Introduction: Periotest is a device that measures the damping characteristics of the periodontium. It has a tapping head which percusses the tooth 16 times in 4 seconds. This sensitive tip records the duration of contact with the tooth and gives us a reading. The Periotest value (PTV) is ranging from -8 to +50. The more mobile the tooth is, the contact time will be longer and the Periotest value will be higher. Periotest is more commonly used in implant dentistry to evaluate implant stability, however there are studies that used the Periotest device to evaluate the outcome of endodontic surgeries, evaluating anterior teeth after trauma and in follow-up visits, and diagnosis of replacement resorption. Percussion test is a part of routine endodontic testing, and the results are subjective and may vary between operators. In addition, pulp necrosis may lead to local bone destruction, less periodontal support of the affected tooth and potentially more mobility. It has been shown that Periotest evaluation provides an objective indication of the extent of periodontal bone loss. Therefore, application of an objective percussion test using this device may provide more accurate diagnostic data regarding the supporting tissue. Purpose: The purpose of this study was to compare the Periotest value in teeth with necrotic pulp and periapical involvement to their healthy contralateral tooth. Materials and Methods: After doing routine endodontic testing, 49 pairs of teeth were included in the study. The inclusion criteria were teeth with necrotic pulp tissue with periapical lesion that needed root canal treatment and have a contralateral tooth with normal pulp and normal apical tissue. Teeth with severe periodontal disease, crown or bridge restoration, teeth in crowded areas, teeth with history of recent trauma or extensive caries were excluded. Periotest device was used to do horizontal percussion test on the tooth with pulp necrosis and its healthy contralateral. The data recorded for each sample. Data was analysis using non-parametric Man—Whitney test to compare test and control groups, with p<0.05 as significant. Results: The average Periotest value (PTV) in the necrotic teeth group was 6.94 and the average in the healthy contralateral teeth was 2.34. Statistical analysis shows a significant difference between the two groups (P value <0.0001).Statistical Analysis of the data by tooth type shows significant difference when comparing the PTV of necrotic molars, premolars, and anterior teeth to their healthy contralateral teeth. Tooth type (post/Ant), and pulp necrosis are significant predictors of PTV, however, Prescence or absence of caries is not a predictor of PTV. PTV of the necrotic teeth with periapical lesion was higher than their contralateral tooth in 93.8% of the cases, equal in 2% of the cases and lower in 4% of them. Conclusion: Periotest may be useful as an objective tool for percussion test in endodontic diagnosis and it may provide needed information regarding the health of the periapical tissue. This device is potentially useful in evaluating the bone healing in periapical region following root canal treatment. / Oral Biology

OBJECTIVE: DEI sexual dimorphism has been observed where male but not female mice mildly immunosuppressed by blockade of IL-1 signaling, and challenged with an endodontic infection, developed facial abscesses, weight loss, splenomegaly, and sepsis which was often fatal. The central hypothesis is that estrogen increases the numbers and function of N1 neutrophils, resulting in effective anti- microbial immunity to DEI, whereas androgens are inhibitory. The aim of this study is to determine the effict of sex hormone modulation in protective immune responses to DEI and sepsis, specifically neutrophil-mediated resistance. MATERIALS AND METHODS: The therapeutic effects of estrogen and the androgen receptor antagonist enzalutamide (ENZ) on DEI will be evaluated in adult male group through direct observation of facial abscess formation, fatigue, and malaise. Additionally, survival rates, weight change, and spleen weights will be recorded and compared between treatment groups. Male mice sub-groups will be categorized by hormonal treatments, which will be administered daily throughout a 31 day observation period after bilateral mandibular pulpal exposures and initiation of endodontic infections. RESULTS: Group 1 received no estrogen and no enzalutamide treatment following pulpal exposures. And 7 mice (n=7) were included in the experiment, however 1 mouse’s final weight was unaccounted for due to the animal facility’s onsite veterinarian sacrificing and removing the mouse during their daily heath assessment. Throughout the course of the 31 day experimental timeline, average weight loss of this group was 4.72 grams. The average final spleen weight was 0.11 grams. Group 2 received enzalutamide treatment only following pulpal exposures and had a total of 12 mice (n=12). 2 mice were observed to have developed facial abscesses over the course of the 31 day hormone treatment period, and 8/12 survived to the end of the experimental period. Throughout the course of the 31 day experimental timeline, the average weight loss of this group was 3.63 grams. The average final spleen weight was 0.11 grams. Group 3 received estrogen treatment only following pulpal exposures and had a total of 8 mice (n=8). 2 mice did not survive the pulpal exposure procedure and accounted for the only mice that were lost in this group resulting in 6/8 mice surviving through the experimental period. Throughout the course of the 31 day experimental timeline, the average weight loss of this group was 3.66 grams. The average final spleen weight was 0.083 grams. Group 4 received both estrogen and enzalutamide treatment simultaneously, totaling in 11 mice (n=11). Throughout the experimental period, only 1 mouse was found deceased following the first round of hormonal treatments. Throughout the course of the 31 day experimental timeline, the average weight loss of this group was 1.45 grams. The average final spleen weight was 0.078 grams. CONCLUSION: Estrogen’s (E2) has a protective role on immune cells and function against DEIs, while enzalutamide (ENZ) appears to effect protection minimally. Based on the comparisons between weight changes, spleen weights, and survival rates, a combination of E2 and ENZ resulted in the least overall weight loss and spleen weights throughout the course of the experiment while the groups that received no treatment and only ENZ resulted in the highest average weight loss and spleen weights.

