Effects of low-level laser therapy on reducing pain, edema, and trismus after orthognathic surgery: a systematic review.

The purpose of this study was to systematically review the scientific evidence of the effect of low-level laser therapy (LLLT) on the perception of pain, edema, and trismus after orthognathic surgery. The literature was searched in 11 databases (MedLine via PubMed, Scopus, LILACS, SciELO, Embase, Web of Science, Cochrane Library, and LIVIVO, OpenGrey, OADT, and OpenThesis), without restriction of publication year or language. This search aimed to identify randomized clinical trials comparing low-level laser therapy and placebo for controlling pain, edema, and trismus after orthognathic surgeries. Two reviewers extracted the data and assessed the individual risk of bias of the eligible studies using the Cochrane Collaboration Risk of Bias Tool (RoB, version 2.0). The initial search resulted in 808 articles, from which only five (total of 190 participants) were included in the qualitative synthesis. The studies were published from 2014 to 2020. Two presented a low risk of bias + in the mean mouth opening of all patients subjected to bimaxillary surgery who received LLLT. However, the other study found a significant difference in maximum mouth opening in the LLLT group at 14, 30, and 60 days after surgery. Based on limited evidence, LLLT was presented as an auxiliary tool for reducing pain and trismus after surgery. However, the reduction of edema is controversial due to the absence of measuring standardization.

A Comparison of Torque Stress on Abutment Screw of External Hexagon and Morse Taper Implant.

AIM: This three-dimensional (3D) finite element analysis observed the stress distribution on the prosthetic screws on external hexagon implant and morse taper implant with different tightening loads. MATERIALS AND METHODS: For this, two different 3D models assembly were obtained from the manufacturer and transferred to finite element analysis software: External hex implant model (EHM), and Morse taper implant model (MTM), both compounds by 3.75 × 7 mm implant, abutment and abutment screw. Bolt pretension force was applied on the shaft next to the threads of the prosthetic abutment. Preload was calculated using the torque on the prosthetic screw as recommended by the manufacturer (EHM30 and MTM20) and 10 Ncm torque above the manufacturer recommendations (EHM40 and MTM30). Maximum von mises equivalent stresses were obtained on the screws. RESULTS: Preload values results were 243.18N (EHM30), 229.71N (MTM20), 324.24N (EHM40) and 344.57N (MTM30). In EHM30, EHM40 and MTM20 models the maximum stresses were below the yield strength of the abutment screw material. However, the maximum stress in MTM30 model was higher than the reference value. CONCLUSION: The torque loads above the manufacturer recommendations can cause plastic deformation in the MT abutment screw threads. The screws of morse taper implant can be more sensitive to higher loads than external hexagon implant. CLINICAL SIGNIFICANCE: The adequate torque can result in screw loosening, while fracture may occur if torque is excessive. Abutment screw suffers many screwing cycles in its lifetime in a way that some tightening forces are above manufacturer recommendations.

Evaluation of Cellular Proliferative Activity in Patients with Actinic Cheilitis through Silver-stained Nucleolar Organizer Region Method.

Introduction: Actinic cheilitis (AC) is a lesion potentially malignant that affects the lips after prolonged exposure to solar ultraviolet (UV) radiation. The present study aimed to assess and describe the proliferative cell activity, using silver-stained nucleolar organizer region (AgNOR) quantification proteins, and to investigate the potential associations between AgNORs and the clinical aspects of AC lesions. Materials and methods: Cases diagnosed with AC were selected and reviewed from Center of Histopathological Diagnosis of the Institute of Biological Sciences, Passo Fundo University, Brazil. Clinical data including clinical presentation of the patients affected with AC were collected. The AgNOR techniques were performed in all recovered cases. The different microscopic areas of interest were printed with magnification of *1000, and in each case, 200 epithelial cell nuclei were randomly selected. The mean quantity in each nucleus for NORs was recorded. One-way analysis of variance was used for statistical analysis. Results: A total of 22 cases of AC were diagnosed. The patients were aged between 46 and 75 years (mean age: 55 years). Most of the patients affected were males presenting asymptomatic white plaque lesions in the lower lip. The mean value quantified for AgNORs was 2.4 ± 0.63, ranging between 1.49 and 3.82. No statistically significant difference was observed associating the quantity of AgNORs with the clinical aspects collected from the patients (p > 0.05). Conclusion: The present study reports the lack of association between the proliferative cell activity and the clinical aspects observed in patients affected by AC through the quantification of AgNORs. Clinical significance: Knowing the potential relation between the clinical aspects of AC and the proliferative cell activity quantified by AgNORs could play a significant role toward the early diagnosis of malignant lesions in the clinical practice. Keywords: Actinic cheilitis, Proliferative cell activity, Silver-stained nucleolar organizer regions.

