DOI: 10.3290/j.qi.b5768586October 1, 2024,Pages 1-21, Language: EnglishToth, Steven / Singer, Steven R. / Jiang, Shuying Sue / Zelig, Rena / Duda, Peter / DePinto, Nicholas / Feldman, Cecile / Touger-Decker, RivaObjectives: To explore associations between periodontal disease (PD) severity and cardiometabolic risk factors, including body mass index (BMI), age, Type 2 Diabetes Mellitus (T2DM) risk, sex, and hypertension (HTN) in patients at an urban dental school clinic. Methods and Materials: A cross-sectional study design was used to analyze electronic health record data, including periodontal status, demographic characteristics, cardiometabolic risk factors and the American Diabetes Association Diabetes Risk Test (DRT) Score. Chi-square tests and ordinal logistic regression were conducted using SAS 9.4. Results: Of those with available data (n=6,778), 44% were male, 70.2% were overweight/obese, and the mean age was 50.9 (SD=16.6) years. Associations between PD severity and BMI, sex, age, DRT score, and HTN were statistically significant (all p<0.0001) in bivariate analyses. Using logistic regression, HTN (p=0.0006), sex (p<0.0001), and age (p<0.0001) were significant predictors of severe PD which was most common in those with HTN (35.9%), males (31.7%), those >60 years (36.6%). The odds of having severe PD for those with HTN were 1.2 times that of those without HTN. Males were 1.7 times more likely to have severe PD than females. Those aged 40-49 years, 50-59 years, and >60 years were 2.9, 4.2, and 4.3 times more likely to have severe PD than those who were 18-39 years, respectively. Conclusion: All cardiometabolic risk factors were associated with PD severity in bivariate analyses. In the logistic regression model, being older, male, and having HTN were significant predictors of PD severity. Future research is needed with a more diverse sample.
Keywords: Body Mass Index, Cardiometabolic Risk Factors, Diabetes Risk, Hypertension, Periodontitis
DOI: 10.3290/j.qi.b5768294October 1, 2024,Pages 1-27, Language: EnglishCampi, Marco / Leitão-Almeida, Bruno / Pereira, Miguel / Shibli, Jamil Awad / Levin, Liran / Fernandes, Juliana Campos Hasse / Fernandes, Gustavo Vicentis Oliveira / Borges, TiagoObjectives: The aim of this study was to observe whether immediate implant placement (IIP) into damaged extraction sockets is a successful modality for treating hopeless teeth that require extraction. Data source: An electronic search was carried out through four databases (PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect) to identify randomized controlled trials (2013-2023) to understand whether IIP in damaged sockets is a successful treatment. The focus question was, “In a patient with a hopeless tooth that needs extraction with the indication for dental implant treatment, is IIP in damaged extraction sockets, compared to undamaged sockets or healed sites, an effective method for the replacement of hopeless teeth and achieving a favorable clinical result?” The risk of bias was appraised and a meta-analysis using random effect was applied. Five studies with 135 patients and 138 implants were included. The implant survival rate was 100% for all studies and period evaluated; the pink esthetic score (PES) scores had no statistically significant result for all articles that evaluated this parameter; the soft tissue changes was reported by two studies: one found no significant differences and the other showed that the test group experienced reduced soft tissue loss at the 1-year evaluation (measured with digital intraoral scanners); other two studies assessed the marginal bone loss, presenting no differences between groups. The meta-analysis showed homogeneity between the studies. There was an equilibrium among the groups in the various studies included, and age tended to be lower in the test group. The buccal bone tissue and pink esthetic score showed favoritism for the test group but without statistical significance. Conclusion: This study suggests that IIP in the presence of buccal bone defects can achieve comparable clinical and radiological outcomes to traditional methods in the short term of the limited studies available. The buccal aspect is not possible to be evaluated through radiographs. Bone regeneration was essential to reach optimal results. It is important to emphasize that IIP requires adherence to rigorous criteria to ensure functionally acceptable results.
