Optimum length of treatment with systemic antibiotics in adults with dental infections: a systematic review.

Introduction Guidelines on the length of treatment of dental infections with systemic antibiotics vary across different countries. We aimed to determine if short-duration (3-5 days) courses of systemic antibiotics were as effective as longer-duration courses (≥7 days) for the treatment of dental infections in adults in outpatient settings.Methods We searched Ovid Medline, Ovid Embase, Cochrane, trials registries, Google Scholar and forward and backward citations for studies published between database inception and 30 March 2021. All randomised clinical trials (RCT) and non-randomised trials which compared length of treatment with systemic antibiotics for dental infections in adults in outpatient settings published in English were included.Results One small RCT met our defined inclusion criteria. The trial compared three-day versus seven-day courses of amoxicillin in adults with odontogenic infection requiring tooth extraction. There was no significant difference between groups in terms of participant-reported pain or clinical assessment of wound healing.Discussion While a number of observational studies were supportive of shorter-course therapy, only one small RCT concluded that a three-day course of amoxicillin was clinically non-inferior versus seven days for the treatment of odontogenic infection requiring tooth extraction. Limited conclusions on shorter-course therapy can be drawn from this study as all participants commenced amoxicillin two days before tooth extraction which is not common clinical practice. The variability in guidelines for use of antimicrobials in dental infections suggests that guidelines are based on local or national historical practice and indicates the need for further research to determine the optimum length of treatment. RCTs are required to investigate if short-duration courses of antibiotics are effective and to provide evidence to support consistent guidance for dental professionals.

Cleaning methods for dental instruments.

It is essential to ensure that reusable dental instruments are scrupulously clean as a first step in the decontamination process. Any residual soil on the surface of equipment creates a risk that will prevent steam, generated during sterilisation, from condensing on the surface of the instrument and raising the temperature to that required to ensure sterilisation. Further, most microorganisms will struggle to attach to the surface of a clean instrument. Adherence of microorganisms to the surface of an instrument that is contaminated with organic soil or the irregular surface of residual dental materials is likely to be greatly enhanced. It is therefore important to ensure that residual dental materials are removed from the surface of instruments, at the point of use, before they are allowed to set.It is also important to ensure that the methods used to clean dental equipment do not damage the instrument. Any method that has the potential to scratch the surface of an instrument and therefore make it more difficult to clean should be avoided. Aggressive cleaning can lead to removal of the passivation layer, the chromium-rich layer that prevents corrosion occurring, formed on the surface of instruments made from stainless steel. If corrosion forms on the surface of an instrument, the surface becomes roughened and possibly stained. Surface staining can then be difficult to differentiate from other stains or marks caused by retained biological soil. Corrosion on the surface of an instrument will make the effective cleaning of the surface more difficult and therefore corroded or stained instruments should be discarded.

Indications for the use of metronidazole in the treatment of non-periodontal dental infections: a systematic review.

Background: Dental practitioners are the largest prescribers of metronidazole. Antibiotics should only be prescribed when systemic involvement is clear and should be limited to monotherapy with ß-lactams in the first instance. Objectives: To determine whether metronidazole used as monotherapy or in addition to a ß-lactam antibiotic offers any additional benefit over ß-lactam monotherapy in non-periodontal dental infections. Methods: Searches of Ovid Medline, Ovid Embase, Cochrane library and trials registries, forward and backward citations, for studies published between database inception and 2 August 2021. All randomized clinical trials (RCTs) and non-randomized trials comparing either systemic metronidazole monotherapy or metronidazole combined with a ß-lactam with ß-lactam monotherapy for the treatment of non-periodontal dental infections in adults or children in outpatient settings were included. Results: Four publications reporting three RCTs comparing metronidazole with a ß-lactam antibiotic were recovered. Studies were conducted in the 1970s-80s and aimed to demonstrate metronidazole was as effective as penicillin for the treatment of acute pericoronitis or acute apical infections with systemic involvement. Meta-analysis of results was not possible due to differences in measurement of infection signs. All studies concluded that metronidazole and penicillin are equally effective for the treatment of non-periodontal dental infections with systemic involvement. Conclusions: Metronidazole does not provide superior clinical outcomes (alone or in combination with a ß-lactam) when compared with a ß-lactam antibiotic alone for the treatment of non-periodontal dental infections in general dental practice. Guidelines should reinforce the importance of surgical interventions and if appropriate the use of a single agent narrow-spectrum ß-lactam.

