Do different protocols affect the success rate or bond strength of glass-ceramics repaired with composite resin? A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Intraoral repair techniques prevent unnecessary replacement of ceramic restorations, thereby increasing the survival rate. However, adhesion between ceramics and the composite resin is challenging and how different protocols influence adhesion is unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to analyze the influence of different protocols on repairing glass-ceramic surfaces with composite resins. MATERIAL AND METHODS: PubMed, Scopus, ISI Web of Science, and Embase electronic databases were searched to select studies comparing bond strength values or survival rates of glass-ceramic repaired with composite resins using different surface treatment protocols. No publication year or language restriction was applied. Data sets were extracted from all included studies, and the mean differences calculated. A 95% confidence interval was calculated by using the random effect model (Rev Man 5.4). RESULTS: The search identified 5037 studies, and 165 were assessed for eligibility. Finally, 123 in vitro studies were included in the systematic review and 48 in the meta-analysis. Considering different glass-ceramics, bond strength tests, and aged or not aged specimens, 37 meta-analyses found the effect of repair protocols: only adhesive, silane plus adhesive alone or preceded by hydrofluoric (HF) acid, airborne-particle abrasion (APA) with Al2O3 particles, silica-coated APA (SCAPA), diamond rotary instrument (DRI), and laser irradiation (LI). CONCLUSIONS: For feldspathic porcelain, HF acid, APA, SCAPA, or DRI improved the repair micromechanical retention; applying silane is essential to HF-conditioned surfaces but the use of adhesive is optional when silane is applied. Results for leucite and lithium disilicate were inconclusive in terms of suggesting a treatment other than HF acid plus silane and adhesive applications.

Stress Response During Rapid Maxillary Expansion in Children.

Purpose: To assess the effect of rapid maxillary expansion (RME) on the inflammatory and stress response of patients undergoing orthodontic treatment. Methods: Eighty salivary samples were collected from patients (n=16) during RME at five moments: before the expander placement (T1); 25 minutes after its first activa- tion (T2); seven days after placement, shortly after the patient arrived at the dental clinic (T3); 25 minutes after the appliance activation on day seven (T4) and one month after the last activation of the appliance (T5). Cortisol and nitric oxide levels were evaluated using an immunoassay kit and the Griess method, respectively. Friedman and Wilcoxon tests were used for statistical analysis (P <0.05). Results: Participants' mean age was 11.5 years. There was a significant change in cortisol levels over the study period in the total sample (P<0.01), for the Haas appliance (P=0.01), female sex (P=0.01), younger children (P=0.01), presence of large overbite (P=0.02), presence of posterior crossbite (P =0.006), Class I type occlusion (P=0.02) and mesofacial facial type (P =0.02). Regarding nitric oxide, there was a significant change over the study period in those who wore the Haas appliance (P =0.04). For nitric oxide levels, T1 was significantly higher than T3, T4 and T5 (P <0.05) for those who wore a Haas appliance. Conclusion: The period anticipating the consultation at the waiting reception area was more stressful than the dental procedure in patients undergoing RME. This procedure did not cause alterations in salivary biomarkers related to inflammation.

Burden of dental caries in individuals experiencing food insecurity: a systematic review and meta-analysis.

CONTEXT: Food insecurity affects approximately 2.37 billion people worldwide. Individuals experiencing food insecurity are more likely to exhibit poor health-related endpoints. Dental caries, a highly prevalent noncommunicable disease, is modulated by an interplay between biological, behavioral, and environmental factors. OBJECTIVE: This systematic review and meta-analysis aimed to assess whether individuals experiencing food insecurity were more likely to exhibit dental caries than individuals facing food security. DATA SOURCES: The Web of Science, PubMed, Scopus, Embase, Ovid, CINAHL, LILACS, and APA PsycINFO databases were checked from inception to November 2021. Grey literature and Google Scholar were also examined. An updated search was conducted in August 2022. Observational studies were included if they evaluated the association between dental caries and food insecurity status. DATA EXTRACTION: Data extraction was performed by two reviewers. DATA ANALYSIS: Random-effects meta-analyses were conducted using R language. In total, 514 references were retrieved from databases, of which 14 articles were included in qualitative synthesis and 7 were merged into meta-analysis. The results of an inverse-variance meta-analysis (OR = 1.62; 95%CI, 1.01-2.60) and a meta-analysis of binary data (OR = 1.66; 95%CI, 1.36-2.02) demonstrated that food-insecure individuals were more likely to exhibit dental caries than food-secure individuals. Inverse-variance meta-analyses appraising multiple strata of food security also showed that individuals experiencing marginal food security (OR = 1.48; 95%CI, 1.28-1.72), individuals experiencing low food security (OR = 1.26; 95%CI, 1.01-1.57), and those experiencing very low food security (OR = 1.33; 95%CI, 1.04-1.71) were more likely to exhibit dental caries than individuals experiencing full food security. CONCLUSION: Dental caries is associated with food insecurity. Individuals living with food insecurity are more likely to exhibit dental caries than those who have food security. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42021268582.

