Publications - Publications

Treatment of pulpal and apical disease

Duncan, H. F., Kirkevang, L. L., Peters, O. A., et al. — Sun, 01 Oct 2023 11:35:51 +0200

Background: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease. Aim: To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. Methods: This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. Results: The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed. Conclusion: The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.

Impact of physiotherapy on orofacial manifestations of juvenile idiopathic arthritis

Vassis, S., Resnick, C. M., Nørgaard, M., et al. — Fri, 01 Dec 2023 11:35:51 +0100

Background: Physiotherapy appears as a promising therapy option for patients with Juvenile Idiopathic Arthritis (JIA) [1, 2], but the effects of physiotherapy and jaw exercises on JIA-related orofacial symptoms remain unknown [3]. The aim of this proof-of-concept study was to assess the impact of orofacial physiotherapy and home-exercise programs in patients with JIA and temporomandibular joint (TMJ) involvement. Methods: Twelve patients with JIA and TMJ involvement received a treatment of physiotherapy, complemented by prescribed home exercises spanning over eight weeks. Orofacial symptoms and dysfunction were monitored pre-treatment, during treatment, after treatment, and at a three-months follow-up. Results: Orofacial pain frequency and intensity significantly decreased during the course of the treatment (p = 0.009 and p = 0.006), with further reductions observed at the three-month follow-up (p = 0.007 and p = 0.002). During treatment, the mandibular function improved significantly in terms of maximal mouth opening capacity, laterotrusion, and protrusion. Conclusions: This proof-of-concept study shows favourable effects of physiotherapy and home excercises in the management of JIA-related orofacial symptoms and dysfunctions.

Asthma medication and risk of dental diseases in children – A prospective cohort study

Nørrisgaard, P. E., Haubek, D., Schoos, A. M. M., et al. — Sun, 01 Oct 2023 11:35:51 +0200

Background: Dental caries and enamel defects are the main causes of poor dental health in children, with a substantial impact on their well-being. Use of inhaled asthma medication is a suspected risk factor, but there is a lack of prospective studies investigating this and other prenatal and early life risk factors. Methods: Copenhagen Prospective Studies on Asthma in Childhood 2010 mother–child cohort (COPSAC₂₀₁₀) consists of 700 women who were recruited at 24 weeks of pregnancy. 588 of their children participated in a dental examination at 6 years of age (84%) at the COPSAC₂₀₁₀ research unit. Caries was defined as decayed, missing, or filled surfaces. Enamel defect was defined as demarcated opacity, post-eruptive enamel breakdown, and/or atypical restoration on at least one molar. Caries and enamel defects were assessed in both deciduous and permanent dentitions. Results: We found no associations between inhaled corticosteroids or β₂-agonists or asthma symptoms in early childhood and the risk of caries or enamel defects by 6 years of age. Furthermore, we found no strong pre-, peri-, or postnatal risk factors for dental diseases at 6 years, except from nominally significant associations between antibiotic use in pregnancy (OR = 1.25, [1.01–1.54]), maternal education level (OR = 1.57, [1.01–2.45]), having a dog at home (OR = 0.50, [0.27–0.93]), and risk of enamel defects. Conclusions: Use of inhaled corticosteroids, β₂-agonists, or asthma symptoms in the first 6 years of life were not associated with the development of caries or enamel defects. This finding is reassuring for parents and physicians prescribing asthma medication for young children.

Myth and evidence in palatal expansion

Melsen, B., Ghafari, J. G. — Fri, 01 Sep 2023 11:35:51 +0200

Untruths and distortion of scientific findings inhabit the medical and dental fields, not intentionally but often because of the lack of firm evidence. The aim in this paper is to visit a common orthodontic treatment modality, palatal expansion, and explore whether the accumulated biologic and mechanical findings are sufficient or misinterpreted for proper intervention. Specifically, questions are raised regarding the sutural response to maxillary widening in relation to the age-related changes in the morphology of the suture. The fractures occurring when expansion of a heavily interdigitated suture is performed and the healing that leads to its closure may impede the sutural pubertal growth spurt. Later widening of the arch width, even when surgically assisted, may lead to a bony relapse and severe bony dehiscence of the lateral teeth. Extensive research is needed to help generate appropriate guidelines for palatal expansion especially the age of the patient, timing and amount of expansion, duration of retention, and factors related to maintenance of the treatment results.

Dental students' attitudes on cardiopulmonary resuscitation training via virtual reality

Bjelovucic, R., Bak, J., Wolff, J., Taneja, P. — Sun, 01 Oct 2023 11:35:51 +0200

Purpose Resuscitation guidelines have advocated the use of virtual learning as a form of pre-course e-learning. Virtual reality (VR) has been identified to provide a method of constructive learning with instant feedback. There are increasing publications of VR use in cardiopulmonary resuscitation (CPR) training; however, there is a dearth from the dental profession. Therefore, the aim of this exploratory study was to investigate dental students' opinions in CPR training using VR.Methods In total, 120 dental students undertook both conventional (manikin) and VR CPR training in a cross-over design. The VR scenario was in a hospital setting. Following, students completed a questionnaire evaluating their experiences.Results The majority of students (n = 88) reported that this was the first time that they had utilised VR. The experience of using VR in CPR training was rated as very good. Most students felt that the inclusion of VR in CPR training created a better learning experience and had a high learning potential. However, the hospital setting was not entirely relevant.Conclusion Dental students recommended that VR CPR training should be used as an adjunct to conventional training in dental education, but the VR scenario would benefit being a virtual dental environment.

Associations between temporomandibular disorders, pain, jaw and masticatory function in dentofacial deformity patients

Madhan, S., Nascimento, G. G., Ingerslev, J., et al. — Fri, 01 Sep 2023 11:35:51 +0200

BACKGROUND AND OBJECTIVE: Patients with dentofacial deformity often present with impaired masticatory function, orofacial pain and temporomandibular disorders (TMD). This study investigates the relationship between TMD, pain, jaw and masticatory function at different stages of orthognathic surgical (OS) treatment.

METHODS: A total of 120 OS patients were prospectively recruited and grouped as pre-orthodontic (group 1), pre-surgery (group 2), 4-month post-surgery (group 3), 24-month post-surgery (group 4), in addition to 30 controls (group 0). Outcomes were assessed using: Jaw Function Limitation Scale (JFLS), McGill pain questionnaire, DC/TMD instrument, voluntary maximum bite force (MVBF), and masticatory efficiency (ME) using two-coloured chewing gum. Data were analysed using structural equation modelling.

RESULTS: The prevalence of non-painful TMD did not differ between groups (p = .827). However, the prevalence of painful TMD differed between groups (p = .001). Among the painful TMDs, the highest prevalence was observed for masseter myalgia in group 2 (p = .031), and importantly group 4 did not differ from group 0 (p = .948). The MPQ score was significantly higher in group 1 (p = .001) compared to group 0, and the JFLS score was significantly higher in groups 1, 2 and 3 compared to group 0. Notably, MPQ (p = .756) and JFLS (p = .572) scores in group 4 were not different from group 0. However, MVBF (p = .996) and ME (p = .991) did not differ between groups 1 and 4. The association of self-reported pain and jaw function with the masticatory function was observed in OS patients.

CONCLUSION: OS was not associated with a negative impact on TMD. Jaw function and pain levels were similar to controls at the 24-month follow-up. The masticatory function was further affected by the surgery and seems to require a longer recovery time. Moreover, it was confirmed that pain and TMD were associated with limitations in jaw function and impacts on masticatory function.

Implantoplasty and the risk of fracture of narrow implants with advanced bone loss

Stavropoulos, A., Bertl, K., Isidor, F., Vult von Steyern, P. — Sun, 01 Oct 2023 11:35:51 +0200

Objectives: To assess the impact of implantoplasty (IP) on maximum implant failure strength of narrow diameter implants of different type/design and material, with simulated advanced bone loss. Materials and Methods: Narrow, parallel-walled implants (3.3 mm in diameter × 10 mm long) with an internal connection of different type/design [bone level (BL), tissue level (TL)] and material [Titanium grade IV (Ti), Titanium-Zirconium alloy (TiZr)] from one specific manufacturer were used. Half of the implants were subjected to IP in their coronal 5 mm; the remaining were used as controls (seven implants per group). Dynamic loading prior to maximum load strength testing was included. Results: During dynamic loading, the fracture rate of BL implants was low and independent of IP, while that of TL implants increased significantly with IP compared with controls (p =.001). Maximum implant failure strength reduction (in %) due to IP, was 1.3%–25.4%; TiZr BL implants were least affected. Implants subjected to IP compared to those without IP as well as TL implants compared to BL implants showed a significantly lower maximum implant failure strength (p <.002); implant material was not significant (p =.845). Conclusions: Based on data from implants of one specific manufacturer, IP has a significant negative impact on the fracture strength of narrow implants suffering from advanced peri-implantitis. TL implants have been more severely affected compared to BL implants and presented an increased risk for failure during normal chewing forces. In addition, this negative impact of IP on TL implants was independent of the implant material (i.e., Ti or TiZr). Clinical Relevance: Narrow single TL implants with advanced horizontal bone loss (e.g., 5 mm), when subjected to IP, appear to have an increased fracture risk during normal function.

Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate

Srivastav, S., Tewari, N., Antonarakis, G. S., et al. — Fri, 01 Sep 2023 11:35:51 +0200

Background: Management of cleft lip and palate is interdisciplinary. An evidence-mapping approach was envisaged to highlight the existing gaps in this field, using only the highest level of evidence. Objectives: To conduct evidence mapping and quality analysis of systematic reviews and meta-analyses related to any aspect of cleft lip and palate. Search Methods: The cleft lip and palate field was divided into 9 domains and 50 subdomains and a method of categorization of systematic reviews was established. A comprehensive search strategy was carried out in seven databases along with the search of gray literature and references of included articles. Selection criteria: Systematic reviews related to any aspect of cleft lip and palate, conducted by a minimum of two reviewers, with a comprehensive search strategy and adequate quality analysis were included. Data collection and analysis: A self-designed, pre-piloted data-extraction sheet was used to collect information that was analyzed through an expert group discussion. Quality analysis was performed using ROBIS-I, AMSTAR 2, and the PRISMA checklist. Results: A total of 144 systematic reviews published between 2008 and 2022 were included. The largest number of these could be categorized in the therapeutic domain (n = 58). A total of 27% of the studies were categorized as inconclusive, 40% as partially conclusive, and 33% as conclusive. As per ROBIS-I, 77% of reviews had high risk of bias while 58% were graded as critically low in quality as per AMSTAR 2. The majority of systematic reviews showed low reporting errors. Conclusions: The majority of systematic reviews related to cleft lip and palate relate to therapeutic and prognostic domains and show high risk of bias and critically low quality regardless of the source journal. The results of this paper might serve as a starting point encouraging authors to carry out high-quality research where evidence is lacking. Registration: A multidisciplinary expert-group formulated an a priori protocol, registered in Open Science Framework (DOI 10.17605/OSF.IO/NQDV2).

Does cone beam CT change the treatment decision for maxillary second and third molars? A prospective study

Hermann, L., Nørholt, S. E., Wenzel, A., Taneja, P., Matzen, L. H. — Sun, 01 Oct 2023 11:35:51 +0200

OBJECTIVES: To evaluate whether information from CBCT changes the treatment plan for maxillary second and third molars and to examine clinical and radiographic parameters with an impact on treatment decision. METHODS: This prospective study included 260 maxillary third molars with superimposition onto the second molar in panoramic images (170 patients; mean age 28 years, range 16-63). An initial treatment plan was based on clinical findings and panoramic images. After CBCT, a final treatment plan was decided. Treatment was undertaken based on the final treatment plan. Through logistic regression analyses, impact of clinical and radiographic parameters on change in treatment plan, removal of the third molar vs no treatment, and removal of the second vs third molar were evaluated. RESULTS: The treatment plan changed in 82 cases (32%). Sixteen cases (6%) changed from removal of the third molar to removal of the second molar. Regression analyses showed that severe resorption in the second molar was significantly related to a change in treatment plan. Removal of a third molar was decided in 180 cases and regression analyses identified that mesioangulation of the third molar, marginal bone loss, superficial resorption, and age were significantly related to removal of the third molar vs no treatment. Thirty second molars were removed, and regression analyses showed that severe resorption was significantly related to removal of the second molar instead of the third molar. CONCLUSIONS: Parameters such as resorption evaluated in CBCT can modify the treatment decision, resulting in removal of the second and/or the third molar.

Magnetic resonance imaging in the diagnosis of periodontal and periapical disease

Sun, 01 Oct 2023 11:35:51 +0200

OBJECTIVES: Early pre-clinical inflammatory changes in periodontal and/or periapical lesions, which typically precede bone loss, are challenging to diagnose using ionizing-radiation-based imaging modalities. MRI provides relevant additional diagnostic information of inflammatory processes in soft and hard tissues. The aim of the present study is to undertake a systematic review of the literature on MRI in the diagnosis of periodontal and/or periapical disease. METHODS AND MATERIALS: The PubMed/MEDLINE and Scopus bibliographic databases were searched (2000-2021) using the search string: ("MRI" or "magnetic resonance imaging") and ("periodontitis" or "periodontal" or "apical pathology" or "endodontic pathology" or "periapical" or "furcation" or "intrabony"). The search was limited to studies published in English. The studies were assessed independently by three reviewers, focusing on the MRI sequences, imaging modalities (radiographs, cone beam CT (CBCT), and MRI), disease definition, assessed parameters, and outcome measurements. RESULTS: The search strategy yielded 34 studies, from which 13 were included. Overall, the findings of MRI were in agreement with CBCT. The studies showed that MRI provided diagnostic information of the hard and soft tissue components affected by periodontal and/or periapical disease with a fairly high sensitivity and specificity. However, the assessed parameters (e.g. MRI acquisition protocols, and disease definition) differed substantially. CONCLUSIONS: The included studies indicate that the use of MRI in the diagnosis of periodontal and/or periapical disease is feasible and promising. More studies are needed to define the accuracy of this non-ionizing-radiation-based diagnostic modality, in the assessment of periodontal and/or periapical lesions.

Risk factors observed in 2-dimensional radiographs for permanent injury of the inferior alveolar nerve after removal of mandibular third molars

Matzen, L. H., Petersen, L. B., Schropp, L., Hermann, L., Wenzel, A. — Sun, 01 Oct 2023 11:35:51 +0200

Objective: To assess whether differences exist in signs observed in 2D radiographs of mandibular third molars between a case group of patients with and a control group without permanent sensory disturbance of the inferior alveolar nerve (IAN) after removal. Study Design: Three observers blinded to patient status assessed radiographs from the case group (n=162) and the control group (n=172). Two new signs, craniocaudal relation of the roots and the mandibular canal and position of the canal over the roots; and 4 “classic” signs, interruption of the white borders of the canal, darkening of the roots, narrowing of the canal lumen, and diversion of the canal over the roots were registered. Chi-square tests assessed differences in distribution of radiographic signs between the groups. Odds ratios expressed the association between radiographic signs and permanent sensory disturbance. Inter- and intraobserver reliability values were calculated. Results: We found significantly more teeth with roots positioned inferiorly to the canal borders (P<0.001; OR 4.1-5.3) and with the canal superimposed over the upper or middle third of the roots (P<0.001; OR 2.6-3.9) in the case group than in the control group. Inter- and intraobserver reproducibility was excellent for roots inferior to the canal borders and fair to good for canal superimposition. Conclusions: Two radiographic signs are valid predictors of permanent sensory disturbance of the IAN in 2D radiographs.

Co-occurrence of Periodontitis and Diabetes-Related Complications

Fri, 01 Sep 2023 11:35:51 +0200

Periodontitis is a common finding among people with diabetes mellitus (DM) and has been cited as a DM complication. Whether and how periodontitis relates to other diabetes-related complications has yet to be explored. This study aims to examine the clustering of periodontitis with other diabetes-related complications and explore pathways linking diabetes-related complications with common risk factors. Using data from participants with DM across 3 cycles of the National Health and Nutrition Examination Survey (NHANES) (n = 2,429), we modeled direct and indirect pathways from risk factors to diabetes-related complications, a latent construct comprising periodontitis, cardiovascular diseases, proteinuria, and hypertension. Covariates included age, sex, socioeconomic status (SES), smoking, physical activity, healthy diet, alcohol consumption, hemoglobin A1c (HbA1c), dyslipidemia, and body mass index (BMI). Sensitivity analyses were performed considering participants with overweight/obesity and restricting the sample to individuals without DM. Periodontitis clustered with other diabetes complications, forming a latent construct dubbed diabetes-related complications. In NHANES III, higher HbA1c levels and BMI, older age, healthy diet, and regular physical activity were directly associated with the latent variable diabetes-related complications. In addition, a healthy diet and BMI had a total effect on diabetes-related complications. Although sex, smoking, dyslipidemia, and SES demonstrated no direct effect on diabetes-related complications in NHANES III, a direct effect was observed using NHANES 2011–2014 cycles. Sensitivity analysis considering participants with overweight/obesity and without DM showed consistent results. Periodontal tissue breakdown seems to co-occur with multiple diabetes-related complications and may therefore serve as a valuable screening tool for other well-known diabetes-related complications.

