Autistic individuals have worse oral status than neurotypical controls: a systematic review and meta-analysis of observational studies

OBJECTIVE

To compare dental caries, oral hygiene, periodontal status, bruxism, malocclusion, tooth loss, and salivary alterations between autistic and typical developing individuals.

MATERIAL AND METHODS

Observational studies presenting clinical measures of oral outcomes between autism spectrum disorder (ASD) individuals and controls. EMBASE, LILACS, PubMed, PsycINFO, Scopus, Web of Science, Google Scholar, and ProQuest were searched up to June 26, 2023. Pairs of reviewers independently conducted study selection, data extraction, and assessments of methodological quality and certainty of evidence. Meta-analyses of standardized mean differences (SMD) and risk ratio (RR) were performed.

RESULTS

A total of 47 studies comprising 6885 autistic individuals were included in the review. Autistic individuals had significantly higher severity of dental-caries experience in primary teeth (SMD 0.29, 95%CI 0.02, 0.56), of dental plaque presence (SMD 0.59, 95%CI 0.24, 0.94), and of gingivitis (SMD 0.45, 95%CI 0.02, 0.88). Autistic individuals showed higher probability of occurrence of gingivitis (RR 1.34, 95%CI 1.08, 1.66,), bruxism (RR 4.23, 95%CI 2.32, 7.74), overjet (RR 2.16, 95%CI 1.28, 3.64), overbite (RR 1.62, 95%CI 1.02, 2.59), crossbite (RR 1.48, 95%CI 1.02, 2.13), and openbite (RR 2.37, 95%CI 1.46, 3.85), when compared to neurotypical individuals. Most estimates showed a small effect size with very low certainty of evidence.

CONCLUSION

Autistic individuals show worse oral health status than controls.

CLINICAL RELEVANCE

The findings reported herein can help to build health policies to better serve autistic individuals including prevention actions and access to specialized dental care.

Personalized and Defect-Specific Antibiotic-Laden Scaffolds for Periodontal Infection Ablation

Periodontitis compromises the integrity and function of tooth-supporting structures. Although therapeutic approaches have been offered, predictable regeneration of periodontal tissues remains intangible, particularly in anatomically complex defects. In this work, personalized and defect-specific antibiotic-laden polymeric scaffolds containing metronidazole (MET), tetracycline (TCH), or their combination (MET/TCH) were created via electrospinning. An initial screening of the synthesized fibers comprising chemo-morphological analyses, cytocompatibility assessment, and antimicrobial validation against periodontopathogens was accomplished to determine the cell-friendly and anti-infective nature of the scaffolds. According to the cytocompatibility and antimicrobial data, the 1:3 MET/TCH formulation was used to obtain three-dimensional defect-specific scaffolds to treat periodontally compromised three-wall osseous defects in rats. Inflammatory cell response and new bone formation were assessed by histology. Micro-computerized tomography was performed to assess bone loss in the furcation area at 2 and 6 weeks post implantation. Chemo-morphological and cell compatibility analyses confirmed the synthesis of cytocompatible antibiotic-laden fibers with antimicrobial action. Importantly, the 1:3 MET/TCH defect-specific scaffolds led to increased new bone formation, lower bone loss, and reduced inflammatory response when compared to antibiotic-free scaffolds. Altogether, our results suggest that the fabrication of defect-specific antibiotic-laden scaffolds holds great potential toward the development of personalized (i.e., patient-specific medication) scaffolds to ablate infection while affording regenerative properties.

Correlation between dental plaque accumulation and gingival health in periodontal maintenance patients using short or extended personal oral hygiene intervals

AIMS

To evaluate the correlation between bacterial dental plaque accumulation and gingival health in subjects with history of periodontitis attending a maintenance programme including personal oral hygiene measures (pOH) at short and extended intervals. This study is a secondary analysis of a randomized clinical trial.

MATERIALS AND METHODS

Forty-two subjects were randomized into groups performing pOH at 12-, 24- or 48-h intervals. The Plaque Index (PlI), Gingival Index (GI) and bleeding on probing (BoP) were recorded at baseline, 30 and 90 days. For the analysis, pOH groups were collapsed into subjects performing pOH at daily (G12/24) or extended (G48) intervals. Summary statistics and Spearman correlations between plaque accumulation and gingival inflammation are presented.

RESULTS

G12/24 and G48 subjects showed significant increases in plaque scores and percentage sites with gingival inflammation over the course of study. At 90 days, G48 subjects showed significantly greater GI and BoP scores than G12/24 subjects. While PlI/GI correlations were not affected by pOH interval, PlI/BoP correlations remained unchanged with short to increase with extended pOH intervals.

