Abstract Aim The intricate architecture of multirooted teeth challenges access to the furcation for treatment. This study aimed to assess the clinical and radiographic efficacy of oxygen-releasing oral gel and 0.8% hyaluronic acid gel along with hydroxyapatite bone graft to treat Class II furcation defects. Methodology Overall, 45 (one site per participant, aged from 20 to 60 years) mandibular molars with periodontitis (stage II and stage III, grade A and B) and class II buccal furcation defects were treated in this study. Selected sites were randomly divided into three groups. In group 1, placebo gel was placed after open flap debridement (OFD), in group 2- 0.8% hyaluronic acid gel + hydroxyapatite bone graft was placed after OFD, and, in group 3, oxygen-releasing oral gel + hydroxyapatite bone graft was placed after furcation defect OFD. Clinical parameters such as gingival index, plaque index, relative vertical clinical attachment level, relative horizontal clinical attachment level, and probing pocket depth were recorded at baseline and six months later. Radiographic measurements—intra bony defect & % bone fill—were measured and calculated by cone beam computed tomography. Results: The mean reduction in intra bony defect was highest in Group 3 (1.433±0.594), followed by Groups 2 (1.000 ± 0.000) and 1 (0.700±0.414). Group 1 showed the lowest mean bone fill (34.69%±12.14), which was significantly lower than in Groups 2 (46.87%±4.71) and 3 (50.93%±4.62), with p-values of (p<0.001) in both comparisons. Conclusion Within the limitations of this study, its results imply that oxygen-releasing gel along with hydroxyapatite bone graft in surgical periodontal therapy to treat class II furcation defects has shown superior regenerative potential. Clinical Trial Register: CTRI/2025/02/081311
INTRODUCTION:Diabetes mellitus impairs oral mucosal wound healing by prolonging inflammation and disrupting angiogenesis and growth factor regulation. AIM:To evaluate the effects of Ora-Aid (TBM Corporation, Gwangju, Republic of Korea) and cyanoacrylate (GluStitch, City of Industry, CA, USA) on palatal wound healing in diabetic and healthy rats. METHODOLOGY:A total of 146 male Wistar albino rats were used: 144 were divided into six groups: control (C), cyanoacrylate (CY), Ora-Aid (OA), diabetes (D), diabetes+cyanoacrylate (DCY), and diabetes+Ora-Aid (DOA) (n=24 each; 8 per time point), and 2 served as baseline controls. Diabetes was induced by intraperitoneal streptozotocin (STZ; Santa Cruz Biotechnology, Texas, USA) at 60 mg/kg. A 4-mm palatal excisional wound was created. Wound area was measured from photographs using ImageJ v1.54g (Wayne Rasband, National Institutes of Health, USA). Immunohistochemical analyses assessed vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), interleukin-10, and tumor necrosis factor-alpha. Data were analyzed using the Kruskal-Wallis test and Bonferroni-adjusted Mann-Whitney U tests. Statistical significance was evaluated based on adjusted p-values, with p<0.05 considered significant. RESULTS:In healthy rats, wound areas after cyanoacrylate and Ora-Aid were similar to controls. In diabetic rats, both wound dressings reduced wound area, particularly on day 14 [median (IQR): D, 0.33 (0.82); DCY, 0.27 (0.71); DOA, 0.09 (0.09); D vs DCY, p=0.037; D vs DOA, p=0.002]. Immunohistochemical analyses showed that Ora-Aid more pronouncedly affected VEGF expression in healthy groups and FGF expression in diabetic groups, whereas cyanoacrylate showed time-dependent effects on growth factors and inflammatory markers. CONCLUSION:Ora-Aid and cyanoacrylate positively influenced oral mucosal wound healing under diabetic conditions. Ora-Aid more prominently supported the VEGF-related angiogenic response under healthy conditions and FGF-related fibroblastic activity under diabetic conditions, whereas cyanoacrylate showed time-dependent regulatory effects on growth factors and the inflammatory response.
