Outcomes of nonsurgical endodontic treatment under general anesthesia in special health care needs: An observational study.

BACKGROUND AND AIM: The alarming rise in the number of people with special health care needs (SHCNs) necessitates a paradigm shift in how to approach their oral health needs. General anesthesia (GA) is a valuable technique for facilitating dental procedures in patients with SHCNs who may not be able to tolerate treatment without it. The aim was to assess nonsurgical endodontic treatment and outcomes in patients with SHCNs performed under GA. METHOD: Seventy-eight permanent teeth in 33 patients who received nonsurgical endodontic treatment under GA were included between 2018 and 2022 in SHCNs hospital clinics. The demographic data, types of SHCNs, pulpal and periapical diagnosis, type of treatment, and material used were analyzed. All patients were recalled for clinical and radiographic examinations. Pre-treatment and recall periapical radiographs were evaluated and scored using the Periapical Index (PAI). RESULTS: Autism and Attention deficit hyperactivity disorder were 39.4% of patients treated. Most treatments delivered were primary nonsurgical root canal treatment (95%). Warm vertical compaction of gutta-percha for obturation accounted for 88% of cases treated. Single cone obturation technique was used in 9 cases (12%) utilizing tricalcium silicate sealer. At the recall visits, 98.7% of teeth treated had survived. Twelve teeth have pre-treatment periapical lesions, and all healed except one. Female patients were found to have higher scores of PAI compared to male patients (23.7% vs 7.5%), yet insignificant. Only 10 patients with nonsurgical root canal treatment reported recurrent caries. CONCLUSION: This study demonstrates a high survival rate for nonsurgical endodontic treatment performed under GA in a cohort of patients with SHCNs. Interestingly, patients with social and communication disorders received the highest proportion of treatments under GA. These findings highlight the potential of GA-facilitated endodontics for this population. However, further research is warranted to explore additional methods for optimizing oral health outcomes in SHCNs.

The Effectiveness of Silver Nanoparticles Mixed with Calcium Hydroxide against Candida albicans: An Ex Vivo Analysis.

INTRODUCTION: The purpose of this study was to assess the antifungal activity of silver nanoparticles (AgNPs) in combination with calcium hydroxide (Ca(OH)2) against Candida albicans (C. albicans). METHODS: AgNPs was mixed with pure Ca(OH)2 powder in an aqueous base. A standard suspension (1 × 108 bacterial cells/mL) of C. albicans was prepared in a 96-well plate and incubated on shaker at 37 °C in 100% humidity to allow fungal biofilm formation in infected dentin slices (n = 98). The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of AgNPs alone or with Ca(OH)2 were determined. The samples were separately placed in 24-well tissue culture plates and divided into three experimental groups (0.03, 0.04, and 0.06) and three control groups; negative (saline) and positive chlorhexidine gel and Ca(OH)2. Quantitative measurements of fungal activity by XTT colorimetric assay and qualitative measurements using confocal laser microscopy and scanning electron microscopy were performed. RESULTS: The cell viability of C. albicans in the experimental groups was significantly reduced compared to the negative control group. The combination of (AgNPs (0.04%) and Ca(OH)2) was the most potent against C. albicans. CONCLUSIONS: The findings demonstrated that combining silver nanoparticles with Ca(OH)2 was more effective against C. albicans biofilm compared to Ca(OH)2 alone, suggesting a combing effect.

Bacterial quantity and interleukin-17 expression in necrotic teeth with apical periodontitis from type II diabetic patients.

