What do we know about Indigenous Peoples with low back pain around the world? A topical review.

BACKGROUND: Low back pain (LBP) represents a worldwide burden with rising disability, especially in low- and middle-income countries. Indigenous Peoples are exposed to many risk factors for LBP and seem to have overall worse health and higher mortality compared to non-Indigenous. This article aims to provide a topical overview of LBP in Indigenous Peoples. METHODS: A comprehensive search was done using the keywords "Indigenous" and "back pain." Secondly, a cross-reference search of the citations list of the included articles was conducted. RESULTS: LBP is a prevalent, disabling health condition among Indigenous Peoples that impacts activities of daily living, emotional well-being, and cultural identity. Indigenous Peoples face numerous and unique barriers to obtain Western health care. LBP in Indigenous Peoples is partly iatrogenic and available health care lacks a culturally secure setting. In combination with racism and discrimination by health care providers, this leads to miscommunication, frustration, and poor outcome in Indigenous patients around the world. CONCLUSION: Contextual considerations and interpretation of findings within the appropriate cultural context are needed in future research and treatment of LBP in Indigenous Peoples. However, our literature analysis exhibits disproportionate representation with the scarcity of studies of Indigenous Peoples of Asia and Africa. Addressing this gap in the literature could provide significant scientific value. Indigenous Peoples should not be forgotten in reducing the global burden for LBP.

A systematic review on 4D images of the upper airway in patients with OSA.

AIM-BACKGROUND: In the treatment of obstructive sleep apnoea (OSA), oral appliances are now being recognized as a valuable alternative to continuous positive airway pressure (CPAP). Various static imaging techniques of the upper airways allow for assessment of bone and soft tissue structures. However, static images do not capture dynamic airway characteristics. The aim of this paper was to review 4D imaging techniques in patients with OSA. METHODS: PubMed/MEDLINE, Web of Science and Embase were systematically searched for studies published before June 2022. The review was compliant with the PRISMA guidelines. The quality of each eligible study was critically evaluated by all four authors independently. Four unique articles with qualitative analyses were retrieved. All included studies had a clear objective/aim, an appropriate endpoint and sufficiently described eligibility criteria. RESULTS: With dynamic imaging (4D) evaluation of the upper airway, the incidence of upper airway collapsibility due to use of a mandibular advancement device (MAD) was reduced, extraluminal tissue pressure was decreased and the space in the upper airway was increased, notably in the retropalatal and retroglossal areas of the airway. These findings suggest that MADs may be effective for OSA regardless of whether or not the obstruction site is in the velopharynx or oropharynx. However, further investigation of dynamic changes in the upper airway is required to explain the efficacy of OSA treatment and the underlying mechanisms.

A scoping review of life skills development and transfer in emerging adults.

Emerging adulthood is a unique and sensitive life period during which most psychiatric conditions emerge. Development of life skills and transfer of these skills between contexts may be considered essential for transitioning from emerging adulthood to young adulthood. In the present scoping review of 83 articles published between 2010 and 2022, we address the state of research on life skills development and transfer in emerging adults aged 18-30. Specifically, we were interested in how life skills are defined, which specific life skills are proposed and how life skills transfer is conceptualized for this age group, with an emphasis on cognitive, personal, and interpersonal components. The results show that only a small minority of the reviewed studies defined the term life skills and an even smaller number mentioned the concept of life skills transfer, with only one study actually mentioning transfer components. Life skills research for emerging adults strongly focuses on vulnerable populations (e.g., developmental and contextual vulnerabilities, and sexually transmittable infections treatment and prevention) with the five most frequently mentioned life skills being budgeting/ finances, communication, problem-solving, decision-making, and emotional regulation. We discuss these results in light of future research directions and the lessons learned for life skills development and transfer research in emerging adults. Systematic review registration: All analyzed articles are available at: https://osf.io/gmk8w/.

Incidence of Peri-Implantitis, Technical and Biological Complications of Single Implants Placed with Flap or Flapless Surgery-A 10-12-Year Case-Series.

