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OBJECTIVES: The purpose of this literature review was to describe enamel matrix derivative (EMD) and how it benefits periodontal patients. EMD's rejuvenating abilities were identified as well as the different functions of EMD. METHODS: Articles chosen for this literature review were randomized control trials that were peer reviewed and published within the last five years. PubMed was accessed through Augusta University's database for research. Keywords used to search included enamel matrix derivative, bone loss, periodontitis, enamel matrix proteins, gum disease, regeneration, therapy, and growth. RESULTS: Studies chosen for this literature review all showed that EMD improves clinical attachment level. It is able to promote hard and soft tissue regeneration because it contains the same proteins that are involved in amelogenesis. These proteins stimulate fibroblasts, anti-inflammatory cytokines, and clotting factors. All these factors make EMD a great adjunct to periodontal surgical procedures. EMD is also able to reduce inflammation, promote wound healing, and stabilize blood clots. CONCLUSIONS: Overall, EMD's ability to assist in the formation of new bone, cementum, and periodontal ligaments makes it an excellent treatment option for periodontally involved patients. It is frequently used with scaling and root planing, flap surgery, and the treatment of infrabony defects.

OBJECTIVES: The purpose of this abstract is to describe how the use of phage therapy can be used to effectively target oral bacteria such as Streptococcus mutans, Aggregatibacter actinomycetemcomitans, and Enterococcus faecalis with minimal side effects to patients. These particular bacteria are important components in the process of caries formation, periodontal disease, and failed endodontic treatment. METHODS: A search of Pubmed was conducted for peer-reviewed randomized control trials, clinical trials, and studies that were less than five years old. The keywords used to find relevant articles were: bacteria, oral bacteria, phage therapy, bacteriophage therapy, pathogenic bacteria, and dental bacteria. RESULTS: The studies that were reviewed demonstrated phage therapy to be effective in reducing oral bacteria commonly responsible for dental caries, periodontal disease, and failed endodontic treatment. The first study showed the isolated phage, SMHBZ8, targeted S. mutans and reduced both biofilm formation and demineralization of enamel. The second study demonstrated the ability of a lysogenic bacteriophage, S1249, to be induced into the lytic cycle in human serum and effectively eliminate A. actinomycetemcomitans, a bacteria implicated in aggressive periodontal disease and known to be resistant to serum. The third study found a phage, PEf771, targeting E. faecalis in endodontically treated teeth with refractory periapical periodontitis was found to have greater substantivity and antibiotic properties than traditional medicaments used in root canal treatment. CONCLUSIONS: These studies prove the viability of phage therapy as a treatment modality in targeting pathogens that contribute to major oral diseases. Benefits of phage therapy include low toxicity, high specificity, biofilm penetrating capabilities, and the ability to continuously replicate in the presence of target bacteria. IMPLICATIONS: With more research to include human trials, phage therapy could prove to be a cost-effective alternative to conventional treatments in dentistry with fewer side effects to patients. Current treatment options for these oral diseases carry risks such as antibiotic resistance, staining, and toxicity. The ability of bacteriophage to target caries-causing bacteria such as S. mutans while sparing commensal bacteria is promising for preventive dentistry while the specificity and replicating abilities are desirable for eliminating periodontal and endodontic pathogens. The use of bacteriophage in dentistry could be adapted for delivery as a rinse, dentifrice, varnish, or targeted delivery system.

