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Guzmán-Flores EC, Fuentes-Ayala AR, Martínez-Martínez AC, Aguayo-Félix DE, Arellano-Osorio MV, Campuzano-Donoso M, Román-Galeano NM, Llerena-Velásquez M, Vásquez-Tenorio Y. Reduction of aerosol dissemination in a dental area generated by high-speed and scaler ultrasonic devices employing the "Prime Protector". PLoS One 2023; 18:e0278791. [PMID: 37535637 PMCID: PMC10399923 DOI: 10.1371/journal.pone.0278791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
The use of an external dome aerosol containment device (Prime Protector) is proposed to reduce the spread of particles within the dental office. Hence, the aim of our study was to compare the spread of bioaerosols generated by a High-speed Handpiece (HH) and an Ultrasonic Prophylaxis Device (UPD), with and without the Prime Protector dome (PP) by counting Colony Forming Units (CFU) of Lactobacillus casei Shirota, at different distances on the x and y axis. The PP was located considering the parallelism between the base of the dome and the frontal plane of the simulator, aligning the center of the mouth with the center of the dome. The PP dome measurements are 560.0mm x 255.0mm x 5mm. Petri dishes were placed at 0.5 m, 1 m and 1.5 m respectively. Aerosol generation in the laboratory environment was done three times with the following experimental groups 1) HH, 2) HH-PP, 3) UPD, 4) UPD-PP. Each dental device activation (HH and UPD) had a time frame of 2 minutes on the upper anterior teeth of the dental phantom with a liquid suspension containing Lactobacillus casei Shirota (YAKULT 0836A 0123; 1027F 0407). Air pressure and ventilation were parameterized. No separate high-volume evacuation used, nor was there any air removal attached to the dome. Results showed no significant difference between distance and axis in the CFU count. When means for devices and distances were compared between each of them all showed significant differences except for UPD and UPD-PP (p <0,004). In conclusion, external devices like Prime Protector could help decrease aerosol diffusion during high-speed handpiece activation. However, this dome does not replace the use of PPE inside dental clinics.
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Affiliation(s)
| | | | | | | | | | - Martín Campuzano-Donoso
- School of Dentistry, Faculty of Medical Sciences, International University of Ecuador, Quito, Ecuador
| | | | - Melanie Llerena-Velásquez
- School of Dentistry, Faculty of Medical Sciences, International University of Ecuador, Quito, Ecuador
| | - Yajaira Vásquez-Tenorio
- School of Dentistry, Faculty of Medical Sciences, International University of Ecuador, Quito, Ecuador
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Wang BY, Henrichs LE, Arricale K, Lien W, Savett DA, Vandewalle KS. Efficacy of a chairside extraoral suction system in the reduction of aerosol contamination. Gen Dent 2023; 71:16-21. [PMID: 37083608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
The dental setting is regarded as a high-risk environment for aerosol concentrations and transmission of respiratory infectious agents, especially in relation to the COVID-19 pandemic. Although a number of approaches and practices have evolved to reduce the spread of pathogens in the dental setting, the risk of airborne infection remains a concern. Several new extraoral suction (EOS) devices have been marketed recently; further investigation is warranted to determine their clinical effectiveness. The aim of this study was to evaluate the efficacy of a chairside EOS device (PAX 2000 Extraoral Dental Suction System) in reducing aerosol contamination from patients receiving ultrasonic scaling by a registered hygienist as a part of initial or supportive periodontal therapy. The number of colony-forming units (CFUs) was measured with agar plates before, during, and after ultrasonic scaling at 3 different locations in the dental operatory (instrument table, patient chest area, and patient foot area). Forty subjects were randomly allocated into 2 test groups (n = 20) in which ultrasonic scaling was performed with or without the use of the EOS device. The CFUs retrieved after incubation were quantified and identified by their bacterial or fungal taxon. The use of the EOS device reduced the number of CFUs during scaling at all 3 locations, but the difference was only statistically significant (P = 0.018; Mann-Whitney U test) at the patient's chest area, where the highest number of CFUs was present. The aerosols consisted of 74 different taxa of human origin. The results suggest that the tested EOS system may reduce aerosol contamination in the clinical dental setting, especially in proximity to the patient's head, where most aerosols are generated.
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Thornhill MH, Crum A, Rex S, Stone T, Campbell R, Bradburn M, Fibisan V, Lockhart PB, Springer B, Baddour LM, Nicholl J. Analysis of Prosthetic Joint Infections Following Invasive Dental Procedures in England. JAMA Netw Open 2022; 5:e2142987. [PMID: 35044470 PMCID: PMC8771300 DOI: 10.1001/jamanetworkopen.2021.42987] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
Importance Dentists in the United States are under pressure from orthopedic surgeons and their patients with prosthetic joints to provide antibiotic prophylaxis before invasive dental procedures (IDP) to reduce the risk of late prosthetic joint infection (LPJI). This has been a common practice for decades, despite a lack of evidence for an association between IDP and LPJI, a lack of evidence of antibiotic prophylaxis efficacy, cost of providing antibiotic prophylaxis, and risk of both adverse drug reactions and the potential for promoting antibiotic resistance. Objective To quantify any temporal association between IDP and subsequent LPJI. Design, Setting, and Participants This cohort study used a case-crossover and time trend design to examine any potential association between IDP and LPJI. The population of England (55 million) was chosen because antibiotic prophylaxis has never been recommended to prevent LPJI in England, and any association between IDP and LPJI would therefore be fully exposed. All patients admitted to hospitals in England for LPJI from December 25, 2011, through March 31, 2017, and for whom dental records were available were included. Analyses were performed between May 2018 and June 2021. Exposures Exposure to IDP. Main Outcomes and Measures The main outcome was the incidence of IDP in the 3 months before LPJI hospital admission (case period) compared with the incidence in the 12 months before that (control period). Results A total of 9427 LPJI hospital admissions with dental records (mean [SD] patient age, 67.8 [13.1] years) were identified, including 4897 (52.0%) men and 4529 (48.0%) women. Of these, 2385 (25.3%) had hip prosthetic joints, 3168 (33.6%) had knee prosthetic joints, 259 (2.8%) had other prosthetic joints, and 3615 (38.4%) had unknown prosthetic joint types. There was no significant temporal association between IDP and subsequent LPJI. Indeed, there was a lower incidence of IDP in the 3 months prior to LPJI (incidence rate ratio, 0.89; 95% CI, 0.82-0.96; P = .002). Conclusions and Relevance These findings suggest that there is no rationale to administer antibiotic prophylaxis before IDP in patients with prosthetic joints.
