Beyond disclaimers: the need for a curation-based model of PubMed.

According to its own description, the biomedical meta-database PubMed exists "with the aim of improving health-both globally and personally." Unfortunately, PubMed contains an increasing amount of low-quality research that may detract from this goal. Currently, PubMed warns its users and protects itself from such problems with a disclaimer stating that the presence of any article, book, or document in PubMed does not imply an endorsement of, or concurrence with, its contents by the NLM, the National Institutes of Health (NIH), or the U.S. Federal Government. However, we are critical of a "disclaimer-only" stance and encourage PubMed to take further action against low-quality research being found and indexed in its database, and thus available for use. To address this problem, we offer two lines of reasoning to argue that PubMed should not function merely as a passive index of health-related research. Instead, we first argue that only trustworthy published research is able to further PubMed's goal of health improvement. Secondly, on the basis of surveys, we argue that researchers place a high level of trust in articles that are referenced in this meta-database. We cannot expect any one set of actors to ensure trustworthy content on PubMed, which requires collective responsibility among authors, peer reviewers, editors, and indexers alike. Instead, we propose a curation-based model that incorporates three mechanisms of collaborative content curation: open expert feedback on indexed content, journal auditing, and constant transparent reassessment of indexed entities.

Condylar motion analysis: a controlled, blinded clinical study on the interindividual reproducibility of standardized evaluation of computer-recorded condylar movements.

The present study investigated to what extent a systematic evaluation of electronic condylar motion recordings leads to reproducible results in different examiners. The study was based on the anonymized condylar motion recordings of 20 patients (Cadiax compact II system). These were recruited consecutively from the examinations in a center specializing in diagnosing and managing temporomandibular disorders (TMD). Four trained practitioners independently evaluated the identical movement recordings of all patients after calibration. The evaluation was based on the previously published evaluation system. The results were recorded digitally in a database. The findings were then compared, and the matching values were determined (Fleiss' Kappa). The evaluation, according to Fleiss' Kappa, showed that the consistency of the assessment of the findings among the examiners is excellent (mean value 0.88, p < 0.00001). The study shows that calibrated dentists achieved reproducible results using this evaluation system and computer-assisted reporting. Good reproducibility confirms the reliability of systematic evaluation of clinical motion analysis. The ambiguities uncovered and eliminated in the study should avoid misunderstandings in the future. Both factors establish the prerequisites for applying condylar motion analysis in clinical practice.

How dental teams can help patients with temporomandibular disorders receive general dental care: An International Delphi process.

BACKGROUND: Many patients with temporomandibular disorders (TMD) find it difficult to undergo dental care due to challenges caused by their condition, previous temporomandibular joint surgery or invasive dental procedures, and the impact of comorbid conditions. Managing routine dental care for some patients with TMD can be seen as challenging by some dental practitioners. OBJECTIVE: The objective of this study was to work with patients experiencing TMD and clinicians to co-produce recommendations aimed at helping general dentists to provide routine dental care for patients with TMD. METHODS: A modified Delphi process was used to co-produce recommendations. Six patients experiencing TMD, patient advocates and seven clinicians took part, including international TMD clinicians. Two meetings were held with patient participants, mediated by a trained facilitator. Recommendations suggested by patient participants were distributed to clinicians who were asked to add additional suggestions, but not to modify patients' recommendations unless to aid clarity. Additional themes were identified from the existing literature, and the recommendations were then reviewed by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) consortium. RESULTS: Recommendations were given to support patients before, during and after dental treatment. Participants identified specific and practical recommendations to help patients with TMD receive routine dental care, but also emphasised the need for professionals to listen sensitively to patients' concerns and work with patients in an empathetic and non-judgmental way. CONCLUSION: These recommendations, co-developed with patients experiencing TMD, should help dental professionals to provide supportive general dental care for patients with TMD.

