Effect of Commonly Prescribed Liquid Medications on Streptococcus mutans Biofilm. An in vitro study.

OBJECTIVE: This study addressed the effect of pediatric liquid antibiotic medications on Streptococcus mutans UA159. These suspensions commonly contain sugars such as sucrose to make them more palatable for children. The study was designed to evaluate the effects of oral liquid antibiotics on Streptococcus mutans growth and biofilm formation. STUDY DESIGN: A 24 hour culture of S. mutans was treated with various concentrations of liquid medications commonly prescribed to children for odontogenic or fungal infections- amoxicillin, penicillin VK, clindamycin, and nystatin. The study was conducted in sterile 96-well flat bottom microtiter plates. The minimum inhibitory and biofilm inhibitory concentrations (MIC/MBIC) of S. mutans were determined for each medication. S. mutans was cultured with and without the test drugs, the amount of total growth measured, the biofilms washed, fixed, and stained with crystal violet. The absorbance was determined to evaluate biofilm formation. RESULTS: Higher concentrations of amoxicillin, penicillin VK and clindamycin had decreased biofilm and overall growth than the control. The MICs were 1:2,560 (1.95 ug/ml), 1:2,560 (1.95 ug/ml) and 1:40 (9.375 ug/ml), while the MBIC were 1:640 (7.8 ug/ml), 1:1,280 (3.9 ug/ml) and 1:20 (18.75 ug/ml), respectively. Lower concentrations provided increased biofilm and overall growth. Nystatin induced significantly more biofilm and overall growth than the control at all concentrations. CONCLUSION: At high concentrations, approximately at the levels expected to be present in the oral cavity of children, amoxicillin, penicillin, and clindamycin inhibited S. mutans biofilm and overall growth due to their antibiotic activity, while at lower concentrations the three antibiotics demonstrated an increase in biofilm and growth. The increase in S. mutans biofilm and overall growth is most likely attributed to the sugar content in the medications. Nystatin provided an increase in biofilm and growth at each concentration tested.

The effect of intraoral suction on oxygen-enriched surgical environments: a mechanism for reducing the risk of surgical fires.

In this study, a mechanical model was applied in order to replicate potential surgical fire conditions in an oxygen-enriched environment with and without high-volume suction typical for dental surgical applications. During 41 trials, 3 combustion events were measured: an audible pop, a visible flash of light, and full ignition. In at least 11 of 21 trials without suction, all 3 conditions were observed, sometimes with an extent of fire that required early termination of the experimental trial. By contrast, in 18 of 20 with-suction trials, ignition did not occur at all, and in the 2 cases where ignition did occur, the fire was qualitatively a much smaller, candle-like flame. Statistically comparing these 3 combustion events in the no-suction versus with-suction trials, ignition (P = .0005), audible pop (P = .0211), and flash (P = .0092) were all significantly more likely in the no-suction condition. These results suggest a possible significant and new element to be added to existing surgical fire safety protocols toward making surgical fires the "never-events" they should be.

Comparison of Oropharyngeal Oxygen Pooling and Suctioning During Intubated and Nonintubated Dental Office-Based Anesthesia.

OBJECTIVE: The risk of a spontaneous surgical fire increases as oxygen concentrations surrounding the surgical site rise above the normal atmospheric level of 21%. Previously published in vitro findings imply this phenomenon (termed oxygen pooling) occurs during dental procedures under sedation and general anesthesia; however, it has not been clinically documented. METHODS: Thirty-one children classified as American Society of Anesthesiologists I and II between 2 and 6 years of age undergoing office-based general anesthesia for complete dental rehabilitation were monitored for intraoral ambient oxygen concentration, end-tidal CO2, and respiratory rate changes immediately following nasotracheal intubation or insertion of nasopharyngeal airways, followed by high-speed suctioning of the oral cavity during simulated dental treatment. RESULTS: Mean ambient intraoral oxygen concentrations ranging from 46.9% to 72.1%, levels consistent with oxygen pooling, occurred in the nasopharyngeal airway group prior to the introduction of high-speed oral suctioning. However, 1 minute of suctioning reversed the oxygen pooling to 31.2%. Oropharyngeal ambient oxygen concentrations in patients with uncuffed endotracheal tubes ranged from 24.1% to 26.6% prior to high-speed suctioning, which reversed the pooling to 21.1% after 1 minute. CONCLUSION: This study demonstrated significant oxygen pooling with nasopharyngeal airway use before and after high-speed suctioning. Uncuffed endotracheal intubation showed minimal pooling, which was reversed to room air ambient oxygen concentrations after 1 minute of suctioning.

