Immunomodulation of periodontitis with SPMs.

Inflammation is a critical component in the pathophysiology of numerous disease processes, with most therapeutic modalities focusing on its inhibition in order to achieve treatment outcomes. The resolution of inflammation is a separate, distinct pathway that entails the reversal of the inflammatory process to a state of homoeostasis rather than selective inhibition of specific components of the inflammatory cascade. The discovery of specialized pro-resolving mediators (SPMs) resulted in a paradigm shift in our understanding of disease etiopathology. Periodontal disease, traditionally considered as one of microbial etiology, is now understood to be an inflammation-driven process associated with dysbiosis of the oral microbiome that may be modulated with SPMs to achieve therapeutic benefit.

E-cigarette explosion injuries in the oral and maxillofacial region and a protocol for their management.

DATA SOURCES: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Embase and Web of Science along with the reference lists from select articles. STUDY SELECTION: Retrospective or prospective cohort studies, randomised controlled trials, case series, case-control studies and case reports on e-cigarette explosion-related facial injuries published in the English language were included. Review articles, nonclinical studies, commentaries, published abstracts and editorials were excluded. Also were excluded, those studies which did not specify injury location or if the injury did not pertain to the maxillofacial region. DATA EXTRACTION AND SYNTHESIS: Data pertaining to bibliographic information, device characteristics, patient details, facial injuries, factors precipitating explosion, complications at follow-up, management and other injuries were extracted. An association between the predictor variables of injury type and location with outcomes of surgical management and intubation was determined by utilising a Chi-squared analysis. RESULTS: A total of 28 studies met the inclusion criteria. A total of 105 facial injuries in 32 patients from 32 e-cigarette explosions were recorded. 73.3% of the injuries were projectile in nature with 26.7% being characterised by burns. 43.8% of all patients suffered both burn and projectile injuries. The eye (10.7%), oral cavity (25%) and face (64.3%) were involved with burn injuries. Projectile injuries mostly involved the lower third of the face (81.8%). 62.5% of patients suffered from a tooth or bone fracture. A 44.4% rate of complications was reported amongst the studies which reported on follow-ups. Surgical management or intubation were found to have no statistically significant relationship with explosive oral injuries. No other statistically significant associations were observed between outcomes and other injury types. CONCLUSIONS: There is a risk of spontaneous combustion with e-cigarettes, which can cause injuries of a serious nature to the oral and maxillofacial region, specially the lower third of the face, commonly necessitating surgical management. Increased regulation along with user education are required in order to improve the safety profile of these devices.

Protocol Registration.

Prospective registration of systematic reviews is encouraged and forms part of the PRISMA guidelines. Providing information pertaining to protocol registration would potentially aid in improving the robustness of the report.

Is there an association between oral hygiene and head and neck cancer?

DATA SOURCES: PubMed, Web of Science, the Cochrane Library and Embase were utilised as databases from inception till November 2021. STUDY SELECTION: The inclusion criteria consisted of cohort and case-control studies published in the English language, which dealt with diagnosed cases of head and neck cancer reporting survival, oral hygiene and comparative data. Studies pertaining to animal experiments along with case reports, conference proceedings, reviews, letters, editorials, errata and protocols were excluded. DATA EXTRACTION AND SYNTHESIS: Data such as publication year, authors' names, country, sources, study groups, age, gender, participant number, education, alcohol, tobacco, study quality, cancer site and outcomes were extracted for each included study. A modified Newcastle-Ottawa Scale was utilized to evaluate the quality of these studies. RESULTS: A total of forty-four studies were included, of which forty were case-control and four were cohort in nature. These comprised of a total of 52,863 patients of which 33,000 were devoid of head and neck cancer (HNC) while, 19,863 had a confirmed diagnosis of HNC. Oral hygiene and HNC were found to be associated. CONCLUSIONS: Poor oral hygiene was concluded to be associated with HNC and the subsites thereof.

Validity of Healthcare-Related Content on Digital Platforms.

With a plethora of unverified digital content on healthcare floating around, it is imperative for organizations and stakeholders in healthcare to take effective measures in order to develop credible as well as popular sources of healthcare-related information to counter the threat of medical misinformation and its consequent catastrophic effects on the society at large. This communication brings to light some such initiatives.

The association between second-hand smoke and the periodontal status of children and adolescents.

