Objective This study aims to investigate whether systemic health condition can be assessed by measuring oral Candida counts. Methods The correlation between Candida counts in the oral cavity and health conditions or immune statuses was assessed in three groups: healthy volunteers, patients with cancer undergoing treatment, and patients with autoimmune diseases who have undergone immune-suppressive treatment. Candida colonies were counted using oral rinse solution by polymerase chain reaction, and the relationship between subjective symptoms using a questionnaire, immunity measured by blood tests, and disease activity was investigated. The score of immunological vigor (SIV) was used to measure immunity, and the physician global assessment (PhGA) was used to assess disease activity. Results Candida counts were correlated with chills recorded in the healthy group (stepwise regression analysis, p < 0.05), SIV in the cancer group (stepwise regression analysis, p < 0.05), and PhGA in the autoimmune disease group stepwise regression analysis, p < 0.05). Conclusions The results of this study indicated the possibility that oral Candida counts may reflect the systemic health status of the host. However, the number of subjects in this study was small, more studies are needed to confirm the relationship between the salivary Candida count and the health and immune status.

Calcium phosphate cement (CPC) demonstrates excellent shape retention; however, the material exhibits a prolonged resorption period. Despite its inferior mechanical strength and poor shape retention, beta-tricalcium phosphate (β-TCP) offers excellent osteoconductivity. We previously reported that incorporating β-TCP into CPC enhances mechanical strength and shape retention. However, the prolonged setting time poses a challenge for clinical application. We aimed to improve the clinical usefulness of the CPC/β-TCP composite material. Samples with different mixing ratios of β-TCP (SUPERPORE) to quick-setting type of CPC (BIOPEX®-R Quick Type) (C0, C10, C30, and C50 with mixing ratios of β-TCP of 0, 10, 30, and 50 wt

AbstractOral hygiene has been implicated in susceptibility to influenza, but its role in coronavirus disease 2019 (COVID-19) remains incompletely understood. Because the oral cavity may serve as both an entry site and reservoir for respiratory viruses, this study investigated the association between oral health status and COVID-19 and influenza through epidemiological, histopathological, and prospective observational analyses. In an epidemiological study of 2,389 citizens using health and dental check-up data linked to the Japanese National Health Insurance database, poor oral hygiene was identified as an independent risk factor for COVID-19 onset (odds ratio, 2.49; 95% confidence interval, 1.15–5.36; p = 0.02). Histopathological analysis demonstrated significantly higher expression of angiotensin-converting enzyme 2 (ACE2) and furin in inflamed gingival epithelium than in non-inflamed epithelium (ACE2, p < 0.001; furin, p = 0.004). A prospective observational study further suggested that improved oral hygiene practices may reduce the incidence of COVID-19 and influenza. Collectively, poor oral hygiene may contribute to COVID-19 onset through increased ACE2 and furin expression, whereas improved oral hygiene may help prevent COVID-19 and influenza.

Medication-related osteonecrosis of the jaw (MRONJ) is a potential adverse event of antiresorptive agents. Several studies have reported MRONJ originating from peri-implantitis; however, there is currently no consensus on the treatment for peri-implantitis-induced MRONJ (Pi-MRONJ). Herein, we report a case of Pi-MRONJ that showed a significant response to conservative surgery combination with hyperbaric oxygen (HBO) therapy. A 74-year-old woman was referred to our department for further examination and treatment of right mandibular lesion. Three years prior to initial visit, she underwent implant treatment in #46 at her regular dental clinic. Subsequently, she started taking ibandronate for osteoporosis. One year after starting the medication, there was swelling of the gums around the #46 implant and the implant was removed. At the first visit, the patient had swelling in the right submandibular region and drainage of pus in the right mandibular gingiva. Panoramic radiography and computed tomography (CT) showed diffuse osteosclerosis and implants with bone resorption at #44 and #45. Single-photon emission CT (SPECT-CT) showed accumulation of 99mTc-MDP/HMDP in the right mandibular body. We diagnosed Pi-MRONJ Stage III and planned HBO therapy prior to surgical therapy. We removed the implant body (#44 and #45) with mobile and necrotic bone at #45. The patient received HBO therapy (total: 40 times). Panoramic radiography showed evidence of new bone formation, and SPECT-CT demonstrated reduced radiotracer accumulation. The dermal fistula was healing, and intraoral examination revealed no bone exposure, swelling, or purulent discharge. Conservative surgery with HBO therapy was effective, allowing us to avoid extensive surgery.

