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Luo W, Yan H, Guo S. Evaluation of the efficiency of antibiotics in treating adult patients with symptomatic apical periodontitis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26405. [PMID: 34160426 PMCID: PMC8238317 DOI: 10.1097/md.0000000000026405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND When a person feels dental pain, it brings great discomfort and damages the quality of life. Symptomatic apical periodontitis is identified as the most frequent cause that triggers dental pain. Symptomatic apical periodontitis arises from an infection or inflammation in the pulpless root canal structure. According to clinical guidelines, the primary form of therapy for such teeth entails removing the inflammation or infection source through local surgical procedures. Presently, systemic antibiotics are recommended only for cases where there is clear indication of an infectious spread or a systemic involvement. Therefore, this study aims to assess the efficacy and level of safety of using antibiotics to treat adult symptomatic apical periodontitis patients. METHODS The present protocol study will conduct a search on electronic databases to look for randomized controlled trials (RCTs) that have evaluated the effectiveness and safety of antibiotics when used to treat adult patients with symptomatic apical periodontitis. The databases will be search from their beginning to April 2021. The search is not bound by publication status or language restrictions. The following databases will be searched: Web of Science, PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure, and EMBASE. This study will employ ZETOC Conference Proceedings and OpenGrey to identify potential grey literature. Afterwards, 2 independent authors will select the studies, extract data from the studies, and conduct a risk assessment to check for bias. All discrepancies between the authors will be resolute via discussion involving a third independent author. The data synthesis and statistical analysis of this study will be done with the RevMan software (Version: 5.3). RESULTS The present protocol report will provide high-quality evidence related to the efficacy and level of safety when using antibiotics to treat mature symptomatic apical periodontitis patients. CONCLUSION The outcomes of the present study will update the evidence available for assessing the efficacy and safeness of using antibiotics to treat mature symptomatic apical periodontitis patients. ETHICS AND DISSEMINATION This study does not require an ethical approval since individual patient data is not included in any form. REGISTRATION NUMBER DOI 10.17605/OSF.IO/CVP8 M (https://osf.io/cvp8m/).
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Affiliation(s)
| | | | - Sijie Guo
- Department of Clinical Laboratory, Wuchang Hospital of Wuhan, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei Province, China
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Javed MQ, Chaudhary FA, Mohsin SF, AlAttas MH, Edrees HY, Habib SR, Riaz A. Dental health care providers' concerns, perceived impact, and preparedness during the COVID-19 pandemic in Saudi Arabia. PeerJ 2021; 9:e11584. [PMID: 34164236 PMCID: PMC8194414 DOI: 10.7717/peerj.11584] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background Dental health care providers (DHCPs)are at high risk of cross-infection during clinical practice therefore, the aim of the study was to evaluate the DHCPs Covid-19 related concerns, its perceived impact, and their preparedness in Saudi Arabia. Methods This cross-sectional study on DHCPs was carried out at five dental teaching hospitals/colleges in four provinces of Saudi Arabia from October to December 2020. A 35-item valid and reliable questionnaire was used to assess the concerns, perceived impact, and preparedness of DHCPs in the COVID-19 pandemic. Chi-square tests and logistic regression were used to compare parameters between the clinical and non-clinical staff. Results A total of 320 DHCPs participated in this study with proportion of clinical staff (57.5%) surpassing the non-clinical staff (42.5%). The clinical DHCPs felt greater odds of falling ill with COVID-19 than non-clinical workers (OR, 2.61) and willing to look for another job (OR, 3.50). The higher proportion in both groups was worried that people close to them would be at higher exposure risk (96.3%) however, slightly more clinical DHCPs were concerned for their children than a non-clinical worker (OR, 3.57). The clinical DHCPs have greater odds of worrying that people would avoid them and their family members because of their job (OR, 2.75). A higher proportion in both groups (75.0%, 63.2%) felt that they would feel stress at work. More non-clinical DHCPs (94.1%) had received training for infection control than clinical (94.1% vs 63.0%: OR 0.10). Similarly, more DHCPs in the nonclinical group received adequate personal protective equipment training (88.2%; OR, 0.48). Most participants practiced self-preparation such as buying masks and disinfection (94.4%, 96.9%). Conclusion The majority of DHCPs felt concerned about their risk of exposure and falling ill from infection and infecting friends/family. These concerns could potentially affect the working of DHCPs during this pandemic. Measures to improve protection for DHCPs, minimize psychological implications, and potential social stigmatization should be identified at the planning phase before any pandemic.
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Affiliation(s)
- Muhammad Qasim Javed
- Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Buraidah, Qassim, Saudi Arabia
| | - Farooq Ahmad Chaudhary
- Department of Community Dentistry, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Syed Fareed Mohsin
- Department of Oral Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Qassim University, Ar Rass, Qassim, Saudi Arabia
| | - Mustafa Hussein AlAttas
- Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Buraidah, Qassim, Saudi Arabia
| | - Hadeel Yaseen Edrees
- Endodontic Department, Faculty of Dentistry, King Abdulaziz Univeristy, Jeddah, Saudi Arabia
| | - Syed Rashid Habib
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Arham Riaz
- Community Dentistry, Academy of Continuing Health Education and Research, Islamabad, Pakistan
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Need of the hour: Dental stewardship. Infect Control Hosp Epidemiol 2021; 42:869-870. [PMID: 33985605 DOI: 10.1017/ice.2021.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ford JH, Liao CY, Crnich CJ. Exploring Antibiotic Utilization in Assisted Living: Identifying Opportunities for Improvement. J Am Med Dir Assoc 2021; 22:1772-1773.e1. [PMID: 33932353 DOI: 10.1016/j.jamda.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- James H Ford
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin, Madison, WI, USA
| | - Chi-Yin Liao
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin, Madison, WI, USA
| | - Christopher J Crnich
- Department of Medicine, School of Medicine & Public Health, University of Wisconsin, Madison, WI, USA; William S. Middleton VA Hospital, Madison, WI, USA
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Emmott R, Barber SK, Thompson W. Antibiotics and toothache: a social media review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:210-217. [PMID: 33880539 DOI: 10.1093/ijpp/riaa024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/24/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Antibiotics are inappropriate for the treatment of toothache, yet many seek them. Social media allows users to express their opinions, share experiences and offer support. This study used social media to investigate the public's experiences of, and attitudes towards, antibiotics for toothache. METHODS A systematic search of posts on Facebook and Twitter was undertaken. Eligibility criteria were applied to select relevant social media posts for thematic analysis of word content. An inductive descriptive coding system was developed from the data and exemplary quotes were identified to illustrate the themes and subthemes identified. Key findings Searches identified 174 posts, of which 144 were selected for analysis. Five themes were identified: experience and expectations, self-care and professional treatment, access to dental care, quality of life and coping strategies. The belief that antibiotics are an appropriate treatment for a toothache was widespread. Antibiotic-seeking behaviour was related to access to professional dental care, including avoiding dental appointments due to dental anxiety and the perceived affordability of dentistry. A range of strategies to cope with the severe impact toothache was having on people's quality of life were identified, from prayer to antibiotics. CONCLUSIONS Social media is used extensively to seek antibiotics, avoid dental treatment and provide support to people with toothache. A general belief that antibiotics are an appropriate and necessary treatment for toothache exists. This improved understanding about the factors driving antibiotic-seeking behaviour provides new targets for the development of approaches to tackling antibiotic resistance, by reducing unnecessary antibiotic use in dental clinics and beyond.
