Airway Phenotypes and Nocturnal Wearing of Dentures in Elders with Sleep Apnea.

The objective of this study was to examine to what extent the anatomic characteristics of the upper airway can influence the effect of nocturnal wearing of dentures on the sleep of edentulous elders with untreated sleep apnea. This study used the data from a randomized crossover clinical trial and an exploratory approach to address its objectives. Cone beam computed tomography scans of 65 edentulous individuals (female, n = 37; male, n = 28; mean ± SD age, 74.54 ± 6.42 y) with untreated obstructive sleep apnea (OSA) were used to identify anatomic variables. Polysomnography data were collected by means of one portable overnight recording. The respiratory variable values, including apnea-hypopnea index (AHI), with and without denture worn during sleep were used to calculate the change. Statistical analyses included multiple linear regressions, cluster analysis, and binary logistic regressions. A receiver operator characteristic curve was used to illustrate the accuracy of the statistical model. The regression model explained 15.8% (R2) of AHI change. An increase in the lateral dimension of the minimum cross-sectional area was associated with a decrease in AHI, oxygen desaturation index, and respiratory arousal index changes (P ≤ 0.041). Furthermore, an increase in the length of the hypopharynx was associated with an increase in AHI and oxygen desaturation index changes (P ≤ 0.027). An increase in the lateral dimension of the minimum cross-sectional area of the upper airway was associated with a decreased likelihood of being in the group having a worsened AHI (odds ratio = 0.85; 95% CI, 0.76 to 0.95; P = 0.006). An increase in the length of the oropharynx was associated with an increased likelihood of having increased AHI (odds ratio = 1.10; 95% CI, 1.01 to 1.20; P = 0.026). The nocturnal aggravation of respiratory variables in edentulous individuals with OSA who wear dentures at night can be linked to certain anatomic characteristics of the upper airway. Replication of these findings may open novel avenues for personalized advice regarding nocturnal wearing of dentures in edentulous individuals with OSA (ClinicalTrials.gov: NCT01868295).

Salivary Biomarkers in Denture Stomatitis: A Systematic Review.

OBJECTIVE: Denture stomatitis (DS) is an oral biofilm-associated inflammation of the denture-bearing mucosa. The objective of this review was to identify and evaluate the quality of evidence on the association between the levels of salivary biomarkers and DS among adults with and without palatal DS. MATERIALS AND METHODS: Following the PRISMA guidelines, Medline, PubMed, EMBASE, and the Cochrane Central Register for Controlled Trials were searched for eligible studies from the beginning of the archives until December 2018. Experimental and observational studies with adult participants were included that had a control group or subgroup analysis and provided data on salivary biomarkers and DS. Articles in languages other than English or French were excluded. The level of evidence and grades of recommendation were established with the 2011 scale of the Oxford Centre for Evidence-Based Medicine. Additionally, the assessment of methodological quality was conducted with the STROBE statement (Strengthening the Reporting of Observational Studies in Epidemiology) and graded according to the Olmos scale. RESULTS: From 1,008 citations, 9 studies were included in the systematic review (8 observational, 1 clinical trial). Seven studies suggested a statistically significant difference in the levels of salivary cytokines (IL-6, CCL3, TGF-ß, CXCL8, GM-CSF, and TNF-α) between participants with DS and controls (P < 0.05). In contrast, 2 studies concluded that the difference in the levels of several salivary cytokines (IL2, IL12, IFN-g, IL-4, IL-8, IL-10, IL-17, TNF-α, and ICAM-1) between the groups was not statistically significant. The level of evidence for the majority of studies was 3, while the grade of recommendation for all the studies was B, interpreted as "favorable." In terms of methodological quality, most studies met 50% to 80% of STROBE criteria and were graded B. CONCLUSION: Palatal inflammation in DS is significantly associated with the levels of salivary cytokines. KNOWLEDGE TRANSFER STATEMENT: The results of this study identified altered levels of specific salivary biomarkers associated with denture stomatitis, which may aid in the early diagnosis and treatment of this disease.

Failure of single-unit restorations on root filled posterior teeth: a systematic review.

