Clinical Dental Practice Research Articles

Oral Health-Related Quality of Life among Implant-Supported Full-Mouth Rehabilitation Patients Treated in a University Dental Hospital - A Retrospective Study

Full-mouth rehabilitation is the restoration of the form and function of the masticatory apparatus. Complete dentistry has five comprehensive goals in full-mouth rehabilitation: anatomic harmony, optimal oral health, best aesthetics, occlusal stability, and functional harmony. Oral health-related quality of life (OHRQoL) has become an important issue in the clinical practice of dentistry. Loss of complete natural teeth and resorption of alveolar bone are considered oral health impairment because they hinder the mastication, phonetics, and aesthetics of the stomatognathic system. A questionnaire was prepared regarding the oral health-related quality of life of implant-supported full-mouth rehabilitation patients, using 2,637 patient records first identified and analyzed according to specific inclusion criteria. Patients who did not fulfill the criteria were not included. Seven patient records were finalized and a telephonic conversation was held to administer the questionnaire. The results obtained were first categorized and analyzed via SPSS as follows: age: 46-60 years; gender: males (57.1%), females (42.9%); difficulties in food chewing: yes (28.6%), no (57.1%), sometimes (14.3%); crown fitting: yes (14.3%), no (85.7%); pain in tissue while masticating: sometimes (14.3%), never (85.7%); self-conscious: yes (57.1%), no (71.4%); changes from natural tooth: yes (28.6%), no (71.4%); difficulties compared with natural teeth: chewing difficult (14.3%), pain (14.3%), no difficulties (71.4%). Within the limits of the study, it was seen that patients with implant-supported full-mouth rehabilitation have improved appearance, better satisfaction, and higher quality of life.

Guideline for dental office in the wake of novel corona virus-19: A summary of proposals

The novel corona virus-19 pandemic has presented an unprecedented challenge to human civilization, and clinical dental practice is one among the most affected sectors. As the virus spread via saliva and droplets, the risk of exposure for dental health care providers is the maximum, for the unique work pattern, like their proximity to patient’s nasal and oral cavity, their handling with blood and saliva etc. In this discussion, we have tried to share our thoughts, and also we have compiled recommendation from different regulatory bodies and present an operational guideline for regular dental practice to ensure infection control during the pandemic.

Assessment of Practical and Emotional Consequences of Novel Coronavirus Emergence on Clinical Dental Practice in Egypt: A Cross Sectional Study

Background: Novel COronaVIrus Disease 19 (COVID-19) outbreak has a great impact on every aspect of life. It caused an emergency status in the health system worldwide. In dentistry, it represents one of the challenges that most of the dentists and patients are facing. This survey was conducted to highlight the practical changes in dental practice created by COVID-19 emergence, and its impact on dentists’ feelings and concerns especially after Egyptian national administrative order of 15 March 2020 (Egypt Declared Partial Curfew). Methods: An anonymous online survey, formed of 23 questions, was sent to 293 dentists practicing in Egypt. Results: Almost all of the respondents (96.6%) closed or reduced their activity to urgent procedures only, 81.9% of patients canceled their appointments after 15 March 2020, and 75.1% of the dentists reported difficulties in finding Personal Protective Equipment. Also, 97.6% of the dentists reported worry of acquiring COVID-19 while working. When thinking about it, 44% of the participants reported anxiety, 28.7% concern, 16.4% fear, only 10.6% felt sad. They overall were worried about their professional future. Most of the dentists believed that some improvements could be effective. Conclusions: COVID-19 pandemic has high negative impact on dentists and dental practice in Egypt.

