Given the prevalence of proximal caries and the challenge of achieving durable marginal seals in Class II restorations, this in vitro study aimed to compare the surface smoothness, cervical microleakage, and marginal adaptation of Class II restorations using several different composites and filling techniques under simulated clinical conditions. Eighteen human molars were selected, and 36 standardized Class II cavities were prepared (two cavities per tooth). The teeth were randomly assigned into six groups (n = 6 cavities/group), which contains three single-composite restoration groups and three hybrid-composite restoration groups: conventional paste type composite layered restoration (S-paste), sonic activated bulk-fill composite restoration (S-sonic), highly filled flowable resin composite layered restoration (S-flow), sandwich technique, glass-ionomer cement liner and paste-type composites (H-GIC), bulk-fill resin liner combined with paste type composite (H-SDR), highly filled flowable resin liner with paste-type composite layered restoration (H-flow). A novel biomechanical model simulating proximal contact and rubber dam isolation was used. After thermocycling, restorations were evaluated for clinical performance, including surface smoothness (FDI criteria), cervical microleakage (ISO scoring), and marginal gap area via scanning electron microscopy (SEM). For surface smoothness, the H-flow group demonstrated optimal FDI score (100
Ultra-translucent zirconia is widely used in dental restorations for its excellent optical properties, yet long-term evidence regarding the stability of its esthetic performance in clinical scenarios remains limited. This study aimed to systematically evaluate the optical stability and underlying mechanisms of 9 commonly used ultra-translucent zirconia materials before and after artificial aging. Ninety specimens (n = 3 per group) were prepared from nine ultra-translucent zirconia brands, namely Wieland (ZNT), 3 M ESPE (LVP), Amann Girrbach (AG), Kuraray Noritake (KAT), Aidite (ADT), Upcera (UPC), Besmile (BSM), Ivoclar Vivadent (ZLT), and Sagemax (NZ), and one lithium-disilicate glass-ceramic control, Ivoclar Vivadent IPS e.max Press (PLT), at thicknesses of 0.5 (for veneers), 1.0 (for veneers or monolithic crowns), and 1.5 mm (for monolithic crowns). Specimens were hydrothermally aged at 134 °C and 0.2 MPa for 4, 8, 12, and 16 h. Translucency parameter (TP) and color difference (the CIEDE2000 ∆E00) were measured before and after each aging duration. Crystalline characteristics and surface morphology were analyzed via X-ray diffraction (XRD) and scanning electron microscopy (SEM). A three-way independent-samples ANOVA with Bonferroni-adjusted pairwise comparisons was applied to TP. ∆E00 was evaluated descriptively against the acceptability threshold. TP was brand- and thickness-specific, with the control group showing the highest values. UPC showed significant TP reduction across all thicknesses, while ZNT (1.5 mm), BSM (1.0 mm), and the PLT control (1.0 mm and 1.5 mm) at selected thicknesses exhibited declines after different aging durations. ∆E00 exceeded the acceptability threshold of 2.25 in most material–thickness combinations from 12 h of aging onward. LVP was the only material that remained below 2.25 at all three thicknesses across all aging times, whereas all other ultra-translucent zirconia materials and the control (PLT) exceeded the threshold at one or more aging durations. XRD confirmed monoclinic phase formation in all zirconia groups and SEM images revealed surface changes of most groups’ specimens after aging. Translucency and color stability of ultra-translucent zirconia are brand- and thickness-dependent under hydrothermal aging conditions, offering preliminary comparative optical data that may inform future comprehensive material evaluations.
