Viability of bacteria associated with root caries after Nd:YAG laser application in combination with various antimicrobial agents: An in vitro study.

BACKGROUND: The neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has various therapeutic applications in dentistry, including the treatment of dentin hypersensitivity and the bacterial reduction therapy in periodontology. The addition of antimicrobial agents may enhance the impact of the laser on bacterial viability. OBJECTIVES: This in vitro study aimed to assess the effect of Nd:YAG laser application in combination with various chemical antimicrobial agents, including hydrogen peroxide (H2O2), sodium hypochlorite (NaOCl), chlorhexidine (CHX), and sodium fluoride (NaF), on the viability of bacteria implicated in the etiology of root caries. MATERIAL AND METHODS: Three oral bacterial species were examined: Streptococcus mutans (S. mutans); Streptococcus sanguinis (S. sanguinis); and Enterococcus faecalis (E. faecalis). The bacteria were grown in broth at 37°C, and then treated with the chemical agents and/or irradiated with an Nd:YAG laser for 30 s. Each treatment modality was repeated 3 times: group 1 - no treatment; group 2 - 0.5% H2O2; group 3 - 0.5% NaOCl; group 4 - 0.12% CHX; group 5 - 2% NaF; group 6 - Nd:YAG laser irradiation; group 7 - laser and 0.5% H2O2; group 8 - laser and 0.5% NaOCl; group 9 - laser and 0.12% CHX; and group 10 - laser and 2% NaF. The viability of the bacteria was determined by plating them, counting viable colonies, converting the data into colony-forming units (CFUs)/mL, and transforming them into the log form. Statistical analysis was performed using the two-tailed paired t test. RESULTS: Irradiation with an Nd:YAG laser alone did not show a statistically significant effect against any of the bacterial species. The only effective antimicrobial used alone was CHX for S. mutans. Chlorhexidine with Nd:YAG resulted in a greater reduction in S. mutans and E. faecalis than either treatment alone. Meanwhile, H2O2 with Nd:YAG also showed an enhanced S. mutans reduction. Treatment with 0.5% NaOCl in conjunction with Nd:YAG brought the most significant reduction in viability for all bacteria in comparison with other treatment modalities. CONCLUSIONS: The Nd:YAG laser combined with 0.5% NaOCl resulted in the most substantial reduction in bacterial survival as compared to the antimicrobials or the Nd:YAG laser used alone.

Systemic management and periodontal treatment of HIV-necrotizing periodontitis: A case report.

BACKGROUND: Necrotizing periodontitis (NP) is a rare form of periodontal disease. It can manifest in immunocompromised patients and present as painful and rapidly progressing destruction with necrotic and ulcerated periodontal tissues. This case report describes a rare case of severe NP in human immunodeficiency virus (HIV)-positive patient including medical management and periodontal treatment. METHODS: A 28-year-old male presented to the periodontal clinic with chief complaint of severe oral pain leading to loss of chewing ability, spontaneous gingival bleeding, generalized gingival recession, tooth mobility, and dentinal hypersensitivity. Clinical and radiographic examination revealed generalized tissue necrosis with severe periodontal destruction, extensive bleeding, spontaneous suppuration, and heavy biofilm. RESULTS: Medical history was positive for perinatal HIV infection, which was treated and patient was asymptomatic until he discontinued antiviral medications nine years ago. Following initial examination, patient was referred to the Infectious disease clinic and multidisciplinary management was initiated with comprehensive management of primary disease including systemic antiviral, antibiotic, and antifungal therapy to establish immunocompetence compatible with providing mechanical nonsurgical periodontal treatment. CONCLUSIONS: This case report highlights a severe and generalized form of NP in an HIV patient due to the cessation of antiviral therapy. Favorable course of interdisciplinary medical and periodontal therapy resulted in significant improvement in patient's systemic, oral, and periodontal health.

Role of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization: A Prospective Multi-Center Cohort of Outpatients With Cirrhosis.

