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Statement of problem Screening for temporomandibular disorders (TMDs) is important in research and clinical practice. The short-form Fonseca Anamnestic Index (SFAI) was recently introduced but had only been validated for muscle disorders. Purpose The purpose of this clinical study was to determine the diagnostic accuracy of the SFAI and its discrete and pooled items in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) benchmark. Material and methods A total of 866 consecutive participants with TMDs and 57 TMD-free controls (aged ≥18 years) were recruited. The participants (n=923; mean age 32.8 ±13.3 years; women 79.2%) answered the FAI, and TMD diagnoses were derived based on the DC/TMD protocol and algorithms. The 5-item SFAI, which comprised 2 pain-related and 3 function-related TMD questions, was subsequently acquired and assessed with reference to the DC/TMD diagnoses. The receiver operating characteristics (ROC) was used to verify accuracy (area under the curve [AUC]) and the best cutoff points. Sensitivity, specificity, predictive values, and likelihood ratios were also examined. Results Pain-related (PT) and intra-articular (IT) TMDs were present in 48.3% (446/923) and 82.7% (763/923) of the participants, respectively. The SFAI demonstrated high accuracy for identifying all TMDs, PT, and IT (AUC of 0.97, 0.99, and 0.97, respectively). The best cutoff points were 12.5 for all TMDs/IT and 17.5 for PT. Sensitivity of the SFAI ranged from 90.7% to 97.5% while specificity varied from 93.0% to 96.5%, with the highest values for PT. As positive predictive values (99.4% to 99.5%) were greater than negative ones (41.7% to 83.3%), the SFAI was better at detecting the presence than the absence of TMDs. With reference to PT, the sensitivity, and specificity of the 2 discrete and pooled pain-related questions (questions 3 and 4), extended from 82.3% to 99.3% and 77.2% to 96.5% respectively. With regard to IT diagnoses, sensitivity and specificity ranged from 56.0% to 98.3% and 86.0% to 98.3% for the 3 discrete and pooled function-related items (questions 1, 2, and 5). Conclusions The SFAI presented high degrees of diagnostic accuracy in relation to the DC/TMD and can be used for screening TMDs. SFAI scores between 15 and 50 points should be used to identify the presence of TMDs, with scores ≥20 points specifying possible pain-related TMDs.

This study estimated the prevalence of dental fear/anxiety (DFA) in Southeast Asian youths and established their dental environment and practitioner preferences.A convenience sample of youths were enrolled from a local polytechnic. The Index of Dental Anxiety and Fear (IDAF-4C) was used to ascertain the presence and severity of DFA. Socio-demographic and IDAF-4C data, along with participants' dental environment and practitioner partialities were gathered electronically. Statistical evaluations were performed with Kruskal-Wallis and Chi-square tests (α = 0.05).Data from a total of 215 participants were appraised. The mean age of the study sample was 18.9 ± 2.0 years (87.4% women). Of these, 12.6% had moderate-to-high DFA and 6.0% had high-to-extreme DFA. As a group, Southeast Asian youths generally liked dental clinics with adorned walls, cooler temperatures, magazines/books, background music and audio-visual devices. In addition, they favoured female practitioners who are younger (≤45 years old), friendly, talkative and maintain a professional relationship. However, those with high-to-extreme DFA preferred a warmer clinic environment and to have an informal relationship with their dental practitioners (p = 0.01).The prevalence of moderate-to-extreme DFA in Southeast Asian youths was 18.6%. Individuals with high-to-extreme DFA may have disparate dental environment and practitioner preferences compared to those with no-to-moderate DFA.

The relationships between temporomandibular disorders (TMDs) and negative affectivity/emotions across cultures and the emotional predictors for TMDs in Southeast Asian youths were investigated.The presence of TMDs and negative affectivity/emotions were determined with the Fonseca Anamnestic Index (FAI) and Depression, Anxiety, Stress Scales-21 (DASS-21). Statistical evaluations were done with non-parametric and logistic regression analyses (α.The total sample comprised 400 Singaporean and 501 Indonesian youths (mean age 19.30 ± 1.48 years; 65.0% women) of whom 47.0% and 59.3% had mild-to-severe TMDs, respectively. For both cultures, participants with TMDs had significantly greater negative affectivity, depression, anxiety, and stress than those with no TMDs. Indonesian youths also presented higher levels of emotional distress than their Singaporean counterparts. Correlations between FAI and anxiety/stress scores were moderately strong.Cultural variations can influence the expression of TMDs and emotional distress. Being female and anxious increased the risk of TMDs.

To investigate the presence/severity of TMDs among Asian youths and examine the associations between TMD severity, otologic, and concomitant pain symptoms.Youths (17-24 years old) were recruited from a local polytechnic. The presence/severity of TMDs was determined with the Fonseca Anamnestic Index (FAI), while otologic/concomitant pain symptoms were appraised with the Maciel's Symptoms Checklist (MSC). Demographic, FAI, and MSC data were evaluated using Kruskal Wallis, chi-square, and relevant post-hoc tests (α = 0.05).Among the participants (n = 200) enrolled, 40.5% had no TMD, whereas mild, moderate, and severe TMD were present in 43.5%, 12.5%, and 3.5%, respectively. Participants with moderate/severe TMDs had significantly more otalgia, tinnitus, vertigo, dizziness, ear pruritus, hearing loss, ear fullness, headache, eye, neck, and back pain than those with no TMDs (Otologic and concomitant pain symptoms were associated with TMDs and appear to increase with progressive TMD severity.

This study translated/cross-culturally adapted the Fonseca Anamnestic Index (FAI) for temporomandibular disorders (TMDs) into Malay and psychometrically tested the Malay-FAI (FAI-M).The FAI-M was created according to international guidelines. Internal consistency/test-retest reliability were assessed with Cronbach's alpha/intra-class correlation (ICC) coefficients. Construct and convergent validity were appraised by relating the FAI-M to the Global Oral Health (GOH) questionnaire and Short-form Oral Health Impact Profile (S-OHIP) using Kruskal-Wallis and Spearman's rho correlation (α = 0.05).Of the 243 participants enrolled, 54.7% (n = 133) had no TMDs, while TMDs were present in 45.3% (n = 110). The FAI-M presented very good internal consistency (α = 0.90) and test-retest reliability (ICC = 0.99). Theoretically predicted FAI-M score patterns matched the GOH categories, and strong correlations were discerned between FAI-M and S-OHIP (The FAI-M exhibited good psychometric properties and can be applied in Malay-speaking populations.

