Managing emerging challenges of Coronavirus disease 2019 (COVID-19) in dentistry.

Dental centers have been referred to as a hub or reservoir for infection, where healthcare professionals and other staff, patients and the public together may potentially spread pathogenic microorganisms. This may occur via saliva, skin or indirectly through air, water, and contaminated surfaces or instruments. Everyone should therefore be considered as potential sources of infection. During a pandemic, limiting unnecessary care has been adopted as a clinical measure for some patient's, to reduce the risk of cross-infection in the short term. However, in order to enable continuation of necessary and qualified care, dental processes need to follow specific infection control strategies in order to prevent transmission of emerging pandemic risks following COVID-19. In this article, we develop a tool with practical recommendations to mitigate infection risks before, during and following pandemics to enable ongoing dental care provision in primary and secondary care based on national and global recommendations.

Evaluation of maxillary sinus expansion in children due to maxillary first molar extraction.

PURPOSE: This study is aimed at understanding the effects of maxillary first molar extraction on the expansion of maxillary sinus in children. SUBJECTS AND METHODS: 119 patients (aged 11-17 years) who had only one extracted maxillary first molar were included in the study. The superoinferior differences of the sinus floor position were measured in both dentate and edentulous sites on panoramic radiographs. The expansion of the maxillary sinus after maxillary first molar extraction was investigated in relation to fixed anatomic structures. The interorbital line (IL) and two zygomatic process lines (IZ) were used as a reference. The vertical distances between the IL and the inferior border of the maxillary sinus (IS) in edentulous (ISX) and in dentate sites (IST) were measured. The data was analyzed statistically. RESULTS: The amount of maxillary sinus expansion in ISX was statistically significant in comparison to IST (p<0.001). The most prominent sinus expansions were found in subjects with extractions over six months prior to analysis (p<0.001). A negative correlation was detected between the amount of maxillary sinus expansion and IST (r = -0.438, p<0.001). There was a positive correlation between the amount of maxillary sinus expansion and IZT (r = 23.8, p<0.009). CONCLUSION: This study showed that the extraction of one maxillary first molar resulted in a negligible amount of sinus expansion in children. The results could be attributed to there being only one tooth extraction and a transferring of functional forces to the area of the neighboring teeth.

Effect of Over-the-Counter Topical Agents on Denture-Induced Traumatic Lesions: A Clinical Study.

PURPOSE: To investigate the effects of over-the-counter products on the healing of denture-induced ulcerations and patients' self-reported pain. MATERIALS AND METHODS: A total of 140 patients with acute denture-induced ulcerations were randomized into seven treatment groups: denture grinding (control); topical application of corn oil gel (placebo); triester glycerol oxide gel; D-panthenol gel; D-panthenol mouthwash; L-arginine mouthwash; and hyaluronic acid gel. Healing and self-reported pain were assessed after 1, 3, and 7 days of treatment. RESULTS: The percentage of healed lesions in the mandible and maxilla after 7 days was 67% and 65%, respectively. The only significance in healing was for mandibular lesions at 3 days after application of L-arginine mouthwash; at this period, the healing rate was significantly higher than d-panthenol gel, d-panthenol mouthwash, and hyaluronic acid gel (P < .05). CONCLUSION: Denture grinding as the current protocol for acute denture-induced ulcerations should remain as the default.

Clinical features and molecular genetic analysis in a Turkish family with oral white sponge nevus

Background: Oral white sponge nevus (WSN) is a rare autosomal dominant benign condition, characterized by asymptomatic spongy white plaques. Mutations in Keratin 4 (KRT4) and 13 (KRT13) have been shown to cause WSN. Familial cases are uncommon due to irregular penetrance. Thus, the aim of the study was: a) to demonstrate the clinical and histopathological features of a three-generation Turkish family with oral WSN b) to determine whether KRT4 or KRT13 gene mutation was the molecular basis of WSN. Material and Methods: Out of twenty members of the family ten were available for assessment. Venous blood samples from six affected and five unaffected members and 48 healthy controls were obtained for genetic mutational analysis. Polymerase chain reaction was used to amplify all exons within KRT4 and KRT13 genes. These products were sequenced and the data was examined for mutations and polymorphisms. Results: Varying presentation and severity of clinical features were observed. Analysis of the KRT13 gene revealed the sequence variant Y118D as the disease-causing mutation. One patient revealed several previously unreported polymorphisms including a novel mutation in exon 1 of the KRT13 gene and a heterozygous deletion in exon 1 of KRT4. This deletion in the KRT4 gene was found to be a common polymorphism reflecting a high allele frequency of 31.25% in the Turkish population. Conclusions: Oral WSN may manifest variable clinical features. The novel mutation found in the KRT13 gene is believed to add evidence for a mutational hotspot in the mucosal keratins. Molecular genetic analysis is required to establish correct diagnosis and appropriate genetic consultation (AU)

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The prevelance of mesiodens in a group of non-syndromic Turkish children: a radiographic study.

