Vital pulp therapy-Factors influencing decision-making for permanent mature teeth with irreversible pulpitis: A systematic review

BACKGROUND

There is an increased tendency towards adopting minimally invasive interventions in dentistry, supported by advancement in materials and techniques. However, the decision-making process in choosing conservative or invasive treatments is influenced by several factors, particularly in permanent teeth with irreversible pulpitis.

OBJECTIVES

The objective of the study was to systematically review the literature regarding factors that influence decision-making for vital pulp therapy (VPT) as definitive treatment option in permanent mature teeth diagnosed with irreversible pulpitis.

METHODS

Two independent reviewers searched five electronic databases (PubMed, Embase, Web of Science, Scopus and Cochrane Library). Grey literature was searched through Google Scholar and contact with experts. Defined search keys were applied, and all peer-reviewed literature published with no language nor publication date limits were included. The All studies investigating the factors influencing treatment decision-making in mature permanent teeth with irreversible pulpitis were included. The quality of included studies was assessed by two independent reviewers using the Joanna Briggs Institute quality assessment tool.

RESULTS

Six articles were included in the review. All included studies used questionnaires to characterize clinician preferences and attitudes in choosing treatment options for mature permanent teeth with irreversible pulpitis. The available evidence suggests that dentist-related factors have a significant influence on the chosen treatment in teeth with irreversible pulpitis, with speciality training and years of experience influencing the choice of VPT over other treatment options. COVID-19 reportedly swayed the dentists' decision to favour VPT. Only one article studied the influence of patient-related factors, such as age and presence of spontaneous pain on decision-making. Of note, a history of cardiovascular disease moved dentists towards prescribing VPT.

DISCUSSION

Collectively, the included studies demonstrated an overriding influence of dentist-related factors on choosing among treatment options for painful teeth diagnosed with irreversible pulpitis. Patient-related factors were acknowledged but there are also potential factors such as socio-economic constraints that were not included in the component studies.

CONCLUSION

In teeth with irreversible pulpitis clinicians educational background influence the decision towards a specific treatment option. Further data, preferably derived from clinical records, is necessary in future investigations to explore the effect of other important factors related to both dentists and patients.

REGISTRATION

PROSPERO database (CRD42022339653).

A Novel Method to Accelerate Orthodontic Tooth Movement Using Low-Intensity Direct Electrical Current in Patients Requiring en-Masse Retraction of the Upper Anterior Teeth: A Preliminary Clinical Report

BACKGROUND

Shortening the duration of orthodontic treatment by speeding up the rate of tooth movement has become an essential goal for both orthodontists and patients. This preliminary report aimed to investigate the safety and effectiveness of a new intraoral removable electrical device in accelerating the en-masse retraction of the upper anterior teeth using low-intensity direct electrical current.

METHODS

This prospective preliminary interventional clinical study was conducted at the Department of Orthodontics, Faculty of Dentistry, Damascus University, Syria, between March 2019 and February 2020. The sample consisted of six patients (four females and two males; mean age: 19.55 ± 0.89 years) whose initial diagnosis was class II division I malocclusion, and their treatment plan suggested the extraction of upper first premolars followed by en-masse retraction. The electrical stimulation was applied on the maxillary anterior region during the en-masse retraction phase using a specially fabricated removable device that was designed by two coauthors of this manuscript (RIS, MYH). Patients were asked to wear their own electrical devices inside their mouths for five hours daily. The primary outcomes were the en-masse retraction rate and duration. The secondary outcomes were safety and patient acceptance.

RESULTS

The average total retraction rate during the treatment period was 0.97±0.06 mm/month. The total amount of retraction achieved during follow-up was 5.65 ± 0.85 mm, which was about 91.86% of the space resulting from the extraction of the upper first premolars. The mean treatment duration to complete the en-masse retraction was 5.66±0.81 months. No side effects of the electrical stimulation were found during the follow-up.

CONCLUSIONS

Low-intensity direct electrical current could be an effective method to accelerate orthodontic movement. The electrical accelerating device used in this study effectively increased the en-masse retraction rate of the upper anterior teeth without any side effects and with high patient acceptance.

Relationship between chewing features and body mass index in young adolescents

BACKGROUND

Behavioural aspects of chewing may influence food intake, nutritional status and in turn body weight.

OBJECTIVES

The current study aimed to study chewing features in adolescents as they naturally occur in home-based settings, and to test for a possible association with weight status.

METHODS

Forty-two adolescents (15.3 ± 1.3 years) were recruited (21 with healthy-weight/21 with overweight). Using a smartphone-assisted wearable electromyographic device, the chewing features of each participant were assessed over one evening, including the evening meal, in their natural home setting.

RESULTS

The mean (±SD) for chewing pace was 1.53 ± 0.22 Hz, chewing power 30.1% ± 4.8%, number of chewing episodes 63.1 ± 36.7 and chewing time 11.0 ± 7.7 minutes. The chewing pace of the group with overweight was slower than that of healthy weight (-0.20 Hz; 95% CI, -0.06 to -0.33; P = .005) while their chewing time was shorter (-4.9 minutes; 95% CI, 0.2-9.7; P = .044). A significant negative correlation was observed between BMI z-score and chewing pace (R = -.41; P = .007), and between BMI z-score and chewing time (R = -0.32; P = .039).

