Oral Health Management of Three Head and Neck Cancer Patients Performed by Dental Hygienists

Introduction: Oral health management is often difficult in patients after surgical tumor resection and/or radiotherapy due to defects, bulky flaps, limitation of tongue movement, and trismus. In addition, patients who have undergone radiotherapy have serious disabilities such as oral mucositis, mucosal weakening, soft tissue fibrosis, salivary gland disorder, and osteoradionecrosis. Dental hygienists must understand the characteristics of patients after surgical tumor resection and/or radiotherapy. In this report, the oral health management of three patients after maxillectomy, mandibulectomy, and radiotherapy was shown. Case Description: Case 1: A 53-year-old male patient visited our clinic after chemotherapy, radiotherapy, and partial maxillectomy for cancer of the right maxillary gingiva. Case 2: A 65-year-old male patient visited our clinic after radiotherapy for a right-sided tongue cancer, partial mandibulectomy of the right tongue to the oropharynx, a right-sided segmental mandibulectomy and a speech aid and a mandibular prosthesis were provided. Case 3: A 36-year-old female visited our clinic for radiotherapy for left-sided tongue cancer. Dental hygienists provided oral health management to the patients. In oral health management, it was suggested that intervention before cancer treatment, oral hygiene instructions tailored to patients’ symptoms, and frequent professional care are important. Conclusion: Oral health management by dental hygienists is extremely important for patients undergoing maxillofacial cancer treatment to maintain their quality of life in the long term.

Relationship among Health Related Quality of Life, Quality of Sleep, and Oral Health Condition

Japan’s aging rate (ratio of elderly aged 65 and older to total population) has exceeded 20%. The aim of this study was to clarify the relationships between Health Related Quality of Life, Body Mass Index (BMI), and sleep quality. Subjects were 51 adults over 55 years old with chronic disease who living in the community. Instruments and structured interviews were used giving due consideration to privacy. Interviews were conducted within 10 - 20 minutes at the out-patient department. The evaluation instruments included bodymass index, Pittsburgh Sleep Quality Index (PSQI), Health Related Quality of Life (HRQOL), and Oral Health Impact Profile (OHIP-14). A significant positive correlation (ρ = 0.321, p < 0.05) between PSQI and QOL (OHIP-14) scores was confirmed with sleep quality being lower with lower QOL scores. A negative correlation (ρ = ?0.339, p < 0.05) between physical health component summary scores (PCS) and mental health component summary scores (MCS) of HRQOL was confirmed, demonstrating that PCS was low, and the level of MCS was high. Sleep quality was found lower among those with lower oral health-related QOL scores. Moreover, in subjects with lower MCS scores, the PCS scores were found to be higher. Accordingly, it was considered appropriate that dental treatment and care, support the maintenance of activities and sleep, and mental health promotion which are likely requisites critical for elderly persons’ maintenance of independent lifestyles in their familiar community.

Development of the Diabetes Oral Health Assessment Tool ©for Nurses

Although some studies had suggested a bidirectional relationship between diabetes and periodontal disease, there were no appropriate tools for nurses to evaluate oral status and oral health behaviors in patients with diabetes. Therefore, the Diabetes Oral Health Assessment Tool (DiO-HAT ?) was developed with items contributed by health care professionals (diabetologists, periodontal specialists, a preventive dentist, a Certified Nurse in Diabetes Nursing, a national registered dietitian, registered nurses, a dental hygienist, and nursing researchers) who were involved in the medical care of patients with diabetes. Subsequently, a survey of 700 Diabetes Nurse Specialists (DNS) was conducted to determine their score of recognition and implementation of the DiOHAT ?, however, 304 participants (43.4%) responded. Constructive concept validation and the Cronbach’s alpha coefficient for all assessment items were 0.931, indicating high reliability: Factor 1, Patient’s oral health status (α = 0.831);Factor 2, Implementation of oral health behaviors (α = 0.890);Factor 3, Information transmission regarding dental visits (α = 0.862);and Factor 4, Perceptions and knowledge of oral health behaviors (α = 0.793). Although the mean score of recognition of DiOHAT ? was 3.5 ± 0.4 points, the mean value of the implementation score was 1.5 ± 0.5 points (obtained using a 4-grade scale). The implementation scores were significantly lower than the recognition scores for all items (p < 0.001). The findings suggested that the DNS were not inclined to implement all items of DiOHAT ?, despite recognizing their importance.

