Global prevalence of edentulism and dental caries in middle-aged and elderly persons: A systematic review and meta-analysis

Are There Clinical Differences Between 3D-Printed and Milled Complete Dentures? A Systematic Review and Meta-analysis

Limited studies assess clinical key factors in the success of digitally fabricated complete dentures between additive and subtractive methods. This study aimed to compare 2 determinants of clinical success-retention and patient satisfaction- in complete dentures fabricated using additive and subtractive approaches. PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar were searched up to August 2024. Records were screened by title, abstract, and full text against the eligibility criteria. The standardized mean difference (SMD) was calculated using the data extracted from each included study. A random effects model pooled the effect sizes, and heterogeneity was assessed with Cochran's Q test, I-squared, and Tau-squared indices; publication bias was evaluated using Begg's funnel plot and the Egger test, while sensitivity analyses checked result robustness. The risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. Of the initial 1098 records, a total of 4 articles were deemed eligible. Although mean denture retention was higher in the additive compared to the subtractive method, the difference was not statistically significant (SMD = 0.165 N, 95% CI = [-0.176, 0.506], P = .343, I² = 58.72%). Similarly, mean satisfaction was lower in the additive compared to the subtractive method, but this difference was not statistically significant (SMD = -0.595, 95% CI = [-1.579, 0.389], P = .236, I² = 85.94%). Considering the high heterogeneity and the small number of studies, it can be cautiously concluded that there is no significant difference between complete dentures fabricated by 3D printing and milling approaches.

Changing Oral Health Trajectories: A 10-Year Cross-Sectional Comparison of 2 Domiciliary Dental Care Patient Groups in Nursing Homes

OBJECTIVES

Since 2010, Gerodent has been a comprehensive oral health care program including biannual domiciliary dental care in nursing homes in Flanders, Belgium. Previous research revealed poor oral health among nursing home residents attending the mobile clinic. The objective of this study was to evaluate potential changes in the oral health needs of patients receiving domiciliary dental care, thus providing insights for future cohorts.

DESIGN

This study compares the oral health status and treatment needs of 2 cross-sectional samples.

SETTING AND PARTICIPANTS

First-time patients attending the mobile dental clinic in nursing homes, collected a decade apart.

METHODS

Generalized estimating equations were used to compare both samples [sample 1 (S1): 2010-2012: n = 1226; sample 2 (S2): 2021-2023: n = 775]. Results were adjusted for age, sex, increased reimbursement for health care costs, number of medications and care dependency. Differences in oral health outcomes were decomposed in a component attributed to the explanatory variables and an unexplained component using the Blinder-Oaxaca decomposition analysis.

RESULTS

There were statistically significant lower edentulism rates in S2 (28%) than S1 [42%; odds ratio (OR), 1.82; 95% CI, 1.34-2.47]. Among dentate patients, S2 had a significantly lower caries prevalence (S1: 70% vs S2: 53%; OR, 0.55; 95% CI, 0.44-0.69) and a significantly higher mean of filled teeth (S1: 1.5 vs S2: 2.8; rate ratio, 1.82; 95% CI, 1.58-2.09). In the dentate sample, 77% of S1 and 54% of S2 residents required extractions and/or restorations (OR, 0.72; 95% CI, 0.53-0.98). The decomposition analysis showed that the change in explanatory variables attributed little to the shift in dental status. The explained component accounted for only 13.5% of the total risk difference in edentulism (bias-corrected and accelerated 95% CI, -0.6% to 30.6%).

CONCLUSION AND IMPLICATIONS

From 2021 to 2023, more dentate care home residents consulted Gerodent with more natural teeth per person, showing lower levels of untreated disease, maintaining dental team treatment demands comparable with 2010-2012. These findings underscore the continued urgency for structured and accessible dental service provision for nursing home residents.

Ginsenoside RB1 Influences Macrophage-DPSC Interactions in Inflammatory Conditions

INTRODUCTION AND AIMS

Unresolved inflammation and tissue destruction are supposed to underlie the failure of dental pulp repair. As crucial regulators of the injury response, dental pulp stem cells (DPSCs) play a key role in pulp tissue repair and regeneration. M2 macrophages have been demonstrated to induce osteogenic/odontogenic differentiation of DPSCs. Ginsenoside Rb1 (GRb1) is the major component of ginseng and manifested an anti-inflammatory role by promoting M1 macrophage polarised into M2 macrophage in inflammatory disease. However, whether GRb1 facilitates odontogenic differentiation of DPSCs via promoting M2 macrophage polarisation under inflammatory conditions has yet to be established.

METHODS

Human monocyte leukemic cells (THP-1) differentiated macrophages were induced into M1 subsets and then treated with GRb1. After that, the conditioned medium was added to DPSCs. The cell co-cultured system was then subjected to odontogenic differentiation in osteogenic media. Effects of GRb1 on human dental pulp stem cells' (hDPSCs') osteogenic/odontogenic differentiation under inflammatory conditions were assessed by alkaline phosphatase (ALP) staining, Alizarin Red S (ARS) staining, and quantitative polymerase chain reaction testing.

RESULTS

Results demonstrated that GRb1 could facilitate the polarisation of macrophages from the M1 subtype to the M2 subtype. Conditioned medium from GRb1 + M1 macrophages, in comparison with M1 macrophages, may markedly increase the gene expression of ALP, DSPP, and DMP1. Moreover, ALP and ARS staining uncovered that the osteogenic/odontogenic differentiation ability of hDPSCs was strengthened in the M1 + GRb1 co-culture group.

CONCLUSIONS

GRb1 plays a crucial role in the inflammatory response and reparative dentine formation after dental pulp injury. Findings show that GRb1 modulates the interaction between macrophages and DPSCs during inflammation. The current study discusses modifications of deep caries therapy.

The non-cariogenic effects of aspartame: A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis evaluated the cariogenicity of aspartame and explored mechanisms of action.

DATA, SOURCES, AND STUDY SELECTION

A literature search was conducted across PubMed, Web of Science, Scopus, and CENTRAL on February 16th, 2024 (registered with PROSPERO CRD42024513463). Eligible studies evaluated the cariogenicity of aspartame in humans, animals, and dental samples compared to sucrose or other controls. Random effects meta-analysis was conducted on caries incidence, acidogenicity, oral bacterial composition, and mineralization for preclinical and clinical trials. Certainty was assessed using the GRADE framework.

CONCLUSION

Four studies in bovine blocks, seven preclinical trials in rats, and two clinical studies were identified. In clinical studies aspartame was less acidogenic than sucrose (standardized mean difference [95 % confidence interval]: 3.07 [-0.97, 7.10], very low certainty), and similar to water (-0.51 [-1.51, 0.48], low certainty). Preclinical studies indicated aspartame did not promote caries development (-0.01 [-0.31, 0.30], low certainty), reduced caries compared to sucrose (-2.51 [-3.50, -1.52], moderate certainty), but had minimal impact when added to sucrose (-0.53 [-1.29, 0.23], very low certainty), except when assessed in sulcal caries (-0.86 [-1.70, -0.02]). Aspartame had minimal effect on bacterial composition. Studies on bovine blocks indicated aspartame was less acidogenic and erosive than sucrose. While aspartame is a non-cariogenic alternative to sucrose, there is limited evidence supporting anti-cariogenicity. The reduction in caries observed with aspartame use is likely due to its role in minimizing sugar intake rather than biological activity. More long-term studies in humans are needed to fully assess aspartame's impact on oral health.

CLINICAL SIGNIFICANCE

Replacement of sugar with aspartame may help maintain healthy oral pH in humans. Animals fed aspartame instead of sugar consistently develop fewer caries, and lab tests indicate aspartame lessens oral acids and dental erosion compared to sugar.

Characterization of craniofacial tissue aging in genetically diverse HET3 male mice with longevity treatment of 17-alpha estradiol

OBJECTIVE

The objective of our study was to 1) characterize craniofacial tissue aging in the new, genetically diverse HET3 mouse model; and 2) ascertain whether increased longevity with 17-alpha estradiol (17αE2) treatment in male mice also improved the health of these tissues. The HET3 mice are a four-strain cross preferred and recommended by the National Institute of Aging to identify longevity treatments and test their ability to reduce age-related pathologies. Previous reports demonstrated increased longevity in male, but not female, HET3 mice with 17αE2 administration.

DESIGN

Male mice were raised to approximately 8 months (young), 16 months (middle-aged), and 25 months (old). Middle-aged and old mice were administered a diet supplemented with 17αE2 for 19 weeks. We quantified craniofacial tissue volume and density changes with micro-computed tomography followed by histology.

