Smitha Sukumar

Certain dental procedures are associated with increased infection risk in specific patient populations. This article outlines when antibiotic prophylaxis is, and is not, indicated for dental procedures based on recent Australian guidelines.

Introduction: Dental students are deemed fit to treat patients (clinical readiness) based on their performance in pre‐clinical summative assessments. This involves assessing knowledge (theory exams) and technical skills (simulation‐based activities). However, there is weak evidence to support whether these pre‐clinical assessments accurately predict clinical performance. The aim of this study was to determine if pre‐clinical summative assessments predicted the clinical performance of students in a graduate dental programme. Materials and Methods: This retrospective longitudinal cohort study analysed the results of pre‐clinical (theory, simulation) and clinical summative assessments in Restorative Dentistry, Periodontics and Endodontics from six cohorts of second‐ and third‐year students (2013 to 2019) enrolled in The University of Sydney's Doctor of Dental Medicine program. The association between pre‐clinical (theory and simulation) marks with clinical marks were analysed by discipline using Pearson's correlation coefficient ( r ² ). Results: A weak but significant positive correlation was found between a student's pre‐clinical theory mark and their clinical performance in all three disciplines. The only significant positive correlation between pre‐clinical simulation marks and clinical performance was found in Restorative Dentistry. Discussion: While some positive correlations were found between pre‐clinical and clinical performance, overall, these results indicate that pre‐clinical ability was not a reliable predictor of a student's clinical competence. Conclusions: Assessing clinical readiness is complex. Our results indicate this attribute may potentially be better assessed using a range of qualitative and quantitative metrics. Further research is required to better define and quantify clinical readiness.

Studying individual ecological niches within the oral cavity is a logical first step to understanding the distribution of antimicrobial resistance genes (ARGs); however, it is not representative of the whole oral resistome. The aim of our systematic review was to provide a map of the oral resistome by reviewing the composition of individual niches. A total of 580 papers were retrieved from a search of all English language publications investigating the presence of oral ARGs in five electronic databases between January 2015 and August 2023. Fifteen studies [10 PCR and 5 next-generation sequencing (NGS)] were included in this review. The heterogeneity of methods precluded meta-analysis. ARGs are present throughout the oral cavity with 158 unique ARGs identified across 6 locations – supra and sub-gingival biofilm, mucosa, oropharynx, root canal system (RCS) and saliva. The supragingival biofilm had the highest resistome richness, while the RCS had the least. Tetracycline was the dominant antimicrobial resistance (AMR) class found. Three core genes were identified – tet(M), tet(O) and ermB.This review highlights the necessity of NGS studies to comprehensively characterize the oral resistome in its entirety. This is the logical foundation for future ‘omics studies to truly understand the scope of the resistome and its contribution to AMR.

Antibiotic overuse has promoted the spread of antimicrobial resistance (AMR) with significant health and economic consequences. Genome sequencing reveals the widespread presence of antimicrobial resistance genes (ARGs) in diverse microbial environments. Hence, surveillance of resistance reservoirs, like the rarely explored oral microbiome, is necessary to combat AMR. Here, we characterise the development of the paediatric oral resistome and investigate its role in dental caries in 221 twin children (124 females and 97 males) sampled at three time points over the first decade of life. From 530 oral metagenomes, we identify 309 ARGs, which significantly cluster by age, with host genetic effects detected from infancy onwards. Our results suggest potential mobilisation of ARGs increases with age as the AMR associated mobile genetic element, Tn916 transposase was co-located with more species and ARGs in older children. We find a depletion of ARGs and species in dental caries compared to health. This trend reverses in restored teeth. Here we show the paediatric oral resistome is an inherent and dynamic component of the oral microbiome, with a potential role in transmission of AMR and dysbiosis.

Antibiotic overuse has promoted the spread of antimicrobial resistance (AMR) with significant health and economic consequences. Surveillance of resistance reservoirs, like the rarely explored oral microbiome, is necessary to combat AMR. We characterised the development of the paediatric oral resistome and investigated its role in dental caries in 221 twin children sampled over the first decade of life. From 535 oral metagenomes, we identified 309 antimicrobial resistance genes (ARGs), which significantly clustered by age, with the influence of host genetics on antimicrobial resistance increasing over time. Our results suggest the mobilisation potential of ARGs increased with age as Tn916 transposase was co-located with more species and ARGs as children grew. Dental caries compared to health was associated with a depletion of ARGs and species, which was reversed when restored. Our results highlight the dynamic nature of the paediatric oral resistome, and its potential role in transmission of AMR and dysbiosis.

Introduction: The SARS‐CoV‐2 virus has forced profound change on all aspects of society, with significant impact on dental education. Dental students like all other dental clinical personnel are considered to be at the highest risk amongst healthcare workers due to the nature of treatment, namely, working in the oral cavity (known reservoir for the virus) and the routine use of aerosol‐generating procedures. The nature of this pandemic has created several challenges to dental clinical education. The aim of this paper is to discuss these challenges and how educators have sought to overcome them.Materials and Methods: This paper reviews the evidence base around bio‐aerosol and infection control measures specifically in the context of dental education.Results: Using current knowledge of bio‐aerosol and increasing understanding of the virus, dental educators can implement evidence‐based measures to ensure safe teaching within both simulation and clinical environments.Discussion: This paper contextualises the current pandemic in a dental education setting by providing a critical appraisal of the challenges posed by SARS‐CoV‐2 and how these challenges may be managed.Conclusion: The SARS‐CoV‐2 pandemic has created unique challenges for dental schools worldwide. Dental educators have sought to identify these challenges and find solutions appropriate to the stage of the pandemic specific to their geographical location.

Antibiotic resistance presents a daunting challenge to health professionals worldwide and has the potential to create major problems for modern health care, resulting in more medical expenditure, extended hospital stays and increased morbidity and mortality. Advanced genome sequencing technologies present a complex picture of resistance, extending our understanding beyond the pharmacotherapeutic interface between pathogens and antibiotics. This review discusses the global scope and scale of antibiotic resistance and contextualizes it for the dental practitioner, emphasizing the role we must play in limiting the progression of resistance through antibiotic stewardship and disease prevention.

Antibiotic resistance is considered one of the greatest threats to global public health. Resistance is often conferred by the presence of antibiotic resistance genes (ARGs), which are readily found in the oral microbiome. In-depth genetic analyses of the oral microbiome through metagenomic techniques reveal a broad distribution of ARGs (including novel ARGs) in individuals not recently exposed to antibiotics, including humans in isolated indigenous populations. This has resulted in a paradigm shift from focusing on the carriage of antibiotic resistance in pathogenic bacteria to a broader concept of an oral resistome, which includes all resistance genes in the microbiome. Metagenomics is beginning to demonstrate the role of the oral resistome and horizontal gene transfer within and between commensals in the absence of selective pressure, such as an antibiotic. At the chairside, metagenomic data reinforce our need to adhere to current antibiotic guidelines to minimize the spread of resistance, as such data reveal the extent of ARGs without exposure to antimicrobials and the ecologic changes created in the oral microbiome by even a single dose of antibiotics. The aim of this review is to discuss the role of metagenomics in the investigation of the oral resistome, including the transmission of antibiotic resistance in the oral microbiome. Future perspectives, including clinical implications of the findings from metagenomic investigations of oral ARGs, are also considered.