Search

Objective The objective of the study is to assess systemic immune markers and microbial factors related to periodontitis severity in people living with HIV. Methods Eighty people living with HIV (PLWH), who exhibited in the last two viral load measurements Results From our group of PLWH, 42.5% and 57.5% suffered from moderate and severe periodontitis, respectively. Oral care habits did not differ between PLWH with moderate and severe periodontitis. Bacterial subgingival plaque loads were higher, and Porphyromonas gingivalis was more prevalent in PLWH with severe periodontitis than with moderate periodontitis (53% vs 7%, respectively). Mean C-reactive protein levels [CRP, 1.6 mg/L versus 0.8 mg/L, p = 0.020] and percentages of senescent CD28-CD57 + CD8 + T-cells in peripheral blood [16.5 versus 8.9, p = 0.035] were higher with severe periodontitis. Infection duration, CD4 count, CD4/CD8 ratio and type of antiretroviral therapy did not differ between both groups. Conclusions Periodontitis severity is related to increased prevalence of Porphyromonas gingivalis, elevated CRP levels, and higher frequencies of circulating CD8 + senescent cells in PLWH.

PURPOSE: Upper blepharoplasty may be related to dry eye symptoms since the function of the orbicularis oculi muscle may affect the tear film. We aimed to assess the effect of blepharoplasty with or without the removal of a strip of orbicularis oculi muscle on tear film dynamics and dry eye symptoms.METHODS: A double-blind, randomized, controlled trial comparing upper blepharoplasty without (group A) or with (group B) orbicularis oculi muscle excision was performed on 54 healthy Caucasian patients. Tear film dynamics and dry eye symptoms were evaluated using multiple dry eye parameters, i.e. tear osmolarity, Schirmer test I, corneal/conjunctival staining, tear break-up time (TBUT), Oxford Scheme, Sicca Ocular Staining Score and Ocular Surface Disease Index questionnaire. All the parameters were assessed preoperatively and 6 and 12 months after upper blepharoplasty. All the groups' outcomes were compared.RESULTS: The differences were not significant between the two upper blepharoplasty techniques regarding most of the above-mentioned outcomes. Subjective symptoms of ocular irritation, consistent with dry eye disease and vision-related impairment, were reduced after upper blepharoplasty independent of the type of the technique applied, while the pre and postoperative outcomes of the objective tear dynamics did not differ 12 months after surgery. However, group B demonstrated a significant increase in tear osmolarity and TBUT at the 6-month follow-up visit.CONCLUSION: An upper blepharoplasty alleviates subjective dry eye complaints in the long term, while not changing the tear dynamics. The improvement was independent of the blepharoplasty technique used.

Objective: This study aimed to develop a consensus-based core outcome set (COS) to be used in clinical trials assessing dry mouth interventions.Study Design: Through 2 systematic literature reviews and interviews with dry mouth patients, we identified relevant outcome domains for dry mouth assessment. A Delphi survey was presented to health care providers attending the American Academy of Oral Medicine annual meeting in Memphis, Tennessee, USA, on May 2022 (n = 104) and 10 dry mouth patients at Cork University Dental School and Hospital, Republic of Ireland. The outcome domains for which no consensus was reached were subsequently discussed in a second consensus process led by a virtual Special Interest Group of 11 oral medicine experts from the World Workshop on Oral Medicine VIII dry mouth working group.Results: After the 2-step consensus process, a consensus was reached for 12 dry mouth outcome domains (i.e., salivary gland flow, signs of hyposalivation, mucosal moisture/wetness, the severity of xerostomia, duration of xerostomia, the overall impact of xerostomia, impact on physical functioning, impact of hyposalivation on general health, impact on social activities, quality of life, the economic impact of dry mouth, patient satisfaction) to be included in the final COS.Conclusions: We propose a consensus-based COS to assess dry mouth interventions in clinical trials. This COS includes the minimum but mandatory set of domains that all clinical trials evaluating dry mouth treatments should assess.

BACKGROUND: Different skin excision shapes may result in different aesthetic outcomes after upper blepharoplasty.METHODS: Two skin-only excision shapes were evaluated objectively and subjectively in 28 matched patients with laterally extended skin excision (group A) or traditional elliptical skin excision (group B). The pretarsal show, lateral eyebrow height, amount of scarring (evaluated with the Patient and Observer Scar Assessment Scale), and patient-reported aesthetic results (evaluated using FACE-Q) were scored and compared at 6 and 12 months postoperatively.RESULTS: In both groups, pretarsal show improved significantly after blepharoplasty. The homogeneity of pretarsal show improved significantly in the lateral extension group (group A) together with slightly more pretarsal show (0.5 to 0.8 mm at central pupil region) at 6 and 12 months of follow-up compared with group B ( P = 0.004). A trend was observed in the exocanthion 45-degree measurement, in which group A had 0.6 mm greater pretarsal show 6 months postoperatively. Homogeneity of the pretarsal show had improved significantly in group A, but not in group B, at 12 months after blepharoplasty. No other significant differences were observed between the groups regarding pretarsal show measurements or FACE-Q scores. Both groups showed descent of the lateral eyebrow, but this was only significant in group B. Group B showed 1.4 to 2.0 mm more descent compared with group A. Scarring and adverse effects scores were low in both groups and did not differ.CONCLUSION: Laterally extended skin excision and traditional elliptical skin excision both result in positive aesthetic results, but the laterally extended skin excision technique is accompanied by a slightly more favorable outcome.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

