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This paper compares experimental results on methylene blue (MB) removal systems based on ozone oxidation, zeolite adsorption, and simultaneous adsorption-oxidation using ozone in the presence of natural zeolite. The effect of pH (2-8), and the presence of radical scavengers (sodium acetate) on process rates and removal efficiencies are assessed at laboratory scale. The experimental system consisted of a 1 L differential circular flow reactor and an ozone generator rated at 5 g O3/h. Results show that ozone oxidation combined with zeolite adsorption increases the overall MB oxidation rate with respect to ozonation process and zeolite adsorption. In presence of free radical scavenger, only a 25% of reduction on MB removal rate are observed in the simultaneous treatment, as compared with 70% when ozonation treatment is used, suggesting that MB oxidation reactions take mainly place on the zeolite surface. [ABSTRACT FROM AUTHOR]

Benzothiazole (BT) is a toxic and poorly biodegradable contaminant, usually found in wastewater from rubber related applications. This compound could be effectively eliminated using advanced treatment processes. This paper compares experimental results on detoxification systems based on ozone oxidation, activated carbon adsorption, and simultaneous adsorption-oxidation using ozone in the presence of activated carbon. The effect of pH (2-11), and the presence of radical scavengers (tert-butyl alcohol and sodium carbonate) on process rates and removal efficiencies are assessed at laboratory scale. The experimental system consisted of a 1 L differential circular flow reactor and an ozone generator rated at 5 g O3/h. Results show that ozone oxidation combined with activated carbon adsorption increases the overall BT oxidation rate with respect to the ozonation process and activated carbon adsorption. In the presence of free radical scavenger, only a 44% reduction in BT removal rate is observed in the simultaneous treatment, as compared with 72% when ozonation treatment is used, suggesting that BT oxidation reactions mainly take place on the activated carbon surface. [ABSTRACT FROM AUTHOR]

Benzothiazoles are frequently present in wastewater from rubber related applications, and may be found in surface and underground water bodies causing significant environmental impact. Cost effective treatment processes to deal with such contaminants are needed in both small and large-scale applications. These compounds are poorly biodegradable and could be removed by ozone oxidation before discharge to recipient water courses. Unfortunately, there is limited experimental data reported in the literature on such processes involving benzothiazoles. This article presents experimental data on ozone treatment of benzothiazole (BT), with a view to process design. The effects of pH and radical scavengers on process rate and removal efficiency were assessed at bench scale. Experimental results show that BT could be effectively removed using ozonisation, particularly at pH above 4. The presence of free radical scavengers drastically reduced the BT removal rate even at very low concentrations. Both direct and indirect reactions between ozone and BT were adequately described by second order kinetic schemes, with rate constants estimated at 20°C: kD = 2.3 mol l-1 s-1 and kI = 6 × 109 mol l-1 s-1, respectively. The free radical mechanism accounted for 83-96% of BT removal rate within the pH range 2-9, at 20°C. [ABSTRACT FROM AUTHOR]

The presence of toxic aromatic organic compounds in industrial wastewater affects the efficiency of conventional biological treatment. The oxidizing power of ozone represents an interesting pretreatment to reduce toxicity and increase biodegradability. At low pH, ozone is known to attack electron-rich structures by direct electrophilic reactions which open aromatic rings, and generate smaller oxidized compounds. This paper reports experimental results on kinetic and toxicity aspects of ozone direct reactions with 1,2-dihydrobenzene. This toxic compound is frequently found in cellulose bleaching effluents. Although the reaction pathway is rather complex, 4-carbon compounds, such asmaleic acid, are readily formed during the first stage of ozonation.These 4-carbon compounds are further oxidized to form smaller molecules (mostly 2-carbon, such as oxalic acid). The apparent kinetics of 1,2-dihydrobenzene follows a second order law, with a rate constant around 0.36 (dm3 mmol-1s-1), at pH 2 and 20 deg. C. Results show that the BOD:COD ratio increase five-foldas ozonation progresses. Furthermore, the mutagenicity of 1,2-dihydrobenzene totally disappears as the aromatic compound is destroyed by ozonation. [ABSTRACT FROM AUTHOR]

Abstract: To compare tetracycline abatement efficiency, tetracycline solutions were irradiated in aqueous suspensions of TiO2 with three different light sources: a UV lamp, a solarium device and a UV-A lamp. Negligible degradation was observed when irradiations were performed in absence of TiO2. In contrast, rapid tetracycline degradation was observed in the presence of 0.5gl−1 of TiO2. Close to 50% of its initial concentration was eliminated after 10, 20 and 120min when the irradiation source used was a UV lamp, a solarium device and a UV-A lamp, respectively. Significant mineralization was also obtained when the UV lamp and solarium were used for photocatalysis. The antibacterial activity of selected microorganisms was drastically inhibited when exposed to tetracycline solutions treated by the photocatalyst over short irradiation periods. [Copyright &y& Elsevier]

