Attitudes towards Antibiotic Prescription and Antimicrobial Resistance Awareness among Italian Dentists: What Are the Milestones?

Antibiofilm, regenerative and bone homeostasis potential of the synergistic association of synoeca-MP peptide with chlorhexidine in oral cavity opportunistic infections

OBJECTIVE

Synoeca-MP is an antimicrobial peptide that belongs to the class of defense peptides, known for their antimicrobial and immunomodulatory properties. To evaluate in vitro the association between synoeca-MP peptide and chlorhexidine, regarding their antimicrobial and antibiofilm activities, saliva stability, effect on tissue repair, bone resorption processes, and mineralized matrix formation.

DESIGN

Initially, the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and antibiofilm concentration were determined. The synergism and degradation of synoeca-MP and chlorhexidine in human saliva were assessed. Furthermore, biocompatibility was evaluated using MTT assays, hemolytic assays, and proliferation and migration assays of periodontal ligament cells. Finally, bone homeostasis was evaluated through osteoclastogenesis assays, alkaline phosphatase determination, and mineralized matrix formation assay with SaOs-2 and ligament cells.

RESULTS

The antimicrobial and antibiofilm activity against the tested microorganisms was confirmed. Low synergistic concentrations of the synoeca-MP and chlorhexidine combination inhibited tested microorganisms. The association of these molecules remained stable in healthy saliva. Nevertheless, it degraded as the severity of periodontal disease increased. Additionally, lower synergistic concentrations of the combination were not cytotoxic to human cells, promoted the proliferation and migration of ligament cells, inhibited osteoclastogenesis, and increased mineral matrix formation of ligament cells and SaOs-2.

CONCLUSIONS

Synoeca-MP and chlorhexidine combination shows potential for oral diseases treatment, as evidenced by its antimicrobial activity, regenerative potential, saliva stability, and bone homeostasis. It may be particularly effective for opportunistic oral infections and in conjunction with mechanical therapy.

Adherence to the current guidelines on antibiotic prescription among dental practitioners: A national survey

BACKGROUND

The global emergence and spread of antibiotic resistance jeopardise health-care advances and life expectancy. Following the latest antibiotic guidelines is crucial to combat this issue. Therefore, the objective of this study was to assess the knowledge regarding antibiotics prescription and investigate the evidence-based practices among dental practitioners in Saudi Arabia.

METHOD

This cross-sectional study was conducted during November 2020 to April 2021 in Saudi Arabia. A self-designed validated questionnaire comprising 27 close ended knowledge-based questions and 9 practice-based question was administered among dentists working in various settings through online generated link. A pilot study in 20 dental specialists and consultants was conducted prior to the study, to arise at sample size of 318. Reliability of the questionnaire was assessed with Cronbach's α value of 0.85, face validity of 84%, and content validity ratio of 0.78. The knowledge and practice score were graded based on quartile derivatives. The data was analyzed using descriptive analysis, chi square analysis, correlation, and regression by IBM SPSS® Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp.

RESULTS

The average age of the participants was 36.3 ±  5.9 years, and their average experience was about 7.3 years. The mean knowledge score was 19.62 ±  4.28 with government employees scoring higher (20.03 ±  3.90) compared to private practitioners and academicians. Clinicians with less than five years of experience had significantly higher knowledge scores (p =  0.002). The majority of the participants, 218 (68.55%), had good practices while 100 (31.44%) participants showed poor practices. Moreover, only half of the participants could correctly identify the majority of case-based scenarios related to antibiotic prescriptions.

CONCLUSION

Dentists in Kingdom of Saudi Arabia have a good level of knowledge and practices on antibiotics prescription. However, some aspects of poor practices particularly among private sector clinicians necessitate the launching of educational campaigns, interventions and provision of latest guidelines for prudent use of antibiotics in dental practice.

Antibiotics Use for Dental or Oral Cavity Infections in Pediatric Dentistry: Knowledge and Prescribing Practices Between Italian Dentists

In pediatric dentistry, antibiotics are currently prescribed for both therapeutic and prophylactic purposes. Antibiotic therapy can be prescribed for the treatment of diffuse dental or oral cavity infections, always as a complement to the most suitable dental procedure for the specific case. The aim of this study was to investigate the knowledge regarding the use and prescribing practices of antibiotics in pediatric patients in a sample of Italian dentists by using an anonymous and telematic questionnaire.

METHODS

A specially prepared questionnaire was electronically transmitted to a cohort of Italian dentists. The questionnaire consisted of two parts: demographic information and general knowledge of antibiotic prescription in pediatric dentistry. The statistical analysis of the obtained data was performed.

RESULTS

The study sample consisted of 242 Italian dentists. Poor statistically significant differences emerged between specialists in Pediatric Dentistry and dentists without specialization or specialists in other branches, as well as between dentists who, in their clinical activity, mainly treat children/adolescents or adults. For the complementary treatment of dental or oral cavity infections, Amoxicillin was the antibiotic indicated as the first choice for pediatric patients with no allergy to penicillins by most of the sample, while more than 20% of dentists would prescribe Clindamycin in patients with an allergy to penicillin. The knowledge regarding the dosage of administration of the chosen antibiotic appeared not to be sufficient.