OBJECTIVES: To assess the outcomes of soft tissue augmentation, in terms of change in level and thickness of mid-buccal mucosa, at implants sites in the zone of the aesthetic priority. MATERIAL AND METHODS: MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases were searched (last search on 1 June 2020). Inclusion criteria were studies reporting outcomes of different materials and timing of grafting in patients undergoing soft tissue augmentation at implant sites in the aesthetic zone with a follow-up of ≥1 year after implant placement. Outcome measures assessed included changes in level and thickness of mid-buccal mucosa, implant survival, peri-implant health and patients' satisfaction. RESULTS: Eighteen out of 2,185 articles fulfilled the inclusion criteria. Meta-analysis revealed a significant difference in vertical mid-buccal soft tissue change (0.34 mm, 95% CI: 0.13-0.56, p = .002) and mid-buccal mucosa thickness (0.66 mm, 95% CI: 0.35-0.97, p < .001) following immediate implant placement in favour of the use of a graft versus no graft. Mean difference in mid-buccal mucosa level following delayed implant placement (0.17 mm, 95% CI: 0.01-0.34, p = .042) was also in favour of the use of a graft versus no graft. With regard to mucosa thickness, the use of a graft was not in favour compared with no graft following delayed implant placement (0.22 mm, 95% CI: -0.04-0.47, p = .095). Observed changes remained stable in the medium term. CONCLUSION: Soft tissue augmentation in the zone of the aesthetic priority results in less recession and a thicker mid-buccal mucosa following immediate implant placement and less recession in mid-buccal mucosa following delayed implant placement compared with no graft.

Altmetric Explorer was searched for the most popular online articles published in Pubmed-indexed journals. The 75 articles with the highest Altmetric Attention Score (AAS) were screened for article information (date, journal, access), authorship (number of authors, affiliation and origin of the corresponding author), and research (type, subject, funding). The reviewed articles displayed a mean AAS of 241.52, were broadcast 17.03 times by news agencies, posted on Twitter 101.47 times, downloaded by 67.21 Mendeley readers, and received 62.67 citations. There was intense online interest in the transgender health literature, mainly related to mental health and social well-being. Online visibility of transgender health articles was not significantly correlated with citation counts, implying that the public, likely including transgender persons and allies, may place emphasis on different health issues than scholars. Monitoring altmetrics and interactions on electronic media may help researchers conduct research that is more meaningful to transgender individuals, and to society in general.

With great interest we have read the recently published study titled “The Implications of the COVID-19 Pandemic on the Interest in Orthodontic Treatment and Perspectives for the Future. Real-Time Surveillance Using Google Trends” [...]

Objective The involvement of salivary glands in primary SS (pSS) can be assessed in different ways: histopathology, salivary flow and ultrasonography. To understand the relative value of these different approaches, it is crucial to understand the relationship between them. As we routinely perform these three modalities in the parotid gland for disease evaluation, our aim was to investigate the construct validity between these modalities in one and the same gland. Methods Consecutive sicca patients underwent a multidisciplinary diagnostic workup including parotid gland biopsy, collection of parotid gland–specific saliva and parotid gland ultrasonography. Patients who were classified as pSS according to the ACR-EULAR criteria were included. Construct validity was assessed using Spearman’s correlation coefficients. Results The 41 included pSS patients completed a full workup within a mean time interval of 2.6 months. Correlations between histopathological features and stimulated parotid salivary flow were fair (ρ = −0.123 for focus score and ρ = −0.259 for percentage of CD45+ infiltrate). Likewise, poor correlations were observed between stimulated parotid salivary flow and parotid ultrasonography (ρ = −0.196). Moderate to good associations were found between the histopathological items focus score and the percentage of CD45+ infiltrate, with parotid US scores (total US score: ρ = 0.510 and ρ = 0.560; highest for homogeneity: ρ = 0.574 and ρ = 0.633). Conclusion Although pSS-associated ultrasonographic findings did correlate with histopathological features, the three modalities that evaluate salivary gland involvement assess different (or at best partly related) constructs. Therefore histopathology, salivary flow and ultrasonography are complementary measurements and cannot directly replace each other in the workup of pSS.

Objectives: To assess the diagnostic accuracy of two smartphone cephalometric analysis apps compared with Viewbox software. Materials and Methods: Pretreatment digital lateral cephalograms of 50 consecutive orthodontic patients (20 males, 30 females; mean age, 19.1 years; SD, 11.7) were traced twice using two apps (ie, CephNinja and OneCeph), with Viewbox used as the gold standard computer software program. Seven angular and two linear measurements, originally derived from Steiner cephalometric analysis, were performed. Results: Regarding validity, intraclass correlation coefficients (ICCs) ranged from .903–.983 and .786–.978 for OneCeph vs Viewbox and CephNinja vs Viewbox, respectively. The ICC values for intratool reliability ranged from .647–.993. None of the CephNinja measurements was below the recommended cutoff values of ICCs for reliability. Conclusions: OneCeph has a high validity compared with Viewbox, while CephNinja is the best alternative to Viewbox regarding reliability. Smartphone apps may have a great potential in supplementing traditional cephalometric analysis.

