Wiley: International Dental Journal: Table of Contents

Current concepts in the management of periodontitis

TaeHyun Kwon, Ira B. Lamster, Liran Levin — Sat, 05 Dec 2020 04:36:17 -0800

Periodontitis is a common disorder affecting >40% of adults in the United States. Globally, the severe form of the disease has a prevalence of 11%. In advanced cases, periodontitis leads to tooth loss and reduced quality of life. The aetiology of periodontitis is multifactorial. Subgingival dental biofilm elicits a host inflammatory and immune response, ultimately leading to irreversible destruction of the periodontium (i.e. alveolar bone and periodontal ligament) in a susceptible host. In order to successfully manage periodontitis, dental professionals must understand the pathogenesis, primary aetiology, risk factors, contributing factors and treatment protocols. Careful diagnosis, elimination of the causes and reduction of modifiable risk factors are paramount for successful prevention and treatment of periodontitis. Initial non-surgical periodontal therapy primarily consists of home care review and scaling and root planing. For residual sites with active periodontitis at periodontal re-evaluation, a contemporary regenerative or traditional resective surgical therapy can be utilised. Thereafter, periodontal maintenance therapy at a regular interval and long-term follow-ups are also crucial to the success of the treatment and long-term retention of teeth. The aim of this review is to provide current concepts of diagnosis, prevention and treatment of periodontitis. Both clinical and biological rationales will be discussed.

Geospatial analysis of the urban and rural/remote distribution of dental services in Scotland, Wales and Northern Ireland

Olivia Jo, Estie Kruger, Marc Tennant — Wed, 25 Nov 2020 18:16:52 -0800

Aim

To address deficits in human resources for oral health data (HROH) in rural and remote areas in Wales, Scotland and Northern Ireland by spatially profiling and modelling the distribution pattern of dental practices according to Health Boards.

Methods

National Health Service (NHS) dental practices were located and mapped against population and rural–urban classifications of Scotland, Wales and Northern Ireland, using Geographic Information System (GIS) tools. All data collected were at the smallest geographical statistical hierarchy level in each country, and population data were retrieved from the 2011 census.

Results

A total of 1,695 NHS dental practices were mapped against 27 Health Board regions. In Scotland, Northern Ireland and Wales, 18.3%, 18.7% and 7.7%, respectively, of the population living in the most remote areas resided within 2.5 km of a dental practice. In each country, the Health Boards with the largest proportion of the population living more than 10 km from a dental practice were the Western Isles (Scotland), Western Health and Social Care Trust (HSCT) (Northern Ireland) and Hywel Dda University Health Board (UHB) (Wales). In each country, the highest practice-to-population (PtP) ratios were found in Forth Valley (1:7,194) (Scotland), Southern HSCT (1:5,115) (Northern Ireland) and Hywel Dda UHB (Wales) (1:7,907).

Conclusion

Dental services are distributed unequally between urban and rural areas. PtP ratios coupled with GIS analysis are important tools to improve HROH distribution.

Diabetes mellitus risk among Jordanians in a dental setting: a cross‐sectional study

Wed, 25 Nov 2020 18:16:52 -0800

Background

Dental offices can be useful to screen and identify patients at risk of developing diabetes mellitus (DM) using risk prediction tools. The Finnish Diabetes Risk Score (FINDRISC) is a validated, questionnaire-based tool used to predict the 10-year risk of developing type II DM.

Objectives

To determine the 10-year DM risk among Jordanians using the FINDRISC questionnaire in a dental setting.

Materials and methods

Participants attending two university dental teaching centres between March 2017 and February 2018 were interviewed using an Arabic translated version of the FINDRISC questionnaire. Anthropometrics including weight, height, waist circumference (WC) and body mass index (BMI) were recorded. Random capillary blood glucose level was measured for each participant. Statistical analysis was done using Chi-square and independent t-tests.

Results

A total of 1,247 (436 males and 811 females) participants were included. As defined by BMI, 1,012 (81.2%) participants were either overweight or obese. Abdominal adiposity as determined by WC was seen in 738 (59.2%) participants. The mean (± SD) FINDRISC score for females (11.3 ± 4.3) was significantly higher (P = 0.001) than males (10.4 ± 4.9). After age adjustment, more females were in the high-risk categories (FINDRISC ≥ 15) compared with males. This trend was seen among all age groups, but was statistically significant in the older age groups; 55–64 years (P = 0.037) and ≥ 65 years (P = 0.004).

Conclusion

In a developing Middle Eastern country such as Jordan, almost half of Jordanians attending university dental clinics are at a moderate to high risk of developing type II DM in 10 years. The risk of DM should be considered in dental patients, particularly older females.

Dental pain and associated factors in Mexican adolescents and young adults: a cross‐sectional study

Wed, 25 Nov 2020 18:16:52 -0800

Objective

To identify the factors associated with the prevalence of dental pain in Mexican adolescents and young adults.

Material and methods

This is a cross-sectional study in which data from 638 Mexican subjects, 16–25 years of age, who were randomly selected from college applicants, were analysed. Questionnaires were administered to collect sociodemographic, economic and behavioural variables. Clinical examinations were carried out to determine the decayed, missing and filled teeth (DMFT) index. The outcome variable was dichotomised as 0 (no dental pain in the last 12 months) or 1 (dental pain in the last 12 months). Statistical analyses included binary logistic regression.

Results

Average age was 18.76 ± 1.76 years, and 49.2% of participants were women. Prevalence of dental pain was 34.0%. In the final model, variables significantly (P < 0.05) associated with the experience of dental pain were the use of preventive dental services (OR = 0.34), being a former smoker (OR = 2.37), self-report of very poor/poor oral health (OR = 1.94) or fair oral health (OR = 1.94), self-reported dental disease (OR = 2.06) or gingival disease (OR = 2.84).

Conclusions

The prevalence of dental pain was associated with self-reported oral health status, preventive dental visits and smoking; these results have implications for dental practice. We found that recent experience of dental pain was common in young adults, being reported by one out of three subjects.

Comparison of perceptions, attitudes and performance regarding collaborative oral health care among health‐care workers

Wed, 25 Nov 2020 18:16:52 -0800

Objective

Collaborative oral health care among health-care workers (HCWs) is important to prevent oral and systemic diseases. The purpose of this study was to investigate the perceptions, attitudes and performance of HCWs regarding collaborative oral health care and to compare them among HCWs.

Method

The subjects were dentists (DTs), dental hygienists (DHs), hospital nurses (HNs), speech–language–hearing therapists (STs) and certified care workers (CCWs) in Fukuoka Prefecture, Japan. DTs were members of the Fukuoka Dental Association, and DHs worked in dental clinics. HNs worked in hospitals without dental departments. STs and CCWs were members of professional associations. Data were collected by a mail survey. The chi-square test and Kruskal–Wallis test were used to compare the data among HCWs.

Results

A total of 119 DTs, 91 DHs, 229 HNs, 119 STs and 121 CCWs participated in this study. The total response rate was 20.6%. There were significant differences in perceptions of what should be performed as part of oral health care among HCWs. Only 20%–60% of HCWs performed collaborative oral health care, while more than 75% were willing to perform such care. Levels of collaborative oral health care with other types of professionals and positive willingness to perform such care were lower among HNs than among the other HCWs.

