Xerostomia and hyposalivation impair oral function and quality of life. Current therapies are largely palliative, and systemic sialogogues are often limited by side effects or contraindications. Intraductal salivary gland irrigation (IDSGI) has emerged as an alternative, being a minimally invasive outpatient technique aimed at relieving oral dryness by flushing and stimulation of the major salivary glands with saline or corticosteroid solutions. This technique has been described for various disorders of the salivary glands (e.g. Sjögren’s syndrome, sialadenitis), and substantial objective and subjective benefits following intraductal irrigation have been reported. The present article describes and critically appraises this technique by presenting three randomly chosen patient cases with documented hyposalivation and severe xerostomia. The patients were all treated by intraductal irrigation of their major salivary glands using sterile saline. Before and after therapy, unstimulated and stimulated whole-saliva flow rates, salivary pH, and subjective dryness using a visual analogue scale (VAS) were measured. The procedure was well tolerated with no complications by all three patients included. After one month, unstimulated and stimulated salivary flow rates increased in two cases and one patient previously treated with sialogogues showed no improvement in salivary flow rates. However, all three patients showed a decreased VAS for dryness by 30-50% with subjective improvement persisting also on later check-ups. The cases presented suggest that IDSGI represents a simple and safe outpatient procedure that can improve salivary flow and xerostomia as an adjunct to other conservative measures, particularly when systemically acting sialogogues are ineffective or contraindicated.
Klinische Beurteilung und Entscheidungsfindung in der Zahnmedizin sind variabel und von Unsicherheiten geprägt. Unterschiedliche diagnostische Gewichtungen, therapeutische Konzepte und patientenbezogene Präferenzen können selbst bei vergleichbaren Ausgangslagen stark divergierende Behandlungspläne erzeugen. Leitlinien geben Orientierung, garantieren jedoch keine einheitliche Umsetzung - insbesondere dort, wo medizinische Ziele mit ästhetischen und komfortbezogenen Zielsetzungen sowie vermeintlichen Qualitätsansprüchen zusammentreffen. Anhand eines Fallbeispiels werden erhebliche Unterschiede in Umfang und Kosten zweier Planungen dargestellt: Die Erstmeinung sah eine mehrphasige Gesamtrehabilitation vor, während die Zweitmeinung eine schrittweise, bewusst risiko- und erhaltungsorientierte Strategie verfolgte. Unabhängige Drittmeinungen aus dem universitären Setting konvergierten ebenfalls in Richtung des letzteren Vorgehens. Zur Einordnung dieser Behandlungsbandbreite wurde ein dreistufiges heuristisches Modell vorgeschlagen, das zwei Ebenen verbindet: Analytisch ordnet es die Optionen nach ihrer Begründungsbasis; normativ kennzeichnet es einen Bereich, in dem eine erhöhte ethische Rechtfertigungslast besteht. Heuristisch ist dabei im Sinne einer Faustregel bzw. eines pragmatischen Orientierungsrahmens für die Entscheidungsfindung zu verstehen: 1) "Need" bezeichnet indikationsbasierte, medizinisch erforderliche Versorgung, 2) "Want" beschreibt legitime, präferenzsensitive Optimierungen innerhalb vertretbarer Grenzen und 3) "Greed" zielt als normativer Warn- und Grenzbegriff auf Konstellationen ab, in denen Leistungsumfang und Kosten über eine ausreichend transparente Zusatznutzenbegründung hinaus ausgedehnt werden. Das Modell dient nicht der Klassifikation in „richtig“ oder „falsch“, sondern der vergleichbaren Darstellung von Nutzen–Risiko–Kosten, Alternativen, Irreversibilität und Folgekosten im Shared-Decision-Making.
