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Abstract This study evaluates the impact of video-based approaches on health education. PUBMED, Web of Science, EMBASE, CENTRAL, and LILACS databases were searched from their inception until November 2022. Randomised controlled trials (RCTs) and non-randomized studies on interventions were included in this review. Studies were grouped according to their reported learning outcomes. A random effects meta-analysis was performed. Meta-regression analyses were used to explore the effects of confounding variables on the overall estimates. Forty studies were included in this meta-analysis. The results showed that video-based learning (VBL) has a significant effect on ‘knowledge acquisition’ in dentistry (Cohen’s d = 2.18), moderate effect in medicine (Cohen’s d = 0.67); moderate effect on ‘skills development’ in medicine (Cohen’s d = 0.76) and nursing (Cohen’s d = 0.59); overall moderate effect on ‘attitude’ (Cohen’s d = 0.74). Egger’s test was performed to assess potential publication bias. VBL offers a valuable educational tool for knowledge acquisition, skill development, and attitude changes in health education. The theoretical and practical implications of these findings are also discussed. To strengthen the evidence base, future research should address the limitations found, such as the high risk of bias (RoB), and employ rigorous study designs when investigating the role of multimedia learning in various academic disciplines.

Sports dentistry is an emerging field focusing on the prevention, treatment, and management of oral health issues in athletes. This review critically examines the current state of sports dentistry, emphasizing the integration of oral health care into athletes' overall health management. The high prevalence of dental caries, erosion, and periodontal problems among athletes is linked to diet, habits, and increased risk of orofacial injuries. Routine oral health evaluations, particularly during the preseason, are recommended to tailor prevention strategies and address potential issues early on. The recently proposed Universal Screening Protocol for Dental Examinations in Sports is discussed, noting its potential limitations in terms of time and complexity. The review explores the challenges posed by athletes' demanding training and competition schedules, stressing the importance of incorporating oral health care into the medical team. Future research should investigate the feasibility and validity of self-reported questionnaires for screening oral health conditions, potentially simplifying the process for athletes. The review highlights the use of athlete-reported outcomes and self-reporting in sports dentistry as crucial for evaluating dental care effectiveness and monitoring long-term health outcomes. It concludes by emphasizing the need for streamlined, universally applicable protocols that fit athletes' schedules while providing comprehensive care, and the importance of further research to explore innovative screening tools and self-reported measures to transform routine care practices and reduce barriers to dental health for athletes.

Abstract Objectives Photobiomodulation (PBM) is a laser-based therapy used to promote tissue repair, reduce inflammation and pain, and has been extensively studied in chemo- and radiotherapy-induced oral mucositis (OM). This review examines the level of evidence of systematic reviews (SRs) that have investigated PBM in such cases of OM. Materials and methods SRs evaluating PBM for both the treatment and prevention of OM in patients undergoing chemotherapy and/or radiotherapy and published before November 30, 2023, on PubMed, Cochrane, Embase, Web of Science, LILACS, TRIP and Open Grey databases were eligible for inclusion. We assessed the level of methodological and meta-analytic procedures. Results Of the 1201 SRs, 21 that met the inclusion criteria were included. The quality of evidence was assessed using the Assessing the Measurement Tool to Assess Systematic Reviews (AMSTAR2), and the majority was of critically low quality (n = 15, 71.4%) with only 28.5% of low quality. A total of 40 meta-analytic estimates were obtained and analyzed. Approximately 87.5% of the meta-analysis were significant (n = 33), but only one meta-analyses had a strength of “highly suggestive”, while the rest were classified as “weak”. When analyzing the overlap values, the covered area was 12.14% and the corrected covered area was 7.75%, indicating a moderate overlap. Only 4 SRs had a very high overlap and one had a high overlap. Conclusion The efficacy of PBM in the treatment of chemotherapy-induced OM is supported by low to critically low quality SRs and meta-analysis of low strength. This review highlights important areas that need to be addressed in future research on this topic. Registration CRD42023484013 (PROSPERO).

BackgroundThe concept of oral frailty has gained scientific and clinical relevance in recent years, and early detection can facilitate timely intervention to manage its progression. The Oral Frailty Index-8 (OFI-8) was developed to assess community-dwelling older adults at risk for oral frailty. ObjectiveThis study aims to investigate the psychometric validity of the OFI-8 in the Portuguese population, named the Portuguese version of the OFI-8 (OFI-8-PT), which may serve as a reference for future studies related to longevity and oral function. MethodsThis study included 2 main phases, involving patients aged 60 years or older, Portuguese speakers, and those who consented to participate in the study. First, the researchers translated and cross-culturally adapted the original questionnaire to make it suitable for native Portuguese speakers. The translated tool was then assessed for psychometric validation, which consisted of test-retest reliability, internal consistency, construct validity, and sex invariance measurement. ResultsA total of 159 older adults participated in the baseline survey, with almost equal numbers of male (n=79, 49.7%) and female participants (n=80, 50.3%). The OFI-8-PT demonstrated good reliability (Cronbach α=0.95) and construct validity (goodness-of-fit index=0.96; comparative fit index=0.85; and root mean square error of approximation=0.05, 90% CI 0.00-0.09). The study found sex invariance, indicating that the OFI-8-PT is equally valid for male and female participants, and the tested-retest reliability of the OFI-8-PT was good, indicating consistent results over time. ConclusionsThe OFI-8-PT showed psychometric validity and good reliability to be used in the Portuguese population.

Background: Machine learning (ML) techniques have been recently proposed as a solution for aiding in the prevention and diagnosis of microbiome-related diseases. Here, we applied auto-ML approaches on real-case metagenomic datasets from saliva and subgingival peri-implant biofilm microbiomes to explore a wide range of ML algorithms to benchmark best-performing algorithms for predicting peri-implantitis (PI). Methods: A total of 100 metagenomes from the NCBI SRA database (PRJNA1163384) were used in this study to construct biofilm and saliva metagenomes datasets. Two AI-driven auto-ML approaches were used on constructed datasets to generate 100 ML-based models for the prediction of PI. These were compared with statistically significant single-microorganism-based models. Results: Several ML algorithms were pinpointed as suitable bespoke predictive approaches to apply to metagenomic data, outperforming the single-microorganism-based classification. Auto-ML approaches rendered high-performing models with Receiver Operating Characteristic–Area Under the Curve, sensitivities and specificities between 80% and 100%. Among these, classifiers based on ML-driven scoring of combinations of 2–4 microorganisms presented top-ranked performances and can be suitable for clinical application. Moreover, models generated based on the saliva microbiome showed higher predictive performance than those from the biofilm microbiome. Conclusions: This feasibility study bridges complex AI research with practical dental applications by benchmarking ML algorithms and exploring oral microbiomes as foundations for developing intuitive, cost-effective, and clinically relevant diagnostic platforms.

