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BMJ Clinical Evidence Aug 2014The incidence of impacted wisdom teeth (third molars) is high, with some 72% of Swedish people aged 20 to 30 years having at least one impacted wisdom tooth. Impacted... (Review)
Review
INTRODUCTION
The incidence of impacted wisdom teeth (third molars) is high, with some 72% of Swedish people aged 20 to 30 years having at least one impacted wisdom tooth. Impacted wisdom teeth occur because of a lack of space, obstruction, or abnormal position. They can cause inflammatory dental disease manifested by pain and swelling of infected teeth and may destroy adjacent teeth and bone.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: Should asymptomatic, disease-free impacted wisdom teeth be removed prophylactically? What are the effects of different operative (surgical) techniques for removing impacted wisdom teeth? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We performed a GRADE evaluation of the quality of evidence for interventions.
RESULTS
We found 11 studies that met our inclusion criteria.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: prophylactic extraction, active surveillance, and different operative (surgical) techniques for extracting impacted wisdom teeth.
Topics: Humans; Molar, Third; Prophylactic Surgical Procedures; Tooth Extraction; Tooth, Impacted; United States
PubMed: 25170946
DOI: No ID Found -
The Cochrane Database of Systematic... Dec 2021A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. The prevalence of posterior crossbite is around 4% and 17% of children and... (Review)
Review
BACKGROUND
A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. The prevalence of posterior crossbite is around 4% and 17% of children and adolescents in Europe and America, respectively. Several treatments have been recommended to correct this problem, which is related to such dental issues as tooth attrition, abnormal development of the jaws, joint problems, and imbalanced facial appearance. Treatments involve expanding the upper jaw with an orthodontic appliance, which can be fixed (e.g. quad-helix) or removable (e.g. expansion plate). This is the third update of a Cochrane review first published in 2001.
OBJECTIVES
To assess the effects of different orthodontic treatments for posterior crossbites.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 8 April 2021 and used additional search methods to identify published, unpublished and ongoing studies.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of orthodontic treatment for posterior crossbites in children and adults.
DATA COLLECTION AND ANALYSIS
Two review authors, independently and in duplicate, screened the results of the electronic searches, extracted data, and assessed the risk of bias of the included studies. A third review author participated to resolve disagreements. We used risk ratios (RR) and 95% confidence intervals (CIs) to summarise dichotomous data (event), unless there were zero values in trial arms, in which case we used odds ratios (ORs). We used mean differences (MD) with 95% CIs to summarise continuous data. We performed meta-analyses using fixed-effect models. We used the GRADE approach to assess the certainty of the evidence for the main outcomes.
MAIN RESULTS
We included 31 studies that randomised approximately 1410 participants. Eight studies were at low risk of bias, 15 were at high risk of bias, and eight were unclear. Intervention versus observation For children (age 7 to 11 years), quad-helix was beneficial for posterior crossbite correction compared to observation (OR 50.59, 95% CI 26.77 to 95.60; 3 studies, 149 participants; high-certainty evidence) and resulted in higher final inter-molar distances (MD 4.71 mm, 95% CI 4.31 to 5.10; 3 studies, 146 participants; moderate-certainty evidence). For children, expansion plates were also beneficial for posterior crossbite correction compared to observation (OR 25.26, 95% CI 13.08 to 48.77; 3 studies, 148 participants; high-certainty evidence) and resulted in higher final inter-molar distances (MD 3.30 mm, 95% CI 2.88 to 3.73; 3 studies, 145 participants, 3 studies; moderate-certainty evidence). In addition, expansion plates resulted in higher inter-canine distances (MD 2.59 mm, 95% CI 2.18 to 3.01; 3 studies, 145 participants; moderate-certainty evidence). The use of Hyrax is probably effective for correcting posterior crossbite compared to observation (OR 48.02, 95% CI 21.58 to 106.87; 93 participants, 3 studies; moderate-certainty evidence). Two of the studies focused on adolescents (age 12 to 16 years) and