Search Results (5,312)

Oral health problems among older adults represent a growing public health concern due to increasing life expectancy and treatment needs. This study aimed to assess dental treatment needs and cost burden within the context of oral health policies. This retrospective study included anonymized data from 250 patients aged ≥65 years (F/M: 121/129; 65–89 years). Sociodemographic characteristics, treatment needs, and costs were obtained from the Hospital Information Management System (HIMS). Costs were adjusted to 2025 Turkish lira values using the Consumer Price Index and converted to international dollars using purchasing power parity (PPP). Patients were classified by total treatment costs using K-means cluster analysis. Periodontal (61.2%), restorative (36.0%), and endodontic (41.2%) treatment needs, which are largely preventable through oral hygiene practices, were more frequent among patients with a lower mean age, whereas tooth loss and prosthodontic treatment needs (89.6%) increased with mean age. Cluster analysis identified two groups: a low-cost group (67.6%) and a high-cost group (32.4%). The high-cost group had a lower mean age (68.84 ± 4.27 years) compared to the low-cost group (70.73 ± 5.18 years), indicating that relatively younger patients needed more complex and costly treatments. Out-of-pocket payments were notable for prosthodontic and surgical treatments, although Social Security Institution (SSI) payments constituted most of the costs. Preventive and early dental care strategies are essential to reduce treatment complexity and cost burden among older adults within the framework of oral health policy. Full article

Background: The association between oral health and gastrointestinal (GI) cancers has been primarily investigated within a periodontitis-centered framework. However, the potential contribution of cumulative oral disease burden, including dental caries and apical pathology, remains insufficiently explored. The Decayed, Missing, and Filled Teeth (DMFT) index reflects lifetime exposure to oral microbial dysbiosis and chronic inflammation. Methods: This retrospective exploratory study included patients with GI cancers referred for perioperative oral screening and management at a tertiary care center between 2015 and 2025. Oral health was evaluated using the DMFT index, periodontal probing depth, and radiographically diagnosed apical periodontitis. Age-stratified DMFT and periodontal parameters were compared with national reference data, while apical periodontitis prevalence was descriptively assessed. Results: Patients with GI cancers demonstrated higher DMFT values than national averages across most adult age groups. The prevalence of periodontal pockets (≥4 mm and ≥6 mm) was also elevated. Apical periodontitis was common, affecting 46.3% of patients, with some age groups exceeding 50%. Overall, these findings indicate oral disease clustering with coexisting chronic oral conditions. Conclusions: Patients with GI cancers exhibit substantial oral disease burden, including increased caries experience, periodontal pathology, and apical lesions. These findings suggest that the oral–gastrointestinal cancer relationship may extend beyond a periodontitis-centered paradigm, and that cumulative oral disease burden—including cariogenic processes—may represent an underrecognized component of this axis. The DMFT index may serve as a surrogate marker of lifelong oral inflammatory exposure. While causal relationships cannot be established, this study provides a basis for future mechanistic and longitudinal investigations. Full article

Salivary aldehyde dehydrogenases (ALDHs), particularly ALDH3A1, are increasingly recognized as potential contributors to oral defense against aldehyde-associated stress at the oral–environment interface. Unlike freely secreted salivary enzymes, measurable salivary ALDH activity primarily reflects intracellular and vesicle-associated enzymes derived from salivary gland epithelial cells, oral mucosal cells, immune cells, and exfoliated cellular components. Within the oral exposome, ALDHs expressed in oral epithelial and salivary gland tissues participate in the detoxification of reactive aldehydes, while salivary ALDH activity may serve as an indicator of local aldehyde-detoxification capacity and tissue redox status. Beyond aldehyde metabolism, emerging evidence suggests that ALDH-associated pathways are linked to redox regulation, epithelial stress adaptation, inflammatory signaling, and tissue repair through NAD(P)⁺-dependent processes and stress-responsive networks such as Nrf2 and SIRT1. This review provides a saliva-focused synthesis of ALDH biology, emphasizing isoform-specific functions and the potential importance of ALDH3A1 in oral epithelial defense. Altered salivary ALDH activity has been reported in association with oral conditions including periodontitis, oral lichen planus, radiation-induced salivary dysfunction, and oral squamous cell carcinoma (OSCC). Genetic factors, particularly ALDH2 polymorphisms, together with environmental exposures and microbial dysbiosis, may further influence aldehyde burden and oral disease susceptibility. Although current evidence supports the biological relevance of salivary ALDHs, their utility as clinical biomarkers or therapeutic targets remains investigational and requires further mechanistic and clinical validation. Full article

