Preferences and experiences regarding the treatment of obstructive sleep apnea with mandibular advancement splints - a cross-sectional pilot survey

OBJECTIVE

To obtain a current overview of the use of mandibular advancement splints (MAS) as a therapeutic option for obstructive sleep apnea (OSA) in the dental profession in Northern Germany.

METHODS

A questionnaire was mailed to 2431 dental professionals, and 8.3% responded. Descriptive data analysis was performed on each question separately.

RESULTS

Most of the surveyed dentists (51.7%) estimated the success rate of MAS therapy to be higher than 75%. Analysis of the relationship between the number of splints prescribed annually and the dental specialization (p = 0.22), work experience (p = 0.14), estimated success rate of MAS therapy (p = 0.96), and discontinuation of MAS therapy (p = 0.57) revealed no significant correlations.

CONCLUSION

Mandibular advancement splints seem to be a safe and successful therapy for OSA. There seems to be a lack of information on the patient side and a lack of education on the dentist side.

Periodontitis, Dental Procedures, and Young-Onset Cryptogenic Stroke

Periodontitis is associated with an increased risk of ischemic stroke, and the risk may be particularly high among young people with unexplained stroke etiology. Thus, we investigated in a case-control study whether periodontitis or recent invasive dental treatments are associated with young-onset cryptogenic ischemic stroke (CIS). We enrolled participants from a multicenter case-control SECRETO study including adults aged 18 to 49 y presenting with an imaging-positive first-ever CIS and stroke-free age- and sex-matched controls. Thorough clinical and radiographic oral examination was performed. Furthermore, we measured serum lipopolysaccharide (LPS) and lipotechoic acid (LTA) levels. Multivariate conditional regression models were adjusted for stroke risk factors, regular dentist visits, and patent foramen ovale (PFO) status. We enrolled 146 case-control pairs (median age 41.9 y; 58.2% males). Periodontitis was diagnosed in 27.5% of CIS patients and 20.1% of controls (P < 0.001). In the fully adjusted models, CIS was associated with high periodontal inflammation burden (odds ratio [OR], 95% confidence interval) with an OR of 10.48 (3.18-34.5) and severe periodontitis with an OR of 7.48 (1.24-44.9). Stroke severity increased with the severity of periodontitis, having an OR of 6.43 (1.87-23.0) in stage III to IV, grade C. Invasive dental treatments performed within 3 mo prestroke were associated with CIS, with an OR of 2.54 (1.01-6.39). Association between CIS and invasive dental treatments was especially strong among those with PFO showing an OR of 6.26 (1.72-40.2). LPS/LTA did not differ between CIS patients and controls but displayed an increasing trend with periodontitis severity. Periodontitis and recent invasive dental procedures were associated with CIS after controlling for multiple confounders. However, the role of bacteremia as a mediator of this risk was not confirmed.

Dental abnormalities in rare genetic bone diseases: Literature review

Currently, over 500 rare genetic bone disorders are identified. These diseases are often accompanied by dental abnormalities, which are sometimes the first clue for an early diagnosis. However, not many dentists are sufficiently familiar with phenotypic abnormalities and treatment approaches when they encounter patients with rare diseases. Such patients often need dental treatment but have difficulties in finding a dentist who can treat them appropriately. Herein we focus on major dental phenotypes and summarize their potential causes and mechanisms, if known. We discuss representative diseases, dental treatments, and their effect on the oral health of patients and on oral health-related quality of life. This review can serve as a starting point for dentists to contribute to early diagnosis and further investigate the best treatment options for patients with rare disorders, with the goal of optimizing treatment outcomes.

Corrigendum: Virtual reality in managing dental pain and anxiety: a comprehensive review

[This corrects the article DOI: 10.3389/fmed.2023.1285142.].

Two-Year Trajectories of Dental Anxiety in Parents and Their Association with Parents' and Children's Oral Healthcare Procedures in FinnBrain Birth Cohort Study

We aimed to identify parents' dental anxiety trajectories and the association of the trajectories with the number of parents' and their children's oral healthcare procedures in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale at gestational weeks (gw) 14 and 34, as well as 3 and 24 months (mo) after childbirth. Oral healthcare procedures from gw14 to 24 mo were obtained from the national patient data register and categorized as preventive and treatment. Trajectories were identified with latent growth mixture modelling for 2068 fathers and 3201 mothers. Associations between trajectories and procedures adjusted for education were analyzed using unordered multinomial logit models. Fathers' trajectories were stable low (80.1%), stable high (3.4%), stable moderate (11.0%), moderate increasing (3.9%) and high decreasing (1.6%). Mothers' trajectories were stable low (80.7%), stable high (11.2%), moderate increasing (5.3%) and high decreasing (2.8%). Mothers with decreasing dental anxiety had a higher number of preventive and treatment procedures. Fathers with decreasing dental anxiety had a higher number of preventive and treatment procedures, while fathers with increasing dental anxiety had fewer procedures. Children of mothers with stable low dental anxiety had higher number of preventive procedures. There seems to be a two-way association between dental anxiety trajectories and oral healthcare procedures.

Concordance of Fathers and Mothers in the Assessment of Their 5-Year-Old Child's Dental Fear

The aim of this study was to evaluate the concordance of parents' assessments of their child's dental fear. Cross-sectional secondary analysis used data from the multidisciplinary FinnBrain Birth Cohort Study. Child dental fear was assessed at age 5 with the Finnish translation of the modified Children's Fear Survey Schedule Dental Subscale (CFSS-M) by both fathers (n = 588) and mothers (n = 1100). Reply alternatives were from 1 = not afraid to 5 = very afraid and 6 = no experience coded as missing and 1. In total, 514 mother-father pairs were eligible for the analyses. Descriptive statistics, percentage agreement and Cohen's Kappa coefficients were used in the analyses. The concordance of parents' assessments was poor (Kappa range 0.072-0.258). The majority of parents replied "No Experience" to items related to invasive treatment or being unable to breathe. Thus, coding of this reply alternative had a significant impact on the mean values of the child's fear. When assessing the fear of a five-year-old child, it might not be safe to rely only on one parent's assessment, and whether or not the child has experience with the question asked should also be considered.

The efficacy of iatrosedation and music listening techniques in attenuating dental anxiety in patients undergoing dental crown preparation: A randomized clinical trial

Dental anxiety is a common problem encountered in dental clinics that affects both patients and dentists. Adequate management of dental anxiety is critical for optimal treatment outcomes for the patient. This study aims to assess the efficacy of two anxiety-reduction techniques (iatrosedation and music listening) for dental crown preparation in adult patients. In this clinical trial, 60 patients were randomly assigned to three groups: Group 1, iatrosedation; Group 2, music listening; and Group 3, control. Patients in all three groups underwent dental crown preparation. To measure the anxiety levels of the patients, heart rate was calculated using a pulse oximeter, and verbal rating scale scores were assessed. One-way analysis of variance, post hoc analysis, and Spearman's correlation were used to compare the mean values of the three groups. Significant differences were observed in the heart rate and verbal rating scale scores among individuals in the study groups. A more substantial reduction in anxiety levels was found in patients exposed to iatrosedation (Group 1), which was followed by music listening (Group 2). Recorded heart rate and verbal rating scores were the highest in the control group patients. The iatrosedation technique significantly reduced dental anxiety for patients undergoing dental crown treatment; however, music listening was less effective than iatrosedation. Educating patients regarding the dental care they are about to receive is vital for reducing their anxiety.

