Mechano-bactericidal anisotropic particles for oral biofilm treatment.

Bacterial biofilms play a major etiological role in dental diseases worldwide. Currently, toothpastes with bactericidal chemicals and abrasive materials are used as preventive care methods. However, chemicals can cause adverse side effects, with the use of antibiotics, fluorides, and antiseptics drastically reducing quality of life. At the same time, the rational design of bulk toothpaste materials has remained unexplored. In this work, we demonstrated a mechano-bactericidal strategy as an antibiotic-free and tooth-safe approach for dental biofilm elimination based on shape-anisotropy CaCO3 (cubic-, stick-, and urchin-shaped). As proof-of-concept, we demonstrated superior efficiency during biofilm eradication from ex vivo teeth using urchin- and stick-shaped microparticles involving both Escherichia coli K12 (227 ± 32.6% and 215 ± 33%, respectively) and Staphylococcus aureus ATCC 209P (210 ± 54.7% and 202 ± 55.5%, respectively) compared to the spherical particles that are employed in conventional toothpastes. These findings will potentially give rise to the development of novel and safer toothpastes with antibiotic-free bactericidal activity for the prevention of dental diseases.

Intraoral management of odontogenic infection associated with severe trismus under local anesthesia.

Trismus is defined as a tonic contraction of the muscles of mastication. It can also refer to limited mouth opening of any cause. Trismus is a classical symptom of masticatory space infections and it can be a sign of an infection in the anterior compartment of lateral pharyngeal space. Common causes in clinical practice followed by trismus are odontogenic infection which can be periodontal or pericoronal. This article will present a clinical report on intraoral management of mandibular odontogenic infection accompanied by severe trismus under local anesthesia using modified Akinosi technique in an outpatient environment. Treatment and postoperative period were routine. This kind of approach provides access to the infection at an early stage without general anesthesia, it shortens the hospital treatment and it enables faster recovery. KEY WORDS: Local Anesthesia, Odontogenic infection, Trismus.

Photodynamic therapy procedures in coronavirus (COVID-19) outbreak: perception of health risks among clinical dental faculty and dental students.

OBJECTIVE: The aim of the study was to investigate clinical faculty members and final year dentistry students' perceptions regarding their health concerns and risks of performing photodynamic therapy (PDT) procedure in dental clinics amidst the COVID-19 pandemic. SUBJECTS AND METHODS: A 21-item questionnaire comprising open and closed questions was sent to dental faculty members (n=43) and final year dentistry students (n=99) of Riyadh Elm University during mid-January 2021 that ended only after two weeks. The survey included health risks perception of performing PDT procedures, the impact of the COVID-19 outbreak on PDT performance and stress levels, perceived efficacy of the preventive steps, perception of the effect of the probable suspension of PDT procedure in dental clinics, and influence of alternative teaching methods of PDT procedure on clinical competence were reported. RESULTS: A response rate of 82% for faculty members (n=35) and 75% for students (n=74) was recorded. 91% of faculty members and 95% of students felt that their health was not at risk during performing PDT procedure in dental clinics amidst the COVID-19. 82% of faculty and 83% of students expressed that the PPE and universal preventive steps to perform PDT procedure were enough for preventing the cross-infection with the virus. 89% of faculty members and 91% of students thought that a provisional suspension of PDT procedures in dental clinics would assist in containment of the virus and reduce the infection risk from the contact and not the PDT procedure. CONCLUSIONS: Students and faculty members reported that their health is not at risk while performing PDT procedure in dental clinics amidst the COVID-19 outbreak.

Current herbal medicine as an alternative treatment in dentistry: In vitro, in vivo and clinical studies.

Since the time that human population comprehended the importance of general health maintenance and the burden of disease, there has been a search for healing properties in the natural environment. Herbal medicine is the use of plants with medical properties for prevention and treatment of conditions that can affect general health. Recently, a growing interest has been observed toward the use of traditional herbal medicine alongside synthetic modern drugs. Around 80% of the population, especially in developing countries relies on it for healthcare. Oral healthcare is considered a major part of general health. According to the world health organization (WHO), oral health is considered an important part of general health and quality of life. The utilization of natural medications for the management of pathologic oro-dental conditions can be a logical alternative to pharmaceutical methods due to their availability, low costs, and lower side effects. The current literature review aimed at exploration of the variety and extent of herbal products application in oral health maintenance including different fields of oral healthcare such as dental caries, periodontal maintenance, microbial infections, oral cancers, and inflammatory conditions.

