Identifying the Variables for Oncoplastic Reconstruction: Preoperative Assessment Tool for Breast Conserving Treatment.

BACKGROUND: A wide range of surgical techniques has been described for breast conservation treatment (Oncoplasty) based on breast size and shape, as well as tumor size and location. However, there is a lack of standardization regarding the indications for oncoplastic reconstruction. This study aims to identify the presurgical parameters associated with poor cosmetic outcomes post-breast conserving treatment. We hope this preoperative model can assist in evaluating whether there is a need for oncoplastic intervention. METHODS: The study group involved 136-adult females (age 35-77) who previously undergone breast conserving surgery and radiation, without oncoplastic intervention between 2007 and 2017. Patient demographics, medical and physical parameters were collected, and each patient filled Breast-QTM-questionnaire and six angles' photographs were taken. Patients' photographs were evaluated by 15 board-certified plastic surgeons. Both univariate and multivariate logistic regression analysis was performed to identify potential confounders for poor outcome in each of the experts' and patients' average-grades. RESULTS: Our analysis identified several variables correlated with poor surgical outcome: high BMI, high chest-wall-circumference, high breast-width and larger volume-removed. The general-aesthetic-result as evaluated by our experts was favorably influenced by an upper lateral quadrant tumor while the breast shape was negatively influenced by a lower medial quadrant tumor. Interestingly, no correlation was found between the patients' and panel's evaluations, nor did we find any clinically significant parameter related to the patients' reported well-being. CONCLUSION: Patients with high BMI, high chest-wall-circumference, large breast-width and larger inferomedial tumors could benefit from early plastic surgery evaluation and intervention. Patient's psychosocial well-being as well as sexual well-being are independent from positive surgical outcome evaluated by plastic surgeons. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Systemic antibiotics in endodontics-International questionnaire study: Choice of types, dosage, loading and duration.

The aim of the study was to investigate the systematic antibiotics (SAs) prescribing practices in the endodontic practice worldwide. 7500 general practitioners, postgraduate students and endodontists from Israel and the former Soviet Union (FSU) states were invited to fill in an online questionnaire. The first-choice SA was amoxicillin (80.12%) among the Israeli (p < 0.05) and amoxicillin + clavulanic acid (88.92%) among the FSU respondents (p < 0.05). The first-choice SA for patients with penicillin allergy was clindamycin (78.2%) among Israeli and azithromycin (35.96%) among the FSU respondents (p < 0.05). Most of the respondents from Israel as well as from the FSU reported prescribing SA for 5-7 days. Only 6.24% of the former and 2.59% of the latter reported prescribing SA until the symptoms disappeared (p > 0.05). The usage of SAs is often not in accordance with existing international guidelines and differs among different dentist's populations.

Evolving Trends in Breast-Implant-Based Procedures in Israel: A National Survey.

Rare reports linking textured breast implants to anaplastic large-cell lymphoma have generated controversies regarding their relative advantage over smooth implants. To evaluate trends in implant use in Israel, we sent a seven-item questionnaire to all active board-certified breast plastic surgeons in the country. About half responded. Approximately 60% of responders reported a moderate-to-considerable decrease in both the relative number of augmentation mammoplasty procedures and the use of implants during mastopexies in the last year. Nearly 40% had switched from textured to smooth implants to some extent. More than 40% still used textured implants for aesthetic procedures, and reconstructive procedures. Surgeons with more experience demonstrated a greater preference for smooth implants. The uncertainty regarding the safety of textured breast implants has led to a partial transition to the use of smoother implants and, importantly, to a general reduction in all breast-implant-based procedures.

Medical Students' Knowledge of Plastic Surgery as a Reflection of the Public Perception.

Plastic surgery is a broad field that requires a mixed skillset. Therefore, it is important that students be exposed to all its various subspecialties to make informed career decisions and to properly refer patients in different clinical situations. A nationwide survey was conducted of Israeli medical students to investigate their knowledge and perceptions regarding the field of plastic surgery and its subspecialties, and the impact of a clinical rotation in plastic surgery on these factors. A total of 300 subjects responded. Approximately, 61% of the cohort was female and 70% were enrolled in a 6-year program. About one-third stated that their field of interest was surgical rather than medical. Significant variability was noted in the accuracy of responses to questions about different procedures encompassed in the scope of plastic surgery. Although 90% of the students were aware of some common plastic surgery procedures that are also often thought to be well known to the public, only 50% were able to correctly identify lesser-known surgeries performed by plastic surgeons. Knowledge about plastic surgery was unrelated to an interest in the field. We recommend adjusting preclinical instruction and clinical rotations in plastic surgery to better prepare students to select a specialty best suited to their future goals, as well as to improve their ability to refer patients to other specialists as necessary.

