Prevalence of SARS-CoV-2 infection among oral health care workers worldwide: A meta-analysis

OBJECTIVES

This systematic review aimed to answer the following question 'What are the worldwide prevalence of SARS-CoV-2 infection and associated factors among oral health-care workers (OHCWs) before vaccination?'

METHODS

Seven databases and registers as well as three grey databases were searched for observational studies in the field. Paired reviewers independently screened studies, extracted data and assessed the methodological quality. Overall seroprevalence for SARS-CoV-2 infection was analysed using a random-effect model subgrouped by professional category. Meta-regression was used to explore whether the Human Development Index (HDI) influenced the heterogeneity of results. The associated factors were narratively evaluated, and the certainty of the evidence was assessed using the GRADE approach.

RESULTS

Seventeen studies were included (five cohorts and twelve cross-sectional studies), summing 73 935 participants (54 585 dentists and 19 350 dental assistants/technicians) from 14 countries. The overall estimated pooled prevalence of SARS-CoV-2 infection among OHCWs was 9.3% (95% CI, 5.0%-14.7%; I2  = 100%, p < .01), being 9.5% for dentists (95% CI, 5.1%-15.0%; I2  = 100%, p < .01) and 11.6% for dental assistants/technicians (95% CI, 1.6%-27.4%; I2  = 99.0%, p < .01). In the meta-regression, countries with lower HDI showed higher prevalence of SARS-CoV-2 infection (p = .002). Age, comorbidities, gender, ethnicity, occupation, smoking, living in areas of greater deprivation, job role and location/municipalities, income and protective measures in dental settings were associated with positive serological SARS-CoV-2 test, with very low certainty of evidence.

CONCLUSIONS

The SARS-CoV-2 virus infected 9.3% of the OHCWs evaluated worldwide before vaccination. OHCWs should be included in policy considerations, continued research, monitoring and surveillance (PROSPERO CRD42021246520).

Use of Photobiomodulation to Reduce Postoperative Pain, Edema, and Trismus After Third Molar Surgery: A Systematic Review and Meta-Analysis

PURPOSE

Third molar extraction can cause surgical trauma, which is associated with pain, edema, trismus, and functional limitations. The aim of the present systematic review was to investigate the effects of photobiomodulation (PBM) following the extraction of impacted mandibular third molars.

METHODS

An electronic search was conducted in 10 databases from inception up to October 2021 and the grey literature, with no restrictions regarding language or year of publication. Randomized controlled clinical trials (RCT) were included. Studies that were not RCTs were excluded. Reviewers independently analyzed titles and abstracts, followed by full-text analysis. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The exposure variable was the use of PBM and the outcomes were pain, edema, and trismus. Meta-analysis was performed using a random-effects model. The estimate was calculated considering standardized mean differences (SMD) and respective 95% confidence intervals (CI) obtained for each outcome on the first, second, third and seventh postoperative days. The level of evidence was assessed using the GRADE approach.

RESULTS

The search resulted in the 3,324 records. Thirty-three RCTs were included in the systematic review and 23 of these were included in the meta-analyses. The studies involved a total of 1,347 participants (56.6% female and 43.4% male) between 16 and 44 years of age. A greater reduction in pain was found in the PBM group compared to the control group on the third postoperative day (SMD: -1.09; 95% CI: -1.63; -0.55; P < .001; low certainty). Edema was discretely lower in the PBM group on the second postoperative day (SMD: -0.61; 95% CI: -1.09; -0.13; P < .001; low certainty) and trismus was discretely lower in the PBM group on the seventh postoperative day (SMD: 0.48; 95% CI: 0.00; 0.96; P < .001; very low certainty).

CONCLUSION

The evidence of the effect of PBM regarding the control of pain, edema, and trismus following third molar extractions is low or very low.

Oral alterations in children with microcephaly associated to congenital Zika syndrome: A systematic review and meta-analyses

AIMS

To synthesize the oral alterations observed in children with microcephaly associated with congenital Zika virus syndrome (CZS), and to compare the oral alterations of these children to a normotypic healthy controls.

METHODS AND RESULTS

A search was performed in six electronic databases. Observational studies published that reported oral alterations in children with CZS were selected. Two authors independently extracted data, assessed study quality, using the Joanna Briggs Institute Critical Appraisal Checklist tools, and the certainty of evidence, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-one studies were included in this systematic review and meta-analysis. The pooled crude occurrence showed 88% of increased salivation (95%CI: 82%-94%), 83% of biofilm (95%CI: 75%-91%), and 73% of bruxism (95%CI: 52%-95%). Compared to normotypic controls, children with CZS-associated microcephaly had a higher chance to have difficulty in lip sealing (OR: 18.28; 95%CI: 1.42-235.91), inadequate lingual posture at rest (OR: 13.57; 95%CI: 4.24-43.44), and delayed eruption (OR: 12.92; 95%CI: 3.42-48.78), with very low certainty.

CONCLUSION

There are several oral alterations found among children with CZS-associated microcephaly. They are more prone to present some of these alterations, such as difficulty in lip sealing, although with very low certainty of evidence.

Treatments for Burning Mouth Syndrome: A Network Meta-analysis

The aim of this systematic review and network meta-analysis (NMA) of randomized controlled trials was to evaluate the effectiveness of treatments for pain relief of burning mouth syndrome (BMS). Five databases and gray literature were searched. Independent reviewers selected studies, extracted data, and assessed the risk of bias. The primary outcome was pain relief or burning sensation, and the secondary outcomes were side effects, quality of life, salivary flow, and TNF-α and interleukin 6 levels. Four comparable interventions were grouped into different network geometries to ensure the transitivity assumption for pain: photobiomodulation therapy, alpha-lipoic acid, phytotherapics, and anxiolytics/antidepressants. Mean difference (MD) and 95% CI were calculated for continuous outcomes. The minimal important difference to consider a therapy beneficial against placebo was an MD of at least -1 for relief of pain. To interpret the results, the GRADE approach for NMA was used with a minimally contextualized framework and the magnitude of the effect. Forty-four trials were included (24 in the NMA). The anxiolytic (clonazepam) probably reduces the pain of BMS when compared with placebo (MD, -1.88; 95% CI, -2.61 to -1.16; moderate certainty). Photobiomodulation therapy (MD, -1.90; 95% CI, -3.58 to -0.21) and pregabalin (MD, -2.40; 95% CI, -3.49 to -1.32) achieved the minimal important difference of a beneficial effect with low or very low certainty. Among all tested treatments, only clonazepam is likely to reduce the pain of BMS when compared with placebo. The majority of the other treatments had low and very low certainty, mainly due to imprecision, indirectness, and intransitivity. More randomized controlled trials comparing treatments against placebo are encouraged to confirm the evidence and test possible alternative treatments (PROSPERO CRD42021255039).

Rhabdomyosarcoma of the oral cavity in children aged 0-2 years: A scoping review

BACKGROUND

The aim of this study was to collect, synthesize, and analyze the clinic-demographic data of rhabdomyosarcoma affecting the oral cavity of young children.

METHODS

The clinical question was "What are the clinical characteristics of oral rhabdomyosarcoma in children aged zero to two years?" Two independent reviewers selected the studies, extracted data, and assessed the methodological quality through the Joanna Briggs Institute Checklist. Descriptive statistics were performed in SPSS. (protocol: osf.io/b9hvy).

RESULTS

Thirty case reports with 41 patients were included (22 males; mean age at diagnosis: 15 months). All studies had some methodological limitations, mainly due to the lack of clarity for a final judgment. More than 70% of the cases affected the tongue or lips. Tumors had a fast growth (mean 2.5 months), usually with red coloration, and variable shape and consistency. Embryonal (63.41%) and alveolar (29.27%) were the most common histological subtypes. Treatment was quite variable but usually included surgery. Most patients (53.66%) were alive without disease at follow-up.