This systematic review investigated the failure rate of conventional single-unit restorations in root filled posterior permanent teeth. Two reviewers independently applied eligibility criteria, extracted data and assessed the quality of the evidence of each included study according to the Cochrane Collaboration's procedures for randomized control trials (RCTs) and the STROBE criteria for observational studies. The MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Oral Health Group Trials Register and CENTRAL (via Cochrane Library) databases were searched electronically (January 1993 to week 1, February 2015). This was complemented by an additional hand search of selected journals and the references of relevant studies. Clinical studies published on root filled single-unit restorative treatments with a mean follow-up period of at least 3 years were selected. The outcome measured was clinical or radiological failure. Overall, the four RCTs and the single observational study included were of low and high quality, respectively. Therefore, a meta-analysis was not possible. The pooled mean failure rates were reported according to the type of treatment and remaining coronal tooth structure. The current evidence suggested that the failure rates of the treatments may depend on the amount of remaining tooth structure and type of treatment. Post-retained crowns were associated with the most favourable outcome in teeth with one to two remaining coronal tooth wall(s), whereas post-free crowns were superior when greater tooth structure was available. Restorations in teeth without ferrules had such a high rate of failure that other treatment options should be considered.

[Association between oral conditions and colorectal cancer: A literature review and synthesis]. / Association entre les affections buccodentaires et le cancer colorectal: une revue et synthèse de la littérature.

BACKGROUND: Chronic periodontitis and tooth loss are chronic oral conditions that, in recent decades, have been implicated in the occurrence of certain types of cancer. In this review, we address the question of whether colorectal cancer is associated with these oral conditions. RESULTS: Epidemiological studies evaluating a potential association between periodontitis, tooth loss and colorectal cancer are scarce. However, several mechanisms argue in favor of this association, notably inflammation, nutrition and possibly infection by specific bacteria, as suggested by this literature review.

Quality of supervision: postgraduate dental research trainees' perspectives.

INTRODUCTION: Supervision is a pillar in enhancing the student's learning environment throughout her/his higher education. Multiple studies qualify graduate supervision among the most important contributors to the successful completion of a higher education degree and to graduate students' positive academic experience. The aim of this study was to assess the views of graduate students enrolled in the Dental Sciences and Craniofacial Research Graduate Programs at McGill University (n = 64) regarding the quality of supervision they are receiving. METHODS AND MATERIALS: An online questionnaire composed of 22 open and closed-ended format items was used and covered five domains: student profile, supervisory relationship, conflict resolution, student progress/thesis writing and career development. Descriptive statistics, chi-square tests and interpretative qualitative analysis were used to evaluate students' perspectives. RESULTS: Fifty-nine students completed the survey (92.2%). The distribution of sample in regard to the graduate student level was almost identical (M.Sc. level n = 28, Ph.D. n = 31). Overall, most graduate students appeared satisfied with the supervision they received and had similar perspectives about the surveyed domains. There was one statistically significant difference (P < 0.05) between MSc and PhD students when asked if their supervisors aided them in career development outside the supervisory relationship, where 77.4% (n = 24) of doctoral students agreed as opposed to 21.4% (n = 12) of Masters' students. CONCLUSIONS: Our results showed that McGill graduate students appeared to be overall satisfied with the supervision they received. The main elements contributing to a positive supervision experience were support, guidance, availability and good communication between supervisees and supervisors.

Tooth Loss Increases the Risk of Diminished Cognitive Function: A Systematic Review and Meta-analysis.

Emerging evidence suggests that oral health is associated with cognitive function. This review aims to systematically assess this association in adult populations via prospective cohort study designs. Eligible study reports were identified by searching the MEDLINE (via Ovoid), EMBASE, PsycoINFO, and Cochrane Library databases. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated with a random effects model. From 1,251 identified articles, 10 were included in the systematic review and 8 in the meta-analysis. Random effects analysis showed, with statistically low heterogeneity, that individuals with suboptimal dentition (<20 teeth) were at a 20% higher risk for developing cognitive decline (HR = 1.26, 95% CI = 1.14 to 1.40) and dementia (HR = 1.22, 95% CI = 1.04 to 1.43) than those with optimal dentition (≥20 teeth). Studies on the association between periodontal disease and cognitive status showed conflicting results. Within the limits of the quality of published evidence, this meta-analysis lends further support to the hypothesis that tooth loss is associated with an increased risk of cognitive impairment and dementia. Knowledge Transfer Statement: Based on the published literature, the results of this study show that the risk for cognitive impairment and dementia increases with loss of teeth. This information adds to the evidence showing links between oral and general health and suggests that oral health strategies aimed to preserve teeth may be important in reducing risk of systemic disease.