Objective: The PANELVIEW questionnaire identifies the strengths and weaknesses of the process and methods used for developing health guidelines from the guideline development group's perspective. To expand its use, PANELVIEW ideally should be available in different languages. We aimed to cross-culturally adapt PANELVIEW into Spanish and assess its acceptability, validity, and reliability., Study Design and Setting: To translate and culturally adapt PANELVIEW to Spanish, we followed ISPOR's Translation and Cultural Adaptation Good Practice Principles guidelines. The process consisted of 1) forward and back translation, 2) input from an expert panel, and 3) cognitive debriefing interviews. We assessed the content validity with experts in guideline development who rated instrument items for relevance to determine the item and scale content validity index (I-CVI; S-CVI). We tested the reliability with health guidelines panels from Spanish-speaking countries and measured internal consistency (Cronbach's alpha). We examined acceptability through the number of missing responses for each item., Results: The content comparison between the back-translation and the original version showed that most items (24/34) were conceptually equivalent but with grammatical differences. Through the cognitive interviews, we identified six items with wording issues, ten with clarity issues, and two with applicability issues. I-CVI ranged from 0.77 to 1.00, with two items needing revision. S-CVI was 0.92, showing excellent content validity. The PANELVIEW Spanish version demonstrated very good reliability (Cronbach's alpha coefficient of 0.96). Panel members responded to all items, showing good acceptability., Conclusion: The PANELVIEW Spanish version was conceptually equivalent to the original version and provided satisfactory evidence of acceptability, validity and reliability., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: We evaluated the comparative effectiveness of all intra-articular injection corticosteroids for treating internal temporomandibular joint (TMJ) disorders. Methods : We searched MEDLINE, CENTRAL, EMBASE, SCOPUS, and LILACS through December 2023. We included randomized clinical trials (RCTs) enrolling patients with symptomatic internal disorders of the TMJ comparing any type of intra-articular corticosteroid therapy against another or to another minimally invasive therapy. The outcomes of interest were pain, range of mandibular motion (RoM), quality of life (QoL) and adverse effects at 1, 3, 6, and 12 months. We assessed the risk of bias using the Cochrane Collaboration's tool. We conducted a frequentist network meta-analysis and assessed the certainty of the evidence (CoE) using GRADE. Results : We included 20 RCTs enrolling 810 participants, which assessed five corticosteroids alone or combined with arthrocentesis or hyaluronic acid. Based on moderate CoE, betamethasone is among the most effective corticosteroids for reducing pain at one (mean difference compared to arthrocentesis [MD], -3.80; 95% confidence interval [CI], -4.55 to -3.05) and three months (MD, -2.74; 95%CI, -3.42 to -2.06), and arthrocentesis plus dexamethasone at six months (MD, -0.80; 95%CI, -1.57 to -0.03). There was no convincing evidence that any intervention was better than arthrocentesis for improving the RoM and QoL at any follow-up time. Methylprednisolone may be more harmful than arthrocentesis for adverse effects. Discussion : Betamethasone and arthrocentesis plus dexamethasone are the most effective in managing pain in the short and medium term compared to arthrocentesis (moderate CoE). Decisions about their use should consider other factors, such as costs, feasibility, and acceptability. Future research should consider QoL as an outcome and assess participants at longer follow-up periods.

Objective: The proposed study aims to compare the effectiveness of conventional endodontic treatment (ET) with that of ET associated with antimicrobial photodynamic therapy (aPDT) in patients with apical lesion. Methods: Controlled, double-blind, randomized clinical trial (RCT); superiority study with three parallel arms. Randomization will be conducted in exchange blocks of six, with allocation 1:1:1. The control group will receive conventional ET, while experimental group 1 (EG1) will receive conventional ET + aPDT with laser at 660 nm, fluence of 600 J/cm 2 ; EG2 will receive conventional ET + aPDT with laser at 660 nm, fluence of 1200 J/cm 2 . The primary outcome will be canal disinfection before treatment, measured by analysis of colony formation (CFU/mL) and the success rate measured after 6 months on the clinical and radiographic evaluations. The mean and standard deviation will be calculated for continuous outcomes, and the CFU/mL mean between groups will be evaluated by ANOVA test. The Chi-squared test will be calculated for binary outcomes. A logistic regression analysis will be performed to assess differences in the success rate between groups, adjusted for the covariates. The Stata 18 software will be used, with a significance threshold of 5%. Conclusions: Few RCTs have evaluated the effectiveness of aPDT in root canal disinfection in patients with permanent dentition presenting apical lesion. New RCTs with larger numbers of participants are needed to support using aPDT as an adjuvant to conventional ET in root canal disinfection for routine use in clinical practice. The trial was registered prospectively in ClinicalTrials.gov (NCT05916859).

Each culture has unique health care related values, habits, perceptions, expectations, norms, etc., that makes cultural competence an important attribute to be developed by healthcare professionals, to ensure they provide effective treatment. Intercultural sensitivity (IS) is the affective dimension of cultural competence. The objective of this study is to explore the self-perceived level of IS in first and last year students of three health sciences professions (i.e., Dentistry, Medicine, and Nursing) at the Universidad de la Frontera, Temuco, Chile. This study adopted a cross-sectional design and a group comparison (e.g., year of study). 312 students completed the Intercultural Sensitivity Scale (ISS). Findings showed that overall ISS scores ranged from 1.83 to 4.94, with a mean score of 4.11 (s.d. 0.43). Group comparison between first and final year students showed statistically significant differences (4.18 vs. 4.00; p < 0.001). Medical and nursing students had a significantly higher overall mean IS score compared to dental students (4.21 and 4.16, respectively vs. 4.02; p < 0.01). There were also significant differences between three factors (interaction engagement; interaction confidence; and interaction enjoyment) by healthcare profession. These findings allow for discussion of the need for explicit incorporation and development of cultural competence in on health care professional curricula. Longitudinal research is needed to explore how IS changes over time, along with generating qualitative data from the student populations IS experiences and exposure., (© 2024. The Author(s).)

