Oral health remains a critical yet overlooked aspect of pediatric health, despite strong evidence linking untreated dental disease with systemic complications, impaired growth, and reduced quality of life. Globally, early childhood caries and related oral conditions affect 60%-90% of children, disproportionately impacting disadvantaged groups. However, pediatric oral health is often siloed from mainstream child health services. Pediatricians, frequently the first point of contact for families, have limited oral health training, while pediatric dentists often see children only when conditions have advanced, reducing opportunities for prevention and early care. Structural barriers-including fragmented professional education, poor referral systems, inadequate insurance, and inconsistent access to preventive services-further limit progress. Families face significant out-of-pocket costs, particularly in low- and middle-income countries, where preventive oral care is excluded from many pediatric health packages. Caregiver health literacy and cultural beliefs also contribute to delayed care-seeking. A policy-level response is essential to bridge these gaps. Key strategies include integrating oral health into routine pediatric visits, advancing interprofessional education, expanding insurance coverage for preventive services, and adopting innovative care models such as telehealth and task-shifting. Embedding pediatric oral health into universal health coverage and child health policies will promote equity and sustainability. Urgent systemic reforms are needed to position pediatric oral health as a core component of child well-being, requiring coordinated action among pediatricians, pediatric dentists, and public health policymakers.
Dental and periodontal indicators provide key biocultural information for reconstructing diet, health, and cultural practices in ancient populations. This study compares oral health profiles from two pre-Hispanic Costa Rican sites located in distinct ecological settings: Palo Blanco (600-1,200 AD, Tempisque lowlands) and Rodríguez (800-1,550 AD, Central Highlands). Macroscopic dental data were recorded for 11 individuals (seven from Palo Blanco site and four from Rodríguez site). Variables assessed included dental caries, calculus, antemortem tooth loss (AMTL), periodontal state (CEJ-AC), dental wear, periapical lesions, malocclusions, and intentional dental modifications. Statistical analyses included Fisher's exact tests for categorical comparisons, Wilcoxon rank-sum tests for periodontal measurements, Wilson 95% confidence intervals, and Bonferroni corrections for multiple testing. To evaluate whether AMTL followed a directional pattern across ecological settings, we applied a Cochran-Armitage Trend Test for ordered proportions, using highland, intermontane, and lowland contexts as ordinal categories. We also analyzed 136 isolated teeth from the studied populations. Although overall caries prevalence did not differ between Palo Blanco and Rodríguez, the anatomical patterning of lesions revealed clear contrasts: buccolingual and root caries were concentrated in the lowland Palo Blanco population, whereas occlusal caries was more frequent in the highland Rodríguez sample. Heavier supragingival and subgingival calculus deposits were detected in Palo Blanco across all scoring systems. AMTL displayed the most pronounced disparity, occurring in 85.7% of Palo Blanco adults but in none from Rodríguez (p = 0.015). Periodontal disease followed the same trend, with significantly greater CEJ-AC distances at Palo Blanco. When viewed alongside the intermediate frequencies reported, the two populations form a coherent ecological gradient, from the comparatively healthy dentitions of the cool highlands to the more inflamed oral environments of the tropical dry lowlands. Variation in periodontal disease, AMTL, and caries across the two sites reflect differing ecological conditions, food-processing practices, and dietary regimes. These results underscore the interpretive value of dental indicators for understanding biocultural adaptation in pre-Hispanic Costa Rica and provide a comparative baseline for future interdisciplinary studies incorporating isotopic, microwear, and biomolecular evidence.
