Clinical and academic recommendations for primary dental care prosthodontics

Managing emerging challenges of Coronavirus disease 2019 (COVID-19) in dentistry

Dental centers have been referred to as a hub or reservoir for infection, where healthcare professionals and other staff, patients and the public together may potentially spread pathogenic microorganisms. This may occur via saliva, skin or indirectly through air, water, and contaminated surfaces or instruments. Everyone should therefore be considered as potential sources of infection. During a pandemic, limiting unnecessary care has been adopted as a clinical measure for some patient's, to reduce the risk of cross-infection in the short term. However, in order to enable continuation of necessary and qualified care, dental processes need to follow specific infection control strategies in order to prevent transmission of emerging pandemic risks following COVID-19. In this article, we develop a tool with practical recommendations to mitigate infection risks before, during and following pandemics to enable ongoing dental care provision in primary and secondary care based on national and global recommendations.

Novel Confocal-Laser-Scanning-Microscopy and conventional measures investigating eroded dentine following dentifrice dab-on and brushing abrasion

Objectives

To validate novel non-contacting Confocal-Laser-Scanning-Microscopy (CLSM) methodology with conventional Contacting Profilometry (CP) measures investigating brushing or dab-on of stannous-fluoride dentifrice on early aggressive dentine erosion.

Methods

75 polished human dentine samples were prepared and eroded in agitated 6% citric acid then randomly allocated into 5 intervention groups; artificial saliva control (1); controlled use of a pressure sensitive counter-rotating oscillatory powered toothbrush with sodium-fluoride NaF (2) or stannous-fluoride SnF₂ (3), and dab-on application of NaF (4) or SnF₂ (5). Samples underwent three cycles of intervention and 2-min agitated 6 % citric acid challenges. CLSM images were taken and 3D reconstructions produced of step height using a developed software algorithm. In addition, 20 % samples were randomised and profiled using CP to measure step height and surface roughness. Vickers's diamond micro-hardness testing was carried out on all samples.

Results

Comparing CLSM and CP; Pearson correlation was 0.77 and Intra-class correlation 0.81 (p = 0.01). There were no significant statistical differences in step height between groups using both CLSM and CP. From baseline, SnF₂ brushing (3) increased micro-hardness more than control (1) (p = 0.03), NaF (4) and SnF₂ dab-on (5) (p ≤ 0.001), and increased surface roughness more than control (p = 0.02), NaF brushing (2) and NaF dab-on (4) (p ≤ 0.017). Dab-on of SnF₂ (5) produced rougher surfaces than control (1) (p = 0.014) and reduced hardness compared with NaF brushing (p = 0.04).

Conclusions

Good agreement and correlation exists between CLSM and CP measures in dentine. There were no significant differences in surface loss after interventions between groups. Compared with control, SnF₂ application increased dentine surface roughness and SnF₂ controlled powered brushing application increased dentine hardness, likely caused by exposure of uneroded dentine.

Clinical significance

Isosurfaces produced using CLSM can be used to represent dentine step height loss. They show good correlation and agreement with conventional CP measures, following early aggressive erosion-abrasion cycles of dentine. The CLSM and computer algorithm therefore provides an accurate, standalone and non-contacting three-dimensional measurement of early dentine wear. Stannous-fluoride brushing, and dab-on application offer no benefits following early aggressive erosion in dentine. To reduce dentine wear, limiting erosive challenges and avoiding brushing post-erosion is advised.