Powered or manual toothbrushes for people with disabilities - which is better?

DESIGN: A systematic review. AIM: Assess the effectiveness of manual toothbrushes (MTB) and powered toothbrushes (PTB) for people with physical or intellectual disabilities. DATA SOURCES AND STUDY SELECTION: The following data sources (MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE) were searched from the date of creation to February 2022 for papers which met the inclusion criteria. There were no language limitations set. The included studies were then hand-searched for relevant studies to be included. DATA EXTRACTION AND SYNTHESIS: Two reviewers screened the studies from the searches using Rayyan web application (Artificial-Intelligence search engine). Studies which met the inclusion criteria were selected. The studies were independently screened for the inclusion/exclusion criteria. Disagreement was resolved by discussion and consensus, or by a third party. Studies were then classified as low/moderate/high risk of bias. Analysis was performed on four subgroups; individual performing the brushing - (1) caregiver or (2) participant, main disability of the participant - (3) physical or (4) intellectual disability. Due to insufficient numerical data, a descriptive analysis was completed in place of the planned meta-analysis. RESULTS: In total, 16 publications were included within the results. There was no significant difference between manual or powered toothbrushing in both disability groups for the removal of plaque or gingival health. This applied to both self-brushing and caregiver brushing. CONCLUSIONS: There is no significant difference between powered and manual toothbrushes for effective oral hygiene maintence for people with physical or intellectual disabilities.

Is prolonged breastfeeding a risk factor for dental caries at 2 years of age?

DESIGN: A birth cohort study. COHORT SELECTION: Children born at Womens and Childrens Hospital of Juruá in the Western Brazilian Amazon from July 2015 to June 2016 were invited to join the study. 1246 children were invited and accepted into the study. Follow-up included visits at 6, 12 and 24 months of age, and a dental caries examination between 21 and 27 months of age (n = 800). Data collected included baseline co-variables and sugar consumption. DATA ANALYSIS: Data was collected at 6, 12 and 24 months. At 24 months, a 24-hour diet recall was obtained from the mother to obtain information on sugar consumption. A dental examination was carried out by two research paediatric dentists and caries was scored in accordance with the WHO criteria: decayed, missing and filled primary teeth (dmft)..Children were then categorised into absence of caries (dmft = 0) or presence of caries (dmft = >1). Follow-up interviews were carried out in 10% of cases to ensure accuracy and quality of the results. Statistical analysis was carried out using the G-formula. It was assumed breastfeeding had a direct effect on caries at 2 years and is indirectly mediated by sugar consumption. This was modified to include the presence of intermediate confounders (bottle-feeding) and time-varying confounders. Total causal effect of these confounders was calculated by the addition of natural direct effect and natural indirect effect. The odds ratio (OR) for total causal effect was estimated. RESULTS: In total, 800 children were followed up throughout the study; of these, the prevalence of caries was 22.8% (95% CI, 19.8%-25.8%). 14.9% (n = 114) of children were breastfed at 2 years of age and 60% of children (n = 480) were bottle-fed. Bottle-fed children were found to have an inverse relationship with caries. Children breastfed for 12-23 months (n = 439) were found to have an OR 1.13 for having caries at 2 years compared to those breastfed <12-months (n = 247), equating to a 13% higher risk. Children breastfed for ≥24-months had an even higher risk (27%) of caries at 2 years of age compared to those breast-fed to 12-months (TCE: OR = 1.27, 95% BC-CI 1.14:1.40). CONCLUSIONS: There is a weak association with prolonged breastfeeding and increased caries rate in children. Decreasing sugar consumption alongside prolonged breastfeeding marginally reduces the effect of breastfeeding on dental caries.

Primary pulpotomies - what should we be using?

Introduction A systematic review and meta-analysis of the effectiveness of Biodentine compared to formocresol for pulpotomies in the deciduous dentition.Data sources and study selection Four electronic data bases were searched (Medline, Embase, Cochrane Central Register of Controlled Trials and Web of Science). Randomised controlled trials (RCTs) which compared the use of Biodentine with formocresol were included in the screening. Two reviewers screened the titles and abstracts of the RCTs independently for inclusion in the review and a third reviewer was consulted in the case of any disagreements. Thirteen articles were used for full-text reading and nine were included in the review. Two investigators assessed risk of bias (RoB) by allocating a score of either high, low or unclear, in line with the Cochrane handbook for systematic reviews of interventions. Failure to blind practitioners paired with a lack of standardised application protocol results in high RoB.Data extraction and synthesis Data was extracted from the included studies using customised forms, including: sample size, patient ages, treatment and clinical and radiographic follow-up and results. Meta-analysis of the results was completed using ReviewManager version 5.4.0.Results In total, 626 children were assessed in the RCTs. All teeth were restored with a preformed metal crown placed directly after the procedure, except for two studies, which placed them 24 and 48 hours later. The primary outcomes of clinical failure were defined as pain, tenderness to percussion, swelling, abscess, fistula and pathological tooth mobility at 12 months. These showed that Biodentine had significantly lower failure rates (RR 0.16; 95% CI 0.003-0.87; N = 394). Radiographic failure rates defined as either internal or pathological external root resorption, furcation radiolucencies or a widened periodontal ligament showed significantly lower failure rates (RR 0.19; 95% CI 0.08-0.49; N = 393). However, the results showed no significant difference for secondary outcomes which assessed the teeth both clinically and radiographically at intervals up to 48 months. Outcomes were assessed using GRADE; this showed all results to be of low certainty due to the high RoB.Conclusions Biodentine may be the superior material to formocresol for pulpotomy in the deciduous dentition. However, the results for both primary and secondary outcomes have a very low to low GRADE rating due to high RoB; therefore, robust future studies should be completed to further substantiate these findings.