OBJECTIVES: Evaluate the role oral hygiene plays in decreasing the risk of contracting Ventilator-Associated Pneumonia (VAP) for patients on life-support. METHODS: Five different research studies were used to measure the effectiveness of various mouthwashes ability to prevent VAP. The mouthwashes evaluated were Clove mouthwash, Ozonated Water (OZW), Chlorohexidine Gluconate (CHG), and Povidone Iodine. For each study, the patients were split into a control and experimental group. All patients were treated with the designated mouthwash, using a mouth swab for application. There was a variation of the duration of each study, as well as the time intervals of mouthwash application. The studies were conducted over the course of anywhere from a few hours to several days. There were numerous data collection instruments used throughout each study to measure the incidence of VAP contraction, such as Acute Physiology and Chronic Health Evaluation II (APACHEII), The Beck Oral Assessment Scale (BOAS), and Modified Clinical Pulmonary Infection Score (MCPIS). RESULTS: • Study One: 40% participants in Chlorohexidine group contracted VAP; double that of the Clove Extract group • Study Two: 9 out of 36 patients in OZW group contracted VAP; 17 out of 37 patients in CHG group contracted VAP • Study Three: Experimental group showed an overall reduction in bacterial growth • Study Four: 0% VAP contraction in experimental group; 10.58% contraction in control group • Study Five: 10 patients in CHG group contracted VAP; 17 patients in placebo group contracted VAP CONCLUSIONS: Overall, this literature review confirms that mouthwash solutions do have a positive effect in the reduction of VAP in critically ill patients. However, research has not consistently shown one solution to be more triumphant than another, when compared. IMPLICATIONS: In a hospital setting the findings influence clinical dentistry by showing the importance of providing professional cleanings within 24 hours of mechanical ventilation, providing oral care using an antibacterial mouthwash 3 times a day, and ensuring that patients teeth are brushed twice a day. In a private practice setting the findings show the importance/need of advocating for patients receiving proper oral care while in a critically ill state and spreading awareness on the effect that oral hygiene has on preventing VAP.

OBJECTIVES: Hyperbaric oxygen therapy (HBOT) brings several benefits to wound healing in various tissues throughout the body by delivering high concentrations of oxygen under increased atmospheric pressure for small intervals of time. In addition to routine scaling and root planning (SRP), HBOT may be able to further improve pocket depths, revive tissues, and maybe even help to regenerate parts of the periodontal ligament. METHODS: The Augusta University Greenblatt online library, Google scholar, and Galileo were used to find credible articles. Criteria for finding credible articles included articles that were published within 5 years of 2023, articles that are not literature reviews, articles that report randomized clinical trials, and articles that do not present an obvious bias. RESULTS: All studies yielded results in favor of the use of HBOT to improve periodontal health. Results included decreases in probing depths, improved clinical attachment levels, decreases in bleeding, and improved gingival indexes. Only one study yielded non-directional results with no noticeable differences between the control group and study group. CONCLUSIONS: After a thorough review of the selected research articles, it is concluded that HBOT would be an effective adjunct to SRP. Adding HBOT to a patient's treatment plan could be beneficial to many components of the periodontal ligament. IMPLICATIONS: HBOT would be a good addition to the dental field by offering a less invasive form of therapy to periodontally affected patients. Certain factors like price and duration of treatment could affect the accessibility of HBOT. Further research will help to bring HBOT into the dental field and become a widely accepted adjunct to periodontal therapy.

Background: Given the current opioid epidemic, it is crucial to highly regulate the prescription of narcotic medications for pain management. The use of electronic prescriptions (e-scripts) through the hospital’s electronic medical record platform allows physicians to fill opioid prescriptions in smaller doses, potentially limiting the total quantity of analgesics patients have access to and decreasing the potential for substance misuse. The purpose of this study is to determine how the implementation of e-scripts changed the quantity of opioids prescribed following shoulder surgeries. Methods: For this single-center retrospective study, data were extracted for all patients aged 18 years or more who received a shoulder procedure between January 2015 and December 2020. Total milligrams of morphine equivalents (MMEs) of opioids prescribed within the 90 days following surgery were compared between 3 cohorts: preimplementation of the 2017 New Jersey Opioid laws (Pre-NJ opioid laws), post-NJ Opioid Laws but pre-escripting, and postimplementation of e-scripting in 2019 (postescripting). Any patient prescribed preoperative opioids, prescribed opioids by nonorthopedic physicians, under the care of a pain management physician, or had a simultaneous nonshoulder procedure was excluded from this study. Results: There were 1857 subjects included in this study; 796 pre-NJ opioid laws, 520 post-NJ opioid laws, pre-escripting, and 541 postescripting. Following implementation of e-scripting on July 1, 2019, there was a significant decrease in total MMEs prescribed (P < .001) from a median of 90 MME (interquartile range 65, 65-130) preimplementation to a median 45 MME (interquartile range 45, 45-90) MME postimplementation Additionally, there was a statistically significant decrease in opioids prescribed for all procedures (P < .001) and for 3 (P < .001) of the 4 orthopedic surgeons included in this study. Conclusion: Our study demonstrated a significant reduction in total MMEs prescribed overall, for all shoulder surgeries, and for the majority of our institution’s providers in the postoperative period following the e-scripting implementation in July 2019. E-scripting is a valuable tool in conjunction with education and awareness on the national, institutional, provider, and patient levels to combat the opioid epidemic.

