DZZ International, 05/2021

Review on the benefits and limitations of animal-assisted therapy in the dental practice Keywords: animal-assisted therapy, benefits, dental practice, dog, limitations, minireview

At the beginning of summer 2020, the names and rankings of the scientific journals with a Journal Impact Factor (JIF) for the year 2019 were released (InCites Journal Citation Reports, Clarivate Analytics). Presently, 12,827 journals have a JIF value. In the following, as regularly since 2015 [22–26], the current JIFs from den¬tistry are presented and compared to the scientific journals with the highest JIF. Furthermore, the Median Impact Factor (MIF) of the category Dentistry, Oral Surgery & Medicine is compared with that of other disciplines. Keywords: EbM Bits, JIF, Journal Impact Factor

Introduction: The Marfan syndrome is a rare connective tissue disorder with autosomal dominant inheritance. The aim of the present study was to evaluate the caries experience in children and adolescents with Marfan syndrome. Materials and Methods: 31 children with Marfan syndrome (Marfan group; mean age: 8.77 ± 3.72 years) and 31 systemically healthy children (control group; mean age: 9.77 ± 3.72 years) were dentally examined according to WHO criteria. The recorded parameters included the dmft/DMFT (differentiated into dt/DT, mt/MT, ft/FT), the dmfs/DMFS (differentiated into ds/DS, ms/MS, fs/FS), the caries restoration index (CRI), and the hygiene index (HI). Statistical evaluation was carried out using t-test for independent samples and chi-square test (p ≤ 0.05) using the statistics software program IBM SPSS Sta-tistics 26. Results: The children of the Marfan group had a significantly lower dmft (p = 0.040) and ft (p = 0.040) than children in the control group. There were no significant differences between the two groups when considering permanent dentition. However, the Marfan group tended to have a lower DMFT (p = 0.064), DT (p = 0.076) and FT (p = 0.059) than the control group. The HI was significantly higher in the control group than in the Marfan group (p < 0.001). Conclusion: In the present study, children and adolescents with Marfan syndrome did not show a higher caries experience compared to a systemically healthy control group. Keywords: DMFS, DMFT, Marfan syndrome, adolescents, caries experience, children

Introduction: The rapid establishment of digital teaching in the dental curriculum, which was necessary in the progress of the COVID-19 pandemic, now poses new challenges for both students and teachers. The aim of this study was to assess the impact of the sudden introduction of synchronous and asynchronous online teaching on dental students. Methods: The evaluation of digital teaching was conducted via online survey using the survey program SoSciSurvey. Dental students at the MHH in the 2nd, 4th, 6th, 8th and 10th semesters were questioned (n = 204, mean age: 23.6 ± 3.7 years, male/female ratio: 28 %/72 %). By means of a sum value calculation over 21 Likert-type items, as well as the evaluation of core aspects (content, technical quality, interaction potential with the lecturer, clarification possibilities of questions, general orientation on the digital platform) according to school grades, the satisfaction of the students was recorded. The statistical evaluation was carried out with the software RStudio. Results: The evaluation of the sum scores showed a mean of 66.9 points (median 68.5) for preclinical students (2nd, 4th semester, asynchronous teaching concept) and 79.4 points (median 81) for clinical students (6th, 8th, 10th semester, synchronous teaching concept). The difference of 12.5 points (median 12.5) between both teaching concepts is statistically significant (p < 0.001). The grading of the core aspects also showed statistically significant differences with regard to content and orientation on the digital platform. Conclusion: The questionnaire-based survey of dental students at the MHH revealed that students were more satisfied with synchronous online teaching than with asynchronous teaching. However, whether there is a fundamental superiority of the synchronous teaching format over the asynchronous approach cannot be answered by the data collected. Keywords: covid-19 pandemic, dentistry, digital teaching, questionnaire-based survey, synchronous and asynchronous learning

