The persistence of oral biofilms on teeth and dental restorative/reconstructive materials is promoted by their extracellular matrix (ECM), which stabilizes microbial communities and restricts antimicrobial penetration. Extracellular DNA (eDNA) is a conserved structural component of the ECM produced by multiple oral microorganisms and represents a promising target for biofilm control. NucB, a nonsequence-specific extracellular endonuclease, degrades eDNA and disperses diverse biofilms without direct bactericidal activity. In this study, we developed a sustained-release system for NucB using nonbiodegradable particles composed of 2-hydroxyethyl methacrylate and trimethylolpropane trimethacrylate (TMPT), and we evaluated the antibiofilm effects of NucB-loaded particles and dental resins incorporating these particles. NucB-loaded poly(2-hydroxyethyl methacrylate)/TMPT (polyHEMA/TMPT) particles released active enzyme for up to 28 d, with an initial burst followed by diffusion-controlled release. The released NucB retained DNA-digesting activity and significantly reduced Streptococcu mutans biofilm biomass and structural integrity without affecting bacterial growth or membrane integrity, consistent with ECM-targeted activity. Polymethyl methacrylate (PMMA) resins containing ≥10 wt% NucB-loaded polyHEMA/TMPT particles showed sustained NucB release for 28 d and inhibited S. mutans biofilm formation while maintaining flexural strength and modulus at loadings up to 30 wt%. Time-course analyses showed that NucB reduced eDNA accumulation from the earliest stages of biofilm development, thereby preventing dense microcolony assembly and maintaining sparse, discontinuous structures for at least 48 h. In a saliva-derived multispecies model, the PMMA resin containing 10 wt% NucB-loaded polyHEMA/TMPT particles significantly reduced biofilm biomass while preserving bacterial membrane integrity, demonstrating matrix-level activity in complex communities. In this study, we established a nonbiodegradable delivery system that enables sustained NucB release and persistent ECM disruption without compromising the mechanical properties of dental resins. This approach provides a promising strategy for developing biofilm-resistant dental materials to improve control of clinically relevant oral biofilms.
Dental patient-reported outcomes (dPROs), which capture patients' subjective experiences of their oral health, promote more patient-centered, personalized, and effective dental care. This study aims to assess the types and frequency of dPROs and dental patient-reported outcome measures (dPROMs) reported in randomized controlled trials (RCTs) in periodontology for the period 2023-2025, and to explore variables associated with reporting of dPROs in these trials. A PubMed search was conducted on July 2, 2025, to identify eligible studies. RCTs in periodontology, involving human subjects, and published from 2023 onward were included. The reported dPROs and the corresponding dPROMs were extracted and summarized. Logistic regression analyses were performed to assess associations between various variables and reporting of dPROs. A total of 175 RCTs were included, of which 53 studies (30.3%) reported at least one dPRO. The most frequently reported dPROs were orofacial pain (N = 23), discomfort (N = 17), and oral health-related quality of life (N = 13). The most commonly reported dPROM for both orofacial pain and discomfort was the Visual Analogue Scale, while the 14-item Oral Health Impact Profile was most commonly reported to assess oral health-related quality of life. The reporting of dPROs was statistically significantly associated with 4-year journal impact factor (odds ratio: 1.48; 95% confidence interval: 1.17-1.88; P < .01) and duration of follow-up of study subjects (odds ratio: 2.14; 95% confidence interval: 1.04-4.42; P = .04). dPROs were infrequently reported in the RCTs in periodontology. RCTs that reported dPROs were more likely to be published in journals with higher impact factors and have longer follow-up times.