Yksilöidyn lääketieteen ongelma

Raittio, E. — Mon, 01 May 2023 11:35:51 +0200

WHO:n ennusteiden jäljillä

Raittio, E. — Thu, 01 Jun 2023 11:35:51 +0200

Advancing Universal Oral Health Coverage via Person-Centred Outcomes

Nascimento, G. G., Raittio, E., Machado, V., Leite, F. R.M., Botelho, J. — Fri, 01 Dec 2023 11:35:51 +0100

The World Health Organization member states proposed a comprehensive “Global Strategy on Oral Health,” which includes achieving universal oral health coverage by 2030. Challenges and barriers, including persistent inequalities, will hamper the achievement of universal oral health coverage. In low- and middle-income countries, the oral health of a large proportion of the population has been neglected, increasing oral health inequalities. In high-income countries, some receive excessive dental treatment, whilst particularly those with higher needs receive too little dental care. Therefore, an analysis of individual countries’ needs, encompassing the training of oral health professionals in a new philosophy of care and attention and the optimisation of the existing resources, is necessary. Distancing from a person-centred focus has prompted individual and societal issues, including under-/overdiagnosis and under-/overtreatment. The person-centred approach considers the perceptions, needs, preferences, and circumstances of individuals and populations. Patient-reported outcome measures, such as self-rated and -reported health, reflect an individual's overall perception of health and are designed to mediate human biology (ie, the disease) and psychology. The usage of patient-reported outcome measures in dentistry to place the individual at the centre of treatment is delayed compared to other areas. This paper discusses some challenges and potential solutions of patient-reported outcome measures in dentistry for achieving universal oral health coverage.

Reporting of costs and economic impacts in randomized trials of de-implementation interventions for low-value care

Falkenbach, P., Raudasoja, A. J., Vernooij, R. W.M., et al. — Tue, 01 Aug 2023 11:35:51 +0200

Background: De-implementation of low-value care can increase health care sustainability. We evaluated the reporting of direct costs of de-implementation and subsequent change (increase or decrease) in health care costs in randomized trials of de-implementation research. Methods: We searched MEDLINE and Scopus databases without any language restrictions up to May 2021. We conducted study screening and data extraction independently and in duplicate. We extracted information related to study characteristics, types and characteristics of interventions, de-implementation costs, and impacts on health care costs. We assessed risk of bias using a modified Cochrane risk-of-bias tool. Results: We screened 10,733 articles, with 227 studies meeting the inclusion criteria, of which 50 included information on direct cost of de-implementation or impact of de-implementation on health care costs. Studies were mostly conducted in North America (36%) or Europe (32%) and in the primary care context (70%). The most common practice of interest was reduction in the use of antibiotics or other medications (74%). Most studies used education strategies (meetings, materials) (64%). Studies used either a single strategy (52%) or were multifaceted (48%). Of the 227 eligible studies, 18 (8%) reported on direct costs of the used de-implementation strategy; of which, 13 reported total costs, and 12 reported per unit costs (7 reported both). The costs of de-implementation strategies varied considerably. Of the 227 eligible studies, 43 (19%) reported on impact of de-implementation on health care costs. Health care costs decreased in 27 studies (63%), increased in 2 (5%), and were unchanged in 14 (33%). Conclusion: De-implementation randomized controlled trials typically did not report direct costs of the de-implementation strategies (92%) or the impacts of de-implementation on health care costs (81%). Lack of cost information may limit the value of de-implementation trials to decision-makers. Trial registration: OSF (Open Science Framework): https://osf.io/ueq32 .

Incidence of Orofacial Manifestations of Juvenile Idiopathic Arthritis From Diagnosis to Adult Care Transition

Glerup, M., Tagkli, A., Küseler, A., et al. — Fri, 01 Sep 2023 11:35:51 +0200

Objective: To estimate the cumulative incidences of orofacial conditions related to temporomandibular joint (TMJ) juvenile idiopathic arthritis (JIA) between diagnosis in childhood to transition into adult care, and to identify features in JIA associated with TMJ involvement. Methods: A population-based cohort analysis was conducted of patients with JIA involving longitudinal data on orofacial health from 2000 to 2018. Regardless of TMJ status, the patients were referred to the Regional Specialist Craniofacial Clinic of Western Denmark for routine orofacial examinations. Data collection included information about disease-specific background characteristics, TMJ involvement, JIA-induced dentofacial deformity, and orofacial symptoms and dysfunction. Results: A total of 613 patients were followed up with a mean clinical TMJ observation time of 4.0 years. From JIA onset to transition into adult care, the cumulative incidence of patients with JIA involvement of the TMJ was 30.1%. Furthermore, 20.6% of the cohort had developed arthritis-induced dentofacial deformity. A substantial proportion of the cohort experienced several events with orofacial symptoms (23.5%) and dentofacial dysfunction (52%). Young age at diagnosis (<9 years), female gender, and antinuclear antibody positivity were significantly associated with TMJ involvement. Conclusion: Orofacial signs and symptoms were frequent findings in children and adolescents with JIA. TMJ involvement was seen in 30.1% of the cohort; and 20.6% of the total cohort developed JIA-related dentofacial deformity before transition into adult care. This is the first population-based study in the era of available biologic treatments to document these frequent orofacial complications in children with JIA.

Obesity, Insulin Resistance, Caries, and Periodontitis

Ladeira, L. L. C., Nascimento, G. G., Leite, F. R. M., et al. — Tue, 01 Aug 2023 11:35:51 +0200

(1) Background: To investigate the grouping of obesity and insulin resistance with caries and periodontitis from a syndemic perspective through pathways of socioeconomic inequalities, smoking, alcohol, and high sugar consumption in adolescence. (2) Methods: The population-based RPS Cohort study, São Luís, Brazil, in ages 18–19 years (n = 2515) was used. The outcomes were the grouping of pbesity and Insulin Resistance Phenotype (latent variable formed by Triglycerides/HDL ratio, TyG index, and VLDL) and the Chronic Oral Disease Burden (latent variable comprising caries, bleeding on probing, probing depth ≥ 4 mm, clinical attachment level ≥ 3 mm, and visible plaque index ≥ 15%). Socioeconomic Inequalities influencing the Behavioral Risk Factors (latent variable formed by added sugar, smoking, and alcohol) were analyzed using structural equation modeling. (3) Results: Socioeconomic Inequalities were associated with the Chronic Oral Disease Burden [Standardized Coefficient (SC) = 0.222, p < 0.001]. Behavioral Risk Factors were associated with increased Chronic Oral Disease Burden (SC = 0.103; p = 0.013). Obesity was associated with the Insulin Resistance Phenotype (SC = 0.072; p < 0.001) and the Chronic Oral Disease Burden (SC = 0.066; p = 0.005). The Insulin Resistance Phenotype and the Chronic Oral Disease Burden were associated (SC = 0.053; p = 0.032). (4) Conclusion: The grouping of obesity and early events of diabetes with caries and periodontitis call for a syndemic approach in adolescence.

Accuracy of Intra-Oral Radiography and Cone Beam Computed Tomography in the Diagnosis of Buccal Bone Loss

Christiaens, V., Pauwels, R., Mowafey, B., Jacobs, R. — Tue, 01 Aug 2023 11:35:51 +0200

Background: The use of cone beam computed tomography (CBCT) in dentistry started in the maxillofacial field, where it was used for complex and comprehensive treatment planning. Due to the use of reduced radiation dose compared to a computed tomography (CT) scan, CBCT has become a frequently used diagnostic tool in dental practice. However, published data on the accuracy of CBCT in the diagnosis of buccal bone level is lacking. The aim of this study was to compare the accuracy of intra-oral radiography (IOR) and CBCT in the diagnosis of the extent of buccal bone loss. Methods: A dry skull was used to create a buccal bone defect at the most coronal level of a first premolar; the defect was enlarged apically in steps of 1 mm. After each step, IOR and CBCT were taken. Based on the CBCT data, two observers jointly selected three axial slices at different levels of the buccal bone, as well as one transverse slice. Six dentists participated in the radiographic observations. First, all observers received the 10 intra-oral radiographs, and each observer was asked to rank the intra-oral radiographs on the extent of the buccal bone defect. Afterwards, the procedure was repeated with the CBCT scans based on a combination of axial and transverse information. For the second part of the study, each observer was asked to evaluate the axial and transverse CBCT slices on the presence or absence of a buccal bone defect. Results: The percentage of buccal bone defect progression rankings that were within 1 of the true rank was 32% for IOR and 42% for CBCT. On average, kappa values increased by 0.384 for CBCT compared to intra-oral radiography. The overall sensitivity and specificity of CBCT in the diagnosis of the presence or absence of a buccal bone defect was 0.89 and 0.85, respectively. The average area under the curve (AUC) of the receiver operating curve (ROC) was 0.892 for all observers. Conclusion: When CBCT images are available for justified indications, other than bone level assessment, such 3D images are more accurate and thus preferred to 2D images to assess periodontal buccal bone. For other clinical applications, intra-oral radiography remains the standard method for radiographic evaluation.

