Visual attention is a significant gateway to a child’s mind, and looking is one of the first beha... more Visual attention is a significant gateway to a child’s mind, and looking is one of the first behaviors young children develop. Untreated caries and the resulting poor dental aesthetics can have adverse emotional and social impacts on children’s oral health-related quality of life due to its detrimental effects on self-esteem and self-concept. Therefore, we explored preschool children’s eye movement patterns and visual attention to images with and without dental caries via eye movement analysis using hidden Markov models (EMHMM). We calibrated a convenience sample of 157 preschool children to the eye-tracker (Tobii Nano Pro) to ensure standardization. Consequently, each participant viewed the same standardized pictures with and without dental caries while an eye-tracking device tracked their eye movements. Subsequently, based on the sequence of viewed regions of interest (ROIs), a transition matrix was developed where the participants’ previously viewed ROI informed their subsequentl...
Silver diamine fluoride (SDF) is commonly used to arrest caries lesions, especially in early chil... more Silver diamine fluoride (SDF) is commonly used to arrest caries lesions, especially in early childhood caries. Recently, it was suggested that SDF can be combined with potassium iodide (KI) to minimize the discoloration of demineralized dentine associated with SDF application. However, the antibacterial efficacy of SDF alone or combined with KI on in-situ biofilm is unknown. Hence, we compared the anti-plaque biofilm efficacy of two different commercially available SDF solutions, with or without KI, using an in-situ biofilm, analysed using viability real-time PCR with propidium monoazide (PMA). Appliance-borne in-situ biofilm samples (n = 90) were grown for a period of 6 h in five healthy subjects who repeated the experiment on three separate occasions, using a validated, novel, intraoral device. The relative anti-biofilm efficacy of two SDF formulations; 38.0% Topamine (SDF T) and 31.3%, Riva Star (SDF R), KI alone, and KI in combination with SDF R (SDF R+KI) was compared. The experiments were performed by applying an optimized volume of the agents onto the biofilm for 1min, mimicking the standard clinical procedure. Afterwards the viability of the residual biofilm bacteria was quantified using viability real-time PCR with PMA, then the percentage of viable from total bacteria was calculated. Both SDF formulations (SDF T and SDF R) exhibited potent antibacterial activities against the in-situ biofilm; however, there was non-significant difference in their efficacy. KI alone did not demonstrate any antibacterial effect, and there was non-significant difference in the antibacterial efficacy of SDF alone compared to SDF with KI, (SDF T v SDF R/KI). Thus, we conclude that the antibacterial efficacy of SDF against plaque biofilms is not modulated by KI supplements. Viability real-time PCR with PMA was successfully used to analyze the viability of naturally grown oral biofilm; thus, the same method can be used to test the antimicrobial effect of other agents on oral biofilms in future research.
Objectives: This study investigated the thresholds at which general dentists in Kuwait would rest... more Objectives: This study investigated the thresholds at which general dentists in Kuwait would restore approximal and occlusal carious lesions and examined the demographic characteristics of the dentists in relation to their decision making. Subjects and Methods: The study population consisted of a random sample of 185 general dentists practicing in the Ministry of Health of Kuwait. A survey questionnaire was administered. The questionnaire presented different stages and locations of carious lesions; the participants were asked to identify the stage at which a restoration is required under different conditions, the preparation technique, and their choice of restorative material. Results: For approximal carious lesions, 74 (40%) of the participants reported that they would restoratively intervene when the carious lesion reached the outer third of the dentin. A total of 91 (49.2%) reported the use of traditional class II restorations. For occlusal carious lesions, 128 (69.2%) said they ...
Declaration xxii Acknowledgements xxiii Chapter 1 Introduction & Literature Review 4.2.3 Experime... more Declaration xxii Acknowledgements xxiii Chapter 1 Introduction & Literature Review 4.2.3 Experimental method 4.2.4 Determination of concentrations of ions present in eluting solutions 4.2.5 Analysis of diffusion characteristics of cumulative data 4.3 Results 4.3.1 Cumulative release for luting and lining materials 4.
