Association between primary headaches and temporomandibular disorders: A systematic review and meta-analysis

BackgroundThe primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults?Types of Studies ReviewedThe protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 6 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation.ResultsNine of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 7 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 1.94 [95% CI, 0.56 to 6.76] to OR, 7.61 [95% CI, 1.84 to 31.48]), migraines (OR, 4.14 [95% CI, 1.38 to 12.43] to OR, 5.44 [95% CI, 3.61 to 8.21]), and chronic headaches (OR, 40.40 [95% CI, 8.67 to 188.15] to OR, 95.93 [95% CI, 12.53 to 734.27]) were calculated. Articular TMDs without pain were evaluated in 2 articles, and both did not show positive association with tension-type headache nor migraine. Three studies were classified as moderate risk of bias and 6 as low risk of bias. The certainty of evidence varied between very low and low.Conclusions and Practical ImplicationsRecognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist.     

Oral health–related quality of life of patients with acute and chronic temporomandibular disorder diagnostic subtypes

BackgroundStudies have indicated the negative effects of temporomandibular disorders (TMDs) on oral health–related quality of life (OHRQoL). The authors investigated the OHRQoL of patients with acute and chronic TMD subtypes.MethodsThe authors recruited a total of 830 patients. They derived TMD diagnoses using the Diagnostic Criteria for TMDs protocol involving symptom history, physical examination, and diagnostic imaging as indicated. The authors categorized patients into acute (≤ 3 months) or chronic (> 3 months) pain-related TMD (PT), nonpainful intra-articular TMD (IT), and combined TMD (CT) groups. They also gathered sociodemographic information and assessed OHRQoL with the Oral Health Impact Profile (OHIP)-TMDs. The authors evaluated data using 2-way analysis of variance and Bonferroni test and multiple regression analysis.ResultsPatients in the chronic PT and CT subgroups had significantly higher mean global OHIP scores than their acute counterparts. The authors observed significant acute-chronic differences in OHIP-TMDs domain scores in 5 and 2 domains for the PT and CT groups, respectively. Patients in the acute IT group had significantly higher functional limitation scores than those in the chronic IT group. The ranking of mean global scores, in descending order was CT, PT, and IT for acute TMDs and PT, CT, and IT for chronic TMDs, with significant differences observed among the 3 TMD subtypes (P < .001).ConclusionsBoth TMD chronicity and subtypes influenced OHRQoL. Painful TMDs (PT and CT) were associated with significantly poorer OHRQoL than nonpainful TMDs. TMD chronicity appeared to affect OHRQoL only for the painful TMD conditions. Future work on the impact of TMDs on OHRQoL should strive to stratify patients by TMD chronicity and subtypes.Practical ImplicationsTMD chronicity and subtypes influence the impact of TMDs on OHRQoL. Given that chronic painful TMDs impair quality of life, early biopsychosocial intervention of acute TMD pain is important for minimizing chronification and OHRQoL deterioration.     

Chairside risk assessment for first-onset temporomandibular disorders: Result from the Orofacial Pain: Prospective Evaluation and Risk Assessment data set

BackgroundTemporomandibular disorders (TMD) risk assessment is difficult in general dentistry owing to the complexity of multifactorial risk contributions and the lack of standardized education. The authors explored a health history–based chairside risk assessment.MethodsSecondary data analysis was performed on the Orofacial Pain: Prospective Evaluation and Risk Assessment data set. Potential demographic, systemic, and local risk contributors were conceptualized into 10 risk categories. Multivariate Cox proportional hazards modeling with backward selection was applied. Variables with P values < .05 were kept in each successive model.ResultsThe analysis included data from 2,737 participants. The final model indicated that people with any psychological conditions, pain disorders, sleep disorders, or orofacial symptoms were at elevated risks of developing first-onset TMD. Results of post hoc analysis showed the coexistence of conditions from multiple body systems conferred greater risk of developing TMD.ConclusionsCoexisting conditions and symptoms from multiple body systems substantially increase the risk of developing TMD pain. Therefore, multisystem risk assessment and interprofessional collaborations are important for the prevention of TMD.Practical ImplicationsDentists should include psychological conditions, pain disorders, sleep disorders, and orofacial symptoms when assessing patients’ risk of developing TMD pain.     

