The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea.

The objective of this article is to review the role of the dentist in the early diagnosis of pediatric obstructive sleep apnea (OSA) and to provide an in-depth review of the best evidence-based practices available to treat and/or to refer these patients for intervention. MATERIAL AND METHODS: A narrative review was performed using indexed data bases (PubMed, Medline, EMBASE, OVID, Scopus and Cochrane) up to year 2020, and approximately 1000 articles were reviewed. The articles included were those with the best information provided. RESULTS: Detailed review of the literature suggests that the role of the dentist has been redefined owing to their expertise in the orofacial region. Every patient consulting a dental practice is not merely a dental patient; he/she also requires a comprehensive medical review. The role of the dentist is pivotal in pediatric patients once diagnosed with OSA; as the patients grow, growth modification can be achieved, and future management will be easier. Initiating dental treatments during growth can benefit patients two-fold, saving them from malocclusion, and intervening in orofacial structural growth can help to avoid cumbersome treatments, such as CPAP and various surgeries. Proper diagnosis and management of systemic illnesses can prevent compromised quality of life, delays in treatment, morbidity and, in some cases, mortality.

Effectiveness of CAD/CAM technology: A self-assessment tool for preclinical waxing exercise.

INTRODUCTION: This study assessed the utility of CAD/CAM technology as a self-assessment tool for preclinical waxing compared to traditional student self-assessment to evaluate preclinical work. MATERIAL AND METHODS: Thirty-seven students completed the wax-up of the maxillary left central incisor with the goal of recreating original anatomy and completed a traditional self-assessment. The original, unreduced cast and waxings were scanned with an intraoral scanner (E4D, Planmeca). Using CAD/CAM software (Compare, Planmeca), each waxing was superimposed over the original. Tolerance (250 µm) was set to illustrate under- and over-contoured areas, enabling visualisation of the waxing compared to original in three dimensions. Students then completed another self-assessment and an exit survey. RESULTS: Twenty-four per cent of self-assessment responses changed after using Compare Software. 20% changed from satisfactory to unsatisfactory. Four per cent changed from unsatisfactory to satisfactory. Greatest change in response occurred in the Incisal Edge (49%) rubric category. Interproximal Contact Area (3%) demonstrated least change in response. Seventy per cent strongly agreed that Compare Software enabled more effective assessment of Lingual Contour. Eight per cent strongly disagreed that Compare Software enabled more effective assessment of finishing. DISCUSSION: CAD/CAM software can improve student's critical self-assessment. Different rubric categories demonstrated differing rates of response change, indicating more critical of certain aspects of the waxing. Majority strongly agreed that the software enabled more effective self-assessment. CONCLUSION: CAD/CAM technology enhances student's learning in dental wax-up through improving self-assessment. This technology may improve teacher-student communication, reduce one-on-one teaching time and allow higher student-teacher ratio.

Salivary biomarkers associated with obstructive sleep apnea: a systematic review.

Introduction: This study aimed to define and characterize current literature describing salivary biomarker changes with the goal of improving diagnosis and treatment outcomes for sleep apnea.Area Covered: A search of six databases yielded 401 peer-reviewed articles published through October 2019 corresponded to 221 unique references following deduplication. Twenty studies were selected. The sample size ranged from 17 to 99. The samples were mostly whole saliva and selected glandular areas.Expert Opinion: Most targeted studies focused on the level of salivary cortisol and ɑ-amylase. One study used RNA transcriptome analysis of 96 genes. Only two explored novel targets using mass spectrometry. ɑ-amylase, myeloperoxidase, and IL-6 were among those biomarkers found associated with OSA. Cytokeratin, CystatinB, calgranulin A, and alpha-2-HS-glycoprotein are upregulated in OSA patients based on non-targeting mass spectrometry. Salivary cortisol and ɑ-amylase and others appeared to be associated with severity of OSA and OSA treatment. There were inconsistencies in saliva collection and processing protocols. More studies are needed in exploring novel biomarkers to examine if these biomarkers are capable of diagnosing and monitoring OSA through proteomics or transcriptomics. Salivary biomarkers have a potential to be a noninvasive measure for the disease diagnosis and treatment outcome monitoring for sleep apnea.

