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Medication-related osteonecrosis of the jaw is currently classified only by clinical staging, with no imaging-based qualitative classification available. To establish foundational data for a new classification method that could help guide treatment decisions and predict prognosis, this study investigated the computed tomography findings commonly observed in patients with medication-related osteonecrosis of the jaw and their frequencies. Computed tomography scans from 784 patients across 19 medical institutions were analyzed for the presence of osteolysis, sequestrum separation, periosteal reactions, mixed-type osteosclerosis, and the bone-within-bone appearance. Clinical factors associated with each finding were also examined. Osteolysis appeared as localized in 55.1% of cases, extended in 27.7%, and advanced in 13.8%. In contrast, 3.4% of patients showed no osteolysis. This non-osteolytic pattern was more common among patients treated with denosumab. Sequestrum separation was seen in 34.7% of patients, most frequently among those with osteoporosis. Periosteal reactions were observed in 5.9% of cases as the attached type, 12.4% as the gap type, and 5.6% as the irregular type. Mixed-type osteosclerosis occurred in 31.9% of cases, most often in the mandibles of patients with malignant tumors. The bone-within-bone appearance was observed in 3.1% of cases. Patients with sequestrum separation had more favorable treatment outcomes. In contrast, those without osteolysis and those with periosteal reactions, mixed-type osteosclerosis, or bone-in-bone appearance were more likely to have poorer outcomes. This multicenter study clarified the prevalence of several key computed tomography features in medication-related osteonecrosis of the jaw, highlighting their potential relevance to clinical outcomes. These findings lay the groundwork for future research into their prognostic and therapeutic implications to support the development of a new imaging-based classification system.

DOI： 10.1038/s41598-025-23915-x

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Sarcopenia is increasingly recognized as a key predictor of adverse health outcomes. This study aimed to evaluate the impact of computed tomography-assessed sarcopenia (CT-SP) on the clinical severity and hospitalization duration of odontogenic deep neck infections (DNIs). Total of 119 patients admitted for odontogenic DNI treatment were included. Patients were divided into two groups by DNI clinical severity (severe or mild) and the patients' characteristics, including CT-SP based on skeletal muscle index (SMI), were compared between two groups. Multivariable logistic regression analysis was performed to identify independent risk factors for severe DNI. The correlation between SMI and hospitalization duration was assessed using Spearman's rank correlation coefficient. Of the 119 patients, 60 (50.4%) presented with severe DNIs, including deep neck abscesses and necrotizing soft tissue infections. After adjusting for potential confounders, multivariable analysis identified CT-SP as the sole independent risk factor associated with severe DNI (Odds Ratio = 3.04; 95% Confidence Interval, 1.20-7.71; p = 0.019). Furthermore, SMI demonstrated a significant, weak negative correlation with the hospitalization duration (r = - 0.331, p < 0.001). CT-SP is a powerful, independent risk factor associated with severity in patients with odontogenic DNIs. This finding underscores the critical role of systemic host factors in the clinical course of maxillofacial infections and highlights the potential of opportunistic CT screening as a factor to consider in risk stratification in this vulnerable population.

DOI： 10.1007/s10266-025-01204-3

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PURPOSE: Osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) are relatively rare and refractory, and there is no consensus regarding the bacteria associated with their development. This study was conducted to identify the bacteria associated with refractory ORN and MRONJ, including severe cases. METHODS: Patients who underwent surgery for osteonecrosis of the jaw were included in this study. Bacterial culture specimens were obtained from tissue as deeply as possible. Severe cases of ORN and MRONJ were defined as stage IV of Lyon's classification and stage III of the AAOMS classification, respectively. Demographic data, clinical features, antimicrobials usage, and bacteria detected were analysed to determine the factors associated with severe disease. RESULTS: Seventy-seven patients (ORN, n = 22; MRONJ, n = 55) were analysed. Penicillins were the most commonly used antimicrobials. A total of 311 bacterial strains were detected in tissue culture (detection rate = 100%). Streptococcus spp. were the most common bacteria (37.0%), followed by anaerobes (33.8%). Gram-negative rods were detected in 10.3% of the patients, antimicrobial-resistant bacteria in 78.4%, and ampicillin resistance in 60.8%. Factors associated with severe disease were ampicillin resistance and malignancy in MRONJ, with odds ratios of 8.74 (95% confidence interval, 1.20-63.4; p = 0.032) and 13.5 (1.09-168, p = 0.043), respectively. Enterobacter spp. were detected only in severe cases. CONCLUSION: Bacteria associated with osteonecrosis of the jaw are similar in composition to those responsible for common odontogenic infections, but with a higher proportion of gram-negative rods. Ampicillin-resistant bacteria, including Enterobacter spp., are implicated in severe disease.

DOI： 10.1007/s00784-025-06547-3

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OBJECTIVES: Severe odontogenic deep neck infections (DNIs) can be life threatening. This study investigated the nutritional status of affected patients and evaluated the usefulness of the Prognostic Nutritional Index (PNI) at admission in helping maxillofacial surgeons identify, at presentation, those likely to require extended hospitalization. METHODS: A total of 112 patients treated for odontogenic deep neck abscesses and necrotizing soft tissue infections at five hospitals in Japan. Patients were included. Patients were categorized by length of hospitalization duration and factors associated with prolonged hospitalization were analyzed using propensity score matching to minimize bias. Spearman's rank correlation analysis was also performed to assess the relationship between PNI and hospitalization duration. RESULTS: Fifty patients (44.6%) required hospitalization for more than 14 days. Multivariate analysis identified PNI ≤ 41.2 (odds ratio [OR] = 2.79) and the presence of abscesses in multiple deep neck spaces (OR = 2.76) as significant predictors of prolonged hospitalization. Propensity score analysis confirmed the significant association between PNI and length of hospitalization duration (P = 0.048). In addition, Spearman's rank correlation coefficient was r = - 0.471 (P < 0.001), indicating a moderate negative correlation. CONCLUSION: The admission PNI may serve as a useful adjunctive indicator for predicting prolonged hospitalization in patients with severe odontogenic DNIs, as it reflects both nutritional status and systemic inflammation.

DOI： 10.1007/s10266-025-01142-0

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BACKGROUND: There are no established guidelines for antibiotic administration to prevent the development of medication related-osteonecrosis of the jaw (MRONJ) after tooth extraction in patients receiving antiresorptive agents (ARAs). Since 2022, the duration of antibiotic administration during extractions in such patients has been intentionally shortened to prevent antimicrobial resistance at our hospitals. METHODS: This retrospective study involved 160 patients on low-dose bisphosphonates (BPs) requiring tooth extractions between 2019 and 2024 at four Japanese institutions. In 2019-2021, patients received amoxicillin (AMPC) 500 mg 1 h before and 750 mg per day for 2 days post-extraction. In 2022-2024, a single 500 mg dose of AMPC was administered 1 h pre-extraction. Patients were managed with tension-free wound suturing and regular follow-up. The rates of MRONJ development were compared between the two periods. RESULTS: MRONJ developed in 3 out of 170 teeth (1.76%) in 2019-2021, and in 2 out of 147 teeth (1.36%) in 2022-2024, with no significant difference (P = 1.000). All MRONJ cases were low-stage (Stage 1) and healed completely within 12-16 weeks. Four out of five MRONJ cases (80%) exhibited radiopaque changes around the root. When all teeth in both groups were surveyed, MRONJ development was significantly higher in teeth with such changes compared to those without (4/58 vs. 1/259; P = 0.004). CONCLUSION: A single preoperative dose of AMPC may be sufficient for tooth extractions in patients on low-dose BPs. However, teeth with radiopaque changes around the root require careful monitoring postextraction.

