Introduction: An absolute majority of dental infections are treated without major complications. In exceptional situations dental infections can spread to surrounding structures such as the airways or even the brain leading to a life-threatening condition that requires hospitalization. According to literature, some qualified risk factors appear to be common in hospitalized patients. Aim: To outline factors typically seen in patients with acute maxillofacial infections with dental origin at Norrland University Hospital (NUS) and find possible association between these factors and the length of hospital stay.  Methods: A literature review using keywords associated with dental infections and acute throat and head infections was performed. Retrospective structured medical journal reviews of 58 patients suffering from acute maxillofacial infections which required hospitalization at NUS were analyzed. The results were analyzed using IBM SPSS Statistics software and Microsoft Office Excel. Results: The results indicated that overweight/obese people (Body Mass Index ⊵25) require longer care at the hospital due to their infection. Every other of the hospitalized patients had received dental treatment within 14 days prior to hospitalization.  Conclusions: In situations with acute maxillofacial infections of dental origin requiring hospitalization, BMI ⊵25 is eventually a risk factor. A group of patients received dental treatment for their infection, but the infection still exacerbated. How come? This requires deeper analysis with further studies.

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La morbi-mortalité élevée des carcinomes épidermoïdes de la cavité orale (CECO), qui peuvent se développer à partir de lésions orales à potentiel malin (LOPM), rend indispensable le développement de nouvelles stratégies thérapeutiques. Le décryptage de l’hétérogénéité moléculaire aux différentes étapes de la carcinogénèse orale pourrait permettre de personnaliser les stratégies thérapeutiques de prévention et de traitement de ces cancers. Notre objectif était de caractériser l’hétérogénéité transcriptomique des LOPM et des CECO.Nous avons d’abord défini des signatures transcriptomiques associées aux changements histologiques de la carcinogénèse orale observés dans le modèle murin induit par le 4-NQO, montrant la pertinence de l’analyse de la dynamique temporelle du transcriptome pour améliorer la prévention des CECO. Cependant, ce modèle ne représentant qu’un sous-groupe particulier des CECO, nous avons ensuite étudié l’hétérogénéité inter-lésionnelle des LOPM en identifiant deux sous-types transcriptomiques principaux nommés « classical » et « immunological », qui sont caractérisés par différents biomarqueurs de risque de CECO.Au stade invasif, nous avons également étudié l’hétérogénéité transcriptomique des CECO HPV-négatifs entre les patients non-fumeurs non-buveurs (NFNB) et les patients fumeurs buveurs (FB). Le microenvironnement immunitaire était la principale différence biologique entre NFNB et FB, suggérant un bénéfice accru des immunothérapies chez les NFNB. Le profil transcriptomique de réponse antivirale observé dans les CECO des NFNB pourrait être en faveur de leur origine virale. En conclusion, l’hétérogénéité transcriptomique des LOPM et CECO suggère de personnaliser les stratégies thérapeutiques des patients porteurs de ces lésions / Oral squamous cell carcinomas (OSCC), which may develop from oral premalignant lesions (OPL), are associated with a substantial morbidity and mortality. A better understanding of the molecular heterogeneity at different steps of oral carcinogenesis may help to refine prevention and treatment strategies of patients suffering from OPL and OSCC. Our goal was to decipher transcriptomic hetereogeneity of OPL as well as OSCC. Using the 4-NQO murine model of oral carcinogenesis, we first identified transcriptomic signatures that characterized the dynamics of gene expression changes through different stages of disease progression, and that could be relevant for refining prevention strategies. Because this model represents only a subgroup of patients suffering from OSCC, we then investigated inter-OPL molecular heterogeneity. We identified two distinct gene expression subtypes, which were named classical and immunological and were characterized by different biomarkers of cancer risk. At invasive steps, we investigated transcriptomic heterogeneity between HPV-negative OSCC from never-smoker never-drinker (NSND) and smoker drinker (SD) patients. The immune microenvironment was the main biological difference between OSCC from NSND and SD, suggesting higher clinical benefit of immunotherapies in OSCC from NSND. The antiviral gene expression profile of OSCC from NSND could suggest a viral origin.In conclusion, we investigated transcriptomic heterogeneity of OPL as well as OSCC, that could help to refine their prevention and treatment strategies

