Investigating the effectiveness of commercially available mouthwash on SARS-CoV-2 in vivo using viable virus titre as the primary outcome. A randomised controlled trial.

This multi-arm, parallel group, single-blinded randomised controlled trial aimed to assess three commercially available mouthwashes effectiveness against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This manuscript has been written in accordance with the CONSORT statement. Methods. Eligible participants were SARS-CoV-2 positive with a positive test in the last 72 h. All participants had mild to moderate symptoms and could provide five saliva samples over a 60 min period. Participants delivered a baseline saliva sample and then used a mouthwash as per manufacturer's instructions. They provided further saliva samples at minute 1, 10, 30 and 60. Participants were randomised to one of four groups; OraWize+, Total Care Listerine, Cool Mint Listerine and water (control). The lab-based research team were blind to the intervention. The research question was: can SARS-CoV-2 be rendered inactive in saliva by using a mouthwash and how long does this effect last? The primary outcome was the amount of viable infectious SARS-CoV-2 virus in the sample, compared to the baseline sample. The secondary outcome measure was the amount of genetic material from the SARS-CoV-2 virus in the sample, measured via PCR testing. Results. In total 100 participants were recruited (25 per group). Eight participants did not receive the allocated intervention and did not have saliva samples collected. There were no adverse events. In total 42 of the 92 participants had viable virus which could be cultured at baseline. Statistical analysis of the primary outcome was not advised due to the reduced level of viable virus at baseline and the positive skewness present in the distribution of log10(titre) data. Observational data of the primary outcome measure is presented. Analysis of the secondary outcome PCR measure showed that there was strong evidence for a decrease in SARS-CoV-2 RNA levels compared to water for all mouthwashes after 1 min, OraWize+ -0.49 (-0.92, -0.05), p-value 0.029, Cool Mint Listerine -0.81 (-1.25, -0.38), p-value<0.001, Total Care Listerine -1.05 (-1.48, -0.62), p-value<0.001. For the remaining timepoints there was generally no evidence of virus level reduction compared to water although there is weak evidence for a decrease at ten minutes using Total Care Listerine -0.44 (-0.88, 0.01), p-value 0.053. Conclusion. The three mouthwashes included in this trial observationally demonstrated a reduction in virus titre level 1 min after use, with virus levels normalising up to 60 min compared to the control. Although an interesting observation, this result could not be statistically analysed. Using the secondary outcome PCR measure all three included mouthwashes reduced virus levels compared to water at 1 min and these results were statistically significant. Clinically this result does not support the use of the included mouthwashes to reduce SARS-CoV-2 levels in saliva.

Efficacy of irrigant activation techniques in removing intracanal smear layer and debris from mature permanent teeth: a systematic review and meta-analysis.

AIMS: To establish whether irrigant activation techniques (IATs) result in greater intracanal smear layer and debris removal than conventional needle irrigation (CNI). METHODOLOGY: Six electronic databases were searched to identify scanning electron microscopy studies evaluating smear layer and/or debris removal following the use of manual dynamic activation (MDA), passive ultrasonic irrigation (PUI), sonic irrigation (SI) or apical negative pressure (ANP) IATs in mature permanent teeth. Meta-analyses were performed for each canal segment (coronal, middle, apical and apical 1 mm) in addition to subgroup analyses for individual IATs with respect to CNI. Outcomes were presented as standardized mean differences (SMD) alongside 95% confidence intervals (95% CI) and chi-squared analysis. RESULTS: From 252 citations, 16 studies were identified. The meta-analyses demonstrated significant improvements in coronal (SMD: 1.15, 95% CI: 0.72-1.57 / SMD: 0.54, 95% CI: 0.29-0.80), middle (SMD: 1.30, 95% CI: 0.59-2.53 / SMD: 0.8, 95% CI: 0.58-1.13) and apical thirds (SMD: 1.22, 95% CI: 0.83-1.62 / SMD: 1.86, 95% CI: 0.76-2.96) for smear layer and debris removal, respectively. In the apical 1 mm IATs improved cleanliness; however, differences were insignificant (SMD: 1.15, 95% CI: -0.47-2.77). Chi-squared analysis revealed heterogeneity scores of 79.3-92.8% and 0.0-93.5% for smear layer and debris removal, respectively. CONCLUSIONS: IATs improve intracanal cleanliness across a substantial portion of the canal, and therefore, their use is recommended throughout root canal preparation. However, current data is too heterogeneous to compare and identify superiority of an individual technique highlighting the need to standardize experimental protocols and develop a more representative research model to investigate the in vivo impact of IATs on clinical outcomes and periapical healing following root canal treatment.

The management of traumatic tooth loss with dental implants: part 2. Severe trauma.

In part 2 of this series, we look at the clinician's role in replacing multiple missing teeth and the associated soft tissues and bone, following severe forms of trauma. These patients usually wish to have fixed prostheses to help restore their appearance and function. In order to fulfil the patient's request, the multidisciplinary team can be faced with significant challenges, often requiring extensive reconstructive surgery and complex implant oral rehabilitation. The aim of this paper is to highlight to the general dental practitioner some of the challenges faced in rehabilitating severe trauma patients with implant retained prosthesis. By understanding the challenges it is hoped that the general dental practitioner will be able to make an assessment of the clinical situation and seek appropriate specialist advice to ensure optimal results for their patients. In the longer term, the management of these patients requires a shared care approach between the general dental practitioner and relevant specialists.

Connecting the dots: grounding quality improvement and cost cutting initiatives in strategic planning.

Discuss cost management and performance improvement with any manager at an acute care hospital and you will hear several consistent themes: Quality improvement (QI) has not produced the anticipated results on a timely basis; Focused cost reduction efforts have at best provided short-term benefits; and The organization needs to be more nimble, more responsive to the marketplace. If your hospital is wrestling with these issues, take some comfort in knowing that you are not alone. In general, the same problems are being experienced by long-term care facilities, group practices, practice plans, and most other provider organizations. However, all is not doom and gloom. A common-sense, easy-to-understand solution to the cost control problem can be implemented if an organization is disciplined and can exercise patience and diligence in implementation. Business Process Redesign (BPR), a performance improvement strategy and tactic that has been successfully deployed throughout private industry, can solve the problem. If undertaken correctly, BPR links the best concepts and principles of quality improvement, operations analysis, and focused cost reduction with an organization's strategic planning efforts. BPR results in the establishment of cost management initiatives that are consistent with the organization's long term goals. This article takes a closer look at the merits of BPR in a changing healthcare environment.

The joint operating company: an innovative approach to collaboration.

Hospitals interested in horizontal integration often run into difficulties. In spite of otherwise sound business logic for two organizations to merge, there may be political, legal or financial reasons why a merger option cannot be pursued. Increasingly, enterprises are turning to a joint operating company structure as the solution to their needs. Scott A. Mason and Donald W. Seymour, partners with consulting firm National Health Advisors, explore situations where a JOC model of collaboration may be appropriate.