Einfluss einer präprozeduralen Mundspülung mit Chlorhexidin auf die Kontamination des Mund-Nasen-Schutzes bei zahnmedizinischen Behandlungen

Hintergrund: Während zahnmedizinischer Behandlungen entsteht Spraynebel, bestehend aus Tröpfchen und Aerosolen, der regelmäßig mit Mikroorganismen kontaminiert ist. In einigen Studien wurde bereits die mikrobielle Kontamination der persönlichen Schutzausrüstung während zahnmedizinischer Behandlungen nachgewiesen. Die Kontamination der persönlichen Schutzausrüstung, insbesondere des Mund-Nasen-Schutzes, gefährdet zahnmedizinisches Personal und Patienten. Ziel der Studie war es, die bakterielle Kontamination des Mund-Nasen- Schutzes bei zahnmedizinischen Behandlungen zu untersuchen, während der Behandler ein Gesichtsvisier trägt und der Patient vor Behandlungsbeginn mit Chlorhexidin spült. Material und Methoden: In dieser prospektiven, randomisierten Studie wurden Einzelzahn- behandlungen, Füllungstherapie und Präparation für eine indirekte Restauration, und Behandlungen der gesamten Dentition, professionelle Zahnreinigung und unterstützende Parodontitistherapie, eingeschlossen. Drei Probandengruppen wurden gebildet, wobei differenziert wurde, ob der Patient vor Behandlungsbeginn 60 s mit 15 ml Chlorhexidin 0,1 % spülte (präprozedurale Intervention mit Chlorhexidin), 60 s mit Wasser aus der Behandlungseinheit spülte (präprozedurale Intervention mit Wasser) oder nicht spülte (Kontrollgruppe). Angesichts der SARS-CoV-2 Pandemie wurde die persönliche Schutzausrüstung unter anderem durch ein zusätzlich getragenes Gesichtsvisier, das den Mund-Nasen-Schutz bedeckte, ergänzt. Nach der Behandlung wurde der Mund-Nasen-Schutz mit Agarplatten in Kontakt gebracht und letztere für 48 h bei 35 °C +/- 2 °C inkubiert. Die Bakterien wurden nach phänotypischen Charakteristika, orientierenden biochemischen Testverfahren und durch Matrix-Assistierte-Laser-Desorption-Ionisierung-Flugzeit-Massenspektrometrie (MALDI-TOF-MS) klassifiziert. Koloniebildende Einheiten (KBE) wurden gezählt und Mittelwerte für die einzelnen Gruppen wurden verglichen (H-Test, U-Test, p < 0,05). Ergebnisse: Insgesamt wurden 306 Behandlungen eingeschlossen. Dabei bezogen sich 141 Behandlungen auf einen Zahn und 165 Behandlungen auf die gesamte Dentition. Je Probandengruppe wurden 102 Behandlungen eingeschlossen. Die Behandlungsmodalitäten waren gleichverteilt. Eine präprozedurale Intervention mit Chlorhexidin (Mittelwert: 24 KBE) führte zu einer statistisch signifikanten Reduktion der bakteriellen Kontamination des Mund-Nasen- Schutzes im Vergleich zur präprozeduralen Intervention mit Wasser (Mittelwert: 47 KBE) und im Vergleich zur Kontrollgruppe (Mittelwert: 80 KBE). Darüber hinaus bewirkte die Intervention mit Wasser eine statistisch signifikante Reduktion der bakteriellen Kontamination des MNS im Vergleich zur Kontrollgruppe. Es gab keine statistisch signifikanten Unterschiede in Hinblick der bakteriellen Kontamination des MNS zwischen der Behandlung eines Zahnes und der gesamten Dentition. Das Keimspektrum wurde von Streptokokken, Staphylokokken, Mikrokokken und Bazillen dominiert, welche die Mund- und Hautflora repräsentieren. Schlussfolgerung: Eine präprozedurale Intervention mit Chlorhexidin ist sinnvoll, um die bakterielle Belastung des Mund-Nasen-Schutzes zu reduzieren. Die Kontamination kann jedoch weder durch die Spülung noch durch das Tragen eines Gesichtsvisiers vollständig verhindert werden. Insbesondere während einer Pandemie ist zu beachten, dass diese zusätzlichen Schutzmaßnahmen die Übertragung von potenziell Pathogenen in die Gesichtsregion nicht vollständig verhindern können. Stehen keine antiseptischen Mundspülungen zur Verfügung, stellt Wasser eine sinnvolle Alternative dar.Background: During dental treatments spray mist is generated, consisting of droplets and aerosols, which is regularly contaminated with microorganisms. Recent studies have already demonstrated microbial contamination of personal protective equipment during dental treatments. Contamination of personal protective equipment, especially surgical mask, puts dental staff and patients at risk. The aim of this study was to investigate bacterial contamination of the surgical mask during dental treatments while the practitioner wore a face shield and the patient rinsed with chlorhexidine before starting treatment. Methods: This prospective, randomized study included single-tooth treatments, filling therapy and preparation for an indirect restoration, and full dentition treatments, professional tooth cleaning and supportive periodontal therapy. Three subject groups were formed: participants rinsed for 60 s with 0.1 % chlorhexidine or with water before treatment, and, for control, a non-rinsing group was included. In context of the SARS-CoV-2 pandemic, a face shield covering the surgical mask enhanced personal protective equipment. After treatment, the surgical mask was brought in contact with agar plates and then incubated at 35 °C +/- 2 °C for 48 h. Bacteria were classified by phenotypic characteristics, biochemical assay methods, and by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOFMS). Colony forming units (CFU) were counted and mean values for each group were compared (H-test, U-test, p < 0.05). Results: A total of 306 treatments were included. Of these, 141 treatments were related to single- tooth and 165 to full dentition treatments. For each group of subjects, 102 treatments were performed. The treatment modalities were equally distributed. Chlorhexidine (mean: 24 CFU) led to a statistically significant reduction of bacterial contamination of the surgical mask in comparison to water (mean: 47 CFU) and to the control group (mean: 80 CFU). In addition, the intervention with water led to a statistically significant reduction compared to the control group. There were no statistically significant differences for the bacterial contamination of the surgical mask between the single-tooth and full dentition treatment. The bacterial spectrum was dominated by Streptococcus spp., Staphylococcus spp., Micrococcus spp., and Bacillus spp. representing the oral and cutaneous flora. Conclusion: Preprocedural intervention by rinsing with chlorhexidine is useful to reduce bacterial contamination of the surgical mask. However, contamination cannot be completely prevented by either rinsing or wearing a face shield. Especially during a pandemic, it should be noted that these additional protective measures cannot completely prevent transmission of potential pathogens to the facial region. If antiseptic mouth rinses are not available, water is a useful alternative

