Low prevalence of multi-resistant bacteria in undergraduate dental students; an observational case-control multi-centre study in Europe.

Objective: This study assessed the prevalence of MRSA, ESBL and VRE in students from four dental schools in Europe. Methods: The hand, tongue and nostrils of the students who treated patients (study group) and who did not treat patients (control group) were sampled. After incubation in TSB and subculturing in the presence of 4 µg/ml oxacillin, positive cultures were identified for Staphylococcus aureus by Mannitol salt agar and agglutination tests. The presence of MRSA was confirmed by specific PCR on the species and on the SSCmec genes. ESBL and VRE were isolated using specific CHROMagar and confirmed using antibiotic sensitivity tests. Results: Of the 879 students who participated in this study (454 students which treated patients, 425 controls) a total of 50 students (5.7%) tested positive for a multi-drug resistant bacterium (MDRB); 13 (1.5%) students tested positive for MRSA, 26 (3.0%) for ESBL and 12 (1.4%) for VRE. No statistically significant differences were found between the students who treated patients compared to the control group for any of the MDRB and study centres, excluding MRSA carriage in the Italian student population. The use of antibiotics the year before sampling, was positively associated with the presence of an MDRB (OR 2.0; 95% Confidence Interval 1.10-3.68; p = 0.02). Conclusion: The risk for MDRB carriage and sequential transmission of MDRB for dental health care students and their patients were acceptably low.

Ecologic association between influenza and COVID-19 mortality rates in European countries.

Ecologic studies investigating COVID-19 mortality determinants, used to make predictions and design public health control measures, generally focused on population-based variable counterparts of individual-based risk factors. Influenza is not causally associated with COVID-19, but shares population-based determinants, such as similar incidence/mortality trends, transmission patterns, efficacy of non-pharmaceutical interventions, comorbidities and underdiagnosis. We investigated the ecologic association between influenza mortality rates and COVID-19 mortality rates in the European context. We considered the 3-year average influenza (2014-2016) and COVID-19 (31 May 2020) crude mortality rates in 34 countries using EUROSTAT and ECDC databases and performed correlation and regression analyses. The two variables - log transformed, showed significant Spearman's correlation ρ = 0.439 (P = 0.01), and regression coefficients, b = 0.743 (95% confidence interval, 0.272-1.214; R2 = 0.244; P = 0.003), b = 0.472 (95% confidence interval, 0.067-0.878; R2 = 0.549; P = 0.02), unadjusted and adjusted for confounders (population size and cardiovascular disease mortality), respectively. Common significant determinants of both COVID-19 and influenza mortality rates were life expectancy, influenza vaccination in the elderly (direct associations), number of hospital beds per population unit and crude cardiovascular disease mortality rate (inverse associations). This analysis suggests that influenza mortality rates were independently associated with COVID-19 mortality rates in Europe, with implications for public health preparedness, and implies preliminary undetected SARS-CoV-2 spread in Europe.

Betel quid chewing among adult male immigrants from the Indian subcontinent to Italy.

OBJECTIVE: Betel quid chewing (BQC) is an important oral cancer risk factor widespread in the Indian subcontinent. This usage also is common among migrants from this region. As the number of immigrants from South-East Asia is dramatically increasing in Italy, this survey was aimed at investigating BQC prevalence among immigrants from the Indian subcontinent. SUBJECTS AND METHODS: First-generation adult male immigrants coming from Pakistan, India, Sri Lanka, and Bangladesh, living in Rome, were consecutively selected. They were interviewed using a validated questionnaire. Descriptive statistics were performed, and factors associated to regular BQC were investigated through regression analysis. RESULTS: A total of 211 subjects (mean age, 33.8 years) living in Rome for 11 years, on average, participated in the study. BQC prevalence was 37.9% with few differences between Pakistani, Sri Lankans, and Indians. Prevalence among Bangladeshi was 7.3%. 69% of the consumers chewed BQ at least twice daily, 90% chewed BQ with tobacco; 30.3% subjects were smokers and chewers. Chewing parents, smoking, health illiteracy were associated with BQC. Most chewers believed that BQ helps to relieve stress. CONCLUSIONS: The number of oral cancers in Italy is expected to increase because of BQC dissemination. Therefore, specific awareness campaigns directed to residents of South-East Asian origin are needed.

