Poor glycemic control impairs oral health in children with type 1 diabetes mellitus - a systematic review and meta-analysis.

OBJECTIVE: There are more than one million children and adolescents living with type 1 diabetes mellitus, and their number is steadily increasing. Diabetes affects oral health through numerous channels, including hyposalivation, immune suppression, and the inflammatory effect of glycation end-products. However, patients with type 1 diabetes must follow a strict sugar free diet that is proven to be carioprotective. Therefore, the aim of this systematic review and meta-analysis is to investigate whether children with type 1 diabetes have a difference in Decayed, Missing, Filled Teeth index (DMFT), salivary function, and periodontal status than children without diabetes, with an emphasis on glycemic control. MATERIALS AND METHODS: PubMed, Embase and Cochrane libraries were screened for articles, using predefined search keys without any language or date restrictions. Two independent authors performed the selection procedure, extracted data from the eligible articles, carried out a manual search of the reference lists, and assessed the risk of bias using the Newcastle-Ottawa scale. Meta-analysis was performed in R using the random-effects model. Effect sizes were mean differences; subgroup analysis was performed on glycemic control. RESULTS: 33 studies satisfied the eligibility criteria. 22 studies did not show a significant difference regarding the DMFT index between the diabetes and non-diabetes groups; six studies found that children living with diabetes had higher DMFT scores, compared to five studies that found significantly lower scores. Meta-analysis found no statistically significant differences in plaque, gingival, and calculus indexes, however it found significant differences in pooled DMFT indexes, and salivary flow rate. Subgroup analysis on glycemic control using DMFT values found significant differences in children with good and poor glycemic control with results of 0.26 (CI95%=-0.50; 1.03) and 1.46 (CI95%=0.57; 2.35), respectively. CONCLUSIONS: Children with poor glycemic control face higher risk of developing caries compared to good control and non-diabetes children. Regular dental check-ups and strict control of glycemic levels are highly advised for children living with type 1 diabetes, further emphasizing the importance of cooperation between dentists and diabetologists.

User Experience of Intraoral Scanners in Dentistry: Transnational Questionnaire Study.

INTRODUCTION: Intraoral scanners (IOS) are continuing to gain popularity in clinical dentistry, replacing the traditional impression-taking and related technology. Despite their increasing importance, there are few data on the utility and usage of IOS amongst dentists. This study investigates the user experience of IOS technology as well as the perceived quality of a variety of IOS used by dental clinicians worldwide. METHODS: An online survey of 1072 dentists was conducted to elicit data on the number of individual IOS used, their accessibility, the maintenance fees, and the programmes used. The first part of the questionnaire included demographic data and related questions, whilst the second part focussed on the specific IOS used by the respondents and the satisfaction with their scanners. RESULTS: We surveyed 1072 respondents from 109 different countries. More than three-quarters of the survey cohort (78.8%) use IOS in their daily work, whilst 21.17% do not. The average number of scanners owned by the respondents was 1.5 (±0.9), and in total, the cohort used 36 different types of IOS. More than one-third (38.6%) of the respondents used computer-aided design (CAD) software as well. As for the frequency of IOS usage, 51.5% used the system on a daily basis, 28.2% did so 2 to 3 times a week, and 10.0% did so once a week. Overall, the top 3 IOS used by the cohort were Medit i700 followed by wireless Medit i700 and Dentsply Sirona Primescan. CONCLUSIONS: This study describes, for the first time, the IOS user experience in an international cohort. More than 75% of the respondents used IOS on a daily basis in their practice, whilst Medit and Dentsply Sirona brands were the most popular scanners amongst the group. It appears that digital impression-taking technology is universal, and digital workflow in dentistry will continue to grow.

Association between Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ).

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a type of jawbone necrosis caused by the use of drugs for some types of cancer and osteoporosis. The current study aimed to evaluate the associations between hyperglycemia and the development of medication-related osteonecrosis of the jaw. METHODS: Our research group investigated data collected between 1 January 2019 and 31 December 2020. A total of 260 patients were selected from the Inpatient Care Unit, Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University. Fasting glucose data were used and included in the study. RESULTS: Approximately 40% of the necrosis group and 21% of the control group presented with hyperglycemia. There was a significant association between hyperglycemia and MRONJ (p < 0.05, p = 0.003). Vascular anomaly and immune dysfunction caused by hyperglycemia can lead to necrosis after tooth extraction. Necrosis is more common in the mandible (75.0%) and in the case of parenteral antiresorptive treatment (intravenous Zoledronate and subcutaneous Denosumab). Hyperglycemia is a more relevant risk factor than bad oral habits (26.7%). CONCLUSIONS: Ischemia is a complication of abnormal glucose levels, a possible risk factor for necrosis development. Hence, uncontrolled or poorly regulated plasma glucose levels can significantly increase the risk of jawbone necrosis after invasive dental or oral surgical interventions.

