Search Results (33)

Inhaled corticosteroids (ICSs) are widely used to manage chronic respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), and human immunodeficiency virus (HIV). However, prolonged use of ICS is associated with the development of oropharyngeal candidiasis, a fungal infection primarily caused by Candida albicans, due to local immunosuppression in the oral cavity. The incidence of oropharyngeal candidiasis varies depending on geographic region, patient age, and comorbidities, with immunocompromised individuals, those with diabetes, and the elderly being particularly vulnerable. Key risk factors include high ICS doses, poor oral hygiene, and improper use of inhalers. Prevention is the cornerstone of managing oropharyngeal candidiasis associated with the chronic use of inhaled corticosteroids. Patient education on proper inhaler technique and oral hygiene is essential to reduce the risk of fungal overgrowth in the oral cavity. Additional preventive strategies include the use of spacers, mouth rinsing after inhalation, and proper denture care. In cases where these measures fail to prevent the infection, prompt detection and early intervention are crucial to prevent progression or recurrence. This narrative review aims to analyze the most effective prophylactic measures to prevent oropharyngeal candidiasis associated with the chronic use of inhaled corticosteroids, emphasizing patient education, oral hygiene, and proper use of inhalation devices. Full article

Xerostomia significantly compromises oral comfort, mucosal integrity, and denture retention. While topical therapies such as oral gels are commonly used to manage symptoms, their effectiveness remains limited due to an inability to replicate the complex biochemical and mechanical functions of natural saliva. This review explores the pathophysiology of salivary dysfunction, the structural and functional roles of mucins, and the tribological and rheological demands of the oral environment—particularly in denture wearers. Emphasis is placed on the interplay between mucosal surfaces, salivary films, and prosthetic biomaterials, as well as the importance of mucoadhesion and aqueous boundary lubrication. A rheological comparison of commercially available oral gels and whole human saliva (WHS) reveals that gels are significantly more viscous and elastic, yet fail to mimic the dynamic responsiveness of saliva. Current formulations lack functional standardization and labeling, limiting clinical guidance. The study proposes design principles for next-generation gels that incorporate amphiphilic, biomimetic components and measurable performance benchmarks. Full article

Introduction: Hypoglossal nerve stimulation (HNS) “Inspire_© therapy” has garnered popularity among obstructive sleep apnea (OSA) patients seeking an alternative to continuous positive airway pressure (CPAP) therapy. The growth in HNS has been particularly high in older adults living with OSA. Consistent and proper use of HNS in the geriatric population faces unique age-associated barriers: a high rate of multiple chronic conditions (MCC) and polypharmacy (being on five or more drugs). Early recognition and patient-centered management of these barriers will allow older patients to obtain maximum benefits from HNS. HNS has distinct advantages in the geriatric population because it overcomes many concerns related to CPAP therapy adherence, such as mechanical limitations due to manual dexterity, maxillofacial anatomy, dental issues such as usage of dentures, allergy/otolaryngology-related disorders, and pre-existing post-traumatic stress disorder-related claustrophobia. This paper describes how we worked with older patients with OSA and their care partners to overcome these barriers so patients can continue to derive cardiovascular, neurologic, and quality of life benefits resulting from optimal OSA management. These benefits are especially important in the older population because of higher rates of comorbidities (dementia, coronary artery disease, and atrial fibrillation) exacerbated by sub-optimally treated OSA. In this article, we describe our clinical experience with elderly patients on Inspire_© therapy, with a focus on the everyday difficulties faced by these patients and the measures implemented to address and mitigate these barriers. Methods: A retrospective chart review was conducted to identify patients aged 65 and above who underwent hypoglossal nerve stimulator insertion. Experiences of older patients during and after the insertion procedure were documented and compared to a younger population of patients on HNS therapy. We specifically collected information on difficulties encountered during activation or follow-up visits and compared them between the different age groups. Using this information, we identified areas to improve treatment adherence from the patients’ perspectives. Results: We identified 43 geriatric (65 to 86 years old) patients who received the Inspire implant at a tertiary academic medical center and compared them to a younger population of 23 patients. Most common challenges noted—with a potential to impact adherence—included orofacial and lingual neuropraxia (ischemic or demyelination-induced neuropathy) at activation, cognitive dysfunction (memory problems), preexisting anxiety, and insomnia. Other difficulties that are less commonly reported but equally important to consistent and proper use of HNS included headaches, concerns of device malfunction, change in comfort levels after cardiac procedures, and general intolerance of the device. The older patient population had a statistically significant higher incidence of cognitive difficulties (30.2% vs. 4.4%) and a smaller social support system (62.8% vs. 91.3%) affecting device usage compared to the younger population. There were no statistically significant differences in the rates of other more commonly reported adverse effects such as headaches, dry mouth, and anxiety between the two age groups. Conclusion: Despite several challenges faced by geriatric patients, Inspire_© hypoglossal nerve stimulation remains a viable, alternative treatment option for OSA with improved tolerance and adherence compared to CPAP. After identifying less commonly reported barriers such as cognitive decline, sensory deficits, and decreased social support systems, minor adjustments and appropriate education on use allows older patients to correctly use and benefit from Inspire_© device therapy, with subsequent improvement in sleep and overall quality of life. Full article

