The impact of COVID-19 on Italian dentists: A cross-sectional survey on 2443 participants.

OBJECTIVE: To evaluate the impact of COVID-19 pandemic among a sample of Italian dentists in terms of infection, strategies for infection control, organization of the dental clinic, attitude, and behavior. MATERIAL AND METHODS: This was a cross-sectional survey. The sample consisted of 8000 Italian dentists selected among 63,375 using a computerized random sampling method. An electronic informed consent had to be signed. The questionnaire categories were on demographic, infection risk management, organization, and dentists' attitude and behavior. Geographic macro-areas were used for subgroup analysis. RESULTS: Among 8000 invited dentists, 2443 agreed to participate to the survey (30.6%). Mean age was 51.2 years, women were 34.5%. A total of 6.1% self-reported COVID-19 experience and higher rate of infection was reported in north Italy compared to the south (p < 0.05). FFP2/FFP3 respirators (97.1%) and visors (97.4%) were used by almost all dentists. While, natural ventilation and mouthwashes were the most frequent approaches used to reduce the infection risk. Most of the dentists reported positive attitude, nevertheless 83.6% felt an increased responsibility. CONCLUSION: The self-reported COVID-19 prevalence was 6.1% with some differences among geographic areas. COVID 19 had a deep impact on preventive strategies, dental office organization, and behavior within this sample.

Aerosol transmission for SARS-CoV-2 in the dental practice. A review by SIdP Covid-19 task-force.

Current evidence suggests that SARS-CoV-2, the virus that causes COVID-19, is predominantly spread from person to person. Aim of this narrative review is to explore transmission modality of SARS-CoV-2 to provide appropriate advice to stakeholders, in order to support the implementation of effective public health measures and protect healthcare workers that primary face the disease. "In vivo" and "in vitro" studies from laboratories and hospitals confirmed the presence of surface contamination and provided insight of SARS-CoV-2 detection in the air, particularly in indoor settings with poor ventilation where aerosol-generating procedures were performed. Measures for aerosol reduction, in conjunction with other effective infection control strategies, are needed to prevent the spread of SARS-CoV-2 in dental setting.

Surface disinfection and protective masks for SARS-CoV-2 and other respiratory viruses: A review by SIdP COVID-19 task force.

OBJECTIVES: Primary focused question for this systematic review (SR) was "Which is the evidence about surfaces decontamination and protection masks for SARS-Cov-2 in dental practice?" Secondary question was "Which is the evidence about surfaces decontamination and protection masks against airborne pathogens and directly transmitted viral pathogens causing respiratory infections?" MATERIALS AND METHODS: PRISMA guidelines were used. Studies on surface decontamination and protective masks for SARS-CoV-2 in dental practice were considered. Studies on other respiratory viruses were considered for the secondary question. RESULTS: No studies are available for SARS-CoV-2. Four studies on surface disinfection against respiratory viruses were included. Ethanol 70% and sodium hypochlorite 0,5% seem to be effective in reducing infectivity by > 3log TCID. Four RCTs compared different types of masks on HCW. The single studies reported no difference for laboratory-diagnosed influenza, laboratory-diagnosed respiratory infection, and influenza-like illness. A meta-analysis was not considered appropriate. CONCLUSIONS: There is lack of evidence on the efficacy of surface disinfection and protective masks to reduce the spread of SARS-CoV-2 or other respiratory viruses in dentistry. However, the consistent use of respirator and routine surface disinfection is strongly suggested. There is urgent need of data on the efficacy of specific protection protocols for dental HCW against viral infections.

COVID-19 and dental workers: The Italian Society of Periodontology and Implantology (SIdP) survey.

