School type and oral conditions associated with school performance and absenteeism in adolescents: A multilevel analysis.

BACKGROUND: Investigations assessing how oral health status affects school performance and attendance considering individual and community variables are lacking. AIM: To analyze the association of school contextual factors and oral conditions with school performance and absenteeism in early adolescence. DESIGN: This cross-sectional study was carried out with 593 12-year-old students from 20 schools in Passo Fundo, a southern city in Brazil. The caregivers provided sociodemographic information by means of a questionnaire. Oral health status was clinically examined for dental caries and gingival bleeding. Students answered the CPQ11-14 questionnaire to assess the oral health-related quality of life (OHRQoL). Information on contextual factors was obtained from the schools' administrators. "School performance" was measured by Portuguese and Mathematic tests' scores, and "school absenteeism" by the number of school days missed. Descriptive statistics was conducted, followed by unadjusted and adjusted multilevel linear regression. RESULTS: At the individual level, low OHRQoL was associated with lower school performance and higher absenteeism. At the contextual level, students from private schools had higher school performance and lower mean of school days missed. CONCLUSIONS: The type of school and OHRQoL were associated with school performance and attendance of adolescents.

3D-printed and conventional provisional single crown fabrication on anterior implants: A randomized clinical trial.

OBJECTIVES: The present study aims to compare provisional single crowns on anterior implants made using conventional PMMA and 3D-printed workflows. The study assessed the occurrence of failures, color variation, signs of early deterioration, operating time, and patients' satisfaction with the treatment through a randomized controlled trial. METHODS: This study was conducted as a randomized controlled trial, following the SPIRIT and CONSORT guidelines. Patients were included in the study after meeting the eligibility criteria and were randomly assigned to one of two groups (conventional and 3D-printed). FDI criteria, visible plaque index (VPI), bleeding on probing (BOP), and color variation were considered as the primary outcomes. Operating time and patient satisfaction were also assessed as secondary outcomes. Fisher's exact test was performed to analyze the association between the primary and secondary outcomes and the study groups. Mann-Whitney test was used to compare the mean VAS satisfaction scores between the conventional PMMA and 3D-printed groups (STATA 14™, with an α = 0.05). RESULTS: A total of 42 provisional single crowns (n = 21) were made for 33 patients. Only the fracture parameter (FDI) showed a statistically significant difference, with 3D-printed provisionals exhibiting higher rates of catastrophic failures compared to conventional ones (p = 0.05). Although the operating time for the 3D-printed group was shorter (p < 0.001), no statistical difference observed in patients' satisfaction regarding esthetics, phonetics, chewing, or comfort. SIGNIFICANCE: 3D-printed and conventional PMMA provisional single crowns showed comparable clinical performance, except for the observed fracture types. Although 3D-printed provisional restorations showed a shorter operating time, overall patients' satisfaction was not affected.

Fatigue and marginal adaptation of bulk fill restoratives: Effect of the layering technique and cavity dimension of extensively damaged teeth.

OBJECTIVES: To evaluate the effect of layering technique and cavity dimension on the fatigue behavior and marginal adaptation of bulk fill (BF) restorations in extensively damaged teeth. METHODS: Seventy-two premolars received class II cavities (MOD) followed by endodontic treatment. Half sample had 1/3 of their palatal cusp removed. Teeth were restored using three techniques: (I) incremental, with conventional resin composite (RC); (C) combined, using BF flow and RC, (B) bulk fill, with regular BF. Specimens were subjected to fatigue (80 N, 2 Hz, 37° C water) for 1 million cycles (n = 12). The test was interrupted every 250,000 cycles to evaluate tooth integrity, restoration fracture and adaptation using FDI criteria. Images of the proximal surfaces were obtained before and after the cycling to measure the gap. Restoration fatigue survival and success were analyzed using Weibull distribution and Maximum Likelihood Estimation. Gap thickness was analyzed with Kruskal-Wallis and Student-Newman-Keuls tests (α = 0.05). RESULTS: For the survival analysis, Weibull modulus (ß) and characteristic lifetime (η) were similar among groups. Yet, for the success analysis, in which only restorations that were free of technical complications were ranked as success, the bulk-fill technique resulted in higher ß, while the combined technique produced restorations with higher η, for teeth that had their cusp removed. C-technique also resulted in smaller gaps than I and B. SIGNIFICANCE: The effect of the layering technique on the success of restorations was dependent on the cavity extension. The combined technique favors the adaptation and the longevity of extensively damaged teeth.

