Bone union formation in the rat mandibular symphysis using hydroxyapatite with or without simvastatin: effects on healthy, diabetic, and osteoporotic rats.

OBJECTIVE: The objective is to compare new bone formation in critical defects in healthy, diabetic, and osteoporotic rats filled with hydroxyapatite (HA) alone and HA combined with simvastatin (SV). MATERIALS AND METHODS: A total of 48 adult female Sprague-Dawley rats were randomized into three groups (n = 16 per group): Group, 1 healthy; Group 2, diabetics; and Group 3, osteoporotics. Streptozotocin was used to induce type 1 diabetes in Group 2, while bilateral ovariectomy was used to induce osteoporosis in Group 3. The central portion of the rat mandibular symphysis was used as a physiological critical bone defect. In each group, eight defects were filled with HA alone and eight with HA combined with SV. The animals were sacrificed at 4 and 8 weeks, and the mandibles were processed for micro-computed tomography to analyze radiological union and bone mineral density (BMD); histological analysis of the bone union; and immunohistochemical analysis, which included immunoreactivity of vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP-2). RESULTS: In all groups (healthy, diabetics, and osteoporotics), the defects filled with HA + SV presented greater radiological bone union, BMD, histological bone union, and more VEGF and BMP-2 positivity, in comparison with bone defects treated with HA alone. CONCLUSIONS: Combined application of HA and SV improves bone regeneration in mandibular critical bone defects compared with application of HA alone in healthy, diabetic, and osteoporotic rats. CLINICAL RELEVANCE: This study might help to patients with osteoporosis or uncontrolled diabetes type 1, but future studies should be done.

Synergistic effect of photodynamic therapy and alendronate on alveolar bone loss in rats with ligature-induced periodontitis.

BACKGROUND AND OBJECTIVE: Photodynamic therapy (PDT) and antiresorptive drugs, such as alendronate (ALN), have been shown to reduce alveolar bone loss. The aim of this study was to evaluate the possible synergic effects of combining PDT and ALN on bone loss in periodontitis in rats. MATERIAL AND METHODS: Periodontitis was induced by ligature in 60 Wistar rats randomized into the following groups: control (Group 1); PDT (Group 2); ALN 0.01 mg/kg (Group 3); ALN 0.25 mg/kg (Group 4); PDT + ALN 0.01 mg/kg (Group 5); and PDT + ALN 0.25 mg/kg (Group 6). The rats were killed on day 12 and the mandibles were processed for macroscopic morphometric analysis, micro-computed tomography to analyze bone mineral density (BMD) and histological analysis. Gingival samples were collected to evaluate myeloperoxidase (MPO) and malonaldehyde (MDA) levels. RESULTS: Bone loss and inflammatory activity in histological studies, from the greatest to least was: control > ALN 0.01 mg/kg > PDT > ALN 0.25 mg/kg > PDT + ALN 0.01 mg/kg > PDT + ALN 0.25 mg/kg, while the order from least to greatest BMD was: control < ALN 0.01 mg/kg < PDT < ALN 0.25 mg/kg < PDT + ALN 0.01 mg/kg < PDT + ALN 0.25 mg/kg. The order of MPO and MDA activity from greatest to least was: control > ALN 0.01 mg/kg > PDT > ALN 0.25 mg/kg > PDT + ALN 0.01 mg/kg > PDT + ALN 0.25 mg/kg. The positive results obtained in the group treated with PDT + ALN 0.25 mg/kg showed statistically significant differences (P ≤ .05) compared with the other 5 groups for BMD, MPO and MDA. CONCLUSION: Combined approach therapy of PDT + ALN 0.25 mg/kg demonstrated a protective effect on alveolar bone loss.

Effects of photodynamic therapy, 2 % chlorhexidine, triantibiotic mixture, propolis and ozone on root canals experimentally infected with Enterococcus faecalis: an in vitro study.

