Psychosocial oral health-related quality of life impact: A systematic review.

BACKGROUND: Psychosocial wellbeing is an important determinant for patients' oral health-related quality of life (OHRQoL). Psychosocial impact (PI), together with the dimensions Oral Function, Orofacial Pain and Orofacial Appearance, has been proposed to cover the different areas of OHRQoL. OBJECTIVE: The objective of the study was to collect further scientific support for the new four-dimensional structure of OHRQoL. This study is one out of a series of four and focuses on the PI in patients with dental anxiety, oral cancer and periodontitis (PROSPERO registration number: CRD42017064033). METHODS: Five databases (Pubmed (Medline), EMBASE, Cochrane, CINAHL and PsycINFO) were electronically searched on 8 June 2017 and updated on 14 January 2019, to identify the studies that measure OHRQoL using the Oral Health Impact Profile (OHIP) for oral health conditions. In this review, studies were included if the mean/median domain scores from OHIP-14 or OHIP-49 were available for patients with dental anxiety, oral cancer or periodontitis. The score of the handicap domain from the OHIP was used to assess patients` PI. The handicap domain includes 6 items for OHIP-49 with a domain score ranging from 0 to 24 and 2 items for OHIP-14 with a domain score ranging from 0 to 8. For comparison between the 2 versions of the OHIP, the domain score of OHIP-49 was conversed into a 0 to 8 metric. The domain scores of the included studies were then pooled, separately for each of the included dental disorders. RESULTS: A total of 2104 records were identified based on the search strategy. After screening of titles and abstracts, 1607 articles were reviewed in full text. Twenty-three articles met the inclusion criteria for this review and were included in the study. The 23 articles contained 3884 patients, grouped in 30 patient populations and 42 patient samples. The pooled mean scores of PI for dental anxiety, oral cancer and periodontitis were 3.2, 1.9 and 0.8, respectively, on the 0 to 8 metric. CONCLUSION: This review provides standardised information about the OHRQoL impact for three dental disorders as a model for the PI dimension. Dental anxiety tends to show the strongest effect on the PI dimension, while periodontitis tends to show the weakest effect on the PI dimension. Future studies need to confirm whether the reported differences in PI scores between the three dental disorders are statistically significant.

Mapping Oral Disease Impact with a Common Metric (MOM)-Project summary and recommendations.

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-the dimensions of oral health-related quality of life-capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information across oral diseases and settings. In this article, project authors summarize MOM's findings and provide recommendations about how to improve standardized oral health impact assessment. Project MOM's systematic reviews identified four-dimensional impact information for 189 adult and 22 pediatric patient populations that were contained in 170 publications. A typical functional, pain-related, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units. Project MOM provides five recommendations to improve standardized oral health impact assessment for all oral diseases in all settings.

Changes in Adolescents' Oral Health Status: Responsiveness of the Child Perception Questionnaire11-14.

Changes in oral health status following treatment should be assessed clinically as well as by patients' reported outcomes. This study investigated changes on oral-health-related quality of life (OHRQoL) of adolescents enrolled in a comprehensive oral health care program for caries and gingival conditions. The sensitivity of the Child Perception Questionnaire11-14 (CPQ11-14) to detect clinical changes, that is, its responsiveness, was assessed. A total of 618 10-15-year adolescents answered the questionnaire before treatment and 560 at follow-up after 1 year. In the follow-up, 2 additional global transition judgment questions were asked. The adolescents were clinically and radiographically examined. At the baseline, 374 adolescents needed only nonoperative treatment, whereas 274 needed non- and operative treatments. After 1 year, the adolescents were regrouped according to the fulfillment of their treatment needs in Group 1 (n = 363) needing/receiving nonoperative treatment only; Group 2 (n = 98) needing/receiving both non- and operative treatments; Group 3 (n = 99) receiving nonoperative treatment only, while needing also operative treatment. The CPQ11-14 total mean change scores by the global transition judgment on self-perceived oral health status indicated significant differences (p < 0.001, ANOVA; internal responsiveness). The effect of the program for the treatment groups was significant (p = 0.014, ANCOVA; external responsiveness). The effect size for the change scores was of moderate magnitude. In conclusion, an overall improvement of adolescents' OHRQoL was observed following 1-year oral health care program for caries and gingival conditions. The CPQ11-14 was internally and externally sensitive to detect substantial clinical changes. The CPQ11-14 seems appropriate for measuring long-term changes on adolescents' OHRQoL.