AIM: This study aimed to compare the physiological responses of dental practitioners wearing N95 masks versus ASTM surgical masks. Prolonged use of sealed masks may lead to hypercapnia and symptoms such as fatigue, headaches, dizziness, and shortness of breath. Additionally, the combination of required personal protective equipment (PPE) in dental settings and decreased thermal ventilation can further burden dental care providers and impact their quality of life and patient care. MATERIALS AND METHODS: Sixty dental residents (N=60) were divided into two groups: one with enhanced PPE and fitted N95 masks, and the other with standard surgical masks (ASTM rated). Vital signs were recorded before and after standard dental procedures, reflecting the physiological changes following mask use. RESULTS: Dental residents wearing N95 masks experienced more significant changes in measurement variables compared to those wearing surgical masks. The N95 group showed a significant decrease in pulse rate and blood pressure, as well as a higher likelihood of reporting post-operative headaches. The ASTM group also had a decrease in pulse rate but no significant changes in other vital signs. CONCLUSION: N95 masks have been crucial for protecting healthcare workers during the COVID-19 pandemic. However, addressing the discomfort and headaches associated with wearing these masks is essential. Understanding the factors contributing to headaches and finding solutions to alleviate them can ensure the well-being of healthcare workers. Collaborative efforts are needed to improve mask design and materials and implement policies that support healthcare workers in demanding environments. Quantitative measurements of carbon dioxide (CO2) should be considered in future studies to enhance reliability.

OBJECTIVES: To examine the association of oral health-related productivity loss (OHRPL) with wealth in 10,908 working-age adults (30-64 years old) using 2011-2018 National Health and Nutrition Examination Survey (NHANES) data. METHODS: This study measured the association of oral health-related productivity loss with wealth. The outcome, OHRPL, was categorized into “Never,” “Sometimes” (“Hardly ever” / “Somewhat often”) and “Always” (“Often” / “Always”). The exposure, wealth, used existing methodology: categorizing NHANES’ homeownership and family monthly income variables into low (<$2900 /not homeowners), middle (≥$2900 /not homeowners or homeowners/<$2900), and high-wealth (≥$2900/homeowners). Using masked variance pseudo-primary sampling units and variables with a full sample 2-year mobile examination center exam weight for the 2011-2018 cycles, descriptive statistical analysis and multinomial logistic regression was used. Regression outputs were converted to average probabilities of OHRPL by financial and education variables for Black participants. RESULTS: Between 2011-2018, 13,223,810 (weighted) US working-age adults experienced OHRPL and those with low-wealth had 1.5 times the odds (95% CI=1.2-1.8) of reporting OHRPL “sometimes” and 2.9 times the odds (95% CI=1.8-4.8) of reporting OHRPL “always” compared to their high-wealth counterparts. Black (95% CI=1.2-2.1) and Multi-Racial/Other (95% CI=1.4-2.9) groups had the strongest, significant positive associations with experiencing OHRPL “sometimes.” Black men with financial barriers to care were 26% more likely to experience OHRPL “sometimes,” and if they had low-wealth, 34% more likely. CONCLUSIONS: Including economic factors that represent resources and generational wealth can enhance understanding of these dynamics as drivers of oral health outcome disparities.