Objective To investigate the effect of light-curing distance on the effectiveness of cure (EC) of bulk-fill resin-based composites (RBCs). Materials and methods Two bulk-fill RBCs (a Tetric N-Ceram Bulk Fill (TN) and a Filtek Bulk Fill (FK)) are evaluated. Specimens (4 mm high) are cured for 20 s at different distances (0 mm (D0), 2 mm (D2), 4 mm (D4), 6 mm (D6) and 8 mm (D8)) and stored for 24 h in 100% relative humidity at 37 °C. The top and bottom surface hardness (SH) (n = 12) are assessed using a Knoop microhardness tester and the EC is calculated. The EC is characterized by the hardness ratio (HR) (mean bottom: top SH). An HR of 0.8 is used as the benchmark for an effective/adequate cure. Data are analyzed using one-way analysis of variance and Tukey’s post hoc test (α = 0.05). Correlations between the top and bottom surfaces are examined using the Pearson correlation (α = 0.05). Results For the TN, the HR at D8 is significantly lower than all other light-curing distances, while for the FK, it is significantly lower than D0 only. Conclusion The effect of light-curing distance on the EC of bulk-fill RBCs is material dependent. Notwithstanding the light-curing distance, the EC of the FK and TN is below the threshold HR value of 0.8 when photopolymerized for 20 s in 4 mm increments in black opaque molds.

Early-stage temporomandibular joint osteoarthritis (TMJOA) is characterized by excessive subchondral bone loss. Emerging evidence suggests that TMJ disc displacement is involved, but the pathogenic mechanism remains unclear. Here, we established a rat model of TMJOA that simulated disc displacement with a capacitance-based force-sensing system to directly measure articular surface pressure in vivo. Micro-CT, histological staining, immunofluorescence staining, IHC staining, and Western blot were used to assess pathological changes and underlying mechanisms of TMJOA in the rat model in vivo as well as in RAW264.7 cells in vitro. We found that disc displacement led to significantly higher pressure on the articular surface, which caused rapid subchondral bone loss via activation of the RANTES-chemokine receptors-Akt2 (RANTES-CCRs-Akt2) axis. Inhibition of RANTES or Akt2 attenuated subchondral bone loss and resulted in improved subchondral bone microstructure. Cytological studies substantiated that RANTES regulated osteoclast formation by binding to its receptor CCRs and activating the Akt2 pathway. The clinical evidence further supported that RANTES was a potential biomarker for predicting subchondral bone loss in early-stage TMJOA. Taken together, this study demonstrates important functions of the RANTES-CCRs-Akt2 axis in the regulation of subchondral bone remodeling and provides further knowledge of how disc displacement causes TMJOA.

Objectives: The relationships between CBCT findings, Temporomandibular disorder (TMD) symptoms, and signs were investigated in patients with TMJ degenerative joint disease (DJD). Materials and Methods: Adult patients with DC/TMD-defined intra-articular conditions were enrolled and subjected to CBCT assessment. The participants were organized into three groups, namely no (NT), early (ET), and late (LT) TMJ DJD based on radiographic findings. TMD symptoms/signs were appraised using the DC/TMD Symptom Questionnaire and examination protocol respectively. Statistical analyses were performed using Chi-square/non-parametric tests and Kappa statistics (α = 0.05). Results: The mean age of the participants (n = 877) was 30.60 ± 11.50 years (86.6% women). NT, ET, and LT were observed in 39.7%, 17.0%, and 43.3% of the study sample. Significant differences in the prevalence of TMD symptoms (TMD pain, TMJ sounds, opening, and closing difficulty) and signs (TMD/TMJ pain, TMJ clicking/crepitus, and opening limitation) were discerned among the three groups. TMD/TMJ pain and opening difficulty/limitation were more prevalent in early rather than late degenerative changes. While moderate agreements between symptoms and signs were observed for TMD pain/opening limitation, the concurrence for TMJ sounds was fair. Conclusions: Patients with TMJ sounds and pain should be routinely examined with CBCT to establish the extent/progress of osseous changes. Clinical Relevance: Patients with TMJ sounds and TMD pain, particularly TMJ crepitus and pain, should be routinely examined with CBCT so that early and accurate TMJ DJD diagnoses can be made. This will facilitate timely therapeutic interventions to minimize further TMJ deterioration and encourage TMJ repair/regeneration.

Objectives This study examined the metric properties of the Oral Health Impact Profile for Temporomandibular Disorders (OHIP-TMD) using Factor/Rasch analyses and created a short-form version of the measure. Subjects and methods Aggregated OHIP-TMD data were obtained from a cross-sectional study involving 844 TMD patients with diagnostic criteria for TMDs defined conditions. The dimensionality of the OHIP-TMD was first evaluated with exploratory factor analysis. An eigenvalue >1.0 and oblique oblimin rotation were applied for extracting the factors. Rasch analysis was subsequently performed on the primary dimension using the ConQuest software. Results Multi-dimensionality of the OHIP-TMD was observed with the primary dimension comprising ten items. Adequate fit to the Rasch model was noted after deleting item 8 with infit/outfit mean-square values ranging from 0.75 to 1.40 logits. Item difficulty ranged from -0.75 to 1.05 logits, while participants' ability to respond varied from -4.55 to 5.19 logits. The respondent spread was slightly skewed and satisfactory item-response targeting was present. Conclusions The 22-item OHIP-TMD demonstrated multi-dimensionality with the primary dimension consisting of nine reliable items with adequate fit to the Rasch model. The 9-item short-form version of the OHIP-TMD (SOHIP-TMD) is a promising tool for evaluating OHRQoL.

In this case-control study, we investigated the presence of differing numbers and types of temporomandibular disorder (TMD) symptoms, their association with psychological distress, and their impact on oral health-related quality of life (OHRQoL).We recruited a total of 814 participants with TMD and 147 control subjects. The participants were instructed to complete the Diagnostic Criteria for Temporomandibular Disorders Symptom Questionnaire; the Depression, Anxiety and Stress Scale-21; and the Oral Health Impact Profile-Temporomandibular Disorders. The participants were subsequently categorized by their number and type of TMD symptoms. Data were analyzed with the Kruskal-Wallis/Mann-Whitney U test (α = .05).The mean age of the participants (N = 961) was 32.99 ± 13.14 years, and 79.2% were women. Participants with more and all types of TMD symptoms generally exhibited significantly higher levels of psychological distress and worse OHRQoL (P.001). Those with TMD pain plus temporomandibular joint (TMJ) sounds/dysfunction had significantly greater psychological distress, whereas those with painful symptoms and TMJ dysfunction experienced significantly more impairment in OHRQoL than individuals with only TMJ sounds.Psychological states and OHRQoL are influenced by the number and type of TMD symptoms. Individuals with more and all types of pain-related TMD symptoms with/without intra-articular features had greater psychological distress and OHRQoL impairment.

