Zirconia-ceramic versus metal-ceramic posterior multiunit tooth-supported fixed dental prostheses: A systematic review and meta-analysis of randomized controlled trials

BackgroundThe authors aimed to compare the survival and complication rates of zirconia-ceramic (ZC) versus metal-ceramic (MC) restorative material in multiunit tooth-supported posterior fixed dental prostheses (FDP).Types of Studies ReviewedThe authors conducted a systematic search of randomized controlled trials (RCTs), with no time or language restrictions, up to May 2019 using the MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases, followed by a manual search.ResultsThe authors included 7 RCTs in the review and 5 RCTs in the meta-analysis. All studies had a low risk of bias. The authors included 330 participants (177 ZC and 173 MC tooth-supported FDP) in the meta-analysis, which revealed a medium-term survival rate of 95.4% (95% confidence interval [CI], 90.5% to 99.1%) for ZC FDP compared with 96.9% (95% CI, 94.3% to 99.4%) for MC FDP, with no significant differences (P = .364). The biological or technical complications did not show statistically significant differences, except in the global ceramic veneering chipping analysis (P = .023; risk difference [RD], 22.3%; 95% CI, 3.0% to 41.6%) and their subanalysis: minor chipping or chipping that can be solved with polishing (P = .044; RD, 19.5%; 95% CI, 0.5% to 38.4%), and major chipping or chipping that needs repair in the laboratory (P = .023; RD, 6.0%; 95% CI, 0.8% to 11.3%).Conclusions and Practical ImplicationsPosterior multiunit ZC restorations are considered a predictable treatment in the medium term, although they are slightly more susceptible to chipping of the veneering ceramic than MC restorations.     

Impact of hyperglycemia on the rate of implant failure and peri-implant parameters in patients with type 2 diabetes mellitus: Systematic review and meta-analysis

BackgroundThe impact of hyperglycemia on dental implant therapy remains unclear. In this systematic review and meta-analysis, the authors compared the rates of implant failure and peri-implant bleeding on probing (BOP), probing depth (PD), and peri-implant bone loss (PIBL) among patients with type 2 diabetes mellitus and nondiabetic patients. The authors performed subgroup analyses based on glycemic level to evaluate whether patients with higher glycemic levels were more prone to peri-implant inflammation.Type of Studies ReviewedThe authors searched 4 databases for original clinical studies. Studies in which the researchers provided information on the rate of implant failure or peri-implant parameters were included.ResultsNine clinical studies were identified on the basis of the inclusion criteria. No significant differences were found in rates of implant failure (P = .46) and PD (P = .1) between diabetic and nondiabetic patients. Significant differences in BOP (P < .00001) and PIBL (P = .02), favoring nondiabetic patients, were observed. Results of subgroup analyses indicated that the increase in glycemic level did not significantly influence BOP, PD, and PIBL values among diabetic patients.Conclusions and Practical ImplicationsPatients with type 2 diabetes mellitus seem to be able to achieve a rate of implant survival similar to that of healthy patients. Regarding peri-implant parameters, BOP and PIBL were higher in patients with type 2 diabetes mellitus, indicating that hyperglycemia is an important risk factor for peri-implant inflammation. No association was found between peri-implant parameters and glycemic level among patients with type 2 diabetes mellitus, providing oral hygiene was strictly maintained.     

Tooth-level predictors of tooth loss and exposed bone after radiation therapy for head and neck cancer

