Effectiveness of haptic feedback devices in preclinical training of dental students-a systematic review.

BACKGROUND: Acquisition of psychomotor skills is of utmost importance for competent preclinical restorative dentistry. Recent advancements in haptic feedback technology have been incorporated into preclinical dental education to augment the conventional phantom head-based training. OBJECTIVE: This systematic review aims to assess the effectiveness of haptic feedback device, Simodont, in improving the skill development and learning outcomes of dental students during their preclinical training. MATERIALS AND METHODS: Electronic databases Web of Science, Scopus, PubMed were searched for relevant studies since inception up until March, 2023. Only English language studies that assessed the effectiveness of haptic feedback devices in preclinical dental education were included. We excluded studies that did not use Simodont as the haptic feedback device or did not involve preclinical restorative work. Study quality was assessed using the revised Cochrane risk of bias tool and ROBINS-I. The primary goal of the study is to evaluate the efficacy of Simodont as a complementary training modality for dentistry students. RESULTS: Results from 9 high-quality studies were analyzed and synthesized to evaluate the overall impact of haptic feedback devices on various aspects of preclinical training. The studies were conducted on 826 undergraduate dental students enrolled in various years of their training across dental colleges and universities in different parts of the world. A majority of studies showed some concerns regarding risk of bias. Haptic feedback devices added a new layer to Virtual Reality (VR) through the perception of touch and force feedback. It assisted junior dental students improve their psychomotor skills and movement skills. Instantaneous feedback on the students' performance helped enhance their self-assessment and correction, and also eliminated the subjectivity of evaluation. Data derived from virtual simulators helped stratify dental students and predict their clinical performance, providing an opportunity to tailor the learning process to meet individual diversity in students' expertise. CONCLUSION: Based on the limited evidence available, Simodont was effective in preclinical training of dental students, offering advantages such as unlimited reproducibility, objective evaluation of preparation by computer assessment, and cost reduction. And further studies are warranted to explore the incorporation of patient's oral environment simulation for better skill training.

Efficacy of laser in re-osseointegration of dental implants-a systematic review.

Despite their high success rates, peri-implantitis can affect the stability and function of dental implants. Various treatment modalities have been investigated for the treatment of peri-implantitis to achieve re-osseointegration. An electronic literature search was performed supplemented by a manual search to identify studies published until January 2022. Articles that evaluated re-osseointegration in peri-implantitis sites in animal models following laser therapy or antimicrobial photodynamic therapy (aPDT) were included. Case reports, case series, systematic reviews, and letters to the editor were excluded. Risk of bias and GRADE assessment were followed to evaluate the quality of the evidence. Six studies out of 26 articles identified on electronic search were included in this review. The studies included animal studies conducted on canine models. Four out of six studies reported a higher degree of re-osseointegration following treatment of implants with laser therapy. The findings suggest that laser decontamination shows potential in enhancing re-osseointegration, particularly with the Er: YAG laser, which effectively decontaminated implant surfaces. However, conflicting outcomes and limitations in the evidence quality warrant caution in drawing definitive conclusions. Based on the limited available evidence, laser therapy may show a higher degree of re-osseointegration of implants than mechanical debridement.

The Cytotoxic Effect of Thermoplastic Denture Base Resins: A Systematic Review.

Partial or complete dentures are constructed from thermoplastic resins that are thermally processed and molded. This review examines the presently available evidence for the cytotoxicity of thermoplasticized denture base resins on human gingival epithelial cells, adipose cells, and fibroblasts; human amnion fibroblasts; and mouse fibroblasts. Electronic searches were performed on PubMed, Scopus, Web of Science, and Google Scholar databases to identify relevant articles to be included in the review until September 2022. Clinical, in vivo, and in vitro studies in English language were searched for. The quality of the studies was assessed using the Toxicological data Reliability Assessment tool (ToxRTool) developed by the European Commission's Joint Research Centre. GRADE assessment was used to evaluate the certainty of evidence. Seven in vitro studies were included in the review. The overall risk of bias was determined to be high, with the majority of studies assessed found to be reliable with restrictions or not reliable. Only two studies were considered reliable without restrictions based on ToxRTool assessment. The effect of thermoplastic denture base resins on viability and cell adherence of human gingival or amnion fibroblasts and mouse fibroblasts (L929s) is not significant. Conditioned media from unpolished specimens of resins were significantly more toxic to cultured cells than those from polished specimens. This may be of concern in cases of poor post-processing of dentures. Based on the limited evidence available, there is low-certainty evidence that thermoplastic denture base resins appear to be biocompatible and show insignificant cytotoxicity. Further well-designed trials adhering to standard reporting guidelines and using objective measures are necessary before outlining universal guidelines for best practice. Long-term in vivo and clinical assessment is necessary to corroborate laboratory findings with clinical outcomes. Denture base resins are in constant contact with oral tissues, and cytotoxic components released by the resins may irritate or inflame the tissues or provoke an allergic response.

