Oral health care and living environment for older people: a scoping review protocol.

OBJECTIVE: This scoping review will map the literature on the extent of knowledge on living environment oral health care (LIVEOR) by examining its different terminologies, its description, the stakeholders involved, the implementation characteristics, and the outcomes reported by the authors. INTRODUCTION: Older people want to receive oral health care in their current living environment. Although several authors have explored some aspects of LIVEOR for older people, there are still inconsistent findings regarding the extent of this model of care. INCLUSION CRITERIA: This scoping review will include quantitative, qualitative, and mixed method studies, as well as any type of knowledge synthesis on LIVEOR involving people aged 60 years and over. The search will not be limited by language, time frame, geographic location, or publication date. METHODS: We will use the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). The search will include MEDLINE, CINAHL, Embase, Web of Science, and the Cochrane Library. A hand-search of the references of the included studies, and a gray literature search will also be conducted. Two independent reviewers will screen titles, abstracts, and full texts of selected studies, and perform data extraction. Findings are expected to explore what is known of LIVEOR targeting older people and to identify any knowledge gaps for future studies. We will disseminate our findings mostly through peer-reviewed publications. REVIEW REGISTRATION: Open Science Framework https://osf.io/e7fm2.

Do nasal and nasopharyngeal obstruction and their medical-surgical deobstruction significantly influence facial divergence? A concise review of major clinical studies with meta-analysis / L'obstruction du nez et du nasopharynx et leur désobstruction médico-chirurgicale influencent-elles significativement la divergence faciale ? Une revue concise des études cliniques majeures avec méta-analyse

Introduction: The term « adenoid facies ¼ suggests a causal relationship between nasopharyngeal obstruction and facial hyperdivergence in growing subjects. The strength of this association is controversial and few « quantified ¼ values exist. Materials and methods: A rapid electronic search was conducted on PubMed and Embase to find the main cephalometric studies involving patients with nasal/nasopharyngeal obstruction compared to a control sample. A meta-analysis was carried out to quantify the effect of obstruction (1) and intervention to relieve the obstruction (2) on mandibular divergence (SN/Pmand angle), maxillo-mandibular divergence (PP/Pmand angle), inclination of the occlusal plane (SN/Poccl) and the gonial angle (ArGoMe). Results: Qualitatively, the studies' bias level ranged from moderate to high. Results were concordant about the significant effect of the obstruction on facial divergence (1) with an increase in SN/Pmand (+3.6° on average, +4.1° in children <6 years), PP/Pmand (+5.4° on average, +7.7° <6 years), ArGoMe (+3.3°) and SN/Pocc (+1.9°). Surgical interventions to remove the respiratory obstacle in children (2) generally did not normalize the direction of growth, with the exception, with a very low level of evidence, of adenoidectomies/adeno-tonsillectomies, performed at an age less than 6-8 years. Conclusion: Early detection of respiratory obstacles and postural abnormalities associated with oral breathing appears to be decisive in order to hope for management at a young age and normalization of the direction of growth. However, the effects on mandibular divergence remain limited, requiring caution, and cannot be considered a surgical indication.

Introduction: Le terme « faciès adénoïdien ¼ suggère une relation de causalité entre l'obstruction nasopharyngée et l'hyperdivergence chez le sujet en croissance. La force de cette association est controversée et peu de valeurs « chiffrées ¼ existent. Matériels et méthodes: Une recherche électronique rapide a été menée sur PubMed et Embase pour retrouver les principales études céphalométriques impliquant des patients avec obstruction nasale/nasopharyngée comparés à une population témoin. Une métanalyse a été réalisée pour quantifier l'effet de l'obstruction (1) et de la désobstruction (2) sur la divergence mandibulaire (angle SN/Pmand), la divergence maxillo-mandibulaire (angle PP/Pmand), l'inclinaison du plan occlusal (SN/Poccl) et l'angle goniaque (ArGoMe). Résultats: Qualitativement, le niveau de biais des études allait de modéré à élevé. Les résultats étaient concordants sur l'effet significatif de l'obstruction sur la divergence faciale (1) avec une augmentation de SN/Pmand (+3,6° en moyenne, +4,1° chez les enfants < 6 ans), PP/Pmand (+5,4° en moyenne, +7,7° < 6 ans), ArGoMe (+3,3°) et SN/Pocc (+1,9°). Les interventions chirurgicales pour lever l'obstacle respiratoire chez l'enfant (2) ne permettaient généralement pas une normalisation de la direction de croissance, à l'exception, avec un très faible niveau de preuve, des adénoïdectomies/adéno-amygdalectomies, réalisées à un âge inférieur à 6-8 ans. Conclusion: Le dépistage précoce des obstacles respiratoires et des anomalies posturales associées à la ventilation orale apparaît déterminant pour espérer une prise en charge en jeune âge et une normalisation de la direction de croissance. Les effets sur la divergence mandibulaire restent cependant limités, imposant la prudence et ne constituant pas une indication chirurgicale.

