Objective: The aim was to evaluate the establishment of an aseptic endodontic operative field in general dentistry by assessing general dentists' ability to reduce the amount of contamination to a non-cultivable level, and to compare the operative field asepsis at a general dentistry clinic with that at an endodontic specialist clinic.

Materials and Methods: A total of 353 teeth were included in the study (153 in general dentistry, 200 at the specialist clinic). After isolation, control samples were taken, the operative fields disinfected with 30% hydrogen peroxide (1 min) followed by 5% iodine tincture or .5% chlorhexidine solution. Samples were collected from the access cavity area and buccal area, placed in a fluid thioglycolate medium, incubated (37 & DEG;, 7 d), evaluated for growth/non-growth.

Results: Significantly more contamination was observed at the general dentistry clinic (31.6%, 95/301), than at the endodontic specialist clinic (7.0%, 27/386) (p <.001). In general dentistry, significantly more positive samples were collected in the buccal area than in the occlusal area. Significantly more positive samples were collected when the chlorhexidine protocol had been used, both in general dentistry (p <.001) and at the specialist clinic (p =.028).

Conclusions: The result from this study shows insufficient endodontic aseptic control in general dentistry. At the specialist clinic, both disinfection protocols were able to reduce the amount of microorganisms to a non-cultivable level. The observed difference between the protocols may not reflect a true difference in the effectiveness of the antimicrobial solutions, as confounding factors may have contributed to the result.

OBJECTIVE: The aim was to explore what affected dental health care workers' sense of safety while working during the COVID-19 pandemic and examine their satisfaction with the information they received on COVID-19 and pandemic protocols.

MATERIAL AND METHOD: An invitation to participate in the survey was distributed to 2,990 dental health care workers in Sweden. Open-ended questions were analyzed using the Theoretical Domains Framework, closed-ended questions with Pearson's chi-squared test.

RESULTS: The response rate was 41.7%. Of the respondents, 78.7% were ‘very satisfied’ or ‘fairly satisfied’ with the information they received. Conflicting messages were reported as a problem, especially regarding how highly prioritized the pandemic protocols were. ‘Fairly safe’ or ‘very safe’ were the responses chosen by 70.9%, while 54.2% recounted situations that made them feel unsafe. The sense of safety was mainly related to one’s own knowledge, self-perceived skills, and support in the workplace. The feeling of not being safe was foremost related to resources: primarily PPE shortages and time-related shortages. Respondents who reported being asked to forego surgical face masks and/or economize with gloves/hand rub because of shortages were more likely to have felt unsafe (p = .001).

CONCLUSIONS: Most were satisfied with the information they had received, and most felt safe during the pandemic, but several respondents reported situations where they felt pressured to make compromises with their infection control. Future pandemic protocols should have ethics clearly incorporated regarding situations when there is a shortage of resources and include better planning for the provision of supplies for infection control.

Objective: To reduce the gap between what can be achieved in endodontic treatments and the observed treatment outcome among general dental practitioners, the present study set out to assess the status of the endodontic practices as regards to knowledge and self-assessed skills among general dental practitioners in Sweden and Norway. Material and method: The questionnaire was sent to 1384 general dental practitioners. It contained questions regarding access to continuing education in endodontics, sources of knowledge for clinical management of patients, post-operative follow-ups, self-assessed success-rate, and the initial diagnosis impact on the outcome of endodontic treatments. Results: The response rate was 61.4%. Almost half estimated their endodontic success-rate to be 90%. About two-thirds of the respondents did not know, or did not believe, that the initial diagnosis could affect the outcome of their endodontic treatments. Respondents who did not believe the diagnosis could impact the outcome were more likely to estimate their success rate as the highest (p<.001). Less than half performed post-operative follow-ups a year after treatment. A third of the respondents had not attended any continuing endodontic education. Conclusion: Dentists who do not receive regular feedback on their treatments may lack insight into their own shortcomings. If this is combined with insufficient knowledge and understanding it may result in sub-par endodontic treatments being performed. It is important to have reliable ways to communicate current endodontic knowledge and to establish robust methods that may help dentists accurately assess their own performance in endodontics.

