Reduction of aerosol dissemination in a dental area generated by high-speed and scaler ultrasonic devices employing the "Prime Protector".

The use of an external dome aerosol containment device (Prime Protector) is proposed to reduce the spread of particles within the dental office. Hence, the aim of our study was to compare the spread of bioaerosols generated by a High-speed Handpiece (HH) and an Ultrasonic Prophylaxis Device (UPD), with and without the Prime Protector dome (PP) by counting Colony Forming Units (CFU) of Lactobacillus casei Shirota, at different distances on the x and y axis. The PP was located considering the parallelism between the base of the dome and the frontal plane of the simulator, aligning the center of the mouth with the center of the dome. The PP dome measurements are 560.0mm x 255.0mm x 5mm. Petri dishes were placed at 0.5 m, 1 m and 1.5 m respectively. Aerosol generation in the laboratory environment was done three times with the following experimental groups 1) HH, 2) HH-PP, 3) UPD, 4) UPD-PP. Each dental device activation (HH and UPD) had a time frame of 2 minutes on the upper anterior teeth of the dental phantom with a liquid suspension containing Lactobacillus casei Shirota (YAKULT 0836A 0123; 1027F 0407). Air pressure and ventilation were parameterized. No separate high-volume evacuation used, nor was there any air removal attached to the dome. Results showed no significant difference between distance and axis in the CFU count. When means for devices and distances were compared between each of them all showed significant differences except for UPD and UPD-PP (p <0,004). In conclusion, external devices like Prime Protector could help decrease aerosol diffusion during high-speed handpiece activation. However, this dome does not replace the use of PPE inside dental clinics.

Efficacy of a chairside extraoral suction system in the reduction of aerosol contamination.

The dental setting is regarded as a high-risk environment for aerosol concentrations and transmission of respiratory infectious agents, especially in relation to the COVID-19 pandemic. Although a number of approaches and practices have evolved to reduce the spread of pathogens in the dental setting, the risk of airborne infection remains a concern. Several new extraoral suction (EOS) devices have been marketed recently; further investigation is warranted to determine their clinical effectiveness. The aim of this study was to evaluate the efficacy of a chairside EOS device (PAX 2000 Extraoral Dental Suction System) in reducing aerosol contamination from patients receiving ultrasonic scaling by a registered hygienist as a part of initial or supportive periodontal therapy. The number of colony-forming units (CFUs) was measured with agar plates before, during, and after ultrasonic scaling at 3 different locations in the dental operatory (instrument table, patient chest area, and patient foot area). Forty subjects were randomly allocated into 2 test groups (n = 20) in which ultrasonic scaling was performed with or without the use of the EOS device. The CFUs retrieved after incubation were quantified and identified by their bacterial or fungal taxon. The use of the EOS device reduced the number of CFUs during scaling at all 3 locations, but the difference was only statistically significant (P = 0.018; Mann-Whitney U test) at the patient's chest area, where the highest number of CFUs was present. The aerosols consisted of 74 different taxa of human origin. The results suggest that the tested EOS system may reduce aerosol contamination in the clinical dental setting, especially in proximity to the patient's head, where most aerosols are generated.

Occupational hazards among dental hygienists: Risk level assessment of scaling work.

OBJECTIVES: This study aimed to classify occupational hazards of ultrasonic scaling by factor and to identify the distribution of occupational risk levels of the study participants according to occupational hazards. In addition, the relationship between the general characteristics of dental hygienists and the occupational risk level of scaling was investigated. METHODS: This study was conducted on 237 dental hygienists. Exposure frequency and the degree of work loss were investigated on a five-point scale for each of the 15 occupational hazards of scaling. RESULTS: Among occupational hazards, the proportion of high-risk individuals for biological hazards (32.9%) was the highest. Dental clinics (33.6%) were found to have a higher proportion of high-risk individuals than dental hospitals (16.5%) (p < 0.05). The proportion of high-risk individuals was higher in the absence of an infection control coordinator (33.9%) (p < 0.05) and infection control education in the preceding 2 years (28.6%) (p < 0.05). CONCLUSION: To create a safe dental work environment, appropriate measures according to the risk level and measurement of occupational risk should be discussed.

