Dental Diagnosis Research Articles

Biosecurity Perspectives in Oral and Maxillofacial Radiology in Times of Coronavirus disease (COVID-19): a Literature Review

The aim of this work was to report biosecurity measures in the Oral and Maxillofacial Radiology (OMR) clinic in the current context of COVID-19, based on a literature review. An electronic search for scientific papers was perform ed using PubMed, Embase, Web of Science, and Scopus database. Although the literature related to care in the OMR clinic regarding COVID-19 is still scarce, this unprecedented scenario created by the pandemic generated an urgent need for measures to prevent the transmission of the virus. Dentists are at maximum risk of contagion and, although the practice of OMR generally does not produce aerosols, radiologists and technicians are continually in contact with body fluids, such as saliva. In additio n, imaging exams are often indispensable for emergency or elective dental diagnosis and treatment. Training in infection control practices during major outbreaks of infectious diseases should be quickly reinforced and dental settings have unique characteristics that warrant specific infection control considerations. Some recommendations have been proposed and were discussed, which cover patient flow, equipment handling and environment, radiographic technique and processing, personal protective equipment and preparation and issuance of radiological reports and access to exam results. Due to the COVID-19 pandemic, biosecurity measures in the routine of the OMR clinic are indispensable to enable emergency dental care and the perspectives of returning to elective treatment. Biosecurity measures and staff training at the OMR clinic should be instituted immediately, since imaging exams are an important and often indispensable part of dental diagnosis and treatment.

MSLPNet: multi-scale location perception network for dental panoramic X-ray image segmentation

Tooth segmentation, as one of the key techniques of medical image segmentation, can be widely applied to various medical applications, e.g., orthodontic treatment, corpse identification, dental training systems, dental disease diagnosis, etc. Although there have been many studies on tooth segmentation, few tooth segmentation studies have focused on enhancing tooth segmentation with fuzzy root boundaries which is a difficult but essential task in dentistry to determine the root resorption and the tooth brace. The existing methods for tooth segmentation usually exploited the contrast enhancement to sharpen the boundaries of teeth, while the final segmentation results heavily depended on the subsequent processing steps of the method. To address the issue of fuzzy boundaries, this paper proposes a novel multi-scale location perception network to segment teeth from panoramic X-ray images. The core of the proposed method stems from three aspects: (1) multi-scale structural similarity loss conducts accurate prediction with clear boundary from patch-level scale; (2) location perception module locates each tooth pixel in the image from the perspective of global-level scale; (3) aggregation module reduces the semantic gap between multi-scale feature branches. Our proposed method was tested on a dataset containing 1500 dental panoramic X-ray images and the Dice score of our method is 93.01%, which outperforms the state-of-the-art approaches. Besides, our proposed method has better boundary quality and the Pratt (1978)’s figure of merit used for boundary quality evaluation reaches 76.56%.

Alteration of mucosa cell maturation pattern after exposure to different radiographic imaging methods

Aim: Dental imaging has been widely used for diagnosis in dentistry. However, dental X-ray may induce cytotoxicity leading to apoptosis in oral mucosa cells. The present study aimed to observe the maturation pattern of buccal and gingival cells after exposure to X-ray radiation from analog/digital panoramic scanning and cone beam computed tomography (CBCT). Methods: The research samples were 40 subjects who fulfilled the inclusion and exclusion criteria. The subjects were divided into the exposed (patients who received analog/digital panoramic radiography or CBCT) and controlled (patients who had no radiography examinations) groups, with 10 subjects in each group. Exfoliative cytology smears were obtained from buccal mucosa and gingiva before exposure (or on day 0 for the control group) and 10 days later. The cells were stained with the Papanicolaou method. Then, the superficial, intermediate, and parabasal cells were counted in each glass slide. Results: No significant differences (p > 0.05) were observed among all cell types between day 0 and 10 in the control group. Meanwhile, after exposure to three kinds of radiography examinations, the frequency of intermediate cells in buccal mucosa and gingiva increased (p < 0.05), but that of superficial cells decreased (p < 0.05) significantly. No significant difference was found in the parabasal cells (p > 0.05). The frequency differences between intermediate and superficial cells showed no significant difference between the buccal mucosa and gingiva. Conclusion: Analog/digital panoramic radiography and CBCT exposure can induce cytotoxicity by altering the maturation pattern of buccal mucosa cells and gingiva, so it is strongly recommended to only perform these procedures if necessary and avoid repeated exposure to the same patient.

