Anaesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta-analysis and trial sequential analysis.

BACKGROUND: Incorporating an additive into lidocaine is a method to enhance the efficacy of the inferior alveolar nerve block (IANB) in mandibular posterior teeth. OBJECTIVES: To assess the efficacy of incorporating additives into lidocaine in the success rate of IANB for teeth with the diagnosis of normal pulp (NP) or symptomatic irreversible pulpitis (SIP). METHODS: Randomized controlled trials (RCTs) assessing the incorporation of additives into lidocaine on the pulpal anaesthesia success rate of mandibular posterior teeth were searched in PubMed, Scopus, Web of Science, Ovid, EBSCO, Embase, and Cochrane databases up to 1 December 2021. The risk of bias (RoB) was assessed by the Cochrane Risk of Bias Tool. A random-effects model was employed to calculate the pooled risk ratio (RR) with a 95% confidence interval (CI), using STATA 16. The trial sequential analysis (TSA) was applied to calculate the required information size (RIS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of the evidence. RESULTS: Of 6966 records retrieved initially, 14 trials (8 for NP and 6 for SIP groups) were included in qualitative and quantitative syntheses. All trials were categorized as low and unclear RoB for NP and SIP groups, respectively. In the NP group, with 307 participants, no significant effect was observed for additives incorporated into lidocaine (RR: 0.84; 95% CI: 0.53-1.32; I2  = 98%). Subgroup analysis revealed that adding mannitol led to a higher success rate (RR = 1.24; 95% CI: 1.15-1.34; I2  = 7.16%). In the SIP group, with 434 participants, no significant effect was shown when the additives were incorporated (RR = 1.22; 95% CI: 0.98-1.52; I2  = 0%). Likewise, in subgroup analysis, incorporating mannitol or sodium bicarbonate demonstrated no significant effect (RR = 1.76; 95% CI: 0.93-3.32; I2  = 18.41% and RR = 1.06; 95% CI: 0.65-1.72; I2  = 53.5%, respectively). DISCUSSION: TSA revealed that the outcome was "inconclusive" for each group. The certainty of the evidence was graded as "very low" and "low" for NP and SIP groups, respectively. CONCLUSIONS: The very low to low certainty of evidence indicated that incorporating additives into lidocaine did not increase the efficacy of IANB and supplemental injections are still necessary to help practitioners achieve painless dentistry. REGISTRATION: PROSPERO database (CRD42020132585).

Meta-Analysis of Correlations between Altmetric Attention Score and Citations in Health Sciences.

INTRODUCTION: In recent years, several controversial reports of the correlation between altmetric score and citations have been published (range: -0.2 to 0.8). We conducted a meta-analysis to provide an in-depth statistical analysis of the correlation between altmetric score and number of citations in the field of health sciences. METHODS: Three online databases (Web of Science, Scopus, and PubMed) were systematically searched, without language restrictions, from the earliest publication date available through February 29, 2020, using the keywords "altmetric," "citation," and "correlation." Grey literature was also searched via WorldCat, Open Grey, and Google Scholar (first 100 hits only). All studies in the field of health sciences that reported on this correlation were included. Effect sizes were calculated using Fisher's z transformation of correlations. Subgroup analyses based on citation source and sampling methods were performed. RESULTS: From 27 included articles, 8 articles comprise several independent studies. The total sample size was 9,943 articles comprised of 35 studies. The overall pooled effect size was 0.19 (95% confidence interval 0.13 to 0.26). Bivariate partial prediction of interaction between effect size, citation source, and sampling method showed a greater effect size with Web of Science compared with Scopus and Dimensions. Egger's regression showed a marginally nonsignificant publication bias (p = 0.055), and trim-and-fill analysis estimated one missing study in this meta-analysis. CONCLUSION: In health sciences, currently altmetric score has a positive but weak correlation with number of citations (pooled correlation = 0.19, 95% C.I 0.12 to 0.25). We emphasize on future examinations to assess changes of correlation pattern between altmetric score and citations over time.

Altmetric Analysis of Contemporary Iranian Medical Journals.

