Association of tooth loss and nutritional status in adults: an overview of systematic reviews.

BACKGROUND: Association of tooth loss and nutritional status has been widely researched with conflicting results. This overview aimed to analyse and summarize findings from systematic reviews on association of tooth loss with nutritional status, in view of their quality assessment and methodological characteristics. METHODS: Overview was conducted as per Cochrane Overviews of Reviews guidelines. 5 databases (PubMed, Dentistry and Oral Sciences Source, Scopus, Cochrane Register of Systematic Reviews, Epistemonikos.org) and one online source (Google Scholar) were searched for systematic reviews published between 2010 - July 2022, with inclusion criteria; population: participants aged 18 years or above, intervention/exposure: loss of teeth, comparison: not applicable, outcome: nutritional status, study: systematic reviews and meta-analysis. Reviews on association of prosthetic interventions with nutritional status were not included. Data were extracted for study characteristics, details of primary studies, and main findings. Narrative synthesis of data, overlap of primary studies and quality assessment of studies were done using AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews). RESULT: Of 1525 articles found, seven systematic reviews were selected (four were systematic reviews, three were systematic reviews with meta-analysis). Five studies showed some or positive association, one found weak association and for one study the association was unclear. Overlap of primary studies was 'very slight'. Meta-analysis of two studies concluded fully or partially edentulous individuals were more likely to be malnourished or at risk of malnutrition, (RR = 1.095, 95% CI 1.007 to 1.190, p = 0.033. RR = 1.22; 95% CI 1.11 to 1.32 p < 0.01), but one found that edentulism was not associated with malnutrition. (RR = 1.072, 95% CI 0.9657-1.200). Quality assessment revealed four studies were 'high', one was 'low' and two were 'critically low.' CONCLUSION: This overview confirms the association between tooth loss and nutritional status specially in elderly. It is evident that tooth loss increases the likelihood of poor nutritional status. Overall, studies show high heterogeneity in the methodology and quality assessment reveals low confidence in the available evidence. Future studies should use standard assessment tools for tooth loss and nutritional status.

Influence of Different Build Directions on the Fracture Load and Surface Roughness of Additively Manufactured Three-unit Provisional Restoration and Comparison with Conventional Methods of Provisional Fabrication.

PURPOSE: To compare the influence of 0, 45 and 90 degrees build direction on fracture load and surface roughness of additively manufactured three-unit fixed provisional restoration, and to compare with provisionals fabricated using conventional materials. MATERIAL AND METHODS: Mandibular typodont right second molar and premolar were prepared for missing mandibular first molar to receive three-unit fixed partial denture. Six groups of 10 samples each, 3-unit provisionals were fabricated using additional manufacturing at 0,45 and 90 degrees, heat polymerized polymethyl methacrylate, auto polymerizing resin and bis-acryl composites resins and tested for fracture load and surface roughness. One way ANOVA and Tukey tests were used to analyze the data. RESULTS: For fracture load, lowest mean value was obtained for auto polymerizing bis-acrylic resin (464.9N) and highest value for 0 degree (596 N), while surface roughness values were lowest for heat polymerized polymethyl methacrylate (0.132µm), and the highest for auto polymerizing polymethyl methacrylate (0.836 µm). Significant differences were obtained between three build directions for fracture load and surface roughness (p=0.001); in all pairwise comparisons except between 0 and 90 degrees (p=0.502) for fracture load; and between all three build directions for surface roughness (p=0.01). On comparing with other provisional materials, significant difference (p=0.001) was observed between all groups. Conclusion- Build direction affected the mechanical properties of additively manufactured three-unit provisionals with 0 degree printed provisionals showing highest fracture load and lowest surface roughness. On comparing with other provisional materials, 0 degree showed highest fracture load, with surface roughness similar to heat polymerized provisionals.

Comparison of accuracy between single posterior immediate and delayed implants placed using computer guided implant surgery and a digital laser printed surgical guide: A clinical investigation.