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Affiliation(s)
- Martin H. Thornhill
- Unit of Oral and Maxillofacial Medicine Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
- Department of Oral Medicine, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Annabel Crum
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Saleema Rex
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Tony Stone
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Richard Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Mike Bradburn
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Veronica Fibisan
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Peter B. Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Bryan Springer
- Joint Replacement Surgeon, OrthoCarolina, Charlotte, North Carolina
| | - Larry M. Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jon Nicholl
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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Abstract
BACKGROUND Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even for those at low risk of developing periodontal disease. There is debate over the clinical and cost effectiveness of 'routine scaling and polishing' and the optimal frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing, or both, of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), which does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. Routine scale and polish treatments are typically provided in general dental practice settings. The technique may also be referred to as prophylaxis, professional mechanical plaque removal or periodontal instrumentation.This review updates a version published in 2013. OBJECTIVES 1. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health.2. To determine the beneficial and harmful effects of routine scaling and polishing at different recall intervals for periodontal health.3. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health when the treatment is provided by dentists compared with dental care professionals (dental therapists or dental hygienists). SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 10 January 2018), and Embase Ovid (1980 to 10 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials of routine scale and polish treatments, with or without oral hygiene instruction, in healthy dentate adults without severe periodontitis. We excluded split-mouth trials. DATA COLLECTION AND ANALYSIS Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (or standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data. We calculated risk ratios (RR) and 95% CIs for dichotomous data. We used a fixed-effect model for meta-analyses. We contacted study authors when necessary to obtain missing information. We rated the certainty of the evidence using the GRADE approach. MAIN RESULTS We included two studies with 1711 participants in the analyses. Both studies were conducted in UK general dental practices and involved adults without severe periodontitis who were regular attenders at dental appointments. One study measured outcomes at 24 months and the other at 36 months. Neither study measured adverse effects, changes in attachment level, tooth loss or halitosis.Comparison 1: routine scaling and polishing versus no scheduled scaling and polishingTwo studies compared planned, regular interval (six- and 12-monthly) scale and polish treatments versus no scheduled treatment. We found little or no difference between groups over a two- to three-year period for gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis when comparing six-monthly scale and polish treatment versus no scheduled treatment was -0.01 (95% CI -0.13 to 0.11; two trials, 1087 participants), and for 12-monthly scale and polish versus no scheduled treatment was -0.04 (95% CI -0.16 to 0.08; two trials, 1091 participants).Regular planned scale and polish treatments produced a small reduction in calculus levels over two to three years when compared with no scheduled scale and polish treatments (high-certainty evidence). The SMD for six-monthly scale and polish versus no scheduled treatment was -0.32 (95% CI -0.44 to -0.20; two trials, 1088 participants) and for 12-monthly scale and polish versus no scheduled treatment was -0.19 (95% CI -0.31 to -0.07; two trials, 1088 participants). The clinical importance of these small reductions is unclear.Participants' self-reported levels of oral cleanliness were higher when receiving six- and 12-monthly scale and polish treatments compared to no scheduled treatment, but the certainty of the evidence is low.Comparison 2: routine scaling and polishing at different recall intervalsTwo studies compared routine six-monthly scale and polish treatments versus 12-monthly treatments. We found little or no difference between groups over two to three years for the outcomes of gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis was 0.03 (95% CI -0.09 to 0.15; two trials, 1090 participants; I2 = 0%). Six- monthly scale and polish treatments produced a small reduction in calculus levels over a two- to three-year period when compared with 12-monthly treatments (SMD -0.13 (95% CI -0.25 to -0.01; 2 trials, 1086 participants; high-certainty evidence). The clinical importance of this small reduction is unclear.The comparative effects of six- and 12-monthly scale and polish treatments on patients' self-reported levels of oral cleanliness were uncertain (very low-certainty evidence).Comparison 3: routine scaling and polishing provided by dentists compared with dental care professionals (dental therapists or hygienists)No studies evaluated this comparison.The review findings in relation to costs were uncertain (very low-certainty evidence). AUTHORS' CONCLUSIONS For adults without severe periodontitis who regularly access routine dental care, routine scale and polish treatment makes little or no difference to gingivitis, probing depths and oral health-related quality of life over two to three years follow-up when compared with no scheduled scale and polish treatments (high-certainty evidence). There may also be little or no difference in plaque levels over two years (low-certainty evidence). Routine scaling and polishing reduces calculus levels compared with no routine scaling and polishing, with six-monthly treatments reducing calculus more than 12-monthly treatments over two to three years follow-up (high-certainty evidence), although the clinical importance of these small reductions is uncertain. Available evidence on the costs of the treatments is uncertain. The studies did not assess adverse effects.
