Dental Treatment Research Articles

Non-pharmacological interventions for reducing dental anxiety in pediatric dentistry: a network meta-analysis

BackgroundChild dental anxiety is a prevalent issue in the field of pediatric dentistry. At present, several non-pharmacological interventions are employed to mitigate anxiety during dental treatments for children. The objective of this study is to assess the effectiveness of diverse non-pharmacological interventions in reducing dental anxiety, as well as enhancing heart rate during pediatric dental treatments. To achieve this, we conducted a systematic review and a network meta-analysis (NMA) to compare the efficacy of various outcome indicators.MethodsA thorough search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, Scopus, APA PsycInfo, CINAHL, and AMED to identify all eligible randomized controlled trials (RCTs) from the beginning of the databases up to August 1, 2024. The quality assessment was carried out using the Cochrane Collaboration’s bias risk tool. The two outcome measures under consideration were dental anxiety and heart rate. Network graphs, league tables and SUCRA were constructed using R 4.2.3 software and Stata 16 software. This study is registered in PROSPERO under the registration number CRD42023467610.ResultsThe study examined 12 different non-pharmacological approaches, drawing from a pool of 61 research studies involving 6,113 participants aged 4 to 16 years. The results of the network meta-analysis revealed that music (SUCRAs: 93.60%) proved to be the most effective measure in mitigating dental anxiety, followed by aromatherapy (SUCRAs: 78.58%) and game (SUCRAs: 70.99%). Moreover, hypnosis (SUCRAs: 98.80%), music (SUCRAs: 79.58%), and relaxation (SUCRAs: 72.41%) were identified as the top three interventions for decreasing heart rate.ConclusionIn this NMA, when contemplating dental anxiety outcomes, music is recommended as a priority. For heart rate outcomes, hypnosis may be a preferred measure. However, owing to the limited number of articles, the conclusion of this study still requires additional confirmation or correction through more high-quality primary studies in the future.

The Relationship between Pediatric Patients' Anxiety Levels During Dental and Oral Care and Treatment Success at RSGM-P Nala Husada

The Relationship between Pediatric Patients' Anxiety Levels During Dental and Oral Care and Treatment Success at RSGM-P Nala Husada

Recent Developments in the Non-Pharmacological Management of Children's Behavior Based on Distraction Techniques: A Concise Review.

Oral diseases and conditions affect children's oral health and negatively influence their overall health. Early detection and intervention are important in mitigating these negative consequences. However, dental fear and anxiety (DFA) regarding dental procedures often hinder children from seeking necessary dental care. Non-pharmacological behavior management strategies, such as distraction techniques, are commonly adopted to manage children's behaviors. Distraction techniques have been developed rapidly in recent years and are widely accepted by both health professionals and parents due to their noninvasive and low-cost nature. This concise review aims to summarize current distraction techniques applied during dental treatments, especially for children. The most commonly reported techniques for children are audio distraction, audio-visual distraction, tactile distraction, olfactory distraction, and gustatory distraction. Audio distraction techniques involving music and storytelling help children relax. Audio-visual distraction techniques help to divert children's attention from the dental treatment. Tactile stimuli can reduce the transmission of pain signals. Olfactory stimuli can help children feel comfortable and relaxed. Gustatory distraction involving sweet substances can create a positive environment. These distraction techniques effectively reduce DFA in children and improve their satisfaction with dental procedures. As technology continues to develop, further research is needed to provide more robust, evidence-based guidance for dentists using distraction techniques.

Patients’ reasons for consulting a general practitioner at the time of having dental problems: a qualitative study