The aim of this study was to evaluate the antibacterial effect of photodynamic therapy (PDT), 2 % chlorhexidine (CHX). The teeth were contaminated with 0.1 mL Enterococcus faecalis (3 × 108 cell/mL) and randomized into eight treatment groups: Group 1 (2.5 % NaOCl); Group 2 (PDT); Group 3 (2 % CHX); Group 4 (TAM); Group 5 (propolis), Group 6 (ozone), Group 7 (positive control) and Group 8 (negative control). Following treatment, the canal content was sampled. The samples were cultured in triplicate on blood agar plates to determine the number of colony forming units (CFU)/mL. The teeth were analyzed by SEM to determine the percentage of area with contamination and debris. The group with the lowest CFU/mL count was the ozone group, which obtained similar values to the PDT group. SEM images showed that 2.5 % NaOCL group showed the lowest percentage of contaminated area. Applications of PDT, 2 % CHX, TAM, propolis and ozone showed antibacterial potential similar to 2.5 % NaOCL.

[Design and evaluation of a booklet for the Oral Health Program in children from birth].

BACKGROUND: There is no preventive control of oral health from birth in Spain. This situation entails a number of risks, such as increased caries lesions in children. The objective of this study was to design a pediatric dentistry booklet for the clinical assessment and follow-up of oral health in children, as well as its evaluation by health professionals and parents. METHOD: Design of the booklet, in 2018, by pediatric dentists of the Murcia University Dental Clinic, based on a biblio-graphic review, to instruct in preventive (dietary and oral hygiene) and curative (planning of pediatric dental visits and treatments) habits. A convenience sampling of forty pediatric dentists, dentists, pediatricians and parents was carried out to evaluate the preliminary design, in 2019. They completed a questionnaire with their data, opinion on different aspects of the booklet and suggestions. RESULTS: The evaluation of the preliminary version of the booklet by health professionals and parents was positive. It was modified in line with their suggestions and the final version was made: a 16-page booklet, with data on the child's affilia-tion and parents, with a preventive and curative approach, making pediatric and pediatric dental check-ups coincide in time. CONCLUSIONS: The pediatric dentistry booklet was created and has been positively valued by professionals and parents, its use is recommended for early dental care, and can be extended to other health systems at the regional level in Spain.

Use of antifungal agents for oral candidiasis: results of a national survey.

BACKGROUND: Candida albicans is an opportunistic agent that colonizes the oral mucosa. OBJECTIVES: To determine the attitude of Spanish dentists toward the oral treatment of candidiasis. METHOD: Between May and November 2006, a questionnaire was circulated to a random selection of 1134 dentists obtained from the General Dental Council's main list. The survey consisted of a block of socio-demographic items followed by another block related to the diagnosis and treatment of oral candidiasis. Replies to the questionnaire were received from 840 (74%) dentists. RESULTS: 50.4% of respondents were men, and 48.1% were female with a mean age of 38 and 12.2 years of professional experience. Miconazole was the most popular choice of antifungal agent prescribed (59.3%), followed by nystatin (57.7%) for topical use. Systemic antifungal agents were used by 30.20% of dentists, with a strong association between their use and the number of years in practice, gender and professional qualifications (P < 0.005). CONCLUSION: Most Spanish dentists make clinical diagnosis and treat oral infections by C. albicans themselves with topical drugs (miconazole and nystatin) as a first choice. Systemic treatments are more commonly chosen by male dentists with long professional experience, especially by stomatologists.

Influence of years of professional experience in relation to the diagnostic skill of general dental practitioners (GDPs) in identifying oral cancer and precancerous lesions.

