Search Results (2,913)

Background/Objectives: Endo-periodontal lesions (EPLs) represent complex pathological entities involving both periodontal and pulpal tissues, often implying diagnostic and therapeutic challenges. Limited evidence exists regarding the relationship between periodontal disease staging and grading and EPL subtype. The aim is to evaluate the clinical and statistical distribution of endo-periodontal lesions and investigate their association with periodontal stage and grade according to the European Federation of Periodontology (EFP) classification. Methods: An observational retrospective study was conducted in the Department of Periodontology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. Among 884 examined patients, 31 of them were diagnosed with EPLs and included in the analysis. Demographic variables, systemic conditions, affected tooth type, EFP stage and grade, and EPL type according to the Foce classification were recorded. Statistical analysis included Fisher’s exact test and univariable and multivariable binomial logistic regression models. Results: The mean age of the patients was 53.55 ± 9.42 years, with a nearly equal gender distribution. Most patients presented Stage III periodontitis (54.8%), Grade B periodontitis (71%), and EPL 3 (58.1%). Pluriradicular teeth were the most frequently affected (64.5%). The only statistically significant association identified was between EFP grading and EPL classification (p = 0.001). Grade B patients were significantly more likely to present EPL 3 than Grade C patients. Logistic regression analysis demonstrated that Grade B was a strong predictor of EPL 3 both in the univariable model (OR = 27.2; 95% CI: 2.712–272.828) and after adjustment for age and gender (OR = 32.676; 95% CI: 2.832–376.984). Neither age nor gender showed a significant association with EPL 3 occurrence. Conclusions: EPL 3 was the predominant lesion subtype in the study. EFP grading was significantly associated with EPL distribution, with Grade B emerging as an independent predictor of EPL 3. These findings suggest that periodontal disease progression may play a key role in the development and characterization of combined endo-periodontal lesions and highlight the importance of integrated periodontal–endodontic assessment in clinical practice. Full article

Tooth-bearing structures are commonly involved in the spread of various odontogenic lesions. Radicular and dentigerous cysts are among the most common odontogenic cysts, exhibiting significant variations in size and morphology within the jawbones. On the other hand, the influence of dental caries, periodontal diseases, and periapical lesions extends beyond tooth-bearing bone and also affects adjacent anatomical structures, especially the maxillary sinuses. In addition to untreated odontogenic lesions, treatment-related complications in the posterior maxilla may also disturb the sinus environment, particularly when oroantral communication is not recognized or adequately managed. The etiology of sinusitis is multifactorial; however, tooth-related infections are the primary cause of odontogenic sinusitis (ODS). Routine upper posterior tooth extraction may also become clinically significant when pre-existing sinus mucosal changes, close sinus floor proximity, or persistent oroantral communication are overlooked. When ODS is undiagnosed or overlooked on a classic computed tomography or a cone beam computed tomography (CBCT) scan, it is frequently inadequately managed by otolaryngological interventions alone; this leaves the underlying dental pathology unaddressed. Consequently, the utilization of CT/CBCT and close collaboration between dentists, oral surgeons, and otolaryngologists are essential for the successful management of these conditions. In advanced cases of ODS, isolated intranasal otolaryngological procedures are often insufficient. Comprehensive management relies on the elimination of all sources of odontogenic infection through endodontic therapy, dental extractions, and localized bone curettage. While the traditional Caldwell–Luc approach (CLA) is not commonly used nowadays, it remains an important surgical option in select cases, especially when infection spreads beyond tooth-bearing structures or soft tissue abscesses are present. This paper presents the radiological and clinical findings of two ODS cases with different etiologies and demonstrates how these findings influenced surgical planning. The aim is not to introduce the Caldwell–Luc approach as a novel technique but to illustrate its selective role when the direct treatment of the odontogenic source and oroantral defect is required. Full article

