Parental anxiety as a possible predisposing factor to child dental anxiety in patients seen in a suburban dental hospital in Nigeria

Summary. Introduction. The aim of this study was to determine the relationship between parents’ anxiety level and that of the child patient. Methods. The Short Form of the Dental Anxiety Survey Schedule was administered to 81 children who were attending the dental clinic for the first time. The Dental Anxiety Scale was also used to collect relevant information from the parents. Results. There was no statistically significant correlation between the anxiety level of the mother (r = ?0·02, P = 0·82) or the father (r = ?0·59, P = 0·62) and that of their child. However, bivariate analysis showed a closer association between the anxiety levels of the mother and the child (P = 0·055) compared to that between the father and the child (P = 0·475) although this was again found not to be statistically significant. Conclusion. Assessment and management of the anxiety level of the mother may be needed in some cases, both to manage the child effectively and to break the cycle of dental care anxiety in families.     

Attitudes about dental care among parents whose children suffer from severe congenital heart disease: a case-control study

Summary. Objectives. To examine attitudes and experiences of parents whose children have complex congenital heart disease (CHD) with respect to dental health information and advice, dental care, and service and to compare the results with data from an age‐ and gender‐matched control group without any medical problems. Setting. Faculty of Medicine (Paediatric Cardiology and Paediatric Dentistry), Umeå University, Umeå, Sweden. Sample and method. Each group comprised parents of 33 children; the children's mean age was 9·4 years. All the cases and the controls resided in the county of Västerbotten, northern Sweden. Data were collected with a questionnaire with 20 joint questions to both groups and four additional questions to the CHD group. Results. Of the 20 joint questions, significant differences were displayed in the following areas: the professional group that provided the parents with dental health information and advice (P < 0·01), attitudes to reception at the dental clinic, and experience of sedation before operative dental treatment (P < 0·05). Parents to 11 children with CHD who were patients at a specialist clinic for paediatric dentistry scored the reception at the dental clinic as excellent in nine cases and satisfactory in two, compared to excellent (3), satisfactory (11), decent (4), and poor (4) among those who were patients in general dental practice (P < 0·01). No statistically significant differences in educational level or in parental experience of dental health were noted between the two groups (P > 0·05). Conclusion. Children with CHD in northern Sweden mainly receive their dental health information from a physician or a dentist, and healthy children mainly receive information from a dental hygienist indicating that children with CHD are given priority in the dental care system. Parental attitudes to reception in the dental service differed, and parents of healthy children scored the reception at the dental clinic better than parents of children with CHD. It is suggested that children with severe CHD should receive dental care in clinics for paediatric dentistry, particularly at early ages.     

Dental caries experience in children with congenital heart disease: a case-control study

Objectives. To compare the dental health of a group of children with complex congenital heart disease with that of age and gender matched healthy controls. Design. Case‐control study. Setting. Faculty of Medicine and Odontology/Pediatric cardiology and Pedodontics, Umeå University, Sweden. Sample and Methods. All the cases and their controls lived in the county of Västerbotten in northern Sweden. Each group comprised 41 children with a mean age of 6·5 years. Data were collected from medical and dental records while all bitewing radiographs were read separately by one of the authors. Results. Children with congenital heart disease had significantly more caries in their primary teeth than the control group. The mean dmfs‐value was 5·2 ± 7·0 in the cardiac group compared to 2·2 ± 3·5 in the control group (P < 0·05). Twenty‐six of the children had all four 6‐year‐molars, and their mean DMFS‐values were 0·9 ± 1·9 in the cardiac group compared to 0·3 ± 0·6 in the control group (P > 0·05). The children with congenital heart disease had received more caries prevention based on the use of fluorides than the control group. There was a significant correlation between the number of fluoride varnish treatments and the dmfs value of the child (r = 0·411, P < 0·01). Fifty‐two per cent of the children in the cardiac group had been prescribed fluoride tablets on one or more occasions compared to 17% in the control group (P < 0·01). Number of months on digoxin medication and the dmfs‐value had a significant correlation (r = 0·368, P < 0·05). Ten of the children had been on digoxin medication between 6 and 87 months; this subgroup had a mean dmfs‐value of 10·1 ± 8·5. Conclusion. Swedish children with complex congenital heart disease have poorer dental health than healthy age and gender matched controls in spite of intensive preventive efforts. In many cases, intervention had been given when caries were present. A closer cooperation between paediatric cardiology and paediatric dentistry is needed.     

