283 research outputs found
impact on overweight and obesity in Germany
Background Consumption of sugar-sweetened beverages (SSBs) increases the risk
of overweight and obesity. Taxing SSBs could decrease daily energy consumption
and body weight. This model-based study evaluated the impact of a 20% SSB-
sales tax on overweight and obesity in the context of Germany. Methods The
population aged 15–79 years was modelled. Taxation was assumed to affect
energy consumption via demand elasticities, which affected weight and BMI.
Model-based analysis was performed to estimate the tax impact on BMI in
different age, gender and income groups. Results Implementing a 20% SSB tax
reduced energy consumption mainly in younger age groups, males, and those with
low income. Taxation decreased the mean BMI in younger groups, with the
largest decrease in those aged 20–29 years, while effects in groups 60 years
or above were minimal. In absolute terms, taxation was estimated to avoid
1,028,000 (−3% relative reduction) overweight individuals and 479,000 obese
individuals (−4%). Overweight decreased the most in males aged 20–29 years
(408,000 fewer cases /−22%), the same applied for obesity (204,000/−22%).
Conclusions An SSB tax could have significant impact on overweight and
obesity, which could translate into substantial reductions of morbidity and
mortality
Artificial intelligence for detecting periapical radiolucencies: A systematic review and meta-analysis
Objectives: Dentists’ diagnostic accuracy in detecting periapical radiolucency varies considerably. This systematic
review and meta-analysis aimed to investigate the accuracy of artificial intelligence (AI) for detecting periapical
radiolucency.
Data: Studies reporting diagnostic accuracy and utilizing AI for periapical radiolucency detection, published until
November 2023, were eligible for inclusion. Meta-analysis was conducted using the online MetaDTA Tool to
calculate pooled sensitivity and specificity. Risk of bias was evaluated using QUADAS-2.
Sources: A comprehensive search was conducted in PubMed/MEDLINE, ScienceDirect, and Institute of Electrical
and Electronics Engineers (IEEE) Xplore databases. Studies reporting diagnostic accuracy and utilizing AI tools
for periapical radiolucency detection, published until November 2023, were eligible for inclusion.
Study selection: We identified 210 articles, of which 24 met the criteria for inclusion in the review. All but one
study used one type of convolutional neural network. The body of evidence comes with an overall unclear to high
risk of bias and several applicability concerns. Four of the twenty-four studies were included in a meta-analysis.
AI showed a pooled sensitivity and specificity of 0.94 (95 % CI = 0.90–0.96) and 0.96 (95 % CI = 0.91–0.98),
respectively.
Conclusions: AI demonstrated high specificity and sensitivity for detecting periapical radiolucencies. However,
the current landscape suggests a need for diverse study designs beyond traditional diagnostic accuracy studies.
Prospective real-life randomized controlled trials using heterogeneous data are needed to demonstrate the true
value of AI.
Clinical significance: Artificial intelligence tools seem to have the potential to support detecting periapical radiolucencies on imagery. Notably, nearly all studies did not test fully fledged software systems but measured the
mere accuracy of AI models in diagnostic accuracy studies. The true value of currently available AI-based
software for lesion detection on both 2D and 3D radiographs remains uncertai
Quality of Information Regarding Repair Restorations on Dentist Websites: Systematic Search and Analysis
Background: Repairing instead of replacing partially defective dental restorations represents a minimally invasive treatment concept, and repairs are associated with advantages over complete restoration replacement. To participate in the shared decision-making process when facing partially defective restorations, patients need to be aware of the indications, limitations, and advantages or disadvantages of repairs. Patients are increasingly using the internet to gain health information like this online.
Objective: We aimed to assess the quality of German-speaking dentist websites on repairs of partially defective restorations.
Methods: Three electronic search engines were used to identify German-speaking websites of dental practices mentioning repairs. Regarding information on repairs, websites were assessed for (1) technical and functional aspects, (2) comprehensiveness of information, and (3) generic quality and risk of bias. Domains 1 and 3 were scored using validated tools (LIDA and DISCERN). Comprehensiveness was assessed using a criterion checklist related to evidence, advantages and disadvantages, restorations and defects suitable for repairs, and information regarding technical implementation. Generalized linear modeling was used to assess the impact of practice-specific parameters (practice location, practice setting, dental society membership, and year of examination or license to practice dentistry) on the quality of information. An overall quality score was calculated by averaging the quality scores of all three domains and used as primary outcome parameter. Quality scores of all three domains were also assessed individually and used as secondary outcomes.
