Evaluation of cardiovascular risk factors in long-term survivors of adult- and childhood-onset brain tumours: a pilot study.

Background: Survivors of childhood brain tumours (SCBT) and teenage and young adult cancer survivors have an adverse cardiovascular risk profile, which translates into an increased vascular mortality. Data on cardiovascular risk profiles in SCBT are limited, and furthermore, there are no data in adult-onset (AO) brain tumours. Patients and: methods: Fasting lipids, glucose, insulin, 24-h blood pressure (BP), and body composition were measured in 36 brain tumour survivors (20 AO; 16 childhood-onset (CO)) and 36 age- and gender-matched controls. Results: Compared with controls, patients had elevated total cholesterol (5.3 ± 1.1 vs 4.6 ± 1.0 mmol/L, P = 0.007), LDL-C (3.1 ± 0.8 vs 2.7 ± 0.9 mmol/L, P = 0.011), insulin (13.4 ± 13.1 vs 7.6 ± 3.3 miu/L, P = 0.014), and increased insulin resistance (homeostatic model assessment for insulin resistance (HOMA-IR) 2.90 ± 2.84 vs 1.66 ± 0.73, P = 0.016). Patients showed adverse body composition, with increased total body fat mass (FM) (24.0 ± 12.2 vs 15.7 ± 6.6 kg, P < 0.001) and truncal FM (13.0 ± 6.7 vs 8.2 ± 3.7 kg, P < 0.001). After stratification by timing of onset, CO survivors showed significantly increased LDL-C, insulin, and HOMA-IR compared with controls. Body composition was characterized by the increased total body and truncal FM. Truncal fat mass was increased by 84.1% compared with controls. AO survivors showed similar adverse cardiovascular risk profiles, with increased total cholesterol and HOMA-IR. Truncal FM was increased by 41.0% compared with matched controls (P = 0.029). No difference in mean 24-h BP was noted between patients and controls irrespective of the timing of cancer diagnosis. Conclusion: The phenotype of both CO and AO brain tumour survivors is characterized by an adverse metabolic profile and body composition, putatively placing long-term survivors at increased risk of vascular morbidity and mortality.

Can probiotics stop oral cancer progression?

Data sources Four electronic databases (PubMed, Web of Science, Scopus and PLOS) were queried to identify studies that investigated the effects of probiotics against oral cancer, published in the English language between January 2015 and February 2020.Study selection Randomised controlled trials (RCT) including in vivo and in vitro studies that evaluated the effects of probiotics against oral cancer were included.Data extraction and synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) 2015 guidelines were followed to conduct this systematic review. Screening of titles, abstracts and full texts was done independently by four authors with disagreements resolved by mutual discussion. Individual studies' year, author, country, as well as strain of probiotics, type of sample, mechanisms of probiotics and outcomes, were analysed by two authors. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools (Checklist for Randomised Controlled Trial) by three authors. Meta-analysis was performed with Review Manager software, Version 5.3 and results were reported in odds ratio. Inconsistency test (I2) was used to examine the heterogeneity between studies.Results From an initial 774 articles, only five met the study eligibility criteria to be included in this review. Two studies used in vivo animal models and three studies conducted in vitro experiments using cancer and normal cell lines. There were no studies on humans. Four probiotics were reported to inhibit oral carcinogenesis; namely, Acetobacter syzygii (A. syzygii), Lactobacillus plantarum (L. plantarum), Lactobacillus salivarius (L. salivarius) Ren and AJ2 (combination of Streptococcus thermophiles, Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus casei, Lactobacillus bulgaricus). Two studies that used L. salivarius Ren were combined quantitatively in a meta-analysis which showed 95% reduction of risk in oral cancer development (OR = 0.05, 95% CI 0.01-0.23; p <0.05).Conclusions Within the limitations of in vivo (animal) and in vitro (cell lines) studies, the authors concluded that the probiotics analysed in this review, especially L. salivarius Ren, seem to play a role in oral cancer inhibition.

Common Dental and Periodontal Diseases.

Oral health is a critical component of overall health and well-being. Dental caries and periodontitis are two of the most common oral diseases and, when not treated, can have irreversible sequelae and overall psychosocial and physiologic impact on individuals, diminishing quality of life. The burden of advanced dental caries and periodontal disease leading to tooth loss is severe. Physicians and allied medical professionals can help in early detection of dental caries, abscess, and periodontal diseases and initiate management followed by prompt referral to dental colleagues.

Implementation science and periodontal practice: Translation of evidence into periodontology.