There has been increasing evidence indicating rather high success rates of vital pulp therapies. This umbrella review aimed to provide an overview of existing systematic reviews regarding the outcomes of vital pulp therapy, specifically direct pulp capping, partial pulpotomy and full pulpotomy, in carious pulp–exposed permanent human teeth. The specific PICO questions were as follows: Population - permanent human teeth with carious pulp exposure; Intervention - direct pulp capping with pulp capping materials; Comparators - partial pulpotomy and full pulpotomy; Outcomes - success rate and prognostic factors. PubMed, Ovid and Cochrane databases were searched in conjunction with hand searching. Grey literature was searched too. Study selection, data extraction and study appraisal were performed independently by two authors. A consensus was reached through discussion when disagreements arose. Six articles fulfilled the inclusion criteria. Higher and more predictable success rates of ≥ 2 years were observed for partial pulpotomy and full pulpotomy in carious pulp–exposed permanent human teeth as compared to direct pulp capping. Possible prognostic factors (pre-operative pulp status, pulp capping material and apex closure) yielded conflicting results. Restorative material, periapical status at baseline, final irrigation solution, age and study type did not seem to affect the treatment outcome. Vital pulp therapy is a reliable treatment option for permanent teeth with carious pulp exposure. However, more high-quality studies are required to corroborate this finding. Vital pulp therapy could be considered as an alternative for root canal treatment for carious pulp–exposed permanent teeth.

This umbrella review (UR) explored the possible associations between temporomandibular disorders (TMDs) and otologic signs/symptoms (OSs) and established the potential impact of TMD interventions on OSs.A systematic review of systematic reviews (SRs)/meta-analyses (MAs) was conducted according to the PRISMA guidelines and Joanna Briggs Institute UR protocol. Electronic search of the PubMed, Scopus, Web of Science, and Open Grey databases was conducted and the quality of the identified studies was assessed using the AMSTAR2 criteria.Out of 923 and 157 articles screened for the first and second focus questions respectively, a total of 8 SRs/MAs fulfilled the eligibility criteria. The prevalence of OSs in TMD patients and contrariwise varied substantially up to 85.0-95.0%. Available evidence indicates that TMDs are associated with OSs, and TMD treatment reduced OSs.Findings suggest that a comorbid relationship between TMDs and OSs exists, and therapeutic TMD interventions improve OSs.

The relation of degenerative temporomandibular joint (TMJ) diseases (DJDs) with sleep and emotional disturbance were investigated.CBCT examination of patients (n = 358) with DC/TMD-defined intra-articular temporomandibular disorders was performed and stratified into NN: no DJD and no arthralgia; NA: no DJD with arthralgia; TO: osteoarthrosis; and TR: osteoarthritis. Sleep and emotional disturbance were assessed with the Pittsburgh Sleep Quality Index (PSQI) and Depression Anxiety Stress Scale-21 (DASS-21). Data were evaluated using non-parametric and multivariate logistic regression analyses (α = 0.05).Distributions of NN, NA, TO, and TR groups were 23.2%, 27.1%,19.0%, and 30.7%, respectively. No significant differences in total-PSQI/DASS scores were detected among the four groups. The presence of pain and stress predicted poor quality sleep with odds ratios of 10.75 and 1.07, accordingly.Sleep quality was affected more by arthralgia and stress than the presence of TMJ DJDs.

The clinical efficacy of selective laser melting (SLM) for fabricating removable partial dentures (RPDs) is not well established.The purpose of this clinical study was to compare the performance of SLM-fabricated frameworks with that of those fabricated via traditional lost wax casting.A double-blind, randomized, crossover design was used to compare cobalt-chromium partial denture frameworks (n=29) fabricated by using SLM or traditional methods. The time taken for adjustments and the clinical fit and stability of the adjusted frameworks were appraised. The accuracy of the frameworks was assessed by measuring the space between the occlusal rest seat and the corresponding rest seat. Statistical comparisons between the 2 frameworks were carried out by using a linear mixed-effect model for repeated measurements (α=.05).Frameworks fabricated by using both SLM and traditional techniques had an acceptable fit based on subjective clinical evaluation. The overall mean ±standard deviation space between the occlusal rest and rest seat for SLM frameworks (273.7 ±44.5 μm) was comparable with that of traditional frameworks (242.2 ±44.5 μm). The clinical fit adjustment time, 7.76 ±6.43 minutes for SLM and 5.49 ±6.39 minutes for traditionally fabricated frameworks, was statistically similar (P=.067).Dentures fabricated via SLM and traditional techniques had comparable accuracy of fit and clinical fitting time.

This study investigated the efficacy of a sequential combination of arthrocentesis, mandibular manipulation, and anterior repositioning splint (ARS) in the management of acute temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). Twenty-one consecutive patients diagnosed with acute DDwoR by Diagnostic Criteria for Temporomandibular Disorders and magnetic resonance imaging (MRI) were recruited and managed with this method. Clinical and MRI data were obtained before and at 1 week after treatment. The disc-condyle relationship was determined by disc-condyle angle measurement. Condyle/disc positions were described as x-y coordinates with the summit of the articular fossa as the coordinate origin. Statistical analyses including independent/paired samples t-tests were conducted; significance was set at P

Systematic review analyzing the treatment outcomes of cracked teeth that received endodontic treatment is unavailable. The purpose of this study was to examine the treatment outcome of cracked teeth that received root canal treatment and to determine factors that influenced outcome. The specific PIO questions were as follows: Population: patients who were healthy individuals ≥ 18 years old and required root canal treatment due to cracked tooth; Intervention: root canal treatment with at least 1 year in occlusal function; Outcomes: survival rate and pre-operative factors. Ovid, PubMed, and Cochrane databases were searched in conjunction with hand searching. Pooled survival rates were determined from a meta-analysis of the data retrieved from the articles. All statistics were performed by the Comprehensive Meta-Analysis software. Four articles met the inclusion criteria. The overall tooth survival at 60 months was 84.1% (95%CI, 72.3–91.5%). Although no pre-operative factors had statistical significance, 4 factors had possible clinical significance. Teeth with single crack and teeth with cracks contained within crowns exhibited lower extraction risk, while teeth with pre-treatment periodontal probing > 3 mm and teeth that were terminal abutments showed a greater risk of extraction. This systematic review determined the survival rate of endodontically treated cracked teeth to be moderately high. More studies in this area are, however, warranted before definitive conclusions can be derived. In view of the relatively high survival rate, endodontic treatment rather than extraction should be considered for cracked teeth.

