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Solomonov M, Hadad A, Ben Itzhak J, Lvovsky A, Azizi H. Is a Pre-Existent Cone-Beam Computed Tomography Able to Detect Metal Dental Posts? Dent J (Basel) 2024; 12:229. [PMID: 39057016 PMCID: PMC11276458 DOI: 10.3390/dj12070229] [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: 06/04/2024] [Revised: 06/30/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: In this study, the efficacy of cone-beam computed tomography (CBCT) in detecting dental posts was compared to periapical radiography. (2) Methods: A retrospective evaluation of 53 patients' periapical radiographs and CBCT images was performed. The presence and type of the intra-canal dental post were initially determined on the periapical images (PA) radiographs' examination and were then compared to the observer's ability to detect the dental post on a CBCT image. The effect of the post's type (metal cast or prefabricated) on its detection on CBCT images was determined. (3) Results: 10.5% of teeth that were identified as having a post on a PA radiograph were not identified as having a post on the CBCT examination (p < 0.05). Approximately 17.6% of teeth that were identified as not having a post on a PA radiograph were identified as having a post on the CBCT examination (p < 0.05). Moreover, 16.3% and 50% of teeth with a prefabricated or cast posts on PA radiographs were falsely identified on the CBCT examination, respectively (p < 0.05). (4) Conclusions: A CBCT image is an insufficient tool for the identification of metal prefabricated and cast posts. A PA image is the recommended radiographic tool for achieving information about the post-endodontic restoration status of teeth candidates for endodontic retreatment in patients with a former CBCT scan.
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Affiliation(s)
- Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, 12271 Jerusalem, Israel
| | - Avi Hadad
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, 12271 Jerusalem, Israel
| | - Joe Ben Itzhak
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, 12271 Jerusalem, Israel
| | - Alex Lvovsky
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, 12271 Jerusalem, Israel
| | - Hadas Azizi
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, 12271 Jerusalem, Israel
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Sović J, Šegović S, Pavelić B, Bago I, Šutej I, Tomašić I. Patterns of Antibiotic Prescription in Endodontic Therapy in the Republic of Croatia. Antibiotics (Basel) 2024; 13:645. [PMID: 39061327 PMCID: PMC11273622 DOI: 10.3390/antibiotics13070645] [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: 05/29/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
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.
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Affiliation(s)
- Josipa Sović
- PhD Postgraduate Study, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Dental Clinic, Health Center Križevci, 48260 Križevci, Croatia
| | - Sanja Šegović
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia; (B.P.); (I.B.)
| | - Božidar Pavelić
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia; (B.P.); (I.B.)
| | - Ivona Bago
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia; (B.P.); (I.B.)
| | - Ivana Šutej
- Department of Pharmacology, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Ivan Tomašić
- School of Innovation, Design and Engineering, Mälardalen University, 721 23 Västerås, Sweden;
- Department of Communication Systems, Jožef Stefan Institute, 1000 Ljubljana, Slovenia
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Méndez-Millán JA, León-López M, Martín-González J, Saúco-Márquez JJ, Cabanillas-Balsera D, Segura-Egea JJ. Antibiotic Over-Prescription by Dentists in the Treatment of Apical Periodontitis: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2024; 13:289. [PMID: 38666965 PMCID: PMC11047734 DOI: 10.3390/antibiotics13040289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
After pulp infection and necrosis, the passage of microbial antigens into the periapical space causes apical periodontitis (AP). Most of the clinical forms of AP can be managed without prescribing antibiotics, only with root canal treatment and abscess drainage or, where appropriate, tooth extraction. However, the scientific literature provides evidence of inappropriate antibiotic prescriptions by dentists in the management of apical disease. OBJECTIVES The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease. METHODS PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle-Ottawa Scale. The certainty of evidence was assessed using GRADE. RESULTS The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low. CONCLUSIONS Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases.