Elder neglect-Oral diseases and injuries.

Elder neglect (EN) is the failure of a designated caregiver to meet the needs of a dependent older person. World EN prevalence, meta-analyzed in this study, is 1.0% or 1.8% according to different statistical methods. Referring alleged EN cases to Adult Protective Services (APSs) by healthcare workers (HCWs) is mandatory in many countries. However, only few claims are substantiated, as EN could be confused with Self-Neglect, and neglect could be unintentional or due to caregiver unawareness. Screening tools are inaccurate, and their use is discouraged by public health organizations, because they lead to too many false positives, which engulf the already overwhelmed APSs. HCWs need effective tools with objective judgments, which do not hamper the HCW-caregiver-patient rapport and prevent lawsuits when allegations are unfounded. Orofacial EN manifestations (poor oral/denture hygiene, lack of needed/improper dentures, dry mouth, skin/mucosal rashes) are essential Forensic Markers of EN. I classified EN-associated oral diseases according to the unmet needs into four groups: (1) traumatic injuries due to lack of caregiver vigilance (e.g., maxillofacial fractures); (2) diseases due to oral hygiene deficiency (e.g., root caries); (3) diseases typical of the elderly with late/no diagnosis (e.g., oral cancer); and (4) diseases typical of the elderly exacerbated by psychological distress (e.g., oral lichen planus).

Nano-TiO2-based photocatalytic disinfection of environmental surfaces contaminated by meticillin-resistant Staphylococcus aureus.

BACKGROUND: Traditional cleaning and disinfection methods are inefficient for complete decontamination of hospital surfaces from meticillin-resistant Staphylococcus aureus (MRSA). Additional methods, such as nano-TiO2-based photocatalytic disinfection (PCD), could be helpful. AIM: To evaluate anti-MRSA activity of PCD on polyvinyl chloride (PVC) surfaces in natural-like conditions. METHODS: Two identical PVC surfaces were used, and nano-TiO2 was incorporated into one of them. The surfaces were contaminated with MRSA isolated from hospitalized patients using a mist sprayer to simulate the mode of environmental contamination caused by a carrier. MRSA cell density was assessed before contamination until 180min after contamination using Rodac plates. The differences between test and control surfaces in terms of MRSA density and log MRSA density reduction were assessed using parametric and non-parametric statistical tests. Five strains were tested, and each strain was tested five times. FINDINGS: The highest median MRSA densities [46.3 and 43.1 colony-forming units (cfu)/cm(2) for control and test surfaces, respectively] were detected 45min after contamination. Median MRSA densities 180min after contamination were 10.1 and 0.7cfu/cm(2) for control and test surfaces, respectively (P<0.01). Log MRSA density reduction attributable to PCD was 1.16logcfu/cm(2), corresponding to 93% reduction of the baseline MRSA contamination. CONCLUSIONS: The disinfectant activity remained stable throughout the 25 testing occasions, despite between-test cleaning and disinfection. The anti-MRSA activity of PCD was compatible with the benchmark for surface hygiene in hospitals (<1cfu/cm(2)), but required 3h of exposure to photocatalysis. Thus, PCD could be considered for non-clinical surfaces. However, for clinical surfaces, PCD should be regarded as supplemental to conventional decontamination procedures, rather than an alternative.

Oral cancer screening usefulness: between true and perceived effectiveness.

