Xerostomia significantly disrupts nutritional status, increases oral complications, and reduces quality of life in head and neck cancer (HNC) patients. This systematic review aimed to determine the best dietary interventions for the management of xerostomia in HNC patients by examining available therapies and their effects. A search of PubMed, Web of Science, and Scopus was conducted for randomised controlled trials, interventional, and observational studies published between December 2000 and December 2021. English articles involving adult HNC patients undergoing or having completed anti-cancer therapy were included. Non-HNC xerostomia causes and abstracts were excluded. Risk of bias was assessed using the Cochrane and Joanna Briggs Institute (JBI) tools. Fifteen studies were included out of 533 articles. Acidic candy, ginger extract, chewing gum, vitamin C/E supplements, and thyme honey were identified as helpful in reducing xerostomia. Dietary counselling and awareness of diet modifications improved symptoms, nutrition, and quality of life. Acidic candy was particularly effective in stimulating salivary f low but may cause dental enamel erosion, and timing precautions were necessary for thyroid patients’ post-radioactive ablation. Hydration techniques were commonly adopted by patients for symptom alleviation. Dietary modifications show promise in managing xerostomia in HNC patients, although further large-scale, randomised trials are needed to confirm these findings and explore new interventions.
Synovial sarcoma (SS) is rare in the head and neck region, accounting for only 10% of all SS, and less than 0.1% of all head and neck malignancies. Head and neck SS in paediatrics is extremely rare, with only a few cases reported worldwide. Here, we report a case of right cheek SS in a child who presented to us with a 5-month history of painless right cheek swelling. On examination, there was a palpable right cheek mass measuring 4 cm x 4 cm in size, firm in consistency, with a smooth surface and a well-defined margin. Examination of the ear, nose, throat, and head and neck was normal. Imaging showed a welldefined enhancing lesion with calcifications, with no involvement of the paranasal sinuses, intraorbital, and intracranial extension. Fine needle aspiration for cytology showed a spindle cell lesion. Excision of the right cheek tumour was done via a sublabial approach. Histopathological diagnosis of biphasic synovial sarcoma was made. Post-operatively, the patient was referred to an oncologist for adjuvant chemoradiotherapy. The patient recovered well, and no recurrence was found during the follow-up at six months.
Yeast is a ubiquitous microorganism commonly found in various parts of the human body, including the oral cavity. In healthy individuals, they typically exist as commensals; however, under specific conditions, they can transition to a pathogenic state, contributing to the onset and progression of diseases such as periodontitis. This study aimed to compare the composition and density of yeast species in the subgingival dental plaque of periodontitis patients and healthy subjects. Subgingival dental plaque samples were collected from 15 periodontitis patients and 15 healthy subjects. The samples were cultured in TYI-S-33 medium, and 16 viable isolates were analysed. Species identification was conducted using MALDI-TOF mass spectrometry, and yeast density was estimated using the McFarland method. Six species of yeast were identified among the isolates. A comparative analysis revealed no statistically significant differences in yeast species composition and density between the two groups. These findings highlight the diversity, prevalence, and density of yeast species in the oral cavities of periodontitis patients compared to those of healthy subjects, although their specific role in the pathogenesis of periodontitis remains inconclusive. Future research should focus on exploring the interactions between yeasts and other components of the oral microbiome to better understand their role in oral health and disease progression.
