Association between nutritional status and children and adolescents' dental caries experiences: an overview of systematic reviews.

An increasing number of systematic reviews (SR) has investigated the association between dental caries and nutritional status in children and adolescents, thus requiring an overview to compile the information in a single piece of evidence. Therefore, this study aimed to evaluate and summarize evidence from published SR on the association between dental caries and nutritional status in children and adolescents. A wide search was conducted on May 29, 2023, in six databases (Medline via PubMed, Scopus, Web of Science, Cochrane library, Embase, and the Virtual Health Library - VHL). An additional search was performed in the gray literature (Open grey and Google Scholar), SR registration databases, and the list of references of the included SR. Our inclusion criteria were based on acronym PECOS. Overall, two reviewers independently extracted the data, evaluated the risk of bias (ROBIS), and assessed the quality of the chosen studies (AMSTAR-2). Data from the included meta-analysis were summarized and certainty of evidence using the GRADE approach was performed. After removing duplicates and applying our eligibility criteria, 19 SR from 2006-2022 were included. We found that 17 SR showed high risk of bias and critically low methodological quality. We observed an association between dental caries experiences and nutritional status since seven SR found an association between obesity/overweight and dental caries; one, an association between underweight and dental caries; and eleven, no associations. The meta-analysis showed divergent results according to the study designs, used indices, and participants' age group, and were scored as having a very low certainty of evidence. Therefore, based on the high risk of bias, low methodological quality, and very low certainty of evidence of the chosen SR, most studies found no association between children and adolescents' nutritional status and dental caries experience.

Association between nutritional status and children and adolescents' dental caries experiences: an overview of systematic reviews

Abstract An increasing number of systematic reviews (SR) has investigated the association between dental caries and nutritional status in children and adolescents, thus requiring an overview to compile the information in a single piece of evidence. Therefore, this study aimed to evaluate and summarize evidence from published SR on the association between dental caries and nutritional status in children and adolescents. A wide search was conducted on May 29, 2023, in six databases (Medline via PubMed, Scopus, Web of Science, Cochrane library, Embase, and the Virtual Health Library - VHL). An additional search was performed in the gray literature (Open grey and Google Scholar), SR registration databases, and the list of references of the included SR. Our inclusion criteria were based on acronym PECOS. Overall, two reviewers independently extracted the data, evaluated the risk of bias (ROBIS), and assessed the quality of the chosen studies (AMSTAR-2). Data from the included meta-analysis were summarized and certainty of evidence using the GRADE approach was performed. After removing duplicates and applying our eligibility criteria, 19 SR from 2006-2022 were included. We found that 17 SR showed high risk of bias and critically low methodological quality. We observed an association between dental caries experiences and nutritional status since seven SR found an association between obesity/overweight and dental caries; one, an association between underweight and dental caries; and eleven, no associations. The meta-analysis showed divergent results according to the study designs, used indices, and participants' age group, and were scored as having a very low certainty of evidence. Therefore, based on the high risk of bias, low methodological quality, and very low certainty of evidence of the chosen SR, most studies found no association between children and adolescents' nutritional status and dental caries experience.

Association Between Apical Periodontitis and TNF-α -308 G>A Gene Polymorphism: A Systematic Review and Meta-Analysis.

Currently, investigations have focused on the identification of Single Nucleotide Polymorphisms (SNP) involved in host response and its ability to generate an immunity deficiency. The aim of this study was to perform a systematic review (SR) and meta-analysis to evaluate the association between TNF-α -308 G>A polymorphism and apical periodontitis (AP) phenotypes. A broad search for studies was conducted. The following databases were used: PubMed, Scopus, Web of Science, and VHL (Medline, SciELO, Ibecs, and Lilacs). The MeSH terms "Periapical Periodontitis," "Periapical Abscess," "Polymorphism, Genetic," and "Polymorphism, Single Nucleotide" were used. MeSH synonyms, related terms, and free terms were included. Clinical investigations of individuals with different AP phenotypes in permanent teeth were selected. After application of the eligibility criteria, selected studies were qualified by assessing their methodological quality. A fixed effect model was used for the meta-analysis. The initial search identified 71 references. After excluding duplicate abstracts, 33 were selected. From these, two were eligible for quality assessment and were classified as being of moderate evidence. The included studies did not demonstrate association between AP and TNF-α -308 G>A SNP. However, the meta-analysis demonstrated an association between the genotype distribution and AP phenotype (OR= 0.49; confidence interval= 0.25, 0.96; p=0.04). The role of TNF-α -308 G>A SNP in AP phenotypes is debatable. Further studies are needed to confirm and understand the underlying mechanisms of the identified association.

