antimicrobial resistance in dentistry

Question 1

define antimicrobials

Answer 1

antibiotics, antivirals, anti fungals and antiparastitic
medicines used to prevent and treat infections in humans ,animals and plants

Question 2

what is AMR - antimcorbial resistance

Answer 2

occurs when bacteria,virsues,fungi and parasites change over time and no longer response to medicines making infections harder to treat and increase risk of disease spread, severe illness, and death

Question 3

in the US how many people are infected and diewith antibiotic resistant bacteria or fungi per year

Answer 3

2.8 million
death - 35,000

Question 4

list 7 modern medical antibiotic resistance challenges

Answer 4

Sepsis 1.7 million
DM- 422M
Organ transplants 330,000
Kidney disease 500K
C section surgeries - 1.2 million
Plastic surgerys 1.8 million
Cancer care

Question 5

How does anitbtioc reissnta affect people

Answer 5

People - antibiotic resistant strains some can spread person to person
Nightmare bacteria - carbapenem resistant - enterobacteriaceae can also survive and grow in sink drains at healthcare facilities and spread to patients and to environment through the waste water

Question 6

name the nightmare bacteria

Answer 6

carbapenem resistant - enterobacteircease

Question 7

how can antibiotic resistance affect animals

Answer 7

ANIMALS- resistant germs can spread between animals and people through food or contact with animals for example ; salmonella heidelberg bacteria can make both cattle and people sick

Question 8

how can anitbtiocb resistant affect the envrioenmtn

Answer 8

Environment - antibiotic resistant germs can spread to the environment. Aspergillus fumigatus, common mould cna make people with weak immune systems sick
In 2018 - A fumigatus was reported in 3 patients
Also found in US crop field treated with fungicides that are similar to antifungal used in human medicine

Question 9

what is the name of the common mould that can mean people with weak immune system sick

Answer 9

aspergillus fumigatus

Question 10

what test needs to be negative otherwise no surgery can be done

Answer 10

MRSA

Question 11

which areas least and most prescriber anitbtiocs

Answer 11

least; London
most ; merseyside

Question 12

when is anitbtiocs needed in dentistry

Answer 12

Endodontic treatment - antibiotic paste or calcium hydroxide
Periimplantitis
Periodontal disease
Oral surgeries
Abscesses- systemic antibiotics
10% of antibiotic prescription

Question 13

LIST 9 WAYS antibtioc stewardship is done

Answer 13

• Enhancing infection prevention and control
  Controlling the source of infection
• Prescribing antibiotics when they are truly needed
• Prescribing appropriate antibiotic with adequate dosages
• Using shortest duration antibiotics based on evidence
• Reassessing treatment when culture results are available
• Supportive surveillance and AMR and HAIs and monitoring antibiotic consumption
• Educating staff
• Supporting an interdisciplinary approach

Question 14

what is DAP AND TAP

Answer 14

• intracanal medicaments dap and TAP on DPSC- dental pulp stem cells

Antimicrobial effect
Cytotoxicity
Double antibiotic paste (DAP) ciprofloxacin and inject into canal
Triple antibiotic paste (TAP) ; 2 antibiotics - amoxicillin to see effect of residual intracanal mendicant of pulp and markets of dentine

Question 15

DESCRIBE regenerative endodotonics using anitbtiobcs on beads

Answer 15

• in a paeds patient they have incomplete root so you cannot fill it with gutta percha after removing the pulp
• instead
  the K file is instead beyond apex and the apical foremen is widened to allow recruitment of apical papilla stem cells inside canal
• it is irrigated and ultrasonic scaling sued to remove debris of canal and make sure the pulp is completelyy disinfected
  from the apical formant the apical papilla stem cells come in the canal
• a anitbtiobc paste and calcium hydroxide placed for 7 days
  after 7 days remove anitbtic paste and allow apical paella stem cells to reinvorgate pulp space and regenerate pulp and remain gin part go root canal

Question 16

what are the consequences of regenerative endodontics

Answer 16

when removing antibtioc paste- its not completely removed so can contribute to resistance because they used at low dosage

Question 17

what effect does DAP AND TAP have on angiogenic gene expression

Answer 17

• 25um = positive effect for both
  But inhibits formation of deitne
  Most endodontic use calcium hydroxide for antibacterial effect

Question 18

what effect does DAP have on regenerative potential of dental pulp

Answer 18

Positive control of TGF beta (manual instrumentation of infected pulp in clinic)
TTGF beta helps regenerative process
Highest cytotoxicity for DAP at 25 micrograms with TGF beta but TAP much elss

Question 19

name 3 alternative antimicrobials that are ebbing investigated

Answer 19

Graphene
Concentrated growth factor
Silver nanoparticles AgNP

Question 20

describe the biocompability of graphene coated implants compared to titanium implants

Answer 20

Cultured in bone marrow stem cells isolated from head form hip replacement surgery =
Culture on surface of implant
Titanium has higher cytotoxic compared to graphene oxide coated disc
BMSCS viability - culture bone marrow stem cells for 3 and 7 days on graphene oxide coated implants and titanium implants
Titanium implants not treated with anything - usually sandblasted and acid etch = gives better results
Stained cells with kit called live dead akres - green fluorescent - efilium homodimer - red- compromised cell membrane
After 7 days no cells seen in titanium

Another bacterial associated with peri implantitis - Porphyromaonas gignivalis
Graphene good effect after 24 hours but even better with antibiotics

Question 21

what is effect of concentrated growth factor on peri implantitis associated bacteria F.n

Answer 21

Compact membrane of fibrin and WBC which we isolate form autologous blood
Blood form patient and isolate GF by centrifugation and look at its antimicrobial effect against FN
No difference

Question 22

What is anitmicorbial effect on peri implantitis associated bacteria P gingiivalis

Answer 22

P gingivalis - huge difference and drop in bacteria colones
Conclusion - use concentration GF with graphene oxide

Question 23

describe AGNF effect on biocompability and cell attachment

Answer 23

Collaborator As proven silver they have minimum inhibitory effects against E faecalis bacteria - cause infected pulpitis
In this study look at biocompatibility of silver nanoparticles and found that cultured cells on dentine surfaces that have been treated with different conc
Calcium hydroxide as positive control
No treatmetn - negative control
- no significant difference on cell attachment between all groups
Similar cell viability
No significant difference between all groups
Higher cytotoxic effect after 3 days
BEST CELL PROLIFERATION WITH POSITIVE CONTROL but no si diff between 0.15%
Less proliferation with 0.01

Question 24

what is the conclusion of AGNF as a anitmciorbial for endodontic treatment

Answer 24

AGNF at conc on 0.02%- MIC is biocompatibility with dental pulp stem cells and cna be used in future as intracanal medicament

Question 25

what percentage of dentistry prescriptions contribute to AMR

Answer 25

10%