Euler-angle norms for tooth rotation, torque and tip

INTRO

The aim of the current study was to develop and describe a new measuring system for the orientation of a tooth in a digitalized cast of a jaw and provide new angular values for the rotation, torque and tip of maxillary and mandibular teeth.

METHODS

This retrospective cross-sectional study involved the utilization of a sub-group of extrinsic Euler-angles to derive optimal norm values per tooth in three different planes of orientation ('rotation', 'torque' and 'tip') by evaluating the digital representations of the teeth derived from a database containing over 17,500 patients. The process involved the entry of the .stl files of the jaw pairs into a fully automated software system (Smyl:Ai, Ulm, Germany) whereupon jaw alignment, teeth segmentation, landmark identification and visual validation of input files was conducted prior to calculation of the norm values for the three different planes of orientation.

RESULTS

The digital scans in stereolithography (.STL)-file format of the upper and lower dentitions of 1914 individuals with optimal occlusion were chosen and evaluated. New mean (standard deviation) angular values were determined for the rotation, torque and tip of maxillary and mandibular teeth.

CONCLUSION

The findings facilitate the reappraisal of rotation, torque and tip values currently acceptable as ideal. They will inform anthropologists and dental researchers about occlusion and alignment in orthodontic and non-orthodontic patients and provide baseline data for future studies. The methodology will also enable the evaluation of large numbers of data in relatively short timeframes.

Evaluation of mandibular trabecular bone by fractal analysis in pediatric patients with hypodontia of the mandibular second premolar tooth

BACKGROUND

It is still unclear whether the trabecular structure of the jaw is different in individuals with hypodontia than in those without hypodontia; this is important for clinicians. The aim was to determine whether the mandibular trabecular bone structure of children and adolescents with hypodontia differs from the control group by using the fractal analysis (FA) method in this study.

METHODS

A total of 138 panoramic radiographs of 69 cases and 69 control subjects (mean age 13.2 ± 10.1) were evaluated. The age and gender of subjects in the case and control groups were matched. Three regions of interest (ROIs) were selected from the panoramic radiographs. ROI1 refers to the center of the ramus rising above the mandibular foramen. ROI2 refers to the area between the apical level of the mandibular molar and the upper border of the mandibular canal. ROI3, the missing tooth region, refers to the apical third of the mesial side of the erupting or fully erupted permanent mandibular first molar. Mann-Whitney U and Wilcoxon tests were used. p < 0.05 was accepted for the significance value.

RESULTS

The mean fractal dimension (FD) values of ROI1, ROI2, and ROI3 were 1,25, 1,20, and 1,13, respectively. The means FD values obtained from the ramus region were higher than the other regions (p < 0.05). The FD values did not differ significantly according to gender and age (p > 0.05). The FD values of the case group were lower than the control group for ROI3 (p < 0.05).

CONCLUSION

The results of this study showed that the mandibular trabecular bone quality of pediatric patients with one missing tooth was different from the healthy group. The difference in the mean FD values from the ROIs indicates that the ramus has a denser structure than the mandibular corpus. Clinicians should factor this into their dental treatment planning process.

Caries and periodontal health status of male inmates: a retrospective study conducted in a French prison

PURPOSE

The purpose of this study is to describe the oral health status of inmates. The secondary aims were to compare recidivists with first-time offenders and also study the impact of psychoactive drugs on the oral health status.

DESIGN/METHODOLOGY/APPROACH

This retrospective study included 120 male inmates from a French prison. Data from the medical and the dental questionnaires and examinations were collected and analyzed.

FINDINGS

The results showed that overall, the inmates had a poor oral health despite their young age. This population was at high risk regarding caries and periodontal diseases due to sedentary behaviors, improper diet, drug, alcohol and tobacco consumption. In total, 93% of inmates had at least one decayed untreated tooth and 95% had periodontal disease. The use of psychoactive drugs seemed strongly related to oral health status degradation. However, the comparison between recidivists and first-time offenders showed few differences.

PRACTICAL IMPLICATIONS

The need for periodontal and dental care is considerable in this population and increased in this environment where risk factors such as addictive behaviors and poor eating habits are common. The impact of psychoactive drugs on oral health should also be taken into consideration.

SOCIAL IMPLICATIONS

Unfortunately, even though strategies for the prevention and management of oral health in prisons have been put in place for some years, the results still seem insufficient.

ORIGINALITY/VALUE

There are still few studies that analyze the impact of this medication on oral health in prisons.

Precision layering techniques: Integrating digital tools for accurate color matching and realistic try-ins in anterior composite restorations

OBJECTIVE

This article aims to demonstrate the clinical application of a comprehensive workflow that integrates digital tools for accurate color matching, and its immediate implementation in the restoration of anterior teeth.

CLINICAL CONSIDERATIONS

Two patients demonstrating dissatisfaction regarding a maxillary central incisor had an old restoration replaced resorting to a digital workflow to enhance the predictability of the new direct restoration. OptiShade allowed the precise assessment of tooth color and the CompoShade application provided precise color and material selection, as well as the determination of a layering strategy. Precision and accuracy of the colorimeter and the composite layering application were demonstrated clinically in vivo.

CONCLUSIONS

Implementing a digital workflow with the integration of OptiShade measurements and the CompoShade layering recipe calculation, as well as the respective realistic try-in, enables the achievement of precise color matching for anterior composite restorations.

CLINICAL SIGNIFICANCE

The employment of a digital colorimeter and layering recipes simplify shade matching, and optimizes composite resin clinical use and success. The implementation of a realistic try-in, previous to the definitive restoration, allows the clinician to perform any adjustments if needed.

In vitro Assessment of lesion activity using simultaneous time-resolved reflectance imaging at 1300 and 1950 nm

The aim of this study was to explore the feasibility of a time-resolved reflectance imaging system employing a single photodetector to assess the activity of caries lesions that exploits the differential absorption of water at 1300 and 1950 nm. The time-resolved reflectivity of 10 active and 10 arrested lesions on the proximal surfaces and 5 active and 5 arrested lesions on the occlusal surfaces of extracted teeth were monitored simultaneously at 1300 and 1950 nm during forced air drying for 60 s. The presence of a highly mineralized surface zone measured with microcomputed tomography (microCT) was used to indicate lesion activity. Multiple kinetic parameters were extracted from the acquired short wavelength infrared (SWIR) intensity versus time dehydration curves and used to assess lesion activity. Differences in the reflectivity between curves acquired at 1300 and 1950 nm due to differential absorption of water provided improved discrimination between active and arrested lesions over the use of 1950 nm alone. This study demonstrates that it is feasible to use a device with a single photodetector operating at 1950 nm to collect dehydration curves for the assessment of lesion activity and that a system employing two SWIR wavelengths with differential water absorption can improve the performance of lesion activity assessment.

Botulinum toxin for bruxism treatment: a nationwide study among oral and maxillofacial surgeons in Germany

INTRODUCTION

This study aimed to evaluate the use of botulinum toxin (BTX) for the treatment of bruxism in oral and maxillofacial surgery in Germany.

MATERIAL AND METHODS

A dynamic online questionnaire comprising 7 to 25 questions was formulated to gather general and specific information regarding using BTX to treat bruxism. The questionnaire underwent internal and external assessments for validation. Subsequently, it was distributed to 906 oral and maxillofacial surgeons (OMFS) affiliated with the German Association for Oral and Maxillofacial Surgery (DGMKG). Weekly reminders were dispatched over four weeks to enhance response rates. Participation in the study was voluntary and anonymized. Descriptive methods were employed for data analysis.

RESULTS

107 OMFS participated in the study, yielding a response rate of 11.81%. On average, 17 patients with bruxism were per month, with 4 of these patients receiving BTX therapy. BTX administration was frequently accompanied by splints and physiotherapy (35.51% of participants). Botox® (Allergan) was the preferred BTX preparation, utilized by 40.79% and reconstituted with saline by 92.11% of participants. The masseter muscles were primarily targeted for BTX treatment (67.57% of participants), averaging 29 BTX (Allergan-) units per side. Injection points for each masseter muscle typically amounted to six per side, preferred by 30.67% of participants. Follow-up assessments post-BTX treatment were conducted regularly, predominantly after four weeks, by 36% of participants. In 8% of cases, additional BTX injections were necessary due to inadequate outcomes. Side effects were reported in 4% of cases, commonly manifesting as a non-disturbing reduction in bite force. Most participating OMFS (61.84%) using BTX for bruxism therapy regarded bruxism treatment with BTX as evidence-based. Notably, 97.37% of respondents expressed their willingness to recommend BTX-based bruxism treatment to their colleagues. Overall, the efficacy of BTX therapy for bruxism was rated as good (53.95%) and very good (40.79%).

CONCLUSION

The use of BTX for the management of bruxism among OMFS in Germany has demonstrated efficacy. Substantial variances in certain facets of bruxism treatment employing BTX have been observed.

CLINICAL RELEVANCE

Additional research endeavors are warranted to comprehensively investigate distinct elements of BTX therapy for bruxism, including the optimal dosage of BTX units and the precise localization of injection sites across various muscles.

Oral microbiome diversity and diet quality in relation to mortality

AIM

To examine the independent and joint associations of oral microbiome diversity and diet quality with risks of all-cause and cause-specific mortality.

MATERIALS AND METHODS

We included 7,055 eligible adults from the U.S. National Health and Nutrition Examination Survey (NHANES). Oral microbiome diversity was measured with α-diversity, including the Simpson Index, observed amplicon sequence variants (ASVs), Faith's phylogenetic diversity, and Shannon-Weiner index. Dietary quality was assessed using the Healthy Eating Index-2015 (HEI-2015). Cox proportional hazard models were used to assess the corresponding associations.

RESULTS

During a mean follow-up of 9.0 years, we documented 382 all-cause deaths. We observed independent associations of oral microbiome diversity indices and dietary quality with all-cause mortality (hazard ratio [HR] = 0.63; 95% confidence interval [CI]: 0.49-0.82 for observed ASVs; HR = 0.68, 95% CI: 0.52-0.89 for HEI-2015). Jointly, participants with the highest tertiles of both oral microbiome diversity (in Simpson index) and HEI-2015 had the lowest hazard of mortality (HR = 0.37, 95% CI: 0.23-0.60). In addition, higher oral microbiome diversity was associated with lower risks of deaths from cardiometabolic disease and cancer.

CONCLUSIONS

Higher oral microbiome α-diversity and diet quality were independently associated with lower risk of mortality.