Results: Fifty websites were included. The median score of quality of information was 23.2% (interquartile range [IQR] 21.7%-26.2%). Technical and functional aspects (55.2% [IQR 51.7%-58.6%]) showed significantly higher quality than comprehensiveness of information (8.3% [IQR 8.3%-16.7%]) and generic quality and risk of bias (3.6% [IQR 0.0%-7.1%]; P.05/generalized linear modeling).
Conclusions: The quality of German-speaking dentist websites on repairs was limited. Despite sufficient technical and functional quality, the provided information was neither comprehensive nor trustworthy. There is great need to improve the quality of information to fully and reliably inform patients, thereby allowing shared decision making
Cost-effectiveness of caries excavations in different risk groups − a micro- simulation study
Background Whilst being the most prevalent disease worldwide, dental caries is
increasingly concentrated in high-risk populations. New caries treatments
should therefore be evaluated not only in terms of their cost-effectiveness in
individuals, but also their effects on the distribution of costs and benefits
across different populations. To treat deep caries, there are currently three
strategies: selective (one-step incomplete), stepwise (two-step incomplete)
and complete excavation. Building on prior research that found selective
excavation generally cost-effective, we compared the costs-effectiveness of
different excavations in low- and high-risk patients, hypothesizing that
selective excavation had greater cost-effectiveness-advantages in patients
with high compared with low risk. Methods An average tooth-level Markov-model
was constructed following the posterior teeth in an initially 18-year old male
individual, either with low or high risk, over his lifetime. Risk was assumed
to be predicted by several parameters (oral hygiene, social position, dental
service utilization), with evidence-based transition probabilities or hazard
functions being adjusted for different risk status where applicable. Total
lifetime treatment costs were estimated for German healthcare, with both mixed
public-private and only private out-of-pocket costs being calculated. For
cost-effectiveness-analysis, micro-simulations were performed and joint
parameter uncertainty introduced by random sampling of probabilities. Cohort
analyses were used for assessing the underlying reasons for potential
differences between strategies and populations. Results Selective excavation
was more effective and less costly than both alternatives regardless of an
individual’s risk. All three strategies were less effective and more costly in
patients with high compared with low risk, whilst the differences between risk
groups were smallest for selective excavation. Thus, the cost-effectiveness-
advantages of selective excavation were more pronounced in high-risk groups,
who also benefitted the most from reduced private out-of-pocket treatment
costs. Conclusions Whilst caries excavation does not tackle the underlying
sources for both the development of caries lesions and the potential
differences of individuals’ risk status, selective excavation seems most
suitable to treat deep lesions, especially in patients with high risk, who
over-proportionally benefit from the resulting health-gains and cost-savings
Environment-Specific Probiotic Supernatants Modify the Metabolic Activity and Survival of Streptococcus mutans in vitro
A range of studies showed probiotics like Streptococcus oligofermentans and Limosilactobacillus reuteri to inhibit the cariogenic activity and survival of Streptococcus mutans, possibly via the production of substances like H2O2, reuterin, ammonia and organic acids. We aimed to assess the environment-specific mechanisms underlying this inhibition. We cultured L. reuteri and S. oligofermentans in various environments; minimal medium (MM), MM containing glucose (MM+Glu), glycerol (MM+Gly), lactic acid (MM+Lac), arginine (MM+Arg) and all four substances (MM+all) in vitro. Culture supernatants were obtained and metabolite concentrations (reuterin, ammonia, H2O2, lactate) measured. S. mutans was similarly cultivated in the above six different MM variation media, with glucose being additionally added to the MM+Gly, MM+Lac, and MM+Arg group, with (test groups) and without (control groups) the addition of the supernatants of the described probiotic cultures. Lactate production by S. mutans was measured and its survival (as colony-forming-units/mL) assessed. L. reuteri environment-specifically produced reuterin, H2O2, ammonia and lactate, as did S. oligofermentans. When cultured in S. oligofermentans supernatants, lactate production by S. mutans was significantly reduced (p < 0.01), especially in MM+Lac+Glu and MM+all, with no detectable lactate production at all (controls means ± SD: 4.46 ± 0.41 mM and 6.00 ± 0.29 mM, respectively, p < 0.001). A similar reduction in lactate production was found when S. mutans was cultured in L. reuteri supernatants (p < 0.05) for all groups except MM+Lac+Glu. Survival of S. mutans cultured in S. oligofermentans supernatants in MM+Lac+Glu and MM+all was significantly reduced by 0.6-log10 and 0.5-log10, respectively. Treatment with the supernatant of L. reuteri resulted in a reduction in the viability of S. mutans in MM+Gly+Glu and MM+all by 6.1-log10 and 7.1-log10, respectively. Probiotic effects on the metabolic activity and survival of S. mutans were environment-specific through different pathways