Retrograde peri-implantitis: incidence and possible co-existing factors: a retrospective analysis.

OBJECTIVES: To evaluate the incidence of retrograde peri-implantitis (RPI) generally and the incidence of RPI with an endodontic-treated adjacent tooth and/or a periapical radiolucency. METHOD: The retrospective case-control study included the follow-up periapical images of single dental implants. Two calibrated graduate endodontic residents evaluated simultaneously the presence of RPI and the adjacent teeth status (a previous root canal treatment (RCT) and the periapical status). RESULTS: Six hundred and eleven dental implants were included in this study. Twenty-three implants with RPI were detected (the incidence of RPI was 3.7%). Thirty-one adjacent teeth to the implants with RPI were recognized. Out of them, seven teeth had a previous RCT and periapical radiolucency or no RCT and periapical radiolucency. The odds ratios for RPI in an implant with periapical radiolucency or with RCT at the adjacent tooth are 6.67 (95% CI 2.7-16.5), P < 0.05; and 0.11 (95% CI 0.007-1.9), P > 0.05 respectively. CONCLUSIONS: Based on periapical radiographs, the RPI incidence was 3.7% in the present study. The incidence of RPI increased in cases with adjacent teeth that had periapical radiolucency. Previous RCT in teeth adjacent to implants without apical radiolucency is not correlated with RPI.

Complicated wound closure following mastectomy and breast reconstruction.

Breast reconstruction incidence increased, including preventive surgery. In this context, providing women best surgical care and results is crucial, with minimum complications, such as wound dehiscence and skin flap necrosis. Tension-free closure of skin flaps is mandatory for successful healing. However, since this is not always possible, various techniques have been developed to reduce tension from wound margins, facilitate primary wound closure, and minimize and improve scarring. These techniques have not been investigated in breast surgeries. The aim of this study was to describe our experience with the Tension-Relief System in mastectomy and breast reconstructive patients, and the advantages of using this technique. The retrospective cohort consisted of 13 breasts of 11 women aged 29-74 years who underwent surgery with primary wound closure using the System, in 2019-2020 in our department. It was applied averagely 19.7 days, demonstrated effectiveness in preventing complications and as secondary treatment following complications. This enabled avoiding further and more extensive surgeries, including donor-site morbidity when needed. In mastectomy and breast reconstruction, the system minimizes complications and yields satisfactory esthetic and functional outcomes, with minimal inconvenience to the patient, and good pain control. The technique is low-cost, simple to use, and does not require special settings, surgical equipment, or particular skills.

A retrospective study of oral pathoses in Israeli military divers and non-divers: 2011-2020.

BACKGROUND/AIM: Self-contained underwater breathing apparatus (SCUBA) diving has grown tremendously as a recreational sport over the past decade. The pain divers experience due to barometric changes is referred to as barodontalgia, and it is known to cause various oral pathoses. Furthermore, divers suffer more frequently from temporomandibular disorders than non-divers. The aim of the study was to characterize oral pathoses between military divers and military non-divers. MATERIAL AND METHODS: Data from the dental files of healthy Israel Defense Forces (IDF) soldiers aged 18-40 years were collected retrospectively for the years 2011-2020. The data for subjects exposed to diving were compared to commando and special forces soldiers. RESULTS: The study population was composed of 6398 soldiers, which included 1036 divers and 5362 non-divers. All participants were male, with a median age of 22 years (mean = 22.1 years). Overall, higher rates of faulty dental restorations were seen among divers than non-divers (9.3% vs. 6.7% p = .006). Temporomandibular disorders were more prevalent among divers, specifically Disc Displacement Without Reduction (DDWOR) (0.4% vs. 0.1% p = .003). While dental fractures showed no significant difference between divers and non-divers (3.8% vs. 3.5% p = 0.8), other oral injuries were nine times more prevalent among divers versus non-divers. CONCLUSION: Military divers are, overall, at a higher risk of oral pathoses than non-divers. This may be related to the characteristics and intensity of their military service.