Implant treatment for atrophic mandibular molars is challenging due to limited space for implant placement and the potential risk of damaging the inferior alveolar nerve. One approach to address these challenges is the angled placement of endosseous implants. We herein report the long-term outcomes of tilted implants placed in atrophic mandibles. Subjects were 12 patients who underwent intentionally tilted implant placement in the atrophic posterior mandible in our department between 2006 and 2014, and 28 implants were placed. Patients were scheduled for follow-up visits every 6 months for a clinical assessment. The minimum observation period was 7.4 years, and the maximum was 16.3 years. Vertical bone loss was monitored on follow-up panoramic radiographs with vertical bone resorption ≥3 mm included in the evaluation. Three implants (in 2 patients) were placed with bone grafting. Twenty implants had single crowns, and 8 were splinted. A radiographic assessment revealed vertical bone resorption ≥3 mm in 7 implants (25%). The 10-year cumulative survival rate was 96.4% (1 implant lost in 9.3 years). There was no damage to the neurovascular structure or permanent paresthesia. Although the rate of vertical bone resorption was high, the prognosis of tilted placement in the mandibular molar region was favorable, suggesting it has potential as a good treatment option to reduce the risk of inferior alveolar nerve damage.

PATIENTS:The patient was an 11-year-old boy with a medical history of congenital acute myeloid leukemia (AML). He received a series of treatments between 1 and 8 months of age, including chemotherapy, total body irradiation, and peripheral blood stem cell transplantation. Although the permanent incisors had erupted, both crown and root formation were incomplete. No tooth buds were observed for the remaining permanent teeth. The deciduous teeth were still present; however, their roots were shortened and showed mobility. At 18 years of age, growth of the upper and lower jaws had ceased; therefore, occlusal rehabilitation was performed using implants. All teeth except the first molars were extracted, and six implants were placed in the jaws. A screw-retained, implant-supported bridge was fitted, and regular follow-up and maintenance were scheduled. Four years and 9 months after placement of the final prosthesis, the occlusion has remained stable. DISCUSSION:This patient had congenital AML and received chemotherapy during early childhood, coinciding with the critical period of tooth development and resulting in root shortening, tooth microdontia, and absence of tooth buds for the permanent teeth. Following completion of maxillofacial growth, occlusal rehabilitation was performed using implants, and the occlusion has remained stable. The findings of the present case suggest that implant-supported prosthetic treatment represents an effective option for full occlusal reconstruction in congenital AML survivors with severe hypodontia. CONCLUSIONS:Dental implant treatment for full occlusal reconstruction in a patient with severe hypodontia who had received chemotherapy for AML is described herein.

Primary malignant salivary gland tumors are rare among pediatric patients. There are few reports about mucoepidermoid carcinoma (MEC) in the minor salivary gland in pediatric patients. Herein, we report a case MEC that arose in salivary hyperplasia on the hard palate in a 10-year-old girl. A 10-year-old girl presented with swelling on the left side of the hard palate. She was referred to our department in October 202X. The patient had experienced swelling of the left hard palate for 2 years, which had been slowly increasing in size. Upon examination, a single, dome-shaped, well-defined mass measuring 18 x 12 mm was observed. Mucosa was normal and there was no tenderness on the left hard palate. The mass showed low signal intensity on T2-weighted magnetic resonance imaging. A biopsy was performed. Although the result indicated salivary hyperplasia, due to suspicion of tumor, total resection was performed. We resected the mass along with the periosteum and removed one layer of the palatal bone under general anesthesia. Histopathologic examination of the surgical specimen revealed lowgrade mucoepidermoid carcinoma. We performed careful follow-up. There was no evidence of recurrence as of years post-surgery.

