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Objective The aim of the present systematic review is to assess the prevalence and severity of and distress caused by xerostomia over time in adult hematopoietic stem cell transplantation (HSCT) recipients. Methods PubMed, Embase, and the Cochrane Library were searched for papers published between January 2000 and May 2022. Clinical studies were included if patient-reported subjective oral dryness was reported in adult autologous or allogeneic HSCT recipients. Risk of bias was assessed according to a quality grading strategy published by the oral care study group of the MASCC/ISOO, resulting in a score between 0 (highest risk of bias) and 10 (lowest risk of bias). Separate analysis focused on autologous HSCT recipients, allogeneic HSCT recipients receiving a myeloablative conditioning (MAC), and those receiving a reduced intensity conditioning (RIC). Results Searches yielded 1792 unique records; 22 studies met the inclusion criteria. The quality scores ranged between 1 and 7, with a median score of 4. The prevalence, severity, and distress of xerostomia increased shortly after HSCT. Severity of xerostomia in allogeneic MAC recipients was higher compared to allogeneic RIC recipients 2–5 months post-HSCT (mean difference: 18 points on 0–100 scale, 95% CI: 9–27); after 1–2 years, there was no significant difference anymore. Conclusion The prevalence of xerostomia in HSCT recipients is high in comparison to the general population. The severity of complaints is raised during the first year post-HSCT. The intensity of the conditioning plays a key role in the short-term development of xerostomia, while factors affecting the recovery in the long term remain largely unknown.

ObjectiveThe purpose of this study was to identify the level of oral health-related quality of life and orofacial appearance in patients with moderate to severe tooth wear. Patients with and without a request for restorative treatment were included.MethodsOne hundred twenty-four patients (98 men, 26 women, mean age: 40.5 ± 8.8 years) with moderate to severe tooth wear were included. Patients without a request for help received a non-restorative treatment of counseling and monitoring. Patients with a request for restorative treatment were treated with a full rehabilitation using composite resin restorations. Oral Health Impact Profile (OHIP-NL) and Orofacial Esthetic Scale (OES-NL) questionnaires were filled in at baseline and after 1 year.ResultsCounseling and monitoring group: baseline OHIP-NL score was 0.4 ± 0.3, baseline summary score of OES-NL was 48 ± 7.0, and baseline impression score was 7.1 ± 1.2. Scores had not changed significantly after 1 year (p = 1.00 after Bonferroni correction).Restoration group: baseline OHIP-NL score was 0.8 ± 0.6, baseline summary score of OES-NL was 38 ± 10, and baseline impression score was 5.9 ± 1.5. Scores had improved significantly after 1 year (p < 0.001 after Bonferroni correction).ConclusionsCounseling and monitoring did not result in a significant deterioration and restorative treatment resulted in a significant improvement of oral health-related quality of life (OHRQoL) and orofacial appearance in this patient group.Clinical significanceIn patients with moderate to severe tooth wear, without functional and esthetical problems, counseling and monitoring may be an appropriate treatment option. Restorative treatment in patients with a need for treatment results in an improved OHRQoL. OHIP and OES questionnaires may be used to monitor changes in clinically relevant symptoms.

Objectives The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection. Materials and methods The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity assessment and (3) forming individualised caries diagnoses. The experts responsible for “caries detection and diagnostic methods” searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous Delphi survey. Results Recommendations ( N  = 8) were approved and agreed upon by the whole expert panel: visual examination ( N  = 3), dental radiography ( N  = 3) and additional diagnostic methods ( N  = 2). While the quality of evidence was found to be heterogeneous, all recommendations were agreed upon by the expert panel. Conclusion Visual examination is recommended as the first-choice method for the detection and assessment of caries lesions on accessible surfaces. Intraoral radiography, preferably bitewing, is recommended as an additional method. Adjunct, non-ionising radiation methods might also be useful in certain clinical situations. Clinical relevance The expert panel merged evidence from the scientific literature with practical considerations and provided recommendations for their use in daily dental practice.

Aim This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail. Material and methods PRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated. Results From 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81–0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited. Conclusion The number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies. Clinical relevance BWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution.