Oral health inequities among immigrants in Canada and the United States remain a major challenge due to systemic, cultural, and socioeconomic barriers that limit access to dental services. Despite existing community and policy initiatives, there is no comprehensive synthesis of evidence addressing barriers, facilitators, and interventions aimed at promoting oral health equity for these populations. The purpose of this scoping review is to identify and map barriers, facilitators, and interventions related to promoting oral health equity among immigrants, refugees, asylum seekers, and non-permanent residents in Canada and the United States. The review will include studies involving immigrants, refugees, asylum seekers, and non-permanent residents living in Canada or the United States that examine barriers, facilitators, or interventions related to oral health equity. Peer-reviewed studies and relevant grey literature published in English will be considered without date restrictions. Studies focusing exclusively on non-migrant populations or not addressing oral health will be excluded. This protocol follows the Joanna Briggs Institute (JBI) methodology for scoping reviews and the PRISMA-ScR reporting guidelines and is registered on the Open Science Framework (OSF) https://doi.org/10.17605/OSF.IO/PDNEM Searches will be conducted in MEDLINE (PubMed), Scopus, Web of Science, EBSCO databases, Embase, and relevant grey literature sources. Two reviewers will independently screen studies and extract data. Quantitative data will be summarized descriptively, and qualitative findings will undergo thematic synthesis. Results will be presented in tables and narrative summaries. Ethical approval is not required as the review uses published literature. Findings will be disseminated through peer-reviewed publications and conference presentations to inform policy and future research.
This study explored oral hygiene behavior (OHB), physical and psychological oral discomfort (OD), and their relationship with sense of defeat (SoD) among Indonesian transgender individuals (warias), for whom oral health plays a vital role in social and sexual interactions. Given the orofacial area's impact on attractiveness and intimacy, poor oral health may significantly affect the wellbeing and perceived desirability of warias. A cross-sectional study was conducted in March-April 2019 among 92 warias, with a mean age of 36 years (standard deviation = 10.5) in Jakarta, recruited via cluster sampling from five districts. Data were collected using a digital, semistructured questionnaire, including an OHB index and the Indonesian version of the Oral Discomfort Scale, which measures both psychological and physical discomfort. Sense of defeat was also assessed. The study was classified as a one-time, non-invasive procedure and was exempt from medical research regulations. Correlation analyses showed that smoking was significantly positively associated with SoD (r = 0.25, p = 0.019), but not with OD or OHB. Perceived oral health was significantly positively associated with experienced emotional aspect (r = 0.31, p = 0.003) and with consumption of sugar-containing snacks and/or soft drinks (r = 0.24, p = 0.02), but it was significantly negatively associated with SoD (r = -0.24, p = 0.02), OD (r = -0.26, p = 0.01), and ODPhy (r = -0.27, p = 0.01). Linear regression analysis identified both SoD (β = 0.23, p = 0.023) and experienced emotional aspect (β = -0.30, p = 0.004) as significant independent predictors of OD, explaining 18% of the variance [R 2 = 0.18, F(3,91) = 7.58, p = 0.001]. The variable expectations of optimal OHB did not have a significant effect (β = -0.11, ns). Psychological distress-particularly feelings of defeat-plays a significant role in the oral health of Indonesian warias. Healthcare and social service providers consider this connection and both emotional wellbeing and oral self-care in interventions.
Although efforts to improve household water security have significantly advanced progress toward Sustainable Development Goal (SDG) 6, environmental hazards, such as geogenic fluoride contamination, continue to threaten the lives of billions of people who rely on unimproved water sources. While awareness of the harmful effects of high fluoride levels in drinking water exists, research on knowledge, attitudes, and behaviors related to fluoride and fluorosis remains limited, particularly among households in areas with naturally elevated fluoride levels. We therefore examined knowledge, attitudes, and behaviors related to fluoride in drinking water among families living in Nakuru County, Kenya, where geogenic fluoride occurs naturally. We conducted semi-structured surveys with 52 individuals living in Nakuru County, Kenya, where water samples exceeded the WHO acceptable levels for drinking water. Most participants (81%) demonstrated a good understanding of fluoride and fluorosis, including their presence in water and their effects on health, such as dental and skeletal fluorosis. However, despite this knowledge, some participants (67%) exhibited negative attitudes, showing little to no concern. While some participants (35%) reported correct practices, such as using alternative sources, a majority (65%) engaged in incorrect practices, such as boiling and chemically treating their water, or persistently brushing their teeth to remove dental fluorosis. Environmental hazards, such as fluoride, continue to challenge water security and pose heightened health risks, including oral health risks. In resource-limited settings, implementing interventions to shift attitudes and behaviors will be necessary to effectively translate existing knowledge.
