The effects of a therapy dog intervention on dental fear and anxiety in adult patients undergoing dental procedures: a pilot study.

Dental anxiety poses challenges for providing effective oral healthcare. While therapy dogs have shown promise in various medical and mental health contexts, their use for alleviating dental anxiety in adults remains underexplored. This study aimed to investigate the emotional and physiologic effects of therapy dogs on self-reported dental anxiety. Adults with dental anxiety were randomly assigned to an intervention group (DOG; n = 19) or a standard care group (SC; n = 14). Standard self-report measures were used to assess dental anxiety (Index of Dental Anxiety and Fear [IDAF-4C+]), depression (Patient Health Questionnaire 9), and generalized anxiety (Generalized Anxiety Disorder 7) prior to the intervention. Participants in the DOG group received a 10-minute therapy dog intervention before dental procedures in sessions 1 and 2, while participants in the SC group rested quietly for 10 minutes before their procedure. The SC participants received the 10-minute therapy dog intervention before dental procedures in the third and final session, while patients in the DOG group received no intervention prior to their third procedure. After the dental procedures, patients completed a questionnaire about their satisfaction with the dog therapy (Therapy Satisfaction Scale) and recorded their anxiety and comfort levels on visual analog scales. Continuous electrocardiographic recording measured heart rate variability during the intervention and dental procedure. Prior to the intervention, most participants (90.9%) met the IDAF-4C+ criteria for dental anxiety, with 7 (21.2%) meeting the criteria for dental phobia. The DOG group participants expressed high satisfaction with the therapy dog intervention. No significant differences in heart rate variability were observed between the groups during dental procedures. Therapy dogs can effectively manage dental anxiety in adults with mild to moderate dental anxiety, offering potential benefits for oral healthcare.

Effect of ultrasonic vibration on the presence of voids in core build-up materials.

The core build-up procedure is utilized to restore teeth with limited remaining coronal tooth structure. However, voids have been observed radiographically within composite resin- and glass ionomer-based core build-ups, potentially compromising the mechanical strength of a fully restored tooth and requiring build-up replacement before a final restoration can be delivered. The purpose of this in vitro study was to determine whether applying ultrasonic vibration during core build-up placement reduces the presence of radiographically detectable voids. A total of 120 acrylic resin mandibular premolar analogs were fabricated using a 3-dimensional printer and randomly allocated into 4 groups (n = 30). Dual-cured composite resin or glass ionomer core build-ups were placed with or without vibration. The final build-ups were assessed radiographically and rated by 3 independent calibrated clinicians based on a 4-category scale for the severity of voids. In an ordinal logistic regression model with the void severity rating as the outcome, a significant interaction was found for glass ionomer, composite resin, and the use of ultrasonic vibration (P = 0.03). Vibration was associated with worse void severity ratings in glass ionomer specimens (P < 0.01). No effect of vibration was found in the composite resin specimens. The Fleiss kappa score (κ = 0.36) indicated fair agreement in all severity ratings among the 3 raters. These results suggest that the application of ultrasonic vibration during core build-up placement may not be clinically advantageous for improving restorative outcomes.

Shade matching and blending capabilities of a new single-shade composite: an in vivo study.

Demand for direct esthetic restorations is high, but shade matching can be challenging. Some manufacturers claim that a single product is able to match all colors of the human dentition, eliminating shade matching challenges. This in vivo study, which followed the International Commission on Illumination's (CIE) CIEDE2000 color difference standard (ΔE00), aimed to quantify the shade matching and blending capabilities of a single-shade composite (Omnichroma PLT) used as a direct veneer. A color difference of ΔE00 ≤ 1.8 was set as the acceptability threshold. Ten participants with an unrestored and noncarious maxillary left central incisor were enrolled in the study. Direct spectrophotometric measurements (CIE L*a*b*) were made on the tooth and then on composite cured on the tooth. Consistency in measurements and composite resin placement were attained through the use of a specially designed jig. A digital photograph was then taken with the composite in place, and colorimetric software was used to obtain the L*a*b* values at the most incisal and cervical edges of the restoration. These values were compared to those of the natural tooth structure immediately adjacent to the composite resin. The ΔE00 scores were calculated to determine the composite's ability to match the tooth shade beneath it (ΔEm) and to blend with the incisal (ΔEi) and cervical (ΔEc) tooth shades. Mean scores for ΔEm, ΔEi, and ΔEc were calculated, and an independent t test (α = 0.05) was used to compare means for ΔEi and ΔEc. The mean (SD) ΔE00 values were 6.16 (2.38), 3.90 (2.47), and 6.84 (1.80) for ΔEm, ΔEi, and ΔEc, respectively. A statistically significant difference (P = 0.008) was observed between ΔEi and ΔEc. As a direct veneer, the tested composite did not meet the acceptability threshold for any ΔE00 measurement; however, it was better at matching the incisal third of the tooth than it was the other thirds. More in vivo studies are needed to verify and expand on these results.

