Ιnternists’ and Endocrinologists’ Knowledge and Attitudes Regarding Periodontal Disease, Caries, Xerostomia and Diabetes Mellitus: A National Survey

Objectives: The present study aims to investigate the current knowledge, attitudes and behaviors of clinicians dealing with diabetes regarding the relationship of Diabetes Mellitus (DM) and odostomatological diseases, such as periodontal disease, xerostomia and caries. Methods:  A twenty-four item closed-ended multiple-choice questionnaire was completed by 225 Greek medical doctors. The sample was divided into three groups according to specialty: a) Endocrinologists; b) Internists; c) Internal medicine registrars. Bivarate analysis, Fisher test, and Spearman correlation were used for statistical analysis. Results:  Most doctors were aware of the bi-directional relationship between periodontal disease and DM. Regarding the relationship between DM and xerostomia, 50% of doctors were unaware that patients with DM have an increased risk of xerostomia and were unfamiliar with the relevant studies. Nearly 50% of doctors agreed that patients with diabetes are at increased risk of developing caries. Age, specialty, and years of expertise have an impact on the way of doctors' answer. Finally, 78,6% of doctors treating diabetes should cooperate with dentists to reduce their patients' risk of odontostomatological complications. Conclusions: The relationship between diabetes and dental problems is often underestimated. Implementation of medical and dental educational programs oriented in increasing inter-professional education as well as collaboration between dentists and doctors dealing with diabetes, are needed in order to achieve the goal of better care of patients with diabetes

Effect of Various Curing Lights on the Degree of Cure of Orthodontic Adhesives

Introduction: The purpose of this study was to compare the percentage degree of cure (%DC) of orthodontic adhesive resins irradiated with 3 types of light sources of various intensities: plasma arc, halogen, and light-emitting diode (LED). Methods: Twenty maxillary incisor stainless steel brackets (0.018-in slot) were divided into 4 groups of 5 brackets each. A standardized amount of composite resin was applied to each bracket base, simulating its clinical application. The brackets were light-cured with a halogen light for 20 seconds (10 seconds each from the incisal and cervical bracket edges), an LED light for 20 seconds (10 seconds per edge), a plasma light for 10 seconds (5 seconds per edge), and an LED light for 10 seconds (5 seconds per edge). The %DC was assessed by using micro-multiple internal reflectance Fourier transform infrared spectroscopy, and the results were analyzed with 1-way ANOVA. Results: Overall, the LED and the halogen lights, with the 20-second regimen, produced higher %DC. No significant difference was found in %DC between the plasma light and the 10-second LED light, whereas both showed lower %DC compared with 20 seconds of halogen or LED light. Conclusions: Significant variations in %DC are associated with the various light-curing units, which must be considered in selecting the light source and the irradiation time

Tobacco Use, Exposure to Secondhand Smoke, and Cessation Counseling Among Health Professions Students: Greek Data from the Global Health Professions Student Survey (GHPSS).

We conducted the GHPSS (Global Health Professions Student Survey) to obtain information regarding health profession students’ smoking habits and perceptions, exposure to secondhand smoke (SHS) as well as level of knowledge and training on tobacco use and smoking cessation counseling. GHPSS is a survey for third-year students in the following fields: health visitors, dentistry, medicine, nursing and/or pharmacy. The highest tobacco use prevalence rate and exposure to SHS were recorded among health visitor students with 46.4% and 33.3% respectively. The majority of the respondents believed that their profession serves as a role model for their patients. Formal training on cessation counseling ranged between 10.7% for health visitor students to 22.4% for nursing students. The relatively high percentage of health profession students who currently smoke and the alarmingly high percentage of those exposed to SHS indicate lack of concerted efforts for implementation and effective enforcement of the anti-tobacco policy measures. Despite its significance, formal training on cessation counseling for students is strikingly low. These results indicate the urgent need to train health professional students on tobacco cessation counseling and educate them on the dangers of tobacco use, SHS and the positively influential role they can play to affect their patients’ smoking habits

Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A systematic review and meta-analysis.