Clinical Relevance Modern day glass ionomer restoratives are not significantly weakened by early ... more Clinical Relevance Modern day glass ionomer restoratives are not significantly weakened by early water exposure, after initial set.
Objective: To evaluate the remineralization of carious dentine following the restoration of an ex... more Objective: To evaluate the remineralization of carious dentine following the restoration of an extensive lesion in a permanent molar with a high strength glass-ionomer cement (GIC). Materials and methods: Thirteen first permanent molars, which were scheduled for extraction because of the presence of extensive caries lesions, were selected for this study. They were first restored, according to the ART technique, using encapsulated Fuji IX GP , which contains a strontium glass rather than the traditional calcium glass. The cavities were prepared with a clean enamel margin and minimal removal of the carious dentine around the walls. After a period of 1-3 months they were harvested and subsequently sectioned and examined using an electron probe microanalysis (EPMA) and scanning electron microscopy (SEM). Results: EPMA demonstrated that both fluorine and strontium ions had penetrated deep into the underlying demineralized dentine. The only possible source of these ions was the GIC restoration. Conclusion: The pattern of penetration of the fluorine and strontium ions into the dentine was consistent with a remineralization process.
Minimally invasive treatment protocols may leave a residual layer of carious dentin, which requir... more Minimally invasive treatment protocols may leave a residual layer of carious dentin, which requires treatment for the inhibition of bacterial growth beneath restorations. We aimed to examine the in vivo effect of silver diammine fluoride (SDF) and SDF + potassium iodide (KI) application on bacteria present in deep carious lesions. We studied the in vivo efficacy in five patients, each of which had five carious lesions. Dentin samples taken before and after treatment were subjected to microbial analyses. Following treatment with SDF, the median colonyforming unit (CFU) counts per mg of dentin reduced from 9 × 10 5 to 1.6 × 10 2 (P < 0.05), and following that with SDF + KI, the counts decreased from 2.9 × 10 5 to 9.2 × 10 (P < 0.05). The use of chlorhexidine gluconate (CHX) reduced CFU counts from 1.1 × 10 5 to 4.8 × 10 2 (P < 0.05). In four of the five patients, no CFUs were found on mitis salivarius-bacitracin agar with respect to SDF or SDF + KI application. For CHX, the median CFU count before treatment was 1.6 × 10 3 and that after treatment was 1.1 × 10 2. SDF completely inhibited mutans streptococci growth in four of the five patients, while the growth of anaerobes was not completely inhibited.
subjected to good mechanical cleansing and salivary flow. The reverse is true with hidden smooth ... more subjected to good mechanical cleansing and salivary flow. The reverse is true with hidden smooth surfaces, as they are less accessible to mechanical cleansing and chemical protection from saliva and fluoride and are therefore more susceptible to caries. It is important to point out that in some situations, the same surface can change its risk status over time. Example 1: a large carious white spot lesion which was formed on the proximal surface of a tooth when it was hidden could become exposed and arrested, or remineralised, with the removal of an adjacent tooth (Figure 1). Example 2: the distal and mesial surfaces of a first permanent molar can be classified as exposed toward the end of the mixed dentition stage, when the second primary molar exfoliates and the second permanent molar is still unerupted. We propose that in high-risk children, these surfaces can be protected from future proximal caries prior to their returning to a hidden status upon the eruption of the second permanent molar and premolar. These surfaces
Purpose: To evaluate the mineralization and morphology of residual (infected and affected) cariou... more Purpose: To evaluate the mineralization and morphology of residual (infected and affected) carious dentin following the restoration of vital primary molars with viscous glass-ionomer cement (GIC). Methods: Encapsulated Fuji IX GP and Ketac-Molar Aplicap GICs were placed in cavities that were prepared using the atraumatic restorative treatment (ART) approach. Four suitable exfoliated teeth with intact restorations were sectioned and then examined by electron probe microanalysis (EPMA) and scanning electron microscopy (SEM). Results: EPMA demonstrated the presence of fluorine and strontium that had penetrated into the underlying residual carious dentin from the adjacent GIC. The concentrations of these two elements, and those of calcium and phosphorous, varied with distance from the GIC/dentin interface. SEM showed varying degrees of dentin tubule destruction and intratubular (peritubular) dentin present immediately subjacent to the GIC/dentin interface. Incomplete removal of carious dentin was observed in all specimens, and GIC remained adherent to the tissue.
