-
Community Dentistry and Oral... Jun 2024Dental antibiotic stewardship is crucial in low- and middle-income countries where the burden of antimicrobial resistance (AMR) is high and antibiotic misuse is common....
OBJECTIVES
Dental antibiotic stewardship is crucial in low- and middle-income countries where the burden of antimicrobial resistance (AMR) is high and antibiotic misuse is common. Given that India is the most populous country, the largest antibiotic consumer and has a large dental prescriber population, this study investigated the extent to which current Indian policy and practice for dental antibiotic prescribing and stewardship aligns with the global policy and best practice.
METHODS
The READ approach was used to identify and extract data and synthesize the findings. Policy documents on dental antimicrobial stewardship were identified using a systematic search strategy involving nine medical and grey literature databases (Medline, Global Health, Web of Science, Cochrane, CINAHL, Eldis, Global Index Medicus, Proquest and Opengrey), targeted websites (government organizations and dental regulatory bodies) and contact with experts. Framework analysis was used to code extracted data into themes related to dental antimicrobial stewardship.
RESULTS
Of the 3039 records screened, 25 documents were included in the final analysis. The analysis showed a lack of guidelines or toolkits for appropriate antibiotic prescribing in dentistry in India. The treatment guidelines for antimicrobial use in common syndromes published by the Indian Council of Medical Research had no section or content for dental practitioners. Furthermore, the undergraduate dental curriculum developed by the Dental Council of India (DCI), included little content on appropriate antibiotic prescribing and no mention of AMR or stewardship. There were no educational resources either for dental practitioners or patients in the documents.
CONCLUSION
This document analysis showed that there was little or no mention of dental antibiotic prescribing guidelines in key policy documents such as the National Action Plan on AMR. In addition, contradictory and subjective information provided in some policy documents could encourage dentists and other health professionals such as general practitioners to prescribe antibiotics for common dental conditions for which they are contra-indicated. There is an urgent need to develop relevant guidelines and include these in Indian policy documents on AMR particularly the National Action Plan on AMR.
PubMed: 38887900
DOI: 10.1111/cdoe.12989 -
Sleep & Breathing = Schlaf & Atmung Jun 2024The goal of this review is to provide sleep physicians, dentists, and researchers with an evidence-based overview of the literature on smart mandibular advancement... (Review)
Review
PURPOSE
The goal of this review is to provide sleep physicians, dentists, and researchers with an evidence-based overview of the literature on smart mandibular advancement devices (MADs) for the treatment of obstructive sleep apnea.
METHODS
A systematic literature search was conducted by two blinded reviewers and an information specialist. A smart MAD was defined as any MAD with additional functionality besides mandibular protrusion. The bibliographic databases Medline, Embase, and Scopus were used to identify relevant publications. Studies were included if they described any stage of development of smart MADs. A total of 3162 titles and abstracts were screened for their relevance. In total, 58 articles were selected for full-text screening, 26 of which were included in this review.
RESULTS
The overall quality of the available literature was low. Most of the studies were observational, clinical or applied-research articles. The authors classified MADs into two main groups: passive and active. Passive MADs measured patient data, most commonly patient compliance. Active MADs adjusted protrusion of the mandible in response to patient data and were found in various phases of technological readiness (in development, demonstration, or deployment).
CONCLUSION
Innovations in smart mandibular advancement devices most frequently track patient compliance. Devices measuring other health parameters and active, feedback-controlled, devices are increasingly reported on. However, studies demonstrating their added benefit over traditional methods remain sparse. With further study, smart mandibular advancement devices have the potential to improve the efficiency of obstructive sleep apnea treatment and provide new treatment possibilities.
PubMed: 38886278
DOI: 10.1007/s11325-024-03068-3 -
Clinical Oral Investigations Jun 2024Tooth extraction is one of the most frequently performed medical procedures. The indication is based on the combination of clinical and radiological examination and...
OBJECTIVES
Tooth extraction is one of the most frequently performed medical procedures. The indication is based on the combination of clinical and radiological examination and individual patient parameters and should be made with great care. However, determining whether a tooth should be extracted is not always a straightforward decision. Moreover, visual and cognitive pitfalls in the analysis of radiographs may lead to incorrect decisions. Artificial intelligence (AI) could be used as a decision support tool to provide a score of tooth extractability.