CONCLUSIONS

An improvement in the knowledge of the Guidelines in Pediatric Dentistry appeared necessary regarding the posology of the antibiotic of choice. More information about the adverse effects of Clindamycin is needed.

Dentists' Awareness of Antibiotic Stewardship and Their Willingness to Support Its Implementation: A Cross-Sectional Survey in a Dental School

OBJECTIVES

Antibiotic overuse is highly reported among dentists worldwide. An antibiotic stewardship programme has been shown to be effective for decreasing the number of unappropriated antibiotic prescriptions. The goal of this survey was to assess dentists' awareness of antibiotic stewardship and their willingness to implement changes accordingly.

METHODS

A structured questionnaire was developed and distributed to dentists at a university hospital with different levels of experience. It included questions regarding antibiotic prescription habits, antibiotic stewardship knowledge and willingness to implement changes in such a programme.

RESULTS

Overall, 256 dentists participated in the survey. Among them, 16.4% (95% confidence interval: 12.1%-21.5%) reported awareness regarding antibiotic stewardship. Awareness levels were higher among specialists (28.3%) and increased with experience. Most dentists in this study reported willingness to improve their antibiotic prescribing practices. The mean willingness score was 8.78 (standard deviation: 1.81).

CONCLUSIONS

Awareness of antibiotic stewardship was low among dentists with different levels of experience. However, dentists were willing to change their antibiotic prescription habits if policies were implemented as part of a stewardship programme at the school.

Antimicrobial resistance, antibiotic prescribing practices and antimicrobial stewardship in South Africa: a scoping review

Introduction

Antimicrobial resistance (AMR) is an emerging global threat, with notable impact evident in low- and middle-income countries. Indiscriminate antibiotic prescribing is recognized as the key factor responsible for the continued spread of AMR.

Objectives

To comprehensively map published data of evidence of AMR in healthcare settings in South Africa, encompassing the exploration of antibiotic prescribing practices and the implementation of antimicrobial stewardship initiatives.

Methods

The scoping review methodology was based on the guidelines outlined by Arksey and O'Malley. The protocol for this scoping review has been registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/PWMFB). The search strategy was documented using the protocol outlined within the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). Databases used were Science Direct, Scopus, PubMed, Wiley, Directory of Open Access Journals; and health organizations such as the WHO. In addition, the Google search engine was used to search for grey matter. The search was restricted to peer-reviewed articles in English on human studies for the period 2019-24.

Results

The search yielded a total of 529 articles from electronic databases and search engines. Twenty-nine articles were accepted for inclusion following the application of the study protocol. The majority of the articles were primary research papers.

Conclusions

The findings reveal that South Africa has measures in place to combat AMR; however, inconsistencies were found between the private and public health sectors, in addition to the lack of adherence to guidelines and limitations in AMR education among healthcare workers and students.

Laccase mediated transformation of fluoroquinolone antibiotics: Analyzing degradation pathways and assessing algal toxicity

Improper waste disposal or inadequate wastewater treatment can result in pharmaceuticals reaching water bodies, posing environmental hazards. In this study, crude extracts containing the laccase enzyme from Pleurotus florida, Pleurotus eryngii, and Pleurotus sajor caju were used to degrade the fluoroquinolone antibiotics (FQs) levofloxacin (LEV), norfloxacin (NOR), ciprofloxacin (CIP), ofloxacin (OFL), and enrofloxacin (ENR) in aqueous solutions. The results for the fungi derived laccase extracts were compared with those obtained using commercially sourced laccase. Proteomics analysis of the crude extracts confirmed the presence of laccase enzyme across all three tested species, with proteins matching those found in Trametes versicolor and Pleurotus ostreatus. In vivo studies were conducted using species pure lines of fungal whole cells. The highest degradation efficiency observed was 77.7% for LEV in the presence of P. sajor caju after 25 days of treatment. Degradation efficiencies ranged from approximately 60-72% for P. florida, 45-76% for P. eryngii, and 47-78% for P. sajor caju. A series of in vitro experiments were also conducted using crude extracts from the three species and outcomes compared with those obtained when commercial laccase was used confirmed laccase as the enzyme responsible for antibiotic removal. The degradation efficiencies in vitro surpassed those measured in vivo, ranging from approximately 91-98% for commercial laccase, 77-92% for P. florida, 76-92% for P. eryngii, and 78-88% for P. sajor caju. Liquid chromatography-high-resolution mass spectrometry (LC-MS/MS) identified the degradation products, indicating a consistent enzymatic degradation pathway targeting the piperazine moiety common to all tested FQs, irrespective of the initial antibiotic structure. Phytoplankton toxicity studies with Dunaliella tertiolecta were performed to aid in understanding the impact of emerging contaminants on ecosystems, and by-products were analysed for ecotoxicity to assess treatment efficacy. Laccase-mediated enzymatic oxidation shows promising results in reducing algal toxicity, notably with Pleurotus eryngii extract achieving a 97.7% decrease for CIP and a 90% decrease for LEV. These findings suggest the potential of these naturally sourced extracts in mitigating antibiotic contamination in aquatic ecosystems.

