Dental trauma in endoscopy:A systematic review and experience of a tertiary endoscopy centre

BACKGROUND Dental injury is the leading cause of litigation in anaesthesia but an underrecognized preventable complication of endoscopy.AIM To determine frequency and effects of dental injury in endoscopy,we present findings from an audit of outpatient endoscopy procedures conducted at a tertiary university hospital and a systematic review of literature.METHODS Retrospective review of 11265 outpatient upper endoscopy procedures over the period of 1 June 2019 to 31 May 2021 identified dental related complications in 0.284%of procedures.Review of literature identified a similar rate of 0.33%.RESULTS Pre-existing dental pathology or the presence of prostheses makes damage more likely but sound teeth may be affected.Pre-endoscopic history and tooth examination are key for risk stratification and may be conducted succinctly with limited time outlay.Tooth retrieval should be prioritized in the event of dental injury to minimize aspiration and be followed by prompt dental consultation for specific management.CONCLUSION Dental complications occur in approximately 1 in 300 of upper endoscopy cases.These are easily preventable by pre-endoscopy screening.Protocols to mitigate dental injury are also suggested.

Biomaterial-based strategies for maxillofacial tumour therapy and bone defect regeneration

Issues caused by maxillofacial tumours involve not only dealing with tumours but also repairing jaw bone defects.In traditional tumour therapy,the systemic toxicity of chemotherapeutic drugs,invasive surgical resection,intractable tumour recurrence,and metastasis are major threats to the patients’lives in the clinic.Fortunately,biomaterial-based intervention can improve the efficiency of tumour treatment and decrease the possibility of recurrence and metastasis,suggesting new promising antitumour therapies.In addition,maxillofacial bone tissue defects caused by tumours and their treatment can negatively affect the physiological and psychological health of patients,and investment in treatment can result in a multitude of burdens to society.Biomaterials are promising options because they have good biocompatibility and bioactive properties for stimulation of bone regeneration.More interestingly,an integrated material regimen that combines tumour therapy with bone repair is a promising treatment option.Herein,we summarized traditional and biomaterial-mediated maxillofacial tumour treatments and analysed biomaterials for bone defect repair.Furthermore,we proposed a promising and superior design of dual-functional biomaterials for simultaneous tumour therapy and bone regeneration to provide a new strategy for managing maxillofacial tumours and improve the quality of life of patients in the future.

Oral manifestations of hepatitis C virus infection

Extrahepatic manifestations (EHMs) of hepatitis C virus (HCV) infection can affect a variety of organ systems with significant morbidity and mortality. Some of the most frequently reported EHM of HCV infection, involve the oral region predominantly or exclusively. Oral lichen planus (OLP) is a chronic inflammatory condition that is potentially malignant and represents cell-mediated reaction to a variety of extrinsic antigens, altered self-antigens, or super antigens. Robust epidemiological evidence support the link between OLP and HCV. As the virus may replicate in the oral mucosa and attract HCV-specific T lymphocytes, HCV may be implicated in OLP pathogenesis. Sjögren syndrome (SjS) is an autoimmune exocrinopathy, characterized by dryness of the mouth and eyes and a multitude of other systemic signs and symptoms. SjS patients have also an increased risk of non-Hodgkin lymphoma. Patients with chronic hepatitis C do frequently have histological signs of Sjögren-like sialadenitis with mild or even absent clinical symptoms. However, it is still unclear if HCV may cause a disease mimicking SjS or it is directly responsible for the development of SjS in a specific subset of patients. Oral squamous cell carcinoma is the most common oral malignant tumour and at least in some part of the world could be linked to HCV.

Analysis of differential expression of tight junction proteins in cultured oral epithelial cells altered by Porphyromonas gingivalis,Porphyromonas gingivalis lipopolysaccharide,and extracellular adenosine triphosphate

