Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis.

BACKGROUND: Adolescence is characterized by complex and dynamic changes, often involving experimentation, including the use of psychotropic substances. Although it is well-established that recreational psychotropic drugs are associated with suicide ideation in adults, evidence of this association in adolescents remains limited. OBJECTIVE: To investigate the relationship between suicide ideation and psychotropic recreational drug use among adolescents. DESIGN AND SETTING: Systematic review with meta-analysis developed at Universidade Federal de Uberlândia (UFU) and Universidade Estadual de Campinas (UNICAMP), Brazil. METHODS: A search across eight electronic databases for observational studies, without language or publication year restrictions, was conducted. The Joanna Briggs Institute tool was used to assess the risk of bias. Random-effects meta-analyses and odds ratios were used to measure the effects. RESULTS: The search yielded 19,732 studies, of which 78 were included in the qualitative synthesis and 32 in the meta-analysis. The findings indicated that suicidal ideation was 1.96 times more likely (95% confidence interval, CI = 1.47; 2.61) for adolescents who used some drug recurrently and 3.32 times more likely (95%CI = 1.86; 5.93) among those who abused drugs. Additionally, adolescents who used cannabis were 1.57 times more likely (95%CI = 1.34; 1.84) to experience suicide ideation compared with non-users, while cocaine users had 2.57 times higher odds (95%CI = 1.47; 4.50). CONCLUSIONS: Psychotropic recreational drug use is associated with suicidal ideation among adolescents regardless of current or previous use, abuse, or type of substance used. SYSTEMATIC REVIEW REGISTRATION: Registered in the PROSPERO database under the identification number CRD42021232360. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232360.

Obesity, Insulin Resistance, Caries, and Periodontitis: Syndemic Framework.

(1) Background: To investigate the grouping of obesity and insulin resistance with caries and periodontitis from a syndemic perspective through pathways of socioeconomic inequalities, smoking, alcohol, and high sugar consumption in adolescence. (2) Methods: The population-based RPS Cohort study, São Luís, Brazil, in ages 18-19 years (n = 2515) was used. The outcomes were the grouping of pbesity and Insulin Resistance Phenotype (latent variable formed by Triglycerides/HDL ratio, TyG index, and VLDL) and the Chronic Oral Disease Burden (latent variable comprising caries, bleeding on probing, probing depth ≥ 4 mm, clinical attachment level ≥ 3 mm, and visible plaque index ≥ 15%). Socioeconomic Inequalities influencing the Behavioral Risk Factors (latent variable formed by added sugar, smoking, and alcohol) were analyzed using structural equation modeling. (3) Results: Socioeconomic Inequalities were associated with the Chronic Oral Disease Burden [Standardized Coefficient (SC) = 0.222, p < 0.001]. Behavioral Risk Factors were associated with increased Chronic Oral Disease Burden (SC = 0.103; p = 0.013). Obesity was associated with the Insulin Resistance Phenotype (SC = 0.072; p < 0.001) and the Chronic Oral Disease Burden (SC = 0.066; p = 0.005). The Insulin Resistance Phenotype and the Chronic Oral Disease Burden were associated (SC = 0.053; p = 0.032). (4) Conclusion: The grouping of obesity and early events of diabetes with caries and periodontitis call for a syndemic approach in adolescence.

Causal inference in dentistry: Time to move forward.

