Efficacy of oral and topical antioxidants in the prevention and management of oral mucositis in head and neck cancer patients: a systematic review and meta-analyses.

PURPOSE: To evaluate the effectiveness of antioxidants in the prevention and management of oral mucositis in adults undergoing radiotherapy and/or chemotherapy with diagnosed head and neck cancer (HNC) compared to placebo intervention. METHODS: Cochrane, EMBASE, PubMed, and Web of Science databases were used to search for randomized controlled trials (RCTs) comparing oral or topical antioxidants with placebo in clinically diagnosed HNC adult patients receiving radiotherapy with/without chemotherapy. The primary outcome was to assess the efficacy of the antioxidant to prevent and decrease the incidence/prevalence and severity of oral/oropharyngeal mucositis. The risk of bias was assessed following Cochrane's guidelines. RESULTS: The database search resulted in 203 records up to February 19, 2021. Thirteen RCTs were included with 650 HNC-diagnosed patients. Included studies showed a statistically significant improvement in mucositis severity score for all antioxidants except melatonin. However, further studies are needed as only one study reported outcomes for zinc, propolis, curcumin, and silymarin. Patients receiving vitamin E were 60% less likely to develop severe mucositis grade 2 or higher than those receiving placebo in one study (P = 0.040). Patients receiving zinc were 95% less likely to develop severe mucositis (grades 3-4) in one study compared to placebo (P = 0.031). One meta-analysis showed no statistical difference in the risk of having severe mucositis (grades 3-4) with 199 patients compared to placebo for honey (n = 2 studies, P = 0.403). Meta-analyses could not be conducted for zinc, propolis, curcumin, melatonin, silymarin, and selenium due to the lack of studies reporting similar outcomes for the same intervention. CONCLUSION: Though oral and topical antioxidants significantly improved mucositis severity scores in HNC patients receiving radiotherapy with/without chemotherapy in individual studies, the quality of the evidence was low due to the small number of studies and unclear/high-risk bias. Additionally, large RCTs are needed to confirm these results.

Efficacy of Antidepressants in the Treatment of Obstructive Sleep Apnea Compared to Placebo. A Systematic Review with Meta-Analyses.

PURPOSE: To establish the efficacy of oral antidepressants compared to placebo in improving obstructive sleep apnea (OSA) as measured on a polysomnography study. Secondary outcomes included self-reported sleepiness. METHODS: Authors identified prospective randomized placebo-controlled studies from MEDLINE through PubMed, Web of Science, the Cochrane Library and EMBASE up to February 2019 in English language. Antidepressants included tricyclic antidepressants (TCA), tetracyclic antidepressants (TeCA), selective serotonin reuptake inhibitors (SSRI), and serotonin receptor modulators (SRM). Studies were assessed for inclusion and exclusion criteria, as well as risk of bias based on the Cochrane handbook. RESULTS: The initial search yielded 254 unduplicated references ultimately reduced to 8 relevant studies, in which 198 OSA participants were included. Patients with an average baseline AHI of 26.7 events/hour taking 15-45mg mirtazapine had a statistically significant reduction in apnea-hypopnea index compared to placebo by -10.5 events/hour (p<0.001), apnea index by -3.6 events/hour (p=0.001) and hypopnea index by -5.9 events/hour (p=0.037). In one study, patients taking 100mg trazodone 1 night improved significantly in AHI compared to placebo group (p<0.001). Arousal index, sleepiness, and sleep efficiency were not statistically significantly reduced with any antidepressant medication compared to placebo (p>0.05). CONCLUSIONS: Of the five antidepressant medications studied, only mirtazapine and trazadone showed a statistically significant reduction in AHI in the treated groups but not in sleepiness scale nor an increase in sleep efficiency. In this review, the total sample sizes were small, adverse side effects of some of the antidepressant medications were clinically significant, overall risk of bias of the studies was high or unclear, and overall quality of the evidence was low. Based on the evidence available at this time, we cannot recommend the antidepressants studied in the treatment of OSA.

Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis.

