Journal of Clinical Medicine

Research

36 pages, 352 KB

Open AccessArticle

Clinical Attitudes Toward Tooth Preservation Versus Implant Therapy: Development and Preliminary Validation of a Questionnaire Among Early-Career Romanian Dentists

by Vlad Constantin, Dragos Ioan Virvescu, Ionut Luchian, Florinel Cosmin Bida, Andrei Georgescu, Oana Maria Butnaru, Teona Ana-Maria Tudorici, Costin Iulian Lupu, Cristian Cojocaru and Dana Gabriela Budala

J. Clin. Med. 2026, 15(9), 3299; https://doi.org/10.3390/jcm15093299 - 26 Apr 2026

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Abstract

Background/Objectives: The clinical decision between preserving periodontally compromised teeth and replacing them with dental implants represents a complex clinical dilemma influenced by biological, prosthetic, economic, and professional factors. The aim of this pilot study was to develop and preliminarily validate a questionnaire [...] Read more.

Background/Objectives: The clinical decision between preserving periodontally compromised teeth and replacing them with dental implants represents a complex clinical dilemma influenced by biological, prosthetic, economic, and professional factors. The aim of this pilot study was to develop and preliminarily validate a questionnaire designed to assess dentists’ attitudes and therapeutic preferences regarding the use of periodontally compromised teeth as prosthetic abutments versus extraction and implant-supported rehabilitation. Methods: An observational cross-sectional study was conducted, among Romanian dentists, using a structured self-administered questionnaire consisting of 43 items organized into seven sections addressing clinical attitudes, decision-making factors, professional competence, prosthetic treatment preferences, and implant-related clinical practices. A total of 111 Romanian dentists completed the questionnaire. Responses were recorded using a five-point Likert scale. Statistical analysis was performed using IBM SPSS Statistics software. Internal consistency was evaluated using Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC). Construct validity was assessed using exploratory factor analysis based on Principal Component Analysis with Varimax rotation. Results: The questionnaire demonstrated good internal consistency across most sections, with Cronbach’s alpha values ranging between 0.795 and 0.859 after scale optimization. Item–total correlations indicated adequate contribution of individual items to overall scale reliability. Intraclass correlation coefficients confirmed moderate reliability for individual items and good reliability for average section scores. Exploratory factor analysis showed satisfactory sampling adequacy (KMO = 0.709) and statistically significant Bartlett’s test of sphericity (p < 0.001), supporting the suitability of the data for factor analysis. The sample population was predominantly composed of early-career dentists with limited clinical experience, which should be considered when interpreting the findings. Conclusions: The developed questionnaire demonstrated satisfactory psychometric properties, including good internal consistency and acceptable construct validity, supporting its use as a research instrument for assessing Romanian dentists’ self-reported attitudes, therapeutic preferences, and perception-based decision patterns regarding the preservation of periodontally compromised teeth and implant-supported prosthetic rehabilitation. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

12 pages, 439 KB

Open AccessArticle

Association Between Psychosocial Factors and the Need for Orthodontic Treatment Based on Self-Perception

by Olimpia Bunta, Diana Petca, Gabriela Ofelia Chiciudean, Dan Sancraian, Daniel Ioan Chiciudean and Dana Festila

J. Clin. Med. 2026, 15(4), 1347; https://doi.org/10.3390/jcm15041347 - 9 Feb 2026

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Abstract

Introduction: Smile esthetics play a central role in social interaction, self-esteem, and self-confidence, and may influence individuals’ perception of orthodontic treatment need. Understanding how patients evaluate their own smile and how this perception relates to treatment demand is increasingly relevant for patient-centered orthodontic [...] Read more.