The Effect of Partial Removable Denture Use on Oral Health Related Quality of Life and Masticatory Function, after 5 Years Use

The aim of this study was to evaluate whether partial removable denture use indeed leads to improved oral health related quality of life and masticatory function. Materials and Methods: Partially edentulous patients presenting for removable denture treatment at the Prosthodontics Service in the Hospital Affiliated to Kinshasa University (Democratic Republic of Congo) were assessed for enrolment in this study. After applying exclusion criteria, 378 patients were included in the study, and randomly assigned into 2 groups. Oral health related quality of life (OHIP-23) and mastication time (MaT), number of chewing cycles (MaC), mastication frequency (MaF), and the sizes of the peanut fragments (FraS) were compared in both groups. Statistical significance was set at p < 0.05. Results: The average MaC, MaT, MaF, and FraS were 119 (± SD 53.70), 86.75 (±SD 35.35), 1.38 (±SD 0.25), and 3.3 (±SD 3.25) for the denture group and 77.9 (±SD 23.9), 60.2 (±SD 17.91), 1.29 (±SD 0.15), and 1.5 (±SD 0.7) for the non-denture group, respectively. Conclusion: The overall oral health related quality of life was best in the non-denture than denture.

The Effect of Umami Stimulation on Salivary Secretion Rate and Duration

Purpose: Umami reportedly promotes salivation. We aimed to investigate the effects of taste stimuli on slow and fast salivary secretion in humans using umami, sweet, and sour stimuli. Methods: Eight healthy women participated between 14:00 and 15:00, taking the circadian rhythm of salivary secretion into account. The types and concentrations of the taste solutions were glutamic acid (1.7 × 10−3 M), inosinic acid (9.8 × 10−3 M), and guanylic acid (9.8 × 10−3 M) for umami stimulation, citric acid (6.5 × 10−3 M) for acidity stimulation, and sucrose (1.6 × 10−2 M) for sweetness stimulation. First, the unstimulated salivary flow rate was measured. Then, 3 ml of a flavor solution was dropped under the tongue using a syringe. The saliva was expelled into an aluminum cup every minute and weighed. The first minute’s value minus 3 ml flavor solution was the stimulated salivary secretion rate produced by each flavor. The time-to-return to the initial unstimulated salivary flow rate was the duration of the stimulated saliva secretion rate. Results: The mean unstimulated salivary flow rate across participants was 0.64 ± 0.25 ml/min (range: 0.23 - 1.03 ml/min). The highest amount of saliva was induced by citric acid. There were significant differences between citric acid and the other flavor solutions (p < 0.05 for glutamic acid, inosinic acid, and sucrose;p < 0.01 for guanylic acid). There were no significant differences in duration of salivation between the flavor solutions. When the participants were divided into slow (0.45 ± 0.16 ml/min) and fast groups (0.83 ± 0.15 ml/min) based on their median resting salivary secretion rate, there were no significant differences between the two groups in the amount of saliva secreted at 1 minute after stimulation and the duration of the salivary secretion rate. Conclusion: Umami stimulation was effective in slowing salivary secretion and sustaining salivary secretion after stimulation.

The neutrophil–osteogenic cell axis promotes bone destruction in periodontitis

The immune-stromal cell interactions play a key role in health and diseases. In periodontitis, the most prevalent infectious disease in humans, immune cells accumulate in the oral mucosa and promote bone destruction by inducing receptor activator of nuclear factor-κB ligand (RANKL) expression in osteogenic cells such as osteoblasts and periodontal ligament cells. However, the detailed mechanism underlying immune–bone cell interactions in periodontitis is not fully understood. Here, we performed single-cell RNAsequencing analysis on mouse periodontal lesions and showed that neutrophil–osteogenic cell crosstalk is involved in periodontitis-induced bone loss. The periodontal lesions displayed marked infiltration of neutrophils, and in silico analyses suggested that the neutrophils interacted with osteogenic cells through cytokine production. Among the cytokines expressed in the periodontal neutrophils, oncostatin M (OSM) potently induced RANKL expression in the primary osteoblasts, and deletion of the OSM receptor in osteogenic cells significantly ameliorated periodontitis-induced bone loss. Epigenomic data analyses identified the OSM-regulated RANKL enhancer region in osteogenic cells, and mice lacking this enhancer showed decreased periodontal bone loss while maintaining physiological bone metabolism. These findings shed light on the role of neutrophils in bone regulation during bacterial infection, highlighting the novel mechanism underlying osteoimmune crosstalk.