Antibiotic use in pediatric dental infections: knowledge and awareness levels of dentists

Antibiotics are crucial in treating infections; however, their unnecessary and incorrect use can lead to numerous health issues, notably antibiotic resistance. Evaluating the accuracy and awareness of antibiotic prescription practices among dentists, who play a significant role in antibiotic use, is critical in developing effective health policies and professional training programs. This study assesses dentists' knowledge levels and practice habits regarding antibiotic use. Using a structured questionnaire, the research employed a cross-sectional design and was conducted with 202 general dentists, 98 pediatric dentists, and 43 oral and maxillofacial surgeons. Data were analyzed using demographic characteristics, antibiotic prescription practices, and scenario-based questions measuring knowledge levels. The results revealed that while most participants were generally knowledgeable about antibiotic use, inconsistencies in prescription practices were evident. Notably, unnecessary antibiotic prescriptions were identified in some cases, contributing to significant health issues such as antibiotic resistance. This study emphasizes the necessity of promoting conscious antibiotic use by evaluating dentists' practices. Therefore, the urgent need for developing professional training programs and strengthening strategies to combat antibiotic resistance is paramount.

The Effect of Photobiomodulation on Third Molar Wound Recovery: A Systematic Review with Meta-Analysis

Objectives: This study addresses the limited body of literature concerning the impact of photobiomodulation on complications following mandibular third molar extractions. Methods: A systematic literature review and meta-analysis of clinical studies that reported the use of photobiomodulation after mandibular third molar surgery was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. The formulation of research questions followed the PICO model, and comprehensive strategies for record search and study selection were devised. The protocol was registered on PROSPERO (The Prospective Register of Systematic Reviews; no CRD42024511892). Two independent reviewers consulted four databases during the literature search: MEDLINE/PubMed, Google Scholar, Clinicaltrial.gov, and Cochrane Library databases without imposing any date restrictions. A search on the grey literature was carried out too (OpenGrey). Duplicate articles were eliminated. Results: After the initial screening, 18 studies were retained to be screened by the reviewers. The full texts of the identified studies were scrutinized for original data, and their related references were manually retrieved and checked for additional relevant studies. The available studies exhibit considerable heterogeneity, exploring various factors related to postoperative outcomes. Our meta-analysis primarily focuses on three key aspects: the incidence of alveolar osteitis (AO), mucosa repair/alveolar pocket healing, and bone repair. The resultant CI of the VAS scale was 98 to 99%. Conclusions: This meta-analysis underscores the need for further research in this domain, highlighting the existing heterogeneity among studies and the importance of a nuanced understanding of photobiomodulation's multifaceted effects on postoperative complications.

Periodontitis in Psoriatic Patients: Epidemiological Insights and Putative Etiopathogenic Links

Psoriasis, a systemic autoimmune disorder primarily affecting the skin, manifests through erythematous plaques and scales, impacting approximately 2-3% of the global population. Chronic periodontitis, a prevalent oral disease characterized by the destruction of tooth-supporting tissues, affects roughly 10-15% of adults worldwide. Emerging evidence suggests a bidirectional relationship between psoriasis and chronic periodontitis, supported by epidemiological studies indicating a higher prevalence of periodontitis among individuals with psoriasis and vice versa. Both conditions are chronic inflammatory diseases marked by dysregulated immune responses and altered cytokine profiles, notably involving proinflammatory cytokines such as TNF-α and IL-17. Clinical studies highlight a reciprocal impact of treating one condition on the other, underscoring the necessity of interdisciplinary collaboration between dermatologists and periodontists in managing patients with both conditions. This narrative review provides a comprehensive overview of the relationship between psoriasis and chronic periodontitis, examining epidemiological associations, shared inflammatory pathways, genetic insights, microbial dysbiosis, environmental factors, and clinical implications. The review emphasizes the importance of integrated care approaches and the potential for targeted therapeutic interventions to improve both psoriatic and periodontal patient outcomes, advocating for further research into the molecular and cellular mechanisms underpinning the comorbidity of these diseases.

Patterns of Antibiotic Prescription in Endodontic Therapy in the Republic of Croatia

In response to the global trend of decreasing antibiotic usage, this study aimed to evaluate the nature and frequency of antibiotic prescriptions in conjunction with endodontic therapy in Croatia and to assess the attitudes of Croatian dental practitioners towards the endodontic treatment of patients susceptible to bacterial endocarditis. A survey questionnaire was sent to all dental practitioners in Croatia, achieving a response rate of 27%. The most frequently prescribed antibiotic was penicillin with clavulanic acid (63.4%), while standalone penicillin was less prevalent (18.6%). For patients exhibiting penicillin allergies, 90% of respondents indicated clindamycin as their preferred alternative. Antibiotics were mostly prescribed for localized acute apical abscesses without fever, followed by prophylaxis for infectious endocarditis and cellulitis. Only 1.3% of the respondents reported frequent antibiotic prescriptions without accompanying local treatment. While a substantial proportion of surveyed practitioners professed familiarity with the latest guidelines for antibiotic prophylaxis, their choice of antibiotics did not consistently reflect this claim. Most respondents conducted endodontic procedures on patients at risk of bacterial endocarditis. The findings highlight a need for targeted continuing education for dental practitioners in the Republic of Croatia, ensuring their practices align with current guidelines and global trends in antibiotic prescription.