Infección odontogénica y tratamiento antimicrobiano en pacientes pediátricos hospitalizados / Odontogenic infection and antimicrobial treatment in hospitalized pediatric patients

Introducción: las infecciones odontogénicas constituyen uno de los problemas más difíciles de tratamiento en odontología, debido a índices de caries y enfermedad periodontal elevados en la población. Objetivo: caracterizar el comportamiento de las infecciones de origen odontogénico en pacientes pediátricos. Método: estudio observacional, descriptivo, longitudinal y retrospectivo en pacientes que acudieron al Cuerpo de Guardia del Hospital Pediátrico Provincial Docente "Pepe Portilla" de Pinar del Río en el período septiembre de 2018 a febrero de 2019. El universo estuvo constituido por 75 pacientes, seleccionándose 27 mediante muestreo aleatorio simple. Resultados: predominó el sexo masculino (74 %) y el grupo de edades de 9 a 15 años (44,4 %). La localización mandibular fue la región anatómica más afectada (63 %), los dientes responsables del mayor número de casos con celulitis odontogénica fueron los primeros molares inferiores (29,6 %). La penicilina fue el antimicrobiano más empleado (33,3 %). Conclusiones: los pacientes masculinos entre 9 y 15 años son propensos a desarrollar infecciones odontológicas, principalmente en la región mandibular, causada por los primeros molares inferiores. El uso de la penicilina fue común, mostrando buena evolución del paciente

Introduction: odontogenic infections are one of the most difficult problems to treat in dentistry, due to the high rates of caries and periodontal disease in the population. Objective: to characterize the behavior of odontogenic infections in pediatric patients. Method: observational, descriptive, longitudinal and retrospective study in patients who came to the dental emergency room at "Pepe Portilla" Pediatric Teaching Hospital in Pinar del Río during the period September 2018 to February 2019. The universe consisted of 75 patients, 27 of them were selected by simple sampling random. Results: male sex (74 %) and 9 to 15 age group (44,4 %) prevailed. The most affected anatomical region (63 %) was the mandibular ramus, the teeth responsible for the highest number of cases with odontogenic cellulitis were the first lower molars (29.6 %). Penicillin was the antimicrobial most used (33.3 %). Conclusions: male patients between the ages of 9 and 15 have a tendency to develop dental infections, mainly in the jaw region, caused by the first lower molars. The use of penicillin was common to treat it, showing a positive effect on the patient's evolution

A Review on Impact of Medicinal Plants on the Treatment of Oral and Dental Diseases.

Plants play a vital role in the general wellbeing of an individual. Globally plants are habitually used by the people for the treatment and prevention of various ailments. There is an increased attempt made from ancient days to prevent the disease occurrence rather than to treat it. Through the development of modern scientific procedures, it is now identified that the usage of plants in different forms promotes the health of the patient. Oral and dental hygiene is the primary factor of a human being to lead a healthy life. Poor diet, nutrition and improper hygienic practices lead to teeth and gum diseases, dental cavities and plaque etc., Use of herbal extracts and their products in day-to-day life is a promising and interesting alternative to synthetic compounds to control oral diseases. The present review summarizes the usage of medicinal plants in the treatment and prevention of oral and dental diseases in different aspects.

A case report of generalized tetanus in a 42-year-old man with dental infection.

Background In the post-vaccination era, as it is today, generalized tetanus is a rare diagnosis, although mortality and morbidity continue to increase significantly throughout the world. Infection occurs when the Clostridium tetani spores are introduced into wounds, skin lesions and infections. The symptoms often begin with stiffness or spasms in the jaw muscles; they are called trismus or "lockjaw" and/or then spread to the neck and abdominal muscles. Case presentation This is a report of a 42-year-old man who was referred to the hospital with dysphagia, rigidity and trismus. He was diagnosed with generalized tetanus with a Philips score of 15. The patient was admitted to the isolation unit, received treatment that included procaine penicillin, metronidazole, diazepam, human tetanus immunoglobulin (TIG) and anti-tetanus serum (ATS). Treatment was considered according to the guidelines of the World Health Organization, and also, the drug dose has no adverse event reaction during the treatment. Conclusion The therapeutic response is related to the identification and appropriate treatment, especially in hospitalized patients with inadequate immunization so that patients recover soon.

Antimicrobial activity of intracanal medications against both Enterococcus faecalis and Candida albicans biofilm.

