Statistical Methods and Machine Learning Algorithms for Investigating Metabolic Syndrome in Temporomandibular Disorders: A Nationwide Study.

The objective of this study was to analyze the associations between temporomandibular disorders (TMDs) and metabolic syndrome (MetS) components, consequences, and related conditions. This research analyzed data from the Dental, Oral, Medical Epidemiological (DOME) records-based study which integrated comprehensive socio-demographic, medical, and dental databases from a nationwide sample of dental attendees aged 18-50 years at military dental clinics for 1 year. Statistical and machine learning models were performed with TMDs as the dependent variable. The independent variables included age, sex, smoking, each of the MetS components, and consequences and related conditions, including hypertension, hyperlipidemia, diabetes, impaired glucose tolerance (IGT), obesity, cardiac disease, obstructive sleep apnea (OSA), nonalcoholic fatty liver disease (NAFLD), transient ischemic attack (TIA), stroke, deep venous thrombosis (DVT), and anemia. The study included 132,529 subjects, of which 1899 (1.43%) had been diagnosed with TMDs. The following parameters retained a statistically significant positive association with TMDs in the multivariable binary logistic regression analysis: female sex [OR = 2.65 (2.41-2.93)], anemia [OR = 1.69 (1.48-1.93)], and age [OR = 1.07 (1.06-1.08)]. Features importance generated by the XGBoost machine learning algorithm ranked the significance of the features with TMDs (the target variable) as follows: sex was ranked first followed by age (second), anemia (third), hypertension (fourth), and smoking (fifth). Metabolic morbidity and anemia should be included in the systemic evaluation of TMD patients.

Patterns of Cone-Beam Computed Tomography (CBCT) Utilization by Various Dental Specialties: A 4-Year Retrospective Analysis from a Dental and Maxillofacial Specialty Center.

The study aimed to analyze the uses of cone-beam computed tomography (CBCT) in the diagnosis and treatment in various dental specialties. This 4-year cross-sectional study analyzed the records of 1409 individuals who underwent a CBCT at the Oral and Maxillofacial Center at Sheba Medical Center, Israel. The average age of the patients was 27.9 ± 11.5 (range: 9-86 years). Patients were referred for CBCT by the following departments: Oral and Maxillofacial Surgery (1063; 75.5%), Endodontics (182; 12.9%), Periodontology (122; 8.6%) and Orthodontics (42; 3.0%). Most CBCT radiographs evaluated the maxilla (774; 55.0%), followed by the mandible (481; 34.1%) and both (154; 10.9%). The target anatomical structures included: bone (694; 49.3%), teeth (307; 21.7%), and both jaws (408; 29.0%). The main indications for CBCT use were: assessment of anatomical structures and implant sites (787; 55.9%), determine root canals morphology (182; 12.9%), visualization of impacted teeth, tooth alignment, and localization (177; 12.6%), suspected cysts or tumors (148; 10.5%), evaluation of Temporomandibular joint disorders (106; 7.5%) and other reasons (9; 0.6%). In 279 (19.8%) of cases, the diagnosis changed following CBCT, mainly in Orthodontics tooth analysis (28 (66.7%); p < 0.001). Practitioners and health authorities should be aware of this baseline information regarding CBCT use in the diagnosis and assessment of various oral and maxillofacial pathologies, anomalies and tooth position relative to anatomic structures. Continuing research and publications of CBCT utilization and guidelines are recommended.

Pre-Operative Oral Health-Related Quality of Life in Patients Attending Surgical Removal of Mandibular Third Molar Teeth.

The study aimed to measure the pre-operative oral health-related quality of life (OHRQoL) and to identify patient and teeth pathologies associated with worse OHRQoL among patients attending mandibular third molar tooth extraction. Data were collected preoperatively from 199 patients attending surgical removal of their mandibular third molar. To that end, we measured the Oral Health Impact Profile-14 (OHIP-14) and analyzed its association with: (1) demographics; (2) health-related behaviors such as smoking, alcohol consumption, physical activity, and dietary habits; (3) Plaque Index (PI); (4) Decay, Missing, and Filled Teeth (DMFT); and (5) clinical characteristics related to third molar extraction, such as the indication for extraction, tooth angulations, and radiographic pathology. The mean age of the study population was 21.5 ± 3.2 years and the mean OHIP-14 global score was 22.5 ± 8.3. The present study identified patient and teeth profiles that are associated with worse pre-operative OHRQoL in patients attending mandibular third molar extraction. The "vulnerable patient" profile includes poor health-related behaviors, particularly the performance of physical activity less than once a week (p = 0.028). The "disturbing teeth" profile includes higher plaque scores (p = 0.023) and specific characteristics of the third molar teeth, such as pericoronitis (p = 0.027) and radiolucency around third molars in panoramic radiography (p < 0.001). These findings support the hypothesis that OHRQoL is a complex phenomenon which is associated with the patient's health-related behaviors as well as with specific tooth pathologies.