BACKGROUND Understanding of socioeconomic context might enable more efficient evidence-based preventive strategies in oral health. AIM The study assessed the caries-related socioeconomic macro-factors in 12-year-olds across European countries. DESIGN This systematic review involved epidemiological surveys on the caries status of 12-year-olds from 2011 to 2022. DMFT was analyzed in relation to gross national income (GNI), United Nations Statistical Division geographical categorization of European countries (M49), unemployment rate, Human Development Index (HDI), and per capita expenditure on dental health care. A meta-analysis was performed for countries reporting data on DMFT, stratified by GNI, and geographical location of European countries, using a random-effects model. RESULTS The study involved 493 360 children from 36 countries in the geographic region of Europe. The analysis confirmed a strong negative correlation between income and caries experience (p < .01). Children living in higher-income countries showed 90% lower odds of poor oral health than in middle-income countries. Children living in West Europe showed 90% lower odds of poor oral health than children living in East Europe. CONCLUSION The strong effect of macro-level socioeconomic contexts on children's oral health suggests favoring upstream preventive oral health strategies in countries with economic growth difficulties, Eastern and Southern parts of Europe

In vitro and in situ evaluation of the interaction mechanism of a remineralizing agent (CCP-ACP) on hard dental tissues

Milk and diary products have demonstrated an anticariogenic potential in human and animal models, mainly assigned to the effect of a milk-phosphoprotein (casein) in combination with the calcium-phosphate components of these products. It has been shown that casein phosphopeptides (CPP) have the capacity to stabilize calcium phosphates in solution through binding amorphous calcium phosphate (ACP) to their multiple phosphoserine residues, forming small CPP–ACP clusters. The anticariogenic effects of CPP–ACP on hard dental tissues may be attributed to suppression of demineralization, enhancement of remineralization, or combination of both. The aim of this study was to investigate in vitro and in situ the interaction mechanism of a commercially available remineralizing agent based on a casein phosphopeptide-amorphous calcium phosphate (CCPACP) system. MATERIALS AND METHODS The agent tested was Tooth Mousse (GC International). The in vitro studies performed were: Α) Micro MIR-FTIR study of the extent of demineralization and remineralization on dentin specimens. Forty dentin specimens were prepared by horizontally sectioning the crowns of sound extracted third molars with hard tissue microtome. The specimens were divided in four groups (A-D, n=10 each). All the specimen surfaces were subjected to surface analysis by Fourier transform micro-multiple internal reflectance infrared spectroscopy (micro MIR-FTIR). The agent was applied on dentin surface specimens of group A, whereas no agent was applied on the specimens of group B (control). All the specimens (groups A-D) were immersed in a demineralizing agent according to tenCate and Duijsters (1982). After 7 days immersion the surfaces of specimens were subjected to micro MIR-FTIR and the mineral (P=O str of hydroxyapatite ~1000 cm- 1) to the organic matrix (C=O str of R1-NCO-R2 or amide I ~1655 cm-1) ratio was used to assess the percentage extent of dentin demineralization of each sample relative to its intact control. The agent was applied on dentin specimens of group C, while the specimens of group D received no treatment (control). Finally, the specimens of groups C and D were immersed in artificial saliva for 7 days according to Smith et al. (2005), subjected again to micro MIR-FTIR and the mineral to matrix ratios were calculated again to assess the extent of dentin remineralization of each sample. Statistical analysis was performed by Student t-test (a=0.05) 154 Β) Micro XCT evaluation of the remineralization capacity of natural carious lesions, without cavity formation. Twenty carious premolars and molars with 2, 3 or 4, caries ranking according to ICDAS II criteria were used in this study. The teeth were imaged by high resolution micro-XCT and divided randomly in two groups (A and B, n=10). Tooth Mousse was applied on the carious surfaces of group A, while the carious surfaces of group B received no treatment. All the teeth were immersed in artificial saliva for 7 days and imaged again by micro-XCT. The tomographic sections were recorded and reconstructed using the 2D-software of the instrument, and the percentage extent of the reduction of the carious lesions before and after treatment were calculated with an image analysis