Oral hygiene prior to cardiac surgery to prevent infections: Randomized clinical trial

CONTEXT

It is not clear if an oral hygiene protocol to control biofilm applied before cardiac surgery can reduce infection rates.

OBJECTIVE

We aim to verify the effectiveness of an oral hygiene protocol in reducing postoperative infections when compared to usual practices, in patients admitted to a cardiology unit, prior to cardiac surgery.

DESIGN, SETTING AND PARTICIPANTS

Randomized, blind, controlled clinical trial, with 107 participants who expected to undergo cardiac surgery, randomized into two groups: Experimental Group (EG) standardized oral hygiene protocol (54) and Control Group (CG), usual practices performed in patients admitted (53).

INTERVENTION

a standardized oral hygiene protocol, 1 day before surgery: professional prophylaxis with a portable ultrasound device, tooth brushing and flossing plus a 0.12% chlorhexidine gluconate solution (0.12% CHX) mouth rinsing. When applicable, removable prostheses cleaning.

PRIMARY OUTCOME

the presence of infection.

RESULTS

The occurrence of postoperative infection was higher in CG = 7 (13.2%) than in EG = 5 (9.3%); but no statistical difference was found between protocols (p = 0.518). The length of stayed from surgery to discharge presented a statistical difference (p = 0.047; RR = 4.9; CI = 1.01-24.33); the percentage of postoperative infection was almost five times higher in those participants who stayed 11 or more days.

CONCLUSION

The standardized oral hygiene protocol with mechanical and chemical cleaning, 1 day before cardiac surgery, was not more effective than the usual practices performed regarding the reduction of postoperative infections. Other interventions regarding oral hygiene procedures before cardiac surgery must be studied to contribute to the reduction of adverse post-surgical events.

CLINICAL TRIAL REGISTRATION

Site Ensaclinicos.gov.br number U1111-1214-2862.

DESCRIPTORS

Healthcare Associated Infections, Cardiovascular Diseases, Periodontal Diseases, Dental Biofilm, Cardiovascular Surgery.

A Global Overview on Electronic Apex Locator Use From 1968 to 2023: A Bibliometric Analysis

INTRODUCTION

This bibliometric review analyzed the research trends and main characteristics of articles related to Electronic Apex Locators (EALs).

METHODS

The search was conducted in November 2023 on the Web of Science Core Collection. Narrative and systematic reviews, observational and intervention studies, laboratory, and clinical studies were included. Two researchers selected the articles and extracted the number of citations, year of publication, journal, study design, theme, country, continent, institutions, author, and keywords. Collaborative networks were generated using the VOSviewer software. The relationship between data were determined by Spearman's correlation.

RESULTS

The search resulted in 374 articles, of which 294 were included. Most cited article had 175 citations. The most prevalent journal was the Journal of Endodontics (n = 84). The predominant study design was the laboratory-based (n = 223). The predominant theme was the EALs accuracy (n = 175). Piasecki L was the author with the highest number of articles (n = 11). Only 8.16% of the studies were conducted in deciduous teeth. The country with the most studies was Brazil (n = 46). Asia (n = 107) was the continent with the highest number of publications. There was a weak positive correlation between the number of citations and impact factor (rho = .294), and a strong negative correlation between citations and year of publication (rho = -.710).

CONCLUSIONS

The majority of articles were laboratory-based studies conducted on permanent teeth, focusing on the accuracy of EALs. Future studies should prioritize research on deciduous teeth, systematic reviews, and, notably, clinical trials.

Dentin hypersensitivity and toothache among patients diagnosed with Molar-Incisor Hypomineralization: A systematic review and meta-analysis

OBJECTIVES

To determine the prevalence of dentin hypersensitivity (DH) and toothache in patients with Molar-Incisor Hypomineralization (MIH); and evaluate whether patients with MIH have greater likelihood of presenting DH/toothache than controls.

DATA

Studies evaluating DH/toothache in patients with MIH were included. Studies focusing on other enamel defects were excluded.

SOURCES

Eight databases, including grey literature, were searched in January 2024.

STUDY SELECTION

The methodological quality of studies was assessed using the Joanna Briggs Institute checklist for Cross-sectional studies. Proportion and association meta-analyses, subgrouped by diagnostic methods, were conducted. The certainty of evidence was assessed using GRADE approach.

RESULTS

Fifteen studies were included in the qualitative analysis and fourteen in the meta-analyses. Two studies fulfilled all items of the methodological quality checklist. The overall prevalence of DH/toothache among patients with MIH was 45 %. Prevalence rates of 30 %, 47 %, and 55 % were estimated based on proxy reports, self-reports, and air stimulation, respectively. The overall prevalence of DH/toothache per tooth was 22 %, ranging from 16 % to 29 % according to the diagnostic method. Patients with MIH demonstrated higher likelihood of presenting proxy reports of DH/toothache compared to those without MIH (OR: 1.51, 95 % CI [1.23-1.85], P < 0.01, I2: 0 %). The certainty of evidence was very low, mainly due to the low methodological quality of included studies and high inconsistency.

CONCLUSIONS

The global prevalence of DH/toothache was 22 %, per tooth, and 45 % per patient. Estimates vary according to diagnostic methods. Patients with MIH showed higher likelihood of presenting proxy reports of DH/toothache than controls.

CLINICAL SIGNIFICANCE

This systematic review contributes valuable information to the dental literature by assessing the prevalence and associated factors of DH/toothache in patients with MIH. The findings can guide future research, inform clinical practices and public policy makers, and ultimately improve the management of oral health of patients with MIH.

REGISTRATION

PROSPERO CRD42023432805.

Publication trends of the Journal of Esthetic and Restorative Dentistry: A bibliometric analysis

OBJECTIVE

The Journal of Esthetic and Restorative Dentistry (JERD) stands out as one of the most prominent international journals publishing research in esthetic dentistry. This study analyzed articles published by JERD since the year 2000 through bibliometric analysis.

METHODOLOGY

The search was conducted in January 2024 using Scopus. The following data were extracted from the articles: citation count, year, language, access type, funding agency, study design, theme (general and specific), country, institution, authors, and keywords. The VOSviewer software was used to generate collaborative network maps among the data. Dimensions were consulted to measure altmetric data. Google Trends was used to investigate the global popularity of JERD research.

RESULTS

A total of 1394 articles were included in this analysis. Citation count ranged from 0 to 625 (average: 16.9). Articles were published between 2000 and 2023. Laboratory studies were more prevalent (n = 850), with the most investigated general theme being restorative procedures (n = 882), and the highlighted specific theme being the use of composite resin (n = 327). The United States had the highest number of articles (n = 640), with the diverse distribution among other countries. The most common keyword was "cad/cam" (n = 63). VOSviewer demonstrated high collaboration among countries. Intense mentions were identified primarily on Facebook. According to Google Trends, Egypt was the country that searched for JERD the most.

CONCLUSIONS

JERD exhibited significant growth in the number of published articles and their diversity by topics, types, origin (country), number of citations, and impact factor.

CLINICAL SIGNIFICANCE

The JERD is a journal that publishes studies influencing clinical practice. Identifying the key characteristics of this journal is essential for charting future paths.

Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories

BACKGROUND & AIMS

Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories.

METHODS

We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level.

RESULTS

After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases.

CONCLUSIONS

We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened.

IMPACT AND IMPLICATIONS

There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into.

A Global Overview of Guided Endodontics: A Bibliometric Analysis

INTRODUCTION

This review aimed to analyze the trend and main characteristics of articles related to guided endodontics (GE).

METHODS

The search was conducted in May 2023 on Web of Science. GE-related articles were included, and conferences were excluded. Three researchers selected the articles and extracted: the number of citations; year and journal; design and study theme; authorship and institutions; country and continent. Collaborative networks were generated in the Visualization of Similarities Viewer software. The relationship between data was determined by Spearman's correlation. Google Trends was used to investigate the global popularity of GE research.

RESULTS

The search resulted in 135 articles, of which 85 were included. The most cited article totaled 116 citations. The studies were published between 2016 and 2023, most frequently in 2022 (n = 22). The most prevalent journal was the Journal of Endodontics (n = 28). Case report (n = 38) was the most frequent study design. The most studied theme was the use of static GE for calcified canals (n = 27). Connert T was the author with the highest number of articles (n = 13). The University of Basel (n = 9) stood out. The most prevalent country was Brazil (n = 13). Europe was the most frequent continent (n = 38). Visualization of Similarities Viewer demonstrated an interaction between authors. There was a moderate positive correlation between citations and the impact factor (rho = .483). According to Google Trends, the United States was the country that most researched GE.

CONCLUSIONS

Based on this review, a more significant research interest in GE was observed in Europe, addressing the application of GE in locating severely calcified root canals.

Worldwide prevalence of natal and neonatal teeth: Systematic review and meta-analysis

BACKGROUND

Identifying the presence of teeth in newborns is important as it may require immediate care. This study aimed to determine the worldwide prevalence of natal and neonatal teeth.

TYPE OF STUDIES REVIEWED

Six electronic databases and the gray literature were searched on February 23, 2023 to identify observational studies reporting the prevalence of natal or neonatal teeth. Studies assuming natal and neonatal teeth as identical terms or not reporting prevalence indicators were excluded. The methodological quality of the studies was assessed using the Joanna Briggs Institute checklist for studies reporting prevalence data. The worldwide prevalence of natal and neonatal teeth was estimated via proportion meta-analysis using a β-binomial model. Heterogeneity across studies was explored via subgroup analyses and meta-regression.

RESULTS

None of the 23 included studies fulfilled all items of the methodological quality checklist. The worldwide prevalence of natal teeth was 34.55 (95% CI, 20.12 to 59.26) per 10,000, and the prevalence of neonatal teeth was 4.52 (95% CI, 2.59 to 17.91) per 10,000. Subgroup analysis by continent showed that the prevalence of natal teeth ranged from 11.26 (95% CI, 7.58 to 16.61) per 10,000 in Asia through 75.32 (95% CI, 51.11 to 99.86) per 10,000 in North America, and the prevalence of neonatal teeth ranged from 3.52 (95% CI, 1.73 to 7.06) per 10,000 in Europe through 6.01 (95% CI, 2.25 to 16.60) per 10,000 in South America. Meta-regression did not find a statistically significant association between prevalence rates and year of publication or sample size.

PRACTICAL IMPLICATIONS

Approximately 1 in 289 newborns had natal teeth and 1 in 2,212 had neonatal teeth. Although this is not a high prevalence, professionals must be alert to identify these conditions, which often require immediate care.

Fluoride Varnish in Dentistry: A Bibliometric Analysis of the 100 Most-Cited Papers

A highly cited paper is a milestone and might impact research and clinical practice. The present study analyzed the 100 most-cited papers on fluoride varnishes in dentistry. A search was performed on July 20, 2022, on the Web of Science Core Collection. Two independent researchers extracted the following data: number and citation density; year and journal of publication; study design; main topic; authors; institutions; keywords; countries and continents. Scopus and Google Scholar were consulted to compare the number of citations. Bibliometric networks were generated in the VOSviewer. The number of citations ranged from 36 to 351, and thirteen papers were cited more than 100 times. The papers were published between 1977 and 2018, most of which were published after 2008 (48%). The most prevalent journal was Caries Research (17%). Intervention studies were the most common design (41%). The most discussed topics were dental caries prevention (48%) and dental remineralization (31%). Europe was the continent with the highest number of publications (46%), mainly from Sweden (14%), and Umea University had the most substantial number of studies (8%). Petersson L.G. was the author with more papers in the top 100 (6%). The most used keywords were "dental caries" (34%) and "fluoride varnish" (31%). It can be concluded that the top 100 cited papers on fluoride varnish primarily originated from Europe, with the majority consisting of intervention studies focusing on the utilization of fluoride varnish for the prevention of dental caries.

Pathways between verbal bullying and oral conditions among school children

PURPOSE

To investigate the direct and indirect pathways between verbal bullying and adverse oral conditions among school-aged children.

METHODS

A cross-sectional survey was conducted with 8- to 10-year-old children, enrolled in public schools in Southern Brazil. Verbal bullying was collected by self-reports. Independent variables included sociodemographic characteristics (sex, age, household income, and caregivers' educational level) and oral conditions (anterior open bite, anterior teeth crowding, upper anterior diastema, large overjet, untreated dental caries, and PUFA index). The pathways between verbal bullying and the independent variables were analysed through structural equation modelling.

RESULTS

1369 children were included. The prevalence of verbal bullying was 26.2% (95% confidence interval [CI] 23.9-28.6%). Verbal bullying was directly influenced by large overjet (standard coefficient [SC] 0.13, P < 0.01), untreated dental caries (SC 0.63, P = 0.01) and PUFA index (SC 0.75, P = 0.02). Sex (SC - 0.005, P = .04) and age (SC - 0.006, P < 0.01) indirectly influenced verbal bullying via untreated dental caries.

CONCLUSIONS

Verbal bullying was directly influenced by large overjet, untreated dental caries and PUFA index. Sex and age indirectly impacted verbal bullying through untreated dental caries.

A Bibliometric Analysis of the Top 100 Most-Cited Papers Concerning Dental Fluorosis

A high number of citations can indicate the potential of any specific paper to influence other research and generate changes in clinical practice. Analyzing the most-cited papers in a certain scientific field may assist researchers to identify the influential papers as well their main characteristics. The present study aimed to analyze the 100 most-cited papers concerning dental fluorosis (DF) through a bibliometric review. A search was performed in the Web of Science Core Collection (WoS-CC) database in November 2021. The papers were displayed in descending order according to the number of citations in WoS-CC. Two independent researchers performed the selection. Scopus and Google Scholar were used to compare the number of citations with WoS-CC. The following data were extracted from the papers: title, authors, number and density of citations, institution, country, continent, year of publication, journal title, keywords, study design, and theme. Collaborative networks were generated using the VOSviewer software. The top 100 most-cited papers were published between 1974 and 2014 and were cited 6,717 times (ranging from 35 to 417). Community Dentistry and Oral Epidemiology (24%), Journal of Dental Research (21%), Journal of Public Health Dentistry (17%), and Caries Research (13%) published the most papers. Observational studies (60%) and literature reviews (19%) were the most common study designs. The main topics were epidemiology (44%) and fluoride intake (32%). The countries with the highest number of papers were the USA (44%), Canada (10%), and Brazil (9%). The University of Iowa (USA) had the most papers (12%). Levy SM was the author with the highest number of papers (12%). The 100 most-cited papers on DF were mainly observational studies focused on epidemiology and originated in North America. There were few interventional studies and systematic reviews among the most-cited papers concerning this topic.