Purpose The purpose of this study was to evaluate the potential impact on science of post-retraction citations in oral hygiene and caries management literature by examining the characteristics of retracted dental articles.Methods The Retraction Watch Database was the data source used for the descriptive study. The database features lists and reports that identify retracted manuscripts. Retractions were characterized by author, year, location, and reason for the retraction. Articles pertaining to oral hygiene and caries management were retrieved, read, and evaluated according to the following criteria: 1) Presented a potential neutral or minimal impact (the citing article cited general background information from the retraction which was not inaccurate nor based on the results of the retracted manuscript); 2) Presented a potential major negative impact on influencing science (the citing article cited inaccurate information or information based on the retracted article); 3) Unable to determine (behind a paywall, in a study without dates of publication, or otherwise unavailable); or 4) Included a notation that the citation was from a retracted article.Results Of the 64,739 retractions listed in the database, there were 297 dentally related retracted publications (0.46% of all retractions and 0.017% of all dentally related articles published from 2004-2025). Twenty-eight retracted articles addressed oral hygiene and caries management. The 28 articles were cited in a total of 1179 articles with 347 post-retractions. Seventy-four post-retraction citations had a potentially major negative scientific impact, 106 had a potential minor impact, 6 had a notation that the reference being used had been retracted, and the remainder were unable to be evaluated.Conclusion There were relatively few dentally related retractions as a percentage of the total number of publications. However, authors who used retracted articles as citations created a potential negative impact on the presentation and sharing of dental research, specifically in oral hygiene and caries management research.
Bone-modifying agents (BMAs) play an integral role in cancer care treatments. Their interface with dentistry remains challenging for oncology patients receiving BMAs and their general dental practitioners (GDPs) providing care for them. This article uses qualitative research methods to explore the challenges of dental care for patients and GDPs receiving BMAs. The study recruited 10 oncology patients receiving BMAs and 20 GDPs. The oncology patients participated in a focus group (n = 6) or qualitative interviews (n = 4) via telephone interviews. GDPs participated in three separate focus groups (n = 20). The interactions were recorded and transcribed, and thematic analysis was completed. Analyses of the results highlighted recurrent themes amongst both patients and GDPs. These could be divided into the awareness of MRONJ, the burden of dental care, treatment planning strategies in this cohort of patients, and multidisciplinary co-ordinated care. Integration of dental services into oncology care remains an important aspect of BMA treatment for oncology patients. This article discusses relevant qualitative factors regarding the onco-dental interface and serves as a real-life template to optimise dental oncology care.
Understanding how Ukrainian refugee children accessed the health care system after fleeing the war is essential to inform future preparedness and resource allocation in host countries. To use latent class analysis of registry data to identify distinct health care utilization profiles among young Ukrainian refugee children who accessed the health care system in southern Poland in 2022. This registry-based retrospective cohort study used electronic health record data from 2022 and included Ukrainian refugee children, aged 0 to 5 years, who received health care services in facilities in Małopolska Voivodeship, Poland. Participants were followed up from February 24 through December 31, 2022. The data were analyzed from April to October 2025. Healthcare utilization indicators among postwar displaced Ukrainian refugee children used as inputs to the latent profile analysis. Latent profile membership of health care utilization based on health care visit types, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coded diagnoses, and intensity of health care use, with temporal patterns of system entry and service trajectories examined after profile identification. The analytic sample included 9845 Ukrainian refugee children aged 0 to 5 years (4849 [49.3%] female) who received 35 199 health care services in Małopolska Voivodeship in 2022. Age at first health care contact was evenly distributed across categories (mean [SD] of 2.7 [1.6] years), 3802 children (38.6%) had a single recorded service, 1845 (18.7%) had more than 5 services, and nearly half (4505 [45.8%]) received care in the regional capital (Krakow). Based on latent class analysis, 5 pediatric patient profiles were identified: mostly primary care (5216 [53.0%]), hospitalized with infectious diseases (1539 [15.6%]), highest health care use (1329 [13.5%]), emergency care for injuries (900 [9.1%]), and dental and preventive care (861 [8.7%]), differing in visit type, diagnostic patterns, and health care utilization intensity. Temporal patterns varied across profiles with earlier system entry among children requiring hospitalization for infectious diseases or emergency care for injuries, and later entry among those using primary care or dental and preventive care. In this cohort study of pediatric Ukrainian refugees in southern Poland, distinct health care utilization patterns were observed with early reliance on hospital and emergency care followed by greater use of primary services. These findings underscore the need for refugee-hosting countries to rapidly adapt health care resources, prioritizing inpatient and emergency care in the initial months following a crisis.