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Affiliation(s)
| | | | | | | | - Daniel Cabanillas-Balsera
- Department of Stomatology (Endodontic Section), School of Dentistry, University of Sevilla, C/Avicena s/n, 41009 Sevilla, Spain; (J.A.M.-M.); (M.L.-L.); (J.M.-G.); (J.J.S.-M.)
| | - Juan J. Segura-Egea
- Department of Stomatology (Endodontic Section), School of Dentistry, University of Sevilla, C/Avicena s/n, 41009 Sevilla, Spain; (J.A.M.-M.); (M.L.-L.); (J.M.-G.); (J.J.S.-M.)
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Yao L, Liu Q, Lei Z, Sun T. Development and challenges of antimicrobial peptide delivery strategies in bacterial therapy: A review. Int J Biol Macromol 2023; 253:126819. [PMID: 37709236 DOI: 10.1016/j.ijbiomac.2023.126819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
The escalating global prevalence of antimicrobial resistance poses a critical threat, prompting concerns about its impact on public health. This predicament is exacerbated by the acute shortage of novel antimicrobial agents, a scarcity attributed to the rapid surge in bacterial resistance. This review delves into the realm of antimicrobial peptides, a diverse class of compounds ubiquitously present in plants and animals across various natural organisms. Renowned for their intrinsic antibacterial activity, these peptides provide a promising avenue to tackle the intricate challenge of bacterial resistance. However, the clinical utility of peptide-based drugs is hindered by limited bioavailability and susceptibility to rapid degradation, constraining efforts to enhance the efficacy of bacterial infection treatments. The emergence of nanocarriers marks a transformative approach poised to revolutionize peptide delivery strategies. This review elucidates a promising framework involving nanocarriers within the realm of antimicrobial peptides. This paradigm enables meticulous and controlled peptide release at infection sites by detecting dynamic shifts in microenvironmental factors, including pH, ROS, GSH, and reactive enzymes. Furthermore, a glimpse into the future reveals the potential of targeted delivery mechanisms, harnessing inflammatory responses and intricate signaling pathways, including adenosine triphosphate, macrophage receptors, and pathogenic nucleic acid entities. This approach holds promise in fortifying immunity, thereby amplifying the potency of peptide-based treatments. In summary, this review spotlights peptide nanosystems as prospective solutions for combating bacterial infections. By bridging antimicrobial peptides with advanced nanomedicine, a new therapeutic era emerges, poised to confront the formidable challenge of antimicrobial resistance head-on.
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Affiliation(s)
- Longfukang Yao
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China; Hubei Key Laboratory of Nanomedicine for Neurodegenerative Diseases, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
| | - Qianying Liu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhixin Lei
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China; Hubei Key Laboratory of Nanomedicine for Neurodegenerative Diseases, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China.
| | - Taolei Sun
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China; Hubei Key Laboratory of Nanomedicine for Neurodegenerative Diseases, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China.
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Schneider-Smith EG, Suda KJ, Lew D, Rowan S, Hanna D, Bach T, Shimpi N, Foraker RE, Durkin MJ. How decisions are made: Antibiotic stewardship in dentistry. Infect Control Hosp Epidemiol 2023; 44:1731-1736. [PMID: 37553682 PMCID: PMC10782556 DOI: 10.1017/ice.2023.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND We performed a preimplementation assessment of workflows, resources, needs, and antibiotic prescribing practices of trainees and practicing dentists to inform the development of an antibiotic-stewardship clinical decision-support tool (CDST) for dentists. METHODS We used a technology implementation framework to conduct the preimplementation assessment via surveys and focus groups of students, residents, and faculty members. Using Likert scales, the survey assessed baseline knowledge and confidence in dental providers' antibiotic prescribing. The focus groups gathered information on existing workflows, resources, and needs for end users for our CDST. RESULTS Of 355 dental providers recruited to take the survey, 213 (60%) responded: 151 students, 27 residents, and 35 faculty. The average confidence in antibiotic prescribing decisions was 3.2 ± 1.0 on a scale of 1 to 5 (ie, moderate). Dental students were less confident about prescribing antibiotics than residents and faculty (P < .01). However, antibiotic prescribing knowledge was no different between dental students, residents, and faculty. The mean likelihood of prescribing an antibiotic when it was not needed was 2.7 ± 0.6 on a scale of 1 to 5 (unlikely to maybe) and was not meaningfully different across subgroups (P = .10). We had 10 participants across 3 focus groups: 7 students, 2 residents, and 1 faculty member. Four major themes emerged, which indicated that dentists: (1) make antibiotic prescribing decisions based on anecdotal experiences; (2) defer to physicians' recommendations; (3) have limited access to evidence-based resources; and (4) want CDST for antibiotic prescribing. CONCLUSIONS Dentists' confidence in antibiotic prescribing increased by training level, but knowledge did not. Trainees and practicing dentists would benefit from a CDST to improve appropriateness of antibiotic prescribing.