BACKGROUND & AIMS: Hospitalizations are a sentinel event in cirrhosis; however, the changing demographics in patients with cirrhosis require updated hospitalization prediction models. Periodontitis is a risk factor for liver disease and potentially progression. The aim of this study was to determine factors, including poor oral health, associated with 3-month hospitalizations in a multi-center cohort of outpatients with cirrhosis. METHODS: North American Consortium for Study of End-stage Liver Disease (NACSELD-3), a new study cohort, recruits outpatients with cirrhosis. Cirrhosis details, demographics, minimal hepatic encephalopathy (MHE), frailty, and comorbid conditions including oral health were collected. All patients were followed for 3 months for nonelective hospitalizations. Multi-variable models were created for this outcome using demographics, cirrhosis details, oral health, MHE, frailty, and comorbid conditions with K-fold internal validation using 25%/75% split. RESULTS: A total of 442 outpatients (70% men; 37% compensated; Model for End-stage Liver Disease-Sodium, 12; 42% ascites; and 33% prior HE) were included. MHE was found in 70%, frailty in 10%; and both in 8%. In terms of oral health, 15% were edentulous and 10% had prior periodontitis. Regarding 3-month hospitalizations, 14% were admitted for mostly liver-related reasons. These patients were more likely to be decompensated with higher cirrhosis complications, MHE, frailty and periodontitis history. Multi-variable analysis showed prior periodontitis (P = .026), composite MHE + frailty score (P = .0016), ascites (P = .004), prior HE (P = .008), and hydrothorax (P = .004) were associated with admissions using the training and validation subsets. CONCLUSIONS: In a contemporaneous, prospective, multi-center cohort study in outpatients with cirrhosis, poor oral health is significantly associated with 3-month hospitalizations independent of portal hypertensive complications, MHE, and frailty. Potential strategies to reduce hospitalizations should consider oral evaluation in addition to MHE and frailty assessment in practice pathways.

The In Vitro Effect of Laser Irradiation (Er:YAG and CO2) and Chemical Reagents (Hydrogen Peroxide, Sodium Hypochlorite, Chlorhexidine, or Sodium Fluoride) Alone or in Combination on Reducing Root Caries Bacteria.

(1) Lasers have been used for the treatment of dentinal hypersensitivity and bacterial reductions in periodontology. The purpose of this in vitro study was to evaluate the effect of Carbon Dioxide (CO2) and Erbium-doped Yttrium Aluminum Garnet (Er:YAG) lasers with chlorhexidine (CHX), hydrogen peroxide (H2O2), sodium hypochlorite (NaOCl), or sodium fluoride (NaF) on the viability of oral bacteria associated with root caries. (2) Streptococcus mutans, Streptococcus sanguinis, and Enterococcus faecalis were grown in Brain Heart Infusion (BHI) broth, diluted to an OD660 of 0.5, and treated with antiseptics with or without simultaneous irradiation with the Er:YAG and CO2 lasers for 30 s repeated three times. The treatment groups consisted of 1: no treatment, 2: 0.5% H2O2 alone, 3: 0.5% NaOCl alone, 4: 0.12% CHX alone, 5: 2% NaF alone, 6: laser alone, 7: laser with 0.5% H2O2, 8: laser with 0.5% NaOCl, 9: laser with 0.12% CHX, and 10: laser with 2% NaF for both lasers. The microbial viability was determined through plating and viable colonies were counted, converted into CFU/mL, and transformed into log form. The statistical analysis was performed using a two-tailed paired t-test. (3) The use of CO2 and Er:YAG lasers alone failed to show statistically significant antibacterial activity against any of the bacteria. The only effective monotreatment was CHX for S. mutans. The combined treatment of 0.5% NaOCl with Er:YAG produced the greatest reduction in overall viability. (4) The combination of the Er:YAG laser with 0.5% NaOCl resulted in the largest reduction in bacterial survival when compared to monotherapies with antimicrobial solutions or lasers.

Efficacy of Various Laser Wavelengths in the Surgical Treatment of Ankyloglossia: A Systematic Review.

Ankyloglossia, commonly known as tongue-tie, is the most common disorder of tongue morphology characterized by aberrant attachment of the lingual frenum. This study aimed to provide a comprehensive literature review and evaluate the effectiveness of various laser wavelengths in the surgical treatment of patients with ankyloglossia. An electronic screening of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted on 8 November 2021. The following search terms were used to review the available data on the subject of interest: (ankyloglossia OR tongue tie OR short lingual frenulum OR lingual frenectomy OR lingual frenulectomy OR lingual frenotomy OR lingual frenulotomy) AND laser. The use of lasers in ankyloglossia treatment resulted in shorter procedure time, reduced indications for general anesthesia, reduced administration of postoperative analgesics, fewer sutures or none needed, reduced postoperative bleeding, and improved healing. Despite many advantages, this method has its clinical limitations: it requires the use of expensive equipment; well-trained personnel familiar with lasers; and personal protective equipment for the patient, caregiver, operator, and assistant. The laser procedure does not eliminate the need for myofunctional exercises and work with a speech therapist.

