Impact of a virtual learning environment on the conscious prescription of antibiotics among Colombian dentists.

Appropriate antibiotic prescription contributes to reducing bacterial resistance; therefore, it is critical to provide training regarding this challenge. The objective of this study was to develop a virtual learning environment for antibiotic prescription and to determine its impact on dentists' awareness, attitudes, and intention to practice. First, the learning content on multimedia resources was developed and distributed into three challenges that participants had to overcome. Then, a quasi-experimental study was performed in which the virtual learning environment was implemented on dentists from seven Colombian cities. The median of correct answers and the levels of awareness, attitudes, and intention to practice were compared before, immediately after, and 6-months post-intervention. Wilcoxon signed-rank and McNemar's tests were used to determine the differences. A total of 206 participants who finished the virtual learning environment activities exhibited a favorable and statistically significant impact on the median of correct answers of awareness (p < 0.001), attitudes (p < 0.001), and intention to practice (p = 0.042). A significant increase occurred in the number of participants with a high level of awareness (p < 0.001) and a non-significant increase in participants with high levels of attitudes (p = 0.230) and intention to practice (p = 0.286). At 6 months, the positive effect on the median of correct answers on awareness and intention to practice persisted (p < 0.001); however, this was not evident for attitudes (p = 0.105). Moreover, there was a significant decrease in the number of participants who showed low levels of awareness (p = 0.019) and a slight increase in those with high levels of the same component (p = 0.161). The use of a virtual learning environment designed for dentists contributed to a rapid improvement in awareness and intention to practice antibiotic prescription; however, their attitudes and information retention need reinforcement.

Infection Control in the Dental Practice with Emphasis on Intraoral Scanners and Semi-Critical Complex Instruments / Control de Infecciones en la Práctica Dental Con Énfasis en Escáneres Intraorales e Instrumentos Complejos Semicríticos

ABSTRACT: We present an integrative review of the literature conducted to find and analyse specific measures for disinfection and/or sterilization of intraoral complex instruments, applicable to intraoral scanners. We performed a two-stage search in the PubMed/MEDLINE, SciELO, REDALYCS, and LILACS databases, and the Google Scholar website, which included full articles in Spanish, Portuguese, and English. The strategy associated the terms 'disinfection', 'biosecurity', 'decontamination', and (a) 'intraoral scanners', and (b) other 'semi-critical' intraoral complex instruments, according to the American Dental Association definition (e.g., 'turbine', etc). Strategy (a) produced just one outcome, whereas (b) produced nine articles, which only suggested low-level disinfectants.The lack of empirically based protocols that allow effective microbiological control makes it necessary to create a new categorization for these instruments when trying to comply with American Dental Association recommendations for dental practice.

RESUMEN: Presentamos una revisión integradora de la literatura realizada para encontrar y analizar medidas específicas de desinfección y / o esterilización de instrumentos complejos intraorales, aplicables a los escáneres intraorales. Realizamos una búsqueda en dos etapas en las bases de datos PubMed / MEDLINE, SciELO, REDALYCS y LILACS, y en el sitio web Google Scholar, que incluía artículos completos en español, portugués e inglés. La estrategia asoció los términos 'desinfección', 'bioseguridad', 'descontaminación' y (a) 'escáneres intraorales', y (b) otros instrumentos complejos intraorales 'semicríticos', según la definición de la Asociación Dental Ameri- cana (p. Ej., 'turbina', etc.). La estrategia (a) produjo un solo resultado, mientras que (b) produjo nueve artículos, que solo sugirieron desinfectantes de bajo nivel. La falta de protocolos de base empírica que permitan un control microbiológico efectivo hace necesario crear una nueva categorización para estos instrumentos, cuando se trata de cumplir con las recomendaciones de la Asociación Dental Americana para la práctica dental.

