Invasive Dental Procedures Research Articles

Dealing With Failure.

Dealing With Failure.

Amoxicillin-Resistant Streptococci Carriage in the Mouths of Children: A Systematic Review and Meta-Analysis.

Streptococcal bacteremia that occurs during invasive dental procedures can lead to infective endocarditis (IE) in children with certain heart diseases. Prior to such procedures, antibiotic prophylaxis (AP) with amoxicillin (AMPC) is recommended. However, the detection of amoxicillin-resistant strains (AMPC-RS) in the mouths of children with heart diseases raises the concern that they would be uncovered by the action of standard AP. This work carried out a systematic review and meta-analysis regarding AMPC-RS carriage in the mouths of children. We consulted databases covering studies between the years 2000 and 2021, following the PRISMA declaration. A meta-analysis was carried out to assess the prevalence of children carrying AMPC-RS in the mouths. The antimicrobial tests were carried out by microdilution (46.2% of articles), disk diffusion (38.3%), and the E-test (15.4%). Streptococcus mitis and S. sanguinis were bacteria with the most found resistance phenotype, with MIC reaching values of 128 µg/mL. Of the 13 selected articles, only 6 presented results that made it possible to calculate the prevalence of children carrying AMPC-RS in their mouths, ranging from 5.5% to 86.3%. Most of the studies were classified as high quality, and the collected data demonstrate the presence of streptococcal strains with different levels of resistance in the collected samples, such as the dental plaque. The meta-analysis pointed to evidence of AMPC-RS being carried, with a prevalence of 21.3% (I² = 0%, p = 0.705). There is an important prevalence of AMPC-RS carriage in the mouths of children. Specific attention should be directed to AP in those susceptible to IE.

Temporal association between invasive procedures and infective endocarditis

ObjectiveAntibiotic prophylaxis has been recommended for patients at increased risk of infective endocarditis (IE) undergoing specific invasive procedures (IPs) despite a lack of data supporting its use. Therefore, antibiotic prophylaxis...

PDL injection in dentistry: An adjunct or alternative

Pain management is the most important prerequisite in performing invasive dental procedures. In situations where block injections fail then supplemental injections provide sufficient analgesia. PDL injection is a supplemental injection technique regaining its popularity in recent days. With the advent of newer anaesthetic molecules and newer PDL injection delivery systems, PDL injection is able to achieve predictable success rates to provide adequate dental anaesthesia. The aim of this article is to provide an insight on PDL injection technique and its efficacy in field of dentistry.

Parental report of dental pain and discomfort in preschool children is associated with sleep disorders: a cross-sectional study in Brazilian families.

To evaluate the prevalence of sleep disorders in Brazilian preschool children and its associations with parental report of dental pain and discomfort. This cross-sectional study involved 604 Brazilian preschoolers (4-5 years old). Sleep disorders (SD) and the parental report of dental pain and discomfort (DPD) were evaluated using the Brazilian versions of the Sleep Disturbance Scale for Children (SDSC) and the Dental Discomfort Questionnaire (DDQ-B), respectively. Bivariate and multivariate Poisson regression analyses with robust variance were performed to analyze the association between SDSC and DP. Prevalence of SD ranged from 7 to 21%. 7.9% of the children had DPD indicating the need for more invasive dental procedures (DDQ-B ≥ 5). Significant associations were found between DPD and the following SDSC domains: sleep hyperhidrosis (p = 0.024; PRa = 1.38; 95% CI: 1.04-1.83), disorders of initiating and maintaining sleep (p < 0.001; PRa = 1.41; 95% CI: 1.15-1.73), parasomnias (p < 0.001; PRa = 1.82; 95% CI: 1.39-2.37), and sleep-wake transition disorders (p = 0.018; PRa = 1.28; 95% CI: 1.04-1.58). Children with higher prevalence of DPD presented 20% higher prevalence of SD than children lower prevalence of DPD (p = 0.039; PRa = 1.20; 95% CI: 1.01-1.44). Preschool children with higher prevalence of DPD are more likely to have SD, such as hyperhidrosis, disorders of initiating and maintaining sleep, parasomnias, and sleep-wake transition.

Predictors of Dental Fear and Anxiety in 9-12-year-old Children in Bosnia and Herzegovina.

