The use of panoramic radiographs to address the oral health needs of vulnerable Canadian populations.

Background: The high demand for oral health care services among vulnerable individuals combined with limited available resources requires a rethinking of the provision of oral health services. This study aimed to determine the usefulness of the dental panoramic radiograph (DPR) as an imaging tool to assess oral health and prioritize dental interventions in vulnerable patients. Methods: This observational and retrospective study evaluated charts of patients who attended Public Health Dental Clinics (PHDC), Alberta Health Services (AHS), in Calgary, Canada, between January 2018 and December 2019. Data collected included sex and age at the time of image acquisition. The following radiographic findings were gathered: the number of missing, present, decayed, restored, and impacted teeth; periapical lesions; retained root; periodontal bone loss; odontogenic and non-odontogenic lesions in the jaws; carotid calcification; and incidental radiographic findings with clinical relevance. Results: Of the 526 DPRs evaluated, 57.4% were from male patients and 42.6% were from female patients, with a mean age of 38.5 years. The average number of present teeth in females and males was 23.7 and 22.6, respectively. The most prevalent dental-related finding was periodontal bone loss (81.5%), followed by periapical lesions (59.6%) and impacted teeth (27%). Among non-dental findings, osseous lesions of the jaws were found in 10.4% of the patients, and carotid atheroma had a frequency of 3.2%. Conclusion: The DPR is a useful adjunct to the clinical exam in this specific population. It provides an opportunistic overview of their oral health and necessary support to establish priorities in oral health care in a public health setting.

Contexte : La forte demande de services de santé buccodentaire chez les personnes vulnérables, combinée aux ressources limitées disponibles, nécessite de repenser la prestation des services de santé buccodentaire. Cette étude vise à déterminer l'utilité de la radiographie panoramique comme outil d'imagerie pour évaluer la santé buccodentaire et prioriser les interventions dentaires chez les patients vulnérables. Méthodes : Cette étude observationnelle et rétrospective a évalué les dossiers des patients qui ont fréquenté les cliniques dentaires de santé publique d'Alberta Health Services (AHS) à Calgary, au Canada, entre janvier 2018 et décembre 2019. Les données recueillies comprenaient le sexe et l'âge au moment de l'acquisition de l'image. Les résultats radiographiques suivants ont été recueillis : nombre de dents manquantes, présentes, cariées, réparées et incluses; lésions périapicales; racine résiduelle; perte osseuse parodontale; lésions odontogéniques et non odontogéniques dans les mâchoires; calcification carotidienne; et résultats radiographiques accessoires pertinents sur le plan clinique. Résultats : Parmi les 526 radiographies panoramiques évaluées, 57,4 % provenaient d'hommes et 42,6 % de femmes, avec un âge moyen de 38,5 ans. Le nombre moyen de dents présentes chez les femmes et les hommes était de 23,7 et 22,6, respectivement. La découverte la plus courante liée aux soins dentaires était la perte osseuse parodontale (81,5 %), suivie des lésions périapicales (59,6 %) et des dents incluses (27 %). En ce qui concerne les résultats non liés aux soins dentaires, des lésions osseuses des mâchoires ont été repérées chez 10,4 % des patients, et l'athérome carotidien avait une fréquence de 3,2 %. Conclusion : La radiographie panoramique est un complément utile à l'examen clinique dans cette population particulière. Elle donne un aperçu de leur santé buccodentaire et le soutien nécessaire pour établir les priorités en matière de soins buccodentaires dans un contexte de santé publique.

Active learning in undergraduate classroom dental education- a scoping review.

INTRODUCTION: Previous reviews on active learning in dental education have not comprehensibly summarized the research activity on this topic as they have largely focused on specific active learning strategies. This scoping review aimed to map the breadth and depth of the research activity on active learning strategies in undergraduate classroom dental education. METHODS: The review was guided by Arksey & O'Malley's multi-step framework and followed the PRISMA Extension Scoping Reviews guidelines. MEDLINE, ERIC, EMBASE, and Scopus databases were searched from January 2005 to October 2022. Peer-reviewed, primary research articles published in English were selected. Reference lists of relevant studies were verified to improve the search. Two trained researchers independently screened titles, abstracts, and full-texts articles for eligibility and extracted the relevant data. RESULTS: In total, 93 studies were included in the review. All studies performed outcome evaluations, including reaction evaluation alone (n = 32; 34.4%), learning evaluation alone (n = 19; 20.4%), and reaction and learning evaluations combined (n = 42; 45.1%). Most studies used quantitative approaches (n = 85; 91.3%), performed post-intervention evaluations (n = 70; 75.3%), and measured student satisfaction (n = 73; 78.5%) and knowledge acquisition (n = 61; 65.6%) using direct and indirect (self-report) measures. Only 4 studies (4.3%) reported faculty data in addition to student data. Flipped learning, group discussion, problem-based learning, and team-based learning were the active learning strategies most frequently evaluated (≥6 studies). Overall, most studies found that active learning improved satisfaction and knowledge acquisition and was superior to traditional lectures based on direct and indirect outcome measures. CONCLUSION: Active learning has the potential to enhance student learning in undergraduate classroom dental education; however, robust process and outcome evaluation designs are needed to demonstrate its effectiveness in this educational context. Further research is warranted to evaluate the impact of active learning strategies on skill development and behavioral change in order to support the competency-based approach in dental education.

