The knowledge regarding the impacts and management of black triangles among dental professionals and laypeople.

This study aimed to assess the knowledge regarding impacts, causes and management of black triangles (BT) among participants from different educational backgrounds including dental students, dentists and laypeople. This descriptive cross-sectional observational research included 435 participants who comprised 4 groups: pre-clinical (3rd year) dental students, clinical (4th and 5th year) dental students, dentists, and laypeople. A constructed self-reported questionnaire was utilized to assess participants' demographic data and their knowledge of the impacts, causes and management of BT. The VAS scale was used to assess participants' ratings for the impacts of BT on esthetics, with 0 meaning no impact and 10 meaning very severe negative impacts. The most reported treatments for BT were "cannot be treated" 99.3% and "non-surgical periodontal treatment" 67.1%. Meanwhile, the least reported was "modify the porcelain" 41.8%. The most reported cause of BT was "periodontal disease" 85.1%. However, the least reported were "parafunction" and "deep implants" 33.1% each. Dental professionals had better knowledge of the causes (t = 8.189, P < 0.001) and management (t = 8.289, P < 0.001) of BT than the non-dental participants. The dentists had the best knowledge, while the laypeople had the least knowledge of the causes (F = 62.056, P < 0.001) and treatment (F = 46.120, P < 0.001) of BT. The knowledge of the causes (t = 0.616, P = 0.538) and treatment (t = 1.113, P = 0.266) for BT was not significantly different between males and females. Age was not significantly related to the total knowledge about the causes (r = -0.034, P = 0.475) or treatment (r = -0.034, P = 0.482) for BT. Dental professionals had better knowledge of the impacts, causes and management of BT than the non-dental participants. The dentists were the best, while the laypeople were the worst in this regard. Age and gender had no relationships with the knowledge of causes or management of BT.

Red/Orange Autofluorescence in Selected Candida Strains Exposed to 405 nm Laser Light.

BACKGROUND: Candida albicans and similar species are significant pathogens in immunocompromised and hospitalized individuals, known for mucosal colonization and bloodstream/organ invasion. Many pathogenic fungi, including these species, exhibit autofluorescence (R/OF) under specific light conditions, a feature crucial for their detection. AIM: We investigated the use of a 405 nm diode laser for the direct observation of red/orange autofluorescence of Candida spp., common in the oral cavity, exploring its potential in health screenings. METHODS: This study utilized cultures of Candida spp. on Sabouraud dextrose agar with Qdot 655 and 685 for fluorescence benchmarking, illuminated using a 405 nm diode laser (continuous wave, power 250 mW, 0.0425 J/cm² fluence, 0.0014 W/cm² power density). Images were captured using a yellow-filter camera at set intervals (48 to 144 h). Visual and computational analyses evaluated the R/OF in terms of presence, intensity, coloration, and intra-colony variation. RESULTS: Most Candida strains displayed red/orange autofluorescence at all observation times, characterized by varied coloration and intra-colony distribution. Initially, there was an increase in R/OF intensity, which then stabilized in the later stages of observation. CONCLUSIONS: The majority of the Candida strains tested are capable of emitting R/OF under 405 nm laser light. This finding opens up new possibilities for integrating R/OF detection into routine dental screenings for Candida spp.

Relationships between perception of black triangles appearance, personality factors and level of education.