Skeletal Class III malocclusion is clinically characterized by occlusal dysfunction and facial disharmony, for which orthognathic surgery represents the standard therapeutic intervention. However, postoperative complications, including hemorrhage, airway swelling, and soft tissue edema, frequently occur and may progress to life-threatening conditions in severe cases. This case report describes a patient who experienced acute airway compromise following bimaxillary orthognathic surgery. The patient presented three concurrent perioperative findings: below-average baseline upper airway dimensions, extensive postoperative soft tissue edema, and isolated postoperative reduction in factor VIII (FVIII) activity. A 22-year-old male patient presented with skeletal Class III malocclusion. Preoperative cranio-maxillofacial CT demonstrated subaverage oropharyngeal airway parameters. The minimal anteroposterior airway diameter measured 8.56 mm, with a cross-sectional area of 183.70 mm². The patient received digitally planned Le Fort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO). The intraoperative course was uncomplicated, yet severe facial swelling, widespread ecchymosis and recurrent acute airway compromise developed on postoperative day (POD) 1. Initial supportive management with oropharyngeal airway placement and supplemental oxygen relieved respiratory distress. Laboratory testing identified FVIII activity decreased to 41.3
Anterior open bite (AOB) is a complex malocclusion in adult patients, characterized by limited vertical overlap of the incisors and a high risk of relapse. Clear aligner therapy has gained popularity as a non-surgical treatment modality; however, conventional thermoformed aligners exhibit limitations in achieving predictable vertical tooth movements, particularly incisor extrusion and molar intrusion. To evaluate the current evidence regarding the clinical effectiveness, biomechanical performance, and limitations of 3D direct-printed shape memory polymer (SMP) aligners in the management of AOB in adult patients. This scoping review was conducted in accordance with PRISMA-ScR guidelines and established methodological frameworks. The eligibility criteria included studies involving adult patients or relevant in vitro/experimental investigations evaluating 3D direct-printed aligners and/or shape memory polymer aligners in the management of AOB. Studies on conventional thermoformed aligners without direct-printed or shape memory components, pediatric-only populations, non-relevant outcomes, and non-original publications were excluded. Sources of evidence included PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library, supplemented by manual reference screening. Data charting was performed independently using a predefined data extraction framework, capturing study characteristics, intervention type, biomechanical properties, and clinical outcomes. Findings were synthesized narratively due to heterogeneity of the included evidence. The available evidence, predominantly derived from in vitro and experimental studies, suggests that SMPaligners provide improved force consistency, reduced force decay, and enhanced vertical control compared with conventional thermoformed aligners. Their temperature-dependent shape memory behavior enables sustained, low-magnitude force delivery, which may improve the predictability of incisor extrusion and posterior molar intrusion. Additionally, direct 3D printing enhances aligner fit and allows customization of force systems. However, clinical evidence remains limited, with a lack of randomized controlled trials and long-term outcome data. 3D direct-printed aligners demonstrate promising biomechanical advantages for the treatment of AOB in adults. Nevertheless, their clinical effectiveness and long-term stability remain uncertain due to the predominance of preclinical evidence. Further well-designed clinical studies are required before SMP aligners can be considered a reliable alternative to conventional orthodontic approaches.
Hypodontia is a common developmental dental anomaly with significant functional and esthetic consequences. However, large-scale multicenter evidence from Saudi Arabia remains limited. This study aimed to estimate the prevalence of hypodontia and identify its demographic and regional determinants across five regions of the Kingdom. This retrospective multicenter cross-sectional study analyzed 3,170 panoramic radiographs from seven academic institutions across Central, Eastern, Western, Northern, and Southern Saudi Arabia (2015–2025). Saudi nationals aged 7 to less than 21 years were included, while individuals with craniofacial anomalies, systemic conditions affecting tooth development, prior orthodontic treatment, and oligodontia were excluded. Data were analyzed using chi-square tests and multivariable logistic regression. The overall prevalence of tooth agenesis, including third molars, was 24.3
Abstract Background Restoration of endodontically treated teeth (ETT) with significant coronal loss poses a challenge in clinical dentistry. Advances in CAD/CAM technology and biomimetic materials have introduced minimally invasive approaches, such as endocrowns and overlays, which can replace traditional post-core and crown approach. Aim The aim of this in-vitro study was to comparatively assess the mechanical behaviour of two restorative designs (endocrowns and overlays) fabricated from two CAD/CAM materials in endodontically treated mandibular molars. Materials and methods Thirty-six endodontically treated lower molars (n = 36) were split into two main groups based on restoration type (n = 18): endocrowns and overlays. Each group was further subdivided into two subgroups based on the CAD/CAM material (n = 9): lithium disilicate (Tessera) and indirect composite (Crios). Restorations were fabricated and bonded to their respective specimens following a strict bonding protocol with an adhesive resin cement (Bisco self-adhesive). Thermo-mechanical aging (Chewing Simulator CS-4, SD Mechatronic) was conducted to simulate oral conditions, followed by a universal testing machine's evaluation of fracture resistance. The test was stopped after fracture. Fractured parts were analysed to determine mode of failure. Data were analyzed using two-way ANOVA followed by Tukey’s honestly significant difference (HSD) test for pairwise comparisons (α = 0.05). Results All specimens survived the 5,000 chewing cycles, simulating early intraoral service. Fracture resistance test showed significantly higher fracture resistance for overlays (2048.46 ± 664.63 N) than endocrowns (1234.54 ± 338.50 N) (p = 0.002). Crios overlays exhibited the highest fracture resistance (2384.60 ± 631.10 N), significantly outperforming Tessera overlays (1712.33 ± 559.59 N) (p = 0.043) and endocrowns (1354.20 ± 346.88 N) (p = 0.004). No substantial material change was seen in endocrown restorations (p = 0.445). Conclusion Overlay restorations and indirect composite material (Crios) provide superior resistance to fracture compared to lithium disilicate overlays and endocrowns and may represent a reliable restorative option for endodontically treated molars.
