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Discover the most talked about and latest scientific content & concepts.

Concept: Dentistry

211

To identify where a consensus can be reached between veterinary experts in feline medicine on the core signs sufficient for pain (sufficient to indicate pain when they occur, but not necessarily present in all painful conditions) and necessary for pain (necessary in the presence of pain, but not always indicative of pain).

Concepts: Neuroscience, Neurology, Acupuncture, Dentistry, Suffering, Necessity

177

The aim was to determine if bracket prescription has any effect on the subjective outcome of pre-adjusted edgewise treatment as judged by professionals. This retrospective observational assessment study was undertaken in the Orthodontic Department of the Charles Clifford Dental Hospital, Sheffield, UK. Forty sets of post-treatment study models from patients treated using a pre-adjusted edgewise appliance (20 Roth and 20 MBT) were selected. The models were masked and shown in a random order to nine experienced orthodontic clinicians, who were asked to assess the quality of the outcome, using a pre-piloted questionnaire. The principal outcome measure was the Incisor and Canine Aesthetic Torque and Tip (ICATT) score for each of the 40 post-treatment models carried out by the nine judges. A two-way analysis of variance was undertaken with the dependent variable, total ICATT score and independent variables, Bracket prescription (Roth or MBT) and Assessor. There were statistically significant differences between the subjective assessments of the nine judges (P<0.001), but there was no statistically significant difference between the two bracket prescriptions (P = 0.900). The best agreement between a clinician's judgment of prescription used and the actual prescription was fair (kappa statistic 0.25; CI -0.05 to 0.55). The ability to determine which bracket prescription was used was no better than chance for the majority of clinicians. Bracket prescription had no effect on the subjective aesthetic judgments of post-treatment study models made by nine experienced orthodontists.

Concepts: Statistics, Hospital, Evaluation, Statistical significance, Assessment, Analysis of variance, Dentistry, Judgment

168

BACKGROUND: There are scarce evidences that evaluated the impact of periodontal disease on oral health-related quality of life (OHRQoL) taking marginal gingival alterations into consideration. Thus, this study aimed to verify the association between OHRQoL and gingival enlargement and gingival bleeding in subjects under fixed orthodontic treatment (FOT). METHODS: 330 participants under FOT for at least 6 months were examined by a single, calibrated examiner for periodontal variables. Socio-economic background, body mass index, time with orthodontic appliances, dental aesthetic index and use of dental floss were assessed by oral interviews. OHRQoL was evaluated using the oral health impact profile (OHIP-14) questionnaire. The assessment of associations used unadjusted and adjusted Poisson regression models. RESULTS: Higher impacts on the OHIP-14 overall were observed in subjects who presented higher levels of anterior gingival enlargement (RR 2.83; 95% CI 2.60-3.09), were non-whites (RR 1.29; 95% CI 1.15-1.45), had household income lower than five national minimum wages (RR 1.85; 95% CI 1.30-2.61), presented body mass index > 25 (RR 1.14; 95% CI 1.01-1.29), andshowed a dental aesthetic index > 30 (RR 1.32; 95% CI 1.20-1.46) . CONCLUSIONS: Anterior gingival enlargement seems to influence the OHRQoL in subjects receiving orthodontic treatment.

Concepts: Regression analysis, Gingiva, Periodontitis, Periodontal disease, Dentistry, Oral hygiene, Minimum wage, Dental floss

151

Methoxyflurane was developed as an anaesthetic agent and introduced into clinical practice in 1960. It soon became evident that it possessed analgesic properties that other drugs did not. Due to toxicity concerns, it lost favour in general anaesthesia and had been largely abandoned by the late 1970’s. The manufacturer withdrew it in 1999, and the Food and Drug Administration in the United States did not renew its license in 2005. It has also been withdrawn by the European Union. However, it continues to be used in Australasia, primarily as an inhaled self-administered analgesic by emergency services immediately following trauma. It has become attractive for use in dental practice, likely due to its effectiveness as an analgesic and its additional sedative qualities. Its acceptance is controversial as its use in dentistry is largely elective. Despite its good safety record in analgesic doses, adverse reactions have been recorded. Practitioners should be well aware of risks associated with its use before considering administration, and carefully assess whether or not there are equally good alternative options that do not the carry the same risks. Methoxyflurane is reviewed below with an emphasis on its use in dental practice. This article is protected by copyright. All rights reserved.

