Massimo Petruzzi

Objective: The objective of this study was to evaluate the diagnostic performance of GPT-5.2 Thinking in identifying oral potentially malignant disorders within a patient sample that also included oral carcinomas and other oral cavity lesions, using intraoral photographs and associated clinical data. Methods: This retrospective exploratory diagnostic accuracy study included 103 oral lesions: 69 oral potentially malignant disorders, 25 oral carcinomas, and 9 other oral pathologies. Each case was assessed in three independent sessions, and the majority diagnosis was compared with the final clinical and/or histopathological reference diagnosis. Results: For oral potentially malignant disorders, sensitivity was 92.75%, specificity was 88.24%, accuracy was 91.26%, positive predictive value was 94.12%, negative predictive value was 85.71%, and Cohen’s kappa was 0.804. Sensitivity was 81.82% for homogeneous leukoplakia, 78.57% for non-homogeneous leukoplakia, and 86.36% for oral lichen planus. For oral carcinomas, sensitivity was 84.00%, specificity was 97.44%, accuracy was 94.17%, positive predictive value was 91.30%, negative predictive value was 95.00%, and Cohen’s kappa was 0.837. Conclusions: GPT-5.2 Thinking showed promising diagnostic performance in this exploratory case-enriched dataset, but predictive values require validation in representative clinical populations.

Oral lichen planus (OLP) is a chronic T cell-mediated inflammatory disorder characterized by recurrent epithelial injury and incomplete inflammatory resolution. Cellular senescence and the senescence-associated secretory phenotype may help explain how stromal cells sustain this inflammatory circuit. This narrative review critically evaluates direct and indirect evidence linking senescence to OLP. A focused search of PubMed/MEDLINE, Scopus, and Web of Science through 31 July 2026 identified evidence localizing senescence-associated signatures predominantly to PDGFRα-positive mesenchymal cells. The available multimodal study also reported enhanced CXCL12–CXCR4 and extracellular matrix–CD44 communication toward CD8-positive T cells and showed that conditioned medium from experimentally induced senescent fibroblasts increased lymphoid-cell activation and keratinocyte injury in non-oral and immortalized cell models. Earlier studies of p16, p21, p53, altered cyclin-dependent kinases, oxidative/nitrative DNA damage, and SASP-compatible cytokines provide supportive evidence but are insufficient to establish cellular senescence. We hypothesize a feed-forward model in which persistent oxidative and cytokine stress induces senescence in mesenchymal and possibly epithelial cells. A context-dependent SASP may recruit and activate cytotoxic lymphocytes, promote basal keratinocyte damage, and propagate further cellular stress. Further progress will require spatially resolved multi-marker validation and functional testing in primary oral-cell models before biomarker-guided clinical trials can be considered. These advances may ultimately support the development of novel targeted therapies for OLP.

Objectives: To evaluate the association between oral mucosal diseases, oral health‐related quality of life (OHRQoL), and depressive symptoms, and to explore differences across categories. Materials and Methods: In this cross‐sectional observational pilot study, consecutive outpatients with oral mucosal disease were enrolled at the Dental Clinic of the Policlinico of Bari over one year. OHRQoL and depressive symptoms were assessed using the Oral Health Impact Profile‐14 (OHIP‐14) and Patient Health Questionnaire‐9 (PHQ‐9). Participants were classified into four diagnostic groups: idiopathic/chronic orofacial pain syndromes, autoimmune diseases, oral potentially malignant disorders (OPMDs), and reactive‐inflammatory/traumatic lesions. Nonparametric tests and a multivariable negative binomial regression model were applied. Results: Sixty‐six patients were included, and OHIP‐14 and PHQ‐9 scores showed a moderate positive correlation (Spearman's p = 0.41; p < 0.01). Kruskal–Wallis testing suggested a difference in OHIP‐14 scores across groups ( p = 0.03), with the greatest exploratory post hoc difference between chronic orofacial pain syndromes and OPMDs (adjusted p = 0.03), whereas PHQ‐9 scores did not differ across groups ( p = 0.93). Conclusions: Diagnostic category appeared to influence OHRQoL, but not depressive symptoms; however, findings should be considered exploratory. Clinical Significance: These exploratory findings suggest that OHRQoL assessment may complement oral mucosal disease evaluation.

