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  1. Menon RK, Gopinath D, Li KY, Leung YY, Botelho MG
    Int J Oral Maxillofac Surg, 2019 Feb;48(2):263-273.
    PMID: 30145064 DOI: 10.1016/j.ijom.2018.08.002
    The objectives of this systematic review were to investigate the efficacy of amoxicillin/amoxicillin-clavulanic acid for reducing the risk of postoperative infection after third molar surgery and to evaluate the adverse outcomes in these patients, as well as in healthy volunteers. A systematic search of four databases was performed on May 26, 2017. Eleven studies qualified for the qualitative analysis and eight were found suitable for meta-analysis. The results suggest that both amoxicillin-clavulanic acid and amoxicillin significantly reduce the risk of infection after third molar extraction (overall relative risk (RR) 0.25, P<0.001). However, with the exclusion of randomized controlled trials with a split-mouth design (due to an inadequate crossover period after antibiotic treatment), only amoxicillin-clavulanic acid was found to be effective (RR 0.21, P<0.001). The risk of adverse effects was significantly higher in the amoxicillin-clavulanic acid group (RR=4.12, P=0.023) than in the amoxicillin group (RR 1.57, P=0.405). In conclusion, amoxicillin-clavulanic acid and amoxicillin may significantly reduce the risk of infection after third molar extraction. However, their use in third molar surgery should be viewed with caution, as recent clinical trials on healthy volunteers have shown evidence of the negative impact of amoxicillin use on bacterial diversity and antibiotic resistance.
  2. Menon RK, Kar Yan L, Gopinath D, Botelho MG
    J Investig Clin Dent, 2019 Nov;10(4):e12460.
    PMID: 31608608 DOI: 10.1111/jicd.12460
    AIM: Randomized controlled trials might be reporting a higher postoperative infection rate for third molar surgery compared to other study designs due to unclear criteria for the classification of "infections". The aim of the present retrospective study was to assess the infection rate after third molar surgery with and without postoperative antibiotic prescription.

    METHODS: Case records of patients who underwent third molar extractions at the Prince Philip Dental Hospital in Hong Kong between 3 July 2012 and 22 June 2017 were evaluated retrospectively. Data extraction was performed for indications, clinical and radiographic findings, antibiotic treatment, postoperative complications, and treatment for postoperative infection. The odds ratio (OR) for postoperative infection was estimated.

    RESULTS: In total, 1615 extracted over 5 years from 992 patient records were included in the final analysis. Antibiotics were prescribed postoperatively for 44% of the extractions. The overall infection rate was 2.05%. There was no significant difference in infection rates between the groups which underwent extractions with or without antibiotics (OR = .68; P = .289). We found a significantly higher risk for infections with increasing age (P = .002).

    CONCLUSION: Infection rates after third molar extraction is minimal in the current setting, with no significant benefit from postoperative antibiotic prescription.

  3. Gopinath D, Menon RK, Banerjee M, Su Yuxiong R, Botelho MG, Johnson NW
    Crit Rev Oncol Hematol, 2019 Jul;139:31-40.
    PMID: 31112880 DOI: 10.1016/j.critrevonc.2019.04.018
    Imbalance within the resident bacterial community (dysbiosis), rather than the presence and activity of a single organism, has been proposed to be associated with, and to influence, the development and progression of various diseases; however, the existence and significance of dysbiosis in oral/oropharyngeal cancer is yet to be clearly established. A systematic search (conducted on 25/01/2018 and updated on 25/05/2018) was performed on three databases (Pubmed, Web of Science & Scopus) to identify studies employing culture-independent methods which investigated the bacterial community in oral/oropharyngeal cancer patients compared to control subjects. Of the 1546 texts screened, only fifteen publications met the pre-determined selection criteria. Data extracted from 731 cases and 809 controls overall, could not identify consistent enrichment of any particular taxon in oral/oropharyngeal cancers, although common taxa could be identified between studies. Six studies reported the enrichment of Fusobacteria in cancer at different taxonomic levels whereas four studies reported an increase in Parvimonas. Changes in microbial diversity remained inconclusive, with four studies showing a higher diversity in controls, three studies showing a higher diversity in tumors and three additional studies showing no difference between tumors and controls. Even though most studies identified a component of dysbiosis in oral/oropharyngeal cancer, methodological and analytical variations prevented a standardized summary, which highlights the necessity for studies of superior quality and magnitude employing standardized methodology and reporting. Indeed an holistic metagenomic approach is likely to be more meaningful, as is understanding of the overall metabolome, rather than a mere enumeration of the organisms present.
  4. Lam WYH, Tse AKL, Tew IM, Man WHC, Botelho MG, Pow EHN
    J Dent, 2020 06;97:103343.
    PMID: 32339601 DOI: 10.1016/j.jdent.2020.103343
    OBJECTIVES: This study was conducted to examine the tooth wear status of nasopharyngeal-carcinoma (NPC) patients who had received radiotherapy at least 5-year previously, and to investigate the salivary parameters that may be associated with the tooth wear.