Maximum impact heights of currently used mouthguards in field hockey.

BACKGROUND/AIM: The effectiveness of mouthguards used in field hockey is unknown. The aim of this study was to compare the maximum impact heights between currently used mouthguards in field hockey to prevent dental injury. METHODS: Four boil-and-bite mouthguards (Dita, Shock Doctor, SISU, and Stag) and one custom-made mouthguard (Elysee) were tested for maximum impact height. A hockey ball was released in a tube from increasing heights onto plaster and polymethylmethacrylate (PMMA) dental models. Models were tested without mouthguard as a control. The experiment was repeated 10 times per mouthguard and for the control on each dental model. The maximum impact height for when the dental model broke was used to calculate the speed. The mouthguards and controls were compared. RESULTS: The maximum impact heights (median [25%-75%] in meters) onto plaster dental models were as follows: control 0.23 (0.15-0.25), Dita 0.35 (0.30-0.35), Elysee 0.45 (0.34-0.50), Shock Doctor 0.68 (0.60-0.74), SISU 0.23 (0.20-0.26), and Stag 0.35 (0.35-0.46). The maximum impact height for Shock Doctor was significantly higher than all other mouthguards and the control (all P < .05). The maximum impact heights onto PMMA dental models were as follows: control 2.00 (1.30-2.50), Dita 3.80 (2.65-6.95), Elysee 3.30 (2.30-4.20), Shock Doctor 6.20 (2.80-8.10), SISU 2.60 (1.90-3.15), and Stag 3.90 (1.25-5.15). The maximum impact height for Shock Doctor was significantly higher than for SISU, Stag, and the control (all P < .05), but did not differ significantly from Dita (P = .43) and Elysee (P = .12). CONCLUSION: Shock Doctor had the highest maximum impact height compared to the other mouthguards and appears to be the most effective mouthguard tested in this study.

Alveolar Iodine Tampon Packing Reduces Postoperative Morbidity After Third Molar Surgery.

PURPOSE: The aim of this study was to assess the efficacy of an iodine tampon after mandibular third molar surgery on oral health-related quality of life (OHRQoL), use of painkillers, postoperative sequelae, and self-care behaviors in the first postoperative week. MATERIALS AND METHODS: This prospective, crossover, randomized controlled study included patients undergoing surgical removal of bilateral symmetrically, horizontally impacted mandibular third molars. The surgical site was randomly allocated to receive an iodine tampon after surgery or wound closure and rinsing with a Monoject syringe (Tyco/Healthcare-Kendall, Mansfield, MA). The primary outcomes measured each day during the first postoperative week were the Oral Health Impact Profile 14 score and postoperative sequelae, including pain, swelling, limited mouth opening, postoperative infection, and alveolar osteitis. The secondary outcome measures were several self-care behaviors. Data were analyzed using repeated-measures analysis of variance and paired-samples t tests. RESULTS: A total of 54 patients (25 men and 29 women; mean age, 25.1 years) were enrolled, with a total of 108 surgically removed impacted mandibular third molars. The use of an iodine tampon resulted in a significantly lower impact on OHRQoL (mean of 21.5 [standard deviation (SD), 9.6] vs 26.5 [SD, 10.6]) on the first postoperative day, which was observable until the seventh postoperative day. In addition, after removal of the impacted third molar, patients with the iodine tampon condition reported less pain (mean of 5.2 [SD, 1.9] vs 6.1 [SD, 2.1] on day 1, lasting throughout the week), less use of painkillers, less limited mouth opening, fewer problems chewing, less swelling, and earlier recovery. CONCLUSIONS: The use of postoperative iodine packing after the removal of impacted mandibular third molars significantly reduces OHRQoL and postoperative sequelae.

