Systemic benefits of periodontal therapy in patients with obesity and periodontitis: a systematic review.

This systematic review aimed to answer the focused question: "What are the benefits of subgingival periodontal therapy on blood hematological and biochemical index, biomarkers of inflammation and oxidative stress, quality of life, and periodontal pathogen counts in patients with obesity and periodontitis?". A systematic literature search was performed in six databases: PubMed, Embase, LILACS, Web of Science, Cochrane and SCOPUS and other sources, and a manual search was conducted as well. Inclusion criteria were randomized and non-randomized clinical trials, and before-and-after studies on patients with obesity subjected to periodontal therapy. The results were synthesized qualitatively. Risk of bias within studies was assessed using RoB 2 and ROBINS-I tools. The certainty of evidence was evaluated following the GRADE approach. Three randomized controlled trials and 15 before-and-after studies were included. Randomized controlled trials were considered to have a low risk of bias, as compared to before-and-after studies assessed as having low, serious, and critical risks of bias. Non-surgical periodontal therapy plus azithromycin, chlorhexidine, and cetylpyridinium chloride reduced blood pressure and decreased serum levels of HbA1c, hsCRP, IL-1ß, and TNF-α. Salivary resistin level also decreased in patients with obesity and periodontitis after therapy and chlorhexidine mouth rinse. Before-and-after data suggest an improvement in total cholesterol, LDL, triglycerides, insulin resistance, C3, GCF levels of TNF-α, chemerin, vaspin, omentin-1, visfatin, 8-OHdG, and periodontal pathogen counts after therapy.

BMP2 rs1005464 is associated with mandibular condyle size variation.

This study aimed to evaluate the association between single nucleotide polymorphisms (SNPs) in endochondral development-related genes and mandibular condyle shape, size, volume, and symmetry traits. Cone-beam Computed Tomographies and genomic DNA from 118 individuals were evaluated (age range: 15-66 years). Data from twelve 3D landmarks on mandibular condyles were submitted to morphometric analyses including Procrustes fit, principal component analysis, and estimation of centroid sizes and fluctuating asymmetry scores. Condylar volumes were additionally measured. Seven SNPs across BMP2, BMP4, RUNX2 and SMAD6 were genotyped. Linear models were fit to evaluate the effect of the SNPs on the mandibular condyles' quantitative traits. Only the association between BMP2 rs1005464 and centroid size remained significant after adjusting to account for the false discovery rate due to multiple testing. Individuals carrying at least one A allele for this SNP showed larger condylar size than common homozygotes GG (ß = 0.043; 95% CI: 0.014-0.071; P value = 0.028). The model including BMP2 rs1005464, age and sex of the participants explained 17% of the variation in condylar size. Shape, volume, and symmetry were not associated with the evaluated SNPs. These results suggest that BMP2 rs1005464 might be associated with variation in the mandibular condyles size.

Occlusion development after premature loss of deciduous anterior teeth: preliminary results of a 24-month prospective cohort study.

OBJECTIVE: This study aimed to evaluate occlusion development after premature loss or extraction of deciduous anterior teeth, by means of a prospective cohort study. METHODS: Fifteen infants and children aged 1 to 5 years old were longitudinally assessed (with loss or extraction of deciduous anterior teeth [n = 9], and without tooth losses [n = 6]). Photographs and dental casts at the baseline and after 24 months of follow-up were performed. Dental casts were scanned, and linear measurements were made on the digitalized models (missing tooth space, arch perimeter, arch length, arch width, intercanine length and intercanine width). The t-test was used for groups comparisons (α = 0.05). RESULTS: Individuals' mean age at baseline was 2.93 (± 1.18) years. No statistically significant differences were observed in the missing tooth space in the group with tooth loss during the 24 months of follow-up (p > 0.05). Arch perimeter, arch length, arch width, intercanine length and intercanine width did not show differences between the groups (p > 0.05). Qualitative photographic evaluation revealed other changes in the dental arches and occlusion, such as exfoliation and eruption of deciduous teeth, eruption of permanent teeth, self-correction or establishment of malocclusion, among others. CONCLUSION: The results suggest that the premature loss of deciduous anterior teeth does not affect the perimeter, length and width of the dental arches; however, other alterations that lead to malocclusion could be established.

Oral health-related quality of life, adaptation/discomfort during open bite treatment with spurs: complementary analysis from a randomized clinical trial.

