6-month Recall Research Articles

Effect of full pulpotomy using a calcium silicate–based bioactive ceramic in adult permanent teeth with symptoms indicative of irreversible pulpitis: A retrospective study

BackgroundThe authors studied the treatment effect of full pulpotomy using a calcium silicate–based bioactive ceramic in adult permanent teeth with symptoms indicative of irreversible pulpitis. MethodsEighty-one adult permanent teeth with symptoms indicative of irreversible pulpitis in 78 patients aged 18 through 72 years were evaluated for inclusion in the study. After caries excavation, the pulp was amputated to the level of the canal orifices. After hemostasis was achieved, calcium silicate–based bioactive ceramic was placed as the capping agent. The cavity was sealed temporarily with a glass ionomer cement and then restored with flowable resin and composite resin after 2 weeks if no positive symptoms were reported or detected. Postoperative evaluation was performed by means of clinical and radiographic examination at 2 weeks and 3, 6, and 12 months. ResultsOverall success rates of the procedure were 96.3% (78 of 81), 93.8% (76 of 81), 92.6% (75 of 81), and 92.6% (75 of 81) at the 2-week, 3-month, 6-month, and 12-month recall visits, respectively. Six of the 81 teeth failed and required root canal therapy. In these 6 teeth, 3 exhibited severe cold stimuli pain and spontaneous pain at the 2-week follow-up, 2 had no response to electric pulp testing with apical percussion pain and periapical rarefaction at the 3-month follow-up, and 1 tooth exhibited periapical rarefaction and labial mucosal fistula at the 6-month follow-up. ConclusionsUnder the conditions of this study, full pulpotomy using a calcium silicate–based bioactive ceramic was a successful option for the treatment of adult permanent teeth with carious originated symptoms indicative of irreversible pulpitis. Practical ImplicationsVital pulp therapy is no longer impossible for adult permanent teeth with carious originated symptoms indicative of irreversible pulpitis.

Abstract 1974: Predictors of correct recall of MC1R genetic risk among Hispanic individuals participating in a skin cancer precision prevention trial

Abstract Skin cancer incidence is increasing among US Hispanics, who experience higher morbidity and mortality and are underserved in precision medicine. A large proportion of Hispanics carry risk variants at MC1R, a robust genetic locus for skin cancer susceptibility. Recall is a fundamental psychological mechanism underlying how people receive health recommendations: better recall has been associated with greater adherence and improved outcomes. However, research on recall of genetic testing information for low to moderate penetrance genes, what predicts recall, and the influence of recall on preventive behavior is limited, especially among Hispanics. We report results of secondary analyses from our previously published randomized controlled trial among self-identified Hispanic participants from Tampa, Florida and Ponce, Puerto Rico. Participants randomized to the precision prevention arm (n=282) were provided MC1R risk information (average or higher) and were asked to recall their genetic risk after 3 and 9 months. Predictors of recall (correct recall, did not recall, or misremembered) at each timepoint were determined by backwards stepwise selection that optimizes AIC, which maximizes overall model fit notwithstanding individual variable p-values. Using all trial participants (n=920), intervention effects on 11 primary and secondary preventive behaviors collected at baseline and post-intervention were estimated within strata of 3-month recall. At 9 months post-intervention, there was a borderline difference in risk recall comparing average- and higher-risk participants (p=0.051), with higher-risk participants 3 times less likely to correctly recall their MC1R risk category (vs. misremember, OR=0.31, 95%CI:0.10-0.95) than average-risk participants. Among average-risk participants, common predictors of correct recall across the 3- and 9-month final models were younger age (OR3=0.97, 95%CI:0.94-1.01, OR9=0.96, 95%CI:0.93-0.99) and higher education (OR3=1.64, 95%CI:1.06-2.63, OR9=1.73, 95%CI:1.12-2.81). Among higher-risk participants, higher education was associated with correct recall at both timepoints (OR3=1.30, 95%CI:0.93-1.85, OR9=1.66, 95%CI:1.21-2.32). Reassessment of intervention effects showed no pattern of improved or worsened preventive behavior by 3-month recall among average-risk participants. However, higher-risk participants who correctly recalled at 3 months had greater odds of wearing sunscreen often or always (OR=1.97, p=0.04) and odds of undergoing a professional skin exam (OR=8.89; p=0.001) than those who did not recall or misremembered (OR=1.32, p=0.45, OR=6.36, p=0.007, respectively). Our results suggest the need for additional strategies, such as reinforcement, for Hispanics with lower education to boost recall, which may consequently improve adoption of preventive behaviors. Citation Format: John C. Lacson, Youngchul Kim, Steven K. Sutton, Richard G. Roetzheim, Susan T. Vadaparampil, Brenda Soto-Torres, Peter A. Kanetsky. Predictors of correct recall of MC1R genetic risk among Hispanic individuals participating in a skin cancer precision prevention trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1974.