Genotoxicity in the oral cells of older people from a Brazilian rural area: a population-based study.

The purpose of this population-based, observational, and cross-sectional study was to evaluate alterations in the oral cells of a population of older people from a Brazilian rural area, using the micronucleus technique to investigate possible associated genotoxic factors. A questionnaire was applied and clinical examination and collection of oral mucosal cells were performed for all older people (≥ 60 years) from a town in southern Brazil. Demographic and socioeconomic variables, deleterious habits (drinking and tobacco use), presence of gastro-oesophageal reflux disease (GERD), and the use of proton pump inhibitors (PPIs) were considered the exposure variables, whereas metanuclear changes (MCs) and the prevalence of cell micronuclei (MN) were considered outcomes. Out of 489 older people, 447 were included in the study, among whom 50.8% were men with a mean age of 70.9 years and 83.9% had a monthly family income greater than US$ 500.00. GERD symptoms were present in 36.2% of the individuals, and 29.1% used PPIs daily, 53.3% consumed alcoholic beverages, and 46.7% used tobacco. The analysis of 1,000 oral mucosal cells per subject showed a MN frequency of 0-2 per individual, and MCs were detected with an average of 15 units per individual (median = 11 per individual). Poisson regression did not show statistical association between the exposure variables and the outcomes (presence of MN and MCs), except for the use of PPIs, which was a protective factor for the prevalence of MN [PR 0.6 (CI 0.3-0,9)]. Age, sex, family income, tobacco use and drinking, and GERD were not associated with the number of MN and MCs in oral mucosal cells of the investigated older people.

The influence of smoking on the effectiveness of at-home bleaching: A prospective clinical study.

OBJECTIVES: To evaluate the effect of smoking on tooth whitening and color change after at-home bleaching. MATERIALS AND METHODS: This prospective clinical study evaluated two groups of participants: NS-non-smokers (n = 24) and S-smokers (n = 16). All subjects were treated with at-home bleaching using 22% carbamide peroxide (CP) for 1 h/day for 14 days. Color coordinates (L*-luminosity, a*-red-green axis and b*-yellow-blue axis) were obtained before bleaching (D0-baseline), 1 day (D1), 15 days (D15), and 1 month (D30) after bleaching. The whiteness index (WID ) and CIEDE2000 color differences (ΔE00 ) were calculated for S and NS. Color changes between S and NS subjects for specific teeth (CI-Central Incisors, LI-Lateral Incisors, and C-Canines) were analyzed using the Mann-Whitney test (α = 0.05). RESULTS: There was no significant difference in WID between S and NS subjects at baseline. NS participants showed higher WID than S at D1, D15, and D30 (p < 0.05). NS showed higher ΔWID for CI and C between D0 and the other evaluation times (D1, D15, and D30) compared to S. Smokers showed higher darkening of CI than NS in ΔWID D30-D1 (p < 0.05). Color changes showed similar overall behavior for ΔWID . For all evaluation times, ΔWID and ΔE00 values were below the corresponding acceptability thresholds. CONCLUSION: At-home bleaching was effective on smokers and nonsmokers. Smoking negatively affected color stability after bleaching. ΔE00 and ΔWID were acceptable for both groups. CLINICAL SIGNIFICANCE: Although smoking negatively affected color stability after bleaching, the observed changes were clinically acceptable.

Association between masticatory dysfunction and gastroesophageal reflux disease: A population-based study in the elderly.