Conclusions

It is suggested that oral health professionals should recognise the presence of differences in the perceptions, attitudes and performance among other types of HCW and try to improve these to promote interprofessional collaboration of oral health care in hospitals.

Rare genetic diseases affecting skeletal development and oral health disparities among children and adolescents: a pathway analysis

Wed, 25 Nov 2020 18:16:52 -0800

Background

To examine the relationships of rare genetic diseases affecting skeletal development, socio-demographic characteristics, and oral health-related behaviours with dental clinical measures in children and adolescents.

Methods

A cross-sectional study paired by age, gender and social class included 61 children and adolescents with osteogenesis imperfecta (n = 40) or mucopolysaccharidoses (n = 21) and those without genetic rare diseases (n = 60). Participants were selected at two referral hospitals for rare genetic diseases in the city of Belo Horizonte, Brazil. Caregivers completed a questionnaire to obtain age, gender, caregiver’s schooling, social class, patterns of dental attendance and duration of breastfeeding. Oral hygiene, dental caries, dental anomalies and malocclusion were assessed through dental examinations. The relationships between variables were estimated through Pathway analysis using the maximum likelihood method.

Results

Rare genetic diseases affecting skeletal development were directly associated with dental caries (β = 0.22), dental anomalies (β = 0.36) and malocclusion (β = 0.29). They were also inversely linked to a preventive pattern of dental attendance (β = −0.25). Rare genetic diseases affecting skeletal development were associated with poor oral hygiene (β = 0.28) and shorter breastfeeding duration (β = −0.21). Rare genetic diseases affecting skeletal development were linked indirectly with dental caries, a reduced pattern of dental attendance and poor oral hygiene (β = 0.43). Patterns of dental attendance mediated the link between rare genetic diseases affecting skeletal development and malocclusion (β = −0.05).

Conclusion

Rare genetic diseases affecting skeletal development were associated with poor oral health. Patterns of dental attendance and poor oral hygiene mediated the link between rare genetic diseases affecting skeletal development and dental clinical measures.

Importance of oral health and dental treatment in organ transplant recipients

Eun‐Jung Kwak, Dong‐Jin Kim, Yiseul Choi, Dong Jin Joo, Wonse Park — Wed, 25 Nov 2020 18:16:52 -0800

Objectives

The purpose of the present study was to investigate which peri-transplant dental treatments were deemed necessary, and to determine retrospectively how often these treatments were actually performed, in patients who had received organ transplants.

Materials and Methods

Medical records of the Department of Advanced General Dentistry at Yonsei University Dental Hospital were searched to identify liver or kidney transplant recipients who attended from 1st March 2014 to 31st December 2017. A total of 418 patients were identified, and their medical charts were reviewed. Sex, underlying systemic disease, oral hygiene status, dental treatment deemed necessary, dental treatment actually performed and durations of follow-up were tabulated.

Results

More than half (53.8%) of the liver transplant recipients had poor oral hygiene, and poor oral hygiene was statistically significantly more prevalent in the liver transplant group than in the kidney transplant group (40.3%). In liver recipients in whom scaling was deemed to be required pre-transplant, the rate of it actually being performed pre-transplant was high (83.2%). By contrast, the rates of tooth extraction and prosthetic treatment actually being performed pre-transplant were low (12.8% and 0%, respectively). In kidney recipients, the rates of scaling, tooth extraction and prosthetic treatment actually performed pre-transplant, when deemed to be required, were 93.5%, 10.0% and 0.0%, respectively.

Conclusions

We recommend that patients scheduled to receive an organ transplant be referred to a dental clinic as soon as possible beforehand, to remove any potential sources of oral infection. Educating physicians, as well as their patients, about the importance of early dental screening and pre-transplant dental treatment is essential.

Accuracy of a questionnaire on xerostomia as a screening tool for hyposalivation

Wed, 25 Nov 2020 18:16:52 -0800

Objective

Determine the accuracy of a questionnaire on xerostomia as a screening tool for hyposalivation.

Methods

A total of 402 adults awaiting dental care at a public healthcare service answered an eight-item questionnaire addressing xerostomia and were submitted to stimulated sialometry, with ≤ 0.7 mL/min considered indicative of hyposalivation. Reproducibility and internal consistency of the questionnaire were evaluated. The correlation between the score and salivary flow was investigated. The total score was also compared between groups with and without hyposalivation and diagnostic precision measures were calculated.

Results

Hyposalivation was identified in 162 participants (40.3%) and a total of 229 (57.0%) answered affirmatively to at least one question. The responses to each question revealed variable reproducibility (κ = 0.450–0.785) and satisfactory internal consistency (Cronbach's α = 0.70). Individuals with a larger number of positive answers had lower salivary flow (Spearman's ρ = −0.193; P < 0.001). The mean number of positive answers was greater in the group with a clinical diagnosis of hyposalivation compared to those without low salivary flow. The sensitivity of the screening tool was 64.8%, with an area under the ROC curve of 0.60 (95% confidence interval: 0.547–0.645; P < 0.001).

Conclusion

The questionnaire proved to be useful for the epidemiological screening of individuals with possible hyposalivation.

Characteristics and trends in the expansion of private dental schools in Brazil

Leila S. Maia, Mario R. Dal Poz — Wed, 25 Nov 2020 18:16:52 -0800

Objective

This article describes and analyses the characteristics of the expansion of private dental education in Brazil from 1996 to December 2018 and its relationships with public policies and the country’s labour and education market in dentistry.

Method

The study used an exploratory and descriptive quantitative approach involving standardised data-collection techniques from open-access secondary databases.

Result

From 1996 to 2018 there was an overall increase of 315% in dental schools (582% in the private sector and 49% in the public sector). Brazil had 374 dental schools in December 2018, 307 of which were private and 67 of which were public. The 374 schools offered 47,192 admission places, 89% of which were private. In five states, dental education is 100% private, while in another 19 states the private supply exceeds 70% of the total. In the other three states this offer is between 40% and 67%. From 1996 to 2016, the private sector’s share of dental school graduates was 66%. Women represented 73% of Brazilian dental-school graduates in 2016.

Conclusion

Privatisation of dental education in Brazil raises challenges for the development of policies, planning, organisation of care, and structuring of the training process for dentists, as well as the dynamics of the labour market in the health system.

The light‐curing unit: An essential piece of dental equipment

Richard B. Price, Jack L. Ferracane, Reinhard Hickel, Braden Sullivan — Wed, 25 Nov 2020 18:16:52 -0800

Introduction

This article describes the features that should be considered when describing, purchasing and using a light-curing unit (LCU).

Methods

The International System of Units (S.I.) terms of radiant power or radiant flux (mW), spectral radiant power (mW/nm), radiant exitance or tip irradiance (mW/cm²), and the irradiance received at the surface (also in mW/cm²) are used to describe the output from LCU. The concept of using an irradiance beam profile to map the radiant exposure (J/cm²) from the LCU is introduced.

Results

Even small changes in the active tip diameter of the LCU will have a large effect on the radiant exitance. The emission spectra and the effects of distance on the irradiance delivered are not the same from all LCUs. The beam profile images show that using a single averaged irradiance value to describe the LCU can be very misleading. Some LCUs have ‘hot spots’ of high radiant exitance that far exceed the current ISO 10650 standard. Such inhomogeneity may cure the resin unevenly and may also be dangerous to soft tissues. Recommendations are made that will help the dentist when purchasing and then safely using the LCU.

