Parental beliefs in and attitudes toward teething signs and symptoms: A systematic review.

BACKGROUND: Parents believe that teething is associated with signs and symptoms, which may induce them to give medications that could harm their children. Some children may require alleviation of symptoms and overall attention. AIM: To assess parents' beliefs in and attitudes toward teething. DESIGN: Through electronic databases and gray literature, this systematic review identified cross-sectional studies reporting parents' beliefs in, knowledge about, and attitudes toward the signs and symptoms of primary tooth eruption in children aged between 0 and 36 months. Three reviewers independently selected the studies, collected the information, assessed methodological quality, and checked for accuracy with disagreements solved by a fourth reviewer. The Agency of Research and Quality in Health questionnaire for cross-sectional studies was used for quality assessment. Descriptive analysis with median and interquartile ranges was adopted. RESULTS: Twenty-nine studies comprising 10 524 participants from all geographic regions were included. The methodological quality of the studies was moderate. Most parents have beliefs in signs and symptoms during dentition, the most reported symptom being the desire to bite. Oral rehydration was the most exposed attitude in the studies included. Only a small proportion of parents reported no attitude. CONCLUSIONS: The majority of parents believed in at least one sign or symptom associated with teething, and only few of them would do nothing or just wait for the signs or symptoms to pass, with no difference among countries (Protocol doi: 10.17605/OSF.IO/S2KZ3).

Tooth wear prevalence in individuals with Down syndrome: a systematic review.

OBJECTIVES: This systematic review investigated the prevalence of tooth wear between patients with and without Down syndrome. METHODS: Six databases (Embase, LILACS, Livivo, PubMed, Scopus and Web of Science) and grey literature (Google Scholar, OpenGrey and ProQuest) were searched until March 7, 2022. Observational studies were included to assess the differences in tooth wear prevalence and/or severity in Down syndrome and non-syndromic controls. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations were followed. Three reviewers independently screened studies, extracted data, assessed the methodological quality (Joanna Briggs Institute) and graded the certainty of evidence through the Grading of Recommendations, Assessment, Development, Evaluation (GRADE) approach. Results were summarized through meta-analyses using a random-effects model. The protocol was registered at PROSPERO (CRD42021266997). RESULTS: Of the 1382 records identified, six cross-sectional studies were included. Individuals with Down syndrome had a higher prevalence and were more likely to have tooth wear than individuals without Down syndrome (44% × 15%; OR = 4.43; 95% CI 3.17-6.18; p < 0.00001; I2 = 8%). Also, the severity of tooth wear was higher in the Down syndrome group (n = 275) compared with the controls (n = 294). The certainty of evidence analysis was very low. CONCLUSIONS: Based on very low certainty of the evidence, patients with Down syndrome had a higher prevalence and likelihood and severity of tooth wear when compared to those without Down syndrome. CLINICAL RELEVANCE: Screening early tooth wear lesions should be carefully done in the Down syndrome population since its occurrence is remarkable compared to the general population.

Impact of the first thousand days of life on dental caries through the life course: a transdisciplinary approach.

This review aimed to describe the importance of the first 1000 days of a child's life as a golden period for interventions and actions to prevent dental caries and other chronic non-communicable diseases (NCDs) throughout the life course and highlight that the first 450 days of life could be even more important for oral health. During the first 1000 days of life (pregnancy and first two years of life), health care providers can identify unhealthy lifestyles, behaviors, and their determinants. Bearing in mind contextual factors like socioeconomic conditions and cultural aspects, this is a unique period to work together with the family and identify opportunities for adopting healthy habits that might last throughout the life of the expected or newborn child. This is a "window of opportunity" for the prevention of chronic NCDs of both systemic and oral origin, such as overweight, obesity, diabetes, cardiovascular diseases, and dental caries. In fact, to effectively prevent dental caries, pregnancy and the first 6 months of a child's life (first 450 days) should be considered the critical period to work together with families to facilitate the adoption of healthy habits. Knowledge about the first thousand days of life is essential and represents a crucial period for the implementation of actions and interventions that will guarantee good oral and general health development that can persist throughout life.

