Medical information

  Monolithic zirconia is a restorative material with increasing popularity due to its excellent mechanical, optical, and biological properties and compatibility with CAD/CAM technology. However, a common concern remains regarding zirconia’s abrasiveness against antagonist teeth. In my opinion, a well-polished zirconia crown delivered in harmonious occlusion does not result in significantly more tooth wear than does enamel. When using monolithic zirconia for my patients, I manage its wear properties by evaluating the following factors: Patient-specific risk factors Impression and mounting methods Instructions to dental laboratory Crown delivery methods Follow-up and maintenance Patient-specific factors It is important to recognize types of patients who will demonstrate more tooth wear in general. They include those with a low Frankfort-mandibular plane angle, lack of mutually protected occlusion, parafunctional habits, and a highly acidic oral environment from extrinsic acid, such as di

  TAKE-HOME MESSAGE This literature review evaluated medications and addictive substances that have the potential to induce or aggravate sleep bruxism and/or awake bruxism and also those medications which potentially attenuate bruxism (sleep and/or awake).  Ultimately, there were three types of bruxism delineated: sleep bruxism, awake bruxism, and nonspecified bruxism; and, while associations were found, the authors concluded that evidence-based data are insufficient to make definite conclusions regarding medications and addictive substances inducing or aggravating bruxism or attenuating bruxism. Bruxism is a repetitive jaw‐muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. It can occur during sleep, indicated as sleep bruxism, or during wakefulness, indicated as awake bruxism. Exogenous risk indicators of sleep bruxism and/or awake bruxism are, among others, medications and addictive substances, whereas also several medi

  TAKE-HOME MESSAGE This retrospective analysis of the utilization of CBCT for evaluation of cemento-osseous dysplasia (COD) included 12,670 CBCT scans, and found 142 COD cases. Roughly 50% of these COD cases were the florid type, while over 90% were in females who were in the fifth decade of life. Over 99% of all cases occurred in the mandible. Cortical bone resorption (78% of all cases) and root resorption (57% of all cases) were the most common sequelae associated with COD.  The authors concluded that, while the majority of COD lesions are benign and require no treatment, proper diagnosis and determination of lesion extension and adjacent structural involvement over a long period of time is usually needed. CBCT is the most effective tool for diagnosis, determination of disease extension, and monitoring of COD lesions. –   Sompop Bencharit, DDS, MS, PhD, FACP OBJECTIVES To describe the effects of cemento-osseous dysplasia (COD) on anatomical structures. METHODS CBCT scans were retros

  TAKE-HOME MESSAGE This cross-sectional cohort study reported on the periodontal status of 24 children with neutrophil-related primary immunodeficiencies (PID) as compared with 24 age-matched healthy children at a tertiary level care center. The findings revealed significantly higher odds of the presence of periodontal disease in patients with PID (OR, 10.0; P = .008) and a higher association with a history of oral ulcers (OR, 12.47; P = .001). Nonetheless, a significant improvement in periodontal parameters was achieved after oral hygiene instructions and nonsurgical periodontal therapy in children with PID. This study found that, despite the high prevalence of periodontal disease in children with PID, severe periodontitis was uncommon. More importantly, when detected early, periodontal disease was very manageable with just oral hygiene and nonsurgical therapy, which underscores the need for closer monitoring of periodontal health in children affected with PID. –   Tapan N. Koticha, 

  TAKE-HOME MESSAGE This best evidence consensus statement identifies that variance in recording the CR position occurs as a result of the technique and materials used as well as a circadian influence, with small variations (100ths of a mm) not being clinically significant. Evidence from the literature suggests that techniques using chin point guidance, bimanual manipulation, power centric, Gothic arch tracing, leaf gauge, and Lucia jig to record CR can all be comparable in precision and accuracy while polyvinyl siloxane and poly ether materials provide the most accurate records.  The review suggests that practitioner training, experience, and familiarity with the techniques are associated with precision of the CR record, while most techniques seem to be comparable, except for the Myomonitor technique, which produced inconsistent and generally poorer results. Multiple CR records to validate the recorded position also seem to reduce the potential for error. –   Tapan N. Koticha, BDS, MD

