[Temporomandibular dysfunction and bruxism in patients with early rheumatoid arthritis and at-risk patients: a cross-sectional study]. / Temporomandibulaire disfunctie en bruxisme bij patiënten met vroege reumatoïde artritis en risicopatiënten: een cross-sectioneel onderzoek.

What is the prevalence of temporomandibular dysfunction in patients with early rheumatoid arthritis and individuals at risk of rheumatoid arthritis? 3 groups (of 50 participants each) were examined for a possible TMD diagnosis: 1. patients with early rheumatoid arthritis, 2. at-risk individuals, and 3. healthy controls. A possible association with bruxism, determined on the basis of self-reporting and clinical features, was also examined. At-risk patients had a higher prevalence of TMD pain diagnoses compared to healthy controls (p = 0.046). Within the early rheumatoid arthritis group, seronegative patients had a higher prevalence of TMD pain diagnoses than seropositive patients (p = 0.048). No further differences in the prevalence of TMD diagnoses were found between the groups. Participants with a TMD pain diagnosis were more often diagnosed with probable sleep bruxism than those without a TMD pain diagnosis. The prevalence of TMD pain is increased in individuals at risk of rheumatoid arthritis and seronegative early rheumatoid arthritis patients, and is associated with signs of bruxism.

The Prevalence and Severity of Dental Caries Among Pregnant Women in the State of Rio de Janeiro, Brazil.

AIM: To assess in a pilot study the prevalence and severity of dental caries among pregnant women compared to non-pregnant women in the state of Rio de Janeiro, Brazil. MATERIALS AND METHODS: A cross-sectional, observational study was conducted. Data collection consisted of clinical examinations and general questionnaires concerning oral hygiene habits and recent dental visits of pregnant and non-pregnant women. Prevalence and severity of caries was determined by the CAST index and the CAST severity score. Permission for this study was granted by the National Research Ethics Commission of Brazil. Written informed consent was obtained from all participants. RESULTS: In total, 67 pregnant women were included (mean age (SD) 25.5 ± 5.4 years) and 79 non-pregnant women (26.0 ± 5.3 years). Mean number of teeth with untreated caries (CAST 4-7) among pregnant women was significantly lower (1.2 ± 1.8) compared to non-pregnant women (2.7 ± 4.0; Mann-Whitney test, p = 0.027). In both groups, 40-60% were in need of curative treatment. There was no significant difference between the two groups in frequency of dental visits (p > 0.05), but pregnant women brushed their teeth more often (Mann-Whitney test, p < 0.001). CONCLUSION: Pregnant women in the state of Rio de Janeiro have fewer untreated caries and less severe dental caries compared to non-pregnant women. Still, half of all women in this study are in need of curative treatment for at least one tooth. Effective preventive programs should therefore be developed to stimulate preventive oral care among all women.

Dental healthcare costs of children living in Amsterdam and associated socio-demographic characteristics.