Two-dimensional radiographs versus cone-beam computed tomography in planning mini-implant placement: A systematic review.

Background: This study aimed to compare two-dimensional radiographs and cone beam computed tomography (CBCT) images for mini-implant planning. Material and Methods: A search was performed in PubMed, Embase, Web of Science, Cochrane Library and Google Scholar electronic databases according to PIRD strategy, on September 11, 2021. In vivo studies that compared two-dimensional imaging with CBCT for mini-implant planning were selected. The methodological quality of each study was assessed using the QUADAS-2 tool. Results: The initial search identified 441 papers. Five studies were added following a manual research. Of the total 446 studies, 40 were selected after title evaluation, 29 remained after abstract evaluation, and 11 were left after full-text analysis. Final screening yielded a total of four studies that composed the narrative synthesis of this systematic review. When comparing the imaging systems for palatal mini-implants, lateral radiographs (LRs) showed approximately the same measurements of bone quantity as those of CBCT, hence bearing no influence on placement site selection. In determining image suitability for interradicular mini-implants, two-dimensional radiographs underestimated the available space. Conclusions: Lateral radiography is sufficient to quantify the available bone for planning mini-implants installed on the palate, in the median region of upper first premolars. CBCT enhances interradicular mini-implant planning by aiding in implantation site selection, and improving the installation success rate. Key words:Systematic Review, Cone beam computed tomography, Radiography, Orthodontic mini-implant, Dental planning.

BURNOUT SYNDROME AMONG DENTISTS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVE: Burnout syndrome has negative consequences on the dentist's health and performance during work. This systematic review aimed to assess the prevalence of Burnout syndrome in dentists. METHODS: Searches were carried out in Medline, Scopus, Web of Science, PsycINFO, EMBASE, LILACS databases, and searches in the gray literature on January 27, 2021. There were no restrictions on language and search period. For the diagnosis of Burnout, only studies that used the Maslach burnout inventory questionnaire and its subscales emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA) were included. Proportion meta-analyses were performed using the Stata 13.0 software. RESULTS: A total of 37 articles were included in the narrative and 31 in quantitative syntheses. The overall prevalence of Burnout syndrome in dentists was 13% (95% confidence interval [CI]: 0.006-0.21; I²: 97.07%) and the total prevalence in the subscales EE, DP, and PA, were, respectively: 28% (95% CI: 0.24-0.32; I²: 20.70%), 18% (95% CI: 0.08-0.28; I²: 85.61%) and 10% (95% CI: 0.08-0.13; I²: 0%). About the levels of Burnout syndrome in the subscales, 25% (95% CI: 0.19-0.31; I² 92.58%) presented high EE, 18% (95% CI: 0.10-0.26; I² 96.62%) high DP and 32% (95% 0.20-0.45; I² 97.86%) low PA. About continuous data, the mean of EE, DP and PA was respectively 17.90 (95% CI: 9.36-26.43; I² 94.8), 6.93 (95% CI: 3.41-10.45; I² 80.2) and, 34.69 (95% CI: 23.82-45.55; I² 98.8). No study presented all the positive criteria of the Joanna Briggs Institute Critical Appraisal checklist. CONCLUSION: In conclusion, there was a considerable prevalence of burnout syndrome in dentists, mainly in the subscale of emotional exhaustion.

Digital anatomy table in teaching-learning process of the temporomandibular joint anatomy.

