Usage of Multiple-Choice Items in Summative Examinations: Questionnaire Survey Among German Undergraduate Dental Training Programmes.

BACKGROUND: Multiple-choice examinations are frequently employed among German dental schools. However, details regarding the used item types and applied scoring methods are lacking. OBJECTIVE: We aimed to gain an insight into the current usage of multiple-choice items (ie, questions) in summative examinations in German undergraduate dental training programmes. METHODS: A paper-based 10-item questionnaire regarding the employed assessment methods, multiple-choice item types, and applied scoring methods was designed. The pilot-tested questionnaire was mailed to the Deans of Studies and to the Heads of Department of Operative/Restorative Dentistry at all 30 dental schools in Germany in February 2023. Statistical analysis was performed using Fisher's exact test (P<.05). RESULTS: The response rate amounted to 90.0% (27/30 dental schools). All respondent dental schools employed multiple-choice examinations for summative assessments. Examinations were delivered electronically by 70.4% (19/27) of the dental schools. Almost all dental schools used single-choice Type A items (88.9%) which accounted for the largest number of items in about half of the dental schools. Further item types (eg, conventional multiple-select items, Multiple-True-False, Pick-N) were only used by fewer dental schools (≤66.7%, up to 18 out of 27 dental schools). For the multiple-select item types, the applied scoring methods varied considerably (ie, awarding [intermediate] partial credit, requirements for partial credit). Dental schools with the possibility of electronic examinations used multiple-select items slightly more often (73.7%, 14/19 vs. 50.0%, 4/8). However, this difference was statistically not significant (P=.375). Dental schools used items either individually or as key feature problems consisting of a clinical case scenario followed by a number of items focusing on critical treatment steps (55.6%, 15/27). Not a single school employed alternative testing methods (eg, answer-until-correct). A formal item review process was established at about half of the dental schools (55.6%, 15/27). CONCLUSIONS: Summative assessment methods among German dental schools vary widely. Especially, a large variability regarding the use and scoring of multiple-select multiple-choice items was found.

Effect of different brushing parameters on erosive tooth wear in primary bovine enamel and dentin.

This in-vitro study aimed to analyse the effect of brushing and different brushing parameters (kind of toothpaste, kind of toothbrush, brushing force) on erosive tooth wear of primary bovine enamel and dentin. Specimens were prepared from primary bovine enamel or dentin (each group n = 12) and cyclically eroded (6 × 60 s/d, citric acid, pH 2.4) and brushed with children's toothbrushes (2 × 15 s/d) over 5 days. The brushing parameters under investigation were: toothpaste (fluoridated, fluoride-free), toothbrush (manual; rotating-oscillating and sonic, each at two different activation modes) and brushing force (1 N, 2 N). Specimens that were only eroded and not brushed served as controls. Enamel and dentin wear was quantified using widefield confocal microscopy. Statistical analysis was performed using three- and one-way ANOVAs followed by Scheffe's (enamel) or Tamhane's (dentin) post-hoc tests (p < 0.05). Brushing with the fluoridated toothpaste was able to significantly reduce erosive wear in enamel (by 15 to 37%, 6 of 10 groups) and in dentin (by 58 to 72%, all groups), while brushing with the fluoride-free toothpaste was not different from the controls. Considering the kind of toothpaste and brushing force, slight differences between the toothbrushes were observed in enamel, but not in dentin. Within the same toothbrush and activation mode, almost no differences between 1 and 2 N brushing force were detected. In conclusion, erosive tooth wear on primary bovine dental hard tissue mainly depends on the kind of toothpaste, rather than on the kind of toothbrush and the brushing force.

Anamnestic risk factors for erosive tooth wear: Systematic review, mapping, and meta-analysis.

OBJECTIVES: Erosive tooth wear is a multifactorial condition. The aim of this systematic review and meta-analysis was to identify key risk factors for erosive tooth wear in permanent dentition. STUDY SELECTION: Observational studies reporting anamnestic risk factors for erosive tooth wear. Methodological quality and risk of bias were assessed using the modified Newcastle-Ottawa scale for cross-sectional studies. Risk factors were visually presented in a heatmap, and where possible, random-effects meta-analyses were performed for the odds ratios (ORs) of risk factors. SOURCES: Electronic databases (MEDLINE, Embase, Scopus, and Web of Science) and manual searches in February 2023. The protocol was registered in PROSPERO (CRD4202339776). DATA: A total of 87 publications reporting on 71 studies were included in the systematic review. The studies examined a variety of anamnestic risk factors (n = 80) that were categorized into ten domains (socio-demographics, socio-economics, general health, oral diseases, medication, oral hygiene, food, beverages, dietary habits, and leisure-related risk factors). Meta-analyses revealed significant associations between erosive tooth wear and male gender (padj.<0.001; OR=1.30, 95 % CI: 1.16-1.44), regurgitation (padj.=0.033; OR=2.27, 95 % CI: 1.41-3.65), digestive disorders (padj.<0.001; OR=1.81, 95 % CI: 1.48-2.21), consumption of acidic foods (padj.=0.033; OR=2.40, 95 % CI: 1.44-4.00), seasoning sauces (padj.=0.003; OR=1.28, 95 % CI: 1.13-1.44), nutritional supplements (padj.=0.019; OR=1.73, 95 % CI: 1.28-2.35), and carbonated drinks (padj.=0.019; OR=1.43, 95 % CI: 1.17-1.75). Most included studies exhibited low bias risk. CONCLUSIONS: Observational studies investigated a variety of anamnestic risk factors for erosive tooth wear. Future studies should employ validated questionnaires, particularly considering the most important risk factors. CLINICAL SIGNIFICANCE: Erosive tooth wear is a prevalent condition. Clinicians should concentrate primarily on symptoms of gastroesophageal reflux disease and dietary factors when screening patients at risk for erosive tooth wear.

