Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 18 appraisals
Clinical and experimental dermatology
Pemphigus vegetans: insights from a systematic review of the literature.
BACKGROUND: Pemphigus vegetans (PVg) is a rare variant of pemphigus vulgaris with distinct clinical and histological features, with fewer than 200 cases of patients with the condition reported. OBJECTIVES: To systematically review cases of patients with PVg and summarize clinical, histopathological, immunological features, treatment and outcomes. METHODS: Following PRISMA guidelines, PubMed, Embase and Web of Science were searched (1889 to January 2025) using 'pemphigus AND vegetans'. Eligible studies included case reports, series and observational studies. Data on demographics, subtypes, histopathology, immunopathology, treatment and outcomes were extracted. RESULTS: In total, 197 patients with the condition from 148 studies were identified. The mean age was 52.2 (SD 20.2) years with near-equal sex distribution. Oral mucosa was the commonest initial site (44.7%, 73/163); flexural areas such as the groin and axilla were frequently involved. Reported triggers included drugs, infections and vaccination. In 89 patients where clinical subtypes were reported, the Hallopeau variant was found in 47 (53%). When treatment outcomes were reported by subtype, patients with the Hallopeau variant demonstrated higher sustained remission rates (68%, 28/41) and lower mortality (2%, 1/41) compared with those with the Neumann variant [52% (16/31) sustained remission; 16% (5/31) mortality]. Key histological findings included suprabasal acantholysis (84.9%, 158/186) and eosinophilic microabscesses (65.1%, 121/186). Direct immunofluorescence showed intercellular IgG (92.4%, 121/131) and C3 (53.4%, 70/131). Oral corticosteroids (89.5%, 145/162) were the most used therapy. Relapse occurred in 23.0% (35/152) of patients achieving remission. CONCLUSIONS: This review highlights the need for standardized diagnostic criteria, improved immunological profiling and collaborative data collection to guide evidence-based management.
25 July 2026
Read appraisal →Scientific reports
Oral cancer in the era of precision medicine: molecular targets and technological innovations
This topical Collection presents a series of studies that examine molecular mechanisms, diagnostic approaches, and therapeutic strategies relevant to oral cancer. The included investigations explore topics ranging from metastasis-associated pathways and immune evasion to emerging detection technologies such as deep learning-based impedance spectroscopy and volatile organic compound analysis. Together, these studies reflect the growing convergence of molecular oncology, digital diagnostics, and translational clinical research in shaping the future of oral cancer management. This Collection represents an ongoing effort to consolidate current knowledge and guide future research in oral squamous cell carcinoma.
28 June 2026
Read appraisal →BMC oral health
Can poor nutrition and diet influence temporomandibular disorder? A systematic review.
BACKGROUND: The relationship between diet, nutrition, and painful temporomandibular disorders (TMD) is not well established, despite increasing interest in lifestyle factors in chronic pain. This systematic review aimed to synthesize available evidence on how dietary patterns and nutritional status may be associated with painful TMD. METHODS: An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL) and Web of Science for clinical and observational trials from the beginning of each database to November 2025. Risk of bias was performed using the Study Quality Assessment Tools from the National Heart, Lung, and Blood Institute (NHLBI). RESULTS: Out of 7,760 records and after the risk of bias assessment, only seven studies judged as having a low risk of bias were included. Overall, the included studies indicate that the association between dietary factors and TMD remains unclear. Prospective cohort studies did not demonstrate that prenatal or adolescent diet quality independently predicted TMD. Cross-sectional studies suggested that specific dietary patterns may be related to TMD-related symptoms. Women with myogenous TMD showed lower intake of several nutrients compared with controls. Experimental evidence indicated that monosodium glutamate ingestion increased pain intensity in myofascial TMD, while the only randomized trial found no significant pain differences between vitamin D supplementation and diclofenac. CONCLUSIONS: Current evidence suggests that some dietary components and nutritional factors may be associated with TMD-related symptoms or pain responses; however, the findings are limited, heterogeneous, and insufficient to support firm causal or therapeutic conclusions.
25 June 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Photobiomodulation for oral mucositis in cancer care: prevention, clinical management, and evidence from randomized controlled trials.