Tratamiento ortodóntico interceptivo para paciente pediátrico con problema periodontal ocasionado por trauma oclusal primario. Reporte de caso

El diagnóstico correcto puede evitar la evolución de patologías que lleven al paciente pediátrico a padecer de problemas graves en el futuro. Este diagnóstico junto con un tratamiento interceptivo a tiempo, puede ayudar a resolver problemas de tipo periodontal causado por el inadecuado posicionamiento dental o injurias oclusales. El objetivo de este artículo es realizar el reporte de caso de un paciente pediátrico que presenta una maloclusion dental tipo mordida cruzada anterior acompañada por un trauma oclusal primario, el cual causo un problema periodontal localizado, a su vez, describir la terapéutica interceptiva basada en el correcto diagnóstico odontopediátrico, ortodóntico y periodontal. Concluyendo que al seleccionar la aparatología adecuada se puede solventar diversos problemas dentales que puedan ocasionar un daño mayor a las estructuras comprometidas.

Consideration of Oral Health and Periodontal Diseases During Pregnancy: Knowledge and Behaviour Among French Pregnant Women.

Purpose: Several studies demonstrated compromised oral health and periodontal diseases as risk factors for adverse pregnancy outcomes. However, consideration of oral health by pregnant women remains elusive. The aim of this study was to evaluate knowledge and behaviour of French pregnant women towards relationship between oral conditions and pregnancy outcomes and to evaluate influencing factors. Materials and Methods: A self-reported questionnaire was given to women between 1 and 3 days after delivery in three specialised clinics in France. The questionnaire aimed to evaluate demographic characteristics, self-perceived oral health, type of pregnancy follow-up and knowledge regarding oral conditions during pregnancy and risk of adverse pregnancy outcomes. A multivariate analysis was performed to evaluate correlation between knowledge and behaviour. Results: The questionnaire was completed by 212 women. Among them, 92% considered prevention of oral diseases during pregnancy important. Despite knowledge of potential negative influence of periodontal diseases on pregnancy outcomes, only 47% of pregnant women received dental diagnosis or treatment during pregnancy. Only 18% of the women discussed oral health consideration during pregnancy with health professional in charge of pregnancy follow-up. Interestingly, absence of dental consultation during pregnancy was associated with low rate of dental consultation prior to pregnancy (p < 0.01). Conclusions: Pregnant women were aware of the association between oral health and pregnancy and of need of prevention. However, consideration of importance of oral health was not adequate to the rate of dental consultation and seems to be influenced by individual dental follow-up habits prior to pregnancy. Clinical Relevance: Dental evaluation should be considered systematically during pregnancy follow-up.

Severe acute respiratory syndrome coronavirus 2 infection in asymptomatic pediatric dental patients

BackgroundChildren with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are typically asymptomatic but contagious. The authors investigated the positivity rate of asymptomatic SARS-CoV-2 infection in pediatric dental patients. MethodsThe authors reviewed consecutive charts of children younger than 18 years scheduled for elective dental procedures from April 1, 2020, through August 1, 2020. All patients were screened for signs and symptoms of SARS-CoV-2 infection. Asymptomatic patients scheduled for dental procedures underwent polymerase chain reaction (PCR) testing for SARS-CoV-2. Sociodemographic characteristics were abstracted, and positivity rates were calculated. Variables for patients who were SARS-CoV-2 positive and SARS-CoV-2 negative were compared using Fisher exact and Mann-Whitney U tests. ResultsThe sample size was 921. The median age was 6 years, and 50.9% were boys. The overall SARS-CoV-2 positivity rate was 2.3%. Age, insurance status, medical history, and dental diagnosis were comparable in patients who were SARS-CoV-2 positive and SARS-CoV-2 negative. Positivity rates were statistically higher for Hispanic or Latinx patients than other groups (P = .038). ConclusionsAlthough the yield of testing was low, the systematic evaluation of asymptomatic pediatric dental cases via PCR resulted in the identification of SARS-CoV-2 carriers who could have been infectious. In this study, Hispanics or Latinx had a higher positivity rate than other demographic groups. Practical ImplicationsPCR testing for SARS-CoV-2 of asymptomatic patients in pediatric dentistry adds value to the use of screening questionnaires for the identification of infected people who could be contagious.