Palatal brushing for the treatment of denture stomatitis: A multicentre randomized controlled trial.

PURPOSE: To determine the effectiveness of palatal brushing in the treatment of denture-related erythematous stomatitis (DES) in complete denture wearers. METHODS: This two-parallel-arm RCT was conducted in three university clinics in Brazil, Canada, and Chile. Participants (n=77) were randomly allocated to receive (i) instructions for palatal brushing and standard oral/denture hygiene ("intervention"); or (ii) standard oral/denture hygiene instructions only ("control"). Data collection was carried out at the baseline and at 3 and 6 months after intervention. Outcomes included the magnitude of oral Candida carriage and the degree of inflammation of denture-bearing tissues. Groups were compared using generalized estimating equations and chi-square test (α=0.05). RESULTS: Palatal inflammation levels were reduced significantly in the "intervention" compared to "control" group at 6 months (intervention: 70%, control: 40%; chi-square, p=0.04). There was no between-group significant difference in the Candida count from denture and palatal biofilms; however, a subgroup analysis restricted to baseline Candida carriers showed further reduction with the intervention at 6 months. No adversity was observed by trialist or reported by participants. CONCLUSIONS: Including palatal brushing in oral instructions for denture wearers has positive impact on DES-related mucosal inflammation. Thus, our findings endorse the inclusion of palatal brushing in standard oral hygiene instructions to treat DES.

Conditioning to Enhance the Effects of Repetitive Transcranial Magnetic Stimulation on Experimental Pain in Healthy Volunteers.

Objective: In this proof-of-concept study we sought to explore whether the combination of conditioning procedure based on a surreptitious reduction of a noxious stimulus (SRPS) could enhance rTMS hypoalgesic effects [i.e., increase heat pain threshold (HPT)] and augment intervention expectations in a healthy population. Methods: Forty-two healthy volunteers (19-35 years old) were enrolled in a randomized crossover-controlled study and were assigned to one of two groups: (1) SRPS and (2) No SRPS. Each participant received two consecutive sessions of active or sham rTMS over the M1 area of the right hand on two visits (1) active, (2) sham rTMS separated by at least one-week interval. HPT and the temperature needed to elicit moderate heat pain were measured before and after each rTMS intervention on the right forearm. In the SRPS group, conditioning consisted of deliberately decreasing thermode temperature by 3°C following intervention before reassessing HPT, while thermode temperature was held constant in the No SRPS group. Intervention expectations were measured before each rTMS session. Results: SRPS conditioning procedure did not enhance hypoalgesic effects of rTMS intervention, neither did it modify intervention expectations. Baseline increases in HPT were found on the subsequent intervention session, suggesting variability of this measure over time, habituation or a possible "novelty effect." Conclusion: Using a SRPS procedure in healthy volunteers did not enhance rTMS modulating effects on experimental pain sensation (i.e., HPT). Future studies are therefore needed to come up with a conditioning procedure which allows significant enhancement of rTMS pain modulating effects in healthy volunteers.

The Effect of Age and Pain on Quantitative Sensory Testing Measurements After Moderate-to-Severe Traumatic Brain Injury: Preliminary Findings.