CONCLUSION

Oral rhabdomyosarcoma is rare in children aged 0-2 years without a marked gender predilection. The tumor presents as a fast and infiltrative growth leading to local and/or systemic symptoms, and a favorable prognosis for most patients.

Frequency of missing data in clinical records in pediatric dentistry: a descriptive study

The aim of the present study was to investigate the frequency of missing data on routine dental care appointments and restorative procedures from the clinical records of children treated at a pediatric dental clinic. A descriptive retrospective study was conducted involving the clinical records of children three to 12 years of age treated only with restorations. The inclusion criteria were clinical records from the past 10 years of children with at least one restored tooth. Data collection was performed by a trained examiner who extracted information from the clinical records on appointments for routine dental care and restorative procedures. The frequency of missing data on clinical records was submitted to descriptive analysis. Among the 249 clinical records analyzed, boys accounted for little more than half (54.2%) and mean patient age was 6.9 ± 1.8 years. Ninety-four of the 249 clinical records were of appointments for routine dental care. Missing data were found for the gingival bleeding index (18.1%), visible plaque index (22.3%) and dietary logs (74.5%). Forty-seven children were submitted to a total of 618 restorative procedures. Information was missing on the type of restorative material (5%), brand of the material used (65.2%), the type of isolation (50.8%) and whether pulp capping was performed (75.9%). The percentage of missing data from clinical records was substantial, demonstrating that important information is not recorded during routine dental care or restorative procedures.

Efficacy of antiseptics and chemomechanical methods for dentin caries lesions: A systematic review with GRADE approach

Objectives

Selective caries removal aims to remove carious tissue in deep dentin lesions. However, a discussion stands on the value of antiseptics and chemomechanical adjuvant methods to reduce the bacterial load on residual caries lesions. This systematic review has addressed two main clinical questions to compare the antimicrobial efficacy of available methods using (1) antiseptic or (2) chemomechanical agents before restoring dentin carious lesions.

Methods

We included randomized and non-randomized controlled trials (RCTs/ NRCTs). We searched eight databases from inception to October 2021. Paired reviewers independently screened studies, extracted data, and assessed the risk of bias. The primary outcome was the reduction in the number of total bacterial in dentin, whereas secondary outcomes were reduction in the number of Lactobacillus and Streptococcus. We used the ratio of ratio of post-treatment to baseline means between two interventions in the logarithmic scale as a proper effect measure. Certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation approach.

Results

We included 14 RCTs and 9 NRCTs, with nine interventions. Regardless the method, the number of bacteria at baseline was similar or exceeded that after the intervention, particularly in NRCTs. The evidence was inconclusive for most comparisons. Among antiseptic agents, chlorhexidine (CHX) resulted in an average of 1.14 times [95% confidence interval (CI): 1.08-1.21] more total bacterial than photodynamic therapy in RCTs. Among NRCTS, the natural agents resulted in five times more total bacterial than CHX (95% CI: 2-11). For chemomechanical methods, the control resulted in eight times (95% CI: 4-17) more total bacterial than Carisolv (SHAA).

Conclusions

The certainty of the evidence was very low for all comparisons showing uncertainty whether one treatment could be more effective than another for dentin disinfection. So far, exclusively removing soft carious dentin would be enough to reduce the bacterial count.

Antimicrobial resistance of microorganisms present in periodontal diseases: A systematic review and meta-analysis

Objective

The aim of this study was to estimate the antimicrobial resistance in microorganisms present in periodontal diseases.

Methods

A systematic review was conducted according to the PRISMA statement. The MEDLINE (PubMed/Ovid), EMBASE, BVS, CINAHL, and Web of Science databases were searched from January 2011 to December 2021 for observational studies which evaluated the antimicrobial resistance in periodontal diseases in permanent dentition. Studies that allowed the antimicrobial consumption until the time of sample collection, studies that used laboratory acquired strains, studies that only characterized the microbial strain present, assessment of cellular morphological changes, sequencing system validation, and time series were excluded. Six reviewers, working in pairs and independently, selected titles, abstracts, and full texts extracting data from all studies that met the eligibility criteria: characteristics of patients, diagnosis of infection, microbial species assessed, antimicrobial assessed, identification of resistance genes, and virulence factors. “The Joanna Briggs Institute” critical appraisal for case series was adapted to assess the risk of bias in the included studies.

Results

Twenty-four studies (N = 2.039 patients) were included. Prevotella and Porphyromonas species were the most cited microorganisms in the included studies, and the virulence factors were related to Staphylococcus aureus. The antimicrobial reported with the highest frequency of resistance in the included studies was ampicillin (39.5%) and ciprofloxacin showed the lowest frequency of resistance (3.4%). The most cited genes were related to macrolides. The quality of the included studies was considered critically low.

Conclusion

No evidence was found regarding the profile of antimicrobial resistance in periodontal diseases, requiring further research that should focus on regional population studies to address this issue in the era of increasing antimicrobial resistance.

Clinical relevance

The knowledge about the present microorganism in periodontal diseases and their respective antimicrobial resistance profiles should guide dentists in prescribing complementary therapy for these infections.

Systematic review registration

[http://dx.doi.org/10.1097/MD.0000000000013158], identifier [CRD42018077810].

Critical appraisal of systematic reviews of intervention in dentistry published between 2019-2020 using the AMSTAR 2 tool

Introduction The number of systematic reviews (SRs) in dentistry published each year has grown considerably, and they have been essential in clinical decision-making and health policy.Objective The objective is to critically appraise SRs of intervention in dentistry using the 'A Measurement Tool to Assess Systematic Reviews 2' (AMSTAR 2) tool published within one year.Methods A search in the Medline/PubMed database was performed. The SRs were identified in two phases. The first phase identified SRs of interventions in dentistry by title and abstract. In the second phase, the full text was read, applying the eligibility criteria. Three calibrated reviewers methodologically assessed all SRs identified using the AMSTAR 2 tool. Data were analysed descriptively, and SRs were grouped according to methodological quality as moderate/high and low/critically low. A logistic regression model was applied to explore the associations between methodological quality and the study's characteristics.Results Two hundred and twenty-two SRs were included. The methodological quality of the SRs included in this study were: critically low (56.8%), low (27.9%), moderate (14.4%) and high (0.9%), according to AMSTAR 2. There were no statistical differences between moderate/high and low/critically low methodological quality and publication year, continent, journal Impact Factor and dental speciality.Conclusion Less than 1% of recently published SRs in dentistry were classified with high methodological quality. We hope that this study will alert researchers about the need to improve the methodological quality of SRs.

Efficacy, acceptability, and tolerability of antidepressants for sleep quality disturbances in post-traumatic stress disorder: A systematic review and network meta-analysis

Sleep quality disturbances are a common occurrence in post-traumatic stress disorder (PTSD) and may remain after evidence-based treatment for PTSD has been implemented. If left untreated, sleep disturbance can perpetuate or aggravate the disorder. A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) was conducted comparing efficacy, acceptability, and tolerability among antidepressants for sleep quality improvement in PTSD, using Cochane's RoB2.0 and GRADE approach for NMA. The Cochrane Library, LILACS, PsycINFO, PTSDpubs, and PubMed Central databases were searched from inception to November 29, 2020, leading to the retrieval of 3733 reports. After the selection process, seven RCTs were included in the review (N = 600). We found low certainty of evidence (LCE) that sertraline may improve sleep quality (measured by PSQI) in adult patients with PTSD (MD -0.48, 95% CrI -0.63 to -0.32). Sertraline was as well accepted (RR 1.12, 95% CrI -0.83 to 1.52, very low certainty [VLCE]) and as well tolerated as placebo (RR 0.58, 95% CrI 0.28 to 1.14, LCE). Mirtazapine (MD -3.35, 95% CrI -9.06 to 2.39, LCE), paroxetine (MD -3.13, 95% CrI -7.47 to 1.26, VLCE), nefazodone (MD -0.25, 95% CrI -5.95 to 5.38, VLCE), and bupropion (MD -2.28, 95% CrI -4.75 to 0.21, VLCE) were similar to placebo for improving sleep quality. These antidepressants resulted in little or no benefit for sleep in PTSD. Although the NMA suggested that sertraline may improve sleep in PTSD compared to placebo, due to the low certainty, these estimates are not robust enough to guide clinical decisions.