Development and Validation of a Remote Monitoring Tool for Assessment of Mild, Moderate, and Severe Infections in Inflammatory Bowel Disease.

Immunomodulators and biologics are cornerstones in the management of inflammatory bowel disease [IBD], but are associated with increased risk of infections. Post-marketing surveillance registries are pivotal to assess this risk, yet mainly focus on severe infections. Data on the prevalence of mild and moderate infections are scarce. We developed and validated a remote monitoring tool for real-world assessment of infections in IBD patients. A 7-item Patient-Reported Infections Questionnaire [PRIQ] covering 15 infection categories was developed with a 3-month recall period. Infection severity was defined as mild [self-limiting or topical treatment], moderate [oral antibiotics, antivirals, or antifungals], or severe [hospitalisation or intravenous treatment]. Comprehensiveness and comprehensibility were ascertained through cognitive interviewing of 36 IBD outpatients. After implementation in the telemedicine platform myIBDcoach, a prospective, multicentre cohort study was performed between June 2020 and June 2021 in 584 patients, to assess diagnostic accuracy. Events were cross-checked with general practitioner and pharmacy data [gold standard]. Agreement was evaluated using linear-weighted kappa with cluster-bootstrapping to account for within-patient level correlation. Patient understanding was good and interviews did not result in reduction of PRIQ items. During validation, 584 IBD patients {57.8% female, mean age 48.6 (standard deviaton [SD]: 14.8), disease duration 12.6 years [SD: 10.9]} completed 1386 periodic assessments, reporting 1626 events. Linear-weighted kappa for agreement between PRIQ and gold standard was 0.92 (95% confidence interval [CI] 0.89-0.94). Sensitivity and specificity for infection [yes/no] were 93.9% [95% CI 91.8-96.0] and 98.5% [95% CI 97.5-99.4], respectively. The PRIQ is a valid and accurate remote monitoring tool to assess infections in IBD patients, providing means to personalise medicine based on adequate benefit-risk assessments.

Climate-related shocks and other stressors associated with depression and anxiety in Bangladesh: a nationally representative panel study

Climate change has major implications for common mental disorders including depression and anxiety in vulnerable nations such as Bangladesh. However, knowledge gaps exist around national estimations of depression and anxiety, and the associations between the prevalence of these disorders with climate-related and sociodemographic risk factors. To address these gaps, this study analysed data from a nationally representative panel study in Bangladesh that examined climate-related and sociodemographic correlates of depression and anxiety. Two rounds of nationally representative household panel data were collected from urban and rural areas between August and September, 2019, and January and February, 2020. Households were selected for inclusion across 150 enumeration areas as the primary sampling units with use of a two-stage stratified random sampling design, and survey instruments were administered to the available adult member of the household. Depression and anxiety were measured with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales, respectively, and weighted prevalence estimates were calculated on the basis of the 2011 national population census. Data on temperature and humidity were collected from 43 weather stations and constructed as mean values for the 2-month period preceding each round of the survey. Self-reported exposure to flooding was collected for a 12-month recall period. We applied a weighted population average logistic model on the pooled sample of both surveys to analyse the associations between ambient temperature, humidity, exposure to flooding, seasonality, sociodemographic variables, and three outcome conditions (depression, anxiety, and co-occurring depression and anxiety; at the level of p<0·1). The models accounted for temporal and spatial heterogeneity. Standard errors were clustered at the level of each primary sampling unit. 3606 individuals were included with 3·5% dropout in the second survey round (pooled sample n=7086; age range 15-90 years; 2898 [40·9%] men and 4188 [59·1%] women). National weighted prevalence estimates were 16·3% (95% CI 14·7-17·8) for depression, 6·0% (4·7-7·3) for anxiety, and 4·8% (3·7-5·9) for co-occurring depression and anxiety. We observed no significant associations between overall seasonality (summer vs winter) and the odds of depression (adjusted odds ratio 3·14 [95% CI 0·52-19·13], p=0·22), anxiety (0·16 [0·02-1·41], p=0·10), or co-occurring depression and anxiety (0·13 [0·01-1·49], p=0·10). An increase in mean temperature of 1°C within the 2 months preceding the surveys was associated with increased odds of anxiety (1·21 [1·00-1·47], p=0·046) and increased odds of co-occurring depression and anxiety (1·24 [1·00-1·53], p=0·045), whereas increased temperature was not associated with depression (0·90 [0·77-1·04], p=0·15). An increase in mean humidity of 1 g/m3 was not associated with depression (0·99 [0·96-1·02], p=0·60) or anxiety (1·04 [0·99-1·09], p=0·13), but was associated with co-occurring depression and anxiety (1·06 [1·00-1·12], p=0·064). Exposure to flooding within the 12 months preceding the survey rounds was associated with increased odds of all outcome conditions (depression, 1·31 [1·00-1·70], p=0·047; anxiety, 1·69 [1·21-2·36], p=0·0020; and co-occurring depression and anxiety, 1·87 [1·31-2·68], p=0·0006). Climate-related shocks and other stressors have an important association with the burden of depression and anxiety in Bangladesh. Community-level interventions for common mental disorders need to be developed and assessed for safety, feasibility, and effectiveness in a Bangladeshi context. Further research on climate-related stressors is needed over different timespans and time intervals. The World Bank.

