Pedro Diz Dios

Objectives: Epidermolysis bullosa (EB) is a rare genetic disease characterized by skin and mucosal fragility caused by pathogenic variants in structural protein genes. Malocclusions have been previously described in patients with EB, mainly in case reports, with no cohort studies characterizing dentofacial characteristics across all EB types. This study aims to describe and compare the dentofacial characteristics of patients with EB across all types in a nationally representative cohort. Material and Methods: A cross‐sectional study examined 101 patients with genetically confirmed EB diagnosis at a national reference center (2023 and 2024). Occlusal and extraoral characteristics were assessed by calibrated examiners (Cohen's Kappa: Intrarater 0.925, Interrater 0.931), including overjet, Angle's molar class, overbite, midline deviation, posterior transverse relationship, dental anomalies, crowding, facial profile, type, and symmetry. Associations were examined using Fisher's exact test with Cramér's V as effect size measure, and Kruskal–Wallis test with epsilon‐squared; p values were adjusted using the Benjamini–Hochberg false discovery rate procedure. Results: The sample included: EB simplex (EBS, n = 26), junctional EB (JEB, n = 6), dominant dystrophic EB ( n = 18), recessive dystrophic EB (RDEB, n = 49), and kindler EB ( n = 2). RDEB presented the highest prevalence of posterior transverse anomalies (74.5%, 95% CI 60.5–84.7; Cramér's V = 0.504, p [FDR] < 0.001) and altered overbite (Kruskal–Wallis p = 0.022, ε ² = 0.106), with a significant difference compared to EBS (post‐hoc adjusted p = 0.022). All participants with JEB presented dental anomalies (100%, 95% CI 61.0–100.0; Cramér's V = 0.762, p [FDR] < 0.001). 53.1% of RDEB participants presented three or more dentofacial features coherent with growth restriction. Conclusions: Dentofacial anomalies vary according to the EB type. RDEB showed the highest prevalence of posterior transverse anomalies and altered overbite, and JEB presented universal dental anomalies. These findings support prioritizing and tailoring orthodontic screening by EB type. Future studies should address genotype–phenotype correlations, multicentre designs, and the relationship between dentofacial anomalies and orofacial functional impairments.

Background: Adults with intellectual disabilities often experience tooth loss and face barriers to accessing implant‐supported rehabilitation. Objective: To evaluate implant‐supported prosthesis outcomes in adults with non‐syndromic intellectual disabilities and to identify variables associated with prosthetic success. Methods: A total of 247 implant‐supported prostheses placed in 137 patients from 7 dental centers in Spain, France, Italy, and South Korea were analysed. Patient characteristics, oral health, implant features, and prosthesis‐related variables were collected. Prosthetic outcomes were categorized as “undamaged and successful”, “damaged but successful”, “loss”, or “undamaged but unsuccessful”. Success was assessed using an adapted United States Public Health Service (USPHS) clinical rating system. Results: At a mean follow‐up of 68.1 months, 94.3% of prostheses were considered successful. Cumulative survival rates were 97% at 5 years, 88% at 10 years, and 85% at 15 years. The most common technical complications were screw loosening (10.4%) and chipping (10%). Fixed prostheses predominated (92.3%), with 65.3% crowns and 34.6% bridges. Screw retention was most common (84.2%), and 94.3% followed a conventional loading protocol. General anaesthesia was used in nearly half of the cases during the impression step, although most framework and delivery procedures were performed without sedation. Among the multinomial mixed‐effects models, implant design was significantly associated with the outcome category “damaged but successful”, whereas age at first implant surgery was significantly associated with the outcome category “loss” (OR = 0.93 per additional year; 95% CI: 0.87–0.99; p = 0.031). However, the model showed no overall discriminatory ability (AUC‐ROC = 0.500), and these associations should therefore be considered exploratory rather than clinically predictive. Random‐effects binomial models showed improved discrimination (AUC‐ROC = 0.754), although no statistically significant associations were identified. Conclusion: Implant‐supported prosthetic rehabilitation is a viable and successful long‐term treatment option for adults with non‐syndromic intellectual disabilities, achieving outcomes comparable to those in the general population.

