Physical activity as a proxy to ameliorate inflammation in patients with type 2 diabetes and periodontal disease at high cardiovascular risk.

While the beneficial impact of physical activity has been ascertained in a variety of pathological scenarios, including diabetes and low-grade systemic inflammation, its potential remains still putative for periodontal health. Periodontal disease has been associated with inflammatory systemic alterations, which share a common denominator with type 2 diabetes mellitus and cardiovascular disease. Physical exercise, along with nutritional counseling, is a cornerstone in the treatment and prevention of type 2 diabetes, also able to reduce the prevalence of periodontal disease and cardiovascular risk. In addition, considering the higher incidence of periodontitis in patients with type 2 diabetes compared to healthy controls, the fascinating research question would be whether physical activity could relieve the inflammatory pressure exerted by the combination of these two diseases. This multi-disciplinary viewpoint discusses available literature in order to argument the hypothesis of a "three-way relationship" linking diabetes, periodontitis, and physical activity.

Antibiotics to prevent complications following tooth extractions.

BACKGROUND: The most frequent indications for tooth extractions, generally performed by general dental practitioners, are dental caries and periodontal infections. Systemic antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection. This is an update of a review first published in 2012. OBJECTIVES: To determine the effect of systemic antibiotic prophylaxis on the prevention of infectious complications following tooth extractions. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 16 April 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 3), MEDLINE Ovid (1946 to 16 April 2020), Embase Ovid (1980 to 16 April 2020), and LILACS (1982 to 16 April 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised, double-blind, placebo-controlled trials of systemic antibiotic prophylaxis in patients undergoing tooth extraction(s) for any indication. DATA COLLECTION AND ANALYSIS: At least two review authors independently performed data extraction and 'Risk of bias' assessment for the included studies. We contacted trial authors for further details where these were unclear. For dichotomous outcomes, we calculated risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. For continuous outcomes, we used mean differences (MD) with 95% CI using random-effects models. We examined potential sources of heterogeneity. We assessed the certainty of the body of evidence for key outcomes as high, moderate, low, or very low, using the GRADE approach. MAIN RESULTS: We included 23 trials that randomised approximately 3206 participants (2583 analysed) to prophylactic antibiotics or placebo. Although general dentists perform dental extractions because of severe dental caries or periodontal infection, only one of the trials evaluated the role of antibiotic prophylaxis in groups of patients affected by those clinical conditions. We assessed 16 trials as being at high risk of bias, three at low risk, and four as unclear.  Compared to placebo, antibiotics may reduce the risk of postsurgical infectious complications in patients undergoing third molar extractions by approximately 66% (RR 0.34, 95% CI 0.19 to 0.64; 1728 participants; 12 studies; low-certainty evidence), which means that 19 people (95% CI 15 to 34) need to be treated with antibiotics to prevent one infection following extraction of impacted wisdom teeth. Antibiotics may also reduce the risk of dry socket by 34% (RR 0.66, 95% CI 0.45 to 0.97; 1882 participants; 13 studies; low-certainty evidence), which means that 46 people (95% CI 29 to 62) need to take antibiotics to prevent one case of dry socket following extraction of impacted wisdom teeth. The evidence for our other outcomes is uncertain: pain, whether measured dichotomously as presence or absence (RR 0.59, 95% CI 0.31 to 1.12; 675 participants; 3 studies) or continuously using a visual analogue scale (0-to-10-centimetre scale, where 0 is no pain) (MD -0.26, 95% CI -0.59 to 0.07; 422 participants; 4 studies); fever (RR 0.66, 95% CI 0.24 to 1.79; 475 participants; 4 studies); and adverse effects, which were mild and transient (RR 1.46, 95% CI 0.81 to 2.64; 1277 participants; 8 studies) (very low-certainty evidence).  We found no clear evidence that the timing of antibiotic administration (preoperative, postoperative, or both) was important. The included studies enrolled a subset of patients undergoing dental extractions, that is healthy people who had surgical extraction of third molars. Consequently, the results of this review may not be generalisable to all people undergoing tooth extractions. AUTHORS' CONCLUSIONS: The vast majority (21 out of 23) of the trials included in this review included only healthy patients undergoing extraction of impacted third molars, often performed by oral surgeons. None of the studies evaluated tooth extraction in immunocompromised patients. We found low-certainty evidence that prophylactic antibiotics may reduce the risk of infection and dry socket following third molar extraction when compared to placebo, and very low-certainty evidence of no increase in the risk of adverse effects. On average, treating 19 healthy patients with prophylactic antibiotics may stop one person from getting an infection. It is unclear whether the evidence in this review is generalisable to patients with concomitant illnesses or patients at a higher risk of infection. Due to the increasing prevalence of bacteria that are resistant to antibiotic treatment, clinicians should evaluate if and when to prescribe prophylactic antibiotic therapy before a dental extraction for each patient on the basis of the patient's clinical conditions (healthy or affected by systemic pathology) and level of risk from infective complications. Immunocompromised patients, in particular, need an individualised approach in consultation with their treating medical specialist.