Longitudinal assessment of the impact of orthodontic treatment on adolescents' quality of life: a comparison between boys and girls using a condition specific questionnaire.

The aim of this study was to compare the impact of the first year of wearing of a fixed orthodontic appliance on the Oral Health-Related Quality of Life (OHRQoL) between boys and girls, by means of a condition-specific instrument. The study included 69 adolescents aged 10 to 18 years, who were undergoing orthodontic treatment with a fixed appliance. Of the 69 adolescents, 38 were girls (55.1%) and 31 were boys (44.9%). They answered the Brazilian version of the Impact of Fixed Appliance Measure (B-IFAM) questionnaire three months (T1) and one year (T2) after the fixed appliance was installed. This questionnaire contains 43 questions, distributed across nine domains. The higher the scores, the more negative the perception of the adolescent concerning the impact of the fixed appliance on his/her OHRQoL. Sociodemographic and clinical variables were also analyzed, and statistical analysis was performed. For the domains, the effect size (the magnitude of the difference between girls and boys) and the minimal clinically important difference were also calculated. The adjusted regression showed that there was a significantly greater increase in the overall B-IFAM score in girls than in boys, indicating a more negative perception of the OHRQoL over the study time [Coefficient=11.77 (3.47- 20.60), p=0.006]. From T1 to T2, there was a significantly greater increase in the scores (more negative perception of OHRQoL over time) in girls than in boys for the domains aesthetics (p=0.034) and physical impact (p=0.011). These differences were clinically significant. The effect size (the magnitude of the difference) was moderate. The impact of wearing a fixed appliance on the OHRQoL was more negative in girls than in boys during the first year of orthodontic treatment.

O objetivo deste estudo foi comparar o impacto do primeiro ano de uso do aparelho fixo na qualidade de vida relacionada a saúde bucal (QVRSB) entre meninas e meninos, através de um instrumento condição específica. Sessenta e nove adolescentes entre 10 e 18 anos, em tratamento ortodôntico com aparelho fixo foram incluídos. Adolescentes responderam ao questionário Impact of fixed appliance measure (B-IFAM) no terceiro mês de uso do aparelho fixo (T1) e um ano após a colagem do aparelho fixo (T2). Este questionário possui 43 perguntas, distribuídas em nove domínios. Quanto maior os escores, mais negativa a percepção do adolescente com relação ao impacto do aparelho fixo na QVRSB. Variáveis sociodemográficas e clínicas também foram avaliadas. Análise estatística foi realizada. Para os domínios, tamanho de efeito (a magnitude da diferença entre meninas e meninos) e diferença mínima clinicamente importante também foram calculadas. Dos 69 adolescentes, 38 eram meninas (55,1%) e 31 eram meninos (44,9%). Na regressão ajustada, meninas apresentaram um aumento significativamente maior do escore total do B-IFAM do que meninos, indicando uma percepção mais negativa da QVRSB ao longo do tempo de acompanhamento [Coeficiente=11,77 (3,47­20,60), p=0.006]. Meninas apresentavam um aumento significativamente maior dos escores de T1 para T2 (percepção mais negativa da QVRSB ao longo do tempo) em relação aos meninos para os domínios estética (p=0,034) e impacto físico (p=0,011). Estas diferenças também foram clinicamente significativas. O tamanho do efeito (a magnitude da diferença) foi moderado. Meninas demonstraram um impacto mais negativo do uso do aparelho fixo na QVRSB do que meninos nos 12 primeiros meses de tratamento ortodôntico.