This study investigated the proportions and clinicopathological presentations of oral candidal lesions in type 2 diabetes mellitus (DM) patients attending the Diabetic Clinic at Teaching Hospital Peradeniya; Sri Lanka. A descriptive cross-sectional study was conducted on 355 DM patients aged over 18 years who had been receiving treatment for at least one year. Clinical photographs and periodic acid–Schiff (PAS)-stained cytological specimens confirmed diagnoses. Oral candidal lesions were found in 17.6% of patients; with Denture Stomatitis (4.0%), Erythematous Candidiasis (3.4%), Pseudomembranous Candidiasis (3.1%), and Chronic Hyperplastic Candidiasis (2.8%) being the most common types. Notably; all lesions were identified as incidental findings. Erythematous Candidiasis was more frequently noted among individuals older than 60 years (p = 0.041); while Denture Stomatitis was more common with higher glycemic levels (>140 mg/dL) (p = 0.045). Males were significantly more susceptible to oral candidal lesions (p = 0.002); except for Pseudomembranous Candidiasis and Denture Stomatitis; which were more frequent in females. Smoking (p = 0.005) and betel quid chewing (p = 0.008) were also identified as significant risk factors. Binary logistic regression revealed that males (OR = 3.160) and denture wearers (OR = 2.348) had a higher likelihood of developing oral candidal lesions. Despite the relatively low prevalence; routine oral examinations are recommended for early detection and management; ensuring better oral health in this at-risk population. Full article

Background/Objectives: Microbial biofilms on denture surfaces pose significant oral and systemic health risks. Although chemical denture cleansers are widely used, they can cause mucosal irritation and disrupt the oral microbiome. The aim of this study was to evaluate the antimicrobial efficacy and biocompatibility of a denture cleanser containing Paeonia lactiflora extract (DC-PL) as a potential natural alternative. Methods: Oral microcosm biofilms were formed using human saliva and matured over 6 days. Then, the biofilms were treated for 1 min daily over 6 days with DC-PL, distilled water (DW; negative control), or Polident^® (PD; positive control). Antimicrobial effects were assessed by measuring the red fluorescence intensity (ratio of red to green fluorescence intensity [Ratio_R/G]) and aciduric bacterial counts. Biocompatibility was evaluated through an oral mucosal irritation test. A one-way analysis of variance followed by Tukey’s post hoc test was used for between-group comparisons. Results: Ratio_R/G in the DC-PL group was significantly lower than that in the DW group (0.94-fold, p = 0.021) and comparable with that in the PD group (p = 0.502). Aciduric bacterial counts in the DC-PL group were 0.92-fold lower than those in the DW group (p = 0.037) and comparable with those in the PD group (p = 0.460). The oral mucosal irritation index was 0, indicating no irritation. Conclusions: DC-PL demonstrated antimicrobial efficacy similar to that of PD while maintaining excellent biocompatibility. These findings underscore its potential as a safe and effective alternative to conventional chemical cleansers, offering a clinically viable solution for improving oral health management. Full article