IntroductionMany patients consult general practitioners instead of dentists for their oral and dental problems every year. This study aims to find the reasons why patients consult general practitioners when they have dental problems.MethodsThe sample consisted of patients visiting dentists and general practitioners in Kerman, Iran. A thematic interview guide, semi-structured questions, and a mind map that allowed for structured and open-ended questions were prepared and used for the interviews. All interviews were recorded and transcribed verbatim by a final-year student. Data collection, transcription, and analysis were conducted simultaneously to allow for new topics to be raised and theoretical saturation to be reached. When researchers determined that sufficient information was available for analysis and understanding of patient opinions and beliefs, the interview process was stopped. As all audio conversations were recorded with the participant’s permission, no note-taking was done during the interviews, which allowed for greater focus on the participants’ conversation. The obtained data was analyzed using the content analysis.ResultsA total of 52 patients were included in this study. The codes related to patients participating in this research, along with the number of respondent groups related to each code were as follows: patient’s perceptions of general practitioner(GP) and dental practitioner’s scope of work [21], flawed dental system (34), dental anxiety [28], financial considerations [25], and more accessibility to GPs (31). Dental abscesses and dental pain were reported as the most common reasons for consulting GPs.ConclusionMost participants agreed that dental problems are more effectively treated by dentists. Reasons for visiting a general practitioner included lack of a specific dentist, dissatisfaction with dental treatments, lack of a dentist nearby, absence of emergency dental care, and familiarity with a physician. The most common reasons for visits were toothache and dental abscesses. Patients also sought treatment for TMJ pain, referred nerve pain, wisdom tooth pain, numbness and tingling in the jaw, gum inflammation, oral lesions, and ulcers. Furthermore, other factors such as opening hours, appointment systems and waiting time can also affect patient’s consult behaviors regarding dental problems.

Biocompatibility and Enamel Remineralization Potential of Titanium-Doped Phosphate Glasses With/Without Diode Laser Irradiation

This study investigates the biocompatibility and enamel remineralization potential of titanium-doped phosphate glasses (TDPG), third-generation materials with promising applications in dentistry. The biocompatibility of TDPG paste and its components (TDPG powder and polyacrylic acid liquid) was assessed using human gingival fibroblast cells (hGF) and human dental pulp stem cells (hDPSC). Cell attachment and viability were examined at 1, 3, and 7 days, comparing results with Nupro® Prophy paste and Teethmate, commonly used desensitizers, and positive control cells in normal tissue culture medium. Furthermore, the remineralization potential of these glasses with or without the use of diode laser irradiation on white spot lesions in enamel was explored at 12- and 21-days using Raman Spectroscopy and Field Emission Scanning Electron Microscopy (FESEM). The remineralization potential of TDPG was compared with Nupro® Prophy paste and Teethmate. Furthermore, both sound and demineralized enamel were also used as other controls.Results indicated that cells exposed to TDPG extracts displayed similar morphology and viability to positive control cells. While all tested pastes did not show remineralizing action after 12 days, Nupro® Prophy and Teethmate exhibited such action after 21 days. However, laser application enhanced remineralization potential for all pastes at both time points, with TDPG showing comparable results to Nupro® Prophy paste and significantly higher potential than Teethmate when used with laser at 21 days.In summary, this study reveals the biocompatibility and enhanced remineralization potential of TDPG when combined with diode laser irradiation. These findings signify innovative strides in dental materials and treatment modalities, offering new possibilities for advanced dental applications.

The association of systemic condition and medications on alveolar bone loss and tooth attrition.

Periodontal disease is caused by subgingival bacteria that adversely affect the host immune system and create and maintain unmitigated inflammation in gingival and periodontal tissues. The condition is also linked to systemic conditions including cardiovascular disease, diabetes, and arthritis. Periodontitis elevates the bacterial load and spreads systemic inflammation through infection and inflammation. The main radiographic sign of periodontitis is marginal bone loss. Risk factors, including medications, smoking, age, and sex, are known to influence periodontal health. However, there is little information about the impact of systemic conditions and medications on tooth wear. The aim of the present study was to assess the association between systemic conditions and medications and radiographic signs of tooth wear and marginal bone loss. This retrospective analysis was conducted on a group of 2,223 consecutive patients who came for dental treatment in the clinics of a large Health Maintenance Organization in Israel. Data available for the study included details of concomitant systemic diseases and medication and full-mouth radiographic surveys. Odds ratio and logistic regression analysis were used to detect associations between systemic conditions and medication, and marginal bone loss and tooth wear. The results indicated an elevated odds ratio for tooth wear associated with age, sex, and smoking across all age groups. Among young patients, those using proton pump inhibitors and psychiatric medications had an elevated risk of tooth wear. Age, smoking, and diabetes conditions were associated with an increased odds ratio for marginal bone loss in all age groups. Psychiatric medications and sex elevated the odds ratio for marginal bone loss only among older patients. The results highlight the significant impact of age, sex, and smoking on tooth wear, and extend these risks to alveolar bone loss when combined with diabetes and psychiatric conditions.

Clinical Issues - October 2024.

