Operationalisation of Successful Ageing in the Oral Health Context: A Citation Analysis.

OBJECTIVES: The rapidly ageing world has placed considerable demands on health and social care. To address this, the World Health Organization (WHO) and United Nations (UN) have declared action for this decade (2021-2030) to promote healthy ageing. Operationalisation of successful ageing in the oral health context in terms of its dimensions and their interconnectedness was determined. METHODS: A citation analysis was conducted following a scoping review to determine oral health's relationship with 5 key dimensions of successful ageing. This included examining the occurrence and co-occurrence amongst dimensions and over time. Specific consideration of citations by country, journal type, and authors through overlay visualisation was performed to map their interconnectedness. RESULTS: The scoping review identified 263 publications covering 1730 specific terms. There was a growing interest in successful ageing in the oral health context, mostly in the past decade (2010 onwards; 65.8%, 173 publications). The dimension of key consideration was "health and ADLs" (activities of daily living); this dimension appeared in 97.3% of publications (n = 256) and was found earliest to emerge, with the greatest link strengths compared to other dimensions. Country-level variations in citation data were observed, and there was good citation interconnectedness between them. Key oracles for dissemination have been medical rather than dental-specific journals. Amongst authors, there was considerable interconnectedness in the field. CONCLUSIONS: Findings highlight how successful ageing in the oral health context has been studied, with implications for addressing the significance of oral health to older peoples' lives in line with the WHO and UN's agenda. Citation analyses identified the "known unknowns" area for further consideration, and these findings have the potential to inform how dental research may best move forward with the successful ageing agenda to bring about translational impact.

Long-term stability of jaw reconstruction with microvascular bone flaps: A prospective longitudinal study.

OBJECTIVES: Microvascular bone flap jaw reconstruction has achieved satisfactory clinical outcomes. However, little is known about the long-term stability of the reconstructed jaw. This prospective longitudinal study aimed to investigate the long-term stability of jaw reconstruction and factors that were associated with it. METHODS: Patients with successful computer-assisted osseous free-flap jaw reconstruction in the Department of Oral and Maxillofacial Surgery, Queen Mary Hospital, Hong Kong were recruited for this prospective longitudinal study. The three-dimensional jaw models at the pre-operative plan, post-operative 1-month, and 2 years were aligned and compared. RESULTS: A total of 69 patients were recruited, among which 48 patients were available for the long-term analysis. Compared to 1-month after surgery, further deviation from the pre-operative plan was observed at post-operative 2 years. Lack of accuracy in surgery, segmental mandible resection especially with the involvement of mandible angles, and post-operative radiation therapy were identified as the significant factors affecting the positional stability of the reconstructed jaw (p < 0.05). Stable reconstruction was observed in the subgroup analysis of patients without post-operative radiation therapy. CONCLUSION: Up to the best of our knowledge, this is the first prospective longitudinal study reporting the long-term stability of jaw reconstruction and its affecting factors. Our data demonstrated that the reconstructed jaw position lacked stability over the postoperative period. How to improve long-term stability of reconstructed jaw thus optimize the functional outcomes warrants further studies.

A quantitative comparison of bone resection margin distances in virtual surgical planning versus histopathology: a prospective study.

BACKGROUND: Positive bone margins have been shown to be associated with worse locoregional control and survival performance in oral oncology patients. With the application of computer-assisted surgery and patient-specific surgical guides, the authors can accurately execute the preoperative osteotomy plan. However, how well the authors can predict the margin distance in the final histopathology with a preoperative computed tomography (CT) scan, the factors associated with it, and how much leeway CT should spare when designing the osteotomy planes during virtual surgical planning (VSP) remain to be investigated. MATERIALS AND METHODS: Patients from January 2021 to December 2022 with benign or malignant jaw tumors and with signs of bone marrow involvement in the preoperative CT scan in our center were prospectively recruited to the study. VSP and measurement of the closest margin distance in the CT scan were performed by the single team of surgeons. The resection specimen was processed, and the margin distances were measured by a dedicated senior pathologist with the knowledge of orientation of the osteotomy planes. RESULTS: A total of 35 patients were recruited, with 21 malignant and 14 benign cases. Sixty-eight bone margins were quantitatively analyzed. No significant difference in margin distances measured from the CT scan and final histopathology was detected ( P =0.19), and there was a strong correlation between the two (r s =0.74, P <0.01). A considerable amount of variance was detected in the level of discrepancy between margin distances measured in the CT scan and final histopathology (overall SD=6.26 mm, malignancy SD=7.44 mm, benign SD=4.40 mm). No significant correlation existed between the two margin distances when only maxilla tumor margins were assessed ( P =0.16). CONCLUSION: The bone margin distance in VSP is reliably correlated to the final pathological margin distance. A leeway distance of 15mm and 9mm should be considered when designing the osteotomy planes for malignancy and benign cases, respectively. Extra attention should be paid to maxilla cases when predetermining the osteotomy planes during VSP.