  TAKE-HOME MESSAGE The authors of this multicenter retrospective study describe 140 delayed immune-related adverse events (irAE) among 118 patients with melanoma treated with anti–PD-1–based immune checkpoint inhibitor therapy for >1 year. The median onset of delayed irAEs was 16 months after starting treatment. Although 74% of delayed irAEs occurred during treatment, 12% occurred <3 months after the last dose, and 14% occurred >3 months after the last dose. More than 50% of patients with a delayed irAE had also had an early irAE (ie, occurring during the first year of therapy). In most of these patients, the early irAEs affected a different organ than the delayed irAE. Colitis, rash, and pneumonitis were the most common delayed irAEs; 39% of delayed irAEs were grade ≥3. The continued risk for serious, life-threatening irAEs after 1 year of anti–PD-1 therapy should be considered when deciding the duration of therapy in patients with melanoma. –   Paul J. Hampel, MD BACKGROUND

  TAKE-HOME MESSAGE Although ophthalmologists write only a small portion of opioid prescriptions, all physicians need to be aware of the ongoing opioid epidemic and strategies to reduce unnecessary opioid prescriptions. Retrobulbar anesthesia, along with peri-operative intravenous or oral nonopioid analgesics, may lead to reduced opioid use postoperatively after eye surgery. With use of opioid prescription guidelines, the number of unnecessary opioid prescriptions has fallen over the past few years. The opioid epidemic affects everyone, and this is a helpful review for ophthalmologists who manage postoperative pain. –   Raza M. Shah, MD   Eye Care Written by     Joseph   W.   Sassani   MD This is a literature review of the implications of the current opioid epidemic for ophthalmology and of the need to decrease prescribing these medications. A very surprising finding was that, "Overall, opioid prescriptions represented approximately 8% of all prescriptions ophthalmologists wrote p

  TAKE-HOME MESSAGE In this cross-sectional retrospective review of 47 inpatients diagnosed with COVID-19 with multisystem inflammatory syndrome in children (MIS-C) in one hospital between March 15 and June 1, 2020, charts were reviewed for demographics, laboratory values, and signs and symptoms. Oral or oropharyngeal findings were identified in more than half (55.3%) of patients with MIS-C. A total of 23 patients (48.9%) had red, swollen, or cracked lips and 5 (10.6%) had documented strawberry tongue. Oral/oropharyngeal findings were associated significantly with the presence of a systemic rash (P = .04), conjunctivitis (P = .02), and absence of a cough (P = .02). In MIS-C, the precise incidence of oral findings and their clinical and prognostic significance is unknown. Oral/oropharyngeal manifestations may constitute a reproducible clinical manifestation of MIS-C and dentists should be cognizant of these features as well as available to evaluate high-risk patients. –   Laurie C. Cart

  As of today, nearly 10% of the entire US population has tested positive for SARS-CoV-2. It is very likely that the true number of people infected during this pandemic is substantially higher. An important question emerges: if infected, are we protected? There has been considerable discussion over the past 4 months on COVID-19 vaccine effectiveness, but what is the effectiveness and durability of prior infection? To answer this question, researchers in Denmark made use of a nationwide registry of PCR results from SARS-CoV-2 testing. Starting with individuals who were tested during Denmark’s first COVID-19 wave (before June 1, 2020), the researchers then evaluated PCR results from the same individuals during the second wave (September 1 through December 31, 2020). Accordingly, they identified 11,068 positive cases and 514,271 negative cases in the first wave. During the second wave, those who were previously positive had an infection rate of 5.4 cases per 100,000 person-days compared w