Protocols of digital diagnostics in patients with reduced lower third of the face

Determination of interalveolar height and centric relationship is a crucial problem in clinical dental practice, because possible failures lead to non-physiological position of mandible, which, in turn, can cause development of temporomandibular joint dysfunction and masticatory muscles disorders. The aim was to improve traditional protocol for determining interalveolar height and centric relationship in patients with reduced lower third of face. Materials and methods. 75 patients (27 men and 48 women) with tooth wear of II—III degree of severity and reduced lower third of face, suffered from pain, tension, fatigue, hypertension of masticatory muscles were examined. All patients were determined interalveolar height and centric relationship using the proposed method: first of all, instrumental diagnostics was performed (anatomico-instrumental method for determining interalveolar height and centric relationship with the help of gnathometer, created using special computer programs), and then the X-ray one (cone-beam computed tomography of temporomandibular joints with fixed together gnathometer’s bases in patient’s mouth). This method is described in clinical case. Results. It was achieved optimal condylar position and no pain in temporomandibular joints and masticatory muscles in the patient. Conclusion. Thus, high accuracy of diagnostics is achieved, due to the use of digital technologies at all clinical and laboratory stages.

Traumatic ulcerative granuloma with stromal eosinophilia: Uncommon or misdiagnosed?

Oral ulcers with different presentations and etiologies are common findings in a dental clinical practice. Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a rare, solitary, self-limiting lesion that may persist from weeks to months. Its indurated margins combined with its rapid development and delayed healing are often confused with oral malignancy and are frequently neglected or more concerningly misdiagnosed by clinicians due to limited knowledge and awareness. The cause, although still rather debated, is believed to be trauma. We present a case of TUGSE in a 65-year-old Chinese male who presented with a history of a painful, nonhealing ulcer of 2 months in duration on the labial mucosa. The ulcer clinically mimicked oral squamous cell carcinoma clinically. There was no evidence of lymph node involvement. With the patient's history and excisional biopsy results, the lesion was diagnosed as TUGSE.

РОЛЬ ЛУЧЕВЫХ МЕТОДОВ ДИАГНОСТИКИ У ПАЦИЕНТОВ С ПРИОБРЕТЕННЫМИ ДЕФЕКТАМИ ЧЕЛЮСТНО-ЛИЦЕВОЙ ОБЛАСТИ

Purpose. To compare radiological methods in clinical dental practice of the patients with acquired defects of the maxillofacial region after tumor treatment manipulations. The search of literature has been done in the date bases SCOPUS, Web of Science, Pubmed, Russian Science Citation Index. The usage of different radiology methods combined with IT-technology makes it possible to improve prosthetic dental treatment of the patients with acquired defects of the maxillofacial region, especially of large anatomical size. However, difficult clinical condition and complicated anatomical relations of the acquired defect do not always allow to choose the specific method or technology. This fact effects on quality of the future dental prosthetic denture. Conclusion. According to the obtained data, both visual analysis and semi-quantitative assessment of 18Ffluorodeoxyglucose PET/CT images showed a good diagnostic performance in the detection of PV IE. The optimal parameter for the diagnosis of IE PV is the SUVratio using aorta with threshold of 1.95 (AUC=0.961).

Classification of Patients by Occlusal Condition

Objective: To propose a classification of patients by occlusal condition and its apparent validation . Material and Methods: This cross-sectional analytical study was divided into two phases. In the first, a trained examiner divided the patients into four groups according to the proposed classification of this design: Type 1 patient – completely dentate individuals; Type 2 - partially edentulous individuals with occlusal stability; Type 3 - partially edentulous individuals with no occlusal stability; Type 4 – completely edentulous individuals. In this phase, 122 patients were analyzed with an instrument developed for this experiment. Results: All patients in the sample of this research were classified in some division of the proposed instrument. In the second phase, the apparent validation of the classification was conducted by three judges, who obtained an excellent agreement with the allocation of patients in one of the types according to the indication of the first examiner (Kappa = 85%) . Conclusion: It is evident that the classification presents reliability, ease of visualization, good conditions for interprofessional communication, and it can be used in dental clinical practice to assist in the study and integrated planning of clinical cases.

Using Concept Videos to Teach Predoctoral Dental Students About Intraoral and Extraoral Photography.