Topological optimization of implant-prosthetic structures.

AIM: The aim of the present study was to verify the possibility of obtaining an optimized prosthetic substructure using generic software, respecting the distribution loads and forces involved. What is considered to be original and innovative in this study is the possibility of designing the prosthetic substructure on the basis of the individual patient's chewing biomechanics, with the purpose of obtaining an even greater efficiency than a prosthesis designed according to a traditional method. MATERIALS AND METHODS: The starting standard triangulation language (STL) file was processed with Rhinoceros software and the tOpos plugin. It was decided to submit the entire prosthetic solution, intended as total volume, to structural analysis and topological optimization because the entire prosthesis is subjected to load during the chewing act. The software program was provided with information on the material, modulus, and direction of the applied forces. The objective was to optimize stiffness by maximizing volume. RESULTS: The volume of the final structure was 2% compared with the starting model and was a completely different design compared with the traditional model. This new design was characterized by trabeculations that reflect the normal bone architecture. The material was distributed on the basis of the load points as well as the direction and modulus of the applied force. CONCLUSIONS: After assessing the applicability of the proposed workflow and the results obtained thus far, the most important clinical implication is represented by the greater efficiency and the same resistance of the prosthesis obtained with topological optimization compared with that obtained with the traditional method.

Effect of Red Wine Intake on Serum and Salivary Melatonin Levels: A Randomized, Placebo-Controlled Clinical Trial.

Melatonin (MLT) is a recently discovered phytochemical in wine, but its influence on physiological MLT levels is still unknown. This study aimed at evaluating variations, in serum and saliva, of MLT concentrations after the intake of MLT-enriched red wine. Twelve healthy volunteers were recruited to receive 125 mL of red wine naturally lacking of MLT (placebo, PLC), or the same wine enriched with MLT (MLT+). A physiological steady decline of serum MLT was observed from baseline up to 90 min, for both wines. After PLC intake, the decrease was significantly faster than the one occurring after MLT+ wine, which thus delayed the drop down of serum MLT with a plateau at 30⁻60 min. Salivary MLT levels slightly peaked at 45 min after MLT+ wine intake, without statistical significance. Therefore, the intake of a glass of MLT-enriched red wine changed serum levels of the indoleamine, supporting the role of wine MLT in counteracting the physiological decline of the hormone into the bloodstream.

Efficacy of an anti-discoloration system (ADS) in a 0.12% chlorhexidine mouthwash: A triple blind, randomized clinical trial.