Introduction: Smile esthetics play a central role in social interaction, self-esteem, and self-confidence, and may influence individuals’ perception of orthodontic treatment need. Understanding how patients evaluate their own smile and how this perception relates to treatment demand is increasingly relevant for patient-centered orthodontic care. This study aimed to examine the associations between demographic factors, self-perception of smile esthetics, psychosocial behaviors, and perceived need for orthodontic treatment. Materials and Methods: A cross-sectional study was carried out using a questionnaire, yielding 303 valid responses. The questionnaire assessed demographic characteristics, satisfaction with smile appearance, smile-related avoidance behaviors, awareness of dental esthetics, and self-perceived orthodontic treatment need. Associations between variables were analyzed using Chi-square tests, Kendall’s tau_b, Spearman’s rho, and Cramer’s V coefficients. Multinomial logistic regression was performed to identify factors associated with perceived treatment need. Results: Gender was significantly associated with satisfaction with smile appearance, concern about dental esthetics, and awareness of the importance of aligned teeth (p ≤ 0.001), with weak to moderate effect sizes. Age showed statistically significant but weak correlations with smile-related behaviors and perceived treatment need (|τ| ≈ 0.11–0.12; p < 0.05). Lower satisfaction with one’s smile was moderately associated with a higher perceived need for orthodontic treatment (τb = −0.20; p < 0.001). Avoidance of smiling and covering the mouth while speaking were positively associated with perceived treatment need (p < 0.01). Discussions: Regression analysis confirmed that dissatisfaction with smile esthetics, smile-avoidance behaviors, and belief in the esthetic benefits of dental alignment were significant predictors of perceived orthodontic treatment need. Self-perception of smile esthetics and related psychosocial behaviors are significantly associated with individuals’ perceived need for orthodontic treatment. Conclusions: These findings underscore the importance of incorporating patient-reported perceptions and psychosocial factors into orthodontic assessment and shared decision-making. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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12 pages, 232 KB

Open AccessArticle

Halloysite-Assisted Delivery of Cannabidiol for the Management of Temporomandibular Pain: A Pilot Study

by Karolina Walczyńska-Dragon, Aleksandra Grzyb, Karolina Dawiec, Maria Pawłowska, Jakub Fiegler-Rudol, Paweł Hadzik, Aleksandra Nitecka-Buchta and Stefan Baron

J. Clin. Med. 2026, 15(1), 145; https://doi.org/10.3390/jcm15010145 - 24 Dec 2025

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Abstract

Background: Bruxism and temporomandibular disorders (TMD) are commonly associated with increased masticatory muscle activity and pain. Cannabidiol (CBD) exhibits analgesic, myorelaxant, and anti-inflammatory properties, while halloysite may enhance mucosal delivery and bioavailability. Methods: In a randomized, double-blind pilot trial, 20 adults [...] Read more.

Background: Bruxism and temporomandibular disorders (TMD) are commonly associated with increased masticatory muscle activity and pain. Cannabidiol (CBD) exhibits analgesic, myorelaxant, and anti-inflammatory properties, while halloysite may enhance mucosal delivery and bioavailability. Methods: In a randomized, double-blind pilot trial, 20 adults with TMD applied either a CBD gel or a CBD plus halloysite gel nightly for 6 weeks. Masseter muscle activity was recorded using surface electromyography (sEMG) at baseline and post-treatment. Results: Both formulations significantly reduced masseter sEMG activity. The mean decrease was 37.95% with CBD alone (SD = 9.37) and 37.41% with CBD plus halloysite (SD = 5.44). Minimum reductions were 20.44% and 20.02%, and maximum reductions reached 55.16% and 82.52%, respectively. Reductions were bilateral and comparable between right and left sides. Differences between formulations were not statistically significant by t-test (t(8) = 1.613, p = 0.145) or Mann–Whitney U test (p > 0.5). However, variability was lower with the CBD plus halloysite formulation, suggesting a more consistent response. A sex effect reached significance within one formulation (t(8) = 2.315, p = 0.049), while no sex difference was observed in the other. Treatment duration did not correlate with effect size for either gel (Spearman’s rₛ = 0.213 and −0.071, both p > 0.5). No adverse events were reported. Conclusions: Nightly intraoral CBD and CBD plus halloysite gels reduced masseter sEMG in adults with TMD, with similar mean efficacy and lower response variability for CBD plus halloysite. These pilot data support further adequately powered, placebo-controlled trials to confirm efficacy, define optimal dosing, and clarify subgroup effects. The trial registration number registered prospectively is NCT05562635 (accessed on 31 August 2022). Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

17 pages, 687 KB

Open AccessArticle

Associations Between Halitosis and Craniofacial Morphology, Salivary Biochemical Parameters, and Mouth Breathing in Adult Patients with Malocclusion: A Cross-Sectional Study

by Koh Kikuchi, Yudai Shimpo, Toshiko Sekiya, Natsuki Shiina, Mami Kiwada, Sakurako Inaba, Yoshiaki Nomura and Hiroshi Tomonari

J. Clin. Med. 2025, 14(23), 8293; https://doi.org/10.3390/jcm14238293 - 22 Nov 2025

Viewed by 1294

Abstract

Background/Objectives: Halitosis is a common oral condition primarily caused by volatile sulfur compounds (VSCs) produced in the oral cavity. Although previous studies have suggested that craniofacial morphology, salivary biochemical characteristics, and functional breathing patterns may relate to malodor development, their combined influence in [...] Read more.