Efficacy of Mandibular 2-implant Overdenture: An Updated Meta-analysis on Patient-based Outcomes.

The extent of heterogeneity regarding the efficacy of the mandibular 2-implant overdenture is still in question. The aim of this meta-analysis is to provide an update on the existing evidence from randomized controlled trials assessing the efficacy of the mandibular 2-implant overdenture in regard to patient-based outcomes. Electronic searches were carried out to September 2015 through MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Systematic Reviews. Only randomized controlled trials that compared conventional dentures with mandibular 2-implant overdentures were included. Patient-based outcomes were assessed, including patient satisfaction and oral health- and general health-related quality of life. Random effects models were used to pool the effect sizes of all included studies. Further stratified analyses and heterogeneity analyses were tested, as was publication bias. In addition to the 7 randomized controlled trials that were included in the previous meta-analysis, 4 new trials were identified and included in this update. A random effects model showed that, when compared with conventional dentures, mandibular 2-implant overdentures significantly improved patient satisfaction (pooled effect size = 0.87, z = 5.31, 95% confidence interval: 0.55 to 1.19, P < 0.0001, χ2 = 41.82, df = 8, P < 0.0001, I2 = 81%) and oral health-related quality of life (pooled effect size = -0.66, z = 2.72, 95% confidence interval: -1.13 to -0.18, P = 0.007, χ2 = 21.26, df = 4, P = 0.0003, I2 = 81%). The differences in participant recruitment and their pretreatment condition were important sources of heterogeneity among the studies. Only 1 study investigated the impact of mandibular implant overdentures on perceived general health, and it revealed no between-treatment differences. The 2-implant mandibular overdenture improves patient satisfaction and quality of life for the general edentate population. Health status, poor oral condition, and patient characteristics may effect patient-based outcomes and should be considered by clinicians in treatment planning. Knowledge Transfer Statement: This meta-analysis shows that mandibular 2-implant overdentures are significantly more satisfactory to the general edentate populations than new conventional dentures. The results also show that mandibular 2-implant overdentures provide significantly better oral health-related quality of life than do new conventional dentures. These results should be shared with edentate patients in planning their treatment.

Interactions between sleep disorders and oral diseases.

Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties. The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management. The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral health-related sleep disorders that are commonly seen in dental practice.

Perceived sleep quality among edentulous elders.

BACKGROUND: Anatomical changes associated with edentulism are thought to disturb seniors' sleep. OBJECTIVES: (1) To determine sleep quality and daytime sleepiness of edentulous elders. (2) To examine the association between oral health-related quality of life and sleep quality. METHODS: Data were collected at a 1-year follow-up from 173 healthy edentulous elders who had participated in a randomised controlled trial and randomly received two types of mandibular prosthesis. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI, range 0-21), with higher scores indicating poorer sleep quality. The Epworth Sleepiness Scale (ESS) was used to measure the level of perceived daytime sleepiness, and scores ≥10 indicated sleepiness. RESULTS: The mean global PSQI and ESS scores were 4.7 ± 3.5 and 5.3 ± 3.9. There were no differences in sleep quality or sleepiness between those who wore their dentures at night and those who did not. Elders with frequent denture problems were sleepier during the day than those with fewer problems (p = 0.0034). General health (p = 0.02) and oral health-related quality of life (p = 0.001) are significant predictors of sleep quality. CONCLUSION: Healthy edentulous elders, independent of nocturnal wearing of their prosthesis, are good sleepers. Maintaining high oral health quality of life could contribute to better sleep.

Is oral health-related quality of life stable following rehabilitation with mandibular two-implant overdentures?