PURPOSE: The aim of the present study is to determine the prevelance and clinical status of mesiodens in a group of non-syndromic Turkish children, with an analysis of the associated clinical-eruptive complications. MATERIALS AND METHODS: This study sample consists of 58142 pediatric patients'. Standard equipment and films were used in the suspected patients. The examination of all radiographs was performed under standard conditions by two pediatric dentists with over 10 years experience. Age, gender, number of mesiodens, morphology and clinical status were recorded in forms. RESULTS: A total of 83 mesiodentes were diagnosed in 59 children with ages ranging from 6-14 years. The prevelance of mesiodens was estimated as 0.1%. Males were more frequently affected than females in the ratio of 2.3:1. Of the 83 mesiodentes, 48.2% were conical, 31.3% were tuberculate and 20.5% were incisor like, 22.9% were inverted, and 68.7% were fully impacted. The number of mesiodens was one in 36 cases (61.0%), two in 22 cases (37.3%) and three in one case (1.7%). The mean age at the time of diagnosis of the mesiodens was 9.5 years. The main complication associated with the mesiodens was displacement or rotation of the permanent teeth (73.3%). CONCLUSION: This study presents 0.1% prevelance of mesiodens in a group of Turkish children sample. The majority of the mesiodentes were unilateral located in the premaxillary region, were conical shaped, and remained unerupted. The mean age at the time of diagnosis of the mesiodens in this study was 9.5 years, with this period being later than the eruption time of the maxillary central incisor.

Quality of life in patients with recurrent aphthous stomatitis treated with a mucoadhesive patch containing citrus essential oil.

PURPOSE: To assess 1) patient satisfaction of a mucoadhesive biopatch with citrus essential oil and 2) the change in pain severity and the oral health-related quality of life in patients with recurrent aphthous stomatitis. PATIENTS AND METHODS: Thirty-seven patients with recurrent aphthous stomatitis participated in the study. Baseline records of personal data, ulcer assessment, visual analog scale, and Oral Health Impact Profile-14 were documented. A mucoadhesive patch was applied over the ulcer. Patients were recommended more applications if pain continued. On the fifth day, a post-therapy assessment was made. RESULTS: The mean visual analog scale scores at baseline and posttreatment were significantly different (7.3±2.11 and 4.9±2.6, respectively; P=0.001). The mean duration of pain reduced after patch application. The mean total Oral Health Impact Profile-14 scores before and after treatment showed a statistically significant difference (P=0.001). In total, 78.4% of patients reported a considerable improvement in oral functions after treatment (P=0.008). CONCLUSION: The mucoadhesive biopatch containing citrus essential oil resulted in satisfying pain alleviation and restoration of oral functions with a significant improvement in the oral health-related quality of life.

Surgery in patients with von Willebrand disease.

Von Willebrand disease (vWD) is the most common inherited bleeding disorder. The biggest challenge in the management of vWD is the difficulty in performing surgical procedures because of bleeding. Treatment guidelines recommend the use of pure von Willebrand factor or von Willebrand factor/factor VIII (vWF/FVIII) concentrate in patients with type 2 or type 3 vWD undergoing surgery, in patients with type 1 vWD undergoing surgery who are unresponsive, and in patients for whom desmopressin acetate is contraindicated. However, there is no consensus on the dosage and optimum levels of these factors to date. The aim of this study was to evaluate the perioperative management of patients with vWD during surgical procedures. Data pertaining to surgical procedures performed at our center from 2003 to 2014 were analyzed retrospectively. All operations, except one appendectomy, were elective, and a plan for the management of hemostasis was prepared for each patient. During this period, 37 surgical procedures (major, minor, and dental) were performed in 23 patients with vWD. Complications occurred in four out of 37 procedures (10.8%). No deaths or life-threatening bleeding occurred during any of the operations and no thromboembolic events were observed. The results from this retrospective study indicate that surgery can be safely performed by providing adequate and timely hemostasis during and after the procedure in patients with vWD. Perioperative and postoperative bleeding complications are rare when patients are closely and carefully monitored.