Clinical supervision, a reflective intervention to support new graduate nurses and midwives enhance their person-centredness: qualitative evaluation

Person-centred care is an international healthcare priority. Strategies are needed to support nurses and midwives to understand the meaning of person-centredness and support them to embed this philosophy into practice. Clinical supervision has been proposed as a strategy to support this but requires more evidence.The aim of this research was to evaluate a newly developed model of clinical supervision, underpinned by person-centred practice theory, to enhance the person-centred practices of new graduate nurses and midwives.

DESIGN

Qualitative study (embedded within a mixed methods study) using focus groupsMethods: Group, online clinical supervision (named C.A.R.E.) underpinned by the Person-centred Practice Framework was provided to 103 new graduate nurses and midwives once per month for one hour, over six months. The researchers used [Braun, V., & Clarke, V. (2022). Thematic analysis; A practical guide. SAGE]. Thematic Analysis to analyse data.

RESULTS

Twenty one participated in the qualitative evaluation. Four themes were identified (1) Person-centredness in Action (person-centredness experienced and delivered by the new graduates) (2) Enhancing the Transitioning Toolkit (professional and personal growth as an outcome of reflection and learning together) (3) The Transitioning Environment (care environment and C.A.R.E. environment) and (4) Challenges to C.A.R.E. (team and organisation, and personal).

CONCLUSION

This supportive safe space allowed new graduates to explore their and other's practices, in relation to person-centred practice theory. Through sharing their experiences, they increased their knowledge and confidence to incorporate new learning into their own practice. This clinical supervision model underpinned by the Person-centred Practice Framework provides person-centred benefits to the new graduates, patients and families. However, without organisational support the benefits will not be realised.

Effects of a 4-week free-sugar avoidance during periodontal therapy: An explorative randomized controlled clinical trial

BACKGROUND

This study investigated the effect of a 4-week free-sugar avoidance on periodontal parameters during periodontal therapy.

METHODS

Twenty-one patients with untreated periodontitis and daily free-sugar intake were allocated to a sugar avoidance group (SAG) and a control group (CG). The SAG received a 45-min dietary consultation and was instructed to avoid free sugars during the following 4 weeks after subgingival instrumentation, while the CG continued with their regular diet. Bleeding on probing (BOP), plaque control record, body weight (BW), visceral fat (FATv), and a food frequency questionnaire (FFQ) were collected at baseline (T1), 4 weeks (T2), and 8 weeks (T3) after subgingival instrumentation.

RESULTS

The main outcome parameter BOP was significantly reduced at T2 by 40.3% ± 15.54 in the SAG and 34% ± 12.47 in the CG (intra-p value both <0.001, inter-p value 0.361). A linear regression analysis of changes at patient level adjusted for age and FATv revealed a significant group difference for BOP (regression coefficient = -6.8; p = 0.019). Significant reductions were observed in BW, FATv and mean daily intake of free sugars (-14.4 g/day), and a significant increase of vitamin C derived from fruits (75.89 mg/day) at T2 in the SAG only.

CONCLUSION

This study may indicate additional beneficial effects of a sugar avoidance on periodontal and metabolic parameters, and nutritional intake during periodontal therapy. German Clinical Trials Register (DRKS00026699).

PLAIN LANGUAGE SUMMARY

The current widespread free-sugar consumption is linked to an increasing incidence of chronic non-communicable diseases. Data indicate a relationship between sugar intake and a higher prevalence of periodontitis and increased gingival inflammation. This study showed that free-sugar avoidance after periodontal therapy had additional beneficial effects on periodontal and metabolic parameters in 10 test and 11 control patients. After 4 weeks of avoiding free sugars like sweets, processed white flour, juice, and so forth, periodontal bleeding was significantly reduced in both groups (-40.3% test group, -34% control group). Further regression analysis revealed a significant difference between groups favoring the intervention. Additionally, body weight and visceral fat were significantly reduced in the intervention group, only. To avoid sugar, patients were allowed to replace it with whole fruit, which led to increased levels of micronutrients such as vitamin C. Therefore, free-sugar avoidance may be of therapeutic benefit in addition to periodontal therapy. Further research is needed to investigate this effect in larger cohorts.

What could be the role of genetic tests and machine learning of AXIN2 variant dominance in non-syndromic hypodontia? A case-control study in orthodontically treated patients

BACKGROUND

Hypodontia is the most prevalent dental anomaly in humans, and is primarily attributed to genetic factors. Although genome-wide association studies (GWAS) have identified single-nucleotide polymorphisms (SNP) associated with hypodontia, genetic risk assessment remains challenging due to population-specific SNP variants. Therefore, we aimed to conducted a genetic analysis and developed a machine-learning-based predictive model to examine the association between previously reported SNPs and hypodontia in the Saudi Arabian population. Our case-control study included 106 participants (aged 8-50 years; 64 females and 42 males), comprising 54 hypodontia cases and 52 controls. We utilized TaqManTM Real-Time Polymerase Chain Reaction and allelic genotyping to analyze three selected SNPs (AXIN2: rs2240308, PAX9: rs61754301, and MSX1: rs12532) in unstimulated whole saliva samples. The chi-square test, multinomial logistic regression, and machine-learning techniques were used to assess genetic risk by using odds ratios (ORs) for multiple target variables.

RESULTS

Multivariate logistic regression indicated a significant association between homozygous AXIN2 rs2240308 and the hypodontia phenotype (ORs [95% confidence interval] 2.893 [1.28-6.53]). Machine-learning algorithms revealed that the AXIN2 homozygous (A/A) genotype is a genetic risk factor for hypodontia of teeth #12, #22, and #35, whereas the AXIN2 homozygous (G/G) genotype increases the risk for hypodontia of teeth #22, #35, and #45. The PAX9 homozygous (C/C) genotype is associated with an increased risk for hypodontia of teeth #22 and #35.

CONCLUSIONS

Our study confirms a link between AXIN2 and hypodontia in Saudi orthodontic patients and suggests that combining machine-learning models with SNP analysis of saliva samples can effectively identify individuals with non-syndromic hypodontia.

In vitro studies support clinical trials showing platelet-rich fibrin-mediated local delivery of antibiotics improves outcomes in impacted mandibular third molar surgery

Our previous clinical observations showed that platelet rich fibrin (PRF) can be used to deliver antibiotics to attenuate postoperative complications after unilaterally impacted mandibular third molar surgery (IMTMS). In order to begin understanding the mechanism involved in the beneficial in vivo effects of PRF-mediated delivery of antibiotics, in vitro studies were performed, which showed that PRF preparations containing amoxicillin/clavulanic acid or clindamycin significantly inhibited the growth of S. aureus bacteria. In our previous study, comparisons were made between control and treated groups. However, since variations among individual patients could possibly affect the results, the current study included patients with bilaterally symmetric impacted mandibular third molars, allowing us to compare control and antibiotic treatment within each patient. The effects of PRF preparations containing amoxicillin/clavulanic acid or clindamycin on IMTMS was tested in 60 clinical cases. Antibiotic-injected PRF treatment after bilaterally IMTMS resulted in significantly reduced pain, less use of analgesics, and reduced swelling and trismus compared to the control group (PRF without antibiotics) confirming our previous results after unilaterally IMTMS. The in vitro results support the hypothesis that in vivo delivery of antibiotics using PRF produces therapeutic effects after IMTMS by attenuating bacterial infection and inflammation.

Multispectral fluorescence imaging of EGFR and PD-L1 for precision detection of oral squamous cell carcinoma: a preclinical and clinical study

BACKGROUND

Early detection and treatment are effective methods for the management of oral squamous cell carcinoma (OSCC), which can be facilitated by the detection of tumor-specific OSCC biomarkers. The epidermal growth factor receptor (EGFR) and programmed death-ligand 1 (PD-L1) are important therapeutic targets for OSCC. Multispectral fluorescence molecular imaging (FMI) can facilitate the detection of tumor multitarget expression with high sensitivity and safety. Hence, we developed Nimotuzumab-ICG and Atezolizumab-Cy5.5 imaging probes, in combination with multispectral FMI, to sensitively and noninvasively identify EGFR and PD-L1 expression for the detection and comprehensive treatment of OSCC.

METHODS

The expression of EGFR and PD-L1 was analyzed using bioinformatics data sources and specimens. Nimotuzumab-ICG and Atezolizumab-Cy5.5 imaging probes were developed and tested on preclinical OSCC cell line and orthotopic OSCC mouse model, fresh OSCC patients' biopsied samples, and further clinical mouthwash trials were conducted in OSCC patients.

RESULTS

EGFR and PD-L1 were specifically expressed in human OSCC cell lines and tumor xenografts. Nimotuzumab-ICG and Atezolizumab-Cy5.5 imaging probes can specifically target to the tumor sites in an in situ human OSCC mouse model with good safety. The detection sensitivity and specificity of Nimotuzumab-ICG in patients were 96.4% and 100%, and 95.2% and 88.9% for Atezolizumab-Cy5.5.

CONCLUSIONS

EGFR and PD-L1 are highly expressed in OSCC, the combination of which is important for a precise prognosis of OSCC. EGFR and PD-L1 expression can be sensitively detected using the newly synthesized multispectral fluorescence imaging probes Nimotuzumab-ICG and Atezolizumab-Cy5.5, which can facilitate the sensitive and specific detection of OSCC and improve treatment outcomes.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2100045738. Registered 23 April 2021, https://www.chictr.org.cn/bin/project/edit?pid=125220.

Assessing peri-implant bacterial community structure: the effect of microbiome sample collection method

BACKGROUND

Oral microbiota comprises polymicrobial communities shaped by mutualistic coevolution with the host, contributing to homeostasis and regulating immune function. Nevertheless, dysbiosis of oral bacterial communities is associated with a number of clinical symptoms that ranges from infections to oral cancer. Peri-implant diseases are biofilm-associated inflammatory conditions affecting the soft and hard tissues around dental implants. Characterization and identification of the biofilm community are essential for the understanding of the pathophysiology of such diseases. For that sampling methods should be representative of the biofilm communities Therefore, there is a need to know the effect of different sampling strategies on the biofilm characterization by next generation sequencing.

METHODS

With the aim of selecting an appropriate microbiome sampling procedure for periimplant biofilms, next generation sequencing was used for characterizing the bacterial communities obtained by three different sampling strategies two months after transepithelial abutment placement: adjacent periodontal crevicular fluid (ToCF), crevicular fluid from transepithelial abutment (TACF) and transepithelial abutment (TA).

