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1.
Comput Biol Med ; 170: 107976, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38219647

RESUMO

BACKGROUND: Pathological speech diagnosis is crucial for identifying and treating various speech disorders. Accurate diagnosis aids in developing targeted intervention strategies, improving patients' communication abilities, and enhancing their overall quality of life. With the rising incidence of speech-related conditions globally, including oral health, the need for efficient and reliable diagnostic tools has become paramount, emphasizing the significance of advanced research in this field. METHODS: This paper introduces novel features for deep learning in the analysis of short voice signals. It proposes the incorporation of time-space and time-frequency features to accurately discern between two distinct groups: Individuals exhibiting normal vocal patterns and those manifesting pathological voice conditions. These advancements aim to enhance the precision and reliability of diagnostic procedures, paving the way for more targeted treatment approaches. RESULTS: Utilizing a publicly available voice database, this study carried out training and validation using long short-term memory (LSTM) networks learning on the combined features, along with a data balancing strategy. The proposed approach yielded promising performance metrics: 90% accuracy, 93% sensitivity, 87% specificity, 88% precision, an F1 score of 0.90, and an area under the receiver operating characteristic curve of 0.96. The results surpassed those obtained by the networks trained using wavelet-time scattering coefficients, as well as several algorithms trained with alternative feature types. CONCLUSIONS: The incorporation of time-frequency and time-space features extracted from short segments of voice signals for LSTM learning demonstrates significant promise as an AI tool for the diagnosis of speech pathology. The proposed approach has the potential to enhance the accuracy and allow for real-time pathological speech assessment, thereby facilitating more targeted and effective therapeutic interventions.


Assuntos
Patologia da Fala e Linguagem , Fala , Humanos , Reprodutibilidade dos Testes , Memória de Curto Prazo , Qualidade de Vida , Distúrbios da Fala
2.
R Soc Open Sci ; 11(1): 231166, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38234434

RESUMO

The mandible or lower jaw is the largest and hardest bone in the human facial skeleton. Fractures of the mandible are reported to be a common facial trauma in emergency medicine and gaining insights into mandibular morphology in different facial types can be helpful for trauma treatment. Furthermore, features of the mandible play an important role in forensics and anthropology for identifying gender and individuals. Thus, discovering hidden information of the mandible can benefit interdisciplinary research. Here, for the first time, a method of artificial intelligence-based nonlinear dynamics and network analysis are used for discovering dissimilar and similar radiographic features of mandibles between male and female subjects. Using a public dataset of 10 computed tomography scans of mandibles, the results suggest a difference in the distribution of spatial autocorrelation between genders, uniqueness in network topologies among individuals and shared values in recurrence quantification.

3.
Eur J Dent Educ ; 2023 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-37876114

RESUMO

The Pandemic has challenged clinical dentistry globally with the dental education sector seeking alternative training environments. Virtual reality (VR) is gaining recognition as a valuable tool for training dental students and its use by dental schools around the world is growing. The continuous improvement of haptic VR dental trainers provides a platform where irreversible procedures can be safely and unlimitedly practised. This driver has led to the exploration and investment into virtual technology to improve education outcomes in dental students. The aim of this study was to share the early experience of a dental school in the United Kingdom that has initiated the process of embedding haptics into their simulation training within the dental curriculum. This paper explores the process of embedding and operationalising haptic training within the undergraduate curriculum. Using current knowledge of education pedagogy, the school aligned to an evidence-based, best-practice framework which utilised the concept of deliberate practice in the development of the Haptics curriculum which was adaptable and iterative in design. This paper contextualises the implementation of haptic training in a UK dental education setting by providing an outline of the framework used to develop the curriculum. Virtual reality haptics trainers have created unique opportunities and challenges for dental schools. Dental educators have sought to utilise this technology in a structured framework to enhance training.