Risk Factors Associated With Implant Marginal Bone Loss: A Retrospective 6-Year Follow-Up Study.

PURPOSE: To analyze the presented evidence behind suggested reasons for long-term marginal bone loss (MBL) around 600 endosseous titanium dental implants according to the radiological findings up to 60 months. MATERIALS AND METHODS: The data of 151 patients are received from the prosthodontic department of a university clinic and analyzed for the effect of implant brand, location, implant diameter and length, implant occlusal table width, cantilever, and smoking on MBL in a 6-year period. RESULTS: MBL is significantly higher in Zimmer SwissPlus implant system. The bone loss in posterior region was higher than anterior region for maxilla. There was no significant difference in mandible. Kruskal-Wallis test showed that MBL was significantly higher when the crown/implant (C/I) ratio was 1.5/2 (P < 0.05). Occlusal table width/implant diameter (OT/I) ratio was analyzed and it showed that MBL was significantly higher when the ratio was 2.5 to 2.99 and higher than 3. There were no significant associations between smoking and nonsmoking groups. Mann-Whitney U test revealed that cantilever does not affect MBL. CONCLUSION: The marginal bone loss is affected by location of the implants (higher in the maxillary posterior region). In addition, excessive C/I and OT/I ratios increase marginal bone loss.

Treatment of giant cell granuloma with intralesional corticosteroid injections: a case report.

Giant cell granuloma is rare in the head and neck region and most commonly affects the maxilla and mandible. Giant cell granulomas are benign but occasionally aggressive lesions that are traditionally treated with surgery. Because it is a benign process, less radical and non-surgical treatment alternatives are required. Corticosteroid injection is a viable alternative in the treatment of central giant cell granuloma to avoid surgery. We aim to present a case which was successfully treated with intralesional corticosteroid injection in the maxilla.

The prevalence of dental anomalies in a turkish population.

PURPOSE: The aim of the present study was to investigate the prevalence of dental anomalies in a Turkish population according to the gender and age. MATERIALS AND METHODS: A retrospective study was performed using panoramic radiographs of 2025 patients (885 males and 1140 females) ranging in age from 9 to 35 (mean age 25.61±10.04) years attending Department of Oral Radiology, University of Istanbul, Faculty of Dentistry. These patients were examined to determine the presence of developmental dental anomalies involving hypodontia, hyperdontia, microdontia, taurodontism and other root anomalies. The incidence of these anomalies were assessed according to the gender and age. RESULTS: Among the 2025 subjects, a total of 96 individuals (42 males and 54 females) showed at least one of the selected dental anomalies (4.74%). Tooth agenesis was the most common dental abnormality (1.77%) followed by taurodontism (1.18%), hyperdontia (0.79%), microdontia (0.54%) and root anomalies (0.44%), respectively. CONCLUSION: Tooth agenesis is the most common developmental dental anomaly in the studied Turkish population followed by taurodontism.

Evaluation of the efficacy of mandibular conventional and implant prostheses in a group of Turkish patients: a quality of life study.

PURPOSE: The aim of this study was to compare the satisfaction and quality of life (QoL) in a group of patients using mandibular complete dentures, implant-retained overdentures, removable partial dentures (RPDs), or implant-supported fixed partial dentures (FPDs). MATERIALS AND METHODS: A total of 116 patients (aged 36 to 81, mean age 58 ± 10.03 years) were assigned to four groups (n = 29) and treated with mandibular implant-retained overdentures, implant-supported FPDs (two implants/three unit FPDs), conventional complete dentures, or RPDs. The groups were well matched in terms of gender, age, and the edentulous period. All patients had edentulous maxillary arches and completely or partially edentulous mandibles. All prostheses were mandibular prostheses. The OHIP-14, OHQoL-UK, and SF-36 surveys were used to determine QoL before implant surgery and 1 year after prosthetic treatment. RESULTS: The baseline and 1-year data from 116 patients were analyzed. A significant improvement was found among the QoL scales for all groups (p < 0.05). The most significant improvement was found in the implant-retained overdenture group (15.67 ± 2.47), while the least improvement was found among the implant-supported FPD group (5.14 ± 2.08). The SF-36 test revealed no differences between the before and after treatment scores for general health, pain, vitality, social function, and physical function difficulties (p > 0.05). The only significant difference was found for mental health (p = 0.011). CONCLUSION: A positive influence on oral health-related QoL was observed in all groups. The QoL values were the most improved in the implant-retained overdenture group.

