To Covid-19, Not Involved yet Worst Hit! Sincerely, Dentistry

Through the spread of unfathomable SARS-CoV-2, you have dwelled a global upheaval in almost all realms of life, with dental health care providers at the highest risk of contracting and transmitting the virus .

Tele-Dentistry Rising: The Apps of Pediatric Dentistry: An Up-ToDate Review

The pandemic changed the landscape of the accessibility to healthcare in an unexpected way. The instant disconnection with healthcare professionals including dental professionals thrusted tele-medicine and tele-dentistry into the spotlight. In pediatric dentistry, there are applications developed for both patients and dentists. This article aims to provide an overview of pediatric dentistry-related applications available on the Apple App Store and Google Play Store that can be useful for children, families and pediatric dentists. iPhone XS was used to access the Apple App Store, and Samsung Galaxy Note 20 devices was used to access the applications in the Google Play Store. The keywords; pediatric dentistry, teeth, brushing teeth, toothbrush timer, pediatric dental care, dentist games, dental pain, dental trauma were selected and searched in Google Play Store and Apple App Store. In total there were 313 applications related to pediatric dentistry which were classified as “Applications for Pediatric Dentists” and “Applications for Pediatric Patients and Their Families”.

Establishing Evaluation Criteria for Digital Dental Simulation Systems and the Differences between Software and Evaluators

Purpose: Cavity and tooth preparation are essential curriculum components in dental education for undergraduate students, and faculty staff determine whether the standard of the work is acceptable. However, evaluators are inevitably subject to variability and bias, so quantification of the evaluation is desirable. Therefore, various digital devices have been developed to quantify evaluations, such as SURFLACER, Simodont, and DentSim. In this study, we aimed to investigate the use of evaluation software and to compare human evaluation with software evaluation using a new digital dental education device with a realtime evaluation function. Material and Method: Dental students prepared a full metal crown on an artificial mandibular left first molar, which was evaluated by the software and a human evaluator (a dentist). Results: The results showed that the software evaluation was more suitable with eight cross-sections than with four crosssections. The dentist evaluated the same teeth according to a set of evaluation criteria, but there were no statistically significant differences in any of the evaluation items. Finally, multivariate analysis was conducted to assess the relationship between the software evaluation using eight cross-sections and the human evaluator using dummy variables, and it revealed that the margin form evaluation by the dentist was a significant explanatory variable for the score by the software. Conclusion: This preliminary study is the first to demonstrate that the new digital dental education device has considerable potential as a digital educational tool.

Post-Endodontic Treatment Flare-Up of Patients Treated By General Dentists and Endodontic Specialists

Objective: This study aims to determine post-endodontic flare-up incidence for patients treated by endodontic specialists and general dental practitioners. Methods: The investigators measured the postoperative pain using a visual analog scale after 24 and 48 hours for patients treated endodontically by specialists and general dentists. The patient factors and operative variables were documented for every patient. The data was then analyzed using SPSS. A Chi-square test was used to evaluate a relationship between categorical variables, where a P < 0.05 was taken to indicate statistical significance. Results: In total, 143 participants were included in this study (male: n=62, 43.3%; and female: n=81, 56.7%). The incidence of post-endodontic treatment flare-ups was 14.8%. The incidence of 48 hours postoperative pain was higher (29%) with the endodontic specialists compared to the general practitioners. The factors that were associated with a higher postoperative flare-up include; patient age, smoking, preoperative pain, and periapical lesion size. Conclusion: Post-endodontic flare-up incidence in this study was within the reported range of flare-up. Patient factors are associated with the occurrence of the postoperative flare-up more than the operative factors.