INTRODUCTION: The use of teaching resources and digital objects has gradually been incorporated into dental schools. This study aimed to evaluate the digital anatomy table in teaching-learning process of the temporomandibular joint (TMJ) anatomy and the student's perception regarding this resource. MATERIALS AND METHODS: A cross-sectional study was conducted on 41 undergraduate dental students. Knowledge assessment tests were applied at different time intervals: before and after the TMJ theoretical class, after the practical class on prosected specimens and after the use of digital anatomy table. The medians of the scores obtained in the three groups (theoretical class, practical class and digital table) were descriptively analysed and submitted to Wilcoxon, Kruskal-Wallis and Student-Newman-Keuls statistical tests. The perception survey was conducted at the end of the study. RESULTS: When the teaching strategies were compared amongst each other, the medians of the scores with the digital anatomy table were significantly higher than after the theoretical and practical classes. At the end of the research, there were no differences amongst the three groups (theoretical class, practical class and digital table). Regarding the perception, the majority of the students reported that the digital anatomy table helped them to understand the content of the theoretical class. CONCLUSION: It was concluded that learning with the use of the digital anatomy table did not increase the knowledge of dental students with respect to the TMJ anatomy. The students' perceptions of the digital anatomy table were positive and that it could be used as an additional resource in the teaching-learning process.

Impact of the first thousand days of life on dental caries through the life course: a transdisciplinary approach

Abstract This review aimed to describe the importance of the first 1000 days of a child's life as a golden period for interventions and actions to prevent dental caries and other chronic non-communicable diseases (NCDs) throughout the life course and highlight that the first 450 days of life could be even more important for oral health. During the first 1000 days of life (pregnancy and first two years of life), health care providers can identify unhealthy lifestyles, behaviors, and their determinants. Bearing in mind contextual factors like socioeconomic conditions and cultural aspects, this is a unique period to work together with the family and identify opportunities for adopting healthy habits that might last throughout the life of the expected or newborn child. This is a "window of opportunity" for the prevention of chronic NCDs of both systemic and oral origin, such as overweight, obesity, diabetes, cardiovascular diseases, and dental caries. In fact, to effectively prevent dental caries, pregnancy and the first 6 months of a child's life (first 450 days) should be considered the critical period to work together with families to facilitate the adoption of healthy habits. Knowledge about the first thousand days of life is essential and represents a crucial period for the implementation of actions and interventions that will guarantee good oral and general health development that can persist throughout life.

Active teaching methodologies in health education / Metodologias ativas no ensino em saúde

ABSTRACT This study is a literature review on the contributions of active methodologies in Higher Education in the health area. From the reviewed literature (texts, articles and books), an academic essay was written, addressing ideas, reflections, literature citations and authors' personal impressions on the theme. After analyzing the literature, it was realized that active methodologies despite being involved in the teaching-learning process for several years, still require that teachers and students widely appropriate their benefits. The implementation of this change will help in coping with the factors that have negatively interfered in higher health education. It is a challenge that needs to be embraced by teachers and students. Conclusions: Active teaching methodologies can be included in all teaching models and methods and aim to promote learning and expand the possibilities for students to develop their competencies.

RESUMO Este estudo trata de uma revisão de literatura sobre as contribuições das metodologias ativas no Ensino Superior na área da saúde. A partir da literatura revisada (textos, artigos e livros), foi redigido um ensaio acadêmico, abordando ideias, reflexões, citações da literatura e impressões pessoais dos autores sobre o tema. Após análise da literatura, percebeu-se que as metodologias ativas apesar de estarem envolvidas no processo ensino-aprendizagem há vários anos, ainda demandam que professores e estudantes apropriem--se amplamente dos seus benefícios. A implementação desta mudança auxiliará no enfrentamento dos fatores que tem interferido negativamente na educação superior em saúde. É um desafio que precisa ser abraçado por professores e estudantes. As metodologias de ensino ativas podem ser incluídas em todos os modelos e métodos de ensino e visam favorecer o aprendizado e ampliar as possibilidades dos estudantes no desenvolvimento de suas competências.

