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Introduction: On the topic of adjuncts to scaling and root planing (SRP), numerous randomized clinical trials (RCTs) were published by a single group of authors and frequently reported unusually large effect sizes. A meta-analysis in part 1 of this project failed to explain the causes for these unusual findings. We assessed the reporting quality and trial registration discrepancies to examine the possibility of replicating the work of this research group as well as the overall rigor of the research methodology. Methods: This study was preregistered at the Open Science Framework ( https://osf.io/4meyd/ ). The Scopus platform was utilized for the RCT search on SRP adjuncts in intrabony defects in patients with periodontitis as compared with SRP alone. The search analysis was limited from 2010 to 2017, and RCTs on SRP adjuncts published by a single research group were selected for screening and inclusion. RCT registration records were assessed for consistency. Results: Out of 92 studies that were retrieved from Scopus and PubMed, 32 were included for quality assessment per the CONSORT guidelines (Consolidated Standards of Reporting Trials). Results showed that all RCTs were characterized by a low reporting quality. The majority of CONSORT items scored Conclusion: RCTs by this group were characterized by poor adherence to reporting quality guidelines. Crucial RCT elements, such as randomization, blinding, and primary outcomes, were not reported properly. RCT registration records revealed systematic inconsistencies when compared with RCT publication. Therefore, the unusually large effects reported by this group should be viewed with extreme caution. Knowledge Transfer Statement: The included randomized clinical trials were characterized by poor adherence to reporting quality guidelines, missing information about important trial items, and discrepancies between the reports and trial registrations. This quality assessment should guide clinical research and show clinicians that they should be cautious when applying evidence in their clinical practice.

Background: A number of studies in patients with periodontitis have compared scaling and root planning (SRP) combined with an adjunctive treatment to SRP alone. Within that literature, an array of studies with overlapping investigators has consistently yielded substantially greater effects of adjunctive treatments than had been previously noted. This report investigates discrepancies between that cluster of research and the most recent American Dental Association (ADA) systematic review. Methods: This review was preregistered at https://osf.io/4meyd/ . A search using the Scopus platform identified 32 articles published from 2010 to 2017 by investigators affiliated with the Government Dental College and Research Institute (GDCRI) in Bangalore, India. The primary outcome used in this meta-analysis was the change in clinical attachment level (CAL) after 6 mo. Effect sizes were estimated using Comprehensive Meta-Analysis software after categorizing agents into groups based on pharmacologic similarity. Results: The search identified 32 studies encompassing 5 sets of adjunctive agents. Across the GDCRI studies, the CAL averaged 1.67 mm (95% confidence interval [CI]: 1.43–1.91 mm), substantially exceeding values reported in the ADA review (mean: 0.39 mm, 95% CI: 0.27–0.51 mm). For categories of studies in which comparable subgroup estimates were available, the evaluations yielded overlapping estimates of SRP alone, but CAL estimates were discrepant for both locally delivered antimicrobials (GDCRI studies: mean: 1.45 mm, 95% CI: 0.63–2.27 mm; ADA review: mean: 0.38 mm, 95% CI: 0.16 –0.60 mm) and systemic antibiotics (GDCRI studies: mean: 1.35 mm, 95% CI: 0.97–1.73 mm; ADA review: mean: 0.39 mm, 95% CI: 0.21–0.57 mm). Conclusion: In the literature on adjunctive agents supplementing SRP, findings from investigators linked to GDCRI stand out as having significantly more favorable estimated effects. Meanwhile, some agents studied by GDCRI-linked investigators have not been investigated by other researchers. In the absence of a clear explanation for discrepant results, it is recommended that unusually favorable reported effects of adjunctive agents be viewed with caution. Knowledge Transfer Statement: The present meta-analysis observed an unusually large effect size of adjunctive agents to scaling and root planning in studies conducted by the same research group. These results were not consistent with trials on adjunctive agents and previous reports. As this research group has exclusively tested most of the agents, their results must be viewed with caution until other independent groups replicate the studies and reproduce the effect size.