    METHODS: Tooth wear status of NPC survivors were clinically assessed using the Exact Tooth Wear Index. A tooth was graded to have severe wear when more than one-third of its buccal/occlusal/lingual surface had dentine loss. At the subject-level, percentages of anterior/posterior/all teeth with severe wear were calculated. Age, number of teeth, flow-rate/buffering capacity/pH of stimulated whole (SWS) and parotid (SPS) saliva's were collected. Correlation and multiple-linear regression tests were performed at the significance level α = 0.05.

    RESULT: Sixty-eight participants (mean age of 60.0 ± 8.9), 697 anterior and 686 posterior teeth were examined with a mean of 10-years post-radiotherapy. Severe tooth wear was found in 63 (92.6 percent) participants, 288 anterior and 83 posterior teeth. The mean percentage of anterior/posterior/all teeth with severe wear were 42.3 ± 28.1, 14.5 ± 19.9 and 30.0 ± 21.7. Anterior teeth, particularly the incisal surface of central incisors were most affected. The mean flow-rate of SWS and SPS were 0.1 ± 0.1 ml/min and 0.03 ± 0.07 ml/min respectively. Thirty (44.1 percent) and 48 (70.6 percent) participants were found to have low/no buffering capacity of SWS and SPS respectively. Multiple-regression analyses revealed the SWS flow-rate was associated with the percentage of anterior teeth with severe wear (p=0.03).

    CONCLUSION: Anterior tooth wear is a significant dental problem among NPC survivors and was associated with hypo-salivation.

    CLINICAL SIGNIFICANCE: Patients with hypo-salivation should be being monitored for tooth wear particularly on the anterior teeth.

  5. Abd-Shukor SN, Yahaya N, Tamil AM, Botelho MG, Ho TK
    Eur J Dent Educ, 2021 Nov;25(4):744-752.
    PMID: 33368978 DOI: 10.1111/eje.12653
    INTRODUCTION: The application of video-based learning in dentistry has been widely investigated; however, the nature of on-screen video enhancements of the video has been minimally explored in the literature. This study investigated the effectiveness of an in-class and on-demand enhanced video to support learning on removable partial dentures in terms of knowledge acquisition, perception and clinical skill performance.

    METHODS: Fifty-four dental students enrolled in 2018 were recruited as participants and assigned to two groups. Both groups were given the same lecture and asked to watch the same video in either the enhanced or non-enhanced version. The enhanced video was modified with the contemporaneous subtitle of the presenters' dialogue, text bullet points and summary text pages. The knowledge acquisition from the two types of video was subjected to pre- and post-tests one month after the students watched the video. A questionnaire was used to evaluate the students' perceptions of the learning experience and a performance test on practical skills was performed after six weeks. All the students responded to the test (100%).

