Decision-making for dental pulp exposure: a survey in graduate programs at Brazilian universities.

Clinical decision-making tends to be based on what clinicians have been taught during undergraduate and graduate programs. The aim of the present study was to assess the clinical approach and to identify the factors that influence the decision-making for dental pulp exposure among graduate students and coordinating professors in endodontics programs offered at Brazilian universities. The study used a mail-out survey developed in the Qualtrics platform, based on seven clinical reports in which dental pulp exposure was evidenced. Descriptive statistics showing vital pulp therapy (VPT) and root canal treatment (RCT) were calculated for each clinical report. Data on the participants' (n = 113) profile and variables related to clinical and radiographic characteristics of the cases were evaluated as to their potential to affect decision-making and analyzed by logistic regression (p < 0.05). VPT was likely to be indicated in cases of patients with immature teeth (OR = 0.017; 95%CI = 0.004 -0.073). RCT indications were related to the presence of symptoms (OR = 5.326; 95%CI = 1.429-19.852) and old age (OR = 21.057; 95%CI=6.809-65.120). In pulp exposure secondary to trauma, time of pulp exposure was significantly associated with RCT indication (OR=3.267; 95%CI=1.332-8.012). The present study demonstrated that patient age, root development, and symptom features were the main factors affecting participants' decision-making.

Effects of periodontitis and periodontal treatment on systemic inflammatory markers and metabolic profile in obese and non-obese rats.

BACKGROUND: Little is known about a synergistic effect of periodontitis and obesity on systemic biomarkers and a possible effect periodontal treatment may exert. This study aimed to evaluate the impact of periodontitis and periodontal treatment on systemic inflammation and metabolic profile in obese and non-obese rats. METHODS: Sixty male Wistar rats were randomly divided in six groups differentiated by diet and periodontal status: no periodontitis (G1 and G4), untreated ligature-induced periodontitis (G2 and G5), and treated ligature-induced periodontitis (G3 and G6). Groups G4, G5, and G6 were exposed to cafeteria diet to induce obesity. Periodontitis was induced by silk ligatures over 4 weeks (G2, G3, G5, and G6). Rats in G3 and G6 received scaling and root planing and were followed for additional 4 weeks. After sacrifice, serum levels of C-reactive protein (CRP), interleukin (IL)-1ß, IL-6, IL-10, IL-17a, tumor necrosis factor alfa (TNF-α), glucose, triglycerides, and total cholesterol (TC) were compared between groups. RESULTS: CRP was significantly higher in obese rats with than without periodontitis (G5 = 10.15 versus G4 = 4.47 µg/L, P = 0.01). No beneficial effects of periodontal treatment were observed for CRP levels, IL-6, IL-1ß, IL-17a, and TNF-α, glucose and triglycerides. Treated periodontitis (G6) exhibited significantly lower TC than the periodontitis group (G5) in obese rats. CONCLUSION: Periodontitis increased serum CRP in obese rats, indicating a synergistic role of periodontitis in the systemic inflammatory burden triggered by obesity. The treatment of induced periodontitis reduced TC levels in obese rats.

[Difficulties encountered during the pandemic reported by dentists]. / dificultades encontradas durante la pandemia y reportadas por odontólogos.

Objective: To evaluate the economic and psychological repercussions, among other difficulties encountered during the COVID-19 pandemic in a group of dentists. Materials and methods: Cross-sectional descriptive observational study. An online questionnaire was applied to dentists from the "Rigoberto Caballero" Central Police Hospital (HCPRC) of Asunción-Paraguay that was distributed between July and September 2021. It consisted of 32 closed questions distributed in 5 sections: sociodemographic data, economic effects of the pandemic, psychological effects, contagion, and experiences with respect to the clinic. The data were analyzed with the Epi Info version 7 program and the results are represented in tables, the Fisher's exact test and the Chi-square test were also used. Results: 78 dentists participated, 78.2% female, 56.4% from the 35-45 age group. 88.5% reported a decrease in income in private practice and the majority had to resort to another source to be able to cover daily expenses. Most reported having suffered symptoms of anxiety and depression during the pandemic and felt the need to consult a psychiatrist. It was reported an increase in the demand for Personal Protective Equipment (PPE) and an increase in its costs. Almost half of all dentists reported getting COVID-19. Conclusion: The pandemic had a considerable impact on HCPRC dentists, causing financial problems, psychological repercussions and difficulties with prices and a shortage of PPE.

Decision-making for dental pulp exposure: a survey in graduate programs at Brazilian universities

Abstract Clinical decision-making tends to be based on what clinicians have been taught during undergraduate and graduate programs. The aim of the present study was to assess the clinical approach and to identify the factors that influence the decision-making for dental pulp exposure among graduate students and coordinating professors in endodontics programs offered at Brazilian universities. The study used a mail-out survey developed in the Qualtrics platform, based on seven clinical reports in which dental pulp exposure was evidenced. Descriptive statistics showing vital pulp therapy (VPT) and root canal treatment (RCT) were calculated for each clinical report. Data on the participants' (n = 113) profile and variables related to clinical and radiographic characteristics of the cases were evaluated as to their potential to affect decision-making and analyzed by logistic regression (p < 0.05). VPT was likely to be indicated in cases of patients with immature teeth (OR = 0.017; 95%CI = 0.004 -0.073). RCT indications were related to the presence of symptoms (OR = 5.326; 95%CI = 1.429-19.852) and old age (OR = 21.057; 95%CI=6.809-65.120). In pulp exposure secondary to trauma, time of pulp exposure was significantly associated with RCT indication (OR=3.267; 95%CI=1.332-8.012). The present study demonstrated that patient age, root development, and symptom features were the main factors affecting participants' decision-making.

