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This case report describes the presentation and management of a 12-year-old female patient with a tissue mass and spacing between her upper front teeth. Clinical examination revealed a reddish pink, lobulated tissue mass measuring approximately 1.5 cm × 2 cm, extending from the upper labial frenum to the incisive papilla and involving the interdental gingiva of the two central incisors. The mass was moderately firm, pedunculated, and prone to bleeding. The patient had poor oral hygiene, exacerbating the condition. Radiographic evaluation ruled out underlying bony lesions, leading to a provisional diagnosis of pyogenic granuloma with differential diagnoses of gingival fibroma or traumatic fibroma. The treatment plan involved excision of the gingival overgrowth and frenectomy. Following routine oral prophylaxis, the surgical procedure was performed, with the excised tissue sent for histopathological evaluation, confirming the diagnosis as pyogenic granuloma. Postoperative care was provided, and the patient was advised against active orthodontic treatment. Regular follow-up appointments were scheduled to monitor healing and spontaneous space closure. This case report underscores the significance of considering both the aberrant labial frenum and the gingival overgrowth in treatment planning and highlights the need for meticulous follow-up care. [ABSTRACT FROM AUTHOR]

In a group of palliative patients, venous thromboembolism (VTE) is a significant cause of death and reduction in quality of life. Current guidelines and scientific research on thromboprophylaxis most often refer to the population of oncology patients, who differ in many aspects from patients receiving palliative care. Thus, doctors working with patients undergoing palliative treatment have to face many problems related to safety and effectiveness of antithrombotic therapy in this type of care. In the case of chronically ill patients, diagnostic process may be somewhat difficult because the symptoms resulting from the underlying diseases can mask VTE symptoms. The aim of this article is to review the literature on symptoms and thromboprophylaxis in this group of patients. According to the latest guidelines of the American Society of Clinical Oncology (ASCO), it is not recommended to use VTE prophylaxis in outpatient oncology patients routinely, but it should be considered in high-risk patients who received a Khorana score of at least 2 before starting a new chemotherapy cycle. In patients diagnosed with VTE, in long-term prophylaxis lasting at least 6 months, due to greater effectiveness, it is recommended to use low-molecular-weight heparins, edoxaban, rivaroxaban or apixaban instead of vitamin K antagonists, which can be used if the previously mentioned drugs are unavailable. There are some studies which show that thromboprophylaxis may be beneficial for patients in palliative care. On the other hand, another studies’ results suggest that patients won’t gain any benefit from prevention. As our article shows it is very crucial to conduct scientific research on palliative patients and create clear guidelines for prophylaxis for this group of people. [ABSTRACT FROM AUTHOR]

The surface of dental materials is exposed to various prophylaxis protocols during routine dental care. However, the impact of these protocols on the functional properties of the material's surface remains unclear. This study investigates the influence of different dental prophylaxis protocols on the surface properties and their effect on the mechanical performance of CAD-CAM restorative materials. Discs (Ø = 15 mm, thickness = 1.2 mm) were fabricated from resin composite (RC, Tetric CAD), leucite-reinforced (LEU, IPS Empress CAD), lithium disilicate (LD, IPS e.max CAD), and zirconia ceramics (ZIR, IPS e.max ZirCAD MT). The materials were subjected to six prophylactic treatments: untreated (CTRL), prophylactic paste fine (PPF), prophylactic paste coarse (PPC), pumice stone (PS), air abrasion with sodium bicarbonate jet (BJ), and ultrasonic scaling (US). Biaxial flexural fatigue tests, along with fractographic, roughness, and topographic analyses, were conducted. No significant changes in fatigue strength were observed for RC, LD, and ZIR under any prophylaxis protocols. However, LEU subjected to BJ treatment exhibited significantly reduced fatigue strength (p = 0.004), with a 22% strength reduction compared to the monotonic test and substantial surface alterations. Surface roughness analyses revealed increased roughness for RC treated with PPF, PPC, and PS compared to CTRL (p < 0.05), while LD exhibited decreased roughness following PPF, PS, and US treatments (p < 0.05). In ZIR, only the BJ protocol increased roughness (p = 0.001). In conclusion, dental prophylaxis protocols do not significantly affect the mechanical strength of RC, LD, and ZIR materials, thus allowing any protocol to be used for these materials. However, for LEU ceramics, the BJ protocol should be avoided due to its effect of reducing fatigue strength and damaging the surface. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the effect of an immune-boosting beverage with Sambucus nigra (SAM), an energy beverage (ENE), an in-office bleaching agent with a novel composition, and a fine-grain professional dental prophylaxis (PDP) paste on the surface roughness (Ra) and microhardness (MH) of CAD/CAM restorative materials over time. Methods: Feldspathic ceramic (FC) and polymer infiltrated ceramic network (PICN) specimens were prepared (N = 126). Glazing, polishing, bleaching and immersion in beverages groups were formed. Bleaching gel containing 25% Hydrogen Peroxide Superior was applied to the specimens with a bleaching pen. Ra and MH were measured at five time points of baseline, days 1, 14, 28 and after PDP. Scanning electron microscopy (SEM) images were taken after PDP. Statistics were performed by ANOVA and Bonferroni tests (α = 0.05). Results: Ra increased over time regardless of material type, polishing method, beverage type and bleaching (p < 0.0001). Glazed and polished FCs caused higher roughness than PICN, SAM and ENE than distilled water, and bleaching than no bleaching (p < 0.0001). For glazed or polished FCs, MH decreased slightly lower at all time points, but for PICN, MH increased until day 28, not changing after PDP. Beverages decreased the MH of ceramics at all time points, but PDP did not lead to a change for PICN (p < 0.0001). The MH decreased more in bleached specimens than in non-bleached specimens up to day 28 (p < 0.0001). According to the SEM images after PDP, the glazed FC had numerous crack marks, pores and detached particles. The polished FC had traces of mechanical polishing. The polymer part of the PICN had voids, but the ceramic part was better preserved. Conclusions: Both energy beverages and immune-boosting beverages can increase roughness on FCs compared to PICNs. There was no significant difference between glazing and polishing in terms of lower roughness in FCs. PDP tended to slightly increase the roughness for ceramics, while it tended not to change it for PICN. Beverages decreased the microhardness of ceramics. PDP further decreased the microhardness in glazed ceramics, but increased it in polished ones. In PICN the microhardness increased over time, but decreased slightly after PDP. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the advantages of a novel protocol involving full‐mouth erythritol‐powder air‐polishing followed by ultrasonic calculus removal in the maintenance of patients treated for gingivitis, with a focus on time and comfort. Methods: Systemically healthy patients with gingivitis were selected. Following a split‐mouth design, quadrants 1–4 and 2–3 were randomly allocated to receive air‐polishing followed by ultrasonic calculus removal following a protocol known as Guided Biofilm Therapy (GBT) or traditional full‐mouth ultrasonic debridement followed by polishing with a rubber cup and prophylactic paste (US + P). Bleeding on probing (BoP) and the plaque index (PI) were collected at baseline (T0), 2 weeks (T1), 4 weeks (T2), 3 months (T3), and 6 months (T4) and 12 months (T5). Following the same randomization, prophylactic therapy was provided at 3 months (T3) and 6 months (T4). Clinical parameters, treatment time and patient comfort and satisfaction were evaluated. Results: A total of 41 patients were selected, 39 completed the study. The clinical parameters were clinically satisfactory for both treatments at every time. At 4 months after treatment, GBT maintained significantly lower BoP and PI. GBT protocol required a significantly lower treatment time, especially at T3 and T4, when it saved 24.5% and 25.1% of the time, respectively. Both treatments were rated positively by most patients. However, GBT was perceived as more comfortable, and a higher number of patients preferred it. Conclusion: No significant difference was observed between GBT and conventional ultrasonic debridement and rubber cup polishing in terms of BoP and PI levels. The GBT protocol allowed less time expenditure and higher patients' perceived comfort. [ABSTRACT FROM AUTHOR]

Abstract Background The effect of an immune-boosting beverage (SAM) containing Sambucus Nigra, an energy beverage (ENE), an in-office bleaching (BLE) agent with 25% hydrogen peroxide superior, glazing (GLA) or polishing (POL) methods, and professional dental prophylaxis (PDP) on the color of CAD-CAM restorative materials is unknown. Methods In total 210 specimens were prepared, consisting of CAD-CAM feldspathic (FC), zirconia-reinforced lithium disilicate ceramic (ZLS) and hybrid ceramic (HC). The ceramic specimens were divided according to the polishing methods of glazing (GLA) and mechanical polishing (POL). All materials were divided into two groups: with and without BLE. A 25% hydrogen peroxide superior (HPS) gel was used for BLE. After the baseline (BAS) measurement, the specimens were immersed in 3 different beverages (distilled water (DIS), SAM, ENE). After 28 days, a fine-grained (RDA 7) prophylaxis paste was applied. Statistical analysis of ∆E00 color difference values was performed by 3-way ANOVA and Bonferroni test (α = 0.05). Results The effect of all other actions except material-BLE-beverage on color for BAS-Day 28 was statistically different (p

