Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: A systematic review with meta-analysis

This study aimed to compare the effectiveness of 0.12% chlorhexidine alone and 0.12% chlorhexidine in combination with toothbrushing to prevent ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The Embase, Latin American and Caribbean Health Science Literature, PubMed, Scientific Electronic Library Online, Scopus, LIVIVO, Web of Science, Cochrane Library, OpenThesis, and Open Access Thesis and Dissertations databases were used. Only randomized controlled trials without restrictions on the year or language of publication were included. Two reviewers assessed the risk of bias using the Joanna Briggs Institute Critical Appraisal Tool. A meta-analysis using a random-effects model estimated the combined relative risk (RR). The Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty of the evidence. Initially, 2,337 studies were identified, of which 4 were considered in the systematic review and 3 in the meta-analysis (total sample: 796 patients). The studies were published between 2009 and 2017. All eligible studies had a low risk of bias. The meta-analysis revealed that the risk of VAP was 24% lower in patients receiving chlorhexidine combined with toothbrushing than in those receiving chlorhexidine alone (RR: 0.76; 95% confidence interval: 0.55-1.06), with moderate certainty of evidence and without statistical significance. In conclusion, considering the limitations of this study, a standard protocol for the prevention of VAP is not yet recommended. More studies with larger sample sizes are needed to draw strong conclusions. However, considering that toothbrushing is a simple intervention, it should be a common practice in mechanically ventilated patients, especially among patients with coronavirus disease

Efficacy of the laser at low intensity on primary burning oral syndrome:a systematic review

Primary burning mouth syndrome (BMS) is a chronic clinical condition of idiopathic mainly characterized by pain and a burning sensation in the oral cavity. The application of laser at low intensity therapy is a treatment option. This systematic review evaluated the efficacy of laser therapy in treating symptoms of burning mouth syndrome. The study was formulated according to the PRISMA and Cochrane guidelines. Seven databases were used as primary sources of research. Only randomized controlled clinical trials were included. The efficacy of the therapy was estimated comparing the values of the visual and numerical scales of pain before and after laser treatment, through qualitative analysis. The search resulted in 348 records and only eight filled the eligibility criteria and were included. All studies evaluated pain and / or a burning sensation considering a time interval of two to ten weeks. The total sample consisted of 314 patients submitted to treatment: 123 from the control group, who participated with laser off or with the tip blocked, and 191 from the intervention group, treated with low-level laser therapy. The female gender stood out and the average age of the participants was 60.89 years. The main symptoms reported were pain and a burning sensation in the oral mucosa and tongue. The parameters adopted by the authors for laser treatment were diverse and the variables were not fully described in the published studies. Visual analog and numerical scales were used to assess symptoms and only three studies showed statistical significance. It is suggested that laser therapy may be an effective alternative in the treatment of BMS. New randomized clinical trials should consider well-established protocols to better understand the efficacy of laser therapy without confounding the effects

Preemptive use of intravenous ibuprofen to reduce postoperative pain after lower third molar surgery: a systematic review of randomized controlled trials

This study aimed to systematically review the literature to assess the effect of preemptive intravenous ibuprofen on pain reduction after lower third molar surgery. Nine databases (PubMed, Scopus, LILACS, SciELO, Embase, Web of Science, Cochrane, Open Gray, and Open Thesis) were used as sources of research, including “grey literature.” The protocol was registered in PROSPERO. Only randomized clinical trials evaluating the effects of preemptive intravenous ibuprofen on pain during and immediately after the extraction of lower third molars were included, without restrictions of year and language. Two reviewers independently performed the study selection, data extraction, and assessment of the risk of bias. The “Joanna Briggs Institute for Randomized Controlled Trials” tool was used to assess the risk of bias. Each study was categorized according to the percentage of positive responses to the questions corresponding to the assessment instrument. The results were measured narratively/descriptively. The initial search resulted in 3,257 records, of which only three studies (n=150 participants) met the eligibility criteria and were included in the qualitative analysis. All studies were published in 2019. The risk of bias ranged from low to moderate. Two studies found significant pain reduction within 48 h after the procedure. In conclusion, the use of preemptive intravenous ibuprofen for extracting third molars reduces pain and analgesic consumption after the surgical procedure

Accuracy of computer-aided image analysis in the diagnosis of odontogenic cysts:a systematic review

