Bisfosfonaattien aiheuttama leukojen osteonekroosi eli BRONJ raportoitiin kirjallisuudessa ensimmäisen kerran vuonna 2003. Se on luun resorptiota estävien lääkkeiden, bisfosfonaattien ja denosumabin käyttöön liittyvä harvinainen haittavaikutus ja ilmenee elimistössä ainoastaan leukojen alueella. Tilan määritelmänä on, että potilaan suun limakalvojen alueella on ollut paljastuneen luun alue vähintään kahdeksan viikon ajan eikä potilas ole saanut leukojen alueen sädehoitoa. Usein BRONJ:a edeltää jokin dentoalveolaarinen kirurginen toimenpide, kuten hampaan poisto. BRONJ:n riski on suurempi suonensisäisesti annosteltavilla bisfosfonaateilla kuin suun kautta annosteltavilla valmisteilla. Tutkimuksen tarkoituksena oli kerätä tietoa Oulun yliopistollisen sairaalan (OYS) Hammas- ja suusairauksien poliklinikalla vuosina 2003–2014 diagnosoiduista ja hoidetuista bisfosfonaattien aiheuttamasta leukojen osteonekroosista kärsivistä potilaista. Tavoitteena oli tutkia potilaiden hoitolinjoja, käyntimääriä ja tautitilan syntyyn mahdollisesti vaikuttaneita riskitekijöitä. Tiedot kerättiin OYS:n potilastietoarkistosta. Aineiston potilaat olivat 1.1.2003–31.12.2014 aikavälillä kaikki diagnoosikoodilla M87.1 Lääkeaineen aiheuttama luukuolio Hammas- ja suusairauksien klinikalla hoidetut potilaat. Aineistosta suljettiin pois tuolla diagnoosikoodilla hoidetut, negatiivisiksi epäilyiksi osoittautuneet potilaat. Yhteensä potilaita oli 43, joista naisia 18 ja miehiä 25. Suurin osa sairastuneista oli saanut lääkityksen suonensisäisesti. Potilaista vain 35 %:lla osteonekroosin puhkeamista edelsi dento-alveolaarikirurginen toimenpide. Lähes kaikilla potilailla oli ainakin yksi osteonekroosin riskiä lisäävä systeeminen riskitekijä, kuten diabetes tai saatu sytostaattilääkitys. Useimmat potilaat saivat hoidon aikana antibioottilääkitystä ja lähes kaikki potilaat määrättiin purskuttelemaan antimikrobisella suuhuuhteella, kuten klooriheksidiinillä. Potilaita hoidettiin sekä kirurgisesti että konservatiivisesti. Kirurgisesti hoidetuilla oli enemmän käyntejä hammas- ja suusairauksien poliklinikalla kuin konservatiivisesti hoidetuilla potilailla. Potilaista parantui seuranta-aikana varmuudella 33 %. Kaikkien parantuneiden potilaiden luustolääkitys tauotettiin hoidon ajaksi. Osa potilaista menehtyi seurannan aikana, osan hoito jatkui muualla ja osan seuranta ja hoito jatkuu Hammas- ja suusairauksien klinikalla edelleen.

