Impact of COVID-19 on Dental Practices in El Salvador and Mexico: A Comprehensive Survey Analysis.

BACKGROUND AND OBJECTIVES: This study aimed to identify the relationship between prevention measures and protective barriers in dental practice in El Salvador and Mexico during the COVID-19 pandemic in 2020 and 2021. MATERIALS AND METHODS: A longitudinal study was conducted from June 2020 to December 2021, involving 1,719 dentists divided into four groups based on location and year. A 20-question survey in Spanish was utilized and validated with a Cronbach's alpha value of 0.84. RESULTS: The use of phone triage (OR = 1.3), thermometers (OR = 1.4), physical distancing (OR = 1.7), and face shields (OR = 2.6) was significantly associated with dental practice in both countries during the pandemic. CONCLUSIONS: During 2020 and 2021, dental care in El Salvador and Mexico was significantly linked to COVID-19 preventive measures. Phone triage, thermometers, distancing, and face shields positively correlated with dental services. National health agencies should promote the use of minimum preventive measures in dental care, preparing for potential reinfections or new pandemics from emerging virus variants.

Depression and opinion of dental students regarding the hybrid learning model during the COVID-19 pandemic.

BACKGROUND: The global spread of COVID-19 forced schools at all educational levels to close, which was repeated in more than 60 countries. In addition, the COVID-19 pandemic has affected the mental health of dental students world wide. This study hypothesizes that the prevalence of depression in dental students from El Salvador is higher than that reported in studies from Europe, Asia, and North America. METHODS: This study was an online cross-sectional survey performed at the Faculty of Dentistry of the University of Salvador. The PHQ-9 questionnaire was applied to know the level of depression of the students, and a questionnaire focused on learning the opinion of the students on the hybrid teaching model adopted. Approximately 450 students participated in both questionnaires. RESULTS: Regarding the levels of depression present in the students, 14% had minimal depression, 29% had medium depression, 23% had moderate depression and, 34% had severe depression. The students had an excellent opinion regarding the hybrid learning model. CONCLUSIONS: The prevalence of depression in dental students in El Salvador seems to be higher than that reported in studies in non-Latin American countries. Therefore, universities must generate care plans for mental health to avoid these harmful effects on students during future contingencies.

Proximal enamel thickness quantification in orthodontics for interproximal reduction: A systematic review / Cuantificación del espesor del esmalte proximal en ortodoncia para la reducción interproximal: una revisión sistemática

Background: Interproximal enamel reduction is a valuable procedure in orthodontics used in several conditions, however, not knowing the average value of proximal enamel thickness might lead to excess enamel removal and consequently to adverse effects. Objective:The objective of this systematic review is to expose the average proximal enamel thicknesses found in the literature, and the differences that might be found between different ethnicities and age groups. Search Methods: 5 electronic databases were used to perform the search. Representative keywords comprised of "enamel", "thickness", "orthodontics" "proximal thickness" and "quantification"; different combination of these keywords with truncation, and medical subject headings (MESH) were used. Selection Criteria: In vitro and in vivo studies, where the quantification of the proximal enamel thickness of the mesial and distal sides were evaluated independently. Data Collection and Analysis: The PICO model was used to evaluate and select the in vitro and in vivo studies. ROBINS-I tool was used to assess the risk of bias of non-randomized clinical studies and a modification of Cochrane risk of bias tool was implemented for the in vitro studies. The quality of evidence and results were evaluated using The Joanna Briggs Institute (JBI) Critical Appraisal checklist tools for Quasi-Experimental Studies. Results: Literature search identified 3298 records from 5 databases. Ultimately, nine eligible studies were included in the review. Conclusions: The proximal enamel thickness increases as we move distal through the arch and is greater on the distal side compared to the mesial side of each individual tooth. Additionally, there is no difference in the proximal enamel thickness between genders but there is between ethnicities.