Background: Older adults present a variety of oral diseases and conditions, in addition to co-morbidities and limited access to dental care, which significantly impact their oral health-related quality of life (OHRQoL). There are many instruments published to measure OHRQoL. However, it is challenging for clinicians and researchers to choose the best instrument for a given purpose., Purpose: To identify OHRQoL instruments available for older adults and summarize the evidence on the conceptual and measurement model, psychometric properties, interpretability, and administration issues of OHRQoL instruments available for older adults through a systematic review., Methods: A systematic search was conducted in MEDLINE, EMBASE, LILACS, and CENTRAL up to February 2023. Articles reporting information on the concept model measurement, psychometric properties, and administration issues of an instrument measuring OHRQoL in older adults were included. Two researchers independently evaluated each instrument using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. The overall score and seven attribute-specific scores were calculated (range 0-100): Conceptual and measurement model, Reliability, Validity, Responsiveness, Interpretability, Burden, and Alternative forms., Results: We identified 14 instruments evaluated in 97 articles. The overall score varied between 73.7 and 8.9, with only six questionnaires over the threshold score 50.0. EORTC QLQ OH-15 (cancer-specific questionnaire) achieved the highest score (73.7), followed by OHIP (generic OHRQoL questionnaire) (66.9), GOHAI (generic OHRQoL questionnaire) (65.5), and OHIDL (generic OHRQoL questionnaire) (65.2). Overall, the Conceptual and measurement model and Validity showed the best performance, while Responsiveness and Interpretability showed the worst. Insufficient information was presented for an overall evaluation of DSQ and OHAI., Conclusion: The evidence supports using EORTC QLQ-OH15 as a specific instrument to assess OHRQoL in cancer patients and the OHIP-49, GOHAI, or OHIDL as generic instruments to assess OHRQoL either for cross-sectional or longitudinal studies in older adults., (© 2024. The Author(s).)

Background: This scoping review aims to systematically and critically describe the numerous legal challenges brought about by the utilization of digital oral health in the delivery of oral healthcare., Methods: A systematic search was conducted. The following electronic databases were reviewed from inception up to March 2023: MEDLINE, Embase, Scopus, and LILACS. The search included any scientific document and paper in English, Spanish, or Portuguese on legal issues raised using digital health in oral healthcare delivery. Two reviewers conducted the selection process and data extraction. Legal issues raised concerning the adoption of digital health technology were analysed using the modified Mars' framework., Results: Seventeen studies were included. Most of the documents identified and covered generic aspects of delivering digital oral healthcare (n = 11) without explicitly referring to any dental specialty. The most mentioned legal issues were data security (n = 15); liability and malpractice (n = 14); consent (n = 12); and confidentiality (n = 12). To a lower extent, patient-practitioner relationship (n = 11); and license and jurisdiction (n = 11) were also covered. These were followed by privacy of information (n = 10); adequacy of records (n = 9); and e-referrals (n = 8). On the other hand, fewer studies commented on social media use (n = 3), authentication (n = 2); or e-prescriptions (n = 2). Before implementing any digital health solution, practitioners need to be aware of the many legal issues that the introduction of these technologies involves, be clear where the responsibility lies, and apply extreme caution in following national guidelines. Current literature concentrates on a few well-known legal issues. Issues around authentication, use of social media, and e-prescriptions received less attention., (© 2023. The Author(s).)

Background: The prevalence and consequences of traumatic dental injuries (TDI) make them a public health problem. Trustworthy TDI clinical practice guidelines (CPGs) assist clinicians in determining a diagnosis and guide them to the most appropriate therapy. The aim of this systematic survey was to identify and evaluate the quality of CPGs for the diagnosis, emergency management, and follow-up of TDIs., Materials and Methods: A systematic search was carried out in MEDLINE, EMBASE, Epistemonikos, Trip database, CPG websites, and dental societies to identify documents providing recommendations for the emergency and sequelae management of TDIs. Reviewers assessed the included guidelines independently and in duplicate, using the AGREE II instrument. ANOVA or Student's t-tests were used to determine the attributes of CPGs associated with the total score in AGREE II., Results: Ten CPGs published between 2010 and 2020 were included, mostly from Europe (n = 6). The overall agreement between reviewers was very good (0.94; 95%CI 0.91-0.97). The mean scores (the higher the score, the better the domain assessment) per domain were as follows: Scope and purpose 78.0 ± 18.9%; stakeholder involvement 46.9 ± 29.6%; rigour of development 41.8 ± 26.7%; clarity of presentation 75.8 ± 17.6%; applicability 15.3 ± 18.8%; and editorial independence 41.7 ± 41.7%. The overall mean rate was 4 ± 1.3 out of a maximum score of 7. Two guidelines were recommended by the reviewers for use in practice and rated as high quality. CPGs developed by government organizations showed a significantly higher overall score., Conclusions: The overall quality of CPGs on TDI was suboptimal. CPG developers should synthesize the evidence and formulate recommendations using high-quality methodologies and standards in a structured, transparent, and explicit way., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Biofilms are responsible for the most prevalent oral infections such as caries, periodontal disease, and pulp and periapical lesions, which affect the quality of life of people. Antibiotics have been widely used to treat these conditions as therapeutic and prophylactic compounds. However, due to the emergence of microbial resistance to antibiotics, there is an urgent need to develop and evaluate new antimicrobial agents. This scoping review offers an extensive and detailed synthesis of the potential role of selenium nanoparticles (SeNPs) in combating oral pathogens responsible for causing infectious diseases. A systematic search was conducted up until May 2022, encompassing the MEDLINE, Embase, Scopus, and Lilacs databases. We included studies focused on evaluating the antimicrobial efficacy of SeNPs on planktonic and biofilm forms and their side effects in in vitro studies. The selection process and data extraction were carried out by two researchers independently. A qualitative synthesis of the results was performed. A total of twenty-two articles were considered eligible for this scoping review. Most of the studies reported relevant antimicrobial efficacy against C. albicans , S. mutans , E. faecalis , and P. gingivalis , as well as effective antioxidant activity and limited toxicity. Further research is mandatory to critically assess the effectiveness of this alternative treatment in ex vivo and in vivo settings, with detailed information about SeNPs concentrations employed, their physicochemical properties, and the experimental conditions to provide enough evidence to address the construction and development of well-designed and safe protocols.