Keywords: Immediate implant placement, Dental implants, Fresh sockets, Buccal bone defect, Compromised extraction sockets
DOI: 10.3290/j.qi.b5754882, PubMed ID (PMID): 39302116September 20, 2024,Pages 1-28, Language: EnglishZhou, Ying / Sun, Liying / Hu, Jinyu / Liu, Xiao / Ma, YajieAims: The aim of this study was to elucidates the nuanced interactions between antihypertensive medications and the risk of periodontitis using Mendelian randomization (MR) analysis method. Methods: Our study adopted a drug-target Mendelian randomization method to assess the long-term effects of nine antihypertensive drug categories on the risk of periodontitis in both acute and chronic cases. We selected genetic variants located in or near genes relevant to the targets of these drugs and associated with systolic blood pressure (SBP) to simulate the influence of antihypertensive treatments. Genetic information on SBP and periodontitis susceptibility was extracted from extensive genome wide association studies for both acute and chronic conditions. Additionally, we conducted a secondary analysis using expression quantitative trait loci for the genes of interest as alternative proxies.Colocalizaion analysis was performed to explore shared variants between antihypertensive drugs and periodontitis. Results: Our analysis revealed that the use of angiotensin converting enzyme inhibitors with an increased risk of acute periodontitis (odds ratio [OR] [95% confidence interval]: 1.43 [1.11, 1.85] per 1 mmHg reduction in SBP; p = 5.93×10-3) and loop diuretics with a decreased risk of chronic periodontitis (OR: 0.94 [0.90, 0.98]; p = 2.94×10-3). Moreover, genetically mimicking the use of a suggestive protective effect of thiazides and related diuretics on acute periodontitis was observed in both acute (OR: 0.95 [0.90, 0.99]; p = 0.021) and chronic (OR: 0.98 [097, 1.00]; p = 0.045) periodontitis. Colocalizaion analysis revealed antihypertensive drugs and periodontitis shared causal variants in ACE and SLC12A2 locus. Conclusion: The research indicates that loop diuretics might decrease the risk of 31 periodontitis, while angiotensin-converting enzyme inhibitors could heighten the risk. Further investigations are required to evaluate the potential of reusing antihypertensive drugs for periodontitis prevention.
Keywords: antihypertensive drugs, periodontitis, Mendelian randomization study, genetic analysis, genetic epidemiology
DOI: 10.3290/j.qi.b5754879, PubMed ID (PMID): 39302115September 20, 2024,Pages 1-25, Language: EnglishEsteves, Lara Maria Bueno / Souza-Costa, Carlos Alberto / Honma, Cíntia Miuky / Aidar, Karen Milaré Seicento / Fagundes, Ticiane Cestari / Briso, André Luiz FragaObjective: This prospective case series aimed to clinically evaluate the bleaching effect, spontaneous tooth sensitivity and variation in the thermal sensation threshold of different groups of teeth undergoing in-office bleaching. Method and materials: Ten patients received conventional bleaching treatment: 35% hydrogen peroxide with 3 bleaching sessions of 45 minutes, evaluating color change (ΔE and ΔE00), whitening index (WID), and tooth sensitivity (VAS). Thermal stimulus-generating devices were used to simulate sensitivity caused by low temperatures through Quantitative Sensory Tests (QST). Analyses were conducted individually on different teeth groups (n=20) (lower incisors LI, upper incisors UI, canines C, upper first premolars PM). Results: Regarding color change, LI and UI did not statistically differ from each other but showed significant difference and greater bleaching potential compared to C and PM (P =.018). Regarding sensitivity, LI and UI presented the highest spontaneous sensitivity values (P =.032), while PM did not display painful symptoms, also observed in provoked sensitivity analysis (P =.025). Conclusions: The general analysis of the results indicates that the tooth type responds differently to the whitening treatment, both in relation to the aesthetic benefit and the occurrence of tooth sensitivity. It was observed that lower incisors reach the degree of chromatic saturation before canines and premolars, in addition to presenting greater bleaching sensitivity. Personalizing the treatment, based on prior knowledge of the degree of saturation, anatomical factors and the risk of sensitivity, can provide considerable advantages in the whitening technique.
Keywords: analysis, color, dentistry, hydrogen peroxide, tooth bleaching, tooth sensitivity, Whitening Index
DOI: 10.3290/j.qi.b5751220, PubMed ID (PMID): 39287091September 17, 2024,Pages 1-13, Language: EnglishMcNeil, Rotem / Haviv, Yaron / Benoliel, Rafael / Sharav, YairTwo cases of pain evoked by cold food ingestion, following root canal therapy (RCT), are presented. The source of pain was detected when cold application to the vestibular, periapical area corresponding to the teeth involved evoked strong pain of about 30 sec durations. In the first case, the patient suffered from strong pain in the right mandibular area over the last 4 months. After successive RCT of 3 right mandibular teeth the spontaneous pain eased significantly, but strong pain evoked by cold food ingestion persisted. Cold application to the vestibular periapical area of teeth involved identified the source of pain, which was abolished by 80 mg/day of slow-release propranolol. In the second case, cold allodynia developed after RCT. The RCT was performed for prosthetic reasons with no prior pain. Pain could be duplicated by cold application to the vestibular area of the treated tooth. The patient preferred no treatment when the source of pain was explained. In both cases cold application did not produce any pain in other intra oral locations, including the contralateral vestibular area or the mid soft or hard palate. Pain mechanisms, neurovascular and neuropathic, which differ for each case are discussed.