Oromandibular dystonia and temporomandibular disorders

BackgroundThe aim of this study was to characterize clinical features of patients with oromandibular dystonia (OMD) who had temporomandibular disorder (TMD) symptoms.MethodsA retrospective chart review of patients seeking treatment at a tertiary-level orofacial pain clinic from January 2015 through December 2020 was undertaken. The inclusionary criteria consisted of a diagnosis of OMD (International Classification of Diseases, Revision 10 code G24.4), which had been confirmed by a neurologist.ResultsEleven patients met the inclusion criteria. Focal dystonia and jaw deviation OMD were the most frequent diagnoses. A dental procedure was a triggering or aggravating factor in 36.4% of patients. All but 2 patients had a sensory trick, or tactile stimulus to a particular body part, and approximately one-half of the patients used an oral appliance as a sensory trick device. All but 1 patient had received a diagnosis of TMD, with myofascial pain of the masticatory muscles being the most prevalent diagnosis. Four patients had received a recommendation for orthodontic treatment. About one-half of the patients had undergone 1 or more invasive dental or maxillofacial surgical interventions to address their dystonia. Anxiety was the most common psychological comorbidity.ConclusionsBecause patients with OMD commonly experience TMD symptoms, they can receive a misdiagnosis of TMD while the OMD is overlooked.Practical ImplicationsOwing to concomitant TMD symptoms, patients most often seek dental consultations and undergo treatments such as orthodontic interventions and temporomandibular joint surgeries. A dentist’s competency in recognizing these patients can prevent unnecessary procedures and facilitate appropriate patient care.     

Caries risk and social determinants of health: A big data report

BackgroundOral health is influenced by social determinants of health (SDH), predisposing people and communities to greater risk of developing caries. This study evaluated the association between caries risk in adults and SDH such as ZIP Codes, systemic diseases, payment methods, and race or ethnicity.MethodsThe BigMouth Dental Data Repository (n = 57,211) was used to extract clinical and SDH data from patients’ dental electronic health records for 2019. Caries risk categories were used as ZIP Code data was merged with the Social Deprivation Index, a composite measure of area-level deprivation based on 7 demographic characteristics collected in the American Community Survey.ResultsThe results showed that the odds of being in the high caries risk group were higher for people in the 49- to 64-year age group (adjusted odds ratio [aOR], 2.24; 95% CI, 2.08 to 2.40; P ≤ .001), men (aOR, 1.19; 95% CI, 1.13 to 1.25; P ≤ .001), people who had comorbidities (diabetes: aOR, 1.16; 95% CI, 1.08 to 1.24; P ≤ .001; cardiovascular disease: aOR, 1.40; 95% CI, 1.32 to 1.50), and people with an Social Deprivation Index score above the 75th percentile (aOR, 2.39; 95% CI, 2.21 to 2.58; P ≤ .001). In addition, Hispanic and Black people had higher odds of being at high caries risk than other races or ethnicities (Hispanic: aOR, 3.05; 95% CI, 2.32 to 4.00; Black: aOR, 2.05; 95% CI, 1.02 to 4.01).ConclusionsThis study shows the association of caries risk with higher social deprivation, reinforcing the role of structural and upstream factors in oral health. This study is unique in using recorded ZIP Code information and assessing caries risk levels for those regions.Practical ImplicationsThe physical and structural environment should be considered contributors to caries risk in people.     