Dental anxiety in a students' paediatric dental clinic: children, parents and students

Summary. Objective. The purpose of the present study was to investigate the dental anxieties of children, parents and student caregivers in a dental school environment. Methods. Eighty‐eight children, parents and the dental students who treated the children were included in the study. They were asked to complete questionnaires which gathered information about demographics and dental anxiety using the Dental Anxiety Scale (DAS). Students were also asked to respond to a visual analogue scale (VAS) to assess their anxiety prior to treating children. Results. Significant differences were observed between the mean DAS of the children compared to the students (8·8 ± 3·9 and 7·3 ± 2·7, respectively), and between the scores of the parents and the students (8·3 ± 2·9 and 7·3 ± 2·7, respectively). No significance was noted between the mean DAS scores of the children and those of the parents. The number of children in family did not influence the mean DAS of the children. Parents’ age, education or place of birth did not influence the mean DAS of the parents or the children. The mean DAS of children who reacted excellently in previous treatments scored significantly lower in DAS compared with children who were fearful. Female dental students demonstrated higher DAS and VAS scores than male students. Students’ seniority, type of last treatment that they received, time since last treatment, parenthood or self‐ranking in class did not seem to significantly influence their DAS or VAS scores. A strong correlation in DAS scores between parents and children was found (r = 0·41, P = 0·0001). No correlation between children's and students’ DAS scores was found. Conclusions. Students’ dental anxiety, or their anxiety prior to treating a child, may not be directly associated with the child's dental anxiety. However, a positive correlation exists between parental and children's dental anxiety.     

Dental health of dentists' children in Mongolia

Summary. Objectives. To describe the dental health of dentists’ children, to evaluate its association with their dentist‐parents’ background and work‐related characteristics and to compare it with that of children in the general population in Mongolia. Design. Cross‐sectional survey, questionnaire‐based data. Subjects. Dentists’ children, aged 3–13 years. Sample. All dentists (n = 250) actively practising in the capital city of Mongolia. Results. The dentists’ children's dmft ranged from 0 to 12, and DMFT from 0 to 8; 50% were caries‐free. The younger the children, the higher was their total caries experience expressed as the sum of DMFT + dmft scores (r = ?0·22; P = 0·001). Dentist‐parents’ background and work‐related factors were not associated with their children's caries status (P > 0·05). When dentists’ children were compared with their counterparts at the population level, mean dmft for 6‐year‐olds was 2·6 for (urban) dentists’ children, 6·5 for children in the urban population and 0·9 for those in rural population of equivalent age. Mean DMFT for 12‐year‐olds were 1·0, 1·8 and 1·2, respectively, in the same three groups. In general, (urban) dentists’ children in all age groups had better dental health than did their urban counterparts at the population level. Among 5–7‐year‐olds, dentists’ children had worse dental health than did their counterparts in the rural population. Conclusions. Despite the dentists’ knowledge and awareness, their children demonstrated higher rates of dental caries than expected. This suggests that Mongolian dentists may have insufficient preventive orientation. In particular, the primary dentition of younger children seems to be poorly valued. In Mongolia, dentists should have better training and education in modern methods of caries prevention and their advantages. Appreciation and care of the primary dentition need to be improved at all levels of oral health promotion in Mongolia.     

