Regeneration of periodontal bone defects with mesenchymal stem cells in animal models. Systematic review and meta-analysis.

The aim of this study was to evaluate the efficacy of mesenchymal stem cells (MSCs) in the regeneration of periodontal bone defects in animal models. A systematic review and meta-analysis were conducted following the PRISMA guidelines, and the study was recorded in PROSPERO under reference number CDR42021247462. The PICO question was: is periodontal regeneration (cementum, periodontal ligament and alveolar bone) with MSCs more effective than other techniques? Three groups were considered: Group 1: MSCs alone or mixed with regenerative materials. Group 2: only regenerative materials. Group 3: no regenerative material nor MSCs. The search was conducted using MeSH with a total of 18 articles for qualitative analysis and 5 for quantitative analysis. For the meta-analysis, a modification of the effect size algorithm was developed, which considered a comparison of means between treatments using the Student's t sample distribution. When comparing the effect size between Group 1 and Group 2, the effect size for the new cementum was 2.83 mm with an estimated confidence interval of 95% (CI 95%) between 0.48 and 5.17 mm. When considering the fit to a random-effects model, the combined variance (τ2) was 6.1573 mm, with a standard deviation (SD) of 5.6008 mm and a percentage of total heterogeneity I2 of 92.33% (p < 0.0001). For new bone, the effect size was 0.88 mm, CI 95% - 0.25 to 2.01 mm, τ2 = 1.3108 mm (SD = 1.2021 mm) and I2 = 80.46%, p = 0.0004). With regard to the new periodontal ligament, it was not possible for the meta-analysis to be performed. MSCs have a greater capacity for tissue regeneration in root cementum than in alveolar bone compared to other regenerative materials.

Consensus report of the XI Congress of the Spanish Society of Odontology for the handicapped and special patients.

This article summarizes the findings of consensus of the XI congress of the SEOEME. All of these conclusions are referring to the review articles responsible to the general rapporteurs in order to bringing up to date knowledge with regard to the use of implants in patients medically compromised and with special needs and, in the dental management of autism and cerebral palsy, in the dental treatment of patients with genetic and adquired haematological disorders, the dental implications of cardiovascular disease and hospital dentistry.

Towards a circular economy in virgin olive oil production: Valorization of the olive mill waste (OMW) "alpeorujo" through polyphenol recovery with natural deep eutectic solvents (NADESs) and vermicomposting.

Virgin olive oil (VOO) production generates large amounts of a harmful by-product, olive mill waste (OMW) or alpeorujo, which has a strong environmental impact and that must be recycled to adapt VOO production to a circular economy model. Here, the valorization of OMW was studied by considering three consecutive stages: Stage 1 involves the generation of OMW; Stage 2 the recovery of bioactive phenolic compounds from the fresh OMW using natural deep eutectic solvents (NADESs), generating a valuable phenolic extract and a new by-product, a dephenolized OMW named "alpeoNADES"; and Stage 3 involves vermicomposting alpeoNADES with Eisenia fetida earthworms. Six NADES were formulated and tested, selecting a NADES composed of citric acid and fructose (CF) derived from food grade and biodegradable substances. CF was the most effective solvent to obtain phenolic extracts for nutraceutical and agronomical purposes, extracting 3988.74 mg/kg of polyphenols from fresh OMW. This alpeoNADES is a non-palatable substrate for E. fetida earthworms, as the residual CF gives it an acidic pH (pH 2). Its palatability was improved by mixing it with horse manure and straw for vermicomposting, in a 1:1 and 3:1 dry weight ratio. When these substrates were precomposted for 3 weeks they reached pH 5.5-6 and they could then be vermicomposted for 23 weeks (using OMW as a control). The best substrate for vermicomposting was determined by the worm biomass, growth rate, carbon to nitrogen (C:N) ratio, and N and P content. AlpeoNADES and manure 3:1 produced the highest quality vermicompost in the shortest time, generating a product that complied with European standards for organic fertilizers. Hence, alpeoNADES was recycled to a low-cost, organic balanced fertilizer in Stage 3, enabling the olive oil industry to transition to sustainable production through this integrated circular economy design.

Prevalence of systemic diseases among patients requesting dental consultation in the public and private systems.