IMPLANT SURVIVAL IN RENAL-TRANSPLANTED PATIENTS: A PROSPECTIVE LONG-TERM STUDY

The present study aims to assess the feasibility of implant rehabilitation in kidney-transplanted patients. Patients with kidney transplantation included in periodontal supportive care and at least one year of dialysis with mono- or partial edentulism were eligible for this study. Histomorphometric evaluation of the harvested bone was matched with radiological bone assessment. Implant stability was also monitored with RFA and ITV. Fixed cemented prostheses have been delivered after conventional loading protocol. Supportive periodontal therapy has been administered. Eleven patients (9 males and 2 females) were included. The mean age was 58.1 ± 9.9 years. A total of 17 implants were inserted and analyzed. Mean ITV was 39.3 ± 23.8 Ncm. The mean primary stability (ISQ) at T0 was 71.7 ± 10.5, whereas the mean secondary stability at T1 was 73.0 ± 7.3. The minimum follow-up was 62 months, with a maximum of 84 months (7 years) reached by four patients. Fourteen out of 15 implants were in function at a 5-year follow-up (survival rate 93.3%). Two implants showed peri-implantitis. Seventeen bone samples were collected (13 in the mandible and 4 in the maxilla). The mean percentage of marrow spaces and lamellar bone was 41.6% and 58.4%, respectively. Class 3, according to Misch classification, was found as the mean value of radiological bone density. It can be concluded that implant-supported rehabilitation in kidney-transplanted patients is possible. Adequate periodontal maintenance allows implant rehabilitation in kidney transplanted patients with long-term sufficient survival rates.

Floating-Harbor syndrome and provision of dental treatment: A case report of the dental considerations

Floating-Harbor syndrome (FHS) is a rare genetic syndrome with limited cases reported in the medical literature. It is an autosomal dominant condition with affected individuals carrying a pathogenic variant of the SRCAP gene. FHS cases show individuals having consistent facial features and differing levels of intellectual disability, which can affect their ability to receive different anaesthetic modalities and have capacity to consent for dental treatment. This case report focuses on the clinical management of a young adult with FHS requiring dental care with different treatment modifications tailored to the patient's individual needs. Further research and awareness of this syndrome is required to fully understand its consistent oral findings and varying intellectual abilities, to ensure appropriate and timely treatment provision. MeSH: dentistry, Floating-Harbor syndrome (FHS), SRCAP gene, clinical management.

Rectal Sedation With Ketamine and Midazolam in the Management of Uncooperative Children During Dental Treatment: A Case Series and Method Description

Background In pediatric dentistry, sedation aims to eliminate anxiety to facilitate the completion of dental procedures. Sedation in children is a multidimensional field that includes the child, parents/guardians, and the health care team. The rectal route is generally painless, making it suitable for children who are afraid of needles. This route has several advantages over the oral route, including reduced patient cooperation requirements, a faster and more predictable onset, and less physical trauma than the intravenous and intramuscular routes. This case series aimed to evaluate the effectiveness and success rate of rectal sedation with ketamine and midazolam in the management of uncooperative children during dental treatment. Case presentation Ten healthy children with definitely negative behavior were enrolled in this study. Each child was given 7 mg/kg of ketamine in combination with midazolam 0.1 mg/kg by the rectal route. The mean onset sedation time was 9.5 minutes, and pulpotomy procedures were done. Behavioral response was monitored throughout treatment using the Ohio State University Behavioral Rating Scale (OSUBRS), and the depth of sedation was measured using the University of Michigan Sedation Scale (UMSS). The Houpt General Behavior Scale was used to estimate the treatment success rate based on the overall behavior rating. All 10 cases showed good anxiolysis and cooperation following rectal administration, with no side effects observed. Conclusions Rectal administration of ketamine in combination with midazolam may be considered a reliable method in the management of uncooperative children during dental treatment. No adverse effects were observed during or after the sedation procedure.

Comparing the Clinical and Radiographic Outcomes of Two Different Surgical Approaches for Treating Infrabony Defects in Chronic Periodontitis Patients

Background

Chronic periodontitis is a prevalent oral health issue, affecting a substantial portion of the population. Infrabony defects, characterized by bone loss around teeth, are a hallmark of this condition and require surgical intervention to prevent further damage and tooth loss. Two commonly used surgical approaches are open flap debridement (OFD) and guided tissue regeneration (GTR).

Materials and Methods

This prospective cohort study included 60 patients with chronic periodontitis and infrabony defects. Patients were randomly assigned to either the OFD or GTR group. Clinical parameters, including probing depth (PD) and clinical attachment level (CAL), were recorded at baseline and at 6-month and 12-month follow-up appointments. Radiographic assessments were conducted using periapical radiographs. The primary outcome measures were changes in PD and CAL, while secondary outcomes included radiographic evidence of bone regeneration.

Results

At the 6-month follow-up, the OFD group demonstrated an average reduction in PD of 2.4 mm (SD = 0.8) and an increase in CAL of 1.6 mm (SD = 0.5). In contrast, the GTR group showed a reduction in PD of 2.1 mm (SD = 0.7) and an increase in CAL of 1.9 mm (SD = 0.6). These differences were not statistically significant (P > 0.05). Radiographic analysis indicated a mean bone fill of 1.2 mm (SD = 0.4) in the OFD group and 1.4 mm (SD = 0.3) in the GTR group at 12 months, with no significant difference observed between the two groups (P > 0.05).

Conclusion

In this study, both OFD and GTR approaches demonstrated comparable clinical and radiographic outcomes in the treatment of infrabony defects in chronic periodontitis patients.

Dental desensitization by dentists and occupational therapists for autistic adults: A pilot study

LAY ABSTRACT

Managing patients with autism in the dental clinic often requires resorting to pharmacological behavioral control techniques, including general anesthesia. References in the literature to desensitization programs are scarce and focus on training children with autism to undergo oral examinations and preventive procedures. This study shows that a dental desensitization program implemented by dentists and occupational therapists could help in performing not only oral examinations but also simple dental therapeutic procedures for a considerable percentage of adults with autism, without using a pharmacological intervention (sedation or general anesthesia).

Late Complications in Long-Term Childhood Cancer Survivors: What the Oral Health Professional Needs to Know

With diagnostic and therapeutic advances, over 80% of children diagnosed with cancer become long-term survivors. As the number of childhood cancer survivors (CCS) continues to increase, dental practitioners become more likely to have CCS among their patients. CCS may develop late complications from damage caused by their cancer treatment to endocrine, cardiovascular, musculoskeletal, and other organ systems. These complications may surface decades after the completion of treatment. Adverse outcomes of childhood cancer treatment frequently involve oral and craniofacial structures including the dentition. Tooth development, salivary gland function, craniofacial growth, and temporomandibular joint function may be disturbed, increasing oral health risks in these individuals. Moreover, CCS are at risk of developing subsequent malignancies, which may manifest in or near the oral cavity. It is important that dental practitioners are aware of the childhood cancer history of their patients and have knowledge of potential late complications. Therefore, this narrative review aims to inform dental practitioners of late oral complications of cancer treatment modalities commonly used in pediatric oncology. Furthermore, selected common non-oral late sequelae of cancer therapy that could have an impact on oral health and on delivering dental care will be discussed.

Association Between the Number of Chronic Diseases and Oral Health Problems in Korean Adults

PURPOSE

The relationship between the number of chronic diseases and oral health problems is unclear. We sought to determine whether the number of chronic diseases and multimorbidity have an association with oral health problems in Korean adults.

MATERIALS AND METHODS

Data from 23,246 adults aged ≥ 19 years, who participated in the Korea National Health and Nutrition Examination Survey from 2016 to 2019, were considered for our analyses. Participants with either masticatory or speech problems were defined as the oral health problems group. Individuals who reported having had dental treatment in the last year were defined as the dental treatment group. We used multivariable logistic regression analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

The proportions of oral health problems and dental treatment were higher in participants with multimorbidity than in those without multimorbidity (all p < 0.001). Moreover, ORs of oral health problems demonstrated a tendency to increase with the number of chronic diseases, even after adjustment (p for trend < 0.001). Compared to the participants without multimorbidity, the risk of having oral health problems increased by 25% (OR: 1.25, 95% CI: 1.12-1.39), and that of receiving dental treatment increased by 23% (OR: 1.23, 95% CI: 1.13-1.34) in patients with multimorbidity.