PURPOSE: To determine the efficacy of an anti-discoloration system (ADS) in a 0.12% chlorhexidine (CHX) mouthwash to reduce dental discoloration. METHODS: A triple-blind, cross-over, randomized clinical trial was carried out in 22 healthy volunteers asked to perform oral rinses, twice a day for 21 days, using 0.12% CHX mouthwashes containing or not ADS (wash-out= 21 days). Dental discolorations were compared via spectroscopy (ΔE), and direct visual examination performed by the dentist and volunteers themselves. At 6 months, a further visual analysis on clinical images was carried out by the same volunteers and ad hoc recruited dental practitioners. RESULTS: A slight discoloration was the most frequent finding, independent of the presence of ADS, while the few severe cases of staining were associated with CHX alone. (ΔE values comparing dental color before and after treatments were similar for CHX (8.4±0.1) and CHX+ADS (8.6±0.9) rinses. Direct visual analysis showed no staining difference between the two mouthwashes. Six months later, volunteers' self-evaluation of clinical pictures again did not detect any significant difference between treatments, while dental practitioners identified CHX+ADS as less discoloring (< 0.05). Slight dental discoloration represents the most common side-effect of 0.12% CHX mouthwash, independent of the presence of ADS. Severe cases are possible, but very rare and mainly associated with CHX alone. CLINICAL SIGNIFICANCE: There was no evidence to support the 0.12% chlorhexidine with anti-discoloration agent to reduce staining.

Interventions for treating oral leukoplakia to prevent oral cancer.

BACKGROUND: Oral leukoplakia is a relatively common oral lesion that, in a small proportion of people, precedes the development of oral cancer. Most leukoplakias are asymptomatic; therefore, the primary objective of treatment should be to prevent onset of cancer. This review updates our previous review, published in 2006. OBJECTIVES: To assess the effectiveness, safety and acceptability of treatments for leukoplakia in preventing oral cancer. SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 16 May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 4), MEDLINE Ovid (1946 to 16 May 2016), Embase Ovid (1980 to 16 May 2016) and CancerLit via PubMed (1950 to 16 May 2016). We searched the metaRegister of Controlled Trials (to 10 February 2015), ClinicalTrials.gov (to 16 May 2016) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials (to 16 May 2016). We placed no restrictions on the language or date of publication when searching electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that enrolled people with a diagnosis of oral leukoplakia and compared any treatment versus placebo or no treatment. DATA COLLECTION AND ANALYSIS: We collected data using a data extraction form. Oral cancer development, demonstrated by histopathological examination, was our primary outcome. Secondary outcomes were clinical resolution of the lesion, improvement of histological features and adverse events. We contacted trial authors for further details when information was unclear. When valid and relevant data were available, we conducted a meta-analysis of the data using a fixed-effect model when we identified fewer than four studies with no heterogeneity. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). We assessed risk of bias in studies by using the Cochrane tool. We assessed the overall quality of the evidence by using standardised criteria (Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE)). MAIN RESULTS: We included 14 studies (909 participants) in this review. Surgical interventions, including laser therapy and cryotherapy, have never been studied by means of an RCT that included a no treatment or placebo arm. The included trials tested a range of medical and complementary treatments, in particular, vitamin A and retinoids (four studies); beta carotene or carotenoids (three studies); non-steroidal anti-inflammatory drugs (NSAIDs), specifically ketorolac and celecoxib (two studies); herbal extracts (four studies), including tea components, a Chinese herbal mixture and freeze-dried black raspberry gel; bleomycin (one study); and Bowman-Birk inhibitor (one study).We judged one study to be at low risk of bias, seven at unclear risk and six at high risk. In general, we judged the overall quality of the evidence to be low or very low, so findings are uncertain and further research is needed.Five studies recorded cancer incidence, only three of which provided useable data. None of the studies provided evidence that active treatment reduced the risk of oral cancer more than placebo: systemic vitamin A (RR 0.11, 95% CI 0.01 to 2.05; 85 participants, one study); systemic beta carotene (RR 0.71, 95% CI 0.24 to 2.09; 132 participants, two studies); and topical bleomycin (RR 3.00, 95% CI 0.32 to 27.83; 20 participants, one study). Follow-up ranged between two and seven years.Some individual studies suggested effectiveness of some proposed treatments, namely, systemic vitamin A, beta carotene and lycopene, for achieving clinical resolution of lesions more often than placebo. Similarly, single studies found that systemic retinoic acid and lycopene may provide some benefit in terms of improvement in histological features. Some studies also reported a high rate of relapse.Side effects of varying severity were often described; however, it seems likely that interventions were well accepted by participants because drop-out rates were similar between treatment and control groups. AUTHORS' CONCLUSIONS: Surgical treatment for oral leukoplakia has not been assessed in an RCT that included a no treatment or placebo comparison. Nor has cessation of risk factors such as smoking been assessed. The available evidence on medical and complementary interventions for treating people with leukoplakia is very limited. We do not currently have evidence of a treatment that is effective for preventing the development of oral cancer. Treatments such as vitamin A and beta carotene may be effective in healing oral lesions, but relapses and adverse effects are common. Larger trials of longer duration are required to properly evaluate the effects of leukoplakia treatments on the risk of developing oral cancer. High-quality research is particularly needed to assess surgical treatment and to assess the effects of risk factor cessation in people with leukoplakia.