Caries reductions between 1995, 1997 and 1999 in preschool children in Diadema,Brazil

Summary. Aims. This study aimed to assess changes in caries prevalence and severity in preschool children in Diadema, Brazil. Methods. Three cross‐sectional surveys were conducted, using the same protocol, in 1995, 1997 and 1999. The first survey included children aged 5–35 months, and the second and third, children aged 5–59 months. Participants were selected from all children attending a National Day of Children’s Vaccination; 548, 992 and 690 in 1995, 1997 and 1999, respectively. This approach was sound as uptake rates for all years studied were above 90% for children aged between 1 and 59 months in all three surveys. Caries experience was measured using the World Health Organization (WHO) def index. Time‐lag and quasi‐longitudinal analysis were carried out. Results. Time‐lag analysis showed a marked and statistically significant decline in the prevalence and severity of coronal and rampant caries between 1995 and 1999. There were reductions of 36·5% in the prevalence of caries in 2‐year‐olds between 1995 and 1997 (P < 0·002) and 36·0% between 1997 and 1999 (P = 0·041). The mean def‐s at the same age decreased from 2·0 in 1995 to 1·1 in 1997 (P < 0·001) and to 1·0 in 1999 (P > 0·05). The quasi‐longitudinal analysis showed a statistically significantly increase in the percentage of children with caries between 1995 and 1997 and 1997 and 1999 (P < 0·001), but not for 2‐year‐old children between 1995 and 1997 (P > 0·05). The same pattern was observed for severity of dental caries. Conclusion. Oral health in preschool children in Diadema improved markedly during 1995–99.     

Oral health and caries related microflora in children during the first three months following renal transplantation

There is little information on the oral health of children undergoing renal transplantation during the early transplant period. Methods. Twenty‐four children undergoing renal transplantation aged 4–13·2 years and their matched controls were recruited. The dmfs, dmft, DMFS and DMFT, plaque, gingivitis and gingival enlargement scores were recorded. The oral microflora was sampled and cultured for S. mutans, Lactobacllus species and Candida species. Results. There was a significantly lower mean dmfs (0·3 ± 0·9; P = 0·03), dmft (0·3 ± 0·9; P = 0·03), DMFS (2·3 ± 5·3; P = 0·01) and DMFT (1·5 ± 2·6; P = 0·02), respectively, in the transplant group. There was a significantly greater mean plaque score (14·7 ± 11) for the permanent dentition, at baseline only, compared with 90 days post‐transplantation (9·4 ± 10·4; P = 0·02). There was a significantly greater gingival enlargement score (1·8 ± 1·4; P = 0·04) 90 days post‐transplantation compared with baseline. The S. mutans and Lactobacillus counts were significantly lower both at baseline (P = 0·0001 and P = 0·004) and 90 days post‐transplantation (P = 0·02; and P = 0·05), respectively, compared with the controls. Conclusions. The transplant children had less active dental disease than the controls although gingival enlargement needs careful monitoring.     

The cause of drooling in children with cerebral palsy – hypersalivation or swallowing defect?

Summary. Objective. To determine whether or not drooling in children with cerebral palsy is due to hypersalivation. Population and methods. The study population consisted of 10 children with cerebral palsy who were identified as having severe drooling, and a matched control group composed of 10 unaffected children who had no known physical or mental disabilities. Salivary flow rate was compared between the cerebral palsied children and the control group using the chin‐cup collection drool quantification method described by Sochanjwskyj. Components of the system included a cup‐like collection device, a vacuum pump, plastic tubing, an airtight collection chamber, and calibrated test tubes held against the subject's chin with elastic straps attached to an orthodontic head bonnet. Statistical analysis was completed using the Student's t‐test and Fisher's Exact Probability test. Results. The ages of the population ranged from 5·2 to 15·6 years, mean age (± SE) of 10·56 ± 1·13 years. There was no statistically significant difference in the rate of salivary flow rate between the two groups’ mean ± SE: cerebral palsy group 0·220 ± 0·018; control group 0·334 ± 0·052 (P = 0·053). The results were further confirmed by comparing the buffering capacity (P = 1·00) and concentrations of the sodium (P = 0·065) and potassium ions (P = 0·058) in the saliva of the study groups. Conclusions. Children with cerebral palsy who drool do not appear to produce excess saliva. Their salivation is similar to the control children.     