RESULTS

Micro-CT showed that the alveolar bone volume and density did not change with age or treatment. Enamel volume and density changed with age but not treatment. Histology revealed region-specific degeneration of periodontal ligaments (PDLs) with age. Cellular cementum demonstrated age-related density decreases but no change in volume. However, cementum volume and density increased with 17αE2 treatment. Dentin volume increased with age whereas density decreased with age, which were attenuated by 17αE2 treatment.

CONCLUSIONS

The HET3 mice present an excellent model with which to study the heterogeneous nature of tooth aging and the effects of longevity interventions. We provide novel data on how 17αE2 improves healthspan by modifying age-related changes in the molar dentin and cementum of male mice.

Clinical and radiographic outcomes of mini-implant-retained maxillary and mandibular overdentures: a systematic review and meta-analysis

OBJECTIVE

To assess the clinical and radiographic outcomes of overdentures and their retaining dental mini-implants, based on a single-arm systematic literature review.

METHODS

Electronic search was undertaken in three databases, last updated in October 2023, plus manual search of journals. Cumulative implant survival rate (CSR) and the estimated marginal bone loss (MBL) under different follow-up times were calculated.

RESULTS

Thirty-nine studies were included, with 3,787 mini-implants supporting 1,026 overdentures (109 maxilla, 896 mandible) in 1,005 patients, with a mean follow-up of 28.1 ± 19.8 months (min-max 0.3-84.0). 202 mini-implants failed, after a mean of 9.4 ± 11.8 months (7-year CSR 91.4%). The implant survival was lower in the maxilla in comparison to the mandible (p < 0.001), lower for early/delayed-loaded in comparison to immediately-loaded implants (p = 0.005) and lower for 2-mini-implant in comparison to 4-mini-implant-retained mandibular overdenture (p < 0.001; Log-rank test). A high rate of transversal fracture of the prosthesis and wear of the attachment parts was observed. The estimated mean MBL gradually increased from 0.518 (≤ 6 months) to 1.260 mm (58.8-90 months). There was an estimated MBL increase of 0.011 mm per additional month of follow-up.

CONCLUSION

Although presenting a high 7-year CSR, mini-implant-retained overdentures may require frequent maintenance follow-ups, due to the high rate of technical complications. The estimated MBL of mini-implants over 80 months is low.

CLINICAL RELEVANCE

The ability to anticipate outcomes is an essential part of risk management in clinical practice. The findings reported herein set some recommendations and potential strategies for minimizing failures and complications commonly associated with this mini-implant-retained overdentures.

Oral health literacy and oral health outcomes among older people: a cross-sectional study

BACKGROUND

Oral health literacy (OHL) might have an impact on oral health outcomes. Currently, relatively few related studies have been conducted among older people. The aim of this study was to explore the impacts of OHL on oral health outcomes in older adults in a cross-sectional design.

METHODS

From November to December 2023, through the utilization of the cluster sampling approach, a questionnaire survey was carried out among elderly patients visiting the Prosthodontics Department of West China hospital of Stomatology. Data were collected through the general information questionnaire, the Chinese version of the Oral Health Literacy Scale, the Geriatric Oral Health Assessment Index, and oral examinations. Descriptive statistics, binary logistic regression, and poisson regression were used to analyse the data.

RESULTS

A total of 407 valid questionnaires were recovered, with an effective retrieval rate of 98.79%. After adjustment for sociodemographic, economic and oral health behaviours, the results of the binary logistic regression indicated that the correlations between OHL and self-rated oral health were not statistically significant, while OHL was a predictor variable for dental expenditures within the past year (OR = 0.591; 95%CI: 0.371-0.939), and the poisson regression revealed that OHL was a predictor variable of the quality of life (PR = 1.062, 95%CI: 1.030-1.084) and the number of lost teeth (PR = 0.917, 95%CI: 0.865-0.972).

CONCLUSIONS

This study showed that OHL was closely associated with recent dental expenditure, oral health-related quality of life and the number of lost teeth. These findings could contribute to the planning and development of oral health education programs aimed at enhancing the OHL among the elderly population.

Oral health of nursing home residents in Flanders, Belgium, and its associated factors

Oral health in care-dependent older adults is often compromised due to care dependency associated with deteriorating general health. This cross-sectional study assessed the oral health of 458 nursing home residents in Flanders, with a mean age of 82.7 years (70.3% female), using the optimised Oral Health Section of the interRAI Suite of Instruments and validated dental indices. Among residents with natural teeth (53.9%), poor oral hygiene (75.7%), poor tooth condition (56.6%), and poor gum condition (49.9%) were common. High dental plaque levels yielded a mean Oral Hygiene Index of 4.5, and 44.0% of participants had untreated caries with pulp involvement. A mean Modified Gingival Index of 1.8 indicated mild inflammation of the entire gingiva. Denture hygiene was inadequate in 68.5% of cases. Self-reported issues included dry mouth (32.8%) and chewing difficulties (23.4%). The higher correlation coefficients were observed between oral hygiene and gum condition (r = 0.324, p < 0.0001) and between chewing difficulty and pain (r = 0.247, p < 0.0001). Bivariate analyses showed cognitive and functional impairments were strongly linked to poor oral hygiene and gingival health. These findings highlighted the persistent need to improve oral health care in nursing home residents, particularly among those with cognitive decline or reduced self-care abilities.Trial registration: ClinicalTrials.gov NCT06536322- Retrospectively registered July 23rd, 2024.

Factors associated with the use of dental services in older adults in Peru

BACKGROUND

The use of dental services by older adults in Peru faces various challenges that impact both their oral and overall health. Several factors play a crucial role in obtaining adequate dental care.

AIMS

To evaluate the factors associated with the use of dental services in older adults in Peru.

METHODS

This study was an observational, analytical, and cross-sectional investigation that utilized data from multiple years (2018-2022) of the Demographic and Family Health Survey (ENDES, by its Spanish acronym). The use of dental services was assessed through a specific survey question and analyzed in association with various socio-demographic variables, employing both descriptive and analytical statistical methods.

RESULTS

In the multivariable analysis, the likelihood of not utilizing dental services was higher among men aPR: 1.53 (95% CI: 1.45-1.61), those without health insurance aPR: 1.44 (95% CI: 1.36-1.53), those who self-identified as other races aPR: 1.22 (95% CI: 1.13-1.33), Afro-descendants aPR: 1.10 (95% CI: 1.01-1.19), whites aPR: 1.12 (95% CI: 1.01-1.25) according to education level, those with a physical limitation aPR: 1.24 (95% CI: 1.15-1.33), and increased as they were poorer; it was lower among the rich but more pronounced among the middle-income, poor, and very poor, adjusted for five variables.

CONCLUSION

It was reported that 15% of older adults did not use dental services, and this was associated with significant socio-demographic variables.

Masticatory function and cognition in older adults: A population-based study

STATEMENT OF PROBLEM

The relationship between masticatory function based on paired teeth-functional tooth units (FTUs) and cognition has yet to be evaluated and reported in a nationally representative sample.

PURPOSE

The purpose of this population-based study was to investigate the association between masticatory function measured by FTUs and cognition in individuals aged 60 and older using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014.

MATERIAL AND METHODS

Data from NHANES 2011-2014 were used. The number of FTUs was defined as pairs of opposing natural and artificial teeth in the posterior region. Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Weighted multivariable linear regression and subgroup analyses were conducted to assess the association between FTUs and cognitive performance. Sensitivity tests were conducted on functional dentition and the presence of FTUs.

RESULTS

The regression models revealed a significant positive association between FTUs and cognitive performance among AFT, DSST, and global cognition. Individuals with higher FTU scores demonstrated better performance in verbal fluency, processing speed, sustained attention, working memory, and global cognition.

CONCLUSIONS

A significant and independent association was demonstrated between masticatory function as measured by FTUs and cognitive function in adults aged 60 and older.

What Is the Survival Rate of Implants Loaded Immediately with a Branemark Protocol Prosthesis? A Review

The aim of this review was to determine the survival rate of implants loaded immediately with a Branemark protocol prosthesis. An electronic search was performed in the PubMed/MEDLINE database from 2006 to February 2024, using a combination of Medical Subject Headings descriptors: "completely edentulous" and "immediate loading." Human clinical articles in English that evaluated the survival rate of implants loaded immediately with a Branemark protocol prosthesis after placement in the bone were included. A total of 546 articles were identified, of which 15 were included in this study. The 15 articles included in the literature showed a high implant survival rate (more than 93%) after immediate loading.

How to Conduct and Publish Systematic Reviews and Meta-Analyses in Dentistry

OBJECTIVE

To provide a guide for conducting systematic reviews and meta-analyses in dentistry, with emphasis on translating research findings into clinical practice.