Efficacy of artificial intelligence in the detection of periodontal bone loss and classification of periodontal diseases: A systematic review.

BACKGROUND: Artificial intelligence (AI) can aid in the diagnosis and treatment planning of periodontal disease by means of reducing subjectivity. This systematic review aimed to evaluate the efficacy of AI models in detecting radiographic periodontal bone loss (PBL) and accuracy in classifying lesions. TYPES OF STUDIES REVIEWED: The authors conducted an electronic search of PubMed, Scopus, and Web of Science for articles published through August 2022. Articles evaluating the efficacy of AI in determining PBL were included. The authors assessed the articles using the Quality Assessment for Studies of Diagnostic Accuracy tool. They used the Grading of Recommendations Assessment, Development and Evaluation criteria to evaluate the certainty of evidence. RESULTS: Of the 13 articles identified through electronic search, 6 studies met the inclusion criteria, using a variety of AI algorithms and different modalities, including panoramic and intraoral radiographs. Sensitivity, specificity, accuracy, and pixel accuracy were the outcomes measured. Although some studies found no substantial difference between AI and dental clinicians' performance, others showed AI's superiority in detecting PBL. Evidence suggests that AI has the potential to aid in the detection of PBL and classification of periodontal diseases. However, further research is needed to standardize AI algorithms and validate their clinical usefulness. PRACTICAL IMPLICATIONS: Although the use of AI may offer some benefits in the detection and classification of periodontal diseases, the low level of evidence and the inconsistent performance of AI algorithms suggest that caution should be exercised when considering the use of AI models in diagnosing PBL. This review was registered at PROSPERO (CRD42022364600).

COVID-19: Ramifications and Effects on University Healthcare Students.

AIM: This study was carefully designed to analyze the perceived psychological impact of the COVID-19 pandemic among Roseman dental students. Students assessed their perceived changes in stress, self-esteem, and lifestyle behavior changes based on the impact of the pandemic. MATERIALS AND METHODS: A self-designed, anonymous, 18-item questionnaire was administered to Roseman dental students after being approved by the Institutional Review Board. Independent samples t-test and one-way ANOVA were utilized for comparison of psychological factors toward gender, as well as year of study. Chi-square correlations between stress and self-esteem, as well as lifestyle behavior, were also reported. RESULTS: In total, 313 students with a mean age of 28.15 (SD:4.21) completed the survey. Statistically significant differences were shown between students based upon age and year of study, with regard to stress and lifestyle behavior changes. Cross-tabulations of stress with self-esteem and lifestyle behavior changes showed positive relationships, as students with higher levels of stress showed significant self-esteem problems and lifestyle behavior changes. The largest frequency of stress/anxiety and lifestyle behavioral changes was found in the age range of 25-34 years old, particularly in the Class of 2024 and 2025. CONCLUSION: The COVID-19 pandemic has imposed a significant psychological impact on dental students at Roseman. However, further studies are needed to assess the long-lasting impacts of the pandemic on University healthcare students as a whole. CLINICAL SIGNIFICANCE: The pandemic has not only affected the way in which dental students progress academically but also as healthcare providers now and into the future.

Triphala extract negates arecoline-induced senescence in oral mucosal epithelial cells in vitro.