P503 The risk of mild, moderate and severe infections in IBD patients: results from a prospective, multicentre, observational cohort study – PRIQ

Abstract Background Immunomodulators and biologicals are essential in current IBD management, but are associated with increased risk of infections. Considering the growing number of treatment options, the benefit-risk balance of drugs is becoming increasingly important in clinical decision making. To date, post-marketing surveillance studies mainly focus on severe infections. As a result, data on mild and moderate infections are scarce. These infections take longer to clear in immunosuppressed patients and can substantially impact quality of life. We aimed to assess the incidence of all infections and identify risk factors for the development of infections in IBD patients. Methods We previously developed and validated a Patient-Reported Infections Questionnaire (PRIQ), with excellent diagnostic accuracy, covering 15 infection categories with a 3-month recall period. The current prospective, multicentre, observational cohort study was performed between Jun, 1 2020 and Jul, 1 2021, enrolling consecutive IBD patients using the PRIQ implemented in myIBDcoach, an established telemedicine platform. Infection severity was defined as mild (self-limiting or topical treatment), moderate (oral antibiotics, antivirals or antifungals) or severe (hospitalization or IV treatment). Incidence rates (IR) were calculated for all infections, stratified for severity and subtype. Risk factors for infections were identified using multivariable logistic regression. Results In total, 629 IBD patients were included which completed 2391 PRIQs during 572 person-years (PY) of follow-up, resulting in 990 reported infections, corresponding to IRs of 17.3, 11.8, 5.1, and 0.4 per 10PY for all, mild, moderate, and severe infections, respectively (Tables 1-2). Upper respiratory tract (IR 26.9/100PY) and urinary tract infections (IR 14.8/100PY) were the most commonly reported mild and moderate infections (Table 3). Compared to patients without treatment, patients on immunosuppressives more frequently experienced infections of any severity (mild: IR ratio (IRR) 1.57 [95%CI 1.21-2.06] p&amp;lt;0.001, moderate: IRR 1.42 [95%CI 1.20-1.69] p&amp;lt;0.001). On multivariable logistic regression, female sex (mild aOR 1.96; moderate aOR 1.71), smoking status (mild aOR 1.66; moderate aOR 1.86), higher BMI (moderate aOR 1.05), and more comorbidities (mild aOR 2.41; moderate aOR 1.82) were all significantly associated with the development of mild and moderate infections (Table 4). Conclusion In this real-world prospective study, immune suppressive therapy was associated with mild and moderate infections of any kind in IBD patients. These infections particularly occur in females, smokers, patients with higher BMI and more comorbidities. This information should be considered in personalised treatment selection.

The efficacy of non-surgical platelet-rich fibrin application on clinical periodontal parameters and periostin level in periodontitis: Clinical trial.

