Still Scholarworks (A.T. Still University)
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Postbiotics and Dental Caries: A Systematic Review
No full textObjective: This systematic review aimed to evaluate the current evidence regarding the impact of postbiotics on dental caries, focusing on the effectiveness of postbiotic interventions in caries prevention, mechanisms of action, optimal dosages, and administration protocols. Methods: A literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. Eligible studies included randomized controlled trials, quasi-experimental, observational, and in vitro studies. The selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A qualitative synthesis was performed due to heterogeneity in study designs and outcomes. Results: Twenty-one studies were included (18 in vitro and three randomized controlled trials). Postbiotics derived from various Lactobacillus species demonstrated inhibitory effects on Streptococcus mutans growth, biofilm formation, and virulence gene expression. Proposed mechanisms include direct antimicrobial activity, inhibition of bacterial adhesion, disruption of biofilm formation, modulation of immune responses, and pH buffering. After postbiotic interventions, human trials showed reduced salivary S. mutans counts and increased salivary pH. Conclusions: Postbiotics offer a promising novel approach to dental caries prevention by targeting cariogenic bacteria and modulating the oral microbiome through multiple mechanisms. Compared to probiotics, postbiotics present additional advantages, including enhanced safety, stability, and ease of incorporation into oral care products
Integrating oral health into primary healthcare: lessons from project OHE-NCHeW (oral health education for nurses and community health workers) in Nigeria
No full textIntroduction: Oral health disparities in Nigeria highlight the need to integrate basic oral health into Primary Health Care (PHC). Project OHE-NCHeW (Oral Health Education for Nurses and Community Health Workers) was developed to train PHC workers in providing basic oral health care, education, and referrals in underserved communities. This study explored the impact of the training program on participants\u27 knowledge, referral practices, and patient outcomes, and gathered feedback to optimize the program for future implementation. Methods: Using a qualitative phenomenological approach, five focus group discussions (FGDs) were conducted with participants to gather insights on knowledge acquisition, changes in referral practices, and barriers or facilitators to implementation. Audio recordings were transcribed verbatim and analyzed thematically using the CREATIVE framework. Additional feedback from trainers and observed patient impact were also considered. Results: The trained PHC workers reported enhanced knowledge and confidence, resulting in improved patient education and referrals. Patients also noted better oral health literacy and increased trust in dental referrals. Facilitators viewed the program as valuable and feasible, emphasizing the importance of ongoing training, resource allocation, and policy integration to maintain the program\u27s impact. Key barriers included insufficient resources, lack of supervision, and cultural beliefs. Discussion: The pilot training enhanced PHC worker capacity and was positively perceived by trainers. Patients reportedly responded favorably, indicating potential impact. However, addressing identified systemic and resource barriers is crucial for sustainable integration. This study offers multi-perspective insights for optimizing oral health integration within PHC in similar settings
The development but not the maintenance of phrenic and sympathetic long-term facilitation after acute intermittent hypoxia requires nucleus tractus solitarii H2O2
No full textAcute exposure to intermittent hypoxia (AIH) produces prolonged increases (long-term facilitation, LTF) in phrenic (PhrNA) and sympathetic (SNA) nerve activity (pLTF and sLTF, respectively) during non-hypoxic periods, and augments cardiorespiratory responses to hypoxia. We recently showed that neuronal activity in the nucleus tractus solitarii (nTS) is required for the induction and maintenance of LTF. However, the specific mechanisms involved were not determined. Because bouts of deoxygenation/reoxygenation produce reactive oxygen species and H2O2 contributes to plasticity in the nTS, we hypothesized that nTS H2O2 contributes to AIH-induced LTF and augmented hypoxic responses. We reduced H2O2 within the nTS acutely by nanoinjecting catalase or chronically by overexpressing catalase via an adenovirus vector. We then evaluated PhrNA and splanchnic SNA (SSNA) in animals subjected to AIH or time control. In control rats subjected to nTS nanoinjections of aCSF or overexpression of eGFP, AIH produced pLTF and sLTF, and augmented PhrNA responses to hypoxia. Reducing nTS H2O2 by either nTS nanoinjections or overexpression of catalase markedly attenuated the development of pLTF and sLTF. Augmented hypoxic responses due to AIH also were diminished. In contrast, after LTF had developed, nanoinjection of catalase had no effect on the magnitude of either PhrNA or SSNA although inhibiting nTS neuronal activity after LTF development reduced pLTF. The data indicate that nTS H2O2 is required for AIH-induced pLTF and sLTF, as well as augmentation of responses to hypoxia. Moreover, while nTS neuronal activity is essential to the maintenance of pLTF once developed, ongoing increases in H2O2 are not required
