Dental Therapy Research Articles

Stem cell therapy in dentistry: the future for oral tissue regeneration

Stem cell therapy in dentistry: the future for oral tissue regeneration

Enhanced antimicrobial efficacy of chlorhexidine-encapsulated halloysite nanotubes incorporated in presurgical orthopedic appliances: an in vitro, controlled study.

Presurgical infant's orthopedic appliances (PSIOs) play an increasingly crucial role in the interdisciplinary management of neonatal CLP, aiming to improve and maintain adequate nasolabial aesthetics, followed by primary lip/nasal surgery in both unilateral and bilateral CLP cases. The use of PSIOs in cleft lip and palate patients can lead to contamination with oral microflora, acting as a potential reservoir for infectious microorganisms. Acrylic surfaces might provide retention niches for microorganisms to adhere, and inhabit, which is difficult to control in immunocompromised patients, thus predisposing them to increased infection risks. The objective of this multi-assay in vitro study was to investigate the effects of incorporating chlorhexidine-loaded halloysite nanotubes (CHX-HNTs) fillers on the morphological, cytotoxic, release, and antimicrobial characteristics of self-cured acrylic polymethyl methacrylate (PMMA) material used in pre-surgical orthopedic appliances. Disk-shaped PMMA specimens were prepared with varying proportions of CHX-HNTs. A control group without any addition served as a reference, and four experimental samples contained a range of different concentrations of CHX-HNTs (1.0, 1.5, 3, and 4.5 wt%). The antimicrobial efficacy was assessed using an agar diffusion test against common reference microorganisms: Candida albicans, Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus agalactiae. Cytotoxicity was examined using the L929 cell line (mouse fibroblasts) through a (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide, MTT) cell viability assay. The release kinetics of CHX were monitored using UV-spectral measurements. The statistical analysis used a one-way ANOVA followed by Tukey's post hoc test. The integration of CHX-HNTs in PMMA exhibited a substantial dose-dependent antifungal and antibacterial effect against microorganisms at tested mass fractions (1.0 to 4.5 wt%). CHX release was sustained for up to 60 days, supporting prolonged antimicrobial activity. Furthermore, no significant cytotoxicity was determined in the L929 fibroblast cell line (control), indicating the biocompatibility of the CHX-HNTs-enhanced PMMA. Incorporating CHX-HNTs in PMMA successfully enhanced its antimicrobial properties, providing sustained CHX release and superior antimicrobial efficacy. These findings demonstrate the potential of antimicrobial nanoparticles in dental therapies to improve therapeutic outcomes. However, rigorous further clinical trials and observational studies are warranted to validate the practical application, safety, and efficacy. This study has the potential to make a major impact on the health of infants born with cleft lip and palate by helping to reduce the prevalence of infectious illnesses. The incorporation of CHX-HNTs into PMMA-based appliances is a novel promising preventive approach to reduce microbial infections.

Knowledge, Attitude and Barriers to Dental Treatment of Mothers Regarding Early Childhood Caries: A Cross-sectional Survey from Taif Province, Saudi Arabia

Introduction: “Early Childhood Caries (ECC), also called ‘baby bottle tooth decay’ or ‘early childhood tooth decay,’ significantly affects infants and children aged six or younger, causing cavities and with lasting impacts on oral health and overall well-being. Its global prevalence concerns healthcare professionals and policymakers due to its multifactorial nature, influenced by diet, oral hygiene, socio-economic factors, and maternal awareness. Mothers, as primary caregivers during early childhood, play a crucial role in ECC prevention and early intervention. Aim: This study examines mothers’ knowledge and attitude regarding ECC and risk factors associated with children’s dental health, to determine difficulties in dental therapy in Taif, Saudi Arabia. Materials and Methods: Using a cross-sectional survey design in the province of Taif, Saudi Arabia, a random sample of 288 mothers of healthy children aged three to seven years were surveyed. A structured questionnaire containing 26 close ended questions was used to gather information regarding the socio-demographic characteristics, knowledge and attitude of the mothers regarding ECC, as well as barriers to dental care. The questionnaire was originally drafted in English and then translated into Arabic by a professional translator. Using Statistical Package for Social Sciences (SPSS) software, an analysis and a representation of data was performed. Results: More than half of the mothers 57.63% (n=166) understood the relation between poor dental health and hygiene and a child’s ability to learn, and 20.13% (n=58) didn’t know if poor dental health can impair a child’s ability to learn (p=0.02). The notion that a visit to the dentist should begin within six months of the appearance of milk teeth was agreed with by 55.55% (n=160) of the mothers, while 28.81% (n=83) of them didn’t know the proper time for a child’s first visit to the dentist (p=0.03). Only 22.22% of the mothers didn’t know what the nearest dental center to them was. Conclusion: The present study revealed that mothers did have awareness of different aspects of oral health and dental caries, several mothers exhibited unfavorable attitudes toward oral health practices, which could set a negative example for their children.