OBJECTIVES: To determine the prevalence and aetiology of systemic disease among patients requesting dental treatment in public and private practice. STUDY DESIGN: A retrospective analysis was performed of the medical histories of 2000 patients requesting dental treatment during the year 2009. One thousand patients came from the Fontiñas Primary Care Oral and Dental Health Unit of the Galician Health Service (SERGAS), Spain, and the other thousand from a private clinic; both clinics were situated in Santiago de Compostela, La Coruña, Spain. The data collected were the following: demographic data (age and sex), presence or absence of systemic diseases and the nosologic categories, and drug history (type and number of drugs). RESULTS: The prevalence of systemic disease was significantly higher among patients seen in the public system (35.2% in the public system versus 28.1% in the private system; p= 0.003). The differences between the two systems were more marked when considering patients aged under 65 years, particularly with respect to rheumatic and endocrine-metabolic (diabetes) disorders. The prevalence of patients receiving polypharmacy (>4 drugs/day) was significantly higher among patients seen in the public system (5.7% in the public system versus 2.7% in the private system; p= 0.009). CONCLUSIONS: There is a high prevalence of medical disorders and of patients receiving polypharmacy among individuals requesting dental care, particularly in the public health system. Dentists must have adequate training in medical disease and must be fully integrated into primary care health teams in order to prevent or adequately resolve complications.

In vivo substantivity of 0.12% and 0.2% chlorhexidine mouthrinses on salivary bacteria.

The in vivo antimicrobial activity of 0.12% and 0.2% chlorhexidine (CHX) on the salivary flora up to 7 h after its application, using epifluorescence microscopy with the SYTO 9/propidium iodide dual staining, was evaluated. Fifteen volunteers performed a single mouthrinse with sterile water (SM-water), a single mouthrinse with 0.12% CHX (0.12% SM-CHX) and a single and double mouthrinse with 0.2% CHX (0.2% SM-CHX and 0.2% DM-CHX). Samples of saliva were taken at 30 s, and 1, 3, 5, and 7 h after each application. In comparison with SM-water, 0.2% CHX (SM and DM) showed a significant antibacterial effect up to 7 h after the mouthrinse, whereas this effect only persisted up to 5 h after the 0.12% SM-CHX mouthrinse. On comparing the two concentrations of CHX, significantly higher percentages of bacterial vitality were observed in all the saliva samples after the use of 0.12% CHX than after 0.2% CHX. On comparison of the 0.2% SM-CHX and 0.2% DM-CHX, significantly higher percentages of live bacteria were observed in the saliva samples taken at 1, 3, 5, and 7 h after the single mouthrinse compared with the double mouthrinse. The 0.2% CHX mouthrinse had the greatest antimicrobial activity on the salivary flora up to 7 h after its application, with a progressive recovery in bacterial vitality. The differences observed with respect to the 0.12% CHX mouthrinse demonstrate the influence of the concentration on its immediate antimicrobial activity and substantivity.

Screening for hypertension in a primary care dental clinic.

OBJECTIVE: The aim of this study was to record blood pressure in patients during their visit to a dental clinic, with the aim of identifying those who have high blood pressure and are unaware of it, as well as those who are aware of their condition but do have their blood pressure under adequate control. STUDY DESIGN: We designed a cross-sectional study which included 154 patients who were seen for a dental checkup at the Primary Dental Care of the Gallician Health Service (SERGAS). All participants completed a standardized medical questionnaire after measuring their systolic blood pressure (SBP) and diastolic blood pressure (DBP), which was conducted using the protocol established by the Spanish Society of Hypertension-Spanish League for the Fight Against Hypertension (HTA). RESULTS: In 45 patients (29%), the figures for blood pressure were recorded as SBP>or=140 mmHg and/or DBP>or=90 mmHg, indicating that they may have hypertension. Only 12 of them had been previously diagnosed with hypertension, but did not have their blood pressure under adequate control. The remaining 33 had no history of hypertension and were referred to a family physician, but only 19 saw their doctor; 11 of these patients were given non-pharmacological treatment, 6 were prescribed drug treatment and no type of treatment was indicated for the other two patients. CONCLUSIONS: By screening for hypertension, especially among patients who are more than 40 years old, the dentist can play an important role in the early diagnosis.

Control of drooling using transdermal scopolamine skin patches. A case report.