Background and Objectives: Oxidized LDL (oxLDL) and Toll-like receptor (TLR) signaling are implicated in inflammatory bone loss and periodontitis, but their cooperative effects on osteoclastogenesis remain unclear. We investigated whether TLR2/4 stimulation regulates the transcription of LOX-1 (lectin-like oxidized low-density lipoprotein receptor-1), a receptor for oxLDL, and whether oxLDL enhances TLR-mediated osteoclastogenic responses in the absence of exogenous RANKL. Materials and Methods: Mouse bone marrow cells (BMCs) were differentiated into bone marrow macrophages (BMMs) with M-CSF and stimulated with TLR ligands (Pam3CSK4 for TLR2 and Lipid A for TLR4) and/or oxLDL, with or without exogenous RANKL. Raw264.7 cells were stimulated with TLR ligands or Porphyromonas gingivalis lipopolysaccharide (LPS). LOX-1 transcriptional activity and osteoclastogenic responses were evaluated using luciferase assays, quantitative RT-PCR, and tartrate-resistant acid phosphatase (TRAP) staining. Results: In Raw264.7 cells, stimulation with Pam3CSK4, Lipid A, or LPS significantly increased LOX-1 promoter activity. In BMCs, Pam3CSK4 significantly increased LOX-1 and MyD88 mRNA expression on day 1, whereas expression decreased by day 3; these changes were suppressed by a TLR2 inhibitor. Lipid A significantly increased LOX-1 and MyD88 mRNA expression on day 3, and the increase in LOX-1 expression was inhibited by a TLR4 inhibitor. Functionally, Pam3CSK4 or Lipid A alone increased mononuclear TRAP-positive cells but did not induce multinucleated TRAP-positive cells. In contrast, co-stimulation of oxLDL with either Pam3CSK4 or Lipid A promoted multinucleated TRAP-positive cell formation even in the absence of exogenous RANKL. Conclusions: TLR2/4 stimulation transiently enhanced LOX-1 transcription and expression in association with increased MyD88 expression. TLR ligands cooperated with oxLDL to promote multinucleated TRAP-positive cell formation in the absence of exogenous RANKL, suggesting that inflammatory and metabolic signals may act synergistically during osteoclastogenesis. These findings improve our understanding of how dyslipidemia-associated factors may contribute to inflammatory bone-resorptive diseases, including periodontitis. Full article

Guided bone regeneration (GBR) is a widely used clinical approach for managing bone defects associated with periodontal disease in dogs, employing barrier membranes to selectively direct tissue regeneration. The performance of these membranes is influenced by composition, structural design, and degradation behavior, which together determine biological responses and clinical outcomes. Biodegradable GBR membranes, fabricated from natural polymers, synthetic polymers, or composite materials, offer advantages over non-biodegradable membranes, including controlled resorption, elimination of secondary surgery, and the potential for delivery of bioactive agents. Preclinical studies in dogs have demonstrated that GBR membranes can promote periodontal regeneration, including bone and cementum formation and space maintenance; however, optimization of degradation behavior remains critical to align membrane resorption with tissue healing in some cases. Clinical studies in dogs with naturally occurring periodontal disease remain scarce, and only two biodegradable membranes (Ossiflex^® and Doxirobe^®) are commercially approved for veterinary use, while all others are applied off-label. These limitations highlight the need for more adaptable and cost-effective regenerative strategies, including membranes that can be customized to different defect sizes and multifunctional membranes incorporating bioactive agents that will offer an advanced regenerative potential and improved predictability in veterinary periodontal therapy. Full article