MATERIAL AND METHODS
Using 26,956 single teeth images from 1,184 panoramic radiographs (PANs), we trained a ResNet50 network to classify teeth as either extraction-worthy or preservable. For this purpose, teeth were cropped with different margins from PANs and annotated. The usefulness of the AI-based classification as well that of dentists was evaluated on a test dataset. In addition, the explainability of the best AI model was visualized via a class activation mapping using CAMERAS.
RESULTS
The ROC-AUC for the best AI model to discriminate teeth worthy of preservation was 0.901 with 2% margin on dental images. In contrast, the average ROC-AUC for dentists was only 0.797. With a 19.1% tooth extractions prevalence, the AI model's PR-AUC was 0.749, while the dentist evaluation only reached 0.589.
CONCLUSION
AI models outperform dentists/specialists in predicting tooth extraction based solely on X-ray images, while the AI performance improves with increasing contextual information.
CLINICAL RELEVANCE
AI could help monitor at-risk teeth and reduce errors in indications for extractions.
Topics: Humans; Radiography, Panoramic; Tooth Extraction; Artificial Intelligence; Dentists; Female; Male; Adult
PubMed: 38886242
DOI: 10.1007/s00784-024-05781-5 -
Journal of Public Health Dentistry Jun 2024This study evaluates the impact of introducing dental therapists (DTs) into Children's Dental Services (CDS), a large non-profit organization in Minnesota. The aim is to...
OBJECTIVES
This study evaluates the impact of introducing dental therapists (DTs) into Children's Dental Services (CDS), a large non-profit organization in Minnesota. The aim is to assess the effect of DTs in improving access and reducing dental care costs in Minnesota by analyzing the trends in dental care delivery and procedures performed by CDS dentists and therapists.
METHODS
Using 2009 to 2021 data from CDS, the study compares trends in patient volume, types of procedures, salary data and payments by dentists, DTs, and registered dental hygienists (RDH). Return on investment (ROI) trends are calculated using salary and revenues for each provider type.
RESULTS
After introducing DTs at CDS and implementing mobile clinics, the number of patients served and volume increased steadily, demonstrating increased access. DTs provided an increasing proportion of fluorides, sealants, and extractions through 2020. Interestingly 2021, there was a decrease for DTs, possibly due to Covid related workforce shortages. ROI analysis showed that DTs' ROI dramatically rose, eventually surpassing dentists, while RDHs maintained a constant ROI. Dentists' ROI also initially increased after adopting DTs in the practice.
CONCLUSION
Integrating DTs at CDS improved access by expanding mobile clinics, increasing patient volume, and redistributing procedures, while demonstrating a positive return on investment. Results suggest that adopting the DT model may be a promising practice for other organizations seeking to improve access to dental care, increase operational efficiency, and boost the dental care team's ROI.
PubMed: 38886024
DOI: 10.1111/jphd.12628 -
Clinical Advances in Periodontics Jun 2024Actinomycosis can be caused by periapical endodontic infection, trauma, or surgical dental procedures. Due to its rare occurrence in a healthy adult patient, persistent...
BACKGROUND
Actinomycosis can be caused by periapical endodontic infection, trauma, or surgical dental procedures. Due to its rare occurrence in a healthy adult patient, persistent actinomycotic osteomyelitis around implants presenting as severe peri-implantitis may be challenging to diagnose.
METHODS
A 26-year-old male patient with non-contributory medical history presented to the Oral and Maxillofacial Surgery Clinic in 2018 with pain and edema associated with endodontically treated maxillary premolar teeth with poor prognosis. Oral examination revealed fair oral hygiene, heavily restored dentition, multiple carious teeth, failing restorations, endodontic treatments in both maxillary quadrants, and normal periodontal examination.
RESULTS
Two years following extractions and restoration with implants, the patient returned with a bony sequestrum and fistula in the buccal gingiva adjacent to the implants. The patient reported shifting of implants and slight change in his occlusion. Clinical, radiographic, and endodontic examinations did not demonstrate a clear origin of the fistula. A periodontist was consulted regarding the possibility of peri-implantitis and tracing of the fistula suggested intraosseous involvement of the implant surface. Flap surgery, biopsy, culture, implant removal, and surgical debridement were performed. Histologic examination revealed colonies of actinomycotic organisms and confirmed likely diagnosis of actinomycosis. The patient was placed on a long course of penicillin VK.