Treatment of Chronic Periodontitis with Periodontal Surgery Including Regenerative Therapy Using Recombinant Human Fibroblast Growth Factor-2 and Papilla Preservation Technique: A Case Report with a Two-year Follow-up.

This report describes a case of generalized chronic periodontitis requiring periodontal therapy including periodontal regeneration. The patient was a 59-year-old man who visited the Tokyo Dental College Suidobashi Hospital with the chief complaint of mobility in tooth #47. Periodontal examination at the first visit revealed that 32.1% of sites had a probing depth of ≥4 mm and 32.7% of sites bleeding on probing. Radiographic examination revealed vertical bone resorption in #26 and horizontal resorption in #12, 13, 42, and 43. Based on a clinical diagnosis of severe chronic periodontitis, initial periodontal therapy consisting of plaque control, scaling and root planing, occlusal adjustment, caries treatment, and placement of an occlusal splint was performed. Tooth #47 was extracted due to bone resorption extending as far as the root apex. After reevaluation, surgical periodontal treatment was performed at the selected site. Periodontal regenerative therapy using recombinant human fibroblast growth factor (rhFGF)-2 and papilla preservation technique was performed for #26. To reduce periodontal pockets, open flap debridement was implemented for #12, 13, 42, and 43. After reevaluation, the patient was placed on supportive periodontal therapy (SPT). Periodontal regenerative therapy with rhFGF-2 and modified papilla preservation technique yielded an improvement in angular bone resorption which has been properly maintained for two years. Periodontal therapy with open flap debridement resulted in an improvement in horizontal bone resorption. Continued SPT is needed to maintain a stable periodontal condition.

Analysis of Prosthetic Joint Infections Following Invasive Dental Procedures in England.

Importance: Dentists in the United States are under pressure from orthopedic surgeons and their patients with prosthetic joints to provide antibiotic prophylaxis before invasive dental procedures (IDP) to reduce the risk of late prosthetic joint infection (LPJI). This has been a common practice for decades, despite a lack of evidence for an association between IDP and LPJI, a lack of evidence of antibiotic prophylaxis efficacy, cost of providing antibiotic prophylaxis, and risk of both adverse drug reactions and the potential for promoting antibiotic resistance. Objective: To quantify any temporal association between IDP and subsequent LPJI. Design, Setting, and Participants: This cohort study used a case-crossover and time trend design to examine any potential association between IDP and LPJI. The population of England (55 million) was chosen because antibiotic prophylaxis has never been recommended to prevent LPJI in England, and any association between IDP and LPJI would therefore be fully exposed. All patients admitted to hospitals in England for LPJI from December 25, 2011, through March 31, 2017, and for whom dental records were available were included. Analyses were performed between May 2018 and June 2021. Exposures: Exposure to IDP. Main Outcomes and Measures: The main outcome was the incidence of IDP in the 3 months before LPJI hospital admission (case period) compared with the incidence in the 12 months before that (control period). Results: A total of 9427 LPJI hospital admissions with dental records (mean [SD] patient age, 67.8 [13.1] years) were identified, including 4897 (52.0%) men and 4529 (48.0%) women. Of these, 2385 (25.3%) had hip prosthetic joints, 3168 (33.6%) had knee prosthetic joints, 259 (2.8%) had other prosthetic joints, and 3615 (38.4%) had unknown prosthetic joint types. There was no significant temporal association between IDP and subsequent LPJI. Indeed, there was a lower incidence of IDP in the 3 months prior to LPJI (incidence rate ratio, 0.89; 95% CI, 0.82-0.96; P = .002). Conclusions and Relevance: These findings suggest that there is no rationale to administer antibiotic prophylaxis before IDP in patients with prosthetic joints.

Liposomal anesthetic gel for pain control during periodontal therapy in adults: a placebo-controlled RCT.

INTRODUCTION: Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. OBJECTIVE: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. METHODOLOGY: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. RESULTS: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. CONCLUSION: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.

Liposomal anesthetic gel for pain control during periodontal therapy in adults: a placebo-controlled RCT

Abstract Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy. Objective: This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy. Methodology: Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor. Results: Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy. Conclusion: Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.

Minimally invasive non-surgical vs. surgical approach for periodontal intrabony defects: a randomised controlled trial.