BACKGROUND: Arecoline found in areca nut causes oral submucous fibrosis. Triphala is an Ayurvedic medicinal preparation used to improve overall physical wellness that has also been shown to improve oral health. OBJECTIVES: To assess the activity of Triphala extract on arecoline-induced senescence in oral mucosal epithelial cells in vitro. MATERIALS AND METHODS: Oral mucosal epithelial cells were isolated and cultured in vitro. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was performed to assess the viability of treated cells, while senescence was assessed by senescence-associated-ß-galactosidase staining. Cell surface marker expression was analyzed by flow cytometry. Finally, real-time quantitative polymerase chain reaction was performed to examine gene expression levels. RESULTS: Triphala extract (5 µg/mL) reversed the cell senescence activity of arecoline, as evidenced by reduced ß-galactosidase activity, increased Ki-67 marker expression, and reduced expression of senescence-related genes p16 and p21. CONCLUSION: Triphala extract helped to reduce the pathological effects of arecoline-induced pathogenesis.Clinical relevance.Arecoline found in the areca nut causes oral pathological conditions including oral submucous fibrosis. Our results showed that Triphala counteracted the adverse effects of arecoline, in particular, negating senescence in oral mucosal epithelial cells. As a translational effect, Triphala treatment could restore normal epithelial thickness in oral submucous fibrosis, thus reducing the clinical severity of the disease. This reestablishment of oral homeostasis would help to improve oral health-related quality of life in patients with oral submucous fibrosis.

Are electronic nicotine delivery systems (ENDs) helping cigarette smokers quit?-Current evidence.

BACKGROUND: Electronic cigarettes (e-cigarettes) and other electronic vaping devices are commonly used as a method to help tobacco smoking cessation. However, the data on their safety and efficacy are currently scarce. The aim of this review was to explore the role of e-cigarettes in tobacco cessation among tobacco users. TYPES OF STUDIES REVIEWED: PubMed, EMBASE, Scopus, Web of Science, and grey literature from January 1990 were searched up to and including September 2018. Two independent reviewers performed the study selection according to eligibility criteria. RESULTS: A total of 13 studies that met the eligibility criteria were included. The majority of studies were done in the USA, and all studies were longitudinal cohort studies. The odds of increased smoking cessation in association with e-cigarette use ranged from onefold to sixfolds. No significant increase in smoking cessation was found among e-cigarette users compared with non-e-cigarette users. Pattern of e-cigarette had positive influence on smoking cessation among users. CONCLUSIONS AND PRACTICAL IMPLICATIONS: E-cigarette use was not significantly associated with increased smoking cessation among cigarette smokers. We also found that pattern of e-cigarette may have significant effect on smoking cessation capability of e-cigarettes. Well-designed randomized controlled clinical trials are needed to assess the clinical efficacy of e-cigarettes in comparison with approved smoking cessation therapies.

Potential Role of Machine Learning in Oncology.

Machine learning (ML) is the ability of computers to learn from data autonomously. It is a core branch of artificial intelligence (AI), which is defined as the ability of a machine to replicate the intellectual processes of humans independently.1,2 The evolution of the microprocessor for home computers resulted in increased computing speed, efficient data collection, storage, and retrieval capacity. Thus AI techniques have evolved, which led to the discovery of artificial neural networks which are computer modeling algorithms mimicking the human brain.3-6 AI has developed to an extent that it can exceed the human brain in board games such as chess, television games, image recognition, and spam e-mail filtering. In addition to engineering, arts, and finance, extensive progress has been made to integrate ML in the field of medicine, especially oncology.

Prosthetic Rehabilitation of Microstomia Patients: A Systematic Review of Published Case Reports and Case Series.