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Affiliation(s)
- Rachel Emmott
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Sophy K Barber
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Wendy Thompson
- Division of Dentistry, University of Manchester, Manchester, United Kingdom
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Unnecessary Antibiotic Prescribing in Dental Practices and Associated Adverse Effects. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patterns of dental antibiotic prescribing in 2017: Australia, England, United States, and British Columbia (Canada). Infect Control Hosp Epidemiol 2021; 43:191-198. [PMID: 33818323 DOI: 10.1017/ice.2021.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Our objective was to compare patterns of dental antibiotic prescribing in Australia, England, and North America (United States and British Columbia, Canada). DESIGN Population-level analysis of antibiotic prescription. SETTING Outpatient prescribing by dentists in 2017. PARTICIPANTS Patients receiving an antibiotic dispensed by an outpatient pharmacy. METHODS Prescription-based rates adjusted by population were compared overall and by antibiotic class. Contingency tables assessed differences in the proportion of antibiotic class by country. RESULTS In 2017, dentists in the United States had the highest antibiotic prescribing rate per 1,000 population and Australia had the lowest rate. The penicillin class, particularly amoxicillin, was the most frequently prescribed for all countries. The second most common agents prescribed were clindamycin in the United States and British Columbia (Canada) and metronidazole in Australia and England. Broad-spectrum agents, amoxicillin-clavulanic acid, and azithromycin were the highest in Australia and the United States, respectively. CONCLUSION Extreme differences exist in antibiotics prescribed by dentists in Australia, England, the United States, and British Columbia. The United States had twice the antibiotic prescription rate of Australia and the most frequently prescribed antibiotic in the US was clindamycin. Significant opportunities exist for the global dental community to update their prescribing behavior relating to second-line agents for penicillin allergic patients and to contribute to international efforts addressing antibiotic resistance. Patient safety improvements will result from optimizing dental antibiotic prescribing, especially for antibiotics associated with resistance (broad-spectrum agents) or C. difficile (clindamycin). Dental antibiotic stewardship programs are urgently needed worldwide.
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Tai YH, Chen JT, Kuo HC, Chang WJ, Wu MY, Dai YX, Liu WC, Chen TJ, Wu HL, Cherng YG. Periodontal disease and risk of mortality and kidney function decline in advanced chronic kidney disease: a nationwide population-based cohort study. Clin Oral Investig 2021; 25:6259-6268. [PMID: 33813639 DOI: 10.1007/s00784-021-03924-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Periodontal disease is prevalent in patients with chronic kidney disease (CKD) and potentially associated with kidney function decline. However, it is uncertain whether periodontal disease affects the risk of mortality and morbidity in patients with advanced CKD. MATERIALS AND METHODS Taiwan's National Health Insurance Research Database was used to conduct a nationwide population-based cohort study. Propensity score matching procedures were performed to select people with stage 5 CKD and to compare the long-term risk of mortality, end-stage renal disease, and major adverse cardiovascular events (MACE) between people with and without periodontal disease. Multivariable Cox regression analyses were conducted to calculate the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for the outcome of interest. RESULTS A total of 8119 subjects with stage 5 CKD were initially included. After matching to demographic and clinical covariates, 1254 subjects with 7099 person-years of follow-up were selected for analyses. Periodontal disease was not associated with long-term risks of all-cause mortality (aHR: 0.77, 95% CI: 0.49-1.22), progression to end-stage renal disease (aHR: 0.91, 95% CI: 0.75-1.10), or MACE (aHR: 1.18, 95% CI: 0.91-1.53). These findings were generally consistent across subgroups of age, sex, comorbid diabetes, uses of systemic antibiotic, and different dental procedures. CONCLUSIONS Periodontal disease is not a predictor for long-term mortality or morbidity in patients with advanced CKD. CLINICAL RELEVANCE These results provide important evidence to elucidate the relationship between periodontitis and critical clinical outcomes of advanced CKD.
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Affiliation(s)
- Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jui-Tai Chen
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsien-Cheng Kuo
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Jen Chang
- Department of Dentistry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Mei-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wan-Chi Liu
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiang-Ling Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Postextraction infection and antibiotic prescribing among veterans receiving dental extractions. Infect Control Hosp Epidemiol 2021; 42:1431-1436. [PMID: 33650471 DOI: 10.1017/ice.2021.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To characterize postextraction antibiotic prescribing patterns, predictors for antibiotic prescribing and the incidence of and risk factors for postextraction oral infection. DESIGN Retrospective analysis of a random sample of veterans who received tooth extractions from January 1, 2017 through December 31, 2017. SETTING VA dental clinics. PATIENTS Overall, 69,610 patients met inclusion criteria, of whom 404 were randomly selected for inclusion. Adjunctive antibiotics were prescribed to 154 patients (38.1%). INTERVENTION Patients who received or did not receive an antibiotic were compared for the occurrence of postextraction infection as documented in the electronic health record. Multivariable logistic regression was performed to identify factors associated with antibiotic receipt. RESULTS There was no difference in the frequency of postextraction oral infection identified among patients who did and did not receive antibiotics (4.5% vs 3.2%; P = .59). Risk factors for postextraction infection could not be identified due to the low frequency of this outcome. Patients who received antibiotics were more likely to have a greater number of teeth extracted (aOR, 1.10; 95% CI, 1.03-1.18), documentation of acute infection at time of extraction (aOR, 3.02; 95% CI, 1.57-5.82), molar extraction (aOR, 1.78; 95% CI, 1.10-2.86) and extraction performed by an oral maxillofacial surgeon (aOR, 2.29; 95% CI, 1.44-3.58) or specialty dentist (aOR, 5.77; 95% CI, 2.05-16.19). CONCLUSION Infectious complications occurred at a low incidence among veterans undergoing tooth extraction who did and did not receive postextraction antibiotics. These results suggest that antibiotics have a limited role in preventing postprocedural infection; however, future studies are necessary to more clearly define the role of antibiotics for this indication.
