[The spread of aerosols and splashes during the removal of dental deposits with an ultrasonic scaler]. / Rasprostranenie aerozolei i bryzg vo vremya udaleniya zubnykh otlozhenii ul'trazvukovym skalerom.

There is an increased prevalence of respiratory infections among dentists, which is associated with a heavily polluted breathing area in the dental office. Patients and dentists are at high risk of cross-infection due to the spread of aerosols in the form of droplets suspended in the air. The ultrasonic scaler is the largest source of aerosols and spatter in the dental office. Aerosols remain in the air for a long time even after the completion of a dental procedure and have a potential risk of inhalation. PURPOSE OF THE STUDY: To evaluate the spatial distribution of aerosols and splashes during a dental appointment during ultrasonic dental treatment. MATERIAL AND METHODS: The study was conducted on a mannequin equipped with phantom jaws, where dental plaque removal was simulated using an ultrasonic scaler filled with fluorescein. The amount of contamination was measured using a transparent grid with a square marking of 1 cm2. The grid was placed on top of a disk of filter paper and the area of contamination was measured by counting the number of soiled squares. If a square had at least 1 yellow area, then it was considered polluted. RESULTS: Aerosols and splashes were distributed up to 60 cm from the head restraint. Aerosols can spread over more than 1 m. CONCLUSIONS: The study showed the spread of aerosols and splashes during dental appointments. The risk of infection can be minimized by following simple protective measures.

Structure and Composition of Candidate Phyla Radiation in Supragingival Plaque of Caries Patients.

OBJECTIVE: To investigate the composition and abundance of candidate phyla radiation (CPR) in the oral cavity in caries patients and a healthy population. METHODS: The raw macrogenomic sequencing data for a total of 88 subjects were downloaded from the National Centre for Biotechnology Sequence Read Archive (NCBI SRA) public database according to the public data usage specifications. Trimmomatic (Department for Metabolic Networks, Potsdam, Germany) and Bowtie 2 (University of Maryland, College Park, MD, USA) were used to quality control and dehost the host sequences. Species annotation was made using Kraken2 (Johns Hopkins University, Baltimore, MD, USA) and Bracken (Johns Hopkins University) based on the reference database. According to the results of the species annotation, the species-significant differences and species correlation of caries and healthy oral microbiota in species composition and microbiota diversity were analysed to study the distribution and abundance differences of CPR in the oral environment. RESULTS: Proteobacteria, Firmicutes, Bacteroidetes, Actinobacteria and Fusobacteria were the main components. The relative abundance of TM7 (Candidatus Saccharibacteria) and GN02 (Candidatus Gracilibacteria) of CPR is second only to the aforementioned five bacteria, indicating that CPR is an important part of the oral microbiota. TM7 and GN02 were common to both the caries patients and healthy patients and were detected in all samples, suggesting that CPR is the 'core microbiome'. There was a correlation between CPR and a variety of oral microbiota, among which the positive correlation with Capnocytophaga was the strongest, suggesting that Capnocytophaga might be the potential host bacteria of CPR. CONCLUSION: CPR is an indispensable part of the oral microbiota. It is the 'core microflora' of the oral cavity and may play an important role in the stability and function of the oral microecological environment. Capnocytophaga may be the potential host bacteria of CPR.

Effects of Calf Horn as Chews on the Behavior of Laboratory Dogs.

It is increasingly required that non-human animals in laboratories are provided with adequate enrichment to promote the welfare of the animals. In a previous publication we showed that laboratory dogs intensively used the horn of calf hooves as chewing objects. In this report, we describe the effect of calf horn on selected behaviors of 62 laboratory dogs (60 beagles, two Foxhound crossbreds) in three research facilities (A, B, C). In addition, we assessed the dogs' tooth condition and fecal consistency. The selected behaviors: "aggressive behavior," "mounting," "tussle," "coprophagy," "manipulation" of the equipment and "abnormal behavior" did not change. In facilities A and C, the dogs receiving horn showed a significant reduction in staying near the fence of the kennel and observing the outside area. By analyzing the overall behavior in facility B, we found that "exploration" increased with horn, whereas "inactivity," "social play" and "other social behavior" decreased. In conclusion, the results indicate that horn of calf hooves offers alternative stimulation. We found positive effects on tartar/plaque reduction and fecal consistency which should be confirmed in further studies.