protocol
Background Clinical trials on caries lesion management use an abundance of
outcomes, hampering comparison or combination of different study results and
their efficient translation into clinical practice. Core outcome sets are an
agreed standardized collection of outcomes which should be measured and
reported in all trials for a specific clinical area. We aim to develop a core
outcome set for trials investigating management of caries lesions in primary
or permanent teeth conducted in primary or secondary care encompassing all
stages of disease. Methods To identify existing outcomes, trials on prevention
and trials on management of caries lesions will be screened systematically in
four databases. Screening, extraction and deduplication will be performed by
two researchers until consensus is reached. The definition of the core outcome
set will by based on an e-Delhi consensus process involving key stakeholders
namely patients, dentists, clinical researchers, health economists,
statisticians, policy-makers and industry representatives. For the first stage
of the Delphi process, a patient panel and a separate panel consisting of
researchers, clinicians, teachers, industry affiliated researchers, policy-
makers, and other interested parties will be held. An inclusive approach will
be taken to involve panelists from a wide variety of socio-economic and
geographic backgrounds. Results from the first round will be summarized and
fed back to individuals for the second round, where panels will be combined
and allowed to modify their scoring in light of the full panel’s opinion.
Necessity for a third round will be dependent on the outcome of the first two.
Agreement will be measured via defined consensus rules; up to a maximum of
seven outcomes. If resources allow, we will investigate features that
influence decision making for different groups. Discussion By using an
explicit, transparent and inclusive multi-step consensus process, the planned
core outcome set should be justifiable, relevant and comprehensive. The
dissemination and application of this core outcome set should improve clinical
trials on managing caries lesions and allow comparison, synthesis and
implementation of scientific data
Radiographic, antibacterial and bond-strength effects of radiopaque caries tagging
Selectively excavated carious lesions remain radiographically detectable.
Radiopaque tagging could resolve the resulting diagnostic uncertainty. We
aimed to evaluate if tagging depends on lesions depths, is antibacterial, or
affects dentin bond-strengths. Artificial lesions (depth-range: 152–682 μm, n
= 34/group) were induced in human dentin samples, evaluated using wavelength-
independent microradiography, treated with one of two tagging materials (70%
SnCl2, 30% SnF2) and re-evaluated. To evaluate antimicrobial effects, 40
dentin samples were submitted to a Lactobacillus rhamnosus invasion-model.
Infected samples were treated with placebo, 0.2% chlorhexidine, SnCl2, SnF2 (n
= 10/group). Dentin was sampled and colony-forming units/mg determined. Micro-
tensile bond-strengths of adhesive restorations (OptiBond FL, Filtek Z250) to
tagged or untagged, sound and carious dentin were assessed (n = 12/group).
Tagged surfaces were evaluated microscopically and via energy-dispersive X
-ray-spectroscopy (EDS). Tagging effects of both materials decreased with
increasing lesion depths (p < 0.001). Un-/chlorhexidine-treated dentin
contained significantly more viable bacteria (median 7.3/3.7 × 105 CFU/mg)
than tagged dentin (no CFU detectable, p < 0.001). Tagging decreased bond
strengths (p < 0.001) on sound (−22%/−33% for SnCl2/SnF2) and carious dentin
(−50%/−54%). This might be due to widespread tin chloride or fluoride
precipitation, as detected via microscopy and EDS. While radiopaque tagging
seems beneficial, an optimized application protocol needs to be developed
prior clinical use
Design and Validity of Randomized Controlled Dental Restorative Trials
Background: The evidence stemming from trials on restorative materials is
shaped not only by trial findings, but also trial design and validity. We
aimed to evaluate both aspects in randomized controlled dental restorative
trials published from 2005–2015. Methods: Using systematic review methodology,
we retrieved trials comparing restorative or adhesive dental materials. Two
authors independently assessed design, risk of bias, registration status, and
findings of trials. Descriptive and regression analyses were performed.