Oral conditions represent a critical public health challenge, and together with descriptive and predictive epidemiology, causal inference has a crucial role in developing and testing preventive oral health interventions. By identifying not just correlations but actual causes of disease, causal inference may quantify the average effect of interventions and guide policies. Although authors are not usually explicit about it, most oral health studies are guided by causal questions. However, methodological deficiencies limit their interpretability and the implementation of their findings. This manuscript is a call to action on the use of causal inference in oral research. Its application starts with asking theoretically sound questions and being explicit about causal relationships, defining the estimates to evaluate, and measuring them properly. Beyond promoting causal analytical approaches, we emphasize the need for more causal thinking to promote thoughtful research questions and the use of appropriate methods to answer them. Causal inference relies on the plausibility of assumptions underlying the data analysis and the quality of the data, and we argue that high-quality observational studies can be used to estimate average causal effects. Although individual efforts to embrace causal inference in dentistry are essential, they will not yield substantial results if not led by a systematic and structural change in the field. We urge scientific societies, funding bodies, dental schools, and journals to promote transparency in research, causal thinking, and causal inference projects to move the field toward more meaningful studies. It is also time for researchers to move forward and connect with the community, co-produce investigations and translate their findings, and engage in interventions that impact public health. We conclude by highlighting the importance of triangulating results from different data sources and methods to support causal inference and inform decision-making on interventions to effectively improve population oral health.

Impact of public health and higher education policies on the profile of final-year Brazilian dental students: Challenges and future developments.

INTRODUCTION: Brazil has experienced transformations in higher education and health services, including launching more inclusive public policies focused on these two areas. OBJECTIVE: To evaluate the profile of final-year dental students from a Brazilian public university from 2010 to 2019, accompanied by changes in public health and higher education policies. METHODS: A prospective observacional study was carried out with final-year dental students. A self-applicable semi-structured questionnaire was applied. RESULT: Six-hundred and seventy-seven students participated, of which 71.5% were women, 72.9% aged between 21 and 25 years, 96.2% single, and 96.4% were without children. Over ten years, it was possible to identify trends in the profile explained by implementing public policies toward more inclusive access to Brazilian higher education by socioeconomically disadvantaged individuals. Students who completed the course between 2018 and 2019 did not have the state capital city (the wealthiest area) as their origin city and had lower parental education and income levels than dental students graduating between 2010 and 2011. Moreover, working as a primary care dentist in the Brazilian National Health System was considered a professional possibility by 61.4% of the students, and has gained prominence significantly over time, ranging from 21.1% in 2010 to 72.9% in 2019 (p < .05). CONCLUSION: Over the study period, concomitantly to advances in public health and higher education policies in Brazil, more diverse access to public dental education was observed, allowing students from low socioeconomic positions to take the education. Changes have also impacted the students' perspectives regarding the need for postgraduate training and a career in public health dentistry. However, these trends need to be consolidated, and public policies continued and strengthened.

Physical violence in children and adolescents: a retrospective study of injuries to the head and neck region

Aim: This study aimed to investigate the prevalence of physical violence and head and neck injuries among children and adolescents who suffered physical aggression, firearm aggression, and white gun aggression referred to the Legal Medical Department in a southern city in Brazil. Methods: This study was performed at Legal Medical Department in the city of Pelotas, RS, Brazil, from January 2011 to December of 2015. Data were collected from medical reports of children and adolescents (0-19 years old). Demographic information such as sex, age, and skin color was collected. Data were submitted to Chi-square test and multivariate Poisson regression analysis. Results: In this study, 2,716 physical examination reports were analyzed, with a total of 2,171 exams resulting from violence; lesions that had physical aggression as their etiology (1,951) had a higher prevalence. The analysis of the exams revealed that the majority were adolescents (90,05%), white (84.09%), and female (50.21%). The head and neck regions were affected in most cases of violence (57.90%). In the adjusted model, the occurrence of injuries in the head and neck region was higher in males (PR 1.16, CI 95% 1.08 - 1.25), among adolescents (PR 1.28, CI 95% 1.10 - 1.48) and in victims of physical aggression compared to victims of the firearm (2.81, CI 95% 1.79 - 4.40). Conclusion: The results revealed a high prevalence of head and face injuries in victims of violence and that there was a greater prevalence of physical violence among adolescents compared to children and males

Survival of atraumatic restorative treatment restorations in the elderly patients: a systematic review.