Knowledge, attitudes, and practice of dentists on Minimal Intervention Dentistry: a systematic review and meta-analysis

OBJECTIVES

To evaluate the knowledge, attitudes, and practice (KAP) of dentists on Minimal Intervention Dentistry (MID).

DATA

Cross-sectional studies that analyzed KAP outcomes on MID principles were included.

SOURCES

Eight databases (Cochrane, DOSS, Embase, LILACS, PsycINFO, PubMed, Scopus, and Web of Science) and the grey literature were searched on January 2022.

STUDY SELECTION

Two independent reviewers selected the included studies, initially by screening titles and abstracts and, finally, by full-text reading. The methodological quality of studies was assessed by using the Joanna Briggs Institute Critical Assessment Checklist for Prevalence Studies. Proportion meta-analysis was conducted using a random effect model for data analysis. Cochran's Q test was used to assess the heterogeneity and the I² statistic for evaluation of true variation due to heterogeneity.

RESULTS

Of 2,079 studies initially identified, twelve were included in the systematic review. Twenty-four statements about MID were included in the meta-analysis, based on data from ten studies (n=1728 participants). The pooled proportion of knowledge on MID was 75.66% (95%CI: 69.33 - 81.48; p<0.01; I²: 97%; Tau2: 0.0456) and of attitudes and practice was 47.95% (95%CI: 38.55 - 57.43; p<0.01; I²: 98%; Tau2: 0.0743). The higher prevalences rates were in the "knowledge" field, and the lowest was in "attitudes and practice".

CONCLUSIONS

The findings suggest that the knowledge of dentists on MID topics is acceptable, and the attitudes and practices need improvements. The studies lacked uniformity in methods and there is still a need for more studies to elucidate the KAP of dentists worldwide.

CLINICAL SIGNIFICANCE

Understanding the cognizance and the way oral healthcare professionals are treating dental caries is the first step to expanding the minimal intervention evidence into a dental practice. The final goal is to change the practice and make Minimal Intervention Dentistry the standard of care for dental caries worldwide.

REGISTRATION

PROSPERO CRD42021257518.

Tooth Bleaching: A bibliometric analysis of the top 100 most-cited papers

This study analyzes the characteristics of the top 100 most-cited papers related to tooth bleaching. A literature search was performed on the Web of Science up to March 2022. The number of citations was cross-matched with the citation count on Scopus and Google Scholar. The following data were collected: number and density of citations; authorship; year and journal of publication; study design and thematic; keywords; institution and country of origin. Spearman's correlation and Poisson regression were used to determine associations between the number of citations and study characteristics. The VOSviewer software was used to generate collaborative network maps for the authors and keywords. The number of citations ranged from 66 to 450. Papers were published between 1981 and 2020. The most frequent study design and topic were laboratory-based studies and 'interaction of the bleaching agent with dental tissues', respectively. Cochran M, Loguercio AD, Matis B, Reis A, and Suliman M were the authors with the highest number of papers. The countries with the most papers were the United States of America (USA) (28%) and Brazil (20%). Indiana University and State University of Ponta Grossa were the institutions with the most papers (6% each). There was a very strong correlation among the number of citations of the three databases. The 100 most-cited papers related to tooth bleaching were mainly published by the USA and Brazil, with laboratory-based studies addressing topics related to the effects of bleaching agents on tooth structure being the most prevalent.

Global Prevalence of Maxillary Sinusitis of Odontogenic Origin and Associated Factors: A Systematic Review and Meta-Analysis

INTRODUCTION

The overall prevalence of maxillary sinusitis of odontogenic origin (MSOO) is still unknown. Therefore, this study aimed to determine the pooled prevalence of MSOO and verify associations between different odontogenic conditions and MSOO.

METHODS

Six electronic databases and the gray literature were searched on August 25, 2022. Two independent reviewers selected observational studies reporting the prevalence of MSOO and associated conditions in adults. Studies that did not use computed tomography for diagnosis were excluded. The methodological quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. Data were analyzed by proportion and association meta-analyses. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Thirty-eight studies were included in the qualitative analysis and thirty-one in the meta-analyses. Only 12 studies (31.6%) fulfilled all items of the methodological quality checklist. Overall, the studies reported prevalence measures per maxillary sinus or patient. Thus, the pooled prevalence of MSOO was 51% per sinus (95% confidence interval [CI] [40%-61%]) and 50% per patient (95% CI [41%-59%]). Apical lesion (odds ratio [OR]: 4.03, 95% CI [2.26-7.19]), periodontitis (OR: 5.49, 95% CI [2.27-13.24]), moderate (OR: 2.57, 95% CI [1.85-3.57]) and severe bone loss (OR: 13.80, 95% CI [2.81-67.85] were significantly associated with MSOO. The certainty of the evidence for the associations was very low.

CONCLUSIONS

The pooled prevalence of MSOO on computed tomography assessment was 51% per maxillary sinus and 50% per patient. Therefore, half of the maxillary sinusitis may be of odontogenic origin. Apical lesion, periodontitis, and moderate and severe bone loss were significantly associated with MSOO.

Evaluation of pH and calcium ions release of two tricalcium silicate-based sealers through roots of primary teeth

Background

This study aimed to evaluate the pH and calcium ions (Ca2+) release from two tricalcium silicate-based sealers (Sealer Plus BC and Bio-C Pulpecto) through roots of primary teeth.

Methods

Forty root canals of primary incisors were prepared and distributed into four groups according to the filling material: GPlusBC (Sealer Plus BC); GBioC (Bio-C Pulpecto); GUltra (Ultracal); and GC (no filled). pH measurement was performed with a digital pH meter, and the Ca2+ release was measured in an atomic absorption spectrophotometer at baseline, 24 h and 1, 2, 3, and 4 weeks later. The data were analyzed using two-way ANOVA and Tukey's post hoc tests.

Results

The results did not reveal significant differences between the groups in terms of pH in 24 h, 1-, and 2-weeks' periods. After 4 weeks, there was a significant difference, with the highest mean pH values in GUltra, followed, respectively, by GPlusBC and GBioC. Regarding the Ca2+ release, the GUltra showed greatest mean values at all evaluated times, and the other groups showed no difference between them.

Conclusion

Both sealers were able to promote the elevation of the pH and Ca2+ release through roots of primary teeth, which brings favorable properties for their use as a filling material.

BURNOUT SYNDROME AMONG DENTISTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVE

Burnout syndrome has negative consequences on the dentist's health and performance during work. This systematic review aimed to assess the prevalence of Burnout syndrome in dentists.

