OBJECTIVES:To examine the determinants of acute pain following tooth extraction, within a set of factors belonging to different domains: biometry, dental nosology and anatomy, psychology toward pain and surgery, and surgical procedure. METHODS:Participants were recruited in two centres in France and Lebanon. A 'simple extraction' (161 patients) and a 'wisdom teeth/tooth' group (at least mandibular) (115 patients) were studied separately. Postoperative pain and total analgesic drug intake (over 5 days) were both expressed as a composite score. Both scores were ranked within each surgery group, and their sum was the primary outcome, which was analysed by multivariable linear mixed models after a factor selection. RESULTS:In the simple extraction group, the primary outcome was predicted positively by preoperative fearfulness (defined by a composite of various phobias) and preoperative dental pain, and negatively by age (≥ 60) and a previous tooth extraction. In the wisdom teeth/tooth group, it was predicted positively by preoperative fearfulness and pain catastrophising, and negatively by a local inflammatory context and preoperative dental pain. CONCLUSIONS:Whereas postoperative pain was constantly favoured by psychological distress, age and other dental factors had different influences on postoperative pain depending on the type of extraction. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT05405088.

Assessing heart rate variability (HRV) before a standardized surgery would help to explore further the relationship between the autonomic nervous system and pain. A single-center prospective cohort of 117 patients (55

Medication-related osteonecrosis of the jaw (MRONJ) is a well-documented adverse effect initially linked to antiresorptive agents such as bisphosphonates. Over time, other drug classes have been associated with MRONJ: monoclonal antibodies targeting RANK ligand, monoclonal antibodies targeting VEGF, tyrosine kinase inhibitors, and mammalian target of rapamycin (mTOR) inhibitors. This article presents the case of an 83-year-old female patient referred to the maxillofacial surgery department due to a submental cutaneous fistula with purulent discharge and localized pain. Her notable medical history includes treatment with palbociclib and exemestane for breast cancer. Palbociclib (cyclin-dependent kinase [CDK] 4/6 inhibitors) are commonly used in combination with hormone therapy for the treatment of HR+/HER2- metastatic breast cancer. Whereas its efficacy in prolonging progression-free survival is well established, its potential impact on bone remodeling and the risk of MRONJ remain under investigation. This case highlights a potential new etiology of MRONJ associated with palbociclib. As CDK 4/6 inhibitors gain widespread use in oncology, clinicians should be aware of this possible complication and closely monitor patients for signs of jaw osteonecrosis.

Introduction: The care of patients living with human immunodeficiency virus has improved in recent decades, and the incidence of infections and tumors encountered in these patients has evolved. The present study aims to describe the prevalence of oral lesions in 2002 and 2022 in the same center. Materials and methods: Adult patients living with human immunodeficiency virus followed in our department were enrolled from 1999 to 2002 (retrospectively) and from October 2021 to April 2022 (prospectively). Results: In the early 2000s, 62 patients living with human immunodeficiency virus were included and 112 in 2022. The two samples were homogeneous with respect to sex, use of tobacco and drugs. Age, alcohol consumption, and access to antiretroviral treatment increased significantly between the two periods. Overall, the disease was better controlled with more patients having a lymphocyte T CD4 level > 350/mm3 (p<0.001) and an undetectable viral load (p<0.001). We found 63 lesions in 62 patients living with human immunodeficiency virus in the early 2000s, and 23 lesions in 22 patients in 2022. Between the two periods, there was a significant decrease in immunosuppression-related lesions (p<0.001), notably oropharyngeal candidiasis (n=46/63 vs n=2/23), but an increase in lesions with malignant potential (n=0/63 vs. n=4/23). Conclusion: Fewer opportunist lesions were seen in 2022 than in 2002 but they were more worrying in terms of severity.