Antecedentes:La reducción del esmalte interproximal es un procedimiento valioso en ortodoncia utilizado en varias condiciones, sin embargo, no conocer el valor promedio del espesor del esmalte proximal puede conducir a una eliminación excesiva del esmalte y, en consecuencia, a efectos adversos. Objetivo:El objetivo de esta revisión sistemática es exponer los espesores promedio de esmalte proximal encontrados en la literatura y las diferencias que se pueden encontrar entre diferentes etnias y grupos de edad. Materiales y métodos:se utilizaron 5 bases de datos electrónicas para realizar la búsqueda. Palabras clave representativas compuestas por "esmalte", "grosor", "ortodoncia", "grosor proximal" y "cuantificación"; Se utilizaron diferentes combinaciones de estas palabras clave con truncamiento y encabezados de temas médicos (MESH). Criterios de Selección: Estudios in vitro e in vivo, donde se evaluó de forma independiente la cuantificación del espesor del esmalte proximal de los lados mesial y distal. Recopilación y análisis de datos:se utilizó el modelo PICO para evaluar y seleccionar los estudios in vitro e in vivo. Se utilizó la herramienta ROBINS-I para evaluar el riesgo de sesgo de los estudios clínicos no aleatorizados y se implementó una modificación de la herramienta Cochrane de riesgo de sesgo para los estudios in vitro. La calidad de la evidencia y los resultados se evaluaron utilizando las herramientas de lista de verificación de evaluación crítica del Instituto Joanna Briggs (JBI) para estudios cuasi-experimentales. Resultados:La búsqueda bibliográfica identificó 3298 registros de 5 bases de datos. Finalmente, se incluyeron nueve estudios elegibles en la revisión. Conclusiones:El grosor del esmalte proximal aumenta a medida que avanzamos distalmente a travésdel arco y es mayor en el lado distal en comparación con el lado mesial de cada diente individual. Además, no hay diferencia en el grosor del esmalte proximal entre géneros, pero sí entre etnias

Corrección de una clase III esqueletal con anclaje óseo en paciente en crecimiento: Reporte de caso / Skeletal class III correction in growing patient with bone anchorage: CaseReport

Antecedentes: La clase III esqueletal, es una deformidad dentofacial donde el tercio inferior de la cara es más prominente, el tratamiento se decide según la etiología y la edad del paciente; si se encuentra en crecimiento la malformación puede ser tratada con un protocolo interceptivo y si es posible evitar la cirugía ortognática a futuro. Objetivo: Mejorar la clase esqueletal, descruzar la mordida u obtener mordida borde a borde, mejorar la posición del labio superior y evaluar el comparativo inicial-final de SNA y ANB. Reporte de caso:Paciente masculino de 13 años, sin antecedentes personales patológicos o familiares reportados; presenta clase III esqueletal responsiva bimaxilar, crecimiento vertical, clase molar I y canina III; fue tratado con el protocolo de mini placas BAMP (bone anchored maxillary protraction) por sus siglas en inglés, elásticos intermaxilares y un paladar con pistas planas. Resultados:La fase ortopédica duro cinco meses y se logró mordida borde a borde y clase I esqueletal. Discusión: Se obtuvieron resultados con el uso de mini implantes sin anclaje extraoral en menos tiempo a comparación de otros métodos que tienen que ser usados por 9-12 meses.Conclusión:El protocolo BAMP puede ser usado en pacientes en crecimiento sin máscara facial para corregir la clase III esqueletal.

Background: Skeletal class III is a dentofacial deformity where the lower third ofthe face is more prominent. The treatment is decided according to the etiology and age of the patient; If the patient is in growing, the malformation can be treated with an interceptive protocol and if possible, avoid a orthognathic surgery in the future. Objective: Improve the skeletal class, uncross the bite or obtain an edge-to-edge bite, improve the position of the upper lip and compare the initial-final relationship of ANS and ANB.Case report:13-year-old male patient, with no reported pathological or family history; presents skeletal class III, vertical growth, molar class I and canine III; he was treated with the protocol of mini BAMP (bone anchored maxillary protraction) plates, intermaxillary elastics and a palate with flat tracks. Results:The orthopedic phase lasted five months and an edge-to-edge bite and skeletal class I were achieved.Discussion:Results were obtained with the use of mini plates without extraoralanchorage in less time compared to other methods that have to be used for 9-12 months. Conclusion: The BAMP protocol can be used in growing patients without a face mask to correct skeletal class III.