The role of hemostatic agents after tooth extractions: A systematic review and meta-analysis

BackgroundHemostatic agents are used to control bleeding after tooth extraction and have been compared with conventional measures (that is, sutures or gauze pressure) in several studies. The objective of this systematic review was to evaluate the benefits of topical hemostatic agents for controlling bleeding after tooth extractions, especially in patients receiving antithrombotic therapy.Types of Studies ReviewedThe authors conducted a literature search in MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Trials, including prospective human randomized clinical trials in which researchers compared hemostatic agents with conventional methods and reported the time to achieve hemostasis and postoperative bleeding events.ResultsSeventeen articles were eligible for inclusion. Hemostatic agents resulted in a significantly shorter time to achieve hemostasis in both healthy patients and patients taking antithrombotic drugs (standardized mean difference, –1.02; 95% CI, –1.70 to –0.35; P = .003 and standardized mean difference, –2.30; 95% CI, –3.20 to –1.39; P < .00001, respectively). Significantly fewer bleeding events were noted when hemostatic agents were used (risk ratio, 0.62; 95% CI, 0.44 to 0.88; P = .007). All forms of hemostatic agents (that is, mouthrinse, gel, hemostatic plug, and gauze soaked with the agent) had better efficacy in reducing the number of postoperative bleeding events than conventional hemostasis measures, except for hemostatic sponges. However, this was based on a small number of studies in each subgroup.ConclusionsThe use of hemostatic agents seemed to offer better bleeding control after tooth extractions in patients on antithrombotic drugs than conventional measures.Practical ImplicationsFindings of this systematic review may help clinicians attain more efficient hemostasis in patients requiring tooth extraction. This systematic review is registered in the PROSPERO database. The registration number is CRD42021256145.     

Management of painful temporomandibular disorders: Methods and overview of The National Dental Practice-Based Research Network prospective cohort study

BackgroundPatients often seek consultation with dentists for temporomandibular disorders (TMDs). The objectives of this article were to describe the methods of a large prospective cohort study of painful TMD management, practitioners’ and patients’ characteristics, and practitioners’ initial treatment recommendations conducted by The National Dental Practice-Based Research Network (the “network”).MethodsParticipating dentists recruited into this study treated patients seeking treatment for painful TMDs. The authors developed self-report instruments based on well-accepted instruments. The authors collected demographics, biopsychosocial characteristics, TMD symptoms, diagnoses, treatments, treatment adherence, and painful TMDs and jaw function outcomes through 6 months.ResultsParticipating dentists were predominately White (76.8%) and male (62.2%), had a mean age of 52 years, and were general practitioners (73.5%) with 23.8% having completed an orofacial pain residency. Of the 1,901 patients with painful TMDs recruited, the predominant demographics were White (84.3%) and female (83.3%). Patients’ mean age was 44 years, 88.8% self-reported good to excellent health, and 85.9% had education beyond high school. Eighty-two percent had pain or stiffness of the jaw on awakening, and 40.3% had low-intensity pain. The most frequent diagnoses were myalgia (72.4%) and headache attributed to TMDs (51.0%). Self-care instruction (89.4%), intraoral appliances (75.4%), and medications (57.6%) were recommended frequently.ConclusionsThe characteristics of this TMD cohort include those typical of US patients with painful TMDs. Network practitioners typically managed TMDs using conservative treatments.Practical ImplicationsThis study provides credible data regarding painful TMDs and TMD management provided by network practitioners across the United States. Knowledge acquired of treatment recommendations and patient reports may support future research and improve dental school curricula.     