4.
BMC Oral Health ; 23(1): 475, 2023 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-37438748

RESUMO

BACKGROUND: Domestic Violence and Abuse (DVA) is a persistent public health problem in the UK. Healthcare settings offer an opportunity to ask patients about DVA, either opportunistically or in response to the presence of injuries. However, it has been suggested that dental practices and dental teams have not been actively involved supporting adult patients when presenting with injuries that might have resulted from DVA. This qualitative study was conducted to satisfy the evaluative component of the Dentistry Responding in Domestic Violence and Abuse (DRiDVA) feasibility study. METHODS: In total, 30 participants took part in the study; nine associate dentists and practice principals/owners took part in one-to-one interviews and 21 auxiliary staff took part across two focus group discussion sessions. Data were analysed using the seven step Framework Analysis process. RESULT: Three key themes were identified from the data, focusing on barriers to enquiring about domestic violence and abuse, Facilitators of identification and referral of DVA in dental settings, and recommendations for further adaptation of intervention to dental settings. CONCLUSION: DVA training coupled with robust referral pathways to a named specialist DVA advocate increases knowledge and awareness of the signs of DVA and confidence in making onward referrals. Further research is needed to understand how to increase dental professional willingness to ask patients about DVA.


Assuntos
Violência Doméstica , Adulto , Humanos , Estudos de Viabilidade , Violência Doméstica/prevenção & controle , Saúde Pública , Odontólogos , Odontologia
5.
Front Artif Intell ; 6: 1278529, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38249794

RESUMO

Patients with facial trauma may suffer from injuries such as broken bones, bleeding, swelling, bruising, lacerations, burns, and deformity in the face. Common causes of facial-bone fractures are the results of road accidents, violence, and sports injuries. Surgery is needed if the trauma patient would be deprived of normal functioning or subject to facial deformity based on findings from radiology. Although the image reading by radiologists is useful for evaluating suspected facial fractures, there are certain challenges in human-based diagnostics. Artificial intelligence (AI) is making a quantum leap in radiology, producing significant improvements of reports and workflows. Here, an updated literature review is presented on the impact of AI in facial trauma with a special reference to fracture detection in radiology. The purpose is to gain insights into the current development and demand for future research in facial trauma. This review also discusses limitations to be overcome and current important issues for investigation in order to make AI applications to the trauma more effective and realistic in practical settings. The publications selected for review were based on their clinical significance, journal metrics, and journal indexing.

6.
Br Dent J ; 233(11): 949-955, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36494544

RESUMO

Objectives Assess the feasibility of using the Identification and Referral to Improve Safety (IRIS) intervention in a general dental practice setting and evaluating it using a cluster randomised trial design. IRIS is currently used in general medical practices to aid recognition and support referral into specialist support of adults presenting with injuries and other presenting factors that might have resulted from domestic violence and abuse. Also, to explore the feasibility of a cluster randomised trial design to evaluate the adapted IRIS.Design Feasibility study for a cluster randomised trial of a practice-based intervention.Setting Greater Manchester general dental practices.Results It was feasible to adapt the IRIS intervention used in general medical practices to general dental practices in terms of training the clinical team and establishing a direct referral pathway to a designated advocate educator. General dental practices were keen to adopt the intervention, discuss with patients when presented with the opportunity and utilise the referral pathway. However, we could not use practice IT software prompts and data collection as for general practitioners because there is no unified dental IT system and because coding in dentistry for diagnoses, procedures and outcomes is not developed in the UK.Conclusion While it was feasible to adapt elements of the IRIS intervention to general dental practice and there was general acceptability, we did not have enough empirical data to plan a definitive cluster randomised trial design to evaluate the IRIS-dentistry intervention within general dental practices.


Assuntos
Violência Doméstica , Adulto , Humanos , Estudos de Viabilidade , Violência Doméstica/prevenção & controle , Encaminhamento e Consulta
7.
Br Dent J ; 233(10): 889-893, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36434238

RESUMO

The Institute of Dentistry at Barts and The School of Medicine and Dentistry, Queen Mary University of London, has seen much change since 1857 when surgeon dentist, H. J. Barrett, was appointed to The London to oversee the extraction of teeth. However, the mission remains the same: provision of excellent patient care through our education and research to improve the oral health and general health of our local population, but also with global impact.The Institute of Dentistry is embedded in a fundamentally multidisciplinary environment of the wider university and this is reflected in our research activity. The available complementary skills in cell and molecular biology, microbiology, materials science, chemistry, biophysics, clinical science and population health allows us to undertake basic science research, patient- and population-based research and clinical biometric research.Our Centre for Teaching and Innovation is a catalyst for educational research, including that related to new technologies and the expansion of e-learning, to ultimately inform local practice and the experience of our students.