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Affiliation(s)
- Thomas Lamont
- University of Dundee, Dental School & HospitalPark PlaceDundeeTaysideUKDD1 4HN
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3Oxford RoadManchesterUKM13 9PL
| | - Janet E Clarkson
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthCoupland Building 3Oxford RoadManchesterUKM13 9PL
- Dundee Dental School, University of DundeeDivision of Oral Health SciencesPark PlaceDundeeScotlandUKDD1 4HR
| | - Paul V Beirne
- University College CorkDepartment of Epidemiology and Public Health4th Floor, Western Gateway Building, Western RoadCorkIreland
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Sharma P, Cockwell P, Dietrich T, Ferro C, Ives N, Chapple ILC. INfluence of Successful Periodontal Intervention in REnal Disease (INSPIRED): study protocol for a randomised controlled pilot clinical trial. Trials 2017; 18:535. [PMID: 29132440 PMCID: PMC5683458 DOI: 10.1186/s13063-017-2236-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 10/04/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) exhibit increased morbidity and mortality which is associated with an increased systemic inflammatory burden. Identifying and managing comorbid diseases that contribute to this load may inform novel care pathways that could have a beneficial impact on the morbidity/mortality associated with CKD. Periodontitis, a highly prevalent, chronic inflammatory disease affecting the supporting structures of teeth, is associated with an increased systemic inflammatory and oxidative stress burden and the successful treatment of periodontitis has been shown to reduce both. This pilot study aims to gather data to inform a definitive study into the impact of successful periodontal treatment on the cardio-renal health of patients with CKD. METHODS/DESIGN This pilot study will employ a randomised, controlled, parallel-group design. Sixty adult patients, with CKD with a high risk of progression and with periodontitis, from the Queen Elizabeth Hospital, Birmingham, will be randomised to receive either immediate, intensive periodontal treatment (n = 30) or treatment at a delay of 12 months (n = 30). Patients will be excluded if they have reached end-stage renal disease or have received specialist periodontal treatment in the previous year. Periodontal treatment will be delivered under local anaesthetic, on an outpatient basis, over several visits by a qualified dental hygienist at the Birmingham Dental Hospital, UK. Patients in the delayed-treatment arm will continue to receive the standard community level of periodontal care for a period of 12 months followed by the intensive periodontal treatment. Randomization will occur using a centralised telephone randomisation service, following baseline assessments. The assessor of periodontal health will be blinded to the patients' treatment allocation. Patients in either arm will be followed up at 3-monthly intervals for 18 months. Aside from the pilot outcomes to inform the practicalities of a larger trial later, data on cardio-renal function, periodontal health and patient-reported outcomes will be collected at each time point. DISCUSSION This pilot randomised controlled trial will investigate the viability of undertaking a larger-scale study investigating the effect of treating periodontitis and maintaining periodontal health on cardio-renal outcomes in patients with CKD. TRIAL REGISTRATION National Institute of Health Research (NIHR) Clinical Research Network (UKCRN ID: 18458), ID: ISRCTN10227738 . Registered retrospectively to both registers on 23 April 2015.
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Affiliation(s)
- Praveen Sharma
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, Birmingham, B5 7EG UK
- College of Medical and Dental Sciences, University of Birmingham, and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, B5 7EG UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospital Birmingham, Birmingham, B15 2GW UK
| | - Thomas Dietrich
- College of Medical and Dental Sciences, University of Birmingham, and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, B5 7EG UK
- Department of Oral Surgery, School of Dentistry, Institute of Clinical Sciences, Birmingham, B5 7EG UK
| | - Charles Ferro
- Department of Renal Medicine, University Hospital Birmingham, Birmingham, B15 2GW UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Heath Research, Birmingham, B15 2TT UK
| | - Iain L. C. Chapple
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, Birmingham, B5 7EG UK
- College of Medical and Dental Sciences, University of Birmingham, and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, B5 7EG UK
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6
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Ding F, Lyu YL, Xuan W, Liu DY, Duan XQ, Han X. [Bleeding control of periodontal mechanical therapy for patients taking aspirin]. Beijing Da Xue Xue Bao Yi Xue Ban 2017; 49:49-53. [PMID: 28203003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the feasibility of periodontal mechanical therapy for chronic periodontitis and coronary heart disease patients with low dose of aspirin. METHODS Sixty nine chronic periodontitis patients with coronary heart disease were randomly selected as the experimental group (medication group, group A), the control group (withdrawal group, group B) including 20 chronic periodontitis patients with coronary artery disease, stopping the drug for one week and another control group with 50 chronic periodontitis patients (group C). The three groups were examined with pocket probing, and received supragingival scaling, subgingival scaling, and root planning. Local bleeding after operation was observed. In 30 minutes after periodontal mechanical treatment, there was still a need to take some hemostatic measures (containing the oxidized cellulose putting in the periodontal pocket, gauze oppressing, and suturing). Nd:YAG laser was used to stop bleeding 60 minutes after operation. RESULTS At baseline, there was no significant difference in the three groups, as to the plaque index(PLI), the probing depth (PD), and the attachment loss (AL). The bleeding index (BI)in group A was significantly higher than that in group C (P=0.024), higher than that in group B (P=0.088). The platelet maximum aggregation rate (Agg(max)) was detected in some subjects. The average Agg(max) value group A was 15.2%, which was much greater than that in group B (60.7%) and group C (62.5%). The three groups were all safe in the treatment of periodontal therapy. There were five cases of active bleeding in group A, one case in group B and one case in group C in 30 minutes after operation. In 60 minutes after operation, there was one case of bleeding actively in group A. Nd:YAG laser was used to stop bleeding successfully. CONCLUSION The chronic periodontitis and coronary heart disease patients with long-term oral administration of low dose of aspirin can be safely treated with periodontal mechanical treatment, and the effect of local hemostasis is positive without stopping the drug.
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Affiliation(s)
- F Ding
- Department of Stomatology,Beijing Anzhen Hospital,Capital Medical University Beijing 100029,China
| | - Y L Lyu
- Department of Stomatology,Beijing Anzhen Hospital,Capital Medical University Beijing 100029,China
| | - W Xuan
- Department of Stomatology,Beijing Anzhen Hospital,Capital Medical University Beijing 100029,China
| | - D Y Liu
- Department of Stomatology,Beijing Anzhen Hospital,Capital Medical University Beijing 100029,China
| | - X Q Duan
- Department of Stomatology,Beijing Anzhen Hospital,Capital Medical University Beijing 100029,China
| | - X Han
- Department of Stomatology,Beijing Anzhen Hospital,Capital Medical University Beijing 100029,China
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Hägi TT, Stirnimann G, Stutz A, Lang NP. [Not Available]. Swiss Dent J 2017; 127:315-323. [PMID: 28480950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Non-surgical periodontal therapy is often performed as a combinational approach using supplemental systemic amoxicillin and metronidazole. Better clinical outcomes, less need for periodontal surgery and limited systemic complications are arguments to justify such an approach. However, combination therapy with systemic antibiotic treatment is still a matter of debate due to emerging antibiotic resistance patterns. In this case report, a 61-year-old women suffering from an acute pancreatitis following systemic antibiotic combinational treatment as part of a non-surgical periodontal therapy is described. Following adequate symptomatic treatment during a hospitalization of three days, the patient recovered and periodontal conditions improved significantly thereafter. This case report illustrates a rare, but potentially serious complication when prescribing systemic combinational antibiotics in non-surgical periodontal therapy. Adequate history taking and timely diagnosis of pancreatitis if developing is important to provide relevant treatment and to avoid pancreatitis-associated complications.
