Role of periodontal treatment in pregnancy gingivitis and adverse outcomes: a systematic review and meta-analysis

BACKGROUND

Pregnancy gingivitis is a common oral health issue that affects both maternal and fetal health. This study aims to evaluate the effectiveness of periodontal treatment in preventing pregnancy gingivitis, preterm birth, and low birth weight through a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive literature search was performed across CINAHL, Scopus, Cochrane, and PubMed/Medline databases from 2000 to the present. Study selection and data extraction were independently carried out by two reviewers. Statistical analyses, including heterogeneity tests, sensitivity analysis, and publication bias assessment, were conducted using RevMan 5.4 and R software.

RESULTS

A total of 13 studies were included. The meta-analysis indicated that periodontal treatment might have a potential effect on preventing pregnancy gingivitis, but this was not statistically significant (OR = 0.85, 95% CI [0.68, 1.06], I2 = 51%). Subgroup analysis revealed that periodontal treatment significantly reduced the rates of preterm birth and low birth weight in lower-quality studies, but no significant effects were observed in higher-quality studies. Sensitivity analysis and publication bias tests confirmed the stability and reliability of the results.

CONCLUSION

While lower-quality studies suggest that periodontal treatment may positively impact pregnancy gingivitis, preterm birth, and low birth weight, these effects were not supported by higher-quality evidence. Further well-designed RCTs are needed to confirm these findings and ensure their reliability. Periodontal treatment could potentially be considered as part of prenatal care to improve maternal oral health and pregnancy outcomes.

Association between salivary /microbiological parameters, oral health and eating habits in young athletes

BACKGROUND

Athletes' oral health can impact overall well-being and sports performance. This study aimed to evaluate the interactions between eating habits and oral health of 120 young athletes as compared to 30 age-matched individuals not practicing sports based on a questionnaire and the analysis of saliva.

METHODS

One hundred twenty subjects practicing various sports activities (test group) and 30 subjects not practicing sports (control group) were selected. A self-administered questionnaire was used to obtain personal data, hours and frequency of weekly training, complete pathological history, history of hard and soft tissues of the oral cavity, family history, and oral hygiene practices. The eating habits of the young participants were analyzed by investigating the number of daily meals; use and frequency in sports practice of supplements/energy drinks, fruit/juices, snacks, chocolate; daily diet; and differences between usual diet and pre-competition diet. At baseline (T0), each participant was clinically assessed for the determination of the number of decayed, missing, and filled teeth (DMFT), Silness & Löe Plaque Index (PI), and the Löe & Silness Gingival Index (GI) and qualitative analysis for the presence/absence of stains and dental erosions. At T0, before (T1) and after training sessions (T2), saliva was collected to determine resting pH, Streptococcus mutans, and Lactobacillus spp counts.

RESULTS

Test groups were trained more than 2 h, 5 times a week. Soccer players and skiers had a high percentage of caries; water polo players demonstrated the highest percentage of erosions and dental stains. Salivary resting pH showed statistically different values in three different observations between the groups. S. mutans was harbored by 60% of soccer and 70% of water polo players, while Lactobacillus spp in 43.33% of the swimmers and soccer players. Combining all the 56 variables including the clinical examination, self-reported parameters, and salivary analysis, we have identified water polo players as a distinct at-risk group for developing dental defects, expressed as an aggregate disease score. In particular, we have found that energy snacks/chocolate intake is strongly associated with ratio of S. mutans/Lactobacillus spp and that S. mutans is linked to dental defects (R = 0.88). Linear regression analysis indicates that energy snacks/chocolate intake in the study population represents a strong driver for oral dysbiosis and dental disease.

CONCLUSIONS

Our study clearly shows that athletes should follow a balanced diet that not only satisfies their nutritional needs but also avoids oral dysbiosis and subsequent dental damage.

Low salivary uric acid levels are independently associated with periodontitis

BACKGROUND

Lower salivary uric acid concentrations, the most abundant antioxidant agent in saliva, have been observed in patients with periodontitis compared to individuals with periodontal health. However, the independent association of salivary uric acid levels with periodontitis, accounting for other risk factors, as well as its association with periodontitis severity, has not been investigated.

AIM

To the independent association of salivary uric acid levels with periodontitis and the association of salivary uric acid levels with the severity of periodontitis.

METHODS

This observational and prospective study measured salivary uric acid levels in subjects with periodontitis (characterized by periodontal loss of tissue) and in subjects without periodontitis (periodontal health or localized gingivitis in < 30% of sites). Multivariate regression analysis was performed to determine independent factors associated with periodontitis. Spearman’s rho correlation coefficient was used to assess the relationship between salivary uric acid levels and periodontitis severity. A receiver operating characteristic analysis was carried out to evaluate the diagnostic performance of salivary uric acid levels in periodontitis, reporting the area under curve (AUC) and its 95%CI.

RESULTS

We included 121 subjects, 61 of them with periodontitis and 60 without periodontitis (39 with periodontal health and 21 with local gingivitis). Subjects with periodontitis compared to those without periodontitis were older (P < 0.001), had higher salivary uric acid levels (P = 0.002), higher rate of arterial hypertension history (P = 0.001) and higher rate of never-smoker history (P < 0.001). The AUC for periodontitis diagnosis by salivary uric acid levels was 66% (95%CI: 57%-75%; P < 0.001) and the better cut-off point was 111 nmol/mL. Multiple logistic regression analysis showed an independent association of salivary uric acid levels < 111 nmol/mL (OR = 6.14; 95%CI: 2.015-18.721; P = 0.001) with periodontitis after controlling for age, never-smoker history and arterial hypertension. A negative correlation of salivary uric acid levels and periodontitis severity was observed (rho = -0.32; P < 0.001).

CONCLUSION

The two novel findings of our research were, first, that low salivary uric acid concentrations are independently associated with periodontitis, even after accounting for established risk factors. Second, salivary uric acid levels show a negative correlation with periodontitis severity.

Chronic orofacial pain and pharmacological management: a clinical guide

Orofacial pain is a widespread health concern that significantly hinders an individual's capacity to engage in daily activities. This type of pain can be classified into three main categories: nociceptive pain, neuropathic pain, and nociplastic pain. Each category involves different mechanisms and requires specific treatment approaches. For optimal treatment of orofacial pain disorders, a multidisciplinary pain management approach is essential. This approach should integrate both nonpharmacological and pharmacological modalities to address the diverse underlying causes and manifestations of pain. In this review, we focus on the current evidence and advancements in the pharmacological management of chronic orofacial pain. We explored the effectiveness of different medications, their mechanisms of action, and their role within a comprehensive pain management plan.

Magnification: The game changer in dentistry

During dental examinations and treatments, many dentists are using magnification to improve their vision. The dental operating microscope serves as the most effective tool for this purpose, enhancing the quality, longevity, and outcome of clinical work. This review will explore the latest research and data on the importance of magnification devices in dentistry, including diagnostic methods, treatment options and ergonomics in specialities such as restorative dentistry, endodontics, pedodontics, periodontics, and prosthodontics. This review aims to provide insights into the optimal magnification for different clinical situations, the specific benefits of dental operating microscopes for each dental branch, and their limitations.

Evaluation of the clinical efficacy of green tea extract gel as local drug delivery for periodontitis

BACKGROUND

Periodontal disease is a chronic inflammatory condition characterized by periodontal pocket formation, clinical attachment loss, and destruction of alveolar bone. Its conventional treatment primarily involves mechanical debridement and plaque control, but localized antimicrobial therapy offers site-specific advantages. While antibiotics such as metronidazole and doxycycline are commonly used, green tea extract, which is rich in epigallocatechin gallate, has been proposed as a promising alternative for local drug delivery due to its anti-inflammatory and antimicrobial properties.

AIM

To compare the clinical efficacy of green tea extract gel and ornidazole gel as adjuncts to scaling and root planing (SRP) in patients with periodontitis.

METHODS

Teeth with probing pocket depths (PPD) of 4-7 mm were selected. Participants’ baseline oral hygiene index-simplified, plaque index, clinical attachment loss, and PPD were recorded. The participants were randomized into two groups: One received green tea extract gel after SRP, and the other received ornidazole gel. Subgingival drug delivery was performed, and participants refrained from brushing or interproximal cleaning for ten days. Their clinical parameters were re-evaluated after one month.

RESULTS

The PPD decreased significantly from baseline to one month in both groups. However, the green tea extract gel group exhibited superior outcomes to the ornidazole gel group, with a mean difference in PPD of 0.28 ± 0.78 mm at one month (P < 0.007).

CONCLUSION

As an adjunct to SRP, green tea extract gel showed greater efficacy in improving clinical periodontal parameters than ornidazole gel.

Multipurpose miniscrew-anchored palatal appliance combined with a fixed multibracket appliance to correct a Class II Division 2 malocclusion with maxillary constriction and impacted upper canine in a 13-year-old girl: A case report

This case report describes the successful non-extraction orthodontic treatment of a 13-year-old female patient affected by a Class II Division 2 malocclusion, maxillary constriction and a unilateral impacted maxillary canine. The miniscrew-assisted palatal expansion (MAPA) system was used for precise palatal miniscrew placement, achieving bicortical engagement. A hybrid T-Rex rapid palatal expander was then employed to achieve both skeletal expansion and molar distalization without requiring patient compliance. After that, tooth 2.3 was surgically exposed and orthodontically repositioned with a miniscrew-supported extrusion cantilever on a fixed vestibular appliance and piggyback mechanics. The orthodontic treatment was completed in a total of 31 months, yielding satisfactory intraoral results. Precise digital planning for palatal miniscrew insertion was instrumental in achieving bicortical anchorage, enabling the efficient use of a single multipurpose, miniscrew-supported palatal appliance.

Navigating the dual burden of dental and periodontal care in individuals who also smoke: an expert review

OBJECTIVES

Smoking poses a significant challenge to oral health, particularly in individuals with dental and periodontal disease. This expert review explores the dual burden of managing periodontal and dental care in smokers, emphasizing the impact of chronic tobacco exposure on disease progression and treatment outcomes.