CONCLUSION

The risk of oral health problems and dental treatment increased in association with the number of chronic diseases in Korean adults. The authors emphasise the risks and importance of oral health in a large population affected by multiple chronic diseases.

Dental Treatment in Special Needs Patients and Uncooperative Young Children: A Retrospective Study

Background and Objectives: Special Needs Patients (SNPs) and young non-collaborative children are more predisposed to develop oral pathologies due to poor collaboration and scarce access to dental treatment. The aim of this retrospective study was to analyze a sample of SNPs who received dental treatments either under general anesthesia (GA) or deep sedation (DS) over a period of 6 years. The number and type of procedure were analyzed. Materials and Methods: In total, 131 patients were included and mostly (>90%) treated under GA. Patients were either uncooperative and phobic (Group 1) or affected by mental, behavioral, and neurological disorders (Group 2), diseases of the nervous system (Group 3), or developmental anomalies (Group 4). Results: Patients in Group 2 required more invasive dental treatments than those in the other groups. Therapies were mainly preventive and restorative, except in Groups 3 and 4, where extractions were more frequent. The type of dental treatment significantly varied according to age and systemic condition. Only 5.3% of the patients needed a second intervention, despite only 17.6% of patients respecting the scheduled follow-up. Conclusions: Treatment under GA is effective, but the poor adherence to follow-ups and the risk of reintervention should be contrasted by improving the perception by parents/guardians of the importance of oral hygiene and periodic visits.

Dental and medical management of the patient with bipolar disorder

OBJECTIVE

The objective of this literature review is to understand the appropriate medical management of patients with bipolar disorder (BD) which subsequently can translate into the effective dental management of patients suffering with this illness METHODS: This study was completed using three databases which included PubMed, Google Scholar and Cochrane library. Additionally, relevant dental and medical textbooks were also used to summarize more complex topics regarding BD. Descriptors used to find relevant articles included "Bipolar Disorder", "Adverse drug effects of bipolar medications", and "Orofacial findings with patients with bipolar disorder". A total of 49 relevant articles and textbooks were found which were included in this literature review.

RESULTS

BD is a mental illness which affects millions worldwide. It is characterized by alternating episodes of mania and depression. During the manic phase there is an abnormal elevation in mood whereas the depressive episodes consist of the opposite. The medical management of BD involves pharmacotherapy and psychotherapy. Common dental findings in patients with BD include caries, periodontal disease, xerostomia and adverse oral effects from the medications used to manage this illness.

CONCLUSION

BD has a significant burden on society and to effectively manage their medical and dental needs, the clinician must be well versed in their illness.

Brazilian special olympics athletes: Oral health problems

AIMS

The people with intellectual disabilities have been reported to be a vulnerable population in terms of oral health. This study was carried out to determine the oral health condition and treatment needs of Special Olympics athletes in Brazil.

METHODS

This study is a retrospective review of oral health data collected from athletes participating in Healthy Athletes Program Special Olympics in Brazil, between the years 2015 and 2019. About 1241 athletes from the Brazil Special Olympics program were screened in the cities of São Paulo, Jundiai and Belo Horizonte (located in southeastern Brazil) and Recife (in northeastern Brazil). At each of these events, volunteer dental professionals performed an oral health screening for each athlete, All oral health assessments were done visually; and extra lighting were available if needed. The examinations were performed with the aid of a wooden spatula of the tongue depressor type and under natural light. The following parameters were recorded: mouth pain, untreated tooth decay, missing teeth, gingival signs, urgency and mouth hygiene habits. Data was analyzed using the STATA 14.0 program. Frequency tables were used for descriptive analyses. Categorical variables were compared between the different years of the event using the Chi-Square or Fisher's Exact test. Continuous variables were compared between different event years using the Kruskal-Wallis test followed by Dunn's post-hoc analyses. Simple logistic regression was used to assess the effect of age on dental assessment results. For all tests, a p-value was considered significant when less than or equal to .05.

RESULTS

No statistically significant differences were observed in the frequencies of Mouth Pain and Missing Teeth over the years (p > .05). In relation to Untreated Tooth Decay, there is a higher frequency in the years 2016 and 2018 and a lower frequency in the year 2015 (p = .048). Regarding Gingival Signs of inflammation, there is a higher frequency in the years 2016 and 2018 and a lower frequency in the year 2017 (p < .001). In relation to cases of urgency (in need of treatment (Urgent treatment need, Non-Urgent or Maintenance)), there was a higher frequency (no urgency) in 2016 (p = .007). Finally, in relation to mouth hygiene habits, there is a higher frequency of participants with irregular habits in the years 2017 and 2019 (p < .001).

CONCLUSION

The dental condition of Brazilian athletes Special Olympycs Brazil reported in this study from 2015 to 2019 showed us that athletes have a high prevalence of dental diseases and these needs could contribute to health damage. The athletes have many unmet dental treatment needs and these needs are similar in different regions of the country and in the years reported.

Survey on the Awareness of the Use of Oropharyngeal Throat Packs in Dental Anesthesia: An International Online Survey

INTRODUCTION

Oropharyngeal throat packs (OPTPs) are frequently used to administer general anesthesia during oral surgery and dental procedures. However, the use of OPTPs has remained controversial, with concerns about their effectiveness, the potential for falling short of expectations, and the inherent risk of serious oversight in removing them. This study aimed to assess the awareness of dental anesthesiologists in the United States of America (USA) and Japan regarding the use of OPTPs.

METHODS

An online questionnaire was distributed to 41 dental anesthesia education facilities in May 2023 and responses were obtained from 32 facilities.

RESULTS

The responses to the questionnaire indicated that dental anesthesiologists in both the USA and Japan believe that using OPTPs during general anesthesia with airway securement is of significant importance, albeit with varying primary purposes for their application. In contrast, notable disparities were observed between the USA and Japan regarding the perceived importance and routine use of OPTPs during open-airway general anesthesia. In both countries, there is a common understanding that the residual risks of OPTPs are severe and that multiple preventive procedures are required.

CONCLUSIONS

 The present study showed that dental anesthesiologists in the USA and Japan believed that the use of OPTPs was generally necessary for dental anesthesia. However, there was a difference in awareness between Japan and the USA regarding the importance of OPTPs for open-airway general anesthesia. Therefore, there should be a consensus among dental anesthesiologists in Japan and the USA on using OPTPs during open-airway general anesthesia in the near future.

Oral Health Statuses of Children and Young Adults with Autism Spectrum Disorder: An Umbrella Review

This study aimed to comprehensively evaluate the oral health statuses of children and adults within the autism spectrum disorder (ASD) population through an umbrella review approach. The prevalence of dental caries, periodontal disease, and associated variables were investigated across selected studies. A systematic search was conducted across databases including PubMed, Scopus, EMBASE, Science Citation Index, Science Direct, Web of Science, MEDLINE, and Wiley Online Library to identify relevant studies. The assessed variables included dental caries prevalence, periodontal disease prevalence, oral hygiene indicators, and the necessity of dental treatment. The pooled prevalence rates, odds ratios, and standardized mean differences were calculated where applicable. The pooled prevalence of dental caries among ASD individuals ranged from 60.6% to 67.3%, while the periodontal disease prevalence ranged from 59.8% to 69.4%. High rates of dental treatment under general anesthesia were reported. Heterogeneous dental caries and periodontal disease prevalence rates were identified, highlighting the need for collaboration and preventive care. Several studies also reported higher prevalence rates of dental trauma and self-inflicted oral injuries among individuals with ASD. However, the review also identified significant methodological limitations in the included studies, including inconsistency in oral health assessment methods and potential bias. The necessity for targeted policies due to high prevalence rates and the requirement for integrated care systems in high DMFT regions were also observed. The umbrella review synthesized diverse findings, revealing variations in dental caries and periodontal disease prevalence among ASD individuals. This review underscores the need for tailored interventions and policies to address oral health disparities. It highlights the necessity of integrated care systems, methodological improvements, and longitudinal studies to comprehensively address the multifaceted oral health challenges within the ASD population.

