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Bisphosphonates and statins may influence wound healing and are frequently prescribed to the same patient group. Bisphosphonates may induce osteonecrosis of the jaw; however, little information is available on the cellular mechanisms and biological effects of co-medication in oral tissues. The aim was to assess the effects of alendronate and simvastatin, both alone and combined, on osteoblasts and gingival fibroblasts in vitro. Primary human gingival fibroblasts and primary human osteoblasts were incubated with alendronate (5 µM) and simvastatin (1, 5 or 10 µM), alone or combined, for up to 14 days. Cells were assessed for viability by measuring lactate dehydrogenase activity and caspase-3 concentration in the cell culture media. Migration and proliferation potential was assessed by scratch-wound assay. Secreted levels of cytokines/chemokines were measured using Luminex 200 multianalytic profiling. High concentrations of simvastatin, both alone and combined with alendronate, affected the proliferation/migration potential and reduced scratch closure. The same exposure induced near abolishment of secreted levels of cytokines affecting angiogenesis, such as VEGF, IL-6, IL-8, and MCP-1, however little effect was found on cell viability. High concentrations of simvastatin, alone or combined with alendronate, may have a negative impact on angiogenetic markers and cell migration/proliferation, affecting wound healing and growth.
To evaluate the association between obstructive sleep apnoea (OSA) and periodontitis and to assess the available evidence on the effects of continuous positive airway pressure (CPAP) therapy on periodontal status. This review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. Comprehensive literature searches were performed in Cochrane, PubMed, Scopus, and Web of Science. Study selection and data extraction were carried out independently by two reviewers. A total of 20 original studies met the inclusion criteria. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. Fourteen of the 20 studies (70%) reported a significant association between OSA and periodontitis. However, only two studies fulfilled all methodological quality criteria, indicating an overall moderate to low quality of evidence. Data on the effects of CPAP therapy on periodontal outcomes were limited, and the available studies generally showed no significant impact. Current evidence supports an association between OSA and periodontitis, suggesting that OSA may contribute to periodontitis. Robust, well-designed studies with larger sample sizes and rigorous methodology are needed to clarify the nature of this relationship and to determine whether CPAP therapy influences periodontal health.
To develop and validate a risk prediction model for gingival embrasures after clear aligner therapy using multimodal oral data. A retrospective study of 340 patients (December 2022-June 2025) was randomly divided into training (n = 238) and validation (n = 102) sets (7:3). Univariate analysis, multivariate logistic regression, and least absolute shrinkage and selection operator regression were applied to identify independent risk factors. Three machine learning models - random forest (RF), logistic regression, and support vector machine - were constructed based on seven core variables. Model performance was assessed using area under the receiver operating characteristic curve (AUC), calibration curves, decision curve analysis, and Shapley Additive Explanations (SHAP) values for interpretability. No significant baseline differences existed between sets (p > 0.05). Seven indicators were identified (p < 0.05). Multivariate analysis confirmed percentage of bleeding on probing-positive sites, interproximal alveolar bone height, and relative movement of adjacent teeth at target site as independent risk factors, while gingival thickness, proximal contact area, interdental papilla height, and buccal/lingual bone plate thickness were protective factors (p < 0.05). The RF model performed best: training AUC = 0.849 (95% CI: 0.786-0.912), validation AUC = 0.815 (95% CI: 0.720-0.910), with good calibration and net benefit. SHAP analysis highlighted gingival thickness and interproximal alveolar bone height as key predictors. A risk prediction model for post-clear aligner gingival embrasures was successfully developed and validated using multimodal oral data, with RF as the optimal algorithm. The model exhibits good discrimination, calibration, and clinical utility, which can be used as an objective auxiliary tool for individualized risk prediction following clear aligner therapy and supplement traditional clinical empirical judgment.
This is a response to the article "Comments on ´'The effect of age on third molar extraction difficulty: a retrospective cross-sectional cohort study' - Danger in describing 'simplicity' in third molar surgery" https://doi.org/10.2340/aos.v85.45933.
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To investigate the level of burnout (BO), secondary traumatic stress (STS), and compassion satisfaction (CS) among Norwegian oral health professionals who work with traumatized and vulnerable patients. Professional Quality of Life-5 was used to assess BO, STS, and CS. Organizational and psychosocial work factors were measured with the Nordic Questionnaire for Psychological and Social Factors at Work.  Results: Participants (n = 114) reported moderate levels across all three dimensions, with 62.6% scoring in the moderate range for STS, 47.4% for BO, and 38.6% for CS. Poor work-life balance was associated with lower levels of CS and higher levels of STS and BO. Support was associated with positive outcomes of BO, STS, and CS.  Conclusions: Psychosocial factors within the work environment contribute more to occupational strain than the direct challenges of working with traumatized or vulnerable patients. Involving oral health professionals in wider conversations about supporting those who care for vulnerable populations is paramount. Addressing organizational conditions alongside individual support is important to promote well-being.