We reviewed the prevalence, the likely aetiopathogenesis, and the management of orofacial mucocut... more We reviewed the prevalence, the likely aetiopathogenesis, and the management of orofacial mucocutaneous manifestations of Coronavirus Disease-2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). English language manuscripts searched using standard databases yielded 26 articles that met the inclusion criteria. In total, 169 cases (75 females; 94 males) from 15 countries with a spectrum of COVID-19 severities were reviewed. Gustatory perturbations were prevalent in over 70%. Mucocutaneous manifestations were reported predominantly on the tongue, palate, buccal mucosa, gingivae, and lips and included ulcers, blisters, erosions, papillary hyperplasia, macules, glossitis, and mucositis. Ulcerative lesions, present in over 50 percent, were the most common oral manifestation. Lesions resembling candidal infections, with burning mouth, were prevalent in 19%. Petechiae and angina bullosa were generally seen, subsequent to COVID-19 therapies, in 11%. Ulcerated, necrotic gingivae were documented in severely ill with poor oral hygiene. These manifestations, present across the COVID-19 disease spectrum, were commonly associated with the immunosuppressed state and/ or the concurrent antimicrobial/steroidal therapies. In summary, a wide variety of orofacial mucocutaneous lesions manifest in COVID-19. They are likely to be secondary to the diseaseassociated immune impairment and/or pharmaco-therapy rather than a direct result of SARS-CoV-2 infection per se.
A recall system is a continuing care regime which provides opportunities to reassess and monitor ... more A recall system is a continuing care regime which provides opportunities to reassess and monitor the oral health of patients and to inform future treatment planning. There is some evidence that recall visits have a positive impact on the natural and functional dentition. Unfortunately, there is a general paucity of reliable evidence about the timing of recall visits despite the widely adopted 6-month interval. In response to political, professional and patient uncertainty, the UK National Institute of Health and Clinical Excellence (NICE) convened a guideline development group to consider both best evidence and best practice in this field. The NICE issued a guidance document in 2004 recommending that the individual risk status should determine the patient&#39;s recall interval. The recommendations cover risk factors such as caries incidence and restorations; periodontal health and tooth loss, patients&#39; well-being, general health and preventive habits, pain and anxiety. Methods and tools to facilitate and standardize the collection of risk information are currently being developed and/or collated by the Scottish Dental Clinical Effectiveness Programme. The selection of a recall interval is a multifaceted and complex decision involving the judgement of both clinician and patient. More research is needed into the rate of progression of oral diseases and the impact of recall on oral health and quality of life. Nevertheless, the NICE guidance is based on the best available evidence, and it should be used to determine personalized variable time intervals to assess, reassess and monitor the oral health and caries status of patients.
Although various probiotic organisms have been evaluated for their utility in the management of p... more Although various probiotic organisms have been evaluated for their utility in the management of periodontitis, their strain-specific mechanisms of action are still unclear. We aimed to systematically review the effect of bifidobacterial probiotics on periodontopathogens and host immune responses in periodontal diseases. An electronic search of articles published until June 2022 in Medline, PubMed, Web of Science, and Cochrane Library databases was performed. Randomised controlled trials (RCTs) and in vitro and animal studies were assessed, and the data regarding antimicrobial properties, immunomodulation, and clinical outcomes were analysed. A total of 304 studies were screened, but only 3 RCTs and 6 animal and in vitro studies met the inclusion criteria. The use of different strains of bifidobacteria led to (1) a reduction of key players of the red complex periodontopathogens; (2) reduced levels of pro-inflammatory cytokines (eg, interleukin [IL]1-b and IL-8) and higher levels of anti-inflammatory cytokines (IL-10); (3) enhanced levels of osteoprotegerin and reduced levels of receptor activator of nuclear factor kappa-B ligand; and (4) a reduction of the dental plaque, bleeding on probing, alveolar bone loss, and clinical attachment loss. Bifidobacterial probiotic adjuvant supplementation, especially with Bifidobacterium animalis subspecies lactis, appears to help improve clinical periodontal parameters and develop a healthy plaque microbiome through microbiological and immunomodulatory pathways. Further human and animal studies are warranted prior to the therapeutic use of bifidobacteria in the routine management of periodontal infections.
