Dentists' knowledge of non-surgical root canal treatment, a systematic review.

OBJECTIVES: Dental practice is based upon dentists' cognitions, knowledge being foundational. Knowledge is attained through education and perception. Although knowledge is modulated by beliefs, attitudes, preferences, and behaviors, it is essential to evidence-based practice. Cross-sectional studies uniformly demonstrate that community NSRCT is of sub-optimal quality worldwide, is lack of knowledge a problem? Our purpose was to measure dentists' knowledge of root canal treatment (NSRCT). DATA: Quantitative and qualitative data were extracted: purpose, topics assessed, authors cited knowledge sources, number of dentists studied, number of questions, authors descriptors of knowledge level,% correct answers by question, authors recommendations. SOURCES: OVID Medline, EMBASE, Web of Science, and hand-searching. STUDY SELECTION: Studies which had measured dentists' knowledge of non-surgical root canal treatment that was valuable, reliable, and had practical implications which could be implemented. A total of 51 papers from 19 countries measured the knowledge of 15,580 dentists using 445 questions on 29 root canal treatment topics. CONCLUSIONS: 'Gold standards' were from literature, external bodies, or expert consensus in 47, 31, and 2 papers respectively. Levels of knowledge by percentage correct answers among studies were poor to moderate and varied considerably. The mean, for the 50 studies where overall study percentages could be calculated, was 57 %, standard deviation 17 %, and a range of 16 % to 82 %. Authors' adjectives describing knowledge levels were generally negative. Additional education was advised in 49 papers, but without evidence that education was inadequate; 6 papers recommended increased use of protocols; only 5 papers advocated research on the cause of lack of knowledge. CLINICAL SIGNIFICANCE: Dentists' root canal treatment knowledge was found to be poor to moderate, as well variable. This may constrain quality of care. However, provision of information without attention to dentists' cognitions and motivations may not be successful. Educational strategies and goals should be re-evaluated. Evidence-based practice faces many barriers.

Low-dose emicizumab prophylaxis in patients with severe hemophilia A: a retrospective study bringing new hope for our patients.

BACKGROUND: Low-dose emicizumab can potentially offer a cost-effective treatment option in persons with hemophilia A, especially in developing countries. OBJECTIVES: To compare the efficacy and safety of low-dose emicizumab with those on low-dose factor (F)VIII prophylaxis via chart review. METHODS: After ethics approval, chart data of 2 groups of patients were reviewed: group 1 (low-dose emicizumab, n = 10; 3 mg/kg monthly without a loading dose) and group 2 (low-dose FVIII prophylaxis, n = 10; 10-20 IU/kg of FVIII concentrates twice a week). Outcomes were target joints, annual bleeding rate, annual joint bleeding rate, Hemophilia Joint Health Score, nonactivated thromboelastometry-rotational thromboelastometry clotting time, plasma emicizumab levels, and direct costs of treatment. RESULTS: All outcome measures were significantly better in the low-dose emicizumab group than in the low-dose FVIII prophylaxis group. For nonactivated thromboelastometry-rotational thromboelastometry, median values after 6 months in the low-dose emicizumab group were comparable with values seen in patients with mild hemophilia, while the values in the low-dose FVIII prophylaxis group were similar to those of patients with moderate hemophilia. The direct cost of low-dose emicizumab was found to be approximately US $6000 and that for low-dose recombinant FVIII prophylaxis used in our study was US $6282 (the cost may range from US $3432 to $7920 depending on the type of factor) when compared to approximately US $15 000 for standard-dose emicizumab. CONCLUSION: Low-dose emicizumab offers a cost-effective treatment option and can improve access in developing countries. These findings need to be confirmed in a larger and better-controlled study.

Effectiveness of an extraoral cold and vibrating device in reducing pain perception during deposition of local anesthesia in pediatric patients aged 3-12 years: a split-mouth crossover study.