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Oral Antibiotic for Empirical Management of Acute Dentoalveolar Infections-A Systematic Review. Antibiotics (Basel) 2021; 10:antibiotics10030240. [PMID: 33670844 PMCID: PMC7997333 DOI: 10.3390/antibiotics10030240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/21/2022] Open
Abstract
Concerns regarding increasing antibiotic resistance raise the question of the most appropriate oral antibiotic for empirical therapy in dentistry. The aim of this systematic review was to investigate the antibiotic choices and regimens used to manage acute dentoalveolar infections and their clinical outcomes. A systematic review was undertaken across three databases. Two authors independently screened and quality-assessed the included studies and extracted the antibiotic regimens used and the clinical outcomes. Searches identified 2994 studies, and after screening and quality assessment, 8 studies were included. In addition to incision and drainage, the antibiotics used to manage dentoalveolar infections included amoxicillin, amoxicillin/clavulanic acid, cefalexin, clindamycin, erythromycin, metronidazole, moxifloxacin, ornidazole and phenoxymethylpenicillin. Regimens varied in dose, frequency and duration. The vast majority of regimens showed clinical success. One study showed that patients who did not receive any antibiotics had the same clinical outcomes as patients who received broad-spectrum antibiotics. The ideal choice, regimen and spectrum of empirical oral antibiotics as adjunctive management of acute dentoalveolar infections are unclear. Given that all regimens showed clinical success, broad-spectrum antibiotics as first-line empirical therapy are unnecessary. Narrow-spectrum agents appear to be as effective in an otherwise healthy individual. This review highlights the effectiveness of dental treatment to address the source of infection as being the primary factor in the successful management of dentoalveolar abscesses. Furthermore, the role of antibiotics is questioned in primary space odontogenic infections, if drainage can be established.
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McKenna AM, Ioannidou E, Banach DB. Antibiotic prescribing at a periodontal residency practice in Connecticut. J Periodontol 2021; 92:e76-e83. [PMID: 33533490 DOI: 10.1002/jper.20-0657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/01/2021] [Accepted: 01/03/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Antibiotics are important in the treatment of odontogenic infections and the prevention of infection following dental procedures in high-risk situations. Little is known about antibiotic prescribing in periodontal practice. This study describes prescribing practices by periodontal faculty and residents in an academic setting in order to identify opportunities to optimize prescribing behaviors. METHODS This cross-sectional study analyzed all antibiotic prescriptions from residents or faculty in an academic periodontal clinic from 2014-2017. Information was manually extracted from the electronic health record. Antibiotic prescriptions were stratified into three indication categories: pre-procedural prophylaxis, post-procedural prophylaxis, and treatment. RESULTS Out of 275 prescriptions analyzed, 266 met inclusion criteria. The most frequent antibiotic indication was post-procedural prophylaxis (n = 130, 48.87%). Amoxicillin was the most frequently prescribed antibiotic across all groups (n = 236, 88.72%), followed by clindamycin (n = 22, 8.27%). Most patients presented in a non-emergent setting (n = 200, 75.19%), without pain (n = 210, 78.95%), and had restorative/endodontic-related clinical findings (n = 55, 20.68%). Among the 35 patients receiving antibiotics for infection treatment, 8 (22.86%) underwent a surgical intervention on the date of antibiotic prescription. Of the 130 patients receiving post-procedural prophylaxis, 121 (93.08%) received surgical interventions on the day of antibiotic prescription. CONCLUSIONS Antibiotics are prescribed in various situations in periodontal practice, most frequently as post-procedural prophylaxis, an indication for which data is limited. There is an urgent need to study the role of post-procedural prophylactic antibiotics and understand antibiotic prescribing in the management of periodontal disease in order to optimize prescribing practices.
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Affiliation(s)
- Alexandra M McKenna
- University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - Effie Ioannidou
- Department of Periodontics, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - David B Banach
- Department of Medicine, Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Samuel SR, Mathew MG, Suresh SG, Varma SR, Elsubeihi ES, Arshad F, Elkareimi Y, Elsahn NA, Khalil E. Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019. Saudi J Biol Sci 2021; 28:2591-2597. [PMID: 33613045 PMCID: PMC7881285 DOI: 10.1016/j.sjbs.2021.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 01/10/2023] Open
Abstract
Pediatric dental emergency management were temporarily suspended during the COVID-19 pandemic, which worsened urgent dental needs. This retrospective study investigated the management of pediatric emergencies during COVID-19 lockdown and the trends in parental preferences from March to July in 2019 and 2020. Pediatric dental emergencies managed during pandemic was collated, procedures were categorized (emergency, restorative, preventive, elective) and trends in parental treatment preference was compared from March-July 2019/2020. Bivariate analysis was performed using fisher-exact test and statistical significance was set at 5%. Total 1081 children were treated during COVID-19 lockdown, and 1509 procedures were performed, of which 20.8% were emergency, 42% restorative, 24.4% preventive, 12.6% elective. In 2019, 7462 children were treated; and except for emergency (10.6%), other procedures were comparable to 2020. Extractions (267) predominated in 2020 followed by sealants (195); but in 2019, pulectomy (1268), scaling (1251) were predominant. None of the residents who performed aerosol procedures got infected with COVID-19 during the lockdown. Emergency dental needs among pediatric patients were very high during the COVID-19 pandemic in South India, and there was not much change in the trend in parental treatment preference in 2019 and 2020. Further, aerosol procedures did not increase the risk of COVID-19 during the pandemic provided proper universal precautions were followed.
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Affiliation(s)
- Srinivasan Raj Samuel
- Saveetha Dental College and Hospital, Saveetha University, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Mebin George Mathew
- Saveetha Dental College and Hospital, Saveetha University, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Sushanthi G Suresh
- Saveetha Dental College and Hospital, Saveetha University, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Sudhir Rama Varma
- Department of Clinical Sciences, College of Dentistry, Ajman University, United Arab Emirates.,Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Emad S Elsubeihi
- Department of Restorative Dentistry, College of Dentistry, Ajman University, United Arab Emirates
| | - Fazil Arshad
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-kharj, Saudi Arabia
| | - Yaser Elkareimi
- Department of Clinical Sciences, College of Dentistry, Ajman University, United Arab Emirates
| | - Nesrine A Elsahn
- Department of Restorative Dentistry, College of Dentistry, Ajman University, United Arab Emirates
| | - Ebtesam Khalil
- Department of Basic and Medical Sciences, College of Dentistry, Ajman University, United Arab Emirates
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63
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Amen TB, Kim I, Peters G, Gutiérrez-Sacristán A, Palmer N, Simon L. Emergency department visits for dental problems among adults with private dental insurance: A national observational study. Am J Emerg Med 2021; 44:166-170. [PMID: 33676310 DOI: 10.1016/j.ajem.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Dental insurance may be a protective factor in reducing unnecessary emergency department (ED) use for nontraumatic dental pain. The purpose of this study was to 1) characterize patient demographics and identify risk factors associated with ED utilization for dental problems among individuals dually enrolled in medical and dental insurance and 2) investigate antibiotic and opioid prescription patterns among these patients following discharge. Further study of this unique population may provide insight into other causes of unmet dental need beyond lack of dental insurance. METHODS Claims data from a large national managed health care plan from 2015 to 2018 were used to evaluate ED use for dental problems in patients with synchronous medical and dental insurance. National counts for ED visits, total visit costs, primary diagnoses, and outpatient treatments for antibiotics and opioids were assessed. Multivariable regression was used to assess any associated demographic and health-related variables. RESULTS 1492 unique patients were admitted to the ED for dental pain and 429,376 unique patients presented for other symptoms. Utilization rates for nontraumatic dental pain were estimated to be 0.4% of all ED visits, with an average cost of $1487 per visit. Within three days following discharge from the ED, 58% of patients filled an opioid prescription and 38% filled an antibiotic prescription. Patients who presented for dental ED pain were more likely to be younger, live in a ZIP code with a lower median household income, have more medical comorbidities, and receive fewer preventive dental procedures within the prior year. CONCLUSION Our findings demonstrate a low rate of ED utilization for nontraumatic dental pain among dentally insured patients and highlight the protective value of prior dental visits for reducing ED use. Given high rates of antibiotic and opioid prescription fill following discharge, comprehensive ED guidelines regarding appropriate antibiotic and opioid treatment pathways may be helpful to provide more definitive care to patients with dental insurance.