STATEMENT OF PROBLEM: Prosthetic techniques commonly employed for the rehabilitation of edentulous patients might not be adequate in the treatment of patients with microstomia. PURPOSE: The purpose of this paper is to systematically review all the prosthetic techniques that have been used in the oral rehabilitation of patients with microstomia. MATERIALS AND METHODS: Data sources, including PubMed, Google Scholar, SCOPUS and Web of Science, were searched for case reports and case series published through September 2017. Three investigators reviewed and verified the extracted data. Only case reports and case series on prosthetic rehabilitation in microstomia patients published in the English language were considered eligible. RESULTS: A total of 212 records were identified from the database search. Forty duplicate records were removed. The remaining 172 articles were assessed for eligibility, and 139 articles were removed because they did not satisfy the inclusion criteria. A total of 34 cases (including 32 case reports and 1 case series) were finally included in the qualitative analysis. The review revealed the use of a modified impression technique with flexible and sectional trays to record impressions in patients with microstomia. Modified forms of oral prostheses ranging from sectional, flexible, collapsible and hinged dentures to implant-supported prosthesis were fabricated to overcome the limited mouth opening. The success of the prosthetic technique primarily depended on the extent of the microstomia and the nature of the cause of the microstomia. CONCLUSION: Even though the patient acceptance of the prosthetic techniques summarized in the systematic review were high, long-term success rates for each option could not be assessed because of the short follow-up time in most of the included case reports and series.

Reviewing the role of human papillomavirus in oral cancer using the Bradford Hill criteria of causation.

Human papillomavirus is a well-established risk factor for oropharyngeal cancer, although its role in oral cancer is still debated. Inconclusive evidence of its role in oral cancer is due to conflicting data arising from methodological differences, mostly due to the use of diagnostic tests with varying sensitivity and specificity. In addition, there is a lack of experimental data linking HPV to oral cancer. Recent epidemiological studies provide data on HPV prevalence in oral squamous cell carcinoma and other potentially malignant oral disorders. Further, molecular data from in vivo and in vitro models have led to new insights into the role of human papillomavirus in oral cancer. The clinical significance of identifying HPV as an etiology for oral squamous cell carcinoma is that if proven, vaccination could be an effective prevention tool. Further, like oropharyngeal squamous cell carcinoma, prognostic differences may exist between human papillomavirus positive and negative oral squamous cell carcinoma. This manuscript reviews data from the published literature using Bradford Hill criteria of causation to assess the role of human papillomavirus in oral cancer. Due to the advancement in molecular biology, the requirements of each of the Bradford Hill criteria of causation are modified to include integrated data from both epidemiological studies and experimental studies exploring molecular carcinogenesis.

Nutrition and oral health.

To maintain health, the human body needs daily nourishment in the form of carbohydrates, proteins and minerals. The associations between oral health conditions, dietary practices and nutritional status, and general health status are complex with many interrelating factors. Inadequate nutrition can affect the oral health including dental caries, periodontal diseases, diseases of oralmucosa and infectious diseases. Compromised oral health can alter food choices and negatively impact food intake leading to suboptimal nutritional status which can lead to chronic systemic diseases. Recognizing and treating oral health and nutrition problems are important in improving the health and quality of life.

Oropharyngeal Candidosis in HIV-Infected Patients-An Update.

Oropharyngeal candidosis (OPC) is an opportunistic fungal infection that is commonly found in HIV-infected patients, even in the twenty-first century. Candida albicans is the main pathogen, but other Candida species have been isolated. OPC usually presents months or years before other severe opportunistic infections and may indicate the presence or progression of HIV disease. The concept of OPC as a biofilm infection has changed our understanding of its pathobiology. Various anti-fungal agents (both topical and systemic) are available to treat OPC. However, anti-fungal resistance as a result of the long-term use of anti-fungal agents and recurrent oropharyngeal infection in AIDS patients require alternative anti-fungal therapies. In addition, both identifying the causative Candida species and conducting anti-fungal vulnerability testing can improve a clinician's ability to prescribe effective anti-fungal agents. The present review focuses on the current findings and therapeutic challenges for HIV-infected patients with OPC.

Role of forensic odontology in the identification of victims of major mass disasters across the world: A systematic review.

