Should we test asymptomatic children for SARS-CoV-2?

Design Cross-sectional study.Sample selection This study included 921 children (471 male, 450 female) due to receive either routine dental care involving aerosol generating procedures or comprehensive dental care under general anaesthetic. Data was collected at a paediatric dental clinic associated with the University of Illinois, Chicago. Patients were screened by a telephone questionnaire assessing for coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Asymptomatic patients and those with no known disease exposure went on to receive a reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2, the causative pathogen for COVID-19. Those displaying symptoms of COVID-19 or who had potentially been exposed to the virus or disease were not included in this study and were referred for onwards medical advice.Data analysis Electronic dental records were accessed to retrieve patient demographics, insurance type, dental diagnosis and past medical history. The percentage of positive SARS-CoV-2 test results was calculated for each category. Positive and negative test results were compared appropriately for both categorical and continuous variables, with significance reached when p <0.05. SPSS version 27 was used for statistical analysis.Results This study found the positivity rate for SARS-CoV-2 to be 2.3% (21/921) in asymptomatic dental patients aged under 18 years. Age, insurance type, medical history and dental diagnosis were comparable in both positive and negative test result groups. The Hispanic/Latinx population had a higher percentage (3.1%) of positive tests than other groups. More male patients tested positive for SARS-CoV-2 (13 male, 8 female), but this was not statistically significant.Conclusions RT-PCR testing identified children carrying SARS-CoV-2 who had been cleared to attend an appointment following a screening questionnaire.

Role of the consultant in restorative dentistry in managing head and neck cancer patients undergoing radiotherapy: a novel intraoral shield appliance design.

Oral cancer incidence is rising, with both the consequences of the disease and sequelae of treatment often having a significant impact on patient oral health and functionality. As a result, the restorative dentist has a key and varied role within the head and neck multidisciplinary team, from dental pre-assessments to complex oral rehabilitations following extensive surgical management. Radiotherapy is a key pillar of head and neck cancer treatment but also presents a particular set of issues for patients and their management by clinicians. Communication between all team members is vital to ensure optimal patient treatment, and ultimately led to the development of two novel intraoral shield appliances for dentate and edentulous patients to help combat some of these undesirable side effects.

Long-term (10-year) dental implant survival: A systematic review and sensitivity meta-analysis.

OBJECTIVES: To identify and appraise the most recent studies reporting dental implant survival in adults (≥18 years) using contemporary implant systems (solid screw, roughened surface) for a period of 10 years; and explore new predictors of implant survival. SOURCE: MEDLINE, Scopus, and the Cochrane Central Register of Controlled trials were searched from 1997 to January 2018 to focus on contemporary implant systems. STUDY SELECTION: Only prospective observational studies with at least 10 participants and 35 implants were included. The unit of study was the 'absolute survival' rate of dental implants after 10 years in the oral cavity. Study quality was assessed utilising a modified Hoy risk of bias tool for prevalence studies. A sensitivity meta-analysis was undertaken utilising a plausibly imputed model for missing data. DATA: 18 studies met the inclusion criteria. The summary estimate for 10-year survival at the implant level was 96.4% (95% CI 95.2%-97.5%) and the prediction interval was 91.5%-99.4%. The sensitivity meta-analysis summary estimate of survival was 93.2% (95% CI 90.1% to 95.8%)p = 0.041 with a prediction interval of 76.6%-100%. Older age (≥ 65 years) was a significant predictor at 91.5%, p = 0.038 in the sensitivity meta-analysis. CONCLUSIONS: A traditional analysis produced similar 10-year survival estimates to previous systematic reviews. A more realistic sensitivity meta-analysis accounting for loss to follow-up data and the calculation of prediction intervals demonstrated a possible doubling of the risk of implant loss in the older age groups. CLINICAL SIGNIFICANCE: Improved analysis provides the clinician with better estimation of the real-world risk of implant failures so helping the clinician communicate the potential risk to patients.

Digital and conventional impressions have similar working times.