Are Technology-Based Interventions Effective in Reducing Dental Anxiety in Children and Adults? A Systematic Review.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of technology-based interventions for the treatment of dental anxiety in children and adults. DATA SOURCES: A systematic search using relevant keywords was conducted in PubMed-Medline, EMBASE, PsycINFO, CINAHL, Scopus, and The Cochrane Library. INCLUSION CRITERIA: Randomized controlled trials (RCTs) that compared technology-based interventions with inactive controls in the treatment of moderate to severe dental anxiety were included. RESULTS: A total of seven RCTs were included in the review. These studies investigated the effectiveness of video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction with music and audiovisual video material. Six studies examining video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction (audiovisual) showed significantly greater reductions in dental anxiety than inactive controls in both children and adults. None of the included studies followed Consolidated Standards of Reporting Trials guidelines completely or reported sufficient data, thereby precluding a possible meta-analysis. Four out of seven included studies were assessed to be at high risk of bias. CONCLUSIONS: A limited number of studies supported the effectiveness of technology-based interventions in the treatment of dental anxiety in children and adults. CLINICAL SIGNIFICANCE: The quality of the methods of studies on the effects of technology-based interventions allows only limited inferences on the effects of these interventions. However, within the limitations of the systematic review, the results converge to suggest that technology-based interventions may be useful as an adjunct to standard dental care. High-quality RCTs are needed to determine the (relative) effectiveness of these interventions. PROSPERO REGISTRATION NUMBER: CRD42017064810.

Diagnostic value of ultrasonography for the detection of disc displacements in the temporomandibular joint: a systematic review and meta-analysis.

OBJECTIVES: The aim was to assess the added diagnostic value of ultrasonography (US) for establishing the presence or absence of disc displacements (DDs) in temporomandibular joints (TMJs). MATERIALS AND METHODS: Pubmed and EMBASE were searched electronically to identify diagnostic accuracy studies that assessed the diagnostic value of US for the diagnosis of DD, using Magnetic resonance imaging (MRI) as the reference standard. Meta-analyses were performed with Metadisc 1.4 and RevMan 5.3. RESULTS: A total of 16 studies qualified for meta-analyses. For the diagnosis of DD at closed mouth position (DD-CM) and DD at maximum mouth-opening position (DD-MMO), the added values of a positive result with US for ruling in DD-CM and DD-MMO were 22 and 41%, while those of a negative result with US for ruling out DD-CM and DD-MMO were 30 and 20%. For the diagnosis of DD with reduction (DDWR) and DD without reduction (DDWoR), the added values of a positive result in US for ruling in DDWR and DDWoR were 35 and 41%, while those of a negative result in US for ruling out DDWR and DDWoR were 21 and 27%. CONCLUSIONS: Using MRI as reference standard, the added values of both positive predictive values and negative predictive values of US for ruling in and ruling out DDs are sufficient in the decision-making in dental practice. CLINICAL RELEVANCE: US can be a good imaging tool to supplement clinical examination findings in patients with suspected DDs. Combined static and dynamic examinations using high-resolution US should be preferred.

Virtual Reality Exposure Therapy for the Treatment of Dental Phobia: A Controlled Feasibility Study.

BACKGROUND: Virtual reality exposure therapy (VRET) has been used to treat a variety of fears and phobias. AIM: To determine the feasibility (i.e. safety and efficacy) of using VRET to treat dental phobia. METHOD: Safety was evaluated by determining any adverse events or symptom exacerbation. Efficacy of VRET was evaluated by comparing the reduction in dental anxiety scores (measured 16 times within a 14-week study period, and at 6-month follow-up), and its behavioural effects with that of an informational pamphlet (IP) on ten randomized patients with dental phobia using a controlled multiple baseline design. Participants' heart rate response during VRET, and their experience post-VRET, were indexed. RESULTS: No personal adverse events or symptom exacerbation occurred. Visual analysis and post-hoc intention-to-treat analysis showed a significantly greater decrease in dental anxiety scores [higher PND (percentage of non-overlap data) scores of 100% and lower POD (percentage of overlap data) of 0%, Modified Dental Anxiety Scale, F (1,8) = 8.61, p = 0.019, and Dental Fear Scale, F (1,8) = 10.53, p = 0.012], and behavioural avoidance in the VRET compared with the IP group [d = 4.2 and -1.4, respectively). There was no increase in average heart rate during VRET. Of the nine treatment completers, six (four from the VRET group and two from the IP group) no longer had dental phobia at 6-month follow-up. Four of the five VRET participants, but none of the IP participants, scheduled a dental treatment appointment following the intervention. CONCLUSION: VRET is a feasible alternative for patients with dental phobia.

