Search Results (252)

Background/Objectives: Antibiotic resistance (AR) is a major public health concern, mainly driven by the misuse of antibiotics. Dental settings are one area where unnecessary antibiotic prescriptions and misconceptions among dental patients contribute significantly to antibiotic misuse. This study aimed to evaluate the knowledge and understanding of antibiotic use and AR among dental clinic visitors in Saudi Arabia. Methods: A cross-sectional survey was conducted between March and June 2024, targeting males and females aged 18 years and older residing in Saudi Arabia who visited a dental clinic within the past five years. A self-administered questionnaire was used to assess participants’ knowledge of antibiotic use and their awareness of AR. Results: A total of 1455 respondents from different regions of Saudi Arabia completed the survey. The majority of participants (70.1%) correctly identified that antibiotics kill bacteria, but around 30% incorrectly believed antibiotics treat viral infections. Additionally, 19.58% thought it was acceptable to stop taking antibiotics once they feel better. More than half of the participants thought that antibiotics reduce inflammation (69.10%) or relieve pain (52.40%). Nearly half of the participants (48.45%) were unaware of the term “antibiotic resistance (AR),” and only 27.2% identified antibiotic overuse as a cause of AR. A significant association was found between undergoing dental procedures and perceiving antibiotics as necessary (p < 0.0001). Educational level was the only significant predictor of AR awareness (AOR = 2.942; p < 0.0001). Conclusions: Although many participants correctly answered a knowledge question about antibiotics killing bacteria, several misconceptions about antibiotic use and a lack of awareness regarding AR were identified. These findings highlight the need for targeted educational interventions and enhanced antibiotic stewardship in dental practice to control AR. Full article

Background: The development of antimicrobial resistance is a major public health issue, in which dentists play a significant role by prescribing 7–11% of worldwide antibiotics. The aim of this study is to evaluate the self-perception and knowledge of antibiotic therapy in fifth-year undergraduate dental students. Methods: This is a cross-sectional observational study based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. An electronic survey consisting of 18 questions was conducted with fifth-year students enrolled in the 2022/23 and 2023/24 academic years. The data were analyzed using descriptive and inferential statistical methods. Results: A total of 139 students (76.4%) completed the questionnaire. A total of 71.9% of students considered that they had received adequate education in antibiotic therapy, particularly in Oral Surgery (89.2%) and Periodontics (86.3%). The theoretical classes (3.50 ± 0.98) and practical sessions (3.18 ± 1.29) provided the knowledge that had the greatest influence on their education. They showed high self-confidence in diagnosing an infection (3.49 ± 0.73) and in choosing the appropriate antibiotic and dosage (3.26 ± 0.73). Over 76% of students answered correctly regarding the need for antibiotic prescriptions in various practical scenarios, except in the replantation of avulsed permanent teeth (54%). Conclusions: Dental students’ knowledge of antibiotics should be reinforced, as a high percentage answered correctly regarding the indications for antibiotics in pulpal and periapical diseases, but students performed less well regarding the choice of antibiotic and dosage in patients without sensitivity to β-lactams. Full article

Peri-implantitis is an inflammatory disease-causing bone loss around dental implants, often requiring reconstructive surgical therapies to reduce probing depth and regenerate bone. However, such surgeries are frequently complicated by postoperative issues. This retrospective case series aimed to identify the main postoperative complications following the reconstructive treatment of peri-implant bone defects in peri-implantitis patients. Data from 14 patients with 21 affected implants were analyzed, including demographics, oral hygiene, surgical techniques, and complications such as wound dehiscence, membrane exposure, and infections. Wound dehiscence was measured using Image J^® software version 1.54. Descriptive and bivariate analyses were performed. The results showed that 11 implants (52.4%; 95% confidence interval (95%CI): 29% to 76%) in nine patients (57.1%; 95%CI = 27% to 87%) developed soft tissue dehiscence after one week, with membrane exposure observed in 4 implants. Dehiscence was significantly associated with mandibular implant location (p = 0.003), poor interproximal hygiene (p = 0.008), and membrane exposure (p = 0.034). No postoperative infections were recorded. In conclusion, more than half of peri-implantitis patients undergoing reconstructive surgery experience wound dehiscence, particularly in cases involving mandible, poor hygiene, and membrane exposure. This complication might compromise bone regeneration and reduce the treatment success rate. These results should be interpreted cautiously due to study design limitations (retrospective design, lack of a control group, and small sample size). Full article