PURPOSE:During follow-up, patients in remission after oral or oropharyngeal cancer are few to express pain, depression or anxiety, their chief complain are dry mouth and difficulties to chewing. The aim of the study is to estimate prevalence of pain, quality of life and their evolution over four years. METHODS:This prospective observational study included 21 patients between June and September 2017. Clinical examination, neurosensory examination and questionnaires (using visual analogic scale DN4, PCS-CF, HADS EORTC QLQ30 and H&N 35) were performed and a second time 4 years later. RESULTS:After 4 years, 17 patients could be reviewed. In 2017 as in 2021, two patients (11.8 %) experience neuropathic pain. In 2017, 14 (82.3 %) reported paresthesia or dysesthesia or hypo/anesthesia, none of them have provoked pain to a mechanical or thermal stimulus. In 2021, only 9 (53 %) still report those symptoms. Global analysis of the questionnaire QLQC30 reveals a significant increase quality of life of all 17 patients (p = 0.0003). For the two questionnaires QLQC30 and QLQ-H&N 35, dry mouth, sticky saliva, difficulties for eating and relation with food, are strong grievances which an absence of amelioration or a degradation. CONCLUSIONS:Neurosensory disturbance is a frequent symptom but pain concerns only 11.8 % of patients. Quality of life increase globally, yet difficulties concerning oral cavity functions endure. IMPLICATIONS FOR CANCER SURVIVORS:For remission patients, pain is an unfrequent situation unlike neurosensory disturbance. Support care improve life quality. In case of onset of pain, recurrence and osteoradionecrosis should be mentioned immediately.

Introduction: There is a bidirectional relationship between anxiety and pain with mutual potentiation. We already have many treatments, pharmacological (anxiolytics, conscious sedation) or not (tell-show-do, hypnosis, music), to control anxiety and/or pain. Of all the digital approaches for the treatment of pain, virtual reality (VR) has for several years been the subject of studies and tests on different types of pain, with promising results. The objective of this meta-analysis is to determine the effects of VR on pain and anxiety in a pediatric population during dental care including minor oral surgery. Materials and method: Our research was carried out using different databases such as PubMed, Web of Science and Cochrane. Review Manager 5.4.1 software was used to perform the quantitative analysis. Randomised controlled trials evaluating pain and/or anxiety in children who received dental treatment and comparing immersive virtual reality to usual care were included. Results: 5 articles were finally selected. Anxiety was measured by the Children's Fear Survey Schedule-Dentale Subscale and by the heart rate which showed a significant reduction of anxiety thanks to the VR (SMD = −0,53, 95%CI = −0,77, −0,28, p<0,0001 and SMD = −0,91, 95% CI = −1,31, −0,51, p<0,00001 respectively). The pain was measured by the Wong-Baker Faces Scale which showed a significant reduction thanks to the VR (SMD = −0,99, 95%CI = −1,24, −0,74, p<0,00001). Discussion: There is a clinical heterogeneity between the studies as well as significant statistical heterogeneity in all the meta-analyses (≥65%). All studies are single-census, with a low number of subjects included (varying from 54 to 104) and a limited age range (from 4 to 12). The population within the studies can be considered heterogeneous since it includes young children and pre-adolescents. Last but not least, it exists a publication bias that decreases the credibility of the results of this review which might influence the validity of the evidence. Conclusion: This meta-analysis is therefore innovative since it is not only the first to carry out a quantitative analysis but also the first to include only VR headsets and to exclude all studies on audio-visual distraction. Our work confirms the very recent interest of immersive VR in reducing pain and anxiety in pediatric dentistry. Nevertheless, further studies are needed to reach a definitive conclusion.