This study aimed to assess the survival of glass ionomer cement (GIC) restorations performed using the atraumatic restorative treatment (ART) in elderly patients. The systematic review protocol was registered in the PROSPERO database. The records were searched until August 2020 in eight electronic bibliographic databases, and included randomized and non-randomized clinical trials and observational studies, with no restrictions on the language or year of publication. Study selection and data extraction were performed independently by two reviewers. Data were extracted, summarized, collected for qualitative analysis, and evaluated for individual risk of bias using the Joanna Briggs Institute's Critical Appraisal Tool. The literature search retrieved 5,186 records; however, only seven studies fulfilled the eligibility criteria and were included. The studies were published between 2002 and 2019. A total of 1,239 restorations were investigated at intervals of 6, 12, 24, and 60 months of follow-up. Some studies had a low risk of bias, while others had moderate and high risk of bias. In general, GIC restorations placed using ART were considered satisfactory. The 6-month, 12-month, and 24-month survival rates ranged from 81.3% to 97.2%, 72.2% to 94%, and 63% to 87%, respectively; additionally, the survival rate for the longest follow-up period (60 months) was 85%. Given the best evidence-based information regarding caries removal, we highlight the need to provide a conservative and effective technique for use in elderly patients. ART is a promising and viable alternative that guarantees the survival of restorations in elderly patients.

Survival of atraumatic restorative treatment restorations in the elderly patients: a systematic review

Abstract: This study aimed to assess the survival of glass ionomer cement (GIC) restorations performed using the atraumatic restorative treatment (ART) in elderly patients. The systematic review protocol was registered in the PROSPERO database. The records were searched until August 2020 in eight electronic bibliographic databases, and included randomized and non-randomized clinical trials and observational studies, with no restrictions on the language or year of publication. Study selection and data extraction were performed independently by two reviewers. Data were extracted, summarized, collected for qualitative analysis, and evaluated for individual risk of bias using the Joanna Briggs Institute's Critical Appraisal Tool. The literature search retrieved 5,186 records; however, only seven studies fulfilled the eligibility criteria and were included. The studies were published between 2002 and 2019. A total of 1,239 restorations were investigated at intervals of 6, 12, 24, and 60 months of follow-up. Some studies had a low risk of bias, while others had moderate and high risk of bias. In general, GIC restorations placed using ART were considered satisfactory. The 6-month, 12-month, and 24-month survival rates ranged from 81.3% to 97.2%, 72.2% to 94%, and 63% to 87%, respectively; additionally, the survival rate for the longest follow-up period (60 months) was 85%. Given the best evidence-based information regarding caries removal, we highlight the need to provide a conservative and effective technique for use in elderly patients. ART is a promising and viable alternative that guarantees the survival of restorations in elderly patients.

Mapping of inflammatory biomarkers in the peri-implant crevicular fluid before and after the occlusal loading of narrow diameter implants.

OBJECTIVE: To monitor the cytokine release patterns in the peri-implant crevicular fluid (PICF) and to investigate which factors affect the success rate of narrow diameter implants (NDI) during the first year. MATERIAL AND METHODS: Mandibular implant overdentures (IOD) retained by 2 NDI were installed in 16 clinically atrophic edentulous patients. The following parameters were monitored during the first year: (i) peri-implant health parameters (plaque index (PI), calculus presence (CP), gingival index (GI), probing depth (PD) and bleeding on probing (BoP); (ii) cytokine concentrations in the PICF (TNF-α, IL-1ß, IL-6, IL-10); (iii) implant stability quotient (ISQ); (iv) marginal bone level (MBL) and bone level change (BLC); (v) implant success. The insertion torque, bone type, mandibular atrophy, time since edentulism, and smoking habits were also recorded. All data were analyzed using multivariable multilevel mixed-effects regression models. RESULTS: The variability in the TNF-α release patterns temporarily reduced at weeks (w) 8-12, while the IL-1ß concentrations remained low until they peaked at w48 [p < 0.05; + 177.55 pg/µl (+ 96.13 - + 258.97)]. Conversely, IL-10 release decreased significantly at w48 [p < 0.05; - 456.24 pg/µl (- 644.41 - - 268.07)]. The PD and ISQ decreased significantly (p < 0.05) over the follow-up period, while the MBL was stable after w48 with a BLC of 0.12 ± 0.71 mm. The overall success rate was 81.3%, and was influenced by TNF-α, IL-1ß, IL-10, PI, GI, PD, smoking, and time since edentulism. CONCLUSION: Pro- and anti-inflammatory cytokine release was balanced during the first 24 weeks. The GI, smoking, and time since edentulism are the most important factors determining the implant success. CLINICAL RELEVANCE: The study contributes to the understanding of the osseointegration process in a clinically atrophic population rehabilitated with IOD, and highlights the importance of monitoring clinical peri-implant health-related parameters, smoking habit, and time since edentulism to predict implant success rates.