Abstract Introduction Forkhead box O3a (FOXO3a) is a stress-responsive transcription factor involved in cellular differentiation across multiple tissues. However, its role in odontoblast differentiation and dentin matrix formation remains poorly defined. Objective This study investigated the functional involvement of FOXO3a in odontoblast differentiation and its association with key odontogenic regulators. Methodology Human dental pulp cells (HDPCs) were induced to undergo odontoblast differentiation in vitro. FOXO3a gene and protein expression patterns were examined during differentiation and in postnatal Sprague Dawley rat molars. Gain- and loss-of-function approaches assessed the role of FOXO3a in odontogenic differentiation. Odontoblast marker expression, alkaline phosphatase activity, and mineralized matrix formation were evaluated. RUNX2 transcriptional activity was analyzed using promoter reporter assays, and the interactions between FOXO3a and AKT signaling were examined through pharmacological modulation. Results FOXO3a expression increased during early odontoblast differentiation. FOXO3a silencing reduced odontogenic marker expression, including DSPP, DMP1, and RUNX2, and significantly attenuated mineralization, whereas FOXO3a overexpression enhanced these effects. FOXO3a increased RUNX2 transcriptional activity and cooperated with RUNX2 to regulate DSPP promoter activity. AKT activation partially rescued odontogenic marker expression in FOXO3a-silenced cells, supporting functional interplay between these pathways. Conclusions FOXO3a contributes to odontoblast differentiation by coordinating with RUNX2-associated transcriptional activity and interacting dynamically with AKT signaling. FOXO3a may represent a regulatory component of dentin matrix gene expression, relevant to regenerative endodontic applications.
Abstract Objective: To investigate associations among periodontal parameters, glycated hemoglobin (HbA1c), and metabolic parameters in adults with and without type 2 diabetes mellitus (T2D). Methodology: A cross-sectional study included 74 adults diagnosed with periodontitis according to the current periodontal classification of 2018. Participants underwent a full-mouth periodontal examination, laboratory assessment, and Body Mass Index (BMI). Periodontitis was categorized into Stages I/II and Stages III/IV. HbA1c, lipid profile, high-sensitivity C-reactive protein (CRP), and insulin resistance (HOMA-IR) were assessed. Periodontal inflammatory burden was quantified using the Periodontal Inflamed Surface Area (PISA). Non-parametric tests and Spearman correlation analyses were performed, stratified by diabetes status (α=5%). Results: Individuals with advanced periodontitis (Stages III/IV) had significantly higher HbA1c levels (6.8% vs. 5.8%; p=0.007), higher triglyceride concentrations (142.0 vs. 100.5 mg/dL; p=0.016), and lower HDL-cholesterol levels (46.0 vs. 52.0 mg/dL; p=0.012) than those in Stages I/II. Poor glycemic control (HbA1c >8.5%) and T2D duration ≥10 years were significantly associated with advanced stages (p<0.05). No significant differences were observed for BMI, LDL, total cholesterol (TC), CRP, or HOMA-IR between groups. In adults with T2D, PISA correlated positively with TC and LDL-cholesterol, whereas in non-diabetic individuals, PISA was associated primarily with triglycerides. Conclusions: Advanced periodontitis was associated with poorer glycemic control and a more atherogenic lipid profile, particularly characterized by elevated triglycerides and reduced HDL-cholesterol. The findings support periodontitis as a potential marker of systemic metabolic dysregulation and reinforce the importance of integrating periodontal care into cardiometabolic risk management strategies.
INTRODUCTION:Pulp stones are radiopaque calcified masses located within the coronal or radicular pulp tissue. They are typically asymptomatic and detected incidentally on radiographic examination. Global prevalence estimates vary widely, and methodological inconsistencies across studies hinder a comprehensive understanding of their epidemiology. Therefore, this systematic review aimed to answer the following question: "What is the global prevalence of pulp stones, and what factors are associated with their occurrence?" Aim: To systematically review and synthesize the evidence on the global prevalence of pulp stones and to identify factors associated with their occurrence. METHODOLOGY:Six electronic databases were searched up to March 2024. Data extraction included participant demographics, diagnostic methods, tooth type, and the presence of systemic diseases. Risk of bias was assessed using the JBI checklist, and prevalence was pooled using random-effects meta-analyses at individual and tooth levels. Meta-regression was performed to explore potential sources of heterogeneity, and the certainty of evidence was assessed using GRADE. RESULTS:Twenty-four studies comprising 10,738 individuals and 94,416 teeth met the inclusion criteria. Pulp stones were present in 46% of individuals and 20% of teeth, with substantial heterogeneity across studies. Meta-regression identified systemic conditions and tooth type as significant contributors to prevalence variability. Individuals with both cardiovascular and renal diseases exhibited a higher prevalence (β=0.31, p=0.04), whereas those with cardiovascular diseases alone showed a lower prevalence (β=-0.33, p=0.04) than healthy participants (R2= 26.0). Risk of bias was moderate in most studies, and the overall certainty of evidence was very low. CONCLUSION:Pulp stones are highly prevalent, and their occurrence may be influenced by systemic conditions and tooth-related factors. However, these findings are based on very-low-certainty evidence and are limited by heterogeneity and methodological inconsistencies across the included studies.