Conclusions

Dental manufacturers should report the radiant power from their LCU, the spectral radiant power, information about the compatibility of the emission spectrum from the LCU with the photoinitiators used, the active optical tip diameter, the radiant exitance, the effect of distance from the tip on the irradiance delivered, and the irradiance beam profile from the LCU.

Issue Information ‐ TOC

Wed, 25 Nov 2020 18:16:52 -0800

International Dental Journal, Volume 70, Issue 6, Page 405-405, December 2020.

Comparison of new formulas of stannous fluoride toothpastes with other commercially available fluoridated toothpastes: A systematic review and meta‐analysis of randomised controlled trials

Danielle Clark‐Perry, Liran Levin — Wed, 25 Nov 2020 18:16:52 -0800

Aim

The aim of this study was to systematically review and analyse the difference in efficacy of stannous fluoride toothpaste formulations in comparison to other fluoridated toothpastes without stannous fluoride.

Materials and methods

A systematic search of the literature was performed according to PRISMA guidelines. A search strategy was developed to answer the study question and was performed in PubMed-Medline databases. Inclusion criteria were randomised controlled clinical trials comparing stannous fluoride toothpaste formulations with other fluoridated toothpastes not containing stannous fluoride.

Results

The search in PubMed-Medline databases resulted in 384 articles; 23 articles were downloaded for review, 16 articles were included in the report and six could be used for meta-analysis. All studies were randomised controlled clinical trials that compared clinical outcomes between toothpastes with stannous fluoride combinations and toothpastes with only fluoride. The overall results of the 16 studies favoured the stannous fluoride formulations. However, in a meta-analysis of the randomised controlled clinical trials, it was demonstrated that stannous fluoride toothpaste formulations provided significantly better outcomes based on the Gingival Index (SMD −0.14, 95% CI −0.20, −0.07, P = 0.0001), but not the Modified Gingival Index (SMD −0.30, 95% CI −0.7, 0.09, P = 0.13).

Practical implications

The antibacterial properties of stannous seem to provide favourable results when formulated with a fluoridated toothpaste. This systematic review highlights the lack of homogenous research available to rigorously compare stannous fluoride toothpaste formulations with other fluoridated toothpastes without stannous fluoride.

Caries prevalence and severity for 12‐year‐old children in Latvia

Ilze Maldupa, Anete Sopule, Sergio E. Uribe, Anda Brinkmane, Egita Senakola — Fri, 30 Oct 2020 15:44:55 -0700

Objectives

To study caries prevalence/severity in 12-year-old children in Latvia and potential risk indicators.

Methods

A cross-sectional oral-health national survey of 12-year-old children was conducted in 2016. A nationally representative stratified-cluster probabilistic sample of 2,138 pupils in 92 schools was selected. Children were examined by seven calibrated examiners (kappa inter-examiner, intra-examiner scores of 0.71–0.77, 0.81–0.97, respectively) at school. Enamel-non-cavitated decay (D₁), enamel cavitation (D₃), dentine cavitation (D₅), missing (M) or filled (F) status at the tooth (T)/surface (S) levels were evaluated, and decayed, missing, and filled (DMF) index scores for severity, along with the Significant Caries Index (SiC), were calculated. An associated caries factor questionnaire was completed by participants.

Results

The prevalence of caries was 98.5% for D₁MFT, 79.7% for D₃MFT, and 71.9% for D₅MFT. The means (standard deviations) for severity were 9.2 (5.3) for D₁MFT, 3.3 (3.0) for D₃MFT, and 2.4 (2.4) for D₅MFT, and 5.6 (2.1) for the SiC. Indicators associated with a lower risk of caries (D₅MFT) were irregular dental visits (prevalence odds ratio POR = 0.45, 95% confidence interval (CI): 0.36, 0.56) and irregular use of mouthwashes (POR = 0.73, 95% CI: 0.60, 0.89).

Conclusions

We found a high caries prevalence and severity in 12 year-old children in Latvia. Although the WHO target for 2010 (D₅MFT ≤ 3) is met, the values for caries prevalence (D₅MFT > 0 = 71.9%) and severity (D₅MFT = 2.5) in 12-year-old Latvian children are higher than the European averages (D₅MFT > 0 = 52%, D₅MFT = 1.1).

Dental pain in homeless adults in Porto Alegre, Brazil

Fri, 23 Oct 2020 15:15:09 -0700

Objective

To evaluate the association of dental pain with time living on the street in a sample of homeless people in the city of Porto Alegre, Brazil.

Methods

A cross-sectional study was carried out with homeless people who accessed social services in 2017. A questionnaire was administered covering socioeconomic variables and including questions about general health, use of tobacco/alcohol/drugs, use of dental services and history of dental pain. The decayed, missing, and filled teeth (DMFT) index was calculated in an oral examination. The association between socioeconomic characteristics, health status, time of homelessness and dental pain was evaluated using chi-square, t-, and Mann-Whitney tests.

Results

A total sample of 214 homeless people was surveyed. Most were male (76.2%), had a low level of education (67.6%) and experienced many episodes of dental pain during life (91.0%). The last episode of pain was moderate or intense (79.7%) and do-it-yourself measures for pain relief were preferred (62.3%). Individuals who were homeless for longer than 1 year had more dental pain in the past (P < 0.001), more frequency of a recent episode of dental pain (P = 0.03), and sought a dentist or healthcare service to relieve pain less frequently (P = 0.03).

Conclusions

Dental pain is frequent in the context of homelessness and does not necessarily result in seeking dental services, even where there is universal oral health care.

Association between arterial hypertension and periodontal status in morbidly obese patients who are candidates for bariatric surgery

Sat, 10 Oct 2020 19:59:25 -0700

Objective

This study aimed to compare the systemic and periodontal conditions between morbidly obese patients with and without hypertension who were candidates for bariatric surgery.

Methods

The study cohort had 111 morbidly obese patients stratified into two groups: patients with (G1 = 54) and without (G2 = 57) arterial hypertension. The following characteristics were compared between the two groups: (i) education level; (ii) anthropometric parameters [weight, height, body mass index (BMI), waist and hip circumferences and waist-to-hip ratio (WHR)]; (iii) risk of developing cardiovascular diseases (based on patients' sex, age and WHR); (iv) behaviours regarding oral hygiene; and (v) periodontal status. The t-test, Mann–Whitney U-test, chi-square test and logistic regression were applied, with a significance level of 5%.

Results

Patients in G1 had a lower level of education (P = 0.002). There were no intergroup differences for weight (P = 0.211), height (P = 0.126), BMI (P = 0.551), waist circumference (P = 0.859) and WHR (P = 0.067); however, patients in G2 had a smaller hip circumference (P = 0.029), and 78% of patients in G1 had a high/very high risk of developing cardiovascular diseases. The prevalence of periodontitis was 72.2% (n = 39) in G1 and 38.6% (n = 22) in G2. On logistic regression analysis, age [adjusted odds ratio (OR) = 1.07; 95% CI = 1.01–1.13; P = 0.008) and the presence of arterial hypertension (OR = 2.77; 95% CI = 1.17–6.56; P = 0.019) were identified as the independent variables associated with periodontitis.

Conclusion

Morbid obesity and arterial hypertension are associated with a higher prevalence of cardiovascular diseases. Moreover, morbidly obese patients with hypertension have a higher prevalence of periodontitis and greater severity of periodontal disease than those without hypertension.

