Global, regional, and national burden and quality of care index (QCI) of oral disorders: a systematic analysis of the global burden of disease study 1990-2017.

BACKGROUND: Oral disorders are still a major global public health challenge, considering their perpetuating and chronic nature. Currently, there is no direct index to measure the quality of care on a population scale. Hence, we aim to propose a new index to measure the quality of care for oral disorders worldwide. METHODS: We generated our database using the data from the Global Burden of Disease (GBD) study 2017. Among different variables such as prevalence, incidence, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine the component that bears the greatest proportion of information to generate the novel quality of care index (QCI) for oral disorders. RESULTS: Global QCI for oral disorders gradually increased from 1990 to 2017 (from 70.5 to 74.6). No significant gender disparity was observed during this period, and the gender disparity ratio (GDR) was considered optimal in 1990 and 2017. Between 1990 and 2017, the age-standardised QCI for all oral disorders increased in all the SDI regions. The highest QCI for all oral disorders in 2017 belonged to high-middle SDI countries (=80.24), and the lowest YLDs rate was seen in the low SDI quintile. In 1990, the quality of care in European, Central Asian, and Central and South American countries was in the lowest quintiles, whereas the North American, East Asian, Middle Eastern, and some African countries had the highest quality of dental care. Maynmar (=100), Uganda (=92.5), Taiwan (=92.0), China (=92.5), and the United States (=89.2) were the five countries with the highest age-standardised QCI. Nicaragua (=41.3), Belgium (=40.2), Venezuela (=38.4), Sierra Leone (=30.5), and the Gambia (=30.3) were the five countries with the least age-standardised QCI values. CONCLUSION: The quality of care for all oral disorders showed an increasing trend on a global scale from 1990 to 2017. However, the QCI distribution was not homogenous among various regions. To prevent the exacerbation of imminent disparities in this regard, better attention to total tooth loss in high-income countries and prioritising primary healthcare provision in low-income countries are recommended for oral disorders.

National and Subnational Trend of Dental Caries of Permanent Teeth in Iran, 1990-2017.

OBJECTIVE: There are currently no integrated data on the trend of dental caries amongst distinct age groups in Iran. We aimed to assess the national and subnational trend of dental caries of permanent teeth in Iran from 1990 to 2017. METHODS: A literature search about dental caries and the decayed-missing-filled teeth index (DMFT) was performed in PubMed, Web of Science, Scopus, and 3 national databases (in Persian). All eligible national oral health surveys in these 28 years were included. We categorised and aggregated the DMFT values and their components based on age (5-year-based groups from 5 to 9 to 60+ years), sex, year, and province. The data for missing spots were estimated using the spatiotemporal Bayesian hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. RESULTS: Nationally, the all-ages mean DMFT increased by nearly 58.0% (6.8 [95% UI, 4.1-10.5] in 1990 to 10.8 [95% UI, 7.5-14.5] in 2017). Decayed teeth (DT) and missing teeth (MT) rose by 84.5% and 31.6% during this period, respectively. Filled teeth (FT) showed almost a 2.6-fold increase in the same period from 0.6 (95% UI, 0.01-1.6) in 1990 to 1.7 (95% UI, 0.6-2.8) in 2017. The proportion of DT and FT continuously increased in both sexes. In 2017, the highest DT, MT, and FT were estimated in the 25-29 (4.9 [95% UI, 2.5-7.2]), 60+ (21.5 [95% UI, 17.5-25.4]), and 35-39 (2.6 [95% UI, 1.3-4.0]) year age groups. CONCLUSIONS: Caries of permanent dentition levies a growing burden on the Iranian population. Considering the continuous increase in caries during the 1990-2017 period, Iranian policymakers should pay heed to these findings and react more proactively to mitigate this perpetuating issue. Implementing nationwide interventions such as sugar consumption management should be encouraged to achieve sustainable outcomes in this regards.

Assessing Google Searches for Toothache during COVID-19 Lockdowns.