Dentin Bond Strength of Dental Adhesives Functionalized with Polyhedral Oligomeric Silsesquioxanes.

This study analyzed the dentin shear bond strength (SBS) of an etch-and-rinse (ER) or a self-etch (SE) adhesive incorporated with multifunctional polyhedral oligomeric silsesquioxanes (MA-POSS-8). An ER adhesive (Solobond Plus, VOCO GmbH, Cuxhaven, Germany) and a universal adhesive applied in SE mode (Scotchbond Universal, 3M, St. Paul, MN, USA) were infiltrated with MA-POSS-8 (Hybrid Plastics Inc., Hattiesburg, MS, USA) at 5 wt.% or 10 wt.%. Pure adhesives served as controls. Bovine dentin specimens were conditioned with one of the adhesives prior to the application of a nano-hybrid composite (Venus Diamond A3, Kulzer, Hanau, Germany). SBS and failure modes were determined after water storage for 24 h, 6 months, 12 months, or 24 months (each subgroup n = 20). Statistical analysis was performed using ANOVAs, Weibull statistics, and χ2 tests (p < 0.05). SBSs for the control groups after 24 h were 17.4 ± 4.9 MPa for the ER adhesive and 19.1 ± 5.2 MPa for the universal adhesive. After 24 months, the SBS of the ER adhesive was significantly higher for 5 wt.% MA-POSS-8 (17.9 ± 5.1 MPa) than for the control group (14.6 ± 3.6 MPa) and 10 wt.% MA-POSS-8 (12.8 ± 4.1 MPa), and more cohesive failures were observed. The SBS of the universal adhesive increased during aging, irrespective of the MA-POSS-8 concentration. 5 wt.% MA-POSS-8 improves the SBS of the ER adhesive and does not impair the SBS of the SE adhesive.

Quality of Patient-Centered eHealth Information on Erosive Tooth Wear: Systematic Search and Evaluation of Websites and YouTube Videos.

BACKGROUND: Due to the declining prevalence of dental caries, noncarious tooth defects such as erosive tooth wear have gained increased attention over the past decades. While patients more frequently search the internet for health-related information, the quality of patient-centered, web-based health information on erosive tooth wear is currently unknown. OBJECTIVE: This study aimed to assess the quality of patient-centered, web-based health information (websites and YouTube videos) on erosive tooth wear. METHODS: German-language websites were systematically identified through 3 electronic search engines (google.de, bing.de or yahoo.de, and duckduckgo.com) in September 2021. Eligible websites were independently assessed for (1) technical and functional aspects via the LIDA instrument, (2) readability via the Flesch reading-ease score, (3) comprehensiveness of information via a structured checklist, and (4) generic quality and risk of bias via the DISCERN instrument by 2 different reviewers. An overall quality score (ie, higher scores being favored) generated from all 4 domains was used as the primary outcome. Quality scores from each domain were separately analyzed as secondary outcomes and compared by the Friedman test. The effect of practice-specific variables on quality scores of websites from private dental offices was assessed using generalized linear modeling. Eligible YouTube videos were judged based on (1) the comprehensiveness of information, (2) viewers' interaction, and (3) viewing rate. The comprehensiveness of information was compared between websites and YouTube videos using the Wilcoxon rank-sum test. RESULTS: Overall, 231 eligible websites and 7 YouTube videos were identified and assessed. The median overall quality of the websites was 33.6% (IQR 29.8%-39.2%). Secondary outcome scores amounted to 64.3% (IQR 59.8%-69.0%) for technical and functional aspects, 40.0% (IQR 34.0%-49.0%) for readability, 11.5% (IQR 3.9%-26.9%) for comprehensiveness of information, and 16.7% (IQR 8.3%-23.3%) for generic quality. While the comprehensiveness of information and generic quality received low scores, technical and functional aspects as well as readability resulted in higher scores (both Padjusted<.001). Regarding practice-specific variables, websites from private dental offices outside Germany (P=.04; B=-6.64, 95% CI -12.85 to -0.42) or from dentists who are a dental society member (P=.049; B=-3.55, 95% CI -7.09 to -0.01) resulted in lower readability scores (ie, were more difficult to read), while a shorter time since dentists' examination resulted in higher readability scores (P=.01; B=0.24 per year, 95% CI 0.05-0.43). The comprehensiveness of information from YouTube videos was 34.6% (IQR 13.5%-38.5%). However, the comprehensiveness of information did not vary between websites and YouTube videos (P=.09). Additionally, viewers' interaction (1.7%, IQR 0.7%-3.4%) and viewing rates (101%, IQR 54.6%-112.6%) were low. CONCLUSIONS: The quality of German-language, patient-centered, web-based information on erosive tooth wear was limited. Especially, the comprehensiveness and trustworthiness of the available information were insufficient. Web-based information on erosive tooth wear requires improvement to inform patients comprehensively and reliably.