The purpose of this review is to conduct a systematic review and meta-analysis comparing the effects of continuous positive airway pressure (CPAP) with a mandibular advancement device (MAD) in improving the quality of life (sleepiness, cognitive, and functional outcomes) in patients diagnosed with obstructive sleep apnea (OSA). Authors identified randomized, placebo-controlled studies from MEDLINE through PubMed, Web of Science, and the Cochrane Library. Studies were assessed for inclusion and exclusion criteria, as well as risk of bias. Initial search yielded 240 unduplicated references, which the authors reduced to 12 relevant studies. Patients with CPAP therapy showed no statistically significant difference in the post-treatment quality of life measured with the SF-36 mental health component (p = .994), or the SF-36 physical functioning component (p = .827). There was no significant improvement in neither Functional Outcomes of Sleep Questionnaire (p = .788) nor cognitive performance (p = .395) compared to patients treated with oral appliances. However, the meta-analyses' overall results showed a significant improvement in the post-treatment apnea-hypopnea index (AHI) in favor of CPAP therapy as compared with the oral appliance group (p < .001). Meta-analyses showed unclear results for sleepiness with no significant differences in average post-treatment Epworth Sleepiness Scale [ESS] (p = .203), but significant differences in change in ESS from baseline favorable to CPAP treatment (p = .047). Further studies are needed. Compliance with treatment was 1.1 h per night significantly lower with CPAP than MAD (p = .004), which could explain why though efficacy (AHI) is better with CPAP, no significant results are shown for quality of life, cognitive, and functional outcomes. Though CPAP is significantly more efficient in reducing AHI (moderate quality of evidence), it has a significantly lower compliance resulting in no differences with MAD in quality of life, cognitive, or functional outcomes. Sleep medicine professionals should monitor treatment compliance and offer patients non-compliant with CPAP an oral appliance for treatment of OSA.

Oral Health-Related Outcomes in Edentulous Patients Treated With Mandibular Implant-Retained Dentures Versus Complete Dentures: Systematic Review With Meta-Analyses.

The objective of this systematic review was to determine the effect on oral health-related outcomes from mandibular implant-retained dentures opposing maxillary complete dentures in edentulous middle-age and older adults, compared with complete removable dentures in both arches. Randomized controlled trials included participants with an average age of 65 years or older. The Cochrane Library, MEDLINE, and Web of Science were searched. A total of 228 abstracts were reviewed for inclusion criteria, with 14 trials included and analyzed for risk of bias. Eleven of these studies were assessed as being at an unclear risk of bias, and 3 were at high risk. Mandibular implant-retained overdenture therapy showed statistically significant improvements in the patients' general satisfaction ( P = .003), oral health-related quality of life ( P < .001), and chewing ability ( P < .001), over the patients with complete dentures. There were no significant differences in the percentage of patients who were satisfied with their overdentures vs complete dentures for comfort, retention, esthetics, or chewing ability; however, only 2 studies reported these outcomes. In terms of nutritional status 1 year after treatment, vitamin B12 blood levels increased significantly in the implant-retained group ( P = .003), but not the other nutritional values. Implant-retained mandibular overdentures are an option for middle-aged and elderly edentulous patients as they significantly improve some of the outcomes; however, the quality of the evidence was moderate/low, due to the small number of studies included and the risk of bias. Future research should include objective outcomes such as masticatory performance, chewing efficacy, and muscular coordination.

Efficacy of chlorhexidine for the prevention and treatment of oral mucositis in cancer patients: a systematic review with meta-analyses.

BACKGROUND: Oral mucositis occurs in patients undergoing chemoradiation for cancer treatment. It is believed that colonization of ulcerated mucosa by bacteria, fungi, and virus results in secondary infections. The effect of chlorhexidine on the incidence and severity of oral mucositis in patients with cancer was evaluated in this review. METHODS: Studies were limited to randomized placebo-controlled trials. Three databases were searched: MEDLINE (via PubMed), Web of Science, and the Cochrane Library up to May 25, 2016. RESULTS: Ninety-eight abstracts were evaluated by three independent reviewers. Twelve studies met the criteria for inclusion. Four of these studies were assessed at unclear risk of bias and eight of them at high risk. Of the 12 studies, nine were included in two meta-analyses. Pooled results showed that chlorhexidine did not significantly reduce incidence of mucositis compared to placebo (P = 0.129), nor chlorhexidine did significantly reduce the severity of mucositis (P = 0.127), although subgroup analysis in the chemotherapy group showed a trend toward significance (P = 0.054). Side effects reported in the included studies were teeth staining and altered taste perception. CONCLUSIONS: This systematic review found that chlorhexidine is not significantly effective in reducing the severity of mucositis (moderate quality of evidence) nor in preventing the incidence of mucositis (low quality of evidence). However, more studies are needed in patients receiving chemotherapy only, as a positive trend toward significance was found (P = 0.054).