Assuntos
Faculdades de Odontologia , Faculdades de Medicina , Humanos , Odontologia , Escolaridade , Londres , Medicina
8.
Oral Surg ; 15(3): 315-323, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35601883

RESUMO

Introduction: Coronavirus disease (COVID-19) was declared a global pandemic on 11 March 2020, and all routine dental care in England was suspended on 25 March 2020. Oral surgeons typically continued their roles due to the requirement of surgical expertise in the management of urgent care. Aims: To survey the British Association of Oral Surgeons' membership of 654 exploring the impact and response of the speciality in the early phase of the pandemic. Methods: British Association of Oral Surgeons members were invited to participate in a weekly online survey commencing 30th March 2020 for 4 weeks. Themes explored included demographics, Personal Protective Equipment (PPE), clinical role and care provided, and financial impact. Results: 400 responses were received over the 4-week period. Telephone advice was rapidly introduced ahead of clinical examinations. Few oral surgeons were initially able to provide emergency oral surgery procedures or clinical examinations due to PPE shortage. Only a small proportion of oral surgeons were required themselves to isolate and only a small proportion were redeployed. Conclusion: The COVID-19 pandemic severely disrupted UK oral surgery services particularly in the early stage and highlight the lack of preparedness. As availability of PPE and evidence on aerosol-generating procedures and infection control became more readily accessible, surgeons became more confident to provide emergency surgical treatment rather than just phone consultations. The impact on patients' oral health is likely to have been profound.

9.
Br Dent J ; 230(6): 351-357, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33772188

RESUMO

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major health concern and causes substantial morbidity and mortality. It is imperative that the signs of sepsis are identified early in both adult and paediatric patients and appropriately escalated to initiate early treatment and improve prognosis. This paper aims to discuss the change in classification from the previous systemic inflammatory response syndrome (SIRS) criteria to the current definition in adults and also the unchanged definition in children. The hallmark signs of sepsis (both red and amber flags) are discussed in relation to their underlying cellular mechanisms to provide a comprehensive overview for clinicians in primary care, hospital and community settings. The rise of antimicrobial resistance is also an increasing global health concern with resistant bacteria from common infections likely to result in greater patient morbidity and worse outcomes.A literature search identified reported sepsis cases in dentistry through searches in Ovid Medline and Embase from January 1990 to December 2019. Only primary studies were included with no restrictions on languages. Four articles were identified which reported sepsis associated with tooth extractions, dental abscess and submental/submandibular cellulitis. It is well known that locoregional infections of dental origin have the potential to cause sepsis. Therefore, dental healthcare professionals need to be vigilant and understand the specific signs and escalation protocols to ensure patient safety.


Assuntos
Sepse , Adulto , Criança , Odontologia , Humanos , Prognóstico , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
10.
Br Dent J ; 229(12): 801-805, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33339931

RESUMO

As routine care was suspended in most countries, one could anticipate progression of undiagnosed and managed oral disease. Patients are usually unaware of the development of oral disease as it is not visible to them and largely asymptomatic, especially in its early stages. The natural progression of conditions such as caries and periodontitis is inevitable without diagnosis and management. The full extent of patient harm because of the suspension of routine dental care can only be estimated when routine oral examinations are fully re-established, and even then, we will probably never know the number of individuals impacted or the extent of disease progression and harm.In first-world countries, there has always been a back-up emergency treatment system for dental problems. For example, in the UK, the safety net for life-threatening swellings and for acute pain relief is the accident and emergency services. This system remained in place during the COVID-19 pandemic. Courts could be expected to understand the coronavirus context and would take this into account should there be a complaint against the clinician about access to care.The suspension of routine dental care to save lives will lead to the closure of many dental practices due to substantial financial impact. The return to routine care will be slow, with prioritisation of non-aerosol generating procedures while we look to further understand methods to mitigate transmission risk via infected aerosol and spatter. Inevitably, the cost of personal protective equipment and the lower volume of patients pose a continued threat to businesses.