Topical fluoride impact in future restorative dental procedures: A claim study.

BACKGROUND: Caries is one of the most prevalent diseases affecting children. Topical fluoride is used to decrease the incidence of caries. The purpose of this study was to investigate the impact of fluoride varnish and gel applications on future restorative dental treatment claims. METHODS: The data were obtained in conjunction with a dental data warehouse through a partnership agreement. A retrospective analysis of dental claims made from 2010 through 2018 was completed. Data were extracted for patients aged 1 through 8 years with topical fluoride application and its subsequent impact on restorative dental claims. RESULTS: Data for 672,889 patients were included in the analysis. Patients who received topical fluoride had significantly lower numbers (P < .001) of restorative procedures and extractions per year and significantly increased time (P < .001) to their first restorative procedure or extraction after the index visit than patients who did not receive topical fluoride. CONCLUSIONS: The application of fluoride varnishes and gels increased the time to future restorative and extraction dental claims and decreased the number of future restorative and extraction dental claims. PRACTICAL IMPLICATIONS: This study is important because it found that the use of topical fluoride decreased the number of future restorative and extraction dental claims.

Effect of titanium dioxide on Streptococcus mutans biofilm.

BACKGROUND: Streptococcus mutans (S. mutans) participates in the dental caries process. Titanium dioxide (TiO2) nanoparticles produce reactive oxygen species capable of disrupting bacterial DNA synthesis by creating pores in cell walls and membranes. OBJECTIVE: The objective of this study was to determine the effect of TiO2 on the disruption of S. mutans biofilm. METHODS: This study was conducted in four phases involving a TiO2-containing toothbrush and TiO2 nanoparticles. Each phase was completed using 24 h established S. mutans biofilm growth. Phase one data was collected through a bacterial plating study, assessing biofilm viability. Biofilm mass was evaluated in phase two of the study by measuring S. mutans biofilm grown on microtiter plates following crystal violet staining. The third phase of the study involved a generalized oxygen radical assay to determine the relative amount of oxygen radicals released intracellularly. Phase four of the study included the measurement of insoluble glucan/extracellular polysaccharide (EPS) synthesis using a phenol-sulfuric acid assay. RESULTS: Both exposure time and time intervals had a significant effect on bacterial viability counts (p = 0.0323 and p = 0.0014, respectively). Bacterial counts after 6 min of exposure were significantly lower than after 2 min (p = 0.034), compared to the no treatment control (p = 0.0056). As exposure time increased, the amount of remaining biofilm mass was statistically lower than the no treatment control. Exposure time had a significant effect on oxygen radical production. Both the 30 and 100 nm TiO2 nanoparticles had a significant effect on bacterial mass. The silver nanoparticles and the 30 and 100 nm TiO2 nanoparticles significantly inhibited EPS production. CONCLUSION: The TiO2-containing toothbrush kills, disrupts, and produces oxygen radicals that disrupt established S. mutans biofilm. TiO2 and silver nanoparticles inhibit EPS production and reduce biofilm mass. The addition of TiO2 to dental products may be effective in reducing cariogenic dental biofilm.

Prescription of bite-wing and panoramic radiographs in pediatric dental patients: An assessment of current trends and provider compliance.

