Dental practice in the era of COVID-19: A review of literature.

Dental practitioners confront the highest risk of COVID-19 infection due to constant exposure to saliva, droplets, blood, and aerosols. Despite the suspension of routine dental care in many countries around the world, dental professionals perceive a moral duty to take part in the global fight against the pandemic. Therefore, dental professionals should be vigilant in defending against the transmission of the virus and as well as in the diagnosis of the disease through the oral manifestations of it. We conducted a literature review on publicly available data to outline updates on guidelines and studies of dental settings during the COVID-19 era. In this literature review, the categorization of the patients for dental treatments, protective precautions for the dental practice, considerations for dental drug prescription, and oral manifestations of the disease has been reviewed.

Applying dental implant therapy in patients with oral lichen planus: a review of literature.

Lichen planus (LP) is a violent, paranormal inflammatory disease that can affect the skin or any lining of the mucous membrane. LPs are a branch of immune-mediated inflammatory disease (IMID) that collaborates with the function and structure of the immune system that are precipitated through various etiological infectious agents. Oral lichen planus (OLP) is one of the most common kinds of IMID. These traumas might limit the normal life of patients and, in some cases, can be treated spontaneously. In patients who are affected by OLP, the dental clinicians must be capable of the proper diagnosis of the disorder. Dental implants are progressively applied for the treatment of partial or complete edentulism. Implant rehabilitation in OLP patients is one of the main challenges for patients and dental clinicians. There is not enough knowledge about this condition, and also medical documents are limited. In this study, by conducting a comprehensive review of literature, we tried to collect related data around the safety and success rate of implant rehabilitation in patients who suffer from OLP disorder. There proved to be no relation between implant survival rate and OLP diseases, but it is proven that some factors such as bone quality and fracture resistance, parafunctional habits, and resection of the marginal mandible could powerfully affect it. For evaluation of the advantages and disadvantages of applying implants in patients with OLP disorders, implementation of controlled studies is required.

Efficacy of Low-Level Laser, Hard Occlusal Appliance and Conventional Pharmacotherapy in the Management of Myofascial Pain Dysfunction Syndrome; A Preliminary Study.

Introduction: Myofascial pain dysfunction syndrome (MPDS) is a common temporomandibular joint disorder. Due to its multifactorial etiology, treatment usually involves more than one modality to obtain complementary results. The purpose of this study was to compare the combined effect of a low-level laser, a hard occlusal appliance, and conventional pharmacotherapy with pharmacotherapy only in the management of patients with MPDS. Methods: In this study, 15 patients with MPDS were diagnosed and randomly assigned to 3 groups (n=5). Subjects in Group 1 were treated with pharmacotherapy (PT); Group 2 received the diode laser (940 nm gallium arsenide) every other day for a total of 10 sessions, plus pharmacotherapy (PTL) and Group 3 were given hard occlusal splint 12 h/day for 4 weeks, plus pharmacotherapy (PTO). The intensity of pain was measured using the visual analog scale (VAS) prior to the treatment, 2 and 4 weeks after the onset of treatment and 2 weeks later. The maximum painless mouth opening and pain intensity at muscle palpation were also recorded. Comparisons were made between the groups via repeated measure analysis of variance (ANOVA) (P<0.05). Results: Pain relief in the subjective VAS was observed in both laser and appliance groups in the third and fourth examination sessions (P<0.05). No statistically significant reduction in pain was noted using pharmacotherapy only. The maximum painless mouth opening and muscle tenderness were not significantly different between the 3 groups (P>0.05). Conclusion: Both the laser and the occlusal appliance combined with pharmacotherapy proved to be effective for pain reduction in patients with MPDS. All groups, however, failed to result in a significant improvement in the maximum mouth opening or tenderness in masticatory muscles.

Determining salivary and serum levels of iron, zinc and vitamin B12 in patients with geographic tongue.

Background. Benign migratory glossitis or geographic tongue, whose cause still remains a mystery, emerges as annular lesions on the dorsal surface of the tongue. Several reasons have been reported for this condition, including vitamin deficiencies, digestive disorders, emotional stress and nutritional deficiencies. In order to introduce an efficient treatment for the geographic tongue, the present study investigated the levels of iron, zinc and vitamin B12 in the blood and saliva. Methods. The present study evaluated 40 subjects. The oral disease specialists examined the patients in the Dental School, Tehran University International Campus and Mashhad Dental School. Accordingly, inclusion and exclusion criteria were used to enroll the patients. The blood and salivary samples were collected from the case and control groups. Finally, independent t-test was used to analyze the data. Results. Overall, 20 subjects suffered from geographic tongue. They consisted of 8 females and 12 males, with a mean age of 33.5±4.8 and age range of 19‒49 years. Moreover, the mean age and age range of the healthy subjects were 29.40±7.5 and 24‒25 years, respectively. It should be pointed out that the subjects were equally divided into 10 males and 10 females. There was no difference between other variables in the blood and saliva. Conclusion. The results showed that patients with geographic tongue had lower levels of salivary zinc, compared to the control group. Although iron and vitamin B12 affect the lingual papillae, their serum and salivary levels did not change.