Si, de leur propre fait, certaines personnes vivant avec le VIH (PVVIH) n'ont pas de suivi dentaire, une étude de AIDES en 2015 indique qu'un tiers des chirurgiens-dentistes refuserait de les prendre en charge sous prétexte d'un manque de connaissance de la pathologie, de sa prise en charge, ou de matériel adapté. L'objectif de cette étude était de décrire le parcours de soins dentaires des PVVIH et leurs pathologies buccales en 2022. Etude monocentrique longitudinale observationnelle ayant inclus toutes les PVVIH adultes infectées suivies dans le service de Maladies Infectieuses qui se rendaient en consultation les lundis et jeudis après-midi entre octobre 2021 et avril 2022 et acceptaient l'étude. Ont été relevées les données sociodémographiques et médicales, le parcours de soins dentaires, l'hygiène et le schéma dentaire et la présence de pathologies des muqueuses buccales. Au total, 112 PVVIH (71% d'hommes) âgées en moyenne de 54±14 ans, ont été incluses. Parmi elles, 73% (81/111) étaient d'origine française, 45% (50/111) précaires, 51% (54/107) fumeuses, 21% (22/107) consommatrices de drogues, 28% (30/107) consommatrices d'alcool, et 75% (84/112) présentant au moins une comorbidité. De plus, 91% (102/112) avaient un ARN VIH plasmatique <50 copies par mL, 68% (76/112) des L CD4 >500 par mm3, 5% (6/110) étaient co-infectées VHB et 14% (15/110) VHC. Si 96% (106/110) des PVVIH avaient déjà consulté un dentiste, 79% (87/110) avaient un référent et 56% (62/110) honoraient leur visite annuelle. Aussi, 73% (77/106) ont dévoilé leur séropositivité à leur dentiste: pour 84% (63/75) d'entre eux la visite s'est déroulée normalement, pour 7% (5/75) le dentiste a refusé de les traiter, pour 8% (6/75) le dentiste n'était pas à l'aise et pour 4% (3/75) l'attitude du dentiste est devenue négative. Les facteurs associés à l'annonce de la séropositivité au dentiste étaient: un diagnostic VIH plus ancien (p=0.048), la présence d'une co-infection VHC ou VHB (p=0.01) et une infection VHC traitée (p=0.02). Par ailleurs, 21% (22/106) des PVVIH avaient déjà rencontré des difficultés pour trouver un dentiste dont 37% (7/19) à cause de leur état viral. Parmi les 49/106 PVVIH qui ne consultaient pas ou rarement un dentiste, 9% (4/46) craignaient d'être ou avaient déjà été mal reçus ou traités différemment en raison de leur séropositivité. Concernant le brossage dentaire, 69% (76/110) des PVVIH se brossaient les dents deux fois par jour. Parmi les pathologies buccales recensées, 23 lésions ont été objectivées chez 22 PVVIH: 15 (65%) lésions non liées au VIH, 4 (17%) pathologies classantes stade B ou C (1 sarcome de Kaposi, 1 leucoplasie chevelue/villeuse orale, 2 candidoses chroniques) et 4 (17%) lésions d'évolution particulière du fait du VIH (2 leucoplasies inhomogènes, 1 cancer des voies orales, 1 papillome verruqueux). Si 79% des PVVIH incluses ont un dentiste référent, la discrimination des dentistes envers les PVVIH persiste toujours pour un certain nombre d'entre eux (16% des PVVIH concernées) et 27% des PVVIH ne se sentent pas prêtes à dévoiler leur infection. Un faible nombre de lésions buccales sont diagnostiquées, majoritairement liées à l'âge ou à la présence de comorbidités, dont certaines, malignes nécessitent d'être identifiées. Aucun lien d'intérêt

Pregnancy epulis is a common and benign vascular tumor that reaches 5% of pregnant women; it respects adjacent structures, such as bone, teeth, and sinus mucosa. This paper reports a rare case of extensive pregnancy epulis with alveolar bone lysis, tooth displacement, and sinusal floor lysis. A 23‐year‐old pregnant woman with 23 weeks of amenorrhea was referred to the Department of Oral and Maxillofacial Surgery with a large maxillary mass and spontaneous bleeding, causing difficulty in speaking and swallowing. Due to the rapid development, the stage of pregnancy, and the need for a sure diagnosis of a benign lesion, a surgical excision was performed. After 1 month, the patient recovered from swallowing and speaking. Pregnancy epulis can be locally aggressive and involve alveolar bone. Biopsy allows to confirm the diagnosis. Surgery during pregnancy or birth waiting should be well ponderated in correlation with the size of the tumor and the delay to birth.