Oral health in patients with different sites of head and neck squamous cell carcinoma is not different.

Oral health might not only act as risk factor for head and neck squamous cell carcinoma (HNSCC), but might also have a predictive value for the patients' survival. Currently, information on the effect of oral health on survival of patients with different sites of HNSCC is lacking. This single-center retrospective study aimed to compare oral health in patients with different sites of HNSCC and to analyse whether oral health is associated with survival in the different subsets of HNSCC patients. Dental records of HNSCC patients referred for dental assessment prior to radio(chemo)therapy were included. Patient-related parameters (age at time of diagnosis, sex, tobacco exposure, alcohol consumption, HPV status), treatment data (primary treatment, intent), performance status, tumor demographics (anatomical site, TNM staging), and oral health parameters (DMFT, periodontal health, teeth with/without root canal treatment and with/without periodontitis apicalis) were obtained. Oral health parameters were compared between different anatomical sites. Survival of all HNSCC patients and of individual subsets was assessed using Kaplan-Meier statistics, and the effect of tumor demographics, patient-related parameters, and oral health on survival was analysed by cox regression analyses (α = 5%). 371 patients with HNSCC (oral: n = 86, oropharyngeal: n = 174, hypopharyngeal: n = 59, laryngeal: n = 15, other: n = 37) were included. Oral health parameters did not differ between subsets (padj.≥0.199). Five-year cumulative survival of HNSCC patients amounted to 78.6%. Only for HNSCC originating in the oral cavity and oropharynx, survival was associated with the treatment intent (p = 0.015) or performance status (p = 0.007) in the multivariable analyses, respectively. Within the limitations of this study, oral health was not different between different subsets and had no significant effect on survival of HNSCC patients.

In vitro study on the preventive effect of children's toothpastes on erosive tooth wear of primary bovine enamel and dentin.

This in vitro study aimed to analyse the effect of various children's toothpastes on erosive tooth wear of primary bovine enamel and dentin. Enamel and dentin specimens (n = 12) were cyclically eroded (6 × 60 s/d, citric acid, pH 2.4) and brushed (2 × 15 s/d, 2 N) over 5 days. Nine fluoride toothpastes (500 to 1450 ppm) and eight toothpastes containing no fluoride or other active ingredients (hydroxyapatite and/or xylitol) were tested. Unbrushed specimens served as control. Tissue loss was quantified using widefield confocal microscopy and statistically analysed using two-way and one-way ANOVAs followed by Scheffe's (enamel) or Tamhane's (dentin) post-hoc tests (p < 0.05). Only one fluoride toothpaste (1400 ppm) was able to reduce erosive wear of enamel significantly by 15% compared to the control (padj. = 0.002). All fluoridated toothpastes reduced dentin surface loss significantly by 32 to 69% compared to the control (padj. ≤ 0.001), while fluoride-free toothpastes were unable to reduce dentin loss significantly (padj. ≥ 0.971). Most fluoridated toothpastes caused less erosive wear compared to fluoride-free toothpastes. Children toothpastes containing fluoride were more effective in reducing erosive wear compared to toothpastes containing no fluoride or other active ingredients.

Risk Factors for and Clinical Presentations Indicative of Vertical Root Fracture in Endodontically Treated Teeth: A Systematic Review and Meta-analysis.