Implementation of dental specialty centers: a descriptive analysis of the current status in the Brazilian territory.

This study aimed to assess the current implementation status of Dental Specialty Centers (Centros de Especialidades Odontológicas - CEO) in Brazil. The sample included CEOs implemented up to November 2015 in the 27 Brazilian federative units. Data were obtained directly from the database of the Informatics Department of the Brazilian Unified Health System, according to the National Registry of Health Facilities (NRHF) of Dental Specialty Centers of all Brazilian regions. Primary care data were also collected from the cities with implemented CEOs, including coverage status of the Family Health Strategy (FHS) and number of Oral Health Teams (OHT) I and II, at 2 collection periods (January 2006 and November 2015). There were 1019 CEOs implemented in Brazil, which were unequally distributed among the Brazilian states, with prevalence of implementation of CEOs type II (n=503, 49.4%). The statistical analysis showed significant difference between the three types of CEO (I, II, and III) and the variables of coverage rate (FHS) and number of teams (OHT I, OHT II) at both data collection periods. Although presenting an evolutionary aspect in the implementation of CEOs, the implementation of medium-complexity care in Brazil is disorganized.

The influence of non-steroidal anti-inflammatory drugs and paracetamol used for pain control of orthodontic tooth movement: a systematic review.

The present study aimed to perform a systematic literature review to determine if there is a non-steroidal anti-inflammatory drug (NSAID) that interferes less within tooth movement. This research was performed according to the PRISMA statement. Articles were searched in eight electronic databases (PubMed, Scopus, Embase, Web of Science, LILACS, SciELO, Google Scholar, and Open Grey). Only experimental studies on male Wistar rats were selected, which included experiments related to the influence of NSAIDs on orthodontic movement. Studies in animals with pathological conditions, literature review articles, letters to the editor and/or editorials, case reports, abstracts, books, and book chapters were excluded. Each of the steps of this systematic literature review was performed by two examiners independently. RESULTS: the total sample consisted of 505 articles, from which 6 studies were eligible after a qualitative analysis. From the drugs assessed, paracetamol was unanimous for not interfering within orthodontic movement when compared to the control group. However, drugs such as aspirin, ibuprofen, sodium diclofenac, and selective cyclooxygenase-2 inhibitors caused a reduction in tooth movement when compared to the control group. CONCLUSION: paracetamol could be considered the drug of choice for pain relief because it interferes less within tooth movement.

A scientific survey on 1550 cases of oral lesions diagnosed in a Brazilian referral center.

The present study aimed to perform an epidemiological survey on the prevalence rate of oral lesions diagnosed in a referral center in Brazil and to establish association between the lesions and the age and gender of the affected patients. This analytical observational study analyzed 3521 medical records of anatomopathological exams of the Pathological Anatomy and Cytopathology Laboratory of the Cancer Hospital of the state of Mato Grosso (Brazil), from December 2011 to September 2015. A total of 1550 relevant medical records was detected. Patients aging between 41 and 60 consisted of 42.84% of the sample. Males were more affected than females (60.13%). Inflammatory processess consisted of the most prevalent diagnosis (43.29%), followed by squamous cell carcinoma (6.06%), and periapical granuloma (5.23%). Oral health public policies must give major attention to Brazilian males aged between the fourth and sixth decades of life in order to improve their quality of life.

Identification and management of elder physical abuse in the routine of dentistry - a systematic review.

