Association between tooth loss-related speech and psychosocial impairment with cognitive function: A pilot study in Hong Kong's older population.

BACKGROUND: Tooth loss has been associated with cognitive decline, but the underlying mechanisms involving speech and psychosocial impairment remain unclear. OBJECTIVES: To investigate the impact of tooth loss-related speech and psychosocial impairment on cognitive function in Hong Kong's older population. METHODS: Seventy-six Cantonese-speaking participants between the ages of 51-92 were classified into three groups: patients with complete dentures (CD), partially edentulous patients with less than 10 occluding tooth pairs (OU <10), and at least 10 occluding tooth pairs (OU ≥10). Cognitive function was assessed using the Montreal Cognitive Assessment Hong Kong Version, One-minute Verbal Fluency Task and Hayling Sentence Completion Test. Objective and subjective speech assessments were carried out using artificial intelligence speech recognition algorithm and a self-designed speech questionnaire. The impact of tooth loss on psychosocial condition was evaluated by the Reading the Mind in the Eyes Test and a self-designed questionnaire. Statistical analyses (one-way ANOVA, ANCOVA, Kruskal-Wallis test, Spearman correlation test) were performed. RESULTS: Tooth loss was significantly associated with lower cognitive function (p = .008), speech accuracy (p = .018) and verbal fluency (p = .001). Correlations were found between cognitive function and speech accuracy (p < .0001). No significant difference in tooth loss-related psychosocial impact was found between the three groups. CONCLUSION: While warranting larger sample sizes, this pilot study highlights the need for further research on the role of speech in the association between tooth loss and cognitive function. The potential cognitive impact of tooth retention, together with its known biological and proprioceptive benefits, supports the preservation of the natural dentition.

Association of dietary inflammation with tooth loss and cognitive decline in older adults from cross-sectional data: The moderated role of albumin.

OBJECTIVE: Growing evidence suggests a potential connection between tooth loss and cognitive function in recent years. Increasing studies have focused on their inter-relationship, however, the underlying mechanism has yet to be fully elucidated. Few studies have considered the role of dietary inflammation and serum albumin in the association between tooth loss and cognitive function. Therefore, the aim of this study was to explore the role of dietary inflammation and serum albumin in the association between tooth loss and cognitive impairment. METHODS: A sample of 1,009 US adults from the National Health and Nutrition Examination Survey (NHANES) provided data on oral condition, cognitive function, dietary intake, and serum tests. The association between tooth loss (exposure variable) and cognitive function (outcome variable) was assessed by linear regression. Furthermore, a moderated mediation model was established to examine the influence of dietary inflammation on the association between tooth loss and cognitive tests, and the visualization of the moderating effect of serum albumin concentration was displayed through the Johnson-Neyman curve. RESULTS: Participants with impaired dentition had worse cognitive function and a higher Dietary Inflammation Index (DII). DII was highly correlated with Immediate Recall Test (IR), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST), which mediated 16.46 %, 14.41 % and 11.28 % of the effect between tooth loss and cognitive functions. Additionally, the relationship between DII and DSST was moderated by serum albumin concentration. CONCLUSION: Tooth loss was associated with cognitive function which was affected by pro-inflammatory dietary patterns and serum albumin level. CLINICAL SIGNIFICANCE: This study presents evidence for dentists that dietary pattern change due to tooth loss plays a role in cognitive deterioration, which can also be moderated by serum albumin level. Therefore, the preservation of natural teeth is important for cognitive function, especially in an immunocompromised population with decreased serum albumin concentrations.