INTRODUCTION: The aim of this study was to identify specific clinical signs or symptoms and potential risk factors which are most likely associated with the presence of a vertical root fracture (VRF) in endodontically treated teeth (ETT). METHODS: Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Scopus, and Web of Science) were searched by 2 reviewers in October 2022 for clinical studies, in which at least either the clinical presentation or potential risk factors associated with a VRF were assessed. Risk of bias was assessed using the Newcastle-Ottawa scale. Meta-analyses of odds ratios (ORs) were performed separately for several signs or symptoms and risk factors. RESULTS: Fourteen sources reporting on 2877 teeth (489 with VRF and 2388 without VRF) were included in the meta-analyses. Regarding the clinical presentation, the presence of sinus tracts (OR = 4.87; 95% confidence interval [CI], 1.58-15.0), increased periodontal probing depths (OR = 13.24; 95% CI, 5.44-32.22), swelling/abscess (OR = 2.86; 95% CI, 1.74-4.70), and tenderness to percussion (OR = 1.76; 95% CI, 1.18-2.61) were significantly associated with the presence of a VRF (Padj. value < .05). None of the assessed risk factors (sex, type of teeth, tooth location, posts, indirect restoration, and apical extension of the root canal filling) were found to be significantly associated with the presence of a VRF (Padj. value > .05). CONCLUSIONS: Four clinical presentations were identified to be the most significant signs or symptoms for a VRF in ETT: presence of sinus tracts, increased probing depths, swelling/abscess, and tenderness to percussion. None of the assessed risk factors pointed out to be significantly associated with a VRF. REGISTRATION: CRD42022354108 (PROSPERO).

Teaching of posterior composites for the restoration of permanent teeth in undergraduate dental training programmes: Systematic review and meta-analysis.

OBJECTIVES: To systematically assess aspects of teaching of posterior composite restorations (PCRs) in permanent teeth in dental schools. STUDY SELECTION: Quantitative studies reporting on dental schools' teaching regarding the placement of PCRs in permanent teeth. Random-effects meta-analyses and meta-regressions were performed. Risk of bias was assessed based on the Medical Education Research Study Quality Instrument (MERSQI). SOURCES: Electronic databases (MEDLINE via PubMed, EMBASE via Ovid, Web of Science, and Scopus) were searched in January 2023. DATA: Forty sources reporting on 34 studies having surveyed 1,286 dental schools were included. Overall, 92.7% (95%-CI: 88.2-95.5) of dental schools reported to teach PCRs. PCRs in three-surface Class II cavities are taught by 82.0% (95%-CI: 70.4-89.7). The mandatory use of liners in deep cavities is taught by 78.3% (95%-CI: 68.9-85.5), and 44.0% (95%-CI: 34.3-54.2) reported to teach bulk-fill composites. While most posterior restorations placed by students were composites (56.1%; 95%-CI: 46.0-65.8), 94.7% (95%-CI: 86.6-98.0) of dental schools (still) teach posterior amalgam restorations. The proportion of dental schools teaching PCRs in three-surface Class II cavities increased and the mean proportion of PCRs among all posterior restorations increased over time (padj.≤0.003). CONCLUSIONS: The teaching of PCRs in dental schools around the world reflects the increased use of resin composite in clinical practice, with students in countries where dental amalgam continues to be used, placing more posterior composites than restorations of dental amalgam. The teaching of PCRs, which is anticipated to increase, will continue to be refined with further developments in adhesive materials, devices, instrumentation, and techniques. CLINICAL SIGNIFICANCE: Graduating dentists can be expected to be familiar with the use of resin composites for the restoration of posterior teeth.

Implementation of repairs in dental practice: Randomized behavior simulation trial.

BACKGROUND: Despite increasing evidence, dentists have not widely adopted repairs. The authors aimed to develop and test potential interventions targeting dentists' behavior. METHODS: Problem-centered interviews were performed. Emerging themes were linked to the Behavior Change Wheel to develop potential interventions. The efficacy of 2 interventions was then tested in a postally delivered behavioral change simulation trial among German dentists (n = 1,472 per intervention). Dentists' stated repair behavior regarding 2 case vignettes was assessed. Statistical analysis was performed using McNemar test, Fisher exact test, and a generalized estimating equation model (P < .05). RESULTS: Two interventions (guideline, treatment fee item) were developed on the basis of identified barriers. A total of 504 dentists participated in the trial (17.1% response rate). Both interventions significantly changed dentists' behavior toward repairs of composite and amalgam restorations, respectively (guideline: difference [Δ] = +7.8% and Δ = +17.6%, treatment fee item: Δ = +6.4% and Δ = +31.5%; adjusted P < .001). Dentists were more likely to consider repairs if they already performed repairs frequently (odds ratio [OR], 1.23; 95% CI, 1.14 to 1.34) or sometimes (OR, 1.08; 95% CI, 1.01 to 1.16), if they regarded repairs as highly successful (OR, 1.24; 95% CI, 1.04 to 1.48), if their patients preferred repairs over total replacements (OR, 1.12; 95% CI, 1.03 to 1.23), for partially defective composite restorations (OR, 1.46; 95% CI, 1.39 to 1.53), and after receiving 1 of the 2 behavioral interventions (OR, 1.15; 95% CI, 1.13 to 1.19). CONCLUSIONS: Systematically developed interventions targeting dentists' repair behaviors are likely efficacious to promote repairs. PRACTICAL IMPLICATIONS: Most partially defective restorations are replaced completely. Effective implementation strategies are required to change dentists' behavior. This trial was registered at https://www. CLINICALTRIALS: gov. The registration number is NCT03279874 for the qualitative phase and NCT05335616 for the quantitative phase.

