Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial.

Importance: Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear. Objective: To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy. Design, Setting, and Participants: Cluster randomized multiple crossover clinical trial conducted at a single US academic hospital. Patients were adults aged 18 years or older having elective or emergent cardiac, thoracic, or vascular surgical procedures who required single-lumen endotracheal intubation for general anesthesia. Patients were enrolled from March 30, 2021, to December 31, 2022. Data analysis was based on intention to treat. Interventions: Two sets of 11 operating rooms were randomized on a 1-week basis to perform hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt. Main Outcomes and Measures: The primary outcome was the number of operating room intubation attempts per surgical procedure. Secondary outcomes were intubation failure, defined as the responsible clinician switching to an alternative laryngoscopy device for any reason at any time, or by more than 3 intubation attempts, and a composite of airway and dental injuries. Results: Among 8429 surgical procedures in 7736 patients, the median patient age was 66 (IQR, 56-73) years, 35% (2950) were women, and 85% (7135) had elective surgical procedures. More than 1 intubation attempt was required in 77 of 4413 surgical procedures (1.7%) randomized to receive video laryngoscopy vs 306 of 4016 surgical procedures (7.6%) randomized to receive direct laryngoscopy, with an estimated proportional odds ratio for the number of intubation attempts of 0.20 (95% CI, 0.14-0.28; P < .001). Intubation failure occurred in 12 of 4413 surgical procedures (0.27%) using video laryngoscopy vs 161 of 4016 surgical procedures (4.0%) using direct laryngoscopy (relative risk, 0.06; 95% CI, 0.03-0.14; P < .001) with an unadjusted absolute risk difference of -3.7% (95% CI, -4.4% to -3.2%). Airway and dental injuries did not differ significantly between video laryngoscopy (41 injuries [0.93%]) vs direct laryngoscopy (42 injuries [1.1%]). Conclusion and Relevance: In this study among adults having surgical procedures who required single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy decreased the number of attempts needed to achieve endotracheal intubation compared with direct laryngoscopy at a single academic medical center in the US. Results suggest that video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures. Trial Registration: ClinicalTrials.gov Identifier: NCT04701762.

[The quality of dental care in children with permanent teeth trauma according to analysis of medical records in an emergency unit of a municipal dental clinic]. / Kachestvo okazaniya neotlozhnoi pomoshchi detyam s travmami postoyannykh zubov po dannym analiza dokumentatsii otdeleniya neotlozhnoi pomoshchi gorodskoi stomatologicheskoi polikliniki.

THE AIM OF THE STUDY: Was to assess the efficacy and timing of emergency dental care in children with permanent teeth trauma according to analysis of medical records in an emergency unit of a municipal dental clinic. MATERIAL AND METHODS: The study involved 320 medical records of pediatric patients admitted to emergency dental care unit of a municipal dental clinic in 2021 because of maxillofacial trauma from which 221 records of children with acute dental trauma were extracted. The quality of documentation of the medical records, rationale for diagnosis and adequacy of emergency dental treatment were analyzed. RESULTS: No records included diagnosis code according to ICD-10. Trauma history was described in the majority of records by in 67% of them no trauma time was stated with proper precision. In 67.6% of permanent teeth trauma cases emergency aid was carried out inadequately. All patients with uncomplicated crown fractures were dismissed with no treatment. In complicated crown fractures needing pulp vitality preservation the pulp was devitalized or just anesthetized. Tooth replantation in avulsion cases was not performed. In 13.5% of records the treatment was not properly described. In 67.6% of records there were no recommendations for follow-ups. CONCLUSION: There is a strong need for the improvement of knowledge of traumatic dental injuries management among Russian pediatric dentists by elaboration and implementation of protocols for dental traumas treatment.

Knowledge and management of traumatic dental injuries among schoolteachers in Hungary: a cross-sectional study with educational intervention.