Longitudinal assessment of the impact of orthodontic treatment on adolescents' quality of life: a comparison between boys and girls using a condition specific questionnaire / Avaliação longitudinal do impacto do tratamento ortodôntico na qualidade de vida de adolescentes: comparação entre meninos e meninas utilizando um questionário condição especifica

ABSTRACT The aim of this study was to compare the impact of the first year of wearing of a fixed orthodontic appliance on the Oral Health-Related Quality of Life (OHRQoL) between boys and girls, by means of a condition-specific instrument. The study included 69 adolescents aged 10 to 18 years, who were undergoing orthodontic treatment with a fixed appliance. Of the 69 adolescents, 38 were girls (55.1%) and 31 were boys (44.9%). They answered the Brazilian version of the Impact of Fixed Appliance Measure (B-IFAM) questionnaire three months (T1) and one year (T2) after the fixed appliance was installed. This questionnaire contains 43 questions, distributed across nine domains. The higher the scores, the more negative the perception of the adolescent concerning the impact of the fixed appliance on his/her OHRQoL. Sociodemographic and clinical variables were also analyzed, and statistical analysis was performed. For the domains, the effect size (the magnitude of the difference between girls and boys) and the minimal clinically important difference were also calculated. The adjusted regression showed that there was a significantly greater increase in the overall B-IFAM score in girls than in boys, indicating a more negative perception of the OHRQoL over the study time [Coefficient=11.77 (3.47- 20.60), p=0.006]. From T1 to T2, there was a significantly greater increase in the scores (more negative perception of OHRQoL over time) in girls than in boys for the domains aesthetics (p=0.034) and physical impact (p=0.011). These differences were clinically significant. The effect size (the magnitude of the difference) was moderate. The impact of wearing a fixed appliance on the OHRQoL was more negative in girls than in boys during the first year of orthodontic treatment.

RESUMO O objetivo deste estudo foi comparar o impacto do primeiro ano de uso do aparelho fixo na qualidade de vida relacionada a saúde bucal (QVRSB) entre meninas e meninos, através de um instrumento condição específica. Sessenta e nove adolescentes entre 10 e 18 anos, em tratamento ortodôntico com aparelho fixo foram incluídos. Adolescentes responderam ao questionário Impact of fixed appliance measure (B-IFAM) no terceiro mês de uso do aparelho fixo (T1) e um ano após a colagem do aparelho fixo (T2). Este questionário possui 43 perguntas, distribuídas em nove domínios. Quanto maior os escores, mais negativa a percepção do adolescente com relação ao impacto do aparelho fixo na QVRSB. Variáveis sociodemográficas e clínicas também foram avaliadas. Análise estatística foi realizada. Para os domínios, tamanho de efeito (a magnitude da diferença entre meninas e meninos) e diferença mínima clinicamente importante também foram calculadas. Dos 69 adolescentes, 38 eram meninas (55,1%) e 31 eram meninos (44,9%). Na regressão ajustada, meninas apresentaram um aumento significativamente maior do escore total do B-IFAM do que meninos, indicando uma percepção mais negativa da QVRSB ao longo do tempo de acompanhamento [Coeficiente=11,77 (3,47-20,60), p=0.006]. Meninas apresentavam um aumento significativamente maior dos escores de T1 para T2 (percepção mais negativa da QVRSB ao longo do tempo) em relação aos meninos para os domínios estética (p=0,034) e impacto físico (p=0,011). Estas diferenças também foram clinicamente significativas. O tamanho do efeito (a magnitude da diferença) foi moderado. Meninas demonstraram um impacto mais negativo do uso do aparelho fixo na QVRSB do que meninos nos 12 primeiros meses de tratamento ortodôntico.

Hemorrhagic complications in individuals with liver disease submitted to minor oral surgery.

Individuals with chronic liver disease (CLD) have an increased risk of bleeding from thrombocytopenia and changes in hemostasis. The aim of this study was to evaluate the frequency of and the factors associated with the occurrence of bleeding in CLD patients who underwent dental surgical procedures. This was a retrospective study whose data were collected in a hospital dentistry service between 2010 and 2016. The patients were referred from the gastroenterology and liver transplantation services of a university hospital for dental treatment. The study followed the STROBE guidelines. Among the 71 surgical procedures performed, there were 17 (24%) perioperative and postoperative bleeding episodes, 14 of which were in pretransplant patients and 11 received blood transfusion before dental surgery. Individuals with a previous history of bleeding (PR = 2.67, CI = 1.07-6.67, P  = 0.035) and those with a platelet count before surgery 50 × 10 9 /l or less (PR = 7.48, CI = 1.70-32.86, P  = 0.008) had a higher prevalence of perioperative and postoperative bleeding episodes than their peers without a previous history of bleeding, and those with platelet count greater than 50 × 10 9 /l. The approach to individuals with CLD is complex and represents a challenge to the clinician. A careful anamnesis combined with laboratory screening of coagulation disorders appears to be useful to identify individuals at a major risk of bleeding. Studies identifying the predisposing factors of bleeding in CLD patients support well tolerated protocols for oral surgery in this group.