Surface microbial contamination in a dental department. A 10-year retrospective analysis

Health care-associated infections may not only occur in a hospital setting, but also in dental clinics. Insufficient environmental decontamination could be one of the risk factors. In this retrospective study, we documented and analyzed the results of surface microbial contamination in a dental university-based department over an observation period of ten years. It was the aim of this investigation to identify general tendencies and potentially problematic sites on a long-term basis allowing suggestions for further improvement. Surface microbial contamination in the Department of Reconstructive Dentistry at the University Center for Dental Medicine in Basel, Switzerland, was evaluated on a regular basis using contact plates. Data gained between January 2007 and December 2016 was collected and summarized for statistical analysis. Although the overall surface microbial contamination was relatively low during the observation period, significant differences depending on localization and test sites were detected. Certain sites, such as the handle of the dentist's chair and computer surfaces, remained problematic. Continuous monitoring of surface microbial contamination can help to improve the hygiene level in a dental set-up. Further improvement might be achieved by avoiding hand-touch handles whenever possible and by relying on flat and easy-to-clean surfaces within the reach of the bacterial aerosol. However, during interventions that may pose a higher risk for the patient, additional measures should be taken by working under almost sterile conditions and by avoiding direct hand contact with problematic sites.

Association between temporomandibular disorders and pubertal development: A systematic review.

The aim of this systematic review (SR) was to determine the association between temporomandibular disorders (TMDs) and pubertal development. Due to the inadequacy of the conventional PICO (Population, Interventions, Comparisons and Outcome) format used for intervention-based SRs, the Joanna Briggs Institute's guidelines for synthesising evidence related to associations with a focus on aetiology were adopted. A search of the PubMed and LIVIVO databases covering the period from January 1980 to May 2018 yielded four publications, which fulfilled the inclusion criteria. Analysis of articles based on the Pubertal Development Scale showed that TMD prevalence increases with pubertal development. Although no sex difference in TMD prevalence and diagnosis was observed, more females reported TMD anamnestic variables, including accounts of temporomandibular pain during pubertal maturity. The higher prevalence of depression and somatisation during pubertal development may contribute to more TMD symptom reporting in females. More prospective studies incorporating standardised methods for diagnosing TMDs and detecting comorbid psychosocial and somatic problems are desired to further elucidate the relationship between TMDs and pubertal development.

Does professional experience save teeth? A survey among prosthodontists.

OBJECTIVES: The aim of this study is to investigate the effect of clinical experience and educational background on clinical decision-making of dentists presented with two prosthodontic cases. METHODS: A questionnaire-based survey was performed among 66 prosthodontists who were divided into two groups. The first group included clinicians from Belgium, Germany, and the Netherlands covering a wide spectrum of dental experience. The second (specialized) group consisted of German dentists performing their last module of a 3-year postgraduate master program in prosthodontics. Two patient scenarios of different complexities were presented to the participants who were asked to make an educated choice among seven therapeutic options. RESULTS: Sixty-six dentists participated. For case #1, 22 therapeutic suggestions were offered within the international group (variation 54%), while 17 options were chosen in the specialized group (variation 68%). For case #2, five (variation 12%) and four (variation 16%) different therapeutic options were planned in the groups, respectively. Treatment planning in combination with implants was clearly preferred by dentists with an experience of 20 years or less. Conversely, participants with more experience favored more conventional treatments. All differences were statistically significant (p < 0.05). CONCLUSION: Clinicians' experience and educational background had a clinically relevant influence on decision-making and treatment planning. A clear preference for implant-free therapies was noted for dentists with more than two decades of professional experience. CLINICAL SIGNIFICANCE: In complex cases, clinicians with more than 20 years of professional experience tend to save questionable teeth rather than to resort to implants. This interindividual variation might less likely occur when more external evidence is taken into account during the decision-making process.

Scarification in sub-Saharan Africa: social skin, remedy and medical import.

Various forms of body modification may be observed in sub-Saharan Africa. Hypotheses and theories of scarification and tribal marking in sub-Saharan Africa are described, plus the procedure of scarification, examples from several African countries, assumed effects in prevention and treatment of diseases, and the medical risks resulting from unsterile manipulation.

Labrets in Africa and Amazonia: medical implications and cultural determinants.