DOI： 10.1007/s00774-025-01617-8

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This review provides a comprehensive overview of the anatomy of the submental vein, synthesizing recent findings on its development, anatomical features, course, and clinical significance. Additionally, it introduces the mylohyoid triangle, a new anatomical landmark where the submental vein, submental artery, and the nerve to the mylohyoid muscle run in parallel. As an essential structure in head and neck reconstructive surgery, the submental vein exhibits considerable anatomical variability, primarily due to its complex developmental process. This review highlights the importance of understanding the anatomy of the submental vein and performing thorough preoperative evaluations to enhance surgical success.

DOI： 10.1007/s00276-025-03636-6

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OBJECTIVE: Using a severity scale, this study aimed to investigate the treatment behavior of patients with odontogenic infections during the COVID-19 pandemic. MATERIALS AND METHODS: This study included patients admitted for odontogenic deep neck infection (DNI) treatment at a single center in Japan between 2017 and 2022. Participants were divided into two groups: a pre-COVID group before 2019 and a COVID group after 2020. Patient characteristics, clinical data, and DNI severity were compared. RESULTS: During the pandemic, the number of patients with mild DNIs decreased significantly, whereas the number of patients with severe DNIs did not change significantly, resulting in a significant increase in the latter proportion (42/101 (41.6%) vs. 26/43 (60.5%); p=0.045). In addition, the patients in the COVID group were significantly older than those in the pre-COVID group (median 66.0 years vs. 56.0 years; p=0.018). CONCLUSIONS: Our results suggest that patients with odontogenic infections, especially the elderly, may have avoided hospitals until their symptoms became severe during the COVID-19 pandemic.

DOI： 10.7759/cureus.81414

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In this study, we aimed to identify risk factors that predict the postoperative need for advanced or prolonged airway management in patients with severe odontogenic deep neck infections (DNIs). This retrospective case-control study included patients of both sexes aged ≥ 18 years who had undergone surgical drainage including debridement of necrotic tissues of odontogenic deep neck abscesses and necrotizing soft tissue infection under general anesthesia between April 2016 and September 2023 at a single center. The patients' characteristics, laboratory tests, and computed tomography (CT) findings were analyzed and compared between the difficult postoperative airway group, which required prolonged intubation or tracheostomy, and the short-term intubation group. Statistical significance was set at P < 0.05. Sixty-four patients required surgical drainage including debridement under general anesthesia. Of them, 7 (10.9%) patients were included in the difficult postoperative airway group. In addition to increased inflammatory markers, the presence of arytenoid edema among laryngeal edema and retro- and parapharyngeal space abscesses on preoperative CT images were identified as risk factors. The presence of pharyngeal space abscesses was significantly associated with laryngeal edema, and the intubation period was longer in patients with more elements relevant to these two factors. Thus, the presence of pharyngeal space abscesses and degree of laryngeal edema on preoperative CT images can be used to predict the complexity of postoperative airway management. Our results suggest that tracheostomy is preferable for patients with retropharyngeal space abscesses, and that patients with parapharyngeal space abscesses and laryngeal edema are desirable to undergo prolonged intubation.

DOI： 10.1007/s10266-024-01041-w

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BACKGROUND: The pathological evaluation of cancellous bone at resection margins of mandibular osteoradionecrosis (ORN) has not been well elucidated. Here, we developed a unique classification system for evaluating the degree of bone marrow fibrosis, one of most common pathological features, in patients with mandibular ORN, based on which we investigated its relationship with treatment outcome. METHODS: This study included 15 patients who underwent mandibulectomy and free fibula osteocutaneous flap reconstruction. The extent of mandibulectomy was determined, with safety margins of approximately 10 mm from the apparent osteolytic areas on preoperative computed tomography image. Special staining was performed on thin sections from center of the osteolytic areas (medial area) and bilateral resection margins, and the degree of bone marrow fibrosis was evaluated and investigated its relationship with presence of bone union as a treatment outcome. RESULTS: The degree of bone marrow fibrosis of medial area was significantly higher than those of resection margins. Although most resection margins had collagen fibers which indicate severe fibrosis, all transferred fibula flaps achieved bone union. CONCLUSION: When mandibulectomy is performed with safety margins of approximately 10 mm from the apparent osteolytic areas, all transferred fibula flaps achieved bone union regardless of the degree of bone marrow fibrosis at resection margin. In other words, the association between severe bone marrow fibrosis at resection margins and treatment outcome was not seen. CLINICAL RELEVANCE: Setting safety margins of approximately 10 mm may achieve bone union, but further study is needed.

DOI： 10.1007/s00784-024-06008-3

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PURPOSE: Mandibular wisdom teeth can occasionally cause infections, which can progress to severe deep neck infections (DNIs) including deep neck abscesses or necrotizing soft tissue infections, which are fatal. This study aimed to identify the radiographic characteristics of mandibular wisdom teeth that developed severe DNIs. METHODS: This study included patients who were admitted for the treatment of severe mandibular wisdom tooth infection between July 2012 and June 2024 at a single center. Patient characteristics, clinical data, and radiographic findings were analyzed and compared between the severe DNI group and mild DNI group including patients with cellulitis or superficial abscess. P < 0.05 was considered significant. RESULTS: Nineteen of 42 patients (45.2%) were included in the severe DNI group. The multivariate analysis showed that the highest odds ratio (OR) was for the presence of a radicular cyst (OR=17.7), followed by the presence of a dentigerous cyst (OR =14.5). The most common mandibular wisdom tooth with a dentigerous cyst in patients with severe DNIs was inverted according to Winter's classification and type IIIC in the Pell and Gregory classification. CONCLUSION: Radiographic characteristics associated with severe DNIs included the presence of radicular and dentigerous cysts in the mandibular wisdom teeth. Especially in dentigerous cysts, deeply impacted teeth should be taken attention.

DOI： 10.7759/cureus.70791

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PURPOSE: Medication-related osteonecrosis of the jaw (MRONJ) occasionally occurs following tooth extractions in cancer patients receiving denosumab (Dmab). However, there are currently no established guidelines for perioperative antibiotic administration during tooth extraction in these patients. The primary objective was to develop guidelines for the dose and frequency of antibiotics during tooth extraction by investigating the correlation between the current status of antibiotic administration and the development of MRONJ. METHODS: This study included 68 cancer patients receiving high-dose Dmab who had tooth extractions between 2012 and 2022 at 10 hospitals. The relationship between the way of perioperative antibiotic administration and the development of MRONJ was analyzed. A P-value < .05 was considered significant. RESULTS: There was considerable variability across hospitals and surgeons regarding the type, dosage, and duration of antibiotic administration. Amoxicillin (AMPC) was the most commonly used antibiotic. Focusing exclusively on teeth extracted under AMPC administration, MRONJ developed in 21 out of 123 teeth (17.0%). No significant relationship was found between the development of MRONJ and the dosage or duration of perioperative AMPC administration. CONCLUSION: Perioperative antibiotic administration alone may not be sufficient to prevent MRONJ. Therefore, a single preoperative dose is likely adequate for effective and appropriate AMPC administration. .

DOI： 10.7759/cureus.67237

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OBJECTIVES: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse effect of antiresorptive and/or antiangiogenic agents. As the treatment application for MRONJ is controversial, we aimed to identify the risk factors for poor prognosis and to help determine appropriate management. METHODS: This study included 119 patients. Relevant clinical data were obtained for all the patients. In computed tomography images, osteosclerosis, osteolysis, cortical perforation (buccal or lingual), periosteal reaction, and sequestration were evaluated. RESULTS: Multivariate analyses showed statistically significant associations between poor prognosis in patients with MRONJ and conservative treatment alone (hazard ratio [HR] 1.89), osteolysis (HR 4.67), and the absence of sequestration (HR 5.33). CONCLUSIONS: Conservative treatment alone without clear objectives needs to be avoided, and osteolytic change could be the criteria for surgical intervention. As the boundary between the lesion and vital bone is indistinct, we recommend extensive surgery in cases with unpredictable sequestration.