Condutas práticas para atendimento odontológico em pacientes com necessidades especiais em tempos de Covid-19: minimizando os riscos / Practical conduct for dental care for patients with special needs in times of Covid-19: minimizings risks

O mundo está diante da pandemia pela Covid-19, novo coronavírus conhecido como causa da Síndrome Respiratória Aguda Grave 2 (SARS-CoV-2) e a Odontologia pode ser considerada uma das áreas com maior risco de contaminação. Objetivo: revisar a literatura existente sobre as manifestações da Covid-19 relacionadas com a atuação odontológica e apresentar orientações aos profissionais de saúde bucal no manejo de pacientes com necessidades especiais. Métodos: foi realizada uma pesquisa bibliográfica nas bases de dados PubMed, SciELO, Wiley Online Library, Portal de Periódicos Capes e Google Acadêmico, além de orientações (protocolos) por órgãos oficiais de saúde nacionais e internacionais. Resultados: durante o atendimento odontológico, ocorre uma proximidade face a face entre dentistas e pacientes, além de exposição a saliva, sangue e instrumentos manuais que podem estar contaminados. A atenção aos pacientes com comprometimento sistêmico requer uma anamnese minuciosa, avaliando a necessidade ou não de interconsulta médica. Enquanto os pacientes de difícil manejo precisarão de técnicas lúdicas para reduzir as barreiras que dificultam o atendimento odontológico. Conclusão: pessoas com deficiência e com outras necessidades em saúde usualmente já tinham maior dificuldade para receber atendimento odontológico. Com a Covid-19, isso se agravou, visto que o atendimento eletivo é contraindicado neste grupo. No entanto, o conhecimento que a comunidade científica está produzindo não servirá apenas para esta pandemia. A melhora na biossegurança e a valorização dos profissionais de saúde devem ser mantidas mesmo quando o surto passar.(AU)

The world is facing the pandemic by Covid-19, a new coronavirus known as the cause of Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) and Dentistry can be considered one of the areas with the highest risk of contamination. The objective of this work was to review the existing literature on the manifestations of Covid-19 related to dental practice and to present guidelines that assist oral health professionals in the management of patients with special needs. Methods: a bibliographic search was performed in the databases PubMed, SciELO, Wiley Online Library, Portal of Journals Capes and Google Scholar, in addition to guidance by official national and international health agencies. Results: during dental care, there is a face- -to-face proximity between dentists and patients, in addition to exposure to saliva, blood and hand instruments that may be contaminated. Attention to patients with systemic impairment requires a thorough anamnesis, assessing the need or not for medical consultation. While difficult-to-manage patients will need playful techniques to reduce barriers that hinder dental care. Conclusion: people with disabilities and other health needs usually already had greater difficulty in receiving dental care. With Covid-19, this worsened, since elective care is contraindicated in this group. However, the TRAD that the scientific community is producing will not only serve for this pandemic. The improvement in biosafety and the valorization of health professionals must be maintained even when the outbreak passes.(AU)

Investigation of Turkish dentists' clinical attitudes and behaviors towards the COVID-19 pandemic: a survey study.

Currently, the whole world is under the threat of the COVID-19 pandemic, and dentists are at high risk. The aim of this study was to investigate what kind of precautions Turkish dentists take in dental clinics during the COVID-19 pandemic. The study population consisted of dentists in Turkey. An online questionnaire (23 questions-57 items) was sent to a sample of Turkish dentists from March 16 to March 20, 2020. The questionnaire comprised a series of questions about dentists' demographic characteristics, their concerns, and the measures taken in dental clinics against COVID-19. This study included a total of 1,958 Turkish dentists. A total of 1,274 (65.1%) were general dentists, and 684 (34.9%) were specialists. Five hundred twenty-two (26.7%) dentists attended an informational meeting on COVID-19. Of these dentists, 69.8% were aware of COVID-19 according to their self-assessed knowledge scores. More than 90% of the dentists were concerned about themselves and their families. Only 12% of the dentists wore an N95 mask. Although Turkish dentists took some precautionary measures, they did not take enough precautions to protect themselves, the dental staff, and other patients from COVID-19. As the number of COVID-19 cases increased, the measures taken slightly increased in dental clinics as well. Dentists are strongly recommended to take maximum precautions in the clinical setting. The guidelines about the COVID-19 pandemic should be sent to all dentists by the regional and national dental associations.

Biological and social aspects of Coronavirus Disease 2019 (COVID-19) related to oral health.