Odontogenic Keratocyst Is Frequently Misdiagnosed for a Lateral Periodontal Cyst in Premolar and Anterior Tooth-Bearing Areas.

INTRODUCTION: Radiolucent lesions with gingival swelling found in the premolar and intercanine region can elicit a different clinical diagnosis than one confirmed by histologic findings. The purpose of the study is to identify and present the frequency of the unexpected microscopic diagnosis of odontogenic keratocyst (OKC) in a location preoperatively favoring a lateral periodontal cyst (LPC) with similar clinical and radiographic appearance. METHODS: A retrospective analysis of biopsies received from 2011 and 2019 was performed, and the number of LPC and OKC cases was assessed. The alignment of clinical and radiographic diagnosis to histologic findings and anatomic location was analyzed, and the number of OKC cases preoperatively misdiagnosed as LPCs was identified. RESULTS: A total of 79,257 biopsies were received. Of those, 184 were diagnosed as LPCs and 742 as OKCs. For all preoperatively diagnosed LPCs, the clinical and histologic diagnosis aligned; however, 182 of 742 OKCs were submitted with a clinical misdiagnosis of LPCs. The location of these lesions with the unanticipated diagnosis overlapped with those for LPCs, specifically the maxillary and mandibular anterior and premolar regions. CONCLUSIONS: Radiolucent lesions with gingival swelling in the premolar and intercanine region are frequently clinically and radiographically misdiagnosed. A biopsy should be considered in all cases to establish the correct pathologic diagnosis and treatment course.

Treatment with Nd:YAG Laser Irradiation Combined with Sodium Hypochlorite or Hydrogen Peroxide Irrigation on Periodontal Pathogens: An In Vitro Study.

Objective: The purpose of this study was to evaluate the effect of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with low concentrations of hydrogen peroxide (H2O2) or sodium hypochlorite (NaOCl) on viability of oral bacteria. Materials and methods: Bacterial species Streptococcus gordonii, Porphyromonas gingivalis, and Fusobacterium nucleatum were grown in an anaerobic chamber at 37°C. Samples were irradiated with the Nd:YAG laser (1064 nm, 300 µm Varian tip) using parameters: 150 mJ, 20 Hz, 3 W, 50 sec, and 100 µs short pulse duration in contact mode. Treatment groups included (1) control, (2) Nd:YAG, (3) 0.5% H2O2, (4) Nd:YAG and 0.5% H2O2, (5) 0.5% NaOCl, and (6) Nd:YAG with 0.5% NaOCl. Viable colonies were counted, calculated into colony forming unit/mL, and converted into log form for statistical analysis using a two-tailed paired t-test. Results: The combined treatment with the Nd:YAG and H2O2 showed the greatest reduction in all bacterial viability compared with other treatment groups (p < 0.001). Antiseptic solutions and laser were most effective against P. gingivalis, least effective against S. gordonii but improved significantly in combination with laser irradiation (p < 0.001). Laser alone was effective against all of three bacterial species, however, it was not significant. Conclusions: Combination treatment with Nd:YAG laser and an oxidative disinfectant (0.5% NaOCl or H2O2) resulted in more effective reduction of bacterial viability than monotherapies.

Effect of postoperative steroids on clinical outcomes and radiographic findings of horizontal alveolar ridge augmentation: A retrospective study.

BACKGROUND: The purpose of the study was to investigate if the prescription of oral postoperative steroids has an effect on clinical outcomes of horizontal ridge augmentation including implant placement and characteristics of the grafted bone. METHODS: A retrospective chart review of 73 horizontal ridge augmentation cases was completed to assess the clinical outcomes, 53 of those cases were further assessed radiographically. Information was gathered regarding surgical technique, grafting materials, postoperative healing, medications used postoperatively, bone growth, and density changes as quantified on a cone-beam computed tomography (CBCT) scan. Statistical analysis was completed to identify whether the use of postoperative oral steroids altered outcomes. RESULTS: Steroids were used postoperatively following various horizontal ridge augmentation procedures. The use of tenting screws and resorbable membranes with a combination of osseous allograft and xenograft was used in 73 cases, 53 of which had preoperative and postoperative CBCT scans. Graft exposure occurred in five of the cases (9%), with the majority (n = 4) among those with postoperative steroids, but this was not statistically significant (P-value = 0.6510). Use of steroids was also not significantly associated with the number of courses of antibiotics (P-value > 0.05), but it was significantly associated with increased number of postoperative visits (P-value < 0.05). Among the subset for radiographic analysis (n = 53), there were significant clinical and radiographic dimensional changes in alveolar ridge width with an average horizontal bone gain of 3.6 mm. There were no statistically significant differences found in radiographic linear bone gain or clinical outcomes with the addition of steroids. A marginally statistically significant in the density of grafted bone was found with the addition of steroids (P-value > 0.05). CONCLUSION: The prescription of postoperative steroids did not make a significant difference in clinical outcomes, success of implant placement or on radiographic assessment of grafted sites following horizontal alveolar ridge augmentation.