This study aimed to clarify whether third molar extraction becomes more difficult as the patient ages. Previous research results on the topic are contradictory. All 12,649 third molar extractions in Helsinki's primary care during 2016 were retrieved from electronic records using treatment codes. The primary outcome was extraction difficulty, classified as simple (forceps) or surgical (raising a flap). The secondary outcome was an extraction labelled as demanding. Predictor variables were age, sex, and the jaw (maxilla/mandible). Statistical analyses included χ2 test and binomial logistic regression. Mean age of the patients was 32.2 years (range 12-97 years). Simple extractions in the maxilla (P < 0.001) and all surgical extractions (P < 0.001) were more likely to be demanding at a higher age. In the mandible, simple extractions were easier at a higher age (odds ratio [OR] 0.971; 95% confidence interval [CI] 0.964; 0.978). Surgical extraction was 1.4 times (95% CI 1.145; 1.766) more likely to be demanding in men and twice (95% CI 1.143; 3.462) as demanding in the mandible. Surgical and maxillary simple extractions were more difficult at a higher age. Surprisingly, in the mandible, simple extractions were easier at a higher age.
treatment strategies, and prognostic assessments made by dental hygienists in general dentistry, compared with the 1999 classification. A questionnaire comprising five patient cases was administered to dental hygienists in Sweden on two separate occasions. For each case, diagnoses, treatment plans, and prognostic assessments were proposed, first using the 1999 and subsequently the 2018 classification. Cases ranged from no marginal bone loss attributed to periodontitis and few (<10%) bleeding sites to marginal bone loss >30% and generalized inflammation (>30%). Answers from the two occasions were compared. A total of 142 dental hygienists completed both questionnaires. Diagnostic assessments changed significantly in three of the five cases when using the 2018 classification (p < 0.05). In four cases, fewer treatment sessions were recommended, and more optimistic prognostic assessments were made when using the 2018 classification (p < 0.05). The 2018 classification resulted in greater variation in proposed diagnoses in cases without clear attachment loss and was associated with fewer recommended treatment sessions and more optimistic prognostic assessments. However, it appeared at least as effective as the 1999 classification in identifying cases with periodontitis.
To assess the mental health trajectory and its influencing factors in young and middle-aged orthodontic patients. In a longitudinal study, 154 patients were recruited from Nantong Stomatological Hospital (March 2023-October 2024). A 1:1 propensity score matching (PSM) control cohort was established to balance demographic characteristics. Data on general information, social support (Social Support Rating Scale), and psychological distress (Kessler 10 scale) were collected at eight time points from treatment initiation to 15 months. Mental health trajectories were analyzed using generalized estimating equations (GEE). The GEE model indicated a significant temporal trend in mental health scores (Wald χ² = 304.51, p < 0.001). Significant factors included female gender (β = 6.12, p < 0.001), student status (β = 2.18, p = 0.020), higher monthly household income (>10,000 RMB (China's currency): β = -3.51, p < 0.001), higher education (Bachelor's degree or above: β = -1.89, p < 0.001), unmarried status (β = 3.05, p = 0.010), severe malocclusion (Class III: β = 1.23, p = 0.018), and social support (β = -0.35, p < 0.001), which was a protective factor. The mental health of young and middle-aged orthodontic patients follows a dynamic trajectory, associated with a combination of sociodemographic and clinical factors. Patients who are female, students, unmarried, or have severe malocclusion are at higher risk, whereas strong social support is protective. These findings highlight the need for timely psychological monitoring and personalized interventions for at-risk individuals throughout orthodontic care.