Influence of ethylenediaminetetraacetic acid on regenerative endodontics: A systematic review.

BACKGROUND: The effects of ethylenediaminetetraacetic acid (EDTA) on regenerative endodontic procedures (REPs) are controversial, because, despite releasing growth factors from dentine, some studies show negative effects on cell behaviour. OBJECTIVES: The aim of the study was to investigate the influence of the use of EDTA in REP on the growth factors' release, cell behaviour and tissue regeneration. METHODS: A systematic search was conducted (PubMed/Medline, Scopus, Cochrane Library, Web of Science, Embase, OpenGrey and reference lists) up to February 2021. Only in vivo and in vitro studies evaluating the effects of EDTA on the biological factors of dentine, pulp/periapical tissues and cell behaviour were eligible. Studies without a control group or available full text were excluded. The growth factors' release was the primary outcome. Risk of bias in the in vitro and in vivo studies was performed according to Joanna Briggs Institute's Checklist and SYRCLE's RoB tool, respectively. RESULTS: Of the 1848 articles retrieved, 36 were selected. Amongst these, 32 were in vitro, three animal studies and one with both models. The EDTA concentrations ranged from 3% to 15%, at different times. Regarding growth factors' release (17 studies), 15 studies found significant transforming growth factor (TGF)-ß release after dentine conditioning with EDTA, and most found no influence on vascular endothelial growth factor release. Regarding cell behaviour (26 studies), eight studies showed no influence of EDTA-treated dentine on cell viability, whereas, five, nine and six studies showed higher cell migration, adhesion and differentiation respectively. No influence of EDTA conditioning was observed in animal studies. In vitro studies had a low risk of bias, whereas animal studies had high risk of bias. Meta-analysis was unfeasible. DISCUSSION: This review found that EDTA increased TGF-ß release and improved cell activity. However, well-designed histological analyses using immature teeth models are needed. CONCLUSIONS: High-quality in vitro evidence suggests that EDTA-treated dentine positively influences TGF-ß release, cell migration, attachment and differentiation; further research to evaluate its influence on tissue regeneration is necessary due to low methodological quality of the animal studies.

Type IV hypersensitivity associated with restorative materials: Clinical report and systematic literature review.

STATEMENT OF PROBLEM: Type IV hypersensitivity reactions (Type IV HR) are immune responses mediated by antigen-specific effector T cells. PURPOSE: The purpose of this clinical report and systematic review was to report the clinicopathological features of Type IV HR in the oral mucosa and to present a systematic literature review of case reports and case series of individuals with Type IV HR in the oral mucosa related to contact with dental materials. MATERIAL AND METHODS: The presented clinical lesions were melanotic macules with burning that affected the internal labial mucosa in contact with composite resin veneer crowns. Histopathological and immunohistochemical analysis of the lesion was performed. The systematic literature review was performed based on a search in 4 electronic databases (PubMed/MEDLINE, Scopus, Web of Science, and Ovid). RESULTS: Immunohistochemistry showed positivity for CD4, CD8, CD20, CD3, tryptase, and CD117. After conservative treatment, the patient reported improvement of symptoms, and a decrease in the number of inflammatory cells was verified. Twenty-one articles were included in the review. Unlike the present patient, the authors of all the articles recommended radical treatment with the removal of the dental material. CONCLUSIONS: Type IV HR in oral mucosa is rare, and the assessment of clinical and histopathological characteristics is essential to perform an accurate diagnosis and provide appropriate treatment.

The applicability of ultrasound in the diagnosis of inflammatory and obstructive diseases of the major salivary glands: a scoping review.

OBJECTIVES: The purpose of the present scoping review was to determine the contribution of ultrasound images in the diagnosis of inflammatory and obstructive diseases of the major salivary glands (MSGs). METHODS: A search of studies of ultrasonographic assessments of human samples was performed in several electronic databases and grey literature up to July 2021. The extracted data were the examined MSG; the diagnostic value of ultrasound (sensibility, specificity, positive- and negative predictive value, accuracy); features of lesions, including number, echogenicity, echotexture, form, margins, size, posterior acoustic aspect, and location; and related clinical information, such as swelling, palpation, sensible to pain, salivation, lymph nodes, recurrence, duration, and causes. RESULTS: After verifying the eligibility criteria, 90 articles focused on detecting inflammatory, and obstructive diseases of the MSG were gathered, with variable study designs and size samples. A wide variety of pathologies were assessed, including sialolitiasis (n = 45), acute sialadenitis (n = 30), chronic sialadenitis (n = 25), granulamatous diseases (n = 15), Kuttner's tumor (n = 11), juvenile recurrent parotitis (n = 9), abscess (n = 7), post-radiotherapy sialadenitis (n = 6), sialadenosis (n = 9), abscess (n = 7), IgG4-related disease sialadenitis (n = 5), HIV-sialadenitis (n = 4), obstructive sialadenitis (n = 3), iodinated contrast-induced sialadenitis (n = 2), and pneumoparotitis (n = 1). Most studies were case reports or series of cases. Few studies exhibited data about the accuracy of ultrasound in detecting MSG diseases. CONCLUSIONS: The present scoping review concluded that ultrasound aspects of different MSG pathologies are similar but contribute to their differential diagnosis and can be considered as a valuable initial method for assessing the MSG of adults and children.

