Exploring the usability of simulated patient methodology in dental clinics in Western Australia: A pilot survey.

OBJECTIVES: This study aimed to explore the dental staff knowledge of simulated patient methodology and support for its use to investigate dental staffs' triaging ability. MATERIAL AND METHODS: Staff at dental practices in Western Australia were invited to participate in a cross-sectional online questionnaire, consisting of demographic questions, questions on triaging, and knowledge of simulated patient methodology. Descriptive and parametric tests were undertaken for quantitative data; qualitative responses were thematically analyzed. RESULTS: Of the 100 participants, most were female (71%), aged 25-39 years (57%), dentists (46%), and worked in private practices (60%). While 82% of participants triaged dental appointment enquiries, only 26% had heard of simulated patient studies. The majority (66%) of participants spent 1-5 min when triaging appointments and less than half (29%) asked about medical history, aggravating or alleviating factors. Although there was a general positive attitude toward use of simulated patient methodology to investigate practice, some concerns were identified. CONCLUSIONS: The findings of our exploratory study suggests that there may be a potential for utilizing simulated patient studies to improve the care of patients by dental receptionists in general dental practices.

Dental students' knowledge of and attitudes towards prescribing medication in Western Australia.

INTRODUCTION: Dentists can prescribe medications for prophylactic and therapeutic purposes. In Australia, dental graduates can autonomously practise within the scope of their qualifications without needing to undertake an internship post-graduation. Although previous research has identified knowledge gaps amongst dental students in Australia on pharmacology and pharmacotherapeutic knowledge, there has been no published research that qualitatively highlights dental students' knowledge of medication prescribing in Australia. This study aimed to undertake a qualitative analysis of Western Australian dental students' attitudes towards and knowledge of medication prescribing. METHODS: This qualitative case study design employed semi-structured interviews as means of collecting data. It utilised a purposive sampling in penultimate and final year dental students at the University of Western Australia. RESULTS: Twenty dental students participated in the study. Five key themes were identified in the data: current and previous education, application when delivering pharmacology and pharmacotherapeutics, teaching to ensure patient-centred care, supervision and referral to relevant resources. Participants agreed that having previous knowledge in the area provides students with confidence regarding medication prescribing. Furthermore, students in this study valued having guidance when prescribing medications. CONCLUSIONS: This study highlights the complexity of medication prescribing for dental students. It also highlights their experience with the current pharmacology and pharmacotherapeutics curriculum. All students interviewed valued application-based teaching, making it specific to dentistry. If curriculum were to be redeveloped, considering their perceptions may be a valuable tool.

Eye movement analysis of children's attention for midline diastema.

No previous studies have investigated eye-movement patterns to show children's information processing while viewing clinical images. Therefore, this study aimed to explore children and their educators' perception of a midline diastema by applying eye-movement analysis using the hidden Markov models (EMHMM). A total of 155 children between 2.5 and 5.5 years of age and their educators (n = 34) viewed pictures with and without a midline diastema while Tobii Pro Nano eye-tracker followed their eye movements. Fixation data were analysed using data-driven, and fixed regions of interest (ROIs) approaches with EMHMM. Two different eye-movement patterns were identified: explorative pattern (76%), where the children's ROIs were predominantly around the nose and mouth, and focused pattern (26%), where children's ROIs were precise, locating on the teeth with and without a diastema, and fixations transited among the ROIs with similar frequencies. Females had a significantly higher eye-movement preference for without diastema image than males. Comparisons between the different age groups showed a statistically significant difference for overall entropies. The 3.6-4.5y age groups exhibited higher entropies, indicating lower eye-movement consistency. In addition, children and their educators exhibited two specific eye-movement patterns. Children in the explorative pattern saw the midline diastema more often while their educators focussed on the image without diastema. Thus, EMHMMs are valuable in analysing eye-movement patterns in children and adults.

Understanding children's attention to traumatic dental injuries using eye-tracking.