Le cancer de la cavité orale représente un problème important de santé publique en France où les taux d’incidence sont parmi les plus élevés au monde. Bien qu’une détection précoce soit possible, ces tumeurs sont souvent diagnostiquées à un stade avancé et sont ainsi responsables de plus de 1500 décès par an. L’objectif général est de clarifier le rôle et l’impact des différents facteurs de risque dans la survenue des cancers de la cavité orale en France, notamment d’examiner de façon détaillée le rôle du tabac et de l’alcool par localisation anatomique précise, et d’étudier les associations avec d’autres facteurs de risque potentiels (indice de masse corporelle, antécédents médicaux, antécédents familiaux de cancer, consommations de café et de thé). Ce travail s’appuie sur les données d’une large étude cas-témoins en population générale, l’étude ICARE. Il porte sur un sous-ensemble de ces sujets (772 cas de cancer de la cavité orale et 3555 témoins). Les résultats montrent que le tabac augmente le risque de cancer de la cavité orale même pour des quantités et/ou durées faibles, alors que l’augmentation de risque liée à l’alcool n’est observée que pour de fortes consommations. L’effet conjoint du tabac et de l’alcool est plus que multiplicatif. Les associations avec les consommations d’alcool et de tabac varient selon la sous localisation : les associations les plus fortes sont observées pour le plancher buccal, les plus faibles pour les gencives. L’étude des autres facteurs de risque a mis en évidence : une association inverse entre risque de cancer de la cavité orale et indice de masse corporelle, avec un risque plus faible chez les personnes en surpoids ou obèses ; un risque augmenté lorsqu’un parent du 1er degré a été atteint d’un cancer des voies aéro-digestives supérieures ; un risque élevé chez les personnes présentant des antécédents de candidose buccale ; un risque diminué chez les consommateurs de thé ou de café. A partir de ces premiers résultats, il est envisagé de construire un score prédictif de cancer de la cavité orale permettant d’identifier les sujets à risque élevé sur lesquels cibler préférentiellement les actions de dépistage. / Cancer of the oral cavity is a major public health problem in France. Incidence rates are among the highest in the world. Although early detection is possible and effective, these tumors are often diagnosed at an advanced stage and are thus responsible for over 1,500 deaths per year. The objective of this work was to clarify the role and impact of several risk factors in the development of cancers of the oral cavity in France, particularly to examine the role of tobacco smoking and alcohol drinking by subsite, and to explore associations with other potential risk factors (body mass index, medical history, family history of cancer, tea and coffee consumption). We analyzed detailed data from 772 cases of cancer of the oral cavity and 3555 controls included in a large population-based case-control study, the ICARE study. Tobacco smoking increased the risk of oral cavity cancer even for low quantities and/or durations, while alcohol drinking increased this risk only in heavy drinkers. The combined effect of tobacco and alcohol was greater than multiplicative. Associations with alcohol and tobacco consumption varied depending on subsite: the strongest associations were observed for the floor of the mouth, the lowest for the gums. The analysis of other risk factors showed: an inverse association between oral cancer risk and body mass index with a lowered risk among overweight or obese; an increased risk associated with an history of head and neck cancer in 1st degree relatives; an elevated risk in people with a history of oral candidiasis and a decreased risk among consumers of tea or coffee. From these first results, it is planned to develop an oral cancer risk score to identify high-risk individuals for screening.

A dor como sintoma inicial do câncer de boca pode ser o primeiro e único indicador da neoplasia. Até o presente momento suas características, à fase do diagnóstico, ainda não são bem definidas, e nem sempre a dor é considerada como critério importante de diagnóstico para o câncer. OBJETIVO. Avaliar a prevalência e as características gerais de dor orofacial, bem como de outros sinais e sintomas, que levaram os pacientes a procurar atendimento à saúde e ao diagnóstico de câncer de cavidade oral ou orofaringe, comparativamente a um grupo controle composto por pacientes sem câncer. MATERIAL E MÉTODO. Dois grupos: a) Grupo Pacientes (GP), formado por 74 pacientes consecutivos do Ambulatório de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, que foi dividido em dois subgrupos: cavidade oral (Ca boca - CaB) e orofaringe (Ca orofaringe - CaO) e b) Grupo Controles (CG), formado por 74 pacientes encaminhados para tratamento odontológico convencional no ambulatório da Divisão de Odontologia do HCFMUSP. Foram utilizados os seguintes instrumentos de avaliação: Ficha clínica da Equipe de Dor Orofacial da Divisão de Odontologia do HCFMUSP (EDOF-HC); Escala Visual Analógica (EVA), Escala Numérica de Dor (END), Escala Verbal de Dor (EVD), Questionário de dor McGill; Ficha de Dor Neuropática do