The professional interactions between speech language therapist and dentist

Aim: This study investigates the collaborative efforts between speech language therapists and dentists to address the challenges faced by patients with concurrent dental and speech issues. It underscores the importance of understanding the complex interactions within the craniofacial system and its implications for both oral health and communication abilities. Methods: A questionnaire-based research was conducted involving speech language therapists and dentists, using Google Forms as the medium of data collection. This study was disseminated through professional networks, where practitioners provided information on their demographics, practices of collaboration, and the perceived advantages of such interdisciplinary work. All ethical standards were adhered to, ensuring the confidentiality and informed consent of the participants. Results: The findings indicate that dentists, often see first patient visits beyond recommended ages primarily for existing conditions, deviating from preventive norms. About half communicate monthly with speech language therapists, revealing gaps in early care and collaboration. Speech language therapists focus on language disorders and orofacial myofunctional disorders (SMOF), with 37% collaborating frequently with dentists. This interaction highlights the potential for enhanced patient outcomes through interdisciplinary cooperation. Despite these challenges, both groups acknowledged the benefits of their collaborative efforts. Conclusions: The partnership between speech language therapists and dentists represents a vital area of healthcare, aimed at tackling the complex issues of oral health and communication through a multidisciplinary approach. Although obstacles in collaboration were identified, the positive outcomes observed from such partnerships emphasize the importance of developing a unified framework to improve integrated healthcare delivery in the future.

Antibiotics Prescribing Pattern and Quality of Prescribing in Croatian Dental Practices-5-Year National Study

PURPOSE

Antibiotic resistance is one of the biggest threats to global health today. The aim of this study was to analyze antibiotic prescribing patterns and quality of prescribing in Croatian dental practices over a 5-year period.

METHODS

This is a retrospective observational study based on the analysis of the electronic prescriptions (medicines in ATC groups J01 and P01) from dental practices in Croatia prescribed from 1 January 2015 to 31 December 2019. Prescriptions were retrieved from the Croatian Health Insurance Fund (HZZO). The analyses included the number of prescriptions, type and quantity of prescribed drugs, indication, and the patient's and prescriber's characteristics.

RESULTS

The consumption increased from 1.98 DID in 2015, to 2.10 DID in 2019. The most prescribed antibiotic was Amoxicillin with clavulanic acid followed by Amoxicillin, Clindamycin, Metronidazole and Cefalexin. The analyses showed that 29.79% of antibiotics were not prescribed in accordance with the contemporary guidelines for the proper use of antibiotics. Additionally, 22% of antibiotics were prescribed in inconclusive indications.

CONCLUSION

The research showed an increase in antibiotic consumption over five years along with unnecessary prescribing of antibiotics in cases with no indications for its use. The development of national guidelines for antibiotic use is necessary.

Antibiotic Prescribing in Dental Medicine-Best Practices for Successful Implementation

With rising rates of antimicrobial resistance throughout the world, it is time to revisit antibiotic prescribing policies and practices, and dentistry is an important area for focused intervention, as it accounts for up to 15% of all antimicrobial prescriptions. In this narrative review, we have analyzed the current state of the knowledge, attitudes, and practice regarding antimicrobial use among dental professionals, and we have identified a set of seven recurring themes that drive inappropriate antibiotic prescribing in dental medicine. These include: 1. Prescribing antibiotics to delay or avoid dental treatment. 2. Overlooking the 5Ds-dental treatment (source control), dental condition (indication), drug (antibiotic choice), dose, and duration. 3. Relying on education from the distant past and on previous experience. 4. The heterogeneity of (too many) guideline recommendations leads to confusion and over-prescribing. 5. Decreased access to guideline information in private practice. 6. Psychological factors such as pressure to prescribe, comfort prescribing and the weekend effect, and 7. Feeling removed from antimicrobial resistance and externalizing responsibility. Based on the existing knowledge, we propose a framework based on four key pillars for focused intervention: 1. Education. 2. Internalizing responsibility. 3. Recognizing recurring counter-productive practices, and 4. Addressing recurring counter-productive practices. This framework can be applied in different dental settings to ensure best practices for the successful implementation of rational antimicrobial prescribing.

Systemic Antibiotic Use in Acute Irreversible Pulpitis: Evaluating Clinical Practices and Molecular Insights

This scoping review systematically evaluates the use of systemic antibiotics in treating acute irreversible pulpitis, integrating clinical practice patterns with recent molecular insights. We analyzed clinical evidence on antibiotic prescription trends among dental professionals and examined molecular research advancements in relation to pulpitis. This review is intended to bridge the gap between clinical practice and molecular research, guiding more evidence-based approaches to treating acute irreversible pulpitis. Electronic databases were searched for relevant articles published in English based on the objective of the review. A second search using all identified keywords and index terms was undertaken across all the included databases. In addition, a reference list of identified articles was searched. Studies including original research, systematic reviews, meta-analyses, clinical trials, and observational and retrospective studies, all written in English and published from 2010 onwards, were included, and an analysis of the text words contained in the titles and abstracts of the retrieved papers and of the index terms used to describe the articles was performed. A total of N = 53 articles were selected. Altogether, N = 43 (76.79%) articles were cross-sectional studies, N = 4 (11.11%) were systematic reviews, and N = 3 (5.36%) were guidelines. The most frequent level of evidence was level VI (N = 43 (76.79%). The mean percentage of dentists who prescribed antibiotics to treat acute irreversible pulpitis was 23.89 ± 23.74% (range: 0.05-75.7). Similarly, for specialists, it was 22.41 ± 15.64 (range 2.2-50.4), and the percentage for undergraduates was 17.52 ± 20.59 (range 0-62.6). The significant developments in research models for pulpitis research and the characterisation of biomarkers have led to better management strategies. Concurrently, significant advancements in molecular research provide new understandings of pulpitis, suggesting alternative therapeutic approaches. Although there are guidelines available, increased rates of antibiotic prescription are still prevalent around the globe.