This study aimed to determine whether flagship smartphones can approach the performance of professional digital single-lens reflex (DSLR) cameras using a standardized workflow incorporating color calibration and optical zoom. Three DSLR cameras (Canon EOS 5D Mark IV, Canon EOS 80D, Nikon D610) and two smartphones (iPhone 17 Pro Max, Galaxy S24 Ultra) were used to capture nine standardized extraoral and intraoral views for each of 25 volunteers. Images were evaluated for color accuracy, dimensional accuracy, and image quality. Statistical analyses were conducted using one-way repeated-measures analysis of variance and paired t-tests, with Bonferroni correction applied for multiple comparisons (α = 0.05). Gray-card calibration significantly reduced smartphone image ΔE values (P < 0.001), resulting in lower ΔE values than those of the DSLR group with standardized white balance (P < 0.001). Regarding dimensional accuracy, images captured with the iPhone 17 Pro Max at 4× optical zoom showed no significant difference from DSLR cameras (P = 0.178), whereas the Samsung device significantly underestimated arch width (P = 0.041). Samsung achieved the most favorable BRISQUE score. Under a standardized workflow incorporating color calibration and appropriate optical zoom, smartphone photography achieved gray-card-based color accuracy and relative dimensional consistency comparable to those of DSLR cameras, providing a more convenient and feasible imaging option. However, DSLR cameras still demonstrated advantages in clinically demanding aesthetic cases. Using a standardized workflow that includes appropriate optical zoom, professional dental lighting, and gray-card-based color calibration, smartphone photography can achieve relatively satisfactory reproduction of dental color and dimensional consistency, representing a potentially reliable and cost-effective option for clinical documentation.
The oral frailty index-8 (OFI-8) is a measure of oral frailty to identify impaired oral function. However, its validity and associations with health outcomes remain unclear. We aim to evaluate its construct validity and associations with appetite, muscle health, falls, functional outcomes, and quality of life (QoL). Cross-sectional analysis of 300 community-dwelling older adults (mean age 67.4 ± 7.10 years; 68.7% female). Exploratory factor analysis (EFA) assessed OFI-8's factor structure. Participants were classified as oral non-frail (ONF), pre-frail (OPF), or frail (OF) based on total scores. Associations with outcomes were assessed using logistic regression, adjusted for relevant covariates. Outcomes included appetite (SNAQ), muscle health (DEXA muscle mass, handgrip strength, SARC-F), falls risk (STEADI), function (IADL), life-space mobility (LSA), mood (GDS), and QoL (EQ-5D-5L). EFA revealed OFI-8's 3-factor structure: swallowing and oral conditions, dental care, and dietary and social habits. Prevalence of ONF, OPF, and OF was 62%, 16%, and 22%, respectively. Compared to ONF, OF showed worse appetite, handgrip strength, SARC-F scores, falls risk, IADL function, and mood (all p < 0.05). In adjusted models, OF was associated with poor appetite (OR = 1.97, 95% CI: 1.07-3.65), increased falls risk (OR = 2.64, 95% CI: 1.21-5.74), and low mood (OR = 5.51, 95% CI: 2.07-14.69). OPF was not associated with any outcomes. No differences were observed across groups in muscle mass, LSA, or QoL. Our findings provide preliminary support for OFI-8's validity as a multi-dimensional tool to identify community-dwelling older persons with oral frailty, which is associated with adverse outcomes. Further research is needed to refine cut-offs and evaluate longitudinal predictive validity.