Recent advances in dental caries diagnosis

Dental caries, a progressive bacterial damage to teeth, is one of the most common diseases that affects 95% of the population and is still a major cause of tooth loss. Recent years have seen an increase in research activity surrounding diagnostic methods, particularly in the assessment of early caries lesions. The use of technologies as adjunct to clinical visual examination for caries diagnosis will facilitate preventive care in dentistry to lower treatment cost as well as reduce the cost and time for testing potential anticaries agents. This article describes the various technologies available to aid the dental practitioners in detecting and diagnosis of dental caries at the earliest stage of its formation, assessing the activities of the detected carious lesion, and quantitatively or qualitatively monitoring of the lesion over time.

Expert System for the Diagnosis and Prognosis of Common Dental Diseases Using Bayes Network

Expert systems are being utilized increasingly in medical fields for the purposes of assisting diagnosis and treatment planning. Existing systems used few symptoms for dental diagnosis. In Dentistry, few symptoms are not enough for diagnosis. In this research, a conditional probability model (Bayes rule) was developed with increased number of symptoms associated with a disease for diagnosis. A test set of recurrent cases was then used to test the diagnostic capacity of the system. The generated diagnosis matched that of the human experts. The system was also tested for its capacity to handle uncommon dental diseases and the system portrayed useful potential.

801. Patients with Clostridioides difficile Infection Following Dental Antibiotic Prescription

BackgroundDentists prescribe few broad-spectrum antibiotics but are the primary prescriber of clindamycin in the U.S. Data is scarce on the association of dental antibiotic prescribing and Clostridioides difficile infection (CDI). Here we present results from a longitudinal cohort of patients with a CDI positive diagnostic test 30 days after receiving an antibiotic prescribed by a dentist.MethodsA cohort of patients with antibiotic prescriptions within 7 days of a dental visit were identified from 2015-2018. From this cohort, patients with positive C. difficile test 30 days after a dental antibiotic were included. Chart reviews obtained information about the dental visit, antibiotic prescribed, and CDI diagnosis. Descriptive statistics were used to describe characteristics of those with CDI following a dental antibiotic.Results212,763 Veterans received an antibiotic from a dentist between 2015-2018. Of them, 87 patients had a positive CDI test within 30 days of receiving their dental antibiotic. Over half (57.4%) of these patients had surgical dental visits and 45.9% had an oral infection coded. Dentists documented reasons for prescription was treatment of a local infection (40%) and post procedure prophylaxis (24%). Amoxicillin (54.0%) and clindamycin (40.2%) were the most commonly prescribed antibiotics. 65.7% of the patients that received clindamycin from the dentist had a documented penicillin allergy. 58.6% of patients had a preexisting gastrointestinal condition and 44.8% were taking gastric acid reducer medication. Only 19.5% of the antibiotic prescriptions met ADA guidelines for appropriate antibiotics (presence of gingival manipulation and a cardiac condition). CDI cases were treated with metronidazole (55.2%), or vancomycin (37.9%); 5.7% had no apparent treatment through the VA. The average number of days between the dental visit and CDI diagnosis was 18.9.ConclusionThe occurrence of CDI was infrequent after a dental antibiotic. However, clindamycin was prescribed more frequently in this cohort than published literature on dentist prescribing. Approximately half had a gastrointestinal risk factor for CDI. More research is needed to determine the type of patient most at risk for CDI following a dental antibiotic.Disclosures All Authors: No reported disclosures

