Letters

Letters to the Editor

Troublesome tauri
I thought I would share an interesting case of
troublesome mandibular tauri.
This 54-year-old patient attended the oral
and maxillofacial outpatients department
complaining of bony growths in his lower
jaw affecting his speech and causing food
impaction. These growths had been present as
long as he could remember, but recently had
increased in size. The patient was otherwise fit
and well.
Examination revealed extensive bilateral
lingual tauri of the mandible, almost meeting
in the midline (Figure 1). The bony growths
were raising his tongue, affecting his speech,
and acting as a reservoir for food impaction.
Treatment options of conservative
measures versus surgical management were Figure 1. Pre-operative picture of the tauri in situ.
offered, and given the ongoing symptoms, the
patient was keen for removal and consented
appropriately for damage to the lingual nerve
and submandibular ducts.
The patient underwent bilateral tauri
removal under local anaesthetic by the author.
Mucosal incisions were made over the bony
growths to expose, a groove was made along
the length of the exostosis using a cooled
surgical burr and subsequent controlled
fracture of the growth from the lingual
aspect of the mandible was carried out using
Coupland’s elevators. Underlying sharp edges
of lingual plate were then smoothed with a
cooled surgical burr, and the mucosal flap was
closed using resorbable sutures. The procedure
was uneventful, and the patient returned home
with antiseptic mouthwash and analgesia.
The patient was reviewed in clinic 4
months later, and despite a turbulent post- Figure 2. Post-operative outcome.
operative period with significant pain and
temporary paraesthesia to the left side of
the tongue, was delighted with the result.
His speech was audibly improved, and he Matt Smith top-quality scientific evidence with clinical
no longer experienced food impaction. Specialty Doctor, Oral and Maxillofacial expertise and patient values to enhance
Examination revealed the area to have healed Department, Mid-Cheshire NHS Hospitals clinical decision-making.1 Given that medical
well with no damage to the underlying Foundation Trust knowledge is being constantly updated,
submandibular ducts and full sensation to his C Shaw streamlining the search process is imperative.
tongue (Figure 2). RGN, Mid-Cheshire NHS Hospitals Finding high-quality clinical care evidence is
Not only has this procedure made vast Foundation Trust a demanding task. In recent years, artificial
improvements to the patient’s current quality intelligence (AI) has shown great potential in
of life, the author also acknowledges that enhancing EBD by uncovering patterns and
The role of AI in advancing connections in medical data, big data analysis
future dental prosthetic management has also
been made more straightforward. Although evidence-based dentistry and evidence synthesis, and aiding clinical
the majority of mandibular tauri are managed Evidence-based dentistry (EBD) is widely decision support.2–4
conservatively, in the right circumstances regarded as the gold standard in global AI can automate time-consuming tasks
surgical management can be of great benefit oral healthcare owing to the increasing such as literature searching and screening.
for patients. complexity of clinical dentistry. EBD integrates Machine learning approaches, for instance, can
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enhance the efficiency and accuracy of high-
quality clinical evidence retrieval in biomedical
literature, allowing rapid evidence synthesis.5
Additionally, natural language models can
extract key data from texts, automating
evidence collection and providing quick access
to up-to-date information, thereby enhancing
clinical decision-making and improving patient
outcomes.6 Moreover, AI tools like ChatGPT
can improve scientific writing by facilitating
and accelerating the creation of high-quality
literature reviews and research articles. They
assist in data management, error identification,
and offer diverse perspectives. It is essential,
however, to review and edit generated text to
avoid issues, such as plagiarism.7
Yet, AI has limitations affecting its
performance and accuracy. These include
training data quality issues, the model’s lack
of common sense or intuition, vulnerability
to adversarial attacks, and accountability
challenges.4 Overcoming these limitations
through advancements in machine reasoning,
knowledge representation, and AI governance
is critical as these technologies become
more prevalent.
In conclusion, AI should complement,
not replace, the expertise and judgement
of dentists. With careful development and
validation, AI has immense potential to
make EBD more efficient, personalized, and
proactive, significantly improving clinical
decision-making and ultimately leading to
enhanced treatment outcomes and greater
patient satisfaction.
References
1. Kishore M, Panat SR, Aggarwal A et al. Evidence
based dental care: integrating clinical expertise
with systematic research. J Clin Diagn Res
2014; 8: 259–2562. https://doi.org/10.7860/
JCDR/2014/6595.4076
2. Schwendicke F, Samek W, Krois J. Artificial
intelligence in dentistry: chances and
challenges. J Dent Res 2020; 99: 769–774.
https://doi.org/10.1177/0022034520915714
3. Chen YW, Stanley K, Att W. Artificial intelligence
in dentistry: current applications and future
perspectives. Quintessence Int 2020; 51: 248–
257. https://doi.org/10.3290/j.qi.a43952
4. Ding H, Wu J, Zhao W et al. Artificial intelligence
in dentistry: a review. Front Dent Med 2023; 4:
1085251.