PURPOSE: This systematic review aimed to evaluate the efficacy of photobiomodulation (PBM) for the prevention and clinical management of oral mucositis (OM) in adult cancer patients, with particular emphasis on protocol characteristics potentially associated with favorable clinical outcomes. METHODS: A systematic search of PubMed, Web of Science, and Scopus was conducted up to March 31, 2026, in accordance with PRISMA guidelines. Randomized controlled trials in adult cancer patients comparing PBM with sham interventions were included. Outcomes of interest included OM incidence, severity, pain, and related clinical outcomes. The review protocol was prospectively registered in PROSPERO. RESULTS: Fifteen randomized controlled trials involving 868 adult patients were included. Most studies reported favorable effects of PBM, including reductions in severe OM incidence, pain intensity, analgesic requirements, and nutritional support needs compared with controls. Preventive intraoral PBM protocols were generally associated with more favorable outcomes, although variability in treatment parameters, delivery methods, and outcome reporting limited comparability. Most included studies demonstrated acceptable methodological quality. CONCLUSIONS: PBM appears to be a promising supportive care intervention for reducing the burden of OM in adult cancer patients, particularly in preventive settings. However, variability across protocols precludes definitive conclusions regarding optimal treatment parameters. Further high-quality randomized trials with standardized reporting are needed to refine protocol recommendations and expand evidence in therapeutic settings.
20 June 2026
Read appraisal →Quintessence international (Berlin, Germany : 1985)
Mapping sequential patterns of periodontal breakdown using longitudinal electronic health records data
OBJECTIVE: To identify probabilistic, sequential patterns of periodontal breakdown using sequential pattern mining (SPM) on a large longitudinal cohort. METHOD AND MATERIALS: Electronic health records from 19,428 patients with periodontitis (2011-2022) were analyzed. A custom SPM algorithm was developed to identify frequent temporal subsequences of tooth mobility and furcation involvement, enforcing strict temporal precedence. 'High-risk' states (eg, generalized clinical attachment loss [CAL] > 3.0 mm) were evaluated as precursors to localized failure. Association rules were ranked by confidence (conditional probability). RESULTS: The analysis revealed distinct biomechanical cascading patterns. In the mandibular anterior sextant, mobility in the central incisors was a strong probabilistic precursor to subsequent failure in the lateral incisors and canines (confidence 7.3%). A significant 'antagonistic cascade' was identified, where mandibular incisor mobility preceded maxillary incisor instability (confidence 8.1%). For molars, furcation involvement acted as a specific temporal sentinel for future mobility (confidence ~5% to 6%). Generalized high CAL was the strongest predictor of localized failure (confidence 18.9%), significantly outperforming active inflammation (bleeding on probing) as a driver of mechanical instability. CONCLUSION: Progressive biomechanical compromise (such as tooth mobility and advanced furcation involvement) follows predictable, probabilistic sequential patterns. The identification of specific 'sentinel events,' such as mandibular incisor mobility and molar furcation involvement, allows for a shift from reactive site-by-site management to predictive intervention. CLINICAL RELEVANCE: These findings underscore the critical role of generalized attachment loss in driving localized mechanical failure cascades.
22 May 2026
Read appraisal →Clinical oral investigations
Evaluation of a novel dual-headed toothbrush design for periodontal health: split-mouth randomized blind clinical trial
BACKGROUND: Optimal oral health largely depends on the successful removal of plaque through effective brushing, but success typically relies on user technique, time, and adherence. The aim was to compare the effectiveness of a newly introduced dual-headed toothbrush with a conventional single-headed toothbrush in control of plaque and gingival health using a split-mouth design. METHODS: In the study, 37 dental professionals used two types of toothbrushes: a dual-headed toothbrush on one side of the mouth (Test side) and a conventional single-headed toothbrush on the other side (Control side). The study compared plaque removal, gingival status, and brushing time, assessing clinical outcomes using plaque index (PI), gingival index (GI), and modified sulcus bleeding index (mSBI) at baseline, 2 weeks, and 4 weeks. At the end, participants completed a Likert scale questionnaire. RESULTS: Both types of toothbrushes were effective in enhancing oral hygiene over time; however, dual-headed toothbrush group showed significant short-term reductions in plaque accumulation, gingival inflammation, and bleeding, particularly at the 2-week interval. A significant majority of participants (89.2%) rated dual-headed brush as "very easy" to use. Using a dual-headed toothbrush significantly reduces the brushing time (0.54 ± 0.17 vs. 0.99 ± 0.05 min for a conventional single-headed toothbrush), suggesting enhanced time efficiency. CONCLUSION: A dual-headed toothbrush would be more effective, faster, and easier to use than a single-headed brush. It would be a convenient alternative, especially for individuals with time constraints.