Azithromycin is widely used in dentistry as a systemic antibiotic, particularly for odontogenic infections and as an alternative in patients with β-lactam hypersensitivity. Beyond its antimicrobial activity, azithromycin possesses unique pharmacokinetic, anti-inflammatory, immunomodulatory, and anti-biofilm properties. Together with growing concerns regarding antimicrobial resistance and antibiotic stewardship, these characteristics have stimulated interest in local drug-delivery strategies that may reduce systemic antibiotic exposure while maintaining therapeutic efficacy. This narrative review evaluates the rationale, potential clinical applications, and current evidence supporting local azithromycin delivery in dentistry. The available literature on azithromycin pharmacology, systemic dental use, immunomodulatory mechanisms, biofilm-related effects, local drug-delivery systems, safety, and regulatory considerations was critically reviewed. Current evidence suggests that locally delivered azithromycin may achieve high drug concentrations at the target site, enhance anti-biofilm activity, modulate local inflammation, and minimize systemic exposure. Potential applications include periodontitis, peri-implant diseases, persistent endodontic infections, oral surgery, and regenerative procedures such as bone augmentation and maxillary sinus floor elevation. Emerging delivery platforms, such as hydrogels, thermoresponsive gels, nanoparticles, and chitosan-based systems, further support the feasibility of this approach. Experimental findings also indicate that azithromycin may inhibit osteoclast activity, suggesting additional benefits for bone preservation and regenerative healing. Despite these promising findings, current evidence remains limited and is derived mainly from preclinical studies and small clinical investigations. Further translational research and well-designed randomized controlled trials are needed to establish the safety, efficacy, and optimal clinical role of locally delivered azithromycin in evidence-based dental practice. Full article

Background: Osteoradionecrosis (ORN) is a severe late complication of radiotherapy for head and neck cancer, associated with impaired bone healing, infection, pain, and exposed bone. Periodontal disease may contribute to ORN by maintaining inflammatory and infectious foci within irradiated tissues with reduced vascularity and repair capacity. Objective: To evaluate whether periodontal disease or poor periodontal status is associated with increased ORN risk in patients with head and neck cancer undergoing radiotherapy. Methods: This systematic review and meta-analysis followed PRISMA 2020 recommendations and was structured according to the PECO framework. Searches were conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, WHO databases, and gray literature. Observational studies involving head and neck cancer patients treated with radiotherapy and reporting periodontal status in relation to ORN were included. Risk of bias was assessed using a domain-based approach. Random-effects models estimated pooled relative effect estimates and ORN prevalence. Results: Six studies were included in the primary association meta-analysis. Periodontal disease was significantly associated with increased ORN risk, with a pooled relative effect estimate of 4.83 (95% CI: 1.96–11.93; p = 0.0006; I² = 50.4%). Seven studies including 1785 patients and 118 ORN events were included in the prevalence meta-analysis, showing a pooled ORN prevalence of 9% (95% CI: 6–13%; I² = 78.0%). Conclusions: The findings suggest that periodontal disease or poor periodontal status may be associated with an increased likelihood of ORN in patients with head and neck cancer undergoing radiotherapy. Given the observational nature of the evidence and the moderate between-study heterogeneity, this association should be interpreted cautiously. Comprehensive periodontal assessment and long-term oral surveillance may be considered as components of multidisciplinary care before and after radiotherapy. Full article

Background: Periodontitis and psoriasis are chronic inflammatory diseases that share common risk factors and immune-mediated pathogenic pathways, suggesting a potential bidirectional relationship. Periodontal inflammation contributes to systemic inflammatory burden, which may influence the severity of immune-mediated diseases, such as psoriasis. Objective: The aim of this systematic review is to evaluate the effects of periodontal therapy on psoriasis severity in patients affected by both conditions. Methods: This review followed the PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251155439). Eligible studies included adults (≥18 years) with both psoriasis and periodontitis undergoing periodontal therapy compared with no periodontal treatment. The primary outcome was Psoriasis Area and Severity Index (PASI), while secondary outcomes included periodontal clinical parameters (PPD, CAL, FMBS). Results: A total of 228 records were identified; after screening and full-text evaluation, two randomized controlled trials, including a total of 166 patients, met the inclusion criteria. Both studies evaluated non-surgical periodontal therapy and reported significant reductions in PASI scores in treated patients compared with controls. Periodontal parameters (PPD, CAL, FMBS) also improved significantly following treatment in both studies. Conclusions: Evidence from the included trials indicates that non-surgical periodontal therapy may reduce psoriasis severity while simultaneously improving periodontal health in patients with both conditions. Periodontal treatment may serve as a beneficial adjunct to dermatological therapy. However, findings are limited by small sample sizes and short follow-up periods. Larger, long-term randomized controlled trials are needed to confirm these results. Full article