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Affiliation(s)
- Erika G Schneider-Smith
- Division of Medical Education, Washington University School of Medicine, St. Louis, Missouri
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and the University of Pittsburgh, School of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania
| | - Daphne Lew
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Susan Rowan
- Division of General Dentistry, University of Illinois College of Dentistry, Chicago, Illinois
| | - Danny Hanna
- Division of General Dentistry, University of Illinois College of Dentistry, Chicago, Illinois
| | - Tracey Bach
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Neel Shimpi
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Randi E Foraker
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Michael J Durkin
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
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Solomonov M, Batashvili G, Shuster A, Slutzky H, Moshonov J, Buchkovskii O, Lvovsky A, Azizi H, Levin A, Ben Itzhak J, Shemesh A. Systemic antibiotics in endodontics-International questionnaire study: Choice of types, dosage, loading and duration. AUST ENDOD J 2023; 49 Suppl 1:58-63. [PMID: 36151950 DOI: 10.1111/aej.12686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/07/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
The aim of the study was to investigate the systematic antibiotics (SAs) prescribing practices in the endodontic practice worldwide. 7500 general practitioners, postgraduate students and endodontists from Israel and the former Soviet Union (FSU) states were invited to fill in an online questionnaire. The first-choice SA was amoxicillin (80.12%) among the Israeli (p < 0.05) and amoxicillin + clavulanic acid (88.92%) among the FSU respondents (p < 0.05). The first-choice SA for patients with penicillin allergy was clindamycin (78.2%) among Israeli and azithromycin (35.96%) among the FSU respondents (p < 0.05). Most of the respondents from Israel as well as from the FSU reported prescribing SA for 5-7 days. Only 6.24% of the former and 2.59% of the latter reported prescribing SA until the symptoms disappeared (p > 0.05). The usage of SAs is often not in accordance with existing international guidelines and differs among different dentist's populations.
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Affiliation(s)
- Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gabriel Batashvili
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Shuster
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hagay Slutzky
- Department of Prosthodontics, Goldschleger School of Dental medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Joshua Moshonov
- Department of Endodontics, Hadassah School of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Oleg Buchkovskii
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alex Lvovsky
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hadas Azizi
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Levin
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joe Ben Itzhak
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Shemesh
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Contaldo M, D’Ambrosio F, Ferraro GA, Di Stasio D, Di Palo MP, Serpico R, Simeone M. Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6025. [PMID: 37297629 PMCID: PMC10252486 DOI: 10.3390/ijerph20116025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.A.F.); (D.D.S.); (R.S.)
| | - Francesco D’Ambrosio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy;
| | - Giuseppe A. Ferraro
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.A.F.); (D.D.S.); (R.S.)
| | - Dario Di Stasio
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.A.F.); (D.D.S.); (R.S.)
| | - Maria Pia Di Palo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy;
| | - Rosario Serpico
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.A.F.); (D.D.S.); (R.S.)
| | - Michele Simeone
- Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80138 Naples, Italy
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