Structural Relationships between Asthma and Dental Caries in Children: A Birth Cohort Study in Southern Brazil.

INTRODUCTION: There is an inconclusive causal association between asthma symptoms and dental caries in the primary dentition. This study aimed to investigate, using SEM (structural equation modeling), a possible causal relation between asthma and dental caries in the primary dentition. METHODS: Using data from the 2004 Pelotas Birth Cohort Study, a sub-sample of 1,303 individuals was selected. Dental caries was clinically evaluated at 5 years old based on decayed, missing, and filled tooth (dmft) index criteria. Asthma-related symptoms (wheezing and shortness of breath) at 1- and 4-year-olds composed a latent variable and were the main exposures to caries occurrence. SEM was used to identify possible direct, indirect, and mediated effects of asthma in primary dentition dental caries. RESULTS: The general prevalence of caries at age 5 was 1.95 (SD: 3.56). When comparing the dmft values for children with asthma symptoms and those without, they presented similar values in both periods where asthma symptoms were evaluated (1- and 4-year-old). SEM analysis showed that asthma was neither directly nor indirectly related to dental caries. CONCLUSION: Asthma, using a latent variable constructed based on asthma symptoms, showed no causal effect on dental caries occurrence in the primary dentition.

Chapter 9.4: Operative Treatment and Monitoring of Coronal Caries in Daily Practice.

After the caries lesion reaches a certain extent of tooth structure loss, a restoration is often needed to repair the defect. Operative interventions in cariology aim to aid biofilm removal and lesion arrest by cavity sealing, avoid pulpal damage, and restore form, function, and esthetics. There are no clear evidence-based parameters to determine the most appropriate treatment option for each clinical situation. Despite of this, direct composite resins have been the preferable restorative treatment. Scientific literature shows that composites and adhesive strategies play a minor role in treatment success. Patient-related risk factors (mainly those associated with lifestyle and health choices), in addition to the dentist's decision-making process, play a significant role in longevity of the restorations, which tend to fail for the same reasons that lead to the need for restoration (dental caries, tooth/restoration fracture, and esthetics). Therefore, monitoring old restorations in clinical service, even if those present clear signs of degradation, is possible and reasonable within the concept of minimal intervention in dentistry. Unnecessary reinterventions are harmful and costly to health systems, and the clinician's efforts must be directed to eliminating or reducing the etiological factors that can cause the restoration to fail. Thus, patient risk factors assessment is a crucial point in monitoring restorations. Clinician should - whenever possible - postpone operative reinterventions, monitoring the etiological factors that may compromise the restoration's longevity. Also, when operative reintervention is necessary, refurbishment, polishing, and repair should be prioritized over replacement.

COVID-19 incidence, severity, medication use, and vaccination among dentists: survey during the second wave in Brazil.

OBJECTIVE: This cross-sectional study with dentists in Brazil assessed the COVID-19 incidence and severity, its vaccination status, and the level of confidence in vaccines in May 2021 (COVID-19 second wave). The medications used to prevent or treat COVID-19, including controversial substances (vitamin D, ivermectin, zinc, and chloroquine), were analyzed. METHODOLOGY: Dentists were recruited by email and responded to a pretested questionnaire until May 31, 2021. Bivariate and multivariate regression analyses were performed (α=0.05). Prevalence ratios were calculated for the association between professional characteristics and two outcomes: SARS-CoV-2 infection and use of controversial substances. RESULTS: In total, 1,907 responses were received (return rate of 21.2%). One third of dentists reported intermediate levels of confidence in the safety and efficacy of COVID-19 vaccines, but 96% had received at least one vaccine dose, mainly CoronaVac. The effect of the pandemic on dental practice was classified as lower/much lower, in comparison with the first wave, by 46% of participants. Moreover, 27% of dentists had already tested positive for SARS-CoV-2 and about 50% had relatives or friends who had been hospitalized or died from COVID-19. At least one medication was used by 59% of participants and 43% used two or more substances. Vitamin D (41%), ivermectin (35%), and zinc (29%) were the most frequent substances. More experienced dentists (≥21 years of professional experience) were 42% more likely to use controversial substances than less experienced dentists. The prevalence of use of controversial substances was 30% higher among dentists with residency or advanced training, such as postgraduate degrees, in comparison with participants holding MSc or PhD degrees. Participants with low confidence in vaccines were 2.1 times more likely to use controversial substances than participants with a very high confidence. CONCLUSION: The results of this study show the high severity of the COVID-19 pandemic in Brazil and raised questions about the use of scientific evidence by dentists in their decision to use controversial substances.

