Dentistry Research Articles

Dentists’ Treatment Decisions Concerning Restorations in Adult Patients in North Norway: A Cross-Sectional Tromsø 7 Study

Introduction: The aim of this cross-sectional study was to explore the degree whereby dentists differentiate between repair versus replacement for failed restorations. A random selection of adult patients from North Norway was chosen from the larger Tromsø 7 study. Methods: A randomized sample of 3,653 persons (11.5% of the total number of individuals invited to the Tromsø 7 study, 51.5% women, aged 40–93 years) were included. Based on FDI’s clinical criteria for the evaluation of restorations – 2010, 17 calibrated dentists evaluated patients by clinical and radiographical pictures in a specially designed software developed for this purpose. The dental practitioners’ opinions gave rise to the reported treatment decisions. Descriptive statistics and multivariable multilevel mixed-effect logistic regression models (STATA 17/SE) were performed. Results: The participants’ DMFT values ranged from 0 (0.9%) to 24 (8.8%) (median DMFT 21.3, mean 20.0). A total of 90.062 teeth (24.7 teeth per patient) were assessed. Re-treatment suggestions were made for 3,006 restorations, i.e., an average of 3.3% re-treatments. Of these, 25.3% (n = 814) were suggested for repair and 74.7% (n = 2,192) for replacement. Dental treatment was suggested for 1,597 patients and varying from 1 to 14 suggestions per patient. Secondary caries (37.6%) and restoration fracture (15.2%) were found to be most frequently used indications for re-treatment, surface properties the least. No significant difference was found between assessing dentists based on sex or age. Clustering by dentist level was checked using intra-class correlation coefficients, demonstrating that 16% of the variance in suggestions for restoration re-treatment was explained at the dentist level. Thus, a wide range of treatment suggestions was noted among the dentists. Conclusion: Need for restoration revision seems low in North Norway. There is a tendency towards larger and more indirect restorations, and the diagnosis of secondary caries is still a matter of uncertainty.

The Connection Between the Oral Microbiota and the Kynurenine Pathway: Insights into Oral and Certain Systemic Disorders

The oral microbiome, comprising bacteria, fungi, viruses, and protozoa, is essential for maintaining both oral and systemic health. This complex ecosystem includes over 700 bacterial species, such as Streptococcus mutans, which contributes to dental caries through acid production that demineralizes tooth enamel. Fungi like Candida and pathogens such as Porphyromonas gingivalis are also significant, as they can lead to periodontal diseases through inflammation and destruction of tooth-supporting structures. Dysbiosis, or microbial imbalance, is a key factor in the development of these oral diseases. Understanding the composition and functions of the oral microbiome is vital for creating targeted therapies for these conditions. Additionally, the kynurenine pathway, which processes the amino acid tryptophan, plays a crucial role in immune regulation, neuroprotection, and inflammation. Oral bacteria can metabolize tryptophan, influencing the production of kynurenine, kynurenic acid, and quinolinic acid, thereby affecting the kynurenine system. The balance of microbial species in the oral cavity can impact tryptophan levels and its metabolites. This narrative review aims to explore the relationship between the oral microbiome, oral diseases, and the kynurenine system in relation to certain systemic diseases.

Effects of Probiotic Therapy on Periodontal and Peri-implant Treatments: An Umbrella Review.

The effectiveness of nonsurgical periodontal treatment is related to patient- and tooth-related factors. To overcome the limitations of the conventional approach, probiotics are one of the adjunct therapies that have been studied. This umbrella review answered the focused question: in adult patients with periodontal diseases or peri-implant diseases, does the use of probiotic therapy as an adjuvant to nonsurgical periodontal treatment when compared with nonsurgical periodontal treatment alone affect treatment effectiveness and clinical disease parameters? A systematic electronic search to identify systematic reviews according to PICOS criteria, defined a priori, was used, and 5 electronic databases were searched (Medline, LILACS, Cochrane Central Registry of Controlled Trials, Google Scholar, and DANS EASY). Included systematic reviews were rated using quality assessment tools by 2 independent reviewers. Thirty systematic reviews were identified evaluating the effectiveness of probiotics in periodontal and peri-implant disease treatment. A quantitative analysis of the results was not possible due to the high heterogeneity of clinical data. Seventeen of 31 reviews reported clinically relevant benefits of probiotic therapy as an adjuvant to scaling and root planning. Twenty-two reviews had a low risk of bias, 7 had a moderate risk, and 2 had a high risk. The evidence from the available studies is conflicting, which means that no definitive conclusions can be made about the effectiveness of probiotic therapy as an adjuvant to nonsurgical periodontal treatment. High-quality primary research studies are needed that control for known confounding variables. This umbrella review provides some evidence regarding the efficacy of probiotics as an adjunct to nonsurgical periodontal therapy, despite some equivocal findings. However, short-term probiotic use alongside therapy appears to be advantageous; there is currently no evidence supporting their long-term benefits. We have also identified that probiotic research is primarily constrained by its origins in gastrointestinal applications, resulting in a lack of approved probiotics for dental use. This review highlights the need for extensive clinical research to ascertain their effectiveness in the oral environment. Nevertheless, the utilization of probiotics alongside periodontal treatment seems safe, with no reported adverse effects in patients. Thus, further clinical validations in oral health care settings are crucial.

