Infection

ObjectivesOur aim was to conduct a meta-analysis on the reliability and consistency of SARS-CoV-2 viral RNA detection in saliva specimens. MethodsWe reported our meta-analysis according to the Cochrane Handbook. We searched the Cochrane Library, Embase, Pubmed, Scopus, Web of Science and clinical trial registries for eligible studies published between 1 January and 25 April 2020. The number of positive tests and total number of conducted tests were collected as raw data. The proportion of positive tests in the pooled data were calculated by score confidence interval estimation with the Freeman-Tukey transformation. Heterogeneity was assessed using the I2 measure and the{chi} 2 test. ResultsThe systematic search revealed 96 records after removal of duplicates. 26 records were included for qualitative analysis and 5 records for quantitative synthesis. We found 91% (95%CI = 80%-99%) sensitivity for saliva tests and 98% (95%CI 89%-100%) sensitivity for nasopharyngeal swab (NPS) tests in previously confirmed COVID-19 infected patients, with moderate heterogeneity among studies. Additionally, we identified 18 registered, ongoing clinical trials on saliva-based tests for detection of the virus. ConclusionSaliva tests offer a promising alternative to NPS for COVID-19 diagnosis. However, further diagnostic accuracy studies are needed to improve their specificity and sensitivity.

ObjectivesAgainst the COVID-19 pandemic backdrop and potential disease transmission risk by dental procedures that can generate aerosol and droplets, this review aimed to identify which clinical dental procedures do generate droplets and aerosols with subsequent contamination, and for these, characterise their pattern, spread and settle. Data SourcesSix databases were searched and citation chasing undertaken (to 11/08/20). Study selectionScreening stages were undertaken in duplicate, independently, by two researchers. Data extraction was performed by one reviewer and verified by another. ResultsEighty-three studies met the inclusion criteria and covered: Ultrasonic scaling (USS, n=44), highspeed air-rotor (HSAR, n=31); oral surgery (n=11), slow-speed handpiece (n=4); air-water (triple) syringe (n=4), air-polishing (n=4), prophylaxis (n=2) and hand-scaling (n=2). Although no studies investigated respiratory viruses, those on bacteria, blood splatter and aerosol showed activities using powered devices produced the greatest contamination. Contamination was found for all activities, and at the furthest points studied. The operators torso operators arm, and patients body were especially affected. Heterogeneity precluded significant inter-study comparisons but intra-study comparisons allowed construction of a proposed hierarchy of procedure contamination risk: higher risk (USS, HSAR, air-water syringe [air only or air/water together], air polishing, extractions using motorised handpieces); moderate (slow-speed handpieces, prophylaxis with pumice, extractions) and lower (air-water syringe [water only] and hand scaling. ConclusionSignificant gaps in the evidence, low sensitivity of measures and variable quality limit firm conclusions around contamination for different procedures. However, a hierarchy of contamination from procedures can be proposed for challenge/verification by future research which should consider standardised methodologies to facilitate research synthesis. Clinical significanceThis manuscript addresses uncertainty around aerosol generating procedures (AGPs) in dentistry. Findings indicate a continuum of procedure-related aerosol generation rather than the current binary AGP or non-AGP perspective. This informs discussion around AGPs and direct future research to help support knowledge and decision making around COVID-19 and dental procedures.