This single-center trial aimed to longitudinally compare the oral health-related quality of life (OHRQOL), adaptation and discomfort during anterior open bite (AOB) treatment with lingual spurs and build-ups (SBU) versus spurs only (S) approaches. Children (7-11 years) with AOB were randomly allocated into two treatment groups (SBU or S). The Child Perception Questionnaire (CPQ8-10) was applied 1 and 12 months after installation of the appliances. Questionnaires evaluating functional adaptation and discomfort during the first month of treatment were also applied. A visual analog scale (VAS) was used in these questionnaires. Generalized mixed models were used for analyzing OHRQOL and discomfort data. Generalized linear models were used to assess adaptation outcomes (α = 0.05). The SBU group included 24 patients (7 males and 17 females; mean age 8.2 years) and the S group included 25 patients (11 males and 14 females; mean age 8.3 years). Regardless of the treatment type, overall OHRQOL scores at 12 months were 0.69 times those recorded at 1 month after the appliances installation (i.e., ~ 31% reduction; exp (ß) = 0.69; 95% CI: 0.55, 0.88). A significant interaction between treatment and time was detected for the 'functional limitations' domain. For this domain, a significant improvement from the first to the twelfth month was observed in the S group (P < 0.001). Patients in both treatment groups showed similar and easy adaptation to the appliances. Independent of the type of treatment, tongue-related discomfort decreased over time. One week and one month after the appliance's delivery, the discomfort scores were 0.19 (i.e., ~ 81% reduction; exp (ß) = 0.19; 95% CI: 0.13, 0.28; P < 0.001) and 0.02 (i.e., ~ 98% reduction; exp (ß) = 0.02; 95% CI: 0.01, 0.07; P < 0.001) times, respectively, those issued immediately after the installation of the appliances. Regardless of treatment type; overall OHRQOL improved from the first to the twelfth month of AOB treatment. The functional limitations score decreased in the S group. Children showed easy adaptation, and their discomfort decreased 1 week after the installation of the appliances.Trial registration: Clinicaltrials.gov; NCT03702881, date of registration: October 11, 2018.

Does occlusal morphology of artificial teeth improve chewing of removable dentures wearers? A systematic review and meta-analysis.

PURPOSE: This systematic review aimed to verify whether anatomic, semi-anatomic, or nonanatomic occlusal morphology of artificial teeth improves the masticatory function of complete or removable partial denture wearers. MATERIALS AND METHODS: According to the PICO strategy, six databases and the grey literature were searched to identify randomized (RCT) and non-randomized clinical trials (N-RCT) comparing masticatory function, in terms of masticatory performance and efficiency, and muscle activity as primary outcomes; and patient-reported results (O) in individuals using removable dentures (P) with different occlusal morphologies of artificial teeth (I/C). Masticatory ability, satisfaction with the prosthetic treatment, and oral health-related quality of life (OHRQoL) were evaluated as secondary outcomes. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2.0) for RCT and Risk of Bias for non-randomized studies with intervention (ROBINS-I) for N-RCT studies. Meta-analyses were performed to compare primary outcomes and masticatory ability between the occlusal morphologies of artificial teeth of complete or removable partial dentures (α = 0.05). Certainty of the evidence was verified using the GRADE approach. RESULTS: Eleven studies (seven RCTs and four N-RCTs) were included. The risk of bias was considered low for two studies, some concerns for five, and high for the last four studies. Meta-analyses showed that removable partial dentures with anatomic artificial teeth improved masticatory efficiency for carrot chewing (MD 6.31; 95% CI [3.39, 9.22], I2 = 0%). However, masseter and temporal muscle activities increased when removable partial dentures with nonanatomic teeth were used (MD -756.97; 95% CI [-892.25, -621.68], I2 = 100%). Masticatory ability was not influenced by occlusal morphology during chewing of all foods in complete denture users: Carrot (MD -0.88, 95% CI [-8.98, 7.23], I2 = 57%); sausage (MD -8.86, 95% CI [-23.05, 5.33], I2 = 71%); apple (MD -5.78, 95% CI [-28.82, 17.26], I2 = 87%); and cheese (MD -4.16, 95% CI [-15.14, 6.82], I2 = 62%). The certainty of evidence for all evaluated outcomes was very low, mainly due to very serious problems found in the parameters of inconsistency, indirectness, and imprecision. CONCLUSIONS: Despite the very low certainty of evidence, the occlusal morphology of artificial teeth influences masticatory function. Anatomic teeth improved the masticatory efficiency and muscle activity of removable partial denture wearers. Nonanatomic teeth increased temporal and masseter muscle activity, which negatively affected chewing in removable partial denture users. However, patients using complete dentures with anatomic and semi-anatomic teeth presented similar masticatory ability.