Diabetes mellitus (DM) increases the susceptibility to infection. A plausible association between apical periodontitis (AP) and DM has been reported, but the underlying mechanism is not yet elucidated. AIM: To investigate the bacterial quantity and the expression of interleukin-17 (IL-17) in necrotic teeth with AP in type 2 DM (T2DM), pre-diabetic and non-diabetic control patients. METHODOLOGY: In all, 65 patients with necrotic pulp and AP [periapical index (PAI) scores ≥3] were included. The age, gender, medical history and medications list, including metformin and statin intake, were recorded. Glycated haemoglobin (HbA1c) was analysed, and the patients were divided into three groups: T2DM (n = 20), pre-diabetics (n = 23) and non-diabetic (n = 22). Bacterial samples (S1) were collected by file and paper points. Bacterial DNA was isolated and quantified using 16S ribosomal RNA gene-targeted quantitative real-time polymerase chain reaction (qPCR). For IL-17 expression, (S2) samples were collected from the periapical tissue fluid using paper points passing through the apical foramen. The IL-17 total RNA was extracted, and reverse transcription (RT-qPCR) analysis was performed. Comparisons between the three study groups were conducted using one-way anova and Kruskal-Wallis test to explore the relationship between bacterial cell counts and IL-17 expression in each group. RESULTS: The distributions of PAI scores were equivalent among the groups, p = .289. T2DM patients had higher bacterial counts and IL-17 expression than other groups, but these differences were not statistically significant, p = .613 and p = .281, respectively. T2DM patients taking statin appear to have lower bacterial cell count than those who do not take statin, approaching the significance level, p = .056. CONCLUSION: T2DM patients had a non-significant higher bacterial quantity and IL-17 expression compared to pre-diabetic and healthy controls. Although these findings indicate a weak association, it may impact the clinical outcome of endodontic diseases in diabetic patients.

High-Glucose Media Reduced the Viability and Induced Differential Pro-Inflammatory Cytokines in Human Periodontal Ligament Fibroblasts.

Hyperglycemic condition in diabetic patients tends to exacerbate periodontitis severity. Thus, the influence of hyperglycemia on the biological and inflammatory response of periodontal ligament fibroblasts (PDLFs) needs to be elucidated. In this study, PDLFs were seeded in media containing glucose concentrations (5.5, 25, or 50 mM) and stimulated with 1 µg/mL of lipopolysaccharide (LPS). PDLFs' viability, cytotoxicity, and the migration ability were determined. The mRNA expression of Interleukin (IL)-6, IL-10, and IL-23 (p19/p40), and Toll-like receptor (TLR)-4 were analyzed; at 6 and 24 h, protein expression of IL-6 and IL-10 was also determined. PDLFs grown in 50 mM glucose medium showed lower viability. The 5.5 mM glucose led to the highest percentage of wound closure compared to 25 mM and 50 mM glucose with/without LPS. Additionally, 50 mM glucose with LPS exhibited the least migration ability among all groups. The expression of IL-6 was amplified significantly in LPS-stimulated cells in 50 mM glucose medium. IL-10 was constitutively expressed in different glucose concentrations, and LPS stimulation decreased it. IL-23 p40 was up-regulated after LPS stimulation in 50 mM glucose concentration. TLR-4 was highly expressed after LPS stimulation in all glucose concentrations. Hyperglycemic conditions limit PDLF proliferation and migration, and enhance the expression of certain pro-inflammatory cytokines to induce periodontitis.

The Incidence of Retrograde Peri-Implantitis in a Single University Dental Hospital Training Center: A Retrospective Analysis.

Background and objective: Retrograde peri-implantitis (RPI) is a periapical radiolucent lesion developed around the implant apex. This study aimed to investigate the Incidence of RPI in a single university dental hospital training center. Materials and Methods: All records of patients who received single Implants between 2016-2020 were screened. For cases that met inclusion criteria, clinical and radiographic data were analyzed. Results: A total of 215 were included and categorized as follows, Category A: implants were placed next to endodontically treated teeth (n = 58, 27%); category B, implants placed at the sites with previous endodontic involvement within 6 months of tooth extraction (n = 25, 11.6%); Category AB: implants placed at sites that fulfill the criteria of groups A and B (n = 18, 8.4%); and Category C: Implants that were placed next to vital teeth and at a site with no previous endodontic treatment or a site that was allowed to heal for more than six (n = 114, 53%). Categories A, B and AB served as the endodontically involved (EI) group, while category C served as non- endodontically involved (NEI) group. Only two sites (0.9%) were confirmed as RPI, both from group A (3.4%). Comparing all groups studied showed no statistically significant difference in RPI incidence. Conclusions: The incidence of RPI is low; however, endodontically treated teeth with periapical lesions (PALs) next to an implant site could contribute to RPI.