Assuntos
COVID-19 , Infecções por Coronavirus , Infecções por Coronavirus/epidemiologia , Assistência Odontológica , Humanos , Pandemias , SARS-CoV-2
11.
Br Dent J ; 229(11): 743-747, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33311687

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus which causes COVID-19, is highly contagious. Dentistry is a high-risk profession for occupational virus transmission because of the close proximity of the operator to the patient during treatment and the procedural generation of aerosols.The impact on the provision of dental care has been profound, with routine care restricted or paused for a period around the world. There have been adverse consequences for dental education and clinical research. Emergency and urgent care provisions have generally proceeded. However, even when a patient's condition is deemed urgent, access to the appropriate care may not have been possible due to lack of the recommended personal protective equipment. The common dental diseases of caries and periodontitis usually present with signs and symptoms after some advancement, hence the recommended regular dental examination so that these may be diagnosed early by a professional with suitable lighting, instruments and radiography. Conditions such as oral cancer similarly present in their early stages without symptoms. Many countries introduced telephone and video consultations for patients with symptoms but much disease has gone undiagnosed and without management.It is difficult to ascertain the full effect of the disruption to dental services, education and research but it is likely to be substantial. The immediate future will focus on return to routine care provision with likely longer-term permanent changes.


Assuntos
Betacoronavirus , COVID-19 , Odontologia , Humanos , Pandemias , SARS-CoV-2
12.
Oral Dis ; 26 Suppl 1: 123-126, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862521

RESUMO

HIV TEACHING: A dental curriculum which fosters knowledge and attitude. OBJECTIVES: A pilot study to explore dental students views of current HIV related teaching and to assess the impact of this teaching on the students' self-perceived confidence in delivering dental care to HIV patients. METHODS: A short cross-sectional survey was conducted to gather the views of students on both objectives. Data was collected using an online self-administered questionnaire. Descriptive data analysis was conducted and used to present the data. Additionally, a one to one interview was performed with a past dental student for a thematic analysis. RESULTS: The HIV teaching at this dental school uses different learning approaches involving didactic, reflective, and participatory methods to address the knowledge, attitudinal and skills objectives. A didactic and experiential problem-based approach using role-play with simulated patients with feedback, and discussion is utilised. Preliminary results show dental students perceive the course to be valuable and there is a general improvement in confidence in their knowledge and ability to communicate with HIV-positive patients. CONCLUSIONS: This evaluation suggests the course format and content are appropriate in providing education and training for dental students and supports the value of teaching HIV to undergraduate students.


Assuntos
Currículo , Educação em Odontologia , Infecções por HIV , Atitude , Estudos Transversais , Humanos , Projetos Piloto , Estudantes de Odontologia
13.
Oral Dis ; 26 Suppl 1: 47-53, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862532

RESUMO

INTRODUCTION: Dentists have an important role in reducing new HIV infections by early diagnosis and need to know how to treat patients with HIV and understand universal cross-infection control. In many parts of the world, healthcare professionals struggle to provide care because of barriers including stigma and cultural attitudes. AIM: To investigate the effectiveness of a brief educational intervention in understanding/changing the views of dental school deans regarding the quality of the oral health and HIV/AIDS teaching and their willingness to undertake a curriculum review if appropriate. METHODS: Questionnaires before and after interactive presentation to the deans of 30 Indonesian dental schools and discussion. RESULTS: Only six of 30 dental school deans believed that their HIV undergraduate dental student teaching was inadequate before the intervention, but 29 of 30 deans recognised the need to review their curriculum after the intervention. Whilst the majority (24/30) felt that their HIV teaching was adequate, good or excellent, the majority also thought that their students would find it difficult to treat patients with HIV. CONCLUSION: The brief educational intervention was effective in improving the understanding/changing the views of dental school deans regarding the quality of HIV/AIDS teaching and learning at their own institution and engaging a willingness to undertake curriculum review.