OBJECTIVE: To evaluate skill in diagnosing cancer and oral precancerous lesions among general dentists in the Autonomous Community of Murcia (Spain). MATERIAL AND METHOD: Twenty randomly distributed clinical images were used, of which 45% corresponded to benign lesions, 35% to oral precancerous lesions, and 20% to oral cancer. Each case was accompanied by a summarised clinical history. The study sample comprised 150 general dentists divided into two groups: group I (60 recently graduated dentists without professional experience) and group II (90 dentists with established professional activity). RESULTS: In group I, the sensitivity of oral cancer diagnosis was 61.3% versus 85.5% in group II (p < 0.001), while the sensitivity of precancerous lesion diagnosis was 71.7% in group I versus 80.7% in group II (p = 0.004). CONCLUSIONS: The results obtained show that junior dentists and general dentists with public or private practice need more training and more experience in diagnosing cancer and oral precancerous lesions.

Spanish dental hygienist attitudes to dental radiological protection: assessment of a 1-day pilot course.

OBJECTIVES: To determine hygienists' knowledge of and attitudes to X-ray equipment and film processing, and to assess both after a 1-day course. STUDY POPULATION: One-hundred and four dental hygienists from the south-east of Spain attending a 1-day course in oral radiology. METHODOLOGY: A questionnaire comprising different sections related with socio-demographic items, X-ray equipment and the processing of dental films was answered before and after a 1-day pilot course on radiation protection. RESULTS: The response rate was 89.42% (n = 93). Of the participants 94.6% were women, with a mean age of 29.52 (SD 6.861) and 7.20 years of professional experience (SD 5.089). The level of knowledge before the course was 48.28%, which increased to 85.62% after the course (P < 0.001). CONCLUSIONS: The prescribed standard was reached by <23.65% of those attending the course at the beginning. Although attending the course led to a considerable improvement, it did not always result in a high level of knowledge of basic radiation equipment and processing.

Diseño y evaluación de una cartilla para el Programa de Salud Bucodental en niños desde el nacimiento / Design and evaluation of a booklet for the Oral Health Program in children from birth

Fundamento: En España no existe un control preventivo de la salud bucodental desde el nacimiento. Estoconlleva una serie de riesgos, como el aumento decaries en niños. El objetivo de este trabajo fue diseñar una cartilla odontopediátrica para la valoración yseguimiento clínico de la salud bucodental en niños,así como su evaluación por profesionales de la salud yprogenitores/tutores. Método: Diseño de la cartilla, en 2018, por odontopediatras de la Clínica Odontológica Universitaria de Murcia,a partir de una revisión bibliográfica, para instruir enhábitos preventivos (dietéticos e higiene bucodental) ycurativos (planificación de visitas y tratamientos odontopediátricos). Evaluación del diseño preliminar, en2019, por un grupo de cuarenta odontopediatras, odontólogos, pediatras y progenitores/tutores, muestreadospor conveniencia. Cumplimentaron un cuestionario consus datos, opinión sobre distintos aspectos de la cartilla y sugerencias. Resultados: La evaluación de la versión preliminar de lacartilla por profesionales de salud y progenitores/tutoresfue positiva; se modificó atendiendo a sus sugerencias yse confeccionó la versión final: cartilla de 16 páginas, condatos de filiación del niño y progenitores/tutores, conenfoque preventivo y curativo, haciendo coincidir en eltiempo revisiones pediátricas y odontopediátricas. Conclusiones: La cartilla odontopediátrica se ha creado y ha sido valorada positivamente por distintosprofesionales y tutores. Se recomienda su uso para laatención odontológica temprana, pudiendo ampliarse aotros sistemas de salud a nivel autonómico en España.(AU)

