Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis

BACKGROUND

Adolescence is characterized by complex and dynamic changes, often involving experimentation, including the use of psychotropic substances. Although it is well-established that recreational psychotropic drugs are associated with suicide ideation in adults, evidence of this association in adolescents remains limited.

OBJECTIVE

To investigate the relationship between suicide ideation and psychotropic recreational drug use among adolescents.

DESIGN AND SETTING

Systematic review with meta-analysis developed at Universidade Federal de Uberlândia (UFU) and Universidade Estadual de Campinas (UNICAMP), Brazil.

METHODS

A search across eight electronic databases for observational studies, without language or publication year restrictions, was conducted. The Joanna Briggs Institute tool was used to assess the risk of bias. Random-effects meta-analyses and odds ratios were used to measure the effects.

RESULTS

The search yielded 19,732 studies, of which 78 were included in the qualitative synthesis and 32 in the meta-analysis. The findings indicated that suicidal ideation was 1.96 times more likely (95% confidence interval, CI = 1.47; 2.61) for adolescents who used some drug recurrently and 3.32 times more likely (95%CI = 1.86; 5.93) among those who abused drugs. Additionally, adolescents who used cannabis were 1.57 times more likely (95%CI = 1.34; 1.84) to experience suicide ideation compared with non-users, while cocaine users had 2.57 times higher odds (95%CI = 1.47; 4.50).

CONCLUSIONS

Psychotropic recreational drug use is associated with suicidal ideation among adolescents regardless of current or previous use, abuse, or type of substance used.

SYSTEMATIC REVIEW REGISTRATION

Registered in the PROSPERO database under the identification number CRD42021232360. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232360.

The Alcohol Harm Paradox in Periodontitis

Individuals of lower socioeconomic position (SEP) experience a greater rate of alcohol-related harms, yet they consume equal or lower amounts of alcohol than higher-SEP individuals. This phenomenon, called the "alcohol harm paradox" (AHP), gained attention recently, and different mechanisms have been proposed to explain it. Since both SEP and alcohol have been suggested to be associated with periodontitis risk, we conducted a secondary analysis using data from the National Health and Nutrition Examination Survey 2011 to 2012 and 2013 to 2014 cycles, aiming to examine 1) whether the association between alcohol consumption and periodontitis is modified by SEP and 2) the extent to which the effect of SEP inequalities on periodontitis is mediated by and/or interacts with alcohol consumption. We set educational attainment as the main SEP proxy and tested the poverty income ratio in subsequent sensitivity analyses. Effect measure modification analysis was employed, considering heavy drinking as exposure, and causal mediation analysis based on the potential outcome's framework decomposed the effect of SEP on periodontitis in proportions attributable to mediation and interaction. Models were fitted using binary logistic regression and adjusted for sex, ethnicity, age, body mass index, smoking status, diabetes, binge drinking, and regular preventive dental visits. The analytical sample comprised 4,057 participants. After adjusting for covariates, less educated heavy drinkers presented 175% (odds ratio, 2.75; 95% confidence interval [CI], 2.04-3.72) higher odds of periodontitis than their counterparts, and super-additive associations were found (relative excess risk due to interaction: 1.35; 95% CI, 0.49-2.20). Additionally, -69.5% (95% CI, -122.1% to -16.8%) of the effects of education on periodontitis were attributable to interaction with heavy drinking, consistent with the AHP. No contribution was found for the mechanism of mediation. Heavy drinking disproportionately impacts the occurrence of periodontitis in lower-SEP individuals. Lower-SEP individuals seem to experience differential effects of heavy drinking on periodontitis.

Co-occurrence of Periodontitis and Diabetes-Related Complications

Periodontitis is a common finding among people with diabetes mellitus (DM) and has been cited as a DM complication. Whether and how periodontitis relates to other diabetes-related complications has yet to be explored. This study aims to examine the clustering of periodontitis with other diabetes-related complications and explore pathways linking diabetes-related complications with common risk factors. Using data from participants with DM across 3 cycles of the National Health and Nutrition Examination Survey (NHANES) (n = 2,429), we modeled direct and indirect pathways from risk factors to diabetes-related complications, a latent construct comprising periodontitis, cardiovascular diseases, proteinuria, and hypertension. Covariates included age, sex, socioeconomic status (SES), smoking, physical activity, healthy diet, alcohol consumption, hemoglobin A1c (HbA1c), dyslipidemia, and body mass index (BMI). Sensitivity analyses were performed considering participants with overweight/obesity and restricting the sample to individuals without DM. Periodontitis clustered with other diabetes complications, forming a latent construct dubbed diabetes-related complications. In NHANES III, higher HbA1c levels and BMI, older age, healthy diet, and regular physical activity were directly associated with the latent variable diabetes-related complications. In addition, a healthy diet and BMI had a total effect on diabetes-related complications. Although sex, smoking, dyslipidemia, and SES demonstrated no direct effect on diabetes-related complications in NHANES III, a direct effect was observed using NHANES 2011-2014 cycles. Sensitivity analysis considering participants with overweight/obesity and without DM showed consistent results. Periodontal tissue breakdown seems to co-occur with multiple diabetes-related complications and may therefore serve as a valuable screening tool for other well-known diabetes-related complications.