Background: Local anesthetic injections may induce pain in children, leading to fear and anxiety during subsequent visits. Among the various approaches recommended to reduce pain, one is the use of a Buzzy Bee™ device that operates on the concept of gate control theory and distraction. The literature regarding its effectiveness during the deposition of local anesthesia remains limited; hence, the aim of the present study was to determine the efficacy of extraoral cold and vibrating devices in reducing pain perception during the deposition of local anesthesia. Methods: A split-mouth crossover study in which 40 children aged 3-12 years requiring maxillary infiltration or inferior alveolar nerve block for extractions or pulp therapy in the maxillary or mandibular posterior teeth were included. The control intervention involved the application of topical anesthetic gel for one minute (5% lignocaine gel), followed by the administration of local anesthetic (2% lignocaine with 1:80,000 adrenaline) at a rate of 1 ml/minute. Along with the control protocol, the test intervention involved using the Buzzy Bee™ device for 2 minutes before and during the deposition of the local anesthetic injection. The heart rate and face, legs, arms, cry, and consolability revised (FLACC-R) scale scores were recorded by the dentist to assess the child's pain perception. Results: The mean age of the participants in Group A and Group B was 7.050 ± 3.12 years and 7.9 ± 2.65 years respectively. A reduction in the mean heart rate and FLACC-R score was observed during the deposition of local anesthetic solution in the tissues when the Buzzy Bee™ was used in both groups at different visits in the same subjects (P < 0.05) The Buzzy Bee™ device was effective in reducing the heart rate and FLACC-R scores when used during maxillary infiltration and inferior alveolar nerve block local anesthesia techniques (P < 0.05). Conclusion: The use of extraoral cold and vibrating devices significantly reduces pain perception during local anesthetic deposition in pediatric patients. Considering the results of this study, the device may be incorporated as an adjunct in routine dental practice while administering local anesthesia in children.

Influence of pretreatment exposure to pediatric dental care using the "Tiny dentist" game on 4-7 years old children's pain and anxiety: a parallel randomised clinical trial.

There have been no experiments on interactive modelling through computer games, although there have been a few on modelling a pre-exposure method for managing anxiety among preschoolers. The impact of partaking in a dental simulation game prior to the dental treatment on pain and anxiety in kids aged 4 to7 years during their first appointment was studied. A total of 156 kids who required unilateral pulp therapy and preformed crowns on their mandibular primary molars were enrolled in this double-blind, randomized clinical trial. They were then randomly assigned to intervention and control groups. The intervention group engaged in the game three times/day for 07 days prior to the anticipated appointment. The Wong-Baker Faces Rating Scale (WBFRS) was used to record their pre- and post-operative pain experienced during the dental procedure. Additionally, a finger pulse oximeter was used to record heart rate (HR) at each of the six treatment phases: baseline (the first session, two weeks prior to treatment) and stages 2-6. Playing video games considerably lowered the heart rate. Playing and the treatment period interacted in a major way. On comparing the groups at every time point, the intervention group displayed lower HR during injection, tooth preparation with an air-rotor and biomechanical preparation with endodontic rotary files.The results suggest that engaging in specific dental simulation games prior to the 1st dentist visit could help preschoolers feel less anxious during routine dental operations.

Evaluating the Efficacy of Certain Intermediate Irrigants in Preventing Precipitate Formed Due to Sodium Hypochlorite and Chlorhexidine Within the Root Canal System: An In Vitro Study.

AIM: Root canal irrigation using a mixture of sodium hypochlorite (NaOCL) and chlorhexidine gluconate (CHX) might cause a precipitate to develop. This study aims to check the efficacy of sodium thiosulfate and normal saline as irrigating solutions. MATERIALS AND METHODS: Roots of 45 teeth were biomechanically prepared, and the teeth were then tested. A size 15k file was introduced to the point where the apical foramen could be visible in order to provide an accurate reading of the working length. As a precaution against irrigating solutions leaking out, the specimens' tips were sealed with modeling wax before being instrumented. Each group's root canals were instrumented with #F4 hand Protaper (Dentsply Sirona, USA) as recommended by the manufacturer. Between instrumentation, The canals were lubricated with ethylenediamine tetraacetic acid (EDTA) and irrigated with 2.5% sodium hypochlorite (RC Help, Prime Dental, Mumbai, India). Fifteen samples were randomly assigned to one of three experimental categories based on the middle watering arrangement used: Group 1 (control), Group 2 (saline irrigant), and Group 3 (3.86% sodium thiosulfate). The jewel plate was submerged in water to cool it down, while two longitudinal scores were made on the root's buccal and lingual surfaces. We used a stereomicroscope to examine the exposed surfaces of the root trench in the coronal, middle, and apical thirds for the orange-earthy colored material (Stereozoom Nikon magnifying lens under 20X amplification), and we used the Mann-Whitney U test and the Kruskal Wallis test during our thorough analysis. RESULTS: The precipitation generated in the coronal, middle, and apical thirds had significantly different thicknesses. While precipitation did occur in all three regions, it was at a much lower rate in the apical third compared to the coronal and middle regions. In Group 1, the control group, the precipitate was thicker than in Groups 2 (saline irrigant) and 3 (3.86% sodium thiosulfate). CONCLUSION: Sodium thiosulfate, which is a biocompatible solution, can be used as an intermediate irrigant as it shows less precipitate as compared to saline.

