The impact of imaging technologies on temporomandibular joint disorder diagnosis

Copyright: Copyright 2012 Elsevier B.V., All rights reserved.publishersversio

Sealants recommended to prevent caries : Are pit and fissure sealants effective in preventing decay in children and adolescents who are at risk of caries?

Copyright: Copyright 2016 Elsevier B.V., All rights reserved.Data sources Sources of studies were the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, Medline, Embase, Scisearch, SIGLE (System for Information on Grey Literature in Europe) CAplus¥, INSPEC*, JICST-EPLUS♯, NTIS★, PASCAL⋆, Database of Abstracts and Reviews (DARE), the UK National Health Service Economic Evaluation Database and Health Technology Assessment database. Reference lists from included articles and review articles were searched for additional relevant publications. All relevant studies in most languages were considered and translated.Study selection Articles were selected for inclusion in the review if they were randomised or quasi-randomised controlled trials of at least 12 months in duration and if sealants were used for preventing caries in children and adolescents of under 20 years of age. Both parallel group and split-mouth study designs were included. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars.Data extraction and synthesis In the first phase, two reviewers independently examined whether a given study was likely to be relevant on the basis of the title, keywords and abstract. In the second phase, four of the reviewers independently classified whether studies would be included in final analyses. Study authors were contacted for additional information. In the split-mouth studies, relative risk (RR) ratios were calculated for the paired differences of tooth surfaces being carious or not. In studies that compared resin-based sealant with no treatment, fixed-effect meta-analyses were used to combine the estimates of RR ratios. In one parallel-group study, the effect-estimate was calculated from data of occlusal surfaces of teeth included in the test and control groups.Results Eight trials were included in this review, of which seven were split-mouth studies and one a parallel-group study. Six studies provided data for comparing sealant with no treatment and three studies compared glass ionomers (GI) with resin-based sealants. The overall effectiveness of resin-based sealants in preventing dental decay on first molars was high. Based on five split-mouth studies with 5–10-year-old children there were significant differences in favour of the second-generation resin sealant compared with no treatment. Pooled RR values were 0.14, 0.24, 0.30 and 0.43 at 12, 24, 36 and 48–54 months, respectively. The reductions in caries therefore ranged from 86% at 12 months to 57% at 48–54 months. The 24-month parallel group study that compared second-generation resin sealant with control in 12–13-year old children also found significantly more caries in the control group children with a DFS of 0.65 (95% confidence interval, 0.47–0.83). Allocation concealment was classified as adequate in three of these six studies. The information on background levels of caries in the population, however, was insufficient to conduct further analyses that would allow an estimate of the effect of resin-based sealants related to baseline caries prevalence. Only one study provided data for the comparison of GI sealant and control. Based on this, there is not enough information to say whether GI sealants are effective or not. The results of three studies comparing resin sealants with GI sealants were conflicting and the meta-analyses were not carried out.Conclusions Sealing with resin-based sealants is recommended to prevent caries of the occlusal surfaces of permanent molars but we recommend that the caries prevalence level of both the individual and population should be taken into account. In practice, the benefit of sealing should be considered locally and specific guidelines for clinicians should be used. The methodological quality of published studies concerning pit and fissure sealants was poorer than expected.publishersversionPeer reviewe

No evidence to support use of glass ionomer as a fissure sealant in primary molars : In pre-school children at high risk of developing dental caries can glass ionomer fissure sealant placed on primary molars decrease the incidence of dental caries?

Copyright: Copyright 2016 Elsevier B.V., All rights reserved.Design Randomised controlled trial in primary care setting. Intervention508 children aged 18–30 months from high caries areas of South Wales with caries-free first primary molars were recruited to the trial after informed consent. All children (n=508) received a standard package of dental health education. Children in the test group (n=241) had their first primary molars sealed with glass ionomer. All the children were re-examined once at varying intervals between 12 and 30 months. Outcome measure Decayed, missing and filled teeth (dmft) and presence of glass ionomer sealant. Results Analysis of the caries data revealed no significant difference between test and control groups for any of the parameters examined. Examination of the confidence intervals showed no indication that there might be a difference even if the sample size had been increased. ConclusionsThere is no evidence that the intervention as used in this population had any effect on caries incidence and it cannot be recommended as a clinical procedure.publishersversionPeer reviewe

Which filling material is best in the primary dentition?

