Cytotoxic effects of silver diamine fluoride.

PURPOSE: To investigate the effect of silver diamine fluoride (SDF) and fluoride varnish (FV) on human gingival fibroblasts (HGF) and bacteria. METHODS: HGF cell viability was assessed after exposure to various dilutions of SDF or FV. Hydroxyapatite (HA) discs treated with SDF, FV, or saline were rinsed in artificial saliva for 84 days. HGF were exposed to treated discs and viability assessed fluorescently. Oral bacteria were exposed to treated discs and survival quantified. RESULTS: At 0.01%, SDF was almost 100% cytotoxic to HGF. SDF and FV treated HA discs, induced near-complete cell death after 24 hours of contact. After rinsing FV discs for 21 days, cell survival exceeded 95%. SDF treated discs were toxic to HGF and bacteria after 9 weeks of rinsing. CLINICAL SIGNIFICANCE: SDF and FV can induce cell death. FV lost its cytotoxicity within 3 weeks, while SDF remained cytotoxic even after 9 weeks of rinsing. This research confirms that SDF has long lasting antimicrobial effects at very low concentrations although it does raise concerns regarding cytotoxicity. However, HGF cells are exposed to other cytotoxic substances in dentistry with little, if any, long-term effects.

Effect of Light Cure Methods for Intermediate Adhesive Layer on Microleakage of Sealants. An in Vitro Study.

Background: The objective of this study was to determine the effect of an adhesive layer and its photopolymerization on the microleakage of sealants. Study design: 0.5mm-deep standardized fissurectomies were performed on extracted molars (n = 72). Teeth were randomly assigned to 3 different sealant materials (n = 24/group). Teeth were further divided to receive sealants with or without an adhesive layer. Each sealant with adhesive was also divided into two groups: adhesive was light-cured separately or light cured together with the sealant. Following thermocycling, microleakage was assessed using dye penetration and image analysis. Data was analyzed using ANOVA and Tukey's studentized ranged HSD tests. Results: Microleakage was not affected by type of sealant material (p>0.05) but was significantly influenced by application (p<0.05). Overall, placement of sealants without adhesive displayed greater microleakage than sealants with uncured adhesive (p<0.05). Within individual sealant types, this difference was only significant for Ultraseal XT (p<0.05). Sealants bonded with and without prior light curing did not show a significant difference in levels of leakage (Tukey's Studentized Range Test, p>0.05). Conclusion: An adhesive layer should be placed beneath sealants, but whether it should be light cured or left uncured before sealant placement varies by the sealant type.

Count every newborn; a measurement improvement roadmap for coverage data.

BACKGROUND: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. METHODS: In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. RESULTS: ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. CONCLUSIONS: The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.

Characteristics of Pediatric Dentists Who Work When Sick.

Purpose: Presenteeism, or working while sick, results in loss of productivity and risk of spreading disease. The purpose of the present study was to identify current work practices and beliefs related to presenteeism, including demographic and practice factors that may significantly relate to presenteeism among practicing dentists in the United States. Methods: A survey of American Academy of Pediatric Dentistry members assessed dentists' practices and beliefs regarding presenteeism. Data were analyzed using descriptive statistics, chi-square test, and multi-variate logistic regression. Results: Most respondents (86 percent) worked at least once while sick in the last year. Years in practice, region, and student debt level were significantly associated with presenteeism after adjusting for confounders. Reasons for presenteeism were related to practice type, gender, years in practice, region, and salary type. Conclusions: The majority of pediatric dentists treat patients while sick. Pediatric dentists are influenced to practice while sick due to perceived economic and social pressures, including meeting expectations of colleagues and patients.

Dental Student and Faculty Perceptions of Uncivil Behavior by Faculty Members in Classroom and Clinic.

Uncivil behavior by a faculty member or student can threaten a classroom environment and make it less conducive to learning. The aim of this study was to explore faculty behaviors that dental faculty and students perceive to be uncivil when exhibited in the classroom and clinic. In 2015, all faculty, administrators, and students at a single academic dental institution were invited to participate in an electronic survey that used a five-point Likert scale for respondents to indicate their agreement that 33 faculty behaviors were uncivil. Response rates were 49% for faculty and 59% for students. Significant differences were found between student and faculty responses on 22 of the 33 behavioral items. None of the three category composite scores differed significantly for students compared to faculty respondents. The category composite scores were not significantly associated with gender, ethnicity, or age for faculty or students. Overall, this study found significant differences between students and faculty about perceived uncivil faculty behaviors, though not for categories of behaviors.

Effect of Cured Versus Uncured Adhesive Inclusion on the Microtensile Bond Strength of Sealants.

PURPOSE: To determine the impact of light curing of bonding agents on the microtensile bond strength (MTBS) of sealants on extracted teeth. METHODS: Flat enamel surfaces were created on 54 extracted, sound human molars by sequential grinding. Three different sealants- Clinpro (3M ESPE), Ultraseal XT Hydro (Ultradent), and Fluorshield VLC (Dentsply)- were placed after acid etching without a bonding agent (control) or with three different bonding agents - Adper Single Bond Plus (3M ESPE), Peak Universal Bond (Ultradent), and Prime&Bond Elect (Dentsply)- each in both light-cured and uncured form. The teeth were sectioned into bar specimens and the MTBS of each specimen was measured. The bond strength data were analyzed using two-way analysis of variance and Tukey's test (P=0.05). RESULTS: There was no significant difference between the MTBS of sealants in the thermocycled and non-thermocycled groups. The uncured adhesive had the lowest bond strength in each group, except for Clinpro after thermocycling. Teeth with uncured adhesive exhibited significantly lower bond strength in the Ultraseal (no thermocycling) and Fluroshield (with thermocycling) groups (P=0.02 and P=0.001, respectively). CONCLUSIONS: Adding bonding agents without curing before sealant placement weakened the microtensile bond strength. There was no significant difference in MTBS between the thermocycled and nonthermocycled groups.

Considerations in identifying pediatric dental neglect and the legal obligation to report.

BACKGROUND: Dental health care professionals play an important role as mandated advocates when health care neglect is suspected in children; however, there is some confusion around what constitutes child neglect. METHODS: The authors reviewed the dental literature for descriptors and definitions of neglect. They studied the individual state statutes to learn the protection afforded for both victims of neglect and for health care providers acting on behalf of such children. They also reviewed methods of action to address suspected neglect. RESULTS: The authors found confusion around what is or is not child neglect. Yet, dental professionals are tasked by the law, and by a moral code, to protect children from neglect. The authors offer a definition of neglect and suggested practice guidelines to assist the practitioner acting as a child's advocate. CONCLUSIONS: Clinicians can use strategies to address the problem of child neglect. A digital data treatment registry may provide additional views of a child's health status. PRACTICAL IMPLICATIONS: With a better understanding of the definition of neglect, strategies can be implemented for use by the dental team to address this problem of neglect and reduce its incidence.