IntroductionClinical photography in dentistry has become a vital part of dental education and clinical practice. Dental students seek demonstrations that help them visualize and understand new concepts and clinical procedures. Few multimedia resources are available that provide instruction regarding clinical photography for dental students. The concept videos serve as adjunctive teaching tools for predoctoral dental students in taking clinical photographs.MethodsI created the three concept videos on intraoral and extraoral photography by recording narrated PowerPoint slideshows. After sessions on basic photography concepts and digital camera operation, I used concept videos to show how to take comprehensive quality dental photographs in a step-by-step manner and to demonstrate positions of an operator and a patient. I collected feedback using an electronic survey sent to all 33 third-year dental students who participated.ResultsEleven students completed the survey; all students responded favorably to this method of instruction. Individual comments were also positive on helpfulness, conciseness, and applicability.DiscussionThese concept videos were shown to be a helpful resource for dental students in enhancing their knowledge and skills in obtaining dental photographs. Multimedia resources that helped provide students with practical tips and suggestions could supplement clinical chair-side teaching with faculty and further advance their knowledge and skills. Future studies could include more interactive platforms for better student utilization of the resource, and also compare students' performance before and after watching the videos.

Fidelity of motivational interviewing with families in high-caries-risk children.

Motivational interviewing (MI) is a promising behavioural intervention for prevention of dental caries in children. Few studies have reported on fidelity of MI delivered in dental settings. The aim of this paper is to explore the fidelity of implementing MI in a clinical dental practice setting, as part of an intervention study investigating caries-preventive effects of MI delivered to high-caries-risk children and their primary caregivers. Three oral health therapy clinicians trained in MI (counsellors) provided MI to high-caries-risk children and their primary caregivers. All MI sessions (n=34) were audio-recorded and analysed using the MI Treatment Integrity code 4.2.1. Qualitative analysis of counsellor self-reflections identified barriers to MI delivery. All counsellors were found to adhere to the MI process and demonstrated fair to good MI proficiency for global scores, with a mean (95% CI) of 3.3 (3.1-3.4) recorded for technical scores and 3.6 (3.5-3.8) for relational scores. The mean (95% CI) per cent complex reflections was 23% (19.4-27.1) and the mean reflection:question ratio was 0.7 (0.6-0.9). No significant differences were observed between counsellors for MI proficiency. Cultural barriers, environmental distractions, participant dental anxiety and counsellor tendency towards prescriptive advice-giving were identified by counsellors as hindrances to effective MI. Motivational interviewing is a skill which requires multifaceted training, practice and mentoring to meet accepted proficiency thresholds. Monitoring of MI using a validated tool is essential to ensure delivery as intended and accurately attribute outcomes to the intervention. Dental organizations intending to implement MI for caries prevention should be aware of the demands on time and resources required to deliver proficient MI and monitor fidelity.

Diagnostic information content of indicators of cytokine profile of gingival fluid in pregnant women with iron deficiency anemia

Relevance. Modern literature and clinical dental practice do not provide enough information about the value of local immunity parameters for early diagnosis of inflammatory periodontal diseases in pregnant women with iron deficiency anemia. Conventional anti-inflammatory medications used to treat inflammatory periodontal disease are frequently contraindicated during pregnancy. It is important to make a reasonable choice of safe medications, prevention methods, and treatment at early stages of inflammatory periodontal diseases in pregnant women with iron deficiency anemia. The aim of the present study is to determine informative cytokine levels in gingival fluid for early diagnosis of inflammatory periodontal disease and evaluation of effectiveness of “Lysobact” medication in pregnant women with iron deficiency anemia (IDA).Materials and methods. Cytokine levels (IL-8, IL-10; IgA, IgG) in gingival crevicular fluid were investigated in 46 pregnant women aged 18-35: among them 16 (n = 16) had mild IDA (D50), 15 (n = 15) didn't have IDA, 15 (n = 15) were non-pregnant controls. «Lysobact» (Reg. #ПN0179/01-2002) was used in pregnant women with IDA; conventional antiinflammatory therapy was used to treat pregnant women without IDA, before and after drug therapy (8-10 days) according to clinical examinations.Results. There was determined diagnostic value of cytokine levels (IgA, IgG; IL-8, IL-10) that are of great importance for early diagnosis, evaluation of the course of the disease and effectiveness of “Lysobact” immunomodulating drug, and that significantly increase in pregnant women with IDA (IL-10 from 0.010 [1.790] to 3.050 [8.550] ng/ml) versus pregnant women without IDA (from 0.001 [1.259] to 2.900 [18.640] ng/ml) in comparison with controls (4.5 [1.13] ng/ml).Conclusion. Clinical laboratory results in pregnant women with inflammatory periodontal disease allowed to determine diagnostic value of gingival crevicular fluid parameters (sIgA, IgG; IL-8, IL-10) that are related to clinical periodontal index levels, and are informative non-invasive method and are of practical importance for early diagnosis of inflammatory periodontal disease and effectiveness of “Lysobact” drug in pregnant women with iron deficiency anemia.