This systematic review aimed to appraise the quality of life of patients with restored endodontically treated teeth. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were employed. The specific PEO question was as follows: population: patients who were healthy individuals ≥18 years old and required endodontic treatment; exposure: endodontic treatment with a coronal restoration with at least 6 months in occlusal function; and outcome: quality of life of patients. Databases were searched in conjunction with hand searching of reference lists of endodontic textbooks, endodontic-related journals, and relevant articles from electronic searching. Six articles met the inclusion criteria. Most studies concluded that non-surgical root canal therapy improved patients' quality of life. The effect of operator type yielded conflicting results. Only one paper compared endodontic treatment with implant placement, and it showed similar patient-centric outcome with a high level of patient satisfaction. Current research is still limited, and further studies are warranted.

OBJECTIVES This study evaluated the functional, physical, and psychosocial impacts of TMJ degenerative joint disease (DJD). The bearing of TMJ osteoarthrosis/osteoarthritis and early/late TMJ DJD on oral health-related quality of life (OHRQoL) were also compared. METHODS Participants were enrolled from a TMD/orofacial pain centre. Those diagnosed with intra-articular conditions based on the Diagnostic Criteria for Temporomandibular disorders (DC/TMD) were subjected to CBCT assessment and categorized into four discrete groups: NN - no TMJ DJD and no arthralgia; NA - no TMJ DJD with arthralgia; TO - TMJ osteoarthrosis; and TR - TMJ osteoarthritis. The TO/TR groups were subdivided into early/late TMJ osteoarthrosis (EO/LO) and osteoarthritis (ER/LR). OHRQoL was examined using the OHIP-TMD and data was appraised with the Kruskal Wallis/Mann-Whitney U tests (α=0.05). RESULTS The study participant (n = 358) had a mean age of 31.85 ± 12.39 years (85.6% women). Frequencies of the TMD groups were: NN - 23.2%; NA - 27.1%; TO - 19.0%; and TR - 30.7%. Participants with TR/NA had significantly worse OHRQoL than those with TO/NN. Additionally, participants with ER/LR reported significantly poorer OHRQoL than their counterparts with EO/LO. For all TMD groups and TMJ DJD subgroups, the psychological discomfort domain was generally the most impaired. Differences in global OHIP scores were significant between participants with and without arthralgia (i.e. NA-NN, ER-EO, and LR-LO). CONCLUSIONS The presence of TMJ pain appeared to impair OHRQoL more than the severity of TMJ DJD. As psychological domains were most impacted, psychosocial care should be incorporated when managing patients with painful TMJ DJD.

This study explored the viability of using the 5 temporomandibular disorder (TMD) symptoms (5Ts) of the Diagnostic Criteria for TMDs (DC/TMD) as a TMD screener.A total of 1039 adults (≥18 years old) with a mean age of 32.65 ± 12.95 years (77.4% women) from a tertiary dental hospital were enrolled. The 5Ts questionnaire (involving items on TMD/facial pain, headaches, temporomandibular joint noises, and closed- and open-locking) was administered, and TMD diagnoses were derived through clinical interviews and examinations, radiographic investigations, and the DC/TMD diagnostic algorithms and diagnostic tree. Diagnostic accuracy of the 5Ts was assessed using the area under the receiver operating characteristics curve and various measures, including sensitivity, specificity, predictive values, and likelihood ratios.Among the participants, 80.2% (n = 833) were 5Ts-positive, and 19.8% (n = 206) were 5Ts-negative, whereas 51.3% and 85.7% received at least 1 pain-related and intra-articular DC/TMD diagnosis, respectively. The 5Ts showed high accuracy for detecting all TMDs, pain-related and intra-articular, with area under the receiver operating characteristics curves of 0.98, 1.00, and 0.98, respectively. Sensitivity ranged from 96.1% to 99.2%, whereas specificity was 100.0%.The 5Ts demonstrated high diagnostic accuracy for identifying pain-related and/or intra-articular disorders.

Objectives: This study established the diagnostic accuracy of the Fonseca Anamnestic Index (FAI) in relation to the Diagnostic Criteria for TMD (DC/TMD) standard.Methods: A total of 866 TMD patients and 57 TMD-free controls were instructed to answer the FAI and DC/TMD Symptom Questionnaire (SQ). Participants were subsequently categorized into no (NT), pain-related (PT), and/or intra-articular (IT) TMDs using the DC/TMD protocolized examination/algorithms. Receiver operating characteristics (ROC) curves, best cut-off points, and accuracy measures were determined.Results:The FAI demonstrated high accuracy for detecting all TMDs, PT, and IT (AUC = 0.96-0.98). The best cut-off points were 22.50 for all TMDs/IT and 27.50 for PT. Sensitivity of the FAI was high (94.23-98.21%), but specificity was moderate (87.72%) for all diagnostic categories.Discussion:The diagnostic accuracy of the FAI for identifying pain-related and intra-articular TMDs was high. FAI scores ≥25 points should be used to screen for TMDs.

Objective The associations between the presence of differing severity/form of temporomandibular disorder (TMD) symptoms and oral health-related quality of life (OHRQoL) were explored. Methods The severity and form of TMDs in young adults were categorized based on the Fonseca Anamnestic Index (FAI) and Diagnostic Criteria for TMDs (DC/TMD), and OHRQoL was assessed with the Oral Health Impact Profile-14 (OHIP-14). Data were analyzed using non-parametric statistics (α = 0.05). Results The study cohort consisted of 501 young adults (mean age 19.7 ± 1.3 years; 75.2% women). Participants with severe/moderate TMDs had significantly higher OHIP severity scores than those with mild/no TMDs. Moreover, participants with combined/pain-related symptoms exhibited significantly higher severity scores compared to those without symptoms. The physical pain and psychological discomfort domains were typically more impaired regardless of severity/form of TMD symptoms. Conclusion More severe and painful symptoms were related to greater impairments in OHRQoL, especially in the physical and psychological domains.