Solunulkoiset vesikkelit (EV:t) ovat pieniä lipidikalvon ympäröimiä rakkuloita, joita solut erittävät ulkopuolelleen. EV:t sisältävät solusta lähtöisin olevia molekyylejä, kuten proteiineja, nukleiinihappoja ja lipidejä. EV:t toimivat solujen välisessä viestinnässä, ja ne jaetaan kokonsa ja syntymekanisminsa mukaan eksosomeihin, mikrovesikkeleihin ja apoptoottisiin kappaleisiin. Syöpäsolujen on todettu edistävän syövän kehittymistä EV:eitä erittämällä. Vesikkeleiden avulla aggressiiviset syöpäsolut kykenevät muun muassa siirtämään patogeenisiä ominaisuuksiaan muille vähemmän aggressiivisille syöpäsoluille. Onkogeenisten molekyylien siirron avulla vastaanottajasyöpäsolujen invaasio-, migraatio- ja metastasoimiskyky voivat parantua tai solut voivat saada lääkeresistenssin. EV:ien avulla syöpäsolut muokkaavat myös syövän mikroympäristöä syövän kehittymistä suosivaksi. Syöpäsolut kykenevät EV-välitteisesti muuntamaan elimistön normaaleja fibroblasteja nk. CAF-soluiksi, jotka tukevat syöpäkasvaimen kasvua edistämällä angiogeneesiä ja syöpäsolujen invaasio- ja metastasoimiskykyä. Syöpäsolut kyke-nevät EV:ien avulla muuntamaan myös elimistön mesenkymaalisia kantasoluja syöpää suosiviksi myofibroblasteiksi ja indusoimaan angiogeneesiä uudelleenohjelmoimalla elimistön endoteelisoluja. Invaasiotaan syöpäsolut edistävät erittämällä vesikkeleissä soluväliainetta hajottavia metalloproteinaaseja. Syöpäsoluista lähtöisin olevat EV:t kulkeutuvat verenkierron mukana ympäri elimistöä, missä ne voivat valmistella otollisia metastasointipaikkoja verenkiertoon levinneille syöpäsoluille. Elimistön terveet solut pyrkivät estämää syövän syntymistä erittämällä vesikkeleissä lähiympäristöönsä muuntuneiden solujen toimintaa inhiboivia mikroRNA-molekyylejä. Syöpäsolujen vesikkelien sisältämät antigeenit voivat myös aktivoida elimistön immunipuolustuksen soluja. Toisaalta taas syöpäsolut kykenevät EV:eitä erittämällä väistämään elimistön immuunijärjestelmää. Syöpäsoluista peräisin olevat EV:t voivat suoraan heikentää leukosyyttien toimintaan, tai ne voivat aktivoida elimistön immunosuppressiivia soluja. EV:ien hyödyntämistä syövän diagnosoimisessa ja uudenlaisten hoitokeinojen kehittelyssä on myös tutkittu viime vuosina. Esimerkiksi ihmisen syljestä voisi tulevaisudeessa olla mahdollista tutkia suusyövän biomarkkereita, jolloin tauti kyettäisiin diagnosoimaan jo varhaisessa vaiheessa ennen näkyvien muutosten ilmenemistä. Tämä parantaisi potilaiden hoitoennustetta ja helpottaisi riskiryhmien seurantaa.

Volatile sulfur compounds are the primary cause of bad breath. They are a byproduct of bacterial metabolism and can be difficult to eliminate because they generally originate on the dorsum of the tongue, an area often missed during oral hygiene practices. Chronic bad breath, or halitosis, can be a cause of extreme anxiety. Indeed, halitosis has been proven to affect people across the globe. However, doctors and dentists are generally unaware of the causes of this disease. While poor oral hygiene is the most obvious cause of halitosis, many sufferers in fact have scrupulous oral hygiene practices. Little is known about the development of the disease; researchers have instead focused on which mouth rinses are the most effective and which bacteria are the most likely culprits.

INTRODUCTION: Human saliva contains a variety of microorganisms and salivary proteins implicated in oral health and disease. The oral bacterium R. mucilaginosa harbors glutamine endoprotease activity degrading salivary proline-rich proteins (PRPs) rich in glutamine residues. PRPs share structural features with dietary gluten proteins, which trigger celiac disease (CD). Their structural similarities and shared destination of the gastrointestinal tract raise the potential for the involvement of PRPs in CD pathogenesis. The aims of this study were to: 1) Investigate to what extent R. mucilaginosa cell-associated enzymes degrade gluten and abolish their immunogenicity; 2) Compare gluten-degrading enzyme activities and microbiomes in whole saliva (WS) from healthy and CD subjects; 3) Study the potential immunogenicity of salivary PRPs. METHODS: Studies on gluten degradation by R. mucilaginosa comprised SDS-PAGE, RP-HPLC, LC-ESI-MS/MS, and ELISA. Clinical studies were conducted with healthy and CD patient groups. Salivary hydrolytic activities were assessed towards Z-YPQ-pNA and gliadin-derived immunogenic 33-mer/26-mer peptides. Oral microbiomes were analyzed by 16S rDNA sequencing. Induction of cytokines (TNF-alpha, IL-10, IFN-gamma, and IL-21) by PRPs was studied in peripheral blood mononuclear cells (PBMCs) collected from CD patients. RESULTS: R. mucilaginosa cell-associated enzymes degraded gliadins/33-mer/26-mer, decreased their recognition by TG2 and abolished epitopes recognized by R5 antibody. WS showed no differences between healthy and CD patients with regard to activities relevant in gluten degradation, and salivary microbiome compositions were similar. PRPs protein patterns revealed minor differences that were not group-specific. Despite structural similarities, PRPs did not stimulate cytokines production by PBMCs, nor did they compete with gliadin-induced cytokine secretion. CONCLUSION: From a therapeutic view point, R. mucilaginosa cells and/or their gluten-degrading enzymes may offer novel perspectives for CD treatment. From an oral physiological perspective, endogenous WS gluten-degrading activities were low and comparable between healthy and CD groups, suggesting such activities may not be sufficient for gluten digestion in vivo, and further supporting the dietary supplementation concept. PRPs do not seem to harbor gliadin-like elements relevant in CD pathogenesis. Deciphering the structural basis for the lack of immunogenicity of salivary PRPs is of interest to inform development of gluten proteins lacking immunogenic epitopes, and their design is discussed.

