Transcranial Magnetic Stimulation for Positive Symptoms in Schizophrenia: A Systematic Review

Transcranial magnetic stimulation (TMS) has been proposed as a potential treatment add-on for positive symptoms in schizophrenia. To summarize the current evidence for its efficacy, we reviewed clinical trials from the last 20 years that investigated TMS for positive symptoms. We performed a search on the PubMed database for clinical trials that used TMS for the treatment of positive symptoms published in peer-reviewed journals. We excluded reviews, case reports, and opinion papers. Of the 30 studies included, the majority (n = 25) investigated auditory verbal hallucinations. Twelve studies found evidence for a positive treatment effect of TMS on positive symptoms, while 18 did not find enough evidence to conclude that TMS is effective for positive symptoms. However, the small sample size of the majority of studies is a limiting factor for the reliability of previous findings. In conclusion, evidence for an effect of TMS on positive symptoms was mixed. Since most of the studies were performed in patients with auditory verbal hallucinations, further research of TMS for other positive symptoms including thought disorder and delusions is warranted.

Ventilation Assessment by Carbon Dioxide Levels in Dental Treatment Rooms

It is important for dental care professionals to reliably assess carbon dioxide (CO₂) levels and ventilation rates in their offices in the era of frequent infectious disease pandemics. This study was to evaluate CO₂ levels in dental operatories and determine the accuracy of using CO₂ levels to assess ventilation rate in dental clinics. Mechanical ventilation rate in air change per hour (ACH_VENT) was measured with an air velocity sensor and airflow balancing hood. CO₂ levels were measured in these rooms to analyze factors that contributed to CO₂ accumulation. Ventilation rates were estimated using natural steady-state CO₂ levels during dental treatments and experimental CO₂ concentration decays by dry ice or mixing baking soda and vinegar. We compared the differences and assessed the correlations between ACH_VENT and ventilation rates estimated by the steady-state CO₂ model with low (0.3 L/min, ACH_SS30) or high (0.46 L/min, ACH_SS46) CO₂ generation rates, by CO₂ decay constants using dry ice (ACH_DI) or baking soda (ACH_BV), and by time needed to remove 63% of excess CO₂ generated by dry ice (ACH_DI63%) or baking soda (ACH_BV63%). We found that ACH_VENT varied from 3.9 to 35.0 in dental operatories. CO₂ accumulation occurred in rooms with low ventilation (ACH_VENT ≤6) and overcrowding but not in those with higher ventilation. ACH_SS30 and ACH_SS46 correlated well with ACH_VENT (r = 0.83, P = 0.003), but ACH_SS30 was more accurate for rooms with low ACH_VENT. Ventilation rates could be reliably estimated using CO₂ released from dry ice or baking soda. ACH_VENT was highly correlated with ACH_DI (r = 0.99), ACH_BV (r = 0.98), ACH_DI63% (r = 0.98), and ACH_BV63% (r = 0.98). There were no statistically significant differences between ACH_VENT and ACH_DI63% or ACH_BV63%. We conclude that ventilation rates could be conveniently and accurately assessed by observing the changes in CO₂ levels after a simple mixing of household baking soda and vinegar in dental settings.

Association between Dental Anomalies and Orofacial Clefts: A Meta-analysis

OBJECTIVES

To conduct a systematic review and meta-analysis to assess whether individuals with nonsyndromic orofacial clefts (OCs) display a higher frequency of dental anomalies (DAs) when compared with individuals without OCs.