Digital impression techniques have gained popularity in dentistry due to their potential advantages in accuracy, efficiency, and patient comfort. This systematic review aims to evaluate and compare the accuracy, chairside time, and patient perception of conventional vs. digital impressions. A systematic search was conducted in Medline/PubMed, EBSCO, Web of Science, and Scopus databases. Inclusion criteria comprised clinical or in vivo studies comparing conventional and digital impression techniques in terms of accuracy, working time, and/or patient comfort. Reviews, meta-analyses, editorials, and studies involving fully edentulous patients or edentulous spans exceeding two teeth were excluded. Study quality was assessed using the QUADAS-2 tool, and intra-operator agreement was evaluated using the Cohen's Kappa statistic. From 269 initially identified articles, 10 met the inclusion criteria. All studies assessed accuracy; only two evaluated working time and patient comfort. The included studies, published between 2016 and 2024, were cross-sectional observational in design, with sample sizes ranging from 5 to 50 participants. A variety of intraoral scanners were evaluated, including Cerec, Trios, iTero, and Primescan. The QUADAS-2 tool indicated an overall unclear risk of bias in patient selection and mixed concerns regarding applicability. While findings on accuracy were mixed, most studies concluded that both techniques are clinically acceptable, with conventional impressions performing better in full-arch cases. Digital impressions were consistently reported as faster and more comfortable for patients. The findings of this review should be interpreted with caution due to methodological heterogeneity, small sample sizes, and the inclusion of predominantly young, fully dentate participants. Intraoral scanners offer advantages in workflow efficiency and patient experience, although conventional impressions remain reliable and widely used. The variability in study designs and outcome measures underscores the need for standardized evaluation protocols in future research. https://doi.org/10.17605/OSF.IO/62RCY.
Diagnosing oral lesions from benign conditions to oral cancer remains challenging due to overlapping visual features and reliance on histopathology. Large language models (LLMs) can integrate textual and visual cues, but their diagnostic accuracy and clinical utility in real decision-making contexts remain uncertain. To systematically evaluate the diagnostic performance, clinical usefulness, and limitations of LLMs in identifying oral lesions. PubMed, CINAHL, Embase, Web of Science, and Google Scholar were searched to 20 July 2025. Eligible studies applied LLMs (e.g., ChatGPT, Gemini, DeepSeek, Copilot, Claude) for diagnosis or differential diagnosis of oral lesions using text, images, or multimodal inputs. Outcomes included diagnostic accuracy, agreement metrics, and qualitative assessments of explanation quality and clinical applicability. Risk of bias was assessed using an adapted QUADAS-2. Narrative synthesis was performed due to heterogeneity. Seventeen studies (>1,200 cases) were included. Diagnostic accuracy ranged from 25%-96%, varying by model version, input modality, and lesion complexity. Multimodal inputs consistently improved performance, with Cohen's κ up to 0.85-0.90. Advanced models (GPT-4o, DeepSeek-R1, o1-preview) outperformed earlier versions and approached expert performance in some tasks, although specialists generally retained superior Top-1 accuracy. Clinical utility was highest when LLMs were used to structure differential reasoning, highlight red-flag features, and support communication, but limited in tasks requiring fine morphological interpretation or severity grading. Overall risk of bias was low to moderate. LLMs demonstrate variable diagnostic performance and context-dependent supportive utility as adjunctive tools in oral lesion assessment, particularly in multimodal settings. They should complement, rather than replace, expert clinical judgment. Future research should prioritize real-world workflow evaluation, standardized prompting strategies, and prospective clinical validation. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251090315, identifier CRD420251090315.