CONCLUSIONS
The occurrence of actinomycosis in a healthy adult patient is rare. This case report describes persistent actinomycosis presenting as osteomyelitis with severe peri-implantitis in a healthy patient, which may have been associated with a previously existing periapical endodontic infection.
PubMed: 38884882
DOI: 10.1002/cap.10295 -
Case Reports in Dentistry 2024Excessive gingival display (EGD) is one of the most common aesthetic concerns, and its correction often presents a challenge to periodontists. It has a multifactorial...
Excessive gingival display (EGD) is one of the most common aesthetic concerns, and its correction often presents a challenge to periodontists. It has a multifactorial etiology, and this article describes a case involving hypermobile upper lip (HUL), altered passive eruption (APE), and vertical maxillary excess (VME). Upon investigation, a positive collum angle and marked subnasal skeletal depression were observed. In this context, it is noted that during a spontaneous smile, the upper lip retracts and gets lodged in this depression. The rehabilitation plan includes included aesthetic crown lengthening via gingivectomy using Chu's proportional gauge for altered passive eruption and filling the subnasal depression by PMMA (polymethylmethacrylate) bone cement. The entire treatment plan was digitalised using cutting edge methods such as computed tomography (CT), cone beam computed tomography (CBCT), and 3D printers for virtual planning of the defect's position, size, and shape. No postoperative complications were reported. After six months, the patient exhibited a harmonious smile with reduced exposed gingiva.
PubMed: 38884011
DOI: 10.1155/2024/6500762 -
The Saudi Dental Journal Jun 2024This randomized clinical trial aimed to evaluate the impact of DryShield isolation (DSI) and rubber dam isolation (RDI) system usage on vital signs, behavior, pain and...
OBJECTIVES
This randomized clinical trial aimed to evaluate the impact of DryShield isolation (DSI) and rubber dam isolation (RDI) system usage on vital signs, behavior, pain and discomfort, and chairside time required among children with different airway patencies based on the Modified Mallampati Classification (MMC).
MATERIAL AND METHODS
Healthy, cooperative children who required fissure sealant in at least two contralateral, fully erupted, permanent first molars were included. Airway patency was determined by two trained and calibrated dentists using the MMC. The participants were categorized based on their MMC scores into patent airways (classes I and II) and non-patent airways (classes III and IV). The dental procedure was videotaped during treatment, and vital signs, including arterial oxygen saturation, heart rate, and blood pressure, were recorded every 3 min. The participants' subjective pain and discomfort were evaluated using a previously validated Arabic interview questionnaire and a validated Arabic version of the Wong-Baker Faces Pain Rating Scale. The participants' behavior and behavioral pain were evaluated utilizing the Frankl Behavior Scale and the face, legs, activity, cry, and consolability scales, respectively.
RESULTS
There were no significant differences in any of the vital signs between DSI and RDI. DSI use yielded a significant reduction in chairside time ( < 0.001) and was more bothersome ( < 0.001) than RDI use among all participants, regardless of airway patency. DSI was associated with significantly better behavior during the dental procedure ( = 0.002) and less behavioral pain ( < 0.001) among all participants, regardless of airway patency.
CONCLUSION
Irrespective of airway patency, DSI outperformed RDI in terms of behavior, pain, and procedure duration; however, DSI was characterized by noise, pressure on soft tissues, and an increased tendency to induce gag reflexes.
PubMed: 38883897
DOI: 10.1016/j.sdentj.2024.03.013 -
Cureus May 2024Introduction Putting in stainless steel crowns as a post-endodontic restoration and space maintainers as a post-extraction appliance to maintain the space for the...
