Periodontal disease metabolomics signatures from different biofluids: a systematic review.

BACKGROUND: Periodontitis is resulted from a complex interaction between genetics and epigenetics, microbial factors, and the host response. Metabolomics analyses reflect both the steady-state physiological equilibrium of cells or organisms as well as their dynamic metabolic responses to environmental stimuli. AIM OF REVIEW: This systematic review of the literature aimed to assess which low molecular weight metabolites are more often found in biological fluids of individuals with periodontitis compared to individuals with gingivitis or periodontal health. KEY SCIENTIFIC CONCEPTS OF REVIEW: All the included studies employed untargeted analysis. One or more biological fluids were analyzed, including saliva (n = 14), gingival crevicular fluid (n = 6), mouthwash (n = 1), serum (n = 3) and plasma (n = 1). Fifty-six main metabolites related to periodontitis have been identified in at least two independent studies by NMR spectroscopy or MS-based metabolomics. Saliva was the main biological fluid sampled. It is noteworthy that 14 metabolites of the 56 detected were identified as main metabolites in all studies that sampled the saliva. The majority of metabolites found consistently among studies were amino acids, organic acids and derivates: acetate, alanine, butyrate, formate, GABA, lactate, propionate, phenylalanine and valine. They were either up- or down-regulated in the studies or this information was not mentioned. The main metabolic pathway was related to phenylalanine, tyrosine and tryptophan biosynthesis. Metabolites more frequently found in individuals with periodontitis were related to both the host and to microorganism responses. Future studies are needed, and they should follow some methodological standards to facilitate their comparison.

Trauma in primary teeth and its effect on the development of permanent successors: a controlled study.

Objective: This controlled study investigated the occurrence of sequelae to permanent successors (SPS) following traumatic dental injury in primary teeth (TDIp). Additionally, this study evaluated whether TDIp is a risk factor for SPS, with a focus on an association between SPS and the child's age and type of trauma. Materials and methods: The trauma group (TG) consisted of permanent teeth, whose antecessors had suffered TDIp, in a population of children with complete eruption of permanent teeth. The control group (CG) consisted of permanent teeth from the same individuals, whose antecessors had not suffered TDIp. There were 214 cases of TDIp with their respective permanent teeth. In the CG 247 permanent teeth, whose antecessor had not suffered TDIp, were included. Data concerning such teeth and when TDIp occurred (in terms of the child's age) and types of SPS were collected. The chi-square test, regression logistic with generalized estimating equations (GEE) test, and risk analyses were applied to investigate the associations. Results: Overall, 29% of the permanent teeth in the TG presented SPS. This was compared to the development disturbances in the CG, which was 7%. The TG demonstrated the highest risk for SPS (OR, 5.388; p = .0001). The discolouration of enamel (37%) was the most common type of SPS found. SPS was more prone to occur in permanent teeth whose antecessors had been intruded (39%; p < .001). TDIp when the child was 1-year old was associated with SPS (p < .001). Moreover, children who had TDIp had a 4.1 times higher risk of presenting SPS. Conclusions: TDIp is a risk factor for the development of SPS. All types of TDIp caused SPS in this research. Additionally, the younger ages at the time of the injury and intrusions were related to SPS.

Longevity of indirect restorations cemented with self-adhesive resin luting with and without selective enamel etching. A Systematic review and meta-analysis.