CONCLUSION

pOH interval influences the correlation between bacterial dental plaque accumulation and gingival inflammation. Subjects using extended pOH intervals exhibit an increased correlation allowing accumulation of bacterial dental plaque to the detriment of gingival health. (ClinicalTrials.gov: 50208115.9.0000.5346). Clinical Trials: ClinicalTrials.gov: NCT02684682.

Bioactive amorphous magnesium phosphate-polyetheretherketone composite filaments for 3D printing

OBJECTIVE

The aim of this study was to develop bioactive and osseointegrable polyetheretherketone (PEEK)-based composite filaments melt-blended with novel amorphous magnesium phosphate (AMP) particles for 3D printing of dental and orthopedic implants.

MATERIALS AND METHODS

A series of materials and biological analyses of AMP-PEEK were performed. Thermal stability, thermogravimetric and differential scanning calorimetry curves of as-synthesized AMP were measured. Complex viscosity, elastic modulus and viscous modulus were determined using a rotational rheometer. In vitro bioactivity was analyzed using SBF immersion method. SEM, EDS and XRD were used to study the apatite-forming ability of the AMP-PEEK filaments. Mouse pre-osteoblasts (MC3T3-E1) were cultured and analyzed for cell viability, proliferation and gene expression. For in vivo analyses, bare PEEK was used as the control and 15AMP-PEEK was chosen based on its in vitro cell-related results. After 4 or 12 weeks, animals were euthanized, and the femurs were collected for micro-computed tomography (μ-CT) and histology.

RESULTS

The collected findings confirmed the homogeneous dispersion of AMP particles within the PEEK matrix with no phase degradation. Rheological studies demonstrated that AMP-PEEK composites are good candidates for 3D printing by exhibiting high zero-shear and low infinite-shear viscosities. In vitro results revealed enhanced bioactivity and superior pre-osteoblast cell function in the case of AMP-PEEK composites as compared to bare PEEK. In vivo analyses further corroborated the enhanced osseointegration capacity for AMP-PEEK implants.

SIGNIFICANCE

Collectively, the present investigation demonstrated that AMP-PEEK composite filaments can serve as feedstock for 3D printing of orthopedic and dental implants due to enhanced bioactivity and osseointegration capacity.

Nanofibrous antibiotic-eluting matrices: Biocompatibility studies in a rat model

This study evaluated the biocompatibility of degradable polydioxanone (PDS) electrospun drug delivery systems (hereafter referred as matrices) containing metronidazole (MET) or ciprofloxacin (CIP) after subcutaneous implantation in rats. Sixty adult male rats were randomized into six groups: SHAM (sham surgery); PDS (antibiotic-free matrix); 1MET (one 25 wt% MET matrix); 1CIP (one 25 wt% CIP matrix); 2MET (two 25 wt% MET matrices); and 2CIP (two 25 wt% CIP matrices). At 3 and 30 days, animals were assessed for inflammatory cell response (ICR), collagen fibers degradation, and oxidative profile (reactive oxygen species [ROS]; lipid peroxidation [LP]; and protein carbonyl [PC]). At 3 days, percentages of no/discrete ICR were 100, 93.3, 86.7, 76.7, 50, and 66.6 for SHAM, PDS, 1MET, 1CIP, 2MET, and 2CIP, respectively. At 30 days, percentages of no/discrete ICR were 100% for SHAM, PDS, 1MET, and 1CIP and 93.3% for 2MET and 2CIP. Between 3 and 30 days, SHAM, 1CIP, and 2CIP produced collagen, while 1MET and 2MET were unchanged. At 30 days, the collagen fiber means percentages for SHAM, PDS, 1MET, 1CIP, 2MET, and 2CIP were 63.7, 60.7, 56.6, 62.6, 51.8, and 61.7, respectively. Antibiotic-eluting matrices showed similar or better oxidative behavior when compared to PDS, except for CIP-eluting matrices, which showed higher levels of PC compared to SHAM or PDS at 30 days. Collectively, our findings indicate that antibiotic-eluting matrices may be an attractive biocompatible drug delivery system to fight periodontopathogens. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B, 2019.

Does Finishing and Polishing of Restorative Materials Affect Bacterial Adhesion and Biofilm Formation? A Systematic Review