Preoperative HbA1c and Blood Glucose Measurements in Diabetes Mellitus before Oral Surgery and Implantology Treatments.

Diabetes mellitus has become a worldwide epidemic and is frequently accompanied by a number of complications proportional to the duration of hyperglycemia. The aim of this narrative review is to assess the most up-to-date guidelines on DM provided by both diabetes and dental associations. Furthermore, to gather evidence on the uni/bidirectional relationships of elevated HbA1c levels on dental surgery, implantology, bone augmentation, and periodontology and to demonstrate the importance of measuring HbA1c levels before invasive dental treatments. HbA1c and blood glucose measurements are a minimally invasive method for preventing complications in diabetes mellitus. The authors conducted a literature review to determine which oral conditions are affected by diabetes mellitus. MEDLINE served as a source with the use of a specific search key. Regarding oral complications of diabetes, prevention is the most vital factor. With this publication, we hope to assist physicians and dentists to make prompt diagnoses and to help in recognizing various oral manifestations of diabetes and follow the existing guidelines.

The Utilisation of CAD/CAM Technology Amongst Austrian Dentists: A Pilot Study.

OBJECTIVE: Computer-aided design (CAD) and computer-aided manufacturing (CAM) technology in dentistry has become noticeably more significant in recent years. The further development of CAD/CAM systems has led to a broader range of applications, more user-friendly operation, and improved accessibility. The present online survey aimed to investigate CAD/CAM technology utilisation amongst Austrian dentists as the first social media pilot study from Europe on this specific topic. MATERIALS AND METHODS: For this purpose, an online survey consisting of 27 questions was created using Google Forms. The questions were divided into 3 sections: general inquiries, questions for CAD/CAM users, and questions for nonusers. The questionnaire was randomly distributed to Austrian dentists via email and social media. A total of 115 responses were submitted. RESULTS: The vast majority of respondents, 52.6% (n = 60), practised as general dentists. Furthermore, a significant proportion of participants specialised in oral surgery, 17.5% (n = 20), and orthodontics, 12.3% (n = 14). Approximately half of the respondents, 51.8% (n = 59), reported having a CAD/CAM device at their current workplace. Amongst the CAD/CAM users, 70.7% (n = 58) believed that CAD/CAM is important in increasing the number of patients visiting the dental practice. In total, 54.2% (n = 26) of nonusers indicated the high initial cost of purchasing a CAD/CAM device as the main reason for not utilising this technology. CONCLUSIONS: CAD/CAM technology appears to have infiltrated the workflow of Austrian dentists with predictions of growing implementation amongst dental practices in the future.

Point-of-care HbA1c Measurements in Oral Cancer and Control Patients in Hungary.

BACKGROUND/AIM: This study aimed to investigate the link between preoperative glycated hemoglobin (HbA1c) levels and oral cancer patients and diabetes mellitus (DM). We aimed to highlight the importance of point-of-care HbA1c measurements in oral cancer patients. PATIENTS AND METHODS: A total of 214 patients were admitted to the Department of Inpatient Care at Semmelweis University's Department of Oromaxillofacial Surgery and Stomatology between 1 September 2020 and 21 May 2021; individuals, who had undergone maxillofacial surgery under general anesthesia, were included in the study. RESULTS: There was a significant difference between the oral cancer group and the control group in terms of smoking (p=0.009) and alcohol intake (p=0.003). There was no statistically significant difference regarding sex (p=0.132) and DM (p=0.147) between the two groups. The tumor group had an 8.52% greater prevalence of DM, which was not significant. In the oral cancer group, twenty individuals (17.69%) had a higher HbA1c level than the upper level of the optimal metabolic value (6.9%). Nine participants (8.91%) in the control group had an HbA1c value greater than 6.9%, which means that their metabolic level was poor. The oral cancer group did not have higher blood glucose levels than those of the control group. CONCLUSION: No direct connection between high blood glucose levels and oral cancer was found. However, point-of-care HbA1c measurement can be a diagnostic tool to detect DM in the dental office.