BACKGROUND: Long-term follow-up of single implants and crowns is scarce, especially when inserted using flapless surgery. AIM: Evaluate survival, peri-implantitis incidence, and technical/biologic complications of solitary implants/crowns after 10-12 years of function. MATERIAL AND METHODS: 49 patients with 53 single implants, initially operated with a one-stage flap (F) or flapless (FL) surgery and delayed loading, were recalled. Implant survival, radiographic bone-level changes compared to baseline, peri-implant health, and soft tissue aesthetics were registered. Differences in implant level between and within groups were statistically tested using the Mann-Whitney U-Test and Wilcoxon Signed Ranks Test, respectively. RESULTS: 36 patients with 40 implants were reassessed, yielding 100% implant and 97.5% crown survival. The bone loss in F (n = 19) was 0.56 mm (SD 0.89; range -0.9-2.02) and -0.85 mm (SD 0.98; range -2.84-0.53) in FL (n = 21), indicative of bone gain in FL (p = 0.003), the latter due to a difference at baseline but bone-level was comparable (p = 0.126). Groups were comparable for probing pocket depth (PPD); (3.32 vs. 3.19 mm), Bleeding Index (BI); (0.15 vs. 0.22), and gingival recession; (0.38 vs. 0.17 mm). According to international criteria, the peri-implantitis incidence was 0%, but 32.5% of the implants/crowns experienced biological or technical complications irrespective of surgical technique. CONCLUSIONS: Solitary implants and crowns show good long-term clinical outcomes and peri-implant health. Flapless surgery is a good alternative to conventional in straightforward cases with sufficient bone volume and proper treatment planning.

A Parental Behavior Scale in Pediatric Dentistry: The Development of an Observational Scale.

Children's treatment means a triangular relationship between the child, practitioner, and parent, with specific interactions influencing the procedure. The objective was to create and validate a hetero-rating scale of parental behavior and verify the correlation between child and parental behavior during pediatric dentistry sessions. Treatment sessions were recorded and evaluated, including 60 children representing three age groups. Two raters interpreted the resulting video clips using the modified Venham scale for children and the new hetero-rating scale for parents. They analyzed the videos twice and attributed scores at different time points of the appointment. The correlation between parental behavior upon entrance and the children's behavioral at the dental office in the treatment stage was significantly positive in both raters (Kendall Tau: 0.20-0.30). Furthermore, a panel of 20 dental practitioners scored a randomized selection of five recordings per age group. The level of agreement between the two experts was higher than that between the 20 clinicians. Venham types of scale involving multiple aspects can be used in research, but their application in dental practice requires further development. The link between parental anxiety and child anxiety is confirmed, but further research is required to incorporate specific aspects of treatment and parental behavior.

Evaluation of marginal and internal fit of lithium disilicate CAD-CAM crowns with different finish lines by using a micro-CT technique.

STATEMENT OF PROBLEM: Whether the precision of fit of computer-aided design and computer-aided manufacturing (CAD-CAM) complete crowns is affected by the finish line configuration is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the marginal and internal fit of CAD-CAM ceramic crowns made from lithium disilicate based on 3 different finish lines (rounded shoulder, chamfer, feather-edge). MATERIALS AND METHODS: Thirty anterior lithium disilicate complete crowns (n=10 per finish line group) were fabricated by following a completely digital workflow based on digital scans made with the TRIOS scanner. The crowns were adhesively cemented on duplicate dies of the respective prepared Typodont teeth, and the marginal gap, absolute marginal discrepancy, and internal gap were evaluated by using microcomputed tomography (µCT). A total of 66 values were obtained for each specimen from sagittal and transaxial sections, and a rendering software program was used to calculate the volume of the cement gap for each specimen by means of 3D region growing. Two-way ANOVA, Tukey post hoc tests with Bonferroni correction, and the Kruskal-Wallis test were used to compare the values between the experimental groups (α=.05). RESULTS: Marginal gap and absolute marginal discrepancy values were statistically significantly different between groups. In ascending order, marginal gap values were 23 ±14 µm for rounded shoulder, 54 ±28 µm for chamfer, and 96 ±36 µm for feather-edge finish lines. Absolute marginal discrepancy values were 96 ±34 µm for rounded shoulder, 124 ±37 µm for chamfer, and 157 ±34 µm for feather-edge finish lines. Internal gap values were 111 ±14 µm for feather-edge, 136 ±22 µm for chamfer, and 168 ±25 µm for rounded shoulder finish lines. The differences in cement volume between groups were not statistically significant (P=.200). CONCLUSIONS: All 3 finish lines produced marginal gaps within the range of clinically accep table values. Lithium disilicate CAD crowns with a rounded shoulder finish line had the best marginal fit but the poorest internal fit, and lithium disilicate CAD crowns with a feather-edge finish line had the best internal fit but the poorest marginal fit.