A multi-country survey on the impact of COVID-19 on dental practice and dentists' feelings in Latin America.

BACKGROUND: The COVID-19 pandemic has significantly influenced the routine of healthcare workers. This study investigated the impact of the pandemic on dental practice and dentists' feelings in Latin America. METHODS: A survey was conducted with dentists from 11 Spanish-speaking Latin American countries in September-December 2020. Professionals were invited by email and via an open campaign promoted on social media. The questions investigated dental care routines, practice changes, and feelings about the pandemic. Descriptive statistics were used to identify frequencies and distributions of variables. Proportions were compared using chi-square tests. RESULTS: A total of 2127 responses were collected from a sample with diverse demographic, sex, work, and education characteristics. The impact of COVID-19 was considered high/very high by 60% of respondents. The volume of patients assisted weekly was lower compared with the pre-pandemic period (mean reduction = 14 ± 15 patients). A high rate of fear to contracting the COVID-19 at work was observed (85%); 4.9% of participants had a positive COVID-19 test. The main professional challenges faced by respondents were reduction in the number of patients or financial gain (35%), fear of contracting COVID-19 (34%), and burden with or difficulty in purchasing new personal protective equipment (22%). The fear to contracting COVID-19 was influenced by the number of weekly appointments. A positive test by the dentists was associated with their reports of having assisted COVID-19 patients. The most cited feelings about the pandemic were uncertainty, fear, worry, anxiety, and stress. Negative feelings were more prevalent for professionals who did not receive training for COVID-19 preventive measures and those reporting higher levels of fear to contract the disease. CONCLUSION: This multi-country survey indicated a high impact of the pandemic on dental care routines in Latin America. A massive prevalence of bad feelings was associated with the pandemic.

Clinical performance of posterior resin composite restorations after up to 33 years.

OBJECTIVES: This retrospective study evaluated the performance of posterior composites after up to 33 years of clinical service and investigated factors associated with the risk of failures over time including patient- and tooth-related variables. METHODS: Patients who received at least one Class I or Class II direct composite restoration in a private office in 1986-1992 and had follow-up appointments were included. Failures and interventions over time were investigated using the dental records. A follow-up clinical recall was carried out in 2020. Two scenarios were considered: restorations that did not require any intervention (success) or restorations that were repaired and still functional (survival). Multivariate Cox regression analyses and Kaplan-Meier curves were performed using success and survival rates (p < 0.05). RESULTS: One hundred patient records and 683 restorations were included. A total of 353 failures were reported (success rate= 48%). Main reasons for failure were fracture and secondary caries. Most interventions after failures were repairs. Replacements were registered in 183 cases (survival rate= 73%). Annual failure rates were below 2.5% (success) and 1.1% (survival). Larger restorations and maxillary molars had higher failure risks. No significant differences in success rates among different resin composites was observed. A typical observation in this sample of restorations was the presence of moderate to advanced signs of aging, including marginal and surface staining, wear, chipping, changes in anatomical shape and translucency. Clearly aged restorations were still clinically satisfactory. SIGNIFICANCE: This long-term, practice-based study indicates that resin composites can be used to restore posterior teeth with a long-lasting durability.

Effect of Dental Course Cycle on Anatomical Knowledge and Dental Carving Ability of Dental Students.