Obesity, Insulin Resistance, Caries, and Periodontitis: Syndemic Framework

(1) Background: To investigate the grouping of obesity and insulin resistance with caries and periodontitis from a syndemic perspective through pathways of socioeconomic inequalities, smoking, alcohol, and high sugar consumption in adolescence. (2) Methods: The population-based RPS Cohort study, São Luís, Brazil, in ages 18-19 years (n = 2515) was used. The outcomes were the grouping of pbesity and Insulin Resistance Phenotype (latent variable formed by Triglycerides/HDL ratio, TyG index, and VLDL) and the Chronic Oral Disease Burden (latent variable comprising caries, bleeding on probing, probing depth ≥ 4 mm, clinical attachment level ≥ 3 mm, and visible plaque index ≥ 15%). Socioeconomic Inequalities influencing the Behavioral Risk Factors (latent variable formed by added sugar, smoking, and alcohol) were analyzed using structural equation modeling. (3) Results: Socioeconomic Inequalities were associated with the Chronic Oral Disease Burden [Standardized Coefficient (SC) = 0.222, p < 0.001]. Behavioral Risk Factors were associated with increased Chronic Oral Disease Burden (SC = 0.103; p = 0.013). Obesity was associated with the Insulin Resistance Phenotype (SC = 0.072; p < 0.001) and the Chronic Oral Disease Burden (SC = 0.066; p = 0.005). The Insulin Resistance Phenotype and the Chronic Oral Disease Burden were associated (SC = 0.053; p = 0.032). (4) Conclusion: The grouping of obesity and early events of diabetes with caries and periodontitis call for a syndemic approach in adolescence.

Effect of Smoking Exposure on Nonsurgical Periodontal Therapy: 1-Year Follow-up

This study investigated the influence of different levels of exposure to smoking on periodontal healing for 12 mo after nonsurgical periodontal therapy and supportive periodontal care every third month. Eighty smokers willing to quit smoking and with periodontitis were included. Participants were offered an individualized voluntary smoking cessation program. Data collection included questionnaires and a full-mouth periodontal examination. Group-based trajectory modeling was used to model smoking trajectories over the follow-up. The effect of smoking trajectory on periodontal parameters over time was estimated with mixed effects modeling. Three smoking patterns were identified: light smokers/quitters (n = 46), moderate smokers (n = 17), and heavy smokers (n = 17). For the periodontal data, the first factor, moderate periodontitis, included the number of sites with clinical attachment levels (CALs) of 4, 5, 6, and 7 mm; periodontal pocket depths (PPDs) of 4, 5, and 6 mm; and bleeding on probing. The second factor, severe periodontitis, consisted of the number of sites with a CAL ≥8 mm and PPD ≥7 mm. Heavy smokers commenced with a higher average CAL of 1.1 mm and 10 more sites with severe periodontitis than light smokers/quitters. While light smokers/quitters and moderate smokers obtained an average improvement of 0.6-mm PPD and 0.7-mm CAL, respectively, heavy smokers experienced 0.5-mm attachment loss. Heavy smokers had only a 50% reduction in the number of sites with moderate periodontitis when compared with light smokers/quitters and moderate smokers. While most participants benefited from nonsurgical periodontal therapy with results affected in a dose-response manner, the therapy had no effect on severe periodontitis among heavy smokers. Smoking cessation should be part of periodontal therapy; otherwise, limited benefits would be observed among heavy smokers, hindering the effect of treatment.

Causal inference in dentistry: Time to move forward

Oral conditions represent a critical public health challenge, and together with descriptive and predictive epidemiology, causal inference has a crucial role in developing and testing preventive oral health interventions. By identifying not just correlations but actual causes of disease, causal inference may quantify the average effect of interventions and guide policies. Although authors are not usually explicit about it, most oral health studies are guided by causal questions. However, methodological deficiencies limit their interpretability and the implementation of their findings. This manuscript is a call to action on the use of causal inference in oral research. Its application starts with asking theoretically sound questions and being explicit about causal relationships, defining the estimates to evaluate, and measuring them properly. Beyond promoting causal analytical approaches, we emphasize the need for more causal thinking to promote thoughtful research questions and the use of appropriate methods to answer them. Causal inference relies on the plausibility of assumptions underlying the data analysis and the quality of the data, and we argue that high-quality observational studies can be used to estimate average causal effects. Although individual efforts to embrace causal inference in dentistry are essential, they will not yield substantial results if not led by a systematic and structural change in the field. We urge scientific societies, funding bodies, dental schools, and journals to promote transparency in research, causal thinking, and causal inference projects to move the field toward more meaningful studies. It is also time for researchers to move forward and connect with the community, co-produce investigations and translate their findings, and engage in interventions that impact public health. We conclude by highlighting the importance of triangulating results from different data sources and methods to support causal inference and inform decision-making on interventions to effectively improve population oral health.

Impact of public health and higher education policies on the profile of final-year Brazilian dental students: Challenges and future developments

INTRODUCTION

Brazil has experienced transformations in higher education and health services, including launching more inclusive public policies focused on these two areas.

OBJECTIVE

To evaluate the profile of final-year dental students from a Brazilian public university from 2010 to 2019, accompanied by changes in public health and higher education policies.

METHODS

A prospective observacional study was carried out with final-year dental students. A self-applicable semi-structured questionnaire was applied.

RESULT

Six-hundred and seventy-seven students participated, of which 71.5% were women, 72.9% aged between 21 and 25 years, 96.2% single, and 96.4% were without children. Over ten years, it was possible to identify trends in the profile explained by implementing public policies toward more inclusive access to Brazilian higher education by socioeconomically disadvantaged individuals. Students who completed the course between 2018 and 2019 did not have the state capital city (the wealthiest area) as their origin city and had lower parental education and income levels than dental students graduating between 2010 and 2011. Moreover, working as a primary care dentist in the Brazilian National Health System was considered a professional possibility by 61.4% of the students, and has gained prominence significantly over time, ranging from 21.1% in 2010 to 72.9% in 2019 (p < .05).

CONCLUSION

Over the study period, concomitantly to advances in public health and higher education policies in Brazil, more diverse access to public dental education was observed, allowing students from low socioeconomic positions to take the education. Changes have also impacted the students' perspectives regarding the need for postgraduate training and a career in public health dentistry. However, these trends need to be consolidated, and public policies continued and strengthened.