Oral lymphatic malformations: A multicenter study of 208 cases and literature review.

BACKGROUND: To evaluate the frequency and analyze demographic and clinical characteristics of individuals with a histopathological diagnosis of oral lymphatic malformations (OLMs). METHODS: A multicenter study was performed, collecting biopsy record data from a consortium of Brazilian Oral and Maxillofacial Pathology Centers. A review was also conducted to compare this data with cases already available in the literature. RESULTS: This study retrieved 208 cases of OLM in the multicenter study and 1035 cases in the literature review. In both, OLMs affected male and female individuals equally, with the most affected site being the tongue. Individuals ≥60 years of age were uncommonly affected. Symptomatic and larger lesions were more commonly reported in the literature review. CONCLUSIONS: This study comprises the largest sample of OLMs to date. OLMs are rare conditions, without sex predilection. The elderly proved to be less frequently affected, and the tongue is the most commonly affected site.

Impact of oral conditions on the quality of life of adolescents in a rural area of Brazil.

The aim of this study was to assess the impact of oral conditions on the oral health-related quality of life (OHRQoL) of early adolescents aged 11 to 14 years in the rural population of a Brazilian municipality. Adolescents attending public schools in the municipality participated in the study. OHRQoL was measured using the short Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) with four domains: oral symptoms, functional limitations, emotional wellbeing and social wellbeing. A higher score indicates a more negative perception of the adolescent regarding his/her OHRQoL. Oral conditions such as dental caries, malocclusion and dental trauma were evaluated using DMTF index, Dental Aesthetics Index (DAI) and Andreasen criteria, respectively. The variables sex and age, number of siblings, parents' schooling, family monthly income, number of times of tooth-brushing/day and visits to the dentist/year were also evaluated. Descriptive analysis and regression models were performed. Of the 202 participants, 94 (46.5%) were female and 108 (53.5%) were male. Adolescents from low-income families (p=0.042) and with more severe malocclusion (p=0.037) scored higher in the CPQ11-14. Those with severe malocclusion scored higher in the emotional wellbeing domain (p=0.009). Females scored higher than males in the oral symptoms domain (p=0.002). Adolescents from low-income families scored higher in the social wellbeing domain (p=0.006). Malocclusion negatively affected the OHRQoL of adolescents from a Brazilian rural area, mainly regarding emotional wellbeing. Negative repercussions were also observed among females and adolescents whose families had lower income.

O objetivo deste estudo foi avaliar o impacto de condições bucais na qualidade de vida relacionada à saúde bucal (QVRSB) de adolescentes de 11 a 14 anos da população rural de um município brasileiro. Adolescentes que estudavam em escolas públicas do município participaram do estudo. QVRSB foi avaliada usando a forma curta da versão brasileira do Child Perceptions Questionnaire (CPQ11-14) com quatro domínios: sintomas bucais, limitações funcionais, bem-estar emocional e bem-estar social. Um escore mais alto indica uma percepção mais negativa do adolescente com relação à sua QVRSB. Condições bucais, tais como cárie dentária, má oclusão e traumatismo dentário foram avaliados com o índice CPOD, Índice Estético Dental (IED) e os critérios de Andreasen, respectivamente. As variáveis sexo e idade dos adolescentes, número de irmãos, escolaridade dos pais, renda familiar mensal, número de vezes de escovação dos dentes/dia e visitas ao dentista/ano também foram avaliadas. Análise descritiva e modelos de regressão foram realizados. Dos 202 participantes, 94 (46,5%) eram meninas e 108 (53,5%) eram meninos. Adolescentes cujas famílias tinham uma renda mais baixa (p=0,042) e com má oclusão mais severa (p=0,037) obtiveram escores mais altos no CPQ11-14. Aqueles com má oclusão severa obtiveram um escore mais alto no domínio de bemestar emocional (p=0,009). Com relação ao sexo do indivíduo, meninas tiveram um escore mais alto no domínio sintomas bucais (p=0,002). Adolescentes cujas famílias tinham uma renda mais baixa obtiveram um escore mais alto no domínio de bem-estar social (p=0,006). A má oclusão afeta negativamente a QVRSB de adolescentes de uma área rural brasileira, principalmente o bem-estar emocional. Repercussões negativas também foram observadas entre meninas e adolescentes cujas famílias tinham uma renda mais baixa.