Introduction: Breast cancer-related lymphoedema (BCRL) is one of the most underestimated and debilitating complications associated with the treatment that women with breast cancer receive. Several systematic reviews (SRs) of different physical exercise programmes have been published, presenting disperse and contradictory clinical results. Therefore, there is a need for access to the best available and summarised evidence to capture and evaluate all the physical exercise programmes that focus on reducing BCRL., Objective: To evaluate the effectiveness of different physical exercise programmes in reducing the volume of lymphoedema, pain intensity and improving quality of life., Method and Analysis: The protocol of this overview is reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, and its methodology is based on Cochrane Handbook for Systematic Reviews of Interventions. Only those SRs involving physical exercise by patients with BCRL will be included, whether on its own or combined with other exercises or other physical therapy interventions.The outcomes of interest to be considered will be lymphoedema volume, quality of life, pain intensity, grip strength, range of motion, upper limb function and any adverse event. The MEDLINE/PubMed, Lilacs, Cochrane Library, PEDro and Embase databases will be searched for reports published from database inception to April 2023.Two researchers will perform study selection, data extraction and risk of bias assessment independently. Any discrepancy will be resolved by consensus, or ultimately, by a third-party reviewer. We will use Grading of Recommendations Assessment, Development and Evaluation System to assess the overall quality of the body of evidence., Ethics and Dissemination: The results of this overview will be published in peer-reviewed scholarly journals and the scientific dissemination will take place in national or international conferences. This study does not require approval from an ethics committee, as it does not directly collect information from patients., Prospero Registration Number: CRD42022334433., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Laser photobiomodulation (laser PBM) is an effective means of accelerating burn wound contraction, however it is still unclear whether laser PBM produces greater benefit when applied directly to excised and unexcised burn wounds . The aim of this systematic review of preclinical studies was to determine the effectiveness of laser PBM in the wound contraction rate in excised and unexcised burn wounds., Materials and Methods: A systematic search was conducted in the EMBASE, MEDLINE and LILACS databases. Preclinical studies were included that analysed the effectiveness of laser PBM in burn wound contraction, and assessed wound closure. The SYRCLE risk of bias tool was used. Random effects models were used to estimate the pooled effect., Results: Thirteen studies were included in the qualitative analysis and six in the quantitative analysis. Two weeks after the lesion, laser PBM favoured the wound contraction percentage, increasing the closure rate in excised burn wounds (SMD= 1.34, CI 95% 0.41 to 2.27, 0.41-2.27, I 2 =0%, =0%, low certainty of evidence. In unexcised burns, it was uncertain whether laser PBM increased or diminished the wound contraction rate (SMD=1.22(SMD=1.22 CI 95% -0.05 to 2.49, I 2 =68%; =68%; very low certainty of evidence)., Conclusions: In the animal model, laser PBM is effective in increasing the wound contraction rate in excised burns. However, due to the low certainty of the evidence, uncertainty remains about the true magnitude of the effect of laser on wound contraction in animals; our results should therefore be interpreted with caution., Competing Interests: Declaration of Competing Interest No competing financial interests exist., (Copyright © 2022. Published by Elsevier Ltd.)

Early childhood caries (ECC) is a worldwide public health problem. The biological and behavioural determinants that are directly involved in ECC have been well documented; however, evidence on the effects of some psychosocial factors remains conflicting. This study aimed to assess the association between child temperament and ECC in Chilean preschoolers. Prior approval of the protocol was obtained from the ethics committee of Universidad de La Frontera (Folio N° 020&#95;17), and all of those involved in the study provided signed informed consent forms. The cross-sectional study was conducted with 172 children aged 3 to 5 years attending preschools in Temuco, Chile. Each child's temperament was assessed based on parents' responses to the Early Childhood Behaviour Questionnaire. The outcomes assessed were caries prevalence and caries experience (dmft scores). The covariates included were socioeconomic position, cariogenic diet, prolonged breastfeeding, presence of dental plaque and hypoplasia. Logistic regression models were used to predict caries prevalence and negative binomial regression for caries experience. The prevalence of ECC was 29.1%, and the most frequent child temperament was 'effortful control'. Regression model analyses, adjusting for covariates, showed no evidence of an association between any domain of children's temperament (surgency, negative affect and effortful control) with the prevalence of caries or caries experience. This cross-sectional study found no association between childhood temperament and ECC in preschool children for this population. However, due to the specificity of this population, the association cannot be entirely ruled out. Further studies are needed to help understand the association between temperament and oral health, including the influences of family environment factors and culture.