Compliance problems in dental infection prevention and control in England: an analysis of Care Quality Commission inspections between 2016 and 2019.

Introduction All dental practices in England must be registered with the Care Quality Commission (CQC). The CQC inspects approximately 10% of practices each year to ensure premises are safe. Compliance with infection prevention and control is assessed during inspections.Aims The aim of this study was to identify common areas of non-compliance in infection prevention and control within general dental practice in England.Materials and methods The CQC inspection reports, for all practices found not safe following an inspection, were thematically analysed for non-compliance specifically in infection prevention and control.Results Between April 2016 and March 2019, 88 practices were deemed not safe. The most common areas of non-compliance were the management of risks associated with legionella, audit and the validation of decontamination equipment.Discussion Infection prevention and control compliance requires good management and leadership. Other factors are also thought to influence compliance including cost and morality.Conclusions Identification of recurrent infection prevention and control compliance issues highlights relevant areas to all CQC dental registrants that merit greater focus.

The experience of dental practices that use automatic washer disinfectors.

BACKGROUND: Understanding the collective sociotechnical experiences of the staff in dental practices with automatic washer disinfectors (AWDs) may help shape future strategies that encourage the transition towards best practice in dental instrument decontamination and reprocessing. OBJECTIVES: To find the emerging themes that reflect the experience of working with an AWD in dental practice. To compare the experience of practice owners to that of the dental nurses. METHODS: A qualitative semi-structured interview-based methodology was applied using a convenience sample of dentists and dental nurses. Verbatim transcripts of audio recordings underwent thematic analysis. RESULTS: Dental practice owners and dental nurses were interviewed. Four themes were common to both groups: impact on daily routine; mundane technology; the decontamination cycle; and safety. Three themes were unique to the dentists: impact on the business; professionalism; and external motivators for change. DISCUSSION: AWDs are a mundane form of technology that dental nurses find simple to operate. The extended time it takes to reprocess instruments using an AWD means that dental nurses must adapt their daily working practices to accommodate this. Initial funding to purchase an AWD, especially where there is a professional expert leading a campaign championing their use, can be effective.

The ferrule effect.

UNLABELLED: When the supra-marginal dentine of a root-filled tooth is engaged by a crown, it may create a stronger tooth/restoration complex. This has been termed the ferrule effect. This paper reviews the current evidence for this effect and examines the influence various post and core materials have on it. Means of achieving a ferrule are discussed and the importance of planning for failure is considered. CLINICAL RELEVANCE: Provision for the ferrule effect when restoring root-filled teeth with a post-retained crown may optimize the strength of the restored tooth.

In vivo labeling and specific magnetic bead separation of RNA for biofilm characterization and stress-induced gene expression analysis in bacteria.

The method of in vivo labeling and separation of bacterial RNA was developed as an approach to elucidating the stress response of natural bacterial populations. This technique is based on the incorporation of digoxigenin-11-uridine-5'-triphosphate (DIG-11-UTP) in the RNA of active bacteria. The digoxigenin fulfills a dual role as a label of de novo synthesized RNA and a target for magnetic bead separation from a total RNA extract. Depending on the growth conditions and the population's composition, the assembly rate of DIG-11-UTP ranged from 1.2% to 12.5% of the total RNA in gram-positive and gram-negative reference bacteria as well as in natural biofilms from drinking water, surface water, and lake sediment. Separation of DIG-RNA from total RNA extracts was performed with a biotinylated anti-digoxigenin antibody and streptavidin-functionalized magnetic particles. The average separation yield from total RNA extracts was about 95% of labeled RNA. The unspecific bindings of non-labeled nucleic acids were smaller than 0.2%, as was evaluated by spiking experiments with an unmarked DNA amplicon. Applicability of the method developed was demonstrated by rRNA-directed PCR-DGGE population analysis of natural biofilms and expression profiling of two stress-induced genes (vanA and rpoS) in reference bacteria.