Oral diseases and cardiometabolic disorders are among the most prevalent non-communicable conditions worldwide and share common inflammatory, metabolic, and social determinants. Over the past two decades, growing evidence has linked poor oral health-particularly periodontitis and tooth loss-to cardiometabolic outcomes such as type 2 diabetes and cardiovascular disease. However, progress in this field has long been constrained by fragmented data systems and limited availability of large-scale resources capturing both oral health exposures and cardiometabolic endpoints. Recent advances in biobank infrastructure, population-based cohorts, and electronic health record linkage have transformed this landscape, enabling robust secondary analyses at unprecedented scale. This narrative review synthesizes current evidence from major biobanks and large-scale epidemiologic datasets relevant to oral-cardiometabolic research. We describe how oral health and cardiometabolic outcomes are operationalized across data ecosystems, critically appraise the strengths and limitations of key resources, and integrate epidemiologic findings with established biological mechanisms, including chronic systemic inflammation, microbial dysbiosis, metabolic dysfunction, and vascular impairment. We further highlight the bidirectional nature of the relationship, whereby cardiometabolic disease can also exacerbate oral inflammatory conditions. Methodological challenges-such as exposure misclassification, residual confounding, and reverse causation-are discussed alongside emerging solutions, including data linkage, multi-omics integration, and advanced analytic approaches. Harnessing large-scale data sources offers a powerful opportunity to reposition oral health within cardiometabolic disease research and prevention. Strategic integration of dental and medical data has the potential to inform precision public health approaches and support more holistic models of chronic disease prevention.
Breastfeeding is widely recognized for its benefits to infant health, yet its potential effects on maternal oral health are rarely addressed. This observational longitudinal study evaluated 90 postpartum period mothers, divided into breastfeeding (n = 55) and formula-feeding (n = 35) groups, assessing periodontal and microbiological parameters at baseline postpartum (T0), 15 ± 2 days (T1), 40 ± 3 days (T2), and six months postpartum (T3). All participants received standardized oral hygiene education. While both groups improved initially, formula-feeding mothers showed progressive improvement through 6 months. In breastfeeding mothers, GBI (bleeding index) increased again at T3 vs. T2, whereas PI (plaque index) returned to T1 levels and S. mutans and Lactobacilli decreased by T3; however, at T3 the BF (breastfeeding) group still showed higher PI/GBI and cariogenic bacteria than FF (formula feeding). These results suggest that the cumulative physical and psychological strain associated with breastfeeding may be associated with reduced oral-hygiene adherence, showing an association with maternal oral health. Targeted oral prevention strategies and inclusion of maternal dental monitoring in perinatal care protocols may help mitigate these risks without compromising the recognized benefits of breastfeeding.
The prevalence of dental caries among minors has always been a major issue globally, especially in economically underdeveloped regions. To investigate the prevalence of dental caries among all school children in Feng'an Town, which is one of the typical grassroots areas in southern China, providing reference basis for the development of oral health care for children in grassroots areas. Data of a total of 2,834 children from all kindergartens, primary schools, and middle schools in Feng'an Town, one of the grassroots area in southern China was surveyed in this retrospective study. The prevalence of dental caries and the mean Decayed, Missing, and Filled Teeth (DMFT/dmft) scores (an index used to measure the severity of dental caries) for deciduous and permanent teeth were statistically analyzed and reported. A Chi-square test was used to assess the differences between the caries-free and have-caries group. The Mann-Whitney U-test or Kruskal-Wallis H-test was used to evaluate mean DMFT/dmft score. The Benjamini-Hochberg procedure was used to correct the P values for False Discovery Rate (FDR). The Spearman's rank correlation coefficient (rs) was used to assess the trend relationship between ordinal variables (age, grade) and caries severity (DMFT/dmft score). In kindergartens, 79% of the 481 children had deciduous teeth caries, with a mean dmft score of 6.69 ± 5.31, and age was a significant factor influencing caries prevalence and mean dmft score (P < 0.05). Primary schools showed a high combined prevalence of deciduous and permanent teeth caries at 88.5% among 1,504 children, with a combined mean DMFT/dmft score of 5.63 ± 4.15. Additionally, 42.6% of these children had permanent teeth caries, with a mean DMFT score of 1.04 ± 1.19. School, part of sex, and grade were significant factors affecting the mean DMFT/dmft and DMFT scores (P < 0.05). In middle schools, 75.9% of the 849 children had permanent teeth caries, with a mean DMFT score of 3.86 ± 3.85, and sex was a significant factor influencing caries prevalence and mean DMFT score (P < 0.05). The prevalence of dental caries among school children in grassroots areas in southern China is severe, necessitating attention and collaborative efforts from multiple sectors. Based on our findings, several policy measures could be considered to improve the oral health of children in grassroots areas. Firstly, monthly structured parental workshops in kindergartens led by certified dental hygienists. Secondly, implement school-based fluoride programs and atraumatic restorative treatments (ART). Thirdly, town government subsidize dental kits for low-income families. Fourthly, schools integrate daily supervised toothbrushing into schedules. Collaboratively, Guangdong Provincial Education Department allocate funds for annual dental check-ups and sealant programs. Finally, schools and health centers design flexible schedules with "dental slots" for emergency and preventive care.