BACKGROUND: Altmetrics is a newly emerging scholarly tool measuring online attention surrounding scientific research outputs. With respect to increasing demand of disseminating research findings on the World Wide Web, this study aims to analyze the altmetric statues of Iranian medical journals. METHODS: On February 27, 2019, the list of Iranian medical journals extracted from http://journals.research.ac.ir/ and consequently altmetric data token out from Altmetric database (Altmetric LLP, London, UK). The science mapping done via keyword co-occurrence, co-citation and co-authorship, network analysis using the VOSviewer. The Pearson coefficient was then employed for the correlation analysis using R. RESULTS: Among a total of 104 journals, 7518 articles were mentioned in Altmetric data resources (Mean: 72.28, Confidence Level (95.0%): 16.8), total mentions were 27577 (Mean: 265.16, Confidence Level (95.0%): 79.9). Considering the total mentions of articles, International Journal of Preventive Medicine achieved the first rank, followed by Journal of Research in Medical Sciences and Iranian Journal of Public Health. Notably, Twitter was the most popular altmetric resource followed by Facebook and news outlets. Tweets were generally from the United States and United Kingdom. Among top 5% popular Iranian medical articles multiple sclerosis, cancer, and anxiety was hot topics. CONCLUSIONS: Iranian biomedical journal editors and research scientists needs to be more dynamic in World Wide Web using social media, post-publication peer review tools, Stack Exchange (Q and A) sites, research highlight tools, Wikipedia, and etc. In spite, more attention to the concept of evidence-based policymaking, by Iranian government along with the health policymakers seems necessary.

Analysis of highly tweeted dental journals and articles: a science mapping approach.

Aim We aimed to rank dental journals according to the number of Twitter mentions related to their articles. We set out to analyse and visualise the bibliometric characteristics of highly tweeted articles.Methods Twitter mentions were extracted from the Altmetric database. Bibliometric data were obtained from the Web of Science and analysed by VOSviewer software. Hotspots among highly tweeted articles visualised by keyword co-occurrence network analysis. Bibliographic coupling network analysis was used to find the most influential journals, institutions and countries.Results A total of 20,520 Twitter accounts which shared 93,776 tweets related to 23,686 articles from 91 journals were analysed. The British Dental Journal had the highest number of Twitter mentions related to dental articles. Children, dental caries, and periodontal disease were the hottest topics among the 134 highly tweeted dental articles. @The_BDJ had the highest number of tweets related to dental articles, followed by @Dddent2 and @gary_takacs. @TheBDA had the highest number of followers, followed by @Dddent2 and @The_BDJ.Discussion Ground breaking issues such as genomic medicine, stem cells, tissue engineering, nanotechnology, and artificial intelligence were not seen among the highly tweeted dental articles. In the 'Twittersphere', some independent scientists are more active than well-known dental organisations and journals. The journals are strongly recommended to be proactive in Twittersphere, to set up their own Twitter profile, and to promote their visibility and social impact by immediately tweeting the articles. Researchers should be alert to the overuse of Twitter in scholarly communications. The Kardashian index will be a useful tool to measure the over/under activity of a researcher on Twitter.

Intra- and Postoperative Complications of Lateral Maxillary Sinus Augmentation in Smokers vs Nonsmokers: A Systematic Review and Meta-Analysis.

PURPOSE: This meta-analysis and systematic review focused on the following question: Does tobacco smoking increase the risk of intra- or postoperative complications of lateral maxillary sinus floor elevation? MATERIALS AND METHODS: The following electronic databases were searched up to and including November 2015 without language restriction: CENTRAL, MEDLINE, Google Scholar, Scopus, Sirous, and Doaj. Studies were included if rates of intra-or postoperative complications of sinus floor elevation in smokers and nonsmokers were recorded separately. The following complications were assessed: sinus membrane perforation, bleeding, wound dehiscence, wound infection, sinusitis, hematoma, and oroantral fistula. The Critical Appraisal Skills Programme was used to assess the risk of bias in included studies. Random-effects meta-analyses were used to assess the number of each complication in smokers and nonsmokers. RESULTS: Out of 929 eligible publications, 11 articles were included. Meta-analysis of the studies revealed a significantly increased risk of developing wound dehiscence after sinus floor elevation among smokers compared with nonsmokers (Risk Ratio [RR]: 7.82; 95% confidence interval [CI]: 2.38, 25.74; P = .0007). Moreover, risk of developing wound infection was greater in smokers when prospective studies were included in the meta-analysis (RR: 5.33; 95% CI: 1.34, 21.25; P = .02). However, the meta-analysis of included studies did not show significant differences between smokers and nonsmokers concerning risk of sinus membrane perforation and bleeding during sinus floor elevation (P = .46 and P = .33, respectively). CONCLUSION: Considering the lack of randomized controlled trials and the small number of included studies, the results indicate that smoking seems to be associated with increased risk of wound dehiscence and infection after the sinus augmentation procedure.