Molar incisor hypomineralisation: current knowledge and practice

Helen D. Rodd, Anna Graham, Niecoo Tajmehr, Laura Timms, Noren Hasmun — Thu, 08 Oct 2020 09:01:00 -0700

Background

Molar incisor hypomineralisation (MIH) is a common developmental dental condition that presents in childhood. Areas of poorly formed enamel affect one or more first permanent molars and can cause opacities on the anterior teeth. MIH presents a variety of challenges for the dental team as well as functional and social impacts for affected children.

Objectives

Here, we provide an up-to-date review of the epidemiology, aetiology, diagnosis and clinical management of MIH.

Materials and methods

A review of the contemporary basic science and clinical literature, relating to MIH, was undertaken using information obtained (up to 10 April 2020) from the electronic databases PubMed, Scopus, Web of Science and the Cochrane Library.

Results

There is a growing body of evidence relating to the aetiology, presentation and clinical management of MIH. Current knowledge appears to be focused on potential genetic aspects, as well as the development and validation of indices for the diagnosis and management of MIH. There has also been increasing recognition of the global and individual burden of this common condition.

Conclusions

Dental health professionals should regularly appraise the basic science and clinical MIH literature to ensure that they provide the best possible short- and long-term care for their young patients.

Evaluation of wound healing following surgical extractions using the IPR Scale

Bahaa Haj Yahya, Gavriel Chaushu, Yafit Hamzani — Thu, 08 Oct 2020 09:00:25 -0700

Objective

To monitor wound healing following surgical extraction of wisdom teeth using the novel Inflammatory Proliferative Remodeling (IPR) Scale.

Methods

A prospective study design was used. Participants included 94 otherwise healthy adult patients undergoing surgical extraction of a wisdom tooth at a tertiary medical centre from June 2018 to June 2019. The IPR Scale was completed by two resident surgeons in oral and maxillofacial surgery at three time points after the procedure, corresponding to the three phases of wound healing. Mean subscale and total scores were calculated. Patients graded their preoperative anxiety, intraoperative pain, and pain during follow-up on a 10 cm visual analog scale, and the findings were correlated with the IPR Scale scores.

Results

Mean IPR total score (range 0–16) was excellent (14.43 ± 1.45). Mean scores by healing phase were as follows: inflammatory 6.35 ± 1.34 (range 0–8); proliferation, 4.56 ± 0.8 (range 0–5); remodeling, 2.83 ± 0.51 (range 0–3). There was a positive correlation between mean preoperative anxiety level (5.9 ± 3.6) and intraoperative pain perception (2.4 ± 2.4; P = 0.65) and a negative correlation between mean preoperative anxiety level and IPR Scale scores for each healing phase. Two cases were complicated by abscesses which resolved with treatment.

Conclusion

The IPR Scale is a promising tool for the effective evaluation of the wound healing process following wisdom tooth extractions. Relaxation methods and behavioural adaptation might help to lower patient anxiety and thereby improve oral wound healing.

Emergency management in dental clinic during the Coronavirus Disease 2019 (COVID‐19) epidemic in Beijing

Chao Wang, Li Miao, Zhigang Wang, Yanjie Xiong, Yang Jiao, Hongchen Liu — Wed, 07 Oct 2020 15:49:17 -0700

Background

In mid-March 2020, the World Health Organization declared that COVID-19 was to be characterised as a pandemic. The purpose of this article is to recommend emergency management procedures for dental clinics during this public health emergency.

Materials and Methods

We have implemented a series of emergency management measures to prevent cross-infection in our dental clinic during the COVID-19 pandemic, including personnel scheduling, division of the clinic into functional areas, limitation or delay of non-emergency patients, staff protection and infection controls, clinical environmental disinfection, and the use of online consultation services, among others.

Results

Due to public health policy and dental emergency management, the number of dental visitors to our clinic dropped sharply, and no COVID-19 suspected cases or high-risk patients received treatment. There have been no reports of infection of dental staff or patients during dental treatment in China to date.

Conclusion

These public health policies and dental emergency management measures were effective in controlling cross-infection of COVID-19 in the dental clinic.

Practical Implications

We share control measures for COVID-19, and hope that they will be helpful for dental professionals worldwide to continue to provide dental care in a safe and orderly manner.

A cross‐sectional study of perceived dental treatment needs and oral health status in community‐dwelling older Australian men: The Concord Health and Ageing in Men Project

Sun, 04 Oct 2020 02:53:55 -0700

Background

Assessing perceived needs for dental treatment is important in understanding and predicting people’s health behaviours. The purpose of this study is to examine older men’s perceptions regarding dental treatment needs, and to investigate the disparity between perceived needs and the actual oral health of a population of community-dwelling older Australians.

Methods

Using cross-sectional data from the 4th wave of the Concord Health and Ageing in Men Project, logistic regression analysis of perceived needs for dental treatment was conducted for 596 men aged 78 and over, with functional tooth units (FTUs), number of decayed tooth surfaces, and periodontitis as independent variables.

Results

Thirty-six percent (n = 216) of the participants believed they required some form of dental treatment. The remaining participants did not perceive a need for treatment, yet 65.3% objectively required prosthodontic or restorative care. The regression model showed men with lower FTUs were significantly more likely to report a perceived need for dental treatment than those with 12 FTUs [0–6 FTUs: adjusted odds ratio (OR) 2.58, 95% CI 1.28–5.20; 7–11 FTUs: adjusted OR 2.43, 95% CI 1.16–5.10]. However, neither the number of decayed tooth surfaces nor the existence of periodontitis was associated with perceived dental treatment needs.

Conclusions

Most older men viewed their oral health positively, and the majority of those with objectively assessed needs, did not perceive themselves as requiring dental treatment. Loss of FTUs appears to alert participants to seek treatment, but not the presence of dental caries or periodontitis.

Assessment of carotid artery calcifications on digital panoramic radiographs and their relationship with periodontal condition and cardiovascular risk factors

Tue, 29 Sep 2020 22:52:03 -0700

Objective

The main purpose of this study is to determine the presence of carotid artery calcification (CAC) detected on digital panoramic radiographs (DPRs) retrospectively and correlate the findings with cardiovascular risk factors including gender, age, smoking status, hypertension, diabetes, and hyperlipidemia, along with atherosclerotic cardiovascular disease and periodontal status.

Methods

This clinical study is registered at ClinicalTrials.gov as NCT04017078. DPRs, periodontal status and cardiovascular risk factors of 1,101 patients (576 males, 525 females) were evaluated. The patients were grouped based on whether CAC was detected in dental DPRs [CAC (+)] or not [CAC (−)]. Periodontal status was categorised as gingivitis, periodontitis, and gingivitis with reduced periodontium (periodontally stable patient).

Results

Out of 1,101 patients, whose mean age was 42.1 ± 15.5 years and 525 (47.7%) were female, 34 (3.1%) were diagnosed with CAC on DPRs. No significant difference was observed between groups considering gender, hypertension, diabetes, hyperlipidemia, smoking, and periodontal status. Patients aged 40–55 years (n = 398, 36.15%) and patients older than 55 years (n = 222, 20.16%) were associated with CAC (odds ratio = 4.49, 95% confidence interval = 1.65–12.17, P = 0.003; odds ratio = 4.41, 95% confidence interval = 1.33–14.61, P = 0.015, respectively).