International questionnaire study on systemic antibiotics in endodontics. Part 1. Prescribing practices for endodontic diagnoses and clinical scenarios.

OBJECTIVES: Part 1 of this two-part study aims to investigate systemic antibiotics (SA) prescribing practices for various endodontic diagnoses and clinical scenarios by general practitioners, post-graduate students and endodontists in Israel and the former Soviet Union (FSU) states. MATERIALS AND METHODS: A total of 7500 dentists from Israel and FSU states were invited to fill in an online questionnaire. The questionnaire consisted the SA prescribing for endodontic diagnoses and clinical scenarios (post operative pain, post apical surgery and post avulsion). The international guidelines of the European Society of Endodontology and the American Association of Endodontists were used as the standard of correct practice. RESULTS: A total of 1310 dentists (response rate of 17.46%, 498 Israeli and 812 FSU dentists) completed the survey. The rates of prescription SA among the Israeli and the FSU respondents for non-recommended diagnoses and clinical scenarios were 24.75% and 11.42% (P>0.05), 16.57% and 16.17% (P>0.05) respectively. The rates of prescription SA among the Israeli and the FSU respondents for recommended diagnoses and clinical scenarios were 63.39% and 62.9% (P>0.05), 27.2% and 13.9% (P>0.05) respectively. CONCLUSIONS: There are gaps between the recommended protocols for prescribing SA for patients with various endodontic diagnoses and clinical scenarios and the actual practices among Israeli and FSU dentists. Continuing education of dentists must be encouraged in order to improve SA prescription practice according to international guidelines. CLINICAL RELEVANCE: When not indicated, prescription of systemic antibiotics might lead to antimicrobial resistance, while non-prescription, when required, might have negative repercussions on the patient's health. Knowledge of the prescription habits of dentists in the endodontic practice will help prevent harmful situations.

Burns in the Military Setting-Analyzing 12,799 Routine and Combat Cases.

Burns are a major trauma source in civilian and military settings, with a huge impact on patient's well-being, health system, and operation status of the force in the military setting. The purpose of our study was to summarize characteristics of all burn cases seen by the Israel Defense Forces primary care physicians during the years 2008 to 2016. This can help understand what causes most burns, in what units, at which stages and settings and consequently will allow commanders to make decisions regarding safety rules, protective equipment and uniforms, medical education for soldiers, etc. Data were collected from the military database system. All burn-related visits were analyzed using a designated big data computerized algorithm that used keywords and phrases to retrieve data from the database. 12,799 burn injuries were found presented in 65,536 burn-related visits which were analyzed according to the demographics, burn mechanism, and military unit. It was observed that most of the burns (70.7%) occurred during routine noncombat setting and there was a gradual decrease in burn injuries during the investigated period, from 17.6% of the cases in 2008 to 2.3% in 2016. Most of the burns occurred in the Air Force (19.4%), and the leading etiology was chemical (35%). The average TBSA was 7.5%. Since most of the burns occurred in a routine setting and were occupational-related, investment in education and improving fire protection has proven itself, leading to the decrease in burn prevalence, we recommend that more emphasis should be given on proper handling of chemicals.

Is Time a Factor in Quality of Life Improvement Following Breast Reduction?

BACKGROUND: Macromastia (breast hypertrophy) has a significant influence on patients' quality of life (QoL), and surgical treatment therefore offers clear medical benefits.Rapid improvements in musculoskeletal complaints are being reported long before final aesthetic results are traditionally evaluated. OBJECTIVES: The aim of this study was to use the RAND Health Status Survey, in modified validated Short Form 36 (SF-36), to analyze patient QoL after breast reduction, and examine whether QoL changes as a function of postoperative time. METHODS: This cross-sectional study included 50 consecutive selected female patients who underwent breast reduction surgery by the same technique performed by a single surgeon between January 2016 and December 2019. Changes in QoL were reported based on a modified SF-36 survey, with scores standardized according to the mean of the general population. Time intervals between the operations and surveys were recorded. RESULTS: The patients were divided into 3 categories according to time since their operation (<3 months, 3-12 months, and >12 months), and assessed pre- and postoperatively. The mean [standard deviation] weight of breast tissue removed was 479.97 [159.38] g per breast. Mean follow-up time was 15.02 [14.3] months. All patients were satisfied with the shape of their new breasts and none reported to have suffered major complications postoperatively. For all 3 groups, patients' scores in the SF-36 survey post- compared with preoperation indicated improvement unrelated to time elapsed since operation. CONCLUSIONS: Breast reduction improves symptoms and well-being, unrelated to amount of tissue removed or to time elapsed postsurgery. This improvement is rapid and may lead to better coverage from medical insurance providers.