The effect of a 3% hydroxyapatite paste prophylaxis after different root-scaling procedures in periodontics / Efeito da profilaxia com pasta de hidroxiapatita 3% após diferentes procedimentos de raspagem radicular na periodontia

Abstract Introduction Root-scaling procedures on the root surface show to increase root surface roughness during instrumentation. The use of a prophylactic paste reduces the roughness. Objetive This study evaluated the influence of prophylaxis paste on the surface roughness of root dentin after hand instruments (HI), ultrasonic scalers (US) and rotational instruments (RI) were applied to root surfaces. Material and method Fifty bovine roots were prepared and randomly divided into 10 groups (n=5) in which instrumentation with HI, US, or RI was carried out with or without prophylaxis using either conventional or 3% hydroxyapatite paste; additionally, a control group without treatment was included. The Ra and Rz roughness values were measured using a perfilometer. The morphological aspects of the root surfaces were analysed qualitatively by scanning electron microscopy (SEM). Data were analysed using two-way ANOVA followed by Tukey's test (α = 0.05). Result The scaling method and the prophylaxis procedure significantly influenced (p < 0.05) root surface roughness. Treatment with US and prophylaxis with 3% hydroxyapatite paste resulted in lower values ​​of Ra (0.14 µm ± 0.02 µm) and Rz (0.89 µm ± 0.18 µm) compared to the other groups. SEM analysis showed smoother and more homogeneous surfaces in the groups with prophylaxis compared to the groups without prophylaxis. There were no substantial differences between the results of applying different pastes. Conclusion The prophylaxis procedure performed with the experimental paste containing 3% hydroxyapatite reduced the roughness of root surfaces treated with HI, US and RI at the same level as the conventional prophylactic paste.

Resumo Introdução Procedimentos de raspagem na superfície radicular aumentam a rugosidade superficial durante a instrumentação. O uso de pasta profilática pode reduzir a rugosidade. Objetivo Este estudo avaliou a influência da profilaxia com pasta na rugosidade superficial da dentina radicular após instrumentação manual (IH), ultrassom (US) e instrumentos rotatórios (IR) aplicados em superfícies radiculares. Material e método Cinquenta raízes bovinas foram preparadas e divididas aleatoriamente em 10 grupos (n = 5) nos quais a instrumentação com HI, US ou RI foi realizada com ou sem profilaxia usando pasta convencional ou hidroxiapatita a 3%; adicionalmente, um grupo controle sem tratamento foi incluído. As rugosidades de Ra e Rz foram medidas por um perfilômetro. Os aspectos morfológicos das superfícies radiculares foram analisados ​​qualitativamente por microscopia eletrônica de varredura (MEV). Os dados foram analisados ​​por meio de ANOVA de dois fatores, seguido pelo teste de Tukey (α = 0,05). Resultado O método de raspagem e o procedimento de profilaxia influenciaram significativamente (p <0,05) a rugosidade da superfície radicular. O tratamento com US e a profilaxia com pasta de hidroxiapatita ao 3% resultaram em menores valores de Ra (0,14 µm ± 0,02 µm) e Rz (0,89 µm ± 0,18 µm) em relação aos demais grupos. A análise por MEV mostrou superfícies mais lisas e mais homogêneas nos grupos com profilaxia em comparação aos grupos sem profilaxia. Não houve diferenças substanciais entre os resultados da aplicação das diferentes pastas. Conclusão O procedimento de profilaxia realizado com a pasta experimental contendo 3% de hidroxiapatita reduziu a rugosidade das superfícies radiculares tratadas com HI, US e RI no mesmo nível da pasta profilática convencional.