Background: Digital impression techniques for edentulous patients present unique challenges due to the absence of stable anatomical landmarks and variable soft tissue morphology. While intraoral scanners have shown promising results in dentate patients, their application in edentulous cases remains problematic, with reported accuracy deviations ranging from 60.6 ± 11.9 μm to 67.2 ± 6.9 μm compared to conventional methods. Material and Methods: This pilot study employed a within-subject, repeated-measures design comparing four scanning protocols in a fully edentulous patient (age: 42, BMI: 24.3 kg/m², Cawood and Howell Class III). Digital scans were performed using iTero Element 5D and Trios 5 scanners (n = 10 scans per group), with and without a modified technique incorporating standardized reference points (1 mm diameter, 5 mm intervals) and systematic soft tissue management. A conventional impression-derived digital model served as the reference standard. Accuracy assessment utilized best-fit alignment and root mean square (RMS) calculations through Geomagic Control X software (version 2020.1.1). Results: The modified technique demonstrated significantly improved accuracy (Groups C/D: 57.8–59.7 μm) compared to standard protocols (Groups A/B: 66.9–68.2 μm) (p < 0.001). Mean scanning times were reduced by 37% with the modified technique (2:10 ± 0:09 min vs. 3:24 ± 0:15 min). Inter-operator reliability showed excellent agreement (ICC = 0.92, 95% CI: 0.88–0.95). Soft tissue management significantly improved vestibular area accuracy (48.7 ± 6.3 μm vs. 72.4 ± 8.9 μm, p < 0.001). Conclusions: The proposed scanning strategy incorporating reference points and systematic soft tissue management significantly improved both accuracy and efficiency in digital impressions of edentulous arches. The technique showed excellent reproducibility and potential clinical applicability across different scanner systems. These findings warrant validation through larger-scale clinical trials to establish definitive protocols for digital impression-taking in edentulous patients. Full article

Background and Objectives: Functional rehabilitation in patients with hemimandibulectomy remains a challenge no matter what method of reconstruction is chosen by physicians. In this paper, we aim to evaluate the feasibility of an acceptable occlusal restoration in patients who have undergone hemimanidublectomy without the reestablishment of mandibular continuity. Materials and Methods: Data were collected retrospectively on 10 patients with varying degrees of mandible resection. The greatest challenge in the restoration of an acceptable occlusion form is the natural latero-deviation that occurs in patients whose mandibular continuity was not restored. This causes an unbalanced and uncoordinated occlusal plane. Based on our research, this deviation is highly dependent on three main factors: the presence of teeth (which allow for a proprioceptive stimulus that counteracts the deviation), the extension of the defect and the presence or lack of the coronoid process. Results: Based on the presence of dental elements or lack thereof, patients were either rehabilitated with implant-supported dentures or removable partial dentures. Although the gold standard of care for these patients remains the restoration of mandible continuity through use of bone grafts, an acceptable rehabilitation of occlusion and therefore function may be acquired in non-grafted patients. Conclusions: Both physicians and patients must manage their expectations carefully and be eager to find a compromise to provide the best possible solution given the challenges of the premises. Full article

Background and Clinical Significance: Denture stomatitis is a clinical manifestation of oral candidiasis, often seen in individuals wearing removable dentures that lead to the formation of sub-prosthetic stomatitis. This is particularly common in maladjusted appliances that have been in use for many years. Studies have shown that patients with systemic diseases such as diabetes, or other medical complexities, have a higher likelihood of developing denture stomatitis. To address this problem, the use of implant-retained dentures with different types of attachments has been introduced, providing increased comfort and hygiene for edentulous patients. However, this solution is not without its own set of challenges, being that the prolonged contact with mucosal surfaces can lead to challenges in cleaning and managing plaque depending on the attachment. Case Presentation: In this clinical case report, we present a female patient who developed bar-retained prosthetic stomatitis induced by oral candidiasis a few months after receiving her provisional prosthesis. Conclusions: In conclusion, this case report emphasizes the need to consider both systemic and local factors when preventing and treating denture stomatitis. By understanding the risk factors involved, healthcare professionals can provide their patients with the best possible care, helping to reduce the prevalence of oral candidiasis in individuals who use implant-retained dentures. Full article