Enterococcus faecalis and Candida albicans have been associated with cases of secondary and persistent root canal infections, been resistant to calcium hydroxide. So, the evaluation of the susceptibility of these microorganisms biofilms to new drugs is an important practice for establishing the best drug and consequently success of treatment. For this, in vitro biofilm formation of E. faecalis and C. albicans was induced separately on blocks obtained from bovine teeth. After the period of specimen incubation for biofilm maturation, the samples were immersed in the pastes: 1 - calcium hydroxide (CH), 2 - chlorhexidine (C), 3 - ciprofloxacin (CP), 4 - metronidazole (MT), 5 - ketoconazole (KE), 6 - double antibiotic (DB), 7 - triple antibiotic (TA), 8 - ciprofloxacin + ketoconazole (CPKE); 9 - ciprofloxacin + metronidazole + ketoconazole (CPMTKE), 10 - metronidazole + ketoconazole (MTKE), and 11 - control (CO) for 7 days. Next, the specimens were live/dead stained for analysis by confocal microscopy. By means of the Bioimage program, the biovolume and percentage of live cells were measured. The data were statistically compared (p = .05). For the C. albicans biofilm, the best antimicrobial action was found for MTKE, CPKE, and MT groups. Whereas for E. faecalis biofilm, the lowest percentage of live bacteria was found in TA, DB, and CP groups; however, KE, CPKE, CPMTKE, and MTKE groups shown to be effective. The authors concluded calcium hydroxide paste and chlorhexidine was not effective for both biofilms. The MTKE and CPKE pastes presented effectiveness for both biofilms. TA and DB pastes were effective just in the E. faecalis biofilms.

Dentine tubule disinfection by different irrigation protocols.

The purpose of this study was to test the antimicrobial activity and the smear layer removal of different irrigation protocols-sodium hypochlorite (NaOCl), NaOCl followed by ethylenediaminetetraacetic acid (EDTA), and NaOCl combined with etidronic acid (HEBP)-against infected dentine tubules during root canal preparation. Single rooted premolars contaminated with Enterococcus faecalis were chemomechanically prepared. Depending on the irrigation protocols, the roots were divided into the following groups: (1) distilled water during and after instrumentation; (2) 2.5% NaOCl during and after instrumentation; (3) 2.5% NaOCl/9% HEBP during and after instrumentation; and (4) 2.5% NaOCl during instrumentation followed by 17% EDTA after instrumentation. The percentage of dead cells and the biovolume in infected dentine tubules were measured using confocal laser scanning microscopy and the live/dead technique. Smear layer removal on root canal wall surfaces was observed by means of scanning electron microscopy. Results were compared through parametric tests (p < .05). The groups NaOCl, NaOCl/HEBP, and NaOCl+EDTA exerted the highest antimicrobial activity (p > .05), followed by the group irrigated with water. All the irrigation protocols-including water-significantly reduced the bacteria biovolume. No dentine tubules free of smear layer were found in the positive control or the 2.5% NaOCl group. With NaOCl/HEBP and NaOCl+EDTA, respectively, 90.41% ± 7.33 and 76.54% ± 15.30 of dentine tubules were free of smear layer (p = .01). NaOCl/HEBP and NaOCl+EDTA exerted an important antimicrobial activity against bacteria inside dentine tubules, lowering the bacteria biovolume and eliminating a high amount of the smear layer, particularly in the NaOCl/HEBP group.

Antibiotic Prescriptions Associated With Dental-Related Emergency Department Visits.

STUDY OBJECTIVE: The frequency of antibiotic prescribing and types of antibiotics prescribed for dental conditions presenting to the emergency department (ED) is not well known. The objective of this study is to quantify how often and which dental diagnoses made in the ED resulted in an antibiotic prescription. METHODS: From 2011 to 2015, there were an estimated 2.2 million (95% confidence interval [CI] 1.9 to 2.5 million) ED visits per year for dental-related conditions, which accounted for 1.6% (95% CI 1.5% to 1.7%) of ED visits. This is based on an unweighted 2,125 observations from the National Hospital Ambulatory Medical Care Survey in which a dental-related diagnosis was made. RESULTS: An antibiotic, most often a narrow-spectrum penicillin or clindamycin, was prescribed in 65% (95% CI 61% to 68%) of ED visits with any dental diagnosis. The most common dental diagnoses for all ages were unspecified disorder of the teeth and supporting structures (44%; 95% CI 41% to 48%; International Classification of Diseases, Ninth Revision, Clinical Modification[ICD-9-CM] code 525.9), periapical abscess without sinus (21%; 95% CI 18% to 25%; ICD-9-CM code 522.5), and dental caries (18%; 95% CI 15% to 22%; ICD-9-CM code 521.0). Recommended treatments for these conditions are usually dental procedures rather than antibiotics. CONCLUSION: The common use of antibiotics for dental conditions in the ED may indicate the need for greater access to both preventive and urgent care from dentists and other related specialists as well as the need for clearer clinical guidance and provider education related to oral infections.

