The Oral Complications of COVID-19

Background: COVID-19 is a novel coronavirus infectious disease associated with the severe acute respiratory syndrome. More and more patients are being cured due to the development of clinical guidelines for COVID-19 pneumonia diagnosis, treatment, and vaccines. However, the long-term impact of COVID-19 on patients after recovery is unclear. Currently available reports have shown that patients recovered from COVID-19 continue to experience health problems in respiratory and other organ systems. Oral problem is one of the important complications which has serious impacts on the rehabilitation and future quality of life, such as ageusia and macroglossia, but the oral complication is often being neglected.Aim of Review: From the perspective of stomatology, we summarized and elaborated in detail the types, pathogenesis of oral complications from COVID-19 patients after rehabilitation, and the reported prevention or treatment recommendations which may improve the COVID-19 patients associated oral diseases.Key Scientific Concepts of Review: 1) To understand the common oral complications and the mechanisms of the development of oral complications after the COVID-19 recovery; 2) To summary the practical strategies to prevent the oral complications and construct the rehabilitation plans for patients with oral complications.

Age-dependent Oral Manifestations of Neurofibromatosis Type 1: A Case-control Study

Introduction: Craniofacial manifestations of neurofibromatosis type 1 (NF1) are considered as a result of tumor compression. We sought to determine age-dependent salivary changes, carious, and periodontal complications in NF1 patients without tumors in the oral cavity.Objective and methods: Eleven NF1 patients without tumors in the oral cavity and 29 matched controls without NF1 were enrolled in this case-control study. Demographic information, medical history, and data of intraoral examinations, including the Decayed, Missing, and Filled Teeth (DMFT) scores and Russel’s periodontal index (PI), were recorded. The functional salivary analysis was performed for sialometry, salivary pH values, and amylase activity. Ingenuity Systems Pathway Analysis (IPA) was conducted to identify mutually activated pathways for NF1-associated oral complications.Results: NF1 patients were associated with periodontitis (OR=1.40, 95% CI=1.06-1.73, P = 0.04), gingivitis (OR=1.55, 95% CI=1.09-2.01, P = 0.0002), and decreased salivary flow rate (OR=1.40, 95% CI=1.05-1.76, P = 0.005). Periodontal destruction, salivary changes, and dental caries in NF1 patients were age dependent. Subgroup analyses based on age stratification suggested that salivary flow rates and salivary amylase activity were significantly lower among NF1 patients aged over 20 years and that salivary pH values, PI and DMFT scores were higher among NF1- controls aged over 20. All oral complications were not significantly presented among NF1 patients aged below 20. IPA analyses suggested that cellular mechanisms underlying NF1-associated oral complications involved chronic inflammatory pathways as well as fibrosis signalling pathway.Conclusion: NF1 patients without tumors in the oral cavity presented with a higher prevalence of age-dependent oral complications, including periodontal destruction and salivary gland dysfunction, which were associated with chronic inflammatory pathogenesis.

Oral Complications of Head and Neck Cancer Therapy

Current therapies for Head and Neck cancer treatment are extremely advanced. Though, they cause oral complications which have deleterious effects on basic life functions, affect oral and overall health, may lead to significant morbidity and treatment discontinuation and have an impact on survivorship and quality of life. As new therapies are introduced, a new spectrum of oral complications is rising, compromising the mucosal integrity and the salivary function, that may not be recognized, reported and treated properly. Oral complications, often permanent and extremely painful, may include mucositis, xerostomia, dysgeusia, infections, trismus and fibrosis, risk of dental disease and necrosis of the jaw, neurosensory disorders and when targeted therapies and immunotherapy are involved, aphthoid and lichenoid lesions can also be reported. Increased awareness is required for the prevention and management of these complications, which can be best provided by a multidisciplinary team.