Methylation and Expression Status of <i>SOCS</i>1 and <i>SOCS</i>3 in Oral Lichen Planus

Oral lichen planus (OLP) is a disease of unknown etiology affecting oral mucosa by mediated chronic inflammation and is classified as a potentially malignant oral disorder. SOCS1 and SOCS3 in the SOCS family have been identified as negative regulators of the cytokine-activated JAK/STAT pathway responsible for inflammatory reaction. The DNA methylation in the promoter regions of SOCS1 and SOCS3 have been reported to correlate with carcinogenesis. In this study, we performed methylation-specific PCR (MSP) to investigate the methylation status of the promoter regions in SOCS1 and SOCS3 genes using biopsy samples from OLP and oral squamous cell carcinoma (OSCC) patients. SOCS1 was methylated in 14/29 (48.3%) cases with OLP and 7/15 (46.7%) cases with OSCC. At the same time, SOCS3 was methylated in 25/29 (86.2%) cases with OLP and 11/15 (73.3%) cases with OSCC. We didn’t recognize any DNA methylation in SOCS1 or SOCS3 genes from the exfoliated cytological specimens of normal buccal mucosa. Furthermore, mRNA expression level was analyzed using real-time RT-PCR method to evaluate the correlation with DNA methylation status. DNA methylation status of SOCS1 seemed not to affect the expression level of SOCS1 mRNA. At the same time, DNA methylation status of SOCS3 was negatively correlated with the expression level of SOCS3 mRNA (p < 0.05). We posit frequent methylation of the SOCS3 gene promoter, theoretically resulting in the increase of cytokines expression, might be associated with the etiological mechanism of OLP.

Evaluation of an oral moisture-checking device for screening dry mouth

Objective: This multicenter clinical study was to assess the clinical usability of an oral moisture-checking device in detecting the dry mouth patients and evaluating the optimal measurement site. Materials and Methods: The study group comprised 250 patients with dry mouth and 241 healthy volunteer subjects at 13 medical centers. This device was used to measure the moisture degrees of the lingual mucosa and the buccal mucosa. Subjective oral dryness, objective oral dryness, and saliva flow rates were also compared between the two groups. For statistical analysis, receiver-operating characteristic analysis was performed to calculate the area under the curve (AUC). Results: The moisture degree of the lingual mucosa was significantly lower in the dry mouth group (27.2 ± 4.9) than that in the healthy group (29.5 ± 3.1, AUC = 0.653). When a lingual mucosa moisture degree of 31.0 or higher was defined as normal, less than 27.0 as dry mouth, and 27.0 to less than 31.0 as borderline zone of dry mouth, both the sensitivity and the specificity for the diagnosis of dry mouth were close to 80%. Conclusion: These results suggest that the oral moisture-checking device is a usable screening device for dry mouth.

Abnormal Change in Arterial Blood Pressure after Adrenaline-Containing in Lidocaine Infiltrated into Oral Submucosa during General Anesthesia

Sudden severe hypotension also occurs in an otherwise stable surgery when adrenaline-containing in lidocaine is infiltrated and care must be taken when using adrenaline-containing in lidocaine because it occasionally induces several adverse reactions. We report the case of a 16-year-old man who scheduled for oral surgery in which abnormal arterial blood pressure changes occurred after adrenaline-containing in lidocaine infiltrated into oral submucosa.

Effect of periodontal treatment on adipokines in type 2 diabetes

The association between adipokines and inflammatory periodontal diseases has been studied over the last two decades. This review was intended to explore the observation that periodontal therapy may lead to an improvement of adipokines in diabetic patients. In summary, substantial evidence suggests that diabetes is associated with increased prevalence, extent and severity of periodontitis. Numerous mechanisms have been elucidated to explain the impact of diabetes on the periodontium. However, current knowledge concerning the role of major adipokines indicates only some of their associations with the pathogenesis of periodontitis in type 2 diabetes. Conversely, treatment of periodontal disease and reduction of oral inflammation may have positive effects on the diabetic condition, although evidence for this remains somewhat equivocal.

Long-term observation of the mineral trioxide aggregate extrusion into the periapical lesion:a case series

One-step apexification using mineral trioxide aggregate(MTA) has been reported as an alternative treatment modality with more benefits than the use of long-term calcium hydroxide for teeth with open apex.However,orthograde placement of MTA is a challenging procedure in terms of length control.This case series describes the sequence of events following apical extrusion of MTA into the periapical area during a one-step apexification procedure for maxillary central incisor with an infected immature apex.Detailed long-term observation revealed complete resolution of the periapical radiolucent lesion around the extruded MTA.These cases revealed that direct contact with MTA had no negative effects on healing of the periapical tissues.However,intentional MTA overfilling into the periapical lesion is not to be recommended.