OBJECTIVES: The aim of this study was to assess associations between socio-demographic characteristics and dental costs of children living in Amsterdam. Having incurred dental costs was an indicator for having visited the dentist. Having incurred low or high dental costs may indicate the type of dental care provided (periodic examination, preventive care or restorative treatment). METHODS: This study followed a cross-sectional, observational design. The research population contained all children up until 17 years living in Amsterdam in 2016. Dental costs from all Dutch healthcare insurance companies were obtained via Vektis, and socio-demographic data were obtained from Statistics Netherlands (CBS). The study population was stratified into age groups: 0-4 and 5-17 years. Dental costs were classified as no dental costs (0 euros), low dental costs (>0 to <100 euros) or high dental costs (≥100 euros). Univariable and multivariable logistic regression analyses were performed to study the distribution of dental costs and associations with socio-demographic child and parent variables. RESULTS: In the population of 142 289 children, 44 887 (31.5%) incurred no dental costs, 32 463 (22.8%) incurred low dental costs and 64 939 (45.6%) incurred high dental costs. Among children of 0-4 years, a much larger proportion (70.2%) incurred no dental costs, compared to those of 5-17 years (15.8%). In both age groups, migration background (adjusted Odds Ratio (aOR) range 1.23-1.98), low(er) household income (aOR range 0.45-0.93), low(er) parental educational level (aOR range 0.51-0.87) and living in a single-parent household (aOR range 0.89-0.91) were strongly associated with incurring high (vs. low) dental costs. Furthermore, in 5-17-year-old children, a lower level of secondary or vocational education (aOR range 1.12-1.17) and living in households receiving social benefits (aOR 1.23) were associated with incurring high dental costs. CONCLUSIONS: Among children living in Amsterdam in 2016, one in three children did not visit a dentist. For children that did visit a dentist, those with a migration background, low parental educational level and from a low household income were more likely to incur high dental costs, which could be indicative for additional restorative treatment. Hence, patterns of oral healthcare consumption, specified by type of dental care over time, and their association with oral health status, are targets for future research.

[International volunteer projects in oral care: an inventory of successful characteristics]. / Internationale vrijwilligersprojecten in de mondzorg: een inventarisatie van succesvolle kenmerken.

This study provides an overview of Dutch oral healthcare volunteer projects abroad and describes to what extent these projects meet the characteristics of a successful volunteer project. These characteristics are based on literature studies and include: preparation of the project, project goal, suitability for the specific population, general approach and scientific justification, composition of the team, sustainability of the project, ethics, external collaborations and sponsors, evaluation of the project, and safety of the volunteers. This study identified 24 Dutch volunteer projects abroad, based on a systematic search. Most of them meet the characteristics of 'project goal and suitability,' 'team composition,' and 'external collaboration and sponsoring.' The information provided for the other characteristics was incomplete, which means that no statements can be made as to the fulfillment of these requirements. These results provide insights into how existing and new volunteer projects can be (further) developed to contribute to oral healthcare in low- and middle-income countries in an effective and well-suited manner.

[A lifetime of proper chewing: oral health and quality of life]. / Een leven lang goed kauwen: mondgezondheid en levenskwaliteit.

Being able to chew properly is crucial to a good quality of life. This, in turn, is based on good oral health. This not only applies to healthy people, but also to those who are vulnerable. To achieve this good oral health, the authors of this opinion paper argue for more integration of medical and dental education, in order to promote shared expertise and, thus, interprofessional collaboration. It is expected this will ultimately benefit both general health and oral health for everyone.

[Implementation of Gewoon Gaaf in practice; what are the experiences of oral healthcare professionals?] / Implementatie van Gewoon Gaaf in de praktijk; wat zijn de ervaringen van mondzorgverleners?

In 2019, a questionnaire study was started in which the experiences, barriers and needs of users of the Gewoon Gaaf caries prevention method were investigated. The survey was distributed via social media, an email list and the Dutch Ivory Cross newsletter. In total,188 people completed the survey. The results showed that the dental practices using this method are satisfied with it and that prevention assistants apply this method most often in practice, often in collaboration with a dental hygienist and/or a dentist. The participants reported positive experiences: the method provides clear tools for daily practice. However, there is a need to share knowledge and experiences with other oral healthcare providers, for example via digital modules or written information. One of the tips given by many users was to spend a lot of time motivating and educating parents. Users' tips derived from this research can be included in the further development of the method.

[Oral hygiene in patients with motor neuron disease: a cross-sectional survey]. / Mondzorg bij patiënten met neuromusculaire aandoeningen: een cross-sectioneel vragenlijstonderzoek.

