The use of anti-inflammatory drugs to prevent bleaching-induced tooth sensitivity is ineffective and unnecessary.

Data sources The authors searched Medline via PubMed, Scopus, Web of Science, the Cochrane Library and ClinicalTrials.gov for published and unpublished clinical trials. Only randomised clinical trials, with either a parallel or crossover design, reporting the tooth sensitivity of participants undergoing in-office dental bleaching and comparing pain frequency and severity with oral premedication of a non-steroidal or other anti-inflammatory drug compared with a placebo were used in the review. Studies that evaluated the topical administration of drugs or desensitising agents were not reviewed.Study selection In total,5,050 randomised clinical studies were screened and 11 studies were included in the various meta-analyses. Nine studies examined the effect of pre-emptive analgesics on the risk of sensitivity and ten studies evaluated the effect of drugs on the severity of sensitivity; seven of these studies were assessed as having a low risk of bias.Data extraction and synthesis This systematic review and meta-analysis was conducted a priori and registered at the International Prospective Register of Systematic Reviews. There were two reviewers who extracted data from the study tables and independently performed quality assessments of the selected trials using the Office of Health Assessment and Translation risk of bias rating tool for human and animal studies. Risk ratios were calculated for the dichotomous sensitivity risk data and mean difference for measures of sensitivity intensity.Results The authors found no effect of the drugs on the risk of sensitivity. Using a visual analogue scale, the authors identified a small but clinically insignificant reduction in the level of sensitivity in the drug-treated group evaluated up to one hour after bleaching. This was not observed when a numerical rating scale was used to measure pain intensity. For the 24-hour pain data, the authors did not find any significant intensity difference between groups. Mean pain intensity scores were generally low in both experimental groups in all randomised controlled trials reviewed. Based on a visual inspection of the funnel plots of all outcomes, the authors concluded that there was no publication bias.Conclusions The data did not support the pre-emptive use of anti-inflammatory drugs in preventing or reducing the intensity of pain caused by in-office tooth bleaching.

Fever and Other Clinical Indicators May Fail to Detect COVID-19-Infected Individuals.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Nishiura H, Kobayashi T, Miyama T, et al.Int J Infect Dis 2020;94:154-155. https://doi.org/10.1016/j.ijid.2020.03.020. SOURCE OF FUNDING: Self-funded. TYPE OF STUDY/DESIGN: Cross-sectional population study.

Large, expansile odontogenic cyst with bilateral maxillary sinus involvement.

Residual cysts are common odontogenic lesions of the tooth-bearing areas of the jaws. A case of an unusually large residual cyst that crosses the maxillary midline and occupies portions of the maxillary sinuses is being reported. Investigations included a panoramic radiograph, CT scan and a biopsy. The differential diagnoses were common odontogenic lesions, including cysts and benign tumors. The value of advanced imaging modalities is stressed when determining the presence and extent of lesions in complex structures such as the maxilla. The need to visualize the entire lesion beyond what may be seen on intraoral views, as well as panoramic radiographs, is discussed.

Large, expansile odontogenic cyst with bilateral maxillary sinus involvement.

Residual cysts are common odontogenic lesions of the tooth-bearing areas of the jaws. A case of an unusually large residual cyst that crosses the maxillary midline and occupies portions of the maxillary sinuses is being reported. Investigations included a panoramic radiograph, CT scan and a biopsy. The differential diagnoses were common odontogenic lesions, including cysts and benign tumors. The value of advanced imaging modalities is stressed when determining the presence and extent of lesions in complex structures such as the maxilla. The need to visualize the entire lesion beyond what may be seen on intraoral views, as well as panoramic radiographs, is discussed.

Quantitative indices for cone-beam CT assessment of Medication-Related Osteonecrosis of the Jaw - a scoping review.

Objectives: It is not unusual for Medication-related osteonecrosis of the jaw (MRONJ) lesions that have similar clinical presentation and staging to have dissimilar radiographic extent of disease. The aim of this review was to explore the published scientific literature for quantitative indices that describe the cone-beam computerized tomography (CBCT) radiographic features of MRONJ lesions and assess their clinical utility. Method and Materials: A scoping review of the literature was performed to identify quantitative indices developed to describe the CBCT radiographic features of MRONJ lesions. Five electronic databases were included in the review: PubMed, Scopus, Web of Science, Trip medical database, and Cochrane Library. Articles published from the year 2003 onward were included in the review. Results: 367 articles were initially included in the review. 39 abstracts were screened for full-text assessment. The scoping review yielded 12 full length articles with169 cases reported. The Composite Radiographic Index score (CRI score) was identified as the most meaningful index in published literature that attempted to quantify qualitative radiographic changes (Walton, Grogan et al. 2019). However, lesions with similar CRI scores that corresponded to intermediate severity (3-5) may be very dissimilar radiographically in both nature and extent of radiographic changes, undercutting its clinical value. Conclusion: The CRI index score was the only relevant index for cross-sectional (one-time) assessment of established MRONJ lesions (non-stage 0). This scoping review yielded several critical questions regarding the clinical significance and prognostic implications of various radiographic changes in MRONJ, thereby identifying focus areas for future research.