Human Adipose-Derived Stem Cells on Rapid Prototyped Three-Dimensional Hydroxyapatite/Beta-Tricalcium Phosphate Scaffold.

In the study, we assess a rapid prototyped scaffold composed of 30/70 hydroxyapatite (HA) and beta-tricalcium-phosphate (ß-TCP) loaded with human adipose-derived stem cells (hASCs) to determine cell proliferation, differentiation toward osteogenic lineage, adhesion and penetration on/into the scaffold.In this in vitro study, hASCs isolated from fat tissue discarded after plastic surgery were expanded, characterized, and then loaded onto the scaffold. Cells were tested for: viability assay (Alamar Blue at days 3, 7 and Live/Dead at day 32), differentiation index (alkaline phosphatase activity at day 14), scaffold adhesion (standard error of the mean analysis at days 5 and 18), and penetration (ground sections at day 32).All the hASC populations displayed stemness markers and the ability to differentiate toward adipogenic and osteogenic lineages.Cellular vitality increased between 3 and 7 days, and no inhibitory effect by HA/ß-TCP was observed. Under osteogenic stimuli, scaffold increased alkaline phosphatase activity of +243% compared with undifferentiated samples. Human adipose-derived stem cells adhered on HA/ß-TCP surface through citoplasmatic extensions that occupied the macropores and built networks among them. Human adipose derived stem cells were observed in the core of HA/ß-TCP. The current combination of hASCs and HA/ß-TCP scaffold provided encouraging results. If authors' data will be confirmed in preclinical models, the present engineering approach could represent an interesting tool in treating large bone defects.

Fiber optics reflectance spectroscopy (45°x: 45°) for color analysis of dental composite.

PURPOSE: To evaluate the application of a fiber optic reflectance spectroscopy (FORS) prototype probe for 45°x: 45° FORS for determining color of dental materials. A portable spectrophotometer with a highly manageable fiber optics co-axial probe was used to apply 45°x: 45° FORS for color matching in restorative dentistry. METHODS: The color coordinates in CIELAB space of two dental shade guides and of the corresponding photopolymerized composites were collected and compared. The 45°x: 45° FORS with the co-axial probe (test system), the integrating sphere spectroscopy (reference system) and a commercial dental colorimeter (comparator system) were used to collect data and calculate color differences (ΔE and ΔE00). RESULTS: FORS system displayed high repeatability, reproducibility and accuracy. ΔE and ΔE00 values between the shade-guide, each other, and the corresponding composites resulted above the clinically acceptable limit. The 45°x: 45° FORS test system demonstrated suitable in vitro performance for dental composite color evaluation. CLINICAL SIGNIFICANCE: 45°x: 45° fiber optic reflectance spectroscopy allows reliable color analysis of small surfaces of dental composites, favoring the color matching of material with the closely surrounding dental tissue, and confirming significant color differences between shade guide tabs and photo-polymerized composites.

Accidental aspiration of foreign bodies in dental practice: clinical management and prevention.

