Lucas Guimarães Abreu

Breastfeeding, bottle feeding and risk of malocclusion in mixed and permanent dentitions: a systematic review.

The aim of the present study was to search for scientific evidence concerning the association between breastfeeding and bottle feeding and risk of malocclusion in mixed and permanent dentitions. An electronic search was performed in eight databases up to February 2015. Additionally, a gray literature search and hand searches of the reference lists of the selected studies were also carried out. There were no restrictions on language or on year of publication. The methodology of the included articles was evaluated using the Newcastle Ottawa scale. Out of the 817 identified citations, six studies fulfilled the eligibility criteria and were included in the systematic review. One study showed that children with mixed and permanent dentitions breastfed for more than 6 months presented greater mean protrusion of mandibular incisors and inclination of maxillary incisors compared with those breastfed for less than 6 months or those who were bottle-fed (p < 0.05). One study revealed that breastfeeding and bruxism were associated with Class II [OR = 3.14 (1.28 - 7.66)] and Class III [OR = 2.78 (1.21 - 6.36)] malocclusion in children with permanent dentition, while another study showed that an increase in breastfeeding duration was associated with a lower risk of malocclusion in children with both mixed and permanent dentitions (p < 0.001). Three studies did not report any significant association. Risk of bias was high in most selected articles. These findings do not support an association between breastfeeding and bottle feeding and the occurrence of malocclusion in mixed and permanent dentitions.

Preadolescent’s oral health-related quality of life during the first month of fixed orthodontic appliance therapy

Objectives To evaluate preadolescent oral health related quality of life (OHRQoL) during the first month of fixed orthodontic appliance therapy. Design Descriptive study. Setting The Department of Pediatric Dentistry and Orthodontics at Federal University of Minas Gerais, Belo Horizonte, Brazil. Participants This study included a sample of 96 preadolescent children aged between 11 and 12 years undergoing orthodontic treatment with a fixed appliance. Methods Preadolescent children were required to answer the short form of the Brazilian version of the Child Perceptions Questionnaire (CPQ11–14) before treatment (T0) and 1 month after placement of the fixed appliance (T1). Statistical analysis was performed using the Wilcoxon signed rank test and the Bonferroni correction for the domains of CPQ11–14. Results Out of the 96 patients originally admitted, one gave up the treatment before the placement of bands and one failed to return the second questionnaire (T1). So, a sample of 94 preadolescents participated in this study, with a response rate of 97·9%. Among the 94 participants, 49 were females (52·1 %) and 45 were males (47·9 %). The mean age was 11·5 years (SD = 0·502). There was a statistically significant improvement in emotional well-being domain (P<0·001) as well as in the overall score (P = 0·032). However, there were no significant changes in oral symptoms, functional limitations and social well-being domains (P>0·013) before treatment and 1 month after the placement of fixed appliance. Conclusion One month after the placement of fixed orthodontic appliance, the preadolescents had positive alterations in their OHRQoL mainly in the emotional well-being domain.

Effectiveness of open bite correction when managing deleterious oral habits in growing children and adolescents: a systematic review and meta-analysis.

Background/objectives: Oral habits are common etiological factors for anterior open bites (AOBs) in growing children and adolescents. The objective of this review was to provide a literature synthesis evaluating the effectiveness of open bite correction in growing individuals with the use of habit-interception appliances. Search methods: Electronic searches were conducted on PubMed, Embase, Cochrane Library, Web of Sciences, Scopus, Google Scholar, Scielo, and Lilacs databases. Trials registries were consulted for ongoing trials, and a partial grey literature search was also conducted. Selection criteria: The selection criteria included controlled clinical trials enrolling growing subjects who underwent habit-interception orthodontic treatment to correct dental and/or skeletal AOB. Data collection analysis: Data was grouped and analysed descriptively. A meta-analysis was only possible regarding crib therapy effectiveness. Qualitative appraisal was performed according to Cochrane Risk of Bias tool for randomized clinical trials (RCTs) and the MINORS tool for non-randomized clinical trials (nRCTs). Results: Two RCTs and nine nRCTs were identified. Most of them presented relevant limitations. Crib therapy demonstrated to be effective (+3.1mm overbite correction). However, most of the dental effects are seemingly lost with time; and the skeletal effects are still controversial. Other habit-interception appliances, such as spurs, were not sufficiently investigated. Conclusions: Crib therapy appears to be effective on a short time basis. As for other habit-interception appliances, insufficient evidence could not provide reliable conclusions.