BACKGROUND: The aim of the authors was to evaluate prescription patterns for bite-wing and panoramic radiographs (PRs) for pediatric and adolescent dental patients after the implementation of the most recent guidelines from the American Dental Association and US Food and Drug Administration. METHODS: The authors accessed paid insurance claims data for all 50 states from January 1, 2013, through June 30, 2019, for patients 18 years and younger and extracted a 5% random sample population. The authors performed statistical analyses to evaluate various imaging metrics for pediatric dentists (PDs) and general practitioners (GPs). RESULTS: A total of 2,123,735 bite-wing images were ordered during 4,734,249 office visits. The average (standard deviation [SD]) time interval between bite-wing examinations ordered by GPs was 13.9 (7.4) months, and for PDs the average (SD) was 13.0 (6.7) months (P < .0001). When divided by age group, 3.5% of all bite-wings were obtained from patients aged 0 through 4 years. For PRs, the authors included 286,824 images in this study. The average (SD) time interval between PRs ordered for the same patient was 3.4 (1.3) years for PDs and 3.3 (1.4) years for GPs. One percent of all PRs were ordered for patients aged 0 through 4 years, with 403 images attributed to PDs and 2,348 to GPs. CONCLUSIONS: PDs were more likely to comply with the guidelines on radiograph prescriptions for pediatric and adolescent patients than GPs. PRACTICAL IMPLICATIONS: Inclusion of patient caries risk with insurance claims data could be considered for more appropriate administration of dental radiography. Future guidelines should be developed to include more explicit recommendations for prescribing PRs.

Blood levels of lead and dental caries in permanent teeth.

OBJECTIVES: The purpose of this study was to determine whether there is an association between lead exposure within the ages of 1-4 years and dental caries in the permanent dentition between ages 9-17 among Mexican youth. METHODS: Data were collected for the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) cohort from a group of 490 children born and reared in Mexico City. Among ages 1-4 years, blood lead levels were measured in micrograms of lead per deciliter of blood (µg/dL) and the presence of caries in adolescence was determined using the International Caries and Detection and Assessment System (ICDAS). The relationship between blood levels of lead and decayed, missing, or filled surfaces (DMFS) was examined using negative binomial regression. Covariates were selected based on previous studies and included age, gender, socioeconomic status, oral hygiene, body mass index, and diet. The nonlinear relationship between lead and DMFS was examined using smoothing splines. RESULTS: The mean overall blood lead level (BLL) was 4.83 µg/dL (S.D. of 2.2). The mean overall caries level (DMFS) was 4.1. No statistically significant association was found between early childhood blood lead levels and dental caries in adolescence. CONCLUSION: This study shows a lack of association between exposure to lead between the ages of 1-4 years of age and dental caries in permanent dentition later in life. Other covariates, such as age and sugar consumption, appeared to play a more prominent role in caries development.

Acceptance of Behavior Guidance Techniques Used in Pediatric Dentistry by Parents From Diverse Backgrounds.

Objective. To investigate if parental background affects acceptance of behavior guidance techniques. Background. Behavior guidance techniques are used for the safe and effective treatment of pediatric patients. Acceptance of these techniques may vary by racial and ethnic background. Methods. A total of 142 parents were recruited and asked to rate videos showing: active restraint/protective stabilization (AR), general anesthesia (GA), nitrous oxide sedation (N2O), oral premedication/sedation (OP), passive restraint/protective stabilization (PR), tell-show-do (TSD), and voice control (VC) techniques. Results. Hispanic parents rated VC most acceptable, followed by TSD, PR, and pharmacologic techniques. Black and white parents rated TSD, followed by N2O, as most acceptable, and AR and PR as least favorable. Hispanics found GA significantly less acceptable than whites or blacks. Hispanics were less accepting of AR than blacks; but more accepting of PR than whites. TSD was highly rated among all 3 cohorts. Parental background affected acceptance of the techniques in this study.

Comparison of Intubated Versus Nonintubated Airway Management in Children Under General Anesthesia Provided by Dentist Anesthesiologists.

Purpose: Use of general anesthesia (GA) for comprehensive dental treatment of children is an essential health benefit. Pediatric dentists utilize dentist anesthesiologists to provide GA for dental rehabilitation of severe early childhood caries. Dentist anesthesiologists deliver GA using intubated or nonintubated GA. The purpose of this study was to compare the incidence of respiratory complications when intubated versus nonintubated general anesthesia was completed by dentist anesthesiologists in a pediatric dentistry setting. Methods: The Society of Ambulatory Anesthesia (SAMBA) Clinical Outcomes Registry (SCOR) database was queried for pediatric dental GA cases completed by dentist anesthesiologists from January 1, 2010 to December 31, 2016. Logistic regression compared intubated GA versus nonintubated GA for differences in the incidence of respiratory complications. Results: Within 9,333 cases, there were 30 incidents of laryngospasm (0.3 percent), 19 incidents of bronchospasm (0.2 percent), two incidents of hypoxia (less than 0.1 percent), and six incidents of difficult airway (0.1 percent). When intubated versus nonintubated GA was compared for respiratory complication incidence, no significant association was found (P=0.81, odds ratio equals 0.93). Conclusion: No significant difference was found between the incidence of respiratory complications with intubated versus nonintubated GA provided by dentist anesthesiologists.