OBJECTIVE: Foreign body aspiration is a possible complication of dental treatment that may result in a life-threatening situation. The foreign body is often spontaneously ejected from the airway, but in other cases, surgical intervention is needed. Prevention, diagnostic procedures, treatment and complications are discussed. MATERIALS AND METHODS: Three cases of aspiration of dental instruments are described: the piece was localised in the right main bronchus in two cases and in the left main bronchus in one case. RESULTS: All three cases underwent surgery (resection and bronchoscopy); in one case, the surgical attempt failed, and the foreign body was not located by radiography; it was assumed to have been expelled spontaneously. CONCLUSION: The management of dental materials and instruments requires particular care, especially if the patient is supine or semi-recumbent. The dentist must be able to manage emergency situations in which patients accidentally inspire or swallow dental instruments or materials during treatment. Preventive techniques must be put in place because these incidents are preventable if the correct precautions are taken.

HIV-Related Oral Mucosa Lesions: A Cross-Sectional Study on a Cohort of Italian Patients.

BACKGROUND: Human immunodeficiency virus (HIV) infection can be associated with oral mucosal diseases, including oral candidiasis and HPV infection, which are putative indicators of the immune status. AIM AND METHODS: This retrospective cross-sectional study was aimed at assessing the prevalence of HIV-related oral mucosal lesions in a cohort of Italian HIV+ patients regularly attending the Clinics of Infectious Diseases. RESULTS: One hundred seventy-seven (n = 177) patients were enrolled and 30 (16.9%) of them showed HIV-related diseases of the oral mucosa. They were mainly found in male patients over 35 years old, undergoing Combination Antiretroviral Therapy (cART), and with CD4+ count < 500/µL. Oral candidiasis was the most common HIV-related oral lesion. No significant correlations could be detected between the prevalence of HPV infection and other clinical parameters (lymphocyte count, cART treatment and viral load). CONCLUSIONS: HIV-related oral mucosal diseases can correlate with immunosuppression. Early diagnosis and management of oral lesions in HIV+ patients should be part of the regular follow-up, from a multidisciplinary perspective of collaboration between oral medicine and infectious disease specialists, in an attempt to reduce morbidity due to oral lesions and modulate antiretroviral therapy according to the patient's immune status.

Adipose-derived adult stem cells: available technologies for potential clinical regenerative applications in dentistry.

Tissue homeostasis depends closely on the activity and welfare of adult stem cells. These cells represent a promising tool for biomedical research since they can aid in treatment and promote the regeneration of damaged organs in many human disorders. Adult stem cells indefinitely preserve their ability to self-renew and differentiate into various phenotypes; this capacity could be promoted in vitro by particular culture conditions (differentiation media) or spontaneously induced in vivo by exploiting the biochemical and mechanical properties of the tissue in which the stem cells are implanted. Among the different sources of adult stem cells, adipose tissue is an attractive possibility thanks to its ready availability and the standard extraction techniques at our disposal today. This review discusses the isolation, characterization, and differentiation of human adipose-derived adult stem cells, as well as regeneration strategies, therapeutic uses, and adverse effects of their delivery. In particular, since oral disorders (e.g., trauma, erosion, and chronic periodontitis) often cause the loss of dental tissue along with functional, phonetic, and aesthetic impairment, this review focuses on the application of human adipose-derived adult stem cells, alone or in combination with biomaterials, in treating oral diseases.

Effect of air polishing with glycine powder on titanium abutment surfaces.