The COVID-19 pandemic highlighted the need for effective protection and rapid development of tests to track and quantify seroconversion through natural infection and vaccination. Recombinant proteins, consisting of the SARS-CoV-2 nucleocapsid and Spike Receptor Binding Domains (RBD) fused with nanoluciferase reporters (GloBodies) were designed and produced. The SARS-CoV-2 specific antibody within serum, from venous blood or eluted from local or remotely-obtained dried blood spots, form a complex with the GloBody, which can be captured on immobilized Protein G or anti-isotype antibody with the retained nanoluciferase activity being proportional to specific antibody levels. Natural infection, vaccination and human and animal SARS-CoV-2 specific antibodies were detectable. These were used to serially monitor infection and vaccination responses in dental healthcare workers (n=82), medical healthcare workers (n=72) and laboratory-based scientists (n=62) within the Royal London, dental and medical hospitals and associated university research institute in Whitechapel, East London. This indicated temporally distinct infection and vaccination profiles, consistent with hospital deployments and local and national lockdowns by dentists and scientists. As such, medical healthcare workers had twice the odds of experiencing COVID-19 symptoms (2.01 95%CI 1.13- 3.58. P<0.001) compared to dentists, who were more at risk than scientists. Likewise, those who performed virus exposure-prone procedures exhibited twice (1.98. 95% CI 1.18-3.34 P=0.01) the odds of symptoms and exhibited higher nucleocapsid titres (0.21 95%CI 0.05-0.38. P=0.012), indicative of higher infection levels. As predicted vaccination was associated with reduced infection risk as shown by reduced titre of nucleocapsid titres (-0.21 95% CI -0.34- - 0.17. P<0.001 and elevated Log10 RBD GloBody titres (1.18. 95%CI 1.09-1.26. P<0.001). The GloBody technology proved to be a versatile and scalable platform for rapid deployment.

ObjectivesThis umbrella review evaluates systematic reviews and meta-analyses for salivary biomarker concentration and activity in caries-affected versus caries-free children. MethodsA comprehensive literature search identified relevant reviews, which were systematically selected using PRISMA guidelines, assessed qualitatively with AMSTAR 2, and analyzed quantitatively using RevMan software. Certainty of evidence was evaluated via the GRADE assessment tool. ResultsOf 609 identified articles, three reviews were included for quantitative analysis. AMSTAR 2 assessments rated three reviews as high quality and one as low quality. Meta-analysis findings showed that for salivary secretory immunoglobulin-A concentration with a mean of 65.54, with a 2.24 higher concentration (0.59 to 3.89 higher) in caries-affected children; carbonic anhydrase-VI concentration with a mean of 2.18, with a 0.92 lower concentration (2.21 lower to 0.38 higher) in caries-affected children; and carbonic anhydrase-VI activity with a mean of 3698.30, with a 2.89 higher activity level (1.24 to 4.54 higher) in caries-affected children. Heterogeneity was low for carbonic anhydrase, high for Salivary secretory immunoglobulin-A, and publication bias risk was low. The GRADE assessment indicated moderate confidence in evidence suggesting slight differences in Salivary secretory immunoglobulin-A and carbonic anhydrase-VI levels in caries-affected children. ConclusionsCaries-affected children under age nine exhibit higher salivary secretory immunoglobulin-A concentration and carbonic anhydrase-VI activity but lower carbonic anhydrase-VI concentration. Current evidence suggests that screening with these three salivary biomarker tests are likely to benefit and unlikely to harm children. Widespread clinical application remains limited until U.S. commercial laboratories provide standardized saliva-based testing for salivary secretory immunoglobulin-A and carbonic anhydrase-VI.

IntroductionThe COVID-19 pandemic has posed many challenges, including provision of urgent dental care. This paper presents a prospective service evaluation during establishment of urgent dental care in the North-East of England over a six-week period. AimTo monitor patient volumes, demographics and outcomes at the North-East urgent dental care service and confirm appropriate care pathways. Main Outcome MethodsData were collected on key characteristics of patients accessing urgent care from 23rd March to 3rd May 2020. Analysis was with descriptive statistics. ResultsThere were 1746 patient triages, (1595 telephone and 151 face-to-face) resulting in 1322 clinical consultations. The most common diagnoses were: symptomatic irreversible pulpitis or apical periodontitis. 65% of clinical consultations resulted in extractions, 0.5% an aerosol generating procedure. Patients travelled 25km on average to access care, however this reduced as more urgent care centres were established. The majority of patients were asymptomatic of COVID-19 and to our knowledge no staff acquired infection due to occupational exposure. ConclusionThe urgent dental care centre effectively managed urgent and emergency dental care, with appropriate patient pathways established over the 6-week period. Dental preparedness for future pandemic crisis could be improved and informed by this data. Three In Brief PointsO_LIA summary is given of how urgent dental care was established in the North East of England during the COVID-19 pandemic which may help with future preparedness for pandemics. C_LIO_LIAerosol generating procedures were almost always avoided in the delivery of urgent dental care C_LIO_LIA telephone triage system was effectively used to determine who needed clinical care, and to separate symptomatic, asymptomatic and shielding patients, with very few failures in triage noted. C_LI