OVERVIEW

Systematic reviews are essential tools for synthesizing research findings and translating evidence into clinical practice. These reviews help to identify the most effective treatment options and to determine areas requiring further research. A structured approach, including defining a concise research question, conducting comprehensive literature searches, and assessing the risk of bias, is critical for ensuring the review's trustworthiness. The GRADE approach facilitates the assessment of the certainty of evidence, which is crucial for formulating conclusions and making informed clinical decisions.

CONCLUSION

Systematic reviews provide invaluable insights into clinical decision-making by compiling, analyzing, and synthesizing multiple primary studies. Following a rigorous methodology ensures that systematic reviews are comprehensive, unbiased, and clinically relevant, ultimately contributing to better patient care and achieving better clinical outcomes.

CLINICAL SIGNIFICANCE

Methodologically sound systematic reviews and meta-analyses provide clinicians with high-quality, synthesized evidence, enabling informed clinical decisions and improved patient outcomes. They save time by consolidating research, informing treatment choices, and facilitating the translation of knowledge into clinical practice.

Disease burden and health inequality of older adults with edentulism and the projected trend until 2040: based on the global burden of disease study 2021

OBJECTIVES

To comprehensively analyze the current situation and the trends over the next 21 years, focusing on health inequalities related to edentulism among the elderly across global regions.

MATERIALS AND METHODS

Data on edentulism in older adults were collected from the 2021 global burden of disease (GBD) study. Disease burden trends were analyzed using a joinpoint model. We used the Slope Index of Inequality (SII) and the Concentration Index (CI) to assess health inequalities. A Bayesian age-period-cohort (BAPC) model was used to analyze the projected trend of prevalence up to 2040.

RESULTS

The number of incident, prevalent, and years lived with disability (YLD) cases of edentulism in older adults is increasing globally, while the rate is declining. According to the analysis of health inequality, the burden of edentulism among older adults was gradually concentrated in countries with lower Sociodemographic Index (SDI). Significant downward trends were expected in the global age-standardized prevalence rate (ASPR) of edentulism for both genders from 2020 to 2040; however, the number is increasing.

CONCLUSIONS

Taken together, the burden of edentulism in older people remains high and generally shifts from higher-SDI countries to lower-SDI countries. There are great differences between countries, and effective measures should be taken in countries with poorer economies.

CLINICAL RELEVANCE

The disease burden of edentulism in older adults is gradually shifting towards lower SDI countries. It is crucial to optimize the utilization and allocation of healthcare resources to reduce health inequities in edentulism in older adults.

Impact of edentulism on community-dwelling adults in low-income, middle-income and high-income countries: a systematic review

OBJECTIVES

This study aims to comprehensively explore the consequences of edentulism on community-dwelling adults in low-income, middle-income and high-income countries.

DESIGN

Systematic review and Synthesis Without Meta-Analysis (SWiM).

DATA SOURCES

MEDLINE, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to 21 March 2023, in addition to grey literature searches, reference cross-checking and study recommendations.

ELIGIBILITY CRITERIA

Interventional and observational epidemiological studies of community-dwelling completely edentulous adults aged 18 years and above, residing in low-income, middle-income and high-income countries were included. Animal studies, studies of children and adolescents, studies of exclusively non-community-dwelling individuals and studies exclusive to partially dentate, dentate and treated edentulous individuals were excluded. There were no language restrictions. Search terms were designed to identify relevant articles, which examined the impact of edentulism on oral health-related quality of life, frailty, general health, physical health, mental health, nutritional status, employability, education, socioeconomic status and mortality.

DATA EXTRACTION AND SYNTHESIS

Data were extracted manually by two authors. Risk of bias was assessed using the QualSyst Tool. Articles were synthesised and reported using SWiM guidelines.

RESULTS

The seven broad outcome areas included mortality, frailty, mental health, general health, quality of life, health behaviour and nutrition. We identified no studies assessing the impact of edentulism on productivity or other economic outcomes, and no randomised trials of treatment for edentulism with any of these outcomes. Among 364 articles identified from database searches and 38 additional articles from reference cross-checks and professional recommendations, title and abstract screening resulted in a full text review of 58. Among these, 32 were subsequently included for narrative synthesis, with sample sizes ranging from 539 to 237 023 participants. All studies (n=32) contributing to the synthesis reported negative impact of edentulism on outcomes including mortality, frailty, mental health, general health, cognition and nutrition.

CONCLUSIONS

Edentulism has a consistently negative impact on the health outcomes examined in this review. Randomised trials are needed to evaluate interventions reducing the burden of edentulism, specifically with regard to economic and productivity outcomes.

PROSPERO REGISTRATION NUMBER

CRD42022320049.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of select 2023 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertize in their subject areas that include (in order of appearance here): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine, oral and maxillofacial surgery, and oral radiology; and dental caries and cariology. The authors have focused their efforts on presenting information likely to influence the daily dental treatment decisions of the reader with an emphasis on current innovations, new materials and processes, emerging technology, and future trends in dentistry. With the overwhelming volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to inform and update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope readers find this work helpful in providing evidence-based care to patients seeking healthier and happier lives.

The Prevalence of Alveolar Ridge Defects According to Seibert's Classification: A Cross-Sectional Study

Background and objective Alveolar ridge defects in partially edentulous patients present significant challenges in prosthodontic treatment planning. Seibert's classification system provides a structured approach to categorizing these defects based on the buccolingual and apico-coronal dimensions of the ridge. Accurate classification is crucial for determining appropriate treatment strategies for implant placement, fixed prosthesis, or tissue augmentation. Hence, this study aimed to assess and classify tissue defects in partially edentulous ridges based on Seibert's classification Methods A cross-sectional study was conducted to measure and classify alveolar ridge defects in partially edentulous patients by using Seibert's classification system. Patients aged 18 years and above with partially edentulous ridges requiring prosthodontic treatment were considered for inclusion. Individuals with systemic conditions affecting healing, completely edentulous patients, and those with active periodontal infections were excluded. Impressions of dental arches were obtained, and the alveolar ridge dimensions were measured using digital calipers. Results The study included 122 participants, with a slight male predominance (n=65, 53.3%). The classification of alveolar ridge defects revealed that 71 (58.2%) were Class III, 33 (27.0%) were Class I, and 18 (14.8%) were Class II. A chi-square analysis indicated no significant association between sex and the classification of alveolar ridge defects (p=0.410). Conclusions The prevalence of Class III alveolar ridge defects highlights the need for tailored treatment approaches in prosthetic rehabilitation. While gender differences were observed, they did not significantly influence defect classification. Future research should investigate additional demographic factors to enhance understanding and improve treatment strategies.

The clinical and microbiological efficacy of a zinc-citrate/hydroxyapatite/potassium-citrate containing toothpaste: a double-blind randomized controlled clinical trial

OBJECTIVES

To evaluate the antibacterial efficacy of two fluoride-containing (1450 ppm F) toothpastes with or without zinc-citrate (ZCT), hydroxyapatite (HAP) and potassium-citrate (KCit); to assess and compare their clinical effects in terms of tooth sensitivity, plaque accumulation and gingivitis, as well as patients' satisfaction.

MATERIALS AND METHODS

Healthy, adult patients were selected and randomly assigned to two groups (n = 50): Experimental: ZCT-, HAP-, KCit- and fluoride-containing toothpaste; Control: fluoride-containing toothpaste. Salivary counts of Streptococcus mutans (S. mutans), plaque and gingival index, as well as clinically diagnosed sensitivity were recorded at baseline, and after 4 weeks. A custom-made questionnaire was used to assess patients' self-reported sensitivity (baseline and after 4 weeks) and overall satisfaction with the tested toothpastes. Data were statistically analyzed (α = 0.05).

RESULTS

After 4 weeks, a statistically significant salivary reduction of S. mutans was observed in both groups (p = 0.001). Furthermore, the percentage of S. mutans decrease was significantly higher in Experimental group (p = 0.014). There were no statistically significant differences between the groups in terms of plaque and gingival index (p > 0.05). After 4 weeks, the self-reported tooth sensitivity was lower in Experimental group (p < 0.001).

CONCLUSIONS

Both toothpastes showed good antimicrobial effect after 4 weeks; however, the toothpaste containing ZCT, HAP, KCit and fluoride was found to be more effective in reducing the salivary counts of S. mutans than the product containing fluoride alone.

CLINICAL RELEVANCE

Toothpaste containing ZCT, HAP, KCit and fluoride can be recommended for patients at risk for developing caries and may also be beneficial for individuals experiencing dental sensitivity.