Copyright: Copyright 2010 Elsevier B.V., All rights reserved.publishersversio

Early childhood caries - Risk factors

Copyright: Copyright 2009 Elsevier B.V., All rights reserved.Design This was an Australian case-control study.Case-control selectionCases were recruited from children referred for dental treatment under general anaesthesia at free public hospitals in eight health service districts in the state of Queensland, Australia [early childhood caries (ECC) public cases], and three private specialist paediatric dental clinics (ECC private cases). Controls were selected from a full list of all childcare facilities in the area using a selection ratio of one in seven children. As dental health status of the children was unknown prior to recruitment, a subgroup of 62 children with ECC was recruited in the control cohort (ECC childcare) and formed the third source of ECC cases.AscertainmentThe teeth of children in dental clinics or childcare facilities were examined using lighting from an examiner's head-lamp, with the child placed on the laps of the mother and examiner. A child was considered to have ECC if at least one cavity was present. Caries was charted using the World Health Organization oral health survey basic methods criteria 1 and enamel hypoplasia using the modified Developmental Defects of Enamel index. Presence of Streptococcus mutans was also assessed. Mothers were interviewed and screened to determine their social, medical and dental histories; dental caries experience; absence or presence of plaque and gingival inflammation; and presence of S. mutans. Validated questionnaires were used to obtain social, medical, dental, dietary and toothbrushing histories of the mothers.Data analysisGroup comparisons of continuous variables (such as age and birthweight) were compared for statistical significance using analysis of variance. Categorical variables were compared for statistical difference across groups using contingency X 2 tests together with multinomial logistic regression modelling.ResultsA large proportion of children tested positive for S. mutans if their mothers also tested positive. A common risk indicator found in ECC children from childcare facilities and public hospitals was visible plaque [odds ratio (OR), 4.1; 95% confidence interval (CI), 1.0-15.9; and OR, 8.7; 95% CI, 2.3-32.9, respectively). Compared with ECC-free controls, the risk indicators specific to childcare cases were enamel hypoplasia (OR, 4.2; 95% CI, 1.0-18.3), difficulty in cleaning the child's teeth (OR 6.6; 95% CI, 2.2-19.8), presence of S. mutans (OR, 4.8; 95% CI, 0.7-32.6), sweetened drinks (OR, 4.0; 95% CI, 1.2-13.6) and maternal anxiety (OR, 5.1; 95% CI, 1.1-25.0). Risk indicators specific to public hospital cases were presence of S. mutans in the child (OR, 7.7; 95% CI, 1.3-44.6) or mother (OR, 8.1; 95% CI, 0.9-72.4), ethnicity (OR, 5.6; 95% CI, 1.4-22.1), and access of mother to pension or healthcare card (OR, 20.5; 95% CI, 3.5-119.9). By contrast, a history of chronic ear infections was found to be protective for ECC in childcare children (OR, 0.28; 95% CI, 0.09-0.82).ConclusionsThis case-control study showed that children of different socioeconomic backgrounds who have ECC share the common risk indicators of visible plaque, consumption of sugary snacks and presence of S. mutans. Additional risk indicators in children from childcare facilities were enamel hypoplasia, difficulty in cleaning the child's teeth, sweetened drinks and maternal anxiety, whereas ethnicity and mothers' access to pension or healthcare cards were specific to the public hospital cases.publishersversionPeer reviewe

Partial caries removal in symptomless teeth reduces the risk of pulp exposure : Is minimal (ultraconservative) caries removal as effective as complete caries removal?

