Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials.

AIMS: The purpose of this systematic review was to evaluate the cost-effectiveness and acceptance of children and their parents of the Hall technique (HT) for dental rehabilitation in pediatric dentistry. BACKGROUND: The approach of the HT is that of minimally invasive treatment of the dental element and is used exclusively on primary molars. Various studies in the literature point to HT as a restorative option well accepted by children and parents and quite predictable, with low retreatment rates and good cost-effectiveness for the management of primary molars with carious lesions. However, no systematic review in the literature has approached randomized clinical trials on these topics to produce a high level of evidence and help establish clinical HT protocols. REVIEW RESULTS: Eight articles were selected for the systematic review. The HT was more cost-effective than procedures using other restorative materials. Regarding acceptance, in terms of esthetics, high percentages of satisfaction were reported for parents and children, with a divergence between studies in the comparison of esthetic preference with atraumatic restorative treatment. However, when considering crown cementation pain, comfort, anxiety, preference, and satisfaction, the HT was generally better evaluated when compared to other restorative materials. CONCLUSION: The HT is an excellent restorative option when considering cost-effectiveness and acceptance and is recommended for use in daily clinical practice. CLINICAL SIGNIFICANCE: Results indicate that HT is superior to other restorative materials regarding its acceptance by children and parents in terms of pain, comfort, anxiety, and crown preference and satisfaction. There were also high percentages of satisfaction with esthetics. Hall technique may initially appear expensive for dentists, but its effectiveness over time and the lesser need for consultations and reinventions ensure better cost-benefit than other restorative materials. How to cite this article: Valentim FB, Moreira KMS, Carneiro VC, et al. Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials. J Contemp Dent Pract 2023;24(12):1016-1025.

Association between periodontitis and type 2 diabetes mellitus: study in a population attended by the Brazilian Health System / Associação entre periodontite e diabetes mellitus tipo 2: estudo em uma população atendida pelo Sistema Único de Saúde Brasileiro

Introduction: Periodontitis control helps to prevent and control diabetes mellitus and understanding of this relationship can lead to changes in health policy. Objective: The purpose of this study was to investigate the association between periodontitis, knowledge, and glycemic control. Material and method: This is a cross-sectional analytical epidemiological survey with 216 Type 2 diabetic patients, non-smokers, who had current blood screenings with glycated hemoglobin (HbA1c). Result: Overall, 93.51% of the patients reported brushing their teeth at least twice a day, 62.5% visited the dentist last year, 81.58% have already undergone treatment for periodontal disease, 43.52% reported having periodontitis and 59.72% had controlled diabetes. No significant (p=0.603) association between HbA1c control and the presence of periodontitis was found. Among the patients with periodontitis, no association between HbA1c control and information on the periodontal disease was found (p=0.996), and know/believe in its relationship with diabetes (p=0.659; p=0.973). Conclusion: No relationship between periodontitis and diabetes was found in the sample, as well as in patients with periodontitis, those with knowledge on periodontal disease and knowledge/belief in its relationship with diabetes, which could be justified by the care by a multi-professional health team.

Introdução: O controle da doença periodontal auxilia na prevenção e no controle do diabetes mellitus. A compreensão dessa relação pode desencadear mudanças nas políticas públicas de saúde. Objetivo: O objetivo deste estudo foi investigar a associação entre a doença periodontal, o controle glicêmico e o conhecimento dessa relação. Material e método: Trata-se de um inquérito epidemiológico analítico transversal com 216 pacientes com diabetes mellitus tipo 2, não fumantes, que realizaram exames de sangue atuais com hemoglobina glicada (HbA1c). Resultado: No geral, 93,51% dos pacientes relataram escovar os dentes pelo menos duas vezes ao dia, 62,5% visitaram o dentista no último ano, 81,58% já fizeram tratamento para doença periodontal, 43,52% relataram ter periodontite e 59,72% tinham diabetes controlado. Não foi encontrada associação significativa (p=0,603) entre o controle da HbA1c e a presença de periodontite. Entre os pacientes com periodontite, não foi encontrada associação entre o controle da HbA1c e informações sobre a doença periodontal (p=0,996), e conhecer/acreditar na sua relação com o diabetes (p=0,659; p=0,973). Conclusão: Não foi encontrada relação entre a doença periodontal e diabetes na amostra, o que poderia ser justificado pelo atendimento por uma equipe multiprofissional de saúde no Sistema Único de Saúde Brasileiro.

The Importance of Integrated Healthcare in the Association Between Oral Health and Awareness of Periodontitis and Diabetes in Type 2 Diabetics.

PURPOSE: Purpose: To assess the association of various factors including education level and oral health with type 2 diabetics' awareness of periodontitis and periodontitis/diabetes relationship, and to evaluate the importance of integrated healthcare in this association. Materials and Methods: 288 type 2 diabetics were evaluated through a validated structured questionnaire about oral hygiene habits, access and attendance to dental treatment, the presence of periodontitis and previously received information of periodontitis and periodontitis/diabetes relationship. Descriptive data were explored and both simple and multiple logistic regressions were performed. Results: The average age of participants was 62.24 (±10.93) years, 81.6% were previously treated for periodontitis and approximately 70% have never received information on periodontitis and its relationship with diabetes. A higher chance of participants having previously received information regarding periodontitis was associated with more than 8 years of schooling, daily flossing habit, presence of periodontitis and prior treatment for periodontitis (p < 0.005). Regarding previously received information about periodontitis/diabetes relationship, statistically significant associations were observed for more than 12 years of schooling and diabetes diagnosed more than 8 years ago (p < 0.05). Conclusion: The vast majority of participants were previously treated for periodontitis without receiving proper oral health education, which means that access to costly dental treatment is provided while patient education is neglected. It was shown the influence of habits and living conditions on the previously received information about diseases, and therefore, particular attention to the population characteristics is important to make the information accessible to everyone.