PURPOSE: This study aimed to evaluate the knowledge of Hungarian schoolteachers in the management of dental trauma injuries (TDI) of children between the ages of 3 and 18 and to illustrate a brief educational intervention on TDI management. METHODS: A 15-item questionnaire on dental injuries was distributed in our observational cross-sectional study to 2720 Hungarian educational institutions to explore and evaluate teachers' knowledge in January 2019. Two years later, targeted information material was made accessible regarding TDI management. In the second post-intervention phase of the study, educator knowledge was re-evaluated using the same questionnaire. Statistical analysis (Mann-Whitney and Chi-square tests) was performed using IBM SPSS Statistics 28. RESULTS: A total of 1426 answers were collected in the initial survey. Although more than half (51.9%) of the respondents previously witnessed TDIs, 86.5% still did not perceive themselves as adequately informed regarding TDI management. Most teachers submitted appropriate responses to the indicator questions relating to the urgency of referral to dental professionals (71.8%), immediate contact with parents (79.0%) or dentists (13.0%), and the solution for avulsed teeth (81.3%). However, only every second (56.2%) educator responded correctly regarding the proper cleaning method. Following accessibility to our educational material, 622 respondents completed the post-intervention questionnaire in the second phase of the study. The percentage of appropriate responses to the five indicator questions significantly increased by 5-20.6%. CONCLUSION: Teachers' knowledge of TDI was inadequate yet can improve with online education. Efforts among dental professionals, the media, and targeted interventions will ensure adequate knowledge while also improving children's dental health.

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 1: General introduction.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 4: Faceshields for the prevention of dental and oral trauma.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 5: Secondary prevention of dental injuries.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 3: Mouthguards for the prevention of dental and oral trauma.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 10: First aid education.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 2: Primary prevention of dental trauma across the life course.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 6: Education.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 8: ToothSOS app.

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

Patient perception of service quality to preanesthetic oral examination: a cross-sectional study using the SERVQUAL model.

BACKGROUND: A phase-III interdisciplinary quality improvement program, the preanesthetic oral examination (PAOE), was implemented as a new program in an academic medical center to prevent perioperative dental injuries. This study was aimed at surveying the perceived service quality and satisfaction of patients who had undergone PAOE based on the SERVQUAL model. METHODS: This cross-sectional survey was conducted at the Kaohsiung Medical University Hospital using convenience sampling. Patients referred for PAOE (PAOE group) and those who had voluntarily availed dental services (control group) were recruited. A modified SERVQUAL questionnaire was used to assess the perceived service quality and patient satisfaction with dental services. Cronbach's alpha for SERVQUAL was 0.861. RESULTS: We enrolled 286 (68.8%) and 130 (31.2%) participants in the PAOE and control groups, respectively. The path analysis revealed that the PAOE group scored lower in dimensions of reliability (ß = -0.074, P = 0.003), responsiveness (ß = -0.148, P = 0.006), and empathy (ß = -0.140, P = 0.011). Furthermore, reliability (ß = 0.655, P < 0.001) and responsiveness (ß = 0.147, P = 0.008) showed a direct effect on patient satisfaction. Overall, participants were highly satisfied with the dental services. CONCLUSIONS: The PAOE group showed lower satisfaction and perceived quality of dental services compared to the control group. Although implementing an interdisciplinary program reduces the perceived service quality, its influence is limited. Employing an interdisciplinary teamwork is a win-win strategy encouraged to improve patient safety and reduce malpractice claims. Future suggestions should focus on establishing waiting times that are considered reasonable by patients. Patient-centered education related to the risk of perioperative dental injuries should be provided, and awareness of oral conditions for patient safety should be improved. Moreover, interprofessional education in continuous and undergraduate programs is necessary to improve professional quality.

Faculty of sports science students, physical education teachers, and athletes' level of knowledge and attitude about mouthguards.

OBJECTIVES: Traumatic dental injury occurs during sports competitions, training, and practice and can be prevented by the use of mouthguards. For this reason, this study aimed to evaluate the knowledge and attitudes of sports science faculty students, physical education teachers, and athletes about mouthguards. METHODS: Five hundred thirty-two participants were reached via social media. In the questionnaire consisting of 20 questions, questions about the sociodemographic characteristics of the participants were asked in part 1, and questions about their level of knowledge and attitudes about the mouthguards were asked in part 2. Descriptive statistical analysis and a chi-square test were used to evaluate the data. RESULTS: The number of people who think that mouthguards protect the athlete from traumatic dental injury is 381 (71.6%). The number of people who think that mouthguards affect the performance of the athlete is positively 228 (42.9%). To protect against traumatic dental injury, 51.48% of the participants preferred the custom-made; 39.3% of them preferred the boil-bite; 33.22% of them preferred the standard/stock type mouth guard; and 22.96% of them preferred the helmet, and 18.26% of them preferred the face mask. CONCLUSIONS: The knowledge and attitude of sports science faculty students, physical education teachers, and athletes are low about mouthguards. Since these people who are engaged in sports have a high exposure to traumatic dental injuries, education should be given to increase their awareness about mouthguards.

The Reparative Function of MMP13 in Tertiary Reactionary Dentinogenesis after Tooth Injury.