Oral Complications of Chemotherapy on Paediatric Patients with Cancer: A Systematic Review and Meta-Analysis

The goal of cancer treatment is to fight and/or control cancer. The aim of this study was to review and meta-analyse the incidence of main oral complications in paediatric oncology during chemotherapy. The search results were obtained from B-on, Web of Science, Scopus, Cochrane Library and PubMed databases. Of 1032 articles potentially relevant, 13 were included in this review. The overall incidence of caries, gingivitis, ulcers, mucositis, and candidiasis was 67.8%, 55.6%, 44.2%, 41.6%, and, 29.5%, respectively. During chemotherapy, paediatric patients with cancer present higher incidence of caries and gingivitis. Incidence rate meta-analysis show high heterogeneity. More studies should be done to reduce uncertainty.

#66: An Educational Needs Assessment of Oral Health Knowledge, Attitude and Practices Among Graduates of St. Jude Global Infectious Diseases Training Programs

Background Chemotherapy and radiotherapy for oncologic diseases can cause oral complications during therapy or thereafter. These oral complications and their consequences may interfere with cancer treatment, prolong hospital stay, and increase overall treatment costs. Therefore, oral examination of children with cancer by healthcare providers must be part of routine clinical examination. According to published literature, oral examination and recommendations of best oral care in children with cancer might not be routinely practiced and varies among providers. We suspect that personal knowledge, attitude and practice may play an important role in the routine practice of healthcare professionals and that the introduction of an oral health curriculum may complement existing practice. To tailor oral health training, we must know the healthcare professional’s educational needs and their attitude toward oral health. Methods Steps followed to build the needs assessment of our targeted learners included: (1) literature review of published surveys; (2) reviews of oral healthcare policies; (3) key-informant interviews with practicing healthcare providers regarding oral health training; (4) selection of essential survey items; (5) face validity; and (6) pilot testing. We used the ©2019Qualtrics® software to build this survey. Face validity was evaluated and approved by five subject matter and survey experts. Graduates of the St. Jude Global Infectious Disease training served as pilot testing subjects. Results Interviews indicated that information about oral health examination is often contained in institutional policies; training in oral health is cursory. Surveys published in the literature have assessed knowledge related to oral complications such as oral mucositis and dental caries. We have added gingival conditions to our survey, which is also one of the most prevalent oral manifestation in pediatric cancer patients. Our 31-item survey is comprised of multiple choice and Likert scale questions distributed in seven sections, namely: (1) demographics; (2) clinical settings; (3) participant’s view of own oral healthcare; (4) knowledge and practice on oral infections; (5) knowledge, attitude and practice of oral examination; (6)attitude and practice of oral healthcare preventive measures, and; (7) continuing education. Validity testing indicated two questions that required modifications—the definition of plaque, its causes, and oral infections and manifestations. The final survey tool will take participants approximately 15 minutes to complete. Conclusion We developed a 31-item survey tool that will be used for assessing the needs of global healthcare providers, from which we can develop targeted and appropriate educational programs.

Effects of oral moisturizing gel containing propolis following head and neck radiotherapy: randomized controlled pilot trial

Aim Topical administration of oral gel may reduce radiotherapy-related oral complications. The aim of this study was to examine clinical and microbiological effects of self-administration of different gel formulations to oral mucosa in head and neck cancer patients. Materials and methods Twenty-seven subjects were recruited from outpatients who underwent radiotherapy of at least 50 Gy to the head and neck area. They were randomly assigned to oral gel with the following different ingredients: placebo, chlorhexidine, curry leaf, propolis, and turmeric. Before and after intervention, oral symptoms were evaluated, and nine oral pathogens in saliva were also quantified using real-time PCR. Results Twenty-five subjects completed the study and their data were analyzed. The number of Porphyromonas gingivalis in saliva significantly decreased after treatment with propolis gel, but not after any other treatments. Propolis gel treatment also relieved oral pain in all subjects who had oral pain at the baseline. Conclusions Topical administration with propolis gel may not only reduce P. gingivalis carriage in saliva, but also relieve oral pain. Discussion A future larger-scale clinical trial of oral propolis gel is needed to determine its clinical efficacy in radiotherapy-related oral complications of head and neck cancer patients.