BackgroundThe objective of this study was to identify tooth-level risk factors for use during preradiation dental care management to predict risk of tooth failure (tooth lost or declared hopeless) and exposed bone after radiation therapy (RT) for head and neck cancer (HNC).MethodsThe authors conducted a prospective observational multicenter cohort study of 572 patients receiving RT for HNC. Participants were examined by calibrated examiners before RT and then every 6 months until 2 years after RT. Analyses considered time to tooth failure and chance of exposed bone at a tooth location.ResultsThe following pre-RT characteristics predicted tooth failure within 2 years after RT: hopeless teeth not extracted pre-RT (hazard ratio [HR], 17.1; P < .0001), untreated caries (HR, 5.0; P < .0001), periodontal pocket 6 mm or greater (HR, 3.4; P = .001) or equaling 5 mm (HR, 2.2; P = .006), recession over 2 mm (HR, 2.8; P = .002), furcation score of 2 (HR, 3.3; P = .003), and any mobility (HR, 2.2; P = .008). The following pre-RT characteristics predicted occurrence of exposed bone at a tooth location: hopeless teeth not extracted before RT (risk ratio [RR], 18.7; P = .0002) and pocket depth 6 mm or greater (RR, 5.4; P = .003) or equaling 5 mm (RR, 4.7; P = .016). Participants with exposed bone at the site of a pre-RT dental extraction averaged 19.6 days between extraction and start of RT compared with 26.2 days for participants without exposed bone (P = .21).ConclusionsIndividual teeth with the risk factors identified in this study should be considered for extraction before RT for HNC, with adequate healing time before start of RT.Practical ImplicationsThe findings of this trial will facilitate evidence-based dental management of the care of patients receiving RT for HNC. This clinical trial was registered at Clinicaltrials.gov. The registration number is NCT02057510.     

Systematic review and meta-analysis of randomized controlled studies comparing oscillating-rotating and other powered toothbrushes

BackgroundThe aim of this study was to systematically review and analyze the difference in efficacy of oscillating-rotating toothbrushes compared with other powered toothbrushes.MethodsThe authors performed a systematic search of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors used the population, intervention, comparison, and outcome format to develop a search strategy to answer the study question. The authors searched PubMed-MEDLINE databases. Inclusion criteria were randomized controlled clinical trials comparing oscillating-rotating (OR) toothbrushes with other powered toothbrushes published from January 1, 2009 through March 1, 2019.ResultsThe authors’ search resulted in 454 articles; 21 articles were downloaded for review, 15 articles were included in the report, and 12 could be used for meta-analysis. All of the studies were randomized controlled clinical trials that assessed plaque removal and gingival inflammation indexes. Results of the meta-analysis of the randomized controlled clinical trials showed that OR toothbrushes had superior, statistically significant outcomes for whole-mouth plaque reduction, assessed using the Rustogi Modified Navy Plaque Index (P < .01), and gingivitis, assessed by using number of bleeding sites (P < .001), but not for the modified gingival index (P > .05) or gingival bleeding index (P > .05).Practical ImplicationsThere is some evidence to suggest that OR powered toothbrushes might remove more plaque and reduce the number of bleedings sites better than other powered toothbrushes, specifically, sonic action toothbrushes.     

Effectiveness of zirconia crowns compared with stainless steel crowns in primary posterior teeth rehabilitation: A systematic review and meta-analysis

BackgroundThe authors’ aim was to evaluate the clinical and radiographic effectiveness of zirconia crowns (ZCs) compared with stainless steel crowns (SSCs) in the rehabilitation of primary posterior teeth.Types of Studies ReviewedUsing predefined combinations of different search terms, the authors searched the standard electronic bibliographic databases—MEDLINE, Embase, Google Scholar, The Cochrane Library, The Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Health Sciences Literature—and the Trip medical database for randomized controlled trials in which the investigators evaluated the clinical and radiographic effectiveness of ZCs and SSCs. Version 2 of the Cochrane risk of bias tool for randomized trials was used for quality appraisal of the included clinical trials. Random-effects model and Mantel-Haenszel test were used for the statistical analysis of estimated effect sizes. The overall quality of evidence was assessed using GRADEpro GDT software (McMaster University and Evidence Prime).ResultsA total of 6 studies were included from the initial 641 results. The overall risk of bias had “low” concerns in 3 studies and “some” concerns in the remaining 3 studies. From the pooled data of the meta-analysis, the authors observed 63 clinical failure events in 497 primary teeth rehabilitated with ZCs or SSCs. Rehabilitation of primary teeth with ZCs may result in fewer clinical failures (risk ratio, 0.48; 95% CI, 0.15 to 1.52; P = .21; I² = 62%) and probably better gingival health (mean difference, –0.32; 95% CI, –0.42 to –0.23; P < .001; I² = 0%) than SSCs.Conclusions and Practical ImplicationsPrimary posterior teeth rehabilitated with ZCs may have less risk of experiencing clinical failure and probably better gingival health after 12 months than SSCs. Considering the quality of available literature, no recommendations could be made regarding the effectiveness of ZCs compared with that of SSCs in the rehabilitation of primary posterior teeth. Pediatric dentists should select ZCs or SSCs according to the clinical situation for successful primary teeth rehabilitation.A protocol was registered with the International Prospective Register of Systematic Reviews (CRD42020194363).     