Introduction Diagnosis of underlying causes for desquamative gingivitis (DG) is often delayed in clinical settings, but little is known about factors influencing its delayed diagnosis. We investigated the diagnostic patterns and associated factors in a cohort of patients presenting primarily with DG.Materials and methods A total of 41 patients presenting primarily with DG were interviewed to evaluate professional and patient diagnostic delays. Severity of DG was evaluated using the desquamative gingivitis clinical score (DGCS) proposed by Arduino et al. (2017).Results The study sample was composed of 29 females and 12 males. On average, patients waited 10.8 ± 10 months (range 4-20 months) before seeking their first professional consultation (that is, patient delay). Less severe disease and female gender were significantly associated with longer patient delay. Patients consulted an average of 4.1 ± 2 healthcare professionals (range two to six) before a definitive diagnosis was reached, with an average professional delay of 7.3 ± 5 months (range 2-11 months). Professional delay was positively correlated with the number of professional consultations (r = 0.69) and absence of other oral mucosal lesions or extraoral involvement.Conclusions Considerable diagnostic delay is a feature of the natural history of DG. Increased patient knowledge and professional awareness regarding DG symptoms and diagnostic measures is needed to reduce diagnostic delay and improve patients' experience with this disease.

ObjectivePoor reporting in randomized clinical trial (RCT) abstracts reduces quality and misinforms readers. Spin, a biased presentation of findings, could frequently mislead clinicians to accept a clinical intervention despite non-significant primary outcome. Therefore, good reporting practices and absence of spin enhances research quality. We aim to assess the reporting quality and spin in abstracts of RCTs evaluating the effect of periodontal therapy on cardiovascular (CVD) outcomes.MethodsPubMed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and 17 trial registration platforms were searched. Cohort, non-randomized, non-English studies, and pediatric studies were excluded. RCT abstracts were reviewed by 2 authors using the CONSORT for abstracts and spin checklists for data extraction. Cohen's Kappa statistic was used to assess inter-rater agreement. Data on the selected RCT publication metrics were collected. Descriptive analysis was performed with non-parametric methods. Correlation analysis between quality, spin and bibliometric parameters was conducted.Results24 RCTs were selected for CONSORT analysis and 14 fulfilled the criteria for spin analysis. Several important RCT elements per CONSORT were neglected in the abstract including description of the study population (100%), explicitly stated primary outcome (87%), methods of randomization and blinding (100%), trial registration (87%). No RCT examined true outcomes (CVD events). A significant fraction of the abstracts appeared with at least one form of spin in the results and conclusions (86%) and claimed some treatment benefit in spite of non-significant primary outcome (64%). High-quality reporting had a significant positive correlation with reporting of trial registration (p = 0.04) and funding (p = 0.009). Spinning showed marginal negative correlation with reporting quality (p = 0.059).ConclusionPoor adherence to the CONSORT guidelines and high levels of data spin were found in abstracts of RCTs exploring the effects of periodontal therapy on CVD outcomes. Our findings indicate that journal editors and reviewers should consider strict adherence to proper reporting guidelines to improve reporting quality and reduce waste.

Direct oral anticoagulants (DOACs) are increasingly used as alternatives to warfarin because of the superior pharmacokinetic properties. Clinical guidelines on the influences of DOACs for dental procedures have emerged, but all of necessity based on low-quality available evidence. Herein, we share our experience with a case series, and propose a protocol regarding the management of dental patients taking DOACs.

Objectives To evaluate the quality of the scientific/clinical information in dentistry delivered by videos hosted by a popular video-sharing website. Methods The gingival recession condition was used as a model and YouTube™ as the video hosting service. A systematic observation of videos containing information on gingival recession was conducted. Videos were analysed to evaluate (i) the scientific reliability and quality of the information using Global Quality Scale (GQS) and DISCREN criteria; and (ii) the understandability of this information using a tailor-made custom comprehensiveness index (CI). Results One hundred and eighty videos were identified. Videos dealing with surgical procedures were not included in the present review. After selection, 41 videos were analysed. The mean GQS was 2.34 on a 0-5 scale, and 25 (61%) videos showed clear aims according to DISCREN criteria. Misleading content was observed in eight videos (19.5%). The scientific sources of information were unclear in 26 (63.4%) videos. All videos failed to give additional references for supplemental information. Only three videos (7%) provided basic information on aetiology, clinical presentations and management of gingival recession. Based on 0-2 CI scores, three, nine and 29 videos had a score of 2, 1 and 0, respectively. Conclusion The present model indicates that social media websites aiming to provide health information should be carefully accounted, especially when dealing with dentistry. It also suggests professional involvement to improve the quality of the delivered information.