In bone tissue engineering, scaffold-based approaches offer great potential for regenerating damaged or lost bone tissue. Composite scaffolds have gained popularity because they combine the beneficial properties of two or more materials, providing promising biomimetic properties for tissue regeneration. In our study, combining the biocompatibility of bioactive glass with the mechanical qualities of polycaprolactone provides tailored properties and scaffold architecture conducive to alveolar bone regeneration. This study aims to develop a bone substitute using bioactive glass/polycaprolactone (BG/PCL) composites and to evaluate its biocompatibility for potential applications in alveolar bone regeneration. BG/PCL scaffolds were fabricated using a solvent-casting method at three different weight percentages (wt.%) ratios (10:90, 20:80, and 30:70). The scaffolds were characterised using scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, and methyl tetrazolium (MTT) (3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide) Assay to evaluate their physical, chemical, and biocompatibility properties. Among the three BG:PCL composite ratios tested (10:90, 20:80, and 30:70), the 10:90 ratio demonstrated the most favourable properties. SEM analysis of this composition revealed optimal surface roughness and well-distributed interconnected pores, which are conducive to cell attachment, enhanced cellular infiltration, and efficient nutrient diffusion. FTIR spectra displayed characteristic absorption bands corresponding to the functional groups of BG and PCL components while the biocompatibility test confirmed the viability and proliferation of periodontal ligament (PDL) fibroblast cells when cultured with the scaffolds. This study demonstrates that the developed BG/PCL composite, especially at the 10:90 ratio, possesses suitable properties and biocompatibility, highlighting its potential for use in alveolar bone regeneration.
Canine impaction is a frequent problem, ranking third in occurrence behind the impaction of the mandibular and maxillary third molars. Palatally displaced canines (PDCs) require more comprehensive treatment and are more challenging to manage. This case report describes the management of a rotated palatally impacted permanent maxillary right canine using the open palatal flap window method and the multiloop edgewise arch wire (MEAW) technique. A 19-year-old female patient presented with dental misalignment, which included a skeletal Class I relationship with Angle Class I malocclusion, a protruding lower jaw, anterior crossbite, and the upper left canine being palatally impacted. The panoramic radiograph indicated the existence of a Type II impaction of the canine teeth (Yamamoto classification). The treatment employed the MEAW technique to expand the maxilla and handle an anterior crossbite. The palatal window flap technique was utilized to achieve access to the maxillary right canine by using a button chain and ligation to the upper archwire. The posttreatment outcomes demonstrated satisfactory eruption and alignment of the maxillary right canine, correction of the anterior crossbite at the maxillary right lateral incisor, and realignment of the midline. One year after retention, a satisfactory occlusion was maintained without recurrence of the anterior crossbite. The use of the open palatal window flap technique and button chain application is effective in correcting PDCs and achieving adequate tooth alignment within the dental arch.
The mental foramen (MF), averaging 4.6 mm x 3.4 mm, is a vital anatomical landmark with significant implications for dental and surgical procedures. Its location, dimensions, and relationship to the inferior alveolar nerve (IAN) are critical in reducing complications such as nerve injury and treatment failure. A literature review of studies published between 1970 and 2024 explored the MF's anatomy, imaging, and clinical outcomes. This review examines variations in the MF's shape, size, number, and position, emphasising their clinical relevance. The MF may occasionally be radiographically or clinically absent and is not always a single opening. Understanding its variability is crucial for accurate localization. This narrative review summarises that, despite an increasing amount of research, human variability influences the shape, size, and location of the mandible. Even within the same ethnicity, different studies have produced different locations and appearances in terms of its shape. Nevertheless, more Western studies generally reported the MF being located between the first and second premolars, and more Asian-centric studies reported it as closer to the second premolar. Accessory mental foramina (AMF), on the other hand, vary between ethnic groups, with a higher prevalence reported among non-Caucasians. Most AMFs were found to be unilateral, occurring more on the right side of the mandible. Bilateral AMFs have also been reported to range from 0% to 33.3%. On the contrary, MF may be missing in between 0.7% and 2.4% of the unilateral mandible.
Nonsyndromic cleft lip and/or palate (NSCL/P) is a common congenital malformation with genetic influences. While Thymocyte selection-associated high mobility group box 3 (TOX3) is involved in other developmental processes, its role in NSCL/P remained unexplored. This study investigated the association between TOX3 copy number, expression, and NSCL/P in 64 Malay NSCL/P cases and 64 normal controls. Samples from patients undergoing cleft repair surgery and eligible volunteers for the control group were quantified via quantitative polymerase chain reactions (qPCR). A higher mean of TOX3 copy number was found in cases (2.195 +/- 0.689) compared to controls (1.962 +/- 0.558; p < 0.05). Similarly, a higher TOX3 expression was observed in cases (0.014 [IQR 0.024]) compared to controls (0.006 [IQR 0.019]; p < 0.001). Unadjusted analyses showed higher TOX3 copy number (OR = 1.850; p < 0.05) and its expression associated with NSCL/P. However, these associations were nullified after adjusting for sex and age (p > 0.05). Instead, male sex emerged as a significant independent predictor for NSCL/P (adjusted OR = 4.03; p < 0.001). Besides, an inverse, weak correlation was observed between TOX3 copy number and expression in NSCL/P patients (rho = -0.285; p < 0.05) indicating the potential role of epigenetics in this condition. While male sex strongly contributed to the NSCL/P condition, our results suggest that TOX3 is not an independent genetic risk factor for NSCL/P in this population. These results highlight sex as a primary demographic risk factor and underscore the importance of considering demographic context in genetic association studies.