Platelet-rich fibrin (PRF) has been widely used in regenerative dentistry due to many growth factors produced. Periostin, a matricellular protein, is a reliable marker for tissue regeneration. Periostin is part of the cellular matrix and regulates bone homeostasis. This study aims to explore the efficacy of PRF in improvement of the clinical periodontal parameters as an adjunct to the scaling and root planing and to evaluate periostin level in gingival crevicular fluid (GCF) at baseline, 1- and 3-month recall visits. Fourteen periodontitis patients who met the inclusion criteria were recruited in this study. Two contralateral periodontal pockets with 4-6 mm in depth in each patient were selected. The sites in every participant were randomly allocated into control sites or test sites. In control sites, only conventional scaling and root planing was carried out. In test sites, however, scaling and root planing method and PRF were applied. Periostin level in GCF and clinical periodontal parameters were measured. The test sites revealed greater relative attachment gain (2.614 ± 0.606 mm and 3.321 ± 0.668 mm) than control sites (1.285 ± 0.671 mm and 1.839 ± 0.632 mm) and a significant pocket reduction (2.535 ± 0.664 mm and 3.321 ± 0.668 mm) than the control sites (1.21 ± 0.508 mm and 1.892 ± 0.655 mm) at 1- and 3-month recall visits respectively. In the test sites, level of periostin (48.83 ± 9.3ng/μl and 98.90 ± 24.94 ng/μl) were greater than periostin levels in the control sites (42.65 ± 7.03 ng/μl and 49.29 ± 15.14 ng/μl) at 1- and 3-month recall visits respectively. In conclusion, the non-surgical application of PRF as an adjunct to scaling and root planing significantly improved the clinical periodontal parameters through raising periostin level in GCF.

An evaluation of the long-term wear of a distal extension-removable partial denture on abutment teeth that have undergone periodontal therapy

Although the evidence is clear on the long-term effects of removable partial dentures (RPDs) on the periodontal health of abutment and non-abutment teeth, little work has been done on the periodontal outcomes of the remaining teeth previously treated with periodontal therapy. The aim of this study was to evaluate the effect of denture loading on teeth previously exposed to periodontal treatment with additional photo-disinfection. Twelve partially edentulous patients classified as having mandibular Kennedy Class I arches were included. In each quadrant of the mandibular arch, the terminal abutment was diagnosed to have untreated chronic periodontitis. Initially, all the affected abutments received a conservative periodontal treatment in form of scaling and conventional root debridement. Patients were randomly received additional treatment with photodynamic therapy in one of the mandibular quadrants (test group). After the periodontal treatment, a 4-week load-free period was planned. Mandibular distal extension RPDs was fabricated to restore the missing teeth. The clinical periodontal parameters including plaque index (PI), gingival index (GI), gingival recession (GR), probing pocket depth (PD), clinical attachment level (CAL) and tooth mobility (TM) were assessed at baseline, and then for two additional 6-month recall appointments over a period of twelve months after prosthetic treatment. In addition, the mean annual vertical bone loss was also assessed. Except for the PI, GR, and PD, values for the mean GI, CAL, and TM scores at the test group were significantly lower than those in the control group. Better annual vertical bone loss results were observed on the proximal sides of abutments treated with additional photodynamic therapy. The results of this study suggest that RPD abutments affected by chronic periodontitis may perform better as abutments for distal extension RPDs when treated with both conventional root debridement and additional antimicrobial photodynamic therapy.

Self-Medication Among the Elderly and Factors Associated with It

Objective: Our study aims to assess the frequency of self-medication in elderly people of Karachi, identify its reasons and associated risk factors. Study Design &amp; Setting: This cross-sectional study was conducted in waiting areas of OPDs at Liaquat National hospital and its outreach centers. Methodology: Study duration was June-December, 2021. We approached all patients and aged 60 years and above. After taking written informed consent, targeted population was interviewed to find out self-medication performed within last three months and its reason and causes. Participants’ demographics, symptoms for which self-medication was performed, different type of medications used, reasons of opting self-medication and different approaches for dose adjustment were also investigated. Data was recorded by a pre-designed questionnaire. Data was analyzed using SPSS version 21. Result: Out of 200 elderly included in the study, 87% of them reported self-medication in a 3-month recall period. Pain (63.8%), fever (56.9%), headache (50%), cough, and cold (37.4%) were the most common symptoms. Pain killers (81.6%), fever-reducing drugs (58%) and cough syrup (39.1%) were the top three medicines used for self-medication. One-fifth of the respondents reported self-medication of antibiotics. Top three frequent reasons for self-medication were convenience (99.4%), disease of mild nature (85.1%) and for quick relief of symptoms (78.7%). None of the patient’s demographic factors were found to be associated with self-medication practice. Conclusion: Self-medication is a highly prevalent practice in elderly people of Karachi including non-prescribed usage of antibiotics. Major reforms in primary health care are needed to address this growing problem

Health Care Utilization in Systemic Sclerosis Patients With Digital Ulcers.