Accuracy and stability of electronic apex locator length measurements in root canals with wide apical foramen: an ex vivo study.

The aim of the current study was to determine the accuracy of electronic apex locator (EAL) measurements when using files of different sizes in roots with wide apical foramina while considering a new parameter of stability of EAL reading. Ten teeth with straight roots were subjected to a sequential widening of the apical foramen to 0.6, 0.7, and 0.8 mm. The roots were embedded after each enlargement stage in an alginate mold and subjected to EAL readings. Measurements were done using sequential K-file sizes and the self-adjusting file (SAF). Measurement stability was introduced as a new additional parameter. As the difference between the file size used and the apical diameter of the canal decreases, the results obtained were more accurate and stable. The stability and accuracy of the measurements coincided with each other in a statistically significant manner. Within the limitations of the present ex vivo study, it may be concluded that in straight canals with wide apical foramina of 0.6-0.8 mm, both SS K-files which fit snugly to the walls of apical foramen and the SAF file may offer both accurate and stable EAL measurements.

Radicular Grooves and Complex Root Morphologies of Mandibular Premolars Among Israeli Population.

INTRODUCTION: Mandibular premolars usually have one root and one root canal. Different studies found that up to 30% of mandibular premolars have more than one root canal, and up to 24% of mandibular premolars have C-shape canals. The purpose of this study was to investigate the root anatomy and the prevalence of complex root canal morphology in mandibular premolars in Israeli population. METHODS: A total of 1020 Israeli patients' cone-beam computed tomography scans were screened and evaluated. A total of 1835 mandibular first premolars and 1678 mandibular second premolars were examined. Irregular root anatomy and different root canal morphologies were recorded and analyzed. RESULTS: The overall prevalence of complex root morphology (types II-VIII) in mandibular first and second premolars was 21% and 2.8%, respectively. The bilateral prevalence of complex root morphology in mandibular first and second premolars was 46% and 29%, respectively. The prevalence of radicular grooves in mandibular first and second premolars with complex root morphology was 48% and 36%, respectively. No significant difference was found according to gender or the side of occurrence. However, complex root canal morphology was significantly found in mandibular premolars with radicular grooves. CONCLUSIONS: Complex root canal morphology frequently occurs in mandibular first premolars in the population of Israel. Radicular groove existence in mandibular first and second premolars is significantly related to complex root canal morphology.

Cone-beam Computed Tomography as a Noninvasive Assistance Tool for Oral Cutaneous Sinus Tract Diagnosis: A Case Series.

An oral cutaneous sinus tract is a relatively uncommon condition that is generally associated with long-standing periapical inflammation. The traditional process of oral cutaneous sinus tract diagnosis is an invasive method based on the insertion of a lacrimal probe or wire. The present article describes the use of cone-beam computed tomographic imaging as a noninvasive assistant tool for the verification of the odontogenic origin.

Relationship between Root Apices and the Mandibular Canal: A Cone-beam Computed Tomographic Comparison of 3 Populations.

INTRODUCTION: This study aimed to investigate the difference in the location of the inferior alveolar nerve (IAN) in relation to the apices of mandibular molars in 3 different populations using cone-beam computed tomographic (CBCT) imaging and to assess the proportion of teeth in close proximity (a distance of 1 mm or less) to the IAN. METHODS: Random CBCT images (N = 1224, Israel = 408, South Korea = 416, and India = 400) were examined. The shortest distance to the mandibular canal was measured by imaging software. RESULTS: The mean distance was 4.81 ± 2.15 mm. The mean distances for Israel, South Korea, and India were 4.60 ± 2.37 mm, 5.45 ± 2.13 mm, and 4.35 ± 1.76 mm, respectively. The distance in samples obtained from South Korea was significantly larger than the distance in samples obtained from Israel and India (P < .05). Samples from Israel exhibited close proximity in 6.6% of samples versus 3% in samples from India and 0.7% of samples from South Korea, a statistically significant difference (P < .05). CONCLUSIONS: Although variation in tooth morphology in different populations was widely researched, the variation in the location of the IAN in relation to tooth apices of different populations was not addressed in the literature. Our study reveals that a difference in the distance of the apices to the IAN exists between populations as well as a difference in the proportion of teeth in close proximity to the IAN.