Impact of oral conditions on the quality of life of adolescents in a rural area of Brazil / Impacto de condiçôes bucais na qualidade de vida de adolescentes em uma área rural do Brasil

ABSTRACT The aim of this study was to assess the impact of oral conditions on the oral health-related quality of life (OHRQoL) of early adolescents aged 11 to 14 years in the rural population of a Brazilian municipality. Adolescents attending public schools in the municipality participated in the study. OHRQoL was measured using the short Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) with four domains: oral symptoms, functional limitations, emotional wellbeing and social wellbeing. A higher score indicates a more negative perception of the adolescent regarding his/her OHRQoL. Oral conditions such as dental caries, malocclusion and dental trauma were evaluated using DMTF index, Dental Aesthetics Index (DAI) and Andreasen criteria, respectively. The variables sex and age, number of siblings, parents ' schooling, family monthly income, number of times of tooth-brushing/day and visits to the dentist/year were also evaluated. Descriptive analysis and regression models were performed. Of the 202 participants, 94 (46.5%) were female and 108 (53.5%) were male. Adolescents from low-income families (p=0.042) and with more severe malocclusion (p=0.037) scored higher in the CPQ11-14. Those with severe malocclusion scored higher in the emotional wellbeing domain (p=0.009). Females scored higher than males in the oral symptoms domain (p=0.002). Adolescents from low-income families scored higher in the social wellbeing domain (p=0.006). Malocclusion negatively affected the OHRQoL of adolescents from a Brazilian rural area, mainly regarding emotional wellbeing. Negative repercussions were also observed among females and adolescents whose families had lower income.

RESUMO O objetivo deste estudo foi avaliar o impacto de condiçôes bucais na qualidade de vida relacionada à saúde bucal (QVRSB) de adolescentes de 11 a 14 anos da populaçâo rural de um municipio brasileiro. Adolescentes que estudavam em escolas públicas do municipio participaram do estudo. QVRSB foi avaliada usando a forma curta da versao brasileira do Child Perceptions Questionnaire (CPQ11-14) com quatro dominios: sintomas bucais, limitaçôes funcionais, bem-estar emocional e bem-estar social. Um escore mais alto indica uma percepçao mais negativa do adolescente com relaçao à sua QVRSB. Condiçôes bucais, tais como cárie dentária, má oclusâo e traumatismo dentario foram avaliados com o indice CPOD, Índice Estético Dental (IED) e os critérios de Andreasen, respectivamente. As variáveis sexo e idade dos adolescentes, número de irmaos, escolaridade dos pais, renda familiar mensal, número de vezes de escovaçao dos dentes/dia e visitas ao dentista/ano também foram avaliadas. Análise descritiva e modelos de regressao foram realizados. Dos 202 participantes, 94 (46,5%) eram meninas e 108 (53,5%) eram meninos. Adolescentes cujas familias tinham uma renda mais baixa (p=0,042) e com má oclusâo mais severa (p=0,037) obtiveram escores mais altos no CPQ11-14. Aqueles com má oclusâo severa obtiveram um escore mais alto no dominio de bem-estar emocional (p=0,009). Com relaçâo ao sexo do individuo, meninas tiveram um escore mais alto no dominio sintomas bucais (p=0,002). Adolescentes cujas familias tinham uma renda mais baixa obtiveram um escore mais alto no dominio de bem-estar social (p=0,006). A má oclusâo afeta negativamente a QVRSB de adolescentes de uma área rural brasileira, principalmente o bem-estar emocional. Repercussoes negativas também foram observadas entre meninas e adolescentes cujas familias tinham uma renda mais baixa.

Direct oral anticoagulants in oral surgery: a prospective cohort.