Er:YAG Laser Irradiation Reduces Microbial Viability When Used in Combination with Irrigation with Sodium Hypochlorite, Chlorhexidine, and Hydrogen Peroxide.

The erbium-doped yttrium aluminum garnet (Er:YAG) laser is used to treat periodontal disease; however, its effectiveness at killing oral bacteria is not well known. Furthermore, the compounding effect of the combination of a laser treatment and irrigation methods with antimicrobials on bacterial viability is yet to be determined. The purpose of this in vitro study was to evaluate the effect of the Er:YAG laser with irrigation using chlorhexidine (CHX), hydrogen peroxide (H2O2), or sodium hypochlorite (NaOCl) on the viability of oral bacteria. Three bacterial species were used in our study: Streptococcus gordonii, Fusobacterium nucleatum, and Porphyromonas gingivalis. Bacteria were grown in an anaerobic chamber in brain heart infusion broth and incubated at 37 °C. Bacterial samples with an OD of 0.5 were irradiated with the Er:YAG laser at 2940 nm using a 400-µm Varian tip. The experiment was repeated four times using these parameters: 40 mJ, 40 Hz, and 1.6 W for 20 seconds with the 300 µs short pulse duration in contact mode. Treatment groups consisted of the following: (1) no treatment, (2) 0.5% H2O2 alone, (3) 0.5% NaOCl alone, (4) 0.03% CHX alone, (5) Er:YAG irradiation alone, (6) Er:YAG irradiation with 0.5% H2O2, (7) Er:YAG irradiation with 0.5% NaOCl, and (8) Er:YAG irradiation with 0.03% CHX. Microbial viability was determined through plating and colony counts and calculated into CFU/ml. Statistical analysis was done using a two-tailed paired t-test. The use of the Er:YAG laser alone failed to show statistically significant antibacterial activity against any of bacteria. The most effective mono-treatment with irrigation solutions for all three bacteria were 0.5% H2O2 and 0.5% NaOCl (p < 0.001 for each solution). Irrigation with 0.03% CHX was most effective against F. nucleatum (p < 0.01) and less against P. gingivalis and S. gordonii and showed the least antibacterial action alone but improved significantly in combination therapy (p < 0.05). The combined treatment with the Er:YAG showed the greatest and most significant improvement in the reduction of bacterial viability compared to any other treatment group (p < 0.05 for each combined treatment). Irradiation with the Er:YAG laser with the addition of 0.5% H2O2, 0.5% NaOCl, or 0.03% CHX under a short working time (20 s) resulted in a significant reduction of bacterial viability for all three bacterial species compared with any single treatment option. The combination of irradiation with the Er:YAG laser with the addition of 0.5% H2O2, 0.5% NaOCl, or 0.03% CHX resulted in a larger reduction of bacterial survival when compared to monotherapies with antimicrobial solutions or laser. The combination of the Er:YAG laser with a low concentration irrigant solution of 0.5% H2O2, 0.5% NaOCl, or 0.03% CHX could be an effective treatment protocol for the reduction of periodontal pathogens and thus suitable treatment for non-surgical periodontal therapy.

Virginia-based periodontists' perceptions: Current and future trends of the specialty.