Screenings, introduced in the 1920s, became rapidly popular in healthcare settings. Chance is an intrinsic screening characteristic. Roughly one half of screened subjects are correctly classified merely by chance, and in high-prevalence settings, even inaccurate screenings detect several diseased individuals by chance, thus appearing effective. The viewpoint is another variable affecting screening perceived effectiveness. For example, public health officers, who seek for mortality rate reductions, look for high sensitivity, which, in turn, is affected by disease prevalence. The relative mortality rate reduction attributable to screening may therefore be significant in high-prevalence areas and irrelevant in low-prevalence areas. This explains why oral cancer visual screening is perceived effective in high-prevalence countries and ineffective in low-prevalence countries. Patients seek for reliable outcomes. Therefore, they require screenings with high positive (PV+) and negative (PV-) predictive values. In high-prevalence areas, PV+ is high, while PV- is low. The reverse occurs in low-prevalence areas. Thus, even for accurate screenings, the perceived effectiveness due to misclassification is low among false-negative patients in high-prevalence areas, who are misclassified as unaffected by the disease, and among false-positive patients in low-prevalence areas, who are subjected to psychophysical sufferings. This article explains the reasons for these and other paradoxes engendered by screening.

Psychological disorders and oral lichen planus: matched case-control study and literature review.

OBJECTIVE: Oral lichen planus (OLP) may be linked to psychological disorders. This study investigated psychological factors associated with OLP. METHODS: A case-control study with incident OLP case patients and age-gender-socio-economic status-matched controls, recruited from among relatives, accompanying persons, and departmental staff, investigated psychological traits using the Psychological General Well-Being Index-Short form. Common factor analysis was used to generate a set of psychological dimensions. The association between these dimensions and OLP adjusted for confounders (education, number of lifetime sexual partners, drinking-smoking) and interactions was assessed through conditional logistic regression and odds ratios (OR) were estimated. RESULTS: A total of 67 case-control pairs were recruited. Psychological dimensions generated were: dimension-1 (anxiety, low vitality), dimension-2 (negative well-being, low vitality), dimension-3 (depressed mood, low self-control). The ORs for OLP were, dimension-1, 1.0 (95% confidence interval -95CI, 0.3-2.6); dimension-2, 0.5 (95CI, 0.2-1.2); dimension-3, 4.8 (95CI, 1.8-12.9). Dimension-3 was highly associated with mild, but not associated with severe, OLP. Literature searching provided 21 studies, with anxiety and depression principally associated with OLP. CONCLUSIONS: Depressed mood and low self-control were highly associated with OLP, particularly the reticular-papular forms. These traits could have a causative role in OLP development-progression, but further investigations are necessary.

How many individuals must be screened to reduce oral cancer mortality rate in the Western context? A challenge.

OBJECTIVE: Controlling oral cancer (OC) through screening is appealing. Advantages of this are as follows: OC is often preceded by visible premalignant lesions, early-stage survival is threefold greater than late-stage survival, and visual screening is inexpensive. Disadvantages of this are as follows: high frequency of false positives, undemonstrated cost-effectiveness, and irregular screening attendance by high-risk individuals. Screening effectiveness in Western countries has not been proven, because of low OC prevalence, which disproportionally increases the number of individuals needed to screen (NNS) to decrease mortality. This study estimated the NNS to obtain an evident decrease in OC mortality rate in the UK. METHODS: Data gathered from reliable databanks were used. NNS to detect one case (NNScase ) was estimated using a Bayesian approach. NNS to prevent one death (NNSdeath ) was assessed multiplying NNScase by the number of cases that must be screen-detected to prevent one death. NNS to decrease mortality rate by 1% (NNSmortality ) was assessed multiplying NNSdeath by 1% of annual OC deaths. RESULTS: NNSmortality was overall 1 125 000 (95% confidence interval - 95CI, 690 000-1 870 000), males 551 000 (95CI, 337 000-916 000), and females 571 000 (95CI, 347 000-942 000). CONCLUSIONS: An OC visual screening campaign capable of producing an evident decrease in mortality rate in the UK requires a large number of adults to be annually and regularly screened.