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Affiliation(s)
- Troy B Amen
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Inkyu Kim
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory Peters
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Nathan Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Lisa Simon
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Yang F, Yu L, Qin D, Hua F, Song G. Online consultation and emergency management in paediatric dentistry during the COVID-19 epidemic in Wuhan: A retrospective study. Int J Paediatr Dent 2021; 31:5-11. [PMID: 32949058 PMCID: PMC7537273 DOI: 10.1111/ipd.12722] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic posed a great challenge to paediatric dentistry, which confronted with the restriction of service and resource shortage. AIM To retrospectively analyse the information of children's dental online health consultation during the COVID-19 pandemic in China, and to provide methods to distinguish between dental emergencies and non-emergencies as well as their management. DESIGN We collected all the online consultation information in Dept. of Paediatric dentistry, School & Hospital of Stomatology, Wuhan University, from 2 February to 31 March 2020, and extracted the information of age, gender, reason for consultation, description of symptom, and preliminary diagnosis of the children. RESULTS A total of 474 online consultations of paediatric dentistry were included within 59 days during lockdown, and 190 (40.1%) were dental emergencies and 284 (59.9%) non-emergencies. Of 190 emergency consultations, 186 (97.9%) showed swelling, pain, and trauma with or without systemic symptoms. Among 284 non-emergency consultations, retained primary teeth (n = 126) and orthodontic consultation (n = 53) were the most common reasons for consultation. CONCLUSION The paediatric emergency and non-emergency problems should be clearly distinguished and sufficient instructions provided in the special period of COVID-19. Priorities also should be set to deal with urgent conditions after the release of lockdown.
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Affiliation(s)
- Fengjiao Yang
- Department of Paediatric DentistryHubei‐MOST KLOS & KLOBMSchool & Hospital of StomatologyWuhan UniversityWuhanChina
| | - Lintong Yu
- Department of Paediatric DentistryHubei‐MOST KLOS & KLOBMSchool & Hospital of StomatologyWuhan UniversityWuhanChina
| | - Danchen Qin
- Department of OrthodonticsHubei‐MOST KLOS & KLOBMSchool & Hospital of StomatologyWuhan UniversityWuhanChina
| | - Fang Hua
- Department of OrthodonticsHubei‐MOST KLOS & KLOBMSchool & Hospital of StomatologyWuhan UniversityWuhanChina,Centre for Evidence‐Based StomatologyHubei‐MOST KLOS & KLOBMSchool & Hospital of StomatologyWuhan UniversityWuhanChina,Division of DentistrySchool of Medical SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchester Academic Health Science CentreManchesterUK
| | - Guangtai Song
- Department of Paediatric DentistryHubei‐MOST KLOS & KLOBMSchool & Hospital of StomatologyWuhan UniversityWuhanChina
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65
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A Review of Guidelines for Antibiotic Prophylaxis before Invasive Dental Treatments. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app11010311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bacteraemia associated with invasive dental treatments can propagate infective endocarditis in high-risk cardiac patients. Over the past decade, antibiotic prophylaxis before dental treatment has been questioned. This review aims to compare the variations between the UK, European and American antibiotic prophylaxis guidelines before dental treatments. Antibiotic prophylaxis guidelines by the National Institute for Health and Care Excellence (NICE)—Clinical Guideline 64, Scottish Dental Clinical Effectiveness Programme (SDCEP), American Heart Association (AHA), European Society of Cardiology (ESC), European Society of Endodontology (ESE) and Belgian Health Care Knowledge Centre (KCE) position statements were compared regarding the indications, high-risk patients and prophylaxis regimens before dental treatments. In the United Kingdom, the NICE—Clinical Guideline 64 and SDCEP—Implementation Advice do not advise the prescription of prophylactic antibiotics for the majority of high-risk cardiac patients undergoing routine dental treatments. On the contrary, the AHA, ESC and KEC recommend the prescription of antibiotics prior to invasive dental procedures in high-risk cardiac individuals. The ESE also indicates prophylaxis before endodontic procedures for patients with other conditions, including impaired immunologic function, prosthetic joint replacement, high-dose jaw irradiation and intravenous bisphosphonates. Among these guidelines, there are variations in antibiotic prophylaxis regimens. There are variations regarding the indications and antibiotic prophylaxis regimens before invasive dental treatments among these available guidelines.
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Langella J, Magnuson B, Finkelman MD, Amato R. Clinical Response to COVID-19 and Utilization of an Emergency Dental Clinic in an Academic Institution. J Endod 2020; 47:566-571. [PMID: 33387553 PMCID: PMC7772583 DOI: 10.1016/j.joen.2020.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022]
Abstract
Introduction The spread of coronavirus disease 2019 (COVID-19) in the spring of 2020 resulted in the temporary suspension of elective dental procedures and clinical dental education in academic institutions. This study describes the use of the Tufts University School of Dental Medicine emergency dental clinic during the peak surge in COVID-19 cases in Massachusetts, highlighting the number of endodontic emergencies. Methods Aggregate data from clinical encounters and call records to an emergency triage phone line from March 30 through May 8, 2020, were used to describe the characteristics of dental emergencies, clinical encounters, and procedures performed. Results A total of 466 patient interactions occurred during this period, resulting in 199 patients advised by phone and 267 clinical encounters. The most common dental emergencies were severe dental pain from pulpal inflammation (27.7% of clinical encounters) followed by a surgical postoperative visit (13.1%). The most frequent procedures were extractions (13.9% of clinical encounters) and surgical follow-up (13.5%); 50.2% of the clinical encounters were categorized as aerosol generating, and 86.1% of encounters would have required treatment in a hospital emergency department if dental care was not available. There were no known transmissions of severe acute respiratory syndrome coronavirus-2 among clinic providers, patients, or staff during this period. Conclusions These results highlight the importance of endodontic diagnosis and treatment in the provision of emergency dental care during a pandemic and demonstrate that dental treatment can be provided in a manner that minimizes the risk of viral transmission, maintaining continuity of care for a large patient population.