BACKGROUND: Caries and periodontal disease may cause tooth losses and chewing difficulty, especially in the elderly. Ingesting poorly chewed food may delay gastric emptying and favour the development of gastroesophageal reflux disease (GERD). OBJECTIVE: This study investigated the association between masticatory dysfunction and GERD in the elderly from a rural area in southern Brazil. METHODS: This census invited all 489 elderly from a city to participate. The study used a GERD symptoms questionnaire, followed by an oral examination. Masticatory dysfunction was analysed based on the chewing difficulty for some food groups. Tooth loss and chewing self-perception were also considered as exposure variables. Poisson regression determined the association among variables by calculating the prevalence ratio [PR (95% confidence interval)]. RESULTS: The response rate was 93.1% (n = 455, average age of 70.9 years, 50.5% men). The prevalence of GERD in this population was 36.9%. GERD was associated with chewing difficulty for vegetables (PR = 1.54), meats (PR = 1.34) and cereals (PR = 1.43) but not with poor chewing self-perception (PR = 0.80) and tooth loss (PR = 1.22). GERD was also associated with xerostomia (PR = 1.63) and the female gender (PR = 1.35). CONCLUSION: Elderly people from a rural area with a reduced number of teeth present chewing difficulty and a high prevalence of GERD, indicating an association between GERD and masticatory dysfunction.

Genotoxicity in the oral cells of older people from a Brazilian rural area: a population-based study

Abstract The purpose of this population-based, observational, and cross-sectional study was to evaluate alterations in the oral cells of a population of older people from a Brazilian rural area, using the micronucleus technique to investigate possible associated genotoxic factors. A questionnaire was applied and clinical examination and collection of oral mucosal cells were performed for all older people (≥ 60 years) from a town in southern Brazil. Demographic and socioeconomic variables, deleterious habits (drinking and tobacco use), presence of gastro-oesophageal reflux disease (GERD), and the use of proton pump inhibitors (PPIs) were considered the exposure variables, whereas metanuclear changes (MCs) and the prevalence of cell micronuclei (MN) were considered outcomes. Out of 489 older people, 447 were included in the study, among whom 50.8% were men with a mean age of 70.9 years and 83.9% had a monthly family income greater than US$ 500.00. GERD symptoms were present in 36.2% of the individuals, and 29.1% used PPIs daily, 53.3% consumed alcoholic beverages, and 46.7% used tobacco. The analysis of 1,000 oral mucosal cells per subject showed a MN frequency of 0-2 per individual, and MCs were detected with an average of 15 units per individual (median = 11 per individual). Poisson regression did not show statistical association between the exposure variables and the outcomes (presence of MN and MCs), except for the use of PPIs, which was a protective factor for the prevalence of MN [PR 0.6 (CI 0.3-0,9)]. Age, sex, family income, tobacco use and drinking, and GERD were not associated with the number of MN and MCs in oral mucosal cells of the investigated older people.

Pain factors related to dental implant surgery: A 7-day observational clinical study

This article aims to associate patient-reported pain intensity in the immediate seven days after dental implant surgery with surgical factors, sex and patient age. The sample was composed of 108 patients from a dental school in southern Brazilian, between 2018 and 2020. The variables torque, pre- and postoperative medication, healing of first and second intention, gender, age, number of quadrants, number of implants and type of surgery were related to the outcome pain. Pain was reported every day by the patient until the seventh day after surgery, using a visual analogic scale (VAS). Univariate Poisson regression models were used to assess the relationship among pain and the factors. Rate ratios were obtained with 95% of confidence intervals. Overall pain was reported as moderate/intense (VAS: 3-10) by 30.56% of patients, mild pain (VAS: 1-3) by 55.56%, and no pain symptoms were reported by 13.89% of patients. Individuals which the implants were installed with high torques (50-80 N) showed more pain (p=0.03) compared to patients which the implants were installed with regular torque (30-45 N). The other factors evaluated were not significant. The torque was the most relevant factor related to pain among the evaluated by the study. High torque generates more postoperative pain than lower torque. The factors gender, age, number of operated quadrants, number of installed implants, type of surgery and pre and postoperative analgesic did not interfere in the patient's pain during the first week after surgery.