Root Canal Morphology Evaluation of Central and Lateral Mandibular Incisors Using Cone-beam Computed Tomography in an Israeli Population.

INTRODUCTION: Central and lateral mandibular incisors usually have 1 root canal. The purpose of this study was to investigate the prevalence of additional root canals in central and lateral mandibular incisors and to investigate the prevalence of oval and long oval canals in the cervical, middle, and apical thirds of cases with 1 root canal. METHODS: A total of 1016 Israeli patients' cone-beam computed tomography scans were screened and evaluated. A total of 1472 central mandibular incisors and 1508 lateral mandibular incisors were examined. The root canal morphology and cross-sectional shape were recorded and analyzed. RESULTS: The overall prevalence of more than 1 root canal in mandibular central and mandibular lateral respectively was 40.5% and 37.9%. The bilateral incidence of more than 1 root canal in mandibular central and mandibular lateral respectively was 69.8% and 68.7%. The root canal separation in type II to type V central and lateral mandibular incisors was found in the middle third of the root in 81.5% and 79.0%, respectively. The septum was smaller than 1 mm in 37% of central mandibular incisors and one-third of lateral mandibular incisors. In central and lateral incisors with 1 root canal, long oval canals were found in the middle third of the root of central and lateral mandibular incisors in 36.8% and 48.9%, respectively. CONCLUSION: The occurrence of more than 1 root canal in central and lateral mandibular incisors is approximately 40% (type III was the predominant canal type). In central and lateral incisors with 1 root canal, long oval canals are common.

Overlap between dental anxiety, gagging and Blood-Injection-Injury related fears - A spectrum of one multidimensional phenomenon.

BACKGROUND AND OBJECTIVES: Dental anxiety (DA) and gagging (GAG) are prevalent problems that severely impact social behavior and quality of life. Furthermore, because dental phobia is considered a Blood-Injection-Injury (B-I-I) phobia, the present study contrasted DA, GAG and control subjects regarding the severity of dental anxiety and investigated the comorbidity of GAG, DA and B-I-I fears. METHODS: Demographics, Verbal Pain Scale (VPS), Oral Health Impact Profile-14 (OHIP-14), Decay, Missing and Filled Teeth (DMFT), Dental Anxiety Scale (DAS) and response to phobic stimuli were collected from 53 GAG, 68 DA and 80 control subjects. RESULTS: GAGs exhibited results between DA and controls regarding the likelihood to have high-anxiety/phobia (DA group: OR=55.56; GAG group: OR=17.24), self-assessed dental anxiety (OR=29.14; OR=17.48), fear of dental injections (OR=8.51; OR=2.91) and dental drills (OR=12.02; OR=5.82). DA and GAG had similar results regarding: DAS score (p=0.13), fear of blood tests (OR=4.68; OR=4.09) and blood donations (OR=3.13; OR=3.10). Overlap between GAG, DA and a B-I-I fear was observed. GAG and DA patients and worse maximal VPS and OHIP-14 scores retained their significant positive association with the DAS score in the multivariate analysis. CONCLUSIONS: The co-occurrence of DA, GAG and B-I-I-related fears suggests these entities are linked. However, different anxiety levels, symptoms and triggers, reflect the broad spectrum of fear of medical/dental situations.

Oral Health Related Quality of Life in Young Individuals with Dental Anxiety and Exaggerated Gag Reflex.