METHODS

Searches were carried out in Medline, Scopus, Web of Science, PsycINFO, EMBASE, LILACS databases, and searches in the gray literature on January 27, 2021. There were no restrictions on language and search period. For the diagnosis of Burnout, only studies that used the Maslach burnout inventory questionnaire and its subscales emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA) were included. Proportion meta-analyses were performed using the Stata 13.0 software.

RESULTS

A total of 37 articles were included in the narrative and 31 in quantitative syntheses. The overall prevalence of Burnout syndrome in dentists was 13% (95% confidence interval [CI]: 0.006-0.21; I²: 97.07%) and the total prevalence in the subscales EE, DP, and PA, were, respectively: 28% (95% CI: 0.24-0.32; I²: 20.70%), 18% (95% CI: 0.08-0.28; I²: 85.61%) and 10% (95% CI: 0.08-0.13; I²: 0%). About the levels of Burnout syndrome in the subscales, 25% (95% CI: 0.19-0.31; I² 92.58%) presented high EE, 18% (95% CI: 0.10-0.26; I² 96.62%) high DP and 32% (95% 0.20-0.45; I² 97.86%) low PA. About continuous data, the mean of EE, DP and PA was respectively 17.90 (95% CI: 9.36-26.43; I² 94.8), 6.93 (95% CI: 3.41-10.45; I² 80.2) and, 34.69 (95% CI: 23.82-45.55; I² 98.8). No study presented all the positive criteria of the Joanna Briggs Institute Critical Appraisal checklist.

CONCLUSION

In conclusion, there was a considerable prevalence of burnout syndrome in dentists, mainly in the subscale of emotional exhaustion.

Are electronic apex locators accurate in determining working length in primary teeth pulpectomies? A systematic review and meta-analysis of clinical studies

BACKGROUND

The lack of a well-defined apical constriction in primary teeth raises concerns regarding the accuracy of electronic apex locators (EALs) for measuring working length.

OBJECTIVES

To evaluate the accuracy of EALs in determining working length in primary teeth pulpectomies.

METHODS

Two reviewers searched ten databases up to September 2021. Clinical studies evaluating the accuracy of the electronic measurement of working length in primary teeth pulpectomies were included. Studies without a comparison group, with samples smaller than ten root canals, and that did not use a multiple frequency EAL were excluded. A meta-analysis was conducted to assess the paired differences in mean lengths between measurements obtained by electronic and comparative methods. In addition, a meta-analysis of proportion was applied according to the level of difference between the measures. The risk of bias and applicability of the studies were assessed using the QUADAS-2 tool. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Twenty-nine studies were included in the qualitative analysis and twenty-three in the quantitative analysis. The methods of comparison for the electronic measurement were the radiographic method, radiovisiographic, scanning electron microscopy, and direct visualization. The meta-analysis showed that the electronic measurement tends to be shorter than radiographic measurement, while the other methods showed no difference. The proportion analysis showed a higher pooled proportion of difference values between electronic and comparative measurements within -0.5 to +0.5 mm (69.31%). The certainty of the evidence suggested very low confidence in estimating the outcome.

DISCUSSION

The results of this review denote a good performance of the EALs in determining working length in primary teeth pulpectomies. However, these results are based on clinical studies with low methodological quality and high heterogeneity, which require careful interpretation for clinical practice.

CONCLUSIONS

Although the results suggest acceptable accuracy of EALs in determining working length in primary teeth pulpectomies, the low quality of the included studies and the very low certainty of the evidence require clinicians to interpret these results with caution. More robust evidence is required to support that these devices are accurate for primary teeth.

Association between sella turcica bridging and impacted maxillary canines

Changes in sella turcica (ST) development may be associated with impaction of the permanent canine teeth. Calcification of the interclinoid ligament, which forms a bridge between the anterior and posterior clinoid processes of the sphenoid bone, has been termed ST bridging. The aim of this study was to evaluate whether an association exists between ST bridging and the presence of impacted maxillary canines (IMCs) in a Brazilian population. In this case-control study, 2 blinded and calibrated examiners measured the length (interclinoidal distance), depth, and diameter of the ST on cephalometric radiographs of 64 adults divided into a case group with IMCs (n = 32) and a control group without IMCs (n = 32). The degree of calcification was established as no (class I), partial (class II), or complete (class III) calcification. A t test was used to compare ST dimensions between the groups, and a chi-square test was used to analyze the association between the degree of calcification and the groups. The association between ST bridging and IMC was estimated by means of logistic regression analysis (α = 0.05). The study findings showed that ST length in the case group was shorter than that in the control group (P = 0.042; t test), and the length was shorter in men than in women (P = 0.038; t test). The ST bridging frequency was higher in the case group (P = 0.03; chi-square test), and there was no difference between men and women. The presence of ST bridging might be associated with increased odds of IMCs (P < 0.01; adjusted odds ratio = 5.92). In this patient sample, the occurrence of IMCs was positively associated with the presence and severity of ST bridging.

Influence of the method for determining working length on the obturation level of primary molars

Efficient working length determination is essential for a successful endodontic treatment. The purpose of the present study was to evaluate whether the method for determining the working length of root canals (radiographic or electronic) influences the obturation level of primary molars. Thus, a controlled, triple-blind, randomized clinical trial was conducted. Sixty-four children aged 6 to 9 years with an indication for primary molar pulpectomy were included. Participants were divided into two groups according to the method used to determine the working length of the root canals: (G1) radiographic and (G2) using an electronic apex locator. The study had 3 operators: #1 performed the clinical procedures, except the electronic measurement; #2 performed radiographic measurement and final evaluation of obturation level; and #3 performed eligibility criteria and electronic measurement. Adequacy of obturation level was evaluated based on the final conventional radiography and it was recorded as acceptable or unacceptable (short or overfilled). Data were analyzed with repeated measures logistic regression. There was no difference between the obturation level of primary molars measured by radiographic and electronic methods (p > 0.05). The other investigated variables (age, tooth type, dental arch position, last instrumentation file, and canal location) also did not influence the obturation level (p > 0.05). In conclusion, both measurement methods resulted in similar adequacy of obturation level in primary molars after pulpectomy.

Prevalence of sequelae after traumatic dental injuries to anterior primary teeth: A systematic review and meta-analysis

BACKGROUND/AIM

Clinical and radiographic sequelae are common following traumatic dental injuries to primary teeth. The aim of this systematic review was to assess the prevalence of such sequelae.

MATERIALS AND METHODS

Searches were conducted in the PubMed, Scopus, Embase, Web of Science, and BBO/LILACS databases as well as the gray literature. The outcome of interest was the prevalence of the most common sequelae following traumatic dental injuries to anterior primary teeth. Observational studies that evaluated such sequelae were included. Data were extracted, and methodological quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The number of sequelae per tooth and the total number of teeth evaluated in each study were considered to calculate pooled prevalence rates with 95% confidence intervals (CI). The quality of the evidence was determined using the GRADE approach.