Fibrodysplasia ossificans progressiva is a rare genetic disorder characterized by progressive heterotopic ossification, which may lead to severe functional impairment. Orofacial involvement can result in marked restriction of jaw movement up to extra-articular temporomandibular ankylosis, severely complicating oral hygiene, diagnostics and dental treatment. This case report describes a 25-year-old male patient with advanced fibrodysplasia ossificans progressiva and complete jaw immobility with a maximum interincisal opening of 0 mm. He presented himself with daily dental pain, poor oral hygiene and recurrent swelling episodes. Conventional dental radiography was not feasible. Computed tomography revealed a permanent dentition except tooth 38, marked crowding and several malpositioned, non-occluding posterior teeth without obvious periapical pathology, marked periodontal bone loss or gross carious lesions. After interdisciplinary planning, including anesthesiologic consultation and expert advice in fibrodysplasia ossificans progressiva care, removal of the posterior teeth was performed to improve oral cleanability, reduce the risk of inflammatory complications in inaccessible posterior regions, facilitate nutrition within the existing limitations and improve emergency access for suction in case of vomiting. Local injection techniques were avoided because of the risk of iatrogenic heterotopic bone formation. The procedure was performed under general anesthesia with awake fibreoptic nasotracheal intubation and standby tracheostomy, using a strict soft-tissue-sparing approach and meticulous avoidance of positioning trauma. The patient was monitored for two nights and recovered without complications. At 11-month follow-up, he remained free of dental pain and recurrent swelling episodes and reported improved food intake with a weight gain of 8 kg. This case highlights the importance of preventive dentistry, strict indication for invasive procedures, multidisciplinary planning, airway preparedness, maximal trauma avoidance and long-term dental follow-up in specialized centers.
The threat of antibiotic resistance has been a global public health issue. This problem is often aggravated by inappropriate antibiotic administration, including those after the third molar surgery. Thus, systemic antibiotic use in third molar surgery should be considered strictly. The use of antiseptics after third molar surgery, such as chlorhexidine, may help prevent postoperative complications; therefore, its use should be encouraged. This study aimed to determine whether chlorhexidine is beneficial in preventing alveolar osteitis without systemic antibiotics. This review was conducted to determine whether chlorhexidine is beneficial in preventing alveolar osteitis (AO) and was designed according to the PICO model. Alternating combinations of keywords were used, including "third molar surgery," "chlorhexidine," "mouthwash," "wound dressing," and "irrigation" to search PubMed, Cochrane Library, and Scopus. Clinical studies of third molar surgery that reported clinical outcomes after postoperative chlorhexidine supplementation without systemic antibiotic prescription were included. Twelve studies were included in the meta-analysis. The incidence of alveolar osteitis (AO) in the chlorhexidine group was significantly lower than that in the control group (9.58% vs. 16.8%, P < 0.0001). Chlorhexidine reduced the risk of AO by 42.9%. The use of chlorhexidine can effectively prevent AO and should be considered good clinical practice to mitigate antimicrobial resistance.
Fibrodysplasia ossificans progressiva is a rare genetic disorder characterized by progressive heterotopic ossification, which may lead to severe functional impairment. Orofacial involvement can result in marked restriction of jaw movement up to extra-articular temporomandibular ankylosis, severely complicating oral hygiene, diagnostics and dental treatment. This case report describes a 25-year-old male patient with advanced fibrodysplasia ossificans progressiva and complete jaw immobility with a maximum interincisal opening of 0 mm. He presented himself with daily dental pain, poor oral hygiene and recurrent swelling episodes. Conventional dental radiography was not feasible. Computed tomography revealed a permanent dentition except tooth 38, marked crowding and several malpositioned, non-occluding posterior teeth without obvious periapical pathology, marked periodontal bone loss or gross carious lesions. After interdisciplinary planning, including anesthesiologic consultation and expert advice in fibrodysplasia ossificans progressiva care, removal of the posterior teeth was performed to improve oral cleanability, reduce the risk of inflammatory complications in inaccessible posterior regions, facilitate nutrition within the existing limitations and improve emergency access for suction in case of vomiting. Local injection techniques were avoided because of the risk of iatrogenic heterotopic bone formation. The procedure was performed under general anesthesia with awake fibreoptic nasotracheal intubation and standby tracheostomy, using a strict soft-tissue-sparing approach and meticulous avoidance of positioning trauma. The patient was monitored for two nights and recovered without complications. At 11-month follow-up, he remained free of dental pain and recurrent swelling episodes and reported improved food intake with a weight gain of 8 kg. This case highlights the importance of preventive dentistry, strict indication for invasive procedures, multidisciplinary planning, airway preparedness, maximal trauma avoidance and long-term dental follow-up in specialized centers.