OBJECTIVE: To investigate the influence of the selective etching in the survival rates of indirect restorations cemented with self-adhesive resin luting. MATERIALS AND METHODS: The eligibility criteria were formulated based on PICOS strategy. The search without restrictions was performed in PubMed/Medline, the Cochrane Library, Web of Science, Scopus, LILACS databases and gray literature until May 2018. Cochrane Collaboration's tool was performed for assessing the risk of bias. According to the bias risk analysis, the studies were classified as low risk of bias and high quality of evidence. The systematic review was conducted according to PRISMA and registered in PROSPERO (CRD42018091202). The meta-analysis was performed using RevMan 5.3 software (RevMan, Copenhagen, Denmark) and the risk ration and confidence interval was obtained (p < 0.05). RESULTS: After database screening, removal of duplicates and eligibility criteria application, two studies were selected for this systematic review, with 65 participants (34 in one and 31 in the other). The pooled meta-analysis demonstrated no statistically significant difference in clinical longevity for selective etching in indirect restorations (P > .05; I2 = 0%) and risk ratio of 0.46 [0.19-1.09]. CONCLUSIONS: Based on the findings, the results of this systematic review suggest that the selective enamel etching prior to application of self-adhesive luting cements systems for indirect restoration do not influence the clinical longevity of indirect restorations. CLINICAL SIGNIFICANCE: The knowledge of the clinical steps of adhesive procedures is fundamental to the success of adhesive restorations and their longevity. Self-adhesive resin cements simplify the luting procedure of indirect restorations. However, adding a step that could significantly improve long-term survival would be of great value. Thus, the results of this systematic review will provide data so that the decision making regarding materials used for adhesive cementation is conducted based on scientific evidence.

Impact of contracted endodontic cavities on fracture resistance of endodontically treated teeth: a systematic review of in vitro studies.

OBJECTIVE: This systematic review was performed to answer the following question: do contracted endodontic cavities (CECs) increase resistance to fracture in extracted human teeth compared to traditional endodontic cavities (TECs)? METHODS: A literature search without restrictions was carried out in PubMed, Science Direct, Scopus, Web of Science, and Open Grey databases. Articles were selected by two independent reviewers. In addition, a reference and hand search was also fulfilled. All included in vitro studies evaluated the influence of CECs on strength to fracture in extracted human teeth and compared to TECs. The quality of the selected studies was evaluated and they were classified as having a low, moderate or high risk of bias. RESULTS: A total of 810 articles were obtained in the electronic search. After the application of the eligibility criteria, reference and hand search, and duplicate removal, six studies were included in this systematic review. All included studies evaluated the influence of CECs on strength to fracture in extracted human teeth and compared to TECs. Characteristics investigated in the selected articles included the sample size and tooth type, access cavity design, filling and restoration procedures, load at fracture test characteristics, and results. The studies demonstrated large variability among the fracture resistance values and standard deviations and low power. Three of the reviewed studies presented low risk of bias and the other three showed medium risk of bias. CONCLUSION: Overall, this systematic review of in vitro studies showed that there is no evidence that supports the use of CECs over TECs for the increase of fracture resistance in human teeth. CLINICAL RELEVANCE: Recently, CECs have gained attention in endodontics due to maximum tooth structure preservation including the pericervical dentin, which could improve the strength to fracture of endodontically treated teeth. However, the influence of access cavity design on fracture resistance remains limited and controversial.

Development and validation of a questionnaire on the feelings of undergraduate dental students regarding child dental care.

OBJECTIVES: This study aimed to develop and test a questionnaire's validity and reliability to evaluate undergraduate dental students' feelings regarding child dental care. METHODS: The questionnaire was developed using a focus group of 10 undergraduate dental students. This questionnaire was then structured and applied digitally via Google Forms to 90 dental students aged 22.95 years (±0.89) who had already completed or were enrolled in a pediatric dentistry discipline. The test-retest was conducted with 15 students. Descriptive analysis, exploratory factorial analysis (EFA), and intraclass correlation coefficient were performed to evaluate the test-retest reliability, Cronbach's alpha (α) to measure the internal consistency, and Mann-Whitney test was used to determine the discriminant validity (p < 0.05). RESULTS: The final version of the questionnaire concerning the feelings of dental students when faced with pediatric dental treatment comprised three items, which evaluated anxiety, fear, and insecurity. The visual analog scale was used to evaluate the answer for each item. The questionnaire resulted in a total score that varied from 0 to 10. The higher the score on the questionnaire, the greater the negative feelings regarding pediatric dental treatment. The results of the EFA were satisfactory (Bartlett's sphericity = 0.001; Kayser-Meyer-Olkin measure = 0.725). The EFA extracted a single dimension with an eigenvalue of 2.4 and a total explained variance of 80%. The internal consistency of the questionnaire was satisfactory (α = 0.877), and the test-retest reliability was good (intraclass correlation coefficient = 0.691). Students who felt confident about carrying out invasive procedures in children demonstrated more positive feelings related to the pediatric dental treatment (average = 3.50 ± 2.73) than those who did not feel such confidence (average = 5.00 ± 2.35; p = 0.007). CONCLUSIONS: The unidimensional questionnaire proposed by this study is valid and reliable in evaluating the feelings of undergraduate dental students regarding child dental care.

