Wednesday, July 27, 2016

Association of Mutans streptococci between Caregivers and their children

          Resident’s Name:        Brian Darling                                                                           Date: 7/27/16
Article Title: Association of Mutans streptococci between
Caregivers and their children
Author(s): Douglas, J. M., Li, Y. and Tinanoff, N
Journal: Pediatric Dentistry
Date: Sept/Oct 2008
Major Topic: Transmission of mutans streptocci in children and prevention of it
Type of Article: Literature Review
Main Purpose: This article aimed to elucidate the association between mutans streptocci in caregivers and their children as well as if there are any interventions that may help decrease MS transmission to children
Key Points: (2 lines Max): Main conclusion or the most interesting
·      In preschool-aged children, higher mutans streptococci levels was associated with higher caries risk
·      Early MS colonization is associated with early development of caries
·      ~50% of children have at least 1 MS isolate from their mothers
·      Most spouses (75%) share at least 1 identical mutans strepotoccus isolate
·      Mothers are a primary transmission source of mutans strepotoccus to children
·      Mothers with high levels of MS are associated with having children with high levels of MS
·      Fathers (as well as other major caregivers) may also be a significant source of MS transmission to children but there is less evidence on the topic.
·      Breast-fed children acquire MS with a higher fidelity than nonbreast-fed children
·      Other factors that complicate these studies (confounding factors) because they are associated with increased risk of MS colonization or earlier colonization: low SES, C-section delivery, fewer courses of antibiotics, increased sugar consumption, enamel hypoplasia
·      Interventions in some studies (such as chlorhexidine treatments, fluoride, xylitol chewing gum, and restorative care) to reduce MS levels in mothers were shown to reduce MS levels in their children. However, this did not always translate to a statistically significant reduction in caries in the children. Thus, it is debatable if these interventions produced clinically significant caries reduction.
·      Further investigation is required to elucidate if strategies to reduce MS levels in mothers is a cost effective measure for trying to reduce MS colonization and thus caries risk in children


Big points:
1.     More and earlier MS à more caries. And mom is a big contributor to MS levels
2.     Treatment of MS in moms has shown some degree of success in decreasing MS in kids but this is debatable
Remarks:
1-
2-
Assessment of Article:  Level 1? Level of Evidence/Comments: Not a true systematic review; essentially just a detailed and well-done PubMed search



Tuesday, July 26, 2016

Survival Rate of Atraumatic Restorative Treatment (ART) Restorations Using a Glass Ionomer Bilayer Technique with a Nanofilled Coating: A Bi-center Randomized Clinical Trial


Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Albert Yamoah                                                                                 Date: 07/18/2016
Article Title: Survival Rate of Atraumatic Restorative Treatment (ART) Restorations Using a Glass Ionomer Bilayer Technique with a Nanofilled Coating: A Bi-center Randomized Clinical Trial
Author(s): Daniela Hesse, DDS, MSc, PhD • Clarissa Calil Bonifácio, DDS, MSc, PhD • Marcelo Bönecker, DDS, MSc, PhD • Camila de Almeida Brandão Guglielmi, DDS, MSc, PhD • Carolina da Franca, DDS, MSc, PhD • Willem Evert van Amerongen, DDS, PhD • Viviane Colares, DDS, MSc, PhD • Daniela Prócida Raggio, DDS, MSc, PhD
Journal: Pediatric Dentistry
Date: Jan / Feb 2016
Major Topic: Atraumatic Restorative Treatment
Type of Article: Randomized Clinical Trial
Main Purpose: investigate the survival approximal ART restorations in primary molars using two different insertion techniques and two different surface protection materials
Key Points: ART may be successful for up to 2 years in half the cases
Background:
·       Surface protection has been suggested to address limitations
1.     Petroleum jelly
2.     Nanofilled coating
·       Bilayer technique of insertion has been show to improve GIC adaptation in approximal cavities
·       This study looks at how insertion technique may improve survival rate
1.     Press-finger technique
2.     Bilayer technique
·       This study also looks at how surface protection materials may improve survival rate
1.     Press-finger technique
2.     Bilayer technique