Association Between Apical Periodontitis and TNF- alpha -308 G>A Gene Polymorphism: A Systematic Review and Meta-Analysis

Abstract Currently, investigations have focused on the identification of Single Nucleotide Polymorphisms (SNP) involved in host response and its ability to generate an immunity deficiency. The aim of this study was to perform a systematic review (SR) and meta-analysis to evaluate the association between TNF-α -308 G>A polymorphism and apical periodontitis (AP) phenotypes. A broad search for studies was conducted. The following databases were used: PubMed, Scopus, Web of Science, and VHL (Medline, SciELO, Ibecs, and Lilacs). The MeSH terms "Periapical Periodontitis," "Periapical Abscess," "Polymorphism, Genetic," and "Polymorphism, Single Nucleotide" were used. MeSH synonyms, related terms, and free terms were included. Clinical investigations of individuals with different AP phenotypes in permanent teeth were selected. After application of the eligibility criteria, selected studies were qualified by assessing their methodological quality. A fixed effect model was used for the meta-analysis. The initial search identified 71 references. After excluding duplicate abstracts, 33 were selected. From these, two were eligible for quality assessment and were classified as being of moderate evidence. The included studies did not demonstrate association between AP and TNF-α -308 G>A SNP. However, the meta-analysis demonstrated an association between the genotype distribution and AP phenotype (OR= 0.49; confidence interval= 0.25, 0.96; p=0.04). The role of TNF-α -308 G>A SNP in AP phenotypes is debatable. Further studies are needed to confirm and understand the underlying mechanisms of the identified association.

Resumo Atualmente as investigações têm focado na identificação de Polimorfismos de Núcleo Único (SNP) envolvidos na resposta do hospedeiro e sua capacidade de gerar uma deficiência de imunidade. O objetivo deste estudo foi realizar uma revisão sistemática (RS) e uma meta-análise para avaliar a associação entre o polimorfismo do gene TNF-α (-308 G> A) e os fenótipos de periodontite apical (PA). Esta RS foi registrada na base de dados PROSPERO, CRD42016035688, e foi conduzida seguindo o método PRISMA. Foi realizada uma ampla pesquisa de estudos. Foram utilizadas as seguintes bases de dados: PubMed, Scopus, Web of Science e BVS (Medline, SciELO, Ibecs e Lilacs). Foram utilizados os seguintes descritores (MeSH) "Periapical Periodontitis," "Periapical Abscess," "Polymorphism, Genetic," and "Polymorphism, Single Nucleotide". Sinônimos, termos relacionados e termos livres foram incluídos. Foram selecionadas investigações clínicas de indivíduos com diferentes fenótipos de PA em dentes permanentes. Após a aplicação dos critérios de elegibilidade, os estudos selecionados foram classificados através da avaliação da qualidade metodológica. Foi utilizado um modelo de efeito fixo para a metanálise. A pesquisa inicial identificou 71 referências. Após a exclusão de resumos duplicados, 33 foram selecionados. Destes, dois eram elegíveis para a avaliação da qualidade e foram classificados como sendo de evidência moderada. Os estudos incluídos não demonstraram associação entre PA e o TNF-α-308 G>A. No entanto, a metanálise demonstrou associação entre a distribuição do genótipo e os fenótipos da PA (OR = 0,49, intervalo de confiança=0,25, 0,96; p=0,04). O papel do TNF-α-308 G>A em fenótipos da PA é discutível. São necessários mais estudos para confirmar e compreender os mecanismos subjacentes à associação identificada.

