Search Results (40)

Background: Antimicrobial photodynamic therapy (aPDT) is a useful adjunct for managing oral biofilm diseases. Natural photosensitizers may be safer and more biocompatible than synthetic ones, but their dental effectiveness is still unclear. Methods: A PRISMA compliant review (PROSPERO ID: CRD420251233910) searched PubMed, Embase, Scopus, and the Cochrane Library for randomized controlled trials published from 2015 to 2025 that used natural photosensitizers for aPDT in dental settings. Three reviewers screened studies, extracted data, and assessed bias with a nine-domain tool adapted for photodynamic therapy. Results: Eleven of 249 records met the established criteria. Natural photosensitizers included curcumin, riboflavin, phycocyanin, chlorophyll derivatives, and plant extracts, tested in periodontitis, peri-implant mucositis, denture stomatitis, caries-related biofilms, and general oral decontamination. Most trials showed short-term microbial reductions and modest clinical gains, with performance comparable to chlorhexidine, methylene blue, or standard care. Adverse effects were minimal. Study quality was generally good, but wide variation in photosensitizer type, light settings, and outcomes, and short follow-up periods hindered meta-analysis and limited conclusions about long-term effectiveness. Conclusions: Natural photosensitizer-based aPDT appears effective and safe as an adjunct, offering consistent short-term microbiological improvements. Current evidence does not support replacing established antimicrobial approaches. Larger, well-controlled trials with standardized methods and longer follow-up periods are needed to define best practice and clarify the role of aPDT in routine dentistry. Full article

Background/Objectives: Complete denture rehabilitation in edentulous patients presents functional and biomechanical challenges. Mini-implant-supported overdentures improve retention, stability, function, and comfort, particularly in complex class II or class III mandibulo-maxillary relationships. However, mechanical complications such as ball abutment wear may compromise long-term success. This case report aims to describe the clinical context, methods employed to manage ball abutment wear, and related complications in a patient with a mandibular mini-implant overdenture. Methods: This retrospective case report presents two approaches to managing abutment wear and enhancing overdenture retention: silicone matrices (Retention.Sil, Bredent Medical GmbH & Co.KG, Senden, Germany) and abutment reconstruction using prefabricated cemented spheres (Concave Reconstructive Sphere, Rhein83, Bologna, Italy). Results: A significant mechanical complication associated with mini-implant overdentures is the wear of ball abutments, which may develop over time as a result of continuous interaction between the O-ring system and the abutment surfaces. Both techniques effectively preserved mini-implants while enhancing denture retention, function, and comfort. Conclusions: Mechanical complications, such as ball abutment wear, may compromise the retention and functional performance of mandibular overdentures. Alternatives like silicone matrices and reconstructive spheres address abutment wear in mandibular overdentures, ensuring long-term retention and sustainable, patient-centered care for the elderly. Full article

Natural compound-based strategies have gained attention as alternatives to conventional antifungal therapies, particularly in the management of Candida infections affecting the oral cavity, such as denture stomatitis. Our aim was to investigate the antifungal activity of the polyphenol pterostilbene (PTE) on clinical Candida isolates and microcosm biofilms from denture stomatitis, as well as to evaluate its toxicity and therapeutic efficacy in Galleria mellonella. PTE exhibited fungicidal effects against Candida albicans and Candida dubliniensis at 32 µg/mL. Time-kill assays demonstrated complete inhibition of viability for both strains within 8 h of exposure. In addition, PTE exhibited broad-spectrum antimicrobial activity, significantly reducing the counts of streptococci, mutans streptococci, staphylococci, and yeasts within microcosm biofilms. In vivo, PTE showed no signs of toxicity in G. mellonella at concentrations up to 20× MIC. Prophylactic treatment with PTE enhanced larval survival in experimental candidiasis caused by both C. albicans and C. dubliniensis. Moreover, prophylactic treatment decreased the fungal burden of C. albicans in the G. mellonella hemolymph, while the recruitment of hemocytes involved in host defense mechanisms remained unaltered. In summary, PTE demonstrated antimicrobial activity against Candida planktonic cells and complex biofilms associated with denture stomatitis, exhibiting favorable biocompatibility and in vivo antifungal efficacy in G. mellonella model. Full article