Heat Treatment Influences Monomer Conversion and Bond Strength of Indirect Composite Resin Restorations.

PURPOSE: To assess the resin microtensile bond strength (MTBS) and the degree of conversion (DC) of indirect composite resin restorations polymerized with light and heat. MATERIALS AND METHODS: Two direct (Filtek Z100 and Premise) and one indirect (Premise Indirect) composite resins were polymerized with a combination of light and heat (138°C for 20 min). For MTBS, 42 cylinders were fabricated (n = 7). After the surface treatment, cylinders were bonded to each other using adhesive resin (Optibond FL). Specimens were stored in water for 24 h. Another 15 cylinders (n = 5) were fabricated for determining degree of conversion using Fourier Transform Infrared Spectrometry immediately and at 24 h. The MTBS and the DC was submitted to two-way ANOVA. The interaction with existing data was explored with univariate ANOVA and two-way ANOVA. Tukey's HSD post-hoc test was used to detect pairwise differences (α = 0.05). RESULTS: The MTBS to light and heat polymerized Z100 was 75.7 MPa, significantly higher than that to Premise (58.6 MPa) and Premise Indirect (63.9 MPa). The immediate DC for Z100, Premise, and Premise Indirect were 51.0%, 68.7%, and 61.8%, respectively. The DC at 24 h ranged from 53.4% (Z100) to 72.8% (Premise Indirect) and significantly increased for Premise Indirect only. Comparison with previously published data revealed that the heat treatment increased both MTBS and DC of Premise and Premise Indirect. CONCLUSION: Z100 showed better bond strength but lower DC. Heat treatment and a 24-h delay before delivery can benefit DC of Premise Indirect. The increase in DC of Premise and Premise Indirect did not affect their bond strength.

Effect of gypsum separating media on the appearance of stone cast surfaces.

STATEMENT OF PROBLEM: Several well-known parameters influence the appearance of the denture base surface, including proper isolation of the dental stone. There is lack of data describing the influence of this parameter on the appearance of the denture base surface. PURPOSE: The purpose of this study was to evaluate the effectiveness of 2 dental stone separating media on the surface of the denture base. MATERIAL AND METHODS: A conventional flasking technique for fabricating a denture base was used. Twenty casts were poured with Type III yellow dental stone to produce 20 identical denture bases. Each cast was sectioned into halves. One half of the cast was treated with Al-Cote (control group) and the other half with Iso-K separating material. Once the denture base was finished, a single examiner, blinded to the experiment, visually compared the 2 surfaces of each cast (right and left part of the cast) under natural light to determine which surface was glossier. The McNemar test (.05 significance level) was used to compare the discordant pairs (20 discordant pairs). RESULTS: Two pairs (10%) were glossier than the Iso-K treatment, and 18 pairs (90%) within the Iso-K treatment were glossier than the treatment with Al-Cote. A statistically significant difference was found between the 2 treatments (P<.001). The odds ratio was 9.00, with a 95% confidence interval of 2.155 to 79.981. CONCLUSIONS: When used according to the manufacturer's instructions, denture surfaces treated with Iso-K appeared glossier than when treated with Al-Cote separating material.

Damping behavior of implant-supported restorations.