OBJECTIVE: To perform a systematic search in the literature in order to verify whether the dentists are able to identify and manage cases elder physical abuse. BACKGROUND: Dentists may play an important legal role contributing to the management of abused patients through the identification of injuries in their face, head and neck. MATERIALS AND METHODS: The present systematic review was performed following the PRISMA Statement and was registered in the PROSPERO database. A search was conducted in the following electronic databases: PubMed, LILACS, SciELO, Embase, Web of Science, OpenGrey, Google Scholar. Specifically, the last two databases were used to search the 'grey literature'. The research question was based on the PVO strategy for systematic exploratory review. Two examiners determined the eligibility criteria for selecting the studies and performed all the research steps. RESULTS: The initial search resulted in 842 studies, from which eight were considered eligible. Six studies used questionnaires to assess the perception, knowledge and attitudes of dentists towards the identification and management of cases of elder abuse, while two studies assessed this information through personal interviews. Two studies were rated as high quality, while six studies reached moderate quality. Male and female dentists were assessed separately in six studies. Only three studies specified the aggressor. CONCLUSION: The dentists revealed insufficient knowledge on elder abuse. Most of the dentists are not able to identify and manage these cases in the clinical routine.

An Alternative Approach for Space Opening in a Bilateral Maxillary Lateral Incisor Agenesis Patient using Miniplates.

AIM: This case report aimed to present an orthodontic mechanic alternative for space opening in a patient missing maxillary lateral incisors, using miniplates as anchorage, associated with self-ligating brackets. BACKGROUND: Dental agenesis affects the population causing esthetic and functional damages. The prevalence of missing maxillary lateral incisors should be considered for its significant rate and negative impact on smile esthetics. CASE REPORT: This treatment was chosen based on the presence of balanced facial pattern, large canine anatomy, the need to improve dental occlusion to prevent further wear, and patient's esthetic complaint. To obtain the results, upper third molars were extracted, and two miniplates were installed to distalize the upper arch with no need for patient compliance or auxiliary devices. Self-ligating brackets were used to reduce friction on posterior teeth, thus facilitating movement with light force application. At the end of 19 months, the patient presented with class I good overbite and overjet, and adequate space for implant and prosthetics; also, good facial esthetic was maintained. CONCLUSION: When indicated, space opening may provide excellent esthetics and functional results, and even more predictable results when skeletal anchorage miniplates are used to distalize all posterior teeth. CLINICAL SIGNIFICANCE: Considering the high level of esthetic and functional compromise caused by dental agenesis, the technique hereby described represents a viable mechanic alternative within orthodontic possibilities.

Influence of Age on Factors associated with Peri-implant Bone Loss after Prosthetic Rehabilitation over Osseointegrated Implants.

INTRODUCTION: To verify the influence of age on factors associated with peri-implant bone loss after prosthetic rehabilitation over osseointegrated implants. MATERIALS AND METHODS: This is an analytical, observational, and longitudinal study with initial 23 participants. Patients presenting with osseointegrated implants with their respective prostheses installed were included, and they could be carriers of chronic and degenerative diseases, such as diabetes, osteoporosis, hypothyroidism, cardiovascular disease (CVD), and systemic arterial hypertension. Thus, 18 participants with 57 implants were selected and followed up from 2009 to 2013. For statistical analysis, chi-square or Fisher's exact test was used for the association of systemic conditions and bone loss. Student's t-test was used for mean comparisons of age and number of total upper and lower implants. RESULTS: The average age of the sample studied was 71.05 years (65-80). The average implant per person was 3.2. Smoking had an influence on both mesial and distal bone loss, and the latter was significant (p = 0.0370). The association between bone loss and gender was also significant (p < 0.05). Moreover, male gender and upper implants were factors significantly associated with bone loss. The systemic conditions, when isolated, did not have significant influence on implant survival. CONCLUSION: Age is not a factor that, alone, contraindicates implant-rehabilitating therapy. On the contrary, smoking has a significant influence on dental implant survival. Systemic diseases, such as osteoporosis, hypothyroidism, diabetes, hypertension, and heart diseases, when controlled, are not contraindication factors. CLINICAL SIGNIFICANCE: This study is relevant for assessing peri-implant bone loss in elderly patients, right after implant installation and over time. Therefore, it was possible to verify that age is not a limiting factor for this procedure. Controlled systemic diseases do not contraindicate implant installation, but smoking is a factor that affects implant survival.

