The effect of mineral trioxide aggregate on the apexification and periapical healing of teeth with incomplete root formation

AIM

To evaluate the influence of mineral trioxide aggregate (MTA) on apexification and periapical healing of teeth in dogs with incomplete root formation and previously contaminated canals and to verify the necessity of employing calcium hydroxide paste before using MTA.

METHODOLOGY

Twenty premolars from two 6-month old dogs were used. After access to the root canals and complete removal of the pulp, the canal systems remained exposed to the oral environment for 2 weeks. Canal preparation was then carried out using Hedström files, under irrigation with 1% sodium hypochlorite, 1 mm short of the radiographic apex. After drying, the canals of two premolars in each dog were left empty (control group). The other eight teeth in each animal were divided into two experimental groups. The apical thirds of the canals of group 1 were filled with MTA. In the teeth of group 2, the canals were dressed with a calcium hydroxide-propylene glycol paste. After 1 week, the paste was removed and the apical third was filled with MTA. All teeth were restored with reinforced zinc oxide cement (IRM) and amalgam. The animals were killed 5 months later, and blocks of the teeth and surrounding tissues were submitted to histological processing. The sections were studied to evaluate seven parameters: formation of an apical calcified tissue barrier, level of barrier formation, inflammatory reaction, bone and root resorption, MTA extrusion, and microorganisms. Results of experimental groups were analysed by Wilcoxon's nonparametric tests and by the test of proportions. The critical value of statistical significance was 5%.

RESULTS

Significant differences (P < 0.05) were found in relation to the position of barrier formation and MTA extrusion. The barrier was formed in the interior of the canal in 69.2% of roots from MTA group only. In group 2, it was formed beyond the limits of the canal walls in 75% of the roots. MTA extrusion occurred mainly in roots from group 2. There was similarity between the groups for the other parameters.

CONCLUSIONS

Mineral trioxide aggregate used after root canal preparation favoured the occurrence of the apexification and periapical healing. The initial use of calcium hydroxide paste was not necessary for apexification to occur, and has shown to be strongly related to the extrusion of MTA and formation of barriers beyond the limits of the root canal walls.

Calcium hydroxide: a review

Calcium hydroxide is a multipurpose agent, and there have been an increasing number of indications for its use. Some of its indications include direct and indirect pulp capping, apexogenesis, apexification, treatment of; root resorption, iatrogenic root perforations, root fractures, replanted teeth and interappointment intracanal dressing. The purpose of this paper is to review the properties and various indications for the use of calcium hydroxide.

A novel dentifrice technology for advanced oral health protection: A review of technical and clinical data

Throughout the world, dentifrices have played a key role in the practice of good oral hygiene and promotion of better oral health. In addition to providing general dental cleaning, toothpastes also have served as an excellent vehicle for the introduction of new agents that deliver therapeutic and cosmetic benefits. Key examples of using dentifrices to provide added benefits include the introduction in 1955 of the first fluoridated toothpaste clinically proven to fight caries (Crest Cavity Protection) and the launch of the first tartar-control dentifrice (Crest Tartar Control) in the mid-1980s. To continue expanding the health and esthetic benefits offered by a single dentifrice, a multitude of agents have been investigated over the past 3 decades. The focus of these investigations has been in the multibenefit segment, the most widely used among US consumers.

Pharmacokinetic/Pharmacodynamic Evaluation of Antimicrobial Treatments of Orofacial Odontogenic Infections

OBJECTIVE

To evaluate the efficacy of antimicrobial therapy in oral odontogenic infections using estimated pharmacokinetic/pharmacodynamic parameters or efficacy indices, and to compare pharmacokinetic/pharmacodynamic breakpoints with National Committee for Clinical Laboratory Standards' (NCCLS) breakpoints.