Keywords: Cold allodynia, ice-cream headache, neurovascular orofacial pain, neuropathic oral pain
DOI: 10.3290/j.qi.b5751226, PubMed ID (PMID): 39287092September 17, 2024,Pages 1-17, Language: EnglishGeuke, Louisa / Carisch, Joelle / Türp, Jens C. / Rohr, NadjaStabilization appliances (Michigan splints) are considered well-studied and widely adopted for managing bruxism and temporomandibular disorders (TMDs). Traditionally, these appliances have been fabricated by wax modeling and pressing resin onto casts made from irreversible hydrocolloid or silicone impressions. This article provides a detailed description of an all-digital workflow that uses intraoral scanning and computer-aided design (CAD) software to design a stabilization splint on a digital cast that can be manufactured autonomously by a computer-aided manufacturing (CAM) grinding machine in a subtractive procedure. The workflow is applicable to both dentists and technicians. Special attention is given to aspects and procedures that are important for the successful fabrication of the splint. Working without a cast can save time and money, and the use of CAD-CAM technology provides a homogeneous splint material quality.
Keywords: bruxism, CAD/CAM, digital, occlusal device, stabilization splint, temporomandibular disorders
DOI: 10.3290/j.qi.b5751228, PubMed ID (PMID): 39287093September 17, 2024,Pages 1-24, Language: EnglishVerma, Richa / Tewari, Shikha / Singhal, Savita Rani / Sangwan, AditiObjectives: Combined oral contraceptives are used for the management of hyperandrogenism and menstrual abnormalities in polycystic ovarian syndrome (PCOS). There is a dearth of literature addressing the effect of ethinyl estradiol/norethisterone acetate (EE/NETA) on gingival and systemic inflammation in these patients. This randomized trial aims to evaluate the effect of EE/NETA with and without scaling on periodontium and high sensitivity C-reactive protein (hsCRP) levels in women with PCOS having gingivitis. Methods: Women having PCOS along with gingivitis were randomly divided into two groups: Test Group (TG, n=30) received EE/NETA + scaling with oral hygiene instructions (OHI) and Control Group 1 (CG1, n=30) received EE/NETA + OHI. Another Control Group (CG2, n=30) consisting of systemically healthy females having gingivitis and who were age and BMI matched with the test group participants received scaling along with OHI. Periodontal and anthropometric parameters were measured at baseline, 3 months and 6 months follow-up. Serum hsCRP levels were also estimated. Results: Serum hsCRP levels and periodontal parameters were significantly decreased in all the groups after 6 months (p≤0.05). The decrease in hsCRP levels was similar among the groups (p>0.05). Significantly more reduction in gingival inflammation was observed in TG compared to CG1 (p≤0.05). Conclusion: EE/NETA used alone and with scaling showed no detrimental effect on gingiva and could reduce systemic and gingival inflammation in women with PCOS having gingivitis.
Keywords: C-reactive protein, dental scaling, gingivitis, inflammation, norethisterone acetate, polycystic ovary syndrome
DOI: 10.3290/j.qi.b5716359, PubMed ID (PMID): 39193935August 28, 2024,Pages 1-33, Language: EnglishYilmaz, Mustafa / Ujanen, Aleksandra / Suominen, Auli / Demir, Esra / Gürsoy, Ulvi KahramanObjectives: Our aim was to investigate the impact of smoking on pocket closure at six months after treatment of severe periodontitis, in relation to residual clinical inflammation. Method and materials: The clinical records of deep pockets (probing depth≥6 mm, n=984) in 46 individuals with periodontitis were analyzed. Following baseline clinical assessments (plaque index, probing depth, clinical attachment level, and bleeding on probing), non-surgical periodontal treatment was performed. Clinical assessments were repeated at 2 and 24 weeks after periodontal therapy. A logistic regression model using generalised estimation equations (GEE) adapting the cluster robust standard errors was performed to investigate potential associations between bleeding on probing and pocket closure at post-treatment 24 weeks. Results: Absence of bleeding at two weeks after non-surgical treatment related to pocket closure after six-months. Pockets that do not bleed neither at baseline nor two weeks (OR=2.7; P <.005) and pockets of non-smokers (OR=6.32; P <.001) and females (OR=1.79; P =.022) associated with pocket closure at six months. Conclusion: Pocket closure is associated with being a non-smoker and the absence of inflammation after non-surgical periodontal treatment, which indicates the importance of smoking cessation and inflammation control in achieving optimal clinical outcomes.