This analytical cross-sectional study evaluated the perception of black triangles (BT) and examined the relationships between the perception of BT, personality factors, different educational backgrounds and demographic factors. 435 participants were included and divided into four groups: dentists, clinical (4th and 5th year) dental students, pre-clinical (3rd year) dental students, and laypeople. Participants' perception of the attractiveness of smile profiles of maxillary and mandibular anterior dentition with BT was rated using a ten-point VAS scale with 0 being the least, and 10 being the most attractive smile profile. The personality was assessed using the NEO-FFI personality questionnaire. The smile profile with multiple large BT was rated the least attractive for the maxillary (mean = 3.6) and mandibular (mean = 3.9) tested profiles. The smile profile without BT was rated the most attractive for the maxillary (mean = 9.1) and mandibular (mean = 8.8) tested profiles. The dental professionals perceived the maxillary smile profile with multiple large BT as less attractive than the non-dental participants (t = - 2.715, P = 0.007). Being a male, having dental education, having lower Neuroticism scores, as well as having higher Openness, Agreeableness, Conscientiousness, and Extraversion scores predicted and contributed more towards perceiving various tested smile profiles as more attractive. These findings show that black triangles negatively impacts the perception of smile attractiveness, and that personality traits and having dental education impact the perception of smile attractiveness for smiles with black triangles.

Photothermal Effects of High-Energy Photobiomodulation Therapies: An In Vitro Investigation.

The purpose of this study was to investigate photothermal aspects of photobiomodulation therapies (PBMT) in vitro to assist in the development of safe clinical parameters with respect to higher-power devices with large surface applicators. Laser wavelengths in the range of 650 nm-1064 nm were investigated using a thermal camera. Thermographic measures of surface and sub-surface temperature variations of similar lean porcine muscle tissue samples were recorded for a series of calibrated experiments. A thermal comparison was then made between Flat-top and Gaussian beam spatial distribution devices. Outcome data were subjected to statistical analysis using an ANOVA model. Results acquired at similar parameters of irradiance indicated that the application of the 980 nm wavelength was associated with the highest rise in temperature, which decreased with other wavelengths in the order 980 > 1064 ≈ 650 >>> 810 nm (p < 5 × 10-20). All wavelengths assessed were associated with a significant temperature increase, and with the exception of 810 nm, all exceeded the threshold of a 6 °C rise within the prescribed parameter limits. Optical scanning by movement of the applied source over a relevant area was found to offer effective mitigation of these temperature increases. An extended discussion is presented, analysing the clinical significance of the study outcomes. Recommendations are made within the limits of this in vitro study in order to assist future clinical investigations.

Oral health status, oral health-related quality of life and personality factors among users of three-sided sonic-powered toothbrush versus conventional manual toothbrush.

OBJECTIVES: This longitudinal within subject controlled randomized observational investigation studied the impacts of three-sided sonic-powered toothbrush versus conventional manual toothbrush on oral health- and oral health-related quality of life (OHRQoL) and assessed the relationship between personality factors and OHRQoL. METHODS: A total of 96 participants (48 females and 48 males; mean age = 22.61 years, SD = 1.21) were recruited into this investigation and were randomly allocated into two groups. The participants were instructed to control oral hygiene for 1 month using either a three-sided sonic brush (Triple Bristle, Dayton, Tennessee, USA) (sonic group) or a conventional manual toothbrush (manual group). Dental plaque was assessed via Turesky-Modified Quigley-Hein Plaque Index (TMQHPI). Bleeding on probing (BOP) was recorded as 1 if present and zero if absent. The NEO Five-Factor Inventory (NEO-FFI) and Oral Health Impact Profile (OHIP-14) were used to assess personality factors and OHRQoL, respectively. TMQHPI, BOP and OHIP were assessed at study baseline and 1 month later. RESULTS: The TMQHPI, BOP and OHIP-14 scores were reduced after 1 month in both groups (p < 0.05), and were more reduced among the three-sided sonic brush users (p > 0.05). Higher neuroticism scores were associated with worse OHRQoL (p < 0.05) in both groups after 1 month. CONCLUSIONS: The three-sided sonic-powered toothbrush was associated with superior oral health and OHRQoL in comparison with the conventional manual toothbrush. Utilizing three-sided sonic toothbrush, less plaque deposits and lower neuroticism scores contributed towards and predicted better OHRQoL after 1 month of oral hygiene maintenance.

Photobiomodulation effects on periodontal ligament stem cells: A systematic review of in-vitro studies.