Transdermal scopolamine has been shown to be very useful in the management of drooling, particularly in patients with neurological or neuropsychiatric disturbances or severe developmental disorders. In this paper, we present the case of a 24-year-old patient with a diagnosis of cerebral palsy and a severe problem of drooling, exacerbated by marked mandibular prognathism. After exclusion of other therapeutic alternatives, it was decided to use sustained-release transdermal scopolamine patches (Scopoderm TTS). This technique consists of the application every three days of a patch with 1.5 mg of scopolamine in the area of the mastoid apophysis; the patch releases a dose of 0.5 mg of the active substance over each 24 hour period. The patient underwent periodic clinical and laboratory follow-up over a period of three years, achieving satisfactory results with no significant undesirable effects.

Oral health status in patients with moderate-severe and terminal renal failure.

AIMS: To evaluate the oral health status of patients with moderate-severe chronic renal failure (CRF) and with terminal renal failure (TRF). DESIGN: The study group was formed of 50 patients: 22 (44%) with moderate-severe CRF and 28 (56%) with TRF included in a haemodialysis programme. The controls (n=64) presented similar characteristics with regard to sex, age, weight and educational level. A single dentist performed an intraoral examination on all the subjects, gathering information on: number of decayed, missing or filled teeth; supragingival plaque accumulation; calculus deposits; periodontal pockets in the Ramfjord teeth; and depth of loss of insertion. RESULTS: No significant differences were detected in the values of the DMF index between the two groups. The mean number of decayed teeth was lower in the patients than in the controls, showing a tendency to statistical significance (p=0.052). The mean number of missing teeth was higher in the patients than in the controls (p=0.002). Twelve patients and seven controls were completely edentate. The mean number of filled teeth was significantly lower in the patients than the controls (p<0.001). Supragingival plaque accumulation and the loss of insertion were significantly greater in the patients than in the controls (p=0.006 and p<0.001, respectively). No significant differences were found with respect to the calculus deposits or to the presence of periodontal pockets in the two groups. The value of the DMF index, the mean number of teeth with caries and the number of filled teeth were significantly higher in the patients with moderate-severe CRF than in the patients with TRF (p=0.004, p=0.030 and p=0.006, respectively). CONCLUSIONS: Patients with CRF have a lower prevalence of caries, more supragingival plaque, more teeth with a loss of insertion and more missing teeth than the healthy controls. The prevalence of caries is affected by the severity of the renal failure and/or by haemodialysis treatment.

An update on the controversies in bacterial endocarditis of oral origin.

OBJECTIVES: The aim of this review was to evaluate the evidence implicating dental procedures in bacterial endocarditis (BE) development and the basis for antimicrobial prophylaxis (AP). STUDY DESIGN: In this article, the literature is reviewed and meaningful findings about epidemiology, pathogenesis, and AP guidelines for BE of oral origin are highlighted. Available results are used to formulate clinical recommendations for the dental practitioner. RESULTS: The nature of dental procedures that cause bacteremia, patients at risk for BE, and the effectiveness of AP guidelines, continue to be points of controversy. There appears to be further evidence to support the important role of oral health status in the prevention of BE of dental origin. CONCLUSIONS: One objective of the dental practitioner in caring for patients at risk for BE should be to promote oral health care. There are no hard data on which to scientifically base the need for AP in patients at risk for BE. However, it would appear prudent, at least from the medicolegal perspective, to provide AP, at least to persons with previous BE or prosthetic heart valves and to those undergoing oral surgery, periodontal treatment, or implant placement.

A multidisciplinary approach to the treatment of oral manifestations associated with Beckwith-Wiedemann syndrome: a long-term case report.

BACKGROUND: Beckwith-Wiedemann syndrome (BWS) is a congenital disorder that involves a somatic overgrowth during the patient's first years of life. Exomphalos, macroglossia and gigantism are the main clinical symptoms. CASE DESCRIPTION: The authors describe a 15-year follow-up in a patient with BWS. They focus on a multidisciplinary approach to treating the patient's oral manifestations from age 9 months. The approach included an initial physiotherapy treatment, a partial glossectomy, a first phase of orthopedic treatment with a tongue crib and chin cap, and a second phase of orthodontic treatment with an edgewise appliance. CLINICAL IMPLICATIONS: To obtain long-term positive and stable results, an appropriate treatment plan for patients with BWS and dentoskeletal alterations, including macroglossia, requires surgical tongue reduction when the patient is young, combined with physiotherapeutic phases and orthopedic and orthodontic treatment.