Abstract Objectives: This study aimed to investigate the association between serum vitamin D3 levels and gingival crevicular fluid (GCF) osteocalcin and N-terminal telopeptide (NTx) levels in periodontally healthy patients and those living with periodontitis. Methodology: This study included 120 non-smoking males aged from 25 to 40 years (60 healthy patients and 60 with periodontitis). Each group was further subdivided into three subgroups according to serum 25-hydroxyvitamin D3 (25[OH]D3) levels: 0–10, 11–20, and 21–30 ng/mL. GCF samples were collected from the buccal sites of maxillary premolar or molar teeth. GCF osteocalcin and NTx levels were measured using enzyme-linked immunosorbent assay and statistically analyzed. Results: Total osteocalcin levels were significantly higher in healthy individuals than in those with periodontitis (p<0.001). The lowest osteocalcin levels were found in patients with periodontitis with 0–10 ng/mL vitamin D3 (p=0.001). Total NTx levels showed no significant differences between groups (p=0.148), but among healthy individuals, NTx decreased with increasing vitamin D3 (p=0.049). Conclusion: Patients with periodontitis and severe vitamin D3 deficiency showed the lowest GCF osteocalcin levels, suggesting that vitamin D3 deficiency may be associated with further alterations in local bone turnover activity in periodontal disease. Further studies are needed to explain these relationships. ClinicalTrials.gov (Trial ID: NCT06871631)
Abstract Objective: Thermosensitive hydrogels have emerged as promising localized drug delivery systems for periodontal therapy. Curcumin possesses anti-inflammatory and antimicrobial properties but is limited by its poor solubility and bioavailability. This study aimed to develop and evaluate a curcumin-loaded chitosan thermosensitive hydrogel for periodontal application. Methodology: This in vitro experimental study included five groups as positive controls, negative control, blank chitosan hydrogel, free curcumin, curcumin-loaded hydrogel, and chlorhexidine (0.12%). The hydrogel was formulated using chitosan and β-glycerophosphate and was characterized for thermosensitive gelation and injectability. Drug release was assessed using dialysis. Cytocompatibility was evaluated in human gingival fibroblasts (HGF-1) using the MTT assay at 24, 48, and 72 h. The anti-inflammatory activity was assessed by measuring the levels of TNF-α and IL-1β in LPS-stimulated cells. Antibacterial activity (MIC/MBC) and antibiofilm efficacy were tested against Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Data were analyzed using ANOVA with the appropriate post-hoc tests (p<0.05). Results: The curcumin-loaded hydrogel showed high cell viability (>90%) and significantly reduced TNF-α and IL-1β levels when compared with free curcumin. It demonstrated improved antibiofilm activity (∼74–79%) and lower MIC values than free curcumin, although slightly less effective than chlorhexidine. A sustained drug release profile (∼81.6% at 14 days) following Korsmeyer–Peppas kinetics was observed. Conclusion: The curcumin-loaded chitosan thermosensitive hydrogel showed improved biological performance and sustained release when compared with free curcumin, suggesting its potential as a localized periodontal drug delivery system. Further in vivo studies are required to validate these findings.
Abstract Despite the potential of nanofibers to reinforce poly(methyl methacrylate) (PMMA) denture base resins, no consensus exists regarding their effects on material properties. This systematic review and meta-analysis aimed to evaluate whether the incorporation of nanofibers into PMMA denture base resins improves flexural strength and other physicomechanical properties when compared with unmodified PMMA. Methodology: This study followed PRISMA guidelines and was registered on the Open Science Framework (). Searches were conducted on Medline/PubMed, Scopus, Cochrane Library, Web of Science, EMBASE, Lilacs, and SciELO. Eligibility criteria included in vitro or in vivo studies comparing nanofiber-reinforced PMMA to conventional PMMA. The meta-analysis was conducted for flexural strength (the only property assessed in all studies). A subgroup meta-analysis was performed to explore heterogeneity between studies. Results: From the 1,893 initially screened articles, six were included. The investigated nanofibers included carbon, acrylonitrile-butadiene-styrene, polyamide-6, polystyrene, cellulose, PMMA–cerium, and polyvinyl alcohol at concentrations from 0.1 to 23%. The evaluated properties included impact strength, flexural strength, fracture resistance, hardness, elasticity, toughness, surface roughness, contact angle, and spectrophotometric color analysis. While the qualitative analysis showed divergent findings regarding property improvement, the quantitative analysis revealed no significant differences in flexural strength between nanofiber-reinforced PMMA and conventional PMMA at the evaluated concentrations: PMMA vs. 0.5% PMMA (p=0.554), PMMA vs. 1% PMMA (p=0.847), PMMA vs. 3% PMMA (p=0.9825), and PMMA vs. 5% PMMA (p=0.222). However, subgroup analysis indicated higher flexural strength for the conventional PMMA when compared with nanofiber-reinforced PMMA, particularly at higher nanofiber concentrations (p<0.0001). Conclusion: Incorporating nanofibers into PMMA resulted in no significant increase in flexural strength, showing inconsistent effects on other physicomechanical properties. Therefore, further standardized laboratory and clinical studies are needed to clarify its efficacy and clinical applicability.