Motivational interviewing for caries prevention in adolescents: a randomized controlled trial.

OBJECTIVE: The objective of this study is to investigate the effectiveness of motivational interviewing (MI) in changing health behaviors (snack and toothbrushing) and preventing dental caries among adolescents. METHODS: Five hundred and twelve adolescents with unfavorable caries-related behaviors ("snacking three times or more a day" and/or "toothbrushing less often than twice a day") were randomly assigned to three groups. Group I received prevailing health education (oral health talks and pamphlets). Participants in group II joined a one-on-one face-to-face MI session. In group III, a patient communication tool (Cariogram) was incorporated to facilitate the MI process. At baseline and 24 months post-intervention, a self-administered questionnaire gathered information of participants' sociodemographic characteristics and oral health self-efficacy and behaviors. Their oral hygiene and tooth status were assessed by a blinded examiner. RESULTS: After 24 months, 460 (89.8%) participants were followed up. Compared with group I, (i) restriction of frequent snacking was more likely in group II [OR (95% CI): 3.91 (1.48-10.33)] and group III [OR (95% CI): 6.33 (2.46-16.27)], whereas group III tended to adopt the behavior of toothbrushing twice a day [OR (95% CI): 4.80 (1.79-12.85)]; (ii) no significant between-group difference in plaque score reduction was found (p > 0.05); and (iii) groups II and III developed fewer cavitated teeth (△DICDASII 3-6MFT) [ß (95% CI): - 0.19 (- 0.37, - 0.01) and - 0.20 (- 0.38, - 0.02), respectively], whereas increment of total carious lesions (△DICDASII 1-6MFT) was lower in group III [ß (95% CI): - 0.63 (- 1.24, - 0.02)]. CONCLUSION: MI outperformed prevailing health education in improving oral health behaviors and preventing dental caries among adolescents. CLINICAL RELEVANCE: Incorporating MI into dental care for caries-prone adolescents contributes to optimal health outcomes. TRIAL REGISTRATION: HKUCTR-1852 ( http://www.hkuctr.com/ ) (Hong Kong, 2013).

The effect of systemic antibiotics on clinical and patient-reported outcome measures of oral implant therapy with simultaneous guided bone regeneration.

OBJECTIVES: The aim of the present superiority study was to determine the effect of systemic antibiotics primarily on patient-reported outcome measures (PROMs) and post-surgical complications in patients undergoing oral implant therapy with simultaneous guided bone regeneration (GBR). MATERIALS AND METHODS: A total of 236 medically and periodontally healthy patients received oral implants with simultaneous GBR at seven centres. Pre-operative antibiotics of 2 g amoxicillin were prescribed to the test group 1 hr prior to surgery and 500 mg thrice daily on days 1-3 after surgery. The control group was given a placebo. Group allocation was performed randomly. Primary outcome variables were PROMs recorded as visual analogue scale scores assessed on days 1-7 and 14 on pain, swelling, haematoma and bleeding. Post-operative complications as secondary outcome variables were examined at 1, 2, 4 and 12 weeks from surgery. Chi-square tests and repeated measures of analysis of variance (ANOVA) were performed for statistical evaluation. RESULTS: No statistically significant differences (p > .05) between the two groups were detected for the evaluated PROMs. The same was noted with respect to post-surgical complications. Four implants were lost-three in the test group and one in the control group. CONCLUSION: In this trial, systemic antibiotics did not provide additional benefits to PROMs, nor the prevention of post-surgical complications in medically and periodontally healthy patients undergoing oral implant therapy with simultaneous GBR. However, further studies with larger sample sizes are still required to support the clinical outcomes of this study.