Effects of calcium hydroxide intracanal medications on T helper (Th1, Th2, Th9, Th17, and Tfh) and regulatory T (Treg) cell cytokines in apical periodontitis: a CONSORT RCT

INTRODUCTION

This CONSORT RCT investigated T helper (Th1, Th2, Th9, Th17, and Tfh), regulatory T (Treg) cell-type cytokines, and their networks in apical periodontitis (AP). We also assessed the effects of calcium hydroxide [Ca(OH)2] intracanal medications (ICMs) on helper T and Treg cell-type cytokines.

METHODS

Twenty teeth with primary endodontic infection and apical periodontitis (PEIAP) were randomly divided into two groups: Ca(OH)2 + saline solution (SSL; n = 10) and Ca (OH)2 + 2% Chlorhexidine-gel (2% CHX-gel; n = 10). Samples were collected from the periradicular tissue fluid (PTF) before (PTFs1) and after 14 days of ICMs (PTFs2). The Human High Sensitivity T Cell Panel was used to quantify target T-helper (Th)1: IL-2, 12, and IFN-γ; Th2: IL-4, -5, -13; Th9: IL-9; Th17: IL-17; T follicular helper cells (Tfh): IL-21; and Treg-cell-type cytokine: IL-10.

RESULTS

Th1-type cytokines were higher, compared to Th2-type, at PTFs1. Positive (+) associations were found among all Th1-type cytokines and all Th2-type cytokines. There were negative (-) correlations between all Th1- and Th2-type cytokines. Size of radiolucent lesions (SRL) and symptoms (TTP and/or POP) were positively correlated with Th1-type cytokines, IL-17, and IL-21 but negatively correlated with Th2-type cytokines and IL-10 (all, p < 0.001). Both ICMs increased Th2-type cytokines and IL-10 (P < 0.05) and decreased Th1- type cytokines, IL-17, and IL-21 (P < 0.05), with no differences among them (P > 0.05).

CONCLUSIONS

Complex T-cell cytokine networks are involved in AP. Both Ca(OH)2 ICMs effectively increased IL-4, IL-5, IL-10, and IL-13 and lowered IL-2, IL-12, IL-17, IL-21, and IFN-γ.

Scoping Review of Oral Health-Related Birth Cohort Studies: Toward a Global Consortium

The multidisciplinary nature and long duration of birth cohort studies allow investigation of the relationship between general and oral health and indicate the most appropriate stages in life to intervene. To date, the worldwide distribution of oral health-related birth cohort studies (OHRBCSs) has not been mapped, and a synthesis of information on methodological characteristics and outcomes is not available. We mapped published literature on OHRBCSs, describing their oral health-related data and methodological aspects. A 3-step search strategy was adopted to identify published studies using PubMed, Embase, Web of Science, and OVID databases. Studies with baseline data collection during pregnancy or within the first year of life or linked future oral health data to exposures during either of these 2 life stages were included. Studies examining only mothers' oral health and specific populations were excluded. In total, 1,721 articles were suitable for initial screening of titles and abstracts, and 528 articles were included in the review, identifying 120 unique OHRBCSs from 34 countries in all continents. The review comprised literature from the mid-1940s to the 21st century. Fifty-four percent of the OHRBCSs started from 2000 onward, and 75% of the cohorts were from high-income and only 2 from low-income countries. The participation rate between the baseline and the last oral health follow-up varied between 7% and 93%. Ten cohorts that included interventions were mostly from 2000 and with fewer than 1,000 participants. Seven data-linkage cohorts focused mostly on upstream characteristics and biological aspects. The most frequent clinical assessment was dental caries, widely presented as decayed, missing, and filled teeth (DMFT/dmft). Periodontal conditions were primarily applied as isolated outcomes or as part of a classification system. Socioeconomic classification, ethnicity, and country- or language-specific assessment tools varied across countries. Harmonizing definitions will allow combining data from different studies, adding considerable strength to data analyses; this will be facilitated by forming a global consortium.

Survival of atraumatic restorative treatment restorations in the elderly patients: a systematic review

This study aimed to assess the survival of glass ionomer cement (GIC) restorations performed using the atraumatic restorative treatment (ART) in elderly patients. The systematic review protocol was registered in the PROSPERO database. The records were searched until August 2020 in eight electronic bibliographic databases, and included randomized and non-randomized clinical trials and observational studies, with no restrictions on the language or year of publication. Study selection and data extraction were performed independently by two reviewers. Data were extracted, summarized, collected for qualitative analysis, and evaluated for individual risk of bias using the Joanna Briggs Institute's Critical Appraisal Tool. The literature search retrieved 5,186 records; however, only seven studies fulfilled the eligibility criteria and were included. The studies were published between 2002 and 2019. A total of 1,239 restorations were investigated at intervals of 6, 12, 24, and 60 months of follow-up. Some studies had a low risk of bias, while others had moderate and high risk of bias. In general, GIC restorations placed using ART were considered satisfactory. The 6-month, 12-month, and 24-month survival rates ranged from 81.3% to 97.2%, 72.2% to 94%, and 63% to 87%, respectively; additionally, the survival rate for the longest follow-up period (60 months) was 85%. Given the best evidence-based information regarding caries removal, we highlight the need to provide a conservative and effective technique for use in elderly patients. ART is a promising and viable alternative that guarantees the survival of restorations in elderly patients.