Manejo de un paciente clase III ósea con cirugía ortognática tardía: reporte de caso clínico / Management of an orthognathic surgery treatment in a skeletal class IIIpatient: case report

Antecedentes: El tratamiento establecido como el estándar de oro para las malformaciones óseas del complejo cráneo facial es el tratamiento de ortodoncia compaginado con cirugía ortognática, para alcanzar estabilidad oclusal, eliminar discrepancia ósea, armonía facial, mejora en la masticación, fonación y respiración. El protocolo de cirugía ortognática tardía consiste en 3 fases: tratamiento de ortodoncia pre-quirúrgica, cirugía ortognática y ortodoncia post-quirúrgica. Objetivo:El objetivo del caso clínico es trasmitir que el enfoque de cirugía tardía puede dar excelentes resultados, ser eficaz y rápido si existe un buen diagnóstico, manejo y una comunicación estrecha entre el ortodoncista y el cirujano maxilofacial. Reporte de caso:Paciente femenino de 18 años de edad clase III ósea. Presenta molestia ocasional, crepitación y luxación de la articulación temporomandibular, laterognasia. El tratamiento establecido fue cirugía ortognática tardía de ambos maxilares con osteotomía sagital unilateral. Resultados:Los objetivos del plan de tratamiento se cumplieron a 1 año 9 meses de haber iniciado el tratamiento ortodóncico. Conclusión:Con un buen diagnóstico y planificación del tratamiento de ortodoncia ­cirugía ortognática asegura excelentes resultados, así como, estabilidad ósea y armonía oclusal post-cirugía.

Introduction: The treatment established as the gold standard for skeletal deformities of the craniofacial complex is orthodontic treatment combined with orthognathic surgery, to achieve occlusal stability, facial harmony, improved mastication, phonation and breathing. The conventional orthognathic surgery protocol consists of 3 phases: pre-surgical orthodontic treatment, orthognathic surgery and post-surgical orthodontics. Case Report: 18-year-old female patient with skeletal class III. She presents occasional pain, crepitation and luxation of the temporomandibular joint, laterognathia. Treatment: Conventional orthognathic surgery of both jaws with unilateral sagittal osteotomy. Results: The objectives of the treatment plan were achieved 1 year and 9 months after starting orthodontic treatment.Conclusion: With a good diagnosis and treatment planning orthodontic -maxillofacial surgery ensures excellent results, as well as bone stability and occlusal harmony post-surgery.

Should We Be Concerned about the Association of Diabetes Mellitus and Periodontal Disease in the Risk of Infection by SARS-CoV-2? A Systematic Review and Hypothesis.

The objective of this article was to conduct a systematic review of the literature to contrast the existing evidence regarding the relationship between periodontal disease (PD) and diabetes mellitus (DM) with the possibly increased risk of SARS-CoV-2 infection, as well as to establish a hypothesis that explains the ways in which this interaction could take place. A literature search up from 1 January 2020 to 21 March 2021 was conducted in three electronic databases, namely, PubMed, Web of Science, and Scopus, in order to identify studies on periodontal disease alone or in conjunction with diabetes mellitus, reporting any relation with SARS-CoV-2 infection as a primary outcome. Only articles published in the English language were included. Due to the lack of studies, we decided to collect all the theoretical and clinical evidence suggesting a possible biological pathway evidencing the relationship among PD, DM, and SARS-CoV-2 infection. From a total of 29 articles, 12 were included for final review studies (five reviews, two hypotheses, one Special Issue, one perspective, one commentary, one case-control study, and one case report). In addition, this systematic review article hypothesizes the correlation between PD and type 2 diabetes mellitus (T2DM) by expression of angiotensin-converting enzyme 2 (ACE2) in periodontal tissue and the risk of SARS-CoV-2 infection. T2DM is a metabolic disorder characterized by high blood glucose levels resulting from altered insulin secretion or action. Likewise, periodontitis and T2DM are inflammatory disorders with a bidirectional association, and both diseases have a similar immunomodulatory cascade and cytokine profile. ACE2 is a crucial component of the renin-angiotensin system (RAS) and the key factor of entry in the cells by the new SARS-CoV-2. ACE2 is widely distributed in the lung and kidneys, and interestingly has a great distribution in the oral cavity, principally in the tongue and periodontal tissue. ACE2 in periodontal tissue plays a crucial role between health and disease. Moreover, the ACE2/Ang-(1-7)/MasR axis is downregulated in the dysbiotic and inflammatory periodontal environment. Nevertheless, the balance of ACE2 activity is modified in the context of concurrent diabetes, increasing the expression of ACE2 by the uncontrolled glycemia chronic in T2DM. Therefore, the uncontrolled hyperglycemia possibly increases the risk of developing periodontitis and triggering overexpression of ACE2 in periodontal tissue of T2DM patients, with these events potentially being essential to SARS-CoV-2 infection and the development of mild-to-severe form of COVID-19. In this sense, we would like to point out that the need for randomized controlled trials is imperative to support this association.