Prevalence of psychological disorders in patients with temporomandibular disorders: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Temporomandibular disorders (TMDs) affect the muscles of mastication, the temporomandibular joint, and associated structures. They are generally classified as muscular or articular and are the main cause of pain in the orofacial region, eventually causing psychological problems. However, the real burden of psychological disorders is unknown. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the prevalence of psychological disorders in patients with TMDs. MATERIAL AND METHODS: The study was conducted through a bibliographic search carried out without initial limit until July 2021 in the following electronic databases: MEDLINE/PubMed, Scopus, and PsycINFO. Clinical observational studies investigating depression and somatization in patients with TMD diagnosed by the Diagnostic Research for Temporomandibular Disorders (RDC/TMD) criteria in muscular, articular, and disc disorders were included. A descriptive analysis of the included studies and a meta-analysis for the prevalence data were performed for the synthesis of evidence. RESULTS: A total of 2320 studies were found, of which 48 complete articles were assessed for eligibility and 22 were included in the analysis. The general prevalence of depression and moderate and severe somatization in patients diagnosed with TMD was estimated at 43.0% (95% confidence interval (CI), 36.0% to 50.0%) and 60.0% (95% CI 52.0 - 67, 0%). The average overall score for depression was estimated at 0.92 (95% CI, 0.69-1.15), being classified as moderate depression. The average overall score for somatization was estimated at 1.09 (95% CI, 0.81-1.36), being classified as severe somatization. All analyses showed high heterogeneity (I2>90%). Based on the quality assessment, 80.9% of studies included in the review had low to moderate risk of bias. CONCLUSIONS: Patients with TMDs who seek clinical care show a high prevalence of depression and somatization.

Are Stress Associated with Temporomandibular Dysfunction? A Cross-Sectional Study / O Estresse Está Associado à Disfunção Temporomandibular? Um Estudo Transversal

Temporomandibular disorders are frequent in different segments of the population and harm the quality of life of individuals. The present sudy aimed to investigate the association between stress and temporomandibular dysfunction (TMD) in university students in Brazil. All incoming students at the Federal University of Pelotas were invited to participate in this cross-sectional study. A self-administered questionnaire was used with socioeconomic and oral health variables. TMD Fonseca questionnaire "Fonseca's anamnestic index" was used to identify the severity of symptoms of temporomandibular dysfunction. The same was elaborated in the form of Helkimo's anamnestic index. Stress was measured using a modified version of the Perceived Stress Scale and categorized into quartiles. Logistic multivariable regression models were used to analyze the associations of interest controlling for possible confounding variables. A backward stepwise procedure was used to select variables that should be kept in the final model. A total of 2,089 students answered the questionnaires and 82 (3.9%) were classified with the presence of TMD. Adjusted logistic regression shows that chance of presenting temporomandibular dysfunction was higher (OR=2.43; 95%CI=1.04-5.65) when the stress level increased. In conclusion, the mild degree of temporomandibular dysfunction was the most prevalent. Stress was associated with individuals with a higher prevalence of temporomandibular dysfunction. (AU)

As disfunções temporomandibulares são frequentes em diferentes segmentos da população e prejudicam a qualidade de vida dos indivíduos. O presente estudo teve como objetivo investigar a associação entre estresse e disfunção temporomandibular (DTM) em estudantes universitários no Brasil. Todos os alunos ingressantes da Universidade Federal de Pelotas foram convidados a participar deste estudo transversal. Foi utilizado um questionário autoaplicável com variáveis ​​socioeconômicas e de saúde bucal. O questionário TMD Fonseca "Índice anamnésico de Fonseca" foi utilizado para identificar a gravidade dos sintomas da disfunção temporomandibular. O mesmo foi elaborado na forma de índice anamnésico de Helkimo. O estresse foi medido usando uma versão modificada da Perceived Stress Scale e categorizado em quartis. Modelos de regressão logística multivariada foram usados ​​para analisar as associações de interesse controlando possíveis variáveis ​​de confusão. Um procedimento de backward stepwise foi usado para selecionar as variáveis ​​que deveriam ser mantidas no modelo final. Um total de 2.089 alunos responderam aos questionários e 82 (3,9%) foram classificados com presença de DTM. A regressão logística ajustada mostra que a chance de apresentar disfunção temporomandibular foi maior (OR=2,43; IC95%=1,04-5,65) quando o nível de estresse aumentou. Em conclusão, o grau leve de disfunção temporomandibular foi o mais prevalente. O estresse foi associado a indivíduos com maior prevalência de disfunção temporomandibular. (AU)

10-year practice-based evaluation of ceramic and direct composite veneers.