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Affiliation(s)
- Tobias T Hägi
- Klinik für Parodontologie, Zahnmedizinische Kliniken der Universität Bern, Bern, Switzerland
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8
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Abstract
Infective endocarditis (IE) is an uncommon but potentially devastating disease. Recently published data have revealed a significant increase in the incidence of IE following the restriction on indications for antibiotic prophylaxis as recommended by the revised guidelines. This study aims to reexamine the basic assumption behind the rationale of prophylaxis that dental procedures increase the risk of IE.Using the Longitudinal Health Insurance Database of Taiwan, we retrospectively analyzed a total of 739 patients hospitalized for IE between 1999 and 2012. A case-crossover design was conducted to compare the odds of exposure to dental procedures within 3 months preceding hospitalization with that during matched control periods when no IE developed.In the unadjusted model, the odds ratio (OR) was 0.93 for tooth extraction (95% confidence interval [CI] 0.54-1.59), 1.64 for surgery (95% CI 0.61-4.42), 0.92 for dental scaling (95% CI 0.59-1.42), 1.69 for periodontal treatment (95% CI 0.88-3.21), and 1.29 for endodontic treatment (95% CI 0.72-2.31). The association between dental procedures and the risk of IE remained insignificant after adjustment for antibiotic use, indicating that dental procedures did not increase the risk of IE.Therefore, this result may argue against the conventional assumption on which the recommended prophylaxis for IE is based.
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Affiliation(s)
- Pei-Chun Chen
- From the Clinical Informatics and Medical Statistics Research Center (PCC, CJC); Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei (YCT, LSW, YSL, PHC); Department of Radiology, Chang Gung Memorial Hospital, Linkou (PWW); Department of Orthodontics and Craniofacial Dentistry, Division of Periodontology, Chang Gung Memorial Hospital, Taipei, Taiwan; and Cheers Dental Clinic, New Taipei, Taiwan (SK); Healthcare Center (PHC); and Heart Failure Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan (PHC)
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9
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Ermetici M, Segù M, Butera A. Comparison to the scanning electron microscope of professional dental hygiene methods on metal-free layered structures and metal-free monolithic structures processed by different polymerization cycles. Minerva Stomatol 2014; 63:189-202. [PMID: 25267148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Aim of the study was to find effective instrumental methodologies and procedures for scaling and deplaquing without compromising the structure of metal-free, monolithic lithium disilicate and layered zirconia prosthetics. METHODS Of 14 decontaminated, extracted teeth in good anatomical condition, 7 veneers lithium disilicate monolithic and 7 layered zirconia crowns were prepared for testing and divided into 6 treatment groups. Each group was composed of a veneer and a crown. The division of the groups was carried out according to the type of treatment performed- instrumental carbon fiber and steel tips, prophylaxis paste with high and low RDA (Relative dentin abrasion), bicarbonate powder. Samples were examined and observed through a scanning electron microscope (SEM). Afterwards a detailed comparison of the images of treated and untreated samples was performed. The images were at the same magnification, thus showing the differences in the treated samples. RESULTS The monolithic lithium disilicate presents minor damage to the surface but no excessive changes to the structure in general post treatment. The layered zirconia resulted in notable damage with evident abrasions on the layered ceramic structure after the use of ultrasound with a steel tip and air flow with bicarbonate. Carbon fibre tips and prophylaxis paste containing perlite and low RDA did not create notable changes to the properties of the materials in question. CONCLUSION The results of the disilicate monolithic appear to show it to be a much more resistant material compared to layered zirconia in ceramic. Its resistance is demonstrated by the lack of notable damage in all the treatment groups.
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Affiliation(s)
- M Ermetici
- Department of Dental Hygiene University of Pavia, Pavia, Italy -
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Wilson NHF, Lynch CD, Wilson NHF, Lynch CD. Prevention and management of scale and polish damage to resin composite restorations. Prim Dent J 2014; 3:70-71. [PMID: 25215345 DOI: 10.1308/205016814812143932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Background The use of resin composite in the restoration of, in particular, posterior teeth is increasing. This trend is set to continue, with the momentum-gathering shift towards minimal-intervention direct approaches to the restoration of diseased, damaged and worn teeth, and subsequent to the signing of the Minamata Convention, aimed, amongst other measures, at ‘phasing down’ the use of dental amalgam.1–3 As a result, members of the dental team should, it is suggested, give consideration to the prevention and management of the damage that routine scaling and polishing may cause to the margins and surfaces of restorations of resin composite, or indeed restorations of other tooth-coloured restorative systems. Such damage may compromise the aesthetic qualities and reduce the life expectancy of tooth-coloured restorations. This article focuses on the prevention and management of scale and polish damage to resin composite restorations.