BACKGROUND: Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent studies have suggested that a minimally invasive non-surgical therapy (MINST) leads to considerable clinical and radiographic defect depth reductions in intrabony defects. The aim of this study is to compare the efficacy of a modified MINST approach with a surgical approach (modified minimally invasive surgical therapy, M-MIST) for the treatment of intrabony defects. METHODS: This is a parallel-group, single-centre, examiner-blind non-inferiority randomised controlled trial with a sample size of 66 patients. Inclusion criteria are age 25-70, diagnosis of periodontitis stage III or IV (grades A to C), presence of ≥ 1 'intrabony defect' with probing pocket depth (PPD) > 5 mm and intrabony defect depth ≥ 3 mm. Smokers and patients who received previous periodontal treatment to the study site within the last 12 months will be excluded. Patients will be randomly assigned to either the modified MINST or the M-MIST protocol and will be assessed up to 15 months following initial therapy. The primary outcome of the study is radiographic intrabony defect depth change at 15 months follow-up. Secondary outcomes are PPD and clinical attachment level change, inflammatory markers and growth factors in gingival crevicular fluid, bacterial detection, gingival inflammation and healing (as measured by geometric thermal camera imaging in a subset of 10 test and 10 control patients) and patient-reported outcomes. DISCUSSION: This study will produce evidence about the clinical efficacy and potential applicability of a modified MINST protocol for the treatment of periodontal intrabony defects, as a less invasive alternative to the use of surgical procedures. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03797807. Registered on 9 January 2019.

The use of immersive virtual reality for pain control during periodontal scaling and root planing procedures in dental hygiene clinic.

OBJECTIVE: To identify the effect of immersive virtual reality (VR) on pain perception during scaling and root planing procedures (SRP) in dental hygiene clinic. METHODS: Participants were recruited based on inclusion and exclusion criteria. Within-subject/split-mouth design was used in this study. The participants received a full mouth SRP. The participants were divided into two treatment conditions: (a) without VR condition or (b) with VR condition. Blood pressure (BP) and pulse rate (PR) were measured. Level of pain was measured by the Visual Analog Scale (VAS). Participants gave ratings using 0-10 scales with cut points on the scale indicating that (0) none, (1-3) mild, (4-6) moderate or (7-10) severe. Participants were also asked three questions to assess presence, realism and nausea. The immersive virtual environment used for this study was nonviolent and inoffensive. RESULTS: Data were analysed using SPSS® software. Fifty subjects with a mean age of 36 years completed the study. The Wilcoxon signed-rank test revealed that VAS scores were significantly (P = < 0.05) lower during VR compared without VR condition. Paired t test revealed that on average, participants experienced significantly lower systolic Bp after using VR (M = 113.72, SE = 2.16) than systolic Bp after treatment without VR However, Bp (diastolic) and PR showed no difference. 84% of the participants felt like they went inside the virtual world, 82% felt that the virtual objects seem real to them, and 94% did not feel nausea. 98% of the participants preferred using VR during SRP. CONCLUSIONS: The results of this study indicate that the immersive VR has the potential in becoming a future method for pain control during scaling and root planing procedures.

Avaliação de diferentes protocolos clínicos para tratamento de lesão endo-periodontal: 3 séries de casos / Evaluation of different clinical protocols for the treatment of Endodontics-periodontal lesions: 3 series of cases

