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The Journal of Evidence-based Dental... Jun 2021Coronary disease and Hypertension are highly prevalent health problems worldwide, with the latter being one of the most common diseases in patients visiting dental... (Review)
Review
BACKGROUND
Coronary disease and Hypertension are highly prevalent health problems worldwide, with the latter being one of the most common diseases in patients visiting dental clinics. Local anesthetics (LAs) with vasoconstrictor agents (VC) are known to be commonly used in dental practice. For the above-mentioned reasons, dentists should know how to adapt and treat patients with these hazardous conditions.
OBJECTIVE
The aim of this study was to find out if the use of local anesthetics (LAs) in combination with vasoconstrictor (VC) agents in dental treatment presents a risk in patient with a known history of Hypertension and/or Coronary disease.
MATERIALS AND METHODS
This systematic review was conducted in accordance with The PRISMA guidelines and registered on the PROSPERO database (CRD42020187369). The search strategy was based on Mesh terms, Boolean operator AND, and the PICO model. It was designed to identify all the randomized clinical trials (RCTs) published in the last 30 years, which assessed whether the use of LA with VC agents in dental treatment produces a significant increase/decrease in hemodynamics in patients with known history of Hypertension and/or Coronary disease. The Cochrane Collaboration's tool was used to assess risk of bias of the included RCTs.
RESULTS
An initial electronic search resulted in 87 papers; however only 9 RCTs met the inclusion criteria. There was a total of 482 subjects (N = 482), of which 412 had a known history of Hypertension or Coronary disease.
CONCLUSIONS
According to the literature reviewed, the use of 1 to 2 cartridges of local anesthetics with 1:80,000, 1:100,000 or 1:200,000 epinephrine in patients with controlled Hypertension and/ or Coronary disease is safe. Randomized clinical trials are essential in determining the safety or risks associated with the use of LAs with VC agents in patients with poorly controlled Hypertension and Coronary disease.
Topics: Anesthetics, Local; Coronary Artery Disease; Dental Care; Humans; Hypertension; Vasoconstrictor Agents
PubMed: 34391560
DOI: 10.1016/j.jebdp.2021.101569 -
International Journal of Environmental... May 2020Musculoskeletal diseases and pain (MSDs) are prevalent among dental professionals. They cause a growing inability to work and premature leaving of the occupation. Thus,...
Musculoskeletal diseases and pain (MSDs) are prevalent among dental professionals. They cause a growing inability to work and premature leaving of the occupation. Thus, the objective of this review was to summarize the evidence of ergonomic interventions for the prevention of MSDs among dental professionals. This review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was carried out in May 2018, with an update in April 2019. Scientific databases such as MEDLINE, CINAHL, PubMed and Web of Science as well as reference lists of the included studies were used. Relevant data were extracted from the studies and summarized. The quality assessment was performed using a validated standardized instrument. Eleven studies were included in this review, of which four are of high quality. Eight studies focused on setting prevention strategies. Of those, in five studies, magnification loupes or prismatic spectacles were the subject of ergonomic interventions. Further subjects were the dental chair ( = 2) and dental instruments ( = 1). Three studies evaluated ergonomic training. In all studies, the ergonomic interventions had positive effects on the study outcome. Several ergonomic interventions to prevent MSDs among dental professionals were found to exert a positive effect on the prevalence of MSDs or working posture. This systematic review adds current evidence for the use of prismatic spectacles in order to prevent MSDs among dental professionals. Further intervention studies about the role of ergonomics for the prevention of MSDs among dental professionals are warranted.
Topics: Dentists; Ergonomics; Humans; Musculoskeletal Diseases; Occupational Diseases; Pain; Posture
PubMed: 32429439
DOI: 10.3390/ijerph17103482 -
The Cochrane Database of Systematic... May 2021Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors.
OBJECTIVES
To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language.
SELECTION CRITERIA
All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach.
MAIN RESULTS
We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review.
AUTHORS' CONCLUSIONS
Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.
Topics: Adult; Bias; Dentists; Female; Health Personnel; Humans; Intimate Partner Violence; Medical Staff; Midwifery; Nursing Staff; Psychology; Randomized Controlled Trials as Topic; Social Workers; Students, Health Occupations
PubMed: 34057734
DOI: 10.1002/14651858.CD012423.pub2 -
BMC Oral Health Jul 2022Implantology represents the gold standard for oral rehabilitation, unfortunately, often, despite there are no local contraindications to this type of rehabilitation,...
OBJECTIVE
Implantology represents the gold standard for oral rehabilitation, unfortunately, often, despite there are no local contraindications to this type of rehabilitation, there are uncertainties regarding the general health of our patients. Many patients nowadays take bisphosphonate drugs, often without first seeking advice from an oral surgeon or a dentist. The purpose of this review is precisely to highlight any contraindications to this type of treatment reported in the literature, in patients who take or have taken bisphosphonate drugs.