Keywords: periodontitis, bleeding, inflammation, initial treatment, maintenance, smoking
DOI: 10.3290/j.qi.b5714883, PubMed ID (PMID): 39190016August 27, 2024,Pages 1-24, Language: EnglishWolf, Thomas Gerhard / Müller, Andrés Urs / Seeberger, Gerhard Konrad / Paulmann, Kerstin / Campus, Guglielmo / Deniaud, Jacques / Wagner, Ralf Friedrich / Zeyer, OliverObjectives: The study examines the impact of changes on dental education and practice in Europe, including the development of new practice models such as investor-owned dental centers and practice chains. Material and methods: This study aimed to collect and critically examine data regarding the care environment, education, and organizational structures of the dental profession across ERO member states and other countries in the WHO European region. A questionnaire from the European Regional Organization of the FDI World Dental Federation (ERO) has been used. Results: National dental associations across 45 countries participated. An average of 1’459.79 (SD 800.80) inhabitants per dentist has been found, with independent practices being the most prevalent form of dental practice (48.65%, SD 28.28%) followed by employment in private practice (24.32%, SD 20.33%), and joint practices (15.27%, SD 20.39%). There are statistically significantly more state universities than private universities (p<0.01); the percentage of females attending dental schools were statistically significantly higher than males (p<0.01). Two-thirds of the participating countries (n=30, 66.67%) have legal frameworks allowing various stakeholders, including investors, and local communities, to establish dental healthcare centers. Conclusions: The findings highlight the evolving landscape of the dental profession in Europe and its regulatory context. There is a clear need for ongoing evaluations and adjustments in educational and practice frameworks to ensure and maintain high-quality oral healthcare. Future research should delve into the various professional dental practice forms and incorporate qualitative, care-related, and patient-centered considerations for a more thorough understanding of Europe’s oral healthcare dynamics.
Keywords: dental healthcare center, dental service, Europe, form of dental practice, independent, liberal, questionnaire, young dentists
DOI: 10.3290/j.qi.b5714863, PubMed ID (PMID): 39190015August 27, 2024,Pages 1-29, Language: EnglishJia, Zhengyong / Chen, KeliBackground: The pathogenesis of periodontitis may be related to host-mediated inflammatory and immune responses caused by accumulation of oral microbial plaque. Nutrients have anti-inflammatory and pro-inflammatory capabilities. Dietary intake of antioxidants and micronutrients is associated with the inflammatory burden of the diet. The Composite Dietary Antioxidant Index (CDAI) is a composite index for assessing the antioxidant properties of a diet and the relationship with periodontitis is unclear. The aim of this study was to investigate the relationship between periodontitis and CDAI. Methods: The study was a cross-sectional design and included 7471 participants from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 database. Participants were divided into experimental and control groups according to the relevant criteria, where the control group consisted of participants with no/mild periodontitis (including 3646 participants) and the experimental group consisted of participants with moderate/severe periodontitis (including 3825 participants). First, baseline characteristics 22 of the two groups of participants were compared. Weighted logistic regression analyses was used to explore the relationship between periodontitis and CDAI. And the linear relationship between the two was assessed using restricted cubic spline. Finally, subgroup analyses was used to assess model stability. Results: Differences between the two groups of participants were statistically significant in age, gender, race, education, ratio of household income to poverty(PIR), body mass index(BMI), smoking status, drinking status, and prevalence of diabetes. CDAI, as a continuous variable, was not found to be significantly associated with periodontitis. The CDAI was converted to categorical variables according to quartile. In model1, participants in the second and third quartile groups had a lower risk of developing periodontitis compared with participants in the lowest quartile group(OR(95%CI):0.81(0.681,0.963),P=0.021;OR(95%CI):0.811(0.691,0. 951),P=0.014;respectively). In model2, participants in the second, third, and fourth quartile groups had a lower risk of developing periodontitis compared to the lowest quartile group(OR(95%CI):0.803(0.66,0.978),P=0.0349;OR(95%CI):0.753( 0.632, 0.897),P=0.0028;OR(95%CI):0.753(0.617,0.92),P=0.0083;respectively). There was a non-linear relationship between CDAI and periodontitis (p non-linearity = 0.0055), with the inflection point occurring at a CDAI equal to 0.6342. Conclusion:There is a nonlinear relationship 44 between CDAI and periodontitis in US adults. However, further prospective studies are still needed to validate our results.