Antibody profile in post-vaccinated & SARS-CoV-2 infected individuals.

Background & objectives: During the COVID-19 pandemic it was important to assess the antibody profile in individuals vaccinated with Covaxin (BBV152) and Covishield (ChAdOx1 nCoV-19) with both 28 and 84 days gaps between two doses, those infected with SARS-CoV-2 and post-COVID-19-infected individuals vaccinated with only one dose of either of the vaccines. The present study was aimed to assess these objectives. Methods: Fifty real time reverse transcription-polymerase chain reaction (qRT-PCR)-confirmed COVID-19-infected individuals, along with 90 COVID-19-naïve (BBV152 and ChAdOx1 nCov-19)-vaccinated individuals, were included in the study. Individuals who received a single dose of either vaccine with a confirmed past diagnosis of SARS-CoV-2 infection (n=15) were also included. Blood samples were collected strictly between the 4th and 5th wk after development of symptoms for SARS-CoV-2 infected individuals and after the first/second vaccination dose. Antibody profile assessment was done using whole-virus, spike-receptor binding domain (RBD) and nucleocapsid-specific ELISA kits along with neutralizing antibody kit. Results: There was an overall 97.7 per cent seropositivity rate in vaccinated individuals, and a strong correlation (R2=0.8, P<0.001) between neutralizing and spike-RBD antibodies. Among individuals who received two standard doses of ChAdOx1 nCoV-19 vaccine, the spike antibody levels developed were of higher titre with a longer prime boost interval than in those with shorter intervals (P<0.01). Individuals vaccinated with two doses as well as only one dose post-SARS-CoV-2 infection had high neutralizing and spike-specific antibodies. Interpretation & conclusions: High neutralizing and spike-specific antibodies were developed in individuals vaccinated only with one dose of either vaccine post-SARS-CoV-2 infection. With the main priority being vaccinating majority of the population in our country, single-dose administration to such individuals would be a sensible way to make the most of the limited supplies. Furthermore, neutralizing antibody levels observed in COVID-19-naïve vaccinees imply the need for booster vaccination.

Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review.

BACKGROUND: Knowledge of the cytotoxicity and bioactivity of endodontic materials may assist in understanding their ability to promote dental pulp stem cell activity and pulp healing in primary teeth. MATERIALS AND METHODS: This systematic review was carried out by searching the electronic databases such as PubMed, Google Scholar, and Cochrane reviews for the articles published between January 2000 and December 2018 using the appropriate MeSH keywords. An independent investigator evaluated the abstracts and titles for possible inclusion, as per the stipulated inclusion and exclusion criteria. The topics considered for extracting data from each study were: cell lineage, cytotoxicity assay used, and type of material tested. RESULTS: Seven eligible studies were selected for assessing the quality of evidence on the bioactivity of bioactive endodontic cements (BECs) (1 human cell line, 2 animal cell lines, and 4 in vitro, animal, and human studies) and 13 studies were selected for reviewing the quality of evidence on cytotoxicity (7 human cell lines, 4 animal cell lines, and 2 animal model studies). Very limited studies had been conducted on the bioactivity of materials other than mineral trioxide aggregate (MTA). With regards to cytotoxicity, the studies were diverse and most of the studies were based on MTT assay. Mineral trioxide aggregate is the most frequently used as well as studied root-end filling cement, and the literature evidence corroborated its reduced cytotoxicity and enhanced bioavailability. CONCLUSION: There was a lack of sufficient evidence to arrive at a consensus on the ideal material with minimal cytotoxicity and optimal bioactivity. More focused human/cell line-based studies are needed on the available root filling materials. CLINICAL SIGNIFICANCE: The present systematic review provides an update on the available literature evidence on the cytotoxicity and bioactivity of various BECs including MTAs and their influence on the different cells with respect to their composition and strength. HOW TO CITE THIS ARTICLE: Maru V, Dixit U, Patil RSB, et al. Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review. Int J Clin Pediatr Dent 2021;14(1):30-39.