Background: Oral lichen planus is a chronic oral potentially malignant disorder requiring timely diagnosis and long-term follow-up, yet its diagnostic pathway remains poorly characterised. This study assessed diagnostic and follow-up intervals in patients with oral lichen planus and explored associated clinical and healthcare-related factors. Methods: This retrospective cohort study included 199 patients with clinically and histopathologically confirmed oral lichen planus managed at the Oral Medicine Unit of the University of Murcia. Diagnostic time points were defined using an adapted Aarhus framework. Patient, primary care, specialist diagnostic and total intervals were analysed using multivariable quasi-Poisson regression. Loss to follow-up was assessed using Cox regression. Results: Older age was associated with longer patient, primary care and total intervals. Women had a shorter patient interval than men (IRR = 0.44; 95% CI: 0.21–0.91; p = 0.03), but a longer primary care interval (IRR = 3.09; 95% CI: 1.12–10.2; p = 0.04). Compared with erosive oral lichen planus, mixed and reticular forms showed shorter primary care intervals and shorter specialist diagnostic intervals, with IRRs ranging from 0.21 to 0.36 (all p < 0.01). Daily alcohol consumption was associated with the longest total interval. Older age was associated with a higher risk of loss to follow-up (HR = 1.02; 95% CI: 1.00–1.04; p = 0.01), whereas non-pharmacological treatment was associated with a lower hazard of loss to follow-up (HR = 0.31; 95% CI: 0.16–0.60; p < 0.001). Conclusions: Diagnostic delay in oral lichen planus is multifactorial and appears to depend on patient characteristics, clinical presentation and healthcare pathway factors. Improved recognition of erosive disease, clearer referral criteria and structured follow-up strategies may enhance care continuity.

Background: Panoramic radiography is one of the most widely used imaging examinations in dental practice, providing a broad view of the jaws and adjacent head and neck structures. Although primarily prescribed for odontogenic assessment, its field of view may reveal non-odontogenic findings with potential clinical significance. Methods: A structured narrative review was conducted according to SANRA criteria. A literature search was performed in PubMed/MEDLINE, Embase, Scopus, and Web of Science for English-language publications from January 2010 to May 2026. Backward and forward citation tracking of relevant articles, key reviews, and reference textbooks was also performed. Eligible studies and authoritative sources addressing non-odontogenic findings detectable on panoramic radiographs were qualitatively synthesized. Results: The review focuses on carotid artery calcifications, maxillary sinus abnormalities, mandibular radiomorphometric signs related to low skeletal bone mineral density, elongation or calcification of the stylohyoid complex, sialoliths, tonsilloliths, calcified lymph nodes, phleboliths, and laryngeal cartilage calcifications. These findings range from benign anatomical variants to radiographic indicators that may require medical or specialist evaluation. Conclusions: Panoramic radiography should be regarded as a tool for recognition and clinical suspicion rather than definitive diagnosis of extraoral or systemic disease. Dentists play a central role in systematically assessing the entire image, documenting relevant abnormalities, correlating them with patient history and risk factors, and initiating appropriate referral when indicated.

Objectives: Non‐plaque‐induced gingivitis encompasses a heterogeneous group of conditions as defined in the 2017 Classification of Periodontal and Peri‐Implant Diseases and Conditions. Recognition is challenging and often leads to diagnostic delay. This study aimed to evaluate diagnostic delay in a cohort of patients with non‐plaque‐induced gingivitis presenting as desquamative gingivitis, and to identify associated factors. Materials and Methods: In this observational study, patients were recruited from public and private oral medicine centres. Participants completed a questionnaire collecting demographic, social, and clinical information related to their condition. Association between variables and diagnostic delay were analyzed using the Student's t ‐test (significance p < 0.05). Results: Eighty‐six patients (43 from private and 43 from public centres) were enrolled. The mean diagnostic delay was 10 months. No statistically significant associations were observed between diagnostic delay and age, gender, symptom presence, smoking habits, or definitive diagnosis. In contrast, diagnostic delay was significantly higher in private oral health centre patients (11.19 months vs. 8.75 months p < 0.05) and in patients living more than 34 km from the diagnostic centre ( p < 0.05). Conclusions: Proximity to specialized diagnostic centres and the type of centre (public vs. private) were identified as determinants to reduce diagnostic delay in patients with desquamative gingivitis.

