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Fakhruddin KS, Matsubara VH, Warnakulasuriya S, Tilakaratne WM, Ngo HC, Samaranayake LP. Mucormycosis of the Mandible and Tongue: A Systematic Scoping Review. Int Dent J 2023:S0020-6539(23)00976-0. [PMID: 38143163 DOI: 10.1016/j.identj.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/26/2023] Open
Abstract
AIM Mucormycosis is a rare human infection associated with Mucorales, a group of filamentous moulds found in different environmental niches. Its oral manifestations may occur in the mandible and tongue despite being rare. We aimed to systematically review the data on clinical manifestations, risk factors, diagnostic approaches, treatment options, and outcomes of mandibular and tongue mucormycosis. METHODS An electronic search of articles published between January 1975 and November 2022 in PubMed, Web of Science, and EMBASE databases was performed. A total of 22 articles met the inclusion criteria and reported 27 cases of oral mucormycosis in total. RESULTS Fourteen patients had mandibular mucormycosis signs unrelated to COVID-19 infection, 6 had SARS-CoV-2-related mandibular mucormycosis, and 6 had manifestations in the tongue. All published case reports during the COVID-19 pandemic were from India. Patient ages ranged from 4 months old to 82 years, and most patients had important comorbidities, such as blood dyscrasias related to immune deficiency and uncontrolled type 2 diabetes mellitus. The signs and symptoms of mandibular and tongue mucormycosis varied from dental pain, loose teeth, and nonhealing sockets to dysphagia and paraesthesia of the lip. Some patients also reported trismus, draining sinus tract, and facial pain. The diagnosis of oral mucormycosis was based on a combination of clinical, radiographic, and histopathologic findings by demonstrating fungal hyphae in tissue specimens. In most cases, mucormycosis was managed with systemic amphotericin B, strict glycaemic control, and aggressive surgical debridement of infected tissue, minimising the progression of the fungal infection and thus improving the survival rate. In some cases, combined antifungal therapy, antibiotic therapy, and chlorhexidine mouthwashes were used successfully. CONCLUSIONS Recognition of the signs and symptoms by oral care providers is pertinent for the early diagnosis and treatment of tongue and mandibular mucormycosis, and providers should be aware of the possibility of this opportunistic fungal infection in patients with COVID-19. A multidisciplinary approach is recommended for the management of this lethal infection.
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Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | | | | | | | - Hien Chi Ngo
- Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Lakshman P Samaranayake
- Faculty of Dentistry, The University of Hong Kong, Hong Kong. Special Administrative Region, China.
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Matsubara VH, Fakhruddin KS, Ngo H, Samaranayake LP. Probiotic Bifidobacteria in Managing Periodontal Disease: A Systematic Review. Int Dent J 2022; 73:11-20. [PMID: 36535806 PMCID: PMC9875235 DOI: 10.1016/j.identj.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Although various probiotic organisms have been evaluated for their utility in the management of periodontitis, their strain-specific mechanisms of action are still unclear. We aimed to systematically review the effect of bifidobacterial probiotics on periodontopathogens and host immune responses in periodontal diseases. An electronic search of articles published until June 2022 in Medline, PubMed, Web of Science, and Cochrane Library databases was performed. Randomised controlled trials (RCTs) and in vitro and animal studies were assessed, and the data regarding antimicrobial properties, immunomodulation, and clinical outcomes were analysed. A total of 304 studies were screened, but only 3 RCTs and 6 animal and in vitro studies met the inclusion criteria. The use of different strains of bifidobacteria led to (1) a reduction of key players of the red complex periodontopathogens; (2) reduced levels of pro-inflammatory cytokines (eg, interleukin [IL]1-β and IL-8) and higher levels of anti-inflammatory cytokines (IL-10); (3) enhanced levels of osteoprotegerin and reduced levels of receptor activator of nuclear factor kappa-B ligand; and (4) a reduction of the dental plaque, bleeding on probing, alveolar bone loss, and clinical attachment loss. Bifidobacterial probiotic adjuvant supplementation, especially with Bifidobacterium animalis subspecies lactis, appears to help improve clinical periodontal parameters and develop a healthy plaque microbiome through microbiological and immunomodulatory pathways. Further human and animal studies are warranted prior to the therapeutic use of bifidobacteria in the routine management of periodontal infections.
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Affiliation(s)
- Victor Haruo Matsubara
- UWA Dental School, University of Western Australia, Perth, Western Australia, Australia,Corresponding author. Dental School, University of Western Australia, 17 Monash Avenue, Nedlands, Perth, WA 6009, Australia.
| | - Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Hien Ngo
- UWA Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Lakshman P. Samaranayake
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Special Administrative Region, China
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Khalifa N, Samaranayake L, Fakhruddin KS. Dental pedagogy in the 'new normal' COVID-19 era: a transition template of teaching protocols. BMC Med Educ 2022; 22:794. [PMID: 36384708 PMCID: PMC9667843 DOI: 10.1186/s12909-022-03864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
AIMS Delivery of clinical dental education, as opposed to clinical medicine, is particularly challenging due to the obligatory aerosol-generating procedures (AGPs) used in dentistry, which are known to facilitate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hence, using AGPs and working in close proximity to patients for extended periods in dental hospital/university settings with multiple teaching clinics have been a formidable prospect for all stake holders. Therefore, several professional and governmental organizations have promulgated variations of infection control guidelines for general practice dentistry in the pandemic era to mitigate SARS-CoV-2 transmission. MATERIALS AND METHODS In the absence of unified guidelines for modified infection control/clinical procedures for dental education. We implemented a clinical protocol template and modified operating procedures (MOP) for teaching clinical dentistry to fit the infection control requirements during the pandemic/post-pandemic period at the Sharjah University, College of Dentistry, UAE. MOPs ranged from various engineering control measures (e.g., negative-pressure ventilation systems in operatories) to administrative control measures featuring post-procedure fallow periods of treatment-abeyance between patient sessions. RESULTS The new MOPs for clinical dentistry in the COVID-19 pandemic era, trialled in a UAE dental teaching hospital, have successfully eliminated infection transmission amongst the students, clinicians, ancillary staff, or attending patients, thus far. CONCLUSIONS The proposed MOPs that complement the standard operating protocols in clinical dentistry were an attempt to mitigate nosocomial infection transmission and protect four different groups of stakeholders, i) the patients, ii) the dental students, iii) the clinical academics, and iv) the para-dental personnel/assistants. Due to the endemicity of the COVID-19 in many regions of the World, the suggested MOPs need periodic review and revision, to fit the emerging data on the disease. Finally, as there are no studies to date comparing the relative efficacy of the MOPs in various dental academic institutions, there is an urgent need for future workers to address this issue.