The advent of evidence-based practice in the 1990s led to the development of processes and resources to support the use of high-quality research in the provision of health care. As the evidence-based approach to health care continues to evolve, it has become apparent that mere creation and access to scientific knowledge is not sufficient to facilitate its routine adoption in health care. Throughout any health care system, there are inherent barriers preventing the adoption and routine use of new evidence in patient care. These barriers include provider-level factors, such as knowledge and access to new evidence, as well as each provider's attitudes and beliefs around adopting and applying the evidence with their patients. Importantly, there are also health care system-level barriers that, even among willing providers, prevent the easy adoption of new evidence and routine application in patient care. In addition to barriers, there are facilitators that help promote adoption of evidence into practice. Understanding and addressing barriers and facilitators to promote adoption of evidence into practice has led to the growth of a new field known as implementation science. Successful application of implementation science in all areas of health care, including periodontology, will help bridge the gap between what are known from clinical research to be effective treatments and what treatments should be applied routinely in clinical practice. This article reviews key concepts in implementation science and how its application in periodontology can facilitate the translation of high-quality evidence into routine periodontal practice and improved patient outcomes.

Management of Cyclosporine-Influenced Gingival Enlargement With Azithromycin.

INTRODUCTION: Management of drug-influenced gingival enlargement is challenging, and surgery is most often indicated. However, because of a unique mechanism of action, azithromycin helps in the management of gingival enlargement caused by cyclosporine. An incidental observation of the effect of azithromycin in the cyclosporine-influenced gingival enlargement by physicians in 1995 led to series of basic investigations and clinical trials confirming this observation and providing a non-surgical treatment modality. CASE PRESENTATION: In this report, successful management of cyclosporine-influenced gingival enlargement in a 39-year-old renal transplant patient with the use of azithromycin without any surgical intervention is presented. CONCLUSION: Use of azithromycin for managing cyclosporine-influenced gingival enlargement is a useful alternative or adjunct to surgical management. It is hoped that this report will raise further awareness of this non-surgical modality in patients taking cyclosporine.

Reflective Journaling by Second-Year Dental Students During a Clinical Rotation.

Reflection involves taking the time to deeply consider a past situation and examine areas of weakness or confusion. It allows identification of learning needs and the development of an action plan to improve future experiences. The aim of this study was to assess second-year dental students' ability to reflect in writing on a clinical rotation when prompted with a guided reflection template. The 76 second-year dental students enrolled in a periodontics clinical rotation course at one U.S. dental school in 2016-17 completed two reflective writing exercises during the semester. A total of 144 journals (after excluding incomplete journals) were analyzed individually by two evaluators following a rubric developed by Kember. This rubric combined Mezirow's seven levels of reflection into four categories: Habitual Action (HA), Understanding (U), Reflection (R), and Critical Reflection (CR). The first two categories are examples of non-reflective thoughts, and the latter two are reflective. The two sets of journals were also compared. On average, the journals contained 0.2% HA, 15.9% U, 73.8% R, and 10.1% CR, averaging 16.1% non-reflective thoughts and 83.9% reflective thoughts. Comparison of the students' first journal submissions to their second showed that the first journals averaged a higher percentage of reflective thought than the second journals: 85.2% vs. 82.7%, respectively. However, the first journals showed a lower average percentage of critical reflection than the second journals: 9.3% vs. 11.3%, respectively. Overall, a high degree of reflection was found in these students' journals after rotation in periodontics clinic, suggesting that reflective journaling can serve as a useful learning exercise to promote continual improvement during clinical training.

Spin in abstracts of randomized controlled trials in dentistry: A cross-sectional analysis.

BACKGROUND: Spin in randomized controlled trial (RCT) abstracts can misguide clinicians. In this cross-sectional analysis, the authors assessed the prevalence of spin in RCT abstracts and explored the factors potentially influencing it. METHODS: In this cross-sectional analysis, the authors conducted a systematic search in top 10 dental journals based on Eigenfactor score and selected RCTs published in 2015 with statistically nonsignificant primary outcomes. The dentistry disciplines covered in these journals include general dentistry, dental research, oral implantology, endodontics, oral surgery, periodontology, and oral oncology. In these RCT abstracts, the authors assessed the prevalence of 3 different categories of spin and factors that could influence its presence using the t test and χ2 test. RESULTS: Spin assessment performed in the included 75 RCTs revealed the existence of spin in 23 abstracts (30.7%). Associations between the presence of spin in abstracts and the variables international collaborations, commercial support type, number of treatment arms, and journal impact factor were found to be statistically nonsignificant (P ≥ .05). CONCLUSIONS: Approximately one-third of the 75 RCT abstracts published in high-impact dental journals in 2015 with nonsignificant outcomes presented with some form of spin, irrespective of funding type and journal impact factor. PRACTICAL IMPLICATIONS: Clinicians should be aware of the potential existence of spin in abstracts and be diligent in reading and appraising the full trial before incorporating its recommendations in clinical practice.