Esthetic perception of smiles with different gingival conditions.

This study aimed to compare the perceptions of smile esthetics among general practitioners, periodontists, and laypeople. Photographs of smiles were taken and digitally modified to create different gingival conditions: gingival asymmetry, unilateral gingival recession, and bilateral gingival recession. These photographs were evaluated by 150 volunteers (19-70 years old) using a 100.0-mm visual analog scale. The volunteers consisted of 50 laypeople with no knowledge of dentistry, 50 general dentists, and 50 periodontists. Analysis of variance and Student t test were performed when data presented a normal distribution. If the hypothesis of normality was rejected, the Newman-Keuls test was applied to the data. Results showed that laypeople noticed gingival asymmetry only when it reached 2.0 mm, while periodontists and general dentists noticed it at 1.0 mm. Periodontists and general dentists considered smiles with unilateral recession of ≥1.0 mm to be less attractive, while the smallest modification that was deemed unesthetic by the laypeople was 2.0 mm. In the evaluation of bilateral gingival recession, general dentists and periodontists found smiles with a 1.0-mm modification less attractive, while the changes were not noticed by laypeople until the modification reached 1.5 mm. It can be concluded that laypeople perceived changes in smile esthetics differently than did dental professionals, which suggests that laypeople may be less concerned about the esthetic effects of minor gingival alterations than are dental professionals. Therefore, it is important for the dentist to understand the individual patient's perception of what constitutes an esthetic smile before recommending a dental treatment plan.

Aesthetic perception of gingival smiles / Percepção estética do sorriso gengivoso

Introduction: Dentists have shown interest in learning new techniques to create more attractive smiles, but with little concern for understanding the reasons why the patient is dissatisfied. Objective: To evaluate the aesthetic perception of laypersons in dentistry in comparison with general practitioner dentists and periodontists regarding the gingival smile, and to compare this aesthetic perception between the male and female genders. Methodology: A photograph of a standard smile was taken and was digitally modified to create the periodontal conditions of a gingival smile from 0.5 mm to 2.5 mm. The photographs were judged by 150 individuals (25-65 years of age), 81 female and 69 male, divided into three groups: 50 laypersons, 50 general practitioners and 50 periodontists. The evaluation was performed using a visual analog scale. The statistical evaluation tests used were the Pearson Chi squared test, Student's t-test, ANOVA and Newman-keuls. Result: The aesthetic perceptions among the professionals are similar, and they observe more subtle changes in the aesthetics of the smile than the laypersons observe. The general practitioners and periodontists were similarly sensitive to changes generated in the gingival smile when these reached 1.5 mm, while laypersons only perceived them when these changes reached 2.5 mm. There was no significant difference in the aesthetic perception of male and female evaluators in any of the groups. Conclusion: The aesthetic perception of the gingival smile between general practitioner dentists and periodontists was similar, and dental professionals were more demanding than the layperson. There was no difference between female and male aesthetic perceptions.

Introdução: Cirurgiões-dentistas têm mostrado interesse em conhecer novos meios para a construção de sorrisos mais atraentes, porém com pouca preocupação em entender os motivos pelos quais o paciente está insatisfeito. Objetivo: Avaliar a percepção estética de pessoas leigas em odontologia em comparação com dentistas clínicos gerais e periodontistas quanto ao sorriso gengivoso, e comparar esta percepção estética do gênero masculino e feminino. Metodologia: Foi realizada fotografia de um sorriso padrão e modificada digitalmente para criar as condições periodontais de sorriso gengivoso de 0,5mm até 2,5mm. As fotografias foram avaliadas por 150 indivíduos (25-65 anos), 81 do gênero feminino e 69 do masculino, divididos em três grupos: 50 leigos, 50 clínicos gerais e 50 periodontistas. A avaliação foi realizada por escala analógica visual. Os testes de avaliação estatística utilizados foram Quiquadrado de Person, t de Student, ANOVA e Newman-keuls. Resultado: As percepções estéticas entre os profissionais são semelhantes, e percebem mudanças na estética do sorriso mais sutis que leigos. Os clínicos gerais e os periodontistas foram sensíveis de forma semelhante às mudanças geradas no sorriso gengivoso quando estas chegaram a 1,5 mm, enquanto que os leigos só perceberam quando estas modificações chegaram a 2,5 mm. Em todos os grupos não houve diferença significativa da percepção estética de avaliadores do gênero masculino e feminino. Conclusão: A percepção estética do sorriso gengivoso entre dentistas clínicos gerais e periodontistas foi semelhante, e os profissionais de odontologia foram mais exigentes do que os leigos. Não houve diferença na percepção estética feminina e masculina.