Virtual reality in managing dental pain and anxiety: a comprehensive review

Objectives

This study aimed to identify, analyze, and summarize the clinical efficacy of virtual reality (VR) distraction therapy for oral treatment in different hospital settings in contrast to medical interventions that induce anxiety and pain. Furthermore, this review aimed to determine the implications for research and clinical practice of VR distraction therapy.

Data

This review investigated the clinical efficacy of VR in the oral treatment of procedural pain or anxiety. Quality assessment of the included studies was conducted. A narrative synthesis of the collected data was performed.

Sources

Literature studies from six electronic databases were searched for a comprehensive review, namely, the Cochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials (Central), MEDLINE (PubMed), EMBASE, Scopus, and Web of Science.

Study selection

One thousand five hundred twenty-two patients aged between 0 and 60 years who used VR during dental treatment were included in this review. Among these studies, 8 and 14 studies comprised adult and pediatric patients.

Conclusion

Overall, the reviewed studies underscore the efficacy of VR to mitigate pain and anxiety in the context of dental treatment. VR is an innovative pain and anxiety management approach that facilitates dental treatment patients to immerse themselves in a virtual world while using distractions to reduce pain and anxiety.

Clinical significance

VR is an effective and novel non-pharmacological method of behavioral management that contributes to improving medication safety for dental patients. VR as a distractive approach can reduce the fear associated with medical interventions and prevent severe pain sensitivity, anxiety, and medical avoidance among adults and children.

Potential impact of natural conditions on the rostral oral health: a study of horses in Iceland

OBJECTIVE

In the context of a study of Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH), elderly Icelandic horses were examined in their originating country. The subject of this survey was the impact of dental treatment and keeping and feeding management on the health of the rostral oral cavity.

ANIMALS

A total of 170 horses (aged ≥ 15) located in different areas of Northwest, West, and South Iceland.

METHODS

The horse owners completed a questionnaire about keeping, feeding, and preventative dental care. The horses were clinically examined with particular attention to gingival and dental disorders of the rostral mouth, such as gingivitis, fistula, gingiva retraction, enlargement of the roots and dental calculus as well as integrity of incisors, bite angle, and tooth mobility.

RESULTS

Most of the horses were kept on pasture all year with little supplementary feeding. The frequency of dental treatment in Iceland was low. Only a few horses were affected by tooth loss, gingivitis, gingival recession, and incisor calculus. Calculus occurred more frequently and more severely in canines than in incisors. The findings did not depend on the location of the horse.

CLINICAL RELEVANCE

Assuming that the remarkable health of the rostral oral cavity in elderly Icelandic horses was not caused by preventive dental care, it is likely that it was due to living conditions in Iceland. Continuity, intensity of chewing, and nativeness of forage might promote the health of incisors and tissue surrounding the tooth even in elderly horses.

Oral Manifestations of Graft vs. Host Disease: A Comprehensive Review for Best Practice in Dentistry

Graft-versus-host disease (GVHD) is a complication of hematopoietic stem cell transplantation (HSCT). GVHD may also develop following solid transplants or blood transfusions if white blood cells are transferred. GVHD affects multiple organs, including the oral tissues. This pictorial review provides a background of GVHD to dental practitioners, describes the most common oral manifestations of GVHD, and highlights the main treatment modifications needed to deliver dental care to patients with GVHD. A narrative review enriched with clinical data was performed by searching the scientific literature for all articles regarding GVHD and oral manifestations/therapies. All articles without exclusion criteria, except animal tests, were included in the above review. Acute GVHD may manifest in the oral mucosa; however, it often develops immediately following HSCT when routine dental treatment is postponed. Chronic GVHD may manifest in the oral mucosa, the salivary glands, and the musculoskeletal compartment. It may indirectly affect the teeth and the oral flora, putting the patient at risk for infections. Importantly, GVHD poses an increased risk for oral cancer. GVHD has a wide range of oral manifestations, some of which may affect dental treatment.

The role of anxiety in patients with hereditary angioedema during oral treatment: a narrative review

Objective

The present study investigated the clinical potential of managing anxiety during dental procedures to reduce acute attacks in patients with hereditary angioedema (HAE). HAE is a rare disease, little known to physicians and dentists, but with an increased hospitalization rate over the years. HAE is due to a deficiency/dysfunction of the C1 esterase inhibitor, leading to increased vascular permeability. Recommendations for HAE management include long-term and short-term prophylaxis and treatment of acute attacks, but the importance of anxiety control is underestimated.

Materials and methods

The authors reviewed the literature to provide the scientific community with an overview of possible protocols for managing anxiety in dental practice and their effectiveness. Management can be used in prosthetics, periodontal and implant surgery, endodontics, and oral surgery.

Discussions

Our analysis shows that although there are few articles in the indexed literature, protocols for managing anxiety in HAE patients in dentistry will become increasingly prevalent in the daily clinical practice of dentists due to its benefits.

Conclusions

The benefits and better control of intraoperative complications and risks may lead clinicians to use sedation, assessment, or anxiety control techniques in daily clinical practice to reduce such attacks. Clinical relevance: This study suggests that controlling and managing anxiety can help prevent and reduce acute angioedema attacks.

The Association between Oral Health Management and the Functional Independence Measure Scores at the Time of Admission of Inpatients to a Convalescent Hospital

Many older patients admitted to convalescent hospitals present with impaired oral function, which is an important function of daily life. This study aimed to investigate the actual status of the oral healthcare needs of inpatients in a convalescent hospital and to clarify the relationship between the level of independence at admission and the oral function. The participants were 147 patients (94 males, 53 females, mean age: 74.6 ± 13.1 years) who received dental visits during their stay at a convalescent hospital. Information regarding general and oral health was extracted from medical records. Most patients were found to have low Functional Independence Measure motor scores, and approximately 70% had some form of oral intake, but approximately 80% had nutritional problems. The mean number of present and functional teeth were 16.6 and 20.8, respectively, and 65% of patients lost molar occlusal support. Multiple regression analysis showed significant positive correlations of high functional independence measure with age, eating status, nutritional status, and the number of functional teeth. This implied that oral health management is important for patients in a convalescent hospital and that enhancing oral health may be related to improved eating textures and better nutritional status.

The Prevalence of Dental Fear and Its Relationship to Dental Caries and Gingival Diseases Among School Children in Wardha

Background Children who are afraid of the dentist have terrible behavioral effects, and one of those effects is that they have a preconceived concept that getting treatment would be unpleasant. Such fear and anxiety can lead to avoidance of dental care. These patients must be recognized and their concerns addressed as soon as possible. It is, therefore, important to highlight the connection between the constructs that target the development of dental fear and anxiety, including its outcome in children concerning the prevalence of dental diseases. Aims and objectives To assess the prevalence of dental anxiety and its correlation to dental caries and gingivitis in students in Wardha aged six to 12 years old. Methods Two hundred schoolchildren between the ages of six and 12 were chosen at random, with 100 boys and 100 girls. Children had an oral examination utilizing the decayed, missing, and filled teeth (DMFT) Index as well as the Loe and Silness gingival index (GI), as well as a modified version of the dental fear survey questionnaire. Results In the study population, the prevalence of low to moderate "general dental fear" was 47%, whereas the frequency of high dental fear was 14%. The mean DMFT (1.80 ± 1.76) and GI (1.04 ± 0.52) of boys did not differ substantially from the DMFT (1.94 ± 81.02) and GI (0.97 ± 0.53) of girls (P > 0.05). Conclusion In terms of DMFT and gingival scores, there was not any obvious distinction between male and female children. Additionally, there was no connection found between "general dental fear" and either the DMFT or GI scores. Dental fear scores decreased with increasing age.