Na prática clínica odontológica é comum observarmos dentes que apresentem lesões endodôntico-periodontais. Apesar das respostas inflamatórias nos dois tecidos poderem ocorrer de maneira isolada, o não-tratamento e a evolução dessas infecções pode levar a formação de lesão combinada, denominada lesão endo-perio. A falta de abordagem eficaz aumenta a possibilidade de possível perda do dente acometido pela lesão. O objetivo desse estudo foi a realização de 3 séries de casos clínicos em 44 dentes com lesão endoperio, utilizando o mesmo protocolo endodôntico e variandose a terapia periodontal proposta - G1 (n=15): debridamento periodontal (RAR), G2 (n=16): antibioticoterapia (RAR + AB) e G3 (n=13): acesso cirúrgico (AC), analisando os dados clínicos de Profundidade de Sondagem (PS), Nível de Inserção Clínico (NIC), Recessão Gengival (RG), mobilidade, Sangramento a Sondagem (SS) e Índice de Placa (IP) nos períodos baseline, 30 dias 3 e 6 meses; além da análise do comprimento linear das lesões em radiografias periapicais e do volume das lesões em tomografias de baseline e 6 meses. Os dados clínicos nos períodos analisados e as avaliações radiográficas e tomográficas prévias e de controle dos tratamentos foram submetidos a análise estatística (Shapiro-Wilk e ANOVA) e evidenciaram melhora nos 3 grupos, considerando os diferentes tratamentos propostos. O G2 apresentou maior diminuição do volume da lesão na análise volumétrica tomográfica bem como na análise radiográfica, de forma estatisticamente significante em relação ao G1 e G3. Os dados clínicos de PS, NIC, RG e mobilidade mostraram melhora nos 3 grupos, sendo G2 melhor que os demais e quanto a SS houve melhora em 3 e 6 meses para os 3 grupos; e IP sem diferença. A partir dessas 3 séries de casos, sugere-se que o protocolo combinado endodôntico até a medicação intracanal (MIC) e terapia periodontal seguida de troca da MIC para posterior obturação endodôntica, resultou em melhora no quadro clínico, radiográfico e tomográfico dos padrões avaliados nos 3 tipos de terapia periodontal realizada nos tempos propostos, sendo que a raspagem e antibioticoterapia (G2) mostrou os melhores resultados no tratamento de lesões endo-perio

In current dental practice it is common to observe teeth with endodontic-periodontal lesions. Although inflammatory responses in both tissues may occur in an isolated manner, non-treatment, and consequently, the evolution of these infections may lead to develop a combined lesion, referred as endo-perio lesion. The lack of an effective approach, besides of making the prognosis of the treatment uncertain, increases the possibility of a possible tooth loss affected by this lesion. The aim of this study was to perform 3 series of clinical cases in 44 teeth with endo-periodontal lesion, using the same endodontic protocol and varying the proposed periodontal therapy, G1 (n = 15): periodontal debridement, G2 (n = 16): antibiotic therapy and G3 (n = 13): surgical access; analysing Probe Depth (PD), clinical atachment level (CAL), gengival ressection (GR), mobility, bleeding on probing (BP), and plaque index at baseline, 30 days, 3 and 6 months, besides the analysis of the linear length of the lesions in periapical radiographic and volume of the lesions in baseline and 6-month CBCTs. clinical data in the analyzed periods and previous radiographic and tomographic evaluations and control of the treatments were submitted to statistical analysis (Shapiro-Wilk and ANOVA) and showed improvement in the 3 groups, considering the different treatments proposed. G2 presented a greater reduction in lesion volume in tomographic volume analysis as well as in radiographic analysis, statistically significant in relation to G1 and G3.The results of PD, CAL, GR and mobility showed improvement in the 3 groups, G2 being better than the others, and in BP there was improvement at 3 and 6 months for the 3 groups; and PI without difference. From these three series of cases, it is suggested that the combined endodontic protocol up to intracanal medication (MIC) and periodontal therapy followed by change of the intracanal medication for later endodontic obturation, resulted in an improvement in the clinical, radiographic and tomographic scores evaluated for the 3 types of periodontal therapy performed at the proposed times, and scalling and antibiotic therapy (G2) showed the best results in the treatment of endo-perio lesions(AU)

Routine scale and polish for periodontal health in adults.