The oral cavity harbors a complex microbial community where pathogens implicated in dental caries and periodontitis can heavily colonize toothbrushes, transforming them into persistent sources of contamination that threaten both oral and systemic health. Consequently, this study evaluated the bactericidal efficacy of 275 nm ultraviolet light-emitting diode (UV-LED) irradiation against common oral bacteria in vitro and its practical utility for extraoral toothbrush sanitization. Suspensions of Streptococcus mutans, Streptococcus sanguinis, Porphyromonas gingivalis, and Fusobacterium nucleatum were irradiated for 3 min, 6 min, and 9 min. Bacterial growth and bactericidal effects were measured using growth curve and colony-forming unit assays, respectively. LIVE/DEAD staining and crystal violet staining were used to evaluate the bacterial viability and multispecies biofilm formation after irradiation. Additionally, the sanitization effects of a 275 nm UVC-based portable device on used toothbrushes were investigated. Direct UVC irradiation at 275 nm exhibited strong bactericidal effects against common oral bacteria in vitro. UVC irradiation also showed great sanitization effects on used toothbrushes. In summary, the vulnerability of common oral bacteria to 275 nm UVC, combined with its sanitizing efficacy on used toothbrushes, establishes a solid basis for extraoral sanitization, offering a reliable strategy to mitigate the risk of oral pathogen transmission from contaminated toothbrushes. Full article

Background: The biological response of the periodontal ligament (PDL) following endodontic treatment remains insufficiently investigated. This systematic review aimed to evaluate the influence of endodontic treatment modalities on PDL-related healing outcomes and periapical tissue repair. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for randomized clinical trials published between 2015 and 2025. Studies evaluating the effects of endodontic interventions on clinical, radiographic, or biological outcomes associated with PDL healing. Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Ten randomized clinical trials involving approximately 710 participants were included. Endodontic treatment was generally associated with favorable healing outcomes, reflected by reductions in periapical lesion size, improvement of radiographic parameters, and resolution of clinical symptoms. Single-visit and multiple-visit treatments demonstrated comparable long-term healing outcomes, although single-visit protocols were associated with increased short-term postoperative discomfort. Activated irrigation techniques appeared to enhance healing compared with conventional irrigation methods. Most studies were judged as having some concerns regarding risk of bias. Conclusions: Current evidence suggests that endodontic treatment can promote favorable healing of the periodontal ligament–periapical complex through effective infection control and resolution of inflammation. However, the certainty of evidence remains moderate because of methodological heterogeneity and the limited availability of studies directly assessing biological PDL outcomes. Further well-designed randomized clinical trials with standardized outcome measures and longer follow-up periods are required. Full article

Magnesium-based membranes are promising biomaterials for guided bone regeneration due to their unique properties of mechanical strength, biocompatibility, and controlled biodegradation. This scoping review aimed to map and synthesize the available evidence regarding the use of magnesium-based membranes and fixation screws in alveolar ridge regeneration and guided bone regeneration procedures. Relevant studies were identified through a literature search conducted from November 2025 to May 2026, using several databases following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Thirty-nine studies met the inclusion criteria, including in vitro studies, preclinical animal studies, clinical case reports and case series, and narrative or systematic reviews. In vitro studies demonstrated cytocompatibility and fibroblast adhesion, while moderate magnesium ion concentrations increased markers of osteogenic differentiation. Preclinical animal studies reported controlled degradation, biocompatible tissue responses, maintenance of barrier function during early healing, and findings suggesting potential osteogenic stimulation. Clinical evidence, limited to case reports and small case series, described the use of magnesium membranes in horizontal and vertical ridge augmentation, sinus lift procedures, immediate dentoalveolar regeneration, periodontal defects, and cystic lesions, with generally uneventful healing outcomes and preserved bone volume. Reported complications were mainly minor and included transient soft tissue reactions, membrane exposure, and localized gas cavity formation. However, the available evidence remains limited to low-level studies without controlled clinical trials. Current findings are insufficient to establish clinical efficacy or superiority over conventional membranes, highlighting the need for larger prospective controlled studies. The review’s findings could help researchers advance the understanding of bone regeneration and help develop new strategies to improve and further investigate bone regeneration. Full article