Data sources The authors searched Embase, Medline/PubMed, Web of Science, Scopus and LILACS ranging from inception to 23 November 2021. A grey literature search was run utilising OpenGrey along with Google Scholar (most relevant first 200 hits). For the identification of additional articles of relevance, a hand-search was also conducted upon the list of references of all the included studies. No restrictions in terms of date and language were utilised in the search. Controlled vocabulary in the form of free text and MeSH terms was utilised to execute the search strategy.Study selection A screening of the studies potentially satisfying the eligibility criteria was conducted independently by two reviewers on the basis of their abstracts and titles. The records so retrieved were classified under the headings of 'exclude', 'include' and 'uncertain'. Upon the completion of this exercise, an acquisition was made of the full texts of papers judged relevant. Data extraction was performed on all the studies which met the eligibility criteria. Diverging views among the reviewers were resolved with consensus. The judgement of a third reviewer was sought to resolve any disagreements.Data extraction and synthesis Information extraction covered measurement details (cotinine levels of children and/or self-reported questionnaires from children and/or parents); study identification (year of publication, first author and location); distribution according to the status of second-hand smoke and sample characteristics; exposure criteria (according to cotinine levels or severity of parental smoking); analytic approach utilised (multivariate or bivariate analysis); results along with assessment of outcomes (partial- or full-mouth protocol used) and criteria (index type used). Due to only cross-sectional studies being included upon retrieval, the methodological quality assessment was performed utilising an adapted variant of the Newcastle-Ottawa scale. The judgement criteria used included non-response rate, sample size and representativity, confounding control, determination of exposure, outcome assessment and statistical analysis. Evidence tables were built utilising qualitative synthesis in order to ascertain differences in the results and characteristics of the included studies. In case the eligibility criteria were met by three or more papers, the data was subjected to pair-wise comparisons between those unexposed to second-hand smoke with those exposed to it in terms of the specified periodontal outcome measures. Periodontal outcomes were evaluated as continuous measures with the random-effects model. Cochran's Q-test was utilised to assess the heterogeneity and in cases where the heterogeneity was unexplained, a sensitivity analysis was conducted to evaluate whether a single study exerted a significant effect upon the pooled results.Results Six hundred and thirty-seven records were obtained from the search. After screening of the abstracts and titles, eight studies met the eligibility criteria subsequent to the reading of the complete text of 16 reports. One study was conducted in a high socio-demographic index (SDI) country with four in the middle-high, one in the middle and two in the lower-middle SDI countries. Four studies did not provide details pertaining to outcome assessment, while one included a full-mouth and another three, a partial-mouth assessment protocol. Two studies were deemed to be of high quality in terms of methodological quality assessment. Three reports possessed a satisfactory sample size while none of the included studies included data relating to non-response rate. The authors deemed meta-analysis to be possible only in the case of periodontal probing depth (PPD) and gingival index (GI) scores. There was a positive association reported between a high GI score and second-hand smoke exposure. There was, however, no difference present at the subgroup level in terms of the SDI of the country of the study, the age of the cohort as well as the period in which the study was carried out. In contrast, a significant effect was observed for the location of the study data collection in that children from areas with a higher current-smoker prevalence exhibited greater GI scores as a result of increased second-hand smoke exposure. There was no observable difference from the pooled estimate for second-hand smoke exposure compared to the unexposed cohort in terms of PPD. No effects were demonstrable at the subgroup level upon data stratification for the study country SDI and period of data collection. There was greater clinical attachment loss among children who were exposed to second-hand smoke, particularly for those whose fathers were smokers despite adjustments being made for gender, plaque scores and age.Conclusions The systematic review demonstrates a very low level of certainty in evidence to point towards second-hand smoke exposure of children up to 15 years of age leads to higher GI scores as compared to their unexposed counterparts. Even though no differences have been demonstrated in terms of PPD, there is a necessity for further research to draw conclusions on other pertinent periodontal parameters such as bleeding on probing and clinical attachment loss.

The Periodontal Status of Orofacial Cleft Patients: A Systematic Review and Meta-Analysis.

Cleft lip and/or palate is the most commonly documented orofacial anomaly and may impact the status of health and disease of adjacent teeth along with their associated supporting structures. The authors performed a systematic review and meta-analysis to assess whether the presence of clefts altered the periodontal status of patients.The study was registered in PROSPERO (CRD42020210178). A systematic search of literature was performed utilizing unique search strings for PubMed, Scopus, and GoogleScholar as databases including gray literature from April 28, 2020 to October 3, 2020.Cross-sectional and longitudinal human studies published in the English language, providing information about periodontal disease and its association with cleft lip, alveolus, and palate.Periodontal outcome measures such as gingival index (GI), clinical attachment level (CAL), plaque index (PI), periodontal probing depth (PPD), and bleeding on probing (BOP) were utilized as the main outcome measures.Patients with clefts were predisposed to poorer periodontal outcomes. Subgroup analysis revealed compromised periodontal measures for clefts as compared to control sites without cleft which were statistically significant in terms of GI [Z = 2.44, P = .01], CAL [Z = 2.52, P = .01], PI [Z = 2.76, P = .006] and not statistically significant for PPD [Z = 0.27, P = .79] and BOP [Z = 1.47, P = .14].Within the limitations of the review, the authors conclude that the presence of orofacial clefts may predispose to periodontal compromise when compared to normal controls. The GRADE rating was moderate.

Do clinical decision support tools have a role to play in dealing with paediatric dental trauma?

Design Randomised controlled trial.Case selection In order to assess baseline knowledge of dental trauma, paediatric dentists and medical students were administered a pre-test, subsequent to which a random assignment was carried out to one of three learning groups: mobile app clinical decision support tools (CDST), print CDST and no CDST, for the purposes of a post-test.Data analysis The correct answers for the pre-test and post-test, time to completion and answers to the demographic survey were subjected to descriptive statistical analyses using IBM SPSS v25.0 for Windows (SPSS, IBM Corp, Armonk, NY). In order to compare the pre- and post-tests for each group, a paired-sample t test was conducted. An independent-sample t test and Pearson χ2 test were utilised to assess for significant differences between paediatric dentists and medical students. Least significant post-hoc and one-way analysis of variance (ANOVA) tests were conducted among the three groups. The level of significance was set at p <0.05.Results Paediatric dentists obtained significantly higher scores on both the pre- and post-tests when compared to medical students (8.57 ± 0.96 vs 4.20 ± 1.58; p <0.001 and 8.37 ± 1.09 vs 4.96 ± 1.99; p <0.001, respectively).No significant difference was noted pertaining to the time taken to complete the tests among both the groups. In both the groups, the highest scores were obtained by those who used the mobile app version of the CDST; these subjects, however, recorded the longest time to complete the post-test (p <0.001).Conclusions When compared to the absence of an aid, both the mobile app and print versions of the CDST improved the diagnosis and management of injuries to the primary dentition. With medical students demonstrating significant improvement in primary dental trauma management with CDST usage, these tools are recommended to enhance the diagnosis and treatment for such patients.