Clinical Dental Practice Research Articles

Implications for clinical dental practice during the coronavirus disease pandemic: A scoping review.

It is over a year since the first case of coronavirus disease (COVID-19) was confirmed in China. This paper reviews and summarizes the characteristics of COVID-19, as understood of December 2020, from a dental perspective. The PubMed and Scopus online databases were searched using a combination of free words and Medical Subject Headings terms: "dentist" OR "oral care" AND "COVID-19" OR "SARS-CoV-2." Older people and those with underlying medical conditions have an increased risk of serious illness due to COVID-19. The virus enters the body by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. It is common for people with COVID-19 to have mild or no symptoms. Moreover, the disease is not contagious in most infected people; it is only highly contagious in some infected people, thereby forming clusters. Due to the large number of virus particles that are shed prior to the onset of symptoms of the disease, retrospective surveys are important. Appropriate personal protective equipment against corona vortices is also important in clinical practice. Although polymerase chain reaction tests are useful for confirming infection in suspected individuals, their reliability is questionable. In addition, concerns regarding long-term sequelae have been reported. There are few high-quality reports on the implications of COVID-19 in dental practice. However, reports suggest that insufficient oral hygiene may be a risk factor for infection. Reports that ACE2 receptors are abundant in the oral cavity also suggest the importance of oral care.

Assessment of knowledge, awareness and attitudes on dental radiation hazards and radiation protection among dentists in Pune

Background: Radiological examination is an essential component of clinical dental practice, with significant advantages for both clinicians and patients. Because dentists are the ones who order the tests, they should be well-versed in radiation. They must determine if the benefits of radiographic information outweighs the risks of the patient's health. Dentists should be prepared to inform their patients about the dangers of X-rays. The purpose of this study was to assess knowledge, importance of radiation protection and radiation hazards among Interns and Dental professionals in Pune city. Materials and Methods: A questionnaire study was conducted among the dental health professionals including the dental undergraduate interns of Pune city, Maharashtra, to assess the knowledge, attitude and awareness of dental radiation hazards and radiation protection. A structured, self-administered, close-ended questionnaire was designed to collect the data which consisted of two parts and comprised of 31 questions related to knowledge, attitudes and practices in dental radiation hazards and radiation protection. The first part consisted of demographic data and the second part consisted of questions based on knowledge, attitude and practice in dental radiation hazards and radiation protection. The reliability statistics were calculated and Cronbach alpha value was 0.618. Statistical analysis was done using descriptive statistics. Results: In this study, there were a total of 159 participants of age 21 and above. 84.8% agreed that dental X-rays are harmful, while 15.2% participants answered No. 94.9% of dentists agreed that dental X-rays have stochastic and deterministic effects over a period of time and only 5.1% of the participants disagreed. Conclusion: The study concluded that the knowledge and awareness regarding radiation hazards and radiation protection among dental health professionals was fair and adequate. Although a continual teaching and education at regular intervals is required to ensure that dentists are taking proper precautions for maximum safety.

Rationale behind a minimally invasive approach in the treatment of dental fluorosis

Modern epidemiology of dental fluorosis is characterized by its high global prevalence. Dental fluorosis is a chronic disease that develops before teething with prolonged ingestion of water or foods with a high content of fluorine compounds. In Russia, an increased concentration of fluorine in water is detected in more than 20 administrative regions. In addition, endemic areas can be assisted with anthropogenic factors, particularly certain chemical industry. Improvement of the novel treatment methods for fluorosis turns out to be important and relevant. For the treatment of various forms of fluorosis, sufficiently effective materials have been currently developed, characterized by convenience and ease of use, as well as safety for a patient. Their use alone or in combination allows achieving high aesthetic results and maximum patient satisfaction. The aim of this study is to measure the adhesive strength of the composite filling material to the Icon infiltrant (infiltration concept), as well as to compare it with the adhesion strength of the composite to the enamel using various adhesive systems. Icon was developed by the German company DMG and has been used worldwide since 2000. To assess the adhesive peel strength, 60 teeth with fluorosis and 60 intact teeth were examined. The largest values of the adhesive shear strength were identified in group 2 (the All bond universal adhesive system) and group 4 (the Icon etch), i.e. the approaches which contained MDP polymer. Overall, the results of our experimental study allowed considering the combined usage of the Icon infiltrant and the low-modulus composite material as a promising strategy in a routine dental clinical practice.