The prevalence and severity of dental fluorosis among 12-year-old schoolchildren in Jordan

Summary. Objectives. To assess dental fluorosis, provide base‐line data among Jordanian children and to compare fluorosis in incisor teeth between areas with different fluoride levels. Design. Cross‐sectional study among school children. Sample and methods. A sample of 1878 subjects aged 12 years, 940 boys and 938 girls, were randomly selected from 128 schools in urban (69 schools) and rural (59 schools) areas. The Thylstrup & Fejerskov (TF) index was used to record the dental fluorosis on the labial surfaces of incisors. Results. A total of 18·5% of the children examined showed dental fluorosis. The difference in fluorosis between males (17%) and females (20%) was not statistically significant (P > 0·05). Children in rural areas had a higher prevalence of fluorosis (31·8%) than their counterparts in urban areas (11·3%), a difference that was statistically significant (P < 0·01). Conclusions and recommendations. Findings suggest that there is a need for continued monitoring of mottling and further investigation into the fluoride intake from all sources in Jordan. However, there is a need to change the drinking water supplies in the southern region of Jordan. Active steps should also be taken to suppress emissions of vapours high in fluoride from phosphate plants to within acceptable limits.     

Comparison of utility weighted DMFT with patient‐reported oral well‐being

This study investigated a method of measuring oral health, as opposed to measuring disease. The objective was to compare DMF score and whole mouth utility scores to a patient‐reported outcome measure (PROM). Disutility values for lost and restored teeth were used to weight the decayed, missing and filled teeths(DMFTs) of 10 adult patients. This gave two whole mouth utility scores (WMU). These scores were then compared with a patient‐reported oral health outcome measure recorded by the use of a visual analogue scale (VAS). The anchors for the VAS were ‘my mouth could not be worse’ and ‘my mouth could not be better’. There was a positive correlation (r = 0·6457) between WMU1 and the patient‐reported outcome measure (P < 0·05) and a negative correlation (r = ?0·8383) between WMU1 and DMFT which was significant at the P < 0·01 level. There was a statistically significant positive correlation of r = 0·7926 between WMU2 and the patient‐reported outcome measure (P < 0·01) and a negative correlation (r = ?0·9393) between WMU2 and DMFT (P < 0·01). The Pearson's correlation between DMFT and the patient‐reported outcome measure was ?0·8757, which was significant at the 0·01 level. Patient reports of their perceived level of health correlate well with DMFT scores. Weighting DMFT scores according to the differential values assigned to missing, or missing and filled, teeth does not increase the degree of correlation between the measure and the patients’ personal quantification of their oral health. Decayed, missing and filled teeth therefore seems to adequately capture the patient's sense of well‐being.     

Caries prediction model in pre-school children in Riyadh, Saudi Arabia

Objectives. To evaluate the significance of variables such as oral hygiene, dietary habits, socio-economic status and medical history of a child in assessing the level of caries risk and to generate a caries prediction model for pre-school Saudi children. Design. Cross-sectional study of pre-school children. Setting. Clinics and schools in Riyadh, Saudi Arabia. Sample and methods. A sample of 446 Saudi pre-school children, 199 males and 247 females, with a mean age of 4·13 years, were selected at random from clinics and schools. Selection was limited to subjects who either had no caries (dmft= 0) or who had high caries experience (dmft > 8). Each child was examined for caries experience and oral hygiene status. Their mothers were interviewed through a standardized questionnaire for information about oral hygiene habits of the children, diet history, childhood illness and socio-economic status. Results. There was a highly significant difference between the two groups in: debris index (P<0.0001), age child started tooth brushing, (P<0·0001), age breastfeeding was stopped (P<0·005), nocturnal bottle feeding with milk formula (P<0·0001), use of sweetened milk (P<0·0001), frequency of use of soft drinks (P<0·0005), frequency of consumption of sweets (P<0·0001), and age at first dental visit (P<0·0001). A caries prediction model developed through stepwise multivariate Logistic Regression (LR) analyses showed debris index, use of sweetened milk in bottle, frequency of consumption of soft drinks, frequency of intake of sweets and child’s age at the first dental visit to be significant. Predictive probability of the model was 86·31% with a sensitivity of 90·1% and a specificity of 80·6%. Conclusions. Risk factors for dental caries have been identified and a caries prediction model has been developed for Saudi pre–school children. The prediction model, if verified, may provide dentists with guidance in identifying high caries risk Saudi pre-school children as targets for preventive programmes     