Antibiofilm Efficacy of Silver Nanoparticles Alone or Mixed with Calcium Hydroxide as Intracanal Medicaments: An Ex-Vivo Analysis.

INTRODUCTION: This study aimed to determine the most effective antibiofilm concentration of silver nanoparticles (AgNPs) alone or in combination with calcium hydroxide (Ca[OH]2) against Fusobacterium nucleatum biofilm. METHODS: The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of AgNPs alone or with Ca(OH)2 were determined. Dentin slices were sterilized and inoculated with F. nucleatum for 3 weeks to establish a biofilm. Samples were randomly assigned to determine the MIC and MBC for AgNPs alone or mixed with Ca(OH)2. A higher concentration of AgNPs for both preparations was also used. Triple antibiotic paste, Ca(OH)2, and saline were used as controls. Specimens in each group were subdivided over 2 observation periods: 7 and 14 days. At the end of each period, specimens were analyzed with 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) to determine the metabolic activity. Also, samples from each group were assessed by scanning electron microscopy. RESULTS: The MIC and MBC of AgNPs alone against F. nucleatum coincided at 0.04%. The combination of AgNPs + Ca(OH)2 exhibited a lower MIC and MBC of 0.03%. MTT analysis showed a significant reduction in bacterial viability in all groups compared with negative controls (P < .05). A more substantial reduction in bacterial cells was observed with increasing concentrations of AgNPs at both periods. The combination (AgNPs [0.06%] + Ca[OH]2) was the most potent against F. nucleatum. CONCLUSIONS: The findings demonstrated that combining AgNPs with Ca(OH)2 was more effective on the F. nucleatum biofilm than either material alone, suggesting a combined effect.

Cytokine expression and anti-microbial effectiveness of different calcium hydroxide dilutions: An In Vitro study.

Aims: To determine the cytokine expression by human gingival fibroblasts in response to different calcium hydroxide (Ca(OH)2) dilutions and test the effectiveness of these dilutions in root canal dentin infected with Enterococcus faecalis (E. faecalis). Methods: UltraCal XS Ca(OH)2 dilutions were prepared (60, 10, and 1 mg\mL) and co-cultured with gingival fibroblasts for 24 and 48 hours. Untreated cells were used as controls. Expressions of interleukin (IL-1ß), tumour necrosis factor alpha (TNF-α), transforming growth factor beta (TGF-ß), and IL-10 were analysed with real-time polymerase chain reaction (PCR). Root canals of extracted human teeth were inoculated with E. faecalis. After 21 days, canals were medicated with Ca(OH)2 dilutions for 7 days. Samples were taken to determine bacterial reduction using quantitative PCR. Analysis of variance, Tukey post-test, and Wilcoxon matched pair test were used for statistics. Results: IL-1ß and TNF-α expressions of all Ca(OH)2 dilutions were higher at 24 and 48 hours compared to the control. Similarly, all Ca(OH)2 dilutions induced TGF-ß expression at 24 hours compared to the control and continued to be higher in 60 mg/mL groups at 48 hours. In contrast, IL-10 was constitutively expressed by untreated cells in the control group and was down-regulated significantly by all Ca(OH)2 dilutions at 24 and 48 hours. All dilutions demonstrated a significant E. faecalis reduction (P < 0.001) with no significant difference between dilution groups (P > 0.05). Conclusions: All Ca(OH)2 dilutions had a differential inflammatory effect on fibroblasts and had a down-regulation effect to IL-10. All dilutions tested were effective against E. faecalis, with 60 mg/mL having the highest bacterial reduction.

Silver Nanoparticles Alone or in Combination with Calcium Hydroxide Modulate the Viability, Attachment, Migration, and Osteogenic Differentiation of Human Mesenchymal Stem Cells.