This study assessed the effect of the course cycle on theoretical knowledge of dental morphology and the dental carving ability of dental students. Thirty-two dental students from the third semester (initial cycle) and 30 students from the eighth and tenth semesters of the dental course (end cycle) had their theoretical knowledge on dental morphology assessed using a questionnaire with ten closed questions. Their dental carving ability was also assessed using wax carvings in macro models of plaster (for the third [S3] and eight [S8] semesters) and natural-sized artificial teeth (for the tenth [S10] semester). The teeth chosen for the dental carving activity were #16 and #47. The scores were statistically analyzed using the t-test, Kruskal-Wallis test, and Mann-Whitney test (α = 0.05). Students from the initial cycle presented better theoretical knowledge than the other groups did (P < 0.007). No significant differences in carving score were found between the initial and end cycles (P > 0.05), although S10 students obtained a higher score for teeth #16 and #47 (P < 0.05). Natural-sized artificial teeth received a higher evaluation score in dental carvings than the macro models (P < 0.001). Within the limits of this study, it was possible to conclude that students from the initial cycle (S3) presented higher theoretical knowledge, whereas no difference in carving ability was observed between the initial and end cycles. The tenth semester (S10) students performed dental carvings with better quality. Furthermore, carvings in natural-sized artificial teeth presented better quality compared with the macro models.

Dental caries and depression in pregnant women: The role of oral health self-perception as mediator.

OBJECTIVE: This study investigated the role of oral health self-perception as mediator of association between dental caries and depression among pregnant women from the 2015 Pelotas Birth Cohort Study, Brazil. MATERIALS AND METHODS: Overall, 2,496 pregnant women participated of this oral health sub-study. Data related to demographic and socioeconomic conditions, lifetime and current depression, and oral health self-perception were collected. Participants were also assessed for dental caries (DMF-T index). Depression was assessed using the Edinburgh Postnatal Depression Scale. For analysis, six outcomes related to dental caries experience were considered. Causal mediation analysis was performed using parametric regression models. RESULTS: When it was assumed that all subjects had poor perception about oral health, it was observed that the presence of moderate/severe depressive signals and symptoms was higher in subjects with dental caries experience (OR 1.13; CI 95% 1.06-1.20), with severity of untreated dental caries (OR 2.08; CI 95% 1.16-3.78), untreated dental caries (OR 1.18; 95% CI 1.07-1.29), tooth loss (OR 1.08; 95% CI 1.02-1.14), and filled tooth (OR 1.07; 95% CI 1.02-1.16). CONCLUSIONS: Our findings show the effect of dental caries on depression is mediated by self-perception about oral health in pregnant women.

COVID-19 incidence, severity, medication use, and vaccination among dentists: survey during the second wave in Brazil

Abstract Objective This cross-sectional study with dentists in Brazil assessed the COVID-19 incidence and severity, its vaccination status, and the level of confidence in vaccines in May 2021 (COVID-19 second wave). The medications used to prevent or treat COVID-19, including controversial substances (vitamin D, ivermectin, zinc, and chloroquine), were analyzed. Methodology Dentists were recruited by email and responded to a pretested questionnaire until May 31, 2021. Bivariate and multivariate regression analyses were performed (α=0.05). Prevalence ratios were calculated for the association between professional characteristics and two outcomes: SARS-CoV-2 infection and use of controversial substances. Results In total, 1,907 responses were received (return rate of 21.2%). One third of dentists reported intermediate levels of confidence in the safety and efficacy of COVID-19 vaccines, but 96% had received at least one vaccine dose, mainly CoronaVac. The effect of the pandemic on dental practice was classified as lower/much lower, in comparison with the first wave, by 46% of participants. Moreover, 27% of dentists had already tested positive for SARS-CoV-2 and about 50% had relatives or friends who had been hospitalized or died from COVID-19. At least one medication was used by 59% of participants and 43% used two or more substances. Vitamin D (41%), ivermectin (35%), and zinc (29%) were the most frequent substances. More experienced dentists (≥21 years of professional experience) were 42% more likely to use controversial substances than less experienced dentists. The prevalence of use of controversial substances was 30% higher among dentists with residency or advanced training, such as postgraduate degrees, in comparison with participants holding MSc or PhD degrees. Participants with low confidence in vaccines were 2.1 times more likely to use controversial substances than participants with a very high confidence. Conclusion The results of this study show the high severity of the COVID-19 pandemic in Brazil and raised questions about the use of scientific evidence by dentists in their decision to use controversial substances.