Influence of facial patterns on the masticatory function and quality of life of completely edentulous patients during the transition to implant-retained mandibular overdentures.

STATEMENT OF PROBLEM: Although implant-retained mandibular overdentures (IMOs) provide functional benefits, the influence of the vertical facial pattern (FP) and the anteroposterior skeletal discrepancy (ASD) on the masticatory function and patient-centered outcomes during the transition to IMOs is still uncertain. PURPOSE: The purpose of this interventional clinical study was to evaluate the influence of the FP and ASD on the masticatory function, oral health-related quality of life (OHRQoL), and satisfaction of completely edentulous patients before and after transition to IMOs. MATERIAL AND METHODS: Cephalometric analysis was performed on 42 participants before treatment. Ricketts analysis was used to classify the FP, and the maxillomandibular relationship to the base of the skull determined the ASD. Masticatory performance (MP) and swallowing threshold (ST) test results were evaluated by the multiple sieve method by using artificial test food (Optocal cubes) to determine the median particle size (×50), homogenization index (B), and masticatory efficiency based on sieves 5.6 (ME: 5.6) and 2.8 (ME: 2.8). OHRQoL and satisfaction were evaluated by using the Dental Impact on Daily Living questionnaire. The data were analyzed using mixed-effects linear regression models to estimate the effect of time, FP, ASD, age, and sex on MP, ST, and OHRQoL. RESULTS: The MP, ST, OHRQoL, and satisfaction improved significantly after IMO loading, irrespective of FP and ASD. However, MP outcomes were most negatively affected mainly among dolichofacial (B and ME: 2.8), class II, and class III (×50, B, and ME: 2.8) participants. The ST test showed that class II participants still showed inferior ×50 values and performed a lower number of cycles than class I and class III participants. Women presented reduced masticatory function for all MP and ST outcomes and reported lower coefficients for appearance and general performance domains than men. CONCLUSIONS: The MP test detected more subtle improvements than the ST test, especially in class III participants. The class II participants benefited the least from the IMO installation according to the ST test. The IMO treatment improved the OHRQoL and satisfaction of edentulous patients, irrespective of the FP or ASD.

How Common is Dry Mouth? Systematic Review and Meta-Regression Analysis of Prevalence Estimates.

The aim of this paper is to systematically review the literature to estimate the overall prevalence of xerostomia/hyposalivation in epidemiological studies. An electronic search was carried out up to February 2018 with no language restrictions. A total of 5760 titles were screened and just twenty-nine papers were included in review and the meta-analysis after a two independently reviewers applied the selection criteria. Data were extracted from PubMed and Web of Science databases. Eligibility criteria included original investigations from observational population-based studies that reported the prevalence of xerostomia or data that allowed the calculation of prevalence of xerostomia and/or hyposalivation. Studies conducted in samples with specific health conditions, literature reviews, case reports and anthropological studies, as conferences or comments were excluded. Sample size, geographic location of the study, study design, age of the studied population, diagnosis methods, and evaluation criteria used to determine xerostomia e/or hyposalivation were extracted for meta-analysis and meta-regression. Multivariate meta-regression analysis was performed to explore heterogeneity among studies. The overall estimated prevalence of dry mouth was 22.0% (95%CI 17.0-26.0%). Higher prevalence of xerostomia was observed in studies conducted only with elderly people. Despite diverse approaches to the condition's measurement, just over one in four people suffer from xerostomia, with higher rates observed among older people. Moreover, the measurement methods used currently may over- or underestimate xerostomia. These findings highlight the need for further work on existing and new clinical measure and will be useful to determine which one is more reliable in clinical and epidemiological perspectives.

