Oral sedation in dentistry: evaluation of professional practice of oral hydroxyzine in the University Hospital of Rennes, France.

PURPOSE: Management of a child's anxiety early in their treatment is essential in dentistry. Sedative medications are used to overcome increased anxiety from previous appointments and to promote the cooperation of children during treatment. Hydroxyzine is currently prescribed to young patients as part of the first level of conscious sedation. The main objective was to evaluate the professional practice of oral hydroxyzine, when prescribed for children presenting anxiety during dental treatment procedure performed by students and senior practitioners. METHODS: A retrospective study of dental records and questionnaires was conducted at the Dental Care Centre of the University Hospital of Rennes, France. Parameters related to the prescription of hydroxyzine in children were evaluated as potential predictors of the dental session success, with adjustments on potential confounders. RESULTS: The therapeutic outcome was very encouraging with 78.3% of success during dental sessions under sedation with oral hydroxyzine. Anxiety levels before the dental procedure and the medication compliance of the child were the main predictors of success. On the other hand, lower age (< 6 years old) and longer treatments (such as pulpotomy) worsened the outcome. CONCLUSIONS: Careful analysis of the literature and results of this work showed the safety of hydroxyzine within the maximum dose authorized without adverse effects, compared to other molecules described and commonly used in dentistry. No adverse effects during dental procedure were noted. This allows for minimal sedation with efficiency for the great majority of pediatric treatment. This solution should be the first step in sedation to help practicing clinicians.

Benefits of sea buckthorn (Hippophae rhamnoides) pulp oil-based mouthwash on oral health.

AIM: The purpose of this study was to conduct phytochemical analysis of sea buckthorn pulp oil and to evaluate the antimicrobial, anti-biofilm and antioxidant activities of its mouthwash form. METHODS AND RESULTS: Fatty acid composition of the sea buckthorn pulp oil was determined by GC-MS analysis, which revealed that, mono-unsaturated fatty acid, palmitoleic acid and saturated fatty acid, palmitic acid, were the major constituents. The antimicrobial and the anti-biofilm capacities of sea buckthorn pulp oil mouthwash form were evaluated against Streptococcus gordonii, Porphyromonas gingivalis, Actinomyces viscosus and Candida albicans, according to the European Norms, and the Biofilm Ring Test® , respectively. These activities were then compared with those of chlorhexidine and herbal mouthwashes. The sea buckthorn-based mouthwash was bactericidal against S. gordonii and P. gingivalis, bacteriostatic against A. viscosus and showed no antifungal effect. Regardless of the strains used, complete inhibition of biofilm formation was achieved. The antioxidant activity of this experimental mouthwash was also assessed by DPPH and NBT assays. CONCLUSION: Sea buckthorn mouthwash showed anti-biofilm activities against select single and multiple oral bacterial species. SIGNIFICANCE AND IMPACT OF THE STUDY: In this study, a mouthwash derived from sea buckthorn (Hippophae rhamnoides) pulp oil has been experimented, for the first time, in order to overcome the problem of a large number of available synthetic mouthwashes which have side effects on teeth, gums and mucous membranes. This mouthwash seemed to be a suitable alternative for a preventive agent for periodontal inflammation.

The oral microbiome - an update for oral healthcare professionals.

For millions of years, our resident microbes have coevolved and coexisted with us in a mostly harmonious symbiotic relationship. We are not distinct entities from our microbiome, but together we form a 'superorganism' or holobiont, with the microbiome playing a significant role in our physiology and health. The mouth houses the second most diverse microbial community in the body, harbouring over 700 species of bacteria that colonise the hard surfaces of teeth and the soft tissues of the oral mucosa. Through recent advances in technology, we have started to unravel the complexities of the oral microbiome and gained new insights into its role during both health and disease. Perturbations of the oral microbiome through modern-day lifestyles can have detrimental consequences for our general and oral health. In dysbiosis, the finely-tuned equilibrium of the oral ecosystem is disrupted, allowing disease-promoting bacteria to manifest and cause conditions such as caries, gingivitis and periodontitis. For practitioners and patients alike, promoting a balanced microbiome is therefore important to effectively maintain or restore oral health. This article aims to give an update on our current knowledge of the oral microbiome in health and disease and to discuss implications for modern-day oral healthcare.