Esthetic and Functional Posterior Rehabilitation With Lithium Disilicate Ceramics for the Replacement of Gold Alloy and Metal-Ceramic Restorations: A Clinical Case With a 10-Year Follow-Up

OBJECTIVE

This case report illustrates a clinical scenario of a patient with insufficient crowns, gold onlays and localized tooth pain in the posterior teeth, treated with partial and full coverage lithium disilicate restorations.

CLINICAL CONSIDERATIONS

A female patient presented in the clinics, complaining about tooth pain and unesthetic metal restorations. After a thorough examination, diagnosis and treatment plan, the existing restorations were removed, and a defect-oriented preparation was done to preserve as much as possible of the remaining tooth structure. Final partial and full coverage lithium disilicate restorations were delivered. After a 10-year follow-up no biological complications were observed. Nevertheless, one major chipping was observed in one of the upper molars. This technical complication was resolved with the fabrication of a new ceramic restoration.

CONCLUSION

Lithium disilicate ceramic posterior full- or partial-coverage restorations are a reliable and predictable treatment option not only for the replacement of tooth structure lost due to caries but also for the replacement of insufficient restorations.

CLINICAL SIGNIFICANCE

The following key factors are to be considered to pursue long-term success with ceramic restorations: patient selection, minimal invasive tooth preparation, appropriate material selection and cementation. Nevertheless, complications are to be expected, and the patient should be informed accordingly.

Alveolar bone loss is a significant contributor to tooth loss in dentate HIV+ patients: A retrospective study

BACKGROUND

The study objectives were to determine tooth loss prevalence and to investigate the relationship between tooth loss and potential risk factors among adult dentate HIV+ patients on newer antiretroviral therapy (ART) regimens.

METHODS

Health records of 450 human immunodeficiency virus (HIV)-infected individuals were surveyed. Eighty-eight records of dentate HIV+ individuals with full-mouth periodontal charting and intra-oral periapical radiographs were identified. We collected data on demographics, systemic risk factors, oral health, and HIV disease measures. Caries exposure and alveolar bone loss (ABL) were radiographically assessed.

RESULTS

Eighty-eight percent of patients showed tooth loss. Patients with ABL ≥15% had a higher number of missing teeth (p < .01). Stepwise regression analyses indicated that tooth loss was positively associated with age (β = 0.45, p < .01) and ABL (β = 0.39, p < .01). By contrast number of years on ART was negatively associated with tooth loss (β = -0.28, p < .05).

CONCLUSIONS

Tooth loss remains prevalent among HIV+ patients, and periodontal disease is a significant contributor. The number of years on ART seem to improve oral health behavior and reduce tooth loss.

The impact of physical activity on the prevalence of edentulism: an analysis of the relationships between active lifestyle and dental health

BACKGROUND

Edentulism is considered the ultimate sign of oral health disease burden. It is a common and frequent clinical disease, mostly seen in the elderly, which has been reported to be closely associated with many diseases. While physical activity is known to benefit many chronic diseases, the relationship between the volume of physical activity and edentulism remains unclear.

MATERIALS AND METHODS

The CHARLS provided the data for this study. A total of 6,480 participants were enrolled in this study, of whom 46.02% were male and 53.98% were female. The edentulism was defined according to self-report and physical activity volume can be represented by metabolic equivalents. Multiple logistic regression, smooth curve fitting, threshold effects analysis, and Cox regression models were used to explore the relationship between physical activity volume and edentulism.

RESULTS

In the fully adjusted model, physically active participants had a 24% lower risk of edentulism compared to those who were physically inactive. Then, we subdivided participants with adequate physical activity into four levels: 600 ≤ PAV < 1200; 1200 ≤ PAV < 1800; 1800 ≤ PAV < 3000; and PAV ≥ 3000. We found that the risk of developing edentulism was lowest and statistically significant at the level of 1,800-3,000 MET-minutes/week physical activity volume (OR = 0.41; 95% CI, 0.24-0.69, p < 0.001). A U-shaped relationship between physical activity volume and edentulism with an inflection point of 2514 (MET-minutes/week) was observed. The results of the longitudinal study also confirm the benefits of physical activity volume with edentulism, participants with adequate physical activity volume had a 21% lower risk of developing edentulism than participants with inadequate physical activity volume (HR = 0.79; 95% CI, 0.67-0.94, p = 0.008).

CONCLUSIONS

This study reveals a U-shaped relationship between physical activity volume and edentulism. Physical activity reduces the risk of developing edentulism in middle-aged and older populations, but it is important to control the appropriate volume of physical activity.

Does intra-oral scan improve the impression accuracy of full-arch implant-supported prostheses: A systematic review and meta-analysis

OBJECTIVES

The present study aimed to systematically review the studies comparing the accuracy of intraoral scan (IOS) and conventional implant impressions (CI) in completely edentulous patients.

MATERIALS AND METHODS

Electronic searches were performed in PubMed, Embase and Cochrane CENTRAL up to December 1, 2023. Clinical studies and in vitro studies reporting the accuracy of digital full arch impressions were included. The primary outcome is the 3-dimensional deviations between the study reference models. A risk of bias assessment was performed for clinical studies. A stratified meta-analysis and a single-armed meta-analysis were conducted.

RESULTS

A total of 49 studies were included, with 8 clinical studies and 41 in vitro studies. For comparison between IOS and conventional impressions, studies were categorized into two groups based on the different measurement methods employed: RMS and CMM. In studies using RMS, the result favored the IOS in the unparalleled situation with the mean difference of -99.29 μm (95% CI: [-141.38, -57.19], I2 = 81%), while the result was opposite with the mean difference of 13.62 μm (95% CI: [10.97, 16.28], I2 = 26%) when implants were paralleled. For different brands of IOS, the accuracy ranged from 76.11 μm (95% CI: [42.36, 109.86]) to 158.63 μm (95% CI: [-14.68, 331.93]).

CONCLUSIONS

Accuracy of intraoral scan is clinically acceptable in edentulous arches, especially for unparalleled implants. More clinical studies are needed to verify the present finding.

Clinicians' perspectives, inducements, preferences, and clinical experiences regarding the use of electronic apex locator and apex locator integrated engine-driven instrumentation: a cross-sectional study

BACKGROUND

This study aimed to investigate the perspectives, preferences, and clinical experiences regarding using electronic apex locator and apex locator integrated instrumentation of dentists and endodontists.

METHODS

A web-based questionnaire consisting of 3 parts and 23 closed-ended questions to achieve the objective of the study was carried out in ethical conditions between August and October 2023. The first part of survey included demographic information, while the second part was about evaluating electronic apex locator usage. In the last part, only participants' use of apex locator-integrated instrumentation was evaluated. Data were analyzed at a significance level of p < 0.05.

RESULTS

A total of 297 clinicians, including 59 endodontists and 34 endodontic residents/Ph.D. students participated in the questionnaire. Endodontists and endodontic residents/Ph.D. students perform statistically significantly more root canal treatments per week on average (p = 0.001). For the working length determination method (multiple option question), 78.5% of participants use an electronic apex locator and 39.7% apex locator-integrated engines. However, the preference rate for electronic apex determination technique was generally 95.6%, with the full rate confirmation of endodontists and endodontic residents/Ph.D. students (100%). A total of 21 endodontists out of 59 prefer apex locator integrated engine-driven instrumentation. Although many of these specialized clinicians use this technique, they stated that they measure electronic working length passively for confirmation of the working length before (90.5%) and after the preparation (66.7%).

CONCLUSIONS

Dentists, as well as endodontists, are skeptical about apex locator-integrated engine-driven instrumentation. Using this technique as a supporter rather than a primary way for preparation within safe limits may give safer results in terms of treatment outcomes.

Global and regional trends in prevalence of untreated caries in permanent teeth: Age-period-cohort analysis from 1990 to 2019 and projections until 2049

OBJECTIVES

This study aims to update the relevant epidemiological information of untreated caries in permanent teeth.

METHODS

Data were derived from the Global Burden of Disease (GBD) study 2019. We described temporal trends in age-standardized prevalence rate (ASPR) of untreated caries in permanent teeth by gender and region from 1990 to 2019. Age-period-cohort (APC) model was utilized to analyze age, period and cohort effects on prevalence, and we used the Bayesian age-period-cohort (BAPC) model to make projections of prevalence between 2020 and 2049.

RESULTS

The global ASPR of untreated caries in permanent teeth presented a decreasing trend from 1990 to 2019 (26593.58/105 vs. 25625.53/105), with females exceeding males annually. Negative correlation was observed between ASPR and Socio-demographic Index (SDI) levels. APC analyses showed that net drift was -0.16 % globally and generally below 0 across all SDI regions. The overall global peak in prevalence occurred in the 20-24 years group (36319.99/105), and there was a decrease trend in the overall global period rate ratio (RR). Compared to younger birth cohorts, prior birth cohorts had higher prevalence risks globally and across all SDI regions. Significant upward trends was predicted in the global ASPR of untreated caries in permanent teeth for both genders from 2020 to 2049.