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Affiliation(s)
- Nadia Khalifa
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Lakshman Samaranayake
- Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Pok Fu Lam, Hong Kong, China.
| | - Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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Fakhruddin KS, Samaranayake LP, Buranawat B, Ngo H. Oro-facial mucocutaneous manifestations of Coronavirus Disease-2019 (COVID-19): A systematic review. PLoS One 2022; 17:e0265531. [PMID: 35648785 PMCID: PMC9159624 DOI: 10.1371/journal.pone.0265531] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/04/2022] [Indexed: 12/26/2022] Open
Abstract
We reviewed the prevalence, the likely aetiopathogenesis, and the management of oro-facial mucocutaneous manifestations of Coronavirus Disease-2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2). English language manuscripts searched using standard databases yielded 26 articles that met the inclusion criteria. In total, 169 cases (75 females; 94 males) from 15 countries with a spectrum of COVID-19 severities were reviewed. Gustatory perturbations were prevalent in over 70%. Mucocutaneous manifestations were reported predominantly on the tongue, palate, buccal mucosa, gingivae, and lips and included ulcers, blisters, erosions, papillary hyperplasia, macules, glossitis, and mucositis. Ulcerative lesions, present in over 50 percent, were the most common oral manifestation. Lesions resembling candidal infections, with burning mouth, were prevalent in 19%. Petechiae and angina bullosa were generally seen, subsequent to COVID-19 therapies, in 11%. Ulcerated, necrotic gingivae were documented in severely ill with poor oral hygiene. These manifestations, present across the COVID-19 disease spectrum, were commonly associated with the immunosuppressed state and/ or the concurrent antimicrobial/steroidal therapies. In summary, a wide variety of orofacial mucocutaneous lesions manifest in COVID-19. They are likely to be secondary to the disease-associated immune impairment and/or pharmaco-therapy rather than a direct result of SARS-CoV-2 infection per se.
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Affiliation(s)
| | | | - Borvornwut Buranawat
- Department of Periodontics and Implant Dentistry, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Hien Ngo
- Dental School, University of Western Australia, Nedlands, WA, Australia
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Samaranayake LP, Fakhruddin KS, Ngo HC, Bandara MHMN, Leung YY. Oro-facial Mycoses in Coronavirus Disease-2019 (COVID-19): A Systematic Review. Int Dent J 2022; 72:607-620. [PMID: 35367044 PMCID: PMC8885299 DOI: 10.1016/j.identj.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/22/2022] Open
Abstract
Objectives Studies reviewing orofacial mycoses in coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome 2 (SARS-CoV-2) infection are sparse. Here we review the major oral and maxillofacial mycoses of COVID-19, the associated comorbidities, and the probable precipitating factors. Methods English-language manuscripts published between March 2020 and October 2021 were searched using PubMed, OVID, SCOPUS, and Web of Science databases, using appropriate keywords. Results We identified 30 articles across 14 countries, which met the inclusion criteria of PRISMA guidelines. These yielded a total of 292 patients with laboratory-confirmed COVID-19, 51.4% (n = 150) of whom presented with oral and maxillofacial fungal infections, mainly comprising candidosis, mucormycosis, and aspergillosis. Candida infections were the most prevalent, present in 64% (n = 96), followed by mucormycosis, and only a single case of aspergillosis was noted. Oral and maxillofacial mycoses were predominantly seen in those with comorbidities, especially in those with diabetes (52.4%). Oral mucormycosis was noted in 8.6% (n = 13) and mainly manifested on the hard palate. An overall event rate of oral/maxillofacial mucormycosis manifestation in patients with COVID-19 with diabetes mellitus type 1/2 was about 94% (49/52; 95% confidence interval, 0.73%-0.89%), implying a very high association between diabetes mellitus and the latter condition. All fungal infections appeared either concurrently with COVID-19 symptoms or during the immediate recovery period. Conclusions SARS-CoV-2 infection–related immunosuppression, steroid therapy, as well as comorbidities such as diabetic hyperglycemia appear to be the major predisposing factors for the onset of oral and maxillofacial mycoses in patients with COVID-19 across all age groups.
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Fakhruddin KS, Samaranayake LP, Hamoudi RA, Ngo HC, Egusa H. Diversity of site-specific microbes of occlusal and proximal lesions in severe- early childhood caries (S-ECC). J Oral Microbiol 2022; 14:2037832. [PMID: 35173909 PMCID: PMC8843124 DOI: 10.1080/20002297.2022.2037832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Severe-early childhood caries (S-ECC) a global problem of significant concern, commonly manifest on the occlusal, and proximal surfaces of affected teeth. Despite the major ecological differences between these two niches the compositional differences, if any, in the microbiota of such lesions is unknown. Methods Deep-dentine caries samples from asymptomatic primary molars of children with S-ECC (n 19) belonging to caries-code 5/6, (ICDAS classification) were evaluated. Employing two primer pools, we amplified and compared the bacterial 16S rRNA gene sequences of the seven hypervariable regions (V2—V4 and V6—V9) using NGS-based assay. Results Bray-Curtisevaluation indicated that occlusal lesions (OL) had a more homogeneous community than the proximal lesions (PL) with significant compositional differences at the species level (p = 0.01; R- 0.513). Together, the occlusal and proximal niches harbored 263 species, of which 202 (76.8%) species were common to both , while 49 (18.6%) and 12 (4.6%) disparate species were exclusively isolated from the proximal and occlusal niches, respectively. The most commonl genera at both niches included Streptococcus, Prevotella, and Lactobacillus. S. mutans was predominant in PL (p ≤ 0.05), and Atopobium parvulum (p = 0.01) was predominant in OL. Conclusions Distinct differences exist between the caries microbiota of occlusal and proximal caries in S-ECC.
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Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, UAE
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Sendai-city, Japan
| | | | - Rifat Akram Hamoudi
- Sharjah Institute for Medical Research, College of Medicine, University of Sharjah, Sharjah, UAE
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Hien Chi Ngo
- Uwa Dental School, The University of Western Australia, Perth, Australia
| | - Hiroshi Egusa
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Sendai-city, Japan
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Samaranayake L, Fakhruddin KS. Pandemics past, present, and future: Their impact on oral health care. J Am Dent Assoc 2021; 152:972-980. [PMID: 34749921 PMCID: PMC8570943 DOI: 10.1016/j.adaj.2021.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pandemics have significantly modified our societal behaviour over the millennia, and the COVID-19 pandemic is no exception. TYPES OF ARTICLES REVIEWED In this article, the authors review the history of pandemics, the probable reasons for their emergence, and the COVID-19 pandemic due to the severe acute respiratory syndrome virus 2 (SARS-CoV-2) and its variants, as well as its possible impact on dentistry during the postpandemic period. RESULTS There are multiple reasons why catastrophic pandemics occur due to new infectious organisms that cross the species barrier from animals to humans. These include, population explosion, mass migration, and prolonged survival of debilitated and susceptible cohorts on various immunosuppressants. Coupled with global warming and the resultant loss of habitats, such vicissitudes of humans and nature lead to microbes evolving and mutating at an exponential pace, paving the way for pandemics. The contemporary epidemics and pandemics beginning with the HIV pandemic have modulated dentistry beyond recognition, now with assiduous and robust infection control measures in place. CONCLUSIONS AND PRACTICAL IMPLICATIONS Because COVID-19 may become an endemic disease, particularly due to emerging SARS-CoV-2 variants the dental community should adopt modified infection control measures, teledentistry, and point-of-care diagnostics, among other measures. It is likely, that clinical ecosystems in future would be rendered even safer by predicting how pathogens evolve and priming the human immune system for the next wave of microbial combatants through vaccines produced using deep mutational scanning in which artificial intelligence and machine learning can predict the next variants even before their arrival.