Machine learning models for Obstructive Sleep Apnea (OSA) diagnosis have largely inherited some structural limitations: reliance on generic, opportunistically collected feature sets; use of the Apnea-Hypopnea Index (AHI) as the sole ground truth; poor performance in multi-class severity grading; and predictions that offer clinicians no mechanistic insight. This study addresses these gaps by prospectively assembling a multi-domain dataset that, alongside established demographic, anthropometric, and questionnaire-based predictors, incorporates a panel of craniofacial and intraoral metrics specifically designed to capture the structural-anatomical contributors to OSA - integrating these into an interpretable framework for three-class severity classification evaluated against both AHI and the Oxygen Desaturation Index (ODI). In this single-center study, 233 treatment-naïve adults from a tertiary referral cohort (61.8% severe OSA prevalence) underwent in-laboratory polysomnography (PSG). All predictor variables were collected prior to PSG outcome disclosure through a standardized clinical examination, requiring no overnight recording or specialized equipment. An Artificial Neural Network (ANN) was independently trained for three-class severity classification (No/Mild, Moderate, Severe) for each index. Model performance was evaluated on an independent test set (n = 47; 20% of the sample), with interpretability assessed using SHapley Additive exPlanations (SHAP). Comparison with an anatomy-excluded ablation model was conducted to establish the added value of the full feature set. The AHI-based model achieved 87.2% overall accuracy (sensitivity/specificity: No/Mild 0.93/0.97, Moderate 0.80/0.91, Severe 0.88/0.93). The ODI-based model achieved 76.6% accuracy, offering reliable exclusion of severe desaturation burden (No/Mild specificity: 0.94). Univariate analyses confirmed significant associations between OSA severity and STOP-BANG score, age, BMI, neck circumference, observed apnea, loud snoring, high blood pressure, Cervico-Mental Angle, Mentocervical Distance, and submental fat (all p ≤ .034 for both indices). SHAP analysis further identified V-shaped maxillary arch, Mallampati score, increased overjet, and alcohol use as influential model predictors - several reaching high model rankings despite modest univariate significance. Notably, AHI and ODI models diverged in their feature weighting - anatomy-driven features dominated AHI prediction while body habitus and comorbidity markers dominated ODI. Against a conventional demographic and questionnaire-based ablation model, the full anatomy-inclusive ANN achieved substantially higher accuracy (87.2% vs. 72.3%), with the largest gain at the Moderate-class boundary (sensitivity: 0.80 vs. 0.58). As a proof-of-concept, this study demonstrates that an interpretable ML framework integrating craniofacial and intraoral assessments with standard clinical predictors can classify OSA severity across three classes and provide feature-level explanations to support clinical reasoning. By developing parallel AHI and ODI models, the framework moves beyond AHI-only paradigms, though both remain frequency-based surrogates; hypoxic burden - quantifying the cumulative oxygen desaturation load per sleep period - is the more physiologically complete target toward which this line of work should progress. Findings are limited by single-center design, spectrum bias from a tertiary referral cohort, modest sample size, and absence of inter-rater reliability data. External validation in larger, more representative populations is needed to confirm the robustness and clinical utility of this approach.
A recent definition of clinical obesity emphasises the presence of age-adjusted limitations in activities of daily living (ADLs). Early identification of ADL limitations and factors negatively influencing the development of disability is needed to enhance the effectiveness of rehabilitation programs. To investigate the relationship between functional limitations in ADLs, body composition parameters, and comorbid conditions in a large cohort of adults with different degrees of obesity. Retrospective observational cross-sectional study. Hospital-based rehabilitation setting. Adult inpatients with different degree of obesity, from mild to severe obesity. Patients were enrolled at hospital admission. Collected data included demographic/anthropometric measures, functional status (by modified Katz ADL Index), comorbidities, body composition, and muscle strength. Out of 3229 enrolled patients, 193 (6.0%) resulted fully dependent, while 2115 (65.5%) were fully independent. The most frequently observed disabilities were in urine/fecal continence (24.7%) and toileting (15.5%). ADL impairments were significantly associated with older age, higher BMI, higher waist circumference, excess of fat mass, reduced fat-free mass and lower values of HGS. The logistic model identified 5 variables statistically associated with the probability to be a fully dependent patient: age, weight and waist circumference increased this probability, while Muscle Mass and Hand Grip strength lowered it. Osteoarthritis was present in 52% of patient with severe limitations. The severity in ADLs is influenced by both body composition and comorbid conditions. Rehabilitation should focus on functional limitations and presence of comorbidities and risk factors in patients with obesity, and particularly on preventing muscle mass loss during weight management.