BACKGROUND: Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even for those at low risk of developing periodontal disease. There is debate over the clinical and cost effectiveness of 'routine scaling and polishing' and the optimal frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing, or both, of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), which does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. Routine scale and polish treatments are typically provided in general dental practice settings. The technique may also be referred to as prophylaxis, professional mechanical plaque removal or periodontal instrumentation.This review updates a version published in 2013. OBJECTIVES: 1. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health.2. To determine the beneficial and harmful effects of routine scaling and polishing at different recall intervals for periodontal health.3. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health when the treatment is provided by dentists compared with dental care professionals (dental therapists or dental hygienists). SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 10 January 2018), and Embase Ovid (1980 to 10 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials of routine scale and polish treatments, with or without oral hygiene instruction, in healthy dentate adults without severe periodontitis. We excluded split-mouth trials. DATA COLLECTION AND ANALYSIS: Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (or standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data. We calculated risk ratios (RR) and 95% CIs for dichotomous data. We used a fixed-effect model for meta-analyses. We contacted study authors when necessary to obtain missing information. We rated the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included two studies with 1711 participants in the analyses. Both studies were conducted in UK general dental practices and involved adults without severe periodontitis who were regular attenders at dental appointments. One study measured outcomes at 24 months and the other at 36 months. Neither study measured adverse effects, changes in attachment level, tooth loss or halitosis.Comparison 1: routine scaling and polishing versus no scheduled scaling and polishingTwo studies compared planned, regular interval (six- and 12-monthly) scale and polish treatments versus no scheduled treatment. We found little or no difference between groups over a two- to three-year period for gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis when comparing six-monthly scale and polish treatment versus no scheduled treatment was -0.01 (95% CI -0.13 to 0.11; two trials, 1087 participants), and for 12-monthly scale and polish versus no scheduled treatment was -0.04 (95% CI -0.16 to 0.08; two trials, 1091 participants).Regular planned scale and polish treatments produced a small reduction in calculus levels over two to three years when compared with no scheduled scale and polish treatments (high-certainty evidence). The SMD for six-monthly scale and polish versus no scheduled treatment was -0.32 (95% CI -0.44 to -0.20; two trials, 1088 participants) and for 12-monthly scale and polish versus no scheduled treatment was -0.19 (95% CI -0.31 to -0.07; two trials, 1088 participants). The clinical importance of these small reductions is unclear.Participants' self-reported levels of oral cleanliness were higher when receiving six- and 12-monthly scale and polish treatments compared to no scheduled treatment, but the certainty of the evidence is low.Comparison 2: routine scaling and polishing at different recall intervalsTwo studies compared routine six-monthly scale and polish treatments versus 12-monthly treatments. We found little or no difference between groups over two to three years for the outcomes of gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis was 0.03 (95% CI -0.09 to 0.15; two trials, 1090 participants; I2 = 0%). Six- monthly scale and polish treatments produced a small reduction in calculus levels over a two- to three-year period when compared with 12-monthly treatments (SMD -0.13 (95% CI -0.25 to -0.01; 2 trials, 1086 participants; high-certainty evidence). The clinical importance of this small reduction is unclear.The comparative effects of six- and 12-monthly scale and polish treatments on patients' self-reported levels of oral cleanliness were uncertain (very low-certainty evidence).Comparison 3: routine scaling and polishing provided by dentists compared with dental care professionals (dental therapists or hygienists)No studies evaluated this comparison.The review findings in relation to costs were uncertain (very low-certainty evidence). AUTHORS' CONCLUSIONS: For adults without severe periodontitis who regularly access routine dental care, routine scale and polish treatment makes little or no difference to gingivitis, probing depths and oral health-related quality of life over two to three years follow-up when compared with no scheduled scale and polish treatments (high-certainty evidence). There may also be little or no difference in plaque levels over two years (low-certainty evidence). Routine scaling and polishing reduces calculus levels compared with no routine scaling and polishing, with six-monthly treatments reducing calculus more than 12-monthly treatments over two to three years follow-up (high-certainty evidence), although the clinical importance of these small reductions is uncertain. Available evidence on the costs of the treatments is uncertain. The studies did not assess adverse effects.

Dental Treatment Effect on Deep Brain Stimulation System in Parkinson's Disease.

Parkinson's disease (PD) is a highly prevalent, long-term neurodegenerative disorder that is sometimes treated by deep brain stimulation (DBS), which significantly reduces the need for dopaminergic drug therapy and improves quality of life. Such patients are cautioned, however, that dental instruments such as a dental turbine or ultrasonic scaler may adversely affect the functioning of such a system. Here, we report dental treatment for right maxillary tooth pain in a 65-year-old woman undergoing DBS for PD. The diagnosis was occlusal trauma. After verification with occluding paper each time, treatment comprised milling of the high contact points of tooth #17, followed by scaling with an ultrasonic scaler. This treatment was spread out over 3 visits, and its course was uneventful. To our knowledge, there are no previous reports on the interaction between dental instruments and DBS systems. Although no interference with the DBS system was observed here, we believe that the dentist should be aware of the potential for such, especially with the use of devices used to measure root canal length, dental lasers, and electrical scalpels.