Oral health and postoperative infective complications Key words: surgical site infection (SSI), dental treatment, periodontal disease, postoperative complications, biofilm. Preoperative dental treatment Key words: periodontal treatment, perioperative oral management, perioperative oral procedures, postoperative complications, focalized approach. Facial hair length Key words: beard cover, facial hair, bacterial shedding, clean shaven, mask. Using multidose medication vials in the OR Key words: multidose medication vial, patient treatment area, labeling, sterile access device, point of use.

Magnetic Resonance Imaging of Temporomandibular Joint and Aortic Root Score in Fibrillinopathies.

Background and Objectives: Fibrillinopathies have different phenotypic expression: Marfan-like skeleton features, MLSF; mitral valve prolapse syndrome, MVPS; MASS phenotype, M = mitral valve prolapse, MVP, A = aortic root dilation, S = skeletal features, and the second S = (cutaneous) striae; Marfan Syndrome, MS. The study had the following main objectives: the correlation between disc displacement, DD (a major sign for temporomandibular joint dysfunction, TMDs) on magnetic resonance imaging, MRI, and aortic Z score (a major sign for aortic root dilation) on echocardiography; the predictive value of DD towards aortic Z score. DD had 2 types of severity: DD with reduction (the mild type, DDwR), and DD without reduction (the severe type, DDwoR). Materials and Methods: The type of fibrillinopathy was precised by clinical exam (systemic score), ophthalmic exam (for ectopia lentis), and echocardiography (aortic Z score, MVP). Medical treatment consisted of betablockers, BB (for patients with tachycardia), or angiotensin II receptor blockers, ARB. Surgical treatment was addressed to aortic root aneurysm, and severe mitral regurgitation, MR. DD benefited from dental conservatory treatment or surgical restoration. Results: DD-Z score had a powerful correlation in MASS (Rho = 0.787, p < 0.01), and in MS patients (Rho = 0.819, p < 0.01). For the entire sample, both DDwR-Z score and DDwoR-Z score had a moderate correlation (Rho = 0.469, and respectively 0.669). Furthermore, DD was an important predictor for Z score. DDwoR had a double power of prediction for the Z score compared with DDwR (B coefficient = 1.661 for DDwR and 3.281 for DDwoR). Conclusions: TMDs had a powerful correlation with aortic root dilation in MASS and MS patients from the sample. Likewise, TMDs was a major predictor for aortic root dilation, in the entire sample. In clinical practice, we can utilize an extracardiac finding, TMDs, obtained by a non-invasive technique, MRI, for cardiac severity stratification of fibrillinopathies.

Changes in the levels of cytokines IL-1β, IL-4, IL-8, and IL-10 in dental orthopedic fixed prosthetics

Despite significant advances in materials science, introduction of new methods and principles of prosthetic treatment into the practice of dentists, complications after prosthetics with fixed structures are encountered. The result of dental prosthetics of patients with defects of hard tissues of teeth depends not only on the chosen construction and materials from which they are made, but is closely connected with the functional activity of the immune system. Cytokines are an important factor of mucosal immunity. The cytokine system represents one of the key components of mucosal immunity. It regulates normal physiological functions, restoration of haemostasis in the interaction of physical, chemical and biological factors on the body and participates in the pathogenesis of allergic, autoimmune, and autoinflammatory processes. The aim of the study is to compare the content of IL-1â, IL-8, IL-10, and IL-4 in unstimulated saliva and gingival fluid in patients during adaptation to metal-ceramic and oxide ceramic tooth-supported constructions. In the period from 2021-2024, we examined 3 groups of patients aged 46±2 years: group 1 – comparison group, patients without dental constructions in the oral cavity (25 people); group 2 – patients treated with tooth-supported metal-ceramic (MC) crowns (25 people); and group 3 – patients treated with tooth-supported zirconium dioxide (ZrO2) crowns (25 people). On the basis of IL-1â, IL-8, IL-10, and IL-4 we concluded that the mucosal immunity of oral mucous membranes is less affected by the structures made of oxide ceramics compared to the crowns made of metal-ceramics. Similar patterns of changes in the levels of IL-1â, IL-8, and IL-4 in saliva and gingival fluid in patients who underwent dental rehabilitation were found, which allows us to use only saliva in order to eliminate the complexity and specificity of gingival fluid sampling. Also, changes in cytokine indices in saliva and gingival fluid at different stages of prosthodontics reflect the level of reaction of oral mucosal immunity, which can serve as a criterion of the quality of the performed dental treatment.