Epidermal cyst: a rare case report in a 5-month-old child / Cisto epidérmico: relato de caso raro em criança de 5 meses

ABSTRACT The epidermal cyst is a rare, benign lesion, usually asymptomatic and slowly enlarging, more frequently located in the submandibular region. Its etiology is believed to be associated with the epithelial residual tissues retained in the midline during the closure of the first and second brachial arches, in the third and fourth weeks of intra-uterine life. Its clinical characteristics are of a rubbery consistency to palpation, well defined borders, with the absence of skin appendages within their squamous epithelium lined walls. The final diagnosis is confirmed through histopathological examination with stratified squamous epithelium findings in the cystic fluid lumen or keratin. The treatment is usually surgical and without recurrence and the final diagnosis is confirmed through histopathological examination. This paper aims to present a case report of a congenital epidermal cyst in a 5-month-old female patient located in the mouth floor near the sublingual gland duct. The case was treated with excisional biopsy and after follow-up, there was no recurrence.

RESUMO O cisto epidérmico é um cisto de desenvolvimento, benigno, raro, localizado com maior frequência na região submandibular, geralmente assintomático e de evolução lenta. Acredita-se que a sua etiologia esteja associada aos restos epiteliais retidos na linha média durante o fechamento do primeiro e segundo arcos braquiais, na terceira ou quarta semana de vida intrauterina. Suas características clínicas são de uma consistência borrachóide à palpação, bordas delimitadas e sem apêndices de pele no seu interior. O diagnóstico é confirmado através do exame histopatológico com achados de epitélio escamoso estratificado e no lúmen fluído cístico ou queratina. O tratamento é geralmente cirúrgico e sem recidivas. Este trabalho relata um caso de cisto epidérmico congênito de uma paciente pediátrica, do sexo feminino, de cinco meses de idade e localizado no assoalho de boca próximo ao ducto da glândula sublingual. O caso foi tratado com a enucleação cirúrgica e em seis meses de acompanhamento não apresentou recidiva.

Children's and parents' perceptions concerning surgical attire: a systematic review / Percepções de crianças e pais sobre trajes médicos: uma revisão sistemática

ABSTRACT Objective: To review the literature about children's and parent's perceptions on surgical attire. Data source: A systematic search was conducted in the databases EMBASE, Latin American and Caribbean Health Sciences (LILACS), PubMed, PsycINFO, Scopus and Web of Science. Grey literature was searched on Google Scholar, Open Grey and ProQuest Dissertations, and Theses Database. Data synthesis: A total of 2,567 papers were identified. After a two-phase selection, 15 studies were included in narrative synthesis. Children favored wearing white coats in five of the nine included studies (55.5% [95%CI 48.3-62.7]; p=1.00). With respect to parents' preferences, results of vote counting showed that in 11 of 15 included studies, they favored physicians wearing white coats (73.3% [95%CI 67.9-78.6]; p=0.11). Conclusions: Children and parents have preferred physicians to wear a white coat with a very low certainty of evidence.

RESUMO Objetivo: Revisar a literatura sobre as percepções de crianças e seus pais a respeito de trajes médicos. Fontes de dados: Buscas sistemáticas foram conduzidas nas bases de dados EMBASE, Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), PubMed, PsycINFO, Scopus e Web of Science. A literatura cinzenta foi pesquisada no Google Scholar, Open Grey e ProQuest Dissertations e Theses Database. Síntese dos dados: Foram identificadas 2.567 publicações e, após uma seleção de duas fases, foram incluídos 15 estudos na síntese qualitativa. As crianças tinham preferência pelo uso de jaleco branco em cinco dos nove estudos incluídos (55,5% [IC95% 48,3-62,7]; p=1,00). Em 11 dos 15 estudos incluídos, os pais tinham preferência pelos médicos que utilizavam jaleco (73,3% [IC95% 67,9-78,6]; p=0,11). Conclusões: Com uma qualidade baixa de evidência, crianças e pais preferem os médicos que usam jaleco branco.

Children's and parents' perceptions concerning surgical attire: a systematic review.

