Stages, risk factors and prevention of early childhood caries

Early childhood caries is a common condition that affects children and young infants. In addition to the effect of the condition on the child's oral health, it has been furtherly shown that many systemic consequences are usually associated. Therefore, it has been reported that these conditions can significantly impair the quality of life of corresponding families based on economic and health-related burdens. Affected children usually present with variable degrees of the condition, and some complications might be associated. Many risk factors have been reported in the literature for developing the condition in children. These include the presence of certain bacterial pathogens (especially through vertical transmission), dietary habits, and poor oral hygiene. Evidence indicates that these risk factors significantly contribute to the development of early childhood caries and the importance of the child's socioeconomic status and his caregivers. Targeting these factors would significantly reduce the risk of developing the condition, in addition to fluoridation as suggested by various relevant investigations.

Epidemiology, etiology, and treatment of denture stomatitis

Multiple factors are involved in the pathogenesis of denture stomatitis, which increases the risk of tissue infection and inflammation. These factors include poor oral hygiene, trauma secondary to poorly fitting prostheses, resin porosity, and bacterial plaque accumulation. Our present review discusses the epidemiology, etiology, and treatment of denture stomatitis based on data from current studies in the literature. The prevalence of denture stomatitis is significantly variable among the different studies, as previously discussed. However, the cumulative incidence of denture stomatitis among their participants ranged between 17-77%. These hugely variable rates have been attributed to the nature of data collection, diagnostic criteria, sample size, and patient demographics. Studies also show that the condition is more prevalent among elderly females. However, not many studies have reported this correlation, indicating the need for future studies. Candida albicans infection is the primary parameter in the etiology and pathogenesis of the condition. However, other factors related to the patient (like status of immunological response) and dentures (like hygiene) were also reported. Therefore, the management of denture stomatitis should be based on applying adequate interventions. Besides, using antifungal medications is also necessary to eradicate organism.

Effects of drug abuse and mental disorders on oral health: a case report

Substance use disorders, related to mental health issues can lead to oral pathologies. The purpose of this case report was to identify the oral conditions and manifestations in a 28-year-old male narco-dependent schizophrenic who smoked tobacco and marijuana. In intra-oral clinical exploration, poor oral hygiene, excessive tartar formation and dental plaque were observed, and the diagnosis of severe chronic periodontitis was established. The choice of a treatment plan in such patients is complex because the consequences of an invasive treatment can aggravate the psychological state and emotional stability leading to a negative effect on behaviour and mental health due to edentulism. The effects of excessive drug consumption related to schizophrenia can cause poor oral hygiene habits leading to oral pathologies and the loss of teeth. Keywords: drugs, schizophrenia, oral manifestations, mental health, oral pathologies.

Conservative Management of Ankyloglossia by Diode Laser: A Case Report

Ankyloglossia or tongue-tie is a congenital condition that results when the inferior lingual frenulum is too short and is attached to the tip of the tongue, limiting its normal movements. Ankyloglossia can lead to different problems such as difficulties in breastfeeding, speech impediments, poor oral hygiene, malocclusion, inability to deglutition, thus being an undesired problem in normal life activity. Among various methods of treatment of ankyloglossia, laser-assisted lingual frenotomy is the simplest, safest, and less traumatic with the most promising results. Here, a case of ankyloglossia and its management by frenotomy with diode laser is reported in a four-year-old female child. After performing partial frenectomy (frenotomy) using a diode laser of 980nm there was an immediate tongue protrusion and slight improvement of phonetics of the patient immediately and altogether improved after six months.

Oral care precautions for patients with cystic fibrosis

Cystic fibrosis (CF) is the most common severe autosomal recessive disease in the Caucasian population. Although it remains incurable, it is currently possible to extend the life expectancy of patients with modern therapeutic possibilities. Given the medical issues that a child with CF faces, oral health may be perceived as being of lesser importance. Thus, the establishment of good dietary and oral hygiene practices may not take place, leading to an increased risk of caries and gingivitis due to poor oral hygiene. A change in patient management may be necessary to ensure optimal care.

Risk Factors of Oropharyngeal Candidiasis in COVID-19 Patients: A Case-control Study

Background: With the emergence and spread of coronavirus disease 2019 (COVID-19) globally, health care systems have faced the biggest challenge in recent decades. Objectives: The present study aimed to identify risk factors associated with oropharyngeal candidiasis (OPC) in COVID-19 patients. Methods: The total number of confirmed COVID-19 patients was 218 (105 cases with OPC and 113 controls without OPC). The questionnaire used in this study consisted of demographic data, treatment strategy, clinical and laboratory data, and underlying diseases collected from the onset of clinical OPC until the end of hospitalization. Results: Pseudomembranous candidiasis (77/105, 73.3%) was the most prevalent form of OPC in case patients. The majority of the cases (58.1%) and controls (58.4%) were males. Increasing age (P = 0.03) and hospitalization length (P = 0.016) were significantly associated with OPC in COVID-19 patients. Diabetes (P = 0.003), solid tumor (P = 0.019), and hypertension (P = 0.000) were the most common underlying conditions. The use of dentures (P = 0.003) and poor oral hygiene (P = 0.000) were related to OPC in the case group. Therapy with chloroquine (P = 0.012), IVIG (P = 0.001), diuretics (P = 0.000), and corticosteroid pulse therapy (P = 0.000) were significantly associated with developing OPC in case patients. Conclusions: Old age, hospitalization length, poor oral hygiene, corticosteroids use, diabetes, solid tumor, and hypertension may predispose COVID-19 patients to develop OPC.