To evaluate the impact of orthodontic treatment on the oral health-related quality of life (OHRQoL) several years after orthodontic treatment. Thirty-two patients with previous orthodontic treatment and 31 patients without previous orthodontic treatment, aged 19 years, were included in the study. A questionnaire consisting of three parts was used: The Oral Health Impact Profile (OHIP-S14), Jaw Functional Limitation Scale (JFLS-20) and Orofacial Aesthetic Scale (OES). Previous orthodontic treatment, malocclusions and earlier dental treatment were registered. There were statistical differences between the orthodontic group and the control group regarding the total OHIP-S14 (p = 0.03) and the total OES (p = 0.028), as subjects in the control group indicated less satisfaction. There were non-statistical differences between the two groups regarding the JFLS-20. When divided into the four domains of OHIP-14, only the psychosocial domain showed a statistically significant difference between the groups (p = 0.006). No association was found between the decayed, missing and filled teeth index and total OHIP, total JFSL or total OES in both groups. Nineteen-year-old individuals who had undergone orthodontic treatment have a significantly better OHRQoL when compared to individuals without need for orthodontic treatment, specifically in the psychosocial and aesthetic domains.
This is a comment on the article "The effect of age on third molar extraction difficulty: a retrospective cross-sectional cohort study" https://doi.org/10.2340/aos.v85.45308.
Periodontitis is a common chronic oral inflammatory disease with multiple etiologies. The relationship between Dietary Diversity Score (DDS) and periodontitis prevalence remains unclear. To elucidate the DDS-periodontitis prevalence association. Logistic regression evaluated the linkage between DDS and periodontitis. Restricted cubic spline (RCS) regression assessed non-linear linkage. Interaction tests identified effect-modifying factors. Weighted quantile sum (WQS) regression identified food categories influencing associations. Mediation analysis investigated the mediating roles of body roundness index (BRI) and red blood cell distribution width (RDW). In the full-adjusted model, higher DDS was linked with lower periodontitis prevalence odds (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.93-0.98; p < 0.001), with an evident dose-response relationship. RCS indicated no significant non-linear association between DDS and periodontitis (p-non- linear = 0.144). WQS showed balanced weight distribution of five main foods (all ~20%), indicating a dietary synergy effect. Subgroup analyses revealed significant interactions between DDS and periodontitis within subgroups of age, smoking, BMI, alcohol consumption, and osteoarthritis (p-interaction < 0.05). RDW (2.26%) and BRI (1.69%) partially mediated the linkage between DDS and the periodontitis prevalence. Higher DDS is independently associated with reduced prevalence of periodontitis, driven by the synergistic contribution of multiple food categories. Optimizing dietary breadth is important in preventing periodontitis.
To map dental health service utilization (DSU) and associated factors among older adults receiving home care services (HCS) in south-eastern Norway, using Andersen's model. In this cross-sectional study of older adults receiving HCS aged ≥ 65 years, data on oral health practices, general health, and predisposing, enabling, and need-based factors were collected via interviewer-administered questionnaire. Of 116 participants (mean age 83, 53.6% female), 67.2% reported annual DSU, while 24.1% used dental health services only for acute problems. Although 95.6% were entitled to free dental care in the public dental service (PDS), 66 were aware of this, and 56.5% made use of their rights. Awareness of entitlements was associated with more frequent PDS use. A higher self-reported number of teeth and using private dental services were also linked to higher DSU. The present study showed underutilization of dental health services among older adults receiving HCS and unawareness of entitlement of their rights in PDS. However, higher self-reported number of teeth and use of private dental services were linked to more frequent DSU. To address underuse, the PDS should improve awareness of entitlements, enhance information delivery, and further investigate reasons for non-utilization.
The objective of this study was to determine the prevalence, spatial patterns, and craniofacial skeletal associations of impacted maxillary canines using panoramic and cephalometric analyses in a large patient cohort. This retrospective cross-sectional study evaluated 9593 panoramic radiographs of individuals aged ≥ 14 years. Cephalometric analysis was achieved on subjects aged ≥ 18 years with skeletal maturity (Cervical Vertebral Maturation Index stage ≥ 6), comparing 94 cases with maxillary impacted canines (MIC) to 100 age- and sex-matched controls. Positional measurements (sector, depth, and angulation) were compared with skeletal patterns using independent t-tests, analysis of variance, and chi-square tests (α = 0.05). Analysis revealed a maxillary canine impaction prevalence of 2.02%, with a significant female predilection (54.1%) and a maxilla-to-mandible ratio of 4:1. The predominant spatial pattern was mesioangular inclination (67%) in Sector 0 (35.2%) at coronal depth (54.1%). Compared to controls, MIC cases exhibited significant maxillary skeletal deficiency (e.g., anterior nasal spine - posterior nasal spine [ANS-PNS]: 50.1 ± 5.1 mm vs. 53.1 ± 3.7 mm; p < 0.001) and vertical hyperdivergence (Sella-Nasion to Gonion-Gnathion angle [SN-GoGn]: 32.8° ± 6.2 vs. 29.8° ± 6.4; p = 0.001). Upper incisor inclination showed no intergroup difference. Maxillary canine impaction is strongly associated with maxillary skeletal deficiencies and vertical growth discrepancies. The common finding of mesioangular impactions in Sector 0 at coronal depth indicates a high risk for adjacent root resorption. We recommend incorporating cephalometric screening (focusing on ANS-PNS < 50 mm and SN-GoGn > 32°) into early adolescent assessments to identify at-risk patients and guide timely interceptive strategies such as maxillary expansion.