Facts and trends in dental antibiotic and analgesic prescriptions in Germany, 2012-2021

OBJECTIVES

The study aims to overview German dentists' development of antibiotic and analgesic prescriptions from 2012 to 2021.

MATERIALS AND METHODS

A longitudinal database analysis was performed based on the annual reports of the "Research Institute for Local Health Care Systems" (WIdO, Berlin).

RESULTS

From 2012 until 2021, dental antibiotic prescriptions fell by 17.9%. In contrast, the dental proportion of antibiotic prescriptions compared to all antibiotic prescriptions in Germany increased from 9.1 to 13.6%. Aminopenicillins enhanced their share from 35.6 to 49.4%, while clindamycin prescriptions declined from 37.8 to 23.4%. The proportion of ibuprofen prescriptions significantly increased from 60.4% in 2012 to 79.0% in 2021.

CONCLUSIONS

Since 2013, the most frequently prescribed antibiotic by German dentists has been amoxicillin reaching nearly half of all dental antibiotic prescriptions in 2021. Simultaneously, the proportion of clindamycin has steadily decreased, but the level is still high compared to international data. During the past decade, ibuprofen as a first-line analgesic in German dentistry was continuously gaining in importance.

CLINICAL RELEVANCE

Aminopenicillins have the best risk-benefit balance in dentistry, but the use of antibiotics generally must be limited only to cases of severe infections or compromised patients. Pre-existing diseases or permanent medications should always be considered when choosing an analgesic.

Medication-Related Osteonecrosis of the Jaw: A Case Report of an Unusual Side Effect of Adalimumab

Background

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse drug reaction characterized by progressive bone destruction and necrosis of mandibular and/or maxillary jaw bone that occurs in patients undergoing treatments with antiresorptive drugs such as bisphosphonates or denosumab, antiangiogenic agents such as bevacizumab, or other kinds of monoclonal antibodies such as rituximab and ipilimumab, for different oncologic and nononcologic diseases. The aim of this study was to report a case of MRONJ in a patient affected by rheumatoid arthritis disease in treatment with adalimumab. Case Presentation. A 70-year-old female patient affected by rheumatoid arthritis (RA), who had been undergoing adalimumab (40 mg subcutaneous injection) every two weeks for 5 years, with no history of antiresorptive or antiangiogenic agent administration, came to our attention for intraoral necrotic bone exposures of the anterior mandible. After drug withdrawal and antibiotic cycles, the patient underwent surgical treatment with bone resection and debridement of necrotic tissues. After an observation period of 8 months, a complete healing without signs of recurrence was detected.

Conclusions

Based on this study, a correlation between adalimumab and MRONJ is possible. Therefore, we believe that an oral cavity examination should be done in every patients, before starting therapy with adalimumab, to possibly avoid MRONJ onset. Further studies are required to confirm the role of adalimumab in MRONJ.

The Interaction between the Oral Microbiome and Systemic Diseases: A Narrative Review

Background: The human being is defined as a ‘superorganism’ since it is made up of its own cells and microorganisms that reside inside and outside the human body. Commensal microorganisms, which are even ten times more numerous than the cells present in the body, perform very important functions for the host, as they contribute to the health of the host, resist pathogens, maintain homeostasis, and modulate the immune system. In the mouth, there are different types of microorganisms, such as viruses, mycoplasmas, bacteria, archaea, fungi, and protozoa, often organized in communities. The aim of this umbrella review is to evaluate if there is a connection between the oral microbiome and systematic diseases. Methodology: A literature search was conducted through PubMed/MEDLINE, the COCHRANE library, Scopus, and Web of Science databases without any restrictions. Because of the large number of articles included and the wide range of methods and results among the studies found, it was not possible to report the results in the form of a systematic review or meta-analysis. Therefore, a narrative review was conducted. We obtained 73.931 results, of which 3593 passed the English language filter. After the screening of the titles and abstracts, non-topic entries were excluded, but most articles obtained concerned interactions between the oral microbiome and systemic diseases. Discussion: A description of the normal microbial flora was present in the oral cavity both in physiological conditions and in local pathological conditions and in the most widespread systemic pathologies. Furthermore, the therapeutic precautions that the clinician can follow in order to intervene on the change in the microbiome have been described. Conclusions: This review highlights what are the intercorrelations of the oral microbiota in healthy subjects and in subjects in pathological conditions. According to several recent studies, there is a clear correlation between dysbiosis of the oral microbiota and diseases such as diabetes, cardiovascular diseases, chronic inflammatory diseases, and neurodegenerative diseases.

Viral Infections of the Oral Cavity in Children

Various viral infections can affect the oral cavities of pediatric patients [...].