RESULTS

Twenty-five articles were included in this systematic review and meta-analysis. The prevalence of each complication in descending order was as follows: 39.7% crown discoloration (95% CI: 29.52-50.32), 24.3% pulp necrosis with infection (95% CI: 17.34-32.06), 16.2% periapical radiolucency (95% CI: 8.88-25.49), 15.9% premature tooth loss (95% CI: 9.93-23.15), 14.8% pulp canal obliteration (95% CI: 8.46-22.73), 11.9% pathological root resorption (95% CI: 7.68-16.98), 7.1% abscess/fistula (95% CI: 4.4-10.6), and 1.8% ankylosis (95% CI: 0.82-3.17). The certainty of the evidence was very low.

CONCLUSIONS

Crown discoloration was the most common sequela in injured primary teeth, but this should be interpreted with caution due to the very low certainty of the evidence. Considerable variation was found in the prevalence of each sequela.

The Top 100 Most-Cited Papers in Erosive Tooth Wear: A Bibliometric Analysis

Citation rates can be used as an indicator of the influence and relevance of scientific papers. The present study analyzed the 100 most-cited articles related to erosive tooth wear (ETW). The top 100 most-cited papers focusing on ETW topics were collected from the Web of Science database on November 11th, 2020. The following bibliometric data were extracted from papers: title, authorship, institutions, countries, number of citations, year of publication, journal title, study design, topic, and keywords. Scopus and Google Scholar were searched to compare the number of citations. The VOSviewer software was used to generate collaborative network maps for the authors and keywords. The number of citations of the 100 most-cited papers ranged from 71 to 330 (average: 97.44). The papers were published between 1949 and 2015. Caries Research (28%) and The Journal of Dentistry (16%) presented the majority of papers. Laboratorial (44%) and observational studies (33%) were the most common study designs. The most studied topics were epidemiology (31%) and the erosive potential of substances [drinks, foods, or medicines] (22%). The countries with the highest number of most-cited papers were England (32%), Germany (18%), and Switzerland (10%). The University of Bern was the institution with the most papers (10%). Lussi A was the author with the highest number of papers in the top 100 (14%). The most common keyword was "dental erosion" with 64 occurrences. The top 100 most-cited papers related to ETW were composed mainly of laboratorial and observational studies focusing on epidemiology and the erosive potential of substances.  .

Fear, changes in routine and dental care for children and adolescents with autism spectrum disorder in the COVID-19 pandemic: A survey with Brazilian parents

AIMS

This study aimed to report the perception of parents of children/adolescents with autism regarding the parents' fear of the pandemic by COVID-19. Also, to report children's fear about the use of individual protective equipment (IPE) in dental appointments, and the impact on the daily routine during the pandemic.

METHODS AND RESULTS

A cross-sectional study through an open online survey was addressed to parents of children/adolescents autistic, aged between 3 and 18 years. The questionnaire had questions regarding the parents' fear of the COVID-19 pandemic, the parents' perception about the children/adolescents' fear of the use of IPEs at dental care, and the impact of the daily routine during the pandemic and social impact after the pandemic. Parents' reports on the degree of ASD (mild, moderate, and severe) of the child/adolescent. A total of 1001 responses were obtained. 50.35% of parents had high fear of the pandemic by COVID-19, 59.34% believe that children/teenagers will be afraid of the dentist's IPE and 61.64% responded that the COVID-19 pandemic had a high impact on the daily routine of children/adolescents with ASD.

CONCLUSIONS

Most parents reported fear of the pandemic by COVID-19, that children/adolescents with autism may be afraid of IPE and had a high impact on their daily routine during the pandemic.

The 100 most-cited papers in dentistry for individuals with neurodevelopmental disorders: Bibliometric profile of scientific research

AIM

To conduct a bibliometric analysis of the top 100 most-cited papers in dentistry for individuals with neurodevelopmental disorders.

METHODS AND RESULTS

A search strategy was constructed and conducted at the Web of Science in the category of "Dentistry, Oral Surgery, and Medicine". The following information was extracted from each paper: title, authorship, year of publication, title of the journal, study subject, study design, age range of sample participants, type of disability, institution, country and continent, number of citations and citation density. Google Scholar and Scopus were used to crosscheck the number of citations of the most-cited papers. The VOSviewer software was used to generate bibliometric network maps. The papers received 4453 citations in Web of Science, ranging from 30 to 106 citations. Most papers were published by the USA (35%), had an observational design (78%) and the main subject was epidemiology (31%). Most studies focused on individuals with Down syndrome (34%) and Autism Spectrum Disorder (18%) and were published in the Journal of Periodontology (10%) and the Pediatric Dentistry Journal (7%).

CONCLUSION

Most of the studies included in this review were characterized as epidemiological studies. Future research should focus on behavior guidance, dental education, and access to dental services.

Impact of primary dentition malocclusion on the oral health-related quality of life in preschoolers

BACKGROUND

Malocclusion is a condition frequently seen in primary dentition due to the interaction of environmental, genetic and behavioural factors. The occurrence of some types of malocclusions can have an impact on oral health-related quality of life in children. Hence, the present study aimed to verify the impact of primary dentition malocclusion on oral health-related quality of life in preschool children.

METHODS

A population-based cross-sectional study was conducted in Florianopolis, Brazil, with a representative sample of 1050 preschoolers aged between 2 and 5 years, randomly selected. Parents answered the Brazilian version of the Early Childhood Oral Health Impact Scale and also to a questionnaire on socio-economic indicators. Data obtained from the questionnaire were obtained by item response theory based on model of gradual response. The malocclusion assessed was: anterior open bite, increased overjet and posterior crossbite. Poisson regression model was employed for multivariate analysis (P < 0.05).

RESULTS

Malocclusion was observed in 36.7% of the children. Of these, 11.4% were anterior open bite, 67.2% were increased overjet, and 21.4% were posterior crossbite. Malocclusion's impact on oral health-related quality of life was 28.6%. In children aged 4-5 years, the prevalence of malocclusion's impact on quality of life was 49.5% higher than in children aged 2-3 years. Statistical analysis showed that preschool children with malocclusion showed no significant impact on quality of life.

CONCLUSIONS

The findings of the present study indicate that the occurrence of primary dentition malocclusion has no impact on the quality of life of children aged 2-5 years.

Prevalence of toothache and associated factors in children and adolescents: a systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to determine the pooled prevalence of toothache in children and adolescents and to verify its association with sociodemographic characteristics and dental caries experience.

MATERIAL AND METHODS

Six main and three grey literature databases were searched in February 2021. Observational studies that assessed the prevalence of toothache and associated factors were included. The methodological quality of the studies was evaluated following the guidelines by Fowkes and Fulton. Proportion and association meta-analyses were performed in MedCalc and Revman software, respectively. The certainty of the evidence was determined with the GRADE approach.

RESULTS

Seventy-one studies met the inclusion criteria. Thirty-two presented high methodological quality and a low risk of bias. The overall pooled prevalence of toothache in children and adolescents was 36.2% (95%CI: 33.0-39.42; I²: 99.72%; P < 0.001). Females (OR: 1.17; 95%CI: 1.08-1.26; I²: 91%; P < 0.001) and children and adolescents whose caregivers had ≤ 8 years of schooling (OR: 1.42; 95%CI: 1.30-1.56; I²: 77%; P < 0.001) presented the higher chance of reporting toothache. Dental caries experience increased the chance of reporting toothache in 3.49 times (95%CI: 2.70-4.51; I²: 92%; P < 0.001). The certainty of the evidence was very low.