Background: Lockdowns due to the coronavirus disease 2019 (COVID-19) pandemic forced many dental offices to be closed. This study aims to investigate the association between COVID-19 imposed lockdowns and online searches for toothache using Google Trends (GT). Methods: We investigated GT online searches for the term "toothache" within the past 5 years. The time frame for data gathering was considered as the initiation and end dates of national/regional lockdowns in each country. We used 1-way analysis of variance to identify statistical differences in relative search volumes (RSVs) between 2020 and 2016-2019 for each country. Results: Overall, 16 countries were included in our analyses. Among all countries, Indonesia (n = 100), Jamaica (n = 56), Philippines (n = 56), Iran (n = 52), and Turkey (47) had the highest RSVs for toothache in the specified period. Compared with the previous 4 years, higher RSVs were seen in the world (as a whole) (2020 RSVs, 94.4; vs 2019 RSVs, 77.8 [ P < 0.001]) and 13 countries (81.3% of the included countries). Conclusion: Generally, searching for the term "toothache" showed an increase during the COVID-19 lockdowns in 2020 compared with the past 4 years. This can imply the importance of dental care as urgent medical care during public health emergencies such as COVID-19.

Is periodontitis associated with the risk of immune-mediated systemic conditions?

AIM: This study evaluates the long-term risk of immune-mediated systemic conditions in individuals with periodontitis compared to those without. DATA SOURCES: A structured online search was conducted in Medline, Cochrane library, and EMBASE using MeSH terms. All the databases were explored from initiation to June 2022. Reference lists of the eligible studies were hand searched as well. STUDY SELECTION: Peer-reviewed longitudinal retrospective/prospective cohorts and randomized controlled trials comparing incident metabolic/autoimmune/inflammatory diseases in periodontitis to healthy individuals were deemed eligible. Only studies with a minimum follow-up of one year were included. DATA EXTRACTION AND SYNTHESIS: The authors checked demographics, data source, exclusion/inclusion criteria, total follow-up duration, disease outcome, and limitations to determine the eligible studies. After assessing the risk of bias for the included studies using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool, the authors used the following measures to quantify the disease outcome: relative risk (RR), odds ratio (OR), and hazard ratio (HR). Systemic conditions were categorized as immune-mediated via disrupted metabolic networks (diabetes, kidney disease, liver disease, metabolic syndrome) or chronic inflammation (inflammatory bowel disease, osteoporosis, RA, psoriasis, Sjogren's syndrome), hence recognized as metabolic or autoimmune/inflammatory diseases, respectively. A random effect meta-analysis was used to synthesize the risk of developing each disease. The authors performed subgroup analysis for periodontitis diagnosis type (self-report/clinically diagnosed) and severity. They also conducted a sensitivity analysis to assess the effect of removing studies that did not adjust for smoking status. RESULTS: From 3354 studies, 166 full texts were screened. Finally, 30 studies were deemed eligible for the systematic review, of which 27 made it to the meta-analysis. The risks of diabetes, rheumatoid arthritis (RA) and osteoporosis were increased in individuals with periodontitis compared to those without periodontitis (diabetes-relative risk [RR]: 1.22, 95% CI: 1.13-1.33; RA-RR: 1.27, 95% CI: 1.07-1.52; osteoporosis-RR: 1.40, 95% CI: 1.12-1.75). The risk of diabetes showed a gradient increase by periodontitis severity (moderate-RR = 1.20, 95% CI = 1.11-1.31; severe-RR = 1.34, 95% CI = 1.10-1.63). CONCLUSIONS: People with moderate-to-severe periodontitis have the highest risk of developing diabetes. In contrast, the effect of periodontal severity on the risk of other immune-mediated systemic conditions requires further investigation. More homologous evidence is needed to assess the periodontitis-multimorbidity association further.

Gender differences in dentistry and oral sciences research productivity by researchers in Nigeria.