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Abstract
BACKGROUND Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing or both of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), that does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. OBJECTIVES The objectives were: 1) to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; 2) to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; 3) to compare the effects of routine scaling and polishing with or without oral hygiene instruction (OHI) on periodontal health; and 4) to compare the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 15 July 2013), CENTRAL (The Cochrane Library 2013, Issue 6), MEDLINE via OVID (1946 to 15 July 2013) and EMBASE via OVID (1980 to 15 July 2013). We searched the metaRegister of Controlled Trials and the US National Institutes of Health Clinical Trials Register (clinicaltrials.gov) for ongoing and completed studies to July 2013. There were no restrictions regarding language or date of publication. SELECTION CRITERIA Randomised controlled trials of routine scale and polish treatments (excluding split-mouth trials) with and without OHI in healthy dentate adults, without severe periodontitis. DATA COLLECTION AND ANALYSIS Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data and, where results were meta-analysed, we used a fixed-effect model as there were fewer than four studies. Study authors were contacted where possible and where deemed necessary for missing information. MAIN RESULTS Three studies were included in this review with 836 participants included in the analyses. All three studies are assessed as at unclear risk of bias. The numerical results are only presented here for the primary outcome gingivitis. There were no useable data presented in the studies for the outcomes of attachment change and tooth loss. No studies reported any adverse effects.- Objective 1: Scale and polish versus no scale and polish Only one trial provided data for the comparison between scale and polish versus no scale and polish. This study was conducted in general practice and compared both six-monthly and 12-monthly scale and polish treatments with no treatment. This study showed no evidence to claim or refute benefit for scale and polish treatments for the outcomes of gingivitis, calculus and plaque. The MD for six-monthly scale and polish, for the percentage of index teeth with bleeding at 24 months was -2% (95% CI -10% to 6%; P value = 0.65), with 40% of the sites in the control group with bleeding. The MD for 12-monthly scale and polish was -1% (95% CI -9% to 7%; P value = 0.82). The body of evidence was assessed as of low quality.- Objective 2: Scale and polish at different time intervals Two studies, both at unclear risk of bias, compared routine scale and polish provided at different time intervals. When comparing six with 12 months there was insufficient evidence to determine a difference for gingivitis at 24 months SMD -0.08 (95% CI -0.27 to 0.10). There were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals, in particular between three and 12 months for the outcome of gingivitis at 24 months, with OHI, MD -0.14 (95% CI -0.23 to -0.05; P value = 0.003) and without OHI MD -0.21 (95% CI -0.30 to -0.12; P value < 0.001) (mean per patient measured on 0-3 scale), based on one study. There was some evidence of a reduction in calculus. This body of evidence was assessed as of low quality.- Objective 3: Scale and polish with and without OHIOne study provided data for the comparison of scale and polish treatment with and without OHI. There was a reduction in gingivitis for the 12-month scale and polish treatment when assessed at 24 months MD -0.14 (95% CI -0.22 to -0.06) in favour of including OHI. There were also significant reductions in plaque for both three and 12-month scale and polish treatments when OHI was included. The body of evidence was once again assessed as of low quality.- Objective 4: Scale and polish provided by a dentist compared with a dental care professionalNo studies were found which compared the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health. AUTHORS' CONCLUSIONS There is insufficient evidence to determine the effects of routine scale and polish treatments. High quality trials conducted in general dental practice settings with sufficiently long follow-up periods (five years or more) are required to address the objectives of this review.
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Affiliation(s)
- Helen V Worthington
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Coupland III Building, Oxford Road, Manchester, UK, M13 9PL
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Fernandes P, Velly AM, Anderson GC. A randomized controlled clinical trial evaluating the effectiveness of an external mandibular support device during dental care for patients with temporomandibular disorders. Gen Dent 2013; 61:26-31. [PMID: 24064159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study tested a jaw support device for patients receiving dental care while suffering from temporomandibular joint pain. This crossover randomized trial used 31 subjects with jaw pain. Subjects underwent 2 consecutive dental scaling sessions of 30 minutes each. For each subject, the device was used for 1 of the sessions. Subjects completed questionnaires regarding jaw pain and jaw fatigue before and after each session. Multivariate analyses were performed to assess the device's effectiveness in preventing the aggravation of pain and fatigue during dental treatment. Statistically significant differences were found for jaw pain (P = 0.001), and fatigue (P = 0.04), indicating the effectiveness of the device. Based on the results, supporting the mandible of patients with temporomandibular disorders during dental treatments may prevent further pain.
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Draenert ME, Jakob M, Kunzelmann KH, Hickel R. The prevalence of tooth hypersensitivity following periodontal therapy with special reference to root scaling. A systematic review of the literature. Am J Dent 2013; 26:21-27. [PMID: 23724545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To provide a current status of the art, answering the question whether a certain procedure of periodontal treatment is more reliable than another and where innovative developments could improve on the incidence of hypersensitivity by a systematic literature review. METHODS Pubmed, Embase and Cochrane library were considered for the study. 2,656 articles of the PubMed search were found, from the beginning of 1945 until April 2011. 99 articles from PubMed were evaluated for this review. From Embase, 60 articles were selected and one was included in this review. From the Cochrane library, 182 were found, of which two contributed to the review. Included were all studies dealing with periodontal treatment followed by hypersensitivity and all studies dealing with the loss of attachment, followed by hypersensitivity. Excluded were any treatments of tooth hypersensitivity with pathogenesis not related to dentin exposure, genetically caused disorders, and fractures. Ultimately, 102 papers were evaluated, included and referred to in the review. RESULTS The term "tooth hypersensitivity" is most often used. Common causes of loss of hard substance are listed and updated. Mechanical loss of hard tissue formed one group of etiological factors; gingival recession and loss of attachment another. Surgical interventions, scaling and root planing were considered and in most cases performed as combined procedures. The different methods were evaluated and critically discussed. There were no properly randomized studies in the literature. The weak point of all epidemiological studies is the lack of any objective measurement. With respect to periodontal therapy, further research and developmental work on medical devices is needed, as well as ongoing applied research with laser technologies, continuing education and training programs for professionals.
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Affiliation(s)
- Miriam E Draenert
- Department of Restorative Dentistry and Periodontology, Ludwig-Maximilians-University, Munich, Germany.