RESULTS

Significant differences in multiple alpha diversity indices were detected at both the OTU and the genus level between different sampling procedures. Differentially abundant taxa were detected between sample collection strategies, including peri-implant health and disease related taxa. At the community level significant differences were also detected between TACF and TA and also between TA and ToCF. Moreover, differential network properties and association patterns were identified.

CONCLUSIONS

The selection of sample collection strategy can significantly affect the community composition and structure.

TRIAL REGISTRATION

This research is part of a randomized clinical trial that was designed to assess the effect of transepithelial abutment surface on the biofilm formation. The trial was registered at Trial Registration ClinicalTrials.gov under the number NCT03554876.

The impact of the COVID-19 pandemic on 397 631 elective dental admissions among the under-25s in England: a retrospective study

BACKGROUND

COVID-19 caused widespread disruptions to health services worldwide, including reductions in elective surgery. Tooth extractions are among the most common reasons for elective surgery among children and young people (CYP). It is unclear how COVID-19 affected elective dental surgeries in hospitals over multiple pandemic waves at a national level.

METHODS

Elective dental tooth extraction admissions were selected using Hospital Episode Statistics. Admission trends for the first 14 pandemic months were compared with the previous five years and results were stratified by age (under-11s, 11-16s, 17-24s).

RESULTS

The most socioeconomically deprived CYP comprised the largest proportion of elective dental tooth extraction admissions. In April 2020, admissions dropped by >95%. In absolute terms, the biggest reduction was in April (11-16s: -1339 admissions, 95% CI -1411 to -1267; 17-24s: -1600, -1678 to -1521) and May 2020 (under-11s: -2857, -2962 to -2752). Admissions differed by socioeconomic deprivation for the under-11s (P < 0.0001), driven by fewer admissions than expected by the most deprived and more by the most affluent during the pandemic.

CONCLUSION

Elective tooth extractions dropped most in April 2020, remaining below pre-pandemic levels throughout the study. Despite being the most likely to be admitted, the most deprived under-11s had the largest reductions in admissions relative to other groups.

Effectiveness of the Immersive Technologies' Applications in Oral Health Promotion and Oral Health Education: A Systematic Review

OBJECTIVE

To evaluate the effectiveness of immersive technologies' application in oral health promotion and education.

METHODS

An extensive literature review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) method. This study was systematically performed in six reputable electronic databases (PubMed, Google Scholar, Web of Science, Cochrane, Scopus, and EBSCO). The risk of bias was assessed with the Cochrane tools using RoB 2.0 and ROBINS-I.

RESULTS

PICOS criteria were formulated for study inclusion. The bibliographical search identified 10,074 articles, which were filtered subsequently. Finally, the most pertinent nine articles were included and scrutinized for data synthesis and analysis. This includes five randomized controlled trials and four non-randomized controlled trials in different countries that focused on children (33.3%), adolescents (11.1%), and adults (55.6%). The interventions used virtual reality (VR) and augmented reality (AR) to promote knowledge and attitudes towards oral care, improve toothbrushing performance, and smoking cessation, and reduce anxiety levels in oral health education.

CONCLUSION

This systematic review demonstrates that immersive technologies, including VR and AR, significantly enhance oral health knowledge, attitudes, and self-efficacy, leading to improved health outcomes.

CLINICAL SIGNIFICANCE

Immersive technologies such as VR and AR have the potential to provide innovative and effective methods for enhancing oral health promotion and education, while promoting positive health behaviours, which are crucial for improving overall oral health outcomes.

Prevalence of classic and non-classic pain sites of coronary artery disease: a cross-sectional study

STUDY OBJECTIVE

This study aims to assess the prevalence of both classic and non-classic pain sites in patients with ischemic heart disease, emphasizing the importance of recognizing and not disregarding non-classic symptoms.

METHODS

This cross-sectional study included 100 patients diagnosed with coronary artery disease (CAD) who were admitted to two major hospitals in Syria. classic pain was identified as pain located in the precordial area, with or without radiation to the neck, jaw, left shoulder or arm. Patients' demographics and previous medical history were documented to investigate any potential associations with non-classic pain.

RESULTS

62% of the patients experienced non-classic pain, while 12% had no precordial pain. For those without precordial pain, the most common pain site was the left chest (66.7%). Non-classic pain was significantly associated with smoking, with 72.2% of smokers experiencing non-classic pain compared to 35.7% non-smokers (p = 0.001). Additionally, patients with previous heart disease were more likely to have non-classic pain (71.7%), compared with patients with no history of heart disease (51.1%) (p = 0.03). Other factors such as age, sex, and diabetes were not statistically significant.

CONCLUSION

Non-classic pain is common, affecting 62% of individuals, primarily in the right shoulder, right arm, and back. This type of pain could be associated with smoking and prior heart disease. Misdiagnosing coronary artery disease can have serious consequences, as patients with non-classic symptoms may miss important pre-hospital procedures like ECG.

Youthful small extracellular vesicles restore the function and reparative capacity of inflammatory-impaired periodontal ligament stem cells via delivering protein biglycan for bone regeneration

Regenerating inflamed bone defects represents a severe clinical challenge due to the undesirable inflammatory microenvironment. The inflammatory stimulus poses a weighty threat to the regenerative capacity of endogenously derived mesenchymal stem cells (MSCs), which are mainly responsible for osteogenic differentiation, thereby resulting in compromised endogenous bone formation. Consequently, alleviating the biological characteristics of inflammatory-impaired MSCs is crucial for promoting inflamed bone regeneration. Nano-sized small extracellular vesicles (sEVs) have emerged as promising therapeutic tools to orchestrate MSCs fate due to their intrinsic biocompatibility and encapsulated bioactive contents. In the present study, we extracted sEVs from youthful and adult dental pulp MSCs and explored their ability to recover inflammation-compromised periodontal ligament stem cells (IPDLSCs). The results indicated that both types of sEVs were capable of facilitating IPDLSCs osteogenesis. However, young sEVs exhibited a more robust potential at a lower concentration compared to adult sEVs. Mechanically, young sEVs enhanced the expression of bone morphogenetic protein 4 (BMP4) via delivering the protein Biglycan, which correspondingly promoted the osteogenic capability of IPDLSCs. Collectively, our findings emphasized that young sEVs hold enormous potential to rescue the inherent function and regenerative competence of inflammation-impaired MSCs, shedding light on their promising therapeutic prospects for infected bone regeneration.

Comparison of the biomechanical effects of the post-core crown, endocrown and inlay crown after deep margin elevation and its clinical significance

BACKGROUND

The purpose of this in vitro study was to compare and evaluate the stress distribution of maxillary first premolar residual crowns restored with post-core crowns, endocrowns and inlay crowns after deep margin elevation, to explore the fitting restoration for residual crowns using finite element analysis.

METHODS

A healthy complete right maxillary first premolar from a male adult was scanned by cone beam computed tomography (CBCT). The finite element model of the tooth was established by reverse engineering software such as Mimics, Geomagic and Hypermesh. On this basis, the residual crown model after deep margin elevation was made, and the experimental group models were divided into three groups, those restored with post core crowns, endocrowns and inlay crowns. Vertical and oblique static loads were applied to the experimental models to simulate the force on the tooth during mastication (the loading position was located in the central fossa of the occipital surface, and the load was 100 N) using Abaqus software.

RESULTS

The peak value and distribution of von Mises stress in each part of the experimental model were observed. After deep margin elevation, the peak dentin von Mises stresses were lower than the tensile strength of normal dentin in the post-core crown, endocrown, and inlay crown groups; the lowest stress results were found in the post-core crown group for the dentin, restoration, enamel, and deep margin elevation (DME) layers under vertical and oblique loading. In terms of stress distribution clouds, the peak stresses in the dentin tissue were located in the apical 1/3 of the root after postcore crown restorations for both loads, while stress concentrations were evident in the cervical and root areas after endocrown and inlay crown restorations; regardless of the load and restoration method, the corresponding stress concentration areas appeared at the junction of the DME and dentin tissue at the loading site of the restorations; CONCLUSIONS: Post-core crowns, endocrowns and inlay crowns can be used to restore residual crowns after deep margin elevation, and post-core crowns can better protect the residual tooth tissue.

A hierarchical deep learning approach for diagnosing impacted canine-induced root resorption via cone-beam computed tomography

OBJECTIVES

Canine-induced root resorption (CIRR) is caused by impacted canines and CBCT images have shown to be more accurate in diagnosing CIRR than panoramic and periapical radiographs with the reported AUCs being 0.95, 0.49, and 0.57, respectively. The aim of this study was to use deep learning to automatically evaluate the diagnosis of CIRR in maxillary incisors using CBCT images.

METHODS

A total of 50 cone beam computed tomography (CBCT) images and 176 incisors were selected for the present study. The maxillary incisors were manually segmented and labeled from the CBCT images by two independent radiologists as either healthy or affected by root resorption induced by the impacted canines. We used five different strategies for training the model: (A) classification using 3D ResNet50 (Baseline), (B) classification of the segmented masks using the outcome of a 3D U-Net pretrained on the 3D MNIST, (C) training a 3D U-Net for the segmentation task and use its outputs for classification, (D) pretraining a 3D U-Net for the segmentation and transfer of the model, and (E) pretraining a 3D U-Net for the segmentation and fine-tuning the model with only the model encoder. The segmentation models were evaluated using the mean intersection over union (mIoU) and Dice coefficient (DSC). The classification models were evaluated in terms of classification accuracy, precision, recall, and F1 score.

RESULTS

The segmentation model achieved a mean intersection over union (mIoU) of 0.641 and a DSC of 0.901, indicating good performance in segmenting the tooth structures from the CBCT images. For the main classification task of detecting CIRR, Model C (classification of the segmented masks using 3D ResNet) and Model E (pretraining on segmentation followed by fine-tuning for classification) performed the best, both achieving 82% classification accuracy and 0.62 F1-scores on the test set. These results demonstrate the effectiveness of the proposed hierarchical, data-efficient deep learning approaches in improving the accuracy of automated CIRR diagnosis from limited CBCT data compared to the 3D ResNet baseline model.

CONCLUSION

The proposed approaches are effective at improving the accuracy of classification tasks and are helpful when the diagnosis is based on the volume and boundaries of an object. While the study demonstrated promising results, future studies with larger sample size are required to validate the effectiveness of the proposed method in enhancing the medical image classification tasks.

A cross-sectional examination of the relationship between learning environment and anxiety among dental hygiene students

OBJECTIVE

This study's purpose was to determine if the learning environment impacts student anxiety in a dental hygiene program by evaluating the two main learning environments: the dental clinic and the traditional classroom. This study also examined educational tasks and their association with anxiety in each learning environment.