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Fakhruddin KS, Perera Samaranayake L, Egusa H, Ngo HC, Pesee S. Profuse diversity and acidogenicity of the candida-biome of deep carious lesions of Severe Early Childhood Caries (S-ECC). J Oral Microbiol 2021; 13:1964277. [PMID: 34447489 PMCID: PMC8386706 DOI: 10.1080/20002297.2021.1964277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction: The retentive niches of deep caries lesions have a distinct biome. Methods: We evaluated the site-specific (occlusal and proximal) Candida-biome of Severe-Early Childhood Caries (S-ECC) in 66- children (132 lesions). Asymptomatic primary molars fitting the definition of the International Caries Detection and Assessment-(ICDAS)-caries-code 5/6 were analyzed. Deep-dentinal sampling and simultaneous assessment of pH were performed. Clinical isolates were speciated using multiplex-PCR and evaluated for their acidogenic and aciduric potential.Results: Surprisingly, a high prevalence of Candida species (72.7%), either singly or in combination, was noted from both the proximal and occlusal cavities. C. tropicalis was the most prevalent species (47%; 34/72), followed by C. krusei (43.1%; 31/72) and C. albicans (40.3%; 29/72), with C. glabrata being the least (9.7%; 7/72). Over 45% low-pH niches (pH <7) of both sites yielded either dual or triple species of Candida. Genotyping revealed three distinct C. albicans genotypes (A, B, and C) with (14/29; 48.3%) of strains belonging to Genotype A. All four evaluated Candida species exhibited acidogenic and aciduric potential, C. tropicalis being the most potent.Conclusion: This, the first report of the high-density, multispecies, yeast colonization of deep-dentinal lesions in S-ECC, suggests that the Candida-biome plays a significant etiologic role in the condition, possibly due to their profound acidogenicity in milieus rich in dietary carbohydrates.
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Affiliation(s)
| | | | - Hiroshi Egusa
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Hien Chi Ngo
- University of Western Australia, Perth, Australia
| | - Siripen Pesee
- Faculty of Dentistry, Department of Oral Diagnostic Science, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
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Alberti A, Corbella S, Taschieri S, Francetti L, Fakhruddin KS, Samaranayake LP. Fungal species in endodontic infections: A systematic review and meta-analysis. PLoS One 2021; 16:e0255003. [PMID: 34293029 PMCID: PMC8297845 DOI: 10.1371/journal.pone.0255003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/07/2021] [Indexed: 12/30/2022] Open
Abstract
Fungal infections are common on oral mucosae, but their role in other oral sites is ill defined. Over the last few decades, numerous studies have reported the presence of fungi, particularly Candida species in endodontic infections, albeit in relatively small numbers in comparison to its predominant anaerobic bacteriome. Here, we review the fungal biome of primary and secondary endodontic infections, with particular reference to the prevalence and behavior of Candida species. Meta-analysis of the available data from a total of 39 studies fitting the inclusion criteria, indicate the overall weighted mean prevalence (WMP) of fungal species in endodontic infections to be 9.11% (from a cumulative total of 2003 samples), with 9.0% in primary (n = 1341), and 9.3% in secondary infections (n = 662). Nevertheless, WMP for fungi in primary and secondary infections which were 6.3% and 7.5% for culture-based studies, increased to 12.5% and 16.0% in molecular studies, respectively. The most prevalent fungal species was Candida spp. The high heterogeneity in the reported fungal prevalence suggests the need for standardized sampling, and speciation methods. The advent of the new molecular biological analytical platforms, such as the next generation sequencing (NGS), and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF), that enables identification and quantitation of a broad spectrum of hitherto unknown organisms in endodontic infections should radically alter our understanding of the endodontic mycobiome in the future. Candida spp. appear to be co-pathogens with bacteria in approximately one in ten patients with endodontic infections. Hence, clinicians should comprehend the importance and the role of fungi in endodontic infections and be cognizant of the need to eradicate both bacteria and fungi for successful therapy.
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Affiliation(s)
- Alice Alberti
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- * E-mail:
| | - Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Lakshman Perera Samaranayake
- College of Dental Medicine, University of Sharjah, Sharjah, UAE
- The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
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Haiat A, Ngo HC, Samaranayake LP, Fakhruddin KS. The effect of the combined use of silver diamine fluoride and potassium iodide in disrupting the plaque biofilm microbiome and alleviating tooth discoloration: A systematic review. PLoS One 2021; 16:e0252734. [PMID: 34115788 PMCID: PMC8195348 DOI: 10.1371/journal.pone.0252734] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Silver diamine fluoride (SDF) is used in minimally invasive dentistry for arresting dental caries. However, discoloration of teeth is a significant side effect that has limited the use of SDF. Hence, the application of potassium iodide (KI) following SDF has been proposed to ameliorate the staining. Although antimicrobial activity is one of the major mechanisms of the caries-arresting effect of SDF, the antimicrobial potency of SDF/KI combination is unclear. Thus, the primary objective of this systematic review was to appraise the studies on the antimicrobial efficacy of SDF/KI combination on cariogenic microbes. The secondary objective was to summarize the evidence on the potential of KI in reducing the discoloration associated with the application of SDF. Electronic databases of Medline via PubMed, Cochrane Library, Web of Science, and EBSCO host were searched for English language manuscripts from January 2005 to 15th November 2020. The reference lists of these manuscripts were manually searched for additional studies. Twelve studies were included in the final analysis, seven of which have investigated the antimicrobial efficacy of SDF/KI, and the rest have examined the anti-staining potential of KI. The exploratory findings from the reviewed articles revealed the promising antimicrobial potential of SDF/KI on cariogenic microbes associated with dentine caries. There is, however, contradictory evidence on the effect of SDF/KI on tooth color. The reviewed in-vitro studies indicated significant effectiveness of KI in preventing staining. A clinical trial on primary dentition showed 25% reduction in the incidence of staining by SDF after applying KI, while a clinical study on root caries in adults showed no significant effect. Within the methodological limitations of this review, we conclude that for arresting dental caries, SDF could be combined with KI, as there may be a lower likelihood of staining. Further, well-designed clinical trials on the antimicrobial and anti-staining effect of SDF/KI are needed to obtain more robust evidence.
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Affiliation(s)
- Anahita Haiat
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - Hien Chi Ngo
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - Lakshman Perera Samaranayake
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
- Faculty of Dentistry, University of Hong Kong, Hong Kong, Hong Kong
| | - Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Samaranayake LP, Seneviratne CJ, Fakhruddin KS. Coronavirus disease 2019 (COVID-19) vaccines: A concise review. Oral Dis 2021; 28 Suppl 2:2326-2336. [PMID: 33991381 PMCID: PMC8242875 DOI: 10.1111/odi.13916] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/05/2021] [Accepted: 05/06/2021] [Indexed: 12/11/2022]
Abstract
The development of a successful vaccine against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the agent of coronavirus disease 2019 (COVID-19), in an unmatched period of ten months, is a tribute to human ingenuity in the face of a vicious pandemic. A return to pre-pandemic "normalcy" depends on the successful delivery of the vaccine to a majority (~70%) so as to develop herd immunity critical to arrest the community spread of infection. Vaccination against COVID-19 is particularly important for dentistry as the dental team works in an environment replete with aerosol-generating procedures (AGP) that facilitate virus spread. Hence, a COVID-19 vaccine is likely to be an obligatory requirement for the dental practice, and the latest addition to the extensive list of vaccines required for dental professionals for the safe delivery of dental care. Here, we review the currently available major candidate vaccines against SARS-CoV-2 and their benefits and risks. These include the vaccines developed on next-generation platforms (mRNA, DNA, and viral vector vaccines), and the classic platforms (the live-attenuated virus, and the protein subunit vaccines) The review concludes with a summary of impending issues and challenges facing the provision of COVID-19 vaccines for all stakeholders in dentistry.