A Sex-Specific Evaluation of Dental Students' Ability to Perform Subgingival Debridement: Randomized Trial.

BACKGROUND: A successful periodontitis treatment demands good manual skills. A correlation between biological sex and dental students' manual dexterity is currently unknown. OBJECTIVE: This study examines performance differences between male and female students within subgingival debridement. METHODS: A total of 75 third-year dental students were divided by biological sex (male/female) and randomly assigned to one of two work methods (manual curettes n=38; power-driven instruments n=37). Students were trained on periodontitis models for 25 minutes daily over 10 days using the assigned manual or power-driven instrument. Practical training included subgingival debridement of all tooth types on phantom heads. Practical exams were performed after the training session (T1) and after 6 months (T2), and comprised subgingival debridement of four teeth within 20 minutes. The percentage of debrided root surface was assessed and statistically analyzed using a linear mixed-effects regression model (P<.05). RESULTS: The analysis is based on 68 students (both groups n=34). The percentage of cleaned surfaces was not significantly different (P=.40) between male (mean 81.6%, SD 18.2%) and female (mean 76.3%, SD 21.1%) students, irrespective of the instrument used. The use of power-driven instruments (mean 81.3%, SD 20.5%) led to significantly better results than the use of manual curettes (mean 75.4%, SD 19.4%; P=.02), and the overall performance decreased over time (T1: mean 84.5%, SD 17.5%; T2: mean 72.3%, SD 20.8%; P<.001). CONCLUSIONS: Female and male students performed equally well in subgingival debridement. Therefore, sex-differentiated teaching methods are not necessary.

The Relation Between Students' Theoretical Knowledge and Practical Skills in Endodontics: Retrospective Analysis.

BACKGROUND: Dental undergraduate students are required to show sufficient practical skills prior to treating patients. Practical skills and the underlying theoretical knowledge are taught in preclinical courses. Usually, the learning outcome is assessed in written multiple-choice examinations (theoretical knowledge) and practical skills tests. However, students' assessment of practical skills is more time consuming and prone to bias than objective multiple-choice examinations. OBJECTIVE: This study aims to analyze the relation between students' theoretical knowledge and practical skills in endodontics. Furthermore, the predictive validity of a theoretical knowledge assessment on students' practical skills was assessed. METHODS: Examination results from all students who participated in the preclinical phantom course in Operative Dentistry (sixth semester of the undergraduate dental curriculum in Germany) between the 2015 summer term and the 2022 summer term were retrospectively evaluated (N=447). The effects of age, sex, previous course participation, and theoretical knowledge on students' practical skills were assessed, using Pearson correlations, Wilcoxon rank sum tests, and a linear regression analysis. Subsequently, students' theoretical knowledge and practical skills were compared via a Fisher exact test to identify a suitable pass mark for students' theoretical knowledge that was associated with sufficient practical skills (≥60%). RESULTS: Students' theoretical knowledge was significantly associated with practical skills (Padjusted=.02; r=0.13). By using the current pass mark for theoretical knowledge (ie, 60%), a significant differentiation between insufficient practical skills (<60%) and sufficient practical skills (≥60%) was achieved (P=.02). However, for the discrimination between students with sufficient practical skills and students with insufficient practical skills, an adapted pass mark for theoretical knowledge would be more appropriate. The ideal pass mark amounted to 58% (P=.02). CONCLUSIONS: Students' practical skills and theoretical knowledge are significantly correlated. By objectively measuring students' theoretical knowledge, a rough estimation of students' practical skills (ie, a differentiation between sufficient and insufficient practical skills) is possible.

Scoring Single-Response Multiple-Choice Items: Scoping Review and Comparison of Different Scoring Methods.