Previous studies have reported a relationship between masticatory function and general and oral health. Questionnaires are commonly used to assess masticatory function; however, no previous studies have examined which specific questions are the most relevant. In this study, we administered a questionnaire to examine the relationship between chewing and general and oral health. We included 2390 subjects (1213 female and 1177 males) with a median age of 65 years who underwent dental and health checkups. The questionnaire consisted of three comprehensive question items to evaluate masticatory function: overall chewing ability, the hardest food to consume, and eating speed. We found that the questionnaire items on overall chewing ability and the hardest food to consume were associated with dental disease. These items demonstrated sufficient specificity to be used for dental health screening. On the other hand, eating speed was associated with oral hygiene only. In addition, the questionnaire items on eating speed and overall chewing ability showed significant associations with body mass index (BMI). These findings suggest that asking patients questions about overall chewing ability and the hardest food to consume can be used to assess oral and dental health. Moreover, we found relationships between overall chewing ability and eating speed and BMI. It is important to understand the characteristics of these questions and use them in health assessments.

The pemphigoid family of bullous pemphigoid (BP) and mucous membrane pemphigoid (MMP) are autoimmune disorders that are characterized by subepidermal blistering and the development of oral lesions. We herein describe the clinical and pathological features of 11 cases of pemphigoid encountered in our department. Eight cases were diagnosed with BP and three with MMP. One case of BP was diagnosed as dipeptidyl peptidase-4 inhibitor-induced BP. Oral lesions were located in the gingiva in seven cases, the buccal mucosa in five, the lip in two, and the soft palate and tongue in one in the first visit. Seven cases of BP (7/8) had skin lesions, and one case of MMP (1/3) had a mucous lesion in the conjunctiva in the first visit. Oral lesions were detected at an average of 2.8 sites. Enzyme-linked immunosorbent assays showed that 8 (8/11) cases were positive for the anti-BP180-NC16a antibody. All cases with oral lesions received oral care, a topical treatment with dexamethasone valerate, and mouth rinse with sodium gualenate hydrate. This study might suggest that pemphigus could be suspected, diagnosed, and treated through oral lesions.

Congenital infiltrating lipomatosis of the face (CILF) is a benign non-epithelial tumor that was initially reported in 1983. Although lipomas are generally encased in fibrous tissue, CILF lacks a fibrous capsule and is characterized by intramuscular invasion. We herein report a case of CILF diagnosed based on the early eruption of permanent teeth and reviewed the English literature. The patient was a 5-year-old male with diffuse swelling of the left upper canine gingiva. He had undergone surgery at 3 years old to debulk left buccal lipoma. At presentation, facial asymmetry and diffuse swelling of the left cheek were noted. Radiographic examinations revealed the early eruption of and accelerated root formation by the left upper permanent teeth, bony hyperplasia of the left maxilla and zygomatic bone, and adipose hyperplasia of the left cheek region. Hormone examinations revealed no abnormalities. A histopathological specimen obtained from surgery to reduce buccal lipoma was re-evaluated and diagnosed as infiltrative lipoma. Based on histopathological and clinical features, the patient was diagnosed with congenial infiltrative lipoma was established. Conservative therapy was performed in consideration of future surgical interventions after adolescence.