Concepts: Clinical trial, European Union, United States, Anesthesia, Dentistry, All rights reserved, Copyright, Legal terms

147

Subjects susceptible to chronic periodontitis (CP) show a high risk for the development of peiimplantitis (PI). Both diseases are multifactorial, presenting similarities in their pathophysiology and polygenic profile. MMP-13 (matrix metalloproteinases 13/ collagenase 3) is a collagenolytic enzyme, which expression is induced by TGF beta 3 (transforming growth factor type 3) in human gingival fibroblasts and inhibited by TIMP-2 (tissue inhibitor of metalloproteinase type 2). The aim of this study was to investigate the occurrence of peiimplantitis (PI) in subjects with history of chronic periodontitis (CP) and polymorphisms frequency in MMP13, TIMP2 and TGFB3 genes. One hundred and sixty-three volunteers received dental implant placement were submitted to oral and radiographic examination in order to identify past history of CP or presence of PI. Volunteers were divided into 4 groups: Control (without PI and CP, n=72), CP (with CP and without PI, n=28), PI (with PI and without CP, n=28) and diseased (with CP and PI, n=35). The chi-square test correlated genotypes in specific regions of MMP13 (rs2252070), TIMP2 (rs7501477) and TGFB3 (rs2268626) genes, considering the interaction between CP and PI. The results showed that volunteers with CP had 3.2 times more susceptibility to develop PI (p=0.0004) compared to those without CP. No significant association was observed in MMP13, TIMP2 and TGFB3 genes with CP or PI. CP is a risk factor to develop PI, however, there is no association of both diseases with polymorphisms in the MMP13, TIMP2 and TGFB3 genes.

Concepts: Gene, Genetics, Dental implant, Dentistry, Tissue inhibitor of metalloproteinases, Transforming growth factor, TGF beta, TGF beta 3

138

The frequent instability of mandibular removable complete dentures affects patient Oral Health Related Quality of Life (OHRQoL). An innovative therapeutic strategy used to improve stability involves placing four symphyseal mini-implants. This study was aimed at assessing OHRQoL over time in subjects in which mini-implants were placed and exploring if certain parameters could predict the evolution of their OHRQoL. The OHRQoL of subjects with dentures was assessed using the Geriatric Oral Health Assessment Index (GOHAI) before (T0), 2-6 months (T1), twelve months (T2) and twenty-four or more months (T3) after mini-implant setting. Age, gender and chewing ability were tested as explanatory variables for the change in OHRQoL with time. Thirteen women and six men were included (mean age: 69 ± 10 years). After treatment, mean GOHAI scores at T1, T2 and T3 increased significantly (p < 0.001). The GOHAI-Add mean score was not affected by age or gender. Baseline chewing ability impacted the "functional" and "pain and discomfort" fields of the mean GOHAI scores (p < 0.05). The OHRQoL quickly improved after mini-implant placement in complete denture wearers and then stabilized over time. Baseline chewing ability can be used as a predictive parameter of OHRQoL.