Background/Objectives: Halitosis is a common oral condition primarily caused by volatile sulfur compounds (VSCs) produced in the oral cavity. Although previous studies have suggested that craniofacial morphology, salivary biochemical characteristics, and functional breathing patterns may relate to malodor development, their combined influence in adults with malocclusion has not been fully clarified. This study aimed to investigate the relationships among craniofacial morphology, salivary biochemical parameters, and mouth breathing in adult patients with malocclusion. Methods: This retrospective cross-sectional study included 234 adults with malocclusion (75 males and 159 females; mean age 29.0 ± 9.5 years). Halitosis was quantified using gas chromatography, and participants were classified into halitosis-positive (total VSC ≥ 150 ppb, n = 79) and halitosis-negative groups (total VSC < 150 ppb, n = 155). Craniofacial morphology was evaluated using lateral cephalometric analysis, salivary biochemical factors were assessed using a multi-item saliva testing system and Saxon test, and mouth breathing was assessed based on standardized clinical indicators. Group comparisons, multiple linear regression, and logistic regression analyses were performed. Results: The halitosis-positive group demonstrated a larger ANB angle, increased overjet, smaller interincisal angle, and higher salivary ammonia levels compared with the halitosis-negative group (p < 0.05). Multiple linear regression identified the interincisal angle as the only independent predictor of total VSC concentration (β = −4.57 per degree reduction in interincisal angle, p = 0.019). Logistic regression revealed that mouth breathing significantly increased the likelihood of halitosis (OR = 4.68, 95% CI: 2.62–8.38). Conclusions: Craniofacial morphology, salivary biochemical environment, and breathing mode collectively influence halitosis in adults with malocclusion. Incorporating assessment of incisor inclination, salivary ammonia levels, and mouth breathing into orthodontic evaluation may support early identification and preventive management of patients at risk for oral malodor. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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13 pages, 268 KB

Open AccessArticle

Orthodontic Treatment Needs in Children with Autism Spectrum Disorder

by Magdalena Prynda, Wojciech Niemczyk, Agnieszka Anna Pawlik, Grzegorz Dawiec, Monika Dawiec, Beata Kazek, Mikołaj Mazur, Natalia Pschionko, Dariusz Skaba, Ewa Emich-Widera and Rafał Wiench

J. Clin. Med. 2025, 14(21), 7743; https://doi.org/10.3390/jcm14217743 - 31 Oct 2025

Viewed by 1327

Abstract

Background/Objectives: Autism spectrum disorder (ASD) is associated with a higher prevalence of oral health problems, including parafunctional habits and malocclusions, which may lead to increased orthodontic treatment needs. The objective of this study was to evaluate orthodontic disorders and treatment requirements in [...] Read more.

Background/Objectives: Autism spectrum disorder (ASD) is associated with a higher prevalence of oral health problems, including parafunctional habits and malocclusions, which may lead to increased orthodontic treatment needs. The objective of this study was to evaluate orthodontic disorders and treatment requirements in children with ASD compared to their neurotypical peers. Methods: A cross-sectional study was conducted on 148 children aged 3–12 years, including 74 children with ASD and 74 controls matched for age and sex. Data were collected via caregiver questionnaires and clinical dental examinations. Malocclusions and orthodontic treatment requirements were assessed using the Index of Orthodontic Treatment Need (IOTN), including both the Dental Health Component (DHC) and Aesthetic Component (AC). Statistical analyses included Mann–Whitney U tests, Student’s t-tests, and effect size calculations, with significance set at p ≤ 0.05. Results: Children with ASD exhibited significantly higher orthodontic treatment needs compared to controls, with elevated scores in both IOTN-DHC (p < 0.001) and IOTN-AC (p < 0.001). No significant differences were observed for the mean overjet or overbite between groups. Gender analysis revealed that boys with ASD had significantly higher scores in both IOTN-DHC and IOTN-AC, while girls with ASD differed from controls only in IOTN-AC. Conclusions: Children with ASD are at increased risk for orthodontic treatment, particularly for both health and aesthetic needs, with boys showing the most pronounced disparities. These findings highlight the importance of early orthodontic assessment and tailored preventive strategies in this population. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