Unilateral condylar hyperplasia (UCH) is an uncommon disease involving progressive facial asymmetry. The aim of this research was to perform an analysis of the diagnosis and treatment of patients with UCH in a clinical series. An observational retrospective study was performed on subjects with progressive facial asymmetry in the lower third of the face; all the subjects were under treatment with condylectomy and orthodontics to improve occlusion and face balance. Variables such as age, sex, clinical type, SPECT (single photon emission computed tomography) intensity and a requirement for secondary surgery were included; the Shapiro Wilk test was performed to analyze the normality of the data and nonparametric analysis and the Kruskal-Wallis or Mann-Whitney tests were used to assess the association between the SPECT difference and the variables, where 2-tailed p values < 0.05 were considered to be statistically significant. Forty-nine patients between 10 and 45 y.o. (average age: 19.1 ± 7.4 y.o.) were included in the study. There were 41 female (83.6%) and 8 male (16.4%) subjects. The SPECT analysis comparing the right and left condyles with more than 10% in caption of the isotope was present in 46 subjects; the results obtained using SPECT were not statistically related to the age or sex of the sample ( p = 0.277). The patients were classified into clinical types I, II and III, and no correlations could be confirmed between the clinical type and other variables. High condylectomy was conducted on all patients, among which 14 patients underwent a secondary surgery for orthognathic or cosmetic treatment, and was not related to the initial variables used in diagnosis ( p = 0.98); interestingly, the second surgical treatment was more present in the clinical type I and in subjects under 16 years old with no statistical differences. Clinical analysis, medical records, 3D imaging and SPECT should be used as a complementary analysis in assessing the diagnosis of UCH and progressive facial asymmetry.

Introduction: Lymphoedema associated with breast cancer is caused by an interruption of the lymphatic system, together with factors such as total mastectomy, axillary dissection, positive lymph nodes, radiotherapy, use of taxanes and obesity. Physiotherapy treatment consists of complex decongestive therapy, manual lymphatic drainage and exercises, among other interventions. Currently, there are several systematic review and randomised controlled trials that evaluate the efficacy of these interventions. However, at present, there are no studies that compare the effectiveness of all these physical therapy interventions. The purpose of this study is to determine which physical therapy treatment is most effective in reducing breast cancer-related lymphoedema, improving quality of life and reducing pain., Methods and Analysis: MEDLINE, PEDro, CINAHL, EMBASE, LILACS and Cochrane Central Register of Controlled Trials will be searched for reports of randomised controlled trials published from database inception to June 2022. We will only include studies that are written in English, Spanish and Portuguese. We will also search grey literature, preprint servers and clinical trial registries. The primary outcomes are reduction of secondary lymphoedema associated with breast cancer, improvements in quality of life and pain reduction. The risk of bias of individual studies will be evaluated using the Cochrane Risk of Bias 2.0 Tool. A network meta-analysis will be performed using a random-effects model. First, pairs will be directly meta-analysed and indirect comparisons will be made between the different physical therapy treatments. The GRADE system will be used to assess the overall quality of the body of evidence associated with the main results., Ethics and Dissemination: This protocol does not require approval from an ethics committee. The results will be disseminated via peer-reviewed publications., Prospero Registration Number: CDR42022323541., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Cultural competence development in the formative process of healthcare professionals is crucial for the provision of culturally appropriate health care. This educational issue is highly relevant in the growing multicultural composition of southern Chile. The objective of this study was to examine how the healthcare professions curricula at the Universidad de La Frontera, in La Araucanía Region, prepares future professionals to respond to patients' cultural needs., Method: A sequential transformative mixed methods design composed of two phases was carried out. Phase 1 reviewed all printed material and documentation to explore content that developed cross-cultural skills and competencies in the curricula. In Phase 2 semi-structured interviews were conducted with academics with responsibilities for the development of the curriculum in each career, to detect how academics envisage the incorporation of cultural competence in the curricula., Results: Regarding curricular contents, findings indicated that the healthcare professions curricula at The Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects' syllabuses, with inclusion of the different CCT, particularly in the Dental and Medical curricula. However, this coverage showed significant variations in the undergraduate healthcare curricula. The analysis revealed that themes around the Ethics and human values for professional practice; the Psychosocial and cultural determinants of health; the Relationship health-family-community, and to a lesser extent, the Clinician-patient relationship were well covered in the courses. On the other hand, Inequalities in health was the theme with the least contact time in all three courses. Academics called for a better organisation of the inclusion of CCT in the curricula. They also highlighted the challenges of maintaining the dominant paradigm underlying healthcare models, practices, and orientations within the academic staff and health discipline., Conclusion: Curricula contents findings indicate that the healthcare professions curricula at Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects' syllabuses. However, its depth of coverage allows for improvements. The systematization of CCT and teaching-learning methodologies in healthcare professions curricula is necessary to develop formative processes that allow future professionals to be aware of and respectful with patients' cultural characteristics and needs., (© 2022. The Author(s).)

