Summary
The purpose of this study was to systematically review the literature for studies that investigated the association between use of psychotropic medications and presence of sleep bruxism (SB). ...Observational studies were selected in a two‐phase process. Searches were performed on six electronic databases, and a grey literature search was conducted on three databases. SB diagnosis was based on questionnaires or clinical examinations; no polysomnography examinations were performed. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross‐Sectional Studies. Overall quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation criteria. Five analytical cross‐sectional studies were included, evaluating antidepressants, anticonvulsants and psychostimulants. One study was judged as low risk of bias, three as moderate risk and one high risk. Antidepressants were evaluated in adult populations only; duloxetine (Odds Ratio OR = 2.16; 95% Confidence Interval 95% CI = 1.12‐4.17), paroxetine (OR = 3.63; 95% CI = 2.15‐6.13) and venlafaxine (OR = 2.28; 95% CI = 1.34‐3.86) were positively associated with SB risk. No increased odds of SB were observed considering use of citalopram, escitalopram, fluoxetine, mirtazapine and sertraline. With regard to anticonvulsants, only barbiturates were associated with SB in children (OR = 14.70; 95% CI = 1.85‐116.90), while no increased odds were observed for benzodiazepine, carbamazepine and valproate. The only psychostimulant evaluated was methylphenidate, and an association with SB was observed in adolescents (OR = 1.67; 95% CI = 1.03‐2.68). Findings from this SR suggested that medications such as duloxetine, paroxetine, venlafaxine, barbiturates and methylphenidate might be associated with SB; however, overall quality of evidence was considered very low, and therefore, caution is recommended.
This study evaluated the association between single‐nucleotide polymorphisms (SNPs) in vitamin‐D‐related genes and the amount of external apical root resorption linked to orthodontic treatment. One ...hundred and forty‐three individuals were assessed. The amount of external apical root resorption of upper central incisors (EARRinc) and lower first molars (EARRmol) were evaluated in radiographs. Seven SNPs were genotyped across four genes including the vitamin D receptor VDR, group‐specific component GC, cytochrome P450 family 27 subfamily B member 1 CYP27B1, and cytochrome P450 family 24 subfamily A member 1 CYP24A1. Linear regressions were implemented to determine allele‐effects on external apical root resorption. Individuals carrying the AA genotype in VDR rs2228570 had a 21% higher EARRmol than those having AG and GG genotypes (95% CI: 1.03,1.40). EARRmol in heterozygous rs2228570, was 12% lower than for homozygotes (95%CI: 0.78,0.99). Participants with the CCG haplotype (rs1544410‐rs7975232‐rs731236) in VDR had an EARRmol 16% lower than those who did not carry this haplotype. Regarding CYP27B1 rs4646536, EARRinc in participants who had at least one G allele was 42% lower than for homozygotes AA (95%CI: 0.37,0.93). Although these results did not remain significant after multiple testing adjustment, potential associations may still be suggested. Further replication studies are needed to confirm or refute these findings.
Breastfeeding is a powerful health-promoting behavior. A 2016 Lancet global collaboration to review the health implications of breastfeeding was among the first to consider oral health outcomes. ...While a role was suggested for breastfeeding in preventing malocclusion, caries was the only included disease condition unfavorably associated with breastfeeding. The present critical review examines the evidence connecting breastfeeding practices to these outcomes and discusses the methodological challenges inherent in reaching causal conclusions. Published systematic reviews show some evidence of a protective effect of breastfeeding against primary dentition malocclusion but no supportive evidence for mixed dentition and permanent dentition malocclusions. Regarding caries, well-conducted studies report a benefit with breastfeeding up to 12 mo but a positive association between caries and breastfeeding of longer duration, at times that vary between 12 and 24 mo, as well as nocturnal feeding. Future studies would be methodologically stronger if focused on specific malocclusion traits that are plausibly associated with sucking movements rather than using general malocclusion indices. Studies should use detailed and consistent terminology for breastfeeding definition, including frequency, intensity, and timing. Analytical studies should be carried out to distinguish between confounders (e.g., prematurity) and mediators (e.g., use of pacifier). Regarding a link to caries, standard terminology for exposures (e.g., nocturnal feeding) is recommended. Statistical analyses must account for known confounding factors (e.g., socioeconomic conditions) but avoid inappropriate adjustment for variables on a causal path between exposure and outcome or for variables not associated with breastfeeding (e.g., tooth brushing), as can be guided using tools such as direct acyclic graphs. For dental practice, the potential caries risk of long-duration breastfeeding should be part of individual patient counseling that incorporates patient values and circumstances. Given the unquestioned overall health benefits of breastfeeding, the dental community should support World Health Organization guidelines that encourage and promote breastfeeding.