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Affiliation(s)
| | | | - Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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Samaranayake LP, Fakhruddin KS, Buranawat B, Panduwawala C. The efficacy of bio-aerosol reducing procedures used in dentistry: a systematic review. Acta Odontol Scand 2021; 79:69-80. [PMID: 33307917 DOI: 10.1080/00016357.2020.1839673] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Bio-aerosols, are routinely generated and airborne in clinical dentistry due to the operative instrumentation within an oral environment bathed in salivary organisms. SARS-CoV-2 transmission being responsible for the current pandemic, appears through airborne aerosols and droplets, thus, there has been an intense focus on such aerosol-generating procedures, and their reduction. Hence the objective of this systematic review was to evaluate available data on three major measures: rubber dam application, pre-procedural oral rinse, and high-volume evacuators (HVE) aimed at reducing bio-aerosols. METHOD PubMed via Ovid MEDLINE, EBSCO host, Cochrane Library and Web of Science databases were searched between 01 January 1985 and 30 April 2020. RESULTS A total of 156 records in English literature were identified, and 17 clinical studies with 724 patients included in the final analysis. Eligible articles revealed the inadequacy of three principle approaches used in contemporary dental practice to minimize such bio-aerosols, rubber dam application, pre-procedural oral rinses, and HVE. The latter is an extremely effective method to reduce bio-aerosols in dentistry, although no single method can provide blanket cover. CONCLUSION Present systematic review indicates that employing combination strategies of rubber dam, with a pre-procedural antimicrobial oral rinse, and HVE may contain bio-aerosols during operative procedures.
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Affiliation(s)
- Lakshman Perera Samaranayake
- Departments of Preventive and Restorative Dentistry and Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kausar Sadia Fakhruddin
- Departments of Preventive and Restorative Dentistry and Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Borvornwut Buranawat
- Faculty of Dentistry, Department of Periodontics and Implant Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Chamila Panduwawala
- Departments of Preventive and Restorative Dentistry and Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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13
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Samaranayake LP, Fakhruddin KS, Mohammad OE, Panduwawala C, Bandara N, Ngo HC. Attributes of dysgeusia and anosmia of coronavirus disease 2019 (COVID-19) in hospitalized patients. Oral Dis 2020; 28 Suppl 1:891-898. [PMID: 33176049 DOI: 10.1111/odi.13713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES While chemosensory dysfunctions, dysgeusia and anosmia/hyposmia, are recognized as distinctive symptoms of COVID-19, their temporality of presentation and association with the patient age, gender, disease severity, and comorbidities has been sparsely studied. Hence, we evaluated the latter associations of chemosensory dysfunction, in hospitalized COVID-19 patients in the United Arab Emirates (UAE). MATERIALS AND METHODS Information on chemosensory dysfunction and history of chronic systemic comorbidities, if any, was obtained from 149 COVID-19 patients in an infectious disease hospital in UAE, using their medical records, as well as from a face-to-face questionnaire survey. Additionally, a modified SNOT-22 questionnaire that measures disease-specific quality of life in patients with upper respiratory tract affections was also administered. RESULTS Chemosensory dysfunction was reported by 94.6% of the cohort, and anosmia with dysgeusia was significantly more in males than females with severe COVID-19. Males with moderate COVID-19 and systemic comorbidities were more likely to present with chemosensory dysfunction in comparison with females. SNOT-22 questionnaire revealed that nasal blockage and runny nose were more prevalent in mild/moderate, than in the severe, state of COVID-19. CONCLUSION Our data confirm the commonality of chemosensory dysfunction during COVID-19 progression, and the significantly more pronounced combined dysfunction in males with severe COVID-19, and comorbidities.
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Affiliation(s)
| | - Kausar Sadia Fakhruddin
- Departments of Preventive and Restorative Dentistry and Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, UAE
| | | | - Chamila Panduwawala
- Departments of Preventive and Restorative Dentistry and Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, UAE
| | - Nihal Bandara
- Oral Microbiology, Bristol Dental School, University of Bristol, Bristol, UK
| | - Hien Chi Ngo
- Dental School, University of Western Australia, Perth, WA, Australia
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Samaranayake LP, Fakhruddin KS, Ngo HC, Chang JWW, Panduwawala C. The effectiveness and efficacy of respiratory protective equipment (RPE) in dentistry and other health care settings: a systematic review. Acta Odontol Scand 2020; 78:626-639. [PMID: 32881590 DOI: 10.1080/00016357.2020.1810769] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The global pandemic of coronavirus disease-19, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is the latest hazard facing healthcare workers (HCW) including dental care workers (DCW). It is clear that the major mode of SARS-CoV-2 transmission is the airborne route, through inhalation of virus-infested aerosols and droplets. Several respiratory protection equipment (RPE), including masks, face shields/visors, and respirators, are available to obviate facial and conjunctival contamination by microbes. However, as their barrier value against microbial inhalation has not been evaluated, we systematically reviewed the data on the effectiveness and efficacy of facemasks and respirators, including protective eyewear, with particular emphasis on dental healthcare. MATERIAL AND METHODS PubMed, MEDLINE, the Cochrane Library, and Embase databases were searched between 01January 1990 and 15 May 2020. RESULTS Of 310 identified English language records, 21 were included as per eligibility criteria. In clinical terms, wearing layered, face-fitting masks/respirators and protective-eyewear can limit the spread of infection among HCWs. Specifically, combined interventions such as a face mask and a face shield, better resist bioaerosol inhalation than either alone. The prolonged and over-extended use of surgical masks compromise their effectiveness. CONCLUSIONS In general, RPE is effective as a barrier protection against aerosolized microbes in healthcare settings. But their filtration efficacy is compromised by the (i) inhalant particle size, (ii) airflow dynamics, (iii) mask-fit factor, (iv) period of wear, (v) 'wetness' of the masks, and (vi) their fabrication quality. The macro-data presented here should inform policy formulation on RPE wear amongst HCWs.