DOI： 10.1002/hed.27574

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Currently, over 500 rare genetic bone disorders are identified. These diseases are often accompanied by dental abnormalities, which are sometimes the first clue for an early diagnosis. However, not many dentists are sufficiently familiar with phenotypic abnormalities and treatment approaches when they encounter patients with rare diseases. Such patients often need dental treatment but have difficulties in finding a dentist who can treat them appropriately. Herein we focus on major dental phenotypes and summarize their potential causes and mechanisms, if known. We discuss representative diseases, dental treatments, and their effect on the oral health of patients and on oral health-related quality of life. This review can serve as a starting point for dentists to contribute to early diagnosis and further investigate the best treatment options for patients with rare disorders, with the goal of optimizing treatment outcomes.

DOI： 10.1002/ca.24117

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INTRODUCTION: Necrotizing fasciitis as a complication of medication-related osteonecrosis of the jaw (MRONJ), which we named "ONJ-NF", has been sometimes reported. This study aimed to investigate the usefulness of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for predicting ONJ-NF. MATERIALS AND METHODS: We included patients with acute MRONJ who required hospitalization at a single institution from April 2013 to June 2022. They were divided into two groups: patients with ONJ-NF and those with severe cellulitis as a complication of MRONJ, which we named "ONJ-SC." LRINEC scores were compared between the groups and the cut-off value of the score was set by creating a receiver operating characteristic curve. RESULTS: Eight patients with ONJ-NF and 22 patients with ONJ-SC were included. The LRINEC score was significantly higher in patients with ONJ-NF (median: 8.0 points, range 6-10 points) than in those with ONJ-SC (median: 2.5 points, range 0-6 points). A LRINEC score of ≥ 6 points had a sensitivity of 100.0%, a specificity of 77.3%, and an area under the curve of 0.97. Among 6 parameters of LRINEC score, only C-reactive protein (CRP) and white blood cell count (WBC) had significant differences between two groups. Most of the patients with ONJ-NF were rescued by antibiotic therapy and surgical drainage including debridement of necrotic tissues, but unfortunately, one patient did not survive. CONCLUSION: Our results suggested that the LRINEC score may be a useful diagnostic tool to predict ONJ-NF but valuating only CRP and WBC may be sufficient particularly in patients with osteoporosis.

DOI： 10.1007/s00774-023-01441-y

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Osteoradionecrosis (ORN) often results in pathological fractures through progression. We aimed to identify the risk factors for pathological fracture in patients with mandibular ORN. Seventy-four patients with mandibular ORN were included in this retrospective study. We investigated various risk factors for pathological fracture in patients with mandibular ORN, including number of mandibular teeth with a poor prognosis each at initial evaluation before radiation therapy (RT) and when fracture occurred, and the proportion of antibiotic administration period in a follow-up duration after RT. The rate of occurrence of pathological fractures in patients with mandibular ORN was 25.7%. The median of duration between RT completion and fracture occurrence was 74.0 months. We found that pathological fracture was significantly associated with a larger number of mandibular teeth with a poor prognosis at initial evaluation before RT (P = 0.024) and when fracture occurred (P = 0.009). Especially, a larger number of mandibular teeth with P4 periodontitis, in other words severe periodontal status, was related to pathological fracture in both timings. The proportion of antibiotic administration period in a follow-up duration was also significant risk factor (P = 0.002). Multivariate analyses showed statistically significant associations between pathological fracture and a larger number of mandibular teeth with a poor prognosis when fracture occurred (hazard ratio 3.669). The patient with a larger number of mandibular teeth with P4 periodontitis may have a risk of not only occurrence of ORN but resulting in pathological fracture by accumulation of infection. Surgeons should consider extraction of those teeth regardless of before/after RT if necessary for infection control.

DOI： 10.1038/s41598-023-30735-4

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BACKGROUND: Empyema is a life-threatening infection often caused by oral microbiota. To the best of our knowledge, no reports have investigated the association between the objective assessment of oral health and prognosis in patients with empyema. MATERIALS AND METHODS: A total of 63 patients with empyema who required hospitalization at a single institution were included in this retrospective study. We compared non-survivors and survivors to assess risk factors for death at three months, including the Renal, age, pus, infection, diet (RAPID) score, and Oral Health Assessment Tool (OHAT) score. Furthermore, to minimize the background bias of the OHAT high-score and low-score groups determined based on the cut-off value, we also analyzed the association between the OHAT score and death at 3 months using the propensity score matching method. RESULTS: The 3-month mortality rate was 20.6% (13 patients). Multivariate analysis showed that a RAPID score ≥5 points (odds ratio (OR) 8.74) and an OHAT score ≥7 points (OR 13.91) were significantly associated with death at 3 months. In the propensity score analysis, a significant association was found between a high OHAT score (≥7 points) and death at 3 months (P = 0.019). CONCLUSION: Our results indicated that oral health assessed using the OHAT score may be a potential independent prognostic factor in patients with empyema. Similar to the RAPID score, the OHAT score may become an important indicator for the treatment of empyema.

DOI： 10.1371/journal.pone.0282191

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BACKGROUND: Severe odontogenic infections in the head and neck region, especially necrotizing soft tissue infection (NSTI) and deep neck abscess, are potentially fatal due to their delayed diagnosis and treatment. Clinically, it is often difficult to distinguish NSTI and deep neck abscess in its early stage from cellulitis, and the decision to perform contrast-enhanced computed tomography imaging for detection is often a challenge. This retrospective case-control study aimed to examine the utility of routine blood tests as an adjunctive diagnostic tool for NSTI in the head and neck region and deep neck abscesses. METHODS: Patients with severe odontogenic infections in the head and neck region that required hospitalization were classified into four groups. At admission, hematologic and inflammatory parameters were calculated according to the blood test results. In addition, a decision tree analysis was performed to detect NSTI and deep neck abscesses. RESULTS: There were 271 patients, 45.4% in Group I (cellulitis), 22.5% in Group II (cellulitis with shallow abscess formation), 27.3% in Group III (deep neck abscess), and 4.8% in Group IV (NSTI). All hematologic and inflammatory parameters were higher in Groups III and IV. The Laboratory Risk Indicator for Necrotizing Fasciitis score, with a cut-off value of 6 and C-reactive protein (CRP) + the neutrophil-to-lymphocyte ratio (NLR), with a cut-off of 27, were remarkably useful for the exclusion diagnosis for Group IV. The decision tree analysis showed that the systemic immune-inflammation index (SII) of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 suggests Group III + IV and the classification accuracy was 89.3%. CONCLUSIONS: Hematologic and inflammatory parameters calculated using routine blood tests can be helpful as an adjunctive diagnostic tool in the early diagnosis of potentially fatal odontogenic infections. An SII of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 can be useful in the decision-making for performing contrast-enhanced computed tomography imaging.

