Oral health & preventive dentistry最新文献

Purpose: This parallel-group clinical study evaluated whether adding natural bioflavonoids to 0.12% chlorhexidine (CHX) mouthwash enhances outcomes of non-surgical therapy for peri-implant mucositis. The primary aim was to assess soft-tissue inflammatory changes and subgingival Porphyromonas gingivalis (P. gingivalis) carriage compared with CHX alone.

Materials and methods: Thirty-three patients were enrolled (test, n = 16; control, n = 17). All patients underwent mechanical debridement, following which patients in the test group were prescribed a bioflavonoid-enriched CHX, whereas those in the control group were prescribed 0.12% CHX. All participants were instructed to rinse their oral cavity every 12 hours for 30 s with their respective oral rinse for 3 weeks. A follow-up clinical evaluation was done after 6 weeks. Peri-implant indices, modified plaque index (mPI), modified bleeding index (mBI), and probing depth (PD) were recorded at baseline and follow-up. Subgingival oral biofilm samples were also collected and assessed for the presence of P.gingivalis in both groups. Statistical significance was set at P 0.05.

Results: At baseline, groups were comparable across clinical parameters. At 6 weeks, the test group exhibited significantly lower mPI, mBI, and PD versus controls (all P 0.05). Specifically, mean PD was 2.2 ± 0.04 mm in the test group versus 2.5 ± 0.03 mm in controls; mPI and mBI also favoured the test rinse (0.38 ± 0.04 vs 0.30 ± 0.07; 0.28 ± 0.05 vs 0.32 ± 0.02, respectively). P. gingivalis was detected at baseline in all participants; at 6 weeks, carriage persisted in 3/16 (18.8%) test versus 9/17 (52.9%) control patients.

Conclusion: Supplementing 0.12% CHX with bioflavonoids provides added clinical benefits when used as an adjunct to mechanical debridement (MD) in patients with peri-implant mucositis. This combined approach appears more effective than 0.12% CHX alone in reducing peri-implant soft-tissue inflammation and P. gingivalis carriage, indicating that bioflavonoid-enriched formulations may represent a valuable therapeutic option in routine clinical practice for improving peri-implant health.

Purpose: Socioeconomic conditions and loneliness are emerging as important determinants of oral and general health. This study explores their impact on odontogenic infections (OIs) severe enough to require hospitalization.

Materials and methods: This retrospective cohort study utilized data of patients with emergency visits to the oral and maxillofacial emergency unit from January 2012 to October 2020 at Helsinki University Hospital. The data were combined with Statistics Finland to analyze the association between socioeconomic factors and OIs. Bivariate comparisons and binomial logistic regression analysis were used to investigate the effect of selected sociodemographic and socioeconomic factors on OIs requiring hospitalization.

Results: The study included 2838 patients, of which 709 (25.0%) were hospitalized. Patients with OIs resulting in hospitalization were statistically significantly more often single, divorced, or widowed, than married (p0.001). Additionally, rental living (p=0.049), a lower level of education (p=0.018), and lower income level (p=0.002) were associated with hospitalization. After adjusting for age, sex, and living arrangement, a marital status of single, divorced, or widowed (odds ratio, OR=1.406, 95% CI 1.148-1.723, p=0.001) and lowest income level (ref. highest income level, OR=1.418, 95% CI 1.090-1.845, p=0.009) predicted hospitalization in logistic regression analysis.

Conclusion: OIs resulted more often in hospitalization if the patient was single, divorced, or widowed, or had a lower income level. These findings highlight the importance of implementing comprehensive public health strategies that tackle socioeconomic disparities to enhance oral health outcomes and reduce the impact of severe dental infections.

Purpose: To evaluate the relationship between self-assessed and clinically measured halitosis, identify associated risk factors, and assess the diagnostic accuracy of a simple self-assessment method.

Materials and methods: A cross-sectional study was conducted among 102 adults in the UAE. Self-perceived halitosis was assessed via questionnaire and the cupping-hands technique (0-5 scale). Clinical halitosis was determined using Oral Chroma (Nissha FIS; Osaka, Japan) to measure volatile sulfur compounds (VSCs). Oral examinations recorded oral hygiene status, tongue coating, periodontal health, caries, and restoration quality. Associations were analyzed using bivariate and multivariate regression. The diagnostic accuracy of self-assessment was evaluated against Oral Chroma findings.