    RESULTS: The enhanced video demonstration improved the students' short-term knowledge acquisition after they watched the video, with an average score of 1.59 points higher in the enhanced group than in the non-enhanced group (p 

  6. Gopinath D, Wie CC, Banerjee M, Thangavelu L, Kumar R P, Nallaswamy D, et al.
    Clin Oral Investig, 2022 Feb;26(2):1647-1656.
    PMID: 34436669 DOI: 10.1007/s00784-021-04137-7
    INTRODUCTION: Smoked, and especially smokeless, tobacco are major causes of oral cancer globally. Here, we examine the oral bacteriome of smokers and of smokeless tobacco users, in comparison to healthy controls, using 16S rRNA gene sequencing.

    METHODS: Oral swab samples were collected from smokers, smokeless tobacco users, and healthy controls (n = 44). Microbial DNA was extracted and the 16S rRNA gene profiled using the Illumina MiSeq platform. Sequencing reads were processed using DADA2, and taxonomical classification was performed using the phylogenetic placement method. Differentially abundant taxa were identified using DESeq2, while functional metagenomes based on KEGG orthology abundance were inferred using LIMMA.

    RESULTS: A significantly higher microbial diversity was observed in smokeless tobacco users and smokers relative to controls (P  1.5; BH adj P 

  7. Menon RK, Gomez A, Brandt BW, Leung YY, Gopinath D, Watt RM, et al.
    Sci Rep, 2019 12 10;9(1):18761.
    PMID: 31822712 DOI: 10.1038/s41598-019-55056-3
    Routine postoperative antibiotic prophylaxis is not recommended for third molar extractions. However, amoxicillin still continues to be used customarily in several clinical practices worldwide to prevent infections. A prospective cohort study was conducted in cohorts who underwent third molar extractions with (group EA, n = 20) or without (group E, n = 20) amoxicillin (250 mg three times daily for 5 days). Further, a control group without amoxicillin and extractions (group C, n = 17) was included. Salivary samples were collected at baseline, 1-, 2-, 3-, 4-weeks and 3 months to assess the bacterial shift and antibiotic resistance gene changes employing 16S rRNA gene sequencing (Illumina-Miseq) and quantitative polymerase chain reaction. A further 6-month follow-up was performed for groups E and EA. Seven operational taxonomic units reported a significant change from baseline to 3 months for group EA (adjusted p  0.05). In conclusion, the salivary microbiome is resilient to an antibiotic challenge by a low-dose regimen of amoxicillin. Further studies evaluating the effect of routinely used higher dose regimens of amoxicillin on gram-negative bacteria and antibiotic resistance genes are warranted.
  8. Gopinath D, Menon RK, Wie CC, Banerjee M, Panda S, Mandal D, et al.
    Sci Rep, 2021 01 13;11(1):1181.
    PMID: 33441939 DOI: 10.1038/s41598-020-80859-0
    Microbial dysbiosis has been implicated in the pathogenesis of oral cancer. We analyzed the compositional and metabolic profile of the bacteriome in three specific niches in oral cancer patients along with controls using 16SrRNA sequencing (Illumina Miseq) and DADA2 software. We found major differences between patients and control subjects. Bacterial communities associated with the tumor surface and deep paired tumor tissue differed significantly. Tumor surfaces carried elevated abundances of taxa belonging to genera Porphyromonas, Enterobacteriae, Neisseria, Streptococcus and Fusobacteria, whereas Prevotella, Treponema, Sphingomonas, Meiothermus and Mycoplasma genera were significantly more abundant in deep tissue. The most abundant microbial metabolic pathways were those related to fatty-acid biosynthesis, carbon metabolism and amino-acid metabolism on the tumor surface: carbohydrate metabolism and organic polymer degradation were elevated in tumor tissues. The bacteriome of saliva from patients with oral cancer differed significantly from paired tumor tissue in terms of community structure, however remained similar at taxonomic and metabolic levels except for elevated abundances of Streptococcus, Lactobacillus and Bacteroides, and acetoin-biosynthesis, respectively. These shifts to a pro-inflammatory profile are consistent with other studies suggesting oncogenic properties. Importantly, selection of the principal source of microbial DNA is key to ensure reliable, reproducible and comparable results in microbiome studies.
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