SURVIVAL AND COMPLICATION RATES OF RESIN COMPOSITE LAMINATE VENEERS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVES: The aim of this systematic review was to evaluate the survival and complication rates of resin composite laminate veneers. METHODS: Randomized controlled trials and cohort studies with a minimum 2-year follow-up assessing survival and complication rates of resin composite laminate veneers on permanent dentition from 1998 to May 2022. Literature searches were conducted in MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Trials electronic databases. References cited in the related reviews and included full-text articles were also hand-searched to further identify potentially relevant studies. RESULTS: A total of 827 articles were identified. Twenty-two studies were considered for full-text review after the title and abstract screening stage. After exclusion, 7 studies (3 randomized controlled trials and 4 cohort studies) were included in the systematic review. Three published scales were adopted for the quality and risk of bias assessment. At the survival rate threshold, the overall heterogeneity (I2) for randomized controlled trials was 50.5% (P = .108). The overall pooled survival rate of the randomized controlled trials was 88% (95% CI: 81%-94%), with the mean follow-up time ranging from 24 to 97 months. Surface roughness, color mismatch, and marginal discoloration were the most reported complications. CONCLUSION: Resin composite laminate veneers demonstrated moderately high survival rates for the entire sample and the direct laminate veneer group demonstrated higher survival rates than the indirect approach. Most of the complications were regarded as clinically acceptable with or without reintervention.

Prevalence of respiratory pathogens colonizing on removable dental prostheses in healthy older adults: A systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to investigate the prevalence of opportunistic respiratory pathogens colonizing removable dental prostheses in older adults without respiratory diseases. METHODS: This review was registered with PROSPERO and conducted in accordance with the principles formed by the working group of the Joanna Briggs Institute (JBI) to evaluate systematic reviews of prevalence data. Literature searches were conducted across five electronic databases. Quality assessments were determined according to a revised JBI critical appraisal checklist across nine criteria. Comparison between fixed- and random-effects meta-analyses were performed for sensitivity analysis. Prediction intervals were also presented when three or more studies were included in the meta-analysis. RESULTS: Across the databases, 1091 articles were identified, and 591 articles remained after the removal of duplicates. Twenty "potentially effective" studies were identified. Ultimately eight studies informed this review and meta-analyses were performed for 13 known respiratory pathogens. The meta-analyses identified the top three common respiratory pathogens residing on the removable prostheses were, in descending order: Staphylococcus aureus: 31.81% (95% CI: 13.34%-48.24%); Staphylococcus epidermidis: 14.07% (95% CI: 7.88%-21.48%); Klebsiella pneumoniae: 10.50% (95% CI: 2.55%-22.30%). The heterogeneity scores for nine respiratory pathogen analyses were classified as "unimportant inconsistency", I2  = 0% (p > 0.1). For sensitivity analysis, there was no difference between the random- and fixed-effects models. CONCLUSION: The existing evidence demonstrated a high burden of certain opportunistic respiratory pathogens, which may be considered a major potential cause of respiratory infections in older adults wearing removable prostheses.

Improvement of parents' oral health knowledge by a school-based oral health promotion for parents of preschool children: a prospective observational study.

BACKGROUND: Parents of preschool children have inadequate oral health knowledge in Hong Kong. Parents play a critical role in preschool children's dietary patterns and oral health behaviors. A school-based oral health promotion (OHP) for parents of preschoolers was developed and investigated. OBJECTIVES: The objective of this study was to evaluate effects of the school-based OHP for parents of preschool children on parents' oral health knowledge and preschool children's early childhood caries (ECC). MATERIALS AND METHODS: This was a quasi-experimental study. Parents of preschool children were divided into the intervention group (IG) and the control group (CG) according to their own selection. Parents in the IG participated in a structured school-based OHP workshop, while those in the CG did not attend the OHP workshop. Parents in both groups were invited to complete a questionnaire assessing their oral health knowledge before (T0), one month after (T1), and twelve months after (T2) the OHP workshop. Preschool children's caries was examined via dmft score at T0 and T2. RESULTS: Parents' oral health knowledge was negatively correlated with preschool children's dmft scores (R = -0.200, P < 0.001). Oral health knowledge was significantly improved in IG (P < 0.001) but not in CG (P = 0.392) at T1. Both groups experienced a significant improvement in oral health knowledge from T0 to T2 (P < 0.001). Parents' oral health knowledge in the IG was significantly higher compared to the CG at T1 (P < 0.001), but difference in the scores at T2 between the two groups showed no significant difference (P = 0.727). No significant difference was found in changes in children's dmft score from T0 to T2 between the IG and CG (p = 0.545). CONCLUSION: Preschool children's high ECC is associated with the limited oral health knowledge of their parents. The school-based OHP workshop for parents increased parents' oral health knowledge within one month. This positive effect was maintained for twelve months and can be extended to a larger scale in the school setting.