STATEMENT OF PROBLEM: The congruence of surgical implant placement with the preplanned position is important for anatomic and prosthetic precision, minimal complications, and increased longevity. The influence of implant placement timing on the surgical deviations in single posterior implants is unclear. PURPOSE: The purpose of this clinical study was to compare deviations between preplanned and single posterior immediate and delayed implants placed using computer-guided digital light processing (DLP) surgical guides fabricated using intraoral scanning and cone beam computed tomography (CBCT). MATERIAL AND METHODS: Implant surgery was performed on 24 participants requiring single immediate or delayed implants in the posterior maxillary and mandibular regions, for which the surgical site data were obtained from CBCT and intraoral scanning. Subsequently, virtual implant planning and DLP surgical guides were fabricated. Preimplant and postimplant placement CBCT scans were overlapped, and mean deviations for the immediate and delayed implant groups were calculated. The groups were compared with unpaired t tests (α=.05). RESULTS: A total of 24 implants were placed, 12 in each group. In participants who received immediate implant placement, the mean ±standard deviation angular deviation, linear deviation at shoulder, linear deviation at apex, and vertical deviation were 1.03 ±0.70 degrees, 0.26 ±0.30 mm, 0.23 ±0.24 mm, and 0.39 ± 0.34 mm, respectively. In participants who received delayed implant treatment, the deviations were 0.53 ±0.60 degrees, 0.15 ±0.18 mm, 0.25 ±0.33 mm, and 0.17 ±0.10 mm, respectively. Significant differences between the 2 groups were found in the vertical deviation (P<.05). CONCLUSIONS: The timing of the single posterior placement was associated with different deviations in the vertical direction. All deviations obtained were below the recommended values. DLP surgical guides fabricated from intraoral and CBCT scans provided accurate implant placement in immediate and delayed single posterior implants.

Effect of addition of titanium dioxide nanoparticles on the antimicrobial properties, surface roughness and surface hardness of polymethyl methacrylate: A Systematic Review.

Background: Polymethyl Methacrylate (PMMA) denture-base resins have poor surface properties that facilitates microbial adhesion causing denture stomatitis. This systematic review aims to evaluate the effect of different sizes and percentages of titanium dioxide nanoparticles (TiO2NP) on the antimicrobial property, surface roughness and surface hardness of PMMA denture base resin.  Methods: A systematic search of English peer-reviewed articles, clinical trial registries, grey literature databases and other online sources was performed using the PRISMA-S Guidelines for In-Vivo and In-Vitro studies. Qualitative data synthesis was performed to analyse sample dimensions, acrylic used, treatments of nanoparticles, methods used for testing and effect of size and percentage of nanoparticle. Risk of bias assessment was done using modified Cochrane risk of bias tool. Results: Out of 1376 articles, 15 were included. TiO 2NP of size less than 30 nm was most frequently used. Both antimicrobial property and surface hardness improved irrespective of the size of the added TiO 2NP. Three studies reported increase in the surface roughness with less than 50 nm TiO 2NP.  3% TiO 2NP was most frequently used. On increasing the percentage, three studies reported an increase in antimicrobial property, while two studies found no change. With TiO 2NP greater than or equal to 3%, six studies reported an increase in surface hardness, while two reported increase in surface roughness. Large methodological variations were observed across studies. All studies except one were of moderate quality. Conclusions:   On addition of TiO 2NP to heat polymerized PMMA, the antimicrobial property and surface hardness improved irrespective of the size of the TiO 2NP, however, addition of nanoparticles less than 50 nm increased the surface roughness. Increasing the percentage of TiO 2NP increased the surface hardness but did not always increase the antimicrobial property. Addition of 3% TiO 2NP provided optimum results with regards to antimicrobial effect and surface hardness, but increase in the surface roughness.

Assessing the Compliance of Dental Clinicians towards Regulatory Infection Control Guidelines Using a Newly Developed Survey Tool: A Pilot Cross-Sectional Study in India.