Background: The aim of the study was to assess gender differences in the productivity, impact, collaboration pattern and author position of dentistry and oral sciences researchers in Nigeria. Methods: We examined the Web of Science (WoS) publication records of dentistry and oral sciences researchers to assess gender differences in productivity, impact, collaboration and authorship pattern (first authorship, last authorship and corresponding author). The analysis included the number of publications in journals ranked based on their quartile rating amongst the journals in the subject area (Q1-Q4). Chi square was used to make gender comparisons. Significance was set at >5%. Results: 413 unique authors published 1,222 articles on dentistry and oral sciences between 2012 and 2021. The number of WoS documents per female author was significantly higher than that per male author (3.7 vs. 2.6, p = 0.03). A non-significantly higher percentage of females authored papers in Q2 and Q3 journals and a higher percentage of males authored papers in Q4 journals. The number of citations per female author (25.0 vs. 14.9, p = 0.04) and the percentage of females listed as first authors (26.6% vs. 20.5%, p = 0.048) were statistically greater than men. The percentage of males listed as last authors was statistically greater than females (23.6% vs. 17.7%, p = 0.04). The correlation between the percentage of papers with researchers listed as first authors and that listed as last authors was not significant for males (p = 0.06) but was significant for females (p = 0.002). A non-significantly greater percentage of females were listed as corresponding authors (26.4% vs. 20.6%) and males were listed as international (27.4% vs. 25.1%) and domestic collaborators (46.8% vs. 44.7%). Also, there was no statistically significant gender difference in the proportion of articles published in open access journals (52.5% vs. 52.0%). Conclusion: Though there were significant gender differences in the productivity, impact, and collaboration profile of dentistry and oral sciences researchers in Nigeria, the higher female research productivity and impact may be driven by cultural gender nuances that needs to be explored further.

Validity of age estimation methods and reproducibility of bone/dental maturity indices for chronological age estimation.

AIM: This systematic review sought to assess the validity of age estimation methods based on bone or dental maturity indices and their reproducibility through a meta-analysis of validation and reproducibility studies. DATA SOURCES: A systematic online search was conducted in PubMed and Google Scholar. STUDY SELECTION: Cross-sectional studies were included. The authors excluded articles without information on validity and reproducibility outcomes, articles not written in English or Italian, and those where it was impossible to obtain pooled reproducibility estimates of Cohen's kappa or the intraclass correlation coefficient (ICC) due to a lack of information on the variability measure. DATA EXTRACTION AND SYNTHESIS: The authors tried to follow the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. They also considered the PICOS/PECOS strategy to assess the research questions in their included studies; nevertheless, no particular guideline was reported to be consistently followed in their study. RESULTS: Twenty-three (23) studies were selected for data extraction and critical appraisal. The pooled male mean error of the age prediction was 0.08 years (95% CI: -0.12; 0.29), and the pooled female mean error was 0.09 years (95% CI: -0.12; 0.30). Studies using Nolla's method had a mean error closest to zero with a slight overestimation: mean male age prediction error of 0.02 (95% CI: -0.37; 0.41) and mean female age prediction error of 0.03 (95% CI: -0.34; 0.41). Haavikko's method had a mean error of -1.12 (95% CI: -2.29; 0.06) and -1.33 (95% CI: -2.54; -0.13) for males and females, respectively. Cameriere's method also underestimated the chronological age and was the only method with a higher absolute mean error for males than females (males: -0.22 [95% CI: -0.44; 0.00]; females: -0.17 [95% CI: -0.34; -0.01]). Overall, Demirjian's and Willems's methods tended to overestimate chronological age in both males (Demirjian: 0.59 [95% CI: 0.28; 0.91]; Willems: 0.07 [95% CI: -0.17; 0.31]) and females (Demirjian: 0.64 [95% CI 0.38; 0.90]; Willems: 0.09 [95% CI: -0.13; 0.31]). The prediction intervals (PI) overlapped zero for all methods, rendering the difference between estimated and chronological ages not statistically significant for males and females. Cameriere's method showed the smallest PI for both biological genders, while the Haavikko and other methods had the widest intervals. No heterogeneity was observed in inter-examiner (heterogeneity: Q = 5.78, p = 0.888) and intra-examiner (heterogeneity: Q = 9.11, p = 0.611) agreement, so a fixed-effects model was used. For inter-examiner agreement, the ICC ranged from 0.89 to 0.99, and the meta-analytic pooled ICC was 0.98 (95% CI 0.97; 1.00), which was near-perfect reliability. Concerning intra-examiner agreement, the ICCs ranged from 0.90 to 1.00, and the meta-analytic pooled ICC was 0.99 (95% CI 0.98; 1.00), which was also close to perfect reliability. CONCLUSIONS: This study recommended the Nolla and Cameriere methods as preferred approaches while mentioning that the Cameriere method was validated on a smaller sample size than Nolla's, thus requiring further testing on additional populations to better assess the mean error estimates by sex. However, the evidence in this paper is of very low quality and offers no certainty.

Trends in dental caries of deciduous teeth in Iran: a systematic analysis of the national and sub-national data from 1990 to 2017.