Harnessing 3D printed highly porous Ti-6Al-4V scaffolds coated with graphene oxide to promote osteogenesis.

Bone tissue engineering (BTE) strategies have been developed to address challenges in orthopedic and dental therapy by expediting osseointegration and new bone formation. In this study, we developed irregular porous Ti-6Al-4V scaffolds coated with reduced graphene oxide (rGO), specifically rGO-pTi, and investigated their ability to stimulate osseointegration in vivo. The rGO-pTi scaffolds exhibited unique irregular micropores and high hydrophilicity, facilitating protein adsorption and cell growth. In vitro assays revealed that the rGO-pTi scaffolds increased alkaline phosphatase (ALP) activity, mineralization nodule formation, and osteogenic gene upregulation in MC3T3-E1 preosteoblasts. Moreover, in vivo transplantation of rGO-pTi scaffolds in rabbit calvarial bone defects showed improved bone matrix formation and osseointegration without hemorrhage. These findings highlight the potential of combining rGO with irregular micropores as a promising BTE scaffold for bone regeneration.

Is there an association between head and neck cancer diagnosis and self-reported dental fear? A dual-center cross-sectional study.

Mental distress is highly reported in cancer patients, resulting in anxiety and depression most of the time. Both conditions, in turn, are recognized to be related to dental fear in adults; however, there are no studies on patients suffering from head and neck cancer. Thus, the present study aimed to investigate whether newly diagnosed patients with head and neck cancer are more prone to self-reported dental fear. This dual-center cross-sectional study was conducted with 25 healthy outpatients and 25 patients with a recent diagnosis of head and neck cancer, all requiring dental care. The patients were informed at the first appointment about their dental therapy planning and the Brazilian Portuguese Version of the Dental Fear Survey (DFS) questionnaire was then applied after appropriate instructions. The DFS total scores did not differ statistically between the groups (Mann-Whitney U test, P = 0,120) but the Cancer Group presented a slightly higher mean score (32.2 ± 10.0) than the Control Group (30.0 ± 14.2). Within the limitations of this study, newly diagnosed patients with head and neck cancer and healthy individuals seem to experience similar self-reported dental fear.

Microscopic study of cultural and diffusion kinetics of the effects of a prototype extracellular matrix on the photodynamic therapy of periopathogenic bacteria - a pilot study.

In dental medicine, photodynamic therapy is a promising treatment for bacterial infections. Oral biofilms, on the other hand, can produce an extracellular matrix that provides protection and stability against external forces.

Stem Cells in Dentistry: Knowledge among the Dental Practitioners of Nepal

Introduction: Dentists are expected to play a major role in advancing the field of stem cell research as well as directing and implementing future stem cell therapies in dentistry. Accordingly, good basic knowledge and a positive attitude toward stem cells and their potential applications are essential among the dentists. Objective: This study aimed to assess the prevalence of knowledge on stem cell among the dental practitioners. Methods: A descriptive cross-sectional study was conducted among the registered dental practitioners in Nepal. An online questionnaire was created with the help of Google forms between 27 October, 2021 to 22 July, 2022 after receiving ethical approval from the Institutional Review Committee of a tertiary care center. The questionnaire was designed after reviewing pertinent literatures. Convenience sampling method was used. Data from Google forms were entered in Microsoft Excel version 2016 and were analysed with IBM SPSS v.20. Results: Among the total of 280 responses received, the prevalence of good knowledge about stem cells was found to be 53 (18.93%) (14.34- 23.52, 95% Confidence Interval). Majority of the respondents with good knowledge score were female 41 (77.36%). Almost all of the respondents knew about the term stem cells and its sources. But very few 68 (24.29%) of them knew about the availability of stem cell banks in Nepal. Conclusions: The prevalence of good knowledge about stem cell in dentistry was found to be less than half the sample size. Hence, there is a need to cover stem cells related information in dental curricula in Nepal.