OBJECTIVES: This 10-year practice-based study aimed to compare survival and success of direct resin composite and ceramic veneers placed in a private dental practice, between January 2008 and March 2014. METHODS: Data were retrieved from a clinical practice's records and were anonymized typed into electronic files. All veneer information was recorded, including previous restorations, repairs or failures, materials used, dates, patient, and age. RESULTS: We analyzed 1459 veneer restorations, of which 1043 (71.5%) were direct composite, and 416 (28.5%) were ceramic, placed in 341 patients. The mean patients' age was 47.8 years, and the mean number of restorations per patient was 4.3 restorations. During all follow-up, 957 (65.6%) veneers were successful without any repair, 252 (17.3%) were repaired and still in place, and 250 (17.1%) had a failure that resulted in replacement. Replacements were usually carried out with the same material placed at first. Considering success analysis, annual failure rates (AFR) for veneers in 5 and 10 years were 9.1% and 10% for direct composite and 2.9% and 2.8% for ceramic, respectively. Survival analysis showed AFR of 3.9% and 4.1% for composite and 1.4% and 1.2% for ceramic at the same periods. Cox regression was made for both success and survival outcomes. Composite veneers presented a higher risk of failure than ceramic veneers with higher hazard ratios for survival (HR) [HR 4.00 (2.74-5.83)] and success [HR 5.16 (2.65-10.04)]. SIGNIFICANCE: Ceramic veneers had superior longevity than direct composite veneers in both success and survival analysis.

Clinical performance of posterior resin composite restorations after up to 33 years.

OBJECTIVES: This retrospective study evaluated the performance of posterior composites after up to 33 years of clinical service and investigated factors associated with the risk of failures over time including patient- and tooth-related variables. METHODS: Patients who received at least one Class I or Class II direct composite restoration in a private office in 1986-1992 and had follow-up appointments were included. Failures and interventions over time were investigated using the dental records. A follow-up clinical recall was carried out in 2020. Two scenarios were considered: restorations that did not require any intervention (success) or restorations that were repaired and still functional (survival). Multivariate Cox regression analyses and Kaplan-Meier curves were performed using success and survival rates (p < 0.05). RESULTS: One hundred patient records and 683 restorations were included. A total of 353 failures were reported (success rate= 48%). Main reasons for failure were fracture and secondary caries. Most interventions after failures were repairs. Replacements were registered in 183 cases (survival rate= 73%). Annual failure rates were below 2.5% (success) and 1.1% (survival). Larger restorations and maxillary molars had higher failure risks. No significant differences in success rates among different resin composites was observed. A typical observation in this sample of restorations was the presence of moderate to advanced signs of aging, including marginal and surface staining, wear, chipping, changes in anatomical shape and translucency. Clearly aged restorations were still clinically satisfactory. SIGNIFICANCE: This long-term, practice-based study indicates that resin composites can be used to restore posterior teeth with a long-lasting durability.

Influence of smoking on oral cells genotoxicity after at-home bleaching using 22% carbamide peroxide: a cohort study.

OBJECTIVE: This study evaluated the influence of smoking on the oral cells genotoxicity before and after at-home bleaching using 22% carbamide peroxide (CP). MATERIALS AND METHODS: This is a prospective observational analytics cohort study which evaluated nonsmokers (NS; n = 24) and smokers (S; n = 16) patients. At-home bleaching was performed using 22% CP gel in individual trays for 1 h per day for 14 days in both groups. Scrapped cells from marginal gums were collected before the bleaching treatment (D0-baseline) and 1 day (D1), 15 days (D15), and 1 month (D30) after its finishing. Cells were stained with Giemsa 10%, and the micronucleus (MN) and metanuclear alterations (MA) were counted by a trained operator in 1000 cells per patient. The collections and data analysis occurred blindly. Data was analyzed by Kruskal-Wallis, Dunn, and Mann-Whitney test (α = 0.05). RESULTS: MN frequency was not influenced by smoking or bleaching. An increase of MA was observed between D0 and D30 for both groups (p < 0.001); however, no statistical difference was found between NS and S (p > 0.05) in the evaluation times. CONCLUSION: Smoking associated with 22% carbamide peroxide gel for at-home bleaching does not show genotoxic potential analyzed by the MN counts. However, a significant increase of MA was found for smokers and nonsmokers. CLINICAL RELEVANCE: Despite of the increase in MA, smoking associated with 22% CP peroxide at-home bleaching showed no important genotoxic potential (MN) for oral cells. Therefore, at-home bleaching treatment is safe for nonsmokers and smokers even with a high carbamide peroxide concentration of 22%.