To develop and validate a nomogram that integrates magnetic resonance imaging (MRI) radiomic features with clinical indicators, including the platelet-to-lymphocyte ratio (PLR) and depth of invasion (DOI), for the preoperative prediction of cervical lymph node metastasis (LNM) in oral squamous cell carcinoma (OSCC). This retrospective study included 148 OSCC patients, randomly split 7:3 into training cohort (n = 103) and test cohort (n = 45). Two head and neck radiologists delineated tumor volumes of interest (VOIs)on T2-weighted imaging (T2WI ) and gadolinium-enhanced T1-weighted imaging(Gd-T1WI).Radiomic features were extracted using the Pyradiomics package. Feature selection was performed using the Mann-Whitney U test, recursive feature elimination (RFE), and least absolute shrinkage and selection operator (LASSO) regression to construct a radiomic score (Radscore). Independent clinical predictors of LNM were identified via univariate and multivariate logistic regression to build a clinical model. A combined predictive nomogram was subsequently developed by integrating the Radscore with these independent clinical predictors. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis, calibration curves, and decision curve analysis (DCA). Multivariate analysis identified PLR ≥ 111.385 and DOI (measured on Gd-T1WI) as independent predictors of LNM (both P < 0.05). Fourteen key features were selected from 2,048 initial features extracted from MRI sequences to construct the radiomic model. The areas under the ROC curve (AUC) for the clinical model were 0.760 (training) and 0.694 (test), and those for the radiomic model were 0.840 (training) and 0.725 (test). The combined model (incorporating Radscore, PLR, and DOI) demonstrated superior predictive performance, with AUCs of 0.892 (training) and 0.804 (test), significantly outperforming the single models (DeLong test, P < 0.05). The calibration curve indicated good agreement between predicted and observed LNM probabilities. DCA showed a higher net clinical benefit for the combined model than for the single models across a wide range of threshold probabilities. The nomogram combining MRI radiomic features, PLR, and DOI effectively predicts cervical LNM in OSCC patients preoperatively, providing a valuable tool for individualized treatment planning.
