Association of periodontal therapy, with inflammatory biomarkers and complications in COVID-19 patients: a case control study.

BACKGROUND: In previous studies, COVID-19 complications were reported to be associated with periodontitis. Accordingly, this study was designed to test the hypothesis that a history of periodontal therapy could be associated with lower risk of COVID-19 complications. METHODS: A case-control study was performed using the medical health records of COVID-19 patients in the State of Qatar between March 2020 and February 2021 and dental records between January 2017 and December 2021. Cases were defined as COVID-19 patients who suffered complications (death, ICU admissions and/or mechanical ventilation); controls were COVID-19 patients who recovered without major complications. Associations between a history of periodontal therapy and COVID-19 complications were analysed using logistic regression models adjusted for demographic and medical factors. Blood parameters were compared using Kruskal-Wallis test. RESULTS: In total, 1,325 patients were included. Adjusted odds ratio (AOR) analysis revealed that non-treated periodontitis was associated with significant risk of need for mechanical ventilation (AOR = 3.91, 95% CI 1.21-12.57, p = 0.022) compared to periodontally healthy patients, while treated periodontitis was not (AOR = 1.28, 95% CI 0.25-6.58, p = 0.768). Blood analyses revealed that periodontitis patients with a history of periodontal therapy had significantly lower levels of D-dimer and Ferritin than non-treated periodontitis patients. CONCLUSION: Among COVID-19 patients with periodontal bone loss, only those that have not received periodontal therapy had higher risk of need for assisted ventilation. COVID-19 patients with a history of periodontal therapy were associated with significantly lower D-dimer levels than those without recent records of periodontal therapy. CLINICAL RELEVANCE: The fact that patients with treated periodontitis were less likely to suffer COVID-19 complications than non-treated ones further strengthen the hypothesis linking periodontitis to COVID-19 complications and suggests that managing periodontitis could help reduce the risk for COVID-19 complications, although future research is needed to verify this.

Effect of time-dependent ibuprofen administration on the post operatory after impacted third molar extraction: a cross-over randomized controlled trial.

PURPOSE: To evaluate time-dependent administration of ibuprofen in a lower third molar extraction model. METHODS: Eleven patients requiring bilateral surgical removal of lower third molars were recruited and randomized into a blinded crossover randomized controlled trial. For 3 days after surgery, the control group was prescribed ibuprofen 400 mg every 8 h. On the other hand, the experimental group received also ibuprofen 400 mg at breakfast and lunch, replacing the dinner intake with a placebo. Pain measurements (Visual Analog Scale from 0 to 10) were recorded at baseline, 24, 48, and 72 h postoperatively. Facial swelling and trismus were also measured at baseline, 24, and 72 h postoperatively. RESULTS: Postoperative swelling and pain perception did not show significative difference between the control and experimental groups at 24, 48, and 72 h. Trismus was significantly lower in the control group than in the experimental group at 72 h postoperatively (p = 0.008). Rescue medication consumption seemed to be comparable between groups. CONCLUSION: Eliminating night time ibuprofen might be insignificant for pain control after third molar extraction.

Chronotherapy in dentistry: A scoping review.

The circadian clock modulates almost all vital aspects of our physiology and metabolism, including processes relevant to dentistry, such as healing, inflammation and nociception. Chronotherapy is an emerging field aiming to improve therapeutic efficacy and decrease adverse effects on health outcomes. This scoping review aimed to systematically map the evidence underpinning chronotherapy in dentistry and to identify gaps in knowledge. We conducted a systematic scoping search using four databases (Medline, Scopus, CINAHL and Embase). We identified 3908 target articles screened by two blinded reviewers, and only original animal and human studies investigating the chronotherapeutic use of drugs or interventions in dentistry were included. Of the 24 studies included, 19 were human studies and five were animal studies. Chrono-radiotherapy and chrono-chemotherapy reduced treatment side effects and improved therapeutic response, leading to higher survival rates in cancer patients. Animal studies reported that tooth movement and periodontal tissue response to orthodontic forces follow a diurnal rhythm that might influence bone metabolism. Profound and prolonged local anesthesia could be achieved when injected in the evening. Although the overall quality of the included studies was low, chronotherapy applications in dentistry seem to have favourable outcomes, especially in head and neck cancer treatments.

NSAID chronotherapy after impacted third molar extraction: a randomized controlled trial.

OBJECTIVES: Postoperative pain management impacts patients' quality of life and morbidity. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are widely used for this following a 3-doses-per-day regime. However, pain and inflammation follow a circadian rhythm, and animal models assessing the scheduling of NSAID administration (e.g., chronotherapy) have shown that while their use during the active phase of the day enhances postoperative recovery, their administration during the resting phase could have detrimental effects. This observation has led us to hypothesize that night administration of NSAID might be unnecessary in post-surgical scenarios. Therefore, a randomized clinical trial was conducted to test this hypothesis in surgical third molar extractions. MATERIALS AND METHODS: Seventy (18-35 years) healthy participants requiring surgical removal of impacted lower third molars were recruited and randomized into a double-blind placebo-controlled study. For three days postoperatively, the treatment group (n = 33) received ibuprofen (400 mg) at 8 AM, 1 PM, and a placebo at 8 PM, while the control group (n = 37) received ibuprofen (400 mg) at 8 AM, 1 PM, and 8 PM. Pain severity was assessed by visual analog scale (VAS) and healing indicators including facial swelling, mouth opening, and C-reactive protein blood levels were also measured. RESULTS: Pain VAS measures showed a circadian variation peaking at night. Also, no significant differences were observed between the two groups of the study in terms of postoperative pain scores (estimate: 0.50, 95% CI = [- 0.38, 1.39]) or any other healing indicator. CONCLUSIONS: Postoperative pain follows a circadian rhythm. Moreover, night administration of ibuprofen might not provide any significant benefits in terms of pain management and control of inflammation, and two doses during the day only could be sufficient for pain management after surgical interventions. KNOWLEDGE TRANSFER STATEMENT: Even though this study cannot rule out the possibility that a reduced regime is different than a standard regime, nocturnal doses of ibuprofen seem to have no clinical significance in the short term, and the results of this study provide evidence in favor of reducing ibuprofen administration from three doses to two doses only after third molar surgery.