Most Frequent Oral Lesions in Patients with Type 2 Diabetes Mellitus.

AIM: Type 2 diabetes mellitus (DM2) is a chronic disease caused by the underproduction of insulin in the organism and it is considered a risk factor to periodontal disease. MATERIALS AND METHODS: This study performed a cross-sectional research on the main oral changes in patients with DM2 and nondiabetics, in Passo Fundo, Rio Grande do Sul, Brazil. The sample included 116 patients examined at the Diabetes Outpatient Clinic of the School of Medicine of the University of Passo Fundo (UPF) and 134 nondiabetic patients examined at the Examinations, Triage, and Emergency Sector of the School of Dentistry of UPF. Inclusion criteria for the study were patients over 35-years old, diagnosed with DM2 for more than 2 years. The same criteria were used for the control group, except for the presence of diabetes. Data collected were analyzed by Statistical Package for the Social Sciences 18.0 for Windows™ software and the Chi-square test at 5% significance. This study showed that, overall, oral lesions were more prevalent in diabetic patients. RESULTS: The stomatological manifestations observed more frequently in such patients were pseudomembranous candidia-sis, lichen planus, lingual varices, xerostomia, and prosthetic stomatitis (p > 0.001). CONCLUSION: Therefore, based on the sample investigated, it is concluded that patients with DM2 present higher prevalence of oral lesions when compared with nondiabetics. CLINICAL SIGNIFICANCE: It is important for the dentist to know about oral lesions because they may allow either early diagnosis in patients unaware of this condition or help diagnosing a potential decompensation. Moreover, oral lesions may represent a potential gateway for infectious agents, and the dentist may restrain this condition by performing treatment as early as possible.

Postoperative pain after third molar extraction surgery in patients with and without bruxism: an observational study.

Third molar extraction surgery is a frequentprocedure in dentistry. Like any surgical procedure, it may lead to inflammatory responses, and postoperative pain is one of its main complications. Furthermore, temporomandibular disorder (TMD) is a collective termfor several clinicalproblems involving orofacial structures. Patients withparafunction are more sensitive to mechanical stimuli such as pressure during surgical procedures. Aim: To analyze postoperative pain in patients with and without bruxism subjected to third molar extraction surgery. Materials and Method: This was an observational study including four groups with a 1:1:1:! allocation ratio, conducted following ethical approval. Patients classified as ASA I with an indication for lower third molar extraction were recruited. Bruxism was self-reported. Two surgical techniques were used: one with only forceps and levers (ST1) and another with osteotomy and odontosection (ST2). Results: Four groups (bruxism and surgical techniques) were enrolled, each with a convenience sample (n=34). Postoperative pain levels were higher in patients with than without bruxism (p<0.05). The comparison between surgical techniques showed significantly higher pain levels only on the seventh day for ST2 groups (p<0.05). Oral mucosaflap incisions did not cause significantly higher persistence and pain levels. Conclusions: Bruxism, osteotomy, and odontosection may have increased postoperative pain levels, whereas performing an oral mucosa flap did not cause significant differences. Nevertheless, these preliminary data should be interpreted carefully. Randomized controlled trials are required to reinforce the findings of this study.