Risk predictors of dental root caries: A systematic review.

OBJECTIVES: To identify the risk predictors of root caries and to describe their relationship with the incidence and increment of root caries. DATA: Observational longitudinal studies. SOURCES: Four electronic databases (PubMed, MEDLINE, EMBASE, and Scopus) (From 1 January 1990 to 31 January 2019). STUDY SELECTION: Information on the factors associated with the incidence or increment of decayed and filled root surfaces (DF-root) and/or decayed root surfaces (D-root) were extracted by two reviewers independently. The factors were put into six categories, namely social-demographic background, general health, health behaviors, fluoride exposure, oral health habits and oral health condition. From the 440 potential papers identified, 19 papers reporting on 16 cohort studies were finally included. The total sample size was 7340 participants from different countries worldwide, with age ranging from 20 to 100 years. Positive correlations between new root caries and age, baseline root caries experience, gingival recession and use of tobacco were reported while negative correlations were found for socio-economic status, good oral hygiene and use of fluorides. Mixed findings were detected for the association between new root caries and the number of natural teeth. CONCLUSION: This systematic review discovered a number of root caries risk predictors in different categories. People who are older, in lower socio-economic status or tobacco users, and those with more root caries experience, gingival recession and poor oral hygiene have higher risk of developing new root caries. CLINICAL SIGNIFICANCE: This systematic review provides support that improvement of oral hygiene, prevention of gingival recession, and use of fluoride would be useful strategy for prevention of new root caries.

The prognostic role of PD-L1 expression for survival in head and neck squamous cell carcinoma: A systematic review and meta-analysis.

BACKGROUND: Programmed death-ligand 1 (PD-L1) is an immune checkpoint that is primarily located on the surface of tumor cells. PD-L1 expression detected by immunohistochemistry (IHC) assays has been widely studied to predict survival outcomes in head and neck squamous cell carcinoma (HNSCC) recently. We aimed to review comprehensively the prognostic role of PD-L1 expression for survival in HNSCC. METHODS: We systematically searched PubMed, Embase, Web of Science, Cochrane Library and Scopus to identify studies investigating the prognostic role of PD-L1 expression in HNSCC. All studies published before March 31, 2018 were screened. Included studies were assessed using the Quality in Prognosis Studies (QUIPS) tool. Data were extracted and overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), disease-specific survival (DSS) were combined and presented as hazard ratios (HR) with 95% confidence interval (CI) using the generic inverse-variance method. RESULTS: Twenty-three studies with 3105 patients were analysed. The overall positive rate of PD-L1 in HNSCC was 0.42 (95% CI: 0.36-0.48). There was no significant difference between PD-L1-positive and -negative HNSCC patients in OS (HR: 0.98; 95% CI: 0.71-1.37; p = 0.93), DFS (HR: 1.07; 95% CI: 0.68-1.70; p = 0.76), and DSS (HR: 0.90; 95% CI: 0.63-1.29; p = 0.56). An improved PFS was observed in patients with positive PD-L1 expression (HR: 0.71; 95% CI: 0.55-0.93; p = 0.01). In patients with low CD8+ tumor-infiltrating T cells, a poorer OS was detected in patients with positive PD-L1 expression (HR: 1.90; 95% CI: 1.07-3.36; p = 0.03). Patients with HPV-positive HNSCC were associated with increased PD-L1 expression (OR: 1.99; 95% CI: 1.50-2.64; p < 0.001). However, PD-L1 expression showed no significant benefit on OS in HPV-positive HNSCC (HR: 1.04; 95% CI: 0.65-1.65; p = 0.88). CONCLUSIONS: PD-L1 expression detected by IHC was not recommended to predict survival in HNSCC patients. However, the positive PD-L1 expression might predict better PFS in patients with advanced HNSCC. The combined effects of PD-L1 expression and CD8+ tumor-infiltrating T cells should be further elucidated.

Longitudinal measurement invariance and explanatory IRT models for adolescents' oral health-related quality of life.