OBJECTIVES: To evaluate the proportion of COVID-19 infections among a population of Italian Dental workers across different geographical area of Italy and to analyze the impact of both the preventive measures/strategies adopted and the psychological influences. SUBJECTS AND METHODS: The current cross-sectional survey was administered with a web-based form. To be eligible for the study, participants had to be 18 years and being dentists or dental hygienists members of the Italian Society of Periodontology and Implantology (SIdP). A 23-item questionnaire concerning positiveness to COVID-19, clinical strategies and psychological attitude within the pandemic was administered. Sub-group analysis was conducted according to geographical macro-area. RESULTS: A total of 790 dentists and dental hygienists were included. A total of 4.7% participants developed a positive diagnosis to COVID-19. The Northwest of Italy experienced almost double of COVID-19-positive participants (p < 0.05). Preoperatory mouthwashes together with natural air change/ventilation were the most frequent approaches used to prevent COVID-19 outbreak. Positive and proactive attitudes were predominant among participants. Only a reduced proportion feels some concerns for the future. CONCLUSIONS: Prevalence of positive COVID-19 among dental workers in Italy was double in Northwest area in comparison with the whole country proportion. Preventive strategies comprise mainly ultrasound reduction and preoperative mouthwashes.

The staging and grading system in defining periodontitis cases: consistency and accuracy amongst periodontal experts, general dentists and undergraduate students.

AIM: The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system. METHODS: Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold-standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy. RESULTS: Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pairwise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy. CONCLUSIONS: Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.

Intrabony defects, open-flap debridement, and decortication: a randomized clinical trial.

BACKGROUND: Intramarrow penetration (IMP) is often incorporated in regenerative periodontal surgical procedures. However, the actual benefits of adding IMP to such a procedure remain undocumented. The purpose of this randomized controlled trial was to investigate the contribution of IMP to the outcomes of open-flap debridement (OFD) treatment of intrabony defects. METHODS: Forty-two chronic periodontitis patients, each contributing a 2-wall, 3-wall, or combined 2- to 3-wall intrabony defect, were treated. Sites were randomly assigned into one of two groups: control (OFD alone) or test (OFD + IMP). Papilla preservation flaps were raised, and defects were thoroughly debrided. In the control group, complete primary closure of flaps was ensured after debridement. In the test group, IMP was performed before flap closure, using a round bur to penetrate the cortical defect wall. Clinical and radiographic parameters were assessed at baseline and 12 months after treatment. RESULTS: At baseline, there were no statistically significant differences between groups. At 12 months, both groups experienced significant improvements, in terms of probing depth reduction, clinical attachment level (CAL) gain, and bone level (clinical and radiographic). The test group experienced significantly greater clinical bone gain (3.07 ± 1.74 mm) and prevalence of CAL gain ≥2 mm (93% of sites) compared with the control group (1.76 ± 2.71 mm, P <0.03; 62%, P = 0.024). The test treatment benefits were particularly evident in mandibular sites, in which OFD + IMP doubled the radiographic bone gain obtained by OFD alone. CONCLUSION: Addition of IMP to an OFD procedure used to treat intrabony defects results in statistically and clinically significant enhancement of both clinical and radiographic outcomes.

Surgical treatment options for grafting areas of gingival recession association with cervical lesions: a review.

STATEMENT OF THE PROBLEM: Gingival recession (GR) is a highly prevalent dental problem that may be associated with dentin hypersensitivity and aesthetic complaint. Furthermore, GR is often complicated by dental cervical wear of substance, such as erosion, abrasion, or abfraction lesions, as well as initial or more extensive carious involvement of the cervical area, which worsen the symptoms and make the treatment of this periodontal condition more challenging. THE PURPOSE OF THE STUDY: To provide an overview of surgical treatment options presented in the literature for sites affected by GR with carious cervical lesions (CCLs) or non-carious cervical lesions (NCCLs). METHODS: The Medline database was searched for items dealing with GR and its treatment options, especially on GR associated with CCLs or NCCLs. RESULTS: Several periodontal surgical techniques have shown good potential for treating GR over the years. Specifically, considering GR associated with CCL or NCCL, an assessment of both hard (dental) and soft (gingival) tissue characteristics of the involved site is recommended in selecting the surgical procedure. CONCLUSIONS: For GR associated with CCL or NCCL, hard and soft tissue characteristics of the involved site have to be carefully evaluated in order to choose the most appropriate surgical procedure. CLINICAL SIGNIFICANCE: A structured decision-making process, considering both hard and soft tissue characteristics of the involved site, is recommended in choosing the most appropriate surgical procedures to treat GR associated with CCL or NCCL defects. The restitutio ad integrum of the dento-periodontal unit is an essential condition to restore the tooth to its original function and esthetics.