found that Hyrax increased the inter-molar distance compared with observation (MD 5.80, 95% CI 5.15 to 6.45; 2 studies, 72 participants; moderate-certainty evidence). Intervention A versus intervention B When comparing quad-helix with expansion plates in children, quad-helix was more effective for posterior crossbite correction (RR 1.29, 95% CI 1.13 to 1.46; 3 studies, 151 participants; moderate-certainty evidence), final inter-molar distance (MD 1.48 mm, 95% CI 0.91 mm to 2.04 mm; 3 studies, 151 participants; high-certainty evidence), inter-canine distance (0.59 mm higher (95% CI 0.09 mm to 1.08 mm; 3 studies, 151 participants; low-certainty evidence) and length of treatment (MD -3.15 months, 95% CI -4.04 to -2.25; 3 studies, 148 participants; moderate-certainty evidence). There was no evidence of a difference between Hyrax and Haas for posterior crossbite correction (RR 1.05, 95% CI 0.94 to 1.18; 3 studies, 83 participants; moderate-certainty evidence) or inter-molar distance (MD -0.15 mm, 95% CI -0.86 mm to 0.56 mm; 2 studies of adolescents, 46 participants; moderate-certainty evidence). There was no evidence of a difference between Hyrax and tooth-bone-borne expansion for crossbite correction (RR 1.02, 95% CI 0.92 to 1.12; I² = 0%; 3 studies, 120 participants; low-certainty evidence) or inter-molar distance (MD -0.66 mm, 95% CI -1.36 mm to 0.04 mm; I² = 0%; 2 studies, 65 participants; low-certainty evidence). There was no evidence of a difference between Hyrax with bone-borne expansion for posterior crossbite correction (RR 1.00, 95% CI 0.94 to 1.07; I² = 0%; 2 studies of adolescents, 81 participants; low-certainty evidence) or inter-molar distance (MD -0.14 mm, 95% CI -0.85 mm to 0.57 mm; I² = 0%; 2 studies, 81 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: For children in the early mixed dentition stage (age 7 to 11 years old), quad-helix and expansion plates are more beneficial than no treatment for correcting posterior crossbites. Expansion plates also increase the inter-canine distance. Quad-helix is more effective than expansion plates for correcting posterior crossbite and increasing inter-molar distance. Treatment duration is shorter with quad-helix than expansion plates. For adolescents in permanent dentition (age 12 to 16 years old), Hyrax and Haas are similar for posterior crossbite correction and increasing the inter-molar distance. The remaining evidence was insufficient to draw any robust conclusions for the efficacy of posterior crossbite correction.
Topics: Adolescent; Bias; Child; Dental Care; Dentition, Permanent; Europe; Humans; Malocclusion
PubMed: 34951927
DOI: 10.1002/14651858.CD000979.pub3 -
Scientific Reports Nov 2021Molar-Incisor Hypomineralization (MIH) is a qualitative defect of enamel of unknown etiology, affecting one or more permanent molars and may include incisors. This... (Meta-Analysis)
Meta-Analysis
Molar-Incisor Hypomineralization (MIH) is a qualitative defect of enamel of unknown etiology, affecting one or more permanent molars and may include incisors. This condition is a clinical challenge and its prevalence is still uncertain given the recent increase in research. Thus, we aimed to comprehensively estimate the overall prevalence of MIH and associated characteristics. This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, MEDLINE, CENTRAL, Web of Science, SciELO, LILACS and TRIP databases, until July 2021. Heterogeneity and publication bias were computed via I test statistics and Egger's significance test, respectively. Random-effects meta-analysis of prevalence were processed. We used the Strength of Recommendation Taxonomy [SORT] to grading the strength of evidence. Overall, 116 observational studies were included, with one study with moderate methodological quality and the remaining of high methodological quality. Subgroup analysis confirmed an influence of not using the 2003 MIH case definition (p = 0.0066). The pooled prevalence of MIH was 13.5% (95% CI 12.0-15.1, I = 98.0%). Affected incisors were seen in 36.6% (95% CI 30.0-43.7, I = 92.5%) of the cases. Lastly, the prevalence of hypomineralization of the second primary molars was observed in 3.6% of the MIH cases (95% CI 1.9-6.8, I = 96.3%). America was the continent with highest prevalence (15.3, 95% CI 12.8-18.3, p < 0.001, I = 96.3%) and Asia had the lowest prevalence (10.7, 95% CI 8.5-13.5, p < 0.001, I = 98.7%), however no continental differences were found. Sample size and year of publication were slight contributing factors to the heterogeneity in the analysis. Overall, these results were classified with a SORT A recommendation.