INTRODUCTION: Gingival tissue thickness plays an important role in that it affects the health of natural teeth and prosthetics, periodontal health, gingival recession, underlying bone quality, and periodontal therapy. Therefore, various methods of gingival thickness assessment have been introduced. However, current modes of assessment are controversial in reliability and safety for patients. OBJECTIVE: The goal of this study was to evaluate the accuracy of using trans-gingival probing as means of determining gingival thickness. MATERIALS AND METHODS: Twenty subjects were included in this pilot study. The gingival biotypes were characterized as either thick or thin. The gingival assessment was conducted by two highly experienced periodontists. The patients were evaluated first by trans-gingival probing. Then, gingiva was reflected to obtain tension-free caliper measurement. RESULTS: It was observed that that the trans-gingival probing methods on average overestimates the caliper measurements by 0.025 mm and had no statistical significantly difference from the tension-free caliper (p-value= 0.77). CONCLUSIONS: The data collected in this pilot study provides important evidence that the periodontal probe is an accurate means to measure gingival thickness.

Bioactive Inorganic Element (BIE) is a bioactive glass that has been developed and studied for bone regeneration, and dentinogenesis. OBJECTIVE: To test the physical and mechanical properties (setting time, pH level, solubility, and compressive strength) of two groups of BIE-containing materials: 20% BIE (20% BIE, 60% Portland cement, and 20% bismuth oxide) and 40% BIE (40% BIE, 40% Portland cement, and 20% bismuth oxide), and compare them with Dycal® and Experimental Mineral Trioxide Aggregate (EMTA) as the control groups, with and without calcium chloride at three different concentrations (5%, 10%, and 15%). METHODS: Ten samples in each group were tested for setting time, pH level, compressive strength, and solubility. Setting time was determined following the ISO specification 6876 using digital dial indicator. The pH level of the storage solutions of each specimen in deionized water was measured after 2 hours, and 1, 7, 21, and 28 days. The compressive strength was measured following the ISO specification 9917, and solubility was measured as a weight loss after storage in deionized water. The compressive strength and solubility were measured at 1, 7, 21, and 28 days. Data were statistically analyzed with two-way ANOVA and Tukey’s tests. RESULTS: Dycal® showed the least setting time material, which was comparable to the 40% BIE + 10%, and 15% CaCl2 (p > 0.05). EMTA showed the longest setting time (p < 0.0001). For the pH level, at 2 hours the lowest level was for the 40% BIE + 15% CaCl2 group, and the highest was for EMTA group. During all time intervals, the lowest compressive strength was for the Dycal®, and the highest was for the 40% BIE (p < 0.0001). During all time intervals, the Dycal® was the most soluble material (p <0.0001), and the solubility levels of EMTA, 20% BIE, and 40 % BIE were comparable (p > 0.05). The pH level, compressive strength, and solubility of all tested material increased with time and decreased with CaCl2 addition. CONCLUSION: The 40% BIE with 10% CaCl2 showed promising physical and mechanical properties that could compete the Dycal® and EMTA when used in pulp capping.

OBJECTIVE: To assess the fluoride release and mechanical properties of four restorative glass ionomer cements (GIC) and to determine the correlation between the mechanical properties and fluoride release. MATERIALS AND METHODS: Four restorative glass ionomers were studied: ChemFil ROCK (DENSPLY), Fuji IX (GC), Riva self cure (SDI), and Ketac Nano (3M ESPE). Fluoride release in deionized water from the tested specimens was measured using a fluoride-selective ion electrode for 9 days. The compressive strengths and diametral tensile strengths after storing in distilled water (room temperature, 24) were tested. Glass ionomer surface wear by dental ceramic (Vita Mark II cylinders) was evaluated by a depth micro analyzer. Data were analyzed using ANOVA followed by Tukey’s test or Bonferroni method (p= 0.05). RESULTS: The fluoride release exhibited high concentration, following by a significant drop on the second day. Fuji IX had the highest fluoride release followed by “Ketac”,” Riva”, and “ChemFil”. Compressive strength results ranked that ChemFil as the highest value, followed by Fuji IX, Ketac, and Riva. The diametral tensile strength test ranked ChemFil and Ketac as the highest values. Surface ear against dental ceramic (Vita Mark II cylinders) revealed that Fuji IX had the lowest material loss, followed by Ketac, ChemFil, and Riva. Data showed significant differences between all of them. After coating the glass ionomer, the surface wear loss was reduced significantly in Riva and ChemFil. CONCLUSIONS: The tested restorative glass ionomers showed differences in fluoride release and the differences decreased over time, with Fuji IX releasing the highest amount of fluoride ion. ChemFil Rock showed the highest mechanical properties but the lowest fluoride release. Riva self cure had the highest material loss value in wear test. There was a weak inverse correlation between fluoride release and compressive strength (r = - 0.32); fluoride release and diametral tensile strength (r = - 0.60), and fluoride release and surface wear against dental ceramic (Vita Mark II cylinders) (r = - 0.55).