Association between components of metabolic syndrome and periodontitis: a systematic review and meta-analysis

OBJECTIVES

To evaluate the role of metabolic syndrome (MetS) components in the association with periodontitis (PE) (#CRD42020218310).

MATERIALS AND METHODS

A systematic electronic search was performed in PUBMED, Scielo and Lilacs databases up to April 2022. Cross-sectional, case-control, and cohort studies presenting data on the association between MetS and PE in the adult and elderly populations were included. A random effect meta-analysis was performed to determine association effect estimates. Results interpretation followed the assessment of methodological quality (Joana Briggs Institute tool) together with the certainty of evidence (GRADE approach).

RESULTS

This review included 52 studies, totalling 140,434 participants, and 38 studies were meta-analyzed. Association between PE and MetS was observed (OR_adj from 1.27 to 1.90; PR_ajd = 1.19; RR_adj from 1.10 to 1.37) (low and very low certainty of evidence). Hyperglycaemia (OR = 1.18), HDL (OR = 1.16), obesity (OR = 1.08), and hypertension (OR = 1.11) were associated with PE, except triglycerides (low and very low certainty of evidence). There was a dose-response gradient between the number of MetS components and PE, with a gradual increase in the effect magnitude for 1 (OR = 1.14), 2 (OR = 1.52), 3 or more (OR = 1.79), and 4 or 5 components (OR = 2.02) (low to high certainty of evidence).

CONCLUSIONS

MetS was associated with PE, with a dose-response gradient between the number of MetS components and the occurrence of PE, with an increasing effect magnitude according to an increasing number of components.

CLINICAL RELEVANCE

Periodontal examination should be part of a comprehensive propaedeutic approach of MetS patients, particularly those presenting a great number of components.

Formulations of desensitizing toothpastes for dentin hypersensitivity: a scoping review

Objective:

This study aimed to review evidence from randomized controlled trials (RCTs) to describe: 1) the active ingredients and desensitizing toothpaste brands; 2) the evaluation of these active ingredients over time, and 3) the fluoride and abrasive content in the formulations designed to treat dentin hypersensitivity (DH).

Methodology:

In total, 138 RCTs and their tested toothpastes were included. Searches were updated up to August 19, 2021. Formulations, reported brands, active ingredients over time, and type of fluoride (ionizable or ionic fluoride) and abrasive (calcium or silica-based) were analyzed (PROSPERO #CRD42018086815).

Results:

Our trials assessed 368 toothpaste formulations, including 34 placebo (9%), 98 control toothpastes with fluoride (27%), and 236 (64%) with active ingredients to treat DH. We tested the following active ingredients: potassium compounds (n=68, 19%), calcium sodium phosphosilicate (CSP) (n=37, 10%), strontium compounds (n=28, 8%), arginine (n=29, 8%), stannous fluoride (SnF2) (n=21, 6%), hydroxyapatite (n=9, 2%), potassium combined with another active ingredient (n=19, 5%), inorganic salt compounds (n=11, 3%), citrate (n=5, 1%), formaldehyde (n=3, 1%), herbal (n=4, 1%), copolymer (n=1, 0.5%), and trichlorophosphate (TCP) (n=1, 0.5%). The number of toothpaste formulations increased since 1968, with the greatest increment after 2010. Most toothpastes described their type of fluoride as sodium monofluorphosphate (MFP) (n=105, 29%) and NaF (n=82, 22%), with silica-based (n=84, 23%) and calcium-based (n=64, 17%) abrasives.

Conclusion:

Patients and dentists enjoy an increasing number of brands and active ingredients to decide what desensitizing toothpaste to use. The most common types of fluoride are MFP and NaF.

Do Children and Adolescents Prefer Pediatric Attire over White Attire during Dental Appointments? A Meta-analysis of Prevalence Data

Purpose

To evaluate the preferences of children and adolescents regarding the professional attire used by dentists (pediatric or white attire).

Materials and methods

Seven electronic databases were searched without restriction regarding language and publication date. The primary outcome was the preference of patients regarding pediatric or white attire; secondary outcomes were preference for a female or male dentist and the use of personal protective equipment or not. We ran a meta-analysis of prevalence data of preferences, calculating effect estimate (ES), 95% CI, subgrouped by anxiety status and sex of the patient. Z-test of interactions was used to compare prevalence between groups (p < 0.05).

Results

Fourteen cross-sectional studies were included, consisting of 5,756 patients with ages ranging from 2 to 15 years. Anxious children preferred more pediatric attire (ES: 0.03; 95% CI: 0.02, 0.03) than non-anxious children (ES: 0.02; 95% CI: 0.01, 0.02) (p = 0.0085). Female dentists were preferred (ES: 0.62; 95% CI: 0.52, 0.72) over male dentists (ES: 0.40; 95% CI: 0.30, 0.49) (p = 0.003) in general and by the girls (ES: 0.41; 95% CI: 0.25, 0.56) but not by boys (ES: 0.20; 95% CI: 0.09, 0.30) (p = 0.036).

Conclusion

There is no difference in the preferences of children and adolescents regarding a specific attire. Anxious children and adolescents preferred dentists using pediatric attire. In general, female dentists were preferred over male dentists and also were preference among girls.

How to cite this article

Kastelic DRA, Volpato LER, de Campos Neves ATS, et al. Do Children and Adolescents Prefer Pediatric Attire over White Attire during Dental Appointments? A Meta-analysis of Prevalence Data. Int J Clin Pediatr Dent 2021;14(1):14-29.

Signs and Symptoms of Primary Tooth Eruption in Preterm and Low Birth Weight Children

Purpose: To evaluate signs and symptoms associated with the eruption of the primary mandibular central incisors in preterm and low birth weight (PLBW) children.<br/>Methods: A prospective longitudinal study was performed with 46 PLBW Brazilian children in a university hospital with a 10-month follow-up. Signs and symptoms of tooth eruption were recorded monthly by clinical examination and caregivers' report. Tooth eruption was categorized into "preeruption" (T0-no erupted crown/month before the eruption), "eruption" (T1-eruption of the tooth up to one-third of the crown/month of eruption), and "posteruption" (T2-from one-third of the erupted crown to completely erupted crown/month after the eruption). Bivariate statistics were performed (P <0.05).<br/>Results: The mean age in T1 was 11 months (±2.50 standard deviation). The symptoms most frequently reported in T1 were increased salivation and finger suction (44.2 percent). The mean number of symptoms in T1 was higher than in T2 (P <0.001). There was a higher frequency of irritability (P =0.022) and itching of the gingiva (P =0.004) in T1 than in T2.<br/> Conclusion: PLBW children presented signs and symptoms mainly in the initial phase of tooth eruption. Increased salivation and digital suction were the most common symptoms.

Effectiveness of photobiomodulation therapy in radiation dermatitis: A systematic review and meta-analysis

PURPOSE

To evaluate the effectiveness of photobiomodulation therapy (PBMT) in the prevention and treatment of radiation dermatitis (RD).

METHODS

A systematic review was conducted using seven databases and the gray literature. We performed a meta-analysis to summarize the effect sizes of response rates (RRs).