Email Vs. Instagram Recruitment Strategies For Online Survey Research.

In this study, we describe a method for reaching a target population (i.e., dentists practicing in Brazil) to engage in survey research using traditional e-mail invites and recruitment campaigns created on Instagram. This study addresses methodological aspects and compares respondents reached by different methods. A pre-tested questionnaire was used and participants were recruited for 10 days via a source list of email addresses and two discrete Instagram organic open campaigns. A total of 3,122 responses were collected: 509 participants were recruited by email (2.1% response rate) and 2,613 by the two Instagram campaigns (20.7% and 11.7% conversion rates), respectively. Response/min collection rates in the first 24 h ranged between 0.23 (email) and 1.09 (first campaign). In total, 98.8% of all responses were received in the first 48 h for the different recruitment strategies. There were significant differences for all demographic variables (p< 0.001) between email and Instagram respondents, except for sex (p=0.37). Instagram respondents were slightly older, had more professional experience (years in practice), and a higher graduate education level than email respondents. Moreover, most email and Instagram respondents worked in the public sector and private practice, respectively. Although both strategies could collect responses from all Brazilian regions, email responses were slightly better distributed across the five territorial areas compared to Instagram. This study provides evidence that survey recruitment of a diverse, large population sample using Instagram is feasible. However, combination of email and Instagram recruitment led to a more diverse population and improved response rates.

Email vs. instagram recruitment strategies for online survey research

Abstract In this study, we describe a method for reaching a target population (i.e., dentists practicing in Brazil) to engage in survey research using traditional e-mail invites and recruitment campaigns created on Instagram. This study addresses methodological aspects and compares respondents reached by different methods. A pre-tested questionnaire was used and participants were recruited for 10 days via a source list of email addresses and two discrete Instagram organic open campaigns. A total of 3,122 responses were collected: 509 participants were recruited by email (2.1% response rate) and 2,613 by the two Instagram campaigns (20.7% and 11.7% conversion rates), respectively. Response/min collection rates in the first 24 h ranged between 0.23 (email) and 1.09 (first campaign). In total, 98.8% of all responses were received in the first 48 h for the different recruitment strategies. There were significant differences for all demographic variables (p< 0.001) between email and Instagram respondents, except for sex (p=0.37). Instagram respondents were slightly older, had more professional experience (years in practice), and a higher graduate education level than email respondents. Moreover, most email and Instagram respondents worked in the public sector and private practice, respectively. Although both strategies could collect responses from all Brazilian regions, email responses were slightly better distributed across the five territorial areas compared to Instagram. This study provides evidence that survey recruitment of a diverse, large population sample using Instagram is feasible. However, combination of email and Instagram recruitment led to a more diverse population and improved response rates.