Tratamiento endodóncico y blanqueamiento interno de un 2.1. con metamorfosis cálcica / Endodontic treatment and internal bleaching of a 2.1. with calcium metamorphosis

Introducción: La metamorfosis cálcica se presenta comúnmente tras lesiones traumáticas y se caracteriza por presentar depósitos de tejido duro dentro del espacio pulpar, obliterando parcial o totalmente la cámara pulpar y/o el conducto radicular. Este proceso suele provocar un cambio de coloración de la corona clínica haciéndola más oscura y opaca. Caso clínico: Paciente mujer de 40 años acude a la consulta motivada por una preocupación estética debido al oscurecimiento del diente 21. Se proponen varias opciones de tratamiento, hasta que finalmente se opta por el tratamiento de conductos de forma ortógrada, así como blanqueamiento interno del diente. Conclusión: El plan de tratamiento en dientes con metamorfosis cálcica sin patología periapical y con compromiso estético partirá siempre desde el más conservador. Es esencial en el tratamiento de estos dientes la experiencia del operador, así como el buen manejo del microscopio y los ultrasonidos, herramientas fundamentales para su abordaje

Introduction: Calcium metamorphosis commonly occurs after traumatic injuries and is characterized by hard tissue deposits within the pulp space, partially or totally obliterating the pulp chamber and/or the root canal. This process usually causes a change in the color of the clinical crown, making it darker and more opaque. Clinical case: A 40-year-old female patient came to the clinic motivated by an aesthetic concern due to the darkening of the tooth 21. Various treatment options are proposed, until finally the endodontic treatment is chosen, as well as internal bleaching of the tooth. Conclusion: The treatment in teeth with calcium metamorphosis, without periapical pathology and with aesthetic compromise, should always be the most conservative. It is essential in the treatment of these teeth the experience of the operator, as well as the correct use of the microscope and ultrasounds, which are fundamental tools for its approach

Presence of trichomonads in subgingival biofilm of patients with periodontitis: preliminary results.

This study aims to evaluate the prevalence of trichomonads in the subgingival biofilm of patients with periodontitis. Secondarily, the trichomonad presence was related to patient characteristics and periodontal clinical parameters, in order to highlight the factor favoring the development of these protozoans. Subgingival biofilm samples were collected from at least two diseased and one healthy site in 50 patients suffering from periodontitis. Trichomonads were identified using phase contrast microscopy. All patient characteristics and periodontal clinical parameter data were then statistically analyzed. From the 50 patients examined, 195 sites were sampled, including 145 diseased ones. Trichomonads were only observed on 16 of the 145 diseased sites (11%) and none in the other 50 healthy sites. Based on these results, 20% (n = 10) of patients were positive for the presence of trichomonads from at least one of the diseased sites collected. Tooth mobility, substantial supra-gingival dental deposits, and severe clinical attachment loss were statistically associated with trichomonad presence. If the subgingival biofilm of male patients over the age of 50 seemed to be more frequently contaminated with trichomonads, this data was not statistically supported. This preliminary study indicates for the first time that in periodontitis-involved patients, trichomonads are observed in the subgingival biofilm collected from diseased sites with severe bone loss, but not from healthy teeth. Further investigations are needed to fully explore the role of this microorganism in the etiology of periodontal disease.

STEM and HRTEM studies of accumulated deposits on human tooth surface.

The aim of this study was to clarify the fine structure of accumulated deposits on the surface of teeth that are considered to affect the gloss of teeth. The study was carried out using, as specimens, human incisor teeth having gloss, which were extracted from teenage donors and those incapable of showing gloss even by brushing which were extracted from donors in their 50s. Thin longitudinal sections of tooth enamel with accumulated deposits on the surface were prepared by focused ion beam (FIB) milling, and the fine structure was analyzed using a scanning transmission electron microscope (STEM) and a high resolution transmission electron microscope (HRTEM). By FIB, thin longitudinal sections could be prepared from tooth enamel together with organic and inorganic substances accumulated on the surface without artifacts. The accumulated deposits on the surface of teeth having gloss were composed of organic substances. However, it was first revealed by STEM observation that the accumulated solid deposits on the surface of teeth having no gloss had a complicated structure wherein inorganic and organic substances coexisted. It is suggested that the organic substances contain proteins derived from saliva. The inorganic substances were spherical and needle-like hydroxyapatites (HAs). It is considered that amino acids constituting the proteins affected the nucleus formation and the crystal formation of HA. It is considered that the unevenness of the accumulated deposits existing on the surface of tooth enamel having no gloss causes the decrease in gloss of teeth due to diffuse reflection of light.