This study aimed to search for scientific evidence concerning the accuracy of computer-assisted analysis for diagnosing odontogenic cysts. A systematic review was conducted according to the PRISMA statements and considering eleven databases, including the grey literature. Protocol was registered in PROSPERO (CRD 42020189349). The PECO strategy was used to define the eligibility criteria and only studies involving diagnostic accuracy were included. Their risk of bias was investigated using the Joanna Briggs Institute Critical Appraisal tool. Out of 437 identified citations, five papers, published between 2006 and 2019, fulfilled the criteria and were included in this systematic review. A total of 5,264 images from 508 lesions, classified as radicular cyst, odontogenic keratocyst, lateral periodontal cyst, glandular odontogenic cyst, or dentigerous cyst, were analyzed. All selected articles scored low risk of bias. In three studies, the best performances were achieved when the two subtypes of odontogenic keratocysts (solitary or syndromic) were pooled together, the case-wise analysis showing a success rate of 100% for odontogenic keratocysts and radicular cysts, in one of them. In two studies, the dentigerous cyst was associated with the majority of misclassifications, and its omission from the dataset improved significantly the classification rates. The overall evaluation showed all studies presented high accuracy rates of computer-aided systems in classifying odontogenic cysts in digital images of histological tissue sections. However, due to the heterogeneity of the studies, a meta-analysis evaluating the outcomes of interest was not performed and a pragmatic recommendation about their use is not possible

Combination of tooth brushing and chlorhexidine compared to exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: a systematic review with meta-analysis

Ventilator-associated pneumonia (VAP) is a pulmonary infection that develops in a patient on mechanical ventilation for more than 48 hours. It is the most common lower respiratory tract infection in mechanically ventilated patients. Oral hygiene is an important factor in preventing VAP. Chlorhexidine is an antiseptic with bacteriostatic and bactericidal effect, and its effect can be potentiated by mechanical removal of microorganisms through tooth brushing. The aim of this study was to compare the efficacy of 0.12% chlorhexidine versus 0.12% chlorhexidine associated with mechanical brushing to prevent VAP. However, a systematic review of randomized controlled trials was initially performed following the PRISMA-P and Cochrane guidelines. Then, a meta-analysis was performed with publications that reported the frequency of VAP in the interest groups of this study. Initially, 2,337 studies were identified, four of which were considered in the systematic review and three in the meta-analysis. The included studies had a low risk of bias. All studies considered in the systematic review showed a lower frequency of VAP in patients undergoing chlorhexidine-associated oral hygiene protocol compared to the exclusive use of chlorhexidine, but in none of them this difference was statistically significant. In the meta-analysis, aggregated results revealed that the risk of VAP was 24% lower for patients receiving CHX and tooth brushing compared with those receiving CHX alone, but this reduction was not statistically significant either. Conclusion: There was convergence of study results regarding the beneficial effect of combined use of brushing and chlorhexidine, however the aggregated results of these studies did not result in significant difference in VAP frequency.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorDissertação (Mestrado)A pneumonia associada à ventilação (PAV) é uma infecção pulmonar que se desenvolve em um paciente colocado em ventilação mecânica por mais de 48 horas. É a infecção no trato respiratório inferior mais comum em pacientes sob ventilação mecânica. A higiene oral é um importante fator na prevenção da PAV. A clorexidina é um antisséptico de efeito bacteriostático e bactericida, e seu efeito pode ser potencializadopela remoção mecânica de microrganismos através da escovação dental. O objetivo deste trabalho foi comparar a eficácia da clorexidina 0,12% versus clorexidina 0,12% associada à escovação mecânica na prevenção da PAV. Para tando, foi realizada inicialmente uma revisão sistemática de ensaios clínicos randomizados seguindo as diretrizes PRISMA-P e Cochrane. Em seguida, uma metanálise foi realizada com publicações que houvessem informado a frequência de PAV nos grupos de interesse deste estudo. Foram identificados inicialmente 2.337 trabalhos, dos quais quatro foram considerados na revisão sistemática e três na metanálise. Os estudos incluídos apresentaram baixo risco de viés. Todos os trabalhos considerados na revisão sistemática mostraram frequência menor de PAV em pacientes submetidos a protocolo de higiene oral com escovação associada à clorexidina, comparados ao uso exclusivo de clorexidina, todavia em nenhum deles essa diferença foi estatisticamente significativa. Na metanálise, os resultados agregados revelaram que o risco de PAV era 24% menor para pacientes que receberam CHX e escovação de dentes em comparação com aqueles que receberam CHX apenas, mas essa redução tampouco se mostrou estatisticamente significativa. Conclusão: Houve convergência dos resultados dos estudos quanto a efeito benéfico do uso combinado da escovação e clorexidina, todavia os resultados agregados desses estudos não resultaram em diferença significativa na frequência de PAV