Do traumatic events have more impact on the development of dental anxiety than negative, non-traumatic events?

The importance of exposure to traumatic events for the development of dental anxiety has not been investigated. The aim of the present study was to test the hypotheses that individuals who reported having been exposed to a traumatic event [that is, fulfilling Criterion A of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), for post-traumatic stress disorder (PTSD)] as the cause of their dental anxiety would report significantly higher levels of dental anxiety, typical trauma-related (PTSD) symptoms, and greater disturbance of memories involving these events than those who reported being exposed to non-traumatic events. Patients of a specialized dental fear clinic (n = 90) were divided into those who reported a traumatic event that initiated their dental trait anxiety and those who did not. The two groups did not differ in their severity of dental anxiety and number of PTSD symptoms, but the memories of those who had been exposed to traumatic events were significantly more vivid than the memories of those in the reference group. Length of time since the event took place did not play a role. Hence, traumatic events are remembered more vividly, but do not seem to initiate more severe forms of dental anxiety than other events.

The factor structure of dental fear.

There is limited empirical information as to whether or how stimuli associated with dental fear can be classified into distinct subtypes. The purpose of the current study was to develop a descriptive framework for the classification of dental fear. Data were collected using a survey among Dutch twin families (n = 11,771). The sample was randomly divided into two subsamples of, respectively, 5,920 and 5,851 individuals. An exploratory factor analysis (EFA) was performed on the first subsample to delineate the multidimensional structure of a set of 28 dental-fear-provoking objects and situations. The second sample was used to confirm the newly derived model using confirmatory factor analysis (CFA). The EFA yielded a three-factor solution with 70.7% explained variance pertaining to: (i) invasive treatment or pain; (ii) losing control; and (iii) physical sensations. The CFA showed an acceptable fit to the data, thereby confirming the stability of the three-factor structure. There are at least three different subtypes of dental fear. As these subtypes require a different treatment approach in clinical practice, it could be important to assess the severity of patients' fear response along these three dimensions.

Predictive Value of Panoramic Radiography for Injury of Inferior Alveolar Nerve After Mandibular Third Molar Surgery.

PURPOSE: The purpose of the present systematic review was to assess the added value of panoramic radiography in predicting postoperative injury of the inferior alveolar nerve (IAN) in the decision-making before mandibular third molar (MM3) surgery. MATERIALS AND METHODS: MEDLINE and EMBASE were searched electronically to identify the diagnostic accuracy of studies that had assessed the predictive value of 7 panoramic radiographic signs, including root-related signs (darkening of the root, deflection of the root, narrowing of the root, and dark and bifid apex of the root) and canal-related signs (interruption of the white line of the canal, diversion of the canal, and narrowing of the canal) for IAN injury after MM3 surgery. RESULTS: A total of 8 studies qualified for the meta-analysis. The pooled sensitivity and specificity of the 7 signs ranged from 0.06 to 0.49 and 0.81 to 0.97, respectively. The area under the summary area under the receiver operating characteristic curve ranged from 0.42 to 0.89. The pooled positive predictive value (PPV) and negative predictive value (NPV) ranged from 7.5 to 26.6% and 95.9 to 97.7%, respectively. The added value of a positive sign for ruling in an IAN injury (PPV minus the prior probability) ranged from 3.4 to 22.2%. The added value of a negative sign for ruling out an IAN injury (NPV minus [1 minus the prior probability]) ranged from 0.1 to 2.2%. CONCLUSIONS: For all 7 signs, the added value of panoramic radiography is too low to consider it appropriate for ruling out postoperative IAN in the decision-making before MM3 surgery. The added value of panoramic radiography for determining the presence of diversion of the canal, interruption of the white line of the canal, and darkening of the root can be considered sufficient for ruling in the risk of postoperative IAN injury in the decision-making before MM3 surgery.