Occlusion development after premature loss of deciduous anterior teeth: preliminary results of a 24-month prospective cohort study

ABSTRACT Objective: This study aimed to evaluate occlusion development after premature loss or extraction of deciduous anterior teeth, by means of a prospective cohort study. Methods: Fifteen infants and children aged 1 to 5 years old were longitudinally assessed (with loss or extraction of deciduous anterior teeth [n = 9], and without tooth losses [n = 6]). Photographs and dental casts at the baseline and after 24 months of follow-up were performed. Dental casts were scanned, and linear measurements were made on the digitalized models (missing tooth space, arch perimeter, arch length, arch width, intercanine length and intercanine width). The t-test was used for groups comparisons (α = 0.05). Results: Individuals' mean age at baseline was 2.93 (± 1.18) years. No statistically significant differences were observed in the missing tooth space in the group with tooth loss during the 24 months of follow-up (p > 0.05). Arch perimeter, arch length, arch width, intercanine length and intercanine width did not show differences between the groups (p > 0.05). Qualitative photographic evaluation revealed other changes in the dental arches and occlusion, such as exfoliation and eruption of deciduous teeth, eruption of permanent teeth, self-correction or establishment of malocclusion, among others. Conclusion: The results suggest that the premature loss of deciduous anterior teeth does not affect the perimeter, length and width of the dental arches; however, other alterations that lead to malocclusion could be established.

RESUMO Objetivo: Este estudo teve como objetivo avaliar o desenvolvimento da oclusão após perda prematura ou extração de dentes decíduos anteriores, por meio de um estudo de coorte prospectivo. Métodos: Quinze bebês e crianças de 1 a 5 anos foram avaliados longitudinalmente (com perda ou extração de dentes anteriores decíduos [n = 9] e sem perdas dentárias [n = 6]). Foram realizadas fotografias e modelos dentais no início e após 24 meses de acompanhamento. Os modelos dentários foram escaneados e medidas lineares foram feitas nos modelos digitalizados (espaço dentário perdido, perímetro da arcada, comprimento da arcada, largura da arcada, comprimento intercaninos e largura intercaninos). O teste t foi utilizado para comparações entre grupos (α = 0,05). Resultados: A média de idade dos indivíduos no início do estudo foi de 2,93 (± 1,18) anos. Não foram observadas diferenças estatisticamente significativas no espaço dentário perdido no grupo com perda dentária durante os 24 meses de acompanhamento (p > 0,05). O perímetro da arcada, comprimento da arcada, largura da arcada, comprimento intercaninos e largura intercaninos não apresentaram diferenças entre os grupos (p> 0,05). A avaliação fotográfica qualitativa revelou alterações nas arcadas dentárias e na oclusão, como: esfoliação e erupção de dentes decíduos, erupção de dentes permanentes, autocorreção ou estabelecimento de má oclusão, entre outras. Conclusão: Os resultados sugerem que a perda prematura de dentes anteriores decíduos não afeta o perímetro, comprimento e largura das arcadas dentárias; entretanto, outras alterações que levam à má oclusão poderiam ser estabelecidas.

Global prevalence of human papillomavirus-related oral and oropharyngeal squamous cell carcinomas: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review to determine the global prevalence of HPV in oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC). MATERIALS AND METHODS: Literature was searched through October 2022 in main databases to address the question "What is the global prevalence of Human Papillomavirus in oral and oropharyngeal cancer?" Studies had to identify HPV by PCR, ISH, or p16 immunohistochemistry to be eligible. Quality was assessed using the JBI checklist for prevalence studies. Meta-analyses were performed, and reporting followed PRISMA guidelines. RESULTS: Sixty-five studies were included, and most of them had methodological limitations related to sampling and the HPV detection tool. The pooled prevalence of HPV-positivity was 10% (event rate = 0.1; 95% CI: 0.07, 0.13; P < 0.01; I2 = 88%) in the oral cavity and 42% (event rate = 0.42; 95% CI: 0.36, 0.49; P = 0.02; I2 = 97%) in oropharynx. The highest HPV prevalence in OSCC was reached by Japan, meanwhile, in OPSCC, Finland and Sweden were the most prevalent. HPV16 is the genotype most frequent with 69% in OSCC and 89% in OPSCC, being the tonsils the intraoral location more affected by HPV (63%, p < 0.01, I2 76%). CONCLUSION: The evidence points to an apparent burden in HPV-related OPSCC, mostly in North America, Northern Europe, and Oceania, especially due to the HPV16 infection suggesting different trends across continents. CLINICAL RELEVANCE: This updated systematic review and meta-analysis provide sufficient evidence about the global HPV prevalence in OSCC and OPSCC and the most frequent HPV subtype worldwide.