US dental health care workers’ mental health during the COVID-19 pandemic

BackgroundThis study was designed to assess the prevalence of anxiety and depression symptoms and understand factors influencing mental health among dental health care workers (DHCWs) during the COVID-19 pandemic.MethodsBeginning in June 2020, 8,902 DHCWs participated monthly in an anonymous longitudinal, web-based survey (response rate, 6.7%). The Patient Health Questionnaire-4 was used to estimate rates of anxiety and depression symptoms. Changes in mental health over time and differences by demographic and practice characteristics, COVID-19 community transmission level, and COVID-19 vaccination status were tested using χ² tests and multilevel multivariable logistic regression.ResultsAnxiety symptom rates peaked in November 2020 (28% of dental hygienists, 17% of dentists) and declined to 12% for both professions in May 2021. Depression symptom rates were highest in December 2020 (17% of dental hygienists, 10% of dentists) and declined to 8% in May 2021. Controlling for gender, age, race or ethnicity, and COVID-19 community transmission level, the authors found that dentists had significantly lower odds of anxiety symptoms (adjusted odds ratio [aOR], 0.82; 95% CI, 0.70 to 0.95) and depression symptoms (aOR, 0.79; 95% CI, 0.67 to 0.93) than dental hygienists. Compared with vaccinated respondents, those who were unvaccinated but planning on getting vaccinated had significantly higher rates of anxiety (aOR, 1.71; 95% CI, 1.20 to 2.44) and depression (aOR, 1.57; 95% CI, 1.07 to 2.29) symptoms.ConclusionsDHCWs’ mental health fluctuated during the pandemic. Anxiety and depression in DHCWs were associated with demographic and professional characteristics as well as perceived risk of COVID-19.Practical ImplicationsMental health support should be made available for DHCWs.This clinical trial was registered at ClinicalTrials.gov. The registration numbers are NCT04423770 and NCT04542915.     

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.     

Edentulism is associated with increased risk of all-cause mortality in adult men

BackgroundPrior reports of positive associations between edentulism and all-cause mortality have been limited by onetime assessments of edentulism and inadequate control of known confounding variables. The authors aimed to assess the association between edentulism and mortality using a longitudinal clinical oral health cohort.MethodsThe authors used data from the Department of Veterans Affairs Dental Longitudinal Study, an ongoing, closed-panel cohort study from 1968 through 2019 (N = 1,229). Dentition status was evaluated through triennial clinical examinations. Mortality was assessed via the National Death Registry. The authors used Cox regression models to estimate the association between edentulism and all-cause mortality after covariate adjustment. Furthermore, the authors calculated propensity scores and assessed hazard ratios (HRs) in a trimmed, matched, and inverse probability weighted sample.ResultsParticipants who were edentulous (N = 112) had 1.24 (95% CI, 1.00 to 1.55) times the hazard of all-cause mortality compared with those who were nonedentulous, after adjustment with time-varying covariates. Use of propensity scores in the model resulted in slightly elevated HRs compared with the standard Cox model, regardless of propensity score method; adjusted HRs were 1.35 (95% CI, 1.01 to 1.80) after matching, 1.26 (95% CI, 1.00 to 1.59) after trimming, and 1.29 (95% CI, 1.18 to 1.42) after inverse probability weighting.ConclusionsEdentulism was associated with an increased risk of all-cause mortality in a cohort that captured incident edentulism. This association was consistent after multiple methods to account for confounding.Practical ImplicationsThe findings of this study suggest that edentulism is associated with an increase in risk of mortality, after accounting for salient confounding variables using multiple approaches. Efforts to improve equitable access to tooth-preserving treatments are critical.     

Disparities in dental health issues and oral health care visits in US children with tobacco smoke exposure

BackgroundThe objective of the authors was to assess the relationships between tobacco smoke exposure (TSE) and dental health and dental care visits among US children.MethodsThe authors examined 2018-2019 National Survey of Children’s Health data on TSE, dental health, and oral health care visits. Children aged 1 through 11 years (N = 32,214) were categorized into TSE groups: no home TSE (did not live with a smoker), thirdhand smoke (THS) exposure (lived with a smoker who did not smoke inside the home), or secondhand smoke (SHS) and THS exposure (lived with a smoker who smoked inside the home). The authors conducted multivariable logistic regression analyses, adjusting for child age, sex, race or ethnicity, prematurity, caregiver education level, family structure, and federal poverty threshold.ResultsChildren with home SHS and THS exposure were at increased odds of having frequent or chronic difficulty with 1 or more oral health problem (adjusted odds ratio [AOR], 1.59; 95% CI, 1.07 to 2.35; P = .022) and carious teeth or caries (AOR, 1.74; 95% CI 1.14 to 2.65; P = .010) than those with no TSE. Compared with children aged 1 through 11 years with no TSE, children with SHS and THS exposure were 2.22 times (95% CI, 1.01 to 4.87; P = .048) more likely to have not received needed oral health care but at decreased odds of having had any kind of oral health care visit (AOR, 0.55; 95% CI, 0.32 to 0.95; P = .032), including a preventive oral health care visit (AOR, 0.60; 95% CI, 0.36 to 0.99; P = .047).ConclusionsTSE in children is associated with caries and inadequate oral health care visits.Practical ImplicationsThe pediatric dental visit is an opportune time to educate caregivers who smoke about dental health to improve their children’s teeth condition and increase oral health care visits.     