BACKGROUND/AIM: Traumatic dental injuries (TDIs) in the primary dentition may result in tooth discolouration and fractures. The aim of this child-centred study was to explore the differences between preschool children's eye movement patterns and visual attention to typical outcomes following TDIs to primary teeth. MATERIALS AND METHODS: An eye-tracker recorded 155 healthy preschool children's eye movements when they viewed clinical images of healthy teeth, tooth fractures and discolourations. The visual search pattern was analysed using the eye movement analysis with the Hidden Markov Models (EMHMM) approach and preference for the various regions of interest (ROIs). RESULTS: Two different eye movement patterns (distributed and selective) were identified (p < .05). Children with the distributed pattern shifted their fixations between the presented images, while those with the selective pattern remained focused on the same image they first saw. CONCLUSIONS: Preschool children noticed teeth. However, most of them did not have an attentional bias, implying that they did not interpret these TDI outcomes negatively. Only a few children avoided looking at images with TDIs indicating a potential negative impact. The EMHMM approach is appropriate for assessing inter-individual differences in children's visual attention to TDI outcomes.

Orofacial Mycoses in Coronavirus Disease-2019 (COVID-19): A Systematic Review.

OBJECTIVES: Studies reviewing orofacial mycoses in coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome 2 (SARS-CoV-2) infection are sparse. Here we review the major oral and maxillofacial mycoses of COVID-19, the associated comorbidities, and the probable precipitating factors. METHODS: English-language manuscripts published between March 2020 and October 2021 were searched using PubMed, OVID, SCOPUS, and Web of Science databases, using appropriate keywords. RESULTS: We identified 30 articles across 14 countries, which met the inclusion criteria of PRISMA guidelines. These yielded a total of 292 patients with laboratory-confirmed COVID-19, 51.4% (n = 150) of whom presented with oral and maxillofacial fungal infections, mainly comprising candidosis, mucormycosis, and aspergillosis. Candida infections were the most prevalent, present in 64% (n = 96), followed by mucormycosis, and only a single case of aspergillosis was noted. Oral and maxillofacial mycoses were predominantly seen in those with comorbidities, especially in those with diabetes (52.4%). Oral mucormycosis was noted in 8.6% (n = 13) and mainly manifested on the hard palate. An overall event rate of oral/maxillofacial mucormycosis manifestation in patients with COVID-19 with diabetes mellitus type 1/2 was about 94% (49/52; 95% confidence interval, 0.73%-0.89%), implying a very high association between diabetes mellitus and the latter condition. All fungal infections appeared either concurrently with COVID-19 symptoms or during the immediate recovery period. CONCLUSIONS: SARS-CoV-2 infection-related immunosuppression, steroid therapy, as well as comorbidities such as diabetic hyperglycemia appear to be the major predisposing factors for the onset of oral and maxillofacial mycoses in patients with COVID-19 across all age groups.

Understanding Children's Attention to Dental Caries through Eye-Tracking.

Visual attention is a significant gateway to a child's mind, and looking is one of the first behaviors young children develop. Untreated caries and the resulting poor dental aesthetics can have adverse emotional and social impacts on children's oral health-related quality of life due to its detrimental effects on self-esteem and self-concept. Therefore, we explored preschool children's eye movement patterns and visual attention to images with and without dental caries via eye movement analysis using hidden Markov models (EMHMM). We calibrated a convenience sample of 157 preschool children to the eye-tracker (Tobii Nano Pro) to ensure standardization. Consequently, each participant viewed the same standardized pictures with and without dental caries while an eye-tracking device tracked their eye movements. Subsequently, based on the sequence of viewed regions of interest (ROIs), a transition matrix was developed where the participants' previously viewed ROI informed their subsequently considered ROI. Hence, an individual's HMM was estimated from their eye movement data using a variational Bayesian approach to determine the optimal number of ROIs automatically. Consequently, this data-driven approach generated the visual task participants' most representative eye movement patterns. Preschool children exhibited two different eye movement patterns, distributed (78%) and selective (21%), which was statistically significant. Children switched between images with more similar probabilities in the distributed pattern while children remained looking at the same ROI than switching to the other ROI in the selective pattern. Nevertheless, all children exhibited an equal starting fixation on the right or left image and noticed teeth. The study findings reveal that most preschool children did not have an attentional bias to images with and without dental caries. Furthermore, only a few children selectively fixated on images with dental caries. Therefore, selective eye-movement patterns may strongly predict preschool children's sustained visual attention to dental caries. Nevertheless, future studies are essential to fully understand the developmental origins of differences in visual attention to common oral health presentations in children. Finally, EMHMM is appropriate for assessing inter-individual differences in children's visual attention.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral positivity and their burden in saliva of asymptomatic carriers - a systematic review and meta-analysis.