Effects of Cold Atmospheric Plasma Pre-Treatment of Titanium on the Biological Activity of Primary Human Gingival Fibroblasts

Cold atmospheric plasma treatment (CAP) enables the contactless modification of titanium. This study aimed to investigate the attachment of primary human gingival fibroblasts on titanium. Machined and microstructured titanium discs were exposed to cold atmospheric plasma, followed by the application of primary human gingival fibroblasts onto the disc. The fibroblast cultures were analyzed by fluorescence, scanning electron microscopy and cell-biological tests. The treated titanium displayed a more homogeneous and denser fibroblast coverage, while its biological behavior was not altered. This study demonstrated for the first time the beneficial effect of CAP treatment on the initial attachment of primary human gingival fibroblasts on titanium. The results support the application of CAP in the context of pre-implantation conditioning, as well as of peri-implant disease treatment

Bacterial contamination potential of personal protective equipment itself in dental aerosol-producing treatments

Personal protective equipment (PPE) has long been a high priority in dental aerosol-producing treatments. Since COVID-19 pandemic, its importance has increased yet again. While importance of PPE in preventing transmission and thus possible infection of pathogens is well known, contamination potential of PPE after treatment itself is less investigated. This review aims to give an overview of the current literature and contamination potential (viral, blood, bacterial) of components of protective equipment itself. The literature search was performed using the Medline database; furthermore, a hand search was conducted. Last search took place on 23 November 2022. Two categories of hygiene-related keywords were formed (category A: mask, face shield, goggles, eyewear, personal protective equipment; category B: contamination, aerosol). Each keyword from one category was combined with all keywords from the other one. In addition, the keyword “dental” was always added. First, a title and abstract screening was performed. Afterward, a full-text analysis was followed for the included studies. A total of 648 search hits were found in the Medline database. 47 were included after title and abstract screening. 22 studies were excluded after full-text analysis, 25 studies were included. The hand search resulted in 4 studies that were included. Bacterial contamination of PPE after treatment has been adequately studied, contamination with blood less. Microorganisms mainly originate from the oral and cutaneous fora; however, a transmission of potential pathogens like Staphylococcus aureus or Escherichia coli was also described. Studies showing transmission pathways starting from PPE and its various components are lacking. No measures have yet been described that fully protect the protective equipment from contamination. There is growing awareness that PPE itself can be a source of pathogen transmission, and thus possible infection. Therefore, not only wearing of protective clothing, but also conscious handling of it is crucial for transmission and possible infection prevention. However, studies showing transmission pathways starting from PPE and its various components are lacking. Several studies have investigated what measures can be taken to protect the protective equipment itself. So far, none of the methods evaluated can prevent contamination of PPE