The effect of low level laser on number of Candida albicans colonies in-vitro: a new finding.

BACKGROUND: Candida albicans is a commensal organism that causes a wide variety of diseases in humans. One of these diseases is oral candidiasis, which occurs at a high recurrence rate in spite of available treatments. The purpose of this study was to compare the effect of low-level laser therapy (LLLT) with the use of nystatin on in-vitro growth of Candida albicans. METHOD: We prepared two samples of Candida albicans at different concentrations: 104 viable cells/ml and 106 viable cells/ml. Specimens from each sample were divided into a control group, a nystatin-treated group, and a group treated with LLLT. The control group was cultured without any intervention. The second group was treated with nystatin and the solution was vibrated for 30 s or 60 s. The third group was irradiated with a gallium-aluminum-argon (Ga-Al-Ar) diode laser (Epic 10; Biolase Inc.)in continuous mode using a wavelength of 940 nm and a power of 1 W for 30 s or 60 s (38 J/cm2 and 76 J/cm2). The specimens from the nystatin group and the LLLT group were cultured and the number of colony-forming units (CFU/ml) for each group was counted and compared. RESULTS: Nystatin completely eliminated the colonies (0 colonies) in all specimens. There was an increase in the number of colonies in the LLLT group for both cell concentrations at 30 s and at 60 s. However, this increase was statistically significant only for a concentration of 104 viable cells/ml at an exposure time of 30s. The increase in the concentration of 106 viable cells/ml at both 30 s and 60 s was statistically significant compared with the control group, although the highest number of colonies remained after an exposure time of 60s. CONCLUSION: LLLT led to an increase in the growth of Candida colonies. However, there was no significant difference related to the exposure time between the different cell concentrations.

Relationship between Parafunctional Habits and Salivary Biomarkers.

OBJECTIVES: Parafunctional habits, as one of the etiological factors of temporomandibular disorders (TMD), are an individual's response to increased stress. During stress and depression, biomarkers such as cortisol and salivary alpha-amylase (SAA) are secreted in the saliva. The present study aimed to investigate whether there is a correlation between salivary stress biomarkers and parafunctional habits. MATERIALS AND METHODS: Thirty-two cases, from May to September 2015, were selected based on two standard stress questionnaires, namely the depression anxiety stress Scale-21 (DASS-21) and the Beck Anxiety Inventory (BAI). Saliva samples were collected to examine the level of unstimulated salivary cortisol and SAA. The significance of the results was assessed via student's t-test and Mann-Whitney test (α=0.05). RESULTS: The mean concentrations of cortisol and SAA in unstimulated saliva were significantly higher in the case group than in the control group (P=0.01 and 0.44, respectively). The mean scores of anxiety, stress, and depression were significantly higher in the case group than in the control group (P<0.05). CONCLUSION: It seems that the levels of salivary cortisol and SAA, as well as stress, anxiety, and depression scores, are higher in patients with parafunctional habits.

Therapeutic and Analgesic Efficacy of Laser in Conjunction With Pharmaceutical Therapy for Trigeminal Neuralgia.

Introduction: Trigeminal neuralgia (TN) is the most common neuralgia in the head and neck region and a common cause of orofacial pain. It is routinely treated with carbamazepine. Laser, acupuncture and radiofrequency are among other treatment modalities for this condition. This study sought to assess the efficacy of laser therapy in conjunction with carbamazepine for treatment of TN. Methods: A total of 30 patients who met the inclusion criteria were divided into 2 groups of cases and controls (n=15) by double blind randomized controlled clinical trial. All patients received 100 mg carbamazepine at baseline and another 100 mg after 2 days for pain control. In the case group, low level laser therapy (LLLT) was also performed in addition to pharmaceutical therapy. Sham laser was used in the control group instead of LLLT. Treatment was continued for 9 sessions (3 days a week). The intensity of pain was measured and compared in the 2 groups using visual analog scale (VAS) in 3 period. The qualitative variables among the groups were compared using the repeated measures analysis of variance (ANOVA). Results: The severity of pain was lower at the end of treatment in the case compared to the control group so this difference was statistically significant (P=0.003). The severity of pain decreased in both groups over time. Significant difference was noted in this regard between the 2 groups either (P=0.003). At the end of treatment pain intensity dropped in the intervention group from 6/8 to 1/2 and control group from 6/6 to 2/7. Conclusion: Laser therapy did add to the value of pharmaceutical therapy for treatment of TN. Both groups experienced significant improvement over time. So it is better to used laser complementary therapy to reduce side effects and the medicine dosage.