DOI： 10.1186/s12879-022-07934-x

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Lower third molar extraction is the most common surgical treatment among routine dental and oral surgical procedures. while the surgical procedures for lower third molar extraction are well established, the difficulty of tooth extraction and the frequency of postoperative complications differ depending on the patient's background. To establish a management protocol for the lower third molars, the prevalence of and risk factors for postoperative complications after lower third molar extraction were investigated in a large number of Japanese patients in a multicenter prospective study. During 6 consecutive months in 2020, 1826 lower third molar extractions were performed at the 20 participating institutions. The medical records of the patients were reviewed, and relevant data were extracted. The prevalence of and risk factors for postoperative complications were analyzed. The prevalence of postoperative complications after lower third molar extraction was 10.0%. Multivariate analysis indicated that age (≤32 vs >32, odds ratio [OR]: 1.428, 95% confidence interval [95% CI]: 1.040-1.962, P < .05), the radiographic anatomical relationship between the tooth roots and mandibular canal (overlapping of the roots and canal vs no close anatomical relationship between the roots and the superior border of the canal, OR: 2.078, 95% CI: 1.333-3.238, P < .01; overlapping of the roots and canal vs roots impinging on the superior border of the canal, OR: 1.599, 95% CI: 1.050-2.435, P < .05), and impaction depth according to the Pell and Gregory classification (position C vs position A, OR: 3.7622, 95% CI: 2.079-6.310, P < .001; position C vs position B, OR: 2.574, 95% CI: 1.574-4.210, P < .001) are significant independent risk factors for postoperative complications after lower third molar extraction. These results suggested that higher age and a deeply impacted tooth might be significant independent risk factors for postoperative complications after lower third molar extraction.

DOI： 10.1097/MD.0000000000029989

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Mechanical stress induces a variety of biochemical and morphological reactions in bone cell biology. This study aimed to investigate appropriate pressures of osteogenesis on the biological responses of 3-dimensional cultured human mandibular fracture haematoma-derived cells by compressive loading. Six patients with mandibular fractures who underwent open reduction and internal fixation were included in the study. During the operation, fracture haematomas that formed fibrin clots were manually removed before irrigation. First, pressures were applied to human mandibular fracture haematoma-derived cell-seeded collagen sponges. The sponges were subjected to mechanical compression using loading equipment applied at no compression, 0.5, or 1 mm. Compressive loading was applied to the samples prior to compression for 0, 6, 12, or 24 hours. Collagen sponge samples were collected for quantification of mRNA using several parameters including alkaline phosphatase (ALP), osteopontin (OPN), osterix (OSX), runt-related gene 2 (RUNX2), protein level, and immunocytochemistry (anti-sclerostin). Among these the 0.5 mm compression group compared with the control and 1.0 mm compression groups upregulated mRNA expression of OPN and OSX after 24 hours. Additionally, compared with the control group, a significantly higher OSX gene expression was observed in both the 0.5 mm and 1.0 mm groups after 6, 12, and 24 hours of compression (p < 0.05). However, no significant differences were observed regarding ALP and RUNX2 expression. These results indicated increased stimulation of osteogenesis of the mandibular fracture-line gap in the 0.5 mm compression group compared with the control and 1.0 mm compression groups.

DOI： 10.1016/j.bjoms.2022.06.001

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PURPOSE: The purpose of this study was to investigate the risk factors associated with post-extraction persistent bleeding in patients on warfarin or direct-acting oral anticoagulants (DOACs) and the ability of risk scores to predict post-extraction bleeding. METHODS: Three hundred ninety-one patients taking warfarin or DOACs underwent tooth extractions. Various risk factors for post-extraction bleeding, including number of tooth extraction, with antiplatelet therapy, and risk scores, were investigated by univariate and multivariate analyses. A post-extraction bleeding was classified into grades 1-3. RESULTS: The incidence of post-extraction bleeding was 26.8% (77 out of 287 patients; grade 1: 63, grade 2:14) in patients taking warfarin, and 26.0% (27 out of 104 patients; grade 1: 20, grade 2:7) in patients taking warfarin DOACs. Multivariate analyses showed that multiple teeth extractions and HAS-BLED scores (above 3 points) in patients taking warfarin, and only multiple teeth extractions in patients taking DOAC, were significantly associated with post-extraction bleeding, respectively. CONCLUSION: Most of the post-extraction bleedings were grade 1, which can be stopped by eligibly pressing gauze by surgeons. If patients taking anticoagulants are scheduled to undergo multiple teeth extractions or their HAS-BLED score are above 3 points (if warfarin), we recommend informing patients risk of post-extraction bleeding before operation, taking carefully hemostasis, and instructing patients to bite down accurately on the gauze for longer than usual.

DOI： 10.1007/s10006-022-01039-0

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Language：Japanese   Publisher：(公社)日本口腔外科学会  

71歳女性。右側頬部の腫脹と開口障害を主訴に前医より歯性感染症を疑われ、当院へ紹介となった。初診時、右側頬部皮膚の腫脹と一致して、右側頬粘膜にも腫脹が認められたが、原因となる歯科疾患はみられなかった。その後、詳細な問診で4年前に両側頬部にバイオアルカミドによる除皺術を受けたことが判明した。MRI所見より頬部の皮膚充填材への感染に起因する右側頬部蜂窩織炎と診断され、治療としてSBT/ABPCの投与を行った結果、炎症所見や腫脹、開口障害の改善が得られた。

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Pre-existing inflammation, corticosteroid therapy, periapical periodontitis, longer duration of denosumab therapy, and female sex were significantly associated with an increased risk of denosumab-related osteonecrosis of the jaw after tooth extraction in patients with cancer on oncologic doses of denosumab. A short drug holiday did not protect against this complication. INTRODUCTION: This study retrospectively investigated the relationship between various risk factors, including brief discontinuation of denosumab, and development of denosumab-related osteonecrosis of the jaw (DRONJ) after tooth extraction in patients with cancer who were receiving oncologic doses of this agent. METHODS: Data were collected on demographic characteristics, duration of denosumab therapy, whether or not denosumab was discontinued before tooth extraction (drug holiday), duration of discontinuation, presence of pre-existing inflammation, and whether or not additional surgical procedures were performed. Risk factors for DRONJ after tooth extraction were evaluated by univariate and multivariate analyses. RESULTS: A total of 136 dental extractions were performed in 72 patients (31 men, 41 women) with cancer who were receiving oncologic doses of denosumab. Post-extraction DRONJ was diagnosed in 39 teeth (28.7%) in 25 patients. Tooth extraction was significantly associated with development of DRONJ only in patients with pre-existing inflammation (odds ratio [OR] 243.77), those on corticosteroid therapy (OR 73.50), those with periapical periodontitis (OR 14.13), those who had been taking oncologic doses of denosumab for a longer period (OR 4.69), and in women (OR 1.04). There was no significant difference in the occurrence of DRONJ between patients who had a drug holiday before tooth extraction and those who did not. CONCLUSIONS: These findings suggest that inflamed teeth should be extracted immediately in patients with cancer who are receiving oncologic doses of denosumab. Drug holidays have no significant impact on the risk of DRONJ.

DOI： 10.1007/s00198-021-05995-3

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PURPOSE: In maxillary wisdom tooth extraction, the necessity of CT is unknown. The purpose of this study was to investigate whether CT adding to orthopantomography is useful for predicting oroantral perforation during maxillary third molar extraction. METHODS: Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analyses. We analyzed those of all patients and the patients who underwent CT, respectively. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) and Archer classification were assessed using panoramic radiography. The number of roots and vertical relationship were assessed using CT. RESULTS: A total of 604 out of 3299 patients underwent CT adding to orthopantomography. In all cases, multivariate analyses except for CT findings showed that the RS classification type III/IV and the Archer classification Type B/C/D in panoramic findings were significantly correlated with oroantral perforation as radiological findings. In cases for which CT was performed, multivariate analyses showed that one root (OR 12.87) and the vertical relationship Type D (OR 5.63) in CT findings, besides the RS classification type III/IV (OR 4.47) in panoramic findings, were significantly related to oroantral perforation. CONCLUSION: The RS classification and the Archer classification in panoramic findings can predict the risk of oroantral perforation. The usefulness of CT adding to orthopantomography is limited. However, when the relationship between the upper wisdom tooth and maxillary sinus floor (RS classification) is unclear, to check whether the number of roots is one and the apex of one root is projecting into the maxillary sinus in CT findings, is useful for the prediction.