OBJECTIVE: The aim of the present study was to evaluate morphological changes induced by glycine powder air polishing on titanium surfaces and its effect on bacteria recolonization in comparison with sodium bicarbonate powder. MATERIALS AND METHODS: 5 mm wide and 1 mm thick titanium grade II disks were divided into three groups of treatments: (i) no treatment; (ii) air polishing with glycine powder; (iii) air polishing with sodium bicarbonate powder. Specimens were characterized by laser profilometry, scanning electron microscopy (SEM) and then installed onto removable appliances worn for 24 h by healthy volunteers. Surface contamination was evaluated using SEM and counting the number of colony forming units (CFU). RESULTS: SEM observation revealed an increased roughness with the formation of craters on samples treated with sodium bicarbonate powder, while not in glycine ones. Statistical analysis failed to show significant differences of both Ra and Rmax parameters in treated groups. SEM observation of specimens surfaces, after 24 h of permanence in the oral cavity, showed a higher contamination of the disks treated with sodium bicarbonate compared with those not treated (P < 0.05). Conversely, the group treated with glycine showed the lower contamination if compared with bicarbonate-treated group (P < 0.05). CONCLUSIONS: Air polishing with glycine powder may be considered as a better method to remove plaque from dental implant because glycine is less aggressive than sodium bicarbonate powder. Moreover, the use of glycine powder seems to have an active role on the inhibition of bacterial recolonization of implants in a short test period (24 h). Further studies are needed to demonstrate the bacteriostatic properties of glycine, envisaged on the basis of reduced contamination of the disks polished with glycine compared with those not treated.

Acupuncture and burning mouth syndrome: a pilot study.

Burning mouth syndrome (BMS) is a chronic condition most common in middle-aged and elderly women, with prevalence rates in the general population ranging from 0.5% to 5%. Defined by the International Headache Society as "an intraoral burning sensation for which no medical or dental cause can be found," BMS is considered a form of neuropathic pain. The management of BMS remains unsatisfactory. In this pilot study, we investigated the use of acupuncture in a small group of BMS patients. The study group, after 4 refusals, was composed of 10 BMS patients (9 females and 1 male; mean age, 65.2 years; range, from 48 to 80 years; mean duration of BMS, 2.6 years; SD ± 0.8 years). Oral pain/burning sensation (primary outcome) was measured using a visual analogue scale (VAS). Health-related quality of life (secondary outcome) was measured using the 36-item Short-Form Health Survey (SF-36). Acupuncture treatment lasted 8 weeks and consisted of 20 sessions. Patients reported a mean reduction in pain of 0.99 points on the VAS (max 2.1-min 0.1), which, although slight, was statistically significant (Wilcoxon test P < 0.009). No significant improvement in the overall score for quality of life was observed, although subjects receiving acupuncture treatment seemed better able cope with their oral symptoms.

Medical emergencies in dental practice: A nationwide web-based survey of Italian dentists.

Objective: Dentists must be prepared to manage medical emergencies, which are arisen during dental practice together with the increase of age population and medically compromised patients. This study aims at assessing the occurrence of medical emergencies in a cohort of Italian dentists, to ascertain their level of confidence in the management of these conditions, also based on their educational training and type of medical graduation, and, finally, to know their educational needs, in order to plan appropriate institutional interventions for specific training. Methods: A national-based cross-sectional study was carried out by means of an online survey sent to all dentists working in Italy. Results: The survey included 6818 questionnaires. Most of the respondents (n = 4443; 65.2%) reported the occurrence of at least one medical emergency during their professional life. The events rarely resulted in death as declared by only 62 (0.9%) of respondents. The commonest medical emergency was the vasovagal syndrome. Most medical emergencies occurred during the dental procedure (n = 4883; 71.6%). An average degree of satisfaction about the ability to diagnose and manage medical emergencies was reported by most of respondents, with high level of confidence in treating vasovagal syndrome, while a lack in preparedness about the management of myocardial infarction or transient ischemic attack (TIA) and stroke. Medical doctors were more confident in managing the emergencies than dentistry graduates (p < .01). Considering the educational needs, almost all of participants (n = 6721; 98.6%) declared the need to improve their training and expressed their interest in theoretical-practical institutional courses as well as in the establishment of an official national register for medical emergencies occurred in dental practice. Conclusions: Medical emergencies are not negligible and the dentist should receive adequate training and continuing education to be updated and ready for their correct management. Clinical significance: The dentist should be ready to deal with medical emergencies and provide first aid to the patient. The dentist is not always prepared to manage the most complex emergencies; therefore, there is the need to organize post-graduate courses and to set up an emergency register.

Pharmacokinetics study about topical clobetasol on oral mucosa.