Periodontal and Microbiological Profile of Intensive Care Unit Inpatients.

INTRODUCTION: The bidirectional relationship between the periodontal diseases and systemic diseases was attributed to the focal infection concept. The aims of this study were to assess the periodontal and microbiological profile of intensive care unit (ICU) inpatients submitted to orotracheal intubation, and classify them regarding gender, age group, ethnic, hospitalization reason and period, nosocomial infection occurrence, and death. MATERIALS AND METHODS: Inpatients were assessed, distributed into toothed and toothless groups. The periodontal clinical condition was assessed 24 hours after the ICU admission through plaque index, gum index, probing depth, and clinical level of insertion. All microbiological samples were collected on the 6th day of admission. These samples were collected from different intraoral sites, depending on the group: In the toothed group, samples were collected from gingival sulcus and in the toothless group, from buccal mucosa and tongue. Identification for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was accomplished and analyzed, using absolute quantification and specific primer pairs through an amplification system with probes. RESULTS: Forty subjects composed the sample: Gender characterized by 60% of male, 27.5% of all patients were older than 60, and 22.5% were hospitalized due to cerebrovascular accident. Regarding hospitalization period, 55% of patients were hospitalized for 6 days and 70% of them died during the period of hospitalization. Of inpatients, 40% presented periodontal disease and 100% presented dental biofilm on assessed sites. When assessing the microbiota, statistical significance was observed between Aa, Pg, and Tf, for both toothed and toothless group (p < 0.0001). CONCLUSION: Large quantities of Aa were found in samples of toothless inpatients, a fact that suggests that the oral environment, even without teeth, presents favorable conditions for bacterial biofilm formation with a related pathogenic potential. CLINICAL SIGNIFICANCE: The dental biofilm may comprise pulmonary pathogen colonies, promoting a perfect environment for their growth and development, facilitating the colonization of the lower airways, as well as colonization by bacteria originally from the oral cavity.

Assessment and management of halitosis.

Halitosis is an unpleasant condition that may be the origin of concern not only for a possible health condition but also for frequent psychological alterations which may lead to social and personal isolation. The most frequent sources of halitosis that exist in the oral cavity include bacterial reservoirs such as the dorsum of the tongue, saliva and periodontal pockets. Volatile sulphur compounds (VSCs) are the prominent elements of oral malodour. Genuine halitosis and pseudo-halitosis should be in the treatment realm of dental practitioners. Clinical Relevance: Halitosis can be a symptom of underlying systemic disease, therefore the exact diagnosis and its source (oral or non-oral) is important in the proper approach to its management.

Effect of time and pH on physical-chemical properties of orthodontic brackets and wires.

OBJECTIVE: To test the hypothesis that treatment time, debris/biofilm, and oral pH have an influence on the physical-chemical properties of orthodontic brackets and arch wires. MATERIALS AND METHODS: One hundred twenty metal brackets were evaluated. They were divided into four groups (n  =  30) according to treatment time: group C (control) and groups T12, T24, and T36 (brackets recovered after 12, 24, and 36 months of treatment, respectively). Rectangular stainless-steel arch wires that remained in the oral cavity for 12 to 24 months were also analyzed. Dimensional stability, surface morphology, composition of brackets, resistance to sliding of the bracket-wire set, surface roughness of wires, and oral pH were analyzed. One-way analysis of variance, followed by a Tukey multiple comparisons test, was used for statistical analysis (P < .05). RESULTS: Carbon and oxygen were shown to be elements that increased expressively and in direct proportion to time, and there was a progressive increase in the coefficient of friction and roughness of wires as a function of time of clinical use after 36 months. Oral pH showed a significant difference between group T36 and its control (P  =  .014). CONCLUSIONS: The hypothesis was partially accepted: treatment time and biofilm and debris accumulation in bracket slots were shown to have more influence on the degradation process and frictional force of these devices than did oral pH.