BACKGROUND: Stem cell therapy has been considered to play a paramount role in the treatment modalities available for regenerative dentistry. The established beneficial effects of photobiomodulation (PBM) at the cellular level have led to the combined use of these two factors (PBM and stem cells). The main goal of this study was firstly to critically appraise the effects of PBM on periodontal ligament stem cells (PDLSCs), and secondly to explore the most effective PBM protocols applied. METHODS: Pubmed, Cochrane, Scopus, Science Direct, and Google Scholar search engines were used to identify experimental in vitro studies in which PBM was applied to cultured PDLSCs. After applying specific keywords, additional filters, and inclusion/exclusion criteria, a preliminary number of 245 articles was narrowed down to 11 in which lasers and LEDs were used within the 630 - 1064 nm wavelength range. Selected articles were further assessed by three independent reviewers for strict compliance with PRISMA guidelines, and a modified Cochrane Risk of Bias to determine eligibility. STATISTICAL ANALYSIS: The dataset analysed was extracted from the studies with sufficient and clearly presented PBM protocols. Simple univariate regression analysis was performed to explore the significance of contributions of potential quantitative predictor variables towards study outcomes, and a one-way ANOVA model was employed for testing differences between the laser or LED sources of the treatments. The significance level for testing was set at α = 0.05. RESULTS: The proliferation rate, osteogenic differentiation, and expression of different indicative genes for osteogenesis and inflammation suppression were found to be positively affected by the application of various types of lasers and LEDs. With regard to the PBM protocol, only the wavelength variable appeared to affect the treatment outcome; indeed, the 940 nm wavelength parameter was found not to exert a favourable effect. CONCLUSIONS: Photobiomodulation can enhance the stemness and differentiation capacities of periodontal ligament stem cells. Therefore, for PBM protocols, there remains no consensus amongst the scientific community. Statistical analyses performed here indicated that the employment of a near-infrared (NIR) wavelength of 940 nm may not yield a significant favourable outcome, although those within the 630 - 830 nm range did so. Concerning the fluence, it should not exceed 8 J/cm2 when therapy is applied by LED devices, and 4 J/cm2 when applied by lasers respectively.

Prospective case series on possible effects of local factors on the development of halitosis in new complete denture wearers.

OBJECTIVES: To assess the development of halitosis in participants wearing new removable complete dentures (RCD). METHOD AND MATERIALS: Seventy-five completely edentulous patients receiving RCD were recruited. Halitosis was assessed by means of FitScan Breath Checker on the day of denture insertion (T0), as well as after 1 month (T1), and after 2 months (T2). Risk factors were studied using a validated questionnaire about oral and denture hygiene, and tongue scoring followed for each participant. A modified plaque scoring technique assessed the percentage of newly formed biofilms accumulated on all surfaces of the RCD. RESULTS: At T0, 44% of the participants revealed halitosis. This percentage insignificantly increased at T1 (66.7%) and T2 (65.6%), respectively (P > .109). At T1, halitosis was significantly lower among persons who reported tongue brushing compared to refraining participants (14.3% vs 72.6%; P = .002). At T2, halitosis was significantly higher among patients suffering from moderate to heavy tongue coatings compared to those with no or only light coatings (83.3% vs 50.0%; P = .006), those who did wear their dentures during sleeping (77.5% vs 45.8%; P = .010), and those who did not brush their tongues at all (87.5% vs 29.2%; P < .0001). With a 16-fold increased probability (95% CI 10.0 to 23.31; P < .001), the multivariate analysis revealed that non-brushing the tongue was the only variable significantly linked to halitosis at both follow-ups. CONCLUSION: Non-brushing of tongues as well as sleeping with dentures seems to be the main causes of halitosis in new RCD wearers.

Impacts of the Triple bristles three-sided sonic powered toothbrush on tooth shade, plaque control and gingival health.