Abstract Background The risk assessment of dental erosion among children and adolescents is an important aspect of dental care, as dental erosion constitutes a rapidly growing, global problem. Dental professionals rely solely on their own perception, as the current risk assessment process is not completely automatized, which affects the risk assessment reliability. Aim To explore dental professionals’ experiences with risk assessment of dental erosion among children and adolescents. Method In-depth interview was used as data collection method. A total of 11 dental professionals were interviewed. The interviews were analyzed using qualitative content analysis. Results The findings were summarized in the categories Professionals’ responsibility, Systematic approach , and Collaboration and communication. Dental staff perceived that their basic knowledge regarding erosion should be improved, and skills development was desired to reduce the knowledge gaps around the risk assessment of dental erosion. They alleged that the systematic approach could be improved by reducing workplace stress, implementing a universal dental erosion index, improving the existing risk assessment software, and automating the risk assessment of the condition. Dental professionals also experienced a need to calibrate and collaborate with each other and with other healthcare professionals to improve patient care. Conclusion Dental professionals experienced their basic knowledge of dental erosion and their risk assessment as good, but a more advanced skill development was required. Furthermore, they experienced the risk assessment software as a good tool that should be improved to compile more objective risk assessment. A universal erosion index was also requested.

Background: Restoring first permanent molars affected with molar incisor hypomineralization (MIH) is challenging. Focusing on improving the quality of life for children affected by MIH, at least until the complete eruption of first permanent molars to receive full coverage, to decrease the hypersensitivity and to be able to perform proper oral hygiene measures, the purpose of this study was to compare silver modified atraumatic restorative technique (SMART) versus the conventional restoration and fluoride varnish application on moderate to severe hypomineralized molars. The comparison considered the restoration survival, hypersensitivity, and digital surface area changes after one year follow up. Methods: Twenty-eight children were selected (20 girls and 8 boys) with at least 2 MIH molars with the same defect severity. The study comprised 2 groups; MOD group (moderate hypomineralized molar severity) and SEV group (Severe hypomineralized molar severity) (n = 28 tooth). Each group was further subdivided into 2 subgroups according to the technique of restoration: SMART subgroup and CONV subgroup (high viscosity glass ionomer restoration and fluoride varnish application) (each = 14 tooth). Evaluation was done in terms of the restoration survival (6 months and 12 months), hypersensitivity at 1 weak, 6 months and 12 months and occlusal surface area changes at 12 months). Professional Fluoride varnish application and home prophylaxis using MI paste were the protocol for each child patient. Results: There was no significant difference between the 4 subgroups, regarding tooth restoration integrity at 6-months vs. 12-months. However, a statistically significant difference in tooth restoration integrity between the 4 subgroups at 12-months (P =.049). Also, the hypersensitivity score, there was a statistically significant difference between the 4-time intervals (P <.001) and a statistically significant difference in surface area changes between the 4 subgroups. Conclusions: Selective removal of carious tissue and SMART restoration, combined with dental home and professional preventive measures every 3 months maintained the integrity of restorations in severely and moderately affected permanent molars up to 1 year. Trial registration: The study protocol was retrospectively registered on Clinical Trials (NCT05931822–05/ 07/2023). [ABSTRACT FROM AUTHOR]

The purpose of this material is to expose the fact that, by using ceramic masses, special results are obtained in manufacturing of the esthetic component of metal-ceramic crowns, the working technique presenting numerous advantages. Compliance with the manufacturing criteria of mixed metal-ceramic prosthetic restorations suitable to clinical situations lead to a high satisfaction both for the patients and for the dentist-dental technician team. Depending on the functional aspects of the prosthetic field, the dentist’s requirements and the patient’s wishes, the prosthetic restoration will be carried out following biomechanical, biofunctional and prophylactic principles. [ABSTRACT FROM AUTHOR]

Background: Growing evidence suggests the type of periodontal treatment could differentially influence the reduction of key cardiovascular risk mediators in periodontitis patients. This randomized, controlled clinical trial compared the impact of minimally invasive non‐surgical therapy (MINST) with quadrant‐wise subgingival instrumentation (Q‐SI) on C‐reactive protein (CRP) together with lipoprotein‐associated phospholipase A2 (Lp‐PLA2) levels, and clinical periodontal outcomes in patients with periodontitis. Moreover, it was evaluated if baseline CRP levels impacted the efficacy of non‐surgical periodontal therapy protocols. Methods: Forty‐two periodontitis patients were enrolled and randomly treated by means of MINST (n = 21) or Q‐SI (n = 21). The outcomes assessed were serum CRP and Lp‐PLA2, and periodontal parameters (probing depth [PD], clinical attachment level [CAL], full‐mouth bleeding score [FMBS]), at baseline and at follow‐ups at 1, 3, and 6 months and at 1 year after treatment. Results: At 1 year, MINST significantly reduced, among others, mean PD (p = 0.007), mean CAL (p = 0.007), the number of pockets >4 mm (p = 0.011) and ≥6 mm (p = 0.005), and FMBS (p = 0.048) compared to Q‐SI. Generalized multivariate analysis evidenced that high baseline CRP (p = 0.039) and FMBS (p = 0.046) levels, together with MINST treatment (p = 0.007) were significant predictors of PD reduction at 1‐year follow‐up. Moreover, the Jonckheere–Terpstra test showed that patients with high baseline CRP levels gained more benefits from MINST treatment at 1‐year follow‐up than they did from Q‐SI. Conclusion: Patients receiving MINST showed a greater reduction in CRP levels than patients with Q‐SI after 1 year of follow‐up. Moreover, patients with high baseline levels of CRP and Lp‐PLA2 gained more benefits from the MINST approach at 1‐year follow‐up. [ABSTRACT FROM AUTHOR]

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Background: The effect of an immune-boosting beverage (SAM) containing Sambucus Nigra, an energy beverage (ENE), an in-office bleaching (BLE) agent with 25% hydrogen peroxide superior, glazing (GLA) or polishing (POL) methods, and professional dental prophylaxis (PDP) on the color of CAD-CAM restorative materials is unknown. Methods: In total 210 specimens were prepared, consisting of CAD-CAM feldspathic (FC), zirconia-reinforced lithium disilicate ceramic (ZLS) and hybrid ceramic (HC). The ceramic specimens were divided according to the polishing methods of glazing (GLA) and mechanical polishing (POL). All materials were divided into two groups: with and without BLE. A 25% hydrogen peroxide superior (HPS) gel was used for BLE. After the baseline (BAS) measurement, the specimens were immersed in 3 different beverages (distilled water (DIS), SAM, ENE). After 28 days, a fine-grained (RDA 7) prophylaxis paste was applied. Statistical analysis of ∆E00 color difference values was performed by 3-way ANOVA and Bonferroni test (α = 0.05). Results: The effect of all other actions except material-BLE-beverage on color for BAS-Day 28 was statistically different (p < 0.05). The effect of material, material-BLE, beverage on color for Day 28-PDP was statistically different (p < 0.05). After 28 days, the lowest color change was found in FC-GLA and HC immersed in DIS (p = 0.0001) and the highest in FC-POL immersed in ENE (p = 0.0002). PDP was efficient in color recovery in HC immersed to DIS, ENE and SAM (p = 0.0010). For FC, HC and ZLS, BLE caused a higher color change (p < 0.0001). Regardless of the material, the highest color change for BLE-beverage was found in BLE-treated specimens immersed in ENE (p = 0.0496) and the lowest color change was found in non-BLE-treated specimens immersed in SAM (p = 0.0074). Conclusions: In materials pre-exposed to 25% HPS, the effect of PDP on color recovery was lower than in unexposed materials. After 28 days, mechanical polishing produced higher color change in FC than glazing, however, in ZLS effects of glazing and mechanical polishing on color were similar. For material/polishing method, HC was the most effective. ENE caused higher color change than DIS and SAM. PDP was more effective than ENE in restoring color to DIS- and SAM-immersed specimens. [ABSTRACT FROM AUTHOR]