Salivary Metabolomic Analysis Reveals Amino Acid Metabolism Shift in SARS-CoV-2 Virus Activity and Post-Infection Condition.

The SARS-CoV-2 virus primarily infects salivary glands suggesting a change in the saliva metabolite profile; this shift may be used as a monitoring instrument during SARS-CoV-2 infection. The present study aims to determine the salivary metabolomic profile of patients with and post-SARS-CoV-19 infection. Patients were without (PCR-), with SARS-CoV-2 (PCR+), or post-SARS-CoV-2 infection. Unstimulated whole saliva was collected, and the 1H spectra were acquired in a 500 MHz Bruker nuclear magnetic resonance spectrometer at 25 °C. They were subjected to multivariate analysis using principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA), as well as univariate analysis through t-tests (SPSS 20.0, IL, USA), with a significance level of p < 0.05. A distinction was found when comparing PCR- subjects to those with SARS-CoV-2 infection. When comparing the three groups, the PLS-DA cross-validation presented satisfactory accuracy (ACC = 0.69, R2 = 0.39, Q2 = 0.08). Seventeen metabolites were found in different proportions among the groups. The results suggested the downregulation of major amino acid levels, such as alanine, glutamine, histidine, leucine, lysine, phenylalanine, and proline in the PCR+ group compared to the PCR- ones. In addition, acetate, valerate, and capronic acid were higher in PCR- patients than in PCR+. Sucrose and butyrate were higher in post-SARS-CoV-2 infection compared to PCR-. In general, a reduction in amino acids was observed in subjects with and post-SARS-CoV-2 disease. The salivary metabolomic strategy NMR-based was able to differentiate between non-infected individuals and those with acute and post-SARS-CoV-19 infection.

A critical review on the association of hyposalivation and dental caries in children and adolescents.

OBJECTIVE: The purpose of this critical review is to assess if children and adolescents with hyposalivation are more affected by dental caries than those with normal flow rate. DESIGN: A literature search was performed using keywords and MeSH terms related to hyposalivation and dental caries in the Medline/PubMed, Web of Science, Cochrane Library, Scopus, LILACS/BBO databases and in gray literature without language or date restrictions until March 2022. Observational studies that accessed the presence of dental caries in patients up to 18 years-old with hyposalivation and compared with a control group (normal salivation rate) were considered eligible. The results from search were imported to EndNote Web, where duplicates were removed followed by title/abstract and full text analysis. RESULTS: A total of 12,236 non-duplicated studies were found and 14 fulfilled the criteria and were included in the present review, 9 cross-sectional and 5 cohorts. Stimulated salivary flow rates were assessed in 3644 participants, aged 3-17 years. Three cohort and three cross-sectional studies observed association between low salivary flow rates and the presence of dental caries, while the other 9 included articles did not verify this association. However, the absence of a standard criteria for the hyposalivation classification in young patients was observed and brough light to this important limitation among the studies. CONCLUSION: The salivary flow rate estimation for caries risk assessment must be the target of further studies to make possible and reliable, homogeneous, and unbiasedly assessment of the association between hyposalivation and dental caries in young patients.

Probiotics and dairy products in dentistry: A bibliometric and critical review of randomized clinical trials.

