Showing papers in "Evidence-based Dentistry in 2023"

Does dental trauma have impact on the oral health-related quality of life of children and adolescents?

Abstract: Does dental trauma have impact on the oral health-related quality of life of children and adolescents?Protocol was designed as per the best practices of evidence-based medicine, guidelines for umbrella reviews and registered in PROSPERO.PubMed, Scopus, Embase, Web of Sciences and Lilacs were searched for studies meeting the inclusion criteria from start of databases to 15th July 2021. Grey literature and registries of systematic review protocols were also searched. Hand searching of the references of included articles was also performed. The literature search was updated on 15th October 2021. Scrutiny of the titles and abstracts and later full text was done as per the inclusion and exclusion criteria.Self-designed pre-piloted form was used by two reviewers.AMSTAR-2 was used to assess the quality of systematic reviews, PRISMA was used to check reporting-characteristics and citation-matrix was used to evaluate study-overlap. Quality of evidence was assessed by using Kohler's-criteria.Qualitative synthesis was performed for describing the study characteristics, details of sampling and the tool of OHRQoL used. The meta-analytic data was used for evaluating the evidence and its strength for each of the outcomes.A significant impact of all types of TDI on OHRQoL in children and adolescents was observed. The effect of uncomplicated TDI on OHRQoL in children and all ages showed no difference from controls. Though the quality of evidence in these interpretations was weak.

Pulpotomy versus root canal treatment in permanent teeth with spontaneous pain: comparable clinical and patient outcomes, but insufficient evidence

Abstract: A systematic appraisal and statistical aggregation of primary studies.Scopus/ELSEVIER, PubMed/MEDLINE, Clarivate Analytics' Web of Science (i.e., Web of Science Core Collection-WoS, Korean Journal Database-KJD, Russian Science Citation Index-RSCI, SciELO Citation Index-SCIELO), and Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library.The complementary searches consisted of OpenGrey, Google Scholar (first 100 returns), Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, DART-Europe E-theses Portal-DEEP, Opening access to UK theses-EThOS.Human clinical trials studies in English language with at least 10 patients with mature or immature permanent teeth with pulpitis characterized by spontaneous pain in each arm (i.e., root canal treatment [RCT] and pulpotomy) at the end of the study, comparing the patient- (Primary: survival, pain, tenderness, swelling assessed by clinical history, clinical examination, and pain scales; Secondary: tooth function, need for further intervention, adverse effects; OHRQoL using a validated questionnaire) and clinical-reported outcomes (Primary: emerging apical radiolucency as per intraoral periapical radiograph or limited FOV CBCT scan; Secondary: radiological evidence of continued root formation and presence of sinus tract).Two independent review authors conducted study selection, data extraction and risk of bias (RoB) assessment and a third reviewer was consulted for solving disagreements. When insufficient or absent information, the corresponding author was reached out to for further explanation. The Cochrane RoB tool for randomized trials (RoB 2.0) was evaluated the quality of studies.The meta-analysis was performed on a fixed-effect model to estimate pooled effect size such as odds ratio (OR) and 95% confidence intervals (CIs) were performed using the R software. The quality of evidence assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach (GRADEpro GDT: GRADEpro Guideline Development Tool [software], McMaster University, 2015).Five primary studies were included. Four studies referred to a multicentre trial assessing postoperative pain and long-term success rate after pulpotomy compared with one-visit RCT in 407 mature molars. The other study was a multicentre trial assessing postoperative pain in 550 mature molars treated with pulpotomy and pulp capping with the calcium-enriched mixture (CEM), pulpotomy and pulp capping with mineral trioxide aggregate (MTA) and one-visit RCT. Both trials primarily reported first molars from young adults. When looking at the results of postoperative pain, all the trials included had a low RoB. However, when evaluating the clinical and radiographic outcomes of the included reports, it was determined that there was a high RoB. The meta-analysis found that the likelihood of experiencing pain (i.e., mild, moderate, or severe) at the 7th postoperative day was not affected by the type of intervention (OR = 0.99, 95% CI 0.63-1.55, I2 = 0%).The study design, risk of bias, inconsistency, indirectness, imprecision, and publication bias domains were used to grade the quality of evidence for postoperative pain between RCT and full pulpotomy, resulting in a 'High' grade. In the first year, clinical success was high for both interventions, with a rate of 98%. However, the success rate declined over time, with pulpotomy showing a 78.1% success rate and RCT showing a 75.3% success rate at the 5-year follow up.This systematic review was limited by the inclusion of only two trials, indicating a lack of sufficient evidence to draw definitive conclusions. Nonetheless, the available clinical data suggests that patient-reported pain outcomes do not differ significantly between RCT and pulpotomy at Day 7 postoperatively, and that the long-term clinical success rate of both treatments is comparable, as demonstrated by a single randomized control trial. However, to establish a more robust evidence base, additional high-quality randomized clinical trials, conducted by diverse research groups, are needed in this field. In conclusion, this review underscores the insufficiency of current evidence to draw solid recommendations.

Is there any association between genetically predicted periodontitis and ischemic stroke?

Abstract: Mendelian randomization study.Using a Mendelian randomization framework, the causal relationship between periodontitis [chronic periodontitis (CP) and aggressive periodontitis (AgP)] and ischemic stroke and its subtypes [cardioembolic (CE) stroke, large artery atherosclerosis (LAA), and small vessel occlusion (SVO)], were studied.Data from three large databanks, namely, UK Biobank, genome-wide association study of European ancestry, and MEGASTROKE consortium of European ancestry were used to obtain genetic variant information of CP, AgP, and ischemic stroke, respectively. UK Biobank contributed 950 cases of CP and 455,398 controls. Genome-wide association study of European ancestry contributed 851 AgP cases and 6836 controls. MEGASTROKE consortium of European ancestry contributed 34,217 cases of ischemic stroke and its subtypes and 406,111 controls. Statistical tests including inverse variant weighted method and sensitivity analyses were performed to analyse the causal inference and to verify the strength of the results.A total of 15 single nucleotide polymorphisms (SNPs) for CP was obtained as genetic instruments. No causal inference of CP on ischemic stroke was found. Among the ischemic stroke subtypes, with the exception of CE stroke, no significant causal inference of CP on LAA or SVO was found. A total of 9 single nucleotide polymorphisms (SNPs) for AgP was obtained as genetic instruments. No causal inference of AgP on ischemic stroke and its subtypes were found.Neither CP nor AgP was found to have a causal inference on ischemic stroke and most of its subtypes. A probable causal effect of CP on CE stroke was noted.