OBJECTIVE: To conduct a systematic review of studies exploring potential biomarkers for development, course and efficacy of treatment of lymphomas in salivary glands of patients with Sjögren's syndrome.MATERIAL AND METHODS: Eligible studies were identified through a comprehensive search of two databases, i.e. PubMed and EMBASE. Quality of included articles was assessed with the 'Quality In Prognosis Studies' (QUIPS) tool. The 'CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies' (CHARMS) was used to facilitate data extraction.RESULTS: Fifty-eight studies met the inclusion criteria. Only one study assessed the progression of lymphoma. Moderate risk of bias was detected in 'outcome measurement', 'study participation' and 'study confounding' domains. Parotid gland enlargement, mixed monoclonal cryoglobulins and low C4 levels represented strongest predictors of lymphoma development. The role of histological biomarkers, and specifically germinal centers, remains controversial. Clinical and methodological heterogeneity across studies precluded conduct of a meta-analysis.CONCLUSIONS: Specific biomarkers in combination with clinical manifestations represent potential candidates for advancing precision medicine approaches to lymphoma prediction in patients with Sjögren's syndrome. Current focus has increasingly been on genetic and epigenetic markers as candidate predictors. Predictive accuracy of key biomarker candidates remains to be tested in well-designed prospectively-followed Sjögren's syndrome cohorts. This article is protected by copyright. All rights reserved.

We describe the case of a patient diagnosed with neurofibromatosis type1 (NF1) where unusually extensive and multiple osteolytic lesions ofboth jaws consistent with central giant cell granulomas (CGCG) causedmassive bone destruction and left her almost “jawless.” The patient wasa 58-year-old woman who at the age of 15 years was diagnosed withNF1 and at the age of 53 years underwent radiation therapy for nasalobstruction due to CGCG. The most significant intraoral findings werebrown tumors on the maxillary gingiva; bilateral expansion of the hardpalate; and a yellow mass on the floor of the mouth. Head and neckexamination revealed mandibular asymmetry and features consistentwith NF1. Panoramic radiograph and cone beam computed tomographydisclosed multiple radiolucent masses. Although the occurrence ofmultiple CGCG of the jaws in patients with NF1 is rare, early diagnosis,regular follow-up and proper therapeutic intervention may limit theextent of bone destruction.

Background Chronic Graft-versus-Host Disease (cGVHD) can impact quality of life, especially in patients with oral involvement. Half of the patients with cGVHD do not respond to first-line therapy with corticosteroids and calcineurin inhibitors. Ruxolitinib is effective in steroid-refractory (SR)-cGVHD cases, but the long-term effects of ruxolitinib on the oral mucosa are unknown. Objective(s) This study aims to assess the effect of ruxolitinib on the oral mucosa of SR-cGVHD patients with oral involvement. Materials and methods An observational longitudinal patient study was conducted in 53 patients with SR-cGVHD and oral involvement who were treated with ruxolitinib. The baseline condition of the oral mucosa was compared to its condition at 4 and 12 weeks after starting ruxolitinib. Results The overall response was 81% (43/53), with a complete response in 53% (28/53) and partial response in 28% (15/53) after 12 weeks (p p = 0.005) and patients with ruxolitinib monotherapy (p = 0.02), respectively. At a longer follow-up (median 20 months), oral symptoms were comparable to the 12-week symptoms (p = 0.78), regardless of ruxolitinib use (p = 0.83). Conclusion Ruxolitinib treatment of SR-cGVHD patients with oral involvement was associated with a significant response of the oral manifestations at 12 weeks. Clinical relevance The oral mucosa of SR-cGVHD patients is likely to improve after 4 and 12 weeks of ruxolitinib treatment. Symptom severity at baseline does not affect the response of the oral mucosa.

With great interest we have read the recent publication by Fisher et al ,1 entitled ‘Effect of rituximab on a salivary gland ultrasound score in primary Sjogren’s syndrome: results of the TRACTISS randomised double-blind multicenter substudy’ in which the authors demonstrated a significant improvement in total ultrasound score (TUS) after rituximab treatment compared with placebo at weeks 16 and 48 in 52 patients with primary Sjogren’s syndrome (pSS). We and others have shown that treatment with rituximab, a chimeric anti-CD20 monoclonal antibody, affects the histopathology of the salivary glands and results in a decrease in area of lymphocytic infiltrate in the labial and parotid glands.2–5 This reduction in infiltrated area, that is, up to 50%, is mainly caused by B cell depletion.2 Rituximab treatment also causes a significant loss of germinal centres.2 Interestingly, rituximab treatment also leads to a significant restoration of the ductal epithelium glandular tissue itself. This is illustrated by a significant decrease in number and severity of lymphoepithelial lesions (LELs) in parotid gland tissue 12 weeks after rituximab treatment.2 6 The normalisation of the epithelium appears to be a direct consequence of depletion of intraepithelial B cells.7 Significant improvement of the parotid gland ultrasound score of patients with pSS has been observed before in another randomised controlled trial (RCT) with rituximab, the Tolerance and Efficacy of Rituximab in Primary Sjogren’s Syndrome (TEARS) study.8 This is an RCT with rituximab versus placebo, performed by a French group. Together with the improvement of the histopathology of the gland, it might not be a surprise that Fisher et al 1 also observed a significant improvement in TUS. This newly …