OBJECTIVES: To evaluate the efficacy of the Triple bristles three-sided sonic powered toothbrush in plaque removal and its impact on tooth shade and gingival health, and to compare this with a conventional manual toothbrush. METHODS: Fifty two participants (26 males and 26 females; mean age [SD] = 22.48 [1.52], SE = 0.210, 95% CI = 22.06-22.90) were recruited into this controlled within-subject, randomized, two-treatment, 1-month crossover and examiner-blinded observational study between October 2020 and January 2021 in the School of Dentistry, University of Jordan. Within each participant, the upper and lower jaws were randomized to receive a brushing protocol either with the Triple bristles three-sided sonic brush or with a soft manual standard toothbrush with flat trimmed bristles. Tooth shades were recorded for upper and lower anterior and premolar teeth. The Turesky-Modified Quigley-Hein Plaque Index (TMQHPI) and bleeding on probing (BOP) were evaluated at study baseline, 1 week and 1 month after applying the brushing protocol. RESULTS: Both tested brushes were associated with significant reduction in plaque scores and BOP (p < 0.05). The Triple bristles brush was more effective in reduction in plaque and BOP in the lower jaw and among females than the manual brush (p < 0.05). CONCLUSIONS: The Triple bristles brush was more superior for reduction in plaque and probing on bleeding in the lower jaw and among females.

Oral Candidal Load and Oral Health Status in Chronic Obstructive Pulmonary Disease (COPD) Patients: A Case-Cohort Study.

OBJECTIVE: The objective of this study was to determine the candidal load of the patients with Chronic Obstructive Pulmonary Disease (COPD) and evaluate the oral health status of subjects with COPD. Material and Methods. N = 112 COPD subjects and N = 100 control subjects were included in the study. The selection of COPD cases was confirmed based on the set criteria from the American College of Physicians. The oral health status was assessed as per WHO criteria to determine the score of decayed, missing, and filled teeth (DMFT), significant caries index (SiC), community periodontal index and treatment needs (CPITN), and oral hygiene index-simplified (OHI-S). Gram staining was performed to identify Candida using the whole saliva. Quantitative evaluation of the candidal load was carried out using Sabouraud Dextrose Agar (SDA). Chrome agar was used to differentiate between the commensal carriages. A statistical analysis paired t-test and 95% confidence interval (CI) for proportions was carried out using STATA software. RESULTS: Candidal growth was found in 21.42% (n = 24) of COPD cases and 1.1% (n = 11) of control cases (p < 0.05) (95% CI 0.45, 0.59). The DMFT score was 8.26 in COPD subjects and 4.6 in controls, the SiC score was 16.42 in COPD subjects and 10.25 in controls, and the CPITN score for both COPD and control cases was score 2. CONCLUSION: In conclusion, there was a higher candidal load among subjects suffering from COPD. Theophylline medication can be a risk factor for increased candidal load in COPD patients.

COVID-19 and Dentistry: An Updated Overview of Dental Perspectives and a Recommended Protocol for Dental Care and Emergency Dental Treatment.