  TAKE-HOME MESSAGE Data from 596 infants in Brazil were analyzed to determine the factors associated with sugar consumption in early life. It was found that nearly all infants had consumed sugar by the age of 6 months. Younger mothers, children without two parents, lower parental education, and maternal smoking status were all found to be associated with more sugar consumption. Breastfeeding in the first hour of life was found to be protective of sugar intake in infancy. Sugar consumption begins early in life, likely before the infant's first dental evaluation. Sugar consumption is greater among infants in families with other high caries–risk factors. Providers should stress prevention with pregnant women and parents of newborn children. –   James Boynton, DDS, MS BACKGROUND Sugar consumption in early childhood is the primary cause of negative health outcomes, including early childhood caries. AIM To investigate risk factors associated with early-life sugar consumption. DESIGN Exp

  TAKE-HOME MESSAGE This best evidence consensus statement aimed to examine the relationship between centric occlusion (CO) and maximal intercuspation position (MIP) and the use of either as a treatment position for complete mouth rehabilitations in dentate or partially dentate patients. A total of 313 articles contributed to this review, finding that CO and MIP are not coincident in a majority of the population. With regard to complete mouth rehabilitation, most reports suggest that CO provides a physiologic, reliable, and reproducible position, with limited reports finding an association between TMJ symptomatology and CO-MIP discrepancies in the treated dentition. While CO-MIP discrepancies are the norm in the natural dentition, complete rehabilitations seem to perform better at CO rather than MIP based on available evidence. It should be noted that the authors could not include lower-quality evidence supporting the use of MIP as the treatment position due to the inclusion criteria o

  TAKE-HOME MESSAGE This systematic review looked at 14 in vitro studies to compare the fitting and occlusal accuracy of digital or CAD/CAM complete dentures compared with conventional complete dentures. The systematic review suggested that the CAD/CAM complete dentures are just as accurate as or more accurate than conventional complete dentures, especially with regard to tissue adaptation and occlusion. The tissue adaptation, especially in the posterior palatal seal area, is much better in the CAD/CAM denture group compared with the conventional one. Clinicians may consider prescribing CAD/CAM dentures when they have a full understanding of the fabrication process. Note that, while the material properties of CAD/CAM dentures are superior to conventional ones, the milled dentures may have issues with undercut areas in some edentulous patients. In the future, 3D printed dentures may become the go-to technology for denture fabrication. –   Sompop Bencharit, DDS, MS, PhD, FACP STATEMENT O

  TAKE-HOME MESSAGE This randomized trial of patients with COVID-19 admitted to the ICU shows that, compared with high-flow nasal oxygen, helmet noninvasive ventilation resulted in similar days free of respiratory support. Helmet noninvasive ventilation fails to yield significant improvement in management of COVID-19–related hypoxemic respiratory failure. –   Neil Majithia, MD IMPORTANCE High-flow nasal oxygen is recommended as initial treatment for acute hypoxemic respiratory failure and is widely applied in patients with COVID-19. OBJECTIVE To assess whether helmet noninvasive ventilation can increase the days free of respiratory support in patients with COVID-19 compared with high-flow nasal oxygen alone. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial in 4 intensive care units (ICUs) in Italy between October and December 2020, end of follow-up February 11, 2021, including 109 patients with COVID-19 and moderate to severe hypoxemic respiratory failure (ratio

  TAKE-HOME MESSAGE This randomized trial of patients with COVID-19 admitted to the ICU shows that, compared with high-flow nasal oxygen, helmet noninvasive ventilation resulted in similar days free of respiratory support. Helmet noninvasive ventilation fails to yield significant improvement in management of COVID-19–related hypoxemic respiratory failure. –   Neil Majithia, MD IMPORTANCE High-flow nasal oxygen is recommended as initial treatment for acute hypoxemic respiratory failure and is widely applied in patients with COVID-19. OBJECTIVE To assess whether helmet noninvasive ventilation can increase the days free of respiratory support in patients with COVID-19 compared with high-flow nasal oxygen alone. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial in 4 intensive care units (ICUs) in Italy between October and December 2020, end of follow-up February 11, 2021, including 109 patients with COVID-19 and moderate to severe hypoxemic respiratory failure (ratio