Concepts: Scientific method, Medicine, Future, Dentistry, Dentures, Removable partial denture, Currying

137

Platelet-rich plasma (PRP) is a new approach to tissue regeneration and it is becoming a valuable adjunct to promote healing in many procedures in dental and oral surgery, especially in aging patients. PRP derives from the centrifugation of the patient’s own blood and it contains growth factors that influence wound healing, thereby playing an important role in tissue repairing mechanisms. The use of PRP in surgical practice could have beneficial outcomes, reducing bleeding and enhancing soft tissue healing and bone regeneration. Studies conducted on humans have yielded promising results regarding the application of PRP to many dental and oral surgical procedures (i.e. tooth extractions, periodontal surgery, implant surgery). The use of PRP has also been proposed in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with the aim of enhancing wound healing and bone maturation. The aims of this narrative review are: i) to describe the different uses of PRP in dental surgery (tooth extractions and periodontal surgery) and oral surgery (soft tissues and bone tissue surgery, implant surgery and BRONJ surgery); and ii) to discuss its efficacy, efficiency and risk/benefit ratio. This review suggests that the use of PRP in the alveolar socket after tooth extractions is certainly capable of improving soft tissue healing and positively influencing bone regeneration but the latter effect seems to decrease a few days after the extraction. PRP has produced better results in periodontal therapy in association with other materials than when it is used alone. Promising results have also been obtained in implant surgery, when PRP was used in isolation as a coating material. The combination of necrotic bone curettage and PRP application seem to be encouraging for the treatment of refractory BRONJ, as it has proven successful outcomes with minimal invasivity. Since PRP is free from potential risks for patients, not difficult to obtain and use, it can be employed as a valid adjunct in many procedures in oral and dental surgery. However, further RCTs are required to support this evidence.

Concepts: Surgery, Tissues, Soft tissue, Dental implant, Dentistry, Oral and maxillofacial surgery

106

Chronic knee pain, most commonly caused by knee osteoarthritis, is a prevalent condition which in most cases can be effectively treated through conservative, non-surgical care involving exercise therapy, education, psychosocial support, and weight loss. However, most people living with chronic knee pain do not receive adequate care, leading to unnecessary use of opiates and surgical procedures.

Concepts: Medicine, Epidemiology, Obesity, Randomized controlled trial, Surgery, Weight loss, Opioid, Dentistry

85

The origins of the genus Homo are murky, but by H. erectus, bigger brains and bodies had evolved that, along with larger foraging ranges, would have increased the daily energetic requirements of hominins. Yet H. erectus differs from earlier hominins in having relatively smaller teeth, reduced chewing muscles, weaker maximum bite force capabilities, and a relatively smaller gut. This paradoxical combination of increased energy demands along with decreased masticatory and digestive capacities is hypothesized to have been made possible by adding meat to the diet, by mechanically processing food using stone tools, or by cooking. Cooking, however, was apparently uncommon until 500,000 years ago, and the effects of carnivory and Palaeolithic processing techniques on mastication are unknown. Here we report experiments that tested how Lower Palaeolithic processing technologies affect chewing force production and efficacy in humans consuming meat and underground storage organs (USOs). We find that if meat comprised one-third of the diet, the number of chewing cycles per year would have declined by nearly 2 million (a 13% reduction) and total masticatory force required would have declined by 15%. Furthermore, by simply slicing meat and pounding USOs, hominins would have improved their ability to chew meat into smaller particles by 41%, reduced the number of chews per year by another 5%, and decreased masticatory force requirements by an additional 12%. Although cooking has important benefits, it appears that selection for smaller masticatory features in Homo would have been initially made possible by the combination of using stone tools and eating meat.

Concepts: Digestion, Dentistry, Human evolution, Mastication

66

Dentists prescribe approximately 10% of antibiotics dispensed in UK community pharmacies. Despite clear clinical guidance, dentists often prescribe antibiotics inappropriately. This cluster-randomised controlled trial used routinely collected National Health Service (NHS) dental prescribing and treatment claim data to compare the impact of individualised audit and feedback (A&F) interventions on dentists' antibiotic prescribing rates.

Concepts: Health care, Medicine, Clinical trial, Randomized controlled trial, Pharmaceutical industry, National Health Service, Dental implant, Dentistry