AIMS: The coronavirus disease 2019 (COVID-19) due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can present either as an asymptomatic carrier state or an acute respiratory disease, with or without severe pneumonia. The asymptomatic carriers are a challenge for the dental profession as the infection could be transmitted via virus-laden, and saliva in dental settings through aerosol-generating procedures (AGPSs). The aim of this review was to perform a systematic review of SARS-CoV-2 in the saliva of asymptomatic individuals. MATERIALS AND METHODS: PubMed, Google scholar, and MedRxiv databases were searched between and a systematic review and meta-analysis of the available data were performed to assess the viral burden in the saliva of asymptomatic carriers of SARS-CoV-2. All investigators of the included studies used qRT-PCR to detect SARS-CoV-2 and yield quantitative data (the Ct values) appertaining to the viral load. RESULTS: A total of 322 records in the English literature were identified, and eight studies with 2642 SARS-CoV-2-positive and asymptomatic individuals were included in the final analysis. Of these, 16.7% (95% CI: 11-23%) yielded SARS-CoV-2-positive saliva samples in comparison to 13.1% (95% CI: 12-17%) of the respiratory specimens (nasopharyngeal or nose-throat swabs). CONCLUSION: As approximately 1 in 5 to 1 in 10 asymptomatic individuals harbour SARS-CoV-2 in either saliva or respiratory secretions, our results highlight the need for continued vigilance and the critical importance of maintaining strict, additional infection control regimens for the foreseeable future to mitigate the potential risks of COVID-19 transmission in dentistry.

The effect of a nano-filled resin coating on the 3-year clinical performance of a conventional high-viscosity glass-ionomer cement.

OBJECTIVES: The main aim of the study was to compare the clinical performance of the conventional high-powder/liquid ratio glass-ionomer cement (GIC) Fuji IX GP Extra (F IX), Fuji IX GP Extra with a low-viscosity nano-filled resin coating, G-Coat Plus (F IX+GCP), and a resin composite, Solare (S), as a comparison material. MATERIALS AND METHODS: Moderate-depth occlusal cavities in the first permanent molars of 91 11-12-year-old children (1-4 restorations per child) were restored with either F IX (87 restorations), F IX+GCP (84 restorations) or S (83 restorations). Direct clinical assessment, photographic assessment and assessment of stone casts of the restorations were carried out at 6 months, 1 year, 2 years and 3 years. RESULTS: The colour match with the tooth of the GIC restorations improved over the 3 years of the study. Marginal staining and marginal adaptation were minimal for all restorations; three restorations exhibited secondary caries at 3 years. From the assessment of the casts, at 2 years, there was significantly less wear of the F IX GP Extra+GCP restorations than the F IX GP Extra restorations (P < 0.005). At 3 years, approximately 37 % of F IX GP Extra restorations showed wear slightly more than the adjacent enamel, compared to 28 % of F IX GP Extra+GCP restorations and 21 % of Solare restorations. Although this was not statistically significant, there was a trend that GCP can protect F IX GP Extra against wear. CONCLUSION: Although both Fuji IX GP Extra and Fuji IX GP Extra with G-Coat Plus showed acceptable clinical performance in occlusal cavities in children, the application of G-Coat Plus gave some protection against wear. CLINICAL RELEVANCE: The application of G-Coat Plus to Fuji IX GP Extra glass-ionomer cement may be beneficial in reducing wear in occlusal cavities.

An in vitro model for the study of chemical exchange between glass ionomer restorations and partially demineralized dentin using a minimally invasive restorative technique.

OBJECTIVES: This study was designed to validate an in vitro model of the Atraumatic Restorative Technique (ART). This model allowed in depth analyses of the migration of apatite forming Sr and F, from a glass-ionomer, Fuji IXGP (GC Corporation, Tokyo, Japan), into partly demineralized dentine. The second objective was to study the effects of the levels of mineral loss on such ionic exchange. METHODS: Artificial lesions were created in thirty third molars, which were divided into three groups based on time of exposure to the demineralizing solution (7, 14 and 21 days). These were restored with Fuji IXGP and left for 21 days. The method of analysis was electron probe microanalysis (EPMA) with wavelength dispersive spectrometry (WDS). This combination can yield both qualitative identification of elements as well as quantitative compositional information, with a minimum detection limit of 0.01%. RESULTS: The results indicated that there was no significant difference in the levels of Ca and P from the control and test sides for all three groups of demineralized dentine. The differences in the depth of penetration and the amount of Sr and F between control and test were significant. CONCLUSIONS: The validity of the in vitro model was confirmed. There was migration of both strontium and fluorine to the artificially demineralized dentine in a pattern consistent with remineralization and similar to what was observed in a previous in vivo study.