Results: Self-reported halitosis prevalence increased from 26% (questionnaire) to 57.8% (cupping-hands), while clinical halitosis was detected in 63.7% of participants. Self-assessment showed moderate agreement with clinical diagnosis (κ = 0.426) and a sensitivity and specificity of 73.9% and 70.3%, respectively. Methyl mercaptan had the strongest association with perceived odor (AUC = 0.782). Both self-assessed and clinical halitosis were statistically significantly associated with tongue coating, poor oral hygiene, gingival bleeding, periodontal pockets, caries, imperfect restorations, and BANA positivity (all p 0.05). Multivariate analysis identified smoking, prosthesis use, infrequent dental visits, and inadequate use of dental floss and mouthwash as independent predictors.

Conclusion: Halitosis was highly prevalent and strongly linked to modifiable oral hygiene and behavioral factors. The cupping-hands method correlated with VSC measurements and may be a useful screening tool. Public health strategies and clinical practice should emphasize tongue cleaning, periodontal care, and regular dental visits to reduce oral malodor.

Purpose: Tooth-level prognostic systems can be used for treatment planning and help to identify teeth at risk of being lost over time. However, several sets of criteria were proposed to estimate tooth prognosis in the context of periodontitis patients.

Objectives: To identify the prognosis tools available and to evaluate their relevance in predicting periodontal-related tooth loss (TLP).

Methods and materials: An electronic search was conducted for published data in MEDLINE, EMBASE, COCHRANE up to January 2025. Reference lists of retrieved studies for full-text screening and reviews were hand-searched for potentially eligible studies.

Results: In total, 1,471 records were identified from databases, and an additional 7 unique records were identified through citation searching of selected studies from the database search. After screening, 33 studies were selected for full-text review, of which 22 were included in the final selection, with 6 classical models, 11 regression-based models, 2 AI-driven prognostic models and 3 external validations. Most prognostic models confirm high precision and accuracy, fluctuating in most cases around a value of area under the curve (AUC) = 0.8.

Conclusions: Patient (smoking, diabetes) and tooth-related factors (furcation involvement, increased probing depth, mobility) influence the prognosis of tooth retention in the long term. The identification of prognostic factors is of crucial importance to better predict the long-term survival of teeth and to adapt the treatment plan. All prognostic systems at the dental level showed excellent predictive capacity for the risk of tooth loss linked to periodontitis. An AI-based machine-learning algorithm will be a helpful tool for determining tooth prognosis.

Purpose: To evaluate the efficacy of a novel educational approach combining hands-on practice with multimedia resources for improving oral hygiene knowledge, attitudes, and behaviours among adolescent orthodontic patients.

Methods and materials: This randomised controlled trial involved 120 adolescent patients (aged 12-18) undergoing fixed orthodontic treatment at Hospital of Xiamen Medical College. Participants were randomly assigned to either the intervention group (n = 60), receiving comprehensive oral hygiene education combining hands-on practice with multimedia resources, or the control group (n = 60), receiving standard verbal instructions and a printed pamphlet. The intervention consisted of three monthly sessions over 12 weeks, followed by a 3-month follow-up. Primary outcomes included oral hygiene knowledge (20-item questionnaire), attitudes (OHIP-14 scale), and clinical parameters (plaque index and gingival index). Secondary outcomes comprised participant satisfaction, oral hygiene practice frequency, and multimedia resource usage.

Results: The intervention group demonstrated significantly greater improvements across all primary outcomes. Oral hygiene knowledge scores increased from 12.3 ± 2.8 to 17.9 ± 1.8 at follow-up in the intervention group versus 12.1 ± 2.9 to 13.8 ± 2.5 in controls (P 0.001). OHIP-14 scores decreased from 18.5 ± 5.7 to 10.8 ± 3.9 in the intervention group versus 18.3 ± 5.5 to 16.8 ± 5.0 in controls (P 0.001). Plaque index reduced from 2.1 ± 0.5 to 1.0 ± 0.3 in the intervention group versus 2.0 ± 0.6 to 1.7 ± 0.5 in controls (P 0.001). Gingival index decreased from 1.8 ± 0.4 to 0.9 ± 0.3 versus 1.7 ± 0.5 to 1.5 ± 0.4, respectively (P 0.001). The intervention group showed 93% satisfaction, with significantly higher brushing frequency (89.5% vs 62.5%) and interdental cleaning frequency (77.2% vs 42.9%) than controls.