Participation of endotoxin in root canal infections: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the relationship between endotoxin levels and presence of clinical signs/symptoms and radiographic features in patients with endodontic infection. Electronic searches were performed on Medline/PubMed, Embase, Cochrane Library, Scielo, Science Direct, Web of Knowledge and Scopus databases for identification of relevant studies published up to December 2016. Grey literature was searched in Google Scholar. The selected literature was reviewed independently by two authors. Clinical studies evaluating the levels of endotoxin and the presence of clinical and radiographic features were included in this review. In order to determine the relationship between endotoxin levels and presence of clinical signs/symptoms and radiographic features meta-analyses were performed. Among the 385 articles identified in the initial search, 30 were included for full-text appraisal and only eight studies met the inclusion criteria for this systematic review. Meta-analysis revealed that individuals having teeth with tenderness to percussion (TTP) (P = 0.04; I² 57%) and previous episode of pain (PEP) (P = 0.001; I² 81%) had higher levels of endotoxin than their counterparts. Size of radiographic lesion >2 mm (P = 0.02; I² 68%) and presence of root canal exudation (EX) (P = 0.0007; I² 0%) were associated with higher levels of endotoxin. This systematic review and meta-analyses provided a strong evidence that endotoxin are related with the presence of clinical signs/symptoms and radiographic features in patients with endodontic infection.

Mapping of inflammatory biomarkers in the peri-implant crevicular fluid before and after the occlusal loading of narrow diameter implants

OBJECTIVE

To monitor the cytokine release patterns in the peri-implant crevicular fluid (PICF) and to investigate which factors affect the success rate of narrow diameter implants (NDI) during the first year.

MATERIAL AND METHODS

Mandibular implant overdentures (IOD) retained by 2 NDI were installed in 16 clinically atrophic edentulous patients. The following parameters were monitored during the first year: (i) peri-implant health parameters (plaque index (PI), calculus presence (CP), gingival index (GI), probing depth (PD) and bleeding on probing (BoP); (ii) cytokine concentrations in the PICF (TNF-α, IL-1β, IL-6, IL-10); (iii) implant stability quotient (ISQ); (iv) marginal bone level (MBL) and bone level change (BLC); (v) implant success. The insertion torque, bone type, mandibular atrophy, time since edentulism, and smoking habits were also recorded. All data were analyzed using multivariable multilevel mixed-effects regression models.

RESULTS

The variability in the TNF-α release patterns temporarily reduced at weeks (w) 8-12, while the IL-1β concentrations remained low until they peaked at w48 [p < 0.05; + 177.55 pg/μl (+ 96.13 - + 258.97)]. Conversely, IL-10 release decreased significantly at w48 [p < 0.05; - 456.24 pg/μl (- 644.41 - - 268.07)]. The PD and ISQ decreased significantly (p < 0.05) over the follow-up period, while the MBL was stable after w48 with a BLC of 0.12 ± 0.71 mm. The overall success rate was 81.3%, and was influenced by TNF-α, IL-1β, IL-10, PI, GI, PD, smoking, and time since edentulism.

CONCLUSION

Pro- and anti-inflammatory cytokine release was balanced during the first 24 weeks. The GI, smoking, and time since edentulism are the most important factors determining the implant success.

CLINICAL RELEVANCE

The study contributes to the understanding of the osseointegration process in a clinically atrophic population rehabilitated with IOD, and highlights the importance of monitoring clinical peri-implant health-related parameters, smoking habit, and time since edentulism to predict implant success rates.

How Common is Dry Mouth? Systematic Review and Meta-Regression Analysis of Prevalence Estimates

The aim of this paper is to systematically review the literature to estimate the overall prevalence of xerostomia/hyposalivation in epidemiological studies. An electronic search was carried out up to February 2018 with no language restrictions. A total of 5760 titles were screened and just twenty-nine papers were included in review and the meta-analysis after a two independently reviewers applied the selection criteria. Data were extracted from PubMed and Web of Science databases. Eligibility criteria included original investigations from observational population-based studies that reported the prevalence of xerostomia or data that allowed the calculation of prevalence of xerostomia and/or hyposalivation. Studies conducted in samples with specific health conditions, literature reviews, case reports and anthropological studies, as conferences or comments were excluded. Sample size, geographic location of the study, study design, age of the studied population, diagnosis methods, and evaluation criteria used to determine xerostomia e/or hyposalivation were extracted for meta-analysis and meta-regression. Multivariate meta-regression analysis was performed to explore heterogeneity among studies. The overall estimated prevalence of dry mouth was 22.0% (95%CI 17.0-26.0%). Higher prevalence of xerostomia was observed in studies conducted only with elderly people. Despite diverse approaches to the condition's measurement, just over one in four people suffer from xerostomia, with higher rates observed among older people. Moreover, the measurement methods used currently may over- or underestimate xerostomia. These findings highlight the need for further work on existing and new clinical measure and will be useful to determine which one is more reliable in clinical and epidemiological perspectives.

Regulation of PGLYRP1 and TREM-1 during Progression and Resolution of Gingival Inflammation

INTRODUCTION

The triggering receptor expressed on myeloid cells 1 (TREM-1) signaling pathway is stimulated by bacteria and, together with its putative ligand peptidoglycan recognition protein 1 (PGLYRP1), propagates proinflammatory responses.

OBJECTIVES

We aimed to evaluate the TREM-1/PGLYRP1/interleukin (IL)-1β regulation in response to biofilm accumulation and removal in an experimental human gingivitis model.

METHODS

The study (n = 42 participants, mean age: 23.8 ± 3.7 y) comprised a recruitment step (day -14) followed by experimentally induced biofilm formation (induction [I] phase, day 0 to +21) and a 2-wk resolution (R) phase (day +21 to +35). Plaque was recorded by the Modified Quigley and Hein Plaque Index (TQHPI), while records of gingival inflammation were based on the Modified Gingival Index (MGI). Unstimulated whole saliva supernatants (n = 210, 5 time points) were tested for TREM-1, PGLYRP1, and IL-1β by enzyme-linked immunosorbent assay.