IntroductionDental settings have been considered high risk setting s for COVID-19. A Dental Public Health Team in South East Scotland have worked to risk assess the situation timeously to break chains of transmission. AimTo present routine data produced from a contact tracing service for COVID-19 cases in the dental setting with a focus on transmission. DesignObservational retrospective analysis of a routine data set of COVID-19 cases associated with a dental setting reported via the national contact tracing system for two health board areas in the east of Scotland. MethodsCOVID-19 cases were confirmed by PCR testing. Descriptive statistics are used to summarise the data collected over a 13-month period (Oct 2020-Dec 2021). A narrative presents themes identified during contact tracing that led to transmission within a dental setting and includes a case study. ResultsA total of 811 incidents are included. No evidence of staff to patient transmission or vice versa was found in this study. Staff to staff transmission occurred in non-clinical areas contributing to 33% of total staff cases. ConclusionTransmission of COVID-19 in a dental setting in the context of this study appears to be confined to non-clinical areas. Future pandemic plans should include tools to aid with implementation of guidance in non-clinical areas. In brief pointsO_LIOutbreaks of COVID-19 in a dental setting appear to be confined to the non-clinical areas of dental practices. C_LIO_LIWe have found no evidence of staff to patient transmission or vice versa using our contact tracing methods. C_LIO_LIFuture pandemic preparedness would benefit from including current quality improvement tools to aid with implementation of new standard operating procedures and other regularly changing guidance. C_LI

IntroductionCoronavirus (COVID-19) has dramatically changed the landscape of dentistry including Paediatric Dentistry. This paper explores paediatric patient data within a wider service evaluation completed within an Urgent Dental Care Centre in the North East of England and North Cumbria over a 6-week period. AimTo assess demand for the service, patient demographics and inform paediatric urgent dental care pathways. Main outcome methodsData collected included key characteristics of paediatric patients accessing Paediatric Dental Services from 23rd March to 3rd May 2020. Descriptive statistics were used for analysis. ResultsThere were 369 consultations (207 telephone, 124 face-to-face and 38 Out of Hours consultations). The mean age of children accessing the service was 7 years old. 7% of those attending face-to-face visits were reattenders. The most common diagnoses were irreversible pulpitis and dental trauma. 49% of face-to-face consultations resulted in extractions, 28% with General Anaesthetic, and 21% with Local Anaesthetic. ConclusionManagement of dental emergencies provided by the Urgent Dental Care Centre for paediatric patients has largely been effective and confirmed the efficacy of patient pathways established. O_LSTThree in Brief PointsC_LST Describes the approach adopted in the North East of England and North Cumbria to managing paediatric dental emergencies during the coronavirus pandemic Provides an overview of dental problems and management provided to paediatric patients in the first 6 weeks of the coronavirus pandemic Confirms the need for general anaesthetic services for exodontia in the paediatric population