Retromolar trigone (RMT) squamous cell carcinoma is an uncommon but highly aggressive oral cavity malignancy owing to its concealed anatomical location and propensity for early invasion of adjacent structures. Diagnosis may be challenging when superficial biopsies fail to detect underlying malignancy, resulting in delayed definitive treatment. A 67-year-old man with a history of tobacco use presented with a two-year history of a persistent non-healing ulcer involving the left retromolar trigone (RMT). Initial biopsies performed elsewhere revealed lichen planus and mild epithelial dysplasia. Despite progressive enlargement of the lesion and worsening pain, multiple repeat biopsies, including incisional, CT-guided bone, and ultrasound-guided soft-tissue biopsies, consistently demonstrated pseudoepitheliomatous hyperplasia and granulation tissue without evidence of invasive carcinoma. However, contrast-enhanced computed tomography (CECT) demonstrated a left RMT lesion with mandibular destruction and extension into the masticator space, corresponding to a clinical stage of cT4b cN0 cM0 based on preoperative clinical examination and CECT of the neck and thorax. Owing to persistent clinicoradiological suspicion of malignancy, the patient underwent wide local excision with segmental mandibulectomy and pectoralis major myocutaneous (PMMC) flap reconstruction. Intraoperative frozen-section examination demonstrated only benign inflammatory changes; however, definitive histopathological examination of the resected specimen confirmed well-differentiated keratinizing squamous cell carcinoma with mandibular invasion (pathological stage pT4a pNx). The patient subsequently received postoperative adjuvant concurrent chemoradiotherapy followed by triple oral metronomic therapy. Following completion of chemoradiotherapy, a post-treatment PET-CT demonstrated no evidence of residual or recurrent disease. The patient subsequently underwent monthly clinical follow-up and remained free of clinically evident locoregional recurrence at six months after surgery. This case highlights the importance of recognizing persistent clinicopathological discordance in suspicious retromolar trigone lesions. When repeated biopsy results remain inconsistent with the clinical and radiological findings, continued multidisciplinary evaluation and repeat tissue sampling are essential to avoid diagnostic delay and facilitate timely definitive management. The patient remains under active postoperative surveillance, and longer follow-up is required before conclusions regarding long-term oncological outcomes can be drawn.
Chronic kidney disease (CKD) is a condition characterized by a progressive loss of kidney function with increased levels of urea and blood urea nitrogen (BUN) in the blood, which contribute to the development of uremic stomatitis. Uremic stomatitis is an oral manifestation of CKD, characterized by inflammation and lesions on the oral mucosa due to irritation from ammonia produced by the hydrolysis of urea in saliva by urease-producing bacteria. The objective of this research was to systematically review and synthesize the reported urea and BUN levels in pediatric and adult patients with uremic stomatitis. This study utilized a systematic review approach based on PRISMA guidelines and reviewed articles from electronic databases such as PubMed, ScienceDirect, Scopus, Cochrane, and Google Scholar. The analyzed articles included observational studies and case reports that examined the relationships between urea and BUN levels and uremic stomatitis in both pediatric and adult CKD patients. Out of 282 identified articles, 10 were selected for analysis, comprising 391 patients. The review findings indicate that CKD patients with uremic stomatitis present significantly elevated urea and BUN levels beyond the normal range. Reported urea levels ranged from 72.8 to 321 mg/dL, while BUN levels ranged from 180 to 400 mg/dL. Uremic stomatitis has been reported in patients with BUN levels exceeding 150 mg/dL and is characterized by white lesions on the oral mucosa, pain, a burning sensation, and an ammonia-like breath odor. The available evidence indicates an association between elevated urea and BUN levels and the occurrence of uremic stomatitis in CKD patients. While urea and BUN are routinely measured to monitor CKD, elevated levels may support the diagnosis of uremic stomatitis. The presence of uremic stomatitis may also serve as a clinical indicator of advanced or poorly controlled renal dysfunction. PROSPERO (CRD420251021047).
Different fabrication techniques for polymethyl methacrylate (PMMA) denture base resins may influence their mechanical and surface properties as well as their resistance to thermal aging. However, studies comprehensively comparing the mechanical and surface properties of conventionally and digitally fabricated PMMA denture base resins before and after standardized thermocycling remain limited. Therefore, the aim of this in vitro study was to compare the flexural strength, elastic modulus, surface hardness, and surface roughness of PMMA denture base resins fabricated by compression molding, fluid resin processing, milling, and 3D printing before and after thermocycling. Eighty PMMA specimens were fabricated using compression molding, fluid resin, milling, and 3D printing. Flexural strength and elastic modulus were evaluated at baseline and after thermocycling using separate matched specimens because the three-point bending test was destructive, whereas surface hardness and surface roughness were measured repeatedly on the same specimens before and after thermocycling. Flexural strength and elastic modulus were assessed using a three-point bending test, while surface hardness and surface roughness were evaluated using Vickers microhardness testing and profilometry. Statistical analyses were performed at α = 0.05. Significant differences were observed among the material–processing combinations for all parameters both before and after thermocycling (P < 0.001). The 3D-printed group showed the lowest flexural strength, elastic modulus, and surface hardness and the highest surface roughness. After thermocycling, flexural strength decreased significantly in the 3D-printed and fluid resin groups (P < 0.05). Elastic modulus decreased significantly in the milled and 3D-printed groups (P < 0.01). Surface hardness decreased significantly in the milled group but increased significantly in the fluid resin group (P < 0.01). Surface roughness increased significantly in the compression-molded, milled, and 3D-printed groups (P < 0.05). Under the tested conditions, the compression-molded material showed no significant changes in flexural strength, elastic modulus, or surface hardness after thermocycling, although surface roughness increased significantly. The fluid resin material showed a significant decrease in flexural strength and a significant increase in surface hardness, while elastic modulus and surface roughness remained statistically unchanged. The milled material showed significant reductions in elastic modulus and surface hardness, together with an increase in surface roughness, whereas the change in flexural strength was not significant. The 3D-printed material exhibited the lowest initial mechanical properties and showed significant reductions in flexural strength and elastic modulus and a significant increase in surface roughness after thermocycling.