The oral environment is an essential part of the human microbiome. The consumption of probiotic products may improve the oral microbiota and reduce the risk of diseases. This paper presents a bibliometric and critical review of randomized clinical trials (RCTs) that used probiotics to analyze oral parameters in humans. RCTs carried out with no age, gender, and ethnicity restrictions and published in the pre-COVID-19 period were included. Furthermore, the utilization of probiotic dairy products to improve oral health is discussed. The bibliometric review demonstrated that 'Microbiology,' 'Dental caries,' and 'Streptococcus mutants' were the most highlighted keywords. Furthermore, Sweden and India have the highest number of publications. The most prevalent outcomes were 'salivary parameters,' 'periodontal disease,' and 'dental caries.' The most used vehicles for probiotic administration were pharmaceutical formulas and dairy products. The administration of probiotic dairy products could modify the oral microbiota (reductions in S. mutans counts), influence the caries development and periodontal disease in children, adolescents, adults, and the elderly, and improve gingival health. The main probiotic dairy products investigated were milk, fermented milk, yogurt, kefir, curd, and cheese. Lacticaseibacillus paracasei SD1 was the most used probiotic culture. The studies demonstrated that the probiotic effect lasted 2-4 weeks after discontinuing consumption. However, the results depended on the subject type, study design, probiotic strain and concentration, and dairy product type. In conclusion, probiotic dairy products are promising alternatives to improve oral health.

Developmental dental alterations in permanent teeth after intrusion of the predecessors: clinical and microscopic evaluation.

This case report describes the management of developmental dental alterations in permanent dentition as a consequence of severe intrusive luxation in its predecessors in a child of 2 years. At 10 years of age, this patient was referred for consultation due to lack of permanent maxillary right central and lateral incisors. Radiographic examination revealed impaction of hypoplasic permanent maxillary central incisor, absence of the lateral incisor and compound odontoma in region of the permanent maxillary lateral incisor. The odontoma was surgically removed and unerupted central incisor was placed in orthodontic traction over a period of 8 months. The central incisor presented with abnormal shape and was restored with composite resin. Odontoma histologic analysis was carried out through Hematoxylin and Eosin coloration and Scanning Electron Microscopy. Cement and osteocement formations were found in soft tissue, as well as some irregularly distributed dentine islands of tooth-like structures, indicative of compound odontoma. We followed up this patient for 5 years and orthodontic management was successfully performed for correct alignment of the maxillary right central incisor impacted by compound odontoma.

Vitality Tests for Pulp Diagnosis of Traumatized Teeth: A Systematic Review.

INTRODUCTION: The objective of this systematic review was to evaluate the efficacy of vitality tests (pulse oximetry and flowmetry) in the pulpal diagnosis of traumatized teeth in comparison with sensibility tests. METHODS: This review was registered in the PROSPERO database (CRD42018097361) and was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An electronic systematic search of the literature was performed in the PubMed (Medline), Scopus, Web of Science, Cochrane Library, Lilacs, and Gray Literature databases and the reference lists of articles published until May 2018. The data of the included articles were extracted, and the methodological quality was judged using the QUADAS-2 quality assessment tool following the Cochrane recommendations. RESULTS: The initial search retrieved 173 potential articles. After the duplicates were removed, 77 articles remained; the titles and abstracts of these 77 articles were read, resulting in the selection of 19 articles for reading the full text. Five articles were selected for data extraction and qualitative analysis. The vitality tests evaluated in the studies were pulse oximetry, laser Doppler flowmetry, and ultrasound Doppler flowmetry compared with cold testing, electrical testing, or both. In all articles, the results were favorable for vitality tests; however, a high risk of bias was found in at least 1 item of the quality evaluation of the included studies. CONCLUSIONS: Because of the high risk of bias and deficiency in the research design, there is still a need for further studies in relation to pulse oximetry, laser Doppler flowmetry, and ultrasound Doppler flowmetry, which consistently prove the diagnostic accuracy and superiority when compared with sensibility tests on traumatized teeth.

Peel bond strength and antifungal activity of two soft denture lining materials incorporated with 1% chlorhexidine diacetate.