Assuntos
Síndrome da Imunodeficiência Adquirida , Educação em Odontologia , Infecções por HIV , Saúde Bucal , Currículo , Humanos , Estudantes de Odontologia , Inquéritos e Questionários
14.
Cochrane Database Syst Rev ; 7: CD004345, 2020 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-32712962

RESUMO

BACKGROUND: Pathology relating to mandibular wisdom teeth is a frequent presentation to oral and maxillofacial surgeons, and surgical removal of mandibular wisdom teeth is a common operation. The indications for surgical removal of these teeth are alleviation of local pain, swelling and trismus, and also the prevention of spread of infection that may occasionally threaten life. Surgery is commonly associated with short-term postoperative pain, swelling and trismus. Less frequently, infection, dry socket (alveolar osteitis) and trigeminal nerve injuries may occur. This review focuses on the optimal methods in order to improve patient experience and minimise postoperative morbidity. OBJECTIVES: To compare the relative benefits and risks of different techniques for surgical removal of mandibular wisdom teeth. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 8 July 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; 2019, Issue 6), MEDLINE Ovid (1946 to 8 July 2019), and Embase Ovid (1980 to 8 July 2019). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication. SELECTION CRITERIA: Randomised controlled trials comparing different surgical techniques for the removal of mandibular wisdom teeth. DATA COLLECTION AND ANALYSIS: Three review authors were involved in assessing the relevance of identified studies, evaluated the risk of bias in included studies and extracted data. We used risk ratios (RRs) for dichotomous data in parallel-group trials (or Peto odds ratios if the event rate was low), odds ratios (ORs) for dichotomous data in cross-over or split-mouth studies, and mean differences (MDs) for continuous data. We took into account the pairing of the split-mouth studies in our analyses, and combined parallel-group and split-mouth studies using the generic inverse-variance method. We used the fixed-effect model for three studies or fewer, and random-effects model for more than three studies. MAIN RESULTS: We included 62 trials with 4643 participants. Several of the trials excluded individuals who were not in excellent health. We assessed 33 of the studies (53%) as being at high risk of bias and 29 as unclear. We report results for our primary outcomes below. Comparisons of different suturing techniques and of drain versus no drain did not report any of our primary outcomes. No studies provided useable data for any of our primary outcomes in relation to coronectomy. There is insufficient evidence to determine whether envelope or triangular flap designs led to more alveolar osteitis (OR 0.33, 95% confidence interval (CI) 0.09 to 1.23; 5 studies; low-certainty evidence), wound infection (OR 0.29, 95% CI 0.04 to 2.06; 2 studies; low-certainty evidence), or permanent altered tongue sensation (Peto OR 4.48, 95% CI 0.07 to 286.49; 1 study; very low-certainty evidence). In terms of other adverse effects, two studies reported wound dehiscence at up to 30 days after surgery, but found no difference in risk between interventions. There is insufficient evidence to determine whether the use of a lingual retractor affected the risk of permanent altered sensation compared to not using one (Peto OR 0.14, 95% CI 0.00 to 6.82; 1 study; very low-certainty evidence). None of our other primary outcomes were reported by studies included in this comparison. There is insufficient evidence to determine whether lingual split with chisel is better than a surgical hand-piece for bone removal in terms of wound infection (OR 1.00, 95% CI 0.31 to 3.21; 1 study; very low-certainty evidence). Alveolar osteitis, permanent altered sensation, and other adverse effects were not reported. There is insufficient evidence to determine whether there is any difference in alveolar osteitis according to irrigation method (mechanical versus manual: RR 0.33, 95% CI 0.01 to 8.09; 1 study) or irrigation volume (high versus low; RR 0.52, 95% CI 0.27 to 1.02; 1 study), or whether there is any difference in postoperative infection according to irrigation method (mechanical versus manual: RR 0.50, 95% CI 0.05 to 5.43; 1 study) or irrigation volume (low versus high; RR 0.17, 95% CI 0.02 to 1.37; 1 study) (all very low-certainty evidence). These studies did not report permanent altered sensation and adverse effects. There is insufficient evidence to determine whether primary or secondary wound closure led to more alveolar osteitis (RR 0.99, 95% CI 0.41 to 2.40; 3 studies; low-certainty evidence), wound infection (RR 4.77, 95% CI 0.24 to 96.34; 1 study; very low-certainty evidence), or adverse effects (bleeding) (RR 0.41, 95% CI 0.11 to 1.47; 1 study; very low-certainty evidence). These studies did not report permanent sensation changes. Placing platelet rich plasma (PRP) or platelet rich fibrin (PRF) in sockets may reduce the incidence of alveolar osteitis (OR 0.39, 95% CI 0.22 to 0.67; 2 studies), but the evidence is of low certainty. Our other primary outcomes were not reported. AUTHORS' CONCLUSIONS: In this 2020 update, we added 27 new studies to the original 35 in the 2014 review. Unfortunately, even with the addition of these studies, we have been unable to draw many meaningful conclusions. The small number of trials evaluating each comparison and reporting our primary outcomes, along with methodological biases in the included trials, means that the body of evidence for each of the nine comparisons evaluated is of low or very low certainty. Participant populations in the trials may not be representative of the general population, or even the population undergoing third molar surgery. Many trials excluded individuals who were not in good health, and several excluded those with active infection or who had deep impactions of their third molars. Consequently, we are unable to make firm recommendations to surgeons to inform their techniques for removal of mandibular third molars. The evidence is uncertain, though we note that there is some limited evidence that placing PRP or PRF in sockets may reduce the incidence of dry socket. The evidence provided in this review may be used as a guide for surgeons when selecting and refining their surgical techniques. Ongoing studies may allow us to provide more definitive conclusions in the future.