OBJECTIVES: The aim of the present study was to assess the shock absorbing capacity of implant-supported restorations (CAD/CAM composite resin or zirconia abutment with composite resin or porcelain crown/onlay) and a simulated natural tooth complex using the Periometer(®) . MATERIAL AND METHODS: One hundred and twenty Morse taper implants (Titamax CM 11 mm) were mounted on bone-simulating acrylic resin base and restored with CAD/CAM zirconia (60) and metal composite resin Paradigm MZ100 (60) abutments. Using CEREC3, standardized onlays (60) and crowns (60) were designed and milled in ceramic (Paradigm C) or composite resin (Paradigm MZ100) to simulate a maxillary premolar. All restorations were luted with a preheated light curing composite resin (Filtek Z100). Fifteen extracted human upper premolars were mounted with a simulated PDL and used as control group. The Periometer(®) , a new handheld percussion probe that measures the energy loss coefficient (LC) for both natural teeth and implant-supported structures, was positioned perpendicularly to the buccal surface of each restoration. Three measurements of the LC were collected for each specimen. The effect of each variable (abutment material, restoration material, and restoration design) on the LC was explored using multiple regression analysis. RESULTS: Differences in LC between the abutment material (zirconia/Paradigm MZ100), the restoration material (Paradigm C/Paradigm MZ100) and the restoration design (onlay/crown) were recorded. The average LC of zirconia and metal composite resin abutments ranged from 0.040 to 0.053 and 0.059 to 0.068, respectively. Zirconia abutments restored with composite resin restorations (LC 0.051-0.053) had the closest LC value when compared with teeth with simulated PDL (0.049). CONCLUSION: Composite resin onlays/crowns bonded to zirconia implant abutments presented similar dynamic response to load (damping behavior) when compared to teeth with a simulated PDL.

Computed gray levels in multislice and cone-beam computed tomography.

INTRODUCTION: Gray level is the range of shades of gray in the pixels, representing the x-ray attenuation coefficient that allows for tissue density assessments in computed tomography (CT). An in-vitro study was performed to investigate the relationship between computed gray levels in 3 cone-beam CT (CBCT) scanners and 1 multislice spiral CT device using 5 software programs. METHODS: Six materials (air, water, wax, acrylic, plaster, and gutta-percha) were scanned with the CBCT and CT scanners, and the computed gray levels for each material at predetermined points were measured with OsiriX Medical Imaging software (Geneva, Switzerland), OnDemand3D (CyberMed International, Seoul, Korea), E-Film (Merge Healthcare, Milwaukee, Wis), Dolphin Imaging (Dolphin Imaging & Management Solutions, Chatsworth, Calif), and InVivo Dental Software (Anatomage, San Jose, Calif). The repeatability of these measurements was calculated with intraclass correlation coefficients, and the gray levels were averaged to represent each material. Repeated analysis of variance tests were used to assess the differences in gray levels among scanners and materials. RESULTS: There were no differences in mean gray levels with the different software programs. There were significant differences in gray levels between scanners for each material evaluated (P <0.001). CONCLUSIONS: The software programs were reliable and had no influence on the CT and CBCT gray level measurements. However, the gray levels might have discrepancies when different CT and CBCT scanners are used. Therefore, caution is essential when interpreting or evaluating CBCT images because of the significant differences in gray levels between different CBCT scanners, and between CBCT and CT values.

Soft palate length and upper airway relationship in OSA and non-OSA subjects.

BACKGROUND: The narrowest area of the airway between the posterior nasal opening and the epiglottis is usually located in the retro palatal area. Many consider this the most likely site of airway obstruction during an obstructive sleep apnea (OSA) event. The aim of this study was to investigate the differences in soft palate and airway length between OSA and non-OSA patients. METHODS: In this study, we analyzed the ratio of the soft palate and the upper airway length in 45 consecutive patients. Twenty-five had an Apnea-Hypoapnea Index of more than 5 events per hour and were classified in the OSA group (male, 19; female, 6). These patients were compared with 20 normal controls (male, 12; female, 8). Controls who complained of snoring did have sleep studies (n = 5). The other fifteen controls were clinically asymptomatic and did not have sleep studies. Medical computed tomography scans were taken to determine the length of the upper airway and the soft palate length measured in the midsagittal image. RESULTS: Soft palate length was significantly larger in OSA patients compared to controls (p = 0.009), and in men compared to women (p = 0.002). However, there were no differences in airway length. The soft palate length, as a percent of oropharyngeal airway length, was significantly larger in OSA patients compared to controls (p = < 0.0001) and in men compared to women (p = 0.02). Soft palate length increases significantly with age by 0.3 mm per year in males (after adjustment for body mass index (BMI) and OSA). Soft palate length as a percent of airway length is larger in OSA patients and increases significantly with BMI in males only after adjusting for age. CONCLUSION: In this study, OSA patients had a longer soft palate in proportion to their oropharyngeal airway compared to controls as well as men compared to women. This proportion could be used for identifying patients at risk for OSA in combination with age.