Abstract Objective This study aimed to analyze the functional adaptations of tongue base volumetric enlargement and reduction on the kinematics of oropharyngeal structures during respiration in a minipig model. Methodology Six same-sex sibling pairs of 8-to-9-month-old Yucatan minipigs were studied. Of each pair, one was diet-induced obese with a BMI>50 (obesity-associated volume enlargement) while the other was normal-weight and underwent partial ablation of the tongue base volume (volume-reduction). Real-time X-ray video fluoroscopic images (30 frames/s) were recorded under sedation, at baseline (before surgery) and 5 weeks postoperatively. Selected landmarks of the soft palate, epiglottis, tongue base, and pharyngeal wall were digitized frame by frame for 25–30 respiratory cycles. Directional movements and distance changes of these oropharyngeal structures were analyzed within the defined coordinate system using video-analysis software. Correlations between areas of airway spaces during respiration and biometric measurements of the dissected tongue at week 5 were included. Results During respiratory phases, movement distances of the soft palate and the pharyngeal wall were significantly larger in the volume-reduced group than in the volume-enlarged group at baseline (p<0.05). These moving distances were also larger compared to those of the volume-enlarged group at both time points. Similarly, distance changes during inspiration between structures (soft palate-pharyngeal wall, soft palate-tongue base, and epiglottis-pharyngeal wall) were significantly larger at week 5 than at baseline (p<0.05) in both groups. Positive correlations during respiratory phases were detected between tongue volume and velopharyngeal width in the volume-reduced group (r=0.86, p<0.05). Negative correlations occurred between retromolar space area and tongue thickness in the volume-enlarged group (r=−0.9, p<0.05). Conclusions These results suggest that oropharyngeal spatial dynamics are enhanced in the tongue base volume-reduced minipigs, with altered moving patterns during respiration. In contrast, smaller distance changes observed over time in the volume-enlarged group suggest continuous airway narrowing and potential restriction of airway dynamics.
CORRESPONDENCE:Ebru Kucukyılmaz Izgı - Izmir Katip Celebi University - Faculty of Dentistry - Department of Pediatric Dentistry - Cigli - Izmir - Turkey - E-mail: ebrukucukyilmaz@hotmail.com - Tel: +902323524040. PURPOSE:This study aimed to evaluate the effects of various therapeutic agents on dentin tissue in the management of dentin hypersensitivity. METHODOLOGY:Overall, 30 caries-free human third molars were sectioned into dentin specimens (n=120) and randomly assigned to control or treatment groups (Curodont™ D'Senz, PRG Barrier Coat, and Curodont™ Repair). After 24 h of artificial saliva storage, dentin microhardness, surface morphology, open dentin tubule count, elemental composition, and penetration depth were evaluated using Vickers microhardness testing, SEM/EDS, and CLSM. Statistical analyses were conducted with a 0.05 significance level. RESULTS:The microhardness measurements showed a statistically significant increase in all groups in comparison with the control group (p<0.05), with no significant differences between the treated groups (p>0.05). EDS analysis showed statistically significant differences between the groups, with the highest calcium and phosphorus levels observed in the PRG Barrier Coat group (p<0.05). SEM analysis showed that the PRG Barrier Coat treatment resulted in the most extensive tubule occlusion and the smallest open tubule diameters (p<0.05). Curodont™ D'Senz and PRG Barrier Coat showed the most significant tubule penetration depths and the highest laser fluorescence values, as per CLSM analyses (p<0.001). CONCLUSION:The findings suggested that the tested materials may occlude dentinal tubules and penetrate dentin to varying extents, with PRG Barrier Coat showing the most pronounced effect. Self-assembling peptide-based agents show limited short-term efficacy but offer potential for biomimetic remineralization.