Assuntos
Dente Serotino/cirurgia , Extração Dentária/métodos , Dente Impactado/cirurgia , Adulto , Viés , Drenagem/métodos , Alvéolo Seco/etiologia , Humanos , Lábio , Mandíbula , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos de Sensação/etiologia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/etiologia , Irrigação Terapêutica/métodos , Língua , Extração Dentária/efeitos adversos , Técnicas de Fechamento de Ferimentos , Adulto Jovem
15.
Br Dent J ; 228(12): 923-926, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591703

RESUMO

Household isolation measures to reduce coronavirus transmission during the COVID-19 pandemic have resulted in increased risk of domestic violence and abuse (DVA). DVA physical injury most frequently involves the face. Dentists, dental care professionals, oral surgeons and oral and maxillofacial surgeons all have a critical part to play in identifying patients experiencing DVA, who present with dental and facial injury, and in making referrals to specialist agencies. This paper describes how to ask questions about DVA sensitively and how to make an appropriate referral. Early intervention and referral to a DVA advocate can prevent an abusive situation becoming worse with more intense violence. It can save lives.


Assuntos
Infecções por Coronavirus , Violência Doméstica , Pandemias , Pneumonia Viral , Cirurgia Bucal , Betacoronavirus , COVID-19 , Humanos , SARS-CoV-2
16.
Br Dent J ; 228(7): 503-505, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32277203

RESUMO

The coronavirus (COVID-19) has challenged health professions and systems and has evoked different speeds of reaction and types of response around the world. The role of dental professionals in preventing the transmission of COVID-19 is critically important. While all routine dental care has been suspended in countries experiencing COVID-19 disease during the period of pandemic, the need for organised urgent care delivered by teams provided with appropriate personal protective equipment takes priority. Dental professionals can also contribute to medical care. Major and rapid reorganisation of both clinical and support services is not straightforward. Dental professionals felt a moral duty to reduce routine care for fear of spreading COVID-19 among their patients and beyond, but were understandably concerned about the financial consequences. Amidst the explosion of information available online and through social media, it is difficult to identify reliable research evidence and guidance, but moral decisions must be made.


Assuntos
Coronavirus , Tomada de Decisões , Odontologia , Princípios Morais , Betacoronavirus , COVID-19 , Infecções por Coronavirus , Humanos , Pandemias , Pneumonia Viral , Saúde Pública , SARS-CoV-2
18.
Prim Dent J ; 7(4): 40-44, 2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30835666

RESUMO

The use of medical management techniques for the management of anxiety is fundamental to the practice of dentistry. Around 7% of the population are likely to need these techniques for general dental care and a higher proportion for more invasive treatment such as oral surgery. This paper highlights the current expectation of effective and safe practice of conscious sedation techniques in light of recent updated guidance from several UK institutions.