BACKGROUND: Longitudinal invariance is a perquisite for a valid comparison of oral health-related quality of life (OHRQoL) scores over time. Item response theory (IRT) models can assess measurement invariance and allow better estimation of the associations between predictors and latent construct. By extending IRT models, this study aimed to investigate the longitudinal invariance of the two 8-item short forms of the Child Perception Questionnaire (CPQ11-14) regression short form (RSF:8) and item-impact short form (ISF:8) and identify factors associated with adolescents' OHRQoL and its change. METHODS: All students from S1 and S2 (equivalent to US grades 6 and 7) who were born in April 1997 and May 1997 (at age 12) from 45 randomly selected secondary schools were invited to participate in this study and followed up after 3 years. Data on the CPQ11-14 RSF:8 and CPQ11-14 ISF:8, demographics, oral health behavior and status were collected. Explanatory graded response models were fitted to both short forms of the CPQ11-14 data for assessing longitudinal invariance and factors associated with OHRQoL. The Bayesian estimation method - Monte Carlo Markov Chain (MCMC) with Gibbs sampling was adopted for parameter estimation and the credible intervals were used for inference. RESULTS: Data from 649 children at age 12 at baseline and 415 children at age 15 at follow up were analyzed. For the 12 years old children, healthier oral health behavior, better gum status, families with both parents employed and parents' education level were found to be associated with better OHRQoL. Four items among the 2 short forms lacked longitudinal invariance. With statistical adjustment of longitudinal invariance, OHRQoL were found improved in general over the 3 years but no predictor was associated with OHRQoL in follow-up. For those with decreased family income, their OHRQoL had worsened over 3 years. CONCLUSIONS: IRT explanatory analysis enables a more valid identification of the factors associated with OHRQoL and its changes over time. It provides important information to oral healthcare researchers and policymakers.

Trends in self-reported oral health of US adults: National Health and Nutrition Examination Survey 1999-2014.

OBJECTIVE: Single-item self-reported oral health (SROH) is a convenient and reliable measure for the assessment of population-based oral health. However, little is known about trends and its associations among US adults. This study investigated trends in SROH (aged 20+ years) and the associated factors among adults living in the United States. METHODS: Self-reported oral health data for 41 621 adults aged 20+ years from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2014 were analysed. Survey-weighted descriptive statistics were computed to provide nationally representative estimates. Multivariable logistic regression was performed separately for each survey period with SROH as the primary outcome. Independent variables included were age, gender, race/ethnicity, education level and family poverty income ratio or PIR. Pooled survey-weighted multivariable logistic regression was also performed to consider possible time-changing effects. RESULTS: The survey-weighted proportions of "excellent or very good" in SROH increased from 27% in 1999-2000 (n = 4873) to 38% in 2013-2014 (n = 5765). Separate multivariable logistic analyses for each survey period suggested that females, Whites (vs Mexican and Black Americans) as well as respondents from high family PIR had higher odds of reporting their oral health as "excellent or very good" (P < .05). The pooled multivariable logistic model confirmed results in the separate logistic regression, and respondents in the more recent survey periods had higher probabilities of reporting "excellent or very good" oral health. Respondents aged 50-59 years were found to have relatively lower probabilities of reporting "excellent or very good" oral health, while people aged 20-29 years had higher probabilities than those aged 30-39 years. Compared to respondents with lower education, those with higher education were more likely to report their oral health as excellent or very good. CONCLUSIONS: Self-reported oral health improved from 1999 to 2014. In general, respondents who were young, female, White, had higher education or higher income or were surveyed in more recent years reported excellent or very good oral health.

Indicators of Dysphagia in Aged Care Facilities.

Purpose: The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly individuals in aged care facilities. Method: A total of 878 individuals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating Assessment Tool score, oral motor assessment score, Mini-Mental State Examination, medical history, and various functional status ratings. Binomial logistic regression was used to identify independent variables associated with dysphagia in this cohort. Results: Two statistical models were constructed. Model 1 used variables from case files without the need for hands-on assessment, and Model 2 used variables that could be obtained from hands-on assessment. Variables positively associated with dysphagia identified in Model 1 were male gender, total dependence for activities of daily living, need for feeding assistance, mobility, requiring assistance walking or using a wheelchair, and history of pneumonia. Variables positively associated with dysphagia identified in Model 2 were Mini-Mental State Examination score, edentulousness, and oral motor assessments score. Conclusions: Cognitive function, dentition, and oral motor function are significant indicators associated with the presence of swallowing in the elderly. When assessing the frail elderly, case file information can help clinicians identify frail elderly individuals who may be suffering from dysphagia.