Basilar artery dolichoectasia an unusual and rare cause of secondary trigeminal neuralgia: a clinical report

Objective: Patients with Trigeminal Neuralgia often consults a dentist for relief of their symptoms as the pain seems to be arising from teeth and allied oral structures. Basilar artery Dolichoectasia is an unusual and very rare cause of secondary Trigeminal Neuralgia as it compresses the Trigeminal nerve Root Entry Zone. Case reports: We report three cases of Trigeminal Neuralgia caused by Basilar artery Dolichoectasia compression. The corneal reflex was found absent in all three of the cases along with mild neurological deficits in one case. Multiplanar T1/T2W images through the brain disclosed an aberrant, cirsoid (S-shaped) and torturous Dolichoectasia of basilar artery offending the Trigeminal nerve Root Entry Zone. Discussion: Based on these findings we propose a protocol for general dentist for diagnosis of patients with trigeminal neuralgia and timely exclusion of secondary intracranial causes. Conclusion: General dentists and oral surgeons ought to consider this diagnosis in patients presenting with chronic facial pain especially pain mimicking neuralgia with loss of corneal reflex or other neurosensory deficit on the face along with nighttime pain episodes. Timely and accurate diagnosis and prompt referral to a concerned specialist can have an enormous impact on patient survival rate in such cases. KEYWORDS Basilar artery; Cirsoid dolichoectasia; Corneal reflex; Trigeminal neuralgia.

The involvement of chronic persistent viral infection to various diseases of the oral cavity

Relevance. According to the literature all over the world, there is a tendency to reduce immunological reactivity in humans, this is facilitated by the presence of chronic persistent herpes viral infection. Herpes infection has systemic immunosuppressive effects of the infection on the human body, and also highlighted the role of the virus in a slow occurrence of combined pathology of internal organs and infectious and inflammatory diseases of the oral tissues and periodontium. High interest of specialists to this problem сaused by the necessity of new methods of complex treatment polymorbidity human pathology. Purpose – to assess the degree of involvement of chronic cytomegalovirus persistence in a number of dental diseases.Materials and methods. In 67 patients dental surgery underwent surgery removal of benign tumors of the soft tissues of the oral cavity, periodontium and jaws, had a clinical blood analysis, blood testing for serological signs of chronic persistence of cytomegalovirus infection (antibodies to CMV Ig G (anti CMV IgG), PCR for CMV in blood and saliva, and also studied the cellular composition of blood immunogram. The age of patients averaged 46 years. Рatients were divided according to the nosological principle into 4 groups. The first group consisted of patients with periapical foci of chronic odontogenic inflammation and radicular cysts of the jaws. The second group consisted of persons with oral fibroids of different localization. The third group is patients with retention cysts of small salivary glands of the oral mucosa. The fourth group – patients with poligamy various locations. All operations are performed outside the phase of acute inflammation. The material obtained after the operation underwent histological examination.Results. Serological signs of chronic persistence of cytomegalovirus infection were revealed in all examined patients, the level of anti CMV Ig was 225 ± 25 U / ml (at the rate of 0.00-0.50 U / ml) (p 0.01). Also, all patients showed lymphocytosis of blood and this corresponded to the same type of changes in the cellular composition of the immunogram with a decrease in the quantitative parameters of B-lymphocytes (CD19+ CD3- ), true natural "killers" (NK-cells) (CD3- CD56+ CD45+ ), NK-cells cytokine-producing (CD3- CD16+ Cd56brightcd45+ ), NK-cells cytolytic (CD3- CD16+ (orhigh) sd56dimcd45+ ). The results of the histological study showed that focal mononuclear and lymphohistiocytic cell infiltration with giant cells with large nuclei are more often detected in areas of the oral mucosa in all patients with radical and retention cysts.Conclusion. The Obtained results demonstrate that in patients regardless of surgical dental diagnosis, chronic persistence of cytomegalovirus with the same type of hematological, immunological abnormalities was revealed. In areas of the oral mucosa with retention cysts of small salivary glands and with radicular cysts, focal lymphohistiocytic and mononuclear cell infiltration with giant cells with large nuclei was revealed.