ABSTRACT Pseudomonas aeruginosa is a ubiquitous, opportunistic human pathogen. Since it often expresses multidrug resistance, new treatment options are urgently required. Such new treatments are usually assessed with one of the canonical laboratory strains, PAO1 or PA14. However, these two strains are unlikely representative of the strains infecting patients, because they have adapted to laboratory conditions and do not capture the enormous genomic diversity of the species. Here, we characterized the major P. aeruginosa clone type (mPact) panel. This panel consists of 20 strains, which reflect the species’ genomic diversity, cover all major clone types, and have both patient and environmental origins. We found significant strain variation in distinct responses toward antibiotics and general growth characteristics. Only few of the measured traits are related, suggesting independent trait optimization across strains. High resistance levels were only identified for clinical mPact isolates and could be linked to known antimicrobial resistance (AMR) genes. One strain, H01, produced highly unstable AMR combined with reduced growth under drug-free conditions, indicating an evolutionary cost to resistance. The expression of microcolonies was common among strains, especially for strain H15, which also showed reduced growth, possibly indicating another type of evolutionary trade-off. By linking isolation source, growth, and virulence to life history traits, we further identified specific adaptive strategies for individual mPact strains toward either host processes or degradation pathways. Overall, the mPact panel provides a reasonably sized set of distinct strains, enabling in-depth analysis of new treatment designs or evolutionary dynamics in consideration of the species’ genomic diversity.IMPORTANCENew treatment strategies are urgently needed for high-risk pathogens such as the opportunistic and often multidrug-resistant pathogen Pseudomonas aeruginosa. Here, we characterize the major P. aeruginosa clone type (mPact) panel. It consists of 20 strains with different origins that cover the major clone types of the species as well as its genomic diversity. This mPact panel shows significant variation in (i) resistance against distinct antibiotics, including several last resort antibiotics; (ii) related traits associated with the response to antibiotics; and (iii) general growth characteristics. We further developed a novel approach that integrates information on resistance, growth, virulence, and life-history characteristics, allowing us to demonstrate the presence of distinct adaptive strategies of the strains that focus either on host interaction or resource processing. In conclusion, the mPact panel provides a manageable number of representative strains for this important pathogen for further in-depth analyses of treatment options and evolutionary dynamics.

Objectives: We aimed to test the psychometric validity of the adapted and translated Self-Management Ability Questionnaire-Short Form (SMAQ-12) to Portuguese. Methods: The translation and adaptation of the SMAQ-12 followed international guidelines. We included 280 participants with chronic periodontitis from the Department of Periodontology of the Egas Moniz Dental Clinic. Participants completed the Portuguese version of the SMAQ-12 (SMAQ-12-PT), a 12-item scale with 3 conceptual domains (Role Management, Medical Management, and Emotional Management). The validity of the content, its construct and internal consistency, as well as test–retest reliability were used to estimate psychometric properties. Results: The SMAQ-12-PT showed an interclass correlation coefficient value of 0.90, with a 95% confidence interval (0.79–0.95; P < .001) and high reliability (Cronbach alpha coefficient ranging between 0.78 and 0.94). Confirmatory factor analysis revealed adequate model fit, with comparative fit index of 0.853, goodness-of-fit of 0.947, and a 0.052 value of root mean squared error of approximation. Conclusions: The SMAQ-12-PT was found to be a valid and reliable instrument in the Portuguese population. Disease management representation for the specialty of periodontology and its impact on periodontal schedules and practices should be evaluated in future studies.

The World Health Organization member states proposed a comprehensive “Global Strategy on Oral Health,” which includes achieving universal oral health coverage by 2030. Challenges and barriers, including persistent inequalities, will hamper the achievement of universal oral health coverage. In low- and middle-income countries, the oral health of a large proportion of the population has been neglected, increasing oral health inequalities. In high-income countries, some receive excessive dental treatment, whilst particularly those with higher needs receive too little dental care. Therefore, an analysis of individual countries’ needs, encompassing the training of oral health professionals in a new philosophy of care and attention and the optimisation of the existing resources, is necessary. Distancing from a person-centred focus has prompted individual and societal issues, including under-/overdiagnosis and under-/overtreatment. The person-centred approach considers the perceptions, needs, preferences, and circumstances of individuals and populations. Patient-reported outcome measures, such as self-rated and -reported health, reflect an individual's overall perception of health and are designed to mediate human biology (ie, the disease) and psychology. The usage of patient-reported outcome measures in dentistry to place the individual at the centre of treatment is delayed compared to other areas. This paper discusses some challenges and potential solutions of patient-reported outcome measures in dentistry for achieving universal oral health coverage.

Introduction: Periodontitis is a non-communicable chronic inflammatory disease with a systemic burden. Animal models of induced periodontitis help elucidate the mechanisms by which periodontal inflammation drives systemic effects. Studying this systemic involvement over longer follow-up periods may provide a strong foundation for future research on the association between diseases and periodontitis, particularly in female rats. Therefore, we aimed to compare blood, endocrine, immunologic, renal, and hepatic markers in a rat model of induced periodontitis in females with their control counterparts.Methods: Experimental periodontitis was induced in 20 female Wistar rats by the application and maintenance of silk ligatures on the upper molars. The rats were then assessed for macroscopical analysis, complete blood count, and biochemical, endocrine, and immunologic markers at 21, 28, 42, and 56 days.Results: Chronic periodontal inflammation was observed after 42 days of exposure to the ligatures. Additionally, it was also possible to notice significant systemic manifestations, such as the reduction of triiodothyronine and thyroxine levels, along with an increase in the expression of alkaline phosphatase, gamma-glutamyl transpeptidase, and lactate dehydrogenase.Discussion: The study’s findings imply that certain changes can be underscored to highlight a reduced risk of conception. Notably, previous investigations have indicated that subfertile women exhibit lower levels of thyroid hormones and elevated lactate dehydrogenase expression. Despite the absence of preclinical data delineating a possible association between periodontitis and female infertility, the results of this study may prove to be a crucial contribution to both the scientific and medical fields.

Abstract To test and evaluate the second installment of DENTIFY, a virtual reality haptic simulator for Operative Dentistry (OD), on preclinical dental students, by focusing on user performance and self-assessment. Twenty voluntary unpaid preclinical dental students, with different background experience, were enrolled for this study. After the completion of an informed consent, a demographic questionnaire, and being introduced to the prototype (on the first testing session), three testing sessions followed (S1, S2, S3). Each session involved the following steps: (I) free experimentation; (II) task execution; S3 also included (III) completion of questionnaires associated with the experiment (total of 8 Self-Assessment Questions (SAQ)); and (IV) guided interview. As expected, drill time decreased steadily for all tasks when increasing prototype use, verified by RM ANOVA. Regarding performance metrics (Comparisons by Student’s t-test and ANOVA) recorded at S3, in overall, a higher performance was verified for participants with the following characteristics: female, non-gamer, no previous VR experience and with over 2 semesters of previous experience of working on phantom models. The correlation between the participants’ performance (drill time), for the four tasks, and user self-assessment evaluation, verified by Spearman’s rho analysis, allowed to conclude that a higher performance was observed in students who responded that DENTIFY improved their self perception of manual force applied. Regarding the questionnaires, Spearman’s rho analysis showed a positive correlation between the improvement DENTIFY inputs on conventional teaching sensed by students, also enhancing their interest in learning OD, their desire to have more simulator hours and the improvement sensed on manual dexterity. All participating students adhered well to the DENTIFY experimentation. DENTIFY allows for student self-assessment and contributes to improving student performance. Simulators with VR and haptic pens for teaching in OD should be designed as a consistent and gradual teaching strategy, allowing multiplicity of simulated scenarios, bimanual manipulation, and the possibility of real-time feedback to allow for the student’s immediate self-assessment. Additionally, they should create performance reports per student to ensure self-perception/criticism of their evolution over longer periods of learning time.