RESULTS

During the I-phase, concentrations of all analytes showed a tendency for downregulation at day +7 compared to day 0. TREM-1 (P = 0.019) and PGLYRP1 (P = 0.007) increased significantly between day +7 and day +21. Although all analyte levels decreased during the R-phase, the difference was not significant except TREM-1 being at borderline significance (P = 0.058). Moreover, TREM-1, PGLYRP1, and IL-1β showed significant positive correlations (P < 0.0001) with each other. The study participants were grouped into "fast" and "slow" responders based on clinical gingival inflammation scores. At each time point, fast responders showed significantly higher concentrations of TREM-1 (P < 0.025), PGLYRP1 (P < 0.007), and IL-1β (P < 0.025) compared to slow responders. Mixed-effects multilevel regression analyses revealed that PGLYRP1 (P = 0.047) and IL-1β (P = 0.005) showed a significant positive association with the MGI scores.

CONCLUSION

The study demonstrated that TREM-1 and PGLYRP1 are regulated in response to biofilm accumulation and removal, and fast responders demonstrated higher levels of these analytes compared to slow responders.

KNOWLEDGE TRANSFER STATEMENT

The results of this study demonstrated the suitability of salivary TREM-1 and PGLYRP1 to reflect biofilm accumulation and removal and PGLYRP1 to monitor the progression and resolution of inflammation in gingivitis-susceptible individuals (fast responders). Combined with conventional risk factors, the molecular toolbox proposed here should be further validated in future studies to confirm whether it can be used for population-based monitoring and prevention of gingivitis.

Influence of facial patterns on the masticatory function and quality of life of completely edentulous patients during the transition to implant-retained mandibular overdentures

STATEMENT OF PROBLEM

Although implant-retained mandibular overdentures (IMOs) provide functional benefits, the influence of the vertical facial pattern (FP) and the anteroposterior skeletal discrepancy (ASD) on the masticatory function and patient-centered outcomes during the transition to IMOs is still uncertain.

PURPOSE

The purpose of this interventional clinical study was to evaluate the influence of the FP and ASD on the masticatory function, oral health-related quality of life (OHRQoL), and satisfaction of completely edentulous patients before and after transition to IMOs.

MATERIAL AND METHODS

Cephalometric analysis was performed on 42 participants before treatment. Ricketts analysis was used to classify the FP, and the maxillomandibular relationship to the base of the skull determined the ASD. Masticatory performance (MP) and swallowing threshold (ST) test results were evaluated by the multiple sieve method by using artificial test food (Optocal cubes) to determine the median particle size (×50), homogenization index (B), and masticatory efficiency based on sieves 5.6 (ME: 5.6) and 2.8 (ME: 2.8). OHRQoL and satisfaction were evaluated by using the Dental Impact on Daily Living questionnaire. The data were analyzed using mixed-effects linear regression models to estimate the effect of time, FP, ASD, age, and sex on MP, ST, and OHRQoL.

RESULTS

The MP, ST, OHRQoL, and satisfaction improved significantly after IMO loading, irrespective of FP and ASD. However, MP outcomes were most negatively affected mainly among dolichofacial (B and ME: 2.8), class II, and class III (×50, B, and ME: 2.8) participants. The ST test showed that class II participants still showed inferior ×50 values and performed a lower number of cycles than class I and class III participants. Women presented reduced masticatory function for all MP and ST outcomes and reported lower coefficients for appearance and general performance domains than men.

CONCLUSIONS

The MP test detected more subtle improvements than the ST test, especially in class III participants. The class II participants benefited the least from the IMO installation according to the ST test. The IMO treatment improved the OHRQoL and satisfaction of edentulous patients, irrespective of the FP or ASD.

How has dental pulp stem cells isolation been conducted? A scoping review

The objective of this study was to realize a scoping review the literature in order to identify the profile of DPSCs isolation and analyze the possible risk factors that could change the native behavior of these cells. An initial search was conducted using the following MeSH terms: "(dental pulp stem cell [MeSH])"; "(dental pulp [MeSH])" AND "(stem cell [MeSH])"; "("dental pulp stem cell" [MeSH]")". The electronic search was done without date restriction up to and including April 2014, in PubMed, Scopus, Scielo and ISI Web of Knowledge databases. Studies were submitted to inclusion and exclusion criteria and 222 articles were included. Data showed that over the past 15 years many studies have been conducted using DPSCs. However this is the first systematic review regarding the isolation of stem cell, and more specifically of dental pulp stem cells. The isolation of dental pulp stem cells showed great variability, hampering the development of standard protocols to achieve in vitro dental pulp stem cells with similar characteristics. This scoping review combined, for the first time, the methodologies used for dental pulp stem isolation, highlighting the most frequently used.

How fast can treatment with overdentures improve the masticatory function and OHRQoL of atrophic edentulous patients? A 1-year longitudinal clinical study

OBJECTIVES

The aim of this prospective clinical study was to evaluate the masticatory function (MF) and subjective perception of patients with poor denture-bearing tissue in relation to change and the time required to identify an improvement in these parameters after rehabilitation with mandibular overdentures (MO) by two narrow-diameter two-piece implants.

MATERIAL AND METHODS

Twenty-three edentulous patients were selected for MO installation. The masticatory function (MF) was evaluated with the masticatory performance (MP) and swallowing threshold (ST) tests. In the MP test, each volunteer was instructed to masticate a portion of Optocal (standardized artificial test food) for 40 masticatory cycles. During the swallowing threshold test, the patients were instructed to chew a new portion of Optocal cubes until they felt the desire to swallow. The MF tests were performed while complete denture (CD) wearers (baseline) and 1, 3, 6, and 12 months after MO loading. In addition, the subjective perception was assessed through the questionnaires Dental Impact on Daily Living (DIDL), Geriatric Oral Health Assessment Index (GOHAI), and Oral Health Impact Profile in Edentulous (OHIP- EDENT) at the baseline and 3, 6, and 12 months after MO loading.