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Åkesson I, Balogh I, Hansson GÅ. Physical workload in neck, shoulders and wrists/hands in dental hygienists during a work-day. Appl Ergon 2012; 43:803-811. [PMID: 22208356 DOI: 10.1016/j.apergo.2011.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 11/29/2011] [Accepted: 12/03/2011] [Indexed: 05/31/2023]
Abstract
Physical workload was recorded by electromyography, inclinometry and goniometry for twelve female dental hygienists during authentic work. Their work was, in relation to other types of work, characterised by pronounced head flexion (90th percentile 46°), high loads on the forearm extensor muscles (90th percentile 23% and 18% of maximal EMG (MVE), for the right and left sides, respectively), average loads on trapezius muscles (90th percentile 15% and 14% MVE), average arm elevation (99th percentile 83° and 72°) and average wrist flexion and velocities (50th percentiles 17° of extension and 7.3°/s, for the right side). Manual scaling and machinery (use of ultrasonic scaling and hand-pieces) showed higher loads on the trapezius muscles, regarding muscular rest, as well as the 10th and 50th percentiles, than the other tasks, and for the forearm extensor muscles, an almost complete lack of muscular rest (0.1% time), and much higher loads regarding the 10th and 50th percentiles. Further, more pronounced head flexion and lower head and upper arm velocities were found, indicating more constrained postures for the neck and shoulders for the manual scaling and machinery. Use of ultrasonic scaler reduced the 50th percentile loads on the right forearm extensor muscles, but had no effect on the fraction of muscular rest and on the 10th percentile load. These findings are consistent with the high prevalences of musculoskeletal disorders among dental hygienists.
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Affiliation(s)
- I Åkesson
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85 Lund, Sweden
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Tao W, Jiang Y. [Evaluation of promoting the oral cavity health measures of rural AIDS patients/HIV-carriers]. Zhonghua Kou Qiang Yi Xue Za Zhi 2011; 46:293-296. [PMID: 21733383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To survey the status of oral cavity hygiene knowledge, attitude and practice (KAP) of rural acquired immunodeficiency syndrome (AIDS) patients and human immunodeficiency virus (HIV) carriers and take corresponding intervention measures to improve the oral health of these patients. METHODS From May to August in 2009, the methods of anonymous face to face structured interview and oral examination at the scene were carried out at the baseline in rural AIDS patients/HIV-carriers. According to the results of the survey, intervention measures were taken. The results of the intervention and the oral hygiene status were compared before and after the intervention. RESULTS The oral health status of 82 AIDS patients and HIV-carriers were in poor before the intervention, and the knowledge of AIDS-related oral health of 76 AIDS patients and HIV-carriers was promoted after interventions, "scaling can spread AIDS" were 22 cases (27%), and after the intervention 41 patients (54%) think that can spread (χ(2) = 20.066, P < 0.001). The oral diseases of related AIDS were decreased dramatically, 68 patients (83%) had gingivitis before intervention and 47 cases (62%) after the intervention (χ(2) = 8.852, P = 0.003). The personal oral cavity hygiene and related oral KAP of AIDS caused by subjective factors had improved to different extent, "brushing teeth over 3 min at every turn", there were over 36 cases (44%) before intervention and 45 patients after intervention (59%) (χ(2) = 4.017, P = 0.045). CONCLUSIONS The oral hygiene and KAP of AIDS patients and HIV-carriers in rural areas were poor and improved after intervention.
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Affiliation(s)
- Wei Tao
- Department of Preventive Dentistry, School of Stomatology, Anhui Medical University, Hefei 230032, China
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Patsouri A, Mavrogiannea A, Pepelassi E, Gaintantzopoulou M, Kakaboura A. Clinical effectiveness of a desensitizing system on dentin hypersensitivity in periodontitis patients. Am J Dent 2011; 24:85-92. [PMID: 21698987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To evaluate the efficacy of the DenShield desensitizing system, based on calcium sodium phosphosilicate, in the hypersensitivity reduction for a 6-month period in periodontitis patients previously subjected to periodontal treatment and to compare the combination of the in-office paste and at-home dentifrice use to the at-home dentifrice use alone. METHODS A total of 248 teeth (eight teeth in each subject) in 31 periodontitis patients (mean age 48 +/- 8 years) previously subjected to periodontal treatment were studied. 193 (77.8%) teeth had been treated with phase I periodontal treatment alone (non-surgical treatment) and 55 (22.2%) had been additionally subjected to periodontal surgery. Periodontal clinical parameters were recorded for each subject. Hypersensitivity was assessed by tactile and air-blast stimuli. The hypersensitive teeth of each of two quadrants in each subject were randomly assigned with split-mouth design to in-office application of DenShield Starter paste (four teeth) or placebo (distilled water) (four teeth). After the in-office application each patient used the DenShield dentifrices (Builder and Saver) for 6 months. The final evaluation was at 6 months. RESULTS The prevalence and the degree of baseline hypersensitivity was significantly higher for the surgically than the non-surgically-treated teeth (83.6% versus 68.4%) and it was greater in teeth with attachment loss. The dentin hypersensitivity observed after periodontal treatment was significantly reduced in periodontitis patients who used the DenShield system for 6 months. There was no difference in hypersensitivity reduction between the additional in-office application of the DenShield and the at-home use of the DenShield dentifrices alone.
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Affiliation(s)
- Aikaterini Patsouri
- Department of Periodontology, School of Dentistry, University of Athens, Greece
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Muhney KA, Dechow PC. Patients' perception of pain during ultrasonic debridement: a comparison between piezoelectric and magnetostrictive scalers. J Dent Hyg 2010; 84:185-189. [PMID: 21047464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To compare patients' perception of discomfort, vibration and noise levels between piezoelectric and the magnetostrictive ultrasonic units during periodontal debridement. METHODS Periodontal debridement was performed on 75 subjects using a split-mouth design. Two quadrants on the same side were instrumented with a piezoelectric ultrasonic device (EMS Swiss Mini Master® Piezon) and the remaining 2 quadrants were instrumented with a magnetostrictive ultrasonic device (Dentsply Cavitron® SPS™). Subjects marked between 0 and 100 along a visual analog scale (VAS) for each of the 3 variables immediately after treatment of each half of the dentition. Scores of the VAS were compared using a nonparametric test for paired data, the Wilcoxon Signed-Rank test. The level of significance was set at p<0.05. Descriptive statistics included the median and the first and third quartiles as a measure of variation. RESULTS Mean scores for patient discomfort and vibration were greater for the magnetostrictive device at p=0.007 and p=0.032, respectively. The scores for noise level between the 2 ultrasonic types were almost equal. CONCLUSION The results show that, on average, patients in this study prefer instrumentation with the piezoelectric as it relates to awareness of associated discomfort and vibration. The results of this study may assist the clinician in the decision over which ultrasonic device may prove more beneficial in decreasing patient discomfort and increasing patient compliance.