Oral diseases cluster in families and follow a strong social gradient, yet how far this familial patterning extends across generations, and whether it reflects shared socioeconomic position, is poorly understood. Most evidence is limited to parents and children and to self-reported oral health. Using clinically measured periodontitis and caries experience, we examined whether clinically measured oral health is concordant between successive generations within co-resident three-generation families, and whether any such association is attenuated after adjustment for the available socioeconomic indicators. Using the Korea National Health and Nutrition Examination Survey (2007–2018), 966 families were linked across three generations, 960 of them among the 2867 households carrying a three-generation composition code; the analysis is therefore not population-representative, and linked and unlinked households differed modestly in income, size and residence. Periodontitis (Community Periodontal Index ≥ 3; grandparent–parent dyad only) and caries experience (decayed, missing and filled teeth, DMFT) were analysed for successive generational dyads by logistic and negative binomial regression with family-clustered standard errors, before and after multivariable adjustment including household income and education; educational mobility was examined as an effect modifier. Concordance was strongest in the two adult generations: for total DMFT the parent–offspring association was weaker and compatible with the null, as was a direct grandparent–offspring analysis. In the grandparent–parent dyads, periodontitis in the two generations was associated (adjusted odds ratio 2.57, 95
This study aimed to investigate the influence of clinical crown length and attachment configuration on the rotational control of mandibular second premolars during clear aligner therapy using finite element analysis. Six three-dimensional mandibular models, including a 45º mesially rotated second premolar, were designed with two different clinical crown heights (standard and long). Three attachment strategies were tested for each crown height: (1) a single buccal beveled vertical rectangular (BVR) attachment (Models 1 and 4), (2) dual bucco-lingual BVR attachments (Models 2 and 5), and (3) a single buccal attachment combined with auxiliary elastic forces simulated via lingual buttons (Models 3 and 6). A derotation degree of 1.2º was programmed. Tooth displacement, aligner deformation, and von Mises stresses in the periodontal ligament (PDL) were analyzed. The dual-attachment configuration on long clinical crown (Model 5) yielded the greatest tooth displacement (33.34 µm) and the lowest aligner deformation (56.52 µm). Conversely, the standard crown with a single buccal attachment exhibited the least movement (22.58 µm) and the highest deformation (63.08 µm). A consistent inverse pattern was identified between aligner deformation and rotational efficiency. Regarding PDL stress, the highest peak von Mises stress (0.187 MPa) was observed in Model 2, localized primarily in the cervical region. Conversely, Model 4 yielded the lowest stress (0.131 MPa) with the most favorable distribution pattern. Increased clinical crown length (long-crown models) directly contributed to greater overall tooth displacement and rotational movement compared to standard crown lengths. This effect was most pronounced in dual-attachment configuration (Model 5). The incorporation of dual bucco-lingual BVR attachments consistently improved rotational control by enhancing aligner engagement and decreasing aligner deformation, despite concentrating PDL stress at the cervical region of the root. While auxiliary elastics were intended to facilitate movement, they yielded slightly lower rotational efficiency compared to dual attachment configurations.