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Affiliation(s)
- Jessica Langella
- Department of Endodontics, Tufts University School of Dental Medicine, Boston, Massachusetts.
| | - Britta Magnuson
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, Massachusetts; Division of Biostatistics and Experimental Design, Tufts University School of Dental Medicine, Boston, Massachusetts
| | - Matthew D Finkelman
- Division of Biostatistics and Experimental Design, Tufts University School of Dental Medicine, Boston, Massachusetts; Department of Public Health and Community Service, Tufts University School of Dental Medicine, Boston, Massachusetts
| | - Robert Amato
- Department of Endodontics, Tufts University School of Dental Medicine, Boston, Massachusetts
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Management of SARS-CoV-2 Transmission in Emergency Dental Settings: Current Knowledge and Personal Experience. Disaster Med Public Health Prep 2020; 16:1604-1611. [PMID: 33722327 PMCID: PMC7985645 DOI: 10.1017/dmp.2020.483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) has seen a violent and fast spread worldwide. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a predominantly respiratory transmission through droplets and aerosol with serious implications for dental settings. This article is based on recent research, guidelines issued by relevant authorities, as well as on the authors’ experience acquired through their involvement in setting up an emergency dental care hub in Cluj-Napoca, Romania, during the COVID-19 lockdown. The present article aims to provide a brief description of COVID-19 implications in dental office and to recommend preventive protocols for dental practitioners to ensure a safe and healthful workplace. The recommendations for infection control presented in this article address the specific risks of exposure to SARS-CoV-2. The article provides a special customized guideline covering patient triage and entrance into the dental practice, personnel protection, dental treatment, and after-treatment management. The implementation of strict preventive measures has been found to be efficient in the prevention of SARS-CoV-2 contamination because no infections have been reported among our staff or patients. COVID-19 is a major emergency worldwide marked by a rapid evolution and warranting a need for further assessment of the implications of COVID-19 outbreak in dental practice.
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Shah S, Wordley V, Thompson W. How did COVID-19 impact on dental antibiotic prescribing across England? Br Dent J 2020; 229:601-604. [PMID: 33188343 PMCID: PMC7662720 DOI: 10.1038/s41415-020-2336-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/14/2020] [Indexed: 11/09/2022]
Abstract
Introduction Antibiotic resistance is a global problem driven by unnecessary antibiotic use. Between 25 March-8 June 2020, COVID-19 restrictions severely reduced access to dentistry in England. Dental practices were instructed to manage patients remotely with advice, analgesics and antibiotics, where appropriate.Aim To describe the impact of the policy to restrict dental access on antibiotic prescribing.Methods NHS Business Services Authority 2018-2020 data for England were analysed to describe national and regional trends in dental antibiotic use.Results Antibiotic prescribing in April to July 2020 was 25% higher than April to July 2019, with a peak in June 2020. Some regions experienced greater increases and for longer periods than others. The increase was highest in London (60%) and lowest in the South West (10%). East of England had the highest rate of dental antibiotic prescriptions per 1,000 of the population every month over the study period (April to July 2020).Conclusion Restricted access to dental care due to COVID-19 resulted in greatly increased dental antibiotic prescribing, against an otherwise downward trend. As dental care adapts to the COVID-19 era, it is important to ensure access for all to high-quality urgent dental care. Understanding the reasons for variation will help to optimise the use of antibiotics in the future.
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Affiliation(s)
- Sagar Shah
- Clinical Fellow, NHS Business Services Authority, 1 St Anne's Road, Eastbourne, East Sussex, BN21 3UN, UK
| | | | - Wendy Thompson
- NIHR Clinical Lecturer in Primary Dental Care, Division of Dentistry, University of Manchester, Couplands 3, Oxford Road, Manchester, M13 9PL, UK.
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Silberman JJ, Moldauer BI, Torres J, Gallardo C, Sanabria-Liviac D. Palatal root surgery of a maxillary molar using a piezosurgery transantral approach with simultaneous sinus lift grafting: a case report. Int Endod J 2020; 54:464-475. [PMID: 33012051 DOI: 10.1111/iej.13423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
AIM To report a case involving transantral palatal root piezoelectric surgery followed by a sinus floor augmentation procedure with the purpose of minimizing and managing complications associated with sinus lining perforations and optimizing bone regeneration at the site of the surgical defect. SUMMARY An asymptomatic 28-year-old male patient with the diagnosis of chronic apical periodontitis on a previously root filled right maxillary first molar (FDI tooth 16) and second premolar (No. 15) was managed by transantral apical surgery. Cone-beam computerized tomography (CBCT) revealed the position of the palatal root of the first molar within the maxillary sinus. The case highlights the management of the palatal root and the handling of a perforation of the Schneiderian membrane through a combination of piezosurgery and a sinus lift grafting procedure involving a second-generation of platelet concentrates. No postoperative complications were observed. Sinus bone augmentation after a 26-month recall period was confirmed by CBCT in the clinically asymptomatic teeth. KEY LEARNING POINTS The selective bone tissue cutting and enhanced visibility obtained by piezoelectric surgery in comparison with current rotary techniques make this technology the preferred tool for apical surgery when the mucosal lining of the maxillary sinus could be compromised. The wound healing and physical properties of the platelet-rich fibrin membranes in combination with an allograft material can be considered as sinus bone graft options when a transantral approach is performed on a palatal root of a maxillary molar. A preoperative tomographic examination is essential for apical surgery using a transantral approach with sinus bone augmentation, because of the information obtained from the axial and coronal views on the CBCT scan.
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Affiliation(s)
- J J Silberman
- Department of Endodontics, Nova Southeastern University College of Dental Medicine, Fort-Lauderdale, FL, USA
| | - B I Moldauer
- Department of Endodontics, Nova Southeastern University College of Dental Medicine, Fort-Lauderdale, FL, USA
| | - J Torres
- Department of Endodontics, Universidad Privada San Juan Bautista, Lima, Perú
| | - C Gallardo
- Department of Endodontics, Universidad Científica del Sur, Lima, Peru
| | - D Sanabria-Liviac
- Department of Endodontics, Universidad Inca Garcilaso de la Vega, Lima, Peru
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Azim AA, Shabbir J, Khurshid Z, Zafar MS, Ghabbani HM, Dummer PMH. Clinical endodontic management during the COVID-19 pandemic: a literature review and clinical recommendations. Int Endod J 2020; 53:1461-1471. [PMID: 32916755 DOI: 10.1111/iej.13406] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/22/2022]
Abstract
The spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in millions of confirmed cases and hundreds of thousands of deaths. Despite all efforts to contain the spread of the disease, the number of infections and deaths continue to rise, particularly in some regions. Given its presence in the salivary secretions of affected patients, and the presence of many reported asymptomatic cases that have tested positive for COVID-19, dental professionals, including Endodontists, are at high risk of becoming infected if they do not take appropriate precautions. As of today, there are no predictable treatments or approved vaccines that can protect the public and healthcare professionals from the virus; however, there is speculation that a vaccine might be available sometime in 2021. Until then, general dentists and Endodontist will need to be able to treat emergency patients in order to relieve pressure on emergency clinics in hospitals or local community hubs. In addition, as the pandemic continues, strategies to manage patients will need to evolve from a palliative to a more permanent/definitive treatment approach. In this article, an update on the treatment considerations for dental care in general is provided, as well as a discussion on the available endodontic guidelines reported in the literature. Recommendations on clinical management of endodontic emergencies are proposed.