Periprosthetic joint infection (PJI) is a devastating complication after total hip and total knee arthroplasty (THA/TKA). While some guidelines no longer recommend routine use of prophylactic antibiotics for dental procedures, many surgeons continue to prescribe antibiotics for their THA/TKA patients. In a setting of increasing antibiotic resistance, it is important to reduce unnecessary antibiotic use. This study aims to evaluate antibiotics prior to dental procedures and the association between dental procedures and PJI. We conducted a retrospective cohort study of patients who underwent THA/TKA between January 1, 2019 and December 31, 2020. The primary outcome was late-presenting PJI, occurring > 90 days after surgery. Patients were designated in the antibiotic group (2,000 mg of amoxicillin) or non-antibiotic group based on their surgeon's prophylaxis protocol. Dental-associated PJIs were considered if the patient had evidence of poor dentition or a recent dental procedure prior to the onset of PJI symptoms. There were 2,871 (26.4%) patients in the no antibiotics group and 8,023 (73.6%) patients in the antibiotics group. We found 27 (0.3%) late-presenting PJIs and 4 dental-associated PJIs. In the univariate and multivariable analyses, body mass index ≥-30 and revision surgery were the only variables that increased the odds of late-presenting PJI. All 4 dental-associated PJIs occurred in patients prescribed antibiotics. We found a low rate of late-presenting PJI. Routine antibiotics prior to dental procedures were not shown to affect the risk of late-presenting PJI. These findings suggest that routine antibiotic prophylaxis before dental procedures is not necessary after THA/TKA. [ABSTRACT FROM AUTHOR]

Introduction: Gingivitis is a common intraoral disease in patients with chronic kidney disease (CKD), which poses a particular interdisciplinary challenge. We aimed to determine the influence of an intensive oral prophylaxis program (OPP) compared to standard prevention measures on the tongue microbiome of young patients with CKD. Methods: Thirty patients with CKD (mean age 14.2 ± 5.2 years) and generalized gingivitis were included. The effects of the intensive OPP were compared with standard prophylaxis according to statutory health insurance (treatment as usual, TAU) as a control. Tongue swabs were taken from the patients at baseline (t1) and after 3 (t2) and 6 (t3) months. Next-generation sequencing of 16S rDNA genes was used to quantitatively characterize microbial communities. Results: There were no differences in the abundance, richness, or diversity of the observed genera and species between the two study groups at baseline or after 3 or 6 months. Furthermore, no change in predefined gingivitis and oral health bacterial clusters were found. At the phylum level, Firmicutes were decreased after intervention in the TAU group (t2TAU 42.9 ± 7.1 to t3TAU 34.8 ± 4.7 (npairs=14), p=0.003; false discovery rate 0.02). The decrease of Firmicutes was not significant in the OPP group. Conclusions: Despite the intensity of dental prophylaxis and decreasing clinical signs of inflammation and decreasing plaque amount, no clinically relevant changes in the tongue microbiome were observed. Our results confirm the conserved and stable nature of the tongue microbiome, even in children with CKD. [ABSTRACT FROM AUTHOR]

Background: This study focuses on the determination and classification of patients as rapid or slowcalculusformersbasedontherateofcalculusformationafteroralprophylaxis. It also aims to determine the factors that positively impact the formation and deposition of calculus in patients and identify the factors that accelerate or decelerate the deposition of calculus. Methods: The study was conducted in the Department of Periodontology, Dr Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University Chandigarh, India. We examined 51 patients after a month of the oral prophylaxis, recorded the amount of calculus present in the oral cavity, and then recorded a detailed history which was briefly divided into Age, Sex, Residence, Oral habits, and maintenance of oral hygiene. Results: An evident and meaningful link was found between age and the rate at which dental calculus forms. The average age of individuals differed significantly between the rapid and slow calculus formers, which could be ascribed to the decline in manual dexterity as age increases, resulting in less effective oral hygiene habits, including toothbrushing. None of the other factors dietary and oral hygiene related could be identified distinctly, probably owing to the small sample of the study. The oral health status exhibited a significant difference between slow and rapid calculus formers. Conclusions: Within the limitations of the study, the data analyzed, identified age as a significant determinant that impact the rate of formation of calculus in patients and reported a significant difference in the oral health status of rapid and slow calculus formers. [ABSTRACT FROM AUTHOR]

Objectives: The relationship between adherence to professional oral maintenance visits and tooth loss is generally accepted in periodontal treatment; however, this relationship has not been clarified in general dental practices. We evaluated the effectiveness of adherence to professional maintenance by a retrospective survey in a private practice. Methods: We retrospectively extracted data of 395 patients in a general dental practice who had been followed for more than 20 years. For comparisons, two patient groups were created based on oral maintenance rates: a high‐ (≥75%) and a low‐ (<75%) adherence groups. Additionally, multiple logistic regression analysis for tooth loss was conducted with the same two adherence groups and three adherence groups (<50%, ≥50% and <75% and ≥75%), adjusting with risk factors including sex, age, decayed, missing, and filled teeth (DMFT), periodontal status, smoking status, and diabetes at the beginning of maintenance. Results: The number of teeth lost and increased DMFT over time were significantly lower in the high‐adherence group than in the low‐adherence group. Multiple logistic regression analysis for tooth loss in the two adherence groups yielded an odds ratio (95% confidence interval) of 6.50 (3.73–11.32) in the low‐adherence group relative to the high‐adherence group. Further analysis with the three adherence groups showed highest risk in the low‐adherence group and a higher risk in the moderate‐adherence group than the high‐adherence group. Conclusions: Patients with high adherence to maintenance schedules for more than 20 years demonstrated significantly less tooth loss. Dental practitioners should promote high adherence to professional maintenance in general dental practices. [ABSTRACT FROM AUTHOR]

Aim: This study evaluated the efficacy of quadrantwise subgingival instrumentation (Q‐SI) versus one‐stage full‐mouth subgingival instrumentation (FM‐SI) on probing depth and periodontal pathogen reduction over a 6‐month follow‐up period, as well as whether baseline periodontal pathogens influenced the impact of periodontal treatment protocols on outcomes. Methods: Patients with periodontitis were randomized to receive Q‐SI (n = 43) or FM‐SI (n = 45). Patients were instructed and motivated to maintain optimal oral hygiene during the treatment sessions. Clinical (probing pocket depth [PPD], clinical attachment loss [CAL], and bleeding on probing [BOP]) and periodontal pathogens were assessed at baseline and after 30, 90, and 180 days. Total bacterial load and periodontal pathogens were analysed via real‐time PCR. Results: At the 6‐month follow‐up, the median PPD decreased from 4.8 mm (interquartile range [IQR]: 4.3–5.2) to 2.6 mm (IQR: 2.3–2.9) in FM‐SI patients and from 4.7 mm (IQR: 4.1–5.2) to 3.2 mm (IQR: 2.4–3.5) in Q‐SI patients (p <.001). At 6 months, FM‐SI was more effective at reducing the median proportions of Porphyromonas gingivalis (Pg), Aggregatibacter actinocomyctemcomitans, and Tannerella forsythia (Tf) (p <.001 for each value). Multilevel linear regression analysis demonstrated that high baseline PPD (p =.029), Pg (p =.014), and Tf (p <.001) levels and the FM‐SI protocol (p <.001) were statistically significant predictors of PPD reduction at 6 months. Furthermore, PPD reduction was significantly greater in the FM‐SI group when lower baseline Pg levels were detected. Conclusion: The FM‐SI was more effective than the Q‐SI in reducing the mean PPD and number of periodontal pathogens in periodontitis patients over a 6‐month follow‐up period. Higher baseline PPD and Pg levels had a negative impact on PPD reduction at 6 months after FM‐SI. [ABSTRACT FROM AUTHOR]

Introduction: Guidelines regarding postsurgical dental care have been common in adult total joint arthroplasty patients despite limited supporting evidence in the literature. There is anecdotal evidence that similar precautions are implemented frequently in postoperative pediatric orthopaedic patients without any published evidence to guide clinicians. Methods: A survey of the Active Members of the Pediatric Orthopaedic Society of North America (POSNA) was performed to assess the use of postsurgical guidelines regarding dental care (procedures and prophylaxis) in pediatric patients. A 20-question survey regarding this subject was developed with the input of, and approved by, the Evidence-Based Practice Committee of POSNA, and a link to participate was distributed to the Active Membership. Results: One hundred seventy-three POSNA Members opened the link to the survey. One hundred sixty-three respondents self-identified as Active, for a response rate of 19.8%. One hundred fifty-seven (96.3%) reported direct involvement in surgical and postsurgical care of pediatric orthopaedic patients. Sixty-two (39.4%) indicated use of a postoperative protocol regarding dental interventions. Forty percent of those indicating use of guidelines were uncertain of the specifics of the protocol(s) used at their institution. Eighty-five percent of those utilizing protocols felt that the use of guidelines was a valuable topic for investigation. Conclusions: These results demonstrate that many of the active Members of POSNA utilize postsurgical guidelines for dental care, particularly for those patients who have undergone spinal surgery with permanent implants. This is despite the fact that there is limited evidence to support their use in adult total joint patients and no literature regarding use of such guidelines in pediatric orthopaedic patients. Key Concepts: (1) There is limited and contradictory evidence that postsurgical dental guidelines are indicated in adult orthopaedic patients. (2) There is no published evidence supporting postsurgical dental guidelines in pediatric orthopaedic patients. (3) Almost 40% of active Pediatric Orthopaedic Society of North America Members responding to a survey appear to utilize postsurgical dental care guidelines in pediatric patients, particularly after spinal procedures utilizing implants. Level of Evidence: Level V