18 pages, 949 KB

Open AccessArticle

Caries Experience and Oral Health-Related Habits in Blind and Low-Vision Individuals in Croatia

by Jelena Dumančić, Marijana Radić Vuleta, Božana Lončar Brzak, Ivana Savić Pavičin, Tara Kurpez, Neda Striber and Ivana Čuković-Bagić

J. Clin. Med. 2025, 14(15), 5576; https://doi.org/10.3390/jcm14155576 - 7 Aug 2025

Viewed by 1386

Abstract

Objectives: The aim of the study was to investigate caries experience in correlation with self-reported oral health-related habits in a sample of blind and low-vision individuals in Croatia. Methods: The study is a part of the research in the “Project for [...] Read more.

Objectives: The aim of the study was to investigate caries experience in correlation with self-reported oral health-related habits in a sample of blind and low-vision individuals in Croatia. Methods: The study is a part of the research in the “Project for Oral Health Promotion in Blind and Visually Impaired Persons” conducted at the Zagreb University School of Dental Medicine from 2014 to 2018. The final sample consisted of 85 adults: 42 females and 43 males; 50 blind and 35 low-vision individuals, age range 18–98. The assessment included dental examination and a questionnaire. Results: The median DMFT (Decayed, Missing, and Filled Teeth) index score was 17.0 (IQR = 12.5–22.0), with no significant difference between sexes or between blind and low-vision individuals. The occurrence of untreated caries was low (median D-component = 1.0), while the median F-component was 6.0. There was a significant increase in M-component and DMFT in older age groups. The number of untreated caries (D-component) was significantly correlated with consummation of soft drinks and smoking. Total DMFT did not correlate with frequency of tooth brushing, time since last dental visit, smoking, or level of education. Conclusions: This study revealed high caries experience among blind and visually impaired individuals that did not correlate with factors that normally influence oral health. Similar results were found in the control group, reflecting a 30-year post-war period without organized preventive care. The low number of decayed teeth reflects the availability of public dental care in Croatia; however, preventive care should be provided for both this vulnerable group and the general population. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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10 pages, 493 KB

Open AccessArticle

Correlation Between Type of Edentulism, Age, Socioeconomic Status and General Health

by Simona Iacob, Radu Marcel Chisnoiu, Alina Zaharia, Mădălina Georgiana Bălaj, Adina Elena Iosa, Ana-Maria Condor, Andrea Chisnoiu, Smaranda Dana Buduru and Andreea Kui

J. Clin. Med. 2025, 14(11), 3924; https://doi.org/10.3390/jcm14113924 - 3 Jun 2025

Cited by 7 | Viewed by 3804

Abstract

Background/Objectives: Edentulism is a significant public health concern, particularly among aging populations, affecting oral functionality, aesthetics, and overall health. This study assessed the edentulism status of patients at the Prosthodontic Clinic of Cluj-Napoca, Romania, and explored the possible correlations with socioeconomic factors [...] Read more.

Background/Objectives: Edentulism is a significant public health concern, particularly among aging populations, affecting oral functionality, aesthetics, and overall health. This study assessed the edentulism status of patients at the Prosthodontic Clinic of Cluj-Napoca, Romania, and explored the possible correlations with socioeconomic factors such as age, general health, smoking, and alcohol consumption. This study aimed to inform public health strategies to reduce edentulism incidence and improve overall oral health outcomes in Romania. Methods: The current study included 208 patients (127 females and 81 males). Each participant completed a standardized data collection form designed to gather comprehensive information on socio-demographic characteristics (including age, gender, and environmental origin), self-reported general health, and lifestyle habits related to smoking and alcohol consumption. The clinical examination was performed by the same operator, recording the odontal and periodontal status, as well as prosthodontic evaluation (including Kennedy class). Results: Findings indicated that female patients had more frequent class 3 and complete edentulism in the maxilla, while males predominantly presented class 3 in the maxilla and class 1 in the mandible. The age distribution revealed that patients aged 20–40 exhibited the highest prevalence of Kennedy class 3, while those over 60 showed a notable increase in complete edentulism (p < 0.05). Although most patients were from urban areas, no significant difference was found between origin and edentulism class. A significant link between alcoholism and mandibular edentulism was also identified (p < 0.05). Conclusions: Edentulism tends to progress with advancing age, often leading to more extensive tooth loss and the need for comprehensive dental rehabilitation. The condition is closely linked to general health status, highlighting its relevance as a potential indicator of systemic health risks. Lifestyle factors, particularly smoking and alcoholism, appear to contribute significantly to the deterioration of oral health, underscoring the importance of preventive strategies and early intervention. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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17 pages, 1064 KB