The acoustical and perceptual features of snore-related sounds in patients with obstructive sleep apnea sleeping with the dynamic mandibular advancement system MATRx plus®.

PURPOSE: The effect of snoring on the bed partner can be studied through the evaluation of in situ sound records by the bed partner or unspecialized raters as a proxy of real-life snoring perception. The aim was to characterize perceptual snore events through acoustical features in patients with obstructive sleep apnea (OSA) with an advanced mandibular position. METHODS: Thirty-minute sound samples of 29 patients with OSA were retrieved from overnight, in-home recordings of a study to validate the MATRx plus® dynamic mandibular advancement system. Three unspecialized raters identified sound events and classified them as noise, snore, or breathing. The raters provided ratings for classification certainty and annoyance. Data were analyzed with respect to respiratory phases, and annoyance. RESULTS: When subdividing perceptual events based on respiratory phase, the logarithm-transformed Mean Power, Spectral Centroid, and Snore Factor differed significantly between event types, although not substantially for the spectral centroid. The variability within event type was high and distributions suggested the presence of subpopulations. The general linear model (GLM) showed a significant patient effect. Inspiration segments occurred in 65% of snore events, expiration segments in 54%. The annoyance correlated with the logarithm of mean power (r = 0.48) and the Snore Factor (0.46). CONCLUSION: Perceptual sound events identified by non-experts contain a non-negligible mixture of expiration and inspiration phases making the characterization through acoustical features complex. The present study reveals that subpopulations may exist, and patient-specific features need to be introduced.

Perceptual snoring as a basis for a psychoacoustical modeling and clinical patient profiling.

PURPOSE: The perceptual burden and social nuisance for mainly the co-sleeper can affect the relationship between snorer and bedpartner. Mandibular advancement devices (MAD) are commonly recommended to treat sleep-related breathing such as snoring or sleep apnea. There is no consensus about the definition of snoring particularly with MAD, which is essential for assessing the effectiveness of treatment. We aimed to stablish a notion of perceptual snoring with MAD in place. METHODS: Sound samples, each 30 min long, were recorded during in-home, overnight, automatic mandibular repositioning titration studies in a population of 29 patients with obstructive sleep apnea syndrome (OSAS) from a clinical trial carried out to validate the MATRx plus. Three unspecialized and calibrated raters identified sound events and classified them as noise, snore, or breathing as well as providing scores for classification certainty and annoyance. Data were analyzed with respect to expiration-inspiration, duration, annoyance, and classification certainty. RESULTS: A Fleiss' kappa (>0.80) and correlation duration of events (>0.90) between raters were observed. Prevalence of all breath sounds: snore 55.6% (N = 6398), breathing sounds 31.7% (N = 3652), and noise 9.3% (N = 1072). Inspiration occurs in 88.3% of events, 96.8% contained at least on expiration phase. Snore and breath events had similar duration, respectively 2.58s (sd 1.43) and 2.41s (sd 1.22). Annoyance is lowest for breathing events (8.00 sd 0.98) and highest for snore events (4.90 sd 1.92) on a VAS from zero to ten. CONCLUSION: Perceptual sound events can be a basis for analysis in a psychosocial context. Perceived snoring occurs during both expiration as well as inspiration. Substantial amount of snoring remains despite repositioning of the mandible aimed at the reduction of AHI-ODI.

