Management of medical emergencies in orthodontic practice.

BACKGROUND: The aims of this study were to survey the occurrence of acute medical situations in Dutch orthodontic practice and to examine the self-perceived competence of orthodontists in managing acute medical emergencies. METHODS: A self-designed questionnaire was distributed among all 149 Dutch orthodontists attending the spring meeting of the Dutch Society for Orthodontists. The questionnaire was divided into three parts, addressing background information of the orthodontist, precautions against and experiences in acute medical situations, and self-perceived competence of nine common medical emergencies. The statistical analysis was performed using the chi-square test and a multiple logistic regression analysis. RESULTS: The response rate was 74.5% (105 out of 149). The male to female ratio in this population was 55:50. Mean age of all participants was 46.9 years (SD 10.4 years) with on average 16.7 years of working experience (SD 10.6 years). The most common medical emergency reported by Dutch orthodontists was vasovagal collapse (n = 219), followed by acute allergic reaction (n = 163) and hyperventilation (n = 83). On average, 75% (n = 79) of the orthodontists felt competent to handle any acute medical situation with an average occurrence of 0.36 acute medical emergencies per orthodontist per year. Male participants were more likely to send patients towards the emergency department (p = 0.049). Moreover, a statistically significant negative correlation was observed between self-perceived competence handling hypoglycemia and years of clinical experience. The longer orthodontists were clinically active, the less competent they felt when encountered with a hypoglycemia (p = 0.031). CONCLUSIONS: Medical emergencies may be rare but challenging occurrences in the orthodontic practice. It is strongly recommended for all orthodontists and supporting staff to be trained regularly in the management of medical emergencies and to possess up-to-date evidence-based knowledge. Familiarity with and availability of appropriate drugs and equipment are deemed essential to the management of acute medical emergencies that may arise in the orthodontic practice.

Quantitative evaluation of the progressive wear of powered interproximal reduction systems after repeated use : An in vitro study.

PURPOSE: To evaluate the residual surface roughness of 5 common diamond-coated interproximal reduction (IPR) systems after consecutive in vitro applications in relation to system, diamond grain size, and instrument thickness. METHODS: IPR was performed on 80 extracted human incisors using motor-driven strips and discs under predefined conditions. The IPR auxiliaries were applied at 5 consecutive sessions of 20 s on intact interproximal surfaces, and the surface profile (Ra, Rz, Rmax) was analyzed at baseline and after each session with an optical profilometer. RESULTS: No overall significant difference in the roughness values was found between systems (P = 0.07 for Ra, P = 0.33 for Rz, and P = 0.48 for Rmax). There was a significant average decrease of Ra, Rz, and Rmax for all systems for every unit increase in time by -0.171 µm (P < 0.001), -3.297 (P ≤ 0.001), and -2.788 µm (P = 0.001), respectively. Ra, Rz, and Rmax values increased significantly, i.e., by 0.194 µm (P = 0.003), 5.890 µm (P = 0.001), and 5.319 µm (P = 0.010) as instrument thickness increased by one unit. No significant reductions in Ra, Rz, and Rmax were observed across grain sizes (-0.008 µm [P > 0.05], -0.244 µm [P > 0.05], and -0.179 µm [P > 0.05], respectively). There was no evidence of interaction between system and time as the P values for Ra, Rz, and Rmax were 0.88, 0.51, and 0.70, respectively. CONCLUSIONS: All IPR materials presented significant gradual decrease of surface roughness after repeated applications. There were no significant roughness changes among auxiliaries of different grain sizes. Thinner auxiliaries showed significantly more roughness reduction, possibly requiring more frequent replacement than thick auxiliaries in clinical practice.

Measuring the social impact of dental research: An insight into the most influential articles on the Web.