Chlorhexidine rinse for prevention of urethritis in men linked to oral sex.

BACKGROUND: Oral sex among teenagers is on the rise. Similarity between the oral flora and organisms recovered from nongonococcal urethritis and prostatitis, points to retrograde entry of bacteria from oral cavity into the urethra following insertive oral intercourse. PRESENTATION OF THE HYPOTHESIS: Chlorhexidine has a wide spectrum of anti-bactericidal activity encompassing gram positive and negative bacteria. It is also effective against HIV and HBV. It produced large and prolonged reductions in salivary bacterial counts within 7-h of its use. Hence, it would seem logic to postulate that rinsing with chlorhexidine before oral sex will be effective for prevention of retrograde entry of bacteria from oral cavity into the urethra. The recommendation for rinsing will be: 15 ml of a 0.12% or 10 ml of 0.2% chlorhexidine rinse for 30 seconds. Also other drug delivery systems such as chlorhexidine chewing gum or spray can be used. TESTING THE HYPOTHESIS: Men suffering from recurrent nongonococcal urethritis or prostatitis are good subjects for testing the hypothesis. They perform genital safe sex via consistent use of condom. Yet they generally received unprotected insertive oral intercourse. Chlorhexidine can be used for prevention of recurrences of the disease. IMPLICATIONS OF THE HYPOTHESIS: The chlorhexidine will be a new, easy, attractive and effective method for reduction of nongonococcal urethritis, prostatitis and epidydimitis following insertive oral intercourse. It is poorly absorbed from skin, mucosa and gastrointestinal tract indicating systemic safety of chlorhexidine. The agent does not cause any bacterial resistance and supra-infection.

Autotransplantation of cryopreserved minor salivary glands: a new approach for management of radiation-induced xerostomia.

To date, it still is impossible to successfully prevent radiation-induced xerostomia. Therefore, further research, particularly regarding treatment, is urgently warranted. Lower labial mucosa with its submucosal minor salivary glands (MSGs) of approximately 2.5 x 3 cm can be prepared by means of a surgical knife or Ellman Surgitron high-frequency/low-temperature radiosurgical device. Also we can consider area of the palatine fovea to find and remove MSGs. We can find locations containing more MSGs via scintigraphy techniques and positron emission tomography. Removing of MSGs can be done 1-2 weeks before start of radiotherapy. Subsequently the MSGs containing complex graft should be cryopreserved via liquid nitrogen for long-term storage. Autotransplantation surgery will be carried out 2-3 months after radiotherapy. The frozen tissue could be thawed rapidly in a 37 degrees C water bath for 2-3 min. Host site should be as far as possible to the radiation zone and has a good blood supply. Hyperbaric oxygen therapy (30 treatment sessions before and 10 sessions after re-implantation) is strongly recommended. An aggressive short or medium-term antibiotic treatment will necessary to avoid infection. Immunosuppressive treatment will not require. The main criticism with this hypothesis is viability and usefulness of MSGs containing graft, after being frozen and subsequently thawed.

Towards a proposal for assessment of blinding success in clinical trials: up-to-date review.