BACKGROUND: Quantitative assessment of bleeding in dental extractions is rarely reported in the literature. The assessment of bleeding might provide additional evidence to predict and minimize postoperative outcomes. The aim of this study was to evaluate the pattern of bleeding in individuals taking direct oral anticoagulants (DOACs) submitted to dental extractions. METHODS: Intraoperative bleeding was evaluated by using total collected bleeding corrected by absorbance reading (dental bleeding score). To monitoring bleeding episodes from the day of surgery, this cohort was followed up until the seventh postoperative day. RESULTS: Forty-five procedures were performed in three comparative groups, patients under DOACs, individuals taking vitamin K antagonists (VKAs) and without anticoagulant therapy. No bleeding events were observed in procedures carried out in individuals of the DOAC group. Additional hemostatic measures were required in two procedures in the VKA group and one in the non-anticoagulated group. The dental bleeding scores obtained for the DOAC and VKA groups were similar. CONCLUSIONS: Our data suggest that the DOAC therapy did not result in increased bleeding outcomes in this sample.

Use of fractal analysis in dental images: a systematic review.

OBJECTIVES: This study reviewed the use of fractal analysis (FA) in dental images. METHODS: A search was performed using PubMed, MEDLINE, LILACS, Web of Science and SCOPUS databases. The inclusion criteria were human studies in the English language, with no date restriction. RESULTS: 78 articles were found in which FA was applied to panoramic radiographs (34), periapical radiographs (21), bitewing radiographs (4), cephalometric radiograph (1), cone beam CT (15), micro-CT (3), sialography (2), and ultrasound (2). Low bone mineral density (21) and systemic or local diseases (22) around the bone of dental implants were the main subjects of the study of FA. Various sizes and sites of the regions of interest were used to evaluate the bone structure. Different ways were used to treat the image and to calculate FA. FA of 43 articles showed significant differences in the comparison of groups, mainly between healthy and sick patients. CONCLUSIONS: FA in Dentistry has been widely applied to the study of images. Panoramic and periapical radiographs were those most frequently used. The Image J software and the box-counting method were extensively adopted in the studies reviewed herein. Further studies are encouraged to improve clarification of the parameters that directly influence FA.

Mandibular radiomorphometric parameters of women with cemento-osseous dysplasia.

OBJECTIVE: To compare the radiomorphometric parameters of mandibular trabecular and cortical bone of females with and without cemento-osseous dysplasia (COD). METHODS: A retrospective cross-sectional paired study was conducted. Digital panoramic radiographs were obtained from females diagnosed in a public service of Oral Medicine. The participants were divided into two groups of 50 subjects each: females with a diagnosis of COD (COD group) and females without a diagnosis of COD (non-COD group), randomly chosen from the image database and paired for age. The radiomorphometric parameters analyzed were: mandibular cortical width (MCW), fractal dimension (FD) and mandibular cortical index (MCI). The paired t-test and Wilcoxon test were used to compare MCW and FD values and the McNemar-Bowker test compared the MCI. RESULTS: The mean age of both groups was 46.84 ± 11.38 years. The median MCW index was 3.12 mm (2.15-4.55) for the COD group and 3.52 mm (1.90-4.70) for the non-COD group (p = 0.034). The mean FD value of the COD group (1.2039 ± 0.0926) was lower than that of the non-COD group (1.2472 ± 0.0894) in the anatomical region of the interest of mandibular cortical bone (p = 0.031), while no difference was detected in alveolar trabecular bone. The C3 degree of MCI was more frequent in the COD group (p = 0.009). CONCLUSION: Females with COD had lower values of radiomorphometric parameters in mandibular cortical bone than females of the same age without COD. These results suggest that, in addition to the dental care recommended in the literature, COD females also require more attention and screening for low bone mineral density.

Malocclusion in children and adolescents with Down syndrome: A systematic review and meta-analysis.

BACKGROUND: Previous studies have shown a high prevalence of malocclusion in people with Down syndrome (DS) compared to individuals without DS, but no systematic review to summarize the evidence on this topic has been performed thus far. AIM: To evaluate whether children/adolescents with DS are more affected by malocclusion than those without DS. DESIGN: A search was performed in seven electronic databases. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. The strength of the evidence from the selected studies was evaluated by the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: Eleven publications were included in the systematic review and eight were meta-analysed. The meta-analysis showed that malocclusion was more prevalent in children/adolescents with DS for Angle Class III (risk difference [RD] = 0.40; confidence interval [CI] = 0.33, 0.46), posterior crossbite (risk ratio [RR] = 3.09; CI = 2.02, 4.73), anterior crossbite (RR = 2.18; CI = 1.41, 3.39), and anterior open bite (RD = 0.21; CI = 0.06, 0.36). CONCLUSION: The occurrence of malocclusion was higher in children/adolescents with DS compared to individuals without the syndrome. The strength of the evidence of the studies analysed, however, was considered moderate and low.