Do patients with molar incisor hypomineralization have more dental anxiety and behavior management problems? A systematic review with meta-analysis.

This systematic review evaluated the available evidence on whether children with molar incisor hypomineralization (MIH) have more dental fear and anxiety (DFA) and dental behavior management problems (DBMPs) than those without MIH (Prospero CDR42020203851). Unrestricted searches were performed in PubMed, Scopus, Web of Science, Lilacs, BBO, Embase, Cochrane Library, APA PsycINFO, Open Grey, and Google Scholar. Observational studies evaluating DFA and/or DBMPs in patients with and without MIH were eligible. Reviews, case reports, interventional studies, and those based on questionnaires to dentists were excluded. The methodological quality assessment was based on the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted to synthesize data on DFA. The certainty of evidence was performed according to GRADE. Seven studies that evaluated a total of 3,805 patients were included. All of them presented methodological issues, mainly in the comparability domain. Most studies observed no significant difference in DFA between children with and without MIH. The meta-analysis did not show a significant effect of MIH on the standardized units for the DFA scores (SMD = 0.03; 95%CI: -0.06-0.12; p = 0.53; I2 = 0%). Synthesis including only the results for severe cases of MIH also did not show a significant effect of the condition on DFA scores (MD = 8.68; 95%CI: -8.64-26.00; p = 0.33; I2 = 93%). Two articles found DBMPs were significantly more frequent in patients with MIH. The overall certainty of evidence was very low for both outcomes assessed. The current evidence suggests no difference in DFA between children with and without MIH; DBMPs are more common in patients with MIH. This information should be viewed with caution because of the very low quality evidence obtained.

Clinical performance of and patient satisfaction with conventional complete dentures with different occlusal schemes: A systematic review of systematic reviews.

STATEMENT OF PROBLEM: The complete denture occlusal scheme may influence clinical performance and patient satisfaction. However, a consensus on which occlusal scheme should be used for complete denture users is lacking. As a result, many dentists choose the scheme based on their preferences and clinical experience. PURPOSE: The purpose of this review was to assess the methodological quality and summarize the scientific evidence from secondary studies about the influence of occlusal schemes on the clinical performance of and patient satisfaction with complete dentures. MATERIAL AND METHODS: Ten sources were surveyed according to the patient, intervention, comparison, outcome (PICO) strategy. Systematic reviews that evaluated the clinical performance and patient satisfaction (O) of rehabilitated edentulous patients with conventional complete dentures (P) under different occlusal schemes (I/C) were included. Methodological quality was assessed by using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool by 2 authors independently. The effect of each occlusal scheme in comparison with others was summarized and classified as positive, neutral, negative, or inconclusive based on the conclusions of the systematic review concerning clinical performance and patient satisfaction outcomes. RESULTS: The search led to the inclusion of 10 systematic reviews. Seven were classified as of critically low, 2 as low, and 1 as moderate methodological quality. The following occlusal designs were included and analyzed: bilateral balanced occlusion, lingualized occlusion, canine guidance, group function, and monoplane occlusion. Bilateral balanced occlusion and canine guidance obtained satisfactory results for both outcomes. Lingualized occlusion showed a trend toward better results than other occlusal schemes for normal and resorbed ridges. Group function presented mainly inconclusive results, and monoplane occlusion did not deliver satisfactory outcomes. CONCLUSIONS: The present overview concluded that occlusal schemes might interfere with the clinical performance of and patient satisfaction with complete dentures. Lingualized, bilateral balanced, and canine guidance are preferred compared with monoplane occlusion, but lingualized occlusion tends to show better results in some reviews. However, the results should be carefully considered because of the low quality of the systematic reviews included.