Describe the dental care pathway of people living with HIV (PLHIV) and their oral pathologies. A monocentric cross-sectional study involving adult PLHIVs followed (October 2021/April 2022) in our department. Socio-demographic and medical data, course of dental care, and presence of pathologies of the oral mucosa were recorded. 112 PLHIV (71

Introduction: Burning Mouth Syndrome (BMS) is defined by a burning sensation or intraoral dysesthesia without obvious causal lesion. Despite the development of research, diagnostic aids for this syndrome are non-existent and treatments are partially ineffective. Some studies have shown changes in salivary composition, viscosity or flow in patients with BMS. The evaluation of the salivary biochemical characteristics of patients with BMS could then help to better understand the pathogenesis of this disease. The objective of this meta-analysis is to perform a qualitative and quantitative synthesis of the literature concerning the salivary biomarkers present in patients with BMS in comparison to healthy subjects. Materials and methods: The PubMed, Web of Science and Cochrane databases were searched to identify articles corresponding to the defined inclusion criteria. Review Manager 5.4.1 software was used to perform the quantitative analysis. Results: The quantitative analysis included 15 articles and found a significant increase in salivary concentrations of cortisol and immunoglobulin A (IgA) with a standardized mean difference SMD = 0.53 and a 95% confidence interval CI [0.33 to 0.74] and SMD = 0.32 to 95% CI [0.10 to 0.55] respectively. For calcium and copper, the analysis found no significant difference in patients with BMS with SMD = 0.06 at 95% CI [–0.19 to 0.32] and SMD = -0.19 at 95% CI [–0.44 to 0.06]. Finally, for magnesium, the analysis found a probable decrease with SMD = -0.29 at 95% CI [–0.52 to -0.06]. Four other biomarkers (potassium, alpha amylase, zinc and total protein) showed too high levels of heterogeneity (I² > 44%) to be able to interpret the results with confidence. Discussion: This strong heterogeneity can be explained by different saliva sampling methods or biomarker measurement techniques that are not strictly identical between the studies. In addition, some saliva samples may have undergone blood contamination which may bias the results. Conclusion: This meta-analysis nevertheless confirms all the interest of focusing on salivary biomarkers in BMS patients; the measurement of cortisol and/or salivary IgA could be a line of research for the establishment of a standardized biological assessment. Nevertheless, the number of available studies being low and of variable methodological quality with a limited number of patients, additional studies are necessary to give a firm and definitive conclusion.

Endodontic treatment is often the first-line procedure to manage the immediate or long-term aftermath of dental trauma, particularly in cases of luxation or avulsion. Failure to manage trauma in the short or medium term leads to significant functional or aesthetic consequences, especially in the adolescence period. Under this specific conditions, endodontic treatment could provide a temporary solution by keeping teeth with poor prognosis on the arch while waiting for better anatomical conditions for implantology. This clinical case aimed to describe the management of a maxilla-facial dental trauma and the following consequences in a 10-year-old male patient. Clinical and radiological examination showed complete extrusive luxation of 11 and 21 and intrusive luxation of 12 and 22. Endodontic treatment of 11 and 21 was performed six months after the trauma. Two years later, the patient was referred to the endodontic department because pink spot lesions appeared on 12 and 22 due to cervical invasive resorptions (class III for 12 and class II for 22). Endodontic treatment of 12 and filling with resin composite of 22 were performed. During the following two years, complication management finally led to placement of four OBI® (Euroteknika, Sallanches, France)-type mini-implants after avulsion of all four maxillary incisors. Palliative endodontic treatment helped maintain the prosthetic space and the volume of supporting tissue needed for future implant placement. The interest of using delaying procedures (palliative endodontic treatments and mini-implants) was to allow the patient to complete growth. Managing early treatment failure of trauma in adolescents has to be pluridisciplinary and should take into account the evaluation of the treatment’s difficulty, the prognosis of the endodontic treatment, the available bone volume and the pubertal growth stage.