How common is dry mouth? systematic review and meta-regression analysis of prevalence estimates

Abstract The aim of this paper is to systematically review the literature to estimate the overall prevalence of xerostomia/hyposalivation in epidemiological studies. An electronic search was carried out up to February 2018 with no language restrictions. A total of 5760 titles were screened and just twenty-nine papers were included in review and the meta-analysis after a two independently reviewers applied the selection criteria. Data were extracted from PubMed and Web of Science databases. Eligibility criteria included original investigations from observational population-based studies that reported the prevalence of xerostomia or data that allowed the calculation of prevalence of xerostomia and/or hyposalivation. Studies conducted in samples with specific health conditions, literature reviews, case reports and anthropological studies, as conferences or comments were excluded. Sample size, geographic location of the study, study design, age of the studied population, diagnosis methods, and evaluation criteria used to determine xerostomia e/or hyposalivation were extracted for meta-analysis and meta-regression. Multivariate meta-regression analysis was performed to explore heterogeneity among studies. The overall estimated prevalence of dry mouth was 22.0% (95%CI 17.0-26.0%). Higher prevalence of xerostomia was observed in studies conducted only with elderly people. Despite diverse approaches to the condition's measurement, just over one in four people suffer from xerostomia, with higher rates observed among older people. Moreover, the measurement methods used currently may over- or underestimate xerostomia. These findings highlight the need for further work on existing and new clinical measure and will be useful to determine which one is more reliable in clinical and epidemiological perspectives.

Resumo O objetivo do estudo é revisar sistematicamente a literatura afim de estimar a prevalência global de xerostomia/hiposalivação em estudos epidemiológicos. Uma busca eletrônica foi conduzida até Fevereiro de 2018 sem restrições de linguagem. Um total de 5760 títulos foram inicialmente identificados e somente vinte e nove artigos foram incluídos na revisão e meta-análise após dois revisores independentes aplicarem os critérios de seleção. Os artigos foram extraídos das bases de dados PubMed/Medline e Web of Science. Os critérios de elegibilidade incluíram investigações originais de estudos observacionais de base populacional os quais reportaram a prevalência de xerostomia ou dados que permitissem o cálculo da prevalência de xerostomia e/ou hiposalivação. Estudos realizados em populações com condições de saúde específicas, revisões de literatura, relato de casos e estudos antropológicos, assim como, conferências ou comentários foram excluídos. Tamanho amostral, localização geográfica aonde foi realizado o estudo, desenho do estudo, idade da população estudada, métodos de diagnóstico e o critério de avaliação para determiner xerostomia e/ou hiposalivação foram extraídos para a meta-análise e metaregressão. Análise de meta-regressão multípla foi realizada para explorar a heterogeneidade entre os estudos. A prevalência global estimada de boca seca foi de 22.0% (95%IC 17.0-26.0%). Uma maior prevalência de xerostomia foi observada em estudos realizados exclusivamente em populações idosas. Apesar de diferentes abordagens utilizadas para mensurar as condições de interesse, cerca de uma em quatro pessoas é acometida por xerostomia, com taxas mais elevadas sendo observadas na população idosa. Além disso, os métodos de mensuração podem ter super- ou subestimado os valores de xerostomia. Os achados do presente estudo salientam a necessidade de mais estudos acerca das existentes e novas formas de avaliação clínica, os quais serão úteis para determinar qual é a mais confiável para as perspectivas clínicas e epidemiológicas.

Exploratory and confirmatory factorial analysis of the OHIP-Edent instrument.