Copyright: Copyright 2016 Elsevier B.V., All rights reserved.Data sources The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, PubMed and Embase databases were searched. The reference lists in relevant papers were checked.Study selection Studies chosen were randomised controlled trials and controlled clinical trials that compared minimal (ultraconservative) caries removal with complete caries removal in unrestored permanent and deciduous teeth.Data extraction and synthesis Outcome measures recorded were exposure of the nerve of the tooth (pulp) during caries removal, patient experience of symptoms of pulpal inflammation or necrosis, progression of caries under the filling, and time until the filling was lost or replaced. Because of the heterogeneity of the included studies, the overall estimate of effect was calculated using a random-effects model.ResultsFour studies met the inclusion criteria, comprising two stepwise excavation studies and two ultraconservative caries removal studies. Partial caries removal in symptomless, primary or permanent teeth reduces the risk of pulp exposure. No detriment to the patient was found in terms of pulpal symptoms in this procedure and there was no reported premature loss or deterioration of the restoration.Conclusions Partial caries removal in symptomless, primary or permanent teeth reduces the risk of pulp exposure. We found no detriment to the patient in terms of pulpal symptoms in this procedure. Therefore, partial caries removal is preferable to complete caries removal in the deep lesions in order to reduce the risk of carious exposure. There is insufficient evidence, however, to know whether it is necessary to re-enter and excavate further — although studies that have not re-entered do not report adverse consequences.publishersversionPeer reviewe

Prevention and management of dental decay in the pre-school child

Copyright: Copyright 2016 Elsevier B.V., All rights reserved.Scope and purposeThe guideline addresses effective strategies for preventing and managing dental decay in the preschool child. The nature of dental decay, its diagnosis and its epidemiology are reviewed. Methods for prevention and management of the disease at an individual and population level are reviewed and identification of children at increased risk of developing dental disease is discussed.MethodologyThe guideline was synthesised following the SIGN methodology (see www.sign.ac.uk/guidelines/fulltext/50/index.html). Searches were devised in collaboration with members of the guideline-development group. Searches for guidelines used Embase and Medline for the period 1996–2003 and a range of websites. Searches for systematic reviews, meta-analyses, randomised controlled trials (RCT) and observational studies were carried out with the Cochrane library, Embase and Medline (1990–2003, with a final update in June 2004). The definitions of the types of evidence and the grading of recommendations used in this guideline originate from the US Agency for Health Care Policy and Research1 and are set out in Tables 1 and 2.Review and updatingThe guideline was published in November 2005 and will be considered for updating in 3 years.Clinical recommendationsFor summary, see Table 3 below.Research recommendationsDuring the identification and critical appraisal of evidence for this guideline, it became apparent that there is limited evidence from high-quality, rigorous and methodologically sound research, and that the evidence currently available is often poor and incomplete. The guideline development group recommended that research should be carried out evaluating the benefits, and potential risks of fluorosis, of a community-based water fluoridation scheme in the current environment in Scotland, determining the relationship between oral health and health inequalities, exploring how dental services should be provided in areas of deprivation to minimise inequalities, evaluating community-based prevention programmes, including the involvement of health visitors, ascertaining the most effective combination of preventive, or preventive and restorative, interventions for different caries-risk groups, with different levels of deprivation, in different settings, examining the relationship between age and caries experience in the preschool child, describing the caries experience of preschool children with special needs, completing RCT to investigate the apparent caries-reducing effect of sugar-substituted sweets, investigating the effect of breast- and bottle-feeding on the development of early childhood caries in studies that control for other dietary factors, identifying effective interventions to improve the diet at weaning and preschool age, examining the effectiveness of structured nursery toothbrushing programmes, determining the optimum age at which to commence brushing children's teeth, exploring the effect of one-to-one dental health education on health outcomes, evaluating the effectiveness of dental health education programmes promoting the use of fluoride outside a structured programme, examining the effects of maternal use of xylitol in preventing caries in young children, identifying specific barriers to the implementation of oral health strategies, and how to overcome them, assessing the effectiveness of preventive advice delivered by the dental team in the dental practice environment, determining the effectiveness of fluoride and chlorhexidine varnishes, and fissure sealing in the primary dentition, conducting RCT in primary care to investigate the relative efficacy of conventional restorative management of carious primary teeth including the role of general anaesthetic compared with alternative techniques, and with a prevention-only approach, establishing the effect of remuneration on quality of dental care and availability of dental practitioners.publishersversionPeer reviewe

The effectiveness of fissure sealants : How effective are fissure sealants in preventing occlusal caries in children and adolescents?