BACKGROUND: Single-choice items (eg, best-answer items, alternate-choice items, single true-false items) are 1 type of multiple-choice items and have been used in examinations for over 100 years. At the end of every examination, the examinees' responses have to be analyzed and scored to derive information about examinees' true knowledge. OBJECTIVE: The aim of this paper is to compile scoring methods for individual single-choice items described in the literature. Furthermore, the metric expected chance score and the relation between examinees' true knowledge and expected scoring results (averaged percentage score) are analyzed. Besides, implications for potential pass marks to be used in examinations to test examinees for a predefined level of true knowledge are derived. METHODS: Scoring methods for individual single-choice items were extracted from various databases (ERIC, PsycInfo, Embase via Ovid, MEDLINE via PubMed) in September 2020. Eligible sources reported on scoring methods for individual single-choice items in written examinations including but not limited to medical education. Separately for items with n=2 answer options (eg, alternate-choice items, single true-false items) and best-answer items with n=5 answer options (eg, Type A items) and for each identified scoring method, the metric expected chance score and the expected scoring results as a function of examinees' true knowledge using fictitious examinations with 100 single-choice items were calculated. RESULTS: A total of 21 different scoring methods were identified from the 258 included sources, with varying consideration of correctly marked, omitted, and incorrectly marked items. Resulting credit varied between -3 and +1 credit points per item. For items with n=2 answer options, expected chance scores from random guessing ranged between -1 and +0.75 credit points. For items with n=5 answer options, expected chance scores ranged between -2.2 and +0.84 credit points. All scoring methods showed a linear relation between examinees' true knowledge and the expected scoring results. Depending on the scoring method used, examination results differed considerably: Expected scoring results from examinees with 50% true knowledge ranged between 0.0% (95% CI 0% to 0%) and 87.5% (95% CI 81.0% to 94.0%) for items with n=2 and between -60.0% (95% CI -60% to -60%) and 92.0% (95% CI 86.7% to 97.3%) for items with n=5. CONCLUSIONS: In examinations with single-choice items, the scoring result is not always equivalent to examinees' true knowledge. When interpreting examination scores and setting pass marks, the number of answer options per item must usually be taken into account in addition to the scoring method used.

Oral health in HPV-positive and HPV-negative patients with oropharyngeal squamous cell carcinoma.

This study compared oral health in oropharyngeal squamous cell carcinoma (OPSCC) patients with positive or negative human papillomavirus (HPV) status and analysed whether oral health was associated with survival. Patients referred for dental assessment prior to radio(chemo)therapy between 2009 and 2019 were included. Patient-related risk factors for OPSCC (alcohol, tobacco, HPV status), age, sex, treatment (primary treatment, intent), performance status, tumor/node/metastasis (TNM) staging, and oral health parameters (DMFT, periodontal status, teeth with/without root canal treatment and with/without periodontitis apicalis) were compared between HPV-negative and HPV-positive patients. Survival was assessed using Kaplan-Meier statistics. The effect of patient-related risk factors and oral health parameters was analysed by cox regression analyses (α=5%). A total of 119 patients (n=50 HPV-negative, n=69 HPV-positive) was included. HPV-positive patients showed more present teeth, a higher number of filled teeth, were less often edentulous and presented a lower DMFT compared to HPV-negative patients (padj.≤0.003). Among dentulous patients, HPV-positive patients showed more present teeth and fewer teeth with periodontitis apicalis lacking a root canal treatment (padj.≤0.036). Survival probability differed between groups (p=0.006) and trended towards being associated with HPV status, tobacco exposure, performance status, T stage, N stage, and the number of missing or filled teeth as well as the number of root canal treated teeth with periodontitis apicalis and the number of teeth with periodontitis apicalis lacking a root canal treatment (p≤0.077). However, only tobacco exposure, performance status, and the number of teeth with periodontitis apicalis lacking a root canal treatment in dentulous patients remained significant in the multivariate analyses (p≤0.047). HPV-negative patients with OPSCC showed a poorer oral health compared to HPV-positive patients, but survival was not associated with oral health.

Three Visual-Diagnostic Methods for the Detection of Enamel Cracks: An In Vitro Study.

Tooth fractures are a common cause of tooth loss, frequently starting as enamel cracks. However, methods for the detection of enamel cracks are poorly investigated. The aim of the study was the validation of three clinical methods for the detection of enamel cracks: dental operating microscope (DOM), near-infrared transillumination (NIR), and fiber-optic transillumination (FOTI), with hard-tissue slices serving as controls. A total of 89 extracted teeth, set up as diagnostic models, were investigated, and the maximum crack depth was scored by two examiners. The actual crack depth was determined microscopically (25×) using horizontal sections. The accuracy of each method was analyzed using receiver operating characteristic (ROC) curves. Across all tooth surfaces, the area under the curve (AUC) amounted to 0.57 (DOM), 0.70 (FOTI), and 0.67 (NIR). For crack detection on vestibular/oral surfaces, the AUC was 0.61 (DOM), 0.78 (FOTI), and 0.74 (NIR); for proximal surfaces, it was 0.59 (DOM), 0.65 (FOTI), and 0.67 (NIR). However, the actual crack depth was underestimated with each method (p < 0.001). Under in vitro conditions, FOTI and NIR are suitable for detection of enamel cracks, especially on vestibular and oral tooth surfaces. However, an exact estimation of crack depth is not possible. Therefore, FOTI and NIR seem to be helpful for the clinical detection of enamel cracks.

Use of Multiple-Select Multiple-Choice Items in a Dental Undergraduate Curriculum: Retrospective Study Involving the Application of Different Scoring Methods.

