Background A growing body of evidence suggests a role for oral bacteria in lung infections. This systematic review aimed to analyse the association between poor periodontal status and the frequency of chronic obstructive pulmonary disease (COPD) exacerbations. Methods PubMed, Embase, Web of Science, CINAHL and Medline were searched for studies published until May 2020, with no language restriction. Studies reporting periodontal condition, or periodontal treatment outcomes, with data on the frequency of exacerbations of COPD, were identified. The primary outcome was the frequency of exacerbations and secondary outcomes included quality of life (QoL) and hospitalisation. Quality and risk of bias assessment were carried out using the Newcastle Ottawa Scale for observational studies, Robins-1 tool for non-randomised intervention studies and Cochrane risk of bias assessment (RoB-2) tool for randomised clinical trials. Studies were assessed for eligibility and quality by two assessors independently. Results Searches identified 532 records and 8 met the inclusion criteria. Included studies were three clinical trials, one prospective cohort study, one case–control, and three cross-sectional studies. A narrative synthesis was performed. The data from intervention studies showed reduction in the frequency of exacerbations following periodontal treatment. Data from observational studies suggest association of worse plaque scores and fewer teeth with exacerbation, but not pocket depth or clinical attachment loss. Better periodontal health was also associated with reduced frequency of COPD exacerbations, hospitalisations and improved quality of life in COPD patients. Due to the high heterogeneity no meta-analysis was performed. The quality of some of the included studies was low and there was evidence of a high risk of bias. Conclusion The data supports possible association between poor periodontal health, the frequency of exacerbations, hospitalisation and quality of life in COPD patients. The evidence is of moderate to low certainty and is limited by high risk of bias suggesting the need for well-designed and adequately powered randomised controlled trials, to inform future research and clinical practice. The PROSPERO registration number CRD42020180328.

Background/aims Mild resting facial asymmetry exists in clinically symmetrical faces, but the effect of smiling on the magnitude of overall facial asymmetry in adults has not been assessed. The aim of the present study was to use stereophotogrammetry to quantify the effect of smiling on overall facial asymmetry in Caucasian adults who presented with Class I incisor relationships and no history of orthodontic treatment. Methods Twenty male and 20 female Caucasians aged 18–30 years with no history of orthodontic treatment, a clinically symmetrical face and a Class I incisor relationship had 3D stereophotogrammetric images captured at rest and on natural and maximal smile (T1). The images were repeated 2–4 weeks later (T2) to assess expression reproducibility. Overall facial asymmetry scores were produced from 27 landmarks using partial Ordinary Procrustes Analysis (OPA) and assessed by an Analysis of Covariance (ANCOVA) model. A random sample of the images was re-examined two months later to calculate intraobserver landmark reproducibility. Results Mean landmark error was low (0.41 ± 0.07 mm). Mean overall facial asymmetry scores were not significantly gender different (p = 0.5300); therefore, the male and female data were pooled. Mean overall facial asymmetry scores for maximal (0.91 ± 0.16) and natural smile (0.88 ± 0.18) were higher than at rest (0.80 ± 0.17) (p < 0.0001) and were reproducible across (T1–T2) sessions (p = 0.3204). Conclusions/implications Overall 3D facial asymmetry scores for the sampled Caucasian adults with clinically symmetrical faces increased in magnitude from rest to natural and to maximal smile. Clinicians should assess overall facial asymmetry at rest and on natural and maximal smile at baseline, during treatment and as part of a core outcome assessment, particularly for cases with unilateral posterior crossbite, unilateral cleft lip and palate or skeletal asymmetry.

BackgroundThe importance of good oral hygiene for patients in Intensive Care Units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear.AimThis study aimed to provide a national picture of oral care practices in adult ICUs in the United Kingdom (UK) to identify areas for improvement.Study DesignA national one‐day point prevalence study was undertaken in adult ICUs in the UK in the period from 30th September to 14th October 2021. Data were collected on all patients in the ICU on the date of data collection. Using a validated electronic data collection form, anonymised data were collected on methods and frequency of oral care provided, and the use of oral care protocols within the ICU. Data were analysed using descriptive analysis.ResultsData from 195 patients in 15 ICUs in England, Wales and Northern Ireland were collected. Written oral care protocols were available for use in the care of 65% (n = 127) of patients. 73% (n = 142) of patients received oral care within the 24‐h period. Oral care methods included toothbrushing 41% (n = 79), foam sticks 3% (n = 5), moisturizing the oral cavity 10% (n = 19) and mouth rinse with chlorhexidine 3% (n = 5) and other oral care methods not specified 12% (n = 23). 44% (n = 85) of patients had an oral assessment within the 24‐h period and variable assessment methods were used.ConclusionThere is large variability in oral care provision and methods for intubated ICU patients and a lack of consensus was revealed in the study. Oral assessment is conducted less frequently using multiple tools. Optimal oral care standards and further research into oral care provision is pivotal to address this important patient‐relevant practice.Relevance to Clinical PracticeOral care is a fundamental part of care for ICU patients, however, there is a large degree of variability, and oral care is often not based upon oral assessment. The use of an oral care protocol and oral assessments would help to improve patient care, ease of use for staff and provide a tailored oral care plan for patients, improving efficiency and preventing wasted resources.

Objective: To evaluate the effectiveness of professionally applied fluoride varnish on the incidence of dental caries amongst older adults resident in LTCFs in Northern Ireland. Background:The oral health status of older adults within Long-Term Care Facilities (LTCFs) is significantly worse than their community living peers. Whilst evidence suggests an important role for fluoride varnish in preventing caries in this population, very few studies have evaluated this intervention. Materials and Methods: A quality improvement project was undertaken with dentate residents (n = 190) in nine LTCFs who had fluoride varnish applied by Dental Care Professionals on two separate occasions during a 12-month period (intervention group). Nine LTCFs were chosen as matched controls (control group) with comparable numbers of residents of similar medical status (n = 217). For the intervention group, oral hygiene training was also provided for the care home staff. Results: A total of 407 patients (n = 271 female) were included in the analyses (mean age [SD]: 84.1 [6.6] years). After 12 months, the intervention group recorded a significant reduction in mean number of carious teeth (mean [95% CI]: −0.85 [−1.12, −0.58]; P < .001). Patients in the control group had significant increases in the mean number of carious teeth (mean [95%