Resumo Neste estudo, descrevemos um método para atingir uma população-alvo (dentistas atuando no Brasil) para se engajar em pesquisa do tipo enquete (survey) utilizando convites tradicionais por e-mail e campanhas de recrutamento criadas no Instagram. Este estudo aborda aspectos metodológicos e compara as pessoas entrevistadas alcançadas por diferentes métodos. Foi utilizado um questionário pré-testado e os(as) participantes foram recrutados(as) por 10 dias por meio de uma lista de endereços de e-mail e duas campanhas abertas orgânicas independentes no Instagram. Foram coletadas 3122 respostas: 509 participantes foram recrutados(as) por e-mail (taxa de resposta 2,1%) e 2613 pelas duas campanhas do Instagram (taxas de conversão 20,7% e 11,7%), respectivamente. As taxas de coleta de resposta/min nas primeiras 24h variaram entre 0,23 (e-mail) e 1,09 (primeira campanha). No total, 98,8% das respostas foram recebidas nas primeiras 48h para as diferentes estratégias de recrutamento. Houve diferenças significativas para todas as variáveis demográficas (p<0,001) entre recrutados(as) por e-mail e Instagram, com exceção de sexo (p=0,37). As pessoas recrutadas via Instagram eram um pouco mais velhas, tinham mais experiência profissional (anos na prática) e nível de pós-graduação superior às entrevistadas por e-mail. Além disso, a maioria dos entrevistados por e-mail e Instagram trabalhava no setor público e na prática privada, respectivamente. Embora ambas estratégias tenham sido capazes de coletar respostas de todas as regiões brasileiras, as respostas por e-mail foram ligeiramente melhor distribuídas nas cinco áreas territoriais em comparação ao Instagram. Este estudo fornece evidências de que o recrutamento de uma amostra de população diversificada e grande usando o Instagram é viável. No entanto, a combinação de e-mail e Instagram no recrutamento levou a uma população mais diversificada e melhores taxas de resposta.

The vicious cycle of dental fear at age 31 in a birth cohort in Southern Brazil.

OBJECTIVES: This longitudinal study assessed the prevalence of dental fear in adulthood and the association with socio-economic, behavioural and clinical variables. Also, the existence of a vicious cycle of dental fear was tested. METHODS: A random sample of adults (n = 535) from the 1982 Pelotas Birth Cohort, Brazil, was selected. Socio-economic data, behavioural characteristics and clinical variables were collected during different cohort waves. Oral health data were collected at ages 15, 24 and 31 years old, using questionnaires and oral examination. Dental fear (the outcome) was assessed by the question: 'Are you afraid of going to the dentist?', with possible responses: dichotomized into 'No' or 'A little/Yes/A lot'. Exposure variables were as follows: dental visit in the last years (at the ages 15 and 31); caries experience (DMFT ≥ mean) at the ages 15 and 31; the trajectory of caries prevalence from 15 to 31 years old; dental pain in the last six months in the two ages evaluated; and self-rated oral health at age 31. Several multivariable Poisson regression models were used to investigate the association between each of the exposure variables and dental fear. RESULTS: Dental fear prevalence was 22.1%, and it was more prevalent among non-white individuals and females. After controlling for potential confounders, dental fear was more likely to be reported by those individuals who had dental pain or a higher prevalence of dental caries at the age 15. Dental fear was also associated with a worse trajectory of dental caries, negative self-rated oral health at age 31 and with not having visited the dentist in the last year (at the age 31). Results supported the proposed vicious cycle of dental fear. CONCLUSIONS: Dental fear in adulthood was related to exposures occurring across the lifecourse. Also, it was possible to observe the occurrence of the vicious cycle of dental fear in the 1982 Pelotas Birth Cohort. Therefore, preventive measures during different periods of the life course are required to prevent dental fear and adulthood.

Periodontal disease and preterm birth: Findings from the 2015 Pelotas birth cohort study.

OBJECTIVES: To verify the association between periodontal conditions and preterm birth. MATERIALS AND METHODS: This study used data from the 2015 Pelotas Birth Cohort Study, Brazil. Pregnant women expected to give birth in 2015 were interviewed and dentally examined by a trained dentist, with periodontal measures collected in all teeth, six sites per tooth. Exposure was periodontal disease. Outcomes were preterm birth (all births <37 weeks of gestational age) and early preterm birth (<34 weeks). Analysis was carried out using Poisson regression according to a directed acyclic graph. RESULTS: A total of 2,474 women participated in the study. Incidence of preterm births was 10.2% and of early preterm births was 3.5%. Frequency of gingivitis was 21.7%, and periodontitis was 14.9%. Periodontitis was associated with a risk almost two times higher of having early preterm delivery compared with healthy pregnant women (RR 1.93; 95% CI 1.09-3.43). Presence of 5+ mm periodontal pocket with bleeding on probing was also associated with higher risk for early preterm delivery. CONCLUSIONS: The association between periodontal disease in pregnancy and the occurrence of preterm delivery is sensitive to the case definitions. Periodontal disease increased the risk of early preterm delivery.