STUDY DESIGN

Retrospective literature search to obtain minimum inhibitory concentration (MIC) values, pharmacokinetic parameters of antimicrobials and NCCLS breakpoints. Pharmacokinetic simulations were carried out using WinNonlin software (Pharsight Corporation, Mountain View, CA, USA).

METHODS

For antimicrobials with time-dependent activity, the time that the plasma drug concentration exceeds the MIC as the percentage of dose interval at steady state was calculated. For antimicrobials with concentration-dependent activity, the total area under the plasma concentration-time curve over 24 hours at steady state divided by the MIC was calculated. Pharmacokinetic/pharmacodynamic breakpoints were calculated according to these parameters.

RESULTS

Only amoxicillin/clavulanic acid and clindamycin showed adequate efficacy indices against the most commonly isolated bacteria in odontogenic infections. Metronidazole reached good indices against anaerobes only. Pharmacokinetic/pharmacodynamic susceptibility breakpoints do not coincide exactly with NCCLS breakpoints.

CONCLUSION

Owing to the scarcity of double-blind, clinical trials on the use of antimicrobials in endodontics, this study may be useful in determining the best antimicrobial treatment in these infections. However, as we have not used concentration data in infected tissue to determine pharmacokinetic/pharmacodynamic indices, it would be necessary to design clinical trials in order to confirm these results.

Azithromycin and dentistry - a useful agent?

OBJECTIVES

Azithromycin has recently replaced clindamycin oral suspension for prop hylaxis of infective endocarditis (IE) in children. It is also currently recommended by the American Heart Association as an alternative to penicillin, along with clindamycin for prophylaxis of infective endocarditis in adults. The objectives of this paper were to firstly, review the current literature on the efficacy of azithromycin as a suitable prophylactic agent in the prevention of infective endocarditis; and secondly, to review its pharmacological properties as a suitable therapeutic agent in the management of odontogenic infections.

DESIGN

A review of the literature.

CONCLUSIONS

The available evidence from animal models on infective endocarditis supports the efficacy of this drug as a prophylactic agent against oral streptococci. The pharmacological properties of this agent would make it a very promising therapeutic adjunct in the management of odontogenic infections. At present there are only a small number of studies available with valuable data on the efficacy of this relatively new drug. Further investigations comparing this compound with other commonly used adjuncts would be of great benefit.

Prescribing antibiotics in odontology and stomatology. Recommendations by the French Health Products Safety Agency

In order to limit the onset of adverse effects and the increasing emergence of bacterial resistance, the prescription of antibiotics must be reserved strictly for situations where their efficacy has been demonstrated. The French Health Products Safety Agency (Afssaps) has updated recommendations concerning the use of antibiotic treatment in odontology and stomatology. The general strategy for the prescription of antibiotics proposed by the present recommendations relies on a professional consensus. The full-length, discussed and referenced text is available at the web site of Afssaps (http://www.afssaps.sante.fr) in the 'Documentation et publications' rubric'.

Revisiting the Role of Dentists in Prescribing Antibiotics

The purpose of this paper is to review the principles of therapeutic and prophylactic prescribing in light of the increasing problem of antibiotic resistance and the evidence of inappropriate use of antibiotics in dentistry. Recommendations based on a review of the evidence and good practice for prescribing therapeutic and prophylactic antibiotics will be given.

Paget’s Disease

A review of the signs, symptoms, and treatment of Paget's disease is presented. Paget, or osteitis deformans, is a chronic, progressive, bone disease of viral etiology. Recent investigations about the causative agent of this disorder have implicated the measles virus of the paramyxovirus family. Additional studies have demonstrated that abnormal virus-infected osteoclasts generate interleukin (IL)-6, a resorptive cytokine from the bone marrow of patients with Paget's bone disease.

Endodontic treatment of permanent teeth in children with a new calcium-carbamide-formaldehyde paste

AIM, MATERIAL AND METHODS: Endodontic treatment of a total of 303 teeth with pulpitis and periodontitis was performed with a new calcium-carbamide-formaldehyde paste. In three children with fractured teeth with complications, the applied treatment was combined (2 teeth with apical osteotomy and 1 with cystectomy). Control examinations were carried out at months 6, 12 and 24 and clinically healthy teeth and teeth with complications were registered.