STUDY SELECTION, DATA, AND SOURCES

Clinical trials, systematic reviews, and international guidelines were consulted where available. Search terms specific to the topic were entered into PubMed, Scopus, and Google Scholar to identify the most relevant literature.

RESULTS

Chronic smoking accelerates biofilm re-accumulation and periodontal tissue destruction, complicating treatment outcomes. Smoking cessation remains the most effective strategy for mitigating these risks, improving healing, reducing inflammation, and restoring microbiota balance. Dental professionals play a crucial role in integrating smoking cessation support into periodontal care through evidence-based interventions such as behavioral counseling, pharmacotherapy, and harm reduction strategies. Emerging technologies, including mobile health applications and remote monitoring, enhance patient engagement in smoking cessation efforts. Alternative nicotine products, such as e-cigarettes and heated tobacco products, may serve as harm reduction tools for smokers unwilling to quit, though their long-term effects on oral health remain unclear.

CONCLUSIONS

A multidisciplinary approach that combines periodontal therapy with tailored smoking cessation interventions is essential for improving oral health outcomes in smokers. Future research should prioritize longitudinal studies to assess the effectiveness of integrated smoking cessation and periodontal treatment strategies.

CLINICAL RELEVANCE

The integration of smoking cessation into routine dental care is essential to improve treatment outcomes and long-term oral health. This review emphasizes the need for evidence-based strategies to manage smokers in dental settings and highlights the importance of further research to refine clinical guidelines.

Using Propensity Score Subclassification to Estimate the Population-Average Causal Effect of Temporomandibular Dysfunction Experience on Oral Health-Related Quality of Life Among Australian Adults

BACKGROUND

Temporomandibular dysfunction (TMD) experience might impair oral health-related quality of life (OHRQoL). Causal inference using population-based cross-sectional data is challenging given the potential for bias. Propensity Score Subclassification (PS-Subclassification) provides a tool to mitigate confounding bias. The aim of this study was to estimate the Population-Average Treatment Effect (PATE) of having TMD experience among Australian adults on OHRQoL using PS-Subclassification and statistically estimated Minimally Important Differences (MID-S).

METHOD

Australia's National Survey of Adult Oral Health (NSAOH) 2004-06 data were used which included a Computer Assisted Telephone Interview, mailed questionnaire and oral epidemiological examination. Data included demographics, socioeconomics, caries experience (DMFT index), periodontitis, TMD experience using the TMD Diagnostic Criteria Question, the Oral Health Impact Profile (OHIP-14) and perceived stress. Analysis steps included: (1) generating propensity scores (PS) for TMD experience probability using causal model-derived confounders while incorporating survey design elements; (2) PS-Subclassification and weighting; (3) assessing common support and group balance and (4) estimating the PATE for TMD experience on OHIP-14 overall and domains scores using complex samples GLM.

RESULTS

Of the 4063 NSAOH participants, 397 with TMD and 3656 without TMD were included in PS-Subclassification (all data were used) and shared common support for their PS and established adequate covariate balance (SMD < 0.2). Experiencing TMD had higher OHIP-14 total scores (B = 3.498, 95% CI: 2.218-4.778) with a small MID-S (Cohen's F2 = 0.03). TMD experience impaired all OHIP-14 domains (p < 0.05) with physical pain and psychological domains among the highest impaired OHIP-14 domains with a small MID-S.

CONCLUSION

TMD experience impaired the overall OHRQoL measured by the OHIP-14 among Australian adults with a small MID-S. Physical pain and psychological domains were among the highest impaired OHRQoL domains with a small MID-S. Clinicians and policymakers might consider these findings to support TMD screening and patient-centred management.

Accuracy and reliability comparison between different intraoral scanning devices in patients with permanent dentition: A prospective clinical study

OBJECTIVES

This study primarily aimed to compare the accuracy and secondarily the reliability of different intraoral scanning (IOS) devices using intra- and interarch linear measurements of three-dimensional digital dental models.

METHODS

Digital dental models were divided into three groups based on their acquisition method: group T (GT) using the Trios® IOS, group P (GP) using the Panda® (IOS), and the control group (CG) consisting of plaster models digitized with the E3® desktop scanner. Two examiners measured the following variables using the OrthoAnalyzer® software: mesiodistal tooth width, clinical crown height, intercanine, interpremolar and intermolar distances, arch perimeter, arch length, overjet and overbite. Intra- and inter-examiner reliability was assessed with the intraclass correlation coefficient (ICC) and Bland-Altman test. Intergroup comparisons were performed using the analysis of variance (Anova) followed by Tukey tests (P<0.05).

RESULTS

The sample consisted of 25 volunteers (11 men, 14 women) with a mean age of 29.6years. Overall, the measurements of digital models obtained from the Trios®, Panda® and the E3® desktop scanner were comparable. For intermolar distance, the mean and standard deviation were as follows: GT (52.4±3.55), GP (52.6±3.56), and CG (52.1±3.96) with P=0.896 for the maxillary arch, and GT (45.8±3.87), GP (46.3±4.40), and CG (46.3±4.08), with P=0.848 for the mandibular arch. No statistically significant differences were observed regarding this and other variables. Measurements showed good to excellent reliability for both Trios® and Panda® IOS.

CONCLUSION

The three scanning devices Trios®, Panda® and E3® presented similar and adequate accuracy and reliability.

Putting 'STOP' to Excess Caries of Cleft Lip and Palate Patients

BACKGROUND

Cleft lip with/without palate (CL/P) patients require multiple interdisciplinary procedures at different phases of their life. CL/P patients have a high burden of care that has financial repercussion, especially in low- and middle-income countries (LMICs). Lowering preventable diseases such as caries can mitigate this challenge.

AIM

To systematically review literature across databases to assess the quantum of caries incidence in CL/P patients in India. Subsequently, to suggest to aim for caries prevention in pilot centres and develop long-term strategies for overcoming the challenges encountered with the implementation of a suitable preventative program such as 'STOP' (Smile Train Oral Health through Prevention).

MATERIAL AND METHODS

A comprehensive literature search was conducted from the databases till December 2023 across Medline/PubMed, Scopus, EBSCOhost, and Google Scholar. The studies utilised standardised assessments, employing the DMFT, dmft, or ICDAS index for caries prevalence in cleft individuals in India. Studies meeting predefined eligibility criteria were included and assessed for methodological quality. Data on caries incidence in CL/P patients in India was extracted from included studies.

RESULTS

The current research highlights a trend towards a higher caries incidence in cleft individuals in India. Thus the need for preventative program becomes important.

CONCLUSION

Caries, which is preventable, is an additional burden both in terms of financial impact as well as chances of failure of clinical procedures.

SUGGESTED SOLUTION

STOP includes age-appropriate anticipatory guidance, preventive and minimally invasive treatment, and definitive oral health management. The outcomes of the pilot program in 4 centres in India can become the starting point for strategies involving the prevention of caries to limit the burden of care in CL/P patients. STOP can become an indispensable part in the interdisciplinary treatment chart of children born with CL/P.

Prognosis of Fragment Reattachment in Anterior Crown Fractures: A Retrospective Study

OBJECTIVE

Although several studies have compared fragment attachment with resin build-ups in anterior crown fractures, none have specifically investigated the outcome of reattached fragments. This retrospective study aimed to evaluate long-term outcomes of fragment reattachment in anterior crown fractures and determine the prognostic affecting their success.

MATERIALS AND METHODS

We retrospectively analyzed clinical records of patients who underwent fragment reattachment for crown fractures in anterior teeth (maxillary and mandibular central and lateral incisors) between 2008 and 2023. All procedures were performed by experienced professors and residents following a standardized protocol. Kaplan-Meier survival curves and Cox proportional hazards regression analyses were performed to evaluate fragment retention outcomes and identify potential prognostic factors.

RESULTS

Among 75 anterior crown fractures, the estimated fragment retention rates were 83.7% at 2 years, 75.2% at 5 years, and 56.4% at 10 years. Multivariate Cox regression analyses identified patient age and extent of crown fracture as significant factors affecting outcomes. The 5-year estimated fragment retention rates were 82.8% and 67.0% for uncomplicated and complicated crown fractures, respectively.

CONCLUSIONS

Fragment reattachment remains a viable treatment option for anterior crown fractures. Treatment success decreased with patient age, and complicated crown fractures demonstrated lower retention rates than uncomplicated ones.

CLINICAL SIGNIFICANCE

Fragment reattachment can provide predictable outcomes in anterior crown fractures when cases are carefully selected, particularly considering the patient's age and the type of crown fracture.

Effects of Electronic Cigarettes on Periodontal Health: A Systematic Review and Meta-Analysis

OBJECTIVES

The use of electronic cigarettes "e-cigarettes," or vaping is growing in popularity, especially among adolescents and young adults. While the effects of cigarette smoking on oral health are well-established, the exact impact that e-cigarettes may have on dental tissues is still uncertain. The aim of the current review was to summarize evidence related to the effect of vaping on the periodontal health status of e-cigarette users.

METHODS

A comprehensive electronic search was performed using PubMed, Web of Science, and Scopus databases, until January 31st, 2024. Two independent reviewers participated in the screening of studies, data extraction, and assessment of the included studies. Any disagreements were resolved by a third reviewer the quality assessment was done using the Newcastle-Ottawa Scale to assess the risk of bias. A frequentist meta-analysis was performed using R Statistical Software. The random effects model was adopted. Data were described as mean difference (MD) and 95% confidence interval (CI). A p-value of ≤ .05 was deemed statistically significant.

RESULTS

Ten studies met the eligibility criteria. Overall, the findings were consistent, with most studies showing that e-cigarette users are at greater risk of periodontal disease than nonsmokers, but that they have a lower risk than cigarette smokers. Pooling results showed lower mean probing depth (PD) among nonsmokers than e-smokers (MD: -1.91; 95% CI: [-3.36: -0.47]; p-value = .01) while it was higher among cigarette smokers in participants with periodontitis (MD:0.43; 95%CI: [0.08:0.79]; p-value = .02). Compared to e-smoking, nonsmokers had lower PI (MD: -20.63; 95%CI: [-28.04: -13.21]; p-value < .001) while cigarette smokers had higher PI (MD: 4.88; 95% CI: [-1.52:11.29]; p-value = .135). Among participants with periodontitis, only cigarette smokers had significantly higher PI (MD: 4.53; 95%CI: [1.94:7.13]; p-value < .001).