Open AccessArticle

Evaluation of Vitamin D and of Some Biomarkers of Bone Remodelling (CTX-1, Osteocalcin, BALP) in Subjects with Periapical Inflammatory Cysts: An Observational Study

by Angela Pia Cazzolla, Vincenzo Brescia, Roberto Lovero, Roberta Cardinali, Francesca Di Serio, Mauro Lorusso, Domenico Ciavarella, Nunzio Francesco Testa, Gianna Dipalma, Michele Di Cosola, Lorenzo Lo Muzio, Vito Crincoli and Mariasevera Di Comite

J. Clin. Med. 2025, 14(11), 3712; https://doi.org/10.3390/jcm14113712 - 26 May 2025

Cited by 2 | Viewed by 1134

Abstract

Objectives: The aim of this observational study was to evaluate whether the presence of periapical inflammatory cysts (PIC) is accompanied by a state of vitamin D (25OHD) 25(OH)D insufficiency or deficiency and biochemical variations in biomarkers of bone metabolism such as osteocalcin (OC), [...] Read more.

Objectives: The aim of this observational study was to evaluate whether the presence of periapical inflammatory cysts (PIC) is accompanied by a state of vitamin D (25OHD) 25(OH)D insufficiency or deficiency and biochemical variations in biomarkers of bone metabolism such as osteocalcin (OC), isoenzyme of bone alkaline phosphatase (BALP), and C-terminal telopeptide of type 1 collagen (CTX). Methods: A total of 56 patients (group P), 36 males and 20 females, of which 42 had one cyst (group P1) and 14 had multiple periapical cysts (group P2), alongside 56 healthy subjects (group H) were recruited. Rx-OPT and clinical evaluation were used to evaluate the presence of PIC. At the first visit, all subjects underwent venous sampling (group P and H) to measure bone biomarkers by the chemiluminescence method. The Mann–Whitney test was used to compare the different biomarkers in the H vs. P, H vs. P1, H vs. P2, and P1 vs. P2 groups. The Mann–Whitney test was used to compare biomarker levels between the study groups. ROC curves were used to search for the concentration of the different biomarkers in which the best sensitivity and specificity were found. Results: 25OHD and CTX showed a difference between H vs. P, H vs. P1, H vs. P2, and P1 vs. P1 groups (p < 0.05). The study of the ROC curves with a comparison between concentrations in the H vs. P group showed the best sensitivity and specificity for 25OHD at a concentration <19 ng/mL, highlighting a picture of 25OHD deficiency. Conclusions: The presence of apical cysts could be indicative of a vitamin D deficiency that should be appropriately treated. The findings suggest that vitamin D deficiency, given its role in bone metabolism and mineralisation, may contribute to a biological environment that favours the development or persistence of periapical cystic lesions. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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15 pages, 586 KB

Open AccessEditor’s ChoiceArticle

Oral Hygiene Status in Children on the Autism Spectrum Disorder

by Magdalena Prynda, Agnieszka Anna Pawlik, Ewa Emich-Widera, Beata Kazek, Mikołaj Mazur, Wojciech Niemczyk and Rafał Wiench

J. Clin. Med. 2025, 14(6), 1868; https://doi.org/10.3390/jcm14061868 - 10 Mar 2025

Cited by 11 | Viewed by 5656

Abstract

Background/Objectives: Children with autism spectrum disorder (ASD) often face challenges in maintaining oral hygiene due to sensory sensitivities, behavioral difficulties, and limited access to specialized dental care. This study aimed to assess the oral hygiene status of children with ASD and compare it [...] Read more.