Prevalence of salivary Streptococcus mutans in mothers and in their preschool children

Summary. Objectives. To establish the prevalence and possible relationship of oral Streptococcusmutans colonization in mother–child pairs. Design and setting. An analytical cross‐sectional study was carried out at a well‐baby evaluation clinic held at the Public Dental Clinic, Varberg, Sweden. Sample and methods. Two hundred preschool children, 100 of which were 18 months old and the remaining 100 were 3 years old, and their mothers attended the clinic. All mothers were interviewed and their children’s medical history, oral hygiene routines and dietary habits established. All children were clinically examined. The presence and level of S. mutans was estimated in the mother–child pairs with the aid of the Strip mutans chair‐side test. Results. Nearly 50% of mothers exhibited high levels of salivary S. mutans, prevalence among the 18‐month‐ and 3‐year‐olds was 30% and 42%, respectively. A statistically significant (P < 0·01) mother–child relationship was found; a greater presence in mothers led to a higher number of children found harbouring the bacteria. Logistic regression analysis found that high maternal S. mutans levels (P < 0·001), daily sweet intake (P < 0·01) and sugary drinks in feeding bottles (P < 0·05) were significant factors for S. mutans colonization in children. Absence of daily toothbrushing and use of feeding bottles at night failed to fit into the model. Caries prevalence (initial and manifest decayed surfaces) was significantly related to S. mutans colonization (P < 0·01). Conclusion. The results support the concept of vertical transmission (mother–child), emphasizing the importance of the dietary component, and justifying a primary preventive approach with targeted action directed at mothers with high levels of S. mutans colonization.     

Evaluation of stress and pain during rapid maxillary expansion treatments

Summary The purpose of this study was to use salivary cortisol levels, pressure pain threshold (PPT) and Spielberger’s State‐Trait Anxiety Inventory for Children (STAIC) to assess stress, anxiety and pain during the expansion and retention phase of rapid maxillary expansion (RME) in children and investigate to whether this parameters are associated with gender or skeletal maturity stages. STAIC was used to assess the anxiety levels of the children. Salivary samples were collected for stress hormone determination. Visual Analog Scale was used for pain determination. Pressure pain threshold (PPT) was measured by using algometer. Data collection was performed a week before RME treatment (T0), at the day of the expansion appliance was bonded (T1), at the days of 1st, 4th, 7th, 14th, 25th, 36th activations of expansion screw (T2, T3, T4, T5, T6, T7) and after the retention period of 3 months (T8). The results of this study showed that the differences were statistically significant within‐day (P < 0·001) and within‐hours (P < 0·001) in cortisol levels during treatment. PPT levels were statistically significant within sex differences and skeletal maturity stages (P < 0·05). State‐trait anxiety scale scores were similar with respect to gender (P > 0·05). There were statistically significant differences of state‐trait anxiety levels between pre and post‐treatment stages (P < 0·05). The maximum number of patients reporting pain were days at T3 and T4. From day T5 the percentage of patients reporting pain then gradually reduced. Based on the findings of this study, it has been shown that RME leads to changes in patients’ state‐trait anxiety and cortisol levels.     