RESULTS

In the pulpitis group the clinically healthy teeth were 97.55% +/- 1.08 at the 6th month; 96.85% +/- 1.26 at the 12th month and 92.92% +/- 2.41 at the 24th month. In teeth with periodontitis 91.56% +/- 3.05 were clinically healthy at the 6th month; 93.83% +/- 2.67 at the 12th month and 98.03% +/- 1.98 at the 24th month. No statistical significance of the differences between pulpites and periodontites was found (P > 0.05). Recovery of the bone structure was observed in the teeth with combined endodontic and surgical treatment at the 12th month.

CONCLUSIONS

The calcium-carbamide-formaldehyde paste stimulates bone regeneration and closing of the apex without coloring the hard dental tissues.

Dentistry and self-medication: a current challenge

The classical definition of self-medication is "the taking of drugs, herbs or home remedies on one's own initiative, or on the advice of another person, without consulting a doctor". Used as a solution to the wide range of complaints and minor health problems which may appear over a lifetime, it can be the result of an individual choice or by the influence of a family who is well informed about which techniques and drugs are safe and useful. This paper reviews the concept of self-medication, placing particular emphasis on the common self-medication errors within dentistry and their negative consequences in terms of systemic disease. Used in a responsible way self-medication is desirable because, as an independent search for a drug treatment, it can complement the work of health professionals. Furthermore, it represents a self affirming, independent attitude on the part of patients. Information, therapeutic advice and education are argued to be the basic elements underlying responsible self-medication.

Evaluation of oral antimicrobial agent levels in tooth extraction sites

OBJECTIVE

The purpose of this study was to evaluate various oral antimicrobial agent levels in tooth extraction sites.

STUDY DESIGN

The concentration of dental alveolar blood in extraction wounds after the oral administration of talampicillin (500 mg), cefaclor (500 mg), cefteram pivoxil (200 mg), cefuroxime axetil (250 mg), cefdinir (200 mg), and ofloxacin (100 mg) was determined in 338 patients and was assessed on the basis of its antimicrobial activity against Streptococcus isolated in odontogenic infections.

RESULTS

The percentage of patients whose concentrations exceeded the minimum inhibitory concentration for 90% of Streptococcus was 62.5% to 100% for talampicillin at 30 to 360 minutes, 0% to 12.5% for cefaclor at 30 to 360 minutes, 18.2% to 100% for cefteram pivoxil at 30 to 480 minutes, 50% to 100% for cefuroxime axetil at 30 to 480 minutes, 0% to 50% for cefdinir at 16 to 290 minutes, and 0% to 40% for ofloxacin at 30 to 480 minutes.

CONCLUSION

These results indicate that talampicillin, cefteram pivoxil, and cefuroxime axetil have minimum inhibitory concentration levels for 90% of Streptococcus in tooth sockets.

[Analgesic effect of Pilostigma reticulatum (nguiguis)]

Mankind has always given himself means to fight pain by using at first, means offered to him by his environment particularly the plants. African pharmacopoeia is rich of thousand of plants. It changes in term of its ecosystem and its vegetation. Decocted leaves of pilostigma reticulatum (nguiguis in ouolof) are used in western Africa, because of its analgesic properties in case of "borom bop" literally meaning headache associated to odontalgias and mumps. In our study we used lyophilisate obtained from dry leaves of the plant which has been used for experimentation while the decocted dry leaves have been used for clinical application. So, it appeared that leaves of pilostigma reticulatum are almost atoxic when administrated by oral tract (DL50 = 17 g/kg) according to GLEASON classification which recognizes as atoxic every substance having a DL50 higher to 15 g of lyophilisate by kilogram of corporal weight. Elsewhere the study of the peripheric analgesic activity (according to the acetic acid test) has shown a very significant peripheric analgesia since the dose of 750 mg/kg which climbs with it. The clinical survey carried out at the dental community center of Pikine Icotaf based on the usual method of the utilization of the decocted (as mouth rinse) has shown that, this plant procures pain sedation in 97% of the patients having undergone dental avulsion and in 78% of the cases of desmondontal syndromes. This inaugural report must be continued in order to certify the pharmacologic or toxic effects of that plant and define clinical doses from experimental doses we have cleared.