MMP13 gene expression increases up to 2000-fold in mineralizing dental pulp cells (DPCs), with research previously demonstrating that global MMP13 deletion resulted in critical alterations in the dentine phenotype, affecting dentine-tubule regularity, the odontoblast palisade, and significantly reducing the dentine volume. Global MMP13-KO and wild-type mice of a range of ages had their molar teeth injured to stimulate reactionary tertiary dentinogenesis. The response was measured qualitatively and quantitatively using histology, immunohistochemistry, micro-CT, and qRT-PCR in order to assess changes in the nature and volume of dentine deposited as well as mechanistic links. MMP13 loss affected the reactionary tertiary dentine quality and volume after cuspal injury and reduced Nestin expression in a non-exposure injury model, as well as mechanistic links between MMP13 and the Wnt-responsive gene Axin2. Acute pulpal injury and pulp exposure to oral fluids in mice teeth showed upregulation of the MMP13 in vivo, with an increase in the gene expression of Mmp8, Mmp9, and Mmp13 evident. These results indicate that MMP13 is involved in tertiary reactionary dentine formation after tooth injury in vivo, potentially acting as a key molecule in the dental pulp during dentine-pulp repair processes.

Risk factors associated with traumatic dental injuries in individuals with special healthcare needs-A systematic review and meta-analysis.

BACKGROUND/AIM: Individuals with special healthcare needs (SHCN) are more likely to sustain traumatic dental injuries (TDIs) due to distinct risk factors. The aim of this review was to assess various risk factors associated with TDIs in individuals with SHCN. MATERIALS AND METHODS: The protocol was designed according to the recommendations of the Cochrane-handbook, Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42022357422). A comprehensive search was performed in PubMed, LILACS, Web of Science, EMBASE and Scopus using a pre-defined strategy without any limitation of language and year of publication. It was last updated on 25 April 2023. Studies addressing the TDIs in individuals with SHCN were included. Data extraction and analyses were performed, risk of bias (ROB) assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed using random-effects model. RESULTS: A total of 21 studies were included in the review. They were categorized according to the target disease/condition: cerebral palsy (n = 5), ADHD and autism spectrum disorders (n = 5), visually impaired (n = 4), and multiple disorders (n = 7). The studies showed variability in the design and methods; however, 17 out of 21 studies showed moderate to low ROB. Increased overjet and lip incompetence were the main risk factors reported in the studies. The commonest injuries were observed to be enamel and enamel and dentine fractures. CONCLUSION: The overall pooled prevalence of TDI in individuals with special healthcare needs was 23.16% with 20.98% in males and 27.06% in females. Overjet >3 mm and inadequate lip coverage were found to be associated with a higher risk of TDI in all the categories of individuals with special healthcare needs except ADHD and ASD. Falls at home in cerebral palsy, falls while walking and self-harm in ADHD and ASD, falls at home and collision in visual impairment, and unspecified falls in multiple disorders could be identified as the most common cause of TDI.

Treatment priorities and arrival time of traumatic dental injuries-An 8-year retrospective study.

BACKGROUND/AIM: Most of the previous studies in the available literature discussed the time of arrival in general to the healthcare system, while a minority studied the relationship between the type of trauma and arrival. The aim of this retrospective study is to assess the arrival time of traumatic dental injuries (TDIs) depending on the urgency of treatment according to Andreasen. MATERIALS AND METHODS: This 8-year retrospective study was carried out at the Department of Pediatric Dentistry at the University Dental Clinic in Zagreb, Croatia. Andreasen's classification was used to define the kind of TDI as well as to divide them by the need for urgent treatment or treatment priorities in three groups: acute, subacute, and delayed. RESULTS: The sample consisted of 1040 children (59% male and 41% female) with a median age of 7. Each year, the age group most affected by TDIs was 6-12 years old. While there is a general increase in the prevalence of TDIs overall, there is a decline in TDIs among children aged 6-12 and an increase among preschoolers and adolescents (below 6 and above 12 years old). Throughout the years, 52.73% red/acute and 41.16% yellow/subacute TDIs were not treated on time due to delayed arrival. More patients from Zagreb come in the first 24 h, while more patients from outside Zagreb come to the clinic a month or more after their injuries. Patients which suffered TDI accompanied with soft-tissue injury arrived sooner. CONCLUSIONS: It is necessary to introduce monitoring and education of patients under the age of 6 and over 12, as well as their parents/caregivers. New programs should be implemented and new referent centers that specialize in treating TDIs outside of Zagreb should be established.