Two soft denture lining materials (SC-Soft Confort and TS-Trusoft) were investigated with and without the addition of 1.0% of chlorhexidine diacetate (1.0% CHX). To assess peel bond strength, specimens (75×10×6 mm) were submitted to a peel test at 10 mm/min immediately and after 24 h. To evaluate Candida albicans growth inhibition, disc of specimens (10×3 mm) were immersed in a solution with 3×106 CFU/mL of C. albicans, and spectral measurements were made following immersion in MTT solution for 2, 4, and 6 days. The agar diffusion test was performed by investigating the diameters of inhibition zones around the disc of specimens (10×3 mm)after 48 h. Data were submitted to statistical analysis (α=0.05) and the failure modes were visually classified. The incorporation of 1.0% CHX significantly decreased the peel bond strength for TS (p=0.001) and SC (p=0.005) for immediate test and for TS after 24 h (p=0.010), but not for SC. C. albicans growth was decreased for both materials over time (p<0.05). SC presented inhibition zones approximately 2.0 times larger than TS. The incorporation of 1.0% CHX inhibited fungal growth without impairment to the peel bond strength for SC after 24 h.

In vitro enamel erosion and abrasion-inhibiting effect of different fluoride varnishes.

OBJECTIVE: To investigate the erosion and abrasion inhibiting effect of CPP-ACP/NaF and xylitol/NaF varnishes. METHODS: Bovine enamel samples (n=40) were exposed to the following treatments (n=10): NaF varnish (Duraphat®, positive control); CPP-ACP/NaF varnish (MI varnishTM); xylitol/NaF (Profluorid®) or distilled and deionized water (MilliQ®, negative control). The samples were submitted for 3days to 4 cycles/day of erosion (5min in Sprite Zero) and 2 cycles of abrasion/day after the first and last erosive challenge, with a toothbrush machine and slurries of a placebo toothpaste for 15s (50 strokes/s). Among the cycles and after the last daily cycle, the specimens remained in artificial saliva. The change in the enamel surface was evaluated by using 3D non-contact optical profilometry with surface roughness (Ra and Sa values) and tooth structure loss (TSL) measurements. Scanning electron microscopy (SEM) assessed the enamel topographic characteristics. Differences in the Ra, Sa and TSL among treatments were tested using one-way ANOVA followed by the Tukey test. RESULTS: All varnishes promoted better results for Ra and Sa values than the negative control (p=0.0001), without difference among them (p>0.05). However, CPP-ACP/NaF varnish stimulated fewer TSL (7.09±0.70µm) compared to NaF varnish (10.33±1.36µm, p=0.002), xylitol/NaF varnish (9.96±0.41µm, p=0.007) and the negative control (18.38±3.32µm, p=0.0001). CONCLUSION: A single-application of fluoride topical varnishes was effective in reducing enamel wear. The CPP-ACP/NaF varnish had the best effect against enamel loss from an erosion-abrasion challenge.

Longevity of direct and indirect resin composite restorations in permanent posterior teeth: A systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review and meta-analysis was to assess the differences in clinical performance in direct and indirect resin composite restorations in permanent posterior teeth. SOURCES: PubMed, the Cochrane Library, Web of Science, Scopus, LILACS, BBO, ClinicalTrials.gov and SiGLE were searched without restrictions. STUDY SELECTION: We included randomized clinical trials (RCTs) that compared the clinical performance of direct and indirect resin composite restorations in Class I and Class II cavities in permanent teeth, with at least two years of follow-up. The risk of bias tool suggested by Cochrane Collaboration was used for quality assessment. DATA: After duplicate removal, 912 studies were identified. Twenty fulfilled the inclusion criteria after the abstract screening. Two articles were added after a hand search of the reference list of included studies. After examination, nine RCTs were included in the qualitative analysis and five were considered to have a 'low' risk of bias. The overall risk difference in longevity between direct and indirect resin composite restorations in permanent posterior teeth (p>0.05) at five-year follow-up was 1.494 [0.893-2.500], and regardless of the type of tooth restored, that of molar and premolars was 0.716 [0.177-2.888] at three-year follow-up. CONCLUSIONS: Based on the findings, there was no difference in longevity of direct and indirect resin composite restorations regardless of the type of material and the restored tooth. CLINICAL SIGNIFICANCE: Contemporary dentistry is based on minimally invasive restorations. Any indication of a less conservative technique must have unquestionable advantages. In vitro and in vivo studies reveal contradictory evidence of the clinical performance of direct and indirect resin composite restorations in posterior teeth. Thus this study clarified this doubt.