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Affiliation(s)
| | | | - Hien Chi Ngo
- School of Dentistry, University of Western Australia, Perth, Australia
| | - Jeffrey Wen Wei Chang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chamila Panduwawala
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, UAE
- Department Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, UAE
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15
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Samaranayake LP, Fakhruddin KS, Panduwawala C. Sudden onset, acute loss of taste and smell in coronavirus disease 2019 (COVID-19): a systematic review. Acta Odontol Scand 2020; 78:467-473. [PMID: 32762282 DOI: 10.1080/00016357.2020.1787505] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Early detection, isolation and management of COVID-19 are crucial to contain the current pandemic. US Centers for Disease Control and Prevention (CDC) recently included 'sudden loss of taste (dysgeusia/ageusia) and smell (anosmia/hyposmia)' as symptoms of COVID-19. If indeed these symptoms are reliable and specific forerunner symptoms of COVID-19, then it may facilitate detection and containment of the disease. Hence, we systematically evaluated the contemporary evidence on dysgeusia and anosmia as trigger prodromal symptoms, and their prevalence in COVID-19 patients. METHODS Ovid MEDLINE, EBSCO host and Web of Science databases were searched between 25 December 2019 and 30 May 2020. RESULTS Of the 13 identified records, eight studies, totalling 11,054 COVID-19 patients, were included, as per the selection criteria. Eligible articles reflected research conducted mostly in the European community, as well as China, the US and Iran. In total, anosmia and dysgeusia symptoms were present in 74.9% and 81.3% ambulatory as well as hospitalized, mild-to-severe cases of COVID-19 patients, respectively. The European, US and Iran data indicate olfactory and gustatory symptoms appear prior to general COVID-19 symptoms in 64.5% and 54.0% of the patients, respectively. CONCLUSIONS To our knowledge, this is the first systematic review analysing the meager data based on the prevalence of chemosensory dysfunction in COVID-19. Critical analysis of such macro-data, as and when available, is essential to evaluate their utility as harbingers of COVID-19 onset, and to establish clinical practice guidelines both in dentistry and medicine.
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Affiliation(s)
- Lakshman Perera Samaranayake
- Departments of Preventive and Restorative Dentistry and Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kausar Sadia Fakhruddin
- Departments of Preventive and Restorative Dentistry and Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Chamila Panduwawala
- Departments of Preventive and Restorative Dentistry and Oral and Craniofacial Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Fakhruddin KS, Egusa H, Ngo HC, Panduwawala C, Pesee S, Samaranayake LP. Clinical efficacy and the antimicrobial potential of silver formulations in arresting dental caries: a systematic review. BMC Oral Health 2020; 20:160. [PMID: 32493272 PMCID: PMC7268710 DOI: 10.1186/s12903-020-01133-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background The use of silver-formulation as microbicide to arrest dentinal caries is gaining popularity. The primary objective of the present appraisal was to systematically review the clinical (in vivo) applications and antimicrobial potential of silver-containing formulations in arresting dentinal caries. Our secondary aim was to sum up the available in vitro applications of silver-containing formulations against cariogenic microbes isolated from dentine lesions. Methods Ovid MEDLINE, EBSCO host, Web of Science, and Cochrane Library databases was searched between January 2009–May 2019. Results In vivo: We observed conflicting evidence of antimicrobial efficacy of SDF on a diverse array of microbial taxa present in carious dentine of primary and permanent teeth. Moreover, there is insufficient evidence on the application of AgNP-fluoride as an effective microbicidal against cariogens of dentine lesions. In vitro: We found a good evidence of microbicidal efficacy of silver diamine fluoride (SDF) on selective cariogenic microbes in human dentine model. Additionally, a good evidence was noted of in vitro application of silver nanoparticles (AgNPs) as a useful microbicidal against S. mutans adhesion, growth and subsequent biofilm formation in human dentine models. Conclusions Taken together, in vitro evidence indicates the promising antimicrobial potential of silver-based formulations (SDF and nanosilver) against the predominant cariogenic flora, particularly from dentine lesions. Post-treatment clinical data of either the bactericidal and bacteriostatic effects of SDF or nanosilver are sparse. Furthermore, the current understanding of the specific size, concentration, antimicrobial mechanisms, and toxicological aspects of nano-silver compounds is inadequate to draw firm conclusions on their clinical utility.
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Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, M28-125, College of Dental Medicine, University of Sharjah, Sharjah, 27272, United Arab Emirates.,Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai City, 980-8575, Japan
| | - Hiroshi Egusa
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai City, 980-8575, Japan.
| | - Hien Chi Ngo
- Department of Preventive and Restorative Dentistry, M28-125, College of Dental Medicine, University of Sharjah, Sharjah, 27272, United Arab Emirates
| | - Chamila Panduwawala
- Department of Preventive and Restorative Dentistry, M28-125, College of Dental Medicine, University of Sharjah, Sharjah, 27272, United Arab Emirates
| | - Siripen Pesee
- Faculty of Dentistry, Department of Oral Diagnostic Science, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Lakshman Perera Samaranayake
- Department of Preventive and Restorative Dentistry, M28-125, College of Dental Medicine, University of Sharjah, Sharjah, 27272, United Arab Emirates. .,The University of Hong Kong, Hong Kong Special Administrative Region, China.
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17
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Fakhruddin KS, Egusa H, Ngo HC, Panduwawala C, Pesee S, Venkatachalam T, Samaranayake LP. Silver diamine fluoride (SDF) used in childhood caries management has potent antifungal activity against oral Candida species. BMC Microbiol 2020; 20:95. [PMID: 32295517 PMCID: PMC7161255 DOI: 10.1186/s12866-020-01776-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/30/2020] [Indexed: 12/24/2022] Open
Abstract
Background The microbiome of Severe-Early Childhood Caries (S-ECC), is characterized by an ecosystem comprising bacterial and fungal species, with a predominance of Candida species. Hence, an anti-cariogen effective against both bacteria and fungi would be valuable in the management of S-ECC. Here we evaluate the antifungal effect of silver diamine fluoride (SDF) against 35-clinical yeast isolates (Ten-each of C. albicans, C. krusei, C. tropicalis and five C. glabrata strains) from dentinal caries-lesions from S-ECC. Results Disc-diffusion and time-kill assays as well as MIC50 and MIC90 evaluations against therapeutic concentrations confirmed the broad-spectrum anti-candidal potency of SDF. Ultrastructural images revealed morphologic aberrations of yeast-cell walls on exposure to SDF. All C. krusei and C. glabrata isolates were significantly more sensitive to SDF, relative to the standard antifungal fluconazole. Further, SDF appears to effectively abrogate filamentation of C. albicans even at very low concentrations. Conclusions Our data, for the first time, elucidate the antifungal potency of SDF, in addition to its known antibacterial activity, in the management of S-ECC.
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Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, University City- Sharjah, University of Sharjah, 27272, United Arab Emirates.,Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai-city, Miyagi, 980-8575, Japan
| | - Hiroshi Egusa
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai-city, Miyagi, 980-8575, Japan.
| | - Hien Chi Ngo
- Department of Preventive and Restorative Dentistry, University City- Sharjah, University of Sharjah, 27272, United Arab Emirates
| | - Chamila Panduwawala
- Department of Preventive and Restorative Dentistry, University City- Sharjah, University of Sharjah, 27272, United Arab Emirates
| | - Siripen Pesee
- Faculty of Dentistry, Department of Oral Diagnostic Science, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Thenmozhi Venkatachalam
- Sharjah Institute of Medical Research, University City- Sharjah, University of Sharjah, 27272, United Arab Emirates
| | - Lakshman Perera Samaranayake
- Department of Preventive and Restorative Dentistry, University City- Sharjah, University of Sharjah, 27272, United Arab Emirates. .,The University of Hong Kong, Hong Kong, Special Administrative Region, China.