AIM: To evaluate the changes in arterial blood pressure during periodontal procedures under local anesthesia in hypertensive and non-hypertensive patients and to compare effects related to gender, age, and different types of blood pressure medications on systolic and diastolic blood pressure. MATERIALS AND METHODS: Fifty-nine patients enrolled and consented to participate in this study. Twenty-eight were diagnosed with hypertension and thirty one were non- hypertensive. Their blood (BP) was measured once during the consultation visit. During the scaling and root planning (SRP) visit BP was measured at three time points: before local anesthesia (LA) injection, immediately after LA and at the end of the procedure. During the surgical visit BP was determined at the same three time points as the SRP visit. RESULTS: There were no statistically significant differences in systolic and diastolic blood pressure between hypertensive and normotensive patients, males versus females, age groups and different types of blood pressure medications during SRP and surgical visits under local anesthesia. CONCLUSION: Although age, gender, blood pressure medications and hypertensive status have no significant influence on the arterial blood pressure in both hypertensive and normotensive patients during SRP and periodontal surgical visits, it is important to measure pre-operative BP to avoid or minimize the chances of life-threatening complications during dental treatment.

OBJECTIVE: The overall objective of this study was to evaluate the relationship between different diseases of the prostate gland (Benign Prostate Hyperplasia (BPH), Prostatitis, and Prostate Cancer) as well as levels of Prostate specific Antigen (PSA) with periodontal disease. METHODS: A subset of data from the VA Dental Longitudinal Study was used for this study. The total sample size was 352 subjects with at least one PSA reading. Diagnoses of diseases of the prostate gland (BPH, Prostatitis, and Prostate Cancer) and PSA were used as the main outcome variables. Measurements of periodontal disease [average clinical attachment loss (CAL), average probing pocket depth (APD), and number of teeth with severe bone loss (NTBL)] were used as the main predictors. Statistical analysis included descriptive, bivariate, and multivariate testing. For the final multivariate analysis, Generalize Estimating Equations (GEE) controlling for potential confounders was used. RESULTS: The study subjects were predominantly Caucasian males. At baseline the mean age was 71 years, and the mean PSA level was 2.5 ng/ml. The proportion of subjects with prostate diseases at baseline was 79.6% for BPH, 7.4% for prostatitis, and 8.8% for prostate cancer. Using GEE models and after controlling for potential confounders we found an association between CAL and BPH, as for every millimeter increase in CAL the odds of having BPH increased by 41%. We have also found that those with BPH and CAL above 2.7mm have higher PSA levels than those with either condition alone. We have not found any relationship between BPH and APD or NTBL. We have also not found any relationship between PSA, Prostatitis, and prostate cancer with any of the measurements of periodontal disease used in this study. CONCLUSION: This study showed an association between an increase in CAL and BPH. As well as showing that those with BPH and CAL above 2.7mm have higher PSA levels than those with either condition alone. These findings support that periodontal disease could affect the health of the prostate gland in an aging population, as well as the importance of oral health as an important and integral part of general health and well-being.

OBJECTIVE: To determine the range of positions and relationships between the maxillary and mandibular canines and the related skeleton, and to evaluate using CBCT imaging whether dental and skeletal transverse discrepancies identified in the molar area also exist in the canine area. METHODS: CBCT scans of 148 patients, with and without crossbite were analyzed to assess the width of the jaws and the inclination of the canines relative to the occlusal plane. The dental and skeletal measurements were compared between the non-crossbite and the crossbite groups. RESULTS: At the canine area, we found no statistically significant differences between the non-crossbite group and the crossbite group in canine transverse angulations and maxillary and mandibular width. There is a weak statistically significant correlation between canine lingual width and both maxillary and mandibular canine axial angles that is not observed between canine palatal width and both maxillary and mandibular canine axial angles. We found a weak statistically significant correlation between maxillary canine and molar angulations as well as palatal and lingual width, but not between mandibular canine and molar angulations. CONCLUSION: We have developed a reliable method to measure transverse tooth angulation and skeletal width using CBCT at the canine level. Changes in transverse angulation and compensation observed in the molar area do not carry on at the canine area. Expansion of crossbite cases are most likely needed at the molar area, as our findings suggest that crossbites are more confined to the molar area and less expressed at the canine level.