Is there a significant difference in the oral microbiome in vapers vs non-vapers?

DATA SOURCES: This study was a secondary data analysis of a parent study that was initially designed to assess saliva and exhaled breath for passive e-cigarette vapour exposure in children. The initial study collected patients using convenience sampling of the local community between July 2018 and February 2019 and ethical approval was obtained prior to commencing. DATA EXTRACTION AND SYNTHESIS: Eligibility criteria for the parent vapers in the original study included self-reported daily use of e-cigarettes in the presence of children via the use of a questionnaire. Microbiome data for a total of 36 adults were collected and analysed in this study (18 vapers and 18 non-vapers). RESULTS: Vapers have a distinct oral microbiome compared with non-vapers. They tend to have a higher relative abundance of Veilonella, an opportunistic pathogen that can stimulate the growth of other opportunistic pathogens. This species has also been found in carious lesions compared with healthy tooth surface.

Down the canal or down the gullet - which form of ibuprofen is best for post-endo instrumentation pain?

Study population and design This randomised observational study compared the analgesic efficacy of intra-canal local ibuprofen paste (Odontocide) with systemic ibuprofen capsules. Ninety patients with symptomatic apical periodontitis scheduled to undergo endodontic therapy were randomised to receive either local ibuprofen, systemic ibuprofen, or no ibuprofen (control). Using a visual analogue scale, pain scores were measured at set time points in the first 48 hours after endodontic instrumentation. The endodontic instrumentation procedures were standardised to use the same endodontic files, sodium hypochlorite, and EDTA irrigants. Canals were dressed with either Odontocide (local ibuprofen paste) or calcium oxide in the systemic ibuprofen and control groups.Data analysis Friedman and Wilcoxon tests were used to compare groups. A power calculation was listed in the methods of the paper which is an important and appropriate step.Results Systemic ibuprofen gave statistically significant better pain relief compared with local ibuprofen paste applied to root canals but only in the first 24 hours after root canal instrumentation. After the 24-hour mark, the systemic ibuprofen had a lower mean pain score but this was not statistically significant. Systemic ibuprofen was always statistically better at providing pain relief than the control.

The light at the end of the tunnel? Can light-based tests increase the accuracy of our diagnoses of pre-cancerous/cancerous lesions?

Study selection Two electronic databases (Medline/PubMed and Embase) were searched up to 30 August 2020. Selected papers fitted the following criteria: human studies published in the English language that assessed adult patients over the age of 18 with a presumptive diagnosis of an oral potentially malignant disorder, oral cancer or oropharyngeal cancer. The studies compared either visual inspection or light-based tests with diagnostic biopsy of the lesions. The outcome measures identified were: sensitivity, specificity, summary receiver operating characteristic curve (SROC), positive predictive value (PPV) and negative predictive value (NPV).Data extraction and synthesis The extraction of data followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline process. Two independent reviewers selected articles via PubMed search, and a further two independent reviewers selected articles via an Embase search. The quantitative data obtained from each study was used to create a database that recorded information on sensitivity, specificity, accuracy, PPV and NPV. Additionally, the value of true positive (VP), false positive (FP), true negative (VN) and false negative (FN) were extracted from each study. In cases where these were not reported, an estimate was calculated. The quality of diagnostic precision studies (QUADAS-2) tool was used to rate the quality of studies as high, unclear, or low.Results A total of 40 papers were ultimately included within the meta-analysis with 5,562 samples of autofluorescence, 1,353 samples of chemiluminescence and 1,892 samples of clinical examination. The majority of the studies evaluating chemiluminescence used the ViziLite technique while most of the studies evaluating autofluorescence used the VELscope. The QUADAS-2 pointed to most of the studies included in this review being of good quality. Clinical examination had the highest specificity (0.78-95% CI [0.65-0.87]) for declaring mucosa to be normal in the absence of dysplasia and malignancy, but had the lowest sensitivity (0.63-95% CI [0.45-0.78]) of actually diagnosing sinister lesions. Autofluorescence more accurately identified premalignant and malignant changes (sensitivity = 0.86 95% CI [0.77-0.91]) compared with chemiluminescence (sensitivity = 0.67 95% CI [0.38-0.87]) and visual examination (sensitivity = 0.63 95% CI [0.45-0.78]). Autofluorescence was also faster and simpler to use compared with chemiluminescence.Conclusions This review and meta-analysis concludes that autofluorescence has greater accuracy in identifying premalignant and early neoplastic changes compared with clinical examination and chemiluminescence. Biopsy remains the gold standard for definitive diagnosis of oropharyngeal and oral premalignant and malignant conditions.