Motivational Interviewing to Promote Oral Health in Adolescents.

PURPOSE: Motivational interviewing (MI) is a counseling strategy to help people change their behaviors. This single-blinded randomized controlled trial evaluated the effectiveness of MI in improving adolescents' oral health. METHODS: Fifteen secondary schools were randomly assigned to three groups: (I) prevailing health education, (II) MI, and (III) MI coupled with interactive dental caries risk assessment (MI + RA). Adolescents (n = 512) with unfavorable oral health behaviors (infrequent toothbrushing and/or frequent snacking) were recruited; 161, 163, and 188 in groups I-III, respectively. Participants in the three groups received their respective interventions. At baseline and after 6 and 12 months, participants completed a questionnaire on their oral health self-efficacy and behaviors. Their oral hygiene (dental plaque score) and dental caries (number of decayed surfaces/teeth status) were recorded. RESULTS: Compared with group I, subjects in groups II and III were more likely to reduce their snacking frequency (odds ratios [95% confidence intervals {CIs}]: 7.12 [1.80-28.16] and 11.17 [2.90-42.98], respectively) and increase their toothbrushing frequency (odds ratios [95% CIs]: 5.26 [2.28-12.16] and 11.45 [4.99-26.26], respectively) after 12 months. Taking group I as a reference, groups II and III had lower number of new carious teeth △D ICDAS II 1-6MFT (ß [95% CI]: -.24 [-.44 to -.04] and -.31 [-.51 to -.11], respectively). CONCLUSIONS: MI was more effective than prevailing health education strategy in eliciting positive changes in adolescents' oral health behaviors and preventing dental caries.

Pathways of oral health knowledge, attitudes, practices, and status in married couples.

OBJECTIVES: This study aimed to assess the pathways from modifiable risk factors to oral health status in husbands and wives, and correlation in oral health KAP and status between married couples in Hong Kong. METHODS: This was a cross-sectional survey using a combination of random household and purposive sampling. Socio-economic status (SES), smoking, oral health knowledge (K), attitudes (A), and practices (P) of individuals were collected by questionnaire. Tooth status, periodontal status, and oral hygiene status were collected by oral examination. RESULTS: Altogether, 432 families (359 husbands and 419 wives) with a 5- to 7-year-old child participated in this study. Husbands' oral health status was found to be directly associated with their oral health behaviors and smoking habit and indirectly with their socio-economic status, oral health knowledge, and attitudes. The explained variance of husbands' oral health status was 47.2%. Wives' oral health status was only directly associated with their oral health behaviors and indirectly with their socio-economic status, oral health knowledge, and attitudes. The explained variance of wives' oral health status was 53.2%. The correlation coefficient between couple's oral health practices and status was 0.98 and 0.43, respectively. CONCLUSIONS: The hypothesized pathways from socio-economic status and modifiable factors to the oral health status in husbands and wives are not rejected. Oral health practices and status were correlated among married couples.

Evaluation of psychometric properties and differential item functioning of 8-item Child Perceptions Questionnaires using item response theory.

BACKGROUND: Four-factor structure of the two 8-item short forms of Child Perceptions Questionnaire CPQ11-14 (RSF:8 and ISF:8) has been confirmed. However, the sum scores are typically reported in practice as a proxy of Oral health-related Quality of Life (OHRQoL), which implied a unidimensional structure. This study first assessed the unidimensionality of 8-item short forms of CPQ11-14. Item response theory (IRT) was employed to offer an alternative and complementary approach of validation and to overcome the limitations of classical test theory assumptions. METHODS: A random sample of 649 12-year-old school children in Hong Kong was analyzed. Unidimensionality of the scale was tested by confirmatory factor analysis (CFA), principle component analysis (PCA) and local dependency (LD) statistic. Graded response model was fitted to the data. Contribution of each item to the scale was assessed by item information function (IIF). Reliability of the scale was assessed by test information function (TIF). Differential item functioning (DIF) across gender was identified by Wald test and expected score functions. RESULTS: Both CPQ11-14 RSF:8 and ISF:8 did not deviate much from the unidimensionality assumption. Results from CFA indicated acceptable fit of the one-factor model. PCA indicated that the first principle component explained >30 % of the total variation with high factor loadings for both RSF:8 and ISF:8. Almost all LD statistic <10 indicated the absence of local dependency. Flat and low IIFs were observed in the oral symptoms items suggesting little contribution of information to the scale and item removal caused little practical impact. Comparing the TIFs, RSF:8 showed slightly better information than ISF:8. In addition to oral symptoms items, the item "Concerned with what other people think" demonstrated a uniform DIF (p < 0.001). The expected score functions were not much different between boys and girls. CONCLUSIONS: Items related to oral symptoms were not informative to OHRQoL and deletion of these items is suggested. The impact of DIF across gender on the overall score was minimal. CPQ11-14 RSF:8 performed slightly better than ISF:8 in measurement precision. The 6-item short forms suggested by IRT validation should be further investigated to ensure their robustness, responsiveness and discriminative performance.