CONCLUSION

Based on the current analysis, conventional cigarette smoking is the most detrimental to periodontal health among the groups compared in all included studies. This indicates that traditional cigarettes have a more severe impact on periodontal tissues than do e-cigarettes. The data suggest a gradient of risk where nonsmokers have the lowest risk, e-cigarette users have a moderate risk, and cigarette smokers have the highest risk for periodontal health issues.

PROPHYLACTIC ANTIBIOTIC USE IN LOWER THIRD MOLAR SURGERY MAY REDUCE DRY SOCKET AND INFECTIONS, BUT EVIDENCE REMAINS WEAK

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Camps-Font O, Sábado-Bundó H, Toledano-Serrabona J, Valmaseda-de-la-Rosa N, Figueiredo R, Valmaseda-Castellón E. Antibiotic prophylaxis in the prevention of dry socket and surgical site infection after lower third molar extraction: a network meta-analysis. Int J Oral Maxillofac Surg. 2024;53(1):57-67.

SOURCE OF FUNDING

None declared.

TYPE OF STUDY/DESIGN

Systematic review with network meta-analysis.

Adenovirus mediated gene delivery of α-calcitonin gene-related peptide facilitates osseointegration of implant in ovariectomized rat

Background

Osteoporosis, which adversely affected osseointegration of dental implants, became prevalent with the entry of ageing era. Recent studies indicated that α-calcitonin gene-related peptide (α-CGRP) played a role in modulating osteoporosis. However, due to the plasma half-life of α-CGRP being estimated at merely 7-10 min, it was difficult to utilize a conventional method that administered sufficient α-CGRP to the implant site. This present study aimed to investigate the efficacy of an α-CGRP transgene in promoting implant osseointegration in ovariectomized (OVX) rats.

Method

The osteoporosis rat model was established through bilateral ovariectomy, following which the subjects were categorized into three distinct groups: the α-CGRP transgene group, the empty virus vector group, and the blank control group. Ad-CGRP-EGFP was locally administered into the bone defect site prior to implant placement in the OVX rats. 7 and 28 days after implantation, the femurs were isolated for molecular and histological analyses, micro-CT analysis and biomechanical test.

Result

Bone marrow stromal cells (BMSCs) transduced with Ad-CGRP-EGFP could continuously express α-CGRP more than 28 days in vitro. Successful transgene expression was confirmed through cryosectioning and Western blot analysis 7 days after implantation in vivo. The results indicated a substantial decrease in the quantity of TRAP + cells in the α-CGRP transgene group. Additionally, quantitative real-time RT-PCR and Western blot analysis revealed a significant elevation in the expression levels of Runx2 and ALP, coupled with a notable reduction in the expression of cathepsin K and RANKL (P<0.05). Moreover, the α-CGRP transgene group exhibited a significant enhancement in osteointegration and restoration of implant stability in OVX rats (P<0.01) 28 days after implantation.

Conclusion

This study implied a great therapeutic potential of α-CGRP in osseointegration of titanium implants in OVX-relative osteoporosis rats, offering valuable insights for guiding bone regeneration strategies under osteoporotic conditions.

Acceptance and Willingness-to-Pay for Teledentistry: A Contingent Valuation Study

OBJECTIVES

The study sought to assess patients' acceptance of teledentistry and their willingness-to-pay (WTP) for teledentistry.

METHODS

Patients attending a dental appointment at a public hospital in Singapore were recruited to participate in a cross-sectional study between August 2021 and March 2023. Patients' acceptance of video consults and reviews were compared using McNemar tests. A bidding game contingent valuation method with random starting points was adopted to elicit participants' WTP for teledentistry. Logistic regression was carried out to assess participants' WTP equivalent in-person costs by sociodemographic factors.

RESULTS

Out of 597 respondents, the proportion willing to have an initial consult via a video call was 54.4% and 70.9% for a video review. Teledentistry acceptance was lower among older age groups and higher among those with higher education levels (adjusted odds ratio [adj. OR] 3.63, 95% CI = 2.16-6.15 for video reviews for university graduates). The proportion of participants willing to pay at least the quantum of in-person care for video consults and reviews was 15.2% and 79.6%, respectively. Compared to those aged 21 to 30 years, the WTP for video reviews was lower among those aged 41 years and above (OR: 0.39, 95% CI = 0.20-0.72).

CONCLUSIONS

Majority of patients were willing to undergo and pay at least in-person costs for video reviews compared to video consults. Younger age and higher education levels were associated with a higher willingness to accept video consults and reviews, and a higher WTP at least the equivalent in-person costs for video reviews.

Changes of the Occlusal Relationship in Patients With Temporomandibular Disorders (TMD) After Manual Therapy: A Pilot Study

OBJECTIVES

Temporomandibular disorders (TMD) are often linked to changes in dental occlusion, yet the impact of therapeutic interventions remains unclear. This pilot study investigates the effects of manual therapy on occlusion in TMD patients through quantitative analysis of intraoral scans.

MATERIAL AND METHODS

Ten individuals were diagnosed with TMD and underwent a 40-min session of manual therapy (Group MT). Ten subjects were allocated to the healthy control group (Group C) and did not receive any therapy during the 10-week control period. Occlusion measurements were obtained using the TRIOS 3 intraoral scanner (3Shape, Denmark) both before and after the therapy or control period. The digital models were analyzed regarding occlusal changes using the GOM Inspect Professional software (GOM, Germany). The differences in the individual axesdX Pat , dY Pat , dZ Pat   ( mm ) ${{dX}}_{{Pat}},{{dY}}_{{Pat}},{{dZ}}_{{Pat}}{\unicode{x02007}}(\mathrm{mm})$ and Euclidean distanced X Y Z Pat   ( mm ) ${dXYZ}_{{Pat}}\unicode{x02007}(\mathrm{mm})$ were computed.

RESULTS

In terms of the arithmetic mean, Group MT exhibited higher deviations across all three axes (dX P a t M T = 0.122   ( mm ) , dY P a t M T = 0.217   ( mm ) ,   dZ P a t M T = 0.193   ( mm ) ${{dX}}_{PatMT}=0.122\unicode{x02007}(\mathrm{mm}),{{dY}}_{PatMT}=0.217\unicode{x02007}(\mathrm{mm}),\unicode{x02007}{{dZ}}_{PatMT}\,=\,0.193\unicode{x02007}(\mathrm{mm})$ ) as well as in the Euclidean distance( d X Y Z P a t M T = 0.347   ( mm ) ) $({dXYZ}_{PatMT}=0.347\unicode{x02007}(\mathrm{mm}))$ than the control group( d X P a t C = 0.060   ( mm ) ,   d Y P a t C = 0.063   ( mm ) ,   d Z P a t C = 0.043   ( mm ) ,   d X Y Z P a t C = 0.113   ( mm ) ) $(d{X}_{PatC}=0.060\unicode{x02007}(\mathrm{mm}),\unicode{x02007}d{Y}_{PatC}=0.063\unicode{x02007}(\mathrm{mm}),\unicode{x02007}d{Z}_{PatC}\,=\,0.043\unicode{x02007}(\mathrm{mm}),\unicode{x02007}dXY{Z}_{PatC}=0.113\unicode{x02007}(\mathrm{mm}))$ . Statistically significant differences were observed for the Y and Z axes, as well as the Euclidean distance (p < 0.05).

CONCLUSION

Considering the limitations of this pilot study, it is reasonable to suggest that manual therapy has a significant influence on occlusion in habitual intercuspidation among TMD patients.

Performance of Artificial Intelligence Chatbots in Responding to Patient Queries Related to Traumatic Dental Injuries: A Comparative Study

BACKGROUND/AIM

Artificial intelligence (AI) chatbots have become increasingly prevalent in recent years as potential sources of online healthcare information for patients when making medical/dental decisions. This study assessed the readability, quality, and accuracy of responses provided by three AI chatbots to questions related to traumatic dental injuries (TDIs), either retrieved from popular question-answer sites or manually created based on the hypothetical case scenarios.

MATERIALS AND METHODS

A total of 59 traumatic injury queries were directed at ChatGPT 3.5, ChatGPT 4.0, and Google Gemini. Readability was evaluated using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. To assess response quality and accuracy, the DISCERN tool, Global Quality Score (GQS), and misinformation scores were used. The understandability and actionability of the responses were analyzed using the Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P) tool. Statistical analysis included Kruskal-Wallis with Dunn's post hoc test for non-normal variables, and one-way ANOVA with Tukey's post hoc test for normal variables (p < 0.05).

RESULTS

The mean FKGL and FRE scores for ChatGPT 3.5, ChatGPT 4.0, and Google Gemini were 11.2 and 49.25, 11.8 and 46.42, and 10.1 and 51.91, respectively, indicating that the responses were difficult to read and required a college-level reading ability. ChatGPT 3.5 had the lowest DISCERN and PEMAT-P understandability scores among the chatbots (p < 0.001). ChatGPT 4.0 and Google Gemini were rated higher for quality (GQS score of 5) compared to ChatGPT 3.5 (p < 0.001).

CONCLUSIONS

In this study, ChatGPT 3.5, although widely used, provided some misleading and inaccurate responses to questions about TDIs. In contrast, ChatGPT 4.0 and Google Gemini generated more accurate and comprehensive answers, making them more reliable as auxiliary information sources. However, for complex issues like TDIs, no chatbot can replace a dentist for diagnosis, treatment, and follow-up care.

Implicit Racial Bias in Oral Health: A Scoping Review of Students' and Providers' Perceptions

INTRODUCTION

Implicit bias is a form of unconscious bias that can affect judgment, decisions, and behaviors.

OBJECTIVES

This scoping review examined what scientific literature exists about implicit bias demonstrated by dental/dental hygiene students and providers and, when possible, how these implicit biases are associated with patients' oral health outcomes.

