Are the counts of Streptococcus mutans and Staphylococcus aureus changed in complete denture wearers carrying denture stomatitis? A systematic review with meta-analyses.

STATEMENT OF PROBLEM: Despite the importance of Candida spp. on the etiology of denture stomatitis (DS), information on the role of the bacterial component is still scarce. PURPOSE: The purpose of this systematic review was to evaluate whether the counts of Staphylococcus aureus and Streptococcus mutans were changed in complete denture wearers diagnosed with Candida-associated DS. MATERIAL AND METHODS: The literature search was performed in 8 databases and by hand searching. The risk of bias was assessed according to the Newcastle-Ottawa qualifier. Meta-analyses were performed considering the microorganism evaluated (S. aureus or S. mutans) and the collection area (mucosa or dentures). The certainty of evidence was assessed according to the grading of recommendations assessment, development and evaluations (GRADE) criteria. RESULTS: Participants with DS presented higher counts of S. aureus in the mucosa compared with those from the control group (OR, 3.16 [1.62, 6.15]; P<.001). No significant difference between the groups was observed for samples collected from dentures (OR, 0.73 [0.50, 1.07]; P=.110). Conversely, participants without DS presented higher counts of S. mutans both in the mucosa (OR, 0.19 [0.06, 0.63]; P=.006) and dentures (OR, 0.64 [0.41, 1.0]; P=.050). CONCLUSIONS: Microbial counts in participants with DS changed as a function of the type of microorganism and collection site. The certainty of evidence ranged from very low to low. The findings reinforce the fact that bacteria also play a relevant role in DS and should be more extensively studied. Such information may be useful to guide further therapies to prevent or control DS.

Masticatory function improvement with the use of mandibular single-implant overdentures in edentulous subjects: a systematic literature review.

INTRODUCTION: In this systematic review, several masticatory function parameters assessed during mandibular single-implant overdenture (SIO) use were compared to pre- SIO placement values in edentulous patients with aim of contributing to a consensus regarding denture treatment options. EVIDENCE ACQUISITION: This study was registered a priori in the PROSPERO database (CRD42018106567). Two independent reviewers carried out electronic searches in eight databases, without language or time frame limitations, to collate clinical studies comparing masticatory function of edentulous patients before versus after SIO installation with the implant placed on the mandibular midline. Risk of bias was assessed with a before-and-after tool and evidence certainty level was evaluated with the Grading of Recommendations Assessment, Development and Evaluation program. EVIDENCE SYNTHESIS: Eleven studies were included in this review (1 prospective, 3 crossover trials, 4 randomized clinical trials, 2 paired clinical trials, and 1 pilot). Enrolled patients were mostly over 60 years old; all patients were using conventional complete dentures (CD) prior to SIO installation. Masticatory performance, masticatory efficiency, bite force, and muscle activity were improved after the SIO placement compared to during mandibular CD use. Mandibular movement and masticatory ability data were inconclusive. Most of the studies had low risk of bias, but all had very low certainly level ratings due to methodological heterogeneity. CONCLUSIONS: Placement of SIO improves masticatory function, as reflected mostly by masticatory performance and efficiency data, relative to CD use. Further studies comparing dental rehabilitation options, including SIOs, are needed to improve the quality of evidence in the literature.

Is there a relationship between malocclusion and bullying? A systematic review.