Abstract Aims The coronavirus disease 2019 (COVID-19) due to the severe acute respiratory syndrom... more Abstract Aims The coronavirus disease 2019 (COVID-19) due to the severe acute respiratory syndrome coronavirus-2 (SARS‐CoV‐2) can present either as an asymptomatic carrier state or an acute respiratory disease, with or without severe pneumonia. The asymptomatic carriers are a challenge for the dental profession as the infection could be transmitted via virus-laden, and saliva in dental settings through aerosol-generating procedures (AGPSs). The aim of this review was to perform a systematic review of SARS‐CoV‐2 in the saliva of asymptomatic individuals. Materials and methods PubMed, Google scholar, and MedRxiv databases were searched between and a systematic review and meta-analysis of the available data were performed to assess the viral burden in the saliva of asymptomatic carriers of SARS-CoV-2. All investigators of the included studies used qRT-PCR to detect SARS-CoV-2 and yield quantitative data (the Ct values) appertaining to the viral load. Results A total of 322 records in the English literature were identified, and eight studies with 2642 SARS‐CoV‐2-positive and asymptomatic individuals were included in the final analysis. Of these, 16.7% (95% CI: 11–23%) yielded SARS-CoV-2-positive saliva samples in comparison to 13.1% (95% CI: 12–17%) of the respiratory specimens (nasopharyngeal or nose-throat swabs). Conclusion As approximately 1 in 5 to 1 in 10 asymptomatic individuals harbour SARS-CoV-2 in either saliva or respiratory secretions, our results highlight the need for continued vigilance and the critical importance of maintaining strict, additional infection control regimens for the foreseeable future to mitigate the potential risks of COVID-19 transmission in dentistry.
Introduction: The retentive niches of deep caries lesions have a distinct biome. Methods: We eval... more Introduction: The retentive niches of deep caries lesions have a distinct biome. Methods: We evaluated the site-specific (occlusal and proximal) Candida-biome of Severe-Early Childhood Caries (S-ECC) in 66-children (132 lesions). Asymptomatic primary molars fitting the definition of the International Caries Detection and Assessment-(ICDAS)-cariescode 5/6 were analyzed. Deep-dentinal sampling and simultaneous assessment of pH were performed. Clinical isolates were speciated using multiplex-PCR and evaluated for their acidogenic and aciduric potential. Results: Surprisingly, a high prevalence of Candida species (72.7%), either singly or in combination, was noted from both the proximal and occlusal cavities. C. tropicalis was the most prevalent species (47%; 34/72), followed by C. krusei (43.1%; 31/72) and C. albicans (40.3%; 29/72), with C. glabrata being the least (9.7%; 7/72). Over 45% low-pH niches (pH <7) of both sites yielded either dual or triple species of Candida. Genotyping revealed three distinct C. albicans genotypes (A, B, and C) with (14/29; 48.3%) of strains belonging to Genotype A. All four evaluated Candida species exhibited acidogenic and aciduric potential, C. tropicalis being the most potent. Conclusion: This, the first report of the high-density, multispecies, yeast colonization of deepdentinal lesions in S-ECC, suggests that the Candida-biome plays a significant etiologic role in the condition, possibly due to their profound acidogenicity in milieus rich in dietary carbohydrates.