DOI： 10.1007/s10006-020-00878-z

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Necrotizing fasciitis (NF) is an acute and life-threatening soft-tissue infection however rarely seen in oro-cervical region. Therefore, the details of oro-cervical NF (OCNF) are not well known. The purpose of this study was to investigate the characteristics of OCNF by comparing it with severe cellulitis of oro-cervical region (OCSC) or NF of other body regions (e.g., limb, perineum, and trunk) (BNF), respectively. MATERIALS AND METHODS: At first, various risk factors for OCNF in oro-cervical severe infection (OCSI; composed of OCNF and OCSC), including neutrophil-to-lymphocyte ratio (NLR) and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, were investigated by univariate and multivariate analyses. Next, the differences between OCNF and BNF, including inflammatory markers and mortality, were investigated. RESULTS: In the present study, 14 out of 231 OCSI patients had OCNF. Multivariate analyses of OCSI patients showed that NLR ≥15.3 and LRINEC score ≥6 points were significantly related to OCNF. During the same period, 17 patients had BNF. The OCNF group had significantly higher inflammatory markers than the BNF group when diagnosis, but significantly lower clinical stages at the time and mortality as outcomes. CONCLUSION: We found that compared to BNF, OCNF can be detected at lower clinical stage by using indexes, such as NLR and LRINEC score, besides clinical findings, which may help contributing to patient's relief.

DOI： 10.1371/journal.pone.0260740

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd  

DOI： 10.1186/s12903-020-01326-w

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Language：Japanese   Publisher：(一社)日本口腔感染症学会  

症例は68歳女性で、11年前に高血圧性腎硬化症を発症し、5年前に夫をドナーとする生体腎移植を受けていた。今回、左側下顎部の疼痛と腫脹を主訴に近在歯科医院を受診し、抗菌薬内服で症状改善を認めないため、精査加療目的に当科を紹介され救急受診した。画像所見より左側頭頸部ガス壊疽と診断し、側頭部および顎下部より切開排膿術、左側下顎第一小臼歯および左側下顎第一から第三大臼歯の抜歯を施行した。側頭筋、内側翼突筋、咬筋の壊死部はデブリードメントを行い、下顎骨の内外側で側頭部と顎下部をそれぞれ交通させペンローズドレーンを計3本留置した。また、初診時血液検査結果より急性腎不全が疑われたため、抗菌薬はスルバクタム・アンピシリン3g/日とクリンダマイシン1.2g/日を併用し経静脈投与した。切開部からの排膿はほぼ消失したため第27病日にすべてのドレーンを抜去し、第39病日に軽快退院となった。

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Language：Japanese   Publisher：(一社)日本有病者歯科医療学会  

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PURPOSE: The present retrospective multicenter study intended to investigate the factors associated with severe oral mucositis and candidiasis in patients undergoing radiotherapy for oral and oropharyngeal carcinomas. METHODS: A total of 326 patients who underwent radiotherapy for oral and oropharyngeal cancers were enrolled in the study. The patients' age, sex, body mass index, primary site, diabetes, serum albumin, creatinine, hemoglobin, leukocyte and lymphocyte, concurrent cisplatin or cetuximab, method of radiation, total radiation dose, feeding route, use of spacers, pilocarpine hydrochloride, and corticosteroid ointment were examined, and the associations of each variable with oral mucositis and candidiasis were analyzed by multivariate Cox regression analysis. RESULTS: Grade 3 oral mucositis occurred in 136 (41.7%) patients. Male sex, oropharyngeal cancer, low hemoglobin levels, low leukocytes or lymphocytes, concurrent cisplatin or cetuximab, and oral feeding were found to be significantly associated with a higher incidence of severe oral mucositis. Oral candidiasis occurred in 101 (31.0%) patients. Oropharyngeal cancer, low leukocyte count, and oral mucositis of grade 2 or higher were found to be significantly associated with a higher incidence of oral candidiasis. The use of a topical steroid ointment was not found to be a risk factor for oral candidiasis. CONCLUSIONS: The present retrospective study demonstrated that certain factors may predispose patients with oral and oropharyngeal cancers receiving radiotherapy to develop severe oral mucositis and oral candidiasis. A preventive strategy for severe oral mucositis needs to be established in the future for high-risk cases.

DOI： 10.1007/s00520-019-04885-z

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本口腔腫瘍学会  

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BACKGROUND: Postoperative pneumonia can be a fatal complication that may occur after lung resection in cancer patients. Some reports have shown that the incidence of postoperative pneumonia is decreased after esophageal surgery by perioperative oral care; however, there exist no data to suggest that a lack of perioperative oral care can be a risk factor for postoperative pneumonia after lung resection. To investigate the association between the preventive effect of oral care and postoperative pneumonia, we conducted a multicenter, retrospective study of lung cancer patients who underwent lung resection. METHODS: Between January 2014 and December 2016, a total of 721 patients underwent lung resections at 1 of the 6 hospitals included in our study. Among 721 patients, 280 (38.8%) received perioperative oral care, and the remaining 441 (61.2%) did not receive any such care. Propensity score matching was performed to minimize selection biases associated with the comparison of retrospective data between the oral care and control groups. RESULTS: Of the 721 patients, 54 (7.5%) experienced postoperative pneumonia involving 13 of the 280 patients (4.6%) in the oral care group and 41 of the 441 patients (9.3%) in the control group (P = .02). On propensity score analysis, a significant difference was also found between oral care intervention and incidence of postoperative pneumonia (P = .002). CONCLUSION: Our results suggest that perioperative oral care is an effective method to decrease the occurrence of postoperative pneumonia in patients who have undergone lung resection.

DOI： 10.1016/j.surg.2018.11.020

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BACKGROUND/AIM: We recently investigated the contribution of the iPS-related genes SOX2, OCT4, and Nanog to de-differentiation by assaying for their mRNA levels. Given that mRNA expression does not always correlate with the protein levels, the aim of this study was to retrospectively determine the expression of these four iPS-related factors in human OSCC specimens by immunohistochemistry and examine their association with patient prognosis. MATERIALS AND METHODS: iPS cell-related gene expression in 89 OSCC patients by tissue microarray, and its correlation with clinicopathological factors, differentiation, metastasis, and poor prognoses were investigated. RESULTS: No evidence of statistically significant relationships was found between the expression of iPS cell-related genes and clinicopathological parameters. However, our data indicated that KLF4 expression was associated with survival, and poor tumor differentiation. In addition, high expression of KLF4 was an independent poor prognostic factor (p=0.004) for OSCC patients. CONCLUSION: In preoperative biopsies, higher KLF4 and poor differentiation may be clinically effective predictors for the prognosis of oral cancer.

