Search Results (106)

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

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

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

Idiopathic nephrotic syndrome (NS) is associated with immune dysfunction and increased susceptibility to infections. Oral health may influence systemic inflammation and disease progression. This study aimed to evaluate the salivary levels of interleukin-6 (IL-6) and interleukin-18 (IL-18) in children with NS and their association with dental health, particularly caries prevalence and the consequences of untreated caries. A cross-sectional study was conducted on 86 children aged 5–17 years, including 40 NS patients and 46 healthy controls. Clinical dental examinations assessed caries prevalence using the dmft/DMFT index and the impact of untreated caries using the pufa/PUFA index. Unstimulated saliva samples were collected, and IL-6 and IL-18 concentrations were measured using enzyme-linked immunosorbent assay. NS patients exhibited a significantly lower prevalence of active carious lesions than controls (50% vs. 72%, p = 0.039). The DMFT index was lower in the NS group (p = 0.003). Salivary IL-6 levels were significantly reduced in NS patients compared to controls (p = 0.015), while IL-18 levels showed no significant difference. IL-6 positively correlated with decayed permanent teeth and pulp/periapical tissue diseases, whereas IL-18 correlated with white spot lesions and pulp infections. IL-6 and IL-18 could serve as potential non-invasive indicators of disease progression in NS patients. Full article

Background: Atherosclerosis is a chronic and progressive condition of the arteries, characterized by the thickening and hardening of their walls due to the formation of atherosclerotic plaques. Low-grade inflammation is implicated in the pathogeny of atherosclerosis. Chronic apical periodontitis (CAP), the chronic inflammation around the root apex of infected teeth, is associated with a low-grade inflammatory state, and thus a connection between atherosclerosis and CAP has been suggested. The aim of this study was to conduct a systematic review with meta-analysis to answer the following PICO question: In adult patients, does the presence or absence of atherosclerosis affect the prevalence of CAP? Methods: The PRISMA guidelines were followed to carry out this systematic review, which was registered in PROSPERO (651359). A bibliographic search was performed in PubMed-MEDLINE, Embase, and Scielo. The inclusion criteria selected studies presenting data on the prevalence of CAP in patients diagnosed with atherosclerosis and control patients. The statistical analysis was carried out using RevMan software v.5.4. The study characteristics and risk ratios with 95% confidence intervals (CIs) were extracted. Random-effects meta-analyses were performed. Risk of bias was assessed using the Newcastle-Ottawa scale, which was adapted for cross-sectional studies. To estimate variance and heterogeneity between trials, the Higgins I2 test was used. The quality of the evidence was evaluated using GRADE. Results: The search strategy recovered 102 articles, and only five met the inclusion criteria. Meta-analysis showed an overall OR = 2.94 (95% CI = 1.83–4.74; p < 0.01) for the prevalence of CAP among patients with atherosclerosis. The overall risk of bias was moderate. The quality of the evidence showed a low level of certainty. Conclusions: Patients with atherosclerosis are almost three times more likely to have CAP. This finding supports the hypothesis that chronic inflammatory processes in the oral cavity could significantly impact cardiovascular health, emphasizing the importance of an integrated approach to oral and systemic health care. This result should be translated to daily clinical practice, and the healthcare community should be aware of this association and suspect atherosclerotic pathology in patients who show a high prevalence of CAP. Likewise, patients with atherosclerosis should be monitored in the dental clinic for CAP. Full article

Objectives: The disinfection of fabricated prostheses is crucial to prevent cross-infection between dental laboratories and clinics. However, there is a lack of information about the effects of chemical disinfection on 3D-printed denture base resins. This study aimed to evaluate the impact of different disinfectants on the flexural strength, elastic modulus, micro-hardness, surface roughness (Ra), and change in color of 3D-printed and conventional heat-polymerized (HP) denture base resins (DBRs). Methods: A total of 240 specimens (80 bar-shaped (64 × 10 × 3.3 mm) and 160 disk-shaped (10 × 2 mm)) were made from HP and 3D-printed DBRs. For each resin, the specimens were divided into four groups (n = 10) according to the disinfectant solution. One remained in water without disinfection as a control group, while the other three groups were disinfected using 1% sodium hypochlorite, 2% glutaraldehyde, or 10% Micro 10+ for 30 min. The flexural strength, elastic modulus, micro-hardness, Ra, and color change were measured. The collected data were statistically analyzed using a two-way ANOVA and Tukey’s post hoc test (α = 0.05). Results: A significant decrease in flexural strength, elastic modulus, and hardness was found with sodium hypochlorite (p < 0.05). When comparing the resins per solution, the 3D-printed resin showed a significant decrease in flexural strength, elastic modulus, and hardness compared with PMMA (p < 0.001), while no change was found in the Ra of both resins with all disinfectants (p > 0.05). Disinfecting with sodium hypochlorite resulted in a significant increase in color change for both resins (p < 0.05); however, all the changes were within clinically acceptable limits. Sodium hypochlorite showed the highest color change, while 2% glutaraldehyde and 10% Micro 10+ showed no significant changes in the tested properties (p > 0.05). Conclusions: Neither resin showed a change in surface roughness with immersion in disinfectants. Sodium hypochlorite had an adverse effect on the flexural properties, hardness, and change in color of the PMMA and 3D-printed DBRs, while the other disinfectants had no effect on the tested properties. Full article