EFFECTIVENESS OF PHENTOLAMINE MESYLATE IN REVERSAL OF LOCAL ANESTHESIA: SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: The aim of the present paper is to summarize the effectiveness of Phentolamine mesylate on the reversal of local anesthesia (LA). METHODOLOGY: Seven electronic databases were searched for randomized clinical trials in patients who received LA (population) and either received a Phentolamine injection (intervention) after LA compared to placebo or sham (control) to cause a return of normal sensation (outcome). Risk of bias assessment was performed using Cochrane risk of bias assessment tool 2.0. The hazard ratio (HR) was calculated as the event (time to return to the normal sensation) was a time-dependent event, as well as the weighted mean difference (WMD), was computed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of the evidence. RESULTS: Ten studies met our inclusion criteria and were included in this review. After pooling the results quantitatively, the value of the HR in the tongue was 0.56 (95% CI: 0.41-0.75, P<.001); in lower lip, the value was 0.56 (95% CI: 0.38-0.83, P = .004) and for upper lip, the value was 0.50 (95% CI: 0.31-0.80, P = .004). The WMD for the time to return for normal sensation was -47.71 min for the tongue (95% CI: -73.63 to -21.80 min, P<.001), -73.29 min for lower lip (95% CI: -88.41 to -58.16 min, P<.001) and -86.86 min for upper lip (95% CI: -101.16 to -72.57 min, P<.001). There is a high certainty of evidence that patients who have been administered local anesthesia may achieve faster recovery of normal sensation in tongue, and moderate certainty of evidence for return of normal sensation in lower lip and upper lip, if Phentolamine was administered after the local anesthesia. The adverse effects were reported in a few studies and were minor, not necessitating any medical intervention. CONCLUSIONS: Phentolamine might be a useful adjunct in patients who desire an earlier return of normal sensation and function after local anesthesia. Future research should be directed to study the cost-effectiveness or dental patient-reported outcomes of Phentolamine after local anesthetic injections.

Prevalence of adenoid hypertrophy among 12-year-old children and its association with craniofacial characteristics: a cross-sectional study.

BACKGROUND: Identifying the prevalence of adenoid hypertrophy (AH) and craniofacial factors associated with this condition requires studies with random sampling from the general population, and multiple criteria can be used for assessing AH on lateral cephalometric radiograph (LCR). The present analysis represents the first report performed according to these requirements in a large cross-sectional sample of children. METHODS: LCRs of 517 12-year-old children (286 males, 231 females) randomly selected from the general population were retrospectively retrieved. AH was defined using three criteria (At/Nd, Ad-Ba/PNS-Ba, 1-Npaa/Npa), and twelve craniofacial variables were measured (SNA, SNB, ANB, Wits, Cd-Gn, MnP^SN, MxP^MnP, TPFH/TAFH, OPT^SN, C2ps-C4pi^SN, H-CV, H-FH). Skeletal characteristics were compared between children with and without AH using Mann-Whitney U test. Binary logistic regression (adjusted for sex and skeletal growth) was used to independently quantify the association between craniofacial factors and AH. RESULTS: The prevalence of children with AH was 17.6% (according to At/Nd), 19.0% (according to Ad-Ba/PNS-Ba), and 13.9% (according to 1-Npaa/Npa). Children with AH presented greater antero-posterior jaw discrepancy (larger ANB, smaller SNB), greater mandibular divergence (larger MnP^SN), forward head posture (larger OPT^SN and C2ps-C4pi^SN), and anteriorly positioned hyoid bone (larger H-CV). Larger SNA (OR = 1.39-1.48), while smaller SNB (OR = 0.77-0.88) and Wits (OR = 0.85-0.87), were associated with greater likelihood of having AH, independently from the assessment method used. CONCLUSIONS: The prevalence of children with AH ranged from 13.9 to 19.0% based on LCR. Greater antero-posterior maxillo-mandibular discrepancy and mandibular retrusion were independently associated with higher likelihood of having AH.

The association between tooth loss and cognitive decline in the aged population: The mediating role of HDL-cholesterol.