This study assessed the current clinical consequences and treatment status of previous traumatic dental injuries (TDIs) affecting permanent anterior teeth among adolescents aged 15–17 years in Cairo, Egypt, and evaluated parental awareness and knowledge regarding the emergency management of TDI. A school-based analytical cross-sectional study assessing treatment history was conducted among 2,000 secondary school students aged 15–17 years using multistage stratified sampling. Stage 1: Students underwent standardized clinical examinations, during which a diagnostic chart was completed to determine the prevalence of traumatic dental injuries (TDIs), with a collection of self-reported history on trauma, sociodemographic characteristics, cause and location of injury, treatment type, time elapsed since injury, and the activity at the time of trauma. Traumatized teeth were classified as either treated or untreated. Current clinical consequences were interpreted conceptually as persistent manifestations of the original injury, possible post-traumatic clinical findings, an indeterminate structural outcome, or a patient-reported impact. Tooth-level comparisons used binary logistic generalized estimating equations (GEE) clustered by student. Stage 2: A structured questionnaire to assess parental awareness of TDI management, treatment-seeking behavior and emergency knowledge among parents of traumatized students was distributed to the parents or legal guardians of students who met the inclusion criteria, along with written informed consent. Statistical analysis included descriptive statistics, bivariate analyses, and clustering-adjusted generalized estimating equations for tooth-level clinical findings. Previous TDIs were confirmed in 340 students. A total of 350 traumatized teeth were recorded; 29 teeth were treated, and 321 were left untreated. Parental awareness questionnaires were completed by 240 parents. Clinical consequences were more frequent in untreated than treated teeth. Uncomplicated crown fracture, tooth discoloration, and esthetic complaints were the most common clinical findings. Sports and activity-related trauma contributed to nearly 70
Cention N® is an alkasite-based restorative dental material containing methacrylate monomers and ion‑releasing alkaline fillers that liberate calcium and fluoride, components that have been implicated in oxidative stress (OS) and potential DNA damage in oral epithelial tissues. This study evaluated buccal cytogenetic damage and OS associated with Cention N® restorations in children, using the buccal micronucleus cytome assay for nuclear abnormalities (NAs) and salivary malondialdehyde (MDA) as a biomarker of oxidative stress. One hundred children were recruited, including 50 caries‑free controls and 50 caries‑affected subjects who received Cention N® restorations. Buccal and attached gingival exfoliated cells and unstimulated whole saliva samples were collected at baseline and 30 days after treatment. Frequencies of NAs and salivary MDA concentrations were quantified and statistically compared between groups and time points. Children treated with Cention N® showed a significant increase in both NAs frequency and salivary MDA levels 30 days after restoration (p < 0.05), whereas controls did not exhibit significant changes. Salivary MDA levels correlated positively with NAs frequency (p < 0.05), supporting an association between oxidative and genotoxic responses in oral epithelial cells. Short-term exposure to Cention N® restorations in children was associated with higher NA frequencies in oral epithelial cells and increased salivary MDA levels, suggesting enhanced OS and buccal cytogenotoxic damage. Long‑term and mechanistic studies are warranted to determine the clinical relevance and persistence of these effects. The observed increases in NAs and MDA following Cention N® restorations in children highlight the importance of carefully balancing restorative performance with potential biological effects when selecting materials for pediatric patients and underscore the central role of caries prevention in minimizing the need for restorative treatment.
This scoping review investigated the demographic data, histological and diagnosis methods, occurrence of recurrence, treatment strategies, and survival status of metastatic lesions arising from odontogenic tumors. A search strategy was conducted in PubMed, Web of Science, and Scopus, spanning the years from 1965 to 2026. Eligibility criteria included case report publications with available full text written in English. Sixty-eight studies were included, amounting to 74 cases. The most common metastatic odontogenic tumor identified was metastasizing ameloblastoma. Patients diagnosed with the primary tumor were aged between 8 and 72 years for males and between 7 and 59 years for females. Clear cell odontogenic carcinoma was the second most prevalent tumor associated with metastasis. The mandible was the most frequent primary location. Metastases mainly affected lungs, followed by cervical lymph nodes. This research offers valuable insights that may assist clinicians, surgeons, and oral pathologists in diagnosing and managing these lesions. Due to the significant recurrence rate linked with tumors, insufficient treatment leads to numerous recurrences; thus, wide resection is regarded as the preferred method of treatment. Early diagnosis and frequent monitoring for recurrence and metastasis are essential. Concurrently, case report studies and existing literature can offer more valuable diagnostic and treatment approaches. However, the results of this review should be interpreted carefully.