Objective: To assess periodontitis prevalence and severity in HIV infected patients as compared to controls. Furthermore, to assess whether HIV infection characteristics are associated with periodontitis.Design: cross-sectional controlled study.Methods: We assessed prevalence and severity of periodontitis in 258 HIV-infected patients and 539 historical controls with the Dutch Periodontal Screening Index (DPSI). HIV characteristics were collected from medical charts. Age-related diseases and oral care were assessed with questionnaires.Results: Severe periodontitis (DPSI 4) was more prevalent in HIV-infected patients than in controls (66% vs. 36%, p =0.002). HIV-infection, increasing age and male sex were significant risk factors for severe periodontitis. In particular, older male HIV patients have a higher risk of severe periodontitis. Clinical, immunological and virologic characteristics, and antiretroviral therapy were not associated with periodontitis prevalence or severity. HIV-infected patients rate the importance of their oral health as high, although many do not disclose their HIV infection to their dentists.Conclusions: Prevalence and severity of periodontitis are higher in HIV-infected patients compared to controls, particularly in older males. Awareness of the increased prevalence of periodontitis associated with HIV-infection among patients and health-care professionals could significantly improve oral health and quality of life of HIV-infected patients. (C) 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

ObjectivesThe aims of this study were (1) to assess the effect of rituximab (RTX; anti-CD20) treatment in patients with primary Sjögren's syndrome (pSS) based on sequential parotid biopsies obtained in a placebo-controlled, randomised clinical trial, and (2) to assess the prognostic value of the histological characteristics of parotid gland tissue with regard to responsiveness to RTX treatment.MethodsIn a double-blinded, placebo-controlled trial, sequential parotid gland biopsies were taken from 20 RTX-treated and 10 placebo-treated patients with pSS, at baseline and 12 weeks after treatment. The relative amount of lymphocytic infiltrate (stained for CD45), absolute number of T cells and B cells per mm2 parenchyma (stained for CD3 and CD20, respectively), focus score, number of germinal centres and of lymphoepithelial lesions per mm2 in parotid gland parenchyma were assessed. Histopathological data were compared between clinical responders (decrease in European League Against Rheumatism Sjögren's Syndrome Disease Activity Index (ESSDAI) score of ≥3 at 12 weeks compared with baseline) and non-responders (change in ESSDAIResultsIn RTX-treated patients, a significant reduction in the number of CD20+ B cells/mm2 parenchyma was observed, while no such reduction was observed in placebo-treated patients. The number of CD3+ T cells/mm2 in parenchyma did not change in either group. Furthermore, the number and the severity of lymphoepithelial lesions/mm2 and number of germinal centres/mm2 was significantly reduced in RTX-treated patients, but did not change in placebo-treated patients. When comparing the pretreatment characteristics of clinical responders with non-responders, the median number of CD20+ B cells/mm2 parenchyma at baseline was significantly higher in responders (1871 vs 353 cells/mm2, pConclusionsRTX treatment in pSS leads to a major reduction of lymphocytic infiltration and to fewer B cells, germinal centres and lymphoepithelial lesions in parotid gland parenchyma. A high pretreatment number of CD20+ B cells/mm2 parotid gland parenchyma predicts better responsiveness of patients with pSS to RTX treatment. Pretreatment parotid gland histopathological characteristics could therefore contribute to a more personalised treatment approach to pSS.

This case report describes the autotransplantation of maxillary right second premolar into the contralateral position in a 14-year-old female using computerized tomographic data and a customized guiding system produced by computer-aided design/computer-assisted manufacture technology. Using innovative surgical guides and keys with navigation features, modification of the recipient socket and handling of the transplant were facilitated without harming the periodontal membrane. Postoperative clinical and radiographic examination showed periodontal and pulp healing earlier than 6 months after surgery.

OBJECTIVES: To assess how patients perceived pain and change of sensibility of the biopsied area after having undergone parotid and labial gland biopsy as part of the diagnostic work-up of primary Sjögren's syndrome (pSS). METHODS: Simultaneously, parotid and labial salivary gland biopsies were taken under local anesthesia. One week, 6 months and 12 months post-operatively, each patient was sent a postal questionnaire to quantify the severity of pain and change of sensibility in the biopsied areas with a visual analogue scale (VAS; range 0-100). RESULTS: 110 patients were included. The median age of patients was 54 years (IQR=47-65) and 92% were female. Changes in sensibility and pain in the biopsied area were significantly higher after a parotid gland biopsy than after a labial gland biopsy at one week and 6 months post-operatively, but rather minor in both areas. At 12 months post-operatively, the change in sensibility and pain level was negligible in most patients and comparable for both biopsied areas. The duration of the technique, outcome of the biopsy, exposure of nerve branches during the biopsy and bleeding during the biopsy did not affect the reported change of sensibility or pain in the biopsied area. ESSPRI was not related to pain level or change of sensibility at any time point (r0.05). CONCLUSIONS: Patient-reported post-operative change of sensibility and pain in the area of the parotid and labial gland biopsy are minor and comparable. Parotid and labial gland biopsies are diagnostic techniques well tolerated by patients suspected with pSS.