ABSTRACT: Aim: The current study's objective was to assess and contrast the benefits of herbal and chemical mouthwash in patients with persistent, widespread gingivitis. Material and Method: Forty-five patients between the ages of 30 and 50 having persistent generalized gingivitis were enrolled in the study and randomly assigned to three groups: Group A received oral prophylaxis, group B received oral prophylaxis and prescribed chemical mouthwash, group C received oral prophylaxis and prescribed herbal mouthwash. The patients were under observation for forty-five days. At the baseline, 7th, 30th, and 45th day gingival index was measured, and the data were statistically analyzed. The one-way ANOVA and Tukey's post-hoc test were performed. Result: The gingival index showed a significant difference. Over time, the gingival index tends to decrease with the use of herbal mouthwash. Conclusion: In summary, our initial investigation demonstrates that herbal mouthwashes are just as successful in reducing gingival inflammation as chlorhexidine further significant difference observed in 30th and 45th day with chlorhexidine. Therefore, in addition to routine dental care, these ayurvedic medications can be taken to reduce gingivitis. [ABSTRACT FROM AUTHOR]

The loss of teeth causes inevitable resorption of the alveolar bone. In the anterior arches, the curved anatomy further adds to the challenge of rehabilitation. These areas often require the shaping of membranes and multiple bone blocks through complex surgery to compensate for the curvature. The split bone block technique (SBBT) has been successfully used in complicated cases. However, the inability to create curves from the blocks means that larger quantities of bone or membranes are needed to compensate for this. Bone bending based on an ancient woodbending technique known as kerfing is proposed to shape rigid SBB plates to recreate the natural anatomy of anterior arches. Three patients presenting with bone destruction of the anterior maxilla underwent bone augmentation before implant placement using the SBBT combined with kerfing. The plates were successfully bent to the shape of each maxilla without any deleterious effects. All bone grafts healed uneventfully, and the bone curvature was successfully reconstructed. No complications were reported. Implant placement took place after 4 months and definitive restorations after 7 to 9 months. Clinical and radiographic assessments were performed at 1 year. Full customization of autogenous bone plates was possible through kerfing. This approach resulted in an ideal bone curve and shape in the facial and palatal aspects of the anterior maxilla. In addition, it enabled ideal implant placement with reduced bone harvesting volumes and decreased the need for soft tissue augmentation to recreate the curved shape. This technique promoted close-fitting autologous osseous plates that followed the anatomical curvature of the anterior maxilla, leading to optimal healing and excellent regeneration of the ridge width. This principle can be valuable when dealing with complex anatomical defects. [ABSTRACT FROM AUTHOR]

The rehabilitation of severely worn teeth is a complex challenge for dental practitioners. There are many different types of dental materials and restorative techniques, and there is not a single way to achieve the desired result. This clinical report demonstrates a complete oral rehabilitation with composite resins when using an indirect application and direct techniques, with the support of the Lucia Jig technique, the Willis technique, and diagnostic waxing for the vertical dimension correction. The wide clinical improvement was achieved with the recovery of the function, the esthetics, and the increase of vertical dimension of occlusion through the planned treatment. The proposed treatment maintained the natural teeth, without the intense wear by the application of the composite resins instead of ceramics, together with excellent conditions for the patient to control the posttreatment and extend the durability, with the correct follow-up of appointments. Young patients with extensive dental wear and the loss of vertical dimension should not be directly submitted to ceramic treatments, with preparations for full crowns. Oral rehabilitation using composite resins, either directly or indirectly, allows for the recovery of the function and esthetics, without the intense predictable dental wear, and reduced financial investment. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the effect of in-vivo produced Nisin which is an antimicrobial peptide (AMP) added to adhesive resin on shear bond strength (SBS) and the adhesive remnant index (ARI) of orthodontic brackets. Methods: Bacterial AMP was produced by fermentation and the ideal AMP/Bond concentration and antimicrobial efficacy of the mixture were tested. To evaluate the SBS and ARI scores of AMP-added adhesive resins, 80 maxillary premolar teeth extracted for orthodontic purposes were used and randomly assigned into 2 groups (n = 40). Group 1: Control Group (teeth bonded with standard adhesive resin); Group 2: Experimental Group (teeth bonded with AMP-added adhesive resin). Statistical analysis was performed using the SPSS package program and applying the Mann-Whitney U and Fisher's exact tests. P < 0.05 was considered as statistically significant. Results: Nisin synthesized in-vivo from Lactococcus lactis (L. lactis) (ATCC 7962) bacteria was provided to form a homogenous solution at an ideal concentration To find the minimum AMP/Bond mixture ratio that showed maximum antimicrobial activity, AMP and Bond mixtures were tested at various concentration levels between 1/160 and 1/2 (AMP/Bond). As a result, the optimum ratio was determined as 1/40. The antimicrobial efficacy of Nisin-added adhesive resin was tested against Streptococcus mutans (S. mutans) (ATCC 35,688) and Lactobacillus strains (cariogenic microorganisms). AMP formed a 2.7 cm diameter zone alone, while 1/40 AMP-bond mixture formed a 1.2 cm diameter zone. SBS values of the teeth bonded with Nisin added adhesive (17.49 ± 5.31) were significantly higher than the control group (14.54 ± 4.96) (P = 0.004). According to the four point scale, Nisin added adhesive provided a higher ARI score in favour of the adhesive and tooth compared to the control group (ARI = 3, n = 20). Conclusions: Nisin produced from L. lactis (ATCC 7962) had greater antimicrobial effects after mixing with adhesive bond against cariogenic microorganisms S. mutans (ATCC 35,688) and Lactobacillus strains. Nisin added adhesive increased shear bond strength (SBS) of orthodontic brackets and ARI scores in favor of adhesive & teeth. Clinical relevance: Clinicians should take into account that using Nisin-added adhesive resin in orthodontic treatments can provide prophylaxis against tooth decay, especially in patients with poor oral hygiene. [ABSTRACT FROM AUTHOR]

Infection management in solid organ transplantation poses unique challenges, with a diverse array of potential pathogens and associated antimicrobial therapies. With limited high-quality randomized clinical trials to direct optimal care, therapeutic "myths" may propagate and contribute to suboptimal or excessive antimicrobial use. We discuss 6 therapeutic myths with particular relevance to solid organ transplantation and provide recommendations for infectious diseases clinicians involved in the care of this high-risk population. [ABSTRACT FROM AUTHOR]

Introduction: Proper tooth brushing is a complicated process for children. Therefore, the aim of this study was to investigate the effect of differential learning to improve tooth brushing in children. Methods: In this prospective, controlled, single-blinded, randomized clinical trial, 58 children between 3 and 8 years of age (mean: 5.7 ± 1.5 years; 29 female) were randomly assigned to test or control group through the child's self-drawing of an unlabeled envelope from a box. All children received oral hygiene instructions and information in these sealed envelopes and were asked to follow the corresponding instructions at home for 28 days. Children in the test group received instructions with exercises using the differential learning method, whereas the children in the control group received the usual tooth brushing instructions. Results: At baseline and planned follow-ups after 4 and 12 weeks, plaque and gingival indices (QHI, PBI) were recorded in both groups by 2 calibrated and blinded investigators. At baseline, there were no significant differences between the test and control groups regarding plaque and gingival indices (QHI: 4.1 ± 0.5 vs. 4.1 ± 0.4; p = 0.7; PBI: 0.6 ± 0.3 vs. 0.6 ± 0.3; p = 0.7). At the 1st and 2nd follow-up, both groups showed improved oral health indices, but there was an overall better improvement in the test group. While the difference in gingival indices was statistically significant in the 1st recall (PBI/test: 0.1 ± 0.2 vs. control: 0.3 ± 0.2; p < 0.001), the difference in plaque indices was not (QHI/test: 2.1 ± 0.9; control: 2.6 ± 0.9; p = 0.07). At the 2nd recall (mean week = 19.5 weeks), the test group showed statistically significant and clinically relevant better oral health indices than the control group (2nd recall, QHI/test: 2.1 ± 0.9 vs. control: 3.2 ± 1; p < 0.001; PBI/test: 0.1 ± 0.2 vs. control: 0.5 ± 0.2; p < 0.001). Conclusion: In conclusion, differential learning leads to oral hygiene improvement in children with high caries risk and initially poor oral hygiene, which was superior to the conventional learning method through repetition in the medium term. [ABSTRACT FROM AUTHOR]