Biofilm (bacterial plaque) accumulation on the surface of restorative materials favors the occurrence of secondary caries and periodontal inflammation. Surface characteristics of restorations can be modified by finishing and/or polishing procedures and may affect bacterial adhesion. The aim of this systematic review was to characterize how finishing and polishing methods affect the surface properties of different restorative materials with regard to bacterial adhesion and biofilm formation. Searches were carried out in MEDLINE-PubMed, EMBASE, Cochrane-CENTRAL, and LILACS databases. From 2882 potential articles found in the initial searches, only 18 met the eligible criteria and were included in this review (12 with in vitro design, four with in situ design, and two clinical trials). However, they presented high heterogeneity regarding materials considered and methodology for evaluating the desired outcome. Risk bias analysis showed that only two studies presented low risk (whereas 11 showed high and five showed medium risk). Thus, only descriptive analyses considering study design, materials, intervention (finishing/polishing), surface characteristics (roughness and surface free energy), and protocol for biofilm formation (bacterial adhesion) could be performed. Some conclusions could be drawn: the impact of roughness on bacterial adhesion seems to be related not to a roughness threshold (as previously believed) but rather to a range, the range of surface roughness among different polishing methods is wide and material dependent, finishing invariably creates a rougher surface and should always be followed by a polishing method, each dental material requires its own treatment modality to obtain and maintain as smooth a surface as possible, and in vitro designs do not seem to be powerful tools to draw relevant conclusions, so in vivo and in situ designs become strongly recommended.

Grinding With Diamond Burs and Hydrothermal Aging of a Y-TZP Material: Effect on the Material Surface Characteristics and Bacterial Adhesion

The aim of this study was to evaluate the effect of grinding with diamond burs and low-temperature aging on the material surface characteristics and bacteria adhesion on a yttrium-stabilized tetragonal zirconia polycrystalline (Y-TZP) surface. Y-TZP specimens were made from presintered blocks, sintered as recommended by the manufacturer, and assigned into six groups according to two factors—grinding (three levels: as sintered, grinding with extra-fine diamond bur [25-μm grit], and grinding with coarse diamond bur [181-μm grit]) and hydrothermal aging—to promote low-temperature degradation (two levels: presence/absence). Phase transformation (X-ray diffractometer), surface roughness, micromorphological patterns (atomic force microscopy), and contact angle (goniometer) were analyzed. Bacterial adhesion (colony-forming units [CFU]/biofilm) was quantified using an in vitro polymicrobial biofilm model. Both the surface treatment and hydrothermal aging promoted an increase in m-phase content. Roughness values increased as a function of increasing bur grit sizes. Grinding with a coarse diamond bur resulted in significantly lower values of contact angle (p<0.05) when compared with the extra-fine and control groups, while there were no differences (p<0.05) after hydrothermal aging simulation. The CFU/biofilm results showed that neither the surface treatment nor hydrothermal aging simulation significantly affected the bacteria adherence (p>0.05). Grinding with diamond burs and hydrothermal aging modified the Y-TZP surface properties; however, these properties had no effect on the amount of bacteria adhesion on the material surface.

Role of the adjunctive antimicrobial photodynamic therapy to periodontal treatment at plasmatic oxidative stress and vascular behavior

BACKGROUND

To evaluate for the first time in vivo the effects of methylene blue (MB) photosensitizer dissolved in ethanol in antimicrobial photodynamic therapy (aPDT) as adjuvant periodontal treatment, at plasmatic oxidative stress and vascular behavior in rat model.

METHODS

Wistar rats were divided into negative control (NC, no periodontitis) and positive control (PC, with periodontitis, without any treatment). The other groups had periodontitis and were treated with scaling and root planing (SRP); SRP+aPDT+MB dissolved in water (aPDT I); SRP+aPDT+MB dissolved in ethanol (aPDT II). The periodontitis was induced by ligature at the mandibular right first molar. At 7/15/30days, rats were euthanized, the plasma was used to determine oxidative stress parameters and gingival tissue for histomorphometric analysis.

RESULTS

PC showed higher thiobarbituric acid reactive substances levels in 7/15/30days. aPDT II was able to block the lipid peroxidation, especially between 15th and 30th days. Glutathione reduced levels were consumed in PC, aPDT I and II groups throughout the experiment. aPDT II increased the vitamin C levels which were restored in this group in the 30th day. aPDT II group showed the highest number of blood vessels.

CONCLUSION

In summary, the aPDT with MB dissolved in ethanol provides better therapeutic responses in periodontitis treatment.

Bacterial Colonization in the Marginal Region of Ceramic Restorations: Effects of Different Cement Removal Methods and Polishing