BACKGROUND: The aim of this survey was threefold: (1) describe the demographics of periodontists and their practices in Virginia; (2) explore periodontists' perceptions of the impact that changes in the field of dentistry (i.e. increasing corporate dentistry, graduate debt, digitalization, and volume of periodontal procedures done by general practitioners [GPs]) are having on the specialty; (3) explore how periodontists might adjust their practices to account for these trends. METHODS: An electronic survey was emailed to Virginia-based American Academy of Periodontology (AAP) members assessing personal and practice demographics, trends in treatment modalities and practice models, and to survey how periodontists plan to adapt their practices for these trends. Virginia has large urban, suburban and rural municipalities, which renders the state a favorable representation of the United States as a whole. RESULTS: The response rate was 31% (n = 46). Most respondents (87%) were male and practiced full-time (70%). Respondents reported practicing predominantly in urban (n = 19, 41%) and suburban (n = 24, 52%) and less in rural areas (n = 3, 7%). In current practice, respondents reported greater numbers of referrals from more experienced GPs. Student debt after periodontal residency was significantly associated with age (P value = 0.0002), with 56% of respondents aged <40 years reporting student loans >$250,000 compared with 3% for those aged ≥40 years. Respondents ranked biologic advances, treatment of peri-implantitis, advances in digital dentistry, development of corporate and group practice models, and integration of more periodontal services in GP practices as the most likely trends to impact periodontal practices. The most commonly reported practice adjustments included expansion of existing services, increasing the number of periodontists in the practice, and joining with other specialists or GPs to create group practices. CONCLUSION: Periodontists perceive the need to expand services, increase the number of providers in their practices or create group practices to account for increased corporate dentistry, graduate debt, digitalization, and volume of periodontal procedures performed by GPs.

Exploring training dental implant placement using computer-guided implant navigation system for predoctoral students: A pilot study.

INTRODUCTION: Recent computer-guided dynamic navigation systems promise a novel training approach for implant surgery. This study aimed to examine learning progress in placement of dental implants among dental students using dynamic navigation on a simulation model. MATERIALS AND METHODS: Senior students with no implant placement experience were randomly assigned five implant placement attempts involving either three maxillary or four mandibular implants distributed in the anterior/posterior, and left/right segments. Implant placement was planned using a Navident Dynamic Guidance system. Surgical time was recorded. Horizontal, vertical and angulation discrepancies between the planned and placed implant positions were measured using superimposed CBCT scans. Data were analysed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = 0.05). RESULTS: Fourteen students participated, with a mean age of 26.1 years and equal males and females. Mean time for implant placement was associated with attempt number (P < 0.001), implant site (P = 0.010) and marginally related to gender (P = 0.061). Students had a significant reduction in time from their first attempt to their second (10.6 vs 7.6 minutes; adjusted P < 0.001) then plateaued. Overall 3D angulation (P < 0.001) and 2D vertical apex deviation (P = 0.014) improved with each attempt, but changes in lateral 2D (P = 0.513) and overall 3D apex deviations (P = 0.784) were not statistically significant. Implant sites were associated with lateral 2D, 2D vertical and overall 3D apex deviation (P < 0.001). DISCUSSION: Males were marginally faster than females, had slightly lower overall 3D angulation, and reported higher proficiency with video games. Novice operators improved significantly in speed and angulation deviation within the first three attempts of placing implants using dynamic navigation. CONCLUSION: Computer-aided dynamic implant navigation systems can improve implant surgical training in novice population.

Burnout, depression and suicidal ideation in dental and dental hygiene students.

INTRODUCTION: The aim of this study was to assess the relationship between burnout, depressive symptoms and suicidal ideation in dental and dental hygiene students and to evaluate the influence of gender, programme type and year of study. SUBJECTS AND METHODS: Third- and fourth-year dental (DS) and first- and second-year hygiene students (DHS) completed the Patient Health Questionnaire (PHQ-9) and an abbreviated Maslach Burnout Inventory online as measures of depressive symptoms/suicidality and burnout, respectively. The statistical analyses included summary statistics and tests for intergroup comparisons (chi-square) to evaluate the influence of gender, programme type (DHS or DS) and year of study. Correlations between depression, suicidality and burnout were also conducted. RESULTS: A total of 32 dental hygiene and 119 dental students participated. 40% of the dental and 38% of the hygiene students met criteria for burnout. No differences were found between years or between programmes. Nine per cent of both dental and hygiene students were above the cut-off for moderate depressive symptoms, but there were no statistical differences between the third- and fourth-year dental and the first- and second-year hygiene students. Six per cent of the dental and 9% of the dental hygiene students were above the cut-off for clinically significant suicidal ideation, but there were no statistical differences between dental and hygiene students. There were no differences noted in the dental students based on gender for any of the measures. Depression was significantly associated with all three subscales of burnout. Suicidal ideation was only significantly related to the lack of personal accomplishment subscale of burnout. DISCUSSION: These findings suggest the need for introducing preventive measures for such affective states in dental and dental hygiene training programmes.