Prediction Models for Oral Health-Related Quality of Life in Patients with Temporomandibular Joint Osteoarthritis 1 and 6 Months After Arthrocentesis with Hyaluronic Acid Injections.

AIMS: To develop models for prognostic prediction of oral health-related quality of life (OHRQoL) for patients with temporomandibular joint osteoarthritis (TMJ OA) at 1- and 6-month follow-ups after arthrocentesis treatment with hyaluronic acid (HA) injections once a week for 4 weeks. METHODS: From a cohort of 522 adult patients with TMJ OA treated with arthrocentesis with HA injections, 510 and 463 adult patients were included in the 1- and 6-month follow-ups, respectively. Patient characteristics and history, clinical examinations, and questionnaires were recorded as potential predictors at start of treatment, and all patients underwent an identical treatment protocol. Patients' OHRQoL values at 1 and 6 months after completing the treatment were used as outcome measures. Logistic regression methods were used to develop prediction models, and the performance and validity of these models were evaluated according to state-of-the-art methods, including receiver-operating characteristics curve for the discrimination of the models and calibration plots for the calibration of the models. RESULTS: History of mental disease, maximal protrusion of the jaw, muscular pain with palpation, joint pain with palpation, awake bruxism, chewing-side preference, and low OHRQoL at baseline were significantly associated with OHRQoL at the 1-month follow-up, while age, pain in other joints, history of mental disease, joint pain with palpation, sleep bruxism, awake bruxism, chewing-side preference, and low OHRQoL at baseline were significantly associated with OHRQoL at the 6-month follow-up. While the performance of both models was found to be good in terms of calibration, discrimination, and internal validity, the added predictive values of the 1-month and 6-month models for ruling in the risk of low OHRQoL were 19% and 31%, respectively, while those for ruling it out were 28% and 15%, respectively. CONCLUSION: Several predictors were found to be significantly associated with patients' OHRQoL after treatment. Both prediction models may be reliable and valid for clinicians to predict a patient's risk of low OHRQoL at follow-up, so the models may be useful for clinicians in decision-making for patient management and for informing the patient.

Clinical Outcome of Sodium Hyaluronate Injection into the Superior and Inferior Joint Space for Osteoarthritis of the Temporomandibular Joint Evaluated by Cone-Beam Computed Tomography: A Retrospective Study of 51 Patients and 56 Joints.

BACKGROUND The aim of this study was to determine the clinical effects of sodium hyaluronate injection into the superior and inferior joint space for osteoarthritis of the temporomandibular joint (TMJ) and to evaluate the joint changes using cone-beam computed tomography (CBCT). MATERIAL AND METHODS A retrospective observational clinical study included 51 patients and 56 TMJs, with a diagnosis of osteoarthritis. All patients received sodium hyaluronate injections into the superior and inferior TMJ joint spaces (articular cavities). At baseline and post-treatment the condylar bony changes were evaluated by CBCT. To evaluate TMJ function, maximum mouth opening (MMO), and Helkimo's index was used, which included an anamnestic index (Ai) and a clinical dysfunction index (Di). Patients were divided into short-term (one year) follow-up groups. RESULTS In both patient follow-up groups, sodium hyaluronate injection of the superior and inferior TMJ space significantly improved MMO, the Ai, and the Di (P<0.05). There were no significant differences between the two groups in condylar bony changes of the TMJ seen by CBCT (sclerosis, erosion, hyperplasia, and flattening) (P>0.05). CBCT showed a good predictive ability on post-treatment symptom relief following sodium hyaluronate injection into the superior and inferior TMJ space in patients with osteoarthritis of the TMJ (P=0.024). CONCLUSIONS The findings of this clinical and CBCT imaging study showed that sodium hyaluronate injection into the superior and inferior TMJ space in patients with osteoarthritis improved clinical symptoms, but did not control the progression of osteoarthritic joint destruction.

Glucosamine oral administration as an adjunct to hyaluronic acid injection in treating temporomandibular joint osteoarthritis.

OBJECTIVE: To investigate the therapeutic effect of oral glucosamine (GS) as an adjunct to hyaluronic acid (HA) injection on patients with temporomandibular joint osteoarthritis (TMJ OA). METHODS: In this clinical trial, 136 participants, diagnosed as TMJ OA clinically and radiographically, were enrolled and randomized into two groups (group GS + HA: oral GS + HA injection; group placebo + HA: oral placebo + HA injection). Pain, maximum interincisal mouth opening (MMO), the levels of IL-1ß, IL-6, and TGF-ß in TMJ synovial were defined as the outcome measurements and conducted before operation, and at 1-month and 1-year follow-up. RESULTS: In both groups, pain scores were decreased and MMOs were increased at 1-month and 1-year follow-up, the changes at 1-year follow-up showed statistically significant intergroup differences. At 1-month follow-up, only IL-6 concentration was lower in group GS + HA than that in group placebo + HA. One year later, TGF-ß concentration was higher and IL-6 and IL-1ß concentrations were lower in group GS + HA than those in group placebo + HA. CONCLUSIONS: Both strategies alleviated symptoms in short term, but the patients treated with GS benefited more than those with placebo in long term, which may be due to the suppression of IL-1ß and IL-6 and the stimulation of TGF-ß.

Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis.

BACKGROUND: There is an association between chronic periodontitis and cardiovascular disease (CVD). However, it is not known whether periodontal therapy could prevent or manage CVD in patients with chronic periodontitis. OBJECTIVES: The objective of this systematic review was to investigate the effects of periodontal therapy in preventing the occurrence of, and management or recurrence of, CVD in patients with chronic periodontitis. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 31 August 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 7), MEDLINE Ovid (1946 to 31 August 2017), Embase Ovid (1980 to 31 August 2017) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL EBSCO) (1937 to 31 August 2017) . The US National Institutes of Health Trials Registry (ClinicalTrials.gov), the World Health Organization International Clinical Trials Registry Platform and Open Grey were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.We also searched the Chinese BioMedical Literature Database (1978 to 27 August 2017), the China National Knowledge Infrastructure (1994 to 27 August 2017), the VIP database (1989 to 27 August 2017) and Sciencepaper Online (2003 to 27 August 2017). SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs were considered eligible. Studies were selected if they included patients with a diagnosis of chronic periodontitis and previous CVD (secondary prevention studies) or no CVD (primary prevention studies); patients in the intervention group received active periodontal therapy compared to maintenance therapy, no periodontal treatment or another kind of periodontal treatment in the control group. DATA COLLECTION AND ANALYSIS: Two review authors carried out the study identification, data extraction and risk of bias assessment independently and in duplicate. Any discrepancies between the two authors were resolved by discussion or with a third review author. A formal pilot-tested data extraction form was adopted for the data extraction, and the Cochrane tool for risk of bias assessment was used for the critical appraisal of the literature. MAIN RESULTS: No studies were identified that assessed primary prevention of CVD in people with periodontitis. One study involving 303 participants with ≥ 50% blockage of one coronary artery or a coronary event within three years, but not the three months prior, was included. The study was at high risk of bias due to deviation from the protocol treatment allocation and lack of follow-up data. The trial compared scaling and root planing (SRP) with community care for a follow-up period of six to 25 months. No data on deaths (all-cause or CVD-related) were reported. There was insufficient evidence to determine the effect of SRP and community care in reducing the risk of CVD recurrence in patients with chronic periodontitis (risk ratio (RR) 0.72; 95% confidence interval (CI) 0.23 to 2.22; very low quality evidence). The effects of SRP compared with community care on high-sensitivity C-reactive protein (hs-CRP) (mean difference (MD) 0.62; -1.45 to 2.69), the number of patients with high hs-CRP (RR 0.77; 95% CI 0.32 to 1.85) and adverse events (RR 9.06; 95% CI 0.49 to 166.82) were also not statistically significant. The study did not assess modifiable cardiovascular risk factors, other blood test results, heart function parameters or revascularisation procedures. AUTHORS' CONCLUSIONS: We found very low quality evidence that was insufficient to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis. No evidence on primary prevention was found.

Rubber dam isolation for restorative treatment in dental patients.