Are multi-detector computed tomography and cone-beam computed tomography exams and software accurate to measure the upper airway? A systematic review.

BACKGROUND: Cone-beam computed tomography (CBCT) has several applications in various fields of dental medicine such as diagnosis and treatment planning. When compared to computed tomography (CT), CBCT's radiation exposure dose is decreased by 3%-20%. However, CBCT produces more scattered signals and may present poorer image quality when compared to medical CT. OBJECTIVES: To review the findings regarding the accuracy of multi-detector computed tomography (MDCT) and CBCT and to compare the different software programs that segment the upper airway. SEARCH METHODS: Three databases (PubMed, Medline, and Web of Science) were searched for articles and a manual search was performed. SELECTION CRITERIA: The inclusion criteria were defined following the PICO framework: P-any patient with a CBCT or CT; I-dimensional evaluation of the upper airway using MDCT or CBCT; C-phantoms; O-the primary outcome was MDCT and CBCT accuracy, the secondary outcome was the evaluation and comparison of software programs used to segment the upper airway. DATA COLLECTION AND ANALYSIS: Articles that met eligibility criteria were assessed using the Critical Appraisal Skills Program Checklist. RESULTS: Among the 16 eligible studies, 6 articles referred to the accuracy of MDCTs or CBCTs and 10 to the accuracy of the software. Most articles were qualified as high quality. CONCLUSIONS: MDCT and CBCT scans' accuracy in upper airway dimensional measurements depends on machine brand, parameters, and segmentation technique. Regarding the segmentation technique, 12 programs were studied. Most either underestimated or overestimated upper airway measurements. In particular, OnDemand3D and INVIVO showed poor accuracy. On the contrary, Invesalius, and MIMICS were accurate in assessing nasal cavities when using an interactive threshold. However, results varied due to methodological differences among the studies. Finally, fully automatic segmentation based on artificial intelligence may represent the future of airway segmentation because it is faster and seems to be accurate. However, further studies are necessary. REGISTRATION: This study was registered in Prospero (International Prospective Register of Systematic Reviews) with the ID number CRD42022373998.

Effects of rapid maxillary expansion on head and cervical posture in growing patients: A systematic review.

OBJECTIVES: To identify and qualify the evidence of published studies evaluating whether rapid maxillary expansion (RME) treatment modifies the head and cervical posture in growing patients. MATERIALS AND METHODS: Electronic database searches were conducted until January 2021 using PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and LILACS. Grey literature was explored using ClinicalTrials, OpenGrey and Google Scholar. Trials involving participants who underwent RME were included. Risk of Bias (RoB) assessment was conducted using the Cochrane tool for randomized trials and the Methodological Index for Non-randomized Studies (MINORS) for non-randomized trials. The certainty level of evidence was evaluated through the Grading of Recommendations, Assessment, Development and Evaluation tool (GRADE). RESULTS: Six clinical trials were included. The RoB scores had unclear and high risks of bias. Low certainty of evidence suggested that the effects following RME include a decrease in craniocervical angulation, as well as a very low certainty of evidence for a decrease in head elevation, an increase in cervical lordosis, and an increase in the inclination of the cervical spine. CONCLUSIONS: There is low and very low evidence that RME alters the head and cervical posture in growing patients. Further investigation regarding long-term effects, possible changes due to somatic growth, and clinical relevance is needed.

Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis.