Bivalirudin and sirolimus co-eluting coronary stent: Potential strategy for the prevention of stent thrombosis and restenosis.

Localized drug delivery with sustained elution characteristics from nanocarrier coated stents represents a viable therapeutic approach to circumvent concerns related to coronary stent therapy. We fabricated a Sirolimus (SRL) and Bivalirudin (BIV) releasing nanoparticles (NPs) coated stent for concurrent mitigation of vascular restenosis and acute stent thrombosis. SRL NPs were prepared by nanoprecipitation method whereas the BIV vesicles were generated using hydrophobic ion pair approach followed by micellization phenomenon. MTT assay and confocal microscopic analysis indicated superior anti-proliferative activity and higher cellular uptake of SRL NPs into human coronary artery smooth muscle cells, respectively. DSC and ATR-FTIR techniques confirmed the formation of complex between BIV and phosphatidylglycerol via some weak physical interactions. More than 2 fold rise in log P value was obtained for DSPG-BIV at 3:1 M ratio compared with native BIV solution. The SAXS analysis indicated formation of oligolamellar vesicles of DSPG-BIV complex which was preferentially entrapped into lipophilic lamellae of vesicles. APTT, PT, and TT tests revealed that the BIV vesicles caused significant prolongation of clotting time compared to native BIV solution. The SEM analysis showed uniform and defect free stent coating. In vitro release study demonstrated that SRL and BIV were eluted in a sustained manner from coated stents.

Differential response to FEIBA is strongly associated with the prothrombotic microparticles.

BACKGROUND: Treatment of patients with hemophilia with an inhibitor is generally done using bypassing agents (BPA), wherein variability in response is observed. Due to lack of validated laboratory assays, monitoring is being carried out by clinical response only. Emerging biomarkers like procoagulant microparticles (MPs) may prove to be promising. AIM: To analyze whether procoagulant MP levels correlate with clinical response to FEIBA therapy. MATERIALS AND METHODS: Total phosphatidylserine (PS) expressing MPs along with different cell derived MPs were measured in blood samples obtained prior and 2 hour post-FEIBA infusion in 64 bleeding episodes associated with 43 severe hemophilia patients. RESULTS AND DISCUSSION: Patients with excellent response showed statistically significant increase in %MP of PS-MPs (p < 0.0001; 95.0% CI Range: -64.33 to -24.42) when compared to those with moderate response; platelet %MP change was also found significantly associated (p < 0.05) with clinical response. In search of an assay for monitoring FEIBA, results though preliminary seem to be promising with increase in %PS-MP correlating well with the clinical response. Coagulation being multifactorial process involves multiple factors for balanced hemostasis, which needs to be accounted. Larger studies in this line may provide indications for usage of MPs as monitoring and dose adjustment tool of FEIBA therapy.

Intensification of delignification of sawdust and subsequent enzymatic hydrolysis using ultrasound.

The current work investigates intensification of delignification of sawdust and subsequent enzymatic hydrolysis to produce reducing sugars with the use of ultrasound. Alkaline hydrolysis of sawdust was initially performed to remove lignin which hampers the rate of enzymatic hydrolysis. Effect of different parameters in the case of ultrasound (US) assisted and conventional processes such as alkali concentration (0.5-2.5 N), substrate loading (0.2-1.0% w/v) and temperature (40-80 °C) have been investigated. Optimized parameters obtained for US assisted process showed better trends as compared to conventional process with about 1.25 times higher yields and significant reduction in time by about 4 h. The process parameters for US assisted and conventional enzymatic hydrolysis to produce reducing sugars were also optimized by varying substrate loading (0.5-10% w/v), reaction temperature (30-70 °C) along with variation in US power (10-80 W) and US duty cycle (30-90%). US assisted enzymatic hydrolysis performed at 4% w/v substrate loading along with 50 W US power and 50% duty cycle at 50 °C resulted in 7.46 mg/mL of reducing sugars yield within 1 h while conventional stirring with 6% w/v substrate loading and 50 °C resulted in approximately same yield of reducing sugars within 3 h. The requirement of lower time for similar yields or in other words higher yield in same time clearly highlights the process intensification benefits due to the use of ultrasound. Overall it can be concluded from the study that US assisted processes resulted in efficient delignification along with higher yield of reducing sugars in lower treatment time as compared to conventional process.

