Metformin-Induced Vitamin B12 Deficiency among Type 2 Diabetes Mellitus' Patients: A Systematic Review.

BACKGROUND: Type 2 diabetes mellitus is one of the most globally common chronic diseases. Metformin is the most popular prescribed medication for the treatment of diabetes. Studies suggest that metformin is associated with vitamin B12 deficiency, which may impart adverse health complications. OBJECTIVE: This review screens the literature to clarify the effect of metformin on vitamin B12 deficiency among type 2 diabetes mellitus patients. METHODS: Google Scholar, PubMed, Research Gate, and Semantic Scholar, were searched for the association between metformin intake and vitamin B12 deficiency in type 2 diabetes mellitus patients using relevant keywords and their combinations. Selected studies were those conducted on patients taking metformin with no vitamin B12 supplement. Nineteen studies (fifteen observational studies and four randomized controlled trials) met the inclusion criteria. These studies were assessed for design, setting, study population, and overall quality. RESULTS: There is a positive correlation between metformin intake and vitamin B12 deficiency. This has been accompanied by increased homocysteine and decreased folate levels. Despite the refuting of the findings, most studies showed that higher doses of metformin were strongly associated with lower vitamin B12 levels, while the duration of treatment was not. CONCLUSION: Regular measurement of vitamin B12 levels during long-term metformin treatment is recommended. A clear policy should be in place to illuminate the importance of this screening in preventing vitamin B12 deficiency complications. Taking therapeutic supplements or injections of vitamin B12 along with a vitamin B12-rich diet may decrease the incidence of its deficiency in diabetic patients taking metformin.

Marginal Adaptation of Different Bulk-fill Composites: A Microcomputed Tomography Evaluation.

OBJECTIVES: In the last decade, bulk-fill materials were introduced to allow resin-based composites (RBC) in one layer (up to 4-5 mm thick) with optimum polymerization. We sought to evaluate the adaptation ability of different bulk-fill composites resin (CRs)and restoration marginal integrity. METHODS: A total of 28 caries-free and crack-free human molars underwent mesio-occlusal-distal cavity preparation. Each sample prepared the mesial margins on enamel, and the distal margins were extended into dentin. Teeth were then randomly distributed into four groups (n = 7 per group) according to the CR used to restore the cavity. Three bulk-fill CRs-Smart Dentin Replacement Flow+, 3M™ Filtek™ One Bulk Fill (FBF), and Tetric® N-Ceram Bulk Fill (TBF)-and one conventional CR (CC)-Filtek™ Z350-were used. The teeth were then subjected to aging via thermocycling, followed by cyclic loading. Finally, the volumetric width of the interfacial gap at the tooth-restoration interface was measured using a microcomputed tomography (µ-CT) analysis. RESULTS: SDR demonstrated the smallest gap volume among all tested CRs, followed by CC in enamel and TBF in dentin after aging. FBF showed the highest gap volume. There was no statistically significant three-way interaction between surface, aging, and material (p > 0.050). CONCLUSIONS: It is safe to suggest using bulk-fill RBC in deep class II cavities instead of conventional layered RBC when dealing with dentin margins. However, further clinical investigation is required.

Antimicrobial efficacy of indocyanine green-mediated photodynamic therapy compared with Salvadora persica gel application in the treatment of moderate and deep pockets in periodontitis.

BACKGROUND: In order to prove the idea that topical application of drugs can improve the clinical parameters affecting periodontal disease, a sound comparison should be made between topical therapeutic models. The aim of the present study was to assess the clinical efficacy of photodynamic therapy (PDT) and Salvadora persica (SP) gel as adjuncts to scaling and root planning (SRP) in the treatment of chronic periodontitis. METHODS: The selected patients were divided into three groups, Group I (PDT + SRP), Group II (SP + SRP) and group III (SRP alone). Clinical inflammatory periodontal parameters including plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) gain were assessed. Assessment of crevicular fluid interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) was performed using enzyme-linked immunosorbent assay technique. All measurements were recorded at baseline, 3 months and 6 months follow-up periods, respectively. RESULTS: A total of 73 patients completed the study. A significant improvement in the BOP was seen in Group II at both follow up visits when compared with other groups (p < 0.05). Only in Group-I that showed statistically significant reduction in moderate periodontal pockets at 3 months (p = 0.021), and significant reductions in deep pockets at 3-months (p = 0.003) and 6-months (p = 0.002), respectively. CAL gain also was reported to be seen in group-I at both visits (p < 0.05). Group- I and II significantly reduced the levels of IL-6 at 3-month period compared to Group-III. This reduction was further maintained by group-II and group-III at 6 months, respectively. TNF-α showed statistically significant decrease in Group II as compared to Group I and Group-III and this reduction was maintained by the end of 6-month visit (p = 0.045). CONCLUSION: Both the treatment modalities PDT and SP helped in reducing periodontal inflammation. PDT reported significant gain in clinical attachment level, whereas the SP significantly reduced the bleeding levels.

Intention to seek esthetic dental treatment and the theory of planned behavior in Saudi dental students and the general population.

STATEMENT OF PROBLEM: Tooth shade is of major concern for patients when receiving esthetic dental treatment. Understanding the motivating factors that drive patients' intentions to seek esthetic dental treatment helps in planning services. PURPOSE: The purpose of this cross-sectional study was to assess the relationship between the intention to seek esthetic dental treatment and the theory of planned behavior (TPB), including attitude regarding tooth shade, perceived ability to seek treatment, and subjective norms of how others perceive tooth shade. MATERIAL AND METHODS: The study included first-year dental students and clinic patients in a Saudi dental school (N=283). The shade of the maxillary central incisors was clinically assessed by using the Crystaleye spectrophotometer, and the L*, a*, and b* values were recorded. Participants were asked to select a shade that represented how others perceived their shades by using the VITA classical shade guide and to respond to a self-administered questionnaire based on a TPB assessing attitude regarding shade (9 items), perceived ability to seek esthetic treatment (7 items) on a 5-point Likert scale, and intention to seek esthetic treatment. The internal consistency of the TPB items was assessed, and scores were calculated. Logistic regression analysis was used to assess factors associated with the intention to seek esthetic treatment, including the TPB components controlled for L*, a*, and b* values in addition to age (α=.05). RESULTS: Of all participants, 49.5% indicated that they intended to seek esthetic treatment. The most commonly perceived shades were B1, B2, A2, A1, and A3 (76%). In adjusted regression, the intention to seek esthetic treatment was significantly associated with a more positive attitude regarding shade (OR=2.31, 95% CI=1.54, 3.47) and a lower b* value (OR=0.74, 95% CI=0.59, 0.93), but not with shade coordinates (P values of L*=.94, a*=.64, and b*=.13). CONCLUSIONS: Intention to seek esthetic dental treatment was associated with a positive attitude regarding the importance of shade and a greater perception of having a less yellow shade, regardless of the shade.