Differences in Perceived Stress During the COVID-19 Pandemic Among Military Dental Postgraduate Residents.

INTRODUCTION: In military training settings, stress can improve focus and motivation fostering effective learning. However, high perceived stress can be debilitating resulting in poor learning and clinical errors. Multiple studies have focused on medical residency stress; but there has been minimal focus on dental residents and even less on the impact of the unique stressors from the COVID-19 pandemic. The objectives of this study were to determine the impact of the COVID-19 pandemic on perceived stress of residents in a military dental residency training program and explore the association among perceived stress and anxiety, depression, sleep quality, and social support. MATERIALS AND METHODS: Dental residents (N = 20) at the Naval Postgraduate Dental School participated in this study. Residents were assessed via self-report measures quarterly from March 2020 through June 2021. The assessment included measures of anxiety (GAD-7), depression (PHQ-9), perceived stress (PSS), fatigue (FSI), and social support (DUKE-SSQ). RESULTS: Before the pandemic shutdown, 60% of participants reported high perceived stress. These residents reported an initial decrease in symptoms of anxiety, depression, and fatigue compared to residents reporting low pre-pandemic perceived stress but returned to baseline levels post-shutdown. Additionally, the high stress participants reported lower social support. CONCLUSIONS: Based on pre-pandemic perceived stress, participants responded differently to the impact of the pandemic shutdown. The low baseline stress participants may have a more robust sense of grit and resilience. These findings suggest that postgraduate dental training programs should integrate coping skills training opportunities, especially for residents reporting high perceived stress before residency.

The Impact of a Pandemic on a Military Oral and Maxillofacial Pathology Biopsy Service.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) and the resulting societal reaction presented new challenges to the medical community by limiting patient access to care in 2020 and 2021. The Navy Postgraduate Dental School (NPDS) oral and maxillofacial pathology biopsy service is dependent on in-office physician or dentist appointments and patient biopsies. The purpose of this study was to understand the regulatory and societal impacts of COVID-19 restrictions on biopsy service submissions by assessing NPDS biopsy submission quantities and disease distribution. MATERIALS AND METHODS: All NPDS oral and maxillofacial pathology biopsy submissions from calendar years 2015 to 2016 and 2019 to 2021 were evaluated, and patient demographics and biopsy diagnoses were recorded in a biopsy registry. Data collected included age, sex, biopsy site, and diagnosis. Data from 2015, 2016, and 2019 were defined as pre-COVID and 2020 and 2021 as COVID. Biopsy reports for each year were organized in quarters. Diagnoses were categorized as malignant, pre-malignant, or benign. Categorical and continuous data were evaluated and presented as counts with percentages and means or medians with standard deviations, respectively. Significant differences in proportions or means were assessed using chi-square analysis or Student t-test, respectively. Cases were aggregated by quarter and year and assessed for temporal trends using linear regression analysis. RESULTS: The study evaluated 9,351 biopsy submission reports. The annual pre-COVID count mean (± standard deviation) and yearly counts for 2020 and 2021 were 2,063 ± 33.3, 1,421, and 1,742, respectively. The mean (± standard deviation) percentage of diagnoses classified as malignant from pre-COVID, 2020, and 2021 were 2.46 ± 0.005%, 3.59%, and 3.04%, respectively. Case counts and representation as a percentage of all biopsy diagnoses for Human Papillomavirus (HPV)-associated squamous cell carcinoma increased significantly during COVID compared to pre-COVID years (P < .05). CONCLUSIONS: Overall, preventative COVID-19 health measures and protocols resulted in a reduction in biopsy submission frequency, particularly during the second quarter (April to June) of 2020. However, case counts for malignant biopsies remained consistent between pre-COVID and COVID time intervals, suggesting that the identification and analysis of cases requiring follow-on care were unaffected by COVID-19 protocols.