OBJECTIVE: Tooth loss and its impact on cognitive impairment have become a heated topic over the past decade as the global population continues to age. Despite the proliferation of research in this area, the underlying mechanism linking tooth loss and cognitive decline remains poorly understood. Limited investigation has been conducted to explore the potential role of lipid metabolism and its impact on the association between tooth loss and cognitive function. This study endeavored to identify the role of high-density lipoprotein cholesterol (HDL-C) concentration among older adults and its contribution to the link between tooth loss and cognitive impairment. METHODS: Data were retrieved from a public database, namely, the National Health and Nutrition Examination Survey (NHANES). Among 1,124 included participants who were aged above 60 years old, linear regression was performed to determine the association between tooth loss (moderate and severe tooth loss) and cognitive function [Consortium to Establish a Registry for Alzheimer's Disease-Immediate Recall (CERAD-IR), Delayed Recall (CERAD-DR), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST)]. Mediation analysis was used to test the effect of HDL-C on the association of tooth numbers and four cognitive tests. RESULTS: Participants with moderate and severe tooth loss had lower scores on cognitive performance (p<0.001) and lower levels of HDL-C (p<0.05). The HDL-C levels were highly correlated with CERAD-IR and DSST, which mediated 2.11% to 5.24% of the total effect between tooth numbers and cognitive function. CONCLUSION: Tooth loss was negatively associated with cognitive function which was mediated by serum HDL-C levels. CLINICAL SIGNIFICANCE: Dentists should realize that the potential broader implications of tooth loss on overall well-being, including cognitive performance. The preservation of natural dentition might serve as a preventive measure against cognitive impairment, possibly mediated by abnormal lipid metabolism.

Rate of Malignant Transformation Differs Based on Diagnostic Criteria for Oral Lichenoid Conditions: A Systematic Review and Meta-Analysis of 24,277 Patients.

OBJECTIVES: This systematic review and meta-analysis aims to evaluate the evidence on the malignant potential of oral lichenoid conditions (OLCs) including oral lichen planus (OLP), oral lichenoid lesions (OLL), and lichenoid mucositis dysplasia (LMD). In addition, it aims to compare the rate of malignant transformation (MT) in OLP patients diagnosed according to different diagnostic criteria, and to investigate the possible risk factors for OLP MT into OSCC. MATERIALS AND METHODS: A standardized search strategy was applied across four databases (PubMed, Embase, Web of Science, and Scopus). Screening, identification and reporting followed the PRISMA framework. Data on MT were calculated as a pooled proportion (PP), subgroup analyses and possible risk factors for MT were pooled as odds ratios (ORs). RESULTS: Among 54 studies with 24,277 patients, the PP for OLCs MT was 1.07% (95% CI [0.82, 1.32]). The estimated MT rate for OLP, OLL and LMD was 0.94%, 1.95% and 6.31%, respectively. The PP OLP MT rate using the 2003 modified WHO criteria group was lower than that using the non-2003 criteria (0.86%; 95% CI [0.51, 1.22] versus 1.01%; 95% CI [0.67, 1.35]). A higher odds ratio of MT was observed for red OLP lesions (OR = 3.52; 95% CI [2.20, 5.64]), smokers (OR = 1.79; 95% CI [1.02, 3.03]), alcohol consumers (OR = 3.27, 95% CI [1.11, 9.64]) and those infected with HCV (OR = 2.55, 95% CI [1.58, 4.13]), compared to those without these risk factors. CONCLUSIONS: OLP and OLL carry a low risk of developing OSCC. MT rates differed based on diagnostic criteria. A higher odds ratio of MT was observed among red OLP lesions, smokers, alcohol consumers, and HCV-positive patients. These findings have implications for practice and policies.