Patients diagnosed with oral cancer frequently exhibit an increased likelihood of experiencing common dental conditions, lower dental health literacy, and a decline in their overall quality of life. However, there is limited understanding on the impact of oral health values on these patients. This study aims to explore the oral health status and their oral health determinants and reported outcomes in patients with oral squamous cell carcinoma (OSCC) at the Instituto Português de Oncologia de Lisboa Francisco Gentil. This cross-sectional study included patients who were diagnosed with OSCC for the first time. These individuals were administered a questionnaire that collected sociodemographic data, as well as their scores on the oral health value scale (OHVS) and the short-form oral health impact profile. In addition, participants self-reported their experiences with periodontitis and caries using the decayed, missing, filled index. The final sample consisted of 46 OSCC patients, consisting of 34 males and 12 females. The average age of the participants was 70.0 years (±13.2), with most of them being retired (65.2%). There were no differences found between sex regarding age (p = 0.531), employment status (p = 0.114), presence of systemic conditions, smoking habits (p = 0.423), or alcohol consumption (p = 0.404). In the OHVS, there was a statistically significant difference between men and women regarding the retention of natural teeth (p = 0.021). Patients with self-perceived periodontitis exhibited worse functional limitation (p = 0.039) and physical pain (p = 0.049). Regarding dental caries experience, it was observed that a majority of patients had a higher incidence of missing posterior teeth (59.2%). This sample presented a significant decline in oral health, in addition to the diagnosed OSCC. The oral health value and quality of life were severely declined. There is a concerning lack of oral care and health that, consequently, impacts the quality of life of these patients.

Previous studies have supported a potential bidirectional association between oral diseases and systemic noncommunicable diseases (NCDs) Here the authors perform an umbrella review of meta-analyses for the association between oral health and NCDs, and report that 27 NCDs were associated with oral disease, however, the overall strength of evidence was found to be unfavorable and with methodological inconsistencies.

Abstract Aim Molar incisor hypomineralization (MIH) is a prevalent oral health condition whose knowledge by dentists is key to the best clinical outcome. This study aimed to evaluate the knowledge, perceptions and clinical experiences of MIH among Portuguese dentists. Methods A cross-sectional structured questionnaire was distributed nationally through a web-based survey platform. Data concerning demographic variables, years of experience, dental specialty, MIH prevalence, diagnosis, severity, training demands and clinical management of MIH were collected. We calculated a knowledge score (KS), and compared data between Pediatric Dentists (PDs), General Dental Practitioners (GDPs) and other dental specialties (ODS). Results Overall, 2.2% of Portuguese dentists (n = 257) answered the questionnaire. Most participants reported having identified MIH in their practice (82.5%), with PD reporting the prevalence appeared to have increased, and practically all (91.7%) considered it a public health problem. Resin composite was often the used material to restore MIH teeth (56.0%), however PDs indicated glass ionomer cements as the preferred and preformed crowns a better option. The average KS on MIH was 41.3 (± 5.7), with GDPs having a similar score than PDs. Most respondents (94.9%) reported a lack of information about MIH and were willing to receive appropriate clinical training. Conclusions The average knowledge on MIH was considered low among Portuguese dentists. Respondents perceived an increased incidence of MIH, despite the lack of prevalence data in Portugal. The material of choice was Glass Ionomer and performed crowns, by PDs, while GDPs and ODS reported poor confidence to manage MIH. These results may serve future programs to increase knowledge, perceptions and clinical experiences towards MIH.

Abstract Periodontitis triggers systemic repercussions, such as elevated levels of high-sensitive C-reactive protein (hs-CRP). This has never been studied within Parkinson’s Disease (PD). The aim of this study is to compare hs-CRP levels of self-reported periodontitis cases versus cases without periodontitis in PD patients. Data from the National Health and Nutrition Examination Survey (2015–2016 and 2017–2018 waves) were analyzed. PD cases were identified through medication regimens and periodontitis cases through a validated self-report questionnaire. 51 participants were included (24 females, 27 males, with mean age of 62.96 (14.71)). While the self-reported periodontitis group presented elevated levels of circulating hs-CRP (5.36 vs. 1.99 mg/L, p = 0.031), the self-reported without periodontitis group presented higher lymphocyte levels (29.35 vs. 28.03%, p = 0.007). Blood levels of hs-CRP were significantly higher in PD cases with self-reported periodontitis. Apart from the lymphocyte levels, there were no other significant differences according to the self-reported periodontal status. Future studies shall explore this association using clinical measures.

Background: One of the main biological mechanisms behind the link between periodontitis and atherosclerotic vascular diseases is vascular endothelial dysfunction. Particularly, circulating endothelial progenitor cells (EPCs) have been considered a biomarker of altered vascular endothelial function. Objectives: The aim of this study was to investigate relationship between periodontal inflammation and increased number of circulating EPCs. Design: This is retrospective cohort study. Methods: In this study, 85 elderly patients with a previous history of hypertension were followed up to 12 months. A baseline full-mouth periodontal assessment was carried out, and the amount of periodontal tissue inflamed per subject was calculated as a proxy of periodontal inflammation [periodontal inflamed surface area (PISA)]. The number of circulating EPCs (CD34 + /CD133 + /KDR + ) was determined by flow cytometry from peripheral blood samples collected at baseline and 12 months. Results: Mean concentrations of CD34 + /CD133 + /KDR + progenitor cells were higher in periodontitis patients than in those without periodontitis at baseline [55.4, 95% confidence interval (CI) = 20.8 to 90.0 versus 27.2, 95% CI = 13.6 to 40.8, p = 0.008] and 12 months (114.6, 95% CI = 53.5 to 175.7 versus 19.1, 95% CI = 10.8 to 27.4, p = 0.003). A significant increase over the follow-up was noticed in the group of subjects with periodontitis ( p = 0.049) but not in the nonperiodontitis group ( p = 0.819). PISA was independently associated with CD34 + /CD133 + /KDR + EPCs at baseline ( B coefficient = 0.031, 95% CI = 0.005 to 0.058; p = 0.021). The relationship between PISA and CD34 + /CD133 + /KDR + EPCs at 12 months was confounded by increased baseline body mass index ( B coefficient = 0.064, 95% CI = −0.005 to 0.132; p = 0.066). Conclusion: Periodontal inflammation is associated with high number of CD34 + /CD133 + /KDR + EPCs, thus supporting a potential link between periodontitis and endothelial dysfunction.

Summary: Background: Pseudomonas aeruginosa is an opportunistic pathogen consisting of three phylogroups (hereafter named A, B, and C). Here, we assessed phylogroup-specific evolutionary dynamics across available and also new P. aeruginosa genomes. Methods: In this genomic analysis, we first generated new genome assemblies for 18 strains of the major P. aeruginosa clone type (mPact) panel, comprising a phylogenetically diverse collection of clinical and environmental isolates for this species. Thereafter, we combined these new genomes with 1991 publicly available P. aeruginosa genomes for a phylogenomic and comparative analysis. We specifically explored to what extent antimicrobial resistance (AMR) genes, defence systems, and virulence genes vary in their distribution across regions of genome plasticity (RGPs) and “masked” (RGP-free) genomes, and to what extent this variation differs among the phylogroups. Findings: We found that members of phylogroup B possess larger genomes, contribute a comparatively larger number of pangenome families, and show lower abundance of CRISPR-Cas systems. Furthermore, AMR and defence systems are pervasive in RGPs and integrative and conjugative/mobilizable elements (ICEs/IMEs) from phylogroups A and B, and the abundance of these cargo genes is often significantly correlated. Moreover, inter- and intra-phylogroup interactions occur at the accessory genome level, suggesting frequent recombination events. Finally, we provide here the mPact panel of diverse P. aeruginosa strains that may serve as a valuable reference for functional analyses. Interpretation: Altogether, our results highlight distinct pangenome characteristics of the P. aeruginosa phylogroups, which are possibly influenced by variation in the abundance of CRISPR-Cas systems and are shaped by the differential distribution of other defence systems and AMR genes. Funding: German Science Foundation, Max-Planck Society, Leibniz ScienceCampus Evolutionary Medicine of the Lung, BMBF program Medical Infection Genomics, Kiel Life Science Postdoc Award.