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18
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Fakhruddin KS, Perera Samaranayake L, Egusa H, Chi Ngo H, Panduwawala C, Venkatachalam T, Kumarappan A, Pesee S. Candida biome of severe early childhood caries (S-ECC) and its cariogenic virulence traits. J Oral Microbiol 2020; 12:1724484. [PMID: 32128040 PMCID: PMC7034489 DOI: 10.1080/20002297.2020.1724484] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/04/2023] Open
Abstract
The protected niche of deep-caries lesions is a distinctive ecosystem. We assessed the Candida biome and its cariogenic traits from dentin samples of 50 children with severe-early childhood caries (S-ECC). Asymptomatic, primary molars belonging to International Caries Detection and Assessment-ICDAS caries-code 5 and 6 were analyzed, and C. albicans (10-isolates), C. tropicalis (10), C. krusei (10), and C. glabrata (5) isolated from the lesions were then evaluated for their biofilm formation, acidogenicity, and the production of secreted hydrolases: hemolysins, phospholipase, proteinase and DNase. Candida were isolated from 14/43 ICDAS-5 lesions (32.5%) and 44/57 ICDAS-6 lesions (77.2%). Compared to, ICDAS-5, a significantly higher frequency of multi-species infestation was observed in ICDAS-6 lesions (p=0.001). All four candidal species (above) showed prolific biofilm growth, and an equal potency for tooth demineralization. A significant interspecies difference in the mean phospholipase, as well as proteinase activity was noted (p < 0.05), with C. albicans being the predominant hydrolase producer. Further, a positive correlation between phospholipase and proteinase activity of Candida-isolates was noted (r = 0.818, p < 0.001). Our data suggest that candidal mycobiota with their potent cariogenic traits may significantly contribute to the development and progression of S-ECC.
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Affiliation(s)
| | - Lakshman Perera Samaranayake
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, UAE.,Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hiroshi Egusa
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Hien Chi Ngo
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, UAE
| | - Chamila Panduwawala
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, UAE
| | | | - Allagappan Kumarappan
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Siripen Pesee
- Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
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19
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Abstract
Objective This study aims to study the impact of preventive care orientation given to caregivers of child daycare centers on their knowledge and on the prevalence of early childhood caries (ECC) among preschool children. Materials and Methods Caregivers of twenty child daycare centers in Emirate of Sharjah were interviewed and 435 children attending these centers were surveyed for decayed missing filled teeth (dmft). The sample data were analyzed using t-tests and one-way ANOVA to assess the statistical significance of the differences in dmft score found between groups. Results No significant correlation was found between dmft scores and family income of urban or rural centers, mothers' level of education, mothers' employment status in public centers, and frequency of dental visits. There was a significant correlation between dmft scores and mothers' employment status in private centers with the lowest scores among children of working mothers. High caries rates were observed in children attending private daycare centers where sweetened milk, juices, and snacks were served more frequently. There was a significant difference between private and public centers in caregivers' level of knowledge regarding oral health in favor of the latter. Low dmft scores were found to be associated with high level of knowledge of caregivers in public centers. Conclusions Children are more likely to develop ECC if their caregivers are lacking knowledge or regular provision of preventive care orientation. This makes caregivers and school teachers better candidates for oral health education programs than parents.
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Affiliation(s)
- Hisham Yehia El Batawi
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
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20
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Fakhruddin KS, Gorduysus MO, El Batawi H. Effectiveness of behavioral modification techniques with visual distraction using intrasulcular local anesthesia in hearing disabled children during pulp therapy. Eur J Dent 2019; 10:551-555. [PMID: 28042274 PMCID: PMC5166315 DOI: 10.4103/1305-7456.195159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: Assessing the effectiveness of behavioral modification techniques in combination with visual distraction with/without video eyewear using computerized delivery system-intrasulcular (CDS-IS) during the application of local anesthetic in hearing-impaired pediatric patients undergoing pulp therapy of primary molars. Materials and Methods: This randomized, crossover clinical study includes 15 children (7 boys and 8 girls), mean age was 6.1 years. Children were randomly distributed into two groups (Group A, n = 7; Group B, n = 8). The study involved three sessions, 1-week apart. During Session I, employing Tell-Show-Do technique, prophylactic dental cleaning was done while participants were watching a movie with sign-language interpretation with/without visual eyewear. At the end of Session I, score on Smiley Faces Program was used for anxiety assessment. During Session II and III, respectively, both groups underwent pulp treatment of equivalent teeth in the opposite sides of the mouth with/without video eyewear vice versa. After the procedure, children were instructed to rate their pain during treatment on the Wong-Bakers' (WBs') Faces Pain Scale. Changes in pulse oximeter and heart rate were recorded every 5 min. Paired sample t-test and independent sample t-test were used to assess the significance of changes during each visit. Results: There was a significant (P > 0.04) change in the heart rate observed for Group A underwent pulp treatment while watching video using video eyewear. Self-reported mean pain score also increases during treatment sessions' with video eyewear, for both groups. Conclusion: Routine psychological (Tell-Show-Do) intervention along with visual distraction with full visibility of the surrounding and use of CDS-IS system for anesthetic delivery is recommended as an effective behavior management technique for children with hearing impairment undergoing invasive dental treatment.
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Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mehmet Omer Gorduysus
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkiye
| | - Hisham El Batawi
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
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21
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Fakhruddin KS, Ngo HC, Samaranayake LP. Cariogenic microbiome and microbiota of the early primary dentition: A contemporary overview. Oral Dis 2018; 25:982-995. [PMID: 29969843 DOI: 10.1111/odi.12932] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 12/24/2022]
Abstract
Recent advances in the field of molecular microbiology provide an unprecedented opportunity to decipher the vast diversity of the oral microbiome in health and disease. Here, we provide a contemporary overview of the oral microbiome and the microbiota of early childhood caries (ECC) with particular reference to newer analytical techniques. A MEDLINE search revealed a total of 20 metagenomic studies describing cariogenic microbiomes of ECC, 10 of which also detailed the healthy microbiomes. In addition, seven studies on site-specific microbiomes, focusing on acidogenic and aciduric microbiota of deep-dentinal lesions, were also reviewed. These studies evaluated plaque and saliva of children aged 1.5-11 years, in cohorts of 12-485 individuals. These studies reveal a very rich and diverse microbial communities, with hundreds of different phylotypes and microbial species, including novel species and phyla such as Scardovia wiggsiae, Slackia exigua, Granulicatella elegans, Firmicutes in the plaque biofilms of children with ECC. On the contrary, bacteria such as Streptococcus cristatus, S. gordonii, S. sanguinis, Corynebacterium matruchotii, and Neisseria flavescens were common in plaque biofilm of noncarious, healthy, tooth surfaces in subjects with caries. The review illustrates the immense complexity and the diversity of the human oral microbiota of the cariogenic plaque microbiome in ECC, and the daunting prospect of its demystification.