Immigrant Parents' Knowledge and Attitudes: Sociodemographic Variation Related to Restriction of Children's Sugar Intake.

Focusing on immigrant parents with children aged 0-6 months, this study assessed whether awareness of and attitudes towards restricting children's sugar consumption vary according to family sociodemographic background and parents' oral-health-related behaviours. A cross-sectional study was conducted including immigrant parents attending child public health centers for vaccination of their children. The study included parents born in Asia, Africa, South America, Central America and Eastern Europe. Parents from Western Europe and North America were included if they were partners of the above-mentioned participants. Cross-tabulation and multiple variable logistic regression were used to assess associations of parental knowledge and attitudes with their child's sugar intake and sociodemographic characteristics. Overall, response rate was 72.6%. A total of 345 parents completed personal, structured interviews during their visit to the health centers. Attitudes and knowledge, but not indulgence, related to children's sugar restriction were sociodemographically unequally distributed among immigrant parents. Employed mothers, mothers with immigrant background from North America or Western Europe as well as parents with less frequent own sugar intake were more likely to confirm positive attitudes towards restricting children's sugar snacking. The corresponding odds ratios were OR=1.8 (95% CI 1.1-3.1) and OR=6.6 (95% CI 2.3-18.9). Employed mothers and parents having received dental care information were more likely than their counterparts to possess good oral-health-related knowledge. Parents from sociodemographically disadvantaged backgrounds were less inclined to express positive attitudes and demonstrate sufficient knowledge regarding the limitation of their children's sugar snacking. Culturally adapted oral health intervention programs should be implemented for immigrants, with special reference to children's dietary habits.

Impact of platelet-rich fibrin derivatives on patient morbidity and quality of life in palatal donor sites following free gingival graft surgery: a randomized clinical trial.

Platelet concentrates are biomaterials with significant potential in tissue regeneration, functioning as scaffolds with greater leukocyte inclusion and a flexible fibrin mesh. However these concentrates have different preparation methods and biological properties. The objective of this clinical investigation was to evaluate the effects of utilizing platelet-rich fibrin (PRF) materials (L-PRF and A-PRF) as a palatal bandage following free gingival graft (FGG) on patients' morbidity and oral health-related quality of life. Thirty-nine participants received FGG to promote keratinized tissue and treat gingival recession. Participants were randomly assigned to L-PRF, A-PRF, and control groups, with 13 participants in each. They used a visual analog scale (VAS) to rate their pain, analgesic medication use, dietary changes, discomfort, and bleeding at 1-7 days, 14 days and 1 month during the healing process. Patients' quality of life was assessed using the Oral Health Impact Profile (OHIP-14) at baseline, 1-7 days, 14 days, 1 month, and 6 months. There was no difference in anxiety levels between the all groups. (p > 0.05). The control group had higher OHIP-14 total scores than the other groups, but the differences were not statistically significant, especially in the first seven days (p > 0.05). In addition, the PRF groups showed an improvement in quality of life after 14 days, 1 month, and 6 months (p < 0.05). Patients' pain and suffering decreased with healing. The control group took more postoperative analgesics than PRF groups. In addition, there was a significant decrease in patient complaints about medicine intake, bleeding, pain, perceived sensitivity, and dietary modifications in all groups during follow-up. PRF palatal bandages may improve patient's quality of life, donor site healing, postoperative pain and morbidity. This study found that preserving the palate in FGG and employing PRF materials that speed palate healing reduce discomfort and morbidity.