A cirurgia de extragao de terceiros molares é um procedimento frequente na odontologia. Como em qualquer procedimento cirúrgico, pode levar a respostas inflamatorias. A dor pós-operatória é uma das principais complicagoes após a cirurgia de extragao de terceiros molares. Além disso, disfungao temporomandibular (DTM) é um termo coletivo para vários problemas clínicos envolvendo estruturas orofaciais. Pacientes com parafungao sao mais sensíveis a estímulos mecánicos como pressao durante procedimentos cirúrgicos. Objetivo: Analisar a dor pós-operatória em pacientes com e sem bruxismo submetidos á cirurgia de extragao de terceiros molares. Material e Método: Um estudo observacional incluindo quatro grupos com uma proporgao de alocagao de 1:1:1:1 foi realizado após aprovagao ética. Foram recrutados pacientes classificados como ASA I com indicagao de exodontia de terceiros molares inferiores. O bruxismo foi autorreferido e foram realizadas duas técnicas cirúrgicas: uma com apenas fórceps e alavancas (ST1) e outra com osteotomia e odontosecgao (ST2). Resultados: Foram incluidos quatro grupos (bruxismo e técnicas cirúrgicas), cada um com uma amostra de conveniencia (n=34). Os níveis de dor pós-operatória foram maiores em pacientes com bruxismo (p<0,05). A comparagao entre as técnicas cirúrgicas mostrou níveis de dor significativamente maiores apenas no sétimo diapara os grupos ST2 (p<0,05). Incisoes de retalhos de mucosa oral nao mostraram níveis de dor significativamente maiores. Conclusoes: Bruxismo, osteotomia e odontosecgaopodem aumentar os níveis de dor pós-operatória, enquanto a realizagao de retalho de mucosa oral nao apresenta diferengas significativas. No entanto, a interpretagao cuidadosa desses dados preliminares é recomendada, e ensaios clínicos randomizados sao necessários para fortalecer os achados deste estudo.

Effect of a low-level laser on bone regeneration after rapid maxillary expansion.

INTRODUCTION: In this study, we evaluated the effects of a low-level laser on bone regeneration in rapid maxillary expansion procedures. METHODS: Twenty-seven children, aged 8 to 12 years, took part in the experiment, with a mean age of 10.2 years, divided into 2 groups: the laser group (n = 14), in which rapid maxillary expansion was performed in conjunction with laser use, and the no-laser group (n = 13), with rapid maxillary expansion only. The activation protocol of the expansion screw was 1 full turn on the first day and a half turn daily until achieving overcorrection. The laser type used was a laser diode (TWIN Laser; MMOptics, São Carlos, Brazil), according to the following protocol: 780 nm wavelength, 40 mW power, and 10 J/cm(2) density at 10 points located around the midpalatal suture. The application stages were 1 (days 1-5 of activation), 2 (at screw locking, on 3 consecutive days), 3, 4, and 5 (7, 14, and 21 days after stage 2). Occlusal radiographs of the maxilla were taken with the aid of an aluminum scale ruler as a densitometry reference at different times: T1 (initial), T2 (day of locking), T3 (3-5 days after T2), T4 (30 days after T3), and T5 (60 days after T4). The radiographs were digitized and submitted to imaging software (Image Tool; UTHSCSA, San Antonio, Tex) to measure the optic density of the previously selected areas. To perform the statistical test, analysis of covariance was used, with the time for the evaluated stage as the covariable. In all tests, a significance level of 5% (P <0.05) was adopted. RESULTS: From the evaluation of bone density, the results showed that the laser improved the opening of the midpalatal suture and accelerated the bone regeneration process. CONCLUSIONS: The low-level laser, associated with rapid maxillary expansion, provided efficient opening of the midpalatal suture and influenced the bone regeneration process of the suture, accelerating healing.

Correlation of different cephalometric measurements to define facial type.

The aim of this study was to analyze a possible correlation of different cephalometric measurements to define facial type and to evaluate the best measurement for diagnosis. The sample consisted of 95 lateral cephalograms of caucasian patients with normal occlusion, aged between 15 years and two months and 21 years and four months, of which 54 were male and 41 female. The facial types were divided into dolichofacial, mesofacial and brachyfacial, according to the standards stated by different authors, and a relationship among them was investigated using the Kappa and Total agreement methods. The highest agreement found was between FMA and SN.GoGn; the lowest was between SN. Gn and VERT index. According to literature review and the interpretation of the results, SN.GoGn appears to be the best measurement to define facial type.

Diagnostic performance of convolutional neural networks for dental sexual dimorphism.

