Dental Cares Research Articles

Zoledronate and osteonecrosis of the jaw in osteoporosis: incidence and risk factors. Analysis of the French Pharmacovigilance Database

IntroductionBisphosphonate-related osteonecrosis of the jaw (BRONJ) have been characterized with the use of oral bisphosphonates in osteoporosis and zoledronate in oncology. Uncertainties remain, though, with the occurrence of BRONJ related to the use of zoledronate in osteoporosis. ObjectivesWe aimed to estimate the incidence and characterize the risk factors of zoledronate-associated BRONJ in osteoporosis as compared with oral bisphosphonates in real life setting. MethodsCases of BRONJ associated with zoledronate, alendronate or risedronate were extracted from the French pharmacovigilance database up to 2020. The incidence of BRONJ was estimated as their respective numbers related to cases of BRONJ in patients treated with bisphosphonates for osteoporosis, over the same period, according to the Medic’AM database. ResultsBetween 2011 and 2020, BRONJ incidence with zoledronate was 9.6/100,000 patient-year (PY), significantly higher than with alendronate (5.1/100,000 PY, P<0.001), and risedronate (2.0/100,000 PY, P<0.001). The number of patients treated with bisphosphonates has steadily decreased by 44.5% over 10 years. Meanwhile, the incidence of BRONJ decreased (5.8/100,000 PY in 2011; 1.5/100,000 in 2020), although a rebound was observed in 2018, including 47.6% of BRONJ following denosumab. Apart from classical risk factors, recent dental cares stood out in more than 40% of BRONJ, and zoledronate had a shorter exposure time than oral bisphosphonates. ConclusionsIn a real-life setting, our data confirm that zoledronate-associated BRONJ in osteoporosis is scarce, seeming slightly more common compared with oral bisphosphonates. We also raise awareness of dental care guidelines and greater vigilance when using bisphosphonates in patients with previous exposure to denosumab.

Prevalence of oral behaviours in general dental patients attending a university clinic in Italy.

Oral behaviors represent a diverse array of habits beyond the physiological behaviors of the stomatognathic system. To describe the prevalence of different oral behaviors, as reported with the Oral Behavior Checklist (OBC-21), in a convenience sample of patients attending an Italian university clinic for routine dental cares. In this study, charts of adult patients presenting to the dental department of a regional hospital in Trieste, Italy, from January 2018 and January 2019 were reviewed. Patients with complete files were retrieved, and those with orofacial pain complaints were excluded. OBC-21 scores and grades (score of 0 corresponding to no risk, 1-24 to low risk, and higher than 24 to high risk) were analyzed and stratified according to age and sex. Data from a total of 1424 patients were reported. The overall mean OBC score was 13.3 ± 9.9, with 6.7% no-risk grade, 79.6% low-risk grade, and 13.7% high-risk grade. In general, mean OBC scores decreased with increasing age. Females showed a higher frequency of high-risk grade than males. Most frequent prevalent habits included yawning (73.1%), eating between meals (66.9%) and chewing food on one side only (63.3%). Other behaviors were also highly prevalent, including pressing, touching, or holding teeth together other than while eating (52.7%) and awake clenching (47.5%). A low-risk grade of oral behaviors has been found to be frequent in our sample. Future studies are warranted to confirm these findings in larger, representative general populations and to assess if any of these habits are linked to negative effects on the stomatognathic system.

Dental care utilization among persons with Parkinson's disease in Denmark.

Persons with Parkinson's disease (PD) have a higher prevalence of oral diseases and orofacial dysfunction, but knowledge about the use of dental care and whether their dental care needs are met is sparse. This study aimed to investigate the dental attendance and usage of dental care services of the total PD population in Denmark and compare it with a control group. National registers were used to identify the total PD population in Denmark (n=6874) and to obtain data on their dental care from 2015 to 2019. These data were compared with a five-fold age-, gender- and geographically matched control group without PD (n=34 285). Register data on age, gender, civil status, educational level, income, nursing homes status and mortality were also collected and adjusted for in the analyses. The dental attendance was analysed using χ2 -test with Bonferroni correction, and the type of dental care services was analysed using negative binomial regression analysis. A significantly higher proportion of persons with PD were irregular attenders of the dental care system (21.0%), compared with the control group (16.9%). Persons with PD had a significantly higher overall usage of dental cares services. Most prominent was the high usage of treatment services, where persons with PD had a 1.50 times higher incidence rate of tooth extractions and a 1.71 times higher incidence rate of tooth fillings in the five years compared with the control group. Persons with PD are more often irregular users of dental care and receive more treatment services than the control group. This indicates a need for high-quality prophylactic initiatives to prevent high filling and tooth extraction rates. Furthermore, this knowledge can be used by clinicians and decision makers to ensure optimal dental care for persons with PD.