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Affiliation(s)
- A A Azim
- Division of Endodontics, University at Buffalo, Buffalo, NY, USA
| | - J Shabbir
- Operative Dentistry Department, Liaquat College of Medicine and Dentistry, Karachi, Pakistan
| | - Z Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
| | - M S Zafar
- Department of Restorative Dental Sciences, College of Dentistry, Taibah University, Almadina Almunawwarah, Saudi Arabia
| | - H M Ghabbani
- Department of Restorative Dental Sciences, College of Dentistry, Taibah University, Almadina Almunawwarah, Saudi Arabia
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Zanjir M, Sgro A, Lighvan NL, Yarascavitch C, Shah PS, da Costa BR, Azarpazhooh A. Efficacy and Safety of Postoperative Medications in Reducing Pain after Nonsurgical Endodontic Treatment: A Systematic Review and Network Meta-analysis. J Endod 2020; 46:1387-1402.e4. [DOI: 10.1016/j.joen.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 12/25/2022]
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Yalcin-Ülker GM, Cakir M, Meral DG. Antibiotic prescribing habits of the clinicians dealing with dental implant surgery in Turkey: a questionnaire study. Int J Implant Dent 2020; 6:66. [PMID: 32980926 PMCID: PMC7519926 DOI: 10.1186/s40729-020-00252-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/27/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Although various prophylactic and/or postoperative systemic antibiotic regimens have been suggested to minimize failure after dental implant placement and postoperative infection, the role of antibiotics in implant dentistry is still controversial. The purposes of this questionnaire study were to determine the current antibiotic prescribing habits of clinicians in conjunction with dental implant placement and to understand whether any consensus has been reached among implant surgery performing clinicians. METHODS An electronic questionnaire was sent by electronic mail to all members of the Turkish Dental Society. The questions were related to whether antibiotics were routinely prescribed either pre- or/and postoperatively during routine dental implant placement. The respondents were also asked to specify their workplace and education. The results were analyzed using SPSS software. Descriptive and chi-square analyses were used to compare categorical data; Kruskal-Wallis test was used to compare the quantitative data by category. RESULTS A total of 429 members responded to the questionnaire. The clinicians having more experience had a greater tendency to prescribe preoperative antibiotics (p < 0.001), but there was no statistically significant difference between the postoperative antibiotic prescription choice of the clinician according to the clinicians' experience (p > 0.05). A total of 175 of the clinicians preferred to prescribe preoperative antibiotics when there was systemic comorbidity; 99 of the clinicians preferred to prescribe antibiotics before every implant surgery. The aminopenicillins were the most commonly prescribed antibiotics by the clinicians. A total of 38.58% of the respondents (n = 130) who were prescribing preoperative antibiotics, 2000 mg aminopenicillin was given 1 h before the surgical procedure. Dentists and solo private practitioners were prescribing more preoperative antibiotics (p < 0,05). CONCLUSIONS There was no consensus among clinicians regarding the use of antibiotics in association with routine dental implant placement. Aminopenicillins were the most commonly prescribed antibiotics for both pre- and postoperatively. Furthermore, most of the antibiotic regimens being used are not in accordance with the current published data.
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Affiliation(s)
- Gül Merve Yalcin-Ülker
- Faculty of Dentistry, Oral and Maxillofacial Surgery Department, Istanbul Okan University, Aydıntepe, Tuzla, 34947, Istanbul, Turkey.
| | - Merve Cakir
- Faculty of Dentistry, Oral and Maxillofacial Surgery Department, Istanbul Okan University, Aydıntepe, Tuzla, 34947, Istanbul, Turkey
| | - Deniz Gökce Meral
- Professor, Head of the Department, Oral and Maxillofacial Surgery Department, Istanbul Okan University, Aydıntepe, Tuzla, 34947, Istanbul, Turkey
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Abstract
INTRODUCTION Like many tissues, the dental pulp is equipped with innate and adaptive immune responses, designed to defend against infection and limit its spread. The pulp's innate immune response includes the synthesis and release of antimicrobial peptides by several dental pulp cell types. These naturally-occurring antimicrobial peptides have broad spectrum activity against bacteria, fungi and viruses. There is a resurgence of interest in the bioactivities of naturally-occurring antimicrobial peptides, largely driven by the need to develop alternatives to antibiotics. METHODS This narrative review focused on the general properties of antimicrobial peptides, providing an overview of their sources and actions within the dental pulp. RESULTS We summarized the relevance of antimicrobial peptides in defending the dental pulp, highlighting the potential for many of these antimicrobials to be modified or mimicked for prospective therapeutic use. CONCLUSION Antimicrobial peptides and novel peptide-based therapeutics are particularly attractive as emerging treatments for polymicrobial infections, such as endodontic infections, because of their broad activity against a range of pathogens.
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Affiliation(s)
- Fionnuala T Lundy
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland.
| | - Christopher R Irwin
- Centre for Dentistry, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Denise F McLean
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Gerard J Linden
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Ikhlas A El Karim
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
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Deniz-Sungur D, Aksel H, Karaismailoglu E, Sayin TC. The prescribing of antibiotics for endodontic infections by dentists in Turkey: a comprehensive survey. Int Endod J 2020; 53:1715-1727. [PMID: 32805741 DOI: 10.1111/iej.13390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/08/2023]
Abstract
AIM To investigate the antibiotic prescribing patterns for endodontic infections based on the reports of Turkish dentists. METHODOLOGY A survey consisting of 20 questions on general information and 13 questions on antibiotic prescribing patterns for endodontic cases was delivered to the e-mail addresses of general dentists and specialists via the database of the Turkish Dental Association. Collected data were analysed using Mc-Nemar-Bowker Test and multivariate ordinal logistic regression tests at the significance level of 0.05. RESULTS A total of 1007 responses were obtained from 17 827 dentists. The majority of the participants were general dental practitioners (GDP, 80%) whilst 8% were Endodontists. Gender, clinical experience, affiliations and speciality were significant risk factors for antibiotic prescription (P < 0.05). GDPs prescribed antibiotics twice as much as all specialists and members of public hospitals prescribed antibiotics three times more than specialists and clinical academics (P < 0.05). Amoxicillin with clavulanic acid was the most prescribed antibiotic (90%), followed by Ornidazole (25%). Clindamycin was the drug of choice for the patients with penicillin allergy (59%). Infection and fever control (76%), prophylaxis (44%) and avoiding swelling and trismus during endodontic treatment (26%) were the most common reasons for antibiotic prescriptions. Completing a course of prescribed antibiotics was recommended by most (75%). Infective endocarditis, immunosuppression, artificial heart valve and mitral valve prolapse were the main causes of prophylaxis in descending order. Uncontrolled and extensive use of antibiotics by patients (62%) was mentioned as the most effective reason for antibiotic resistance. Up to 10% of participants prescribed antibiotics for symptomatic irreversible pulpitis, asymptomatic apical periodontitis with or without endodontic treatment (8, 12 and 11%, respectively). Up to 20% of dentists prescribed antibiotics for symptomatic apical periodontitis when the pulp was vital or necrotic (13 and 23%, respectively). Almost one third of the participants prescribed antibiotics for symptomatic apical periodontitis of previously treated teeth with or without radiographic lesions whilst 34% prescribed antibiotics for acute apical abscess with localized swelling without systemic involvement. CONCLUSIONS The majority of dentists reported they prescribed antibiotics inappropriately. It is necessary to improve the knowledge of dentists about antibiotics and their indications in endodontics.