STUDY OBJECTIVES: This review aimed to evaluate the association between craniofacial features in children and adolescents with pediatric obstructive sleep apnea (OSA). METHODS: Seven databases were searched to fulfill our research objectives. Clinical studies that included participants younger than 18 years with fully diagnosed OSA or without OSA and that evaluated skeletal, soft craniofacial features, or dental arch morphology were considered for this review. The risk of bias and certainty of evidence were assessed. A meta-analysis was performed when low methodological and clinical heterogeneity were detected. This review followed the protocols recommended by the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA-2020) guidelines. RESULTS: Nine studies were identified at the end of the selection process, from which 5 did not report differences. Four studies reported differences between craniofacial features when OSA was compared to an asymptomatic control group. Mandibular retrognathia, reduced anteroposterior linear dimensions of the bony nasopharynx (decreased pharyngeal diameters at the levels of the adenoids), longer facial profile, and a narrower intercanine width were described among children with OSA. A meta-analysis was performed considering the studies with a similar methodological approach, and no differences were observed in all the considered cephalometric angles (SNA, SNB, ANB, NSBa, U1-L1, U1-SN). All the included studies were considered at low risk of bias even though some limitations were noted. CONCLUSIONS: Due to the very low to moderate level of certainty, neither an association nor a lack thereof between craniofacial morphology and pediatric OSA can be supported by these data. CITATION: Fagundes NCF, Gianoni-Capenakas S, Heo G, Flores-Mir C. Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2022;18(7):1865-1875.

Comparison of Adjusted Fluoride Concentrations Between Water Treatment Facilities and Endpoints in Alberta, Canada.

OBJECTIVES: This investigation aimed to determine whether fluoride concentration in water at the user endpoint remains the same as at the adjusted source, i.e., water treatment facilities. METHODS: Daycares in Alberta, Canada, were used as the endpoint to measure fluoride concentration. They were randomly selected from a list of 400 licensed daycares provided by the Ministry of Children's Services. All water samples collected from the daycares were sent to the accredited Alberta Centre for Toxicology (ACFT) for analysis within 7 days of collection. ACFT used ion chromatography to determine fluoride concentration levels. Statistics analyses were conducted using the software SPSS 25. RESULTS: Water samples were collected from 141 daycares in 35 municipalities. In municipalities that adjust fluoride content, public water is supplied by 8 Alberta Environment & Parks regulated water systems. Fluoride concentration in water samples examined at the endpoint ranged from 0.58 mg/L to 0.79 mg/L. The differences between fluoride concentration at the water treatment facilities and the daycares ranged from -0.03 to 0.22 mg/L. CONCLUSIONS: This study confirms that the concentration of fluoride adjusted at water treatment facilities in Alberta is maintained at endpoints at the approximate optimal level of 0.7 mg/L.

Oropharyngeal 3-dimensional changes after maxillary expansion with 2 different orthodontic approaches.

INTRODUCTION: The objective of this research was to compare the oropharyngeal volume and minimal cross-sectional area (MCA) changes after maxillary expansion using either the Damon system or Hyrax appliances as assessed through cone-beam computed tomography (CBCT) imaging. METHODS: Patients aged between 11 and 17 years with skeletal maxillary transverse discrepancy in need of maxillary expansion were included and allocated randomly into 1 of the 2 treatment groups, Damon or Hyrax. Patients underwent CBCT imaging at 2 time points: T1, after initial clinical evaluation before treatment, and T2, after completion of full orthodontic treatment. The CBCT data were assessed using Dolphin software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). In addition, a qualitative assessment of breathing function was done using the modified Nasal Obstruction and Septoplasty Effectiveness Scale questionnaire. RESULTS: A statistically significant increase in the oropharyngeal volume (2.23 mL; P = 0.005) and MCA (29.72 mm2; P = 0.007) after the completion of treatment (T2 - T1) for the Hyrax group was suggested. No statistically significant difference was found in the Damon group for volume (1 mL; P = 0.311) and for MCA (7.32 mm2; P = 0.643). In addition, no statistically significant difference was found in the breathing function in both treatment groups (P >0.05). CONCLUSIONS: Hyrax expansion followed by fixed appliances produced more dimensional upper airway changes at the oropharyngeal level than the Damon system approach. No breathing functional changes were noted in either samples.

Comparison of Skeletal and Dental Changes Obtained from a Tooth-Borne Maxillary Expansion Appliance Compared to the Damon System Assessed through a Digital Volumetric Imaging: A Randomized Clinical Trial.