Occlusal dysesthesia and its impact on daily practice

In 1976, Marbach first described in the literature a clinical entity that he called “the phantom bite,” now known as “occlusal dysesthesia” (OD). Most patients suffering from OD are going through an unusually stressful period in their lives and have undergone dental therapy at the same time, resulting in a mental fixation on their teeth. They perceive clinically unremarkable occlusal contacts as bothersome or uncomfortable and TMD is a common comorbidity. Although there is no apparent relationship between the clinical findings and the nature and severity of the reported occlusal complaints, patients search for their “ideal” occlusion or to regain their “lost bite.” As a result, they suffer from persistent and severe emotional distress. The co-occurrence of depression, anxiety and/or personality disorders is common. The primary therapeutic goal is to improve oral health-related quality of life. Occlusal adjustments are contraindicated. Instead, professional counseling and education as information therapy, psychological therapy, oral splints as a form of occlusal therapy with the goal of defocusing effects and medication are recommended forms of therapy. Unfortunately, the acceptance of the diagnosis of OD and the therapeutic recommendations is usually low among these patients and a large proportion reject therapeutic efforts out of conviction and continue their journey in search of “healing” invasive therapy.

The effectiveness of using mesodiencephalic modulation in combination with ozone therapy in patients with peri-implantitis according to long-term results of the study

BACKGROUND: Evaluation of the clinical effectiveness of the use of various treatment regimens for peri-implantitis should take into account not only the immediate results achieved during treatment, but also the manifestations of the disease in the long-term period. AIM: Assessment of the effectiveness of the integrated use of mesodiencephalic modulation (MDM therapy) and ozone therapy in patients with dental peri-implantitis based on long-term results of the study. MATERIALS AND METHODS: The study was carried out with the participation of 116 patients with peri-implantitis of classes I and II according to S.A. Jovanovic. Using the fixed randomization method, all patients were divided into 4 groups based on the results of generating random numbers obtained using a computer program. Patients of the first group (control group, n=28) received standard dental therapy, including professional oral hygiene and local use of antiseptics. Patients of the second group (comparison group 1; n=29) received a course of ozone therapy in addition to standard dental therapy, for which the periimplant area was irrigated with ozonated saline solution with an ozone concentration of 2.5–5.5 μg/ml for 15 minutes. Patients of the third group (comparison group 2; n=30) received a course of MDM therapy in addition to standard dental therapy. In the fourth group (main group; n=29), patients, along with standard dental therapy, received a course of complex physiotherapy in the form of a combination of ozone and MDM therapy. Long-term results of complex therapy for peri-implantitis were assessed 6 and 12 months after the end of treatment. RESULTS: A comparative assessment of dental indices in the long-term period showed that the addition of SST with a course of physiotherapeutic effects, in general, is accompanied by the preservation of the effect achieved after the end of treatment. At the same time, the best results were noted in the main group with the combined use of ozone and MDM therapy. Changes in the osseointegration index also indicated the preservation of the values achieved after the end of therapy, and in the main group a significant increase in this parameter was observed, which indicated additional activation of osseointegration processes under the influence of the physiotherapeutic complex. CONCLUSION: The results of the performed follow-up study convincingly prove the advantages of the additional use of therapeutic physical factors (MDM therapy, ozone therapy and their combination).

Analysis of some factors reducing the efficiency and effectiveness of dental accompanying therapy in cancer patients

Introduction. One of the areas of maintenance therapy in oncology is dental support for patients, the effectiveness of which is currently low. The prevalence of complications of anticancer treatment reaches 100 % of cases. This negatively affects the prognosis of the treatment of an oncological patient and the quality of his life.Aim. To analyze the factors that reduce the effectiveness and efficiency of accompanying dental therapy.Materials and methods. Retrospective analysis of clinical observations of the Department of General and Clinical Dentistry named after V.S. Dmitrieva was carried out on the basis of the Russian Scientific Center of Roentgenoradiology.Results. Factors decreasing the quality and effectiveness of accompanying dental therapy are dental unpreparedness of patients prescribed antitumor treatment, very low level of personal hygiene of the oral cavity, as well as insufficient number of available highly effective techniques for treatment and prevention of radiation injuries.Absence of professionals having skills in dental care for oncological patients at all stages of routing (from diagnosis to rehabilitation after completion of antitumor treatment) is another factor contributing to low effectiveness of accompanying therapy and, in our opinion, the most significant. The current clinical guidelines governing the process of examination and treatment of patients with malignant tumors do not contain detailed instructions for dentists about the techniques, approaches of dental accompaniment, and the necessary medications.Conclusion. Factors that reduce the effectiveness and efficiency of dental accompanying therapy have been identified: the lack of trained dental personnel with the skills to provide care to cancer patients; underestimation of the role of a dentist in solving general clinical problems; lack of a systematic approach to providing accompanying therapy to cancer patients; lack of continuity between the polyclinic link and the stationary.