OBJECTIVE: To review the literature about children's and parent's perceptions on surgical attire. DATA SOURCE: A systematic search was conducted in the databases EMBASE, Latin American and Caribbean Health Sciences (LILACS), PubMed, PsycINFO, Scopus and Web of Science. Grey literature was searched on Google Scholar, Open Grey and ProQuest Dissertations, and Theses Database. DATA SYNTHESIS: A total of 2,567 papers were identified. After a two-phase selection, 15 studies were included in narrative synthesis. Children favored wearing white coats in five of the nine included studies (55.5% [95%CI 48.3-62.7]; p=1.00). With respect to parents' preferences, results of vote counting showed that in 11 of 15 included studies, they favored physicians wearing white coats (73.3% [95%CI 67.9-78.6]; p=0.11). CONCLUSIONS: Children and parents have preferred physicians to wear a white coat with a very low certainty of evidence.

Children's Perceptions of the Dentist and Dental Office Through Drawings.

Purpose: To evaluate children's perceptions of the dentist and dental office using drawings and its association with age, sex, and previous dental experience.
Methods: Participants included 144 four- to six-year-old children who were instructed to make a drawing of their perception of the dentist and dental office. Data collected included age, sex, and previous dental care experience. The data were analyzed descriptively and through multivariate logistic regression.
Results: Boys were 2.3 times more likely to have a negative perception of the dentist than girls (P =0.024). Children who had no previous dental experience were four times more likely to have a negative perception of dentists (P =0.002). Six-year-old children were three times more likely to have a negative perception of the dentist compared to four-year-old children (P =0.031).
Conclusion: Drawings can be a useful tool to evaluate children's perceptions of the dentist and dental office.

Effectiveness of anesthetic solutions for pain control in lower third molar extraction surgeries: a systematic review of randomized clinical trials with network meta-analysis.

OBJECTIVE: To assess the effectiveness of different anesthetic solutions for pain control immediately after the extraction of lower third molars. METHODS: Nine databases were used to identify randomized clinical trials, without restriction of language or year of publication. The "JBI Critical Appraisal Tools for Systematic Reviews" was used to assess the risk of bias in the studies. The network meta-analysis was performed to compare the effectiveness of different anesthetics to control the pain immediately after the surgery of lower third molars, using the standardized mean difference (SMD) as the effect estimate. The GRADE approach was used to assess the certainty of evidence. RESULTS: The search presented 13,739 initial results, from which 45 met the eligibility criteria and presented low to moderate risk of bias. Thirteen studies were included in the meta-analysis. The 2% lidocaine + clonidine presented the lowest pain scores (SMD = - 1.44; - 2.72 to - 0.16) compared to 4% articaine + adrenaline, followed by 0.5% bupivacaine + adrenaline (SMD = - 1.36; - 2.13 to - 0.59). The certainty of evidence varied between very low to moderate. CONCLUSION: 2% lidocaine + clonidine and 0.5% bupivacaine + adrenaline were the anesthetics with the highest probability for pain control immediately after the surgical procedure of removing impacted lower third molars. CLINICAL SIGNIFICANCE: The use of an adequate anesthetic with effective pain control can contribute to a more comfortable postoperative period.

The Impact of Temporomandibular Disorders on the Oral Health-Related Quality of Life of Brazilian Children: A Cross-Sectional Study.

Purpose: To evaluate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in children and the impact on their oral health-related quality of life (OHRQoL).
Methods: Data were collected by means of a questionnaire to evaluate the presence of TMD symptoms in eight to 10-year-old children. For those who answered at least one of the four questions in a positive manner, a clinical exam was done to confirm the diagnosis. The Child Perceptions Questionnaire (CPQ8-10) was applied to evaluate the OHRQoL. Poisson regression was used to associate the total scores and individual domains of the CPQ8-10 with sociodemographic factors and clinical conditions.
Results: A total of 245 children participated in this cross-sectional study. One hundred and twenty-one (49.4 percent) were diagnosed with TMD; 57.9 percent were females and 42.1 percent were males. Children with a diagnosis of disc displacement with reduction had a negative impact on the domain of functional limitations (rate ratio=2.61, 95 percent confidence interval=1.19 to 5.75, P =0.017).
Conclusion: The prevalence of signs and symptoms of TMD was high in our sample, and signs and symptoms of TMD had a negative impact on children's OHRQoL in the domain of functional limitations.