Novel PAradigm to improve Inflammatory burden in end stage Renal disease (rePAIR): study protocol for a randomized controlled trial.

BACKGROUND: Given the importance of inflammation as a predictor of poor outcomes in End Stage Renal Disease (ESRD), reductions in inflammatory biomarkers have been proposed as a critical target in this population. This study targets chronic periodontitis, an oral inflammatory disease of microbial etiology causing persistent inflammation in ESRD. Unlike the previously reported episodic periodontal interventions, we propose to control periodontal inflammation with a continuous maintenance and oral health behavior modifications. We hypothesize that this strategy will improve systemic inflammation and oxidative stress, oral health and quality of life within the 6-month observation period. METHODS: The rePAIR (novel PAradigm to improve Inflammatory burden in ESRD) study is a pilot and feasibility, parallel-arm, and randomized controlled clinical trial that will recruit 72 ESRD subjects with periodontitis in a model of computerized block randomization. This trial aims to compare the effect of standard-of-care vs. repeated non-surgical periodontal therapy on systemic and oral inflammatory burden. This trial will recruit ESRD adult patients with periodontitis older than 21 years old with a minimum of 12 teeth and no history of periodontal treatment within a year. The trial will examine serum C-reactive protein (CRP) (primary outcome) as a biomarker of inflammation as well as interleukin-6 (IL-6), F2 isofurans and F2 isoprostanes (secondary outcomes) and compare their difference between groups from baseline to 6 months. The trial will also compare the difference between groups in patient-centered and clinical oral outcomes from baseline to 6 months. DISCUSSION: The trial follows a rigorous and transparent study design capturing elements such as pre-specified eligibility criteria, pre-specified primary and secondary outcomes, detailed intervention description to allow replication, intervention random allocation and concealment, blinding in outcome assessment, appropriate sample size calculations, explanation of interim analysis, as per CONSORT Guidelines. Further, gender diversity is secured not only at recruitment but also throughout the trial and during the analysis. Therefore, treatment response outcomes will be examined per gender category. In order to manage anticipated problems, the protocol has included alternative approaches. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03241511 . Registered on 7 August 2017.

Periodontitis and dental scaling associated with pyogenic liver abscess: A population-based case-control study.

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the relationship between periodontitis, dental scaling (DS) and pyogenic liver abscesses (PLAs). MATERIAL AND METHODS: A nationwide population-based case-control study was applied using data from the National Health Insurance Research Database in Taiwan. We identified and enrolled 691 PLA patients, who were individually matched by age and sex to 2764 controls. RESULTS: Conditional logistic regression was applied to estimate adjusted odds ratios (aORs) in patients with exposure to periodontitis and DS before PLA. After adjusting for other confounding factors, periodontitis remained a risk factor for PLA among patients aged 20-40 years, with an aOR of 2.31 (95% confidence interval [CI] = 1.37-3.90, P = .0018). In addition, the average aOR for PLA was significantly lower among patients with one DS (aOR = 0.76, 95% CI = 0.59-0.96) and more than one DS (aOR = 0.61, 95% CI = 0.39-0.95) within 1 year before the index date. CONCLUSION: According to these results, we concluded that adult patients with periodontitis aged <50 years old are more at risk for PLA than controls, particularly when they have no DS. Moreover, from 20 years of age, non-periodontal patients subjected to at least 2 DS per year are less at risk for PLA than controls.

Effects of ultrasonic instrumentation on enamel surfaces with various defects.