BACKGROUND:Periodontitis affects millions of people and is characterized by the accumulation of bacteria in the gingival sulcus with an immune-inflammatory response of the body causing effects. There is a notable relation between periodontitis and steatosis, in which caspase-8 may be a relevant player in the pathophysiology of these conditions. This study is the first to investigate the effect of treatment based on Lactobacillus sp. on steatosis and caspase-8 expression in a ligature-induced periodontitis model. This study aims to investigate whether treatment with Lactobacillus sp. reduces oral and hepatic changes caused by ligature-induced periodontitis. METHODOLOGY:Twenty-four Wistar rats were separated into groups: control, periodontitis, and periodontitis plus Lactobacillus sp. Administration of 1 mL of fermented milk containing 108 CFU/mL of Lactobacillus sp. by gavage was performed daily for 20 days of ligature-induced periodontitis. After the treatment, we evaluated the gingival bleeding index (GBI), tooth mobility, probing pocket depth (PPD), alveolar bone loss, histomorphometry, and histopathological aspects of liver, as well as the levels of glutathione (GSH), malondialdehyde (MDA) and myeloperoxidase (MPO). We also evaluated caspase-8-positive cells and blood biomarkers. RESULTS:Lactobacillus sp. reduced inflammatory clinical parameters, including GBI, PPD, and tooth mobility, as well as neutrophil infiltration in gingival tissue. Morphometric analysis showed significantly less alveolar bone loss. Analysis of hepatic tissue showed reduced neutrophilic infiltration and improved antioxidant activity. Treatment also decreased caspase-8 expression. CONCLUSIONS:Lactobacillus sp. significantly reduced the clinical parameters of periodontal lesion and steatosis score, improved hepatic oxidative status, and decreased caspase-8 expression in the liver tissue.
OBJECTIVE:This study investigated the impact of physical activity levels on growth factor concentrations within leukocyte- and platelet-rich fibrin (L-PRF). METHODOLOGY:In total, 120 participants were categorized into sedentary (n=60) and physically active (n=60) groups via the International Physical Activity Questionnaire. Venous blood was collected to analyze platelet count, mean platelet volume, white blood cell count, red blood cell count, plateletcrit, platelet distribution width, and platelet-large cell ratio, and to prepare the L-PRF. Concentrations of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β), and platelet-derived growth factor (PDGF) were determined using ELISA. RESULTS:Metabolic equivalent of task (MET) values were significantly higher in the active group (p<0.001). Conversely, VEGF, TGF-β, and PDGF levels were significantly higher in the sedentary group (p<0.001). Hemoglobin and hematocrit values were also significantly higher in active individuals (p=0.025 and p=0.040, respectively). A significant moderate negative correlation was found between MET values and concentrations of VEGF, TGF-β, and PDGF (r=-0.33, r=-0.33, and r=-0.31, respectively; p<0.01). Multivariable linear regression analyses, adjusted for sex, periodontal parameters, and hematological variables, confirmed that Total MET constituted an independent negative predictor of all growth factors (all p<0.001), whereas periodontal indices showed no significant independent associations. Sex-stratified analyses and interaction models showed that the association between physical activity and growth factor levels was significantly sex dependent (MET × sex interaction: all p<0.05), with stronger effects in women. CONCLUSIONS:Physical activity seems to be associated with variations in growth factor levels in L-PRF, suggesting that individual physiological status may influence the biological composition of autologous platelet concentrates.
OBJECTIVE:Biofilms exhibit virulence traits that promote microbial protection, such as an extracellular matrix composed of exopolysaccharides (EPS), and contribute to host tissue damage via acid production. This study evaluated bacterial viability, biovolume, matrix (β-polysaccharides), and EPS (α-polysaccharides) formation in monospecies and mixed biofilms of Streptococcus mutans and Enterococcus faecalis, as well as pH and lactic acid production. METHODOLOGY:Biofilms were grown on dentin blocks for 7 days, and aliquots were collected for colony-forming unit (CFU/mL) counts. Subsequently, biofilms were stained with LIVE/DEAD®, Calcofluor White®, and Alexa Fluor 647-dextran conjugate® to assess bacterial viability, matrix formation, and EPS formation, respectively, using confocal laser scanning microscopy (CLSM). Lactic acid production was determined by enzymatic spectrophotometry, and the pH of the culture medium was measured using a pH meter. Kruskal-Wallis and Dunn's tests were used for pH, viability, biovolume, matrix, and EPS analyses, while one-way ANOVA followed by Tukey's test was applied for CFU/mL counts and lactic acid production (α = 0.05). RESULTS:Dual-species biofilms showed higher viability and biovolume than S. mutans monospecies biofilms (p < 0.05), whereas the other parameters did not differ among groups (p > 0.05). CONCLUSION:Dual-species biofilms of S. mutans and E. faecalis may represent a suitable model for investigating antimicrobial strategies, as their association increased viability and biovolume, which are relevant features in cariology and endodontics.