A Comprehensive Review on Classification of Oral Ulcerative Lesions

Oral mucosal lesions are a broad group of lesions which are located in the soft tissues of the oral cavity identified by its specific etiology, clinical manifestations, differential diagnosis and treatment. White lesions of the oral cavity constitute a rather common group of lesions that are encountered during routine clinical dental practice. The process of clinical diagnosis and treatment planning is of great concern to the patient as it determines the prognosis. There should be in-depth knowledge to the consultant about the varied clinical features, etiology of the disease and various treatment plans. Clinical diagnostic skills and ideal judgment forms the key to successful management of white lesions of the oral cavity This review will discuss many of the most common intraoral white lesions including their clinical presentation, how to make an accurate diagnosis

Long-Term Follow-Up of Dental Rehabilitation of a Patient with Clouston Syndrome and Congenital Edentulism (Issues of Theory and Clinical Practice)

Abstract The article presents results of a concise analysis of domestic and foreign literature addressing the problem of determining of distinctive diagnostic features in patients with Clouston syndrome as an orphan disease rarely encountered in clinical practice of dentistry. A clinical case of effective orthopaedic rehabilitation of a 10-years-old patient with Clouston syndrome and congenital edentulism using minimally invasive orthopaedic dentistry measures: removable dentures application using shape memory materials is presented. Technological peculiarities and advantages of the chosen approach to treatment are described. Photographic documents of orthopaedic dental treatment results including long-term results within the follow-up period of 10 years are presented providing strong evidence of effective aesthetic, functional and social rehabilitation of the patient. Detailed analytical conclusion is drawn according to the study results.

Minimizing transmission of coronavirus disease 2019 at the clinical dental practice

A brief introduction of unexpected occurrences of diseases that can become epidemic or pandemic such as what happened with COVID-19 is made. Current and anticipated global impact of the disease, characteristics and reported cases in China are described. Possible explanations and factors that may contribute or be responsible for possible transmission of diseases in the dental clinic are offered as well as emphasis on the need to exercise infection control strategies and special precautions to minimize Disease transmission are emphasized; additional precautions to implement for treating individuals that have been diagnosed of being infected with COVID-19 are given, as well as emphasis on the possibilities of treating asymptomatic patients; Advice on existence of protocols prepared by health organizations such as the US. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) are stressed and the lector is advised to visit websites that are available from CDC with detail information pertinent to protocols Health Care Providers can follow. Ideal recommendations as well as minimal recommendations to be followed by oral health care personnel and protection equipment are given. General facts related to survival of the COVID-19 virus that need to be taken into consideration are offered and precautions that health experts have recommended are also summarized.

Mechanical performance of Anatomic-Functional-Geometry dental treatments: A computational study

In this paper the biomechanical response of a novel dental preparation technique, referred to as the Anatomic-Functional-Geometry treatment (AFG), is investigated through a 3D nonlinear finite-element modelling approach. A comparative investigation against a standard technique employed in dental clinical practice is carried out, by simulating typical experimental mechanical tests and physiological functional conditions. Failure mechanisms of treated tooth models are investigated through a progressive damage formulation implemented via a displacement-driven incremental approach. Computational results clearly show that AFG-treated teeth, as a consequence of a more conservative morphological preparation of the tooth, are characterized by more effective crown-dentin loading transfer mechanisms, higher fracture strength levels and more homogeneous stress patterns than the standard-treated ones, thereby opening towards widespread clinical application.

Rethinking Assessment Concepts in Dental Education.