Determinants of Microscale pH in In Situ–Grown Dental Biofilms

Kristensen, M. F., Lund, M. B., Schramm, A., Lau, E. F., Schlafer, S. — Wed, 01 Nov 2023 11:35:51 +0100

Dental biofilm pH is the most important determinant of virulence for the development of caries lesions. Confocal microscopy-based pH ratiometry allows monitoring biofilm pH with high spatial resolution. Experiments performed on simplified biofilm models under static conditions identified steep pH gradients as well as localized acidogenic foci that promote enamel demineralization. The present work used pH ratiometry to perform a comprehensive analysis of the effect of whole saliva flow on the microscale pH in complex, in situ-grown 48-h and 96-h biofilms (n = 54) from 9 healthy participants. pH was monitored in 12 areas at the biofilm bottom and top, and saliva flow with film thicknesses corresponding to those in the oral cavity was provided by an additively manufactured microfluidic flow cell. Biofilm pH was correlated to the bacterial composition, as determined by 16S rRNA gene sequencing. Biofilm acidogenicity varied considerably between participants and individual biofilms but also between different areas inside one biofilm, with pH gradients of up to 2 units. pH drops were more pronounced in 96-h than in 48-h biofilms (P = 0.0121) and virtually unaffected by unstimulated saliva flow (0.8 mm/min). Stimulated flow (8 mm/min) raised average biofilm pH to near-neutral values but it did not equilibrate vertical and horizontal pH gradients in the biofilms. pH was significantly lower at the biofilm base than at the top (P < 0.0001) and lower downstream than upstream (P = 0.0046), due to an accumulation of acids along the flow path. pH drops were positively correlated with biofilm thickness and negatively with the thickness of the saliva film covering the biofilm. Bacterial community composition was significantly different between biofilms with strong and weak pH responses but not their species richness. The present experimental study demonstrates that stimulated saliva flow, saliva film thickness, biofilm age, biofilm thickness, and bacterial composition are important modulators of microscale pH in dental biofilms

The feasible application of microfluidic tissue/organ-on-a-chip as an impersonator of oral tissues and organs

Farshidfar, N., Assar, S., Amiri, M. A., et al. — Sat, 01 Jul 2023 11:35:51 +0200

Currently, cell culture models play a key role in determining cell behavior under various conditions. However, the accurate simulation of cellular behavior that imitates the body’s conditions remains a challenge. Therefore, to overcome this obstacle, three-dimensional cell culture models have been developed. Microfluidic tissues/organs-on-chips (TOOCs) are new devices that have provided the opportunity to culture cells in a medium that is almost similar to the physiological conditions of the body. TOOCs can be designed in simple or complex models, which are mostly fabricated by soft lithography. These novel structures have been developed to mimic the conditions of various tissues and organs; however, microfluidic models for oral and dental tissues have not yet been widely used. The application of TOOCs for oral tissues/organs can provide the opportunity to study cell interactions with biomaterials used in dentistry. Furthermore, TOOCs can provide the opportunity to study the cellular interactions and developmental stages of oral tissues/organs more accurately. This review of the current advances in the field of TOOC development for oral tissues provides a comprehensive understanding of this burgeoning concept, shows the progress and applications of these novel models in the imitation of oral tissues/organs thus far, and reveals the limitations that TOOCs confront. Moreover, it suggests further perspectives for future applications. Graphic abstract: [Figure not available: see fulltext.].

World Workshop on Oral Medicine VIII: Development of a core outcome set for dry mouth

Wiriyakijja, P., Niklander, S. E., Santos-Silva, A. R., et al. — Thu, 01 Jun 2023 11:35:51 +0200

Objective: The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project “World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research” to develop a core outcome set for dry mouth. Study Design: A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. Results: From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. Conclusion: There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.

Influence of supracrestal tissue height on peri-implant hard and soft tissues of single implants placed in the esthetic area using the one abutment-one time approach

dos Reis, I. N. R., Todescan, F. F., Ruiz, G. M., et al. — Sat, 01 Jul 2023 11:35:51 +0200

Objective: This pilot, prospective interventional study aimed to analyze the influence of supracrestal tissue height when using the one abutment-one time concept at the time of implant placement, on peri-implant hard and soft tissue remodeling in esthetic areas. The definitive crown was placed 7days later. Method and materials: Facial mucosal margin position, mesial and distal papilla levels, and mesial and distal marginal bone loss were assessed after 7 days (placement of the definitive crown), and 1, 2, 3, 6, and 12 months after implant placement. Patients were classified according to the supracrestal tissue height as thin (< 3 mm) and thick (> 3 mm). Results: Fifteen patients fulfilled the eligibility criteria and were included in the study. Eight presented a thick supracrestal tissue height and seven a thin supracrestal tissue height. After 12 months, the implant success rate was 100%. The mean recession at the facial mucosal margin position was-0.47 ± 0.57 mm and -0.19 ± 0.41 mm in thin and thick groups, respectively (P = .29). The mean mesial papilla level recession was -0.19±0.06mm in the thin group and -0.01± 0.07 mm in the thick group (P< .01), and the mean distal papilla level recession was -0.15±0.09mm in the thin group and 0.00 ± 0.15 mm in the thick group (P<.05).The mean bone loss was -0.21 ± 0.18 mm and -0.04 ± 0.14 mm in the thin and thick groups, respectively (P<.05). Conclusion: Single maxillary anterior implants with thin supracrestal tissue height (<3 mm) at the time of implant placement had greater bone loss and papillary recession than implants with a thick soft tissue height (> 3 mm), even when using the one abutment-one time concept.

Pressure release technique versus placebo applied to cervical and masticatory muscles in patients with chronic painful myofascial temporomandibular disorder

Fri, 01 Sep 2023 11:35:51 +0200

Background: The therapeutic approach to myofascial TMD should focus on pain relief and rehabilitation of function. Objective: This study investigated whether pressure release technique (PRT) is effective for reducing pain in people with chronic myofascial temporomandibular disorders (TMD). Methods: A single-blinded randomised parallel-group trial, with 3 months follow-up was conducted. A total of 72 patients were randomly allocated to receive PRT or sham PRT. Primary outcome was pain assessed with a visual analogue scale (VAS). Secondary outcomes included pressure pain thresholds (PPTs), range of opening of the mouth (ROM), Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK-11), State–Trait Anxiety Index (STAI) and State–Trait Depression Index (ST-DEP). All parameters were assessed at baseline, at the end of the treatment and at 3 months follow-up. Statistical analysis was performed by ANOVA. Results: There were significant main effects of time, group and interaction between time and group (F ≥ 21.92; p <.001) on VAS pain. Post hoc tests showed a significant reduction in VAS pain scores in the PRT group (≥31.9%; p <.001). Effect sizes were moderate in the PRT group at all follow-up periods (≥1.25 Cohen's d). Also, there were significant effects of time in secondary outcomes (F ≥ 9.65; p <.001), and there were also interactions between time and group (F ≥ 3.82; p <.002) with better effects in the PRT group. Conclusions: The inclusion of PRT to conventional management with occlusal splints and self-care management appears to be effective to improve self-reported levels of pain in patients with chronic myofascial TMD pain. Retrospectively registered (ClinicalTrials.gov: NCT03619889).

Effects of short-term motor training on accuracy and precision of simple jaw and finger movements after orthodontic treatment and orthognathic surgery

Liu, J., Hou, W., Gu, J., et al. — Tue, 01 Aug 2023 11:35:52 +0200

Background: Orthognathic surgery has been performed with increasing frequency for the treatment of severe malocclusion, yet the postsurgical neuromuscular recovery of patients has been inadequately studied. Objective: To investigate the effect of short-term and simple jaw motor training on accuracy and precision of jaw motor control in patients following orthodontic treatment and orthognathic surgery. Methods: Twenty patients who had completed preoperative orthodontics, 20 patients who had undergone bimaxillary orthognathic surgery and 20 age-and-gender-matched healthy controls participated in the study. Participants were asked to perform 10 continuous jaw opening and finger lifting movements before and after a 30-min motor training session. The variability in the amplitude of these simple movements was expressed as percentage in relation to the target position (accuracy – D_accu) and as coefficient of variation (precision – CV_prec) to describe the motor performance. Furthermore, the changes in amplitude before and after training were measured in percentage. Results: D_accu and CV_prec of simple jaw and finger movements significantly decreased after motor training (p ≤.018) in all groups. The relative changes in finger movements were higher than jaw movements (p <.001) but with no differences among the groups (p ≥.247). Conclusion: Both accuracy and precision of simple jaw and finger movements improved after short-term motor training in all three groups, demonstrating the inherent potential for optimization of novel motor tasks. Finger movements improved more than jaw movements but with no differences between groups, suggesting that changes in occlusion and craniofacial morphology are not associated with impaired neuroplasticity or physiological adaptability of jaw motor function.