To assess the inter- and intraobserver reliability of ultrasound of major salivary glands in patients clinically suspected of having primary Sjögren's syndrome (pSS) as well as to assess sources of variation in outcomes of ultrasonographic evaluation. 80 consecutive outpatients with clinically suspected pSS underwent ultrasound evaluation. The following ultrasound variables of the parotid and submandibular salivary glands were assessed: echogenicity, parenchymal homogeneity, presence of hypoechogenic areas, hyperechogenic reflections and clearness of posterior glandular border, according to the scoring system of Hocevar et al. (total score range: 0 - 48). Images were scored independently by three blinded observers in two sessions. The intraobserver reliability of the total ultrasound score was excellent, with an intraclass correlation (ICC) ranging from 0.89 to 0.96. The interobserver reliability was good to excellent, with ICCs of 0.84 and 0.76 for the total ultrasound score in the two sessions. The kappa value ranged from 0.60 to 0.83 depending on the applied cut-offs (cut-off score ≥ 15 and ≥ 17). Hypoechogenic areas and homogeneity of parotid glands showed the highest interobserver reliability. The median kappa for echogenicity was low. The total ultrasound scores varied more between observers in patients with higher ultrasonographic scores (approximately scores ≥ 20). Ultrasound of major salivary glands is a reliable imaging technique for patients with clinically suspected pSS. Discrepancies between observers in assessing the severity of ultrasound findings may interfere with detecting 'true' changes over time. When monitoring the progression of pSS or treatment efficacy, it is advised that a particular patient be scored by the same ultrasonographer at every time point.ZIEL: Beurteilung der Inter- und Intraobserver-Reliabilität des Ultraschalls der großen Speicheldrüsen bei Patienten mit klinischem Verdacht auf primäres Sjögren-Syndrom (pSS) und Bewertung der Schwankungsquellen der Sonografie-Ergebnisse. 80 aufeinander folgende ambulante Patienten mit klinischem Verdacht auf pSS wurden sonografisch bewertet. In der Glandula parotidea und Glandula submandibularis wurden die folgenden Ultraschallvariablen untersucht: Echogenität, Homogenität des Parenchyms, Nachweis von echoarmen Reflexionen und deutliche Abgrenzung des posterioren Drüsenrands nach dem Scoring-System von Hocevar et al. (gesamter Score-Bereich: 0 – 48). Die Bilder wurden unabhängig voneinander durch drei verblindete Beobachter in zwei Sitzungen eingeteilt. Die Intraobserver-Reliabilität der Gesamt-Ultraschall-Scores war ausgezeichnet, mit einer Intraklasse-Korrelation (ICC) zwischen 0,89 und 0,96. Die Interobserver-Reliabilität war gut bis ausgezeichnet, mit ICCs von 0,84 und 0,76 für den Gesamt-Ultraschall-Score in den beiden Sitzungen. Der kappa-Wert war zwischen 0,60 und 0,83 je nach verwendetem Cut-off (Cut-off Score ≥ 15 und ≥ 17). Echoarme Bereiche und die Homogenität der Parotisdrüsen zeigten die höchste Interobserver-Reliabilität. Der mediane Kappawert für die Echogenität war gering. Bei Patienten mit höheren Ultraschall-Scores variierten die Gesamt-Ultraschall-Scores stärker zwischen den Beobachtern (Scores von etwa ≥ 20). Die Sonografie der großen Speicheldrüsen ist eine zuverlässige bildgebende Diagnostik bei Patienten mit klinischem Verdacht auf pSS. Widersprüchliche Bewertungen des Schweregrads von Ultraschall-Befunden zwischen Beobachtern können den Nachweis "echter" Veränderungen im Laufe der Zeit stören. Bei der Überwachung der Progression des pSS oder der Wirksamkeit der Therapie wird empfohlen, dass ein bestimmter Patient jedes Mal vom selben Ultraschalldiagnostiker beurteilt wird.

Objective: To evaluate the online visibility of the most popular orthodontic articles in Web platforms in relation to publication details and citations.Materials and Methods: Altmetric Explorer (Altmetric LLP, London, UK) was searched for articles published in 11 orthodontic journals without time limits in publication and citation on social media. The 200 articles with the highest Altmetric Attention Score (AAS) were collected and screened for data related to publication (date, journal, access), authorship (number of authors, affiliation and origin of the corresponding author), and research (type, subject, funding). Citation counts were harvested from Scopus.Results: The top 200 articles presented a median AAS of 8.0 (range: 5.0-196.0), and were mostly bookmarked in Mendeley (median: 16.6 references; range: 0-199.0). American Journal of Orthodontics & Dentofacial Orthopedics, European Journal of Orthodontics and The Angle Orthodontist contributed 86 per cent of the total number of research outputs. Studies investigating socio-demographics had significantly higher AAS compared to diagnostic studies (median AAS: 19.0; range: 7.0-34.0; versus median AAS: 6.0; range: 5.0-10.0. No other study parameter was found to be statistically significant. AAS did not correlate to the number of citations as reported in Scopus.Limitations: The early stage of altmetrics and their complementary role in assessing together with the citation-based metrics the research impact need to be acknowledged in the interpretation of the results.Conclusions: Visibility of orthodontic articles on the Web is not significantly correlated with citations. Studies on socio-demographics had significantly higher number of online mentions. More constructive online presence of orthodontic journals is needed to reinforce dissemination of research data among scholars and non-scholars.