BACKGROUND: Dental caries is the most prevalent child affliction in the world and can be reduced through effective preventive interventions. To plan cost-effective interventions, clear and integrated data are needed. This study has been designed to overcome the lack of national trend in deciduous dental caries in Iran. OBJECTIVE: To estimate the dental caries trend in deciduous teeth in the Iranian population at different ages from 1990 to 2017. METHODS: From 1990 to 2017 a literature search about dmf and its components (decayed, missed, and filled tooth, abbreviated as dt, mt, and ft) as well as dental caries was done in the Iranian population in three English (PubMed, Web of Science, and Scopus) and three national databases (in Persian). All eligible national oral health surveys in these 28 years were included. National dmft data were categorised based on age (1-4, 5-9, and 10-14), sex, province and year. The final trends were estimated using an age-spatio-temporal hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. Finally, the estimations of dmft, dt, mt, and ft with a 95% UI were reported from 1990 to 2017. RESULTS: Almost 22% of the Iranian deciduous teeth were involved with dental caries in 1990 [dmft = 4.37; (95% UI 2.23, 6.62)] which more than 83% of it was dt [3.64 (1.53, 5.88)] and less than 7% was ft [0.30 (0.06, 0.65)]. During 1990-2017, dmft increased by more than 15% [in 2017, dmft = 5.03 (2.82, 7.29)]. The highest increase was seen in dt which was more than 17% [in 2017, dt = 4.27 (1.96, 6.57)]. CONCLUSION: Increasing dental caries among Iranian children over 28 years shows that oral health policies in Iran need critical evaluation. We need cost-effective nationwide interventions (e.g., supervised tooth brushing and improving dietary habits) and training well-experienced intermediate manpower (e.g., dental hygienists) to reduce dental caries.

Dental floss as an adjuvant of the toothbrush helps gingival health.

Design and aim This randomised controlled clinical trial assessed the efficacy of using dental floss in addition to toothbrushing in reducing gingival and plaque indices.Intervention The participants received oral hygiene instruction and supervised personal and professional plaque removal every week for two months. The research team instructed the participants to perform toothbrushing twice daily - groups 'toothbrushing and flossing' (TB + DF) and 'toothbrushing alone' - and use dental floss once daily - group TB + DF. Gingival index (GI) and plaque idex (PI) were evaluated at baseline and after one and two months.Case selection The authors invited the participants via the Federal University of Santa Maria screening service, social media and public posters. The participants were 18 years and older, without interproximal clinical attachment loss, with papillae completely filling the interproximal space and with at least 24 teeth remaining. The participants were included if they had a gingival index score of two at more than 15% of the interproximal sites. The authors excluded dental students, patients with xerostomia or diabetes, pregnant women, smokers, patients with orthodontic appliances and restraints, patients requiring antimicrobial prophylaxis, patients having used antibiotics/anti-inflammatory agents within the last three months and those with psychomotor disorders.Experimental groups and data analysis The authors used a block randomisation sequence with block sizes of ten. Randomisation confidentiality was maintained using serially sealed, numbered, opaque envelopes. At baseline, all the participants received oral prophylaxis and their GI, probing depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP) were assessed. A clinical staff member disclosed the experimental group assignments, distributed scheduled oral hygiene materials and conducted assigned study interventions. Each participant received a soft toothbrush (Colgate Twister Compact Head, New York, NY, USA) and fluoride dentifrice (Colgate Triple Action, 90 g, New York, NY, USA). Patients were instructed to brush their teeth twice daily. Subjects from the TB + DF group also received dental floss and were asked to use it once daily (Colgate, Tarpaulin, New York, NY, USA). The research team supervised the oral hygiene practices at day zero and recalled the patients to provide them with personalised oral hygiene instruction and dental plaque removal. Individual patients were considered as units of analysis. PI, GI, CAL, PD, gingival bleeding (GI = 2), BOP and percentage sites with different GI scores were presented as means, standard deviations and standard errors. The authors used multiple imputations to replace missing data and mixed linear models to analyse and compare the experimental groups.Results In total, 75 participants were randomised. Both groups showed a significant reduction in gingival inflammation (GI = 2) in the first month, albeit no change was seen in the second month. Adding flossing to toothbrushing significantly reduced the GI = 2 by the end of the first month (37.7 to 15.9%), maintaining optimised overall oral health through day 60 (15.1%) compared with toothbrushing alone. No significant differences were noted between the two groups from the first to the second month. Interproximal dental plaque was reduced for both groups from baseline to day 30 with no marked change from then to day 60. Plaque reduction was similar in both groups.Conclusions Toothbrushing reduces interdental plaque build-up and halts its progression while improving gingival health in adults with no interdental attachment loss. Dental flossing as an adjuvant to toothbrushing also enhances these benefits.

