Saliva as an alternative to blood in the determination of uremic state in adult patients with chronic kidney disease: a systematic review and meta-analysis.

OBJECTIVES: To assess whether salivary urea and creatinine levels accurately reflect their serum levels in blood samples of adults to detect chronic kidney disease. MATERIALS AND METHODS: A systematic review was conducted in eight electronic databases. The protocol was registered in PROSPERO. Only diagnostic test studies were included. The JBI critical appraisal tools assessed the risk of bias. A meta-analysis of proportions was performed. The GRADE tool assessed the quality of evidence and strength of recommendation across the studies included. RESULTS: Eight studies met the eligibility criteria and were included. Six studies assessed salivary urea, and six studies assessed salivary creatinine. All studies presented moderate risk of bias. The meta-analysis depicted an overall sensitivity of 93.3% (95% CI = 88.6; 97.9) for salivary creatinine levels and 87.5% (95% CI = 83.2; 91.8) for salivary urea levels, while the overall specificity was 87.1% (95% CI = 82.8; 91.3) and 83.2% (95% CI = 65.0; 101.4) for salivary creatinine and urea levels, respectively. The overall accuracy of salivary creatinine was 5.2 percentage points higher compared with salivary urea levels (90.8% vs. 85.6%). According to the GRADE tool, the analysed outcomes were classified as having low to moderate level of certainty. CONCLUSION: Compared with blood samples, salivary urea and creatinine levels presented high diagnostic values for chronic kidney disease screening, but should not be considered equivalent to levels obtained from blood at stages three, four, or five of the disease. CLINICAL SIGNIFICANCE: Chronic kidney disease patients could receive a clinically significant benefit from replacing blood with saliva for potentially monitoring renal function. Saliva collection presents greater simplicity, comfort, safety, and lower collection cost.

Maxillary incisor root morphology in patients with nonsyndromic tooth agenesis: A controlled cross-sectional pilot study.

INTRODUCTION: This study aimed to investigate the association between root morphology of maxillary incisors and nonsyndromic tooth agenesis in patients compared with a control group without agenesis. METHODS: This controlled cross-sectional pilot study (1:4) was performed with a random sample of 335 records from Brazilian applicants for orthodontic treatment, paired by sex and age. Panoramic and periapical radiographs were analyzed to diagnose tooth agenesis and to assess root morphology. The agenesis group (n = 67) included patients with nonsyndromic tooth agenesis, and the control group (n = 268) included patients without tooth agenesis. The statistical analysis included the Student t test and z test, conditional logistic regression, and odds ratio estimates. RESULTS: Occurrence of root morphological changes was significantly higher among patients with agenesis (P <0.05). Significant morphological changes (short, blunt, apically bent, and pipette-shaped roots) were found in the roots of remaining teeth when comparing agenesis and control groups (P <0.05). Patients with agenesis were more likely to show root morphological changes (odds ratio, 74.23; 95% confidence interval, 16.93-325.46; P <0.001). CONCLUSION: Patients with agenesis are more likely to present root morphological changes, which should be considered to minimize problems during orthodontic treatments.

Social determinants of health and maxillofacial injuries in children and adolescents victims of violence: A novel GIS-based modelling application.

BACKGROUND: Physical violence against children and adolescents comprises a serious public health problem and often results in oral and maxillofacial traumas. Social determinants may favour the occurrence of these events, but few studies have critically evaluated the interaction between social and geographical risk factors. AIMS: To investigate the spatiotemporal distribution of oral and maxillofacial traumas resulting from violence against children and adolescents through geostatistical techniques. METHODS: This study was an ecological analysis of cases of trauma caused by violence against Brazilian children and adolescents using aggregated data from victims attended at a Center of Forensic Medicine and Forensic Dentistry between January 2012 and December 2015. Data were analysed through modelling based on geographic information system (GIS). RESULTS: Two distinct patterns of longitudinal trajectory of oral and maxillofacial trauma related to violence against children and adolescents were identified (TP1 and TP2, P < 0.05). The spatial regression analysis revealed a statistically significant association between higher incidence of cases and areas with worse socioeconomic conditions (ß = 0.047, SE = 0.020, P < 0.05). CONCLUSION: Neighbourhoods with considerable socio-spatial vulnerability for violence against children and adolescents and maxillofacial traumas were identified.

Firearms, Violence-Related Injuries, and Victimization Profiles: An Approach Using Cluster Analysis.