program. Statistical analysis was performed by paired t-test before and after treatment and t-test between the two groups after the treatment (a=0.05) C) LV-SEM evaluation of demineralized dentin surface topography after application of the agent. Three dentin specimens were prepared by horizontally sectioning the crowns of intact extracted molars extracted with a hard tissue microtome. The top surface was demineralized with 37% orthophosphoric acid for 10 s. Immediately after, the surfaces were examined by LV-SEM. Then the agent was applied on acid demineralized dentin, the specimens were immersed in artificial saliva for 7 days and imaged again by LVSEM. D) Buffering capacity of the agent The buffer capacity was performed by a) pH measurements after gradual lactic acid addition (pH=4.5) and b) pH measurements after gradual agent dilution with distilled water. E) In situ mesurements Five subjects aged 20-35 with good oral health participated in the in situ experiment. Removable orthodontic appliances were made with a custom made retainer for Ge crystals, enamel and dentin slab specimens. ........................................Σήμερα ο τρόπος αντιμετώπισης της τερηδόνας βασίζεται σε ένα σύνολο ενεργειών που αναφέρονται: στην πρόληψη και καταστολή της εξέλιξης της τερηδονογόνου νόσου, στην αναχαίτιση των αρχόμενων τερηδονικών βλαβών και τέλος στην αποκατάσταση των οδοντικών ιστών, όπου είναι αναγκαίο, με την ελάχιστη επέμβαση στους ιστούς. Συνεπώς, η ανάπτυξη βιοενεργών παραγόντων οι οποίοι με την απελευθέρωση στοιχείων τους στο στοματικό περιβάλλον μπορούν να λειτουργήσουν τόσο για την αναχαίτιση της τερηδονικής βλάβης όσο και για την επούλωση των προσβεβλημένων οδοντικών ιστών, παρουσιάζει ιδιαίτερο κλινικό και ερευνητικό ενδιαφέρον. Στην κατηγορία αυτών των υλικών κλινικά κυριαρχούν για πολλά χρόνια οι διάφοροι τύποι φθοριούχων σκευασμάτων, δίνοντας άλλοτε άλλου βαθμού ικανοποιητικά αποτελέσματα. Πρόσφατα, όμως κυκλοφόρησε στο εμπόριο ένας τέτοιος παράγοντας, ο οποίος βασίζεται στο σύμπλοκο μέρους μιας πρωτεΐνης του γάλακτος, η οποία ονομάζεται φωσφοπεπτίδιο της καζεΐνης (CPP) και του άμορφου φωσφορικού ασβεστίου. Σκοπός της ερευνητικής μελέτης είναι να μελετηθεί in vitro και in situ οι μηχανισμοί δράσης ενός σύγχρονου εμπορικού παράγοντα ενασβεστίωσης των σκληρών οδοντικών ιστών, ο οποίος βασίζεται στο σύμπλοκο φωσφοπεπτιδίου καζεΐνης-άμορφου φωσφορικού ασβεστίου (CCP-ACP). Για το σκοπό της μελέτης χρησιμοποιήθηκε το εμπορικό σκεύασμα Tooth Mousse (GC International). Ο μηχανισμός δράσης του ενασβεστιωτικού παράγοντα διερευνήθηκε με εργαστηριακές μελέτες και μελέτες in situ. Πραγματοποιήθηκαν οι ακόλουθες εργαστηριακές μελέτες: Α) Μελέτη της επίδρασης του παράγοντα σε τεχνητή απασβεστίωση και επανασβεστίωση οδοντίνης με μικροϋπέρυθρη φασματοσκοπία πολλαπλής εσωτερικής ανάκλασης μετασχηματισμού Fourier (micro MIR-FTIR). Με τη βοήθεια μικροτόμου σκληρών οδοντικών ιστών παρασκευάστηκαν 40 παραλληλεπίπεδα δοκίμια οδοντίνης. Τα δοκίμια αυτά χωρίστηκαν τυχαία σε τέσσερις ομάδες τις Α, Β, Γ και Δ (ν=10). Στα δοκίμια των ομάδων Α και Β λήφθηκαν φάσματα με την τεχνική micro MIR-FTIR. Στα δοκίμια της ομάδας Α έγινε επάλειψη της επιφάνειας τους με τον υπό μελέτη παράγοντα. Στα δοκίμια της Β ομάδας δεν έγινε καμία επάλειψη (ομάδα ελέγχου). Ακολούθως, τα δοκίμια και των δύο ομάδων (Α και Β) καθώς και των Γ και Δ τοποθετήθηκαν σε απασβεστιωστικό ρυθμιστικό διάλυμα, το οποίο έχει περιγραφεί από τους tenCate και Duijsters (1982). Αμέσως μετά το πέρας των 7 ημερών έγινε λήψη φάσματος των επιφανειών και των τεσσάρων ομάδων δοκιμίων. Ακολούθως, στις επιφάνειες των δοκιμίων της ομάδας Γ έγινε επάλειψη του παράγοντα ενώ σε εκείνες της ομάδας Δ δεν έγινε καμία επεξεργασία. Στη συνέχεια τα δοκίμια και των δύο ομάδων τοποθετήθηκαν σε τεχνητό σάλιο για 7 ημέρες, η σύσταση του οποίου έχει περιγραφεί από τους Smith και συν. (2005). Σε κάθε φάσμα που λήφθηκε από όλες τις ομάδες υπολογίστηκε 151 ποσοτικά η αναλογία οργανικών / ανόργανων υπόστρωμα της οδοντίνης και μετρήθηκε η απασβεστίωση και επανασβεστίωση. Β) Μελέτη της επίδρασης του παράγοντα στην επανασβεστίωση δοντιών με τερηδόνα χωρίς σχηματισμό κοιλότητας, με μικροϋπολογιστική τομογραφία ακτίνων-Χ (micro CTX). Χρησιμοποιήθηκαν 20 τερηδονισμένοι προγόμφιοι και γομφίοι με βαθμός τερηδονισμού 2, 3 ή 4, σύμφωνα με τα κλινικά κριτήρια ICDAS II. Τα δόντια απεικονίστηκαν με τη χρήση μικροϋπολογιστικού τομογράφου ακτίνων-Χ. Τα δόντια χωρίστηκαν σε δύο ομάδες Α και Β (ν=10). Στα δόντια της ομάδας Α έγινε επάλειψη της επιφάνειας που εμφάνιζε τερηδονική αλλοίωση με τον παράγοντα ενώ στα δόντια της ομάδας Β δεν έγινε καμία επεξεργασία. Στη συνέχεια τα δόντια και των δύο ομάδων τοποθετήθηκαν στο τεχνητό σάλιο για 7 ημέρες, και επαναλήφθηκε η απεικόνιση τους στον μικροτομογράφο. ...............................