Periodontitis is currently understood as a multifactorial, biofilm-associated, and immunoinflammatory disease. Modern dietary patterns, often characterized by a high intake of free sugars and ultra-processed foods, deviate from evolutionary adaptations and are frequently associated with systemic inflammatory processes. This position paper by the Swiss Society of Periodontology (SSP) evaluates the role of nutrition as a modifiable risk factor and integrates nutritional considerations across all phases of periodontal therapy. Available evidence suggests that a plant-based, fiber-rich, and low-sugar diet can reduce gingival inflammation and support microbial homeostasis in prevention (Stage 1). During the active therapy phases (Stages 2 and 3), the modulation of the host response by nutrients may be clinically relevant. Adjunctive intake of omega-3 fatty acids and antioxidants appears to positively influence the outcomes of non-surgical therapy, while an adequate supply of proteins and vitamin D is discussed as a supportive factor for wound healing following surgical interventions. In supportive periodontal care (SPC/ Stage 4), a sustained anti-inflammatory dietary pattern may support long-term stability. Consequently, nutrition should be considered an integral, modifying component of periodontal care that meaningfully complements mechanical therapy.
A 28-year-old patient was referred to the Oral Surgery and Implantology Unit at Geneva University Hospitals for extraction of the mandibular third molars following multiple episodes of pericoronitis. A two-dimensional panoramic radiograph (PAN) showed a subtle radiopaque image apparently superimposed on the roots of the third molar, projected over the course of the inferior alveolar canal, suggesting of a close relationship between the inferior alveolar nerve (IAN) and the apices of tooth 38 evoking a nerve conflict. To further assess this apparent anatomical relationship, a three-dimensional cone-beam computed tomography (CBCT) scan was performed. The CBCT demonstrated no direct contact between the mandibular third molar and the inferior alveolar nerve canal. Instead, it revealed a well-defined radiopaque lesion adjacent to the nerve canal, separate from the tooth roots, consistent with idiopathic osteosclerosis. This case highlights the limitations of two-dimensional imaging in evaluating complex anatomical relationships in the posterior mandible. When panoramic radiography shows equivocal findings due to superimposition and suggests a potential nerve–tooth conflict, three-dimensional imaging is essential for accurate diagnosis and treatment planning.
Die segmentale odontomaxilläre Dysplasie (SOD) ist eine seltene, nicht hereditäre Entwicklungsstörung, die eine Seite der Maxilla betrifft und sich auf das Hart- und Weichgewebe sowie die Dentition im betroffenen Bereich auswirkt. Die Erkrankung geht häufig mit einer Vergrößerung des Weich- und Hartgewebes im betroffenen Bereich und Zahnanomalien einher, gelegentlich auch mit kutanen Manifestationen. SOD ist eine nicht progrediente Entwicklungsstörung. Zur Überwachung der dentoalveolären Entwicklung werden jährliche klinische und radiologische Nachuntersuchungen empfohlen. Kieferorthopädische Behandlungen und dentoalveoläre Eingriffe gelten als erfolgreiche Behandlungsoptionen. Wir stellen einen Fall eines Patienten mit SOD vor und diskutieren die Rolle des Zahnarztes bei der Früherkennung und die Bedeutung der Nachsorge betroffener Patienten.