The CONSORT statement recommended that investigators should clearly report which key trial persons were blinded to treatment allocation and test for the success of blinding. Clinical researchers, however, more often than not overlook the assessment of the success of blinding. The severe under-reporting on the success of blinding may improve with awareness of existing quantitative methods. The two statistical methods, James' blinding index (BI) and Bang's BI, are currently available. Subjects could be asked to guess their treatment assignment, possibly with an option to express the degree of certainty. Assessments of blinding at various points may serve different purposes, i.e. to evaluate comparability between experimental versus control treatments before the trial by the third party; to examine further comparability and credibility of the control treatment and patients' expectation about treatment received in early stage of the trial, and to summarize the overall maintenance of the blinding success at the end of the trial. In this article, we review BIs and how to use these methods along with discussion of other issues in blinding assessment and reporting. We contend the two BIs that were independently developed but carry complementary properties would characterize blinding behaviours in clinical trials qualitatively as well as quantitatively, and may also shed some lights on the interpretation of the study findings. Finally we urge the Item 11b of the CONSORT statement to be revised to require the assessment/reporting of blinding success for all trials that adopt blinding schemes.

Towards tooth friendly soft drinks.

Most soft drinks contain high concentration of simple carbohydrates and have a pH of 3 or even lower. Therefore, they are harmful for tooth structure. A tooth friendly soft drink (T.F.S.D) should have the following characteristics and elements; fluoride (approximately 1 ppm), casein phosphopeptide-amorphous calcium phosphate (2%), xylitol (4-6g/serving), tea polyphenols (2-4 mg/ml), cranberry extract (250 mg/ml of the flavonoids quercetin and myricetin), sugar free, pH close to 5.5 and super oxygenation (240,000 ppm) vs. carbonation. T.F.S.D can be packaged in a container which gaseous oxygen is dissolved in a liquid in the form of bubbles. However, looking at opportunities for so-called sophisticated soft drinks, T.F.S.D will be an example for a functional and health oriented soft drink.

Bluetooth technology for prevention of dental caries.

Caries is caused when the pH at the tooth surface drops below 5.5. A miniaturized and autonomous pH monitoring nodes can be attached to the tooth surface, like a tooth jewel. This intelligent sensor includes three components: (a) digital micro pH meter, (b) power supply, (c) wireless communicating device. The micro pH meter facilitates long term tooth surface pH monitoring and providing real time feedback to the patients and dental experts. Power supply of this system will be microfabricated biocatalytic fuel cell (enzymatic micro-battery) using organic compounds (e.g. formate or glucose) as the fuel to generate electricity. When micro pH meter detects the pH lower than 5.5, wireless Bluetooth device sends a caution (e.g. "you are at risk of dental caries") to external monitoring equipment such as mobile phone or a hands-free heads. After reception of the caution, subjects should use routine brushing and flossing procedure or use a medicated chewing gum (e.g. chlorhexidine containing chewing gum) or rinse with a mouthwash.

Multiple-blind: Towards a new blinding protocol for future generations of clinical trials.

In this hypothesis we try to suggest a new blinding protocol acting as a gold standard for design and conduction of unbiased clinical trials. All of the following five categories of key trial persons should be blinded to treatment allocation: (a) participants, (b) healthcare providers, (c) data collectors, (d) outcome assessors and (e) data analysts. Furthermore, personnel writing the manuscript should be blinded through submission two drafts of a manuscript, with draft 1 written assuming that group A is the treatment group and draft 2 assuming that group B is the treatment group. Also, double-blind peer review procedure (in which the reviewers' and authors' names and affiliations are not disclosed to one another) should be carried out. Test of the success of blinding should be used. Participants, healthcare providers and data collectors, should be tested for the success of blinding in early stage of the trial and at the end of the trial. For outcome assessors, data analysts, manuscript writers and peer reviewers one test session in the end of their work is enough.

Microfabricated biocatalytic fuel cells: a new approach to accelerating the orthodontic tooth movement.

Direct electric current is a potent biologic mean to accelerate periodontal tissue turnover and orthodontic tooth movement. The main problem associated with this approach is the source of electricity. A noninvasive, removable enzymatic micro-battery, will administer minute electric currents to the alveolar bone and oral soft tissues, utilizing glucose as a fuel, becoming a possible source of the electrical power required for accelerating the velocity of orthodontic tooth movement.

Newly formulated chlorhexidine gluconate chewing gum that gives both anti-plaque effectiveness and an acceptable taste: a double blind, randomized, placebo-controlled trial.