RESULTS

We included seven clinical trials. Breast cancer patients receiving PBMT developed more grade 1 RD than the control group (RR 1.55, 95 % CI 1.14-2.10, I² = 51 %). PBMT appears to prevent RD grade 2 (RR 0.33, 95 % CI 0.09-1.23, I² = 85 %) and RD grade 3 (RR 0.21, 95 % CI 0.05-0.94, I² = 0%) with very low certainty of evidence.

CONCLUSIONS

There is very low certainty of evidence that PBMT was effective in the prevention of RD. However, PBMT showed a significant effect to prevent grade 3 RD in breast cancer patients. Thus, further randomized clinical trials are required to confirm the promising effect of PBMT in RD.

Does ankyloglossia interfere with breastfeeding in newborns? A cross-sectional study

BACKGROUND AND AIM

Ankyloglossia is a congenital anomaly that can affect breastfeeding. The aim was to evaluate the prevalence of ankyloglossia in newborns and breastfeeding difficulties reported by mothers; assess possible factors that may interfere with breastfeeding.

METHODS

A cross-sectional study was conducted with 391 pairs of mothers/newborns at a university hospital. A pediatric dentist examined the oral cavity of the newborns for the occurrence of ankyloglossia. We analyzed medical records and the mothers answered a self-administered questionnaire to assess birth variables, breastfeeding difficulties, and sociodemographic factors. We calculated prevalence ratios (PRs) of breastfeeding difficulties according to the independent variables.

RESULTS

The mean age of the newborns was 2.5±2.9 days and 52% were male. The prevalence of ankyloglossia was 15% and 91.4% of mothers reported not having breastfeeding difficulties. Ankyloglossia was not associated with breastfeeding difficulties (PR: 0.5; 95% CI: 0.2-1.4). Mothers with a low income (PR: 0.5; 95% CI: 0.3-0.8), those who received instructions on breastfeeding (PR: 0.4; 95% CI: 0.2-0.9), and those who breastfed exclusively (PR: 0.3; 95% CI: 0.1-0.8) had fewer breastfeeding difficulties.

CONCLUSION

Successful breastfeeding was more dependent on being born at full term, the family income, receiving guidance with regard to breastfeeding, and exclusive breastfeeding. Although ankyloglossia was not associated with breastfeeding, future prospective studies should evaluate the long-term factors that may interfere with breastfeeding.

RELEVANCE FOR PATIENTS

This study brings a new perspective on the importance of assessing ankyloglossia and breastfeeding difficulties, reinforces the benefits of exclusive breastfeeding and the need for breastfeeding instructions, as well as the need to evaluate breastfeeding before making a decision regarding frenectomy.

Developmental Enamel Defects and Dental Caries in the Primary Dentition of Preterm Children

Purpose: To assess developmental enamel defects (DED) and dental caries of preterm (PT) and/or low birth weight (LBW) children compared to full term (FT) and/or normal birth weight (NBW) infants, and to evaluate the association of DED with socioeconomic factors, gestational health, and postnatal factors.<br/>Methods: This study included 84 two- to five-year-old children. The PT/LBW group included 42 children who received medical care at a university hospital, while FT/ NBW group included 42 subjects. Children were matched by sex and age (1:1 ratio). Descriptive statistics, bivariate analysis, and Poisson regression were used to analyse the data.<br/>Results: Children in the PT/LBW group had a significantly higher number of teeth with DED than subjects in the FT/NBW group. No difference was observed between the groups regarding dental caries (P >0.05). Admission to the neonatal intensive care was significantly associated with DED unit (prevalence ratio = 0.21 [95 percent confidence interval = 0.1 to 0.5]).<br/> Conclusion: PT/LBW children presented more DED than FT/NBW children. No differences were observed between the groups for dental caries. Admission to the neonatal intensive care unit was associated with DED.

Prevalência de tabagismo ativo e passivo durante a gravidez: estudo transversal

The aim of the present study was to evaluate the prevalence of active and passive smoking during pregnancy and its association with sociodemographic indicators, as well as perinatal and postnatal outcomes in newborns. Methods: This cross-sectional study was comprised of 431 pairs of mothers/ newborns. The study variables were: preterm birth, birth weight, oral mucosal lesions, sociodemographic indicators and smoking data. We collected data from medical records and through a self-administered questionnaire answered by mothers. A pediatric dentist examined the newborns for oral mucosal lesions. Bivariate and multivariate logistic regression models were used to evaluate the association between active and passive smoking and the other variables (α=5%). Results: The prevalence of active (9.5%) and passive smoking (4.2%) during pregnancy was low. Active smoking was statistically associated with low birth weight (OR: 2.4; 95%CI:1.1-5.3), lower schooling level (OR: 0.2; 95%CI:0.1-0.5) and mothers aged ≥36 years old (OR: 4.9; 95%CI:1.2-20.0). Passive smoking was not statistically associated with the other variables. There was no association between active or passive smoking during pregnancy and premature birth and oral lesions of the newborn. Conclusions: The prevalence of active and passive smoking were low. Active smoking was associated with low birth weight, maternal age and mother's schooling, suggesting a social influence of smoking behavior among a population with a lower educational level. There was no association between active and passive smoking and prematurity and oral lesions of the newborn

Approaches of integrating the development of guidelines and quality indicators: a systematic review

Background

Guidelines and quality indicators (for example as part of a quality assurance scheme) aim to improve health care delivery and health outcomes. Ideally, the development of quality indicators should be grounded in evidence-based, trustworthy guideline recommendations. However, anecdotally, guidelines and quality assurance schemes are developed independently, by different groups of experts who employ different methodologies. We conducted an extension and update of a previous systematic review to identify, describe and evaluate approaches to the integrated development of guidelines and related quality indicators.

Methods

On May 24th, 2019 we searched in Medline, Embase and CINAHL and included studies if they reported a methodological approach to guideline-based quality indicator development and were published in English, French, or German.

Results: Out of 16,034 identified records, we included 17 articles that described a method to integrate guideline recommendations development and quality indicator development. Added to the 13 method articles from original systematic review we included a total 30 method articles. We did not find any evaluation studies. In most approaches, guidelines were a source of evidence to inform the quality indicator development. The criteria to select recommendations (e.g. level of evidence or strength of the recommendation) and to generate, select and assess quality indicators varied widely. We found methodological approaches that linked guidelines and quality indicator development explicitly, however none of the articles reported a conceptual framework that fully integrated quality indicator development into the guideline process or where quality indicator development was part of the question formulation for developing the guideline recommendations.

Conclusions

In our systematic review we found approaches which explicitly linked guidelines with quality indicator development, nevertheless none of the articles reported a comprehensive and well-defined conceptual framework which integrated quality indicator development fully into the guideline development process.

Prevalence of Oral Inclusion Cysts in a Brazilian Neonatal Population

Purpose: To evaluate oral inclusion cysts in newborns and their association with birth weight, preterm birth, newborn health, maternal health, prenatal factors, and socio-economic factors.<br/> Methods: The sample consisted of 411 pairs of mothers and their newborns born at a university hospital in Brazil. The oral inclusion cysts, diagnosed by clinical examination, were Epstein pearls, Bohn's nodules, and dental lamina cysts. Medical records and a questionnaire were used to collect data related to newborns and mothers. Data were analyzed using the chi-square, linear by linear, and Fisher's exact tests for bivariate analysis, while Poisson regression with robust variance was used for multivariate analysis (α =five percent).<br/> Results: The prevalence of inclusion cysts was 56.7 percent. A total of 42 (62.7 percent) low birth weight (LBW) newborns, 192 (56.0 percent) normal weight newborns, 38 (63.3 percent) preterm newborns, and 187 (56.7 percent) full-term newborn had inclusion cysts. Epstein pearls (n=164, 39.9 percent) were more prevalent and associated with prematurity (P =0.025), LBW newborns (P =0.033), and mothers who worked during pregnancy (P =0.019). Bohn's nodules (n=80, 19.9 percent) were more prevalent in newborns of mothers who did not receive welfare support (P =0.004). Dental lamina cysts occurred in 5.6 percent (N=23) of the sample and were not associated with independent variables.<br/> Conclusion: Epstein pearls were more common in LBW and preterm infants.