Biofilm Formation on Hybrid, Resin-Based CAD/CAM Materials for Indirect Restorations: A Comprehensive Review

Hybrid materials are a recent addition in the field of restorative dentistry for computer-aided design/computer-aided manufacturing (CAD/CAM) indirect restorations. The long-term clinical success of modern dental restorative materials is influenced by multiple factors. Among the characteristics affecting the longevity of a restoration, the mechanical properties and physicοchemical interactions are of utmost importance. While numerous researchers constantly evaluate mechanical properties, the biological background of resin-based CAD/CAM biomaterials is scarcely investigated and, therefore, less described in the literature. This review aims to analyze biofilm formation on the surfaces of novel, hybrid, resin-based CAD/CAM materials and evaluate the methodological protocols followed to assess microbial growth. It is demonstrated that the surface structure, the composition and the finishing and polishing procedures on the surface of a dental restorative material influence initial bacterial adhesion; however, most studies focus on in vitro protocols, and in vivo and/or in situ research of microbiomics in CAD/CAM restorative materials is lacking, obstructing an accurate understanding of the bioadhesion phenomenon in the oral cavity

Different Methods of Scan Alignment in Erosive Tooth Wear Measurements: An In Vitro Study

Background: Model alignment in cases of erosive tooth wear can be challenging, and no method has been reported to outweigh the others. Methods: Extracted human teeth were mounted on two models and scanned at different times, from 1 h to 2 weeks, with an intraoral scanner (3Shape TRIOS 4) before and after immersion in Monster® energy drink and tap water. The scans were superimposed (3Shape TRIOS Patient Monitoring, Version 2.2.3.3, 3Shape A/S, Copengagen, Denmark). Best fit, best-fit tooth comparison, reference best fit using fillings, and palatal rugae as reference points were used for alignment. Surface profile differences were calculated in a cross-section view. The nonparametric Bland–Altman and Kruskal–Wallis tests were used. Results: First, statistically significant differences were marked after 4 days of immersion. The measurements obtained after 2 weeks of immersion were statistically significantly different from the measurements obtained at the different time points until 1 week. No statistically significant differences (p < 0.05) were observed among the alignment methods at any time. Conclusion: In comparison to the best-fit model, both palatal rugae and fillings can be used. The best-fit tooth comparison method is a reliable option; however, it should be used with caution in cases of major surface loss

Applications of Mass Spectrometry in Dentistry

Mass Spectrometry (MS) is one of the fastest-developing methods in analytical instrumentation. As a highly sensitive, universal detector, it can identify known and unknown compounds, which can indeed be found in a minimal concentration. This review aims to highlight the significant milestones in MS applications in dentistry during recent decades. MS can be applied in three different fields of dentistry: (1) in research of dental materials and chemical agents, (2) in laboratory analysis of biospecimens, and (3) as a real-time diagnostic tool in service of oral surgery and pathology. MS applications on materials and agents may focus on numerous aspects, such as their clinical behavior, possible toxicity, or antimicrobial properties. MS is also a valuable, non-invasive tool for biomarkers’ detection in saliva and has found great application in -omics technologies as it achieves efficient structure-finding in metabolites. As metabolites are located beyond the central dogma, this technique can provide a complete understanding of cellular functions. Thus, it is possible to determine the biological profile in normal and pathological conditions, detect various oral or systematic diseases and conditions, and predict their course. Lastly, some promising advances concerning the surgical approach to potentially oral malignant or malignant disorders exist. This breakthrough method provides a comprehensive approach to dental materials research and biomarker discovery in dental and craniofacial tissues. The current availability of various ‘OMIC’ approaches paves the way for individualized dentistry and provides suggestions for clinical applications in the point-of-care hubs