Abstract Background Previous studies have suggested that tumorigenesis of adenomatoid odontogenic tumor (AOT) may involve the activation of the mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) pathway. However, research on other oncogenic signaling pathways in AOT remains limited. Objective This study aimed to investigate gene mutations (Kirsten rat sarcoma viral oncogene homolog (KRAS), catenin beta 1 (CTNNB1), and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)) and their associated protein expressions (phosphorylated extracellular signal-regulated kinase 1 and 2 (p-ERK1/2), β-catenin, and phosphorylated mechanistic target of rapamycin (p-mTOR)) in AOT cases. The association between gene mutations and protein expression was also examined. Methodology In total, eight formalin-fixed, paraffin-embedded AOT tissue samples were manually micro-dissected for DNA extraction. Polymerase chain reaction was performed. Positive samples underwent DNA sequencing. Mutations were analyzed in KRAS exon 2 (codons 12 and 13), CTNNB1 exon 3 (codons 32-45), and PIK3CA exon 9 (codons 542-549). Protein expression was assessed using immunohistochemistry. Results KRAS mutations (specifically G12R and G12V) were detected in three of the eight cases (37.5%). CTNNB1 mutation (T42I) was identified in one of six cases (16.7%), whereas no PIK3CA mutation was observed. Moreover, moderate expression of p-ERK1/2 and p-mTOR were found in tumor cells of AOT. β-catenin accumulation was detected in seven cases (87.5%), predominantly showing membranous and cytoplasmic localization with no nuclear β-catenin expression. Statistical analysis indicated no association between gene mutations and protein expression. Conclusions KRAS mutations and p-ERK1/2 expression support a potential role of MAPK/ERK signaling in AOT pathogenesis. The absence of PIK3CA mutations despite p-mTOR expression may in part suggest mutation-independent activation of the PI3K/mTOR pathway. The lack of nuclear β-catenin accumulation may suggest that canonical Wnt signaling is less likely to significantly contribute to AOT tumorigenesis. Further studies with larger cohorts and investigations of additional molecules related to these pathways are warranted.
Abstract Introduction Tooth loss remains a public health problem in Brazil, reflecting social inequality, population aging, and limited access to oral rehabilitation. For many individuals, complete dentures (CD) are the only option available free of charge through the Brazilian Unified Health System (Sistema Único de Saúde, SUS). However, nationwide assessments of service delivery and regional equity in prosthetic rehabilitation are limited. Objective To quantify national trends and regional disparities in CD production within the SUS and examine how prosthetic output relates to demographic, socioeconomic, and infrastructure indicators using the most recent data available. Methodology This ecological-analytical time-series study used open data from the SUS Outpatient Information System (SIA/SUS). The analysis included maxillary and mandibular CD procedures recorded between 2000 and 2022, representing the most recent consolidated period for temporal modeling, and a state-level snapshot for 2023 to describe the latest correlational scenario. Production rates were standardized per 100,000 inhabitants. Temporal trends were analyzed using segmented linear regression to estimate the average annual percent change (AAPC), which summarizes overall long-term changes in complete denture production, and to identify inflection points. Correlations between CD production and demographic or socioeconomic indicators were tested using Spearman’s rho (α = 0.05). Results Between 2000 and 2022, a total of 5,239,089 complete dentures were delivered through the Brazilian Unified Health System. CD production increased significantly nationwide from 2000 to 2022 (AAPC = 9.7%; 95% CI: 4.8–14.9), a relatively high annual growth rate for public health service expansion, with the steepest rise between 2006 and 2014 (AAPC = 29.2%; 95% CI: 18.6–40.7). Regional trends varied across the country, with the highest growth observed in the Northeast (AAPC = 16.4%; 95% CI: 11.7–21.3), followed by the North (AAPC = 14.3%; 95% CI: 10.9–17.7), Central-West (AAPC = 13.4%; 95% CI: 4.9–22.5), and South (AAPC = 12.8%; 95% CI: 9.0–16.7), whereas the Southeast showed the smallest expansion (AAPC = 8.0%; 95% CI: −1.7–18.8). In 2023, the SUS network included 2,903 prosthetic laboratories, highlighting the organizational infrastructure supporting prosthetic rehabilitation services. In 2023, São Paulo (Southeast region) produced 111,396 dentures, and Piauí (Northeast region) recorded the highest production rate (833.36 per 100,000 inhabitants). Strong correlations were observed between CD production and population size (ρ = 0.742, p < 0.001) and number of municipalities (ρ = 0.938, p < 0.001). Conclusion Over the past two decades, complete denture production within the SUS expanded substantially, reflecting the consolidation of Brazil’s public oral health policies. However, persistent regional disparities and heterogeneous production rates indicate that service expansion has not translated into equitable coverage nationwide. These findings highlight the importance of demographic and organizational factors in shaping prosthetic service provision and underscore the need for targeted planning and resource allocation to reduce inequalities in access to oral rehabilitation.