Neuromuscular disorders cause damage to the motor nerves. Arm-hand function can severely be impaired. The needs of and limitations of patients with neuromuscular disorders and the role of their carers in providing oral hygiene were studied. To this end, an online survey was sent to 706 patients with a neuromuscular disorder (amyotrophic lateral sclerosis, spinal muscular atrophy, primary lateral sclerosis and progressive bulbar palsy). The survey questions concerned, among other things, self-reliance, the oral situation and oral hygiene. Oral health-related quality of life and subjective well-being were also measured. A total of 259 patients (36.7%) responded, of whom 71.9% declared themselves not to have been informed about the importance of maintaining good oral health. Moreover, 40.4% wished to receive help from an oral care professional regarding their oral hygiene; 19.8% was not satisfied with the oral care they provided for themselves or as provided by their carers. It was concluded that attention to oral hygiene for patients with neuromuscular disorders by both multidisciplinary treatment teams and oral care professionals is required.

[Online survey on oral care for children and young people: the results]. / Online enquête naar mondzorg voor jeugdigen: de uitkomsten.

An online survey was used to gauge the opinions of Dutch oral care providers about various aspects of oral care for children and young people. A relatively large number of dental hygienists responded (22%), which is in line with the commitment of all oral care providers to the treatment of children and young people. A majority of the respondents indicated that the Dutch oral care guidelines for children and young people are helpful in determining the bitewing-interval and in making treatment decisions regarding caries.

[Impact of the coronavirus on Dutch oral health care and practice]. / Impact van het coronavirus op de praktijkvoering van de Nederlandse mondzorg.

Among dental hygienists and dentists in the Netherlands, the impact of the SARS-CoV-2 pandemic on oral healthcare practices from March to July 2020 was investigated. Of the 1,700 healthcare providers approached, 433 completed questionnaires could be used. The results show that the pandemic has had a profound impact on both the accessibility of oral healthcare and on care provided in oral healthcare practices. Extra attention was paid to hygiene and infection prevention: the types of personal protective equipment and the protocols and procedures were adjusted by many oral healthcare providers. The confirmed prevalence of oral healthcare providers with COVID-19 in this study was 1.6%. However, testing was not available to all respondents with complaints during this initial period. Over half of the respondents estimated that even with additional measures there is an increased risk of infection to oral healthcare providers during their work. The efficacy of the various additional measures in oral healthcare practices related to COVID-19 is still unknown.

[Cross contamination: spatters, aerosols, and biofilm in dental practices]. / Kruiscontaminatie: spatten, aerosolen en biofilm in de mondzorgpraktijk.

During treatment in dental practices, drops of different sizes are produced (spats and aerosols). Microorganisms in these drops are of human origin or originate from the water in the dental unit. Therefore, these drops can contribute to cross contamination in dental practices. Large drops settle quickly, while smaller drops can remain suspended in the air for a longer period of time. The highest level of contamination is found in the immediate vicinity of the source (the patient's mouth). Further away from the source and after stopping drop producing activities, the level of contamination in the air is comparable to control circumstances. Studies into the spread of viruses via this route in the dental practice have not yet been conducted. The risk of catching an infectious disease in the dental practice seems limited, but can be high in the case of a virulent microorganism, when the circumstances for spread of the virus are favorable, or if the recipient is immunocompromised.

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.

Modeling of the Transmission of Coronaviruses, Measles Virus, Influenza Virus, Mycobacterium tuberculosis, and Legionella pneumophila in Dental Clinics.