RESULTS

A significant improvement in masticatory function (p < .05) was observed already in the first month of loading. Three months after MO loading, a significant improvement (p < .05) was found in the subjective perception of patients. The effect size indicates that the MO had the greatest impact on the domains related to function and comfort of all questionnaires and in relation to psychosocial domain of the GOHAI. The level of patient satisfaction increased significantly after the MO loading and reached >90% satisfied patients at 12 months.

CONCLUSION

The MO improved both the MF of the patient and their oral health-related quality of life and satisfaction regarding the prosthesis in a short time period.

Edentulism, Severe Tooth Loss and Lack of Functional Dentition in Elders: A Study in Southern Brazil

The aim of this study was to estimate self-reported prevalence of edentulism, severe tooth loss and lack of functional dentition in elders, and to identify potential associated factors. A population based cross-sectional study was carried out with 1,451 elders (≥60 years), in Pelotas, RS, Brazil. Crude and adjusted prevalence ratios were estimated using Poisson regressions. The prevalence of edentulism, severe tooth loss and lack of functional dentition was 39.3%, 60.9% and 82.7%, respectively. The factors positively associated with tooth loss in the three-degree severity were sex (females), older individuals, low familial income, low level of schooling and having the last dental visit longer than 24 months ago. The high prevalence of tooth loss in its different degrees of severity and the association with preventable factors highlight the need of programs focused on elders, emphasizing the prevention of tooth loss and need for prosthetic rehabilitation.

Use of motorcycle in Brazil: users profile, prevalence of use and traffic accidents occurrence — a population-based study

Abstract This study aimed to describe the profile of motorcycle users and determine the prevalence of use. Also, to evaluate the reason for using a motorcycle, users' perceived risk of traffic accident, pattern of helmet wearing and number of accidents related to motorcycle use in the last 12 months. This cross-sectional study was conducted in the city of Pelotas, Southern Brazil. Sampling process was carried out in two stages, with the primary unit being the census track and the secondary the house. The study included 3,004 individuals aged 10 to 59 years, which answered a structured questionnaire. The outcome of the study was the use of motorcycle. The prevalence of motorcycle use was 25%. The majority of the riders were composed by males (79%). Individuals aged from 18 to 35-years-old comprised 42% of the total number of users, mainly as riders (24%). Forty percent of the users were not using properly the helmet strap. The major part of the users (76%) had a perception of high risk for accidents. The prevalence of accidents was 8%; it was higher among males and among those individuals aged from 18 to 35 years. The use of motorcycle was widespread in the population. Users were aware of the risk of accident, even though they reported to not wear correctly the helmet.

The split crest technique and dental implants: a systematic review and meta-analysis

This systematic review aimed to determine: (1) the expected bone volume gain with the split crest technique, and (2) how the use of surgical instruments affects the performance of this technique. An electronic search was performed in the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Embase, PubMed/MEDLINE, Scopus, and Web of Science databases. Twenty-seven articles met the selection criteria and were subjected to meta-analysis of bone gain and survival rate; 17 reported the use of conventional surgical instruments and nine the use of surgical ultrasound. A total of 4115 implants were installed in 1732 patients (average patient age 52 years). The overall implant survival rate was 97%. The average bone gain in studies that used conventional surgical instruments was 3.61mm, while this was 3.69mm in those that used ultrasound. Only two studies presented a low risk of bias. The greatest problems identified during the qualitative analysis were related to random selection of the population and the absence of statistical analysis. The split crest technique appears to be a promising and effective technique to gain bone width, regardless of the surgical instruments used. Considering the diversity of the studies and implant types, no definitive recommendations can be made, especially with regard to the best instruments and implant design to be used.

Is there a relationship between obesity and tooth loss and edentulism? A systematic review and meta-analysis

This study conducted a systematic review to assess the bi-directional association between tooth loss/edentulism and obesity. Electronic searches were performed in four different databases. Observational studies that tested associations between tooth loss/edentulism and obesity as either exposures or outcomes were included. Additionally, meta-analyses, funnel plots and sensitivity analyses were conducted to synthesize the evidence. A total of 549 articles were identified in the electronic database search. Out of which, 16 studies were included within the meta-analyses: 75% considered tooth loss/edentulism as exposure and obesity as outcome, whereas 25% alternatively considered obesity as exposure and tooth loss/edentulism as outcome. Pooled estimates showed that obese individuals had 1.49 (95%CI 1.20-1.86) and 1.25 (95%CI 1.10-1.42) times higher odds of having any tooth loss and edentulism, respectively. Alternatively, when tooth loss or edentulism were considered as exposures, individuals with any tooth loss had 1.41 (95%CI 1.11-1.79) times higher odds for obesity, while edentates had even higher odds (OR 1.60; 95%CI 1.29-2.00). The results indicate a bi-directional association between tooth loss and obesity. Considering that all selected studies were of cross-sectional study design limiting inferences on temporality, longitudinal prospective studies are required to test the causal relationship between tooth loss/edentulism and obesity or vice a versa. © 2016 World Obesity.

Mini-implants for Orthodontic Anchorage: Surface Analysis after Redrilling and Sterilization - An in vitro Study

OBJECTIVE

This study aimed to investigate, in vitro, possible alterations on mini-implants surface after retrieval and if the cleaning process and sterilization can predispose damages.

MATERIALS AND METHODS

Two commercial mini-implants were tested for deformations after drilling and removing in artificial bone four times. Samples were analyzed by scanning electron microscopy, and surface alterations verified through thread and pitches deformation. To alterations caused by insertion/removal and the cleaning process and sterilization were verified in different procedures: Insertions and sterilization, only insertions, and only sterilization. Photomicrographs were analyzed in order to compare the surface characteristics. Head deformation was verified qualitatively. For a quantitative analysis, distances between threads were measured across the active part of the mini-implants.

RESULTS

No deformation was observed in both groups. The cleaning and sterilization processes did not provoke alteration in both groups. Nevertheless, the presence of synthetic bone was noted in some samples. The mean distances between implant threads were similar after all steps in all regions in both groups.