The custom of wearing labrets has a long tradition. Labrets appeared independently several thousand years ago in various culture groups in Asia, Europe, Africa and the Americas. Today, apart from diverse body modifications as increasingly practiced in western civilisations, lip plates and plugs are found among a small number of tribal groups only in Africa and Amazonia. We summarise the history of labrets in different societies, describe medical consequences of wearing lip plates and plugs for jaws and teeth and address relevant cultural issues.

Disk displacement, eccentric condylar position, osteoarthrosis - misnomers for variations of normality? Results and interpretations from an MRI study in two age cohorts.

BACKGROUND: Clinical decision-making and prognostic statements in individuals with manifest or suspected temporomandibular disorders (TMDs) may involve assessment of (a) the position of articular disc relative to the mandibular condyle, (b) the location of the condyle relative to the temporal joint surfaces, and (c) the depth of the glenoid fossa of the temporomandibular joints (TMJs). The aim of this study was twofold: (1) Determination of the prevalence of these variables in two representative population-based birth cohorts. (2) Reinterpretation of the clinical significance of the findings. METHODS: From existing magnetic resonance imaging (MRI) scans of the TMJs that had been taken in 2005 and 2006 from 72 subjects born between 1930 and 1932 and between 1950 and 1952, respectively, the condylar position at closed jaw was calculated as percentage displacement of the condyle from absolute centricity. By using the criteria introduced by Orsini et al. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:489-97, 1998), a textbook-like disc position at closed jaw was distinguished from an anterior location. TMJ morphology of the temporal joint surfaces was assessed at open jaw by measuring the depth of the glenoid fossa, using the method proposed by Muto et al. (J Oral Maxillofac Surg 52:1269-72, 1994). Frequency distributions were recorded for the condylar and disc positions at closed jaw. Student's t-test with independent samples was used as test of significance to detect differences of condylar positions between the age cohorts (1930 vs. 1950) and the sexes. The significance levels were set at 5%. First, the results from the measurement of the age cohorts were compared without differentiation of sexes, i.e., age cohort 1930-1932 versus age cohort 1950-1952. Subsequently, the age cohorts were compared by sex, i.e., men in cohort 1930-1932 versus men in cohort 1950-1952, and women in cohort 1930-1932 women men in cohort 1950-1952. RESULTS: In both cohorts, condylar position was characterized by great variability. About 50% of the condyles were located centrically, while the other half was either in an anterior or in a posterior position. In both female cohorts, a posterior position predominated, whereas a centric position prevailed among men. Around 75% of the discs were positioned textbook-like, while the remaining forth was located anteriorly. Age had no statistically significant influence on condylar or on disc position. Conversely, comparison between the age groups revealed a statistically significant decrease of the depth of the glenoid fossa in both older cohorts. This age-dependent changes may be interpreted as flattening of the temporal joint surfaces. CONCLUSIONS: We call for a re-interpretation of imaging findings because they may insinuate pathology which usually is not present. Instead, anterior or posterior positions of the mandibular condyle as well as an anterior location of the articular disc should be construed as a variation of normalcy. Likewise, flattening of articular surfaces of the TMJs may be considered as normal adaptive responses to increased loading, rather than pathological degenerative changes. TRIAL REGISTRATION: Not applicable.

Infant oral mutilation in East Africa - therapeutic and ritual grounds.

This paper reviews the practice and ritual traditions of infant oral mutilation, drawing on a literature search in PubMed and Google Scholar, historical reports, relevant textbooks, NGO materials and personal observations of the authors.

Digital Michigan splint - from intraoral scanning to plasterless manufacturing.