Influence of different presentations of denture adhesives on masticatory function of complete denture wearers: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Denture adhesives improve the mastication of complete denture wearers. However, the impact of denture adhesives with different presentations on mastication remains unclear. PURPOSE: The purpose of this systematic review was to answer the focused question, "Do different presentations of denture adhesives affect the masticatory function of complete denture wearers?". MATERIAL AND METHODS: This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases and the non-peer-reviewed literature were searched up to July 2021. Only clinical studies (randomized clinical trials and nonrandomized clinical trials) comparing the use of different denture adhesive presentations (cream, powder, or strips) were included, without language or follow-up restrictions. The risk of bias was assessed by using the Cochrane tools (RoB 2.0 and ROBINS-I). Masticatory performance, by using single and multiple sieves, masticatory performance with color-changing chewing gum (mixing ability), swallowing threshold (particle size and number of cycles), jaw kinematics, and occlusal force were considered. Meta-analyses were conducted to evaluate masticatory performance (single sieve) and occlusal force outcomes (α=.05), and the certainty of the evidence was determined with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) evaluations. RESULTS: Nine studies (6 randomized and 3 nonrandomized clinical trials) were included. The risk of bias was considered moderate. Meta-analyses showed no differences between cream and powder denture adhesives for masticatory performance (standard mean difference=0.02; 95% CI=-0.46 to 0.50, P=.93) or between cream and strip denture adhesives for occlusal force (mean difference=14.35; 95% CI=-11.14 to 39.84, P=.27). Similarly, in qualitative analysis, cream and powder denture adhesives' performances were similar regarding masticatory performance with color-changing chewing gum (mixing ability), occlusal force, swallowing threshold (particle size and number of cycles), and jaw kinematics (P>.05). However, for resorbed ridges, cream denture adhesive resulted in a higher masticatory performance than strip (P<.05). When comparing powder to strip denture adhesives, the occlusal force was higher in the powder group (P<.05). The certainty of evidence was very low for all evaluated outcomes. CONCLUSIONS: Different presentations of denture adhesives seem to improve the masticatory function of complete denture wearers in a similar way. However, the qualitative analysis showed that, in patients with a resorbed ridge, a cream denture adhesive may be better than strips to improve mastication, although the certainty of evidence was very low.

Evaluation of tooth eruption rate of incisor teeth in rats with estrogen deficiency.

OBJECTIVES: To assess the influence of estrogen deficiency on tooth eruption rate (TER) and gene expression of estrogen receptor alpha and beta (ERα and ERß) in the odontogenic region of teeth with continuous formation in a rat model. MATERIALS AND METHODS: Ovariectomies (OVX; n = 25) and sham surgeries (SHAM; n = 25) were performed in female Wistar rats when animals were 25 days old. The TER of the lower incisors, both in impeded (hyperfunction condition) and unimpeded (trimmed incisal edge-hypofunction condition) conditions, was evaluated using standardized digital photographs acquired every 48-72 h for 3 weeks (35th-53rd day of life), using a camera coupled to a stereomicroscope. Quantitative real-time PCR was performed to evaluate the relative gene expression of ERα and ERß in the odontogenic region. RESULTS: The OVX group showed a significant reduction in TER when compared to the SHAM group, only in the impeded condition (p = 0.03). There was no statistically significant difference between the groups in ERα gene expression (p = 0.33). ERß showed a significantly higher gene expression in the OVX group (p ≤ 0.05). CONCLUSIONS: Estrogen deficiency decreases TER in teeth under impeded condition. Estrogen deficiency also increases ERß gene expression in the odontogenic region of teeth with continuous formation. CLINICAL RELEVANCE: Hormonal disturbances affecting estrogen levels can cause alterations in dental formation and teeth eruption.

Do patients with molar incisor hypomineralization have more dental anxiety and behavior management problems? A systematic review with meta-analysis

Abstract This systematic review evaluated the available evidence on whether children with molar incisor hypomineralization (MIH) have more dental fear and anxiety (DFA) and dental behavior management problems (DBMPs) than those without MIH (Prospero CDR42020203851). Unrestricted searches were performed in PubMed, Scopus, Web of Science, Lilacs, BBO, Embase, Cochrane Library, APA PsycINFO, Open Grey, and Google Scholar. Observational studies evaluating DFA and/or DBMPs in patients with and without MIH were eligible. Reviews, case reports, interventional studies, and those based on questionnaires to dentists were excluded. The methodological quality assessment was based on the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted to synthesize data on DFA. The certainty of evidence was performed according to GRADE. Seven studies that evaluated a total of 3,805 patients were included. All of them presented methodological issues, mainly in the comparability domain. Most studies observed no significant difference in DFA between children with and without MIH. The meta-analysis did not show a significant effect of MIH on the standardized units for the DFA scores (SMD = 0.03; 95%CI: -0.06-0.12; p = 0.53; I2 = 0%). Synthesis including only the results for severe cases of MIH also did not show a significant effect of the condition on DFA scores (MD = 8.68; 95%CI: -8.64-26.00; p = 0.33; I2 = 93%). Two articles found DBMPs were significantly more frequent in patients with MIH. The overall certainty of evidence was very low for both outcomes assessed. The current evidence suggests no difference in DFA between children with and without MIH; DBMPs are more common in patients with MIH. This information should be viewed with caution because of the very low quality evidence obtained.

Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review.

The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated with teething. A systematic search up to February 2021, without restrictions on language or date of publication, was carried out in MEDLINE/PubMed, SCOPUS, Web of Science, The Cochrane Library, EMBASE, LILACS, BBO, OpenGrey, Google Scholar, Portal de Periódicos da CAPES, clinicaltrials.gov, and the references of the included studies. Clinical studies that evaluated the effect of any intervention to alleviate the signs and symptoms associated with teething in babies and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. The characteristics and results of the individual studies were extracted and synthesized narratively. The GRADE approach was followed to rate the certainty of the evidence. Three randomized and two non-randomized clinical trials were included. The outcomes of these five articles were classified as high or serious risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort, and excess salivation. One study showed a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gingival redness, and poor sleep quality. Another study applied non-pharmacological treatments, which were more effective, especially against excess salivation. Although the present systematic review suggests some therapies could have a favorable effect on signs and symptoms related to teething, definitive conclusions on their efficacy cannot be drawn because of the very low certainty of the evidence. The existing literature on the subject is scarce and heterogeneous and has methodological flaws; therefore, further high-quality investigations are necessary.

Palatal coverage and oral stereognosis: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Complete denture wearers present with less sensory function than dentate individuals because of the loss of periodontal receptors. However, the role of the palatal receptors on such function is still unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the influence of palatal coverage associated with complete dentures or palatal devices on oral stereognosis in edentulous or dentate adults. MATERIAL AND METHODS: Eight major literature databases and the nonpeer-reviewed literature were searched up to December of 2021. Randomized clinical trials and nonrandomized clinical trials comparing oral stereognosis in edentulous or dentate participants using conventional complete dentures or implant-supported prostheses or those using palatal devices were included. Bias was assessed with Cochrane tools (ROBINS-I and RoB 2.0). Meta-analyses were conducted to compare oral stereognosis before and after palatal coverage (α=.05). Certainty of the evidence was verified using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Of 14 included studies, the risk of bias was considered low for 9 studies and moderate for 5 studies. Despite the very low certainty of evidence, meta-analyses showed no differences in oral stereognosis immediately after complete denture insertion (standardized mean difference [SMD]=0.302; 95% confidence interval [CI]: -0.124, 0.728; P=.165; I2=92.4%). Oral stereognosis scores improved after ≥1 month of complete denture use compared with initial evaluations without them. Qualitative analysis indicated that oral stereognosis was not influenced by palatal coverage shortly after complete denture installation and that oral stereognosis scores improved over time after prosthesis use. CONCLUSIONS: Oral stereognosis improved with the use of palate-covering prostheses over time. However, because of the very low certainty of evidence, the statement must be interpreted with caution.

Emoji as promising tools for emotional evaluation in orthodontics.

BACKGROUND: Emoji are pictograms frequently used in social networks capable of expressing emotions. These tools can provide insights into people's behavior that could not be obtained with the use of textual communication. Recently, emoji have been introduced to various research fields as successful alternatives to word-based questionnaires for measure emotional responses. The objective of this study was to preliminarily evaluate the discriminating ability and relationship of these tools with different occlusal conditions/malocclusions. METHODS: Online surveys were applied to adult individuals (n = 201; mean age = 27.4 ± 5.7; 37.3% males, 62.7% females). Subjects issued acceptance scores (10-point scale) and expressed their emotional status using a 30-emoji list in relation to nine occlusal conditions: C1-crowding, C2-anterior open bite, C3-interincisal diastema, C4-increased overjet + deep bite (Class II div. 1), C5-anterior crossbite (Class III), C6-ideal occlusion, C7-unilateral posterior crossbite, C8-anterior open bite plus bilateral posterior crossbite plus crowding, and C9-deep bite (Class II div. 2). Cochran's Q and McNemar tests were used to compare the frequencies of choice of emoji between conditions. Correspondence analyses were applied to assess the association between occlusal conditions and emoji. Kendall's correlation coefficient was calculated to evaluate the relationship between mean acceptance scores and frequency counts of each emoji. RESULTS: The frequency of choice between conditions showed a significant difference for 25 of the 30 emoji (P < 0.05), indicating an adequate discriminating ability of these tools. Emoji were grouped predominantly based on their emotional valence (positive/negative) and arousal/activation (high/low). Positive emoji were associated with the most accepted conditions (i.e., C6, C3), while negative emoji with the most rejected ones (i.e., C8, C1, C2). Although only weak, positive correlations between acceptance and positively valenced emoji, and negative correlations between acceptance and negatively valenced emoji were observed (P < 0.05). CONCLUSIONS: Emoji have an adequate discriminatory ability and would allow determining emotional profiles in the face of different occlusal conditions. Further research is necessary to consolidate the use of these tools in an instrument that allows measuring emotional responses.