Oral health for baby boomers: Past, present, and future.

AIMS: This paper reviews the oral health services which were available for early (1945-1955) and late (1956-1964) baby boomers, as well as predicts their future oral healthcare needs. METHODS AND RESULTS: The knowledge, beliefs, and attitudes of the parents of the baby boomers toward dental hygiene and oral healthcare, are reviewed. The introduction of dental health screenings occurred from 1910 to early 1970s, the creation of the first dental hygiene school and the introduction of water fluoridation influenced oral healthcare. Technology introduced in the dental offices in the 1960s included the high-speed handpiece, followed by intraoral suction in 1979. Baby boomers are keeping their teeth at higher rates than preceding generations due to improved prevention and advances in the treatment of periodontal disease, and overall lower rates of smoking in older adults, when compared to younger adults. However, access to dental care remains an issue for many. Advances in prevention and treatment of periodontal disease, early detection of root caries, new restorative techniques, and improved technologies to replace teeth are also discussed. CONCLUSIONS: Early detection of periodontal disease, oral, and oropharyngeal cancer, risk factors for tooth loss and untreated caries are needed to improve the oral health for baby boomers. Access to oral healthcare is still an issue due to socio-economic disparities in America.

Imaging software accuracy for 3-dimensional analysis of the upper airway.

INTRODUCTION: The aim of this study was to compare the precision and accuracy of 6 imaging software programs for measuring upper airway volumes in cone-beam computed tomography data. METHODS: The sample consisted of 33 growing patients and an oropharynx acrylic phantom, scanned with an i-CAT scanner (Imaging Sciences International, Hatfield, Pa). The known oropharynx acrylic phantom volume was used as the gold standard. Semi-automatic segmentations with interactive and fixed threshold protocols of the patients' oropharynx and oropharynx acrylic phantom were performed by using Mimics (Materialise, Leuven, Belgium), ITK-Snap (www.itksnap.org), OsiriX (Pixmeo, Geneva, Switzerland), Dolphin3D (Dolphin Imaging & Management Solutions, Chatsworth, Calif), InVivo Dental (Anatomage, San Jose, Calif), and Ondemand3D (CyberMed, Seoul, Korea) software programs. The intraclass correlation coefficient was used for the reliability tests. A repeated measurements analysis of variance (ANOVA) test and post-hoc tests (Bonferroni) were used to compare the software programs. RESULTS: The reliability was high for all programs. With the interactive threshold protocol, the oropharynx acrylic phantom segmentations with Mimics, Dolphin3D, OsiriX, and ITK-Snap showed less than 2% errors in volumes compared with the gold standard. Ondemand3D and InVivo Dental had more than 5% errors compared with the gold standard. With the fixed threshold protocol, the volume errors were similar (-11.1% to -11.7%) among the programs. In the oropharynx segmentation with the interactive protocol, ITK-Snap, Mimics, OsiriX, and Dolphin3D were statistically significantly different (P <0.05) from InVivo Dental. No statistical difference (P >0.05) was found between InVivo Dental and OnDemand3D. CONCLUSIONS: All 6 imaging software programs were reliable but had errors in the volume segmentations of the oropharynx. Mimics, Dolphin3D, ITK-Snap, and OsiriX were similar and more accurate than InVivo Dental and Ondemand3D for upper airway assessment.

A new method to measure mesiodistal angulation and faciolingual inclination of each whole tooth with volumetric cone-beam computed tomography images.