The influence of therapeutic physical factors on the dynamics of the clinical condition and quality of life of patients with peri-implantitis

BACKGROUND: The use of dental implants, being the gold standard in the dental rehabilitation of edentulous patients, is often accompanied by the development of inflammatory complications leading to loss of the implant. Common methods in dental practice for the prevention and treatment of peri-implantitis based on local antiseptic and antibacterial drugs and periodic measures of professional oral hygiene are limited and do not contribute to solving the existing problem.
 AIM: Assessment of the clinical effectiveness and dynamics of the quality of life of patients with peri-implantitis during complex therapy using mesodiencephalic modulation, ozone therapy and their combination.
 MATERIALS AND METHODS: the study was carried out with the participation of 116 patients with peri-implantitis of classes I and II according to S.A. Jovanovic. All patients were divided into 4 groups using simple fixed randomization. The first group (control; n=28) received standard dental therapy, including professional oral hygiene and local use of antiseptics. In the second group (comparison group 1; n=29), in addition to standard therapy, a course of ozone therapy was performed, for which the peri-implant area was irrigated with ozonated saline solution with an ozone concentration of 2.5–5.5 μg/ml for 15 minutes. In the third group (comparison group 2; n=30), standard treatment was supplemented with a course of MDM therapy. Patients of the fourth group (main group; n=29), along with standard treatment, received complex treatment, including a course of ozone therapy and MDM therapy. The results were assessed after the end of therapy based on the dynamics of dental indices, the osseointegration parameter of the implant and the level of quality of life of the patients.
 RESULTS: A course of use of various treatment regimens was accompanied by a significant improvement in the clinical and dental status of patients, but the severity of the effect was different in the groups. To a lesser extent, positive changes were identified in the control group. Additional course use of therapeutic physical factors (ozone and MDM therapy) was accompanied by a significant increase in regression of complaints and improvement in objective indicators of dental status. Achieving the maximum positive result was clearly evident in the main group with the complex use of the studied physiotherapeutic factors. The use of the correlation adaptometry method to assess the clinical effectiveness of various treatment regimens for peri-implantitis made it possible to establish that under the influence of the integrated use of ozone and MDM therapy, the most pronounced decrease in mutual correlations between the studied parameters is observed. This indicates an increase in functional reserves and adaptive capabilities of patients in the main group.
 CONCLUSION: the results obtained convincingly prove the high effectiveness of the complex use of therapeutic physical factors in the implementation of a therapeutic strategy aimed at eliminating inflammatory manifestations in the area of dental implants and improving the quality of life of patients.

Bioengineering: An Alternative Technological Innovation for the Use of Dental Laser

The word "laser" is an acronym for Light Amplification by Stimulated Emission of Radiation. These words define the unique qualities of lasers, whose application in the dental field focuses on dental therapy, aesthetic dentistry, prosthetics, and oral and periodontal surgery. Through this literature review, the application of lasers in dental clinical practice and its relevant parameters will be evaluated from a bioengineering perspective. Bioengineering can serve as a transdisciplinary bridge between engineering and dentistry, which is refined in the use of lasers to enhance the oral health of patients.

The Efficacy of Apple Cider Vinegar at Different pH Values as an Antimicrobial Agent: An In Vitro Study.