BACKGROUND: Successful restorations in dental patients depend largely on the effective control of moisture and microbes during the procedure. The rubber dam technique has been one of the most widely used isolation methods in dental restorative treatments. The evidence on the effects of rubber dam usage on the longevity of dental restorations is conflicting. Therefore, it is important to summarise the available evidence to determine the effects of this method. OBJECTIVES: To assess the effects of rubber dam isolation compared with other types of isolation used for direct and indirect restorative treatments in dental patients. SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health's Trials Register (searched 17 August 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 7) in the Cochrane Library (searched 17 August 2016), MEDLINE Ovid (1946 to 17 August 2016), Embase Ovid (1980 to 17 August 2016), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 17 August 2016), SciELO BIREME Virtual Health Library (1998 to 17 August 2016), Chinese BioMedical Literature Database (CBM, in Chinese) (1978 to 30 August 2016), VIP (in Chinese) (1989 to 30 August 2016), and China National Knowledge Infrastructure (CNKI, in Chinese) (1994 to 30 August 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform, OpenGrey and Sciencepaper Online (in Chinese) for ongoing trials. There were no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (including split-mouth trials) assessing the effects of rubber dam isolation for restorative treatments in dental patients. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. We resolved disagreement by discussion. MAIN RESULTS: We included four studies that analysed 1270 participants (among which 233 participants were lost to follow-up). All the included studies were at high risk of bias. We excluded one trial from the analysis due to inconsistencies in the presented data.The results indicated that dental restorations had a significantly higher survival rate in the rubber dam isolation group compared to the cotton roll isolation group at six months in participants receiving composite restorative treatment of non-carious cervical lesions (risk ratio (RR) 1.19, 95% confidence interval (CI) 1.04 to 1.37, very low-quality evidence). It also showed that the rubber dam group had a lower risk of failure at two years in children undergoing proximal atraumatic restorative treatment in primary molars (hazard ratio (HR) 0.80, 95% CI 0.66 to 0.97, very low-quality evidence). One trial reported limited data showing that rubber dam usage during fissure sealing might shorten the treatment time. None of the included studies mentioned adverse effects or reported the direct cost of the treatment, or the level of patient acceptance/satisfaction. There was also no evidence evaluating the effects of rubber dam usage on the quality of the restorations. AUTHORS' CONCLUSIONS: We found some very low-quality evidence, from single studies, suggesting that rubber dam usage in dental direct restorative treatments may lead to a lower failure rate of the restorations, compared with the failure rate for cotton roll usage. Further high quality research evaluating the effects of rubber dam usage on different types of restorative treatments is required.

[Application of peer-assisted learning in evidence-based dentistry teaching].

PURPOSE: To explore the effects of peer-assisted learning (PAL) for evidence-based dentistry (EBD) teaching. METHODS: Four hundred and eleven students who attended EBD class were randomly classified into PAL group (n=75) and traditional teaching group (n=326) via a ratio of 1:5. Students in traditional teaching group received traditional theoretical teaching; while PAL group received traditional theoretical teaching and group study with tutors introduced and finished study protocols given by the teachers. Teaching effects were evaluated by final examinations, questionnaires and published articles via bibliographic searching. Statistical analysis was carried out with STATA 11.0 software package. RESULTS: In the final examination, students in PAL group had 6.9 higher scores than traditional teaching group (P<0.05). The results of questionnaires showed that students in PAL group had higher interests and contentments in EBD class (P<0.05), and PAL had positive effects on their usage of EBD methodology and involvement in EBD research (P<0.05). In publication of articles, the number and ratios of article publication in PAL group were significantly higher than the traditional group (P<0.05). CONCLUSIONS: PAL has positive effects on EBD teaching.

Interventions for the treatment of Frey's syndrome.

BACKGROUND: Frey's syndrome is a rare disorder, the symptoms of which include sweating, flushing and warming over the preauricular and temporal areas following a gustatory stimulus. It often occurs in patients who have undergone parotidectomy, submandibular gland surgery, radical neck dissection, infection and traumatic injury in the parotid region, and is caused by the aberrant regrowth of facial autonomic nerve fibres. Currently there are several options used to treat patients with Frey's syndrome; for example, the topical application of anticholinergics and antiperspirants, and the intradermal injection of botulinum toxin. It is uncertain which treatment is most effective and safe. OBJECTIVES: To assess the efficacy and safety of different interventions for the treatment of Frey's syndrome. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; ICTRP and additional sources for published and unpublished trials. The date of the search was 28 April 2014. SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials (RCTs) in participants diagnosed with Frey's syndrome using a clinical standard such as Minor's starch-iodine test. We planned to include trials in which participants received any intervention versus no treatment (observation) or an alternative intervention, with or without a second active treatment. Our primary outcome measures were success rate (as assessed clinically by Minor's starch-iodine test, the iodine-sublimated paper histogram method, blotting paper technique or another method) and adverse events. Our secondary outcome measure was success rate as assessed by patients (disappearance or improvement of symptoms). DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We identified no RCTs or quasi-RCTs that fulfilled the inclusion criteria. Our searches retrieved eight potentially relevant studies, but after assessment of the full-text reports we excluded all of them due to the absence of randomisation or because the patients did not have Frey's syndrome. We excluded one randomised controlled trial that compared two different doses of botulinum toxin in patients with Frey's syndrome because the comparator was not an alternative treatment. AUTHORS' CONCLUSIONS: We are unable to establish the efficacy and safety of the different methods used for the treatment of Frey's syndrome.RCTs are urgently needed to assess the effectiveness of interventions for the treatment of Frey's syndrome. Future RCTs should include patients with Frey's syndrome of different ranges of severity and report these patients separately. Studies should investigate all possibly effective treatments (such as anticholinergics, antiperspirants and botulinum toxin) compared to control groups using different treatments or placebo. Subjective assessment of Frey's syndrome should be considered as one of the outcome measures.