Background and Objectives: Periodontal diseases are highly prevalent worldwide and have been associated with impaired oral health-related quality of life (OHRQoL). However, the strength and direction of this association remain inconsistent, particularly when sociodemographic and behavioural factors are considered. The aim of this study was to evaluate the independent association between periodontal status and OHRQoL in Bulgarian adults attending a university dental clinic, while accounting for sociodemographic factors and sleep quality, which was included as a clinically relevant behavioural determinant of oral health-related quality of life. Materials and Methods: This cross-sectional study included 504 adult participants (≥18 years) who underwent comprehensive periodontal examination and completed validated questionnaires. OHRQoL was assessed using the culturally adapted Bulgarian version of the Oral Health Impact Profile (OHIP-14), and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Due to the skewed distribution of OHIP-14 scores, the outcome was dichotomized at the sample median. Multivariable logistic regression analysis was performed to assess independent associations, adjusting for age, sex, education, financial status, place of residence, and sleep quality. Results: Periodontal status, sex, and sleep quality were independently associated with impaired OHRQoL. Females demonstrated lower odds of impaired OHRQoL compared to males (OR = 0.636; 95% CI: 0.428-0.924; p = 0.025). Poor sleep quality was associated with increased odds of impaired OHRQoL (OR = 1.554; 95% CI: 1.041-2.321; p = 0.031). Periodontitis was significantly associated with impaired OHRQoL (OR = 3.526; 95% CI: 2.073-5.998; p < 0.001), reflecting a complex relationship between clinical periodontal status and subjective health perception. Conclusions: OHRQoL is influenced by a multifactorial framework integrating periodontal status, behavioural factors, and sociodemographic characteristics. These findings highlight the importance of incorporating patient-reported outcomes into periodontal assessment and support a biopsychosocial approach to oral health research.
This cross-sectional survey aimed to assess oral health in patients with inflammatory bowel diseases (IBD) living in Austria. Data collection was conducted with an online questionnaire, including when possible validated tools, covering general medical history, socioeconomic factors, IBD-related parameters, and various oral health parameters, that is, tooth loss rate, prevalence of severe periodontitis, oral health-related quality of life (OHRQoL), and presence of oral lesions. The questionnaire was disseminated to the members of the Austrian Crohn's Disease/Ulcerative Colitis Association. The analysis included the responses of 327 patients (68% female; average age 46 years), 134 with ulcerative colitis (UC) or IBD unclassified, and 193 with Crohn's disease (CD). Based on self-reported data, about 85% of the patients reported intake of an IBD-related medication and about two thirds of the responders reported some IBD activity in the past 12 months. Approximately 24% of the patients had < 20 remaining teeth, 34% had severe periodontitis, and 7% reported poor OHRQoL. IBD diagnosis did not affect the odds for having < 20 teeth or self-reported severe periodontitis, but patients with CD presented more frequently with poor OHRQoL. In addition, patients with CD received more frequently information from their physician on the possibility of oral lesions due to IBD; however, > 50% of all patients indicated not having any problems with oral lesions. Oral health remains inadequately addressed in patients with IBD despite the significant need for dental care. Hence, treating physicians should motivate patients with IBD to inform their dentist about their diagnosis and to maintain regular dental checkups.
This study quantified how frequently questionable publications by predatory or suspect journals appear in orthodontic evidence syntheses and examined whether inclusion of these studies influences pooled estimates in orthodontic systematic reviews (SRs) with meta-analyses (MAs). Orthodontic SRs with MAs published in English between January 1, 2020, and December 31, 2023, were identified through multiple databases. One MA per SR (prioritized primary outcome/earliest time point) was selected when data were extractable from forest plots. Journals were classified as legitimate, suspect, or predatory using a prespecified approach. For MAs containing at least 1 predatory or suspect study, pooled effect estimates were recalculated under 2 scenarios using random-effects models (restricted maximum likelihood), including 1) all studies and 2) legitimate studies only. Changes were assessed using differences in the pooled estimates between scenarios. From 10,905 records, 340 orthodontic SRs with accessible meta-analytical data were included, most commonly addressing treatment modalities (32.4%). Among the 1,992 primary studies identified, most were published in journals indexed in Medline (n = 1,494; 75%). Overall, 16.2% of SRs were published in predatory or suspect (questionable) journals. One-third of selected MAs (114/340; 33.5%) included at least 1 questionable primary study published in a predatory or suspect journal, and 21.4% (73/340) included at least 1 primary study published in a predatory journal. The inclusion of questionable primary studies was similar whether the SR was published in a legitimate (33.7%), suspect (30%), or predatory journal (33.3%). In the final reanalysis set (n = 106), the pooled estimate decreased in 55% and increased in 45% of MAs after removal of suspect/predatory studies. Predatory and suspect publications are present in 1 in 3 orthodontic meta-analyses and may influence the pooled estimates. Routine legitimacy screening, study quality assessment, and sensitivity analyses excluding questionable studies should be integrated into evidence synthesis and editorial assessment in orthodontics.