Adherence to the dental practice regulatory guidelines instituted during the COVID-19 pandemic is essential to minimize the transmission of SARS-CoV-2 strains. Given the lack of a valid and reliable survey tool to assess the adherence to dental practice guidelines, this study aims to develop, validate, and test a survey tool on a pilot sample of dental clinicians practicing in India. A survey tool was developed/validated through a sequential phasic approach: Phase I- developing survey using conceptual and literature framework; Phase II: ascertaining its validity and reliability; Phase III: pilot testing; and Phase IV: assessing construct validity by exploratory factor analysis (EFA) on the responses collected in Spring 2021. The EFA was achieved using a traditional unweighted least squares extraction method through a varimax rotation with Kaiser normalization. A six-factor solution with 18 items (with the global reliability of 86%) related to screening, regular infection prevention measures, infection control inside the dental operatory, disinfection of the dental unit, disposal, and other COVID-19-specific preventive measures were extracted. Our sample had higher compliance with regard to providing alcohol-based hand scrubs, providing protective gear to attendees, collecting travel/medical history, and screening patients for COVID-19 symptoms. In contrast, less compliance was observed regarding the use of paperless forms of practice and rubber dams in the operatory. The use of a validated survey tool ensures the collection of reliable and valid data, which can serve as baseline data to measure the uptake and effectiveness of dental practice regulatory guidelines in a clinical setting and community dental health clinics.

Perceptions of Dental Undergraduates Towards Online Education During COVID-19: Assessment from India, Nepal and Sri Lanka.

PURPOSE: The social distancing mandates instituted during COVID-19 pandemic mark the sudden transition in the mode of dental education's delivery to the virtual instruction. It is vital to assess students' perceptions towards virtual learning environments, particularly among those gaining education in resource-strained countries. This cross-sectional study aims to assess the perceptions of dental undergraduates towards online education, environment and transferable skills and patient care during COVID-19 in India, Nepal, and Sri Lanka. MATERIALS AND METHODS: Dental preclinical and clinical undergraduate students from India, Nepal and Sri Lanka were recruited from November 2020 to March 2021 through a 47-item web-based survey consisting of psychometrically valid subscales of Dundee Ready Educational Environment Measure (DREEM) and Transferable Skills Questionnaire. The mean scores of students' perceptions of learning, environment, and patient care skills were compared among preclinical and clinical students of the participating countries. RESULTS: Of total 930 participants, 44.4% were from India, 26.1% from Sri Lanka and 29.5% responses from Nepal. Sri Lanka reported the highest mean scores across all domains of perception indicative of positive attitude. Clinical students from all participating countries had statistically significantly higher positive perception of transferable skills in patient care as opposed to their preclinical counterparts. On the contrary, perception towards learning was higher among preclinical students as opposed to clinical students. These differences were statistically significant for Nepal and Sri Lanka. CONCLUSION: The findings of this study underscore the need to develop and implement effective online dental educational interventions to foster academic growth and essential practical skills without compromising academic rigor and continuity in the dental education curriculum.

Knowledge, Protective Behaviors and Risk Perception of COVID-19 among Dental Students in India: A Cross-Sectional Analysis.