Oral manifestations arising from oral piercings: A systematic review and meta-analyses.

OBJECTIVE: The aim of this study was to perform a systematic review of oral manifestations arising from oral piercings. STUDY DESIGN: Literature was searched through January 2022 in PubMed, Scopus, Embase, Web of Science, Cochrane Library and Virtual Health Library, OpenGrey, and Google Scholar to address the question, "Is there an association between oral piercings and oral alterations, complications, or lesions?" Quality was assessed using the Joanna Briggs Institute appraisal tools. Meta-analyses were performed, and certainty of evidence was assessed through Grading of Recommendations Assessment, Development and Evaluation (GRADE). Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Fifty-four studies were included, with 15 achieving good methodological quality. Periodontal and tooth damage were the most reported, followed by soft tissue/mucosal injuries, speech disorders, chewing, soft plaque, and saliva. Pain was the most reported complication, followed by infection, swelling, bleeding, inflammation, allergy, and adornment aspiration. Meta-analyses revealed that 33% of participants with piercings had gingival recession (GR) (event rate [ER] = 0.329). In participants with piercings, ER values for nonspecified dental damage (NSDD), tooth chipping, wear/abrasion, and dental fracture (DF) were 27% (ER = 0.270), 22% (ER = 0.219), 34% (ER = 0.344), and 34% (ER = 0.338), respectively. Certainty of evidence was very low. CONCLUSIONS: Alterations, complications, and lesions were associated with oral piercings and adornments, of which GR, DF, and NSDD were the most prevalent.

Is there a correlation between dental and cervical vertebrae maturation stages in growing subjects? A systematic review with meta-analysis.

OBJECTIVE: To assess the evidence on the relationship between dental and cervical vertebrae maturation. MATERIALS AND METHODS: Searches were performed (up to December 2021) in seven databases, as well as in gray literature. Studies that included growing subjects, which evaluated the correlation between the stages of tooth formation and the maturation of cervical vertebrae, were eligible. The methodological quality of the selected reports was assessed using the JBI checklist for cross-sectional studies. Random-effects meta-analyses were implemented to calculate the pooled correlation coefficients between the maturation stages of cervical vertebrae and each tooth type. The GRADE approach was followed to assess the certainty of evidence. RESULTS: Seventy-seven studies were selected. Most of them had limitations related to sampling and reliability of the methods to evaluate maturation. The syntheses evidenced positive correlations between the maturation of cervical vertebrae and the formation/calcification stages of the following lower teeth: canine (n = 7318; r = 0.692; 95% CI: 0.656-0.724), first premolar (n = 6194; r = 0.689; 95% CI: 0.649-0.725), second premolar (n = 6194; r = 0.695; 95% CI: 0.659-0.729), and second molar (n = 7905; r = 0.698; 95% CI: 0.652-0.739). All estimates were affected by the risk of bias and the presence of unexplained statistical heterogeneity. CONCLUSIONS: The evidence points to an apparent positive correlation between dental and cervical vertebrae maturation. These results need to be carefully evaluated as the body of evidence is of very low quality. CLINICAL RELEVANCE: Dental maturation might be a potential indicator of skeletal craniofacial growth status. A routine dental x-ray could be sufficient, reducing radiation exposure by requesting additional radiographs.

Is there variation in the depth of the curve of Spee in individuals with different dentoskeletal patterns? A systematic review with meta-analysis.