Introduction of “professional field exploration” for Saarland University dentistry students

Seit dem Wintersemester 2021/2022 gilt die neue zahnärztliche Approbationsordnung (ZApprO). Darin wurde festgelegt, dass ein „Praktikum der Berufsfelderkundung“ als Lehrveranstaltung im Zahnmedizinstudium durchgeführt wird. In der Universität des Saarlandes besteht die Lehrveranstaltung aus 5 Teilen: (I) Einführung, (II) Praktikum, (III) Reflexionsbericht, (IV) Symposium, (V) Evaluation. Das Praktikum soll den Studierenden eine frühe Berührung mit der klinischen Realität ermöglichen und ihnen mehr Selbstvertrauen im Umgang mit Patienten geben, sie motivieren und ihnen die professionelle Rolle im Gesundheitsberuf vermitteln. Zusätzlich soll durch den Reflexionsbericht und das Symposium die Entwicklung wissenschaftlicher Kompetenzen initiiert werden. Die Evaluation dient zusammen mit der Bewertung der Reflexionsberichte der Überprüfung des Erfolgs der Einführung des Faches. Ziel dieses Beitrags ist es, die neue Lehrveranstaltung zu beschreiben und die Ergebnisse der Auswertung der beiden Veranstaltungen in den Jahren 2021 und 2022 darzustellen.The new dental licensing regulations (ZApprO) have been in effect since the 2021/2022 winter semester and stipulate that a “professional field exploration course” be offered in the dentistry degree program. At Saarland University, the course consists of five parts: (I) introduction, (II) practicum, (III) reflection report, (IV) symposium, and (V) evaluation. The practicum is designed to provide students with earlier exposure to clinical reality, give them more confidence in dealing with patients, motivate them, and teach them about the professional role in the healthcare profession. In addition, the reflection report and symposium will initiate the development of scientific competencies. The evaluation, together with the evaluation of the reflection reports, serves to verify the success of the introduction of the course. The purpose of this paper is to describe the new course and to present the results of the result of the evaluation of the two courses in 2021 and 2022

<i>L. reuteri</i> in Supportive Periodontal Therapy—Are There Already Clinical Effects after 3 Months with One Lozenge a Day? A Double-Blind Randomized Placebo-Controlled Study

Aim: The purpose of this study was to investigate whether a clinical effect of Lactobacillus reuteri in supportive periodontal therapy can already be detected with a minimum dose of one tablet a day and a minimum observation and intake period of 3 months. Materials and Methods: 28 patients with stage III and IV periodontitis undergoing periodontal follow-up were randomly divided into two groups receiving a lozenge containing L. reuteri or a placebo preparation daily for 90 days. After 0, 4, 8, and 12 weeks, the parameters bleeding on probing (BoP), plaque control record (PCR), periodontal probing depth (PPD), and clinical attachment level (CAL) were recorded in the test and control groups. Results: The results sed a different effect of L. reuteri on the respective patients. In certain patients, clinical parameters worsened or remained largely unchanged. However, in other patients, there were positive effects on the clinical parameters. In the overall analysis, BoP was the only clinical parameter that was statistically significantly reduced. Conclusions: The oral administration of one lozenge per day for 3 months with L. reuteri in supportive periodontal therapy might have a positive influence on clinical parameters in supportive periodontal therapy, depending on the individual

L. reuteri in Supportive Periodontal Therapy—Are There Already Clinical Effects after 3 Months with One Lozenge a Day? A Double-Blind Randomized Placebo-Controlled Study

Aim: The purpose of this study was to investigate whether a clinical effect of Lactobacillus reuteri in supportive periodontal therapy can already be detected with a minimum dose of one tablet a day and a minimum observation and intake period of 3 months. Materials and Methods: 28 patients with stage III and IV periodontitis undergoing periodontal follow-up were randomly divided into two groups receiving a lozenge containing L. reuteri or a placebo preparation daily for 90 days. After 0, 4, 8, and 12 weeks, the parameters bleeding on probing (BoP), plaque control record (PCR), periodontal probing depth (PPD), and clinical attachment level (CAL) were recorded in the test and control groups. Results: The results sed a different effect of L. reuteri on the respective patients. In certain patients, clinical parameters worsened or remained largely unchanged. However, in other patients, there were positive effects on the clinical parameters. In the overall analysis, BoP was the only clinical parameter that was statistically significantly reduced. Conclusions: The oral administration of one lozenge per day for 3 months with L. reuteri in supportive periodontal therapy might have a positive influence on clinical parameters in supportive periodontal therapy, depending on the individual

Cold Atmospheric Plasma Improves the Colonization of Titanium with Primary Human Osteoblasts: An In Vitro Study