OBJECTIVES: The superiority of mandibular two-implant overdentures (IODs) over conventional complete dentures (CDs) in terms of quality of life is still questioned. Furthermore, the stability and magnitude of the treatment effect over time remain uncertain. This follow-up study aimed to determine the stability and magnitude of the effect of IODs on oral health-related quality of life (OHRQoL). MATERIAL AND METHODS: 172 participants (mean age 71 ± 4.5 years) randomly received CDs or IODs, both opposed by conventional maxillary dentures. OHRQoL was measured using the Oral Health Impact Profile (OHIP-20) at baseline, 1 and 2 years post-treatment. Repeated measures ANOVAs were conducted to assess the effects of time and treatment on the total OHIP and its individual domain scores. RESULTS: A statistically significant improvement in OHRQoL was seen for both treatment groups (P < 0.001). This improvement was maintained over the 2 year assessment. At both follow-ups, participants wearing IODs reported significantly better total OHIP scores than those wearing CDs (P < 0.001), with a 1.5 times larger magnitude of effect. In the CD group, baseline OHIP scores influenced the post-treatment scores (P < 0.001). This effect was not found in the IOD group. CONCLUSIONS: The effect of mandibular two-IODs on OHRQoL is stable over a 2-year period. The large magnitude of effect of this treatment supports its clinical significance.

Better oral health related quality of life: type of prosthesis or psychological robustness?

UNLABELLED: Sense of coherence (SOC) is an individual-based coping characteristic and believed to influence a person's ability to adapt to life stressors, such as edentulism and using complete denture. Thus, SOC may mediate the effect of prosthetic treatment on quality of life. OBJECTIVES: 1. To simultaneously test the effect of type of treatment and sense of coherence on oral health related quality of life (OHRQoL) in edentate elders and to identify any interaction. 2. To report the level of sense of coherence among a sample of edentate elders. METHODS: Data were collected and analysed cross-sectionally at a 1-year follow-up from 173 edentulous elders who had randomly received mandibular-implant overdentures or conventional dentures, both opposed by new conventional maxillary dentures. The dependent outcome variable, oral health related quality of life, was measured using the Oral Health Impact Profile (OHIP-20). Independent variables included SOC and prosthesis type, as well as socio-demographic variables. SOC was evaluated using the 13-item likert scale of The Orientation to Life questionnaire. RESULTS: The group mean SOC score was 70.28 (SD=9.6). Married or coupled people had significantly higher SOC scores than those who were separated, single or divorced (p=0.04). General linear model analyses demonstrated that there was a statistically significant main effect for type of prosthesis, F(1.169)=0.71, p=0.008, with no interaction with SOC. CONCLUSION: The results of this study suggest that, in edentulous elders, SOC does not mediate the effect of the type of prosthetic treatment on oral health related quality of life.

Favoring trauma as an etiological factor in denture stomatitis.

The etiology of denture stomatitis remains controversial. Trauma due to unstable dentures has been suggested as an etiological factor. Therefore, we tested the hypothesis that the prevalence of denture stomatitis is reduced when mandibular dentures are stabilized by implants. Data were collected at a one-year follow-up from 173 edentulous elders who had randomly received mandibular implant overdentures or conventional dentures. The diagnosis of denture stomatitis was determined according to the Newton classification. Elders wearing conventional dentures were almost 5 times more likely to have denture stomatitis than those wearing mandibular two-implant overdentures (P < 0.0001, Fisher's exact test). Adjusted odds ratios showed that only the type of the prosthesis (AOR = 4.54, 95% CI 2.20 to 9.40) and nocturnal wear (AOR = 3.03, 95% CI 1.24 to 7.40) predict the frequency of denture stomatitis. Thus, implant overdentures may reduce oral mucosal trauma and control denture stomatitis.

Gastric bezoar following penetrating abdominal injury. Diagnosis and endoscopic therapy.

We present a patient who developed a gastric bezoar following extensive penetrating abdominal trauma. Bezoar pathogenesis, diagnosis, and endoscopic therapy are highlighted. Additionally, alternative therapeutic modalities are explored with a review of the literature. Combination endoscopic lavage fragmentation/extraction presents a safe method of bezoar resolution.

[Detection of erythrocyte antibodies using solid phase assays]. / Nachweis Erythrozytärer Antikörper mit Hilfe von Festphasenplatten.

The use of solid-phase assays for the detection of irregular antibodies facilitates automatization and rationalization in blood group serology. We compared the solid screen assay, (SP-assay, Biotest AG, Frankfurt, FRG) with conventional assays for antibody screening. The SP assay was as sensitive as the conventional indirect antibody test (IAT). Whereas only 4% of cold-reactive antibodies detected in enzyme tests showed positive results in the SP-assay, this test produced unspecific positive reactions in 7% of all tested sera. We found two additional antibodies with the SP-assay, not detectable in conventional techniques (anti-D, immune anti-A).