Assessing Adherence to Provider's Recommendations in Caries Risk Assessment and Management: A Retrospective Data Review.

AIM: To evaluate the distribution of caries risk category of patients at a dental institution and determine adherence to providers' recommendations. MATERIALS AND METHODS: A cross-sectional retrospective review of 1,235 patients records that included data collection on demographics, the sum of the number of decayed, missing due to caries, and filled teeth in the permanent teeth (DMFT), presence of frequent snacking, stimulated salivary flow rate, stimulated saliva pH, saliva buffering capacity, biofilm activity, caries risk category, anti-caries prescription accept/decline, and change in the caries risk category. Statistical analysis was carried out through Pearson's Chi-squared test and linear model ANOVA with a significance level of 0.05. RESULTS: Pearson's Chi-squared test showed a statistically significant difference in frequency by risk category (p < 0.001) indicating that patients were skewed toward high and extreme caries risk. Linear model ANOVA showed that higher risk categories were associated with lower salivary flow rates (p = 0.010) and higher biofilm activity (p < 0.001). About, 1 out of 3 patients were reported to have frequent snacking (N = 391, 32%). Frequent snacking patients were more likely to present with higher caries risk assessment (p < 0.001), younger age (p < 0.001), and female (p < 0.001). Despite recommendations from the dental student provider, only 27% accepted the anti-cavity prescriptions while 61% declined the recommendation. CONCLUSION: Distribution of caries risk category is not evenly distributed, but rather skewed toward high and extreme caries risk levels. Despite the identified risks, there is low adherence to the recommendations provided by healthcare providers. The results underscore the necessity for targeted interventions and initiatives aimed at fostering behavioral changes to enhance oral health outcomes. CLINICAL SIGNIFICANCE: There is a high need for targeted interventions and initiatives that promote behavioral changes to enhance oral health outcomes.

Methicillin-Resistant Staphylococcus aureus Endovascular Infection in a Neonate: Prolonged, Safe, and Effective Use of Daptomycin and Enoxaparin.

We report on a former 28-week gestation neonate with persistent methicillin-resistant Staphylococcus aureus (MRSA) endocarditis, with a heterozygous Factor V Leiden mutation. The neonate became clinically ill after 1 week of life, with positive blood cultures for MRSA. Echocardiography revealed large thrombi in the inferior vena cava and right atrium. Bacteremia persisted despite removal of umbilical arterial and venous catheters and empiric administration of therapeutic doses of vancomycin (minimum inhibitory concentration [MIC] 2 mg/L) and ceftazidime. To narrow therapy, ceftazidime was discontinued, while gentamicin and rifampin were added. Cultures remained positive and, therefore, linezolid was added, and subsequent blood cultures became negative. Since prolonged linezolid use of 2 weeks or longer carries potential adverse effects, antibiotics were changed to daptomycin, which is bactericidal and recommended for treatment of invasive MRSA infections when vancomycin MICs are ≥2 mg/L to minimize vancomycin treatment failure. Enoxaparin was initiated, with anti-Xa assay monitoring. A workup for thrombophilia revealed heterozygous Factor V Leiden mutation. Serial echocardiograms demonstrated decreasing size of the thrombi, which were no longer visualized at 2 months of age. Creatinine kinase remained normal. The infant had no seizures on daptomycin. The management of persistent MRSA bacteremia in neonates associated with a large thrombus poses a unique challenge due to the long duration of treatment. To our knowledge, this is the first case of prolonged and safe daptomycin and enoxaparin use in a preterm neonate. Daptomycin may be considered in cases of clinical failure with vancomycin when a lengthy treatment course is contemplated.

Comparative evaluation of fracture resistance of various post systems using different luting agents under tangential loading.

OBJECTIVE: The purpose of this in vitro study was to evaluate the fracture resistance of various post system using different luting agents under tangential loading after wet thermocycling. MATERIAL & METHODS: Seventy freshly extracted maxillary central incisors were endodontically treated and post-spaces were prepared to receive different post system. They were assigned to 7 groups. Composite resin was used as core material in all the groups. Three type of post system: prefabricated post system (ParaPost(®) XP™), fibre post (ParaPost(®) fiber Lux™), cast nickel-chromium alloy post and two type of luting cements dual cure resin cement (ParaCem(®), Whaledent) and glass ionomer cement (Fuji I, GC) were used. The specimens were thermocycled and subjected to tangential loading at a crosshead speed of 1.5 mm/min. The failure loads were recorded and data were statistically analyzed with one-way ANOVA (p < 0.05) and Student's t tests (p < 0.001). RESULTS: Significant differences of fracture resistance were detected among groups (p < 0.001). The greatest number of repairable fracture mode was recorded in fibre posts and resin cement system. CONCLUSIONS: Within the limitations of this in vitro study, it can be stated that fibre posts can be recommended as a better alternative to the cast post and cores and prefabricated metallic posts in the anterior region and resin cement might give additional fracture resistance when used for post and crown cementation.

Use of ultrasound, color Doppler imaging and radiography to monitor periapical healing after endodontic surgery.

This study evaluated the effectiveness of ultrasound, color Doppler imaging and conventional radiography in monitoring the post-surgical healing of periapical lesions of endodontic origin. Fifteen patients who underwent periapical surgery for endodontic pathology were randomly selected. In all patients, periapical lesions were evaluated preoperatively using ultrasound, color Doppler imaging and conventional radiography, to analyze characteristics such as size, shape and dimensions. On radiographic evaluation, dimensions were measured in the superoinferior and mesiodistal direction using image-analysis software. Ultrasound evaluation was used to measure the changes in shape and dimensions on the anteroposterior, superoinferior, and mesiodistal planes. Color Doppler imaging was used to detect the blood-flow velocity. Postoperative healing was monitored in all patients at 1 week and 6 months by using ultrasound and color Doppler imaging, together with conventional radiography. The findings were then analyzed to evaluate the effectiveness of the 3 imaging techniques. At 6 months, ultrasound and color Doppler imaging were significantly better than conventional radiography in detecting changes in the healing of hard tissue at the surgical site (P < 0.004). This study demonstrates that ultrasound and color Doppler imaging have the potential to supplement conventional radiography in monitoring the post-surgical healing of periapical lesions of endodontic origin.

General O-glycosylation of 2-furfuryl alcohol using beta-glucuronidase.

beta-Glucuronidase from bovine liver is able to catalyze transfer of several carbohydrates to furfuryl alcohol, an acid-sensitive diene, with transfer yields as high as 84%. Carbohydrates that were transferred in yields of 30% or higher include gluco-, galacto-, xylo-, and fucopyranose. Small variations in the configuration of the substrate hydroxyls lead to large variations in the catalytic behavior of the enzyme in terms of both the initial reaction velocities and the final ratios of transfer-to-hydrolysis. The high transfer yields and surprising nonspecificity towards carbohydrate suggest that the enzyme may be a versatile tool for the general O-glycosylation of dienic alcohols.