Dental care providers are essential in screening and co-managing sleep-breathing disorders, particularly obstructive sleep apnea. As an integral component of dental medicine education, Dental ...Sleep-disordered Breathing Education (DSBE) aims to equip undergraduate and graduate dental students with the necessary knowledge, skills, and attitude to screen for and manage sleep-breading disorders as part of interdisciplinary teams. Studies on DSBE have mainly focused on undergraduate dental programs. Thus, research is needed to support the improvement of DSBE in dental residency programs, especially in orthodontics, to address the learning needs of future dental students, including Generation Z learners. This perspective paper suggests key research areas and methodologies to support this much-needed undertaking. These areas include curriculum mapping, outcome evaluation, and improvement/innovation. Dental researchers are encouraged to investigate these areas, employing the suggested methodologies. This will help overcome existing educational challenges and advance the available knowledge on DSBE in residency programs in orthodontics and dentistry at large.
Summary
The purpose of this study was to systematically review the literature for studies that assessed the effects of glucosamine supplements (GS) on pain and maximum mouth opening (MMO) restriction ...compared to other therapies, placebo or no intervention on painful temporomandibular joint osteoarthritis (TMJ OA). Randomised controlled trials were selected in a two‐phase process. Seven electronic databases, in addition to three grey literature databases, were searched. Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Twelve potentially eligible studies were identified, from which three were finally included. Furthermore, two were categorised at low risk and one at high risk of bias. Intervention groups were treated with glucosamine‐sulphate, while controls were treated with placebo or ibuprofen. In two studies, GS were equally effective regarding pain reduction and mouth opening improvement compared to ibuprofen taken two or three times a day over 12 weeks; however, one study did not find significant differences in follow‐up evaluations concerning these clinical variables in both glucosamine and placebo groups administered over six weeks. There is very low evidence regarding GS therapeutic effects on TMJ OA. Considering a follow‐up of 12 weeks, GS were as effective as ibuprofen taken two or three times a day. However, over six weeks of medication intake, GS were not superior to placebo. Still, included studies presented major drawbacks, and therefore, conclusions must be interpreted with caution.
Many dental procedures are considered aerosol-generating procedures that may put the dental operator and patients at risk for cross-infection due to contamination from nasal secretions and saliva. ...This aerosol, depending on the size of the particles, may stay suspended in the air for hours. The primary objective of the study was to characterize the size and concentrations of particles emitted from 7 different dental procedures, as well as estimate the contribution of the nasal and salivary fluids of the patient to the microbiota in the emitted bioaerosol. This cross-sectional study was conducted in an open-concept dental clinic with multiple operators at the same time. Particle size characterization and mass and particle concentrations were done by using 2 direct reading instruments: Dust-Trak DRX (Model 8534) and optical particle sizer (Model 3330). Active bioaerosol sampling was done before and during procedures. Bayesian modeling (SourceTracker2) of long-reads of the 16S ribosomal DNA was used to estimate the contribution of the patients’ nasal and salivary fluids to the bioaerosol. Aerosols in most dental procedures were sub-PM1 dominant. Orthodontic debonding and denture adjustment consistently demonstrated more particles in the PM1, PM2.5, PM4, and PM10 ranges. The microbiota in bioaerosol samples were significantly different from saliva and nasal samples in both membership and abundance (P < 0.05) but not different from preoperative ambient air samples. A median of 80.15% of operator exposure was attributable to sources other than the patients’ salivary or nasal fluids. Median operator’s exposure from patients’ fluids ranged from 1.45% to 2.75%. Corridor microbiota showed more patients’ nasal bioaerosols than oral bioaerosols. High-volume saliva ejector and saliva ejector were effective in reducing bioaerosol escape. Patient nasal and salivary fluids are minor contributors to the operator’s bioaerosol exposure, which has important implications for COVID-19. Control of bioaerosolization of nasal fluids warrants further investigation.
A systematic review was undertaken to evaluate the validity of intra‐arch dimensional measurements made from laser‐scanned digital dental models in comparison with measurements directly obtained from ...the original plaster casts (gold standard). Finally included articles were only those reporting studies that compared measurements from digital models produced from laser scanning against their plaster models. Measurements from the original plaster models should have been made using a manual or digital caliper (gold standard). Articles that used scans from impressions or digital photographs were discarded. Detailed individual search strategies for Cochrane, EMBASE, MEDLINE, PubMed, and LILACS were developed. The references cited in the selected articles were also checked for any references that could have been missed in the electronic database searches. A partial gray literature search was undertaken using Google Scholar. The methodology of selected studies was evaluated using the 14‐item quality assessment tool for diagnostic accuracy studies (QUADAS). Only 16 studies were finally included for the qualitative/quantitative synthesis. The selected studies consistently agree that the validity of measurements obtained after using a laser scanner from plaster models is similar to direct measurements. Any stated differences would be unlikely clinically relevant. There is consistent scientific evidence to support the validity of measurements from digital dental models in comparison with intra‐arch dimensional measurements directly obtained from them.
Background
A systematic review assessing autologous versus alloplastic bone for secondary alveolar bone grafting in patients with cleft lip and palate was published in 2011 and included only one ...randomized controlled trial comparing traditional iliac bone graft to recombinant human bone morphogenetic protein-2 (rh-BMP2).