Digital ulcers (DUs) occur in half of the patients with systemic sclerosis (SSc) and require health care interventions for treatment and monitoring for complications. Our objective was to assess the impact of DUs on resource utilization, including hospitalizations, outpatient visits, and procedures within a large SSc Canadian registry in a matched cohort study. A total of 1,698 SSc patients who completed 1 or more 84-item Resource Utilization Questionnaire (RUQ) for a 12-month recall period between September 2005 and February 2020 were included (9,077 questionnaires). Organ involvement was assessed by the Disease Severity Scale (DSS) on the Medsger scale. Unadjusted and adjusted regression analyses compared the association between DUs and resource utilization. RUQs in 104 SSc patients with active DUs at 2 consecutive annual visits were compared with 104 patients without DUs matched 1:1 for age, sex, disease subtype, and duration. Over 1 year, DUs were associated with a higher number of tests (P ˂ 0.05) and visits to health professionals, especially to a rheumatologist (P ˂ 0.0001) and internist (P=0.003), a greater need for an accompanying person (P ˂ 0.05), and aids purchased/received (P ˂ 0.05). Having DUs was associated with more severe disease, even after excluding the peripheral vascular domain from a total DSS score (9.7 ± 4.5 versus 5.6 ± 2.7, P ˂ 0.0001). After adjustment for disease severity in other organs, the presence of DUs remained a significant predictor of more frequent physician visits and more tests (P for all ˂ 0.05) by linear regression analysis. SSc patients with DUs used significantly more health care resources per year even after adjustment for disease severity in other organ systems.

PCR127 Impact of Dry Eye on Daily Life and Patient Satisfaction Using Eye Drops. Psychometrics Properties of a New Scale

Dry eye disease (DED) affects quality of life. Ocular Surface Disease Index (OSDI) and Dry Eye questionnaire (DEQ-5) are two frequently used tools. OSDI is psychometrically sound but its 12-item does not cover all the patient experience. DEQ-5 validity is questioned and the 1-month recall period may introduce a memorization bias. Aim of this study was to check the psychometrics properties of a new scale capturing a wider picture of patient perception.

Management of Multiple Idiopathic Root Resorption in a Rheumatoid Arthritis Patient: A Case Report with 4-year Follow-up

Cervical root resorption is a rare destructive disease that originates from the external cervical root surface. It has a multifactorial etiology. Cervical root resorption may affect several teeth and its treatment can be complicated due to the size, location, and extension of the resorptive defect. Rheumatoid arthritis is a chronic inflammatory autoimmune disease that has systemic effects. The objective of this article was to report a rare case of multiple idiopathic cervical resorptions in a patient with rheumatoid arthritis. A 52-year-old male patient with a 20-year history of rheumatoid arthritis was diagnosed with multiple idiopathic cervical resorptions through cone-beam computed tomography (CBCT) and clinical examination. All known causes for cervical resorption were ruled out after a detailed anamnesis. This report details inflammation due to rheumatoid arthritis as a possible cause of idiopathic cervical resorption. The systemic alterations wrought by rheumatoid arthritis could be related to the etiopathogenesis of cervical root resorption. Non-surgical endodontic treatment was done for the maxillary left canine. The defect was surgically repaired using bioceramic putty. The 12-month recall revealed the good healing of the periodontal and periradicular conditions with no obvious clinical symptoms. At the 36-month recall visit, clinical and radiographic evidence of deterioration in the repair material was observed. At the 54-month follow-up, deterioration of repair material was observed with an increase in the extension of resorption in tooth 14 was detected. Reasons for this deterioration remain unclear. Ruling out all other factors for cervical root resorption, how rheumatoid arthritis contributes to cervical root resorption is still lacking/unclear. Dental care providers must be vigilant for signs of cervical root resorption in vulnerable patients with rheumatoid arthritis for early diagnosis and prompt treatment. Keywords: External root resorption, Inflammatory markers, Multiple root resorption, Rheumatoid arthritis, Resorption repair.

Recurrence of an Episode of Low Back Pain: An Inception Cohort Study in Emergency Departments.

To (1) determine the 1-year estimate of recurrence of low back pain (LBP) in a cohort of people presenting to emergency departments who have recently recovered from an episode of acute LBP in a middle-income country, (2) estimate a recurrence of LBP stratified by the STarT Back Screening Tool (SBST), and (3) determine prognostic factors for the recurrence of LBP. Prospective inception cohort study. We included 238 patients who presented to emergency departments with recent-onset nonspecific LBP in São Paulo, Brazil. The outcome was the recurrence of an episode of LBP, assessed using 2 definitions: (1) 12-month recall alone and (2) pain measurements at follow-up. Prognostic factors were determined by logistic regression. Within 1 year, the estimated recurrence of an episode of LBP ranged from 35% (79/225 events) (first definition) to 44% (100/226 events) (second definition). When patients were stratified by the SBST, the estimate of recurrence ranged from 29% to 37% (21-27/73 events) for low-risk patients, from 33% to 39% (24-28/72 events) for medium-risk patients, and from 43% to 56% (34-45/80 events) for high-risk patients. Age, perceived risk of persistent LBP, and disability were independent prognostic factors associated with LBP recurrence within 1 year. After recovering from a previous episode of acute LBP, 4 in every 10 patients experienced a recurrence within 1 year. This estimate varied depending on the classification used in the SBST. Within 1 year, age, perceived risk of persistent LBP, and baseline disability were predictors of recurrence. J Orthop Sports Phys Ther 2022;52(7):484-492. Epub: 18 May 2022. doi:10.2519/jospt.2022.10775.