Background/Objectives: Children with autism spectrum disorder (ASD) often face challenges in maintaining oral hygiene due to sensory sensitivities, behavioral difficulties, and limited access to specialized dental care. This study aimed to assess the oral hygiene status of children with ASD and compare it with neurotypical peers. Methods: A cross-sectional study was conducted with 74 children with ASD and 74 neurotypical children. Dental exams measured oral hygiene and caries prevalence using the DMFT/dmft, Oral Hygiene Index (OHI), and Sulcus Bleeding Index (SBI). Tooth brushing frequency and dental visits were also recorded. Statistical analysis was performed using the Mann–Whitney U test and Fisher’s exact test. Results: Children with ASD had significantly poorer oral hygiene and higher caries rates compared to controls. Boys with ASD had higher DMFT scores, indicating more caries. Additionally, ASD children brushed their teeth less often and had fewer dental visits. Preventive treatments were underutilized in this group despite a higher need. Conclusions: Children with ASD face notable oral health challenges, including poor hygiene, higher caries prevalence, and limited preventive care. These findings highlight the need for tailored interventions, improved parental education, and specialized dental care strategies for this population. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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Review

Jump to: Research, Other

18 pages, 663 KB

Open AccessReview

Patient with Inflammatory Bowel Disease in a Dental Office—Which Antibiotic to Choose?—Narrative Review

by Stanisław Niemczyk, Wojciech Niemczyk, Katarzyna Bąk-Drabik, Katarzyna Latusek-Kotyczka, Anna Zawilska, Rafał Wiench, Jakub Hadzik and Marzena Dominiak

J. Clin. Med. 2025, 14(23), 8392; https://doi.org/10.3390/jcm14238392 - 26 Nov 2025

Cited by 1 | Viewed by 1490

Abstract

Background/Objectives: The rising global prevalence of inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, has resulted in an increase in the number of affected patients requiring dental care. The heightened risk of Clostridioides difficile infection (CDI) in IBD patients, particularly [...] Read more.

Background/Objectives: The rising global prevalence of inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, has resulted in an increase in the number of affected patients requiring dental care. The heightened risk of Clostridioides difficile infection (CDI) in IBD patients, particularly when exposed to commonly used dental antibiotics, is attributable to their altered gut microbiota and frequent immunosuppressive therapy. The objective of this review is to evaluate current antibiotic strategies for dental management in IBD and to identify safe and effective alternatives that minimise CDI risk. Methods: A narrative review was conducted in accordance with the SANRA guidelines. A comprehensive analysis of literature sourced from PubMed, Embase, Scopus, and Google Scholar was conducted. Results: The available evidence suggests that first- and second-line dental antibiotics—amoxicillin, ampicillin, and clindamycin—carry the highest risk of CDI. In contrast, metronidazole, which exhibits a comparable antimicrobial spectrum, has been shown to possess significantly reduced CDI potential and minimal disruption of gut microbiota. The utilisation of emerging local delivery systems, such as platelet-rich fibrin (PRF), has the potential to further reduce systemic antibiotic exposure. The adjunctive use of probiotics, prebiotics and synbiotics has been demonstrated to have the capacity to maintain microbial balance during therapy. Conclusions: Tailored, microbiome-conscious antibiotic strategies are essential in dental management of IBD patients. Further clinical research is needed to develop evidence-based guidelines and validate promising adjunctive approaches. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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17 pages, 1412 KB

Open AccessReview

Alzheimer’s Disease and Oral Health from Clinical Challenges to Interdisciplinary Care: A Narrative Review

by Diana Tatarciuc, Florin Razvan Curca, Dragos Ioan Virvescu, Oana Maria Butnaru, Ancuta Goriuc, Simona Bida, Ionut Luchian, Zinovia Surlari, Mihaela Scurtu, Ramona Gabriela Ursu and Dana Gabriela Budala

J. Clin. Med. 2025, 14(19), 6696; https://doi.org/10.3390/jcm14196696 - 23 Sep 2025

Cited by 3 | Viewed by 2619

Abstract

The link between oral health and Alzheimer’s disease (AD) has gained increasing attention in recent years. Emerging evidence suggests that this association is bidirectional, involving both biological mechanisms and behavioral consequences that reinforce one another over time. Literature Review: A narrative synthesis [...] Read more.