Dental health care workers are in close contact to their patients and are therefore at higher risk for contracting airborne infectious diseases. The transmission rates of airborne pathogens from patient to dental health care workers are unknown. With the outbreaks of infectious diseases, such as seasonal influenza, occasional outbreaks of measles and tuberculosis, and the current pandemic of the coronavirus disease COVID-19, it is important to estimate the risks for dental health care workers. Therefore, the transmission probability of these airborne infectious diseases was estimated via mathematical modeling. The transmission probability was modeled for Mycobacterium tuberculosis, Legionella pneumophila, measles virus, influenza virus, and coronaviruses per a modified version of the Wells-Riley equation. This equation incorporated the indoor air quality by using carbon dioxide as a proxy and added the respiratory protection rate from medical face masks and N95 respirators. Scenario-specific analyses, uncertainty analyses, and sensitivity analyses were run to produce probability rates. A high transmission probability was characterized by high patient infectiousness, the absence of respiratory protection, and poor indoor air quality. The highest transmission probabilities were estimated for measles virus (100%), coronaviruses (99.4%), influenza virus (89.4%), and M. tuberculosis (84.0%). The low-risk scenario leads to transmission probabilities of 4.5% for measles virus and 0% for the other pathogens. From the sensitivity analysis, it shows that the transmission probability is strongly driven by indoor air quality, followed by patient infectiousness, and the least by respiratory protection from medical face mask use. Airborne infection transmission of pathogens such as measles virus and coronaviruses is likely to occur in the dental practice. The risk magnitude, however, is highly dependent on specific conditions in each dental clinic. Improved indoor air quality by ventilation, which reduces carbon dioxide, is the most important factor that will either strongly increase or decrease the probability of the transmission of a pathogen.

[Infection prevention in dental care during the outbreak of SARS-CoV-2]. / Infectiepreventie in de mondzorg tijdens de uitbraak van SARS-CoV-2.

COVID-19 is an emerging infectious disease with widespread transmission of the coronavirus SARS-CoV-2 in the Netherlands. Some of those infected become seriously ill. Others do not show any symptoms, but can still contribute to the transmission of the virus. SARS-CoV-2 is excreted in the oral cavity and can be spread via aerosols. Therefore, there is an increased risk of its spread during aerosol-producing treatments in dental care clinics. Due to the risk of infection of dental care workers and patients, and based on the evidence currently available, additional infection control measures for all patients are strongly recommended when providing emergency dental care in this phase of the pandemic. Other treatments should be postponed. Based on guidance in scientific literature and advice from the Dutch National Institute for Public Health and the Environment (RIVM), consideration should be given to what infection control measures are necessary when providing emergency and regular dental care in both the current situation and in the future.

Dental aerosols: microbial composition and spatial distribution.

Background: High-speed dental instruments produce aerosols, which can contribute to the transmission of pathogenic microorganisms. The aim of this study is to describe the microbial load and - composition and spatial distribution of aerosols in dental clinics. Methods: In four dental clinics active and passive sampling methods were used before, during and after treatment and at different locations. Retrieved colony forming units (CFU) were sequenced for taxon identification. Results: The samples contained up to 655 CFU/plate/30 minutes and 418 CFU/m3/30 minutes during dental treatment for active and passive sampling, respectively. The level of contamination after treatment and at 1.5 m distance from the patient's head was similar to the start of the day. The highest contamination was found at the patient's chest area. The aerosols consisted of 52 different taxa from human origin and 36 from water. Conclusion: Contamination in dental clinics due to aerosols is mainly low, although high level of contamination with taxa from both human and water origin was found within 80 cm around the head of the patient. Our results stress the importance of infection control measures on surfaces in close proximity to the head of the patient as well as in dental water lines.

Heterogeneity in the efficacy of dental chemical disinfectants on water-derived biofilms in vitro.

Conditions in dental unit waterlines are favourable for biofilm growth and contamination of dental unit water. The aim of this study was to assess the effect of several chemical disinfectants on bacteria in a biofilm model. Water-derived biofilms were grown in a static biofilm model (Amsterdam Active Attachment model), using two growth media. Biofilms were challenged with Alpron/Bilpron, Anoxyl, Citrisil, Dentosept, Green & Clean, ICX and Oxygenal in shock dose and maintenance doses. The concentration and the composition of the chemical disinfectants influenced the number of culturable bacteria in the biofilms. The application of a single shock dose followed by a low dose of the same chemical disinfectants resulted in the greatest suppression of viable bacteria in the biofilms. Exposure to Citrisil and ICX consistently resulted in failure to control the biofilms, while Alpron/Bilpron had a substantial and relevant effect on the number of bacteria in the biofilms.