BACKGROUND: Scoring and awarding credit are more complex for multiple-select items than for single-choice items. Forty-one different scoring methods were retrospectively applied to 2 multiple-select multiple-choice item types (Pick-N and Multiple-True-False [MTF]) from existing examination data. OBJECTIVE: This study aimed to calculate and compare the mean scores for both item types by applying different scoring methods, and to investigate the effect of item quality on mean raw scores and the likelihood of resulting scores at or above the pass level (≥0.6). METHODS: Items and responses from examinees (ie, marking events) were retrieved from previous examinations. Different scoring methods were retrospectively applied to the existing examination data to calculate corresponding examination scores. In addition, item quality was assessed using a validated checklist. Statistical analysis was performed using the Kruskal-Wallis test, Wilcoxon rank-sum test, and multiple logistic regression analysis (P<.05). RESULTS: We analyzed 1931 marking events of 48 Pick-N items and 828 marking events of 18 MTF items. For both item types, scoring results widely differed between scoring methods (minimum: 0.02, maximum: 0.98; P<.001). Both the use of an inappropriate item type (34 items) and the presence of cues (30 items) impacted the scoring results. Inappropriately used Pick-N items resulted in lower mean raw scores (0.88 vs 0.93; P<.001), while inappropriately used MTF items resulted in higher mean raw scores (0.88 vs 0.85; P=.001). Mean raw scores were higher for MTF items with cues than for those without cues (0.91 vs 0.8; P<.001), while mean raw scores for Pick-N items with and without cues did not differ (0.89 vs 0.90; P=.09). Item quality also impacted the likelihood of resulting scores at or above the pass level (odds ratio ≤6.977). CONCLUSIONS: Educators should pay attention when using multiple-select multiple-choice items and select the most appropriate item type. Different item types, different scoring methods, and presence of cues are likely to impact examinees' scores and overall examination results.

Micro-CT evaluation of frozen and embalmed human cadavers on the effect of root canal preparation on microcrack formation in old dentin.

The aim of this study was to evaluate the existence of preoperative dentinal defects among differently preserved dentoalveolar bone-blocks (frozen vs. embalmed) and to investigate the effect of varying apical forces (low: <4 N, high: 4-8 N) during root canal preparation on microcrack formation using micro-computed tomography (micro-CT). Thirteen embalmed and seven frozen bone-blocks containing 1-3 single rooted teeth were collected. The teeth were evenly divided into three groups (n = 10): FLow (frozen, <4 N), ELow (embalmed, <4 N), EHigh (embalmed, 4-8 N). After working length determination all specimens were scanned preoperatively. Root canal preparation was performed using nickel-titanium instruments sizes 25/.06 and 40/.06 (F6 SkyTaper; Komet, Lemgo, Germany). A postoperative scan was performed and image stacks were co-registered. All cross-sectional images were screened to identify the presence of dentinal defects. The results were expressed as the percentage of teeth/slices presenting dentinal defects. The statistical analyses were performed with Kruskal-Wallis-Test and Mann-Whitney-U-Test (α = 5%). Embalmed specimens presented a significantly higher percentage of slices with preoperative microcracks (p<0.05) than frozen specimens. No significant difference between groups was observed regarding the induction of microcracks (p>0.05). Root canal preparation does not induce microcracks in dentoalveolar bone-blocks from donors of old age, irrespective of the preservation method and the apically directed forces.

Effect of face masks on salivary parameters and halitosis: Randomized controlled crossover trial.

BACKGROUND: Face masking is associated with self-perceived dry mouth and halitosis. Aim of the study was to measure the effect of different face masks on salivary parameters and halitosis. METHODS: The randomized controlled crossover clinical trial with four periods included 40 oral healthy participants using different face masks (cloth mask, surgical mask, filtering facepiece 2 [FFP2] mask) or no mask (control) for 4 h in random order. Unstimulated salivary flow rate (primary outcome) and stimulated salivary flow rate, salivary pH and buffer capacity of stimulated and unstimulated saliva (secondary outcomes, blinded), and volatile sulfur compounds (secondary outcome) were measured before and after the 4-h periods. Statistical analysis was performed by repeated measures ANOVA (p < 0.05). RESULTS: Of 40 randomized participants, 39 completed the study. Unstimulated salivary flow rate prior to face masking amounted to 0.6 ± 0.3 ml/min. Face masking had no significant effect on unstimulated salivary flow (p = 0.550). Face masking had also no significant effect on the other salivary parameters (p ≥ 0.518). The concentration of volatile sulfur compounds (VSC) prior to face masking amounted to 157.3 ± 59.7 ppb. After face masking, the concentration of VSC increased slightly, but not significantly (p = 0.055): 168.1 ± 76.3 ppb (control), 199.3 ± 132.7 ppb (cloth masks), 188.5 ± 101.1 ppb (surgical masks), and 189.7 ± 90.1 ppb (FFP2 masks). CONCLUSION: Four hours of face masking did not change the salivary flow rate, pH, and buffer capacity, and had no significant effect on VSC's levels. Wearing face masks does not seem to result in measurable side-effects on salivary parameters such as a reduced salivary flow rate or VSC's levels. CLINICAL TRIAL REGISTRATION: The protocol was prospectively registered at ClinicalTrials.gov (NCT04914208) on June 4, 2021.