Background: Research has demonstrated that the loss of one or more natural teeth can be an emotionally traumatic experience that mirrors processes associated with bereavement. There remains scant literature examining the role of emotions in dental encounters. One such exception is the literature on the idea of the ‘treatment alliance’ in dental encounters. The aim of this paper is to explore the role of the ‘treatment alliance’ in dentist–patient encounters. Methods: Data were collected from clinical observations, semi-structured interviews and focus groups exploring the experience of tooth loss and how the treatment alliance shaped the patient journey. Data analysis was conducted using the grounded theory method influenced by phenomenology. Coding was conducted using NVIVO and the unit of analysis was the treatment alliance. Results: Twenty participants took part in the interviews (eleven male; nine female; 22–86 years; mean age = 58.9 years). Observations were carried out with a further fourteen participants (seven male; seven female; 50–101 years; mean age = 62.2 years). The paper draws on four cases taken from the observational data to illustrate important dynamics underpinning how the treatment alliance varied. These case studies are then used as the basis for a critical discussion of the importance of the treatment alliance in dentistry. Conclusions: The treatment alliance acted as an important moderator in the clinical encounter, helping to influence successful outcomes. An important foundational component of the treatment alliance was the degree of emotional work the dental team conducted when ‘getting to know’ unfamiliar patients. Whilst emotions were an important factor in dental encounters, their acknowledgement and management were not essential to all successful outcomes. Much more research is therefore needed into the role of emotional labour in dental encounters. Full article

Candida albicans (C. albicans) adhering to denture-based resins (DBRs) is a known cause of denture stomatitis. A new approach to prevent denture stomatitis is to include antimicrobial substances within DBRs. Here, we examined the mechanical performance and antifungal properties of DBRs containing benzyldimethyldodecyl ammonium chloride (C₁₂BDMA-Cl) as an antimicrobial compound. C₁₂BDMA-Cl is a quaternary ammonium compound, and its antifungal properties have never been investigated when combined with dental acrylic resin. Therefore, we modified a commercially available heat-polymerized acrylic DBR to contain 3 and 5 wt.% of C₁₂BDMA-Cl. Unmodified DBR was used as a control group. Specimens were prepared using the conventional heat processing method. The specimen’s flexural strength, elastic modulus, microhardness, and surface roughness were evaluated. C. albicans biofilm was grown on the specimens and assessed via colony-forming units (CFUs) and scanning electron microscopy (SEM). In silico molecular docking was applied to predict the potential C₁₂BDMA-Cl inhibition activity as an antifungal drug. The 3% C₁₂BDMA-Cl DBR demonstrated antifungal activities without a deterioration effect on the mechanical performance. SEM images indicated fewer colonies in DBR containing C₁₂BDMA-Cl, which can be a potential approach to managing denture stomatitis. In conclusion, C₁₂BDMA-Cl is a promising antifungal agent for preventing and treating denture stomatitis. Full article

Background and Objectives: With increases in cancer incidence and the number of cancer survivors, the demand for cancer management is growing. However, studies on dental prosthetic treatment for patients with cancer are rare. We aim to investigate the dental prosthetic treatment in patients with cancer aged ≥65 years after expanded health insurance coverage. Materials and Methods: This retrospective study included patients who were treated with implants and removable dentures at Ulsan University Hospital in South Korea between June 2015 and June 2023. Data on age, sex, cancer location, comorbid systemic diseases, number of remaining teeth, dental prosthetic treatment history, type of dental prosthetic treatment, and insurance coverage status were extracted from patient medical records and panoramic radiographs. The influence of multiple variables on dental prosthetic treatment was analyzed using the Chi-square and Fisher’s exact tests. Results: The study included 61 patients with cancer (32 men, 29 women; average age: 70.9 years). Among them, 56 (91.8%) had insurance coverage benefits, and 34 (55.7%) received treatments such as implants, removable partial dentures, or complete dentures for the first time. Treatment types included 37 (60.7%) cases of implant prostheses and 24 (39.3%) conventional removable dentures. No statistical differences were observed in the type of dental prosthetic treatment according to sex, age, cancer location, number of systemic diseases, and dental prosthetic treatment history (p > 0.05). Patients with <10 remaining teeth received treatment with conventional removable dentures, which was statistically significant (p < 0.001). Conclusions: Of the 61 patients, 56 (91.8%) received insurance benefits, and 34 (55.7%) underwent dental prosthetic treatment for the first time. Within the limitations of this retrospective study, the expanded health insurance coverage alleviated the unmet demand for dental prosthetic treatment. As cancer prevalence continues to increase, expanding customized health insurance coverage is crucial to meet this demand. Full article