The aim of this article is to carry out a systematic analysis of the literature concerning the diagnosis of oral cancers by salivary samples. Different biomarkers, produced by the tumor itself or by its environment, show significant variations in their concentration at the salivary level, correlated or not at the blood or tissue level. After studying 239 articles, we included 36 in this analysis. This allowed us to extract 46 potential molecules for salivary diagnostics. Only 26 demonstrated a good level of evidence. 8 clusters have also been proposed for better specificity and sensitivity. To date, the protocols of the studies carried out do not allow to affirm that one or more biomarkers are effective for a salivary diagnosis of oral cancers. Part of the results contradict or sometimes lack precision. In addition, the studies included here do not have a good methodological quality and do not always take into account other factors influencing the concentrations (systemic diseases, age, sex, tobacco, alcohol, etc.). Additional studies are still necessary, notably with larger groups of patients, representative of the general population and standardization of the protocols for the study and quantification of biomarkers.

BACKGROUND:This study determines the prevalence and particularities of headache and pain with neuropathic characteristics (NC) in a large French group of patients with pituitary adenoma (PA).METHODS:Analysis of validated self-administered questionnaires, radiological characteristics and treatment strategies of PA was performed.RESULTS:Of the 221 sent questionnaires, 146 could be used for statistical analysis, 50% of which were completed by women. Among responders, 58.9% had pain: 30.1% migraine, 15.7% pain with NC and 13.1% other types of pain. Migraine was more common in patients with PA than in the general population (30.1% vs. 21.3%, p = .010) and attacks received appropriate treatment for less than 20% of these patients. Furthermore, the prevalence of chronic migraine was much higher than in the general population (6.8% vs. 2.2%, p = .003). Neuropathic pain was also more frequent in PA patients than in the general population (15.8% vs. 6.9%, p < .001). Neuropathic pain was most often located in the extremities and was frequently described as an 'electric shock', 'numbness', or 'pins-and-needles'. Multivariate analyses linked migraine to younger age, anxiety, pain with NC, and a visible tumour on MRI, regardless of its invasiveness or secretory nature.CONCLUSIONS:Migraine headaches and neuropathic pain are more frequent and disabling in PA patients than in the general population. Both types of pain are comorbid in PA patients and are poorly treated. Migraine is associated with the presence of a tumour. Thus, biological mechanisms of this relationship need to be characterized to design optimal treatments for these individuals.SIGNIFICANCE:Migraine headaches and neuropathic pain are more common in PA patients than in the general population and are generally poorly treated. A systematic screening for migraine should be done by physicians in daily practice to provide adequate therapeutics.

Background: The advent of digital medical imaging, medical image analysis and computer vision has opened the surgeon horizons with the possibility to add virtual information to the real operative field. For oral and maxillofacial surgeons, overlaying anatomical structures to protect (such as teeth, sinus floors, inferior and superior alveolar nerves) or to remove (such as cysts, tumours, impacted teeth) presents a real clinical interest. Material and methods: Through this work, we propose a proof-of-concept markerless augmented reality sys-tem for oral and maxillofacial surgery, where a virtual scene is generated preoperatively and mixed with reality to reveal the location of hidden anatomical structures intraoperatively. We devised a computer soft-ware to process still video frames of the operating field and to display them on the operating room screens. Results: Firstly, we give a description of the proposed system, where virtuality aligns with reality without artificial markers. The dental occlusion plan analysis and cusps detection allow us to initialise the alignment process. Secondly, we validate the feasibility with an experimental approach on a 3D printed jaw phantom and an ex-vivo pig jaw. Thirdly, we evaluate the potential clinical benefit on a patient. Conclusion: this proof-of-concept highlights the feasibility and the interest of augmented reality for hidden anatomical structures visualisation without artificial markers. (c) 2021 Elsevier Masson SAS. All rights reserved.