An In Vitro Comparison of Antimicrobial Effects of Curcumin-Based Photodynamic Therapy and Chlorhexidine, on Aggregatibacter actinomycetemcomitans.

INTRODUCTION: Considering the importance of prevention in periodontal diseases and the important role of Aggregatibacter actinomycetemcomitans in induction and progression of these diseases, the aim of the present in vitro study was to compare the antimicrobial effects of chlorhexidine digluconate (CHX), curcumin and light-emitting diode (LED) laser, on this bacterium. METHODS: Antimicrobial activity of curcumin (5 mg/ml), CHX (2%), LED (120 J/cm(2)) and LED + curcumin (120 J/cm(2) + 2.5 mg/ml) against A. actinomycetemcomitans were tested in vitro, using micro-broth dilution test. One-way analysis of variance (ANOVA) and Tukey's HSD tests served for statistical analysis. RESULTS: Regarding the minimum inhibitory concentration (MIC), CHX had a significantly lower MIC than curcumin (P < 0.05). Sorted out by bacterial growth from lowest to highest, were CHX, LED + curcumin, curcumin, and LED groups. All the differences were found to be statistically significant (P < 0.05) except for the LED group. CONCLUSION: We conclude that curcumin is an effective substance in preventing the growth of A. actinomycetemcomitans, whose impact is reinforced when used simultaneously with photodynamic therapy (PDT).

Traditionally used herbal medicines with antibacterial effect on Aggegatibacter actinomycetemcomitans: Boswellia serrata and Nigella sativa.

BACKGROUND: Since bacterial strains developed resistance against commonly used antibiotics and side effects became more serious, other alternatives have been postulated. There is an answer for this issue in ancient medicine. Many plants have been proved to provide antibacterial effect. In this study, Boswellia serrata (BS) and Nigella sativa (NS) were assessed to evaluate the antibacterial effect on Aggregatibacter actinomycetemcomitans (A.a) known as main pathogen of aggressive periodontitis. MATERIALS AND METHODS: Broth microdilution method was used to obtain minimum inhibitory concentration (MIC) of crude extract of BS and NS. Furthermore, the logarithm of colony forming units grown in fresh brain heart infusion bacterial culture was assessed. Three groups including BS+ (containing only BS), NS+ (containing only NS), and BS-NS- (control group) were defined. For each group, the experiment was repeated 12 times. RESULTS: MIC of BS and NS were 512 µg/mL and 128 µg/mL, respectively. No growth was observed in our negative control group. The mean ± standard deviation of logarithm of CFU/mL for BS, NS, and control group was 4.32 ± 0.36, 3.61 ± 0.3, and 5.57 ± 0.19, respectively. ANOVA test revealed significant difference (P values < 0.0001) of these groups which was later confirmed using the post hoc test of Tukey's honest significant difference (all P < 0.0001). CONCLUSIONS: Both BS and NS are effective against A.a which should be taken into account as appropriate ingredient for oral hygiene products.

Relationship of stimulated saliva 17beta-estradiol and oral dryness feeling in menopause.

OBJECTIVES: The aim of this study was to compare stimulated whole saliva 17beta-estradiol of menopausal women with/without oral dryness (OD) feeling, and evaluate the relationship between saliva 17beta-estradiol and severity of OD feeling. METHODS: A case-control study was carried out in 76 selected menopausal women aged 41-77 years with or without OD feeling (38 as case and 38 as control) conducted at the Clinic of Oral Medicine, Tehran university of medical sciences. Paraffin-stimulated saliva samples were obtained by expectoration. Xerostomia inventory (XI) score was used as an index of OD feeling severity. The saliva 17beta-estradiol concentration was measured by ELISA. Statistical analysis of Student's t-test and Spearman correlation was used. RESULTS: No significant difference was found in stimulated whole saliva flow rate between the two groups, but the mean concentration and output of saliva 17beta-estradiol were significantly lower in case than control. There was significant negative correlation between XI score and stimulated whole saliva concentration (r=-0.391, P=0.004) and output (r=-0.302, P=0.002) of 17beta-estradiol in menopausal women. CONCLUSIONS: It seems that there is a negative correlation between OD feeling severity and stimulated whole saliva 17beta-estradiol in menopausal women.