Introduction Dental education involves teaching and assessing the acquisition of verifiable domains that require superior psychomotor, communication, and cognitive skills. Evolving technologies and methods of assessment could enhance student's learning environment and improve tutor assessment experience. The aim of this study was to review the current body of research and evaluate the effectiveness of various methods of assessments in improving learning and performance in preclinical and clinical dental practice. Materials and Methods A search strategy was implemented using electronic search in major databases. The following key terms, clinical skills, preclinical, dental students, and assessment, were included in the search. Two reviewers independently screened all the articles retrieved following very specific inclusion criteria. Results The initial search generated 5371 articles and 24 articles were selected for review and data extraction. Cohen's kappa coefficient was used to measure interrater agreement and a score of 94.7% was obtained. Conclusion Preclinical assessment is an effective tool for promoting skills transfer to clinical phase. Early psychomotor skills assessment is valuable. It allows early intervention in the learning process and assists in effective utilization of learning resources. Technology-enhanced assessment systems allow better patient simulation, enhance learning and self-assessment experiences, and improve performance evaluation. However, these systems serve as an adjunct to conventional assessment methods. Further research should aim at calibrating and integrating these systems to optimize students learning and performance.

Association Between use of Interdental Cleansing Aids Gingival Conditions in Fixed Dental Prosthesis Patients

Background The fixed dental prosthesis are one of the most commonly used prosthesis which are difficult for cleansing in dental clinical practice especially the interproximal areas. As a result, periodontal disease most commonly develops in interproximal areas. The efficacy of using dental floss and interdental brushing in addition to tooth brushing reduce plaque and gingival inflammation. Objective To assess gingival condition in patients after placement of fixed dental prosthesis for a period of 3 months who regularly use or do not use dental floss and interdental brushing. Method Patients visiting the Dental Outpatient Department of Dhulikhel Hospital were selected for study. The examination was conducted using basic diagnostic tools (Mouth mirror, periodontal probe and explorer). The total number of patients involved in the study were 200. Teeth and gingiva were examined using the Plaque (Silness and Loe) and Gingiva Index (Löe and Silness). The examinations were conducted after 15 days and 3 months of placement of fixed dental prosthesis along with the oral hygiene instructions. Chi-square test and McNemar Bowker test were done to find statistical association using SPSS 20.0. Result Statistical analysis showed that there was association between frequency of interdental cleaning and plaque index (p=0.012) and gingival index (p=0.036) examined in 15 days and 3 months. Conclusion Use of Interdental cleansing aids was statistically significant to oral hygiene outcomes i.e. plaque index and gingival index. Oral hygiene instructions play a vital role in improving overall oral health.

Comparison of screening methods for obstructive sleep apnea in the context of dental clinics: A systematic review

ABSTRACT Objective To review the available bibliographic data to identify the best screening methods to detect potential obstructive sleep apnea (OSA) patients during dental clinical practice. Methods Relevant studies published up to April 2020 were sourced from PubMed, Embase, MEDLINE, Cochrane, and LILACS databases. Results Thirty studies were selected. For adults, the screening methods available to the dentist included questionnaires, scales, indexes, pulse oximetry, and anatomical factors. A combination of questionnaires is potentially the most reliable method to detect OSA risk. For children, only information on questionnaires and anatomical factors was found; two questionnaires accurately identified potential OSA risk cases. Anatomical factors also displayed a significant relation with OSA for both populations. Conclusion Dentists have a fundamental role in early detection of potential OSA cases since they can use the methods identified in this review to perform an initial screening of the population. Abbreviations OSA: Obstructive sleep apnea; PSG: Polysomnography; HST: Home sleep study; BMI: Body mass index; PPV: Positive predictive value; NPV: Negative predictive value; AHI: Apnea hypopnea index; RDI: Respiratory disturbance index; ODI: Oxygen desaturation index; PSQ: Pediatric Sleep Questionnaire; SRBD: Sleep-related breathing disorder; CSHQ: Children’s Sleep Habits Questionnaire; ESS: Epworth Sleepiness Scale; PSQI: Pittsburgh Sleep Quality Index

COVID-19 and dental clinical practice: Students and clinical staff perceptions of health risks and educational impact.