Oral health in children is additionally burdened with the presence of dental fear and anxiety (DFA). These clinical psychologic entities in their progressive stages inevitably lead to avoidance of dental appointments, which makes prevention and therapy of oral diseases more difficult. Upon the onset of DFA in general, as one of the emotional outcomes of stress in a dental office, most children patients could define the specific stressors that were most intense for them, which could predict the presence of DFA. To examine the predictors of DFA presence in 9-12-year-old children, and investigate how they could explain the DFA occurrence in study participants. The sample consisted of 200 children aged from 9 to 12 years. The DFA presence was determined by the modified version of the CFSS-DS scale. The child's behavior in the dental office during the treatment was evaluated by the trained observer using Venham anxiety and behavior rating scales. Socioeconomic status, characteristics of dental office visits, and previous caries experience were also analyzed. The main DFA predictors were related to invasive dental treatments, where the behavior during dental treatment was the most accurate expression of the DFA appearance. Invasive dental procedures are the main stressful factor for DFA occurrence. Predisposing factors could strengthen the DFA occurrence.

The risk of endocarditis in hemodialysis patients who have undergone invasive dental treatment: a cohort case-control analysis of the Taiwan National Health Insurance Database.

The objective of this study was to determine if hemodialysis patients who have undergone an invasive dental treatment are at risk of developing infective endocarditis. This study was a cohort case-control design and used secondary data collected from the National Health Insurance Research Database of Taiwan. The case group and the control group were each comprised of 19,602 hemodialysis patients. The control group was matched for four variables: age, gender, a medical history of diabetes mellitus, and a cerebrovascular event. After matching, the case group and the control group were each comprised of 19,602 hemodialysis patients. Cox regression analysis determined hazard ratios and 95% confidence intervals. Patients were followed up at 1month and 3months after receiving invasive dental treatment. The results showed the cohort case-control hazard ratio was 0.88 (95% CI, 0.49, 1.57) 1month after receiving invasive dental treatment. Three months after receiving IDT, the cohort case-control hazard ratio was 1.04 (95% CI, 0.71, 1.52). Hazard ratios did not differ significantly between groups. Hemodialysis patients who received invasive dental treatment had no greater risk of developing infective endocarditis than matched control patients. The results of this study should alleviate concerns for hemodialysis patients and dentists about invasive dental treatment procedures. We recommend hemodialysis patients undergo invasive dental treatment when needed. The results of this study showed that invasive dental treatment did not increase their risk of developing infective endocarditis. Hemodialysis patients in need of an invasive dental procedure should be encouraged to undergo treatment if the dentist deems it necessary.

Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery: Part 1

Increasing numbers of patients seeking dental care are at heightened thrombotic or thromboembolic risk and are therefore taking either oral antiplatelet (OAP) or oral anticoagulant (OAC) agents that disrupt the coagulation process. In addition, the arsenal of OAP and OAC agents in use has continued to expand as new drug development persists. The impairment of functional coagulation by these agents can lead to prolonged and/or major blood loss from surgical sites during invasive dental procedures. To properly manage these patients perioperatively, sedation and anesthesia providers for dentistry and oral surgery must understand the pharmacokinetics and pharmacodynamics of these agents as well as the factors that influence and augment bleeding and thrombotic risk. Part 1 of this review will present a summary of the coagulation processes and discuss the pharmacokinetic and pharmacodynamic properties of oral antithrombotics currently approved for use in the United States. Part 2 will focus on factors that affect perioperative management of antithrombotic agents with special consideration given to procedures typically encountered when providing sedation and anesthesia in the dental setting.

The influence of prior dental pathology on medical complications and peri-prosthetic joint infections following primary shoulder arthroplasty.