Keywords: Composite dietary antioxidant index, Periodontitis, Risk 48 factor
DOI: 10.3290/j.qi.b5714710, PubMed ID (PMID): 39190014August 27, 2024,Pages 1-24, Language: EnglishMethuen, Mirja / Suominen, Anna L. / Lussi, Adrian / Vähänikkilä, Hannu / Lakka, Timo / Anttonen, VuokkoObjective: To evaluate the ability of near-infrared light transillumination (NIR-LT) to detect interproximal enamel and dentinal caries lesions compared to clinical-visual inspection (VI) aided by fibre-optic transillumination (FOTI). Method and Materials: From 170 Finnish adolescents aged 15-17 years, 5294 interproximal surfaces of premolars and molars were examined first clinical-visually aided by FOTI (VI+FOTI) using the International Caries Detection and Assessment System (ICDAS) classification. Subsequently, the surfaces were examined using NIR-LT. The extent of lesions was determined using the modified NIR-LT classification based on the Söchtig criteria. For the analyses, data on upper and lower premolars and molars were combined. Distributions of lesions were presented as frequencies. Differences between VI+FOTI and NIR-LT at the tooth and tooth surface levels were analysed by Chi-square and Fisher’s exact tests. Sensitivity and specificity of the NIR-LT method to detect any lesion was performed using VI+FOTI as the gold standard. Results: By VI+FOTI, 92.4% surfaces were classified as sound and by NIR-LT, 88.2%. Enamel caries lesions were found on 7.0% of the surfaces by VI+FOTI and on 11.6% by NIR-LT. Enamel lesions identified by NIR-LT were nearly double for all examined teeth groups, except for lower molars it was 1.3-fold. In 66% of the surfaces, the differences between NIR-LT and VI+FOTI findings were statistically significant (p<0.001). The sensitivity for all teeth of NIR-LT was 48.4% and the specificity was 91.1%. Conclusion: Radiation-free NIR-LT method shows considerable potential as a supplementary method for early detection of caries lesions among low caries prevalence adolescents.
Keywords: adolescent, caries detection, enamel caries, interproximal caries, NIR-LT, radiation-free
DOI: 10.3290/j.qi.b5695436, PubMed ID (PMID): 39162208August 20, 2024,Pages 1-36, Language: EnglishZheng, Wentian / Pang, Yongzhi / Gong, Hui / Shi, Min / Song, Ning / Guo, Tao / Jiang, YingyingObjectives: Diode laser represent a practical clinical strategy for treating gingival hyperpigmentation. However, its effectiveness remains controversial. We conducted a meta-analysis evaluating the quantitative effects of diode laser therapy on gingival hyperpigmentation. Method and materials: Pubmed, Embase, Web Of Science, and Cochrane Library were systematically searched for the use of diode laser in gingival hyperpigmentation. The primary outcomes assessed were the Dummett-Gupta Oral Pigmentation Index (DOPI), Visual Analog Scale (VAS) pain scores, and the Wound Healing Index (WHI) for overall evaluation. I2 index was calculated to identify heterogeneity and sensitivity analyses sources of heterogeneity. Funnel plots and Egger's test were utilized to evaluate publication bias. Results: Thirteen randomized controlled trials (RCTs) involving a total of 233 participants were included in this study. The analysis demonstrated that diode laser had a significant effect on DOPI (standard mean difference [SMD] = -0.245, 95% CI = -0.415 to -0.040, P =.019) and VAS (SMD = -0.089, 95% CI = -1.332 to -0.285, P =.002), with no significant effect on WHI (SMD = -0.224, 95% CI = -1.100 to 0.653, P =.617). Despite the significant heterogeneity in VAS and WHI indicated by the I2 index statistic, the sensitivity analyses' results demonstrated the main findings' reliability. While no significant publication bias was detected for DOPI and WHI, the VAS results exhibited notable publication bias. Conclusion: The study demonstrated that diode laser prolongs gingival repigmentation time and reduces pain compared to other treatments. However, the efficacy in wound healing did not significantly promote.