Medidas empleadas por odontólogos paraguayos para disminuir el riesgo biológico en la práctica odontológica durante la pandemia de Covid-19 / Infection control procedures used by Paraguayan dentists to reduce biological risk in dental practice during the Covid-19 pandemic

Resumen Introducción: los profesionales en odontología han sido identificados como de muy alto riesgo de exposición al coronavirus, específicamente cuando llevan a cabo procedimientos de generación de aerosoles en pacientes infecciosos. El objetivo fue conocer los mecanismos mecánicos y químicos usados por los odontólogos paraguayos para evitar la propagación del COVID-19. Evaluar el porcentaje de odontólogos que hayan atendido pacientes COVID positivo y que posteriormente hayan desarrollado la enfermedad. Métodos: estudio observacional descriptivo de corte transversal. Participaron del estudio odontólogos paraguayos con acceso a internet. La difusión del enlace de acceso se realizó por redes sociales. Se recolectaron datos sociodemográficos y medidas de protección utilizadas en el consultorio a fin de disminuir el riesgo biológico. Resultados: participaron 428 odontólogos, 84,11 % fueron mujeres, 38,32 % tenía de 30-39 años. Las medidas de desinfección y cuidados más utilizadas fueron la desinfección del sillón dental (96,7 %), lavado de manos del profesional (93,46 %) y desinfección de superficies con alcohol 70 (88,08 %). El 59,1% utilizaba el peróxido de hidrógeno al 1% como enjuague bucal preoperatorio. La mayoría utilizaba tapabocas KN95 (48,83%), bata de tela tejida (78,04 %), bata desechable (72,20%); uso de gorrito (89,49%) y/o cubre calzado (76,40 %) por parte del paciente, y esterilizan en autoclave sus instrumentales (82,48%). Un profesional relató haberse contagiado en el consultorio odontológico. Conclusión: La mayoría de los odontólogos paraguayos encuestados cumple con los protocolos establecidos por el Ministerio de Salud y organismos internacionales, los cuales aparentan ser efectivos como mecanismos de protección contra el COVID-19 en el ambiente clínico.

Abstract Introduction: dental professionals have been identified as having a very high risk of exposure to coronavirus, specifically when they carry out procedures to generate aerosols in infectious patients. The objective was identifying the mechanical and chemical mechanisms used by Paraguayan dentists to prevent the spread of COVID-19. Evaluate the percentage of dentists who have treated positive COVID patients and who have subsequently developed the disease. Methods: it was a cross-sectional descriptive observational study. Paraguayan dentists with internet access participated. The questions were about sociodemographic data and protection measures used in the office to reduce biological risk. The access link was disseminated through social networks. Results: 428 dentists participated in the study, 84.11 % were women, 38.32 % were 30-39 years old. The most used disinfection and care measures were dental chair disinfection (96.7 %), hand washing (93.46 %) and surface disinfection with alcohol 70 (88.08 %). 59.1% used 1% hydrogen peroxide as a preoperative mouthwash. The majority wore KN95 masks (48.83 %), woven cloth robe (78.04 %), disposable robe (72.20 %); The patient is fitted with a disposable surgeon's cap (89.49 %) and/or shoe covers (76.40 %), and their instruments are sterilized in an autoclave (82.48%). One professional reported having been infected in the dental office. Conclusion: most of the Paraguayan dentists surveyed comply with the protocols established by the Ministry of Health and international organizations, which appear to be effective as protection mechanisms against COVID-19 in the clinical environment.

Impact of endodontic and periodontal diseases and treatments on the aorta and liver of obese and non-obese rats.

AIM: To evaluate the impact of the presence and treatment of periodontal disease (PD) and apical periodontitis (AP) on the aorta and liver of obese and non-obese rats. METHODOLOGY: One hundred and forty Wistar rats were divided into two groups, according to the diet administered: normal diet (-n), without obesity; and cafeteria diet (-c), with induced obesity. These groups were divided into seven subgroups according to the specific experimental protocols: naïve control (NC); AP; AP with treatment (APt); PD; PE with treatment (PDt); AP and PD (APPD); and AP and PD with treatment (APPDt). AP and PD lesions were induced for four weeks. Four weeks after treatments, the animals were euthanatized, and the aorta and liver were dissected for histological evaluation. For the comparison of the thickness of the aorta between groups, the Kruskal-Wallis test was used, followed by the Mann-Whitney test. For the analysis of other variables related to the aorta and liver outcomes, logistic regression was carried out. RESULTS: Both PD and AP were associated with the development of histological alterations in the aortic arch, with no significant difference between obese and non-obese animals (p = .17). The aorta thickness was increased significantly (p < .05) with the combination of PD and AP in obese rats (APPDt-c group) compared with the other groups (NC-n, APt-n, APt-c and AP-c). The logistic regression models revealed that the untreated (OR = 7.78; 95%CI = 2.4-25) and treated (OR = 2.9; 95%CI = 1.0-8.4) groups were significantly more likely to have endothelial alterations compared with the control groups (p = .002). Obesity (OR = 16.5; 95%CI = 3.4-81.3) was the only predictor variable of liver steatosis (p < .001). CONCLUSION: Histological alterations in the aortic arch of obese and non-obese rats were observed in the presence of periodontal disease and apical periodontitis. The combination of PD and AP increased the aorta thickness in obese rats. A reduction of vascular endothelial lesions was observed with the treatments of PD and AP.