Wear Comparison of a Plain Toothbrush versus Eleven Commercial Toothbrushes

Objective: To compare the wear of the Sound Feelings SOFT Plain Toothbrush 47 tuft (flat bristles) versus eleven manual toothbrushes. Methods: Twelve brand-new manual toothbrushes (n = 35 in each group) were used for comparison. Each toothbrush was run on a toothbrushing simulator with a brushing force of 2N for approximately 2 hours to simulate 1 month of toothbrushing (9,333 strokes @ 45° lingual of posterior teeth, 9,333 strokes on the top surface, and 9,333 strokes @ 45° buccal of posterior teeth), using the Bass technique on a quadrant typodont. Wear was measured by wear index and wear rating. The Wear index measures the degree of bristle splaying whereby the bristles spread apart and take on a permanent curvature. Wear rating is a subjective rating scale consisting of a series of four numbers increasing from zero to three. The Olympus SZX16 microscope was used to measure the wear rating then was inputted into a formula and averaged. The subjective wear seen as bristle splay/ curling was also measured and recorded. Comparison of the wear index and wear rating between each manual toothbrush was conducted using the Mann-Whitney test. Results: Wear index and wear rating for all toothbrushes ranged from 0.03 to 0.34 and from 0.57 to 2.06, respectively. There was a significant difference in the wear index between each toothbrush and the Sound Feelings SOFT Plain toothbrush. The difference in the wear rating was significant between the Sound Feelings SOFT Plain toothbrush and all other toothbrushes other than the Reach Advanced Design Soft toothbrush. Conclusion: The Sound Feelings SOFT Plain Toothbrush had the lowest wear rating and index among all the manual toothbrushes tested.

COVID-19 Infection Rate among Dental Health Care Workers

Background: First infections of COVID-19 pandemic occurred in December 2019 in China and then spread rapidly all over the world. In February 2020, the first Corona case was diagnosed in Israel, since then, three national lockdowns have been imposed. Israeli Ministry of health published guidelines for dental treatment during times of social distancing which include: 1) Questioning patients prior to admittance. 2) Increasing intervals between appointments. 3) Restricting number of people permitted in the waiting room to prevent crowds. 4) Wearing masks at all times. 5) Wearing long sleeve waterproof surgical gowns, goggles / face shield. Methods: Data from 54 dental clinics (MaccabiDent health maintenance organization) were collected between March and October 2020 regarding: 1) Number of treatments performed. 2) Number of health care providers participating in the procedures. 3) Number of patients with positive COVID-19 results. 4) Number of healthcare workers positive for COVID-19. 5) Number of paramedical and administrative staff positive for COVID-19. 6) Number of patients treated by dentists who later turned out to be infected by the virus. Results: 1,079 dentists and 354 dental hygienists worked during the study period, and performed 1.29 million procedures of these, seventy eight dentists treated 99 verified COVID-19 patients. 17 dentists (1.58%) tested positive for the virus. Conclusion: By following guidelines, the risk of transmission of coronavirus is minimal in the dental setting. Practical Implications: This article reinforces the evidence regarding the importance of education and following guidelines regarding infection control for dental professionals employed in public clinics.

Decontamination of Hard Tissue Using a Scanning Pulsed 9.3-µm CO2 Laser

Purpose: The aim of the study was to evaluate the use of a scanning 9.3-µm CO2 laser beam to reduce or eliminate bacteria on hard tissue as a new method of non-specific decontamination to prevent cross-contamination during dental or medical procedures. Methods: A low energy level of a 9.3-μm CO2 laser beam was designed to deliver overall uniform photothermal energy in a 2-mm-diameter beam to eliminate bacteria on the surface of dental enamel without damaging the surface of the tooth. The study was conducted in two parts. The first part consisted of 10 human molars polished to a 1-μm finish and inoculated with S. mutans. The bacteria were stained with methylene blue and imaged through cross-polarization microscopy, and the area of the imaged surface containing bacteria was analyzed using ImageJ. The second part of the study consisted of 20 uncleaned extracted human molars used for evaluating cross-contamination of bacteria by measuring bacteria Colony Forming Units (CFU) ejected during an aerosol-generating procedure in vitro. Tryptic soy agar (TSA) plates were used to collect bacteria while cutting enamel. The TSA plates were incubated at 35o C for 24 hours, after which bacteria colonies were counted. Results: Examination using cross-polarization microscopy and imaging showed that the CO2 laser eliminated >98% of bacteria on the surface without altering the surface of teeth and similarly >98% in the aerosol/splatter from cutting of the enamel. Conclusion: The 9.3-μm CO2 laser resulted in nearly a complete elimination of viable bacteria.