METHODS

A web-based survey was conducted using a convenience sample of dental hygiene students enrolled in a two or four year CODA-accredited dental hygiene program in the United States. The Beck Anxiety Inventory was used to determine each participant's anxiety levels in both learning environments. Data analysis included descriptive statistics, correlation, and an analysis of variance.

RESULTS

According to the Beck Anxiety Inventory scoring, dental hygiene students experience a moderate level of anxiety when learning in the dental clinic and a low level of anxiety when learning in the classroom. Nervousness was the most reported anxiety symptom in both the dental clinic and the traditional classroom. Test results from the Spearman correlation show that all dental clinic and classroom educational tasks have a significant correlation (p < 0.01) to a student's anxiety level. Anxiety reported by students did not statistically differ by the year in which they were in the dental hygiene program.

CONCLUSION

Findings suggest anxiety does exist at a moderate level in dental hygiene students. The dental clinic learning environment is associated with greater anxiety among dental hygiene students. Results from this study will be beneficial in understanding how to facilitate student success in a dental hygiene program.

Evaluation of the effect of thermocycling on the trueness and precision of digitally fabricated complete denture bases

BACKGROUND

While many denture base materials are currently available on the market, little data exists regarding their dimensional stability after exposure to the oral environment. This study aimed to evaluate the effect of thermocycling on the trueness and precision of milled, 3-dimensional (3D)-printed, and conventional digitally fabricated complete denture bases (CDBs).

METHODS

A completely edentulous maxillary stone model was scanned to generate a standard tessellation language (STL) file; this was imported into metal-milling-machine software (Redon Hybrid CAD-CAM metal milling machine, Redon, Turkey) to produce a metal model for fabricating 30 CDBs. These were divided into three groups (n = 10 in each) according to the construction technique: group 1, CAD-CAM milled CDBs; group 2, 3D-printed CDBs; and group 3, conventional compression molded CDBs. All CDBs were scanned after fabrication and evaluated before and after thermocycling using superimposition. The data were analyzed using a one-way ANOVA, Tukey's post hoc test, and a paired t-test.

RESULTS

The level of trueness between the CAD-CAM milled, 3D-printed, and compression molded CDBs showed significant differences before and after thermocycling (P < 0.05). Group 1 showed the highest degree of trueness before and after thermocycling, group 3 exhibited a higher degree of trueness than group 2 before thermocycling, and group 2 had a higher degree of trueness than group 3 after thermocycling. There was a significant difference in the precision for each CDB type before and after thermocycling (P < 0.05).

CONCLUSION

The trueness of the CAD-CAM milling system in complete denture (CD) fabrication is superior to that of the 3D printing and conventional compression molding systems before and after thermocycling. Thermocycling had a significant effect on the precision of all CDB types. The compression molding system in CD construction is the most negatively affected via thermocycling with regard to the measures of trueness and precision.

CLINICAL TRIAL NUMBER

Not applicable, no human participants were involved.

The impact of virtual reality haptic simulators in pre-clinical restorative dentistry: a qualitative enquiry into dental students' perceptions

PURPOSE

In the realm of restorative dentistry, the integration of virtual reality haptic simulation (VRHS) for learning operative skills has garnered varied perceptions among dental students. Therefore, the aim of this study was to delve deep into undergraduates dental students' perceptions related to the impact of VRHS in pre-clinical restorative dentistry.

METHODS

A homogeneous purposive sampling method was utilized to gather data from third-year undergraduate dental students (n = 23) at the College of Dental Medicine, Qatar University, to thoroughly investigate their views on the impact of VRHS on their learning experience in preparing a standard class I cavity. An explorative qualitative method using face-to-face focus group sessions were conducted in English during 2023. Focus group sessions were recorded and transcribed using Microsoft Teams. Two authors independently read the transcripts, coded the text, and manually analyzed text using an inductive thematic approach.

RESULTS

A total of 21 (91.3%) students participated in this study. Analysis of 3 focus group interviews revealed five primary themes summarized with the term "MASTR" (M = manual dexterity, A = assessment, S = sequence, T = training, and R = realism). Based on frequency of reported themes, students perceived realism/ lifelike nature of VRHS requiring further enhancement to achieve the desired learning objective.

CONCLUSION

Although, VRHS play a crucial role in modern dental education, offering innovative solutions for training, evaluation, and feedback, the need to enhance their ability to simulate real-life dental procedures and learning environment (realism), coupled with interactive and immersive learning experiences were the most frequently raised theme by students. In terms of curriculum design and learning pedagogies, dental educators should consider the appropriate sequence when integrating VRHS within the undergraduate curricula.

Effects of two dentifrices on the surface properties and staining susceptibility of polymer-based materials

PURPOSE

This study examined the effect of whitening and abrasive regular dentifrices on the surface characteristics and stain susceptibility of polymer-based CAD-CAM blocks subjected to artificial toothbrushing abrasion (TB).

MATERIALS AND METHODS

Two resin composite blocks [CeraSmart (CS) and Grandio Blocs (GB)], one polymer-infiltrated ceramic [Vita Enamic (VE)], and one direct resin composite [GrandioSO (RC)] were used to produce 60 specimens. The baseline mass, gloss, roughness, Vickers hardness (Hv), and color were measured after 7 days of water storage. The specimens were then separated into three TB treatment groups (n = 5): water control (C), regular daily dentifrice (R), and whitening dentifrice (W). Measurements were repeated post-TB (20,000 cycles). All specimens were immersed in coffee, and the CIE ΔE00 was measured after 1, 7, and 14 days. Two-way, one-way ANOVA, and Tukey's post hoc tests were performed to determine any significant differences between the materials and TB groups. To determine the stain resistance, repeated measures of ANOVA, one-way ANOVA, and Tukey's post hoc tests were used (α = 0.05).

RESULTS

The R and W mass changes were minimal (-3.77 to 3.16 g%). W reduced the gloss of all the materials by 12.6%-65%. All materials in W were slightly rougher (Ra, 0.107-0.144 μm) than those in R (Ra, 0.049-0.072 μm). The ΔE00 ranged from 0.6 to 1.6 in W and 0.4 to 1.4 in R. VE was the hardest material at baseline (Hv = 362), whereas brushing and staining lowered Hv in all TB groups (282.8-300.6). After brushing in W, VE, and RC were more susceptible to coffee stains than were CS and GB.

CONCLUSIONS

The whitening dentifrice roughened CAD-CAM specimens, reducing gloss, yet lightened some materials. Polymer-infiltrated ceramic and direct resin composite specimens brushed with abrasive regular or whitening dentifrice resulted in more intense staining than the CAD-CAM resin composites.

Effect of three-dimensional print angle on integrity of interim crowns: A systematic review

STATEMENT OF PROBLEM

Three-dimensional printing is a rapid and cost-effective method that eliminates material waste during the manufacture of indirect restorations. Parameters such as print angle significantly affect the physical properties of the printed material. Several manufacturers suggest using an angle of 45 degrees to perform printing; however, different angles have been used, and the optimum parameters are unclear.

PURPOSE

The purpose of this systematic review was to compare the 45-degree print angle with other protocols and evaluate the effect of print angle on the physical and mechanical material properties.

MATERIAL AND METHODS

Two researchers independently searched for relevant studies published up to June 2023 in the PubMed/MEDLINE, Scopus, Web of Science, and Lilacs electronic databases. The population, intervention, comparison, outcome (PICO) question was: "Does the 45-degree print angle promote better physical characteristics for 3-dimensionally printed interim crowns?" Studies that compared the properties of the different print angles of interim crowns were analyzed.

RESULTS

Ten in vitro studies were selected for qualitative analysis. When evaluating marginal and internal fits, most studies selected the 45-degree angle, resulting in less discrepancy. The results of flexural strength analysis showed a high level of heterogeneity. The 0-degree print angle yielded better results in 3 studies, followed by the 90-degree print angle in 2 studies. The 45-degree angle yielded the highest fracture resistance value in 1 study and similar results to those of the control group (milled PMMA) in another study.

CONCLUSIONS

The marginal and internal adaptation and resistance to flexure of printed interim crowns are satisfactory when a 45-degree print angle is used.

Effects of online marketplace-sourced over-the-counter tooth whitening products on the colour, microhardness, and surface topography of enamel: an in vitro study

OBJECTIVES

This study compared the whitening effect, microhardness, and enamel surface alterations of over-the-counter (OTC) tooth bleaching products with those of a dentist-prescribed at-home bleaching agent.

MATERIALS AND METHODS

The products available on a popular online marketplace were comprehensively searched and then rated using a specific formula. The effects of the lowest-rated OTC agent (LRA) and the highest-rated OTC agent (HRA) were compared with those of a dentist-prescribed bleaching agent (DPA) on the enamel of extracted human teeth. The bleaching efficacy, post-bleaching microhardness changes, and morphological alterations were assessed by spectrophotometric analysis, Vickers hardness testing, and scanning electron microscopy (SEM) respectively. Statistical analyses included one-way ANOVA and post hoc tests, maintaining a significance level of P < 0.05.

RESULTS

The search of the online marketplace revealed 15 products. The LRA (Teeth Whitening Serum Gel, GEN, China) and the HRA (Bright White-Lovely Smile Premium Teeth Whitening strips, Ray of Smile, USA) were identified on the basis of their ranking. DPA resulted in significantly better tooth whitening than did LRA. The enamel microhardness was lower in the LRA treatment group (14.2%) than in the control and HRA treatment groups (8.84% and 7.26%, respectively). LRA also caused severe topographical alterations to the enamel.

CONCLUSION

Compared with the poorly rated product, the dentist-prescribed tooth bleaching product resulted in greater colour improvement, less microhardness reduction, and surface changes. The highest-rated product was comparable with the dentist-prescribed agent in this study.