Background Studies on temporomandibular disorder (TMD) severity in patient populations are scarce. Objectives This study sought to compare the psychological states and oral health–related quality of life (OHRQoL) among patients with differing TMD severity. Methods Adult patients (≥18 years old) with and without (controls) TMDs were recruited from the TMD/oro-facial pain centre and prosthodontics department, respectively. The presence and severity of TMDs were established with the Fonseca Anamnestic Index (FAI), and TMD diagnoses were confirmed with the Diagnostic Criteria for TMDs (DC/TMD). Psychological states and OHRQoL were examined with the Depression, Anxiety, Stress Scales-21 (DASS-21) and Oral Health Impact Profile for TMDs (OHIP-TMD). Data were subjected to chi-square, Kruskal-Wallis/Mann-Whitney U tests and Spearman's correlation (α = .05). Results A total of 961 participants with a mean age of 32.99 ± 13.14 years (71.19% women) were assessed. Frequencies of the various TMD categories were as follows: no TMD/controls (12.07%), mild TMD (24.56%), moderate TMD (40.37%) and severe TMD (23.00%). The three most common TMD-related symptoms were TMJ noises, mouth opening difficulty and muscle pain. Participants with moderate/severe TMD presented a higher proportion of intra-articular and/or combined disorders. They reported significantly higher levels of depression, anxiety, stress and poorer OHRQoL than their counterparts with no/mild TMD (p < .001). Moderate-to-strong correlations were observed between FAI and DASS-21/OHIP-TMD scores (rs = 0.42–0.72). Conclusions Patients with moderate/severe TMD had significantly higher levels of psychological disturbance and poorer OHRQoL. As OHRQoL and psychological states are correlated, psychological well-being must be considered when managing patients with moderate/severe TMDs.

Objectives This study determined the differences in emotional states, sleep and oral health-related quality of life (OHRQoL) between patients with pain-related and intra-articular Temporomandibular disorders (TMDs), and associated emotional symptoms with sleep and OHRQoL. Methods Participants were recruited from a tertiary TMDs referral centre. The Depression, Anxiety, Stress Scales-21 (DASS-21), Pittsburgh Sleep Quality Index (PSQI) and Oral Health Impact Profile-TMDs (OHIP-TMDs) were used to assess emotional states, sleep and Oral health-related quality of life (OHRQoL), respectively. TMD-related and sociodemographic data were also gathered. Patients were divided into pain-related (PT), intra-articular (IT) and combined TMDs (CT) groups based on the Diagnostic Criteria for TMDs. Data were analysed using one-way ANOVA, Chi-square test, Pearson's correlation and logistic regression analysis with the significance level set at P Results Data from 1079 participants with a mean age of 29.6 ± 14.2 years were appraised (93.3% response rate). The severity/prevalence of emotional distress, impaired sleep and OHRQoL of the PT/CT groups were higher than the IT group. Moderate-to-strong inter-relationships between emotional, sleep and OHRQoL variables were more explicit for participants with painful TMDs. Logistic regression analysis demonstrated that painful TMDs were associated with higher stress and poorer OHRQoL with odds ratios (ORs) of 1.482 (95% CI 1.039-2.114) and 6.502 (95% CI 3.201-13.210), respectively. Conclusions Painful TMDs are associated with higher levels of emotional distress, sleep and OHRQoL impairments. Routine evaluation of the biopsychosocial distress, especially stress and life quality, is necessary for patients with painful TMDs.

Objective: This study examined the impact of early biofilm on the tooth surface, during the assessment of initial enamel erosion using swept-source optical coherence tomography (SS-OCT). Method and materials: Forty-five enamel windows of 2 × 4 mm2 were prepared on 23 extracted human teeth. The specimens were exposed to citric acid (pH 3.2) for 30 minutes and randomly divided into three groups (n = 15): Group 1, no biofilm; Group 2, 1-day-old biofilm; and Group 3, 3-day-old biofilm. Specimens in Groups 2 and 3 were inoculated with oral bacteria (Streptococcus sanguinis, Streptococcus mitis, and Actinomyces naeslundii) to produce early laboratory-cultivated biofilms for 1 and 3 days respectively. Surface microhardness (SMH) measurements were taken at pre- (t1) and post-erosion (t2); and SS-OCT scans were done at t1, t2, and post-biofilm cultivation (t3). Integrated reflectivity (IR) of the tooth-air interface (IRsurface) and enamel (IRenamel) were computed from the mean A-scans. Statistical analysis was performed using paired t tests and one-way ANOVA (α = .05). Results: A significant increase in IRenamel was observed at t2 (P .05). At t3, IRsurface between Group 1 (control) and Group 2 (P = .012) as well as Group 3 (P = .001) were significantly different. Significant variances in IRenamel were perceived between t2 and t3 for Groups 2 and 3 but not for Group 1. Conclusion: As early biofilm affected SS-OCT assessment of initial enamel erosion, they should be removed from the tooth surface prior to OCT procedures..

There has been increasing evidence indicating rather high success rates of vital pulp therapies. This umbrella review aimed to provide an overview of existing systematic reviews regarding the outcomes of vital pulp therapy, specifically direct pulp capping, partial pulpotomy and full pulpotomy, in carious pulp-exposed permanent human teeth.The specific PICO questions were as follows: Population - permanent human teeth with carious pulp exposure; Intervention - direct pulp capping with pulp capping materials; Comparators - partial pulpotomy and full pulpotomy; Outcomes - success rate and prognostic factors. PubMed, Ovid and Cochrane databases were searched in conjunction with hand searching. Grey literature was searched too. Study selection, data extraction and study appraisal were performed independently by two authors. A consensus was reached through discussion when disagreements arose.Six articles fulfilled the inclusion criteria. Higher and more predictable success rates of ≥ 2 years were observed for partial pulpotomy and full pulpotomy in carious pulp-exposed permanent human teeth as compared to direct pulp capping. Possible prognostic factors (pre-operative pulp status, pulp capping material and apex closure) yielded conflicting results. Restorative material, periapical status at baseline, final irrigation solution, age and study type did not seem to affect the treatment outcome.Vital pulp therapy is a reliable treatment option for permanent teeth with carious pulp exposure. However, more high-quality studies are required to corroborate this finding.Vital pulp therapy could be considered as an alternative for root canal treatment for carious pulp-exposed permanent teeth.