Novel modified quantitative index for cone-beam CT assessment of medication-related osteonecrosis of the jaw - comparative analysis with original index.

Purpose: The main research goal was to address the critical need for an objective and quantitative index to describe the nature and extent of radiographic features of medication-related osteonecrosis of the jaw (MRONJ) lesions and complement the descriptive radiographic interpretation of the lesion and its clinical assessment. Method and Materials: A retrospective review of MRONJ patients assessed at our institution was performed to compare the Composite Radiographic Index (CRI), identified from a prior scoping review, with a proposed modification, the Modified CRI index ('Mod-CRI'). The Mod-CRI index was weighted to assign a higher score for diffuse radiographic involvement of a given lesion, and delineated MRONJ lesions into those with 'high' and 'low' severity. Twenty-two MRONJ cases imaged with CBCT were retrospectively assessed with both CRI and Mod-CRI indices and the two indices were compared for their ability to quantitatively describe cone-beam computerized tomography (CBCT) radiographic features and complement the clinical staging of the MRONJ lesion. Results: There was a statistically significant association between increased clinical stage and higher mod-CRI score (p = 0.040). The Mod-CRI index sorted the patients who scored intermediate scores with the CRI (n = 15) into either the low (n = 8) or high categories (n = 7). Conclusion: The Mod-CRI index eliminated the ambiguous intermediate-category-scores in the previously published CRI index and provided greater clarity to the interpretation of a given index score. Adopting the Mod-CRI could improve MRONJ assessment and enhance communication between the radiologist and the clinician.

Design and Initial Evaluation of a Novel Oral Hygiene Technology for a Special Needs Population: A New Way to Clean.

9.4 million People have swallowing problems in the US. In special needs populations, routine oral hygiene procedures such as tooth brushing can result in aspiration of microbial laden fluids leading to a significant systemic challenge. Aspiration may lead to pneumonia in susceptible populations. These circumstances indicate the need for innovative approaches to oral hygiene for special needs, convalescent, the elderly populations, and young children learning to brush who can ingest excess fluoride which causes mottled enamel. Methods include describing some of the design considerations of the new prototype fabrication and microbiological evaluation of this new device, as well a comparison study of the versions 2 and 3 of the oral care device. Results concluded that version 3.0 regarding patient ease of use was better in comparison to version 2, which was the major difference, and 90% in both groups said they would recommend the new toothbrush. In the microbiological evaluation no growth was seen on any plates containing samples from either the experimental or the control after 48 h of incubation.

In vitro evaluation of the Spectra early caries detection system.

OBJECTIVE: The goal of this study was to perform an in vitro evaluation of the Spectra, a new caries detector that uses light-induced fluorescence of healthy tooth structure and bacterial pigments to optically detect caries. The Spectra generates a storable color map image of examined tooth surfaces which shows areas of enamel and dentin caries. In this study, Spectra readings of occlusal surfaces were compared to clinical, radiographic, and histological assessments of caries. METHODS: Two examiners evaluated 41 extracted molars. The teeth were radiographed and then visually assessed. The International Caries Detection and Assessment System (ICDAS) was used to classify the extent of caries. The teeth were then sectioned and assigned a histological score based on the extension of caries into enamel or dentin. RESULTS: Teeth lacking radiographic caries had a mean Spectra reading of 1.5. Teeth having radiographic caries had a mean Spectra reading of 2.0. This difference was statistically significant. In general, higher ICDAS scores were associated with higher Spectra readings. Teeth with histologically evident deep dentin caries had significantly higher Spectra readings than intact teeth or teeth with superficial enamel demineralization. Spectra assessment of occlusal caries agrees with clinical and radiographic methods. CONCLUSION: Spectra images illustrate the full spectrum of caries severity, from enamel demineralization to dentin decay. The Spectra is a promising technology for the diagnosis and for monitoring the progression of occlusal caries.