Topics: Dental Enamel Hypoplasia; Disease Susceptibility; Genetic Predisposition to Disease; Global Health; Humans; Incisor; Molar; Phenotype; Population Surveillance; Prevalence; Risk Factors; Severity of Illness Index; Sex Factors
PubMed: 34789780
DOI: 10.1038/s41598-021-01541-7 -
Medicina Oral, Patologia Oral Y Cirugia... Jan 2022The main objective of this systematic review was to collect the pre-existing scales for assessing the difficulty of third molar extraction. The secondary objective was...
BACKGROUND
The main objective of this systematic review was to collect the pre-existing scales for assessing the difficulty of third molar extraction. The secondary objective was to design a proposal for a preoperative evaluation protocol for the difficulty of third molar extraction.
MATERIAL AND METHODS
Two independent researchers conducted an electronic search in Pubmed (MEDLINE), Cochrane, and Scopus databases during March 2021. Included studies evaluated the prediction of the difficulty of surgical removal of impacted upper or lower third molars using new indices/scales or pre-existing scales with or without modifications. Articles referring to coronectomies or assessing pre-surgical difficulty using other tools were excluded. Neither language nor publication date restrictions were applied.
RESULTS
Out of 242 articles, 13 prospective cohort studies were finally selected. Seven developed new indices/scales, and 6 assessed the predictive ability of some pre-existing scales. Most of the indices/scales contained radiological variables and few added any patient-related variables. We proposed a preoperative assessment protocol of the difficulty of third molar extraction to facilitate treatment planning and/or considerate referral in cases of high difficulty. This proposal used patient-related, radiological and surgical variables.
CONCLUSIONS
Using a preoperative protocol to evaluate the surgical difficulty, including different patient-specific, radiological and surgical variables, could facilitate treatment planning, help clinicians prevent complications and assess the possibility of referral.
Topics: Humans; Molar, Third; Prospective Studies; Tooth Extraction; Tooth, Impacted
PubMed: 34874928
DOI: 10.4317/medoral.24951 -
European Journal of Paediatric Dentistry Dec 2021The aim of this systematic review was to evaluate the clinical outcome of partial pulpotomy, pulpotomy and pulpectomy for treating primary teeth with normal or infected...
AIM
The aim of this systematic review was to evaluate the clinical outcome of partial pulpotomy, pulpotomy and pulpectomy for treating primary teeth with normal or infected pulp or with irreversible pulpitis.
METHODS
Two reviewers on Pubmed and ISI Web of Science performed a comprehensive literature review of publications from 1966 until July 2019. Pico outline was used to facilitate literature research. Among abstracts, publications were selected according to the following criteria: prospective clinical study, correct indication for the performed treatment, clear definition of clinical and/or radiographic success criteria and at least 6-month follow-up period. The strict selection criteria under the keywords "pulpotomy", "partial pulpotomy" and "pulpectomy" resulted in a limited amount of randomised controlled trials (RCT) or controlled clinical trials (CT). Qualitative assessment of the selected clinical studies and level of evidence was included according to the criteria described by the Oxford Centre for Evidence-Based Medicine (CEBM).
CONCLUSION
Prerequisites for a successful pulpotomy are symptom-free teeth, sterile removal of coronal pulp and haemostasis. Both MTA and formocresol perform well for partial pulpotomies after caries exposure. Formocresol had been the most popular amputation material for pulpotomies. Due to the potential side effects, other medicaments, such as ferric sulfate, mineral trioxide aggregate (MTA) or NaOCl are suggested. Grey and white MTA yeld the same results. Lasers are not recommended due to their large diversity. Regarding pulpectomy, the conditions, procedures, and evaluation for the treatment were not well defined in the studies. Nevertheless, there is evidence to use calcium hydroxide, zinc oxide eugenol paste or iodoform based pastes as root filling materials for non-vital molars. Pulpectomies showed better success rates than pulpotomies. Stainless steel crowns are recommended as definite restorations after both endodontic treatments. Longer follow-up periods, further clinical studies with comparable conditions and clear definition of evaluation criteria are needed to further confirm the results of endodontic treatment in primary teeth.