This study evaluates the antimicrobial activities of commercially available 5% apple cider vinegar (ACV) against Enterococcus faecalis, Streptococcus mutans, and Lactobacillus casei. Materials and methods: Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were conducted using the broth microdilution method. Sodium hypochlorite (NaOCl) of 5.25% was used as a positive control, and comparisons were also made with acetic acid (AA) as the main ingredient in ACV. The three test bacteria treated with the most effective ACV dilution were visualized under a transmission electron microscope (TEM) for structural changes. Minimal inhibitory concentration was determined at 0.625% of the concentration of ACV against S. mutans and E. faecalis and 1.25% of the concentration of ACV against L. casei with two-fold serial dilutions. A concentration of 5 × 10-1% with 10-fold serial dilutions was found to be the MIC value for all three bacteria. No significant differences were found when compared with the positive control (NaOCl) (p = 0.182, p = 0.171, and p = 0.234), respectively, for two-fold serial dilutions and (p = 1.000, p = 0.658, and p = 0.110), respectively for 10-fold serial dilutions. MBC was observed to be 5% ACV for both E. faecalis and S. mutans. However, positive microbial growth was observed on the agar plate when cultured with L. casei. An independent sample t-test showed no significant differences (p > 0.05) in the antimicrobial activities between 5% ACV and 5% pure AA. TEM revealed cell wall and cytoplasmic membrane disruptions on all three bacteria at MIC value. Apple cider vinegar has antimicrobial activities against Enterococcus faecalis, Streptococcus mutans, and Lactobacillus casei at their respective MIC values. Apple cider vinegar can be an alternative antimicrobial dental pulp disinfectant to sodium hypochlorite. Apple cider vinegar can be used safely, especially in children's dental pulp therapy and deep caries management, when adequate tooth isolation is not readily achievable. Thus, adverse reactions commonly associated with other frequently used chemical disinfectants can be avoided.

Implications of Gene Therapy in Dentistry and Periodontics: A Narrative Review.

The relentless march of technological progress entails constant evolution and adaptation. A concerted effort is underway in medical researchto unravel various diseases' cellular and molecular underpinnings. The traditional approaches to disease treatmentoften fallshort of delivering entirely satisfactory outcomes, which has prompted a shifting spotlight on gene therapy as a versatile solution for many inherited and acquired disorders. Genes, intricate sequences of genetic code, are the complicated blueprints dictating the production of essential proteins within the human body. Remarkably, each individual's genetic makeup is uniquely distinct, with variations in these genetic sequences serving as the bedrock of our diversity. Gene therapy represents an innovative medical strategy that harnesses the power of genes themselves to function as therapeutic agents. It serves as a conduit through which defective genes are either substituted or mended with the introduction of remedial genetic material. This groundbreaking method can tackle various illnesses, from conditions originating from single-gene abnormalities to intricate disorders influenced by multiple genes. In dentistry and periodontics, gene therapy finds a promising array of applications. It contributes significantly to managing salivary gland disorders, autoimmune diseases, and the regeneration of damaged bone tissue, as well as addressing cancerous and precancerous conditions. Moreover, the possibilities extend into DNAvaccination and broader areas of oral health. The advent of gene therapy in dentistry represents a new era of significant progress, offering substantial advancements in the management of periodontal disease and the reconstruction of the dental alveolar apparatus. The aim of this narrative review is to providea comprehensive overview of the landscape of gene therapy investigations in these disciplines, shedding light on its potential implications for oral health and treatment. With its potential to rectify the genetic underpinnings of various conditions, gene therapy offers a novel frontier in healthcare that continually shapes the landscape of medicine and holds the promise of more effective and personalised treatments.

Therapeutic Awareness Trends of Dentistry among Public in Tamil Nadu: A web engine search based study

Brief Background - The awareness of the dental ailments and its treatment modalities was initially assessed by means of questionnaire based epidemiological surveys. However, the advancement in technology will not only be used by the public to know about the importance of various dental ailments but also their treatment. On the other hand, the technology also utilizes to find out the awareness of the same among public. Google trends is a web engine based tool, provided by google. It allows the public to identify the popularity of a particular search term. Using this particular tool, we could identify the search trend of various dental terms pertaining to disease and treatment digitally. To evaluate the awareness of dental ailments and its treatments in Tamilnadu in 2020 and to compare the same, with that of previous decade to analyze the change in awareness over time. Material and Methods - Google is the most commonly used by the general public worldwide. Hence we used Google search Engine to know the awareness of dental ailments and the treatment modalities among the general public. Five keywords were selected for each dental specialty. All the key words were run through google trends web engine. Results - On the whole significantly highest searched terminology in Tamilnadu for the year of 2020 was extraction with 67 searches. Following this dental braces were the next commonly searched term with the count of 44. The significantly searched term for the year of 2010 was removable denture with 64 searches. The next commonly searched term was impaction with 56 searches and dental floss with 55 searches. Conclusion - The current study is a novel attempt and paves a new platform to evaluate the awareness of disease, its trend and its treatment in dentistry and various other specialties. Key Words - Dental disease, Dental therapy, Google trends, Oral health awareness, Web awareness

The effect of bone remodeling with photobiomodulation in dentistry: a review study.