The use of the phrase "data not shown" in dental research.

OBJECTIVE: The use of phrases such as "data/results not shown" is deemed an obscure way to represent scientific findings. Our aim was to investigate how frequently papers published in dental journals use the phrases and what kind of results the authors referred to with these phrases in 2021. METHODS: We searched the Europe PubMed Central (PMC) database for open-access articles available from studies published in PubMed-indexed dental journals until December 31st, 2021. We searched for "data/results not shown" phrases from the full texts and then calculated the proportion of articles with the phrases in all the available articles. From studies published in 2021, we evaluated whether the phrases referred to confirmatory results, negative results, peripheral results, sensitivity analysis results, future results, or other/unclear results. Journal- and publisher-related differences in publishing studies with the phrases in 2021 were tested with Fisher's exact test using the R v4.1.1 software. RESULTS: The percentage of studies with the relevant phrases from the total number of studies in the database decreased from 13% to 3% between 2010 and 2020. In 2021, out of 2,434 studies published in 73 different journals by eight publishers, 67 (2.8%) used the phrases. Potential journal- and publisher-related differences in publishing studies with the phrases were detected in 2021 (p = 0.001 and p = 0.005, respectively). Most commonly, the phrases referred to negative (n = 16, 24%), peripheral (n = 22, 33%) or confirmatory (n = 11, 16%) results. The significance of unpublished results to which the phrases referred considerably varied across studies. CONCLUSION: Over the last decade, there has been a marked decrease in the use of the phrases "data/results not shown" in dental journals. However, the phrases were still notably in use in dental studies in 2021, despite the good availability of accessible free online supplements and repositories.

Chewing Gums as a Drug Delivery Approach for Oral Health.

Background: Drug delivery approaches with the shortest therapeutic period and the lowest side effects have always been considered a sublime target in the medical sciences. Among many delivery methods, chewing gum could be perceived as a promising drug carrier that can carry several types of drugs for oral health. These drug carriers could represent optimal therapeutic time and lower side effects due to their sustained release capability and lower required thresholds for the drug compared with other delivery approaches. The convenient use in the oral cavity's local environment and the ability to locally carry multiple drugs are considered the main advantages of this delivery approach. Aim: This review aimed to explore chewing gum as a promising drug carrier that can carry several types of drugs for oral health. Materials and Methods: Articles were searched for on PubMed, ISI, SCOPUS, Google Patents, the Royal Society of Chemistry website, and electronic databases using MESH terms and the following keywords: ("Gum" OR "Chewing gum") and ("Drug delivery OR Drug delivery systems") in the English language. No time limit was applied, and all documents as of August 30th, 2020 were retrieved. Results: Gum-drug interactions, mechanisms of release, and formulations of the drugs might all play a role in this versatile delivery method. Accordingly, chewing gum-based carriers may be presented as a plausible candidate for drug delivery in oral diseases. Conclusion: Gum-driven drugs could be introduced as promising candidates for treating oral diseases due to their ability to deliver the proper local dosages of active ingredients, short contact time, biocompatibility, and biodegradable chemical structures.

Preprocedural mouth rinses can reduce bacterial contamination in aerosols during periodontal prophylaxis.