Examining the Alignment of Pharmacists\u27 Daily Tasks, Employer-advertised Skills, and the Entrustable Professional Activities
No full textObjective: To understand alignment of pharmacist jobs’ daily tasks, employer-advertised skills, and pharmacy education of entrustable professional activities (EPAs). Methods: The study team compiled the top 20 tasks pharmacists reported performing at least daily from the Occupational Information Network survey (2022), the top 50 employer-advertised skills from 89,819 pharmacist job postings in 2022 from Lightcast and the 13 EPAs from accreditation standards that define a practice-ready pharmacist. Two experienced faculty and licensed pharmacists mapped employer-advertised skills, each task performed at least daily, and the EPAs. Trends in alignment between what pharmacists report doing daily with these other stakeholder expectations were described. Results: Of the top 20 daily pharmacist tasks from the Occupational Information Network, 55% were categorized as product-centric. Legal compliance (30%) and prescription review (25%) were the employer-advertised skills most frequently mapped to these daily tasks. EPA 13 (pharmacy administration and operations) was the EPA most frequently mapped to daily tasks (45%). EPA 8 (education of the patient and others on medications) was the second most frequently mapped EPA to 30% of daily tasks. Conclusion: Prescription processing, legal compliance, and operational pharmacy management are the most essential daily functions of today\u27s pharmacists, contrasting with the person-centered nature of the EPAs. Amid the curricular evolution that has occurred to meet the future vision of pharmacy practice, programs must, nonetheless, continue to teach the skills required for the existing marketplace to ensure that graduates are practice-ready for today\u27s positions
Confidence and Preparedness of Wisconsin Speech-Language Pathologists and Graduate Students in Serving Bilingual Children
No full textThis study examined the self-perceived confidence and preparedness of 128 certified speech-language pathologists (SLPs) and 26 SLP graduate students in Wisconsin when serving bilingual children. Participants, monolingual or bilingual, completed an online survey. The relationship between confidence, preparedness, academic coursework, and continuing education was investigated. Results indicated that bilingual SLPs show higher confidence and preparedness levels than monolingual SLPs when working with bilingual children. However, both groups exhibited significantly higher confidence and preparedness when working with monolingual children. A regression analysis revealed that the number of continuing education courses (CEUs) significantly predicts confidence and preparedness levels for working with bilingual children. In contrast, the number of academic coursework topics covered did not significantly correlate with confidence or preparedness. The results highlight the need for specialized learning opportunities that focus on the complexities of bilingual service provision in improving the readiness of both monolingual and bilingual SLPs, and graduate students to serve bilingual populations effectively
Immediate implant placement in damaged extraction sockets: a systematic review and meta-analysis of randomized controlled trials
No full textObjectives: The aim of the study was to observe whether immediate implant placement into damaged extraction sockets is a successful modality for treating hopeless teeth that require extraction. Data sources: An electronic search was carried out through four databases (PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect) to identify randomized controlled trials (2013 to 2023) to understand whether immediate implant placement in damaged sockets is a successful treatment. The focus question was, “In a patient with a hopeless tooth that needs extraction with the indication for dental implant treatment, is immediate implant placement in damaged extraction sockets, compared to undamaged sockets or healed sites, an effective method for the replacement of hopeless teeth and achieving a favorable clinical result?” The risk of bias was appraised and a meta-analysis using random effect was applied. Results: Five