Use of toothbrushing in conjunction with chlorhexidine for preventing ventilator-associated pneumonia: A random-effect meta-analysis of randomized controlled trials.

OBJECTIVE: The oral cavity with poor hygiene is a reservoir of a complex community of commensal and pathogenic bacteria. Improved oral hygiene (OH) may reduce the incidence of ventilator-associated pneumonia (VAP); however, research on the efficacy of different OH treatments and their potential synergistic effects has remained inconclusive. The objective of this study was to examine whether in patients on mechanical ventilation, using a toothbrushing (T) in conjunction with chlorhexidine (CHX), as opposed to only CHX, reduced the incidence of VAP. METHOD: A random-effect meta-analysis of randomized clinical trials, which compare the effect of CHX+T (intervention) with CHX (control) on the risk of VAP, was conducted. The Mantel-Haenszel model was used to determine the mean differences (MD), relative risks (RR) and 95% confidence intervals (CI). RESULTS: Seven studies with 1424 patients were included. Oral care with CHX+T reduced the incidences of VAP (RR = 0.67; CI = [0.50, 0.88], p = 0.005) compared with that with CHX alone. The former also reduced the duration of mechanical ventilation (MD = -1.38; CI = [-2.43, -0.33], p = 0.01) and length of stay in the ICU (MD = -1.47; CI = [-2.74, -0.20], p = 0.02), although the risk of ICU mortality did not reduce (RR = 0.87, 95% CI = [0.72, 1.04], p = 0.17). CONCLUSIONS: Toothbrushing along with CHX significantly reduced the risk of VAP. Further well-designed randomized controlled trials with a careful focus on the OH are needed to fully establish the advantage of toothbrushing along with CHX for reducing the risk of VAP.

Anxiety Levels among Polish and Turkish Dentists during the COVID-19 Pandemic.

Working conditions, work-related stressors and high risk of infection, as well as the fear of contagion and spreading the disease to family members, may have influenced dentists' mental health during the COVID-19 pandemic. The aim of this study was to evaluate the anxiety levels among Polish and Turkish dentists during the COVID-19 pandemic and to investigate any relevant predictors. The study was an anonymous online questionnaire-based cross-sectional study that was conducted among dentists from two countries: Poland and Turkey. In total 400 dentists (200 from each country) participated in the study. The survey consisted of two parts: part 1 comprised demographic data, including age, gender, country of origin, COVID-19 infection history, place of work and lockdown history; part 2 was based on the State-Trait Anxiety Inventory (STAI). The mean trait and state anxiety levels of the Polish dentists was statistically significantly lower than that of the Turkish dentists (p = 0.000; p < 0.05). However, Polish dentists had higher state anxiety levels than trait levels, while both types of anxiety among Turkish dentists were almost at the same level. The number of dentists who suffered from COVID-19 was found to be statistically significantly higher in Poland (54%) than in Turkey (16%) (p = 0.000; p < 0.05). The percentage of dentists reporting anxiety was 51% in Poland and 95.5% in Turkey. Polish dentists reported a lower mean anxiety level during the COVID-19 pandemic than the dentists in Turkey but their anxiety levels were more affected by the COVID-19 pandemic as they had a higher difference between their state and trait anxiety levels. The higher coronavirus infection rate and lack of governmental lockdowns of dental practices during the pandemic in Poland compared with those in Turkey may explain the difference in the state and trait anxiety levels.

Clinical Trial Evaluating Quality of Life in Patients with Intra-Oral Halitosis.

Halitosis is considered to be extremely unattractive in the context of social interactions. The main research objective of this study was to evaluate whether intra-oral halitosis may impact patients' quality of life (QOL). One hundred generally healthy adult participants complaining about oral malodor and diagnosed with intra-oral halitosis were enrolled in this study. For halitosis diagnosis, a gas chromatography (GC) analysis by the Oral Chroma portable device was used. QOL assessment was based on the Short Form 36-item Health Survey (SF-36). The respondents had the highest scores in the physical functioning (PF), activity limitations caused by emotional problems (RE) and activity limitations caused by physical problems (RP) domains, and the weakest in the general health perception (GH), vitality (VT) and emotional wellbeing (MH) ones. The total volatile sulfur compounds (VSCs) level was negatively correlated with SF-36 domains. The SF-36 domains' scores decreased the higher the level of VSC was. The respondents assessed their QOL to be at its best in physical functioning and activity limitations caused by emotional and physical problems and the worst in general health perception, vitality and emotional wellbeing. The strongest correlation between halitosis and decreased QOL was found in the social functioning (SF), vitality, emotional wellbeing and general health perception domains.