Nanomagnetic-mediated drug delivery for the treatment of dental disease.

Maintaining the vitality of the dental pulp, the highly innervated and highly vascular, innermost layer of the tooth, is a critical goal of any dental procedure. Upon injury, targeting the pulp with specific therapies is challenging because it is encased in hard tissues. This project describes a method that can effectively deliver therapeutic agents to the pulp. This method relies on the use of nanoparticles that can be actively steered using magnetic forces to the pulp, traveling through naturally occurring channels in the dentin (the middle layer of the tooth). This method can reduce the inflammation of injured pulp and improve the penetration of dental adhesives into dentin. Such a delivery method would be less expensive, and both less painful and less traumatic than existing therapeutic options available for treatment of injured dental pulp. This technique would be simple and could be readily translated to clinical use.

Melatonin: A Review of Its Potential Functions and Effects on Dental Diseases.

Melatonin is a hormone synthesised and secreted by the pineal gland and other organs. Its secretion, controlled by an endogenous circadian cycle, has been proven to exert immunological, anti-oxidant, and anti-inflammatory effects that can be beneficial in the treatment of certain dental diseases. This article is aimed at carrying out a review of the literature published about the use of melatonin in the dental field and summarising its potential effects. In this review article, an extensive search in different databases of scientific journals was performed with the objective of summarising all of the information published on melatonin use in dental diseases, focussing on periodontal diseases and dental implantology. Melatonin released in a natural way into the saliva, or added as an external treatment, may have important implications for dental disorders, such as periodontal disease, as well as in the osseointegration of dental implants, due to its anti-inflammatory and osseoconductive effects. Melatonin has demonstrated to have beneficial effects on dental pathologies, although further research is needed to understand the exact mechanisms of this molecule.

Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications.

BACKGROUND: The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center. METHODS: All adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care. RESULTS: Of 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization. CONCLUSIONS: ADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged.

A survey of awareness related to the use of antibiotics for dental issues among non-medical female university students in Riyadh, Saudi Arabia.

Inappropriate use of antibiotics may lead to adverse side effects. This cross-sectional survey aimed to investigate the knowledge and attitude of female non-medical students regarding the medical and dental use of antibiotics. Four hundred validated self-administered questionnaires were distributed in Princess Norah Bint-Abdurrahman University, Riyadh, Saudi Arabia. The questionnaire included questions about accessibility, attitude toward usage, efficacy, side effects, resistance, and usage for dental issues. Knowledge was estimated for every respondent by counting the correct answers, which were considered as points. The scores were categorized as poor, moderate, and high. Of the respondents, 77.8% answered they get antibiotics according to a doctor's prescription; however, 31% stops taking antibiotics when they feel well. Only 38.8% of respondents knew that antibiotics may cause allergic reactions while 59.8% believed the human body can be resistant to antibiotics. The percentages of answers related to dental issues were: antibiotics relieve dental pain (68.8%), antibiotics can be harmful for children's teeth (27.3%), antibiotics are best avoided in pregnancy (56.7%) and no need for antibiotics after scaling (33.8%), root canal treatment (16%), or simple extraction (40.3%). Of respondents, 68% had poor scores about antibiotics efficacy, side effects, and resistance while 86.8% had poor scores related to dental problems. This study noticed a bad attitude related to antibiotics usage, with many misconceptions and poor knowledge. Moreover, the necessity of antibiotics for treatment of dental disease or after dental procedures was totally unclear for the respondents. Community campaigns are recommended every university semester to educate students about the indications, efficacy, and side effects of antibiotics.

[Rational antibiotic therapy in the dental office: Practical guidelines for decision-making].

Although most dental and periodontal diseases are caused by bacteria, the usual therapy is mechanical/surgical rather than antimicrobial medications. However, sometimes antibiotic administration may be necessary in addition to or as an alternative to the surgical/mechanical treatment. Many studies have shown that the misuse of antibiotics by dentists may be mostly attributed to unnecessity or inefficient regimen, and could contribute to bacterial resistance to antibiotics. The article presents practical guidelines to the administration of antibiotics in the dental office.

Empiric systemic antibiotics for hospitalized patients with severe odontogenic infections.