Photobiomodulation (PBM) has been emerging as a promising alternative therapy in dentistry. However, various parameters of PBM are used in different studies, and there is limited cumulative data on PBM for improving bone formation in clinical trials. The aim of this review was to evaluate the effectiveness of PBM in the process of bone remodeling in dentistry using randomized controlled trials. Initially, a total of 1,011 articles published from January 2008 to December 2021 were retrieved from five electronic databases (PubMed, Scopus, Cochrane Library, EMBASE, and CINAHL). After a two-step review, nine articles met the inclusion criteria. The parameter of PBM, group, treatment sessions, assessment times and outcomes of the included studies were reviewed. Eighty-nine percent of the studies revealed positive effects on bone formation between the laser group and the control group. Only one article reported that light-emitting diode did not significantly enhance osteogenesis. Additionally, the present study shows that Gallium aluminum arsenide of near infrared (NIR) laser with continuous mode is the most commonly used form of PBM. The biostimulatory effects are dependent on several parameters, with wavelength and dose being more important than others. Based on this review, it is suggested that the NIR range and an appropriate dose of PBM could be used to increase the efficiency of stimulating bone healing and remodeling. However, standardization of treatment protocols is needed to clarify therapeutic strategies in dentistry.

Photo biomodulation of dental derived stem cells to ameliorate regenerative capacity: In vitro study

BackgroundDental regeneration benefits from improving the features of dental derived stem cells. Gallium-aluminum-arsenide laser had a significant role in modification of cell behavior in different cell lines and culture conditions. Hence, exploring its mechanism and effect on dental derived stem cells would benefit prospective regenerative dental therapies. ObjectivesTo assess the impact of photo biomodulation by Low-Level-Laser on isolated Dental Pulp derived Stem Cells and Periodontal Ligament derived Stem Cells regarding their proliferation and osteogenic differentiation. MethodsIsolated DPSCs and PDLSCs from impacted third molars were subjected to Gallium-aluminum-arsenide laser for 12 sec and 3.6 J/cm2. The proliferative capacity was evaluated via 3-(4,5-dimethylthiazol-2-yl),2,5-diphenyltetrazolium bromide (MTT) Assay and Trypan blue stain. Cell osteogenic differentiation potentials were assessed by alkaline phosphatase assay and alizarin red stain, polymerase chain reaction was performed to quantify Nuclear factor Kappa gene expression. ResultsDPSCs subjected to laser bio-stimulation showed the best results regarding cell viability (MTT) and osteogenic differentiation (ALP assay), and calcium deposition at 3 intervals (3, 7, 14 days), meanwhile, PDLSCs subjected to laser bio-stimulation showed better result than control but less than DPSCs. While NF-KB gene expression was proven to be approximately comparable for both groups. Generally, the Photo-bio modulated groups showed better results than their control groups. ConclusionLow-level laser bio-stimulation (LLL) therapy improves DPSC and PDLSC osteogenic differentiation and proliferation via the activation of the NF-KB pathway. Also, the DPSCs outperformed PDLSCs in terms of performance. Clinical significanceThese results can be beneficial information and a reference database for more research in tissue engineering, dental therapy, and regeneration.

The oral health impact of dental hygiene and dental therapy populations: a systematic review