High-throughput metagenomic sequencing and advances in mucosal immunology have refuted the traditional physiological concept of a sterile respiratory tract. The oral cavity has been recognized as a dynamic determinant of systemic health. As in other parts of the body, recent studies also suggest that pulmonary health may be linked to oral health. Under eubiotic conditions, the oral microbiome maintains local immunological homeostasis and colonization resistance. Oral dysbiosis, characterized by sequential shifts in microbial communities and the proliferation of the pathogenic red complex (Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia), induces a state of chronic systemic inflammation, potentially involved in an infectious axis between the oral cavity and the lung. This review evaluates the tripartite systemic pathways of metastatic infection, metastatic injury, and metastatic inflammation that govern the translocation of oral pathobionts and their bioactive components, including lipopolysaccharides, outer membrane vesicles, and matrix metalloproteinases, to the lower respiratory tract via microaspiration and hematogenous circulation. The clinical implications across the chronic respiratory disease spectrum are examined, with a focus on how deficits in oral microbial diversity influence chronic obstructive pulmonary disease (COPD) pathogenesis, modulate the pulmonary virome and mycobiome, and stimulate maladaptive trained immunity. Furthermore, the contribution of biological aging is assessed, highlighting the roles of immunosenescence, inflammaging, and physiological reflex decline within the broader mucosal continuum. Finally, the clinical translation of this axis is analyzed, emphasizing the integration of saliva-based point-of-care nano-theranostics, metatranscriptomic profiling, and targeted interventions—such as professional oral biofilm management in intensive care settings and precision microbiome engineering—to preserve respiratory function and restore immune homeostasis. Full article

Sphingolipids, essential structural components of biological membranes, form a framework that maintains their stability and fluidity. In addition to their structural function, these lipids and their metabolites participate in regulating multiple cellular processes, including proliferation, differentiation, gene expression, and apoptosis, thereby contributing to the maintenance of oral homeostasis. Dysregulation of sphingolipid metabolism is involved in the pathogenesis of several major oral diseases: oral squamous-cell carcinoma (OSCC), periodontitis, oral candidiasis, Sjögren’s syndrome (SS), and periapical diseases. Accordingly, a deeper understanding of sphingolipid biology may provide new opportunities for developing therapeutic strategies targeting these disorders. This review provides a comprehensive analysis of the structural characteristics and principal metabolic pathways of key sphingolipids (e.g., ceramide, sphingosine-1-phosphate [S1P], and glucosylceramide [GlcCer]), discusses their diverse roles in oral diseases, and summarizes recent advances in pharmacological approaches targeting enzymes involved in sphingolipid metabolism. Full article