Topics: Calcium Compounds; Drug Combinations; Humans; Molar; Oxides; Pulpectomy; Pulpotomy; Silicates; Tooth, Deciduous; Treatment Outcome; Zinc Oxide-Eugenol Cement
PubMed: 35034465
DOI: 10.23804/ejpd.2021.22.04.4 -
Journal of Oral Rehabilitation Jan 2022Alveolar osteitis (AO) is a poorly understood, common, painful complication following exodontia. It is sometimes managed by inappropriate prescription of antibiotics... (Review)
Review
BACKGROUND
Alveolar osteitis (AO) is a poorly understood, common, painful complication following exodontia. It is sometimes managed by inappropriate prescription of antibiotics which contributes to the global threat of antimicrobial resistance. Use of intra-alveolar chlorhexidine also presents a serious risk of anaphylaxis to the patient.
OBJECTIVE
This scoping review aims to investigate the aetiology, prevention and management of AO and highlight the extent of inappropriate prescribing and intra-alveolar chlorhexidine use.
DESIGN
A scoping review was undertaken using the PRISMA guidelines. Medline, Ovid and Pubmed were searched between 2010 and 2020, from which 63 studies were selected for review that related to the aetiology, prevention or management of AO. Data were analysed for frequency of studies reporting information on risk factors for aetiology, prevention strategies and management including inappropriate management using antibiotic prescribing and intra-alveolar chlorhexidine.
RESULTS
Impaired immune response, surgical technique and age were identified as significant factors in the development of AO, while there is conflicting evidence regarding the effects of smoking and gender. With regard to prevention, the use of prophylactic antibiotics is not supported within the literature. Saline irrigation and eugenol pastes used preventively have been shown to be cheap and effective alternatives to chlorhexidine with no adverse effects. Hyaluronic acid and low-level laser therapies showed a significant reduction in pain and soft-tissue inflammation in the management of AO compared to Alveogyl.
CONCLUSIONS
Further understanding of the pathophysiology of AO is needed, in addition to large high-quality RCTs or long-term observational studies into the aetiology, prevention, and management of AO to produce up-to-date evidence-based clinical guidelines. Clinicians should also be mindful of their contribution to growing antimicrobial resistance and avoid inappropriate prescribing of antibiotics. Saline should replace chlorhexidine as the intra-alveolar irrigant of choice.
Topics: Chlorhexidine; Dry Socket; Humans; Molar, Third; Smoking; Tooth Extraction
PubMed: 34625985
DOI: 10.1111/joor.13268 -
Dentistry Journal Apr 2023Molar incisor hypomineralization (MIH) is a defect of the dental enamel that predominantly affects first molars and permanent incisors. Identifying the significant risk... (Review)
Review
Molar incisor hypomineralization (MIH) is a defect of the dental enamel that predominantly affects first molars and permanent incisors. Identifying the significant risk factors associated with MIH occurrence is essential for the implementation of prevention strategies. The purpose of this systematic review was to determine the etiological factors associated with MIH. A literature search was carried out from six databases until 2022; it covered pre-, peri-, and postnatal etiological factors. The PECOS strategy, PRISMA criteria, and the Newcastle-Ottawa scale were used, and 40 publications were selected for qualitative analysis as well as 25 for meta-analysis. Our results revealed an association between a history of illness during pregnancy (OR 4.03 (95% CI, 1.33-12.16), = 0.01) and low weight at birth (OR 1.23 (95% CI, 1.10-1.38), = 0.0005). Furthermore, general illness in childhood (OR 4.06 (95% CI, 2.03-8.11), = 0.0001), antibiotic use (OR 1.76 (95% CI, 1.31-2.37), = 0.0002), and high fever during early childhood (OR 1.48 (95% CI, 1.18-1.84), = 0.0005) were associated with MIH. In conclusion, the etiology of MIH was found to be multifactorial. Children with health disorders in the first years of life and those whose mothers underwent illnesses during pregnancy might be more susceptible to MIH.