Conclusion

Among all parameters, only age exhibited significant correlation with an increased risk of carotid calcification. Further studies with prospective designs and larger study populations are needed.

Awareness about dental amalgam among Turkish dentists and patients: a questionnaire and search engine based cross‐sectional study

Özlem Erçin, Begüm Berkmen, Elif Durukan, Neslihan Arhun — Tue, 29 Sep 2020 22:49:40 -0700

Objectives

There has been considerable controversy concerning the health risks and benefits of using mercury-containing amalgam. This study aimed to evaluate the Turkish dentists’ and patients’ preference and opinion about amalgam and to assess Internet search trends about amalgam.

Methods

The study consists of three stages. The first two stages of the study are cross-sectional studies to verify both the patients’ perception with amalgam restorations and dentists’ attitudes regarding the use of dental amalgam. The third stage of the study evaluated the Internet search trends of Turkish people about mercury and amalgam related concerns between 2004 and 2018.

Results

A total of 320 patients (180 female, 140 male) and 1,211 dentists (533 female, 678 male) participated in this study. Majority of the patients have no idea about the type of dental restorations and effect of dental materials on their health. 188 (58.8%) participants stated that they would not prefer amalgam restoration in their teeth as amalgam is unaesthetic. A total of 24% (291) of the dentists used amalgam routinely; 9.5% (156) of them used amalgam rarely, and 63.1% (764) did not use amalgam at all. The reason for not using amalgam included the patients' desire and unaesthetic properties. According to the Internet search trends, Turkish people do not know as much about amalgam as people in the rest of the world.

Conclusion

Awareness about dental amalgam is low among patients studied. Although dentists do not use dental amalgam frequently, they disagree on banning dental amalgam.

Residual periodontal ligament in extracted teeth – is it associated with indication for extraction?

Sun, 27 Sep 2020 16:24:39 -0700

Background

Periodontal disease is a major cause of tooth loss. Few studies have evaluated the residual area of the periodontal ligament in extracted teeth and, to the best of our knowledge, none from Latin America have done so regarding indications for extraction. The aim of this study was to evaluate the residual periodontal ligament (RPL) with respect to indication for extraction in a sample of teeth from a Brazilian Public Health Service district.

Materials and methods

All teeth extracted within the Public Health Service district of Santa Maria, Brazil, over a 5-month period were requested for analysis. A total of 414 teeth eligible for measurement were stained and evaluated for RPL using a stereo microscope. Participating Public Health Service dentists completed a questionnaire detailing demographic variables and indication for each extracted tooth. The percentage of RPL was determined for each tooth. Comparisons of RPL between teeth extracted on periodontal versus other indications were made using the Mann-Whitney test.

Results

RPL averaged 34.8% for teeth extracted on periodontal indications versus 79.5% for other teeth (P ≤ 0.001). When considering teeth with an RPL ≥ 30% as possible to maintain, 189 (76%) of the teeth extracted on periodontal indications could have been maintained. When RPL cut-off limits of ≥ 40% or ≥ 50% are applied, 93 (37%) and 43 (17%) teeth, respectively, could have been maintained.

Conclusion

This study suggests that strictly based on RPL, a large number of teeth extracted on periodontal indications conceivably could be maintained.

Use of a modified mandibular splint to reduce nocturnal symptoms in persons with post‐traumatic stress disorder

Donald B. Giddon, Donald R. Moeller, Curtis K. Deutsch — Sun, 27 Sep 2020 06:03:08 -0700

Objective: Based on a series of clinical observations that a thicker mandibular splint than that commonly used to treat bruxism and related craniomandibular myofascial pain reduced post-traumatic stress disorder (PTSD) nocturnal symptomatology (sleep disruptions, headaches, and nightmares), this study of 100 PTSD participants was undertaken to systematically establish 'proof of concept' of the therapeutic effectiveness of this modified splinting procedure. Methods: Following the fabrication of splints thicker than those conventionally used, the effectiveness of this new procedure used by dentists was determined by comparing the self-reported frequency and intensity/severity of PTSD symptomatology during a seven-night pretreatment baseline period without the splint with a second seven-night period in which the modified splint was inserted. The scoring for the three dependent measures (sleep disruptions, headaches, and nightmares) was based on the frequencies on a scale from 0–7 multiplied by the intensity/severity on a scale of 1–10. Results: Compared with the pre-splint baseline period, the insertion of the thickened splint resulted in a highly significant reduction of sleep disruption, nocturnal headaches, and nightmares. A second seven-night control period without the splint was followed by a second seven-night period with the splint, reproducing the effectiveness of the first splinting period. Conclusion: The results of this study provide the first systematic, documented proof of concept of the effectiveness of a modified splinting procedure in reducing key nocturnal symptoms in PTSD patients.

Climate change and oral health

Donna M. Hackley — Fri, 25 Sep 2020 20:39:22 -0700

International Dental Journal, EarlyView.

Treatment of gingival recession: when and how?

Jean‐Claude Imber, Adrian Kasaj — Thu, 24 Sep 2020 19:30:08 -0700

Gingival recession is a common finding in daily clinical practice. Several issues may be associated with the apical shift of the gingival margin such as dentine hypersensitivity, root caries, non-carious cervical lesions (NCCLs), and compromised aesthetics. The first step in an effective management and prevention program is to identify susceptibility factors and modifiable conditions associated with gingival recession. Non-surgical treatment options for gingival recession defects include establishment of optimal plaque control, removal of overhanging subgingival restorations, behaviour change interventions, and use of desensitising agents. In cases where a surgical approach is indicated, coronally advanced flap and tunnelling procedures combined with a connective tissue graft are considered the most predictable treatment options for single and multiple recession defects. If there is a contraindication for harvesting a connective tissue graft from the palate or the patient wants to avoid a donor site surgery, adjunctive use of acellular dermal matrices, collagen matrices, and/or enamel matrix derivatives can be a valuable treatment alternative. For gingival recession defects associated with NCCLs a combined restorative-surgical approach can provide favourable clinical outcomes. If a patient refuses a surgical intervention or there are other contraindications for an invasive approach, gingival conditions should be maintained with preventive measures. This paper gives a concise review on when and how to treat gingival recession defects.

Ageusia, a highly specific symptom of COVID‐19, for which an unaware patient may seek dental assistance

Tue, 22 Sep 2020 15:53:16 -0700

International Dental Journal, EarlyView.

Trends in self‐rated poor oral health among all age populations in Korea from 2007 to 2015: monitoring expansion of dental insurance

Song‐Yi Kim, Nam‐Hee Kim — Fri, 18 Sep 2020 19:58:36 -0700

Objectives: This study explored trends in self-rated poor oral health (SRPOH) from 2007 to 2015 among all age groups to monitor changes after the expansion of dental insurance. Methods: Repeated cross-sectional data from 2007 to 2015 Korea National Health and Nutrition Examination Surveys were collected and analysed. The respondents (n = 20,199) were categorised into four age groups: 0–19, 20–44, 45–64, and ≥65 years. The outcome variable was SRPOH, with independent variables being socioeconomic factors, sex, household income, and education. The age–sex standardised prevalence rate was calculated to determine trends, and complex samples logistic regression analysis was performed to confirm the factors affecting SRPOH. Results: Self-rated poor oral health prevalence decreased significantly from 2007 to 2009 (25%) to 2013 to 2015 (14%) in the age groups of 0–19 and 20–44 years (P < 0.05), whereas the SRPOH prevalence in the age groups of 45–64 and ≥65 years did not undergo any significant changes. Although the prevalence decreased by 6% among older adults, over 40% older women still experienced SRPOH. A sex gap increased with age but did not change over time. SRPOH was strongly associated with sex, income, and education across all age groups; the association did not notably change from 2007 to 2015. Conclusions: Self-rated poor oral health improved among younger people in Korea. The gender gap in the prevalence increased with age and persisted over time. However, income was the strongest determinant of SRPOH among all age groups, regardless of dental insurance expansion. Further studies should aim to draw causal inferences to explore the policy impact of dental insurance benefits.