studies with 135 patients and 138 implants were included. The implant survival rate was 100% for all studies and period evaluated; the pink esthetic score (PES) scores had no statistically significant result for all articles that evaluated this parameter; the soft tissue changes was reported by two studies: one found no significant differences and the other showed that the test group experienced reduced soft tissue loss at the 1-year evaluation (measured with digital intraoral scanners); another two studies assessed the marginal bone loss, presenting no differences between groups. The meta-analysis showed homogeneity between the studies. There was an equilibrium among the groups in the various studies included, and age tended to be lower in the test group. The buccal bone tissue and pink esthetic score showed favoritism for the test group but without statistical significance. Conclusion: This study suggests that immediate implant placement in the presence of buccal bone defects can achieve comparable clinical and radiologic outcomes to traditional methods in the short term of the limited studies available. It was not possible to evaluate the buccal aspect through radiographs. Bone regeneration was essential to reach optimal results. It is important to emphasize that immediate implant placement requires adherence to rigorous criteria to ensure functionally acceptable results
The use of methylprednisolone after third molar surgery. A systematic review and meta-analysis of randomized controlled trials
No full textBackground: Extraction of impacted third molars is a standard procedure in dentistry. However, the postoperative inflammation and pain are undesired and uncomfortable. Methylprednisolone has emerged as a possible solution to improve outcomes. This systematic review aimed to evaluate methylprednisolone in the postoperative period of impacted third molars in relation to its efficacy in postoperative pain and edema, dosage regimens, administration forms, and adverse effects. Material and Methods: Following the PRISMA guidelines, the focus question was: “In patients who underwent impacted third molar extraction, what was the effect of methylprednisolone used postoperatively compared to non-use or the use of other medications within the same pharmacotherapeutic group to reduce inflammation and pain?” PubMed/MEDLINE and Scopus were consulted, and an additional manual was performed. The search included articles published in the last 10 years, with the language restriction to English. The articles were analyzed using the PRISMA principles, with pre-defined eligibility criteria. The data were extracted based on the general necessary information. The risk of bias for the RCTs included was performed using a revised Cochrane risk-ofbias tool for randomized trials, and a meta-analysis was performed. Results: Nine articles were included, and five were quantitatively analyzed. Evaluating the test and control groups (methylprednisolone versus controls), there was no significant heterogeneity for pain at 24 hours (p=0.15, I²=47%) and 7 days (p=0.15, I²=47%), with non-significant effects (p=0.85). In the inter-incisal reduction, there was homogeneity at 48 hours (p=0.96, I²=0%) and 7 days (p=0.37, I²=0%), with a greater reduction in the methylprednisolone group (p\u3c0.01 and p\u3c0.05, respectively). Conclusions: Methylprednisolone is efficient in safely treating patients after third molar extraction, reducing pain, edema, and trismus. It achieved better results for the inter-incisal level than dexamethasone; otherwise, dexamethasone is preferable in minimizing postoperative trismus, presenting superior potential in this specific clinical context
Comparing dentist and chatbot answers to dental questions for quality and empathy
No full textBackground: Integration of large language models (LLMs) into health care, particularly in patient communication, is a growing trend. This study evaluated the effectiveness of LLM chatbots in addressing dental patient queries compared with responses from human dentists on a public online forum. Methods: In January 2024, 20 patient questions and responses were randomly sampled from Reddit\u27s dental advice community. We assessed the quality and empathy of ChatGPT-generated responses (Version GPT-3.5, OpenAI) by 9 blinded dentists. The dentists were selected from a dental faculty pool familiar with reading and assessing written communication. The evaluators rated the information quality of the responses on a Likert scale (very poor, 1; poor, 2; acceptable, 3; good, 4; very good, 5) and empathy (not empathetic, 1; slightly empathetic, 2; moderately empathetic, 3; empathetic, 4; very empathetic, 5). Subsequently, they selected the best response (dentist or artificial intelligence). Nine blinded dentists rated 20 responses to the online inquiries, providing 180 potential responses. Results: The results indicated