Sleep bruxism (SB) may be not associated with obstructive sleep apnea (OSA): A comprehensive assessment employing a systematic review and meta-analysis

Associations between obstructive sleep apnea (OSA) and sleep bruxism (SB) are the subject of discussion but have not been confirmed definitively. Therefore, the objective of this meta-analysis was to examine the relationship between OSA and SB. This systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase and Web of Science were screened up to February 2024. The risk of bias was assessed with the Joanna Briggs Institute tool. 2260 records were identified, but only 14 studies were included. The odds of SB presence in OSA did not differ from the control group (OR: 1.23, 95 % CI: 0.47-3.20). The chance of SB compared to controls also did not differ in mild OSA (OR: 1.56, 95 % CI: 0.76-3.18), in moderate OSA (OR: 1.51, 95 % CI: 0.77-2.94) and in severe OSA (OR: 1.50, 95 % CI: 0.68-3.29). Additionally, the odds of SB were not increased in moderate OSA in comparison to mild OSA (OR: 1.14, 95 % CI: 0.63-2.94), in severe OSA compared to moderate OSA (OR: 1.31, 95 % CI: 0.61-2.79) or in severe OSA compared to mild OSA (OR = 1.42, 95 % CI: 0.69-2.93). The presence of SB in OSA did not differ between genders (OR: 2.14, 95 % CI: 0.65-7.05). The quality of the major studies included is low; therefore, the noted lack of correlation between OSA and SB may require further research. The relationship between OSA and SB seems to be multi-faceted. Presented results should not exempt clinicians from exact diagnosis of concomitant sleep conditions in OSA subjects.

Comparative analysis of shear bond strength of MTA and Theracal PT with different restorative materials

BACKGROUND

This study aimed to compare the in vitro shear bond strength (SBS) of mineral trioxide aggregate (MTA) and dual-cured, resin-modified calcium silicate material (Theracal PT) to composite resin, compomer, and bulk-fill composite, and to evaluate the bond failure mode under a stereomicroscope.

METHODS

Ninety acrylic specimens, each with a 4 mm diameter and 2 mm height central hole, were prepared. These specimens were randomly divided into two groups based on the capping materials: MTA and Theracal PT. Each group was further subdivided into three subgroups (n = 15) according to the restorative materials: composite resin, compomer, and bulk-fill composite. The specimens were then subjected to shear testing using a universal testing machine at a crosshead speed of 1 mm/min. Post-test, the fracture locations were examined using a stereomicroscope. Data were analyzed using a two-way analysis of variance (ANOVA) and the Tukey test.

RESULTS

The SBS values for the Theracal PT group were significantly higher than those for the MTA group (p < 0.001). Within the MTA groups, no significant differences were observed in SBS values across the different restorative materials. However, a significant difference was found between the mean SBS values of the Theracal PT + composite resin group and the Theracal PT + compomer group (p < 0.001).

CONCLUSIONS

Theracal PT shows promise in dentistry due to its superior bond strength. Given its bond values, Theracal PT appears capable of forming durable and long-lasting restorations by establishing reliable bonds with various restorative materials commonly used in dentistry.

When is surgical intervention needed in oral and maxillofacial space infection patients? A retrospective case control study in 46 patients

OBJECTIVE

Patients with mild oral and maxillofacial space infection (OMSI) usually need only antimicrobial therapy. However, surgical intervention is eventually needed after using antibiotics for a period. The objective of this study was to explore the risk factors for drug therapy failure in OMSI.

SUBJECTS AND METHODS

A retrospective case‒control study was designed. From August 2020 to September 2022, patients at Shanghai Jiao Tong University Affiliated Ninth People's Hospital who were diagnosed with OMSI were retrospectively reviewed. The outcome variable was surgical intervention after the use of antibiotics. We collected common biological factors, including demographic characteristics, routine blood test results, C-reactive protein (CRP) levels and composite indicators, such as neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). The χ2 test and binary logistic regression were used to examine the association between biological factors and the outcome variable.

RESULTS

Forty-six patients were included in this study. Further surgical intervention was needed in 20 patients (43.5%). The NLR showed a significant association with further surgical drainage (p = 0.01). A binary logistic regression equation was found by using stepwise regression based on the Akaike information criterion (R2 = 0.443), which was associated with sex (odds ratio [OR], 0.216; p = 0.092), NLR (OR, 1.258; p = 0.045), red blood cell (RBC) count (OR, 4.372; p = 0.103) and monocyte (MONO) count (OR, 9.528, p = 0.023). Receiver operating characteristic analysis produced an area under the curve for NLR of 0.725 (p = 0.01) and for the binary logistic regression model of 0.8365 (p < 0.001).

CONCLUSION

Surgical interventions are needed in some mild OMSI patients when antimicrobial therapy fails to stop the formation of abscesses. The binary logistic regression model shows that NLR can be used as an ideal prognostic factor to predict the outcome of antimicrobial therapy and the possibility of requiring surgical intervention.

STATEMENT OF CLINICAL RELEVANCE

Using simple, inexpensive, and easily achieved biological parameters (such as routine blood test results) and composite indicators calculated by them (such as NLR) to predict whether surgical intervention is needed in the future provides a reference for clinical doctors and enables more cost-effective and efficient diagnosis and treatment.

Effect of different mouthwashes on ventilator-related outcomes and mortality in intensive care unit patients: A network meta-analysis

BACKGROUND

Ventilator-associated pneumonia is a common and life-threatening complication in intensive care unit (ICU) patients. Maintaining oral hygiene is crucial for reducing ventilator-associated pneumonia incidence. Various mouthwash solutions are used for oral care in ICU settings, but their comparative effectiveness remains unclear. This study aims to systematically evaluate and compare the efficacy and safety of commonly used mouthwashes for oral care in mechanically ventilated ICU patients.

METHODS

We searched PubMed, Web of Science, Embase, and Cochrane Library for randomised controlled trials (RCTs) comparing saline, chlorhexidine, sodium bicarbonate, oxidising agents, herbal extracts, and povidone-iodine for oral care in ventilated ICU patients. Outcomes included ventilator-associated pneumonia incidence, ICU mortality, duration of ventilation, and Escherichia coli fixed value. A network meta-analysis (NMA) was conducted to synthesise direct and indirect evidence. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols, 2023120028.

RESULTS

FourteenRCTs with 1644 participants were included. Oxidising agents showed a trend towards reducing the incidence of VAP compared to the control group (risk ratio: 0.24, 95% confidence interval: 0.05-1.10). Administration of saline was associated with a notable reduction in ICU mortality (risk ratio: 0.18, 95% confidence interval: 0.04-0.88) versus no mouthwash. No significant differences were observed in the duration of mechanical ventilation between chlorhexidine, povidone-iodine, and the control group.

CONCLUSIONS

Antimicrobial mouthwashes, especially chlorhexidine, pose potential risks in ICU patients; oxidising solutions demonstrate relative safety. Saline solution emerges as a promising alternative, associated with a significant reduction in mortality rates. However, the need for large, high-quality RCTs remains paramount to substantiate these findings and establish evidence-based oral-care protocols in ICU settings.

REGISTRATION

This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols, 2023120028.

Collaborating with non-radiological clinical colleagues

Paediatric radiology is a challenging and intriguing subspecialty, dealing with children, guardians and non-radiological clinical colleagues. Paediatric radiologists are routinely in contact with numerous paediatric and surgical subspecialties, all having different needs, perceptions, prioritisations and expectations. Moreover, the radiologist is part of the team of radiographers, sonographers, nurses and secretaries, assisted by appropriate equipment and electronic tools. The framework of good collaboration to ensure safety and effectiveness for the imaged child is a shared responsibility among all medical practitioners involved. Communication in routine practice has many forms and includes appropriately filled radiology requests in accordance to the patient's medical records, routine and timely production of structured, problem-solving radiology reports, face-to-face or electronic-assisted communications and discussions on a pre-defined framework, mutually-agreed and evidence-based protocols adjusted to local availability, skills and national and international guidelines. Mutual understanding of advantages and limitations of imaging is paramount. Well-meant discussions, professionalism and empathy should promote soft skills, bidirectional communication and good collaboration for the benefit of added-value paediatric radiology. International societies, health authorities, medical directors and senior consultants have the responsibility to suggest and safeguard frameworks and recommendations. Regular multidisciplinary meetings and multidisciplinary research projects under openness, honesty and transparency are pathways favouring good collaboration.

Periodontal treatment causes a longitudinal increase in nitrite-producing bacteria

BACKGROUND

The oral microbiome-dependent nitrate (NO3 -)-nitrite (NO2 -)-nitric oxide (NO) pathway may help regulate blood pressure. NO2 --producing bacteria in subgingival plaque are reduced in relative abundance in patients with untreated periodontitis compared with periodontally healthy patients. In periodontitis patients, the NO2 --producing bacteria increase several months after periodontal treatment. The early effects of periodontal treatment on NO2 --producing bacteria and the NO3 --NO2 --NO pathway remain unknown. The aim of this study was to determine how periodontal treatment affects the oral NO2 --producing microbiome and salivary NO3 - and NO2 - levels over time.

METHODS

The subgingival microbiota of 38 periodontitis patients was analysed before (baseline [BL]) and 1, 7 and 90 days after periodontal treatment. Changes in NO2 --producing bacteria and periodontitis-associated bacteria were determined by 16s rRNA Illumina sequencing. Saliva samples were collected at all-time points to determine NO3 - and NO2 - levels using gas-phase chemiluminescence.

RESULTS

A significant increase was observed in the relative abundance of NO2 --producing species between BL and all subsequent timepoints (all p < 0.001). Periodontitis-associated species decreased at all timepoints, relative to BL (all p < 0.02). NO2 --producing species negatively correlated with periodontitis-associated species at all timepoints, with this relationship strongest 90 days post-treatment (ρ = -0.792, p < 0.001). Despite these findings, no significant changes were found in salivary NO3 - and NO2 - over time (all p > 0.05).

CONCLUSIONS

Periodontal treatment induced an immediate increase in the relative abundance of health-associated NO2 --producing bacteria. This increase persisted throughout periodontal healing. Future studies should test the effect of periodontal treatment combined with NO3 - intake on periodontal and cardiovascular health.

Laying the foundation for iCANmeditate: A mixed methods study protocol for understanding patient and oncologist perspectives on meditation

BACKGROUND

People with cancer experience heightened levels of stress and anxiety, including psychological or physical. In recent years, digitally delivered complimentary therapies, such as meditation, have gained attention in cancer research and advocacy communities for improving quality of life. However, most digital meditation resources are commercially available and are not tailored to the unique needs of cancer patients (addressing fears of recurrence). As such, this study lays the foundation to co-design a publicly available digital meditation program called iCANmeditate that contains cancer-specific meditation content.

AIMS

To understand: (1) cancer patients' perceptions and practices of meditation, as well as their needs in addressing the stress that accompanies their cancer diagnosis and (2) current knowledge of meditation and prescribing trends amongst oncologists in Canada.