Orofacial pain for clinicians

May, A., Benoliel, R., Imamura, Y., et al. — Tue, 01 Aug 2023 11:35:52 +0200

BACKGROUND: Primary headache syndromes such as migraine are among the most common neurological syndromes. Chronic facial pain syndromes of non-odontogenic cause are less well known to neurologists despite being highly disabling. Given the pain localization, these patients often consult dentists first who may conduct unnecessary dental interventions even if a dental cause is not identified. Once it becomes clear that dental modalities have no effect on the pain, patients may be referred to another dentist or orofacial pain specialist, and later to a neurologist. Unfortunately, neurologists are also often not familiar with chronic orofacial pain syndromes although they share the neural system, i.e., trigeminal nerve and central processing areas for headache disorders. CONCLUSION: In essence, three broad groups of orofacial pain patients are important for clinicians: (i) Attack-like orofacial pain conditions, which encompass neuralgias of the cranial nerves and less well-known facial variants of primary headache syndromes; (ii) persistent orofacial pain disorders, including neuropathic pain and persistent idiopathic facial/dentoalveolar pain; and (iii) other differential diagnostically relevant orofacial pain conditions encountered by clinicians such as painful temporomandibular disorders, bruxism, sinus pain, dental pain, and others which may interfere (trigger) and overlap with headache. It is rewarding to know and recognize the clinical picture of these facial pain syndromes, given that, just like for headache, an internationally accepted classification system has been published and many of these syndromes can be treated with medications generally used by neurologists for other pain syndromes.

Transparency of COVID-19-related research

Sofi-Mahmudi, A., Raittio, E., Uribe, S. E. — Sat, 01 Jul 2023 11:35:52 +0200

Background We aimed to assess the adherence to five transparency practices (data availability, code availability, protocol registration and conflicts of interest (COI), and funding disclosures) from open access Coronavirus disease 2019 (COVID-19) related articles. Methods We searched and exported all open access COVID-19-related articles from PubMed-indexed journals in the Europe PubMed Central database published from January 2020 to June 9, 2022. With a validated and automated tool, we detected transparent practices of three paper types: research articles, randomized controlled trials (RCTs), and reviews. Basic journal- and article-related information were retrieved from the database. We used R for the descriptive analyses. Results The total number of articles was 258,678, of which we were able to retrieve full texts of 186,157 (72%) articles from the database Over half of the papers (55.7%, n = 103,732) were research articles, 10.9% (n = 20,229) were review articles, and less than one percent (n = 1,202) were RCTs. Approximately nine-tenths of articles (in all three paper types) had a statement to disclose COI. Funding disclosure (83.9%, confidence interval (CI): 81.7–85.8 95%) and protocol registration (53.5%, 95% CI: 50.7–56.3) were more frequent in RCTs than in reviews or research articles. Reviews shared data (2.5%, 95% CI: 2.3–2.8) and code (0.4%, 95% CI: 0.4–0.5) less frequently than RCTs or research articles. Articles published in 2022 had the highest adherence to all five transparency practices. Most of the reviews (62%) and research articles (58%) adhered to two transparency practices, whereas almost half of the RCTs (47%) adhered to three practices. There were journal- and publisher-related differences in all five practices, and articles that did not adhere to transparency practices were more likely published in lowest impact journals and were less likely cited. Conclusion While most articles were freely available and had a COI disclosure, adherence to other transparent practices was far from acceptable. A much stronger commitment to open science practices, particularly to protocol registration, data and code sharing, is needed from all stakeholders.

Challenges in treating juvenile idiopathic arthritis

Twilt, M., Stoustrup, P., Rumsey, D. — Fri, 01 Sep 2023 11:35:52 +0200

Purpose of reviewJuvenile idiopathic arthritis (JIA) diagnosis and classification is currently still based on clinical presentation and general laboratory tests. Some joints such as the temporomandibular joint (TMJ) and sacroiliac (SI) are hard to assess and define as actively inflamed based on clinical examination. This review addresses these difficult to assess joints and provides the latest evidence for diagnosis and treatment.Recent findingsRecommendations on clinical examination and radiological examination are available. Recent 2021 ACR recommendations were made for TMJ arthritis and in 2019 for sacroiliitis.SummaryNew evidence to guide clinical suspicion and need for further investigations are available for these hard to assess joints. These guidelines will help healthcare providers in diagnosis and treatment assessment.

Protein ligand and nanotopography separately drive the phenotype of mouse embryonic stem cells

Ghorbani, S., Christine Füchtbauer, A., Møllebjerg, A., et al. — Sun, 01 Oct 2023 11:35:52 +0200

Biochemical and biomechanical signals regulate stem cell function in the niche environments in vivo. Current in vitro culture of mouse embryonic stem cells (mESC) uses laminin (LN-511) to provide mimetic biochemical signaling (LN-521 for human systems) to maintain stemness. Alternative approaches propose topographical cues to provide biomechanical cues, however combined biochemical and topographic cues may better mimic the in vivo environment, but are largely unexplored for in vitro stem cell expansion. In this study, we directly compare in vitro signals from LN-511 and/or topographic cues to maintain stemness, using systematically-varied submicron pillar patterns or flat surfaces with or without preadsorbed LN-511. The adhesion of cells, colony formation, expression of the pluripotency marker,octamer-binding transcription factor 4 (Oct4), and transcriptome profiling were characterized. We observed that either biochemical or topographic signals could maintain stemness of mESCs in feeder-free conditions, indicated by high-level Oct4 and gene profiling by RNAseq. The combination of LN-511 with nanotopography reduced colony growth, while maintaining stemness markers, shifted the cellular phenotype indicating that the integration of biochemical and topographic signals is antagonistic. Overall, significantly faster (up to 2.5 times) colony growth was observed at nanotopographies without LN-511, suggesting for improved ESC expansion.

A new formula for converting dose-area product to effective dose in dental cone-beam computed tomography

Pauwels, R. — Tue, 01 Aug 2023 11:35:52 +0200

Purpose: The purpose of this study was to determine a dedicated conversion formula between dose-area product (DAP) and effective dose (E) for dental CBCT, which incorporates X-ray beam energy as well as geometric factors. Methods: CBCT exposures of an adult phantom were simulated using PCXMC 2.0 (STUK, Finland). Fifty-seven fields of view (FOV) were included, ranging from Ø4x4cm to Ø21x19cm. Six tube voltages (70 kV to 120 kV), eight combinations of Al (2.5 to 10 mm) and Cu (0 to 0.5 mm) filtration, and four source-isocentre distances (35 to 65 cm) were used, resulting in 10 896 simulated scan protocols. In addition, 10 944 random combinations of scan parameters within the aforementioned ranges were simulated, resulting in 21 840 scan protocols that were used for fitting a formula using multiple linear regression with 8 independent variables. Finally, 2304 random scan protocols were simulated as validation data to evaluate the formula's generalizability. Results: E/DAP ranged between 0.031 µSv/mGy.cm² and 0.294 µSv/mGy.cm², with a mean of 0.150 µSv/mGy.cm². Due to extensive clustering of the E/DAP, three formulas were determined according to FOV categories (Small: <100 cm², Medium: 100–400 cm², Large: >400 cm²). The resulting formulas showed mean absolute errors of 7.9%, 4.0% and 3.6%, respectively, for the validation data. Conclusion: The new formulas allow for a straightforward, yet accurate, estimation of the effective dose for dental CBCT based on DAP. Further fine-tuning of the model could be achieved by incorporating, for example, bowtie filtration and off-axis beam geometries.

Referred sensations in the orofacial region are associated with a decreased descending pain inhibition and modulated by remote noxious stimuli and local anesthesia

Sago, T., Costa, Y. M., Ferreira, D. M., Svensson, P., Exposto, F. G. — Sun, 01 Oct 2023 11:35:52 +0200

Referred sensation (RS) as a specific clinical phenomenon has been known for a long time, although the underlying mechanisms remain unclear. The aims of this study were to assess if (1) healthy individuals who experienced RS had a less active endogenous pain system when compared with those who did not; (2) activation of descending pain inhibition mechanisms can modulate RS parameters; and finally, (3) a transient decrease in peripheral afferent input because of a local anesthetic (LA) block in the masseter muscle can modulate RS parameters. To assess these, 50 healthy participants were assessed in 3 different sessions. In the first session, conditioned pain modulation (CPM) as well as mechanical sensitivity and RS at the masseter muscle were assessed. In the same session, participants who experienced RS had their mechanical sensitivity and RS assessed again while undergoing a CPM protocol. In the second and third sessions, participants had their mechanical sensitivity and RS assessed before and after receiving an injection of 2 mL of LA and isotonic saline into the masseter muscle. The main findings of this study were (1) participants who experienced RS during standardized palpation exhibited increased mechanical sensitivity (P < 0.05, Tukey post hoc test) and decreased CPM (P < 0.05, Tukey post hoc test) when compared with those who did not; RS incidence (P < 0.05, Cochran Q test), frequency (P < 0.05; Friedman test), intensity (P < 0.05, Tukey post hoc test), and area (P < 0.05, Tukey post hoc test) were all significantly reduced when assessed (2) during a painful conditioning stimulus and (3) after LA block. These novel findings highlight that RS in the orofacial region are strongly modified by both peripheral and central nervous system factors.