Increased phosphatidylcholine concentration in saliva reduces surface tension and improves airway patency in obstructive sleep apnoea

Surface tension may have important role for maintaining upper airway patency in patients with obstructive sleep apnoea. It has been demonstrated that elevated surface tension increases the pharyngeal pressures required to reopen the upper airway following collapse. The aim of the study was to evaluate the associations between the concentrations of endogenous surfactants in saliva with indices of upper airway patency in obstructive sleep apnoea. We studied 20 male patients with obstructive sleep apnoea (age: 60·3 ± 10·3 years; BMI: 25·9 ± 4·6 kg m^?2; AHI: 41·5 ± 18·6 events h^?1). We obtained 100‐μL samples of saliva prior to overnight polysomnographic sleep study. The surface tension was determined using the pull‐off force technique. The concentration of phosphatidylcholine (PC) was evaluated by liquid chromatography‐mass spectrometry (LC‐MS/MS). Regression analysis between apnoea, hypopnoea and apnoea/hypopnoea indices and the ratio of hypopnoea time/total disordered breathing time (HT/DBT) with surface tension and PC were performed. P < 0·05 was considered significant. The mean saliva surface tension was 48·8 ± 8·0 mN m^?1 and PC concentration was 15·7 ± 11·1 nM. The surface tension was negatively correlated with the PC concentration (r = ?0·48, P = 0·03). There was a significant positive correlation between surface tension with hypopnoea index (r = 0·50, P = 0·03) and HT/DBT (r = 0·6, P = 0·006), but not apnoea or apnoea/hypopnoea index (P > 0·11). Similarly, PC concentration negatively correlated with hypopnoea index (r = ?0·45, P = 0·04) and HT/DBT (r = ?0·6, P = 0·004), but not with apnoea index or AHI (P > 0·08). An increase in salivary PC concentration may increase upper airway patency in obstructive sleep apnoea through a reduction in surface tension.     

The relationship between dental aesthetic index (DAI) and perceptions of aesthetics,function and speech amongst secondary school children in Ibadan,Nigeria

Objective. The purpose of the study was to investigate the relationship between a professionally derived index, the Dental Aesthetic Index, and some indications for orthodontic treatment as perceived by potential patients. Methods. An epidemiological survey of 614 secondary school students, 327 males (53·3%) and 287 females (46·7%) was carried out in Ibadan, Nigeria. Children aged 12–18 years (mean age, 14·9 ± 2·9 SD) were randomly selected, none of them had received previous orthodontic treatment. One examiner assessed the students using the Dental Aesthetic Index (DAI). Subjects were also asked to complete a questionnaire consisting of three questions concerning appearance, function, and speech, using a 5‐point Likert scale. Results. Weak but statistically significant correlations were found for subjective assessments of appearance of teeth and the DAI (r = 0·174; P < 0·01) and between biting/chewing and appearance of teeth (r = 0·095; P < 0·05). Statistically significant correlations were found between appearance of teeth and speech (r = 0·148; P < 0·01) and biting/chewing and speech. The last showed the strongest correlation (r = 0·268; P < 0·01). Conclusion. The study has shown weak but significant correlation between DAI and children's perceptions of the appearance of their teeth. We recommend further study involving both DAI and Index of Orthodontic Treatment Need (IOTN) for comparison in the Nigerian population.     

Dental fluorosis and caries experience in relation to three different drinking water fluoride levels in South Africa