Focal osteoporotic bone marrow defects (FOBMDs) of jaws are rare and usually discovered as an incidental radiographic finding. They present as a poorly demarcated radiolucency affecting the posterior mandible of middle-aged women with pathogenesis remaining unknown. A 60-year-old female patient had visited our dental college for routine dental checkup and oral prophylaxis. Her radiograph revealed a well-defined radiolucency in the left mandibular posterior region as an incidental finding. Clinical examination revealed a diffuse swelling in the above-mentioned region which the patient had not noticed. The patient gave a history of trauma in the same region almost 20 years back. Incisional biopsy was performed. Microscopic examination revealed multiple bits of fatty fibro cellular tissue resembling the bone marrow with aggregates of blood cells. A diagnosis of FOBMD was given. FOBMD, although rare, should be included in differential diagnosis of the radiolucent lesions of the jaws. [ABSTRACT FROM AUTHOR]

(1) Background: Periodontal instrumentation with dental curettes is associated with discomfort, fatigue, and musculoskeletal diseases. The goal of this study was to compare comfort, fatigue, and muscle work using three different curettes. (2) Methods: Eight hygienists each scaled three typodonts using the three different curettes. Curette A was a prototype with a novel adaptive design, Curette B had a conventional stainless-steel design, and Curette C featured a conventional silicon-covered handle. Time-based work in four muscles, comfort, fatigue, tactile feedback, grip and blade position, and pinch and grasp strength were recorded. Statistical analysis was performed using a General Linear Model (GLIM) and Tukey's post hoc test. The level of significance was set at p < 0.05. (3) Results: Comfort, correct grasp, fingertip placement, and blade-to-tooth adaptation were significantly better with Curette A (p < 0.05). While pinch and grasp strength were significantly reduced post-instrumentation for Curettes B and C (p < 0.05), they remained unchanged for Curette A. Curette A required significantly less total muscle work and work in individual muscles, resulting in significantly less post-instrumentation fatigue than for Curettes B and C, but similar levels of tactile feedback (p < 0.05). (4) Conclusions: The ergonomic performance of a prototype adaptive periodontal curette was significantly better than that of two conventional instruments with rigid handle designs. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the effects of diabetes care on periodontal inflammation. Materials and Methods: This prospective cohort study included 51 Japanese patients with type 2 diabetes who underwent intensive diabetes care including educational hospitalization and regular outpatient treatment for 6 months. Dental prophylaxis without subgingival scaling was provided three times during the observational period. Associations between changes in periodontal parameters and glycaemic control levels were evaluated using multiple regression analysis. Results: Overall, 33 participants (mean age: 58.7 ± 12.9) were followed up for 6 months. At baseline examination, 82% were diagnosed with Stage III or IV periodontitis. Haemoglobin A1c (HbA1c) level changed from 9.6 ± 1.8% at baseline to 7.4 ± 1.3% at 6 months. The ratio of probing pocket depth (PPD) ≥4 mm, bleeding on probing (BOP), full‐mouth plaque control record (PCR), periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) also significantly improved. The reduction in PPD and PESA was significantly associated with changes in both HbA1c and fasting plasma glucose (FPG) levels, and the reduction in PISA was significantly associated with an improvement in FPG after adjusting for smoking, change in body mass index and full‐mouth PCR. Conclusions: This is the first study to report a significant improvement in PPD and BOP after intensive diabetes care and dental prophylaxis without subgingival scaling. Clinical trial registration number: UMIN000040218. [ABSTRACT FROM AUTHOR]

Aim: To evaluate site‐related changes in periodontal pocket depth (PPD) after non‐surgical periodontal therapy and to identify predictors for PPD changes in a retrospective patient data analysis. Materials and Methods: PPD, clinical attachment level, bleeding on probing, tooth mobility (TM), furcation involvement (FI), abutment status, adherence to supportive periodontal care (SPC) and SPC follow‐ups were obtained from fully documented patient data before periodontal therapy (baseline, T0), after active periodontal therapy (APT, T1) and during SPC (T2). PPD changes were classified into deteriorated or unchanged/improved at the site level. Multi‐level logistic regression analysis was performed to identify factors influencing PPD changes during SPC. Results: This retrospective study included 51 females and 65 males (mean T0 age: 54.8 ± 10.1 years, 25 smokers, 12 diabetics) suffering from Stage III/IV periodontitis. Evaluation outcome: T0/16,044 sampling sites/2674 teeth; T1/15,636/2606; T2/14,754/2459. During 9.0 ± 2.3 years SPC, PPD decreased (−1.33 ± 0.70 mm) by 21.8% of the sites, remained unchanged by 41.4% and increased (1.40 ± 0.78 mm) by 36.8%. Distopalatal FI (p <.001, odds ratio [OR]: 0.252, 95% confidence interval [CI] for OR: 0.118–0.540), residual pockets (p <.001, OR: 0.503, 95% CI: 0.429–0.590) and TM Degrees I–III (Degree I: p =.002, OR: 0.765, 95% CI: 0.646–0.905; Degree II: p =.006, OR: 0.658, 95% CI: 0.489–0.886; Degree III: p =.023, OR: 0.398, 95% CI: 0.180–0.879) correlated significantly with increasing PPD. Conclusions: Over 75% of PPD remained unchanged or increased during SPC. Distopalatal FI, TM Degrees I–III and residual pockets after APT lead to worsening of periodontal pockets. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) directly affects oral health. Yet data about halitosis in young CKD patients and the impact of dental prophylaxis is limited. Therefore, as part of this randomized clinical trial, halitosis in young CKD patients undergoing intensive or standard oral preventive procedures was to be explored. Methods: Three volatile sulfur compounds (hydrogen sulfide, methyl mercaptan and dimethyl sulfide) were measured in 30 young patients with CKD (mean age 14.2 years; 16 males, 14 females). Breath samples were taken after 3 and 6 months and analyzed with selective gas chromatography (OralChroma). Tongue coating (Winkel Index) and clinical indices to determine local inflammation or oral hygiene (Papillary Bleeding Index and Quigley-Hein Index) were assessed. Within an extended anamnesis, patients and their mothers and nurses were questioned about the perceived halitosis. Corresponding quotes were noted verbatim. Patients were randomized to either intensive need-related oral health care measures (oral preventative program, OPP) or a one-stage standard prevention (treatment as usual, TAU). Results: While there were no differences in volatile sulfur compound levels between TAU and OPP at the three time points of measurements (p > 0.05), there was a tendency towards a reduction in dimethyl sulfide and hydrogen sulfide of affected patients within the OPP group over time. Looking at potential differences between both groups with regard to tongue coating, significant differences were observed between baseline and 3 months after study start in the OPP group, and between baseline and 6 months after study start in the TAU group (p < 0.05). The burden of halitosis was frequently reported by patients' mothers and nurses. Conclusions: Young CKD patients regularly suffered from halitosis and dimethyl sulfide was its main source. Preventive measures mainly resulted in a reduction of tongue coating. Trial registration: The German Clinical Trial Register (# DRKS00010580). [ABSTRACT FROM AUTHOR]