Background Open Science Practices (OSPs) are essential when assessing research integrity and quality of Randomised Clinical Trials (RCTs). As dental caries represents a significant oral health burden, our objective was to identify and analyse the adoption of OSPs within RCTs focused on addressing this disease. Methods We searched PubMed to retrieve RCTs related to dental caries published from January 2000 to March 2022. Two independent researchers assessed a random sample of these articles to evaluate their eligibility until reaching the minimum sample size. Then, the same examiners reviewed the included texts regarding the OSPs adopted in the articles. The collected variables related to OSPs were reporting guidelines, protocol registration, detailed methodology available, open-source software, statistical analysis code sharing, statistical analysis plan, data sharing, open peer review, and open access. Association analyses using logistic regression were conducted considering the publication year, the continent of the first author, impact factor and open-access policy of the journals (explanatory variables), and adoption of at least one OSP or one OSP other than open access (outcomes). The recommendations for adopting OSPs were assessed by reviewing the “Instructions for Authors” section of the most frequently used journals where the included papers were published. Results 64.8% of the articles (95% Confidence Interval = 59.3–70.1%) adopted at least one OSP. However, no individual OSP was adopted by more than 50% of the articles. The most adopted practices were protocol registration (37.1%), the use of reporting guidelines (33.1%) and publishing open access (37.3%). These are also the OSPs most often recommended by journals in the Instructions for Authors. A few articles adopted other practices. Older articles presented a lower frequency of adopting these practices, and articles published in higher impact factor journals were positively associated with both outcomes. Conclusion The RCTs published on dental caries demonstrate a low frequency of adoption of most OSPs. However, a trend toward increased adoption of these practices has been notable in recent years.

Aim This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination (VE), bitewing radiography (BW) and laser fluorescence (LF), in relation to their ability to detect (dentin) caries under clinical and laboratory conditions. Materials and methods A systematic search of the literature was performed to identify studies meeting the inclusion criteria using the PIRDS concept ( N  = 1090). A risk of bias (RoB) assessment tool was used for quality evaluation. Reports with low/moderate RoB, well-matching thresholds for index and reference tests and appropriate reporting were included in the meta-analysis ( N  = 37; 29 in vivo/8 in vitro). The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR) and areas under ROC curves (AUCs) were computed. Results SP ranged from 0.50 (fibre-optic transillumination/caries detection level) to 0.97 (conventional BW/dentine detection level) in vitro. AUCs were typically higher for BW or LF than for VE. The highest AUC of 0.89 was observed for VE at the 1/3 dentin caries detection level; SE (0.70) was registered to be higher than SP (0.47) for VE at the caries detection level in vivo. Conclusion The number of included studies was found to be low. This underlines the need for high-quality caries diagnostic studies that further provide data in relation to multiple caries thresholds. Clinical relevance VE, BW and LF provide acceptable measures for their diagnostic performance on occlusal surfaces, but the results should be interpreted with caution due to the limited data in many categories.

Abstract ObjectivesDeterioration in anterior resin composite restorations placed in tooth wear patients was investigated after 36 months.Materials and methodsData collected prospectively for 47 participants of the Radboud Tooth Wear Project were used (41 ± 8 years, 90% male, n = 270 restorations). Restorations were individually evaluated using intraoral photographs and 3D scans to rate modified FDI scores and to record the presence of degradation features. Four groups with distinct combinations of composites and techniques were assessed, and multivariable logistic regression models were used to analyze the data (p < 0.05).ResultsFor all groups together, early degradation signs were present at 1 month: irregularities (41.5%) and ditching (7.4%) were observed at the surface and adhesive interfaces. The frequency of irregularities decreased in the 36-month evaluation (37%), but ditching (12.2%) and fractures (10.7%) were more common. The most frequent deterioration (based on photographs) was observed for staining (44%) and loss of luster (31%). In 3D scans, the most frequent were for wear (25%), marginal adaptation (24%), and the presence of irregularities (19%). Canines had 5.5 times more chances of deterioration by ditching than incisors (p < 0.001). The differences between composites and restorative techniques were minor.ConclusionsA continuous degradation process of restorations placed in tooth wear patients was observed in anterior teeth restored with different composites, with a progression of the deterioration over 36 months.Clinical relevanceWhen placing anterior resin composite restorations in tooth wear patients, it could be important to establish realistic expectations and the need for checkup appointments.