METHODS

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). This review included English-language PubMed peer-reviewed studies meeting inclusion criteria, published through October 2023, measuring the implicit bias of dental/dental hygiene students or professionals and how such bias can affect patient oral health outcomes.

RESULTS

A total of 363 records were found. After removing duplicates (n = 114) and title screening (n = 60), 54 abstracts were screened, 24 reports were assessed, and 10 were included in the final review. Implicit bias was assessed using the Implicit Association Test (IAT), Brief IAT (BIAT), and Color-Blind Racial Attitudes Scale (CoBRAS). BIAT scores revealed a pro-White unconscious racial bias in clinical decision-making among dental professionals, and additional IAT results suggested implicit racial preferences for European Americans over African Americans; non-White participants showed more positive implicit preferences toward African Americans in comparison with White participants. Studies using CoBRAS suggest moderate levels of color-blind racial attitudes among students and professionals, indicating an unawareness of racism and a need to further understand the implications of bias on patient outcomes.

CONCLUSION

Despite small sample sizes and a lack of racial/ethnic diversity that limit their generalizability, the included studies provide evidence for implicit racial bias held by some dental/dental hygiene students and professionals that may affect the oral health outcomes of patients. Training to increase awareness of and reduce implicit bias among those providing oral health care is an important first step to providing a more equitable health care system for all patients.Knowledge Transfer Statement:Despite small sample sizes and a lack of racial/ethnic diversity that limit their generalizability, the included studies provide evidence for implicit racial bias held by some dental/dental hygiene students and professionals that may affect the oral health outcomes of patients. Training to increase awareness of and reduce implicit bias among those providing oral health care is an important first step to providing a more equitable health care system for all patients.

Do dental nurses and trainee dental nurses suffer from job-related stress and could mentorship help them to cope with that stress?

Background Stress in dentistry is widely researched and the evidence is that it is a stressful profession. Research has mainly focused on dentists and oftentimes the rest of the team has not been considered. Working in dentistry relies on teamwork and the multidisciplinary team; therefore, it is of paramount importance that all members of the team are researched.Aim To investigate current perceptions of stress and its triggers in dental nurses (DNs) (including trainee dental nurse [TDNs]) and explore if mentoring could help.Methodology Case study design with a phenomenological aspect. Perceptions of DNs/TDNs around stress in dentistry and its triggers and perceptions of mentoring were collected using on online questionnaire. The questionnaire was posted on Facebook using closed professional groups. The questionnaire invited interested participants to opt-in to take part in semi-structured interviews to gather more detailed insights into stress in dentistry relating to their own experiences, triggers and coping mechanisms. The semi-structured interviews were conducted and recorded on Microsoft Teams. Data were analysed using reflexive thematic analysis (RTA).Results In total, 61 DNs/TDNs with various amounts of professional experience, backgrounds and working environments completed the questionnaire, and five chose to take part in semi-structured interviews. In answering the questionnaire, all participants reported that working in dentistry is stressful, where 92% said that they are suffering or have suffered from burnout and 95% thought that having a mentor would be beneficial. The analysis of the semi-structured interviews resulted in six themes: nature of the problem - emotions, team, burnout and money; triggers - regulation/complaints, patients, time and communication; coping mechanisms - time off, reducing hours and talking; support - peers, management and friends; self-doubt - training, confidence and imposter syndrome; and mentoring - seen as a positive, unknown and mentees choice of mentor.Conclusions DNs/TDNs face job-related stress. Since they are hired members of the team, they frequently have no influence over their working environment, which fosters multiple triggers of stress. Mentoring could be a support system and coping technique. Implementation of mentorship in the early phases of a DN's/TDN's training/career may assist to lessen the negative effects of stress, such as burnout, and thus lower the number of registered employees quitting the field.

Evidence Mapping and Quality Assessment of Systematic Reviews in Dental Traumatology: A 54 Months Update

BACKGROUND/AIMS

This update of previously conducted evidence mapping and quality analysis of systematic reviews related to dental traumatology aimed to assess the distribution of systematic reviews published in a period of past 54 months in various domains and subdomains and evaluate their quality. An attempt was also made to compare the trends of methodological and quality characteristics between the two Evidence Mapping studies.

METHODS

An a priori protocol was prepared as per the recommendations of Global Evidence Mapping and registered in Open Science Framework. The boundary conditions were defined and a search was performed electronically by two authors on November 30, 2024 in PubMed, LILACS, Web of Science, Cochrane, Scopus, and EMBASE without any restrictions. EndNote Online was used to remove the duplicates and perform screening of titles and abstracts and the full texts. Data extraction was performed using a self-designed sheet and analyzed by the research group. AMSTAR-2 and ROBIS tools were used for assessing the quality of included systematic reviews.

RESULTS

The evidence mapping included 66 systematic reviews that could be distributed in six domains. The maximum number of them were in Epidemiologic domain (n = 21) and the subdomain of "treatment protocols of permanent teeth" (n = 14). The conclusion of 27 SRs was graded as inconclusive. An a priori registration of protocol was done in 55 SRs, majority of reviews did not have any restrictions in search, and gray literature search was done in 39 SRs. The most common risk of bias (ROB) tool used was the Jonna Briggs Institute's Critical Appraisal Checklist. The ROB of 51 SRs was low as per ROBIS, and high level of confidence was exhibited by 24 SRs as per AMSTAR-2.

CONCLUSION

The highest number of SRs was seen in the domain of epidemiology, followed by therapeutic and prognostic domains. As per ROBIS, 77.27% of SRs were found to have low ROB with a high level of confidence in 39.4% SRs as per AMSTAR-2. There was significant improvement in methodological and quality trends as compared to the previous Evidence Mapping.

Vacuum Ultraviolet (VUV)-Induced Physicochemical Engineering of Titanium: Enhanced Fibroblast Activity, Redox System, and Glycosaminoglycan Binding for Soft Tissue Integration

Bacterial invasion at the titanium-tissue interface causes peri-implant inflammation, posing challenges for implants in orthopedics, maxillofacial prosthetics, and dentistry. This study hypothesized that titanium surface decarbonization improves soft tissue cell adhesion and growth. One-minute vacuum ultraviolet (VUV) light treatment at 172 nm reduced surface carbon from 60% to 29% without altering surface topography, making surfaces hydrophilic and hydro-attractive. Human fibroblasts attached to VUV-treated surfaces 2-4 times more frequently than untreated surfaces, with an even greater increase on tilted and curved surfaces. Fibroblast proliferation rose 2-6 times, with an expedited G1-to-S phase transition. Cell retention under dislodging forces increased 2-5 times on VUV-treated surfaces. RNA sequencing showed upregulation of extracellular matrix production, growth factors, cell cycle progression, antioxidant defenses, and proteoglycan/glycosaminoglycan (GAG)-binding, alongside downregulation of the inflammatory response on VUV-treated titanium surfaces. An oxidative stress test showed minimal adverse effects from hydrogen peroxide on cells on VUV-treated surfaces, attributed to increased intracellular glutathione reserves. Enhanced adhesion on VUV-treated titanium was negated by treating the cells with GAG-cleaving enzymes. These findings demonstrate that VUV-mediated decarbonization enhances fibroblast attachment, proliferation, and adhesion by fostering homeostatic cellular phenotypes involving proteoglycan/GAG interactions and antioxidant defense, offering a strategy to improve the soft tissue sealing around titanium implants.

Artificial intelligence in pediatric dental trauma: do artificial intelligence chatbots address parental concerns effectively?

BACKGROUND

This study focused on two Artificial Intelligence chatbots, ChatGPT 3.5 and Google Gemini, as the primary tools for answering questions related to traumatic dental injuries. The aim of this study to evaluate the reliability, understandability, and applicability of the responses provided by these chatbots to commonly asked questions from parents of children with dental trauma.

METHODS

The case scenarios were developed based on frequently asked questions that parents commonly ask their dentists or Artificial Intelligence chatbots regarding dental trauma in children. The quality and accuracy of the information obtained from the chatbots were assessed using the DISCERN Instrument. The understandability and actionability of the responses obtained from the Artificial Intelligence chatbots were assessed using the Patient Education Materials Assessment Tool for Printed Materials. In statistical analysis; categorical variables were analyzed in terms of frequency and percentage. For numerical variables, skewness and kurtosis values were calculated to assess normal distribution.

RESULTS

Both Artificial Intelligence chatbots performed similarly, although Google Gemini provided higher quality and more reliable responses. Based on the mean scores, ChatGPT 3.5 had a higher understandability. Both chatbots demonstrated similar levels of performance in terms of actionability.

CONCLUSION

Artificial Intelligence applications can serve as a helpful starting point for parents seeking information and reassurance after dental trauma. However, they should not replace professional dental consultations, as their reliability is not absolute. Parents should use Artificial Intelligence applications as complementary resources and seek timely professional advice for accurate diagnosis and treatment.

Global, regional, and national caries of permanent teeth incidence, prevalence, and disability-adjusted life years, 1990-2021: analysis for the global burden of disease study

OBJECTIVES

This study aims to analyze the global, regional, and national incidence, prevalence, and disability-adjusted life years (DALYs) related to caries of permanent teeth from 1990 to 2021, as part of the Global Burden of Disease Study (GBD).

STUDY DESIGN AND METHODS

Data on incidence, prevalence, and DALYs were extracted and analyzed for various demographic and regional categories. Age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR), and age-standardized DALY rates (ASDAR) were calculated. Temporal trends and associations with sociodemographic index (SDI) were also examined.

RESULTS

In 2021, there were approximately 2.37 billion cases of caries of permanent teeth, with an ASIR of 29,777.03 per 100,000 population. The prevalence was around 2.24 billion, with an ASPR of 27,543.34 per 100,000. Females exhibited a higher disease burden than males, and the burden increased with age, peaking in the 20-24 age group. Regions with lower SDI showed higher ASIRs, while the highest burden was noted in Tropical Latin America. Significant increases in disease burden were observed from 1990 to 2021, particularly in China and Colombia, while Japan showed a decrease. The Bayesian age-period-cohort (BAPC) predictions indicate that the burden of caries of permanent teeth will continue to increase year by year.