INTRODUCTION: The purpose of this study was to develop a methodology to measure the mesiodistal angulation and the faciolingual inclination of each whole tooth (including the root) by using 3-dimensional volumetric images generated from cone-beam computed tomography scans. METHODS: A plastic typodont with 28 teeth in ideal occlusion was fixed in position in a dry human skull. Stainless steel balls were fixed to the occlusal centers of the crowns and to the apices or bifurcation or trifurcation centers of the roots. Cone-beam computed tomography images were taken and rendered in Dolphin 3D (Dolphin, Chatsworth, Calif). The University of Southern California root vector analysis program was developed and customized to digitize the crown and root centers that define the long axis of each whole tooth. Special algorithms were used to automatically calculate the mesiodistal angulation and the faciolingual inclination of each whole tooth. Angulation measurements repeated 5 times by using this new method were compared with the true values from the coordinate measuring machine measurements. Next, the root points of 8 selected typodont teeth were modified to generate known angulation and inclination values, and 5-time repeated measurements of these teeth were compared with the known values. RESULTS: Intraclass correlation coefficients for the repeated mesiodistal angulation and faciolingual inclination measurements were close to 1. Comparisons between our 5-time repeated angulation measurements and the coordinate measuring machine's true angulation values showed 5 teeth with statistically significant differences. However, only the maxillary right lateral incisor showed a mean difference that might exceed 2.5° for clinical significance. Comparisons between the 5-repeated measurements of 8 teeth with known mesiodistal angulation and faciolingual inclination values showed no statistically significant differences between the measured and the known values, and no measurement had a 95% confidence interval beyond 1°. CONCLUSIONS: We have developed the novel University of Southern California root vector analysis program to accurately measure each whole tooth mesiodistal angulation and faciolingual inclination, in a clinically significant level, directly from the cone-beam computed tomography volumetric images.

Mesiodistal angulation and faciolingual inclination of each whole tooth in 3-dimensional space in patients with near-normal occlusion.

INTRODUCTION: An important objective of orthodontic treatment is to obtain the correct mesiodistal angulation and faciolingual inclination for all teeth. Current techniques are based on crown angulation and inclination standards, and not enough attention has been given to the roots. In this study, we report the mesiodistal angulation and faciolingual inclination of each whole tooth including the root in patients with near-normal occlusion. METHODS: We screened 1840 patients who had cone-beam computed tomography scans taken before treatment to obtain a sample of 76 patients with near-normal occlusion. Using our custom University of Sourthern California root vector analysis software program, we digitized the crown and root centers to determine the "true" long axis of each tooth from where the mesiodistal angulation and the faciolingual inclination were measured. RESULTS: The means and standard deviations for the mesiodistal angulation and the faciolingual inclination of each whole tooth were calculated. The maxillary angulations of the teeth started from approximately 6° for the central incisors, slightly increased for the lateral incisors, and peaked at 11° for the canines; then it gradually decreased to just above 0° for the first molars and eventually reached -6° for the second molars. The mandibular angulations started from about 0° for the incisors and increased to 17.5° for the second molars. The maxillary inclination was the highest at 33.5° for the central incisors, decreased to about 0° at the second premolars, and then increased for the 2 molars. The mandibular inclination also was the highest at 26.5° for the central incisors, decreased also to about 0° at the second premolars, and continued to decrease for the 2 molars. For the opposing tooth pairs, the interdental mesiodistal angulations always remained within 10° from one another, whereas the interdental faciolingual inclination increased from about 120° for the incisors to about 180° for the second premolars and the 2 molars. CONCLUSIONS: We obtained the average mesiodistal angulation and faciolingual inclination for each whole tooth measured from its long axis digitized on the cone-beam computed tomography volumetric images of 76 patients with near-normal occlusion. We found distinctive angulation and inclination relationships between the neighboring and opposing teeth. This information can be used in addition to the crown standards for positioning each whole tooth properly in the arches.

Regeneration of temporomandibular joint using in vitro human stem cells: A review.