Antibiotic prophylaxis before invasive dental procedures is a common practice in the USA. Consensus regarding the influence of prior dental pathology (DP) on postoperative complications is lacking. The objectives are to determine the association of DP prior to shoulder arthroplasty (SA) on: (1) lengths of stay (LOS), (2) medical complications, (3) readmissions, (4) implant-related complications including peri-prosthetic joint infections (PJIs) and (5) healthcare expenditures. The PearlDiver database was queried for primary shoulder arthroplasty from 2010 to 2020. Patients with history of dental caries or dental implant placement before SA represented the study group (n = 1419). Patients without prior DP represented controls (n = 7062). Study group patients were 1:5 ratio matched to controls by age, sex, and comorbidities. Outcomes included LOS, 90-day complications, readmissions, 2-year implant-related complications, and healthcare reimbursements. Logistic regression was used to calculate odds ratios (OR) of complications and readmissions. T tests compared LOS and costs. P values < 0.003 were significant. LOS (2.17 vs. 2.07days; p = 0.071) were similar between groups. Patients with DP had higher 90-day medical complications compared to controls (OR: 1.74, p < 0.0001), including myocardial infarctions (2.2% vs. 0.8%; OR: 2.79, p < 0.0001), acute kidney injuries (8.3% vs. 4.6%; OR: 1.92, p < 0.0001), and pneumonias (8.7% vs. 5.3%; OR: 1.72, p < 0.0001). Readmission rates (1.97% vs. 1.54%; p = 0.248) were similar. Two-year implant complications were higher in patients with DP compared to controls (16.1% vs. 11.5%; OR: 1.38, p = 0.0003), including dislocations (6.4% vs. 4.5%; OR: 1.45, p = 0.002) and mechanical loosenings (4.0% vs. 2.4%; OR: 1.67, p = 0.001); however, PJIs were similar (2.2% vs. 1.9%; OR: 1.12, p = 0.583). Healthcare expenditures between groups were similar ($12,611 vs. $12,059; p = 0.075). Patients with prior DP have higher 90-day medical complications and 2-year implant-related complications. Two-year incidence of PJIs were similar between groups. These findings can help shoulder surgeons counsel patients with a pertinent dental history. Retrospective comparative study.

Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures

BackgroundAntibiotic prophylaxis (AP) before invasive dental procedures (IDPs) is recommended to prevent infective endocarditis (IE) in those at high IE risk, but there are sparse data supporting a link between IDPs and IE or AP efficacy in IE prevention. ObjectivesThe purpose of this study was to investigate any association between IDPs and IE, and the effectiveness of AP in reducing this. MethodsWe performed a case-crossover analysis and cohort study of the association between IDPs and IE, and AP efficacy, in 7,951,972 U.S. subjects with employer-provided Commercial/Medicare-Supplemental coverage. ResultsTime course studies showed that IE was most likely to occur within 4 weeks of an IDP. For those at high IE risk, case-crossover analysis demonstrated a significant temporal association between IE and IDPs in the preceding 4 weeks (OR: 2.00; 95% CI: 1.59-2.52; P = 0.002). This relationship was strongest for dental extractions (OR: 11.08; 95% CI: 7.34-16.74; P < 0.0001) and oral-surgical procedures (OR: 50.77; 95% CI: 20.79-123.98; P < 0.0001). AP was associated with a significant reduction in IE incidence following IDP (OR: 0.49; 95% CI: 0.29-0.85; P = 0.01). The cohort study confirmed the associations between IE and extractions or oral surgical procedures in those at high IE risk and the effect of AP in reducing these associations (extractions: OR: 0.13; 95% CI: 0.03-0.34; P < 0.0001; oral surgical procedures: OR: 0.09; 95% CI: 0.01-0.35; P = 0.002). ConclusionsWe demonstrated a significant temporal association between IDPs (particularly extractions and oral-surgical procedures) and subsequent IE in high–IE-risk individuals, and a significant association between AP use and reduced IE incidence following these procedures. These data support the American Heart Association, and other, recommendations that those at high IE risk should receive AP before IDP.

DENTAL COMPLICATIONS IN CHRONIC RENAL FAILURE PATIENTS: A RETROSPECTIVE STUDY

<h3>Objectives</h3> The purpose of this study was to assess the frequency of complications during and after invasive and noninvasive dental procedures in patients with chronic renal failure (CRF) on dialysis, whether or not preceded by a prophylactic antibiotic (PA). <h3>Study Design</h3> A retrospective study of 225 medical records of patients with CRF undergoing dialysis at CAPE-FOUSP was carried out. <h3>Results</h3> The main underlying diseases that led to the occurrence of CRF were systemic arterial hypertension (48 patients) and diabetes mellitus (23 patients). In 225 patients, 1390 dental procedures were performed, including 856 noninvasive and 443 invasive procedures. Among the invasive procedures, there were 259 extractions, of which 80 were prescribed a PA (31%), and in 29 local hemostatics were necessary (49.1%). There were 16 cases of transoperative bleeding (7.1%), 5 cases of postoperative bleeding (2.2%), and 2 cases of postoperative complications (0.7%). <h3>Conclusions</h3> The most prevalent postoperative complication in patients with CRF on dialysis was hemorrhage. The frequency of complications after extractions was very low, with no statistical difference in its incidence between those who received PA or not. The results allow us to infer that the use of PA for these procedures is not justified.