CONCLUSION

The burden of caries of permanent teeth varies significantly across regions and demographics, with higher rates in lower SDI areas. The findings underscore the importance of targeted interventions and resource allocation in high-burden regions to improve dental health outcomes.

Dental Trauma Education Among North American Dental Schools: Results From Multi-Center Interviews With Dental Educators

BACKGROUND/AIMS

Studies highlighted the limited confidence of general dentists to effectively manage dental trauma (DT) cases. DT education at the predoctoral level varies globally; however, little is known about it in North American dental schools. This gap in understanding could explain deficiencies in general dentists' treatment of DT cases. Therefore, this study aimed to gain insights into the existing predoctoral DT education across North American dental schools, identify gaps, and recommend improvements to refine and unify DT education.

METHODS

Interviews were conducted with DT instructors and curriculum coordinators from North American dental schools. A validated questionnaire was used for the interviews. The questionnaire was divided into three sections: DT curriculum, student assessments, and clinical exposure during predoctoral training. Qualitative data were analyzed individually and grouped for common findings.

RESULTS

The overall response rate was 62.6% (n = 52 universities). Sixty-three instructors from 48 dental schools participated in the analysis. Four schools opted out of the study. DT education was found to be fragmented in 47 schools, with a mean of 5.7 ± 1.57 h allocated to DT teaching. Only nine schools assessed students after completing DT coursework, and just one conducted a final examination solely on DT. All instructors reported insufficient clinical exposure to DT cases during rotations.

CONCLUSIONS

Dental educators reported significant deficiencies in DT education in North American dental schools. Limited clinical exposure and an inconsistent curriculum may leave students ill prepared for managing DT cases. Increased hands-on experience and curriculum standardization across schools could improve DT education and preparedness.

Facts and Fallacies of the Fluoride Controversy: A Contemporary Perspective

Fluoride is a natural element recognized for its dental benefits. Fluoride prevents caries due to its antimicrobial activity, enhancing enamel resistance and promoting remineralization After decades of fluoridation of municipal water supplies to reduce dental caries, an intense debate has resurfaced regarding water fluoridation as a public health strategy to combat caries. This renewed discourse occurs against the backdrop of extensive data that clearly demonstrate the vital role of fluoride in caries prevention. Indeed, the Centres for Disease Control and Prevention has stated water fluoridation as 1 of the top ten public health interventions in the twentieth century. The FDI World Dental Federation also advocates systemic fluoride use as a cost-effective caries prevention strategy, and supports its inclusion in public health policies through a number of policy directives. This debate in the US has intensified as a Court concluded that water fluoridation poses unreasonable risks such as reduction of the intelligence quotient (IQ) in children. Additionally, recent statements from the leadership of the US Health and Human Services agency suggest that water fluoridation may cause more harm than good leading some states, like Utah, to revoke fluoridation mandates This article aims to provide a contemporary perspective on fluoride by revisiting its benefits, controversies, and potential risks. It highlights the dual role of fluoride in both individual oral care and public health and underscores the necessity for safe, equitable, and effective delivery strategies tailored to the needs of diverse populations, balancing its preventive advantages with potential health concerns. The review culminates with a summary of policy statements from the FDI World Dental Federation regarding the promotion of oral health through both systemic and topical fluoridation.

Cytopathological quantification of NORs using artificial intelligence to oral cancer screening

Oral squamous cell carcinoma (OSCC) remains the most prevalent neoplasm of the head and neck. In recent decades, the incidence and prevalence of OSCC have not significantly changed, highlighting the critical need to develop and implement new risk assessment measures. The present study aimed to define argyrophilic proteins of the nucleolar organizer region (AgNOR) cut-off risk points by oral exfoliative cytological smears comparing specialized humans with a convolutional neural network (CNN) system AgNOR Slide-Image Examiner. This study included four experimental groups: control, exposure to carcinogens (alcohol and tobacco), oral potentially malignant disorders, and OSCC. In the first phase, 50 cells were used for AgNOR quantification. In the second phase, AgNOR quantification was established in an automated manner using an AgNOR System - Slide Examiner (captured - bounding-boxed - CNN analysis). In phase 1, the cut-off point for considering a smear as suspicious was established at 3.69 AgNORs/nucleus with sensitivity of 86%, specificity of 93%, and accuracy of 90%. In phase 2, the analysis of the intraclass correlation coefficient of AgNORs attributed to the system and human was 0.896 (95% confidence interval = 0.875-0.915; p < 0.0001), and this quantification with the CNN was 20 min compared to 67 h, considering human analysis. The AgNOR Slide-Image Examiner successfully differentiated the nuclei and accurately quantified the number of NORs in oral cytological smears. The cut-off risk point of 3.69 AgNOR/nucleus indicates a suspicious sample may contribute to improvements in oral cancer screening.

IL7-IL7R Interaction Mediates Fibroblast-Driven Macrophage-to-Osteoclast Differentiation in Periodontitis

Aim

To identify osteoclastogenic macrophage subsets and their regulatory mechanisms in periodontitis.

Methods

We integrated single-cell RNA sequencing datasets from human and murine periodontitis to construct a comprehensive macrophage and monocyte atlas. Employing functional enrichment, cell-cell communication, pseudotime, transcription factor, and machine learning analyses, we characterized and selected the specific macrophage subset involved in cell interactions. In vitro and in vivo experiments, including enzyme-linked immunosorbent assay, TRAP staining, micro-CT, qPCR, flow cytometry, and immunofluorescence staining, were performed to dissect the osteoclastogenic potential of specific macrophage subsets and to identify the key pathways.

Results

We discovered that the IL7R+ macrophage subset possesses significant osteoclast differentiation potential. Our findings indicate that the IL7/IL7R signaling axis facilitates osteoclast differentiation. Genes highly expressed in IL7R+ macrophages were identified as strong predictors for periodontitis by machine learning models. In vivo and in vitro experimental validation confirmed an increase in IL7R+ macrophages, along with their enhanced osteoclastogenic capacity. confirmed an increase in IL7R+ macrophages, along with their osteoclastogenic capacity. The inhibition of the IL7/IL7R signaling pathway was found to mitigate periodontitis progression by impeding osteoclast differentiation. Furthermore, fibroblasts were found to secret IL7 interacting with IL7 receptors on macrophages.

Conclusion

Our study identifies IL7R+ macrophages as potential osteoclast precursors in periodontitis. We demonstrate that the IL7/IL7R signaling pathway is a critical driver of osteoclast differentiation. Moreover, targeting IL7R is a potential therapeutic strategy to curb periodontitis bone resorption.

Post-treatment stability after insertion of CAD/CAM fabricated or Conventional fixed orthodontic retainers: a two-year follow-up

OBJECTIVE

Since relapse after orthodontic treatment and stability and failure of CAD/CAM fabricated and Conventional fixed retainers are widely discussed, this study investigated and compared two-year post-treatment stability after insertion of a CAD/CAM fabricated or Conventional fixed retainer in the lower jaw.

MATERIALS AND METHODS

Digitized dental casts or intraoral scans of n = 60 patients were used for data acquisition. The patients were divided into two groups according to the retention protocol: CAD/CAM fabricated fixed retainer (n = 30, mean age 16.97 ± 5.74 years) and Conventional fixed retainer (n = 30, mean age 15.70 ± 4.19 years). The evaluation included established procedures for dental measurements of the mandible (Intercanine Distance and Little´s Irregularity Index) before orthodontic treatment, at the end of orthodontic treatment, when the fixed retainer was inserted and two years after the insertion of the fixed retainer. All retainers were inserted by the same practitioner. Complications were recorded. Statistics included Shapiro-Wilk-, T- and Friedman-Tests. The level of significance was set at p < 0.05.

RESULTS

In patients with Conventional fixed retainers the change of the Intercanine Distance between insertion of the fixed retainer and two years afterwards was significantly more pronounced than in patients with CAD/CAM fabricated fixed retainers (ICD: Δ CAD/CAMt1-t2: -0.03 ± 0.22 mm; Δ Conventionalt1-t2: 0.12 ± 0.29 mm). Stability of Intercanine Distance was less in patients with Conventional fixed retainers. The change of Little´s Irregularity Index was not significant between the groups. In two patients with a Conventional fixed retainer a bonding surface was renewed within the first three months.

CONCLUSIONS

Within two years, CAD/CAM fabricated fixed retainers showed less relapse of Intercanine Distance and fewer complications than Conventional fixed retainers.

CLINICAL RELEVANCE

Considering the amount of relapse and the differences in complications, CAD/CAM fabricated fixed retainers and Conventional fixed retainers are useful appliances for stabilization of treatment results with favorable stability. Fabrication of CAD/CAM based fixed retainers is aside from that timesaving compared to Conventional fixed retainers.

Association between restoration of missing teeth with dentures and cognitive function

A COMMENTARY ON

Ma X, Zhang Y, Wang J et al. Association between denture restoration for tooth loss and cognitive impairment: a systematic review and meta-analysis. J Prosthodont Res 2025; https://doi.org/10.2186/jpr.JPR_D_24_00060 .

DATA SOURCES

A search was conducted across five electronic databases, including PubMed, EMBASE, Cochrane Library, MEDLINE, and CNKI, from January 2000 to January 2024. The search strategy included keywords related to tooth loss, dentures, cognitive function, memory loss and dementia. Reference lists of relevant studies were also screened to identify additional articles. The search was limited to the English language only.

STUDY SELECTION

Observational studies examining the association between denture restoration and cognitive impairment were included. Eligible studies had to report cognitive impairment or dementia as the outcome and denture restoration as the exposure factor. Six studies with a total of 24,252 participants met the inclusion criteria.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted relevant data, including study design, participant characteristics, dental status, cognitive assessment methods, and statistical results. Meta-analysis was conducted using risk ratios (RR) with 95% confidence intervals (CI), applying a random-effects model due to clinical and methodological variations. Newcastle-Ottawa Scale and the Agency for Healthcare research and quality scale were used for quality assessment of included studies. Beg- Mazumdar and Egger regression tests were used to assess the publication bias.