Periodontitis, a chronic inflammatory disease affecting the periodontium, is primarily driven by dysbiosis of the oral microbiome with Porphyromonas gingivalis as a keystone pathogen. Current therapeutic approaches rely on mechanical debridement and antimicrobials, which face limitations including antibiotic resistance and microbiome disruption. Pathoblockers represent a novel therapeutic strategy that selectively targets virulence factors without bactericidal effects, potentially reducing resistance development while preserving beneficial microbiota. Here, we describe the characterization of S-0636, a novel reversible inhibitor of zinc-dependent glutaminyl cyclase (PgQC), as a compound to selectively inhibit the bacterial virulence of P. gingivalis. The compound's effects were assessed through enzymatic assays, bacterial growth studies, virulence factor activity measurements (gingipain activity, hemagglutination, keratinocyte invasion), selectivity testing against commensal oral bacteria, resistance development analysis over 50 passages, and cytotoxicity evaluation in human cell lines. S-0636 demonstrated potent PgQC inhibition with a Ki value of 0.014 μM and has successfully reduced the intracellular PgQC activity by 50% at 8 μM and had no bactericidal effects. Treatment of P. gingivalis with S-0636 significantly decreased gingipain activity, impaired hemagglutination capacity, and reduced keratinocyte invasion by 76% at 62.5 μM. The compound showed high selectivity, with no growth inhibition of ten tested oral commensal species at concentrations up to 0.25 mM. Importantly, no resistance development was observed after 50 bacterial passages, and cytotoxicity remained minimal in human cell lines with >80% viability at 0.5 mM. In previous studies, PgQC was suggested as an enzyme responsible for pGlu-modification and stabilization of bacterial virulence factors. The current study now validates PgQC as an attractive target for pathoblocker development, demonstrating that S-0636 effectively attenuates P. gingivalis pathogenicity through selective virulence factor inhibition while preserving bacterial viability and oral microbiome integrity. The absence of resistance development and low cytotoxicity profile support the potential clinical translation of this approach for periodontal disease management, representing a promising alternative to conventional antimicrobial therapies.
Probiotics are proposed adjuncts for oral health, but findings from meta-analyses are inconsistent. We conducted an umbrella review of meta-analyses to synthesize evidence on probiotics' effects on cariogenic bacteria such as Streptococus (S.) mutans and Lactobacillus, halitosis (volatile sulfur compounds and organoleptic scores), and caries progression. PubMed, Web of Science and Scopus databases were searched up to October 2025 for meta-analyses of clinical trials investigating the effect of probiotics on oral health outcomes. Two reviewers screened studies, extracted data on strains, doses, durations, and pooled effect estimates, and assessed review quality using AMSTAR-2. Directions and key pooled estimates reported in included meta-analyses were summarized. Eleven meta-analyses met inclusion criteria, encompassing participants from infancy to adulthood (reported mean/median ages 0.2-42.5 years), probiotic doses reported between ∼5 × 105 and 5 × 1010 CFU, and intervention durations of 7 days to 24 months. Common strains included Lactobacillus, Bifidobacterium, and S. salivarius. Probiotics were associated with reductions in S. mutans counts in most reported comparisons and improved halitosis measures in the majority of comparisons. Pooled estimates for caries-related outcomes indicated modest reductions (example pooled SMDs reported∼-0.24; 95% CI -0.39 to -0.10 and for Lactobacillus rhamnosus -0.41; 95% CI -0.60 to -0.21). Most meta-analyses were rated moderate by AMSTAR-2; substantial heterogeneity, variable strains/delivery, and reliance on surrogate endpoints were common. Evidence suggests modest benefits of certain probiotic strains on cariogenic bacteria and halitosis, but heterogeneity, surrogate outcomes, and moderate review quality limit certainty. High-quality, strain-specific RCTs with standardized clinical endpoints are needed.
