Background External factors such as the daily use of antimicrobial mouthwashes to maintain oral hygiene and to reduce the microbial activity can contribute to alter the mechanical properties of the elastomeric chains used during orthodontic treatments, causing loss of effectiveness. This systematic review and a meta-analysis assessed the rate of force decay and degradation of the polymeric chains depending on the type of mouthwash. Methods A systematic search of the literature were there was an exposure of orthodontic elastomeric chains to certain mouthwashes was conducted in the electronic databases of PubMed, Cochrane Library (CENTRAL), Scopus, EMBASE and Web of Science, as well as grey literature (Opengrey). No limit was placed on publication year and research was done up to June 2022. Based on inclusion/ exclusion criteria, data were extracted by two independent reviewers. For the quantitative analysis, studies were analysed with a mixed-effect (random effect) meta-regression model, with beta coefficients and R [2] values. I [2] index and Q and Egger tests were used to find heterogeneity among studies. Results A total of 178 potentially eligible studies were identified, of which 14 were eventually included in the qualitative analysis and 14 in the quantitative meta-analysis. The meta-analysis showed that all the mouthwashes were associated with a greater force decay than the control groups. After 7 days (p = 0.005) significant differences were found among the different mouthwashes, with those containing alcohol having significantly higher impact on the force decay than those containing chlorhexidine 0.2%, sodium fluoride or Persica. However, at 24 h (p = 0.200), 14 days (p = 0.076), 21 days (p = 0.120) and 28 days (p = 0.778) no statistically significant differences among the different mouthwashes were found, although those containing alcohol presented a strong tendency. Conclusion Although mouthwashes tend to increase the speed of force decay of elastomeric chains, especially those containing alcohol, clorhexidine 0.2% can be a good alternative due to its low impact on the force decay and its ability to maintain low microbial activity. More in vitro and in vivo studies comparing different manufacturers and other agents should be performed.
Introducción: Conocer los aspectos fundamentales del consentimiento informado es imprescindible para una correcta practica clínica odontológica. Objetivo: Valorar el conocimiento de los odontólogos sobre el Consentimiento Informado y relacionarlo con género, edad y especialidad del odontólogo. Analizar la relación entre apreciación sobre la formación ética del odontólogo y el manejo de situaciones éticas en la consulta con género, edad y especialidad del odontólogo. Material y método: se aplicó un cuestionario online a los odontólogos que prestan servicio en la Clínica odontológica de la Universidad Europea de Valencia. Resultados: se analizaron 62 cuestionarios. Se obtuvo una nota ponderada de 4,27 ± 0,55 en conocimiento objetivo. Conclusiones: Los odontólogos suelen tener un nivel de conocimiento entre medio y bajo. No se ha encontrado ninguna diferencia estadísticamente significativa entre el nivel de conocimientos sobre consentimiento informado en Odontología y las variables edad, género y especialidad. La percepción que el odontólogo tiene sobre su formación ética no guarda ninguna diferencia estadísticamente significativa con edad, género y especialidad. El manejo de la situación clínica guarda una relación estadísticamente significativa con la especialidad de Ortodoncia con independencia de la edad y género del odontólogo. En relación a la segunda situación clínica no se ha encontrado ninguna diferencia estadísticamente significativa con respecto a edad, género y especialidad del odontólogo.
Introduction: Orthodontic elastomeric chains are used in many orthodontic treatments. However, their activation or the action of external factors such as the daily use of mouthwashes can contribute to the increase of force decay causing a loss of effectiveness. The objective of this systematic review and a meta-analysis was to analyse the influence of the most widely used mouthwashes and their mainly components on the force decay of the orthodontic elastomeric chains.Material and Methods: A systematic search of the literature was performed in the electronic databases of PubMed, Cochrane Library (CENTRAL), Scopus, EMBASE and Web of Science, as well as grey literature (Opengrey). No limit was placed on publication year and research was done up to June 2021. Controlled clinical trials, randomized clinical trials (RCTs), cohort studies, case–control studies, cross-sectional studies, multicentre studies, and in vitro studies were there was an exposure of orthodontic elastomeric chains to certain mouthwashes and their main components were included. For the quantitative analysis, studies were analysed with a mixed-effect (random effect) meta-regresion model, with beta coefficients and R2 values. I2 index and Q and Egger tests were used to find heterogeneity among studies. Results: 14 articles met the inclusion criteria and were selected for qualitative analysis. The same 14 articles were selected for the quantitative synthesis (meta-analysis). The results of the meta-analysis showed that, in general, all the mouthwashes were associated with a greater force decay than the control agents at 24 hours, at 7, 14, 21 and at 28 days. When comparing the different mouthwashes, the results showed that at 7 days (p=0.005) significant differences were found in the force decay among them. Mouthwashes containing alcohol had a significantly higher percentage of degradation than those containing chlorhexidine 0.2%, sodium fluoride (NaF) or Persica. On the contrary, in the measurements performed at 24 hours (p=0.200), 14 days (p=0.076), 21 days (p=0.120) and 28 days (p=0.778) no differences in the strength among the different mouthwashes were found.Conclusion: In general, mouthwashes tend to increase the speed of force decay and have a negative impact in the physical properties of orthodontic elastomeric chains, resulting in a loss of effectiveness. For mouthwashes such as Listerine® and those containing alcohol this difference can be higher than for mouthwashes containing chlorhexidine, NaF or bleaching agents.
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