The impact of oral health on depression: A systematic review.

As of 2020, about 21% of adults in the United States have a diagnosable mental health disorder, excluding substance use and developmental disorders. Depression, predicted by the WHO to be the leading cause of disease burden by 2030, is linked to various systemic conditions and has been associated with poor oral health. Both behavioral factors, like poor dental hygiene and irregular visits, and biological mechanisms, such as changes in salivary immunity, contribute to this connection, which impacts overall well-being and quality of life. This systematic review aims include: (1) Does tooth loss affect depression? (2) Does oral pain, such as that experienced during chewing and speaking, impact depression? (3) Does oral functionality, including chewing and speaking, influence depression? (4) Does overall oral health affect depression? We conducted a systematic search of PubMed, EBSCO host, Medline, and Google Scholar databases from January 2000 to June 2024 using relevant keywords. Studies examining the impact of oral health parameters (tooth loss, oral pain, oral functionality, overall oral health) on depression were included. Articles were included if (1) full text manuscripts in English were available, (2) the study described the association of oral health and depression, and (3) the independent value was an oral related factor and the dependent value was depression. The following were excluded from our analysis: (1) any articles where oral factors were not the independent value, (2) systematic reviews, (3) case reports, and (4) duplicate studies among our databases. Thirty-one studies met the inclusion criteria. Tooth loss, oral pain, and impaired oral functionality were consistently associated with increased depressive symptoms across the included studies. Greater tooth loss was linked to higher odds of both onset and progression of depression. Oral pain exacerbated depressive symptoms, while difficulties in chewing or speaking were associated with elevated risks of depression. There is a bidirectional relationship between oral health and depression, highlighting the urgent need for comprehensive public health initiatives. Integrating oral health assessments into routine medical care, and developing targeted interventions are crucial steps to mitigate the impact of poor oral health on mental health outcomes.

Associations of Chronic Marijuana Use with Changes in Salivary Microbiome

The legalization of marijuana (MJ) for medicinal and recreational use has raised concerns about its potential impact on health, including oral health. While MJ use has been linked to poor oral health, its effects on the composition of the oral microbiome remain unclear. This cross-sectional study analyzed saliva samples from chronic MJ users (n = 18) and nonusers (n = 20) to investigate MJ-related changes in salivary microbiome composition. We identified significant differences in the relative abundance of 16 taxa, including seven species, such as Megasphaera micronucliformis, Prevotella melaninogenica, and Streptococcus anginosus. Additionally, five species showed positive correlations with cumulative lifetime MJ use, including Streptococcus vestibularis and Streptococcus parasanguinis. By grouping salivary microbial communities into clusters based on their association with periodontal health, we found that the cluster with species associated with poor periodontal health had the highest percentage of MJ users. Moreover, MJ use significantly contributed to variance in microbial communities in individuals with relatively good periodontal health. These findings suggest that chronic MJ use is associated with alterations in the salivary microbiome, highlighting its potential broader impact on oral and systemic health.

Dentists' perceptions of providing care to community-dwelling older people.

This study explored the attitudes of New Zealand (NZ) general dental practitioners (GDPs) towards older adults living within the community and the barriers and difficulties caring for their oral health needs. Adults are living longer and retaining teeth. Their dentitions are complex and alongside their dental needs, older adults often experience age-related systemic disease or decline. Ageism and stereotypical views of older adults impedes access to dental care. While there is some understanding of older adults and ageism from the perspective of dental students, there is a paucity of knowledge about dentists' management of this patient demographic. A mixed-methods survey questionnaire collected quantitative and qualitative data. Quantitative data were analysed descriptively followed by bivariate analysis. Qualitative data responses to open-ended questions were analysed thematically. A total of 382 GDPs participated (response rate of 24%) and demonstrated positive attitudes and low levels of ageism towards older adults who they enjoyed treating. Confidence was positively related to clinical experience, and most dentists had engaged in gerodontology updates. Barriers to care for older adults were perceived to be beyond their control and mostly related to cost, chronic disease or age-related change. Consent processes could create difficulty and so collaboration with family or caregivers was important. The GDPs displayed positive attitudes and confidence towards older adults who are a rewarding patient cohort. Gerodontology education during training and following graduation is critical to enhance oral health outcomes for older patients.