Antimicrobial Efficacy of Plant Extracts Combined with Endodontic Sealer on the Growth of Oral Pathogen - An In Vitro Study

Aim: The aim of this study is to evaluate the antimicrobial efficacy of synthetic sealing material (Zinc oxide eugenol based sealer- Pulp canal sealer EWT) and medicinal plant extracts (Glycyrrhiza glabra, Zingiber officinale, Cinnamon zeylanicum) individually and in combination against oral pathogen (Enterococcus faecalis). Methods: The herbal extracts were independently mixed in different ratios with zinc oxide powder, followed by mixing with eugenol to know the effective concentration using antibacterial assay. Different concentrations of each test material were placed into Agar diffusion wells and zones of inhibition were measured against the selected bacteria. The concentration with maximum zone of inhibition for each test material was assessed and grouped as group I- Glycyrrhiza glabra and pulp canal sealer EWT, group II-Zingiber officinale and pulp canal sealer EWT, group III-Cinnamon zeylanicum and pulp canal sealer EWT,Group IV- Plain pulp canal sealer EWT and compared. Results: It was found that all the groups exhibited varied antimicrobial activity against test microorganism. Highest antimicrobial efficacy was noticed in group III followed by group II, group I and least with group IV samples. Conclusion: Zinc oxide eugenol based sealer with plant extracts produced inhibitory zones against tested microorganism. Hence the plant extract can be added as one of the component of endodontic sealer, but further clinical trials need to be conducted before recommending them as sealers.

Use of 9.3μm CO2 Laser for Removal of Zirconia Restorations

Objective: The primary aim of this study was to test if a 9.3µm Carbon Dioxide (CO2 ) laser could be used to effectively separate a cemented zirconia restoration from dentin. The secondary aim was to compare shear bond strength (SBS) between RelyXTM Unicem 2 Automix Cement (3M ESPE) (RelyXTM Unicem 2) and RelyXTM Luting Plus Automix Cement (3M ESPE) (RelyX™ Luting Plus). Methods: 40 teeth were prepared to expose dentin and then randomized into four groups of 10 samples. Zirconia slices (non-glazed Yttrium stabilized zirconia samples (2.5 x 3 x 1.5 mm)) were sandblasted with 50 micron aluminum oxide at 30 psi and then cemented onto the dentin samples with RelyX™ Unicem 2 or RelyX™ Luting Plus, dependent on the group. The cements were applied to both the zirconia and dentin with a force of 20 g/mm2 for 30 seconds following manufacturer’s recommendations. After 48 hours, the 9.3µm CO2 laser was used on half the samples for 5 seconds. All 40 zirconia samples were removed with the Instron 5566A in a traditional SBS test. The groups were: 1A - RelyX™ Unicem 2 and Laser, 1B - RelyX™ Unicem 2 and Shear Bond, 2A - RelyX™ Luting Plus and Laser, and 2B - RelyX™ Luting Plus and Shear Bond. The Mann–Whitney U test was used for comparison. Results: Mean SBS of four groups ranged from 0.5 to 4.4 MPa. There was a significant difference in the SBS between 9.3µm CO2 laser and Shear Force methods for RelyX™ Luting Plus. However, the difference between the two methods was not significant for RelyX Unicem 2. RelyX™ Unicem 2 provided significantly higher SBS than RelyX™ Luting Plus for both the CO2 laser and shear force methods (Table 2). Conclusion: The 9.3µm CO2 laser effectively separated the zirconia restoration cemented with RelyX™ Luting Plus from dentin. RelyX™ Unicem 2 provided significantly stronger SBS than RelyX™ Luting Plus.

Assess the Age of Majority Using Lower Wisdom Teeth

This article is signed by 27 authors from four continents led by Roberto Cameriere one of the most cited authors in the field of dental age assessment. Determining dental age is a very important segment in the forensic sciences because it gives the best results for an individual’s age.