Background The aim of this study was to describe salivary flow rate, subjective oral dryness and dental caries 5 years post haematopoietic cell transplantation (HCT). Methods HCT survivors of a previous longitudinal observational cohort study in the Netherlands (the H-OME study) were invited to participate in this additional follow-up after 5 years (the HOME2 study). During the additional follow-up appointment, stimulated (SWS) and unstimulated whole saliva (UWS) was collected, participants rated subjective oral dryness on a 0 – 10 scale, and caries lesions were assessed. Furthermore, dental records, including treatments and radiographs, were requested for the 5 years preceding and the 5 years following transplantation. Paired t-tests were performed to determine changes in UWS and SWS flow rates and subjective oral dryness from pre-HCT, and to compare the number of caries-related dental treatments (restorations, endodontic treatments or extractions) before and after HCT. Hyposalivation of UWS (< 0.2 mL/min) and SWS (< 0.7 mL/min) at 3 and 12 months, was used to explore the predictive potential of hyposalivation on a high dental treatment need (> 3 treatments) over the 5 years post-HCT. Results Five years post-HCT, 39 HCT survivors were included. The mean UWS flow rate was 0.36 mL/min (SD 0.26) and the mean SWS flow rate 1.02 (SD 0.57); survivors were diagnosed with a median of 0 dentine lesions (range 0 – 12) and 73% reported a subjective oral dryness score ≥ 1. Survivors underwent a median of 3 (range 0 – 20) dental treatments during the 5 years following transplantation. The mean difference in UWS 5 years post-HCT compared to pre-HCT was 0.03 (95% CI: -0.07 – 10.12), the mean difference for SWS was -0.18 (95% CI: -0.45 – 0.08) and for subjective oral dryness 1.2 (95% CI: 0.2 – 2.1). In the 5 years post-HCT, non-significantly more treatments were performed compared to the 5 years pre-HCT (mean difference: 0.5, 95%CI: -1.2 – 2.2). Seventy eight percent of patients with hyposalivation of SWS at 12 months had a high dental treatment need, compared with 38% with no hyposalivation. Conclusions Five years post-HCT, mean UWS and SWS flow rates were not significantly different from pre-HCT levels but subjective oral dryness scores were elevated.

Purpose Oral focus screening is recommended before HCT (haematopoietic cell transplantation). Acute foci are generally treated pre-HCT. However, it is unclear whether chronic foci should be treated pre-HCT. This study aimed to evaluate the association between number of foci and early post-HCT morbidity and mortality. Methods Patients who received an oral screening pre-HCT at Radboudumc between 2013 and 2023, with a recent panoramic radiograph, were included. Foci were defined as teeth or implants with deep pockets, furcation radiolucencies, periapical radiolucencies, deep caries, partial eruption or retained roots. Dental interventions were provided pre-HCT if deemed necessary and possible. Hospital length of stay (LOS), mortality and oral exacerbations were assessed in the first hundred days post-HCT. Hospital LOS was log-transformed to normalize its skewed distribution. Multivariate regression analyses were performed. Results Five hundred patients were included (median age 58 years, 37% female, 56% allogeneic). Four acute foci in two patients remained untreated pre-HCT. Forty-eight percent had at least one untreated chronic focus pre-HCT (mostly furcation radiolucencies and post-endodontic periapical lesions). Mean LOS was 22 days; 20 patients died, and four patients had an oral exacerbation before HCT day + 100. After adjustment for conditioning intensity, age, socioeconomic status and number of teeth, HCT recipients with ≥ 3 foci had five additional days in the hospital compared to those without foci (ratio of means 1.21; 95% CI 1.00 – 1.46). The number of foci was not associated with early post-HCT mortality. Conclusion The presence of ≥ 3 oral foci is associated with extended hospital LOS in the first hundred days post-HCT.

ObjectiveThe aim of this study was to evaluate changes in speech characteristics and self-perceived quality of speech in tooth wear patients, after occlusal rehabilitation.Materials and methodsPatients with tooth wear were included in this study after informed consent. The amount of tooth wear was scored with Tooth Wear Evaluation System (TWES). To assess the perspective of the patient, the Dutch Speech Handicap Index was used (SHI). Acoustic analysis was performed to evaluate changes with the use of voice recordings. These were made before treatment, T0; directly after treatment, T1; 1 month after treatment, T2. With the use of PRAAT software, the spectral characteristic centre of gravity (COG) was evaluated for the sounds /s/, /f/, /v/, /d/, /t/, /m/.ResultsRecordings of 17 patients (14 men, 3 women, mean age 41.2 ± 10.4 years) were included. SHI scores did not change significantly between T0 and T2 (p = 0.054). A multiple regression model showed that for all sounds the intercept was negative, but statistically significant only for /s/ and /f/ between T0 and T1. The effect of the initial change (between T0 and T1) on the change between T1 and T2 was clearly negative for all sounds (p < 0.001), showing a rebound effect ranging between 29 and 68% of the initial change.ConclusionTooth wear patients perceive improvement in speech function after treatment.Clinical significanceClinicians may explain to patients that speech is likely to alter for a short period due to treatment but that there will be a good adaption to the new situation.