Prevalence of dental caries in preschool children born preterm and/or with low birth weight: A systematic review with meta-analysis of prevalence data

The aim of the present systematic review and meta-analysis was to evaluate the prevalence of dental caries among preschool children who had been born preterm and/or with low birth weight (LBW) compared with those who had been born full term and/or with normal birth weight (NBW). Eight electronic databases were searched from interception up to November 2018 with no restrictions imposed regarding the date of publication or language. Two independent reviewers screened studies, extracted data, and assessed the risk of bias. A random-effects meta-analysis was run to pool the crude prevalence of dental caries according to gestational age and birth weight. We performed a narrative synthesis and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Fifty-nine observational studies were included (55 in the meta-analysis). The prevalence of dental caries was 39% among preterm children, 30% among full-term children, 40% among LBW children, and 33% among NBW children (I² :97%-99%). The majority of studies reported that dental caries was not associated with gestational age or birth weight, with very low certainty of evidence. Preschool children born preterm or with LBW have similar dental caries experience as those born full term or with NBW, with very low certainty of evidence (PROSPERO #CDR42018118086).

Desensitizing Toothpastes for Dentin Hypersensitivity: A Network Meta-analysis

The goal of this systematic review and network meta-analysis was to compare the relative effects of toothpaste formulations for dentin hypersensitivity (DH), tested in randomized controlled trials (RCTs). We searched 7 databases to February 2019. Paired reviewers independently screened studies, extracted data, and performed risk of bias assessment. The outcome of interest was painful response measured through tactile, cold, and air stimuli. We conducted a random-effects Bayesian network meta-analysis using standardized mean difference (SMD) and their credible intervals (CIs) as the measure of effect for each pain stimuli. We assessed certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included 125 RCTs (12,541 patients). For tactile stimulus, the following active ingredients showed large beneficial effects compared to fluoride with moderate certainty of evidence (SMD; 95% CI): potassium + stannous fluoride (SnF₂) (3.05; 1.69-4.41), calcium sodium phosphosilicate (CSP) (2.14; 0.75-3.53), SnF₂ (2.02; 1.06-2.99), potassium + hydroxyapatite (2.47; 0.3-4.64), strontium (1.43; 0.46-2.41), and potassium (1.23; 0.48-1.98). For cold stimulus, CSP showed large beneficial effects compared to fluoride (3.93; 0.34-7.53) with moderate certainty; for air stimulus, arginine (2.22; 1.45-2.99), potassium + hydroxyapatite (2.44; 0.33-4.55), potassium + SnF₂ (2.28; 0.87-3.69), CSP (1.98; 0.99-2.98), and SnF₂ (1.9; 1.03-2.77) showed large beneficial effects compared to fluoride with moderate to high certainty. Most toothpaste formulations showed evidence of superiority against placebo or fluorides (amine fluoride, sodium monofluorophosphate, or sodium fluoride). CSP was most beneficial for all 3 stimuli with high to moderate certainty. SnF₂ alone and potassium combined with SnF₂ or hydroxyapatite were beneficial for tactile and air stimulus with high to moderate certainty. Arginine was beneficial for air stimulus, and strontium and potassium were beneficial for tactile stimulus, with moderate certainty.

Oral lesions of higher clinical frequency in children – literature review

Abstract Objective: The objective of this article is to present to the dental professionals, through a literature review, the main oral lesions that are part of the odontopediatric stomatology, in order to improve the knowledge and attention to the health of the pediatric patients. Methods: The searches were carried out in the following bibliographic databases - PubMed, Web of Science, LILACS and Bireme. Data synthesis: This article deals with the description of the most frequent oral lesions in Pediatric Dentistry, ranging from characteristic changes in the newborn to pathological, non-pathological, congenital, fluid retained, ulcerative and those related to the main infectious diseases of childhood, with clinical manifestations in the oral cavity. Conclusion: It is very important, for General Practitioner and Pediatric Dentistry to,recognize oral lesions in children, to make a correct and early diagnosis of them, in order to improve the knowledge, attention to the health and quality of life of the pediatric patients. RESUMO Objetivo: apresentar aos profissionais da Odontologia, por meio de uma revisão da literatura, as principais lesões bucais que fazem parte da Odontopediatria, a fim de melhorar o conhecimento e a atenção à saúde dos pacientes pediátricos. Métodos: As buscas foram realizadas nas seguintes bases de dados bibliográficas - PubMed, Web of Science, LILACS e Bireme. Síntese dos dados: Este artigo trata da descrição das lesões bucais mais frequentes na Odontopediatria, desde mudanças características no recém-nascido até patológicas, não patológicas, congênitas, lesões com retenção de líquido, ulcerativas e aquelas relacionadas às principais doenças infecciosas da infância, com manifestações clínicas na cavidade bucal. Conclusão: É muito importante, para o clínico geral e para o odontopediatra, reconhecer as diversas lesões que podem acometer a cavidade bucal das crianças, propiciando um diagnóstico correto e precoce das mesmas, a fim de melhorar o conhecimento, atenção à saúde e qualidade de vida dos pacientes pediátricos. .

Panoramic versus CBCT used to reduce inferior alveolar nerve paresthesia after third molar extractions: a systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review was to verify whether CBCT in comparison with panoramic radiography reduced the cases of temporary paresthesias of the inferior alveolar nerve (IAN) associated with third molar extractions.

METHODS

The literature search included five databases (PubMed, Scopus, Web of Science, Cochrane, SciELO), in addition to gray literature and hand search of reference list of included studies. Two reviewers independently screened titles/abstracts, and full texts according to eligibility criteria, extracted data and evaluated risk of bias through Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2.0). Data were meta-analyzed by comparing CBCT versus panoramic radiographs for number of events (temporary paresthesia after third molar surgery). Fixed effect model was used for non-significant heterogeneity; relative risk (RR) and 95% CI were calculated. The certainty of evidence was evaluated by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

RESULTS

Four randomized controlled trials (RCTs) were included in meta-analysis, and for the majority of domains they presented low risk of bias. RR was 1.23 (95% IC: 0.75-2.02; I²: 0%; p = 0.43) favouring panoramic radiography, but without significant effect, and with moderate certainty of evidence.

CONCLUSIONS

We concluded that both interventions had a similar ability to reduce temporary paresthesia of the IAN after third molar surgery with moderate certainty of evidence.

Tumor depth of invasion and prognosis of early-stage oral squamous cell carcinoma: A meta-analysis

OBJECTIVES

To assess the prognosis for early-stage oral squamous cell carcinoma according to tumor depth of invasion (DOI).

METHODS

This study was logged in the PROSPERO database under protocol # CRD42017059976. The search was conducted in six electronic databases up to May 2019. Fixed-effects meta-analysis was performed for the calculation of the odds ratio (OR) and respective 95% CI. Primary outcomes were lymph node metastasis, recurrence, and survival. Heterogeneity was calculated by the I² test. The certainty of evidence was assessed by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Twenty-seven studies were included (19 in the meta-analysis) with 2,404 patients with a mean of 60 years of age. High tumor DOI is associated with a greater chance of presenting lymph node metastasis, regardless of the cutoff point for DOI (13 meta-analysis; OR 1.69-53.08), recurrence (five meta-analysis; OR 1.22-3.83), and lower chance of survival (1 meta-analysis; OR 0.49). The certainty of evidence varied from very low to low.