Online Learning Modalities in Dental Education during COVID-19 Pandemic

Remote learning on digital platforms has replaced conventional learning to alleviate the effects caused by the pandemic. Dental educational institutions had opted for alternative methods to continue with the academics to allow students to pursue their education even with the physical shutdown of schools worldwide. Embracing various challenges, remote learning has been implemented since over a year in many dental schools in Nepal. Although still practiced in many educational institutes, the efficacy of these new modalities, however, remains in doubt, especially in medical/ dental field, where practical and clinical practice is concerned.

Does toxic stress impact paediatric dental procedures? An integrative review

Toxic stress is defined as strong, repetitive stress with prolonged activation, without the child having the support of an adult caregiver. It is plausible that invasive and complex paediatric interventions produce or contribute to the development of toxic stress. This article aims to evaluate, discuss and synthesize the association between toxic stress and paediatric dental clinical practice through an integrative review of studies published in several databases. The results of this study allow us to state that this subject is little explored in the dental literature and, therefore, that it is essential to encourage clinical studies and specific research. The expansion of these studies will provide health professionals with scientific evidence regarding the implementation of proper clinical practice, thus reducing or even eliminating the development of toxic stress.

Current opportunities of primary endodontic treatment of chronic apical periodontitis with endo-perio origin

Primary endodontic treatment of chronic apical periodontitis caused by primary perio lesion, a frequent case in the dental clinical practice. This situation is a dilemma when drawing up a comprehensive treatment plan for a patient, taking into account the pathogenesis of the disease. Extracting or saving a tooth is still a controversial issue for dental surgeons and therapists. To obtain a successful result, it is necessary to carry out high-quality endodontic and periodontal treatment. This article represents a clinical case of primary endodontic treatment of tooth 1.7 with endo-perio lesion. At the final stage, the final result of the treatment is presented in 2 weeks. This article will help dentists acquire additional knowledge necessary for making decisions and choosing treatment tactics in difficult clinical situations.

How Did the COVID-19 Pandemic Effect Dental Patients? An Italian Observational Survey Study.

The primary aim of this observational survey study was to assess patients’ attitudes toward clinical dental practice during the COVID-19 pandemic; the secondary aim was to evaluate patients’ attitudes towards oral health by maintaining an appropriate lifestyle and oral hygiene at home. The questionnaire was developed using Google Forms. The questionnaire consisted of three parts: Part A—geographic, demographic, and personal data; Part B—patients’ attitude toward oral health selfcare and lifestyle; Part C—patients’ attitude toward dental practice. This survey, conducted during the months of November and December 2020, enrolled 1135 subjects throughout Italy. All data were statistically analyzed. COVID-19 has changed patients’ approach to dental procedures. Most of the people interviewed lived in families, and their greatest fear was infecting a family member. Restrictive measures forced people to stay at home, which led to an increased consumption of various types of food, including cariogenic foods. People said they felt safe when they went to the dentist, but they also paid special attention to measures to prevent contagion. Among the measures that should be introduced in similar situations in the future, people wanted telemedicine, a phone recall, and the possible use of video clips for home oral care instructions.

Monomer Elution from Three Resin Composites at Two Different Time Interval Using High Performance Liquid Chromatography-An In-Vitro Study.

Esthetics, improved colour stability and ease of contour have made photo-activated resin based restorative materials being widely used in routine dental clinical practice. Perhaps improper and inadequate polymerization of resin based composite material might lead to elution of monomer. Thus, the aim of the current study was to quantify the monomer elution from three resin composites. The intended analysis was made using high performance liquid chromatography (HPLC) at two different time periods. Three different materials that were investigated in the current study included Swiss Tech resin composite (Group A), Ceram X (Group B) and Beautifil Injectable composite (Group C). Ten cylindrical samples were fabricated in each study group. In 75% wt of ethanol, the samples were ingressed immediately and stored at room temperature. A 0.5 mL of the samples was assessed at pre-defined time intervals at 24 h and 7th day. Later, assessment of the samples was performed with HPLC and the data was analyzed using statistical test. Bisphenol A-glycidyl methacrylate (Bis-GMA), Triethylene glycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA) and Urethane dimethacrylate (UDMA) were quantified in the samples. When analyzing the release monomer, it was found that at the end of 24 h Bis-GMA was eluted more in the injectable resin composite whereas, TEGDMA was eluted from Swiss Tech and Ceram X resin composites. At the end of the 7th day it was evident that Bis-GMA was eluted maximum in all the three resin composites. Thus, monomer release was found to be evident among all three resin composites and it is of utmost important to be assessed in routine clinical practice.