Utilization of Stainless Steel Crowns by Pediatric and General Dentists.

Purpose: Dental caries affects 23 percent of U.S. children aged two to five years old. 1 Stainless steel crowns (SSCs) are used for extensive caries and offer greater longevity than other restorations; however, disparity exists between pediatric and general dentists in restoration type provided. The purpose of this study was to evaluate utilization of stainless steel crowns among pediatric and general dentists by reviewing insurance claims. Methods: Data were obtained from a commercial dental insurance claims data warehouse from more than 50 dental insurance plans and multiple carriers in the United States for children 12 years old and younger. Data were examined for treatment of the primary dentition using SSCs or direct restorations. A generalized linear mixed effects model tested differences in the utilization of SSCs by general dentists (GDs) versus pediatric dentists (PD). Results: The data included 107,487 GDs and 5,395 PDs. The records included 2,555,726 claims for direct restorations and 440,423 claims for SSCs. PDs are more likely to place SSCs compared to GDs (odds ratio equals 3.2; P<0.0001). Conclusions: Pediatric dentists are more likely to restore carious primary dentitions with stainless steel crowns than general dentists. Perhaps increased training at the dental undergraduate level and access to more continuing education courses for general dentists would increase the utilization of SSCs.

Silver Diamine Fluoride and Potassium Iodide Disruption of In Vitro Streptococcus mutans Biofilm.

Purpose: The purpose of this study was to investigate the inhibitory in vitro effects of silver diamine fluoride (SDF) with and without a saturated solution of potassium iodide (SSKI) on established Streptococcus mutans biofilm.Methods: Fifty µl of an overnight S. mutans culture (106 CFU per mL) in Tryptic Soy Broth (TSB) and three ml of fresh TSB supplemented with one percent sucrose (TSBS) were incubated for 24 hours to establish an S. mutans biofilm in six-well tissue culture plates. Four treatments (SDF, SSKI, SDF plus SSKI, and untreated control) were used to disrupt the biofilm. The biofilm groups were each treated with reagent and washed; the biofilm was collected, diluted, and spiral-plated onto blood agar plates; and an automated counting machine was used to determine the bacterial colony forming units (CFU).Results: The control had significantly more CFU than the SSKI, SDF, and SDF plus SSKI groups (P<.0001). The SSKI group had significantly more CFU than the SDF and SDF plus SSKI groups (P<.0001). The SDF group had significantly fewer CFU than the SDF plus SSKI group (P=.02). The reduction from the control was more than seven-fold for SDF, four-fold for SDF plus SSKI, and two-fold for SSKI.Conclusions: SDF alone, SDF plus SSKI, and SSKI disrupted an established S. mutans biofilm. SDF alone had the greatest overall disruption.

In Vitro Effects of Sports and Energy Drinks on Streptococcus mutans Biofilm Formation and Metabolic Activity.

PURPOSE: Sports and energy drinks are being increasingly consumed and contain large amounts of sugars, which are known to increase Streptococcus mutans biofilm formation and metabolic activity. The purpose of this in vitro study was to investigate the effects of sports and energy drinks on S. mutans biofilm formation and metabolic activity. METHODS: S. mutans UA159 was cultured with and without a dilution (1:3 ratio) of a variety of sports and energy drinks in bacterial media for 24 hours. The biofilm was washed, fixed, and stained. Biofilm growth was evaluated by reading absorbance of the crystal violet. Biofilm metabolic activity was measured by the biofilm-reducing XTT to a water-soluble orange compound. RESULTS: Gatorade Protein Recovery Shake and Starbucks Doubleshot Espresso Energy were found to significantly increase biofilm (30-fold and 22-fold, respectively) and metabolic activity (2-fold and 3-fold, respectively). However, most of the remaining drinks significantly inhibited biofilm growth and metabolic activity. CONCLUSIONS: Several sports and energy drinks, with sugars or sugar substitutes as their main ingredients inhibited S. mutans biofilm formation. Among the drinks evaluated, Gatorade Protein Recovery Chocolate Shake and Starbucks Doubleshot Energy appear to have cariogenic potential since they increased the biofilm formation and metabolic activity of S. mutans.