Background and Objectives: Cigarette smoking is a recognized risk factor for periodontal disease and subgingival dysbiosis; however, the impact of electronic cigarettes on the subgingival microbiome in young adults is still not sufficiently investigated. This study aimed to characterize and compare the carriage and bacterial load of 20 subgingival species among young adult cigarette smokers, e-cigarette users, and non-smokers, and to evaluate whether e-cigarette use is linked to a periodontopathogen-enriched profile similar to that of smoking. Materials and Methods: In this exploratory cross-sectional study, fifty young adults were divided into three groups: cigarette smokers (n = 18), e-cigarette users (n = 16), and non-smokers (n = 16). Subgingival specimens were examined using real-time Polymerase Chain Reaction (PCR) (Perio panel; ADD Laboral B.V., Malden, The Netherlands) for 20 bacterial species. Carriage was analyzed across groups utilizing Fisher’s exact test with Cramér’s V as the effect size, while bacterial load was assessed using the Kruskal–Wallis test accompanied by Dwass–Steel–Critchlow–Fligner post hoc comparisons (jamovi; significance threshold established at p < 0.05). Results: Red-complex pathogens were more prevalent and present in greater quantities in smokers and e-cigarette groups compared to non-smokers. Porphyromonas gingivalis prevalence was seen in smokers (94.4%), vapers (75.0%), and non-smokers (56.2%; p = 0.028), whereas Tannerella forsythia was found in 100% of smokers, 87.5% of vape users, and 68.8% of the non-smokers (p = 0.022). Aggregatibacter actinomycetemcomitans was not present in non-smokers but was identified in 37.5% of vapers and 16.7% of smokers (p = 0.018), whereas Eubacterium nodatum was significantly elevated in tobacco users (p = 0.012; Cramér’s V = 0.449). In contrast, Prevotella nigrescens was predominant among non-smokers (87.5%; p = 0.022). Conclusions: In young adults, the red-complex bacteria—Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola—were found more frequently and in larger quantities among smokers and vapers as compared to non-smokers. Full article

Canine periodontitis is one of the most prevalent chronic diseases for dogs over two years of age. Periodontal pockets may serve as a reservoir for opportunistic bacteria including Pasteurella stomatis, Neisseria animaloris, and Streptococcus canis; however, data on their antimicrobial susceptibility and potential One Health relevance remain limited. This pilot study investigated culturable bacterial isolates recovered from periodontal pockets of dogs with different stages of periodontal disease. Subgingival samples were collected under general anesthesia after periodontal probing and dental radiographic assessment during routine comprehensive oral health assessment and treatment (COHAT) procedures. Bacterial isolates were cultured, identified using MALDI-TOF MS, and tested for minimum inhibitory concentrations (MIC) against amoxicillin (AML), doxycycline (DX), trimethoprim–sulfamethoxazole (SXT), gentamicin (CN), chloramphenicol (C), and ciprofloxacin (CIP). In total, 122 isolates from 101 dogs were analyzed, including Pasteurella stomatis (n = 54), Neisseria animaloris (n = 33), and Streptococcus canis (n = 35). MIC distributions varied between bacterial species and antimicrobial agents, while interpretation was limited by the lack of species-specific veterinary medicine breakpoints for some isolates. These preliminary findings highlight the need for larger standardized studies to support antimicrobial resistance surveillance in canine oral microbiota. Full article

Oral diseases, such as periodontitis, remain a major global concern due to their high incidence and significant morbidity. The principal drivers are bacterial overgrowth and associated inflammation. Bioactive glass of the 45S5 Bioglass^® composition (BG) is known for its remineralising, osteogenic and antibacterial effects via ion release, but its application has been limited in oral environments. In this study, a photocurable GelMA hydrogel was developed as a carrier matrix for BG (1–15% w/v) to obtain synergy between the adhesive properties of the GelMA and the bioactivity of the glass. Incorporation of 10% w/v BG improved ultimate tensile strength (97 kPa) compared to pure GelMA (58 kPa) and reduced swelling by 18%. The composites showed ~60% higher adhesive strength on collagen sheets than GelMA alone. Tensile bonding strengths reached 54 kPa on collagen sheets and 23 kPa on tooth sections. Lap-shear adhesive strengths were 44 kPa on collagen and 18 kPa on implant metal. In vitro studies confirmed the composite’s biocompatibility with dental pulp stem cells and antibacterial activity against Escherichia coli and methicillin-resistant Staphylococcus aureus. Overall, the GelMA/BG composite presents a multifunctional platform for dental remineralisation with promising mechanical, adhesive and antibacterial performance. Full article

