The Australian Therapeutic Guidelines: Oral and Dental and Antibiotic were updated in 2025 with revised indications for antibiotic prophylaxis for dental procedures and recommendations for prophylactic regimens. Most community-based patients undergoing minor oral surgeries do not require antibiotic prophylaxis, unless they are profoundly immunocompromised; in which case, antibiotic prophylaxis may be considered in consultation with the treating medical specialist or team. Antibiotics may also be considered following reinsertion of avulsed (knocked-out) teeth. Antibiotic prophylaxis is recommended for hospital-based patients undergoing specific oral and maxillofacial surgeries. It is also recommended for patients with high-risk cardiac conditions undergoing invasive dental procedures to prevent infective endocarditis.

PurposeAccurate history-taking is crucial for diagnosis and treatment planning in dentistry yet there is insufficient time in pre-clinical years to practice this essential skill. This study evaluated dental student motivations and enjoyment using a generative artificial intelligence (AI) chatbot to practice these skills.MethodsIn 2024, first- and second-year Doctor of Dental Medicine students trialed a virtual patient (VP) chatbot using generative AI based on GPT-4 and then completed surveys to assess expectations, motivations, and feedback on the chatbot and compare their experience with in-person learning.ResultsA total of 31 students participated in the trial. The cohort saw a significant improvement in perceived competence after using the chatbot. Second-year students found more value in the chatbot than first-year students. While the students felt the chatbot increased their participation and provided more practice opportunities, most found it less interesting compared to in-person teaching. Overall, students were supportive of the integration of the chatbot into the curriculum.ConclusionEducational chatbots can act as VPs, allowing users to practice patient history-taking. This chatbot was seen as a beneficial, supplementary resource for pre-clinical dental students, allowing them to supplement the currently limited opportunities to practice this skill.

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 (r2). 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.

In all health professions, taking a patient history is critical to accurate diagnosis and the formulation of an appropriate patient-focused management plan.1 Misdiagnosis and inappropriate treatment are common sequelae when clinicians fail to work through history in a logical and thorough manner. Traditionally, history taking in dentistry is taught in a clinical setting with some opportunities to practice in a simulated environment prior to students entering treatment clinics. Pre-clinical teaching is currently done in a tutorial setting where a clinical educator acts as a patient and the students act as the dentist. Such simulations allow repetitive practice in different clinical situations, within a risk-free environment.2 However, interviews with dental school staff members and observation of these tutorials revealed that in most classes, only one or two students actively participated in this role-playing. ChatGPT is a publicly available artificial intelligence (AI) large language model from OpenAI.3 It receives natural language inputs and responds realistically based on the conversation context. AI can be used to develop educational chatbots that are affordable and can provide a new medium of simulation with more scalability, personalization, and access.4 Research studies have demonstrated the effectiveness of ChatGPT in improving diagnostic accuracy, clinical judgment, and knowledge retention among healthcare learners.4 The use of an AI-generated chatbot is proposed as a solution to these problems by requiring individual interaction with the chatbot prior to clinical training. An educational chatbot was developed and trialed in a group of third-year Doctor of Dental Medicine students. A history-taking chatbot was developed with the student user/"clinician" taking a history from the chatbot/"patient" Students could interact either verbally or by typing. The chatbot was hosted on Vercel, using the Next.js framework for the front end and utilizing Vercel's native serverless functions for access to OpenAI's Application Programming Interface at the backend (Figure 1). The chatbot employs the GPT-3.5 Instruct model with structured chat prompts based on an ideal script to guide patient-practitioner dialogue. A small illustrative section is shown in Figure 2. The use of generative AI allows the chatbot to understand variably expressed questions and respond as realistically as possible. Observation of the tutorial with the clinical educator acting as the patient found only two of 13 students actively participated by asking questions compared with 100% involvement with the chatbot. Students generally found the chatbot useful and perceived competence was improved following chatbot use (Figure 3). Most students also agreed that they participated more with the chatbot and that the chatbot would provide more opportunities for them to practice. Staff also recognized the versatility of the tool and AI's potential to generate more cases, although cautious of the current fallibility of generative accuracy. There is clear potential for educational chatbots in dental education which were well-received by staff and senior students. Future directions include development with GPT-4 and updated AI models, trialing with early-year dental students, and iterations of more cases. This study was supported by the FMH Media lab at The University of Sydney. Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians.

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, Tn 916 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.

Aim or Purpose: To analyse the caries status of primary school children in metropolitan and regional New South Wales (NSW) and regional Victoria. Materials and Methods: Ethics approval was obtained from The University of Sydney (HRECS 2022/839) to analyse the anonymized oral health data of 841 primary school children collected by the community outreach program, Carevan Sun Smiles in 2019. This retrospective case-cohort study investigated caries status of children at each school using ICDAS II scores. Analysis was undertaken based on age with four groups created - Group 1 (Kindergarten/Year1), Group 2 (Year 2/3), Group 3 (Years 3 and 4) and Group 4 (Years 5 and 6). The Kruskal-Wallis rank sum test was undertaken to compare ICDAS scores between schools for each age group. Results: The school with the highest caries burden (mean ICDAS II score = 1.45) and the biggest range in scores (ICDAS 1 - 1.68) was the regional Victorian school compared to both NSW schools (mean score of 1.40, ICDAS 1.27 - 1.5). However, this difference in school means was not statistically significant (Kruskal Wallis p=0.37). Furthermore, we found no statistical difference in mean ICDAS II score in all age groups between the three schools. Conclusions: Our results indicate that Australian regional communities may carry a heavier burden of tooth decay and this is consistent with the literature. While larger studies are required to provide more definitive results, access to preventive dental care remains a priority for primary school children to minimize treatment required and ensure long term oral health.