Are stress and symptoms of depression associated with halitosis? A cross-sectional study

Mood disorders such as stress and depression can promote alterations of several hormones Aim: The present study aimed to evaluate if symptoms of depression and stress are associated with halitosis. The hypothesis is that halitosis is associated with stress and depression symptoms. Methods: All university students' entrants in the Federal University of Pelotas (UFPel) were invited to participate. Self-reported halitosis was measured using a visual analog scale. Students were also asked about the presence of halitosis perceived by close individuals. The stress level was measured using a modified version of the Perceived Stress Scale and symptoms of depression were screened by Patient Health Questionnaire-2. Poisson Regression Models were performed. Results: Of a total of 2,058 students who participated in the study, only 16% of them have reported not having any degree of halitosis and 17.6% were informed of closed individuals having halitosis. After adjustments, stress and depression symptoms remained associated with halitosis selfreported. Individuals from the higher stressed quartile presented higher scores of halitosis (RR 1.37 CI95% [1.24­1.53]). Students who presented depressive symptoms showed higher scores of self-perceived halitosis (RR 1.20 CI95% [1.10­1.32]). When the association of stress and halitosis reported by close individuals was tested, symptoms of depression lost the association in the adjusted model, while individuals from the highest quartile from stress remained associated (PR 1.36 CI95% [1.02­1.81]). Conclusion: Halitosis was associated with stress even after control for oral health and socioeconomic variables

Hydrogen peroxide as an auxiliary treatment for COVID-19 in Brazil: a randomized double-blind clinical trial.

OBJECTIVES: This study evaluated the effectiveness of hydrogen peroxide (H2O2) as mouthwash and nasal spray on symptom relief in coronavirus disease 2019 (COVID-19) patients. METHODS: Patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), who were treated in a hospital or at home, and patients' family members (not positive for SARS-CoV-2), were randomized into 2 groups: experimental (1% H2O2 for gargling, 0.5% H2O2 for nasal wash), and control. Patients gargled the solution 3 times a day, and applied the nasal spray twice a day, for a 7-day period. Family members received the same treatment as the treated COVID-19 patient. The researchers contacted patients every 2 days over an 8-day period. An average post-treatment interval of 8 days passed before testing family members. RESULTS: The most frequent symptoms on day 0 were cough, loss of taste, and hyposmia; there were no significant differences between groups, independent of the period. The symptom of dyspnea presented a significant difference between days 2 and 4 (p<0.05). Among family members, 86.0% had no antibodies, 2.3% had antibodies, and 11.6% had active infections (4 in the experimental group and 6 in the control group). The most frequent adverse effects in the H2O2 group were a burning throat and nose. CONCLUSIONS: H2O2 was not effective for the relief of COVID-19 symptoms and was associated with reports of transient adverse effects.

Slow Spread of SARS-CoV-2 in Southern Brazil Over a 6-Month Period: Report on 8 Sequential Statewide Serological Surveys Including 35 611 Participants.

Objectives. To evaluate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) over 6 months in the Brazilian State of Rio Grande do Sul (population 11.3 million), based on 8 serological surveys. Methods. In each survey, 4151 participants in round 1 and 4460 participants in round 2 were randomly sampled from all state regions. We assessed presence of antibodies against SARS-CoV-2 using a validated lateral flow point-of-care test; we adjusted figures for the time-dependent decay of antibodies. Results. The SARS-CoV-2 antibody prevalence increased from 0.03% (95% confidence interval [CI] = 0.00%, 0.34%; 1 in every 3333 individuals) in mid-April to 1.89% (95% CI = 1.36%, 2.54%; 1 in every 53 individuals) in early September. Prevalence was similar across gender and skin color categories. Older adults were less likely to be infected than younger participants. The proportion of the population who reported leaving home daily increased from 21.4% (95% CI = 20.2%, 22.7%) to 33.2% (95% CI = 31.8%, 34.5%). Conclusions. SARS-CoV-2 infection increased slowly during the first 6 months in the state, differently from what was observed in other Brazilian regions. Future survey rounds will continue to document the spread of the pandemic.

Experimental methodologies to evaluate the masking ability of dental materials: A systematic review.