21 May 2026
Read appraisal →Brazilian oral research
Effect of strict oral hygiene on self-rated halitosis and quality of life in patients with periodontitis: a secondary randomized controlled trial analysis
This single-blind, randomized clinical trial evaluated the impact of a strict oral hygiene (OH) phase on self-reported halitosis and quality of life (QoL) in patients with periodontitis. This study reports a secondary analysis of a single-blind randomized controlled trial (parallel, 1:1), registered at RBR-5jmx32v. The study included 24 individuals diagnosed with periodontitis who were randomly assigned to the intervention group (IG; n = 12) and the no-intervention group (NIG; n = 12). After receiving personalized OH instructions, the IG participants followed a rigorous OH phase for 45 days, whereas the NIG participants received no guidance during this period. The halitosis-associated QoL test (HALT) was administered at baseline and after 45 days. Data were analyzed using t-tests, chi-square tests, and multilevel linear regression, with significance set at p < 0.05. The average age of the study participants was 47.2 years, with a balanced sex distribution and no differences in income or education. Self-reported halitosis decreased from 100% to 50% in the IG after 45 days, whereas it remained at 91.6% in the NIG (p = 0.034). The IG also showed a mean HALT score reduction of 11.9 points (-11.88; 95% CI: -19.40 to -4.36), with significant improvements in social impact and self-esteem (p < 0.05). Clinically, BOP (p < 0.001) and VPI (p = 0.03) improved significantly in the IG, with no significant changes in NIG. This exploratory trial demonstrates that implementing a strict OH phase in patients with periodontitis may help reduce self-reported halitosis, improve HALT scores, and improve clinical outcomes, supporting its role as an adjunctive strategy in periodontal care.
21 May 2026
Read appraisal →Biomedical physics & engineering express
Oral squamous cell carcinoma diagnosis with time and frequency domain features from optical coherence tomography A-scan signals
Optical coherence tomography (OCT) is extremely useful in the screening and detection of oral cancers. But various challenges, such as its subjectivity, operator dependence in interpretation, and lack of quantitative outcomes, have been delaying its adoption in clinical decision-making. The objective of this research is to quantify various A-scan features embedded in the OCT signal through advanced signal processing techniques and machine learning algorithms.Ex vivoimaging of biopsied oral tissues (normal mucosa, carcinomain situ(CIS), well-differentiated, and poorly differentiated oral squamous cell carcinoma) was performed using a spectral domain OCT system. Our A-scan dataset consisted of representative 1D signals obtained from different regions of the tissue bed. A set of 12 time- and 8 frequency-domain features were computed on each A-scan, and ten machine learning models were evaluated for binary and multi-label classification. LightGBM achieved the highest performance in both binary (accuracy: 0.8847,F1: 0.8878, AUC: 0.9539) and multi-label classification (accuracy: 0.8248,F1: 0.8201, AUC: 0.964). LightGBM was selected as the final model based on its superior and consistent performance across both classification paradigms. Our proof-of-concept feasibility study demonstrates good accuracy for differentiating oral mucosal tissues, highlighting the biomarker signature of A-scans.