Desmoplastic fibroma is a rare, benign but locally aggressive fibroblastic tumor of bone, accounting for less than 0.1% of primary bone neoplasms. The mandible is its most frequent site, and occurrence in children is exceptionally uncommon. Because of its infiltrative behavior and the potential for significant functional and aesthetic consequences in growing patients, determining the optimal treatment approach-particularly the role of emerging non-surgical therapies-remains a clinical challenge. A 10-year-old boy presented with a one-year history of progressive, painless swelling of the right mandible. Imaging revealed an expansive mandibular lesion, and incisional biopsy confirmed desmoplastic fibroma. The family sought evaluation regarding both surgical and non-surgical management options, reflecting current therapeutic uncertainty surrounding this rare tumor in pediatric patients. Following multidisciplinary counseling, definitive surgical treatment was chosen. Using virtual surgical planning and patient-specific 3D-printed guides, a segmental mandibulectomy was performed, followed by immediate reconstruction with a vascularized fibula free flap and a prebent reconstruction plate. Microvascular anastomoses were successful, postoperative imaging demonstrated accurate anatomical restoration, and recovery was uneventful with a stable, well-perfused flap. This case highlights the diagnostic and therapeutic complexities of pediatric mandibular desmoplastic fibroma and underscores the ongoing debate regarding surgical vs. emerging systemic treatment strategies. Despite increasing interest in non-surgical modalities, wide resection with microvascular reconstruction remains the most reliable approach for achieving durable local control and restoring mandibular continuity in children. Early diagnosis, comprehensive imaging, and advanced virtual surgical planning are essential to optimizing outcomes in these rare and challenging cases.
To estimate the impact of explicit fluoride-related language in prefectural dental health ordinance on the dissemination of school-based fluoride mouth-rinse (S-FMR) programs. A longitudinal ecological design was employed to analyze prefectural-level panel data from Japan spanning 2007 to 2018. Ordinances enacted between 2010 and 2014 were categorized by the presence of explicit fluoride-related terms: 1) explicit mention of "fluoride mouth-rinse" (FMR group); 2) explicit mention of "fluoride application" (FA group); and 3) no fluoride-related policy language (NF group). The outcome was the proportion of children aged 4-15 years participating in S-FMR programs. Total prefectural income per year, prefectural mean age, and prefectural mean number of decayed, missing, or filled primary teeth (dmft) among 3-year-old children were included as covariates. The Callaway and Sant'Anna Difference-in-Differences (CSDID) method was applied to estimate the average treatment effects on the treated (ATT) for the FMR and FA groups under a conditional parallel trends assumption. A total of 39 prefectures were analyzed. The pre-post increase in S-FMR participation was greater in the FMR group than in the FA or NF groups, with comparable differences (FMR: 12%; FA and NF: 5% each). In the CSDID analysis, both the FMR and FA groups showed a significant increase in S-FMR participation compared with the NF group, with a larger effect in the FMR group [FMR: 8% (95% CI: 2%-15%); FA: 5% (95% CI: 0%-9%)]. The event-study estimates indicated that the effects strengthened over time, particularly in the FMR group. Prefectural dental health ordinances explicitly refer to fluoride, particularly FMR, are associated with a greater dissemination of the proportion of children participating in S-FMR programs. These findings suggest that more specific and explicit policy language in dental health ordinances may enhance the dissemination of S-FMR programs.