Assuntos
Anestesia Dentária , Ansiedade ao Tratamento Odontológico , Cirurgia Bucal , Sedação Consciente , Ansiedade ao Tratamento Odontológico/tratamento farmacológico , Assistência Odontológica , Humanos
19.
Cochrane Database Syst Rev ; 5: CD006698, 2018 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-29791009

RESUMO

BACKGROUND: Implants may be placed penetrating the oral mucosa (1-stage procedure) or can be completely buried under the oral mucosa (2-stage procedure) during the healing phase of the bone at the implant surface. With a 2-stage procedure the risk of having unwanted loading onto the implants is minimized, but a second minor surgical intervention is needed to connect the healing abutments and more time is needed prior to start the prosthetic phase because of the wound-healing period required in relation to the second surgical intervention. OBJECTIVES: To evaluate whether a 1-stage implant placement procedure is as effective as a 2-stage procedure. SEARCH METHODS: The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Authors of all identified trials, an Internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCTs). The last electronic search was conducted on 21 January 2009. SELECTION CRITERIA: All RCTs of osseointegrated dental implants comparing the same dental implants placed according to 1- versus 2-stage procedures with a minimum follow up of 6 months after loading. Outcome measures were: prosthesis failures, implant failures, marginal bone level changes on intraoral radiographs, patient preference including aesthetics, aesthetics evaluated by dentists, and complications. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Authors were contacted for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. MAIN RESULTS: Five RCTs were identified and included reporting data on 239 patients in total. On a patient, rather than per implant basis, the meta-analyses showed no statistically significant differences for prosthesis and implant failures, though trends, especially in fully edentulous patients, favoured 2-stage (submerged) implants. AUTHORS' CONCLUSIONS: The number of patients included in the trials was too small to draw definitive conclusions. The 1-stage approach might be preferable in partially edentulous patients since it avoids one surgical intervention and shortens treatment times, while a 2-stage submerged approach could be indicated when an implant has not obtained an optimal primary stability or when barriers are used for guided tissue regeneration, or when it is expected that removable temporary prostheses could transmit excessive forces on the penetrating abutments especially in fully edentulous patients.


Assuntos
Implantação Dentária/métodos , Implantes Dentários , Gengiva/cirurgia , Arcada Edêntula/reabilitação , Mucosa Bucal/cirurgia , Humanos , Mandíbula , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Implant Dent ; 25(4): 492-8, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26963746

RESUMO

PURPOSE: Validation of platelet-rich plasma (PRP) system and assessing its enhancing effect on the healing of iliac crest grafts before implant placement. MATERIALS AND METHODS: Patients randomly allocated to test (n = 13) and control (n = 9) groups. Iliac crest grafts were mixed with PRP in the test group. Tetracycline labeling preceded implant placement. Bone samples were harvested for histomorphometrical analysis. Platelet and growth factor quantifications were performed. ANALYSIS: Data were analyzed using SPSS software package. Independent t test was used and statistical significance was set at 5%. RESULTS: The PRP group showed significantly higher platelet counts, PDGF-BB, and TGF-ß1 concentrations. Tendency to higher volume of woven bone was observed in the PRP group (13 ± 11 vs 4 ± 6, P = 0.1). Histomorphometry showed increased seam separation in the PRP group (8.8 ± 9 µm vs 1.5 ± 3 µm, P = 0.039). Remodeling activity was higher in PRP-woven bone sections and comparable in trabecular sections. CONCLUSION: PRP significantly increased platelet and growth factor concentrations and was of possible enhancing effect on the rate of bone formation at 3 to 4 months of grafting. The clinical significance of this enhancement is yet to be established.


Assuntos
Desenvolvimento Ósseo , Transplante Ósseo/métodos , Ílio/cirurgia , Peptídeos e Proteínas de Sinalização Intercelular/análise , Maxila/cirurgia , Plasma Rico em Plaquetas , Adolescente , Adulto , Idoso , Becaplermina , Desenvolvimento Ósseo/fisiologia , Feminino , Humanos , Ílio/patologia , Peptídeos e Proteínas de Sinalização Intercelular/fisiologia , Masculino , Maxila/patologia , Pessoa de Meia-Idade , Contagem de Plaquetas , Plasma Rico em Plaquetas/química , Plasma Rico em Plaquetas/fisiologia , Proteínas Proto-Oncogênicas c-sis/análise , Proteínas Proto-Oncogênicas c-sis/fisiologia , Levantamento do Assoalho do Seio Maxilar/métodos , Fator de Crescimento Transformador beta1/análise , Fator de Crescimento Transformador beta1/fisiologia , Adulto Jovem
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