OBJECTIVE: The aim of this study was to analyse the enamel damage caused by ultrasonic scaling of teeth with various enamel conditions that are difficult to identify by visual inspection, such as enamel cracks, early caries and resin restorations. METHODS: In total, 120 tooth surfaces were divided into 4 experimental groups using a quantitative light-induced fluorescence-digital system: sound enamel group, enamel cracks group, early caries group and resin restoration group. A skilled dental hygienist performed ultrasonic scaling under a standardized set of conditions: a ≤ 15° angle between the scaler tip and tooth surface and 40-80 g of lateral pressure at the rate of 12 times/10 s. Following scaling, the depth of enamel damage was measured using a surface profilometer and observed using scanning electron microscopy (SEM). RESULTS: The damage depth was the greatest in the enamel cracks group (37.63 ± 34.42 µm), followed by the early caries group (26.81 ± 8.67 µm), resin restoration group (19.63 ± 6.73 µm) and the sound enamel group (17.00 ± 5.66 µm). The damage depth was significantly deeper in the enamel cracks and early caries groups than in the sound enamel group (P < .05). SEM clearly revealed enamel loss in the enamel cracks, early caries and resin restoration groups. CONCLUSIONS: The results of this study suggest that ultrasonic scaling can cause further damage to teeth with enamel cracks, early caries and resin restorations. Therefore, accurate identification of tooth conditions and calculus before the initiation of ultrasonic scaling is necessary to minimize damage.

aPDT for periodontitis treatment in ovariectomized rats under systemic nicotine.

BACKGROUND: This study evaluated the antimicrobial photodynamic therapy (aPDT) as an adjunctive therapy to scaling and root planning (SRP) for the treatment of experimental periodontitis (EP) in ovariectomized rats under systemic nicotine. METHODS: Female ovariectomized rats (n = 180) were divided into two groups: vehicle administration (Veh) and nicotine administration (Nic). Mini-pumps containing either vehicle or nicotine were inserted in the rats 30 days before the induction of EP, which was induced by placing a ligature around the left mandibular first molar. The rats were randomly divided into three treatment subgroups: SRP, SRP plus low-level laser therapy (LLLT), and SRP plus aPDT. aPDT consisted of the application of a phenothiazine photosensitizer followed by LLLT. Ten animals from each group were euthanized at days 7, 15, and 30 after periodontal treatment. The furcation region was evaluated using histological, histometric analyses and immunolabelling for PCNA, TRAP, RANKL, and OPG. RESULTS: Nicotine administration resulted in greater bone loss (BL). aPDT resulted in lower BL compared to SRP. aPDT showed higher quantities of PCNA-positive cells compared to SRP, regardless of the nicotine status. aPDT resulted in less recruitment of osteoclasts and lower RANKL immunolabelling compared to LLLT and SRP. CONCLUSION: aPDT was effective in animals treated with nicotine.

Bacteremia after supragingival scaling and dental extraction: Culture and molecular analyses.

OBJECTIVE: To study the incidence and magnitude of bacteremia after dental extraction and supragingival scaling. SUBJECTS AND METHODS: Blood samples were taken before and 5 and 30 min after dental extraction and supragingival scaling from individuals at high (n = 44) or negligible risk (n = 51) for infective endocarditis. The former received prophylactic antibiotic therapy. Samples were subjected to aerobic and anaerobic culture and quantitative real-time polymerase chain reaction to determine the incidence of bacteremia and total bacterial levels. RESULTS: Patients who did not receive prophylactic antibiotic therapy had a higher incidence of positive blood cultures (30% 5 min after extraction) than patients who received prophylactic antibiotic therapy (0% 5 min after extraction; p < .01). Molecular analysis did not reveal significant differences in the incidence or magnitude of bacteremia between the two patient groups either 5 or 30 min after each of the procedures evaluated. Extraction was associated with higher incidence of bacteremia than supragingival scaling by blood culture (p = .03) and molecular analysis (p = .05). CONCLUSIONS: Molecular methods revealed that dental extraction and supragingival scaling were associated with similar incidence of bacteremia in groups receiving or not prophylactic antibiotic therapy. However, blood culture revealed that antibiotic therapy reduced viable cultivable bacteria in the bloodstream in the extraction group.

INfluence of Successful Periodontal Intervention in REnal Disease (INSPIRED): study protocol for a randomised controlled pilot clinical trial.