CONCLUSIONS

The overall pooled prevalence of toothache was considered high. Sociodemographic characteristics (sex and caregivers' educational level) and previous dental caries experience were significantly associated with toothache reports.

CLINICAL RELEVANCE

Toothache is still a recurrent issue in many countries. Thus, it is essential to understand its possible associated factors to reduce the occurrence of new episodes.

The top 100 most-cited papers authored by Dr. Jens Ove Andreasen: A bibliometric analysis

BACKGROUND/AIM

Dr. Jens Ove Andreasen, the "father" of dental traumatology, passed away on September 26, 2020. As a tribute, the aim of this study was to catalog and analyze the top 100 most-cited papers (co)authored by Dr. Andreasen.

MATERIALS AND METHODS

A bibliometric analysis was conducted on October 21, 2020, in the Web of Science Core Collection (WoS-CC) database. The numbers of citations in the WoS "All Databases" section, Scopus, and Google Scholar databases were cross-matched. Two researchers collected the following bibliometric data: title, number of citations, authors, country, year, journals, study design, and theme. The VOSviewer software was used to generate collaborative network maps for the authors and keywords.

RESULTS

Of 194 papers identified in WoS-CC, a list was compiled with the 100 most-cited papers (co)authored by Dr. Andreasen. The number of citations of each paper ranged from 24 to 365 (mean: 85.4). Nine papers were cited more than 200 times. Most papers were published in Dental Traumatology (55%), between the 1990's and 2000's (60%), with a laboratory design (40%). One hundred and nine (co)authors, from 19 countries were identified in the top 100 most-cited papers. Dental traumatology was the most studied theme (52%).

CONCLUSIONS

The top 100 most-cited papers (co)authored by Dr. Jens Ove Andreasen were composed mainly of laboratory and observational studies, published mostly in Dental Traumatology. The present study was a humble homage to highlight the importance of his research and work. However, his legacy goes beyond the numbers and will always remain unsurpassed.

Prevalence of clinical signs and symptoms of the masticatory system and their associations in children with sleep bruxism: A systematic review and meta-analysis

Sleep bruxism (SB) is a behavior of central origin that is related to different factors. This systematic review aimed to determine the prevalence of clinical signs and symptoms of the masticatory system and their association in children with SB. A structured search in ten databases were taken. Two authors independently selected studies, extracted the data, study quality assessment and graded the evidence. A meta-analysis of proportion and association was performed under random-effect model, confidence interval of 95% and p < 0.05 for pulled values. Were included 22 studies, and their overall quality was poor. The more common clinical signs and symptoms of the masticatory system in children with SB were primary canine wear (P:84.13, 95% CI:78.13-89.32; p = 0.248; I² 25.05), dental wear (P:73.76, 95% CI:38.73-96.91; p < 0.001; I² 97.62) and headache (P:52.85, 95% CI:38.92-66.56; p < 0.001; I² 93.65). The prevalence of SB in children was 31.16% (P:31.16, 95% CI:22.18-40.92; p < 0.001; I² 98.56). There was no significant risk of dental wear and headache in children with SB. There is low to very low certainty of the evidence. The more prevalent clinical signs and symptoms of the masticatory system presented in children with SB were primary canine wear, dental wear and headache. Further studies of high quality are still needed to elucidate these important questions.

THE PERCEPTION OF CAREGIVERS OF POOR ORAL HEALTH OF THEIR CHILDREN AND ITS RELATED CLINICAL CONDITIONS

Objective:

To determine the association between the perception of caregivers regarding the oral health of their children and socio-demographic characteristics, report of dental pain, and clinical oral conditions.

Methods:

A cross-sectional study was conducted with 570 children aged two to five years old, enrolled at public preschools, and with their caregivers. Data regarding perceptions of oral health status in children, socio-demographic characteristics, and dental pain were collected from a questionnaire. Three examiners (Kappa>0.7) evaluated children’s oral health status using the dmft index, pufa index, and the Andreasen classification for traumatic dental injury (TDI). The occurrence of open bite and overjet was also investigated. Descriptive analyses, and unadjusted and adjusted logistic regression were used, considering a 5% significance level.

Results:

A total of 24.7% of children had poor oral health status, which increased 4.92-fold (95% confidence interval [95%CI] 3.05-7.93) when children had dental caries, and 3.78-fold (95%CI 1.63-8.76) when there were consequences from dental caries. The perception of poor oral health was also associated to open bite (Odds Ratio [OR] 1.98; 95%CI 1.16-3.38) and TDI (OR 1.68; 95%CI 1.06-2.68). No associations were found between the perception of caregivers and socio-demographic variables or overjet.

Conclusions:

The perception of caregivers of poor oral health in their children was associated to dental caries, its consequences, TDI, and open bite.

Influence of hand and rotary files for endodontic treatment of primary teeth on immediate outcomes: Secondary analysis of a randomized controlled trial

BACKGROUND

Endodontic treatment of primary teeth can be time-consuming.

AIM

To compare hand and rotary files regarding the time for root canal chemical-mechanical preparation, child's behavior, apical limit of the obturation, and post-operative pain.

DESIGN

This secondary data from a randomized clinical trial with two parallel arms evaluated endodontic instrumentation in 88 children aged 4-9 years. Stratified and block randomization was performed into two groups: K-file hand and ProDesign Logic rotary files. The evaluated outcomes were the chemical-mechanical preparation time, child's behavior using the Frankl scale, apical limit of the obturation, and post-operative pain using the Faces Pain Scale-Revised. One operator and all outcome appraisers were blinded to the chemical-mechanical technique. Multiple linear regression, chi-square, and Fisher's exact test were performed.

RESULTS

The mean time for chemical-mechanical preparation using hand files was 24.5 (SD 4.0) minutes, and using rotary files, it was 17.0 (SD 2.5) minutes (P < .001). No difference was found between the instrumentation methods in the child's behavior, apical limit of the obturation, or post-operative pain.

CONCLUSIONS

The ProDesign Logic file reduced the average procedure time but presented no difference in the other variables studied when compared to the K-file.

Does the pre-emptive administration of paracetamol or ibuprofen reduce trans- and post-operative pain in primary molar extraction? A randomized placebo-controlled clinical trial

BACKGROUND

There is no consensus whether the pre-emptive administration of analgesics reduces trans- and post-operative pain in primary molar extraction.

AIM

Investigate whether the pre-emptive administration of ibuprofen and paracetamol reduces trans- and post-operative pain on primary molars extraction compared to placebo.

DESIGN

A parallel, placebo-controlled, triple-blind, randomized clinical trial was conducted. Forty-eight children who needed primary molar tooth extraction were selected and treated under local anaesthesia and pre-emptive administration of placebo or analgesics. Self-reported pain was evaluated during the anaesthesia, extraction, and 2, 6, and 24 hours of post-operative period, using a visual analogue scale (VAS). Children's baseline anxiety, behaviour during the procedure, parents' anxiety, and post-operative analgesia were also assessed. Data analysis included descriptive statistics and multiple linear regression.