Background: There is no preventive control of oralhealth from birth in Spain. This situation entails anumber of risks, such as increased caries lesions inchildren. The objective of this study was to design apediatric dentistry booklet for the clinical assessmentand follow-up of oral health in children, as well as itsevaluation by health professionals and parents.Method: Design of the booklet, in 2018, by pediatricdentists of the Murcia University Dental Clinic, basedon a bibliographic review, to instruct in preventive(dietary and oral hygiene) and curative (planning ofpediatric dental visits and treatments) habits. A convenience sampling of forty pediatric dentists, dentists,pediatricians and parents was carried out to evaluatethe preliminary design, in 2019. They completed a questionnaire with their data, opinion on different aspects ofthe booklet and suggestions. Results: The evaluation of the preliminary version ofthe booklet by health professionals and parents waspositive. It was modified in line with their suggestionsand the final version was made: a 16-page booklet, withdata on the child’s affiliation and parents, with a preventive and curative approach, making pediatric andpediatric dental check-ups coincide in time. Conclusions: The pediatric dentistry booklet was created and has been positively valued by professionalsand parents, its use is recommended for early dentalcare, and can be extended to other health systems atthe regional level in Spain.(AU)

The status of Spain's dental practices following the European Union directive concerning radiological installations.

OBJECTIVES: To assess the influence of new European Union (EU) legislation on dental radiology practices and the reduction in patient radiation exposure. STUDY DESIGN: A total of 7176 official reports from Spanish dental offices or clinics covering the period 1996 to 2001 were analyzed. RESULTS: Of the dental radiological installations inspected in 2001, 72.79% used the kilovoltage recommended by the EU (70 kVp) and 98.85% used at least 1.5 mm Al filtration. At least 90.11% of the installations had a focal film distance of 20 cm although there were no cases with a rectangular collimator as adapted to the size of film. Thirty percent of the installations showed a mechanical fault every year. In 17.62% of cases the radiological film was stored in the exposure room. Few clinics (10.24%) used high-speed films and only 11.95% of clinics employed digital systems. The mean dose received by patients fell during the 5 years studied by 18.75%. Radiological equipment fulfilling the EU specifications emitted significantly lower doses than other nonapproved equipment. CONCLUSIONS: The introduction of legislation has resulted in a gradual improvement in dental radiology practices.

Dental students' knowledge of and attitudes toward anticoagulation dental treatment: assessment of a one-day course at the University of Murcia, Spain.

The aim of this study was to determine a group of Spanish dental students' knowledge of and attitudes toward anticoagulated patients and clinical practice and to assess the need for additional education in this area. A survey with sections on demographics and knowledge of general coagulation, anticoagulation treatment, clinical practice, local hemostatic measures, and antibiotic prophylaxis was distributed to students before and after a one-day course on oral anticoagulation. The response rate was 67.1 percent (n=96). Of the respondents, 78.1 percent (seventy-five) were women. The students who benefited most from the course were third-year students since they had the lowest level of knowledge at the beginning of the course (p>0.05). Fifth-year students and postgraduates had a good initial level of knowledge (87 percent). This study identified a lack of knowledge among this group of Spanish dental students prior to the course, but participating in the course led to considerable improvement.

Evolution of diagnostic reference levels in Spanish intraoral radiology.

A total of 16 175 official reports of quality assurance on dental radiodiagnostic surgeries from 16 Spanish autonomous regions compiled during 2002-09 were studied to determine the evolution of diagnostic reference levels (DRLs) for obtaining a diagnostic image in the normal conditions of clinical practice in Spanish dental clinics. A DRL of 3.1 mGy was set in 2009, which represents a 35.4 % decrease compared with the dose determined in 2002 (4.8 mGy). During the same period, the mean dose fell by only 17.2 %. The DRL recommended by the European Union in 2004 for intraoral radiology is 4 mGy, and this study shows that 83.4 % of the installations used a dose below this. Of the installations using indirect or direct digital systems 1.1 and 1.2 %, respectively, used doses higher than those recommended, while 14.2 % of those using radiographic film exceeded this limit.

Chemical genoprotection: reducing biological damage to as low as reasonably achievable levels.