Keywords: diode laser, gingival hyperpigmentation, meta-analysis
DOI: 10.3290/j.qi.b5687920, PubMed ID (PMID): 39150194August 16, 2024,Pages 1-24, Language: EnglishSonnenschein, Sarah K. / Reccius, Ingvi / Kilian, Samuel / Kim, Ti-SunObjective: To evaluate two methods for assessing the changes in periodontitis grading in patients undergoing supportive periodontal therapy (SPT) ten years (T10) after retrospective baseline (BL) grading. Materials and Methods: The periodontitis grade of 51 SPT-patients was assessed using indirect evidence as the primary criterion for periodontitis progression at BL and T10 (radiographic bone loss/age index, periodontitis phenotype). Grading at T10 was also performed using the direct evidence for periodontitis progression (clinical attachment loss over the previous five years). The use of indirect evidence for periodontal progression at BL and T10 was defined as method 1 (M1) to assess the changes in periodontitis grading. The use of indirect evidence at BL and direct evidence at T10 was defined as method 2 (M2). Changes in periodontitis grading using M1 and M2 were evaluated (Wilcoxon signed-rank test). Agreement between M1 and M2 was assessed (Cohen's kappa). Results: Indirect BL-grading revealed five grade B and 46 grade C patients. The indirect grading at T10 revealed 17 grade B and 34 grade C patients. The direct T10-grading classified all patients as grade C. M1 led to an overall improvement in periodontitis grading after ten years of SPT (p=0.00297), whereas M2 led to a deterioration (p=0.0369). The comparison between M1 and M2 showed that they lead to different results in terms of grading (Cohen's Kappa=0.116208). Conclusions: Periodontitis grading may change during SPT. Using indirect or direct evidence as the primary grading criterion during SPT may lead to different results.
Keywords: Periodontitis, Periodontitis grade, Prognosis, Periodontal diseases, Periodontitis classification
DOI: 10.3290/j.qi.b5687916, PubMed ID (PMID): 39150195August 16, 2024,Pages 1-23, Language: EnglishThies, Anke / Backhaus, Joy / Olmos, Manuel / Eitner, StephanObjectives: Prevalence of work-related musculoskeletal disorders (WRMSDs) among dentists and orthodontists is approximated to range between 64%-93%. Etiology of WRMSDs in the mentally and physical demanding occupation remains unclear, for which reason aim of the study was to clarify the interplay of physical, psychological, and mental factors on WRMSDs Material and Methods: Of 94 orthodontists and 187 dentists, (Mage=35 years) questioned using an online-survey, 84% reported persisting tension or pain in the back, neck, or shoulders. While 71% of females were employed (29% self-employed), solely 39% of male participants were employed. Cluster analysis was used to characterize dentists according to their movement profile and the moderating effect of stress on WRMSDs scrutinized. Results: Three movement profiles of dentists and orthodontists were significantly predictive of WRMDS. The minority could be characterized as healthy (n=45), whereas twice as many reported nearly twice as much pain (n=90). Stress proved to be a strong, significant moderator of WRMDs in relation to gender, employment status, and BMI. Conclusion and Outlook: Prevalence of WRMSDs found in this study is alarming. Given the feminization of dentistry the being a female, stressed and an employee (rather than self-employed) a significant predictor of WRMSDs represents a serious danger to the German health system.
Keywords: Dentist, Pain, Posture, Stress, WRMDSs
DOI: 10.3290/j.qi.b5640008, PubMed ID (PMID): 39078171July 30, 2024,Pages 1-27, Language: EnglishLy-Mapes, Oriana / Jang, Hoonji / Al Jallad, Nisreen / Rashwan, Noha / Castillo, Daniel A. / Lu, Xingyi / Fiscella, Kevin / Xiao, JinObjectives: Although early-life dental care is crucial for preventing early childhood caries and has numerous benefits, the utilization rate of such care remains remarkably low worldwide, especially in families of low socioeconomic status. The aim of this study was to systematically review the scientific evidence relating to the effectiveness of interventions on improving early-life dental care utilization of very young children. Method and materials: We reviewed scientific evidence relating to these positive changes, with 7 randomized controlled trials after qualitative evaluation. Interventions assessed included prenatal oral health promotion, motivational interviewing, intraoral camera use alongside social work consultations to aid in decreasing barriers to care, monetary incentives for tooth brushing, fluoride varnish applications, and probiotic usage. Results: The intervention was significantly effective in reducing the incidence of dental caries among children, especially in caries risk. Caries reduction was significant when oral health information was provided at frequent intervals prenatally. Caries increment was also reduced when probiotics were introduced when administered daily. Interventions that attempted to increase parental involvement in oral health care by increasing motivation and decreasing barriers had inconclusive results within the study groups. Conclusions: Considering high rates ECC, early establishment and preservation of a dental home should be a focus in public health measures. Continuous monitoring and parental involvement are key components to maintaining healthy oral conditions. Future studies could explore and test various innovative strategies that utilize technological platforms to engage with parents and promote early-life dental care utilization among the underserved population.