ObjectiveTo assess whether ultrasonographic scoring of (i) both parotid and submandibular salivary glands and (ii) all individual components of the Hocevar scoring system, is needed for classifying patients as primary Sjögren’s syndrome (pSS).MethodsUltrasound examination of the major salivary glands (sUS) was performed in 204 consecutive patients clinically suspected (n=171) or diagnosed (n=33) with pSS.Parenchymal echogenicity, homogeneity, hypoechogenic areas, hyperechogenic reflections and salivary gland posterior border were scored in left and right parotid and submandibular glands. Logistic regression analyses were performed to assess which glands and sUS components contributed significantly to classification as pSS or non-pSS according to the 2016 American College of Rheumatology-European League Against Rheumatism (ACR-EULAR) criteria.Results116 (57%) patients were classified as pSS, the remaining as non-pSS. Instead of scoring both sides (area under the curve; AUC=0.856, Nagelkerke R2=0.526), multivariate analysis showed that sUS scoring of only right (AUC=0.850; R2=0.518) or left (AUC=0.852; R2=0.511) parotid and submandibular glands is sufficient to predict ACR-EULAR classification. Moreover, all individual components of the Hocevar scoring system significantly predicted classification. Multivariate analysis showed that parenchymal echogenicity and hypoechogenic areas contributed independently to ACR-EULAR classification (AUC=0.857; R2=0.539). Scoring these components in one parotid and one submandibular gland highly predicted ACR-EULAR classification (AUC=0.855; R2=0.539). Scoring only hypoechogenic areas on one side showed almost similar results (AUC=0.846; R2=0.498).ConclusionsUS examination of parotid and submandibular glands on one side is sufficient to predict classification of patients according to the ACR-EULAR criteria. To further increase feasibility of sUS in outpatient clinics worldwide, only hypoechogenic areas can be scored.

We thank Professor Warnakulasuriya for his letter (Warnakulasuriya, 2019) and comments in relation to our systematic review of prospective studies assessing the prognostic biomarkers of oral leukoplakia (Villa et al., 2019). We agree that identifying prognostic biomarkers for oral leukoplakia is an important topic for oral medicine specialists. Hence our commitment to addressing such a diverse and scientifically challenging area as a component of World Workshop of Oral Medicine VII. This article is protected by copyright. All rights reserved.

Objective To assess the qualitative standards of the information distributed via the Internet regarding xerostomia. Materials and Methods A comprehensive electronic search was performed for ‘xerostomia’ and ‘dry mouth’ separately using four search engines. The first 30 results from each search term–engine combination were pooled for analysis. After excluding promotional product sites, discussion groups, video feeds, scientific articles, non-operative sources, sites with denied direct access through password requirement, non-English language domains, and online medical dictionaries, 50 Web pages were evaluated in terms of readability, accessibility, usability, and reliability using recommended research methodology the Flesch Reading Ease Score and the LIDA instrument. Author and information details were also recorded. Results The results revealed a variable quality of the available Internet information on xerostomia. The Web sites required advanced reading skills, while LIDA scores for accessibility, usability, and reliability ranged from medium to low with average scores extending from 29.1% to 81.3%. Conclusions The quality of information about xerostomia among Web sources presents high variability. The existing discrepancy should be alleviated by referring patients to evidence-based education materials on the Internet. Improvement in xerostomia information e-resources will contribute to a more advanced quality in oral health care.

Objectives: This article reviews the present literature on the issues encountered while coping with children with autistic spectrum disorder from the dental perspective. The autistic patient profile and external factors affecting the oral health status of this patient population are discussed upon the existing body of evidence. Material and Methods: The MEDLINE database was searched using the terms ‘Autistic Disorder’, ‘Behaviour Control/methods’, ‘Child’, ‘Dental care for disabled’, ‘Education’, ‘Oral Health’, and ‘Pediatric Dentistry’ to locate related articles published up to January 2013. Results: Most of the relevant studies indicate poor oral hygiene whereas they are inconclusive regarding the caries incidence in autistic individuals. Undergraduate dental education appears to determine the competence of dental professionals to treat developmentally disabled children and account partly for compromised access to dental care. Dental management of an autistic child requires in-depth understanding of the background of the autism and available behavioural guidance theories. The dental professional should be flexible to modify the treatment approach according to the individual patient needs. Key words:Autism spectrum disorder, dental management, children.

ObjectivesTo quantitatively and qualitatively assess the characteristics of YouTube videos dealing with Sjogren's syndrome.Materials & MethodsA comprehensive electronic search was performed for Sjogren's syndrome' in YouTube. After excluding duplicates, irrelevant videos, and non-English-language domains, 70 videos were included for analysis. Videos were classified as useful, misleading, or personal experience. The overall quality of videos was scored according to the Global Quality Scale (GQS). Useful videos were assessed for reliability and comprehensiveness based on two 5-point scales. Key points of the misleading videos were explored and patients' personal experiences were further investigated.ResultsThirty-six videos (51.4%) were classified as useful, 6 (8.6%) as misleading, and 28 (40%) as patient's personal experience. Independent users tend to upload videos with personal experience, while university channels/professional organizations share useful videos with evidence-based information. Significant difference was observed in GQS among useful, misleading videos, and patient's experiences. The mean reliability, comprehensiveness, and GQS scores of useful videos were 2.5 (s.d.:1.2), 2.6 (s.d.:1.4), and 3.4 (s.d.:1.0), respectively, whereas only six videos (16.7%) were rated as complete vis-a-vis content. The most frequently misleading topics were etiology and treatment.ConclusionsSpecialists should refer their patients to validated e-information resources and actively participate in the development of video-sharing platforms.