Comparative in vitro study of commercially available products for alveolar ridge preservation.

BACKGROUND: Ridge preservation is performed by placing a biocompatible product, following tooth extraction, to maintain bone volume. However, current ridge preservation therapies do not always maintain the volume required for future implant placement. Variations in surgical technique and material selection contribute to determining clinical outcomes. The wide variety of grafting materials available and conflicting efficacy reports make selecting the appropriate graft materials challenging. To investigate how different commercially available ridge preservation products might perform clinically: Helistat (collagen control) (Material 1), OsteoGen Plug (Material 2), Bio-Oss Collagen (Material 3), and J-Bone (native bone) (Material 4) were evaluated. METHODS: These products underwent field emission scanning electron microscopy, microcomputed tomography, helium pycnometry, and infrared spectra analysis. Human osteosarcomas were incubated on products and proliferation was monitored with CCK-8 and visualized with confocal microscopy. Scaffold osteoconductivity was evaluated through the cellular production of proteins osteocalcin, osteonectin, and osteopontin. RESULTS: Results indicated that products varied in porosity and pore interconnectivity. Although Material 3 was chemically similar to Material 4, Material 2 demonstrated significantly better biocompatibility. Functionally, Material 1 and Material 2 elicited higher osteonectin release than Material 3 and Material 4 which suggests the latter products suppress endogenous osteonectin secretion. Furthermore, osteopontin secretion was minimal for all products, while osteocalcin was elevated. This seems to suggest that high levels of mineralization might be deleterious for bone regeneration. CONCLUSIONS: Although all products are marketed as effective preservation products, the results demonstrated high variability in physical, chemical, and biological effects; however, this study suggests a product with higher ratio of collagen to mineral component may have the most desirable effects for the use in alveolar ridge preservation.

The Effect of Simulated Field Storage Conditions on Dental Restorative Materials for Military Field Use.

INTRODUCTION: Dental readiness, one critical component of medical readiness, is adversely impacted by dental emergencies. Many dental emergencies require restorative materials such as glass ionomers, resins, and zinc oxide eugenols to remedy them. The Authorized Dental Allowance List (ADAL) and Authorized Medical Allowance List (AMAL) contain the equipment and materials used by Navy dentists to treat Sailors and Marines. These supplies are subjected to harsh storage conditions on deployments. Much is known about how materials behave when stored at room temperature, but less is known about how their properties are affected after exposure to high temperatures and humidity. We subjected five dental restorative materials to storage in aggravated conditions, and then tested them to determine which products are more robust. MATERIALS AND METHODS: Unopened packages of Fuji Triage, Fuji IX GP (both GC America Inc., Alsip, Illinois), TPH Spectra ST Low Viscosity, Intermediate Restorative Material (both Dentsply Sirona, York, Pennsylvania), and Herculite XRV (Kerr Corporation, Orange, California) were exposed to 0, 5, or 10 days' storage at 30-60°C with 95% relative humidity. After storage in these aggravated conditions, we tested the compressive strength, hardness, elastic modulus, flexural strength, flexural modulus, sorption, and solubility of each material. RESULTS: The physical properties of all materials were affected by storage in aggravated conditions, though the properties of some materials degraded more than others. Both glass ionomers, Fuji Triage (P = 0.0012) and Fuji IX GP (P = 0.0031), and the composite Herculite XRV (P = 0.0253) lost compressive strength after 5 or 10 days in aggravated conditions. The hardness values for all materials were affected (P < 0.05) by the aggravated conditions, though the elastic modulus of TPH Spectra was not affected (P > 0.05). None of the materials lost flexural strength (P > 0.05) or had changes in their flexural modulus (P > 0.05). The water sorption behavior of Fuji Triage (P = 0.0426) and Fuji IX GP (P = 0.0201) changed after 10 days of aggravated storage, and the solubility of all materials was altered by the harsh conditions. CONCLUSION: Some materials degrade more than others in aggravated conditions. Both resin composite materials were more resistant to high temperatures and humidity levels than the glass ionomers tested. These changes in physical characteristics should be considered when reviewing or optimizing the ADAL/AMAL for different projected operational environments.