Psychological Outcomes on Anxiety and Depression after Interventions for Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

Many studies have shown mutual interaction between temporomandibular disorders (TMD) and psychological distress. However, evidence on the effectiveness of therapeutic interventions for TMD on psychological outcomes is scarce. This review aimed to summarise the best evidence on the association between interventions for TMD and psychological outcomes regarding symptoms of anxiety and depression. Electronic search was carried out in databases, including Pubmed, Web of Science, Medline, Cochrane Library, and Scopus. All eligible studies were included for narrative synthesis. Eligible randomised controlled trials (RCTs) were included for the meta-analysis. The overall effect size of interventions for TMD was analysed in standardised mean difference (SMD) in levels of anxiety and depression. Ten studies were included in the systematic review. Of these, nine were included in the narrative analysis and four were included in the meta-analysis. All included studies and the result of the narrative analysis showed a statistically significant beneficial effect of interventions for TMD on improving symptoms of anxiety and depression (p < 0.0001); however, a statistically significant overall effect was not found in the meta-analyses. Current evidence is in favour of the interventions for TMD in improving symptoms of depression and anxiety. However, the effect is statistically uncertain and warrants future studies to enable the best synthesis of the evidence.

Effect of magnifying loupes on tooth preparation of complete coverage crown: A quantitative assessment using a digital approach.

OBJECTIVE: The purpose of this study was to evaluate the use of magnifying loupes (×2.5) on the quality of tooth preparation for complete coverage crowns; performed by predoctoral students using an objective and quantitative digital method. MATERIALS AND METHODS: Forty-two predoctoral students were randomly assigned into 2 groups to perform tooth preparation for a complete coverage crown on a mandibular first molar in a manikin, with and without the use of magnifying loupes. All preparations were digitally evaluated by PrepCheck 3.0 (Dentsply Sirona). Parameters including tooth reduction, total occlusal convergence (TOC), undercut, margin quality and surface quality were assessed. Continuous data were analysed using Paired t-tests or Wilcoxon Signed Ranks tests. Ordinal data were analysed by McNemer's tests. To further detect the majority pattern ( > 50%) in each group (with and without loupes), one-sample t-test or one-sample Wilcoxon Signed Rank test was performed. The level of significance was set at p = .001 after Bonferroni adjustments for multiple testing. RESULTS: No significant differences in the measured outcomes were found between the groups with or without the use of magnifying loupes (p > .002). The majority (>50%) of both groups had no undercuts (99.3% and 99.4% both p < .001) and the preparation type was within tolerance (81.6% and 85.3%, both p < .001) with acceptable margin (86.4% and 86.3%, both p < .001) and acceptable surface quality (99.0% and 99.1%, both p < .001). However, the majority of both groups underprepared occlusally (96.0% and 95.4%, both p < .001) and axially (65.3% and 67%, both p < .001). Only 30.0%-42.1% of the participants achieved the TOC within 0-20°. CONCLUSIONS: Within the limitations of this study, the use of magnification loupes does not appear to significantly improve the quality of tooth preparation for complete coverage crown. The TOC was also found to be overprepared and occlusally underprepared.

Factors affecting periodontal healing of the adjacent second molar after lower third molar surgery: a systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aim to evaluate the effect modifiers which may influence the periodontal healing of the adjacent second molar after lower third molar surgery. MATERIALS AND METHODS: Prospective studies including patients with third molars requiring removal, with at least 6 months follow-up were considered. Outcomes were periodontal probing depth (PPD) reduction, final PPD, clinical attachment level (CAL) change, final CAL, alveolar bone defect (ABD) reduction, and final ABD depth. Meta-regression was performed to identify factors. RESULTS: Fourteen studies were included in the quantitative synthesis. At 6 months, the PPD reduction was 1.06 mm (95% CI, 0.72 to 1.39 mm) and the remaining PPD was 3.81 mm (95% CI, 3.00 to 4.62 mm). Baseline PPD was strongly correlated with the remaining PPD at 6 months (p < 0.001, adjusted R2 = 70.05%). CONCLUSIONS: Lower third molar surgery results in a modest reduction in PPD, CAL, and ABD; however, periodontal defects still remain at 6 months and beyond. Baseline PPD is strongly correlated with final PPD. While age is not shown to have effect on most of the periodontal parameters, a larger baseline PPD is more likely to manifest with increasing age and third molar surgery should be done before severe periodontitis occurs to avoid persistent periodontal defects. CLINICAL RELEVANCE: This study shows that lower third molar surgery results in modest improvement in periodontal parameters on adjacent second molars and identified factors such as baseline PPD which may affect the healing, which may guide the pre-, peri-, and post-operative management of lower third molar surgery.