PubMed: 37232762
DOI: 10.3390/dj11050111 -
Healthcare (Basel, Switzerland) Jun 2023(1) Background: Molar-incisor hypomineralization (MIH) is a clinical condition affecting permanent teeth in children, with a documented rising trend in the last two... (Review)
Review
(1) Background: Molar-incisor hypomineralization (MIH) is a clinical condition affecting permanent teeth in children, with a documented rising trend in the last two decades. The aim of the present study was to analyze and synthesize the available evidence on caries experience (dmft/DMFT) and MIH in children. (2) Methods: A systematic review and meta-analysis were conducted according to the PRISMA statement. (3) Results: 59 papers published between 2007 and 2022 were included in the qualitative synthesis and 18 in the meta-analysis. The total sample of subjects was 17,717 (mean: 896), of which 2378 (13.4%) had MIH (mean: 119), with a girl/boy ratio of 1:1. The mean age of the enrolled participants was 8.6 (age range 7-10 years). Meta-analysis showed that MIH has a positive correlation with both dmft (effect size of 0.67, 95% CI [0.15, 1.19]) and DMFT (effect size of 0.56, 95% CI [0.41, 0.72]); (4) Conclusions: Children with MIH should be diagnosed correctly and on time. Treatment and management options for moderate and severe forms of MIH should consider prognosis based on known risk factors, and secondary and tertiary prevention policies should also consider the multifactorial nature of caries etiology.
PubMed: 37372913
DOI: 10.3390/healthcare11121795 -
The British Journal of Oral &... Jul 2021Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of preoperative,... (Review)
Review
Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of preoperative, perioperative, and postoperative antibiotic prophylaxis to reduce the incidence of surgical site infections must be balanced with considerations of a patients' risk of antibiotic-related adverse events. This review aimed to provide evidence-based recommendations for antibiotic prophylaxis. Searches were conducted using MEDLINE, the Cochrane Library, EMBASE, and PUBMED for maxillofacial procedures including: treatment of dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting, limited to articles published since 2000. A total of 98 out of 280 retrieved papers were included in the final analysis. Systematic reviews were assessed using AMSTAR criteria. Randomised controlled trials were assessed for bias using Cochrane Collaborative tools. The overall quality of evidence was assessed using GRADE. Prophylactic antibiotic use is recommended in surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants. Prophylactic antibiotic use is not routinely recommended in fractures of the upper or midface facial thirds. Further research is required to provide recommendations in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically-compromised patients.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Humans; Molar, Third; Surgery, Oral; Surgical Wound Infection
PubMed: 34016464
DOI: 10.1016/j.bjoms.2020.09.020 -
The Journal of Clinical Pediatric... Jul 2023This scoping review aims to summarize the available evidence on strategies employed in preventing caries in patients with molar incisor hypo-mineralization (MIH). MIH... (Review)
Review
This scoping review aims to summarize the available evidence on strategies employed in preventing caries in patients with molar incisor hypo-mineralization (MIH). MIH refers to an enamel defect involving opacities, and sometimes post-eruptive degradation due to enamel porosity; resulting in outcomes ranging from a mild atypical caries to severe coronary destruction. A systematic review was conducted for literature in PubMed, Cochrane Library, Epistemonikos and Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). The search was aimed at studies published between January 2010 and February 2022. Data were independently selected and extracted. 989 studies were found from the systematic search and 8 studies met the eligibility criteria. Most studies evaluated remineralization and cariogenic risk, both of which are crucial elements in caries prevention, as well as decreased sensitivity. The included studies investigated fluoride varnish, dental sealants, giomers, casein, and Icon as preventative methods for dental caries. Several methods for preventing dental caries in paediatric patients with MIH exist, but more research is needed to determine their effectiveness and safety. Any preventive intervention should consider the etiological aspects of the disease, the risk of caries, the type and extent of lesions, hypersensitivity level and patient's age. Collaboration between patients and carers is critical for disease diagnosis and caries prevention.
Topics: Humans; Child; Dental Caries; Dental Enamel Hypoplasia; Molar Hypomineralization; Dental Enamel; Molar; Prevalence
PubMed: 37408341
DOI: 10.22514/jocpd.2023.030