RESULTS

The meta-analysis revealed that participants with tooth loss without dentures had a 1.27-fold higher odds of having cognitive impairment, whereas those with dentures had only a 1.02-fold odds. A dose-response analysis showed that each additional missing tooth increased the cognitive impairment risk by 1.009 times in the non-denture group, while the denture group exhibited a lower risk increase of 1.003 times. Heterogeneity was influenced by follow-up duration and cognitive assessment tools. There was significant evidence of publication bias in non denture group as compared to the denture restoration group which showed nonsignificant evidence of publication bias.

CONCLUSIONS

This study suggests denture restoration is associated with a reduced risk of cognitive impairment in individuals with tooth loss. The findings highlight the potential protective role of timely denture rehabilitation in mitigating cognitive decline. Future research should focus on longitudinal and interventional studies to establish causality.

Psychosocial factors associated with physical activity, weight management, and sleep in adults with hip and knee osteoarthritis: a systematic review

BACKGROUND

Osteoarthritis (OA) is a chronic disease primarily affecting older adults, mainly impacting the hip and knee joints. The increasing prevalence of OA contributes to rising healthcare demands and costs. Current OA treatment guidelines emphasize the importance of self-management education and guidance, particularly in promoting physical activity and weight management. In addition, improving sleep is crucial for managing OA. Developing effective self-management interventions necessitates a comprehensive understanding of the factors that facilitate these behaviors. Especially for changing health behaviors, it is important to focus on psychosocial factors. Therefore, this systematic review aimed to identify the psychosocial factors associated with physical activity, weight management, and sleep in adults with hip and/or knee OA.

METHODS

Five databases (PubMed, Embase, CINAHL, PyschINFO, Web of Science) were searched for observational studies reporting statistics on the association between psychosocial determinants and physical activity, weight management, or sleep in people with OA. The methodological quality was assessed using the Quality Assessment Tool for Observational Studies of the National Heart, Lung, and Blood Institute. After screening 5,812 articles, 31 studies were included for analysis.

RESULTS

The results showed that intention, self-efficacy, and willpower beliefs were positively associated with physical activity. Kinesiophobia, pain catastrophizing and pain-related fear were negatively associated with physical activity. Depressive symptoms, negative affect, pain catastrophizing, and low willpower beliefs were associated with poor weight management. Anxiety, depression, pain anxiety, and post-traumatic stress disorder were related to poor sleep behavior.

CONCLUSIONS

This review enhances the understanding of the psychosocial factors underlying physical activity, weight management and sleep in OA. These insights are valuable for developing tailored behavior change interventions aimed at improving physical activity, weight management and sleep in patients with hip and/or knee OA. Future research is warranted to gain more in-depth insights, particularly through longitudinal studies and further research into the psychosocial determinants of sleep, as current literature in this area is limited.

The content quality and educational significance of early childhood caries on short video platforms

BACKGROUND

Early clinical screening and prevention can reduce the incidence and severity of early childhood caries (ECC). With the development of social media, TikTok and Douyin were used as important tools for ECC popularization and early screening. The purpose of this study was to evaluate the educational impact from the integrity, accuracy and quality of ECC-related short videos on TikTok and Douyin.

METHODS

We searched for short videos related to ECC on the mobile application TikTok and Douyin on April 15, 2024. The search keywords were as follows: "Early childhood caries" on TikTok in both English and Japanese, and Chinese search on Douyin. The first 100 short videos were selected as samples for each group. we applied an instrument called DISCERN, which consisted of 3 sections and a total of 16 questions to evaluate the quality of each short video, and used a checklist to rate the content of videos. The accuracy of the content was evaluated based on the Children's Caries Risk Assessment and Management Guidelines.

RESULTS

A total of 115 short videos were assessed for the useful information quality of ECC, including 78 Chinese, 26 English, and 11 Japanese. The score for the content quality of short videos showed that each of the three groups assigned the highest scores to the sections on symptoms and treatment, with Chinese short videos achieving the top ratings. The DISCERN scores for useful short videos in each group were 33.10 ± 3.49 in Chinese, 29.54 ± 2.37 in English, and 28.27 ± 2.61 in Japanese, respectively. Compared with English and Japanese videos, Chinese videos had the highest DISCERN score with significant differences (p < 0.05). Meanwhile, in Chinese short videos, healthcare professionals or organizations uploaded videos with higher DISCERN scores, which were more comprehensive and extensive than those uploaded by private users.

CONCLUSIONS

It is necessary for more healthcare professionals and institutions to join in to improve the quality of content on short video platforms and solve more health problems for patients through short videos.

A cross-sectional study on the relationship between dietary magnesium intake and periodontitis in different body mass index and waist circumference groups: National Health and Nutrition Examination Survey, 2009-2014

This cross-sectional study aimed to investigate the correlation between magnesium consumption and periodontitis in different body mass index (BMI) and waist circumference (WC) groups. 8385 adults who participated in the National Health and Nutrition Examination Survey during 2009-2014 were included. The correlation between dietary magnesium intake and periodontitis was first tested for statistical significance by descriptive statistics and weighted binary logistic regression. Subgroup analysis and interaction tests were performed to investigate whether the association was stable in different BMI and WC groups. There was a statistical difference in magnesium intake between periodontitis and non-periodontitis populations. In model 3, participants with the highest magnesium consumption had an odds ratio of 0.72 (0.57-0.92) for periodontitis compared to those with the lowest magnesium consumption. However, in subgroup analysis, the relationship between magnesium intake and periodontitis remained significant only in the non-general obese (BMI ≤ 30 kg/m2) and non-abdominal obese populations (WC ≤ 102 cm in men and ≤ 88 cm in women). Dietary magnesium intake might decrease the periodontitis prevalence in the American population, and this beneficial periodontal health role of magnesium consumption might only be evident in non-general obese and non-abdominal obese populations.

Spin Bias in randomized controlled trials of botulinum toxin for bruxism management: a meta-epidemiologic study

OBJECTIVE

To perform a quantitative and qualitative analysis of spin bias in randomized clinical trials (RCTs) focusing on botulinum toxin (BTX-A) for managing bruxism.

STUDY DESIGN AND PROTOCOL

This is a meta-epidemiologic study. The protocol was registered on the Open Science Framework.

STUDY SELECTION

We included RCTs that evaluated the effectiveness of BTX-A for managing bruxism, associated or not with signs and symptoms of temporomandibular disorders. The outcomes were changes in pain and bruxism events. Spin bias was investigated in abstract and main text. The frequency of spin bias was assessed, and a qualitative analysis was conducted. The study was classified as effective if the outcome analyzed was statistically significant (p-value 0.05) and reached the minimum important difference of 20% and ineffective if the reported outcome was statistically nonsignificant or the study did not report the p-value or the results did not reach the minimum important difference of 20%.

RESULTS

An overall frequency of 59.4% spin bias was identified in eight included RCTs. The conclusion in the main text (87.5%) was the section with the highest frequency of spin bias. In the qualitative analysis, the most common strategies identified were inadequate extrapolation to a large population (30.61%), inadequate implication for clinical practice (20.41%), and misleading reporting (12.25%).

CONCLUSION

There is a high frequency of spin bias in RCTs that evaluated BTX-A for bruxism management. Close to 90% of the selected RCTs presented spin bias in the main text's conclusion. The most common spin was the inadequate extrapolation of the results.

CLINICAL SIGNIFICANCE

Applying BTX into the temporalis did not reduce muscle activity and the results for masseter injections remain controversial. It seems that BTX-A injections can reduce pain from two weeks to one year. It is not possible to have certainty about the efficacy and safety of using BTX-A to reduce pain and bruxism events.

Severe adverse reactions to benzathine penicillin G in rheumatic heart disease: A systematic review and meta-analysis

BACKGROUND

Fear of severe adverse reaction (SAR) and reluctance of health care providers to administer intramuscular injections are major contributing factors to poor adherence of benzathine penicillin G (BPG) in the management of rheumatic heart disease (RHD). However, data on the risk of SARs following BPG injections for RHD are relatively limited and inconclusive. Our systematic review and meta-analysis aimed to evaluate the incidence of SARs associated with BPG injections used for secondary prophylaxis of RHD.

METHODS

A systematic literature search of PubMed, Scopus and Web of Science databases was conducted to identify relevant studies reporting adverse reactions following BPG injections in patients with acute rheumatic fever (ARF) and/or RHD. A random effect meta-analysis was performed to estimate the pooled incidence of SARs.

RESULT

Nine studies (eight cohort and one randomized controlled trial), comprising 11,587 participants and > 154,760 BPG injections, were included in the analysis. The pooled incidence of SARs was 9.7 per 10,000 cases (95% CI: 0.1-29.2) and 1.1 per 10,000 BPG injections (95% CI: 0.4-2.2). Six fatal reactions were reported (0.05% of patients and 24% of SARs), all occurring in patients with severe RHD.

CONCLUSION

SARs following BPG injections in patients with ARF or RHD are rare. Our findings highlight the importance of balancing the low rate of SARs against the benefits of BPG in secondary prophylaxis for RHD, particularly in high-risk populations. High-quality longitudinal research and comprehensive adverse reaction reporting are essential to address safety concerns among healthcare providers and patients that impact BPG delivery.