METHODS AND ANALYSIS

A mixed-methods design comprised of online patient and oncologist surveys and interviews with patients will be used. Survey data analysis will use multivariate logistic regressions to examine predictors of: (1) interest in using a meditation app among patients and (2) prescribing meditation among oncologists. Patient interviews will gather insights about the contexts of daily living where meditation would be most beneficial for people with cancer; this data will be analyzed thematically.

DISCUSSION

The results of this study will inform iterative co-design workshops with cancer patients to build the digital meditation program iCANmeditate; interview results will be used to develop vignettes or "personas" that will supply the initial stimulus material for the iterative co-design workshops. Once the program has been finalized in partnership with cancer patient participants, a usability and pilot study will follow to test the functionality and efficacy of the tool. Results from the oncologist survey will form the basis of knowledge mobilization efforts to facilitate clinical buy-in and awareness of the benefits of meditation to cancer patients.

Integrating Structured Digital Tools with the Traditional Hands-on Puzzle Method for Teaching Tooth Morphology: A Comparative Study of Educational Outcomes

The study of tooth morphology is a critical component of the dental curriculum, highlighting the importance for dental students to acquire comprehensive and detailed knowledge of the complex structure of teeth. This study compared the educational outcomes of two student cohorts in a tooth morphology course, using traditional methods for the control group and additional digital video-based resources for the experimental group. We hypothesized that early integration of digital resources would significantly reduce the learning time. We retrospectively analyzed two groups of Master of Dentistry students. The control group (42 students) was taught using the traditional 'tooth puzzle' method, while the experimental group (42 students) supplemented traditional teaching with digital video-based tools developed by our department. Both groups' curricula culminated in a practical post-course test requiring the identification of 40 teeth, along with a mid-course test to track the students' learning progression. The number and type of incorrectly identified teeth were recorded. The mid-course test showed significant performance differences. The control group had a median (Q1, Q3) value of faults of 12.0 (7.8, 20.5), whereas the respective value for the experimental group was 4.0 (0.0, 8.0) (p < 0.001). In the control group, none achieved faultless results, with only two students (4.8%) having at most two faults, and six students (14.3%) having no more than four faults. The control group averaged 13.5 faults per student, with 19 students (45.2%) failing the test. Conversely, the experimental group showed improved performance: 12 students (28.6%) had no faults, and 25 students (59.5%) had four or fewer faults. The experimental group averaged 5.2 faults per student, with only four students (9.5%) failing. By the end of the course, both groups achieved commendable results on the practical tooth identification test. The experimental group slightly outperformed the control group, though the difference was not significant. The median (Q1, Q3) values were 0.0 (0.0, 2.5) and 1.0 (0.0, 4.5) for the experimental and control groups, respectively (p = 0.372). The students using both traditional and structured digital video-based tools showed greater learning advancement than those using only the traditional 'tooth puzzle' method.

Shared decision-making in adolescent healthcare: a literature review of ethical considerations

PURPOSE

Adolescence is a period of growing independence and maturity, within the period of legal minority. As parents or guardians are socially and legally responsible for adolescents' medical decisions, shared decision-making in adolescent healthcare could be ethically challenging. This review aims to identify and map the ethical tensions in shared decision-making in adolescent healthcare.

METHODS

We systematically searched the literature following the PRISMA guidelines to identify relevant articles, which were analyzed using the review of reasons methodology Strech and Sofaer (J Med Ethics 38(2):121-6, 2012).

RESULTS

We included 38 articles which involved adolescents, healthcare professionals and parents as being the main stakeholders. Shared decision-making was influenced not only by individual stakeholders' characteristics, but by tensions between stakeholder dyads. Most studies supported the involvement of the adolescent in decision-making, depending on their life experience, decision-making capacity and clinical condition.

CONCLUSIONS

Shared decision-making in adolescent health is receiving increasing attention. However, questions remain on what this concept entails, the roles and involvement of stakeholders and its practical implementation.

WHAT IS KNOWN

• Although adolescents wish to be involved in health decisions, shared decision-making in adolescents is underexplored • Adolescent shared decision-making is different from pediatric and adult shared decision-making, and is ethically complex due to the adolescent's growing autonomy What is new: • Adolescent SDM involves three-way interactions between the adolescent, healthcare professional and parents • In adolescent shared decision-making, involving or excluding a stakeholder and sharing or withholding information are ethically value-laden steps • Research is needed to further understand the roles of adolescents' personal value systems, extended or reconstituted families and decision aids in shared decision-making.

Effects of a hollow pontic design with various wall thicknesses on the axial internal fit and failure load of 3D printed three-unit resin prostheses

STATEMENT OF PROBLEM

A 3-dimensionally (3D) printed 3-unit interim fixed dental prosthesis (FDP) undergoes inward polymerization shrinkage to the pontic region, leading to nonuniform internal fit and improper accuracy. Whether axial wall thickness influences accuracy is unclear.

PURPOSE

The purpose of this in vitro study was to analyze the axial internal fit and failure load associated with a hollow pontic design of varying wall thicknesses in stereolithography (SLA) 3D printed 3-unit interim FDPs.

MATERIAL AND METHODS

A master model for a 3-unit interim FDP with 2 implant abutments was designed. Two master models were produced by using milling and direct metal laser sintering (DMLS). Sixty SLA 3D printed specimens were produced with a hollow pontic design of 4 wall thicknesses (solid and 2.5, 2.0, and 1.5 mm). Fifteen milled specimens were produced with a solid pontic design. The axial internal fit in the coronal section was measured in terms of intaglio and cameo mid-axial wall areas relative to the abutments by using microcomputed tomography (μCT). The failure load was measured by using a universal testing machine at a loading rate of 1 mm/minute. For statistical analysis, parametric tests were performed (α=.05). Horizontal μCT sections were compared qualitatively, and failure patterns were categorized among groups.

RESULTS

The hollow pontic designs with 2.0- and 1.5-mm wall thicknesses presented significantly lower mean intaglio mid-axial gaps than the solid pontic design (P<.001) and similar intaglio and cameo mid-axial gaps in the horizontal μCT sections. The hollow pontic design with the 2.0-mm wall thickness had a significantly higher mean failure load than that with the 1.5-mm wall thickness (P<.001) and a statistically similar mean failure load to that of the solid pontic design (P=.549). As the wall thickness of the hollow pontic decreased from 2.5 to 1.5 mm, the ratio of pontic fracture to complete fracture of the prosthesis increased.

CONCLUSIONS

For SLA 3D printed 3-unit interim FDPs, axial internal fit was enhanced by the application of an appropriate hollow pontic design. Considering both the structural strength and fit, a hollow pontic design with a 2.0-mm wall thickness should be selected.

Evaluation and comparison of autologous particulate dentin with demineralized freeze dried bone allograft in ridge preservation procedures - a prospective clinical study

OBJECTIVES

To compare effectiveness of Autologous Particulate Dentin (APD) with Demineralized Freeze-Dried Bone Allograft (DFDBA) in ridge preservation, using radiographic and clinical parameters.

MATERIALS AND METHODS

Thirty subjects with indication of mandibular posterior teeth extraction were randomly assigned to either test or control group. After atraumatic extraction, ridge preservation was performed using APD or DFDBA mixed with i-PRF in test and control groups respectively. Both groups had sockets sealed with A-PRF membrane. Clinical parameters (plaque, gingival and healing indices) and radiographic parameters (vertical ridge height, horizontal ridge width) were assessed at baseline and 6 months using CBCT. Statistical analysis was performed using an independent t-test to compare clinical and radiographic parameters between the groups.

RESULTS

Both groups had significant decreases in ridge dimensions over 6 months (p < 0.001). The test group showed less reduction in ridge dimensions than control group at 6 months (p < 0.001). Mean change in vertical height was not significant (1.37 ± 1.32, 1.7311 ± 0.563), but in horizontal ridge width (1.3120 ± 1.13, 1.8093 ± 1.16) was significantly different between test and control groups respectively. There was no statistical difference in clinical parameters between the groups at 6 months (p > 0.001).

CONCLUSIONS

APD grafts resulted in significant improvements in radiographic parameters, specifically in vertical ridge height and horizontal ridge width, compared to DFDBA group.

CLINICAL RELEVANCE

Autologous particulate dentin is a promising, versatile substitute for regenerative procedures. While more research on its long-term efficacy and application is needed, current evidence suggests it could significantly improve patient care and outcomes.

Digital workflow for the fabrication of custom-fit additively manufactured sports mouthguards with balanced occlusion using an optical jaw tracking system: A dental technique

Custom sports mouthguards are used in various sports to protect teeth, temporomandibular joints, and soft tissues from impact forces. The present article demonstrates a digital workflow to fabricate a 3-dimensionally (3D) printed individualized sports mouthguard. An optical jaw tracking system is used to record a repeatable reference position, and mandibular excursive movements to achieve a completely balanced occlusion. The technique simplifies the fabrication of a custom-fit mouthguard over the conventional approach by providing increased thickness accuracy, control of design, and integration of jaw motion.

Patient-provider communication during consultations for elective dental procedures: A scoping review

INTRODUCTION

Patient-provider communication (PPC) is a critical component of patient-centered care. Original studies have examined specific factors related to PPC during consultations for elective dental procedures, but this evidence has yet to be comprehensively summarized. This scoping review aimed to understand better the extent and depth of the available literature regarding factors that influence PPC during consultations for elective dental procedures.

METHODS

The authors considered electronically available, English-language, original research published since 1990 assessing communication during consultations for elective dental procedures. Four electronic databases, Google Scholar, and reference lists of inclusions were searched until August 2023. No quality assessment was completed. Two independent researchers assessed article eligibility. Data were charted with a narrative review approach.

RESULTS

A total of 37 studies were included. The most popular discipline studied was orthodontics. Prospective cohorts and cross-sectional were the most common study designs. Information recall, patient satisfaction, and patient comprehension were the most common outcome measures. Most studies employed questionnaires, surveys, or interviews for data collection. Nineteen factors related to PPC during elective dental consultations were identified and categorized into information delivery (4), patient-related (9), and provider-related factors (6).

CONCLUSIONS

This scoping review is the first to present a list of evidence-supported factors related to PPC in elective dental consultations. Identifying these factors is an important first step to better understanding their influence on PPC and designing interventions targeting those that may be modifiable. PPC during elective dental consultations is a dynamic, ongoing process. Several recommendations emerged that may help improve PPC, including appropriate information delivery, patient engagement, providing adequate time, and educating ourselves on approaches to PPC.