INTRODUCTION:Temporomandibular Disorder (TMD) is a musculoskeletal condition prevalent in women, especially during menopause. This phase of life is marked by decreased estrogen levels, which can exacerbate pain and psychosocial symptoms. OBJECTIVE:This study aimed to evaluate the association between menopause with and without hormone replacement therapy, grade of chronic pain, jaw functional limitations, and symptoms of anxiety and depression in women with painful TMD. METHODOLOGY:This exploratory cross-sectional study was conducted with 45 women diagnosed with painful TMD, divided into three groups: women with regular menstrual cycles (RMC, n=15), women in menopause without hormone replacement therapy (M, n=14), and women in menopause with hormone replacement therapy (MWH, n=16). The evaluation was conducted using the following instruments: the Graded Chronic Pain Scale (GCPS-2), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), the Jaw Functional Limitation Scale (JFLS-8), and the Pain Catastrophizing Scale (B-PCS). The data were analyzed descriptively using Jamovi software (version 2.3.21). Analysis of variance (ANOVA) was performed, followed by multivariate analysis of covariance (MANOVA). Tukey's post-hoc test was used to identify differences between groups. The significance level adopted for all analyses was 5%. RESULTS:The mean age of participants was 50.0 years (±13.7). The overlap between muscle and joint disorders was most prevalent among the groups. The interference score was significantly lower in the MWH group (p=0.003), as was also the case with depressive symptoms (p<0.001) and anxious symptoms (p=0.012). CONCLUSION:The findings highlight the association between menopause, especially with hormone replacement therapy, and emotional and psychosocial aspects related to pain, with lower scores for interference with daily activities, depression, anxiety, and fewer catastrophic thoughts about pain.
Abstract Denture stomatitis is a condition that commonly affects the palatal mucosa of denture wearers. Recently, several treatments have shown promising results, including the addition of antimicrobial drugs to tissue conditioners. However, before initiating clinical trials, the safety profile of this modified material must be assessed. Objective This study investigated the potential systemic toxicity of a tissue conditioner modified with antifungals in a rat model of denture stomatitis. Methodology Male Wistar rats (N=59) were randomly assigned to the following groups: NC (negative control), SD (sterile device), DS (denture stomatitis), Soft (Softone), Nys (nystatin), Nys:βCD (nystatin:β-cyclodextrin), Chx (chlorhexidine), and Chx:βCD (chlorhexidine:β-cyclodextrin). Animals of all groups, except for NC and SD, wore a palatal device contaminated with Candida albicans for the induction of denture stomatitis. Rats from the Soft group had their devices relined with a tissue conditioner (Softone) with no drugs added, while devices from groups Nys, Nys:βCD, Chx, and Chx:βCD were relined with antifungals at their minimum inhibitory concentrations against C. albicans SC5314 (32 mg, 36 mg, 64 mg, and 46 mg for each gram of tissue conditioner, respectively). Four days after treatment, the animals had their blood collected for biochemical analyses and had their livers, lungs, stomachs, and kidneys removed for histopathological and enzymatic analyses. Results No significant renal, gastric, or pulmonary changes were detected. Some rats from groups Nys, Nys:βCD, Chx, and Chx:βCD presented vacuolation of hepatocytes, although this is not necessarily a sign of hepatic damage. However, the livers of the Chx group presented higher myeloperoxidase activity when compared to the NC, SD, and DS groups. Conclusion These findings suggest that incorporating Nys, Nys:βCD, and Chx:βCD into this tissue conditioner may represent a safe option for denture stomatitis treatment.