BACKGROUND: Clobetasol is the most potent topical corticosteroid used in oral medicine for muco-cutaneous diseases. Several papers reported about patients with cushingoid appearance, suggesting an adrenal suppression related to clobetasol systemic absorption after local application. Owing to the lack of studies, our goal is to assess whether transmucosal assimilation, after its application on oral mucosa, really occurs and to define clobetasol pharmacokinetics profile. METHODS: Data were recorded by collecting blood samples both on 10 patients in clobetasol therapy and on 14 healthy volunteers instructed about standardized clobetasol applications. A new technique of analytical chemistry was employed to detect its serum concentrations. RESULTS: Clobetasol absorption was ascertained, showing a certain accumulation rate. Different levels have been found in relation to oral disease and individual features (as smoking habits and presence of oral mucosa erosion). CONCLUSIONS: Our study validates clobetasol systemic transmucosal absorption, also recommending a careful monitoring of patients in corticosteroid therapy to avoid local and systemic adverse effects.

Antibiotics to prevent complications following tooth extractions.

BACKGROUND: The most frequent indications for tooth extractions are dental caries and periodontal infections, and these extractions are generally done by general dental practitioners. Antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection. OBJECTIVES: To determine the effect of antibiotic prophylaxis on the development of infectious complications following tooth extractions. SEARCH METHODS: The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 25 January 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1948 to 25 January 2012), EMBASE via OVID (1980 to 25 January 2012) and LILACS via BIREME (1982 to 25 January 2012). There were no restrictions regarding language or date of publication. SELECTION CRITERIA: We included randomised double-blind placebo-controlled trials of antibiotic prophylaxis in patients undergoing tooth extraction(s) for any indication. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias for the included studies and extracted data. We contacted trial authors for further details where these were unclear. For dichotomous outcomes we calculated risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. For continuous outcomes we used mean differences (MD) with 95% CI using random-effects models. We examined potential sources of heterogeneity. The quality of the body of evidence has been assessed using the GRADE tool. MAIN RESULTS: This review included 18 double-blind placebo-controlled trials with a total of 2456 participants. Five trials were assessed at unclear risk of bias, thirteen at high risk, and none at low risk of bias. Compared to placebo, antibiotics probably reduce the risk of infection in patients undergoing third molar extraction(s) by approximately 70% (RR 0.29 (95% CI 0.16 to 0.50) P < 0.0001, 1523 participants, moderate quality evidence) which means that 12 people (range 10-17) need to be treated with antibiotics to prevent one infection following extraction of impacted wisdom teeth. There is evidence that antibiotics may reduce the risk of dry socket by 38% (RR 0.62 (95% CI 0.41 to 0.95) P = 0.03, 1429 participants, moderate quality evidence) which means that 38 people (range 24-250) need to take antibiotics to prevent one case of dry socket following extraction of impacted wisdom teeth. There is also some evidence that patients who have prophylactic antibiotics may have less pain (MD -8.17 (95% CI -11.90 to -4.45) P < 0.0001, 372 participants, moderate quality evidence ) overall 7 days after the extraction compared to those receiving placebo, which may be a direct result of the lower risk of infection. There is no evidence of a difference between antibiotics and placebo in the outcomes of fever (RR 0.34, 95% CI 0.06 to 1.99), swelling (RR 0.92, 95% CI 0.65 to 1.30) or trismus (RR 0.84, 95% CI 0.42 to 1.71) 7 days after tooth extraction.Antibiotics are associated with an increase in generally mild and transient adverse effects compared to placebo (RR 1.98 (95% CI 1.10 to 3.59) P = 0.02) which means that for every 21 people (range 8-200) who receive antibiotics, an adverse effect is likely. AUTHORS' CONCLUSIONS: Although general dentists perform dental extractions because of severe dental caries or periodontal infection, there were no trials identified which evaluated the role of antibiotic prophylaxis in this group of patients in this setting. All of the trials included in this review included healthy patients undergoing extraction of impacted third molars, often performed by oral surgeons. There is evidence that prophylactic antibiotics reduce the risk of infection, dry socket and pain following third molar extraction and result in an increase in mild and transient adverse effects. It is unclear whether the evidence in this review is generalisable to those with concomitant illnesses or immunodeficiency, or those undergoing the extraction of teeth due to severe caries or periodontitis. However, patients at a higher risk of infection are more likely to benefit from prophylactic antibiotics, because infections in this group are likely to be more frequent, associated with complications and be more difficult to treat. Due to the increasing prevalence of bacteria which are resistant to treatment by currently available antibiotics, clinicians should consider carefully whether treating 12 healthy patients with antibiotics to prevent one infection is likely to do more harm than good.