Aim or Purpose: To develop a prototype chatbot which simulates a patient to allow dental students to practice history taking skills as part of the patient interview for treatment planning. Materials and Methods: An existing patient case used in the first year of the Doctor of Dental Medicine program at the University of Sydney was adapted as the chatbot patient on the Google Dialogflow platform. Chatbot design targeted a specific learning outcome – to familiarize students with the Sydney Dental School patient interview protocol via interacting with the chatbot patient, Pia Patel. The prototype was tested by a range of academics, both clinicians (general dental practitioners) and non-clinical academics, from which their documented feedback informed further development throughout a period of six months. Results: The chatbot prototype of Pia Patel was successfully created, tested by academics and updated over a period of six months. A significant issue faced was programming the chatbot to respond consistently to the multitude of ways a single question can be asked. Overall feedback was generally positive, in terms of platform usability and authenticity of chatbot interactions. Conclusion/Clinical Significance: The use of chatbot patients in dental schools is an opportunity to improve foundational clinical skills through repeated exposure. The next steps include student trials of the chatbot to assess qualitative (feedback) and quantitative (student performance) data, the addition of more cases and the use of alternative platforms such as ChatGPT. Our results indicate the potential of artificial intelligence, particularly the usage of chatbots to improve student learning outcomes and subsequently patient care.

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.

Our paper reviews how dietary changes during human evolution have contributed to the increased incidence and prevalence of dental caries in modern populations by shifting the oral microbiome from a “healthy” to “carious” state. We addressed two questions: (1) what is the microbial difference between the states of health and caries, and (2) how has the development of an agricultural diet impacted the oral microbiome?

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.

Purpose: Prosthodontic treatment has a positive effect on oral health-related quality of life (OHRQoL); however, there is a paucity of studies assessing the impact of OHRQoL based on where in the mouth ("location") the treatment is performed. This exploratory study investigated the association of the location (anterior, posterior region) of prosthodontic treatment with magnitude and nature of OHRQoL changes.Methods: In this non-randomized prospective clinical study, 190 adult patients (17-83 years) were recruited at baseline and 104 were available for the follow-up analyses. Of those, 50 patients received treatment only in the posterior segment and 54 patients in both anterior and posterior regions. Treatment included conventional fixed partial prostheses, removable prostheses or a combination of both. OHRQoL was assessed with the German language version of the 49-item Oral Health Impact Profile (OHIP) at baseline and the questionnaire was repeated 4-6 weeks post-treatment. Magnitude and effect size of changes in summary and sub-scale scores were calculated and data analyzed.Results: Patients experienced a substantially impaired OHRQoL (mean OHIP score: 32.3 points) at baseline and an improvement in OHRQoL of 6.8 OHIP points following treatment. This study showed a greater improvement in OHRQoL in patients treated in both regions compared to those treated in the posterior region alone, especially in the function and aesthetic domains.Conclusions: This explorative study suggests that OHRQoL improvement is affected by where prosthodontic treatment is performed in the mouth. Greater understanding of qualitative aspects of reconstructive therapies is needed for improved treatment planning and patient consent. (C) 2014 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.

STATEMENT:A predictable esthetic outcome is imperative when placing ceramic veneers. Discolored teeth pose a major challenge as sufficient material thickness is required to achieve a good esthetic result. There is limited evidence in the literature that compares the masking ability of multi-laminate veneers.PURPOSE:The aim of this in-vitro study was to compare the masking ability of bi-laminate (BL) and tri-laminate (TL) all-ceramic veneers cemented on tooth-colored ceramic discs.MATERIALS AND METHODS:A total of 40 veneers (shade A1, 10-mm diameter, 0.8-mm thick) were manufactured-20 BL veneers (0.4-mm pressable ceramic coping veneered with 0.4-mm thick enamel layer) and 20 TL veneers (0.4-mm coping veneered with 0.2-mm thick opaque interlayer and 0.2-mm thick enamel layer). A bonding apparatus was utilized to adhesively cement all veneers on the ceramic discs (shade A1), simulating teeth of light and dark color. The resulting groups (N = 10 each) were the reference groups (shade A1 ceramic base) BL-1 and TL-1 veneers, and the test groups (shade A4 ceramic base) BL-4 and TL-4 veneers. The color of the cemented veneers was measured using a spectrophotometer. The data were converted to CIE L*a*b* coordinates, and ΔE* were calculated to allow for statistical analysis.RESULTS:The color differences between the samples with the A1 and A4 ceramic bases were significantly lower when covered with TL veneers (mean ΔE*: 3.2 units) than with BL veneers (mean ΔE*: 4.0 units: p < 0.001), indicating a better masking ability of the TL veneers.CONCLUSION:The 0.8-mm thick TL veneer was able to mask darker tooth-colored ceramic disc within clinically acceptable limits.CLINICAL SIGNIFICANCE:Increased understanding of the masking ability of ceramics and of color science is necessary in these esthetically aware times. Providing tri-laminate veneers for darker colored teeth seems to result in more predictable esthetical results than when using bi-laminate veneers. Patients with discolored/darker teeth may benefit from a more predictable esthetic result when teeth restored with tri-laminate rather than bi-laminate veneers.