BackgroundThe use of antibiotic prophylaxis in dental implant surgery is controversial, with conflicting guidelines and variations in clinical practice. This systematic review aimed to evaluate the effectiveness of antibiotic prophylaxis in preventing implant failure and post-operative infection in healthy patients. MethodsA systematic search of the PubMed database was conducted to identify relevant randomized controlled trials (RCTs). Four RCTs met the inclusion criteria and were included in the review. Data on implant failure, post-operative infection, and study characteristics were extracted. ResultsThe four included RCTs, published between 2008 and 2022, encompassed 966 participants. The findings regarding the effect of antibiotic prophylaxis on implant failure were mixed. Two studies reported lower failure rates in the antibiotic group, one found similar rates, and one reported a higher failure rate in the antibiotic group. The findings regarding post-operative infections were also inconclusive, with generally low infection rates reported across both groups. ConclusionThe evidence regarding the benefit of antibiotic prophylaxis in preventing implant failure and post-operative infection in healthy patients is mixed and inconclusive. Further well-designed and adequately powered RCTs are needed to clarify the role of antibiotic prophylaxis in this setting. In the meantime, clinicians should carefully consider the individual patients risk factors, the potential benefits and harms of antibiotic prophylaxis, and the available evidence when making decisions about antibiotic use in dental implant surgery.

A systematic review was performed to answer the following questions: 1) Do dental, oral and maxillofacial (OMF) surgical procedures generate bioaerosols (and if so, which ones), which can result in transmission of COVID-19?; 2) Are aerosolized airborne droplets (and to which extent is splatter) in dental and OMF procedures infective?; 3) Is enhanced personal protective equipment (PPE) an essential to prevent spreading of COVID-19 during dental and OMF aerosol generating procedures (AGPs)? Authors performed a systematic review to retrieve all pertinent literature that assessed effectiveness of surgical mask vs respirators for protecting dental health care workers during dental and OMF AGPs surgical procedures. Additionally, studies which assessed potential aerosolization during dental, OMF and orthopaedic surgeries were retrieved. There is moderate evidence showing that ultrasonic scaling and bone drilling using high speed rotary instruments produces respirable aerosols. Additionally, there is very weak/inconclusive evidence to support the creation of infectious aerosols during dental procedures. According to available very weak/inconclusive evidence, transmission of SARS-CoV-2 via infective aerosol during AGPS, so far, must remain speculative and controversial. As, however, this is a probable opportunistic way of transmission which at least cannot be sufficiently excluded and therefore should not be dismissed out of hand prematurely, proper and equally important properly applied protective equipment (i.e., N95 respirators or FFP-2 masksv or above regarding mouth and nose protection) should always be used during AGPs.

IntroductionChronic periodontitis is a slow-progressing, multifactorial inflammatory disease of the periodontium that may lead to its destruction, which is detectable as increasing probing pocket depth (PPD), subsequent tooth mobility and tooth loss. The purpose of this systematic review was to update and appraise the current trial evidence to the question: Does probiotic (L. reuteri) lozenge taken twice daily over 3-4 weeks reduce PPD in patients with chronic periodontitis after 3 months? Methods and analysisReference checks of previous systematic review and trial reports on the topic were conducted. PubMed, Scopus, Cochrane Library and the Directory of Open Access Journals (DOAJ) were searched. All selected trial reports were independently appraised by two reviewers, using the CQS-2B trial appraisal tool. Meta-analysis was conducted using a random effect model with the inverse variance method, stratified according to CQS-2B corroboration levels (C1-C4). The I2-test with 95% confidence interval was used to establish whether any statistical heterogeneity exists between datasets. ResultsSeven trials were included for appraisal and analysis. None complied with all appraisal criteria and thus were rated with an overall 0-score (high bias risk). Meta-analysis results at the lower C3-level (MD -0.64, 95% CI: -1.09 to -0.18) were found as being at risk of overestimating the true probiotic effect. ConclusionThe clinical evidence identified in this systematic review is at high risk of representing an overestimation of the true therapeutic effect due to systematic error. The results of large randomised control trials are needed before any clinically relevant answer to the review question can be made.

