Research Articles (Oral Medicine and Periodontics)

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    Efficacy and safety of propolis for treating recurrent aphthous stomatitis (ras): A systematic review and meta-analysis
    (MDPI, 2024) Roberts, Tina; Kallon, Idriss Ibrahim; Schoonees, Anel
    The systematic review assessed the efficacy and safety of propolis for treating recurrent aphthous stomatitis (RAS). The review adopted the PICO framework to examine the effects of topical and systemic propolis on RAS while also comparing it to established treatments, placebos, or no treatment. The main focus was on the healing time, pain levels, adverse effects, the likelihood of ulcer recurrence, and accompanying symptoms such as redness. The team included randomised controlled trials (RCTs) and quasi-randomised trials, excluding case reports and studies on oral ulcers other than RAS. In May 2022, the review team comprehensively searched nine databases and trial registries following the PRISMA guidelines. The protocol was registered in the PROSPERO database under the registration number CRD42022327123. Two review authors conducted a comprehensive and autonomous search for pertinent papers and extracted essential data. Where data permitted, the team utilised Review Manager 5 to conduct a random-effects meta-analysis, assessing the risk of bias and heterogeneity of the included studies. Where possible, the GRADE Pro programme was used to assess the certainty of the evidence for all the outcomes. This review included 10 RCTs, comprising 825 participants aged between 18 and 69 years. Seven studies evaluated the efficacy and safety of propolis when applied topically, all of which used different formulations, concentrations, and carriers. The remaining three studies assessed systemic administration in tablet form. The duration of investigations ranged from 5 days to 3 years. The review team classified two studies as having an overall ‘high risk’ of bias, while the remaining studies were categorised as having an overall ‘uncertain risk’. The overall certainty of the evidence was ‘very low’. The results indicate that topical and systemic propolis may decrease the duration of healing, alleviate pain, and reduce redness in patients with RAS compared to a placebo. However, the certainty of the evidence is very low. These may be due to the high risk of bias, substantial heterogeneity, and limited sample sizes in the included studies. For these reasons, the results of this review should be interpreted with caution. Nevertheless, the limited number of adverse effects observed suggests that propolis may have a favourable safety profile when used for a short period in treating RAS.
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    Investigating the association between Catechol-O-Methyltransferase gene activity and pain perception in South African patients with different temporomandibular disorders diagnoses
    (Multidisciplinary Digital Publishing Institute (MDPI), 2024) Chetty, Manogari; Meyer, Mark Keith; Ismail, Enas
    Background: Temporomandibular disorders (TMD) affect a significant portion of the population, with profound psychological, behavioral, and social repercussions. Recent investigations have explored the genetic basis underlying pain perception in individuals with TMD, aiming to elucidate the role of specific genetic factors in modulating the condition. Notably, genetic variations have been implicated in the pathogenesis of TMD, particularly genes involved in pain perception pathways. One of the primary candidates is the Catechol-O-Methyltransferase (COMT) gene, which plays a crucial role in the catecholaminergic system and has been associated with the regulation of nociceptive processes. This study seeks to investigate the correlation between COMT gene activity and pain perception among South African patients diagnosed with varying forms of TMD. Methodology: In this study, a total of 196 participants were enrolled, comprising 97 patients diagnosed with TMD and 99 control participants. The control group was meticulously matched with the TMD group for age, gender, and ethnicity. Data collection involved clinical and radiological investigations, and saliva sampling. The English version of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I was utilized to evaluate all TMD participants, focusing on standard diagnostic measures based on clinical signs and symptoms of TMD, which primarily describe common physical manifestations of the disorder. Genomic DNA was extracted from saliva samples, enabling the analysis of single-nucleotide polymorphisms (SNPs) in the COMT gene, specifically targeting polymorphisms rs165774, rs9332377, rs6269, rs4646310, rs165656, and rs4680. Results: The current study demonstrated a pronounced gender disparity, with 80.41% of the participants being female and 19.59% male, suggesting that women in South Africa either exhibit a higher susceptibility to TMD or are more likely to seek treatment for the condition compared to men. The highest prevalence of TMD was observed in the white population (58.76%). Additionally, over 65% of TMD patients were diagnosed with at least two Axis I diagnoses, a figure that increased to 89% for those diagnosed with three Axis I diagnoses. The findings further indicated significant associations between several single-nucleotide polymorphisms (SNPs) in the Catechol-O-Methyltransferase (COMT) gene—specifically rs165656, rs9332377, rs4646310, rs6269, and rs165774—and both TMD and TMD-related pain. Myofascial pain with referral and myalgia showed a strong association with the COMT SNPs rs9332377 and rs4646310. Furthermore, COMT SNP rs4646310 was also associated with disability related to TMD. Conclusions: This study substantiates the hypothesis that pain is prevalent in a considerable proportion of patients affected by TMD. Furthermore, the findings reveal a significant association between COMT gene activity and pain perception in South African patients diagnosed with TMD.
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    Exploring optimal methods for age-at-death estimation using pulp/tooth area ratios: a South African study
    (Springer Science and Business Media Deutschland GmbH, 2024) Kotze, Daniël; Phillips, Vincent M.; Mole, Calvin G.
    Age-at-death estimation is pivotal in the identification of unknown human decedents in forensic medicine. The pulp/tooth area ratio (PAR) method, assessing pulp cavity size as a marker of secondary dentine apposition, is widely utilised for adult age estimation. Despite extensive evaluation of this technique, the influence of image type and enamel area inclusion on method accuracy is insufficiently explored. The present study evaluated the PAR method’s applicability using maxillary canines from a South African cadaveric sample, examining reliability, sex bias, and accuracy across different image types and enamel area considerations. An observational, cross-sectional study design was followed. Fifty-two adult maxillary canines were radiographed, sectioned, and analysed using stereomicroscopy. Labiolingual and mesiodistal periapical radiographs, alongside labiolingual stereomicroscopic tooth section images, were analysed using ImageJ to calculate PARs. Age estimation linear regression models were developed for each image type, with and without enamel area inclusion. Models were compared for performance and accuracy using best-subsets regression and cross-validation analyses. Results indicated that the PAR method is a reliable, sex-independent technique, providing relatively accurate age-at-death estimates for South African adults. Image type significantly influenced accuracy, with tooth section images exhibiting the best/lowest error values, followed by labiolingual and mesiodistal radiographs, respectively. Exclusion of enamel area consistently enhanced model performance across all image types. This study contributes valuable data to the underexplored field of dental age estimation techniques for South African adults, highlighting optimal approaches when applying the PAR method to maxillary canines. Additionally, it introduces a refined stereomicroscopic technique, augmenting and enhancing existing practices.