This research analyzed metabolomic and proteomic differences between participants with gingivitis (>20 bleeding sites) and generally healthy participants (≤3 bleeding sites) at baseline and 4 weeks post stannous fluoride (SnF₂) dentifrice treatment. Sixty-two metabolites were different (p < 0.05) between groups at baseline. Forty cytokines were analyzed using immunoassays and a group of proinflammatory cytokines (IL-1α, IL-1β, TNF-α, SAA, ICAM-1, VCAM-1) was elevated in participants with gingivitis (p < 0.1) versus healthy gingiva at baseline, with C-reactive protein (p < 0.05) being significantly elevated. Proteomic analysis carried out in baseline oral lavage revealed four of the top hits (p < 0.0004) were central-metabolism-related: aldolase A, triosephosphate isomerase, lactate dehydrogenase, and malate dehydrogenase. Enzymatic assays confirmed the proteomic finding that malate dehydrogenase and triosephosphate isomerase activities were elevated in gingivitis samples; SnF₂ dentifrice treatment reduced their activity. Collectively, 20 proteins with the lowest p-values in oral lavage appeared to be indicative of periodontal health, potentially forming the basis to cluster samples into healthy and unhealthy groups. A TLR-ATP biosensor model was established and demonstrated that microbial virulence factors induced the observed changes in oral lavage. Combined findings suggest gingivitis involves upregulation of host cell bioenergetic processes involving enzymatic activity in the glycolysis and citric acid cycle pathways. Full article

Artificial intelligence (AI) has transformed orthodontic diagnosis, yet its application to orthodontic materials science remains critically underexplored. This perspective identifies and characterizes the AI–materials integration gap as the central unresolved problem in digital orthodontics: AI-optimized treatment plans are currently executed through empirically selected materials whose mechanical behavior is never modeled by the planning system. We examine four domains where this gap is consequential: thermoplastic aligner polymers (PETG vs. TPU), where supervised ANNs can predict force decay from polymer composition; NiTi archwire alloys, where Bayesian optimization and Gaussian process regression are accelerating alloy design; additive manufacturing of orthodontic devices, where supervised ML reduced print-parameter optimization burden in a 2025 five-variable surface roughness study; and AI-driven biological response prediction, where FEA-surrogate neural networks reduced biomechanical computation from minutes to milliseconds per patient query. A scoping review of clear aligner AI identified 41 studies—none addressing aligner material properties as a primary outcome. We argue that closing the AI–materials gap requires standardized open material-performance datasets; FEA-surrogate models integrating polymer stiffness as a treatment-planning input; patient-specific digital twins with defined material, mechanical, and biological parameter layers; and federated learning infrastructure spanning clinics and manufacturers. Full article

Recent advances in three-dimensional (3D)-bioprinted hydrogels show promise for overcoming the limitations of conventional techniques for dental tissue regeneration. This scoping review systematically analyses the physical, mechanical, and rheological properties of these hydrogels in dental applications, aiming to identify knowledge gaps, limitations, and current and future directions for advancing and translating hydrogel-based 3D bioprinting in dentistry. In accordance with PRISMA-ScR guidelines, a comprehensive literature search was conducted across Ovid, PubMed, EBSCOhost, and Web of Science up to January 2026. Included studies focused on (i) 3D-bioprinted hydrogels, (ii) quantitative characterisation, and (iii) dental tissue engineering. A total of twenty-one studies met the inclusion criteria. The findings revealed substantial variability in formulations and properties. Gelatine-based hydrogels reinforced with β-tricalcium phosphate demonstrated the highest compressive strength within the range of cancellous bone, whereas GelMA/PEGDA composites exhibited tunable stiffness suitable for soft tissue applications. Extrusion-based bioprinting emerged as the predominant method, with photocrosslinking and ionic crosslinking as the primary gelation techniques. Biodegradation rates varied notably with composition and regenerative objectives. This review uniquely consolidates the physical, mechanical, and rheological evaluations of 3D-bioprinted hydrogels for dental applications. The review highlights critical gaps in methodological standardisation and validation, emphasising the importance of biomaterial selection to optimise scaffolds and regenerative outcomes in periodontal, bone, and pulp tissue engineering. Full article