Relation between medication-related jaw necrosis and blood glucose levels A retrospective epidemiological study / A gyógyszer okozta állcsontnekrózis és a vércukorszint kapcsolata. Retrospektív epidemiológiai vizsgálat

Maslach and Jackson. Results: In the field of examined dimensions of burnout syndrome, the most characteristic was emotional exhaustion, which has occurred with a frequency of nearly 30% and with typically high intensity among professionals working in neonatal intensive care units (N = 278). In addition, one-fifth were characterized by a high frequency and intensity of depersonalization. At the same time, nearly a third of them experienced a decrease in personal effectiveness. Workplace and time spent in healthcare did not show a significant connection with the incidence of burnout syndrome, however, burnout syndrome occurred with a higher frequency and intensity among those working in level III. neonatal intensive care unit. Conclusion: This is the first comprehensive burnout survey among premature and new born intensive care units in

User Experience and Sustainability of 3D Printing in Dentistry.

BACKGROUND: 3D printing is a rapidly developing technology in the healthcare industry and in dentistry. Its application clearly shows that this area of digital dentistry has potential for everyday usage across all fields, including prosthodontics, orthodontics, maxillofacial surgery, and oral implantology. However, despite gaining ground, there is a lack of information about how specialists (dentists and dental technicians) use additive technology. Our research group aimed to investigate the impact of social media on additive manufacturing technology among dental specialists and their everyday usage of 3D printing. METHODS: This paper investigated specialists' everyday usage of 3D printers via an online survey (Google Forms). The survey questions aimed to discover the number of 3D printers used, the accessibility of the devices, the annual cost, and the design programs. Since specialists tend to build online communities on social media, we circulated our study questionnaire using our profiles on LinkedIn, Facebook, and Instagram platforms during our research. RESULTS: A total of 120 responses were received from 20 countries, with the most significant numbers being from Hungary 23.7% (n = 27), the United States 18.4% (n = 21), and the United Kingdom 7.9% (n = 9). Most of the participants were dentists (n = 68) or dental technicians (n = 29), but some CAD/CAM specialists (n = 23) also completed our survey. The participants had an average of 3.8 years (±0.7) of experience in the 3D printing field, and owned a total of 405 printing devices (3.6 on average/person). CONCLUSIONS: The impact of social media on this research field is growing increasingly. Hence, we support specialists in joining virtual communities on professional platforms. This article intended to provide a practical overview, feedback, and direction for dentists interested in 3D printing technology. From our survey, we can conclude that additive technology is broadening dental applications and the services that we can provide for our patients.

Oral Health Status of Children Living with Type 1 Diabetes Mellitus.

BACKGROUND: Diabetes is a well-known predisposing factor for oral diseases, so prevention in an early age is mandatory. OBJECTIVE: To provide oral screening for children living with type 1 diabetes. We aimed to investigate the oral and general health indexes of T1DM children and compare these data to healthy siblings and controls. METHODS: In this cross-sectional study, 120 DM patients and 78 siblings, thereafter 80 DM children and 95 controls, took part. A detailed questionnaire, panoramic radiographs, and lateral cephalograms were obtained in every orthodontic consultation. We used Pearson's chi-square test for statistical analysis and compared the data of the study and control groups. RESULTS: The oral health values of DM children were significantly better (DMF-T 0.83-1.3) than the national average (3.8-4.5). A total of 75% (n = 60) of the children needed orthodontic treatment for orthodontic or skeletal anomalies. The prevalence of skeletal anomalies was significantly (p < 0.05) higher among patients with diabetes mellitus (DM) than in the control group. The frequency of coeliac disease was significantly elevated compared to any literature data (1-3.5%) in the study (15%) and in the control sibling group (13%). CONCLUSIONS: Co-morbidities such as CD should get more attention as a prognostic factor for a future higher incidence of diabetes. T1DM children can be motivated and health-conscious patients with excellent oral hygiene and dental status. Orthodontic treatment can help eliminate the oral complications of DM. Special diabetes ambulances may help provide oral care for patients with DM.

