Odontological Drugs and Their Action on Some Biological Organisms

Odontology is the study of teeth, of theirs diseases and treatment of these. Many odontological drugs are commonly used in dental practice. Antibiotics are indicated for the treatment of odontogenic infections, oral non-odontogenic infections, as prophylaxis against focal infection, and as prophylaxis against local infection and spread to neighboring tissues and organs. In addition to antibiotic, antifungals (drugs for classes azoles, imidazoles and polyenes), antiviral such as antimicrobial mouthwashes and nucleases inhibitors are also indicated for the treatment. These drugs prescription is almost invariably associated with the prescription of Nonsteroidal Antiinflammatory Drugs (NSAIDs), topical corticoids, local anaesthesic for odontological pain and/or Sodium Fluoride for dental caries. Odontalogical drugs act on several levels of metabolism either of microorganisms’ constitutive material (e.g. wall, membrane, cytoplasm and nuclear materials for antibiotics, antivirals, antifungals and oxidizing substances) to destroys them or of humans system cells (receptors, enzymes, hormones for painful, inflammation, local anaesthesic and dental building drugs) to inhibit or stimulate them for the best functioning.

Genetic Basis of Dental Agenesis: Non-Syndromic Hypodontia

Tooth agenesis or hypodontia is one of the most prevalent developmental anomalies of the human dentition which affects up to 8% of the Caucasian population. It is a quite heterogenous condition which describes the congenital absence of one or more teeth and can occur either with a syndrome (syndromic hypodontia) or without (non-syndromic hypodontia). Hypodontia still constitutes a challenging clinical problem. Our insight on the cause of tooth agenesis is increasing as a result of recent advances in the field of molecular biology and human genetics. Further research is needed to establish a genotype phenotype correlation and to fully understand the pathogenesis of tooth agenesis. This review presents the genes and signaling pathways associated with nonsyndromic hypodontia, based on the most current literature and provides an overview of novel genes that seem to contribute to dental agenesis.

Screw-Retained Implant-Supported Fixed Dental Restorations: A Rational Method to Overcome Esthetic Issues with the Screw-Access Hole

Achieving both esthetics and a perfect seal of the screw-access hole in a screw-retained implant-supported fixed dental restoration is a great challenge. From a functional point of view, a perfect seal needs to be obtained to prevent bacterial contamination along the screw access canal and the occlusion shall be addressed. Such a challenging procedure has to be based on a rational analysis of the different materials used. Screw-retained zirconia-based restorations offer a new perspective for esthetic and biocompatible results. The aim of this article is to describe an easy and reproducible clinical procedure to esthetically seal the screw-access hole of screw-retained implant-supported fixed dental restorations.

Application of High-Frequency Conduction for Persistent Apical Periodontitis: A Case Report

We report the case of a 39-year-old male with Persistent Apical Periodontitis (PAP) caused by infection in an uninstrumented area, wherein conventional chemical root canal treatment is not possible, which was sterilized via highfrequency conduction. He underwent root canal filling after multiple endodontic treatments for tooth #4. As symptoms recurred, he was referred to our department with the chief complaint of dull pain during mastication. Present symptoms were percussion pain of the tooth, buccal mucosa swelling at the apical portion, and grade 1 mobility. Radiography revealed inadequate root canal filling. A radiolucent image 5×6 mm in diameter and with an unclear boundary was observed around the apex. External root resorption was mainly observed in the apical foramen, with a crown root ratio of approximately 1:1. Using 6% sodium hypochlorite under dental microscopy, chemomechanical root canal preparation was performed. Passive ultrasonic irrigation and calcium hydroxide application were conducted three times; however, periapical tissue inflammation did not subside. Therefore, the patient was diagnosed with PAP, and the uninstrumented area was sterilized via high-frequency conduction. High-frequency currents were applied to the apex, root surface, and periapical lesion at 500 kHz and 90 V; periapical tissue inflammation resolved after 2 weeks. Subsequently, the root canal was filled. Follow-up radiography revealed a bone regeneration-like image at 2 months. Bone defects healed at 11 months. Although surgical endodontic therapy is conventionally performed in PAP patients, high-frequency conduction could be a minimally invasive nonsurgical endodontic treatment option for uninstrumented areas in PAP patients.