ObjectiveTo perform a systematic review and meta-analysis on studies examining the properties of ultrasonography of major salivary glands for diagnosing Sjogren's syndrome.Materials and MethodsWe searched for the literature on eight databases. The quality of included articles was assessed with the QUADAS-2 tool. Publication bias, pooled sensitivity, specificity, diagnostic odds ratio, and 95% confidence intervals (95%CI) were calculated. Meta-regression analysis was performed.ResultsWe identified 37 studies and 33 ultrasonographic scoring systems. High risk of bias was observed in patient selection', conduct and interpretation of ultrasound', and flow of patients and timing of tests' in 78%, 70%, and 51% of the studies. We included 29 studies in the meta-analysis. Publication bias was highly probable. Pooled sensitivity was 0.69 (95%CI: 0.67-0.71), specificity 0.92 (95%CI: 0.91-0.93), and diagnostic odds ratio 33.89 (95%CI: 20.75-55.35). Significant heterogeneity was detected between studies. Meta-regression analysis showed that studies with high risk of bias in conduct and interpretation of ultrasound' and studies evaluating only parenchymal homogeneity had higher log diagnostic odds ratio (1.09 and 2.49, respectively, pConclusionsThe quality of current studies is low, thus not allowing to judge the likelihood of salivary gland ultrasonography as a reliable and practical tool in diagnosing Sjogren's syndrome.

Background Ultrasound of major salivary glands (sUS) is an upcoming diagnostic method to assess the involvement of major salivary glands in primary Sjogren9s syndrome (pSS). In the AECG, ACR and recently published ACR-EULAR criteria, a positive salivary gland biopsy and/or presence of anti-SSA antibodies are necessary to classify a patient as pSS, while sUS is not included as a diagnostic item. Objectives To assess whether combining anti-SSA antibody status with sUS outcome can predict classification of patients as pSS in our inception cohort study. Methods Consecutive outpatients clinically suspected with pSS underwent sUS of the parotid and submandibular glands. Parenchymal echogenicity, homogeneity, hypoechogenic areas, hyperechogenic reflections and clearness of salivary gland border were scored according to the Hocevar scoring system (total score 0–48). 1 Positive sUS was defined as total score ≥15. Patients underwent a diagnostic work up according to the AECG, ACR and ACR-EULAR criteria. We analyzed the predictive value of the combination of anti-SSA antibody status and sUS outcome for classification as pSS or non-pSS. Separate analyses were done considering either i) parotid gland biopsy or ii) labial gland biopsy as an item, when applying these classification criteria. Results Anti-SSA antibody status was positive in 53 (51%) patients and sUS was positive in 40 (39%) patients. When parotid gland biopsy outcome was considered as an item of the criteria, 45 of 97 patients were classified as pSS according to the AECG, 44 of 97 according to the ACR and 52 of 99 according to the ACR-EULAR criteria. The combination of presence of anti-SSA antibodies with positive sUS showed a very high positive predictive value for classification as pSS (94–97%) and the combination of absence of anti-SSA antibodies with negative sUS highly excludes classification (negative predictive value 98–100%). When labial gland biopsy outcome was considered as an item of the criteria, 49 of 96 patients were classified as pSS according to the AECG, 43 of 93 according to the ACR and 55 of 97 according to the ACR-EULAR criteria. The combination of presence of anti-SSA antibodies with positive sUS showed a high positive predictive value for classification as pSS (94–97%). However, the combination of absence of anti-SSA antibodies with negative sUS did not per se exclude classification (negative predictive value 89–93%). Conclusions In our prospective inception cohort study derived from daily clinical practice, the combination of presence of anti-SSA antibodies and positive sUS outcome highly predicts classification as pSS according to the AECG, ACR and ACR-EULAR classification criteria. References Hocevar et al. Rheumatology (Oxford) 2005;44:768–72. Disclosure of Interest None declared

SUMMARY The aim of this study was to investigate potential occurrence of bacteremia in orthodontic patients after removal of miniscrews.The study group comprised 30 healthy subjects (17 males, 13 females) with a mean age of 24.1 years treated with self-ligating fixed appliances and mini-implant anchorage. Two 20ml venous blood samples were obtained prior to and 30-60 seconds after miniscrew explantation following an aseptic technique. Blood culturing in aerobic and anaerobic conditions was carried out by means of the BACTEC blood culture analyzer. Microbiological analysis showed that none of the pre- and post-operative samples exhibited detectable bacteremia. Future research should be focused on determining the collective bacteremic effect of a sequence of orthodontic procedures including miniscrew placement or removal, typically performed during a single treatment session

Salivary gland biopsy is a technique broadly applied for the diagnosis of Sjogren's syndrome (SS), lymphoma accompanying SS, sarcoidosis, amyloidosis, and other connective tissue disorders. SS has characteristic microscopic findings involving lymphocytic infiltration surrounding the excretory ducts in combination with destruction of acinar tissue. This article focuses on the main techniques used for taking labial and parotid salivary gland biopsies in the diagnostic workup of SS with respect to their advantages, their postoperative complications, and their usefulness for diagnostic procedures, monitoring disease progression, and treatment evaluation.

Objective: To investigate the quality of the data disseminated via the Internet regarding pain experienced by orthodontic patients. Materials and Methods: A systematic online search was performed for ‘orthodontic pain’ and ‘braces pain’ separately using five search engines. The first 25 results from each search term–engine combination were pooled for analysis. After excluding advertising sites, discussion groups, video feeds, and links to scientific articles, 25 Web pages were evaluated in terms of accuracy, readability, accessibility, usability, and reliability using recommended research methodology; reference textbook material, the Flesch Reading Ease Score; and the LIDA instrument. Author and information details were also recorded. Results: Overall, the results indicated a variable quality of the available informational material. Although the readability of the Web sites was generally acceptable, the individual LIDA categories were rated of medium or low quality, with average scores ranging from 16.9% to 86.2%. The orthodontic relevance of the Web sites was not accompanied by the highest assessment results, and vice versa. Conclusions: The quality of the orthodontic pain information cited by Web sources appears to be highly variable. Further structural development of health information technology along with public referral to reliable sources by specialists are recommended.