METHODS
For this study the scientific information sources were consulted using as search terms "("bisphosphonate AND "dental implant")", obtaining 312 results, these were subsequently skimmed according to the inclusion and exclusion criteria, and further evaluated their relevance to the study and the presence of requested outcomes.
RESULTS
Only 9 manuscripts (RCTs, Multicentric studies and Clinical Trials) were included in this review, as they respected the parameters of this review, they were analyzed and it was possible to draw important results from them. Surely from this study it is understood that the use of bisphosphonate drugs does not represent an absolute contraindication to implant therapy, it is evident how adequate pharmacological prophylaxis, and an adequate protocol reduce the risks regarding implant failures. Furthermore, the values of marginal bone loss over time seem, even if not statistically significant, to be better in implant rehabilitation with bisphosphonate drugs association. Only a few molecules like risedronate, or corticosteroids, or some conditions like smoking or diabetes have shown a high risk of surgical failure.
CONCLUSION
Although this study considered different studies for a total of 378 patients and at least 1687 different dental implants, showing better results in some cases for dental implant therapy in cases of bisphosphonate intake, further clinical, randomized and multicentric studies are needed, with longer follow-ups, to fully clarify this situation which often negatively affects the quality of life of our patients and places clinicians in the face of doubts.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Restoration Failure; Diphosphonates; Humans; Quality of Life
PubMed: 35843929
DOI: 10.1186/s12903-022-02330-y -
BMC Oral Health Aug 2023Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth's strength is known to reduce significantly after the root...
BACKGROUND
Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth's strength is known to reduce significantly after the root canal treatment, occlusal loading as a result of functions such as chewing, biting and certain parafunctional tendencies makes the endodontically treated tooth vulnerable to fracture. Hence, after endodontic treatment, it is vital to give adequate and appropriate restorative material to avoid tooth fractures. Accordingly, the choice of such restorative material should be dictated by the property of fracture resistance.
OBJECTIVE
The goal of this study was to conduct a systematic review and critical analysis of available data from in vitro studies examining the fracture resistance of endodontically treated posterior teeth restored with fiber-reinforced composites.
METHODOLOGY
The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRIS-MA) Statement was used to guide the reporting of this systematic review A comprehensive literature search was performed using MEDLINE (via PubMed), Scopus, ScienceDirect, Google Scholar, and LILACS. A manual search of the reference lists of the articles was also performed. The databases provided a total of 796 studies from the electronic systematic search. The databases provided a total of 796 studies from the electronic systematic search. Two reviewers scrutinized the papers for eligibility based on inclusion/exclusion criteria and extracted data. The studies were assessed for their potential risk of bias. Based on modified JBI & CRIS (checklist for reporting in vitro studies) guidelines, along with the methodology and treatment objective, we have formulated 13 parameters specifically to assess the risk of bias. A total of 18 studies met the inclusion criteria and were included for qualitative analysis. Considering the high heterogeneity of the studies included, a meta-analysis could not be performed.
RESULTS
The majority of the included studies had a moderate or high risk of bias. When compared to traditional hybrid composites, fiber-reinforced composites showed increased fracture resistance of endodontically treated teeth in the majority of investigations. On the other hand, limited evidence was found for the bulk fill composites. Moreover, moderate evidence was found for the fracture resistance of inlays and fiber posts with fiber-reinforced composites for core build-up in endodontically treated teeth. No evidence could be found comparing the fracture resistance of endo crowns and fiber-reinforced composites in endodontically treated teeth.
CONCLUSION
According to the research, using fiber-reinforced composites instead of conventional hybrid composites improves the fracture resistance of endodontically treated teeth. However, there was a high risk of bias in the research considered. No judgments could be reached about the superiority of one material over another based-on comparisons between other core restorations.
Topics: Humans; Tooth, Nonvital; Dental Materials; Crowns; Tooth Fractures; Composite Resins; Dental Stress Analysis
PubMed: 37574536
DOI: 10.1186/s12903-023-03217-2 -
Health Technology Assessment... Jun 2020Impacted third molars are third molars that are blocked, by soft tissue or bone, from fully erupting through the gum. This can cause pain and disease. The treatment...
BACKGROUND
Impacted third molars are third molars that are blocked, by soft tissue or bone, from fully erupting through the gum. This can cause pain and disease. The treatment options for people with impacted third molars are removal or retention with standard care. If there are pathological changes, the current National Institute for Health and Care Excellence guidance states that the impacted third molar should be removed.
OBJECTIVE
The objective of this study was to appraise the clinical effectiveness and cost-effectiveness of the prophylactic removal of impacted mandibular third molars compared with retention of, and standard care for, impacted third molars.