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.     

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).     

COVID-19 vaccine acceptance and hesitancy among dental and medical students

BackgroundDental students (DS) and medical students (MS) are exposed to COVID-19. It is important to achieve high COVID-19 vaccination coverage rates in both of these groups. The authors developed a survey to assess COVID-19 vaccine hesitancy among MS and DS.MethodsThe authors conducted the study at 3 US dental schools and 1 US medical school using an online survey that assessed previous immunization behavior, attitudes about and perceptions of COVID-19 vaccines, and personal experience with COVID-19.ResultsA total of 248 DS and 167 MS completed the survey. Forty-five percent of DS and 23% of MS were hesitant about receiving the COVID-19 vaccine. Results of bivariate analyses found that MS were 2.7 times more likely than DS to receive the vaccine (odds ratio, 2.74; 95% CI, 1.76 to 4.31; P = .0001). Although DS were more likely than MS (P < .05) to have had COVID-19 and to personally know someone who had COVID-19, MS were more likely to agree with mandates and trust information about the vaccines. In multivariable analyses, after controlling for demographic variables, experience with COVID-19, and personal vaccination behaviors, being a MS or DS was no longer predictive of willingness to get the vaccine.ConclusionsThese results highlight the need for profession-specific curricula designed to enhance student knowledge about the vaccines and vaccine counseling skills.Practical ImplicationsThe American Dental Association supports dentists administering vaccines, including the COVID-19 vaccines. Dentists and DS should be willing to receive the vaccines themselves. Education about the vaccines is needed to improve uptake.     

The association between vitamin D levels and caries experience in children and youth participating in National Health and Nutrition Examination Survey 2011-2016: A cross-sectional study

BackgroundGiven equivocal findings from existing nationally representative studies, the authors sought to determine associations between vitamin D levels and caries experience in US children using updated National Health and Nutrition Examination Survey data.MethodsThe authors used data from 2011-2016 National Health and Nutrition Examination Survey. Vitamin D status was assessed on the basis of the sufficiency thresholds of 50 and 75 nmol/L for serum 25-hydroxyvitamin D (25[OH]D) recommended by the Institute of Medicine (now National Academy of Medicine) and Endocrine Society, respectively. Caries experience was defined as the total number of decayed or filled tooth surfaces (dfs) and decayed, missing, or filled tooth surfaces (DMFS) and a binary measure of any dfs and DMFS. Associations between 25(OH)D and any or total dfs and DMFS were examined in children aged 2 through 5, 6 through 8, 9 through 11, and 12 through 18 years, using multivariable logistic and linear regression models after adjustment for covariates.ResultsChildren aged 2 through 5 years with 25(OH)D above 75 nmol/L experienced fewer total dfs (β = –1.94; 95% CI, –3.60 to –0.28) than those with 25(OH)D below 75 nmol/L. Children 6 through 8 years with 25(OH)D above 75 nmol/L had lower presence of any dfs (odds ratio, 0.59; 95% CI, 0.36 to 0.95) than those with 25(OH)D below 75 nmol/L, and those with 25(OH)D above 50 nmol/L had lower presence of any DMFS (odds ratio, 0.38; 95% CI, 0.19 to 0.79) than those with 25(OH)D below 50 nmol/L. There were no associations of 25(OH)D status with either any or total DMFS in children 12 through 18 yearsConclusionsThere were no consistent associations of 25(OH)D status with caries experience across age groups.Practical ImplicationsVitamin D status was not associated consistently with reduced caries experience.     