Cognitive impairment is a growing concern in rapidly aging societies, including China, and oral health has been proposed as a modifiable correlate of cognitive aging; however, few studies compare distinct oral health domains within the same older population or identify the subgroups in which associations are strongest. We analyzed data from 1707 community-dwelling adults aged 55+ in the 2022 Lifelong Learning and Productive Aging Survey of Shanghai (LEAP-SH) study. Cognitive problems were measured with the Ascertain Dementia 8 (AD8) total score (0–8; higher = worse). Self-reported oral health, oral health knowledge, and oral hygiene behavior were each standardized and entered in separate models adjusted for sociodemographic and health covariates; interaction models tested effect modification by six sociodemographic moderators. All three domains were associated with lower AD8 scores, most strongly oral health status (β = −0.26; p < 0.001), followed by oral health knowledge (β = −0.14; p = 0.004) and oral hygiene behavior (β = −0.10; p = 0.036). Associations were broadly consistent across subgroups; only two interactions, both involving knowledge, were nominally significant, and neither survived correction for multiple comparisons. Oral health may be a modifiable correlate of cognitive aging, although the cross-sectional design precludes causal inference. Full article

Background: Geranium robertianum L. (GR) is a perennial herbaceous plant that belongs to the Geraniaceae family, widely distributed across temperate regions of Europe, Asia, North Africa, and America. It has been used in traditional ethnomedicine for its antibacterial, haemostatic, and anti-allergic properties in the treatment of oropharyngeal conditions, wounds, and inflammatory diseases. Beyond these traditional applications, pharmacological studies have documented several biological activities of its extracts and constituents. Objective: The aim of this review is to evaluate the therapeutic potential of GR by examining the phytochemical composition and the pharmacological properties relevant to dental medicine. Methods: A literature screening was conducted (PubMed, Google Scholar, PubMed Central), with focus on studies concerning phytochemical composition, pharmacological effects, and potential applications of GR and its major bioactive constituents in oral health. Results: Phytochemical analysis reveals that GR is characterized by a rich content of polyphenols, particularly tannins, flavonoids, and phenolic acids, with geraniin, ellagic acid, gallic acid, quercetin, and kaempferol identified as its principal bioactive constituents. Recent studies have confirmed that these constituents are responsible for the plant’s therapeutic potential in oral medicine. These compounds possess a variety of effects, from antibacterial and anti-inflammatory properties to antifungal and antiviral activities, as well as antioxidant, wound-healing, and anticancer benefits relevant to dental medicine. Conclusions: Despite its long-standing traditional use, GR remains largely underexplored in the context of oral health. This gap in the literature highlights GR as a promising phytotherapeutic candidate, calling for further in vitro and in vivo studies in order to investigate its efficacy and establish its mechanism of action in dental medicine. Full article

Fermented foods contain diverse microorganisms that may influence oral microbial ecology and contribute to oral health. This narrative review aimed to examine the current evidence regarding microorganisms present in fermented foods and their role in oral health promotion. Twenty relevant clinical, experimental, observational, and review studies published between 2016 and 2026 were identified through a structured literature search and critically synthesized according to major thematic areas, including oral microbiota modulation, dental caries prevention, periodontal health, probiotic delivery systems, and evidence from review articles. The findings appear to indicate that fermented food-derived microorganisms may reduce cariogenic and periodontal pathogens, modulate oral biofilms, improve gingival health, and promote microbial homeostasis. Yogurt, kefir, fermented dairy products, and kimchi-derived microorganisms were the most frequently investigated sources. Emerging evidence further suggests that the benefits of these microorganisms are linked to ecological regulation of the oral microbiome and host–microbe interactions rather than direct antimicrobial activity alone. Microorganisms associated with fermented foods may therefore represent promising functional dietary components for supporting oral health and complementing preventive oral healthcare strategies. Further well-designed clinical studies are needed to establish strain-specific recommendations and explore the potential of postbiotic applications in dentistry. Full article