Permanent tooth agenesis in non-syndromic Robin sequence and cleft palate: prevalence and patterns.

OBJECTIVES: Partial tooth agenesis is frequently observed in Robin sequence. Tooth anomalies are increasingly considered as an extended phenotype of the cleft palate population. The study objective was to compare the prevalence and patterns of tooth agenesis in a group of patients with non-syndromic Robin sequence (ns-RS) and a group with non-syndromic cleft palate (ns-CP). MATERIALS AND METHODS: The panoramic radiographs of 115 ns-RS and 191 ns-CP patients were assessed for agenesis of the permanent dentition (excluding third molars) and the patterns recorded using the Tooth Agenesis Code. RESULTS: Partial tooth agenesis was observed in 47.8% of ns-RS and 29.8% of ns-CP patients with a greater prevalence in the mandibula than in the maxilla, particularly in ns-RS. The teeth most frequently absent in both groups were the mandibular second premolars and maxillary lateral incisors. Tooth agenesis was bilateral in two-thirds of affected ns-RS patients and one-half of ns-CP patients. In ns-RS, bilateral agenesis of the mandibular second premolars was more frequently observed in female than that in male patients. Completely symmetrical patterns of hypodontia were found in around 45% of ns-RS patients with tooth agenesis compared to 35% in ns-CP. No association was found between the extent of the palatal cleft and the severity of hypodontia. CONCLUSION: Tooth agenesis is more prevalent in ns-RS than that in ns-CP, demonstrates a much greater predilection for the mandible in ns-RS, and bears no relation to the extent of the palatal cleft. CLINICAL RELEVANCE: When compared to ns-CP, additional developmental disturbances are likely involved in the etiology of tooth agenesis in ns-RS. Future research could help identify the underlying genetic traits and aid in classifying patients in those with and without expected tooth agenesis in order to facilitate orthodontic management strategies.

Patterns of orodental injury and mouthguard use in Dutch field hockey.

BACKGROUND: Orodental injuries in field hockey are a growing cause of concern that requires attention. OBJECTIVE: The objective of this cross-sectional study was to investigate the patterns of orodental injury, and the use of mouthguards in Dutch national field hockey. MATERIALS AND METHODS: In the period from 1 May to 31 July 2014, a 33-item questionnaire about orodental injury and mouthguard use was sent to 7 field hockey clubs in the Netherlands. Data were analysed using 2 multivariable logistic (non-)linear regression per outcome measurement: (1) orodental injury and (2) type of mouthguard. RESULTS: Out of 6585 players, 1299 (20%) responded sufficiently and were eligible for the study. In total, 214 hockey players (16%) experienced at least 1 orodental injury in their career. The injuries were less severe in athletes who wore a mouthguard during an accident than in those who did not, OR=2.1 to 3.3, p≤0.05. Players without mouthguard sustained broken and knocked out teeth more frequently, while players with a mouthguard had more lip cuts (p≤0.05). Players complained less about custom-made than about mouth-moulded mouthguards (p≤0.05). Also, males were more at risk for an orodental injury, OR=1.4 (95% CI 1.0 to 1.9), and were less likely to have a custom-made mouthguard, OR=0.7 (95% CI 0.6 to 0.9), than females. CONCLUSIONS: A substantial number of field hockey players suffers from orodental injury. Mouthguards should be included in prevention strategies as they are associated with less severe injuries and patterns of injury are to be taken into account when targeting specific groups.

The mouth care item of the MOBID pain scale: secondary analyses of unique video uptakes by dental professionals.