Impact of Bone Augmentation of Facial Bone Defect around Osseointegrated Implant: A Three Dimensional Finite Element Analysis.

(1) Background: When dental implants are placed at the esthetic zone, facial bone fenestration might be expected. This study aimed to evaluate the biomechanical effect of bone augmentation around implants with facial bone fenestration defects using the finite element method. (2) Methods: An anterior maxillary region model with facial concavity was constructed with a threaded implant inserted following the root direction, resulting in apical threads exposure to represent the fenestration model. Several bone coverage levels were simulated by gradually shifting the deepest concavity point buccally, mimicking bone augmentation surgeries with different bone fill results. Oblique forces were applied, and analysis was performed. (3) Results: Peak compressive stress magnitude and distribution varied according to the level of exposure and facial concavity depth. The fenestration model demonstrated a slightly lower peak peri-implant bone stress, smaller implant displacement, and smaller bone volume with strain levels above 200 µ strain. A gradual increase in compressive stress, implant displacement, and bone volume exhibited strain level above 200 µ strain was observed with the increased bone fill level of the facial bone fenestration. (4) Conclusions: Exposure of implants apical threads at the maxillary anterior region does not significantly affect the peri-implant stress and strain results. However, increasing the buccolingual width and eliminating the buccal concavity might increase the peri-implant bone volume exhibited favorable loading levels.

Needle-free injection: Dental infiltration anesthesia.

This study aimed to develop an optimal Needle-Free Liquid Jet Injection (NFLJI) technique for dental infiltration anesthesia and evaluate its clinical safety and feasibility. The fluid dynamics of NFLJI in the dentoalveolar region were investigated using soft tissue phantoms supported by rigid glass. NFLJIs were performed at different incident angles and recorded using a high-speed camera. Accordingly, an optimal NFLJI for infiltration anesthesia was developed and validated on cadavers, then assessed in two pilot Randomized Controlled Trials (RCT): one for validating the safety of optimal NFLJI technique, the other for evaluating its feasibility and safety. High-speed videos showed that perpendicular NFLJIs induced significantly more regurgitation than oblique NFLJIs, which was confirmed in cadavers. Clinical trials revealed that perpendicular NFLJIs induced a high risk of bleeding (83.3%) and laceration (83.3%), whereas oblique NFLJIs induced a low risk of bleeding (33.3%) and laceration (16.7%). Moreover, the preliminary success rates of oblique NFLJIs and needle injections were both 83.3%. The recruitment took 3-5 weeks with a rate of 100%. Oblique NFLJIs could be a promising approach for dental infiltration anesthesia, causing minimal drug regurgitation with a relatively low risk of complication. The pilot RCTs confirmed the feasibility for conducting a non-inferiority RCT.

Impact of Blended Learning on Dental Students' Performance and Satisfaction in Clinical Education.

The aim of this study was to evaluate the effectiveness of a blended learning model with a flipped classroom approach in a clinical dental education setting based on student performance and perceptions. Comparisons were made between blended learning and traditional methods for all fourth-year dental students in two consecutive cohorts in a conservative dentistry course at a dental school in Jordan. The 2016-17 cohort (control group) consisted of 364 students taught with conventional methods. The 2017-18 cohort (study group) consisted of 253 students taught with blended learning using a flipped classroom method. Performance measures were two exams (online and written), two assignments, inclinic quizzes, and clinical assessment. The study also assessed the number of posts made by students in the study group on an online discussion forum. The results showed that the study group students had significantly better performance on all assessments than the control group students. The students' overall grades in the blended learning cohort were an average 7.25 points higher than in the control cohort. Students who participated in the online forum also had better performance in the course: one participation correlated with 0.697 standard deviations higher score. Overall, students' perceptions were positive and supported the adoption of a blended learning model in the course. These results showing improved student performance provide support for blended learning and use of an online discussion forum.

Debate as an Adjunct Tool in Teaching Undergraduate Dental Students.

This work is an attempt to explore the potential of a new educational method that integrates debate as a teaching tool. This new teaching method was implemented into a single academic semester of an undergraduate bachelor of dentistry program. We sought to combine knowledge delivery with high-level debate between student debaters, and with the active participation of the audience who were themselves students. The teaching method comprised of three elements namely debates, reply speeches, and policy papers. Debating followed the World School Debate Championship (WSDC) format. Debate evaluation involved five main categories; argument, rebuttal, style, definition and strategy, and points of information (POIs). Student perception towards this educational method was evaluated using a Likert-scale questionnaire. Students gained valuable knowledge from the experience as reflected by the favorable Likert outcome scores. This work sheds light on the potential advantages of utilizing debate as a teaching tool from a student's perspective. Implementing debate in teaching improved students' ability to search and appraise scientific papers and proved to be meaningful and enjoyable. The carefully tailored 10-week format ensured good student responsiveness and engaged the entire class in an interactive, participatory setup. This educational method proved to be very effective in evidence-based dentistry teaching by promoting a deeper approach to learning that can help students to learn meaningfully and enhance their critical thinking skills.