OBJECTIVES: To identify the most discussed dental articles on the Web and to assess the association between the intensity of online attention, publication characteristics, and citations. MATERIALS AND METHODS: An Altmetric Explorer search was conducted for articles published in the 91 dental journals included in 2015 InCites™ Journal Citation Report® and mentioned online at all times. The 100 articles with the highest online attention, as measured by the "Altmetric Attention Score" (AAS), were screened for journal title, quartile of impact factor distribution (Q1-Q4), publication date, origin and affiliation of first author, article topic, type, and access. Citation counts were harvested from Scopus. RESULTS: The top 100 articles presented a median AAS of 119 and were mostly discussed on news outlets, Twitter, and Mendeley. Forty-one articles were published in Q1 journals, 24 in Q2 journals, 32 in Q3 journals, and three in Q4 journals. AAS was significantly higher in articles of Q2 journals (median AAS = 398, range = 70-513) than in articles of Q1. A weak reverse correlation existed between AAS and time since publication (r = -.25, p < .05). No correlation was detected between AAS and other publication characteristics or number of citations. CONCLUSIONS: Increased social impact of dental articles is not significantly associated with high citation rates.

Is YouTube useful as a source of information for Sjögren's syndrome?

OBJECTIVES: To quantitatively and qualitatively assess the characteristics of YouTube videos dealing with Sjögren's syndrome. MATERIALS & METHODS: A comprehensive electronic search was performed for 'Sjögren's syndrome' in YouTube. After excluding duplicates, irrelevant videos, and non-English-language domains, 70 videos were included for analysis. Videos were classified as useful, misleading, or personal experience. The overall quality of videos was scored according to the Global Quality Scale (GQS). Useful videos were assessed for reliability and comprehensiveness based on two 5-point scales. Key points of the misleading videos were explored and patients' personal experiences were further investigated. RESULTS: Thirty-six videos (51.4%) were classified as useful, 6 (8.6%) as misleading, and 28 (40%) as patient's personal experience. Independent users tend to upload videos with personal experience, while university channels/professional organizations share useful videos with evidence-based information. Significant difference was observed in GQS among useful, misleading videos, and patient's experiences. The mean reliability, comprehensiveness, and GQS scores of useful videos were 2.5 (s.d.:1.2), 2.6 (s.d.:1.4), and 3.4 (s.d.:1.0), respectively, whereas only six videos (16.7%) were rated as complete vis-à-vis content. The most frequently misleading topics were etiology and treatment. CONCLUSIONS: Specialists should refer their patients to validated e-information resources and actively participate in the development of video-sharing platforms.

Internet information on xerostomia: what should patients expect?

OBJECTIVE: To assess the qualitative standards of the information distributed via the Internet regarding xerostomia. MATERIALS AND METHODS: A comprehensive electronic search was performed for 'xerostomia' and 'dry mouth' separately using four search engines. The first 30 results from each search term-engine combination were pooled for analysis. After excluding promotional product sites, discussion groups, video feeds, scientific articles, non-operative sources, sites with denied direct access through password requirement, non-English language domains, and online medical dictionaries, 50 Web pages were evaluated in terms of readability, accessibility, usability, and reliability using recommended research methodology the Flesch Reading Ease Score and the LIDA instrument. Author and information details were also recorded. RESULTS: The results revealed a variable quality of the available Internet information on xerostomia. The Web sites required advanced reading skills, while LIDA scores for accessibility, usability, and reliability ranged from medium to low with average scores extending from 29.1% to 81.3%. CONCLUSIONS: The quality of information about xerostomia among Web sources presents high variability. The existing discrepancy should be alleviated by referring patients to evidence-based education materials on the Internet. Improvement in xerostomia information e-resources will contribute to a more advanced quality in oral health care.

[Bone anchorage in orthodontics. A review]. / Botverankering in de orthodontie. Een overzicht.

The achievement of absolute anchorage in orthodontics overcoming the reaction forces and moments has been problematic for a long time. This was caused on the one hand by the limitations of the devices available and on the other hand by the dependence on patient cooperation. The introduction of bone anchorage systems changed the traditional way of thinking on orthodontic anchorage. Whereas the application of anchor systems, such as palatal implants and onplants, has specific indications, bone screws with or without plates seem to have the potential of being used on a routine basis. However, appropriate data for more complete understanding of the biological and biomechanical background of this concept of orthodontic anchorage are still lacking. Furthermore, studies on the effectiveness of these systems when compared to the traditional orthodontic anchorage and based on large groups of patients are not available. Well-designed prospective clinical trials substantiating the evidence-based use of these devices are needed.