Older adults often experience poor oral functions, hindering rehabilitation post-acute disease treatment. However, characteristics of hospitalized patients who would benefit from professional oral-health management (POHM) have not been clarified. Therefore, we aimed to elucidate systemic and oral characteristics of patients requiring POHM during hospitalization in a convalescent hospital. This study included 312 participants admitted to the rehabilitation department of a convalescent hospital for a year. The patients were categorized according to POHM requirements (no-POHM group: 137 patients; POHM group: 175 patients) by discharge. Age, sex, primary disease at admission, Glasgow coma scale (GCS), Functional Independence Measurement (FIM), Mini nutritional assessment-short form (MNA-SF), Functional oral intake scale (FOIS), number of present and functional teeth, Oral Health Assessment Tool (OHAT) scores, and POHM details provided during patient hospitalization were compared. Binomial logistic-regression analysis identified patients requiring POHM as those who had suffered a stroke and had a low number of present teeth, poor overall oral health, low food form, and low motor skills at admission. A high percentage of POHM interventions comprised oral-hygiene care and denture treatment. In summary, patients whose oral health has deteriorated and those experiencing oral-intake difficulties upon admission to a convalescent hospital may require oral-health management. Full article

Laser, an acronym for Light Amplification by Stimulated Emission of Radiation, is a powerful tool with diverse applications in modern dentistry. It emits monochromatic, coherent light resulting from photon-induced chain reactions. Available dental lasers include diode, argon, Er,Cr:YSGG, Er:YAG, Nd:YAG, and CO₂. The unique property of these lasers, allowing them to be effectively used on both soft and hard tissues based on the operational parameters, positions them as particularly suited for a wide range of dental procedures. Compared to traditional methods, lasers offer advantages such as improved hemostasis and quicker wound healing. Such benefits stress the shift towards laser technology in dental treatment. In the realm of dental prosthodontics, which focuses on esthetics, functionality, and the physiological aspects of dental prostheses, lasers provide promising outcomes. Among the prosthetic options, fixed partial dentures stand out for their ability to mimic natural teeth, offering both esthetic and functional features, leading to satisfactory long-term outcomes if managed properly. This review paper delves into the specific application of laser technology in the context of prosthetic rehabilitation involving fixed partial dentures. By investigating intraoral laser procedures, it contributes to understanding laser’s role in improving patients’ satisfaction and clinical efficiency in this field. Full article

Introduction: Implant placement in the maxillary anterior area requires sufficient quantity and quality of both soft and hard tissue. In cases where soft and hard tissues are insufficient, additional regeneration using biomaterials is recommended. Treatment using bovine-derived xenograft and acellular dermal matrix (ADM) may increase bone volume and soft tissue thickness. Case and management: A 65-year-old woman sought help for discomfort and aesthetic issues with her denture, reporting missing teeth (11, 12, 13, 14, and 21) and bone volume shrinkage due to disuse atrophy. Intraoral examination revealed 1 mm gingival thickness. CBCT showed labio-palatal bone thickness of 6.0 mm, 5.8 mm, and 4.7 mm for teeth 21, 12 and 14, respectively. Implant planning and surgical guide fabrication were carried out before the surgery. Surgery included the placement of implants 3.3 mm in diameter and 12 mm in length, with the use of xenograft and ADM. Three months post-op, improvements in soft and hard tissues were observed, with a final prosthesis being a long-span implant-supported bridge. Conclusions: Disuse alveolar atrophy causes soft and hard tissue deficiency. The use of xenograft and ADM show favourable results even on a geriatric patient. Full article

The aim of the current study was to present the clinical and radiological outcomes of monolithic zirconia superstructures compared to the metal–ceramic ones in the All-on-4 concept for the prosthetic rehabilitation of the maxillae. A total of 30 patients were subdivided into groups according to their superstructure type (metal–ceramic (n = 15) or monolithic zirconia (n = 15)). All implants were functionally loaded within 24 h after insertion with provisional acrylic superstructures. Prosthetic complications, marginal bone loss, plaque accumulation, probing pocket depth, bleeding on probing, and bite force were documented over a period of 5 years. Marginal bone loss around the implants of the ceramic group remained well over the five years (1.21 ± 0.23 mm). However, marginal bone loss was significantly lower around the implants in the monolithic zirconia group (0.22 ± 0.14 mm) (p < 0.001). Bleeding on probing, plaque accumulation, and probing pocket depth values were correlated with marginal bone loss. Among all evaluated parameters, no differences could be detected in terms of the angulation of the implants. Detachment or chipping was observed in seven cases in the metal–ceramic superstructure group. In all cases, dentures were removed and repaired in the laboratory. In the monolithic zirconia group, chipping was detected after one year in two cases, after two years in four cases, and after five years in one case and could be managed by polishing in situ. Monolithic zirconia superstructures presented superior results regarding the parameters evaluated. Full article