COVID-19 challenges to dentistry in the new pandemic epicenter: Brazil.

A nationwide survey of dentists was carried out in Brazil, a new pandemic epicenter, to analyze how dental care coverage has been affected in public versus private networks, changes in routine and burdens, and how local prevalence of COVID-19 affects dental professionals. Dentists were recruited via email and Instagram®. Responses to a pre-tested questionnaire were collected May 15-24, 2020. COVID-19 case/death counts in the state where respondents work was used to test associations between contextual status and decreases in weekly appointments, fear of contracting COVID-19 at work, and current work status (α = 0.05). Over 10 days, 3,122 responses were received (response rate ~2.1%) from all Brazilian states. Work status was affected for 94%, with less developed regions being more impacted. The pandemic impact on clinical routine was high/very high for 84%, leading to varied changes to clinic infrastructure, personal protective equipment use, and patient screening, as well as increased costs. COVID-19 patients had been seen by 5.3% of respondents; 90% reported fearing contracting COVID-19 at work. Multilevel models showed that greater case and death rates (counted as 1000 cases and 100 deaths per million inhabitants) in one's state increased the odds of being fearful of contracting the disease (18% and 25%). For each additional 1000 cases/100 deaths, the odds of currently not working or treating only emergencies increased by 36% and 58%. The reduction in patients seen weekly was significantly greater in public (38.7±18.6) than in private clinics (22.5±17.8). This study provides early evidence of three major impacts of the pandemic on dentistry: increasing inequalities due to coverage differences between public and private networks; the adoption of new clinical routines, which are associated with an economic burden for dentists; and associations of regional COVID-19 incidence/mortality with fear of contracting the disease at work.

The impact of cyberbullying on schoolchildren's dental anxiety in Brazil: A cross-sectional multi-level study.

OBJECTIVES: This cross-sectional study assessed the correlation between individual and school-related social environment variables with dental anxiety in Brazilian schoolchildren aged 8-12 years. METHODS: A sample of children from 20 private and public schools (n = 1211) from Pelotas, Brazil, were selected. Socioeconomic data were collected from parents, and data regarding children characteristics were collected using a questionnaire. Dental anxiety (the outcome) was assessed by the following question: 'Are you afraid of going to the dentist?' Dental examinations were performed to assess caries experience (DMFT ≥ 1). The social school environment was assessed by a questionnaire administered to schools' coordinators and considered: type of school, verbal violence between students, presence of gangs at school and cyberbullying episodes. Multilevel Poisson regression was used to investigate the association between school social environment and dental anxiety. RESULTS: The prevalence of dental anxiety was 9.1% (95%CI 7.5-10.8). For the individual variables, anxiety was more prevalent in girls [1.85 (1.21-2.81)], in children with less-educated mothers [1.50 (1.00-2.27)] and in children who never attended to the dentist [2.48 (1.65-3.72)]. For contextual variables, episodes of cyberbullying in school increased the prevalence of dental anxiety by almost 80% [1.78 (1.14-2.78)]. CONCLUSIONS: The school social environment influences dental anxiety. The results suggest that it is important to establish strategies focused on promoting healthier environments and preventing cyberbullying in order to reduce the occurrence of dental anxiety.

Income at birth and tooth loss due to dental caries in adulthood: The 1982 Pelotas birth cohort.