Several studies have shown that cold atmospheric plasma (CAP) treatment can favourably modify titanium surfaces to promote osteoblast colonization. The aim of this study was to investigate the initial attachment of primary human osteoblasts to plasma-treated titanium. Micro-structured titanium discs were treated with cold atmospheric plasma followed by the application of primary human osteoblasts. The microwave plasma source used in this study uses helium as a carrier gas and was developed at the Leibniz Institute for Surface Modification in Leipzig, Germany. Primary human osteoblasts were analyzed by fluorescence and cell biological tests (alkaline phosphatase activity and cell proliferation using WST-1 assay). The tests were performed after 4, 12, and 24 h and showed statistically significant increased levels of cell activity after plasma treatment. The results of this study indicate that plasma treatment improves the initial attachment of primary human osteoblasts to titanium. For the first time, the positive effect of cold atmospheric plasma treatment of micro-structured titanium on the initial colonization with primary human osteoblasts has been demonstrated. Overall, this study demonstrates the excellent biocompatibility of micro-structured titanium. The results of this study support efforts to use cold atmospheric plasmas in implantology, both for preimplantation conditioning and for regeneration of lost attachment due to peri-implantitis

Effects of Cold Atmospheric Plasma Pre-Treatment of Titanium on the Biological Activity of Primary Human Gingival Fibroblasts

Cold atmospheric plasma treatment (CAP) enables the contactless modification of titanium. This study aimed to investigate the attachment of primary human gingival fibroblasts on titanium. Machined and microstructured titanium discs were exposed to cold atmospheric plasma, followed by the application of primary human gingival fibroblasts onto the disc. The fibroblast cultures were analyzed by fluorescence, scanning electron microscopy and cell-biological tests. The treated titanium displayed a more homogeneous and denser fibroblast coverage, while its biological behavior was not altered. This study demonstrated for the first time the beneficial effect of CAP treatment on the initial attachment of primary human gingival fibroblasts on titanium. The results support the application of CAP in the context of pre-implantation conditioning, as well as of peri-implant disease treatment

Cold Atmospheric Plasma Improves the Colonization of Titanium with Primary Human Osteoblasts: An In Vitro Study

Several studies have shown that cold atmospheric plasma (CAP) treatment can favourably modify titanium surfaces to promote osteoblast colonization. The aim of this study was to investigate the initial attachment of primary human osteoblasts to plasma-treated titanium. Micro-structured titanium discs were treated with cold atmospheric plasma followed by the application of primary human osteoblasts. The microwave plasma source used in this study uses helium as a carrier gas and was developed at the Leibniz Institute for Surface Modification in Leipzig, Germany. Primary human osteoblasts were analyzed by fluorescence and cell biological tests (alkaline phosphatase activity and cell proliferation using WST-1 assay). The tests were performed after 4, 12, and 24 h and showed statistically significant increased levels of cell activity after plasma treatment. The results of this study indicate that plasma treatment improves the initial attachment of primary human osteoblasts to titanium. For the first time, the positive effect of cold atmospheric plasma treatment of micro-structured titanium on the initial colonization with primary human osteoblasts has been demonstrated. Overall, this study demonstrates the excellent biocompatibility of micro-structured titanium. The results of this study support efforts to use cold atmospheric plasmas in implantology, both for preimplantation conditioning and for regeneration of lost attachment due to peri-implantitis

Detection of viable oral bacteria of the patient on the surgical mask of dentists

INTRODUCTION AND AIM: Bioaerosols contaminate the personal protective equipment (PPE), especially masks. The PPE harbors microorganisms from various sources. However, no previous studies have investigated the specific sources of bacteria found on used masks and their correlation with those from the treated patient. SETTING, DESIGN, MATERIAL AND METHODS: Intraoral samples from the patient were collected prior to dental aerosolproducing treatments using a nylon flock fiber swab. After treatment, the practitioner’s mask was imprinted onto agar plates. MAIN OUTCOME METHODS: Following cultivation, colony forming units were counted and identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). After the samples were analyzed, the intraoral samples as well as the mask samples were assessed for the presence of identical species, which were subsequently quantified. RESULTS: 126 treatments were included. One species match occurred most frequently (26.2%), followed by two (11.9%%) and three or more (3.97%). In the intraoral samples, Neisseria subflava occurred most often, within mask samples Staphylococcus epidermidis were detected most. Staphylococcus aureus could be cultivated three times more often in intraoral samples than on the mask. DISCUSSION AND CONCLUSION: Oral microorganisms originating from the patient’s oral cavity can be found on the outside of masks. When using PPE during treatments, it should therefore always be in mind that potentially pathogenic microorganisms may land on the mask becoming a source of for itself