PURPOSE: The Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale has been developed for the assessment of pain in elderly individuals with severe dementia. From the initial draft of the MOBID, the teeth/mouth care item was removed due to its low correlation with the total score. However, the observation of this item was done by non-dental professionals only. The aim was to revisit the unique teeth/mouth care video uptake fragments with a group of experienced elderly care dentists, as to establish the reliability of this item. MATERIAL AND METHODS: Using the Orofacial MOBID Pain Scale, 11 fragments were assessed by 12 specialists during two sessions with a 4-week interval. The specialists scored whether or not they observed orofacial pain/discomfort-related behaviours (pain noises, facial expressions and/or defence) and/or dementia-related behaviours (anxiety, aggression and/or confusion). The threshold for agreement in scoring was arbitrarily set at 66.6%. As a next step, reliability was quantified using Cohen's kappa. RESULTS: For only two video fragments, substantial agreement was obtained during both sessions, while for three fragments, the agreement was substantial during one session only. In addition, only three observers were able to provide consistent scores. For two of those, the various kappa values could be qualified as moderate to good. Notably, all consistent scores pertained to dementia-related behaviours; not to orofacial pain/disability-related behaviours. CONCLUSION: Teeth/mouth care, as displayed on video uptakes, cannot be interpreted reliably by experienced elderly care dentists in terms of orofacial pain/discomfort-related behaviour or dementia-related behaviour with the Orofacial MOBID Pain Scale.

Self-perceived halitosis influences social interactions.

BACKGROUND: To determine the impact of self-perceived halitosis on social interactions, and the effect of using an oral rinse for management of halitosis. METHODS: A survey among a representative sample of the Dutch population (n = 1082), and a pre-post study among a sample of consecutive coming-by volunteers (n = 292). RESULTS: Participants of the representative sample rated their oral odor as 66.8 ± 17.2 and the consecutive volunteers as 70.9 ± 16.7 (range: 0-100). Sizable proportions (15.3 % and 38.1 %, respectively) indicated to always take into account their (bad) oral odor when meeting a person for the first time. The worse people perceived their oral odor, the more likely they were to take into account to keep a certain distance. Following the use of the oral rinse, a significant decline was found of the extent to which the participants reported to take into account their oral odor when meeting a person for the first time. Both studies identified a subgroup of individuals (9.1 % and 28.1 % respectively) who reported to keep a certain distance when meeting other people, despite a "fresh" self-perceived oral odor. CONCLUSION: The results suggest that self-perceived oral odor negatively affects social interactions, and that adequate management of halitosis has the potential to improve such interactions.

Java project on periodontal diseases: periodontal bone loss in relation to environmental and systemic conditions.

OBJECTIVE: To assess in a population deprived from regular dental care the relationship between alveolar bone loss (ABL) and environmental/systemic conditions. MATERIAL & METHODS: The study population consisted of subjects from the Purbasari tea estate on West Java, Indonesia. A full set of dental radiographs was obtained of each subject and amount of ABL was assessed. In addition, the following parameters were evaluated: plasma vitamin C, vitamin D3 , HbA1c and CRP, the haptoglobin phenotype, presence of putative periodontopathic bacteria and viruses, dietary habits, smoking and anthropometrics. RESULTS: In this population 45% showed vitamin C depletion/deficiency, 82% had vitamin D3 insufficiency/deficiency, 70% were in a pre-diabetic state, 6% had untreated diabetes, 21% had elevated CRP values ranging from 3.1 to 16.1 mg/l. Results of the regression analysis, including all above mentioned parameters, showed four significant predictors, explaining 19.8% of the variance of ABL. Number of Porphyromonas gingivalis cells and CRP values showed a positive relationship with ABL, whereas BMI and number of guava fruit servings were negatively related. CONCLUSION: Results confirm previous findings that elevated levels of P. gingivalis may be indicative for periodontitis progression. A new finding is that guava fruit consumption may play a protective role in periodontitis in a malnourished population.

Do oral health conditions adversely impact young adults?