DOI： 10.21873/anticanres.13231

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DOI： 10.1007/s00198-018-4746-8

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Language：Japanese   Publisher：(一社)日本口腔感染症学会  

当科で経験した薬剤関連顎骨壊死症例65例(男性15例、女性50例、平均74.9歳)を分析し、転帰に影響する因子について検討した。原疾患別では、悪性腫瘍が23例(35.4%)、骨粗鬆症が39例(60.0%)、悪性腫瘍・骨粗鬆症合併が3例(4.6%)であった。治療法はnonsurgical approach群が35例(53.8%)、conservative surgery群が23例(35.4%)、extensive surgery群が7例(10.8%)であった。転帰については、「症状消失」が38例(58.5%)、Stageが下がった「症状改善」が11例(16.9%)、「症状不変」が7例(10.8%)、Stageが上昇した「症状悪化」は5例(7.7%)、経過観察中に患者が原疾患により死亡した症例が4例(6.3%)であった。原疾患別とリスク製剤休薬・変更の可否で統計学的に有意差が認められ、悪性腫瘍と休薬・変更不可症例では「症状消失」症例が有意に少なかった。また、各Stageに占める「症状消失」症例の割合をみたところ、Stage 0:8/10例(80.0%)、Stage 1:14/17例(82.4%)、Stage 2:14/29例(48.3%)、Stage 3:2/5例(40.0%)であった。

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INTRODUCTION: Skin flap procedures are widely used to reconstruct skin and soft tissue defects. Skin flap necrosis is a serious postoperative complication. Many researchers have introduced pharmacological agents to improve flap ischemia in experimental studies. However, outcomes of these studies remain controversial. We previously demonstrated that transcutaneous CO2 application improves hypoxia in fracture repair. In this study, we hypothesized that improving hypoxia by transcutaneous CO2 application can improve the blood flow in skin flaps and increase angiogenesis. We investigated whether transcutaneous CO2 application can increase the survival of random-pattern skin flaps. MATERIALS AND METHODS: Six-week-old male Sprague-Dawley rats were divided into two equal groups: the control group (n = 6) and CO2 group (n = 6). A random-pattern skin flap was constructed in these rats. Topical CO2 was applied using a hydrogel every day for 5 days in the CO2 group. The flap survival area was measured on postoperative days 1, 3, and 5. The vessel density and expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and hypoxia-inducible factor-1α (HIF-1α) were evaluated on postoperative day 5. RESULTS: A statistically significant difference was found in the percentage of the flap survival area between the two groups on postoperative days 3 and 5 (p < 0.05). Furthermore, the expression of VEGF and bFGF was significantly higher and that of HIF-1α was significantly lower in the CO2 than in the control group (p < 0.05). CONCLUSIONS: Transcutaneous CO2 application can improve the blood flow in skin flaps and increase angiogenesis, thus increasing the survival of random-pattern skin flaps.

DOI： 10.1016/j.bjps.2018.06.010

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Enhancing the antitumor effect of radiation, while reducing damage to organs, is a significant challenge in radiation therapy for head and neck malignancies. One promising radiosensitizer is gold. The present study aimed to determine whether gold nanoparticles (AuNPs) have the potential to enhance the effects of X-ray irradiation on head and neck cancer cells. The human head and neck carcinoma cell line HSC-3 was used. Total cell number and the levels of cell proliferation and apoptosis were compared between control cells and cells treated with 5-nm AuNPs alone at four concentrations (0.1, 0.4, 1.0 and 10.0 nM), X-ray irradiation alone at three doses (2, 4 and 8 Gy), or a combination of 4 Gy X-ray irradiation and 1.0 nM AuNPs. Analysis of variance and Tukey-Kramer testing were performed to compare the different groups. The total number of cells significantly decreased following 4 and 8 Gy X-ray irradiation, compared with in the control group (control vs. 4Gy, P=2.19×10-4; control vs. 8Gy, P=1.28×10-6). The combination of 4 Gy X-ray irradiation and 1.0 nM AuNPs significantly reduced the total number of cells compared with 4 Gy X-ray irradiation alone (P=2.95×10-4). Cell proliferation was not affected by AuNP treatment alone, 4 Gy X-ray irradiation alone or the combination of X-ray irradiation and AuNPs. The combination of 4 Gy irradiation and 1.0 nM AuNPs significantly increased the number of apoptotic cells compared with 4 Gy irradiation alone (P=0.0261). In conclusion, AuNPs combined with X-ray irradiation enhanced the cytotoxic effect on human head and neck cancer cells in vitro, through the induction of apoptosis, but not inhibition of cell proliferation.

DOI： 10.3892/br.2018.1142

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Radiotherapy (RT) is one of the main treatment modalities for oral squamous cell carcinoma (OSCC), however, radioresistance is a major impediment to its clinical success and poses as a concern that needs to be addressed. Tumor hypoxia is known to be significantly associated with radioresistance in various malignancies, hence, resolving the hypoxic state of a tumor may improve the antitumor effect of RT on OSCC. We have previously revealed that transcutaneous CO2 induced mitochondrial apoptosis and suppressed tumor growth in OSCC by resolving hypoxia. Considering the previous study, we hypothesized that transcutaneous CO2 may enhance the antitumor effect of RT on OSCC by improving intratumoral hypoxia, thereby overcoming radioresistance. In the present study, the combination of transcutaneous CO2 and RT significantly inhibited tumor growth compared with other treatments. This combination therapy also led to decreased expression of HIF-1α in parallel with increased expression of the cleaved forms of caspase-3-8-9 and PARP, which play essential roles in mitochondrial apoptosis. Additionally, the combination therapy increased the expression of ROS modulator 1 and subsequent mitochondrial ROS production, compared to RT alone. These results indicated that transcutaneous CO2 could potentially improve the antitumor effect of RT by decreasing the intratumoral hypoxia and increasing the mitochondrial apoptosis. Our findings indicated that CO2 therapy may be a novel adjuvant therapy in combination with RT for OSCC.

DOI： 10.3892/or.2018.6444

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Language：Japanese   Publisher：(一社)日本口腔感染症学会  

ガイドライン導入前の当院の抗菌薬予防投与指針に準じて抗菌薬予防投与を行った口腔癌即時再建手術の術後感染発症例を後ろ向きに調査し、術後感染の発症に影響を与える因子について検討した。当科で気管切開術、口腔癌切除術、頸部郭清術および血管柄付遊離皮弁による即時再建術を施行した40例を対象とした。術後感染を認めた症例は40例中12例で、発症率は30.0%であった。基礎疾患の有無による術後感染発症率に有意差は認められず、アルブミン値およびヘモグロビン値との関連もなかった。手術時間での比較では、術後感染を認めなかった症例の平均手術時間が684.1分であったのに対し、術後感染発症例の平均手術時間は785.0分と長く有意差を認めた。また、術中の出血量においても感染を認めなかった症例の平均出血量が671.9mlであったのに対し、術後感染発症例の平均は1050.3mlと多く有意差を認めた。

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PURPOSE: The appearance of osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) is similar, but clinically important differences between ORN and MRONJ exist. The aim of this study was to compare the clinical data between ORN and MRONJ and to reveal the critical differences between these diseases. METHODS: We retrospectively reviewed the epidemiological data, clinical findings, and treatment in 27 ORN and 61 MRONJ patients. Radiographic signs before the initiation of treatment were also assessed. RESULTS: The median age (P = 0.0474) and the ratio of female to male patients (P < 0.0001) were significantly higher in MRONJ patients. There were significantly more MRONJ patients who reported a history of pain when compared with ORN patients (P = 0.0263). As an aetiological factor, tooth extraction was significantly more relevant to MRONJ than ORN (P = 0.0352). When assessing the radiographic signs on computed tomographic images, periosteal reaction was found only in MRONJ patients (P = 0.0158). Minimal debridement was performed significantly more frequently for MRONJ (P = 0.0093), and by contrast, surgical resection was performed more frequently for ORN (P = 0.0002). CONCLUSIONS: Understanding the clinical and underlying pathological differences between ORN and MRONJ probably contributes to the selection of appropriate treatment for each patient.

