Background: The increasing number of people who experience mental disorders is a global problem. People with mental disorders have high rates of co-morbidity and significantly poorer oral health outcomes than the general public. However, their oral health remains largely a hidden and neglected issue. A complex range of factors impact the oral health of this group. These include anxiety and dental phobia, dietary habits, including the heavy consumption of sugary drinks, substance misuse of tobacco, alcohol, and/or psychostimulants, the adverse orofacial side effects of anti-psychotic and anti-depression medications, and financial, geographic, and social barriers to accessing oral health care. Methods:The aim of this realist systematic review is to (a) identify and synthesise evidence that explores oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal, contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level. Using a five-step process, that incorporates primary data collection from key stakeholders, a beginning theoretical framework will be developed to describe contextual and mechanistic factors and how they might impact on the success or failure of oral health interventions for people with mental disorders. Key database searches will be conducted, with data extraction focused on the factors that might have impacted on intervention implementation and outcomes. Quality appraisal of studies will occur, and the theoretical framework will be populated with extracted data. Stakeholder input will support the development and refinement of a theory on oral health interventions for people with mental disorders.Discussion: This will be the first review to take a realist approach to explore the broad scope of causal factors that impact on the success or failure of oral health interventions for people with mental disorders. The approach includes extensive stakeholder engagement and will advance realist systematic review methodology. Review outcomes will be important in guiding policy and practice to ensure oral health interventions better meet the needs of people with mental disorders. Systematic review registrationThis review protocol is registered with PROSPERO (Number) 155969. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit l...
Aim The aim of this overview is to identify and collate evidence from existing published systematic review (SR) articles evaluating various methodological approaches used at each stage of an SR. Methods The search was conducted in five electronic databases from inception to November 2020 and updated in February 2022: MEDLINE, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and APA PsycINFO. Title and abstract screening were performed in two stages by one reviewer, supported by a second reviewer. Full‐text screening, data extraction, and quality appraisal were performed by two reviewers independently. The quality of the included SRs was assessed using the AMSTAR 2 checklist. Results The search retrieved 41,556 unique citations, of which 9 SRs were deemed eligible for inclusion in final synthesis. Included SRs evaluated 24 unique methodological approaches used for defining the review scope and eligibility, literature search, screening, data extraction, and quality appraisal in the SR process. Limited evidence supports the following (a) searching multiple resources (electronic databases, handsearching, and reference lists) to identify relevant literature; (b) excluding non‐English, gray, and unpublished literature, and (c) use of text‐mining approaches during title and abstract screening. Conclusion The overview identified limited SR‐level evidence on various methodological approaches currently employed during five of the seven fundamental steps in the SR process, as well as some methodological modifications currently used in expedited SRs. Overall, findings of this overview highlight the dearth of published SRs focused on SR methodologies and this warrants future work in this area.