CONCLUSIONS

Tumor DOI is a good prognosticator for early-stage OSCC. The findings of the current meta-analysis highlight the clinical relevance of DOI and corroborate its incorporation for staging OSCC.

A Systematic Review of Pulp Revascularization Using a Triple Antibiotic Paste

Purpose: The purpose of this systematic review was to summarize the clinical and radiographic results of pulp revascularization procedures employing a triple antibiotic paste in teeth with incomplete root formation. Methods: Electronic searches were conducted in February 2017 using PubMed, Medline, Web of Science, Scopus, The Cochrane Library, ProQuest, Lilacs and The Brazilian Library of Dentistry, UK National Institute for Health and Care Excellence, U.S. National Institutes of Health, Clinical Trials, and Google. The search was updated in March 2019. Clinical trials in English, Portuguese, and Spanish, without any restrictions regarding the year of publication, were included. The quality of the studies was analyzed using the Cochrane Collaboration tool. Results: The search retrieved 1,768 references, and eight studies were included for a qualitative analysis. In these eight studies, the risk of bias across the Cochrane tool's domains varied from low to unclear. The included studies demonstrated that the clinical and radiographic success of pulp revascularization using calcium hydroxide or triple antibiotic paste appears to resolve symptoms and periapical healing. Conclusions: Triple antibiotic paste is effective in the pulp revascularization therapy of teeth with incomplete root formation. Absence of symptoms and the achievement of periapical integrity have been observed. (Pediatr Dent 2019;41(5):341-53).

Use of distraction techniques for the management of anxiety and fear in paediatric dental practice: A systematic review of randomized controlled trials

OBJECTIVE

To determine whether distraction techniques (DT) reduce children's/adolescent's anxiety and fear during dental treatment.

METHODS

Randomized controlled trials (RCTs) in which any type of DT were used to manage dental anxiety and dental fear in children/adolescents were included. A systematic search of PubMed, Web of Science, Scopus, Cochrane Library, Lilacs, and Google Scholar was conducted. Two independent reviewers selected studies, extracted data, assessed methodological quality of studies using the Cochrane Collaboration's Risk of Bias tool (CCRBT), and approached certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Data were analysed descriptively.

RESULTS

Twenty studies covering several types of DT (audio, audiovisual, instruments camouflage, biofeedback, dental operating microscope, toys) were included. Qualitative analysis showed with very low certainty of evidence that DT effectively reduced dental anxiety and fear depending on the distraction type, instrument used to measure dental anxiety and dental fear, and dental procedure. CCRBT evaluation identified many methodological issues in included studies.

CONCLUSION

There is a very low certainty of evidence that DT can be effective in managing children's/adolescents' dental fear and anxiety during dental treatment. The heterogeneity of methodologies and findings in the studies, however, suggests more robust, and well-executed RCTs are needed.

Association between bruxism and temporomandibular disorders in children: A systematic review and meta-analysis

BACKGROUND

Bruxism in children and its relation to the development of temporomandibular disorders (TMD) has not been clearly determined yet.

AIM

The objective of this systematic review was to evaluate the possible association between bruxism and TMD in children.

DESIGN

Seven databases were searched, and 497 articles were assessed. Methodological quality was assessed through Newcastle-Ottawa Scale. The meta-analysis was performed with the articles in which extraction of data was possible and the summary effect measure through odds ratio (OR) and respective 95% confidence intervals (CIs). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence.

RESULTS

Ten cross-sectional studies were included in the systematic review. Of these, 8 showed a statistically significant association between bruxism and TMD. Seven studies however presented a high risk of bias. The meta-analysis was performed with 3 articles and obtained an OR of 2.97 (95% CI ranging from 1.72-5.15), indicating that children with bruxism are 2.97 times more likely to present TMD, with very low level of certainty defined by GRADE.

CONCLUSIONS

Although the studies showed high risk of bias, the qualitative analysis of individual studies showed that the children with bruxism have greater chance of developing TMD.

Association between sense of coherence and dental caries: systematic review and meta-analysis

Sense of coherence (SOC) is regarded as the individuals' capacity for managing the stressors over their lifespan. The aim of this systematic review and meta-analysis was to evaluate the association between SOC and dental caries. Electronic searchers were conducted in six databases: PubMed, Medline, Scopus, Web of Science, Lilacs and Proquest from their date of inception until November/2017. An update took place in August/2018. A hand search in the reference list of the included articles and gray literature search were also carried out. Retrieved titles/abstracts were screened by two review authors. Data of the included articles were extracted and quality assessment was also conducted. The first search retrieved 346 titles/abstracts. The update retrieved 33 records. Following the removal of 70 duplicates, 309 references were screened and 17 were included. The quality assessment ranged from low quality articles to high quality articles. High quality study showed that adult individuals with lower SOC were more likely to have dental caries. Meta-analysis showed that adolescents with low SOC were 5.41 times more likely to present dental caries than adolescents with high SOC (CI = 2.15–13.59). Mothers with low SOC were 5.55 times more likely to have children/adolescents with dental caries than mothers with high SOC (CI = 2.92–10.57). The subgroup analysis exploring continuous data showed that the SOC of mothers of children/adolescents without dental caries was significantly higher than the SOC of mothers of children/adolescents with dental caries (CI = 0.10–0.51). Higher levels of SOC seem to be associated with lower levels of dental caries.

Mechanical and optical properties of conventional restorative glass-ionomer cements - a systematic review

Objectives

To perform a systematic review of test methodologies on conventional restorative glass-ionomer cement (GIC) materials for mechanical and optical properties to compare the results between different GICs.

Material and Methods

Screening of titles and abstracts, data extraction, and quality assessments of full-texts were conducted in search for in vitro studies on conventional GICs that follow the relevant specifications of ISO standards regarding the following mechanical and optical properties: compressive strength, flexural strength, color, opacity and radiopacity.

Sources

The Latin American and Caribbean Health Sciences (LILACS), Brazilian Bibliography of Dentistry (BBO) databases from Latin-American and Caribbean System on Health Sciences Information (BIREME) and PubMed/Medline (US National Library of Medicine - National Institutes of Health) databases were searched regardless of language. Altogether, 1146 in vitro studies were selected. Two reviewers independently selected and assessed the articles according to pre-established inclusion/exclusion criteria. Among all the properties investigated, only one study was classified as being of fair quality that tested compressive strength and was included. It was observed that many authors had not strictly followed ISO recommendations and that, for some properties (diametral tensile strength and microhardness), there are no guidelines provided.

Conclusions

It was not possible to compare the results for the mechanical and optical properties of conventional restorative GICs due to the lack of standardization of studies.

Mediterranean diet is associated with bone mineral density and muscle mass in postmenopausal women

PURPOSE

This study aimed to investigate the association between the Mediterranean diet (MD), body composition, and bone mineral density (BMD) in postmenopausal women.

METHODS

In this cross-sectional study, 105 apparently healthy postmenopausal women aged between 45 and 65 years were included. BMD, percentage body fat, and appendicular lean mass index (ALMI, appendicular lean mass/height squared) were assessed by dual-energy X-ray absorptiometry. Dietary intake was assessed by a validated food frequency questionnaire. Assessment of MD adherence was based on intake of cereals, vegetables, fruits, meats, dairy products, fish, red wine, and olive oil, and expressed as the Mediterranean diet score (MDS).

RESULTS

Women with higher adherence to the MD had higher ALMI (6.6 ± 0.8 kg/m² vs. 6.3 ± 0.7 kg/m²; p = 0.039) and lumbar spine BMD (1.076 ± 0.149 vs. 0.997 ± 0.143 g/cm²; p = 0.007) compared to those with lower MDS. Linear regression analysis adjusted for previous hormone therapy, previous smoking behavior, and habitual physical activity showed an independent positive contribution of MDS to lumbar spine BMD (mean difference 0.088 g/cm², 95% confidence interval 0.028-0.147; p = 0.004) and ALMI (mean difference 0.296 kg/m², 95% confidence interval 0.020-0.591; p = 0.049).