A revised classification for direct tooth-colored restorative materials.

Composite resins and glass-ionomer cements were introduced to dentistry in the 1960s and 1970s, respectively. Since then, there has been a series of modifications to both materials as well as the development other groups claiming intermediate characteristics between the two. The result is a confusion of materials leading to selection problems. While both materials are tooth-colored, there is a considerable difference in their properties, and it is important that each is used in the appropriate situation. Composite resin materials are esthetic and now show acceptable physical strength and wear resistance. However, they are hydrophobic, and therefore more difficult to handle in the oral environment, and cannot support ion migration. Also, the problems of gaining long-term adhesion to dentin have yet to be overcome. On the other hand, glass ionomers are water-based and therefore have the potential for ion migration, both inward and outward from the restoration, leading to a number of advantages. However, they lack the physical properties required for use in load-bearing areas. A logical classification designed to differentiate the materials was first published by McLean et al in 1994, but in the last 15 years, both types of material have undergone further research and modification. This paper is designed to bring the classification up to date so that the operator can make a suitable, evidence-based, choice when selecting a material for any given situation.

Influence of environmental calcium/phosphate and pH on glass ionomers.

This study investigated the effects of environmental calcium/phosphate and pH on the hardness and elastic modulus of two glass-ionomer cements (GICs) [Fuji IX Fast (FN) and KetacMolar (KM)]. Specimens were randomly subjected to storage media of pH 3, 5, and 7. The calcium and phosphate levels of the storage solutions ranged from 0 to 2.4 mM. After 4 wk of conditioning, hardness and elastic modulus were determined using a depth-sensing microindentation test. Sectioned surfaces were observed with scanning electron microscopy. For both FN and KM, no significant change in hardness, elastic modulus, or surface structure were observed at pH 7 and 5, regardless of the concentration of calcium and phosphate. FN and KM specimens conditioned at pH 3 had lower hardness and modulus in comparison to those conditioned at pH 7. An increased level of environmental phosphate led to higher hardness and elastic modulus of FN and KM at pH 3. In general, a microscopic surface reaction layer was observed in specimens conditioned at pH 3. The thickness and structure of the reaction layer varied depending on environmental phosphate levels. The results suggest that the influence of environmental calcium and phosphate on GICs was pH dependent.

Chemical exchange between glass-ionomer restorations and residual carious dentine in permanent molars: an in vivo study.

OBJECTIVE: To evaluate the remineralization of carious dentine following the restoration of an extensive lesion in a permanent molar with a high strength glass-ionomer cement (GIC). MATERIALS AND METHODS: Thirteen first permanent molars, which were scheduled for extraction because of the presence of extensive caries lesions, were selected for this study. They were first restored, according to the ART technique, using encapsulated Fuji IX(GP), which contains a strontium glass rather than the traditional calcium glass. The cavities were prepared with a clean enamel margin and minimal removal of the carious dentine around the walls. After a period of 1-3 months they were harvested and subsequently sectioned and examined using an electron probe microanalysis (EPMA) and scanning electron microscopy (SEM). RESULTS: EPMA demonstrated that both fluorine and strontium ions had penetrated deep into the underlying demineralized dentine. The only possible source of these ions was the GIC restoration. CONCLUSION: The pattern of penetration of the fluorine and strontium ions into the dentine was consistent with a remineralization process.

Clinical effects of glass ionomer restorations on residual carious dentin in primary molars.

PURPOSE: To evaluate the mineralization and morphology of residual (infected and affected) carious dentin following the restoration of vital primary molars with viscous glass-ionomer cement (GIC). METHODS: Encapsulated Fuji IX GP and Ketac-Molar Aplicap GICs were placed in cavities that were prepared using the atraumatic restorative treatment (ART) approach. Four suitable exfoliated teeth with intact restorations were sectioned and then examined by electron probe microanalysis (EPMA) and scanning electron microscopy (SEM). RESULTS: EPMA demonstrated the presence of fluorine and strontium that had penetrated into the underlying residual carious dentin from the adjacent GIC. The concentrations of these two elements, and those of calcium and phosphorous, varied with distance from the GIC/dentin interface. SEM showed varying degrees of dentin tubule destruction and intratubular (peritubular) dentin present immediately subjacent to the GIC/dentin interface. Incomplete removal of carious dentin was observed in all specimens, and GIC remained adherent to the tissue.