OBJECTIVE: This study's objective was to examine the knowledge, performance in practicing protective behaviors, and risk perception of Coronavirus disease-19 (COVID-19) among dental students of India. METHODS: A web-based cross-sectional survey was conducted from 10-30 August 2020, involving 381 dental students that were enrolled at the Uttaranchal Dental and Medical Research Institute in India. A web-based structured questionnaire assessed the COVID-19 related knowledge, protective behaviors, and risk perception performance. The independent-samples-t and analysis of variance tests were used to analyze the differences in knowledge, protective behaviors, and perception across the groups. RESULTS: Of the dental students surveyed, 83% had adequate knowledge of COVID-19, and nearly 80% followed appropriate practices regarding COVID-19. The COVID-19 related risk perception was higher among females as compared to males. COVID-19 related knowledge was significantly correlated with preventive behaviors (r = 0.18; p < 0·01) and risk perception (r = 0.10; p < 0.05). We found a high score of COVID-19 related knowledge and precautionary behaviors and moderate risk perception among students. CONCLUSIONS: Knowledge and protective behaviors towards infectious diseases, such as COVID-19, have clinical applications in developing educational and formal training programs to promote adherence to the infection control practices among dental students. CLINICAL SIGNIFICANCE: The findings of this study will inform policymakers to emphasize on effective risk communication. Dental institutions can incorporate infection control modules in the current curriculum, thereby making future dental professionals capable of performing effective infection control management in the clinical settings. This is critical in improving their knowledge of infection control practices to minimize the risk of nosocomial infections.

Comparative evaluation of elastic recovery of three different elastomeric impression materials on chemical disinfection and autoclaving: An in vitro study.

AIM: The aim of the study was to investigate the effect of disinfection and steam autoclaving on the elastic recovery of three different elastomeric impression materials. SETTINGS AND DESIGN: In vivo - comparative study. MATERIALS AND METHODS: Ninety dumbbell-shaped specimens of commercially available two addition-cured silicones (AFFINIS and AQUASIL) and one condensation-cured silicone (SPEEDEX) impression materials were prepared and treated with chemical disinfectant and steam autoclaving. Specimens were seal packed and sent to laboratory for testing elastic recovery. After the specimen had been pulled to failure, the broken parts were fitted back together, and the distance between the marks was measured using an electronic Vernier caliper. STATISTICAL ANALYSIS USED: one-way analysis of variance test and Tukey post hoc test for multiple comparisons. RESULTS: The result showed significant difference in elastic recovery of AFFINIS when it was disinfected and steam autoclaved whereas elastic recovery showed no significant difference when SPEEDEX and AQUASIL were disinfected and steam autoclaved. Similarly, results were alike when AFFINIS, SPEEDEX, and AQUASIL were compared on disinfection. However, significant difference was noted on steam autoclaving, highest being the mean value of AFFINIS. CONCLUSION: Within the limitations of this in vitro study, conclusion was made that the elastic recovery of AFFINIS was the least which improved with disinfection and autoclaving. Elastic recovery of SPEEDEX and AQUASIL was similar. However, all the three materials used in the study can be safely sterilized after clinical use and before being sent to the laboratory without significantly affecting their elastic recovery.

A spirometric and cephalometric comparative evaluation of mandibular advancement devices and occlusal jig.

AIM: Aim of the current study was to evaluate the effect of occlusal jig with increased vertical dimension and mandibular advancement device on the oropharangeal volume in completely edentulous patients using spirometry and cephalometry. MATERIALS AND METHODS: The current study included includes 30 completely edentulous patient according to inclusion criteria. They were each subjected to cephalometric and spirometric analysis wearing CCD, OJ & MAD. Results obtained were subjected to following statistical analysis, one-way ANOVA test, unpaired t-test, and Dunnett's test. RESULT: Both OJ & MAD brings about significant change in oropharangeal volume hence both the devices are effective treatment of choice for OSA, while greater increase was observed in oropharangealvolume of OJ as compared to MAD. Spirometric analysis shows insignificant changes in the oropharangeal volume caused by MAD while OJ causes small but significant change in oropharangeal volume (PIFR]. CONCLUSION: Within the limitation of the study, it can be concluded that, on cephalometric & spirometric evaluation, OJ shows greater increase in oropharangeal volume when compared to MAD in completely edentulous patient.

Ehlers danlos syndrome - a case report.

Ehlers Danlos syndrome (EDS) is a hereditary collagen disorder which primarily manifests in the skin and joints. Clinically, it is characterized by hyperelasticity of skin and joint hypermobility. This article has described a rare condition seen in a 10-year-old boy who was diagnosed with EDS, based on the clinical, radiographic and histological findings.