Dentist Empathic Accuracy Is Associated With Patient-Reported Reassurance

The aim of this work was to determine dentists' ability to accurately estimate patients' anxiety level during dental treatment (ie, "empathic accuracy") and to determine the strength of the association between empathic accuracy and patient-reported reassurance. A cross-sectional study was conducted amongst 177 adult patients who underwent different invasive dental procedures (ie, extractions or procedures requiring injections and drilling) performed by 10 different dentists from 3 dental offices in the Netherlands. Patients reported their anxiety level during treatment and the extent to which they felt reassured by the dentist using a visual analogue scale (VAS). Simultaneously, the dentists estimated patients' anxiety level. Empathic accuracy was calculated as an absolute difference between patient-reported anxiety (100-point VAS) and dentist estimation of anxiety (100-point VAS). Agreement between dentists' assessment of patients' anxiety and patient-reported anxiety proved good, intraclass correlation coefficient (177)=0.63; 95% confidence interval [CI], 0.53-0.71. A small to medium-sized positive correlation, r (177)=0.15; 95% CI, 0.00-0.29, was found between dentists' empathic accuracy and patient-reported reassurance. A negative correlation was found between empathic accuracy and patients' anxiety scores, r (177)=-0.23; 95% CI, -0.38 to -0.09. Given that greater empathic accuracy was associated with higher patient-reported reassurance during treatment, training young dental professionals in empathic accuracy might help patients feel reassured. Importantly, our results also suggest that with elevated levels of patient anxiety it is increasingly challenging for dentists to recognise this emotion, and thus support the patient in anoptimal manner.

Dental manifestations of hereditary hemorrhagic telangiectasia: a clinical case

A rare disorder that changes the blood vessels of many organs and causes bleeding. The disease affects the lungs, liver, central nervous system, gastrointestinal tract, skin and mucous membranes. The degree of incidence of Randu-Weber-Osler disease is not high and ranges from 1 detected case per 50 thousand – per 100 thousand population. The scientific article presents a clinical case with dental manifestations of Randu-Weber-Osler disease and indicates the important role of the dentist in monitoring such patients. The red border of the lips is dry, pale, with pronounced multiple punctate telangiectasias of red-violet color. In the area of the lower lip, brightly colored round nodules with a diameter of about 5 mm are found, protruding above the surface, painless on palpation. On the dorsal and lateral surfaces, there are papular formations of a red-violet color, with a diameter of 5 to 7 mm, protruding above the surface. The gums are hyperemic, edematous, loose, bleeds on probing, periodontal pockets with exudative contents. On examination, attention was drawn to an insufficient amount of saliva, which was located mainly in the retromolar region; it was frothy. The salivation rate is reduced (0.1 ml per minute). It is assumed that before and during invasive dental procedures, antibiotic therapy is necessary, especially when working in infected areas (500 mg of amoxicillin) every 8 hours starting 12 hours before the procedure for 7 days. Given that hypoxia and cerebral embolism are frequent complications, the dental chair should be in an upright position throughout the patient's appointment. Treatment of this disorder is only supportive in nature, its goals are to relieve symptoms, treat complications and prevent progression of the disease. Early definition of the manifestations of this disease and careful observation of the patient gives a favorable prognosis of the course and prevents the development of severe complications. Keywords: hereditary hemorrhagic telangiectasia, periodontitis, xerostomia.

Risk of infective endocarditis associated with invasive dental procedures in patients with cardiac rhythm devices.