Objectives: Inequalities have been reported between high, middle and low socioeconomic position (SEP) children. However, the effect of contextual and individual SEP on existing inequalities among socioeconomically deprived children varies between local contexts. The aim of this study was to assess the impact of contextual and individual SEP on individual caries experience among socioeconomically deprived children in Chile., Methods: Cross-sectional multilevel analysis of data from the 2015 electronic register of the National Board of School Aid and Scholarships (JUNAEB) of Chile. The contextual variables were the municipality Human Development Index (HDI) and rurality index. Individual variables included gender, living in extreme poverty and school grade. Multilevel negative binomial models assessed their impact on DMFT/dmft., Results: 112,429 children in 255 municipalities were included. Overall, contextual SEP (HDI) was not associated with caries experience in the primary or permanent dentition. Individual SEP (living in extreme poverty) was associated with caries experience in both dentitions. The proportion of children living in extreme poverty with caries experience in the primary teeth was 17% higher than children not living in extreme poverty (PR 1.17; 95% CI 1.15-1.19), while for children with permanent teeth it was 9% higher (PR 1.09; 95% CI 1.08-1.11)., Conclusion: These findings could support the development of health strategies focused on individual SEP to efficiently reduce oral health inequalities among socioeconomically deprived children., (Copyright© 2022 Dennis Barber Ltd.)

Rationale, Aims and Objectives: In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical. The guideline development process includes prioritization of the guideline topic, questions and health outcomes. This case study describes the application of a new methodology to prioritize questions and rate the importance of health outcomes for a COVID-19 dental guideline., Methods: Panel members rated the topic and the questions' overall importance, using a 9-point scale (1 = least important; 9 = most important). In addition, they rated six criteria if multiple questions received the same overall importance rating: common in practice, uncertainty in practice, variation in practice, new evidence available, cost consequences, not previously addressed. Panellists also rated the importance of each outcome, defined with health outcome descriptors, using a 9-point scale and the utility of health outcomes on a visual analogue scale. The correlation between each criterion and overall question importance was tested by Spearman correlation coefficient., Results: Of seven topics, four were rated as high priority and three were rated as important, but not of high priority. Thirty-six percent of the questions (18/50) were rated as high priority to address in the guideline and 64% (32/50) were rated as an important question but not of high priority. Of the 11 outcomes, 72.7% were rated as critical for decision making. The mean utility rating was 0.57 (SD 0.32), with a minimum mean rating of 0.16 and a maximum of 0.76 (SD 0.23)., Conclusion: This case study demonstrated that this approach provides a rigorous and transparent methodology to conduct the prioritizations of guideline topics, questions and health outcomes., (© 2022 John Wiley & Sons Ltd.)