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Affiliation(s)
- D Deniz-Sungur
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - H Aksel
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.,Division of Endodontics, School of Dental Medicine, University at Buffalo, New York, USA
| | - E Karaismailoglu
- Department of Medical Informatics, University of Health Sciences, Ankara, Turkey
| | - T C Sayin
- Private Practice, Fort Lauderdale, Florida, USA
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Abstract
Oral health is a critical component of overall health and well-being. Dental caries and periodontitis are two of the most common oral diseases and, when not treated, can have irreversible sequelae and overall psychosocial and physiologic impact on individuals, diminishing quality of life. The burden of advanced dental caries and periodontal disease leading to tooth loss is severe. Physicians and allied medical professionals can help in early detection of dental caries, abscess, and periodontal diseases and initiate management followed by prompt referral to dental colleagues.
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Thompson W, McEachan R, Pavitt S, Douglas G, Bowman M, Boards J, Sandoe J. Clinician and Patient Factors Influencing Treatment Decisions: Ethnographic Study of Antibiotic Prescribing and Operative Procedures in Out-of-Hours and General Dental Practices. Antibiotics (Basel) 2020; 9:antibiotics9090575. [PMID: 32899670 PMCID: PMC7558392 DOI: 10.3390/antibiotics9090575] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
Operative treatment is indicated for most toothache/dental abscesses, yet antibiotics instead of procedures are often prescribed. This ethnographic study aimed to identify clinician and patient factors influencing urgent dental care for adults during actual appointments; and to identify elements sensitive to context. Appointments were observed in out-of-hours and general dental practices. Follow-up interviews took place with dentists, dental nurses, and patients. Dentist and patient factors were identified through thematic analysis of observation records and appointment/interview transcripts. Dentist factors were based on a published list of factors influencing antibiotic prescribing for adults with acute conditions across primary health care and presented within the Capability-Opportunity-Motivation-Behaviour model. Contextually sensitive elements were revealed by comparing the factors between settings. In total, thirty-one dentist factors and nineteen patient factors were identified. Beliefs about antibiotics, goals for the appointment and access to dental services were important for both dentists and patients. Dentist factors included beliefs about the lifetime impact of urgent dental procedures on patients. Patient factors included their communication and negotiation skills. Contextual elements included dentists’ concerns about inflicting pain on regular patients in general dental practice; and patients’ difficulties accessing care to complete temporary treatment provided out of hours. This improved understanding of factors influencing shared decisions about treatments presents significant opportunity for new, evidence-based, contextually sensitive antibiotic stewardship interventions.
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Affiliation(s)
- Wendy Thompson
- Division of Dentistry, University of Manchester, Manchester M13 9PL, UK
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
- Correspondence: ; Tel.: +44-7837-190387
| | - Rosemary McEachan
- Bradford Institute for Health Research, Bradford BD9 6RJ, UK;
- Faculties of Life Sciences & Health Studies, University of Bradford, Bradford BD7 1DP, UK
| | - Susan Pavitt
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
| | - Gail Douglas
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
| | - Marion Bowman
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
| | - Jenny Boards
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
| | - Jonathan Sandoe
- Faculty of Medicine and Health, University of Leeds, Leeds LS2 9LU, UK; (S.P.); (G.D.); (M.B.); (J.B.); (J.S.)
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Komagamine J, Kobayashi M, Mori T. Prevalence of and rationale for antimicrobial prescription during ambulatory care visits in Japan: a prospective, multicentre, cross-sectional study. BMJ Open 2020; 10:e039329. [PMID: 32843518 PMCID: PMC7449277 DOI: 10.1136/bmjopen-2020-039329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the rate of outpatient antimicrobial use and the rationale for antimicrobial prescription. DESIGN A prospective, multicentre, cross-sectional study. SETTING Ambulatory care settings at community general hospitals. PARTICIPANTS A total of 1972 consecutive ambulatory visits by 1952 patients were included from 2 February 2020 to 13 February 2020. Visits resulting in hospital admission and regularly scheduled visits were excluded. MAIN OUTCOME MEASURES The primary outcome was the proportion of ambulatory visits resulting in antimicrobial drug prescriptions. The secondary outcomes were the reasons for antimicrobial drug prescription and the proportion of unnecessary antimicrobial prescriptions among all antimicrobial drugs used for treatment. RESULTS The mean patient age was 53.8 (SD 25.8) years old, and the proportion of women was 52.6%. A total of 162 antimicrobial drugs were prescribed in 153 (7.8%) visits. The most common antimicrobial drugs were penicillins (n=48, 29.6%), followed by third-generation cephalosporins (n=35, 21.6%) and quinolones (n=20, 12.4%). Among all the antimicrobial drugs prescribed, 125 (77.2%), 18 (11.1%) and 11 (6.8%) were used for infection treatment, wound prophylaxis and surgical prophylaxis, respectively. Of the 125 antimicrobial drugs used for infection treatment, 60 (48.0%) were judged to be unnecessary. CONCLUSIONS One in every 13 ambulatory visits resulted in antimicrobial use in Japan. Three-fourths of the prescribed antimicrobial drugs were used for infection treatment, but approximately half of those drugs may have been unnecessary. Further efforts to reduce unnecessary antimicrobial drug use are needed. TRIAL REGISTRATION NUMBER UMIN000039360.
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Affiliation(s)
- Junpei Komagamine
- Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Masaki Kobayashi
- Geriatrics and Gerontology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Takahiro Mori
- Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
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Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2020; 124:274-349. [PMID: 32811666 DOI: 10.1016/j.prosdent.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/20/2023]
Abstract
This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.
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79
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Teoh L, Thompson W, McCullough M. Questioning dual antimicrobial therapy as first line in recent Australian Therapeutic Guidelines. Aust Dent J 2020; 65:302-304. [PMID: 32588465 DOI: 10.1111/adj.12783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Affiliation(s)
- L Teoh
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
| | - W Thompson
- University of Manchester, Manchester, UK
| | - M McCullough
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
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80
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Wu KY, Wu DT, Nguyen TT, Tran SD. COVID-19's impact on private practice and academic dentistry in North America. Oral Dis 2020; 27 Suppl 3:684-687. [PMID: 32472974 PMCID: PMC7300727 DOI: 10.1111/odi.13444] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic is a major public health crisis for countries around the world. In response to this global outbreak, the World Health Organization declared a public health emergency of international concern. Dental professionals are especially at high risk of contracting the COVID-19 virus due to the unique nature of dentistry, more specifically, exposure to aerosols and droplets. When it comes to dental emergencies, it was crucial to maintain urgent dental care services operational to help reduce the burden on our healthcare system and hospitals already under pressure. The COVID-19 pandemic has significantly impacted how dentistry is practiced in North America in both the private practice and academic settings. This article shares the perspectives of dentists practicing in private practice and clinician-researchers in academic dental institutions. More specifically, we discuss about measures implemented to minimize risks of disease transmission, challenges in emergency dental care, impact on patients, as well as impact on the professional and personal lives of the dental team during the COVID-19 crisis.