Aim This study evaluates the effectiveness of preprocedural mouth rinsing when performing non-surgical periodontal prophylaxis to reduce bacterial aerosol contamination.Data sources The authors used the population, intervention, control and outcomes (PICO) question format to perform a systematic online search in Scopus, PubMed, Cochrane Library and Web of Science. All the databases were explored with no time limit until April 2020.Study selection Randomised clinical trials were included in this systematic review. No inclusion or exclusion criteria are mentioned in this study and it is limited to bacterial contamination studies.Data extraction and synthesis The authors extracted the following information from the included studies: authors; article publication year; study design; sampling size and allocation of test and control groups; intervention details; type and description of periodontal prophylaxis procedures; and primary outcomes. They focused on statistically significant findings and the reduction of bacterial aerosol contamination between groups was measured by colony forming units (CFU) using means and percentages. The primary outcome was that bacterial count expressed as CFU on blood agar plates. If permissible, they calculated the mean CFU reduction in the included studies and reported them. The authors also assessed the studies' risk of bias using the revised Cochrane risk of bias tool for randomised trials.Results In total, 30 randomised controlled trials were included, 21 of which assessed the preprocedural rinsing and the remaining nine focused on other interventions. The bacterial incubation protocol differed among studies. The data collection sites differed among the studies in terms of the number of samples obtained, position, direction and distance from the subjects' mouths. There were no marked differences in the CFU reduction regarding the periodontal prophylaxis devices used and the location of aerosol sampling collection from these studies. Nearly half of the studies (52.4%, 11/21) collected the sample at or near the operator and dental assistant. Chlorhexidine (CHX) rinse was mostly tested (80.9%, 17/21) with various concentrations and volumes. Among studies comparing CHX with other agents (71.4%, 15/21), CHX was more effective for the better part of studies, with more than half of the studies (7/15) reporting over a 70% reduction in CFU when using CHX preprocedural mouth rinse.Conclusions Evidence corroborates the effectiveness of preprocedural mouth rinses, especially CHX, in reducing the bacterial contamination of aerosols in periodontal, non-surgical prophylaxis compared with mouth rinsing with water, or with no rinsing. Nevertheless, the low-quality of evidence and the high heterogeneity among the included studies warn that one should be cautious in generalising the findings of this study to other settings and contaminating agents, like viruses. The findings of this study emphasise the need for more studies on the efficacy and effectiveness of preprocedural rinses in reducing the viral load in aerosols (and droplets) during periodontal prophylaxis procedures.

Global, regional, and national burden and quality of care index (QCI) of lip and oral cavity cancer: a systematic analysis of the Global Burden of Disease Study 1990-2017.

BACKGROUND: To measure the quality of care for lip and oral cavity cancer worldwide using the data from the Global Burden of Disease (GBD) Study 2017. METHODS: After devising four main indices of quality of care for lip and oral cavity cancer using GBD 2017 study's measures, including prevalence, incidence, years of life lost, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine a component that bears the most proportion of info among the others. This component of the PCA was considered as the Quality-of-Care Index (QCI) for lip and oral cavity cancer. The QCI score was then reported in both men and women worldwide and different countries based on the socio-demographic index (SDI) and World Bank classifications. RESULTS: Between 1990 and 2017, care quality continuously increased globally (from 53.7 to 59.6). In 1990, QCI was higher for men (53.5 for men compared with 50.8 for women), and in 2017 QCI increased for both men and women, albeit a slightly higher rise for women (57.2 for men compared with 59.9 for women). During the same period, age-standardised QCI for lip and oral cavity cancer increased in all regions (classified by SDI and World Bank). Globally, the highest QCI scores were observed in the elderly age group, whereas the least were in the adult age group. Five countries with the least amount of QCIs were all African. In contrast, North American countries, West European countries and Australia had the highest indices. CONCLUSION: The quality of care for lip and oral cavity cancer showed a rise from 1990 to 2017, a promising outcome that supports patient-oriented and preventive treatment policies previously advised in the literature. However, not all countries enjoyed such an increase in the QCI to the same extent. This alarming finding could imply a necessary need for better access to high-quality treatments for lip and oral cavity cancer, especially in central African countries and Afghanistan. More policies with a preventive approach and paying more heed to the early diagnosis, broad insurance coverage, and effective screening programs are recommended worldwide. More focus should also be given to the adulthood age group as they had the least QCI scores globally.

What is the best mechanical device to clean the teeth in periodontal maintenance patients?