Impact of visual inspection and radiographs for caries detection in children through a 2-year randomized clinical trial: The Caries Detection in Children–1 study

BackgroundVisual inspection (VIS) with radiographic examination (RAD) is the recommended diagnostic strategy for detecting caries in children; however, this recommendation is based on accuracy studies. The authors conducted a clinical trial to compare the detection and subsequent treatment of carious lesions in primary molars performed with VIS alone and with RAD.MethodsChildren (3-6 years old) were randomly assigned to 2 groups according to the diagnostic strategy used for caries detection on primary molars: VIS or RAD. Participants were diagnosed and treated according to the management plan related to the allocated group. The primary outcome was the number of new operative interventions during the 2-year follow-up period. Other secondary outcomes were also compared. Comparisons were performed with Mann-Whitney test using an intention-to-treat approach.ResultsOf the 252 children included and randomized, 216 were followed-up after 2 years (14.3% attrition rate). There was no difference between the groups for the primary outcome (P = .476). For the secondary outcomes, the RAD group had more restoration replacements (P = .038) and more restorations performed since the beginning of the study (P = .038) compared with the VIS group. In addition, the RAD group had a higher number of false-positive results than the VIS group (P < .001).ConclusionsSimultaneous use of VIS and RAD for caries diagnosis in primary molars of children who seek dental treatment does not provide additional benefits compared with VIS alone.Practical ImplicationsDentists should perform VIS only, not RAD, for detecting carious lesions in preschool-aged children.ClinicalTrials.gov: NCT02078453.     

The relationship between diabetes and carotid artery calcifications detected via dental cone-beam computed tomography in patients undergoing implant treatment planning

BackgroundThe authors investigated the association between carotid artery calcifications (CACs) detected incidentally on dental cone-beam computed tomographic scans and positive diabetes status.MethodsTwo patient groups were identified retrospectively from a patient database: positive for CACs based on cone-beam computed tomographic scans and positive diabetes status. In addition to demographic characteristics, data including diabetes status and presence, type, and absence of CACs were obtained. A χ² statistical analysis was completed by means of dividing the data into sets of known CAC and known history of diabetes; significance level was P < .05.ResultsTo satisfy the a priori power analysis, records from 2010 through 2021 were used.For the positive CAC group, data were obtained from 288 patients (171 men, 117 women) and 68 patients (24%) had a positive diabetes status at the time of cone-beam computed tomography (P < .001). There were significantly more male patients (n = 47) than female patients (n = 21) with diabetes (χ² = 9.9; P = .002). For the positive diabetes group, data were obtained from 225 patients (149 men, 76 women), and 100 patients (44%) had an identifiable CAC. There were significantly more male patients (n = 73) than female patients (n = 27) with CAC (χ² = 21.2; P < .001).ConclusionsThere was a significant relationship to diabetes for patients with CACs, indicating potential undiagnosed diabetes. Male patients with diabetes are significantly more at risk of developing CACs.Practical ImplicationsPeople with CAC may be at risk of having undiagnosed diabetes and require heightened awareness during implant treatment planning.     

Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis

BackgroundThe authors conducted a systematic review and meta-analysis to verify the existence and level of scientific evidence concerning the association between metabolic syndrome (MetS), as the main exposure, and tooth loss (TL), as the outcome.Types of Studies ReviewedThrough electronic databases and partially through gray literature, the authors identified observational studies in adults. The authors used no date or language restrictions. The authors evaluated the studies’ methodological quality by using the Newcastle-Ottawa Scale. The authors conducted a random-effects model meta-analysis. The authors assessed the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation criteria.ResultsTwelve studies met the eligibility criteria, and 9 were retained for the meta-analysis. Most were cross-sectional studies with good methodological quality. Participants with MetS had fewer teeth (standardized mean difference, −2.77; 95% confidence interval, −4.56 to −0.98) and an increased likelihood of lacking functional dentition (odds ratio, 2.37; 95% confidence interval, 1.89 to 2.96) than did those without MetS. The overall quality of evidence was very low.Conclusions and Practical ImplicationsBetter-conducted longitudinal studies are necessary to establish a causal relationship between MetS and TL to inform the best strategies to prevent TL in populations with MetS.     