A survey on oral care practices for ventilator-assisted patients in intensive care units in 3A hospitals of mainland China.

Oral hygiene is a critical element of patient care, particularly among patients who need ventilator-assisted equipment. The objective of this study was to explore the current status of oral care practices, attitudes, education and knowledge among intensive care unit (ICU) nurses caring for ventilator-assisted patients in 3A hospitals in mainland China. To achieve this aim, an 18-item self-assessment questionnaire was mailed to head ICU nurses in 189 Grade 3A hospitals. Additional data were collected through in-person interviews at 38 ICUs throughout Sichuan, Shanxi, Jiangsu provinces, as well as Chongqing and Beijing. We found that most ICUs conducted oral examinations at patient admission, and that this care was largely provided by nurses. The most common oral care methods were foam swabs and mouth rinse containing antibiotics or disinfectants. Although the majority of ICUs provided continuing training for oral care, and most training was conducted by head nurses, the content and scope of training were not consistent among the hospitals in the study. The most popular sources of oral care knowledge were academic journals, Internet and professional books. Overall, it is clear that an evidence-based oral care standard manual is urgently needed for oral practice in ICUs in mainland China.

[Study on the influence of psychological factors in developing manifestations of temporomandibular disorders].

PURPOSE: To determine whether psychological factors be a risk of temporomandibular disorders (TMDs) or not. METHODS: A case-control study was carried out in 100 patients with TMD and 100 controls without TMD. A self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used as the instruments to evaluate tendencies of anxiety and depression. The suspected confounding factors such as habit of eating hard food, chewing on one side, knocking teeth, night bruxism and history of extraction of teeth were also recorded. The data were analyzed by using Stata 11.0 software package to estimate risk strength of the psychological factors and confounding factors in occurrence of TMD. The cut point of significance was set up at 0.05. RESULTS: The mean scores of SAS and SDS of TMD group were significantly higher than those of control group (P<0.05).The trend tests of OR in SAS and SDS were both reaching to a significant level. The logistic analysis showed that only SAS and lateral chewing are significant risk factors of TMD (P<0.05). CONCLUSIONS: Tendencies of anxiety and depression are the significant risk factors related to TMD. However, when confounding factor such as chewing on one side exists, only tendency of anxiety remains a significant risk of TMD.

Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis.

BACKGROUND: There is an association between chronic periodontitis and cardiovascular disease (CVD). However, it is not known whether periodontal therapy could prevent or manage CVD in patients with chronic periodontitis. OBJECTIVES: The objective of this systematic review was to investigate the effects of periodontal therapy in preventing the occurrence of, and management or recurrence of, CVD in patients with chronic periodontitis. SEARCH METHODS: The electronic databases that were searched were the Cochrane Oral Health Group's Trials Register (to 7 April 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 3), MEDLINE via OVID (1946 to 7 April 2014), EMBASE via OVID (1980 to 7 April 2014), CINAHL via EBSCO (1937 to 7 April 2014), OpenGrey (to 7 April 2014), the Chinese BioMedical Literature Database (1978 to April 2014), the China National Knowledge Infrastructure (1994 to April 2014) and the VIP database (1989 to April 2014). We searched the US National Institutes of Health Trials Register, the World Health Organization (WHO) Clinical Trials Registry Platform and Sciencepaper Online for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs were considered eligible. Studies were selected if they included patients with a diagnosis of chronic periodontitis and previous CVD (secondary prevention studies) or no CVD (primary prevention studies); patients in the intervention group received active periodontal therapy compared to maintenance therapy, no periodontal treatment or another kind of periodontal treatment in the control group. DATA COLLECTION AND ANALYSIS: Two review authors carried out the study identification, data extraction and risk of bias assessment independently and in duplicate. Any discrepancies between the two authors were resolved by discussion or with a third review author. A formal pilot-tested data extraction form was adopted for the data extraction, and the Cochrane Collaboration's tool for risk of bias assessment was used for the critical appraisal of the literature. MAIN RESULTS: No studies were identified that assessed primary prevention of CVD in people with periodontitis. One study involving 303 participants with ≥ 50% blockage of one coronary artery or a coronary event within three years, but not the three months prior, was included. The study was at high risk of bias due to deviation from the protocol treatment allocation and lack of follow-up data. The trial compared scaling and root planing (SRP) with community care for a follow-up period of six to 25 months. No data on deaths (all-cause or CVD-related) were reported. There was insufficient evidence to determine the effect of SRP and community care in reducing the risk of CVD recurrence in patients with chronic periodontitis (risk ratio (RR) 0.72; 95% confidence interval (CI) 0.23 to 2.22; very low quality evidence). The effects of SRP compared with community care on high-sensitivity C-reactive protein (hs-CRP) (mean difference (MD) 0.62; -1.45 to 2.69), the number of patients with high hs-CRP (RR 0.77; 95% CI 0.32 to 1.85) and adverse events (RR 9.06; 95% CI 0.49 to 166.82) were also not statistically significant. The study did not assess modifiable cardiovascular risk factors, other blood test results, heart function parameters or revascularisation procedures. AUTHORS' CONCLUSIONS: We found very low quality evidence that was insufficient to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis. No evidence on primary prevention was found.