Crohn's disease (CD) is a chronic inflammatory disorder with systemic manifestations, including potential effects on oral health. Evidence regarding its association with periodontal disease remains inconsistent. We systematically searched PubMed, Embase, Web of Science, Scopus, Cochrane Library, CNKI, and WanFang Data up to August 28, 2025, for observational studies comparing periodontal -outcomes in adults with CD and non-inflammatory bowel diseases controls. Random-effects meta--analyses were -performed to estimate pooled odds ratios (ORs) for prevalence and standardized mean differences (SMDs) for clinical parameters. Subgroup and sensitivity analyses were conducted. Thirty-four studies, including 6482 CD patients and 9137 controls, were analyzed. CD was -associated with a higher risk of periodontitis (OR = 2.14, 95% confidence interval [CI]: 1.65-2.77). Clinical periodontal parameters were also significantly worse in CD patients: probing depth (SMD = 0.42), clinical attachment loss (CAL) (SMD = 0.50), bleeding on probing (SMD = 0.47), plaque index (SMD = 0.39), and gingival index (SMD = 0.31). Associations were stronger in European populations and in studies using CAL criteria. Sensitivity analyses confirmed the robustness of results. CD is associated with increased prevalence and severity of periodontal disease. These -findings support routine periodontal screening and integrated multidisciplinary management for CD patients, highlighting shared inflammatory pathways as potential therapeutic targets.
This study investigates clear aligner treatment (CAT) of adult patients in private dental practice and aims to identify: 1) The awareness of and knowledge about CAT among citizens, 2) how citizens who have received CAT experience the treatment and 3) how general dentists and orthodontists assess CAT. The study was based on an observational cross-sectional questionnaire investigation. Two separate online questionnaires were sent out to all private dental clinics in Denmark and to a group of 2000 citizens aged ≥18 years. 217 citizens and 200 practitioners were included in the analysis. The citizens' awareness of CAT was poor in general, and younger citizens were more aware of CAT. The citizens most often became aware of CAT through their own dentist or through friends and family. The citizens were in general satisfied with their treatments.The practitioners always/often informed about all parameters possible. The most frequent indication for CAT was cosmetics. The orthodontists more often included a lateral cephalogram in the diagnostics before CAT and more often made changes and more comprehensive changes to the digital treatment plan. The orthodontists were less satisfied with CAT compared to the general dentists. This study has provided valuable knowledge on the awareness and satisfaction of CAT among the citizens and indicated how practitioners assess CAT of adult patients in private dental practice in Denmark.
Effective communication between dental professionals and patients is essential for quality care. We aimed to evaluate whether Grasp, a novel handheld squeezable device providing real-time visual and auditory feedback to signal discomfort, improved communication between patients and their dentists during dental procedures. Patients aged 6-25 years were recruited from two dental clinics in Norway. Participants were divided into two groups: One received standard care, the other used Grasp in addition to standard care. All patients - and additionally caregivers of those under 16 - completed pre- and post-treatment questionnaires, rating communication on a 1-10 scale. Multiple linear regression analyses were conducted to evaluate the intervention's effect, adjusting for baseline scores. A total of 121 patients (58% females; median age 16 years) participated, with 60 using Grasp. Patients using Grasp reported greater confidence that the dentist understood their feelings, recognized when they wanted to stop, and found it easier to speak up during treatment (β = 2.10-2.54, p < 0.05). The effect of Grasp was more pronounced for participants reporting lower baseline confidence in communication with their dentist. Grasp appeared to improve communication regarding discomfort during dental procedures, particularly for those who initially reported lower levels of communication confidence.