Self-Perceived Oral Health Related to Eating Disorders-A Cross-Sectional Questionnaire Study.

To investigate oral problems experienced by patients with eating disorder (ED). A cross-sectional study where ED patients (n = 48) at two Swedish specialised clinics filled out a questionnaire about perceived oral health problems and habits, and specific behaviours related to ED. The majority exhibited poor eating and drinking habits, f.i. drinking light drinks (63%), and most of them were on medication (71%). The most common problems were hypersensitive teeth (three out of five) and perceived dryness of the mouth (almost four out of five). Likewise, pain in the teeth (38%) and the jaws (46%) was frequent. About one-third had been binge eating and/or vomiting in recent weeks and these behaviours were associated with pain in the teeth and snacking. Almost two out of three participants were concerned about informing their dentist or dental hygienist about their vomiting. The ED patients in this study experienced oral problems and exhibited many risk behaviours regarding oral health. Both dental staff and ED staff who meet ED patients should be aware of the risk of oral health problems and preventive measures should be taken.

A Pilot Study to Assess the Feasibility of Real-Time Teledentistry in Residential Aged Care Facilities

Background/Objectives: Unmet oral health needs of residents in residential aged care facilities (RACFs) arise due to the unique challenges of assessing oral health statuses and maintaining oral healthcare in RACFs. This pilot study assessed the feasibility of using real-time teledentistry under the guidance of a dentist to train RACF staff to undertake an oral health assessment. Methods: An oral health assessment of residents was first conducted by RACF staff at two Queensland, Australia RACFs using the Oral Health Assessment Tool, with an intra-oral camera connected to a laptop, through videoconferencing, under the guidance of a dentist. A survey recorded the views of RACF staff on the acceptability of the teledentistry method. The quality of the images obtained through the camera was assessed by the dentist. Finally, cost-effectiveness was calculated between teledentistry and traditional face-to-face assessments. Results: Sixteen residents (mean age 79.3 ± 8.68 years) and eight staff (mean age 33.3 ± 6.16 years) participated in this study. Both RACF staff and residents found that the real-time teledentistry set-up was user-friendly, while the dentist rated the quality of the images as acceptable for diagnostic purposes. Real-time teledentistry was more cost-effective than bringing a dentist on-site, while taking the RACF residents to an off-site dental office for examination was the most expensive approach. Conclusions: Real-time teledentistry is feasible and cost-effective, and it is an acceptable alternative to a face-to-face clinical exam for oral health assessment in RACFs. This approach could be used in RACFs where wireless internet connectivity is available.

Current State of Professionalism Curriculum in Oral Health Education.

The aim of this study was to systematically review the relevant literature on teaching professionalism in dental curricula and report the relevant data from a survey of members of the Association for Dental Education in Europe (ADEE) on the topic. We conducted a systematic review of the literature and a cross-sectional study using an online questionnaire regarding teaching and assessment of professionalism in dental schools, members of the ADEE. The literature review identified 33 articles related to professionalism in dental curricula. The survey sent to the membership of the Association for Dental Education in Europe yielded responses from 27 European dental schools and four schools outside Europe. Various study designs were identified in the review, and the main themes discussed included teaching/pedagogy, ethics/humanities, core domains and assessment of professionalism. Twenty schools reported having specific courses dedicated to professionalism, while the format varied, including entire modules, separate learning outcomes or unit structures. Ethics, communication, law/legal framework/deontology, teamworking and management/leadership were among the common topics taught under the banner of professionalism. Many schools reported increases or no changes in hours, staffing, themes/topics covered and weight in the curriculum for professionalism over the last decade. The paper provides valuable insights into the current state of professionalism education in dental curricula and offers directions for enhancing its effectiveness and relevance in preparing future dental professionals. Collaborative efforts among dental educators and institutions can contribute to the continuous improvement of professionalism education and practice in dentistry.

Dental fear and caries prevalence in schoolchildren with hearing impairment in Greece.