Periodontal treatment is associated with improvement in gastric Helicobacter pylori eradication: an updated meta‐analysis of clinical trials

Ayla Ozturk — Fri, 18 Sep 2020 01:36:04 -0700

Objectives

The efficacy of conventional systemic antibiotic therapy for eradication of Helicobacter pylori has been seriously challenged by antibiotic resistance. Identification of alternative therapeutic strategies might help to overcome this limitation. The aim of this study was to update previous meta-analyses that investigated the effect of periodontal treatment on gastric H. pylori eradication.

Methods

A systematic electronic search of the literature was conducted to identify all published clinical trials that compared the effect of adjunct periodontal treatment on conventional systemic H. pylori eradication therapy.

Results

The updated analysis (consisting of 541 participants representing six studies) demonstrated that, compared with conventional systemic eradication therapy alone, the addition of periodontal treatment resulted in improvements in gastric H. pylori eradication rates with OR 4.11 (P = 0.01). Moreover, not to lose any data, the previously presented Chinese results that could not be assessed by any available mechanism deduced from previously published meta-analysis and with other records were re-analysed. Similarly, the second meta-analysis adding up to a final cluster of 10 studies (909 participants) gives further credence to periodontal treatment as a useful concomitant therapy in the H. pylori eradication therapy (odds ratio [OR] = 2.65; P = 0.0002). Finally, the meta-analysis of four trials consisting of 177 cases and 161 controls showed that periodontal treatment also improved non-recurrence rates of gastric H. pylori infection, with an OR of 5.36 (P-value = 0.0002).

Conclusion

Although the inclusion of five additional clinical trials in this updated meta-analysis has not changed the result of the previous review, the current meta-analysis is superior for having removed one study involving the use of chlorhexidine, which did not meet appropriate criteria for inclusion. Our results strengthen the value of periodontal treatment as an adjunctive remedy. Consistency of these results suggests that the incorporation of professional periodontal treatment with systemic eradication therapy may be a wise strategy, enhancing the efficacy of H. pylori eradication therapy.

Systematic review registration: in PROSPERO ID number: CRD42019119347.

Local anaesthesia in dentistry: a review

Derek Decloux, Aviv Ouanounou — Thu, 17 Sep 2020 20:49:37 -0700

Over the past century, there is perhaps no greater contribution to the practice of clinical dentistry than the development and application of local anaesthesia. What were once considered painful procedures have now been made routine by the deposition and action of local anaesthetics. This article will serve as a review of basic pharmacological principles of local anaesthesia, subsequent sequelae that can arise from their use, considerations when using local anaesthetics, and recent advances in the delivery of local anaesthetics.

Socioeconomic inequality in dental caries experience expressed by the significant caries index: cross‐sectional results from the RaNCD Cohort Study

Thu, 17 Sep 2020 19:43:33 -0700

Introduction

Socioeconomic inequality in dental caries among Iranian middle-aged adults remains largely unstudied. This study aimed to measure socioeconomic inequality in dental caries experience and to identify determinants of this inequality.

Materials and methods

Data were obtained from the Ravansar Non-Communicable Diseases (RaNCD) Cohort Study. This cross-sectional analysis included 10,002 adults aged 35–65 years. Caries experience was dichotomised based on the decayed, missing and filled teeth (DMFT) of one-third of the population with the highest caries scores (i.e. significant caries index). Socioeconomic status (SES) was calculated using the principal component analysis. The concentration index (CI) was used to quantify the extent of socioeconomic inequality in dental caries experience. Decomposition analysis was conducted to quantify the contribution of each determinant to the observed inequality.

Results

The mean DMFT for all individuals was 16.1(SD 9.1). The CI of having significant dental caries was −0.236 (95% CI: −0.0259, −0.213), indicating that having significant dental caries was more concentrated among low-SES individuals. SES (65.6%), age group (24.7%) and female gender (3.7%) were found to have the largest percentage of contributions to the observed inequality in dental caries.

Conclusion

This study indicates pro-rich inequalities in dental caries experience among middle-aged adults in Iran. The findings highlight the importance of early prevention of dental caries experience before it happens. To mitigate inequalities in dental caries experience, policy interventions should focus on females, older age groups, and low-SES individuals.

The prevalence and impact of dental anxiety among adult New Zealanders

Ishani Sukumaran, Shay Taylor, W. Murray Thomson — Mon, 14 Sep 2020 21:05:08 -0700

Objective

To describe the prevalence and impact of dental anxiety in the New Zealand adult population.

Methods

Secondary analysis of data from the 2009 New Zealand national oral health survey. Dental anxiety was measured using the Dental Anxiety Scale (DAS).

Results

The prevalence of dental anxiety was 13.3% (95% CI = 11.4, 15.6). On average, DAS scores were higher by 14% among females, lower among those in the oldest age group (55+), higher by 10% among those in the European/Other ethnic category, and higher by 10% among those residing in the most deprived neighbourhoods. Those who were dentally anxious had greater oral disease experience and were less likely to have visited a dentist within the previous 12 months. They also had poorer oral health-related quality of life, with the highest prevalence of OHIP-14 impacts observed in dentally anxious 35- to 54-year-olds.

Conclusions

Dental anxiety is a dental public health problem. It is an important contributor to poor oral health and care avoidance among New Zealanders. There is a need to develop both clinical and population-level interventions aimed at reducing the condition’s prevalence and impact.

Health‐related quality of life and its associated predictors in patients with oral lichen planus: a cross‐sectional study

Tue, 01 Sep 2020 22:10:24 -0700

Abstract

Objectives

To investigate levels of quality of life (QoL) and determine associated predictors in patients with oral lichen planus (OLP).

Materials and methods

A total of 300 patients with OLP at one tertiary Oral Medicine clinic in the UK were recruited in a cross-sectional study from January 2018 to July 2019. The 15-item Chronic Oral Mucosal Disease Questionnaire (COMDQ-15) and 14-item Oral Health Impact Profile (OHIP-14) were used to assess the level of QoL related to OLP. A number of potential determinants were considered, including patient demographics, treatment, the severity of oral symptoms, the clinical activity of the disease, and the patient psychological status, which were measured using the pain-Numerical Rating Scale, the Oral Disease Severity Score, the Hospital Anxiety and Depression Scale, and the 10-item Perceived Stress Scale. Multivariate linear regression was employed to identify independent determinants associated with overall and aspects of QoL.

Results

On multivariate analyses, after adjusting for confounding variables, the QoL levels in patients with OLP were significantly associated with levels of oral pain, anxiety, stress and use of topical corticosteroids. The COMDQ-15 instrument performed better than OHIP-14 at capturing the association between QoL and pain and disease activity in patients with OLP.