Aim This study evaluates the available clinical evidence with regards to the effectiveness of mechanical oral hygiene devices in patients who are in periodontal maintenance.Data sources A structured online search was conducted in PubMed/Medline, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase. All the databases were explored from initiation to October 2019. Reference lists of all the included studies were hand-searched as well.Study selection Randomised clinical trials or controlled clinical trials were included in this systematic review if the participants were adult patients (≥18 years) in the maintenance phase of treatment with no systemic disorder. The scope of included studies was to assess the effects of manual toothbrushes (MTBs) and powered toothbrushes (PTBs) or interdental brushes (IDBs) on dental plaque removal and other parameters of periodontitis and gingivitis. These parameters were as follows: plaque index score (PI), bleeding on probing, clinical attachment level (CAL), gingival index (GI), probing pocket depth (PPD), gingival index (GI) and gingival recession (REC).Data extraction and synthesis The Cochrane Handbook for Systematic Reviews of Interventions (2011) and the recommendations for strengthening the reporting of systematic reviews and meta-analyses (PRISMA) were both applied to extract data (with regards to population, intervention, comparison and outcomes) in this systematic review. A network meta-analysis (NMA) was performed to compare (either directly or indirectly) the studies that shared (at least) a common treatment. Treatments were then ranked using frequentist weighted least squares method. This was done based on the standardised mean difference of end plaque scores for each oral hygiene device. Finally, the authors provided a clinical significance assessment of study results using distribution-based methods.Results In the 16 included trials, 17 comparisons were selected to be assessed. In comparisons between PTBs and MTBs, 80% of them found no difference with respect to improving clinical parameters (four out of five). When adjunctive effect of an oral irrigator (OI) in addition to regular hygiene was evaluated, 66% (two out of three) of comparisons showed a positive significant effect on the GI, bleeding index scores and PPD in favour of using an OI. In 50% of comparisons (two out of four) concerning PI reduction, IDBs showed significantly better results than dental floss. This finding was endorsed by the authors' clinical significance assessment. Indirect results of the NMA ranked the cylindrical and conical IDBs as the best oral hygiene devices (compared to MTBs) in removing interdental plaque.Conclusions Considering the dearth of evidence that met the inclusion criteria for each oral hygiene device and the low certainty of the resultant findings, no definite conclusion could be drawn to recommend any device as the best option to use in periodontal maintenance patients. Yet, according to indirect evidence, it was found that IDBs, as adjuvants to tooth brushing, could significantly improve PI reduction compared with merely using MTBs.

Quality Assessment of Studies Included in Cochrane Oral Health Systematic Reviews: A Meta-Research.

OBJECTIVES: To assess the Risk of Bias (RoB) and other characteristics of published randomised clinical trials within Cochrane oral health systematic reviews. MATERIALS AND METHODS: All the published clinical trials within Cochrane oral health systematic reviews until 1 June 2020 were identified and examined. RoB was assessed for all the included clinical trials according to the Cochrane review standards. The Overall Risk of Bias (ORoB) was defined in this study using Cochrane's RoB tool-v2. Descriptive analyses were carried out to determine the frequency of each variable in the study sample. RESULTS: Out of a total of 2565 included studies, the majority (n = 1600) had sample sizes of 50 or higher. Regarding blinding, 907 studies were labelled as double-blind. Among the various domains of bias, the performance bias showed the highest rate of high risk (31.4%). Almost half of the studies had a high ORoB, compared to 11.1% with a low ORoB. The studies that used placebos had a higher percentage of low ORoB (14.8% vs. 10.7%). Additionally, the double- and triple-blind studies had higher percentages of low ORoB (23.6% and 23.3%, respectively), while the studies with a crossover design had the highest percentage of low ORoB (28.8%). CONCLUSION: The RoB of oral health studies published as Cochrane reviews was deemed high.

Assessing research misconduct in Iran: a perspective from Iranian medical faculty members.

BACKGROUND: Research misconduct is a global concern in biomedical science. There are no comprehensive data regarding the perception and situation of scientific misconduct among the Iranian medical faculty members. We conducted a nationwide survey to assess the research misconduct among the medical faculty members in Iran. METHODS: We used the Persian version of the research misconduct questionnaire (PRMQ) on the Google Forms platform. We sent the survey link to a systematic random sample of medical faculty members in Iran (N = 4986). Descriptive analyses were performed on the individual items of the PRMQ, with frequencies and percentages for categorical and Likert-type response items, and means and standard deviation (S.D.) for continuous variables. Chi-square analysis was conducted to test hypotheses examining differences in the frequency of responses related to factors influencing misconduct. We also defined four tenure categories (TC) based on the working years of the participants as tenured faculty members. All the analyses were performed using R 3.6.0. RESULTS: The response rate was 13.8% (692 responses). Nearly 70% of the respondents agreed that their publication output would be of higher quality if there were no publication pressure. Approximately three-quarters (N =499, 72.1%) of the respondents had been aware of some instances of research misconduct during the previous year according to their understanding of misconduct. Among the participants, 18.5% perceived the effectiveness of their associated organisation's rules for reducing research misconduct to be high or very high. Pressure for tenure was identified as the item most frequently perceived with a strong behavioural influence on engaging in research misconduct (80.2%). CONCLUSIONS: This study confirms that research misconduct needs to be actively addressed among the medical faculty members. Making policies with a focus on boosting awareness regarding the occasions of scientific misconduct and its management seems to be indispensable in the future in Iran.