The relationship between consumption of beverages and tooth wear among adults in the United States.

OBJECTIVES: To investigate the prevalence and severity of tooth wear (TW) and its relationship with consumption of beverages among adults in the United States. METHODS: The National Health and Nutrition Examinations Survey data for 2003-2004 was analyzed. TW was defined as "wear on at least one surface of at least one examined tooth." Drink/juice consumption was ascertained via a Food Frequency Questionnaire processed with Diet*Calc software to obtain the average daily consumption frequency for all queried drinks and juice categories including milk. Survey-weighted descriptive and multivariable analyses with interaction terms were performed. RESULTS: Our study sample consisted of 3,773 adults (aged 20 and above). Eighty percent of the subjects had evidence of TW, and soft drinks were the most consumed beverage. Significant interactions between the effects of age, gender, and race/ethnicity on TW were found (P < 0.001). After adjustment for demographic factors, consumption of fruit drinks was found to be significantly associated with the severity [odds ratio (OR) = 1.32 and 1.42], but not prevalence of TW. However, this trend was reversed for grape juice consumption (OR = 0.34, 0.41). CONCLUSIONS: This study demonstrates that a substantial proportion of adults had evidence of TW, which was affected by demographic factors in a complex way. Fruit drinks consumption in adults was associated with the severity of TW, but not with the prevalence of TW after adjusting for demographics. These findings are important for the development of appropriate treatment guidelines, public policy, and programs aimed at reducing TW in adults.

Treatment seeking behaviour in southern Chinese elders with chronic orofacial pain: a qualitative study.

BACKGROUND: Chronic orofacial pain (OFP) is common in general adult populations worldwide. High levels of psychological distress and impaired coping abilities are common among Western people with chronic OFP but limited information was found in southern Chinese people. This study aimed to explore the perceptions and experiences of community dwelling elderly people with chronic OFP symptoms and their treatment seeking behaviour in Hong Kong. METHODS: An exploratory qualitative interview study was conducted. Elderly people experiencing chronic OFP symptoms were invited to take part in an individual semi-structured interview. A total of 25 semi-structured interviews were performed for 25 participants. RESULTS: Pertinent issues relating to the treatment seeking behaviour emerged from the interviews, many of which were inter-related and overlapping. They were organized into three major themes: (i) Impact of chronic OFP on daily life; (ii) Personal knowledge and feeling of chronic OFP; (iii) Management of chronic OFP. The participants were found to have the intention to seek professional treatment, but there were barriers which discouraged them continuing to seek professional treatment. They also received complementary treatment for chronic OFP, such as acupuncture, massage and "chi kung". Moreover, a wide range self-management techniques were also mentioned. On the other hand, those who did not seek professional treatment for the chronic OFP claimed that they had accepted or adapted to the pain as part of their lives. CONCLUSIONS: This qualitative study observed that elderly people affected by chronic OFP symptoms in Hong Kong sought many different ways to manage their pain including traditional and complementary approaches. The role of the dentist in dealing with chronic OFP is unclear. Multiple barriers exist to accessing care for chronic OFP. The findings may be used to inform future chronic OFP management strategies in Hong Kong.

Effect of systemic antibiotics on clinical and patient-reported outcomes of implant therapy - a multicenter randomized controlled clinical trial.