Use of ePortfolio Assessment for Developing Reflective Practitioners

The purpose of the newly implemented ePortfolio assessment program was to help students develop self-directed learning and reflection skills in clinical education and professional values including ethics, professionalism and conscientiousness. Development of higher-level cognitive skills through a student-centered learning modality could ultimately promote reflective learners who will continue to learn throughout their profession. Student self-assessment skills and self-learning plans were captured during the initial patient care exposure in the second year of clinical education using an ePortfolio platform in Canvas (Salt Lake City, UT) learning management system. This new learning methodology can be useful in measuring non-traditional competencies, such as ethics, professionalism and conscientiousness and provide an opportunity for students to become reflective learners. Leveraging this new tool could contribute toward creating reflective practitioners who are competent in ethics and professionalism and self-assessment skills.

Programs and Policies Targeted to Improve Access to Dental Care for Low Income Adults and Children in the US: An Integrative Literature Review

Objective: The authors conducted an integrative literature review of recent studies that explored the impact of interventions implemented in the U.S. that focused on improving access to dental care for low-income and vulnerable populations. Methods: The authors conducted an integrative literature review of studies published between 2012-2018 that addressed six oral health policy spheres. 1) Community-based dental access programs; (2) Medicaid reimbursement and expansion; (3) Student loan support; (4) Oral health services in non-traditional settings and dental residency programs; (5) Programs to improve oral health literacy; and (6) Use of dental therapists. Results: The authors included 39 articles for qualitative synthesis. Numerous public health initiatives and programs exist in the US aimed at increasing access to quality oral health care. Medicaid expansion, increased Medicaid fee-for-service reimbursement rates, and state loan repayment programs have demonstrated some success in improving access among underserved populations. A diversified dental workforce, with community dental health workers and mid-level providers like dental therapists, as well as interprofessional training of nurses and primary-care physicians in oral health have also shown positive impacts in advancing health equity. Further studies are needed to understand how oral health literacy programs can affect access and utilization of dental services. Conclusions: Improvements to the oral health care safety net will require a holistic and multifaceted approach in order to reduce oral health disparities. Policy levers should work, not in isolation, but rather in complementary fashion to one another.

Using Mouthwashes by a Healthcare Practitioner in Order to Decrease the Chance of Transmission of COVID-19