Objectives: To investigate and synthesize systematically the evidence from animal studies pertaining to the effect of pharmacological agents on tooth movement relapse following cessation of orthodontic force application. Materials and Methods: An electronic search was conducted in seven online databases (including gray sources) without restrictions until the third week of April 2019, followed by a hand search in the reference lists of eligible articles. Controlled animal studies investigating the effect of pharmacological agents on tooth movement relapse following orthodontic treatment were selected. Relevant data were extracted from eligible studies and the risk of bias assessment was done using SYRCLE's risk of bias tool. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation tool. Results: The search identified 2354 records, of which 7 studies were deemed eligible for inclusion in the qualitative synthesis, with the majority presenting an unclear risk of bias. Orthodontic relapse was shown to decrease with the administration of pamidronate disodium, atorvastatin, aspirin, and chemically modified tetracycline-3. Inconsistent effects on relapse were observed after the use of simvastatin. The overall quality of retrieved evidence was assessed as low at best.Conclusions: The available evidence shows that the investigated pharmacological agents may demonstrate variable effects on tooth movement relapse following cessation of orthodontic force. Additional evidence of higher quality is required to draw definitive conclusions on their effects and to make potential recommendations for clinical application. (Angle Orthod. 2020;90:598-606.) Although planned, analyses for small-study effects, publication bias, or exploratory subgroup analyses were not feasible because of the inadequate number of studies. The quality of evidence
Objectives: To examine the spatial accessibility to public dental services (PDS) relative to the estimated oral health needs of refugee populations within the state of Victoria, Australia. Methods:The study employed enhanced two-step floating catchment area method to measure spatial accessibility to PDS by driving and public transit modes at statistical area level 2 (SA2). Principal component analysis of select census-derived socioeconomic variables specific to the refugee population was conducted to derive an areabased indicator of refugee oral health needs, also at SA2 level. Individual indices were then developed for each of these components using standardized z-scores. Finally, an integrated need-accessibility index was developed to identify low-accessibility areas associated with high needs. Results:The results show clear contrast in spatial accessibility to PDS for the refugee populations between metropolitan and rural areas as well as between driving and public transit modes. There are critical limitations in accessibility for refugees living in the rural areas and those dependent on public transit mode for travel. Also, there is evident disparity between the estimated oral health needs of refugees in metropolitan and rural areas. Overall, approximately 29% of all SA2s with refugee population are in the 'High' needs category, which comprise 19.8% of the total Victorian refugee population. Integrating accessibility and oral health needs measures revealed that about 30% and 18% of refugee population are identified as under-serviced, when considering driving and public transit modes respectively. Conclusion:The findings provide implications for researchers and policy makers to address the inequalities in access to PDS among the refugee population in Victoria.The methodology outlined in this study provides a complementary approach in planning oral health service provision in the absence of population level data at a smallarea scale on access to dental services or need for oral health care. K E Y W O R D Sdental health services, health services accessibility, health services needs and demand, population oral health, refugeesThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Background The purpose of the study was to explore, analyse, and describe the patterns of public dental services utilisation among the refugee populations in Victoria, Australia, and determine their predictors at the individual and contextual levels. Methods Data on the refugees who attended Victorian public dental services between July 2016 to June 2020 was gathered from the Dental Health Program dataset. Latent profile analysis was used to identify discrete groups among the refugee clientele with similar mean utilisation patterns across six indicator variables describing the attributes of dental services received and the site of care provision, over the study period. Multilevel multinomial logistic regression analysis was performed to examine the individual and contextual level correlates of the identified utilisation patterns. Results Six distinct profiles of public dental service utilisation were identified among the study population (n = 25542). The largest group comprised refugees predominantly using restorative services under general course of care (38.10%), followed by extraction services under emergency course of care (23.50%). Only a small proportion were estimated as having a higher mean utilisation of preventive services under general course of care (9.10%). Multilevel analysis revealed that the following variables had a significant association with refugee utilisation pattern: at the individual-level – demographic and ethnic attributes including age, gender, region of birth, preferred language for communication, use of language interpreter services, and type of eligibility card; at the contextual-level – characteristics of refugees’ area of residence including urbanicity, area-based socioeconomic disadvantage, delivery of Refugee Health Program at the community health centres, and spatial accessibility to public dental services via driving and public transit modes of travel. Conclusions The study represents a significant step towards the development of an evidence-based knowledge around public dental service utilisation among Victorian refugees. Overall, the study findings reiterate the critical need for targeted strategies to promote the importance of routine dental visits, oral disease prevention, and timely intervention among refugee groups.