ObjectiveThis scoping review aims to systematically identify the types, characteristics, and possible pathophysiologic etiologies of the oral ulcers that emerge in COVID-19 patients. IntroductionThe oral cavity is a vulnerable niche for the most diverse microbial ecosystem in the human body; therefore, it presents a wide array of mucocutaneous complications that could indicate various acute and chronic conditions. The COVID-19-related oral conditions, including oral ulcers, had been widely debated as direct manifestations or indirect complications of the SARS-CoV-2 infection. According to a preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews and the JBI Evidence Synthesis, there is no published nor registered scoping review concerned with the oral ulcers of COVID-19 patients. Inclusion criteriaThe review will include studies included COVID-19 patients whose infection had been confirmed by RT-PCR testing regardless of infection severity and clinical course. Only the studies that reported COVID-19 patients with oral ulcers. MethodsA three-phase search strategy will be carried out: an initial limited search, a full electronic search, and hand search using the reference lists of all included records. The main bibliographic databases of published literature will include MEDLINE(R) (Ovid), EMBASE (Elsevier), and Cochrane COVID-19 Study Register. All identified records will be managed using EndNote 9.2, and the titles and abstracts will be screened against the inclusion criteria before the full text of all potentially relevant studies will be examined. The data will be presented in tabular form, rating maps, and narrative summary. RegistrationThis protocol had been pre-registered in Open Science Framework (OSF) Registries.[1]

IntroductionSilver diamine fluoride (SDF) is a simple and non-invasive agent used to arrest early childhood caries (ECC). This study aimed to investigate potential changes to the oral microbiome in children with ECC who were treated with SDF at three different frequency regimens. MethodsForty-five children (n=15 per group) with ECC were recruited into a randomized clinical trial testing three different treatment frequency regimens of SDF. A total of 195 carious lesions were treated with two applications of 38% SDF and 5% sodium fluoride varnish (NaFV) and assessed over three study visits (one month (Regimen 1M), four months (Regimen 4M), or six months (Regimen 6M) apart). Dental plaque samples were collected at each visit. Sequencing of the V4-16S rRNA and ITS1 rRNA genes were used to study the supragingival plaque microbiome. ResultsThe overall arrest rates for treated carious lesions were 75.9% at Visit 2 and 92.8% at Visit 3. Arrest rates were higher for all lesions after two applications of SDF with NaFV, and applications one month and four months apart had higher arrest rates (95.9% and 98.5%) than six months (81.1%) apart. The microbial diversity analyses showed no significant differences in the overall microbiome after SDF treatment. However, significant changes in the abundance of specific bacteria and fungi, particularly Lactobacillus spp., Bifidobacterium spp., and Candida spp. were observed after treatment. Furthermore, overabundance of Streptococcus mutans and Candida dubliniensis at baseline was observed in children who had at least one caries lesion not arrested after one SDF application, compared to those who had 100% arrest rates. ConclusionSDF with NaFV applications were an effective modality for arresting ECC, with higher arrest rates after two SDF applications. No loss of diversity but significant changes in the abundance of specific bacteria and fungi were consequences of SDF treatment.

IntroductionTransmission of SARS-Cov-2 through aerosol has been implicated particularly in the presence of highly concentrated aerosols in enclosed environments. It is accepted that aerosols are produced during a range of dental procedures, posing potential risks to both dental practitioners and patients. There has been little agreement concerning aerosol transmission associated with orthodontics and associated mitigation. MethodsOrthodontic procedures were simulated in a closed side-surgery using a dental manikin on an acrylic model using composite-based adhesive. Adhesive removal representing debonding was undertaken using a 1:1 contra-angle handpiece (W&H Synea Vision WK-56 LT, Burmoos, Austria) and fast hand-piece with variation in air and water flow. The removal of acid etch was also simulated with use of combined 3-in-1 air water syringe to remove etch. An Optical Particle Sizer (OPS 3330, TSI Inc. Minnesota, USA) and a portable Scanning Mobility Particle Sizer (NanoScan SMPS Nanoparticle Sizer 3910, TSI Inc Minnesota, USA) were both to assess particulate matter ranging from very small (0.08 - 0.26 m) to large (2.7 - 10 m) particles. ResultsStandard debonding procedure (involving air but no water) was associated with clear increase in the very small and small (0.26 - 0.9 m) particles but only for a short period. Debonding procedures without air appeared to produce similar levels of aerosol to standard debonding. Debonding in association with water tended to produce large increase in aerosol levels, producing particles of all sizes throughout the experiment. The use of water and a fast hand-piece led to the most significant increase in particles. Combined use of the 3-in-1 air water syringe did not result in any detectable increase in the aerosol levels. ConclusionsParticulate matter was released during orthodontic debonding, although the concentration and volume was markedly less than that associated with the use of a fast hand-piece. No increase in particulates was associated with prolonged use of a 3-in-1 air-water syringe. Particulate levels reduced to baseline levels over a short period (approx. 5 minutes). Further research within alternative, open environments and without air exchange systems is required.