Neoadjuvant Hyperthermia Combined with Hybrid Nanoarchitectures Enhances Chemoradiotherapy Efficacy in Head and Neck Carcinoma

Head and neck squamous cell carcinomas are characterized by a high incidence of recurrence, especially in patients with locally advanced disease. Standard treatment strategies can be associated with severe side effects to healthy tissues that can negatively impact the patient's quality of life. Hyperthermia (HT) is a noninvasive treatment modality that has improved the effectiveness of chemotherapy (CT) and/or radiotherapy (RT) for the management of some solid neoplasms. In this context, the association of this approach with rationally designed nanomaterials may further enhance the treatment outcome. In this study, we demonstrate the enhanced effect of neoadjuvant HT in combination with hybrid nanoarchitectures enclosing a cisplatin prodrug (NAs-CisPt) and RT. All the treatments and their combinations have been fully evaluated by employing standardized chorioallantoic membrane tumor models of HPV-negative head and neck carcinoma. An improved tumor-shrinking effect was observed by the administration of the trimodal treatment (HT/NAs-CisPt/RT), which also highlighted a significant increase in apoptosis. Our findings demonstrate that the combination of HT with nanotechnology-based CT and RT in a certain order enhances the in vivo treatment outcome. On a broader basis, this study paves the way for the next exploration of noninvasive treatment approaches for the clinical management of oral cancer based on innovative strategies.

Exploring healthcare workers' perceptions of child health research at Kamuzu Central Hospital, Malawi: an interpretative phenomenological analysis

BACKGROUND

Children's health is a global public health priority and a determinant of development and sustainability. Its effective delivery and further improvements require constant and dedicated research on children, especially by child healthcare workers (HCWs). Studies have shown a high involvement of child HCWs from developed countries in child health research, with an under-representation from the global south in authorship and leadership in international collaborations. To our knowledge, there is very little literature on challenges faced by child HCWs in Malawi in conducting child health research. We sought to explore the lived experiences of child HCWs at Kamuzu Central Hospital (KCH) in Malawi by examining their perceptions of child health research and assessing the availability of child health research opportunities.

METHODS

From July 2023 to August 2023, we conducted five key informant interviews with purposively sampled policymakers and 20 in-depth interviews with child HCWs at KCH. The interviews were conducted in English, audio-recorded, and transcribed verbatim. We utilised interpretative phenomenological analysis by reviewing initial transcripts for familiarity, generating codes manually, and refining them into broader themes through comparisons and iterative processes.

RESULTS

The analysis revealed three main themes on perceptions of child HCWs at KCH in child health research. These are (i) perceived motivation and challenges for engaging in child health research, (ii) perceptions of resource availability and research opportunities at KCH, and (iii) perceptions of gaps in research training and participation among child HCWs.

CONCLUSIONS

Our study has uncovered critical factors influencing the low participation of child HCWs in child health research at KCH. Lack of collaboration, limited financial opportunities, and non-research-based training were the key barriers to participation in child health research among child HCWs at KCH. We advocate for the inclusion of child HCWs at all stages of collaborative health research, transparency on funding opportunities for child health research, and inclusion of research in the training of HCWs. These initiatives can strengthen the participation of child HCWs in child health research and ultimately enhance child health outcomes in Malawi.

Oral and dental health utilization determinants in special health care needs: a systematic review of reviews

BACKGROUND

Oral health is essential for overall well-being and can significantly improve quality of life. However, people with special health care needs (SHCN) often face challenges in accessing dental services. This study aimed to systematically review all available evidence on the oral and dental service utilization determinants among these individuals. Based on the findings, we also explore strategies to increase their access to dental care.

METHOD

This study is a systematic review of reviews based on the PRISMA 2020. Six databases were systematically searched including PubMed, Web of Science, Scopus, Embase, ProQuest, and Cochrane Library. Related keywords were applied up to 30 October 2023. This study includes all systematic, scoping, and rapid reviews written in English that examine the factors affecting dental service use among SHCNs. Microsoft Power BI was used for descriptive quantitative analysis, and MAXQDA version 10 was applied for qualitative thematic analysis.

RESULTS

The number of 2238 articles were retrieved based on the search strategy. After excluding duplications and appraising the eligibility, 7 articles were included. An examination of these 7 articles shows that they were all carried out from 2016 to 2022. Of these, 42% were systematic reviews, 42% used a scoping method, and one study (14%) was a rapid review. According to the thematic analysis, there were five main themes concerning determinants of oral and dental utilization of SHCN: "Financial considerations," "Patient-Provider Relationship," "Accessibility and Availability of Services," "Patient Factors," and "Quality of Care." Additionally, regarding strategies for improving utilization, three main themes emerged: "Education and Training," "Service Improvement," and "Policy Solutions.

CONCLUSION

This study delves into the intricate challenges SHCNs face in accessing dental services, highlighting the imperative for comprehensive interventions addressing supply and demand. Supply-oriented measures encompass dentist education, implementing financial policies for affordable services, and integrating dental care into primary healthcare systems. On the demand side, strategies revolve around empowering patients and caregivers and enhancing cultural inclusivity. Despite sustained efforts, current utilization rates fall short of optimal levels. Thus, effective strategic planning by policymakers and healthcare leaders is paramount to bolster dental service utilization among SHCNs, thereby enhancing their overall well-being.

Gastrin-releasing peptide receptor antagonist RC-3095 inhibits Porphyromonas gingivalis lipopolysaccharide-accelerated atherosclerosis by suppressing inflammatory responses in endothelial cells and macrophages

OBJECTIVE

Porphyromonas gingivalis (P. gingivalis), one of the major periodontopathogens, is associated with the progression and exacerbation of atherosclerosis. In this study, we aimed to investigate whether the gastrin-releasing peptide receptor antagonist, RC-3095, could attenuate P. gingivalis LPS-induced inflammatory responses in endothelial cells and macrophages, as well as atherosclerosis in an ApoE-/- mouse model treated with P. gingivalis LPS.

METHODS

The effect of RC-3095 on P. gingivalis LPS-induced endothelial inflammation was examined using HUVECs and rat aortic endothelium. THP-1 cells were polarized into M1 macrophages by exposure to P. gingivalis LPS, with or without RC-3095. The effect of RC-3095 on atherosclerosis progression was assessed in high-fat-fed male ApoE-/- mice through injections of P. gingivalis LPS, RC-3095, or a combination of both.

RESULTS

RC-3095 significantly reduced P. gingivalis LPS-induced leukocyte adhesion to endothelial cells and aortic endothelium by suppressing NF-κB-dependent expressions of ICAM-1 and VCAM-1. In addition, RC-3095 inhibited the P. gingivalis LPS-induced polarization of M1 macrophages by blocking the MAPK and NF-κB signaling pathways. Moreover, RC-3095 decreased the area of atherosclerotic lesions in ApoE-/- mice, which was accelerated by P. gingivalis LPS injection, and lowered the expressions of ICAM-1 and VCAM-1 in the aortic tissue of mice with atherosclerosis.

CONCLUSIONS

RC-3095 can alleviate P. gingivalis LPS-induced endothelial inflammation, macrophage polarization, and atherosclerosis progression, suggesting its potential as a therapeutic approach for periodontal pathogen-associated atherosclerosis.

Acceptance among the public of weight screening and interventions delivered by dental professionals: observational study

OBJECTIVE

The objective of this study was to explore the acceptability to the public of receiving weight screening and the offer of support to lose weight from dental teams.

METHODS

A cross-sectional survey was conducted with recruitment of adults from dental practices and community and hospital settings in England and the National Institute for Health and Care Research (NIHR) Be Part of Research initiative.

RESULTS

A total of 3580 participants were recruited across 22 dental sites and the NIHR Be Part of Research initiative. Sixty percent (n = 2055/3430) of participants reported that they would be comfortable with their height and weight being measured at a dental appointment. Male participants and those of non-White race and ethnicity had significantly increased odds of accepting weight screening (odds ratio [OR]: 1.98, 95% CI: 1.66-2.36; OR: 2.07, 95% CI: 1.42-3.03). Fifty-seven percent (n = 1915/3375) of participants reported that it would be acceptable for their dental team to offer support to help with weight management. Male participants and those of non-White race and ethnicity had significantly increased odds of accepting support (OR: 1.79, 95% CI: 1.49-2.13; OR: 1.62, 95% CI: 1.11-2.37). The most accepted form of support was provision of information on local weight-management programs (n = 1989/2379, 83.6%).

CONCLUSIONS

The public is largely receptive to receiving weight screening and the offer of weight interventions from dental teams. Feasibility studies to test the implementation of lifestyle weight interventions in dental settings are required.

Implementation of a patient reminder system in Haiti in a socio-political crisis context: evaluation of outcomes

BACKGROUND

In Haiti, patient's adherence to treatment and compliance with medical appointments are very challenging due to different local factors. We aimed to assess the effectiveness of a reminder system implemented in health facilities in Haiti in a context of socio-political crisis.

METHODS

We used appointment data from patients aged 15 years and older between January 2021 and November 2023 from four healthcare centers in the Port-au-Prince metropolitan area. We performed descriptive analysis, crossing covariates with appointment attendance. We performed Pearson's Chi-squared test, and multivariate regression analysis using a mixed-effect logistic regression model in order to explore the association between sending reminders and appointment attendance, with and without adjustment for other patient-level covariates.

RESULTS

A total of 14 108 appointments were registered on the reminder systems, with 2 479 (17.6%) attendances. Among those to whom reminders were sent, the number of attendances was 167 (17.4%) for email recipients only, 199 (36.7%) for SMS recipients only, and 19 (42.2%) for both SMS and email recipients - versus 2 094 (16.7%) for non-reminders. After adjusting on all other covariates, we found that patients to whom a reminder was sent via email (aOR: 1.45; CI: 1.08, 1.94), SMS (aOR: 2.95; CI: 2.41, 3.60), and both SMS and email (aOR: 2.86, CI: 1.37, 5.96) were more likely to show up on their appointment day compared to those who did not receive any reminder. Other socio-demographic factors such as being 50 years and older (aOR: 1.31; CI: 1.10, 1.56) compared to under 30 years, living as couple (aOR: 1.23; CI: 1.10, 1.37), and not having children (aOR: 1.21; CI: 1.07, 1.37) were significantly associated with appointment attendance.

CONCLUSIONS

Our study suggests that patient reminder systems may be used to reduce non-attendance in Haiti, even in a context of socio-political crisis.