There have been limited reports on hearing impaired (HI) children's oral health, but no data on their dental fear. The aim of this study was to assess dental fear and caries prevalence in HI children and adolescents. Upon ethical approval, all elementary and junior/senior high schools for the HI in Greece were invited to participate in the study. Students were asked to fill in the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). High school students additionally answered the Modified Dental Anxiety Scale (MDAS). Both questionnaires were translated into sign language by the same licensed interpreter. Caries prevalence was evaluated by dmfs/DMFS indices. Statistics by SPSS Statistics 28 (IBM) included parametric and non-parametric tests (significance at p ≤ 0.05). 33 elementary and 53 junior/senior high school students (mean age = 10.89 ± 2.63 and 16.23 ± 1.33years, respectively) participated in the study. Means of CFSS-DS were 24.1 ± 9.9 and 26.9 ± 10.5, respectively. Mean MDAS (high school students) was 11.3 ± 4.7. Mean dmfs was 2.5 ± 5.2 for elementary and mean DMFS was 3.5 ± 5.4 for elementary and 7.3 ± 9.0 for high school students, higher than similar-age general population. Dental fear was not significantly associated to age, gender, severity of hearing impairment (HI) or caries prevalence. HI children present similar dental fear values, but higher caries prevalence compared to similar-age Greek hearing population.

Implementation and Effectiveness of a Nurse-Led Oral Hygiene Program for Schoolchildren: A Quasi-Experimental Study.

Good oral hygiene is essential for schoolchildren's well-being. However, lack of knowledge, negative attitudes, and poor oral hygiene practices may predispose to oral-related diseases. This study aimed to examine the effectiveness of a nurse-led oral hygiene program on schoolchildren's knowledge, attitudes, and practices. A quasi-experimental design with pre-and-post-test was used. Using the convenience sampling technique, we recruited 400 schoolchildren, aged 11-12 and in grades 5-6, from two primary schools in Egypt. The study was conducted from September 2022 to May 2023. The Oral Hygiene Program served as the primary intervention. This program contains health education topics (e.g., the importance of oral hygiene, techniques for effective tooth brushing, and dietary choices that promote dental health). Three visits were conducted (Visit 1: introduction of the program purpose and objectives and pre-test scores collection, Visit 2: implementation of oral hygiene topics, and Visit 3: post-test scores collection). We used three self-report instruments (Oral Health Knowledge Questionnaire, Hiroshima University's Dental Behavioral Inventory, and Oral Health Practice Questionnaire) for pre- and post-test. Paired T test and Pearson correlation analysis were used for data analysis. After the intervention program, the oral hygiene program effectively enhanced schoolchildren's knowledge, attitudes, and practices. The post-intervention mean scores were 7.83±0.488 (knowledge), 6.63±1.7 (practices), and 9.33±1.1 (attitudes). High statistically significant differences were noted between schoolchildren's oral health knowledge, attitudes, and practices before and after implementing the program (p=0.000). There were enhancements in the level of knowledge, with improved positive attitudes and satisfactory practices among schoolchildren after the implementation of the oral hygiene program. Integrating oral hygiene programs into the general curriculum in primary schools and training school nurses, caregivers, and teachers in implementing oral hygiene programs could improve oral health knowledge, attitudes, and practices for preventing oral problems.

The role of aryl hydrocarbon receptor in the occurrence and development of periodontitis

Periodontitis is a condition characterized by dysbiosis of microbiota and compromised host immunological responses, resulting in the degradation of periodontal tissues. The aryl hydrocarbon receptor (AHR), a ligand-activated transcription factor, plays a crucial role in the pathogenesis of periodontitis. AHR serves as a pivotal mediator for the adverse impacts of exogenous pollutants on oral health. Research indicates elevated expression of AHR in individuals with periodontitis compared to those without the condition. However, subsequent to the identification of endogenous AHR ligands, researches have elucidated numerous significant advantageous roles associated with AHR activation in bone, immune, and epithelial cells. This review concentrates on the modulation of the AHR pathway and the intricate functions that AHR plays in periodontitis. It discusses the characteristics of AHR ligands, detailing the established physiological functions in maintaining alveolar bone equilibrium, regulating immunity, facilitating interactions between the oral microbiome and host, and providing protection to epithelial tissues, while also exploring its potential roles in systemic disorders related to periodontitis.