Oral Microbiota, Bacterial Infections, Antibiotic Prescriptions, and Antimicrobial Resistance in Children

The oral cavity hosts the second most diverse microbial community, over 700 bacterial taxa, with the human gut having the widest diversity [...].

Do Systemic Diseases and Medications Influence Dental Implant Osseointegration and Dental Implant Health? An Umbrella Review

The aim of this umbrella review is to evaluate what are the most common medications and systemic diseases that can affect bone-implant integration, the success rate and survival rate of dental implants, peri-implant tissue health, and implant loss. Systematic reviews, with meta-analysis or not, about how systemic diseases and medications influence dental implant osseointegration, survival rate, success rate, and peri-implant diseases, published only in the English language, are electronically searched across the most important scientific databases. The present umbrella review includes eight systematic reviews, and osteoporosis and diabetes are the most investigated pathologies. Systemic diseases, such as neurologic disorders, HIV, hypothyroidism, cardiovascular diseases, and drugs, such as beta blockers, anti-hypertensives, or diuretics do not show a decreased rate of implant osseointegration. It seems that drugs, such as proton-pump inhibitors (PPIs) or serotonin reuptake inhibitors (SSRIs), negatively affect implant osseointegration. Few studies compare the effects of drugs and systemic diseases on the parameters considered in this overview. It is important to underline how the results of this review need to be validated with subsequent and more reviews.

Clinics and Practice: Consolidating Best Practices in Periodontal Management

Periodontitis is a multifactorial inflammatory disease [...].

Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth

Antibiotics have undoubtedly revolutionized medicine and the health and survival of patients with life-threatening infections, being nonetheless free from potential adverse effects, and the risk of intestinal dysbiosis, antimicrobial resistance, and the resulting consequences for the patient's health and the public purse. The present study narratively reviewed the epidemiological data on worldwide antibiotic consumption and administration in dental practice, patients' adherence to prescriptions, the antimicrobial resistance phenomenon in dentistry, and the evidence supporting and recommending appropriate antibiotic use in dental care. Eligible systematic reviews and original studies in humans published in the English language from January 2000 to 26 January 2023 were considered. A total of 78 studies, 47 on the epidemiology of antibiotic use and prescription in dentistry, 6 on antibiotic therapy in dentistry, 12 on antibiotic prophylaxis in dentistry, 0 on adherence of dental patients to antibiotic prescription, and 13 on antimicrobial resistance in dentistry, were presently considered. Retrieved evidence revealed that antibiotics are frequently overused and misused in dental practice, dental patients frequently do not adhere to prescriptions, and antimicrobial resistance in dentistry is a still rising phenomenon also secondary to improper oral antiseptics use. The present findings highlighted the need to establish more evidence-based and accurate antibiotic prescriptions to sensitize dentists and dental patients to minimize and rationalize the use of antibiotics only when it is indicated and necessary, improve patients' adherence, and enhance knowledge and awareness of the antimicrobial resistance in dentistry.

Characterization of the Oral Microbiome in Wearers of Fixed and Removable Implant or Non-Implant-Supported Prostheses in Healthy and Pathological Oral Conditions: A Narrative Review

Oral commensal microorganisms perform very important functions such as contributing to the health of the host. However, the oral microbiota also plays an important role in the pathogenesis and development of various oral and systemic diseases. The oral microbiome may be characterized by a higher prevalence of some microorganisms than others in subjects with removable or fixed prostheses, depending on oral health conditions, the prosthetic materials used, and any pathological conditions brought about by inadequate prosthetic manufacturing or poor oral hygiene. Both biotic and abiotic surfaces of removable and fixed prostheses can be easily colonized by bacteria, fungi, and viruses, which can become potential pathogens. The oral hygiene of denture wearers is often inadequate, and this can promote oral dysbiosis and the switch of microorganisms from commensal to pathogens. In light of what emerged from this review, fixed and removable dental prostheses on teeth and on implants are subject to bacterial colonization and can contribute to the formation of bacterial plaque. It is of fundamental importance to carry out the daily hygiene procedures of prosthetic products, to design the prosthesis to facilitate the patient's home oral hygiene practices, and to use products against plaque accumulation or capable of reducing oral dysbiosis to improve patients' home oral practices. Therefore, this review primarily aimed to analyze the oral microbiome composition in fixed and removable implant or non-implant-supported prostheses wearers in healthy and pathological oral conditions. Secondly, this review aims to point out related periodontal self-care recommendations for oral dysbiosis prevention and periodontal health maintenance in fixed and removable implant or non-implant-supported prostheses wearers.

Oral Mycobiome and COVID-19

The most common signs and symptoms of COVID-19 include fever, cough, dyspnea, conjunctivitis, diarrhea, and olfactory and gustatory disturbances [...].

Is Ozone a Valid Adjuvant Therapy for Periodontitis and Peri-Implantitis? A Systematic Review

INTRODUCTION

Ozone is a naturally occurring unstable compound with three oxygen atoms that generally transforms into an oxygen molecule, releasing one oxygen atom. This feature has been exploited in dentistry for numerous applications, including for periodontal diseases and peri-implantitis.

METHODS

This review was performed in relation to the PRISMA flow chart and was annotated in the PROSPERO register. PICO questions were used as research questions. The risk of bias in the non-randomized clinical trials was appraised using the ROBINS-I tool.