Vibration-assisted orthodontic treatment accelerates tooth movement and reduces complications associated with prolonged interventions. While vibration has been shown to enhance osteogenic potential in bone marrow-derived mesenchymal stem cells (MSCs), its effects on dental tissue-derived MSCs remain unclear. This study investigated the impact of acoustic-frequency vibratory stimulation (AFVS) on gingival-tissue-derived MSCs (GT-MSCs) at 20 Hz and 60 Hz under both basal and osteogenic conditions. A custom vibratory platform was developed, and GT-MSCs were assessed for viability, proliferation, and osteogenic differentiation. Resazurin assay, Calcein-AM staining, and vimentin immunohistochemistry were used to evaluate cell viability, proliferation, and morphology, while Alizarin Red staining and calcium accumulation assays measured extracellular matrix mineralization at 7, 14, and 21 days. A Reverse-Transcription Quantitative Polymerase Chain Reaction (RT-qPCR) reaction was performed to quantify osteogenic markers (colagen type I [COL-I], osteopontin [OPN], and alkaline phosphatase [ALP]), and protein expression for COL-I and OPN was confirmed by immunohistochemistry. The results showed that AFVS at 20 Hz and 60 Hz enhanced osteogenic differentiation in GT-MSCs compare with other groups. Extracellular matrix mineralisation increased significantly, with 60 Hz resulting in the highest calcium deposition. Transcript levels of COL-I and OPN were markedly upregulated at 60 Hz, indicating a frequency-dependent response. Cell proliferation was also promoted, with optimal results observed at 60 Hz compare with other groups. These findings highlight the role of mechanical stimulation in enhancing the osteogenic potential of GT-MSCs, suggesting that AFVS is a promising tool for regenerative and orthodontic treatments. This study provides new insights into the frequency-specific effects of vibration, supporting the use of vibration therapy strategies in dental applications.
The neutral zone impression technique is a predictable, less invasive, and cost-effective option for patients who have a severely resorbed mandibular ridge. The utilisation of neutral zone impression allows the visualisation of an individual neutral zone, which assists in forming a polished denture surface and the position of acrylic teeth, significantly improving the stability of the mandibular denture. This case series highlights the role of neutral zone impression in managing various conditions interfering with the stability of the mandibular denture. The clinical procedures completed by both undergraduate and postgraduate students successfully addressed the patients' concerns. With proper supervision, the neutral zone impression technique for mandibular complete dentures can be managed by undergraduate dental students despite the technical demands.
Oral myiasis, a rare condition characterised by infestation of dipterous larvae in the oral cavity, poses unique diagnostic and therapeutic challenges. Herein, we present a case study of a 35-yearold quadriplegic man presenting with oral myiasis localised to the palatal region, likely attributable to malnutrition and suboptimal oral hygiene. Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots. Initial diagnostic considerations encompassed mucormycosis and neoplastic lesions; however, further scrutiny revealed primary palatal myiasis caused by Chrysomya bezziana species. Therapeutic interventions entailed bedside maggot removal and meticulous wound care, with topical hyaluronic acid application and oral hygiene guidance. This case underscores the significance of uncommon conditions such as palatal myiasis, especially among patients with intricate medical backgrounds. A comprehensive diagnostic approach and optimal treatment ensure favourable outcomes.