OBJECTIVE: In previous investigations the chlorhexidine (CHX) chewing gums tasted unpleasant. The main problem with different CHX formulations is the high incompatibility of CHX with anionic compounds. The purpose of this study is to introduce a new formulation for CHX gum that gives both anti-plaque effectiveness and an acceptable taste. DESIGN: Randomized, double blind, placebo-controlled crossover trial, employing two 5-day trial periods without mechanical oral hygiene. PARTICIPANTS: 18 from 22 volunteer dental students (8 males, 10 females, mean age 22 +/- 2.3 years). INTERVENTION: Active gum, containing 10 mg CHX, and placebo were used for 20 min twice daily. A 7-day washout period between trial periods was used. MAIN OUTCOME MEASURES: Turesky modification of the Quigley and Hein index was used to assess plaque formation. Success of blinding was assessed at the second day of each test period. At the end of each test period, subjects were asked to evaluate the taste of the products used. RESULTS: CHX gum has a significantly higher anti-plaque effect than placebo (95% confidence interval 2.7865 to 3.5302, p < 0.0001). Subjects could not determine the study drug assignment by taste or otherwise (p = 0.6250). The difference between subjective evaluations of the taste of chewing gums was not significant (p = 0.5879). CONCLUSION: CHX can be successfully incorporated in a chewing gum-based delivery system for use as an adjunct to or even short-term replacement for mechanical plaque control. The observation period needs to be extended if this product is anticipated for longer-term use.

Rinsing with chlorhexidine gluconate solution after brushing and flossing teeth: a systematic review of effectiveness.

OBJECTIVE: The purpose of this study was to discuss the concept of delaying the use of chlorhexidine mouthrinse (CHX) until some time after the use of dentifrice. METHOD AND MATERIALS: Sources included 13 electronic databases, 7 international drug reference books, and the World Wide Web; references of all relevant papers; and further information requested from authors and organizations. Inclusion criteria were a predefined hierarchy of evidence. Study validity was assessed with checklists. Two reviewers independently screened sources, extracted data, and assessed validity. RESULTS: CHX, a cation, interacts and forms salts of low solubility and antibacterial activity with anions, such as sodium lauryl sulfate (SLS) and sodium monofluorophosphate (MFP). CHX and MFP are not compatible in clinically relevant concentrations in vitro. A 30-minute interval between SLS and CHX rinsing gave a significantly reduced antiplaque effect of CHX, whereas after 2 hours the neutralizing effect of SLS disappeared. Rinsing with dentifrice slurry and CHX produced a significantly increased plaque score compared to CHX and water. In regard to tooth staining by CHX mouthrinses, use of dentifrice before CHX showed a reduction in staining of 18%, whereas CHX followed by dentifrice showed a reduction in staining of about 79%. Literature relating to this interaction is limited; more controlled microbiologic and clinical studies are needed to certify the inaccuracy of this modality of administration. CONCLUSION: To optimize the antiplaque effect of CHX, it seems best that the interval between toothbrushing and rinsing with CHX be more than 30 minutes, cautiously close to 2 hours after brushing.

Systemic toxicity following ingestion of the chlorhexidine gluconate solution: a case report.

The purpose of this article is to discuss possible adverse effects and emergency treatments following the ingestion of chlorhexidine (CHX). In this case a dental student (age 25, male) accidentally swallowed one shot of 20% CHX solution, which is equal to 100 shots of the standard 0.2% CHX mouthwash. Clinical emergency treatment included: washing the oral cavity with 30 g of toothpaste, drinking 100 ml of 5% (w/v) alginate syrup and ingestion of 5 g of cork. The following adverse effects were experienced: headache, euphoria, giddiness, blurred vision (duration = 12 h), stomachache, gastric lavage with demulcents (duration = 24 h) and complete loss of taste sensation (duration = 8 h), which recurred during the next 48 h. No change in plasma aminotransferase level was seen. We used basic chemical information about the incompatibilities of CHX for clinical management of unintentional ingestion. It is known that CHX is a cation, and, therefore, first aid in case of intoxication with CHX involves using anionic materials.