OBJECTIVES: The aim of this study was to evaluate the antioxidant substances present in the human diet with an antimutagenic protective capacity against genotoxic damage induced by exposure to X-rays in an attempt to reduce biological damage to as low a level as reasonably possible. METHODS: Ten compounds were assessed using the lymphocyte cytokinesis-block micronucleus (MN) cytome test. The compounds studied were added to human blood at 25 µM 5 min before exposure to irradiation by 2 Gy of X-rays. RESULTS: The protective capacity of the antioxidant substances assessed was from highest to lowest according to the frequency of the MN generated by X-ray exposure: rosmarinic acid = carnosic acid = δ-tocopherol = l-acid ascorbic = apigenin = amifostine (P < 0.001) > green tea extract = diosmine = rutin = dimetylsulfoxide (P < 0.05) > irradiated control. The reduction in genotoxic damage with the radiation doses administered reached 58%, which represents a significant reduction in X-ray-induced chromosomal damage (P < 0.001). This degree of protection is greater than that obtained with amifostine, a radioprotective compound used in radiotherapy and which is characterised by its high toxicity. CONCLUSION: Several antioxidant substances, common components of the human diet and lacking toxicity, offer protection from the biological harm induced by ionizing radiation. Administering these protective substances to patients before radiological exploration should be considered, even in the case of small radiation doses and regardless of the biological damage expected.

Diagnostic reference levels in intraoral radiology: from the laboratory to clinical practice.

To determine the diagnostic reference levels (DRLs) for obtaining a diagnostic image in the normal conditions of clinical practice and to explain the differences between the levels found and the DRLs obtained in other experimental conditions, suggesting that there has been a reduction in the European Union (EU) recommended levels. A total of 2296 official reports on dental surgeries from 16 Spanish autonomous regions compiled during 2008 were studied. A mean DRL of 3.3 mGy was determined: 2.6 mGy for installations using direct digital systems, 3.4 mGy for those using indirect systems, 4.4 mGy for those using Ultra-speed film and 3.7 mGy for those using Insight. The DRLs found in this survey are below the EU recommended values but far above previously described values, possibly because all the different systems were considered and because values refer to those of the normal work conditions of clinical practice.

The status of Spain's dental practice following the European Union directive concerning radiological installations: 11 years on (1996-2007).

OBJECTIVES: The aim of this study was to assess the influence of European Union legislation on dental radiology practice in Spain and the reduction in doses administered in dental radiological installations 11 years after its introduction. METHODS: A total of 19 079 official reports on dental surgeries from 16 Spanish autonomous regions published between 1996 and 2007 were studied. We analysed the physical characteristics of the X-ray units, anomalies, film processing, exposure times and mean radiation doses administered in clinical situations. RESULTS: The dose applied to obtain a radiograph of an upper second molar had decreased by 37% up until 2007, the mean dose being 2.7 mGy, with 81.1% of installations using a dose of less than 4 mGy, with a reference dose for the 3(rd) quartile of 3.6 mGy. Of note was the incorporation of digital systems (50.1%), which are gradually replacing manual processing systems (45.3%). There were significant differences between the systems: direct digital radiology < indirect digital radiology = Insight = Ektaspeed = Ultraspeed (P < 0.001). In installations with digital systems, 6.3% used more than 4 mGy (20.5% with direct radiology and 3.2% with indirect radiology) and 7.4% a dose of less than 0.5 mGy, with a mean dose of 1.8 mGy and a reference dose for the 3(rd) quartile of 2.3 mGy. CONCLUSION: There has been a gradual improvement in dental radiology practices; however, the incorporation of digital systems has not resulted in all the benefits hoped for, and mistakes are frequent. Besides the physical parameters that have been established, anatomical and clinical image quality criteria should be established to convince dentists of the real benefits of incorporating quality guarantee procedures in their practices.

Collimator with filtration compensator: clinical adaptation to meet European Union recommendation 4F on radiological protection for dental radiography.