Concordance Between Clinical Practice and Published Evidence: Findings From Virginia Commonwealth University School of Dentistry.

OBJECTIVES: To evaluate the concordance between clinical practice and published evidence by dental faculty and graduating students of the Virginia Commonwealth University School of Dentistry. METHODS: A questionnaire previously developed by the National Dental Practice-Based Research Network with 12 clinical scenarios was administered to VCU faculty and graduating students. Responses were scored as either consistent or inconsistent with published evidence and then analyzed for differences between dental faculty, graduating students, and the national results. RESULTS: There were 43 dental faculty members with at least half-time student contact who responded to the survey. Faculty concordance ranged from 33% to 100%, and general practice faculty had the highest concordance (82%). Eighty-five of the graduating class of 98 responded to the survey, and student concordance ranged from 18% to 92% and averaged 67%. General practice faculty had higher concordance with published evidence than recently graduated dental students. CONCLUSIONS: Graduating students and dental faculty demonstrated higher concordance with evidence-based practice than practitioners in the National Dental Practice-Based Research Network. General practice dental faculty demonstrated adequate concordance, but students demonstrated only a medium-level concordance. Practitioners involved in teaching dental students are better able to keep up with evolving evidence and are better able to demonstrate evidence-based practice.

The Effects of Faculty Calibration on Caries Risk Assessment and Quality Assurance.

Accurate caries risk assessment (CRA) plays a pivotal role in managing the disease of dental caries. The aim of this quality assurance study was to determine if faculty calibration training using a specific set of guidelines in a single session would improve the faculty members' CRA decision making. A calibration seminar was held in December 2014 at the Virginia Commonwealth University School of Dentistry, during which seven completed CRA forms for simulated patients were used to test 55 faculty members' risk assignment level before and after an instructional lecture was given. The results showed a statistically significant increase in the proportion of faculty members responding correctly for five of the seven cases on the pre- and posttests (p<0.01). One case showed no significant increase in correct responses (p=0.07), and on the seventh case, which presented low caries risk, there was a significant decrease in the percentage responding correctly (p<0.0001) due to an increase in the proportion overestimating caries risk. This study's findings were consistent with those in previous studies that, without calibration, faculty members are not necessarily accurate at CRA diagnosis. Since the calibration training improved these faculty members' caries risk assessment scoring, future studies should extend to evaluations for both faculty and students.

Increased vertical dimension effects on masseter muscle fiber phenotype during maturation.

OBJECTIVE: To determine changes in mouse myosin heavy chain (MyHC) protein expression that may occur with a clinically relevant vertical dimension of occlusion (VDO) increase. MATERIALS AND METHODS: Six CD-1 male mice (age: 6 weeks) underwent a 10% bite opening to replicate the clinical condition using composite on the maxillary molars and were compared to six age-matched controls. Mice were sacrificed at day 7 and 14 after bite opening. A representative masseter transverse cryosection from each animal was examined in selected sampling regions (anterior, posterior, posterior-deep, and posterior-intermediate) to assay fiber phenotype proportions and fiber size. RESULTS: In control masseter muscles, the proportion of muscle fibers containing MyHC IIb increased in the posterior-intermediate and posterior-deep regions between 7 and 14 days (ANOVA, P < .05). The increase in the proportion of MyHC IIb fibers in the bite opening group did not occur when compared to the control group (P < .05). In addition, after 14 days of bite opening, the proportion of fibers positive for MyHC IIa was decreased in the anterior region compared to control masseter muscles. Muscle fiber diameter remained unchanged in both groups (experimental and control) and over time (P > .10). CONCLUSION: These data are consistent with a selective plasticity of the expression of MyHC IIb protein in the deep regions of the male masseter muscle in response to a clinically relevant VDO increase.