Background: Oral surgical treatment, such as tooth extraction, has been identified as a risk factor for the onset of medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ may already be latent, and its manifestation may be triggered by extraction. Purpose: The purpose of this study was to examine the association between pre-extraction imaging and MRONJ. Study Design, Setting, Sample: We performed a multicenter case-control analysis of patients receiving antiresorptive agents (ARAs) who underwent extraction between 2012 and 2016. We enrolled patients who had undergone tooth extraction in the setting of ARA exposure. Predictor Variables: The predictor variables comprised preoperative radiographic findings associated with MRONJ stage 0. These findings included alveolar bone loss, thickening or obscuring of the periodontal ligament, and osteosclerosis involving the alveolar bone. They were coded as present or absent before tooth extraction. Main Outcome Variable: The primary outcome variable was MRONJ status coded as present or absent. Covariates: Sex, age, underlying diseases necessitating the administration of ARA, the type of ARA used, corticosteroid use, extraction region, and wound closure were analyzed. Analyses: Mann-Whitney U test, chi(2) test, Fisher's exact test for univariate analysis, and multiple logistic regression analysis were performed. P values < .05 were significant. Results: The subjects consisted of 26 patients and 110 controls (male: 8/36, female: 18/74). The mean ages of the MRONJ group and the control group were 77.0 +/- 11.9 and 63.0 +/- 15.8, respectively (P value = .001). The prevalence of osteosclerosis was significantly higher in the MRONJ group than in the control group (14/72, 53.9%/29.3%, P < .01). Multivariate analysis identified osteosclerosis (odds ratio: 8.4, 95% confidence interval: 2.133.9, P < .01) as a significant independent predictor associated with the development of MRONJ after extraction. Conclusion and Relevance: These findings suggest that a precursor to MRONJ is highly likely to be present in patients with osteosclerosis at the time of extraction. The majority of patients who devel oped MRONJ after extraction had imaging findings that suggested infection in the surrounding alveolar bone. (c) 2024 American Association of Oral and Maxillofacial Surgeons

Proper food intake is important for maintaining good health in humans. Chocolate is known to exert anti-inflammatory effects; however, the mechanisms remain unclear. In this study, we aimed to investigate the effects of cocoa butter intake on gut immunity in rats and rabbits. Cocoa butter intake increased the lymph flow, cell density, and IL-1β, IL-6 and IL-10 levels in mesenteric lymph. Clodronate, a macrophage depletion compound, significantly enhanced the release of all cytokines. The immunoreactivities of macrophage markers CD68 and F4/80 in the jejunal villi were significantly decreased with clodronate. Piceatannol, a selective cell surface ATP synthase inhibitor significantly reduced the cocoa butter intake-mediated releases of IL-1β, IL-6 and IL-10. The immunoreactivities of cell surface ATP synthase were observed in rat jejunal villi. Shear stress stimulation on the myofibroblast cells isolated from rat jejunum released ATP and carbon dioxide depended with H + release. In rabbit in vivo experiments, cocoa butter intake increased the concentrations of ATP and H + in the portal vein. The in vitro experiments with isolated cells of rat jejunal lamina propria the pH of 3.0 and 5.0 in the medium released significantly IL-1β and IL-6. ATP selectively released IL-10. These findings suggest that cocoa butter intake regulates the gut immunity through the release and transport of IL-1β, IL-6, and IL-10 into mesenteric lymph vessels in a negative feedback system. In addition, the H + and ATP released from cell surface ATP synthase in jejunal villi play key roles in the cocoa butter intake–mediated regulation of gut immunity.

The higher permeability of the venules in jejunal microcirculation to albumin contributes to the increased mesenteric lymph formation. Recently, we demonstrated that water intake induced serotonin release from enterochromaffin cells in rat jejunum, serotonin of which circulated through the portal vein into blood circulation and then increased the mesenteric lymph formation. The mode of action of serotonin remains unclear. Therefore, we aimed to clarify the mechanisms involved in the regulation of the jejunal lymph formation with permeant albumin in in vivo rat experiments. We investigated the effects of intravenous administration of serotonin or water intake on the jejunal-originated lymph volume and the concentration of albumin in the lymph in the presence or absence of L-NAME. The effects of intravenous administration of L-NAME, nicardipine, A23187, and ML-7 on the lymph formation with permeant albumin were also evaluated. Serotonin or water intake significantly increased the mesenteric lymph volume with permeant albumin in the jejunal microcirculation. The serotonin- and water intake-mediated responses were significantly reduced by the pretreatment with intravenous administration of L-NAME. Intravenous administration of L-NAME itself also decreased significantly the jejunal lymph formation. Administration of A23187 and ML-7 significantly reduced the jejunal lymph formation with permeant albumin. In contrast, administration of nicardipine significantly increased the lymph formation. In conclusion, portal venous blood flow- or serotonin-mediated NO release from venular endothelial cells plays physiologically key roles in the lymph formation in rat jejunum via the extrusion of calcium ions and inactivation of MLCK in endothelial cells.