Inclusion of initial caries lesions in a population-based sample of Brazilian preschool children: Impact on estimates and treatment needs.

This study aimed to assess changes in epidemiological estimates and treatment needed when initial caries lesions are included in a population-based survey of preschool children. A cross-sectional survey was conducted in a Brazilian municipality, collecting data of preschool children in 16 health centers. Caries detection used the merged codes (epi-codes) for ICDAS/ICCMS. An option for treatment, according to ICCMS, was chosen during the examination. Caries experience (dmft/dmfs) and prevalence were estimated considering three thresholds (A- initial, moderate, and severe lesions, B- only moderate and severe lesions and C- severe lesions). Incremental need for non-operative care was also verified. The sample consisted of 663 children aged 2-4 years (response rate of 99.85%). Including initial lesions, a 2-fold increase in dmft was observed (A: 3.36, B: 1.02, p<0.001). With the inclusion, the caries prevalence increased to 75% compared to threshold B only (28%). The majority (76%) of children who required any intervention (56%) should be scheduled for non-operative care. We suggest that including initial caries lesions in an epidemiological survey may significantly impact assessment of population caries experience.

Dental Pain in Preschool Children Using the Brazilian Dental Discomfort Questionnaire and its Association with Dental Caries and Socioeconomic Factors.

Purpose: To assess the prevalence of dental pain in preschool children through the Brazilian Dental Discomfort Questionnaire (DDQ-B) and its association with dental caries, its severity, and socioeconomic factors. Methods: The study included 485 three- to four-year-olds who attended the National Day of Children's Vaccination in São Paulo, Brazil. Parents answered the DDQ-B and questions of socioeconomic conditions. Calibrated dentists assessed dental caries using the decayed, missing, and filled primary teeth (dmft) index and its severity using the pulpal involvement, ulceration of mucosa due to root fragments, fistula, and abscess (PUFA) index. Poisson regression with robust variance was used with a level of significance of five percent. Results: The prevalence of dental pain was 11.8 percent. Dental pain was associated with a prevalence of dental caries (prevalence ratio [PR] equals 2.47; 95 percent confidence interval [95% CI] equals 1.33 to 4.58; P=0.004) and severe caries (PR equals 2.98; 95% CI equals 1.39 to 6.39; P=0.005). Socioeconomic factors were not associated with dental pain. Conclusions: The prevalence of dental pain in preschool children is relevant when assessed through the Brazilian Dental Discomfort Questionnaire. Dental pain is associated with dental caries prevalence and its severity. Socioeconomic factors were not associated with dental pain.

Oral and cranio-maxillofacial trauma in children and adolescents in an emergency setting at a Brazilian hospital.

BACKGROUND/AIMS: Very few studies have been performed to evaluate cranio-maxillofacial trauma diagnosed in hospitals in children and adolescents. The aim of this study was to perform an analysis of oral and cranio-maxillofacial trauma in the aforementioned population. MATERIALS AND METHODS: A hospital-based retrospective study, which reviewed 1438 patient records, was conducted at the "Teresina Emergency Hospital", Brazil. Data regarding demographics, day of the week on which trauma occurred, type of injury, etiology, anatomic trauma site, time of hospital admission, and associated comorbidities (or injuries) were collected. RESULTS: There were 1092 (75.9%) males and 346 (24.1%) females. The largest group was adolescents aged between 13 and 18 years (956, 66.5%). The majority lived in urban areas (69%). Trauma occurred most frequently during the week. The most prevalent etiology was road traffic accidents involving motorcycles (771, 53.6%) causing facial and skull fractures (598, 41%). The most prevalent soft tissue lesions were facial abrasions (49%), followed by injuries to the cheek (16.7%). Comorbidities associated with craniofacial trauma were present in 82%, with complications from traumatic brain injuries being the most prevalent (65.6%) Dental trauma was recorded in only 81 cases (5.6%). CONCLUSION: Male adolescents living in urban areas were most affected by craniofacial trauma. The most common cause was road traffic accidents involving motorcycles, resulting in facial and skull fractures. Complications from traumatic brain injuries were the most common associated injuries.