Optimization of a peptide extraction and LC-MS protocol for quantitative analysis of antimicrobial peptides.

We optimized a peptide extraction and LC-MS protocol for identification and quantification of antimicrobial peptides (AMPs) in biological samples. Amphipathic AMPs were extracted with various concentrations of ethanol, methanol, acetonitrile, formic acid, acetic acid or trichloroacetic acid in water. Yields were significantly greater for extraction with 66.7% ethanol than other extraction methods. Liquid chromatography was accomplished on a C18 column with a linear gradient of acetonitrile-formic acid, and mass spectrometry detection was performed in the positive electrospray multiple reaction monitoring mode by monitoring the transitions at m/z 385.2/239.2 and m/z 385.2/112.0 (AMP 1018), m/z 418.1/104.1 and m/z 418.1/175.1 (Methionine-1018). This method was shown to be reliable and efficient for the identification and quantification of scorpion AMPs Kn2-7 and its D-isomer dKn2-7 in human serum samples by monitoring the transitions at m/z 558.7/120.2 and m/z 558.7/129.1 (Kn2-7/dKn2-7).

Construction of a genetically modified T7Select phage system to express the antimicrobial peptide 1018.

Bacteriophage therapy was an ascendant technology for combating bacterial infections before the golden age of antibiotics, but the therapeutic potential of phages was largely ignored after the discovery of penicillin. Recently, with antibiotic-resistant infections on the rise, these phages are receiving renewed attention to combat problematic bacterial infections. Our approach is to enhance bacteriophages with antimicrobial peptides, short peptides with broad-spectrum antibiotic or antibiofilm effects. We inserted coding sequences for 1018, an antimicrobial peptide previously shown to be an effective broad-spectrum antimicrobial and antibiofilm agent, or the fluorescent marker mCherry, into the T7Select phage genome. Transcription and production of 1018 or mCherry began rapidly alter E. coli cultures were infected with genetically modified phages. mCherry fluorescence, which requires a 90 min initial maturation period, was observed in infected cultures after 2 h of infection. Finally, we tested phages expressing 1018 (1018 T7) against bacterial planktonic cultures and biofilms, and found the 1018 T7 phage was more effective than the unmodified T7Select phage at both killing planktonic cells and eradicating established biofilms, validating our phage-driven antimicrobial peptide expression system. The combination of narrow-spectrum phages delivering relatively high local doses of broad-spectrum antimicrobials could be a powerful method to combat resistant infections. The experiments we describe prove this combination is feasible in vitro, but further testing and optimization are required before genetically modified phages are ready for use in vivo.

Evidence for a serum factor that initiates the re-calcification of demineralized bone.

The present studies show for the first time that demineralized bone re-calcifies rapidly when incubated at 37 degrees C in rat serum: re-calcification can be demonstrated by Alizarin Red and von Kossa stains, by depletion of serum calcium, and by uptake of calcium and phosphate by bone matrix. Re-calcification is specific for the type I collagen matrix structures that were calcified in the original bone, with no evidence for calcification in periosteum or cartilage. Re-calcification ceases when the amount of calcium and phosphate introduced into the matrix is comparable to that present in the original bone prior to demineralization, and the re-calcified bone is palpably hard. Re-calcified bone mineral is comparable to the original bone mineral in calcium to phosphate ratio and in Fourier transform infrared and x-ray diffraction spectra. The serum activity responsible for re-calcification is sufficiently potent that the addition of only 1.5% serum to Dulbecco's modified Eagle's medium causes bone re-calcification. This putative serum calcification factor has an apparent molecular mass of 55-150 kDa and is inactivated by trypsin or chymotrypsin. The serum calcification factor must act on bone for 12 h before re-calcification can be detected by Alizarin Red or von Kossa staining and before the subsequent growth of calcification will occur in the absence of serum. The speed, matrix-type specificity, and extent of the serum-induced re-calcification of demineralized bone suggest that the serum calcification factor identified in these studies may participate in the normal calcification of bone.