CONCLUSION

The current study suggests that adolescents who are overweight eat at a slower pace for a shorter period of time than their counterparts who are a healthy weight. This unexpected finding based on objective data appears to conflict with existing questionnaire findings but provides impetus for further work testing the effectiveness of changing eating behaviour as a weight-management intervention in youth.

Efficacy of removing Candida albicans from orthodontic acrylic bases: an in vitro study

Background

This study evaluated the efficacy of four methods in removing Candida albicans from the acrylic base material used to fabricate removable orthodontic appliances.

Methods

Heat-processed bars of orthodontic acrylic were incubated in a suspension of C. albicans for 2 h at 37 °C. Samples were allocated into five groups (five bars per group) according to the cleaning method: (1) manual brushing using a toothbrush; (2) soaking in a commercial denture cleaning solution; (3) soaking in a commercial mouthwash solution; (4) using an ultrasonic cleaner; and (5) soaking in distilled water as a negative control. Yeast remaining attached to the bars after cleaning were removed by vortexing in growth medium and plated on Sabouraud dextrose agar. The reduction in yeast colony count after cleaning was calculated and expressed as the number of colony forming units per acrylic bar (CFU/bar). The experiment was carried out three times.

Results

All four cleaning methods resulted in a significant decrease in viable yeast cells associated with the acrylic bars compared to the control group. The mean percentage reduction in viable yeast cells affected by the cleaning methods was: brushing 89.9%; chlorhexidine 95.8%; ultrasonic cleaning 99.9%; and denture tablet 100%.

Conclusions

All four methods evaluated in this study were effective, to some extent, in removing C. albicans from orthodontic acrylic samples. The most effective, and readily available, cleaning method was the use of commercial denture sterilizing tablets.

Efficacy of a Mandibular Advancement Appliance on Sleep Disordered Breathing in Children: A Study Protocol of a Crossover Randomized Controlled Trial

BACKGROUND

Sleep-Disordered Breathing (SDB) varies from habitual snoring to partial or complete obstruction of the upper airway and can be found in up to 10% of children. SDB can significantly affect children's wellbeing, as it can cause growth disorders, educational and behavioral problems, and even life-threatening conditions, such as cardiorespiratory failure. Adenotonsillectomy represents the primary treatment for pediatric SDB where adeno-tonsillar hypertrophy is indicated. For those with craniofacial anomalies, or for whom adenotonsillectomy or other treatment modalities have failed, or surgery is contra-indicated, mandibular advancement splints (MAS) may represent a viable treatment option. Whilst the efficacy of these appliances has been consistently demonstrated in adults, there is little information about their effectiveness in children.

AIMS

To determine the efficacy of mandibular advancement appliances for the management of SDB and related health problems in children.

METHODS/DESIGN

The study will be designed as a single-blind crossover randomized controlled trial with administration of both an "Active MAS" (Twin-block) and a "Sham MAS." Eligible participants will be children aged 8-12 years whose parents report they snore ≥3 nights per week. Sixteen children will enter the full study after confirming other inclusion criteria, particularly Skeletal class I or class II confirmed by lateral cephalometric radiograph. Each child will be randomly assigned to either a treatment sequence starting with the Active or the Sham MAS. Participants will wear the appliances for 3 weeks separated by a 2-week washout period. For each participant, home-based polysomnographic data will be collected four times; once before and once after each treatment period. The Apnea Hypopnea Index (AHI) will represent the main outcome variable. Secondary outcomes will include, snoring frequency, masseter muscle activity, sleep symptoms, quality of life, daytime sleepiness, children behavior, and nocturnal enuresis. In addition, blood samples will be collected to assess growth hormone changes.

TRIAL REGISTRATION

This study was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR): [ACTRN12614001013651].

Acceptance and discomfort in growing patients during treatment with two functional appliances: a randomised controlled trial

AIM

To evaluate the levels of acceptance and discomfort between two types of functional appliances.

STUDY DESIGN

Randomised controlled trial.

MATERIALS AND METHODS

A sample of patients who met the inclusion criteria were distributed randomly and equally into two groups: the Trainer for Kids™ made up of 26 patients with an average age of 10.3 years (Group A), and the modified Activator with 28 patients, with an average age of 10.6 years (Group B), as control. A special questionnaire including eight questions about tension, pressure, sensitive teeth, pain, impaired speech, impaired swallowing, oral constraint and lack of confidence in public caused by the appliance was administered at T1 (7 days), T2 (14 days), T3 (3 months), and T4 (6 months).

RESULTS

The sensation of pressure, teeth sensitivity, pain and impaired speech declined significantly in Group A. All complaints decreased significantly in Group B, but the changes in 'lack of confidence in public' were not significant. Moreover the sensation of pressure, teeth sensitivity, oral constraint and impaired speech were significantly higher in Group A than in Group B.

CONCLUSION

The modified Activator caused less discomfort than the Trainer for Kids™ and was more acceptable.