Impact of public health and patient-centered prevention strategies on periodontitis and caries as causes of tooth loss in high-income countries.

In high-income countries, the oral health of the population is influenced by public health interventions, widespread use of oral care products, dental practice measures, and the cost of dental treatment. We compiled information on changes of the prevalence of proximal and upstream determinants of periodontitis, caries, and tooth loss over the last three decades to outline their potential effects on changes of oral health during this period. Information was retrieved from repeated cross-sectional studies and from published literature. While both the prevalence of edentulism and the number of missing teeth (from the DMF-T index) decreased, the number of sound teeth as well as the total number of teeth increased. The prevalence of severe periodontitis was unchanged, whereas the prevalence of periodontal health and moderate periodontitis may have increased to a minor extent. Concerning oral health risk factors, the proportion of individuals with tertiary education increased, while smoking prevalence declined. More and more people used oral care products. Whether one reimbursement system worked better than another one in terms of tooth retention could not be elucidated. In tooth retention, population-wide use of fluoridated toothpastes had the greatest impact. To some extent, the higher number of teeth present may be related to the more frequent use of interdental cleaning aids and powered toothbrushes. Since there was no decrease in severe periodontitis in most cohorts, periodontal interventions probably contributed little to improved tooth retention.

Knowledge, Attitude, and Barriers toward Smoking Cessation Counseling: A Cross-Sectional Study among Clinical Dental Students in Indonesia

Abstract Objectives The World Health Organization has promoted the integration of smoking cessation programs into normal dental treatment since they have significant positive effects on oral health. However, there are stillmany barriers including a lack of knowledge about the smoking cessation counseling (SCC). The high incidence of smoking is an important health challenge in Indonesia. This study determined the relationships between sociodemographic factors and knowledge about the effects of smoking on oral health, as well as knowledge of, attitudes about, and barriers to SCC among clinical dental students in Indonesia. Materials and Methods This was a cross-sectional study utilizing a questionnaire involving clinical dental students throughout Indonesia. Clinical dental students from 32 dental schools in Indonesia were invited to participate in the study. Twenty-seven dental schools agreed to participate in the study and the estimated sample size was 416 participants. The questionnaire included sociodemographic data, smoking status, knowledge about the effects of smoking on oral health, and knowledge of, attitudes about, and barriers to SCC. Statistical Analysis Mann–Whitney U and Kruskal–Wallis tests were used to determine differences in knowledge about the effects of smoking on oral health and the knowledge of, attitudes about, and barriers to SCC among clinical dental students' sociodemographic factors and smoking status. The Spearman's correlation analysis was used to determine the correlation between knowledge of, attitudes about, and barriers to SCC. Results A total of 614 students participated in the study. Significant differences were found in students' knowledge regarding the effects of smoking based on smoking status, SCC based on educational stages, attitudes based on sex and smoking status, and barriers based on sex (p &lt; 0.05). Significant relationships were found between students' knowledge of the effects of smoking and of SCC (r = 0.226), knowledge of the effects of smoking and attitudes about SCC (r = 0.110), knowledge of and attitudes about SCC (r = 0.162), knowledge of and barriers to SCC (r = –0.17), as well as attitudes about and barriers to SCC (i = –0.224). Conclusion Clinical dental students' knowledge regarding SCC are lacking, but they have positive attitude regarding SCC. It is necessary to improve education quality in every dental educational institution related to SCC.

Nonodontogenic Causes of Toothache: A Case Series and Narrative Review

Abstract Chronic orofacial pain is a complex and frequently misdiagnosed condition that significantly impacts individuals’ well-being. Accurately diagnosing orofacial pain can be challenging due to the overlap between headaches and orofacial regions. Patients who complain of tooth pain may actually be experiencing pain unrelated to dental issues. It is crucial for clinicians to accurately pinpoint the source and location of the pain to devise effective treatment plans. Nonodontogenic facial pain can stem from various causes such as musculoskeletal, neuropathic, or neurovascular issues. In addition, toothaches can result from conditions originating from other areas like systemic disorders related to the heart, nose, throat, or sinuses. Referred pain phenomena are acknowledged in the literature but are poorly understood, presenting significant treatment challenges. This is worrisome because such patients are more prone to developing chronic pain conditions, and invasive treatments may exacerbate their suffering and overall health. In the current review paper, three cases are detailed: one of myofascial pain, the second of trigeminal neuralgia, and the third of posttraumatic trigeminal neuropathy. In all three cases, dentists were the initial point of consultation as the pain was perceived in the teeth, resulting in unnecessary dental interventions. There remains a lack of knowledge regarding nonodontogenic toothache among clinicians. Increasing awareness of nonodontogenic toothache can help avoid unnecessary interventions and improve overall pain relief for patients.