Visual attention is a significant gateway to a child’s mind, and looking is one of the first beha... more Visual attention is a significant gateway to a child’s mind, and looking is one of the first behaviors young children develop. Untreated caries and the resulting poor dental aesthetics can have adverse emotional and social impacts on children’s oral health-related quality of life due to its detrimental effects on self-esteem and self-concept. Therefore, we explored preschool children’s eye movement patterns and visual attention to images with and without dental caries via eye movement analysis using hidden Markov models (EMHMM). We calibrated a convenience sample of 157 preschool children to the eye-tracker (Tobii Nano Pro) to ensure standardization. Consequently, each participant viewed the same standardized pictures with and without dental caries while an eye-tracking device tracked their eye movements. Subsequently, based on the sequence of viewed regions of interest (ROIs), a transition matrix was developed where the participants’ previously viewed ROI informed their subsequentl...
Silver diamine fluoride (SDF) is commonly used to arrest caries lesions, especially in early chil... more Silver diamine fluoride (SDF) is commonly used to arrest caries lesions, especially in early childhood caries. Recently, it was suggested that SDF can be combined with potassium iodide (KI) to minimize the discoloration of demineralized dentine associated with SDF application. However, the antibacterial efficacy of SDF alone or combined with KI on in-situ biofilm is unknown. Hence, we compared the anti-plaque biofilm efficacy of two different commercially available SDF solutions, with or without KI, using an in-situ biofilm, analysed using viability real-time PCR with propidium monoazide (PMA). Appliance-borne in-situ biofilm samples (n = 90) were grown for a period of 6 h in five healthy subjects who repeated the experiment on three separate occasions, using a validated, novel, intraoral device. The relative anti-biofilm efficacy of two SDF formulations; 38.0% Topamine (SDF T) and 31.3%, Riva Star (SDF R), KI alone, and KI in combination with SDF R (SDF R+KI) was compared. The experiments were performed by applying an optimized volume of the agents onto the biofilm for 1min, mimicking the standard clinical procedure. Afterwards the viability of the residual biofilm bacteria was quantified using viability real-time PCR with PMA, then the percentage of viable from total bacteria was calculated. Both SDF formulations (SDF T and SDF R) exhibited potent antibacterial activities against the in-situ biofilm; however, there was non-significant difference in their efficacy. KI alone did not demonstrate any antibacterial effect, and there was non-significant difference in the antibacterial efficacy of SDF alone compared to SDF with KI, (SDF T v SDF R/KI). Thus, we conclude that the antibacterial efficacy of SDF against plaque biofilms is not modulated by KI supplements. Viability real-time PCR with PMA was successfully used to analyze the viability of naturally grown oral biofilm; thus, the same method can be used to test the antimicrobial effect of other agents on oral biofilms in future research.
Objectives: This study investigated the thresholds at which general dentists in Kuwait would rest... more Objectives: This study investigated the thresholds at which general dentists in Kuwait would restore approximal and occlusal carious lesions and examined the demographic characteristics of the dentists in relation to their decision making. Subjects and Methods: The study population consisted of a random sample of 185 general dentists practicing in the Ministry of Health of Kuwait. A survey questionnaire was administered. The questionnaire presented different stages and locations of carious lesions; the participants were asked to identify the stage at which a restoration is required under different conditions, the preparation technique, and their choice of restorative material. Results: For approximal carious lesions, 74 (40%) of the participants reported that they would restoratively intervene when the carious lesion reached the outer third of the dentin. A total of 91 (49.2%) reported the use of traditional class II restorations. For occlusal carious lesions, 128 (69.2%) said they ...
Declaration xxii Acknowledgements xxiii Chapter 1 Introduction & Literature Review 4.2.3 Experime... more Declaration xxii Acknowledgements xxiii Chapter 1 Introduction & Literature Review 4.2.3 Experimental method 4.2.4 Determination of concentrations of ions present in eluting solutions 4.2.5 Analysis of diffusion characteristics of cumulative data 4.3 Results 4.3.1 Cumulative release for luting and lining materials 4.