Lavage Volume of Arthrocentesis in the Management of Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

The aim of this study was to investigate the most effective lavage volume of arthrocentesis in the management of temporomandibular disorders. A comprehensive electronic search, based on the PRISMA guidelines, was performed, which included a computer search with specific keywords, a reference list search and a manual search. The inclusion criteria were the following: a randomized controlled trial, at least 20 subjects who underwent arthrocentesis, mention of the irrigation materials used for the arthrocentesis, mention of the irrigation volumes used for the arthrocentesis, MMO and pain measured as VAS or NRS, were reported as outcome figures, mention of a specific diagnosis or signs and symptoms, and inclusion of the data on the MMO or VAS/NRS at 6-month follow-up. Sixteen publications were enrolled in the meta-analysis, comparing arthrocentesis with a lavage volume <150 mL and arthrocentesis with a lavage volume ≥150 mL, in the efficacy of the improvement in the mouth opening and pain reduction. The results revealed the group with a lavage volume <150 mL had a greater improvement in the mouth opening and pain reduction. However, results are to be interpreted with caution, due to the paucity of the randomized controlled literature and other confounding factors. Further high-quality studies are required to provide a better conclusion to the treatment outcomes of the different lavage volumes.

A neural-related gene risk score for head and neck squamous cell carcinoma.

OBJECTIVES: This study aimed to establish a neural-related gene risk score (NRGRS) for the prediction of head and neck squamous cell carcinoma prognosis and explore its predictive value on the benefit of immune checkpoint inhibitor therapy. METHODS: Based on the transcriptome data of HNSCC patients (n = 546) from The Cancer Genome Atlas database, 37 neural-related hub genes were identified by weighted gene co-expression network analysis. Four genes (ITGA5, PYGM, GNG7 and ATP2A3) were identified to construct NRGRS using Lasso-Cox regression method based on the derivation cohort and validated in the Gene Expression Omnibus cohort (n = 109). The survival analysis was performed to validate the prognostic value of NRGRS and immune characteristics in NRGRS-defined subgroups were analyzed. RESULTS: NRGRS-high patients had a worse overall survival than NRGRS-low patients. Tumors with high NRGRS were more likely to have high infiltration of naive CD4+ T cells, M0, M2 macrophages and resting mast cells, which illustrated suppressive immunity and less benefit from immunotherapy therapy. CONCLUSION: NRGRS strongly correlates with survival and is a promising biomarker to predict immunotherapy benefits for head and neck cancer patients. This study provides evidence for the potential correlation between neural-related transcriptome alteration and immune activity.

Non-Pharmacological Interventions for Reducing Fear and Anxiety in Patients Undergoing Third Molar Extraction under Local Anesthesia: Systematic Review and Meta-Analysis.

This report investigated the effectiveness of non-pharmacological interventions for reducing dental fear and anxiety in patients undergoing third molar extraction under local anesthesia. In November 2020, multiple electronic databases (Cochrane, EMBASE, MEDLINE, PsycInfo, PsycArticles, PubMed, and Web of Science) were searched for articles published in English. Inclusion criteria were randomized-controlled trials reporting the effectiveness of any non-pharmacological interventions in reducing fear or anxiety levels in patients with third molar extraction. A total of 3015 studies by electronic search and 2 studies by hand search were identified. After screening, 21 studies were eligible for systematic review. Seven studies were included in the meta-analysis. Study selection, data extraction, and quality assessment of the included studies were performed by two independent investigators. The anxiety levels after intervention in each study were pooled and meta-analyzed by the random-effect model. A significant reduction in anxiety level was observed in non-pharmacological intervention groups (SMD = -0.32; 95% CI -0.57 to -0.07; p = 0.01). Subgroup analyses showed that a significant anxiety reduction by non-pharmacological interventions could be demonstrated by pooled data from studies using psychometric assessments, but not from studies using physiological assessments. Non-pharmacological interventions appear to reduce fear and anxiety levels in patients undergoing third molar extraction under local anesthesia.