Role of cone beam computed tomography in dental diagnosis and treatment planning: An update

Diagnostic treatment planning is crucial to achieve optimal success in oral rehabilitation, and this will be impossible without assistance of diagnostic imaging. For this reason, cone beam computed tomography (CBCT) was introduced and is known for its accuracy and variegated clinical importance. In current era, cone-beam tomography is aiding in the process of diagnosis by dispensing an exorbitant three dimensional image. CBCT not only be used in surgical fields, endodontics, prosthodontics, and orthodontics, for appropriate treatment planning and effective dental care, but also in forensics and radiotherapy. The clinical significance of this review is to update dental clinicians about CBCT applications in several fields of dental sciences. Keywords: Cone beam computed tomography, Pathology, Radiology, Three-dimensional, Imaging.

Should we root treat children's first permanent molars?

Study selection Medline via PubMed and Embase were searched on 6 November 2019 and all studies up to this date were included, including case reports and case series. This was noted as being due to the limited number of studies available in this research area. The outcome measured was clinical success, which was defined as the tooth being present and an assumption that it was sound and asymptomatic at the end of the study. Studies that did not include a minimum of six months' follow-up were excluded, as were editorial letters, in vitro studies and studies not reported in English.Data extraction and synthesis One reviewer searched databases for appropriate studies, then a second reviewer assisted in assessing studies by title and abstract. For each eligible article the operator, sample size, and a full dental diagnosis were recorded. Treatment method, follow-up and treatment success were also assessed.Results The systematic review included eleven studies. The GRADE approach was used to assess quality of evidence. Three studies were of high quality, six of low quality, and two of very low quality. Cochrane and Robins-I risk tools were used to assess bias. All randomised controlled trials were assessed to be of high risk of bias, due to the blinding process not being stated. Six non-randomised controlled trials were assessed to be of critical risk of bias, as the measurement of treatment outcomes was not stated. There was a high risk of bias determined overall.The review reported a 90.5% (range 70-100%) success rate over a mean follow-up period of 28.4 months (range 6-73.6 months) for coronal pulpotomies, which is in line with the results from adult studies. For partial pulpotomies the review reported a 91.3% (range 78.5-100%) success rate over a mean follow-up period of 34.4 months (range 12-140 months), which is slightly lower than reported in adult studies.Only one study on conventional pulpectomies was included in the review that reported a success rate of 36% for a small sample of patients (n = 10).No studies on apexification of molar teeth were included in the review. Therefore, further evidence is required to assess the success of this therapy.One case report showed success with regenerative endodontics for a single molar. Therefore, significant further evidence will be required to assess this approach.Conclusion The systematic review ascertained that partial and coronal pulpotomies had successful treatment outcomes for treating compromised first permanent molar teeth.

Automatic diagnosis of dental diseases using convolutional neural network and panoramic radiographic images

ABSTRACT People may experience tooth decay many times in a lifetime; however, its early diagnosis can greatly help accelerate the treatment process. Intelligent methods are now widely used in medicine, especially for diagnosis through panoramic radiographs. However, dental diseases have received little research focus due to the lack of a standard dataset. This study aimed to collect a standard dataset of panoramic radiographs of jaws and teeth. A deep neural network algorithm was then employed to classify teeth as healthy, decayed, root-canaled, and restored categories. The dataset was divided into five groups to analyse the proposed method in performance. Different evaluation criteria, confusion matrices, and precision percentages were determined for each group. On average, the final precision was 92% in the five groups. Moreover, the trained network results were compared with those of AlexNet and VGGNet16. Six months were spent collecting two new datasets labelled by experts. A smart method was also proposed to determine the dental location of jaws and reach dental diagnosis. According to the final results, the proposed network proved to be highly stable and managed to establish a better dental diagnosis.

Dental Diagnosis and Treatment Assessments: Between X-rays Radiography and Optical Coherence Tomography.