ObjectivesTo identify, appraise and synthesize the published evidence from quantitative studies on the individual and contextual‐level factors determining access to dental care among refugees worldwide.MethodsA systematic literature search was conducted until the last week of February 2022 in four electronic databases – MEDLINE, Embase, Web of Science (all databases) and APA PsycINFO – without any restrictions. Quantitative studies published in English language and meeting the a priori eligibility criteria were reviewed and data extracted. Quality assessment was conducted using the National Institutes of Health tool. The identified factors were stratified according to the framework of the Behavioural Model of Health Services Use, and the evidence related to each of these factors was summarized in tables. Narrative synthesis of the findings was conducted.ResultsThe search retrieved 6776 unique records, of which 69 were deemed eligible for full‐text screening and nine studies were included in the final data analysis and synthesis. The studies were rated to be of ‘fair’ quality at best. Self‐reported previous dental visits was the most commonly used measure of access. Associations between individual‐level factors and dental care access were most frequently examined (predisposing [n = 6], need [n = 2] and enabling [n = 1]), while the contextual‐level factors were rarely examined (predisposing and enabling [n = 1, each]).ConclusionsIndividual‐level predisposing factors, such as English language proficiency, education, health and dental literacy and acculturation and integration, were shown to be significantly associated with refugees' access. There is limited evidence to determine the effect of individual enabling and need and contextual factors.
The aim of the present case report was to present the treatment of a growing patient with skeletal class II malocclusion with by mandibular retrusion using Powerscope TM anchored to mini plates. After initial leveling and alignment of the upper arch using fixed appliance (MBT prescription; 0.022-inch slot), 0.021 X 0.025-inch SS arch wire was inserted. One week after the placement of miniplates bilaterally at the symphysis of mandible, powerscope was installed on to the miniplates and the upper 0.021 X 0.025 inch archwire anterior to the molars. After eight months, powerscope was removed and lower arch strap up was done. Favorable skeletal and dental changes were observed at the end of active treatment with powerscope and finishing and detailing with fixed appliance.
relationships in mixed dentition patients treated with rapid maxillary expansion. A prospective clinical study. Angle Orthod 2010;80:230-8. 8. Zimmerman DW. A note on preliminary tests of equality of variances. Br J Math Stat Psychol 2004;57:173-81. Rapid palatal expansion, with and without alternating constriction W e read the article "Effect of maxillary protraction with alternating rapid palatal expansion and constriction vs expansion alone in maxillary retrusive patients: a single-center, randomized controlled trial" in the October 2015 issue with great interest. 1 The study compared the effects of facemask protraction combined with alternating rapid palatal expansion and constriction (Alt-RPE/C) vs rapid palatal expansion alone in maxillary retrusive patients and concluded that Alt-RPE/C with maxillary protraction positively affects the forward movement of the maxilla compared with rapid palatal expansion alone. The confounding factors such as age and sex were not mentioned in the article.Whereas we do accept that this study was a welldesigned randomized control trial providing considerable evidence for clinicians to adopt the new expansion regimen, we request the authors to consider the following.1. In this study, the achievement of a positive overjet was the treatment completion criterion. The authors concluded that Alt-RPE/C with maxillary protraction might result in a greater orthopedic-orthodontic Table II. Initial age, distribution of the Michigan and Bauru subjects among the evaluated groups, sex distribution between the Michigan and Bauru subjects and among evaluated groups Variable Michigan Bauru P Initial age, Michigan 3 Bauru subjects (y), Mean (SD) 8.68 (60.75) 8.71 (60.97) 0.873* Group 1A, Michigan 3 Bauru subjects (%) 60 40 0.869 y Group 2A, Michigan 3 Bauru subjects (%) 70.8 29.2 Group 2B, Michigan 3 Bauru subjects (%) 65.6 34.4 Group 3A, Michigan 3 Bauru subjects (%) 66.2 33.8 Male Female P Michigan subjects, male 3 female (%) 58.4 41.6 0.091 y Bauru subjects, male 3 female (%) 44.4 55.6 Group 1A, male 3 female (%) 63.3 36.7 0.106 y Group 2A, male 3 female (%) 45.8 54.2 Group 2B, male 3 female (%) 68.7 31.3 Group 3A, male 3 female (%) 46.3 53.7 *t tests.; y chi-square.
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