Predictors of Parental Acceptance towards Contemporary Behavior Management Techniques Used in Pediatric Dentistry: A Preliminary Study on Turkish Population

BACKGROUND

Parents, who make the final decision regarding their child's treatment, play a significant role in their dental care. Parental approval is important for each stage of treatment and may affect the physician's approach to the treatment. Therefore, it is essential for pediatric dentists to comprehend which behavior management techniques (BMTs) are acceptable to parents and to identify the factors that influence their acceptability.

METHODS

Parents who were bringing their children for dental treatment answered a survey on the acceptance of twenty contemporary BMTs. The sociodemographic data of the parents and the age, gender, and Frankl behavior rating scale (Frankl) scores of their children were recorded. Parents were asked to indicate their level of acceptance of each BMT. Binary logistic regression analysis was designed to see the predictors of "accepted" and "declined" answers.

RESULTS

According to acceptance frequencies, the most accepted technique was communication and communicative guidance. The most declined technique was parental absence. The child's age, gender, Frankl score, parental educational status, and parent type predict the acceptability of some BMTs.

CONCLUSION

This study revealed that pediatric dentists must consider parent and child factors when selecting BMTs for children. We believe that this study can provide a basis for determining which factors pediatric dentists should consider when selecting individualized BMTs.

Assessment of Scattered Dose to the Eye in Dentistry: A Systematic Review

Cone-beam computed tomography (CBCT) is a tool for dental imaging of impactions, maxillofacial discrepancies, facial trauma, and tumors. In addition, It is used in treatment planning for dental implants, orthognathic surgery, and general maxillofacial surgery. There are no standardized methods for utilizing CBCT dosimetry, and there is no consensus among dental and medical physics health professionals regarding dental CBCT imaging procedures. The eyes and thyroid glands are radiosensitive organs that lie outside the primary beam but receive a significant amount of radiation due to scattered radiation. This study aimed to assess the dose to eye lens in patients imaged using CBCT. This review aims to evaluate the scattered doses to the eye from CBCT among adult patients seeking dental treatment. The search included published articles in the Web of Science, PubMed (MeSH and Web PubMed), Medline, and Google Scholar databases using the appropriate keywords from January 2010 to July 2022. The inclusion criteria were based on the method of dose measurement (phantom studies using Optically stimulated luminescence (OSL) and Thermoluminescent dosimeter (TLD), language, and type of protocol used. A literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and flow chart. Out of 653 articles identified, 5 met the inclusion criteria. The results show that the scattered radiation dose ranged between 0.103 mSv and 8.3 mSv. This variation exists due to the difference in the field of vision (FOV), phantom exposure, dosimeters used, degree of rotation in the protocol, and finally, the scanner used. The scattered dose to the eye from CBCT is higher than the background radiation, with huge variability in the range of the dose measured. Clear guidelines for utilizing CBCT should be implemented, and dose reference levels should be established for benchmarking and optimization in practice.

Impact of the COVID-19 pandemic on patients' anxiety levels related to dental appointments in Poland

BACKGROUND

The reasons for the fear of coronavirus disease 2019 (COVID-19) infection are the ease of the transmission of the virus, the severe course of the disease and possible complications, as well as treatment difficulties. The dental office is a place of increased risk. Despite the applied epidemiological protection measures and the hygienic regimen, a dental visit may cause anxiety and generate stress.

OBJECTIVES

The aim of the study was to determine the level of fear of coronavirus infection in dental patients during the COVID-19 pandemic, taking into account the patients' age, gender and education, the number of people in the household, and the reason for the appointment. In addition, the patients assessed the epidemiological comfort provided during their visit to the dental clinic.

MATERIAL AND METHODS

The survey was conducted among 100 adults who visited the University Dental Clinic (UKS) in Cracow, Poland, for dental treatment. The patients completed 2 questionnaires: "Assessment of the level of anxiety associated with COVID-19"; and "Impact of the COVID-19 pandemic on the need of dental treatment and the level of epidemiological safety of patients". The results were statistically analyzed and interpreted.

RESULTS

The level of anxiety assessed with the questionnaire was moderate, and there were no statistically significant differences with regard to the age, gender and education of the respondents or the number of people in the same household. The main reason for reporting to the clinic was the desire to start and continue treatment. Most of the respondents believed that wearing a mask and measuring the temperature protect against infection, but 27% assessed the security measures as insufficient. Nearly half feared impeded access to dental services, and more than half were afraid of increased costs of treatment.

CONCLUSIONS

Despite the safety measures taken in place, patients felt anxious about dental appointments during the COVID-19 pandemic.

Awareness and Attitude of Dental Practitioners on Impact of Music Therapy on Patients Anxiety Level during Various Types of Dental Treatments

Music therapy plays an important role in reducing the anxiety of patients during various procedures of dental treatments. Dental practitioners should also be aware of the employment of music therapy on patients before various dental treatments to reduce dental anxiety and the feasibility of its implementation in regular dental practice. A questionnaire study was conducted regarding the awareness and attitude of dental practitioners on the impact of music therapy on dental patients, to which 305 participants responded. A comparison was made between the Undergraduates, Postgraduates, Faculties, Interns, and Private practitioners. They were also asked about the drawbacks associated with music therapy. There was a level of agreement amongst participants regarding the awareness of music therapy. But there was a statistically significant difference (p = 0.011) noted across groups. The majority of the participants agreed that it could be incorporated into a regular dental practice as a stress management procedure.

Evaluation of Knowledge and Practice of Resident Dentists in Iasi, Romania in the Management of Traumatic Dental Injuries: A Cross-Sectional Study

Dentists play an essential role in the treatment of dental and periodontal traumatic injuries by providing early and correct treatment. The purpose of the present study was to assess the level of knowledge of dental residents regarding dental trauma. The cross-sectional study was conducted at the Faculty of Dental Medicine within the "Grigore T. Popa" University of Medicine and Pharmacy in Iasi, Romania on a sample of 366 residents in General Dentistry, Pediatric Dentistry and Periodontology. To assess their knowledge, a questionnaire was created containing 18 questions about the clinical signs and therapy of dental trauma, with a focus on tooth avulsion. A very low level of knowledge (<25%) was found only for the type of splinting required to maintain an avulsed tooth on the arch. The highest number of correct answers was provided by the residents in Periodontology. Physiological serum as storage medium was recognized by a percentage of 75.9-80% of the subjects, and 60-77% of them recognized pulp necrosis as complication of dental avulsion. The study underlines the need to introduce in the curriculum of all categories of residents additional information, not only in the already existent theoretical form, but also as possible scenarios of various clinical situations.

Comparing knowledge and opinions of medical and dental students in the field of pediatric anesthesia

Background and Purpose

Dental treatment under general anesthesia (GA) is one of the common treatment methods today for dental treatment in children, so dentists' point of view in this field is very important. Therefore, the purpose of this study was evaluation the awareness and attitude of pediatric dentists and final-year dental students about dental treatment for children under GA.

Methods

To conduct this study, 150 people, including 75 general dentists (GD) and 75 final-year dental students (FYDS), were randomly selected in Tehran. In this study, a researcher-made questionnaire containing 15 questions (7 awareness questions and 8 attitude questions) was used to evaluate the awareness and attitude of the participants. After extracting the raw results, statistical analysis of the results was done using SPSS-Ver. 22 software.

Results

60% of the participants (90 people) were men and the remaining 40% (60 people) were women. The results showed that the level of awareness of male dentists was significantly higher than that of female dentists (P = 0.015). In addition, although the awareness level of FYDS was lower than GD, this difference was not statistically significant (P = 0.130). The average level of awareness among different age groups had a significant difference (P = 0.009), so the age group of 36-45 years compared to the younger age groups (25-35 years) and the older age groups (36-45 and 55 -46 years), had a higher level of awareness.

Conclusion

According to the findings, it can be concluded that it is necessary to use appropriate educational methods to improve the level of awareness and attitude of children's dentists.