GLP-1 receptor agonists (GLP-1RAs) are widely used in the treatment of type 2 diabetes and obesity and are increasingly relevant in periodontal and implant practice. This review covers mechanisms, preclinical and early human evidence, and practical periodontal considerations; the structured database search is conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) and the International Committee of Medical Journal Editors (ICMJE) principles. Two pathways explain GLP-1RAs’ relevance: indirect effects from better glycemic control, weight loss, and reduced inflammation; and direct tissue effects involving GLP-1R signaling and the GLP-1/dipeptidyl peptidase-4 (DPP-4) axis. Preclinical studies show reduced inflammation, osteoclast activity, and alveolar bone loss, along with improved periodontal stem cell function under hyperglycemia or inflammation via Nuclear Factor-kappaB (NF-kappaB), Wingless-related integration site (Wnt)/beta-catenin, and Mitogen-Activated Protein Kinase (MAPK) pathways. Animal studies on implants and local delivery, including exendin-4 platforms, suggest osteometabolic benefits. Human data are limited and mostly observational, and confounders include metabolic status, smoking, medication, and nutrition. Oral side effects such as xerostomia and dehydration are also noted. At present, GLP-1RA therapy should be regarded as a contextual modifier of periodontal risk and healing capacity rather than as a stand-alone periodontal therapy. Full article

Background and Objectives: Halitosis is a prevalent oral concern that meaningfully affects oral health-related quality of life (OHRQoL), yet how active dental treatment is associated with short-term changes in the objective–subjective halitosis–QoL nexus remains poorly quantified. Interpretation is complicated by the multifactorial nature of malodor and by baseline differences between patients selected for different dental procedures. We compared changes in volatile sulfur compound (VSC) emissions, organoleptic ratings, tongue-coating burden, and OHIP-14 across three contrasting treatment modalities and explored whether VSC change statistically accounted for OHRQoL change. Methods: In a non-randomized prospective comparative study, 119 adults (18–67 y) commencing one of three procedures were assessed at baseline and at 8 weeks: scaling and root planing (Group A, n = 42), fixed prosthodontic rehabilitation (Group B, n = 38), or fixed orthodontic appliance bonding (Group C, n = 39). Outcomes included Halimeter^® VSC (ppb), Rosenberg organoleptic score (0–5), Winkel tongue-coating index (TCI), self-perceived halitosis, and OHIP-14 total and seven-domain scores. Mixed-design ANOVA, ANCOVA, prespecified multivariable regression, mediation (5000 bootstrap resamples), receiver operating characteristic analysis, and four-class latent class analysis were performed. A sensitivity-analysis framework including expanded covariate adjustment, propensity-score overlap weighting, and baseline-severity strata was also applied to address residual baseline imbalance. Secondary mediation, ROC, and latent-class analyses were considered exploratory. Results: At 8 weeks, VSCs fell by 116.4 ± 38.7 ppb in Group A and 35.4 ± 29.1 ppb in Group B but rose by 34.3 ± 28.6 ppb in Group C (p < 0.001). OHIP-14 improved by 10.3 and 4.9 points in A and B and worsened by 3.7 in C (p < 0.001). ΔVSC correlated with ΔOHIP-14 (ρ = 0.51, p < 0.001) and most strongly with the psychological discomfort domain (ρ = 0.58). VSC change mediated 35.1% of the periodontal-versus-orthodontic association on QoL (indirect β = −4.7; 95% CI −6.3 to −3.1). Because VSC and OHIP-14 changes were measured over the same interval, mediation was interpreted cautiously. A ΔVSC threshold of −63 ppb predicted clinically meaningful OHIP-14 improvement (AUC = 0.81). Latent class analysis identified four distinct responder phenotypes. The cutoff and responder classes were internally derived and require external validation. Sensitivity analyses preserved the direction of the primary contrasts, but residual confounding remains possible. Conclusions: Treatment modality was associated with the direction and magnitude of halitosis and QoL change, with orthodontic patients constituting a vulnerable subgroup. Targeted oral-hygiene reinforcement during fixed-appliance therapy is warranted. Full article