Mechanical, Antibacterial, and Physico-Chemical Properties of Three Different Polymer-Based Direct Restorative Materials: An In Vitro Study

A novel resin-based bulk-fill restorative material (ST; Stela SDI, Bayswater, Victoria, Australia) has been recently introduced as a self-curing alternative to traditional light-cured composites. Promoted for its unlimited depth of cure, enhanced aesthetics, and unique primer composition, it aims to address challenges associated with amalgam and light-curing composites. Thus, the aim of this in vitro study was to investigate the performance of the new self-curing polymer-based restorative material, ST, compared to two conventional light-cured composites for direct restoration. The study evaluated compressive strength with and without aging, antibacterial activity, mineral deposition in contact with Phosphate-Buffered Saline (PBS) and artificial saliva, porosity, and wettability of ST (Tetric EvoCeram (TE; Ivoclar Vivadent, Schaan, Liechtenstein) and Clearfil Majesty ES-2 (CM; Kuraray Noritake Dental, Tokyo, Japan)). The data was statistically analyzed (α = 0.05) through one-way and two-way analysis of variance (ANOVA). ST demonstrated significantly higher compressive strength than TE and CM at baseline and after aging (p < 0.001), while aging significantly reduced compressive strength across all materials (p < 0.001). Fracture mode analysis revealed brittle fractures for TE and CM, whereas ST fractured in multiple smaller fragments. CM showed the highest void volume and diameter, significantly differing from ST and TE (p < 0.001). Scanning electron microscopy (SEM) analysis revealed cubical-like crystalline formations on ST's surface after 28 days of immersion in PBS and saliva, indicating some level of bioactivity, whereas no changes were observed for TE and CM. Wettability testing showed ST had the lowest contact angle (12.24° ± 2.1°) compared to TE (62.78° ± 4.68°) and CM (64.64° ± 3.72°) (p < 0.001). Antibacterial activity testing displayed a significant decrease in bacterial growth for CM compared to ST (p = 0.001) and TE (p = 0.002); however, ST and TE showed no significant differences (p = 0.950). To conclude, ST Automix demonstrated promising results across several key parameters, making it a potential candidate for long-lasting restorative applications. Future studies should explore its long-term clinical performance and investigate formulations that enhance its antibacterial properties. Moreover, the bond strength of these materials to dentin and the cytotoxicity should be evaluated.

Minimally invasive advantage? Patient feedback supports osseodensification in sinus lift surgery

A COMMENTARY ON

Gaspar J, Botelho J, Proença L et al. Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement: a randomized clinical trial on patient-reported outcome measures. Clin Implant Dent Relat Res 2024; 26: 113-126.

STUDY DESIGN

A randomized, controlled, parallel-arm clinical trial.

OBJECTIVE

To compare patient-reported and surgical outcomes between osseodensification (OD) and lateral window (LW) techniques for sinus floor elevation (SFE) with concurrent implant placement.

PATIENTS AND METHODS

The study received approval from the local Ethics Committee, followed the Helsinki Declaration and CONSORT guidelines, and obtained written informed consent from all participants. Eligibility criteria included adults aged 18 or older, in good systemic health, with a missing posterior maxillary tooth, residual bone height (RBH) ≤ 4 mm, and crestal bone width >6 mm. Patients were randomly assigned to either the OD group or the LW group. Both techniques involved simultaneous single implant placement, and all surgical and prosthetic procedures were performed by one experienced clinician. Primary outcomes were pain (measured on a visual analogue scale), and quality of life (QoL) using a modified Oral Health Impact Profile-14 (OHIP-14) questionnaire, assessed daily for the first week postoperatively. Patients also self-reported symptoms like edema, hematoma, and epistaxis using a 5-point Likert scale. Secondary outcomes included implant stability (ISQ), surgery duration, complications, and analgesic use. Follow up extended for 1 year.

RESULTS

A total of 20 participants (8 males, 12 females; mean age 47.9 years) were included in the study. Up to Day 3, pain levels were significantly lower (p < 0.05) in OD group, which also had a significantly reduced average analgesic intake throughout the first postoperative week (p < 0.001) compared to LW group. The OHIP-14 total scores were significantly lower in OD group on all days except Day 5 (p < 0.05). The mean surgical time was significantly shorter in the OD group (33 vs. 71 min; p < 0.001). Additionally, postoperative symptoms and complications were significantly fewer (p < 0.001), and the ISQ at 6 months was higher in the OD group (p < 0.05). All implants were restored using screw-retained zirconia crowns, with a 100% success rate.

CONCLUSION

Both OD and LW techniques were effective for SFE with simultaneous implant placement in cases with RBH ≤ 4 mm. However, OD showed superior short-term outcomes, including less pain and swelling, faster surgery, lower analgesic use, and improved QoL measures.

Are Salivary and Plasma Levels of Toll-Like Receptors 2 and 4 Elevated in Subjects With Chronic Periodontitis?: A Systematic Review and Meta-Analysis

Toll-like receptors (TLR2 and TLR4) are crucial in the detection of pathogen-associated molecular patterns (PAMPs) during periodontitis, resulting in exacerbated production of proinflammatory cytokines and ultimately tissue damage and bone loss associated with this periodontal disease. This systematic review and meta-analysis aimed to systematically analyze and quantify the differences between TLR2 and TLR4 levels in the saliva and plasma of individuals with chronic periodontitis (CP) and systemically and periodontally healthy subjects (SPHS). The databases consulted were Scopus, Web of Science, and PubMed from 2011 to 2024 to locate cross-sectional studies that measured TLR2 and TLR4 levels. Studies selected were human research articles published in English, evaluating these biomarkers through ELISA. Data were extracted, and the quality of studies was appraised using the Joanna Briggs Institute (JBI) tool for observational studies. Meta-analyses were executed using STATA V.15 (StataCorp LP, College Station, Texas) employing fixed or random-effects models based on the degree of heterogeneity using I2 statistics. Out of 404 articles found, four studies were included for both qualitative and quantitative synthesis. We found an increase in salivary TLR4 levels in subjects with CP compared with SPHS (SMD = 265.217 (95% confidence interval (CI) = 109.311-421.122); p=0.001). As well as an increase in plasma levels of TLR4 in subjects with CP compared with SPHS (SMD = 2.93 (95% CI = 1.57-4.29); p=0.001). TLR4 concentrations in saliva and plasma of subjects with CP were higher than those observed in the healthy population. However, further validation in larger prospective studies is needed before clinical implementation.

PRF and PRP in Dentistry: An Umbrella Review

Introduction: Platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) utilize autologous blood and share the objective of leveraging blood-derived growth factors to enhance the body's natural healing process. A large extensive use has been made in various branches of dentistry. Methods: A total of 4175 records were identified from the electronic search, specifically 291 from BioMed Central, 3406 from MEDLINE/PubMed, 304 from the Cochrane library databases, and 174 from the PROSPERO register. This review was performed in relation to the PRISMA flow chart and was annotated in the PROSPERO register. Results: In total, 3416 title abstracts were screened, and a total of 40 systematic reviews were finally included in the present umbrella review. Conclusions: Research supports the use of PRF and PRP in different fields of dentistry. This is a huge potential for the patient but also for the doctor as these products are from the patient and have zero cost. However, further studies are needed, especially RCTs, to have clearer evidence on the role of PRF and PRP.

Preventing white spot lesions around orthodontic brackets: efficacy of pre-reacted glass-ionomer barrier coat versus silver diamine fluoride: an in vitro study

OBJECTIVES

to compare the effect of using a pre-reacted glass-ionomer (PRG) barrier coat versus silver diamine fluoride (SDF) varnish treatment before orthodontic bracket bonding to prevent white spot lesions (WSL). The effect of these materials on the shear bond strength of orthodontic brackets was evaluated through an in vitro study.

METHODS

One hundred-five premolars were used; forty-two specimens were designated for comparing SDF versus PRG-barrier coat using a scanning electron microscope (SEM) with elemental analysis and microhardness testing (n = 21/group). Tested materials were applied in a split-tooth design protocol (side A: control, side B: treated). Measurement was made at baseline and after bracket placement and exposure to the pH cycle. A polarized light microscope (PLM) was used for qualitative examination. Sixty-three specimens were intended for shear bond strength (SBS) testing after the pH cycle as follows: control group (no treatment), SDF group, and PRG-barrier coat group (n = 21/group). Statistical analysis was done using Paired T-test.

RESULTS

SEM for specimens treated by SDF or PRG revealed enamel remineralization with calcium deposits and small porosities between the crystallites. All groups had a significant difference regarding the Ca/P ratio and microhardness. Baseline hardness for both groups was significantly higher than the treated sides, which was significantly higher than the non-treated sides (P = 0.000*) and (P = 0.000*) in accordance with the Paired T-test. In comparing SDF with PRG-coat groups, the T-test showed non-significant differences in mean differences between treated and baseline hardness values (T = 0.32, P = 0.74). PLM for treated specimens by SDF or PRG depicted an evident remineralized surface enamel layer. SBS values did not differ significantly between groups.

CONCLUSIONS

As confirmed by SEM and PLM, applying either SDF varnish or PRG-barrier coat before bonding orthodontic brackets could effectively prevent the development of WSL and achieve surface enamel protection. In addition, the two applied varnishes showed slightly higher shear bond strength of orthodontic brackets compared to the control group, with the SDF slightly higher than PRG. Also, clinical translation is needed in future research to evaluate the study.

Lack of bidirectional associations between gastroesophageal reflux disease and periodontitis: a systematic review and meta-analysis

The bidirectional relationship between gastroesophageal reflux disease (GERD) and periodontitis (PD), particularly the temporal directionality, remains unclear. A systematic review and meta-analysis were conducted to evaluate bidirectional associations between GERD and PD. Three databases (PubMed, Embase, and Cochrane Library) were systematically searched from inception to December 1, 2024. Risk estimates from individual studies were pooled using random-effects models. Five studies assessed the risk of PD in patients with GERD, while three studies evaluated the risk of GERD in patients with PD. The overall analysis suggested an increased risk of PD among patients with GERD (odds ratio [OR] = 1.27; 95% confidence interval [CI]: 1.02-1.57; p = 0.029; I2 = 96.5%). However, sensitivity analyses, limited to cohort studies (OR = 1.15; 95% CI: 0.93-1.42; P = 0.05; I2 = 96.9%) and subgroup analyses, did not support this finding. Similarly, PD patients did not exhibit a higher risk of GERD (OR = 1.19; 95% CI: 0.90-1.57; P = 0.223; I2 = 94.3%). The present study could not confirm any bidirectional associations between GERD and PD. Further high-quality longitudinal studies are required to validate these findings.