OBJECTIVE: To conduct a systematic review on the masking ability of discolored substrates, analyzing the capacity and quality of the response produced by the different methodologies and techniques applied to overcome this clinical challenge. MATERIALS AND METHODS: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The electronic search was conducted in MEDLINE/PubMed, Scopus and Web of Science databases, without date restriction. In vitro studies, written in English, applying different methodologies to evaluate masking ability were included. The variables of interest were: type, color and thickness of the restorative and/or cement material; use of pigments in the restorative material and/or cement; color of the substrate; and background color used for the evaluations. RESULTS: Database search retrieved 307 eligible papers with a final inclusion of 47 published papers. Approximately 98% of the studies used ΔE, 36% used TP, and only 6% used CR to evaluate the masking ability of restorative materials. CONCLUSIONS: The most appropriate methodology to evaluate the masking ability is using color difference equations (ΔE) associated with the perceptibility and acceptability thresholds. CLINICAL SIGNIFICANCE: As different methodologies have been used to evaluate the masking ability of esthetic restorative materials on colored substrates, there is an urgent need to reach a consensus and propose a method, which is suggested by the present systematic review.

Effectiveness of hydrogen peroxide as auxiliary treatment for hospitalized COVID-19 patients in Brazil: preliminary results of a randomized double-blind clinical trial.

OBJECTIVES: To evaluate the effectiveness of hydrogen peroxide (H2O2) in the form of mouthwash and nasal spray as an auxiliary treatment for coronavirus disease 2019 (COVID-19). METHODS: Forty hospitalized patients who tested positive for severe acute respiratory syndrome coronavirus 2 using a reverse-transcription polymerase chain reaction test were evaluated. They were randomly divided into an experimental group (n= 20; gargling with 1.0% H2O2 and nasal wash with 0.5% H2O2) or a control group (n= 20). The solutions were used for 7 days and the patients were monitored every 2 days, for a total of 8 days. At check-ups, patients were asked about their symptoms and possible adverse effects of the solutions. The presence and severity (mild, moderate, or severe) of symptoms were recorded. Data were compared using the Student test and the Fisher exact test (α= 0.05). RESULTS: There was no significant difference between the 2 groups in the length of hospital stay (p= 0.65). The most frequent symptom on day 0 was coughing (72.0% in the experimental group and 76.5% in the control group), which abated over time. There was no significant difference between the groups in the evaluated symptoms. Most (75.0%) of the patients in the experimental group presented a reduction in dyspnea between days 0 and 2. Few patients reported adverse effects from the use of the solutions. CONCLUSIONS: H2O2 as a mouthwash and nasal spray is safe to use. There is insufficient evidence to demonstrate that H2O2 is effective as an auxiliary treatment for hospitalized COVID-19 patients.

COVID-19 pandemic and its impact on dental students: A multi-institutional survey.

PURPOSE/OBJECTIVES: To investigate dental students' perceptions and concerns regarding the COVID-19 pandemic, their coping strategies and support resources, and their perceived stress levels. METHODS: A customized 19-item survey and the perceived stress scale (PSS) were applied to undergraduate dental students from the US, Spain, Ireland, Chile, India, and Brazil between April 10 and July 5, 2020. Linear modeling and mediation analysis were used to explore the relationships among demographics, stressors, coping mechanisms, social support, and stress RESULTS: A total of 4475 students responded to the survey. The majority (72.4%) were women, and 52.3% had no COVID-19 training at the time of the survey. The students reported that they had to accommodate to changes in patient care (96.6%) and didactic learning (95.2%) activities, while 88.5% of the respondents indicated at least one of their courses moved online. Transition to online courses went "smoothly with some troubles" for 51.8% of the respondents, and 48.3% perceived the faculty as prepared for the online transition; however, 45.9% reported feeling extremely concerned about the impact of COVID-19 on their education. The average PSS score was 21.9 of 40 (moderate stress). Multivariate models were built for participants with full data (n = 3899). Being male, having completed more dental coursework, and perceiving a smoother transition were associated with lower PSS scores; more concern about academic progress was associated with higher PSS. Faculty support mediated the relationship between a smoothness of transition and concern about academic progress and PSS scores CONCLUSION: Stress caused by the pandemic may be alleviated by smoother transition and good faculty support.