Conclusion

Clinicians should expect reduced QoL in OLP patients with high pain levels, high anxiety levels, high perceived stress and use of topical corticosteroids. The COMDQ-15 is best suited to measure QoL in this population.

Dispensing patterns of medicines prescribed by Australian dentists from 2006 to 2018 – a pharmacoepidemiological study

Joon Soo Park, Amy T. Page, Estie Kruger, Marc Tennant — Thu, 27 Aug 2020 21:46:57 -0700

Objectives

Dentists are independent prescribers that can prescribe subsidised medicines under the Australian Pharmaceutical Benefits Scheme (PBS). It is hypothesised that increased dental prescribing can partly be accounted for by the growth in both the Australian population and the number of practising dentists. This pharmacoepidemiological study aims to determine the dispensing patterns of medications amongst dentists and to identify trends over time.

Materials and methods

Data on dental medications under PBS from 2006 to 2018 were accessed. All the dentist-prescribed concessional medicines dispensed at pharmacies in 2018 were included for time trend analysis. Cumulative dispensing counts and defined daily dose (DDD) per 1,000 concessional population days (DPD) were analysed for time trend analysis.

Results

Out of the 56 medications within the dental PBS schedule, the top 20 medicines had a total cumulative dispensing count of 5,058,556, which accounts for 97.4% of the total dispensing count. Eleven out of 20 medicines were antibiotics. Overall, increases were observed for seven out of 20 medicines (amoxicillin + clavulanic acid, clindamycin, ibuprofen, diazepam, oxycodone, tramadol, naproxen) in both dispensing count and trend, as expressed per DPD.

Conclusion

This study highlights the increasing dispensing pattern and trends of dentist-prescribed antibiotics, opioids and benzodiazepines. Further investigation may be required to determine whether the medicine use is appropriate. In the future, this could provide new educational opportunities on the appropriate use of medicines for dentists.

COVID‐19 and saliva: A primer for dental health care professionals

Sun, 23 Aug 2020 21:29:14 -0700

International Dental Journal, EarlyView.

Occurrence and risk factors of dental root perforations: a systematic review

Simran Kaur Sarao, Yuli Berlin‐Broner, Liran Levin — Thu, 20 Aug 2020 03:23:57 -0700

Background

Iatrogenic root perforations are an unfortunate accident that can occur during dental treatment and can lead to peri-radicular damage, poor treatment outcome and extraction of the tooth. The aim of this review was to analyse the occurrence and risk factors for root perforation.

Methods

A systematic search of the literature was conducted in CINAHL, Cochrane, EMBASE, Medline and SCOPUS in May 2019. Additional literature was identified through a hand search. Clinical studies enrolling adults with permanent dentition were included. Single case studies and case reports were excluded. Duplicate articles were removed, titles and abstracts were screened and studies were selected according to the inclusion criteria. Data were collected and reported in accordance with PRISMA guidelines. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools.

Results

A total of 916 articles were screened, from which 47 full-text articles were analysed and 22 articles were finally included in the study. The data were analysed qualitatively because meta-analysis could not be conducted owing to lack of heterogeneity among the studies. Most of the articles were retrospective cross-sectional studies on root canal treatments performed by undergraduate students. The occurrence of perforation ranged from 0.6% to 17.6%. Risk factors for perforation included experience of the practitioner, tooth type, and tooth morphology. The risk of bias in most of the studies included was assessed as low.

Conclusions

This systematic review suggests a need for additional studies on the risk factors associated with iatrogenic root perforation as the current literature is insufficient. Educational efforts in dental schools should address the issue of perforations and provide more clinical experience prior to graduation in order to improve the clinical skills of graduates.

Clinical and self‐reported measurements to be included in the core elements of the World Dental Federation's theoretical framework of oral health

Wed, 12 Aug 2020 15:41:20 -0700

Introduction

Oral health is part of general health, and oral diseases share risk factors with several non-communicable diseases. The World Dental Federation (FDI) has published a theoretical framework illustrating the complex interactions between the core elements of oral health (CEOHs): driving determinants, moderating factors, and general health and well-being. However, the framework does not specify which self-reported or clinical measurements to be included in the CEOHs.

Objectives

To explore oral health measurements relevant for a general adult population to be included in the CEOHs in the FDI’s theoretical framework of oral health.

Materials and methods

A psychometric study was performed, using cross-sectional data from Sweden (N = 630, 54% women, mean age 49.7 years). The data set initially consisted of 186 self-reported and clinical measurements. To identify suitable measurements, the selection was discussed in different settings, including both experts and patients. Principal component analyses (PCAs) were performed to explore, reduce and evaluate measurements to be included in the three CEOHs. Internal consistency was estimated by Cronbach’s Alpha.

Results

The validation process yielded 13 measurements (four clinical, nine self-reported) in concordance with the CEOHs. PCAs confirmed robust validity regarding the construction, predicting 60.85% of variance, representing psychosocial function (number of measurements = 5), disease and condition status (number of measurements = 4), and physiological function (number of measurements = 4). Cronbach’s Alpha indicated good to sufficient internal consistency for each component in the constructs (α = 0.88, 0.68, 0.61, respectively).

Conclusion

In a Swedish general adult population, 13 self-reported and clinical measurements can be relevant to include to operationalise CEOHs in the FDI’s theoretical framework.

Socio–economic disparities in dental health and dental care utilisation among older Chinese

Chaofan Li, Nengliang Aaron Yao — Fri, 31 Jul 2020 22:57:57 -0700

Introduction

Dental care is mostly excluded from healthcare coverage in China. This study examines disparities in dental care and in the costs of such care, according to insurance type and socio–economic status, among Chinese older adults.

Methods

The data were obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). A final sample of 5,230 respondents was included, with a mean age of 72 years. Edentulousness, any dental visit and per-patient dental care expenditure were used as outcome variables. Both unweighted and weighted logistic regression analyses were used to examine the association of socio–economic status (education, insurance type and income) associated with edentulousness and use of dental care.

Results

We found that 28% of Chinese older adults have no remaining teeth and that only 19% had used dental care in the past year. The uninsured and those with rural resident insurance had edentulousness rates of 31%, while the edentulousness rate in those with urban employee insurance was 19%. About 13% of the uninsured study respondents and 15% of those with rural resident insurance had used dental care compared with 30% of those with urban employee insurance. Those in the highest income and education groups and those enrolled in a plan with a lower coinsurance rate had a higher likelihood of using dental care services and spending more on dental care than did those in the lowest socio–economic groups.

Conclusions

Dental care disparities in China may be reduced through increasing the proportion of the population with insurance and expanding the range of dental treatments covered by all three major insurance schemes.

Periodontal status among schoolchildren in the Republic of Moldova: a cross‐sectional study using the Pathfinder study design

Mon, 27 Jul 2020 16:47:55 -0700

Objectives

To screen a sample of Moldavian schoolchildren to establish their periodontal condition using the Pathfinder study design of the World Health Organization (WHO).

Methods

Two cohorts – 12- and 15-year schoolchildren – were screened in 12 schools around the country: four schools in the capital city; four more schools in two other larger cities (two schools in each city); and four village schools (one school in each village). In addition to demographic data, the periodontal parameters dental plaque, calculus and bleeding on probing (BOP) were collected. Periodontal pocket depth (PPD) was also measured but only in the cohort of 15-year-old schoolchildren. Measurements were recorded for the six Ramfjord index teeth.