Background and Objectives: This study aims to evaluate the recent literature on the oral–gut connection in the context of periodontal disease, emphasizing the significance of systemic risk associated with chronic inflammation. This review explores whether chronic inflammation resulting from periodontal disease can induce systemic conditions through alterations in the gut microbiome and whether periodontal treatment may contribute to overall health improvement. Materials and Methods: A systematic database search was performed using pre-established search strategies. Searches were conducted in three databases between 1 and 20 October 2025. A total of 578 articles were screened for eligibility based on inclusion and exclusion criteria. Two authors agreed on the selection process used. The methodological quality of the included studies was assessed using the Newcastle–Ottawa scale and the Risk of Bias 2 Tool. Results: Eleven studies were considered eligible for inclusion in the review. The gut microbiome is similar to the oral microbiome in patients with periodontitis. Gut microbial shifts may drive systemic inflammation and metabolic dysfunction. Tooth loss and gum disease are linked to alterations in the gut bacteria, potentially compromising the intestinal barrier permeability. In contrast, the presence of natural teeth may prevent oral–gut bacterial transmission. Changes in the gut microbiota are correlated with improvements in periodontal status after non-surgical periodontal therapy. Conclusions: The evidence presented in this review supports an association between periodontitis, oral–gut microbial alterations, and systemic inflammatory conditions. However, most available studies are observational, limiting causal inference. Targeted modulation of the gut microbiome may represent a promising area for future research, but its clinical applicability remains inconclusive. Full article

Background and Objectives: Child dental neglect is a clinically significant form of maltreatment that frequently reflects broader challenges related to caregiving within the family environment. Although oral manifestations have been described in prior research, the socio-behavioral profile of responsible caregivers remains insufficiently characterized, particularly in Central and Eastern European contexts. This study aimed to identify caregiver-level socio-behavioral characteristics associated with child dental neglect and to examine their relationships with clinical outcomes. Materials and Methods: A retrospective cross-sectional analytical study was conducted on 333 children (aged 4–17 years) diagnosed with dental neglect, presenting at a municipal hospital and a private dental practice in Oradea, Romania (2020–2024). Caregiver-level variables included age, educational attainment, socioeconomic status, health condition, substance use, and family structure. Associations were analyzed using Fisher’s Exact Test, Pearson Chi-Square, and Mann–Whitney U test, with Bonferroni correction applied where appropriate. Results: Most caregivers were young adults (93.1%), with low educational attainment (40.2% had no formal schooling) and high rates of alcohol use (47.1%). Low family income was present in 89.2% of cases and was significantly associated with non-adherence to the dental treatment plan (p  =  0.039). Caregivers without formal education were associated with neglect in rural areas (43.4% vs. 26.2%; p  <  0.001). Children of drug-using caregivers were significantly older at presentation (median: 12 vs. 8 years; p  =  0.014), and caregiver drug use was more prevalent in urban settings (18.0% vs. 1.8%; p  <  0.001). Over half of the children (52.9%) came from disrupted family environments. Conclusions: Dental neglect was consistently associated with young, poorly educated, and financially disadvantaged caregivers exhibiting high rates of substance use and unstable family structures. These factors may interact in complex ways, highlighting the multifactorial nature of dental neglect. Dental professionals are well positioned for early identification and have a professional and ethical responsibility to integrate child safeguarding into routine clinical practice. Full article