BACKGROUND: Patients with chronic kidney disease (CKD) exhibit increased morbidity and mortality which is associated with an increased systemic inflammatory burden. Identifying and managing comorbid diseases that contribute to this load may inform novel care pathways that could have a beneficial impact on the morbidity/mortality associated with CKD. Periodontitis, a highly prevalent, chronic inflammatory disease affecting the supporting structures of teeth, is associated with an increased systemic inflammatory and oxidative stress burden and the successful treatment of periodontitis has been shown to reduce both. This pilot study aims to gather data to inform a definitive study into the impact of successful periodontal treatment on the cardio-renal health of patients with CKD. METHODS/DESIGN: This pilot study will employ a randomised, controlled, parallel-group design. Sixty adult patients, with CKD with a high risk of progression and with periodontitis, from the Queen Elizabeth Hospital, Birmingham, will be randomised to receive either immediate, intensive periodontal treatment (n = 30) or treatment at a delay of 12 months (n = 30). Patients will be excluded if they have reached end-stage renal disease or have received specialist periodontal treatment in the previous year. Periodontal treatment will be delivered under local anaesthetic, on an outpatient basis, over several visits by a qualified dental hygienist at the Birmingham Dental Hospital, UK. Patients in the delayed-treatment arm will continue to receive the standard community level of periodontal care for a period of 12 months followed by the intensive periodontal treatment. Randomization will occur using a centralised telephone randomisation service, following baseline assessments. The assessor of periodontal health will be blinded to the patients' treatment allocation. Patients in either arm will be followed up at 3-monthly intervals for 18 months. Aside from the pilot outcomes to inform the practicalities of a larger trial later, data on cardio-renal function, periodontal health and patient-reported outcomes will be collected at each time point. DISCUSSION: This pilot randomised controlled trial will investigate the viability of undertaking a larger-scale study investigating the effect of treating periodontitis and maintaining periodontal health on cardio-renal outcomes in patients with CKD. TRIAL REGISTRATION: National Institute of Health Research (NIHR) Clinical Research Network (UKCRN ID: 18458), ID: ISRCTN10227738 . Registered retrospectively to both registers on 23 April 2015.

Comparative evaluation of effectiveness of intra-pocket anesthetic gel and injected local anesthesia during scaling and root planing - A split-mouth clinical trial.

BACKGROUND AND AIM: Pain control is an important outcome measure for successful periodontal therapy. Injected local anesthesia has been used to secure anesthesia for scaling and root planing (SRP) and continues to be the anesthetic of choice for pain control. Alternatively, intra-pocket anesthetic gel has been used as an anesthetic during SRP. Hence, this clinical trial was done to compare the effectiveness of intra-pocket anesthetic gel and injected local anesthesia during SRP and also to assess the influence of intra-pocket anesthetic gel on treatment outcomes in chronic periodontitis patients. MATERIALS AND METHODS: Fifteen systemically healthy chronic periodontitis patients were recruited. The dental quadrants on right side received either intra-pocket 20% benzocaine gel (Gel group) or infiltration/block by 2% lidocaine with 1:80,000 adrenaline (injection group). Quadrants on the left side received the alternative. Pain perception and patients preference for the type of anesthesia was recorded. Clinical parameters: plaque index, modified gingival index, modified sulcular bleeding index, probing pocket depth, and clinical attachment level were recorded at baseline and 1 month after treatment. RESULTS: No difference was observed in visual analog scale (P > 0.05) and verbal rating scale (P > 0.05) pain perception between gel group and injection group. A slightly increased preference to gel as anesthesia (53% vs. 47%) was observed. The treatment outcome after SRP did not show a significant difference between gel and injection group (P > 0.05). CONCLUSION: Intra-pocket administration of 20% benzocaine gel may be effective for pain control during SRP and may offer an alternative to conventional injection anesthesia.

Akute Pankreatitis nach nicht chirurgischer Parodontaltherapie in Kombination mit systemischer Antibiotikatherapie.

Non-surgical periodontal therapy is often performed as a combinational approach using supplemental systemic amoxicillin and metronidazole. Better clinical outcomes, less need for periodontal surgery and limited systemic complications are arguments to justify such an approach. However, combination therapy with systemic antibiotic treatment is still a matter of debate due to emerging antibiotic resistance patterns. In this case report, a 61-year-old women suffering from an acute pancreatitis following systemic antibiotic combinational treatment as part of a non-surgical periodontal therapy is described. Following adequate symptomatic treatment during a hospitalization of three days, the patient recovered and periodontal conditions improved significantly thereafter. This case report illustrates a rare, but potentially serious complication when prescribing systemic combinational antibiotics in non-surgical periodontal therapy. Adequate history taking and timely diagnosis of pancreatitis if developing is important to provide relevant treatment and to avoid pancreatitis-associated complications.