Molar incisor hypomineralisation (MIH) is a common developmental dental defect of unknown etiology and considerable morbidity. Observational and experimental studies suggest systemic inflammation as a key mechanism, but there are no prospective human data. This study aimed to describe how the prevalence and severity of MIH vary with early childhood inflammation. It also aimed to investigate the extent to which early childhood inflammation affects the risk of MIH. Data were from the Barwon Infant Study, a population-based prebirth cohort. Glycoprotein acetyls (GlycA), measured by nuclear magnetic resonance, and high-sensitivity C-reactive protein (hsCRP), measured by immunoassay, were quantified from prenatal maternal serum and infant plasma from birth, 6 mo, 12 mo, and 4 y. Cytokine/chemokine responses were also measured from samples collected at 4 y of age. MIH was diagnosed by standardized clinical dental examination at 9 to 13 y of age via the modified European Association of Paediatric Dentistry index. In total, 1,074 mother-infant dyads consented to participate; 481 participants had dental examinations at a mean of 11.9 y (standard deviation = 0.96), and the prevalence of MIH was 27% (n = 129). The unadjusted odds ratio for standardized hsCRP and GlycA showed no difference in the odds of MIH and when comparing the mild and severe MIH subgroups to the non-MIH group at any time point. The estimated average causal effect after adjusting for confounding showed that a 1-unit increase of GlycA measured at 12 mo of age led to a decrease of 0.03 in the risk of MIH (95% confidence interval = -0.07, 0.02, P = 0.24). In this present study, there was no clear evidence of an association between systemic inflammation in early childhood and the risk of MIH.
Given its unique composition and physicochemical stability, dentin obtained from teeth extracted for clinical reasons represents a promising source for the development of functional biomaterials. Photopolymerizable compounds based on demineralized dentin modified with acrylamide groups were developed, with the aim of formulating ester-free adhesive primers. Dentin powder obtained from the crown and root was demineralized and reacted with methacrylic anhydride (MA). Following reaction, dialysis, and lyophilization, the resulting granular and sticky materials were evaluated for their degree of functionalization (methacrylation) using the 2,4,6-trinitrobenzenesulfonic acid (TNBS) assay and infrared (attenuated total reflectance Fourier transform infrared [ATR-FTIR]) spectrometry. The compounds were subsequently suspended in phosphate-buffered saline and collagen-methacrylamide, supplemented with lithium acylphosphinate, injected into custom molds, and photopolymerized using a dental-curing unit, producing 3-dimensional constructs. Morphology, water sorption, solubility, degree of swelling, flexural modulus, biodegradability, and biocompatibility were assessed. TNBS analysis indicated a lower degree of functionalization in methacrylated crown dentin (CD-MA, 41%) than in methacrylated root dentin (RD-MA, 55%), consistent with ATR-FTIR results. CD-MA exhibited greater solubility and swelling, as well as a lower flexural modulus (1.8 ± 0.2 MPa), compared with RD-MA (2.2 ± 0.3 MPa). However, CD-MA and RD-MA demonstrated comparable water sorption, biodegradability, and >95% metabolic activity and cell viability in OD-21 and MDPC-23 cell lines. As a proof of concept, CD-MA, which exhibited the higher yield, was selected for evaluation as an adhesive primer and compared with a commercial methacrylate-based etch-and-rinse adhesive. Specimens bonded with the experimental CD-MA primer showed significantly lower bond strength at the initial evaluation (24 h) than the control group. Nonetheless, after 6 mo of storage in simulated body fluid, the experimental group maintained stable bond strength, whereas the control group exhibited an approximately 30% reduction. Taken together, these findings demonstrate that dentin is a viable raw material for the development of methacrylamide-based dental primers, which exhibit greater bond strength stability than a conventional methacrylate-based adhesive system.