AIM: To investigate whether the fully digital, plasterless fabrication of clinically usable Michigan splints can be accomplished in a time- and cost-efficient manner. MATERIALS AND METHODS: Digital scans of the maxillary and mandibular arches of 10 subjects were acquired with an intraoral scanner (3Shape, Copenhagen) and used to generate virtual models of the dental arches. Jaw relation records were made using jigs placed on the subjects' anterior teeth, and silicone registration material was referenced to the jaw models. The data sets were then sent via the company's online portal to the dental laboratory, where computer-aided design (CAD) of the Michigan-type maxillary splints was performed. After receiving the designs, the splints were milled in-office using computer-aided manufacturing (CAM) software, and finished manually. During try-in, the splints where checked for fit, retention quality, and occlusal contacts of the mandibular teeth on the splint surfaces in static and dynamic occlusion. RESULTS: Fit and retention were clinically acceptable in 10 splints and 9 splints, respectively. The number of initial occlusal contacts on the splint surfaces ranged from 4 to 16. CONCLUSIONS: The question addressed in this study can be answered in the affirmative. Some of the main advantages of digital manufacturing of Michigan splints over traditional, conventional, impression-based manufacturing are the time-efficient manufacturing process, the high material quality, and the possibility of manufacturing duplicate splints.

Prevalence of self-reported jaw pain in Germany: two cross-sectional surveys of the general German population.

OBJECTIVES: This study evaluated the prevalence of jaw pain as a local, regional, or widespread pain condition and its association with psychosocial variables in a large representative group of the general population from all regions in Germany. METHODS: In two representative samples consisting of 2524 and 2515 subjects, respectively, the 7-day and 3-month pain prevalences were measured by using the Regional Pain Scale (RPS). Somatic symptom burden (somatization) and pain-related depression were assessed with the Patient Health Questionnaire and the Somatic Symptom Scale, respectively. Binary logistic regression was chosen to calculate the associations between demographic and psychological clinical predictor variables with jaw pain. RESULTS: The 7-day jaw pain prevalence was 4.0 % (95 % CI = 3.2-4.8). Of the subjects with jaw pain, only 9 % had local pain (1 pain site), while the remaining 91 % reported regional pain (2-5 pain sites), or widespread pain (6-19 pain sites). The 3-month prevalence of generally present jaw pain was 0.9 % (95 % CI = 0.6-1.0). Regional or widespread pain was present in 82 % of the participants. Jaw pain was predicted by somatic symptom burden (past 7 days, OR = 1.15 [95 % CI = 1.09-1.22]; past 3 months, OR = 1.13 [95 % CI = 1.02-1.25]), but not by depression. CONCLUSIONS: Most individuals with jaw pain have additional pain in other anatomical regions. They might also exhibit a greater risk for pain-associated somatic symptom burden. CLINICAL RELEVANCE: Assessment of pain distribution in the whole body and the use of a psychometric screening questionnaire for somatic symptom burden are recommended for individuals presenting with jaw pain in a clinical setting.

Motion analysis of the mandible: guidelines for standardized analysis of computer-assisted recording of condylar movements.

Mandibular movement recording has long been established as the method for the physiological design of indirect dental restorations. Condylar movement recording is the basis for individual, patient-specific programming of partially or fully adjustable articulators. The settings derived from these recordings can generally be used in both traditional mechanical and electronic virtual articulators. For many years, condylar movement recordings have also provided useful information about morphological conditions in the temporomandibular joints (TMJs) of patients with masticatory system dysfunction based on the recorded movement patterns. The latest clinical application for recorded jaw-motion analysis data consists of functional monitoring of the patient as a diagnostic and surveillance tool accompanying treatment. Published parameters for the analysis of such recordings already exist, but a standardized and practicable protocol for the documentation and analysis of such jaw-movement recordings is still lacking. The aim of this article by a multicenter consortium of authors is to provide an appropriate protocol with the documentation criteria needed to meet the requirements for standardized analysis of computer-assisted recording of condylar movements in the future.

SADMFR guidelines for the use of Cone-Beam Computed Tomography/ Digital Volume Tomography.

Cone-Beam Computed Tomography (CBCT) has been introduced in 1998. This radiological imaging procedure has been provided for dentistry and is comparable to computed tomography (CT) in medicine. It is expected that CBCT will have the same success in dental diagnostic imaging as computed tomography had in medicine. Just as CT is responsible for a significant rise in radiation dose to the population from medical X-ray diagnostics, CBCT studies will be accompanied by a significant increase of the dose to our patients by dentistry. Because of the growing concern for an uncritical and consequently rapidly increasing use of CBCT the Swiss Society of Dentomaxillofacial Radiology convened a first consensus conference in 2011 to formulate indications for CBCT, which can be used as guidelines. In this meeting, oral and maxillofacial surgery, orthodontics and temporomandibular joint disorders and diseases were treated and the most important and most experienced users of DVT in these areas were asked to participate. In general, a highly restrictive use of CBCT is required. Justifying main criterion for CBCT application is that additional, therapy-relevant information is expected that should lead to a significant benefit in patient care. All users of CBCT should have completed a structured, high-level training, just like that offered by the Swiss Society of Dentomaxillofacial Radiology.

