Oral Squamous Cell Carcinomas in Patient with Graft Versus-Host Disease Following Allogenic Bone Marrow Transplantation: A Case Report during Mutant COVID-19 Pandemic

Aplastic anaemia is a severe haematological disorder characterized by an inadequate number of hematopoietic stem cells, resulting in pancytopenia, formed by a hypocellular bone marrow. Disorders of this nature are widely treated with haematopoietic stem cell transplantation (HSCT). A potential chronic complication following (HSCT) is the growth of secondary malignancies. Notably, patients suffering from chronic graft versus host disease (cGvHD) secondary to HSCT have been shown to be more susceptible to oral squamous cell carcinoma (OSCC). Here, we present a rare case of a 30-year-old Libyan woman treated with HSCT for aplastic anaemia, with subsequent complications of cGvHD and OSCC after few months of HSCT. These carcinomatous lesions were detected in the buccal gingiva and retromolar pad area at the age of 31. The present case report emphasizes the connection between oral cGvHD and OSCC, and the potential appearance of OSCC after HSCT at any time of patient life. Thus, closer follow-up is mandatory for all patients treated with HSCT who developed cGvHD, and efficient cGvHD prevention and therapeutic approaches are needed.

Training Non-Specialists for Craniomaxillofacial Trauma in a Warzone Setting

This study investigated a simulated craniomaxillofacial (CMF) trauma training programme for nonspecialist clinicians involved in warfare environments. Many clinicians lack CMF surgical training and the course was designed as a one-day research programme to establish if non-specialists could acquire CMF trauma skills adequate for a warzone. The course consisted of six simulation skills, of which four used sheep heads to teach craniotomy, epistaxis, canthotomy and cantholysis and external pin fixation for mandibular fracture fixation. In addition, two skills utilised plaster dental models designed to enable fixation of mandibular fractures with the Erich arch bar or dental eyelet wiring. This simulation-based programme taught trauma management without the expense of cadavers or risks to patients [1]. The trainees were scored for each of the six skills by hierarchical task analysis (HTA) designed by CMF specialists [2, 3]. The trainee assessment scores improved significantly in all skills post-training, regardless of their medical or surgical deficiencies demonstrating that non-specialists can learn important surgical techniques, valuable for war environments.

Comparison of Caries Experience of Asthmatic and Non-Asthmatic Children in Enugu, Nigeria

Background: Asthma and dental caries are two most common chronic diseases among children. The aim of the present study was to determine and compare the dental caries experience between asthmatic and nonasthmatic children in Enugu. Methods: 120 asthmatic children who had been diagnosed of asthma for at least 1 year were selected and matched for age 2-17 years with 120 non-asthmatic controls. Prevalence of caries was assessed using the decayed, missing, and filled surfaces (dfs for deciduous teeth and DMFS for permanent teeth) index through clinical examination by two calibrated dentists according to WHO guidelines. Information on various confounding factors were collected through questionnaires and patients’ medical records. Results: Asthmatic children had significantly higher (P<0.000) caries experience on primary teeth (dfs was 2.02±0.18 for 2-6 years-old and dfs was 2.46±0.68 for 7-12 years-old) and permanent teeth (DMFS was 1.86±1.12 for 7-12 years-old and DMFS is 1.84±1.22 for 13-17 years-old). Asthmatic children did not differ significantly from their non-asthmatic counterparts with respect to gender, dietary habits, oral hygiene, time since last dental visit and parents’ education. Conclusion: Children with asthma have higher caries experience than their non-asthmatic counterparts in this study. Reasons for this difference are multifactorial necessitating the need for special multidisciplinary oral health preventive program for these high-caries-risk children.

Craniomaxillofacial War Injuries in Misrata, Libya

Injury to the craniomaxillofacial (CMF) area has major implications for mortality and morbidity depending on many factors that influence the level of treatment. In warzones, the extent of CMF injuries is amplified mainly due to the damage caused by bomb blasts. This study presents CMF injury as the result of war incidents to highlight the differences in injury type as well as the impact that an austere environment has on treatment. The author has unique insight and experience of treating CMF injuries in Misrata, Libya, where there is ongoing civil conflict. Surgeons in Libyan hospitals require intensive training intervention to effectively manage gunshot injuries, blast injuries and disasters and while these cases represent an austere environment, conclusions can be drawn for recent incidents involving terrorism. This study presents an analysis of injury patterns of patients presenting with CMF trauma during the Misrata battle of the Libyan conflict in 2011.

Single Nucleotide Polymorphisms in COL1A2 Gene and Dental Fluorosis Among 4 and 8-Year-Old Nigerian Children

Aim: To determine the association between single nucleotide polymorphisms (SNPs) within the COL1A2 gene and dental fluorosis among 4- and 8-year-old Nigerian children. Methods: A cross-sectional study was undertaken among 125 four and eight-year-old Nigerian children living in naturally fluoridated areas of Ibadan, Nigeria. Drinking and cooking water samples were collected for F analysis. Buccal mucosa swabs were collected from all children and genomic DNA extracted. Presence or absence of the SNP within the COL1A2 gene was identified by PCR and DNA sequencing for 70 of the participants. Results: The median (minimum, maximum) F concentration of drinking and cooking water were 0.05 (<0.1, 3.0) mg/L and 0.01 (<0.1, 4.0) mg/L respectively. The majority of the study participants (52.9%) were heterozygous for the SNP. There was a statistically significant association between F concentration in drinking water and the occurrence of dental fluorosis (p=0.04). F concentration in drinking water was the only statistically significant predictor of dental fluorosis (p=0.03, OR=3.64(CI=1.11-11.94)) after adjusting for F concentration in cooking water and SNPs. The risk of dental fluorosis tended to increase with the presence of SNPs AA and AC (RR > 1) but this association was not statistically significant. Conclusion: The majority of the study participants had the heterozygote SNP AC genotype of COL1A2 gene. F concentration in drinking water was the only statistically significant predictor of dental fluorosis. The risk of dental fluorosis tended to increase with the presence of SNPs AA and AC (RR > 1) but was not statistically significant.