The purpose of this study was to evaluate and compare dental and skeletal changes associated with the Damon and Rapid Maxillary Expander (RME) expansion using Cone-Beam Computed Tomography (CBCT). Eighty-two patients, from The University of Alberta Orthodontic Clinic, were randomly allocated to either Group A or B. Patients in Group A received orthodontic treatment using the Damon brackets. Patients in Group B received treatment using the Hyrax (a type of RME) appliance. CBCT images were taken two times (baseline and after expansion). The AVIZO software was used to locate 18 landmarks (dental and skeletal) on sagittal, axial, and coronal slices of CBCT images. Comparison between two groups showed that transverse movement of maxillary first molars and premolars was much greater in the Hyrax group. The lateral movements of posterior teeth were associated with buccal tipping of crowns. No clinically significant difference in the vertical or anteroposterior direction between the two groups was noted. Alveolar bone next to root apex of maxillary first premolar and molar teeth showed clinically significant lateral movement in the Hyrax group only. The comparison between two groups showed significantly greater transverse expansion of the first molar and first premolars with buccal tipping in the RME group.

Effectiveness and Perceptions of Flipped Learning Model in Dental Education: A Systematic Review.

When educators adopt flipped learning in their courses, online sources are assigned for students to study prior to class, and then the class period is devoted to face-to-face (F2F) interactions. The aims of this systematic review were to evaluate published research on the effectiveness of flipped learning for dental students' learning and on dental students' perceptions of the model and to report the results based on the first two phases of Kirkpatrick's model: reaction and learning. A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) was performed. Articles in which the objective was to determine the effectiveness of students' learning or students' perceptions of flipped learning in both dental and advanced dental education were collected. The Risk of Bias of the included studies was assessed using the MINORS Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Summary of Findings table. The authors screened the title and abstract of 650 studies; after application of inclusion criteria, eight articles remained for analysis. In those studies, a total of 572 dental students were participants. The effectiveness of flipped learning and conventional lectures was compared in five of the eight studies; three of the studies compared students' perceptions of flipped learning and the conventional format; and four of the studies assessed students' perceptions of flipped learning without comparison to another methodology. The findings suggest that flipped learning was an effective way to deliver knowledge in these eight studies. Time flexibility was a particular asset found in this review since flipped learning allowed each student to assimilate the educational material at her or his own pace.

Unilateral vicious mastication ­ The importance and resolution: A case report

Introduction: Patients presenting Temporomandibular Disorders (TMD) are common in our daily clinical practice. One of the possible conditions that lead to TMD is the habitual chewing side syndrome. Methods: In this case report a clinical approach is presented to manage the TMD related to unilateral vicious mastication. A 42 years old woman presented reporting headaches, difficulty to open mouth, presence of sensitivity in the left ear and TMJ region, soreness on the left side temporal region and sensitivity in the anterior inferior teeth. It was noted that the patient habitually clenched and ground teeth. Patient mentioned chew more on the left side. Results: After confirming the unilateral mastication, a modified therapy based on the Neuro occlusal Rehabilitation was applied through the use of a splint. After 60 days the patient described absence of the previous symptoms and pain relief. Conclusion: The evaluation of the masticatory pattern is often neglected; however, it is of great importance since it can lead to several conditions such as condyle wear, pain, alteration of the occlusal plane, deviation of the medial line, deviation of the mandible at mouth opening, bone alterations, Temporomandibular joint(TMJ) hypofunction, headache, among others.

Prevalence of reported percutaneous injuries on dentists: A meta-analysis.

OBJECTIVES: To answer the focused question, "What are the prevalence of percutaneous injuries (PIs) on dentists, the location with the highest prevalence, and the dental instrument most responsible for these injuries?" As secondary outcomes, the prevalence by geographic location, type of PI, sex distribution, and dentist's specialty were also considered. ELIGIBILITY CRITERIA: Observational descriptive studies investigating the prevalence of percutaneous injuries on dentists were included. SOURCES: Five electronic databases and three partial grey literature searches were performed. RISK OF BIAS: The MAStARI tool assessed the potential risk of bias (RoB) among the studies, while the GRADE approach determined the level of evidence. INCLUDED STUDIES: Among 2284 identified studies, 55 were included. Three studies were classified as low RoB, 17 as moderate RoB, and 35 as high RoB. The sample size ranged from 9 to 4107 dentists. SYNTHESIS OF RESULTS: The PI prevalence in dentists ranged from 7.72% (95% confidence interval [CI]: 0.93-37.59) to 66.74% (95%CI: 29.83-94.51). North America was the most affected region, while South America was the least affected. Differences between sexes were not significant. The dental bur was the most commonly reported dental instrument causing PIs. LIMITATIONS: Owing to the very low GRADE level of evidence, caution should be applied when considering these findings and further research is required. CONCLUSIONS: A high PI prevalence among dentists was noticed, and most were caused by dental burs. These findings imply that PIs should be considered by every dentist and proper measures instituted to reduce their prevalence.