Copyright: Copyright 2016 Elsevier B.V., All rights reserved.Data sources Sources were Medline, the Cochrane Library, reference lists of identified articles and selected textbooks.Study selection Selected studies were randomised clinical trials (RCT), quasi-RCT or controlled clinical trials that compared fissure sealing with no treatment or another preventive treatment, in children of up to 14 years of age at the beginning of study, with clearly described diagnostic criteria, and with at least 2 years follow-up. Studies reported in Danish, English, French, German, Italian, Norwegian, Spanish or Swedish were considered.Data extraction and synthesis Inclusion decisions and grading of the studies was done independently by two of the authors. The main outcome was caries increment and the measure of treatment effect was either relative risk (RR) reduction or prevented faction. A pooled estimate was calculated for studies using resin-based materials.Results Thirteen studies were included, eight of which used resin-based material and were selected for meta-analysis. The pooled estimate of effect for a single application of resin-based sealant on first permanent molars showed the RR of developing caries in sealed teeth relative to controls was 0.67 (95% confidence interval, 0.55–0.83), a reduction in RR of 33%. For repeated applications, the reduction in RR varied from 69 to 93%.Conclusions The review provides limited evidence that fissure sealing of first permanent molars with resin-based materials has a caries-preventive effect. The evidence is incomplete for second permanent molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations of both low and high caries risk.publishersversionPeer reviewe

Numerical validation of the incremental launching method of a steel bridge through a small-scale experimental study

The final publication is available at Springer via http://dx.doi.org/10.1007/s40799-016-0037-5This article presents an experimental and a numerical study of an incremental launching process of a steel bridge. The former is deployed in a scale-reduced laboratory,whereas the latter is performed using the finite elementmethod. The numerical simulation is based upon realistic transient boundary conditions and accurately reproduces the elastic response of the steel bridge during launching. This numerical approach is validated experimentally with the scale-reduced test performed at the laboratory. The properly validated numerical model is subsequently systematically employed as a simulation tool of the process. The proposed simulation protocol might be useful for design and monitoring purposes of steel bridges to be launched. Results concerning strains, stresses, and displacements might be inferred from the model and thus compared to field measurements obtained in situ. The conditions presented at the end of the article are potentially useful for researchers and practice engineers alike.Peer ReviewedPostprint (author's final draft

Lack of Association between BRAF Mutation and MAPK ERK Activation in Melanocytic Nevi

The mitogen-activated protein kinase (MAPK) extracellular signal-regulated kinase signaling pathway can be activated through mutations of V-RAF murine sarcoma viral oncogene homolog B1 (BRAF) oncogene, frequently found in melanoma (60%), common nevi (CN) (73–82%), and atypical nevi (AN) (52–80%). MAPK activation has been reported between 0 and 22% in nevi, and 86% of primary melanoma, without any knowledge of BRAF mutational status. We studied the correlation of MAPK activation status, BRAF mutation, and B-Raf expression in CN, AN, and melanoma. Using immunohistochemistry, phosphorylated (active) MAPK and B-Raf expression was studied in 24 CN, 21 AN, and 26 primary cutaneous melanomas (PM). BRAF mutations at codon 600 were assessed by PCR-RFLP. Active MAPK was detected in 29% of CN, 48% of AN, and 85% of PM. BRAF mutation was found in 67% of CN, 62% of AN, and 58% of PM. In all, 23% of CN, 54% of AN, and 93% of PM with BRAF mutation have activated MAPK. All lesions expressed B-Raf. BRAF mutation does not seem to be sufficient to produce MAPK activation in melanocytic nevi, and it is suggested that other events are needed to induce MAPK activation, that is, B-Raf overexpression, inhibition of MAPK phosphatases, or suppression of RAF kinase inhibitors