A close causal relationship has been suggested to exist between cancer and periodontitis. We hypothesized that the immune surveillance system is impaired in patients with periodontitis, which contributes to cancer development and growth. Therefore, the present study investigated the relationship between immune surveillance mechanisms and periodontitis in cancer patients. The presence or absence of periodontitis was assessed and the peripheral blood (PB) concentrations of IL-6, immunosuppressive cytokines (VEGF, TGF-β1, and CCL22) and proportion of T regulatory cells (Treg, CD3 + CD4 + CD25 + Foxp3 +) were measured. Subjects were classified into the following four groups: non-cancer patients without periodontitis (C − P −), non-cancer patients with periodontitis (C − P +), cancer patients without periodontitis (C + P −), and cancer patients with periodontitis (C + P +). The results of a multivariate analysis showed that the PB concentration of IL-6 was significantly higher in C + than in C- and higher in C + P + than in C + P −. The PB proportion of Treg was significantly higher in C + P + than in C + P −, C − P + , and C − P −. The results of this study suggested that the presence of periodontitis and cancer synergistically increased Treg in PB, which may be one of the underlying causes of immunosuppression and immune evasion in cancer. It was also suggested that the presence of periodontal disease and/or cancer also increases IL-6 in PB, which would be associated with cancer progression. These results suggest the possibility that the presence of periodontitis might synergistically contribute to cancer progression.

The number of patients administered oral antithrombotic drugs who require elective surgery has increased. Perioperative heparin bridging needs to be considered for patients at a high risk of thromboembolism. The present study investigated the effects of perioperative heparin bridging therapy on perioperative complications (postoperative bleeding and thrombotic events) in oral cancer surgery. The medical records of 98 patients who underwent oral cancer surgery with perioperative bridging therapy were retrospectively analyzed. Postoperative hemorrhage occurred in 16 patients (16.3%) and thrombotic events (deep venous thrombosis) in 5 (5.1%), which were higher than in other surgeries. A multivariate analysis identified the administration of prostaglandins as the only significant independent risk factor for postoperative hemorrhage, and a longer duration of postoperative heparin bridging therapy was associated with the incidence of deep venous thrombosis. The present results suggest a higher incidence of thrombotic and bleeding events in patients who underwent oral cancer surgery with heparin bridging, and the nature of surgery (such as revascularization and prolonged bed rest) may be a contributing factor. Future studies are needed to establish whether heparin bridging is effective in oral cancer surgery.

Background: A close causal relationship has been suggested to exist between cancer and periodontitis. We hypothesized that the immune surveillance system is impaired in patients with periodontitis, which contributes to cancer development and growth. Therefore, the present study investigated the relationship between immune surveillance mechanisms and periodontitis in cancer patients.Methods: Thirty cancer and 31 non-cancer patients were recruited for the present study. The presence or absence of periodontitis was assessed and the peripheral blood (PB) concentrations of inflammation cytokines(IL-6), immunosuppressive cytokines (VEGF, TGFβ-1, and CCL22) and proportion of T regulatory cells (Treg, CD3+CD4+CD25+Foxp3+) were measured.Findings: Subjects were classified into the following four groups: non-cancer patients without periodontitis (C-P-), non-cancer patients with periodontitis (C-P+), cancer patients without periodontitis (C+P-), and cancer patients with periodontitis (C+P+). The results of a multivariate analysis adjusted for confounding factors (age, sex, smoking status, diabetes mellitus, and tooth number) showed that the PB concentration of IL-6 was significantly higher in C+ than in C- and higher in C+P+ than in C+P-. The PB proportion of Treg was significantly higher in C+P+ than in C+P-, C-P+, and C-P-.Interpretation: The present results showed that the presence of cancer and periodontitis synergistically increased the proportion of Treg and concentration of IL-6 in PB, which may be one of mechanisms underlying immunosuppression and immune evasion in cancer. Therefore, the presence of periodontitis may contribute to immune evasion in cancer.Funding Information: JPS KAKENHI Grant Number JP21K16943. Declaration of Interests: The authors have no conflicts of interest directly relevant to the content of this article.Ethics Approval Statement: The study protocol was approved by the Ethics Committee of Shinshu University School of 31 (Approval number #4144). The present study was performed in accordance with the Declaration of Helsinki (2013 Fortaleza revision) and Ethical Guidelines for Medical Research for Humans. Patients agreed with informed consent to participate in the present study.