RESULTS

An electronic search found a total of 1073 records, in particular, 842 from MEDLINE/PubMed, 13 from Bio Med Central, 160 from Scopus, 1 from the Cochrane library databases, and 57 from the PROSPERO register. A total of 17 studies were included in the present systematic review. Information regarding the characteristics of the periodontal clinical and radiographic parameters for gaseous ozone, ozonate water, ozonate oil, and ozone gel, including clinical attachment loss (CAL) probing depth (PPD), bleeding on probing (BoP), plaque index (PI), gingival index (GI), and marginal bone levels (MBL), were obtained.

CONCLUSIONS

The studies included in this systematic review show different results regarding the ozone in periodontal treatment in association with or without SRP.

Post-Operative Complications and Risk Predictors Related to the Avulsion of Lower Impacted Third Molars

Background and Objectives: This prospective cohort study aimed to evaluate the onset and severity of pain and other complications following lower impacted third molar extraction and to identify potential risk predictors. Materials and Methods: Twenty-five patients were treated with at least one lower impacted third molar extraction. The primary outcome was the onset of post-operative pain, evaluated at 6 h, 12 h, 24 h, 48 h, 72 h, and 7 days. The secondary outcomes (trismus, edema, alveolitis, dehiscence, neuralgic injury, and suppuration) were recorded at 3, 7 and 21 days after oral surgery. A correlation analysis was performed to identify potential associations between patient- and tooth-related factors and VAS (Visual Analogue Scale) scale. When a statistically significant correlation was identified, a regression analysis was performed. Results: Most of the patients were female (84%) with a mean age of 25 ± 3 years; the reason for oral surgery was dysodontiasis in 60% of cases, while the most frequent Pell and Gregory class was BII (36%). The VAS scale showed the onset of mild pain at 6 h (44%), 12 h (48%), 24 h (68%) and 48 (68%) after surgery. Trismus, edema, and alveolitis were observed at 3-day (20%, 64% and 12%, respectively) and at 7-day (16%, 12% and 4%, respectively) follow-up. Neuralgic injury was reported in one case (4%). The linear regression analysis showed a statistically significant association (p < 0.05) between the duration of oral surgery and VAS scores at 6 and 12 h. Finally, the binary logistic regression identified systemic disease, Pell and Gregory classification, duration of oral surgery, VAS at 6 and 12 h, trismus, and edema at 3 and 7 days as predictive factors of post-operative complications. Conclusions: Within their limits, the results of this study suggest that the onset of post-operative complications increases in proportion to the duration of the surgical procedure.

Local and Systemic Antibiotics in Peri-Implantitis Management: An Umbrella Review

The present umbrella review aimed to characterize the type and regimen of antibiotics administered locally and/or systemically, alone or in combination with surgical and nonsurgical treatments, for peri-implantitis and to evaluate and compare the associated clinical, radiographic, and crevicular peri-implant outcomes. The secondary objective was to determine the most effective antibiotic type, route of administration, regimen, and protocols (antibiotics alone or in combination with other approaches) for treating peri-implantitis. The study protocol, which was developed in advance under the PRISMA statement, was registered at PROSPERO (CRD42022373957). BioMed Central, Scopus, MEDLINE/PubMed, the Cochrane Library databases, and the PROSPERO registry were searched for systematic reviews through 15 November 2022. Of the 708 records found, seven reviews were included; three were judged of a critically low and four of low quality through the AMSTAR 2 tool. Locally administered antibiotics alone or as an adjunct to surgical or nonsurgical treatments for peri-implantitis showed favorable outcomes, albeit with limited evidence. The administration of systemically-delivered antibiotics in combination with nonsurgical or surgical treatments remained questionable. Local plus systemic antibiotics have not been shown to have durable efficacy. Due to the heterogeneity of reported antibiotic types, routes, regimens, and protocols, no definitive conclusions could be drawn regarding the most effective antibiotic use in treating peri-implantitis.

Opinions of Prospective Dentists and Prospective Teachers on Antibiotic Use

The purpose of this study was to examine the opinions of prospective dentists and prospective teachers on antibiotic use. In this study, a survey method based on a quantitative research paradigm was utilized. A 19-item instrument was applied to the sample group including 414 university students attending to the Faculty of Dentistry and Faculty of Education. The instrument was composed of three main subscales in addition to demographic characteristics. The first part focused on attitudes, the second part focused on subjective norms, and the third part focused on the prospective dentists and prospective teachers' intentions regarding the phenomenon of antibiotics use. While the dependent variables of the study were the participants' levels of agreement in the subscales of the instrument, the independent variable was faculty studied. The data were analyzed through descriptive statistics, and the Mann-Whitney U test was used to compare the participants' views on antibiotic use. The findings in terms of the faculties showed that dentistry and education faculties in our country prepare well in expanding their reasonable consumption of antibiotics. Yet, antibiotics are used more incorrectly by some prospective teachers than by prospective dentists. According to the findings in terms of subscales, the participants have positive attitudes toward the reasonable use of antibiotics in terms of the attitude subscale. However, the results from the subjective norm indicated that participants are influenced by their environment in their antibiotic use. Finally, the results from the intention indicated that participants avoid using antibiotics irregularly or frequently.