CONCLUSION

The results suggest that the tested mini-implants can be retrieved without damage of its surface after four cycles of insertion, removal, and sterilization.

KEYWORDS

Orthodontic mini-implant, Redrilling, Sterilization.

CLINICAL SIGNIFICANCE

Mini-implants can be retrieved without damage to its surface after four cycles of insertion, removal, and sterilization in the same patient without representing a biological concern.

Soft tissue cone beam computed tomography (ST-CBCT) for the planning of esthetic crown lengthening procedures

OBJECTIVE

The aim of this study was to measure the clinical crown, anatomical crown, and amount of gingiva covering the enamel of anterior maxillary teeth with soft tissue cone beam computed tomography (ST-CBCT) and thus propose a protocol for the application of this noninvasive method for the planning of esthetic crown lengthening procedures to prevent undesired root exposure.

MATERIALS AND METHODS

Ten young patients (mean age 22.8 years) requiring esthetic crown lengthening surgeries but not restorative procedures were included in this study. The ST-CBCT images were analyzed with an image editor and analysis software (Pixelmator 3.2), and the clinical crown, anatomical crown, and amount of gingiva covering the enamel were measured.

RESULTS

The mean value of the length of the anatomical crowns of the central incisors, lateral incisors, and canines were 11.06 mm, 9.55 mm, and 9.77 mm, respectively. Thus, the canines were approximately 1.3 mm shorter than the central incisors.

CONCLUSION

It was shown that ST-CBCT is a useful tool to assess the actual length of the anatomical crown and the amount of gingival tissue that needs to be surgically removed in an esthetic crown lengthening procedure to prevent undesired root exposure. Thus, ST-CBCT is a helpful noninvasive procedure for the planning of esthetic crown lengthening surgeries, making it possible to better predict their final outcome.

Effect of breastfeeding on malocclusions: a systematic review and meta-analysis

AIM

The objective of this systematic review was to investigate whether breastfeeding decreases the risk of malocclusions.

METHODS

Six databases were systematically searched to the end of October 2014. Observational and interventional studies were included. Breastfeeding was evaluated in three categories: (i) ever versus never; (ii) exclusive versus absence of exclusive; and (iii) longer periods versus shorter periods. All types of malocclusion were considered as the outcome. Pooled adjusted odds ratio and its 95% confidence interval (95%CI) were obtained from meta-analyses. Heterogeneity was assessed with both the Q-test and the I-square. Funnel plots and Egger's test were employed to assess publication bias.

RESULTS

Forty-eight studies were included in the systematic review, and 41 were included in the overall meta-analysis (n = 27 023 participants). Subjects who were ever breastfed were less likely to develop malocclusions than those never breastfed (OR 0.34; 95% CI 0.24; 0.48), those who were exclusively breastfed presented lower risk to present malocclusion than those with absence of exclusive breastfeeding (OR 0.54; 95% CI 0.38; 0.77), and subjects longer breastfed were less likely to have malocclusions than those shorter breastfed (OR 0.40; 95% CI 0.29; 0.54).

CONCLUSION

Breastfeeding decreases the risk of malocclusions.

Do clinical experience time and postgraduate training influence the choice of materials for posterior restorations? Results of a survey with Brazilian general dentists

The aims of this study were to evaluate the materials available for posterior restorations and to assess whether clinical experience time and post-graduate training influence dentists' choices. A cross-sectional study was conducted using a questionnaire with closed questions applied to dentists (n=276) of a mid-sized city of the southern Brazil. Information was collected regarding sociodemographic variables, level of specialization, time since graduation and working place. In addition, options regarding posterior restorations including the first choice of material, type of composite resin (if used) and use of rubber dam were also collected data. Data were submitted to descriptive analysis and the associations were evaluated using chi-square and Fisher's exact tests (α=0.05). The response rate was 68% (187). Direct composite resin was broadly indicated (73.2%) as the first-choice for posterior restorations. Most professionals used microhybrid composite (74.5%) and 42.6% of the participants used rubber dam for placement of posterior composite restorations. Dentists with more time of clinical practice used less composite (p=0.014). Specialists used more frequently rubber dam to restore posterior teeth than did non-specialists (p=0.006). The results of this survey revealed that direct composite was the first choice of dentists for posterior restorations; microhybrid was the preferred type of composite and the use of rubber dam for composite resin placement in posterior teeth was not frequent; time since graduation and level of specialization affected dentists' choices.

Use of Fusidic Acid for Desquamative Gingivitis Treatment: 1-Year Follow-Up

<p>This study evaluated retrospectively the effect of fusidic acid on the management of desquamative gingivitis (DG). The study population consisted of 15 patients with DG. Patients were requested to make topical application of 2% fusidic acid ointment 4 times a day for 6 weeks. Clinical assessments were recorded at baseline, at 6 weeks and 12 months after beginning the therapy. Patients' examination involved lesion size area, pain score and impact on daily activities. All patients presented lesions in maxilla; in 9 patients (60.0%) lesions were predominately at the anterior region and 6 (40.0%) at the posterior region of maxilla. Treatment significantly (p<0.05) reduced the pain intensity (from 5.4±1.12 to 1.16±0.97) and its periodicity (from 53.33% with pain>3 x/week to 13.33%), and the lesion size in 72.47% (±4.12) immediately after 6 weeks of treatment. Improvements were sustained for 12 months compared to baseline (p<0.001). It also reduced the impact of disease in daily activities (eating and oral hygiene performance), and improved the emotional condition of patients, who reported better social relationships and habits. Topical application of fusidic acid may be a possible alternative local palliative therapy for desquamative gingivitis treatment.</p>

Estimated prevalence of erosive tooth wear in permanent teeth of children and adolescents: an epidemiological systematic review and meta-regression analysis

OBJECTIVES

The main purpose of this systematic review was to estimate the prevalence of dental erosion in permanent teeth of children and adolescents.