Results

In total, 720 children were surveyed: 365 (50.7%) were 12 years of age and 355 (49.3%) were 15 years of age; 351 (48.8%) were girls and 369 (51.2%) were boys; 490 (68%) lived in an urban area and 230 (32%) lived in a rural area. Only 4.5% of 15-year-old children presented with a pocket depth of ≥3.5 mm. Children who lived in rural areas had higher plaque scores than children who lived in urban areas (64.8% vs. 54.1%, P = 0.007). In addition, children who lived in urban areas had significantly less calculus (P = 0.047) and shallower PPDs (P = 0.019). Deeper PPD was associated with higher PI and calculus scores.

Conclusions

Moderate-to-deep periodontal pockets were not uncommon in children in the 15-year-old cohort. Periodontal status was worse in children from rural areas than in children from urban areas. It is therefore suggested that an educational programme, together with preventive and interceptive protocols, should be adopted in early adolescence and especially in rural regions.

Patterns of maxillofacial injuries in the Middle East and North Africa: a systematic review

Mohamed A. Jaber, Feras AlQahtani, Khaled Bishawi, Sam Thomas Kuriadom — Tue, 14 Jul 2020 03:34:27 -0700

Objective:

The objective of this review was to investigate the epidemiological characteristics of maxillofacial fractures (MFFs), to establish the prevalence of MFFs, and to recognise the major causative factors in both males and females in the Middle East and North Africa (MENA) region.

Study design:

The protocol of this systematic reviews was established according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P); the following databases were searched: PubMed/Medline, Scopus, Google Scholar and Web of Science. We used STROBE checklist to assess the risk of bias in all identified studies, 37 studies fulfilled the eligibility criteria, and hence were selected for analysis.

Results:

A total of 27,994 patients (22,965 males and 5,129 females) ranging from 0 to 97 years who experienced maxillofacial injuries during the study period were entered into this review. Road traffic accidents (RTAs) were the most common cause of MFF followed by falls. The mandible was the most common site of injury. In the MENA region, males outnumbered females in terms of maxillofacial injuries with a ratio of 4.5:1

Conclusion:

Maxillofacial fractures are highly prevalent in the MENA region, and they are mainly caused by RTAs, especially among young males. Therefore, the concerned authorities need to employ and implement stricter traffic rules in order to minimise the risk of maxillofacial injuries and their subsequent increased morbidity and mortality rates.

Developing a standard set of patient‐centred outcomes for adult oral health – an international, cross‐disciplinary consensus

Sun, 05 Jul 2020 15:37:22 -0700

Objective

To develop a minimum Adult Oral Health Standard Set (AOHSS) for use in clinical practice, research, advocacy and population health.

Materials and methods

An international oral health working group (OHWG) was established, of patient advocates, researchers, clinicians and public health experts to develop an AOHSS. PubMed was searched for oral health clinical and patient-reported measures and case-mix variables related to caries and periodontal disease. The selected patient-reported outcome measures focused on general oral health, and oral health-related quality of life tools. A consensus was reached via Delphi with parallel consultation of subject matter content experts. Finally, comments and input were elicited from oral health stakeholders globally, including patients/consumers.

Results

The literature search yielded 1,453 results. After inclusion/exclusion criteria, 959 abstracts generated potential outcomes and case-mix variables. Delphi rounds resulted in a consensus-based selection of 80 individual items capturing 31 outcome and case-mix concepts. Global reviews generated 347 responses from 87 countries, and the patient/consumer validation survey elicited 129 responses. This AOHSS includes 25 items directed towards patients (including demographics, the impact of their oral health on oral function, a record of pain and oral hygiene practices, and financial implications of care) and items for clinicians to complete, including medical history, a record of caries and periodontal disease activity, and types of dental treatment delivered.

Conclusion

In conclusion, utilising a robust methodology, a standardised core set of oral health outcome measures for adults, with a particular emphasis on caries and periodontal disease, was developed.

COVID‐19 dentistry‐related aspects: a literature overview

Vittorio Checchi, Pierantonio Bellini, Davide Bencivenni, Ugo Consolo — Sun, 05 Jul 2020 15:37:06 -0700

A new coronavirus (Sars-CoV-2) was detected in China at the end of 2019 and has since caused a worldwide pandemic. This virus is responsible for an acute respiratory syndrome (COVID-19), distinguished by a potentially lethal interstitial bilateral pneumonia. Because Sars-CoV-2 is highly infective through airborne contamination, the high infection risk in the dental environment is a serious problem for both professional practitioners and patients. This literature overview provides a description of the clinical aspects of COVID-19 and its transmission, while supplying valuable information regarding protection and prevention measures.

Impact of COVID‐19 on oral emergency services

Jie Bai, Tao Xu, Ai‐Ping Ji, Wei Sun, Ming‐Wei Huang — Thu, 02 Jul 2020 23:00:18 -0700

Objective

To retrospectively review the impact of the outbreak of coronavirus disease 2019 (COVID-19) on services in the oral emergency room.

Materials and methods

A statistical analysis of epidemiological characteristics and the patients’ diagnoses and treatments in the Emergency Department of Peking University Hospital of Stomatology during the outbreak of COVID-19 in 2020 compared with those in 2019 in Beijing, China.

Results

There were fewer total visits in 2020 than in 2019 (P = 0.001), and the proportions of patients who were children, adolescents and elderly people were lower in 2020 than in 2019 (P < 0.001). The proportions of patients with acute toothache and infections were higher in 2020 than in 2019, and the proportions of patients with maxillofacial trauma and non-emergencies were lower in 2020 than in 2019 (P < 0.001). Drug treatment for acute pulpitis was used more often in 2020 than in 2019, and endodontic treatment and examination consultations were less common in 2020 than in 2019 (P = 0.022).

Conclusions

The outbreak of COVID-19 affected the patient population and structure of disease types and oral services in the emergency room. The number of visits to the oral emergency room and the proportions of the patients who were children, adolescents and elderly people were reduced, meanwhile the percentage of emergency cases, except trauma, and conservative treatments increased during the outbreak of COVID-19.

Oral graft‐versus‐host disease: a pictorial review and a guide for dental practitioners

Sharon Elad, Omar Aljitawi, Yehuda Zadik — Sun, 28 Jun 2020 14:30:37 -0700

Introduction

Graft-versus-host disease (GVHD) is a complication of haematopoietic stem cell transplantation (HSCT). GVHD may also develop following solid transplants or blood transfusions if white blood cells are transferred. GVHD affects multiple organs, including the oral tissues.

Objective

This pictorial review provides a background of GVHD to dental practitioners, describes the most common oral manifestations of GVHD and highlights the main treatment modifications needed to deliver dental care to patients with GVHD.

Methods

A narrative review enhanced with clinical photographs.

Results

Acute GVHD may manifest in the oral mucosa; however, it often develops immediately following HSCT when routine dental treatment is postponed. Chronic GVHD may manifest in the oral mucosa, the salivary glands and the musculoskeletal compartment. It may indirectly affect the teeth and the oral flora, putting the patient at risk for infections. Importantly, GVHD poses an increased risk for oral cancer.

Conclusion

GVHD has a wide range of oral manifestations, some of which may affect dental treatment.