Is periodontitis associated with the severity of COVID-19?

Data sources The national electronic health records of the Hamad Medical Corporation (HMC) in the State of Qatar.Data extraction and synthesis This case-control study included 568 patients from the HMC electronic database for data eliciting from 27 February 2020 to 31 July 2020. Patients with coronavirus disease 2019 (COVID-19) complications were considered as cases. Controls were defined as COVID-19 patients without major complications (discharged). Multivariate logistic regression was performed to assess the association between the exposures (periodontitis, demographics and medical conditions) and outcomes (COVID-19 complications). The association was adjusted for possible confounding factors. Additionally, sensitivity analyses were performed to account for stronger risk factors of the determined complications. The results were reported using the odds ratio (OR) and 95% confidence intervals (CIs). Laboratory data (blood parameters concerning the course of COVID-19) were also compared between the case and control groups.Results The patients were divided into 40 cases and 528 controls. Among the patients with periodontitis, 12.8% (33/258) went through COVID-19 complications, whereas 2.2% (7/310) of those without periodontitis experienced complications. The adjusted OR of patients with periodontitis was 3.67 (95% CI 1.46-9.27) for all COVID-19 complications, 8.81 (95% CI 1.00-77.7) for death, 3.54 (95% CI 1.39-9.05) for intensive care unit admission and 4.57 (95% CI 1.19-17.4) for the need of assisted ventilation. After conducting subgroup analyses for age, diabetes and smoking, periodontitis was still significantly associated with all the outcomes. Laboratory biomarkers (haemoglobin A1c, white blood cells and C-reactive protein) had higher levels in COVID-19 patients with periodontitis than those without periodontal disease.Conclusions This study concluded that periodontitis was significantly associated with higher risks of COVID-19 complications and higher blood marker levels. These results, however, are not of high quality and further research in this regard is required.

Machine learning and orthodontics, current trends and the future opportunities: A scoping review.

INTRODUCTION: In recent years, artificial intelligence (AI) has been applied in various ways in medicine and dentistry. Advancements in AI technology show promising results in the practice of orthodontics. This scoping review aimed to investigate the effectiveness of AI-based models employed in orthodontic landmark detection, diagnosis, and treatment planning. METHODS: A precise search of electronic databases was conducted, including PubMed, Google Scholar, Scopus, and Embase (English publications from January 2010 to July 2020). Quality Assessment and Diagnostic Accuracy Tool 2 (QUADAS-2) was used to assess the quality of the articles included in this review. RESULTS: After applying inclusion and exclusion criteria, 49 articles were included in the final review. AI technology has achieved state-of-the-art results in various orthodontic applications, including automated landmark detection on lateral cephalograms and photography images, cervical vertebra maturation degree determination, skeletal classification, orthodontic tooth extraction decisions, predicting the need for orthodontic treatment or orthognathic surgery, and facial attractiveness. Most of the AI models used in these applications are based on artificial neural networks. CONCLUSIONS: AI can help orthodontists save time and provide accuracy comparable to the trained dentists in diagnostic assessments and prognostic predictions. These systems aim to boost performance and enhance the quality of care in orthodontics. However, based on current studies, the most promising application was cephalometry landmark detection, skeletal classification, and decision making on tooth extractions.

Dental Care in Times of the COVID-19 Pandemic: A Review.

Given the dynamic relationship between oral and general health, dental care must not be neglected even during a public health emergency. Nevertheless, the fear of contracting the infection appears to have caused instances of dental treatment avoidance. In these times of uncertainty, regulatory and public health organizations have made numerous and sometimes controversial recommendations to practitioners and to the public about how to secure their oral health care needs. Dentists, as advocates of oral health, should actively maintain their practices while considering local epidemiological reports and recommendations regarding prevention of SARS-CoV-2 infection. Providing appropriate safety measures, accurate triage and prioritization of patients, notice to susceptible communities, remote health care delivery when appropriate, and epidemiological reports of COVID-19 (whenever possible) are all critical considerations for dental practitioners.