METHODS

An electronic search was performed up to and including March 2014. Eligibility criteria included population-based studies in permanent teeth of children and adolescents aged 8-19-year-old reporting the prevalence or data that allowed the calculation of prevalence rates of tooth erosion. Data collection assessed information regarding geographic location, type of index used for clinical examination, sample size, year of publication, age, examined teeth and tissue exposure. The estimated prevalence of erosive wear was determined, followed by a meta-regression analysis.

RESULTS

Twenty-two papers were included in the systematic review. The overall estimated prevalence of tooth erosion was 30.4% (95%IC 23.8-37.0). In the multivariate meta-regression model use of the Tooth Wear Index for clinical examination, studies with sample smaller than 1000 subjects and those conducted in the Middle East and Africa remained associated with higher dental erosion prevalence rates.

CONCLUSIONS

Our results demonstrated that the estimated prevalence of erosive wear in permanent teeth of children and adolescents is 30.4% with high heterogeneity between studies. Additionally, the correct choice of a clinical index for dental erosion detection and the geographic location play an important role for the large variability of erosive tooth wear in permanent teeth of children and adolescents.

CLINICAL SIGNIFICANCE

The prevalence of tooth erosion observed in permanent teeth of children and adolescents was considerable high. Our results demonstrated that prevalence rate of erosive wear was influenced by methodological and diagnosis factors. When tooth erosion is assessed, the clinical index should be considered.

[Inequalities in oral health: are schoolchildren receiving the Bolsa Família more vulnerable?]

OBJECTIVE

To evaluate the association between being a recipient of the Bolsa Família program and oral health conditions in Brazilian schoolchildren.

METHODS

A cross-sectional study was conducted with 1,107 schoolchildren aged between eight and 12 years from 20 public and private schools in Pelotas, RS, Southern Brazil. A list of all children receiving the Bolsa Família program was provided by the participant schools. Demographic, socioeconomic and oral hygiene information were assessed using a questionnaire completed by the schoolchildren and their parents. Dental exams were performed to assess the presence of dental plaque and prevalence of dental caries. Data were analyzed by Chi-square test, Chi-square test for linear trend and multivariate Poisson Regression (prevalence ratio; 95% confidence interval).

RESULTS

Schoolchildren from non-nuclear families, with a DMFT ≥ 1 and who had never visited a dentist were associated with receiving the Bolsa Família. Final model showed that caries prevalence was twice as high (PR 2.00; 95%CI 1.47;2.69) in schoolchildren benefiting from the Bolsa Família . It was also showed that schoolchildren benefiting from the program presented greater severity of dental caries compared to school children from private schools (RR 1.53; 95%CI 1.18;2.00). After final adjustments, the prevalence of schoolchildren who have never visited a dentist was six times higher in children who received the government benefit (PR 6.18; 95%CI 3.07;12.45) compared to those from private schools.

CONCLUSIONS

Schoolchildren benefiting from the Bolsa Família program experienced more caries lesions and have less frequently accessed dental care services, which suggest the need to include oral health in the program.

Effect of the association between citric acid and EDTA on root surface etching

OBJECTIVE

This study aims to compare the clot stabilization on root surfaces conditioned with citric acid and ethylenediamine-tetraacetic acid (EDTA).

MATERIALS AND METHODS

Scaled root samples (n = 100) were set in fve groups: group I-control group (saline solution); group II (24% EDTA); group III (25% citric acid); group IV (EDTA + citric acid); group V (citric acid + EDTA). Fifty samples were assessed using the root surface modifcation index (RSMI). The other 50 received a blood drop after conditioning. Clot formation was assessed using blood elements adhesion index (BEAI). A blind examiner evaluated photomicrographs. Statistical analysis considered p < 0.05.

RESULTS

Groups-III and G-V attained the best results for RSMI and BEAI in comparison to control. The worst results for clot stabilization were seen in group-II. EDTA employment before citric acid (group-IV) reduced clot formation in comparison to citric acid use alone (group-III).

CONCLUSION

Root conditioning with citric acid alone and before EDTA had the best results for smear layer removal and clot stabilization. EDTA inhibited clot stabilization on root surface and must have a residual activity once it has diminished clot adhesion to root even after citric acid conditioning. Thus, EDTA can be used to neutralize citric acid effects on periodontal cells without affecting clot stabilization. Clinical signifcance: To demonstrate that citric acid use on root surfaces previously affected by periodontal disease may favor clot stabilization and may have a benefcial effect on surgical outcomes. Also, EDTA can be used to neutralize citric acid effects on periodontal cells.

Perfil de utilização dos serviços odontológicos na Atenção Primária à Saúde: experiência de duas unidades de saúde do município de Porto Alegre – Rio Grande do Sul

Objetivo: estabelecer o perfil de utilização dos serviços odontológicos nas Unidades de Saúde SESC e NSA do Grupo Hospitalar Conceição. Materiais e métodos: analisou-se o relatório do Sistema de Informação-SIS das consultas odontológicas (meses junho a agosto/2011). As variáveis foram: características sócio-demográficas (idade, gênero e microárea), motivo da consulta (CID-10) e tipo de consulta ambulatorial: consulta programada ou consulta não programada. Resultados: na US NSA prevaleceu os usuários do gênero feminino, faixa etária 35-44 anos, proveniente da microárea NSA3; o acesso aos serviços odontológicos foi por consultas programadas, e o código CID-10 K02 foi o mais freqüente. Na US SESC destaca-se de diferente a faixa etária de 0-11 anos e maior utilização do código CID-10 Z01.2. Conclusão: Os achados demonstram que é possível utilizar os dados do SIS para conhecer o perfil de utilização e a partir destes organizar o acesso em SB, baseado nos princípios APS.