19 May 2026
Read appraisal →Molecular biology reports
Oral mucosal microbiome alterations in recurrent aphthous stomatitis: a systematic review of 16 S rRNA gene sequencing studies
Recurrent aphthous stomatitis (RAS) is a prevalent inflammatory disorder of the oral mucosa characterized by recurrent painful ulcerations in otherwise healthy individuals. This systematic review aimed to evaluate alterations in the oral mucosal microbiome of patients with RAS based on studies using 16 S rRNA sequencing. A systematic search of PubMed, Scopus, and Web of Science was conducted on April 14, 2026. Eligible studies included human case-control investigations evaluating oral mucosal swab samples from patients with clinically diagnosed RAS and healthy controls using 16 S rRNA sequencing. Studies based solely on saliva, culture methods, PCR-only analyses, or lacking controls were excluded. Joanna Briggs Institute Critical Appraisal Checklist for Case-Control Studies was used for the evaluation of selected articles. Six studies met the inclusion criteria. Considerable heterogeneity was observed in alpha and beta diversity outcomes. Most studies reported reduced microbial richness in RAS lesions, whereas others found increased or unchanged diversity. Ulcerated sites frequently demonstrated reduced abundance of health-associated taxa such as Streptococcus and Firmicutes, with increased levels of Proteobacteria and inflammation-associated genera including Neisseria, Haemophilus, Prevotella, and Fusobacterium. Microbial alterations were most pronounced at active ulcer sites, while non-ulcerated or healed mucosa more closely resembled healthy controls. Current evidence suggests that RAS is associated with localized, site-specific microbial dysbiosis rather than generalized oral microbiome disruption. However, methodological heterogeneity and small sample sizes limit definitive conclusions. Future standardized longitudinal studies integrating functional metagenomics are warranted to clarify the role of the microbiome in RAS pathogenesis.
16 May 2026
Read appraisal →Clinical oral investigations
Classification of occlusal caries severity using spectrophotometric CIELAB measurements and machine learning algorithms
OBJECTIVES: This study evaluated whether spectrophotometric CIELAB color measurements can support machine-learning (ML) classification of occlusal caries severity based on ICDAS categories. METHODS: Three hundred extracted human teeth were visually classified using ICDAS (0-4) and served as labels for supervised learning. Five occlusal sites per tooth were measured using a spectrophotometer under standardized conditions. Site-level CIELAB values were transformed into engineered color features and aggregated at the tooth level. Teeth were categorised as sound (ICDAS 0), initial carious lesions (1-2), and moderate carious lesions (3-4). Five ML models: Random Forest (RF), XGBoost, CatBoost, Multilayer Perceptron (MLP), and a Deep Sets architecture were trained. Performance was evaluated using accuracy, balanced accuracy (BA), and macro-F1, with additional binary analyses for early (ICDAS 1-4 vs. 0) and operative lesion detection (ICDAS 3-4 vs. 0-2), based on the included ICDAS range. Learning curve analysis was performed to evaluate the effect of training data size on model performance. RESULTS: Deep Sets achieved the highest multiclass performance (BA = 0.89) followed by the MLP (BA = 0.72). Tree-based models demonstrated lower performance overall. For early lesion detection, all models showed high sensitivity (SE) but reduced specificity (SP). At the operative level, the MLP achieved 100% SE and moderate SP. Learning-curve analysis showed that neural models benefited most from increased training data, whereas tree-based models showed limited improvement. CONCLUSION: Under controlled in-vitro conditions, spectrophotometric CIELAB measurements enabled machine-learning classification of occlusal caries severity. Deep sets achieved the highest overall performance, supporting the potential of color-based approaches as adjunctive tools for caries assessment. CLINICAL RELEVANCE: Spectrophotometric tooth color measurements may support machine learning classification of occlusal caries severity under controlled conditions, using an image-independent approach. Such color-based methods may complement visual assessment by providing a more standardized and reproducible evaluation of enamel changes following further validation.
16 May 2026
Read appraisal →Clinical oral investigations
Efficacy of subgingival irrigation with chemical agents as adjuvants to non-surgical periodontal therapy: systematic review and meta-analysis
OBJECTIVE: This systematic review aims to assess the efficacy of chemical agents (CA) in subgingival irrigation as an adjunct to non-surgical periodontal treatment (NSPT) in the treatment of periodontitis. METHODS: Search strategies were developed for MEDLINE via PubMed, Web of Science, and LILACS databases for publications up to March 2025. Risk of bias was assessed according to the RoB 2.0 tool. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing pocket depth (PPD), and bleeding on probing (BOP). RESULTS: From 1244 studies initially screened, 16 randomized clinical trials were included for qualitative and quantitative analyses. Studies assessed the effects of the following chemical agents: Povidone-iodine (PVP-I), Essential Oils (EOs); Chlorhexidine (CHX), Ozonated water (OW) and Boric Acid (BA). Overall, the meta-analysis showed that the adjunctive use of CA as subgingival irrigation did not provide additional benefit in PPD reduction, CAL gain, and BOP compared with controls (P > 0.05). Most studies raised some concerns with risk of bias, and 2 showed a high risk of bias. CONCLUSION: Adjunctive use of chemical agents in subgingival irrigation during NSPT for periodontitis patients does not appear to provide additional benefit over NSPT alone, although evidence levels are low to very low. CLINICAL RELEVANCE: CA are frequently used as adjuncts to NSPT, despite uncertainty regarding their real clinical contribution. The findings of this study help clinicians make more evidence-based decisions and avoid unnecessary use of adjunctive subgingival irrigation strategies during periodontal treatment.