Survival analysis of fragment reattachments and direct composite restorations in permanent teeth after dental traumatic injuries.

BACKGROUND/AIM: In case of crown fractures after traumatic dental injuries, the affected teeth can be restored either with reattachment of the fractured fragment or with a direct composite restoration. So far, longevity data for reattachments and direct composite restorations with regard to different failure types (pulp necrosis and infection, restoration loss) are scarce. Therefore, the aim of this retrospective study was to evaluate the restorative and biological survival of reattached fragments and composite restorations after crown fractures in permanent teeth. MATERIAL AND METHODS: Dental records of patients treated between 2000 and 2018 were retrospectively analysed regarding the restoration (reattachment or direct composite restorations) of teeth with crown fractures. Survival (no further intervention) and restorative and/or biological failure of all restored teeth were recorded. Statistical analysis was performed using Kaplan-Meier statistics, and the mean annual failure rates for two and 5 years were calculated. Furthermore, the effect of potential risk factors on survival was assessed. Log-rank tests and univariate Cox regression models (likelihood ratio tests) were used to assess the univariate effect of all variables of interest. Variables with a p-value ≤.10 were included in a multivariate Cox regression model with shared frailty (p < .05). RESULTS: Overall, 164 patients with 235 teeth (uncomplicated crown fracture: N = 201, complicated crown fracture: N = 34) were included (1.6 ± 2.5 years observation time). Of these, 59 teeth were restored with reattachment of the fragment and 176 with a composite restoration. Overall, composite restorations had a significantly higher survival rate than reattachments (p = .002). The cumulative survival after 2 years was 42.9% and 65.0% for teeth treated with a reattachment (mAFR = 34.5%) and a composite restoration (mAFR = 19.3%), respectively. When differentiating between failure types, restoration failure and pulp necrosis were significantly more frequently detected in reattached crown fractures compared to composite restorations (restorative failure: p = .001; biological failure: p = .036). In the multivariate Cox regression model, the variable jaw and luxation significantly influenced the survival when the tooth was restored with a composite restoration. The survival was not influenced by the fracture type. CONCLUSIONS: Restorative and biological failures were more frequently detected when the tooth was restored with a reattached fragment compared to a direct composite restoration. Both, restoration failure and pulp necrosis with infection should be considered as frequent complications after restoration of crown-fractured teeth which emphasizes the necessity of regular and short follow-up intervals throughout the first 2 years.

Clinical performance of CAD-CAM partial-coverage restorations: Experienced versus less-experienced operators.

STATEMENT OF PROBLEM: Less-experienced operators have been shown to require additional training to achieve results similar to those of experienced operators. However, clinical data comparing the survival and success of ceramic restorations by experienced and less-experienced operators by using the computer-aided design and computer-aided manufacturing (CAD-CAM) technology are lacking. PURPOSE: The purpose of this retrospective clinical study was to analyze and compare the clinical performance of CAD-CAM lithium disilicate restorations fabricated by less-experienced (predoctoral dental students) and experienced (dentists) operators. MATERIAL AND METHODS: Patients who received an adhesively luted CAD-CAM lithium disilicate restoration between 2011 and 2019 were included in the study. Clinical performance was assessed by calibrated examiners by using World Dental Federation (FDI) criteria. Success and survival were calculated by the Kaplan-Meier method and statistically compared by log-rank tests and univariate Cox regression analyses. FDI criteria were compared by using Mann-Whitney-U tests (α=.05). RESULTS: Ninety-two restorations (students: n=65, dentists: n=27) were assessed (mean ±standard deviation time from insertion: 4.04 ±1.55 years). The survival rates after 2 years (students: 93.8%, mean annual failure rate [mAFR]: 3.1%; dentist: 96.3%, mAFR: 1.9%) and after 4 years (students: 87.3%, mAFR: 3.3%; dentists: 88.3%, mAFR: 3.1%) were not significantly different (P=.525). Also, success rates after 2 (students: 90.8%, mAFR: 4.7%; dentists: 92.6%, mAFR: 3.8%) and 4 years (students: 82.4%, mAFR: 4.7%; dentists: 76.1%, mAFR: 6.6%) were not significantly different (P=.778). FDI criteria were also not significantly different between less-experienced and experienced operators (P≥.110). CONCLUSIONS: Operator experience did not affect the short-term clinical performance of CAD-CAM lithium disilicate restorations.