The link between oral health and Alzheimer’s disease (AD) has gained increasing attention in recent years. Emerging evidence suggests that this association is bidirectional, involving both biological mechanisms and behavioral consequences that reinforce one another over time. Literature Review: A narrative synthesis of systematic reviews, meta-analyses, and scoping reviews published between January 2010 and March 2024 was conducted. Searching was performed in four electronic databases (PubMed, Scopus, the Web of Science, and the Cochrane Library), using a combination of MeSH terms and free-text keywords related to dementia and oral health. Inclusion criteria targeted human studies published in English with full-text access and a clear focus on the interplay between oral status and Alzheimer’s disease. Results: The reviewed literature indicates that periodontal disease, tooth loss, and oral microbiome alterations may contribute to neuroinflammation and cognitive decline, potentially influencing the onset and progression of AD. Conversely, Alzheimer’s disease negatively affects oral health through impaired self-care, reduced motor coordination, salivary changes, and altered pain perception. Conclusions: By mapping out these interconnections, the findings support a shift in perspective; oral health should be considered a relevant factor in both the prevention and management of Alzheimer’s disease. Dentistry and neurology must move closer together in clinical practice, particularly in the care of older adults. Promoting oral health is not just about preserving teeth; it may be part of preserving cognitive function and quality of life. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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Other

Jump to: Research, Review

32 pages, 1845 KB

Open AccessSystematic Review

Relationship Between Maxillary Transverse Deficiency and Respiratory Problems: A Systematic Review of the Effectiveness of Devices over the Past Decade

by Gaetano Ierardo, Fabiana Nicita, Iole Vozza, Antonella Polimeni and Valeria Luzzi

J. Clin. Med. 2025, 14(24), 8861; https://doi.org/10.3390/jcm14248861 - 15 Dec 2025

Viewed by 998

Abstract

Background/Objectives: Maxillary transverse deficiency is linked to impaired nasal breathing and pediatric sleep-disordered breathing. This systematic review evaluated the effects of maxillary expansion (ME) on upper-airway morphology and breathing function in growing patients. Methods: The search was conducted on PubMed/MEDLINE, Scopus, [...] Read more.

Background/Objectives: Maxillary transverse deficiency is linked to impaired nasal breathing and pediatric sleep-disordered breathing. This systematic review evaluated the effects of maxillary expansion (ME) on upper-airway morphology and breathing function in growing patients. Methods: The search was conducted on PubMed/MEDLINE, Scopus, ScienceDirect, Cochrane CENTRAL, and gray literature (January 2015–April 2025). Eligible RCTs, controlled trials, and cohort/observational studies assessed airway morphology and/or respiratory outcomes after ME in pediatric/adolescent patients. Risk of bias was evaluated with RoB 2 (RCTs) and ROBINS-I (non-randomized studies). The findings were synthesized qualitatively and certainty graded with GRADE. Results: Forty-one studies were included. Imaging consistently showed enlargement of the nasal cavity and nasopharynx after expansion, whereas the effects in the oropharynx and hypopharynx, as well as in the maxillary sinuses, were smaller or variable. Objective patency improved in several studies (higher peak nasal inspiratory flow, reduced nasopharyngeal obstruction, and nasal resistance), whereas computational fluid dynamics generally showed non-significant trends toward lower resistance. Spirometry improved, particularly in oral breathers (gains in FEV₁, FVC, FEF25–75%). Polysomnography indicated reductions in AHI and improved oxygenation in some pediatric OSA cohorts, although other RCTs reported null PSG effects. Caregiver-reported sleep and quality-of-life outcomes were consistently enhanced. Device design modestly influenced regional widening, but overall respiratory effects were similar across expanders. By GRADE, certainty was low for airway morphology and very low for breathing function. Conclusions: In growing patients, ME reliably enlarges upper-airway compartments, especially the nasal cavity and nasopharynx, yet functional improvements are heterogeneous. Standardized outcomes and integrated morphological–functional assessments are needed to strengthen the evidence base. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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40 pages, 9650 KB

Open AccessSystematic Review

Oropharyngeal Interventions in Intubated Patients for Preventing Ventilator Associated Pneumonia: A Systematic Review and Multi-Variate Network Meta-Analysis Evaluating Pharmacological Agents

by Kannan Sridharan, Gowri Sivaramakrishnan and Ghazi Abdulrahman Alotaibi

J. Clin. Med. 2025, 14(22), 8174; https://doi.org/10.3390/jcm14228174 - 18 Nov 2025

Cited by 2 | Viewed by 2889

Abstract

Background: Ventilator-associated pneumonia (VAP) is a prevalent and serious complication of invasive mechanical ventilation (MV), contributing to significant mortality and increased healthcare resource utilization. While numerous oropharyngeal interventions exist, their comparative efficacy across critical outcomes remains uncertain due to a lack of direct [...] Read more.