Oral manifestations may precede the diagnosis of acute myeloid leukemia (AML), particularly in monocytic subtypes, but the typical findings are gingival enlargement, spontaneous bleeding, petechiae, or nonspecific ulceration. Band-like necrosis confined to the gingival margins and interdental papillae as the first clinical clue is unusual and may be misinterpreted as a local necrotizing periodontal or infectious lesion. A previously healthy 29-year-old woman presented with gingival swelling and pain for 1 month, followed by low-grade fever and fatigue for 1 week. Oral examination revealed generalized erythematous gingival swelling with band-like gray-white necrosis involving the gingival margins and interdental papillae in the bilateral posterior regions of both jaws, accompanied by punctate bleeding and tenderness. The initial complete blood count showed marked leukocytosis (134.35×10^9/L), anemia (hemoglobin, 100 g/L), thrombocytopenia (49×10^9/L), and abnormal white cells accounting for 83
Subcutaneous emphysema (SCE) is a rare condition where gas enters the subcutaneous tissue, causing swelling. This report details a 35-year-old woman who developed cervicofacial SCE after a composite resin restoration on a lower molar following a root canal. The swelling and crepitus spread to her cheek and submandibular area but resolved in ten days without major treatment. The cause is linked to pre-existing periodontal issues and procedural factors like gingival management and air-generating tools. This case highlights the risk of SCE in routine dental procedures on teeth with deep subgingival defects, emphasizing the need for caution to prevent this complication.
Complete tooth loss (edentulism) is linked to multiple adverse health outcomes, yet the role of multidimensional social disadvantage in its onset remains poorly understood. Existing evidence has largely focused on single socioeconomic indicators. We used data from two nationally representative cohorts: CHARLS (Wave 3 to Wave 4, N = 3,906) and HRS (Wave 8 to Wave 11, N = 6,135), including participants aged ≥ 50 years and dentate at baseline. A cumulative social disadvantage score (range 0–6) was constructed from six indicators: low education, low wealth, non-employment, rural residence, no social activity, and digital exclusion. Incident complete tooth loss was defined as transition from having at least one natural tooth at baseline to none at follow-up. Logistic regression estimated odds ratios (ORs) with sequential covariate adjustment. Restricted cubic splines and subgroup analyses were performed to examine dose-response patterns and effect modification. In fully adjusted models, each one-point score increment was associated with 15
The global aging population has heightened the need for comprehensive oral care in older adults, yet evolving aspects such as preventive strategies, technological advancements, and interdisciplinary approaches remain underexplored. This systematic review and qualitative meta-synthesis aimed to synthesize qualitative evidence on perceptions, experiences, barriers, facilitators, and impacts of oral care in older adults, guided by the Socio-Ecological Model. Following PRISMA and ENTREQ guidelines, a systematic search was conducted in MEDLINE (PubMed), Embase, CINAHL, PsycINFO, Scopus, and Web of Science for qualitative studies published from January 2000 to December 2025. Eligibility criteria were defined using the SPIDER framework, focusing on older adults (aged ≥ 60) and stakeholders. Two reviewers independently screened records, extracted data, and appraised quality using CASP. Thematic synthesis was performed using NVivo to generate higher-order themes. From 1,416 records, 49 studies were included, involving diverse participants from multiple countries. Four overarching themes emerged: [1] Meaning-Making and Beliefs Surrounding Oral Health (e.g., cognitive biases, links to general health, responsibility); [2] Barriers to Accessing and Maintaining Oral Care (e.g., financial, physical, systemic); [3] Facilitators, Strategies, and Ethical Considerations in Oral Care Delivery (e.g., interprofessional collaboration, education, autonomy); and [4] Oral Health as a Determinant of Quality of Life and Human Dignity (e.g., functional, psychosocial, broader implications). A conceptual model illustrated the cyclical evolution of oral care. Oral health in older adults is influenced by multifaceted perceptions and systemic factors, impacting well-being. Findings advocate for interprofessional models, policy reforms, and education to address gaps and promote equitable, holistic care. Future research should explore digital interventions and multilingual syntheses.