This study aimed to evaluate the effect of silver nanoparticles (AgNPs) alone or in combination with calcium hydroxide (Ca(OH)2) on the proliferation, viability, attachment, migration, and osteogenic differentiation of human mesenchymal stem cells (hMSCs). Different concentrations of AgNPs alone or mixed with Ca(OH)2 were prepared. Cell proliferation was measured using AlamarBlue, and hMSCs attachment to dentin disks was evaluated using scanning electron microscopy. Live-dead imaging was performed to assess apoptosis. Wound healing ability was determined using the scratch-migration assay. To evaluate osteogenic differentiation, the expression of Runt-related transcription factor (RUNX2), Transforming growth factor beta-1 (TGF-ß1), Alkaline Phosphatase (ALP), and Osteocalcin (OCN) were measured using real-time reverse transcriptase polymerase chain reaction. ALP staining and activity were also performed as indicators of osteogenic differentiation. AgNPs alone seemed to favor cell attachment. Lower concentrations of AgNPs enhanced cell proliferation. AgNP groups showed markedly less apoptosis. None of the medicaments had adverse effects on wound closure. The expression of TGF-ß1 was significantly upregulated in all groups, and OCN was highly expressed in the AgNP groups. AgNPs 0.06% showed the most enhanced ALP gene expression levels, activity, and marked cytochemical staining. In conclusion, AgNPs positively affect hMSCs, making them a potential biomaterial for various clinical applications.

Public Awareness of the Association between Periodontal Disease and Systemic Disease.

Periodontal disease is associated with other non-communicable diseases including diabetes mellitus, coronary heart disease and atherosclerosis, hypertension, and respiratory tract infections. This association merits careful study of the general population's awareness level in order to leverage the current state of science to improve general health and quality of life. This study included 502 residents of Saudi Arabia who received computer-assisted interviews to fill up the survey. Results indicated a low level of awareness among the study population regarding the association of periodontal disease to diabetes mellitus, coronary heart disease and atherosclerosis, hypertension, and respiratory tract infections. A higher level of awareness was noticed with individuals with periodontal disease, themselves or a member of their family having a systemic disease, and who have a specialized person or scientific article as their source of information. This observed low level of awareness deserves the attention of public health authorities to prioritize programs that increase the awareness, improve health, and reduce burden of systemic diseases of high prevalence, morbidity, and mortality.

Ex vivo microbial leakage analysis of polytetrafluoroethylene tape and cotton pellet as endodontic access cavity spacers.

BACKGROUND: The endodontic spacers are placed between the endodontic appointments or after completion of the endodontic therapy, and until the placement of a definitive restoration. AIMS: The aim of this study was to evaluate the sealing ability of polytetrafluoroethylene (PTFE) access spacer against microbial leakage and to compare it with that of a cotton pellet. MATERIALS AND METHODS: Fifty-two extracted human single-rooted premolars were divided into two experimental groups (n = 20) according to the endodontic spacer; cotton pellet or PTFE tape, and two control groups (n = 6). Following standardized access cavity, cleaning, and shaping procedures, the access cavities received a standardized thickness of the spacer material followed by a Cavit restoration in all the teeth except for the positive controls, which were left empty. Negative controls had the root surfaces completely sealed with nail polish. A dual-chamber microbial leakage model was used with Enterococcus faecalis as the test strain. At days 7 and 30, samples of the lower chambers' solution were obtained and subjected to the quantitative real-time polymerase chain reaction (qPCR) analysis to quantify bacterial levels. Furthermore, broth turbidity in the lower chambers was recorded weekly. The Mann-Whitney U test and Wilcoxon test were used to compare E. faecalis counts between and within groups, respectively. RESULTS: At days 7 and 14, the experimental groups leaked similarly as determined by broth turbidity. However, at days 21 and 30, a significantly higher number of cotton pellet samples exhibited microbial leakage. Analysis by qPCR revealed higher levels of E. faecalis counts in cotton pellet samples compared with PTFE samples. This difference was statistically significant at day 7, but not at day 30. CONCLUSIONS: PTFE spacer showed improved sealing ability compared with the commonly used cotton pellet and may serve as an alternative endodontic access cavity spacer.