14 May 2026
Read appraisal →International journal of oral science
Machine learning-driven discovery of therapeutic nucleoside hydrogels for periodontitis
Supramolecular hydrogels hold significant potential in drug delivery and tissue engineering, with standing out for their unique properties. Despite their promise, predicting nucleoside bioactivity remains challenging. This study aims to predict the biological activity of nucleosides to guide the rational synthesis of hydrogels. Specifically, nine predictive models and databases for various biological activities were built with feature-selected machine learning methods including decision trees, logistic regression, random forest, and extreme gradient boosting. Then, the Molecular Bioactivity Specificity Index (MBSI) was introduced to gauge the primary bioactivity of nucleoside derivatives, and the Composite Molecular Attribute Score (CMAS) was devised to measure the overall performance of nucleoside derivatives. Subsequently, screening strategies for bioactive nucleoside hydrogels were established, and two candidate hydrogels (GMP and dGMP) with high hydrogel-forming ability, biocompatibility, and antibacterial activity were identified. Finally, two hydrogels were validated for antibacterial treatment of periodontitis. This study highlights the feasibility of ML-based strategies and MBSI/CMAS in rationally designing bioactive nucleoside hydrogels for biomedical applications. The discovery of GMP and dGMP hydrogels and their successful validation in periodontitis models highlight the potential of this strategy for developing targeted therapies for oral diseases.
14 May 2026
Read appraisal →Scientific reports
Effectiveness of intracanal cryotherapy in reducing post-endodontic pain in irreversible pulpitis: a systematic review and meta-analysis
Irreversible pulpitis is characterized by persistent inflammation and moderate to severe pain, often requiring pharmacological or adjunctive strategies for postoperative management. Intracanal cryotherapy has emerged as a simple, cost-effective technique to mitigate this pain by utilizing cold-induced physiological responses. This systematic review and meta-analysis aimed to evaluate the clinical evidence regarding the effectiveness of intracanal cryotherapy in reducing postoperative pain in teeth with irreversible pulpitis. Electronic searches were conducted in PubMed, Web of Science, Cochrane, and Scopus up to October 2025. Randomized controlled trials (RCTs) comparing intracanal cryotherapy to conventional endodontic treatment. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2. Random-effects meta-analysis was performed using SMD for pain levels at 6, 12, 24, 48, and 72 h. Twelve RCTs were included; nine were meta-analyzed. Cryotherapy significantly reduced pain at 6 and 12 h but not later time points. Intracanal cryotherapy appears to be a safe and inexpensive adjunct that is associated with reduced early postoperative pain, with the most consistent effect observed within the first 6-12 h. Heterogeneity and short follow-up periods. Cryotherapy reduces early postoperative pain only.Registration: PROSPERO CRD420261295239.