Temporomandibular joint disorders (TMDs) range from gross anatomic deformities of the disc and hard tissue to functional disturbances. Traditional treatment of TMDs includes physical therapy, use of appliances, pharmacological, surgical and psychological interventions. However, during the late stage of TMDs, conventional management often results in inadequate relief of symptoms. Stem cell-based tissue regeneration has been studied extensively in joint regeneration, including the Temporomandibular Joint (TMJ). This study aims to review the potential of various human stem cells (HSC) for the regeneration of the TMJ. In vitro studies using human mesenchymal stem cells cultured under different conditions to evaluate regeneration of TMJ related structures were searched on PubMed, EMBASE, Cochrane, and Web of Science up to March 2020. In vitro studies utilized several different types of stem cells under varying conditions. Increased osteogenesis and/or chondrogenesis were noted with stem cell interventions compared to control groups on Alkaline Phosphatase (ALP) activity, Col-I, Col-II, Col-X, RUNX2, LPL, and Aggrecan mRNA expression. This review emphasizes the potential of stem cell therapies in the regeneration of TMJ-related structures. However, further in vivo studies are required to evaluate the efficacy and safety of these therapies in humans.

Efficacy of alpha-lipoic acid in patients with burning mouth syndrome compared to that of placebo or other interventions: a systematic review with meta-analyses.

Burning mouth syndrome (BMS) is a chronic oral disorder of unknown etiology which presents therapeutic challenges. Alpha-lipoic acid (ALA) has been studied as a potential treatment for BMS. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of ALA compared to that of placebo or other interventions in individuals with BMS. Randomized controlled trials (RCT) using ALA to treat BMS were identified from MEDLINE, Cochrane Library, EMBASE, and Web of Science up to February 3, 2021. The assessment of the risk of bias in the included studies was based on the Cochrane guidelines. The primary outcome evaluated was the visual analog scale (VAS) pain intensity. ALA was compared with placebo, clonazepam, gabapentin, pregabalin, ALA plus gabapentin, capsaicin, Biotène®, and laser therapy. Altogether, 137 records were scanned for inclusion/exclusion, and nine RCTs (two unclear and seven at high risk of bias) were included in the qualitative and quantitative analyses, with a total of 594 patients with BMS included in this review. All studies reported an improvement in VAS pain scores ranging from -0.72 to -2.77. Meta-analysis results showed a non-significant reduction in pain intensity for ALA (P = 0.616) compared to that of placebo on a VAS of 0-10. Patients taking ALA were 1.923 times more likely to show an improvement in self-reported BMS symptoms (P = 0.031) than those in the placebo group. Clonazepam and pregabalin showed a significant VAS pain reduction of 4.08 and 4.68 (P < 0.001), respectively, compared to that with ALA. Although ALA intervention provided a non-significant improvement in the pain score and was more likely to produce a reduction in BMS symptoms, the evidence was of low quality. Further research is needed to establish clear guidelines for the use of ALA for BMS treatment.

Opioids and older adults: Increasing trends in opioid usage in a dental population compared to a National Database (NHANES).

AIM: To examine self-reported opioid prevalence at a dental school clinic for patients ≥65 years old as compared to national data, comparing gender, ethnicity/race and older adult age groupings. METHODS AND RESULTS: Self-reported prescription opioid medication use was extracted from the medical record for dental patients ≥65 years old who visited the school's general dental clinic (GDC) in 2012 or 2017. This data was compared to the National Health and Nutrition Examination Survey (NHANES) data for 2011-2012 and 2017-18. There was a significant increase in prevalence of opioid use in adults ≥65 between 2012 (4.5%) and 2017 (6.5%) and for ages 65-79 (from 4.7% to 6.3%) and ≥80 (3.4% to 7.9%), women (4.8% to 7.0%), and African Americans (4.7% to 8.4%) in the GDC. Older adults at the GDC reported less opioid use than the NHANES national average for both periods no matter the gender or the age with variable results for race/ethnicity. CONCLUSION: The prevalence of older adults taking opioids in our general dental school clinic population increased significantly in 2017 as compared to 2012 but was lower than the national average for the respective periods. Awareness of existing opioid usage in older adult patients and its higher adverse risk potential is critical when prescribing analgesics for dental pain for this age group.

Association of Oral Health and Mini Nutritional Assessment in Older Adults: A Systematic Review with Meta-analyses.