Background and objective: Age estimation is an important tool when dealing with human remains or undocumented minors. Although the skull, the skeleton or the hand-wrist are used in age estimation as maturity indicators, they often present a lack of good conditions for a correct identification or estimation. Few systematic reviews (SRs) have been recently published; therefore, this umbrella review critically assesses their level of evidence and provides a general, comprehensive view. Materials and methods: Considering the review question “What is the current evidence on age determination approaches in Forensic Dentistry?” an electronic database search was conducted in four databases (PubMed, Cochrane, WoS, LILACS) up to December 2022, focusing on SRs of age estimation through forensic dentistry procedures. The methodological quality was analyzed using the measurement tool to assess SRs criteria (AMSTAR2). Results: Eighteen SRs were included: five of critically low quality, six of low quality, three of moderate quality and four of high quality. The SRs posited that Willems’ method is more accurate and less prone to overestimation; most methods seem to be geographically sensitive; and 3D-imaging and artificial intelligence tools demonstrate high potential. Conclusions: The quality of evidence on age estimation using dental approaches was rated as low to moderate. Well-designed clinical trials and high-standard systematic reviews are essential to corroborate the accuracy of the different procedures for age estimation in forensic dentistry.

Abstract Molar-Incisor Hypomineralization (MIH) is a qualitative defect of enamel of unknown etiology, affecting one or more permanent molars and may include incisors. This condition is a clinical challenge and its prevalence is still uncertain given the recent increase in research. Thus, we aimed to comprehensively estimate the overall prevalence of MIH and associated characteristics. This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, MEDLINE, CENTRAL, Web of Science, SciELO, LILACS and TRIP databases, until July 2021. Heterogeneity and publication bias were computed via I2 test statistics and Egger’s significance test, respectively. Random-effects meta-analysis of prevalence were processed. We used the Strength of Recommendation Taxonomy [SORT] to grading the strength of evidence. Overall, 116 observational studies were included, with one study with moderate methodological quality and the remaining of high methodological quality. Subgroup analysis confirmed an influence of not using the 2003 MIH case definition (p = 0.0066). The pooled prevalence of MIH was 13.5% (95% CI 12.0–15.1, I2 = 98.0%). Affected incisors were seen in 36.6% (95% CI 30.0–43.7, I2 = 92.5%) of the cases. Lastly, the prevalence of hypomineralization of the second primary molars was observed in 3.6% of the MIH cases (95% CI 1.9–6.8, I2 = 96.3%). America was the continent with highest prevalence (15.3, 95% CI 12.8–18.3, p

Halitosis is an unpleasant breath odor that interferes with self-confidence and with people’s professional and social lives. The aim of this cross-sectional study was to evaluate the impact of tongue coating on intra-oral halitosis in patients with periodontitis. The Winkel Tongue Coating Index (WTCI) score was found to be positively and significantly correlated with VSC values (rho = 0.473, p < 0.001). WTCI may be associated with levels of volatile sulfur compounds (VSCs) when other causes of extra-oral halitosis are excluded.

Abstract To explore the association between bacterial vaginosis (BV) and periodontitis (PD) and to determine whether PD and BV might be linked with systemic serum alterations. We used the National Health and Nutrition Examination Survey 2001–2004, with women aged 18–49 years old and diagnosed with or without BV according to Nugent’s method. PD was defined according to the 2012 case definition. We compared serum counts according to the presence of PD and the presence of BV. Multivariable regression was used to explore and identify relevant variables towards the presence of BV. 961 women fulfilled the inclusion criteria. In women with BV, PD was associated with higher inflammation, characterized by increased white blood cells (p = 0.006) and lymphocyte (p = 0.009) counts. Predictive models presented a statistically significant association between PD and BV [Odds Ratio (OD) = 1.69, 95% Confidence Interval (CI): 1.09–2.61 for periodontitis; OD = 2.37, 95% CI: 1.30–4.29 for severe PD]. Fully adjusted models for age, smoking, body mass index, diabetes mellitus and number of systemic conditions reinforced this association [OD = 1.71, 95% CI: 1.06–2.76 for PD; OD = 2.21, 95% CI: 1.15–4.25 for severe PD]. An association between BV and PD is conceivable. PD was associated with higher systemic markers of inflammation in women with BV. Our data is novel and could serve as a foundation to guide future studies in the confirmation of this association and the underlying mechanisms.

Abstract Background To determine if periodontal risk assessment (PRA), the number of missing teeth, diabetes mellitus (DM), perceived stress and interproximal cleaning are associated with oral health-related quality of life (OHRQoL), using Andersen’s behavioral modelling (ABM). Material and methods Data derived from 472 adults derived from a representative population of the Study of Periodontal Health in Almada-Seixal (SoPHiAS) was used. Socioeconomic status, perceived stress scale (PSS-10), oral health behaviors and oral health impact profile (OHIP-14) were collected through questionnaire. Periodontal conditions were assessed with a full-mouth periodontal examination. PRA was computed through behavioral and clinical information. Variables were grouped into Predisposing Factors, Enabling, Need, Oral Health Behaviors and Perceived Health Outcome latent variables. Confirmatory factor analysis, structural ABM and model fitness were conducted. Results ABM applied to OHIP-14 showed acceptable model fit (χ2 = 2.75, CFI = 0.92, TLI = 0.90, RMSEA = 0.05, CI 90% [0.04–0.07]). The average of OHRQoL was 9.5 ± 11.3. Patient with periodontitis and with a high number of missing teeth experienced worse OHRQoL. Uncontrolled DM participants had more periodontal treatment necessity and poorer OHRQoL. Characteristic like aging and lower levels of education were directly associated with better OHRQoL, but in indirect path the OHRQoL was diminishes. Good oral hygiene and preventative measures were associated to lower periodontal treatment necessity. Lower periodontal treatment necessity was associated to higher OHRQoL. Age, tooth loss and interproximal cleaning were the most associated items to Predisposing, Need and Oral Health Behaviors, respectively. Conclusion ABM confirmed age, number of missing teeth, DM, interproximal cleaning and perceived stress as associated factors for OHRQoL. Uncontrolled DM was associated to higher Need and poorer OHRQoL. Good oral hygiene habits promote a healthy periodontium and, consequently, increases OHRQoL.

Abstract Background To investigate if self-perceived xerostomia and stress are significant variables on the Oral-Health Related Quality of Life (OHRQoL) of elderly patients, considering the periodontal status, oral hygiene habits and sociodemographic characteristics simultaneously. Methods The study cohort included 592 participants (320 females/272 Males), aged 65 years or older, representing the elder inhabitants of the Study of Periodontal Health in Almada-Seixal (SoPHiAS). Patients answered a socio-demographic and oral hygiene habits questionnaire. The Oral Health Impact Profile-14 (OHIP-14), Summated Xerostomia Inventory-5 (SXI-5) and Perceived Stress Scale-10 (PSS-10) were used. Full-mouth circumferential periodontal inspection was carried out. Multivariable regression analyses were used considering the level of periodontitis, clinical characteristics, the number of teeth, SXI, PSS-10, age, gender and oral hygiene habits. Results Self-perceived xerostomia and stress showed a positive significant correlation with OHRQoL and each of its domains. Multiple linear regression analysis demonstrated the significant impact of SXI-5 (B = 1.20, p

Abstract A reusable water bottle was swabbed as part of the citizen science project “Swab and Send,” and a Klebsiella grimontii isolate was recovered on chromogenic agar and designated SS141. Whole‐genome sequencing of SS141 showed it has the potential to be a human pathogen as it contains the biosynthetic gene cluster for the potent cytotoxin, kleboxymycin, and genes for other virulence factors. The genome also contains the antibiotic‐resistant genes, blaOXY‐6‐4, and a variant of fosA, which is likely to explain the observed resistance to ampicillin, amoxicillin, and fosfomycin. We have also shown that SS141 forms biofilms on both polystyrene and polypropylene surfaces, providing a reasonable explanation for its ability to colonize a reusable water bottle. With the increasing use of reusable water bottles as an alternative to disposables and a strong forecast for growth in this industry over the next decade, this study highlights the need for cleanliness comparable to other reusable culinary items.