Pattern of Antibiotic Prescription for Orofacial Infections among Dentists: A Narrative Review of Literature

Bacterial infections are common in dental and oral clinical practice. It is been estimated that about 10% of total antibiotic prescriptions are related to dental infections. Combination of amoxicillin-clavulanate and plain amoxycillin is the most commonly used drug by dentists across the world. Three general considerations were recognized in this literature review—Empirical antibiotic prescription by dentists without a culture test; concomitant prescription of antibiotics with non-steroidal anti-inflammatory drugs which may ultimately affect the bioavailability of the former drug; and the increased antimicrobial resistance amongst oral pathogens. Since decades, antibiotics have been prescribed for the treatment of odontogenic infections and non-odontogenic oral infections, and for focal infections and sepsis prophylaxis. Renal failure, liver failure, and pregnancy are situations that require special attention when considering an antibiotic prescription. This review attempted to contribute to the rational use and abuse of antibiotics while focusing on the general characteristics of these drugs.

Dental care for children with Down syndrome: a guide for the dental practice team

Down syndrome is the most common genetic cause of intellectual disability and increases the risk of a range of medical problems that may have implications for oral health. Children diagnosed with Down syndrome should be signposted to dental services as part of their schedule of health checks. To ensure that appropriate access and support are available from the dental team, it is important that dental professionals are familiar with medical and dental conditions and characteristics that occur with increased frequency in patients with Down syndrome. CPD/Clinical Relevance: Down syndrome is the most common chromosomal abnormality likely to present in clinical dental practice. This paper provides guidance for dental professionals for dental checks and surveillance of the developing dentition for children with Down syndrome.

Evaluation of Dental Students’ Knowledge and Opinion About Learning with Virtual Reality

AIM: Virtual reality (VR) based technologies have been used in dentistry for almost two decades. Dental simulators, treatment planning software, and CAD/CAM systems have evolved significantly over the years, changing both dental education and clinical practice. The purpose of this survey study is to learn the knowledge, opinions, and thoughts of dental students in our country on the use of VR-based dental simulators in education, and to raise awareness on this issue. METHODS: Questions testing participants’ knowledge were based on the data from peer-reviewed dental journals. The survey questions consisting of a total of 25 questions were delivered online via Google Forms (Google Inc., USA) to students who had preclinical training in the dental faculty before the Covid-19 pandemic. The data obtained were evaluated using the descriptive statistics and Pearson chi-square test. RESULTS: 422 of the 662 students in the study were female and 240 were male students. 82.3% of the study participants were studying at a state university. 74.6% of the participants in the study stated that they needed more preclinical education. While 89.9% of the students participating in the survey stated that they do not have information about preclinical education with virtual reality, 97.4% stated that they have not used a VR-based dental simulator before. 85.5% of them stated that they feel positive about training in virtual environment with VR-based dental simulator and 86% of them prefer using both VR-based training and phantom models in preclinical training. CONCLUSION: Dental students had overall positive attitudes towards VR-based dental simulator but very few used VR-based dental simulators in education and practice. While using VR-based dental simulators as part of undergraduate and continuing education programs is rapidly advancing in the world, in our country having knowledge about VR-based dental simulators will increase awareness for the development of such technologies and their inclusion in dentistry education.

Curriculum of gross anatomy education in Korean dental hygiene programs: Perceptions of clinical dental hygienists.

It is essential for dental hygienists to have basic knowledge of gross anatomy to provide efficient treatment. However, gross anatomy course is relatively neglected due to their disparity from actual clinical dental practice. This study aimed to propose an effective dental hygiene gross anatomy curriculum that reflects the opinions of professional clinical dental hygienists. The study had an online-based cross-sectional design and the survey was distributed to clinical dental hygienists via social networks (n=200). The questionnaire consisted of questions on the utilization of anatomical knowledge in clinical practice, opinions on the contents and methods of gross anatomy education, and general characteristics. The present study found that 186 (93%) used anatomical knowledge at an above-average level. Qualitative analysis indicated that dental implant surgery, radiography, and extraction were the clinical procedures that required the most anatomical knowledge. The clinical dental hygienists answered that the most-necessary knowledge is that of the mandibular nerve, followed by that on the temporomandibular joint, mandible, maxilla, maxillary nerve, and masticatory muscle. The methods proposed to improvegrossanatomyeducation were (in decreasing order of importance) using videos or photographs (X-rays, CT, MRI, etc.), integrating education with clinical subjects, and using a three-dimensional visualization program. Higher education levels of respondents have increased their tendency to believe that the contents and methods of the presented education were necessary. Dental hygienists who utilized anatomical knowledge more often tended to be had a greater appreciation of the necessity of all educational contents and methods.