AIM AND OBJECTIVE: This manuscript aims to provide an overview of the coronavirus disease-2019 (COVID-19) pandemic from dental perspectives, and presents standards and guidelines of dental care provision based on available research in this field as well as clinical experience and practice. BACKGROUND: The current COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading around the globe and interferes with the provision of dental care for many individuals from different communities and backgrounds. A search for the literature on PubMed, ISI Web of Science, Scopus, EMBASE, and Cochrane Library from March 1, 2020 to December 30, 2020 was conducted. Also, the bibliographies included in the indicated articles were used to identify further literature. Recommendations by health authorities in different countries were also consulted. RESULTS: COVID-19 is causing many fatalities and is disrupting people's daily life and the economy in many countries around the world. Due to the potential of cross-infection through dental treatments, especially dental aerosol generation procedures, the dental profession has been disrupted during this pandemic. Dental care provision has been ceased completely or partially (limited to emergency or urgent treatment) in most countries around the world. Until this pandemic is controlled by new suitable treatments and/or vaccination, there is an urgent need to adopt immediate guidelines and standards for the safe provision of dental care to meet patients' demands, especially for the dental aerosols. CONCLUSION: Guidelines and standards for dental treatment amidst the COVID-19 pandemic are required. This manuscript provides an overview of the COVID-19 pandemic from dental perspectives and presents standards and guidelines of dental care provision based on available research in this field as well as clinical experience and practice. CLINICAL SIGNIFICANCE: This manuscript provides guidelines and standards for dental treatment and clinical management within dental settings amidst the COVID-19 pandemic, and resembles part of the quest to set the golden standards for dental care during the current circumstances. How to cite this article: AL-Omiri MK, Al-Shayyab MH, Al Nazeh AA, et al. COVID-19 and Dentistry: An Updated Overview of Dental Perspectives and a Recommended Protocol for Dental Care and Emergency Dental Treatment. J Contemp Dent Pract 2021;22(5):572-586.

Treatment of symptomatic, deep, almost cariously exposed lesions using ozone.

The aim of this controlled randomized crossover study was to assess post-treatment pain and the need for root canal treatment after the use of a traditional caries removal method followed by restoration, or after an ozone method of more conservatively managing the deep caries and a restoration. 84 participants (42 males and 42 females, mean age ± SD = 23.9 ± 2.0 years) were randomly allocated to receive either a traditional (n = 42, 21 males and 21 females) or ozone (n = 42, 21 males and 21 females) method. The ozone method only differed from the traditional method by leaving the deep leathery caries on the pulpal floor and then treating this with 20 s of ozone from the healozone X4 (Curozone, Germany). All caries was removed in the traditional group. A conventional glass ionomer cement (Riva Self Cure High Viscosity, SDI, Australia) was placed followed by a bonded composite resin restoration (Filtek Z250 Universal Restorative, 3 M ESPE, USA) in each cavity. The visual analogue scale was used to assess pain scores before treatment and after 24 h. The participants were then followed up for 2 years to assess the need for root canal treatment. Statistical significance levels were set at α ≤ .05. Both groups were associated with significant reduction of pain scores 24 h after treatment (p < .0001). The ozone treatment was associated with less pain 24 h after treatment (p < .0001) and less need for root canal treatment (p = .014), after 2 years follow up, than the conventional treatment. In conclusion, treatment of symptomatic, deep carious lesions by ozone following partial removal of caries was accompanied with less pain and occurrence of RCT after treatment compared to traditional complete caries removal.

COVID-19 and Personality: A Cross-Sectional Multicenter Study of the Relationship Between Personality Factors and COVID-19-Related Impacts, Concerns, and Behaviors.

Background: This cross-sectional observational study aimed to evaluate coronavirus disease 2019 (COVID-19)-related precautions to avoid COVID-19 infection, distress and behavioral changes, fears and concerns, and effects on opinions and beliefs among participants from different backgrounds and also to identify the relationships between personality factors and COVID-19-related changes and impacts. Methods: One thousand and three hundred nineteen participants (744 females and 575 males, mean age ± SD = 32.7 ± 11.6 years) completed a three-section survey collecting data regarding demographic information, personality factors [using the NEO Five-Factor Inventory (NEO-FFI)], and COVID-19-related issues (using the VAS scale). Findings: COVID-19 was associated with changes related to precautions to avoid COVID-19 infection, distress and behavioral changes, fears and concerns, and effects on opinions and beliefs (P < 0.05). Higher neuroticism scores were associated with more negative COVID-19-related changes and impacts (P < 0.05). Higher extraversion, agreeableness, and conscientiousness scores were associated with more acceptance of COVID-19 containment measures as well as less COVID-19-related changes and impacts (P < 0.05). Conclusions: Personality factors were associated with COVID-19-related impacts. These findings demonstrate the importance of the relationship between personality factors and COVID-19-related changes.