RESULTS

No association was found between the use of pre-emptive analgesic and lower scores of trans- and post-operative pain compared to placebo. Children who presented negative behaviour reported greater pain during anaesthesia (P = .04) regardless of pre-emptive analgesia group. Children from the placebo group were more likely to need post-operative analgesia at 2 hours of follow-up (P = .03).

CONCLUSION

The pre-emptive administration of analgesics did not significantly reduce trans- and post-operative pain in children after primary molars extraction.

ASSOCIATION BETWEEN TROUBLE SLEEPING AND ORAL CONDITIONS AMONG SCHOOLCHILDREN

Objective:

To investigate the prevalence of self-reported trouble sleeping due to dental problems and its association with oral conditions in schoolchildren.

Methods:

This is a cross-sectional study carried out with a representative sample of 1,589 schoolchildren aged 8-10 years enrolled in public schools from Florianópolis, Santa Catarina, Brazil. Non-clinical data included a questionnaire about socioeconomic indicators answered by parents/guardians. Children were questioned about whether they had trouble sleeping due to dental problems and about previous history of toothache. Clinical oral examinations were performed to evaluate dental caries - Decayed, Missing, and Filled Teeth Index (DMFT/dmft index) and its clinical consequences [PUFA/pufa index: considering the presence of pulpal involvement (P/p); ulceration of tissues due to tooth fragments from decayed crowns (U/u); fistula (F/f); and abscesses (A/a), and traumatic dental injuries (TDI)]. We conducted a descriptive analysis and used adjusted logistic regression models (p<0.05; 95%CI).

Results:

The prevalence of trouble sleeping due to dental problems was 28%. Children with untreated dental caries (OR 1.32; 95%CI 1.05-1.67) and clinical consequences from the PUFA/pufa index (OR 1.89; 95%CI 1.45-2.46) had higher chances of reporting trouble sleeping due to dental problems.

Conclusions:

Approximately one-third of the children declared having trouble sleeping due to dental problems. Untreated dental caries and its clinical consequences were associated with self-reported trouble sleeping due to dental problems in schoolchildren.

Is there an association between crown discoloration and pulp necrosis in traumatized per in vitro manent teeth? A meta-analysis

The present study aimed to identify the scientific evidence regarding the association between crown discoloration and pulp necrosis in traumatized permanent teeth. A systematic literature search was conducted in the PubMed/Medline, Lilacs/BBO, Scopus, Web of Science, Cochrane Library databases, and grey literature. Quality assessment and bias control were carried out according to the Fowkes and Fulton guidelines. Meta-analysis was performed, and the odds ratio was calculated with a 95% confidence interval. The quality assessment of the evidence was determined for the meta-analysis outcomes using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From 2,702 studies identified, five articles met the inclusion criteria. One among these showed no methodological soundness and was excluded from the meta-analysis, and the remaining four studies were included in the meta-analysis. The total number of traumatized permanent teeth evaluated in the meta-analysis was 367. The results showed a positive association between crown discoloration and pulp necrosis in permanent teeth. Teeth with crown discoloration showed 23 times more chance to present pulp necrosis than teeth without crown discoloration (OR 23.82 [1.25, 452.87]; p = 0.03), with a very low certainty of evidence. There is a significant association between crown discoloration and pulp necrosis of traumatized permanent teeth. Due to the very low strength of evidence according to GRADE, this result should be viewed with caution.

Efficacy and adverse events of 4% articaine compared with 2% lidocaine on primary molar extraction: A randomised controlled trial

BACKGROUND

There is no consensus regarding the most effective anaesthetic solution for children; nerve block, especially mandibular, can be difficult for general dentists. Therefore, the study aims to compare the efficacy and the adverse events of articaine 4% with epinephrine 1:100 000 with lidocaine 2% with epinephrine 1:100 000 for primary molar extraction using buccal infiltration.

METHODS

These are data from a parallel triple-blind randomised controlled trial with a computer-generated allocation treatment. Forty-three children aged 6-10 years with a clinical and radiographic indication of primary molar extraction were enrolled. The intervention was local buccal infiltration with articaine 4% compared with lidocaine 2%. The main outcome was pain during anaesthetic injection and tooth extraction. Adverse events were examined as secondary outcomes. Children were treated in a University setting from April to June 2019.

RESULTS

Both solutions had similar anaesthetic efficacy in primary molar extraction when applied by the infiltrative technique (β -0.47; 95% CI -3.19 to 2.24; P = .76); however, children reported higher mean pain during articaine deposition (β 2.43; 95% CI 0.28-4.57; P = .02). The measured lidocaine pH was 3.19 (0.15) and articaine was 2.43 (0.00) (P = .04). Post-operative pain, oedema and nausea were observed without differences between the groups.

CONCLUSIONS

There was no difference in the efficacy of articaine compared to lidocaine for primary molar extraction. Articaine was more painful during the injection.

PRACTICAL IMPLICATIONS

Primary molar extractions can be performed with both articaine and lidocaine buccal infiltration.

Association of gender, oral habits, and poor sleep quality with possible sleep bruxism in schoolchildren

The aim of this study was to verify the oral habits, symptoms, and characteristics of some children aged 8 to 10 years that could be associated with possible sleep bruxism. A cross-sectional study was performed. Questionnaires were sent to parents to obtain information on sex, age, school shift, sleep quality, parents' perception of children's behavior, and children's oral habits (nail biting, object biting, and lip biting), and symptoms such as headache or earache. In addition, parents reported the frequency of sleep bruxism (no day to 7 days a week). Descriptive analysis and multinomial logistic regression were performed and the level of significance was set at 5%. A total of 1,554 parents of children aged 8 to 10 years participated in this study. Possible sleep bruxism was reported as mild for 65.7%, moderate for 25.3%, and severe for 9% of the children. In the adjusted multinomial logistic regression, boys were 79% more likely to have sleep bruxism (OR: 1.79; 95%CI 1.23-2.60) and were 2.06 more times at risk of being in the habit of lip biting (OR: 2.06; 95%CI 1.26-3.37). Children with possible severe sleep bruxism were 61% more likely to develop object biting (OR: 1.61; 95%CI 1.09-2.39), 52% more likely to have headaches (OR: 1.52; 95%CI 1.01-2.28), and 3.29 more times at risk of poor sleep quality (OR: 3.29; 95%CI 2.25-4.82). Based on the report, boys with lip and object biting habits, headaches, and poor sleep quality presented a higher chance of possible severe sleep bruxism.

Socio-economic characteristics, acid drinking patterns and gastric alterations associated with erosive tooth wear in children: a cross-sectional study

AIMS

Assessing the influence of socio-economic characteristics, acid drinking patterns and gastric alterations considering erosive tooth experience in children.