Objectives To determine the prevalence and severity of temporomandibular disorders (TMDs) in prospective orthodontic patients. The association between TMDs and malocclusion severity as well as the impact of TMDs on oral health–related quality of life (OHRQoL) were also examined. Materials and Methods A total of 350 consecutive patients seeking orthodontic treatment were invited to participate in the study. The presence of TMDs was established with the Fonseca Anamnestic Index (FAI), while malocclusion severity and OHRQoL were evaluated using the Peer Assessment Rating (PAR) index and Oral Health Impact Profile–14 (OHIP-14), respectively. Data were analyzed using chi-square, Kruskal-Wallis, and Mann-Whitney U tests and Spearman's correlation (P < .05). Results Of the 350 patients, 164 consented to participation. Data from 26 participants were excluded because of incomplete entries, and that from 138 subjects (mean age 21.02 ± 5.45 years) were examined. TMD-related symptoms were present in two-thirds of the subjects, with 20.3% experiencing moderate/severe TMDs. While no significant difference in PAR scores were observed between the group with no TMDs and those with TMDs, subjects with TMDs had significantly higher OHIP-14 summary/domain scores than those without TMDs. Although a moderately strong correlation was observed between the FAI and summary OHIP-14 scores (rs = 0.57), no association was observed between FAI and PAR index scores. Conclusions The prevalence of TMD-related symptoms in prospective orthodontic patients was high, emphasizing the importance of screening the masticatory system before initiating orthodontic therapy. Although the presence of TMDs was not associated with malocclusion severity, it had a significant negative impact on OHRQoL.

Background Studies 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. Methods The 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. Results Patients 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 Conclusions Both 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 Implications TMD 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.

Objectives This study determined the effects of self-adhesive resin coatings on viscoelastic properties of highly viscous glass ionomer cements (HVGICs) using dynamic mechanical analysis. Materials and Methods The HVGICs evaluated were Zirconomer [ZR] (Shofu), Equia Forte [EQ] (GC) and Riva [RV] (SDI). Sixty specimens (12mm x 2mm x 2mm) of each material were fabricated using customized Teflon molds. After initial set, the specimens were removed from their molds, finished, measured and randomly divided into 3 groups of 20. Half the specimens in each group were left uncoated while the remaining half was covered with the respective manufacturers’ resin coating. The specimens were subsequently conditioned in distilled water, artificial saliva or citric acid at 37°C for 7 days. The uncoated and coated specimens (n=10) were then subjected to dynamic mechanical testing in flexure mode at 37°C with a frequency of 0.1 to 10Hz. Storage modulus, loss modulus and loss tangent data were subjected to normality testing and statistical analysis using one-way ANOVA/Scheffe’s post-hoc test and Ttest at significance level p Results Mean storage modulus ranged from 1.39 ± 0.36 to 10.80 ± 0.86 GPa while mean loss modulus varied from 0.13 ± 0.03 to 0.70 ± 0.14 GPa after conditioning in the different mediums. Values for loss tangent ranged from 39.4 ± 7.75 to 213.2 ± 20.11 (x10 -3 ). Significant differences in visco-elastic properties were observed between mediums and materials. When conditioned in distilled water and artificial saliva,storage modulus was significantly improved when ZR, EQ and RV were uncoated. Significantly higher values were, however, observed with resin coating when the materials were exposed to citric acid. Conclusion The visco-elastic properties of HVGICs were influenced by both resin coating and chemical environment

The present study investigated the effect of piezoelectric sutural ostectomies on accelerated bone-borne sutural expansion.Sixteen male New Zealand white rabbits (20 to 24 weeks old) were randomly divided into 4 experimental groups (n = 4): group 1, conventional rapid sutural expansion; group 2, accelerated sutural expansion; group 3, accelerated sutural expansion with continuous ostectomy; and group 4, accelerated sutural expansion with discontinuous ostectomy. All sutural ostectomies were performed using a piezoelectric instrument (Woodpecker DTE, DS-II, Guangxi, China) before expander application with the rabbits under anesthesia. Modified hyrax expanders were placed across the midsagittal sutures of the rabbits and secured with miniscrew implants located bilaterally in the frontal bone. The hyrax expanders were activated 0.5 mm/day for 12 days (group 1) or with a 2.5-mm initial expansion, followed by 0.5 mm/day for 7 days (groups 2 to 4). After 6 weeks of retention, the bone volume fraction, sutural separation, and new bone formation were evaluated using micro-computed tomography and histomorphometry. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests and Spearman's rho correlation (P .05).Ranking of the median sutural separation was as follows: group 1, 3.05 mm; group 2, 3.97 mm; group 4, 4.78 mm; and group 3, 5.66 mm. The least and most bone formation were observed in groups 1 (63.63%) and 3 (75.93%), respectively. Spearman's correlation showed a strong, positive, and significant correlation (r = 0.932; P .01) between the new sutural bone formation and amount of sutural separation.Piezoelectric sutural ostectomies increased the rate of sutural separation and promoted new sutural bone formation/osteogenesis. Continuous ostectomy gave better results than discontinuous ostectomy.

SUMMARYThis study compared the viscoelastic properties of restorative and flowable bulk-fill resin-based composites (RBCs) with their conventional counterparts and evaluated the impact of aqueous solutions on viscoelastic properties. The materials examined included three conventional RBCs (Filtek Z350, Tetric N Ceram, and Beautifil II), three restorative bulk-fill RBCs (Filtek Bulk-Fill Restorative, Tetric N Ceram Bulk-Fill, and Beautifil Bulk-Fill Restorative) in addition to three flowable bulk-fill RBCs (Filtek Bulk-Fill Flowable, Tetric N Flow Bulk-Fill, and Beautifil Bulk-Fill Flowable). Beam-shaped specimens (12×2×2 mm) were fabricated using customized stainless-steel molds, finished, and measured. The specimens were randomly divided into four groups and conditioned in air (control), artificial saliva, 0.02 N citric acid, and 50% ethanol-water solution for seven days at 37°C. They were then subjected to dynamic mechanical analysis (n = 10) in flexure mode at 37°C with a frequency of 0.1 to 10 Hz. Storage modulus, loss modulus, and loss tangent data were subjected to statistical analysis using one-way analysis of variance/Tukey post hoc test at a significance level of α = 0.05. Viscoelastic properties of the RBCs were found to be product and conditioning medium dependent. For most RBCs, exposure to aqueous solutions, particularly an ethanol-water solution, degraded viscoelastic properties. With the exception of Filtek Bulk-Fill Restorative, bulk-fill restorative and flowable RBCs generally had significantly lower storage and loss modulus than their conventional counterparts regardless of conditioning medium. Conventional RBCs are thus favored over their bulk-fill counterparts, particularly for high-stress-bearing areas.

