Educational Interventions to Improve Dental Anatomy Carving Ability of Dental Students: A Systematic Review

This systematic review aimed to identify the level of impact of educational strategies for teaching tooth carving on the carving ability of undergraduate dental students. The PubMed-NCBI, Cochrane-CENTRAL, LILACS, Ibecs, BBO, Web of Science, and Scopus databases were searched in May 2019, for randomized controlled trials (RCTs) and two-arm non-randomized studies of interventions (NRSI) addressing educational interventions toward the dental carving of undergraduate students. Studies from the year 2000 until the search date, written in English, Portuguese, and Spanish were included. Study screening and data extraction were performed in duplicate and blinded. The data were presented narratively, considering the dental carving ability of students the primary outcome. The risk of bias was assessed using the RoB tool 2.0 and ROBINS-I, and the level of evidence was determined with GRADE. Of 3,574 studies, 6 were included, with 3 RCTs and 3 NRSIs. Very low level of evidence was provided from the NRSIs that flipped classroom (1 study; n = 140) and a student-driven revised module (1 study; n = 264) improved the carving ability of students. Additionally, there was moderate evidence of online complementary material (1 RCT; n = 30) and reinforcement class improving the carving ability of students (1 RCT; n = 29). The replacement of traditional classes by an instructional DVD (1 RCT; n = 73) and assessment of carving projects through digital systems (1 NRSI; n = 79) did not enhance the carving ability of students. Study design, risk of bias, and imprecision downgraded the level of evidence. There was a very low to moderate evidence on the effectiveness of student-driven educational approaches and complementary classes of dental anatomy in improving the dental carving ability of students.

Proliferative leukoplakia: Proposed new clinical diagnostic criteria

OBJECTIVE

We aimed to characterize proliferative verrucous leukoplakia (PVL) from a clinical and histopathological standpoint and suggest an updated classification.

SUBJECTS AND METHODS

Records of patients seen at three oral medicine centers with a clinical diagnosis of PVL were reviewed for clinical and histopathological features and malignant transformation (MT).

RESULTS

There were 42 patients (median age: 69 years [range: 36-88]; 35 females). 12.2% were current smokers. Family history of cancer was present in 43.7% of patients. Partial demarcation of lesion margins was present in 31.3% of lesions, followed by verrucous (27.5%), smooth (22.7%) erythematous (22.3%), and fissured (18.3%) appearance. Large and contiguous and multisite and non-contiguous lesions comprised 57.1% (24/42) and 35.7% (15/42) of PVL cases, respectively. 19.1% had prominent erythema (erythroleukoplakia). The most common histopathological diagnosis at first visit was hyperkeratosis without dysplasia (22/42; 56.4%). MT occurred in 71.4% patients after a median of 37 months [range: 1-210] from initial visit; erythroleukoplakia exhibited MT in 100% of cases.

CONCLUSION

The generic term "proliferative leukoplakia (PL)" may be more appropriate than PVL because 18.3% were fissured and 22.7% erythematous. We also propose the term proliferative erythroleukoplakia to more accurately describe the subset of PL with prominent erythema, which had the highest MT rate.

Amlodipine-induced gingival overgrowth in a child after liver transplant

Drug-induced gingival overgrowth (GO) has been associated with phenytoin, cyclosporine, and calcium channel blocker therapies. This study reports the case of an 11-year-old girl who was referred for evaluation of GO, which had occurred over the last 6 months. Her medical history included a liver transplant due to biliary atresia 3 years ago, immunosuppressive therapy, and hypertension, which is why she was started on a daily intake of amlodipine. The intraoral examination showed generalized GO, and the treatment consisted of a gingivectomy. Subsequently, amlodipine was replaced with captopril and oral hygiene instructions. There was no recurrence of GO after 28 months of follow-up. Although GO may be related to the chronic use of amlodipine, such an association is uncommon in pediatrics, and the treatment consists of the replacement of medication combined with a surgical approach and plaque control.