Introduction: Antiresorptives are used in patients with osteoporosis and malignant tumors to inhibit resorption processes in the bone. Antiresorptive-related osteonecrosis of the jaw (ARONJ) is an adverse drug reaction and is associated with a considerable impairment of quality of life. Therefore, prevention and early identification of ARONJ events are crucial. Methods: The data of 249 patients (mean age: 68.8 ± 10.4 years) with 343 ARONJ events were retrospectively assessed according to etiology (extraction-related, denture-related, idiopathic), risk profile (high, moderate, low), and localization (maxilla/mandible; buccal/crestal/oral). For this purpose, Pearson's χ2-test and t-test for independent samples were applied. The significance level was set at α = 0.05. Results: The majority (88.4 %) of patients received the antiresorptive drug as part of the oncologic treatment and thus exhibited a high risk profile. Extraction-related ARONJ (51.6 %) were most frequently observed, followed by denture-related (30.3 %) and idiopathic (18.1 %). Most ARONJ were located in the mandible (69.4 %). Regarding oro-buccal extension of the ARONJ, the buccal sites were significantly more often affected in the maxilla compared to the mandible (p < 0.001), whereas the oral sites were significantly more often affected in the mandible compared to the maxilla (p < 0.001). In this context, it should be noted that 75.6 % of idiopathic ARONJ of the mandible extended to the oral sites. Molars were significantly more frequently affected (51.8 %; p < 0.001) than premolars and anterior teeth. Discussion and conclusion: Patients with a high risk profile are known to be susceptible for the development of ARONJ following tooth extractions. The high proportion of denture-related ARONJ underlines that high risk patients wearing removable partial and complete dentures should be closely monitored in the dental practice. Particular caution is required in patients with a thin soft tissue layer and missing keratinization. These anatomical peculiarities seem to predispose for idiopathic ARONJ and may explain the high occurrence in the area of the mylohyoid ridge. Keywords: antiresorptive-related osteonecrosis of the jaw (ARONJ), denture, etiology, idiopathic, localization, risk profile, tooth extraction

Facial nerve palsy may occur in rare cases in connection with dental treatment. Its causes have not been entirely clarified so far. If facial nerve palsy sets in immediately after the administration of a local anesthetic, it is likely that the unintended, accidental anesthesia of the branches of the facial nerve has occurred. Once the effect of the anesthetic subsides, the palsy disappears and is completely reversible. Direct damage to the facial nerve with the injection needle seems improbable. Delayed facial nerve palsy, which ini-tially sets in hours or days after dental treatment, must be considered separately. In the past, various causes have been discussed in literature. Presently, it is thought that the most likely cause is the reactivation of viruses (herpes simplex virus type 1 or varicella zoster virus) from nerve ganglia of the facial nerve by dental treatment. This can also occur in cases where no local anesthesia has been used. In addition, this does not have to result in the formation of blisters on the skin (zoster sine herpete), which is typical of herpes labialis or herpes zoster. In order to treat delayed onset facial palsy after dental treatment, drug therapy with glucocorticoids (prednisolone) and antivirals (acyclovir) is the current recommendation. For successful therapy, the drugs should be administered in less than 72 hours after the onset of the first symptoms. Dentists should thus promptly refer patients to a neurologist and otherwise be aware of the potential (irreversible) damage to the facial nerve by the viruses. Keywords: Bell's Palsy, Treatment complications, dental treatment, facial nerve palsy, local anesthesia, viral infection

Introduction: Cognitive biases affect perception, memory, thinking and judgment. Mostly, they are the result of heuristics, i.e. mental shortcuts accelerating the decision-making process. In medicine, several biases can be recognized in both patients and practitioners such as choosing between treatment options and making errors in diagnostics and therapy, respectively. Methods: In order to synthesize this review, the literature in psychology and medicine was analyzed for the purpose of elucidating various biases and describing their relevance in dental practice. Results: Several cognitive biases were found to be relevant for diagnostics, decision making, treatment and practice management: the tailored framing of the communication content changes the perception of risks and influences the placebo and nocebo effects. The status quo bias may explain why patients tend to avoid undergoing reasonable treatment due to loss aversion. Affect heuristics shows the dependence of decision making on current emotions, which are rarely beneficial for the patient. Both the confirmation bias and attribution error affect diagnostics; facts supporting the initial diagnosis are given preferential consideration and the symptoms of patients who are perceived as difficult characters may be ignored or conveniently classified as psycho-somatic. The anchoring effect demonstrates why initial information has a disproportionate influence on the diagnosis. The overconfidence bias results in the practitioner's distorted self-perception, which can result in errors in diagnostics and therapy. Priming can direct the patient's perception towards a more positive outcome. The peak-end rule states that the recollection of a treatment is mainly influenced by the most aversive and final stimulus. The hindsight and outcome biases illustrate the tendency to remember a past experience in a distorted manner after events occur, thus underlining the importance of detailed patient records. The perception of the dentist's competence depends not only on dental skills, but due to the halo and nocebo effects, also on the environment, circumstances and style of communication. Discussion and conclusion: Cognitive biases affect both patients and dentists and this leads to errors in diagnostics, decision making and treatment. Dentists can try to use debiasing strategies in order to reduce those effects. Visual images such as pie charts and bar graphs help to reduce the effects of framing, especially in patients who are not mathematically inclined. The strategic use of cognitive biases by practitioners can be used to direct patients' perceptions towards more positive treatment experiences. Keywords: biases, decision making, diagnostics, heuristics, practice management, psychology, treatment