CONCLUSION

Bone mineral density at the lumbar spine and ALMI were positively associated with the MDS in a sample of postmenopausal women from a non-Mediterranean region.

Association between psychological factors, socio-demographic conditions, oral habits and anterior open bite in five-year-old children

OBJECTIVE

The aim of the present study was to evaluate association between psychological factors, socio-demographic conditions, oral habits and anterior open bite in five-year-old preschool children.

MATERIALS AND METHODS

A cross-sectional study was conducted with 764 pairs of children and parents/caregivers in preschools. The parents/caregivers answered questionnaires addressing oral health-related quality of life (OHRQoL), sense of coherence, locus of control, oral habits and socio-demographic characteristics. The children answered a self-report questionnaire addressing OHRQoL and were submitted to a clinical examination for the anterior open bite by examiners. Descriptive analysis was conducted, followed by Poisson's regression analysis.

RESULTS

The prevalence of anterior open bite was 15.2%. The following variables remained significantly associated with anterior open bite: pacifier use (PR = 7.09; 95% CI: 4.06-12.39), attending a public preschool (PR = 2.40; 95% CI: 1.68-3.43), digit sucking (PR = 2.15; 95% CI: 1.27-3.62), greater number of residents in the home (PR = 1.67; 95% CI: 1.18-2.36) and impact on OHRQoL according to child's report (PR = 1.56; 95% CI: 1.11-2.20).

CONCLUSIONS

Anterior open bite was associated with OHRQoL according to the children's reports. Moreover, attending a public preschool, a greater number of residents in the home, digit sucking and pacifier sucking were associated with this type of malocclusion.

Is infrared thermography effective in the diagnosis of temporomandibular disorders? A systematic review

OBJECTIVE

The aim of this study was to systematically review the scientific efficacy of infrared thermography (IT) on the diagnosis of temporomandibular joint disorders (TMDs).

STUDY DESIGN

An electronic search was performed in 8 databases for publications up to May 2018. Additionally, a hand search of the reference lists was conducted. There were no restrictions on language or on year of publication. Two independent reviewers selected the studies, reviewed the abstract information, and assessed the quality. The methodology of the included articles was evaluated by using the QUADAS-2 tool.

RESULTS

Nine studies fulfilled the eligibility criteria and were included in the systematic review. Four studies concluded that IT presents low accuracy or is not an accurate instrument for TMD diagnosis, but there was substantial variation in sensitivity, specificity, and receiver operating characteristic curve values. Five studies concluded that IT appears to be promising or may be a complementary diagnostic aid in the evaluation of TMDs. These studies presented sensitivity values ranging from 70% to 90% and specificity values ranging from 62% to 92%. All studies were judged as being "at risk of bias" and as having "concerns regarding applicability."

CONCLUSIONS

The literature is still lacking in sufficient number of studies regarding the reliability of IT for the diagnosis of TMDs.

Effects of smoking on tooth loss among individuals under periodontal maintenance therapy: a systematic review and meta-analysis

Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies' risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.

A survey of dental journal methodological practices: Reporting guidelines and ethical policies

BACKGROUND

The authors evaluated instructions for author norms among existing dental journals and analyzed whether these journals address the practice of reporting guidelines and ethics policies.

METHODS

The authors evaluated 87 journals indexed in Journal Citation Reports (Thomson Reuters). The authors extracted information regarding the journals from the Journal Citation Reports database and from the instructions for authors of each journal. The authors conducted bivariate analysis to compare the methodological policy issues of journals with higher and those with lower impact factors (≥ 1.452 and ≤ 1.436, respectively).

RESULTS

Among journals, 44 (50.6%) required the use of Consolidated Standards of Reporting Trials, 22 (25.3%) Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 21 (24.1%) Animal Research: Reporting of In Vivo Experiments, 17 (19.5%) STrengthening the Reporting of OBservational Studies in Epidemiology, 6 (6.9%) Standards for Reporting of Diagnostic Accuracy Studies, 3 (3.4%) Meta-analysis of Observational Studies in Epidemiology, and 1 (1.1%) Standard Protocol Items: Recommendations for Interventional Trials. No journals required STrengthening the REporting of Genetic Association Studies. Journals with higher impact factors had more instructions related to the peer review process (P = .027), redundant publication (P < .001), authorship policy (P = .024), contributorship policy (P < .001), ethical conduct of biomedical research with human participants (P = .021), ethical conduct of biomedical research with nonhuman participants (P = .001), registration of clinical trials (P = .004), and conflicts involving editors as authors in their own journals (P < .001) than did journals with lower impact factors. The submission of clinical case studies was significantly more prevalent in journals with lower impact factors (P = .008).

CONCLUSIONS

Journals with higher impact factors have more rules regarding publication policies.

PRACTICAL IMPLICATIONS

Journals with higher impact factors are stricter regarding publication policies than are journals with lower impact factors. Authors should be careful with the instructions for authors and plan studies with high methodological quality to publish their studies in a scientific journal.

Alterations of cytochrome P450 and the occurrence of persistent organic pollutants in tilapia caged in the reservoirs of the Iguaçu River

Environmental chemicals originating from human activities, such as persistent organic pollutants (POPs), may interfere with the endocrine system of aquatic organisms. The effect of these chemicals on biota and human populations is of high public concern but remains poorly understood, especially in aquatic environments of South America. The aim of this study was to investigate the bioavailability of POPs and the related effects in caged male tilapia (Oreochromis niloticus) in four cascading reservoirs of the Iguaçu River, Southern Brazil. POPs including organochlorine pesticides (OCPs), polychlorinated biphenyl (PCBs), and polybrominated diphenyl ethers (PBDEs) were determined in the reservoir water and tissue samples of tilapia after two months of exposure. The PCB levels in water (14.7 ng L^-1) were 14 times higher than the limits permitted by the Brazilian legislation in the Salto Santiago (SS) reservoir. Similarly, concentrations of aldrin and its metabolites (6.05 ng L^-1) detected in the water sample of the Salto Osório (SO) reservoir were also above the permitted limits. RT-qPCR analysis revealed different transcript levels of cytochrome P450 enzymes (CYP1A and CYP3A) in the liver among the four groups, with induced activity in tilapia from the SS reservoir. Quantification of the CYP3A mRNA expression and catalytic activity showed higher values for fish caged at the SS reservoir. The fish from this site also had a higher number of eosinophils observed in the testes. Although overt measurements of endocrine disruption were not observed in caged fish, alteration of CYP enzymes with co-occurrence of organochlorine contaminants in water may suggest bioavailability of contaminants from agricultural sources to biota. Additional studies with feral or caged animals for a longer duration may be necessary to evaluate the risks of the waterways to humans and wildlife.

Preterm Birth, Pacifier use and Breastfeeding: is there a Relationship?

Abstract The immaturity of born to preterm infants may predispose to sucking difficulties. This research aimed to evaluate if pacifier use is associated with preterm birth and influenced in type of infant feeding. This comparative cross-sectional study was conducted in Belo Horizonte, Brazil and evaluated 250 children aged 3 to 5 years. As a sample, two groups were established: the normal term children group (n=125) was selected at a day-care centre and the group of preterm children (125) was identified at a public university hospital with a preterm care project from birth to seven years of age. To collect data, a pre-tested questionnaire regarding information on gestational age, infant development, infant feeding and non-nutritive sucking habits was used for both groups. Bivariate and multivariate Poisson regression was used for the statistical analysis. Pacifier use was more prevalent in the preterm group (PR=1.20, 95% CI=1.02-1.42) who used the bottle (PR=1.38, 95% CI=1.15-1.64) and were breastfed for less than six months (PR=1.19, 95% CI=1.01-1.41). The majority of breastfed infants were of normal term birth (PR=1.14, 95% CI=1.04-1.20) and had monthly family income greater than USD 450.28 (RP= 1.10, 95% CI=1.01-1.20). In this study, pacifier use was more prevalent among preterm infants and associated with less than six months of breastfeeding and used of bottle. Monthly family income was associated with a prevalence of breastfeeding.