Background: Fiber-reinforced composites (FRCs) have emerged as transformative materials in restorative dentistry, particularly for managing partial edentulism through fixed partial dentures (FPDs). Their superior aesthetic, mechanical, and adhesive properties offer a minimally invasive alternative to traditional metal–ceramic restorations. Objective: This review aims to evaluate the historical evolution, clinical applications, technological advancements, and prospects of FRCs in prosthodontics, emphasizing their potential to deliver durable, aesthetic, and cost-effective treatment solutions. Methods: This narrative review follows the SANRA guidelines. A comprehensive literature search was conducted across PubMed, ScienceDirect, and Google Scholar for studies published between January 1995 and January 2025. Search terms included “fiber-reinforced composite”, “fixed prosthodontics”, “fixed partial dentures”, “adhesive restorations”, and “implant-supported restorations”. Only English-language studies addressing the clinical applications, mechanical properties, technological innovations, or survival outcomes of FRCs were included. Data were extracted from original research papers, systematic reviews, and narrative reviews. Results: Advancements in fiber architecture, resin matrices, and polymerization techniques have enhanced the strength, aesthetics, and longevity of FRC-based FPDs. Their high flexural strength, fatigue resistance, and compatibility with adhesive restorative techniques provide clinicians with versatile treatment options. Clinical studies demonstrate favorable survival rates and long-term success, positioning FRC FDPs as reliable alternatives to conventional restorations. Emerging technologies such as CAD/CAM and 3D printing further broaden their scope and precision. Conclusions: FRC FPDs have evolved from interim solutions to predictable, long-term restorations. With ongoing technological innovations and clinical validation, they are poised to become a mainstream treatment choice in prosthodontics. FRC FPDs offer a durable, aesthetic, and cost-effective solution aligned with minimally invasive dentistry, reducing tooth preparation while improving patient-centered outcomes. Full article

Candida spp. are common components of normal microbiota in the oral cavity. However, Candida albicans can be a primary cause of superficial infections in the oral cavity and esophagus, especially in immunocompromised individuals. While these infections are rarely life-threatening, they can significantly impair quality of life and, in severe cases, progress to hematogenous dissemination. Oral candidiasis often exhibits as pseudomembranous, erythematous (atrophic), chronic hyperplastic, denture stomatitis, or angular cheilitis. Esophageal candidiasis is typically diagnosed by upper endoscopy, which involves histological examination and brushing. Clinical guidelines recommend topical antifungal agents for mild oral candidiasis, and systemic agents for moderate-to-severe disease or when topical therapy fails. However, azole antifungals pose a substantial risk of drug–drug interactions, primarily due to the inhibition of cytochrome P450 enzymes and drug transporters, which dramatically alters the pharmacokinetics of co-administered drugs. Additionally, amphotericin B, a polyene macrolide antibiotic, may cause nephrotoxicity and electrolyte disturbances (e.g., hypokalemia and hypomagnesemia). Moreover, the co-administration of nephrotoxic drugs may augment the toxicity associated with amphotericin B. Therefore, this review aimed to provide a comprehensive overview of the management of oral and esophageal candidiasis from the viewpoint of clinical pharmacology, with a particular focus on drug–drug interactions and adverse effect profiles. Full article

Successful health management in older adults requires adequate nutrition, which is often compromised by oral health issues like edentulism. Tooth loss can reduce masticatory function, especially when rehabilitation treatments fail. The present study aims to generate initial information on the potential effects of the placement of mandibular mini-implants in patients with complete maxillary and mandibular dentures on mandibular kinetics, electromyographic activity, and quality of life. Participants with complete dentures, adequate mandibular bone height, and good general health were recruited. All underwent cone beam computed tomography for diagnosis and planning to place two mandibular mini-implants. Mandibular movements were analyzed using electromagnetic articulography and electromyography before treatment and five months after implant placement. Oral health-related quality of life (OHRQoL) was assessed using the OHIP-7sp at baseline and six months post-treatment. Five subjects were included (mean age 69.7 ± 10.8 years). All mini-implants demonstrated a 100% initial success rate. At five months, significant improvements were observed in the vertical range of maximum opening, as well as in the area, trajectory, and range of frontal and sagittal movement envelopes (p < 0.05)—along with increased movement symmetry. OHRQoL also improved, with greater esthetic satisfaction, communication, and social engagement. Mandibular mini-implants improved mandibular movements and prosthetic stability, enhancing patients’ oral health-related quality of life without altering muscle activity. Full article

Complete dentures (CD) are prone to biofilm formation, particularly by Candida species, which may lead to denture stomatitis (DS). As edentulism remains highly prevalent among the global ageing population, denture-related infections represent a significant public health concern. The novelty of this study lies in integrating the clinical severity of DS with the prevalence, microbial load, and antifungal susceptibility profile of Candida spp., providing new insights into the pathogenesis and therapeutic management of this condition. Biofilm from the CD and palate was seeded for prevalence and microbial load. The identification of strains was confirmed molecularly, and susceptibility to micafungin, nystatin, fluconazole, and miconazole was assessed by the broth microdilution method. Prevalence was shown in percentage, microbial load was analyzed using a generalized linear model test, and susceptibility was assessed using Pearson’s Chi-square test (p < 0.05). Candida albicans was the most prevalent regardless of DS. However, a higher microbial load of C. albicans was observed with increased severity of DS (p = 0.038). Except for Candida tropicalis, the microbial load of the CD was higher than that of the palate. C. tropicalis showed resistance to fluconazole with increased severity of DS (p = 0.004). All strains were susceptible to nystatin and miconazole, and three were resistant to micafungin. The findings suggest that the prevalence of Candida spp. is not a determining factor in the variation in DS severity. Nevertheless, patients with severe inflammation harbor an increased load of C. albicans on both sites. Nystatin and miconazole appear to be effective treatments for DS. Full article

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