Volatile compounds of Salvadora persica inhibit the growth of oral Candida species.

OBJECTIVE: The antibacterial effect of Salvadora persica has been demonstrated both in vitro and in vivo. However, data on its possible antifungal effect is scarce. Therefore, the aim of the present study was to investigate the antifungal effect of solid or pulverized S. persica on clinically important oral Candida species in vitro. DESIGN: The antifungal activity of S. persica was examined against reference strains and clinical isolates of oral Candida species by two different methods. In an agar diffusion test, solid as well as pulverized pieces of S. persica were tested. Mounting the S. persica test specimens inside the lid tested growth inhibition by volatile compounds. RESULTS: S. persica exhibited antifungal activity against all Candida species tested. In particular, the volatile compounds of solid test specimens demonstrated strong growth inhibition, whereas pulverized S. persica revealed no antifungal activity. Parameters such as storage and incubation time as well as the diameter of the sticks influenced the growth inhibition. CONCLUSIONS: Volatile compounds of S. persica have antifungal activity against oral Candida species. Storage time after harvesting may play an important role for the strength of this antifungal activity.

[Temporomandibular disorders: Evaluation of the usefulness of a self-test questionnaire]. / Kraniomandibuläre Dysfunktionen: Überprüfung der Eignung eines Selbsttest-Fragebogens.

BACKGROUND: A self-test questionnaire has been provided in the internet and in some dental offices for some time now. By using this questionnaire, interested individuals may assess whether they have a temporomandibular disorder (TMD) which might require therapy. It is the aim of this article to examine whether the 11 questions are apt to reliably identify patients with suspected TMDs within a given population. METHODS: Each question has been examined for its relevance by resorting to the current literature. Accordingly, the inclusion of each question into the self-test questionnaire has been rated as suitable or unsuitable. RESULTS: Only 2½ of the 11 questions are useful to detect individuals with as-yet undiagnosed TMDs. CONCLUSIONS: Due to its missing content validity, the questionnaire cannot be recommended.

[The therapy of masticatory muscle pain with oral splints]. / Therapie von Kaumuskelschmerzen mit Okklusionsschienen.

Myofascial masticatory muscle pain is the second most frequent pain-related complaint in the orofacial region. Like unspecific musculoskeletal pain in other body segments, masticatory muscle pain is characterised by a multifactorial aetiology. The aim of this article is to document the current knowledge about the therapy with oral splints. It is shown that in both the short and long term, oral appliances can achieve sufficient pain relief in the majority of patients. In chronic myofascial jaw pain associated with psychosocial impairment in patients, effectiveness of splint therapy is limited, though. Within an interdisciplinary pain management programme, additional involvement of a psychotherapist is essential.

[Pharmacological therapy of temporomandibular joint pain]. / Medikamentöse Therapie bei Kiefergelenkschmerzen.

Pharmacological interventions in temporomandibular joint (TMJ) pain differ from corresponding therapeutic interventions of jaw muscle (myofascial) pain. An actual systematic literature search lists and evaluates available articles on randomised controlled trials for treatment of arthralgia of the TMJ. On the basis of the few available trial reports, non-steroidal anti-inflammatory drugs (NSAIDs) seem to be effective, but side effects and drug interactions need to be considered. In relation to other therapeutic modalities, the rapidity of the onset of action of NSAIDs seems to be different, and the extension of side effects can be varied or reduced by changing the application route (oral versus topical). Palmitoylethanolamide (PEA) as dietary supplement for special medical purposes can apparently evoke positive therapeutic effects in TMJ arthralgia which need to be analysed in further studies.