PURPOSE: To measure the oral health-related quality of life (OHRQoL) among young individuals presenting with dental anxiety and exaggerated gag reflex and to compare it to the OHRQoL among young individuals attending restorative dental treatment. MATERIALS AND METHODS: Patients with dental anxiety and/or exaggerated gag reflex who were referred to the Department of Oral Medicine were included. Clinical examinations included DMFT index (Decayed, Missing and Filled Teeth) according to the WHO criteria and oral hygiene was assessed with the plaque index (PI). The survey included the validated Hebrew version of the Oral Health Impact Profile (OHIP-14). RESULTS: Overall, 322 patients completed the study. The dental anxiety group consisted of 68 patients, the exaggerated gag reflex group of 54 patients and the control group of 200 patients. Control group patients presented with lower PI and DMFT values. Patients with dental anxiety and/or exaggerated gag exhibited worse OHIP-14 scores overall as well as on each separate subscale. PI and DMFT were found to be in strong relation to the OHIP-14. Multivariable logistic regression analysis of factors influencing the OHIP-14 scores revealed a significant influence of the DMFT score. CONCLUSIONS: Patients with dental anxiety and exaggerated gag reflex were shown to suffer considerably from impaired oral health-related quality of life. This impairment may be attributed to a higher prevalence of caries and avoidance of dental treatment. Those populations should be identified and monitored carefully as well as encouraged to seek the appropriate behavioural treatment in order to improve their dental heath and oral health related quality of life.

Demographic profile, plaque index and DMFT scores of young individuals with dental anxiety and exaggerated gag reflex.

PURPOSE: To characterise demographic and clinical parameters among individuals with dental anxiety and exaggerated gag reflex compared to a control group and to analyse the associations between the various parameters. MATERIALS AND METHODS: Sixty-eight patients with dental anxiety and 54 patients with exaggerated gag reflex were compared to a control group of 200 individuals undergoing dental treatment. The collected data included demographic parameters, health status, smoking habits, Decayed, Missing and Filled Teeth (DMFT) and plaque index (PI) scores. RESULTS: PI was significantly higher among patients with exaggerated gag reflex (1.91 ± 0.95) and dental anxiety patients (1.82 ± 0.89) compared to the control group (1.27 ± 0.74; P < 0.001). DMFT was significantly higher among patients with dental anxiety (13.64 ± 7.57) compared to patients with exaggerated gag reflex (10.52 ± 5.42; P = 0.033), and between both groups compared to the control group (4.09 ± 4.034; P < 0.001). Multivariate logistic regression analysis revealed that PI, DMFT and age were positively associated with exaggerated gag reflex and that DMFT and educational level were positively associated with dental anxiety compared to the control group. DMFT was the only significant parameter positively associated with dental anxiety compared to exaggerated gag reflex. CONCLUSION: DMFT and PI scores were higher among patients with dental anxiety and exaggerated gag reflex. Clinicians should consider additional oral hygiene measures and education, maintenance meetings and recall visits in those patients, as well as using supplementary aids, such as fluoride mouthwash and fluoride varnish applications, to maintain oral hygiene without triggering the exaggerated gag reflex.

Sleep quality in patients with dental anxiety.

BACKGROUND: Psychological distress is associated with sleep disturbances; however there is little research on sleep quality in dental anxiety (DA) patients. OBJECTIVES: To measure the sleep quality in patients with DA compared to patients with an exacerbated gag reflex (GAG) and controls and to analyze its association with various demographic and behavioral parameters. METHODS: 67 DA patients, 54 GAG patients and 100 controls with no history of DA or GAG participated in the study. Data regarding: demographic details, smoking habits, the Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain assessment, Corah's dental anxiety scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), plaque index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were collected. RESULTS: 49.3% of the DA group and 38.9% of the GAG group were poor sleepers (mean PSQI score > 5), compared to 29.0% of the controls (PSQI mean scores: 5.8 ± 3.4, DA group; 5.2 ± 3.6 GAG group vs. 4.5 ± 2.7, control group; p = 0.029). Compared to controls, DA and GAG patients exhibited poorer scores in the sleep disturbances PSQI component (p = 0.001). DA patients exhibited poorer scores in the sleep duration PSQI component compared to the control (p = 0.002) and GAG groups (p = 0.033). Female gender (p = 0.039), higher current (p = 0.046) and maximal NRS (p = 0.019), higher DAS (p < 0.001) and OHIP-14 (p < 0.001) scores and more missing teeth (p = 0.003) were positively associated with higher PSQI scores. CONCLUSIONS: DA patients suffered more from impaired sleep than controls and GAGs. Impaired sleep in DA patients is multidimensional phenomenon influenced by the specific diagnosis, gender, pain, dental anxiety levels, dental experience and oral health related quality of life.