Oral Problems and Self-Confidence in Preschool Children

The aim of the present study was to evaluate the impact of clinical oral factors, socioeconomic factors and parental sense of coherence on affected self-confidence in preschool children due to oral problems. A cross-sectional study with probabilistic sampling was conducted at public and private preschools with 769 five-year-old children and their parents/caretakers. A questionnaire addressing socio-demographic characteristics as well as the Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5) and the Sense of Coherence Scale (SOC-13) were administered. The dependent variable was self-confidence and was determined using the SOHO-5 tool. Dental caries (ICDAS II), malocclusion and traumatic dental injury (TDI) were recorded during the clinical exam. Clinical examinations were performed by examiners who had undergone training and calibration exercises (intra-examiner agreement: 0.82-1.00 and inter-examiner agreement: 0.80-1.00). Descriptive statistics and Poisson regression analysis were performed (a=5%). Among the children, 91.3% had dental caries, 57.7% had malocclusion, 52.8% had signs of traumatic dental injury and 26.9% had bruxism. The following variables exerted a greater negative impact on the self-confidence of the preschool children due to oral problems: attending public school (PR=2.26; 95% CI: 1.09-4.68), a history of toothache (PR=4.45; 95% CI: 2.00-9.91) and weak parental sense of coherence (PR=2.27; 95% CI: 1.03-5.01). Based on the present findings, clinical variables (dental pain), socio-demographic characteristics and parental sense of coherence can exert a negative impact on self-confidence in preschool children due to oral problems.

Is parental oral health literacy a predictor of children's oral health outcomes? Systematic review of the literature

BACKGROUND

The scientific evidence regarding the association between parental oral health literacy (OHL) and children's oral health is unclear.

AIM

To evaluate the scientific evidence concerning the association between parental OHL and children's oral health outcomes.

DESIGN

Eight databases were searched. Studies that evaluated oral health outcomes among children and measured parental OHL through a validated tool were included. Two independent reviewers selected studies, extracted data and analysed the risk of bias.

RESULTS

Eleven studies were included. Most (n = 6) had a high risk of bias. Most studies evaluating dental caries found association between lower parental OHL and higher prevalence/experience of dental caries. Poor oral health-related quality of life was associated with decreased parental OHL (P < 0.05). Studies diverged on the association between OHL and the number of filled, extracted teeth, and dental visits. There was no association between children's tooth brushing frequency, use of toothpaste, oral health claim, oral health expenditures and parental OHL. The literature was inconclusive regarding the association between night bottle feeding, negative parental perception of the child's oral health and OHL.

CONCLUSION

Low parental OHL was associated with dental caries among their children. It is too soon to assume an association between OHL and the remaining outcomes.

Preemptive Effect of Dexamethasone in Third-Molar Surgery: A Meta-Analysis

The aim of the present study was to assess the effectiveness of preemptive dexamethasone in surgery of the lower third molars and to compare it with other oral anti-inflammatories. An electronic search was conducted for preemptive effects related to lower third-molar surgery in 3 separate databases. The variables pain, swelling, and trismus were assessed. Meta-analysis was used to calculate the pooled effect measures for mean and standard deviation values (95% confidence interval [CI]). Seven split-mouth clinical trials were selected. Two studies were included in the meta-analysis. Three studies showed a low risk of bias; 2 studies exhibited a moderate risk and 2 a high risk of bias. Dexamethasone was better than nonsteroidal anti-inflammatories for preemptive effectiveness. Meta-analysis for swelling confirmed better results for dexamethasone than for methylprednisolone after 2 days (95% CI = -1.28 to -0.38), 4 days (95% CI = -1.65 to -0.71), 7 days (95% CI = -1.42 to -0.71), and overall (95% CI = -1.25 to -0.72). Dexamethasone was better than methylprednisolone for mouth opening after 4 days (95% CI = 0.18 to 1.07). There is insufficient evidence through meta-analysis to conclude that dexamethasone is better than other nonsteroidal anti-inflammatories or methylprednisolone as a preemptive analgesic. The results of this meta-analysis suggest that dexamethasone is more effective than methylprednisolone for swelling and trismus.

Third Molar and Their Relationship with Caries on the Distal Surface of Second Molar: A Meta-analysis

PURPOSE

The aim of this meta-analysis was to determine which characteristics of mandibular third molars (MTMs) are more often associated with an increase in the prevalence/incidence of caries on the distal surface of mandibular second molars (MSMs).

METHODS

Three electronic databases were analyzed: PubMed; OVID and the Virtual Health Library. Observational studies were included, and the risk of bias was assessed using The Newcastle-Ottawa Scale. The Comprehensive Meta-Analysis software program was used for meta-analysis.

RESULTS

Fifteen studies were included in this systematic review, and five were included in the meta-analysis. The distal surface of MSMs were more likely to exhibit caries in the following scenarios: when MTMs were found in the A position, rather than the C position (OR: 3.45, 95% CI: 2.28-5.22, p<0.001); when the horizontal position was compared with the vertical (OR: 8.12, 95% CI: 3.75-17.58, p<0.001) and distoangular (OR: 9.75, 95% CI: 3.49 - 27.25, p<0.001) positions; and when the mesioangular position was compared with the vertical (OR: 7.25, 95% CI: 3.48-15.10, p<0.001) and distoangular (OR: 9.54, 95% CI: 3.47 - 26.21, p<0.001) positions.

CONCLUSION

The results of this study suggest that the presence of MTMs increases the incidence of caries on the distal surface of MSMs. Furthermore, caries on the distal surface of MSMs is more commonly associated with position A and horizontal and mesioangular mandibular molars.

Periodontal disease in patients with Down syndrome: A systematic review

BACKGROUND

The authors systematically reviewed the scientific evidence of an association between periodontal disease and Down syndrome (DS).

TYPES OF STUDIES REVIEWED

In this systematic review, the authors included observational studies in which the investigators assessed the prevalence, incidence, or experience of periodontal disease in patients with DS compared with that in healthy patients. The authors used the Population, Exposure, Comparison, Outcome structure. The population was patients of any age, the exposure was the presence of DS, the comparison was the absence of DS, and the outcome was the presence of periodontal disease. The authors conducted an electronic search in 5 databases through March 2017. Two independent reviewers assessed the risk of bias by using the Fowkes and Fulton scale. The authors performed a meta-analysis to compare periodontal disease among patients with DS and those without DS. The authors calculated a summary effect measure-standard mean difference-when evaluating the means of the oral hygiene index. The authors assessed the strength of evidence from the selected studies by using a modified Grading of Recommendations Assessment, Development and Evaluation system.

RESULTS

The authors included 23 case-control studies in the systematic review and submitted 3 to meta-analysis. In the qualitative analysis, results from most studies showed that the prevalence of some periodontal parameters was higher among patients with DS than among those without DS. Evaluations of the Fowkes and Fulton scale point to many methodological problems in the studies evaluated. Results of the meta-analysis revealed no differences between groups with regard to the oral hygiene index (standard mean difference, 0.05; 95% confidence interval, -0.55 to 0.65; I² = 0.0%).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Further research is required, in particular well-designed studies that avoid the deficiencies identified in the studies in this review.