Topical fluoride hesitancy among caregivers: Development of a content-valid topical fluoride hesitancy identification item pool

OBJECTIVES

To develop a content-valid set of items to characterize different types of topical fluoride hesitancy among caregivers. We will use this information to develop and test tailor-made interventions directed to caregivers with varied types and levels of topical fluoride hesitancy, to ultimately improve child oral health.

METHODS

Caregivers participated in three study activities, in the following order: (1) semi-structured concept elicitation interviews (n = 56), (2) cognitive interviews (n = 9), and (3) usability interviews (n = 3). Interviews were conducted via telephone and audio-recorded and transcribed for qualitative analysis. Twelve pediatric dental providers and researchers participated in item review. An assessment of reading level of items was made with goal of 6th grade reading level or less.

RESULTS

Based on elicitation interviews, we initially developed 271 items, which the investigative team evaluated for conceptual clarity, specificity to topical fluoride hesitancy, and sensitivity to potential interventions. After four rounds of review and cognitive interviews, we retained 33 items across five previously identified domains. Changes after cognitive interviews included item revision to improve comprehension and item re-ordering to avoid order effects. Changes after usability testing including clarification regarding referent child for families with multiple children. The reading level of the item pool is grade 3.2.

CONCLUSIONS

The resulting 33-item fluoride hesitancy item pool is content valid and will address an important need for identifying and addressing topical fluoride hesitancy in the context of dental research and clinical practice. Next steps include psychometric evaluation to assess scale and test-retest reliability and construct validity.

Oral health status and dental care for individuals with visual impairment. A narrative review

Visual impairment is a highly prevalent condition worldwide. Oral health care in this group of patients is not always adequate. This is due to the low awareness of the importance of oral health in this population group and the fact that these patients prioritize their general health over oral health. Therefore, caries and periodontal disease are frequent in this population group. Especially, periodontal status is worse in patients with acquired visual impairment compared to patients with congenital visual impairment. On the other hand, the proportion of treated caries in this group is very low. This may be due to the poorer access of this population to dental care, which is limited by physical, social, and information barriers. Dental phobia and the lack of dental professionals capable of treating this population group have been identified as one of the most important factors. Therefore, establishing oral hygiene routines that are adapted to individuals' skills and needs is essential to achieve good oral health and improve patient's quality of life. This narrative review also updates those dental treatment considerations, depending on each dental specialty, that can help improve patient satisfaction when they come to the dental office.

Comparing Direct Measurements and Three-Dimensional (3D) Scans for Evaluating Facial Soft Tissue

The inspection of patients' soft tissues and the effects of various dental procedures on their facial physiognomy are quite challenging. To minimise discomfort and simplify the process of manual measuring, we performed facial scanning and computer measurement of experimentally determined demarcation lines. Images were acquired using a low-cost 3D scanner. Two consecutive scans were obtained from 39 participants, to test the scanner repeatability. An additional ten persons were scanned before and after forward movement of the mandible (predicted treatment outcome). Sensor technology that combines red, green, and blue (RGB) data with depth information (RGBD) integration was used for merging frames into a 3D object. For proper comparison, the resulting images were registered together, which was performed with ICP (Iterative Closest Point)-based techniques. Measurements on 3D images were performed using the exact distance algorithm. One operator measured the same demarcation lines directly on participants; repeatability was tested (intra-class correlations). The results showed that the 3D face scans were reproducible with high accuracy (mean difference between repeated scans <1%); the actual measurements were repeatable to some extent (excellent only for the tragus-pogonion demarcation line); computational measurements were accurate, repeatable, and comparable to the actual measurements. Three dimensional (3D) facial scans can be used as a faster, more comfortable for patients, and more accurate technique to detect and quantify changes in facial soft tissue resulting from various dental procedures.

Deep Sedation for Dental Care Management in Healthy and Special Health Care Needs Children: A Retrospective Study

BACKGROUND

Very young children, and those with disabilities and extensive oral pathology, who cannot be treated in the dental chair, require deep sedation or general anesthesia for dental treatment.

OBJECTIVE

The aim of this study is to describe and compare the oral health status in healthy and SHCN children and the treatments performed under deep sedation on an outpatient basis with a minimal intervention approach, and their impact on quality of life.

METHODS

A retrospective study between 2006 and 2018 was made. A total of 230 medical records of healthy and SHCN children were included. The data extracted were age, sex, systemic health status, reason for sedation, oral health status before sedation, treatments administered during sedation, and follow-up. The quality of life after deep sedation of 85 children was studied through parental questionnaires. Descriptive and inferential analyses were made.

RESULTS

Of the 230 children, 47.4% were healthy and 52.6% were SHCN. The median age was 7.10 ± 3.40 years (5.04 ± 2.42 in healthy children and 8.95 ± 3.09 in SHCN children). The main reason for sedation was poor handling in the dental chair (99.5%). The most frequent pathologies were caries (90.9%) and pulp pathology (67.8%). Healthy children had more teeth affected by decay and with pulp involvement. Patients aged < 6 years received more pulpectomies and pulpotomies. After treatment, parents stated that children were more rested and less irascible, ate better, increased in weight, and had improved dental aesthetics.

CONCLUSIONS

Differences in treatments carried out did not depend on the general health status or the failure rate but on age, with more pulp treatments in healthy children who were younger, and more extractions near to the age of physiological turnover in children with SHCN who were older. Intervention under deep sedation with a minimally invasive treatments approach met the expectations of parents and guardians, as it improved the children's quality of life.

Conscious Sedation for Dental Treatments in Subjects with Intellectual Disability: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis was aimed to investigate the conscious sedation efficiency in patients with intellectual disability undergoing dental treatment (PROSPERO CRD42022344292). Four scientific databases were searched by ad-hoc prepared strings. The literature search yielded 731 papers: 426 were selected, 42 were obtained in full-text format, and 4 more were added after hand searching. Fourteen studies were finally included, 11 of which were included in the meta-analysis (random effect model). A high heterogeneity in the drugs used and route of administration was retrieved. Success rate, occurrence of side effects, and deep sedation occurrence were combined to give an overall efficiency of each drug. N₂O/O₂ reported the highest efficiency (effect size = 0.90; p < 0.01) and proved to be more efficient when used alone. Nine papers reported a success rate of sedation of 80% or more. The prevalence of side effects (6 studies) ranged from 3% to 40%. Enteral and parenteral benzodiazepines showed the same overall efficiency (effect size = 0.86). No meta-analysis has yet been conducted to define the most effective and safest way to achieve conscious sedation in patients with intellectual disability; nitrous oxide appears to be the best choice to perform conscious sedation in patients with intellectual disability undergoing dental treatment.

Dental treatment under general anesthesia in patients with severe intellectual disability at the Gregorio Marañón General University Hospital: a 10-year retrospective study

OBJECTIVES

There is a high demand for dental treatment in a hospital setting for patients with severe intellectual disability (ID), due to their inability to cooperate. The objective was to determine the types of dental treatment carried out on patients with severe ID, as well as the possibility of performing clinical and radiographic examinations prior to treatment and to identify their characteristics.

METHOD AND MATERIALS

A retrospective observational study was performed, based on the medical histories of patients with severe ID or a disability included in the portfolio of dental services of Community of Madrid, who underwent dental treatment at the Stomatology Service of the Gregorio Marañón General University Hospital from the year 2009 to 2019. Data on age, sex, etiology of disability, and dental treatment were obtained.

RESULTS

A total of 1,845 patients were included. The type of disability in the majority of cases was unknown, followed by encephalopathy, cerebral paralysis, and Down syndrome. In total, 8,439 dental extractions were performed on 1,548 patients (83.9%). Clinical and radiographic exploration were carried out on 874 patients (47.4%).

CONCLUSIONS

Ultrasonic scaling was the most frequently performed treatment in patients. Dental extractions were the next most common treatment. An increase in age showed a higher demand for surgical procedures and extractions. Over half of the patients (52.6%) did not tolerate clinical or radiographic examinations.