Convolutional neural networks (CNN) led to important solutions in the field of Computer Vision. More recently, forensic sciences benefited from the resources of artificial intelligence, especially in procedures that normally require operator-dependent steps. Forensic tools for sexual dimorphism based on morphological dental traits are available but have limited performance. This study aimed to test the application of a machine learning setup to distinguish females and males using dentomaxillofacial features from a radiographic dataset. The sample consisted of panoramic radiographs (n = 4003) of individuals in the age interval of 6 and 22.9 years. Image annotation was performed with V7 software (V7labs, London, UK). From Scratch (FS) and Transfer Learning (TL) CNN architectures were compared, and diagnostic accuracy tests were used. TL (82%) performed better than FS (71%). The correct classifications of females and males aged ≥ 15 years were 87% and 84%, respectively. For females and males < 15 years, the correct classifications were 80% and 83%, respectively. The Area Under the Curve (AUC) from Receiver-operating Characteristic (ROC) curves showed high classification accuracy between 0.87 and 0.91. The radio-diagnostic use of CNN for sexual dimorphism showed positive outcomes and promising forensic applications to the field of dental human identification.

Accuracy of computer-assisted image analysis in the diagnosis of maxillofacial radiolucent lesions: A systematic review and meta-analysis.

OBJECTIVES: This study aimed to search for scientific evidence concerning the accuracy of computer-assisted analysis for diagnosing maxillofacial radiolucent lesions. METHODS: A systematic review was conducted according to the statements of Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols and considering 10 databases, including the gray literature. Protocol was registered at the International Prospective Register of Systematic Reviews (CRD42018089945). The population, intervention, comparison and outcome strategy was used to define the eligibility criteria and only diagnostic test studies were included. Their risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal tool. Random-effects model meta-analysis was performed and heterogeneity among the included studies was estimated using the I2 statistic. The grade of recommendation, assessment, development, and evaluation (GRADE) tool assessed the quality of evidence and strength of recommendation across included studies. RESULTS: Out of 715 identified citations, four papers, published between 2009 and 2017, fulfilled the criteria and were included in this systematic review. A total of 191 lesions, classified as periapical granuloma and cyst, dentigerous cyst or keratocystic odontogenic tumor, were analyzed. All selected articles scored low risk of bias. The pooled accuracy estimation, regardless of the classification method used, was 88.75% (95% CI = 85.19-92.30). Heterogeneity test reached moderate values (I2 = 57.89%). According to the GRADE tool, the analyzed outcome was classified as having low level of certainty. CONCLUSIONS: The overall evaluation showed all studies presented high accuracy rates of computer-aided diagnosis systems in classifying radiolucent maxillofacial lesions compared to histopathological biopsy. However, due to the moderate heterogeneity found among the studies included in this meta-analysis, a pragmatic recommendation about the use of computer-assisted analysis is not possible.

Evaluation of anxiety levels and their characteristics in dental care: Cross-sectional study.

CONTEXT: Anxiety is defined as an emotion produced by a set of feelings and physical changes. Many patients are afraid of some procedures involved in dental therapy. AIM: The objective of this study was to verify the anxiety of patients regarding the visits to dental clinics of a higher education institution, as well as to observe the moment of greatest anxiety. SETTINGS AND DESIGN: It is a cross-sectional observational study including 94 patients from the dental clinics of an educational institution in a city of southern Brazil. MATERIALS AND METHODS: The Corah Dental Anxiety Scale, composed of four questions, was used to evaluate the dental anxiety levels of all patients. The sample universe included registered patients under treatment in the clinics of the studied institution, from August to November of 2016. We included only healthy patients over 18-year old who were subjected to surgical and nonsurgical procedures. STATISTICAL ANALYSIS: The data were analyzed through descriptive statistic to verify the frequency distribution of all variables. Pearson's Chi-square test, at 5% significance level and 95% confidence interval, was used to evaluate the association between the dependent variable (dental treatment anxiety) and the independent variables (demographics), aided by the SPSS software 20.0. Results: It was found that most of the participants were not anxious (69.1%) and the moment of greatest anxiety reported was before local anesthesia. In addition, statistics showed no correlation among gender, age group, and type of procedure performed. It was possible to conclude that the level of anxiety of the patients regarding the dental care performed in the clinics of the studied institution was low for both surgical and nonsurgical procedures. CONCLUSION: This survey revealed that the moment of greatest anxiety for the patients was before the anesthetic procedure, and gender, age, and type of procedure did not influence the level of anxiety felt by the patient.