The incidence of infective endocarditis related to cardiac implantable electronic devices (CIEDs) has gradually increased. The risk associated with dental procedures in patients with CIED implantation and the need for prevention of infective endocarditis remain unclear. The present study investigated the incidence and risk of infective endocarditis associated with invasive dental procedures in patients with CIEDs. We analysed a nationwide population-based cohort of patients with CIEDs who underwent dental procedures. We performed a self-controlled case series analysis and evaluated the incidence rate ratio of infective endocarditis 3 months after dental procedures. Of a total of 62 019 patients who underwent CIED implantation, 32 536 patients underwent at least one dental procedure during follow-up, and the mean number of dental procedures was 3.4 per patient. They were 152 infections with an incidence of 445 per 100 000 person-years in the dental procedure period and 500 events at an incidence of 255 per 100 000 person-years in the non-dental procedure period. The CIED-related infective endocarditis in the dental procedure period occurred significantly more frequently than during non-dental procedure periods (odds ratio, 1.75; 95% confidence interval, 1.48-2.05; P < 0.001). The mean time interval from dental procedure to infective endocarditis was 59.6 ± 47.3 days. Invasive dental procedures are associated with an increased risk of infective endocarditis in those who underwent CIED implantation. Appropriate preventive therapy might be needed in these patients.

Is Virtual Reality Distraction Technique Effective to Cater Dental Pain and Anxiety Among Children?

Objective: The current study investigated the virtual reality distraction technique as an indicator of pain and anxiety reduction in children with an age between 6 to 9 years during short invasive dental procedure using salivary cortisol level as an indicator for measuring level of anxiety Method: This randomized clinical trial was conducted in a dental hospital of Lahore in the department of Pediatric dentistry. Data was collected from 30 patients which were divided in two groups. One group was containing patients who had screen time of less than 4hours whereas the other group contained patients who had screen time of more than 4hours in a day. Data was entered in SPSS version 25.0. Frequencies and percentages were calculated as descriptive analysis whereas comparison among both groups was made using Chi-Square test. Results: The results of chi-square test revealed that there is a significant difference in the pain perception of patients using virtual reality distraction technique during dental treatment (X2=4.701, P=.030). The results of paired sample t test revealed a significant difference between patients who has less than 4 hours screen time and patients who has more than 4 hours screen time in terms of salivary cortisol level (P=.001). Conclusion: The application of virtual reality distraction technique for the dental treatment of children is more effective among those who have more screen time as compared to the children who have less screen time Keywords: Virtual reality distraction, Pain, Anxiety, Dental treatment

Major clinical findings of minimally invasive surgery in dentistry: a systematic review

Introduction: In the scenario of surgery or minimally invasive dental procedures there are more than 300 clinical studies. The studies were classified in the areas of periodontics, cardiology, implantology, endodontics, orthodontics, oral pathology, oral and maxillofacial surgery, prosthesis, and others. Uncertainty is about the conclusions obtained from a set of studies on minimally traumatic surgery. Objective: It was to demonstrate the evolution and consequent importance of improving minimally traumatic surgery techniques in dentistry. Methods: The present study followed a systematic review model, following the rules of systematic review – PRISMA. The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The present study was carried out from January to March 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 121 articles were found. A total of 86 articles were fully evaluated and 27 were included in this study. Since the most primordial extraction techniques were created and developed, several attempts have been made to minimize the professional's effort, reduce surgical time and alleviate bleeding and the inflammatory processes, edema, pain, and ecchymosis that can affect patients, in trans and postoperative periods. Thus, maximum preservation of the integrity of soft tissues (papilla and free and attached gingiva) adjacent to the prosthetic spaces should be sought, and preservation of the level of the alveolar bone ridge, minimizing surgical trauma. Conclusion: There are many attempts to minimize the professional's effort, reduce surgical time and alleviate bleeding and inflammatory processes, edema, pain, and ecchymosis that can affect patients. Thus, maximum preservation of the integrity of the soft tissues adjacent to the prosthetic spaces and the preservation of the level of the alveolar bone ridge should be sought to achieve the minimization of surgical trauma.

Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures.