Parental Stress in Autistic Children with Poor Oral Hygiene: A Pilot Study to Develop and Validate a Measurement Scale

Background/Objectives: Research indicates that children with autism spectrum disorder (ASD) exhibit a deficiency in skills and initiative when it comes to adhering to daily oral hygiene routines. This, in turn, increases the likelihood of oral pathologies, thereby placing a significant emotional strain on their parents. In addition to the typical stress they already experience, parents of children with ASD are also burdened with pediatric oral health issues. However, a review of the literature reveals a lack of studies measuring stress in parents of children whose oral health affects their autistic condition. This research aimed to design and to validate a stress scale for parents of autistic children with poor oral hygiene. Methods: The study used an exploratory, non-experimental design to validate and determine the reliability of the scale. Scale reliability was assessed through a cross-sectional pilot test to evaluate internal scale consistency, with a focus on item similarity. We used Aiken’s V to estimate the validity of the scale, and Cronbach’s α for calculating scale reliability. Calculations, estimations, and statistical analysis were conducted using SPSS. Results: Expert validation, a pilot test, and a cross-sectional, non-experimental design established the reliability of the scale. Conclusions: We conclude that the 20-item scale exhibits validity (0.95) and reliability (0.965), ensuring its applicability in future research.

Metalloproteinase inhibitors in the adhesion process dental

Matrix metalloproteinases (MMPs) are enzymes involved in tooth physiological development, caries processes, and hybrid layer degradation, in addition to being associated with dentin collagen breakdown. The interplay of MMP activity, masticatory forces, and biofilm action may, over time, compromise composite resin restorations. To reduce hybrid layer degradation by endogenous proteases and extend the longevity of resin restorations, MMP inhibitors and collagen cross-linking agents have been extensively studied. This work aims to identify, through a literature review, agents capable of inactivating MMPs at the dentin adhesive interface. This integrative review, based on studies retrieved from PUBMED/MEDLINE, LILACS, BBO, and VHL databases, identified 19 agents able to inhibit MMP activity at the adhesive-dentin interface in studies published between January 2018 and June 2023. It can be concluded that several agents can partially or completely block MMP activity, thereby enhancing restoration longevity. However, further studies are required to facilitate the clinical use of these agents, beyond chlorhexidine, in dental practice, with the application techniques suited to dentists’ daily clinical routines.

The impact of an online gamified virtual tour on cognitive enhancement in dental practice management.

Dental practice management is usually a mandatory course for both undergraduate and postgraduate programs. However, learners and educators may encounter challenges in gaining experiences in real-life dental practice. The concept of a gamified virtual tour could have potential to improve dental practice management skills. A quasi-experimental study was conducted to evaluate the educational impact of a gamified virtual dental clinic (GVDC) on dental practice management skills among dental undergraduates (UG) and postgraduates (PG). All participants were assigned to complete the GVDC. Pre- and post-knowledge assessments were administered to evaluate knowledge acquisition. A self-administered questionnaire was distributed to investigate user perceptions toward the use of GVDC. There were 20 dental undergraduates and 20 orthodontic residents participating in UG and PG groups, respectively. Both groups demonstrated statistically significant increases in their assessment scores after completing the GVDC (P < 0.001). Although the pre-knowledge assessment score of the PG group was notably higher than that of the UG group (P = 0.041), there was no statistically significant difference in their post-knowledge assessment score (P = 0.491). Participants had positive perceptions of GVDC in terms of usefulness, ease of use, and enjoyment, with no statistically significant differences between the two groups (P > 0.05). Overall, the GVDC demonstrated positive educational impacts on acquiring knowledge and understanding of dental practice management, with participants expressing favorable perceptions of this immersive learning intervention.

Unintentionally Retained Elevator Blade Left for 8 Years Causes Mild Chronic Pain.

Fracture of surgical instruments in dental practice is not usually reported in the literature. Management involves searching for and retrieving the fragment to avoid issues such as infection, swallowing, or aspiration. Although foreign bodies may not cause symptoms for years, some can cause chronic pain. The authors describe herein the unusual case of an unintentionally retained broken elevator blade left for 8 years before being found during an orthodontic evaluation. Panoramic radiography revealed a foreign body in the alveolar bone of the right mandibular third molar that was causing mild chronic pain. The patient was unaware whether routine radiographic examination had revealed its presence. Cone-beam computer tomography was performed to identify the position of the blade fragment, and surgery was performed to retrieve it. The mild chronic pain disappeared after removal. It is advisable to use high-quality surgical instruments and to perform routine checkups before and after surgery.