Background: Periodontitis represents the foremost oral condition in young men, strongly correlated with socioeconomic elements and oral health behaviors. This research aimed to assess the prevalence of periodontitis and associated associations with socio-demographics and oral health practices for subsequent Hazard Ratio (HR) estimation. Methods: A total of 46,476 young men were recruited to the study between August 2022 and October 2023. A questionnaire on socio-demographic factors and oral health-related behaviors related to periodontitis was completed. The standard procedure was used for oral examination. Logistic regression and hazard ratios were used to estimate the influencing factors, whereas the nomogram was used to predict the risk of periodontitis in young men. Results: A total of 46,476 young men were surveyed and completed the questionnaire. The overall prevalence of periodontitis among young men was 1.74%. Out of these, 1.7% had mild periodontitis and 0.6% had moderate periodontitis. Age and dental calculus were important factors in the periodontal health of young men. This nomogram, which includes 7 easily obtainable clinical characteristics routinely collected during periodontitis risk assessment, provides clinicians with a user-friendly tool to assess the risk of periodontal disease in young men. Conclusions: Regular dental prophylaxis is crucial for young men to maintain their gingival health and prevent the onset of periodontitis. Dental calculus plays a prominent role in this matter, as it serves as a significant contributing factor. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the prevalence of oral bacteria in the conjunctiva of brachycephalic and nonbrachycephalic dogs. ANIMALS 12 brachycephalic (9.58 ± 3.55 years) and 12 nonbrachycephalic (8.33 ± 4.92 years) dogs without systemic disease, regardless of breed and sex, were included in the study, and half of the dogs in each group had periodontitis. METHODS This prospective study investigated clinical data including craniofacial ratio, ophthalmic examination results, and periodontal status of the included dogs. Bacterial samples were collected by swabbing the oral mucosa and conjunctival surfaces. The presence and quantity of bacteria were analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, 16S rRNA sequencing analysis, and the 10-fold dilution method. Statistical analyses were performed to assess correlations and factors influencing the presence of oral bacteria in the conjunctiva. RESULTS The most common bacteria in the conjunctival flora in both groups were Micrococcus luteus, Corynebacterium spp, and Staphylococcus spp. The prevalence of oral bacteria on the conjunctival surface was 33%, with a significantly higher incidence in brachycephalic dogs (P = .027). Oral bacteria detected in the conjunctiva were predominantly Frederiksenia canicola, Neisseria spp, and Moraxella spp. Multiple regression analysis identified age, craniofacial ratio, and gingival index as factors influencing the presence of oral bacteria in the conjunctival flora. CLINICAL RELEVANCE Oral resident bacteria have often been isolated from severe infectious corneal ulcers. This study provided evidence that brachycephalic dogs may require dental prophylaxis to reduce their oral bacterial load and that the association of oral bacteria in ocular diseases should be considered. [ABSTRACT FROM AUTHOR]

Introduction: Dental examination and stabilization are performed prior to allogeneic hematopoietic cell transplantation to decrease infection risk during neutropenia. Burden of dental disease and treatment need is not well characterized in this population. Objectives: This report describes the dental status of a cohort of patients within the Chronic Graft‐versus‐Host Disease Consortium and treatment rendered prior to transplant. Methods: The cohort included 486 subjects (Fred Hutchinson: n = 245; Dana‐Farber: n = 241). Both centers have institutional‐based dental clearance programs. Data were retrospectively abstracted from medical records by calibrated oral health specialists. Results: The median age at transplant was 55.9 years, 62.1% were male, and 88% were white. Thirteen patients were edentulous (2.7%). The mean teeth among dentate patients before clearance was 26.0 (SD, 4.6). Dental findings included untreated caries (31.2%), restorations (91.6%), endodontically treated teeth (48.1%), and dental implants (5.7%). Pretransplant procedures during clearance included endodontic therapy (3.6%; mean = 0.1 teeth), restorations (25.1%; mean = 0.7), dental prophylaxis (59.2%), scaling/root planing (5.1%), and extraction (13.2%; mean = 0.3). The mean teeth after clearance was 25.6 (SD, 5.0). Conclusions: Retrospective analysis of pre‐AlloHCT dental data in subjects at two large transplant centers identified low levels of dental need. Findings suggest high access to care. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to determine whether visiting only a pediatric dentist (as opposed to visiting only a general dentist) was associated with the provision of preventive dental services for a U.S.-based pediatric population (those 18 years and younger). Methods: This study analyzed pooled Medical Expenditure Panel Survey data from 2018 and 2019 to compare the use of certain preventive dental services (i.e., examination, radiographs, prophylaxis, dental sealant, and fluoride treatment) among those who reported visiting a pediatric dentist versus those who visited a general dentist. Survey procedures were used in Stata 14.0 to perform multivariable logistic regression analyses. Results: Controlling for demographic and insurance variables, children who visited only pediatric dentists had statistically significantly greater odds of receiving radiographs (adjusted odds ratio [AOR] equals 1.22; 95 percent confidence interval [95% CI] equals 1.01 to 1.48; P=0.04), fluoride treatment (AOR equals 1.57; 95% CI equals 1.30 to 1.90; P≤0.001), and sealants (AOR equals 1.63; 95% CI equals 1.24 to 2.16; P=0.001) compared to children who visited only general dentists. There was no statistically significant difference in the provision of periodic examinations and prophylaxis services. Conclusion: Based on the nationally representative data evaluated, pediatric dentists are more likely to provide more optimal preventive services than general dentists (i.e., radiographs, fluoride treatments, and sealants) to children in the United States. [ABSTRACT FROM AUTHOR]

Objectives: To simulate the abrasive potential of an interdental brush when applied with toothpastes and prophylactic gels/solutions in a novel laboratory brushing simulation set‐up. Methods: A brushing device was customized to treat dentin samples mimicking a simplified interdental space with an interdental brush (ISO 2). The brushing, that is, 7200 strokes for 1 h, was performed with artificial saliva (control), a povidone‐iodine solution, and slurries of chlorhexidine and fluoride gels as well as three toothpastes with different RDA values ranging from 29 to 100, respectively. The loss of dentin was profilometrically assessed and compared with ANOVA and Fishers LSD. Results: While artificial saliva as control, the solution and the gel slurries showed no measurable dentin loss, toothpastes resulted in a measurable linear surface damage with respect to the actual intrinsic RDA values and ranged from 12.6 to 26.5 μm (p < 0.001). Conclusions: Any interdental cleaning product should be tailored and carefully instructed. Any over‐ and misuse should be avoided, which applies especially to the use of interdental brushes in combination with abrasive toothpastes. [ABSTRACT FROM AUTHOR]

IntroductionGingivitis is a common intraoral disease in patients with chronic kidney disease (CKD), which poses a particular interdisciplinary challenge. We aimed to determine the influence of an intensive oral prophylaxis program (OPP) compared to standard prevention measures on the tongue microbiome of young patients with CKD.MethodsThirty patients with CKD (mean age 14.2 ± 5.2 years) and generalized gingivitis were included. The effects of the intensive OPP were compared with standard prophylaxis according to statutory health insurance (treatment as usual, TAU) as a control. Tongue swabs were taken from the patients at baseline (t1) and after 3 (t2) and 6 (t3) months. Next-generation sequencing of 16S rDNA genes was used to quantitatively characterize microbial communities.ResultsThere were no differences in the abundance, richness, or diversity of the observed genera and species between the two study groups at baseline or after 3 or 6 months. Furthermore, no change in predefined gingivitis and oral health bacterial clusters were found. At the phylum level, Firmicutes were decreased after intervention in the TAU group (t2TAU 42.9 ± 7.1 to t3TAU 34.8 ± 4.7 (npairs=14), p=0.003; false discovery rate 0.02). The decrease of Firmicutes was not significant in the OPP group.ConclusionsDespite the intensity of dental prophylaxis and decreasing clinical signs of inflammation and decreasing plaque amount, no clinically relevant changes in the tongue microbiome were observed. Our results confirm the conserved and stable nature of the tongue microbiome, even in children with CKD.

Objective: Chlorhexidine is the gold standard for chemical biofilm control in dentistry. As with all therapeutic agents, side effects should be considered, which may include allergic reactions. The present review focused on the allergy-causing potential of dental CHX mouthrinses. Method and materials: Four databases were searched for systematic reviews related to chlorhexidine and dentistry (MEDLINE, Embase, Web of Science, and Scopus). Original papers available in the identified studies and meta-analyses were individually screened for allergy by both authors. Results: An initial 804 studies were identified, of which 46 systematic reviews and the original papers described therein were ultimately analyzed. Only two reviews explicitly addressed the topic of allergy. In a total of 194 original studies and a total of 9,698 patients, no allergies were reported. In 44 control studies, the topic was touched upon, but only in connection with the inclusion and exclusion criteria and possible contraindications. Conclusions: The topic of "allergy" regarding chlorhexidine application as a mouth rinse in dentistry seems to be omnipresent. Nevertheless, true allergies to chlorhexidine in dentistry appear to be low to nonexistent. Precautions, however, should still be taken in practice and further studies should be envisaged, especially in patients with an alleged history of chlorhexidine contact allergy. [ABSTRACT FROM AUTHOR]

(1) Background: Periodontal instrumentation with dental curettes is associated with discomfort, fatigue, and musculoskeletal diseases. The goal of this study was to compare comfort, fatigue, and muscle work using three different curettes. (2) Methods: Eight hygienists each scaled three typodonts using the three different curettes. Curette A was a prototype with a novel adaptive design, Curette B had a conventional stainless-steel design, and Curette C featured a conventional silicon-covered handle. Time-based work in four muscles, comfort, fatigue, tactile feedback, grip and blade position, and pinch and grasp strength were recorded. Statistical analysis was performed using a General Linear Model (GLIM) and Tukey’s post hoc test. The level of significance was set at p < 0.05. (3) Results: Comfort, correct grasp, fingertip placement, and blade-to-tooth adaptation were significantly better with Curette A (p < 0.05). While pinch and grasp strength were significantly reduced post-instrumentation for Curettes B and C (p < 0.05), they remained unchanged for Curette A. Curette A required significantly less total muscle work and work in individual muscles, resulting in significantly less post-instrumentation fatigue than for Curettes B and C, but similar levels of tactile feedback (p < 0.05). (4) Conclusions: The ergonomic performance of a prototype adaptive periodontal curette was significantly better than that of two conventional instruments with rigid handle designs.

