Accuracy of linear measurements for implant planning based on low-dose cone beam CT protocols: a systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review was to verify the accuracy of linear measurements performed on low-dose CBCT protocols for implant planning, in comparison with those performed on standard and high-resolution CBCT protocols. METHODS: The literature search included four databases (Pubmed, Web of Science, Embase, and Scopus). Two reviewers independently screened titles/abstracts and full texts according to eligibility criteria, extracted the data, and examined the methodological quality. Risk of bias assessment was performed using the Quality Assessment Tool For In Vitro Studies. Random-effects meta-analysis was used for pooling measurement error data. RESULTS: The initial search yielded 4684 titles. In total, 13 studies were included in the systematic review, representing a total of 81 samples, while 9 studies were included in the meta-analysis. The risk of bias ranged from medium to low. The main results across the studies indicate a strong consistency in linear measurements performed on low-dose images in relation to the reference methods. The overall pooled planning measurement error from low-dose CBCT protocols was -0.24 mm (95% CI, -0.52 to 0.04) with a high level of heterogeneity, showing a tendency for underestimation of real values. Various studies found no significant differences in measurements across different protocols (eg, voxel sizes, mA settings, or dose levels), regions (incisor, premolar, molar) and types (height vs. width). Some studies, however, noted exceptions in measurements performed on the posterior mandible. CONCLUSION: Low-dose CBCT protocols offer adequate precision and accuracy of linear measurements for implant planning. Nevertheless, diagnostic image quality needs must be taken into consideration when choosing a low-dose CBCT protocol.

The Role of Dyslipidemia in Periodontitis.

Studies have suggested an important role of dyslipidemia, a condition with alterations in blood lipid levels, in promoting an additional effect on periodontal breakdown. Thus, this study aimed to explore the theoretical pathways associated with dyslipidemia and periodontitis. We used data from 11,917 US adults with complete periodontal examinations participating in the Third National Health and Nutrition Examination Survey (NHANES III). Our hypothesis was tested using structural equation modelling (SEM). Dyslipidemia was defined according to the National Cholesterol Education Program (NCEP-ATP III) and periodontitis as a latent variable reflecting the shared variance of the number of surfaces with periodontal pocket depth [PPD] = 4 mm, PPD = 5 mm, PPD ≥ 6 mm, clinical attachment level [CAL] = 4 mm, CAL = 5mm, CAL ≥ 6 mm, and furcation involvement. The model also considered distal determinants (age, sex, and socioeconomic status) and proximal determinants (HbA1c, smoking and alcohol consumption, and obesity). The model showed sufficient global fit (Root Mean Squared Error of Approximation = 0.04, 90%CI = 0.04−0.05, Tucker−Lewis Index = 0.93, Comparative Fit Index = 0.95). Age, sex, socioeconomic status, obesity, and smoking were directly associated with periodontitis (p < 0.01). Dyslipidemia revealed a significant direct effect on periodontitis (standardized coefficient [SC] = 0.086, SE 0.027; p < 0.01), also mediated via an indirect pathway through HbA1c (SC = 0.021; SE 0.010; p = 0.02) and obesity (SC = 0.036; SE 0.012; p < 0.01) and resulted in a total effect on periodontitis. Dyslipidemia was associated with periodontitis through a direct pathway and indirectly through HbA1c and obesity in the US population. These results support the need for a multi-professional approach to tackling oral and noncommunicable diseases (NCDs), directed at their common risk factors.

Prevalence of SARS-CoV-2 infection among oral health care workers worldwide: A meta-analysis.

OBJECTIVES: This systematic review aimed to answer the following question 'What are the worldwide prevalence of SARS-CoV-2 infection and associated factors among oral health-care workers (OHCWs) before vaccination?' METHODS: Seven databases and registers as well as three grey databases were searched for observational studies in the field. Paired reviewers independently screened studies, extracted data and assessed the methodological quality. Overall seroprevalence for SARS-CoV-2 infection was analysed using a random-effect model subgrouped by professional category. Meta-regression was used to explore whether the Human Development Index (HDI) influenced the heterogeneity of results. The associated factors were narratively evaluated, and the certainty of the evidence was assessed using the GRADE approach. RESULTS: Seventeen studies were included (five cohorts and twelve cross-sectional studies), summing 73 935 participants (54 585 dentists and 19 350 dental assistants/technicians) from 14 countries. The overall estimated pooled prevalence of SARS-CoV-2 infection among OHCWs was 9.3% (95% CI, 5.0%-14.7%; I2  = 100%, p < .01), being 9.5% for dentists (95% CI, 5.1%-15.0%; I2  = 100%, p < .01) and 11.6% for dental assistants/technicians (95% CI, 1.6%-27.4%; I2  = 99.0%, p < .01). In the meta-regression, countries with lower HDI showed higher prevalence of SARS-CoV-2 infection (p = .002). Age, comorbidities, gender, ethnicity, occupation, smoking, living in areas of greater deprivation, job role and location/municipalities, income and protective measures in dental settings were associated with positive serological SARS-CoV-2 test, with very low certainty of evidence. CONCLUSIONS: The SARS-CoV-2 virus infected 9.3% of the OHCWs evaluated worldwide before vaccination. OHCWs should be included in policy considerations, continued research, monitoring and surveillance (PROSPERO CRD42021246520).