Conclusion: The combination of hands-on practice and multimedia education significantly improved oral hygiene outcomes among adolescent orthodontic patients compared to traditional instruction methods.

Clinical recommendations: Orthodontic practices should consider implementing structured educational programmes combining hands-on training with digital tools, allocating time for practical sessions during appointments, and conducting regular follow-ups to reinforce proper techniques.

Purpose: The decision to restore or extract a tooth is influenced by various clinical factors, but it remains subjective and lacks standardized guidance. This study evaluated the clinical decision-making capabilities of predoctoral students, interns, and general dental practitioners (GPs) regarding tooth restorability, exploring factors that affected their confidence in assessing tooth restorability.

Materials and methods: A cross-sectional study was conducted across multiple dental schools targeting predoctoral students, interns, and GPs. The online questionnaire included four hypothetical case scenarios for assessing decision-making regarding tooth restorability, as well as items assessing factors that influence confidence levels. The data were analyzed using chi-square tests, exploratory factor analysis (EFA), and regression analysis.

Results: In total, 360 participants completed the questionnaire, with a response rate of 90%. There were statistically significant differences in some restorability and prognosis decisions across educational levels. EFA has identified two factors: preparedness for tooth restorability assessment and challenges and considerations in tooth restorability assessment. Regression analysis revealed that preparedness was a significant positive predictor of confidence (B = 0.791, p 0.001), whereas challenges and considerations in tooth restorability assessment were not (B = -0.086, p = 0.165).

Conclusion: Enhancing educational preparation can better equip dental practitioners to make confident and informed restorative decisions. Future research should explore strategies to enhance educational programs, mentorship, and guidelines to support dental practitioners in their decision-making processes.

Purpose: This study aimed to investigate a range of patient- and procedure-related factors influencing the success rate and postoperative pain of orthodontic microimplants, and propose potential personalised management strategies based on a large, single-centre dataset.

Methods and materials: A total of 853 participants (1,277 microimplants) were included in this single-centre, retrospective investigation. Clinical and demographic information were collected. The primary outcome was implant-level failure within 6 months (yes/no), with success defined as stable retention and function for ≥6 months without severe inflammation or reinsertion. Postoperative pain was assessed at 6 h, 24 h, and 7 days using the visual analogue scale (VAS). Analgesic usage and soft-tissue inflammation were recorded as secondary outcomes. Microimplant success was defined by stable retention over at least 6 months, absence of severe inflammation, and no requirement for reinsertion. Multivariable logistic regression and Cox proportional hazards models were used to identify independent predictors of microimplant failure over time. In addition, a random forest model was employed to rank risk-factor importance.

Results: Overall, 1,089 microimplants (90.8%) remained stable throughout the follow-up period, with a higher failure rate observed among older adults, smokers, and patients with lower cortical bone thickness (P 0.05). High insertion torque (>15 Ncm) significantly increased the odds of postoperative discomfort (OR = 1.85, 95% CI 1.30-2.65). Operator experience also correlated with lower failure and pain scores (P 0.01). The random forest analysis highlighted bone density, insertion torque, and smoking as the top three predictors.

Conclusions: Incorporating individualised strategies can improve clinical outcomes. Controlling insertion torque, accounting for cortical thickness, counselling smokers, and allocating senior operators are actionable steps to improve stability and patient comfort.

Purpose: Oral frailty, an age-related decline in oral function and health linked to adverse geriatric outcomes, involves multiple phenotypes. Chronic periodontitis, a key inflammatory driver of tooth loss and systemic disease, is a cornerstone of this syndrome, yet the shared genetic architecture connecting it to other oral conditions remains uncharacterised.

Methods and materials: We employed genomic structural equation modelling (genomic SEM) to integrate genome-wide association studies (GWAS) summary statistics from five oral frailty-related phenotypes, defining a common latent factor reflecting their shared genetics. We further integrated several post-GWAS analytical methods, including locus and gene discovery (MAGMA, TWAS/FOCUS), fine-mapping (SuSiE, FINEMAP), pathway and cell-type enrichment (S-LDSC, CELLECT), spatial mapping (gsMap), and Polygenic Risk Score analyses.