Comparative Assessment of Retention and Caries Protective Effectiveness of a Hydrophilic and a Conventional Sealant-A Clinical Trial.

Sealants are highly efficient and the most secure method for the prevention of caries lesions from pits and fissures in recently erupted permanent teeth. The aim of this study is to clinically assess and compare the retention and evolution of caries of a moisture-tolerant resin-based sealant with a conventional hydrophobic resin-based sealant. Material and method: We have included in the study 28 children with between 6 and 8 years old. For each child we sealed 4 permanent molars (a total of 112 teeth). The study group was divided into two subgroups: the Embrace Group—consisting of 56 first permanent molars that underwent dental sealing with moisture-tolerant resin-based fissure sealant (Embrace™ WetBond™ Pulpdent, Watertown, MA, USA) and the Helioseal Group—represented by the same number of 56 first permanent molars that were sealed with conventional hydrophobic resin-based sealant (Helioseal F™, Ivoclar Vivadent Schaan, Liechtenstein). The retention and the incidence of new carious lesions of each sealant were assessed clinically at 6, 12, 18, and 24 months. Results: The 12-month follow-up assessment showed perfect integrity in 50 molars (89.28%) sealed with moisture-tolerant resin-based material (Embrace Group), and in 51 molars (91.07%) with conventional resin-based sealant (Helioseal Group). At the 24-month recall, the retention was maintained in 44 molars (78.57%) in the Embrace Group and in 45 molars (80.35%) in the Helioseal Group, respectively. The follow-up assessments showed no statistically significant differences (p > 0.5) between the two materials regarding sealant retention. First evidence of new carious lesions was present at 12 months on two molars sealed with Embrace WetBond and on one molar sealed with Helioseal. At the 24-month evaluation, the prevalence of caries in the Embrace Group was 7.14% (four caries) and 3.56% (two caries) in the Helioseal Group. Moreover, there were no statistically significant differences (p > 0.05) between the two materials regarding new caries development at any of the follow-up assessments. Conclusions: Moisture-tolerant resin-based sealant was effective in terms of retention and caries prevention.

A parallel randomised controlled trial of the Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised self-care (HARPdoc)

Impaired awareness of hypoglycaemia (IAH) is a major risk for severe hypoglycaemia in insulin treatment of type 1 diabetes (T1D). To explore the hypothesis that unhelpful health beliefs create barriers to regaining awareness, we conducted a multi-centre, randomised, parallel, two-arm trial (ClinicalTrials.gov NCT02940873) in adults with T1D and treatment-resistant IAH and severe hypoglycaemia, with blinded analysis of 12-month recall of severe hypoglycaemia at 12 and/or 24 months the primary outcome. Secondary outcomes included cognitive and emotional measures. Adults with T1D, IAH and severe hypoglycaemia despite structured education in insulin adjustment, +/− diabetes technologies, were randomised to the “Hypoglycaemia Awareness Restoration Programme despite optimised self-care” (HARPdoc, n = 49), a psychoeducation programme uniquely focussing on changing cognitive barriers to avoiding hypoglycaemia, or the evidence-based “Blood Glucose Awareness Training” (BGAT, n = 50), both delivered over six weeks. Median [IQR] severe hypoglycaemia at baseline was 5[2–12] per patient/year, 1[0–5] at 12 months and 0[0–2] at 24 months, with no superiority for HARPdoc (HARPdoc vs BGAT incident rate ratios [95% CI] 1.25[0.51, 3.09], p = 0.62 and 1.26[0.48, 3.35], p = 0.64 respectively), nor for changes in hypoglycaemia awareness scores or fear. Compared to BGAT, HARPdoc significantly reduced endorsement of unhelpful cognitions (Estimated Mean Difference for Attitudes to Awareness scores at 24 months, −2.07 [−3.37,−0.560], p = 0.01) and reduced scores for diabetes distress (−6.70[−12.50,−0.89], p = 0.02); depression (−1.86[−3.30, −0.43], p = 0.01) and anxiety (−1.89[−3.32, −0.47], p = 0.01). Despite positive impact on cognitive barriers around hypoglycaemia avoidance and on diabetes-related and general emotional distress scores, HARPdoc was not more effective than BGAT at reducing severe hypoglycaemia.