27 Apr 2026
Read appraisal →PloS one
Development and evaluation of a multimodal feature-based predictive model for radiotherapy-induced oral mucositis in nasopharyngeal carcinoma
BACKGROUND: Accurate prediction of radiation-induced oral mucositis is crucial for personalized treatment in head and neck cancer. However, developing robust predictive models utilizing high-dimensional multimodal data (CT imaging, dose distribution, and clinical features) remains challenging, particularly in cohorts with limited sample sizes. OBJECTIVE: This study aimed to rigorously evaluate and compare the multi-class predictive performance of traditional machine learning algorithms and deep learning architectures under a small-cohort setting. METHODS: Multimodal data from 108 patients were collected. A comprehensive evaluation framework incorporating nine traditional machine learning algorithms and two deep learning models (a dimensionality-reduced 1D-CNN and a multimodal 3D-CNN) was established. To ensure robust evaluation, a stratified 5-fold cross-validation was employed. Model performance was comprehensively quantified using mean ± standard deviation (SD) across multiple metrics, including the Area Under the Curve (AUC), accuracy, and Matthews Correlation Coefficient (MCC). RESULTS: Inter-rater reliability for RIOM grading was excellent (Cohen's kappa = 0.82, 95% CI: 0.73-0.91). Among traditional machine learning approaches, the Extra Trees (ET) algorithm achieved the highest discriminative capacity (AUC: 0.956 ± 0.046), while Logistic Regression (LR) demonstrated optimal overall accuracy (0.832 ± 0.155) and stability. Regarding deep learning, the lightweight 1D-CNN utilizing fused low-dimensional features exhibited highly competitive and robust performance (AUC: 0.900 ± 0.072; Accuracy: 0.732 ± 0.140). In stark contrast, the high-dimensional multimodal 3D-CNN suffered from severe overfitting and mode collapse phenomenon, yielding significantly inferior results (AUC: 0.568 ± 0.090; MCC: -0.025 ± 0.031). CONCLUSIONS: For small-cohort radiomics and dosimetric analyses, ensemble learning models (e.g., ET) and appropriately regularized linear models (e.g., LR) remain highly effective. While deep learning holds promise, high-dimensional architectures like 3D-CNNs are highly susceptible to mode collapse without massive datasets. Instead, employing feature dimensionality reduction combined with lightweight networks (1D-CNN) is a vastly superior strategy to extract reliable predictive patterns from limited clinical data.
10 Apr 2026
Read appraisal →JMIR formative research
Evaluation of GPT-5 in Periodontitis Staging and Grading: Retrospective Observational Study
BACKGROUND: Periodontitis is a chronic gum disease affecting approximately 42% of adults aged 30 years and older in the United States. Training dental students to accurately diagnose and manage periodontitis is a critical component of dental education and clinical care. Recent advances in large language models offer new opportunities to support both domains, yet their performance in periodontal diagnosis remains largely unexplored, particularly for newer models such as GPT-5. OBJECTIVE: This study conducted an exploratory evaluation of GPT-5's ability to stage and grade periodontitis. METHODS: A total of 25 publicly available clinical cases explicitly reporting periodontitis stage and grade were identified through Google and PubMed searches. Each case description was entered into GPT-5 using a zero-shot prompting approach to assess guideline-based reasoning without exemplar conditioning. The model's predictions were compared with the published reference diagnoses. Performance was measured using accuracy, 95% CI, unweighted Cohen κ, and weighted Cohen κ. RESULTS: Across these cases, GPT-5 showed marked class-dependent performance and a tendency to overestimate disease severity. Grading performance was notably imbalanced, with high recall for grade C but substantially lower discrimination for grade B. GPT-5 achieved a staging accuracy of 68% (95% CI 48.4%-82.8%) and a grading accuracy of 77.3% (95% CI 56.6%-89.9%), with corresponding Cohen κ values of 0.454 (95% CI 11.0%-75.6%) and 0.179 (95% CI -15.8% to 63.8%), respectively. While staging performance showed fair agreement beyond chance, the low κ for grading indicates poor agreement and limited reliability in distinguishing periodontal disease severity. CONCLUSIONS: These findings suggest that although GPT-5 demonstrates potential for guideline-based periodontitis staging and grading, its current diagnostic performance, particularly for periodontitis grading, limits its use in clinical assessment and educational training. Meaningful application in periodontal diagnosis and training will require substantial improvements in reliability and rigorous validation in larger, more diverse, and prospectively collected datasets.