Abstract Background Achieving sufficient professional mechanical biofilm removal (PMPR) can be challenging in supportive periodontal therapy (SPT), particularly in patients with prosthetic restorations. This experimental study aimed to simulate five years of SPT with periodic PMPR near the luting gap of ceramic restorations using a rubber cup with polishing paste (RCP), air polishing with two different low-abrasive powders (LAPA-1: glycine powder, LAPA-2: erythritol powder), and non-professional mechanical cleaning (control group) to measure the extent of volume loss in the luting gap after baseline (∆V = Vbaseline-V1-5; in µm3). Methods Two operators randomly performed PMPR ten times for thirty seconds on one of four sides of 30 crown replicas fixed with glass-ionomer cement (CGIZ: n = 15) or adhesive bonding (CAB: n = 15). The replicas were separated in a template during PMPR, and afterward, cleaned for five seconds per side with a sonic brush under flowing water. The artificial aging process between two PMPRs simulated a 5-year SPT with two PMPRs per year. Profilometric measurements were performed at baseline and after each second PMPR to obtain the mean change of ∆V. The statistical evaluation of the data was carried out using nonparametric tests with Bonferroni correction applied for multiple tests. Results Ninety-six out of 120 sides could be included in the analysis. PMPR methods showed a loss of substance in the luting gap with a ∆V (mean(standard deviation)) of -4.35 × 106(4.8 × 106)µm3 versus 8.79 × 104(1.05 × 106)µm3 for control at V5 (p ≤ 0.001). No significant differences of ∆V1-5 values could be identified in the control (p > 0.05), whereat all PMPRs showed a significant increasing loss of substance per simulated year (p ≤ 0.001). Intergroup comparison identified LAPA-1 as having the highest significant loss of substance determined on CAB (∆V: -1.05 × 107 (7,2 × 106) µm3), followed by LAPA-2 on CAB (∆V: -6.29 × 106 (4,24 × 106) µm3), LAPA-1 on CGIZ (∆V: -4.15 × 106 (3,25 × 106) µm3), LAPA-2 on CGIZ (∆V: -3.0 × 106 (2,23 × 106) µm3), RCP on CAB (∆V: -1.86 × 106 (2,23 × 106) µm3) and CGIZ (∆V: -1.2 × 106 (1,31 × 106) µm3; p ≤ 0.001)). Conclusions Within study limitations, all PMPRs caused a significantly higher loss of substance in the luting gap versus control without professional intervention, with the highest values in the CAB group for LAPA-1, LAPA-2 and RCP. Similar findings were observed for CGIZ, although the loss values were lower.

A 31-year-old man presented with gingival mass-like lesions. The patient reported occasional bleeding from lesions; otherwise, the lesions were asymptomatic. Intraoral examination revealed multiple interdental red/purple soft, sessile, nodular lesions involving both the maxillary and mandibular buccal and lingual gingivae, with poor oral hygiene. After performing incisional biopsy, the patient was diagnosed with pyogenic granuloma. Subsequently, the patient underwent cleaning of his teeth and within only 3 days of dental cleaning, the patient reported rapid regression of all his lesions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and summarize clinical practice guidelines on the prevention, diagnosis, and treatment of dental diseases during pregnancy, and to provide summary recommendations for general dental practitioners involved in the dental care of pregnant women. Method and materials: Using keywords related to prenatal dental care in combination with guidelines or consensus statements, online databases, websites of professional organizations, and evidence-based practice platforms were searched. Published guidelines or consensus statements that met the inclusion criteria were selected and evaluated with the Appraisal of Guidelines for Research & Evaluation Instrument II (AGREE-II) tool. Key recommendations were summarized and assessed for consistency across the guidelines. Results: A total of 15 guidelines or consensus statement documents for oral health care during pregnancy were found after the initial search, of which 7 documents met the inclusion criteria; these were analyzed with AGREE-II. These guidelines were developed by expert panels and consensus meetings after comprehensive review of the best available evidence, and consistently deliver clear messages that preventive, diagnostic, restorative, and periodontal procedures and tooth extractions are safe throughout pregnancy and effective in improving and maintaining the oral health of mothers and their children. Dental diseases should be treated in a timely manner and dental emergency treatments can be provided at any time during pregnancy. Dental examination and prophylaxis should be conducted every 6 months to maintain the oral health of pregnant women. Con clusion: Published clinical guidelines are consistent in delivering clear messages and providing guidance to dental practitioners for timely and effective dental care during pregnancy. Prevention, diagnosis, and treatment of oral diseases are safe throughout the pregnancy. [ABSTRACT FROM AUTHOR]

To evaluate the timing, duration and incidence of bacteremia following invasive dental procedures (IDPs) or activities of daily living (ADL). Eight databases were searched for randomized (RCTs) and nonrandomized controlled trials (nRCTs) evaluating bacteremia before and after IDPs or ADL in healthy individuals. The risk of bias was assessed by RoB 2.0 and ROBINS‐I. For the meta‐analysis, the primary outcomes were the timing and duration of bacteremia. The secondary outcome was the incidence of bacteremia, measuring the proportion of patients with bacteremia within 5 min after the end of the procedure compared with baseline. We included 64 nRCTs and 25 RCTs. Peak bacteremia occurred within 5 min after the procedure and then decreased over time. Dental extractions showed the highest incidence of bacteremia (62%–66%), followed by scaling and root planing (SRP) (44%–36%) and oral health procedures (OHP) (e.g., dental prophylaxis and dental probing without SRP) (27%–28%). Other ADL (flossing and chewing) (16%) and toothbrushing (8%–26%) resulted in bacteremia as well. The majority of studies had some concerns RCTs or moderate risk of bias nRCTs. Dental extractions, SRP and OHP, are associated with the highest frequency of bacteremia. Toothbrushing, flossing, and chewing also caused bacteremia in lower frequency. [ABSTRACT FROM AUTHOR]

Background: The Brazilian Dental Specialty Centers (CEO, in Portuguese) represent the strategy of the National Oral Health Policy to provide secondary-level dental care. They offer more complex procedures, such as the treatment of periodontitis. This study aims to investigate the factors associated with the performance and the achievement goals of specialized procedures and the achievement gols of periodontics in CEO. Methodology: Analytical and cross-sectional study using secondary data. The database of the second cycle of the External Evaluation of the National Program for Improving Access and Quality in CEO (PMAQ-CEO, in Portuguese), was utilized, which assessed 1,042 CEO on-site in 2018. The data were analyzed using multiple Poisson regression, estimating the prevalence ratio (PR) (p < 0.05). Results: A third of the CEO (n = 305) performed all specialized procedures, with a higher prevalence observed in those with more than one bicarbonate jet prophylaxis unit (RP = 2.12; 95% CI: 1.160–3.881; p = 0.015) and when they had a higher percentage of specialist professionals (RP = 1.004; 95% CI: 1.002–1.006; p < 0.001). The periodontics goal was achieved by 617 (59.2%) CEO, with a higher prevalence among those who had a manager with supplementary training (PR = 1.21; 95% CI: 1.100-1.335; p < 0.001) and with a higher workload for the periodontist dentist (PR = 1.15; 95% CI: 1.103–1.201; p < 0,001). Conclusion: Although most CEOs do not perform allspecialized periodontics procedures, more than half achieved the established goals. The provision of specialized periodontics services in CEO and the achievement of goals are influenced by the quantity and professional qualifications, as well as the availability of equipment. [ABSTRACT FROM AUTHOR]