Infective endocarditis is a severe infection arising in the lining of the chambers of the heart. It can be caused by fungi, but most often is caused by bacteria. Many dental procedures cause bacteraemia, which could lead to bacterial endocarditis in a small proportion of people. The incidence of bacterial endocarditis is low, but it has a high mortality rate. Guidelines in many countries have recommended that antibiotics be administered to people at high risk of endocarditis prior to invasive dental procedures. However, guidance by the National Institute for Health and Care Excellence (NICE) in England and Wales states that antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures. This is an update of a review that we first conducted in 2004 and last updated in 2013. Primary objective To determine whether prophylactic antibiotic administration, compared to no antibiotic administration or placebo, before invasive dental procedures in people at risk or at high risk of bacterial endocarditis, influences mortality, serious illness or the incidence of endocarditis. Secondary objectives To determine whether the effect of dental antibiotic prophylaxis differs in people with different cardiac conditions predisposing them to increased risk of endocarditis, and in people undergoing different high risk dental procedures. Harms Had we foundno evidence from randomised controlled trials or cohort studies on whether prophylactic antibiotics affected mortality or serious illness, and we had found evidence from these or case-control studies suggesting that prophylaxis with antibiotics reduced the incidence of endocarditis, then we would also have assessed whether the harms of prophylaxis with single antibiotic doses, such as with penicillin (amoxicillin 2 g or 3 g) before invasive dental procedures, compared with no antibiotic or placebo, equalled the benefits in prevention of endocarditis in people at high risk of this disease. An information specialist searched four bibliographic databases up to 10 May 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: Due to the low incidence of bacterial endocarditis, we anticipated that few if any trials would be located. For this reason, we included cohort and case-control studies with suitably matched control or comparison groups. The intervention was antibiotic prophylaxis, compared to no antibiotic prophylaxis or placebo, before a dental procedure in people with an increased risk of bacterial endocarditis. Cohort studies would need to follow at-risk individuals and assess outcomes following any invasive dental procedures, grouping participants according to whether or not they had received prophylaxis. Case-control studies would need to match people who had developed endocarditis after undergoing an invasive dental procedure (and who were known to be at increased risk before undergoing the procedure) with those at similar risk who had not developed endocarditis. Our outcomes of interest were mortality or serious adverse events requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse effects of the antibiotics; and the cost of antibiotic provision compared to that of caring for patients who developed endocarditis. Two review authors independently screened search records, selected studies for inclusion, assessed the risk of bias in the included study and extracted data from the included study. As an author team, we judged the certainty of the evidence identified for the main comparison and key outcomes using GRADE criteria. We presented the main results in a summary of findings table. Our new search did not find any new studies for inclusion since the last version of the review in 2013. No randomised controlled trials (RCTs), controlled clinical trials (CCTs) or cohort studies were included in the previous versions of the review, but one case-control study met the inclusion criteria. The trial authors collected information on 48 people who had contracted bacterial endocarditis over a specific two-year period and had undergone a medical or dental procedure with an indication for prophylaxis within the past 180 days. These people were matched to a similar group of people who had not contracted bacterial endocarditis. All study participants had undergone an invasive medical or dental procedure. The two groups were compared to establish whether those who had received preventive antibiotics (penicillin) were less likely to have developed endocarditis. The authors found no significant effect of penicillin prophylaxis on the incidence of endocarditis. No data on other outcomes were reported. The level of certainty we have about the evidence is very low. There remains no clear evidence about whether antibiotic prophylaxis is effective or ineffective against bacterial endocarditis in at-risk people who are about to undergo an invasive dental procedure. We cannot determine whether the potential harms and costs of antibiotic administration outweigh any beneficial effect. Ethically, practitioners should discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.

Infective endocarditis following invasive dental procedures: IDEA case-crossover study