This study evaluated the effects of excess cement removal techniques, with or without subsequent polishing, on biofilm formation and micromorphology in the marginal region of the tooth/restoration. From bovine teeth, 96 dentin blocks (4 × 8 × 2 mm) were produced, molded, and reproduced in type IV gypsum, on which 96 pressed ceramic blocks (Vita PM9, Vita Zahnfabrik; 4 × 8 × 2 mm) were produced via the lost wax technique. The dentin blocks and their respective ceramic blocks were cemented with a self-adhesive resin cement (RelyX U200, 3M ESPE), and cement excess was removed from the margin using four different techniques, followed or not by polishing with silicone rubber tips: MBr, removal with microbrush and photoactivation; MBr-Pol, MBr + polishing; Br, removal with brush and photoactivation; Br-Pol, Br + polishing; Photo-Expl, 5 seconds of initial photoactivation, removal with explorer, and final curing; Photo-Expl-Pol, Photo-Expl + polishing; Photo-SB, 5 seconds of initial photoactivation, removal with scalpel, and final curing; and Photo-SB-Pol, Photo-SB + polishing. After 24 hours, the roughness in the marginal region was analyzed using a profilometer (three measurements on each sample). Micromorphological analyses of the region were performed by stereomicroscope and scanning electron microscopy (SEM). Then the samples were contaminated with sucrose broth standardized suspension with Streptococcus mutans, Staphylococcus aureus, and Candida albicans and incubated for a period of 48 hours. The samples were quantitatively analyzed for bacterial adherence in the marginal region by confocal laser scanning microscopy and counting of colony-forming units (CFUs/mL) and qualitatively analyzed using SEM. Roughness data (Ra) were submitted to two-way analysis of variance, Tukey test at a confidence level of 95%, and Student t-tests. CFU, biomass, and biothickness data were analyzed by Kruskal-Wallis, Mann-Whitney, and Dunn tests. The removing technique statistically influenced Ra (MBr, p=0.0019; Br, p=0.002; Photo-Expl, p=0.0262; Photo-SB, p=0.0196) when comparing the polished and unpolished groups. The MBr and MBr-Pol technique differed significantly for CFU/mL values (p=0.010). There was no significant difference in the amounts of biomass and biothickness comparing polished and unpolished groups and when all groups were compared (p>0.05). Different morphological patterns were observed (more regular surface for polished groups). We conclude that margin polishing after cementation of feldspar/pressed ceramic restorations is decisive for achieving smoother surfaces, as the excess cement around the edges can increase the surface roughness in these areas, influencing bacterial adhesion.

Confocal Laser Microscopic Analysis of Biofilm on Newer Feldspar Ceramic

When the glazed surface of glass ceramics is submitted to chairside preparation, polishing with rubber points followed by felt disks impregnated with a fine-aluminum oxide particle appears be a good option to polish the surface of the glass ceramic, since this finishing-polishing method results in biofilm formation similar to the glazed ceramic surface.

Surface roughness of glazed feldspar, alumina, and zirconia-based ceramics

The aim of this study was to compare the mean surface roughness (Ra) of feldspar-, alumina-, and zirconia-based ceramics, testing the hypothesis that the feldspathic ceramics have lower average surface roughness (Ra) than the ceramics used for infrastructure. Eight disk specimens (5mm in diameter; 2mm in thickness) of each ceramic material were fabricated according to the manufacturer’s specifi cations: V7-feldspathic veneer ceramic (Vita VM7); VA-feldspathic veneer ceramic (Vitadur-α); IA-slip casted, glass-infi ltrated alumina-based ceramic (Vita In-Ceram Alumina); IZS-slip casted, glass-infi ltrated zirconia-reinforced alumina-based ceramic (Vita In-Ceram Zirconia); IZB-dry-pressed block ofglass-infi ltrated zirconia-reinforced alumina-based ceramic (Vita In-Ceram Zirconia 2000 for Cerec InLab). All materials were glazed as recommended by the manufacturer. Four Ra readings (Mitutoyo SJ 400) per specimen were performed, averaging the value per specimen (n=8). Ra values were statistically analyzed using one-way ANOVA and Tukey test (α=0.05). V7 showed the lowest mean Ra value (0.43±0.07 μm) compared to the other ceramics. There were no statistical differences between the mean Ra values of VA (0.94±0.2 μm), IA (0.7±0.13 μm), IZS (0.98±0.3 μm) and IZB (0.75±0.4 μm). The testing hypothesis was partially accepted. V7 showed a smoother ceramic surface than the VA. There were no statistically differences between the mean Ra value of the high crystalline content ceramics (IA, IZS, IZB).

SEM evaluation of in situ early bacterial colonization on a Y-TZP ceramic: a pilot study

This study aimed to evaluate the effect of surface glazing and polishing of yttrium-stabilized tetragonal zirconia polycrystal ceramic on early dental biofilm formation, as well as the effect of brushing on the removal of adhered bacteria. Two subjects used oral appliances with polished and glazed samples fixed to the right and left sides. After 20 minutes, 1 hour, and 6 hours, the subjects manually brushed the samples on the right side. The samples were analyzed using scanning electron microscopy. Granular material was verified on the samples, especially on irregular surfaces. After 1 hour, there was no significant difference between glazed and polished surfaces in terms of bacterial presence. However, glazed surfaces tended to accumulate more biofilm, and brushing did not completely remove the biofilm. Polished surfaces seem to present a lower tendency for biofilm formation.