The prevalence of persistent post-traumatic headache in adult civilian traumatic brain injury

Herrero Babiloni, A., Bouferguene, Y., Exposto, F. G., et al. — Fri, 01 Dec 2023 11:35:52 +0100

The most recent prevalence estimate of post-traumatic headache (PTH) after traumatic brain injury (TBI) in veterans and civilians dates back to 2008. The prevalence was found to be 57.8%, with surprising higher rates (75.3%) in mild TBI when compared with those with moderate/severe TBI (32.1%). However, the revision of mild TBI diagnostic criteria and an historic peak of TBI in the elderly individuals attributed to the ageing population may lead to different results. Thus, we conducted a systematic review and meta-analysis to assess the updated prevalence of PTH during the past 14 years only in civilians. A literature search was conducted following PRISMA guidelines guided by a librarian. Screening, full-text assessment, data extraction, and risk of bias assessment were performed blindly by 2 raters. Meta-analysis of proportions using the Freeman and Tukey double arcsine method of transformation was conducted. Heterogeneity, sensitivity analysis, and meta-regressions were performed with the predictors: year of publication, mean age, sex, TBI severity, and study design. Sixteen studies were selected for the qualitative analysis and 10 for the meta-analysis. The overall prevalence estimate of PTH was 47.1%, (confidence interval = 34.6, 59.8, prediction intervals = 10.8, 85.4), being similar at different time points (3, 6, 12, and 36+ months). Heterogeneity was high, and none of the meta-regressions were significant. The overall prevalence of PTH after TBI over the past 14 years remains high even if assessed only in civilians. However, the prevalence rates attributed to mild and moderate/severe TBI were similar, differing significantly from previous reports. Efforts are needed to improve TBI outcomes.

European survey on the use of patient contact shielding during radiological examinations

Granata, C., Briers, E., Candela-Juan, C., et al. — Thu, 01 Jun 2023 11:35:52 +0200

OBJECTIVES: Contact shielding (CS) of patients during X-ray studies has been used for decades to protect radiosensitive organs. This practice has not changed much despite increasing evidence that CS is not useful in many cases. The Gonad And Patient Shielding (GAPS) group-founded by representatives of the main European bodies involved in radiology-promoted this survey to assess the current practice of CS among European radiology departments and the attitude towards a non-shielding policy.

METHODS: Over a four-month period (15 May-15th September 2021) European Society of Radiology and European Society of Paediatric Radiology radiologist members were invited to respond to a web-based questionnaire consisting of 59 questions.

RESULTS: 225 centres from 35 countries responded to this survey. CS was routinely applied in at least one radiological modality in 49.2% of centres performing studies in adults, 57.5% of centres performing studies in children, and 47.8% of centres performing studies on pregnant women. CS was most frequently used in conventional radiography, where the most frequently shielded organs were the gonads, followed by thyroid, female breasts, and eye lens. 83.6% respondents would follow European recommendations on the use of CS when provided by the main European bodies involved in radiology.

CONCLUSIONS: This review shows that CS is still largely used across Europe. However, a non-shielding policy could be adopted in most departments if European professional societies provided recommendations. In this regard, a strong commitment by European and national professional societies to educate and inform practitioners, patients and carers is paramount.

CLINICAL RELEVANCE STATEMENT: According to this survey expectations of patients and carers, and skepticism among professionals about the limited benefits of CS are the most important obstacles to the application of a no-shielding policy. A strong commitment from European and national professional societies to inform practitioners, patients and carers is fundamental.

Influence of metal artefact reduction on the diagnosis of contact between implant and mandibular canal in cone beam computed tomography

Mon, 01 May 2023 11:35:52 +0200

OBJECTIVE: To evaluate the influence of metal artefact reduction (MAR) in the diagnosis of dental implant contact with the mandibular canal (MC) using cone beam computed tomography (CBCT).

METHODS: Dental implants were installed with surgical guides in the posterior hemiarches of 10 dry human mandibles: 0.5 mm above to the MC cortex (G1/n = 8) and 0.5 mm inside the MC (G2/n = 10). The experimental set-up was scanned with two CBCT equipment using 85 kV and 90 kV, MAR ON or OFF, and different tube currents (4 mA, 8 mA and 10 mA). Two dentomaxillofacial radiologists (DMFRs) and two dentists (DDS) scored the relation between the dental implant and MC. Descriptive statistics were used to observe the absolute frequency of scores. Sensitivity, specificity and accuracy were calculated considering the known relation between the dental implant and the MC interior. McNemar's test (α = .05) was applied to compare the diagnostic efficacy of MAR ON versus MAR OFF.

RESULTS: Overall specificity was higher than sensitivity for both DDS and DMFR (97% vs. 50% and 92.0% vs. 78.0% respectively). There was a significant effect of MAR (p = .031) for DMFR in the case of contact between the dental implant with the MC interior, in which sensitivity decreased with MAR activation from 90% to 40%. DMFR observers showed a better diagnostic performance compared with the DDS observers (accuracy of 84.0% and 71.0%, respectively).

CONCLUSIONS: Due to the limited efficacy of MAR, it should not be used when conducting CBCT scans for the evaluation of contact between the implant and the mandibular canal.

Salivary fluoride levels after daily brushing with 5000 ppm fluoride toothpaste

Staun Larsen, L., Nyvad, B., Baelum, V. — Thu, 01 Jun 2023 11:35:52 +0200

This study explored salivary fluoride levels following toothbrushing with 5000 and 1450 ppm fluoride toothpaste and determined the decline in salivary fluoride levels following the return from 5000 to 1450 ppm fluoride toothpaste. The study was a randomised, controlled double-blind parallel clinical trial (n = 24/group) measuring salivary fluoride five times during a 3-week trial phase involving 2×/day use of 5000 or 1450 ppm fluoride toothpaste, and five times during an ensuing 2-week wash-out phase where all participants used 1450 ppm toothpaste. Salivary fluoride was measured using a fluoride electrode and data were analysed using multilevel mixed-effects linear regression. Baseline salivary fluoride geometric means were 0.014 and 0.016 ppm for the 1450 and 5000 ppm groups, while the values at the end of the trial phase were 0.023 and 0.044 ppm, respectively. During the trial phase, except at baseline, differences between groups were statistically significant. The salivary fluoride levels for the 5000 ppm group remained statistically significantly higher than for the 1450 ppm group only at the first measurement in the wash-out phase (≈30 h after the last 5000 ppm brushing), indicating that higher salivary fluoride levels resulting from use of 5000 ppm are sustained only as long as the brushing habit continues.

Quality assessment of online information on orthodontic Web sites in the United States

Thu, 01 Jun 2023 11:35:52 +0200

Introduction: The objective of this study was to assess the quality of online information on orthodontic treatment provided by orthodontic Web sites in the United States and investigate their claims. Methods: Three hundred and one American orthodontic Web sites were identified after an advanced Google search. Data collection included: the location of the clinic, treatment options offered, quality-of-information assessment using the DISCERN tool, and finally, claims when promoting 1 treatment option against another, as well as the presence of information on relapse risk and retention needs. Results: All Web sites belonged to private clinics, with more than half (60.5%) in a single location. Invisalign (Align Technology, Santa Clara, Calif) was the most commonly promoted treatment option (94%), followed by the full fixed appliance (FFA) (92%). The mean DISCERN total score was poor (36.78 out of 80.00), whereas the mean reliability (questions 1-8) and quality-of-information (questions 9-15) scores were 17.06 out of 40.00 and 16.85 out of 35.00, respectively. Almost one-third (28%) of the Web sites compared aligners to FFA, whereas 25% claimed that aligners are less painful than FFA, faster than FFA (14%), or give better results than FFA (1%). Almost half of the Web sites (47%) failed to display information on relapse risk and retention needs after orthodontic treatment (41%). The Web sites that displayed such info had higher DISCERN total scores (P <0.001). Conclusions: Invisalign seems to be the treatment modality most commonly mentioned online. According to DISCERN, U.S. orthodontic Web sites display poor or fair quality information. On many Web sites, aligner treatment was compared with FFA, with some stating that aligners cause less pain than FFA or are more efficient/faster than FFA. Moreover, almost half of the American orthodontic Web sites failed to display information on the relapse risk or retention need. Display of such information can be an indicator of better-quality Web sites. There is ample room for improvement in the online information American orthodontists provide to potential patients.

A novel method for assessment of human midpalatal sutures using CBCT-based geometric morphometrics and complexity scores

Vassis, S., Bauss, O., Noeldeke, B., Sefidroodi, M., Stoustrup, P. — Tue, 01 Aug 2023 11:35:52 +0200

INTRODUCTION: Management of dentofacial deficiencies requires knowledge about sutural morphology and complexity. The present study assesses midpalatal sutural morphology based on human cone-beam computed tomography (CBCT) using geometric morphometrics (GMM) and complexity scores. The study is the first to apply a sutural complexity score to human CBCT datasets and demonstrates the potential such a score has to improve objectiveness and comparability when analysing the midpalatal suture.