Cleft lip and palate (CLP) is a common congenital condition presenting significant orthodontic challenges due to maxillofacial growth disturbances, associated malocclusions, and dental anomalies. Patients with CLP often have complex dental and skeletal issues, requiring a comprehensive, interdisciplinary approach to address functional and aesthetic concerns. An 11-year-old female presented with unilateral cleft lip, alveolus, and palate (UCLP) associated with dental anomalies, which included a skeletal Class I relationship with Angle Class II malocclusion, bimaxillary retrognathia, bidental retroclination, negative overjet, lower dental midline shifting, anterior crossbite, microdontia #12, agenesis #22, and several malpositioned teeth. The patient was treated with fixed orthodontic appliances, including the extraction of remaining deciduous teeth, mesialisation of the teeth on the upper left side to close the space resulting from agenesis, and space management in the mandible. Significant improvements were observed in overjet, dental alignment, occlusion, and aesthetics after a 17-month treatment period. Following orthodontic treatment, restorative procedures were performed on teeth #12 and #23. Adhering to the prescribed retainer schedule is essential to preserving dental esthetics and the stability of the treatment results. Comprehensive orthodontic treatment with fixed appliances effectively addressed the complex dental and skeletal issues of this patient with UCLP. The treatment led to improved dental function and aesthetics, highlighting the importance of a personalised approach in addressing cleft cases.
The objective of this study was to assess and compare horizontal and vertical tooth movements between two clear aligner materials, Erkodur and Zendura FLX. Nineteen participants were divided into two groups, and received either Erkodur or Zendura FLX aligners, with digital models obtained at intervals over six months. Horizontal and vertical tooth movements were measured and compared using statistical tests, including the Mann-Whitney U test for overall movement and the Wilcoxon Signed-rank test for individual tooth movement between both groups. Overall, horizontal tooth movements between Erkodur and Zendura FLX were not statistically different, but vertical movements showed significant differences at the fifth and sixth months (p < 0.05). Significant differences between predicted and achieved horizontal tooth movement (p < 0.05) were observed for Erkodur on teeth 11, 41, and 35, and for Zendura FLX on teeth 17, 16, 25, 27, 45, 44, 41, 32, 36, and 37, predominantly indicating overcorrection, except for teeth 11 and 41 in the Erkodur group and tooth 41 in the Zendura group. Significant differences in vertical tooth movement (p < 0.05) were identified for Erkodur on teeth 14, 13, 11, 27, 44, 35, and 37, and for Zendura FLX on teeth 47, 45, and 44. Erkodur and Zendura FLX revealed no significant differences in initial horizontal tooth movements. However, significant disparities between the materials emerged in later stages of treatment, with both exhibiting notable discrepancies between predicted and achieved movement in both vertical and horizontal tooth movements over a sixmonth interval.
Children with cerebral palsy (CP) are highly dependent on their caregivers to access oral health care services (OHS), which leads to unmet oral health needs that affect their oral health-related quality of life (OHRQoL). This study explored accessibility to OHS and OHRQoL among children with CP attending Community-Based Rehabilitation (CBR) centres in Kelantan by their primary caregivers. A cross-sectional study using Accessibility to Oral Health Care Services (CP2OHS) and Parental-Caregiver Perception Questionnaire (P-CPQ) was conducted on 81 children with CP and their primary caregivers. CP2OHS domains are “ability to perceive”, “ability to engage”, “ability to seek”, “ability to pay”, and “ability to reach”, while PCPQ domains include oral symptoms, functional limitation, emotional wellbeing, and social well-being. Children with CP were mostly males (63.0%), with a mean (SD) age of 10.3 (3.93) years, Gross Motor Function Classification System (GMFCS) Level V (46.9%), and Communication Function Classification System (CFCS) Level III (33.3%). Their caregivers were mainly female (85.2%), aged 43.6 (9.34) years. The mean (SD) total score for CP2OHS was 29.67 (10.81) of –56 to 56 and P-CPQ was 13.21 (5.89) of 8 to 40. There was a significant difference in accessibility scores between tertiary, lower secondary, and primary levels of education (p = 0.009); village and city/ town residents (p = 0.013); and transportation with personal car and motorcycle (p = 0.004). The Pearson analysis revealed a weak positive correlation between accessibility and OHRQoL scores (r = 0.158, p = 0.16) that was not statistically significant. Children with CP posed high CP2OHS scores and low P-CPQ scores, indicating high accessibility to OHS and high OHRQoL. Strengthening OHS utilisation among these children is crucial for a better quality of life for them.