The effect of oolong tea as an adjunct to nonsurgical management of chronic periodontitis: A randomized controlled clinical trial

Introduction: Oolong tea, a functional food, has numerous therapeutic benefits owing to the presence of bioactive polyphenols, theasinensins (TS) and catechins. The present study aimed to evaluate the influence of systemic administration of oolong tea as an adjunct to nonsurgical periodontal therapy (NSPT) in the management of chronic periodontitis (CP).Methods: A total of 60 subjects with mild to moderate CP were randomly divided into two groups of tests (n = 30) and the controls (n = 30). They underwent NSPT with adjunctive oolong tea supplementation in the test group only. At baseline, 1, and 3 months, their gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment loss (CAL), percentage of sites with bleeding on probing (BOP), and lobene stain index (LSI) were recorded. Furthermore, the levels of glutathione peroxidase (GPx), total antioxidants (TAO), and malondialdehyde (MDA) were also estimated in gingival crevicular fluid (GCF), saliva and serum. Additionally, colony-forming units (CFUs) of selective supra and subgingival plaque bacteria were estimated in the plaque samples.Results: In both groups, at 1 month, the GI, PI, BOP, GPx, and TAO levels were improved with a reduction in the levels of MDA and CFU’s and no staining of teeth (P &lt; 0.05). The results were maintained in the test group at 3-month recall visit.Conclusion: Adjunctive administration of oolong tea with NSPT reduced the local and systemic oxidative burden and rapidly resolved the inflammation in CP. This would be specifically beneficial in CP subjects with systemic conditions.

Non-surgical management of a large periapical lesion using triple antibiotic paste: A case report

Root canal infection is considered to be a polymicrobial infection, consisting of both aerobic and anaerobic bacteria. Because of the complexity of the root canal infection, it is unlikely that any single antibiotic could result in effective sterilization of the canal. A combination of antibiotic drugs (metronidazole, ciprofloxacin, and minocycline/doxycycline in this case) is used to eliminate bacteria, which are possible sources of endodontic lesions. Case report describes the nonsurgical endodontic treatment of maxillary right central and lateral incisor with large periapical lesion. A triple antibiotic paste was used for 4 months at monthly interval. After 4 months, teeth was asymptomatic and was obturated. Complete periapical healing was observed at the 24-month recall. This report confirms that for treatment of a large periapical lesion it is not always necessary to do surgical treatment and even cyst-like periapical lesions heal following conservative endodontic therapy. The results of the case show that when most commonly used medicaments fail in eliminating the symptoms, then a triple antibiotic paste can be used clinically in the treatment of teeth with large periapical lesion.

Implants in GBR-Augmented Sites in Patients Treated for Generalized Aggressive Periodontitis: A 10- to 20-Year Prospective Case Series.

The aim of this case series was to evaluate implants inserted in bone after guided bone regeneration (GBR). Fourteen patients with generalized aggressive periodontitis (GAP) who had lost one or two maxillary teeth in the incisor or premolar region were enrolled in the study. Due to bone resorption, the lateral width and vertical height of the bone were insufficient for implant placement. GBR was carried out in a staged approach using titanium-reinforced e-PTFE (expanded polytetrafluoroethylene) membranes. No bone grafts or bone substitute materials were used. After 6 to 8 months, turned-surface implants (n = 47) were inserted in augmented and nonaugmented bone sites and prosthetically treated with single crowns. All patients were examined during a 3- to 6-month recall schedule over a 10- to 20-year period, and clinical and radiographic examinations were performed. GBR yielded mean vertical and lateral bone gains of 4.5 and 7.0 mm, respectively. The implant survival rate was 100%, mucositis was present in 28.8% of sites, and peri-implantitis was not found. The annual bone loss at tooth sites was significantly higher than at implant sites in augmented bone (0.5% vs 0.2%, respectively; P = .000), and the adjacent teeth had significantly higher annual bone loss (0.8%; P = .000). Thus, severely periodontally compromised patients can be managed successfully in the long-term with the described clinical protocol.

Retention Ability of a Glass Carbomer Pit and Fissure Sealant.