Clinical Relevance Modern day glass ionomer restoratives are not significantly weakened by early ... more Clinical Relevance Modern day glass ionomer restoratives are not significantly weakened by early water exposure, after initial set.
Objective: To evaluate the remineralization of carious dentine following the restoration of an ex... more Objective: To evaluate the remineralization of carious dentine following the restoration of an extensive lesion in a permanent molar with a high strength glass-ionomer cement (GIC). Materials and methods: Thirteen first permanent molars, which were scheduled for extraction because of the presence of extensive caries lesions, were selected for this study. They were first restored, according to the ART technique, using encapsulated Fuji IX GP , which contains a strontium glass rather than the traditional calcium glass. The cavities were prepared with a clean enamel margin and minimal removal of the carious dentine around the walls. After a period of 1-3 months they were harvested and subsequently sectioned and examined using an electron probe microanalysis (EPMA) and scanning electron microscopy (SEM). Results: EPMA demonstrated that both fluorine and strontium ions had penetrated deep into the underlying demineralized dentine. The only possible source of these ions was the GIC restoration. Conclusion: The pattern of penetration of the fluorine and strontium ions into the dentine was consistent with a remineralization process.
Minimally invasive treatment protocols may leave a residual layer of carious dentin, which requir... more Minimally invasive treatment protocols may leave a residual layer of carious dentin, which requires treatment for the inhibition of bacterial growth beneath restorations. We aimed to examine the in vivo effect of silver diammine fluoride (SDF) and SDF + potassium iodide (KI) application on bacteria present in deep carious lesions. We studied the in vivo efficacy in five patients, each of which had five carious lesions. Dentin samples taken before and after treatment were subjected to microbial analyses. Following treatment with SDF, the median colonyforming unit (CFU) counts per mg of dentin reduced from 9 × 10 5 to 1.6 × 10 2 (P < 0.05), and following that with SDF + KI, the counts decreased from 2.9 × 10 5 to 9.2 × 10 (P < 0.05). The use of chlorhexidine gluconate (CHX) reduced CFU counts from 1.1 × 10 5 to 4.8 × 10 2 (P < 0.05). In four of the five patients, no CFUs were found on mitis salivarius-bacitracin agar with respect to SDF or SDF + KI application. For CHX, the median CFU count before treatment was 1.6 × 10 3 and that after treatment was 1.1 × 10 2. SDF completely inhibited mutans streptococci growth in four of the five patients, while the growth of anaerobes was not completely inhibited.
subjected to good mechanical cleansing and salivary flow. The reverse is true with hidden smooth ... more subjected to good mechanical cleansing and salivary flow. The reverse is true with hidden smooth surfaces, as they are less accessible to mechanical cleansing and chemical protection from saliva and fluoride and are therefore more susceptible to caries. It is important to point out that in some situations, the same surface can change its risk status over time. Example 1: a large carious white spot lesion which was formed on the proximal surface of a tooth when it was hidden could become exposed and arrested, or remineralised, with the removal of an adjacent tooth (Figure 1). Example 2: the distal and mesial surfaces of a first permanent molar can be classified as exposed toward the end of the mixed dentition stage, when the second primary molar exfoliates and the second permanent molar is still unerupted. We propose that in high-risk children, these surfaces can be protected from future proximal caries prior to their returning to a hidden status upon the eruption of the second permanent molar and premolar. These surfaces
Purpose: To evaluate the mineralization and morphology of residual (infected and affected) cariou... more Purpose: To evaluate the mineralization and morphology of residual (infected and affected) carious dentin following the restoration of vital primary molars with viscous glass-ionomer cement (GIC). Methods: Encapsulated Fuji IX GP and Ketac-Molar Aplicap GICs were placed in cavities that were prepared using the atraumatic restorative treatment (ART) approach. Four suitable exfoliated teeth with intact restorations were sectioned and then examined by electron probe microanalysis (EPMA) and scanning electron microscopy (SEM). Results: EPMA demonstrated the presence of fluorine and strontium that had penetrated into the underlying residual carious dentin from the adjacent GIC. The concentrations of these two elements, and those of calcium and phosphorous, varied with distance from the GIC/dentin interface. SEM showed varying degrees of dentin tubule destruction and intratubular (peritubular) dentin present immediately subjacent to the GIC/dentin interface. Incomplete removal of carious dentin was observed in all specimens, and GIC remained adherent to the tissue.