Analysis of emergency dental visits of pediatric patients in the National Health Insurance of Taiwan in 2020

Background/purposeThe unconventional state associated with acute dental problems may lead people to seek emergency visits for dental care and abandon routine dental services. The aim of this study was to analyze the emergency dental visits of pediatric patients in the National Health Insurance (NHI) of Taiwan in 2020. Materials and methodsData on the population and medical records of NHI were obtained from the websites of Ministry of the Interior and the NHI Administration. The pediatric dental patient data were divided into 3 age groups (0–4, 5–9, and 10–14 years) to investigate and analyze emergency dental visit records claimed in 2020. ResultsIn Taiwan, the two most common oral diseases of children treated in emergency dental visits were diseases of pulp and periapical tissues, and gingivitis and periodontal diseases. Children in the 5-9-year age group had the highest number of emergency dental visits per 10,000 people (12.68 visits), followed in a descending order by all patients in the overall population (12.01 visits), children in the 0-4-year age group (9.65 visits), and children in the 10-14-year age group (7.13 visits). The male pediatric patients usually had higher number of emergency dental visits than female pediatric patients. ConclusionWe conclude that some children seek for dental emergency cares but do not continue to receive routine dental cares, especially in children of the 0-4-year age group. Therefore, it is imperative to continuously raise public awareness of emergency dental visits and reduce the use of dental health insurance resources incorrectly.

Extraction and Partial Purification of Thaumatin from Arils of Thaumatococcus daniellii Fruit

Thaumatococcus daniellii is a large flowering herb with rhizomatous rootstock, commonly found mostly in the western part of Nigeria. Thaumatococcus daniellii fruit arils that contain the sweetener, are embedded within a gel-like fluid that is richly composed of polysaccharide. The extraction and partial purification of thaumatin (protein) was undertaken to devise simpler means to extract and purify the protein, following the difficulty associated with the extraction due to the presence of the gel that encapsulates the protein. The research was carried out in department of biochemistry laboratory, covenant university Ota, Nigeria, between 10 August 2015 and 13 November 2018. In attempt to determine the optimal pH and temperature for extraction of crude thaumatin in different media from 4,000mg of the sample. Extraction was carried out at different pH values (2, 3, 4 and 5) in varied temperatures (25oC, 30oC, 40oC, 45oC, 50oC, 55oC, 60oC, 70oC, 80oC and 90oC). Maximum concentration of crude thaumatin extracted in 50ml of distilled water was 13.40mg/ml at pH 3 and temperature of 50oC while 28.17mg/ml at pH 3 and temperature of 55oC was extracted in 50ml of 0.85M of aqueous sodium chloride (dilute sodium chloride). Each extracted crude thaumatin was subjected to centrifugation at 10,000rpm for 1800secs, the decanted extracted crude thaumatin (supernatant) formed were assayed for protein via lowry method. Having pooled each decanted supernatant, the extracted crude thaumatin were precipitated with ammonium sulphate, dialyzed and subjected to column chromatography while the eluent were collected, tested for protein then freeze dried and stored as partially purified thaumatin. From the above findings, the extraction and partial purification of thaumatin can be optimized in dilute sodium chloride at optimal pH and temperature thereby making protein more readily available. Thaumatin a protein with very low calorie is an excellent alternative to other sweeteners with high calories especially sucrose, consequently will go a long way to reducing health challenges associated with sucrose such as obesity, hyperglycaemia, dental cares and even diabetes.