Impact of the first eight months of orthodontic treatment with a fixed appliance on the families of adolescent patients

OBJECTIVE To evaluate the impact of the first 8 months of orthodontic treatment with a fixed appliance on the families of adolescent patients and to examine the evaluative properties of the Family Impact Scale (FIS). MATERIALS AND METHODS The study involved a sample of 94 parents/caregivers of adolescents undergoing orthodontic treatment with a fixed appliance. The participants were asked to answer the Brazilian version of the FIS before treatment (T1) and 8 months after the bonding of the fixed appliance (T2). Statistical analysis was carried out using the Wilcoxon signed rank test and the Bonferroni correction for the overall score and FIS subscales. Responsiveness of the measure and the minimal clinically important difference (MCID) were also assessed. RESULTS Among the 94 participants initially admitted to the present study, two were excluded as a result of treatment dropout and failure to return the second questionnaire. Thus, a sample of 92 parents/caregivers participated (response rate: 97.8%). Among the 92 participants, 70 were the mothers of patients, 16 were fathers, and six were other family members. Statistically significant improvements were found in the overall score (P < .001) as well as in both parental activity and parental emotions subscales (P < .001). The reductions in scores were associated with effect sizes showing moderate clinically meaningful changes in the overall FIS and in the parental/family activity, parental emotions, and family conflict subscales. The MCID was 2.66 for the overall FIS. CONCLUSION The first 8 months of orthodontic treatment with a fixed appliance had a positive impact on the families of adolescents.

It is about time to stop misusing the P‐value?

Interpretation of scientific data is not a simple task and demands a thorough and critical analysis by researchers and clinicians. The use of the P-value has been one of the most debated issues over the last few decades and has been a subject of much interest in statistics. Based on the P value in scientific papers, many clinicians started making their decisions on the results by only taking into account such an estimate (1). Therefore, some concerns regarding the interpretation of statistical analyses are relevant and should be considered by researchers, clinicians and journal readers and reviewers. A recent publication of American Statistician Association (ASA) (2) which critiqued the P-value presented some important issues regarding its use and misuse in scientific research. For the sake of clarity, a P-value should be considered as the probability under a specified statistical model that a statistical summary of the data (e.g. the mean difference of salivary IL-6 concentration between two compared groups) would be equal to or more extreme than its observed value. The P-value determines by how much the data contradict the null hypothesis. The smaller the P-value, the greater the incompatibility of data with the null hypotheses. However, some issues can arise when researchers misuse such an estimate. The use of a ‘bright line’ threshold (e.g. P < 0.05) as a unique measure, without any context or other evidence, provides very limited information to readers and has been a matter of considerable controversy among statisticians (3). Scientific conclusions must include other parameters, such as the quality of the study design, the internal validity, confidence intervals, numerical and graphical summaries of data as well as the difference between statistical significance and clinical relevance. Researches should also avoid conducting multiple analyses and reporting only those with significant P-values. Not only should the entire result of a selected analysis be reported, but it is also recommended that analyses are discussed and finalised before obtaining the study data. Multiple analyses of data without the statement of a clear null hypothesis should not be advocated among scientists or clinicians. If researchers manipulate their data long enough, they will show the outcome they want to see in any event (4). It is interesting, over the past 25 years, the number of published articles across the biomedical literature reporting only statistically significant results has increased dramatically, and, in a subgroup analysis, few articles have included confidence intervals, Bayes factors or effect sizes (5). The extensive use of P-value is not a problem in itself. Issues arise when this measure is misinterpreted or selectively reported and also when it is reported as a single estimate without any other aside parameter. It is doubtful that the practice of using of P-values only will be abolished, but interpretation and application of this statistical measure need to be changed (6). Therefore, it is time for us in Oral Medicine and Pathology to rethink some of our beliefs over the interpretation of scientific data. It is also important to understand that values of statistical significance may not necessarily imply significance into clinical or laboratory practice. Authors should be encouraged to discuss the limitations of their studies and the plausibility of their hypothesis along with all the supportive evidence on which the research is based (7). Indeed, they need to be aware that the statistical analysis is not the end, but the onset of the significance of an experiment. This may also remind practitioners the essential role that judgment acquired through clinical experience plays in interpreting and applying research findings (1). The Journal of Oral Pathology andMedicine will do everything possible to assist in this process.

Perception of parents and caregivers regarding the impact of malocclusion on adolescents’ quality of life: a cross-sectional study

ABSTRACT Objective: The objective of this article was to assess the perception of parents and caregivers regarding the impact of malocclusion on adolescents’ oral health -related quality of life (OHRQoL). Methods: This cross-sectional study consisted of a sample of 280 parents/caregivers of 11 and 12-year-old adolescents who answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ). Parent-assessed quality of life of adolescents was the dependent variable. The main independent variable was adolescents’ malocclusion which was diagnosed by means of the Dental Aesthetic Index (DAI). Based on DAI cut-off points, adolescents were classified into four grades of malocclusion, with different orthodontic treatment recommendations assigned to each grade: no need/slight treatment need, elective treatment, highly desirable treatment and mandatory treatment. Adolescents’ age and sex, as well as family monthly income, were considered as confounding variables. Statistical analysis involved descriptive statistics, bivariate analyses, and Poisson regression with robust variance. Results: Of the 280 parents/caregivers initially accepted in this study, 18 refused to answer the P-CPQ. Therefore, 262 individuals participated in this assessment, providing a response rate of 93.5%. The severity of adolescents’ malocclusion was significantly associated with a higher negative impact on parents’/caregivers’ perception on the oral symptoms (p< 0.05), functional limitations (p < 0.001), emotional well-being (p < 0.001), and social well-being (p < 0.001) subscale scores as well as on the overall P-CPQ score (p < 0.001), even after having been adjusted for the controlling variables. Conclusions: Parents/caregivers reported a negative impact of malocclusion on adolescents’ OHRQoL. Increased severity of malocclusion is associated with higher adverse impact on OHRQoL.