We reviewed the prevalence, the likely aetiopathogenesis, and the management of orofacial mucocut... more We reviewed the prevalence, the likely aetiopathogenesis, and the management of orofacial mucocutaneous manifestations of Coronavirus Disease-2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). English language manuscripts searched using standard databases yielded 26 articles that met the inclusion criteria. In total, 169 cases (75 females; 94 males) from 15 countries with a spectrum of COVID-19 severities were reviewed. Gustatory perturbations were prevalent in over 70%. Mucocutaneous manifestations were reported predominantly on the tongue, palate, buccal mucosa, gingivae, and lips and included ulcers, blisters, erosions, papillary hyperplasia, macules, glossitis, and mucositis. Ulcerative lesions, present in over 50 percent, were the most common oral manifestation. Lesions resembling candidal infections, with burning mouth, were prevalent in 19%. Petechiae and angina bullosa were generally seen, subsequent to COVID-19 therapies, in 11%. Ulcerated, necrotic gingivae were documented in severely ill with poor oral hygiene. These manifestations, present across the COVID-19 disease spectrum, were commonly associated with the immunosuppressed state and/ or the concurrent antimicrobial/steroidal therapies. In summary, a wide variety of orofacial mucocutaneous lesions manifest in COVID-19. They are likely to be secondary to the diseaseassociated immune impairment and/or pharmaco-therapy rather than a direct result of SARS-CoV-2 infection per se.
A recall system is a continuing care regime which provides opportunities to reassess and monitor ... more A recall system is a continuing care regime which provides opportunities to reassess and monitor the oral health of patients and to inform future treatment planning. There is some evidence that recall visits have a positive impact on the natural and functional dentition. Unfortunately, there is a general paucity of reliable evidence about the timing of recall visits despite the widely adopted 6-month interval. In response to political, professional and patient uncertainty, the UK National Institute of Health and Clinical Excellence (NICE) convened a guideline development group to consider both best evidence and best practice in this field. The NICE issued a guidance document in 2004 recommending that the individual risk status should determine the patient&#39;s recall interval. The recommendations cover risk factors such as caries incidence and restorations; periodontal health and tooth loss, patients&#39; well-being, general health and preventive habits, pain and anxiety. Methods and tools to facilitate and standardize the collection of risk information are currently being developed and/or collated by the Scottish Dental Clinical Effectiveness Programme. The selection of a recall interval is a multifaceted and complex decision involving the judgement of both clinician and patient. More research is needed into the rate of progression of oral diseases and the impact of recall on oral health and quality of life. Nevertheless, the NICE guidance is based on the best available evidence, and it should be used to determine personalized variable time intervals to assess, reassess and monitor the oral health and caries status of patients.
Although various probiotic organisms have been evaluated for their utility in the management of p... more Although various probiotic organisms have been evaluated for their utility in the management of periodontitis, their strain-specific mechanisms of action are still unclear. We aimed to systematically review the effect of bifidobacterial probiotics on periodontopathogens and host immune responses in periodontal diseases. An electronic search of articles published until June 2022 in Medline, PubMed, Web of Science, and Cochrane Library databases was performed. Randomised controlled trials (RCTs) and in vitro and animal studies were assessed, and the data regarding antimicrobial properties, immunomodulation, and clinical outcomes were analysed. A total of 304 studies were screened, but only 3 RCTs and 6 animal and in vitro studies met the inclusion criteria. The use of different strains of bifidobacteria led to (1) a reduction of key players of the red complex periodontopathogens; (2) reduced levels of pro-inflammatory cytokines (eg, interleukin [IL]1-b and IL-8) and higher levels of anti-inflammatory cytokines (IL-10); (3) enhanced levels of osteoprotegerin and reduced levels of receptor activator of nuclear factor kappa-B ligand; and (4) a reduction of the dental plaque, bleeding on probing, alveolar bone loss, and clinical attachment loss. Bifidobacterial probiotic adjuvant supplementation, especially with Bifidobacterium animalis subspecies lactis, appears to help improve clinical periodontal parameters and develop a healthy plaque microbiome through microbiological and immunomodulatory pathways. Further human and animal studies are warranted prior to the therapeutic use of bifidobacteria in the routine management of periodontal infections.