Presence of SARS-CoV-2 and Its Entry Factors in Oral Tissues and Cells: A Systematic Review.

Background and Objectives: The aim of this systematic review is to summarize the current data about the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its entry factors in oral tissues and cells. Materials and Methods: This systematic review was carried out based on the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA). Three databases were analyzed (Pubmed, Web of science and Scopus) by three independent researchers. From the 18 identified studies, 10 of them met the inclusion criteria. The presence of SARS-CoV-2 or its entry factors (angiotensin-converting enzyme II (ACE2), transmembrane serine proteases (TMPRSS), and furin) was analyzed in these 10 studies during the pandemic. Results: ACE2 expression was analyzed in 9 of the 10 studies. ACE2 is expressed mainly in the tongue, oral mucosa, salivary glands and epithelial cells. The expression of the TMPRSS2 gene or protein was analyzed in 6 studies. These studies reported that the expression of TMPRSS2 was mainly in the salivary glands, tongue, sulcular epithelium and oral mucosa; as well as in cells of the salivary glands (ductal, acinar and myoepithelial cells) and the tongue (the spinous-based cell layer, horny layer and the epithelial surface). Other TMPRSS were also reported. The expression of TMPRSS3, TMPRSS4, TMPRSS5, TMPRSS7 and TMPRSS11D was reported mainly in salivary glands and in epithelial-type cells. Furan expression was analyzed in three studies. The expression of furin was detected mainly in epithelial cells of the tongue. A variety of methods were used to carry out the detection of SARS-CoV-2 or its input molecules. Conclusions: These results show that SARS-CoV-2 can infect a wide variety of oral tissues and cells, and that together with the theories dedicated to explaining the oral symptoms present in SARS-CoV-2 positive patients, it provides us with a good scientific basis for understanding the virus infection in the oral cavity and its consequences.

Saliva: What Dental Practitioners Should Know about the Role of This Biofluid in the Transmission and Diagnostic of SARS-CoV-2.

A novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has become a global ongoing pandemic. This pandemic represents a great work risk for all health professionals, it includes dental professionals who are in constant contact with saliva, which represents one of the main routes of transmission of the disease. This is due to the fact that a wide variety of oral tissues and cells are susceptible to infection by SARS-CoV-2 and that they express the ACE2 receptor, which is the main route of entry of the virus into cells, as well as the proteins TMPRSS and furin that contributes to the binding of the virus to the host cells. According to recent studies, some of the oral cells most susceptible to infection by SARS-CoV-2 are the epithelial cells of the salivary glands. This explains the presence of the virus in the saliva of infected patients and provides scientific evidence that supports the use of saliva as a biofluid that offers the opportunity to develop new detection and diagnostic techniques. This is because saliva is much easier to collect compared to nasopharyngeal swab. However, the presence of the virus in saliva, also represents a great source of transmission, since the main form of infection is through microscopic drops that are generated when infected people cough or sneeze. Likewise, health professionals, such as dentists are exposed to contagion through saliva. The objective of this review article is to provide a perspective on the main cells and tissues that can be affected by the virus, the risk of contagion that the presence of the virus in saliva represents for dentists; and the new techniques developed from saliva samples for the diagnosis and surveillance of SARS-CoV-2 infection. This review is expected to contribute to the knowledge of oral health professionals about the risk of saliva in the spread of SARS-CoV-2, but also its advantages as a diagnostic tool for pandemic control. In conclusion, the authors can mention that information that provides more scientific evidence of the mechanisms of infection of the coronavirus in oral cells and tissues is being published continually. This also explains the presence of the virus in the saliva of infected people and the risk of contagion that this means. It also provides scientific evidence of the use of saliva as a biofluid for the detection, diagnosis, monitoring, and control of the spread of the virus.