Dentist Related Factors Associated with Implementation of COVID-19 Protective Measures: A National Survey.

Little is known about the extent to which dentists have implemented COVID-19 infection control guidelines and the factors influencing this process in daily practice. This national online survey assessed the implementation of enhanced infection control guidelines in daily practice, and explored dentist related factors influencing their application, more specifically dentist infection status and their perceived risk of cross-infection in the dental setting. The survey was validated, pretested and carried out in 2020. A total of 1436 dentists participated, of whom 9.1% presumably had COVID-19 infection experience. At least 75% of dentists complied with the core part of the recommended protective measures protocol. For each patient treated during the pandemic, an additional cost of 10-30 EUR (86.7%) and an extra time of 10-30 min (70.7%) was estimated. A stepwise binary logistic regression analysis revealed that dentists assumed to have experienced COVID-19 reported a higher self-perceived risk of virus acquisition (ß = 2.090; p = 0.011), lower concern of getting infected (ß = 0.576; p = 0.027), and lower confidence in being able to prevent disease transmission in the dental setting (ß = 0.535; p = 0.022). Some parts of the protective measures were more difficult to apply than others; however, there was no indication of increased disease acquisition in the dental setting.

The Decisive Role of Laser Doppler Flowmetry for Pulp Preservation in Discolored Traumatized Teeth.

Objective: It has been stated that blood pigments within discolored teeth may interfere with Laser Doppler Flowmetry (LDF) measurements. The aim of this study was to assess pulp vitality with LDF in a cohort of discolored traumatized teeth referred for endodontic treatment or where the referring dentist had doubts regarding maintained tooth vitality. Background: Discoloration of teeth is a common sequel of dental trauma. Still today, it is taken as an indicator for root canal treatment. Transient apical breakdown (TAB) is confused with apical periodontitis, although it is a sequel of dental trauma in young mature teeth and will result in revascularization and dissolution of the apical radiolucency. Methods: A total of 26 patients with 28 discolored teeth, belonging to a cohort of referred patients with traumatized teeth referred for root canal treatment and/or pulp vitality assessment were screened on color with photographs by three investigators, with traditional sensibility tests and with a Moor VMS II LDF meter. Results: The color of the intrinsically discolored teeth was grayish in 58% of teeth, blue 20%, pink/crimson 12%, and yellow 4%. Eighty-five percent were central maxillary incisors, 11% were mandibulary incisors. Thanks to LDF, 43% of the trauma cases in this small cohort with discoloration underwent root canal treatment instead of 70% with traditional sensibility tests as indicator. TAB was found in 11%. Conclusions: LDF was decisive in diagnosing vitality of discolored teeth and there was no negative impact of tooth discoloration on LDF measurements.

Use of mandibular advancement devices for the treatment of primary snoring with or without obstructive sleep apnea (OSA): A systematic review.

The aim of this review was to systematically evaluate the available scientific evidence on the benefit of mandibular advancement devices (MADs) in the treatment of primary snoring (PS). From 905 initially identified articles, 18 were selected. Papers that provided indirect information regarding obstructive sleep apnea syndrome (OSAS) and/or sleep breathing disorders (SBD) were included. Information was obtained on monoblock and duoblock appliances from the selected studies. The devices were most commonly able to achieve 50%-70% of the maximum mandibular protrusion. The frequently used outcome measurements were the apnea-hypopnea index, Epworth sleepiness scale, and oxygen desaturation index, which all yielded positive post-treatment results. The most common side effects were temporomandibular joint pain and excessive salivation, which improved with time. Our findings indicated that the use of MADs, even with varying designs, improved outcomes in all the reported patient populations (PS, OSAS, and SBD). Despite the lack of studies on PS, the available evidence supports the use of MADs for treatment of PS. Snoring should be treated from a preventive and psychosocial perspective to avoid progression to more severe diseases that could have a significant medical and economic impact.

Oral appliances in the treatment of oromandibular dystonia: a systematic review.