The expansion of coronavirus disease 2019 (COVID-19) throughout the world has alarmed all health professionals. Especially in dentistry, there is a growing concern due to it's high virulence and routes of transmission through saliva aerosols. The virus keeps viable on air for at least 3 hours and on plastic and stainless-steel surfaces up to 72 hours. In this sense, dental offices, both in the public and private sectors, are high-risk settings of cross infection among patients, dentists and health professionals in the clinical environment (including hospital's intensive dental care facilities). This manuscript aims to compile current available evidence on prevention strategies for dental professionals. Besides, we briefly describe promising treatment strategies recognized until this moment. The purpose is to clarify dental practitioners about the virus history and microbiology, besides guiding on how to proceed during emergency consultations based on international documents. Dentists should consider that a substantial number of individuals (including children) who do not show any signs and symptoms of COVID-19 may be infected and can disseminate the virus. Currently, there is no effective treatment and fast diagnosis is still a challenge. All elective dental treatments and non-essential procedures should be postponed, keeping only urgent and emergency visits to the dental office. The use of teledentistry (phone calls, text messages) is a very promising tool to keep contact with the patient without being at risk of infection.

Recommendations for a safety dental care management during SARS-CoV-2 pandemic / Recomendaciones para una atención odontológica segura durante la pandemia por SARS-CoV-2 / Recomendações para um atendimento odontológico seguro durante a pandemia do SARS-CoV-2

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted mainly through droplets, sneezes and aerosols, there is a high risk of transmission during dental procedures. This report describes measures that can be adopted by oral healthcare personnel to minimize the risk of cross-contamination in clinical practice during the current SARS-CoV-2 pandemic. (AU)

Dado que el SARS-CoV-2, causante de síndrome respiratorio agudo severo, se transmite principalmente por medio de gotitas, estornudos y aerosoles, existe un alto riesgo de transmisión durante los procedimientos dentales. En este informe se describen las medidas que puede adoptar el personal de salud bucodental para reducir al mínimo el riesgo de contaminación cruzada en la práctica clínica durante la actual pandemia por SARS-CoV-2.(AU)

Como o SARS-CoV-2, que causa síndrome respiratória aguda grave, é transmitido principalmente por gotícu-las, espirros e aerossóis, há um alto risco de transmissão durante os procedimentos odontológicos. Este relatório descreve os passos que podem ser tomados pelo pessoal de saúde oral para minimizar o risco de contaminação cruzada na prática clínica durante a actual pandemia do SARS-CoV-2.(AU)

Biological and social aspects of Coronavirus Disease 2019 (COVID-19) related to oral health

Abstract The expansion of coronavirus disease 2019 (COVID-19) throughout the world has alarmed all health professionals. Especially in dentistry, there is a growing concern due to it's high virulence and routes of transmission through saliva aerosols. The virus keeps viable on air for at least 3 hours and on plastic and stainless-steel surfaces up to 72 hours. In this sense, dental offices, both in the public and private sectors, are high-risk settings of cross infection among patients, dentists and health professionals in the clinical environment (including hospital's intensive dental care facilities). This manuscript aims to compile current available evidence on prevention strategies for dental professionals. Besides, we briefly describe promising treatment strategies recognized until this moment. The purpose is to clarify dental practitioners about the virus history and microbiology, besides guiding on how to proceed during emergency consultations based on international documents. Dentists should consider that a substantial number of individuals (including children) who do not show any signs and symptoms of COVID-19 may be infected and can disseminate the virus. Currently, there is no effective treatment and fast diagnosis is still a challenge. All elective dental treatments and non-essential procedures should be postponed, keeping only urgent and emergency visits to the dental office. The use of teledentistry (phone calls, text messages) is a very promising tool to keep contact with the patient without being at risk of infection.