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Affiliation(s)
- Kevin Y Wu
- Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - David T Wu
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Thomas T Nguyen
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Simon D Tran
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
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81
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Roberts EP, Roberts BS, Burns A, Goodlet KJ, Chapman A, Cyphers R, Atkinson J. Prevalence and dental professional awareness of antibiotic self-medication among older adults: Implications for dental education. J Dent Educ 2020; 84:1126-1135. [PMID: 32535958 DOI: 10.1002/jdd.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Antibiotic stewardship has been recognized as an essential component of dental education. A notable threat to stewardship is the growing trend toward self-medication with nonprescribed antibiotics (SMNPA), particularly among older adults who may be at increased risk for adverse outcomes. This study aimed to assess the need to incorporate SMNPA into dental education by researching (1) professional awareness and (2) self-medication behaviors among older adults. METHODS A SMNPA awareness survey was administered to dentists in Arizona with 148 respondents including general dentists, dental school faculty, and public health clinicians. A second survey was distributed to 410 households in an independent and assisted living facility. RESULTS The dentists were aware of sources of SMNPA such as friends/family, leftover prescriptions, as well as sources outside of the United States; however, most (>80%) were not aware that ornamental fish antibiotics could be obtained online or in pet stores. The survey response rate for the older adults was 46.3%, of which 68.3% reported antibiotic use within the past 2 years (several for dental premedication) and 6.4% (n = 12) admitted to SMNPA for treating cold symptoms or pain. The main reason given for self-treatment was the belief that antibiotics had resolved similar symptoms in the past. One-third of the older adult respondents were unaware that antibiotics only treat bacterial infections. CONCLUSION Approximately 1 in 16 older adults surveyed reported SMNPA. Dental professionals reported some knowledge of SMNPA but were unaware of all sources. This study highlights the need for SMNPA education, awareness, and implementation within dental curricula.
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Affiliation(s)
- Eugenia P Roberts
- College of Dental Medicine - Arizona, Midwestern University, Glendale, USA
| | - Bradley S Roberts
- College of Dental Medicine - Arizona, Midwestern University, Glendale, USA
| | - Andrea Burns
- College of Pharmacy - Glendale, Midwestern University, Glendale, Arizona, USA
| | - Kellie J Goodlet
- College of Pharmacy - Glendale, Midwestern University, Glendale, Arizona, USA
| | - Alice Chapman
- College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
| | - Russel Cyphers
- College of Dental Medicine - Arizona, Midwestern University, Glendale, USA
| | - Jennifer Atkinson
- College of Dental Medicine - Arizona, Midwestern University, Glendale, USA
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82
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Umer F. Ancillary considerations for endodontic emergency treatment of Covid-19 positive patients. SPECIAL CARE IN DENTISTRY 2020; 40:395-396. [PMID: 32501576 PMCID: PMC7300585 DOI: 10.1111/scd.12484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Fahad Umer
- Department of Surgery, Aga Khan University and Hospital, Karachi, Pakistan
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83
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Long RH, Ward TD, Pruett ME, Coleman JF, Plaisance MC. Modifications of emergency dental clinic protocols to combat COVID-19 transmission. SPECIAL CARE IN DENTISTRY 2020; 40:219-226. [PMID: 32447777 PMCID: PMC7283718 DOI: 10.1111/scd.12472] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/01/2020] [Accepted: 05/09/2020] [Indexed: 12/18/2022]
Abstract
During the COVID‐19 pandemic, incidence rates for dental diseases will continue unabated. However, the intent to prevent the spread of this lethal respiratory disease will likely lead to reduced treatment access due to restrictions on population movements. These changes have the potential to increase dental‐related emergency department visits and subsequently contribute to greater viral transmission. Moreover, dentists experience unique challenges with preventing transmission due to frequent aerosol‐producing procedures. This paper presents reviews and protocols implemented by directors and residents at the Dental College of Georgia to manage a dental emergency clinic during the COVID‐19 pandemic. The methods presented include committee‐based prioritization of dental patients, a multilayered screening process, team rotations with social and temporal spacing, and modified treatment room protocols. These efforts aid in the reduction of viral transmission, conservation of personal protective equipment, and expand provider availability. These protocols transcend a university and hospital‐based models and are applicable to private and corporate models.
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Affiliation(s)
- Robert Hollinshead Long
- Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Tyrous David Ward
- Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Michael Edward Pruett
- Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, Georgia
| | - John Finklea Coleman
- Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Marc Charles Plaisance
- Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, Georgia
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84
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COVID-19 Disease in Children: What Dentists Should Know and Do to Prevent Viral Spread. The Italian Point of View. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103642. [PMID: 32455859 PMCID: PMC7277868 DOI: 10.3390/ijerph17103642] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/23/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has spread rapidly across the globe, becoming a major public health challenge not for China only, but also for countries around the world. Despite worldwide efforts to contain viral spread, the outbreak has not been stopped yet. Among healthcare personnel, dentists seem to be at elevated risk of exposure to COVID-19. This risk is even more serious in pediatric dentistry, since affected children, frequently, present an asymptomatic, mild or moderate clinical viral infection and, therefore, they may play a major role in community-based COVID-19 transmission. To date, despite no universal guidelines are available for dental procedures in pediatric dentistry during COVID-19 outbreak, routine dental practice should be postponed and only severe dental emergencies must be treated. In the case of a dental emergency, involving a pediatric patient, dentists should be aware of which recommended management protocol can be adopted during the practice to protect patient health, to safeguard their-self and to prevent viral transmission. The aim of this paper is to provide clinical recommendations, presenting a needed tool for dentists to allow a valid and safe how-to-do protocol. Pediatric dentists should keep a high level of awareness to help patients, minimize risk and prevent viral spread.
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85
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Lamster IB. The 2019 FDI Policy Statements. Int Dent J 2020; 70:3-4. [DOI: 10.1111/idj.12560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/26/2022] Open
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86
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Tampi MP, Pilcher L, Urquhart O, Kennedy E, O'Brien KK, Lockhart PB, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Lang MS, Patton LL, Paumier T, Suda KJ, Cho H, Carrasco-Labra A. Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: Systematic review and meta-analysis-a report of the American Dental Association. J Am Dent Assoc 2019; 150:e179-e216. [PMID: 31761029 DOI: 10.1016/j.adaj.2019.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use. TYPE OF STUDIES REVIEWED The authors updated 2 preexisting systematic reviews to identify newly published randomized controlled trials. They also searched for systematic reviews to inform additional harm outcomes. They conducted searches in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Pairs of reviewers independently conducted study selection, data extraction, and assessment of risk of bias and certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS The authors found no new trials via the update of the preexisting reviews. Ultimately, 3 trials and 8 additional reports proved eligible for this review. Trial estimates for all outcomes suggested both a benefit and harm over 7 days (very low to low certainty evidence). The magnitude of additional harms related to antibiotic use for any condition were potentially large (very low to moderate certainty evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS Evidence for antibiotics, either alone or as adjuncts to DCDT, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.
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