BackgroundAs is known, the pathologies of the posterior teeth in the first and second quadrant and their treatments can be associated with pathology of the maxillary sinus. Both implant and pre-implant surgery have increased their incidence. It is necessary, therefore, to address sinonasal pathology (SN) related to dental pathology (DP) or dental treatments (DT) from an interdisciplinary point of view by establishing collaborative working groups between Dentistry (DEN) and Otolaryngology (ENT), as well as by developing registries and establishing coordinated diagnosis and treatment protocols of sinonasal pathology. The aim of this study is to design a useful classification of SN pathology associated with DP or DT to record information of DEN and ENT. Material and methodsBibliographic review and design of a classification system of SN, DP and DT pathology. ResultsSix categories are described in our system: 0- absence of SN pathology and DP; 1 and 4- patients with DP associated or associated with SN pathology, respectively; 2 and 5- patients with DT not associated or associated with SN pathology, respectively and 3- patients with SN pathology without DP. The classification has applications in diagnosis (association and possible causal relationship between the SN pathology and DP) and in the treatment of NS and DP simultaneously or sequentially. ConclusionsThe classification proposed integrates the presence or absence of DP or DT, and its causal association or the lack of it with SN pathology. Moreover, it facilitates the communication between DEN and ENT and eases the registration of information and the planning of dental, implant and pre-implant treatments.

AIMTo evaluate and compare the marginal bone loss and aesthetic outcomes of zirconia implants with titanium implants in randomized controlled trials (RCTs). MATERIAL AND METHODSElectronic [PubMed] and hand searches were performed to identify randomized controlled trials that were published between January 2008 to April 2020 which investigated and compared various outcomes between zirconia and titanium dental implants. Outcomes included assessment of marginal bone loss and aesthetics using spectrophotometric measurements. Meta-analysis was performed to estimate the above parameters among various studies. RESULTSA total of 58 articles were screened for titles and abstracts. Subsequently 8 articles were selected for data extraction and evaluation. Zirconia implants were investigated and compared to titanium implants for marginal bone loss [MBL]. Customized zirconia and titanium abutments seated over implants were analyzed for aesthetic outcomes using spectrophotometric method using CIE-Lab measurements. Meta-analysis estimated that zirconia implants exhibited marginal bone loss reduction of 0.179mm (95% CI, 0.02 to 0.33) and -0.242mm (95% CI, -4.026 to 3.542) in aesthetic measurements than titanium implants. CONCLUSIONSNo heterogeneity was observed among studies analyzed for marginal bone loss and significant differences were noticed between two groups. Noticeable heterogeneity was observed among studies assessing aesthetics using spectrophotometry and CIE-Lab measurements and results revealed no many significant differences between the two groups.