Investigation of Turkish dentists clinical attitudes and behaviors towards the COVID-19 pandemic: a survey study

Abstract Currently, the whole world is under the threat of the COVID-19 pandemic, and dentists are at high risk. The aim of this study was to investigate what kind of precautions Turkish dentists take in dental clinics during the COVID-19 pandemic. The study population consisted of dentists in Turkey. An online questionnaire (23 questions-57 items) was sent to a sample of Turkish dentists from March 16 to March 20, 2020. The questionnaire comprised a series of questions about dentists' demographic characteristics, their concerns, and the measures taken in dental clinics against COVID-19. This study included a total of 1,958 Turkish dentists. A total of 1,274 (65.1%) were general dentists, and 684 (34.9%) were specialists. Five hundred twenty-two (26.7%) dentists attended an informational meeting on COVID-19. Of these dentists, 69.8% were aware of COVID-19 according to their self-assessed knowledge scores. More than 90% of the dentists were concerned about themselves and their families. Only 12% of the dentists wore an N95 mask. Although Turkish dentists took some precautionary measures, they did not take enough precautions to protect themselves, the dental staff, and other patients from COVID-19. As the number of COVID-19 cases increased, the measures taken slightly increased in dental clinics as well. Dentists are strongly recommended to take maximum precautions in the clinical setting. The guidelines about the COVID-19 pandemic should be sent to all dentists by the regional and national dental associations.

¿Por qué hacerlo? Simplemente porque es un procedimiento lógico y necesario / Why to do it? Just because is a logical and necessary procedure

En la odontología, el aislamiento absoluto del campo operatorio facilita y aumenta la eficacia de todos los procedimientos clínicos. Un campo operatorio seco y libre de contaminación protege al paciente, al profesional y al personal auxiliar. En general, el profesional, por incapacidad o impericia, recurre con frecuencia a excusas, sin comprender que su uso es lógico e insustituíble. La caída de instrumentos y la ingestión o la aspiración de cuerpos extraños que tienen origen dental constituyen la segunda causa médica más común de este tipo de accidentes. Teniendo en cuenta todos los cuidados y las precauciones que se toman para combatir y/o prevenir la infección microbiana durante un tratamiento endodóntico, resulta paradójico que muchas veces, en la reconstrucción posendodóntica, se trabaje sin efectuar la aislación absoluta...

Standards of teeth preparations for anterior resin bonded all-ceramic crowns in private dental practice in Jordan

OBJECTIVES: To investigate if general dental practitioners (GDPs) in private practice in Jordan follow universal guidelines for preparation of anterior teeth for resin bonded all-ceramic crowns (RBCs). MATERIAL AND METHODS: A sample (n=100) of laboratory models containing 208 tooth preparations for IPS Empress and In Ceram, featuring work from different GDPs, was obtained from 8 commercial dental laboratories. Aspects of preparations were quantified and compared with accepted criteria defined following a review of the literature and recommendations of the manufactures' guidelines. RESULTS: Subgingival margins on the buccal aspect were noticed in 36 percent of the preparations, 54 percent demonstrated overpreparation with a tendency to overprepare the teeth on the mesiodistal plane more than buccolingual plane. Twenty percent of samples presented a shoulder finish line while a chamfer margin design was noticed in 39 percent. Twenty-nine percent and 12 percent of samples had either a feathered or no clear margin design respectively. Incisal underpreparation was observed in 18 percent of dies of each type. Only 17 percent of all preparations were found to follow the recommended anatomical labial preparations while 29 percent of the RBC preparations were found to have the recommended axial convergence angle. In total, 43 percent of preparations were found to have the recommended depth of the finish line. CONCLUSIONS: It was found that relevant guidelines for RBC preparations were not being fully adhered to in private practice in Jordan.

Standards of teeth preparations for anterior resin bonded all-ceramic crowns in private dental practice in Jordan.

OBJECTIVES: To investigate if general dental practitioners (GDPs) in private practice in Jordan follow universal guidelines for preparation of anterior teeth for resin bonded all-ceramic crowns (RBCs). MATERIAL AND METHODS: A sample (n=100) of laboratory models containing 208 tooth preparations for IPS Empress and In Ceram, featuring work from different GDPs, was obtained from 8 commercial dental laboratories. Aspects of preparations were quantified and compared with accepted criteria defined following a review of the literature and recommendations of the manufactures' guidelines. RESULTS: Subgingival margins on the buccal aspect were noticed in 36% of the preparations, 54% demonstrated overpreparation with a tendency to overprepare the teeth on the mesiodistal plane more than buccolingual plane. Twenty percent of samples presented a shoulder finish line while a chamfer margin design was noticed in 39%. Twenty-nine percent and 12% of samples had either a feathered or no clear margin design respectively. Incisal underpreparation was observed in 18% of dies of each type. Only 17% of all preparations were found to follow the recommended anatomical labial preparations while 29% of the RBC preparations were found to have the recommended axial convergence angle. In total, 43% of preparations were found to have the recommended depth of the finish line. CONCLUSIONS: It was found that relevant guidelines for RBC preparations were not being fully adhered to in private practice in Jordan.