Use of calcium-containing bioactive desensitizers in dental bleaching: A systematic review and meta-analysis

BackgroundTopical application of calcium-containing bioactive desensitizers (CBs) has been used to minimize bleaching-induced tooth sensitivity (TS). This study answered the research question “Is the risk of TS lower when CBs are used with dental bleaching in adults compared with bleaching without desensitizers?”Types of Studies ReviewedThe authors included randomized clinical trials comparing topical CB application with a placebo or no intervention during bleaching. Searches for eligible articles were performed in MEDLINE via PubMed, Cochrane Library, Brazilian Library in Dentistry, Latin American and Caribbean Health Sciences Literature, Scopus, Web of Science, Embase, and gray literature without language and date restrictions and updated in September 2022. The risk of bias was evaluated using Risk of Bias Version 2.0. The authors conducted meta-analyses with the random-effects model. The authors assessed heterogeneity with the Cochrane Q test, I² statistics, and prediction interval. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence.ResultsAfter database screening, 22 studies remained, with most at high risk of bias. No difference in the risk of TS was detected (risk ratio, 0.95; 95% CI, 0.90 to 1.01; P = .08, low certainty). In a visual analog scale, the intensity of TS (mean difference, ?0.98; 95% CI, ?1.36 to ?0.60; P < .0001, very low certainty) was lower for the CB group. The color change was unaffected (P > .08).Practical ImplicationsAlthough topical CB dental bleaching did not reduce the risk of TS and color change, these agents slightly reduced the TS intensity, but the certainty of the evidence is very low.     

Oral Candida carriage in smokers and tobacco users: A systematic review and meta-analysis of observational studies

ObjectiveTo synthesize evidence from observational studies that evaluated the association between smoking and smokeless tobacco with oral Candida carriage.MethodsFollowing the PRISMA guidelines, we searched through PubMed/MEDLINE, Web of Science, Embase, and Scopus without restrictions until April 2020 for studies that assessed this association. Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed by two independent authors using the Newcastle-Ottawa Scale. A fixed-effect meta-analysis was performed due to insignificant heterogeneity between studies.ResultsWe identified 14 studies that were eligible for inclusion in this review. The pooled odds ratio (OR; six studies) for Candida carriage among smokers and non-smokers was 2.15 (95% confidence interval [CI]: 1.47, 3.14; I² = 8%; P < 0.0001). The OR (five studies) for Candida carriage among smokeless tobacco users and non-users was 1.77 (95% CI: 1.29, 2.44; I² = 46%; P = 0.0004).ConclusionOur findings suggest a significant relationship between smoking/smokeless tobacco users and oral Candida carriage. However, observational studies cannot clarify whether the observed epidemiologic association is a causal effect or the result of some unmeasured confounding variables. Therefore, continued efforts to measure the association between smoking and oral Candida carriage are required.     

Antiplaque and antigingivitis efficacy of cetylpyridinium chloride with zinc lactate compared with essential oil mouthrinses: Randomized clinical trial

BackgroundThe authors of this study aimed to evaluate the clinical antiplaque and antigingivitis effects of 3 oral hygiene regimens: toothbrushing with standard fluoride toothpaste and manual toothbrush and using a mouthrinse containing cetylpyridinium chloride, zinc lactate, and fluoride (CPC + Zn + F) in an alcohol-free base; toothbrushing with standard fluoride toothpaste and manual toothbrush and using a mouthrinse containing essential oils (EO) in an alcohol-free base; and toothbrushing with manual toothbrush and standard fluoride toothpaste and manual toothbrush (control).MethodsThe participants (N = 120) were randomly assigned to study groups and followed the assigned regimens twice daily for 6 weeks. The participants were examined by a calibrated examiner for the Quigley-Hein plaque index (Turesky modification) and Löe-Silness gingival index at baseline, week 4, and week 6. Statistical analyses were performed separately for plaque and gingival indexes by means of analysis of variance, paired t test, and analysis of covariance (α = 0.05).ResultsAt week 4, the CPC + Zn + F group presented additional reductions in dental plaque compared with EO and control groups of (21.4% [P < .001] and 31.4% [P < .001], respectively). After 6 weeks, these values were 26.7% (P < .001) and 44.8% (P < .001), respectively. For Löe-Silness gingival index, additional reduction in the CPC + Zn + F group compared with EO were 10.6% (P < .001) and 13.7% (P < .001) at 4 and 6 weeks, respectively. Compared with control, these reductions were 13.6% (P < .001) and 17.8% (P < .001), respectively.ConclusionsThe regimen including a mouthrinse containing CPC + Zn + F presented higher antiplaque and antigingivitis effects than EO and control regimens.Practical ImplicationsA mouthrinse containing CPC + Zn + F is an effective protocol for the control of dental plaque and gingivitis.     