Cell-based therapies using periodontal ligament stromal cells (PDLSC) for periodontal regeneration may represent an alternative source for mesenchymal stromal cells (MSC) to MSC derived from bone marrow (MSC(M)) and adipose tissue (MSC(AT)). We aimed to characterize the osteogenic/periodontal potential of PDLSC in comparison to MSC(M) and MSC(AT). PDLSC were obtained from surgically extracted healthy human third molars, while MSC(M) and MSC(AT) were obtained from a previously established cell bank. Flow cytometry, immunocytochemistry, and cell proliferation analyses provided cellular characteristics from each group. Cells from the three groups presented MSC-like morphology, MSC-related marker expression, and multilineage differentiation capacity (adipogenic, chondrogenic, and osteogenic). In this study, PDLSC expressed osteopontin, osteocalcin, and asporin, while MSC(M) and MSC(AT) did not. Of note, only PDLSC expressed CD146, a marker previously applied to identify PDLSC, and presented higher proliferative potential compared to MSC(M) and MSC(AT). Upon osteogenic induction, PDLSC exhibited higher calcium content and enhanced upregulation of osteogenic/periodontal genes compared to MSC(M) and MSC(AT), such as Runx2, Col1A1 and CEMP-1. However, the alkaline phosphatase activity of PDLSC did not increase. Our findings suggest that PDLSC might be a promising cell source for periodontal regeneration, presenting enhanced proliferative and osteogenic potential compared to MSC(M) and MSC(AT).

Periodontitis is greatly related to worse perceived oral health-related quality of life (OHRQoL), yet this association has never been explored using radiographically screened periodontal bone loss. Here we have radiographically screened patients for periodontitis via a validated method and assessed its association with measures of OHRQoL. From a total of 10,267 participants (6,112 females and 4,155 males), self-reported general health questionnaire, body mass index, self-reported oral health behaviours, panoramic x-rays and the oral health impact profile (OHIP-14) were gathered. Radiographically screened periodontitis was measured through a radiographic-based periodontal bone loss (R-PBL) approach. We compared the respective variables according to the R-PBL status and explored using multiple logistic regression adjusted for the significant variables. Overall, patients with periodontitis shown significantly different sociodemographic, health measures and oral hygiene characteristics. All domains of the OHIP-14 were significantly worsened in the periodontitis group, and further confirmed through adjusted logistic regression (p

Periodontitis has been associated with low-grade inflammation as assessed by C-reactive protein (CRP) levels and its treatment can decrease CRP serum levels. The aim of this systematic review was to critically appraise the evidence comparing CRP serum levels (standard and high-sensitivity [hs]) of otherwise healthy patients suffering from periodontitis when compared to controls. The impact of intensive and non-intensive nonsurgical periodontal treatment (NSPT) on hs-CRP was also investigated. Four electronic databases (Pubmed, The Cochrane Central Register of Controlled Trials [CENTRAL], EMBASE and Web of Science) were searched up to February 2021 and the review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO No. CRD42020167454). Observational and intervention studies that: 1) evaluated CRP and hs-CRP serum levels in patients with and without periodontitis, and; 2) hs- CRP levels after NSPT were included. Following risk of bias appraisal, both qualitative and quantitative analyses were performed. Pooled estimates were rendered through ratio of means (RoM) random-effects meta-analyses. After screening 485 studies, 77 case-control studies and 67 intervention trials were included. Chronic and aggressive periodontitis diagnoses were consistently associated with higher levels of CRP and hs-CRP (p

AbstractIntroduction The Miller McEntire Periodontal Prognostic Index (MMPPI) is a simple, powerful, evidenced-based, statistically validated, and accurate motivational tool that provides the periodontal prognosis on molar teeth [1]. This study aimed to evaluate and establish the periodontal prognosis and risk assessment of diseased molars, based on the MMPPI, in a sample of patients from a population-based epidemiologic survey carried out in the southern Lisbon Metropolitan Area.Materials and methods From December 2018 to April 2019, data were collected on 4,063 molars from a total of 1,064 patients, by two calibrated examiners (J.B. and V.M.). The considered prognosis parameters for MMPI calculation were: age, furcation involvement, smoking, probing depth (mm), mobility and molar type [2]. An MMPPI score higher than six was considered representative of a molar tooth at high risk. Potential risk factors, such as gender, dental arch, and quadrant location were assessed by logistic regression modelling. Univariate and adjusted multivariate odds ratio (OR) and correspondent 95% confidence intervals (95% CI) were determined. This study was approved by the ARSLVT Ethics Committee (3525 & 8696/CES/2018).Results From the 4,063 molars present at the time of observation (47.7% from total), 202 (5.0%, 95% CI: 4.3–5.7%) were identified as being at high risk. Overall, the MMPPI score ranged from 0 to 12 with a median of 2. A logistic regression model was fitted to the data. Within the model, being located on the upper arch (OR = 8.9, 95% CI: 5.4–14.7) and belonging to a male patient OR = 2.0, 95% CI: 1.5–2.6), were the factors significantly associated with a tooth at high risk.Discussion and conclusions This index contributes to a more informed prognostic assessment of periodontally compromised molars [1]. Male patients and upper molars are the main risk factors that increase the likelihood of developing periodontal problems in molars. These results highlight potential targeting for public health measures.

AbstractIntroduction The impact of dental malocclusion in the oral health-related quality of life (OHRQoL) has been described in the literature [1,2]. However, the impact of severity of skeletal malocclusion on the OHRQoL has never been addressed. Therefore, this exploratory study aimed to evaluate the relationship between patient perception of OHRQoL and skeletal malocclusion.Materials and methods This study was approved by the Egas Moniz Ethics Committee. This cross-sectional observational study involved patients that sought orthodontic treatment between January and April 2019, at the Orthodontic Care Consultation of Egas Moniz Dental Clinic (Monte de Caparica – Almada, Portugal). Exclusion criteria were patients with severe diseases, craniofacial abnormalities, cognitive deficits, caries, periodontal diseases, and previous orthodontic treatment history. A total of 19 patients met the criteria and were enrolled in the study. OHRQoL was assessed through the Oral Health Impact Profile – Portuguese validated version (OHIP-14) [3] and skeletal malocclusion by cephalometric Steiner criteria [4]. Resulting data were submitted to descriptive and inferential statistical analysis.Results The sample included 7 (37%) males and 12 (63%) females, with a mean age of 27.9 years. Patient distribution among Steiner’s classes was as follows: 10 (52.6%) Class I, 7 (36.8%) Class II and 2 (10.6%) in Class III. The OHIP-14 total score ranged from 0 to 49. Significant differences were found for the OHRQoL domain related to psychological discomfort, among the three skeletal classes (p = .027), with lower median scores obtained for Class II (0) when comparing to Class I (3.5) and Class III (4.5). All other OHRQoL domains were not found to be significantly different among the skeletal classes (p > .05).Discussion and conclusions For the first time, OHRQoL’s psychological discomfort domain was found to be significantly different when considering the severity of skeletal malocclusion. Overall, Class II patients have less psychological discomfort with their clinical condition than the remaining malocclusion patients. This is the first study to evaluate the OHRQoL quantifying the severity of skeletal malocclusion. This pilot study will serve as the basis for larger-scale studies in order to comprehensively validate these preliminary findings.