OBJECTIVE: Our aim was to develop a compensated filtration collimator for use in paediatric patients undergoing cephalometric radiography that reduces the radiation dose administered and fulfils recommendation 4F of the European guidelines on radiation protection in dental radiology. METHODS: An easy to use filtration-compensated collimator was constructed of plastic, lead and aluminium and used randomly with a group of 32 children (mean age 11 years) undergoing cephalometric radiography before receiving orthodontic treatment. The radiation doses administered to patients (eye lens and thyroid, submandibular and parotid glands) and to the chassis of the radiographic equipment were determined. RESULTS: The filtration-compensated collimator is easily fixed to the external surface of the radiographic equipment and results in (a) as collimator, a reduction of 40% in the surface irradiated in the children and of 61.4% in the dose administered to the thyroid glands (P<0.001); (b) as filtration compensator, a reduction of 32.8% administered to the eye lens (P<0.001), 31.45% to the submaxillary gland (P<0.01) and 11.4% to the parotid gland (P<0.05); there was no difference in the dose determined on the radiographic film. CONCLUSIONS: A radiographic examination can be carried out with children using only a third of the dose normally used with no increase in the time or cost involved.

Is it true that the radiation dose to which patients are exposed has decreased with modern radiographic films?

OBJECTIVES: To determine whether the radiation dose administered to patients has decreased with new radiographic films and digital imaging systems. METHODS: A total of 10 171 official reports on radiological practice in dental surgeries (covering the years 1996-2003) from 16 Spanish autonomous regions were studied, analysing the type of film used, the exposure times and the radiation doses administered in each dental clinic for four different teeth: upper molar, lower molar, upper incisor and lower incisor. RESULTS: The Agfa Dentus M2 radiographic film needed the longest exposure times for all of the teeth (0.6 s, 0.5 s, 0.4 s and 0.4 s, respectively) followed in decreasing order by Ultraspeed, Insight, Ektaspeed and the digital systems, the decrease with respect to the first reaching as much as 60%. Regarding the dose administered, Agfa Dentus M2 used the highest dose (3.1 mGy) followed by Ultraspeed (2.7 mGy), Insight (2.2 mGy), Ektaspeed (2.2 mGy) and, finally, the digital systems (1.1 mGy). Statistical analysis showed significant differences between the doses administered for the digital systems with respect to the radiographic films (P < 0.001) and with respect to manual or automatic processing (P < 0.001). However, there were no significant differences in dose between the different types of films themselves, or between the radiographic developing processes themselves (manual and automatic). CONCLUSION: Not even the use of the most sensitive of modern films has brought about a reduction of the dose administered to patients in Spain. Only digital systems, it seems, will bring about reduction in this dose.

A comparative study of three periapical radiographic techniques for endodontic working length estimation.

AIM: To compare the diagnostic quality of endodontic working length estimation films produced using film holders with those taken using the bisecting angle technique and to assess the level of acceptance of film holders by operator and patient. METHODOLOGY: Five post-graduate and 20 final year undergraduate students attending a UK Dental School produced working length radiographs using either the paralleling or the bisecting angle technique. The paralleling group used one of two film holders, the Endoray II or the XCP Endodontic Instrument, on alternate patients. An assessment of the ease of use of the device and the patients' views on the comfort of the examination were recorded. Each radiograph was examined simultaneously by two assessors, scored for film faults and diagnostic acceptability. Statistical data was derived using the Mann-Whitney U test and Cohen's kappa. RESULTS: The rates of unacceptable radiographs for the XCP Endodontic Instrument, Endoray II and the bisecting angle techniques were 12.2%, 21.4% and 48.6%, respectively. The combined percentage of unacceptable paralleling technique films (16.7%) was highly significantly different (P < 0.001) when compared with the bisecting angle technique (48.6%). The paralleling technique produced a significant reduction in incorrect vertical angulation (P < 0.001), cone cutting (P < 0.001) and incorrect film placement (P < 0.001). Film holders were rated either excellent or good in 90% of examinations by operators and 47.5% of patients reported no discomfort. CONCLUSIONS: These results support the use of the film holders for endodontic working length estimation.