Background The microbial aetiology of early childhood caries (ECC) in sub-Saharan African populations remains poorly characterised, with most studies focusing on conventional cariogenic pathogens like Streptococcus mutans. This study aimed to characterise the salivary microbial profile of children with ECC in urban Kano, northern Nigeria. Methods In this cross-sectional study of 162 children aged 3-5 years in urban Kano, unstimulated saliva samples were collected and analysed using standard bacteriological culture methods. Caries status was assessed using decayed, missing, and filled teeth (dmft) index and International Caries Detection and Assessment System (ICDAS). Microbial isolates were identified through Gram staining, colony morphology, and biochemical tests (catalase, coagulase, oxidase). Results Of 32 microbial isolates obtained, Staphylococcus aureus was the most prevalent (43.8%, n=14), followed by Streptococcus species (28.1%, n=9), Klebsiella species (12.5%, n=4), non-aureus staphylococci (6.3%, n=2), yeast (6.3%, n=2), and Pseudomonas species (3.1%, n=1). Only one isolate demonstrated direct association with dmft-detectable caries. Polymicrobial colonisation occurred in four cases (12.5%), predominantly featuring S. aureus-yeast combinations (n=2). White spot lesions (ICDAS 1-2) were associated with S. aureus and Klebsiella species in two separate cases. Conclusion This study reveals an unexpected predominance of S. aureus in the salivary microbiome of children in northern Nigeria, challenging conventional paradigms of ECC microbiology. The low correlation between microbial isolates and clinical caries suggests complex, multifactorial aetiology. These findings highlight the need for molecular characterisation of oral microbiomes in African populations and reconsideration of caries pathogenesis models in this unique epidemiological context.

The presence of high SARS-coronavirus 2 (SARS-CoV-2) titres in saliva may result in transmission of the virus and increase the risk of COVID-19 infection. This is particularly important as significant amounts of aerosols are generated during dental procedures, posing risk to dental care personnel and patients. Thus, reducing the titres of SARS-CoV-2 in the saliva of infected patients could be one of the key approaches to reduce the risk of COVID-19 transmission during dental procedures. In this randomised control trial, the efficacy of three commercial mouth-rinse viz. povidone-iodine (PI), chlorhexidine gluconate (CHX) and cetylpyridinium chloride (CPC), in reducing the salivary SARS-CoV-2 viral load in COVID-19 positive patients were compared with water. A total of 36 COVID-19 positive patients were recruited, of which 16 patients were randomly assigned to four groups-- PI group (n=4), CHX group (n=6), CPC group (n=4) and water as control group (n=2). Saliva samples were collected from all patients at baseline and at 5 min, 3 h and 6 h post-application of mouth-rinses/water. The samples were subjected to SARS-CoV-2 RT-PCR analysis. The fold change of Ct values were significantly increased in CPC group at 5 minutes and 6 h time points (p<0.05), while it showed significant increase at 6 h time point for PI group (p<0.01). Considering Ct values as an indirect method of arbitrarily quantifying the viral load, it can be postulated that CPC mouth-rinse can decrease the salivary SARS-CoV-2 levels within 5 minutes of use, compared to water rinsing. The effect of decreasing salivary load with CPC and PI mouth-rinsing was observed to be sustained at 6 h time point. Within the limitation of the current study, it can be concluded that use of CPC and PI formulated commercial mouth-rinses, with its sustained effect on reducing salivary SARS-CoV-2 level, may be useful as a pre-procedural rinse to help reduce the transmission of COVID-19.

BackgroundAccumulation of dental plaque can lead to gum problems. A fluoride toothpaste containing naturally occurring enzymes and proteins has been shown to improve gingival health and reduce supragingival plaque in European populations. The objective of the current study was to evaluate the ability of this toothpaste to improve gingival condition and reduce supragingival plaque in an alternative study population. MethodsThis was a double-blind (participant, examiner, investigator, statistician), randomised, parallel group, efficacy study conducted at a Chinese university dental hospital. Participants (age 18-70) with a mean gingival index (GI) [&ge;] 1.0 and mean modified Quigley and Hein plaque index (MQHPI) [&ge;] 1.5 were randomised using sex stratification to twice-daily brushing with either test toothpaste (n=127) or control fluoride toothpaste (n=124) for 26 weeks. Assessments of GI (primary outcome) and MQHPI were conducted at baseline and after 4, 13 and 26 weeks of product use. Results were analysed using ANCOVA model for between product comparison (= 0.05). ResultsOne hundred and six participants using test toothpaste and 92 using control toothpaste completed the study. The test toothpaste was more effective than control toothpaste in improving gingival condition after 4, 13 and 26 weeks of product use, with estimate product differences in GI of -0.18 at week 4 (p < 0.0001, 95% CI -0.23 to -0.12), -0.16 at week 13 (p < 0.0001, 95% CI -0.20 to -0.11) and -0.53 at week 26 (p < 0.0001, 95% CI -0.60 to -0.46). The test toothpaste was also significantly more effective than control toothpaste in reducing supragingival plaque after 4, 13 and 26 weeks of product use, with estimated product differences of -0.29 at week 4 (p < 0.0001, 95% CI -0.38 to -0.21), -0.35 at week 13 (p < 0.0001, 95% CI -0.45 to 0.25) and -0.96 at week 26 (p < 0.0001, 95% CI -1.06 to -0.85). ConclusionThe study demonstrated that a toothpaste containing naturally occurring enzymes and proteins significantly improved gingival health and reduced supragingival plaque compared to a control toothpaste, after 4, 13, and 26 weeks of use.