Prevalence of Diabetes and Impaired Fasting Glycemia in Patients With Oral Cancer: A Retrospective Study in Hungary.

BACKGROUND/AIM: Diabetes mellitus (DM) is one of the most common chronic metabolic disorders. Our research aimed to demonstrate the relationship between DM and oral cancer. PATIENTS AND METHODS: We pursued a retrospective research study in Hungary between January 2019 and December 2020. We investigated 597 inpatient records and compared them to the results of our previous studies (1998-2002 and 2012-2015). RESULTS: The frequency of patients with DM in the oral cancer group is 2.45 times higher today than 20 years ago. The prevalence rate of DM and oral malignancies increased from 14.6% to 35.8%. In the oral cancer group, 54.4% of the patients had elevated blood glucose levels and of these, 61.1% of them had type 2 diabetes, 34.2% had impaired fasting glycemia, and only 4.7% had type 1 diabetes. We observed that 45.3% of them were smokers. Of those whose blood sugar levels were under 6.1 mmol/l, the mean body mass index was 25.33 [standard deviation (SD)=±4.5; range=15.57-39.84], while among patients with DM, it was 26.92 (SD=±5.8; range=18.36-44.08). CONCLUSION: It may be necessary to continuously monitor the patient's blood sugar level to maintain euglycemic levels when managing patients with malignant oral lesions.

Oral Health Knowledge and Habits of People With Type 1 and Type 2 Diabetes.

OBJECTIVES: This study aimed to collect information about oral health knowledge and the habits of people living with diabetes (PwD), primarily type 1 diabetes, using the newly developed World Health Organisation Oral Health Questionnaire for Adults (Annex 7). MATERIALS AND METHODS: Comparable and reliable questionnaires, comprising 23 questions for PwD, were sent to diabetes social media groups, mailing lists, and associations. The survey explored the relationships amongst demographic factors, age, dental education, eating habits, and other factors. RESULTS: The 23-question survey was answered by 307 individuals from 60 different countries. Alcohol and tobacco use, dental anxiety, and bad habits were often reported. Of the participants, 61.2% (n = 188) had at least 1 drink during the past 30 days. Of the participants, 22.8% (n = 70) were smokers. In total, 80.8% (n = 248) of the participants consumed biscuits, 76.2% (n = 234) consumed sweets, and 63.2% (n = 194) consumed soft drinks regularly. A total of 26.4% (n = 81) of the participants reported being afraid of dental treatment. Of the participants, 48.5% (n = 149) reported dry mouth and other oral complications. The frequency of visits to the dentist was satisfactory. A total of 71.3% (n = 219) of the participants reported visiting a dentist during the past 12 months. CONCLUSIONS: There is a need for proper oral health education for PwD. Trained diabetes advocates could be core messengers. However, interdisciplinary cooperation is mandatory for both education and the clinical aspect of diabetes care. For example, diabetes nurses need to be educated with the help of dentists or oral hygienists.

Maternal-related factors in the origin of isolated cleft palate-A population-based case-control study.

OBJECTS: Isolated cleft palate (CPO) is the rarest form of oral clefting affecting 1-25 per 10 000 newborns worldwide. There is increasing evidence for the different pathogenetic backgrounds of CPO and cleft lip with or without cleft palate. The role of environmental factors in the origin of non-syndromic and syndromic CPO is unclear in most patients. The aim of this study was to estimate possible maternal risk factors in the origin of CPO. SETTING AND SAMPLE POPULATION: The Hungarian Case-Control Surveillance of Congenital Abnormalities contains data of 32 345 birth defect cases and 57 231 control newborns. The study samples included 751 cases with isolated CPO, 1196 matched controls and 57 231 population controls. MATERIAL AND METHODS: Maternal diseases during pregnancy in cases and population controls were compared, and adjusted ORs with 95% CI were calculated in a multivariable unconditional logistic regression model. RESULTS: Beyond the well-known robust female excess (58.9%)-maternal smoking (OR with 95% CI: 2.34, 1.94-2.81) medically recorded maternal anaemia, threatened abortion and excessive vomiting in pregnancy were associated with a higher risk for CPO in the offspring. An elevated risk was found in Graves' disease (OR: 4.30, 1.74-10.62), epilepsy (OR: 4.64, 2.44-8.82), migraine (OR: 2.82, 1.18-6.76) and essential hypertension (OR: 2.33, 1.32-4.10). Among acute diseases common cold (OR: 4.94, 3.48-7.03), acute respiratory infections (OR: 4.20, 1.49-11.82), influenza (OR: 2.95, 1.75-4.95), pulpitis (OR: 7.85, 2.80-22.03), cholecystitis (OR: 3.15, 1.16-8.60), acute urinary tract infections (OR: 4.08, 2.22-7.49) and pelvic inflammatory diseases (OR: 3.93, 1.62-9.53) during pregnancy also were associated with an increased risk for developing CPO. CONCLUSION: The findings of this study suggest that maternal diseases and lifestyle factors during the first trimester play a significant role in the development of isolated cleft palate.