[Self medication during orodental diseases in urban Ivory Coast. Results of a study in the region of Abidjan]

During six months, a study enclosing 418 patients from 15 to 60 years old, has been realised in nine dental offices of the Abidjan area. Self-medication has been found among 37.32 per cent of the patients. The most concerned medicines are no steroid inflammatories, analgesics and antibiotics. According to this study, the main reasons of the self-medication are the pain, the lack of money, the practice and the fear of the dental surgeon. The medicines are obtained at the chemist's or bought at the market or in the street. The results of the study are compared to others did in different specialities.

Equine dental disease part 4: a long-term study of 400 cases: apical infections of cheek teeth

Of 400 horses referred because of equine dental disease, 162 suffered from primary apical infections of their cheek teeth (CT), including 92 with maxillary CT infections and 70 with mandibular CT infections. Maxillary swellings and sinus tracts were more common (82 and 26% incidence, respectively) with infections of the rostral 3 maxillary CT, than with infections of the caudal 3 maxillary CT (39 and 5% incidence, respectively). Nasal discharge was more commonly present with caudal (95%) than rostral (23%) maxillary CT infections. Mandibular CT apical infections commonly had mandibular swellings (91%) and mandibular sinus tracts (59%) and these infections were closely related to eruption of the affected CT. A variety of treatments, including medical treatment, apical curettage, repulsion and oral extraction of affected teeth were utilised in these cases, with oral extraction appearing to be most satisfactory. Infections of caudal maxillary CT with a secondary paranasal sinusitis were most refractory to treatment, with a complete response to the initial treatment achieved in just 33% of these cases. Most other cases responded fully to their initial treatment. The long-term response to treatment was good in most cases.

Antibiotic prescribing for dental conditions: general medical practitioners and dentists compared

OBJECTIVE

To compare the level of prescribing and types of antibiotics prescribed for dental problems by general medical practitioners and dentists.

DESIGN

Secondary analysis of standard consultation data and prescription records from four different settings.

SETTING

30 participating general practices in the General Practice Morbidity Database for Wales in 1996.

SUBJECTS

1,185 attendances for tooth-related problems, at 30 participating practices in the General Practice Morbidity Database for Wales in 1996. Standard consultation records from a GDP emergency dental rota, and two weekend emergency dental clinics: one in a health centre, the other in a dental hospital.

RESULTS

More than two thirds (68%) of attendances at general medical practices for tooth-related problems resulted in a prescription for antibiotics. In contrast less than a third (28%) of patients seen by a GDP rota, about half (52%) of patients at a weekend emergency clinic in a health centre, and just more than a third (38%) of patients attending the dental hospital clinic received antibiotics. General medical practitioners were also more likely to prescribe broad-spectrum antibiotics than dentists.

CONCLUSION

For acute dental problems general medical practitioners are more likely to prescribe antibiotics than dentists. There also appear to be inter-professional differences in the tendency to prescribe broad spectrum antibiotics. Initiatives to rationalise prescribing for dental conditions may need to target doctors as well as dentists.

Acute dentoalveolar infections: an investigation of the duration of antibiotic therapy

OBJECTIVE

To evaluate shortened courses of antibiotics in the management of dentoalveolar abscesses.

DESIGN

Prospective clinical study over a 3-year period.

SETTING

Examinations department of the Liverpool University Dental Hospital.