Efficacy of a Zinc Lactate Mouthwash and Tongue Scraping in the Reduction of Intra-Oral Halitosis: A Single-blind, Controlled, Crossover Clinical Trial-A Pilot Study.

Intra-oral halitosis is defined as an unpleasant odor that comes out of the mouth. The aim of this study was to investigate the effect of zinc lactate mouthwash and tongue scraping on intra-oral halitosis. The study was conducted on 60 volunteers that were divided into two groups and fol-lowed two types of 14-day oral hygiene protocols on a cross-over basis after a 7-day wash-out period. One protocol was based on tooth brushing only, while the other was based on additional mouth rinsing with a zinc lactate product and tongue scraping. Morning mouth breath was as-sessed organoleptic and by volatile sulfur compound concentrations. The highest mean organo-leptic and volatile sulfur compound measurement values were found in the tooth brushing without mouth washing and tongue scraping oral hygiene protocol (p < 0.05). The zinc lactate mouthwash combined with tongue scraping appears to be an important hygienic procedure to reduce breath odor.

Effects of COVID-19 Pandemic on Working Conditions of Dentists in Poland and Turkey.

Background and Objectives: Due to the specific working conditions dental professionals represent a group of high risk of infection and COVID-19 pandemic in many ways have influenced their working environment. The aim of this study was to evaluate effects of COVID-19 pandemic on working conditions of dentists in Poland and Turkey. Materials and Methods: The study was an anonymous online questionnaire conducted among thedentists in two countries: Poland and Turkey. The survey consisted of general questions, COVID-19 pandemic infection and working history as well as working conditions before and during pandemic. Chi-square test, Fisher's Exact test, Fisher Freeman Halton test and Continuity (Yates) Correction were used to compare qualitative data. Results: The study was conducted with a total of 400 participants, 162 (40.5%) men and 238 (59.5%) women, aged between 23 and 67. The mean age of the participants was 42.39 ± 9.99 years. Positive COVID-19 test results among dentists in Poland were found to be significantly higher than in Turkey. Time of dental procedures during the COVID-19 pandemic in Poland and Turkey was significantly increased. The usage of N95/FFP2 or N99/FFP3 masks and surgical gowns during COVID-19 pandemic compared to pre-COVID-19 periods was clearly higher (p < 0.05). Reusable full-face and half-face elastomeric respirators are increasingly used in Turkey. During the COVID-19 pandemic a 25% decrease in dentists' income in Poland (81%) was significantly high than in Turkey (47.5%). Conclusions: COVID-19 pandemic has influenced working conditions of dentists. Many dentists got infected during the pandemic, dental procedures' time has increased, and protective equipment usage has become higher. Further studies analyzing the working conditions of dentists during COVID-19 pandemic should be conducted for better planning of future decisions taken by governments and authorities.

COVID-19 and respiratory protection for healthcare providers.

This article has investigated the considerations of healthcare facilities to utilize reusable respirators as an alternative to disposable respirators during the COVID-19 pandemic. The decision to choose specific equipment should be based on the protection factors and also on the overall analysis of given conditions. International scientific databases, such as Web of Science, PubMed and MedLine, were searched on May 5, 2020, with the following key words: COVID-19, respiratory protection, surgical masks, filtering facepiece respirators (FFRs) and disposable respirators. The differences between various respiratory protective equipment, i.e., surgical masks, respirators such as FFRs, elastomeric half-facepiece respirators, elastomeric full-facepiece respirators and powered air-purifying respirators (PAPRs), were compared. Reusable elastomeric respirators (RERs) may provide a better adaptation to the face and may be more stable when used by healthcare providers (HCPs). Protection factors were found to be higher in FFRs compared to surgical masks. While FFRs provide a one-tenth decrease in the inhaled aerosol concentration, PAPRs diminish the inhaled aerosol up to one-twenty-fifth. Even with some full-face PAPRs and helmets, the protection factor assigned by the Occupational Safety and Health Administration can reach a value up to 1000. For HCPs, the evidence shown in this article provides an additional support for the utilization of RERs. Such equipment might be less prone to leakages, can provide a better fit, and indicates a better stability compared to disposable FFRs (N95 and similar). By providing higher protection factors, reusable elastomeric respirators are recommended to be used by HCPs under controlled cleaning and disinfection protocols. Int J Occup Med Environ Health. 2021;34(2):307-18.