Oral Health-Related Quality of Life in Patients with Temporomandibular Disorders.

AIMS: To measure the oral health-related quality of life (OHRQoL) in patients with temporomandibular disorders (TMD) compared to controls and analyze its association with various demographic and clinical parameters. METHODS: The survey included 187 TMD patients and 200 controls. OHRQoL was measured using the validated Hebrew version of the Oral Health Impact Profile-14 (OHIP-14). A self-report questionnaire assessed personal details, smoking habits, history of trauma and orthodontic treatment, comorbid headaches, oral habits, and pain. TMD patients were divided into diagnostic categories according to the newly recommended diagnostic criteria for TMD (DC/TMD) Axis I protocol. Differences between groups were examined with a Pearson chi-square test for categorical variables and analysis of variance (ANOVA) for continuous variables. RESULTS: Among TMD patients, the diagnostic categories included: (1) masticatory muscle disorders (MMD; n = 38; 20.32%), (2) isolated disorders of the temporomandibular joint (TMJ; n = 46; 24.59%), (3) patients with both MMD and TMJ (TMP; n = 103; 55.08%). Compared to controls, TMD patients exhibited worse global OHIP-14 scores (12.50 ± 8.14 vs 9.58 ± 10.00; P = .002) and worse scores in the following domains: physical pain (P < .001), psychological discomfort (P = .005), physical disability (P = .004), and psychological disability (P = .013). Among TMD patients, those categorized as TMP exhibited the highest scores in the physical pain (P = .02) domain. Previous orthodontic treatment, comorbid headache and body pain, limitations in mouth opening and lateral movement, pain, and muscle tenderness scores were found to be strongly related to the OHIP-14. CONCLUSION: TMD patients suffered from impaired OHRQoL considerably more than controls. OHRQoL in TMD patients is a multidimensional phenomenon influenced by previous orthodontic treatment, comorbid symptoms, pain, functional limitations, and muscle tenderness scores.

Retention and marginal leakage of provisional crowns cemented with provisional cements enriched with chlorhexidine diacetate.

STATEMENT OF PROBLEM: Provisional crowns cemented with provisional luting agents are susceptible to washout, marginal leakage, and secondary caries when placed for a prolonged period. PURPOSE: The purpose of this study was to examine the effect of incorporating chlorhexidine diacetate (antibacterial agent) into provisional cements on retention and marginal leakage of provisional crowns in vitro. MATERIAL AND METHODS: Provisional crowns of acrylic resin (Duralay) were fabricated for 12 intact human molars with rounded-shoulder preparations. The 12 provisional crowns were luted individually with Temp Bond, Temp Bond NE, and Freegenol provisional cements with and without incorporation of chlorhexidine diacetate (CHDA) salt. Each test group included the same 12 specimens. Specimens with no luting agent served as the control (n=12). Specimens were thermal cycled 100 times (5 degrees C and 55 degrees C) with a 10-second dwell time, stored in 100% humidity at 37 degrees C for 6 days, and then immersed in a 0.5% basic fuchsin at 37 degrees C for 6 hours. Seven days after cementation, removal test of the crowns (tensile retention test) was conducted with a universal testing machine at a crosshead speed of 5 mm/min. Marginal leakage was assessed with a 5-level dye penetration scale. Results of the retention test were subjected to a 2-way ANOVA with repeated measures. A Bonferroni test was used to compare the means. Marginal leakage data were subjected to a nonparametric Wilcoxon signed ranks test. All hypothesis testing was conducted at the 95% level of confidence. RESULTS: Retention of provisional crowns cemented with Freegenol enriched with CHDA increased 3-fold to an average level of 80.9 N. However, incorporation of CHDA into Temp Bond or Temp Bond NE did not affect retention. CHDA incorporated into the cements had no significant effect on the marginal leakage of all the tested cements. CONCLUSIONS: The addition of CHDA increased retention of Freegenol and had no significant effect on the marginal leakage of the tested cements.