Objective: To evaluate changes in general and oral health-related quality of life (HRQoL) in patients with dentofacial deformity undergoing orthognathic surgery, and whether these changes vary according to type of deformity., Material and Methods: This is a prospective longitudinal multicenter study of patients with dentofacial deformities (n = 90). The Orthognathic Quality of Life Questionnaire (OQLQ), Oral Health Impact Profile (OHIP-14), and Short-Form Health Survey version2 (SF-36v2) were self-completed by patients before surgery, 3 and 6 months after orthognathic surgery. Change was tested using paired t-test, and compared between Class II and Class III of dentofacial deformity by unpaired t-test. The magnitude of change was examined estimating the standardized response mean (SRM)., Results: The OQLQ and OHIP-14 showed statistically significant improvements 6 months after surgery, compared with the pre-surgical evaluation, but the SF-36v2 only in the physical component summary. The SRM was large in OQLQ oral function (-1.11) and dentofacial facial aesthetics (-0.76) dimensions, and moderate in most of OHIP-14 dimensions. Differences in mean change between Class II and III were statistically significant for global scores of OQLQ (-10.08 vs -20.30, p = 0.0271) and OHIP-14 (-3.79 vs -10.56, p = 0.0144)., Conclusions: A significant improvement was observed in oral HRQoL and in the physical component of general health in patients with dentofacial deformities Class II and III after orthognathic surgery. Improvement was greater among Class III than in Class II patients., Clinical Relevance: These results provide patients, oral health care professionals, and planners with valuable information to make evidence-based decisions and facilitate shared clinical decision-making, taking into account the patients' perspective., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Pit and fissure sealants are plastic materials that are used to seal deep pits and fissures on the occlusal surfaces of teeth, where decay occurs most often in children and adolescents. Deep pits and fissures can retain food debris and bacteria, making them difficult to clean, thereby causing them to be more susceptible to dental caries. The application of a pit and fissure sealant, a non-invasive preventive approach, can prevent dental caries by forming a protective barrier that reduces food entrapment and bacterial growth. Though moderate-certainty evidence shows that sealants are effective in preventing caries in permanent teeth, the effectiveness of applying pit and fissure sealants to primary teeth has yet to be established., Objectives: To evaluate the effects of sealants compared to no sealant or a different sealant in preventing pit and fissure caries on the occlusal surfaces of primary molars in children and to report the adverse effects and the retention of different types of sealants., Search Methods: An information specialist searched four bibliographic databases up to 11 February 2021 and used additional search methods to identify published, unpublished and ongoing studies. Review authors scanned the reference lists of included studies and relevant systematic reviews for further studies., Selection Criteria: We included parallel-group and split-mouth randomised controlled trials (RCTs) that compared a sealant with no sealant, or different types of sealants, for the prevention of caries in primary molars, with no restriction on follow-up duration. We included studies in which co-interventions such as oral health preventive measures, oral health education or tooth brushing demonstrations were used, provided that the same adjunct was used with the intervention and comparator. We excluded studies with complex interventions for the prevention of dental caries in primary teeth such as preventive resin restorations, or studies that used sealants in cavitated carious lesions., Data Collection and Analysis: Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We presented outcomes for the development of new carious lesions on occlusal surfaces of primary molars as odds ratios (OR) with 95% confidence intervals (CIs). Where studies were similar in clinical and methodological characteristics, we planned to pool effect estimates using a random-effects model where appropriate. We used GRADE methodology to assess the certainty of the evidence., Main Results: We included nine studies that randomised 1120 children who ranged in age from 18 months to eight years at the start of the study. One study compared fluoride-releasing resin-based sealant with no sealant (139 tooth pairs in 90 children); two studies compared glass ionomer-based sealant with no sealant (619 children); two studies compared glass ionomer-based sealant with resin-based sealant (278 tooth pairs in 200 children); two studies compared fluoride-releasing resin-based sealant with resin-based sealant (113 tooth pairs in 69 children); one study compared composite with fluoride-releasing resin-based sealant (40 tooth pairs in 40 children); and one study compared autopolymerised sealant with light polymerised sealant (52 tooth pairs in 52 children). Three studies evaluated the effects of sealants versus no sealant and provided data for our primary outcome. Due to differences in study design such as age of participants and duration of follow-up, we elected not to pool the data. At 24 months, there was insufficient evidence of a difference in the development of new caries lesions for the fluoride-releasing sealants or no treatment groups (Becker Balagtas odds ratio (BB OR) 0.76, 95% CI 0.41 to 1.42; 1 study, 85 children, 255 tooth surfaces). For glass ionomer-based sealants, the evidence was equivocal; one study found insufficient evidence of a difference at follow-up between 12 and 30 months (OR 0.97, 95% CI 0.63 to 1.49; 449 children), while another with 12-month follow-up found a large, beneficial effect of sealants (OR 0.03, 95% CI 0.01 to 0.15; 107 children). We judged the certainty of the evidence to be low, downgrading two levels in total for study limitations, imprecision and inconsistency. We included six trials randomising 411 children that directly compared different sealant materials, four of which (221 children) provided data for our primary outcome. Differences in age of the participants and duration of follow-up precluded pooling of the data. The incidence of development of new caries lesions was typically low across the different sealant types evaluated. We judged the certainty of the evidence to be low or very low for the outcome of caries incidence. Only one study assessed and reported adverse events, the nature of which was gag reflex while placing the sealant material., Authors' Conclusions: The certainty of the evidence for the comparisons and outcomes in this review was low or very low, reflecting the fragility and uncertainty of the evidence base. The volume of evidence for this review was limited, which typically included small studies where the number of events was low. The majority of studies in this review were of split-mouth design, an efficient study design for this research question; however, there were often shortcomings in the analysis and reporting of results that made synthesising the evidence difficult. An important omission from the included studies was the reporting of adverse events. Given the importance of prevention for maintaining good oral health, there exists an important evidence gap pertaining to the caries-preventive effect and retention of sealants in the primary dentition, which should be addressed through robust RCTs., (Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Our aim was to assess the impact of combined orthodontic-surgical treatment on patients' oral health-related quality of life (OHRQoL) according to type of dentofacial deformities, by synthesizing the available evidence., Methods: Search was conducted in the PubMed, Embase/MEDLINE, Scopus, and Cochrane databases. The eligibility criteria were studies that measured OHRQoL before-after orthognathic surgery, with results disaggregated by Class II and III. Two researchers independently performed the selection process, data extraction, and methodological quality assessment. Meta-analysis of the standard mean differences (SMD) was performed using random effect models., Results: The search identified 1047 references. Thirteen studies met the inclusion criteria, and four were included in the meta-analysis. The SMD of OHRQL global score showed large improvement 4-7 months after surgery in Class II and III patients (2.09, 95% CI 0.68 to 3.49 and 1.96, 95% CI 1.22 to 2.70, respectively). The sensitivity analyses, excluding studies with weak methodological quality, showed that Class III patients' improvement in functional limitation was significantly higher than in Class II patients (SMD 0.57, 95% CI 0.12-1.02)., Conclusions: There is not enough evidence to support differences between Class II and III patients in the OHRQoL impact after orthognathic surgery, but findings suggest lower improvement of some domains in Class II patients.