Background/Objectives: Orthodontic treatment induces controlled mechanical forces that alter the periodontal environment, including changes in oral microbiota composition and activation of local inflammatory pathways. Despite the widespread and growing use of orthodontic appliances across all age groups, the magnitude, timing, and multi-domain biological impact of these changes have not been comprehensively quantified in a single systematic synthesis. This systematic review and meta-analysis aimed to synthesize the available evidence on periodontal clinical parameters, oral microbiota composition, and local inflammatory biomarkers associated with orthodontic treatment using fixed appliances and clear aligners, and to provide a structured, GRADE-rated evidence base for clinical practice. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to March 2026. Prospective cohort studies, longitudinal clinical studies, and randomized controlled trials evaluating periodontal parameters, oral microbiota, and inflammatory biomarkers during orthodontic treatment were included. Quantitative synthesis was performed using mean differences or standardized mean differences with 95% confidence intervals, primarily assessing within-group (pre–post) changes. Results: Eighteen studies (n = 812 patients; follow-up 3–12 months) met inclusion criteria. Fixed orthodontic appliances were consistently associated with transient increases in plaque index (MD 0.45, 95% CI 0.32–0.58; I² = 62%), gingival index (MD 0.38, 95% CI 0.25–0.51; I² = 55%), and bleeding on probing (MD 15.2%, 95% CI 10.1–20.3%; I² = 48%), particularly during early treatment phases. Microbiological analyses demonstrated within-group shifts toward increased prevalence of periodontopathogenic species (Streptococcus mutans OR 2.45, 95% CI 1.89–3.18; Porphyromonas spp. OR 2.14, 95% CI 1.67–2.75) in patients treated with fixed appliances. Local inflammatory responses were characterized by elevated IL-1β (MD 1.2, 95% CI 0.8–1.6) and IL-6 (MD 0.9, 95% CI 0.6–1.2) in gingival crevicular fluid. Certainty of evidence was rated moderate for plaque and gingival indices and low for microbiological and inflammatory outcomes (GRADE). Conclusions: Orthodontic treatment—particularly with fixed appliances—is associated with transient, reversible deterioration of periodontal indices, shifts toward a more dysbiotic oral microbiome, and elevation of local inflammatory mediators in gingival crevicular fluid during active treatment phases. These changes are manageable through structured preventive protocols and regular periodontal monitoring. Future prospective studies with concurrent control groups and standardized multi-domain outcome measures are needed to better define the magnitude and reversibility of these biological responses. PROSPERO: CRD420261336117. Full article

Bone loss in the maxillofacial region arises from multiple causes, including periodontal disease, trauma, surgical procedures, infection, congenital anomalies, and cancer. Traditional treatment relies on bone grafting, either alone or in combination with biomaterials. Advances in tissue engineering have introduced synthetic or natural scaffolds to mimic the mineralized bone matrix. Natural scaffolds offer excellent biocompatibility and similarity to native tissue but often lack sufficient mechanical strength and exhibit poor degradation rates. Synthetic scaffolds provide tunable porosity and mechanical stability; however, their biological inertness makes them poor sources of osteogenic signaling. A key factor in the success of any scaffold is its interaction with the host immune system. Upon implantation, the innate immune response is initiated, with neutrophils and macrophages being the first cells to contact the scaffold. Macrophage polarization toward proinflammatory (M1) or anti-inflammatory (M2) phenotypes determines whether the microenvironment favors inflammation or remodeling. The adaptive immune response also plays a critical role: T and B lymphocytes may promote tolerance and integration through Th2/Treg pathways and antibody-mediated regulation, or they may trigger chronic inflammation and rejection through Th1/Th17 activation. This review examines the natural and synthetic materials used for bone remodeling and their biological properties. It then outlines the sequence of immune events occurring from the moment a scaffold is implanted to its potential integration or failure. Finally, this study highlights the relevance of cellular models and in vitro assays for the early evaluation of immunogenicity and biocompatibility, which are essential for optimizing scaffold design and improving outcomes in maxillofacial bone regeneration. Full article