COVID-19 Related Information on Pediatric Dental Care including the Use of Teledentistry: A Narrative Review

In addition to the direct impact of the SARS-CoV-2 infection, the COVID-19 pandemic reports multiple effects on people's health and psycho-physical well-being. In the dental field, oral hygiene sessions, regular dental check-ups, and aerosol-generating procedures were commonly postponed, thus resulting in repercussions on oral health also favored by the changing eating and oral hygiene habits during the multiple lockdowns. Furthermore, dental settings and practices were generally perceived as at high risk for SARS-CoV-2 transmission, thus unsafe, and by general and pediatric dentists themselves. Last, the consequences of stress related to deprivation of social life and playful activities should not be underestimated in children, exposing them to the deleterious effects of bad oral habits, with repercussions on the balanced growth and development of the stomatognathic system. The present work intends to analyze the medium-term and long-term impact of COVID-19 on pediatric oral and dental care provision, reviewing pediatric dentistry practice and oral and dental needs of pedodontics patients during the first peak and the various waves of the COVID-19 pandemic, and lessons learned.

Immediate Loading of Fixed Prostheses in Fully Edentulous Jaws: A 7-Year Follow-Up from a Single-Cohort Retrospective Study

The aim of this retrospective single-cohort study was to evaluate the clinical outcome of four-to-five implants immediately restored with metal-resin screw-retained cross-arch fixed prostheses in edentulous jaws 10 years after loading. One-hundred-and-four consecutive patients received four to five implants placed with a torque superior 35 Ncm. One-hundred-and-twenty-seven metal-resin screw-retained fixed prostheses (59 mandibular and 68 maxillary) were to be delivered within 3 days. Outcome measures, evaluated by the treating clinician, were: prosthesis and implant failures, prosthetic modifications, peri-implant mucositis, and biological and prosthetic complications. A total of 549 implants were placed. Twenty-one implants failed in 14 patients and 102 prostheses were remade, at least once, in 81 patients: 2 due to implant failures and 33 because of fractures of the prostheses. In particular, 25 original metal-resin prostheses had to be remade because of fractures versus only eight of the replacement monolithic metal-resin prostheses. All patients were wearing fixed prostheses at the end of the follow-up. Thirty-six biological complications occurred in 22 patients. Eighty-six prosthetic complications occurred in 42 patients. In conclusion, immediately loaded cross-arch prostheses supported by four-to-five immediately placed implants are a viable therapeutic option if robust prostheses are made.

Probiotics in Periodontal and Peri-Implant Health Management: Biofilm Control, Dysbiosis Reversal, and Host Modulation

Periodontitis and peri-implantitis are microbially associated diseases of the tissues supporting the teeth and dental implants that are mediated by host inflammation and eventually lead to tooth and dental implant loss. Given the probiotics' role in biofilm control, dysbiosis reversal, and host modulation, their potential beneficial effects on the improvement of periodontitis and peri-implantitis have been recently investigated. Moreover, probiotics use has also been proposed in periodontal health management in patients undergoing fixed orthodontic therapy. Therefore, the present study aimed to review, considering the periodontal microbiome composition around teeth and dental implants in healthy and pathological conditions, the putative favorable effects of probiotics on gingivitis, periodontitis, and peri-implantitis. The secondary aim of the present narrative review was to synthesize the supporting evidence and proposed protocols for probiotics use as adjuncts in periodontitis and peri-implantitis treatment and the periodontal health management of orthodontic patients with fixed appliances. Contrasting findings from the literature may be due to the different methods, posology, and duration of probiotics prescriptions and due to the heterogeneous biological and clinical measurement methods employed. Thus, no definitive conclusions could be drawn about the effectiveness of probiotics in periodontal management, both in healthy and pathological conditions. Further studies are needed to validate probiotics for periodontal management and provide recommended protocols.

Adherence to Antibiotic Prescription of Dental Patients: The Other Side of the Antimicrobial Resistance

Since non-adherence to antibiotic therapy can cause several problems, including antimicrobial resistance (AMR) and treatment failures, the present study evaluated adherence to oral antibiotic therapy and AMR awareness among consecutively enrolled dental patients. Data concerning age, gender, socioeconomic status, education level, cohabitation, and general health were retrieved from medical records. AMR awareness was investigated through direct questions and adherence to antibiotic treatment was assessed through a modified Italian version of the Morisky medical scale-8 items. Participants’ characteristics were analyzed in relation to treatment adherence and AMR, using a Χ2 independence test (significance level of α <0.1). Dental patients generally showed a low (51.82%) adherence to oral antibiotic therapy, and medium and high adherence was reported only by 29.37% and 18.81% of participants. Treatment adherence was similar in relation to participants’ gender and age but significantly lower in subjects with only secondary school graduation and higher in participants with higher education levels. Non-cohabitants were significantly more adherent than cohabitants. AMR awareness was declared by 42.15% of males and 38.70% of females: 56.52% of dental patients aware of AMR were 18−38 years old, 35.20% were 39−59 years old, and 26.95% were aged between 60 and 80. Further studies are needed to develop adequate strategies, expanding dental patients’ knowledge of AMR, thus optimizing the benefits and reducing the risks of antibiotic administration in dental patients.