AbstractIntroduction The assessment of the oral health-related quality of life (OHRQoL) and dental malocclusion are described in the literature and the results indicate a decrease in OHRQoL when clinically determined dental malocclusion severity increase [1,2]. However, there is still a lack of information for the Portuguese population for this issue. This exploratory study aimed to evaluate the relationship between patient perception of OHRQoL and the severity of dental malocclusion in a Portuguese sample.Materials and methods This work was approved by the Egas Moniz Ethics Committee. This cross-sectional observational study involved patients that sought orthodontic treatment between January and April 2019, at the Orthodontic Care Consultation of Egas Moniz Dental Clinic (Monte de Caparica – Almada, Portugal). Exclusion criteria were patients with severe diseases, craniofacial abnormalities, cognitive deficits, caries, periodontal diseases, and previous orthodontic treatment history. A total of 19 patients were enrolled in the study. OHRQoL was assessed by application of the Oral Health Impact Profile – Portuguese validated version (OHIP-14) [3] and dental malocclusion through the Index of Complexity, Outcome and Need (ICON) [4]. Based on the ICON score, patients were categorised as: in need of treatment (ICON > 43) or not (ICON ≤ 43). Resulting data were submitted to descriptive and inferential statistical analysis.Results The sample included 7 (37%) males and 12 (63%) females, with a mean age of 27.9 years. Overall OHIP-14 score ranged from 0 to 49 and ICON score from 13 to 75 (9 (47.4%) subjects with ICON > 43 and 10 (52.6%) with ICON ≤ 43). Total OHIP-14 score and all seven median domain scores were not found to be significantly different (p = .113 to p = .968), when comparing both groups.Discussion and conclusions OHRQoL was not found to be significantly different when considering the severity of dental malocclusion. Overall, results highlight a difference between patients’ self-perception of clinical condition impact in OHRQoL when compared to a clinical expertise judgement.

AbstractIntroduction Periodontitis is a major condition associated with rheumatic diseases (RDs) [1] and some studies have clarified the effect of the oral microbiome in RDs [2,3]. However, due to the lack of information this observational study aimed to describe the periodontal status of RDs in a sample of patients from a population-based epidemiologic survey carried out in the southern Lisbon Metropolitan Area.Materials and Methods From December 2018 to April 2019, a total of 1064 patients, from public health centres of Almada-Seixal Group of Centres, were randomly enrolled in the study. RDs were assessed through a medical history and medication questionnaire. Periodontitis and Gingivitis were circumferentially evaluated according to the 2018 World Case Definitions [4,5] by two calibrated examiners (J.B. and V.M). This study was approved by the ARSLVT Ethics Committee (3525 & 8696/CES/2018).Results Overall, the prevalence of rheumatic conditions was 2.8% (95% CI: 1.8–3.8%) (n = 30). Individual RD prevalence distribution in the study group were as follows: rheumatoid arthritis (RA) 23.3% (n = 7), fibromyalgia (FM) 36.7% (n = 11), systemic lupus erythematosus (SLE) 10.0% (n = 3), arthritis (ART) 13.3% (n = 4), gout 3.3% (n = 1), systemic scleroderma 3.3% (n = 1), FM + osteoarthritis (OA) 3.3% (n = 1), FM + SLE 3.3% (n = 1), FME + OA + ART 3.3% (n = 1). The prevalence of periodontitis among RD patients was 60% (n = 18), with 13.3% (n = 4), 16.7% (n = 5) and 26.7% (n = 8) of mild, moderate and severe stages, respectively. Gingivitis cases were residual, 3.3% (n = 1). The average missing teeth were 10.7 (±6.8) and the mean percentage of probing depth ≥4 mm was 5.7% (±10.9%).Discussion and conclusions Despite the low incidence of RDs, these results reveal a considerable high prevalence of periodontitis and gingivitis among those patients. Also, the average number of missing teeth is worrisome. These findings unveil a very disturbing high burden of periodontitis in this sample of Portuguese rheumatic patients and roots basis for future public health measures implementation.

A 53-year-old female appeared with pain in the right mandible ramus, for the past 9 months, after tooth extraction. Clinical and radiological examination using conventional and advanced computerized tomography diagnostic imaging led to a provisional diagnosis of multiple complex odontomas. Complete conservative excision of the lesion was performed. The clinical diagnosis was confirmed histopathologically. Postoperative period was uneventful with no evidence of recurrence. According to an extensive literature review, this report describes the oldest patient ever diagnosed with multiple odontomas in the literature.

ABSTRACTHorizontal transfer of plasmids plays a pivotal role in dissemination of antibiotic resistance genes and emergence of multidrug-resistant bacteria. Plasmid sequencing is thus paramount for accurate epidemiological tracking in hospitals and routine surveillance. Combining Nanopore and Illumina sequencing allowed full assembly of a carbapenemase-encoding megaplasmid carried by multidrug-resistant clinical isolate FFUP_PS_41. Average nucleotide identity analyses revealed that FFUP_PS_41 belongs to the recently proposed new species Pseudomonas shirazica, related to the P. putida phylogenetic group. FFUP_PS_41 harbours a 498,516-bp megaplasmid (pJBCL41) with limited similarity to publicly-available plasmids. pJBCL41 contains genes predicted to encode replication, conjugation, partitioning and maintenance functions and heavy metal resistance. The |aacA7|blaVIM-2|aacA4| cassette array (resistance to carbapenems and aminoglycosides) is located within a class 1 integron that is a defective Tn402 derivative. This transposon lies within a 50,273-bp region bound by Tn3-family 38-bp inverted repeats and flanked by 5-bp direct repeats (DR) that composes additional transposon fragments, five insertion sequences and a Tn3-Derived Inverted-Repeat Miniature Element. The hybrid Nanopore/Illumina approach allowed full resolution of a carbapenemase-encoding megaplasmid from P. shirazica. Identification of novel megaplasmids sheds new light on the evolutionary effects of gene transfer and the selective forces driving antibiotic resistance.

Abstract Background The evolution and spread of antibiotic resistance is often mediated by mobile genetic elements. Integrative and conjugative elements (ICEs) are the most abundant conjugative elements among prokaryotes. However, the contribution of ICEs to horizontal gene transfer of antibiotic resistance has been largely unexplored. Results Here we report that ICEs belonging to mating-pair formation (MPF) classes G and T are highly prevalent among the opportunistic pathogen Pseudomonas aeruginosa, contributing to the spread of carbapenemase-encoding genes (CEGs). Most CEGs of the MPFG class were encoded within class I integrons, which co-harbour genes conferring resistance to other antibiotics. The majority of the integrons were located within Tn3-like and composite transposons. Conserved attachment site could be predicted for the MPFG class ICEs. MPFT class ICEs carried the CEGs within composite transposons which were not associated with integrons. Conclusions The data presented here provides a global snapshot of the different CEG-harbouring ICEs and sheds light on the underappreciated contribution of these elements to the evolution and dissemination of antibiotic resistance on P. aeruginosa.

Hypomineralized primary second molars (HPSM) are characterized by enamel opacities accompanied by hypersensitivity and atypical caries lesion, on one to four primary second molars. The correct treatment and follow-ups of those teeth have an important impact on a correct eruption of the first permanent molars and future occlusion. Hence, this report aims to describes a case of a severe HPSM in all second molars of a four-year-old girl and subsequent four-year follow-ups. The rehabilitation involved the placement of four stainless steel crowns on all four second primary molars under general anesthesia. Concerning the available literature and the case severity of HPSM, the treatment approach proposed for the case provided good functional outcome.