Abstract Apical periodontitis is characterized by a robust inflammatory response and activation of innate immunity. Probiotics have been proposed as modulators of this response, but their local and systemic effects remain unclear. Objective To evaluate whether systemic supplementation with L. rhamnosus LR-04 and L. acidophilus LA-14 modulates the expression of TLR4, hBD-2, and hBD-3 in a rat model of experimental apical periodontitis (AP), and to assess potential histopathological alterations in the liver. Methodology Twenty-four male Wistar rats were randomly allocated into three groups (n=8): control (AP + water), AP + L. rhamnosus LR-04, and AP + L. acidophilus LA-14. AP was induced by exposing the pulp chambers of the first mandibular molars for 30 days. From the day of induction, probiotics (109 CFU/day via oral gavage) or water (control) were administered daily. After 30 days, the rats were euthanized. Mandibles were processed for immunohistochemical analysis of hBD-2, hBD-3, and TLR4 expression, which was assessed semi-quantitatively. Liver samples were collected, fixed, and stained with hematoxylin-eosin for histopathological evaluation of lobular inflammation, necrosis, portal inflammation, and fibrosis. Data were analyzed using the nonparametric Kruskal–Wallis test at a 5% significance level. Results No hepatic histopathological alterations were observed in any group. Probiotic supplementation resulted in significantly greater hBD-2 immunoreactivity in periapical tissues compared to the control group (P<0.05). hBD-3 expression was significantly higher in the L. acidophilus LA-14 group than in both the control and L. rhamnosus LR-04 groups (P<0.05). TLR4 expression in periapical lesions was increased in both probiotic groups relative to control (P<0.05). Conclusion Systemic supplementation with L. rhamnosus LR-04 and L. acidophilus LA-14 enhanced the local immune response in apical periodontitis, as evidenced by upregulation of TLR4, hBD-2, and hBD-3, without inducing detectable hepatic histopathological alterations.
INTRODUCTION:Narghile (waterpipe) tobacco use has increased worldwide, partly due to limited awareness of its harmful effects. Despite the widespread misconception that the water filters toxic substances, the chemical composition of narghile smoke is comparable to that of cigarette smoke. However, its effects on airway tissues remain poorly understood. OBJECTIVE:This study aimed to evaluate the histological and immunohistochemical profiles of the tongue and trachea in Swiss mice exposed to narghile smoke. METHODOLOGY:Sixty animals were divided into six groups: a control group (0 days) and experimental groups exposed daily to narghile smoke for seven, 15, 30, 60, and 90 days. After euthanasia, tongue and tracheal tissues were collected for histological (hematoxylin and eosin staining) and immunohistochemical analyses of NANOG, OCT-4, SOX-2 (neoplastic stem cell markers), Ki-67, and p53 in epithelial cells. RESULTS:Histological evaluation revealed cytological and architectural alterations in the tongue, suggestive of early dysplastic changes. In the trachea, early metaplastic modifications were observed, including cilia loss, epithelial hyperplasia, and mild keratinization. These changes increased with longer exposure duration. Immunohistochemical analysis showed greater expression of NANOG, OCT-4, SOX-2, and p53, peaking at 30 days, whereas Ki-67 expression peaked at 90 days. Elevated p53 levels suggest alterations in cell cycle regulation and apoptosis. CONCLUSION:Narghile smoke induced histological and molecular changes in the tongue and tracheal epithelium of mice, indicating a potential carcinogenic effect. Further in vitro, in vivo, and clinical investigations are warranted to validate these biomarkers and better elucidate the biological effects of narghile smoke exposure.
Abstract Exposure to environmental tobacco smoke (ETS) poses significant risks to children’s oral health by inducing oxidative stress and triggering inflammatory responses. Even in the absence of clinically evident oral inflammation, early biological changes can be detected in children exposed to ETS. Objectives This study aimed to evaluate salivary cotinine and S100A8/A9 levels in children exposed to ETS and to examine the relationship between exposure intensity and inflammatory biomarker expression. Methodology This observational case-control study included 150 systemically healthy children aged 6–12 years. ETS exposure was determined using parent-reported questionnaires. Clinical parameters, including plaque index, gingival index, and probing pocket depth, were recorded. Unstimulated saliva samples were analyzed for cotinine, S100A8, and S100A9 using ELISA kits. Group comparisons were conducted using the Mann–Whitney U test, and correlations were assessed using Spearman’s rank correlation coefficient. Statistical significance was set at p<0.05. Results ETS-exposed and non-exposed groups did not differ significantly in age, sex, socioeconomic status, oral hygiene habits, or clinical periodontal parameters (p>0.05). However, salivary cotinine, S100A8, and S100A9 levels were significantly higher in ETS-exposed children (p<0.05). Cotinine demonstrated a moderate positive correlation with S100A8, while its correlation with S100A9 was weak and non-significant. Exposure intensity was positively associated with cotinine and S100A8 levels, but not with S100A9. Conclusion ETS exposure in children is associated with early biochemical signs of inflammation, even in the absence of clinically detectable periodontal changes. Elevated salivary cotinine and S100A8 levels highlight the potential utility of salivary biomarkers for identifying subclinical effects of passive smoking. These findings underscore the importance of interventions aimed at reducing children’s exposure to ETS to protect long-term oral health. Clinical trial registration: NCT06791707