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Casarin RCV, Bittencourt S, Ribeiro EDP, Nociti FH, Sallum AW, Sallum EA, Casati MZ. Influence of immediate attachment loss during instrumentation employing thin ultrasonic tips on clinical response to nonsurgical periodontal therapy. Quintessence Int 2010; 41:249-256. [PMID: 20213026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Mechanical instrumentation is fundamental to periodontal treatment. However, independent of the instrument used in scaling, an immediate attachment loss occurs at the bottom of the periodontal pocket. This study aimed to determine the influence of tip diameter on attachment loss and the influence of attachment loss on the periodontal response to nonsurgical treatment. METHOD AND MATERIALS Fifteen patients presenting periodontal pockets with a probing depth of 3.5 mm or more in bilateral teeth were divided into two groups: test group-instrumented with a thin tip, and control group-instrumented with a traditional tip. Probing depth, relative gingival position, and relative attachment level were evaluated immediately before and after and at 1 and 3 months after treatment using an electronic computerized probe. The data were analyzed using ANOVA and Tukey tests (P = .05). RESULTS Both groups presented attachment loss immediately after instrumentation; however, the thin tip resulted in statistically higher immediate clinical attachment loss than the traditional tip (0.85 and 0.15 mm, respectively; P < .0001). However, both groups showed a similar healing after the ultrasonic therapy, at all parameters evaluated (P > .05). CONCLUSION In spite of the higher immediate clinical attachment loss inflicted by thin ultrasonic tips during instrumentation, this did not affect the clinical response to the nonsurgical treatment.
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Affiliation(s)
- Renato Corrêa Viana Casarin
- Department of Prosthodontics and Periodontics, School of Dentistry at Piracicaba, Campinas State University, São Paulo, Brazil
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Kasaj A, Willershausen B, Zafiropoulos GG. Flexible gingival epithesis: treatment of recession defects. Dent Today 2010; 29:108-100. [PMID: 20084857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Adrian Kasaj
- Department of operative dentistry and Periodontology, Johannes Gutenberg University of Mainz, Germany.
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Pérez-Chaparro PJ, Lafaurie GI, Gracieux P, Meuric V, Tamanai-Shacoori Z, Castellanos JE, Bonnaure-Mallet M. Distribution of Porphyromonas gingivalis fimA genotypes in isolates from subgingival plaque and blood sample during bacteremia. Biomedica 2009; 29:298-306. [PMID: 20128354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Porphyromonas gingivalis is considered as a major etiological agent in the onset and progression of chronic destructive periodontitis. Porphyromonus gingivalis fimA type has been correlated to the virulence potential of the strain; therefore this gene could be involved in the ability of P. gingivalis to reach blood stream. OBJECTIVE The classifications of P. gingivalis fimA types will be compared in subgingival plaque and blood samples collected after scaling and root root planing of periodontitis patients. MATERIALS AND METHODS Fifteen periodontitis patients requiring scaling and root planing were enrolled. P. gingivalis isolates were classed to genotype with fimA type-specific PCR assay. fimA gene was sequenced if the isolate was listed as unclassifiable after PCR technique. RESULTS Six patients showed positive P. gingivalis bacteremia. The most frequent fimA was fimA type II, followed by Ib, III and IV. In blood strains, type II was followed by IV, Ib and III. CONCLUSION Type II was the most frequent genotype in blood samples and in subgingival plaque samples. However, no correlation was found between the frequency of any fimA type with SRP induced bacteremia. P. gingivalis fimA type appears to be conserved within individual patients throughout the times of sample collection, fimA gene sequence results were not in agreement with results of fimA genotyping by PCR.
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Loggner Graff I, Asklöw B, Thorstensson H. Full-mouth versus quadrant-wise scaling--clinical outcome, efficiency and treatment discomfort. Swed Dent J 2009; 33:105-113. [PMID: 19994560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The aim of this randomized clinical study was to compare full-mouth scaling and root planing (FM-SRP) in two sessions within 24 hours with quadrant-wise scaling and root planing (Q-SRP) in four sessions within 4-6 weeks and evaluate (I) clinical outcome, (II) treatment efficiency, and (III) treatment discomfort of patients and therapists. Twenty individuals, aged 28-65 years, with severe chronic periodontitis were randomly assigned to treatment with FM-SRP or Q-SRP. At baseline and after 6 months, there were no between-group differences in clinical findings, treatment discomfort, or post-treatment body temperature. The therapists, however, felt that FM-SRP was more physically and psychologically demanding than Q-SRP. Mean effective scaling and root planing (SRP) time was 165.5 min during the two FM-SRP sessions and 202.1 min during the four Q-SRP sessions. FM-SRP's initial time savings of 36.6 min compared with Q-SRP diminished to 30.8 min at the 6-month follow-up due to rescaling needs. Total mean treatment time (comprising SRP and patient reinformation and reinstruction in oral hygiene) during the first 6 months post-treatment was 321.2 min for FM-SRP and 353.0 min for Q-SRP. Thus, mean savings in total treatment time with FM-SRP was 31.8 min compared with Q-SRP. In conclusion, this study found that both treatment modalities may be recommended for chronic periodontitis patients. Although time saving is possible with FM-SRP,the modality may compromise the therapist's well-being if practiced frequently due to the risk of musculoskeletal problems.