Medical Emergencies in Dental Practice

Medical emergencies in Dental Practice:Abstract "In the middle of difficulty lies opportunity."– Albert Einstein.In the realm of dental practice, the presence of medical emergencies poses both challenges and opportunities for dental professionals.We will look into specific emergencies such as syncope,seizures, asthma attacks, allergic reactions, anaphylaxis, airway obstruction,diabetes-related issues, and cardiac emergencies. Each emergency will be discussed in terms of its occurrence in dental practice, underlying causes,symptoms, and effective treatment protocols. Two more important topics:Importance of history taking,Medico legal aspect of medical emergency in dental office will be seen.

Influence of Academic Training and Professional Experience on the Management of Deep Caries Lesions.

Managing caries lesions that affect the inner third of the dentin is crucial to ensuring pulp vitality; the clinician must make decisions that will affect the vitality of the tooth. Our purpose is to understand the behavior of Spanish dentists in treating deep cavities and to examine whether variations exist based on their academic training and/or years of professional experience. This study was approved by the ethics committee of the Balearic Islands CEI-IB. A survey was conducted using the SurveyMonkey platform with 11 questions, the first 4 of which focused on defining the characteristics of the respondents. The following six concerned a clinical case of deep caries in tooth number 4.7, and the last regarded the opinion of the actual treatment of the case. The survey was sent by email in April 2022. The results were analyzed with the SPSS 29.0 program using the chi-square test. A total of 347 responses were obtained (93.95%), and those surveyed stated that they apply minimal intervention concepts in their treatments, with 90.49% performing conservative dentistry treatments daily. A total of 56.48% of the respondents had bachelor's degrees, 12.39% had graduated, 33.14% had a postgraduate degree, 38.90% had a master's degree, and 17% had a doctorate. Most (40.63%) had been in professional practice for 16-30 years. Significant differences were identified regarding years of professional experience in terms of decision-making in methods of treatment and the choice of materials used for pulp protection. Likewise, significant differences were found regarding the academic training of the respondents, the cavity cleaning method selected, and the use of chemical substances for removing carious dentin. We can conclude that academic training and years of professional practice influence decision-making at some points in treating deep caries lesions.

Antibacterial Properties of Grape Seed Extract-Enriched Cellulose Hydrogels for Potential Dental Application: In Vitro Assay, Cytocompatibility, and Biocompatibility.

Hydrogels elaborated from Dasylirion spp. and enriched with grape seed extract (GSE) were investigated for tentative use in dental treatment. Cellulose-GSE hydrogels were elaborated with varying GSE contents from 10 to 50 wt%. The mechanical and physical properties, antimicrobial effect, biocompatibility, and in vitro cytotoxicity were studied. In all the cases, the presence of GSE affects the hydrogel's mechanical properties. The elongation decreased from 12.67 mm for the hydrogel without GSE to 6.33 mm for the hydrogel with the highest GSE content. The tensile strength decrease was from 52.33 N/mm2 (for the samples without GSE) and went to 40 N/mm2 for the highest GSE content. Despite the adverse effects, hydrogels possess suitable properties for manipulation. In addition, all hydrogels exhibited excellent biocompatibility and no cytotoxicity, and the antibacterial performance was demonstrated against S. mutans, E. Faecalis, S. aureus, and P. aureginosa. Furthermore, the hydrogels with 30 wt% GSE inhibited more than 90% of the bacterial growth.