Background: Ventilator-associated pneumonia (VAP) is a prevalent and serious complication of invasive mechanical ventilation (MV), contributing to significant mortality and increased healthcare resource utilization. While numerous oropharyngeal interventions exist, their comparative efficacy across critical outcomes remains uncertain due to a lack of direct comparisons in clinical trials. Methods: We conducted a systematic review and network meta-analysis (NMA) with a comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL up to September 2025 for randomized and non-randomized studies comparing topical oral interventions in intubated patients. The primary outcome was VAP incidence; secondary outcomes were intensive care unit (ICU) mortality, duration of MV, and ICU length of stay (LOS). Pairwise and network meta-analyses were performed, and the certainty of evidence was assessed. The effect estimates were odds ratios (OR) for categorical outcomes and mean difference (MD) for numerical outcomes represented with 95% confidence intervals (95% CI). Results: Ninety-six studies (20,650 patients) were included, evaluating 44 interventions. For VAP prevention, several interventions were superior to reference/control, including Antimicrobial combinations (OR: 0.21, 95% CI: 0.05–0.39), Povidone-iodine (OR: 0.47, 95% CI: 0.21–0.98), and Chlorhexidine (OR 0.61, 95% CI 0.39–0.95). However, only Chlorhexidine plus toothbrushing significantly reduced mortality (OR: 0.74, 95% CI: 0.58–0.93). For resource utilization, only antimicrobial combinations significantly reduced the duration of MV (MD: −5.55 days, 95% CI: −10.75–−1.7) and ICU LOS (MD: −7.74 days, 95% CI: −13–−4). Evidence certainty (GRADE) was moderate for chlorhexidine and very low for other comparisons. Conclusions: This NMA demonstrates that while multiple oropharyngeal interventions are effective for VAP prevention, their benefits are outcome specific. The choice of intervention should be guided by clinical priorities, as the most effective strategy for preventing VAP may not concurrently reduce mortality or resource use. These findings can inform guideline development and underscore the need for standardized, multi-faceted oral care protocols in the ICU. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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Open AccessSystematic Review

Review of the Safety and Clinical Considerations of Vasoconstrictor Agents in Dental Anesthesia During Pregnancy

by Andrei Urîtu, Victor Bogdan Buciu, Ciprian Roi, Doina Chioran, Denis Mihai Serban, Nicolae Nicoleta, Elena Lavinia Rusu, Mihai Ionac, Mircea Riviș and Sebastian Ciurescu

J. Clin. Med. 2025, 14(13), 4773; https://doi.org/10.3390/jcm14134773 - 6 Jul 2025

Cited by 2 | Viewed by 7266

Abstract

Background: The use of vasoconstrictors in dental anesthesia during pregnancy raises clinical concerns due to their potential effects on uteroplacental blood flow and fetal well-being. Despite widespread use, the safety profiles of agents such as epinephrine, levonordefrin, and felypressin remain insufficiently reviewed, [...] Read more.

Background: The use of vasoconstrictors in dental anesthesia during pregnancy raises clinical concerns due to their potential effects on uteroplacental blood flow and fetal well-being. Despite widespread use, the safety profiles of agents such as epinephrine, levonordefrin, and felypressin remain insufficiently reviewed, particularly in isolation from local anesthetics. Methods: A systematic literature search was conducted using PubMed (MEDLINE) for studies published between January 2000 and May 2025, following PRISMA 2020 guidelines. Included studies assessed the use, pharmacokinetics, or outcomes of vasoconstrictor agents used in dental procedures during pregnancy. Articles were selected based on predefined inclusion criteria and synthesized narratively. Results: Out of 95 screened records, only six narrative reviews and three clinical guidelines met eligibility criteria. Epinephrine was the most frequently described agent, generally regarded as safe at low dental doses (1:100,000–1:200,000) when properly administered. Levonordefrin showed insufficient safety data and was associated with potential uterine vasoconstriction. Felypressin was contraindicated due to its oxytocic properties and high risk of inducing uterine contractions. Conclusions: Among vasoconstrictors, epinephrine remains the only agent with an acceptable safety profile in pregnancy when used correctly. Levonordefrin lacks adequate evidence, and felypressin poses clear risks. Until further clinical trials are available, individualized risk assessment and adherence to obstetric and dental guidelines are critical for ensuring maternal and fetal safety. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations: Second Edition)

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