The association between food insecurity,diet quality,and untreated caries among US children

BackgroundThe aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship.MethodsThe authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach.ResultsFood-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries.ConclusionsFood insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries.Practical ImplicationsSocial factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.     

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.     

Systematic review and meta-analysis on the effect of self-assembling peptide P11-4 on arrest,cavitation, and progression of initial caries lesions

BackgroundSimple noninvasive evidence-based interventions for caries are needed to overcome limitations in the restorative paradigm. The self-assembling peptide P₁₁-4 is a noninvasive intervention that regenerates enamel in initial caries lesions.Studies ReviewedThe authors conducted a systematic review and meta-analysis on the effectiveness of the P₁₁-4 products Curodont Repair (Credentis; now manufactured by vVARDIS) (CR) and Curodont Repair Fluoride Plus (Credentis; now manufactured by vVARDIS) on initial caries lesions. Primary outcomes were lesion progression after 24 months, caries arrest, and cavitation. Secondary outcomes were changes in merged International Caries Detection and Assessment System score categories, quantitative light-induced fluorescence (QLF; Inspektor Research System), esthetic appearance, and lesion size.ResultsSix clinical trials met the inclusion criteria. Results of this review represent 2 primary and 2 secondary outcomes. When compared with parallel groups, use of CR likely results in a large increase in caries arrest (relative risk [RR], 1.82 [95% CI, 1.32 to 2.50]; 45% attributable risk [95% CI, 24% to 60%]; number needed to treat [NNT], 2.8) and likely decreases lesion size by a mean (SD) of 32% (28%). The evidence also suggests that use of CR results in a large reduction in cavitation (RR, 0.32 [95% CI, 0.10 to 1.06]; NNT, 6.9) and is uncertain about lowering merged International Caries Detection and Assessment System score (RR, 3.68 [95% CI, 0.42 to 32.3]; NNT, 19). No studies used Curodont Repair Fluoride Plus. No studies reported adverse esthetic changes.Practical ImplicationsCR likely has clinically important effects on caries arrest and decreased lesion size. Two trials had nonmasked assessors, and all trials had elevated risks of bias. The authors recommend conducting longer trials. CR is a promising treatment for initial caries lesions. The protocol for this systematic review was registered a priori with PROSPERO (304794).     

Effect of preradiation dental intervention on incidence of osteoradionecrosis in patients with head and neck cancer: A systematic review and meta-analysis

BackgroundThe purpose of this systematic review was to examine whether dental intervention involving bone or soft-tissue manipulation preradiotherapy (pre-RT) is associated with lower rates of osteoradionecrosis of the jaw (ORNJ) in patients with head and neck cancer (HNC).Types of Studies ReviewedThe authors included relevant studies from MEDLINE, Embase, and Cochrane Library, including observational studies published from 2007 through 2021 and involving adults who underwent dental intervention pre-RT for HNC. Authors assessed evidence certainty by using the Grading of Recommendations Assessment, Development, and Evaluation approach. Random-effects models were used to calculate pooled relative risk estimates and hazard ratios. When meta-analysis was not possible, study-level measures of association and narrative summaries of the evidence were reported.ResultsTwenty-two studies were included. From the pooled, unadjusted analysis, patients undergoing pre-RT extractions may have a 55% increased risk of experiencing ORNJ (relative risk, 1.55; 95% CI, 0.85 to 2.86; very low certainty); the unadjusted pooled hazard ratio was 3.19 (95% CI, 0.99 to 10.31; very low certainty), corresponding to a possible increased hazard of developing ORNJ (very low certainty). Findings for other pre-RT procedures manipulating bone or tissue relied on limited, observational studies with low or very low certainty evidence.ConclusionsMostly very low certainty evidence suggests that patients with HNC who need pre-RT dental intervention may have an increased risk of developing ORNJ compared with those who do not.Practical ImplicationsMaintaining optimal oral health may help reduce the need for urgent pre-RT dental treatment, potentially reducing ORNJ risk and minimizing delay of oncologic treatment in patients with HNC.