[Incidence of type 2 diabetes among oral cancer patients in Hungary]. / A 2-es típusú diabetes mellitus prevalenciájának változása szájüregi carcinomás betegek körében.

INTRODUCTION: Data proves that Hungary has a leading role in the statistics of oral cancer and patients living with type 2 diabetes. AIM: Our aim was to understand the statistical correlation between oral cancer and metabolic disorder (diabetes mellitus and impaired fasting glucose) due to the valuable data from the Semmelweis University. METHOD: We analyzed the data of 835 patients diagnosed with malignant oral cancer and 587 tumor-free control patients. We investigated the incidence and location of oral cancer among patients living with diabetes, and compared these datasets with our previous data from 14 years earlier. RESULTS: We found that in oral cancer patients, 26.1% had diabetes and 20.8% had impaired fasting glucose; in the control group these ratios were 10.8% and 11.1%. This difference is significant (p<0.05). 14 years ago in the tumor group 14.6%, in the control group 5.6% had diabetes, while 9.7% and 5.5% had impaired fasting glucose. Lip cancer had the biggest incidence. CONCLUSIONS: The rise of type 2 diabetes in the tumor group was significant. This could be a burden for the health care system. We want to highlight the importance of interdisciplinary cooperation between health care professionals. Orv Hetil. 2018; 159(20): 803-807.

Type-2 Diabetes Mellitus and Oral Tumors in Hungary: A Long-term Comparative Epidemiological Study.

BACKGROUND: Hungary has a leading place in global statistics of oral cancer and there is a high incidence of type-2 diabetes. PATIENTS AND METHODS: A retrospective diabetes and impaired fasting glucose (IFG) screening of 758 inpatients with histologically-confirmed oral malignancies was performed. The control group comprised of 534 tumor-free adults. The results were compared to data collected 14 years earlier. RESULTS: Diabetes mellitus (DM) was found in 25.9% and IFG in 20.6% of patients with oral cancer. Fourteen years earlier, DM was diagnosed in 14.6% and IFG in 9.7% of cancer patients. Among diabetic patients, the labial tumor location showed long-term dominance. The smoking rate of diabetes patients with oral cancer was higher in the present than in the previous study. CONCLUSION: The prevalence of type 2 diabetes and IFG increased significantly among oral cancer patients in the last 14 years.

[Change in the incidence of diabetes mellitus in oral cancer patients based on a long-term comparative study]. / A diabetes mellitus elofordulási gyakoriságának változása a malignus szájüregi daganatos betegek körében hosszútávú összehasonító vizsgálat alapján.

Our research is focused on the incidence of diabetes mellitus and glucose metabolic disorders among oral cancer patients and the frequency of different oral localizations of cancer. Diabetes mellitus affects 7% of the Hungarian population. This study uses data spanning 14 years, with 2 datasets of 1998-1999 and 2012-2013, collected first hand by the authors. These datasets have led us to examine the blood glucose level in 267 patients with histologically confirmed malignant tumours in the oral cavity. Diabetes mellitus was found in 59 of them (22.1%), The blood glucose was elevated in 32 cases (12%). The most frequent tumor locations among the diabetic patients: labial, lingual and gingival tumors gingivae. Comparative epidemiological study demonstrates that in 2012-2013 dataset there was an increased observed percentage of people with diabetes mellitus [17.6% to 22.1%]. The percentage of patients with IFG (impaired fasting glucose) also increased from 9.8% to 12%. Overall the number of patients with glucose metabolic disorders climbed from 27.4% to 34.1%, (p > 0.05). Our intention of this introductory analysis is to emphasize the close connection of these two very important disease groups, and the wider spread of diabetes mellitus.