This study investigated the association between hypoplastic condyles and disc displacements without reduction (DDw/oR). Consecutive patients with non-syndromic unilateral condylar hypoplasia were recruited and clinical, cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) data were acquired. Linear measurements including condylar head width, depth, height and condyle length were determined with CBCT while MRI was used to assess disc position, morphology and displacement. A total of 43 patients were enrolled of which 93.02% had a history of temporomandibular disorders (TMDs) and 83.72% presented with TMD signs and symptoms. Depth and height of the condylar head along with condyle length of hypoplastic joints (6.68±1.67mm, 4.97±1.25mm and 14.49±3.02mm, respectively) were significantly lesser than normal joints (7.77±1.26mm, 6.35±1.45mm and 18.20±3.18mm) (P

SUMMARY The objectives of the study were to compare the flexural modulus and strength of restorative and flowable bulk-fill resin-based composites (RBCs) to their conventional counterparts and to determine the effects of conditioning environment on their flexural properties. The materials evaluated included three conventional RBCs (Filtek Z350, Tetric N Ceram, and Beautifil II), three restorative bulk-fill RBCs (Filtek Bulk-Fill Restorative, Tetric N Ceram Bulk-Fill, and Beautifil Bulk-fill Restorative), as well as three flowable bulk-fill RBCs (Filtek Bulk-Fill Flowable, Tetric N Flow Bulk-Fill, and Beautifil Bulk-Fill Flowable). Specimens were fabricated using customized stainless-steel molds, finished, measured, and randomly divided into four groups. The various RBCs were conditioned in the following mediums (n=10) for seven days at 37°C: air, artificial saliva (SAGF), 0.02 N citric acid, and 50% ethanol-water solution. After conditioning, the specimens were rinsed, blotted dry, measured, and subjected to flexural testing using a universal testing machine. Data were subjected to statistical analysis using analysis of variance and the Tukey test at a significance level of α = 0.05. Significant differences in flexural properties were observed between materials and conditioning mediums. Bulk-fill restorative RBCs exhibited higher flexural modulus than their bulk-fill flowable and conventional counterparts. With the exception of Filtek Bulk-Fill Flowable, bulk-fill flowable RBCs had significantly higher flexural strength than bulk-fill restorative and conventional RBCs. Flexural properties were highest when RBCs were conditioned in air and generally the lowest after exposure to ethanol.

This study evaluated the occurrence of degenerative temporomandibular joint (TMJ) changes in adolescents and young adults with recent on-set disc displacement without reduction (DDw/oR) using high-resolution cone beam computed tomography (CBCT). The associations between types of osteoarthrosis (OA) changes and clinical factors including disease duration were also examined. CBCT and clinical data of 300 patients (84.70% females, mean age 20.93 ± 4.77 years) diagnosed with unilateral DDw/oR (≤12 months) based on RDC/TMD were acquired. CBCT images of both symptomatic and contralateral asymptomatic TMJs were independently evaluated and scored by two radiologists. Associations between OA changes and gender, age, mouth opening and duration of DDw/oR were analyzed statistically. Condylar OA changes were present in 59.30% of the joints with DDw/oR. Early-stage OA changes (loss of continuity of articular cortex and/or surface destruction) constituted most (45.67%) of the alterations. Prevalence of early-stage OA increased from 24% to about 60% one month after TMJ closed-lock occurred. Logistic regression analysis showed the risk of developing early-stage OA changes was 5.33 times higher one month after onset of DDw/oR. A high prevalence of degenerative TMJ changes was observed with recent on-set DDw/oR in adolescents and young adults. Early diagnosis and intervention of DDw/oR is therefore prudent.

Eagle's syndrome is a rare clinical entity associated with craniofacial and cervical pain. It is caused by an elongated or deviated styloid process and/or calcification/ossification of the stylohyoid ligament. Complete ossification and aberrant thickening of the stylohyoid chain is the most unusual manifestation. We report a patient who presented with complaints of foreign body sensation, dysphagia and moderate submandibular pain caused by unilateral complete ossification, abnormal thickening and hypertrophy of the stylohyoid chain. This case was also unique in that histopathological investigation demonstrated mature bone with both compact and cancellous bone as well as bone marrow.

Summary Objective This systematic review aims to determine the effects of non-surgical rapid maxillary expansion (RME) on breathing and upper airway structures. Materials and methods An electronic search of the scientific literature from January 2005 to June 2016 was done using Web of Science, Dentistry & Oral Sciences Source and PubMed databases. A combination of search terms “rapid maxillary expansion”, “nasal”, “airway” and “breathing” were used. Studies that involved surgical or combined RME-surgical treatments and patients with craniofacial anomalies were excluded. Results The initial screening yielded a total of 183 articles. After evaluation of the titles, abstracts and accessing the full text, a total of 20 articles fulfilled both inclusion/exclusion criteria and possessed adequate evidence to be incorporated into this review. Conclusions Non-surgical RME was found to improve breathing, increase nasal cavity geometry and decrease nasal airway resistance in children and adolescents.

SUMMARY The objective of this study was to determine the influence of specimen dimension and conditioning medium on the dynamic and static flexural properties of resin-based composites (RBCs). One conventional (Filtek Z350) and two bulk-fill RBCs (Filtek Bulk-fill and Beautifil-Bulk Restorative) were evaluated. Bar-shaped specimens with dimensions 25 × 2 × 2 mm (ISO flexural [IFT]) or 12 × 2 × 2 mm (mini-flexural [MFT]) were fabricated using customized stainless-steel molds, finished, measured, randomly divided into two groups, and conditioned in air or artificial saliva (SAGF) for seven days at 37°C. The specimens (n=10) were then subjected to dynamic and static three-point flexural testing. Data for storage modulus, loss modulus, loss tangent, flexural strength, and modulus were computed and subjected to t-test, analysis of variance/Tukey test, and Pearson correlation at a significance level of α = 0.05. For both IFT and MFT, significant differences in dynamic and static flexural properties were more prevalent between materials after storage in saliva. For both conditioning mediums, the strongest correlation between IFT and MFT was observed for flexural strength. While significant positive correlations were observed for all flexural properties with saliva, no significant correlations were detected for loss tangent and flexural modulus with air. For both IFT and MFT, storage in saliva appeared to be more discriminative than storage in air. As moderate to strong positive relationships exist between IFT and MFT for dynamic and static flexural properties, the mini-flexural test holds promise as a replacement for the ISO 4049 in view of its clinical relevance and greater efficiency.