PURPOSE: To evaluate whether poor oral health is associated with a higher risk of malnutrition based on the Mini Nutritional Assessment (MNA) or MNA-SF (short form) in older adults. STUDY SELECTION: For this meta-analysis, cohort and cross-sectional studies with adults 65 years and older, reporting oral health outcomes (i.e. edentulism, number of teeth) and either the MNA or MNA-SF were selected. Four electronic databases were searched (Medline via PubMed, Web of Science, Cochrane Library and EMBASE) through June 2020. Risk of bias was assessed with the checklist by the Agency for Healthcare Research and Quality scale. RESULTS: A total of 928 abstracts were reviewed with 33 studies, comprising 27,559 participants, aged ≥65 being ultimately included. Meta-analyses showed that the lack of daily oral hygiene (teeth or denture cleaning), chewing problems and being partially/fully edentulous, put older adults at higher risk of malnutrition (p<0.05). After adjustment for socio-demographic variables, the included studies reported lack of autonomy for oral care, poor/moderate oral health, no access to the dentist and being edentulous with either no dentures or only one denture were risk factors significantly associated with a higher risk of malnutrition (p<0.05). CONCLUSION: These findings may imply that once elders become dependent on others for assistance with oral care, have decreased access to oral healthcare, and lack efficient chewing capacity, there is increased risk of malnourishment. Limitations of the study include heterogeneity of oral health variables and the observational nature of the studies. Further studies are needed to validate our findings.

Comparing the Berlin and the ARES questionnaire to identify patients with obstructive sleep apnea in a dental setting.

PURPOSE: The aim of this study was to compare the sensitivity and specificity of two questionnaires to identify patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS: Fifty-three moderate to severe OSA patients [with a respiratory disturbance index (RDI) ≥ 15] and 31 controls (RDI < 15) based on ambulatory somnographic assessment were recruited through flyers and mail at USC School of Dentistry. Each patient answered the Berlin and apnea risk evaluation system (ARES) questionnaires. The responses to the questionnaires were scored and compared for significant group differences. RESULTS: Moderate and severe OSA patients were predominantly male, older, had a larger neck size, and larger body mass index than controls. There were no significant differences in race or ethnicity between the two groups. In this study, subjects having a "high risk" ARES questionnaire were 7.9 times as likely to have OSA as subjects with "low or no risk" score (p = 0.0002). The ARES questionnaire had a sensitivity of 90.6%, specificity of 43.2%, a positive predictive value (PPV) of 73.8%, and negative predictive value (NPV) of 73.7% compared to 67.9%, 54.8%, 72%, and 50%, respectively, for the Berlin questionnaire using a cut point of RDI ≥ 15. CONCLUSIONS: In this specific patient group, not uncommon to the regular dental private practice, the ARES questionnaire performed better than the Berlin questionnaire with higher sensitivity, similar PPV, higher NPV, but lower specificity. The lower specificity could be explained in part because the ARES has been tailored to screen patients with an RDI ≥ 5, and our study included mostly mild to severe patients. In conclusion, in this specific group of subjects, the ARES questionnaire is a better choice than the Berlin questionnaire; however, the Berlin questionnaire is publicly available and the ARES screener is proprietary.

Temporomandibular joint findings in CBCT images: A retrospective study.

OBJECTIVE: To evaluate radiological characteristics of the temporomandibular joint. METHODS: Retrospective study of images of 20-80 year-old patients. Two independent clinicians analyzed the images, and a radiological score was obtained, considering sclerosis, osteophites, cysts, and erosion. RESULTS: Seventy eight percent of the joints belonged to females. The main complaints were pain and headache (54.5%) and reduced motion (21.2%). The most common diagnoses were disc dislocation with reduction (35.9%), myofascial pain (20.7%), and osteoarthritis (15.2%). The majority of the joints (96.5%) showed degeneration, with an average radiological score of 3.86 ± 1.47 (0-8). Non-parametric tests showed that females had significantly higher radiological scores (p = 0.014), and TMD-joint patients had higher scores than TMD-muscle patients (p = 0.013). No statistically significant association between radiological scores and chief complaint. CONCLUSION: There were differences among the radiological findings between genders and joint/ muscle TMD, as well as across diagnoses, as expected.