Abstract Mesenteric lymph has received attention for its important roles in nutrient absorption and mucosal immunity. It contains cytokines and immune cells that control the immune responses. The aim of this study to evaluate the effects of cocoa butter intake on rat mesenteric lymph flow, cell density, and the IL-1β, IL-6 and IL-10 levels in the lymph. Cocoa butter intake increased the lymph flow, cell density and the cytokine levels in the lymph. Clodronate released IL-1β, IL-6 and IL-10 and slightly accelerated the cocoa butter intake-mediated release of IL-6, but not that of IL-1β and IL-10. A Toll-like receptor (TLR) 2 and 4 inhibitor significantly reduced the linoleic acid-mediated releases of IL-1β, IL-6 and IL-10 in the medium of isolated cells from lamina propria of jejunal villi. Our findings suggest that cocoa butter intake regulates gut immunity through the release of IL-1β, IL-6 and IL-10 via a negative feedback mechanism.

The present study aims to investigate the roles of water intake in serotonin production and release in rat jejunum. We evaluated the changes in concentrations of serotonin in the portal vein and mesenteric lymph vessel induced by the intragastric administration of distilled water. The density of granules in enterochromaffin cells and the immunoreactivity of serotonin in the jejunal villi were investigated before and after water intake. The effects of intravenous administration of serotonin and/or ketanserin on mesenteric lymph flow and concentrations of albumin and IL-22 in the lymph were also addressed. Water intake increased serotonin concentration in the portal vein, but not in the mesenteric lymph vessel. The flux of serotonin through the portal vein was significantly larger than that through the mesenteric lymph vessel. Water intake decreased the density of granules in the enterochromaffin cells and increased the immunoreactivity of serotonin in the jejunal villi. The intravenous administration of serotonin increased significantly mesenteric lymph flow and the concentrations of albumin and IL-22; both were significantly reduced by the intravenous pretreatment with ketanserin. We showed that serotonin released from enterochromaffin cells by water intake was mainly transported through the portal vein. Additionally, serotonin in blood was found to increase mesenteric lymph formation with permeant albumin in the jejunal villi via the activation of 5-HT2 receptor.

Salivary dysfunction, such as reduced salivary flow and an altered salivary composition, is caused by several diseases, medical conditions, and medications. The purpose of the present study was to clarify the relationship between hypertension and morphological changes in the submandibular glands. An epidemiological study was conducted to elucidate the relationship between hypertension and dry mouth. The effects of hypertension on morphological changes and the intima thickness of arteries in the submandibular glands were histopathologically investigated. Among 1933 subjects in the epidemiological study, 155 (8.0%) had dry mouth. A multivariate analysis revealed that dry mouth correlated with age (p < 0.001), sex (p < 0.001), and hypertension (p < 0.05). No significant differences were observed in the size of the submandibular glands between patients with or without hypertension. The average area of acinar cells was smaller in patients with than in those without hypertension (0.366 ± 0.153 vs. 0.465 ± 0.178, p < 0.05). The arteriosclerotic index was significantly higher in patients with than in those without hypertension (0.304 ± 0.034 vs 0.475 ± 0.053, p < 0.05). Hypertension may contribute to the degeneration of the submandibular glands by decreasing the number of acinar cells and promoting fatty infiltration and stenosis of the arteries. There may be a correlation between hypertension and the degeneration of the submandibular glands by decreasing the number of acinar cells and promoting fatty infiltration and stenosis of the arteries.