How Dentists Face the COVID-19 in Mexico: A Nationwide Cross-Sectional Study.

Background: on 7 January 2020, a new type of coronavirus was isolated, the Severe Acute Respiratory Syndrome Coronavirus2 (SARS-CoV-2), the organism causing the outbreak that has affected the lives of all humans and has modified the rules of coexistence around the world. In Mexico, from 3 January 2020 to 9 January 2021, there have been 1439, 569 confirmed cases of COVID-19 with 131,031 deaths. The World Health Organization reported that Mexico was ranked twelfth, in terms of confirmed cases of COVID-19 by country. Aim: the objective of this study was to determine what modifications dentists from the Mexican Republic have made to their dental practice during theCOVID-19 pandemic. Methods: the study was conducted based on a questionnaire to evaluate the dentists' response and knowledge on the modifications in their dental practice to combat the new coronavirus's cross-transmission. The questionnaire was piloted before it was distributed. The questionnaire was disseminated through the social network Facebook. The questionnaire was distributed to groups of dentists on Facebook, in each of the Mexican Republic states. The survey was carried out during June 2020. Results and Conclusions: from the 32 states of the Mexican Republic, 29 participated with at least one respondent. The results of the applied survey suggest that dentists, at least the population of surveyed ones, have proper knowledge of detection methods of patients suspected of COVID-19, preventive measures that must be applied in the dental office to decrease the risk of infection, and the appropriate procedures and solutions for dental office disinfection.

Effective Control of Molds Using a Combination of Nanoparticles.

Molds are filamentous fungi able to grow on a variety of surfaces, including constructed surfaces, food, rotten organic matter, and humid places. Mold growth is characterized by having an unpleasant odor in enclosed or non-ventilated places and a non-aesthetic appearance. They represent a health concern because of their ability to produce and release mycotoxins, compounds that are toxic to animals and humans. The aim of this study was to evaluate commercial nanoparticles (NPs) that can be used as an additive in coatings and paints to effectively control the growth of harmful molds. Four different NPs were screened for their antifungal activities against the mycotoxin producing mold strains Aspergillus flavus and A. fumigatus. The minimal inhibitory concentrations of the NPs were determined in broth media, whereas an agar diffusion test was used to assess the antimold activity on acrylic- and water-based paints. The cytotoxic activity and the inflammatory response of the NPs were also evaluated using the established human derived macrophage cell line THP-1. Results showed that a combination of mix metallic- and ZnO-NPs (50:10 µg/mL) effectively inhibited the fungal growth when exposed to fluorescent light. Neither cytotoxic effect nor inflammatory responses were recorded, suggesting that this combination can be safely used in humid or non-ventilated environments without any health concerns.

Facile Synthesis, Characterization, and Cytotoxic Activity of Europium-Doped Nanohydroxyapatite.

The objective of this study was to synthetize europium-doped nanohydroxyapatite using a simple aqueous precipitation method and, thereafter, characterize and impregnate selected samples with 5-fluorouracil in order to explore the properties and the releasing capacity of this material. The nanohydroxyapatite was doped with 3, 5, 10, and 20 wt% of europium. The obtained samples were characterized after they were dried at 80°C and hydrothermal treated at 120°C by 2 hours. The samples were analyzed by transmission electron microscopy, X-ray diffraction analysis, Fourier transform infrared spectroscopy, and photoluminescence. Also, impregnation and release of 5-fluorouracil were assessed in PBS. The toxicity effects of all samples were studied using viability assays on human fibroblasts cells (HGF-1) in vitro. The sizes of the crystallites were about 10-70 nm with irregular morphology and present the phase corresponding to the JCPDS card 9-0432 for hydroxyapatite. The results of the toxicity experiments indicated that doped and undoped powders are biocompatible with fibroblasts cells. Hydroxyapatite samples doped with 5% of europium and loaded with 5-fluorouracil release almost 7 mg/L of the drug after 60 minutes in PBS and decrease the viability of HeLa cells after 24 hours.