The use of mouthwashes has shown that they can reduce the viral load of Covid-19, with the most promising mouthwashes containing hydrogen peroxide (H2O2). Cetylpyridinium Chloride (CPC), Povidone Iodine (PVP-I) and Chlorhexidine Gluconate (CHX) [1]. Since Sars-Cov-2 is transmitted by airborne droplets and the respiratory tract is the main route of infection, having a way to clear this pathway can ensure that the practitioner does not contract Covid-19 in their patients. Discussion Chlorhexidine (CHX) CHX is a wider-spectrum antiseptic that has an action on Gramnegative and Gram-positive facultative anaerobes, fungi, bacteria, and aerobes by increasing the bacterial cell wall permeability, then causing its cell lysis [2,3]. It is mainly used in dentistry procedure to treat periodontal disease and reduce dental plaque [4]. Evidence shows that an in-vitro consequence against lipidenveloped viruses likes herpesvirus 1, influenza A, cytomegalovirus, hepatitis B and parainfluenza virus [5]. Even though COVID-19 is virus with an envelope, 0.12% CHX gluconate was recommended to have no or little effect against coronaviruses when associated with other type of mouthwashes [6-8]. On the other hand, Yoon et al. [9] shown that SARS-CoV-2 suppression for two hours after consuming 15ml 0.12% CHX once, suggesting that its application would be helpful for the transmission of control of COVID-19. Hydrogen peroxide (H2O2) Since the turn of the century, H2O2 has been used in dentistry in salt combination or alone since the turn of the century [10]. Like a mouthwash, it is a clear, colorless, odorless liquid [11]. No adverse effects on soft tissue have been shown in many studies using 1-1.5 % H2O2 as a daily rinse over two years of follow-up [12,13]. An the study of in vitro study that 3% H2O2 entirely inactivates type 4 adeno-associated viruses, influenza A and B, 1B and 7 rhinoviruses, type 6 and 3 adenoviruses, type 1A, mixoviruses, respiratory syncytial virus with a long-term strain, and the Coronavirus strain 229E within 1-30 minutes, the study shows that influenza virus and coronaviruses were the most subtle [14]. Because SARS-CoV2 is susceptible to oxidation, pre-procedure mouth rinses containing oxidizing agents like the 1% H2O2 h should have reduced viral load in saliva [6,15]. Iodopovidone Povidone Iodine (PVP-I) is a iodine water-soluble mixture that is widely used as a preoperative mouthwash and skin antiseptic [16]. It is commonly used at a concentration of 1% [17] to treat mucositis, prevent ventilator-associated pneumonia and prevent oropharyngeal infections. Its antimicrobial effect is manifested after free iodine dissociates from polyvinylpyrrolidone, then iodine quickly penetrates microbes, destroying proteins and oxidizing nucleic acid structures, causing the death of microbes [18,19]. Prior studies have shown that PVP-I is more virucidal than other commonly used antiseptics, including benzalkonium chloride and CHX [20]. It is nontoxic, reporting a incidence of 0.4% of allergy cases [21], does not cause or taste disturbance and tongue or tooth discoloration [22] and, nothing like alcohol-based products, can be used along with electrocautery [23]. Its efficiency has been well revealed in many studies of in vitro against several viruses, including and influenza A (H1N1) virus SARS-CoV, and MERS-CoV [16,20,24]. Recent studies have shown that 0.23% PVP-I mouthwash perfore procedure for at least 15 seconds before can reduce viral load in saliva [24], representing its procedure in COVID patients -19 [6,18,25,26]. Effectiveness of mouthwash on viral load The Centers for Disease Control and Prevention (CDC) has long suggested taking advantage over mouthwash in reducing airborne pathogens of all kinds prior to clinical procedures [27]. During this global pandemic, given the encounters associated with dispatching dental procedure, attention has been drawn to the potential use of mouthwashes to reduce and prevent SARS-CoV-2 transmission. Conclusion Mouthwashes are an effective way to reduce the transmission of viruses that infect the respiratory tract. As oral cavities are a major source of entry and transmission for human coronaviruses, so mouthwashes are the preventive measure to reduce the risk of COVID-19. Mouthwashes, especially PVP-I, are a potential antiviral that can significantly minimize viral load in saliva and then aerosols, thereby reduce the spread of COVID-19 infection. However, there is paucity of literature and, as a result, a lack of knowledge among dental practitioners about the value of using mouthwashes. Consequently, there is a great need for more clinical trials in order to take a step forward in clinical practice.

Value of Interceptive Orthodontic Treatment for the Management of Sleep Disordered Breathing: A Prospective Longitudinal Study

Background: The paediatric population has a high incidence of sleepdisordered breathing (SDB). One notable risk factor for SDB is the presence of craniofacial abnormalities. The aim of this study was to evaluate the prevalence of SDB by means of questionnaires in patients who received interceptive treatment, to determine whether there is a relationship between the nature and duration of treatment and the prevalence of SDB, and to correlate cephalometric changes with the type of orthopaedic treatment received and questionnaire results. Materials and Methods: Prospective study of 203 patients who required interceptive treatment. Two sleep questionnaires (the Paediatric Sleep Questionnaire (PSQ) and the Sleep Disturbance Scale for Children (SDSC)) were used which were completed by the parents at baseline (T1) and after completion of interceptive treatment (T2). The results of the questionnaires were analysed, grouped according to the type of treatment received and related to 12 cephalometric variables on cephalometric radiography at T1 and T2. Results: The prevalence of SDB at T1 was 21.2% according to PSQ and 33% according to SDSC. The mean age at T1 was 8.5 years and the mean duration of treatment was 13.8 months. Between 10.8% (PSQ) and 17.2% (SDSC) of patients showed improvement in SDB after interceptive treatment (p<0.05). Treatment led to statistically significant cephalometric changes in the variables of mandibular length, maxillary length and overbite, with no significant differences between treatment groups or in relation to questionnaire results. Conclusion: Interceptive treatment achieves significant improvements in SDB. The type and duration of treatment do not affect the prevalence of SDB, although RPE is associated with a higher rate of improvement. The improvement in SDB is independent from the type of treatment and the cephalometric changes effected.