SUMMARY This study determined the influence of shrinkage and viscosity of flowable composite liners on the cervical microleakage of Class II restorations using micro-CT. Seven composites of varying viscosities were selected and included five giomers (Shofu Beautifil II [BF], Flow Plus F00 and F03 [F00 and F03], Flow F02 and F10 [F02 and F10]) and 2 nano-filled composites (3M-ESPE Filtek Z350 [Z350] and Filtek Z350 Flowable [Z350F]). Polymerization shrinkage (n=7) was assessed with the Acuvol volumetric shrinkage analyzer while complex viscosity was determined with the advanced rheometric expansion system at 25°C. Standardized Class II restorations incorporating 1-mm horizontal layers of different flowable liners and 3-mm oblique layers of BF or Z350 were subjected to a silver nitrate test for 24 hours and examined using micro-CT. Microleakage was determined at 0.1-mm intervals from the buccal to lingual surfaces providing 30 sites per specimen and scored accordingly. Statistical analysis was performed with the one-way ANOVA, Kruskal-Wallis test, and Spearman's rho correlation at a significance level of p

SUMMARY This study investigated the viscoelastic properties of contemporary bulk-fill restoratives in distilled water and artificial saliva using dynamic mechanical analysis. The materials evaluated included a conventional composite (Filtek Z350), two bulk-fill composites (Filtek Bulk-fill and Tetric N Ceram), a bulk-fill giomer (Beautifil-Bulk Restorative), and two novel reinforced glass ionomer cements (Zirconomer [ZR] and Equia Forte [EQ]). The glass ionomer materials were also assessed with and without resin coating (Equia Forte Coat). Test specimens 12 × 2 × 2 mm of the various materials were fabricated using customized stainless-steel molds. After light polymerization/initial set, the specimens were removed from the molds, finished, measured, and conditioned in distilled water or artificial saliva at 37°C for seven days. The materials (n=10) were then subjected to dynamic mechanical testing in flexure mode at 37°C and a frequency of 0.1 to 10 Hz. Storage modulus, loss modulus, and loss tangent data were subjected to normality testing and statistical analysis using one-way analysis of variance/Dunnett's test and t-test at a significance level of p < 0.05. Mean storage modulus ranged from 3.16 ± 0.25 to 8.98 ± 0.44 GPa, while mean loss modulus ranged from 0.24 ± 0.03 to 0.65 ± 0.12 GPa for distilled water and artificial saliva. Values for loss tangent ranged from 45.7 ± 7.33 to 134.2 ± 12.36 (10−3). Significant differences in storage/loss modulus and loss tangent were observed between the various bulk-fill restoratives and two conditioning mediums. Storage modulus was significantly improved when EQ and ZR was not coated with resin.

SUMMARY This study compared the effectiveness of cure of bulk-fill composites using polywave light-emitting diode (LED; with various curing modes), monowave LED, and conventional halogen curing lights. The bulk-fill composites evaluated were Tetric N-Ceram bulk-fill (TNC), which contained a novel germanium photoinitiator (Ivocerin), and Smart Dentin Replacement (SDR). The composites were placed into black polyvinyl molds with cylindrical recesses of 4-mm height and 3-mm diameter and photopolymerized as follows: Bluephase N Polywave High (NH), 1200 mW/cm2 (10 seconds); Bluephase N Polywave Low (NL), 650 mW/cm2 (18.5 seconds); Bluephase N Polywave soft-start (NS), 0-650 mW/cm2 (5 seconds) → 1200 mW/cm2 (10 seconds); Bluephase N Monowave (NM), 800 mW/cm2 (15 seconds); QHL75 (QH), 550 mW/cm2 (21.8 seconds). Total energy output was fixed at 12,000 mJ/cm2 for all lights/modes, with the exception of NS. The cured specimens were stored in a light-proof container at 37°C for 24 hours, and hardness (Knoop Hardness Number) of the top and bottom surfaces of the specimens was determined using a Knoop microhardness tester (n=6). Hardness data and bottom-to-top hardness ratios were subjected to statistical analysis using one-way analysis of variance/Scheffe's post hoc test at a significance level of 0.05. Hardness ratios ranged from 38.43% ± 5.19% to 49.25% ± 6.38% for TNC and 50.67% ± 1.54% to 67.62% ± 6.96% for SDR. For both bulk-fill composites, the highest hardness ratios were obtained with NM and lowest hardness ratios with NL. While no significant difference in hardness ratios was observed between curing lights/modes for TNC, the hardness ratio obtained with NM was significantly higher than the hardness ratio obtained for NL for SDR.

Oral health is essential to total health and satisfactory quality of life. According to the World Health Organization (2012), oral health has been defined as a state of being free of mouth and facial pain, oral infections and sores, and oral and other diseases that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial well-being. Oral conditions like dental caries and periodontal (gum) disease continue to plague humanity. Nearly all adults have existing tooth decay, and severe gum disease occurs in 15 to 20% of middle-aged adults. The adverse effects of inadequate care for teeth, gums, bite, and jaws can move beyond the mouth to affect overall physical and psychological health. Research has indicated that poor oral health may be associated with medical conditions such as heart disease, stroke, diabetes, pneumonia, and other respiratory diseases. It has also been linked to pre-term births and low-birth-weight babies. Jaw problems are also a common cause of headaches and ear and facial pain. Dental clearance prior to medical treatment, including cancer/bisphosphonate therapy and cardiac surgery, minimizes both oral and systemic complications. Many medical conditions have oral manifestations, and some medications have side effects that lead to compromised oral health as well as jaw function disabilities. This paper summarizes and highlights the importance of oral-systemic connections. In addition, the features of common dental problems are discussed.