Objective: Description of the odontoblast lifecycle, an overview of the known complex molecular interactions that occur when the health of the dental pulp is challenged and the current and future management strategies on vital and non-vital teeth. Methods: A literature search of the electronic databases included MEDLINE (1966-April 2019), CINAHL (1982-April 2019), EMBASE and EMBASE Classic (1947-April 2019), and hand searches of references retrieved were undertaken using the following MESH terms ‘odontoblast*’, ‘inflammation’, ‘dental pulp*’, ‘wound healing’ and ‘regenerative medicine’. Results: Odontoblasts have a sensory and mechano-transduction role so as to detect external stimuli that challenge the dental pulp. On detection, odontoblasts stimulate the innate immunity by activating defence mechanisms key in the healing and repair mechanisms of the tooth. A better understanding of the role of odontoblasts within the dental pulp complex will allow an opportunity for biological management to remove the cause of the insult to the dental pulp, modulate the inflammatory process, and promote the healing and repair capabilities of the tooth. Current strategies include use of conventional dental pulp medicaments while newer methods include bioactive molecules, epigenetic modifications and tissue engineering. Conclusion: Regenerative medicine methods are in their infancy and experimental stages at best. This review highlights the future direction of dental caries management and consequently research.

Objective: The purpose of this study was to investigate endodontic infection prevention and control routines among general dental practitioners in Sweden and Norway. Materials and methods: A questionnaire were sent by email to 1384 general dental practitioners employed in Sweden and Norway. The participants were asked questions concerning different aspects of infection prevention and control during endodontic treatment; use of rubber dam, sealing of rubber dam, antibacterial solutions, and use of hand disinfectant and gloves. Results: The response rate was 61,4 % (n 819). 96,9 % reported routinely using rubber dam during endodontic treatment. 88,3% reported always, or sometimes, sealing the area between rubber dam and tooth. Most disinfected the endodontic operative field, but the antibacterial solutions used varied. 11,9 % did not use gloves at all during treatment, and 10,5 % did not use hand disinfectant during treatment. Conclusions: Most of the general dental practitioners took measures to establish and maintain aseptics during endodontic treatment, which infers an awareness of the importance of endodontic infection prevention and control. But the results were self-reported and there may be a gap between claimed and actual behavior. Further studies using observation methodologies are needed to assess how infection control routines are performed in everyday clinical practice.

Inom tandvården sker behandlingar i en miljö som är mycket rik på mikroorganismer och med risk för smittspridning. För att minska denna risk behöver vi aktivt verka för att reducera smittkällor och bryta transportvägarna för mikroorganismer. Att arbeta aseptiskt och därmed «bevara det rena rent» är en grundläggande princip vid endodonti. Ett aseptiskt arbetsfält skapas med hjälp av kofferdam och antiseptika, och detta aseptiska arbetsfält måste upprätthållas under hela behandlingen. 90 % av svenska och 30 % av de danska tandläkarna använder kofferdam regelbundet. Trots införandet av flera nya tekniker för både instrumentering och rotfyllning under senare år ses inte någon minskad mängd apikal parodontit i befolkningen. Det är troligt att andra faktorer, som till exempel det aseptiska och antiseptiska tillvägagångssättet, kan spela en större roll för utfallet av den endodontiska behandlingen än vad som tidigare antagits.

In dentistry the treatments take place in an environment that is very rich in microorganisms, and there is a risk of transmission of infection. In order to reduce that risk, we need to actively work to minimize the sources if infection, and break the routes of transmission. Working aseptically and thus reducing the probability of contamination, is a fundamental principle. An aseptic operative field is created by the use of a rubber dam and antiseptics, and these aseptic conditions must be maintained during the whole procedure. 90% of Swedish and 30% of Danish dentists use rubber dam regularly. Though several new techniques for both instrumentation and obturation have been introduced in recent years, no reduction of the prevalence of apical periodontitis can be seen. Other factors, such as the aseptic and antiseptic approach probably plays a more important role in the outcome of the endodontic treatment than previously assumed.

Objectives. Successful endodontic treatment depends on effective measures to eliminate and prevent infection of root canals. Initially treatment should start with isolation and disinfection of the operating field. This review makes an inventory of the available knowledge regarding its establishment and maintenance. Materials and Methods. A literature search was conducted in the PubMed database in order to identify clinical trials examining disinfection or unintentional contamination of the endodontic operative field. A list of 115 articles was obtained and screened. Five relevant articles were identified. These articles were read in full text. The reference lists from these articles were checked manually for additional studies and 3 studies were obtained. A total of 8 articles met the inclusion criteria. Results. There was a great variety in terms of aim, method and material of the included studies. None could prove a totally reliable aseptic operative field and not one chemical, or combination of chemicals, were found in more than one study. Conclusions. No study documented complete asepsis following initial disinfection, and no study could document predictable maintenance of an established bacteria-free surface. Critical appraisal and standardization of the disinfection and aseptic procedures in endodontics are needed.