The aims of this study were 1) to determine how ligature-induced periodontitis (LIP) disrupts barrier functions of the junctional epithelium (JE); 2) to determine, using a genetic approach, the necessity of Wnt signaling for JE barrier functions; and 3) to test, using a biochemical strategy, whether a WNT therapeutic is sufficient to improve barrier functions of a pocket epithelium. In a murine model of LIP, quantitative analyses performed at multiple time points assessed epithelial apoptosis; expression of attachment proteins laminin 5 and β4 integrin, inflammation, and bone resorption. Axin2CreERT2/+; R26RmTmG/+ mice were used to evaluate how LIP impacted Wnt-responsive cells and their progeny, and K14CreERT2/+;Wlsfl/fl mice were used to determine whether Wnt signaling was required for JE barrier functions. In some cases, LIP was followed by a recovery period to assess molecular changes in pocket epithelium, and in a subset of these mice, a liposomal formulation of human WNT3A protein (L-WNT3A) was tested for its effects on early repair dynamics in pocket epithelium. LIP triggered apoptosis, significantly reduced expression of laminin 5 and β4 integrin in the JE, and disrupted the Wnt-responsive compartment; these epithelial changes were accompanied by inflammation and alveolar bone resorption. Reepithelialization occurred even with a ligature present, but this pocket epithelium had compromised barrier functions. Wntless (Wls) deletion was sufficient to convert a JE into pocket epithelium, while topical L-WNT3A treatment was sufficient to increase hemidesmosomal protein expression in pocket epithelium and reduce inflammation at early time points. LIP destroys barrier functions and thus converts a JE into pocket epithelium. Deletion of epithelial Wls demonstrates that this conversion is a Wnt-dependent event. L-WNT3A restores some early barrier features to pocket epithelium; future studies will focus on the durability of these effects.
In super-aged societies such as Japan, achieving "healthy longevity with well-being" requires not only medical and long-term care services but also a seamless continuum that integrates health promotion, frailty prevention, and community-based support, along with age-friendly physical and social environments that support functional ability, social participation, and independent living. Within this framework, oral frailty (OF)-defined as the accumulation of slight declines in oral function, including tooth loss, chewing and swallowing difficulties, oral dryness, and low articulatory oral motor skills-has emerged as a key indicator linking oral health to systemic frailty, disability, and mortality. Originating in Japan, the concept of OF emphasizes early detection and reversibility through multidisciplinary collaboration. The 2024 Consensus Statement issued by three academic societies (the Japan Geriatrics Society, the Japanese Society of Gerodontology, and the Japanese Association on Sarcopenia and Frailty) proposed a definition, conceptual model, and assessment using the Oral Frailty 5-item Checklist (OF-5). This review summarizes the development of OF initiatives within Japan's Community-Based Integrated Care System and discusses recent international trends, including the WHO Global Oral Health Action Plan (2023-2030), the FDI policy statement "Oral Health for Healthy Ageing," and emerging global research evidence. Practical examples, such as a community-wide campaign in Hiratsuka City, illustrate multisectoral collaboration to prevent and raise awareness of OF. Finally, we highlight future directions, including integration of oral health into community development, strengthening interprofessional collaboration, and leveraging digital technologies for monitoring and education. By integrating clinical, community, and policy perspectives, the Japanese concept of OF offers a promising, implementable model for global healthy aging.
Hypohidrotic ectodermal dysplasia (HED), primarily caused by mutations in EDA and EDAR, is characterized by tooth agenesis and other dental anomalies, including smaller teeth, conical or peg-shaped teeth, and taurodontism. However, the specific role of EDAR in this process remains unclear, and suitable animal models for functional studies are lacking. In this study, we generated both global and epithelium-specific Edar knockout mice, demonstrating that epithelial Edar is essential for ectodermal organ development. Loss of Edar in the epithelium led to multiple developmental dental anomalies, including third molar agenesis, reduced tooth size, fused roots, decreased cusp number, taurodontism-like molars, and enamel hypoplasia, which could mimic most of the phenotypes seen in global Edar deletion and HED. Single-cell RNA sequencing further revealed that Edar deletion alters the normal developmental progression of preameloblast lineage cells toward later ameloblast states. This alteration may underlie the enamel defects observed upon Edar loss and is further supported by the finding that Edar knockdown impaired mineralization of ameloblast lineage cells in vitro. Notably, Dlx3 was downregulated in ameloblasts at various stages in Edar-deficient mice, and Dlx3 overexpression in Edar-knockdown ameloblast lineage cells could rescue the mineralization function. Chromatin immunoprecipitation-quantitative polymerase chain reaction revealed that p65 binds to the Dlx3 promoter, linking Edar to Dlx3 transcriptional activation via NF-κB signaling. Collectively, these findings reveal a critical role of epithelial EDAR in tooth development and, for the first time, provide evidence that its downregulated expression can lead to enamel formation defects, offering new insights into the pathogenic mechanisms of EDAR-related HED.