The Effects of Mouth Bacterial Infection on Saliva Flow

Background: Mouth bacterial infections most probably due to dental cares are a prevalent disease. Salivaryflow rate is affected by many diseases but there is not enough published data about the effect of mouthbacterial infection on the salivary flow rate. Objective: this study examines the relationship between salivaryflow rate and mouth bacterial infection in adult population. Methodology: cross sectional study. Result:salivary flow rate is affected by mouth bacterial infection as it is founded to be very low flow rate in 17% andlow flow rate in 40% of the sample population. Conclusion Salivary flow rate is affected by oral bacterialinfections that need urgent medical intervention to improve the outcome of those patients.

Antibacterial and antibiofilm activity of probiotic based silver nanoparticles is a green approach in biomedical applications

Biosynthesis of nanoparticles is not a new approach in nanotechnology. Stability, size, catalysis ability, non-toxicity, biocompatibility and speed of synthesis are the facts considering while selecting the method of synthesis for medical applications. Probiotics are beneficial microorganisms that comes under generally regarded as safe status. The ability of two probiotic bacteria Bacillus clausii and Bacillus subtilis from Enterogermina® is tested for its ability to synthesize silver nanoparticles and its biological applications. Synthesis was confirmed by UV- Vis spectroscopy, FTIR, XRD, SEM- EDX and TEM. The biosynthesized silver nanoparticles showed good antibacterial activity against all the gram negative pathogens tested but not to Staphylococcus aureus. Even though S. aureus was not inhibited, its biofilm formation was inhibited by the AgNPs. AgNPs also exhibited a dose dependent antioxidant activity. The antibacterial, antibiofiilm and antioxidant properties of biosilver nanoparticles extended their applications in medical field especially in catheters and dental cares.

Potency of dental permanent tooth eruption because of body mass index disturbance due to untreated teeth in elementary students

Aim: To analyze the correlation between body mass index (BMI) to the tooth eruption and the severity level of dental caries in elementary school-aged children. Materials and Methods: A descriptive cross-sectional observational study was conducted among the students of an elementary school. The population of this study comprised students aged 9–12 years. A total of 49 samples obtained in this study were selected by simple random sampling technique. In this study, PUFA (pulp, ulceration, fistula, abscess) index was performed in intraoral examination. BMI examination was conducted to measure the body mass of the respondents. The statistical analysis was carried out using SPSS software (Statistical Package for the Social Sciences), version 21. Analysis method used in this study was odds ratio with P 0.05). Meanwhile, 53.6% respondents with normal BMI level had dental cares without pulp-involvement (P > 0.05). Conclusion: Tooth eruption and dental caries severity did not correlate with BMI.

Are the Guidelines for Surgical Dental Cares Suitable for COVID-19 Pandemic?

Are the Guidelines for Surgical Dental Cares Suitable for COVID-19 Pandemic?

Autistic patients: a retrospective study on their dental needs and the behavioural approach.

Autism spectrum disorder (ASD) is a lifelong heterogeneous psychiatric disorder that represents a challenge for dentists. The aim of this retrospective study was to analyse ASD patients' dental needs and to investigate key factors influencing the behavioural management. One hundred eighteen ASD subjects (levels 2 and 3 of the DSM-5), adults and children, treated at university dental hospital, were included. For each of them, an index card was created to record general and medical information, dental care progress and treatment management. Data were analysed to characterize this specific population in terms of dental needs, technical approach and follow-up. The relationships between care approach and age (ANOVA test), care approach and concomitant pathologies as well as care approach and required treatment (chi-square test) were evaluated. Almost all patients required oral care. No treatment could be provided under conscious conditions. Oral premedication and/or nitrous oxide/oxygen inhalation was significantly more efficient in children and allowed conservative procedures. In adults, general anaesthesia was significantly more employed. Few patients were followed up over a long period. The variety of autism spectrum disorders complicates the statement of guidelines for dental care. The development of the collaboration between psychiatrics and dentists emerges as a key factor to improve the quality and the success of oral outpatient treatment. Oral premedication and/or nitrous oxide/oxygen inhalation at high dose represented a good way to carry out conservative dental cares, with a significant efficiency in children. Nevertheless, in a considerable number of ASD patients, especially in adults, general anaesthesia could not be avoided.