Centro de Dor do HCFMUSP; Índice de disfunção de Helkimo; Índice CPOD; Questionário de Qualidade de Vida (UW-QOL) e o Índice de Desempenho de Karnofsky (IDK). RESULTADOS. Os dois grupos foram pareados em relação ao gênero (4:1 homens); idade (58,46 anos no GP e 58,61 GC), raça (2:1 leucoderma) e ocupação. As diferenças estatísticas predominantes no GP foram as seguintes: tabagista/ex-tabagista e etilista/ex-etilista (p < 0,001); motivos de procura por assistência: dor (p < 0,001), úlcera e aumento de volume (p < 0,001); queixa principal: dor (p < 0,001), aumento de volume (p < 0,001) e úlcera (p=0,016); localização da queixa principal: língua e garganta (p < 0,001), ouvido (p=0,033) e palato (p=0,028); prevalência de dor no momento do estudo (p<0,001); problema mais importante nos últimos sete dias (p < 0,001); motivo de procura por assistência médica (p < 0,001); dor constante muitas vezes explosiva em algum momento (p < 0,001); dor espontânea ou provocada (p < 0,001); fatores desencadeantes da dor: mastigação ou deglutição (p=0,001); dor acorda o paciente (p<0,001); dor moderada a forte (EVA=6; p<0,001), (END=7,5; p < 0,001); duração variável (p<0,001); indiferente quanto ao período do dia (p=0,001); múltiplos descritores, destacando-se: pontada, queimação, latejante (p < 0,001) e tipo \"dor de dente\" (p=0,006) e otalgia reflexa uni ou bilateral (p < 0,001). Os seguintes índices também foram piores no GP: índice de disfunção clínica de Helkimo (p < 0,001); índice CPOD (p=0,004); biofilme dental (p=0,002); questionário de dor McGill (p < 0,001); ficha de dor neuropática (p < 0,001); índice de qualidade de vida (p < 0,001) e IDK (p < 0,001). No GP, 25% estavam nos estádios 0, I ou II, e 75% nos III ou IV; o número de profissionais procurados variou de 1 a 9; cirurgião dentista e cirurgião de cabeça e pescoço fizeram os diagnósticos em ambos os subgrupos e o otorrinolaringologista no CaO; pacientes com CaO procuraram mais por médicos. Houve diferença estatística entre os subgrupos CaB e CaO nos seguintes tópicos; dor tipo \"dor de dente\" (p=0,044) e queimação (p=0,016) no CaB; peso (p=0,018), deglutição como desencadeante de dor (p=0,009), garganta como local de queixa principal (p < 0,001) e otalgia bilateral (p=0,004) no CaO. CONCLUSÃO. Os dados deste estudo mostram que a dor foi sintoma presente em toda a fase de diagnóstico dos cânceres de cavidade oral e orofaringe, inclusive nos estágios iniciais. Destacaram-se as seguintes características: gênero masculino, acima de 50 anos de idade, dor difusa (localização variada), intensidade moderada a forte, indiferente ao período do dia, podendo acordar o paciente, predominantemente em pontada, queimação, latejante ou tipo \"dor de dente\", desencadeada por mastigação ou deglutição, otalgia reflexa uni ou bilateral, limitação ou incapacitação da função mandibular, pacientes com a condição clínica claramente comprometida tanto em qualidade de vida como em funcionalidade. Esses dados podem auxiliar no diagnóstico diferencial dos cânceres de boca e orofaringe, principalmente quando há dor persistente e refratária aos tratamentos / Pain as an early symptom of oral cancer may be the first and only indicator of neoplasia. To date, its characteristics at the diagnostic stage are not still well defined, and pain is not always considered as an important diagnostic criterion for cancer. Objective. To evaluate the prevalence and general characteristics of orofacial pain, as well as other signs and symptoms, which led the patients to seek health care and the diagnosis of cancer of the mouth or oropharynx, compared to a control group composed of patients without cancer. Patients and Method: Two groups: a) Patient Group (PG), consisting of 74 consecutive patients from the Head and Neck Surgery Outpatient Clinic of the Hospital das Clínicas of the Medical School of the University of São Paulo, which was divided into two subgroups:oral cancer(CaB) and oropharynx cancer (CaO) and b) Control Group (CG), formed by 74 patients referred for conventional dental treatment in the outpatient clinic of the Dentistry Division of HCFMUSP. The following evaluation instruments were used: Clinical record form of the Orofacial Pain Team of the Dentistry Division of HCFMUSP (EDOF-HC); Visual Analogue Scale (VAS), Numerical Pain Scale (NPS), Verbal Pain Scale (VPS), McGill Pain Questionnaire; Neuropathic Pain chart of the HCFMUSP Pain Center; Helkimo dysfunction index; DFMT,Index; Quality of Life Questionnaire (UW-QOL) and the Karnofsky performance status (KPS).Results. The two groups were compared for gender (4:1 men); age (58.46 years in PG and 58.61 CG), race (2: 1 white) and occupation. The predominant statistical differences in PG were: smoker / ex-smoker and alcoholic/ex- alcoholic (p < 0.001); reasons for seeking care: pain (p < 0.001), ulcer and swelling (p < 0.001); main complaint: pain: (p < 0.001) swelling (p < 0.001) and ulcer (p=0.016). Location of the main complaint: Tongue and throat (p < 0.001), ear (p=0.033) and palate (p = 0.028); prevalence of pain at study time (p < 0.001); the most important issues in the past seven days (p < 0.001);reason for seeking medical care (p < 0.001); constant pain with attacks of explosions (p < 0.001); spontaneous or induced pain (p < 0.001); pain-triggering factors: chewing or swallowing (p=0.001); pain wakes up the patient (p < 0.001); moderate to severe pain (VAS=6, p < 0.001), (NPS=7.5, p < 0.001); variable duration (p < 0.001); regardless of the period of the day (p=0.001); multiple descriptors, such as: jumping, burning and throbbing (p < 0.001) and toothache type (p=0.006) and unilateral or bilateral reflex otalgia (p < 0.001). The following indexes were also worse in PG: Helkimo clinical dysfunction index (p < 0.001); DMFT index (p=0.004); dental biofilm (p = 0.002); McGill pain questionnaire (p < 0.001); neuropathic pain scale (p < 0.001); index of quality of life (p < 0.001) and KPS (p < 0.001). In PG, 25% were in stages 0, I or II, and 75% in stages III or IV; the number of professionals sought ranged from 1 to 9; dentist and head and neck surgeon made the diagnoses in both subgroups and the otolaryngologist in CaO; patients with CaO sought more physicians. There was a statistical difference between CaB and CaO subgroups in the following topics: toothache-like pain (p=0.044), CaB burning (p=0.016) in the CaB; heavy (p=0.018), swallowing as pain trigger (p=0.009), throat as the primary complaint site (p < 0,001) and bilateral otalgia in CaO (p=0.004). Conclusion. The data from this study show that pain was a symptom present throughout the diagnostic phase of oral cancer. The following characteristics were noted in the sample with oral cancer: male gender, over 50 years of age, diffuse pain (varied location), moderate to strong intensity, indifferent to the time of day, being able to awaken the patient, burning, throbbing, stabbing or toothache-like pain, triggered by chewing or swallowing, unilateral or bilateral reflex otalgia, limitation or incapacitation of mandibular function, patients with a clinical condition clearly compromised both in quality of life and in functionality. These data may aid in the differential diagnosis of oral cancer, especially when there is persistent and refractory orofacial pain

The Dissertation work presented herein monitors the significance of oral hygiene in adults, while aiming at preventive measures leading to lowering mouth cavity illness occurrences. Within the theoretical part, I focus on the delineation of important terms relating to preventive care for oral cavity, information concerning anatomy, physiology of oral cavity, influence of foods and other problems within the oral cavity, among which there are tooth cavities and diseases of gingiva. In the practical part of the work I aim on the assessment of the level of oral health, trough the help of applied clinical research methodologies and investigative tooth indices such as API, PBI, and CPITN. Furthermore, educational materials are passed on, for the purpose of dissemination of needed information in the area of dental hygiene, teaching correct teeth brushing techniques, and utilization of other between-the-tooth tools. The following graphic presentation reveals the level of dental health. As well, within my work, I have verified that, within a larger proportion of patients an improved oral hygiene ensued; thanks to educational program together with an improved home oral hygiene care. Familiarity, care of oral cavity and dental hygiene are the most important prerequisites for each individual, when attempting to improve dental health.

Osteoporosis is a systemic bone disease with an increasing prevalence in the elderly population. There is conflicting opinion about whether osteoporosis affects the alveolar bone of the jaws and whether it poses a risk to the osseointegration of dental implants. The aim of the present study was to evaluate the effects of systemic glucocorticoid administration on the jaw bone density of minipigs. Thirty-seven adult female minipigs were randomly divided into two groups. Quantitative computed tomography (QCT) was used to assess bone mineral density BMD of the lumbar spine as well as the mandible and maxilla, and blood was drawn. One group of minipigs initially received 1.0 mg prednisolone per kg body weight daily for 2 months. The dose was tapered to 0.5 mg per kg body weight per day thereafter. The animals in the other group served as controls and received placebo. QCT and blood analysis were repeated after 6 and 9 months. BMD was compared between the two groups by measuring Hounsfield units, and serum levels of several bone metabolic markers were also assessed. A decrease in BMD was observed in the jaws from baseline to 9 months. This was more pronounced in the prednisolone group. Statistically significant differences were reached for the mandible (p < 0.001) and the maxilla (p < 0.001). The administration of glucocorticoids reduced the BMD in the jaws of minipigs. The described model shows promise in the evaluation of osseointegration of dental implants in bone that is compromised by osteoporosis.