COVID-19 and Dental Education: the Experience of the Dental School from the University of Milan.

In late February 2020, Lombardy became one of the outbreak areas of the novel coronavirus pandemic, leading to the revolution of traditional teaching. Here, we describe our teaching experience at the Dental School of the University of Milan, with a focus on the management of distance learning and clinical training. Distance education was enhanced with streaming lectures and videos of clinical procedures. Students' opinions on this "digital revolution" were very positive, despite few technical and organizational problems. For assuring the clinical training, we completely renovated the structural architecture from open spaces to closed spaces. The pandemic changed dental education with future repercussions.

The impact of COVID-19 on the dental hygienists: A cross-sectional study in the Lombardy first-wave outbreak.

The impact of COVID-19 on socio-economical activities has changed everyday life. Dental hygienists, who perform aerosol generating procedures, have been strongly affected by changes in routine procedures. This cross-sectional study aimed at carrying out an online survey among dental hygienists in Lombardy. The survey was implemented after the first-wave lockdown focusing on the level of knowledge on COVID-19 and Sars-CoV-2, the virus-related changes in their attitude and working routine, and the socio-economic effects. In this report, we included 313 questionnaires of respondents (259 Females, and 54 Males; age = 33 ± 9 years). A significant percentage of respondents acknowledged the use of "word of mouth" among colleagues (n = 114, 36%) and social networks (n = 113, 36%) to be up to date on COVID-19. About half of respondents correctly identified the main COVID-19 symptoms/signs, just 13% (n = 41) identified the routes of transmission. Three quarters of respondents (n = 234, 75%) were afraid of being infected during the clinical practice, and about half of them would be afraid to treat patients having symptoms attributable to COVID-19. Twenty-one percent (n = 67) of participants also thought about changing job. Air-polishing was identified as the highest risk procedure, and 82% (n = 256) reported that they eliminated its use. Most claimed they never had a swab or a serological test, with two respondents positive to molecular test (0.6%), and 12 positives to serological test (3.8%). More than half of the participants (65%; n = 202) complained the dental hygienist is not protected, despite a loss of earnings due to lockdown between 2,000 and 10,000 euros. This study demonstrated that dental hygienists were emotionally and economically affected by the pandemic, significantly changing their work routine. Anti-epidemic protocols are pivotal to react promptly and to contain the virus in the dental setting.

Sex-Related Differences in Allelic Frequency of the Human Beta T Cell Receptor SNP rs1800907: A Retrospective Analysis from Milan Metropolitan Area.

This paper aims at retrospectively re-analyzing the different distribution, between males and females, in the allelic frequency of the human ß T cell receptor (TCR ß) single nucleotide polymorphism (SNPs) rs1800907 in Caucasian patients in the Milan metropolitan area. The allelic frequency significantly differed between sexes. Females showed higher frequency of C/C genotype than males, but lower T/C genotype (p < 0.0001). Heterozygous (T/C) versus homozygous (T/T + C/C) genotypes resulted in a different distribution of frequencies in males than in females, the latter possessing higher homozygosis (p < 0.0001). Within the limitations of this work (small number of included studies that concerned just a specific geographical area), allelic distribution according to sex might account the role of TCRß-related SNPs in autoimmune diseases and further investigations are required to explain better this genetic background, in the perspective of a sex-related T cell immune responsiveness and auto-immunity.