Analyzing private dental clinics in Riyadh City, Saudi Arabia.

AIM: To survey private dental clinics and analyze its clinicians in Riyadh city Saudi Arabia. MATERIALS AND METHODS: Private dental clinics that had been registered with the Ministry of Health (MOH), Health Affairs System and accepted to participate were included. All clinics were visited to collect data. Number of practicing dentists, nationality, and their specialty classification were recorded. The location and year of establishment of each dental center were also collected. RESULTS: Out of 236 private dental clinics registered in MOH, 162 clinics accepted to participate. The total number of dentists in these clinics was 877. The majority of dentists were males (63.97%). The percentage of non-Saudi dentists were 86.66%, and Syrians dentists being the highest group (40.25%). The primary specialty of dentists was general dentistry (70.5%). The location of private dental clinics was found to be concentrated in some areas and not evenly distributed in Riyadh city. There were 49 clinics in Olaya, followed by 45 clinics in Rawdha municipality. CONCLUSION: Private dental clinics in Riyadh city are operated mainly by Non-Saudi dentists. Moreover, there is still a need for more female dentists and dental specialists. There are areas in Riyadh city that lack private dental clinics.

Antifungal activity of endosequence root repair material and mineral trioxide aggregate.

INTRODUCTION: The purpose of this study was to investigate the antifungal activity of Endosequence Root Repair Material (ERRM; Brasseler USA, Savannah, GA) as compared with mineral trioxide aggregate (MTA) using Candida albicans. METHODS: All materials were packed into sterilized intravenous tubing to obtain standardized samples and allowed to set for 3 or 24 hours and then exposed to a suspension of C. albicans for incubations of 24 or 48 hours. To analyze the mechanisms of the material's antifungal activity, additional samples of each test material were prepared in the same manner and allowed to set for 24 hours; these were then incubated in a culture medium for 24 hours. The pH of each conditioned media was measured before transferring to wells containing C. albicans. The development of biofilm was analyzed after 24 and 48 hours with 2,3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-([phenyl amino] carbonyl)-2H-tetrazolium hydroxide reduction assay. RESULTS: Materials in both experimental groups significantly limited biofilm formation at each interval (ie, 24 and 48 hours). After incubating for a 24-hour period in the presence of C. albicans, ERRM in both experimental groups showed a reduction in biofilm formation that was statistically significant in comparison with MTA. However, when set for 24 hours and incubated for 48 hours, gray MTA and white MTA showed a more substantial reduction in biofilm formation than comparable samples of ERRM. Cultured media conditioned with test materials showed statistically significant antifungal biofilm activity after 48 hours. CONCLUSIONS: All materials tested have comparable antifungal biofilm activity. It appeared that changing the environment, such as the pH, contributed to this activity.

Bisphosphonate-associated osteonecrosis of jaw reoccurrence after methotrexate therapy: a case report.

INTRODUCTION: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-known complication caused by amino-bisphosphonate therapy. We document one case of BRONJ associated with oral administration of methotrexate, a known immunosuppressive drug used to treat rheumatoid arthritis. METHODS: A 66-year-old woman was referred for evaluation and endodontic surgery of recently re-treated tooth 13. Tooth 14 was extracted 3 months prior, and the extraction site had not completely healed. Her medical history revealed rheumatoid arthritis and osteoporosis. She had been taking Fosamax (alendronate) 70 mg daily. Because of adequate root canal therapy of tooth 13, endodontic surgery was performed. Five months after apicoectomy, her symptoms had not changed. Tooth 13 was extracted, and the socket healed without complications. The socket of extracted tooth 14 was also healing. At the 3-month recall visit, bone exposure and purulent discharge at the site of extracted tooth 14 were noted. The patient had recently received methotrexate. The methotrexate was discontinued, and she was given course of amoxicillin. RESULTS: At the 18-month follow-up, the healing progressed, and the wound was closed. CONCLUSIONS: A medication that suppresses the immune system such as methotrexate may complicate the management of BRONJ. Once a diagnosis of BRONJ is made, a closely monitored conservative approach is recommended.