Diagnosis and prescribing pattern of antibiotics and painkillers among dentists.

PURPOSE: To examine the pattern of antibiotic and painkiller prescriptions per diagnosis by dentists. MATERIALS AND METHODS: A cross-sectional study was conducted in Karachi, Pakistan. Dentists in the outpatient departments of the Dr. Isharat-ul-Ebad Khan Institute of Oral Health Sciences (DIKIOHS) filled out a form for each patient visiting during a two-week period. The form included: personal history of the patient, i.e. name, age, sex and education, patient's complaint(s), medical history, dental history, full examination of the teeth and oral cavity, treatment need as far as different specialties are concerned, investigations, provisional diagnosis and treatment given. The WHO ATC system for drug classification was used. The number of prescriptions and defined daily doses (DDD) were recorded. RESULTS: A total of 709 patient forms (355 for male patients and 354 for female patients) were collected and included in the analysis. Of these, 123 (17%) included antibiotics and 455 (64%) painkillers. Caries/pulpitis was the most common diagnosis (n = 222; 31% of cases), of which 48 (21%) were prescribed antibiotics. Amoxicillin and metronidazole were the most common antibiotics prescribed for this diagnosis (n = 25); for caries/pulpitis diagnosis, 44 DDD/100 patients were prescribed. This was also the diagnosis for which painkiller prescription was most common (n = 191; 86%), with 102 DDD/100 patients. CONCLUSION: Our study shows the prescription pattern of antibiotics and painkillers by dentists in Pakistan for the first time. There is a clear need to emphasise correct diagnostic methods and develop contextualised prescription guidelines and educational initiatives, so that the optimum effect of antibiotics and painkillers will be achieved without compromising patients' health.

Decision-Making for Residual Periodontal Pockets after Aetiological Treatment.

The practitioner may have difficulties making decisions regarding the most appropriate therapeutic approach in the case of the persistence of periodontal pockets after initial periodontal treatment. Several options may be considered: aetiologic retreatment, maintenance, surgery of the pocket or extraction of the tooth for strategic reasons or when the conservation of the tooth is impossible. There are no clear guidelines for the treatment decision. The aim of this article is to present the main factors involved in making a treatment decision. An algorithm and its background rationale are presented to help the practitioner make a decision about residual periodontal pockets after aetiological treatment.

Pyrosequencing of supra- and subgingival biofilms from inflamed peri-implant and periodontal sites.

BACKGROUND: To investigate the microbial composition of biofilms at inflamed peri-implant and periodontal tissues in the same subject, using 16S rRNA sequencing. METHODS: Supra- and submucosal, and supra- and subgingival plaque samples were collected from 7 subjects suffering from diseased peri-implant and periodontal tissues. Bacterial DNA was isolated and 16S rRNA genes were amplified, sequenced and aligned for the identification of bacterial genera. RESULTS: 43734 chimera-depleted, denoised sequences were identified, corresponding to 1 phylum, 8 classes, 10 orders, 44 families and 150 genera. The most abundant families or genera found in supramucosal or supragingival plaque were Streptoccocaceae, Rothia and Porphyromonas. In submucosal plaque, the most abundant family or genera found were Rothia, Streptococcaceae and Porphyromonas on implants. The most abundant subgingival bacteria on teeth were Prevotella, Streptococcaceae, and TG5. The number of sequences found for the genera Tannerella and Aggregatibacter on implants differed significantly between supra- and submucosal locations before multiple testing. The analyses demonstrated no significant differences between microbiomes on implants and teeth in supra- or submucosal and supra- or subgingival biofilms. CONCLUSION: Diseased peri-implant and periodontal tissues in the same subject share similiar bacterial genera and based on the analysis of taxa on a genus level biofilm compositions may not account for the potentially distinct pathologies at implants or teeth.

The prevalence of xerostomia in patients with removable prostheses.