METHODS

Cross-sectional study to assess 08-10-year-old children enrolled in the primary education in public schools in Florianopolis, Brazil (n = 1085). Caregivers have answered questionnaires comprising independent variables (head of the household education frequency consumption of sports drinks, acid juice/soda, chewing gum, recurrent vomiting, gastric disorders and vomiting after overeating). Four trained dental surgeons have examined the children for the erosive tooth wear-dependent variable (O'Sullivan index), as well as collected dental caries (DMFT) and dental crowding (DAI index) information. A two-stage cluster-sampling plan was conducted. Unadjusted and adjusted logistic regression models were applied (Odds ratio, OR; 95% Confidence interval, CI and 5% significance level).

RESULTS

The prevalence of erosive tooth wear was 15.67%. Erosive tooth wear was positively associated with high consumption of sports drinks (OR 3.42; 95% CI: 1.18-9.23). Children whose caregivers' educational level was equal or less than four years of study were less likely to have erosive tooth wear (OR 0.39; 95% CI: 0.17-0.88).

CONCLUSION

High consumption of sports drinks is positively associated with erosive tooth wear. Children whose caregivers' educational level is low are less likely to present erosive tooth wear.

Is there any difference in length measurement methods for pulpectomies in primary teeth?-A double-blind, controlled clinical trial

BACKGROUND

Working length is an important step in primary teeth pulpectomy.

AIM

To evaluate whether there is a significant difference in the accuracy of electronic apex locators compared to the conventional radiography in working length measurements.

DESIGN

Sixty-four children (192 canals) between 5 and 9 years of age with indication for pulpectomy of a primary molar were included after eligibility criteria. A radiographic measurement was obtained from pre-operative radiography from the cusp tip to the apex or resorption of the root. The electronic measurement was obtained from a complete measurement of the canal with an electronic device up to the apex. Data were analysed with Bland-Altman plots and Wilcoxon test. Statistical significance was set at P ≤ .05.

RESULTS

Statistically, there is not any significant difference between radiographic and electronic measurements for the palatal canal or distal canal, as well as mesiobuccal canals (P > .05). Statistically, there, however, is a significant difference between the measurements for the distobuccal canal and mesiolingual canal measurements (P < .05). High internal consistency for both radiographic and electronic methods was achieved (α ≅ 1).

CONCLUSIONS

Electronic and radiographic methods are similar in determining the length measurement of the root canals in primary teeth pulpectomies, except in distobuccal or mesiolingual canals.

Demystifying behaviour and dental anxiety in schoolchildren during endodontic treatment for primary teeth-controlled clinical trial

BACKGROUND

Behaviour and anxiety of children are predictors of effective dental treatment.

AIM

Compare the behaviour and anxiety during preventive care, endodontic treatment, and dental extraction.

DESIGN

Controlled clinical trial was conducted with 99 children aged 6-9 years. The children were distributed among three groups: G1 (control)-prophylaxis and topical fluoride; G2 (intervention)-endodontic treatment; and G3 (intervention)-tooth extraction. Behaviour was measured using the Frankl scale. Dental anxiety was assessed using the modified Venham Picture Test and measured at three moments: before, during, and after the procedure. Caregivers answered a questionnaire addressing the child's previous dental experience. Clinical examinations were performed by a calibrated examiner (Kappa > 0.70) for the identification of dental caries (d-dmft/D-DMFT). Statistical analysis involved repeated-measures Poisson regression, with level of significance was P < 0.05.

RESULTS

Neither negative behaviour nor anxiety was associated with the type of procedure. Negative behaviour was associated with the need for restraint during a previous dental appointment (P = 0.012). Dental anxiety was associated with age (P = 0.037), previous difficult behaviour (P < 0.001), moment of measurement (P < 0.001), and dental caries on permanent teeth (P = 0.001).

CONCLUSIONS

Negative behaviour and dental anxiety in children were not associated with the type of treatment performed.

Prevalence of self-reported dental pain and associated factors among eight- to ten-year-old Brazilian schoolchildren

Aim

To assess the prevalence of self-reported dental pain and its association with sociodemographic, clinical and behavioral/psychosocial indicators among 8- to 10-year-old Brazilian schoolchildren.

Design

A cross-sectional study was carried out with 1,589 eight- to ten-year-old children randomly selected from public schools of Florianopolis, Brazil. Self-reports of dental pain were collected through a single question as follows: “In the last month, how many times have you had pain in your teeth?” Caries experience was determined by the DMFT/dmft index and its clinical consequences by the PUFA/pufa index. Dental trauma, dental fluorosis and molar-incisor hypomineralization were assessed through the Andreasen, Dean and European Academy of Pediatric Dentistry classifications, respectively. Clinical signs of dental erosion were also observed. Sociodemographic indicators were obtained through a questionnaire answered by the children’s caregivers. Information about behavioral/psychosocial indicators was collected through questions from the Brazilian version of the Child Perception Questionnaire 8–10 years (CPQ_8–10). Descriptive analysis, chi-square test, and hierarchically adjusted Poisson regression models were performed.

Results

819 children (51.5%) reported episodes of dental pain in the last month prior to the study, whereas 55.6% (n = 509) were girls. The presence of dental pain was significantly associated with sex, trouble sleeping, difficulty eating, school absenteeism, difficulty with paying attention in class, difficulty doing homework, staying away from recreational activities, caries experience, PUFA/pufa index and ulceration (p<0.05).

Conclusion

The prevalence of self-reported dental pain in 8- to 10- year-old Brazilian schoolchildren was high and was associated with sociodemographic, clinical and behavioral/psychosocial indicators.

Antigenic response to CT-P13 and infliximab originator in inflammatory bowel disease patients shows similar epitope recognition

AIM

To test the cross-immunogenicity of anti-CT-P13 IBD patients' sera to CT-P13/infliximab originator and the comparative antigenicity evoked by CT-P13/infliximab originator sera.

METHODS

Sera of patients with IBD with measurable anti-CT-P13 antibodies were tested for their cross-reactivity to 5 batches of infliximab originator and CT-P13. Anti-drug antibody positive sera from treated patients were used to compare antigenic epitopes.

RESULTS

All 42 anti-CT-P13 and 37 anti-infliximab originator IBD sera were cross-reactive with infliximab originator and CT-P13 respectively. Concentration of anti-drug antibodies against infliximab originator or CT-P13 were strongly correlated both for IgG1 and IgG4 (P < 0.001). Anti-CT-P13 sera of patients with IBD (n = 32) exerted similar functional inhibition on CT-P13 or infliximab originator TNF binding capacity and showed reduced binding to CT-P13 in the presence of five different batches of CT-P13 and infliximab originator. Anti-CT-P13 and anti-infliximab originator IBD sera selectively enriched phage-peptides from the VH (CDR1 and CDR3) and VL domains (CDR2 and CDR3) of infliximab. Sera reactivity detected major infliximab epitopes in these regions of infliximab in 60%-79% of patients, and no significant differences were identified between CT-P13 and infliximab originator immunogenic sera. Minor epitopes were localised in framework regions of infliximab with reduced antibody reactivity shown, in 30%-50% of patients. Monoclonal antibodies derived from naïve individuals and ADA-positive IBD patients treated with CT-P13 provided comparable epitope specificity to five different batches of CT-P13 and infliximab originator.

CONCLUSIONS

These results strongly support a similar antigenic profile for infliximab originator and CT-P13, and point toward a safe switching between the two drugs in anti-drug antibody negative patients.