Tight junctions （TJs） are the most apical intercellular junctions of epithelial cells formed by occludin, claudins, junctional adhesion molecules （JAMs）, and zonula occludens （ZO）. Tight junction proteins can sense the presence of bacteria and regulate the transcription of target genes that encode effectors and regulators of the immune response. The aim of this study was to determine the impact of TJ proteins in response to Porphyromonas gingivalis （P. gingivalis）, P. gingivalis lipopolysaccharide （P. gingivalis LPS）, and extracellular adenosine triphosphate （ATP） in the oral epithelial cell culture model. Quantified real time- polymerase chain reaction （RT-PCR）, immunoblots, and immunostaining were performed to assess the gene and protein expression in TJs. It was found that P. gingivalis infection led to transient upregulation of the genes encoding occludin, claudin- 1, and claudin-4 but not JAM-A, claudin-15, or ZO-1, while P. gingivalis LPS increased claudin-1, claudin-15, and ZO-1 and decreased occludin, JAM-A, and claudin-4. Tight junction proteins showed significant upregulation in the above two groups when cells were pretreated with ATP for 3 h. The findings indicated that P. gingivalis induced the host defence responses at an early stage. P. gingivalis LPS exerted a more powerful stimulatory effect on the disruption of the epithelial barrier than P. gingivalis. ATP stimulation enhanced the reaction of TJ proteins to P. gingivalis invasion and LPS destruction of the epithelium.

An early report: a modified porphyrin-linked metronidazole targeting intracellular Porphyromonas gingivalis in cultured oral epithelial cells

Porphyromonas gingivalis （P. gingivalis） has a strong association with the pathogenesis of periodontal disease. Recurrence of periodontal disease following therapy is attributed to numerous factors, and of growing interest is the potential problem of intracellular bacteria that are able to persist and multiply within the host cell, thereby facilitating relapse of infection. The effect of antibiotic therapy in controlling P. gingivalis is questionable. Accordingly, while metronidazole is very effective against anaerobic extracellular P. gingivalis by disrupting the DNA of anaerobic microbial cells, this antibiotic does not effectively penetrate into mammalian cells to inhibit intracellular bacteria. Therefore in the present study, a modified porphyrin-linked metronidazole adducts, developed in our laboratory, was used to kill intracellular P. gingivalis. A series of experiments were performed, including cytotoxicity assays and cellular uptake of adducts by flow cytometry coupled with live cell imaging analysis, P. gingivalis invasion and elimination assays, and the analysis of colocalization of P. gingivalis and porphyrin-linked metronidazole by confocal laser scanning microscopy. Findings indicated that P. gingivalis and porphyrin-linked metronidazole were colocalized in the cytoplasm, and this compound was able to kill P. gingivalis intracellular with a sufficient culture time. This is a novel antimicrobial approach in the elimination of P. gingivalis from the oral cavity.

The role of YAP in the control of the metastatic potential of oral cancer

The Yes-associated protein(YAP)is a downstream effector of the Hippo pathway and acts as a key transcription co-factor to regulate cell migration,proliferation,and survival.The Hippo pathway is evolutionarily conserved and controls tissue growth and organ size.Dysregulation and heterogeneity of this pathway are found in cancers,including oral squamous cell carcinoma(OSCC),leading to overexpression of YAP and its regulated proliferation machinery.The activity of YAP is associated with its nuclear expression and is negatively regulated by the Hippo kinase-mediated phosphorylation resulting in an induction of its cytoplasmic translocation.This review focuses on the role of YAP in OSCC in the context of cancer metastatic potential and highlights the latestfindings about the heterogeneity of YAP expression and its nuclear transcription activity in oral cancer cell lines.The review also discusses the potential target of YAP in oral cancer therapy and the recentfinding of the unprecedented role of the desmosomal cadherin desmoglein-3(DSG3)in regulating Hippo-YAP signaling.

Exosome-mediated cellular crosstalk within the tumor microenvironment upon irradiation

Radiotherapy is one of the most effective treatment methods for various solid tumors.Bidirectional signal transduction between cancer cells and stromal cells within the irradiated microenvironment is important in cancer development and treatment responsiveness.Exosomes,initially considered as"garbage bins"for unwanted from cells,are now understood to perform a variety of functions in interactions within the tumor microenvironment.Exosome-mediated regulation processes are rebuilt under the irradiation stimuli,because the exosome production,uptake,and contents are markedly modified by irradiation.In turn,irradiation-modified exosomes may modulate the cell response to irradiation through feedback regulation.Here,we review current knowledge and discuss the roles of exosome-mediated interactions between cells under radiotherapy conditions.