MATERIALS AND METHODS: CBCTs of various age and sex groups were analysed retrospectively (n = 48). For the geometric morphometric analysis, landmark acquisition and generalised Procrustes superimposition were combined with principal component analysis to detect variability in sutural shape patterns. For complexity analysis, a windowed short-time Fourier transform with a power spectrum density (PSD) calculation was applied to resampled superimposed semi-landmarks.

RESULTS: According to the GMM, younger patients exhibited comparable sutural patterns. With increasing age, the shape variation increased among the samples. The principal components did not sufficiently capture complexity patterns, so an additional methodology was applied to assess characteristics such as sutural interdigitation. According to the complexity analysis, the average PSD complexity score was 1.465 (standard deviation = 0.010). Suture complexity increased with patient age (p < 0.0001), but was not influenced by sex (p = 0.588). The intra-class correlation coefficient exceeded 0.9, indicating intra-rater reliability.

CONCLUSION: Our study demonstrated that GMM applied to human CBCTs can reveal shape variations and allow the comparison of sutural morphologies across samples. We demonstrate that complexity scores can be applied to study human sutures captured in CBCTs and complement GMM for a comprehensive sutural analysis.

Global status of knowledge of parents for emergency management of traumatic dental injuries

Tewari, N., Goel, S., Srivastav, S., et al. — Sun, 01 Jan 2023 11:35:52 +0100

Research protocol: The protocol was developed as per the recommendations of the Cochrane-handbook and PRISMA and was registered in PROSPERO. Literature search: Search was performed by using MeSH-Terms and keywords in PubMed, Scopus, Embase, Web of Sciences, Lilacs, and Cochrane databases and gray literature sources 15th July 2022. There were no limits regarding the year of publication and language. Hand-searching of included articles was also performed. Titles and abstracts and later full texts were screened as per strict inclusion and exclusion criteria. Data extraction: Self-designed pilot-tested form was used. Quality appraisal: Risk of bias was analyzed through Joanna-Brigg’s-Institute’s-critical appraisal checklist. The evidence analysis was done by using the GRADE approach. Data analysis: Qualitative synthesis was performed for describing the study characteristics, details of sampling, and results of various questionnaires. It was discussed by the expert group and presented using KAP heat map. Meta-analysis was done by using Random Effects Model. Results and interpretation: The risk of bias was found to be low in seven and moderate in one study. It was observed that >50% of parents knew about the urgency to seek professional advice after TDI. Only <50% of parents were confident of their ability to identify the injured tooth, clean the soiled avulsed tooth, and perform the replantation. Appropriate responses regarding immediate action after tooth avulsion were given by 54.5% (95% CI: 50.2–58.8, p = 0.042) of parents. The knowledge of the parents regarding the emergency management of TDI was found to be inadequate. The majority of them were interested in obtaining information about dental trauma first aid.

Association of service use with subjective oral health indicators in a freedom of choice pilot

Raittio, E., Torppa-Saarinen, E., Sokka, T., et al. — Wed, 01 Feb 2023 11:35:52 +0100

Objectives: A freedom of choice pilot provided access to private oral health care services without queuing and with fixed public service-fees for participants in Tampere region, Finland in 2018–2019. The aim of this study was to investigate how use of oral health care services differed by demographics, socioeconomic status, dental fear, and self-reported oral health in this pilot. Material and methods: SMS-messages including a link to online questionnaire were sent to participants who had booked an appointment, and to those who had not booked an appointment despite registering to pilot. We categorized participants to (1) those who had booked their first appointment before receiving SMS (visitors), (2) those who booked an appointment after receiving the SMS-message (late-visitors), and (3) those who had not booked an appointment during pilot (nonvisitors). We used regression analysis to estimate the association of age, gender, dental fear, economic situation, Oral Health Impact Profile-14-severity (oral health-related quality of life [OHRQoL]), self-reported oral health and need for oral health care (exposures) with oral health care service use during the pilot (outcome). Results: Out of 2300 participants, 636 (28%) responded. Late-visitors were more likely older and reported more likely need for oral health care, poorer oral health and OHRQoL than visitors or nonvisitors. Nonvisitors were younger and had better OHRQoL than the others. The differences in the service use by gender, economic situation, and dental fear were small. Conclusions: Service use during the pilot depended on the subjective oral health. Our findings highlight the potential of reminders in increasing care use among those with perceived need for services.

Does dental trauma have impact on the oral health-related quality of life of children and adolescents?

Tewari, N., Mathur, V. P., Goel, S., et al. — Wed, 01 Mar 2023 11:35:52 +0100

Research question: Does dental trauma have impact on the oral health-related quality of life of children and adolescents? Research protocol: Protocol was designed as per the best practices of evidence-based medicine, guidelines for umbrella reviews and registered in PROSPERO. Literature search: PubMed, Scopus, Embase, Web of Sciences and Lilacs were searched for studies meeting the inclusion criteria from start of databases to 15th July 2021. Grey literature and registries of systematic review protocols were also searched. Hand searching of the references of included articles was also performed. The literature search was updated on 15th October 2021. Scrutiny of the titles and abstracts and later full text was done as per the inclusion and exclusion criteria. Data extraction: Self-designed pre-piloted form was used by two reviewers. Quality appraisal: AMSTAR-2 was used to assess the quality of systematic reviews, PRISMA was used to check reporting-characteristics and citation-matrix was used to evaluate study-overlap. Quality of evidence was assessed by using Kohler’s-criteria. Data analysis: Qualitative synthesis was performed for describing the study characteristics, details of sampling and the tool of OHRQoL used. The meta-analytic data was used for evaluating the evidence and its strength for each of the outcomes. Results and interpretation: A significant impact of all types of TDI on OHRQoL in children and adolescents was observed. The effect of uncomplicated TDI on OHRQoL in children and all ages showed no difference from controls. Though the quality of evidence in these interpretations was weak.

World Workshop on Oral Medicine VIII

Niklander, S. E., Simms, M. L., Wiriyakijja, P., et al. — Thu, 01 Jun 2023 11:35:52 +0200

Objective: This study aimed to develop a consensus-based core outcome set (COS) to be used in clinical trials assessing dry mouth interventions. Study Design: Through 2 systematic literature reviews and interviews with dry mouth patients, we identified relevant outcome domains for dry mouth assessment. A Delphi survey was presented to health care providers attending the American Academy of Oral Medicine annual meeting in Memphis, Tennessee, USA, on May 2022 (n = 104) and 10 dry mouth patients at Cork University Dental School and Hospital, Republic of Ireland. The outcome domains for which no consensus was reached were subsequently discussed in a second consensus process led by a virtual Special Interest Group of 11 oral medicine experts from the World Workshop on Oral Medicine VIII dry mouth working group. Results: After the 2-step consensus process, a consensus was reached for 12 dry mouth outcome domains (i.e., salivary gland flow, signs of hyposalivation, mucosal moisture/wetness, the severity of xerostomia, duration of xerostomia, the overall impact of xerostomia, impact on physical functioning, impact of hyposalivation on general health, impact on social activities, quality of life, the economic impact of dry mouth, patient satisfaction) to be included in the final COS. Conclusions: We propose a consensus-based COS to assess dry mouth interventions in clinical trials. This COS includes the minimum but mandatory set of domains that all clinical trials evaluating dry mouth treatments should assess.

Mihin otsoni kelpaa?

Raittio, E. J. — Thu, 01 Dec 2022 11:35:52 +0100

Kirjoitusnopeus tarkastelussa

Raittio, E. J. — Sun, 01 Jan 2023 11:35:52 +0100

Mitä parodontiitin lähes sadan prosentin esiintyvyys tarkoittaa?

Raittio, E. J. — Wed, 01 Mar 2023 11:35:52 +0100

Clinical Trial Data on the Mechanical Removal of 14-Day-Old Dental Plaque Using Accelerated Micro-Droplets of Air and Water (Airfloss)

Chokyu Del Rey, Y., Rikvold, P. D., Johnsen, K. K., Schlafer, S. — Sat, 01 Apr 2023 11:35:52 +0200

Novel strategies to combat dental biofilms aim at reducing biofilm stability with the ultimate goal of facilitating mechanical cleaning. To test the stability of dental biofilms, they need to be subjected to a defined mechanical stress. Here, we employed an oral care device (Airfloss) that emits microbursts of compressed air and water to apply a defined mechanical shear to 14-day-old dental plaque in 20 healthy participants with no signs of oral diseases (clinical trial no. NCT05082103). Exclusion criteria included pregnant or nursing women, users of oral prostheses, retainers or orthodontic appliances, and recent antimicrobial or anti-inflammatory therapy. Plaque accumulation, before and after treatment, was assessed using fluorescence images of disclosed dental plaque on the central incisor, first premolar, and first molar in the third quadrant (120 images). For each tooth, the pre- and post-treatment plaque percentage index (PPI) and Turesky modification of the Quigley-Hein plaque index (TM-QHPI) were recorded. The mean TM-QHPI significantly decreased after treatment (p = 0.03; one-sample sign test), but no significant difference between the mean pre- and post-treatment PPI was observed (p = 0.09; one-sample t-test). These data are of value for researchers that seek to apply a defined mechanical shear to remove and/or disrupt dental biofilms. Dataset: The dataset is submitted as a supplement Dataset License: CC-BY-NC.