Simetria gengival na região estética ­ estudo transversal com uma população brasileira / Gingival symmetry in the esthetic zone ­ a cross-sectional study with a Brazilian population

Objetivo: avaliar o padrão da disposição da margem gengival (simétrica ou assimétrica) na zona estética. Material e métodos: foram avaliados 55 adultos jovens brasileiros, de ambos os sexos, estudantes do curso de graduação em Odontologia da Faculdade de Nova Friburgo, na faixa etária entre 18 e 25 anos. Foram avaliados incisivos centrais superiores direito e esquerdo, por um único examinador especialista em Periodontia, considerando os seguintes parâmetros clínicos: índice de placa, sangramento a sondagem e profundidade clínica de sondagem, coletados nos sítios distal, vestibular e mesial de cada elemento dentário estudado. Foram realizadas, ainda, análises morfométricas quanto à disposição das margens gengivais (simetria ou assimetria) entre incisivos centrais (direito e esquerdo), através de avaliação visual em fotos, utilizando modelos zocalados para uma segunda avaliação, objetivando fidelizar a avaliação antes realizada nas fotos. Resultados: o incisivo central direito foi responsável por 64% das relações assimétricas observadas. A assimetria das margens gengivais, entre incisivos centrais, foi observada em 25,45%, não havendo diferença estatisticamente significante em relação ao sexo. Conclusão: o reconhecimento dos aspectos gengivais (simetria gengival) e sua relação com elementos dentais tornam-se indispensáveis, visto que no processo de restauração é fundamental o entendimento do normal, possibilitando prever as dificuldades encontradas no processo de reconstrução de estruturas alteradas.

Objective: to evaluate the gingival margin disposition (symmetry of the lack of) in the esthetic zone. Material and methods: 55 Brazilian dental students (18-25 years-old) from both genders were evaluated at the Nova Friburgo Dental School. The maxillary right and left central incisors were examiner by an single specialist in Periodontics, considering the following parameters: plaque index, bleeding on probing, pocket probing depth, collected at the distal, buccal, and mesial sites of each element. Also, morphometric analyses were performed regarding the gingival margin disposition through photographic records and standardized stone casts to confirm the data obtained. Results: the maxillary right central incisor was responsible for 64% of asymmetries. The asymmetry between the central incisors was observed in 25.45% being not statistically different between genders. Conclusion: the identification of gingival aspects (gingival symmetry) and its relationship with the dental elements are invaluable to standardize what can be considered as a reference to normal standards, while it still predicts the drawbacks found in the reconstructive process of altered tissues.

Correção de erupção passiva alterada por meio de cirurgia plástica periodontal / Correction of altered passive eruption by periodontal plastic surgery

Vários aspectos influenciam nas características do sorriso, tais como: linha mediana, posicionamento dental, linha do sorriso e características gengivais. A erupção passiva alterada é uma condição que interfere na estética do sorriso, por originar coroas clínicas curtas e estar associada ao sorriso gengival. Este trabalho relata um caso clínico de paciente do sexo feminino com erupção passiva alterada que, devido às suas características, interferia na harmonia do sorriso, sendo corrigida pela técnica de gengivectomia com bisel interno associada à osteotomia. A queixa da paciente estava relacionada à estética do seu sorriso, devido à diferença no tamanho das coroas clínicas dos elementos anteriores e excessiva exposição gengival na região. Após o diagnóstico de erupção passiva alterada tipo 1B na face vestibular do elemento 11, seu tratamento consistiu na realização de gengivectomia com incisão de bisel interno. Após 12 meses, pôde-se observar que o resultado almejado foi alcançado sem necessidade de cirurgias adicionais. Concluiu-se que a técnica de gengivectomia mostra-se eficaz para a correção e o restabelecimento da harmonia do sorriso, em casos de erupção passiva alterada associada apenas ao posicionamento coronário do tecido gengival em relação à junção cemento-esmalte.