The aim of this work was to investigate the published evidence on the comparison of self-perception and diagnosis of orthodontic treatment need. A search of Cochrane Library, MEDLINE, Scopus databases, and archives of two orthodontic journals was carried out from January 1966 to August 2011 by the two authors using Medical Subject Heading terms. Studies that investigated solely either self-perception of orthodontic need by laypersons or assessment of orthodontic need by professionals were excluded from the data analysis. The methodological soundness of each study and the aggregate level of evidence were evaluated according to predetermined criteria. Moderate level of evidence, the relatively highest grade, was assigned to 9.1 per cent of the 22 studies, finally included in the data analysis. The overall evidence level provided by the evaluated publications was rated as limited. However, the existing body of evidence indicated a highly variable association between self-perception of orthodontic treatment need and orthodontist's assessment. Future controlled studies with well-defined samples and common assessment methodology will clarify further the relationship between perception of treatment need by laypersons and orthodontists and enhance international comparison and development of health care strategies.

Objective: To assess the prevalence of lateral incisor agenesis impacted canines and supernumerary teeth in a young adult male population. Materials and Methods: The panoramic radiographs of 1745 military students (mean age: 18.6 ± 0.52 years) who attended the Center of Aviation Medicine of the Armed Forces of Greece during the period 1997-2011 were initially analyzed for lateral incisor agenesis by two observers. After exclusion of the known orthodontic cases, a subgroup of 1636 examinees (mean age: 18.6 ± 0.44 years) was evaluated for canine impaction and supernumerary teeth. Results: Twenty-eight missing lateral incisors were observed in 22 military students, indicating an incidence of 1.3% in the investigated population. No lateral incisor agenesis was detected in the mandibular arch. A prevalence rate of 0.8% was determined for canine impaction in the sample of young adults. The majority of impacted teeth (86.7%) were diagnosed in the maxillary arch. Thirty-five supernumerary teeth were observed in 24 examinees (prevalence rate: 1.5%). The ratio of supernumerary teeth located in the maxilla versus the mandible was 2.2:1. The most common type of supernumerary tooth was the upper distomolar. Conclusion: The prevalence of lateral incisor agenesis, canine impaction, and supernumerary teeth ranged from 0.8 to 1.5% in the sample of male Greek military students.

Objective: The purpose of this study was to identify all outcome domains utilized in clinical studies of xerostomia, i.e. subjective sensation of dry mouth. This study is part of the extended project ‘World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research (WONDER)’ to develop a core outcome set (COS) for dry mouth.Study design: A systematic review was performed on MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human subjects from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Corresponding outcome measures were summarized.Results: From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures was consistently utilized across all the studies. Severity of xerostomia and physical functioning were the two most frequently assessed domains.Conclusion: There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment in order to enhance comparability across studies and facilitate synthesis of robust evidence for the management of patients with xerostomia.

Objective: To identify all outcome measures used to assess salivary gland hypofunction (i.e.: objective measures used to determine actual changes in saliva quantity or to assess response to treatment of salivary gland hypofunction) and to group these into domains.Study Design: A systematic review including clinical trials, and prospective or retrospective observational studies involving human participants with dry mouth, with any type of intervention where objective assessment of salivary gland hypofunction was described.Results: Five hundred fifty-three studies involving 31,507 participants were identified. The majority assessed both salivary gland hypofunction and xerostomia (68.7%), whilst 31.3% assessed salivary gland hypofunction alone. The majority of studies investigated ‘amount of saliva’ and the highest number of outcome measures was within the domain ‘clinical/objective signs of salivary gland hypofunction’.Conclusions: Seven domains encompassing 30 outcome measures were identified, confirming the diversity in outcomes and outcome measures used in research regarding salivary gland hypofunction. Identified items will be used in conjunction with those identified regarding xerostomia to create a COS for dry mouth quantification for use in future clinical trials, with the overall goal of improving the standardization of reporting, leading to the establishment of more robust evidence for the management of dry mouth and improving patient care.

ObjectiveTo develop a composite responder index in primary Sjögren’s syndrome (pSS): the Sjögren’s Tool for Assessing Response (STAR).MethodsTo develop STAR, the NECESSITY (New clinical endpoints in primary Sjögren’s syndrome: an interventional trial based on stratifying patients) consortium used data-driven methods based on nine randomised controlled trials (RCTs) and consensus techniques involving 78 experts and 20 patients. Based on reanalysis of rituximab trials and the literature, the Delphi panel identified a core set of domains with their respective outcome measures. STAR options combining these domains were proposed to the panel for selection and improvement. For each STAR option, sensitivity to change was estimated by the C-index in nine RCTs. Delphi rounds were run for selecting STAR. For the options remaining before the final vote, a meta-analysis of the RCTs was performed.ResultsThe Delphi panel identified five core domains (systemic activity, patient symptoms, lachrymal gland function, salivary gland function and biological parameters), and 227 STAR options combining these domains were selected to be tested for sensitivity to change. After two Delphi rounds, a meta-analysis of the 20 remaining options was performed. The candidate STAR was then selected by a final vote based on metrological properties and clinical relevance.ConclusionThe candidate STAR is a composite responder index that includes all main disease features in a single tool and is designed for use as a primary endpoint in pSS RCTs. The rigorous and consensual development process ensures its face and content validity. The candidate STAR showed good sensitivity to change and will be prospectively validated by the NECESSITY consortium in a dedicated RCT.