AimTo study the symptoms and perception reported by patients with peri-implant diseases, as well as their signs and their potential impact on the oral health quality of life. Materials and Methods240 randomly selected patients were invited to participate. As part of the history assessment, the patient OHIP-14Sp was evaluated together with, for each implant, the patient perception regarding the peri-implant health status and the history of pain, spontaneous discomfort, bleeding, suppuration, swelling and discomfort during brushing. As part of the clinical examination, the following potential signs of peri-implant diseases were collected: probing pocket depth (PPD), mucosal dehiscence (MD), extent of BoP, presence of SoP, and visual signs of redness and swelling. Those parameters were analyzed in relation to the actual peri-implant health diagnosis. Results99 patients with a total of 458 dental implants were studied. Even in case of peri-implantitis, 88.89% of the implants were perceived by the patients as healthy. The total OHIP-14Sp sum score did not differ in relation to the peri-implant health diagnosis. Increased reports of spontaneous discomfort, bleeding, swelling and discomfort during brushing were observed in presence of disease. However, only a minor proportion of implants with peri-implant diseases presented symptoms. PPD[&ge;]6 mm was more frequent in diseased than in healthy implants(p<0.01), while PPD[&ge;]8 in pre-periimplantitis/peri-implantitis than in healthy/mucositis implants(p<0.01). Implants with peri-implantitis showed higher MD than implants without peri-implantitis(p<0.01). ConclusionsPeri-implant diseases are in most cases asymptomatic and not perceived by the patients. Despite being unable to accurately discriminate between peri-implant mucositis and peri-implantitis, PPD and MD resulted as the only two clinical signs associated with pre-periimplantitis/peri-implantitis.

BackgroundThe objective of this study was to investigate the experience of Saudi dental practitioners with intraoral scanners, investigate the current knowledge and improve the practice accordingly. MethodsAt random, electronic surveys were distributed to Saudi dental practitioners. The study received 400 questionnaires, with 310 judged valid for the study. The questionnaire was divided into the following sections: (i) Practitioners demographic information such as gender, practice level, and practice experience. (ii) Experience and benefits of intraoral scanners. (iii) Require skills and training of IOS. (iv) Knowledge of IOS usage. Descriptive statistics such as numbers and percentages were used to analyze the collected data. The Chi-square and Fishers Exact tests were used to assess the results. ResultsThere were 161 women (51.8%) and 149 men among the participants (47.9%). General practitioners (198, or 63.7%) had the most subjects, followed by specialists (80, or 25.7%) and consultants (32, or 10.3%). In terms of IOS use in dental practice, most participants (70.6%) do not use it, while less than one-third do. The majority of participants (52.3%) intend to purchase IOS with significant variations based on gender, experience, and level of practice (p<0.05). Compared to traditional, most participants believe that IOS will eventually replace it, improve quality, and be more aesthetically pleasing. Most dentists believe that using IOS requires special skills and training. More than half of dentists believe IOSs have the same level of accuracy as conventional in producing three units FPDs, implant prosthesis, and complete denture. ConclusionIt can be concluded that dentists have a high level of satisfaction and a favorable attitude toward using IOS technology in clinical dentistry practice.