Review of a new bone tumor therapy strategy based on bifunctional biomaterials

Bone tumors,especially those in osteosarcoma,usually occur in adolescents.The standard clinical treatment includes chemotherapy,surgical therapy,and radiation therapy.Unfortunately,surgical resection often fails to completely remove the tumor,which is the main cause of postoperative recurrence and metastasis,resulting in a high mortality rate.Moreover,bone tumors often invade large areas of bone,which cannot repair itself,and causes a serious effect on the quality of life of patients.Thus,bone tumor therapy and bone regeneration are challenging in the clinic.Herein,this review presents the recent developments in bifunctional biomaterials to achieve a new strategy for bone tumor therapy.The selected bifunctional materials include 3D-printed scaffolds,nano/microparticle-containing scaffolds,hydrogels,and bone-targeting nanomaterials.Numerous related studies on bifunctional biomaterials combining tumor photothermal therapy with enhanced bone regeneration were reviewed.Finally,a perspective on the future development of biomaterials for tumor therapy and bone tissue engineering is discussed.This review will provide a useful reference for bone tumor-related disease and the field of complex diseases to combine tumor therapy and tissue engineering.

Expert consensus on early childhood caries management

Early childhood caries(ECC)is a significant chronic disease of childhood and a rising public health burden worldwide.ECC may cause a higher risk of new caries lesions in both primary and permanent dentition,affecting lifelong oral health.The occurrence of ECC has been closely related to the core microbiome change in the oral cavity,which may be influenced by diet habits,oral health management,fluoride use,and dental manipulations.So,it is essential to improve parental oral health and awareness of health care,to establish a dental home at the early stage of childhood,and make an individualized caries management plan.Dental interventions according to the minimally invasive concept should be carried out to treat dental caries.This expert consensus mainly discusses the etiology of ECC,caries-risk assessment of children,prevention and treatment plan of ECC,aiming to achieve lifelong oral health.

Expert consensus on dental caries management

Dental Caries is a kind of chronic oral disease that greatly threaten human being’s health.Though dentists and researchers struggled for decades to combat this oral disease,the incidence and prevalence of dental caries remain quite high.Therefore,improving the disease management is a key issue for the whole population and life cycle management of dental caries.So clinical difficulty assessment system of caries prevention and management is established based on dental caries diagnosis and classification.Dentists should perform oral examination and establish dental records at each visit.When treatment plan is made on the base of caries risk assessment and carious lesion activity,we need to work out patient-centered and personalized treatment planning to regain oral microecological balance,to control caries progression and to restore the structure and function of the carious teeth.And the follow-up visits are made based on personalized caries management.This expert consensus mainly discusses caries risk assessment,caries treatment difficulty assessment and dental caries treatment plan,which are the most important parts of caries management in the whole life cycle.

Expert consensus on regenerative endodontic procedures

Regenerative endodontic procedures(REPs)is a biologic-based treatment modality for immature permanent teeth diagnosed with pulp necrosis.The ultimate objective of REPs is to regenerate the pulp-dentin complex,extend the tooth longevity and restore the normal function.Scientific evidence has demonstrated the efficacy of REPs in promotion of root development through case reports,case series,cohort studies,and randomized controlled studies.However,variations in clinical protocols for REPs exist due to the empirical nature of the original protocols and rapid advancements in the research field of regenerative endodontics.The heterogeneity in protocols may cause confusion among dental practitioners,thus guidelines and considerations of REPs should be explicated.This expert consensus mainly discusses the biological foundation,the available clinical protocols and current status of REPs in treating immature teeth with pulp necrosis,as well as the main complications of this treatment,aiming at refining the clinical management of REPs in accordance with the progress of basic researches and clinical studies,suggesting REPs may become a more consistently evidence-based option in dental treatment.

Damage and Fatigue Failure of Conventional and Bulk-Filled Resin Composites

Objectives: Resin-based composites are the most widely used dental restorative materials. Bulk-fill resin composites are of rising interest as they can be clinically applied in thicker increments compared to conventional composites. The purpose of the study was to evaluate the flexural fatigue strength of a conventional and bulk-filled resin composite placed incrementally or non-incrementally. Methods: Resin composite specimens were fabricated using either a conventional (Brilliant EverGlow?) or a bulk-fill (Fill-Up!TM) resin composite by either non-incremental filling (2 × 2 × 25 mm3) or in increments of (1 × 2 × 25 mm3). Specimens were stored in distilled water for 24 h or thermocycled for 5000 cycles. The static flexural strength (σ), flexural fatigue limit (FFL) after 105 cycles and post-fatigue flexural strength (PFσ) were measured. Data were analyzed using ANOVA, with a post-hoc Tukey’s test to compare mean FFL (p σ and PFσ compared to conventional composites regardless of incremental cure or thermocycling (p σ and FFL for conventional composites but not bulk-filled composites. There was no significant difference in PFσ compared to σ after 24 h storage, but a significant increase in PFσ after thermocycling (p < 0.05). Conclusions: The type of composite rather than incremental placement had a greater effect on flexural strength, suggesting that operator placement technique had less influence than material selection. Thermocycling in combination with cyclic loading caused a strengthening effect in the composites, likely due to the absorption and dissipation of stresses, thereby enhancing resistance to fracture.