OBJECTIVE: LPS secreted by gram negative bacteria in the oral cavity leads to bone loss. Attempts to find substitutes for lost bone and Enamel Matrix Derivative show promise. However, little is known about the pathway by which EMD treatment regenerates bone. These studies were designed to test the effectiveness of EMD against LPS-induced bone loss. Bone regeneration was induced by activation of factors such as c-jun or MMP-9. The hypothesis was that EMD may alleviate LPS-induced bone loss via activation of these factors. The aim of my project is thus to investigate the mechanism of EMD treatment on bone regeneration. MATERIALS AND METHODS: Human THP-1 monocyte-like cells were treated with EMD and LPS from E. coli. Each treatment was analysed by ELISA/Protein assay and the values were graphed and further evaluated. All the experiments were performed in triplicate and statistical analyses were conducted with the SAS software package. RESULTS: Through this study: 1. EMD treated cells showed reduced levels of LPS-induced cytokine expression of the proinflammatory cytokines TNF-⍺, IL-1α and IL-10. 2. EMD treatment does not induce a significant difference in expression of the apoptotic genes, Caspase-3, Caspase-9 and Bax. 3. Additionally, EMD significantly enhances c-jun and MMP-9 expression. CONCLUSIONS: It is known from previous studies that TNF-⍺ and IL-1α production leads to bone loss and expression of c-jun and MMP-9 induces bone regeneration. This suggests that EMD may affect bone regeneration through either the reduction of LPS-induced pro-inflammatory cytokines or the expression of c-jun/MMP-9. CLINICAL SIGNIFICANCE: Our data here will help researchers gather more information about the bone regeneration process which can be used in clinics. It could also lead to medical applications for the treatment of various diseases. Our study will induce researchers to further investigate EMD mediated biological function.

Invasive cervical resorption (ICR) is a complex and multifaceted dental condition characterized by the progressive loss of hard tooth tissue in the cervical region of permanent teeth. This literature review aims to critically examine the current knowledge on ICR, focusing on its etiology, diagnosis, and treatment approaches, as well as identifying potential variables that could impact treatment outcomes and rehabilitation. Due to the limited availability of randomized clinical trials and the reliance on case reports and case series, drawing definitive conclusions about the predisposing factors and their association with ICR remains challenging. This review found that maxillary central incisors are the most frequently affected teeth in the dentition. Cone-beam computed tomography (CBCT) has been identified as an invaluable tool for the accurate diagnosis of ICR lesions, with its three-dimensional imaging capabilities providing critical information for the classification and treatment planning of ICR cases. In contrast, two-dimensional radiographs may not always lead clinicians to the correct diagnosis. The use of trichloroacetic acid (TCA) as a diagnostic material for ICR lesions is not well-supported in the existing literature. In terms of restorative materials, glass ionomer (GI) and resin-modified glass ionomer (RMGI) demonstrated the highest success rates in the treatment of ICR lesions. This review highlights the need for further research to establish standardized diagnostic processes and treatment planning for ICR in permanent dentition. Future research should focus on identifying the factors contributing to treatment failure and determining the most effective methods to reduce tooth loss. The development of randomized clinical trials and longitudinal studies would significantly enhance our understanding of ICR, its etiology, and the most effective strategies for diagnosis and treatment. Overall, this literature review provides a comprehensive and critical analysis of the existing knowledge on ICR and suggests directions for future research to improve treatment outcomes and reduce tooth loss in patients affected by this rare but challenging dental condition.

The fluoridation of community water has been a hotly contested topic since it was first introduced. Fluoride helps to strengthen enamel structure and stave off cavities. Dental decay can be deadly and lead to sepsis, the life-threatening reaction of the body to an infection. Those with low socioeconomic status and children are among those who can suffer the most from dental decay. Many people live without access to dental care and good-quality dental clinics. Fluoride is even more vital to these people because it can strengthen enamel and minimize dental decay. Fluoridating community water supplies is a low-cost solution to remedy this issue and can be a viable option for helping communities that have less resources and are underserved. Community acceptance is needed for the fluoridation to be implemented and of benefit. Although children can have some of the best benefits from fluoride with their newly erupted teeth, many parents choose to not allow their children to drink fluoridated water. This is despite several decades of research showing its safety and its effectiveness in protecting teeth development, especially primary teeth. Oftentimes falsehoods about fluoride spread which make it challenging for dental providers to educate caregivers on the benefits of fluoride. Although fears persist surrounding the potential negative effects of fluoride and fluoridated water sources, there is no substantial evidence that the fluoride levels found in monitored, regulated, drinking water cause significant negative effects. The most common complaint of enamel fluorosis can be avoided by proper regulation of concentration, and its appearance if observed mitigated. Furthermore, the claim that fluoride in the levels found in supplemented water supplies cause cancer, attention deficit disorder, cognitive and other learning issues, lacks supportive evidence as discussed here. Studies both locally and globally, have demonstrated the safe and effective use of fluoridated water in protecting enamel, reducing early childhood caries, and helping to mitigate dental health disparities. Fluoride at the level present in community water sources is healthful and safe and should be consumed by individuals. This can be especially beneficial to those who are marginalized, and lack other access to oral health resources, especially children with developing teeth, as it is a key means of support for their oral health and wellbeing.

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