Oromandibular dystonia (OMD) is a clinically and etiologically heterogeneous form of focal dystonia with variable social and functional implications. The results of pharmacological treatment and botulinum toxin infiltrations are often unsatisfactory. We performed a systematic review on the effects of oral and dental appliances in patients with OMD. Most of the reports in the literature are single subject descriptions or small case series with a considerable variability in the type of dystonia, the type of evaluated appliances and in the outcome measures. Only one report included a large group of unselected patients that were evaluated with a mixture of outcome measures. Although it appears that a number of OMD patients, especially those who benefit from sensory tricks, may sustain some improvement with the use of oral appliances, no definitive conclusions can be drawn about the type of patients that may benefit, nor about the preferred type or mode of appliance. More research in this field is needed, using standardized approaches and clearly defined outcome measures in larger cohorts of OMD patients that are clinically and diagnostically well characterized.

Depression and anxiety levels in patients with temporomandibular disorders: comparison with the general population.

OBJECTIVES: The objective of this study was to compare levels of depression and anxiety of a group of patients with orofacial pain attributed to a temporomandibular disorder (TMD) to the general population. MATERIALS AND METHODS: Diagnosis of orofacial pain attributed to a TMD was given according the DC/TMD classification system. PHQ-9 and GAD-7 questionnaires were used to respectively screen for depression and anxiety. Scores of these two questionnaires in the study group were compared to the scores of two large population samples representing normative data in the general population. RESULTS: Two hundred forty-three patients (191 females and 52 males) were included in the study. Both Kolmogorov-Smirnov and chi-square testing showed statistically significant higher scores (p ≤ 0.05) for both PHQ-9 and GAD-7 in the study group in comparison with the general population and PHQ-9 and GAD-7 scores were strongly correlated. CONCLUSIONS: The results of this study indicate that screening for depression and anxiety should be considered in the diagnosis of patients with orofacial pain attributed to a TMD. CLINICAL RELEVANCE: PHQ-9 and GAD-7 could be used to assist clinicians, without specific training in mental health, to screen for potential signs of existing comorbidity of depression or anxiety disorders in patients with orofacial pain attributed to TMD.

Quantifying increased rates of erosive tooth wear progression in the early permanent dentition.

OBJECTIVES: To investigate if quantitative analysis of intraoral scans of study models can identify erosive tooth wear progression. METHODS: Data were collected from a retrospective longitudinal study, using pre-and post-orthodontic treatment casts of 11-13 year olds, recorded at two consecutive appointments 29 months apart. Casts were digitised with intra-oral scanner TRIOS™ (3Shape, Copenhagen, Denmark) and first molar scan pairs used for analysis. Occlusal surfaces of each molar pair were visually assessed using the BEWE index as having no BEWE progression (n = 42) or BEWE progression (n = 54). Scan pairs were aligned and analysed for volume loss, maximum profile loss and mean profile loss in WearCompare (Leedsdigitaldentistry.com/wearcompare) using previously published protocols. Data were analysed in SPSS and not normal. Mann-Whitney U test with a Bonferroni correction assessed differences between progression groups. Receiver-operating-characteristic (ROC) curves were used to identify the sensitivity and specificity of quantified wear progression rates at determining visual wear progression. RESULTS: Surfaces with visible progression demonstrated a median volume loss of -2.19 mm3 (IQR-3.65, -0.91) compared to a median volume loss of -0.37 mm3 (IQR -1.02, 0.16) in the no visible progression group (p < 0.001). Mean profile loss was -75.2 µm (IQR-93.9, -61.0) and 63.2 µm (IQR -82.5, -49.7) for the progression and no-progression groups respectively (p = 0.018). Volume loss of -1.22mm3 represented a 79 % sensitivity and 61 % specificity. The estimated area under the curve for volume loss was 0.80 (95 %CI 0.71-0.89, p < 0.001). CONCLUSIONS: This is the first study to propose rates of high wear progression in adolescents. Limited sensitivity and specificity confirms that quantitative analysis is an adjunct tool to be used alongside history taking and clinical judgement. CLINICAL SIGNIFICANCE: The rapid advancement of digital technologies may result in improved diagnosis in erosive tooth wear (ETW). Intra-oral scans and registration software are a promising adjunct for monitoring ETW progression in clinical practice.

The perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders, Belgium.

OBJECTIVES: To assess the perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders. MATERIALS AND METHODS: Two questionnaires were developed, one for managers and one for caregivers. The questionnaires were distributed in all 570 organizations for people with disabilities in Flanders. The survey was carried out in February 2018. RESULTS: Sixty-five managers completed the questionnaire and 63 of them could be linked to 57 unique organizations (10% of the contacted organizations). Managers perceived oral health to be better (P = 0.019) and mentioned less oral health needs (P = 0.049), when collaboration with a dentist was reported. When an oral health policy had been established in their organization, oral health was also perceived to be better (P = 0.048). The responses of 91 caregivers were included for analysis and 87 of them could be linked to 39 unique organizations (7% of contacted organizations). Seventy percent and 75% of the caregivers mentioned to have enough/comprehensive theoretical knowledge and practical skills, respectively, and 46% were interested in receiving oral health education. Most interest was shown in practical education and education customized to clients' needs. In organizations with an oral health project, more caregivers indicated that the organization was open to oral health questions than in organizations without such a project (97% compared with 81%; P = 0.045). When there was a collaboration with a dentist, the organization was more open to caregivers' questions (96% compared with 72%; P = 0.004) and a clear contact point was more readily available (81% compared with 48%; P = 0.004). Furthermore, caregivers were more interested to receive oral health education (P = 0.023) and mentioned to be more aware of the oral health of their clients (P = 0.015). About 23% and 30% of the caregivers indicated that guidelines were used in their organization for cleaning natural teeth and prostheses, respectively. CONCLUSIONS: Despite the low response rate to the survey and reaching the management and caregivers of only 10% and 7% of the organizations respectively, this study indicates relevant issues to be incorporated when formulating recommendations for oral health promotion in people with disabilities in Flanders. CLINICAL RELEVANCE: The results of this survey could affect the development of strategies and interventions to ameliorate the oral health of people with disabilities.

Stimuli involved in dental anxiety: What are patients afraid of?: A descriptive study.

BACKGROUND: Dental anxiety is a psychological response inducing aversion following a dental ill-defined stimulus, non-imminent and perceived as potentially dangerous. It is better to intervene during childhood than to resolve in adulthood when dental anxiety is more settled. AIM: The purpose of this study is to determine the nature of dental anxiety-provoking stimuli in young patients. DESIGN: A questionnaire was submitted to 566 children between 3 to 18 years in health institutions and schools in Brussels, Belgium. The items were divided into 3 groups: environment (ENV), local anaesthesia (LA), and intervention (INT) and summarized through averaging per group. Descriptive analysis and non-parametric testing were combined with logistic regression after discretization, above mild, for the group averages. RESULTS: About 7.2% of the respondents expressed high to severe dental anxiety. Several items presented a clear bimodal distribution dividing the population in fearless and fearing patients, for example, sight and feel of the syringe, sight and taste of blood and extraction. Others presented with a gradually lower incidence with increasing fear level. Fear for the environment was generally low. Gender and ethnic origin contribute significantly to the prediction of fear caused by LA. For fear caused by INT, first the place of questioning enters the models, thereafter follow: negative experience, frequency of dental visit, and gender (P < .05). CONCLUSIONS: While the dental environment is in general not causing fear, the invasive part of the anaesthesia and the invasive dental procedures are involved. Fear seems to be related to culture, previous experience, and gender.

School Food Policies Related to Soft Drink and Fruit Juice Consumption as a Function of Education Type in Flanders, Belgium.