Correlation between bony changes measured with cone beam computed tomography and clinical dysfunction index in patients with temporomandibular joint osteoarthritis.

OBJECTIVES: To investigate the correlation between clinical dysfunction index (Di) and condylar bony changes, glenoid fossa bony changes and joint space changes. METHODS: Clinical data and cone beam computed tomography (CBCT) images of 240 patients with temporomandibular joint osteoarthritis (TMJ OA) were analyzed. The patients were assigned a score of Helkimo's clinical Di ranging from 1 to 25 and thereafter divided into 3 groups by the degree of Helkimo's Di. The condylar bony changes observed with CBCT were graded by the classification method of Koyama et al. Glenoid fossa bony changes and joint space changes were both classified as "positive" or "negative". Spearman's rank correlation test was used to correlate the score or degree of Helkimo's Di with the maximum condylar bony changes, glenoid fossa bony changes, and joint space changes. RESULTS: There was a significant correlation between the Helkimo's Di score and the maximum condylar bony changes (P ≤ 0.0001) and glenoid fossa bony changes (P ≤ 0.0001), and there was a poor correlation between the Helkimo's Di score and joint space changes (P = 0.184). Furthermore, there was a significant correlation between the degree of Helkimo's Di and the maximum condylar bony changes (P ≤ 0.0001) and glenoid fossa bony changes (P ≤ 0.0001), but there was a poor correlation between the degree of Helkimo's Di and joint space changes (P = 0.346). CONCLUSIONS: Both the score and degree of Helkimo's Di were highly correlated with maximum condylar changes and glenoid fossa bony changes, but not with joint space changes.

Evaluation of arthrocentesis with hyaluronic acid injection plus oral glucosamine hydrochloride for temporomandibular joint osteoarthritis in oral-health-related quality of life.

OBJECTIVES: To evaluate the changes in oral-health-related quality of life (OHRQoL) in patients with temporomandibular joint osteoarthritis (TMJ-OA) who underwent five weekly hyaluronic acid injections together with oral glucosamine hydrochloride for three months. MATERIALS AND METHODS: This prospective observational study included 211 consecutive patients who completed the Chinese version of the 14-item Oral Health Impact Profile (OHIP-C14) before treatment (T0), and at first month (T1), third month (T2), and sixth month (T3) after the first injection. RESULTS: Significant changes in the summary scores on OHIP-C14 were observed during follow-up (P < 0.001). The scores were significantly reduced at T1, T2, and T3 compared with T0 (P < 0.001), and were significantly reduced from T0 to T1 (P < 0.001) and T1 to T2 (P < 0.001), but not from T2 to T3 (P = 0.369). Compared with the norms, the scores were significantly higher at T0 (P < 0.001), not significantly different at T1 (P = 0.482), and significantly lower at T2 (P = 0.013) and T3 (P = 0.003). The changes in the scores differed significantly among age groups (P = 0.012) but not between sexes (P = 0.293). CONCLUSIONS: TMJ-OA has a negative effect on patient OHRQoL. OHRQoL scores were improved to normal levels in both the short and long terms after therapy. OHRQoL improvement was the greatest in the youngest group, but did not differ between the sexes.

Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta-analysis of randomised controlled trials.

The objective of the study was to assess the efficacy and safety of mepivacaine compared with lidocaine used in local anaesthesia in dentistry. Medline, Cochrane Central Register of Controlled Trials, EMBASE, Chinese BioMedical Literature Database, China National Knowledge Infrastructure and WHO International Clinical Trials Registry Platform were searched electronically. Relevant journals and references of studies included were hand-searched for randomised controlled trials comparing mepivacaine with lidocaine in terms of efficacy and safety. Twenty-eight studies were included, of which 15 had low risk of bias and 13 had moderate risk of bias. In comparison with 2% lidocaine with 1:100,000 adrenaline, 3% mepivacaine showed a lower success rate (P = 0.05), a shorter onset time of pulpal anaesthesia (P = 0.0005), inferior pain control during injection phase and superior inhibition of heart rate increase (P < 0.0001). In contrast, 2% mepivacaine with 1:100,000 adrenaline gave a higher success rate (P < 0.00001), a similar onset time of pulpal anaesthesia (P = 0.34) and superior pain control during injection phase (P < 0.0001); 2% mepivacaine with 1:20,000 levonordefrin had the same success rate (P = 0.69) and similar onset time of pulpal anaesthesia (P = 0.90). In addition, 3% mepivacaine had shorter onset time (P = 0.004), same level of success rate (P = 0.28) and similar pain control during injection and postinjection compared with 2% lidocaine with 1:50,000 adrenaline. Given the efficacy and safety of the two solutions, 2% mepivacaine with vasoconstrictors is better than 2% lidocaine with vasoconstrictors in dental treatment. Meanwhile, 3% plain mepivacaine is better for patients with cardiac diseases.