Could dentists be the first to diagnose COVID-19 due to oral manifestations?

Data sources A search of electronic databases (PubMed and Google Scholar) was carried out, with publication being set from 2019 to October 2020.Study selection Titles and abstracts from the original search were reviewed by two reviewers independently. Overall, 17 studies were included in the final analysis.Data extraction and synthesis Data extraction was conducted independently by two reviewers. Studies that were chosen were examined and the following data parameters were included: age and gender, COVID-19 polymerase chain reaction (PCR) test, COVID-19 manifestations, treatment for COVID-19, cutaneous lesions, oral manifestations, days after COVID-19 diagnosis, treat/healing or oral symptoms.Results Seventeen studies were included; 14 articles were case reports, two case series and one systematic review. The results showed that dry mouth, dysgeusia, oral ulcerations and opportunistic infections were among the most common oral manifestations expressed in COVID-19-positive patients.Conclusion The authors recommended carrying out careful clinical intraoral examinations on both COVID-19-positive patients or any patients requiring dental care, as oral symptoms can still be the only or initial symptom of COVID-19.

Could certain mouthwashes reduce transmissibility of COVID-19?

Data sources Six electronic databases were searched including PubMed/Medline, Embase, Web of Science, Scopus, Cochrane, and Latin American and Caribbean Literature in Health Science (LILACS). Grey literature was also examined. There were no restrictions with regards to language, time of publication or participant demographics including gender, age and ethnicity.Study selection Both clinical and in vitro studies were included in the data search. Inclusion and exclusion criteria were clearly identified. Study selection was carried out in two phases by two independent reviewers. The studies included fitted the following criteria: studies that hypothesised the use of mouthwashes as a form of intervention to decrease the viral load in saliva contaminated with coronavirus. Two other studies were included in this review and both were conducted in Germany, performed in vitro, which tested povidone-iodine (PVP-I) mouthwash at two different concentrations: 1% and 7%. Both studies used the same culture mediums for clean and dirty conditions, and the evaluated outcome was the viral titre of MERS-CoV and SARS-CoV. The studies were published in 2015 and 2018. Neither study evaluated the action of this mouthwash on SARS-CoV-2 infection.Data extraction and synthesis The extraction of data followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline process. Studies chosen for analysis included assessment of the following data parameters for risk of bias: cell origin and cell type used, duration of exposure, frequency of exposure, magnetic flux density of exposure, environmental background magnetic field, use of control treatment, temperature control, blinding of exposure, randomisation of exposure, measurement of cell vitality, identical methods for control and exposure groups, randomisation of data measurements and potential industry sponsorship.Results One study assessed the effect of the mouthwash on MERS-CoV and the other on both MERS-CoV and SARS-CoV. In both studies, following 15 seconds of exposure to the mouthwash, a reduction in viral load of >99.99% was seen. There was a measurable reduction in viral titre in the samples, with one study reporting a reduction to 4.30 log10 TCID50/ml from 6.00-6.50 log10 TCID50/ml. Other mouthwashes such as hydrogen peroxide and chlorhexidine were not assessed in these studies.Conclusions The study concludes that PVP-I mouthwash at concentrations of 1% and 7% for 15 seconds may be effective at reducing the viral load of COVID-19 in human saliva. The level of scientific evidence, however, is low.