Validation of clinical photography and a laser fluorescence device for assessment of enamel demineralization during multi-bracketed fixed orthodontic treatment.

AIM: To compare the validity of DIAGNOdent pen™ 2190 and clinical photographs in the diagnosis (presence or absence) and assessment of white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment. METHODS: A total of 1607 readings from 99 patients were obtained using DIAGNOdent pen™ 2190, clinical photographs, and visual assessment criteria to assess WSLs at 6 -, 12- and 18 months after bonding of brackets. Receiver operating characteristic curves were constructed, and areas under the curve (AUC) were calculated to assess the presence or absence of WSLs and distinguish the severity of WSLs as slight or severe. Sensitivities, specificities, and AUC were calculated for outcomes at an alpha of 0.05 and 95% confidence intervals (CIs). RESULTS: The values of sensitivity and specificity of DIAGNOdent pen™ 2190 were found to be 0.78 and 0.83, respectively, to distinguish presence/absence of WSLs with good accuracy (AUC= 0.855; 95% CI: 0.820-0.889) and for digital photographs, accuracy was excellent (AUC= 0.973, 95% CI: 0.956-0.991) with sensitivity and specificity of 0.96 and 0.99, respectively. However, the accuracy of DIAGNOdent pen™ 2190 was poor (AUC= 0.543, 95% CI: 0.418-0.668) in delineating slight and severe WSLs with a sensitivity of 0.31 and specificity of 0.83; while the values of sensitivity and specificity for distinguishing slight or severe lesions for clinical photographs were 0.96 and 0.99, respectively with excellent accuracy (AUC=0.978, 95% CI: 0.936-1.000). CONCLUSIONS: Clinical photographs had better validity than DIAGNOdent pen™ 2190 in diagnosis and assessment of severity of demineralized lesions during multi-bracketed fixed orthodontic treatment.

Myogenous Temporomandibular Disorders: Diagnostic Concepts and Prospective Pilot Study on Extracorporeal Shockwave Therapy.

The aims of this article are to discuss the current, and potential future directions, in the diagnosis of myogenous temporomandibular disorders (M-TMD), as well as to report a pilot study to investigate the feasibility and clinical outcomes of extracorporeal shockwave therapy (ESWT) in the treatment of M-TMD. Forty-one adult patients presented with M-TMD were recruited into the study and randomized into two groups: Group 1 received ESWT treatment, whereas Group 2 received placebo treatment. The variables investigated were pain, measured by a numerical rating scale (NRS) and mouth opening. Twenty-six patients (Group 1: n = 14, mean age = 45.3 (16.7) years; Group 2: n = 12, mean age = 46.8 (19.7) years) completed 1-year follow up and were included into the final analysis. In both groups, reduction in pain and increase in MO (unassisted maximum, assisted maximum, and pain-free) were seen at post-treatment 1 year. There were more reduction in pain and increase in all MO in Group 1 than Group 2, but statistical significance was not detected. No major complications were encountered in this study. Although significant differences were not seen between groups, this prospective pilot study provided preliminary evidence that ESWT is safe and potentially beneficial in the treatment of M-TMD.

Topical fluoride to prevent early childhood caries: Systematic review with network meta-analysis.

OBJECTIVES: To summarize the evidence on prevention of early childhood caries (ECC) by professionally or self-applied topical fluorides using network meta-analysis. DATA: Randomized-controlled trials with minimum 1-year follow-up assessing caries-preventive effect among children younger than six years. SOURCES: Eight electronic databases and grey literature. STUDY SELECTION: After screening and data extraction, risk of bias assessment using Cochrane risk of bias tool 2.0 was done. Twenty-four trials were included, among which 17 were assessed as "high risk" and remaining as "low risk". Fifteen studies evaluated professionally-applied, and the other nine used self-applied topical fluorides. Ten studies on professionally-applied fluorides reporting the net caries increment (dmfs increment) at 2-years follow-up were included in Network meta-analysis (NMA). NMA and ranking the interventions were conducted using a frequentist random-effects approach and surface under the cumulative ranking command, followed by assessing the certainty of evidence using an extension of GRADE approach with CINeMA framework. Among the eight included interventions of professionally-applied fluorides, only two, i.e., 3-monthly 0.9% difluorosilane (DFS) and 6-monthly 5% sodium fluoride varnish were effective in preventing ECC compared to control with 3-monthly DFS application ranking higher than 6-monthly sodium fluoride varnish application. CONCLUSION: Among all the professionally-applied topical fluoride interventions reviewed, very low to moderate evidence was found with 0.9% DFS application at 3-monthly intervals, which was ranked highest in prevention of ECC. Among the included studies on self-applied topical fluorides, the evidence was inconclusive due to heterogeneity among studies. CLINICAL SIGNIFICANCE: The 0.9% DFS varnish applied every 3 months is most effective for preventing early childhood caries. The review recommends that good quality studies be conducted in future, comparing two or more interventions for both self- as well as professionally-applied topical fluoride agents with adequate follow-up.

