Propolis use in dentistry: A narrative review of its preventive and therapeutic applications

Propolis is a resinous substance produced naturally by bees, and it consists of the exudates of plants mixed with enzymes, wax, and pollen. Propolis continues to gain considerable scientific interest due to its potential health benefits. The modern-day use of propolis in pharmaceutical preparations, such as toothpastes, mouthwashes, chewable tablets, mucoadhesive gels, and sprays, is increasing. However, the effectiveness of using propolis-containing pharmaceuticals in dentistry is not clear. The present paper aims to review the literature on the dental applications of propolis in preventive dentistry, periodontics, oral medicine, and restorative dentistry and discuss its clinical effectiveness. A literature search was conducted using Scopus, PubMed, and Web of Science databases. In total, 104 studies were included, of which 46 were laboratory studies, 5 animal studies, and 53 human clinical studies. Overall, the laboratory studies revealed a range of antimicrobial effects of propolis on oral pathogens. Clinical investigations of propolis in biofilm and dental caries control as well as adjuvant periodontal therapies reported positive outcomes in terms of plaque control, pathogenic microbial count reduction, and periodontal tissue inflammation control. Additional investigations included the use of propolis for the management of recurrent aphthous stomatitis, oral mucositis, and cavity disinfection after caries removal as well as the development of a range of restorative dental materials. Based on the reported outcomes of the studies, the clinical usage of propolis has potential. However, the majority of the evidence is derived from studies with flaws in their methodological design, making their results and conclusions questionable. As a consequence, properly designed and well-reported clinical studies are required to affirm the effectiveness of propolis for dental applications. Additionally, the safety of propolis and the optimal concentrations and extraction methods for its clinical use warrant further investigation. Utilisation of standardised propolis extracts will help in quality control of propolis-based products and lead to the achievement of reproducible outcomes in research studies

Effect of dental trauma management resources on dental practitioners' confidence and knowledge: A pilot cross-sectional study

Background/Aim: The knowledge of standardized care guidelines is critical to the confidence of practitioners in managing dental trauma. Therefore, the aim of this study was to assess the awareness, use and impact of the International Association of Dental Traumatology guidelines, and the online Dental Trauma Guide on general dental practitioners' self-reported confidence and knowledge in managing traumatic dental injuries in the primary and permanent dentitions. Materials and Methods: A cross-sectional, pre-piloted, 27-item self-administered questionnaire survey was distributed electronically to general dental practitioners' working within five member states of the Gulf Cooperation Council countries (Kingdom of Bahrain, Kingdom of Saudi Arabia, Kuwait, Oman, and Qatar) between September and December 2020. Data were collected and analysed using descriptive statistics and Wilcoxon Signed Rank test analysis for relevant comparisons. Results: A total of 294 respondents completed the survey, with the majority being from the Kingdom of Saudi Arabia (47.4%) and Qatar (27.3%). A lack of evidence-based knowledge in managing traumatic dental injuries was evident among more than half of the respondents. Respondents who were cognizant of the recent International Association of Dental Traumatology guidelines (2020) and those who use the Dental Trauma Guide routinely demonstrated a higher self-reported confidence level in managing both simple and complex primary dentition trauma, as well as simple traumatic dental injuries in the permanent dentition (p <.05). Conclusion: This survey highlights critical deficiencies in the knowledge of a large number of the respondents in the management of dental trauma which is likely to cause irreversible long-term patient effects.Open Access funding provided by the Qatar National Library

Decellularised dental pulp tissue as a potential biological scaffold for endodontic tissue regeneration

Background: There is an unmet need for regenerating functional dental pulp, particularly in non-vital immature permanent teeth where dental pulp necrosis arrests further radicular maturation, putting young patients at risk of tooth loss. Despite the progress achieved over recent decades, dental pulp regeneration still faces challenges in promoting post-implantation vascularisation and inducing odontoblast-like cell differentiation. Aim: The overall aim of the research presented in this thesis was to investigate the potential of a decellularised dental pulp matrix (DDP) of bovine origin to facilitate vascularisation and support dental pulp regeneration. Methods: Bovine dental pulp tissues were retrieved and decellularised. The efficiency of the decellularisation method was evaluated using histological analysis, DNA quantification assay, immunohistochemical staining and scanning electron microscopy. Furthermore, the cytocompatibility of the developed DDPs were assessed using contact and extract cytotoxicity assays. DDPs were then recellularised with human dental pulp stem cells (hDPSCs) and analysed in vitro using scanning electron microscopy, fluorescent staining and confocal scanning laser microscopy, Live/Dead® cells assay, Quant-iT™ PicoGreen® dsDNA assay and histology. The effect of DDPs on gene expression of markers involved in angiogenesis and odontogenesis in hDPSCs was evaluated in vitro using reverse-transcription quantitative polymerase chain reaction (RT-qPCR). A preliminary in vivo study was then conducted in which hDPSCs-seeded and unseeded DDPs were inserted in debrided human premolar root slices and implanted subcutaneously into immunodeficient mice. Samples were retrieved after 30 days and analysed using histological and immunohistochemical staining. Results: Acellular dental pulp matrices retaining the native histoarchitecture, vasculature, essential extracellular matrix components and several growth factors were generated following bovine dental pulp decellularisation. The in vitro cytocompatibility evaluation of the developed DDPs revealed no apparent cytotoxic effect on the growth and morphology of the cells grown in direct contact with the DDPs, and on the viability of cells grown in an extract of DDPs. Upon recellularisation of the DDPs with hDPSCs, the in vitro analyses showed cell engraftment with progressive repopulation of the matrix and vasculature of the DDPs, and with enhanced gene expression of the markers involved in angiogenesis and odontogenesis. In vivo implantation of root slices with hDPSCs-seeded DDPs revealed apparent vascularisation enhancement, whilst those with unseeded DDPs showed host cell recruitment and infiltration. Conclusions: The developed decellularised dental pulp matrix is a cytocompatible, pro-angiogenic and pro-odontogenic scaffold characterised by the retention of native histoarchitecture, vasculature, essential extracellular matrix components and angiogenic and odontogenic growth factors in the matrix following decellularisation. Seeding of hDPSCs onto the DDP led to progressive cell repopulation of the matrix and vasculature, enhanced expression of the markers involved in angiogenesis and odontogenesis in hDPSCs and improved in vivo vascularisation capacity of the DDP. Moreover, the DDP has a chemotactic activity in vivo, enabling host cells mobilisation and recruitment. The findings of this research suggest that a combination of DDP and hDPSCs could provide a promising vascularisation promoting strategy for dental pulp regeneration via cell transplantation. Furthermore, the use of DDP, in its acellular form, could provide a strategy for dental pulp regeneration via cell homing