Dental sealants are an excellent means to prevent pits and fissure decay. Currently, there are multiple commercially available sealant materials. The purpose of this study was to assess the retention of glass carbomer fissure sealant and the incidence of secondary caries over a period of 24 months in comparison with a resin-based sealant. Materials and Methods: We included 32 children in the study, with ages between six and eight years and an average age of 6.8 years old. For each child, we sealed four permanent molars (totaling 128 teeth). The study group was divided into sub-groups. Sub-group A was represented by 64 first permanent molars which underwent dental sealing procedures with composite resin-based fissure sealant, Helioseal F™, and sub-group B was represented by 64 first permanent molars which underwent dental sealing procedures with glass carbomer cement, GCP Glass Seal™. The sealants were assessed clinically at 6, 12, 18, and 24 months. Results: The 6-month follow-up evaluation showed no statistically significant differences between the two materials neither regarding sealant retention nor new carious lesions formation (p > 0.05). At the 12-month recall, 57 molars had good retention (89.06%) from sub-group A and 44 molars (68.75%) from sub-group B; there was a statistically significant difference (p = 0.0187) between the two treatment choices only regarding material retention. At the last recall after 2 years, sub-group A had a higher number of molars with perfect sealing (47–73.43%) and 8 molars (12.5%) with new caries lesions and sub-group B had 23 (35.93%) molars with perfect sealing and 15 molars (23.44%) with new caries lesions; there was a statistically significant difference (p < 0.0001) between the two treatment choices only regarding material retention. Conclusions: The glass carbomer retention is very inferior to the resin-based material. The glass carbomer sealant was effective in preventing new caries development, comparable with the conventional resin-based sealant.

Evaluating construct validity of the Asthma Impairment and Risk Questionnaire using a 3-month exacerbation recall

BackgroundRecurrent assessment of asthma control is essential to evaluating disease stability and intervention impacts. An assessment that can be administered between annual clinic visits is needed. The Asthma Impairment and Risk Questionnaire (AIRQ) is a cross-sectionally validated, 10-item, yes or no, composite control tool evaluating previous 2-week symptoms and previous 12-month exacerbations. ObjectiveTo evaluate the construct validity of the AIRQ using a 3-month recall period for exacerbation-based risk questions and retaining the 2-week recall for symptom-based impairment items. MethodsAt baseline, patients completed the AIRQ with 12-month recall exacerbation items, Asthma Control Test (ACT), St. George's Respiratory Questionnaire (SGRQ), and global self-assessments of asthma risk, control, and symptom severity. Patient-reported exacerbations were captured monthly. The AIRQ with 3-month recall exacerbation items, ACT, and global self-assessments was administered at months 3, 6, and 9, and SGRQ at month 6. ResultsA total of 1112 patients aged 12 years or older were enrolled (mean [SD] age, 43.9 [19.5] years). The AIRQ and each administration of the AIRQ with 3-month recall exacerbation items classified asthma control similarly to an ACT plus exacerbation validation standard. For both AIRQ versions, SGRQ scores were higher with worsening asthma control (P < .001). At months 3, 6, and 9, worse AIRQ control levels were associated with higher proportions of patients with 1 or more and 2 or more exacerbations in the previous 3 months and patient global self-assessments indicating greater asthma morbidity (all P < .001). ConclusionThe AIRQ using exacerbation risk items with a 3-month recall period exhibits construct validity for classifying current asthma control and can be administered between annual AIRQ assessments.

The Deficit Schizophrenia Subtype Is Associated with Low Adherence to the Mediterranean Diet: Findings from a Case-Control Study.

Accumulating evidence indicates that individuals with schizophrenia show poor dietary habits that might account for increased susceptibility to cardiovascular diseases in this population. However, it remains unknown whether this observation can be generalized over the whole population of individuals with schizophrenia. Therefore, in this study we aimed to investigate dietary habits, in terms of adherence to the Mediterranean diet (MD) in subjects with the deficit subtype of schizophrenia (SCZ-D), those with non-deficit subtype (SCZ-ND), and healthy controls (HCs). We recruited 45 individuals with SCZ-ND, 40 individuals with SCZ-D, and 60 HCs. Dietary habits were assessed using the Food Frequency Questionnaire-6 with a 12-month recall. Adherence to MD was decreased only in subjects with SCZ-D compared with HCs. Lower adherence to MD was associated with significantly higher levels of clinician-rated and self-reported negative symptoms (including alogia, avolition, and anhedonia). No significant correlations of adherence to MD with depressive symptoms were found. Lower adherence to MD was related to significantly higher body mass index in subjects with schizophrenia, but not in HCs. Our results indicate that poor adherence to MD is associated with a diagnosis of SCZ-D, higher severity of negative symptoms, and greater risk of developing overweight or obesity.