Effect of virtual reality and music therapy on anxiety and perioperative pain in surgical extraction of impacted third molars

BackgroundThe objective of this study was to evaluate the effect of virtual reality (VR) and music therapy on anxiety and perioperative pain in patients undergoing extraction of impacted third molars.MethodsA total of 275 patients who had to undergo surgery for third-molar extraction participated in a randomized controlled trial and were divided into 3 parallel groups: music therapy intervention (n = 91), VR intervention (n = 93), and control (n = 91). The Spielberger State-Trait Anxiety Inventory and the visual analog scale of pain intensity were used as measurements in this study.ResultsPatients in the music therapy and VR groups showed a greater reduction in anxiety level scores after third-molar extraction surgery (reduction in total anxiety in music group: 15.12; 95% CI, 13.16 to 17.08; Rosenthal r, 1.61; P < .001; reduction in total anxiety in VR group: 9.80; 95% CI, 7.66 to 11.95; Rosenthal r, 0.97; P < .001; reduction in total anxiety in control group: 9.80; 95% CI, 7.66 to 11.95; Rosenthal r, 0.97; P < .001). The intensity of pain after the intervention was lower in patients in the music therapy group than patients in the control group (P = .04). After the intervention, the music therapy and VR groups presented a significant decrease in systolic blood pressure (P < .05), diastolic blood pressure (P < .05), and heart rate (P < .05) compared with the control group.ConclusionsThese findings suggest that the use of music therapy and VR during third-molar extraction surgery reduces anxiety and improves the patient’s physiological parameters.Practical ImplicationsImplementation of these interventions (noninvasive, nonpharmacologic, economic) in the field of oral and maxillofacial surgery and dentistry could improve procedures performed under local anesthesia, improving the clinical experience of patients. This clinical trial was registered with the Australian New Zealand Clinical Trials Registry. The registration number is ACTRN12622000384752.     

Association between rs11362 polymorphism in the beta-defensin 1 (DEFB1) gene and dental caries: A meta-analysis

ObjectivesBeta-defensin 1, encoded by the DEFB1 gene, is an important molecule that confers protection from dental caries. Numerous studies have been conducted on the rs11362 polymorphism in the DEFB1 gene. We evaluated the results from studies that have investigated the association between rs11362 polymorphism and dental caries, through a meta-analysis.MethodsThis meta-analysis was designed according to the PRISMA statement guideline. Electronic databases (PubMed, Web of Science, Scopus, and Cochrane Library) were scanned by two independent researchers. The publication bias was determined by statistical analyses using funnel plot, Egger regression test, and Begg and Mazumdar rank correlation test. Heterogeneity was evaluated using the chi-square test, tau-square, and Higgins I² test. Odds ratio (OR) was used to measure the effect size.ResultsRank correlation and regression procedures showed the absence of publication bias in the meta-analysis (p > 0.05). The DEFB1 rs11362 polymorphism in the heterozygous (CC vs. CT: OR = 2.20, 95% confidence interval (CI): 1.17, 4.10; p = 0.014) and dominant (CC vs. CT + TT: OR = 3.11, 95% CI: 1.18, 8.21; p = 0.022) models in the permanent dentition subgroup showed significant differences. However, there was no significant difference between any model in either the deciduous dentition (p > 0.05) or the mixed dentition subgroups (p > 0.05).ConclusionsThis meta-analysis suggests that the DEFB1 rs11362 polymorphism is associated with dental caries in permanent dentition. Moreover, individuals with the TT genotype were found to have seven times higher risk of dental caries than individuals with the CC genotype. There was no such association or statistical difference observed for deciduous and mixed dentitions.     