METHODS
Five electronic databases were searched (1999 to 29 April 2016) to identify relevant evidence [The Cochrane Library (searched 4 April 2016 and 29 April 2016), MEDLINE (searched 4 April 2016 and 29 April 2016), EMBASE (searched 4 April 2016 and 29 April 2016), EconLit (searched 4 April 2016 and 29 April 2016) and NHS Economic Evaluation Database (searched 4 April 2016)]. Studies that compared the prophylactic removal of impacted mandibular third molars with retention and standard care or studies that assessed the outcomes from either approach were included. The clinical outcomes considered were pathology associated with retention, post-operative complications following extraction and adverse effects of treatment. Cost-effectiveness outcomes included UK costs and health-related quality-of-life measures. In addition, the assessment group constructed a de novo economic model to compare the cost-effectiveness of a prophylactic removal strategy with that of retention and standard care.
RESULTS
The clinical review identified four cohort studies and nine systematic reviews. In the two studies that reported on surgical complications, no serious complications were reported. Pathological changes due to retention of asymptomatic impacted mandibular third molars were reported by three studies. In these studies, the extraction rate for retained impacted mandibular third molars varied from 5.5% to 31.4%; this variation can be explained by the differing follow-up periods (i.e. 1 and 5 years). The findings from this review are consistent with the findings from previous systematic reviews. Two published cost-effectiveness studies were identified. The authors of both studies concluded that, to their knowledge, there is currently no economic evidence to support the prophylactic removal of impacted mandibular third molars. The results generated by the assessment group's lifetime economic model indicated that the incremental cost-effectiveness ratio per quality-adjusted life-year gained for the comparison of a prophylactic removal strategy with a retention and standard care strategy is £11,741 for people aged 20 years with asymptomatic impacted mandibular third molars. The incremental cost per person associated with prophylactic extraction is £55.71, with an incremental quality-adjusted life-year gain of 0.005 per person. The base-case incremental cost-effectiveness ratio per quality-adjusted life-year gained was found to be robust when a range of sensitivity and scenario analyses were carried out.
LIMITATIONS
Limitations of the study included that no head-to-head trials comparing the effectiveness of prophylactic removal of impacted mandibular third molars with retention and standard care were identified with the assessment group model that was built on observational data. Utility data on impacted mandibular third molars and their symptoms are lacking.
CONCLUSIONS
The evidence comparing the prophylactic removal of impacted mandibular third molars with retention and standard care is very limited. However, the results from an exploratory assessment group model, which uses available evidence on symptom development and extraction rates of retained impacted mandibular third molars, suggest that prophylactic removal may be the more cost-effective strategy.
FUTURE WORK
Effectiveness evidence is lacking. Head-to-head trials comparing the prophylactic removal of trouble-free impacted mandibular third molars with retention and watchful waiting are required. If this is not possible, routine clinical data, using common definitions and outcome reporting methods, should be collected.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42016037776.
FUNDING
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 24, No. 30. See the NIHR Journals Library website for further project information.
Topics: Cost-Benefit Analysis; Humans; Molar, Third; Treatment Outcome; United Kingdom
PubMed: 32589125
DOI: 10.3310/hta24300 -
International Journal of Clinical... 2020To assess the children's perceptions of the dentist's attire and environment. The protocol is available in the PROSPERO database.
AIM
To assess the children's perceptions of the dentist's attire and environment. The protocol is available in the PROSPERO database.
SEARCH STRATEGIES
Systematic searches in the databases were performed in Cochrane, Latin American and Caribbean Health Sciences, PubMed, PsycINFO, Scopus, and Web of Science from their inception to December 12, 2019, Google Scholar, Open Grey, and ProQuest Dissertations.
SELECTION CRITERIA
Criteria consisted of descriptive studies regarding the above matter while two authors assessed the information. The risk of bias was also performed.
RESULTS
Databases showed 1,544 papers and a two-phase assessment selected 21 studies in narrative and 9 in the quantitative synthesis. A meta-analysis demonstrated no difference between white coat and child-friendly attire (OR = 0.63; 95% CI 0.16-2.49; = 3,706) and a decorated plain dental clinic was the preference of the children's majority (OR = 8.75; 95% CI 1.21-63.37; = 150).
CONCLUSION
It can be concluded that there is no difference in the children's perception, white coat vs child-friendly attire; however, children prefer a decorated dental clinic.
HOW TO CITE THIS ARTICLE
Oliveira LB, Massignan C, De Carvalho RM, Children's Perceptions of Dentist's Attire and Environment: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2020;13(6):700-716.