Dental care experiences and clinical phenotypes in children on the autism spectrum

AIMS

Children diagnosed with autism spectrum disorder may be at higher likelihood of experiencing poorer oral health and difficulties accessing dental health care. However, identifying which children on the autism spectrum may be more vulnerable to experiencing dental care difficulties is still unknown. This study investigated parental reports of oral health and dental service needs of children diagnosed with autism and explored relationships with clinical phenotypes.

METHODS AND RESULTS

Participants (n = 140) were parents of children on the autism spectrum who had participated in a large national biobank study, the Australian Autism Biobank, invited to complete additional surveys about oral health, service use, and barriers to care. One third of parents reported their child's oral health was worse than other children the same age, with 26% reporting untreated dental problems. A third of children were reported to have undergone general anaesthesia at least once for dental procedures. Children who had undergone general anaesthesia were more likely to have intellectual disability and greater functional difficulties. Parents of children with greater functional limitations and sensory challenges reported experiencing barriers to accessing dental care more frequently.

CONCLUSION

These results have important implications for paediatric dentists working with children diagnosed with autism with co-occurring intellectual, functional, and sensory challenges. Findings may inform the development of more personalised autism-specific supports.

Comprehensive Dental Treatment under General Anesthesia Improves Mastication Capability in Children with Early Childhood Caries-A One-Year Follow-Up Study

BACKGROUND

Using the granulometry of ready-to-swallow food boluses, this study investigated the evolution of masticatory capability of children with Early Childhood Caries (ECC) after comprehensive dental treatment under general anesthesia (GA).

METHODS

Sixteen children with ECC were assessed before and over one year after dental treatment under GA, in comparison with 12 children with a Healthy Oral State (HOS). Oral health criteria, quality of life, body mass index, and frequency of orofacial dysfunctions were recorded. Masticatory kinematic parameters and median food bolus particle size (D50) at swallowing were assessed while masticating raw carrot (CAR), cheese (CHS), and breakfast cereals (CER). The impact of posterior teeth extractions was analyzed.

RESULTS

Quality of life and orofacial functions improved after dental treatment. Chewing frequency for all three foods increased without reaching the values of children with HOS, while D50 values for CAR and CHS decreased. After one year, children with posterior teeth extractions exhibited higher D50 values for CAR and CHS than children with only conservative treatment. One third of children with ECC were overweight or obese.

CONCLUSIONS

Comprehensive dental treatment improved children's mastication, and their BMI subsequently increased. Links between mastication and nutrition should be investigated further in children.

Influence of Single-Nucleotide Polymorphisms on Vitamin D Receptor Expression in Periodontal Ligament Fibroblasts as a Response to Orthodontic Compression

This study aimed to evaluate if single-nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) gene are associated with gene expression in human periodontal ligament (hPDL) fibroblasts under simulated orthodontic compressive force. hPDL samples from 57 patients were used. A physiological compressive strain was performed to simulate orthodontic tooth movement in pressure areas under cell culture conditions. The RNA from hPDL fibroblasts was isolated to determine the relative gene expression (mRNA) of the VDR. The DNA was also isolated for the genotyping analysis of five SNPs in the VDR gene: BglI (rs739837, G/T), BsmI (rs1544410, T/C), ApaI (rs7975232, A/C), FokI (rs2228570, A/G), and TaqI (rs731236, A/G). Real-time polymerase chain reaction was used for both analyses. Kruskal−Wallis tests were used to compare VDR expression among genotypes of each SNP. A linear regression analysis was performed to evaluate SNP−SNP interaction. An established alpha of 5% was used. The relative mRNA VDR expression according to the genotypes in the SNPs BglI, BsmI, ApaI, FokI, and TaqI was not statistically significantly different (p > 0.05). The SNP−SNP interaction evaluated by regression analysis did not demonstrate any statistically significant association. No association was observed (p > 0.05). In conclusion, the SNPs BglI (rs739837), BsmI (rs1544410), ApaI (rs7975232), FokI (rs2228570), and TaqI (rs731236) did not show an impact on VDR gene expression in hPDL fibroblasts under simulated orthodontic compressive force.

Dental Anxiety and Influencing Factors in Adults

Dental anxiety is one of the most common conditions present amongst the masses globally. It is this fear that makes individuals avoid seeking dental treatment which results in a deteriorated oral health-related quality of life (OHRQoL). Discrepancies exist in the prevalence of dental anxiety based on gender, education levels, level of deprivation of a society and its socioeconomic status. In this study, a sample size of 522 respondents was collected. Kuppuswamy's socioeconomic status scale and modified dental anxiety scales were used to collect the necessary data. These data were analyzed by cross tabbing and chi-square test of significance was applied to assess the association between dental anxiety and other factors. Female gender was significantly associated with dental anxiety with p-value = 0.03. Higher education levels and dental anxiety also displayed significant associations with each other, with a p-value of 0.048. Seventy-six percent of the individuals of lower socioeconomic status were prone to be more dentally anxious. Dental anxiety was more significant in individuals with higher levels of education in our study. Respondents who were part of a lower socioeconomic class were also more prone to being anxious while receiving dental treatment. Knowing the factors that cause dental anxiety can help dentists effectively manage and treat their patients.

A cross-sectional hospital-based study on how patients perceive the dental care provided by male or female dentists

Awareness and knowledge of patient choice were important for developing the standard of dental health. It is important to maintain the patient-dentist relationship, which must be done with sincerity. For patients, the quality of social care is crucial. Therefore, the study's goal is to determine whether patients perceive dental treatment provided by male or female dentists differently. A descriptive cross-sectional hospital-based study (Saveetha University) was conducted using a structured questionnaire which consisted of questions which assessed the patient opinion about dental care provided by male or female dental practitioners. To evaluate statistical significance, we shall utilize (P = 0.05). The Chi-square test was performed to evaluate patient perception toward gender preference in providing dental care. Male and female participants appear to have the same degree of knowledge when compared, according to a statistically significant connection (P = 0.05) that was discovered. The study demonstrated that patients' perceptions of the expertise levels of male and female dentists were the same.

Odontogenic Sinusitis: From Diagnosis to Treatment Possibilities-A Narrative Review of Recent Data

The maxillary sinus is a structure at the border of specialties: otorhinolaryngology and maxillofacial surgery. Due to this fact, regarding etiology, it can be affected by both the rhinogenic and odontogenic path and can impose diagnostic difficulties. The etiopathogenic mechanisms that can affect the Schneiderian membrane are mainly inflammatory, iatrogenic, traumatic, and tumorous in nature. From a microbiological point of view, the bacteriology is polymorphic, including both aerobic and anaerobic species in acute OS, the predominating species in acute OS being aerobic, and in chronic anaerobic germs. The role of fungi in the determination of this pathology and in the production of the biofilm that leads to resistance to antibiotic treatment is also discussed. The present paper aims to present the etiopathogenesis, bacteriology, clinical manifestations, as well as treatment of odontogenic sinusitis (OS) from an updated perspective through reviewing the literature. If unilateral maxillary sinusitis is usually due to odontogenic causes, this does not clinically exclude the possibility of strictly rhinogenic causes in the occurrence of sinusitis. This underlines the important role of complex oral and rhinological clinical examination as well as the role of preclinical examinations in specifying the certainty diagnosis. Simple radiography, orthopantomography, CT, and CBCT are compared in terms of diagnostic accuracy. The treatment of OS is complex, involving medication, dental, and surgical measures. The value of endoscopic surgery is emphasized, comparing its advantages over the classic Caldwell-Luc technique.