Background/Objectives: The formation of oral biofilms in periodontal pockets and around dental implants with induction of periodontitis or peri-implantitis is an increasing problem in dental health. The intelligent design of a biofilm makes the bacteria embedded in the biofilm matrix highly tolerant to antiseptic therapy, often resulting in tooth or implant loss. The question therefore arises as to which mouthwashes have eradication potential against oral biofilm. Methods: A human oral biofilm model was developed based on donated blood plasma combined with buffy coats, inoculated with oral pathogenic bacterial species found in periodontal disease (Actinomyces naeslundii, Fusobacterium nucleatum, Streptococcus mitis, and Porphyromonas gingivalis). Over a span of 7 days, we tested different mouth rinsing and antiseptic solutions (Chlorhexidine, Listerine^®, NaOCl, Octenisept^®, and Octenident^®) covering the matured biofilm with 24 h renewal. Phosphate-buffered saline (PBS) was used as a control. Bacterial growth patterns were detected via quantitative polymerase chain reaction (qPCR) after 2, 4, and 7 days of treatment. Results: While all groups showed initial bacterial reduction, the control group demonstrated strong regrowth from day 2 to 4. Listerine showed a near-significant trend toward bacterial suppression. Additionally, strain-specific efficacy was observed, with Octenisept^® being most effective against Streptococcus mitis, Octenident^® and NaOCl showing superior suppression of Actinomyces naeslundii, and Listerine^® outperforming other solutions in reducing Fusobacterium nucleatum. Donor-specific, individual variability further influenced treatment outcomes, with distinct trends in bacterial suppression and regrowth observed across donors. Conclusions: These findings underscore the complexity of biofilm-associated infections and highlight the importance of targeted therapeutic approaches for managing bacterial biofilms. In this experiment, the donor-specific outcomes of the antimicrobial effects of the solutions may indicate that genetic predisposition/tolerance to oral infections appears to play a critical role in the control of oral biofilms. Full article

Background and objectives: ABs are widely used in dental practice in the treatment of odontogenic infections and as systemic prophylaxis in high-risk patients. However, AB overuse contributes to antimicrobial resistance (AMR), which is a major global concern. This study examined dental AB prescribing trends in Germany in 2024, focusing on the share of overall AB prescriptions, patient demographics, and commonly used agents. Methods: This retrospective cross-sectional study used data from the IQVIA Longitudinal Prescription Database (LRx), covering approximately 80% of prescriptions reimbursed by statutory health insurance funds in Germany. Patients with at least one AB prescription (ATC code: J01) issued by a dentist in 2024 were analyzed. Descriptive statistics covered age, sex, and prescribed substances. Results: In 2024, German dentists prescribed ABs to 2,325,500 patients, accounting for 13.9% of all patients in the database who received AB prescriptions. Dentists were the second-largest group of AB prescribers, surpassed only by general physicians. Amoxicillin (54.2%) was most frequently prescribed, followed by amoxicillin with clavulanic acid (24.5%) and clindamycin (21.0%). Dental patients receiving AB prescriptions were older (mean age: 49.8 years) than the general antibiotic patient population (44.7 years). Interestingly, dental AB prescriptions increased during the COVID-19 pandemic, in contrast to the sharp overall decline in AB prescriptions. Between 2015 and 2019, the proportion of dental antibiotic prescriptions showed a moderate upward tendency, followed by a marked increase during the COVID-19 pandemic and a subsequent decline. In contrast, the number of patients receiving antibiotic prescriptions from other medical disciplines decreased over the same period. One particularly notable finding was the extended use of clindamycin, a reserve AB with known side effects and resistance risks, in dentistry. Conclusions: Dentists are responsible for a significant share of AB prescriptions in Germany. The rise in dental AB prescriptions, particularly the frequent prescription of clindamycin, underscores the need for interventions such as updated clinical guidelines and awareness campaigns concerning AB-related risks and their mitigation directed at dentists. These could focus on microbial culture and sensitivity testing and patient adherence education and control for targeted AB interventions. Emphasizing preventive and alternative anti-infective treatment strategies in dentistry may also help to contain AMR. Full article