Implementation of repairs in dental practice: Randomized behavior simulation trial

BackgroundDespite increasing evidence, dentists have not widely adopted repairs. The authors aimed to develop and test potential interventions targeting dentists’ behavior.MethodsProblem-centered interviews were performed. Emerging themes were linked to the Behavior Change Wheel to develop potential interventions. The efficacy of 2 interventions was then tested in a postally delivered behavioral change simulation trial among German dentists (n = 1,472 per intervention). Dentists’ stated repair behavior regarding 2 case vignettes was assessed. Statistical analysis was performed using McNemar test, Fisher exact test, and a generalized estimating equation model (P < .05).ResultsTwo interventions (guideline, treatment fee item) were developed on the basis of identified barriers. A total of 504 dentists participated in the trial (17.1% response rate). Both interventions significantly changed dentists’ behavior toward repairs of composite and amalgam restorations, respectively (guideline: difference [Δ] = +7.8% and Δ = +17.6%, treatment fee item: Δ = +6.4% and Δ = +31.5%; adjusted P < .001). Dentists were more likely to consider repairs if they already performed repairs frequently (odds ratio [OR], 1.23; 95% CI, 1.14 to 1.34) or sometimes (OR, 1.08; 95% CI, 1.01 to 1.16), if they regarded repairs as highly successful (OR, 1.24; 95% CI, 1.04 to 1.48), if their patients preferred repairs over total replacements (OR, 1.12; 95% CI, 1.03 to 1.23), for partially defective composite restorations (OR, 1.46; 95% CI, 1.39 to 1.53), and after receiving 1 of the 2 behavioral interventions (OR, 1.15; 95% CI, 1.13 to 1.19).ConclusionsSystematically developed interventions targeting dentists’ repair behaviors are likely efficacious to promote repairs.Practical ImplicationsMost partially defective restorations are replaced completely. Effective implementation strategies are required to change dentists’ behavior.This trial was registered at https://www.clinicaltrials.gov. The registration number is NCT03279874 for the qualitative phase and NCT05335616 for the quantitative phase.     

Secular trends in dental services provided by dental therapists and dentists in Southwest Alaska

BackgroundThe goal of the study was to identify secular trends in dental service delivery between dental therapists and dentists in the Yukon-Kuskokwim Delta region of Southwest Alaska, the first area of the United States to authorize dental therapy practice.MethodsElectronic health record transactions from the Yukon-Kuskokwim Health Corporation from 2006 through 2015 (n = 27,459) were analyzed. Five types of dental services were identified using Current Dental Terminology procedure codes: diagnostic, preventive, restorative, endodontic, and oral surgery. Main outcomes were percentages of services provided by dental therapists compared with dentists and population-level preventive oral health care.ResultsThe overall number of diagnostic, preventive, and restorative services in the Yukon-Kuskokwim Delta increased. For diagnostic services, there was a 3.5% annual decrease observed for dentists and a 4.1% annual increase for dental therapists (P < .001). Similar trends were observed for restorative services. For preventive services, there was no change for dentists (P = .89) and a 4.8% annual increase for dental therapists (P < .001). Dental therapists were more likely than dentists to provide preventive care at the population level.ConclusionsDental therapists have made substantial contributions to the delivery of dental services in Alaska Native communities, particularly for population-based preventive care.Practical ImplicationsThe study’s findings indicate that there is a role for dental therapy practice in addressing poor access to oral health care in underserved communities.     

Salivary factors related to caries in pregnancy: A systematic review and meta-analysis