OBJECTIVE: To systematically evaluate all the evidence assessing variations in the depth of the curve of Spee (COS) according to the presence/absence of different dentoskeletal characteristics. SEARCH METHODS AND ELIGIBILITY CRITERIA: The eligibility criteria were outlined following the PECO framework, as follows: studies evaluating individuals with complete permanent dentition including second molars (P), which compared a group with a certain dentoskeletal variation (E) versus another group without the variation (C), regarding the depth of the COS (O). MEDLINE (via PubMed), Scopus, Web of Science, The Cochrane Library, LILACS and BBO (via Virtual Health Library), OpenGrey, and Google Scholar were searched up to September 2021 to identify eligible reports. DATA COLLECTION AND ANALYSIS: Duplicates were removed from all the records retrieved. The selection process and data collection were performed independently by two review members. The risk of bias was also assessed independently and in duplicate, using the guideline described by Fowkes and Fulton. Several meta-analyses (α = 0.05) were conducted to estimate the mean differences (MD) or standardized mean differences (SMD) in the depth of COS between individuals presenting or not certain dentoskeletal characteristics. The certainty of evidence was assessed using the GRADE tool. RESULTS: Thirty-five studies were selected for qualitative synthesis, and 29 of them for quantitative synthesis. All studies had methodological limitations that affected the risk of bias and increased the likelihood that results were due to chance. Syntheses showed that Class II malocclusion (SMD = 0.87; 95% CI: 0.61, 1.13; P < 0.00001; six datasets including 260 subjects analysed), Class II division 1 (SMD = 1.09; 95% CI: 0.62, 1.56; P < 0.00001; 14 datasets including 823 subjects analysed) and Class II division 2 (SMD = 2.65; 95% CI: 1.51, 3.79; P < 0.00001; eight datasets including 476 subjects analysed) had deeper COS than Class I malocclusion. The skeletal Class II also presented higher COS values than skeletal Class I (SMD = 0.57; 95% CI: 0.02, 1.12; P = 0.04; four datasets including 299 subjects analysed). Individuals with Class III malocclusion had flatter COS than the subjects having Class I malocclusion (SMD = -0.57; 95% CI: -1.07, -0.08; P = 0.02; nine datasets including 505 individuals analysed). No difference was shown in the COS depth between skeletal Class III and Class I (P > 0.05). Deep bite individuals had higher COS depth than those with normal overbite (MD = 0.61; 95% CI: 0.41, 0.82; P < 0.00001; two datasets including 250 subjects analysed). In addition, hypodivergent individuals presented deeper COS than normodivergents (SMD = 0.62; 95% CI: 0.37, 0.86; P < 0.00001; six datasets including 305 subjects analysed), and there was no significant difference in the COS depth between hyperdivergent and normodivergent individuals (P = 0.66). The certainty of evidence was rated as very low for all the syntheses. LIMITATIONS: All the quantitative syntheses included results from studies with methodological flaws. Therefore, they are potentially biased. Moreover, the evidence was also mainly affected in terms of the inconsistency of the results and the imprecision of the estimates. CONCLUSIONS: Although an apparent influence of dentoskeletal Class II, Class III malocclusion, deep bite, and the hypodivergent skeletal pattern on the depth of the COS is suggested, it is not possible to make definitive conclusions on the matter due to the very low certainty of the evidence. Further high-quality research is necessary.

Development, validation, and application of a Brazilian sleep myths and truths assessment scale (SLEEP-MTAS).

OBJECTIVE: This study aimed to develop, validate, and apply a scale assessing knowledge of sleep-related myths and truths and associate it with sociodemographic factors. METHODS: A scale with 15 questions was created, containing statements about the characteristics of sleep and related to sleep and dentistry. Each answer ranged from 0 to 4 points, generating a total score from 0 to 60, where higher scores represented greater knowledge. A preliminary study with 200 people assessed its convergent and discriminant construct validity, internal consistency, and temporal stability. The main study included 1965 respondents over 18 years. Additionally, sociodemographic data were collected and a classification of the level of knowledge was performed. Data were analyzed with Student's t-test and one-way ANOVA (p < 0.05). RESULTS: The questionnaire showed convergent (p < 0.001) and discriminant (p = 0.024) construct validity, internal consistency (alpha = 0.7), and temporal stability (ICC = 0.87). In the main study, 90.3% of the participants had moderate and high knowledge, with the score ranging from 24 to 58. Adults over 28 years old (p < 0.001), from the southern region of Brazil (p < 0.001), who lived in capital or metropolitan areas (p < 0.001), with higher education (p < 0.001), without religion (p < 0.001), and involved in dentistry (p < 0.001) had greater knowledge than their peers. CONCLUSIONS: The scale presented good psychometric properties. Most participants had moderate and high knowledge on sleep, with a difference in knowledge related to the age, region and area of residence, education, involvement with dentistry, and religion.

Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: A randomized controlled trial.

INTRODUCTION: This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health-related quality of life (OHRQOL) in children. METHODS: Eighty participants aged 8-10 years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n = 40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T1), at the end of RPE (T2), and 1 month after the appliance removal (T3). Generalized mixed models were used for data analysis (α = 0.05). RESULTS: Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T1 and T2, this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T1 95% confidence interval [CI], 1.08-1.26; T2 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T3 are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T3 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T3 (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T1 and T2. CONCLUSIONS: Correction of the transverse maxillary deficiency by RPE in children aged 8-10 years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement. FUNDING: This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code 001.