BACKGROUND: Chronic pain after moderate-to-severe traumatic brain injury (TBI) is associated with notable sensory alterations. Although the incidence of TBI is rapidly growing in older populations, elderly individuals have been largely excluded from sensory testing studies, thus limiting evidence regarding the influence of age on pain-related sensory alterations after TBI. This study aimed to investigate the effect of age on the sensory profiles of patients with and without chronic pain after moderate-to-severe TBI. METHODS: Thermal and mechanical quantitative sensory testing were performed on the painful and contralateral body regions in TBI participants with pain (TBI-P) and on both forearms in TBI participants without pain (TBI-NP). Descriptive information about chronic pain and psychological comorbidities was assessed using validated questionnaires. RESULTS: Participants included 37 young (18-59 years, 57% with chronic pain) and 22 elderly (≥60 years, 46% with chronic pain) survivors of moderate-to-severe TBI. TBI-P participants exhibited significant alterations in heat and pressure pain sensitivity compared to TBI-NP participants, with more pronounced decreases in heat detection in the elderly group and increased warmth sensitivity in the young group. Alterations were not always associated with chronic pain, as cold hypoesthesia was found in elderly TBI-NP participants. In both age groups, chronic pain was associated with higher levels of depressive mood. CONCLUSIONS: Results suggest that young and elderly TBI survivors have both common and unique sensory properties, highlighting the need to pursue sensory testing studies in older patient groups. Depression might also be an important target for pain management after TBI.

Effectiveness of Interprofessional Manikin-Based Simulation Training on Teamwork Among Real Teams During Trauma Resuscitation in Adult Emergency Departments: A Systematic Review.

STATEMENT: This systematic review synthesizes the relevant evidence about the effectiveness of interprofessional manikin-based simulation training on teamwork among real teams during trauma resuscitation in adult civilian emergency departments. A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, EBM reviews, PsycINFO, and Web of Science with no time limit. Only experimental and quasi-experimental studies were included. Effects of the simulation intervention on teamwork were categorized according to a modified version of the Kirkpatrick's model. From the 1120 studies found, 11 studies were included for synthesis. All studies showed immediate improvement in teamwork after training, but divergent results were found regarding skills retention. Although this review focused on interprofessional manikin-based simulations in real trauma teams, the results are similar to previous systematic reviews including different types of simulation. This raises significant questions regarding the importance of simulation design characteristics to improve teamwork in trauma care.

Chronic Central Pain Among Community-Dwelling Survivors of Moderate-to-Severe Traumatic Brain Injury: A Quantitative Sensory Testing Study.

BACKGROUND: Central pain associated with changes in sensory thresholds is one of the most enduring consequences of major trauma. Yet it remains sparsely studied among community-dwelling survivors of moderate-to-severe traumatic brain injury (TBI). PURPOSE: To describe and compare thermal and mechanical sensory thresholds in home-based patients with and without central pain after moderate-to-severe TBI with a cohort of healthy controls. DESIGN: Cross-sectional. METHOD: Thresholds for cold/heat detection, thermal pain, touch, and distorted sensation were gathered using quantitative sensory testing (QST). QST was performed on the painful and contralateral pain-free body regions in TBI participants with pain (TBI-P) and on both forearms in TBI participants without pain (TBI-NP) and healthy controls (HC). Central pain was characterized using the Brief Pain Inventory-Short Form. RESULTS: We tested 16 TBI-P patients, 17 TBI-NP patients, and 16 HC. Mean time since injury for TBI patients was 24 ± 15 months. TBI-P and TBI-NP patients showed significant loss in innocuous mechanical sensitivity compared to HC (F = 18.929; Bonferroni-adjusted p ≤ .001). Right-left differences in cold pain sensations were significantly larger in TBI-P than in TBI-NP and HC participants (F = 14.352; Bonferroni-adjusted p ≤ .001). Elevated heat sensitivity thresholds were also observed in TBI-P participants but remained within normal range. CONCLUSION: Damage to cutaneous mechanoreceptors is a necessary, but not sufficient, condition for the development of chronic central pain following TBI. Damage or incomplete recovery of cutaneous thermoreceptors may be a contributing factor to chronic pain after TBI.