Disseminated Herpes Simplex Virus in an Immunocompetent Patient Without Presence of Epidermal or Mucosal Lesions.

ABSTRACT: Herpes simplex virus (HSV) is a disease usually characterized by lesions within the epidermis or mucosa of children and adults. However, this infection can also cause complications to many systems of the body, including the peripheral and central nervous system, respiratory system, and hepatobiliary system. In this case, we present a 43-year-old man with a history of substance abuse, who presented with fever, cough, and headache, and within days, progressed into fulminant hepatitis and hypoxic failure. Bacterial and fungal cultures were negative, as well as the workup for human immunodeficiency virus. However, the presence of HSV was detected in a bronchial lavage culture after the patients had expired. This result, along with the findings at autopsy, including viral cytopathic effect in the lung and liver, which were confirmed with immunohistochemical stains for HSV, strongly suggest that the cause of death is from disseminated herpes virus infection with hepatitis and viral pneumonitis. This disseminated infection occurred in an immunocompetent host without any evidence of mucocutaneous lesions.

A Spectrophotometric Study on Light Attenuation Properties of Dental Bleaching Gels: Potential Relevance to Irradiation Parameters.

BACKGROUND: During in-office bleaching, appropriate light sources are applied in order to enhance the activity of the bleaching gels applied onto teeth. For this method to be effective, a high absorption of light within the gel is necessary. Variation in the light attenuation capability of the gel, the duration of application and light activation can contribute towards safety hazards associated with this procedure. METHODS: In this study, seven different gels and hydrogen peroxide have been evaluated for their optical properties by means of spectrophotometry (440-1000 nm). The transmitted light spectrum was used to estimate the intensity loss for each gel. The mean intensity decreases observed were statistically analysed using an analysis of variance (ANOVA). RESULTS: The five more-pigmented gels tested indicated a very similar intensity loss of around 80%, whereas the remaining two gels showed significantly less attenuation (predominantly, p < 10-6). CONCLUSIONS: Throughout the spectrum of wavelengths examined, and according to the underlying studies evaluated, five of the gels assessed demonstrated an attenuation high enough to possibly avoid overheating of the underlying enamel dentine and pulp. An evaluation of appropriate irradiation parameters is proposed.

Laser Analgesia Associated with Restorative Dental Care: A Systematic Review of the Rationale, Techniques, and Energy Dose Considerations.

It is a common experience amongst laser dentists and patients that mid-IR wavelength application in cavity preparation may be achieved without causing any associated pain. The erbium family of lasers (Er,Cr:YSGG 2780 nm and Er:YAG 2940 nm) are frequently used without employing injectable local anesthesia as an adjunct: the phenomenon arising from the application of these devices is known as laser analgesia. This review seeks to apply a systematic approach to the examination of appropriate published studies but also to highlight the need for much more structured clinical investigations that consolidate photonic dose and methodology. A search of published data using PRISMA criteria was carried out to examine clinical trials into laser analgesia in conjunction with restorative dentistry, applying inclusion and exclusion criteria. From this, 10 published articles were selected for analysis. Suitability assessment was carried out, using a modified Cochrane risk of bias methodology. In 8/10 of the included studies, laser-induced analgesia is claimed to be better and effective, while in 2/10 of the studies, no difference was exhibited compared to the control group. Statistical analysis of three split mouth studies concluded that only one of these investigations reviewed demonstrated a significant analgesic effect for laser treatment while the other two did not support this observation. From this data, it is inconclusive to assess the predictability of laser analgesia in cavity preparation. A possible rationale and laser operating parametry has been discussed. Successful implementation of this treatment modality remains technique sensitive and subject to further investigation.

Systematic Review of Post-Surgical Laser-Assisted Oral Soft Tissue Outcomes Using Surgical Wavelengths Outside the 650-1350 nm Optical Window.