Several instruments have been used to measure oral health-related quality of life (OHRQoL). The Oral Health Impact Profile (OHIP) questionnaire was based on the concept that sequential events related to oral diseases can cause discomfort, functional limitations and consequently, result in dysfunctions and even disabilities. There are few studies in the literature that structurally analyze the instruments to verify whether they measure the requirements to which they were designed to. The objective of the study was to evaluate the internal structure of the OHIP-Edent questionnaire. The OHIP-Edent was administered to 54 edentulous patients' wearers of conventional complete dentures. For structural analysis, an exploratory factorial analysis (EFA) was carried out. After determining the internal consistency of the model (Cronbach's alpha = 0.88), the fit was checked using the root mean square error approach (value 0.04), the comparative fit index (value 0.982) and the Tucker-Lewis index (value 0.976). After analysis of the 19 questions and the seven domains proposed in the OHIP-Edent questionnaire, the hypothetical factorial model showed three dimensions denominated "Physical Impact", "Psychological Impact" and "Social Impact". In this sample of conventional complete denture wearers, the OHIP-Edent seems adequate to measure the "Physical Impact", "Psychological Impact", and "Social Impact" of the OHRQoL. The confirmatory factorial analysis confirmed the model and, through adjustment indexes, it was verified that the three dimensions have convergence and consistence adequate in order to characterize the OHRQoL construct with validity.

Epidemiology and Risk Factors of Maxillofacial Injuries in Brazil, a 5-year Retrospective Study.

AIM: The etiology and epidemiology of maxillofacial injuries varies widely in different regions of the world due to socioeconomic status, cultural aspects in addition to road traffic and drug consumption. The aim of this study is to determine major causes and epidemiological characteristics of maxillofacial trauma in a 5-year period. MATERIALS AND METHODS: Reports of corporal trauma (n = 25,632) from 2007 to 2011 in the Department of Forensic Medicine were analyzed as to the presence of maxillofacial injuries. Data were submitted to Chi square test and to multivariate Poisson regression. RESULTS: 3262 reports referred maxillofacial trauma. The majority were men (55.8%), single (68.9%), most of them white (75.7%). The average age was 28.9 years (SD = 8.42), and victims with age between 16 and 30 years old were the most affected (48.0%). Women comprised 44% of total sample, 67.8% (971) were single, 76% (1.076) white and 46% (691) aged between 16 and 30 years old. Middle third injuries were associated after adjustment with females (PR 1.05; 95% CI 1.01-1.11), non-white subjects (PR 1.06; 95% CI 1.01-1.12) and physical aggression (PR 1.07; 95% CI 1.02-1.13). Injuries in the oral region was more prevalent in men (PR 1.24; 95% CI 1.09-1.41), in those aged between 16 and 30 (PR 1.97; 95% CI 1.48-2.61) and in subjects with injuries caused by traffic accident (PR 1.21; 95% CI 1.02-1.44). The presence of injuries in the lower third of face remained associated in the final model only with traffic accident (PR 1.75; 95% CI 1.43-2.15). CONCLUSION: Health care practitioners must recognize vulnerable population and most prevalent sites of lesion to identify cases of violence.

Tooth Erosion Association with Obesity: Findings from a Brazilian Survey in Schoolchildren

Objective: To evaluate a possible association between tooth erosion and weight status in Brazilian schoolchildren. Material and Methods: 1211 children aged 8-12-year-old from public and private schools in Southern Brazil were selected by a two-stage cluster method. Oral conditions were assessed by six trained and calibrated examiners. Tooth erosion assessment was determined by using the O´Sullivan index. Anthropometric measures were taken in order to obtain the body mass index. Socio-demographic and behavioral data were collected using questionnaires in children and parents. Multivariate Poisson regression model considering the cluster sample was used for data analysis (Prevalence ratio - PR; 95% Confidence Interval - CI). Results: Tooth erosion was observed in 25.1% of the children. Obesity and overweight prevalence was 34.6%. In the multivariate adjusted model, tooth erosion was associated with children from private schools (PR 1.68; 95%CI 1.05-2.68) and higher frequency of physical activity weekly (PR 1.48; 95%CI 1.04-2.09), whereas dental crowding in both arches was considered a protective effect (PR 0.55; 95%CI 0.34-0.89). In the stratified analysis regarding the type of school, children from private schools presented a positive association between tooth erosion and obesity (PR 3.26; 95%CI 1.38-7.69). Conclusion: Tooth erosion was not associated with obesity in the total sample. Socioeconomic differences seem to influence the relationship tooth erosion and obesity.