Validity of micro-CT for in vitro caries detection: a systematic review and meta-analysis.

OBJECTIVE: To investigate the validity of micro-CT for in vitro caries detection in comparison with histology as the reference standard. METHODS: A systematic search was conducted in the databases Latin American and Caribbean Health Sciences (LILACS), LIVIVO, PubMed, Scopus and Web of Science from their inception to 16 January 2019. Grey literature was searched on Open Grey, ProQuest Dissertations and Theses Database and Google Scholar. In vitro studies assessing the validity of micro-CT for caries detection were included when compared with histology as the reference standard were included. Two authors independently collected the information and sensitivity, specificity, positive and negative likelihood ratios, as well as diagnostic odds ratios were calculated. The risk of bias of the included studies was assessed using the QUADAS-2 tool. Certainty of evidence was assessed with GRADE. RESULTS: A total of 270 papers were identified, and after a 2-phase selection, 12 studies were included in qualitative and three in quantitative synthesis. For enamel caries diagnostic, sensitivity values ranged from 29.0 to 84.0% indicating high variability while specificity varied from 88.0 to 95.0% indicating good to excellent micro-CT capability do identify the true negative. For dentine caries diagnostic, sensitivity values ranged from 61.0 to 77.0% indicating fair-to-good probability of micro-CT to identify the true positives, while specificity varied from 88.0 to 94.0%. The majority of the included studies presented low risk of bias and moderate certainty of evidence. CONCLUSIONS: This study demonstrated the validity of micro-CT for in vitro caries detection in comparison with histology.

Bleeding Risk in Patients Using Oral Anticoagulants Undergoing Surgical Procedures in Dentistry: A Systematic Review and Meta-Analysis.

The management of patients who undergo dental surgical procedures and receive oral anticoagulant therapy requires particular attention due to the risk of bleeding that may occur during the procedure. Bleeding rates in these trans- or post-operative patients tend to be unpredictable. The aim of this study was to conduct a systematic review in order to assess the risk of bleeding during and after performing oral surgery in patients administered oral anticoagulants compared with a group that discontinued anticoagulant therapy. For the purposes of this review, we searched the databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), and the Virtual Health Library (VHL) from inception of the database to December 2018. The primary outcome was defined as the occurrence of local bleeding during and after oral surgical procedures. Four reviewers, independently and in pairs, screened titles and abstracts for full-text eligibility. Data regarding participant characteristics, interventions, and design and outcomes of the included studies were extracted. The data were pooled using random-effects meta-analyses and described as risk ratios (RRs) with a 95% confidence interval (95% CI). The confidence for the pooled estimates was ascertained through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and the protocol of this review was recorded in PROSPERO (CRD42017056986). A total of 58 eligible studies were identified, of which three randomized controlled trials were included in the meta-analysis, covering a total of 323 adult participants, among whom 167 were taking anticoagulants at the time they underwent dental surgery. Of these patients, 14.2% had reported bleeding. The risk of bleeding was found to be one to almost three times greater in patients taking warfarin compared with patients who discontinued the use of anticoagulant during the trans-operative period (RR = 1.67, 95% CI = 0.97 to 2.89) and in the post-operative period (RR = 1.44, 95% CI = 0.71 to 2.92), although the quality of evidence was very low. The results indicate that there is no evidence that the use of anticoagulants eliminates the risk of bleeding during surgical dental procedures.