Is non-cavitated proximal lesion sealing an effective method for caries control in primary and permanent teeth? A systematic review and meta-analysis.

OBJECTIVES: The aim of this study was to perform a systematic review and meta-analysis on the effectiveness of sealing non-cavitated proximal caries lesions in primary and permanent teeth. DATA: Only controlled clinical trials and randomized controlled clinical trials that evaluated the effectiveness of sealing on non-cavitated proximal caries with a minimum follow-up of 12 months were included in the study. The primary outcome should be arrestment/progression of proximal caries evaluated by bitewing radiographs. A risk of bias evaluation based on the Cochrane Collaboration common scheme for bias was carried out for each study. The meta-analysis was performed on the studies considered low risk of bias and with pair-wise visual reading results through RevMan software. SOURCES: A comprehensive search was performed in the Systematic Electronic Databases: Pubmed, Cochrane Library, Scopus, IBI Web of Science, Lilacs, SIGLE, and on website Clinical trials.gov, through until June 2013. STUDY SELECTION: From 967 studies identified, 10 articles and 3 studies with partial results were assessed for eligibility. However three articles were excluded and our final sample included 10 studies. According to the risk of bias evaluation, six studies were considered "high" risk of bias, and four "low" risk of bias. The forest plot of the meta-analysis showed low heterogeneity (I(2)=29%) and a favourable outcome for the Infiltrant. The chance of caries progression when this technique was used was significantly lower (p=0.002) compared with Placebo. CONCLUSION: Our results suggest that the technique of sealing non-cavitated proximal caries seems to be effective in controlling proximal caries in the short and medium term. Further long-term randomized clinical trials are still necessary to increase this evidence. CLINICAL SIGNIFICANCE: Contemporary dentistry is focused in minimally invasive approaches that prevent the destruction of sound dental tissues next to carious lesions. This paper searches for evidence of the efficacy of sealing/infiltrating non-cavitated proximal caries in arresting caries progression both in permanent and primary teeth.

Influence of topical fluoride application on mechanical properties of orthodontic bonding materials under pH cycling.

OBJECTIVE: To evaluate in vitro the influence of topical fluoride application on the mechanical properties of orthodontic cements containing fluoride under pH cycling conditions. MATERIALS AND METHODS: Edgewise brackets for maxillary central incisors were bonded to 192 bovine incisors using Transbond XT (G1), Transbond Plus Color Change (G2), and Fuji Ortho LC (G3) (n  =  64 for each group). The specimens of each group were subdivided (n  =  16) into different subgroups. Subgroup A received no topical fluoride application during pH cycling, while the experimental subgroups received topical fluoride treatments as follows: B, application three times per day of fluoride dentifrice (1450 ppm F); C, application one time per day of fluoride mouth rinse (250 ppm F); and D, combination of fluoride dentifrice and fluoride mouth rinse. After 14 days of pH cycling, the shear bond strength and Adhesive Remnant Index were evaluated statistically. RESULTS: Polarized light microscopy showed that pH cycling induced mineral loss in all specimens. The topical application of fluoride did not have an influence on shear bond strength, although the association of fluoride dentifrice and mouth rinse increased the shear bond strength of the resinous cement without fluoride (P < .01). Regarding the Adhesive Remnant Index, no statistical differences were found within the groups G1 (P  =  .23), G2 (P  =  .47), and G3 (P  =  .74). CONCLUSION: Topical fluoride treatments improved the shear bond strength of resinous cement, regardless of the material's fluoride-releasing capacity, and reached the adhesive fractures.