Background: Various studies have examined the relationship between preoperative mental health diagnoses (MHDs) and postoperative outcomes in orthopedic shoulder patients. However, few investigations delve into the relationship between a preoperative MHD and postoperative opioid pain control regimens in patients who have undergone rotator cuff repair (RCR), total shoulder arthroplasty (TSA), and reverse TSA (rTSA). We hypothesize that orthopedic shoulder patients with a preoperative MHD will be prescribed more opioids (ie, request more refills) postoperatively than those without a MHD. Methods: An institutional review board-approved retrospective chart review was performed on 438 patients, 18 years or older, who underwent RCR, TSA, or rTSA. Patients were divided into two groups: those diagnosed with depression, anxiety, bipolar disorder, and/or schizophrenia (n = 193), and those with no previous MHD (n = 245). Statistical outcomes were analyzed with the independent t-test, Mann-Whitney U test, one-way Analysis of Variance, and Kruskal-Wallis test. Results: Univariate analysis demonstrated significant differences between the MHD group and non-MHD group in average 90-day postoperative opioid scripts (2.10 vs. 1.55, respectively, P

Background: Real-world data on the use of left bundle branch area pacing (LBBAP) as an alternative novel pacing strategy to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT) remains scarce. We aimed to investigate the outcomes of LBBAP as an alternative to BVP as a method of CRT. Methods: Electronic databases were searched for studies on the use of LBBAP as CRT and studies that compared LBBAP with BVP. The main outcomes examined were changes in New York Heart Association classification, left ventricular end-diastolic diameter, left ventricular ejection fraction, and paced QRS duration post CRT device implantation. Results: Our meta-analysis included 8 nonrandomized studies with a total of 527 patients who underwent LBBAP as CRT. In studies with a BVP comparison group, patients with LBBAP had a greater reduction in paced QRS (mean difference [MD], 27.91 msec; 95% confidence interval [CI], 22.33-33.50), and a greater improvement in New York Heart Association class (MD, 0.59; 95% CI, 0.28-0.90) and left ventricular ejection fraction (MD, 6.77%; 95% CI, 3.84-9.71). Patients with underlying left bundle branch block appeared to benefit the most from LBBAP compared with patients without underlying left bundle branch block. Conclusions: LBBAP might be a reasonable option for patients who meet indications for CRT, particularly in those who have limited anatomy or do not benefit from CRT. Randomized trials are needed to compare LBBAP with BVP for CRT and to identify which populations might benefit the most from LBBAP. RÉSUMÉ: Contexte: On dispose de peu de données obtenues en contexte réel sur l'utilisation de la stimulation de la branche gauche (SBG) comme nouvelle stratégie remplaçant la stimulation biventriculaire (SBV) dans le cadre d'une thérapie de resynchronisation cardiaque (TRC). Nous avons voulu étudier les résultats de la SBG à titre de solution de rechange à la SBV comme méthode de TRC. Méthodologie: Nous avons cherché dans les bases de données électroniques les études examinant l'utilisation de la SBG comme TRC, et les études comparant la SBG à la SBV. Les principaux résultats examinés étaient les changements dans les classes de la New York Heart Association (NYHA), le diamètre télédiastolique du ventricule gauche, la fraction d’éjection du ventricule gauche (FEVG) et la durée du QRS stimulé après l'implantation du dispositif de TRC. Résultats: Notre méta-analyse portait sur huit études sans répartition aléatoire, portant sur un total de 527 patients ayant subi une SBG comme TRC. Dans les études comportant un groupe témoin ayant subi une SBV, les patients ayant subi une SBG présentaient une réduction plus importante du QRS stimulé (différence moyenne [DM] : 27,91 ms; intervalle de confiance [IC] à 95 % : 22,33-33,50), ainsi qu'une amélioration plus importante des classes de la NYHA (MD : 0,59; IC à 95 % : 0,28-0,90) et de la FEVG (MD : 6,77 %; IC à 95 % : 3,84-9,71). Les patients avec un bloc de la branche gauche (BBG) sous-jacent ont semblé bénéficier davantage de la SBG que les patients sans BBG sous-jacent. Conclusions: La SBG peut être une option raisonnable pour les patients chez qui la TRC est indiquée, en particulier ceux qui ont des restrictions sur le plan de l'anatomie ou qui ne bénéficient pas de la TRC. Des essais randomisés sont nécessaires pour comparer la SBG à la SBV comme TRC, et pour déterminer les populations qui pourraient bénéficier le plus de la SBG.