that the LLM chatbots’ responses were rated as higher quality and exhibited higher levels of empathy than human responses. Among 179 responses (1 was missing) to the question about whether the response was better from ChatGPT or the dentist, 167 (93.3%) responses indicated ChatGPT and 12 (6.7%) indicated dentist (P \u3c .001). Conclusions: Although subjective variations in assessing quality and empathy may exist, this study suggests that LLM chatbot responses show higher quality and empathy than online dentist responses. The use of LLM chatbots by dentists can enhance patient communication in dental practice owing to their efficiency, empathy, and quality. Further research is needed to determine the full potential of artificial intelligence in dentistry
Skeletal and Dentoalveolar Effects Using Three Types of Maxillary Protraction Protocols
No full textIntroduction: The purpose of this study is to compare the skeletal and dentoalveolar effects of the three types of facemask protocols in children. Subjects and Methods: Forty-eight subjects were grouped into three groups: bone-anchored facemasks (BAFMs) (BAFM group, n = 16, mean age 10.77 ± 1.00), facemask with miniscrew-assisted rapid palatal expanders (MARPEs) (MARPE/FM group, n = 16, mean age 10.47 ± 1.43) and facemask with rapid palatal expanders (RPEs) (RPE/FM group, n = 16, mean age 10.45 ± 1.04). Lateral cephalograms were taken at the initial observation (T0) and after maxillary protraction (T1). Cephalometric analysis was performed, and significance was assessed between the three groups. For statistical analysis, 1-way ANOVA or Kruskal–Wallis test was performed. Results: During maxillary protraction (T0–T1), greater maxilla advancement and greater intermaxillary relationship improvement were attained in BAFM (SNA: 2.28°, Mx. length: 3.13 mm, ANB: 3.41°, AB to MP: 5.31°) and MARPE/FM (SNA: 2.22°, Mx. length: 2.91 mm, ANB: 3.28°, AB to MP: 5.57°) groups than in the RPE/FM group (SNA: 1.09°, Mx. length: 1.46 mm, ANB: 2.08°, AB to MP: 2.77°) (p \u3c 0.01). Protraction of the orbitale was greater in the BAFM (SNOr: 2.54°) group than in MARPE/FM (SNOr: 1.53°) and RPE/FM (SNOr: 1.28°) groups (p \u3c 0.001). Also, the BAFM (PP to U6: 1.17 mm, U6 to VRmx: −1.18 mm) and MARPE/FM (PP to U6: 2.74 mm, U6 to VRmx: −2.80 mm) groups showed less maxillary first molar movement than the RPE/FM (PP to U6: 2.74 mm, U6 to VRmx: −2.80 mm) group. There was no significant difference in the mandibular variables and most of the vertical variables. Conclusion: The orthopaedic effects of BAFM and MARPE/FM were greater with maxillary protraction and intermaxillary relationship improvement than RPE/FM after protraction. Midface traction effects with MARPE/FM were less than with BAFM. However, MARPE/FM was more effective in preventing mesial movement and extrusion of the maxillary first molars
Performance on the Concussion Balance Test Is Indicative of Time to Recovery in Athletes Following Sports-Related Concussion: An Exploratory Analysis
No full textObjective: Sports-related concussions (SRCs) are commonly occurring injuries among athletic and recreationally active populations. SRCs can result in vestibular dysfunction that should resolve before returning to activity. It has been suggested that vestibular impairment is a factor that may influence recovery time. The objective of this study was to evaluate the effect of vestibular function on recovery following SRC. Design: Retrospective chart review. Setting: Multidisciplinary Concussion Clinic. Intervention: A total of 32 patient charts (21 males, 15.34 [1.47] y, 171.29 [8.44] cm, 68.37 [15.47] kg) from patients diagnosed with SRC presenting to a concussion clinic between August of 2016 and July 2017 with clinician-identified vestibular involvement were included. Main Outcome Measures: Scores on the Post-Concussion Symptom Scale, Dynamic Visual Acuity Test, Gaze Stabilization Test, Concussion Balance Test (COBALT), and other clinical data were used for analysis. Descriptive statistics were calculated for all variables. Pearson correlations were used to identify variables related to time to recovery. Variables were entered into a forward linear regression model. Results: Moderate to good relationships were identified between days to recovery and Dynamic Visual Acuity Test lines lost in the leftward direction (1.17 [0.52]; r = .39, P = .04), COBALTcondition 8 sway velocity (1.20 [0.18]; r = .44, P = .01), and days to successful completion of the COBALT (14.72 [8.35]; r = .63, P \u3c .001). Patients’ predicted time to recover was equal to 14.61 (0.86) (days to successful COBALT). The model was significant (P \u3c .001, R2 = .30). Conclusion: The single predictor of time to recover was the number of days to successful completion of the COBALT. Thus, the ability to complete the task may be more informative than the performance on the task in predicting recovery time