Interventions to Improve the Oral Hygiene of Individuals with Alzheimer's Disease: A Systematic Review

This systematic review evaluates published evidence on oral hygiene interventions conducted in Alzheimer’s disease (AD) patients. PubMed, Embase, Cochrane Library, CINAHL, Dentistry & Oral Sciences Source, and Web of Science were searched for articles published up to 19 April 2021. The main outcomes of interest were the Plaque index score (PI), oral health knowledge of participants or their caregivers, and behaviors and attitudes towards oral hygiene. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Institutes of Health. The study was conducted under PROSPERO registration code CRD42021247733. Two studies met the inclusion criteria. One was a pre-post study conducted in Brazil, and the other was a prospective cohort study carried out in China. The sample sizes of these studies were 29 and 168, respectively. Both studies were carried out in institutionalized patients and presented a significant loss to follow-up. The PI and gingival index scores both improved after the application of the respective interventions, yet the differing methodologies used precluded further comparisons. The studies were deemed to be of good and regular quality, respectively. Despite the need for more comprehensive interventions to ensure a better oral health status and a higher quality of life for AD patients, an alarming lack of studies have been conducted in this population.

Mind the gap: an administrative data analysis of dental treatment outcomes and severe mental illness

BACKGROUND

Oral health of people with severe mental illness (SMI) remains an important public health issue, despite evidence pointing suboptimal dental health outcomes in this population.

AIMS

We test the hypotheses that individuals with SMI have lower contact with dental services and higher levels of fillings and extractions. We also examine effect modification by age-group.

METHODS

We used linked administrative data from general practitioner (GP), hospital and dental records to examine dental service use and treatments (extractions, fillings, crowns and x-rays) among the Northern Ireland hospital population between January 2015 and November 2019 (N = 798,564).

RESULTS

After adjusting for available socio-demographic characteristics, analysis indicated lower levels of dental service use (OR = 0.80, 95% CI = 0.77, 0.84), including lower likelihood of fillings (OR = 0.81, 0.77, 0.84) and x-rays (OR = 0.77, 0.74, 0.81), but higher levels of extractions (OR = 1.23, 1.18, 1.29) among patients with SMI. We also found effect modification by age-group, with older individuals with SMI less likely to have each of the four dental treatments.

CONCLUSIONS

We suggest that in the general area of physical healthcare for people with SMI, oral healthcare is neglected. There is a need for improved understanding of the barriers to routine care and treatment, and development of psychoeducational interventions.

Invasive dental treatment and acute vascular events: A systematic review and meta-analysis

BACKGROUND

Acute infection/inflammation increases the risk of acute vascular events (AVEs). Invasive dental treatments (IDTs) trigger short-term acute inflammation.

PURPOSE

The aim of this work is to critically appraise the evidence linking IDTs and AVEs.

DATA SOURCES

Six bibliographical databases were searched up to 31 August 2021. A systematic review following PRISMA guidelines was performed.

STUDY SELECTION

Intervention and observational studies reporting any AVEs following IDT were included.

DATA EXTRACTION

Two reviewers independently extracted data and rated the quality of studies. Data were pooled using fixed-effect, inverse variance weights analysis.

RISK OF BIAS

Risk of bias was assessed by the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Cochrane Handbook-Rob 2.0 for randomized controlled trials.

DATA SYNTHESIS

In 3 out of 16 clinical studies, a total of 533,175 participants, 124,344 myocardial infarctions, and 327,804 ischaemic strokes were reported. Meta-analysis confirmed that IDT did not increase incidence ratios (IR) for combined vascular events either at 1-4 weeks (IR of 1.02, 95% CIs: 0.92 to 1.13) and at 5-8 weeks (IR of 1.04, 95% CIs: 0.97 to1.10) after treatment.

LIMITATIONS

A high level of heterogeneity (study designs and time point assessments) was found.

CONCLUSION

Patients who received IDT exhibited no substantial increase in vascular risk over 8 weeks post treatment.

Dental procedures and operating time under day-care general anesthesia among medically compromised and uncooperative pediatric patients

OBJECTIVE

To analyze dental procedures and operating time provided to medically compromised and uncooperative pediatric patients under general anesthesia (GA).

METHOD AND MATERIALS

This cross-sectional retrospective study reviewed hospital records of pediatric patients treated under day-care GA at a Malaysian university hospital between January 2013 and December 2019. Dental procedures were categorized into preventive, restorative, pulp therapy, extraction, and surgical procedures. Age groups were categorized into < 6 years (primary), 6 to 12 years (mixed) and > 12 years old (permanent), to represent different dentitions. The treatment and operating times under GA were compared between age groups, sex, and medical conditions.

RESULTS

A total of 595 patients (455 uncooperative healthy and 140 medically compromised) were included in the study. The mean age of the patients was 5.7 years. Male patients (58.3%) outnumbered female patients (41.7%). The most frequently performed procedure was primary tooth extraction. A higher number of surgical procedures were performed on children aged > 12 years compared to younger age groups (P = .001). Children with medical problems had more preventive (mean 3.85 ± 3.65) than restorative treatments (mean 2.66 ± 2.80) and the results were reversed for healthy children. The mean operating time was 64.71 ± 27.89 minutes. Regardless of health status, children > 12 years old had longer operating times, and the mixed dentition group had the shortest treatment durations.

CONCLUSIONS

Different types of dental treatment modalities are provided under GA for pediatric patients and operating time was associated with age group. Findings will be useful to improve efficiency of management of pediatric dental cases under day-care GA.

Association of Age and Temperamental Traits with Children's Behaviour during Dental Treatment

During paediatric dental treatment, cooperation by children is essential, and temperament can determine their behaviour style. This study aimed to associate temperamental traits and age with behaviour during paediatric dental treatment. This was an observational and cross-sectional study of patients aged 3-10 years. To determine the temperamental traits, an Emotionality Activity and Sociability Temperament Survey (EAS) was performed with the children's parents. The type of behaviour was determined with Frankl's criteria. The total scores for temperamental traits, means, and standard deviations were obtained. The chi-squared test, one-way ANOVA and Student's t-test were applied. A total of 140 patients, who were 5 ± 2.1 years old, participated in the study. Age was determinant for negative behaviour, with a greater frequency in children ≤5 years old (p < 0.05), and a significant negative correlation between age and behaviour (rho = -0.245, p = 0.001). Patients with higher emotionality and activity presented negative and definitely negative behaviours more frequently (p < 0.01). The values for sociability and shyness were similar for positive or negative behaviours. In conclusion, the temperamental traits of emotionality and activity were more frequent in children with disruptive behaviours; therefore, conducting a survey on temperamental traits can be useful for planning behavioural approaches in paediatric dentistry.

[Anesthesia for dental care management in children with dystrophic epidermolysis bullosa]

THE AIM OF THE STUDY

Was to summarize our experience in dental treatment of children with dystrophic epidermolysis bullosa (DEB) under deep intravenous sedation.

MATERIAL AND METHODS

The study comprised 11 DEB patients aged 2-17 years who received full oral rehabilitation under deep sedation in Hospital Pediatric Dentistry department of the Central Research Institute of Dentistry and Maxillofacial Surgery in 2021-2022. Intravenous induction was used if a child already had venous access installed or it was feasible before sedation. If not the case inhalation induction with sevoflurane was performed for vein catheterization. Sedation was sustained by propofol infusion up to aimed concentration. Both dental treatment and extractions were carried out.

RESULTS

In 11 children 37 teeth were treated and 14 extracted. Mean duration of the procedure under deep sedation was 53 min (30-190 min). In two children multiple dental extractions resulted in extensive oral mucosa injury with bullae and erosions formation in vermillion, cheeks, and hard palate areas. No skin injuries, airway obstruction or long-term complications of both anesthesiologic an dental procedure were observed. The paper describes main preventive measures minimizing risks of skin and mucosa adverse events.

CONCLUSION

Intravenous sedation with spontaneous respiration allows full oral rehabilitation in DEB children with minimal risks of skin and mucosal injury associated with intubation techniques when performing described preventive measures. Use of cofferdam is crucial for success and safety of the procedure as it prevents water, dust and dental fragments contamination of oropharynx which is especially important in case of sedation with spontaneous respiration.