Impression-making plays an important role in dentistry, where records of the oral cavity are needed to provide an optimum treatment plan for the patient. In this study, we utilised both the conventional impression method and the intraoral scanner (IOS) to make a comparison on the accuracy of the resulting oral cavity imprint using three-dimensional (3D) superimposition. In this study, a total of 18 participants were involved. Alginate impressions were made in a stock maxillary tray and poured with type III dental stone. The models were then scanned using IOS to generate virtual dental models where digital analysis can be made. For the IOS method, the scanning was done directly on the patient’s oral cavity by the same operator. Meshmixer software was utilised to convert the virtual models into a Standard Tessellation Language file, and then CloudCompare software program was selected to evaluate the volume, surface area, Dice similarity coefficient (DSC) and Hausdorff distance (HD) of the dental models produced from both methods. Statistical analyses were carried out using an independent t-test. It was revealed that the p-value of area and volume for both methods is > 0.05, which shows no significant differences. Besides, the mean and standard deviation for the HD were 0.02 and 0.01, respectively, which shows minimal differences between the two datasets. The mean DSC was also 0.9, which shows close to 100% overlap. These findings significantly indicate that conventional impression and IOS have comparable accuracy and are both reliable for impression-making.
Synovial sarcoma is a rare and aggressive type of sarcoma that develops from mesenchymal cells and accounts for around 8% to 10% of all cases of soft tissue sarcoma. The presence of synovial sarcoma in the head-and-neck region is characterised by aggressive behaviour and a generally unfavourable prognosis. Understanding the various manifestations of synovial sarcoma, particularly uncommon locations like the oropharynx, significantly improves patient outcomes by facilitating early diagnosis and prompt management. We report a case of a 57-year-old Malay woman who presented with a two-month history of sore throat and odynophagia, complicated with partial airway obstruction. She underwent endoscopic excision of the right oropharyngeal tumour via transoral approach, and the histopathological examination revealed monophasic synovial sarcoma. The surgical management, histopathological characteristics, and rarity of the disease are discussed.
Fibro-osseous lesions (FOLs) of the jaws are a group of lesions characterized by the replacement of normal bone by fibrous tissue. In this study, four cases of FOLs with different characteristics will be evaluated with cone beam computed tomography (CBCT) images. Focal osseous dysplasia and florid osseous dysplasia were incidentally detected in patients and diagnosed based on clinical and radiographic features. In cases of fibrous dysplasia and ossifying fibroma, patients applied to with complaints of swelling in the jaws. The wide spreads of the pathologies were determined by CBCT images and the diagnosis was made by histopathological examination. While two-dimensional conventional imaging is sufficient for asymptomatic and small-sized cases, CBCT is necessary for large lesions to assess their relations with surrounding tissues. It is important to interpret the CBCT images of these lesions correctly and to bring the cases with various clinical, radiographic and demographic features into the literature.
Fibro-osseous lesions (FOLs) of the jaws are a group of lesions characterized by the replacement of normal bone by fibrous tissue. In this study, four cases of FOLs with different characteristics will be evaluated with cone beam computed tomography (CBCT) images. Focal osseous dysplasia and florid osseous dysplasia were incidentally detected in patients and diagnosed based on clinical and radiographic features. In cases of fibrous dysplasia and ossifying fibroma, patients applied to with complaints of swelling in the jaws. The wide spreads of the pathologies were determined by CBCT images and the diagnosis was made by histopathological examination. While two-dimensional conventional imaging is sufficient for asymptomatic and small-sized cases, CBCT is necessary for large lesions to assess their relations with surrounding tissues. It is important to interpret the CBCT images of these lesions correctly and to bring the cases with various clinical, radiographic and demographic features into the literature.