Chronic obstructive pulmonary disease as a risk factor for suicide: A systematic review and meta-analysis.

BACKGROUND: Patients living with chronic obstructive pulmonary disease (COPD) commonly present several limitations in their daily activities, high depression rates, and low quality of life, which makes this population a risk group for suicide. This study aims to systematically assess the literature on the association between CPOD and the likelihood of suicide. METHODS: The protocol was registered in PROSPERO (CRD42018096618). The Latin-American and Caribbean Health Sciences Literature (LILACS), PubMed, SciELO, Scopus, LIVIVO, Web of Science, and PsychNET databases were used as primary study sources. OpenThesis and OpenGrey were used to partially capture the "grey literature". A manual search was also performed through a systematized analysis of the references of eligible articles. The risk of bias among the studies included was assessed with the Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews. A random effects meta-analysis was performed to estimate the variation in odds ratio (OR) and 95% confidence intervals (95% CI). RESULTS: The search provided 4762 results, from which only seven met the eligibility criteria and were ultimately included in the qualitative assessment of the review. The studies were published from 2002 to 2015. All studies presented low risk of bias. The total sample included 1390 suicide cases of COPD patients. The meta-analysis, which was based on five eligible case control studies, found that people with history of COPD are more likely to commit suicide (OR = 1.90; 95% CI = 1.27-2.48; p = 0.002). CONCLUSION: COPD patients are 1.9 times more likely to commit suicide than people without COPD.

Mouth breathing in children and its impact in dental malocclusion: a systematic review of observational studies.

INTRODUCTION: Mouth breathing in childhood can compromise the dental occlusion and, consequently, the functions performed by the stomatognathic system. The purpose of this systematic review was to evaluate which is the highest prevalence of dental malocclusion in mouth breathing children. EVIDENCE ACQUISITION: Bibliographic searches of observational studies were performed in five electronic databases (PubMed, LILACS, SciELO, Scopus and Open Grey) without language restriction, from 2007 to 2014. Were selected cross-sectional or longitudinal studies of the past seven years that described the prevalence of malocclusions of Angle Class I and Class II, division 1. After the selection, the studies were evaluated for their methodological quality. Subsequently, the description of the selected articles was made. EVIDENCE SYNTHESIS: From 125 records, seven articles were selected (5.6%), with a majority of Brazilian authors (71.43%). There seems to be a higher prevalence of malocclusion in mouth breathers when related to gender. The prevalence of malocclusion of Angle Class II, division 1, was higher than Class I malocclusion in mouth breathers, according to most studies in the sample. Interdisciplinary and controlled studies deserve more attention from researchers of the area, given the need for researches with greater methodological strength. CONCLUSIONS: Considering the results, the prevalence of malocclusion of Angle Class II, division 1 tends to be higher than Class I malocclusion in mouth breathing children.

Postoperative pain after third molar extraction surgery in patients with and without bruxism: an observational study / Dor pós-operatória após cirurgia de extração de terceiros molares em pacientes com e sem bruxismo: um estudo observacional

ABSTRACT Third molar extraction surgery is a frequentprocedure in dentistry. Like any surgical procedure, it may lead to inflammatory responses, and postoperative pain is one of its main complications. Furthermore, temporomandibular disorder (TMD) is a collective termfor several clinicalproblems involving orofacial structures. Patients withparafunction are more sensitive to mechanical stimuli such as pressure during surgical procedures. Aim: To analyze postoperative pain in patients with and without bruxism subjected to third molar extraction surgery. Materials and Method: This was an observational study including four groups with a 1:1:1:! allocation ratio, conducted following ethical approval. Patients classified as ASA I with an indication for lower third molar extraction were recruited. Bruxism was self-reported. Two surgical techniques were used: one with only forceps and levers (ST1) and another with osteotomy and odontosection (ST2). Results: Four groups (bruxism and surgical techniques) were enrolled, each with a convenience sample (n=34). Postoperative pain levels were higher in patients with than without bruxism (p<0.05). The comparison between surgical techniques showed significantly higher pain levels only on the seventh day for ST2 groups (p<0.05). Oral mucosaflap incisions did not cause significantly higher persistence and pain levels. Conclusions: Bruxism, osteotomy, and odontosection may have increased postoperative pain levels, whereas performing an oral mucosa flap did not cause significant differences. Nevertheless, these preliminary data should be interpreted carefully. Randomized controlled trials are required to reinforce the findings of this study.