Dental anxiety and dental care - a comparison between Albania and Germany

BackgroundThe present study is the first in Albania on dental fear and dental anxiety and also in the field of psychosocial medicine. The purpose of this study was to find out whether there are differences in dental anxiety using the Dental Anxiety Scale, their level of psychological distress using the Brief Symptom Inventory-18 and the evaluation of oral health among Albanian and German patients.MethodsThis study was conducted in the period from December 2019 to July 2020, a sample of N = 263 patients (133 Germans, 130 Albanians) using the Dental Anxiety Scale questionnaires to determine anxiety before dental treatment and the Brief Symptom Inventory-18 to evaluate psychological distress. Moreover, the patients answered questions regarding their oral health and dental care. In Germany, there were four refusals to entrance in the study due to various reasons, in contrast to Albania, where there were no refusals at all For the purposes of this study, data on both populations aged 14 years and older were used.ResultsThe questionnaires results were calculated for all participants. The current subjective health status of Albanian patients was assessed to be significantly worse than that of German patients (p < 0,000). Germans were more susceptible to signs of Anxiety (p < 0,000), Depression and Somatization and scored higher on the Dental Anxiety Scale and the Global Severity Index (p < 0,000) than Albanian patients. Additionally Albanian patients scored significantly lower on the preventive care index (p < 0,000). Despite an elevated DAS anxiety level, German patients reported going to the dentist more frequently than Albanian patients.ConclusionThe results showed that between both populations differences in dental anxiety, psychological distress and oral health exists. Patients from Germany report more psychological distress and described more dental anxiety compared to Albanian patients. Albanian patients reported not utilization on oral health care.The implementation of educational programs and preventive measures, would contribute to raising awareness about the importance of oral health and increased use of dental services.

Correlation of Personality, Temperament, and Behavior of Children in the Dental Environment.

A child's temperament, influenced by inborn traits and emotional regulation, can impact their dental behavior and caries risk. Parenting styles, such as authoritative, authoritarian, permissive, or neglectful, also play a significant role. Authoritative parenting tends to yield more favorable dental outcomes, while permissive parenting can lead to a higher prevalence of caries. Studying these interactions can help tailor dental interventions and address potential risks associated with caries development. Thus, the study aims to correlate parental personality, the child's temperament to dental caries, and child's behavior in a dental setting. A cross-sectional study was conducted on 160 children in the age-group of 6-9 years. The children were selected based on the selection criteria. The children were asked to fill out the parental perception questionnaire (PPQ), and the parents were asked to fill out the emotionality, activity, sociability (EAS) questionnaire to assess the parenting style and child's temperamental status. Later, the child's behavior pattern was assessed using the Frankl behavior rating scale. The children were intraorally examined for the presence of caries using the decayed, extracted, filled teeth (deft) and decayed, missing, filled teeth (DMFT) index. All the data were tabulated and statistically analyzed. In this study, a total of 160 children were assessed, including 84 boys (52.3%) and 76 girls (47.5%), with an average age of 7.8 years. One-way analysis of variance (ANOVA) followed by Scheffe's post hoc test was performed to compare the temperamental status and parenting style with the behavior of the child in the dental office. The results were statistically significant with a p-value of 0.001. Pearson's correlation coefficient revealed a significant positive correlation between Temperament E scores and def scores in children with positive behavior (p-value = 0.004). This study's findings suggest that a child's behavior in a dental office is influenced by the parent's personality, the child's temperament, and the dentist. A child's capacity to handle dental visits and their overall oral health can be notably affected by the child's temperament and parenting style. Thamilvanan S, Srinivasan D, Benedict CH, et al. Correlation of Personality, Temperament, and Behavior of Children in the Dental Environment. Int J Clin Pediatr Dent 2024;17(8):907-912.

Treatment of Traumatic Dental Injuries in the Public Dental Services—A Qualitative Exploration of Perceived Challenges and Needs

ABSTRACTBackground/AimThis study explored perceived challenges in the management of traumatic dental injuries (TDI) among general dentists in the public dental service (PDS) of Vestland County in Western Norway and their needs for improving treatment care for TDI patients.Participants and MethodsThis qualitative study conducted three focus group discussions. We recruited a purposive sample of seven general dentists employed in the PDS in Vestland County in Western Norway. The three focus groups consisted of two, two, and three participants, respectively. The focus group discussion took place via the Microsoft electronic platform Teams, and it was visual, and audio recorded. Transcripts of the interviews were analyzed using systematic text condensation.ResultsThe general dentists in this study experienced the management of TDI as a set of complex procedures that require good theoretical knowledge, clinical experience, skills, and teamwork. We were able to group these challenges into three results categories: (1) proficiency challenges, (2) the challenge of stress and discomfort during dental procedures, and (3) the challenge of the organization of the PDS. The participants also expressed the need for practical courses, calibration, and refresher courses in dental traumatology. Their needs fell into two categories: (1) regular, clinically relevant continuing professional development and (2) collective efforts in TDI management.ConclusionIncreasing awareness of the challenges in TDI management and addressing the need for improved dental treatment for TDI patients may lead to targeted programs to enhance dentists' knowledge and skills. There is considerable potential for training dentists in dental traumatology.