OBJECTIVES: To determine the effect of various systemic antibiotic prophylaxis regimes on patient-reported outcomes and postsurgical complications in patients undergoing conventional implant installation. MATERIAL AND METHODS: Three hundred and twenty-nine healthy adults in need of conventional implant installation were randomly assigned to one of four groups: (i) preoperatively 2 g of amoxycillin 1 h before surgery (positive control, PC), (ii) postoperatively 2 g of amoxycillin immediately following surgery (test 1, T1), (iii) preoperatively 2 g of amoxycillin 1 h before and 500 mg thrice daily on days 2 and 3 after surgery (test 2, T2), (iv) preoperatively 2 g of placebo 1 h before surgery (negative control, NC). Subjects were examined clinically by blinded examiners over 8 weeks after implant installation. In addition, Visual Analogue Scales (VAS) for pain, swelling, bruising and bleeding were obtained over 14 days. ANOVA was performed for the VAS. Chi-square tests were applied for postsurgical complications. RESULTS: All VAS scores were low for all groups and decreased over time (P < 0.001). There were no significant differences for the VAS scores between the various groups at any time point (P > 0.05). There was only a significant difference in flap closure at week 4, where NC had 5% of the subjects not achieving complete wound closure compared to 0% for the three other groups (P = 0.01), with no other significant differences for any postsurgical complications (P > 0.05). CONCLUSION: For standard single implant placement, prophylactic systemic antibiotics either before or after, or before and after the surgical procedure do not improve patient-reported outcomes or prevalence of postsurgical complications.

Suitability of time estimates for survival analysis of endodontic treatment.

INTRODUCTION: This study aimed to determine the most suitable estimates of the event date for Kaplan-Meier (K-M) survival analysis for the assessment of endodontic treatment outcomes. Survival probability computed using the Weibull accelerated failure time (WAFT) models based on interval-censored data was used for comparison. METHODS: A sample of root canal-treated teeth was included for survival analysis using the K-M and WAFT models. Treatment outcomes were categorized for the presence or absence of periapical healing and tooth survival. For the K-M analysis, the following time estimates between a visit when failure was diagnosed and the preceding visit were tested: the one-quarter point (T1), the half-way point (T2), the three-quarter point (T3), the date of diagnosis (T4), and the geometric mean (T5). RESULTS: The survival curve plotted from T2 consistently showed the least discrepancies in trend when compared against the WAFT curve. Those curves generated from T1 to T5 were significantly different from each other for periapical healing but not for tooth survival. CONCLUSIONS: T2 is the most reliable date for K-M analysis for measuring endodontic outcomes, especially when periapical healing is concerned. T4 would be a reasonable estimate for assessing tooth survival. Further research aiming at appropriate statistical exercise with simulations followed by proper goodness of fit tests should be considered.

Relationship between children's oral health-related behaviors and their caregiver's sense of coherence.

BACKGROUND: Sense of coherence (SOC) is hypothesized to be an important psychological factor that enables people to cope with stressors and successfully maintain and improve health. Mother's SOC has been shown to be an important psychological factor associated with oral health and oral health-related behaviors of adolescents and 11- to 12-year-old children. However, little is known about the relationship between the caregiver's SOC and oral health-related behaviors of the preschool children. The objective of this study was to investigate the relationship between oral health-related behaviors of 5-year-old children in Southern China and SOC of their caregiver. METHODS: A cross-sectional study was conducted in a randomized sample of 1332 children aged 5 years and their caregivers in Guangzhou, Southern China. Data were collected through questionnaires completed by the caregivers. The Chinese short version of Antonovsky's SOC scale (13 items) was employed to assess the caregiver's SOC. The outcome variables were the child's oral health-related behaviors, including frequency of sugary snack intake, toothbrushing frequency, utilization of dental service, and pattern of dental visits. Multiple logistic regression was used to analyze the relationship between the variables. RESULTS: No association was found between the children's sugary snack intake and the mother's or the father's SOC. After adjustment for other significant factors related to the child's oral health-related behaviors, 8.9% of the children whose grandparents (as caregivers) had higher SOC scores had a lower frequency of sugary snack intake, compared with the children whose grandparents had lower SOC scores (OR = 0.61, 95% CI = 0.50-0.73, p = 0.008). The other measures of oral health-related behaviors of the child were not significantly associated with the caregiver's SOC. CONCLUSION: Sugary snack intake behavior of the 5-year-old children was not associated with the mother's or the father's SOC. It was associated with the SOC of their grandparents, who are a small group of the caregivers in China.