CONCLUSIONS

Age-period-cohort effects exerted a significant impact on the prevalence of untreated caries in permanent teeth during the study period.

CLINICAL SIGNIFICANCE

The ASPR of untreated caries in permanent teeth may increase in the next 30 years by projections. And the disease burden of untreated caries in permanent teeth may be affected by population ageing. It is essential to implement targeted prevention and control policies to disadvantaged groups and attempt to reduce caries inequalities.

Complete dentures associated with frailty among edentulous older Japanese people: A prospective analysis

OBJECTIVE

This study aimed to explore the cross-sectional and prospective associations between self-reported functionality of complete dentures (FCD), satisfaction with complete dentures (SCD) and the ability to chew hard food (ACHF) on the one hand and the frailty index (FI) on the other hand among edentulous community-dwelling older Japanese people.

METHODS

The study examined 770 edentulous participants of the Nihon University Japanese Longitudinal Study of Aging. The self-reported FCD, SCD and ability to chew six groups of food (from hardest to softest) with complete dentures were the independent variables at the baseline. The FI was computed including 40 deficits as the dependent variable at the baseline and 4 years later. Cross-sectional and prospective generalized linear regression models were fitted controlling for age, gender, marital status, education, working status and area of residence.

RESULTS

The use of non-functional complete dentures and dissatisfaction with complete dentures were both associated with a higher FI cross-sectionally (3.9% [95% CI 2.2-5.6] and 3.2% [95% CI 1.5-4.9], respectively) and prospectively (3.9% [95% CI 2.0-6.0] and 3.3% [95% CI 1.3-5.3], respectively). Regarding the ability to chew, a higher FI at baseline was observed among those able to chew food of Group 2 (1.9%, [95% CI 0.1-3.7]) and Groups 4-6 (1.9%, [95% CI 0.1-3.7]), and a progressive increment in the FI, as the participants reported being able to chew softer groups of food at the follow-up (Group 2: 2.2% [95% CI 0.05-4.3]; Group 3: 3.6% [95% CI 1.2-6.0]; and Groups 4-6: 3.4 [95% CI 0.7-6.1]).

CONCLUSION

Self-reported use of non-functional complete dentures, dissatisfaction with dentures and a reduced ACHF with complete dentures were associated with a higher FI both cross-sectionally and prospectively.

Pain-related analysis on a resorbed ridge with various denture occlusal schemes using finite element method

Resorbed alveolar ridges, particularly in the lower jaw, have a small denture supporting area, which may cause the stress distribution of mastication load to exceed the pressure-pain threshold (PPT) and induce pain in the mucosa or potentially worsen the ridge resorption. Thus, choosing the ideal occlusal scheme among bilateral balanced (BBO), lingualized (LO), and monoplane (MO) for such conditions becomes crucial. The experiment was conducted using the finite element method on a modeling of a resorbed alveolar ridge in the lower jaw with three dentures placed on top, each of which was given different loading points according to the tooth arrangement of BBO, LO, and MO. The axial load was 100 N, and the resultant oblique loads on BBO and LO were 119 N and 106 N, respectively. The von Mises stresses for BBO, LO, and MO were observed in nine denture-supporting areas, and the results showed that the axial load did not produce stresses that exceeded the PPT value (0.64925 MPa) for BBO, LO, and MO with the highest value on area H, 0.43229 MPa, 0.39715 MPa, and 0.31576 MPa, respectively. However, the oblique load direction showed that the BBO had more areas (area E 0.80778 MPa and area H 0.76256 MPa) that exceeded the PPT than LO (area E 0.64394 MPa). The lingualized occlusal scheme is ideal for patients with resorbed alveolar ridge conditions, especially in terms of limiting interferences when the denture is functioning while maintaining comfort but still providing good masticatory performance and satisfactory esthetics.

Relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults: a cross-sectional study

BACKGROUND

Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults.

METHODS

An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Świętokrzyskie Province in Poland in 2010-2011. The research material included the cross-sectional data of 11,901 individuals aged 40-64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0-2 points), moderate (3-5 points), and severe depressive symptoms (6-8 points). The self-reported number of lost teeth was analysed according to the following categories: 0-4, 5-8, 9-27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption.

RESULTS

The likelihood of both moderate (OR = 1.189; 95%CI: 1.028-1.376; p < .020) and severe (OR = 1.846; 95%CI: 1.488-2.290; p < .001) depressive symptoms showed the strongest relationship with a total lack of natural teeth. A loss of more than 8 natural teeth was also significantly associated (OR = 1.315; 95%CI: 1.075-1.609; p < .008) with the occurrence of severe depressive symptoms.

CONCLUSIONS

The loss of natural teeth was positively related to the occurrence of depressive symptoms in middle-aged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals.

Effect of surgical and prosthodontic protocols of distal extension implant-supported removable partial dentures on clinical and patient-reported outcomes: A systematic review

STATEMENT OF PROBLEM

Standard surgical and prosthodontic protocols for managing partially dentate patients with implant-supported removable partial dentures (ISRPDs) are lacking.

PURPOSE

The purpose of this systematic review was to determine clinical and patient-reported outcome measures (PROMs) in patients provided with ISRPDs in distal edentulous arches based on different surgical and prosthodontic protocols.

MATERIAL AND METHODS

An electronic and manual literature search was conducted in 3 databases, PubMed/MEDLINE, SCOPUS, and Cochrane Library, for clinical studies on distal extension ISRPDs related to clinical and patient-reported outcomes. Kennedy Class I and II arches described in articles published from January 2000 to December 2023 were included. Clinical parameters regarding implant type, location, loading protocols, and implant survival rate and PROMs including masticatory performance, esthetics, and overall satisfaction were compared. The risk of bias was determined by using the Cochrane Risk of Bias Tool 2.0 (RoB 2.0).

RESULTS

An initial total of 103 studies were identified, but only 11 articles were selected after implementing the inclusion and exclusion criteria. Ten studies evaluated PROMs, and 6 studies evaluated clinical outcomes (5 studies evaluated both). The implant survival rate ranged from 91.7% to 100%, with no clear differentiation among the studies with immediate or delayed loading protocols. Most studies described implants positioned in the molar region. In general, patient satisfaction and oral health-related quality of life (OHRQoL) improved significantly with ISRPDs compared with conventional removable partial dentures (RPDs) or RPDs with healing abutments. Posttreatment clinical outcomes revealed stable peri-implant health with no significant bone loss or prosthetic complications. No specific implant configuration, including implant type and location or attachment system, appeared to be better than another. Ball attachments were the commonly used attachments. Two studies were of high risk and 3 studies of low risk. The remaining 6 studies were judged to have some concerns based on the RoB 2.0 analysis.

CONCLUSIONS

Providing an ISRPD improved patient satisfaction, OHRQoL, and the clinical outcomes in distal extension situations, with most studies positioning the implants in the molar region. The type of attachment did not significantly affect the outcomes, although ball attachments were the most used attachment in ISRPDs.

Higher Prevalence of the Periodontal Pathogen Selenomonas noxia among Pediatric and Adult Patients May Be Associated with Overweight and Obesity

New evidence has suggested that oral and gut microflora may have significant impacts on the predisposition, development, and stability of obesity in adults over time-although less is known about this phenomenon in children. Compared with healthy-weight controls, overweight and obese adult patients are now known to harbor specific pathogens, such as Selenomonas noxia (S. noxia), that are capable of digesting normally non-digestible cellulose and fibers that significantly increase caloric extraction from normal dietary intake. To evaluate this phenomenon, clinical saliva samples (N = 122) from subjects with a normal BMI (18-25) and a BMI over 25 (overweight, obese) from an existing biorepository were screened using qPCR. The prevalence of S. noxia in samples from normal-BMI participants were lower (21.4%) than in overweight-BMI (25-29; 46.1%) and obese-BMI (30 and above; 36.8%) samples-a strong, positive correlation that was not significantly affected by age or race and ethnicity. These data strongly suggest that S. noxia may be intricately associated with overweight and obesity among patients, and more research will be needed to determine the positive and negative feedback mechanisms that may be responsible for these observations as well as the interventions needed to remove or reduce the potential effects of this oral pathogen.

Fabrication of a mandibular implant-retained overdenture using an existing subperiosteal implant: A clinical report

A 64-year-old edentulous woman with a mandibular fracture received a subperiosteal implant for fracture fixation and dental rehabilitation. However, the ball abutments were submerged by the soft tissue because they were too short. Therefore, we designed a connector to lengthen the attachment and achieve adequate stability and retention for the overdenture.