This study assessed the extent to which clinically measured oral health conditions, adjusted for sociodemographic and oral health behavior determinants, impact adversely on the oral health-related quality of life (OHRQoL) in a sample of Belgian young adults. The null hypothesis was that, among young adults, the oral health conditions would have no impact on their quality of life. The participants were 611 new patients aged 16-32 years seeking consultation at the Saint-Luc University Hospital in Brussels in 2010-2011. The patients (56.0% female) were examined for their oral health conditions and answered a validated questionnaire about sociodemographic and oral health behavior determinants in addition to questions about their OHRQoL. The abridged Oral Health Impact Profile-14 was used to assess the OHRQoL. Interexaminer reliability for caries was 0.86 (95% CI 0.84-0.89, nonweighted κ). The outcome was a high score on the OHRQoL (median split). Hierarchical logistic regression analysis showed that young adults with clinical absolute D1MFS scores between 9 and 16 (OR = 2.14, p = 0.031) and between 17 and 24 (OR = 3.10, p = 0.003) were significantly more likely to report a high impact on their quality of life than those with lower scores. Also, periodontal conditions compromised significantly (OR = 1.79, p = 0.011) the quality of life of young adults. In conclusion, this study identified oral health conditions with a significant adverse effect on the OHRQoL of young adults. However, the prevalence of young adults reporting impacts on at least 1 performance affected fairly often or very often was limited to 18.7% of the sample.

Longitudinal Changes in Dental Fear and Coping Behavior in Children, Adolescents, and Young Adults With Cleft Lip and/or Cleft Palate.

OBJECTIVE: To determine changes in dental anxiety levels of cleft lip and/or palate (CL/P) children and to explore the role of coping strategies in the development of their dental anxiety. DESIGN: Prospective study. SETTING: Free University Medical Center Amsterdam. PATIENTS: A sample of CL/P children (at T1: n = 153, 4 to 18 years, 67 girls; at T2: n = 113, 7 to 21 years, 51 girls). Data were available at both time points for 102 children. MEASURES: Dental anxiety and coping strategies were assessed at the start of the study (T1; mean age: 9.8 years, standard deviation 4.1) and 3 years later (T2; mean age: 13.4 years, standard deviation 3.8). These scores were compared to a normative group of Dutch children. MAIN OUTCOME MEASURE(S): The severity of dental anxiety was indexed using the Parental Version of the Dental Subscale of the Children's Fear Survey Schedule. Dental coping strategies were assessed with the Dental Cope Questionnaire. RESULTS: Overall, dental anxiety decreased to a level equal to normative scores of Dutch children. However, 5% of the children became more anxious. At T2, children used significantly fewer coping strategies. Children whose level of dental anxiety increased significantly used more destructive coping strategies than children whose level of dental anxiety decreased significantly or remained stable. CONCLUSIONS: Results suggest that dental anxiety levels of most CL/P children gradually decline over time. Whereas some coping strategies have the potential to be protective, more destructive coping strategies may put children at greater risk for developing and maintaining their dental anxiety.

Patterns of tooth agenesis in patients with crouzon or apert syndrome.

PURPOSE: Dental agenesis is the most common anomaly of dental development and can be a component of a congenital syndrome. The purpose of this study was to evaluate the prevalence of agenesis and to describe patterns of tooth agenesis in patients with Crouzon or Apert syndrome compared with nonsyndromic controls. PATIENTS AND METHODS: Longitudinal records of 67 patients with Crouzon syndrome (n = 39) or Apert syndrome (n = 28) from the Erasmus Medical Centre were examined. Syndromic patients were compared with patients in a nonsyndromic control group (n = 284). RESULTS: Prevalence of tooth agenesis in patients with Crouzon syndrome (35.9%) and patients with Apert syndrome (46.4%) was significantly higher than the prevalence in control subjects (27.5%) (P < .005). In all groups third molars were the most likely to be agenetic. Tooth agenesis excluding third molars was significantly higher in syndromic patients than in control subjects (P < .001). Bilateral agenesis of mandibular second premolars occurred significantly more often in patients with Crouzon and Apert syndrome than in control subjects (P < .001). CONCLUSIONS: Tooth agenesis is more prevalent in patients with Crouzon or Apert syndrome than in control subjects. Tooth agenesis and mandibular symmetrical patterns of second premolar agenesis are more prevalent in syndromic patients.

Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth.

BACKGROUND: Both paracetamol and ibuprofen are commonly used analgesics for the relief of pain following the surgical removal of lower wisdom teeth (third molars). In 2010, a novel analgesic (marketed as Nuromol) containing both paracetamol and ibuprofen in the same tablet was launched in the United Kingdom, this drug has shown promising results to date and we have chosen to also compare the combined drug with the single drugs using this model. In this review we investigated the optimal doses of both paracetamol and ibuprofen via comparison of both and via comparison with the novel combined drug. We have taken into account the side effect profile of the study drugs. This review will help oral surgeons to decide on which analgesic to prescribe following wisdom tooth removal. OBJECTIVES: To compare the beneficial and harmful effects of paracetamol, ibuprofen and the novel combination of both in a single tablet for pain relief following the surgical removal of lower wisdom teeth, at different doses and administered postoperatively. SEARCH METHODS: We searched the Cochrane Oral Health Group'sTrials Register (to 20 May 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 4); MEDLINE via OVID (1946 to 20 May 2013); EMBASE via OVID (1980 to 20 May 2013) and the metaRegister of Controlled Trials (to 20 May 2013). We checked the bibliographies of relevant clinical trials and review articles for further studies. We wrote to authors of the identified randomised controlled trials (RCTs), and searched personal references in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied to the searches of the electronic databases. SELECTION CRITERIA: Only randomised controlled double-blinded clinical trials were included. Cross-over studies were included provided there was a wash out period of at least 14 days. There had to be a direct comparison in the trial of two or more of the trial drugs at any dosage. All trials used the third molar pain model. DATA COLLECTION AND ANALYSIS: All trials identified were scanned independently and in duplicate by two review authors, any disagreements were resolved by discussion, or if necessary a third review author was consulted. The proportion of patients with at least 50% pain relief (based on total pain relief (TOTPAR) and summed pain intensity difference (SPID) data) was calculated for all three drugs at both two and six hours postdosing and meta-analysed for comparison. The proportion of participants using rescue medication over both six and eight hours was also collated and compared. The number of patients experiencing adverse events or the total number of adverse events reported or both were analysed for comparison. MAIN RESULTS: Seven studies were included, they were all parallel-group studies, two studies were assessed as at low risk of bias and three at high risk of bias; two were considered to have unclear bias in their methodology. A total of 2241 participants were enrolled in these trials.Ibuprofen was found to be a superior analgesic to paracetamol at several doses with high quality evidence suggesting that ibuprofen 400 mg is superior to 1000 mg paracetamol based on pain relief (estimated from TOTPAR data) and the use of rescue medication meta-analyses. The risk ratio for at least 50% pain relief (based on TOTPAR) at six hours was 1.47 (95% confidence interval (CI) 1.28 to 1.69; five trials) favouring 400 mg ibuprofen over 1000 mg paracetamol, and the risk ratio for not using rescue medication (also favouring ibuprofen) was 1.50 (95% CI 1.25 to 1.79; four trials).The combined drug showed promising results, with a risk ratio for at least 50% of the maximum pain relief over six hours of 1.77 (95% CI 1.32 to 2.39) (paracetamol 1000 mg and ibuprofen 400 mg) (one trial; moderate quality evidence), and risk ratio not using rescue medication 1.60 (95% CI 1.36 to 1.88) (two trials; moderate quality evidence).The information available regarding adverse events from the studies (including nausea, vomiting, headaches and dizziness) indicated that they were comparable between the treatment groups. However, we could not formally analyse the data as it was not possible to work out how many adverse events there were in total. AUTHORS' CONCLUSIONS: There is high quality evidence that ibuprofen is superior to paracetamol at doses of 200 mg to 512 mg and 600 mg to 1000 mg respectively based on pain relief and use of rescue medication data collected at six hours postoperatively. The majority of this evidence (five out of six trials) compared ibuprofen 400 mg with paracetamol 1000 mg, these are the most frequently prescribed doses in clinical practice. The novel combination drug is showing encouraging results based on the outcomes from two trials when compared to the single drugs.