Treponema denticola improves adhesive capacities of Porphyromonas gingivalis.

Porphyromonas gingivalis, an important etiological agent of periodontal disease, is frequently found associated with Treponema denticola, an anaerobic spirochete, in pathogenic biofilms. However, interactions between these two bacteria are not well understood at the molecular level. In this study, we seek to link the influence of T. denticola on the expression of P. gingivalis proteases with its capacities to adhere and to form biofilms. The P. gingivalis genes encoding Arg-gingipain A (RgpA), Lys-gingipain (Kgp), and hemagglutinin A (HagA) were more strongly expressed after incubation with T. denticola compared with P. gingivalis alone. The amounts of the three resulting proteins, all of which contain hemagglutinin adhesion domains, were increased in culture supernatants. Moreover, incubation of P. gingivalis with T. denticola promoted static and dynamic biofilm formation, primarily via a time-dependent enhancement of P. gingivalis adhesion capacities on bacterial partners such as Streptococcus gordonii. Adhesion of P. gingivalis to human cells was also increased. These results showed that interactions of P. gingivalis with other bacterial species, such as T. denticola, induce increased adhesive capacities on various substrata by hemagglutinin adhesion domain-containing proteins.

[Bacteremia of oral origin]. / Bactériémies d'origine buccale.

Transient bacteremia from oral cavity related to oral anaerobic bacteria may occur as a result of dental healthcare procedures but also as a result of daily gestures involving the gums (chewing and oral hygiene). The risk of presenting a transient bacteremia is related to oral cavity bacterial load and to the severity of inflammation in the oral cavity. Although bacteremia is transient, in patients with immunodeficiency or comorbidity, this bacteremia may cause extra-oral infections. The bacteremia rate and the identified bacteria vary from one study to the next, depending on the method used to isolate and identify bacteria. Nevertheless, the risk for bacteremia is determined by the infectious and inflammatory conditions of each patient.

Expression patterns of genes induced by oxidative stress in Porphyromonas gingivalis.

INTRODUCTION: Porphyromonas gingivalis, a gram-negative anaerobic bacterium, is a major periopathogen whose transmission from host to host involves exposure to atmospheric oxygen. P. gingivalis contains genetic factors that function in an oxidative stress response, but their expression has not been analyzed during exposure to atmospheric oxygen. The aim of this study was to obtain a better understanding of atmospheric adaptation of P. gingivalis. METHODS: The aerotolerance of wild-type and oxyR mutant P. gingivalis strains were determined, and quantitative polymerase chain reaction was performed to analyze gene expression patterns in response to exposure to atmospheric oxygen. The analyzed P. gingivalis genes encoded proteins involved in oxidative response (oxyR, ahpC-F, batA, dps, ftn, tpx) as well as several major virulence factors (hagA, hagB, hagE, rgpA, rgpB, hem). RESULTS: Our results demonstrated a critical role for the oxyR gene in the aerotolerance of P. gingivalis. The ahpC-F, batA, and hem genes were slightly overexpressed (between 1.65-fold and 2-fold) after exposure to atmospheric oxygen compared to anaerobic conditions. The level of transcription of dps, ftn, tpx, and rgpA genes increased more than 2.5-fold, and the expression of ahpC-F, dps, ftn, and tpx was partially or completely OxyR-dependent. CONCLUSION: A different transcription pattern of P. gingivalis genes was observed, depending on the stimulus of oxidative stress. We present new evidence that the expression of tpx, encoding a thiol peroxidase, is partially OxyR-dependent and is induced after atmospheric oxygen exposure.