SUBJECTS

759 patients, with acute dentoalveolar abscesses associated with swelling, and an elevation of axillary temperature to above 38.5 degrees C, were included in the investigation. The minimum age of the patients was 16 years.

INTERVENTIONS

The initial treatment was to drain the abscess by incision (124 patients), or extraction (635). The patients were prescribed amoxycillin (250 mg every 8 hours), clindamycin (150 mg every 6 hours) or erythromycin stearate (250 mg every 6 hours) and instructed to drink plenty of fluid. All the patients were seen 2 or 3 and 10 days later; only patients who were seen at these times were included in the trial.

MAIN OUTCOME MEASURES

Resolution of the swelling and a normal axillary temperature.

RESULTS

At first review 748 patients (98.6%) had normal temperatures, marked resolution of the swelling and the antibiotic was discontinued. None of these 748 patients required further antibiotic therapy.

CONCLUSIONS

The duration of antibiotic therapy in most patients with acute dentoalveolar infections can safely be 2-3 days, provided that drainage has been established. It is not, therefore, necessary for the majority of patients to complete a 5-day course of antibiotics.

[Use of drugs in stomatology II. Use of antibiotics in dental practice]

The authors summarized 514 questionner on dental patient medication, and established that, the dentists use an average in Hungary 29 box antibiotics per months. The most frequently prescribed medicine (Dalacin C, Rulid, Augmentin, Semicillin, Maripen, Doxycycline) take the 75% of the total number. The 52% of dentists use antibiotics for prophylactic aims, 94.6% for the treatment of inflammatory diseases. The examination gave data for creating the picture of the use of antibiotics in Hungarian dental practice in 1995.

Antibiotic prescription for acute dental conditions in the primary care setting

To determine the pattern of antibiotic prescribing (source and type) for acute dental conditions in the emergency setting, a prospective cross-sectional study was undertaken of 500 consecutive new patients attending the examination and emergency clinic of the Cardiff Dental Hospital in May 1994. The source and type of antibiotics prescribed, the nature of complaint and type of antibiotic prescribed in the primary care and dental hospital setting were recorded. Antibiotic prescription was a feature of the treatment of 30% (149/500) of patients. The 60 patients who had received emergency treatment prior to attending the hospital emergency clinic had been prescribed a total of 14 different types of antibiotics; 41% of these patients had sought treatment from general medical practitioners. Antibiotics were frequently prescribed without generally accepted criteria and there was wide variation in prescribing. Overall, only seven different types of antibiotics were prescribed in the dental hospital setting. The use of second generation antibiotics was more common in general practice than in the dental hospital. The results suggest that many patients with dental pain may seek treatment from medical practitioners, prior to, or in place of, definitive dental treatment. In summary, rationalisation of antibiotic prescription and the provision of emergency dental treatment is needed.

An audit of antibiotic prescribing by general practitioners in the initial management of acute dental infection

A sub-regional audit showed a high rate of referral of acute dentoalveolar infections as emergencies. In Torbay Hospital alone, 21 patients required admission following such referrals in a period of 3 months. A questionnaire was therefore sent out to all general medical and general dental practitioners in the area covered by Torbay Hospital in order to survey their choice of antibiotics in the initial management of acute dentoalveolar infections. The results showed that the prescribing patterns of general medical practitioners differed significantly from those of general dental practitioners and that practitioners were reluctant to prescribe metronidazole as a first choice, even in patients allergic to penicillin. The authors conclude that awareness about the use of antibiotics, particularly among general dental practitioners, needs to be increased.

Pharmacologic management of patients with diseases of the endocrine system

Endocrine disorders are commonly seen in the general population. This article discusses the physiology, pathogenesis, and the medical and dental management of patients with thyroid, parathyroid, and pituitary gland disorders. In addition, the pharmacologic treatment, common side effects, and dental drug interactions of concern are discussed.