This study develops a dual-mode antibacterial orthodontic adhesive by integrating quaternary ammonium salt-modified large-pore mesoporous silica nanoparticles (QLMSN@CHX). The material integrates two antibacterial mechanisms: (1) contact killing via covalently anchored quaternary ammonium salts (QACs) and (2) sustained release of chlorhexidine (CHX) from radially aligned macropores. The experimental results demonstrated that QLMSN@CHX (5 wt%) achieved rapid biofilm eradication (near-complete biofilm eradication at 24 h) and prolonged antibacterial activity, while maintaining shear bond strength comparable to commercial adhesives (6.62 ± 0.09 MPa after 30-day aging). The large-pore structure enabled controlled CHX release without burst effects, and covalent grafting ensured negligible QAC leaching over 30 days. The composite demonstrated good biocompatibility with human dental pulp mesenchymal stem cells at clinically relevant concentrations. This dual-mode design provides a clinically viable strategy to combat bacterial contamination in orthodontic treatments, with potential applications in other oral infections. Future studies will focus on validating efficacy in complex in vivo biofilm models. Full article

Novel three-dimensional porous composites of alginate–pectin (A/P) with zinc- or manganese-substituted hydroxyapatites (A/P-ZnHA and A/P-MnHA) were synthesized via lyophilization and calcium cross-linking. Powder X-ray diffraction and infrared spectroscopy analyses confirmed single-phase apatite formation (crystallite sizes < 1 µm), with ZnHA exhibiting lattice contraction (*c*-axis: 6.881 Å vs. 6.893 Å for HA). Mechanical testing revealed tunable properties: pristine A/P sponges exhibited an elastic modulus of 4.7 MPa and a tensile strength of 0.10 MPa, reduced by 30–70% by HA incorporation due to increased porosity (pore sizes: 112 ± 18 µm in the case of MnHA vs. 148 ± 23 µm-ZnHA). Swelling capacity increased 2.3–2.8-fold (125–155% vs. 55% for A/P), governed by polysaccharide interactions. Scanning electron microscopy investigation showed microstructural evolution from layered A/P (<100 µm) to tridimensional architectures with embedded mineral particles. The A/P-MnHA composites demonstrated minimal cytotoxicity for the NCTC cells and good viability of dental pulp stem cells, while A/P-ZnHA caused ≈20% metabolic suppression, attributed to hydrolysis-induced acidification. Antibacterial assays highlighted A/P-MnHA′s broad-spectrum efficacy against Gram-positive (Bacillus atrophaeus) and Gram-negative (Pseudomonas protegens) strains, whereas A/P-ZnHA targeted only the Gram-positive strain. The developed composite sponges combine cytocompatibility and antimicrobial activity, potentially advancing osteoplastic materials for bone regeneration and infection control in orthopedic/dental applications. Full article

Objectives: To introduce a novel method for apical lesion sampling using a protected paper point device and to evaluate its effectiveness and robustness during the sampling process in vitro. Methods: A prototype for apical sample collection was developed as an adaptation of the Micro-Apical Placement System—the device features a highly tapered screw head with a thin, hollow, stainless-steel tube and an internal wire piston. Standardized 5 mm paper points (ISO 10; PD Dental, Switzerland) served as carrier material. The prototype was tested using 30 × 3D-printed, single-rooted tooth models inoculated using two bacterial strains (Staphylococcus epidermidis and Escherichia coli) to simulate apical and intraradicular bacterial infections, respectively. The sampling process involved collecting and analyzing samples at specific timepoints, focusing on the presence or absence of E. coli contamination. Following sample collection, cultural detection of bacterial presence was performed by incubating the samples on agar plates to confirm the presence of E. coli. Samples were collected as follows: S0 (sterility control of the prototype), P0 (sterility control of the tooth model), P1 (apical sample collected with the CAPS (controlled apical sampling) device, and P2 (contamination control sample to check for the presence of E. coli inside the root canal). Results: Handling of the CAPS prototype was straightforward and reproducible. No loss of paper points or complications were observed during sample collection. All sterility samples (P0, S0) were negative for tested microorganisms, confirming the sterility of the setup. P2 samples confirmed the presence of E. coli in the root canal in all trials. The P1 samples were free from contamination in 86.67% of trials. Conclusions: The CAPS method for apical sampling demonstrated advances in the successful and precise sample collection of apically located S. epidermidis and will be a useful tool for endodontic microbiological analysis. Its user-friendly design and consistent performance highlight its potential for clinical application, contributing to more accurate microbial diagnostics and later patient-specific therapeutic approaches in endodontic treatments. Full article