METHODS

A literature search of indexed databases (PubMed, Cochrane, Web of Science, Embase, Scopus, and LILACS) was conducted without language restriction up to and including February 1, 2020. Cross-referencing was used to further identify articles. Several cleft teams across the United States and Europe were contacted to obtain unpublished data. The eligibility criteria were observational studies with original data that statistically compared individuals with OC without syndromes and those without OC on any type of DA in primary and/or permanent dentition. Random effects meta-analysis through the Mantel-Haenszel estimator was used to evaluate the association between OC and DA based on odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

The literature search generated 933 records, and 75 full-text articles were reviewed. Twenty-six studies encompassing 15,213 individuals met the inclusion criteria. The meta-analysis revealed statistically significant associations between OC and agenesis (OR, 14.2; 95% CI, 9.4 to 21.3), supernumerary teeth (OR, 5.7; 95% CI, 3.3 to 9.7), developmental enamel defects (OR, 5.6; 95% CI, 3.5 to 9.0), microdontia (OR, 14.8; 95% CI, 4.0 to 54.6), peg-shaped anterior teeth (OR, 12.2; 95% CI, 3.6 to 41.2), taurodontism (OR, 1.7; 95% CI, 1.0 to 2.7), tooth malposition and/or transposition (OR, 5.6; 95% CI, 2.8 to 11.5), tooth rotation (OR, 3.2; 95% CI, 1.3 to 8.2), and tooth impaction (OR, 3.6; 95% CI, 1.1 to 12.2). The OR estimates of the reviewed studies exhibited significant heterogeneity (P < 0.0001). No association was observed between OC and fusion and/or gemination.

CONCLUSION

Within the limitations of this study, the available evidence suggests that individuals with OCs are more likely to present with a range of DAs than their unaffected peers.

KNOWLEDGE TRANSFER STATEMENT

The findings of the current review suggest that individuals with orofacial clefts (OCs) are more likely to present with a range of dental anomalies than their unaffected peers. Understanding the association between OCs and dental anomalies is essential in guiding clinicians during treatment-planning procedures and is important in raising our awareness of the possible need for future dental treatment for patients with OCs.

A Systematic Review of Exposure to Bisphenol A from Dental Treatment

INTRODUCTION

Dental composite restorations and dental sealants containing bisphenol A glycidyl methacrylate (BisGMA) are commonly used materials in dentistry. Bisphenol A (BPA) is used to manufacture BisGMA and can be a by-product in BisGMA-based dental materials. BPA is an endocrine-disrupting chemical that may affect reproductive, psychological, cognitive, and endocrine-related health. We conducted a systematic review of clinical studies that measured urinary BPA (uBPA) concentrations before and after dental treatment to evaluate the extent to which individuals are exposed to BPA from dental treatment.

METHODS

Eligibility included studies that measured uBPA concentrations before and after dental treatment with any type of resin-based dental material. We searched PubMed, Cochrane, Web of Science, Virtual Health Library, Science Direct, ProQuest, and Clinical Trials with no date or language restrictions to identify published studies. We summarized eligible studies across participant characteristics, amount of treatment, and time of follow-up measures. Because methods of measuring uBPA varied, our primary outcome was the direction and percentage change between baseline and 24 h posttreatment and at later time points as available.

RESULTS

We identified 1,190 abstracts and 7 eligible studies: 4 in children and 3 in adults. In all studies, BPA concentrations increased 24 h after treatment. The 2 studies with the largest sample sizes found statistically significant increases >40% in uBPA concentrations at 24 h posttreatment (both P values <0.01). The 1 study to examine uBPA concentrations beyond 1 mo posttreatment found that concentrations returned to baseline by 14 d after treatment and remained at baseline 6 mo after treatment.

CONCLUSIONS

Our findings suggest that uBPA concentrations increase 24 h after dental treatment. One study showed that uBPA concentrations return to baseline by 14 d. Additional research is needed to determine the magnitude of change from pre- to post-dental treatment and the trajectory of uBPA concentrations posttreatment.

KNOWLEDGE TRANSFER STATEMENT

BPA is an endocrine-disrupting chemical that may have negative human health effects. Our findings suggest that urinary BPA concentrations increase in the short term after dental treatment. The extent to which such an increase may affect the health of patients remains an open question, particularly since there are no established thresholds for safety or harm related to BPA exposure.