Dental unit water treatment with hydrogen peroxide and monovalent silver ions artificially contaminated with freshly isolated pathogens.

BACKGROUND: Dental unit water (DUW) could be contaminated by human pathogens coming from biological fluids penetrated during patient treatment and by opportunistic pathogens detached from aquatic biofilm. These microorganisms could be spread to following patients. We tested the disinfectant activity of hydrogen peroxide and monovalent silver ions (H(2)O(2)-Ag(+)) into DUW artificially contaminated with freshly isolated pathogens. METHODS: The tested microorganisms were Staphylococcus aureus, Enterococcus faecalis, Candida albicans, Pseudomonas aeruginosa, Legionella pneumophila, Mycobacterium chelonae, non-pathogenic Bacillus clausii spores. Bacterial suspensions were inoculated into the waterlines of pre-sterilized dental turbines. The test-turbines were connected to DUW and contaminated water was treated for 10 minutes with H(2)O(2)-Ag(+)-based disinfectant (H(2)O(2) 3% v/v, Ag(+) 0.001% w/v). The control-turbines were left untreated. Turbines were washed with sterile hard water used to assess the residual bacterial loads (expressed in colony forming units -cfu). Each strain was tested five times and the mean log loads were assessed. Following the European Standardization Committee, the disinfectant activity was evaluated as mean log load reduction, that is, the difference between the mean log load detected on the control-turbines and the mean log load detected on the test-turbines. RESULTS: Mean bacterial loads detected on the control-turbines ranged between 105-107 cfu. The mean log load reductions resulted 7.5 log cfu for S. aureus, E. faecalis, P. aeruginosa, 6.3 for C. albicans, 5.4 for L. pneumophila, 5.3 for M. chelonae, 2.9 for B. clausii spores. CONCLUSIONS: DUW disinfection with H(2)O(2)-Ag(+) could help minimize the risk that planktonic pathogens are spread to patients during dental treatment.

Alcohol is not a risk factor for oral cancer in nonsmoking, betel quid non-chewing individuals. A meta-analysis update.

BACKGROUND: Alcohol drinking is associated with high oral cancer (OC) risk. This association is particularly evident in tobacco smoking/betel quid (BQ) chewing subjects. In a previous stratified meta-analysis (Petti S et al., Cancer Epidemiol 2012) we reported that drinking was inversely associated with OC in non-smoking BQ non-chewing individuals, while this association was reversed in smoking individuals. However, the previous study could be excessively influenced by a large primary study, which yielded more than 50% of the weight of all the primary studies. Therefore, we updated this analysis using only recent studies. METHODS: Case-control studies published between 2010 and 2012 were searched. In each study, non-smoking/ BQ non-chewing exposed (ever routine drinkers) and unexposed (never drinkers) subjects with (cases)/without (controls) OC were extracted and odds ratio (OR) calculated. Between-study heterogeneity was assessed with Cochran's Q. Publication bias was formally assessed with trim and fill method. Sensitivity analysis to inclusion criteria was made. The pooled OR was assessed with the fixed- and random-effect methods and corrected for publication bias. RESULTS: Seven of these studies met the inclusion criteria: they were not heterogeneous enough. Correction for publication bias was not necessary and provided only one missing study. The OR estimates were 0.70 (95% confidence interval -95CI, 0.51-0.98), 0.70 (95CI, 0.51-0.96), 0.75 (95CI, 0.54-1.03) with the three methods. Sensitivity analysis did not change the OR estimates considerably. CONCLUSIONS: This analysis corroborated the results of the previous analysis, confirming that drinking was inversely associated with OC in non-smoking, BQ non-chewing subjects.

Orofacial diseases in solid organ and hematopoietic stem cell transplant recipients.