Introduction: Epidermolysis Bullosa (EB) is a rare genetic condition with skin and mucosal fragility. Patients with EB present extra- and intraoral manifestations that can limit their access to dental treatment, including orthodontic treatment. This research aims to determine the barriers, benefits and complications of orthodontic treatment reported by a group of patients living with EB. Materials and Methods: This observational study included n = 101 patients with a genetic diagnosis of EB. After their regular dental consultation, they were interviewed about factors they considered barriers to accessing orthodontic treatment. Those who underwent orthodontic treatment (n = 24) reflected about their perceived benefits and complications from the therapy. Data were analysed with descriptive statistics and multiple Fisher’s exact tests with false discovery rate (FDR) correction. Results: The most prevalent barrier was that most patients with EB had never been evaluated by an orthodontist (74.3%), even if the teams had an orthodontist. Other barriers included distance to the treatment centre (42.6%), poor oral hygiene (27.7%) and poor oral health status (26.7%). Patients with limited mouth opening perceived greater treatment benefit compared to those without this limitation (φ = −0.28, p = 0.0242), while an increasing age was associated with a reduced perception of treatment benefit (Cramér’s V = 0.29, p = 0.0404). Among those who underwent orthodontic treatment, the most prevalent benefits of orthodontic treatment were aesthetic improvement (62.5%), oral hygiene improvement (20.8%) and occlusal stability (12.5%), while the most prevalent complications were wounds and ulcers (75.0%), gingivitis (54.1%), poor oral hygiene (41.6%) and caries (33.3%). Discussion: People living with EB reported different barriers to orthodontic treatment relating to psychosocial and professional aspects, which vary according to the EB type and severity. The involvement of orthodontists in multidisciplinary special care teams and the reduction in access barriers to dental specialities can be facilitated by a more comprehensive understanding of conditions such as EB.

Conventional: Endodontic outcome criteria established by the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE) rely heavily on radiographic, clinical, and functional parameters. These criteria may not be applicable to patients with special health care needs, who often present with limited cooperation, communication impairments, and altered pain perception. Objective: This study aims to propose an adapted classification system for evaluating non-surgical root canal treatment outcomes in this underserved population. Methods: Based primarily on the criteria established by the ESE and our clinical experience, a novel classification system was developed, delineating three outcome categories grounded in both clinical and radiographic parameters. This framework deliberately excludes the “functional” criterion and introduces a “not assessable” category. It was retrospectively applied to 217 non-surgical root canal treatments performed in 137 patients with special health care needs, each with a minimum one-year follow-up. Outcomes were categorized as “favorable,” “uncertain,” or “unfavorable.” Results: Using the proposed criteria, 87 treatments (40.0%) were classified as “favorable,” 88 (40.5%) as “uncertain,” and 42 (19.3%) as “unfavorable.” By contrast, the application of AAE/ESE standards resulted in a 71.9% “favorable” classification. Most “uncertain” outcomes occurred in patients with neurodevelopmental disorders, where clinical or radiographic evaluation was not feasible. Conclusions: We propose adapted clinical and radiographic criteria for assessing non-surgical root canal treatment outcomes in patients with special health care needs, though broader validation is required. The findings suggest that this procedure remains advisable in this population, with fewer than 20% showing an “unfavorable” long-term outcome.

Objective: To determine the oral health status and dental treatment needs in a cohort of children and adults with different types of Epidermolysis Bullosa (EB). Materials and methods: A cross-sectional study was designed. 101 participants with EB (EB Simplex n = 26, Junctional EB = 6, Dominant Dystrophic EB (DDEB) = 20, Recessive Dystrophic EB (RDEB) = 47, Kindler EB = 2) were assessed including simplified debris index (DI-S), Basic Periodontal Examination (BPE), Decay/Missing/Filled Teeth index (DMFT/deft index) and Orthodontic index of complexity, outcome and need (ICON). Treatment needs were classified into preventive, periodontics, restorative, endodontics, orthodontics, prosthodontics, oral surgery, oral pathology, oral radiology, speech therapy and others. Descriptive and statistical analyses were performed. Results: The sample showed a Debris Index of 2.04 ± 0.8, with higher levels in participants with recessive dystrophic EB (2.34 ± 0.7). 15.1% of the total sample ( n = 15) showed a BPE value of 3 or 4. DMFT was 11.2 ± 0.1, while 30.1% ( n = 28/93) showed an ICON value of 43 or higher. Treatment needs were high, with a median of 3 referrals per patient, with the highest needs in restorative dentistry ( n =55, 54.5%), prosthodontics ( n =52, 51.5%), and speech/oral function therapy ( n =43, 42.6%). By EB type, junctional EB (3.67±0.52) and recessive dystrophic EB (3.34±1.03) showed the highest need for referrals. Conclusion: Oral health status among people living with EB differed across major types. Patients with recessive dystrophic EB were associated with poorer oral hygiene, a higher caries experience and more missing teeth, whereas those with junctional EB were associated with a higher number of restored teeth. On the opposite, those with simplex EB and dominant dystrophic EB were associated with more favourable oral health indicator. The greatest referral needs were for restorative dentistry, prosthodontics and speech therapy, with higher referral needs observed among EB subtypes with high risk of oral disease (recessive dystrophic EB, junctional EB and Kindler EB). Older age was associated with periodontics and prosthodontics referral needs, while male participants were associated with a higher need for speech therapy. Clinical relevance: This research seems to indicate that patients with recessive dystrophic EB and junctional EB are at high risk of oral disease, requiring referrals to at least 3 different dental specialities. In addition to paediatric dentists, special care dentists and orthodontists, dental teams caring for patients with EB should include specialists in restorative dentistry and prosthodontics, with access to consultants in speech and language therapy, endodontics and periodontics.