Clinical and radiological evaluation of inverse impaction of supernumerary teeth

Objective: To describe the clinical and radiological features of children with inverted supernumerary teeth. Study Design: Thirty eight patients with inverted supernumerary teeth (ST) were enrolled in this descriptive and restrospective study. Data from patient records including age, gender, status of dentition, number of ST, number of ST in inverted position, coexistence of ST in inverted and normal direction of eruption, location, orientation, morphology, clinical complications, management and radiography were assessed during 3-years period. Results: Thirty eight patients with a mean age of 9.10±1.97 years (range:6-13) and a strong male preponderance of 3.7:1 (male:30, female:8) had a total of 69 ST, of which 41 were in inverted position. Thirty five patients had one (92.1%) inverted tooth, whereas 3 patients had two inverted teeth per case (7.9%). All cases were located in the maxilla. Midline was the most frequent site for the single inverted supernumerary tooth in 18 (47.4%) patients, followed equally by the right and left premaxillary region in 10 patients each (26.3%). Regarding morphology, 30 patients had conical (78.9%) and 8 (21.1%) had incisiform ST. No tuberculate shaped ST was detected. There was no statistically significant difference between number of inverted teeth and delayed tooth (..) (AU)

Clinical and radiological evaluation of inverse impaction of supernumerary teeth.

OBJECTIVE: To describe the clinical and radiological features of children with inverted supernumerary teeth. STUDY DESIGN: Thirty eight patients with inverted supernumerary teeth (ST) were enrolled in this descriptive and restrospective study. Data from patient records including age, gender, status of dentition, number of ST, number of ST in inverted position, coexistence of ST in inverted and normal direction of eruption, location, orientation, morphology, clinical complications, management and radiography were assessed during 3-years period. RESULTS: Thirty eight patients with a mean age of 9.10 ± 1.97 years (range:6-13) and a strong male preponderance of 3.7:1 (male:30, female:8) had a total of 69 ST, of which 41 were in inverted position. Thirty five patients had one (92.1%) inverted tooth, whereas 3 patients had two inverted teeth per case (7.9%). All cases were located in the maxilla. Midline was the most frequent site for the single inverted supernumerary tooth in 18 (47.4%) patients, followed equally by the right and left premaxillary region in 10 patients each (26.3%). Regarding morphology, 30 patients had conical (78.9%) and 8 (21.1%) had incisiform ST. No tuberculate shaped ST was detected. There was no statistically significant difference between number of inverted teeth and delayed tooth eruption, diastema, local malocclusion, palatinal swelling (p>0.05). There was no statistically significant difference between complications and age (p>0.05). Surgical removal at the time of diagnosis with subsequent follow-up during completion of permanent dentition was the treatment approach in all cases. CONCLUSIONS: Thorough clinical examination followed by a comprehensive radiographic screening is the crucial determinant of an accurate diagnosis of an impacted ST. Early diagnosis and timely management are key factors to prevent or minimize the complications, which may influence function and esthetics of the teeth and even psychological condition of the growing child.

The Effectiveness of a New Hemostatic Agent (Ankaferd Blood Stopper) for the Control of Bleeding following Tooth Extraction in Hemophilia: A Controlled Clinical Trial.

OBJECTIVE: To assess the hemostatic efficacy of a new local hemostatic agent, Ankaferd Blood Stopper (ABS), for the control of bleeding following tooth extraction in hemophiliacs. MATERIALS AND METHODS: Simple tooth extractions were performed in 27 hemophilia A patients. In the treatment group (n=17) local hemostasis was achieved via application of ABS to the extraction sockets, whereas in the control group (n=10) local hemostasis was achieved via direct packing with gauze. RESULTS: In all, 57 (21 primary and 36 permanent) teeth extractions were performed in 27 hemophilia A patients. There were no significant differences in age or factor VIII level distribution between the 2 groups (p>0.05). The most significant clinical difference between the groups was associated with the use of ABS; those in the treatment group had significantly shorter duration of bleeding (p=0.002). CONCLUSION: This is the first study to evaluate the efficacy of ABS for the control of bleeding following tooth extraction in hemophiliacs. ABS can be considered an alternative local hemostatic agent for reducing clotting factor concentrates in hemophilia patients. CONFLICT OF INTEREST: None declared.

Implant-assisted dental rehabilitation of a patient with maxillary rhabdomyosarcoma.