Ortodontia brasileira: ainda há boas safras / Brazilian orthodontics: still there are good vintages

O presente artigo relata o caso clínico ortodôntico de uma paciente adulta, tratada por Ortodontia fixa, com extração de quatro primeiros pré-molares e mecânica Straight Wire/Tweed. Destaca-se a importância do diagnóstico, baseado na avaliação clínica e análise da documentação ortodôntica; e da disciplina na aplicação do plano de tratamento, para contemplar a demanda estética e funcional da paciente e do ortodontista.

The assessment of infection control in dental practices in the municipality of São Paulo.

OBJECTIVE: The goal of this study was to evaluate the infection control measures actually implemented by dental surgeons during dental practice, as patients and professionals are exposed to high biological risk in dental care environments. METHOD: 614 questionnaires (90.69%) were answered by professionals registered in updating or in post-graduate courses in the Municipality of São Paulo. RESULTS: Out of surveyed professionals 30.62% admitted that surface protection barriers were not used, whereas 34.17% were using non ideal or outdated pre-disinfection practices. The autoclave was used by 69.38% of participants, although 33.80% were not monitoring control of the sterilization cycles. Chemical and biological indicators were not used simultaneously by 83.21% of respondents and were not employed on a daily or weekly basis by at least 81.75%. Dubious methods of sterilization were cited by 44.77%. Occupational accidents caused by cutting and piercing objects were reported by 47.88%; however, the biologic risk was underestimated by 74.15% of the professionals who suffered the accidents. Irritant solutions were used as an antiseptic agent by 18.55%. CONCLUSIONS: Infection control measures reported by dental surgeons during their practices are deficient. It is necessary to educate, raise awareness of professionals, and promote constant updating courses on procedures which aim at improving safety of dental care.

The assessment of infection control in dental practices in the municipality of São Paulo

OBJECTIVE: The goal of this study was to evaluate the infection control measures actually implemented by dental surgeons during dental practice, as patients and professionals are exposed to high biological risk in dental care environments. METHOD: 614 questionnaires (90.69 percent) were answered by professionals registered in updating or in post-graduate courses in the Municipality of São Paulo. RESULTS: Out of surveyed professionals 30.62 percent admitted that surface protection barriers were not used, whereas 34.17 percent were using non ideal or outdated pre-disinfection practices. The autoclave was used by 69.38 percent of participants, although 33.80 percent were not monitoring control of the sterilization cycles. Chemical and biological indicators were not used simultaneously by 83.21 percent of respondents and were not employed on a daily or weekly basis by at least 81.75 percent. Dubious methods of sterilization were cited by 44.77 percent. Occupational accidents caused by cutting and piercing objects were reported by 47.88 percent; however, the biologic risk was underestimated by 74.15 percent of the professionals who suffered the accidents. Irritant solutions were used as an antiseptic agent by 18.55 percent. CONCLUSIONS: Infection control measures reported by dental surgeons during their practices are deficient. It is necessary to educate, raise awareness of professionals, and promote constant updating courses on procedures which aim at improving safety of dental care.