General anesthesia increases the risk of bacteremia following dental extractions.

OBJECTIVE: The influence of oral health status, the number of teeth extracted, and the anesthetic modality used is currently a matter of debate in the prevalence of bacteremia following dental extractions (BDE). The aim of the present study was to analyze the factors affecting the prevalence, duration, and etiology of BDE. STUDY DESIGN: Blood samples were collected from 210 patients at baseline, 30 seconds, 15 minutes, and 1 hour after performing dental extractions. Samples were processed in the Bactec 9240 and the subculture and further identification of the isolates were performed using conventional microbiological techniques. RESULTS: The prevalence of BDE at 30 seconds, 15 minutes, and 1 hour were 71%, 45%, and 12%, respectively. In the multivariate analysis, the "anesthetic modality" (local anesthesia versus general anesthesia) was the only variable related to BDE. CONCLUSION: General anesthesia represents a risk factor for BDE, increasing its prevalence and duration.

Evaluation of the substantivity in saliva of different forms of application of chlorhexidine.

OBJECTIVE: To evaluate the in vivo antimicrobial activity of different forms of application of chlorhexidine digluconate (CHX). METHOD AND MATERIALS: A group of 10 volunteers performed mouth rinsings with a 0.2% and 0.12% solution of CHX and applied CHX in the form of a 0.2% gel, a 0.2% and a 0.12% spray and a swab impregnated with a 0.2% solution. Samples of saliva were taken at baseline; 30 seconds; and 1, 3, 5, and 7 hours after each application. An epifluorescence microscopy technique (BacLight Live/Dead stain) was used to evaluate bacterial vitality. RESULTS: Bacterial vitality under basal conditions was 92%. At 30 seconds after CHX application, the lowest levels of viable bacteria were detected with the 0.2% and 0.12% solutions (1% and 8%, respectively). After 3 hours, the percentage of live bacteria achieved with the gel and sprays was similar to the basal figures (80% to 91%). At 7 hours, bacterial vitality recovered basal percentages, except with the 0.2% solution (77%). CONCLUSION: The 0.2% solution of CHX had the greatest sustained antimicrobial effect on the salivary flora, confirming the influence of the concentration and form of application on CHX substantivity.

Oral health status of patients with a mild decrease in glomerular filtration rate.

OBJECTIVE: The aim of this study was to evaluate the oral health status of patients with mildly decreased glomerular filtration rate (GFR). STUDY DESIGN: The study group comprised 80 adults with GFR 60-89 mL/min. A group of 80 age- and gender-matched control subjects with GFR > or =90 mL/min were selected. Medical history, clinical examination, and biochemistry blood tests were performed in patients and control subjects. Renal function was estimated using the Modification of Diet in Renal Disease formula. A single dentist performed an intraoral examination of each patient and control subject. RESULTS: No significant differences were detected between patients and controls in the number of decayed, missing, or filled teeth, supragingival plaque accumulation, calculus deposits, gingival inflammation, depth of periodontal pockets, clinical attachment loss, or dental mobility. CONCLUSION: To our knowledge, this is the first study on dental health in the early stages of chronic renal failure. The results suggest that in patients with mildly decreased GFR, there are no alterations of the oral health status.

Consensus Report of the XI Congress of the Spanish Society of Odontology for the Handicapped and Special Patients

This article summarizes the findings of consensus of the XI congress of the SEOEME. All of these conclusions are referring to the review articles responsible to the general rapporteurs in order to bringing up to date knowledge with regard to the use of implants in patients medically compromised and with special needs and, in the dental management of autism and cerebral palsy, in the dental treatment of patients with genetic and adquired haematological disorders, the dental implications of cardiovascular disease and hospital dentistry

Pre-assessment of severely handicapped patients suitable of dental treatment under general anesthesia.

