Priti Mulimani, a health-care professional and PhD student, highlights how pressure to publish in high-impact journals that are biased towards research on Western populations obstructs pivotal ...research on the majority of the world’s population.
Discovery of odontogenic mechanisms essential for regenerating dental tissues and eventually developing a biomimetic artificial whole tooth for replacement is an ongoing aspiration for dental ...clinicians and researchers. Studying the diversity, development and evolutionary changes of mammalian dentitions, can provide key insights into the mechanisms of odontogenesis that can be harnessed for regenerative dental medicine. A myriad of influences is expected to have shaped the dentitions of mammals and our objective is to highlight the contributions of phylogeny, functional adaptation, and development to tooth shape. Innovations in tooth shape analysis will be discussed, such as in imaging methodologies and quantitative comparisons, molecular biology approaches to phylogeny and the ontogenetic basis of tooth form. Study of the inter and intra-species differences in tooth form as well as dental anomalies has provided clues toward the mechanisms of evolutionary change in dental form. Thus, phenotypic variation in tooth shape will also be discussed, including the role of development in creating tooth shape differences that evolutionary selection pressures may act upon. Functional adaptations have occurred in the context of the phylogenetic signal of primitive mammals, and predecessors to each phylogenetic branch, and examples will be discussed within members of the Order Carnivora, the Superfamily Suoidea and the Order Primates. The comparative study of mammalian tooth shape holds potential to inform dental research areas, such as etiopathogeneses of dental variation, and tooth shape anomalies, molecular mechanisms of tooth development and functional issues. Ultimately, insights from these research areas can be potentially translated for futuristic clinical applications like, regeneration of various tooth tissue layers and eventually full tooth replacement.
Orthodontic treatment is an appliance-intensive endeavor, where an array of mechanical devices is used to bring about tooth movement. By virtue of remaining in close proximity to the enamel, gingiva ...and periodontal ligament intra-orally over a prolonged period of time, orthodontic appliances have a significant impact on the paradental tissues, oral environment and oral microbiome. Orthodontic appliances by acting as anchors for biofilm and plaque formation, accumulate bacteria and other micro-organisms in amounts unfavorable for maintenance of healthy equilibrium. The resulting loss of balance in the oral microbiome causes dysbiosis which manifests clinically as increased enamel demineralization, dental caries and periodontal disease. Mechanical removal of the accumulated plaque by maintaining rigorous oral hygiene has been proven to be the single most important factor to mitigate the harmful effects of dysbiosis. This review investigates how each of the various components of the orthodontic appliances, different types of appliances and unique surface properties of biomaterials have contributory effects at the interface of orthodontic biomaterials and oral biology. The information thus obtained will be critical in instituting the best diagnostic and therapeutic measures at the clinical level. It will also be instrumental in devising improvements and providing new directions for future research in general and precision orthodontics in particular.
Background
Dentistry is a profession with a high prevalence of work‐related musculoskeletal disorders (WMSD) among practitioners, with symptoms often starting as early in the career as the student ...phase. Ergonomic interventions in physical, cognitive, and organisational domains have been suggested to prevent their occurrence, but evidence of their effects remains unclear.
Objectives
To assess the effect of ergonomic interventions for the prevention of work‐related musculoskeletal disorders among dental care practitioners.
Search methods
We searched CENTRAL, MEDLINE PubMed, Embase, PsycINFO ProQuest, NIOSHTIC, NIOSHTIC‐2, HSELINE, CISDOC (OSH‐UPDATE), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP) Search Portal to August 2018, without language or date restrictions.
Selection criteria
We included randomised controlled trials (RCTs), quasi‐RCTs, and cluster RCTs, in which participants were adults, aged 18 and older, who were engaged in the practice of dentistry. At least 75% of them had to be free from musculoskeletal pain at baseline. We only included studies that measured at least one of our primary outcomes; i.e. physician diagnosed WMSD, self‐reported pain, or work functioning.