OBJECTIVE: To estimate the effect of income at birth on adulthood tooth loss due to dental caries in 539 adults from the 1982 Pelotas birth cohort. METHODS: Family income was collected at birth. Tooth loss was clinically assessed when individuals were aged 31. Dental visit and oral hygiene at age 25 were considered mediators. Confounders included maternal skin color, and individual's skin color, sex, and income in adulthood. Marginal structural modeling was used to estimate the controlled direct effect of income at birth on tooth loss due to dental caries that was neither mediated by the use of dental service nor oral hygiene. RESULTS: Forty-three percent of the individuals of low income at birth lost one/two teeth, and 23% lost three or more; among those non-poor, the prevalence was 30% and 14%, respectively. Poor individuals at birth had a 70% higher risk for missing teeth in adulthood than those non-poor. The risk of losing one/two (risk ratio 1.68) and three or more teeth (risk ratio 3.84) was also higher among those of low income at birth. CONCLUSIONS: Economic disadvantage at birth had an effect on tooth loss due to dental caries at age 31 not mediated by individual risk factors.

The school social environment and oral health-related quality of life in children: a multilevel analysis.

This study aimed to explore the association between schoolchildren's oral health-related quality of life (OHRQoL) and the school-related social environment (contextual factors). A cross-sectional study was performed with 1,211 children, aged 8-12 yr, from 20 private and public schools. Sociodemographic information was collected from a questionnaire given to parents, and children were interviewed using the Child Perceptions Questionnaire (CPQ) and examined for oral health conditions. Contextual variables were obtained from school coordinators regarding the social environment. Data analysis was performed through multilevel Poisson regression. A high negative impact on OHRQoL was found for participants who were girls, older, had very severe malocclusion, had dental trauma and caries, and had mothers with less schooling. A negative impact on OHRQoL was also found for children who attended schools in which police security was required (rate ratios [RR] = 1.11; 95% CI: 1.01-1.22) and in which violence among students occurred in the last year (RR = 1.17; 95% CI: 1.02-1.35). The need for police security was associated with a negative impact on the emotional well-being domain, and violence among students was associated with negative impact on the oral symptoms, functional limitations, and social well-being domains. Children in healthier environments have better OHRQoL.

Performance of noninvasive scores for the diagnosis of advanced liver fibrosis in morbidly obese with nonalcoholic fatty liver disease.

OBJECTIVES: Liver fibrosis is one of the most important predictors of mortality related to nonalcoholic fatty liver disease (NAFLD). The use of noninvasive markers has the advantage of a simple and low-cost evaluation. The aim of this study was to evaluate the performance of six noninvasive scores for the diagnosis of advanced liver fibrosis in morbidly obese patients. MATERIAL AND METHODS: A retrospective study validation included 323 morbidly obese patients undergoing bariatric surgery. Advance fibrosis was defined as stage 3 and 4 (septal fibrosis or cirrhosis). Accuracy, sensitivity, specificity, positive (PPV) or negative (NPV) predictive value, and positive (PLR) or negative (NLR) likelihood ratio test of the following noninvasive liver fibrosis scores were evaluated: aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR); AST to platelet ratio index (APRI); BARD; FIB4, NAFLD fibrosis score (NFS) and BAAT, which were compared with the histological findings of the intraoperative liver biopsy. The cutoff points established in the validation studies were used: AAR > 1; APRL > 0.98; BARD ≥ 2; FIB4 > 2.67; NFS > 0.676 and BAAT > 1. RESULTS: Twenty-nine patients (8.97%) presented advanced fibrosis. APRI presented the higher specificity (99.61%), PPV (85.71%), PLR (62.5) and accuracy (0.93). FIB4 was the second test in accuracy (0.9) and in PLR (10.53). BAAT presented the highest sensitivity (73.08%) and NPV (94.78%); NFS the lowest sensitivity (12,5%), and BARD the lowest accuracy (0.44). CONCLUSION: APRI and FIB-4 were the tests with best performance to predict advanced fibrosis.

Effectiveness of a reciprocating single file, single cone endodontic treatment approach: a randomized controlled pragmatic clinical trial.