OBJECTIVE: To analyze the importance of an individualized preoperative assessment in severely handicapped patients suitable of dental treatment under general anesthesia (GA). DESIGN: The study group consisted of 564 patients referred to a Special Needs Unit specialized in the dental care of handicapped people, who would be treated under GA. Medical and dental records of every patient were evaluated, as well as the findings in the oral examination and the assessment carried out by the anesthesiologists. RESULTS: Approximately 15% of patients (n=84) did not have any dental needs at the time of the examination; 42% (n=234) underwent treatment under GA and 43% (n=242) were treated under local anesthesia. Only 1.7% of the patients liable to undergo GA were discharged by the anesthesiologist due to their systemic condition. Medical and dental complications were scarce and, generally mild. During the follow-up period (mean 44 +/- 6 months) 4.8% of patients needed another treatment session under GA due to new dental pathology. CONCLUSION: Applying systematic selection criteria to perform any dental treatment under GA in severely handicapped patients reduces the indiscriminate use of this technique, minimizing complications as well as the necessity of new interventions.

Chemoprophylaxis of bacterial endocarditis recommended by general dental practitioners in Spain.

The aim of this study was to assess the current practice of antibiotic prophylaxis of Bacterial Endocarditis (BE) among General Dental Practitioners (GDPs) in Spain. GDPs were asked over the telephone by a fictitious patient what antibiotic prophylaxis they would administer to an "at risk" patient for BE before a tooth extraction. Four hundred randomly selected Spanish GDPs were surveyed, 200 of them were asked about BE prophylaxis in penicillin non-allergic patients and the remaining 200 in penicillin allergic patients. Of the GDPs surveyed, 182 (45.5%) did not recommend any prophylactic treatment; 74.7% of those stated that an oral examination before treatment was needed and 25.3% referred the patient to his/her physician or cardiologist for further advice. Of the 97 GDPs who recommended antibiotics to penicillin nonallergic patients, only 30 (30.9%) suggested the prophylactic guidelines proposed by the American Heart Association or the British Society for Antimicrobial Chemotherapy. For penicillin allergic patients, 68.2% of the GDPs prescribed erythromycin as the antibiotic of first choice, while 17.6% of the GDPs prescribed clindamycin. Nonetheless, fewer than 30% administered both antibiotics with the adequate dosages. These results show important gaps in the knowledge of antibiotic prophylaxis for "at risk" patients before dental procedures among Spanish GDPs.

Oral health status in patients with moderate-severe and terminal renal failure

Objetivos. Evaluar el estado de salud oral de pacientes con insuficiencia renal crónica moderada/severa (IRC-MD) y con fallo renal terminal (FRT).Diseño. El grupo de estudio lo constituyeron 50 pacientes: 22 (44%) con IRC-MD y 28 (56%) con FRT incluidos en un programa de hemodiálisis. Los controles (n= 64) tenían características similares en relación al sexo, edad, peso y nivel educacional. Se realizó una exploración intraoral a todos los participantes recogiendo información acerca de: número de dientes cariados, ausentes y obturados; acúmulo de placa supragingival; acúmulo de cálculo; profundidad de bolsas periodontales en los dientes de Ramfjord; y pérdida de inserción. Resultados. No se detectaron diferencias significativas en los valores del índice CAO entre pacientes y controles. El número medio de dientes cariados fue inferior en los pacientes que en los controles (p= 0,052). En los pacientes, el número medio de dientes ausentes fue mayor que en los controles (p= 0,002). Había 12 pacientes y 7 controles totalmente edéntulos. El número medio de dientes obturados fue significativamente inferior en los pacientes que en los controles (p< 0,001). El acúmulo de placa supragingival y la pérdida de inserción fue significativamente mayor en los pacientes que en los controles (p= 0,006 y p< 0,001, respectivamente). No se encontraron diferencias significativas en relación al acúmulo de cálculo ni a la presencia de bolsas periodontales entre ambos grupos. El valor del índice CAO, el número medio de dientes cariados y el de obturados fue significativamente superior en los pacientes IRC-MD que en los pacientes FRT (p= 0,004, p= 0,030 y p= 0,006, respectivamente). Conclusión. Los pacientes con IRC tienen menor prevalencia de caries, más placa supragingival, más dientes con pérdida de inserción y más ausencias dentarias, que los controles sanos. La prevalencia de caries está condicionada por la severidad de la insuficiencia y/o por el tratamiento de hemodiálisis