DOI： 10.1007/s10006-017-0667-5

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Authorship：Lead author   Language：Japanese   Publisher：(公社)日本口腔外科学会  

症例は72歳男性で、左腎癌に対して左腎摘出術を施行した。経過観察していたが、胸部CT画像にて肺癌を指摘された。左肺癌の診断で胸腔鏡補助下左下葉切除術を施行し、病理組織学的に腎細胞癌の肺転移と診断した。経過観察していたが、胸部CT画像で右胸膜・縦隔リンパ節転移を認めた。スニチニブの経口投与を開始したが、6日後に肝機能障害を認めたため中止した。スニチニブを減量し、2週内服1週休薬で施行し、4コース目までが終了した。右下顎大臼歯部の骨露出および同部への舌の接触痛を自覚した。薬剤関連性顎骨壊死と診断し、口腔衛生管理および局所の洗浄を行うこととした。露出骨に対し鋭縁研磨を行い、右舌縁部の潰瘍に対しデキサメタゾン軟膏塗布を行った。スニチニブは減量し、2週内服1週休薬で継続した。2ヵ月後には骨露出部に歯肉の増生を認め、露出範囲は縮小し、右舌縁部の潰瘍は消失した。初診より8ヵ月目の胸部CT画像から肺転移巣にPDが確認され、スニチニブを中止し、新たにアキシチニブの内服を開始した。胸部CT画像から胸膜転移巣の増大ありと判断した。アキシチニブを中止し、新たにオプジーボの内服を開始し、現在も継続中である。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01073&link_issn=&doc_id=20180227400009&doc_link_id=10.5794%2Fjjoms.64.83&url=https%3A%2F%2Fdoi.org%2F10.5794%2Fjjoms.64.83&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(公社)日本顎顔面インプラント学会  

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Language：Japanese   Publisher：(一社)日本口腔感染症学会  

術後追加療法として化学放射線療法(CRT)を行った口腔癌21例、中咽頭癌26例の計47例(男33例、女14例、平均年齢59.9歳、範囲16〜76歳)を対象に、頭頸部癌に対するCRT中の口腔粘膜炎の重症度を予測する因子について、後ろ向きに検討した。CRT中に出現した口腔粘膜炎のGrade別はGrade 2が40例(85.1%)、Grade 3が7例(14.9%)であり、背景因子の比較では栄養学的予後指数(PNI)に有意な群間差を認めた。また、Grade 3出現例ではGrade 2出現例よりも末梢血総リンパ球数、血清アルブミン濃度が有意に低値を示し、算出したCRT開始前のPNIについてROC曲線のカットオフ値は41.1で、AUC:0.86、感度:0.95、特異度:0.71であった。PNIは口腔粘膜炎の重症度を予測する因子となる可能性が示唆された。

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Language：Japanese   Publisher：(一社)日本口腔感染症学会  

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Language：Japanese   Publisher：(一社)日本口腔感染症学会  

5年間に入院加療を要した顎口腔領域の重症感染症例40例(平均61.1歳、範囲7〜90歳、男性14例)について臨床的に検討した。臨床診断名は蜂窩織炎33例、下顎骨骨髄炎5例、壊死性筋膜炎2例であり、原因疾患は根尖性歯周炎17例、辺縁性歯周炎5例、智歯周囲炎5例などで原因部位は下顎大臼歯部が多かった。起因菌として通性嫌気性菌ではStreptococcus属、偏性嫌気性菌ではPeptostreptococcus属、Prevotella属が多く、抗菌薬投与日数の中央値は5.5日であった。また、下顎臼歯部を原因とする症例は難治性になりやすく、易感染性の基礎疾患を有する症例は抗菌薬投与日数が長くなる傾向にあり、発症から当科受診までの期間が長くなるほど、CRP値が高いほど治療期間が延長する傾向がみられた。早期の消炎手術は治療期間(抗菌薬投与期間)の短縮につながると考えられた。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Ltd  

DOI： 10.1016/j.ajoms.2016.12.010

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BACKGROUND/AIM: Cancer stem cells are suspected to contribute to malignancy in tumors. Hypoxia affects cell differentiation and induces stem-cell-like characteristics in malignancies. Induced pluripotency was demonstrated in mouse fibroblasts by reprogramming with four transcriptional factors: Oct3/4, Sox2, c-Myc, and Klf4. Conversely, oncogenic transformations frequently express transcriptional factors and Nanog. Therefore, cancer cells present some similarities with induced pluripotent stem (iPS) cells. MATERIALS AND METHODS: We investigated the expression of iPS-related genes in vitro and in clinical samples to identify their relationships with hypoxia and tumorigenesis. RESULTS: Oral squamous cell carcinoma (SCC) cells were used to show that expression levels of Oct3/4, Sox2, and Nanog were significantly increased in hypoxic condition in vitro and in moderately- and poorly-differentiated samples. CONCLUSION: We propose that Oct3/4, Sox2 and Nanog are associated with tumor hypoxia characterized in oral SCC and that these factors may also contribute to the undifferentiated potency observed in oral SCC clinically.

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Mandibular cortical bone measurement with x-ray imaging is known to be a potentially useful tool in the detection of dimensional changes caused by bisphosphonate. The primary purpose of this study was to assess the meaning and limitation of cortical bone measurement with computed tomography (CT) in patients with medication-related osteonecrosis of the jaw (MRONJ). The investigators obtained DentaScan images of the mandible from 15 patients with MRONJ, 15 patients with a history of antiresorptive agent administration without symptoms of MRONJ (non-MRONJ), and 15 control subjects. The cortical bone width measured on DentaScan images was compared between the three groups (ANOVA and Tukey's test). Interobserver reliability between two observers was also assessed. The values of interclass correlation coefficient were 0.48 in the MRONJ group, 0.29 in the Non-MRONJ group, and 0.34 in control group. The cortical bone widths calculated both by observer 1 and observer 2 were thicker in patients with MRONJ than in the non-MRONJ group and controls. There were significant differences in cortical bone width among the MRONJ, non-MRONJ, and control groups in observer 1 (P < 0.001) and observer 2 (P < 0.001), specifically comparing the MRONJ group with the non-MRONJ group and the control group. Cortical bone width measurement is useful for the distinction between medication-related osteonecrosis of the jaw and normal bone, in spite of the low interobserver reliability.

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Language：English   Publishing type：Research paper (scientific journal)  

The purpose of this study was to retrospectively investigate the outcomes of Brånemark System Mk III TiUnite/Groovy implants placed in patients at Kobe University Hospital. Various risk factors for implant failure, including mechanical coupling, were investigated by univariate and multivariate analysis. The predictive variables investigated included age, sex, smoking habit, general health, history of radiation therapy, application of a dentomaxillary prosthesis, type of prosthesis, use of alveolar bone augmentation, site of implant insertion, mechanical coupling between implants, and the length and diameter of the implants. Of the 907 implants investigated, only 23 were unsuccessful; the overall survival rate was 96.7%. Increased age, radiation therapy, application of a removable prosthesis or dentomaxillary prosthesis, lack of mechanical coupling between implants, and shorter implants (≤8.5mm) were significant risk factors for implant failure according to univariate analysis (P<0.05). Multivariate analysis identified a significant association (P<0.05) between dental implant failure and a lack of mechanical coupling between implants (odds ratio 6.88) and shorter implants (≤8.5mm) (odds ratio 3.43). The findings of this study demonstrated multivariate relationships between various risk factors and dental implant failure.

DOI： 10.1016/j.ijom.2016.10.014

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PURPOSE: The objectives of this study were to retrospectively describe the characteristics and outcomes of patients with oral squamous cell carcinoma (OSCC) with level IV/V metastases, and to evaluate the multivariate relationships among potential risk factors for metastasis and prognosis. MATERIALS AND METHODS: We evaluated 291 patients (178 men and 113 women; mean age, 65.9 ± 13.5 years). Clinicopathological data, time of development of level IV/V metastases, and clinical course were investigated. RESULTS: Twenty-three patients (7.9%) developed level IV/V metastases. The 3-year overall survival rates when level IV/V metastasis first developed were 27.3% upon initial treatment, 57.1% when metachronous neck metastasis developed, and 40.0% when the tumor recurred. Oral tongue tumor subsite, high N staging, neck dissection when metachronous neck metastasis developed, as well as recurrence were independent risk factors for level IV/V metastasis. CONCLUSION: We demonstrate here the multivariate relationships among the risk factors indicated above for level IV/V metastasis and their prognostic significance for patients with OSCC. Oral tongue tumors, high N staging, and neck dissection upon the occurrence of metachronous neck metastasis or recurrence were risk factors for level IV/V metastasis and positive extracapsular spread, presence of multiple lymph metastases, and moderate or poor differentiation were poor prognostic factors.