Results: 114 studies on 15,321 restorations placed mainly in permanent teeth
of 5232 patients were included. Per trial, the median number of patients was
37 (25th/75th percentiles: 30/51). Follow-up was 24 (20/48) months. Seventeen
percent of trials reported on sample size calculations, 2% had been
registered. Most trials (90%) used US Public Health Service (USPHS) criteria,
and had a high risk of bias. More recent trials were more likely to have been
registered, to have reported on sample size calculations, to be of low risk of
bias, and to use other than USPHS-criteria. Twenty-three percent of trials
yielded significant differences between groups. The likelihood of such
differences was significantly increased in older studies, studies with
potential reporting bias, published in journals with high impact factor (>2),
longer follow-up periods, and not using USPHS-criteria. Conclusions: The
majority of dental restorative trials published from 2005–2015 had limited
validity. Risk of bias decreased in more recent trials. Future trials should
aim for high validity, be registered, and use defined and appropriate sample
sizes, follow-up periods, and outcome measures
Probiotic Effects on Multispecies Biofilm Composition, Architecture, and Caries Activity In Vitro
While probiotics have been tested for their anti-caries effect in vitro and also clinically, there is a lack of understanding of their effects on complex dental biofilms. We assessed two probiotics, Lactobacillus reuteri and Streptococcus oligofermentans, on a continuous-cultured model containing Streptococcus mutans, Lactobacillus rhamnosus and Actinomyces naeslundii. Cariogenic biofilms were grown on bovine enamel specimens and daily challenged with L. reuteri or S. oligofermentans whole culture (LC/SC) or cell-free supernatant (LS/SS) or medium only (negative control, NC) (n = 21/group) for 10 days. Biofilm was assessed via counting colony-forming units, quantitative polymerase chain reaction, and fluorescence in situ hybridization. Caries activity was determined by pH measurements and by assessing mineral loss (ΔZ) using transverse microradiography. Both LC and SC significantly reduced total and strain-specific cariogenic bacterial numbers (p < 0.05). ΔZ was reduced in LC (mean ± SD: 1846.67 ± 317.89) and SC (3315.87 ± 617.30) compared to NC (4681.48 ± 495.18, p < 0.05). No significant reductions in bacterial numbers and ΔZ was induced by supernatants. Biofilm architecture was not considerably affected by probiotic applications. Viable probiotics L. reuteri and S. oligofermentans, but not their culture supernatants, could reduce the caries activity of multi-species biofilms in vitro
Outcomes in Trials for Management of Caries Lesions (OuTMaC):protocol
Background
Clinical trials on caries lesion management use an abundance of outcomes, hampering comparison or combination of different study results and their efficient translation into clinical practice. Core outcome sets are an agreed standardized collection of outcomes which should be measured and reported in all trials for a specific clinical area. We aim to develop a core outcome set for trials investigating management of caries lesions in primary or permanent teeth conducted in primary or secondary care encompassing all stages of disease.
Methods
To identify existing outcomes, trials on prevention and trials on management of caries lesions will be screened systematically in four databases. Screening, extraction and deduplication will be performed by two researchers until consensus is reached. The definition of the core outcome set will by based on an e-Delhi consensus process involving key stakeholders namely patients, dentists, clinical researchers, health economists, statisticians, policy-makers and industry representatives. For the first stage of the Delphi process, a patient panel and a separate panel consisting of researchers, clinicians, teachers, industry affiliated researchers, policy-makers, and other interested parties will be held. An inclusive approach will be taken to involve panelists from a wide variety of socio-economic and geographic backgrounds. Results from the first round will be summarized and fed back to individuals for the second round, where panels will be combined and allowed to modify their scoring in light of the full panel’s opinion. Necessity for a third round will be dependent on the outcome of the first two. Agreement will be measured via defined consensus rules; up to a maximum of seven outcomes. If resources allow, we will investigate features that influence decision making for different groups.
Discussion
By using an explicit, transparent and inclusive multi-step consensus process, the planned core outcome set should be justifiable, relevant and comprehensive. The dissemination and application of this core outcome set should improve clinical trials on managing caries lesions and allow comparison, synthesis and implementation of scientific data.
Trial registration
Registered 12 April 2015 at COMET (http://www.comet-initiative.org
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