The aim of this study was to characterize the profile of nonlethal victims of urban violence by firearms and to describe traumas suffered by victims, according to a medical-legal and forensic perspective. A cross-sectional and exploratory study was conducted at the Center of Forensic Medicine and Dentistry in northeastern Brazil. The sample consisted of 233 victims of urban violence by firearm who presented some type of trauma. Descriptive and multivariate statistics using cluster analysis (CA) were performed. The TwoStep Cluster method was chosen to characterize the profile of victims. The night shift (56.8%) and the period corresponding to Saturdays (20.0%) and Sundays (20.4%) concentrated the largest number of occurrences. Cases of trauma in more than one region of the body simultaneously prevailed (31.8%). Based on the CA results, the formation of two clusters with distinct victimization profiles was verified. Cluster 1 was mostly characterized by younger single victims who suffered violence by firearm in the urban area perpetrated by an unknown perpetrator, resulting in greater occurrence of isolated upper and lower limb traumas. In contrast, Cluster 2 consisted essentially of older, married, or stable-union victims who experienced firearm violence in the suburban area, perpetrated by a known aggressor, resulting in greater occurrence of multiple traumas, that is, affecting several regions of the body at the same time. These findings reveal different risk groups for urban violence by firearms and traumas, contributing to the planning of strategies with emphasis on health care, prevention, and promotion.

Aesthetic facial perception and need for treatment in simulated laterognathism in male faces of different ethnicities.

PURPOSE: This study aimed to compare the aesthetic perception and treatment need in individuals of different ethnicities with various degrees of laterognathism assessed by orthodontists, oral and maxillofacial surgeons, and laypersons. METHODS: Three male descendants of different ethnicities were assessed, in which the mandibular deviation was manipulated digitally in different angulations (from 0 to 8°). The assessment was performed by three groups (orthodontists, maxillofacial surgeons, and laypersons (n = 20)), and it consisted of scoring the degree of pleasantness of the images presented in a numerical scale and indicating or not a corrective treatment for the respective image. RESULTS: The higher the degree of deviation, the lower the scores assigned to the image (p < 0.05). Laypersons assigned the highest scores, with a significant difference between laypersons and oral and maxillofacial surgeons (p < 0.05). In terms of treatment need according to the group of evaluators, there were no statistically significant differences among them (p > 0.05). Moreover, the increase in degree of deviation increased the perception of treatment need (p < 0.05). The African faces received the highest scores, with significant differences from the Caucasian faces (p < 0.05). The overall tendency was higher treatment indication for the Caucasian faces, with statistically significant differences from the African faces (p < 0.05). CONCLUSION: The greater the mandibular deviation, the lower the aesthetic pleasantness. Laypersons are less critical regarding the assessment of mandibular deviation. There was no difference for treatment indication by the different groups of evaluators. In addition, ethnicity may influence the perception and treatment indication.

Prevalencia de Hipomineralización Molar-Incisica (HMI) en niños brasileños y asociación con enfermedades respiratorias o nacimientos prematuros / Prevalence of Molar Incisor Hypomineralization (MIH) in Brazilian children and investigation with respiratory diseases or premature births

La Hipomineralización Molar Incisiva (HMI) se describe como un defecto cualitativo en el desarrollo del esmalte que afecta al menos a un molar permanente, pudiendo o no afectar a los incisivos permanentes. La prevalencia reportada en la literatura mundial varía del 2,8% al 44%. Su etiología aún es incierta, y frecuentemente se asocia con factores prenatales, perinatales y posnatales. Objetivos: evaluar la prevalencia de HMI en pacientes atendidos en una Facultad de Odontología en la ciudad de Vitória-ES y su asociación con factores causales. Métodos: se evaluaron clínicamente 302 niños, con edades comprendidas entre los 5 y 14 años, en condiciones ideales en la Clínica Infantil de la Facultad de Odontología de MULTIVIX, y se les aplicó un cuestionario. Resultados: 66 niños (21,85%) presentaron HMI. No hubo diferencias significativas entre los sexos y no se encontró asociación con enfermedades respiratorias en la infancia ni parto prematuro. Conclusión: se encontró una alta prevalencia de HMI en niños brasileños y ninguna asociación con enfermedades respiratorias o partos prematuros. Se sugiere realizar nuevos estudios con criterios estandarizados para determinar la prevalencia y su relación con factores causales.

Molar Incisor Hypomineralization (MIH) is described as a qualitative enamel development defect that affects at least one permanent molar and may or may not affect the permanent incisors. The prevalence reported in the world literature ranges from 2.8% to 44%. Its etiology is still unclear, with prenatal, perinatal and postnatal factors often associated. Objectives: evaluate the prevalence of HMI in patients attented at a Dental School in the city of Vitória-ES and its association with causal factors. Methods: 302 children with the presence of first permanent molars, aged between 5 and 14 aged, were clinically evaluated under ideal conditions at the Children's Clinic of the Faculty of Dentistry of MULTIVIX and a questionnaire was applied. Results: 66 children (21.85%) had HMI. There was no significant difference between the sexes and there was no association with childhood respiratory diseases and preterm birth. Conclusion: High prevalence of MIH was found in Brazilian children and no association with respiratory diseases or premature births. It is suggested that further studies be carried out with standardized criteria to determine the prevalence and its relationship with causal factors.