How fast can treatment with overdentures improve the masticatory function and OHRQoL of atrophic edentulous patients? A 1-year longitudinal clinical study.

OBJECTIVES: The aim of this prospective clinical study was to evaluate the masticatory function (MF) and subjective perception of patients with poor denture-bearing tissue in relation to change and the time required to identify an improvement in these parameters after rehabilitation with mandibular overdentures (MO) by two narrow-diameter two-piece implants. MATERIAL AND METHODS: Twenty-three edentulous patients were selected for MO installation. The masticatory function (MF) was evaluated with the masticatory performance (MP) and swallowing threshold (ST) tests. In the MP test, each volunteer was instructed to masticate a portion of Optocal (standardized artificial test food) for 40 masticatory cycles. During the swallowing threshold test, the patients were instructed to chew a new portion of Optocal cubes until they felt the desire to swallow. The MF tests were performed while complete denture (CD) wearers (baseline) and 1, 3, 6, and 12 months after MO loading. In addition, the subjective perception was assessed through the questionnaires Dental Impact on Daily Living (DIDL), Geriatric Oral Health Assessment Index (GOHAI), and Oral Health Impact Profile in Edentulous (OHIP- EDENT) at the baseline and 3, 6, and 12 months after MO loading. RESULTS: A significant improvement in masticatory function (p < .05) was observed already in the first month of loading. Three months after MO loading, a significant improvement (p < .05) was found in the subjective perception of patients. The effect size indicates that the MO had the greatest impact on the domains related to function and comfort of all questionnaires and in relation to psychosocial domain of the GOHAI. The level of patient satisfaction increased significantly after the MO loading and reached >90% satisfied patients at 12 months. CONCLUSION: The MO improved both the MF of the patient and their oral health-related quality of life and satisfaction regarding the prosthesis in a short time period.

Colonization of oropharynx and lower respiratory tract in critical patients: Risk of ventilator-associated pneumonia.

OBJECTIVE: To investigate the microbial diversity existing in oral cavity and respiratory tract samples (from mini-bronchoalveolar lavage (BAL), endotracheal aspirate, and orotracheal tube) of patients on mechanical ventilation by using the checkerboard DNA-DNA hybridisation. Also, the study aimed to evaluate whether the microbial profile in the oral cavity is found in respiratory tract samples, at different periods of mechanical ventilation time (12h, 48h, 96h) in attempt to identification of relationship between VAP (ventilator-associated pneumonia) and bacterial species studied. The last objective was to analyses correlation between blood cultures and VAP. DESIGN: The samples were collected from ten patients in intensive care unit with medical prescription of orotracheal intubation and mechanical ventilation. Clinical data were tabulated and blood cultures were performed according medical indication. For checkerboard samples collection, chosen sites were the dorsal side of the tongue and gingival sulcus at 12h, 48h, 96h, BAL, at 12h, endotracheal aspirate at 48 and 96h, and orotracheal tube at extubation time, when feasible. RESULTS: It was possible to identify the presence of bacterial species in mouth and in the BAL/endotracheal aspirate. The data demonstrated an increase in the quantity of bacterial associated with prolonged use of mechanical ventilation (48 and 96h). CONCLUSIONS: Bacterial species may migrate rapidly from mouth and upper airways during orotracheal intubation which contributes to the pathogenesis of VAP. There were associations between VAP and Enterococcus faecalis, Fusobacterium periodonticum, Gemella morbillorum, Neisseria mucosa, Propionibacterium acnes, Prevotella melaninogenica, Streptococcus oralis, Streptococcus sanguinis, Treponema denticola, Treponema socransckii, and Veillonella parvula.