Recent data on erosive tooth wear (ETW) in Belgium have associated a vocational/technical type of education with ETW risk. Since the role of schools is essential to the promotion of healthy diets, this study aimed to investigate school food policies (SFP) related to soft drink and fruit juice consumption and to detect differences among schools in Flanders, Belgium (BE-F). An online questionnaire related to the control of acidic beverages and promotion of healthy drinking habits was sent to all Flemish secondary schools. For analysis, schools (n = 275) were grouped by type of education (vocational secondary education (VSE) and general secondary education (GSE)), and by socioeconomic status. Multiple factor analyses (MFA) were performed to identify schools with a similar SFP profile. Additionally, descriptive analyses were performed to determine other associations. Overall, 44% of schools in BE-F claimed to have written SFP related to the consumption of soft drinks. SFP expressly prohibiting or limiting acidic beverages were significantly more frequent in GSE schools (p < 0.05), where a higher economic status was present. This study shows that a considerable group of schools in BE-F have no or incomplete rules concerning acidic beverage consumption. Such rules differ between types of education, with VSE schools reporting less control regarding the consumption of drinks.

How standard deviation contributes to the validity of a LDF signal: a cohort study of 8 years of dental trauma.

The aim of this cohort study was to document the potential of laser Doppler flowmetry (LDF) for diagnosing tooth vitality in traumatized teeth in a population of 88 referred patients with dental trauma over a period of 8 years (2011-2018). The main reason to refer was tooth discoloration (26%), and the main trauma cause was a traffic injury (35%). Taking into account that referral for LDF is best given within the week after trauma, 66% of referrals were overdue. In 73% of cases, root canal treatment could be avoided, and in 65%, the presence of a fixed orthodontic retainer showed beneficial for pulp recovery. Data of 394 teeth were collected and submitted to multilevel modelling statistics. As a general conclusion, both LDF perfusion and concentration values proved to be highly reliable in the appreciation of tooth vitality. The difference of variability of standard deviation and range of LDF measurements involving intra-subject control teeth showed statistically significant in discriminating between vital and non-vital pulps. In non-vital teeth, the diagnostic combination of LDF, sensibility tests and peri-apical X-ray is advised.

Systematic review of the different aspects of primary snoring.

Primary snoring, also known as simple or non-apnoeic snoring, is regarded as the first stage of sleep disordered breathing without severe medical consequences for the snorer and co-sleeper. Although it is a highly prevalent phenomenon in the general population, our knowledge is limited because of the lack of a consensus on terminology. This systematic review of the aspects used in the definitions of simple/primary snoring was conducted to obtain an inventory of current practices and compare these definitions with the conceptual definition of the American Academy of Sleep Medicine. PubMed and Web of Science were searched from July 2016 onwards without any language limitations, and 362 references were obtained. After selection based on titles, 39 remained, among which 29 contained a definition or reference to a definition. In 69% of the studies, a cut-off <5 apnoea/Hypopnoea events per hour of sleep on the Apnoea-Hypopnoea Index was used. Despite this tendency, the cut-offs ranged from 0 to <15/h. Unfortunately, the cut-off and occasional requirements did not match the conceptual definition of the American Academy of Sleep Medicine. A consensus must be reached on an operational and clinically relevant definition based on the clear conceptual definition.

Grey value contrast sensitivity of dental practitioners in function of luminance and age.

OBJECTIVES: Grey value perception is important in viewing and interpreting X-ray images. It is possible that ageing decreases the number of gray values that a person can distinguish. This hypothesis was tested in a group of dental practitioners from students to experienced dentists using a 12-bit grey scale. METHODS AND MATERIALS: A custom-made computer software was used based on the principle of the "just noticeable difference" (JND). Observers were shown a picture of an outer square with increasing grey value in which a smaller square of different grey value popped up in changing positions. As soon as the observers could see the difference, they clicked the inner square. The grey values were shown with a 12-bit depth in batches of 400 grey value steps. 59 dentists of 3 age groups (20-24, 25-45 and 46-70 years) participated in the study. A subgroup of 20 practitioners performed a validation test with test-retest and test in reversed grey value sequence (white to black). JND was calculated and plotted against grey value using a third-order polynomial function. These curves were compared statistically. RESULTS: Test-retest, also in reversed order did not yield different curves (p values between 0.79 and 0.97). Curves between different age groups showed significant differences, with older practitioners needing more contrast to accomplish the task. Contrast sensitivity showed an optimum in the darker third of the grey scale (values around 1200). CONCLUSION: Age and grey value played a significant role in grey value perception by dental practitioners.