Current COVID-19 vaccine epidemiology and dentistry

The coronavirus disease 2019 (COVID-19) vaccine story is continuously unfolding. Since our previous COVID-19 commentaries, much new information has transpired on the subject, and here we revisit this topic, which has practical implications for all stakeholders in dentistry, as well as the public. This article, on current vaccine epidemiology, provides an account of why vaccines fail in general, and the particular concerns in relation to the new Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and related ‘variants of concern’. Issues related to vaccine failure are fundamentally dichotomous in nature, appertaining either to the vaccine strain (type) per se, and/or the numerous endogenous factors of the vaccine recipient/vaccinee. Societal factors such as vaccine hesitancy and its impact on herd immunity appear to overarch the long-term goal of total or partial global suppression of SARS-CoV-2, and its eventual endemicity. CPD/Clinical Relevance: To describe the reasons for the failure of currently administered COVID-19 vaccines, particularly in relation to the advent of the SARS-CoV-2 ‘variants of concern’, and discuss implications for clinical dental practice.

Predatory publishing in dentistry: an analysis of its impact and potential risks.

The aim of this study was to make a quantitative assessment of the impact that predatory publishing has on a single author over a year, analyzing the number of invitations, the subject areas of the inviting journals and their characteristics. An analysis of all invitations to publication, received during 12 months, was carried out in order to analyze their number, the area of specialization, the presence in reputable databases, publication criteria and presence in the Beall's list. A total of 864 invitations had been received at the end of the 12 months, all with open access policies. Ninety-nine were from journals not on Beall's list. Eight were indexed on reputable databases. The thematic areas were distributed as follows: 370 dental, 346 medical, 122 unspecified subject, 26 non-medical. Predatory publishing is spreading in dentistry. Poor-quality articles and, at the same time, loss of potentially valuable research could seriously pollute the scientific evidence that founds dental clinical practice.

Quality of biosafety guidelines for dental clinical practice throughout the world in the early COVID-19 pandemic: a systematic review.

OBJECTIVESTo conduct a systematic review of coronavirus disease 2019 (COVID-19)-related biosafety guidelines for dental clinical practice in the early stage of the pandemic, focusing on quality assessment.METHODSElectronic (via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, and Cochrane Library) and gray literature searches were performed for documents published up to May 12, 2020. Guidelines updated until April 17, 2021 were identified. Documents were included as guidelines if they (1) consisted of a set of statements, directions, or principles presenting current or future rules or policy; (2) were developed by government agencies, institutions, organizations, or expert panels; and (3) were related to the general conduct of healthcare activities rather a particular condition. Two researchers, using the Appraisal of Guidelines for Research & Evaluation II, independently extracted the recommendations and evaluated the quality of the guidelines.RESULTSTwenty-seven documents from 19 countries were included in the review. These documents presented 122 recommendations related to (1) professional biosafety; (2) patients’/companions’ safety; (3) the organization and biosafety of the physical dental facility environment; and (4) the work process in dental care. Overall, the scientific quality of the guidelines was considered low. Some recommendations presented in these guidelines would require further research to establish their effectiveness.CONCLUSIONSWe found a wide variety of biosafety guidelines for dental practice regarding COVID-19 in the early months of the pandemic, but their quality was low. Biosafety recommendations should be frequently updated.

What do dental students value about their rural placements-Is clinical experience enough?

Melbourne Dental School's (MDS) rural dental clinical placement program operates in two Victorian rural areas and offers final year dental students an integrated program of practical clinical experience and rural lifestyle exposure. The objective of this study was to understand the student's experiences to determine whether they increased the likelihood of them seeking rural employment after graduation. The University of Melbourne final year dental students attended 5-week mandatory rural clinical placements in 2018 and 2019. At the completion of their placement, students were invited to complete an anonymous questionnaire about their experiences, which had both quantitative and qualitative questions. This study examined the qualitative data using thematic analysis to identify common themes. Rural clinical dental placements at Goulburn Valley Health and Latrobe Community Health Service. Final year Dentistry and Oral Health students. Clinical placementevaluation questionnaire. To examinedentalstudents interest in rural practicepost rural clinical placement. Of the 129 students who completed the survey, 116 completed the open-ended questions and four themes were identified. Rich clinical experience; social capital; rural life and infrastructure. High levels of satisfaction were reported across all themes. This study demonstrated the rural clinical program to be a positive and enjoyable placement which increased dental students' clinical practice experience and their interest in considering rural practice upon graduation. Exposure to rural lifestyle and supportive clinical and social relationships were shown to be important influences. The current survey can benefit from refinement and further research following up MDS graduate workplace locations is recommended.