Parents' and caregivers' perceptions of the quality of life of adolescents in the first 4 months of orthodontic treatment with a fixed appliance.

Objectives To evaluate adolescents oral health-related quality of life (OHRQoL) in the first 4 months of fixed orthodontic appliance treatment using parents and caregivers as proxies. Design Descriptive study. Setting Department of Pediatric Dentistry and Orthodontics at Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. Participants A sample of parents and caregivers of 95 adolescents undergoing orthodontic treatment with a fixed appliance. Methods Participants were required to answer the Brazilian version of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) before adolescents treatment (T1) and 4 months after bonding of the fixed appliance (T2). Statistical analysis was carried out using the Wilcoxon signed rank test and the Bonferroni correction for the domains of P-CPQ. Results Among the 95 participants, there were 73 mothers, 18 fathers and 4 were other relations. There was a statistically significant improvement in the overall score as well as in both emotional and social wellbeing subscales (P<0·001). Conclusion Parents and caregivers report an improvement on their adolescents OHRQoL in the first 4 months of orthodontic treatment with a fixed appliance.

Odontogenic carcinosarcoma: A systematic review

The aim of this study was to integrate the available data published on odontogenic carcinosarcoma into a comprehensive analysis of their features, treatment and recurrence. An electronic search with no publication date or language restriction was undertaken in March 2018 in the following databases: Medline Ovid, PubMed, Web of Science, Scopus and LILACS. Eligibility criteria included publications having enough clinical, imaginological and histopathological information to confirm a definite diagnosis of the neoplasm. Data were evaluated descriptively and statistically using the MedCalc software. The Kaplan-Meier method was used for survival analysis. The systematic review detected nine articles from eight countries. Six cases with no age predilection occurred in male individuals complaining of painful swelling in the posterior mandible. Radiographically, the lesions were large, with expansive radiolucency and with ill-defined borders and seven cases were associated with preexisting odontogenic lesions. Radical surgery was the treatment of choice in the majority of cases. Recurrences (n = 6), metastasis (n = 4) and death (n = 4) were frequently observed in many cases. Odontogenic carcinosarcoma is a very aggressive neoplasm with a poor prognosis. This study provides knowledge that could help surgeons, oncologists, otorhinolaryngologists and oral maxillofacial pathologists with the diagnosis and management of these lesions.

t(6;9)(MYB‐NFIB) in head and neck adenoid cystic carcinoma: A systematic review with meta‐analysis

The presence of a translocation involving MYB and NFIB genes have been described in adenoid cystic carcinoma (AdCC) from different anatomical regions. However, the exact frequency of this genetic event and its prognostic impact for patient survival remain obscure. The aim of this study was to carry out a systematic review to address the prevalence and the prognostic potential of t(6;9)(MYB-NFIB) in head and neck AdCC. Quantitative analysis was done to determine the prevalence of the translocation. A total of 1,107 articles were initially retrieved with 36 remaining for data extraction. The prevalence of t(6;9)(MYB-NFIB) varied significantly (16%-100%), especially due to methodological heterogeneity among studies. A total of 11 studies attempted to determine the prognostic importance of the translocation, but no study found any significant association with survival rates; only three studies observed a significant association with age, sex, tumour location and the presence of recurrences and metastases. The prevalence of t(6;9)(MYB-NFIB) in head and neck AdCC varies according to the laboratorial methods used, and the best evidence available demonstrates that t(6;9)(MYB-NFIB) does not seem to be a prognostic determinant.

Calcifying epithelial odontogenic tumours: Collaborative study of 32 cases and review of literature

OBJECTIVES To analyse the occurrence of calcifying epithelial odontogenic tumours (CEOT) based on biopsy records from different Brazilian geographic regions and to contrast the data with a review of the literature. MATERIALS AND METHODS A 2-step study was conducted. Step 1 consisted of a collaborative study of biopsies obtained from 1953 to 2017 at six Brazilian oral and maxillofacial pathology centres. Evaluation of 86,268 biopsy records was performed. Demographic and histopathological diagnosis data were assessed. In Step 2, a review of the literature of case reports and cases series of CEOT identified across five electronic databases was conducted. RESULTS In the collaborative study, 32 cases of CEOT were evaluated. This figure represented 0.03% of the oral and maxillofacial lesions and 1.7% of all odontogenic tumours across the centres. Women in the fourth decade of life were more affected. CEOT occurred more in the mandible than in the maxilla (ratio 1.9:1). The review of the literature showed that Asian individuals were more affected by this neoplasm. CONCLUSIONS Useful knowledge on the epidemiology, treatment and follow-up of CEOT has been provided. Demographic data and clinical features of the cases presented in this collaborative study were quite similar to those of studies reported worldwide.