This study aimed to assess the influence of upper incisor inclinations on smiling profile aesthetics in skeletal Class III patients, considering the effects of skeletal simulations, the assessor's expertise, and the assessor's gender. A smiling profile photograph of a Thai female with normal skeletal, dental, and soft tissue features was digitally adjusted to represent 16 images with 4 skeletal simulations and 4 upper incisor inclinations. The number of assessors was 180, which included orthodontists, general dentists, and laypersons. They were asked to evaluate the smiling profile aesthetics of each image using a numerical rating scale. The aesthetic scores were analysed using a mixed between-within-subjects ANOVA (p < 0.05). The results showed that the interaction effect between orthodontic expertise and upper incisor inclinations was not observed in the skeletal Class III groups. Normal upper incisor inclination had the highest aesthetic score. Proclination of the upper incisors by 3 degrees significantly decreases the aesthetic score, except in the skeletal Class III with prognathic mandible group. The assessor's gender did not affect the aesthetics score of the smiling profile. In conclusion, upper incisor inclinations and skeletal simulations significantly influenced smiling profile aesthetics in the skeletal Class III simulations. The assessor's expertise and gender did not affect the evaluations.
This scoping review aims to comprehensively assess the existing evidence from both clinical and in vitro studies concerning removable partial dentures (RPD) made from poly-ether-ether-ketone (PEEK) to identify current research gaps and enhance the understanding of PEEK’s viability as a material for RPD. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews was applied. A search was made using PubMed, Web of Science, Elsevier’s Scopus, ProQuest and Springer Link databases for articles in the English language up to November 2023, focusing on case reports, clinical, and in vitro studies. A total of 33 studies were included in the analysis, which consisted of 4 case reports, 6 clinical studies, and 23 in vitro studies. Clinical studies predominantly examined patient satisfaction post-PEEK RPD insertion, framework accuracy, dimensional changes in residual ridges, and fungal/bacterial adhesion to PEEK. In vitro studies emphasised retentive force clasps (12 studies), accuracy and fitness (5 studies), material staining effects (3 studies), and diverse surface treatments (3 studies). The current body of evidence reveals a scarcity of clinical studies investigating PEEK as an RPD framework. In vitro studies primarily focused on assessing material retentive forces, with limited attention given to accuracy, surface treatment, and staining of denture base materials. Future research should address these gaps, exploring aspects such as adhesion and biofilm formation (e.g. Candida albicans) on RPD surfaces. Rigorous, well-designed clinical trials and expanded in vitro investigations are essential to establish PEEK RPD as definitive prostheses for partially edentulous patients.
Gene expression plays a crucial role in progression, invasion, and metastasis in many groups of oral squamous cell carcinoma. Based on extensive patient data, no research has been done so far on the differences in gene expression between groups of male patients with tongue squamous cell carcinoma who drink alcohol and those who do not, about lymph node metastasis. Our study analysed differential gene expression in male patients with and without lymph node metastasis in tongue cancer, utilising messenger ribonucleic acid (mRNA) sequencing data from The Cancer Genome Atlas (TCGA) program. Analysis was performed using R and bioinformatics tools to process mRNA sequencing data, compare differential gene expression, and examine functional signaling pathways and survival analysis. After screening the database, 38 out of 74 cases with metastasis were selected for the analysis. The computational analysis identified a significant increase in cancer invasion transcription factors, such as GATA2, SP1 and MYC in the metastatic group, whereas CREB1 was more associated with the non- metastatic group. Functional analysis suggested new prognostic biomarkers for unfavourable outcomes (TRIML2 and EXOSC4) and favourable outcomes (HS3ST4 and SFTPA1). New suggested markers for oral and tongue cancer such as TRIML2, EXOSC4 are known for their role in non-oral cancer including lung and liver cancer. Especially head and neck squamous cell carcinoma (HNSCC) survival analysis and protein atlas investigation confirmed the indirect biological roles of found markers. The study indicates that TRIML2 and EXOSC4 could serve as biological markers for predicting lymph node metastasis in tongue squamous cell carcinoma among male patients who consume alcohol. These findings suggest that gene expression profiles may play a role in the progression and metastasis of tongue cancer. Further research is needed to validate these results and to develop targeted therapies for patients with tongue cancer.