Objectives. The purpose of this study was to determine the relationship between caries experience, degree of fluorosis and different concentrations of fluoride in the drinking water of children. Sample and methods. The study included 282 children aged 10–15 years, who lived continuously since birth in three different naturally fluoridated areas (Leeu Gamka, 3·0; Kuboes 0·48 and Sanddrif 0·19 p.p.m. F), with virtually no dental care or any fluoride therapy. The teeth of the children were examined for caries using the DMFT index according to the WHO criteria and for fluorosis, using Dean’s criteria according to the WHO guidelines. Results. The prevalence of fluorosis (scores 2, 3, 4 and 5) among the school children was 47% in Sanddrif, 50% in Kuboes and 95% in Leeu Gamka. Almost half the children in the two low fluoride areas had no fluorosis (scores 0 and 1), whereas only 5% in Leeu Gamka had no fluorosis. Of the children in Sanddrif, 42·5% had very mild/mild (scores 2 and 3) fluorosis, 44·3% in Kuboes and 34·1% in Leeu Gamka. Except for one individual in Kuboes, severe fluorosis (score 5) was only observed in the high fluoride area in 30% of the children. According to the Bonferroni adaptation for multiple comparisons, the degree of fluorosis in Leeu Gamka differed significantly from both those of Sanddrif and Kuboes. The mean DMFT for the children in Sanddrif and Kuboes was similar (1·64 ± 0·30 and 1·54 ± 0·24, respectively) but the caries experience of Leeu Gamka (1·98 ± 0·22) was significantly higher (P < 0·05) than that of both the other two areas. A strong positive correlation (P < 0·05) was found between the caries experience and the fluorosis scores of children in the high fluoride area (Leeu Gamka) but no correlation could be found in the other two areas. Significantly (P < 0·01) more children had decayed teeth in the high F area (Leeu Gamka) than in the other two areas. Conclusion. The results suggest a positive association between high F levels in the drinking water and dental caries. Furthermore, a low caries experience and no difference in DMFT and fluorosis between the two low fluoride areas were found.     

Microbiological assessment of saliva from children subsequent to atraumatic restorative treatment (ART)

Summary. Aims. The aim of this study was to evaluate mutans streptococci (MS) in the saliva following use of the atraumatic restorative treatment (ART) technique. Methods. Sixteen 5–7‐year‐old children had restorations using the ART technique and employing FUJI IX glass‐ionomer cement as the restorative material. Decayed tissue was manually excavated without local anaesthesia, being careful to avoid discomfort. Saliva was collected for microbiological assessment using Kit Caritest MS before treatment, one week, four weeks and one year after ART was used. The procedure for saliva collection, incubation, storage, and comparative reading of MS counts followed the manufacturer's instructions. The data were statistically analysed, using non‐parametric tests (Wilcoxon Signed Ranks and Sign Test) at a significance level of 0·05. Results. The results showed a significant reduction of MS levels in saliva when comparing the results before treatment with those obtained one week (95·95%; P = 0·003), four weeks (93·27%; P = 0·000) and one year (95·56%; P = 0·002) after ART. Conclusions. It is concluded from the results that the ART technique proved satisfactory and appeared to have produced a significant and sustained reduction in levels of MS. These results need to be confirmed in a larger study.     

Efficacy of low‐level laser therapy in the treatment of TMDs: a meta‐analysis of 14 randomised controlled trials

This study was designed to evaluate the efficacy of low‐level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMDs). We searched electronic databases and references lists of relevant articles, retrieved all of the published randomised controlled trials in regard to these issues and then performed a meta‐analysis. Fourteen highly qualified RCTs reporting on a total of 454 patients, which evaluated the effectiveness of LLLT for patients suffering from TMDs were retrieved. The results indicated that LLLT was not better than placebo in reducing chronic TMD pain (weighted mean difference = ?19·39; 95% confidence interval = ?40·80–2·03; P < 0·00001; I² = 99%). However, the LLLT provided significant better functional outcomes in terms of maximum active vertical opening (MAVO) (weighted mean difference = 4·18; 95% confidence interval = 0·73–7·63; P = 0·006; I² = 73%), maximum passive vertical opening (MPVO) (weighted mean difference = 6·73; 95% confidence interval = 01·34–12·13; P = 0·06; I² = 73%), protrusion excursion (PE) (weighted mean difference = 1·81; 95% confidence interval = 0·79–2·83; P = 0·59; I² = 0%) and right lateral excursion (RLE) (weighted mean difference = 2·86; 95% confidence interval = 1·27–4·45; P = 0·01; I² = 73%). The results of our meta‐analysis have provided the best evidence on the efficacy of LLLT in the treatment of TMDs. This study indicates that using LLLT has limited efficacy in reducing pain in patients with TMDs. However, LLLT can significantly improve the functional outcomes of patients with TMDs.