BackgroundThe authors of this meta-analysis aimed to assess saliva-related caries risk factors, including calcium and phosphate, hydrogen ion concentration, buffer capacity, Streptococcus mutans and Lactobacillus counts, flow rate, and decayed, missing and filled teeth index in each trimester during pregnancy.Types of Studies ReviewedThe authors searched electronic databases up to July 1, 2019. Eligible observational studies were included. The authors assessed the quality of the included studies by using the Joanna Briggs Institute scale. To estimate the effects of pregnancy, standardized mean differences with 95% confidence intervals were pooled using the random-effects model. Subgroup analysis and meta-regression were used to explore heterogeneity. Publication bias was assessed using Begg and Egger tests.ResultsTwenty-nine studies were included in the meta-analysis, representing 1,230 pregnant women in the case groups and 715 in the control groups (nonpregnant women). The results showed that salivary calcium concentration decreased in the third trimester, salivary phosphate decreased in the second and third trimesters, saliva hydrogen ion concentration decreased in the first and third trimesters, stimulated saliva flow rate increased in the third trimester, and salivary S mutans count increased in the second and third trimesters. In addition, the results showed that saliva calcium, phosphate, S mutans, and buffer capacity amounts had changed from the first trimester to the third.Conclusions and Practical ImplicationsIn the third trimester, most salivary factors related to caries change and can increase the risk of developing caries in the future. Interventions and screening for caries prevention in pregnancy should start in the first or second trimesters.     

Clinical predictors of persistent temporomandibular disorder in people with first-onset temporomandibular disorder: A prospective case-control study

BackgroundWhen patients first develop a painful temporomandibular disorder (TMD) and seek care, 1 priority for clinicians is to assess prognosis. The authors aimed to develop a predictive model by using biopsychosocial measures from the Diagnostic Criteria for Temporomandibular Disorders (DC-TMD) to predict risk of developing TMD symptom persistence.MethodsAt baseline, trained examiners identified 260 participants with first-onset TMD classified by using DC-TMD–compliant protocols. After follow-up at least 6 months later, 72 (49%) had examiner-classified TMD (persistent cases), and 75 (51%) no longer had examiner-classified TMD (transient cases). For multivariable logistic regression analysis, the authors used blocks of variables selected using minimum redundancy maximum relevance to construct a model to predict the odds of TMD persistence.ResultsAt onset, persistent cases had multiple worse TMD clinical measures and, among Axis II measures, only greater baseline pain intensity (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.04 to 2.2; P = .030) and more physical symptoms (OR, 1.8; 95% CI, 1.2 to 2.9; P = .004) than did transient cases. A multivariable model using TMD clinical measures showed greater discriminative capacity (area under the receiver operating characteristic curve, 0.74; 95% CI, 0.73 to 0.75) than did a model involving psychosocial measures (area under the receiver operating characteristic curve, 0.63; 95% CI, 0.62 to 0.64).ConclusionsClinical measures that clinicians can assess readily when TMD first develops are useful in predicting the risk of developing persistent TMD. Psychosocial measures are important predictors of onset but do not add meaningfully to the predictive capacity of clinical measures.Practical ImplicationsWhen TMD first develops, clinicians usefully can identify patients at higher risk of developing persistence by using clinical measures that they logically also could use in treatment planning and for monitoring outcomes of intervention.     

Correlation of plasma osteopontin and osteocalcin with lower renal function in dental patients with carotid artery calcification and tooth loss

ObjectivesTo investigate plasma osteopontin (OPN) and osteocalcin (OCN) levels in dental patients with carotid artery calcification (CAC) and determine the correlations between these proteins and renal function and tooth loss.MethodsThe health parameters and number of teeth of 99 participants were recorded. Panoramic radiographs were taken for CAC evaluation, and OPN and OCN levels were measured.ResultsNone of the participants had overt kidney disease, and 14 (14.14%) had CAC. The age, sex, and health profiles of patients with CAC were not different from those without CAC. The OPN and OCN levels in participants with CAC were higher than in those without (p = 0.026 and p = 0.025, respectively). The OPN levels were correlated with the estimated glomerular filtration rate (eGFR) (p = 0.021) and tooth loss (p = 0.027). The OCN levels were correlated with the eGFR (p = 0.002), tooth loss (p = 0.023), blood urea nitrogen (p = 0.040), and creatinine levels (p = 0.031). The median tooth loss in individuals with an eGFR <60 mL/min/1.73 m² was higher than that of individuals with an eGFR ≥60 mL/min/1.73 m² (p = 0.033). In individuals with CAC, tooth loss correlated more strongly with the eGFR, and the correlation between OPN and OCN levels was more apparent.ConclusionDental patients with CAC and increased tooth loss have a greater tendency for decreased renal function, which may be associated with OPN and OCN; thus, these patients should be referred for investigation.