Background & Aims: Infection with hepatitis C virus (HCV) remains a major cause of morbidity and mortality worldwide despite the recent advent of highly effective direct-acting antivirals. The envelope glycoproteins of HCV are heavily glycosylated with a high proportion of high-mannose glycans (HMGs), which serve as a shield against neutralizing antibodies and assist in the interaction with cell-entry receptors. However, there is no approved therapeutic targeting this potentially druggable biomarker. Methods: The anti-HCV activity of a fusion protein consisting of Avaren lectin and the fragment crystallizable (Fc) region of a human immunoglobulin G1 antibody, Avaren-Fc (AvFc) was evaluated through the use of in vitro neutralization assays as well as an in vivo challenge in a chimeric human liver (PXB) mouse model. Drug toxicity was assessed by histopathology, serum alanine aminotransferase, and mouse body weights. Results: AvFc was capable of neutralizing cell culture–derived HCV in a genotype-independent manner, with 50% inhibitory concentration values in the low nanomolar range. Systemic administration of AvFc in a histidine-based buffer was well tolerated; after 11 doses every other day at 25 mg/kg there were no significant changes in body or liver weights or in blood human albumin or serum alanine aminotransferase activity. Gross necropsy and liver pathology confirmed the lack of toxicity. This regimen successfully prevented genotype 1a HCV infection in all animals, although an AvFc mutant lacking HMG binding activity failed. Conclusions: These results suggest that targeting envelope HMGs is a promising therapeutic approach against HCV infection, and AvFc may provide a safe and efficacious means to prevent recurrent infection upon liver transplantation in HCV-related end-stage liver disease patients.

A 37-year-old African American male with a past medical history significant for end stage renal disease on hemodialysis via a femoral arteriovenous graft, systemic lupus erythematous, with a recent hospitalization for cavitary Candida pneumonia treated with micafungin, presented with a fever of 102° F for 3 days and worsening left groin pain. He also complained of chills, nausea, and malaise. On physical examination, the patient was hemodynamically stable with swelling and tenderness at the site of the graft. He was started on vancomycin, piperacillin/tazobactam and micafungin. Computed tomography scan and duplex scan of the left lower extremity showed diffuse swelling and attenuation of the graft material consistent with thrombosis of the graft. Excision of the graft and thrombectomy was performed and the graft thrombus was sent for culture. Examination of the sample showed fungal hyphae (Figure). Micafungin was switched to voriconazole; however, the patient did not show any improvement of his groin pain. On day 5 of hospitalization, culture showed Fusarium, and hence amphotericin B was added resulting in subsequent clinical improvement. We are presenting an unusual site of Fusarium infection which responded to combination therapy, a case which has not been reported. Keywords: Fusarium species, Fungal infection, Arteriovenous graft infection, Systemic lupus erythematous