Objectives
To perform a systematic review with meta-analysis on the use of secondary alveolar bone grafting (autologous bone and rh-BMP2 graft) in order to improve bone volume and height in patients with cleft lip and palate.
Data sources
An electronic search was conducted via PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CONTROL) via Cochrane Library, EMBASE via Ovid, and LILAC for studies published between January 2008 and September 2018. The systematic review registration number at PROSPERO was 42018085858.
Eligibility criteria
Only RCTs were included. Inclusion criteria were patients with the diagnosis of unilateral cleft lip and palate older than 5 years of age, radiographic evaluation (CT and/or CBCT) of the cleft area, and at least a 6-month follow-up.
Main outcome measures
Bone formation and bone height by radiographic CT evaluation (preoperatively, after 6 months and after 1 year of follow-up) and length of hospital stay were assessed.
Results
Four studies met strict inclusion criteria. Autologous bone graft showed statistically significant higher bone formation after 6-month follow-up (MD − 14.410; 95% CI − 22.392 to − 6.428;
p
= 0.000). No statistically significant difference was noted after a 1-year follow-up (MD 6.227; 95% CI − 15.967 to 28.422;
p
= 0.582). No statistically significant difference in bone height was noted after 6-month (MD − 18.737; 95% CI − 43.560 to 6.087;
p
= 0.139) and 1-year follow-up (MD − 4.401; 95% CI − 30.636 to 21.834;
p
= 0.742). Patients who underwent rh-BMP2 graft had a statistically significant reduced hospital stay (MD − 1.146; 95% CI − 2.147 to − 0.145;
p
= 0.025).
Limitations
The main limitation is the high risk of bias among included studies.
Conclusion
Autologous bone and rh-BMP2 graft showed a similar effectiveness in maxillary alveolar reconstruction in patients with unilateral cleft lip and palate assessing bone graft volume and height although rh-BMP2 graft showed a relative shorter length of hospital stay (high uncertainty level).
The objectives of this study were to systematically review the literature for studies that used cone beam CT (CBCT) to automatically or semi-automatically model the upper airway (including the ...pharyngeal, nasal and paranasal airways), and to assess their validity and reliability. Several electronic databases (MEDLINE®, MEDLINE In-Process & Other Non-Indexed Citations, all evidence-based medicine reviews including the Cochrane database, and Scopus) were searched. Abstracts that appeared to meet the initial selection criteria were selected by consensus. The original articles were then retrieved and their references were searched manually for potentially suitable articles that were missed during the electronic search. Final articles that met all the selection criteria were evaluated using a customized evaluation checklist. 16 articles were finally selected. From these, five scored more than 50% based on their methodology. Although eight articles reported the reliability of the airway model generated, only three used intraclass correlation (ICC). Two articles tested the accuracy/validity of airway models against the gold standard, manual segmentation, using volumetric measurements; however, neither used ICC. Only three articles properly tested the reliability of the three-dimensional (3D) upper airway model generated from CBCT and only one article had sufficiently sound methodology to test the airway model's accuracy/validity. The literature lacks proper scientific justification of a solid and optimized CBCT protocol for airway imaging. Owing to the limited number of adequate studies, it is difficult to generate a strong conclusion regarding the current validity and reliability of CBCT-generated 3D models.
Summary
We performed a systematic review of the literature to assess the association between sleep apnea and bone metabolism diseases including osteoporosis in adult population. Results from clinical ...trials suggest that the association between sleep apnea and low bone mass in adults is possible.
Introduction
This study aimed to synthesize existing evidence on the potential association between sleep apnea and low bone mass in adults.
Methods
Electronic searches of five databases were performed. The inclusion criteria consisted of studies in humans that assessed potential associations between sleep apnea and bone metabolic diseases in an adult population. For diagnosis of sleep apnea overnight polysomnography, home polygraphy, or validated records from healthcare databases were considered. Reduced bone density, osteoporosis, serum/urinary levels for markers of bone formation and resorption, or risk of fractures caused without history of trauma were considered indicators of low bone mass. A random-effects model meta-analysis was applied when possible.
Results
Of the 963 relevant references, 12 studies met our inclusion criteria and were assessed to be of medium to low bias. Nine out of 12 studies reported an association between sleep apnea and low bone mass (increased bone resorption markers, reduced bone density, and higher risk of osteoporosis). Two studies did not report a significant association, whereas one study reported an increase of bone density in sleep apnea patients compared to non-sleep apnea patients. Meta-analysis of 2 studies (
n
= 112,258 patients) showed that sleep apnea was a significant risk factor for osteoporosis (odds ratio (OR), 1.92; 95%CI, 1.24 to 2.97; I
2
= 66%); females only had an OR of 2.56 (95% CI, 1.96 to 3.34; I
2
= 0%) while the OR in males was 2.03 (95% CI, 1.24 to 3.35; I
2
= 38%).
Conclusions
An association between sleep apnea and low bone mass in adults is plausible, but supporting evidence has a risk of bias and is inconsistent.
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