On the road to smart biomaterials for bone research: definitions, concepts, advances, and outlook

The demand for biomaterials that promote the repair,replacement,or restoration of hard and soft tissues continues to grow as the population ages.Traditionally,smart biomaterials have been thought as those that respond to stimuli.However,the continuous evolution of the field warrants a fresh look at the concept of smartness of biomaterials.This review presents a redefinition of the term“Smart Biomaterial”and discusses recent advances in and applications of smart biomaterials for hard tissue restoration and regeneration.To clarify the use of the term“smart biomaterials”,we propose four degrees of smartness according to the level of interaction of the biomaterials with the bio-environment and the biological/cellular responses they elicit,defining these materials as inert,active,responsive,and autonomous.Then,we present an up-to-date survey of applications of smart biomaterials for hard tissues,based on the materials’responses(external and internal stimuli)and their use as immune-modulatory biomaterials.Finally,we discuss the limitations and obstacles to the translation from basic research(bench)to clinical utilization that is required for the development of clinically relevant applications of these technologies.

Biology of chronic graft-vs-host disease:Immune mechanisms and progress in biomarker discovery

Chronic graft-vs-host disease(c GVHD) is the leading cause of long-term morbidity and mortality following allogeneic hematopoietic stem cell transplantation. It presents as a chronic inflammatory and sclerotic autoimmune-like condition that most frequently affects the skin, oral mucosa, liver, eyes and gastrointestinal tract. Both clinical and animal studies have shown that multiple T cell subsets including Th1, Th2, Th17, T follicular helper cells and regulatory T-cells play some role in cG VHD development and progression; B cells also play an important role in the disease including the production of antibodies to HY and nuclear antigens that can cause serious tissue damage. An array of cytokines and chemokines produced by different types of immune cells also mediate tissue inflammation and damage of cG VHD target tissues such as the skin and oral cavity. Many of these same immune regulators have been studied as candidate cG VHD biomarkers. Recent studies suggest that some of these biomarkers may be useful for determining disease prognosis and planning long-term clinical followup of cG VHD patients.

Intragingival injection of Porphyromonas gingivalis-derived lipopolysaccharide induces a transient increase in gingival tumour necrosis factor-a, but not interleukin-6,in anaesthetised rats

This study used in vivo microdialysis to examine the effects of intragingival application of lipopolysaccharide（LPS） derived from Porphyromonas gingivalis（Pg-LPS） on gingival tumour necrosis factor（TNF）-a and interleukin（IL）-6 levels in rats. A microdialysis probe with an injection needle attached to the surface of the dialysis membrane was implanted into the gingiva of the upper incisor. For comparison, the effects of LPS derived from Escherichia coli（Ec-LPS） on IL-6 and TNF-a levels were also analysed. Pg-LPS（1 mg/1 m L） or Ec-LPS（1 or 6 mg/1 m L） was applied by microsyringe, with gingival dialysates collected every hour. Enzyme-linked immunosorbent assay（ELISA） revealed that gingival dialysates contained approximately 389 pg？m L21 of IL-6 basally; basal TNF-a levels were lower than the detection limit of the ELISA. Pg-LPS failed to alter IL-6 levels but markedly increased TNF-a levels, which remained elevated for 2 h after treatment. Neither IL-6 nor TNF-a were affected by Ec-LPS. Reverse transcriptase-polymerase chain reaction（RT-PCR） analysis revealed that the gingiva expresses Toll-like receptor（TLR） 2 and TLR4 m RNA. Immunohistochemical examination showed that TLR2 and TLR4 are expressed by gingival epithelial cells. The present study provides in vivo evidence that locally applied Pg-LPS, but not Ec-LPS, into the gingiva transiently increases gingival TNF-a without affecting IL-6. The present results suggest that TLR2 but not TLR4 expressed on gingival epithelial cells may mediate the Pg-LPS-induced increase in gingival TNF-a in rats.

One-Step Multiplex PCR for Simultaneous Detection and Identification of Eight Medically Important <i>Candida</i>Species

Recently, the incidence of Candida infections has substantially increased. Conventional identification methods for Candida species are technically difficult to conduct and cannot accurately distinguish each species. The purpose of the present study was to design primers to identify and detect simultaneously eight medically important Candida species using one-step multiplex PCR. PCR primers were designed based on partial sequences of intergenic spacer (IGS) and internal transcribed spacer (ITS) genes of eight medically important Candida species. These primers were able to distinguish each Candida species and did not display cross-reactivity with representative Candida species other than the eight Candida species. Moreover, our developed one-step multiplex PCR method is accurate, specific, cost-effective, time-saving, and worked without requiring DNA extraction.