HOCl-producing electrochemical bandage is active in murine polymicrobial wound infection

Wound infections, exacerbated by the prevalence of antibiotic-resistant bacterial pathogens, necessitate innovative antimicrobial approaches. Polymicrobial infections, often involving Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA), present challenges due to biofilm formation and antibiotic resistance. Hypochlorous acid (HOCl), a potent antimicrobial agent, holds promise as an alternative therapy. An electrochemical bandage (e-bandage) that generates HOCl in situ via precise polarization controlled by a miniaturized potentiostat was evaluated for the treatment of murine wound biofilm infections containing both P. aeruginosa with "difficult-to-treat" resistance and MRSA. Previously, HOCl-producing e-bandage was shown to reduce murine wound biofilms containing P. aeruginosa alone. Here, in 5-mm excisional skin wounds containing 48-h biofilms comprising MRSA and P. aeruginosa combined, polarized e-bandage treatment reduced MRSA by 1.1 log10 CFU/g (P = 0.026) vs non-polarized e-bandage treatment (no HOCl production), and 1.4 log10 CFU/g (0.0015) vs Tegaderm only controls; P. aeruginosa was similarly reduced by 1.6 log10 CFU/g (P = 0.0032) and 1.6 log10 CFU/g (P = 0.0015), respectively. For wounds infected with MRSA alone, polarized e-bandage treatment reduced bacterial load by 1.1 log10 CFU/g (P = 0.0048) and 1.3 log10 CFU/g (P = 0.0048) compared with non-polarized e-bandage and Tegaderm only, respectively. The e-bandage treatment did not negatively impact wound healing or cause tissue toxicity. The addition of systemic antibiotics did not enhance the antimicrobial efficacy of e-bandages. This study provides additional evidence for the HOCl-producing e-bandage as a novel antimicrobial strategy for managing wound infections, including in the context of antibiotic resistance and polymicrobial infections.

IMPORTANCE

New approaches are needed to combat the rise of antimicrobial-resistant infections. The HOCl-producing electrochemical bandage (e-bandage) leverages in situ generation of HOCl, a natural biocide, for broad-spectrum killing of wound pathogens. Unlike traditional therapies that may exhibit limited activity against biofilms and antimicrobial-resistant organisms, the e-bandage offers a potent, standalone solution that does not contribute to further resistance or require adjunctive antibiotic therapy. Here, we show the ability of the e-bandage to address polymicrobial infection by antimicrobial resistant clinical isolates of Staphylococcus aureus and Pseudomonas aeruginosa, two commonly isolated, co-infecting wound pathogens. Effectiveness of the HOCl-producing e-bandage in reducing pathogen load while minimizing tissue toxicity and avoiding the need for systemic antibiotics underscores its potential as a tool in managing complex wound infections.

Assessment of the relationship between the three-dimensional precise location of the mandibular third molar and the volume ratio of the impacted mandibular third molar to the mandibular angle, and the patterns of mandibular angle fracture: A retrospective study

This study aimed to evaluate the relationship between the precise three-dimensional location of the third molar (M3) and mandibular angle fracture (MAF) patterns and to assess the effect of the volume ratio occupied by M3 in the mandibular angle on fracture patterns. The location of M3 was assessed in 218 patients with MAF using computed tomography reconstruction. The bone volume of the mandibular angle and the bone volume occupied by M3 were measured to calculate the volume ratio of M3 to the mandibular angle (M3/MA). MAF patterns were categorized into simple fracture (Type I), displaced fracture (Type II), and comminuted fracture (Type III) based on fracture severity. The results showed that the location of M3 significantly influenced MAF patterns (vertical position: P = .001; horizontal position: P = .002; angulation: P = .027, respectively) and the volume ratio of M3/MA was significantly higher for Type III fracture than Types I and II (P < .001). Regression analysis showed that the horizontal position and angulation of M3 and the volume ratio of M3/MA were the main predictors for comminuted MAF. A larger volume ratio (odds ratio [OR], 1.201; 95% confidence interval [CI], 1.037-1.391; P < .014), Class III position (OR, 7.978; 95% CI, 1.275-49.910; P < .026), and horizontal angulation (OR, 7.212; 95% CI, 1.028-50.581; P < .047) of the M3 were more prone to comminuted MAF than simple fracture. Our findings indicate that the location of M3 significantly affects MAF patterns, and that M3 may weaken the mandibular angle by occupying more bone space, thereby increasing the risk of a comminuted fracture.

Possible Association between Behçet's Disease and Periodontal diseases

AIM

This study explores the connection between Behçet's disease (BD), characterized by persistent oral and genital ulcers alongside iritis, and periodontal disease. It examines the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and nitric oxide (NO) in gingival crevicular fluid (GCF) and saliva.

METHODS

Forty Behçet's patients with gingivitis or periodontitis and 47 patients with either gingivitis or periodontitis but without BD were studied. Periodontal status was recorded with standard clinical indexes. GCF and saliva samples were obtained. NO, IL-1β and TNF-α levels were analysed. Current Behçet's symptoms and medications usage were recorded.

RESULTS

Mean salivary IL-1β was elevated (p = .045), and mean NO level was decreased in BD patients with gingivitis compared to patients without BD (p = .000). In contrast, mean NO level in crevicular fluid was higher in Behçet's patients with periodontitis than in patients without BD (p = .009). Furthermore, among Behçet's patients, those with vascular involvement had lower salivary NO level compared to patients without vascular involvement (p = .000).

CONCLUSIONS

Based on our findings, the elevated levels of IL-1β in the saliva of Behçet's patients with gingivitis, along with the decreased NO level, indicate an altered inflammatory response in the oral cavity.

Childhood obesity in relation to risk of dental caries: a cumulative and dose-response systematic review and meta-analysis

INTRODUCTION

Earlier studies reported inconsistent findings for the association of childhood obesity with the risk of dental caries. In this systematic review and meta-analysis, we aimed to summarize earlier studies on the association of overweight and obesity with risk of dental caries in children.

METHODS

Relevant studies published up to December 2023 were identified through searches in PubMed, MEDLINE, SCOPUS, EMBASE, and Google Scholar, using suitable keywords. All observational studies, including cross-sectional or cohort or case-control studies, about the association of each obesity index with risk of dental caries in children which reported odds ratio (OR), hazard ratio (HR), or relative risk (RR) and 95% CIs, were included. Studies involving adults, randomized clinical trials, studies on animals or pregnant women, and studies on other dental disorders were excluded. Risk of bias was assessed using standard methods for observational studies. A total of 22 studies including 40673 participants were included. Studies were pooled using the random-effect model, and results were synthesized with subgroup analyses and assessments of heterogeneity. Limitations included potential publication bias and heterogeneity among study designs. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS).

RESULTS

Children at the highest category of BMI were 44% more likely to have early childhood caries (ECC) than those at the bottom (OR: 1.44; 95% CI: 1.16 to 1.78). Moreover, combined analysis also showed no significant association between waist circumference (WC) and risk of dental caries in children. However, significant linear and non-linear associations were found between BMI and risk of childhood dental caries. No publication bias was found for the relationship between BMI and the risk of ECC based on visual inspection of a funnel plot and Egger's test.

CONCLUSIONS

This study showed a significant direct association between BMI and the risk of dental caries in children. Non-linear analysis showed higher risk of dental caries in children with higher BMI and also among underweight children. Further prospective studies are required to expand current knowledge in this issue.

IMPACT STATEMENT

The findings of this study have significant implications for public health and dental care, suggesting association between BMI and the risk of dental caries in children. This comprehensive meta-analysis is among the first to summarize earlier publications on the association of obesity with risk of dental caries in children, highlighting the need for more accurate methods of obesity assessment and further research to understand this relationship better. These findings can help inform public health policies and interventions to reduce the prevalence of childhood obesity and dental caries.

Positive identification through comparative dental analysis in mass disaster: a systematic review and meta-analysis

PURPOSE

The study aimed to assess the probability of achieving positive identification through comparative dental analysis (CDA) and to determine the factors that influence its success rate in mass disaster scenarios.

METHODS

An electronic literature search was conducted across six databases for observational studies that reported both the total number of mass disaster victims and the count of victims identified through CDA alone. A random-effect meta-analysis, using the proportion of victims identified with CDA as the effect size, was conducted alongside subgroup analyses based on the type of disaster (natural or non-natural), the disaster classification (open or closed), and the geographical region (i.e., Europe, Asia).

RESULTS

The search yielded 3133 entries, out of which 32 studies were deemed eligible. Most of the studies (96.8%) presented a low risk of bias. The meta-analysis revealed a mean weighted-proportion probability of 0.32, indicating that forensic odontology could identify about one-third of the victims in a mass disaster. The probability of comparative dental identification was three times higher in closed mass disasters compared to open disasters (p < 0.05) and was higher in mass disasters occurring in North America and Europe compared to other regions (p < 0.05).

CONCLUSION

The current result suggested that CDA can identify approximately 32% of a victim in a hypothetical scenario, emphasizing the integral role of teeth and forensic odontology in victim identification framework.

Unhealthy weight control behaviors and health risk behaviors in American youth: a repeated cross-sectional study

BACKGROUND

Unhealthy weight control behaviors (UWCBs) involve weight control strategies to reduce or maintain weight, such as fasting, taking diet pills, and vomiting or taking laxatives. UWCBs in teenagers can escalate into severe health issues such as eating disorders. Understanding the trends of UWCBs and their association with risk behaviors in teenagers is crucial, as early intervention and prevention strategies are pivotal.

METHODS

This study utilized eight waves of the youth risk behavior surveillance system (YRBSS) data from 1999 to 2013. Our primary outcome was UWCBs engagement. We used multinomial logistic models to analyze the association between UWCBs and risk behaviors among adolescents including driving after alcohol consumption, suicide attempts, smoking, alcohol use, and sexual intercourse.

RESULTS

Among 109,023 participants, UWCBs prevalence was 16.64%. Body Mass Index (BMI) was significantly associated with UWCBs risk. In addition, we found the intention of weight management confounded the relationship between BMI and UWCBs. The unadjusted logistic regression indicated a monotone-increasing association between BMI and the risk of UWCBs. In contrast, the adjusted logistic regression indicated a U-shaped curve with the lowest (BMI < 17 kg/m2) and highest (BMI > 30 kg/m2) BMI groups having significantly higher odds of engaging in UWCBs compared to the reference BMI group (18.5 ≤ BMI ≤ 24.9 kg/m2).

CONCLUSIONS

The intention of weight management confounded the relationship between Body Mass Index (BMI) and the risk of UWCBs. These findings suggest that healthcare interventions for weight management behaviors should be tailored to adolescents with BMI ≥ 25 and BMI < 18.5.