Network Modelling and Visualisation Analysis of the Undergraduate Dental Curriculum System in China

Objectives: This study aims to present the characteristics of the undergraduate dental curriculum system using network modelling and visualisation analysis based on complex network theory, thus providing a theoretical foundation for the course development and curriculum reform. Methods: The correlation coefficient was used to quantify the intensity of the correlation between courses, and a visualisation complex network of the dental curriculum was built to explore the curriculum pattern from a dynamic perspective. Further, the statistical measurements of curriculum network were adopted to express the most relevant topological features. Subsequently, the minimum spanning tree and parallel coordinates plot were drawn to explore the curriculum community structure, quantify the key courses, and present different courses in time and space relationships. Results: The correlation analysis results show that the courses are closely related to each other. The main courses focus on pathology, pathophysiology, oral anatomy and physiology, closely connecting almost all medicine-related courses. The whole course network has an average degree value of 41.53, and a clustering coefficient of 0.78, indicating an obvious small-world characteristic. From the perspective of curriculum attributes, the number of public and theoretical courses was more than that of skills and practical courses. Moreover, the academic performance of skills and practical courses was lower than that of public and theoretical courses. Conclusion: The undergraduate dental courses have a progressive structure from basic professional knowledge to professional skills, which is reasonable for the dental education in China. However, some efforts towards curriculum reform based on this study are needed.

Risk Factors of Malnutrition among Karen Children in Chiang Mai, Thailand

The objective of this study was to determine the risk factors of malnutrition and its association with iron deficiency anaemia (IDA) among Karen hill tribe children. We conducted a study on blood samples from children from Baan Yang Poa School, Chiang Mai, Thailand aged between 9 and 15 years old. Of 193 children, 31 (16.1%) had malnutrition and 12 (6.2%) had IDA. Children who had at least five family members were found to have a significantly higher risk of malnutrition (P = 0.005), a reflection of the importance of socioeconomic factors in the problem of malnutrition. We also found that malnutrition was not associated with IDA although the assessment of the association of malnutrition and other types of anaemia is still of interest.

Extracellular vesicle-based biomarker in head and neck cancer: prospects and challenges

Head and neck squamous cell carcinoma(HNSCC)represents the sixth most common malignancy worldwide.However,very few established diagnostic biomarkers for HNSCC have been universally applied in clinical practice.Recently,much attention has been paid to extracellular vesicles(EVs)regarding their roles as cancer biomarkers because EVs carry plentiful cargoes,including lipids,proteins,nucleic acids,and metabolites.In HNSCC,several molecules carried by EVs,which are derived from peripheral blood and saliva,have been implicated to be effective in cancer detection,staging,treatment planning,response monitoring,and prognosis prediction.Although several EV molecules have been identified to be significantly correlated with a set of clinicalpathological parameters of HNSCC,several key limitations need to be resolved before the clinical application of EVs as carriers of biomarkers in HNSCC.In this review,we discuss current knowledge in the literature regarding EV-based biomarkers in HNSCC,emphasizing current limitations of their clinical applications.

Microarray analysis of signalling interactions between inflammation and angiogenesis in subchondral bone in temporomandibular joint osteoarthritis