Effect of zeta potentials on bovine serum albumin adsorption on crown composite resin surfaces <i>in vitro</i>

We previously studied the mechanism underlying the adsorption of oral bacteria on the surfaces of dental prosthetic materials such as ceramics and resins in vitro. The aim of the present study was to examine bovine serum albumin (BSA) adsorption on crown composite resin surfaces by means of zeta potential. We measured the zeta potentials of resins alone, BSA alone, and resins after BSA adsorption. Eight resins were pulverized into powders (300 - 1000 nm). All experiments were conducted in 10 mM sodium chloride solution (pH 6.5). BSA was dissolved in 10 mM NaCl with a concentration of 2.0 × 10-5 mol/l. An adsorption assay was performed for one hour at 37°C under continuous rotation (6 rpm). The zeta potentials of both resins and BSA were negative, with BSA itself less negative than the resins themselves as an absolute value (p < 0.0001). The zeta potentials of seven resin surfaces after BSA adsorption were significantly less negative than were those of the resins without BSA adsorption (p < 0.0001). Eight resins were divided into two classes based on the size of the surface potential difference between each resin and the BSA. The difference in surface potential between the resins and the BSA were small, leading to the theory that particles with identical charges repulse each other, and the amounts of adsorbed BSA on these resins might be less. On the other, when the differences between the other resins and BSA are large, so that the repulsive force between two nonidentical particles becomes zero and an attractive force might be generated, then more BSA might be adsorbed on those resins. Therefore, the zeta potentials were affected by BSA adsorption and became less negative. These results suggested that electrostatic interactions play an important role in the adsorption of BSA on resin surfaces.

Hepatitis C virus-associated pruritus: Etiopathogenesis and therapeutic strategies

In addition to its contributing role in the development of chronic liver diseases, chronic hepatitis C virus(HCV) infection is associated with extrahepatic manifestations, particularly, cutaneous-based disorders including those with pruritus as a symptom. Pruritus is frequently associated with the development of chronic liver diseases such as cholestasis and chronic viral infection, and the accumulation of bile acids in patients' sera and tissues as a consequence of liver damage is considered the main cause of pruritus. In addition to their role in dietary lipid absorption, bile acids can trigger the activation of specific receptors, such as the G protein-coupled bile acid receptor(GPBA/ TGR5). These types of receptors are known to play a crucial role in the modulation of the systemic actions of bile acids. TGR5 expression in primary sensory neurons triggers the activation of the transient receptor potential vanilloid 1(TRPV1) leading to the induction of pruritus by an unknown mechanism. Although the pathologic phenomenon of pruritus is common, there is no uniformly effective therapy available. Understanding the mechanisms regulating the occurrence of pruritus together with the conduction of large-scale clinical and evidence-based studies, may help to create a standard treatment protocol. This review focuses on the etiopathogenesis and treatment strategies of pruritus associated with chronic HCV infection.

Calcitonin and vitamin D3 have high therapeutic potential for improving diabetic mandibular growth

The goal of this study was to assess the effect of the intermittent combination of an antiresorptive agent （calcitonin） and an anabolic agent （vitamin D3） on treating the detrimental effects of Type 1 diabetes mellitus （DM） on mandibular bone formation and growth. Forty 3-week-old male Wistar rats were divided into four groups： the control group （normal rats）, the control C＋D group （normal rats injected with calcitonin and vitamin D3）, the diabetic C＋D group （diabetic rats injected with calcitonin and vitamin D3） and the diabetic group （uncontrolled diabetic rats）. An experimental DM condition was induced in the male Wistar rats in the diabetic and diabetic C＋ D groups using a single dose of 60 mg.kg-1 body weight of streptozotocin. Calcitonin and vitamin D3 were simultaneously injected in the rats of the control C＋D and diabetic C＋D groups. All rats were killed after 4 weeks, and the right mandibles were evaluated by micro-computed tomography and histomorphometric analysis. Diabetic rats showed a significant deterioration in bone quality and bone formation （diabetic group）. By contrast, with the injection of calcitonin and vitamin D3, both bone parameters and bone formation significantly improved （diabetic C＋ D group） （P 〈 0.05）. These findings suggest that these two hormones might potentially improve various bone properties.

Anesthetic Management of a Patient with Sick Sinus Syndrome during General Anesthesia for Maxillofacial Surgery

Sick sinus syndrome (SSS) is a generalized abnormality of cardiac impulse formation. Patients with SSS occasionally need temporary pacing during general anesthesia. The most common issue arising in the perioperative period is electromagnetic interference with device function. We report a case of a 66-year-old man who required temporary cardiac pacing during maxillary cyst extirpation using electrocautery.