Subsurface enamel demineralization beneath an intact surface layer or white spots lesions (WSL) can and should be treated with non-invasive procedures to impede the development of a cavitated lesion. We aim to analyze if infiltrative resin improves enamel roughness, microhardness, shear bond strength, and penetration depth. MEDLINE [via Pubmed], Cochrane Central Register of Controlled Trials, Embase, Web of Science, Scholar, and LILACS were searched until May 2021. Methodological quality was assessed using the Joanna Briggs Institute Clinical Appraisal Checklist for Experimental Studies. Pairwise ratio of means (ROM) meta-analyses were carried out to compare the enamel properties after treatment with infiltrative resin on sound enamel and WSLs. From a total of 1604 articles, 48 studies were included. Enamel surface roughness decreased 35% in sound enamel (95%CI: 0.49–0.85, I2 = 98.2%) and 54% in WSLs (95%CI: 0.29–0.74, I2 = 98.5%). Microhardness reduced 24% in sound enamel (95%CI: 0.73–0.80, I2 = 99.1%) and increased by 68% in WSLs (95%CI: 1.51; 1.86, I2 = 99.8%). Shear bond strength reduced of 25% in sound enamel (95%CI: 0.60; 0.95, I2 = 96.9%) and increased by 89% in WSLs (95%CI: 1.28–2.79, I2 = 99.8%). Penetration depth was 65.39% of the WSLs (95%CI: 56.11–74.66, I2 = 100%). Infiltrative resins effectively promote evident changes in enamel properties in sound and WSLs. Future studies with long-term follow-ups are necessary to corroborate these results from experimental studies.

Here, we assess the association between homocysteine (Hcy) serum levels and periodontal status in a large representative sample of the National Health and Nutrition Examination Survey (NHANES). Using the 2001–2002 and 2003–2004 NHANES databases, participants with a periodontal examination, medical self-reported data, blood pressure (BP) and blood samples to determine complete blood count, C-reactive protein (CRP) and Hcy levels. We then calculated the periodontal inflamed surface area (PISA) and the periodontal epithelial surface area (PESA). Multivariable regression analysis explored the association between Hcy, periodontal measures and BP. Mediation analysis was performed to understand the effect of PISA and PESA in the link between Hcy and BP. 4021 participants fulfilled the inclusion criteria. Hcy levels showed significant correlations with systolic BP, diastolic BP, PISA, PESA and age. PESA showed to be significantly associated with Hcy both for the crude and adjusted models (p < 0.01), but not PISA (p > 0.05). In the association of Hcy with systolic BP, PISA significantly mediated 17.4% and PESA 0.9%. In the association of Hcy with diastolic BP, PISA significantly mediated 16.3% and PESA 47.2%. In conclusion, Hcy and periodontitis are associated. Further, both PISA and PESA significantly mediated the association of Hcy with systolic BP and diastolic BP. Future studies shall deepen the mechanisms by which Hcy levels increase in a clinical situation of periodontitis.

Objectives: Currently, there is lack of human in vitro full tooth models that hold the odontoblast layer with pulp tissue in their native environment. The appearance of new in vitro and in vivo models has provided new understanding of the potential of tissue engineering in dental pulp regeneration. However, the development of new in vitro full tooth models will allow us to get closer to in vivo conditions. Thus, the aim of this study is to preserve a living dentin-pulp complex, in a novel in vitro full crown model, after tooth extraction. Methods: Twenty intact third molars, after preparation, were divided into four groups, with five samples each. We placed the negative control samples (C) in saline, and the tested groups were placed (T) in supplemented DMEM, at two different times: 1 and 7 days. The specimens were processed for light microscopy observation. Results: Contrary to C-groups, T-groups showed a functional dentin-pulp complex. The treated dentin-pulp complex presents normal histological appearance. Conclusions: This study showed that it is possible to preserve a living dentin-pulp complex after tooth extraction during 7 days.

Alveolar ridge resorption is a natural consequence of teeth extraction, with unpleasant aesthetic and functional consequences that might compromise a future oral rehabilitation. To minimize the biological consequences of alveolar ridge resorption, several surgical procedures have been designed, the so-called alveolar ridge preservation (ARP) techniques. One important characteristic is the concomitant use of biomaterial in ARP. In the past decade, autogenous teeth as a bone graft material in post-extraction sockets have been proposed with very interesting outcomes, yet with different protocols of preparation. Here we summarize the available evidence on autogenous teeth as a biomaterial in ARP, its different protocols and future directions.

The rapid and accurate testing of SARS-CoV-2 infection is still crucial to mitigate, and eventually halt, the spread of this disease. Currently, nasopharyngeal swab (NPS) and oropharyngeal swab (OPS) are the recommended standard sampling techniques, yet, these have some limitations such as the complexity of collection. Hence, several other types of specimens that are easier to obtain are being tested as alternatives to nasal/throat swabs in nucleic acid assays for SARS-CoV-2 detection. This study aims to critically appraise and compare the clinical performance of RT-PCR tests using oral saliva, deep-throat saliva/posterior oropharyngeal saliva (DTS/POS), sputum, urine, feces, and tears/conjunctival swab (CS) against standard specimens (NPS, OPS, or a combination of both). In this systematic review and meta-analysis, five databases (PubMed, Scopus, Web of Science, ClinicalTrial.gov and NIPH Clinical Trial) were searched up to the 30th of December, 2020. Case-control and cohort studies on the detection of SARS-CoV-2 were included. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2). We identified 1560 entries, 33 of which (1.1%) met all required criteria and were included for the quantitative data analysis. Saliva presented the higher accuracy, 92.1% (95% CI: 70.0–98.3), with an estimated sensitivity of 83.9% (95% CI: 77.4–88.8) and specificity of 96.4% (95% CI: 89.5–98.8). DTS/POS samples had an overall accuracy of 79.7% (95% CI: 43.3–95.3), with an estimated sensitivity of 90.1% (95% CI: 83.3–96.9) and specificity of 63.1% (95% CI: 36.8–89.3). The remaining index specimens could not be adequately assessed given the lack of studies available. Our meta-analysis shows that saliva samples from the oral region provide a high sensitivity and specificity; therefore, these appear to be the best candidates for alternative specimens to NPS/OPS in SARS-CoV-2 detection, with suitable protocols for swab-free sample collection to be determined and validated in the future. The distinction between oral and extra-oral salivary samples will be crucial, since DTS/POS samples may induce a higher rate of false positives. Urine, feces, tears/CS and sputum seem unreliable for diagnosis. Saliva testing may increase testing capacity, ultimately promoting the implementation of truly deployable COVID-19 tests, which could either work at the point-of-care (e.g. hospitals, clinics) or at outbreak control spots (e.g., schools, airports, and nursing homes).

Avulsion is one of the most serious dental traumatic injuries with a reserved prognosis. This case report describes multiple trauma lesions in permanent central incisors of an eight-year-old girl and a four-year follow-up. The right upper incisor suffered avulsion, remained 16 h extraorally, and was replanted after extraoral endodontic therapy. The left maxillary central incisor suffered a noncomplicated crown fracture with concomitant subluxation. The present case adds to the literature a rare occurrence of success in a severe case with poor prognosis. For this reason, the International Association for Dental Traumatology (IADT) guidelines should be followed and, even in extreme situations, replantation should always be considered.

