Consensus Report : 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis

Postoperative wound infections after a proctectomy Patient

AbstractPoor perineal wound healing and infections after proctectomy surgery cause a significant proportion of physical andpsychological morbidities, such as pain, leakage, and abscesses. In the long run, some of these symptoms will lead toextended periods of hospitalization. These kinds of postoperative complications are also associated with delays in possiblechemotherapy treatment. The aim of this study was to describe patient experiences of perineal wound infections followingproctectomy due to rectal cancer, and the importance of the communication with and the self-care support from the nursefor these patients. Five women and five men (61-87 years, median age 71 years) were included and interviewed. Aqualitative content analysis of the interviews was carried out and the following main categories emerged: ‘‘Managingpostoperative complications,’’ ‘‘Being independent,’’ ‘‘Feeling safe,’’ and ‘‘Accepting the situation.’’ A perineal woundinfection after a proctectomy is devastating for the individual patient. The limitations and changes to the patients’ lives turninto new daily routines, which force them to find new ways to live and to accept the situation. For many of them, theinfections remained for several months and, sometimes, for years. The ability to lead an independent life is drasticallyreduced, but through continuity in care it is possible to create a feeling of safety. Information, communication, and self-caresupport are all important and valuable factors for recovery. Specialized care containing an action plan is therefore needed inclinical practice to reduce the number of perineal wound infections postoperatively and should be initiated when the patientis discharged from the ward and continue until recover

Indication and timing of soft tissue augmentation at maxillary and mandibular incisors in orthodontic patients. A systematic review

Objective:To assess the indication and timing of soft tissue augmentation for prevention or treatment of gingival recession when a change in the inclination of the incisors is planned during orthodontic treatment.Materials and methods:Electronic database searches of literature were performed. The following electronic databases with no restrictions were searched: MEDLINE, EMBASE, Cochrane, and CENTRAL. Two authors performed data extraction independently using data collection forms.Results:No randomized controlled trial was identified. Two studies of low-to-moderate level of evidence were included: one of prospective and retrospective data collection and one retrospective study. Both implemented a periodontal intervention before orthodontics. Thus, best timing of soft tissue augmentation could not be assessed. The limited available data from these studies appear to suggest that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontics may yield satisfactory results with respect to the development or progression of gingival recessions. However, the strength of the available evidence is not adequate in order to change or suggest a possible treatment approach in the daily practice based on solid scientific evidence.Conclusions:Despite the clinical experience that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontic treatment may be a clinically viable treatment option in patients considered at risk, this treatment approach is not based on solid scientific evidence. Moreover, the present data do not allow to draw conclusions on the best timing of soft tissue augmentation when a change in the inclination of the incisors is planned during orthodontic treatment and thus, there is a stringent need for randomized controlled trials to clarify these open issues

Gingival recessions and the change of inclination of mandibular incisors during orthodontic treatment

Item does not contain fulltextSUMMARY A recent systematic review demonstrated that, overall, orthodontic treatment might result in a small worsening of periodontal status. The aim of this retrospective study was to test the hypothesis that a change of mandibular incisor inclination promotes development of labial gingival recessions. One hundred and seventy-nine subjects who met the following inclusion criteria were selected: age 11-14 years at start of orthodontic treatment (TS), bonded retainer placed immediately after treatment (T(0)), dental casts and lateral cephalograms available pre-treatment (TS), post-treatment (T(0)), 2 years post-treatment (T(2)), and 5 years post-treatment (T(5)). Depending on the change of lower incisor inclination during treatment (DeltaInc_Incl), the sample was divided into three groups: Retro (N = 34; DeltaInc_Incl -1 degree and 1 degree). Clinical crown heights of mandibular incisors and the presence of gingival recessions in this region were assessed on plaster models. Fisher's exact tests, one-way analysis of variance, and regression models were used for analysis of inter-group differences. The mean increase of clinical crown heights (T(0) to T(5)) of mandibular incisors ranged from 0.6 to 0.91 mm in the Retro, Stable, and Pro groups, respectively; the difference was not significant (P = 0.534). At T(5), gingival recessions were present in 8.8, 4.5, and 16.3 per cent patients from the Retro, Stable, and Pro groups, respectively. The difference was not significant (P = 0.265). The change of lower incisors inclination during treatment did not affect development of labial gingival recessions in this patient group

Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial

Aim To evaluate the clinical outcomes of the use of a xenogeneic collagen matrix (CM) in combination with the coronally advanced flap (CAF) in the treatment of localized recession defects. Material & Methods In a multicentre single-blinded, randomized, controlled, split-mouth trial, 90 recessions (Miller I, II) in 45 patients received either CAF + CM or CAF alone. Results At 6 months, root coverage (primary outcome) was 75.29% for test and 72.66% for control defects (p = 0.169), with 36% of test and 31% of control defects exhibiting complete coverage. The increase in mean width of keratinized tissue (KT) was higher in test (from 1.97 to 2.90 mm) than in control defects (from 2.00 to 2.57 mm) (p = 0.036). Likewise, test sites had more gain in gingival thickness (GT) (0.59 mm) than control sites (0.34 mm) (p = 0.003). Larger (>= 3 mm) recessions (n = 35 patients) treated with CM showed higher root coverage (72.03% versus 66.16%, p = 0.043), as well as more gain in KT and GT. Conclusions CAF + CM was not superior with regard to root coverage, but enhanced gingival thickness and width of keratinized tissue when compared with CAF alone. For the coverage of larger defects, CAF + CM was more effective

Patient-reported outcomes and aesthetic evaluation of root coverage procedures: a 12-month follow-up of a randomized controlled clinical trial

Aim: To assess patient-reported outcome measures (PROMs), aesthetics and stability of root coverage procedures from a previous 6-month RCT after 1\ua0year. Material & Methods: Forty-five patients (90 recessions) had received a coronally advanced flap (CAF\ua0=\ua0control) only or a xenogeneic collagen matrix in addition (CAF\ua0+\ua0CMX\ua0=\ua0test). Visual analogue scales (VAS) and questionnaires were used for PROMs and the root coverage aesthetic score (RES) for professional aesthetic evaluations. Results: VAS scores (patient satisfaction) amounted to 8.58\ua0\ub1\ua01.86 (test) versus 8.38\ua0\ub1\ua02.46 (control). Six patients preferred CAF\ua0+\ua0CMX concerning surgical procedure and aesthetics, six preferred CAF and 29 were equally satisfied. RES was 7.85\ua0\ub1\ua02.42 for the test group versus 7.34\ua0\ub1\ua02.90 for the controls. Root coverage (RC) was 76.28% for test and 75.05% for control defects. The mean increase in keratinized tissue width was higher in test (from 1.97 to 3.02\ua0mm) than in controls (from 2.00 to 2.64 mm) (p\ua0=\ua00.0413). Likewise, test sites showed more gain in gingival thickness (0.52\ua0mm) than control sites (0.27\ua0mm) (p\ua0=\ua00.0023). Compared to 6\ua0months, clinical outcomes were stable. Conclusions: Results for PROMs, RES and RC did not significantly differ between treatment groups. Thickness and width of keratinized tissue were enhanced following CAF\ua0+\ua0CMX compared to CAF alone