Development of topical medicaments to promote caries arrest,    Dr. Hetal Desai

Hetal Desai 1, Cameron Stewart 1, Dennis Cvitkovitch 1,2, J Paul Santerre 1,2, Yoav Finer 1,2

1 Faculty of Dentistry, University of Toronto, Ontario

2 Institute of Biomedical Engineering, University of Toronto, Ontario

Objectives: Caries-arresting medicaments (CAMs) are used as interim measures to promote caries arrest. Silver Diamine Fluoride (SDF) is one such efficacious (77-89%) CAM, however, its use results in a permanent dark discoloration, limiting patient acceptance.

We previously engineered in our laboratory high content drug-silica co-assembled particles (DSPs), which can be applied to prevent biofilm formation in dental restorative materials. CAMs are applied to carious lesions to disrupt pre-exiting biofilms and therefore necessitate a higher drug concentration relative to that needed to prevent biofilm formation. Owing to the high drug loading of DSPs, they could be utilized as drug depots for the development of CAMs, however, their drug release profile must be modulated to exhibit rapid release of higher drug concentration.

Our aim is to accelerate the drug release from DSPs by incorporating network-modifying ions into their silica construct, and apply these modified-DSPs to develop highly effective CAMs with esthetic outcomes.

Methods: Modified-DSPs were synthesized using Ca2+ alone and Ca2+/PO4- as network-modifying ions in a one-pot synthesis approach with Octenidine dihydrochloride (OCT) as the drug and particle pore-templating agent. Particles were characterized using Scanning Electron Microscopy (SEM) with energy dispersive X-ray spectroscopy (SEM EDX). Drug release kinetics were measured at pH 7.4 and 5.0 using UV-Vis spectrophotometry.

CAMs were formulated by incorporating modified-DSPs into a commercial vehicle (Gluma®, Kulzer) (5% wt/wt) and the biofilm disruption of the formulations was assessed by performing minimum biofilm eradication concentration (MBEC), minimum biocidal concentration (MBC) and log10 reduction assays, using the Calgary Biofilm Device (CBD). Wells with no treatment, Gluma® (a co-adhesion molecule) alone and Gluma®+ calcined particles (5% wt/wt) served as relative controls.

Results: At pH 7.4, Ca2+/PO4- modified-DSPs demonstrated a 2 and 1.4 fold higher OCT release relative to DSPs at 24 and 48 hr, respectively. At pH 5.0, the Ca2+ modified-DSPs demonstrated a 2.6 and 1.6 fold higher drug release relative to DSPs without Ca2+, at 24 and 48 hr, respectively. MBEC and MBC assays showed no bacterial growth in wells treated with CAM formulations, whereas growth was observed in all relative control wells. All treatment formulations showed a 6-log reduction in bacterial growth relative to relative controls.

Conclusions: The drug release from DSPs can be accelerated by incorporating network-modifying ions into their silica structure. These modified-DSPs demonstrate potent antimicrobial/antibiofilm effects, and can be further developed as CAMs.

Traumatic dental injuries: Prognostic Factors Affecting Treatment Outcomes of Luxation Injuries in Permanent Teeth, Dr. Shamira Naik

Shamira Naik, Joy Richman, Jolanta Aleksejuniene, Ahmed Hieawy

Objectives: In Vancouver, BC Children’s Hospital provides urgent dental services to children referred by dentists or presenting directly to the emergency department. However, their follow-up care is managed by community dentists, resulting in a gap in understanding the success of initial emergency treatments. This study aims to identify prognostic factors affecting the treatment outcomes of luxation injuries in permanent anterior teeth treated at BC Children’s Hospital.

Methods: This retrospective follow-up study was conducted in two stages. The first stage involved collecting data from the electronic health records of patients who presented to BC Children’s Hospital emergency department with traumatic dental injuries to anterior teeth from September 2019 to September 2022. Various prognostic factors influencing clinical and radiographic outcomes were recorded. The second stage involved follow-up visits for children with luxation injuries, including lateral luxation, intrusion, extrusion, and subluxation. Follow-up visits consisted of clinical and radiographic examinations, with outcomes assessed based on healing criteria (healed, non-healed, healing/functional). Associations between prognostic factors and treatment outcomes were examined using a Chi-squared test.

Results: The study included 60 traumatised permanent teeth, of which 40 were luxation injuries. Significant prognostic factors affecting treatment outcomes were the stage of root development (p=0.003) and the time elapsed from trauma to treatment (p=0.01). Injuries treated within five hours of trauma and teeth with closed apices had better outcomes. The health status of the patient showed a trend towards significance, with healthier individuals more likely to have favorable outcomes (p=0.09). Factors such as type of initial treatment, presence of a combination injury, and location of the incident did not have statistically significant associations with treatment outcomes.

Conclusions: Clinical variables such as the stage of root development and the time elapsed from trauma to initial treatment significantly impact the outcomes of luxation injuries. These factors should be considered when triaging patients in hospital emergency departments to ensure optimal prognosis following emergency treatment.

Caregiver’s perceptions of the quality of dental care provided for their autistic children at BC Children’s Hospital (BCCH), Dr. Atyaf Saleh

Authors and affiliations: Atyaf Saleh, Jennifer Park and Joy M. Richman, University of British Columbia and British Columbia Children’s Hospital, Vancouver, Canada

Abstract

Objectives: Dental care for children with autism spectrum disorder (ASD) is challenging for the child, caregiver and dental provider. Several studies assess Oral Health-Related Quality of Life of Children with autism as perceived by the caregiver but do not address the quality of care. Our aim was to carry out a quality improvement/quality assurance survey of caregivers at a tertiary care hospital where many children with autism are referred for dental care.

Methods: A custom survey consisting of multiple-choice questions and free text boxes was distributed between Dec. 1, 2023 and July 5, 2024. After opening the survey and consenting, caregivers were given access to the questions. Anonymous responses were collected using REDCap. Frequency histograms for the survey questions were created using Prism v10. The positivity and negativity of text box responses was measured using word-cloud software. This study was approved by the BCCH Research Data Management committee.

Results: There were 348 caregivers (98% were parents) who completed all 4 sections and 20 who responded to the optional questions about aging-out-of-system. Most families were from the lower mainland of BC (85%), and 66% stated their first language was English reflecting the diversity of the population in BC. The average age of diagnosis of autism was 3.81±2.41 years agreeing with the national average. The main barrier to care was the behaviour of their child (41.67%). Many caregivers favoured in-person visits (85%) over virtual visits, as they felt their child's dental needs cannot be addressed with virtual visits. In contrast, caregivers felt virtual visits were better for their child and were less distracting. There were 615 free-text-boxes completed which provided rich feedback in the following areas 1) physical layout of the clinic, 2) length of visits, 3) sensory stimulation and 4) staff training. Positive comments included overall high satisfaction (88.5%) with the dental providers and the systematic desensitization program. However, a majority of caregivers (75%) felt they are ill-prepared to transition their child out, mainly because they cannot find a suitable dental home.

Conclusions: These results will be used to design a new BCCH dental clinic space. Visits will be shortened and staff training in ASD will be implemented. Our study highlights the significant challenges for caregivers when their child needs to find a dental home in their local community. Since there are relatively few pediatric dentists, better training for general dentists would improve the care for adults with ASD.