This in vitro study compared the efficacy, dentin loss, and outcomes of ultrasonic, Masserann, and Broken Tool Remover Pen (BTR-Pen) techniques for removing fractured endodontic instruments using cone-beam computed tomography (CBCT) analysis. Ninety extracted single-rooted teeth were randomly allocated into three groups (n = 30). ProTaper F2 instruments were intentionally fractured in the middle third of each canal, creating 3-4 mm fragments. Removal was performed using ultrasonic tips, Masserann trephine burs, or the BTR-Pen loop system. CBCT scans quantified dentin loss. Success rates, removal times, and complications were analyzed using one-way analysis of variance, Tukey honestly significant difference, chi-square, and likelihood-ratio chi-square tests (p < 0.05). Ultrasonic removal showed the highest success rate (90.0%), followed by BTR-Pen (86.7%) and Masserann (70.0%). Pairwise likelihood-ratio chi-square analysis showed lower success for Masserann than ultrasonic removal (p = 0.049). Masserann caused significantly greater canal volume increase (4.50 ± 0.50 mm³) than ultrasonic (0.75 ± 0.30 mm³) and BTR-Pen (0.93 ± 0.40 mm³) techniques (p < 0.001). Ultrasonic removal required the shortest time (110.0 ± 35.0 s), followed by BTR-Pen (213.4 ± 40.0 s) and Masserann (240.0 ± 50.0 s). Ultrasonic and BTR-Pen techniques achieved high success with better dentin preservation than Masserann. When retrieval is indicated, techniques that maximize dentin preservation should be preferred to reduce the risk of root weakening and procedural complications.
Dental anxiety (DA) and dental pain are closely interrelated. Anxiety often leads to an exaggerated perception of pain, while the experience of pain can further intensify anxiety, creating a vicious cycle. This cycle can significantly have an effect on individual's oral health-related quality of life (OHRQoL). Therefore, it is essential to implement both clinical and psychological interventions to effectively manage DA. The aim of this study is to assess the level of dental pain and its association with DA and OHRQoL among patients attending dental treatment. A cross-sectional study involving 805 participants was conducted using consecutive sampling. Data were collected on demographic characteristics, dental health status, and self-rated health. The participants' dental pain and DA were assessed using a 100-mm Visual Analog Scale (VAS), the Dental Fear Survey (DFS), and the Dental Anxiety Scale (DAS). Descriptive analyses were performed, followed by logistic regression to identify determinants of Oral Impacts on Daily Performance (OIDP). The study sample consisted of 805 participants, comprising 69.7% males and 30.3% females. Most participants were aged between 31 and 50 years (46.9%). The study's findings revealed no significant differences in dental pain prevalence by gender, age, or education level. However, participants with dental pain reported greater difficulties in daily activities, particularly in eating and social interactions. Significant mean differences were observed in DA (P < 0.001) and DFS (P = 0.009), with individuals experiencing dental pain reporting higher mean scores for DA (7.74 vs. 7.10) and DFS (37.56 vs. 35.55). Logistic regression identified decayed teeth [OR = 1.48 (95% CI: 1.06, 2.05), p = 0.020] and higher dental pain levels [OR = 6.08 (95% CI: 4.39, 8.41), p < 0.001] as factors significantly associated with OIDP. The study shows a significant association between dental pain and a poor OHRQoL. These findings emphasize the importance of addressing dental health issues to improve overall well-being and quality of life among affected individuals.
This study aimed to investigate the following: (1) the preferences of public dentists for procedures and materials in carious or non-carious pulp exposure of permanent teeth; (2) how factors such as clinical experience, scientific literature reading, and material availability affect their choices; (3) the self-assessed risk of root canal treatment after pulp capping. An online questionnaire consisting of 20 multiple choice and open-ended questions was e-mailed to Norwegian public dental clinics. It assessed dentists' material preferences for direct pulp capping for carious or non-carious exposures, alongside factors such as years since graduation, scientific literature engagement, availability of materials, and clinical scenario choices. Respondents were also asked to estimate and reason long-term outcomes of their chosen materials. Standardized case descriptions ensured shared clinical understanding. Data were statistically analyzed and p-values ≤ 0.05 were considered statistically significant. A total of 218 (23.9%) dentists responded. Direct pulp capping was preferred by 65% of respondents, with chemically curing materials - primarily calcium hydroxide - being most used. Chi-square analyses showed that dentists with fewer years of experience and those who had read scientific literature were more likely to prefer calcium silicate materials; however, these variables were not statistically significant predictors in the logistic regression models. Material availability was the strongest predictor of preference, with significantly increased odds of selecting calcium silicates or light-curing materials when available. 'Satisfied with clinical results for the chosen material' was the most frequently reported reason for material selection. Most respondents in this study preferred calcium hydroxide for direct pulp capping in permanent teeth with closed apices, despite the superior clinical outcomes of hydraulic calcium silicates. Material availability in the clinic was the primary factor influencing dentists' choices, surpassing clinical experience and scientific literature engagement.