Wurzelresorptionen sind ein pathologischer Vorgang, welcher viele Ursachen haben kann und verschiedene Folgen mit sich zieht. Dieser Fall zeigt einen Patienten mit multiplen stark fortgeschrittenen Wurzelresorptionen. Die klinischen und radiologischen Befunde sprachen für Ersatzresorptionen und cervikale Resorptionen. Die histologische Untersuchung des einen entfernten Zahns zeigte unspezifische Befunde ohne Anhalt auf eine Ersatzresorption. Die Ursache für die Resorptionen in diesem Fall bleibt unklar, auch wenn eine mögliche Verbindung mit einem Testosteronmangel in Betracht gezogen wird.
This comparative cross-sectional study aimed to determine the association between periodontitis severity and tooth loss (TL) with gastric cancer (GC) in adult patients. It was conducted between February and April 2025 at the "Virgen de la Puerta" High-Complexity Hospital and the "Dr. Luis Pinillos Ganoza" Regional Institute of Neoplastic Diseases - IREN NORTE in Trujillo (Peru). A total of 240 adult patients were evaluated: 120 without gastric cancer (NGC) and 120 with GC. Inter- and intra-rater calibration was performed to diagnose periodontitis, tooth loss, bleeding on probing (BOP), and dental plaque control (DPC). GC was diagnosed by the hospital's specialist oncologist. Statistical analysis included bivariate and multivariate models, with a significance level of P < 0.05. Results showed an association between periodontitis severity and GC (P = 0,001); nevertheless, there was no association between TL and GC (P = 0.966). The GC prevalence increased among patients with severe periodontitis (P < 0.0001), among men (P = 0.027), and among those aged <70 years. In conclusion, severe periodontitis is associated with GC, whereas TL is not.
This comparative cross-sectional study aimed to determine the association between periodontitis severity and tooth loss (TL) with gastric cancer (GC) in adult patients. It was conducted between February and April 2025 at the "Virgen de la Puerta" High-Complexity Hospital and the "Dr. Luis Pinillos Ganoza" Regional Institute of Neoplastic Diseases – IREN NORTE in Trujillo (Peru). A total of 240 adult patients were evaluated: 120 without gastric cancer (NGC) and 120 with GC. Inter- and intra-rater calibration was performed to diagnose periodontitis, tooth loss, bleeding on probing (BOP), and dental plaque control (DPC). GC was diagnosed by the hospital's specialist oncologist. Statistical analysis included bivariate and multivariate models, with a significance level of P < 0.05. Results showed an association between periodontitis severity and GC (P = 0,001); nevertheless, there was no association between TL and GC (P = 0.966). The GC prevalence increased among patients with severe periodontitis (P < 0.0001), among men (P = 0.027), and among those aged <70 years. In conclusion, severe periodontitis is associated with GC, whereas TL is not.
Xerostomia and hyposalivation impair oral function and quality of life. Current therapies are largely palliative, and systemic sialogogues are often limited by side effects or contraindications. Intraductal salivary gland irrigation (IDSGI) has emerged as an alternative, being a minimally invasive outpatient technique aimed at relieving oral dryness by flushing and stimulation of the major salivary glands with saline or corticosteroid solutions. This technique has been described for various disorders of the salivary glands (e.g. Sjögren’s syndrome, sialadenitis), and substantial objective and subjective benefits following intraductal irrigation have been reported. The present article describes and critically appraises this technique by presenting three randomly chosen patient cases with documented hyposalivation and severe xerostomia. The patients were all treated by intraductal irrigation of their major salivary glands using sterile saline. Before and after therapy, unstimulated and stimulated whole-saliva flow rates, salivary pH, and subjective dryness using a visual analogue scale (VAS) were measured. The procedure was well tolerated with no complications by all three patients included. After one month, unstimulated and stimulated salivary flow rates increased in two cases and one patient previously treated with sialogogues showed no improvement in salivary flow rates. However, all three patients showed a decreased VAS for dryness by 30-50% with subjective improvement persisting also on later check-ups. The cases presented suggest that IDSGI represents a simple and safe outpatient procedure that can improve salivary flow and xerostomia as an adjunct to other conservative measures, particularly when systemically acting sialogogues are ineffective or contraindicated.