Inflammation and angiogenesis,the major pathological changes of osteoarthritis(OA),are closely associated with joint pain;however,pertinent signalling interactions within subchondral bone of osteoarthritic joints and potential contribution to the peripheral origin of OA pain remain to be elucidated.Herein we developed a unilateral anterior crossbite mouse model with osteoarthritic changes in the temporomandibular joint.Microarray-based transcriptome analysis,besides quantitative real-time polymerase chain reaction,was performed to identify differentially expressed genes(DEGs).Overall,182 DEGs(fold change≥2,P<0.05)were identified between the control and unilateral anterior crossbite groups:168 were upregulated and 14 were downregulated.On subjecting significant DEGs to enrichment analyses,inflammation and angiogenesis were identified as the most affected.Inflammation-related DEGs were mainly enriched in T cell activation and differentiation and in the mammalian target of rapamycin/nuclear factor-κB/tumour necrosis factor signalling.Furthermore,angiogenesis-related DEGs were mainly enriched in the Gene Ontology terms angiogenesis regulation and vasculature development and in the KEGG pathways of phosphoinositide 3-kinase-protein kinase B/vascular endothelial growth factor/hypoxia-inducible factor 1 signalling.Protein-protein interaction analysis revealed a close interaction between inflammation-and angiogenesis-related DEGs,suggesting that phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit delta(Pi3kcd),cathelicidin antimicrobial peptide(Camp),C-X-C motif chemokine receptor 4(Cxcr4),and MYB proto-oncogene transcription factor(Myb)play a central role in their interaction.To summarize,our findings reveal that in subchondral bone of osteoarthritic joints,signal interaction is interrelated between inflammation and angiogenesis and associated with the peripheral origin of OA pain;moreover,our data highlight potential targets for the inhibition of OA pain.

Gold nanorods and nanohydroxyapatite hybrid hydrogel for preventing bone tumor recurrence via postoperative photothermal therapy and bone regeneration promotion

Osteosarcoma is a malignant bone tumor,which often occurs in adolescents.However,surgical resection usually fails to completely remove the tumor clinically,which has been the main cause of postoperative recurrence and metastasis,resulting in the high death rate of patients.At the same time,osteosarcoma invades a large area of the bone defect,which cannot be self-repaired and seriously affects the life quality of the patients.Herein,a bifunctional methacrylated gelatin/methacrylated chondroitin sulfate hydrogel hybrid gold nanorods(GNRs)and nanohydroxyapatite(nHA),which possessed excellent photothermal effect,was constructed to eradicate residual tumor after surgery and bone regeneration.In vitro,K7M2wt cells(a mouse bone tumor cell line)can be efficiently eradicated by photothermal therapy of the hybrid hydrogel.Meanwhile,the hydrogel mimics the extracellular matrix to promote proliferation and osteogenic differentiation of mesenchymal stem cells.The GNRs/nHA hybrid hydrogel was capable of photothermal treatment of postoperative tumors and bone defect repair in a mice model of tibia osteosarcoma.Therefore,the hybrid hydrogel possesses dual functions of tumor therapy and bone regeneration,which shows great potential in curing bone tumors and provides a new hope for tumor-related bone complex disease.

Update on oral and oropharyngeal cancer staging-International perspectives

Squamous cell carcinoma of the oral cavity and oropharynx have been used synonymously and interchangeably in the world literature in the context of head and neck cancers.As the 21st century progresses,divergence between the two have become more evident,particularly due to evidence related to human papillomavirus-associated oropharyngeal squamous cell carcinoma.As such,the American Joint Committee on Cancer recently published the 8th edition Cancer Staging Manual,serving as a continued global resource to clinicians and researchers.Through changes in staging related to T and N clinical and pathologic classifications,the new system is expected to influence current management guidelines of these cancers that have distinct anatomic and etiopathogenic characteristics.This article aims to review such impactful changes in a time of critical transition of the staging of head and neck cancer and how these changes may affect clinicians and researchers worldwide.

Inflammation-associated ectopic mineralization

Ectopic mineralization refers to the deposition of mineralized complexes in the extracellular matrix of soft tissues.Calcific aortic valve disease,vascular calcification,gallstones,kidney stones,and abnormal mineralization in arthritis are common examples of ectopic mineralization.They are debilitating diseases and exhibit excess mortality,disability,and morbidity,which impose on patients with limited social or financial resources.Recent recognition that inflammation plays an important role in ectopic mineralization has attracted the attention of scientists from different research fields.In the present review,we summarize the origin of inflammation in ectopic mineralization and different channels whereby inflammation drives the initiation and progression of ectopic mineralization.The current knowledge of inflammatory milieu in pathological mineralization is reviewed,including how immune cells,pro-inflammatory mediators,and osteogenic signaling pathways induce the osteogenic transition of connective tissue cells,providing nucleating sites and assembly of aberrant minerals.Advances in the understanding of the underlying mechanisms involved in inflammatory-mediated ectopic mineralization enable novel strategies to be developed that may lead to the resolution of these enervating conditions.