Trend in the Incidence of Severe Partial Edentulism among Adults Using the Korean National Health Insurance Service Claim Data, 2014-2018

PURPOSE

Missing teeth is one of the most important indicators of oral health behavior and the result of dental caries, periodontal disease, and injuries. This study examined a trend in the incidence of severe partial edentulism (SPE) using the Korean National Health Insurance Service (KNHIS) data.

MATERIALS AND METHODS

Data of adults aged ≥20 years were obtained from the KNHIS for the 2014-2018 period. SPE was defined in dental information within a population with a treatment history of dental scaling as having 1 to 8 natural teeth. Crude incidence rates (CIRs) and age-standardized incidence rates (AIRs) with 95% confidence interval were calculated per 100000 persons. The Cochran Armitage trend (CAT) test and average annual percentage change were used to analyze SPE trends.

RESULTS

The CIRs among Korean adults were from 346.29 to 391.11 in 2014-2016 and from 391.11 to 354.09 in 2016-2018. The AIRs trend statistically increased by 4.31% from 346.29 to 376.80 and decreased by 4.72% from 376.80 to 342.10. The AIRs in men increased by 4.00% and decreased by 3.01%. The AIRs in women decreased by 2.18% and increased by 2.11% (CAT; p<0.01). The AIRs by region and income also showed trends of increase and decrease.

CONCLUSION

The study showed that the incidence trend of SPE increased and decreased from 2014 to 2018. This result would be able to aid in the planning of public oral health, and may also serve as fundamental data for verifying the impact of the public oral health policies implemented.

Investigation of the presence of Non-carious cervical lesions (NCCLs) in ancient adult skulls: analyzing data from prehistoric and historical samples through a systematic review and meta-analysis

OBJECTIVES

Historically, the prevalence of caries has undergone significant changes, particularly increasing with the industrialization of sugar consumption. When examining ancient populations, lower caries rates are discovered, attributed in part to dietary factors. These populations consumed abrasive foods, leading to occlusal wear and reduced non-axial occlusal forces, potentially influencing Non-Carious Cervical Lesions (NCCLs). Although some attribute NCCLs to abfraction, the mechanism remains debated. This systematic review aims to evaluate the presence of NCCLs in ancient populations, shedding light on the factors contributing to their occurrence.

MATERIALS AND METHODS

The present systematic review was registered on PROSPERO, and the manuscript was prepared following PRISMA guidelines.

RESULTS

After the literature search and article screening, data from 6 studies were included in the meta-analysis, with only 2 reporting NCCLs in ancient skulls, encopassing 17 subjects in 805 examined skulls, suggesting their presence even before the widespread use of toothbrushes. This finding indicates a potential etiopathogenic mechanism linked to abfraction, but the cause is complex and involves abrasive and erosive factors closely tied to dietary habits.

CONCLUSIONS

In summary, NCCLs were present in ancient populations, albeit with a much lower prevalence. Their occurrence cannot be solely attributed to wear mechanisms but must be connected to abrasive factors related to diet or practices with religious and cultural significance, such as the use of labrets.

CLINICAL RELEVANCE

Th the knowledge of NCCLs presence in acient sculls is crucial today for better understand the associated risk factors. In this context, the analysis of ancient skulls allows us to discern the role that tooth brushing and diet played in the formation of NCCLs, over the past century.

Mediterranean diet: a potential player in the link between oral microbiome and oral diseases

Background

The oral microbiome is a complex and dynamic assemblage of microorganisms that colonize different sites of the oral cavity maintaining both oral and systemic health. Therefore, when its composition is altered, oral diseases occur. Among oral inflammatory pathologies, periodontal diseases affect the tissues surrounding the teeth, representing the main cause of tooth loss and one of the most important threats to the oral health. Lifestyle and eating habits influence the composition of the human oral microbiota and the development and progression of oral diseases. In this context, the Mediterranean Diet (MD) model, comprising both healthy dietary choices and lifestyle, is linked to the prevention of several metabolic and chronic-degenerative pathological processes, including oral diseases. Indeed, the MD is a plant-based diet, enriched of anti-inflammatory and antioxidant nutrients, which may induce beneficial effects against dental caries and periodontal diseases.

Aim

This review summarizes the role of the oral microbiome in the development of the oral diseases and the potential of MD in modulating the oral microbiome leading to implications for oral health.

Conclusions

The data collected highlight the need to promote the MD pattern along with the correct hygiene habits to prevent the development of oral diseases.

Caries Experience before and after COVID-19 Restrictions: An Observational Study

Background: The declaration of COVID-19 as a pandemic by the World Health Organization in 2020 led to the suspension of several clinical practices globally, including dentistry. This study investigates the impact of these restrictions on dental caries experience. Methods: A retrospective cross-sectional study was conducted at Egas Moniz University's dental hospital in the Lisbon Metropolitan Area from June 2019 to June 2021. The study involved 3380 participants who were divided into two cohorts: after and before COVID-19 restrictions. Data collection included a questionnaire, full-mouth clinical examinations, and radiographs (panoramic X-rays, bitewings). Results: Before the COVID-19 restrictions, the prevalence of dental caries was 91.8%, with an average DMFT (decayed, missing, and filled teeth) index of 12.13. Post-restrictions, the prevalence decreased to 84.5%, with a DMFT index of 10.99. There was an increase in missing teeth and a decrease in decayed and filled teeth. Additionally, the frequency of toothbrushing declined among participants. Conclusions: The COVID-19 pandemic restrictions have significantly impacted dental caries experiences and oral health, highlighting a decrease in dental caries, but also a concerning reduction in oral hygiene practices. These results emphasize the importance of customized dental healthcare during public health emergencies to reduce impacts and maintain oral health.

Research hotspots and trends of oral health in older adults from 2013 to 2023: A bibliometric and visual analysis

Background

Oral health problems seriously affect the quality of life of older adults. It is of great significance to investigate the statuses of oral health in older adults. The study aimed to analyze the current status, hotspots and frontiers of global oral health research in older adults through bibliometrics to provide references and guidance for future research in this field.

Methods

Literature on oral health in older adults from 2013 to 2023 was retrieved from the Web of Science Core Collection (WoSCC) database. CiteSpace 6.2.R4 was used for bibliometric and visual analysis, including journal and co-cited journal, country/region, institution, author, co-cited references, and keyword analysis.

Results

A total of 1430 publications related to oral health in older adults were included. The number of publications has gradually increased over the past decade. The most widely published and cited journal was Gerodontology. The most prominent contribution came from the United States of America, and the University of London and Hirohiko Hirano were the most prolific institution and author, respectively. The current research hotspots were summarized as oral hygiene interventions, oral health-related quality of life and oral health issues in older adults. Cohort studies of oral health, the relationship between oral health and frailty, and the correlation between oral health and nutritional status may be emerging research trends.

Conclusions

This study systematically analyzed the hotspots and frontiers of oral health in older adults and called for increased collaboration among countries, institutions, and authors. In addition, oral hygiene interventions for older adults, oral health-related quality of life, oral health issues, cohort studies of oral health, and the relationship between oral health and frailty or nutritional status may be the focus of future research.

Evaluation of oral health status in the population above 50: evidence from the ardakan cohort study on aging (ACSA)

BACKGROUND

The global population is undergoing rapid aging, and older individuals are more susceptible to various health issues, including oral health problems. Despite the increasing attention given to healthy aging, oral health has often been overlooked in discussions related to health problems. This study aims to assess the oral health status of middle-aged and older adults in Iran.

METHODS

This cross-sectional study analyzed data from 4970 men and women aged 50 years and above, who participated in the Ardakan Cohort Study on Aging (ACSA) between 2020 and 2022. Trained personnel administered a questionnaire and conducted oral health examinations to determine the oral health status and oral hygiene behaviors of the participants.

RESULTS

The mean value (SD) of the total Decayed, Missing, and Filled Teeth (DMFT) index was 21.3 (10.7). Approximately 46% of all participants were completely edentulous (without natural teeth). Moreover, 58.5% of the total sample wore dentures, and the mean age (SD) when they started using dentures was 48.5 (20.7) years. About 71% of participants with natural teeth reported brushing their teeth at least once a day, while about 63% of denture wearers cleaned their dentures daily. In the sample, 28% of individuals had visited a dentist in the last year. The prevalence of difficulty in biting and chewing food among the participants was 48.2% and 44.6%, respectively. Additionally, nearly 68% of all samples reported experiencing at least one difficulty in daily functioning due to oral/dental conditions. The study identified cutoff points of seven (sensitivity = 56.8 and specificity = 77.5) and 10 (sensitivity = 72.1 and specificity = 71.1) missing teeth, indicating the presence of at least one problem in daily functioning due to oral/dental conditions in middle-aged and older adults, respectively.