Method
·       2,000 6yo-7yo children screened in each city
·       389 children selected for study
·       One cavity per child was included in study
·       Group 1 – Conventional ART + PJ
·       Group 2 – Bilayer ART + PJ
·       Group 3 – Conventional ART + NC
·       Group 4 – Bilayer ART + NC
·       All groups were evaluated and scored at 1, 6, 12, 18, 24 months

Conclusions:
·       The bilayer technique of glass ionomer cement insertion can improve the survival rate of approximal atraumatic restorative treatment (ART) restorations in primary molars.
·       The application of a nanofilled coating does not influence the survival rate of approximal ART restorations in primary molars.
·       The city/geographic location in which treatments are performed can have an influence in the survival rate of ART restorations.
Remarks:
1. The text mentioned that the PJ was removed from the experimental group, however this group was never supposed to be exposed to it in the first place!
2. Is it possible that the difference between the 2 cities was due to the operator?
Assessment of Article: 
·   Level of Evidence/Comments: Since this article is a randomized clinical trial, it has an internal validity of II.

Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident’s Name:        Jonathan Kaczmarski                                                  July 27th, 2016                         Date:
Article Title: Eating disorders and oral health: a matched case-control study
Author(s): Johansson A-K, Norring C, Unell L, Johansson A.
Journal: Eur J Oral Sci 2012:120:61-68.
Date:
Major Topic: Relation between eating disorders and oral health
Type of Article: Journal Article
Main Purpose: Compare Oral Health of Eating Disorders vs Control
Key Points: (2 lines Max): Main conclusion or the most interesting

1.      Compared 54 ED, Eating Disorder (Anorexia Nervosa, Bulimia Nervosa, and combo) to 54 age and sex match controls comparing oral health.
2.      Eating disorder pts had:
·         Significantly higher dental erosion (partly due to acid, and reduced salivary function)
·         Similar DMFT, DMFS, IP caries, and number of first molar cuspings
·         Lower Gingival Bleeding Index (due to better, sometimes obsessive hygiene)




The dental team should be aware of the following signs and symptoms of eating disorders so that they can identify pts with ED and discuss/refer for treatment: dental erosion, tooth wear, dental problems, burning mouth, dry/cracked lips, lump in throat (globus sensation) and good oral hygiene.
The study weeded out two Eating disorder pts from the control group by giving the control group an eating disorder survey.
Remarks: From Mentor, Dr. S. Sapir
1-      The study group completed their questionaires in the ED examination room while the controls completed it in the dental clinic (does stress before treatment could have had influence on their answers?
2-      Would have been intresting to compare the reported symptoms and clinical finding as a factor of length of ED habits. The study group had a wide range...
Assessment of Article:  Level of Evidence/Comments:


Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident’s Name:        Michael Hatton                                                                       Date: 7/27/16
Article Title: Standard and Transmission-Based Precautions: an update for dentistry
Author(s): Harte JA
Journal: J Am Dent Assoc 2010;141;572-581
Date: May 2010
Major Topic: Prevention of disease transmission in the dental setting
Type of Article: Literature review and expert opinion
Main Purpose: Give dentists information on the current standards of practice concerning infection control
Key Points: Dental health care professionals must be familiar with, and must adhere to, the CDCA’s most recent Standard Precaution guidelines, as well as the additional Transmission-Based Precautions, during treatment of patients.
Standard Precautions apply to any contact with bodily fluids, secretions, and excretions (except sweat). All potentially infectious materials are to be treated as though they are infectious; thus the degree of precaution is dictated by the procedure, not by the medical history of the patient. Standard Precautions include the following points:
·         Hand hygiene
·         Use of personal protective equipment
·         Proper handling and sterilization of contaminated materials and equipment
·         Use of engineering and work practice controls
·         Respiratory hygiene*
·         Safe injection practices*

Transmission Based Precautions are a second set of guidelines that are used when dealing with patients known or suspected to be infected with select highly transmissible diseases, and are used in conjunction with Standard Precautions.
·         Airborne
o   PPE
o   Patient positioning
o   Patient transport
·         Droplet
o   PPE
o   Patient positioning
o   Patient transport
·         Contact
o   PPE
o   Patient positioning
o   Patient transport



Remarks:
1-      New CDC guidelines published in 2015 (not really relevant to dentistry).
2-       
Assessment of Article:  Level of Evidence/Comments: VII