DOI： 10.1016/j.jcms.2016.10.011

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PURPOSE: The relationship between radiographic findings and the occurrence of oroantral perforation is controversial. Few studies have quantitatively analyzed the risk factors contributing to oroantral perforation, and no study has reported multivariate analysis of the relationship(s) between these various factors. This retrospective study aims to fill this void. METHODS: Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analysis. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) was assessed using panoramic radiography and classified as types 1-5. The relationship between the maxillary second and third molars was classified according to a modified version of the Archer classification. The relative depth of the maxillary third molar in the bone was classified as class A-C, and its angulation relative to the long axis of the second molar was also recorded. RESULTS: Performance of an incision (OR 5.16), mesioangular tooth angulation (OR 6.05), and type 3 RS classification (i.e., significant superimposition of the roots of all posterior maxillary teeth with the sinus floor; OR 10.18) were all identified as risk factors with significant association to an outcome of oroantral perforation. CONCLUSION: To our knowledge, this is the first multivariate analysis of the risk factors for oroantral perforation during surgical extraction of the maxillary third molar. This RS classification may offer a new predictive parameter for estimating the risk of oroantral perforation.

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Oral squamous cell carcinoma (OSCC) is the most common form of oral cancers. Recent studies have shown that the malignant transformation of various carcinomas, including OSCC, is associated with epithelial-mesenchymal transition (EMT), and that expression of the EMT factors are significantly associated with tumor invasion, tumor metastasis, and survival rates in OSCC patients. Hence, there is a possibility that EMT suppression may improve the prognosis of OSCC patients. Hypoxia inducible factor-1α (HIF-1α) is a crucial microenvironmental factor in tumor progression, which induces the expression of EMT factors. We previously reported that transcutaneous CO2 suppresses both human OSCC tumor growth and metastasis to the regional lymph nodes by improving hypoxia in treated tissue. According to this background, we hypothesized that increased EMT with HIF-1α expression may increase the progression and the metastatic potential of OSCC, and that decreased hypoxia by transcutaneous CO2 could suppress EMT. In the present study, in vitro studies showed that hypoxic conditions increased the expression of HIF-1α and EMT factors in OSCC cells. In addition, in vivo studies revealed that transcutaneous CO2 increased E-cadherin expression with the decreased expression of HIF-1α, Snail, Slug, N-cadherin, and Vimentin in tumor treatment. These results suggest that transcutaneous CO2 could suppress EMT by improving hypoxia, resulting in the reduction of metastatic potential of OSCC. The findings indicate that transcutaneous CO2 may be able to improve the prognosis of OSCC patients through the suppression of EMT.

DOI： 10.3892/ijo.2016.3380

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本口腔診断学会  

症例は68歳男性、大動脈弁狭窄症に対して大動脈弁置換術を施行した。胸腹部CT画像にて右下葉にスリガラス様不透過像と左下葉結節影を指摘され、肺腺癌と診断した。化学療法を施行し、4コース終了後の胸腹部CT画像にて左下葉結節影の増大や胸水の増量などからPDと診断した。追加治療としてシスプラチンとペメトレキセドを併用した化学療法を2週ごとに施行した。骨盤転移に対しては、ゾレドロン酸を1回、デノスマブを毎月1回投与した。食事時に口腔内の接触痛を自覚し、両側下顎臼歯部の骨露出を指摘された。保存的に経過観察していたが、接触痛の増悪を自覚した。両側下顎大臼歯部舌側に10mm大の骨出と、周囲歯肉の発赤、接触痛および軽度腫脹を認めた。薬剤関連下顎骨壊死と診断し、口腔衛生管理および局所の洗浄を行った。デノスマブ投与は中止した。体調不良により通院困難となり、多臓器不全のため初診より6ヵ月後に死亡した。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J02383&link_issn=&doc_id=20151102230010&doc_link_id=10.15214%2Fjsodom.28.208&url=https%3A%2F%2Fdoi.org%2F10.15214%2Fjsodom.28.208&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The purpose of this study was to retrospectively investigate the multivariate relationships among the various risk factors for postoperative delirium in patients undergoing oral cancer surgery. MATERIAL AND METHODS: The medical records of all patients with oral cancer who underwent curative head and neck surgery between April 2011 and March 2013 at our institution were retrospectively reviewed. There was a total of 188 patients, including 110 males and 78 females. RESULTS: We found that older age, extensive surgical procedure, longer operation, excessive hemorrhage, blood transfusion, longer postoperative management in the intensive care unit, longer postoperative hospital stay, lower albumin level in the preoperative blood test, and lower total protein, albumi, n and hemoglobin levels and a higher C-reactive protein (CRP) level in the postoperative blood tests were significant variables in the univariate analysis (p < 0.05). We also determined that an older age (odds ratio [OR] = 6.83), intraoperative lower hemoglobin levels (OR = 6.82), and excessive hemorrhage (OR = 3.62) during surgery were significant variables in the multivariate analysis. CONCLUSION: Clinicians should pay special attention to preventing delirium during the postoperative management of older patients with these risk factors. Furthermore, increasing the hemoglobin levels during surgery may be able to prevent postoperative delirium.

DOI： 10.1016/j.jcms.2015.06.011

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本口腔感染症学会  

82歳男。左側口蓋部の腫瘤を指摘された。左側口蓋から左側上顎結節部にかけて25×15mm大の腫瘤を認め、その中心部に潰瘍を認めた。左側口蓋悪性腫瘍の診断で全身麻酔下に口蓋腫瘍切除術を施行した。摘出物の病理組織診断結果は、口蓋嚢胞腺癌であった。軽快退院となったが、外来通院中に撮影したCTにて右側頸部リンパ節に後発転移を認めた。全身麻酔下に右側根治的頸部廓清術変法を施行した。病理組織検査結果は転移が疑われるリンパ節は癌陽性および節外陰性、他リンパ節は癌陰性であった。SBT/ABPCを投与したが、炎症値の著しい上昇を認め、腹部に著明な膨満と軽度圧痛を認めた。CTにて著明な腸管拡張を認めた、中毒性巨大結腸症と診断した。バンコマイシンの経口投与に変更した。内視鏡的脱気術によるガス抜きや肛門バルーン留置による吸引にて、糞便貯留は改善した。

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本口腔診断学会  

45歳女。左側舌背部の表層に表面滑沢で周囲よりやや赤色を呈する比較的境界明瞭な15×15mmの腫瘤を認め、軽度の接触痛を有していた。MR画像では舌表層に比較的境界明瞭な軟組織腫瘤を認め、T2強調像で高信号を呈した。舌良性腫瘍の診断で組織生検を行い、病理組織学的に顆粒細胞腫と診断し、全身麻酔下に腫瘍切除術を施行した。術後経過は良好で、再発は認めていない。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02383&link_issn=&doc_id=20141029210010&doc_link_id=10.15214%2Fjsodom.27.253&url=https%3A%2F%2Fdoi.org%2F10.15214%2Fjsodom.27.253&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：(一社)日本小児血液・がん学会  

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Language：Japanese   Publisher：(一社)日本成人先天性心疾患学会  

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Language：Japanese   Publisher：(一社)日本呼吸器学会  

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Language：Japanese   Publisher：(NPO)日本口腔科学会  

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