CONCLUSION

The study reveals a high prevalence of edentulism and denture use among participants aged 50 years and above. The majority of samples reported difficulties in daily functioning due to oral and dental conditions, especially in biting and chewing food. These findings highlight the importance of proactive measures to address oral health issues in middle-aged and older adults, thereby enhancing their overall health and well-being.

Demographics, smoking status, and systemic health factors associated with apical periodontitis in a Brazilian rural population: a cross-sectional study

OBJECTIVE

To determine whether the systemic diseases diabetes mellitus (DM) and arterial hypertension (AH), and smoking status are associated with apical periodontitis (AP) in a representative rural population.

MATERIALS AND METHODS

Cross-sectional study using a representative sample of individuals obtained from a population-based epidemiological survey carried out in the rural area of the city of Rosário do Sul, RS, Brazil, from March 2015 to May 2016. Data were collected through structured questionnaires and clinical examination. Binary logistic regression analysis was performed to identify variables independently associated with AP.

RESULTS

Of the 584 individuals included in the study, 353 (60.4%) had AP. The presence of AP was independently associated with age ≥ 40 years (odds ratio [OR] = 1.867, 95% confidence interval [CI]: 1.193-2.923, p = 0.006), non-white ethnicity (OR = 1.509, 95% CI: 1.029-2.115, p = 0.035), active or former smoker (OR = 2.087, 95% CI: 1.241-3.510, p = 0.006) and DM or prediabetes (OR = 1.676, 95% CI: 1.150-2.443, p = 0.007).

CONCLUSION

The study identified significant associations between AP and demographics, smoking status, and systemic disease in a Brazilian rural population.

CLINICAL RELEVANCE

The study emphasized the significance of comprehending and managing associated factors in preventing and treating AP.

Research progress of biomimetic materials in oral medicine

Biomimetic materials are able to mimic the structure and functional properties of native tissues especially natural oral tissues. They have attracted growing attention for their potential to achieve configurable and functional reconstruction in oral medicine. Though tremendous progress has been made regarding biomimetic materials, significant challenges still remain in terms of controversy on the mechanism of tooth tissue regeneration, lack of options for manufacturing such materials and insufficiency of in vivo experimental tests in related fields. In this review, the biomimetic materials used in oral medicine are summarized systematically, including tooth defect, tooth loss, periodontal diseases and maxillofacial bone defect. Various theoretical foundations of biomimetic materials research are reviewed, introducing the current and pertinent results. The benefits and limitations of these materials are summed up at the same time. Finally, challenges and potential of this field are discussed. This review provides the framework and support for further research in addition to giving a generally novel and fundamental basis for the utilization of biomimetic materials in the future.

Oral Hypofunction and Risk of Weight Change among Independent Older Adults

Oral health is essential for nutritional status; however, little is known about its association with weight change. This study aimed to investigate whether the risk of weight change differs according to the presence of each important component of oral hypofunction (fewer remaining teeth, low chewing efficiency, swallowing problems, and xerostomia) among independent older adults. This was a three-year follow-up cohort study based on self-reported questionnaires. The participants were independent older adults aged ≥65 from the Japan Gerontological Evaluation Study (JAGES). We used >5% weight loss/gain during follow-up as the outcome variables, and the number of remaining teeth (≥20/10-19/0-9), the presence of chewing difficulty, swallowing problems, and xerostomia (yes/no) as the exposure variables. We fitted the Poisson regression model, including possible confounders to estimate the risk ratios (RRs) and 95% confidence intervals (CIs). For weight loss, RRs were significantly higher among those with 0-9 remaining teeth (RR = 1.17; 95% CI = 1.11-1.23), chewing difficulty (RR = 1.12; 95% CI = 1.07-1.16), and xerostomia (RR = 1.11; 95% CI = 1.06-1.16), but there was no significant association with swallowing problems (RR = 1.01; 95% CI = 0.97-1.06). For weight gain, we also found similar associations with oral hypofunction. Oral hypofunction among older adults could have non-negligible health impacts on nutritional status.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2022 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertise in their subject areas that include (in order of the appearance in this report): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence the daily dental treatment decisions of the reader with an emphasis on innovations, new materials and processes, and future trends in dentistry. With the tremendous volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope that readers find this work helpful in managing patients.

Fresh-frozen allogeneic bone blocks grafts for alveolar ridge augmentation: Biological and clinical aspects

The possibilities for oral bone regeneration procedures vary depending on the type of bone defect to be treated, which in turn dictate the type of graft to be used. Atrophic alveolar ridges are non-contained defects and pose a challenging defect morphology for bone regeneration/augmentation. Successful results are regularly obtained with the use of particulate grafts in combination with barrier membranes. In cases of very narrow ridges with need of larger amount of bone augmentation, block grafts are often used. Fresh-frozen allogeneic bone block grafts have been proposed as an alternative to autogenous (AT) bone blocks. Based on a systematic appraisal of pre-clinical in vivo studies and clinical trials including a direct comparison of fresh-frozen bone (FFB) blocks versus AT bone blocks it can be concluded that a FFB block graft: (a) cannot be considered as a reliable replacement of a AT bone block, and (b) should only be considered in cases where the amount of necessary augmentation-in a lateral direction-is relatively limited, so that the main portion of the body of the implant lies within the inner (i.e., the vital) aspect of the block.

A Systematic Review of the Use of mHealth in Oral Health Education among Older Adults

Oral diseases are largely preventable. However, as the number of older adults is expected to increase, along with the high cost and various barriers to seeking continuous professional care, a sustainable approach is needed to assist older adults in maintaining their oral health. Mobile health (mHealth) technologies may facilitate oral disease prevention and management through oral health education. This review aims to provide an overview of existing evidence on using mHealth to promote oral health through education among older adults. A literature search was performed across five electronic databases. A total of five studies were identified, which provided low to moderate evidence to support using mHealth among older adults. The selected studies showed that mHealth could improve oral health management, oral health behavior, and oral health knowledge among older adults. However, more quality studies regarding using mHealth technologies in oral health management, oral health behavior, and oral health knowledge among older adults are needed.

Oral Health Inequities among CALD and Non-CALD Older Australians: A Decomposition Analysis

BACKGROUND

Among Australia's older population, the burden of oral disease is disproportionality borne by culturally and linguistically diverse (CALD) communities. This study aims to examine changes in untreated decay surfaces (DS) between 2004-2006 and 2017-2018 among older CALD and non-CALD Australians.

METHODS

Data were sourced Australian national oral health surveys conducted in 2004-2006 and 2017-2018. An Oaxaca-Blinder decomposition analysis was used to assess the contribution of socio-demographics and dental behaviours.

RESULTS

A total of 246 CALD and 2853 non-CALD dentate participants aged 60+ years took part in 2004-2006, and 363 and 4278 in 2017-2018, respectively. There were increases in mean DS for both CALD (0.74 to 1.42) and non-CALD (0.72 to 1.50) groups between 2004-2006 and 2017-2018. The decomposition model showed that, for CALD participants in 2004-2006 with untreated DS, 40% of the contribution was from not having dental insurance; nearly three-quarters of the contribution was from last dental visit being over one year ago (72.9%) in 2017-2018. Among non-CALD participants in 2017-2018 with untreated DS, 42.5% of the contribution was from the last dental visit being over one year ago.

CONCLUSIONS

Our findings suggest that social determinants, including increased access to dental insurance, could mitigate the oral health inequities observed.

Differential analysis of the dentin soluble proteomic

OBJECTIVES

To perform a differential analysis of the dentin soluble proteomic and assess the effects of tissue health state and protocol for protein extraction. We hypothesized the dentin soluble proteomic varies according to the tissue physiopathological state (intact vs. caries-affected) and protocol used to extract its proteins.

METHODS

Dentin from freshly extracted non-carious and carious teeth were randomly assigned for protein extraction using either guanidine-HCl/ethylenediaminetetraacetic acid (EDTA) or acetic acid. Protein extracts from intact and caries-affected dentin were processed and digested with trypsin for shotgun label-free proteomic analysis (nLC-ESI-MS/MS). Peptides identification was performed on a nanoACQUITY UPLC-Xevo Q-Tof MS system. Peptides identified with scores of confidence greater than 95% were included in the quantitative statistical analysis embedded in the PLGS software. Differences between experimental conditions were calculated using Student test-t with significance pre-set at α=0.05.