RESUMO A cirurgia de extragao de terceiros molares é um procedimento frequente na odontologia. Como em qualquer procedimento cirúrgico, pode levar a respostas inflamatorias. A dor pós-operatória é uma das principais complicagoes após a cirurgia de extragao de terceiros molares. Além disso, disfungao temporomandibular (DTM) é um termo coletivo para vários problemas clínicos envolvendo estruturas orofaciais. Pacientes com parafungao sao mais sensíveis a estímulos mecánicos como pressao durante procedimentos cirúrgicos. Objetivo: Analisar a dor pós-operatória em pacientes com e sem bruxismo submetidos á cirurgia de extragao de terceiros molares. Material e Método: Um estudo observacional incluindo quatro grupos com uma proporgao de alocagao de 1:1:1:1 foi realizado após aprovagao ética. Foram recrutados pacientes classificados como ASA I com indicagao de exodontia de terceiros molares inferiores. O bruxismo foi autorreferido e foram realizadas duas técnicas cirúrgicas: uma com apenas fórceps e alavancas (ST1) e outra com osteotomia e odontosecgao (ST2). Resultados: Foram incluidos quatro grupos (bruxismo e técnicas cirúrgicas), cada um com uma amostra de conveniencia (n=34). Os níveis de dor pós-operatória foram maiores em pacientes com bruxismo (p<0,05). A comparagao entre as técnicas cirúrgicas mostrou níveis de dor significativamente maiores apenas no sétimo diapara os grupos ST2 (p<0,05). Incisoes de retalhos de mucosa oral nao mostraram níveis de dor significativamente maiores. Conclusoes: Bruxismo, osteotomia e odontosecgaopodem aumentar os níveis de dor pós-operatória, enquanto a realizagao de retalho de mucosa oral nao apresenta diferengas significativas. No entanto, a interpretagao cuidadosa desses dados preliminares é recomendada, e ensaios clínicos randomizados sao necessários para fortalecer os achados deste estudo.

Self-ligating versus conventional metallic brackets on Streptococcus mutans retention: A systematic review.

OBJECTIVE: The present study aimed to review the literature systematically and assess comparatively whether self-ligating metallic brackets accumulate less Streptococcus mutans biofilm than conventional metallic brackets. MATERIAL AND METHODS: The systematic search was performed following PRISMA guidelines and registration in PROSPERO. Seven electronic databases (Google Scholar, LILACS, Open Grey, PubMed, SciELO, ScienceDirect, and Scopus) were consulted until April 2016, with no restriction of language and time of publication. Only randomized clinical studies verifying S. mutans colonization in metallic brackets (self-ligating and conventional) were included. All steps were performed independently by two operators. RESULTS: The search resulted in 546 records obtained from the electronic databases. Additionally, 216 references obtained from the manual search of eligible articles were assessed. Finally, a total of 5 studies were included in the qualitative synthesis. In 1 study, the total bacterial count was not different among self-ligating and conventional brackets, whereas in 2 studies the amount was lower for self-ligating brackets. Regarding the specific count of S. mutans, 2 studies showed less accumulation in self-ligating than in conventional brackets. CONCLUSION: Based on the limited evidence, self-ligating metallic brackets accumulate less S. mutans than conventional ones. However, these findings must be interpreted in conjunction with particularities individual for each patient - such as hygiene and dietary habits, which are components of the multifactorial environment that enables S. Mutans to proliferate and keep retained in the oral cavity.