Rhabdomyosarcoma is a malignant, soft tissue neoplasm consisting of cells derived from the primitive mesenchyme that exhibit a profound tendency to undergo myogenesis. Multimodality therapy for tumors in the head and neck regions has a significant effect on maxillofacial skeletal growth, dental development, and the whole ecologic system of the oral cavity. Here we aimed to discuss the influence of head-neck cancer therapy in pediatric patients with long-term follow-up and present a case with implant-assisted dental rehabilitation and also functional and aesthetic outcomes.

The roles of matrix metalloproteinases-2, -7, -10 and tissue inhibitor of metalloproteinase-1 in the pathogenesis of oral lichen planus.

BACKGROUND: The aim of this study was to investigate the roles of Matrix Metalloproteinases (MMP)-2, Metalloproteinases-7, Metalloproteinases-10 and Tissue Inhibitors of Metalloproteinase-1 (TIMP-1) in the pathogenesis of oral lichen planus (OLP) disease in same tissue samples. METHODS: Thirty-nine individuals [29 patients with OLP (74%) and 10 healthy control subjects (25%)] were included in our study. The mean age was 48 ± 14.39 with a range of 20-75. RESULTS: MMP-2 and MMP-7 expression was significantly different in the patient and control groups in the epithelium and the connective tissue (P<0. 05). The ratio of MMP-2/TIMP-1 and MMP-7/TIMP-1 were higher in patient with OLP group than control group. CONCLUSIONS: Along with the exposure of the role of MMPs activity on diseases characterized by the tissue destruction, several studies were conducted on the pharmacological control of MMPs activity. However, understanding of the biological functions of MMPs is very important for the development and implementation of MMP inhibitors in the treatment of diseases. According to the results of this study, we suggest that MMP-2, MMP-7, and TIMP-1 may be involved in the formation of OLP lesions. Further studies on MMPs may be useful for understanding and treating the diseases such as OLP.

The evaluation of fibrin sealants and tissue adhesives in oral surgery among patients with bleeding disorders.

OBJECTIVE: The aim of this study was to evaluate the efficiency of two local hemostatic agents administered with apreoperative dose of replacement therapy in patients with bleeding disorders undergoing oral surgery. MATERIAL AND METHODS: The study included 21 patients that were randomly divided into 3 groups. Patients in Group1 (n = 7) received preoperative replacement therapy and postoperative fibrin sealant applied to the surgical site. Patientsin Group 2 (n = 7) received preoperative replacement therapy and postoperative tissue adhesive applied to the surgicalsite. Patients in Group 3 (n = 7) were given replacement therapy pre- and postoperatively. RESULTS: Postoperative bleeding was not observed in 17 of the 21 patients, including 5 in Group 1 (71.42%), 6 in Group2 (85.71%), and 6 in Group 3 (85.71%). Hemorrhagic complications occurred in only 4 of the 21 patients. CONCLUSION: The use of fibrin sealant and tissue adhesive was beneficial, as they reduced the level of factor concentratesused for replacement therapy and resulted in rapid hemostasis at the surgical site, facilitating the ability to performserial surgical procedures concurrently.

Reasons for early loss of primary molars.

PURPOSE: The aims of this study were to investigate the principal reasons for untimely loss of primary molars and to evaluate the risk factors of early primary molar loss in children aged four to nine years. MATERIALS AND METHODS: 1150 untimely lost primary molars were analyzed from 546 patients. The early loss of primary molars was analyzed in relation to age, sex, dmf (t), DMF (T) scores, toothbrushing frequency, history of treatment and maternal education. The data were converted to SPSS format. Pearson Chi-square test was used for statistical analysis. RESULTS: Among the investigated subjects, 15.2% of children reported regular toothbrushing. Only 23.1% of subjects had a history of treatment before the tooth extraction and 33% of mothers had a low education level. Untimely loss of primary molars due to pain, caries and sepsis were 30.2%, 31% and 38.8%, respectively. The frequency of 'only one primary molar loss' was significantly higher in group 1 (p < 0.05), however the frequency of 'more than one primary molar loss' for group 2 was more than group 1 (p < 0.05). Irregular toothbrushing for the children in group 2 was found significantly high than in group 1 (p < 0.05). Irregular toothbrushing was associated with number of early primary molar loss in group 2 (p < 0.05). The level of maternal education was associated with dmf (t) scores (p < 0.05). The caries incidence was associated with number of early primary molar loss in both groups (p < 0.05). The mean number of treated teeth before extraction for group 2 was significantly higher than for group 1 (p < 0.05). CONCLUSION: Results of this study suggested that irregular toothbrushing, high dmf (t) scores and untreatment of carious primary molars were significant risk factors in early loss of primary molars. Every effort must be taken into account in restoring rather than extracting carious teeth.