Background: Dental professionals were thought to have the most significant risk of coronavirus infection during the pandemic. Since the first Coronavirus Disease 2019 (COVID-19) patient was detected in Japan in January 2020, Japan has faced several waves of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections. However, no cluster of SARS-CoV-2 infections associated with dental procedures has been reported in Japan. In this study, we aimed to investigate the actual status of SARS-CoV-2 infection during the pandemic through antibody testing for dental professionals. We further investigated saliva and oral management-related aerosol to estimate the risk of virus transmission during dental procedures. Methods: SARS-CoV-2 antibody titer in the blood of dental professionals and their families was determined during the pre-vaccinated period of the SARS-CoV-2 wave to see the history of infection in Japan. Viral loads in saliva and in the aerosol generated during the oral management of COVID-19 patients were detected by RT-qPCR. Results: The antibody testing of dental healthcare providers during the early phases of the pandemic in Japan revealed low antibody positivity, which supported the low incidence of infection clusters among dental clinics. The aerosol generated during dental procedures may contain trace levels of SARS-CoV-2, indicating the risk of transmission through dental procedures is limited. Therefore, SARS-CoV-2 did not spread through dental clinics. Conclusions: Very few SARS-CoV-2 infections were observed in dental professionals who took appropriate infection control measures in the early period of the pandemic. Performing dental procedures using standard precautions seems to be sufficient to prevent SARS-CoV-2 infections. Full article

Background: Infection control is fundamental in dental practice, especially following the COVID-19 pandemic, which highlighted the variability in students’ adherence to disinfection protocols. This study aimed to evaluate the knowledge, attitudes, and practices of the fifth-year dental students at the National and Kapodistrian University of Athens regarding antisepsis and infection control, and to assess the effectiveness of an educational intervention. Methods: A pre-post interventional study was conducted involving two in-person seminars, supplementary e-learning material, and a structured questionnaire administered before and after the intervention. The survey assessed the knowledge, clinical practices, and attitudes toward infection control, including vaccination history and prior exposure incidents. Results: The intervention led to statistically significant improvements in infection control knowledge, especially in risk-based sterilization strategies, disinfectant classification, and PPE use. Students with prior hepatitis B vaccinations and antibody testing demonstrated higher baseline scores and more significant knowledge gains. However, some misconceptions, particularly regarding surface disinfection and prosthetic care, persisted after the intervention. Conclusions: The findings support the effectiveness of structured educational interventions in improving infection control awareness among dental students. Practical, simulation-based training and earlier curriculum integration are recommended to enhance compliance and ensure safe clinical practice. Full article

Cyanoacrylate-based adhesives have gained increasing attention in dentistry for their rapid polymerization, biocompatibility, and antimicrobial activity. This review analyzes the clinical use of cyanoacrylate adhesives—particularly the Glubran II formulation—in dental procedures, including wound closure, tissue management, and bleeding control. A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science databases for studies published between 2000 and 2024, using specific inclusion criteria (clinical and in vitro studies focusing on dental applications of cyanoacrylates) and exclusion criteria (non-dental uses, insufficient data). The findings indicate that compared to traditional sutures, cyanoacrylates, especially n-butyl and octyl derivatives, significantly reduce operative time, postoperative pain, and infection rates. However, differences among formulations—such as degradation rate and cytotoxicity—require further exploration. Glubran II, in particular, shows promising results in hemostasis and wound stability. This review highlights the potential of cyanoacrylate adhesives as effective, minimally invasive alternatives in dental surgery and underlines the need for standardized protocols and long-term comparative studies. Full article

Regenerative Endodontic Therapies (RETs) offer transformative potential by leveraging polymer-based scaffolds, stem cells, and growth factors to regenerate damaged dental pulp tissue, thereby restoring tooth vitality and prolonging tooth function. While conventional treatments focus on infection control, they often compromise the structural and biological integrity of the tooth. RETs, in contrast, aim to restore the natural function of the pulp–dentin complex by promoting cellular regeneration and immune modulation. In this context, biodegradable polymers—such as collagen, gelatin methacryloyl (GelMA), and synthetic alternatives—serve as scaffolding materials that mimic the extracellular matrix, support cell attachment and proliferation, and enable localized delivery of bioactive factors. Together, the tissue engineering triad—polymer-based scaffolds, stem cells, and signaling molecules—facilitates root development, apical closure, and increased fracture resistance. Recent innovations in polymeric scaffold design, including injectable hydrogels and 3D bioprinting technologies, have enhanced clinical translation by enabling minimally invasive and patient-specific RETs. Despite progress, challenges such as immune compatibility, scaffold degradation rates, and the standardization of clinical protocols remain. RETs, thus, represent a paradigm shift in dental care, aligning with the body’s intrinsic healing capacity and offering improved long-term outcomes for patients. Full article