BACKGROUND: Forensic odontology (FO) is regarded in the literature as one of the most reliable and economical scientific methods for victim identification in mass disasters (MDs). The present paper systematically reviews the role of forensic odontologists in various global MDs. METHOD: A comprehensive search of the literature databases (PubMed, Medline, SCOPUS, Web of Science and Google Scholar), along with cross-referencing published peer-reviewed articles, was conducted. The search included full texts, abstracts or titles, had no inclusion year limit (searched until September 2017) and was limited to the English language. Keywords included a combination of 'Forensic odontology', 'Dental records', 'Victim identification', 'Natural mass disaster', 'Criminal mass disaster', 'Accidental mass disaster' and 'Victim disaster'. RESULTS: Of the included disasters (20), 12 (57.14%) were accidental, 5 (23.80%) natural and 3 (19.04%) were criminal. The maximum number of victims was associated with the Japan tsunami (15892), followed by the Thailand tsunami (4280) and the Estonia ferry disaster (852). A total of 23654 victims were reported, of which 20569 (86.96%) were positively identified. Reports from 17 MDs included the use of FO in victim identification [3025 (14.70%) cases]. In addition, 1094 victims (5.31%; from 7 papers) were identified using FO in combination with other methodologies. The highest percentage of victims was identified using FO following the Kentucky air crash (47; 100%), followed by the Newark air crash (38; 76%), the Nepal air crash (10; 71.42%), the France air crash (56; 65.88%), the Australian bushfire (14; 63.63%), and the Estonia ferry disaster (57; 60.63%). CONCLUSION: FO has played a significant role in victim identification in several MDs around the world. The success of FO-based identification is heavily dependent on the availability of ante-mortem records from general dental practitioners. Hence, adequate knowledge about FO and appropriate dental record keeping among general dental practitioners are critical.

Early Screening of Diabetes and Hypertension in Primary Care Dental Clinics at King Saud University in Riyadh, Kingdom of Saudi Arabia.

INTRODUCTION: Diabetes mellitus and hypertension are the leading chronic diseases in Saudi Arabia; 23.1% of the Saudi population are diabetic and 25.5% are hypertensive. This cross-sectional study was made on dental setting to determine the effectiveness of screening of diabetes and hypertension in dental clinics. MATERIALS AND METHODS: This study was carried out in the primary care dental clinics at the Dental College in King Saud University in Riyadh, Saudi Arabia. Before starting any treatment, a face-to-face interview was administered to collect a brief medical history and personal data followed by measurement of body mass index (BMI). After that, blood pressure level reading was obtained using electrical sphygmomanometer. Finally, a glucose level reading was obtained from capillary blood from the patient's third fingertip using glucose reader. RESULTS: Our study included 283 participants, 118 of whom were females (41.7%). Our study showed that a significant amount of the participants are at risk of having hypertension (44.8%). In addition, a significant number (10.2%) of the participants are at risk of having diabetes. Furthermore, 35.7% of the sample had obesity as a risk factor for diabetes and hypertension. CONCLUSION: The dental team can play an important role in screening of diabetes, hypertension, and other chronic diseases. In Saudi Arabia, public awareness of the chronic diseases is still critically insufficient. CLINICAL SIGNIFICANCE: Our study showed the importance of the screening even for patients with negative history of diabetes or hypertension.

Chronic periodontitis and smoking. Prevalence and dose-response relationship.

OBJECTIVES: To determine the prevalence and dose-response relationship of chronic periodontitis among smokers in Pakistan. METHODS:   This is a cross-sectional study among participants seeking dental care in Karachi Medical and Dental College, Karachi, Pakistan. A total of 443 participants with a mean age of 44.3 (±6.5) participated in the study from April 2011 to December 2011. Males comprised 64.7%, and females comprised 35.2%. Participants were interviewed on social demographics and oral habits. Participants with shallow pockets (3.5-5.5 mm) and deep pockets (greater than 5.5 mm) were considered suffering from chronic periodontitis. The characteristics of participants were assessed using frequency distribution for categorical variables and mean (standard deviation) for continuous variables.  RESULTS: Among 443 participants, smokers were distributed as 55.1% and non-smokers as 44.9%. Smoking was found to be significantly related to young adults (p less than 0.007), male gender (p less than 0.001), and lower education level (p less than 0.01). Overall prevalence of chronic periodontitis among smokers was estimated at 81.6%. Heavy smoking was found to have significantly high prevalence (p less than 0.001) and severity (p less than 0.001) of periodontitis as compared with moderate and light smokers. The multivariate unadjusted model depicted 3.5 times higher risk of chronic periodontitis among smokers (p less than 0.001). CONCLUSION: Chronic periodontitis had a high prevalence among smokers. Heavy smoking was found to have a higher risk for having periodontitis.