In Italy, access to public dental care is limited, and the characteristics of patients seeking hospital-based services are poorly described. A single-centre retrospective cross-sectional study was conducted, including all individuals attending their first appointment at the public Dental Clinic of Bari University Hospital (Southern Italy) between 1 January and 31 December 2023. Demographic and clinical variables, comorbidities, reasons for consultation, and travel distance from residence were retrieved from electronic records and analysed. Among 1361 patients (49% male; mean age 47.8 ± 23.3 years), most attended for oral surgery (35%) or oral pathology (17%), while other specialties accounted for the remaining visits. Many patients presented with multiple systemic conditions, particularly cardiovascular and metabolic diseases; however, a sizeable proportion were young, apparently healthy individuals who did not meet national eligibility criteria for publicly funded dental care. The dental clinic served a wide catchment area, including referrals from other regions. Documentation on education and behavioural risk factors was frequently incomplete. Overall, these findings show that complex oral medicine and oral surgery needs are concentrated in a small number of hospital clinics and support the expansion of Italian public dental services and improvements in routine data collection.

Angioedema (AE) is a heterogeneous condition characterized by acute, localized, non-pitting edema of the skin, mucosa, and submucosal tissues, with potentially life-threatening airway involvement. This comprehensive review aims to provide an updated overview of the different AE subtypes, their pathogenesis, clinical presentation, diagnostic criteria, therapeutic strategies, and dental implications. A literature search of PubMed, MEDLINE, and Google Scholar was performed for articles published between 1950 and 2025, focusing on both bradykinin- and histamine-mediated forms. The findings highlight the importance of distinguishing histaminergic AE, which typically responds to antihistamines, corticosteroids, and epinephrine, from bradykinin-mediated AE, which requires targeted therapies such as C1 esterase inhibitor (C1-INH), icatibant, or kallikrein inhibitors. Subtypes including hereditary, acquired, and drug-induced AE are reviewed, with emphasis on diagnostic markers (C4, C1-INH, C1q) and recent genetic insights in HAE-nC1INH. In dental and surgical settings, invasive procedures may act as triggers, making prophylaxis with plasma-derived C1-INH and stress management strategies essential. In conclusion, accurate subtype recognition is crucial to guide therapy and perioperative care, and further research is needed to refine diagnostic algorithms and preventive strategies.

Objectives: This multicentre case–control study aimed to investigate the potential association between oral lichen planus (OLP) and extraoral cancers. The secondary objective included the identification of risk factors for this association. Methods: The study was conducted between January 2023 and June 2024 and included 21 Italian Oral Medicine centres affiliated with the Italian Society of Oral Medicine (SIPMO). The study protocol was approved by the Ethics Committee of Università Cattolica del Sacro Cuore (Prot. ID 4073) and registered at clinicaltrials.gov (ID NCT06449248). Results: In total, 1650 participants were enrolled (550 OLP and 1100 non‐OLP patients) matched for age and sex. OLP patients showed a significantly higher prevalence of extra‐oral cancers (19.8%) compared to controls (12.4%) with a 1.79 OR (1.34–2.39, p < 0.05). Moreover, erosive OLP ( n = 32/120, 26.7%, p < 0.01) and plaque‐like variants ( n = 27/114, 23.7%, p < 0.04) seem to have a slightly increased risk of extra‐oral cancer. Conclusions: Patients with OLP had a higher risk of developing extraoral cancer; moreover, erosive and plaque‐like forms could be considered at higher risk. Potential pathogenic mechanisms involve an interplay between chronic inflammation, immune dysregulation and carcinogenesis. Therefore, the directionality of such association remains unclear, underscoring the need for prospective studies to clarify causality and temporal dynamics.