Implant-associated infections (IAIs) are major complications in dental and orthopedic implants, potentially compromising osseointegration and eventually causing implant loosening or removal. Thus, early prevention of bacterial adhesion and biofilm formation is critical for successful long-term osseointegration. Polyetheretherketone (PEEK) exhibits excellent physicochemical properties and an elastic modulus similar to bone tissue, making it a promising material for dental and orthopedic implants. However, its inherent lack of antibacterial properties limits its ability to prevent IAIs. Herein, an antibacterial coating with controlled drug release and excellent biocompatibility is designed by immobilizing minocycline (Mino)-doped carboxymethyl chitosan (CMCS) onto the PEEK surface via a polydopamine (PDA)-mediated Michael addition and Schiff base reaction. The coating is characterized by SEM, XPS, water contact angle measurements, and in vitro Mino release assays. Antibacterial activity is evaluated using the zone of inhibition (ZOI), turbidity, and colony counting assays, while biocompatibility is assessed through a SEM analysis of cell morphology and CCK-8 assay. The results show that the Mino-modified coating is successfully fabricated on the PEEK surface, achieving sustained Mino release for up to 14 days. Among the three Mino concentrations, the PEEK-0.5Mino group demonstrates the best balance of antibacterial activity and biocompatibility, highlighting its potential for preventing IAIs in orthopedic and dental applications. Full article

Effective local hemostasis is essential in oral surgery to prevent complications such as delayed healing, infection, and the need for re-intervention. Postoperative bleeding occurs in 4–6% of cases, increasing to 9–12% in patients receiving anticoagulant or antiplatelet therapy. This review evaluates the efficacy, safety, and clinical utility of local hemostatic agents based on 51 studies published between 1990 and 2023. Traditional agents, such as oxidized cellulose and gelatin sponges, control bleeding in over 85% of standard cases but offer limited regenerative benefits. Autologous platelet concentrates (APCs), including platelet-rich plasma (PRP) and leukocyte- and platelet-rich fibrin (L-PRF), reduce bleeding time by 30–50% and enhance soft tissue healing. Studies show the PRP may reduce postoperative bleeding in dental surgery by 30–50%, and in orthopedic and cardiac surgery by 10–30%, particularly in patients on anticoagulants. Tranexamic Acid mouthwash can reduce postoperative bleeding by up to 50–60%. Fibrin sealants achieve a 70–90% reduction in bleeding among high-risk patients, while topical tranexamic acid decreases hemorrhagic events by up to 80% in anticoagulated individuals without increasing thromboembolic risk. However, comparative studies remain limited, particularly in medically compromised populations. Additional gaps persist regarding long-term outcomes, cost-effectiveness, and the standardized use of emerging agents such as nanomaterials. Future research should prioritize high-quality trials across diverse patient groups and develop clinical guidelines that integrate both safety and regenerative outcomes. Full article

This study aimed to evaluate the adverse effects of using Oxycide™ (Ecolab, Copenhagen, Denmark) disinfectant in dental practices and assess the need for improved safety measures. Materials and methods: An observational study was conducted in dental offices, evaluating 200 dental assistants exposed to Oxycide™ disinfectant. Data on disinfectant use practices, personal protective equipment, and reported symptoms were collected through an online questionnaire. Results: 63% (126 out of 200) of staff experienced symptoms including respiratory irritation, eye irritation, and skin reactions after Oxycide™ exposure. Inconsistent use of personal protective equipment and improper application techniques were observed. In conclusion, the use of Oxycide™ disinfectant in dental offices has been associated with a wide range of respiratory and cutaneous symptoms among staff, ranging from mild irritative manifestations to severe allergic reactions. Improved protocols, staff training, and consideration of safer alternatives are needed to protect dental personnel while maintaining infection control standards. For a sustainable dental practice, it is essential to balance effective disinfection with staff safety. While high-level disinfectants like Oxycide™ are effective against pathogens, their repeated use—especially in poorly ventilated areas—can lead to respiratory discomfort and skin reactions. To mitigate these risks, clear preventive measures should be implemented: adherence to manufacturer guidelines, proper ventilation, consistent use of personal protective equipment, and ongoing staff training. These steps are crucial to reducing exposure to irritants and ensuring a safe and efficient working environment. Full article