Objective: To explore via systematic review the validation of uneventful post-surgical healing, associated with shorter and longer laser wavelength applications in minor oral surgery procedures. Methods: From April 28 to May 11, 2020, PubMed, Cochrane Database of Systemic Reviews, and Google Scholar search engines were applied to identify human clinical trials of photobiomodulation (PBM) therapy in clinical dentistry. The searches were carried out with reference to (1) dental laser wavelengths shorter than 650 nm; (2) wavelengths localized within the 2780-2940 nm; and (3) the 9300-10,600 nm range. Selected articles were further assessed by three independent reviewers for strict compliance with PRISMA guidelines and modified Cochrane Risk of Bias to determine eligibility. Results: Using selection filters of randomized clinical trials, moderate/low risk of bias, and the applied period, and following PRISMA guidelines, 25 articles were selected and examined. A risk of bias was completed, where 11 out of 25 publications were classified as low risk of bias, and 14 out of 25 were classified as medium risk status. In total, 6 out of 13 (46% of) studies comparing the examined laser wavelengths with scalpel-based treatment showed positive results, whereas 6 out of 13 (46%) showed no difference, and only 1 out of 13 (7.7%) presented a negative outcome. In addition, 5 out of 6 (83% of) studies comparing the examined laser wavelengths with other diodes (808-980 nm) showed positive results, whereas 1 out of 6 (17%) had negative outcomes. Conclusions: A detailed and blinded examination of published studies has been undertaken, applying strict criteria to demonstrate research outcome data, which suggests positive or at worst neutral comparatives when a given laser wavelength system is used against an alternative control therapy. As such, substantiated evidence for laser surgery in delivering uneventful healing and analgesic effects, as an expression of a PBM-like (quasi-PBM) influence, has been shown.

Photobiomodulation Dose Parameters in Dentistry: A Systematic Review and Meta-Analysis.

OBJECTIVE: This systematic review and meta-analysis of published randomized controlled trials examines a possible relationship between optical spot size at surface tissue, irradiance, radiant exposure, total energy delivered, operator technique and reported clinical outcomes. BACKGROUND: Clinical photobiomodulation (PBM) therapy has achieved a high level of evidence-based acceptance in the mitigation of oral mucositis associated with cancer radiotherapy and chemotherapy, and supportive clinical research in relation to orthodontic tooth movement, oral medical conditions, including burning mouth syndrome, xerostomia and lichen planus. Inconsistent outcomes have been reported not withstanding a substantial body of primary supportive research from clinical, in vitro and animal studies. MATERIALS AND METHODS: PubMed, Cochrane Database of Reviews and Google Scholar search engines were applied to identify human clinical trials of PBM therapy in clinical dentistry. A total of 766 articles between February 2009 and June 2020 were identified and following a full text evaluation, 38 papers with sufficient data to permit analyses are included in this investigation. RESULTS: Following a detailed assessment of potential factors that may have an influence in clinical outcome, a clear trend is apparent associating optical spot size to a positive or negative effect. Furthermore, there is a clear difference in the reported results in relation to total energy applied, delivery techniques and optical parameters, which merits further investigation. Factorial statistical analyses identified an association between smaller optical surface applications and an overall lower level of reported clinical success in treating superficial and deeper targets, and correspondingly sub-surface larger target tissues were found to be more responsive to therapy by use of a larger optical surface spot size. Moreover, use of multiple small diameter probe applications was found to provide inconsistent results. CONCLUSIONS: Many factors can confound clinical success including variations in anatomy, site location, clinical condition and subject individuality. To achieve higher levels of predictable outcome, a mature appreciation of these factors, plus an expanded understanding of laser parametry, tissue volume and target depth to deliver an adequate dose within current recommended guidelines, is essential.

Laser-Assisted aPDT Protocols in Randomized Controlled Clinical Trials in Dentistry: A Systematic Review.