Enamel pearls are developmental anomalies caused by enamel formation in atypical locations during tooth development. While the exact etiology of these developmental anomalies remains unclear, they occur in approximately 2-6 % of the population. In this case report, a 15-year-old female presented with pain in the region of the right maxillary first molar. Radiographic imaging showed a periapical radiolucency and an opaque mass in the furcation area. Cone-beam computed tomography (CBCT) identified a round radiodensity consistent with an enamel-dentin pearl, which probably promoted the development of periodontal destruction due to a lack of periodontal attachment from the cemento-enamel junction to the furcation area. Due to its unfavorable location, tooth extraction was unavoidable. Histologic examination confirmed a large enamel pearl connected to the crown enamel via an enamel spur. Alternating layers of enamel, cementum-like tissue, and cementicles were observed. Enamel-dentin pearls, although rare, can lead to severe periodontal destruction. Advanced imaging, such as CBCT, is vital for accurate diagnosis and treatment planning. In this case, despite precise localization, conservative treatment was unfortunately not possible.
Dysphagia management in older adults often involves the use of oral thickening agents to modify the consistency of foods and liquids and thereby, reduce the risk of aspiration. Currently, there is limited evidence on the cariogenic potential of these agents and the consequences for oral health in elders. This pilot, comparative in-vivo study evaluated the cariogenicity of four commercially available thickening agents in water: Ensure Multi-thick, Thick & Easy, Thicken Up Clear, and Thicken Up Gel Express. The products were tested in three older adult volunteers (n = 8 tests; two replicates per product across four products) using intraoral plaque pH telemetry. Absolute cariogenicity (AC) was assessed via acidogenic potential (area under the pH-curve below 5.7), and relative cariogenicity (RC) was calculated relative to a 10 % glucose control rinse. One-way ANO-VA was used to compare mean AC and RC across products. All four products demonstrated measurable cariogenicity (AUC < 5.7). Mean AC ranged from 13.70 (Thick & Easy) to 21.62 (Thicken Up Gel Express). Thicken Up Clear and Thicken Up Gel Express showed narrow standard deviations (SD = 0.09 and 0.49, respectively); Ensure Multi-thick showed high variability (SD = 21.02). RC values were highest for Thicken Up Gel Express (0.81 ± 0.15), then Thicken Up Clear (0.68 ± 0.08), and lower for Ensure Multi-thick (0.42 ± 0.42) and Thick & Easy (0.43 ± 0.36). The ANOVA revealed no statistically significant differences among products (P > 0.05). Within the limitations of this pilot study, all tested thickening agents showed moderate relative cariogenicity that may be clinically relevant in older adults with existing caries risk factors. These preliminary findings suggest that product selection and preventive oral care strategies are important when thickening agents are used for dysphagia management. Further analyses with larger samples and in vivo clinical outcomes are needed to confirm and extend these results.
Segmental Odontomaxillary Dysplasia (SOD) is a rare, non-hereditary developmental disorder affecting one side of the maxilla, impacting hard and soft tissue as well as dentition in the affected area. The condition is often associated with enlargement of soft and hard tissue on the affected area and dental anomalies, with occasional cutaneous manifestation. SOD is a non-progressive developmental disorder. Annual clinical and radiological follow-ups are recommended to monitor dentoalveolar development. Orthodontic treatments and dentoalveolar interventions are considered successful treatment options. We present the case of a patient suffering from SOD and discuss the dentist's role in early detection and the importance of the follow-up care of affected patients.