Condutas do cirurgião-dentista frente a acidentes biológicos / Dentist behavior concerning occupational biological accidents

Objetivo: revisar as condutas a serem adotadas em casos de acidente com material biológico contaminado, propondo um fluxograma de encaminhamento aos setores de competência, além de pesquisar junto aos profissionais de Odontologia o conhecimento dos mesmos a respeito das condutas frente aos referidos acidentes. Outro objetivo foi avaliar os aspectos éticos e legais envolvidos com a questão. Material e métodos: a pesquisa foi realizada por meio do envio de questionários distribuídos de forma aleatória à cirurgiões dentistas da cidade de Macaé-RJ. Posteriormente os dados foram tabulados e analisados por estatística simples. Resultados: dentre os pesquisados, 95,2% disseram conhecer os riscos biológicos presentes na atividade clínica diária e 38,1% responderam que já sofreram algum tipo de acidente biológico, sendo que metade dos participantes declararam conhecer as condutas a serem tomadas nessas situações. Conclusões: foi possível propor um fluxograma de fácil entendimento para os interessados. Há um conhecimento incipiente dos profissionais questionados sobre o protocolo a ser seguido em caso de acidente com contaminação biológica, bem como a inobservância de importantes aspectos éticos e legais que norteiam a profissão.

Aim: review the measures to be adopted in cases of accidents with biological material contaminated by proposing a flow chart for referral to the areas of jurisdiction, and research from the professionals of Dentistry of the same knowledge about the behavior front to such accidents, as well as the ethical and legal issues involved with the issue. Material and methods: the study was conducted by sending questionnaires distributed randomly to dentists in the city of Macaé. Subsequently, data were tabulated and analyzed by simple statistics. Results: among those surveyed, 95.2% said they were aware of biological hazards present in daily practice and 38.1% said they had experienced some kind of biological accident, half of the participants said they knew the conduct to be taken in these situations. Conclusions: it was possible to propose a flow chart easy to understand for those interested. There is an incipient knowledge of the professionals were asked about the protocol to be followed in case of accidents with biological contamination and the failure of important ethical and legal issues that guide the profession.

Occlusal tooth surface treatment plans and their possible effects on oral health care costs.

PURPOSE: The aim of this study was to evaluate decision making with regard to detection and treatment of carious lesions on occlusal tooth surfaces and to evaluate the possible costs related to the different treatment plans of a group of clinicians in private practice. MATERIALS AND METHODS: Forty extracted permanent teeth with no fillings or macroscopic carious cavitations were selected and radiographed, using a standard method similar to bitewing and then mounted in two models. A sample of 130 clinicians in private practice in Piracicaba, Brazil were asked to carry out combined visual-radiographic caries examination of the occlusal surfaces and to recommend possible treatment plans for each surface. Teeth were sectioned bucco-lingually and caries was assessed using a stereomicroscope and classified as either enamel or dentine lesions. The costs of treatments suggested by each examiner were calculated, using a fee scale reported by the Brazilian Federal Council of Dentistry. RESULTS: Most teeth (53.7%) that were found to be sound on histological examination were considered to have enamel lesions. In 85.7% of these cases, the clinicians recommended restorative treatments. There was about 14-fold difference among clinicians concerning the costs related to decision making. CONCLUSION: Not only did the clinicians overestimate the presence and depth of carious lesions, but they also tended to treat enamel lesions using invasive therapeutic procedures. Great disparities were observed with regard to treatment costs related to decision making. Assuming an in vivo situation, the clinicians may be performing overtreatments and consequently interfering in the quality of patients' oral health.

Assessment of the frequency of routine removal of dental plaque prior to caries diagnosis by dentists in three cities in southern Brazil.

The aim of this study was to assess the frequency of routine use of dental prophylaxis prior to visual inspection, in order to diagnose caries, by dentists with different lapses of time after graduating time. One hundred and fifty one Brazilian dentists were interviewed in 3 Brazilian cities to determine if they usually remove dental plaque prior to visual inspection for caries diagnosis. The dentists were stratified according to year of graduation. The association between the lapse of time after graduating and the practice of routinely removing dental plaque before clinical examination was tested using the chi-square test with a significance level of 5%. Only 28.5% of the dentists reported that they usually remove dental plaque prior to clinical examination. The dentists who graduated in the last 15 years presented the lowest percentages of plaque removal prior to clinical examination (15.1%), whereas the more experienced dentists reported that they perform prophylaxis more frequently. Of the professionals who graduated from 1960-1975, 23.9% reported that they performed dental plaque removal prior to diagnosis, whereas the figure for those graduating from 1976-1990 was 46.2%. Most of the dentists interviewed reported that they did not remove dental plaque prior to performing visual diagnosis of caries.