PURPOSE: The objective of this study was to determine the prevalence of xerostomia among patients attending a dental clinic for provision of dentures and to investigate the oral cleanliness in those patients. MATERIALS AND METHODS: Denture-wearing patients who reported dry mouth completed a questionnaire related to xerostomia. Dryness of the mouth was determined by clinical observation. Dental and denture cleanliness was determined using the Modified Debris Index. RESULTS: One hundred twenty patients had xerostomia. Oral cleanliness was generally poor. CONCLUSION: There was a high prevalence of xerostomia in the patient population. A high proportion of subjects had poor oral cleanliness.

Oral health benefits of a daily dental chew in dogs.

An independent study was conducted to determine and quantify the oral care benefits of a daily edible dental chew in dogs as measured by plaque and calculus control, gingival indices, and oral malodor. A "clean mouth" test model was used comparing a commercial dry diet and a commercial dry diet plus one dental chew per day. The dental chew tested was representative of a retail canine dental chew. The test dental chew was a green-colored dental dog chew with a flexible texture that can be readily chewed by dogs. They are made with a knuckle bone shape on one end and a toothbrush shape on the other end. Sixty adult dogs were allocated in either control or test groups based on plaque stratification and studied for 28-days. The test group (30 dogs) received a dry diet and 1 dental chew each day. The control group (30 dogs) received the same dry diet only. At the end of the study, measurements of plaque and calculus accumulation and evaluations of oral malodor and gingival heath were performed. Adding a dental chew to the diet resulted in statistically significant reductions in plaque and calculus accumulation, and oral malodor while improving gingival indices.

Dental disease prevalence among methamphetamine and heroin users in an urban setting: a pilot study.

BACKGROUND: Researchers have reported rampant caries among methamphetamine users. The authors investigated the prevalence of dental disease and associated risk behaviors in methamphetamine users compared with those in heroin users. METHODS: This pilot project was a cross-sectional study of an ongoing cohort of young adult injection-drug users (IDUs) in San Francisco. Participants completed an oral health questionnaire administered by a research assistant, and dentists performed clinical examinations to record the participants' data in terms of scores on the decayed-missing-filled surfaces (DMFS) index, presence of residual roots, scores on an oral hygiene index and whether any salivary hypofunction was observed. RESULTS: The prevalence of dental disease among 58 young adult IDUs was strikingly high compared with that in the U.S. general population; however, the authors found no difference in the level of dental disease between users of methamphetamine and users of heroin. The mean DMFS score and number of decayed surfaces exceeded 28 in both groups. CONCLUSIONS: Although the authors detected no difference in dental disease between methamphetamine and heroin users, they found a high prevalence of caries and caries-associated behaviors in the sample of young adult IDUs. CLINICAL IMPLICATIONS: Given the high level of dental disease observed in this population of young adult IDUs, one next step may be to explore the feasibility and effectiveness of providing low-intensity preventive measures (such as distribution of chlorhexidine rinses or xylitol gum or application of fluoride varnishes) through outreach workers.

Level of education and gender-specific self-reported oral health behavior among dental students.

PURPOSE: To identify the oral health attitudes/behaviour among dental students in Jordan, and analyse the variations in oral health attitudes based on gender and level of education. MATERIALS AND METHODS: Out of the 653 registered dental students at the faculty of dentistry, 580 students (455 females and 125 males, mean age = 20.1 ± 1.6 years) participated in the study (response rate 89%). The Hiroshima University-Dental Behavioural Inventory (HU-DBI) was used to assess oral heath attitudes and behaviour of the participants. Data were analysed using the chi-square test, and statistical significance was set at P < 0.05. RESULTS: Females had better oral health attitudes and behaviour, especially towards visiting the dentist, toothbrushing habits and oral hygiene practice (P < 0.05). Also, students from the higher years had better oral health attitudes, behaviour and knowledge, especially towards gingival health, oral hygiene practice, toothbrushing and visiting the dentist (P < 0.05). CONCLUSION: Dental students in Jordan had poor oral health attitudes and behaviour. Females had better oral health knowledge, attitudes and behaviour than males. With increasing years of study, some aspects of dental students' oral health behaviour and attitudes improved. However, this improvement was limited and students should be encouraged to become an example of oral health for their society. Better comprehensive dental education with early exposure to dental health and prevention was suggested to improve dental students' oral health attitudes and behaviour.