUENCE OF DIABETES IN PEDIATRIC DENTISTRY

Pediatric diabetes presents significant challenges in dental treatment, requiring a tailored approach to minimize the risks associated with oral complications. Optimal glycemic control is fundamental before any intervention, and close collaboration with the diabetologist is essential to stabilize glucose levels. Local anesthesia should be used with caution, preferring solutions with low adrenaline concentrations, especially in patients with inadequate glycemic control. Dental treatment in children with diabetes involves a specialized approach due to the increased risks of oral complications and the peculiarities associated with this condition. Stable glycemic control is essential before any dental intervention, and collaboration with the diabetologist is crucial for adjusting the treatment. Local anesthesia should be administered with caution, using solutions with low adrenaline concentrations, especially in patients with unstable glycemic control. Educating patients and families about oral hygiene, diet, and the importance of regular visits to the dentist play a fundamental role in preventing dental complications. Children with diabetes are at increased risk of gum disease, such as gingivitis and periodontitis, so prompt management of these conditions through scaling and regular evaluations is vital. Rigorous oral hygiene should be encouraged to prevent infections and complications associated with compromised immune response. Interdisciplinary collaboration between dentists, diabetologists and other health professionals is essential for developing a coordinated and effective treatment plan.

COMPARATIVE EVALUATION OF THE PERIODONTAL STATUS AND SERUM PARAMETERS IN NORMAL BODY MASS INDEX AND OBESE CHILDREN

Objective: Childhood obesity is a growing global health concern, with established associations to both systemic and oral health complications. This study aimed to compare periodontal status and inflammatory biomarkers between obese and non-obese children. Materials and methods: Fifty-two children (26 obese, 26 non-obese) were included, with key parameters such as Plaque Index (PI), Bleeding on Probing (BOP), Probing Depth (PD), and Clinical Attachment Loss (CAL) assessed to evaluate periodontal health. Paraclinical indicators including fibrinogen, C-reactive protein (CRP), and vitamin D (25(OH)D) levels were also measured. Results and Discussion: Results demonstrated that obese children exhibited significantly higher values for PI, BOP, PD, and CAL, indicating poorer periodontal health. Elevated serum fibrinogen and CRP levels, coupled with lower vitamin D levels in obese children, underscored a state of chronic inflammation and potential nutrient deficiency associated with obesity. Conclusion: These findings highlight the need for a multidisciplinary approach to managing obesity and promoting oral health, suggesting that early intervention in dietary and lifestyle factors could mitigate these risks.

The Oral Microbial Ecosystem in Age-Related Xerostomia: A Critical Review.

Xerostomia is a widespread condition among the elderly, impacting as many as 50% of individuals within this demographic. This review aims to analyze the association between age-related xerostomia and the oral microbial ecosystem. Xerostomia not only induces discomfort but also heightens the susceptibility to oral diseases, including dental caries and infections. The oral microbial ecosystem, characterized by a dynamic equilibrium of microorganisms, is integral to the maintenance of oral health. Dysbiosis, defined as a microbial imbalance, can further aggravate oral health complications in those suffering from xerostomia. This review investigates the composition, diversity, and functionality of the oral microbiota in elderly individuals experiencing xerostomia, emphasizing the mechanisms underlying dysbiosis and its ramifications for both oral and systemic health. A comprehensive understanding of these interactions is vital for the formulation of effective management and prevention strategies aimed at enhancing the quality of life for older adults.

The Involvement of Resolvins in Pathological Mechanisms of Periodontal Disease Associated with Type 2 Diabetes: A Narrative Review.

Resolvins are specialized pro-resolving mediators (SPMs) derived from omega-3 fatty acids that play a critical role in resolving inflammation and restoring tissues to a state of health after an immune response. Their role in chronic inflammatory conditions highlights their importance in maintaining a balance between an effective immune response and the resolution of inflammation to prevent tissue damage. Periodontal disease is a chronic inflammatory condition affecting the tissues surrounding the teeth, leading to gum damage and bone loss. Chronic inflammation in periodontal disease can exacerbate systemic inflammation and influence other conditions, such as diabetes. There is a bidirectional relationship between diabetes and periodontal disease, as both are characterized by chronic inflammation and exacerbate systemic and oral health complications. This narrative review aims to synthesize the current knowledge on how resolvins influence inflammatory pathways and the tissue repair mechanism in periodontal disease in patients with type 2 diabetes. Furthermore, this review serves as a foundation for developing targeted therapeutic strategies, addressing the pressing need for effective treatments that consider both systemic and oral health outcomes.

Interdisciplinary Practice for the Management of Nutritional Deficiencies in Patients with Oral and Dental Complications

Interdisciplinary Practice for the Management of Nutritional Deficiencies in Patients with Oral and Dental Complications

Oral Manifestations in Patients in Treatment with Antidepressants: A Systematic Review.

Background/Objectives: The rising use of antidepressants is linked to oral health risks, including xerostomia, caries, and periodontal disease. Recognizing these risks is essential for improving patient care. To systematically review oral manifestations in patients undergoing antidepressant treatment. Methods: This review follows the PRISMA guidelines and includes observational studies published in the last 21 years. A PICO-based question was developed to select relevant studies, which were assessed for quality using a modified STROBE checklist. Results: A total of 11 studies were analyzed, revealing a consistent association between antidepressant use and the increased risk of xerostomia, caries, and periodontal disease. Additional findings included taste dysfunction and oral bleeding complications. Among the antidepressants, selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) were most commonly associated with xerostomia and caries. However, no significant impact was observed on the chemical composition of saliva or on hemostasis in invasive dental procedures. Conclusions: Antidepressant use may lead to significant oral health issues, notably xerostomia and caries. Further studies are recommended to clarify the influence of specific antidepressants and confounding factors, such as treatment duration, dosage, and hygiene habits, on oral health outcomes.