Sedation of Adults with Orally Administered Midazolam in Dentistry - A Retrospective Study.

The use of midazolam (MZ) has increased in dentistry, but the effect in adults is sparsely studied. The aim of this study was to investigate doses, effects, and side effects of orally administered MZ as a sedative for adults in a dental care organization. A retrospective record review was performed including all adult patients in the dental care organization ≥20 years receiving MZ, identified through a logbook for addictive drugs, during 2020. From patients' records, the following data were extracted: age, gender, medical history, reason for sedation, performed treatments, doses, effects, and side effects of MZ. Results: In total, 265 patients on 418 occasions had been sedated, which constituted 2.3 sedations per 1,000 visits and 3.3 sedations per 1,000 treated patients. Mean age was 40.8 years and 67.7% were females. The most common reason for sedation was anxiety. Mean dose in primary dental clinics was 7.9 mg and in specialist clinics, 6.8 mg (p < 0.001). Older patients (>70 years) had lower doses than younger (p < 0.001), while no difference was found between ages 55-70 years and those who were younger. Dental treatment was completed in 91.9% of occasions, and side effects were registered in 2.2%. Successful dental treatment was related to type of treatment performed. Sedation is rarely used, particularly in primary dental care, and the use varies widely between clinics. MZ administered by dentists seems to be safe and effective. A sedation record should be used to make patient data such as weight and medical conditions available.

Influence of dental status on postoperative complications in major visceral surgical and organ transplantation procedures—the bellydent retrospective observational study

PurposeThe significance of dental status and oral hygiene on a range of medical conditions is well-recognised. However, the correlation between periodontitis, oral bacterial dysbiosis and visceral surgical outcomes is less well established. To this end, we study sought to determine the influence of dental health and oral hygiene on the rates of postoperative complications following major visceral and transplant surgery in an exploratory, single-center, retrospective, non-interventional study.MethodsOur retrospective non-interventional study was conducted at the Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Germany. Patients operated on between January 2018 and December 2019 were retrospectively enrolled in the study based on inclusion (minimum age of 18 years, surgery at our Department, intensive care / IMC treatment after major surgery, availability of patient-specific preoperative dental status assessment, documentation of postoperative complications) and exclusion criteria (minor patients or legally incapacitated patients, lack of intensive care or intermediate care (IMC) monitoring, incomplete documentation of preoperative dental status, intestinal surgery with potential intraoperative contamination of the site by intestinal microbes, pre-existing preoperative infection, absence of data regarding the primary endpoints of the study). The primary study endpoint was the incidence of postoperative complications. Secondary study endpoints were: 30-day mortality, length of hospital stay, duration of intensive care stay, Incidence of infectious complications, the microbial spectrum of infectious complication. A bacteriology examination was added whenever possible (if and only if the examination was safe for the patient)for infectious complications.ResultsThe final patient cohort consisted of 417 patients. While dental status did not show an influence (p = 0.73) on postoperative complications, BMI (p = 0.035), age (p = 0.049) and quick (p = 0.033) were shown to be significant prognostic factors. There was significant association between oral health and the rate of infectious complications for all surgical procedures (p = 0.034), excluding transplant surgery. However, this did not result in increased 30-day mortality rates, prolonged intensive care unit treatment or an increase in the length of hospital stay (LOS) for the cohort as a whole. In contrast there was a significant correlation between the presence of oral pathogens and postoperative complications for a group as a whole (p < 0.001) and the visceral surgery subgroup (p < 0.001). Whilst this was not the case in the cohort who underwent transplant surgery, there was a correlation between oral health and LOS in this subgroup (p = 0.040). Bacterial swabs supports the link between poor oral health and infectious morbidity.ConclusionsDental status was a significant predictor of postoperative infectious complications in this visceral surgery cohort. This study highlights the importance preoperative dental assessment and treatment prior to major surgery, particularly in the case of elective surgical procedures. Further research is required to determine the effect of oral health on surgical outcomes in order to inform future practice.Trial registrationTrial registered under the ethics-number S-082/2022 (Ethic Committee of the University Heidelberg).