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Affiliation(s)
| | - Hien Chi Ngo
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, UAE
| | - Lakshman Perera Samaranayake
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, UAE.,The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
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22
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Fakhruddin KS, ElBatawi H, El-Damanhoury HM. Behavioral management using sequenced treatment paradigm and audiovisual distraction during dental treatment in children with attention deficit/hyperactivity disorder. Eur J Dent 2018; 12:262-268. [PMID: 29988204 PMCID: PMC6004798 DOI: 10.4103/ejd.ejd_59_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: The present study aimed to assess behavioral management using sequenced treatment approach and audiovisual distraction (AVD) with/without video eyewear during dental procedure in children with attention deficit/hyperactivity disorder (ADHD). Materials and Methods: This clinical trial included 31 children (n = 21 boys; n = 10 girls), aged between 6.5 and 8.1 years, distributed into Group A (n = 17, children not on ADHD medication) and Group B (n = 14, children taking medication for ADHD symptoms). The study involved four sessions, 1 week apart. Sessions I and II included behavioral management assessment and dental screening, respectively, while participants watched cartoon movie using an AV distracter with/without a video eyewear. During Sessions III and IV, dental prophylaxis and sealants were placed on first permanent molars, respectively, for both upper and lower jaws in both the groups. During the procedure, children were distracted with AV distracter with/without a video eyewear, and the mean changes in blood oxygen saturation (SaO2) and pulse rate were recorded every 5 min. Independent samples t-test was used, assessing for significant changes in pulse rate and SaO2 during each visit in both groups. Results: Almost 95% (n = 113) of the first permanent molars showed signs of pit and fissure demineralization of varying severities, classified as the International Caries Detection and Assessment System-codes 1–3. During Session IV, there were significant differences (P ≤ 0.03 and P ≤ 0.05) in mean pulse rate in both groups of children, respectively, during fissure sealants or preventive resin restoration application on their permanent molars while being distracted using AVD with video eyewear. Conclusion: Our study recommends splitting of dental visits into multiple short sessions and video eyewear distraction for optimum behavioral management during dental procedures of children with ADHD.
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Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Hisham ElBatawi
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | - Hatem M El-Damanhoury
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
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Abstract
Objective: The present study aimed to assess and monitor patterns of dental caries among primary and permanent molars using Caries Assessment Spectrum and Treatment (CAST) index and to evaluate integration of CAST tool into patient health information (PHI) system of a Teaching Dental Hospital. Materials and Methods: Dental records of n = 348 children, aged 7–9-years, attending University Dental Hospital Sharjah, for routine checkup and treatment as part of School Dental Program were assessed and translated into CAST codes. Dental caries prevalence for the second primary and first permanent molars were recorded. Spearman's correlation coefficient was used to assess the correlation of the status between primary and permanent molar. Results: CAST codes 0–2 were observed only in about 3% of primary and almost 5% in permanent dentition. The prevalence of children with diseased first permanent molar (codes 4–7) was almost 67%, while it was over 70% in second primary molars. A strong correlations were observed in the status between second primary and first permanent molars in the lower jaw on both right and left sides, r was 0.694 and 0.643 (P = 0.001), respectively. In the upper jaw, both right and left second primary molars revealed moderate correlation r = 0.435 (P ≤ 0.05) between disease stages with their neighboring permanent first molars. The unweighted kappa value for the intraexaminer reliability was 0.97 for second primary and 0.95 for first permanent molars. Conclusion: Our study recommends the integration of CAST tool in the PHI system where a simple numerical value can express clinical progress, overcome interruptions of treatment, and ensures continuity of patient care in teaching hospitals.
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Affiliation(s)
- Hisham El Batawi
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, United Arab Emirates
| | - Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, United Arab Emirates
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Fakhruddin KS, El Batawi H, Gorduysus MO. Effectiveness of audiovisual distraction with computerized delivery of anesthesia during the placement of stainless steel crowns in children with Down syndrome. Eur J Dent 2017; 11:1-5. [PMID: 28435357 PMCID: PMC5379820 DOI: 10.4103/ejd.ejd_288_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: Assessing effectiveness of audiovisual (AV) distraction with/without video eyewear and computerized delivery system-intrasulcular (CDS-IS) for local anesthesia during placement of stainless steel crowns for the management of pathological tooth grinding in children with Down syndrome. Materials and Methods: This clinical study includes 22 children (13 boys and 9 girls), with mean age being 7.1 years. The study involved three sessions 1-week apart. During Session I, dental prophylaxis to the upper jaw was done while watching a movie projected on the ceiling without video eyewear whereas prophylaxis for the lower jaw and impressions of both jaws were taken while watching another movie using eyewear projection. After 1 week, during Session II/III, children had their upper and lower second primary molars which were prepared and steel crowns inserted, respectively, while watching movies which were projected using video eyewear under the effect of CDS-IS local anesthesia. Changes in pulse oximeter and heart rate were recorded every 5 min. Independent sample t-test was used to assess significance of changes during each visit. Results: A statistically significant difference (P < 0.03) was observed in mean pulse rate between dental prophylaxis without video eyewear and during dental prophylaxis and dental impression taken while children were distracted using AV distracter with video eyewear. We observed an increase in mean pulse rate during tooth preparation use dental drills, but this does not lead to disruptive behavior as children were being distracted by AV distracter with video eyewear. Conclusion: Routine psychological (Tell-Show-Do) intervention along with visual distraction using video eyewear and use of CDS-IS system for anesthetic delivery is recommended as an effective behavior management technique for children with Down syndrome during invasive dental treatment.
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Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hisham El Batawi
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - M O Gorduysus
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkiye
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Fakhruddin KS, El Batawi HY. Effectiveness of audiovisual distraction in behavior modification during dental caries assessment and sealant placement in children with autism spectrum disorder. Dent Res J (Isfahan) 2017; 14:177-182. [PMID: 28702058 PMCID: PMC5504869 DOI: 10.4103/1735-3327.208768] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The aim of this study was to evaluate the effectiveness of audiovisual (AV) distraction in behavior modification during dental caries assessment and sealant placement in children with autism spectrum disorder. Materials and Methods: This study was conducted on 28 children diagnosed with autism spectrum disorder, aged 6.5−9.8 years. Children underwent one introductory (desensitization) appointment and three treatment sessions. During the introductory session, children had the procedures explained to them, they watched a movie projected on a screen while oral screening and assessment of cooperation level were carried out. In treatment session I, oral examination, charting, and dental x-rays were undertaken, whereas the children watched movies with or without video eyewear. During treatment sessions II/III, dental prophylaxis was carried out on upper and lower jaws in addition to the application of dental sealants on the right upper and lower and the left upper and lower permanent molars, respectively, while the children were distracted by cartoon movies using video eyewear. Changes in pulse oximeter and heart rate were recorded every 5 min. Independent samples t-test was used to assess the significance of changes in pulse and O2 saturation levels during each visit. Results: International Caries Detection and Assessment System-code 2 was found to be the most prevalent (n = 58; 52%). A significant difference (P < 0.02) was observed in mean heart rate during dental screening of the upper and lower jaws with and without video eyewear. A decrease was observed in the mean heart rate during subsequent treatment sessions. Conclusion: Initial desensitization appointment and “tell-show-do” approach, followed by short and positive treatment sessions, assisted in gaining cooperation and improving behavior in the subjects. Video eyewear distraction proved an effective tool in managing children with autism spectrum disorder during noninvasive preventive dental procedures.