INTRODUCTION: Odontogenic infections may lead to severe head and neck infections with potentially great health risk. Age, location of purulent affected sites and beta-lactam allergy are some mentionable factors regarding patients' in-hospital stay and course of disease. Are there new challenges regarding bacteria' antibiotic resistance for empiric treatment and what influences do they have on patients' clinical course? METHODS: We analyzed in a 4-year retrospective study the medical records of 294 in-hospital patients with severe odontogenic infections. On a routine base bacteria were identified and susceptibility testing was performed. Length of stay in-hospital was evaluated regarding patients' age, beta-lactam allergy profile, affected sites and bacteria susceptibility to empiric antibiotics. RESULTS: Length of stay in-hospital was detected to be associated with affected space and penicillin allergy as well (p < 0.05). Isolates presented large amounts of aerobic gram-positive bacteria (64.2%), followed by facultative anaerobic bacteria (gram+/15.8%, gram-/12.7%). Tested ampicillin in combination with sulbactam (or without) and cephalosporins displayed high susceptibility rates, revealing distinguished results regarding clindamycin (p < 0.05). Co-trimoxazol and moxifloxacin showed high overall susceptibility rates (MOX: 94.7%, COTRIM: 92.6%). DISCUSSION: This study demonstrates ampicillin/sulbactam in addition to surgical intervention is a good standard in treatment of severe odontogenic neck infections. Cephalosporins seem to be a considerable option as well. If beta-lactam allergy is diagnosed co-trimoxazol and moxifloxacin represent relevant alternatives. CONCLUSION: Age, allergic profile and bacteria' resistance patterns for empiric antibiotics have an influence on patients in-hospital stay. Ampicillin/sulbactam proves itself to be good for empiric antibiosis in severe odontogenic infections. Furthermore cephalosporins could be considered as another option in treatment. However moxifloxacin and co-trimoxazol deserves further investigation as empiric antibiosis in odontogenic infections if beta-lactam allergy is diagnosed.

[Clinical and preclinical application of PTH and BMP to dental treatment].

Bone formation is the important factor which contributes to the successful periodontal tissue regeneration in periodontitis and osseointegration of implant placement. To achieve the sufficient bone volume in the process of dental treatment, several growth factors and hormones which enhance bone formation have been evaluated in clinical and preclinical studies. BMP2 and BMP7 have recently been approved for sinus augmentation by FDA. A phase2a randomized controlled clinical studies were conducted to evaluate the potential of GDF5 to stimulate periodontal tissue regeneration and GDF5 significantly stimulated alveolar bone regeneration compared to control. Moreover, increased alveolar bone formation was observed by the use of PTH (1-34) Teriparatide in patients of severe periodontitis. PTH and GDF5 are promising agents for future periodontitis treatment.

General practitioners' attitudes towards the management of dental conditions and use of antibiotics in these consultations: a qualitative study.

OBJECTIVES: This study aimed to produce an account of the attitudes of general practitioners (GPs) towards the management of dental conditions in general practice, and sought to explore how GPs use antibiotics in the treatment of dental problems. DESIGN: Qualitative study employing semistructured telephone interviews and thematic analysis. PARTICIPANTS: 17 purposively sampled GPs working in Wales, of which 9 were male. The median number of years since graduation was 21. Maximum variation sampling techniques were used to ensure participants represented different Rural-Urban localities, worked in communities with varying levels of deprivation, and had differing lengths of practising career. RESULTS: Most GPs reported regularly managing dental problems, with more socioeconomically deprived patients being particularly prone to consult. Participants recognised that dental problems are not optimally managed in general practice, but had sympathy with patients experiencing dental pain who reported difficulty obtaining an emergency dental consultation. Many GPs considered antibiotics an acceptable first-line treatment for acute dental problems and reported that patients often attended expecting to receive antibiotics. GPs who reported that their usual practice was to prescribe antibiotics were more likely to prioritise patients' immediate needs, whereas clinicians who reported rarely prescribing often did so to encourage patients to consult a dental professional. CONCLUSIONS: The presentation of patients with dental problems presents challenges to GPs who report concerns about their ability to manage such conditions. Despite this, many reported frequently prescribing antibiotics for patients with dental conditions. This may contribute to both patient morbidity and the emergence of antimicrobial resistance. This research has identified the need for quantitative data on general practice consultations for dental problems and qualitative research exploring patient perspectives on reasons for consulting. The findings of these studies will inform the design of an intervention to support patients in accessing appropriate care when experiencing dental problems.