Oral candidiasis, an opportunistic fungal infection mainly caused by Candida albicans, is highly prevalent in immunocompromised individuals. Saliva acts as the oral cavity's first line of defense, with secretory immunoglobulin A (sIgA) as its key specific immune component. In this review, we systematically clarify sIgA's multifaceted roles in oral immunity and its significance in the pathogenesis, progression, and management of oral candidiasis. We detail sIgA's biological characteristics (synthesis, secretion) and core mechanisms: immune exclusion (inhibiting fungal adhesion/invasion), virulence factor neutralization, biofilm interference, and immune regulation. We also explore sIgA-C. albicans interactions, including antigen recognition, hyphal transition inhibition, and fungal evasion strategies (protease degradation, antigenic variation). Clinical evidence shows that compromised salivary sIgA levels/function-due to systemic diseases (e.g., HIV/AIDS, Sjögren's syndrome), aging, radiotherapy, or immunosuppression - correlates with increased susceptibility and severity of oral candidiasis, with functional quality being equally crucial as quantity. Given conventional antifungal limitations, we discuss sIgA-based interventions (recombinant sIgA passive immunization, mucosal vaccines, probiotic adjuvants). In conclusion, salivary sIgA is critical to maintaining oral mucosal homeostasis against C. albicans, and enhancing its function offers promising avenues for preventing and treating oral candidiasis.
Autologous dentin has emerged as a biologically active alternative to xenogeneic grafts, yet its clinical application in periodontal healing remains limited. Leukocyte- and platelet-rich fibrin (L-PRF) provides a scaffold that releases biomolecules to enhance wound healing. This case series evaluates the clinical and radiographic outcomes of a fully autologous L-PRF dentin block for the treatment of infrabony periodontal defects. Six patients presenting with twenty infrabony defects were treated with an L-PRF dentin block graft composed of particulate autologous dentin combined with L-PRF membranes and liquid fibrinogen. At baseline and after 6 months, Clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP) were evaluated clinically, and defect dimensions were assessed by Cone-beam computed tomography (CBCT). Pain was evaluated using a visual analog scale at 0, 7, 14, and 21 days. Significant improvements were observed in all clinical parameters at 6 months: CAL decreased from 5.7 mm (95% CI: 5.1-6.2) to 1.6 mm (95% CI: 0.8-2.4; p < 0.0001), PD decreased from 7.2 mm (95% CI: 6.2-8.2) to 3.7 mm (95% CI: 3.0-4.3; p < 0.0001), and BOP from 80% to 10% (p < 0.0001). CBCT analyses demonstrated significant reductions in defect depth (p < 0.03) and mesiodistal and buccopalatal dimensions (p < 0.0001). Patients reported low postoperative pain from day 7 onward. The L-PRF dentin block represents a promising, fully autologous, biologically based approach for the treatment of infrabony periodontal defects, associated with favorable preliminary clinical and radiographic outcomes with minimal postoperative discomfort. These findings suggest that this approach may represent a feasible and biologically compatible alternative to conventional graft materials. However, randomized clinical trials are needed to confirm these preliminary findings.
Oral health in Africa is a significantly neglected public health priority, impacting approximately 480 million people (43.7% of the WHO African region population). Despite its critical link to general well-being and other Non-Communicable Diseases (NCDs), the continent faces a high burden of conditions like untreated dental caries, severe periodontal disease, and life-threatening conditions such as Noma. Key challenges include a historic lack of prioritisation in health policy and resource allocation, a critically under-resourced oral health workforce (ratio of 0.44 professionals per 10,000 people), and limited access to care, with high rates of symptomatic visits for tooth removal. Furthermore, there is a significant disparity in research output compared to other continents, reflecting a 10/90 gap in oral health research and a profound lack of longitudinal and clinical trials. Addressing this high burden and low prioritisation demands urgent, evidence-based policy shifts, increased financial investment, strengthening of the workforce, and robust, African-led research to meet global commitments like the WHA 2022 resolution and SDG 3.