Matrix Metalloproteinase-2 Gene Polymorphisms Decrease Chances of Muscle TMD Development in Brazilian Population

Introduction: Muscular Temporomandibular disorders or masticatory disorders are characterized by orofacial pain and functional limitations associated with oral dysfunctions, emotional changes and/or genetic factors. Matrix Metalloproteinases (MMPs) are proteolytic enzymes that constitute the extracellular matrix and play an important role in the skeletal muscle adaptation. Objectives: To evaluate the association between polymorphisms in the Matrix Metaloprotease-2 (MMP2) gene and the presence of muscular disorders. Methods: RDC/TMD questionnaire was applied for clinical diagnosis of Temporomandibular Disorders (TMD) in the study sample and three diagnosis groups were formed: control group (n=154), muscular TMD (n=122) and joint TMD (n=49). Genomic DNA was obtained from saliva samples and six single nucleotide polymorphisms in the MMP2 gene were selected. Results: A tendency of association between the presence of the CT genotype (rs243865) and the absence of muscular TMD was observed when compared to the control group (p=0.05). There was a significant prevalence of the polymorphic CT+TT (rs243865) genotypes in the control group (p=0.04) compared to the muscular TMD group (p=0.05). Confirming these results, TCCACC MMP2 haplotype showed higher association (p=0.01) with protection against muscular TMD. Conclusion: Polymorphism in the MMP2 gene (rs243865) is related to protection against muscular TMD.

Virus Pandemic, Dentistry and the Global Scientific Order

The world had changed. This opening dialogue was actually from the Oscar award winning movie, The Lord of the Rings Part 1. In reality, starting 2020 the same dialogue became the mouthpiece for the common man, kids, students, virologists, healthcare officials that includes doctors, nurses, and therapists, lawmakers, leaders across the globe. Yes, we are in 2021 but the scars of this pandemic left behind in the minds of each and every individual is yet to heal. There are nearly half dozen theories put forth in the last one year for possible origins of this deadly virus by various virologists and WHO [1] officials who recently visited the Wuhan city, in Hubei province of central China, from where the viral pandemic actually began. This is a basic fundamental truth, which no scientist can deny. But the fact of the matter is the open letter [2] signed by 26 scientists across the globe including one from my country, where the scientists had clearly mentioned the shortcomings encountered during their current investigation and had also explained the requirements still needed for fair, open, transparent probe. The investigators had no access to critical and sensitive information including the old initial positive patient samples of Wuhan virus. The reasons for these hurdles are quite obvious. WHO had scrapped plans of tabling interim report on the origins of this virus [3]. The single most mind throbbing question is whether this Pandemic was indeed an avoidable or at least preventable in the very early stages, from global spread if air travel could had been brought under tremendous restrictions across the globe, given the fact there was unrestricted, usual type of travel observed in early first quarter of 2020. The current global spread had been directly attributed to the lack of dissemination of evolving scientific information from local authorities of Wuhan city and from the top leadership of China at that point of time. At this point I am reminded of the information on pandemic systemic failure across the globe [4]. Another recent information I came across was, about a poll conducted across scientific community where they had indicated the current pandemic most likely to exist as an endemic [5]. Recently a study published in PLOS Biology journal explains the fact that after assessment of over a thousand genomic sequences of the COVID viruses, authors had clearly stated properties acquired by this virus have evolved in bats prior to spillover to humans [6]. Dentistry remains one of the worst hit field across the globe because of the droplet mode of spread of the virus which was acknowledged by WHO in first half of 2020 [7]. Nevertheless after evolving evidences on aseptic clinical practices and their role in dental practice coupled with patient selection criterias, currently the situation in dental treatment has changed from psychological fear to evidence based [8-16]. The world woke up after the rude shock of tsunami in 2004, and subsequently it led to the establishement of tsunami warning systems. Similarly, this current pandemic had shaken the globe and had brought about the need to have a global surveillance mechanism or a system to monitor the spread of new forms of viruses from any part of the world. All wet markets across the globe, animal farm houses, mountains harbouring bats should be under biotechnology driven scientific scrutiny. Hoping that to happen soon, it should become a reality. Please do remember that currently our earth is the only viable planet for human life, in our entire solar syatem and in our milky way galaxy. High time, to decontaminate various pollutants including this pandemic biothreat and for that to happen, world countries need to become really serious about their national health policies. This pandemic had indeed given a lesson for all of us to learn on management of Public health crisis [17]. Former WHO director general had also explained on four points for dealing with resolving of global health crisis [18]. Better late than never. Let us save our planet and the future generations.