Giving Nature a Second Chance: Minimally Invasive Management of a Maxillary Central Incisor with a Severe Traumatic Lesion

The decision to save or extract a natural tooth which has been compromised is one of the dilemmas of dental practitioners, as well as the patients. Although there was a considerable effort to save the natural teeth in the past, with the introduction of osseointegrated implants, there is a tendency to extract the compromised teeth and replace them with implant-supported prosthesis. In this article, this important clinical decision is investigated, and a successful restoration of a traumatized anterior tooth is presented.

Significant Occlusal Alteration Following Use of an Intra-Oral Removable Device: A Case Report

Intra-oral removable devices are readily available and increasingly advocated for the correction of body posture and alleviation of associated musculoskeletal symptoms. The precise clinical application and mechanism of action is poorly understood and their use remains controversial. We present the case of a 47- year-old female where prolonged use of such a splint resulted in significant and adverse occlusal alteration

The Effect of Dental Enamel Pre-Etching for Self-Etching Adhesives According to their Primer pH: An In Vitro Bond Strength, Etching Pattern and Adhesive Failure Evaluation

Dental enamel pre-etching before the application of a self-etching adhesive (SEA) has different effects depending on the pH of the adhesive acidic monomer, being not always beneficial. This study aimed to evaluate the shear bond strength (SBS), etching pattern, and fracture type of different acidity SEAs, with and without previous phosphoric acid etching. One-hundred-sixty bovine incisors were subjected to SBS testing with the following adhesive systems: Adper-Prompt-L-Pop (APLP) (strong acidity), Futurabond NR (FB), AdheSE One F (AD) (intermediary acidity) and Clearfil SE (CSE) (mild acidity), with and without previous phosphoric acid etching. Results were evaluated applying both ANOVA and Tukey’s test. Besides, forty bovine incisors were used to assess etching patterns using scanning-electron-microscopy (SEM). Adhesive failure was evaluated, classifying bond failure as one of five types. SBS averages were (MPa): without pre-etching: APLP (20.61±11.84), CSE (17.29±10.16), FB (11.44±6.99), AD (7.88±4.85) and with pre-etching: APLP (16.17±9.68), CSE (25.96±11.75), FB (20.12±9.39), AD (14,28±9.42). Different enamel etching patterns were observed depending on each SEA’s pH and whether the surface was pre-etched. Most fracture failures were adhesive type. Less than 10 % were cohesive type. SBS improves when mild and intermediary strength SEAs are pre-etched. However, it decreases when strong SEAs are pre-etched.

Onplant Use for Orthodontic Anchorage Reinforcement

Introduction: In 1995, Block and Hoffman reported the successful use of a subperiosteal disk (onplant) to reinforce orthodontic anchorage in an experimental study in dogs and monkeys. It was concluded that onplants provide sufficient anchorage to successfully move and anchor teeth. Aims: The aim of this article is to discuss the development of onplant, key design features, clinical indications for use as well as any available supporting evidence. Methods: Review of the literature was carried out using the following search methods: MEDLINE and EMBASE. The search was focused on various keywords including: "onplant", "bone anchorage device" and "subperiosteal disk", which were conducted on studies published until January 2020. Results: Evidence from clinical studies is scarce, a total of 9 related papers were retrieved from the literature (2 animal studies, 3 RCTs, 2 case series and 2 case reports). All types of study designs were included in the summary to maximize potential information gain. Conclusion: In this article, we reviewed the development of onplant and outlined the general design features as well as specific design features. The onplant is no longer available in the market given that it never gained acceptance among the orthodontic community and its use is almost obsolete.

Post-COVID Strategies Based on Clinical Dentistry in South Korea

Introduction: The United Kingdom is in the process of gradually lifting the lockdown, and a lot of uncertainties and concerns exist in the field of dentistry in terms of clinical management of patients due to the high risk of work-related transmission. Learning from the strategies of clinical dental practice in other countries may help in the development of national recommendations. Aims: South Korea managed to contain COVID-19 without full-scale lockdown. This article aims to provide a comprehensive overview of clinical practice of dentistry and orthodontics in South Korea and compare it with information from other countries throughout the world. Design: An anonymous 21-item questionnaire covering post-COVID strategies was sent to the orthodontic departments of eleven University Dental Hospitals in South Korea for completion. Results: Three of the eleven hospitals completed the survey. All hospitals provided information on their post-COVID strategies in terms of staff and patient considerations, clinical working environment, clinical arrangements, dental procedures, personal protective equipment and disinfection. Conclusion: The current evidence on COVID-19 is limited and the risk of its transmission through aerosol generating procedures is still unclear. In the meantime, robust post-COVID strategies must be in place in order to minimize the risk of spread.