This case report describes an autologous tooth transplantation from tooth 38 to tooth 36 associated with atypical displacement of teeth 36 and 37. It demonstrates the osteogenic potential of desmodontal cells in tooth transplantation. The pronounced bone defect in region 36/37 after removal of 36 and the cranially located 37 was completely filled by transplantation of the tooth germ 38 in combination with subsequent orthodontic alignment over the course of 8 months through complete regeneration of the alveolar process. The case shows that tooth autotransplantation and subsequent orthodontic fine adjustment can result in significant regeneration of locally missing alveolar bone.
In view of the increasing prevalence of dental erosion and erosive tooth wear, preventive approaches are increasingly becoming the focus of interest. A proven way to reduce the erosive potential of food and drinks is adding calcium. However, whole meals and the taste of calcium-enriched drinks have not been studied. This study aimed to create erosion-protective recipes for food and beverages. In part 1, erosive meals were modified with calcium-rich ingredients. In part 2, varying amounts of CaCl₂ were added to acidic drinks. A sensory panel assessed flavour. Caries-free human teeth served as enamel test specimens. After a 2-hour saliva immersion to form a pellicle, the specimens were exposed to the test solution (food blended, drinks mixed with CaCl₂) under constant agitation. After 2 minutes, Vickers hardness was measured. Calcium-rich food ingredients significantly reduced enamel softening. The addition of CaCl₂ to drinks showed mixed results - ineffective in Coca-Cola, most effective in orange juice. Some drinks tasted saltier or bitter. The modified recipes offer erosion protection and may help patients to change their diet without losing enjoyment. Overall, the study highlights the link between dentistry and nutrition and encourages collaboration.
This pilot study investigates the morphological changes and end-rounding quality of polyamide 6.12 (PA 6.12) toothbrush filaments over six months of regular use. Ten adult participants (N=10) used standardized manual toothbrushes twice a day, and filament tips were sampled at four intervals: baseline, 90, 180, and 360 brushing cycles. Using 360° rotational microscopy, the study assessed filament geometry and surface residues. Results showed a decline in acceptably rounded filaments decreased from 64% at baseline to 29% after 360 cycles, whereas surface residues decreased significantly from 87% in the unused state to 17% and 18% after 180 and 360 brushing cycles. Rotational analysis revealed asymmetrical wear and angle dependent damage, often missed by static imaging. These findings suggest that residues on new toothbrushes may originate from manufacturing processes or micro-plastic contamination, highlighting the importance of rinsing new brushes before use. The study demonstrates that longitudinal in vivo evaluation with 360° microscopy enables precise assessment of surface residues and tip rounding quality under real-world brushing conditions.
Large language models (LLMs) are increasingly used in clinical and educational settings. However, there is a paucity of data on LLMs' performance in specialized dental domains. This study assessed the performance of four LLMs, including two general-purpose models, ChatGPT-4o and DeepSeek-R1, and two research-focused models, Consensus and Perplexity, using a validated set of 50 multiple-choice questions in periodontology. Each LLM completed five independent trials encompassing the full question set under both primed and non-primed conditions. A validated answer key served as the benchmark. Performance was analyzed using one-way and two-way analysis of variance and independent-samples t-tests, with additional item-level analyses to identify questions that were consistently difficult. Overall accuracy across all models and trials was 65.0% (95% confidence interval: 63.4-66.6%) with a standard deviation of 3.0. There were no significant differences between models (p = 0.336). Role-specific priming, in which models were instructed to respond as board-certified periodontists, did not improve performance (p = 0.836). At the item level, four questions were never answered correctly, and several others were answered correctly in fewer than 13% of trials. These difficult items generally required detailed procedural knowledge, rare factual recall, or application of classification frameworks. Overall, these findings suggest that current LLMs demonstrate moderate domain knowledge in periodontology but fall short of the reliability required for unsupervised clinical decision support.