OBJECTIVES: To compare the root filling quality, the sealer extrusion, and the healing rates of apical lesions addressed via two endodontic treatment approaches. The hypothesis tested was that both techniques present similar apical periodontitis healing results. MATERIALS AND METHODS: This study was a parallel-design, pragmatic, and randomized clinical trial. One hundred twenty anterior teeth with necrotic pulps and apical periodontitis were randomly allocated to be either instrumented with hand files and obturated with the lateral compaction technique or instrumented with a single file in a reciprocating movement and obturated with a single-cone technique. The root canal filling quality, the occurrence of sealer extrusion, and apical periodontitis healing were the outcomes of interest. Data were analyzed through chi-square analysis, and the odds ratio for healing was adjusted using a logistic regression model (α = 0.05). RESULTS: No significant differences were observed between the endodontic techniques regarding the root filling quality or sealer extrusion. Six months after treatment, both endodontic techniques presented equivalent results regarding apical periodontitis healing. The healing rate was affected only by the periapical status at baseline. CONCLUSIONS: The obturation of the root canal of the anterior teeth using reciprocating file-matched single cones presented a similar quality to that obtained with manual instrumentation followed by the lateral condensation technique. Similar healing rates of apical lesions were also observed. CLINICAL RELEVANCE: For treating anterior teeth with apical periodontitis, a reciprocating single-file, single-treatment protocol was as effective as a traditional protocol combining hand instrumentation and the lateral compaction obturation technique.

Prevalence of oral mucosal lesions in population-based studies: A systematic review of the methodological aspects.

OBJECTIVES: To conduct a systematic review of the literature to evaluate the methodological aspects of population-based studies on the prevalence of oral mucosal lesions (OMLs). METHODS: Two reviewers independently conducted a literature search in three databases (PubMed, Web of Science and Scopus) and extracted data using a standardized form. Data on the following characteristics of the included studies were collected: sample size; age of participants; references used to define the diagnostic criteria, training of the examiners, and data collection; type, grouping and characteristics of the lesions; and lesions excluded and measures of agreement between examiners. Data were analysed descriptively, and data synthesis was performed for each of the studies included in the analysis. A quality analysis of the studies was conducted, and the risk of bias was evaluated. RESULTS: A total of 29 studies were included in the analysis. Most of the published studies on the prevalence of OMLs were performed in Asian countries. The sample sizes ranged from 255 to 39 206. The World Health Organization guidelines were followed by most of the studies, in terms of design, examiner training and data collection. Approximately 25% of the studies did not determine inter-examiner reliability. Moreover, almost half of the studies included did not report the response rate nor did they present the results with the appropriate confidence intervals. CONCLUSIONS: Several important points need to be improved in population-based studies focusing on the prevalence of OMLs. In particular, these studies should adequately report the response rate and findings, and to a lesser extent, the diagnostic criteria and training of the examiners. We encourage more research in this field and reinforce the importance of standardized studies to facilitate the comparison of different findings. PROSPERO registration number: CRD42018099386.

Is the use of Cannabis associated with periodontitis? A systematic review and meta-analysis.

Recent studies have shown that there is also biological plausibility for a possible relationship between periodontal disease and Cannabis use, thus the aim of this study was to investigate whether the use of Cannabis is associated with periodontitis. Electronic searches were performed in PubMed, Scopus, ISI-Web of Science, BVS-Virtual health library and Scielo without restrictions. Search strategy was performed using relevant keywords considering the structure of each database. Longitudinal and cross-sectional studies that investigated the association between the use of Cannabis and periodontal disease were included. Meta-analyses and sensitivity analysis were conducted. A total of 143 records were found in the initial searches and five articles were included in the systematic review, being four studies included in the meta-analysis. Overall, 13 491 individuals were included, of which 49.5% were males. Three of included studies investigated the relationship between cannabis and periodontal disease in adults and the other two studies were performed in adolescents. A positive association was observed between the use of cannabis and periodontitis (PR 1.12 CI 95% [1.06-1.19]) with 19.0% of heterogeneity. The analysis of sensibility showed that none study influenced the results enough to change the pooled estimate. Regarding to the quality assessment, all studies presented high quality. The results of systematic review and meta-analyses demonstrate that the use of Cannabis is associated with a higher prevalence of periodontitis.