Efficacy of AZM therapy in patients with gingival overgrowth induced by Cyclosporine A: a systematic review.

BACKGROUND: In daily clinical practice of a dental department it's common to find gingival overgrowth (GO) in periodontal patients under treatment with Cyclosporine A (CsA). The pathogenesis of GO and the mechanism of action of Azithromycin (AZM) are unclear. A systematic review was conducted in order to evaluate the efficacy of Azithromycin in patients with gingival overgrowth induced by assumption of Cyclosporine A. METHODS: A bibliographic search was performed using the online databases MEDLINE, EMBASE and Cochrane Central of Register Controlled Trials (CENTRAL) in the time period between 1966 and September 2008. RESULTS: The literature search retrieved 24 articles; only 5 were Randomised Controlled Trials (RCTs), published in English, fulfilled the inclusion criteria. A great heterogeneity between proposed treatments and outcomes was found, and this did not allow to conduct a quantitative meta-analysis. The systematic review revealed that a 5-day course of Azithromycin with Scaling and Root Planing reduces the degree of gingival overgrowth, while a 7-day course of metronidazole is only effective on concomitant bacterial over-infection. CONCLUSION: Few RCTs on the efficacy of systemic antibiotic therapy in case of GO were found in the literature review. A systemic antibiotic therapy without plaque and calculus removal is not able to reduce gingival overgrowth. The great heterogeneity of diagnostic data and outcomes is due to the lack of precise diagnostic methods and protocols about GO. Future studies need to improve both diagnostic methods and tools and adequate classification aimed to determine a correct prognosis and an appropriate therapy for gingival overgrowth.

Treatment of intrabony defects using guided tissue regeneration or enamel matrix derivative: a 3-year prospective randomized clinical study.

BACKGROUND: The aim of this randomized, controlled, prospective clinical study was to compare guided tissue regeneration (GTR) to enamel matrix derivative (EMD) for the treatment of intrabony defects in patients with chronic advanced periodontitis. METHODS: Forty (39 evaluable) 3-wall intrabony defects, each with a depth > or = 4 mm measured from the crest of the bony defect, were treated in 40 subjects with advanced chronic periodontitis. Regeneration of angular bone defects was induced using non-resorbable membranes (GTR group; n = 20) or EMD (EMD group; evaluable n = 19). Clinical parameters, including probing depth (PD), clinical attachment level (CAL), gingival recession, radiographic measurement of the defect depth, plaque index, and bleeding on probing, were measured at baseline and at 12 and 36 months following surgery. RESULTS: Twelve months after surgery, sites treated with GTR demonstrated a mean CAL gain of 2.5 +/- 1.2 mm and a mean reduction in PD of 3.5 +/- 1.2 mm compared to baseline. The corresponding outcomes at 36 months were 2.0 +/- 1.1 mm (CAL) and 3.2 +/- 1.1 mm (PD). Sites treated with EMD demonstrated a mean CAL gain of 2.9 +/- 1.4 mm and a mean reduction in PD of 3.5 +/- 1.4 mm at 12 months, with a mean CAL gain of 2.4 +/- 1.2 mm and a mean PD reduction of 3.1 +/- 1.4 mm at 36 months. The differences in PD reduction and CAL gain were statistically significant between the groups and for each time point compared to baseline. Attachment loss was seen in both groups between the 12- and 36-month observations. Measured radiographic bone fill was 57.0% +/- 21% at 12 months and 53.7% +/- 14.3% at 36 months in the GTR group compared to 50.5% +/- 19% at 12 months and 58.8% +/- 14.9% at 36 months in the EMD group. CONCLUSIONS: The treatment of intrabony defects in patients with chronic advanced periodontitis using GTR or EMD led to significantly improved clinical parameters. Tests of statistical significance demonstrated better results with EMD, although the absolute differences between treatment modalities was small. Further studies with a larger number of treated defects are necessary to verify these findings.