5. Abdelkader W, Navarro T, Parrish R et al.
Machine learning approaches to retrieve
high-quality, clinically relevant evidence from
the biomedical literature: systematic review.
JMIR Med Inform 2021; 9: e30401. https://doi.
org/10.2196/30401
6. Mayer T, Marro S, Cabrio E, Villata S. Enhancing
evidence-based medicine with natural
language argumentative analysis of clinical
January 2024
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trials. Artif Intell Med 2021; 118: 102098. https://
doi.org/10.1016/j.artmed.2021.102098.
7. Huang J, Tan M. The role of ChatGPT in scientific
communication: writing better scientific review
articles. Am J Cancer Res 2023; 13: 1148–1154.
Mojtaba Mehrabanian
Alumnus of University of Debrecen,
Hungary
Aisan Eskandari-Yaghbastlo
Alumnus of Gulf Medical University, UAE
Stem cell therapy in
dentistry: the future for oral
tissue regeneration
In the last period in medicine, including the
field of dentistry, extensive research has been
conducted on the regenerative ability of
stem cells. Currently, therapies for oral health
diseases can permit certain clinical parameters
during the diagnosis and development of
diseases, but cannot regenerate lost tissue.
In light of this, researchers are increasingly
interested in achieving proper regeneration of
lost dental tissues as technology develops.1
Dental-related stem cells are attractive
sources of mesenchymal stem/stromal cells
(MSCs), which can be isolated from the dental
pulp, primary teeth, dental follicles, and
periodontal ligaments.2 Dental pulp should
be only from healthy teeth, and ideally from
donors younger than 30 years old because
the cells lose their ability to regenerate. There
are many potential applications for stem cell
therapy in dentistry, and it holds promise for
a wide range of clinical outcomes, although
everything is still in at an in vitro experimental
stage. The following are some noteworthy
areas where stem cell therapy has shown
potential in dentistry.3,4
 Treatment of periodontal disease:
Stem cell therapy has the potential to
cure periodontal diseases including
periodontitis. MSCs can be used to
repair periodontal tissues, stimulate
tissue healing, and modify immune
responses, thus providing a unique
therapeutic method for the treatment of
periodontal disease.
 Reconstruction of maxillofacial defects:
Dental stem cells, particularly those
generated from the dental pulp and
periodontal ligament, have shown
promise in stimulating bone regeneration
and correcting maxillofacial bone
defects. These stem cells may develop
into osteoblasts and induce bone tissue
growth, providing a restorative therapy for
individuals with bone deficiencies.
 Regeneration of dental tissue: Stem cell-
based treatments may help to regenerate
Letters
damaged dental tissues like dentin, pulp,
and periodontal tissues. MSCs produced
from the dental pulp and periodontal
ligament have been demonstrated to
have the ability to differentiate into
various dental cell types and contribute to
tissue regeneration.
 Implantation of tooth: Stem cell-
based techniques have the potential
to significantly improve the success
rate of tooth implantation procedures.
Regenerating supporting tissues around
dental implants, such as the periodontal
ligament and alveolar bone, can be
achieved using stem cells, leading to
enhanced implant stability and longevity.
In addition, with the application of tissue
engineering, it may be possible to completely
regenerate teeth in the near future, replacing
the placement of traditional dental implants.
Moreover, dental stem cell storage services in
various developing countries, which can serve
patients for medical treatment in later years,
are increasing.5
Although the potential applications of
stem cell therapy in dentistry are promising,
further research and clinical studies are
needed to fully understand the safety, efficacy,
and long-term outcomes of these treatments.
However, available research suggests that
dental stem cells, including MSCs, have the
potential to revolutionize dental treatments
and contribute to regenerative dentistry.
References
1. Paul K, Islam A, Volponi AA. Future horizons:
embedding the evolving science of regenerative
dentistry in a modern, sustainable dental
curriculum. Br Dent J 2022; 232: 207–210.
2. Li Y, Duan X, Chen Y et al. Dental stem cell-
derived extracellular vesicles as promising
therapeutic agents in the treatment of diseases.
Int J Oral Sci 2022; 14: 2. https://doi.org/10.1038/
s41368-021-00152-2
3. Srijaya T C, Sriram S, Sugii S, Kasim N H A. Stem
cells in dentistry: potential applications and
perspectives in clinical research. In: Pham P
(ed.) Bone and Cartilage Regeneration. Stem
Cells in Clinical Applications. Cham, Switzerland:
Springer, 2016.
4. Soudi A, Yazdanian M, Ranjbar R et al. Role and
application of stem cells in dental regeneration:
a comprehensive overview. EXCLI J 2021; 20:
454–489.
5. Zeitlin BD. Banking on teeth – stem cells and
the dental office. Biomed J 2020; 43: 124–133.
https://doi.org/10.1016/j.bj.2020.02.003
Enis Veseli
Department of Prosthodontics, Dental School,
Faculty of Medicine, University of Pristina,
Pristina, Kosovo
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