Endo-sinus bone gain following osteotome-mediated sinus floor elevation with Bio-Oss Collagen compared with no grafting material

Starch-Jensen, T., Bruun, N. H., Spin-Neto, R. — Wed, 01 Nov 2023 11:35:52 +0100

The objective of this study was to assess endo-sinus bone gain (ESBG) following osteotome-mediated sinus floor elevation with Bio-Oss Collagen (test) compared with no grafting material (control) using two- and three-dimensional radiographic methods, as part of a randomized controlled trial (ClinicalTrials.gov, NCT04618900). Forty healthy patients who met the necessary eligibility criteria were allocated by block randomization to either the test group (20 patients) or control group (20 patients). Cone beam computed tomography scans were obtained at enrolment (T0), immediately after surgery (T1), at delivery of the prosthetic rehabilitation (T2), and 1 year after functional implant loading (T3). Mean differences were expressed with the 95% confidence interval; significance was set at P < 0.05. ESBG was significantly increased with Bio-Oss Collagen compared with no grafting material at T1, T2, and T3 (P < 0.001). A gradual decrease in ESBG was observed over time with both treatment modalities (P < 0.001), which diminished the difference between the test and control groups at T2 and T3. ESBG was observed to be positively correlated with implant protrusion length and negatively correlated with the residual bone height. In osteotome-mediated sinus floor elevation, the application of Bio-Oss Collagen underneath the elevated Schneiderian membrane improved ESBG significantly when compared with no grafting material. However, the increased ESBG seems not to have positively improved the treatment outcomes in terms of the implant stability quotient or the survival of the implants or suprastructures.

Causal inference in dentistry

Schuch, H. S., Nascimento, G. G., Demarco, F. F., Haag, D. G. — Wed, 01 Feb 2023 11:35:52 +0100

Oral conditions represent a critical public health challenge, and together with descriptive and predictive epidemiology, causal inference has a crucial role in developing and testing preventive oral health interventions. By identifying not just correlations but actual causes of disease, causal inference may quantify the average effect of interventions and guide policies. Although authors are not usually explicit about it, most oral health studies are guided by causal questions. However, methodological deficiencies limit their interpretability and the implementation of their findings. This manuscript is a call to action on the use of causal inference in oral research. Its application starts with asking theoretically sound questions and being explicit about causal relationships, defining the estimates to evaluate, and measuring them properly. Beyond promoting causal analytical approaches, we emphasize the need for more causal thinking to promote thoughtful research questions and the use of appropriate methods to answer them. Causal inference relies on the plausibility of assumptions underlying the data analysis and the quality of the data, and we argue that high-quality observational studies can be used to estimate average causal effects. Although individual efforts to embrace causal inference in dentistry are essential, they will not yield substantial results if not led by a systematic and structural change in the field. We urge scientific societies, funding bodies, dental schools, and journals to promote transparency in research, causal thinking, and causal inference projects to move the field toward more meaningful studies. It is also time for researchers to move forward and connect with the community, co-produce investigations and translate their findings, and engage in interventions that impact public health. We conclude by highlighting the importance of triangulating results from different data sources and methods to support causal inference and inform decision-making on interventions to effectively improve population oral health.

The Role of Dyslipidemia in Periodontitis

Sun, 01 Jan 2023 11:35:52 +0100

Studies have suggested an important role of dyslipidemia, a condition with alterations in blood lipid levels, in promoting an additional effect on periodontal breakdown. Thus, this study aimed to explore the theoretical pathways associated with dyslipidemia and periodontitis. We used data from 11,917 US adults with complete periodontal examinations participating in the Third National Health and Nutrition Examination Survey (NHANES III). Our hypothesis was tested using structural equation modelling (SEM). Dyslipidemia was defined according to the National Cholesterol Education Program (NCEP-ATP III) and periodontitis as a latent variable reflecting the shared variance of the number of surfaces with periodontal pocket depth [PPD] = 4 mm, PPD = 5 mm, PPD ≥ 6 mm, clinical attachment level [CAL] = 4 mm, CAL = 5mm, CAL ≥ 6 mm, and furcation involvement. The model also considered distal determinants (age, sex, and socioeconomic status) and proximal determinants (HbA1c, smoking and alcohol consumption, and obesity). The model showed sufficient global fit (Root Mean Squared Error of Approximation = 0.04, 90%CI = 0.04–0.05, Tucker–Lewis Index = 0.93, Comparative Fit Index = 0.95). Age, sex, socioeconomic status, obesity, and smoking were directly associated with periodontitis (p < 0.01). Dyslipidemia revealed a significant direct effect on periodontitis (standardized coefficient [SC] = 0.086, SE 0.027; p < 0.01), also mediated via an indirect pathway through HbA1c (SC = 0.021; SE 0.010; p = 0.02) and obesity (SC = 0.036; SE 0.012; p < 0.01) and resulted in a total effect on periodontitis. Dyslipidemia was associated with periodontitis through a direct pathway and indirectly through HbA1c and obesity in the US population. These results support the need for a multi-professional approach to tackling oral and noncommunicable diseases (NCDs), directed at their common risk factors.

Reporting of absolute and relative risk measures in oral health and cardiovascular events studies

Raittio, E., Ashraf, J., Farmer, J., Nascimento, G. G., Aldossri, M. — Sat, 01 Apr 2023 11:35:52 +0200

Objectives: To understand the magnitude of risk of health events, such as cardiovascular diseases (CVD), related to poor oral health, both relative and absolute risk measures should be reported. Our aim was to investigate the extent to which absolute and relative measures of risk are reported in longitudinal studies that assess the association between oral health indicators (OHIs) and CVD. Methods: A systematic search of longitudinal studies investigating the association of any OHI with CVD was carried out using the Embase, Medline and Cochrane library databases. The search covered each database from its inception date to August 2021. Data about reporting relative and absolute risks of the relationship between CVD and OHI from the abstract were extracted. If the relative risk for OHIs and CVD was reported in the abstract, then the underlying absolute risks were searched from the full text, and it was assessed whether it was similarly adjusted for confounding than was the relative risk in the abstract. Results: One hundred-six articles were included. From these, 85 (80%) studies reported the association of OHIs and CVD with one or more relative risks in the abstract. Of those 85 studies, the underlying absolute risks were accessible or calculable from the abstract or full text of 60 studies. However, of these 60 studies, in only 10 (12%), the underlying absolute risks were similarly adjusted, as were the relative risks in the abstract. The absolute risks of CVD by OHIs were rarely reported without corresponding relative risks in the abstract (n = 2, 2%). Median absolute risk difference in the CVD risk between exposure levels to which the first relative risk in the abstract referred was 1.8% (interquartile range 0.6–4.6, n = 63). Conclusions: Focusing on relative risks over absolute risks was a common practice in literature. Reporting similarly adjusted underlying absolute risks of relative risks was rare in most studies, despite those being helpful for comprehending the magnitude of CVD-risk increase related to poor oral health. Current reporting practices could lead to an overinterpretation of risk increase of CVD related to poor oral health.

Salivary cytokine expression after non-surgical periodontal therapy in smokers

Leite, F. R.M., López, R., Møller, H. J., Nascimento, G. G. — Sat, 01 Jul 2023 11:35:52 +0200

Background: Diverse smoking trajectories may influence cytokine expression after non-surgical periodontal therapy and supportive periodontal care. Thus, we aimed to describe cytokine profiles in periodontal healing after periodontal therapy in smokers. Methods: A smoking cessation program and non-surgical periodontal therapy were offered to 80 smokers with periodontitis. Smoking trajectories (quitters/light, moderate, heavy) were observed. The association of salivary interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α) with smoking trajectories and periodontal outcomes was determined using mixed-effects linear regression. Results: Among quitters/light smokers, IL-1β was associated with an increase in mean periodontal pocket depth (PPD) and mean clinical attachment level (CAL). IL-6 was associated with a decrease in mean PPD and CAL in heavy smokers, whereas IL-8 was associated with a decrease in PPD among moderate smokers. TNFα was associated with a reduction in mean PPD and CAL among quitters/light smokers, while among moderate smokers, TNFα was associated with an increase in mean PPD and CAL. IL-12 and IL-13 were associated with a decrease in mean PPD in moderate smokers. Conclusion: Our findings suggest that distinctive smoking exposures induce differential cytokine expression, which, in turn, seems to influence periodontal repair.