SEM-EDX Analysis of the Dental Plaque of the Knight Bayard (1473?-1524) Permits to Study his Diet Habits and Dental Cares

SEM-EDX Analysis of the Dental Plaque of the Knight Bayard (1473?-1524) Permits to Study his Diet Habits and Dental Cares

Childhood Oral Health : Maternal Knowledge and Practice in Tabuk, Saudi Arabia

Background: Dental cares is a prevalent health problem among preschool children, despite the fact that oral health is a main component of preschool children’s well-being. Objectives: To assess the knowledge and practice of mothers in Tabuk city, Saudi Arabia towards their preschool children oral health. Methods: This cross-sectional study was carried at Tabuk city, Kingdom of Saudi Arabia. It was carried out in King Khalid military. All mothers having children aged between 3 and 6 years and attended the out-patients` clinics of King Khalid military hospital during the period of Augusr1st-October 31st, 2017 and accept to participate were invited to be included in the study sample. Arabic self-administered structured questionnaire was utilized for collecting data. It includes two main sections. The first section includes socio-demographic information and the second section includes ten knowledge and nine practice questions regarding children`s dental health and hygiene. Results: The study included 389 mothers. More than half of children were males (50.4%). Nearly one-third of mothers (34.3%) were in the age group 30-34 years whereas 10.3% of them aged above 45 years. Almost half of mothers (49.4%) reported all of social media, dentist and mass media as a source of information regarding oral health and hygiene whereas social media and dentist alone were reported by 17.2% and 21.3% of them, respectively. Collectively, sufficient knowledge was observed among 26% of the participants whereas adequate practice regarding oral health was reported by 36.5% of mothers. Dental cares was reported among 115 children (29.6%) whereas dental deformity was reported among 171 children (44%). Conclusion: This study revealed insufficient knowledge and inadequate practice of mothers regarding their children oral health and hygiene. Some factors were identified affecting both child`s oral health knowledge and practice.

Planktonic free-living amoebae susceptibility to dental unit waterlines disinfectants.

A high diversity of microorganisms is encountered inside dental unit waterlines (DUWL). Among those the presence of free-living amoebae (FLA) appears currently underestimated, although human infections may occur due to contact with FLA-contaminated water during dental cares. In order to limit microbial DUWL contamination, disinfectants are provided by dental unit manufacturer, however, with limited documentation on their activities against FLA. The aim of this study was to evaluate the efficiency of three commercial DUWL disinfectants: the Calbenium© (Airel, Champigny-sur-Marne, France), the Oxygenal 6© (Kavo, Biberach, Germany) and the Sterispray© (Gammasonic, Billom, France), against two FLA species, i.e. Acanthamoeba castellanii and Vermamoeba vermiformis alone or co-cultured with Pseudomonas aeruginosa and Candida albicans at concentrations ranging from 0% to 5% (v/v). Results showed varied efficacies of disinfectants: the Oxygenal 6© did not exhibit FLA killing activity, while the Sterispray© and the Calbenium© displayed concentration- and species-dependent activities with a maximum eradication rates of 100% and 86%, and 79% and 97% for A. castellani and V. vermiformis, respectively. None of the disinfectants were able to totally eradicate FLA at concentrations recommended by manufacturers. Present results highlight unsatisfactory anti-FLA activities of 3 DUWL disinfectant preparations advocating deeper investigation of antimicrobial spectra of commercial disinfectants in use for DUWL maintenance.

Identification of oral risk factors for chronic graft versus host disease in haematological patients who underwent allogeneic haematopoietic stem cell transplantation.