Background: Despite the potential benefits of implant‐supported rehabilitation, data on implant performance and peri‐implant health in adults with intellectual disabilities (ID) are limited. Objective: To evaluate dental implant outcomes in adults with non‐syndromic ID and to identify variables associated with peri‐implant health, complications, and implant loss. Methods: This multicenter retrospective cohort study included adults with non‐syndromic ID who received at least one dental implant and had a minimum follow‐up of 36 months. Dental implants placed in 137 patients across 7 specialised centers in Spain, France, Italy, and South Korea were analysed. Standardised data were collected on patient characteristics, oral health status, implant design, prosthetic variables, and follow‐up care. Clinical outcomes were categorised as peri‐implant health, mucositis, peri‐implantitis, or implant loss. Results: Of the 453 implants placed, 418 (92.3%) remained functional at a mean follow‐up of 75.9 ± 42.7 months (range: 36–211 months). Among the 445 implants evaluated for clinical outcomes, 63.6% were classified as healthy, 23.4% as presenting with mucositis, 4.4% with peri‐implantitis, and 7.3% were lost during the follow‐up period. Tissue‐level implant type, cement‐retained fixed prostheses, and the use of general anaesthesia during the impression step were significantly associated with peri‐implant clinical outcomes. No variables were identified as statistically significant predictors of implant loss. Conclusions: Dental implant therapy represents a viable long‐term treatment option for adults with non‐syndromic ID. Despite the clinical challenges of this population, high survival and success rates can be achieved, particularly when appropriate implant selection, prosthetic retention systems, and behavioural management techniques are implemented.

Yoo SY, et al. J Adv Prosthodont. 2026 Oct;18(5):520-532. https://doi.org/10.4047/jap.2026.18.5.520

Emerging evidence suggests periodontitis may contribute to stroke risk via vascular inflammation and endothelial dysfunction, promoting atherothrombosis and atrial fibrillation. This review aims to synthesize the evidence on the presence of oral bacteria and their products in biological samples from stroke patients and assess their potential impact on stroke pathophysiology, clinical outcomes, and prognosis. We conducted a narrative review of epidemiological, serological, and molecular studies examining the presence of oral bacterial DNA, endotoxins and antibodies against oral pathogens in biological samples (blood, saliva and thrombi) from stroke patients. Seropositivity for periodontal pathogens in blood was associated with incident stroke, as well as with poorer prognosis. Oral bacterial DNA, mainly from Streptococcus spp. and Prevotella spp., was consistently detected in thrombi, whereas no DNA from classic periodontal pathogens was found. The presence of P. gingivalis antibodies in thrombi was associated with lower complete reperfusion rates, while Acinetobacter spp. and Enterobacteriaceae correlated with higher early adverse events and poorer prognosis. DNA detection was limited by low-biomass samples and methodological constraints. These findings support a potential link between periodontitis and ischemic stroke. However, further studies using improved molecular methods are needed to clarify underlying mechanisms and to assess the presence of periodontal pathogen DNA in thrombi.

Handwashing is essential for reducing the risk of cross-infection in the dental setting, as evidenced by the heightened significance of this practice during the COVID-19 pandemic. The extent of adherence to handwashing in the dental setting in the post-COVID-19 phase remains unclear, particularly regarding the pandemic’s impact on this practice among dental students. This inquiry constitutes the primary objective of the present study. A cross-sectional study was designed involving 100 randomly selected undergraduated dental students at the Santiago de Compostela University (Spain). In 2023, the handwashing procedures performed by students at the end of practical classes were recorded through direct observation. The variables analyzed were: duration of the procedure, cleaning agent used, and the location of handwashing. Results were compared with those obtained from a similar study conducted in 2015, prior to the COVID-19 outbreak. In 2023, 29% of students washed their hands after practical classes, compared to 42% in 2015 (p = 0.046). No students adhered the WHO handwashing recommendations. Among senior students, the percentage practicing handwashing increased (p = 0.019), as did the duration of the procedure (p = 0.013), compared to mid-senior students. A higher percentage of students engaged in handwashing (p = 0.01) and for a longer duration (p = 0.038) at the conclusion of clinical training session compared to preclinical simulation session. Despite the impact of the COVID-19 pandemic, handwashing is not a standard practice among dental students. Therefore, it is imperative to implement educational measures that promote genuine adherence to this hygiene practice.