How Brazilian oral health care workers face COVID-19: surveillance, biosafety, and education strategies

Aim: To investigate surveillance, biosafety, and education strategies of Brazilian oral health care workers (OHCWs) during the first wave of the COVID-19 outbreak. Methods: This was a cross-sectional study covering OHCWs from a single multicenter research centre. A self-administered and validated online questionnaire was used for data collection, including the following variables: sociodemographic, medical history, biosafety, professional experience, surveillance, and education. Results: The sample consisted of 644 OHCWs (82.5% dentists, 13.2% dental assistants and 4.3% technicians), most without comorbidities (84.8%), from the public (51.7%) and private (48.3%) health systems, in 140 cities of a southern state. The most prominent measures of surveillance were waiting room distancing and visual alerts, symptom assessment, and availability of guidelines on COVID-19. Regarding biosafety measures, the lowest adherence was related to intraoral radiographs (2.7±1.4; 95%CI: 2.6­2.9), use of dental dams (2.1±1.4; 95%CI: 2.0­2.2), and availability of high-power suction systems (2.5±1.7; 95%CI: 2.3­2.6). Among OHCWs, 52.6% received guidance on measures to take during dental care in the workplace. Continuing education was mainly through documents from non-governmental health authorities (77.4%). Conclusion: Surveillance and biosafety measures were adopted, but activities that reduce the spread of aerosols had less adherence. These findings underscore the importance of considering dental practices, and surveillance and education strategies to formulate policies and relevant support to address health system challenges during the COVID-19 pandemic. A coordinated action of permanent education by policymakers is necessary

Minimizing patient morbidity after free gingival graft harvesting:A triple-blind randomized-controlled clinical trial.

OBJECTIVES: This study aimed to evaluate the effect of photobiomodulation therapy (PBMT) on patient morbidity and donor site healing after free gingival graft (FGG) harvesting. METHODS: Forty-four patients requiring FGG were selected for this trial. Individuals were randomly assigned to test group (PBMT, n = 22) or control group (placebo, n = 22) applied immediately after surgery, 24 and 48 h after. Demographic, surgical-related and psychosocial variables possibly associated with treatment response were collected. The primary outcome was postoperative pain at the donor site evaluated using Visual Analog Scale (VAS) immediately after surgery and 6, 24, 48 and 72 h after. Secondary outcomes include medication consumption, patient-reported outcome measures (PROMs) and percentage of wound closure. RESULTS: Intragroup analysis showed no differences in VASLOG means for placebo group throughout the study (p > .05), whereas a significant difference in PBMT group at 6 h, 24 h, 48 h and 72 h (p < .05) were observed. Postoperative rescue analgesic requirement was significantly higher in the placebo group (p = .004). The number needed to treat(NNT) was 2.43. PBMT group reported significant better function related to sleeping, going to work/school and daily routine activities, less restriction to mouth opening, chewing and food consumption, less swelling and bleeding (p < .05), mainly in the first 48 h. PBMT group presented a significantly higher palatal wound closure at 7 days compared to placebo group (33.41 vs. 21.20 respectively, p = .024) after adjustment for confounding. No adverse effects were reported. CONCLUSIONS: Photobiomodulation therapy accelerated the pain resolution time and palatal closure, decreased rescue medication consumption and significantly improved patient satisfaction in the postoperative period.

Narratives about a stigma: attributing meaning to the early loss of deciduous teeth on children's caregivers

Abstract: Qualitative approach about the implications that occur succeeding the premature loss teeth is still insufficient. This study aimed to understand the experience of early loss of deciduous teeth in children's lives, from the perspective of their caregivers. Qualitative case study included 52 caregivers of children from an outpatient service of a public university in the south of Brazil. Early loss of deciduous teeth to trauma or caries was identified through analysis of health records, and afterwards, semi-structured interviews were performed. Textual material was interpreted through the content analysis proposed by Bardin, supported by the ATLAS.ti software. The theoretical perspective of stigma was guided according to the principles of the phenomenology of Maurice Merleau-Ponty, centred on the experience of early loss of deciduous teeth as a historic-cultural expression of a social group. According to caregivers, premature loss of deciduous teeth due to trauma or decay brings functional limitations with chewing and speaking, and impairments related to social interaction with other children. The repercussions of missing teeth were not limited to the child's image, but also brought changes in families' daily lives. However, when early tooth loss was due to extraction because of pain and suffering, caregivers perceived the loss as 'commonplace' in children's lives. The understanding of how children see themselves without teeth in their social world for their caregivers, which also includes their family and friends, determines how much experiencing tooth loss affects their lives. Besides, caregivers' perceptions related to early loss of deciduous teeth should be included in strategies of oral health promotion programs.