Interventions for managing relapse of the lower front teeth after orthodontic treatment.

BACKGROUND: Orthodontic relapse can be defined as the tendency for teeth to return to their pre-treatment position, and this occurs especially in lower front teeth (lower canines and lower incisors). Retention, to maintain the position of corrected teeth, has become one of the most important phases of orthodontic treatment. However, 10 years after the completion of orthodontic treatment, only 30% to 50% of orthodontic patients effectively retain the satisfactory alignment initially obtained. After 20 years, satisfactory alignment reduces to 10%. When relapse occurs, simple effective strategies are required to effectively manage the problem. The periodontal, physiological or psychological conditions may be different from those before orthodontic treatment, so re-treatment methods may also need to be different. OBJECTIVES: To assess the effects of interventions used to manage relapse of the lower front teeth after first fixed orthodontic treatment. SEARCH METHODS: The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 9 November 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10), MEDLINE via OVID (1950 to 9 November 2012), EMBASE via OVID (1980 to 9 November 2012). There were no restrictions regarding language or date of publication. A thorough handsearch was done in relation to the following journals: American Journal of Orthodontics and Dentofacial Orthopedics (1970 to 9 November 2012), Angle Orthodontist (1978 to 9 November 2012), European Journal of Orthodontics (1979 to 9 November 2012), Journal of Orthodontics (1978 to 9 November 2012), Chinese Journal of Stomatology (1953 to 9 November 2012), West China Journal of Stomatology (1983 to 9 November 2012), Chinese Journal of Dental Materials and Devices (1992 to 9 November 2012) and Chinese Journal of Orthodontics (1994 to 9 November 2012). SELECTION CRITERIA: We would have included randomised controlled trials (RCTs) which compared any of the following: fixed options (including labial braces, lingual braces and fixed lingual wire), removable options (including Hawley's retainer with active components such as Hawley's retainer with spring elastomeric module, Bloore removable aligner and any other modifications on the Hawley's retainer to correct the lower front teeth, and invisible removable aligners such as Invisalign and Clearstep) and no active treatment for the management of relapsed lower front teeth after orthodontic treatment. We excluded RCTs of participants with craniofacial deformities/syndromes or serious skeletal deformities who received prior surgical/surgical orthodontic treatment. DATA COLLECTION AND ANALYSIS: Two review authors, independently and in duplicate, assessed the results of the searches to identify studies for inclusion. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. MAIN RESULTS: We did not identify any RCTs which met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: This review has revealed that there was no evidence from RCTs to show that one intervention was superior to another to manage the relapse of the alignment of lower front teeth using any method or index, aesthetic assessment by participants and practitioners, treatment time, patient's discomfort, quality of life, cost-benefit considerations, stability of the correction, and side effects including pain, gingivitis, enamel decalcification and root resorption. There is an urgent need for RCTs in this area to identify the most effective and safe method for managing the relapse of alignment of the lower front teeth.

Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in persons who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions may reduce the risk of VAP in these patients. OBJECTIVES: To assess the effects of OHC on the incidence of VAP in critically ill patients receiving mechanical ventilation in intensive care units (ICUs) in hospitals. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 14 January 2013), CENTRAL (The Cochrane Library 2012, Issue 12), MEDLINE (OVID) (1946 to 14 January 2013), EMBASE (OVID) (1980 to 14 January 2013), LILACS (BIREME) (1982 to 14 January 2013), CINAHL (EBSCO) (1980 to 14 January 2013), Chinese Biomedical Literature Database (1978 to 14 January 2013), China National Knowledge Infrastructure (1994 to 14 January 2013), Wan Fang Database (January 1984 to 14 January 2013), OpenGrey and ClinicalTrials.gov (to 14 January 2013). There were no restrictions regarding language or date of publication. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed all search results, extracted data and undertook risk of bias. We contacted study authors for additional information. Trials with similar interventions and outcomes were pooled reporting odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes using random-effects models unless there were fewer than four studies. MAIN RESULTS: Thirty-five RCTs (5374 participants) were included. Five trials (14%) were assessed at low risk of bias, 17 studies (49%) were at high risk of bias, and 13 studies (37%) were assessed at unclear risk of bias in at least one domain. There were four main comparisons: chlorhexidine (CHX mouthrinse or gel) versus placebo/usual care, toothbrushing versus no toothbrushing, powered versus manual toothbrushing and comparisons of oral care solutions.There is moderate quality evidence from 17 RCTs (2402 participants, two at high, 11 at unclear and four at low risk of bias) that CHX mouthrinse or gel, as part of OHC, compared to placebo or usual care is associated with a reduction in VAP (OR 0.60, 95% confidence intervals (CI) 0.47 to 0.77, P < 0.001, I(2) = 21%). This is equivalent to a number needed to treat (NNT) of 15 (95% CI 10 to 34) indicating that for every 15 ventilated patients in intensive care receiving OHC including chlorhexidine, one outcome of VAP will be prevented. There is no evidence of a difference between CHX and placebo/usual care in the outcomes of mortality (OR 1.10, 95% CI 0.87 to 1.38, P = 0.44, I(2) = 2%, 15 RCTs, moderate quality evidence), duration of mechanical ventilation (MD 0.09, 95% CI -0.84 to 1.01 days, P = 0.85, I(2) = 24%, six RCTs, moderate quality evidence), or duration of ICU stay (MD -0.21, 95% CI -1.48 to 1.89 days, P = 0.81, I(2) = 9%, six RCTs, moderate quality evidence). There was insufficient evidence to determine whether there is a difference between CHX and placebo/usual care in the outcomes of duration of use of systemic antibiotics, oral health indices, microbiological cultures, caregivers preferences or cost. Only three studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups.From three trials of children aged from 0 to 15 years (342 participants, moderate quality evidence) there is no evidence of a difference between OHC with CHX and placebo for the outcomes of VAP (OR 1.07, 95% CI 0.65 to 1.77, P = 0.79, I(2) = 0%), or mortality (OR 0.73, 95% CI 0.41 to 1.30, P = 0.28, I(2) = 0%), and insufficient evidence to determine the effect on the outcomes of duration of ventilation, duration of ICU stay, use of systemic antibiotics, plaque index, microbiological cultures or adverse effects, in children.Based on four RCTs (828 participants, low quality evidence) there is no evidence of a difference between OHC including toothbrushing (± CHX) compared to OHC without toothbrushing (± CHX) for the outcome of VAP (OR 0.69, 95% CI 0.36 to 1.29, P = 0.24 , I(2) = 64%) and no evidence of a difference for mortality (OR 0.85, 95% CI 0.62 to 1.16, P = 0.31, I(2) = 0%, four RCTs, moderate quality evidence). There is insufficient evidence to determine whether there is a difference due to toothbrushing for the outcomes of duration of mechanical ventilation, duration of ICU stay, use of systemic antibiotics, oral health indices, microbiological cultures, adverse effects, caregivers preferences or cost.Only one trial compared use of a powered toothbrush with a manual toothbrush providing insufficient evidence to determine the effect on any of the outcomes of this review.A range of other oral care solutions were compared. There is some weak evidence that povidone iodine mouthrinse is more effective than saline in reducing VAP (OR 0.35, 95% CI 0.19 to 0.65, P = 0.0009, I(2) = 53%) (two studies, 206 participants, high risk of bias). Due to the variation in comparisons and outcomes among the trials in this group there is insufficient evidence concerning the effects of other oral care solutions on the outcomes of this review. AUTHORS' CONCLUSIONS: Effective OHC is important for ventilated patients in intensive care. OHC that includes either chlorhexidine mouthwash or gel is associated with a 40% reduction in the odds of developing ventilator-associated pneumonia in critically ill adults. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There is no evidence that OHC including both CHX and toothbrushing is different from OHC with CHX alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP.

Arginine-containing toothpastes for dentin hypersensitivity: systematic review and meta-analysis.