Treatment planning for full-mouth rehabilitation in patients with generalized aggressive periodontitis often requires a staged approach. Few articles have addressed treatment planning and sequencing issues in this patient population. This report describes the multidisciplinary management of a young adult by a combination of periodontal and implant therapy and rehabilitation with fixed prostheses. At a 2-year follow-up, the patient's periodontal health and peri-implant conditions were stable. Prosthodontic rationale and treatment planning concepts in a patient with multiple challenges are discussed.

Aim The aim of this analysis is to investigate the association between periodontal status and renal allograft function in a cohort of renal transplant patients using different periodontitis case definitions.

Inflammation is associated with the deterioration of solid-organ transplants. Chronic periodontitis is linked to systemic inflammation, although it is unknown whether it plays a causative or comorbid role. We hypothesized that transplant subjects have a greater prevalence of severe periodontitis, accompanied by higher levels of serum interleukin-6 (IL-6) and C-reactive protein (CRP), compared to systemically healthy subjects.We recruited 90 renal and cardiac transplant recipients and 72 age-matched controls and compared their periodontal and systemic inflammatory status.The prevalence of severe periodontitis was not statistically significantly different between transplant and control subjects. Serum IL-6 and CRP were higher in transplant subjects compared to control subjects and in subjects with severe periodontitis compared to subjects without periodontitis, but multivariate analysis showed that severe periodontitis was a significant positive predictor of serum IL-6 in the control group only. In the test group, significant predictors of systemic inflammation were age, diabetes, higher body mass index, and a cadaveric transplant donor.Despite the presence of higher levels of systemic markers of inflammation in transplant subjects with severe periodontitis compared to transplant subjects without periodontitis, periodontal parameters were not statistical predictors of systemic inflammation in this population in a multivariate model.

Oropharyngeal candidiasis (OPC) is an opportunistic infection caused by Candida, a ubiquitous fungal organism that is part of the normal microbiota of the oropharyngeal and gastrointestinal tract. OPC is a major cause of morbidity in immunocom-promised patients (7) and can predispose these patients to esophageal candidiasis (19, 46), an invasive form of infection with significant morbidity and higher risk for fatal, disseminated infection (42, 44). Candida albicans is the species implicated in the overwhelming majority of OPC cases in immunocompromised patients (7, 12), although other species such as Candida glabrata are recently emerging as possible etiological agents (8, 11). Invasive fungal infections attributed to Candida species are particularly prevalent after organ transplantation, especially in the immediate post-transplant period (30). Candida can trigger bloodstream, esophageal, gastrointestinal, respiratory and uri-nary tract infections in solid organ transplant recipients, with prevalence during the first 6 months after transplantation ranging between 5 and 50% depending on the type of transplant (e.g. renal vs. liver) (4, 19, 29). It was reported that up to 80% of Candida-esophagitis episodes in renal transplant patients were preceded by oral thrush or colonization (4, 19). In addition transplant patients with OPC, who are otherwise asymptomatic, are frequently discovered to have esophageal candidiasis upon endoscopy (21). Despite the increased prevalence of other fungal infections in solid organ transplant recipients, the overall significant morbidity of OPC, and its possible implications in more invasive esophageal infections, few studies have assessed the prevalence of OPC in this population and all of these were conducted outside the USA (3, 12, 18). In addition, the oral carriage frequency, intensity of carriage, and speciation of Candida colonizing transplant patients who are clinically stable, and consequently unlikely to present transient fluctuations in the oral microbial flora due to changes in the immunosuppressive regimen, have never been studied before. In this work we studied the prevalence of OPC, Candida carriage frequency, titers and species colonizing the oral mucosa, in clinically stable transplant patients who were at least 1 year post-transplant, and examined relevant risk factors.