7 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Preventive effects of dexamethasone oral solution on radiation-induced mucositis in patients with head and neck cancer: a randomized, triple-blind, parallel-group trial
PURPOSE: Radiation-induced oral mucositis is a frequent and debilitating complication of curative radiotherapy for head and neck cancer. This randomized, triple-blind, placebo-controlled, parallel-group trial evaluated whether a topical dexamethasone oral solution (0.5 mg/10 mL) used as a prophylactic mouthwash reduces the incidence and severity of radiation-induced oral mucositis. METHODS: Fifty-four patients with non-metastatic head and neck squamous cell carcinoma scheduled to receive ≥ 60 Gy radiotherapy were randomized 1:1 to dexamethasone mouthwash or placebo and instructed to gargle 10 mL four times daily during radiotherapy. The primary endpoint was the incidence and maximum severity of oral mucositis occurring during radiotherapy, defined as the highest grade recorded using the WHO Oral Toxicity Scale and NCI-CTCAE criteria v. 5. Secondary endpoints included patient-reported pain (VAS), dysphagia, treatment discontinuation, and mucositis status at 2 months. Fifty patients completed the study (25 per arm); four patients discontinued (reasons reported in Results). RESULTS: The dexamethasone group had significantly lower mucositis severity at all time points by WHO and CTCAE scales (all p < 0.01), a delayed peak severity (week 5 vs week 3), lower pain scores from weeks 4-7 (median VAS 0-3 versus 4-6; p < 0.01), and lower dysphagia at 2 months (32% vs 72%; p = 0.01). No grade 4 mucositis occurred in the dexamethasone arm; two grade 4 events occurred in placebo. There were no statistically significant differences in treatment discontinuation. Topical dexamethasone was well tolerated; no signal of treatment-related systemic steroid toxicity or increased oral infections was observed. CONCLUSION: In this phase II study, prophylactic topical dexamethasone mouthwash reduced the severity and delayed the onset of radiation-induced oral mucositis and improved patient-reported pain. These findings are promising but require confirmation in larger multicenter trials with longer follow-up and formal patient-reported outcomes (e.g., EORTC QLQ-H&N35, OMAS) and comparison with guideline-recommended strategies such as photobiomodulation. TRIAL REGISTRATION NUMBER: Iranian Registry of Clinical Trials; trial registration number: IRCT20240525061893N1; date of registration: 21 July 2024.
4 Apr 2026
Read appraisal →Journal of dentistry
A deep learning method for diagnosis of oral potentially malignant disorders
OBJECTIVES: This study aimed to develop and validate a two-stage deep learning method for diagnosing oral potentially malignant disorders (OPMDs). We also compared its diagnostic performance with that of clinicians at different levels of seniority and evaluated its utility as a clinical decision support tool. METHODS: A two-stage deep learning method was developed. CLA OPMD-OOML was designed to differentiate OPMDs from other oral mucosal lesions (OOML), while CLA OPMDs was designed to classify specific OPMD subtypes. The method was trained on an internal dataset (ZJUSS, n = 3305), and its generalizability was evaluated on two external multicenter datasets (WCHS and CS-SJTU, n = 1756). In a blinded, two-step comparative study, nine clinicians (junior, intermediate, and senior groups) performed diagnoses independently and then with AI assistance. RESULTS: The method significantly outperformed all clinician groups, achieving higher F1 scores in both CLA OPMD-OOML (89.9 % vs. 78.4-82.6 % for clinicians) and CLA OPMDs (92.2 % vs. 77.7-80.0 % for clinicians). It showed robust generalizability on the two external datasets, with F1 scores of 87.3 % and 86.9 % for CLA OPMD-OOML and 75.9-83.0 % for CLA OPMDs. With AI assistance, the diagnostic precision of junior and intermediate clinicians increased by 10.8 % and 5.9 %, respectively, raising the junior group's performance to the level of senior clinicians. CONCLUSIONS: The developed two-stage deep learning method demonstrated diagnostic performance comparable to or exceeding that of experienced clinicians in classifying OPMDs from clinical images. It functions as a powerful assistive tool that substantially enhances the diagnostic capabilities of junior and intermediate clinicians. CLINICAL SIGNIFICANCE: This AI method has the potential to serve as a reliable tool for large-scale early screening of OPMDs, particularly in regions with limited access to specialist dental care. It can also serve as a valuable training and decision support system for junior clinicians, helping to standardize diagnostic accuracy and improve patient outcomes through timely and accurate detection. A supplemental appendix to this article is available online.
4 Apr 2026
Read appraisal →Dental clinics of North America
Artificial Intelligence in Diagnostic Oral and Maxillofacial Imaging, Surgical Applications, and Teledentistry
The article deals with the utilization of artificial intelligence (AI) and related technologies for the diagnosis of oral and maxillofacial anatomic variants and pathologic entities. The diagnosis of dental caries and periodontal disease is the most common aspect of dental diagnosis in a general dental setting and so, there was a subsection for this topic. There are dedicated portions within this article on applications of AI for oral and maxillofacial surgery.
4 Apr 2026
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