Results: The genomic SEM model demonstrated a good fit and revealed a common genetic factor underlying oral frailty. We identified four genome-wide significant loci, three of which are novel for oral frailty. Fine-mapping prioritised rs150699482 (KIAA0247), rs78975199 (SPG11), and rs2705755 (SNORA77) as likely causal variants. MAGMA highlighted 13 candidate susceptibility genes, with SPG11 and CCDC91 among the top candidates. TWAS and FOCUS analyses robustly implicated RP11-967K21.1 as a putative causal gene. Cell-type enrichment analysis indicated significant involvement of brain endothelial cells, immune cells, and mammary gland stromal cells. Heritability was enriched in evolutionarily conserved regions and active regulatory elements. Notably, gsMap analysis showed that genetic risk for oral frailty is enriched not only in jaw and tooth tissues but also across multiple embryonic tissues, including adipose tissue, dorsal root ganglion, mucosal epithelium, and connective tissue.

Conclusions: This study provides the first comprehensive genomic SEM-based characterisation of the shared architecture underlying oral frailty-related traits. By demonstrating a common genetic basis linking periodontitis with other oral dysfunctions, it provides novel insights into shared aetiological pathways and reinforces the concept of oral frailty as a systemic issue.

Purpose: The workflow for virtual surgical planning (VSP) and the application of CAD/CAM (computer-aided design/computer-aided manufacturing) procedures are mainly based on computed tomography (CT) derived DICOM data sets. Alternatively, this study aims to preclinically illuminate the feasibility of a magnetic resonance imaging (MRI) based workflow and the impact of artificial intelligence (AI) based segmentation on the required fidelity on basic 3D geometry acquisition.

Materials and methods: Porcine cadaver mandibles were imaged with CT and a T1-weighted MRI sequence. The resulting DICOM data sets were segmented conventionally (Mimics Medical 17.0, Materialize; Belgium) and with AI-based segmentation software (ImFusion Labels and Suite, Version 2.19.2, ImFusion; Germany). The four standard tessellation language (STL) files were superimposed with a corresponding reference model derived from an optic scan (Artec Space Spider, Artec 3D; Luxembourg) and the following parameters were analysed: Hausdorff distance (HD), mean surface distance (MSD), root mean square distance (RMSD), time.

Results: In comparison to the reference model, all four parameters were significantly (P 0.001) better for the CT imaging and the AI-based segmentation. MRI-derived AI-based segmentation reached the fidelity of CT imaging data sets and conventional segmentation (HD, MSD, and RMSD each P >0.05).

Conclusion: The use of AI-based segmentation software proved to be useful and feasible for MRI-derived data sets, and generated the desired 3D geometry more quickly while maintaining the necessary quality. Nevertheless, the results for the CT were still better and remain yet the standard.

Purpose: Oral lichen planus (OLP) is a chronic inflammatory disorder recognised as a potentially malignant disorder of the oral cavity. This review aimed to synthesize available evidence from Saudi Arabia regarding OLP prevalence, clinical presentation, associated factors, and risk of malignant transformation.

Materials and methods: A systematic search was conducted across several electronic databases (e.g., PubMed, Scopus, Saudi Digital Library) up to February 2024. Eligible studies were original clinical investigations on OLP in Saudi Arabia, reporting at least one of the following: prevalence, clinical presentation, treatment, or malignant transformation. Study quality was appraised using the Joanna Briggs Institute (JBI) checklists.

Results: Eleven studies - eight cross-sectional and three case-control - met the inclusion criteria. Reported prevalence of OLP across Saudi Arabian populations ranged from 0.35% to 11.08%. Clinical forms most often included the reticular variant, followed by erythematous and erosive forms. Topical corticosteroids were the most frequently applied treatment. Reported associations included diabetes mellitus, hypertension, thyroid disease, and hepatitis C virus infection. Histopathological confirmation was not consistently applied across studies. Dysplastic changes were noted in up to 12% of cases, while malignant transformation rates ranged from 0.2% to 5.6%.

Conclusion: Prevalence estimates of OLP in Saudi Arabia are highly variable, reflecting methodological and diagnostic inconsistencies. There is a possible relationship with systemic comorbidities, particularly hepatitis C infection. Multi-center, prospective studies with standardized diagnostic and follow-up protocols are needed to accurately determine epidemiology and malignant potential.