A correct diagnosis in dental medicine is typically provided only after clinical and radiological evaluations. They are also required for treatment assessments. The aim of this study is to establish the boundaries from which a modern, although established, imaging technique, Optical Coherence Tomography (OCT), is more suitable than the common X-ray radiography to assess dental issues and treatments. The most common methods for daily-basis clinical imaging are utilized in this study for extracted teeth (but also for other dental samples and materials), i.e., panoramic, intraoral radiography, and three-dimensional (3D) cone beam computed tomography (CBCT). The advantages of using OCT as an imaging method in dentistry are discussed, with a focus on its superior image resolution. Drawbacks related to its limited penetration depth and Field-of-View (FOV) are pointed out. High-quality radiological investigations are performed, measurements are done, and data collected. The same teeth and samples are also imaged (mostly) with an in-house developed Swept Source (SS)-OCT system, Master-Slave enhanced. Some of the OCT investigations employed two other in-house developed OCT systems, Spectral Domain (SD) and Time Domain (TD). Dedicated toolbars from Romexis software (Planmeca, Helsinki, Finland) are used to perform measurements using both radiography and OCT. Clinical conclusions are drawn from the investigations. Upsides and downsides of the two medical imaging techniques are concluded for each type of considered diagnosis. For treatment assessments, it is concluded that OCT is more appropriate than radiography in all applications, except bone-related investigations and periodontitis that demand data from higher-penetration depths than possible with the current level of OCT technology.

Immunological aspects related to diseases incident in dental practice: Literature review

The microbiome of the human body is home to an extensive community of microorganisms that interact with the immunologically competent host, and may even favor its physiological actions. However, these microbial colonies have potential for harmfulness, including that present in the oral cavity, being able to express themselves intensely in cases of momentary or chronic misadjustment of the human defense system. The diseases with the highest incidence in the oral cavity, periodontitis and dental caries, are pathological processes with microbial involvement and have in the patient’s immune system a great combatant to its development, either as a preventive barrier or with direct actions of defensive response. Both pathological conditions were pointed out in this article, extolling the need for the dentist to observe the immunological aspects of impact on oral health. A bibliographic survey was conducted delimited by the theme- the immunological aspects that impact dental practice, through the databases of the digital platforms Google Academic and PubMed; for the realization of this literature review. Based on the scientific notes raised by this work, we suggest the perspective that; the analysis of immunological aspects associated with the proposed dental diagnoses and treatments may offer a complementation of arguments and approaches that could be much more assertive and effective in the clinical routine.

Challenges and Experiences of Dental Medicine in Combating the COVID-19 Pandemic.

The world has been suffering incredible loss due to a pandemic caused by a novel coronavirus called severe acute respiratory syndrome coronavirus 2' (SARS-CoV-2; 2019-nCoV). The disease was later named the coronavirus disease-19 (COVID-19). The transmission routes of COVID-19 include respiratory transmission, aerosol transmission, and contact transmission. Many dental diagnosis and treatment procedures generate droplets and aerosols, and thus both dental staff and patients are at a high risk of becoming infected and transmitting COVID-19 to others. Shanghai Ninth People's Hospital is a comprehensive hospital with 18 craniofacial-/dental-related departments. During the outbreak of COVID-19 and up to the present date, there have been no confirmed cases of COVID-19 in this hospital thanks to strict protocols for infection prevention and control. In this communication, we would like to share with the prosthodontic community our experience in the prevention and control of COVID-19 in our dental departments and hope it will contribute to the worldwide efforts to overcome the global COVID-19 pandemic.

Automatic tooth roots segmentation of cone beam computed tomography image sequences using U-net and RNN.