Abstract Aims The coronavirus disease 2019 (COVID-19) due to the severe acute respiratory syndrom... more Abstract Aims The coronavirus disease 2019 (COVID-19) due to the severe acute respiratory syndrome coronavirus-2 (SARS‐CoV‐2) can present either as an asymptomatic carrier state or an acute respiratory disease, with or without severe pneumonia. The asymptomatic carriers are a challenge for the dental profession as the infection could be transmitted via virus-laden, and saliva in dental settings through aerosol-generating procedures (AGPSs). The aim of this review was to perform a systematic review of SARS‐CoV‐2 in the saliva of asymptomatic individuals. Materials and methods PubMed, Google scholar, and MedRxiv databases were searched between and a systematic review and meta-analysis of the available data were performed to assess the viral burden in the saliva of asymptomatic carriers of SARS-CoV-2. All investigators of the included studies used qRT-PCR to detect SARS-CoV-2 and yield quantitative data (the Ct values) appertaining to the viral load. Results A total of 322 records in the English literature were identified, and eight studies with 2642 SARS‐CoV‐2-positive and asymptomatic individuals were included in the final analysis. Of these, 16.7% (95% CI: 11–23%) yielded SARS-CoV-2-positive saliva samples in comparison to 13.1% (95% CI: 12–17%) of the respiratory specimens (nasopharyngeal or nose-throat swabs). Conclusion As approximately 1 in 5 to 1 in 10 asymptomatic individuals harbour SARS-CoV-2 in either saliva or respiratory secretions, our results highlight the need for continued vigilance and the critical importance of maintaining strict, additional infection control regimens for the foreseeable future to mitigate the potential risks of COVID-19 transmission in dentistry.
Introduction: The retentive niches of deep caries lesions have a distinct biome. Methods: We eval... more Introduction: The retentive niches of deep caries lesions have a distinct biome. Methods: We evaluated the site-specific (occlusal and proximal) Candida-biome of Severe-Early Childhood Caries (S-ECC) in 66-children (132 lesions). Asymptomatic primary molars fitting the definition of the International Caries Detection and Assessment-(ICDAS)-cariescode 5/6 were analyzed. Deep-dentinal sampling and simultaneous assessment of pH were performed. Clinical isolates were speciated using multiplex-PCR and evaluated for their acidogenic and aciduric potential. Results: Surprisingly, a high prevalence of Candida species (72.7%), either singly or in combination, was noted from both the proximal and occlusal cavities. C. tropicalis was the most prevalent species (47%; 34/72), followed by C. krusei (43.1%; 31/72) and C. albicans (40.3%; 29/72), with C. glabrata being the least (9.7%; 7/72). Over 45% low-pH niches (pH <7) of both sites yielded either dual or triple species of Candida. Genotyping revealed three distinct C. albicans genotypes (A, B, and C) with (14/29; 48.3%) of strains belonging to Genotype A. All four evaluated Candida species exhibited acidogenic and aciduric potential, C. tropicalis being the most potent. Conclusion: This, the first report of the high-density, multispecies, yeast colonization of deepdentinal lesions in S-ECC, suggests that the Candida-biome plays a significant etiologic role in the condition, possibly due to their profound acidogenicity in milieus rich in dietary carbohydrates.
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