OBJECTIVE: Solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients are at risk of several diseases, principally attributable to immunosuppression. This global overview of SOT/HSCT-associated orofacial diseases is aimed at providing a practical instrument for the oral healthcare management of SOT/HSCT recipients. METHODS: Literature search was made through MEDLINE. The associations between orofacial diseases and SOT/HSCT were assessed using observational studies and case series and were classified into 'association', 'no association', and 'unclear association'. RESULTS: Lip/oral cancers, drug-induced gingival overgrowth (DIGO), infections, including hairy leukoplakia and, less frequently, post-transplantation lymphoproliferative disorders (PTLDs) and oral lichenoid lesions of graft-versus-host disease (GVHD), were associated with SOT. Lip/oral cancers, GVHD, mucositis, DIGO, infections and, less frequently, PTLDs were associated with HSCT. Associations of orofacial granulomatosis-like lesions and oral mucosa-associated lymphoid tissue-type lymphoma with SOT, and of pyogenic granuloma and hairy leukoplakia with HSCT were unclear. Periodontal disease and dental caries were not associated with SOT/HSCT. For none of the local treatments was there a strong evidence of effectiveness. CONCLUSIONS: Solid organ transplant/HSCT recipients are at risk of orofacial diseases. Adequate management of these patients alleviates local symptoms responsible for impaired eating, helps prevent systemic and lethal complications, and helps where dental healthcare has been neglected.

Antibacterial activity of yoghurt against viridans streptococci in vitro.

OBJECTIVE: Yoghurt consumption leads to a selective decrease in the oral level of mutans streptococci. It is not clear whether this decrease is due to the bactericidal activity of yoghurt or other mechanisms. The present study investigated the differences in susceptibility to yoghurt between several strains of viridans streptococci. DESIGN: The sources of variation were minimised, at the expense of the external validity of the study, using culture collection strains. Each strain was tested separately on five occasions in planktonic form and logarithmic growth phase. Two strains of each of the following Streptococcus species were tested: mutans, sobrinus, gordonii, oralis, parasanguinis and sanguinis. One millilitre [10(8) colony-forming units (cfu)] of each strain was incubated (37 degrees C, 60min) with 9mL of fat-free plain yoghurt containing Streptococcus thermophilus and Lactobacillus bulgaricus (10(8) and 10(7)cfu/g, respectively) in gently vortexed tubes. Survival rates were calculated every 15min by dividing the number of viable cells, obtained using conventional laboratory procedures, by the baseline number. RESULTS: Survival rates were 8% (S. mutans 6519T), 12% (S. mutans 31738), 35% (S. oralis 25671) and >50% (all other species tested) after 15min, and 0.01% (S. mutans) and >10% (all other species tested) after 30min. Overall, S. parasanguinis and S. sobrinus were the most resistant species. When heat-treated yoghurt (<10cfu/g bacteria and inactivated bacteriocins) was used, this antibacterial activity was not found. CONCLUSION: In vitro, yoghurt with live bacteria showed selective anti-mutans activity, suggesting that the overall decrease in mutans streptococci in vivo could be due to a bactericidal effect on S. mutans but not on S. sobrinus.

National Italian Guidelines for caries prevention in 0 to 12 years-old children.

AIM: Oral and dental health improved tremendously over the last fifty years in Italy but still prevalence of dental caries in children remains a significant clinical problem. This report describes the National Italian Guidelines for caries prevention. METHODOLOGY: A panel of experts coordinated by the Italian Society of Paediatric Dentistry (SIOI) planned to elaborate the national Italian guidelines for caries prevention in children. The structure of the guidelines has been planned to follow the principles of modern caries treatment and management as well as science based dentistry. The main procedure was based on a hierarchic evaluation of literature. CONCLUSION: The guidelines are planned for dentist working in primary dental care, however, they are also designed to be of interest for other care professionals such as paediatricians, gynecologists, pharmacists and general medical practitioners and also for parents and/or guardians of the children.