Digital panoramic radiography and cone-beam CT as ancillary tools to detect low bone mineral density in post-menopausal women.

OBJECTIVES: To evaluate the usefulness of the mandibular cortical index (MCI) obtained by digital panoramic radiography (DPR) and by panoramic reconstruction (PR) of cone-beam CT (CBCT) with three different slice thicknesses for the screening of low bone mineral density (BMD) in post-menopausal women. METHODS: Two trained oral and maxillofacial radiologists assessed the MCI based on the morphology of the mandibular bone cortex (classified as C1, C2 or C3). The DPR and PR of CBCT with slice thicknesses of 5, 15 or 25 mm were compared to the BMD obtained by dual-energy X-ray absorptiometry (DXA) in post-menopausal women. Measures related to accuracy were calculated with MedCalc software. The confidence interval was set at 95%. RESULTS: 54 women (mean age 58.70 ± 7.35 years) participated in the study. The sensitivity and specificity values obtained for DPR were 52.6% and 56.2%, respectively, and values for PR of CBCT with 5, 15, and 25 mm slice thicknesses were 63.1% and 43.7%, 50.0% and 50.0%, and 52.6% and 62.5%, respectively. For the tools evaluated, the positive likelihood ratio ranged from 1.00 to 1.40 and negative likelihood ratio from 0.76 to 1.00. The positive predictive value (PPV) ranged from 70.4 to 76.9% and the negative predictive value (NPV) from 29.6 to 35.7%. Among the examinations, the highest value for area under the curve (AUC) was obtained for CBCT with 25 mm slice thickness (57.6%). CONCLUSIONS: The MCI calculated by DPR and CBCT differed with regard to accuracy. Within the limitations of this study, the PR of CBCT with 25 mm slice thicknesses seems to be the most accurate among the examinations evaluated. Should the dentist be attentive, DPR and CBCT may be useful tools for the screening of low BMD in post-menopausal women, facilitating their timely referral for further assessment.

Calcifying epithelial odontogenic tumours: Collaborative study of 32 cases and review of literature.

OBJECTIVES: To analyse the occurrence of calcifying epithelial odontogenic tumours (CEOT) based on biopsy records from different Brazilian geographic regions and to contrast the data with a review of the literature. MATERIALS AND METHODS: A 2-step study was conducted. Step 1 consisted of a collaborative study of biopsies obtained from 1953 to 2017 at six Brazilian oral and maxillofacial pathology centres. Evaluation of 86,268 biopsy records was performed. Demographic and histopathological diagnosis data were assessed. In Step 2, a review of the literature of case reports and cases series of CEOT identified across five electronic databases was conducted. RESULTS: In the collaborative study, 32 cases of CEOT were evaluated. This figure represented 0.03% of the oral and maxillofacial lesions and 1.7% of all odontogenic tumours across the centres. Women in the fourth decade of life were more affected. CEOT occurred more in the mandible than in the maxilla (ratio 1.9:1). The review of the literature showed that Asian individuals were more affected by this neoplasm. CONCLUSIONS: Useful knowledge on the epidemiology, treatment and follow-up of CEOT has been provided. Demographic data and clinical features of the cases presented in this collaborative study were quite similar to those of studies reported worldwide.

A multicentre study of 268 cases of calcifying odontogenic cysts and a literature review.

OBJECTIVES: To investigate the frequency of calcifying odontogenic cysts (COCs) that have been submitted for microscopic examination from representative geographic regions of Brazil and to compare it with literature data. MATERIALS AND METHODS: A retrospective study was conducted on biopsies obtained from 1953 to 2016 at 10 Brazilian oral and maxillofacial pathology centres. A total of 198,350 biopsy specimens were analysed. Demographic data and histopathological diagnosis were evaluated descriptively and statistically. In addition, a literature review of case series was carried out in four electronic databases. RESULTS: A total of 268 cases of COC were surveyed, representing 0.1% of the oral lesions at the centres studied. Female patients in their second decade of life and the maxilla were more affected. The mean lesion size of symptomatic individuals was larger than that of cases without symptoms (p = 0.026). The literature review showed a higher frequency in Asia and Europe, mainly affecting men in the third decade of life. CONCLUSIONS: COC is a rare lesion. Novel data on the clinicopathological features of 268 cases have been added to the literature. Data regarding gender and age of the Brazilian patients reported herein contrast with findings of case series and retrospective studies reported elsewhere.