The aim of this prospective observational study was to identify local risk factors for the development of clinical manifestations of oral chronic Graft versus Host Disease (cGvHD) in a cohort of patients affected by haematological malignant diseases who underwent allogeneic haematopoietic stem cell transplantation (HSCT). In the context of an active collaboration between the Rome Transplant Network of the Hematology and the Oral Pathology Division at "Policlinico Tor Vergata", in Rome, 47 haematological patients were included in this trial based on a systematic dental screening and follow-up protocol. The dental checks were planned 1 month before the transplant procedure while the subsequent follow ups were scheduled on day +100, +180, +365 and + 730 after the transplant. The tool used for the dental checks was a detailed report including all the potential oral features responsible of mechanical, chemical or infective injuries, except for the drugs. Overall, 64% of patients (N=30) did not perform dental hygiene during the screening pre-transplant and 53% (25/47) developed cGvHD with oral involvement. The most part of patients (84%) who experienced oral manifestations of cGvHD during the follow-up period after HSCT did not perform dental hygiene before the transplant procedure. Moreover, the comparison between the "presence" or "absence" of dental hygiene before the allogeneic HSCT showed a statistical significant increasing during the follow-up period in the occurrence of oral lesions due to the cGvHD for patients who lack pre-transplant dental care (p=0.029).On the contrary, the frequency of the other factors such as malocclusions, fractured teeth, incongruous prosthesis, food, smoke, alcol and bad habits, resulted similar between the group with or without typical oral lesions of cGvHD. The prevention of oral infectious complications provided by primary and secondary dental cares can result in a great benefit for haematological patients who underwent allogeneic HSCT. The combined hematological and dental management represents a clinical need before and after allogeneic HSCT for the removal of inconvenient issues with impact on the short and long-term outcome. Poor dental hygiene seems to be a local risk factor for the development of oral lesions due to cGvHD. However, a larger cohort of patients is necessary to confirm these preliminary data and to evaluate the best preventive and therapeutic oral hygiene protocol in this specific setting.

The utilization of fluoride varnish and its determining factors among Taiwanese preschool children

BackgroundThe Taiwanese government considers fluoride varnish to be a major component of preventive dental cares for preschool children. This study aimed to explore the extent of utilization of fluoride varnish and its determining factors among Taiwanese preschool children. MethodsUsing preschool children under the age of 5 years as our participants, this study was conducted based on the 2008 Taiwan database of the Ministry of the Interior, linked with information gathered between 2006 and 2008 on preventive healthcare and health insurance from the Bureau of Health Promotion and the National Health Research Institute. A total of 949,023 preschool children (< 5 years old) were identified to meet the requirement for fluoride varnish services. ResultsThe percentage of Taiwanese preschool children that used fluoride varnish was 34.85%.The probability that fluoride varnish would be utilized was higher among children with catastrophic illness/injury or relevant chronic illnesses than those without. In addition, the probability of children with disabilities using fluoride varnish was lower than that of nondisabled children. Finally, parent sex, parent age, urbanization level of residence, and parents' premium-based salary significantly affected the children's utilization probability of fluoride varnish. ConclusionIn order to increase the utilization of fluoride varnish among preschool children in Taiwan in the future, target groups consisting of females, children < 3 years of age, and disabled children should be prioritized. Parental factors are also important in affecting the utilization of fluoride varnish in children.

Changes in socioeconomic inequalities in the use of dental care following major healthcare reform in Chile, 2004-2009.

The study examines changes in the distribution and socioeconomic inequalities of dental care utilization among adults after the major healthcare reform in Chile, 2004–2009. We evaluated the proportion of people who visited the dentist at least once in the previous two years, and the mean number of visits. These outcome variables were stratified by sex, age (20–39, 40–59, 60–63; ≥64 years), educational level (primary, secondary, higher), type of health insurance (public, private, uninsured), and socioeconomic status (quintiles of an asset-index). We also used the concentration index (CIndex) to assess the extent of socioeconomic inequalities in the use of dental care, stratified by age and sex as a proxy for dental care needs. The use of dental care significantly increased between 2004 and 2009, especially in those with public health insurance, with lower educational level and lower socioeconomic status. The CIndex for the total population significantly decreased both for the proportion who used dental care, and also the mean number of visits. Findings suggest that the use of dental care increased and socioeconomic-related inequalities in the utilization of dental care declined after a Major Health Reform, which included universal coverage for some dental cares in Chile. However, efforts to ameliorate these inequalities require an approach that moves beyond a sole focus on rectifying health coverage.