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Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Hisham Yehia El Batawi
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Fakhruddin KS, El Batawi H, Gorduysus MO. Effectiveness of audiovisual distraction eyewear and computerized delivery of anesthesia during pulp therapy of primary molars in phobic child patients. Eur J Dent 2015; 9:470-475. [PMID: 26929683 PMCID: PMC4745226 DOI: 10.4103/1305-7456.172637] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study is to assess the effectiveness of audiovisual distraction technique with video eyewear and computerized delivery system-intrasulcular (CDS-IS) during the application of local anesthetic in phobic pediatric patients undergoing pulp therapy of primary molars. MATERIALS AND METHODS This randomized, crossover clinical study includes 60 children, aged between 4 and 7-year-old (31 boys and 29 girls). Children were randomly distributed equally into two groups as A and B. This study involved two treatment sessions of pulp therapy, 1-week apart. During treatment session I, group A had an audiovisual distraction with video eyewear, whereas group B had audiovisual distraction using projector display only without video eyewear. During treatment session II, group A had undergone pulp therapy without video eyewear distraction, whereas group B had the pulp treatment using video eyewear distraction. Each session involved the pulp therapy of equivalent teeth in the opposite sides of the mouth. At each visit scores on the Modified Child Dental Anxiety Scale (MCDAS) (f) were used to evaluate the level of anxiety before treatment. After the procedure, children were instructed to rate their pain during treatment on the Wong Bakers' faces pain scale. Changes in pulse oximeter and heart rate were recorded in every 10 min. RESULTS From preoperative treatment session I (with video eyewear) to preoperative treatment session II (without video eyewear) for the MCDAS (f), a significant (P > 0.03) change in the mean anxiety score was observed for group A. Self-reported mean pain score decreases dramatically after treatment sessions' with video eyewear for both groups. CONCLUSION The use of audiovisual distraction with video eyewear and the use of CDS-IS system for anesthetic delivery was demonstrated to be effective in improving children's cooperation, than routine psychological interventions and is, therefore, highly recommended as an effective behavior management technique for long invasive procedures of pulp therapy in young children.
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Affiliation(s)
| | - Hisham El Batawi
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mehmet Omer Gorduysus
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Endodontics, Hacettepe University, Faculty of Dentistry, Turkiye
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El-Damanhoury HM, Fakhruddin KS, Awad MA. Effectiveness of teaching International Caries Detection and Assessment System II and its e-learning program to freshman dental students on occlusal caries detection. Eur J Dent 2014; 8:493-497. [PMID: 25512730 PMCID: PMC4253105 DOI: 10.4103/1305-7456.143631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To assess the feasibility of teaching International Caries Detection and Assessment System (ICDAS) II and its e-learning program as tools for occlusal caries detection to freshmen dental students in comparison to dental graduates with 2 years of experience. Materials and Methods: Eighty-four freshmen and 32 dental graduates examined occlusal surfaces of molars/premolars (n = 72) after a lecture and a hands-on workshop. The same procedure was repeated after 1 month following the training with ICDAS II e-learning program. Validation of ICDAS II codes was done histologically. Intra- and inter-examiner reproducibility of ICDAS II severity scores were assessed before and after e-learning using (Fleiss's kappa). Results: The kappa values showed inter-examiner reproducibility ranged from 0.53 (ICDAS II code cut off ≥ 1) to 0.70 (ICDAS II code cut off ≥ 3) by undergraduates and 0.69 (ICDAS II code cut off ≥ 1) to 0.95 (ICDAS II code cut off ≥ 3) by graduates. The inter-examiner reproducibility ranged from 0.64 (ICDAS II code cut off ≥ 1) to 0.89 (ICDAS II code cut off ≥ 3). No statistically significant difference was found between both groups in intra-examiner agreements for assessing ICDAS II codes. A high statistically significant difference (P ≤ 0.01) in correct identification of codes 1, 2, and 4 from before to after e-learning were observed in both groups. The bias indices for the undergraduate group were higher than those of the graduate group. Conclusions: Early exposure of students to ICDAS II is a valuable method of teaching caries detection and its e-learning program significantly improves their caries diagnostic skills.
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Affiliation(s)
- Hatem M El-Damanhoury
- Department of General and Specialist Dental Practice, College of Dental Medicine, University of Sharjah, Sharjah, UAE.,Department of Operative Dentistry, Faculty of Dentistry, Suez Canal University, Ismalia, Egypt
| | - Kausar Sadia Fakhruddin
- Department of General and Specialist Dental Practice, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Manal A Awad
- Department of General and Specialist Dental Practice, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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Fakhruddin KS, Kawas SA. Response from the authors. Dent Traumatol 2013; 29:250. [PMID: 23814872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Fakhruddin KS, Kawas SA. Prevalence and etiological factors related to dental injuries amongst 18-22-year-olds in United Arab Emirates. Dent Traumatol 2010; 26:388-92. [DOI: 10.1111/j.1600-9657.2010.00917.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fakhruddin KS, Lawrence HP, Kenny DJ, Locker D. Impact of treated and untreated dental injuries on the quality of life of Ontario school children. Dent Traumatol 2008; 24:309-13. [DOI: 10.1111/j.1600-9657.2007.00547.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fakhruddin KS, Lawrence HP, Kenny DJ, Locker D. Etiology and environment of dental injuries in 12- to 14-year-old Ontario schoolchildren. Dent Traumatol 2008; 24:305-8. [DOI: 10.1111/j.1600-9657.2007.00548.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fakhruddin KS, Lawrence HP, Kenny DJ, Locker D. Use of mouthguards among 12- to 14-year-old Ontario schoolchildren. J Can Dent Assoc 2007; 73:505. [PMID: 17672954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To investigate the frequency of use of mouthguards among a representative sample of Ontario schoolchildren, the type of mouthguard most commonly used and reasons for noncompliance during sporting activities. MATERIALS AND METHODS A population-based, matched case-control study was undertaken in a total of 30 schools in 2 suburban Ontario communities. Dental hygienists trained in the use of the Dental Trauma Index screened 2,422 children 12 to 14 years of age. Of 810 children identified as potential cases (with evidence of dental trauma) and controls (no dental trauma), 270 responded to a mail survey (135 cases and 135 age- and sex-matched controls). The children with dental injuries provided information such as the age at which the injury occurred and the setting and causes of the injury. Children from both case and control groups answered questions concerning use of mouthguards during sports. Parents provided demographic and other information. RESULTS Only 5.5% of children wore mouthguards for school sports, and 20.2% wore protection in league sports. Of those who wore mouth protection, 48.2% wore boil-and-bite mouthguards and 21.4% wore stock-type mouthguards; only 30.4% wore professionally made, custom mouthguards. This high proportion of ill-fitting mouthguards was the major contributor to the commonly perceived problems of speech, breathing discomfort and poor appearance associated with mouthguard use. Boys were 1.52 times more likely to wear mouthguards than girls. Data on history of dental trauma and regularly visiting a dentist were not related to mouthguard use. The single most important predictor of mouthguard use was parents who had private dental insurance (p = 0.02), followed by having a family dentist (p = 0.16). CONCLUSION Mouthguard use was very low in both school and league sports in this sample of Ontario schoolchildren, and the largest proportion of those who wore mouth protection used generic products rather than custom-fitted mouthguards. Lack of parental or coaching advice on mouthguard usage and peer beliefs about esthetics and function were the main reasons for noncompliance.
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