RESULTS

A total of 158 human proteins were identified. Approximately one-sixth of proteins (24/158) were present in at least two different extracts. Conversely, the greatest number of proteins (134/158) was identified uniquely in only one of the extracts. Overall, a larger number of soluble proteins was retrieved from caries-affected than intact dentin (86/158). Likewise, a greater number of proteins was extracted by the guanidine-HCl/EDTA (106/158) in comparison to acetic acid protocol. Several proteins detected in dentin extracts, mainly those from caries-affected teeth, are biological and/or metabolically involved with tissue turnover/remodeling.

CONCLUSION

The identity/abundance of soluble proteins retrieved from and remained in dentin noticeably depend on this tissue physiopathological state and protocol used to remove its minerals.

CLINICAL SIGNIFICANCE

The present findings brought new insight into the proteomic phenotype of human dentin and may provide targets for the development of novel caries disease-prevention therapies.

Evaluation of the Oral Health Conditions and Oral Health-Related Quality of Life in a Community-Dwellers Population Aged ≥ 45 Years in the Canton of Bern: A Preliminary Pilot Study

OBJECTIVE

To evaluate oral health conditions and oral health-related quality of life in community-dwellers aged ≥ 45 years in the Canton of Bern, Switzerland.

MATERIALS AND METHODS

One hundred subjects (63% males; mean age: 73 years), selected randomly using a cluster procedure within the Canton of Bern, underwent a clinical oral examination after completing questionnaires on socio-economic level, medical history, oral health behaviour, and Geriatric Oral Health Assessment Index (GOHAI). Descriptive analyses and multinomial regression models were applied to investigate the association between oral health diseases (dental caries and periodontitis) and specific participant characteristics.

RESULTS

The mean number of decayed, missing, and filled teeth (DMFT) was 0.30, 4.20, and 8.75, respectively; the mean DMFT score = 13.35. Dental caries prevalence (ICDAS > 0) was 15% and periodontitis prevalence was 46%. Logistic regression models revealed that living in an urban area was associated with lower odds (OR 0.03, _95%CI 0.00-0.36) of having periodontal disease. Male gender was associated with lower odds for dental caries (OR 0.31, _95%CI 0.09-1.01) and total lack of professional tooth cleaning was associated with higher odds for dental caries (OR 41.99, _95%CI 0.01-0.38). Ordinal logistic regression revealed that both the presence of dental caries (RR 12.80, _95%CI 1.47-111.20) and periodontal disease (RR 6.91, _95%CI 1.16-84.00) were statistically significantly associated with rheumatoid arthritis.

CONCLUSION

Within the study limitations, untreated dental caries and periodontal disease are prevalent in the Swiss population, despite the high level of self-performed oral hygiene and access to the dental care system.

In vitro investigation of the impact of contemporary restorative materials on cariogenic bacteria counts and gene expression

OBJECTIVES

The aim of this study was to compare the antibacterial effect of different fluoride-containing and bioactive restorative materials, and their effect on the expression of specific biofilm-associated genes and therefore the caries process.

MATERIALS AND METHODS

The restorative materials utilized in this study included: 1. Filtek Z250, 2. Fuji II LC, 3. Beautifil II, 4. ACTIVA, and 5. Biodentine. For each material, disc-shaped specimens were prepared. The inhibitory effects against Streptococcus mutans, Lactobacillus acidophilus, and Leptotrichia shahii were tested. After incubation for 24 hours and 1 week, colony-forming units (CFUs) were enumerated. From the plates dedicated for biomass quantification and RNA purification, the target glucosyltransferase B (gtfB) and glucan-binding protein B (gbpB) genes were chosen for S. mutans. For L. acidophilus, a gene involved in exopolysaccharide synthesis (epsB) was chosen.

RESULTS

Except for Filtek Z250, all four materials showed statistically significant inhibitory effects on the biofilms of all three species. When biofilms were grown in the presence of the same four materials, the expression of S. mutans gtfB and gbpB genes, was significantly reduced. For L. acidophilus, the decrease in the expression of gtfB gene in the presence of ACTIVA was the highest change seen. The epsB gene expression also decreased. Compared to fluoride-releasing materials, bioactive materials had more inhibitory effect against L. acidophilus, both at 24 hours and 1 week.

CONCLUSIONS

Both fluoride releasing and bioactive materials exhibited a significant inhibitory effect on the biofilm growth. The expression of the targeted biofilm-associated genes was downregulated by both material groups.

CLINICAL SIGNIFICANCE

The findings from this study give insight into the antibacterial effect of fluoride-containing and bioactive materials which would help to reduce the chances for secondary caries and therefore increase the lifetime of dental restorations placed for patients.

The Shear Bond Strength between Milled Denture Base Materials and Artificial Teeth: A Systematic Review

The data about bond strength between digitally produced denture base resins and artificial teeth are scarce. Several studies investigated shear bond strength values of milled denture base resins and different types of artificial teeth. The purpose of the present study was to compare and evaluate the available evidence through a systematic review. A bibliographic search was conducted in PubMed, Scopus, and Web of Science to assess adequate studies published up to 1 June 2022. This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The appropriate studies that determined the shear bond strength values between milled denture base resins and artificial teeth were selected. The initial search identified 103 studies, which were included in the PRISMA 2020 flow diagram for new systematic reviews. Three studies met the inclusion criteria, and all of them present a moderate risk of bias (score 6). Two studies found no statistical differences between heat-polymerized and CAD/CAM (milled) denture base materials when attached with different types of artificial teeth, while one study showed higher values of CAD/CAM (milled) denture base materials. Bonding agents ensure bonding strength at least similar to the conventional methods. In order to improve the quality of future studies, it would be advantageous to use a larger number of specimens with standardized dimensions and a blinded testing machine operator to decrease the risk of bias.

Dental caries experience among qat chewers in dental college clinics, Jazan, Saudi Arabia

AIMS

There is a considerable debate on the impact of qat chewing on dental and oral health. Thereby, this study aimed at assessing the dental caries among qat chewers (QC) and non-qat chewers (NQC) who attend outpatient dental clinics, College of Dentistry, Jazan, Saudi Arabia.

MATERIALS AND METHODS

A sample of 100 QC and 100 NQC were recruited amongst those attended dental clinics, college of dentistry, Jazan University during the 2018-2019 academic year. Their dental health was assessed by three pre-calibrated male interns using DMFT index. The Care Index, Restorative Index and Treatment Index were calculated. Comparisons between both subgroups were done using independent t test. Multiple linear regression analyses were further conducted to stand on the independent determinants of the oral health among this population.

RESULTS

QC were unintentionally older (36.55 ± 8.74 years) than NQC (32.96 ± 8.49 years; P = 0.004). Fifty-six percent of QC reported brushing their teeth compared to only 35% (P = 0.001). NQC with university and postgraduate educational levels were more than QC. The mean Decayed [5.91 (5.16)] and DMFT [9.15 (5.87)] were higher among QC compared to NQC [3.73 (3.62) and 6.7 (4.58); P = 0.001 and 0.001, respectively]. The other indices were not different between both subgroups. The multiple linear regression revealed that qat chewing and age, individually or together, as independent determinants for the dental decay, missing, DMFT and TI.

CONCLUSION

Qat chewing habit has a detrimental impact on dental health. It is associated with higher dental caries and missing teeth, and a lower treatment index.

Comparative Analysis of Edentulism in a Sample of Mexican Adults with and without Type 2 Diabetes

The objective of the present study was to compare the prevalence of edentulism in Mexican adults with and without a diagnosis of type 2 diabetes mellitus (T2DM) when they are seeking dental care. A cross-sectional study was conducted on 1921 medical records of Mexican adults 40 years of age and older who sought dental care at clinics of a public university in Mexico. The dependent variable was edentulism, clinically determined through an oral examination. The main independent variable was the self-report of previous T2DM diagnosis made by a physician. Sociodemographic, socioeconomic and behavioral covariates were included in a multivariate binary logistic regression model. Overall edentulism prevalence was 8.4% (95% CI = 7.1-9.6). The prevalence of T2DM was 14.3% (n = 274). The prevalence of edentulism among individuals with T2DM was 13.1%, but only 7.6% among individuals without T2DM. In the multivariate binary logistic regression model, a previous T2DM diagnosis increased the probability of being edentulous 1.61 times (95% CI = 1.03-2.50). For each year a person's age increased, the likelihood of being edentulous increased by 12% (95% CI = 10-14%). In summary, a higher prevalence of edentulism was present in Mexican adults with T2DM and in those of older age. This information may be used by dental care providers and health policymakers to improve approaches to preventive care, as well as to characterize and anticipate care needs more accurately for the adult and older adult populations.