Background and objectives: People with Parkinson’s disease (PD) may be at risk of having bad periodontal status. A consistent periodontal examination is critical to investigate how it impacts on PD quality of life. We aimed to assess the periodontal status of people with PD, and its association with quality of life and self-perceived xerostomia. Materials and Methods: To this end, from February to March 2020, we consecutively enrolled 28 PD individuals, and motor and non-motor symptoms of PD were assessed using the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). We performed full-mouth periodontal examination and gathered information on self-perceived quality of life in PD, oral health impact profile (OHIP-14) and xerostomia. Results: The prevalence of periodontitis was 75.0% and most cases were identified as severe (46.4%). Upper extremity rigidity, hand posture and kinetic tremors were significantly correlated with worse periodontal status. PDQ-8 showed to be correlated with self-perceived oral health-related quality of life and xerostomia levels. Conclusions: This group of people with PD had a high prevalence of periodontitis. Deteriorated levels of the upper extremities in advanced stages of PD were associated with worse periodontal status and hygiene habits. Quality of life in PD appears to be associated with self-perceived OHRQoL and xerostomia.

Accurate sex prediction is a key step in creating a postmortem forensic profile as it excludes approximately half the population. It is our goal to develop a predictive model to establish sex through teeth mesiodistal widths in a Portuguese population. The pretreatment dental casts of 168 of Portuguese orthodontics subjects (59 males and 109 females) were included. Mesiodistal widths from right first molar to left first molar were measured on each pretreatment cast to the nearest 0.01 mm using a digital caliper. Overall, the mesiodistal widths of the upper and lower canines, premolars, and molars were found to be significantly different between females and males. Conversely, no significant differences between sexes were identified for incisors. A multivariate logistic regression model for sex prediction was developed and the teeth included in the final reduced model being the upper left canine (2.3), the lower right lateral incisor (4.2) and the lower right canine (4.3). There is a prevalence of sexual dimorphism in all teeth except the incisors. The canines present the most noticeable difference between sexes. The presented sex determination predictive model exhibits an overall correct classification of 75%, outperforming all available models for this purpose and therefore is a potential tool for forensic analysis in this population.

Rhabdomyosarcoma is one of the most common soft-tissue sarcomas in children. The therapy for this condition has evolved significantly over recent decades, as has survival rates. Nevertheless, multiagent chemotherapy, radiation therapy, surgical resection or a combination of these modalities still have to be performed. This case report presents a 16-year-old boy with oral and dental effects after rhabdomyosarcoma treatment, diagnosed at the age of 4 years old. This report highlights the key role of dentists in the clinical management of rhabdomyosarcoma cases before, during and after treatment, and its potential side effects.

We aimed to compare the pain discomfort levels between clear aligners and fixed appliances at multiple time points. Four electronic databases (Pubmed, Medline, CENTRAL and Scholar) were searched up to May 2020. There were no year or language restrictions. Randomized clinical trials and case–control studies comparing pain perception through pain visual analog scale (VAS) in patients treated with clear aligners and with fixed appliances were included. Risk of bias within and across studies was assessed using Cochrane tool and Newcastle–Ottawa Scale (NOS) approach. Random-effects meta-analysis were conducted. VAS score and analgesic consumption were collected. Random-effects meta-analyses were used to synthesize available data. Following the review protocol, five articles met the inclusion criteria and were included, with a total of 273 participants (177 females, 96 males). Overall, clear aligners were associated with significantly less pain than fixed appliances during the first seven days of orthodontic treatment. Patients treated with clear aligners experience less pain discomfort than those treated with fixed appliances and consume less analgesics, with SORT A recommendation.

Objectives To assess the prevalence and extent of chronic periodontitis, and its risk factors in a Portuguese subpopulation referred to periodontal examination. Methods This retrospective cross-sectional study used a subset of data from patients who sought dental treatment in a university dental clinic in the Lisbon metropolitan area. The sample consisted of 405 individuals (225 females/180 males), aged 20–90 years. All patients underwent a full-mouth periodontal examination and chronic periodontitis was defined as Clinical Attachment Loss (CAL) ≥ 3 mm affecting two or more teeth. Aggressive periodontitis cases were excluded from the analysis. Results Prevalence of chronic periodontitis was 83.5% (95% CI [80.4–86.6%]). For these subjects, CAL ≥ 3 mm affected 86.0% (95% CI [84.7–87.2]) of sites and 83.7% (95% CI [81.7–85.6]) of teeth, respectively. Mean CAL ranged from 3.6 to 4.3 mm, according to age. In the multivariate logistic regression model, smoking (OR = 3.55, 95% CI [1.80–7.02]) and older age (OR = 8.70, 95% CI [3.66–20.69] and OR = 4.85, 95% CI [2.57–9.16]), for 65+ and 45–64 years old, respectively, were identified as risk indicators for CAL ≥ 3 mm. Conclusions This particular Portuguese adult subpopulation had a high prevalence of chronic periodontitis, with severe and generalized clinical attachment loss, and its presence was significantly associated with age and smoking. This data should serve to prepare future detailed epidemiological studies and appropriate public health programs.

This systematic review aimed to investigate the influence of periodontitis on post-transplant IL-6 serum levels of solid organ transplanted patients as compared to healthy subjects. Four databases (PubMed, Scholar, EMBASE, and CENTRAL) were searched up to February 2020 (PROSPERO CRD42018107817). Case-control and cohort studies on the association of IL-6 serum levels with a periodontal status of patients after solid organ transplantation were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses were thoroughly conducted. GRADE assessment provided quality evidence. Four case-control studies fulfilled the inclusion criteria (274 transplant recipients and 146 healthy controls), all of low risk of bias. Meta-analyses revealed significantly higher IL-6 levels in transplanted patients than healthy individuals with low-quality evidence (Mean Difference (MD): 2.55 (95% confidence interval (CI): 2.07, 3.03)). Transplanted patients with periodontitis have higher serum IL-6 levels than transplanted patients without periodontitis with moderate quality evidence (MD: 2.20 (95% CI: 1.00, 3.39)). We found low-quality evidence of higher IL-6 levels than healthy patients in patients with heart and kidney transplant. In these transplanted patients, there was moderate quality evidence that periodontitis is associated with higher IL-6 serum levels. Future research should consider the impact of such a difference in organ failure and systemic complications.

Dental trauma is more common in young patients and its sequelae may have great impact on the esthetics, functions, and phonetics. This paper reports a case of trauma in both central incisors in a young 17-year-old patient who was treated using adhesive tooth fragment reattachment on tooth 2.1 and a palatal indirect composite veneer on tooth 1.1. Regarding the available literature and fracture extension, the treatment approach proposed for this case provided good functional and esthetic outcomes. Clinical and radiographic results after 1 year were successful. This case demonstrates the importance of establishing a multidisciplinary approach for successful dental trauma management.

Abstract This retrospective study evaluated the influence of known risk factors on nonsurgical periodontal treatment (NSPT) response using a pocket depth fine-tuning multilevel linear model (MLM). Overall, 37 patients (24 males and 13 females) with moderate-to-severe chronic periodontitis underwent NSPT. Follow-up visits at 3, 6, and 12 months included measurements of several clinical periodontal parameters. Data were sourced from a previously reported database. In a total of 1416 initially affected sites (baseline PD ≥ 4 mm) on 536 teeth, probing depth (PD) and clinical attachment loss (CAL) reductions after NSPT were evaluated against known risk factors at 3 hierarchical levels (patient, tooth, and site). For each post-treatment follow-up, the variance component models fitted to evaluate the 3-level variance of PD and CAL decrease revealed that all levels contributed significantly to the overall variance (p < 0.001). Patients who underwent NSPT and were continually monitored had curative results. All 3 hierarchical levels included risk factors influencing the degree of PD and CAL reduction. Specifically, the type of tooth, surfaces involved, and tooth mobility site-level risk factors had the strongest impact on these reductions and were highly relevant for the success of NSPT.