Keywords: early-life dental care, early childhood caries, caries, caries prevention, randomized controlled clinical trial, infants
DOI: 10.3290/j.qi.b5586051, PubMed ID (PMID): 39016671July 17, 2024,Pages 1-23, Language: EnglishWong, Kristal / Nadella, Srighana / Mupparapu, Mel / Sethna, ChristineObjective: The aim of this study was to identify the relationship between preventative dental practices and cardiometabolic health in adolescents.
Methods: Analysis included children aged 13-17 years enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2011-2018 who completed an Oral Health Examination and Questionnaire. Deferred dental care was defined as not having a dental visit in the past year. Financial barriers to seeking dental care (vs. no financial barriers) were assessed among those with deferred dental care in the past year. Primary cardiometabolic outcomes included obesity, elevated blood pressure and hypertensive blood pressure. Secondary outcomes included dyslipidemia, glucose intolerance, uric acid, glomerular hyperfiltration, and albuminuria. Regression models adjusted for age, sex, ethnicity, household income, food insecurity, health insurance status, household education, and body mass index z-score examined associations using complex survey design procedures.
Results: Of 2,861 adolescents, 17.6% (SE 0.9%) did not receive dental care in the past year and 20.2% (SE 1.9%) had a financial barrier to accessing dental care. In adjusted regression models, adolescents with deferred dental care had higher odds of dyslipidemia (OR= 1.51, 95% CI 1.07, 2.11 p = 0.020). Having a financial barrier was associated with a lower odd of dyslipidemia (OR=0.35, 95% CI 0.14, 0.89 p = 0.03). Financial barriers were associated with lower non-HDL (b=-7.95, 95% CI -14.87, -1.05 p=0.03) and higher HDL (b=3.06, 95% CI 0.37, 5.75 p=0.03) in adjusted models. Deferred dental care and financial barriers were not associated with any other cardiometabolic parameters.
Conclusion: In this nationally representative cohort of adolescents, there was an association between lack of preventative dental care and the cardiometabolic health marker of dyslipidemia. However, financial barriers to dental care were surprisingly associated with higher HDL levels and lower odds of dyslipidemia.
Keywords: cardiometabolic, dyslipidemia, financial barriers, pediatric dental, pediatrics, preventative dental practices
DOI: 10.3290/j.qi.b5566187, PubMed ID (PMID): 38985439July 10, 2024,Pages 1-22, Language: EnglishBrandt, Silvia / Winter, Anna / Lauer, Hans-Christoph / Romanos, Georgios E.Objectives: To evaluate clasp-retained removable partial dentures (C-RPDs) with a metal framework for survival, maintenance requirements, and biological implications.
Method and Materials: C-RPDs were retrospectively analyzed based on patient records. Treatment failure was defined as fracture of a framework component (metal base or connector) or loss of an abutment tooth. Other outcome variables included factors that might conceivably impact C-RPD survival (maxilla vs. mandible, Kennedy classes, opposing dentitions, treatment by students vs. certified dentists), mobility and caries of abutment teeth (in relation to clasp designs), and maintenance requirements (relining, clasp or resin fractures). Differences were evaluated by appropriate statistical tests at the P ≤ .05 level.
Results: A total of 612 patients (339 men, 273 women) 60.0 ± 11.5 years old at delivery were included, covering 842 C-RPDs and a mean observation period of 42.1 ± 33.2 months. Kaplan-Meier C-RPD survival was 76.2% after 5 years and 49.5% after 10 years. Biological complications (i.e. loss of abutment teeth) accounted for the vast majority (95.6%) of C-RPDs failures, and Kaplan-Meier C-RPD survival was significantly better in the mandible (P = .015). Some clasp designs contributed significantly to caries and removal of abutment teeth (both P < .05). No other significant differences were noted.
Conclusion: Tooth loss both emerges as the main cause of C-RPDs failure and might be amenable to careful selection of clasp designs. Overall, better C-RPD survival should be expected in the mandible. A non-contributory role of Kennedy classes and opposing dentitions is tentatively suggested based on numerically heterogeneous subgroups.