Temporomandibular joint function, periodontal health, and oral microbiome in early rheumatoid arthritis and at-risk individuals: a prospective cohort study protocol.

OBJECTIVES/AIMS: Rheumatoid arthritis (RA) is an autoimmune disease affecting the joints, including the temporomandibular joint (TMJ). Early diagnosis and treatment can alleviate symptoms and prevent progression. Predictors for disease outcome in individuals at risk for RA are therefore valuable. While limited information is available on the prevalence of TMJ involvement in early RA, previous studies suggest that RA, periodontitis and the oral microbiome are interrelated. Predictive factors for RA development may thus be present in the oral cavity. Our two aims are: (1) to assess the prevalence of TMJ involvement in early RA, and (2) to investigate the predictive value of oral factors in RA development. MATERIALS AND METHODS: We will include 150 individuals in this multi-center, prospective cohort study: 50 patients with early RA, 50 at-risk individuals, and 50 healthy controls. At baseline, the TMJ, periodontal health, and the oral microbiome will be examined. The general health will be followed over time, on four occasions up to 3 years. DISCUSSION: Our results will provide insight into the prevalence and clinical characterization of TMJ involvement in early RA. For at-risk individuals, oral factors can be studied as possible predictors for the development of RA.

Microbial water quality management of dental unit water lines at a dental school.

Contaminated dental unit water lines (DUWLs) are a possible source for spreading micro-organisms in dental practices. This study reports the microbial load of the water from DUWLs of a large dental school over time. The water quality of 231 dental chairs was tested three times over 1.5 years; 175 DUWLs at student clinics and 56 DUWLs at staff clinics. DUWLs at the staff clinics met the Dutch requirement of 100 colony-forming units/mL. An increasing number of DUWLs at the student clinics complied with this requirement, indicating that the local protocols are adequate but that compliance can be improved.

Cross-transmission in the Dental Office: Does This Make You Ill?

PURPOSE OF REVIEW: Recently, numerous scientific publications were published which shed new light on the possible risks of infection for dental healthcare workers and their patients. This review aimed to provide the latest insights in the relative risks of transmission of (pathogenic) micro-organisms in the dental office. RECENT FINDINGS: Of all different routes of micro-organism transmission during or immediately after dental treatment (via direct contact/via blood-blood contact/via dental unit water and aerosols), evidence of transmission is available. However, the recent results put the risks in perspective; infections related to the dental office are most likely when infection control measures are not followed meticulously. SUMMARY: The risk for transmission of pathogens in a dental office resulting in an infectious disease is still unknown; it seems to be limited in developed countries but it cannot be considered negligible. Therefore, maintaining high standards of infection preventive measures is of high importance for dental healthcare workers to avoid infectious diseases due to cross-contamination.

[Implementation of effective infection control: furnishing a -dental practice]. / Infectiepreventie in de praktijk ­ het inrichten van de tandartspraktijk.

The increasing resistance to antibiotics and the aging of the population of patients who visit the dental practice can lead to more frequent infections with (resistant) microorganisms. The prevention of cross contamination by the implementation of effective measures in the area of hygiene and procedures of infection control is therefore important. The furnishing of a dental practice can play an important part in prevention. What are the important issues in furnishing a practice? A distinction is made between 'critical' and 'non-critical' rooms. Patients are only treated and instruments are only prepared for reuse in critical rooms. In these rooms, a strict separation is maintained between clean and contaminated, in both place and time. Only furniture that is strictly necessary for the treatment of patients is present in the critical rooms. Materials and equipment that are kept within the splatter area must be stored as much as possible in drawers and closed cabinets. Water taps can be controlled in a touch-free manner and are located within the present walking routes of the practice.