COVID-19 pandemic: mental health (distress as depression) in orthodontists

ABSTRACT Objectives For health professionals, pandemic conditions impacted all societal aspects, including economic, wellness, and mental health. This study analysed sociodemographic factors, post-traumatic stress disorder symptoms (PTSD), and depression levels caused by the coronavirus disease 2019 (COVID-19) pandemic in orthodontists. Materials and Methods A sociodemographic questionnaire, the Impact of Event Scale (IES), and the Patient Health Questionnaire (PHQ-9) were used. Following data collection, multiple statistical analyses were applied: scores were compared using the Mann-Whitney and Kruskal-Wallis tests, followed by Dunnett's multiple comparisons. The association between variables was verified using Chi-square or likelihood ratio tests. Multiple logistic regression models were estimated after bivariate logistic regression tests (p < 0.10). The final models using the Stepwise backward selection method were assessed for variables at 5%. Results Of the respondents, 69.3% were women, and their mental health questionnaire scores were significantly higher (p < 0.001). The IES avoidance and PHQ-9 scores were statistically different between the age groups (p = 0.040 and p < 0.001, respectively). Subjective distress was associated with years of practice, monthly income, fear of contracting COVID-19 during dental care, transmitting COVID-19 to patients, and thinking about the future (p < 0.05). Depression was significantly associated with orthodontic practice type, self-confidence in providing dental care, pandemic impact on dental practice, remote care, monthly income, changes in financial expenses, fear of contracting COVID-19 and thinking about the future (p < 0.05). Conclusion Over half of the orthodontists experienced moderate-to-severe mental distress, and the same number suffered from mild-to-severe depression during the pandemic. Registration: Ethics and Research Committee (CEP) of the Faculty of Dentistry of the University of São Paulo (FOUSP): CAAE: 34223720.1.0000.0075 Protocol: 4.191.353

Reliability and utility of blood glucose levels in the periodontal pockets of patients with type 2 diabetes mellitus: a cross-sectional study

Background Several studies have measured gingival blood glucose (GBG) levels, but few have confirmed systematic bias using Bland–Altman analysis. This study compared the effectiveness of GBG levels with that of fingertip blood glucose (FTBG) levels using Bland–Altman and receiver operating characteristic (ROC) analyses. Methods A total of 15 healthy volunteers and 15 patients with type 2 diabetes were selected according to inclusion and exclusion criteria. Each group comprised eight male and seven female participants. The GBG and FTBG levels were measured using a self-monitoring blood glucose device after periodontal examination. Pearson’s product‒moment correlation and simple linear regression analyses were performed. In addition, Bland‒Altman analysis was also performed to assess the degree of agreement between the two methods. ROC analysis was conducted to determine the sensitivity, specificity, and cutoff values for patients with diabetes. The area under the ROC curve (AUC) was used to identify significant differences. Results The mean GBG and FTBG levels were 120 ± 44.8 mg/dL and 137 ± 45.1, respectively, for the whole sample. The mean GBG and FTBG levels were 145 ± 47.2 mg/dL and 163 ± 49.1, respectively, in the diabetes group. The mean GBG and FTBG levels in the nondiabetes group were 95.3 ± 25.2 and 111 ± 18.8, respectively. Patients with diabetes were more likely to have a probing pocket depth (PPD) of ≥4 mm at the sampled site. Pearson’s product‒moment correlation and simple linear regression analyses revealed a significant correlation between the GBG and FTBG measurements. Bland–Altman analysis revealed that GBG and FTBG measurements differed significantly among all participants; however, no significant differences were observed among the patients with diabetes (mean difference (MD) ± standard deviation (SD) = −18.1 ± 34.2, 95% confidence interval (CI) [−37.0 to 0.88]) or among the participants with a PPD of ≥4 mm (MD ± SD = −15.2 ± 30.4, 95% CI [−30.8 to 0.43]). The sensitivity, specificity, and cutoff values of the GBG measurements for detecting diabetes were 80%, 93%, and 123.5 mg/dL, respectively. The sensitivity, specificity, and cutoff values of the FTBG measurements for detecting diabetes were 73%, 87%, and 134.0 mg/dL, respectively. No significant differences were observed between the AUCs (0.078, 95% CI [−0.006 to 0.161]). Conclusions The GBG measurements aligned with the FTBG measurements in the patients with diabetes and among the participants with a PPD of ≥4 mm. Patients with diabetes were more likely to have a PPD of ≥4 mm at the sampled site, GBG levels can be used to screen for type 2 diabetes in dental clinics.