Introduction Putting in stainless steel crowns as a post-endodontic restoration and space maintainers as a post-extraction appliance to maintain the space for the eruption of underlying teeth in case of early loss in children are some of the most commonly practised procedures that pediatric dentists undertake in their day-to-day lives. Maintaining good oral hygiene for better gingival health is important. If it is not taken care of, gradual destruction of supporting soft and hard tissues of the teeth occurs. There were numerous studies conducted over the past few years, but no split-mouth study compares the crowns and bands. Hence, this study compares the gingival health between stainless steel crowns and band and loop space maintainers. Materials and methods This split-mouth randomised controlled trial included 31 children aged between four and nine years who had stainless steel crowns on one side and a band and loop space maintainer on the other side of the mandibular arch. The split-mouth study was carried out to minimise the outcome bias as oral hygiene practices differ from one individual to another. Presence/absence of bleeding on probing (BOP) and the Gingival Index (GI) using the Loe and Silness GI were assessed at baseline and at six months. Data was entered in an Excel sheet (Microsoft Corporation, Redmond, Washington, United States) and analysed in IBM SPSS Statistics for Windows, Version 23, (Released 2015; IBM Corp., Armonk, New York, United States). The significance level was fixed as 5% (α = 0.05). The Shapiro-Wilk test was used to assess the normality of parameters of gingival health. The parameters are described in terms of mean, standard deviation, frequency and percentages. Intragroup analysis was done using Friedman tests across the timelines. Intergroup analysis using Mann-Whitney U tests was done between the groups at different timelines. Results At the beginning of the study, 46 children (22 girls and 24 boys) were enrolled considering the dropout. However, 15 children did not attend the follow-up review, resulting in a loss to follow-up. Consequently, only 31 children, each with a band and loop space maintainer and a stainless steel crown, were included for the final interpretation of the results in this study. At one month, both BOP and GI were significantly different (p<0.05) between the stainless steel crown and stainless steel band where the crown showed better gingival health and absence of bleeding than the band and loop. At three months and six months, gingival health improved in both groups, but there was no significant difference between the groups. The Friedman test revealed that both the stainless steel crown and stainless steel band groups had a significant difference at six months from baseline. Mann-Whitney tests were done to analyse the difference in parameters at baseline and at six months between both groups. There was no significant difference in the baseline in the parameters between the groups. Conclusion Within the limitations of the study, this study concludes that the gingival health based on BOP and GI shows a significant difference across the timeline within the groups, namely, stainless steel crown and stainless steel band, but no significant difference between the groups at various timelines.
PubMed: 38883065
DOI: 10.7759/cureus.60473 -
Journal of Pharmacy & Bioallied Sciences Apr 2024To assess the dentist perception of efficiency, treatment outcome, and stability of the tooth movement treated with mysmartalign clear aligner therapy (MSA CAT).
AIM AND OBJECTIVE
To assess the dentist perception of efficiency, treatment outcome, and stability of the tooth movement treated with mysmartalign clear aligner therapy (MSA CAT).
MATERIALS AND METHOD
A cross-sectional web-based questionnaire survey was carried out to evaluate the dentist perception of MYSMARTALIGN (MSA). To determine the sample size, a pilot study has been carried out and the final sample arrived was 4990 subjects. The current study's inclusion criteria took into account those who had finished their BDS and MDS as well as dentists and orthodontists who had been using the MSA CAT system on their patients for the previous 7 years.
RESULTS
The result of the study showed that most research participants (3650) used MSA to treat mild to moderate malocclusion, and 3996 participants said that initial digital treatment plans have been authorised with no revisions. In view of efficiency, 3894 doctors were satisfied with the final outcome.
CONCLUSIONS
Finally concluded that recent survey showed that dentists were very satisfied with the effectiveness and treatment results of the MSA clear aligner procedure.
PubMed: 38882901
DOI: 10.4103/jpbs.jpbs_1095_23 -
Journal of Pharmacy & Bioallied Sciences Apr 2024The most significant accomplishment of dentists is the early detection of oral dysplasia or the rapid diagnosis of potentially malignant lesions. An additional test that...
The most significant accomplishment of dentists is the early detection of oral dysplasia or the rapid diagnosis of potentially malignant lesions. An additional test that assists in the diagnosis of numerous oral illnesses is exfoliative cytology. This study was conducted among dental professionals in the city of Bhubaneswar to assess their exfoliative cytology knowledge, attitudes, and practices. Fifty-eight dental interns participated in a cross-sectional, descriptive, Web-based questionnaire study. The findings reveal that while some interns were knowledgeable about some components of exfoliative cytology in oral cancer (OC) screening, they lacked a thorough understanding of other crucial elements. To enhance early diagnosis and lessen the prevalence of OC, it is critical that dental practitioners increase their understanding of and use of exfoliative cytology. To address the misconcepts found in the study, it draws attention to the necessity of patient education and public awareness campaigns. The study recommends more awareness and education among dental practitioners and emphasizes the need of tackling OC through preventive measures and appropriate diagnostic techniques such as exfoliative cytology.
PubMed: 38882891
DOI: 10.4103/jpbs.jpbs_619_23