Dental products and evidence-based dentistry.

Dentists make frequent product recommendations to their patients. Many dental products are intended to exert a therapeutic action such as caries prevention or desensitization. The purpose of this article is to highlight the contributions the principles of evidence-based dentistry (EBD) can make in guiding therapeutic product recommendations. Dental practitioners are exposed to product claims in advertising and in the professional literature. All studies are not equivalent in making treatment decisions. Although useful for screening active ingredients and providing other background information, laboratory studies should not directly inform clinical decision-making. Properly designed and conducted randomized controlled clinical trials assess the impact of an intervention on a disease-relevant outcome measure (like pain scores or periodontal pocket depth). Where available, systematic reviews can help clinicians determine if there are trends and agreement in clinical trial results. Clinical studies need to be evaluated for publication and other forms of bias. In order to use study results in clinical decision-making, the clinical significance of the trial results must be considered. Determining that a result is statistically significant is inadequate since it does not inform the clinician of the magnitude of the treatment effect. Although clinical studies may generate observations that are valid for the conditions and selected population that was used in the trial, the results may not predict how well an intervention will work in actual use by a diverse group of consumers. In order to better inform clinical judgment, practice-based research networks examine the effectiveness of interventions under real-world circumstances. Applying these basic EBD principles should allow dental practitioners to use consumer products to promote oral health.

The clinical performance of chairside caries risk assessment kits.

OBJECTIVE: Caries risk assessment is an important component of clinical practice. The goal of this project was to evaluate the diagnostic performance of two commercially available kits (the Saliva-Check mutans and the Plaque-Check pH kit; GC-America) in distinguishing caries-active from caries-free individuals. The effect of following instructions not to eat, drink, or perform oral hygiene, prior to testing, was also investigated on the effectiveness of these kits. METHOD AND MATERIALS: The subjects included 26 caries-affected children and 20 caries-free adults. Plaque and saliva samples were collected for analysis by the two kits following the manufacturer's instructions. For 63 additional subjects, instructions not to eat, drink, or practice oral hygiene were omitted prior to sample collection. The sensitivity and specificity in distinguishing caries-free from caries-active subjects was calculated for both kits. RESULTS: The sensitivity (88%) and specificity (90%) of the Saliva-Check mutans kits were satisfactory in the subjects refraining from eating etc. In contrast, both the sensitivity and the specificity of this kit were reduced when subjects were tested without use instructions. When tested in subjects that followed instructions, the pH kit's sensitivity and specificity were 72% and 55% respectively. This modest diagnostic performance was reduced when pH values were measured in subjects not following use instructions. CONCLUSION: These kits, particularly the Saliva-Check mutans kits, can contribute to patient education by documenting microbial caries risk factors. Though difficult to implement in practice, subjects should refrain from eating or other activities that disturb the oral environment prior to sample collection.

Use of dental radiographic minipanel series in disabled adults in a university-based special care dental clinic.

OBJECTIVE: To compare the diagnostic efficacy of a minipanel series to a conventional 18-radiograph full-mouth series in a disabled adult population in a university clinic. METHOD AND MATERIALS: Eighty patients who attended the New Jersey Dental School special care services clinic between 2004 and 2006 were selected for a double-blind quasiexperimental study based on existing full-mouth series radiographs. A minipanel series consisting of eight radiographs from the 18-radiograph full-mouth series was used as a comparison against a matched pair of an 18-radiograph exam. The diagnostic efficacy of this eight-radiograph series was tested against the more conventional 18-radiograph full-mouth series to determine whether the minipanel series was an acceptable substitute for the full-mouth series in this population group. Traditionally, it is difficult to obtain full-mouth series radiographs in patients with disabilities. RESULTS: From the 80 studied patients, a total of 2,219 teeth were available for study. A median of 29 teeth per patient was found in the full-mouth series and 28 teeth per patient in the minipanel series category. The difference was statistically significant (P < .001). Of the patients evaluated, 78 (97.5%) had at least one problem detected when the full-mouth series was used. Of these 78 with at least one problem, 74 (94.8%) were identified using the minipanel series. The sensitivity for the minipanel series when compared to the gold-standard full-mouth series was 63% (95% confidence interval [CI], 59.2 to 68.0) for tooth-specific disease; the specificity was 92% (95% CI, 92.2 to 94.5). CONCLUSION: Prospective studies are needed for the acceptance and use of minipanel radiographic series in conjunction with a clinical examination.