Epidemiology of traumatic dental injuries in Tunisia: A prospective study

Purpose: The aim of this study was to investigate the epidemiological characteristics of traumatic dental injury (TDI) in Tunisian patients. Patients and Methods: All the trauma patients who had attended the Department of Dental Medicine, Hospital, Sahloul, Sousse city, during 4 years (2009-2013), were included in this study. Age, sex, etiology, and, time between the TDI and dental cares were recorded. The type of trauma was identified according to Andreasen's classification. Data were evaluated using the Chi-square, ANOVA, and Student's t-test. Results: TDIs were higher among the age group of 11-20 years (35%), with more males being affected (sex ratio: 2.2:1). Falls was the most common etiological factor causing TDI (33%). The most frequent type of trauma is enamel-dentin fracture without pulp exposure (38%). Only 9% of patients sought dental care within 24 h of the injury. A significant difference of the sex repartition between different trauma etiologies (P = 0.013) was found. Age group repartition and etiology of trauma was significantly associated (P = 0.007) (the most common etiology of TDIs in 11-20 years age group is fall). Conclusion: In this study, fall is the most common etiology of TDI and that the majority of patients sought dental treatment after more than 24 h of the injury. Therefore, significant strategies of trauma prevention and immediate treatment of injuries such as awareness campaigns in primary schools, colleges for emergency attitudes to adopt in case of dental trauma including total dislocation are needed to change epidemiologic data to the better.

Dental Cares for Patients Who Have a Hearing Impairment

Dental Cares for Patients Who Have a Hearing Impairment

So depression is an inflammatory disease, but where does the inflammation come from?

BackgroundWe now know that depression is associated with a chronic, low-grade inflammatory response and activation of cell-mediated immunity, as well as activation of the compensatory anti-inflammatory reflex system. It is similarly accompanied by increased oxidative and nitrosative stress (O&NS), which contribute to neuroprogression in the disorder. The obvious question this poses is ‘what is the source of this chronic low-grade inflammation?’DiscussionThis review explores the role of inflammation and oxidative and nitrosative stress as possible mediators of known environmental risk factors in depression, and discusses potential implications of these findings. A range of factors appear to increase the risk for the development of depression, and seem to be associated with systemic inflammation; these include psychosocial stressors, poor diet, physical inactivity, obesity, smoking, altered gut permeability, atopy, dental cares, sleep and vitamin D deficiency.SummaryThe identification of known sources of inflammation provides support for inflammation as a mediating pathway to both risk and neuroprogression in depression. Critically, most of these factors are plastic, and potentially amenable to therapeutic and preventative interventions. Most, but not all, of the above mentioned sources of inflammation may play a role in other psychiatric disorders, such as bipolar disorder, schizophrenia, autism and post-traumatic stress disorder.

Inherited platelet disorders and oral health

Platelets play a key role in thrombosis and hemostasis. Accumulation of platelets at the site of vascular injury is the first step in the formation of hemostatic plugs, which play a pivotal role in preventing blood loss after injury. Platelet adhesion at sites of injury results in spreading, secretion, recruitment of additional platelets, and formation of platelet aggregates. Inherited platelet disorders are rare causes of bleeding syndromes, ranging from mild bruising to severe hemorrhage. The defects can reflect deficiency or dysfunction of platelet surface glycoproteins, granule contents, cytoskeletal proteins, platelet pro-coagulant function, and signaling pathways. For instance, Bernard-Soulier syndrome and Glanzmann thrombasthenia are attributed to deficiencies of glycoprotein Ib/IX/V and GPIIb/IIIa, respectively, and are rare but severe platelet disorders. Inherited defects that impair platelet secretion and/or signal transduction are among the most common forms of mild platelet disorders and include gray platelet syndrome, Hermansky-Pudlak syndrome, and Chediak-Higashi syndrome. When necessary, desmopressin, antifibrinolytic agents, and transfusion of platelets remain the most common treatment of inherited platelet disorders. Alternative therapies such as recombinant activated factor VII are also available for a limited number of situations. In this review, we will discuss the management of patients with inherited platelet disorders in various clinical situations related to dental cares, including surgical intervention.