BACKGROUND: Antimicrobial photodynamic therapy (aPDT) has been proposed as an effective alternative method for the adjunctive treatment of all classes of oral infections. The multifactorial nature of its mechanism of action correlates with various influencing factors, involving parameters concerning both the photosensitizer and the light delivery system. This study aims to critically evaluate the recorded parameters of aPDT applications that use lasers as the light source in randomized clinical trials in dentistry. METHODS: PubMed and Cochrane search engines were used to identify human clinical trials of aPDT therapy in dentistry. After applying specific keywords, additional filters, inclusion and exclusion criteria, the initial number of 7744 articles was reduced to 38. RESULTS: Almost one-half of the articles presented incomplete parameters, whilst the others had different protocols, even with the same photosensitizer and for the same field of application. CONCLUSIONS: No safe recommendation for aPDT protocols can be extrapolated for clinical use. Further research investigations should be performed with clear protocols, so that standardization for their potential dental applications can be achieved.

Improving oral health: a short-term split-mouth randomized clinical trial revealing the superiority of resin infiltration over remineralization of white spot lesions.

OBJECTIVES: To evaluate masking effects of resin infiltration on labial white spot lesions (WSL), by comparing the latter with a remineralization approach (using hydroxyapatite and fluorides) and conventional oral care (using fluoride-free toothpaste). METHOD AND MATERIALS: Fifteen patients with at least three WSL were enrolled for a within-person randomized controlled trial, thus allowing for intrapersonal comparisons. Each WSL per tooth in every patient was randomly assigned to one of the following groups. Group 1: lesions were resin-infiltrated with Icon (RI; DMG); Group 2: Remin Pro (RP; VOCO) was used as remineralizing agent; and Group 3 (control): affected teeth were brushed with Complete Care toothpaste (CC; Himalaya). RP and CC were applied by means of a polishing brush, using a low-speed handpiece (5 min), and these procedures were repeated chairside thrice daily for 7 consecutive days. Digital photographs were captured before and after lesion treatment under standardized conditions. The CIE L*a*b* color system was used to analyze the optical outcome, and intrapersonal color differences were statistically evaluated. RESULTS: Compared to RP and CC, RI showed prompt and subjectively satisfactory color improvements, and this was primarily driven by L* and b* shifts. Statistical analysis of the objective color differences (ΔE*) between the three groups revealed significant differences for RI vs RP (P = .029), RI vs CC (P < .001), and RP vs CC (P = .001). CONCLUSION: Resin infiltration is considered a time-effective treatment option for esthetically camouflaging WSL, while RP and CC failed to improve lesion appearance and oral health in the current short-term trial.

Photobiomodulation and Oral Mucositis: A Systematic Review.

Oral mucositis (OM) is a debilitating complication of chemotherapy, and head and neck radiotherapy. In an effort to offer the best possible advice within the limitations of published research, a systematic review with an extended discussion and commentary on dosimetry and dose delivery is presented. Using keywords as listed, Pubmed, Google Scholar and Cochrane databases were searched during a period extending from 1995 to 2019. A total of 782 abstracts were identified. A total of 50 papers were analysed, and of these, 29 satisfied criteria required for systematic review in accordance with an optimized PRISMA statement. Clinical outcome as reported was subject to analysis with respect to time of intervention, incidence and severity of oral mucositis, and pain amelioration, and a comprehensive combined univariate and multivariate statistical analysis of the methods employed was performed. Recommendations are made with respect to the timing of the intervention. Moreover, there is an extended discussion available on the treatment care rationale of photobiomodulation (PBM), and its adjunctive association with OM. In conclusion, early prophylactic application offers clear advantages in clinical management. The many studies and associated variables and covariables assessed here revealed a choice of delivery techniques, associated wavelengths and many further indices to consider with regard to the accomplishment of optical parameters. It is therefore our recommendation that clinicians use PBM as a therapy with a full and proper understanding and training in order to optimise the clinical effects achievable.