In situ treatment with a TLR9 agonist virus-like particle to promote immune responses against oral epithelial dysplasia progression

Leukoplakia, a common type of oral dysplasia, is simply defined as a white patch in the mouth or other mucosal surface. Oral dysplasia is the most common premalignancy in the oral cavity and yet it is insufficiently researched and thus both diagnosing and treating oral dysplasia are still problematic issues. This study focuses on the immune signature of oral dysplasia and explores whether stimulating the immune system with an immune therapy, vidutolimod (± immune checkpoint blockade (ICB)), can prevent the progression of oral dysplasia or even cause regression. Vidutolimod, a virus-like particle encapsulating G10, is believed to activate plasmacytoid dendritic cells (pDCs) through the activation of the Toll-like receptor 9 (TLR9). To investigate this, an established murine model for inducing oral cancer was used to study oral dysplasia development and response to in situ injection of vidutolimod at the premalignant phase. The effect of treatment was analyzed histologically and immunologically. ELISA revealed significantly elevated levels of IFN-γ, IL-12, and TNF-α in the sera of mice after 24 h of one treatment with vidutolimod + ICB as well as increased levels of proliferating T cells and pDCs in draining lymph nodes 72 h after the third and final treatment, thus indicating the immune-boosting effect of this therapy. Vidutolimod + ICB caused a significant decrease in Ki-67 expression by epithelial cells in the lesion area compared to untreated mice, implicating that this treatment regime may prevent lesion progression.

Freehand vs. computer-aided implant surgery: a systematic review and meta-analysis-part 1: accuracy of planned and placed implant position

OBJECTIVES

This systematic review aimed to investigate and compare the accuracy of free-hand and computer-aided implant surgery (CAIS) approaches in dental implant placement.

MATERIAL AND METHODS

The PICO question as follows: In patients receiving dental implants, does computer-aided implant surgery superior in accuracy compared to non-computer-aided implant surgery? The primary outcome was angular deviation between the planned and placed position of the implant. An electronic search was made to identify all relevant studies reporting the accuracy of CAIS approaches and freehand for dental implant placement. The data were extracted in the descriptive description, and a meta-analysis of single means was performed to estimate the deviations for each variable using a random-effects model.

RESULTS

Out of 1609 initial articles, 55 were selected for data extraction. The mean value of angular, entry, and apex deviations were 7.46°, 1.56 mm, and 2.22 mm for freehand, 5.94°, 1.13 mm, and 1.43 mm for pilot drill-sCAIS, 2.57°, 0.72 mm, 0.88 mm for fully guided-sCAIS (fg-sCAIS), and 3.67°, 1.01 mm, and 1.36 for dynamic CAIS (dCAIS), respectively. Significant differences were found between the freehand and CAIS approaches (p < 0.04). Fg-sCAIS was significantly more accurate than dCAIS systems at the entry (p < 0.001).

CONCLUSIONS

Compared to the freehand approach, both sCAIS and dCAIS improve implant placement accuracy, with angular deviations ranging from 2° to 6°. Detailed planning is crucial for CAIS, particularly for fg-sCAIS, which demonstrated the highest accuracy than others. As apex deviations of 1 to 2 mm have been observed in CAIS approaches, a 2-mm safety margin should be implemented to minimize surgical risks.

Questionnaires related to Evidence-Based Practice applied to dentists, faculty members or dental students: a scoping review

BACKGROUND

Numerous instruments have been suggested to analyze the essential Evidence-Based Dentistry (EBD) dimensions, but it is unclear whether they were comprehensive and validated appropriately.

AIM

To investigate instruments that assess EBD-related dimensions.

METHODS

We included primary studies involving dentists, faculty members, or dental students at any level of professional career that described validation or translation/transcultural adaptation processes of EBD instruments or reported the application of such instruments. Searches were conducted at PubMed, Embase, Web of Science, and Scopus, along with manual searches in EBD journals, Google Scholar and reference lists. Descriptive data were collected and standardized in tables, and summarized.

RESULTS

Fifty studies were included. The KACE (Knowledge, Attitudes, Access, and Confidence Evaluation) instrument demonstrated clarity, internal consistency, face validity, discriminant validity, and responsiveness, but neglected important dimensions such as EBD-related practices, patient benefits, barriers/facilitators, and willingness to learn and disseminate EBD practices. The modified Berlin questionnaire designed to measure perceived/actual knowledge, showed clarity, internal consistency, content validity, and discriminant validity, but lacked data on reproducibility, face validity, construct validity, and responsiveness. Other questionnaires, while broader, had significant limitations in reported reliability and validation.

CONCLUSIONS

Although the KACE instrument and the modified Berlin questionnaire underwent relatively rigorous reliability and validation testing, they were considered insufficiently comprehensive. When analyzed together, other questionnaires were found to be relatively more comprehensive, but they exhibited more significant limitations regarding reported reliability and validation assessments. This suggests the need for a novel instrument that fulfills a more significant number of validation phases and EBD-related dimensions.

Fragment Reattachment: A Conservative Approach to Restoring Traumatic Fractures in Anterior Dentition

OBJECTIVES

Tooth fragment reattachment is a conservative approach for treating various types of traumatic dental injuries. This review examines the classification of the traumatic dental injuries, provides a detailed description of the steps involved in fragment reattachment, and discusses the factors influencing its success, along with potential complications.

OVERVIEW

Clinicians should be familiar with the types of traumatic dental injuries and their signs and symptoms to establish an accurate diagnosis. Proper hydration of the tooth fragment is essential for optimal reattachment through bonding procedures. Techniques for preparing the fragment and tooth remnant vary in effectiveness, and it is generally accepted that combining adhesive systems with composite resin as the intermediate material is often the most effective option. It is important to discuss the advantages and disadvantages of this treatment option with patients to help them make an informed decision suited to their specific situation.

CONCLUSIONS

Tooth fragment reattachment should be considered the preferred technique when the fragment is available and viable. Despite differences in techniques and materials, reattachment appears to show a survival rate comparable to direct composite restorations. Regular and frequent follow-up appointments are essential to monitor for potential complications.

CLINICAL SIGNIFICANCE

Tooth fragment reattachment is a conservative treatment option available to patients. Due to significant advancements in adhesive dentistry, fragment reattachment can be offered as a definitive treatment option.

Strategies for preventing aerosol-generated microbial contamination in dental procedures: A systematic review and meta-analysis

BACKGROUND

Aerosol generation in dental practice is a significant concern in infection control. This study aimed to investigate the strategies for controlling and preventing aerosol-generated microbes during dental procedures.

METHODS

A comprehensive literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines through electronic databases (PubMed, ScienceDirect, Cochrane Library, Google Scholar, and Scopus) for studies reporting interventions, including mouthwash and suction devices, that were effective against pathogens generated during dental procedures. Predefined criteria identified eligible studies. Pooled efficacy was estimated using RevMan 5.4's random-effects model.Quality assessments were performed using RoB-2.0 and the Robvis web application.

RESULTS

This systematic review and meta-analysis included 19 papers. Cetylpyridinium chloride, chlorhexidine, chlorine dioxide, hydrogen peroxide, botanical medicines, and suction devices are the most used dental therapies to minimise microbial contamination. Overall, these treatments showed success with a pooled effectiveness of -46.64 (95% CI: -60.89 to -32.38, I2=100%, p<0.00001).

CONCLUSIONS

This study emphasises the need for a multifaceted approach that uses antiseptic mouthwash and suction devices to reduce cross-contamination and infection transmission during aerosol-generated dental procedures, safeguarding patients and dental workforce.

Users' positive attitudes, perceived usefulness, and intentions to use digital mental health interventions: A systematic literature review and meta-analysis

BACKGROUND

Digital Mental Health Interventions (DMHIs) hold significant potential in addressing gaps in mental health treatment, enhancing mental health literacy, and mitigating associated stigma. However, DMHIs have not been systematically evaluated in terms of potential users' attitudes, perceived usefulness, and intentions to use. Thus, this study aims to consolidate evidence to ascertain users' attitudes, perceived usefulness, and intentions to utilize DMHIs.

METHODS

The meta-analysis reports adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A comprehensive search of databases: Medline, CINHAL, PsycINFO, SCOPUS, and Web of Science, was conducted. As part of the screening process, Covidence database management software was used. Metaprop command was used to calculate the outcome using a random-effects model. Heterogeneity was assessed using Cochrane chi-square (χ2) and the index of heterogeneity (I2 statistics) test. Sensitivity test and subgroup analysis were performed. Publication bias was examined by funnel plots and Egger's test.

RESULTS

In total, 26 studies were analyzed, including data from 13,923 participants. The overall percentage of users' positive attitudes, perceived usefulness, and intentions to use DHMIs was 0.66 (95 % CI; 0.52, 0.79), 0.73 (95 % CI; 0.64, 0.81), and 0.67 (95 % CI; 0.6, 0.74), respectively. Significant heterogeneity was observed; nonetheless, sensitivity analyses indicated that none of the included individual studies exerted undue influence on the overall pooled prevalence. Assessment of funnel plots and Egger's test (p ≤ 0.895) showed no evidence of publication bias.

CONCLUSION

The results of this meta-analysis indicate that, overall, two-thirds of participants have a positive attitude toward DMHIs, around three-quarters find DMHIs useful, and around two-thirds intend to use them. The findings suggest the need to target users' positive attitudes, perceived utility, and willingness for the improved adoption and sustained use of DMHIs.

Dental practitioner approaches to bruxism: Preliminary findings from the national dental practice-based research network

OBJECTIVE

Bruxism is a repetitive masticatory muscle activity. This study investigates dental practitioners' approaches to bruxism assessment and treatment in practices.

METHODS

A brief 5 question questionnaire ("Quick Poll") on bruxism was conducted.

RESULTS

A total of 397 practitioners responded. More than half (55%) initiated treatment for bruxism on one to three patients per month. The majority believed that stress (97%) and sleep patterns (82%) affected bruxism in their patients. Interestingly, 96% offered an occlusal guard/appliance and 46% made occlusal adjustments.

CONCLUSION

This study highlights inconsistencies in practitioner approaches to bruxism assessment and management in clinical settings, suggesting gaps in practitioner knowledge evidenced by the varied responses.

ABBREVIATIONS

PBRN - Practice-Based Research NetworkMMA - Masticatory muscle activitySB - Sleep bruxismAB - Awake bruxismTMJ - Temporomandibular jointOSA - Obstructive sleep apnea.