Pitfalls for diagnosis of burning mouth-like syndrome

This research gives a scientific framework for burning mouth syndrome(BMS) etiology and diagnostic approach in clinical dental and medical practice. BMS-like symptoms can be induced by systemic diseases such as diabetes, gastrointestinal, endocrine disorders, allergy etc. or by local oral cavity conditions as candidiasis or geographic tongue or odontogenic causes. Because the etiology of BMS is multifactorial, treatment can only be distinctive, and is aimed at relieving symptoms. The complexity of BMS symptoms and associated psychosocial infirmities, anxiety and depression raise the need for a multidisciplinary and individualised approach.

The Onset of Dental Erosion Caused by Food and Drinks and the Preventive Effect of Alkaline Ionized Water.

In recent years, the incidence of dental erosion caused by the ingestion of acidic foods and drinks, including sports drinks, has been increasing in Japan and elsewhere. Therefore, the problems associated with this injury can no longer be ignored in dental clinical practice. The ingestion of these foods and drinks is important from the viewpoint of overall health and disease prevention. For example, fermented foods, such as Japanese pickles, enhance the nutritional value of foodstuffs and promote the absorption of nutrients into the body, and sports drinks are useful for preventing heat stroke and dehydration. Therefore, eliminating these intakes is not a viable solution. In this paper, we outline the mechanism of dental erosion caused by acidic beverages and also describe the effectiveness of alkaline ionized water (AIW) at preventing acid erosion. Given the fact that the complete elimination of acidic beverage consumption is highly unlikely, remedies such as the use of alkaline ionized water (AIW) may be helpful.

Biomimetic Lamellar Chitosan Scaffold for Soft Gingival Tissue Regeneration

AbstractMucogingival surgery has become a common procedure for soft gingival tissue reparation in dental clinical practice, which mainly relies on autograft or commercial collagen membranes (CM). However, the autograft faces grand challenges in source availability and long‐term post‐surgery pain management, and the CM is restricted by its poor mechanical properties in an aqueous environment. Here, it is reported that a bio‐inspired lamellar chitosan scaffold (LCS) with long range ordered porous structure, manufactured through a bidirectional freezing method, can serve as a promising gingival tissue engineering material. The LCS not only exhibits excellent mechanical properties in the hydrated state but also accelerates vessel formation and soft tissue regeneration in vivo. Most interestingly, the LCS is found to be capable of inducing macrophage differentiation to M2 macrophages, which is thought to play an important role in tissue regeneration. These advantages combined with its easy and low‐cost preparation process make the LCS a promising candidate for dental clinical applications.

A systematic review and gap analysis of frailty and oral health characteristics in older adults: A call for clinical translation.

This systematic review updates the evidence for association between oral health characteristics and frailty status, identifying gaps in translational dental research and application of frailty assessment into clinical practice. Clinicians have little guidance on stage-appropriate dental treatment for medically complex older adults. Oral health characteristics have been associated with frailty status, determined through validated assessment tools representing a concise measure of health. Translation of frailty assessment into dental practice has not been the focus of previous reviews. Utilising the PRISMA framework for systematic reviews, a comprehensive database search identified articles describing the association of interest. Those included were cross-sectional or longitudinal, in English, included participants aged 50years or older, used validated frailty assessments and measured clinically relevant oral health outcomes. From 835 screened articles, 26 full-text articles were eligible for quality appraisal and synthesis. Frailty prevalence ranged from 8.5% to 66.0%. Most studies utilised the Fried frailty criteria. Qualitative synthesis of 17 cross-sectional and nine longitudinal studies demonstrated significant covariate-adjusted association between frailty status and number of teeth, chewing ability, prosthetic characteristics, dental caries, periodontitis, dental utilisation and oral health-related quality of life factors. Variability in findings reflected study sample diversity based on country of study origin, age at recruitment, sample size, frailty assessment type, use of clinical versus self-reported outcome measures and differences in statistical analysis. Despite robust evidence of association with oral health characteristics, frailty assessment has yet to be sufficiently applied to translational dental research and clinical practice.