The Prognostic Value of Human Papilloma Virus Infection in Oral Cavity Squamous Cell Carcinoma: A Meta-Analysis.

OBJECTIVES/HYPOTHESIS: Human papilloma virus (HPV) infection has been confirmed as a favorable prognostic factor in oropharyngeal cancer. However, the prognostic value of HPV in oral squamous cell carcinoma (OSCC) is still unclear. Therefore, a systematic review and meta-analysis was performed to evaluate the prognostic value of HPV infection in OSCC patients. STUDY DESIGN: Systematic literature review with meta-analysis. METHODS: A systematic literature review was conducted in accordance with PRISMA guidelines in PubMed, EMBASE, and MEDLINE databases. The primary outcomes were overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and secondary outcomes were local control (LC), regional control (RC), and distant control (DC). RESULTS: A total of 22 articles with 3065 OSCC patients were included in this study. Meta-analysis demonstrated that compared to HPV-negative OSCC patients, HPV-positive OSCC patients had a significantly shorter OS (hazard ratio [HR] = 1.45, 95% confidence intervals [CI], 1.10-1.93) and lower DC (HR = 2.16, 95% CI, 1.54-3.04). There was no significant difference in DFS (HR = 1.20, 95% CI, 0.63-2.26), DSS (HR = 1.20, 95% CI, 0.63-2.26), LC (HR = 1.44, 95% CI, 0.97-2.14), and RC (HR = 1.50, 95% CI, 0.98-2.30) between HPV-positive and negative OSCC patients. Sensitivity analysis confirmed the above results. CONCLUSIONS: Our systematic review and meta-analysis reveal that HPV-positive is associated with significantly decreased OS and DC, suggesting HPV infection is an adverse prognostic factor in OSCC. Laryngoscope, 132:1760-1770, 2022.

The Impact of Coronavirus Disease 2019 on the Disease Pattern of Oral and Maxillofacial Surgery Inpatients: A Comparative Study.

Objective: Oral and maxillofacial surgery (OMFS) is a high-risk specialty involving airway and aerosol-generating procedures, which is potentially of more risk in the era of coronavirus disease 2019 (COVID-19). We aimed to identify the impact of COVID-19 on the disease pattern of OMFS inpatients and surgeries under general anesthesia in a comparative study. Materials and Methods: We reviewed the admission and operating theater records of OMFS patients from Jan 1 to Aug 31 in 2020 and 2019. The total number of cases, presenting disease patterns, and proportion of essential and non-essential medical services were compared between 2020 and 2019. Results: There were 664 admissions and 356 general anesthesia surgical procedures included in this study. Both admission and surgery numbers were significantly reduced in 2020, compared with 2019 (p = 0.012 and 0.007, respectively). The proportion of malignancy cases increased significantly, whereas that of cleft lip and palate and temporomandibular disorder (TMD) decreased. There was a significant increase in the proportion of essential services compared with non-essential services in 2020 compared with 2019. Conclusion: Our results first reported the epidemiological data of the impact of COVID-19 on OMFS disease pattern in a comparative study. The change of disease pattern and caseload will have a long-term impact on OMFS patient care, education, and training during the pandemic. Our paper provides evidence for health policy makers to consider the relocation of medical resources and optimization of medical education and services.