Significant Factors Related to Failed Pediatric Dental General Anesthesia Appointments at a Hospital-based Residency Program.

PURPOSE: The purposes of this study were to: (1) evaluate the relationship between appointment failure and the factors of age, gender, race, insurance type, day of week, scheduled time of surgery, distance traveled, and weather; (2) investigate reasons for failure; and (3) explore the relationships between the factors and reasons for failure. METHODS: Electronic medical records were accessed to obtain data for patients scheduled for dental care under general anesthesia from May 2012 to May 2015. Factors were analyzed for relation to appointment failure. RESULTS: Data from 3,513 appointments for 2,874 children were analyzed. Bivariate associations showed statistically significant (P<0.05) relationships between failed appointment and race, insurance type, scheduled time of surgery, distance traveled, snowfall, and temperature. Multinomial regression analysis showed the following associations between factors and the reason for failure (P<0.05): (1) decreased temperature and increased snowfall were associated with weather as reason for failure; (2) the African American population showed an association with family barriers; (3) Hispanic families were less likely to give advanced notice; and (4) the "additional races" category showed an association with fasting violation. CONCLUSION: Patients who have treatment under general anesthesia face specific barriers to care.

Behavior Assessment in Children Following Hospital-Based General Anesthesia versus Office-Based General Anesthesia.

The purpose of this study was to determine if differences in behavior exist following dental treatment under hospital-based general anesthesia (HBGA) or office-based general anesthesia (OBGA) in the percentage of patients exhibiting positive behavior and in the mean Frankl scores at recall visits. This retrospective study examined records of a pediatric dental office over a 4 year period. Patients presenting before 48 months of age for an initial exam who were diagnosed with early childhood caries were included in the study. Following an initial exam, patients were treated under HBGA or OBGA. Patients were followed to determine their behavior at 6-, 12- and 18-month recall appointments. Fifty-four patients received treatment under HBGA and 26 were treated under OBGA. OBGA patients were significantly more likely to exhibit positive behavior at the 6- and 12-month recall visits p = 0.038 & p = 0.029). Clinicians should consider future behavior when determining general anesthesia treatment modalities in children with early childhood caries presenting to their office.

The success of stainless steel crowns placed with the Hall technique: a retrospective study.

BACKGROUND: In this retrospective study, the authors evaluated the clinical and radiographic success of stainless steel crowns (SSCs) used to restore primary molars with caries lesions, placed by means of both the traditional technique (involving complete caries removal and tooth reduction before placement of the SSC) and the Hall technique (involving no caries removal, no crown preparation and no use of local anesthetic before placement of the SSC). METHODS: The authors conducted a retrospective chart review by using the patient records at a private pediatric dental practice at which the Hall technique had been introduced in June 2010 as an alternative treatment to traditional SSC placement. The inclusion criteria were caries lesions on a primary molar with no clinical or radiographic evidence of pulpitis, necrosis or abscess, as well as follow-up of at least six months or until failure, whichever came first. They graded restoration success by using a four-point scale based on presence or loss of the SSC, and whether or not the patient needed further treatment associated with pulpal pathology or secondary caries. They collected and summarized patient demographic information. They used a Kaplan-Meier survival curve along with 95 percent confidence intervals to evaluate clinical success. RESULTS: The authors found that 65 (97 percent) of 67 SSCs placed with the Hall technique (mean observation time, 15 months; range, four-37 months) and 110 (94 percent) of 117 SSCs placed with the traditional technique (mean observation time, 53 months; range, four-119 months) were successful. CONCLUSION: Findings of this study show a similar success rate for SSCs placed with the traditional technique or the Hall technique.