Oral health-related quality of life (OHRQoL) is pivotal in patient care, reflecting oral health through dental patient-reported outcomes (dPROs). This systematic review aims to outline the 4-dimensional (4-D) impact of OHRQoL within patient populations routinely treated by dental hygiene and/or dental therapy providers, as there is limited literature present for these oral health care professionals. The study extracted and analyzed characteristics and multidimensional impact of OHRQoL, using the Oral Health Impact Profile (OHIP) as the primary dental patient-reported outcome measure (dPROM). The search strategy spanned 7 databases: Medline via the Ovid interface (Ovid MEDLINE(R) ALL), Embase via Ovid, Cinahl, APA PsycINFO via Ovid, Dentistry and Oral Sciences Search, Scopus, and Web of Science (Core Collection). It commenced September 2, 2022, with a refinement search on July 5, 2023. English language criteria yielded 645 articles postduplication removal. A screening procedure involving 3 reviewers encompassed title, abstract, and full-text review. After application of inclusion and exclusion criteria, 5 articles were subjected to data extraction, capturing domain-specific information including baseline and follow-up OHRQoL data. An additional set of 13 articles containing summarized OHRQoL data underwent separate analysis. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized for risk bias assessment of the included articles. The 4-D impact scores reported for baseline OHRQoL data, ranged from 3.10 to 4.20 for Oral Function, 0.84-2.70 for Orofacial Pain, 1.70-4.50 for Orofacial Appearance, and 0.44-2.50 for Psychosocial Impact. In follow-up OHRQoL data, the range for Oral Function was 1.52-3.60, Orofacial Pain 0.60-2.10, Orofacial Appearance 0.91-2.25, and Psychosocial Impact 0.10-0.60. This review highlights a critical call for standardization in OHRQoL data collection for dental hygiene and dental therapy patient populations as only 26% of the predetermined distinct populations were found to have studies completed with 4-D impact of OHRQoL. Moreover, the presence of limited research in describing the multi-dimensional impact in patients routinely treated by these providers shows the urgency of substantive research in this area.

Exploring reasons why South African dental therapists are leaving their profession: A theory-informed qualitative study.

Dental therapy is a category of mid-level oral health professional that was introduced to address inequities in oral health service provision in South Africa within a constrained human resource for health context. However, low numbers of registered dental therapists and attrition threaten this strategy. This study explored reasons for this attrition, building on the Hertzberg Two-Factor Theory. Through a qualitative exploratory study design, in-depth interviews were conducted with former dental therapists to explore their reasons for leaving the profession. They were recruited using snowball sampling. All interviews were audio recorded, transcribed verbatim, and coded in NVIVO12. A team of researchers applied thematic analysis to agree on themes and sub-themes, guided by Hertzberg's ideas of intrinsic and extrinsic factors. All 14 former dental therapists interviewed expressed their passion for the profession, even though their motivations to join the profession varied. Many of their reasons for leaving aligned with extrinsic and intrinsic factors defined in Hertzberg's Two-Factor Theory. However, they also spoke about a desire for a professional identity that was recognized and respected within the oral health profession, health system, and communities. This is a novel study contribution. Dental therapist attrition in South Africa is mainly caused by job dissatisfaction and motivation issues resulting from health system level factors. While the Hertzberg Two-Factor Theory helped identify extrinsic and intrinsic factors at an individual level, we used the Human Resources for Health System Development Analytical Framework to identify solutions for dental therapist production, deployment, and retention. Addressing these issues will enhance retention and accessibility to oral health services in the country.

Clinical diagnostic approach in the treatment of chronic periodontitis in mandibular molars: Clinical cases

Background. Inflammatory process in periapical tissues causes tooth extraction in more than 50% of cases. The development of chronic apical periodontitis can be triggered by an intracanal infection in undetected/missed root canal of the mandibular molars. The morphology of mandibular molars is distinguished by additional canals in the mesial root in some cases. Different studies reveal the middle mesial canal in 4.5% to 26% of cases with quite high incidence in youth. The dental therapy has been searching for effective approaches to diagnosis and treatment of chronic periodontitis, enabling the focus of chronic inflammation to be eliminated and the tooth to be saved. Case descriptions. The paper presents clinical cases of patients with destructive changes in bone tissues in the periapical region of the mesial root in mandibular molars. The developing of this pathology is associated with missed anatomy in the mesial root during primary endodontic treatment. The patients underwent clinical examination consisting of basic methods (interview, examination) and additional techniques (intraoral radiography). An additional middle mesial canal in the root of the mandibular molar was identified taking into account the complex morphology of the root system of the tooth and verified by its careful analysis and radiography. The final clinical diagnosis, chronic apical periodontitis (K04.5), was made following the obtained diagnostic results and the ICD-10 classification. Diagnostic examination and endodontic retreatment were performed using a dental operating microscope. Conclusion. An operating dental microscope provides visualization of microscopic anatomotopographical details, promoting the efficiency of diagnosis and treatment of chronic apical periodontitis in mandibular molars. Using dental microscope facilitates systematization of the data obtained during the examination, making a final clinical diagnosis, and development of a reasonable personalized treatment plan focused on detecting an additional middle canal in the mesio-buccal canal of the mandibular molar. Due to the suggested approach, the long-term outcomes of endodontic treatment can be an objective assessed in dynamics, thereby improving the quality of treatment for chronic apical periodontitis in patients.