Infective endocarditis is a heart infection with a first-year mortality rate of ≈ 30%. It has long been thought that infective endocarditis is causally associated with bloodstream seeding with oral bacteria in ≈ 40-45% of cases. This theorem led guideline committees to recommend that individuals at increased risk of infective endocarditis should receive antibiotic prophylaxis before undergoing invasive dental procedures. However, to the best of our knowledge, there has never been a clinical trial to prove the efficacy of antibiotic prophylaxis and there is no good-quality evidence to link invasive dental procedures with infective endocarditis. Many contend that oral bacteria-related infective endocarditis is more likely to result from daily activities (e.g. tooth brushing, flossing and chewing), particularly in those with poor oral hygiene. The aim of this study was to determine if there is a temporal association between invasive dental procedures and subsequent infective endocarditis, particularly in those at high risk of infective endocarditis. This was a self-controlled, case-crossover design study comparing the number of invasive dental procedures in the 3 months immediately before an infective endocarditis-related hospital admission with that in the preceding 12-month control period. The study took place in the English NHS. All individuals admitted to hospital with infective endocarditis between 1 April 2010 and 31 March 2016 were eligible to participate. This was an observational study; therefore, there was no intervention. The outcome measure was the number of invasive and non-invasive dental procedures in the months before infective endocarditis-related hospital admission. NHS Digital provided infective endocarditis-related hospital admissions data and dental procedure data were obtained from the NHS Business Services Authority. The incidence rate of invasive dental procedures decreased in the 3 months before infective endocarditis-related hospital admission (incidence rate ratio 1.34, 95% confidence interval 1.13 to 1.58). Further analysis showed that this was due to loss of dental procedure data in the 2-3 weeks before any infective endocarditis-related hospital admission. We found that urgent hospital admissions were a common cause of incomplete courses of dental treatment and, because there is no requirement to record dental procedure data for incomplete courses, this resulted in a significant loss of dental procedure data in the 2-3 weeks before infective endocarditis-related hospital admissions. The data set was also reduced because of the NHS Business Services Authority's 10-year data destruction policy, reducing the power of the study. The main consequence was a loss of dental procedure data in the critical 3-month case period of the case-crossover analysis (immediately before infective endocarditis-related hospital admission), which did not occur in earlier control periods. Part of the decline in the rate of invasive dental procedures may also be the result of the onset of illness prior to infective endocarditis-related hospital admission, and part may be due to other undefined causes. The loss of dental procedure data in the critical case period immediately before infective endocarditis-related hospital admission makes interpretation of the data difficult and raises uncertainty over any conclusions that can be drawn from this study. We suggest repeating this study elsewhere using data that are unafflicted by loss of dental procedure data in the critical case period. This trial is registered as ISRCTN11684416. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 28. See the NIHR Journals Library website for further project information.

Recent Advances in Direct Adhesive Restoration Resin-Based Dental Materials With Remineralizing Agents

Resin-based dental materials are popular restorative materials especially in direct adhesive restoration because of the excellent mechanical and esthetic properties. Toward the realization of minimally invasive dental procedures, direct composite resin adhesive restoration has become the main treatment for dental defects. In addition, for caries-affected dentin close to the pulp, conservation remineralization has been advocated to save the living pulp. However, the resin–dentin interface can be destabilized by various factors, especially the enzymatic degradation of collagen fibrils within the hybrid layer and polymer hydrolysis. Furthermore, for resin-based restorative materials, the marginal gap remains a major problem that can lead to the occurrence of secondary caries. To address these issues, research efforts have focused on the remineralization of mineral-depleted dental hard tissues using remineralizing bioactive substances. In this review, we first described various bioactive agents with remineralizing properties. Furthermore, we discussed recent advances in resin-based dental materials for enamel or dentin remineralization. Finally, we examined the current challenges and prospects of these emerging materials. This work aims to provide a theoretical foundation for the future development of resin-based dental materials in direct adhesive restoration with remineralizing agents.

Changing Trends in the Clinical Characteristics and Treatment Strategies for Odontogenic Sinusitis Over the Past 10 Years.

The incidence of odontogenic sinusitis has been gradually increasing due to the recent increases in invasive dental procedures. This study aimed to describe the clinical features of present patients with odontogenic sinusitis compared to the past, confirm the importance of endoscopic sinus surgery (ESS), and analyze the predictive factors for ESS. This retrospective review included all patients diagnosed with odontogenic sinusitis between January 2010 and December 2011 and between January 2019 and December 2020. The patients were classified into 2 groups (past and present) depending on the time of the first visit. The clinical characteristics and treatment modalities were compared between the two groups. In addition, among patients in the present group, we analyzed variables to identify factors contributing to the risk of undergoing ESS. This study included 56 patients (23 in the past group and 33 in the present group). Compared to the past group, the present group had an older mean age (P = .001) and significantly increased iatrogenic etiologies (52.1% vs 90.9%; P = .002). The proportion of patients treated with ESS also increased in the present group compared to that in the past group (39.1% vs 66.7%; P = .041). In the present group, 11 patients (33.3%) were cured with conservative treatment, while 22 patients (66.7%) underwent additional ESS. Multivariate analysis revealed that the Lund-Mackay score was the only significant predictor of ESS (odds ratio [OR]: 14.901, P = .035). The incidence of odontogenic sinusitis with iatrogenic etiologies has increased compared to the past. In addition, two-thirds of the patients in the present study underwent ESS, a significantly higher proportion than in the past. Therefore, ESS is one of the most important treatment modalities for odontogenic sinusitis, especially iatrogenic, in recent years. A severe Lund-Mackay score was associated with a significantly increased risk of ESS.