Study Objective: Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed‐dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti‐Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single‐center study. This study compared BMI‐, TBW‐, EBV‐based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti‐Factor Xa (anti‐Xa) levels in trauma patients. Design: Multicenter, retrospective review. Data Source: Electronic health records from participating institutions. Patients: Adult trauma patients who received enoxaparin twice daily for VTE prophylaxis and had at least one appropriately timed anti‐Xa level (collected 3 to 6 hours after the previous dose after three consecutive doses) from January 2017 through December 2020. Patients were excluded if the hospital‐specific dosing protocol was not followed or if they had thermal burns with > 20% body surface area involvement. Intervention: Dosing strategy used to determine initial prophylactic dose of enoxaparin. Measurements: The primary end point was percentage of patients with peak anti‐Xa levels within the target prophylactic range (0.2‐0.4 units/mL). Main Results: Nine hospitals enrolled 742 unique patients. The most common dosing strategy was based on BMI (43.0%), followed by EBV (29.0%). Patients dosed using EBV had the highest percentage of target anti‐Xa levels (72.1%). Multiple logistic regression demonstrated EBV‐based dosing was significantly more likely to yield anti‐Xa levels at or above target compared to BMI‐based dosing (adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 2.29‐5.62, p < 0.001). EBV‐based dosing was also more likely than hybrid dosing to yield an anti‐Xa level at or above target (aOR 2.30, 95% CI 1.33‐3.98, p = 0.003). Other pairwise comparisons between dosing strategy groups were nonsignificant. Conclusions: An EBV‐based dosing strategy was associated with higher odds of achieving anti‐Xa level within target range for enoxaparin VTE prophylaxis compared to BMI‐based dosing and may be a preferred method for VTE prophylaxis in adult trauma patients. [ABSTRACT FROM AUTHOR]

Study Objective: The objective of the study was to assess clinical outcomes (composite of any venous thromboembolism [VTE], any bleeding, and mortality) associated with anti‐Xa monitoring in the 30 days following enoxaparin initiation for VTE prophylaxis. Design: Retrospective cohort study. Setting: Hospital within an academic healthcare system. Patients: Propensity score‐matched hospitalized adults receiving enoxaparin for VTE prophylaxis. Intervention: Low‐molecular‐weight heparin anti‐Xa monitoring. Measurements and Main Results: During the 13‐month study period, a total of 6611 patients received enoxaparin for VTE prophylaxis, 301 in the anti‐Xa monitored group and 6310 in the unmonitored group (4.6% received monitoring). The mean age was 52.9 years and 52% of patients were male. The mean body mass index was 31 kg/m2 and the mean creatinine clearance was 109 mL/min. Twenty percent of patients had active cancer. The most common indication for enoxaparin prophylaxis was hospitalization for medical illness (52%) followed by nonorthopedic surgery (37%). The adjusted odds ratio for the primary outcome comparing monitored to unmonitored patients was 1.26 (95% confidence interval, 0.75–2.11). None of the between‐group differences in the individual components of the composite outcome were statistically significant. Conclusions: Thirty‐day clinical outcomes in patients receiving enoxaparin for VTE prophylaxis were not improved by anti‐Xa monitoring. Our results support current evidence‐based guideline recommendations against anti‐Xa monitoring for patients receiving enoxaparin for VTE prophylaxis. [ABSTRACT FROM AUTHOR]

Introduction: While the dental management of patients with haemophilia has changed considerably in the last decade, haemophiliacs in Western Australia have continued to receive pre‐operative factor support for dentistry regardless of the type of dental procedure. Aim: To review the efficacy and safety of established dental protocols that reduce factor use in the dental management of patients with haemophilia and to estimate cost savings. Methods: Records of 11 patients with haemophilia that were seen in the pilot programme period were reviewed. These were cross‐referenced with previous dental and haematology notes that stated the amount and type of pre‐operative factor used. Cost savings were estimated using the Australian National Blood Authority's Product List. Results: All study participants were male, and included those with haemophilia A (n = 9), and B (n = 2). Mean age was 45 years (range 22–80). A variety of dental treatments were undertaken, and no pre‐operative factor was used. Patients on prophylaxis (n = 6) received dental treatment the same day as their regular factor administration. It was estimated AUD$26,314 was saved by not using pre‐operative factor. One patient had bleeding post‐extraction and was seen the following day to achieve haemostasis using local measures. The remaining patients had no complaints of post‐operative bleeding, and did not require any further haemostatic measures. Conclusion: This pilot programme supports data that haemophiliacs can safely receive a variety of dental treatments without the need for pre‐operative factor, and the significant cost savings of doing so. Further data is required to support this protocol for invasive dental procedures. [ABSTRACT FROM AUTHOR]

Dental caries remains a prevalent concern among children globally and is associated with Candida sp. Some researchers have suggested probiotic supplements as a possible solution for reducing dental caries. A study conducted in Tamil Nadu focused on collecting 80 dental caries samples from both males and females, obtained from two different locations. The samples underwent processing using the spread plate technique, followed by anticandidal activity assessments. Through ITS sequence analysis, candida strains were identified, including C. albicans (DDGRPO1, DDGRPO2). The study specifically investigated the ability of the probiotic bacterial strain Lb. fermentum cell-free filtrate to inhibit C. albicans. The research revealed that Lb. fermentum probiotics effectively inhibited the growth of C. albicans DDGRP01, displaying strong antifungal activity against Candida sp. (98%). While these results are promising, it is worth mentioning the increasing interest in exploring innovative alternatives to probiotic-based treatments. This avenue of research offers potential for a more comprehensive approach to addressing this issue. Notably, Lb. fermentum, derived from the human oral cavity, emerges as a significant postbiotic candidate for dental prophylaxis, indicating a hopeful direction for future studies. [ABSTRACT FROM AUTHOR]

Dentists are an overlooked group of prescribers but are responsible for up to 10% of antibiotic prescriptions written in the United States annually, most of which are for prophylaxis. Dental prophylaxis in orthopedic patients has been an area of confusion, with discordance among societal guidelines. In 2020, an antimicrobial stewardship (AS) group spearheaded a collaborative effort among dental, orthopedic surgery, and infectious diseases specialties to develop a protocol for the use of dental antibiotic prophylaxis for patients with total joint replacements (TJRs) based on the most current American Dental Association-American Academy of Orthopaedic Surgeons statement. This study aimed to assess antibiotic prescribing for dental prophylaxis before and after an AS intervention. This study is an interventional, pre-post review of dental encounters with patients with a history of TJR before (October 2019 to July 2021) and after (August 2021 to April 2023) the intervention. Charts were reviewed to determine the frequency and appropriateness of dental procedure prophylactic antibiotics. A total of 1587 encounters from October 2019 to April 2023 were identified. Notably, 179 encounters in the pre- and 183 encounters in the postgroup were analyzed, 31 encounters (17%) in the pregroup versus 33 (18%) in the postgroup had a prophylactic antibiotic associated with it (P > 0.05), 26 of 31 antibiotics (84%) in the pregroup were prescribed for prosthetic joint infection prophylaxis compared with 18 of 33 (55%) in the postgroup (P > 0.05), and 151 of 179 encounters (84.3%) were guideline adherent in the preintervention group compared with 160 of 183 encounters (87.4%) in the postintervention group (P > 0.05). This study observed a shift in the distribution of antibiotic indications and a decreased rate of inappropriate prophylactic prescriptions in dental patients with a history of TJR after an AS-led, collaborative intervention. Although the overall rate of prophylactic antibiotic prescribing remained the same and the changes did not reach statistical significance, lessons learned through this process can help inform future interventions in our institution and for others. [ABSTRACT FROM AUTHOR]

OBJECTIVES Enoxaparin for the prevention of venous thromboembolism (VTE) in pediatric patients is typically dosed twice a day. The use of once-daily dosing like that used in adult patients is limited because of a lack of safety and efficacy data. The aim of this study was to evaluate the safety and efficacy of once-daily versus twice-daily dosing of enoxaparin for pediatric VTE prophylaxis based on incidence of thrombotic and bleeding events. METHODS This was a 3-year retrospective chart review of enoxaparin received for VTE prophylaxis at Cohen Children's Medical Center, New Hyde Park, NY. Exclusion criteria were age 18 years or older, and renal dysfunction. RESULTS A total of 177 enoxaparin courses (81 in the once-daily and 96 in the twice-daily group) were included. The median dose in the once-daily group was 0.68 mg/kg/dose with dose capping at 40 mg/dose in 70% of patients. One patient in the once-daily group had a VTE, whereas no patients in the twice-daily group experienced a VTE. One major bleeding event occurred in the once-daily group (p = 0.46); however, minor bleeding events were comparable between the 2 groups (p = 0.69). CONCLUSIONS Once-daily enoxaparin prophylaxis appears to be safe and effective based on minimal differences in incidence of thrombotic and bleeding events when compared to twice-daily dosing. Based on this study, it may be reasonable to consider once-daily enoxaparin dosing for prophylaxis, especially in older children. A larger multicenter cohort study evaluating once-daily dosing for prophylaxis is warranted to validate the safety and efficacy specifically for risk-based dosing strategies. [ABSTRACT FROM AUTHOR]