Aims. To evaluate the oral health status of patients with moderate-severe chronic renal failure (CRF) and with terminal renal failure (TRF).Design. The study group was formed of 50 patients: 22 (44%) with moderate-severe CRF and 28 (56%) with TRF included in a haemodialysis programme. The controls (n=64) presented similar characteristics with regard to sex, age, weight and educational level. A single dentist performed an intraoral examination on all the subjects, gathering information on: number of decayed, missing or filled teeth; supragingival plaque accumulation; calculus deposits; periodontal pockets in the Ramfjord teeth; and loss of insertion. Results. No significant differences were detected in the values of the DMF index between the two groups. The mean number of decayed teeth was lower in the patients than in the controls, showing a tendency to statistical significance (p=0.052). The mean number of missing teeth was higher in the patients than in the controls (p=0.002). Twelve patients and seven controls were completely edentate. The mean number of filled teeth was significantly lower in the patients than the controls (p<0.001). Supragingival plaque accumulation and the loss of insertion were significantly greater in the patients than in the controls (p=0.006 and p<0.001, respectively). No significant differences were found with respect to the calculus deposits or to the presence of periodontal pockets in the two groups.The value of the DMF index, the mean number of teeth with caries and the number of filled teeth were significantly higher in the patients with moderate-severe CRF than in the patients with TRF (p=0.004, p=0.030 and p=0.006, respectively). Conclusions. Patients with CRF have a lower prevalence of caries, more supragingival plaque, more teeth with a loss of insertion and more missing teeth than the healthy controls. The prevalence of caries is affected by the severity of the renal failure and/or by haemodialysis treatment

Prevalence of systemic diseases among patients requesting dental consultation in the public and private systems

Objectives: To determine the prevalence and aetiology of systemic disease among patients requesting dental treatment in public and private practice. Study Design: A retrospective analysis was performed of the medical histories of 2000 patients requesting dental treatment during the year 2009. One thousand patients came from the Fontiñas Primary Care Oral and Dental Health Unit of the Galician Health Service (SERGAS), Spain, and the other thousand from a private clinic; both clinics were situated in Santiago de Compostela, La Coruña, Spain. The data collected were the following: demographic data (age and sex), presence or absence of systemic diseases and the nosologic categories, and drug history(type and number of drugs).Results: The prevalence of systemic disease was significantly higher among patients seen in the public system(35.2% in the public system versus 28.1% in the private system; p= 0.003). The differences between the two systems were more marked when considering patients aged under 65 years, particularly with respect to rheumatic and endocrine-metabolic (diabetes) disorders. The prevalence of patients receiving polypharmacy (>4 drugs/day)was significantly higher among patients seen in the public system (5.7% in the public system versus 2.7% in the private system; p= 0.009).Conclusions: There is a high prevalence of medical disorders and of patients receiving polypharmacy among individuals requesting dental care, particularly in the public health system. Dentists must have adequate training in medical disease and must be fully integrated into primary care health teams in order to prevent or adequately resolve complications (AU)

Screening for hypertension in a Primary Care Dental clinic

Objective: The aim of this study was to record blood pressure in patients during their visit to a dental clinic, withthe aim of identifying those who have high blood pressure and are unaware of it, as well as those who are awareof their condition but do have their blood pressure under adequate control.Study design: We designed a cross-sectional study which included 154 patients who were seen for a dental checkupat the Primary Dental Care of the Gallician Health Service (SERGAS). All participants completed a standardizedmedical questionnaire after measuring their systolic blood pressure (SBP) and diastolic blood pressure (DBP),which was conducted using the protocol established by the Spanish Society of Hypertension-Spanish League forthe Fight Against Hypertension (HTA).Results: In 45 patients (29%), the figures for blood pressure were recorded as SBP¡Ý140 mmHg and/or DBP ¡Ý90mmHg, indicating that they may have hypertension. Only 12 of them had been previously diagnosed with hypertension,but did not have their blood pressure under adequate control. The remaining 33 had no history ofhypertension and were referred to a family physician, but only 19 saw their doctor; 11 of these patients were givennon-pharmacological treatment, 6 were prescribed drug treatment and no type of treatment was indicated for theother two patients.Conclusions: By screening for hypertension, especially among patients who are more than 40 years old, the dentistcan play an important role in the early diagnosis (AU)

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