Feline immunodeficiency virus (FIV) is the domestic cat analogue of HIV infection in humans. Both viruses induce oral disease in untreated individuals, with clinical signs that include gingivitis and periodontal lesions. Oral disease manifestations in HIV patients are abated by highly effective combination antiretroviral therapy (cART), though certain oral manifestations persist despite therapy. Microorganisms associated with oral cavity opportunistic infections in patients with HIV cause similar pathologies in cats. To further develop this model, we evaluated characteristics of feline oral health and the oral microbiome during experimental FIV infection over an 8-month period following cART. Using 16S rRNA sequencing, we evaluated gingival bacterial communities at four timepoints in uninfected and FIV-infected cats treated with either cART or placebo. Comprehensive oral examinations were also conducted by a veterinary dental specialist over the experimental period. Gingival inflammation was higher in FIV-infected cats treated with placebo compared to cART-treated cats and the controls at the study endpoint. Oral microbiome alpha diversity increased in all groups, while beta diversity differed among treatment groups, documenting a significant effect of cART therapy on microbiome community composition. This finding has not previously been reported, and indicates cART ameliorates immunodeficiency virus-associated oral disease via the preservation of oral mucosal microbiota. Further, this study illustrates the value of the FIV animal model for investigations of mechanistic associations and therapeutic interventions for HIV’s oral manifestations. Full article

This review explores the latest advancements in enhancing the biocompatibility and antibacterial properties of implantable structures, with a focus on titanium (Ti) and its alloys. Titanium implants, widely used in dental and orthopedic applications, demonstrate excellent mechanical strength and biocompatibility, yet face challenges such as peri-implantitis, a bacterial infection that can lead to implant failure. To address these issues, both passive and active surface modification strategies have been developed. Passive modifications, such as altering surface texture and chemistry, aim to prevent bacterial adhesion, while active approaches incorporate antimicrobial agents for sustained infection control. Nanotechnology has emerged as a transformative tool, enabling the creation of nanoscale materials and coatings like TiO₂ and ZnO that promote osseointegration and inhibit biofilm formation. Techniques such as plasma spraying, ion implantation, and plasma electrolytic oxidation (PEO) show promising results in improving implant integration and durability. Despite significant progress, further research is needed to refine these technologies, optimize surface properties, and address the clinical challenges associated with implant longevity and safety. This review highlights the intersection of surface engineering, nanotechnology, and biomedical innovation, paving the way for the next generation of implantable devices. Full article

Objectives: This randomized clinical trial evaluated the microbiological efficacy and the ergonomic impact of three prototypes of a device to reduce aerosol dispersion during dental procedures. Methods: Sixty patients undergoing dental care using high-speed turbines and/or ultrasonic tips were randomly assigned to 4 groups (n = 15): CG: control group, with standard personal protective equipment (PPE); G1: PPE + acrylic device (AD) with aspiration; G2: PPE + AD without aspiration; and G3: PPE + polyvinyl chloride device. The device prototypes consisted of a rigid translucent acrylic structure (G1 and G2), or a rigid PVC tube structure surrounded by layers of translucent flexible PVC films (G3), adjusted to the dental chair, involving the patient’s head, neck and chest. The main outcome was the microbiological analysis (mean Δ of CFU at 10 different sites), and the secondary outcome was the ergonomic evaluation (questionnaire to dentists and patients). Results: The final sample comprised 59 participants (mean age 38.6 ± 11.4 years, 55.2% male). The overall mean time for dental procedures was 32.4 ± 16.9 min, with no differences between groups (p = 0.348). Microbiological analyses showed that the use of the device significantly reduced contamination in the light reflector (01.46 ± 4.43 ΔCFU in G2 vs. 19.25 ± 36.50 ΔCFU in CG; p = 0.028), apron (09.11 ± 12.05 ΔCFU in G3 vs. 21.14 ± 43.41 ΔCFU in GC; p = 0.044), and face shield (08.80 ± 32.70 ΔCFU in G1 vs. 56.78 ± 76.64 ΔCFU in the GC; p = 0.017). The device was well accepted by patients and increased the dentists‘ perception of safety and protection (p < 0.001), but significantly decreased ergonomics related to the clinical view, space, agility and access to the patient, and ease of performing procedures (p < 0.001). Conclusions: The tested device can be an additional tool for infection prevention and control in dentistry, not only during the COVID-19 pandemic, but also for the control of future infectious diseases and epidemics. Full article

Background: Understanding microbial colonization on different membranes is critical for guided bone regeneration procedures such as socket preservation, as biofilm formation may affect healing and clinical outcomes. This randomized controlled clinical trial (RCT) investigates, for the first time, the microbiome of two different high-density polytetrafluoroethylene (d-PTFE) membranes that are used in socket preservation on a highly molecular level and in vivo. Methods: This RCT enrolled 39 participants, with a total of 48 extraction sites, requiring subsequent implant placement. Sites were assigned to two groups, each receiving socket grafting with a composite bone graft (50% autogenous bone, 50% bovine xenograft) and covered by either a permamem^® (group P) or a Cytoplast™ (group C). The membranes were removed after four weeks and analyzed using scanning electron microscopy (SEM) for bacterial adherence, qPCR for bacterial species quantification, and next-generation sequencing (NGS) for microbial diversity and composition assessment. Results: The four-week healing period was uneventful in both groups. The SEM analysis revealed multispecies biofilms on both membranes, with membranes from group C showing a denser extracellular matrix compared with membranes from group P. The qPCR analysis indicated a higher overall bacterial load on group C membranes. The NGS demonstrated significantly higher alpha diversity on group C membranes, while beta diversity indicated comparable microbiota compositions between the groups. Conclusion: This study highlights the distinct microbial profiles of two d-PTFE membranes during the four-week socket preservation period. Therefore, the membrane type and design do, indeed, influence the biofilm composition and microbial diversity. These findings may have implications for healing outcomes and the risk of infection in the dental implant bed and should therefore be further explored. Full article