Due to the nature of the profession, dental healthcare workers are exposed to infectious diseases such as coronavirus disease 2019 (COVID-19), and the severity of the pandemic presents challenges to dental education institutions worldwide. This study investigated dental students and clinical staff perceptions of health risks and impacts on clinical competence of working in teaching clinics during the COVID-19 outbreak. A 39-item survey composed of closed and open questions was sent to students and clinical staff of a prominent Australasian dental school. Questions focused on students and clinical staff perceived impact of COVID-19 on their health, clinical safety and dental education. The majority of staff and students perceived their health to be at risk and this increased their stress and impacted clinical performance, particularly for students. The production of aerosols and violation of cross-infection protocols by some students were the main perceived contributors to COVID-19 cross-infection in teaching clinics. Both students and staff considered the closure of teaching clinics would cause extreme impacts on students' clinical competence; however, online case-based discussions and tutorials were suggested as potential alternative teaching methods that could be adopted during that period. The challenges of the COVID-19 pandemic also bring opportunities for dental education development; mainly in terms of infection prevention and control improvement, preparedness to respond to future contagious diseases, and exploring the benefits of online learning in dentistry.

Evidence-practice gap in minimal intervention dentistry: Findings from a dental practice-based research network

ObjectivesThis study aimed to 1) quantify the evidence-practice gap (EPG) between dental clinical practice and published evidence on Minimal Intervention Dentistry (MID) among dentists in Japan; and 2) examine the hypothesis that dentist characteristics have a significant association with the EPG. MethodsWe conducted a cross-sectional study via use of a web-based questionnaire survey of dentists who were affiliated with the Dental Practice-based Research Network Japan (n = 297). To quantify the EPG on MID, we used a questionnaire that included 10 clinical questions or scenarios to assess concordance between dental practice and published evidence on MID. We evaluated concordance by coding responses to each question as consistent or inconsistent with the evidence. An overall concordance was then determined as percent of responses that were consistent with published evidence for 10 questions. Subsequently, multiple logistic regression analysis was conducted to examine the associations between dentist characteristics and higher overall concordance (≥median) with published evidence. ResultsMean and median overall dentist-level concordance were both 60 % (SD: 18, interquartile range: 50–75 %). Logistic regression analysis showed that “gender of dentist”, “city population”, and “frequency of obtaining evidence from the scientific journal articles in English” were significantly associated with high concordance, with odds ratios (95 % CIs) of 2.33 (1.01–5.39), 2.01 (1.02–3.96), and 2.45 (1.08–5.59), respectively. ConclusionsJapanese dentists demonstrated medium concordance with published evidence, indicating that an EPG on MID exists in Japanese dental clinical practices. Dentist-specific characteristics had significant associations with high concordance with published evidence. Clinical SignificanceDespite the establishment and dissemination of the concept of MID, the EPG on MID exists in Japanese dental clinical practices. A high concordance was significantly associated with the following dentist characteristics: “female dentist”, “dental clinic location in a government-ordinance-designated city”, and “frequently obtaining evidence from the English-language scientific journal articles”

Current Clinical Dental Practice Guidelines and the Financial Impact of COVID-19 on Dental Care Providers.

The novel coronavirus disease 2019 (COVID-19) has been acknowledged as a pandemic by the World Health Organization (WHO). The aim of this study was to review guidelines issued by different health regulatory bodies amid the COVID-19 outbreak and financial constraints faced by dentists globally. Relevant papers and news articles were identified in Google Scholar and PubMed. The search was made using the keywords “COVID-19,” “COVID-19 and dentistry,” and “the financial impact of COVID-19 on dentistry.” Studies and news articles published in languages other than English were excluded and a final selection of 53 relevant studies, guideline documents, and news articles were made. The outbreak of COVID-19 has affected all businesses including general dental practices, which are suffering huge financial losses as they have been advised to provide only emergency dental care. These recommendations should be appreciated as a positive step but they have caused serious financial implications for dental practices. It can be concluded that current dental practice globally is limited to the provision of emergency treatments only. This step is appreciative, but has resulted in huge financial losses sustained by dental care providers (DCPs) worldwide. The governments and health regulatory bodies of developed countries are trying to help dental practices to evolve from this troublesome situation, but there is no visible policy from the underdeveloped world that could help the DCPs to save their practices from closing down due to the financial constraints.