Exploratory and confirmatory factorial analysis of the OHIP-Edent instrument

Abstract Several instruments have been used to measure oral health-related quality of life (OHRQoL). The Oral Health Impact Profile (OHIP) questionnaire was based on the concept that sequential events related to oral diseases can cause discomfort, functional limitations and consequently, result in dysfunctions and even disabilities. There are few studies in the literature that structurally analyze the instruments to verify whether they measure the requirements to which they were designed to. The objective of the study was to evaluate the internal structure of the OHIP-Edent questionnaire. The OHIP-Edent was administered to 54 edentulous patients' wearers of conventional complete dentures. For structural analysis, an exploratory factorial analysis (EFA) was carried out. After determining the internal consistency of the model (Cronbach's alpha = 0.88), the fit was checked using the root mean square error approach (value 0.04), the comparative fit index (value 0.982) and the Tucker-Lewis index (value 0.976). After analysis of the 19 questions and the seven domains proposed in the OHIP-Edent questionnaire, the hypothetical factorial model showed three dimensions denominated "Physical Impact", "Psychological Impact" and "Social Impact". In this sample of conventional complete denture wearers, the OHIP-Edent seems adequate to measure the "Physical Impact", "Psychological Impact", and "Social Impact" of the OHRQoL. The confirmatory factorial analysis confirmed the model and, through adjustment indexes, it was verified that the three dimensions have convergence and consistence adequate in order to characterize the OHRQoL construct with validity.

How has dental pulp stem cells isolation been conducted? A scoping review.

The objective of this study was to realize a scoping review the literature in order to identify the profile of DPSCs isolation and analyze the possible risk factors that could change the native behavior of these cells. An initial search was conducted using the following MeSH terms: "(dental pulp stem cell [MeSH])"; "(dental pulp [MeSH])" AND "(stem cell [MeSH])"; "("dental pulp stem cell" [MeSH]")". The electronic search was done without date restriction up to and including April 2014, in PubMed, Scopus, Scielo and ISI Web of Knowledge databases. Studies were submitted to inclusion and exclusion criteria and 222 articles were included. Data showed that over the past 15 years many studies have been conducted using DPSCs. However this is the first systematic review regarding the isolation of stem cell, and more specifically of dental pulp stem cells. The isolation of dental pulp stem cells showed great variability, hampering the development of standard protocols to achieve in vitro dental pulp stem cells with similar characteristics. This scoping review combined, for the first time, the methodologies used for dental pulp stem isolation, highlighting the most frequently used.

Participation of endotoxin in root canal infections: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the relationship between endotoxin levels and presence of clinical signs/symptoms and radiographic features in patients with endodontic infection. Electronic searches were performed on Medline/PubMed, Embase, Cochrane Library, Scielo, Science Direct, Web of Knowledge and Scopus databases for identification of relevant studies published up to December 2016. Grey literature was searched in Google Scholar. The selected literature was reviewed independently by two authors. Clinical studies evaluating the levels of endotoxin and the presence of clinical and radiographic features were included in this review. In order to determine the relationship between endotoxin levels and presence of clinical signs/symptoms and radiographic features meta-analyses were performed. Among the 385 articles identified in the initial search, 30 were included for full-text appraisal and only eight studies met the inclusion criteria for this systematic review. Meta-analysis revealed that individuals having teeth with tenderness to percussion (TTP) (P = 0.04; I2 57%) and previous episode of pain (PEP) (P = 0.001; I2 81%) had higher levels of endotoxin than their counterparts. Size of radiographic lesion >2 mm (P = 0.02; I2 68%) and presence of root canal exudation (EX) (P = 0.0007; I2 0%) were associated with higher levels of endotoxin. This systematic review and meta-analyses provided a strong evidence that endotoxin are related with the presence of clinical signs/symptoms and radiographic features in patients with endodontic infection.