BACKGROUND: Malocclusion is a highly prevalent public health problem, and several studies have shown its negative correlation with quality of life, self-esteem, and social perceptions. However, its association with bullying is still controversial. OBJECTIVES: To evaluate the relationship between malocclusion and bullying in children and adolescents. SEARCH METHODS: The databases used for the electronic researches were PubMed, Scopus, Lilacs/BBO, Web of Science, and Cochrane Library. Grey literature was reviewed through Open Grey literature with no language or date restrictions. Selection criteria, based on the PECO strategy, were considered eligible observational studies that included schoolchildren or adolescents (P) with malocclusion (E), compared to those with normal occlusion (C), in which the relationship between malocclusion and bullying was determined (O). DATA COLLECTION AND ANALYSIS: Risk of bias evaluation was made for the qualitative synthesis by the Fowkes and Fulton criteria. Data regarding the age of participants and types of malocclusion and of bullying were extracted among other reported data. The quality of the evidence analyzed was evaluated through the GRADE approach. RESULTS: From 2744 articles identified in databases, nine met the eligibility criteria and were included in present systematic review, of which two studies were judged with methodological soundness. The quality of the evidence was classified as very low due to very serious problems for "risk of bias" and "other considerations" and serious problems of "indirectness". The age of participants ranged from 9 to 34 years considering a cohort study, with a bullying recalling perspective. Malocclusion was both evaluated by researchers and self-reported by participants addressing dentofacial characteristics mostly related to the incisors relationship. All studies evaluated the verbal type of bullying, while 3 also considered physical type. Both types were reported as related to malocclusion, although the results showed that extreme maxillary overjet (> 4 mm, > 6 mm, > 9 mm), extreme deep overbite, and having space between anterior teeth or missing teeth were the types of malocclusion with the strongest relations to bullying. CONCLUSIONS: With very low certainty of evidence, the results of this systematic review suggest that conspicuous extreme malocclusion may be related to the occurrence of bullying among children and adolescents.

The use of mouthguards and prevalence of dento-alveolar trauma among athletes: A systematic review and meta-analysis.

BACKGROUND/AIMS: The evidence that mouthguards prevent dental trauma is inconsistent. The aim of this study was to determine, through a systematic review and meta-analysis (MA), the impact of mouthguards (MG) on the prevalence of dento-alveolar trauma (DT) among athletes of contact sports. MATERIAL AND METHODS: Searches were performed at Medline, Scopus, Web of Science, Lilacs, Cochrane Library, and SIGLE without restriction of language or publication date. After the application of eligibility criteria, studies were evaluated regarding their methodology quality and risk of bias. Two meta-analyses (MA) were performed considering: studies free of problems or with minor problems (MA1) and only free of problems studies (MA2). DT prevalence (events) and total number of athletes from each group (use of MG and non-use of MG) were used for odds ratio calculation (α = 5%). The evidence was quality tested using the GRADE approach. RESULTS: A total of 256 articles were identified. After applying the eligibility criteria, 14 studies were selected for qualitative synthesis, and 11 were used in quantitative synthesis. Meta-analyses showed that 73% (MA1) and 83% (MA2) of mouthguard users have a lower prevalence of DT. In MA1 (eight studies), DT prevalence among MG users was 7.75% (n = 183), while non-users had 48.31% (n = 974) (OR = 0.18, 95% CI = 0.07-0.45, P < 0.001). In MA2 (three studies), DT prevalence among MG users was 7.5% (n = 160), while DT prevalence among non-users was 59.48% (n = 750) (OR = 0.10, 95% CI = 0.05-0.08, P < 0.001), with moderate evidence quality level. CONCLUSION: Mouthguards contribute to a lower prevalence of dento-alveolar trauma among athletes of contact sports.

The relationship of previous dental trauma with new cases of dental trauma. A systematic review and meta-analysis.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are a public health concern with high prevalence and recurrence rate. The aim of this study was to perform a systematic review and meta-analysis to determine whether previous dental trauma is a predictive factor for new episodes of TDI (recurrence or first episodes). MATERIALS AND METHODS: Electronic searches were performed with no language or date restrictions. According to the PECOS strategy, cohort studies that investigated subjects with and without previous TDI, and its association with new TDI episodes, as primary or secondary outcomes, were included. Quality assessment and bias control were carried out according to Fowkes and Fulton guidelines. A meta-analysis was performed by sub-grouping studies into deciduous and permanent dentition, and the risk ratio (RR) was also calculated (P ≤ 0.05). The evidence was quality-tested using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: After titles and abstracts were examined, and full texts were read, five studies were included in this systematic review. Four studies had high methodological quality, and one presented a risk of bias on confounding factors. No association and a positive association were determined between previous history of TDI and new episodes of TDI in the primary (RR 1.26 [0.99, 1.62], P = 0.06) and in the permanent dentitions (RR 2.68 [1.20, 4.19], I2  = 37%, P < 0.00001), respectively. The pooled results demonstrated a positive association (P < 0.00001) between previous dental trauma and new episodes of TDI (RR 2.17 [1.20, 3.90], P = 0.01, I2  = 83%) with moderate evidence quality level. CONCLUSIONS: Individuals that have suffered previous TDI present a greater risk of suffering new episodes of TDI.