Data collection and analysis
Three authors independently screened and selected 20 potentially eligible references from 946 relevant references identified from the search results. Based on the full‐text screening, we included two studies, excluded 16 studies, and two are awaiting classification. Four review authors independently extracted data, and two authors assessed the risk of bias. We calculated the mean difference (MD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% confidence intervals for dichotomous outcomes. We assessed the quality of the evidence for each outcome using the GRADE approach.
Main results
We included two RCTs (212 participants), one of which was a cluster‐randomised trial. Adjusting for the design effect from clustering, reduced the total sample size to 210. Both studies were carried out in dental clinics and assessed ergonomic interventions in the physical domain, one by evaluating a multi‐faceted ergonomic intervention, which consisted of imparting knowledge and training about ergonomics, work station modification, training and surveying ergonomics at the work station, and a regular exercise program; the other by studying the effectiveness of two different types of instrument used for scaling in preventing WMSDs. We were unable to combine the results from the two studies because of the diversity of interventions and outcomes.
Physical ergonomic interventions. Based on one study, there is very low‐quality evidence that a multi‐faceted intervention has no clear effect on dentists' risk of WMSD in the thighs (RR 0.57, 95% CI 0.23 to 1.42; 102 participants), or feet (RR 0.64, 95% CI 0.29 to 1.41; 102 participants) when compared to no intervention over a six‐month period. Based on one study, there is low‐quality evidence of no clear difference in elbow pain (MD −0.14, 95% CI −0.39 to 0.11; 110 participants), or shoulder pain (MD −0.32, 95% CI −0.75 to 0.11; 110 participants) in participants who used light weight curettes with wider handles or heavier curettes with narrow handles for scaling over a 16‐week period.
Cognitive ergonomic interventions. We found no studies evaluating the effectiveness of cognitive ergonomic interventions.
Organisational ergonomic interventions. We found no studies evaluating the effectiveness of organisational ergonomic interventions.
Authors' conclusions
There is very low‐quality evidence from one study showing that a multi‐faceted intervention has no clear effect on dentists' risk of WMSD in the thighs or feet when compared to no intervention over a six‐month period. This was a poorly conducted study with several shortcomings and errors in statistical analysis of data. There is low‐quality evidence from one study showing no clear difference in elbow pain or shoulder pain in participants using light weight, wider handled curettes or heavier and narrow handled curettes for scaling over a 16‐week period.
We did not find any studies evaluating the effectiveness of cognitive ergonomic interventions or organisational ergonomic interventions.
Our ability to draw definitive conclusions is restricted by the paucity of suitable studies available to us, and the high risk of bias of the studies that are available. This review highlights the need for well‐designed, conducted, and reported RCTs, with long‐term follow‐up that assess prevention strategies for WMSDs among dental care practitioners.
Organized evidence-based practice is said to have started in the medical field in the late 20th century. Its principles and usage eventually spread to other health sciences, including orthodontics. ...Although the conceptual foundations and basic tenets of evidence-based orthodontics are based on the classical approach of testing medical interventions, differences unravel as we encounter the ground realities in orthodontics, which are unique due to the length, complexity, and diversity involved in orthodontic treatment and research. How has this led to the evolution of evidence-based orthodontics and changes in its applications? Is it being translated to better clinical answers, treatment strategies, patient satisfaction, and information for orthodontists? What more needs to be done, considering the rapidly changing orthodontic scenario? This article aims to explore these questions to evaluate how evidence-based orthodontics has played itself out so far, so that it can continue to grow strong and stand up to the challenges of 21st century orthodontics.
•Evolution of evidence-based practice in response to unique issues in Orthodontics is a necessity.•Classical evidence pyramid variants, may provide solutions relevant to the field of Orthodontics.•Quality refinement and standardization of primary research will strengthen evidence base.Pre-appraised, easily accessible formats of evidence enhance usability and clinical application.Symbiotic “evidence” and “expert” aligned with patients’ values or preference ensure best care.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Author's response Mulimani, Priti Subhash
American journal of orthodontics and dentofacial orthopedics,
March 2018, Volume:
153, Issue:
3
Journal Article
Peer reviewed
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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