PubMed: 33976499
DOI: 10.5005/jp-journals-10005-1839 -
International Dental Journal Oct 2021Because of the heterogeneous nature of the evidence regarding dentists' job satisfaction, an overview was necessary to examine dentists' level of job satisfaction and to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Because of the heterogeneous nature of the evidence regarding dentists' job satisfaction, an overview was necessary to examine dentists' level of job satisfaction and to determine related work environmental factors.
MATERIALS AND METHODS
A literature search was conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Electronic database searches of PubMed/MEDLINE, EMBASE, and Web of Science were performed until March 1, 2020. Two independent authors collected data and assessed the methodological quality of primary studies using the Newcastle Ottawa Scale.
RESULTS
Nine studies were included from the 1987 initially retrieved. Among the included studies, 5 exhibited a neutral level of satisfaction and originated from China, South Korea, Egypt, and the United States, and 3 studies from Canada, Lithuania, and the United States showed a high level of satisfaction. Only 1 study did not report the mean job satisfaction score. According to bias evaluation, 9 studies were considered low risk.
CONCLUSION
The findings showed that dentists were satisfied with their jobs at a moderate to high level, and specialists were more satisfied than general dentists. Regarding work environmental factors, the 6 most satisfied factors were patient relationships, respect, delivery of care, staff, professional relationship, and professional environment. Five of the least satisfied factors were personal time, stress, income, practice management, and professional time. However, longitudinal studies would be required to identify changes in these factors. Further studies should be performed in middle- and low-income countries using the Dentist Satisfaction Survey, including stress evaluation.
Topics: Dentists; Humans; Income; Job Satisfaction; Republic of Korea; Surveys and Questionnaires
PubMed: 33612262
DOI: 10.1016/j.identj.2020.12.018 -
Journal of Pharmacy & Bioallied Sciences Jul 2023To evaluate the clinical and radiographic outcomes of apexogenesis with mineral trioxide aggregate (MTA) against other pulpotomy agents in carious/traumatized immature... (Review)
Review
OBJECTIVES
To evaluate the clinical and radiographic outcomes of apexogenesis with mineral trioxide aggregate (MTA) against other pulpotomy agents in carious/traumatized immature permanent teeth.
DATA SOURCE
A web-based search for possibly relevant scientific papers in the English language between January 2013 and August 2022 was undertaken in the databases such as PubMed, Scopus, Cochrane Library, and EMBASE. Only randomized clinical trials that compared MTA against other pulpotomy medicaments conducted in vital immature permanent dentition with open apex, having a sample size of not less than 20 with at least 6 months follow-up, reporting clinical or radiographic outcomes were included in the current review. Case studies, case series, animal studies, studies, non-clinical/clinical trials on mature/necrotic permanent or primary dentition, systematic reviews, and letters to the editor were excluded.
STUDY SELECTION
A total of 236 articles were retrieved from the databases during the search procedure. Two independent investigators conducted a full-text review of 83 studies following a screening of titles and abstracts. Eventually, seven studies were considered for the review. The Cochrane bias assessment tool was used to evaluate the quality of included studies. Five of the selected studies were assigned a low evidence level, whereas two were rated a high evidence level.
CONCLUSION
The present review indicated that the diverse pulpotomy agents had comparable clinical outcomes with MTA for apexogenesis in traumatized or carious immature permanent teeth. However, there is a lack of substantial information to draw firm conclusions about the benefits of one material over another.
PubMed: 37654389
DOI: 10.4103/jpbs.jpbs_530_22 -
Journal of Clinical Medicine Jan 2023The aim of this study was o determine the relationship between sleep bruxism (SB) and sleep apnea-hypopnea syndrome (SAHS) at the pathophysiological level, the risk... (Review)
Review
The aim of this study was o determine the relationship between sleep bruxism (SB) and sleep apnea-hypopnea syndrome (SAHS) at the pathophysiological level, the risk factors, as well as the common signs and symptoms. A search was carried out using the databases PubMed, Web of Science, Scopus, and the Cochrane Library together with the Boolean equation "bruxism" AND "sleep apnea" AND "relation*"; the systematic search strategy limited the results to English language articles published from 2013 until December 2021. This review was conducted in accordance with the PRISMA statement. Nine articles were reviewed to relate SAHS and SB at different levels: two were systematic reviews (22%) and seven were research studies (78%). According to the literature reviewed, SB and SAHS occur simultaneously in 21.0% to 41.3% of cases. There are signs and symptoms that are common to both SAHS and SB. Rhythmic masticatory muscle activity (RMMA) precedes an SAHS event in 25% of subjects with SB, in contrast to 55% of the general population. SB and SAHS seem to have a certain concomitance, ranging between 20% and 40%, and they also share some risk factors such as advanced age, obesity, smoking, and alcohol consumption. Dentists should be aware of this relationship, as part of a multidisciplinary team, for early diagnosis.
PubMed: 36769558
DOI: 10.3390/jcm12030910