Automatic segmentation of individual tooth root is a key technology for the reconstruction of the three-dimensional dental model from Cone Beam Computed Tomography (CBCT) images, which is of great significance for the orthodontic, implant and other dental diagnosis and treatment planning. Currently, tooth root segmentation is mainly done manually because of the similar gray of the tooth root and the alveolar bone from CBCT images. This study aims to explore the automatic tooth root segmentation algorithm of CBCT axial image sequence based on deep learning. We proposed a new automatic tooth root segmentation method based on the deep learning U-net with AGs. Since CBCT sequence has a strong correlation between adjacent slices, a Recurrent neural network (RNN) was applied to extract the intra-slice and inter-slice contexts. To develop and test this new method for automatic segmentation of tooth roots using CBCT images, 24 sets of CBCT sequences containing 1160 images and 5 sets of CBCT sequences containing 361 images were used to train and test the network, respectively. Applying to the testing dataset, the segmentation accuracy measured by the intersection over union (IOU), dice similarity coefficient (DICE), average precision rate (APR), average recall rate (ARR), and average symmetrical surface distance (ASSD) are 0.914, 0.955, 95.8% , 95.3% , 0.145 mm, respectively. The study demonstrates that the new method combining attention U-net with RNN yields the promising results of automatic tooth roots segmentation, which has potential to help improve the segmentation efficiency and accuracy in future clinical practice.

DENTAL MANAGEMENT IN LIVER CIRRHOSIS

Objective: To evaluate the dental management of patients with liver cirrhosis. Study design: Integrative review, with searches accomplished through the descriptors and Boolean operators: (liver cirrhosis OR hepatic cirrhosis OR hepatic cirrhoses OR liver fibroses OR liver fibrosis) AND (oral health OR dental treatment OR dental services OR dentistry OR diagnosis, oral OR mouth diseases OR mouth rehabilitation) in the PubMed and Bireme databases. A total of 2274 articles were found in PubMed, 307 articles were found in the Bireme, and 13 of them were selected for this review. Results: There is no consensus in the literature about the risk of bleeding after dental procedures in patients with cirrhosis, and most of the studies haven’t found any relation between the laboratory examinations carried out and the risk of bleeding. A platelet level of ≥ 100,000/mm3 is recommended for surgical procedures presenting greater risk of bleeding and a platelet level of 50,000/mm3 for procedures presenting a lower risk. Patients with cirrhosis who have a platelet level of > 40,000/mm3 and an international normalized ratio (INR) < 2.5 can be considered low risk for bleeding after tooth extraction. Conclusion: Dental management of the patient with cirrhosis has a series of specific features, which must be known so as to avoid possible complications. Objective: To evaluate the dental management of patients with liver cirrhosis. Study design: Integrative review, with searches accomplished through the descriptors and Boolean operators: (liver cirrhosis OR hepatic cirrhosis OR hepatic cirrhoses OR liver fibroses OR liver fibrosis) AND (oral health OR dental treatment OR dental services OR dentistry OR diagnosis, oral OR mouth diseases OR mouth rehabilitation) in the PubMed and Bireme databases. A total of 2274 articles were found in PubMed, 307 articles were found in the Bireme, and 13 of them were selected for this review. Results: There is no consensus in the literature about the risk of bleeding after dental procedures in patients with cirrhosis, and most of the studies haven’t found any relation between the laboratory examinations carried out and the risk of bleeding. A platelet level of ≥ 100,000/mm3 is recommended for surgical procedures presenting greater risk of bleeding and a platelet level of 50,000/mm3 for procedures presenting a lower risk. Patients with cirrhosis who have a platelet level of > 40,000/mm3 and an international normalized ratio (INR) < 2.5 can be considered low risk for bleeding after tooth extraction. Conclusion: Dental management of the patient with cirrhosis has a series of specific features, which must be known so as to avoid possible complications.

Evaluation of Virtual Reality Simulation of Dental Caries through Student Questionnaire

The purpose of this study was to evaluate the applicability of virtual reality simulation after experience of dental caries diagnosis for dental students before exposing to clinical pediatric practice.A pediatric patient model of a five-year-old child with primary dentition was developed and a caries model that is amenable to VR(virtual reality) diagnosis was organized and set-up. The dental student’s were allowed to use the simulated model for fifteen minutes and their experiences were evaluated using a self-reported questionnaire to evaluate presence and usability of this application.Overall, virtual presence and appearance area of the simulation were highly scored. The result indicates that the VR model has no significant difference from the actual clinical caries regardless of grade of students, gender and VR experience. If the prototype is continuously advanced, its applicability in dental education will increase.