Role of lupus anticoagulants in immediate acting inhibitor positivity in congenital haemophilia A patients.

OBJECTIVES: Presence of lupus anticoagulants (LA) in haemophilia and their interference in coagulation assays is well-known. Factor VIII (FVIII) inhibitors are generally time and temperature dependent whereas LAs are immediate acting inhibitors (IAIs). The present study reports the challenges in laboratory detection of both progressive and non-progressive, specific FVIII inhibitors in the presence of LA. METHODS: From 2012 through 2015, 4900 HA patients were screened for inhibitors. APTT based inhibitor screening tests and Nijmegen-modified Bethesda assay (NBA) were done in all samples. LA test and FVIII inhibitors by ELISA were done in patients with IAIs. RESULTS: Out of 451 patients positive for inhibitors in the initial screening tests, classical and progressive FVIII inhibitors were observed in 398 patients while 53 had IAIs showing no/partial correction in 1:1 mixtures of NPP and patient plasma. In 27 patients, both FVIII and FIX activity levels were <1%, resulting in difficulty in diagnosis. In 48 HA patients with IAIs, 42 were LA positive. 4 patients were found to have only LA with false positive results in NBA while 38 had a combination of LA and FVIII inhibitors. Six patients were LA negative and had only FVIII IAIs. Five (62.5%) of 8 HA patients initiated on immune tolerance induction (ITI) also were positive for IAIs. CONCLUSION: The findings emphasizes the presence of specific FVIII inhibitors in congenital HA with absence of time dependent inactivation kinetics in a small proportion of cases. ELISA or chromogenic assays along with LA testing can offer accurate laboratory diagnosis in patients with coexisting LA.

Microparticles as prognostic biomarkers in dengue virus infection.

Promising biomarkers which may help predict the risk of developing severe dengue virus infection (DVI) are lacking and will be helpful. Thus the main aim of this study was to analyze the role of cell-derived microparticles (MP) in DVI. Sixty patients with DVI i.e. 18: dengue with warning signs (DWS); 1: DSS and 41: dengue without warning signs (DWOS); along with 15 controls (other febrile illness) were included in the study. The following MPs were assessed: annexinV, platelet (CD41a), red blood cell (RBC) (CD235a) and activated endothelial (CD62e) MPs. Patients with profound thrombocytopenia without bleeding had statistically elevated platelet MP (PMP) levels when compared to patients with profound thrombocytopenia with bleeding (p < .001). RBC MPs were found to be significantly elevated in the 2nd phase in patient with DWS which was seen earliest on day 4 of infection with a cut off of ≥2200 MPs/µl when compared to patients with DWOS (p < .0001). PMPs may prove to be a promising novel biomarker which helps discriminate patients in need of prophylactic platelet transfusion from those who do not. RBC MPs, on the other hand could be potential biomarkers capable of identifying potentially severe patients who require immediate care. Thus, MPs seem to be a promising important biomarker in many aspects of DVI.

Management of pregnancy in dysfibrinogenemia cases: a dilemma.

Dysfibrinogenemia is a very challenging disorder, and there are no firm guidelines on treatment for pregnant patients with dysfibrinogenemia. A 37-year-old patient with a history of six unexplained recurrent miscarriages was referred for thrombophilia testing. Elevated procoagulant microparticles were found, for which during her seventh pregnancy anticoagulant therapy was initiated. However, she again miscarried and bled excessively. She was then diagnosed with dysfibrinogenemia. DNA sequence analysis revealed a novel homozygous insertion-deletion in exon 7 in FGB. Dysfibrinogenemia is very difficult to diagnose and even after diagnosis, the treatment varies with the patient's symptoms. In this case, anticoagulant therapy failed. With her history of recurrent miscarriages, it is clear that pregnancy without any treatment is not an option. Few reports suggest a combination of intravenous fibrinogen infusions along with anticoagulants in which successful pregnancy outcome was achieved. The present case thus stresses on the need for some treatment guidelines in such cases.