Experiências de perda dentária em usuários adultos e idosos da Atenção Primária à Saúde / Tooth loss experiences in adult and elderly users of Primary Health Care

Resumo Partindo da perspectiva teórica da fenomenologia, este artigo propôs-se a compreender as experiências de perda dentária em usuários da Atenção Primária à Saúde de Porto Alegre, Rio Grande do Sul. A perda dentária foi identificada pela análise de prontuários odontológicos dos usuários adultos e idosos que acessaram o serviço de saúde bucal na Unidade de Saúde estudada. A partir desta identificação, entrevistas domiciliares individuais foram realizadas. A amostra foi intencional. Os dados foram interpretados pela análise de conteúdo, com apoio do software ATLAS.ti (Visual Qualitative Data Analysis). O estudo teve aprovação ética. Perder dentes foi uma experiência que expressou subjetividades, mostrando narrativas plurais, com destaque para a função social da boca. Para além do número de dentes perdidos, o entendimento do modo como as pessoas se percebiam sem esses dentes determinou o quanto a perda dentária afetou suas vidas. O uso de próteses agregou valor ao corpo, permitindo o restabelecimento do seu equilíbrio com o mundo. Estudos de abordagem qualitativa nos serviços de saúde devem ser considerados para o planejamento de ações que priorizem as necessidades percebidas pelas pessoas em seus territórios, buscando reduzir estigmas e desigualdades sociais.

Abstract From the theoretical perspective of phenomenology, this article seeks to understand the experiences of tooth loss in adult and elderly users of Primary Health Care in Porto Alegre, Rio Grande do Sul. Tooth loss was identified by the analysis of dental records of users that attended the oral health service at the Health Unit under study. Following this identification, individual household interviews were carried out. The sample was intentional. Data were interpreted by content analysis using the software ATLAS.ti (Visual Qualitative Data Analysis). The study had ethical approval. Losing teeth was an experience that expresses subjectivities, showing plural narratives and highlighting the social function of the mouth. Besides the number of missing teeth, the understanding of how people perceived themselves without their teeth determined how much tooth loss affected their lives. Wearing prostheses adds significance to individuals' perceptions of their body, restoring the balance between their body and the world. Qualitative approach studies in health services should be considered in order to plan interventions which prioritize people's individual needs in their own territories, thus reducing stigmas and social inequalities.

Saúde bucal em usuários da atenção primária: análise qualitativa da autopercepção relacionada ao uso e necessidade de prótese dentária / Oral health in primary care users: qualitative analysis of self-perceived associated to use and need of dental prosthesis

Resumo Este estudo de caso de abordagem qualitativa propôs-se a analisar a autopercepção da saúde bucal em usuários da Atenção Primária de Porto Alegre que usam e/ou necessitam de prótese dentária. A coleta de dados aconteceu por meio da análise de prontuários odontológicos, diários de campo e entrevistas domiciliares semiestruturadas com 70 usuários do serviço de saúde nas faixas etárias de 15 a 19, 35 a 44 e 65 a 74 anos, que usam e/ou necessitam de prótese dentária (amostra intencional por saturação). Os relatos das entrevistas foram interpretados pela análise de conteúdo de Bardin com o apoio do software ATLAS.ti. A autopercepção positiva de saúde bucal foi percebida por adultos e idosos usuários de próteses bem adaptadas, que não machucavam a boca e não interferiam na mastigação, na fala e na comunicação. Houve grande valorização do uso de próteses pela possibilidade da reabilitação bucal. O desejo do uso de próteses esbarrou em seu alto custo e no acesso limitado a tal procedimento no serviço público do município. Essas informações permitem a análise do significado da saúde bucal para os usuários do Sistema Único de Saúde, podendo ser utilizadas como uma ferramenta de avaliação complementar da necessidade de tratamento odontológico.

Abstract This qualitative study aimed to perceive the self-perception of oral health in users of Primary Care in Porto Alegre who use and/or need dental prosthesis. Data collection performed by odontology records analysis, field diaries and semi-structured home interviews with 70 health service users in age groups 15-19, 35-44 and 65-74 years who use and/or need dental prosthesis (intentional sample saturation). The reports of interviews were interpreted by Bardin thematic content analysis and ATLAS.ti software to support. The positive self-perception of oral health was perceived by adults and elderly who use well-fitting dental prosthesis that do not hurt the mouth and did not interfere in chewing, speech and communication. There was great appreciation of the use dental prosthesis for the possibility of oral rehabilitation. The desire of using dental prosthesis bumped in their high cost and limited access in the public service of the municipality. This information allows the analysis of the significance of oral health to Unified Health System users and can be used as a tool assessment need for dental treatment.