Data sourcesMedline, Cochrane, Science Direct, Scopus and Embase were electronically searched and complemented with hand searches. Studies published from 1955 to July 2016 were considered.Study selectionClinical studies (prospective, retrospective and RCTs) relating to digital implant or tooth impression techniques, comparing patient reported outcome measures (PROMs) and procedure working times compared to conventional impression techniques were considered. The following exclusions were adhered to; in vitro studies, ex vivo studies, systematic reviews, clinical cases, animal studies and any studies not comparing digital and conventional impression techniques.Data extraction and synthesisData extraction was carried out independently by two reviewers. Risk of bias assessment was conducted using the Cochrane4 tool for RCTs and a modified Newcastle-Ottawa scale for non-RCTs. In all 2943 publications were reviewed following the initial electronic search, of which 2916 were excluded at this stage. A qualitative analysis was conducted.ResultsFive studies were included; all three of the RCTs included were at high' risk of bias and the observational studies were judged to have a methodology of medium quality. Given the differences in the studies, a meta-analysis could not be performed. Three studies conducted involved implant supported prostheses only, two reported on tooth supported prostheses with a total of 155 participants included. Four studies comparing PROMs between the different impression techniques reported, a digital impression technique reduced anxiety and nausea, being considered more comfortable than a conventional impression technique. The remaining study reported no difference in patient comfort when comparing techniques.3,6,7,8 With respect to procedure working time three studies reported that the digital impression technique required less time;3,6,7 conversely two studies reported less time for the conventional technique.2,8ConclusionsThis systematic review draws two conclusions; working times are similar for both conventional and digital impression techniques and patients prefer the experience of digital to conventional impressions. It does acknowledge the lack of relevant studies in this area.

Rubber dam may increase the survival time of dental restorations.

Data sourcesCochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, LILACS, SciELO, Chinese BioMedical Literature Database, VIP, China National Knowledge Infrastructure, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, OpenGrey and Sciencepaper Online databases. Handsearches in a number of journals.Study selectionRandomised controlled trials, including split-mouth studies assessing the effects of rubber dam isolation for restorative treatments in dental patients.Data extraction and synthesisTwo review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies.ResultsFour studies involving a total of 1,270 patients were included. The studies were at high risk of bias. One trial was excluded from the analysis due to inconsistencies in the presented data. Restorations had a significantly higher survival rate in the rubber dam isolation group compared to the cotton roll isolation group at six months in participants receiving composite restorative treatment of non-carious cervical lesions (risk ratio (RR) 1.19, 95% confidence interval (CI) 1.04 to 1.37, very low-quality evidence). The rubber dam group had a lower risk of failure at two years in children undergoing proximal atraumatic restorative treatment in primary molars (hazard ratio (HR) 0.80, 95% CI 0.66 to 0.97, very low-quality evidence). One trial reported limited data showing that rubber dam usage during fissure sealing might shorten the treatment time. None of the included studies mentioned adverse effects or reported the direct cost of the treatment, or the level of patient acceptance/satisfaction. There was also no evidence evaluating the effects of rubber dam usage on the quality of the restorations.ConclusionsWe found some very low-quality evidence, from single studies, suggesting that rubber dam usage in dental direct restorative treatments may lead to a lower failure rate of the restorations, compared with the failure rate for cotton roll usage. Further high quality research evaluating the effects of rubber dam usage on different types of restorative treatments is required.

Provisional Restorations ­ A Permanent Problem?

Provisional restorations play an important role when providing indirect restorations. There are a number of materials and techniques available for their construction. Careful planning and construction can protect the prepared tooth surface, improve the periodontal condition and help plan for the definitive restoration. A good provisional restoration can save time, money and effort. Clinical relevance: Provisional restoration construction is an integral part of the indirect restorative process for inlays, onlays, crowns and bridges.

Odontogenic Cysts - An Overview.

This article aims to discuss the clinical features, radiological assessment, histopathology and management of a variety of odontogenic cysts. It also highlights the reclassification of odontogenic keratocysts to keratocystic odontogenic tumours.