Upright epiglottis prevents aspiration in patients with nasopharyngeal carcinoma post-chemoradiation

NPC is the most widely found malignant tumor in the head and neck region in Indonesia. Chemoradiation therapy for NPC can induce swallowing disorders (dysphagia) that adversely affects a patients quality of life. This study aimed to assess the swallowing process by flexible endoscopic evaluation of swallowing in patients with nasopharyngeal carcinoma after chemoradiation. Thirty-nine patients with NPC who had chemoradiation therapy more than one month previously underwent flexible endoscopic evaluation of swallowing and were assessed for oral transport time, sensation, standing-secretion, pre-swallowing leakage, residue, penetration, aspiration, and silent aspiration. The most common structural abnormalities were an upright and swollen epiglottis (89.4%), poor oral hygiene, and velopharyngeal closure defects (56.4%). This examination also revealed a mild degree of standing secretion (38.5%) and aspiration (10.3%). No penetration was observed in 64.1% of the patients, and no silent aspiration was observed in any of the patients. A severe degree of residue (45.7%) was observed when administering oatmeal, while the residue was mild to moderate when administering gastric rice, crackers, and milk. The residue changed to a mild degree (32.3%–51.4%) in all food administrations after the watering maneuver. The highest penetration was noted after oatmeal administration (42.8%), and the highest aspiration was found after milk administration (8.6%). Standing secretion in almost all patients was caused by hyposensitivity of the hypopharynx. Persistent residue and hyposensitivity of the hypopharynx led to aspiration. The low percentage of aspiration and silent aspiration might have been caused by the upright and swollen epiglottis that prevented aspiration. Poor oral hygiene and a dry mouth led to prolonged oral transport. Therefore, most patients had hypopharyngeal abnormalities in the form of a swollen and upright epiglottis. Secretion and food residue were also detected. Drinking helps to expedite the swallowing process by facilitating oral phase transport and reducing residues.

Case Report: Poor oral hygiene leading to an emergency condition: A case report of Ludwig’s angina

Ludwig’s angina (LA) is a rapidly spreading and potentially life-threatening infection having an odontogenic infection as the most common source. It involves the floor of the mouth and neck. Modernization in medical care has made this entity rare and of low mortality at the present but it is still feared as a lethal entity due to rapidly progressive airway obstruction that follows. Here we report a case of a 15-year-old male who suffered from LA. Presenting symptoms and findings of the examination helped in the clinical diagnosis. Immediate intubation, use of broad-spectrum antibiotics, and treatment of complications aided the patient’s recovery. LA should be considered for differential diagnosis in the case of neck swelling especially in those having a history of poor oral hygiene and recent dental procedures. Management of LA and its complications should always involve doctors from multiple disciplines.

Association between halitosis and female fecundability in China: a prospective cohort study

Background Periodontal diseases and poor oral hygiene are potentially associated with decreased female fecundability. Fecundability refers to the probability of conception during a given period measured in months or menstrual cycles. This study aims to examine whether halitosis is associated with female fecundability in a large sample of Chinese women who planned to be pregnant. Methods In 2012, a total of 6319 couples came for preconception care in eight districts in Shanghai, China and were followed by telephone contact. Three thousand nine hundred fifteen women who continued trying to be pregnant for up to 24 months remained for final statistical analyses. Halitosis was self-reported at the preconception care visit. Time to pregnancy (TTP) was reported in months and was censored at 24 months. Fecundability ratio (FR) was defined as the ratio of probability of conception among those with and without halitosis. FR and 95% confidence interval (CI) were estimated using the discrete-time Cox model. Results 80.1 and 86.1% of women had self-reported clinically confirmed pregnancy within 12 and 24 months, respectively. Halitosis was reported in 8.7% of the women. After controlling for potential confounders, halitosis was associated with a reduced probability of spontaneous conception (for an observation period of 12 months: adjusted FR 0.82, 95% CI 0.72–0.94; for an observation period of 24 months: adjusted FR 0.84, 95% CI 0.74–0.96). Conclusions Halitosis is associated with reduced fecundability in Chinese women.

Proposed protocol for treatment of severe periodontitis without platelet transfusion in patients with aplastic anemia: a case report

Background Aplastic anemia is an intractable disease characterized by pancytopenia, susceptibility to infection, and difficulty in achieving hemostasis. In patients with severe periodontal disease and aplastic anemia, spontaneous bleeding from the gingival tissue due to thrombocytopenia and during brushing is common, which may further exacerbate dental issues. Comprehensive periodontal treatment for patients with aplastic anemia is highly challenging and requires collaboration with a hematologist. Here, we discuss the case of a patient with aplastic anemia and severe periodontitis who was successfully treated in collaboration with our hematology department. Case presentation A 36-year-old Japanese woman with chief complaints of spontaneous gingival bleeding, pain, and increasing tooth mobility consulted our department. She had developed pancytopenia at age 11 years and was later diagnosed with aplastic anemia, making her susceptible to infection due to leukopenia. The results of the initial periodontal examination led to a diagnosis of severe generalized periodontitis (generalized stage IV grade C periodontitis) caused by leukopenia and poor oral hygiene. We adopted a comprehensive treatment plan, including invasive dental procedures. The patient exhibited no postoperative bleeding due to aplastic anemia-induced thrombocytopenia and experienced a good outcome. Conclusions Both physicians and dentists should be aware that immunocompromised patients with aplastic anemia are at risk of developing severe periodontitis with severe alveolar bone resorption if the condition is combined with poor oral hygiene. Even in the presence of aplastic anemia, patients with severe periodontitis can undergo comprehensive dental treatment, including dental extraction and periodontal surgery, if bleeding and susceptibility to infection are controlled. This requires the cooperation of the patient and hematologists and can ultimately contribute to improving the patient’s quality of life.