Regenerative dentistry, driven by dental stem cells (DSC), offers biologically based approaches for tissue repair and regeneration. Despite increasing scientific advances, clinical translation depends largely on dental practitioners' knowledge, attitudes, and readiness to adopt these therapies. In Saudi Arabia, where biomedical innovation is emphasized under Vision 2030, the integration of DSC-based applications into routine dental practice remains insufficiently understood. This study assessed the level of knowledge, attitudes, and clinical practice intentions (KAP) regarding dental stem cell applications among dental practitioners in Saudi Arabia and identified key demographic and professional predictors. A nationwide, cross-sectional, online survey was conducted between November 2024 and August 2025 using a validated questionnaire. A total of 493 fully completed responses from actively practicing dentists were analyzed. Descriptive statistics summarized KAP outcomes, while chi-square tests and multivariate binary logistic regression were used to examine associations and independent predictors of good knowledge, positive attitude, and favourable clinical practice intention. A pronounced knowledge-practice gap was identified. Although 83.3% of participants demonstrated a positive attitude toward DSC-based regenerative therapies, only 16.7% exhibited good knowledge and 50.1% reported good clinical practice intention. Prior education on stem cells was the strongest independent predictor of both good knowledge (OR=2.13, 95% CI: 1.43-3.19; p < 0.001) and positive attitude OR=2.10, 95% CI: 1.31-3.36; p = 0.002). Specialist qualification (OR=2.03, 95% CI: 1.23-3.36; p = 0.006) and mid-career status (31-50 years) (OR=2.03, 95% CI: 1.27-3.24; p = 0.003) were also significant predictors of a positive attitude, while no factors independently predicted clinical practice intention. Saudi dentists show strong enthusiasm for regenerative dentistry but limited knowledge and clinical readiness. These findings highlight the need for structured curricular integration, targeted continuing professional development, and supportive regulatory frameworks to bridge the gap between theoretical interest and the safe, effective clinical application of dental stem cell-based therapies in Saudi Arabia.
Oroantral communication (OAC) is an abnormal connection between the oral cavity and maxillary sinus, often occurring after posterior maxillary tooth extraction. If untreated, OAC can progress to oroantral fistulas (OAFs), leading to chronic sinusitis and treatment failure. Platelet-rich fibrin (PRF), an autologous biomaterial with regenerative potential, has been proposed as a therapeutic option. This study aimed to evaluate the efficacy and safety of PRF in the closure of OACs/OAFs. This systematic review and meta-analysis followed PRISMA guidelines and was registered with PROSPERO. A comprehensive literature search was conducted in April 2025 across Cochrane, PubMed, Google Scholar and Web of Science. Studies were selected using PICO criteria: patients with OACs/OAFs; PRF as a standalone or adjunct intervention; comparison to conventional treatments; outcome of successful closure; and human studies published in English or Arabic. Data extraction and risk of bias assessment were performed independently by multiple reviewers using Cochrane RoB 2, MINORS, and MMS tools. Meta-analysis was conducted using Review Manager software. Nineteen studies including 442 patients were included. PRF demonstrated high closure rates, often within three weeks, with enhanced mucosal and bone healing. Minimal complications were reported. Although methodological heterogeneity and moderate-to-high risk of bias were observed, the overall findings support the beneficial role of PRF in OAC/OAF management, particularly in minor to moderate defects. PRF is a safe, effective, and minimally invasive adjunct for the closure of OACs/OAFs. Its application is associated with significantly reduced patient morbidity, including less pain, lower analgesic consumption, minimal swelling, and greater overall comfort. Furthermore, as a minimally invasive and entirely autologous material, PRF eliminates the risks of immunogenic reactions or disease transmission, while its application helps preserve critical anatomical structures like the buccal sulcus, which is essential for future prosthetic rehabilitation. PROSPERO CRD420251028634.
Oral squamous cell carcinoma (OSCC) remains difficult to treat because of its intricate molecular profile, its limited responsiveness to conventional therapeutic approaches, and the challenge of targeting key oncogenic drivers with standard drugs. An emerging approach that addresses these limitations is the use of proteolysis-targeting chimeras (PROTACs), which shifts the focus from traditional inhibition of protein activity to the deliberate degradation of disease-associated proteins. PROTACs can eliminate oncogenic proteins like EGFR, STAT3, c-MYC, and anti-apoptotic regulators by hijacking the ubiquitin-proteasome system, many of which are essential for OSCC pathophysiology and are considered undruggable. This method provides a catalytic, sustained mechanism of action and overcomes the resistance arising from target overexpression, mutation, or signaling redundancy. Recent advances in PROTAC design, consisting of orally bioavailable degraders and tissue-directed delivery systems, highlight their translational capacity in epithelial tumors. PROTACs enable degradation of critical effectors involved in proliferation, immune evasion, and therapy resistance in OSCC. Hence, this review highlights how PROTAC technology addresses the current molecular targeting gaps in OSCC and outlines future directions for translating targeted protein degradation into clinical therapy.