Influence of reminder therapy for controlling bacterial plaque in patients undergoing orthodontic treatment: A systematic review and meta-analysis.

OBJECTIVE: To assess the scientific evidence regarding the influence of reminder therapy on plaque index, gingival index, and white spots in patients subjected to orthodontic treatment. MATERIALS AND METHODS: Randomized clinical trials were searched in the electronic databases LILACS, PubMed, SciELO, Scopus, Web of Science, Embase, LIVIVO, and Cochrane Library. The databases OpenThesis and OpenGrey were used to capture the "gray literature," preventing selection and publication biases. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials tool. The software Review Manager was used for the meta-analysis. The heterogeneity among studies was assessed through the I 2 statistic. A summary of the overall strength of evidence available was assessed using the Grades of Recommendations Assessment, Development, and Evaluation tool. RESULTS: A total of 332 records were found, from which only 7 articles met the inclusion criteria and were subjected to analysis. Reminder therapy showed improved scores for the plaque index (standardized mean difference = -1.22; 95% confidence interval = -2.03 to -0.42; P = .003) and the gingival index (standardized mean difference = 1.49; 95% confidence interval = -2.61 to 0.37; P = .009). Moreover, there was lower occurrence of white spots (relative risk = 0.53; 95% confidence interval = 0.38 to 0.74; P < .001) when reminder therapy was implemented. CONCLUSIONS: According to the existing high-quality evidence, reminder therapy is a valuable strategy and may contribute to the reduction of plaque and gingival indices as well as to the lower occurrence of white spots in patients subjected to orthodontic treatment.

Intimate partner violence against women, circumstances of aggressions and oral-maxillofacial traumas: A medical-legal and forensic approach.

INTRODUCTION: Intimate partner violence (IPV) is a serious public health problem that frequently results in oral-maxillofacial traumas, generating high social and economic costs. The aim of this study was to describe the profile of women victims of IPV and determine the pattern of oral-maxillofacial traumas, according to a medical-legal and forensic perspective. An exploratory study of 1361 suspected cases of women victims of IPV was carried out based on database of an Institute of Legal Medicine and Forensic Dentistry of Northeastern Brazil during a period of 4 years. Medico-legal and social records of victims were searched for information related to sociodemographic data, circumstances of aggressions and trauma patterns. Descriptive and multivariate statistics and Multiple Correspondence Analysis (MCA) were performed. MAIN RESULTS: Almost half of victims exhibited some oral-maxillofacial trauma resulting from IPV (45.8%). Lesions affecting more than one third of the face (41.3%), especially in soft tissues (96.1%) were the most common. Based on the MCA results, two distinct victimization profiles (P1 and P2) have been identified. P1 was mainly characterized by women aged less than 28 years, living in the urban area, with higher education and working. They were assaulted using physical force in community settings perpetrated by former partner or ex-boyfriend during the night and weekends, resulting in oral-maxillofacial traumas. P2 was mainly composed of women aged over 28 years, living in the suburban or rural areas, with low schooling and who did not work. They were assaulted by firearm or weapon in their own home, perpetrated by their partner or boyfriend during the day and weekdays, resulting in trauma to other body parts. CONCLUSIONS: Oral and maxillofacial traumas are very common among women victims of IPV who searched for medical-legal service. In this context, forensic dentists can play a key role during the diagnostic process and should always work together with medical, biochemical and toxicological experts. The findings of this study may contribute to the formulation of evidence-based policies.

Facial trauma as physical violence markers against elderly Brazilians: A comparative analysis between genders.

The aim of this study was to characterize the profile of elderly Brazilians with injuries resulting from physical violence and identify victimization differences. A descriptive and exploratory study was conducted involving the analysis of medico-legal and social records of 259 elderly victims of physical violence treated at an Institute of Forensic Medicine and Dentistry over four years (from January 2008 to December 2011). The forensic service database was evaluated by researchers properly trained and calibrated to perform this function between January and March 2013. Socio-demographic variables of victims, aggression characteristics, aggressor's profile and types of lesions were evaluated. Descriptive and multivariate statistics using Multiple Correspondence Analysis (MCA) were performed. The prevalence of facial trauma was 42.9%. Based on the MCA results, two groups with different victimization profiles were identified: married men aged 70-79 years, victims of community violence at night, suffering facial injuries; and single, widowed or separated women aged 60-69 years, victims of domestic violence during the day, suffering trauma in other areas of the body. The results suggest that there is a high prevalence of facial injuries among elderly Brazilians victims of physical violence and there are important differences related to victimization characteristics according to gender.