To systematically map the existing literature regarding dental patient-reported outcomes (dPROs) in clear aligner therapy (CAT) and to identify current knowledge gaps for guiding future research. Guided by JBI methodology and PRISMA-ScR, a comprehensive search was conducted in MEDLINE, Embase, and Web of Science for relevant literature published up to September 2025. Studies investigating dPROs among orthodontic patients receiving CAT were selected for analysis. Data were charted and synthesized. The literature search yielded 1116 citations, with 55 studies meeting the inclusion criteria. These studies represented a total of 2757 patients undergoing CAT, yielding 48 dPRO items relevant to patients with CAT. Among 55 included studies, these items were subsequently categorized into seven domains: oral health-related quality of life (94.5%, 52/55), satisfaction (29.1%, 16/55), oral symptom (20.0%, 11/55), general well-being (12.7%, 7/55), oral hygiene (9.1%, 5/55), convenience (3.6%, 2/55) and adherence (3.6%, 2/55). Although CAT offers distinct patient-centered advantages such as improved aesthetics and comfort, the evidence is limited by the absence of standardized, CAT-specific instruments. Future research should prioritize the development of a core outcome set and validated instruments specific to CAT to enhance the consistency and comparability of clinical evidence.
Molar root-incisor malformation (MRIM) is characterized by abnormalities in the root and pulpal floor, which may lead to dental complications. However, research on MRIM remains limited and is largely confined to case-based observations. Therefore, this study aimed to characterize the morphology and proteomic profile of the cervical mineralized diaphragm (CMD) in MRIM. Extracted MRIM-affected teeth (n = 11) from 6 patients and extracted third molars as controls (n = 11) were collected. Two MRIM-affected teeth and two control teeth were subjected to micro-computed tomography and scanning electron microscopy. CMD tissues adjacent to the pulpal floor and control pulpal-floor dentin were harvested for protein extraction and analyzed by liquid chromatography-tandem mass spectrometry. Label-free quantification and bioinformatics analyses (gene set enrichment and protein-protein interaction network analysis) were performed, and proteins with >2-fold change were considered differentially expressed. Micro-computed tomography demonstrated a highly radiopaque CMD at the pulpal floor that occluded pulp-root canal communication, with a radiodensity between that of the enamel and dentin and a dense/porous internal architecture. Scanning electron microscopy revealed columnar and crystal-like structures. Proteomic profiles differed between MRIM and controls, with reduced epithelial-mesenchymal transition signaling in MRIM (normalized enrichment score = 1.47, false discovery rate = 0.116; control vs. MRIM). A total of 116 proteins showed >2-fold change (62 upregulated and 54 downregulated). Upregulated proteins included keratinization-associated proteins (KRT75, KRT82, EVPL, and KRT6B) with enrichment of keratinization- and epidermis-related terms, whereas downregulated proteins included SPP1, AMBN, and ECM1, which were associated with biomineral tissue development. Within the limits of this study, the CMD in MRIM exhibits a distinctive mineralized microarchitecture and a proteomic signature implicating altered epithelial-associated and extracellular matrix/mineralization processes. These findings provide candidate targets for tissue-level validation and mechanistic studies of MRIM.
Implant dentistry, as a relatively young field in dental medicine, has seen significant growth in research over the past decade. This article reviews the recent developments in implant dentistry by focusing on 3 key aspects: the current state of research, the reliability and reporting quality of evidence, methodological and statistical limitations, and additional factors shaping clinical decisions. Despite the increasing volume of studies, the quality and methodology of research remain inconsistent, and reporting bias continues to distort the evidence base. High-level evidence, such as randomized controlled trials (RCTs) and systematic reviews, is essential for clinical decision-making; however, reporting bias remains a persistent issue. Furthermore, the increasing reliance on digital platforms for academic dissemination has both enhanced the accessibility of research and introduced new challenges regarding accuracy, transparency, and commercial influence. The article also highlights the need for improvements in reporting standards, development of core outcome sets, and prevention of reporting bias to strengthen the reliability of evidence in implant dentistry. This article aims to provide a comprehensive overview of the state of evidence-based implant dentistry and offer insights into its future development.