A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans.

BACKGROUND: Removal of teeth results in both horizontal and vertical changes of hard and soft tissue dimensions. The magnitude of these changes is important for decision-making and comprehensive treatment planning, with provisions for possible solutions to expected complications during prosthetic rehabilitation. OBJECTIVES: To review all English dental literature to assess the magnitude of dimensional changes of both the hard and soft tissues of the alveolar ridge up to 12 months following tooth extraction in humans. METHODS: An electronic MEDLINE and CENTRAL search complemented by manual searching was conducted to identify randomized controlled clinical trials and prospective cohort studies on hard and soft tissue dimensional changes after tooth extraction. Only studies reporting on undisturbed post-extraction dimensional changes relative to a fixed reference point over a clearly stated time period were included. Assessment of the identified studies and data extraction was performed independently by two reviewers. Data collected were reported by descriptive methods. Weighted means and percentages of the dimensional changes over time were calculated where appropriate. RESULTS: The search provided 3954 titles and 238 abstracts. Full text analysis was performed for 104 articles resulting in 20 studies that met the inclusion criteria. In human hard tissue, horizontal dimensional reduction (3.79 ± 0.23 mm) was more than vertical reduction (1.24 ± 0.11 mm on buccal, 0.84 ± 0.62 mm on mesial and 0.80 ± 0.71 mm on distal sites) at 6 months. Percentage vertical dimensional change was 11-22% at 6 months. Percentage horizontal dimensional change was 32% at 3 months, and 29-63% at 6-7 months. Soft tissue changes demonstrated 0.4-0.5 mm gain of thickness at 6 months on the buccal and lingual aspects. Horizontal dimensional changes of hard and soft tissue (loss of 0.1-6.1 mm) was more substantial than vertical change (loss 0.9 mm to gain 0.4 mm) during observation periods of up to 12 months, when study casts were utilized as a means of documenting the changes. CONCLUSIONS: Human re-entry studies showed horizontal bone loss of 29-63% and vertical bone loss of 11-22% after 6 months following tooth extraction. These studies demonstrated rapid reductions in the first 3-6 months that was followed by gradual reductions in dimensions thereafter.

A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year.

BACKGROUND: Type I immediate implant placement has gained popularity because it may reduce treatment time, number of surgeries and post-extraction bone loss. However, this is potentially challenged by inadequate keratinized mucosa for flap adaptation and difficulties in achieving primary stability. Moreover, it has been proven that post-extraction bone loss is an inevitable biological process, which affects treatment outcomes. OBJECTIVES: To estimate survival and success rates of implants and the implant-supported prostheses, the prevalence of biological, technical and aesthetic complications, and the magnitude of soft and hard tissue changes following implant placement immediately into fresh extraction sockets. MATERIAL AND METHODS: An electronic search in MEDLINE (PubMed) and the Cochrane Library from 1991 to July 2010 was performed to include prospective studies on immediate implants with a mean follow-up time of at least 1 year. The survival rates were computed using the STATA statistical software. Weighted means of soft and hard tissue changes were obtained by the inverse variance method. RESULTS: A total of 46 prospective studies, with a mean follow-up time of 2.08 years, were included. The annual failure rate of immediate implants was 0.82% (95% CI: 0.48-1.39%), translating into the 2-year survival rate of 98.4% (97.3-99%). Among the five factors analysed (reasons for extraction, antibiotic use, position of implant [anterior vs. posterior, maxilla vs. mandible), type of loading], only the regimen of antibiotic use affected the survival rate significantly. Lower failure rates were found in groups that were provided with a course of post-operative antibiotics. The success of implant therapy was difficult to assess due to scarce reporting on biological, technical and aesthetic complications. Soft tissue changes occurred mostly in the first 3 months after the provision of restoration, and then stabilized towards end of the first year. Marginal bone loss predominantly took place in the first year after implant placement, with a magnitude generally less than 1 mm. Controversy on hard tissue preservation with platform-switching technique remained unsolved. CONCLUSIONS: Despite the high survival rate observed, more long-term studies are necessary to determine the success of implant treatment provided immediately after tooth extraction. Special attention has to be given to aesthetic outcomes.