OBJECTIVE: Arginine-containing toothpastes are a promising new treatment for dentin hypersensitivity (DH), which afflicts a considerable number of patients. However, there have to date been only individual studies. We aim to present an overview of the clinical evidence in order to determine trends and establish firmer conclusions regarding the use of arginine-containing toothpastes for management of DH. METHOD AND MATERIALS: A protocol was developed based on the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0), including: search strategy, selection criteria, data extraction, and risk of bias assessment. We searched electronic databases (up to October 2012) without language limitation, and reference lists of relevant papers for randomized controlled trials that assessed the efficacy of arginine-containing toothpastes for DH treatment. Data extraction and domain-based risk of bias assessment were independently performed by two reviewers. The meta-analysis was performed in STATA (version 12.0). The GRADE analysis was conducted in GRADE profiler (version 3.6). RESULTS: Fourteen randomized controlled studies with different risk of bias were included in the meta-analysis, all evaluated by tactile and air blast assessment. The mean differences and standard deviations for each treatment group were pooled for analysis using a random-effect model. We found that arginine-containing toothpastes had better overall effects in comparison with placebo toothpastes (P < .05), potassium salt-containing toothpastes (P < .05), and strontium-containing toothpastes (P < .05). The GRADE analysis showed that quality of the evidence was moderate when arginine-containing toothpastes were compared to placebo and potassium salt-containing toothpastes, and quality of the evidence was low with comparison to strontium-containing toothpastes. CONCLUSION: Current available clinical evidence suggests that arginine-containing toothpastes are associated with the reduction of DH compared to both placebo and positive control toothpastes. However, there are limitations to the current studies, and more well-designed trials are needed to confirm the efficacy.

[Assessment of reliability and validity of assessment of multiple systematic reviews in Chinese systematic reviews on stomatology].

OBJECTIVE: To measure the agreement, reliability and validity of assessment of multiple systematic reviews (AMSTAR) to assess Chinese systematic reviews on stomatology. METHODS: A comprehensive electronic search was made through Chinese BioMedical Literature Database, VIP Database for Chinese Technical Periodicals and China National Knowledge Infrastructure electronically on March 1st 2011 together with handsearch through 19 stomatological journals to identify published Chinese systematic reviews on stomatology. Each systematic review was assessed by two reviewers with overview quality assessment questionnaire (OQAQ) and AMSTAR. And reliability (interobserver Kappa of the 11 AMSTAR items), interclass correlation coefficient (ICC) of the sum scores and construct validity (ICC of the sum scores of AMSTAR compared with those of the OQAQ) were reported. RESULTS: A total of 52 systematic reviews on stomatology were eligible. The reviewers agreement of the individual items of AMSTAR was with a mean Kappa of 0.81 [95% CI(0.73, 0.89)] while the OQAQ was 0.74 [95% CI (0.66, 0.83)]. The ICC of the total score for AMSTAR was 0.98 [95% CI (0.97, 0.99), P = 0.000]. Cronbach' alpha was 0.69 [95% CI (0.56, 0.80), P = 0.000]. And ICC of the sum scores of AMSTAR compared with those of the OQAQ was 0.94 [95% CI (0.90, 0.97), P = 0.000]. CONCLUSION: AMSTAR has good agreement, reliability and validity. AMSTAR can be well used in Chinese stomatology and can bring dentists much convenience when assess the methodological quality of systematical reviews on stomatology.

Graft for prevention of Frey syndrome after parotidectomy: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: To detect the effect and safety of different types of grafts for the prevention of Frey syndrome after parotidectomy. MATERIALS AND METHODS: The following data bases were searched electronically: MEDLINE (using OVID, from 1948 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL, issue 2, 2011), EMBASE (available from: http://embase.com, 1984 to July 2011), World Health Organization International Clinical Trials Registry Platform (July 2011), Chinese BioMedical Literature Database (1978 to July 2011), and the China National Knowledge Infrastructure (1994 to July 2011). The relevant journals and reference lists of the included studies were manually searched for randomized controlled trials studying the effect and safety of different types of grafts for preventing Frey syndrome after parotidectomy. The risk of bias assessment using Cochrane Collaboration's tool and data extraction was independently performed by 2 reviewers. The meta-analysis was performed using Review Manager, version 5.1. RESULTS: A total of 14 randomized clinical trials and 1,098 participants were included. All had an unclear risk of bias. The meta-analysis results showed that the use of an acellular dermis matrix can reduce by 82% the risk of Frey syndrome compared with the no-graft group using an objective assessment (relative risk [RR] 0.18, 95% confidence interval [CI] 0.12 to 0.26; P < .00001; Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] quality of evidence: high). The acellular dermis matrix can also reduce by 90% the risk of Frey syndrome compared with the no-graft group using a subjective assessment (RR 0.10, 95% CI 0.05 to 0.22; P < .00001; GRADE quality of evidence: high). The muscle flaps can reduce by 81% the risk of Frey syndrome compared with the no-graft group (RR 0.19, 95% CI 0.13 to 0.27; P < .00001; GRADE quality of evidence: high). No statistically significant difference was found between the acellular dermal matrix and muscle flap groups (RR 0.73, 95% CI 0.15 to 3.53, P = .70; GRADE quality of evidence: low). No serious adverse events were reported. CONCLUSIONS: The present clinical evidence suggests that grafts are effective in preventing Frey syndrome after parotidectomy. More randomized clinical trials are needed to confirm our conclusions and prove the safety of the grafts.