Keywords: clasp-retained removable partial dentures, dentures, maintenance requirements, prosthodontic treatment, secondary caries
DOI: 10.3290/j.qi.b4925761, PubMed ID (PMID): 38299599February 1, 2024,Pages 1-19, Language: EnglishSubramanian, Gayathri / Yeung, Vincent / Baredes, Soly / Kim, Sung / Bergsbaken, Tessa / Quek, Samuel Y. P.Radiation treatment plays a mainstream role in the management of head and neck cancers (HNSCC). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathological fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCC. Adverse impact on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCC exposed to both radiation treatment to the jaws and ICI therapy.
This manuscript documents adverse jaw outcomes including osteonecrosis and pathological fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC and had received prior radiation treatment.
A potential link between immunotherapy and adverse jaw outcomes is consistent with our growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC.
The general dentist may encounter such patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management.
Keywords: Cancer, Case-report/series, immunotherapy, Oral surgery , Osteonecrosis, Pathology, Radiation Therapy
DOI: 10.3290/j.qi.b4920305, PubMed ID (PMID): 38289001January 30, 2024,Pages 1-25, Language: EnglishHamadeh, Wiam / Alhabashneh, Rola / Abdelhafez, Reem / Khader, YousefObjective: Currently, there is no established treatment protocol to treat Interdental papillary loss. This research aimed to evaluate the outcomes of interdental papillary reconstruction using minimally invasive surgery, with injectable hyaluronic acid (HA) gel.
Materials and Methods: Seventeen patients were included, each with five sites of class 1 papillary recession; (forty sites in the upper jaw and forty-five sites in the lower jaw). Subperiosteal tunneling was performed through a horizontal incision made apical to the base of the papilla without penetrating it. The free gingival sulcus was sealed by 000 retraction cord. After that a total of 0.2-0.6 mL HA was injected gradually. The incision was sutured with polyglycolic sutures. Treated sites underwent clinical and digital evaluation at three follow up time points (1 month, 3 months and 6 months).
Results: The interdental papillary defect height in the upper jaw sites significantly reduced by 60%, 66%, and 42% at 1 month, 3 and 6 months, respectively. Also, in lower jaw sites, the reduction was of about 54%, 55%, and 40% at the same follow up time points. Regarding interdental papillary defect surface area in the upper jaw the reduction was about 65%, 71%, and 45% at 1 month, 3 and 6 months. In the lower jaw, a reduction of about 60%, 64%, and 48% was noticed at the same time points. Regarding patients’ pain level score, during the day of surgery, sixteen patients reported pain, the average pain score out of 10 was 3.94, and eleven patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. Also, at the day of the treatment twelve out of the seventeen patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity or allergy was noted in any patient.
Conclusion: Subperiosteal tunneling with HA injection demonstrates clinical improvements in papilla height and papillary recession surface area reduction after 3 months of follow-up with reduction in improvement after 6 months.
Keywords: black triangle, dental papilla augmentation , hyaluronic acid, minimal invasive surgery, periodontal surgery, Periodontology
DOI: 10.3290/j.qi.b4790573, PubMed ID (PMID): 38126717December 21, 2023,Pages 1-21, Language: EnglishTobias, Guy / Khaimov, Alexander / Zini, Avi / Sgan-Cohen, Harod D / Mann, Jonathan / Chotiner Bar-Yehuda, Yael / Aflalo, Efrat / Vered, YuvalObjectives: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5000 individuals was fluoridated. In 2014 CWF in Israel stopped.
Methods: Data on 12-year-old children from all areas in Israel from the national crosssectional epidemiological survey conducted in 2011-2012 were stratified by city water fluoridation and by city and school socio-economic status (SES). Two dependent variables were defined: (1) DMFT index -caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov (TF) classification of fluorosis.
Results: Data from 2181, 12-year-olds was analyzed. the average DMFT was 1.17+1.72 and 49% were caries free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs. 0.98 in fluoridated cities) and there were more caries free children 56.4% in fluoridated cities vs. 40.6% in non-fluoridated. DMFT was higher in cities with lower SES than high SES (1.29 vs. 1.05 respectively, p<0.001) and there were less caries free children in low SES (44.5% vs. 53% in high SES cities, p<0.0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in TF index), had questionable to mild fluorosis (9.3%).
Conclusions: CWF is a cheap, simple method of dental health protection that reaches all socio-economic levels and cessation of water fluoridation reduced the health of Israel's children.
Clinical Significance: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities.
Keywords: Caries detection, DMFT, Epidemiology, Fluoride, Public health