Objectives: The aim of this study was to conduct a systematic review in order to assess the impact of early childhood caries (ECC) and its severity on Oral health-related quality of life (OHRQoL)., Materials and Methods: An electronic search was conducted in MEDLINE, EMBASE, Cochrane, SciELO and Lilacs databases. The study eligibility criteria were primary studies published in English, Spanish or Portuguese that assessed OHRQoL in preschool children with dental caries using validated instruments. Two researchers independently performed the selection process and data extraction. The Effective Public Health Practice Project's Quality Assessment Tool was used for the quality assessment. Random effects models were used to estimate the pooled effect for continuous and categorical data., Results: Of 2,037 identified articles, thirty-five studies (37 articles) met the inclusion criteria. The methodological quality was judged mainly as moderate. Children with ECC were more likely to report any impact on OHRQoL than children without caries (OR: 1.99; 95% CI: 1.51-2.62; 6 studies). Severe ECC (dmft > 5) presented a higher effect (OR: 5.00; 95% CI: 3.70-6.74; 8 studies). Sensitivity analysis including only population studies showed uncertain results on the impact of ECC on OHRQoL (OR: 1.67; 95% CI: 0.99-2.82; I 2  = 95%). The symptom and psychological domains were the most affected (SMD: 0.60, 95% CI: 0.38-0.81 and SMD: 0.61, 95% CI: 0.37-0.85 respectively)., Conclusions: ECC has a negative impact on the OHRQoL of both preschoolers and their families. However, its impact on OHRQoL is diluted when it is evaluated at population level., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To evaluate the quality of clinical practice guidelines (CPGs) on dental services provision during the first months of the COVID-19 pandemic., Materials and Methods: We systematically searched in MEDLINE, EMBASE, LILACS, Epistemonikos, Trip databases, websites of CPG developers, compilers of CPGs, scientific societies and ministries of health to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. Reviewers independently and in duplicate assessed the included CPGs using the AGREE II instrument. We calculated the standardized scores for the 6 domains and made a final recommendation about each CPG. The inter-appraiser agreement was assessed using the intraclass correlation coefficient (ICC)., Results: Twenty-three CPGs published were included. Most of the CPGs were from America (n = 15) and Europe (n = 6). The overall agreement between reviewers was very good (ICC = 0.93; 95%CI 0.87-0.95). The median score for each domain was the following: Scope and purpose 67% (IQR 20%); Stakeholder involvement 33% (IQR 14%); Rigour of development 13% (IQR 13%); Clarity of presentation 64% (IQR 31%); Applicability 19% (IQR 17%) and Editorial independence 8% (IQR 8%). Twenty two guidelines were not recommended by the reviewers. Only one of the CPGs was recommended with modifications. The median overall rate was 3 (IQR 1). All CPGs were classified as low quality., Conclusions: The overall quality of CPGs on dental services provision during the first months of the COVID-19 pandemic was low, which makes its implementation difficult for clinicians and policy makers. Therefore, it is critical that developers are transparent and forthcoming about the difficulties that have arisen during the CPG development process., Competing Interests: CONFLICT OF INTEREST The authors declare that they have no conflict of interest with any financial organization regarding the material discussed in the manuscript., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.

The eradication of endodontic pathogens continues to be the focus of the search for new root canal system (RCS) disinfection strategies. This scoping review provides a comprehensive synthesis of antimicrobial photodynamic therapy (aPDT) using nanoparticles (NPs) as an alternative to optimize RCS disinfection. A systematic search up to March 2021 was carried out using the MEDLINE, EMBASE, Scopus, Lilacs, Central Cochrane Library, and BBO databases. We included studies focused on evaluating the activation of NPs by aPDT in inoculated root canals of human or animal teeth or bacterial cultures in the laboratory. The selection process and data extraction were carried out by two researchers independently. A qualitative synthesis of the results was performed. A total of seventeen studies were included, of which twelve showed a substantial antibacterial efficacy, two assessed the substantivity of the disinfection effect, and three showed low cytotoxicity. No adverse effects were reported. The use of functionalized NPs with photosensitizer molecules in aPDT has been shown to be effective in reducing the bacteria count, making it a promising alternative in endodontic disinfection. Further studies are needed to assess the development of this therapy in in vivo conditions, with detailed information about the laser parameters used to allow the development of safe and standardized protocols.

Melanocortin-4 receptor (MC4R) has been investigated as a potential drug target for the treatment of neuropathic pain. The objective of the study was to systematically identify the effects of MC4R antagonists on hypersensitivity in rat models of neuropathic pain. A systematic search was conducted using the following databases: WoS, PubMed, SCOPUS, and MEDLINE. Inclusion criteria were: rat hypersensitivity induced by models of neuropathic pain with reported effects of MC4R antagonist. Two researchers performed the selection process and data extraction. SYRCLE risk of bias tool was used. Standard mean differences (SMD) were calculated and pooled by meta-analysis using random effect models. Ten articles met the eligibility criteria and were included in the systematic review and meta-analysis. The results reveal that, in animals exposed to neuropathic pain, administration of MC4R antagonists significantly increased paw withdrawal threshold (SHU9119 SMD = 1.67, 95% CI: [0.91, 2.44], I 2  = 0%; HS014 SMD = 2.2, 95% CI: [0.53, 3.87], I 2  = 71%) and heat withdrawal latency (HS014 SMD = 3.35, 95% CI: [0.56, 6.14], I 2  = 83%) compared to vehicle-treated animals. MC4R antagonists are effective in the alleviation of hypersensitivity in rodent neuropathic pain models. SHU9119 and HS014 antagonists showed the most prominent results. However, further investigation is needed to determine the optimal dose and time of treatment., (© 2021 European Journal of Oral Sciences.)