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Affiliation(s)
- Ingela Loggner Graff
- Department of Periodontology/Endodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden
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Maestre JR, Mateo M, Sánchez P. [Bacteremia after periodontal procedures]. Rev Esp Quimioter 2008; 21:153-156. [PMID: 18792815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Bacteremia frequently occurs after oral surgery and odontology procedures. Periodontitis may affect the incidence and bacterial spectrum of bacteremia. Periodontal disease may be a significant risk factor for the development of certain systemic diseases. This study has aimed to evaluate the frequency of aerobic and anaerobic bacteria in the bloodstream following scaling and root planing. MATERIAL AND METHODS Thirteen patients with generalized chronic periodontitis were included in the study. Two samples of peripheral blood were drawn for culture at different times: pre-treatment and immediately after odontology treatment (full-mouth scaling). RESULTS None of the 13 patients had bacteremia before the procedures. Bacteremia after scaling occurred in 10/13 (76.9 %) of periodontitis patients. The anaerobic bacteria (Prevotella spp., Micromonas micros and Fusobacterium nucleatum) were the most predominant microorganism. CONCLUSIONS Our findings suggest that periodontal procedures induce bacteremia and may represent risk of developing systemic complications. The use of antibiotic prophylaxis is crucial for its prevention.
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Affiliation(s)
- J R Maestre
- Servicio de Microbiología Clínica, Hospital Gómez Ulla, Madrid.
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Stoltenberg JL, Osborn JB, Carlson JF, Hodges JS, Michalowicz BS. A preliminary study of intra-pocket topical versus injected anaesthetic for scaling and root planing. J Clin Periodontol 2007; 34:892-6. [PMID: 17850608 DOI: 10.1111/j.1600-051x.2007.01128.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Compare the efficacy of topical benzocaine gel to injected lidocaine during scaling and root planing. MATERIALS AND METHODS In each of 21 participants undergoing root planing, two dental quadrants were randomly assigned to receive topical 20% benzocaine gel delivered subgingivally (TOP) or injection anaesthesia using 2% lidocaine (INJ). Baseline, intra- and immediate post-operative pain was assessed using the Heft-Parker pain scale. Intra-subject differences (INJ-TOP) were analysed using paired t-tests and mixed models. RESULTS Baseline and post-operative pain did not differ between treatments (p>0.50). The injected anaesthetic, however, was associated with less intra-operative pain than the topical (INJ-TOP=-24.9 mm, p=0.005) Six participants required rescue (injected) anaesthesia during treatment with the topical. Eleven participants (52%) preferred topical over injected anaesthetic. Among these 11, intra-operative pain scores did not differ significantly (TOP=38.6 mm, INJ=28.4 mm, p=0.23). Among those who preferred the injected anaesthetic, intra-operative pain scores differed significantly (TOP=84.7 mm, INJ=43.8 mm, p=0.03). CONCLUSIONS Intra-pocket benzocaine gel is less effective than injected lidocaine in controlling pain during scaling and planing. Anaesthetic preference was related to the level of pain experienced during treatment with the topical. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Jill L Stoltenberg
- Department of Primary Dental Care, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA.
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Kumar PS, Leblebicioglu B. Pain control during nonsurgical periodontal therapy. Compend Contin Educ Dent 2007; 28:666-671. [PMID: 18186172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Nonsurgical approaches such as scaling and root planing are routinely used to prevent or treat periodontal diseases. However, fear of pain and discomfort during subgingival instrumentation has been reported to deter nearly 10% of the population from seeking treatment. The degree of periodontal pain experienced by the patient is influenced by several factors, including amount of inflammation, depth of the pockets, and location of the disease. Thus, timely elimination of inflammation is important not only in treating the disease but also in preventing or controlling pain. Mechanical instrumentation of the subgingival environment commonly is used in the initial treatment of the disease, as well as during periodontal maintenance. Traditional methods for pain control during these procedures have included local anesthesia administered through injection, which in itself is a significant source of discomfort. Certain recently developed drug delivery systems show considerable promise as adjuncts to injection-based local anesthesia and in some cases provide alternatives. Prevention of pain before its initiation or before transmission of nociceptive information is known to be safer and more effective than attempts to minimize pain after it begins. This article reviews the transmission pathways of periodontal pain and discusses some of the current strategies to control pain during periodontal examination and nonsurgical periodontal therapy.
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Affiliation(s)
- Purnima S Kumar
- Section of Periodontology, The Ohio State University, Columbus, Ohio, USA
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Abstract
BACKGROUND Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided. OBJECTIVES The main objectives were: to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; to compare the effects of routine scaling and polishing provided by a dentist or professionals complementary to dentistry (PCD) (dental therapists or dental hygienists) on periodontal health. SEARCH STRATEGY We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. Date of most recent searches: 5th March 2007. SELECTION CRITERIA Trials were selected if they met the following criteria: design - random allocation of participants; participants - anyone with an erupted permanent dentition who were judged to have received a 'routine scale and polish' (as defined in this review); interventions - 'routine scale and polish' (as defined in this review) and routine scale and polish provided at different time intervals; outcomes - tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patient-centred outcomes and economic outcomes. DATA COLLECTION AND ANALYSIS Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration's statistical guidelines were followed and both standardised mean differences and mean differences were calculated as appropriate using random-effects models. MAIN RESULTS Nine studies were included in this review. All studies were assessed as having a high risk of bias.Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, involving patients attending a recall programme following periodontal treatment, found no statistically significant differences for plaque, gingivitis and attachment loss between experimental and control units at each time point during the 1 year trial. The other study, involving adolescents in a developing country with high existing levels of calculus who had not received any dental treatment for at least 5 years, reported statistically significant differences in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12 and 22 months (in favour of 'scale and polish units') following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish provided at different time intervals, there were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals: 2 weeks versus 6 months, 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth and attachment change); 3 months versus 12 months (for the outcomes plaque, calculus and gingivitis). There were no studies comparing the effects of scaling and polishing provided by dentists or professionals complementary to dentistry. AUTHORS' CONCLUSIONS The research evidence is of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High quality clinical trials are required to address the basic questions posed in this review.
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Affiliation(s)
- P Beirne
- University College Cork, Department of Epidemiology and Public Health, Brookfield Health Sciences Complex, College Road, Cork, Ireland.
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Lafaurie GI, Mayorga-Fayad I, Torres MF, Castillo DM, Aya MR, Barón A, Hurtado PA. Periodontopathic microorganisms in peripheric blood after scaling and root planing. J Clin Periodontol 2007; 34:873-9. [PMID: 17850606 DOI: 10.1111/j.1600-051x.2007.01125.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM The objective of this study was to evaluate the frequency of periodontopathic and other subgingival anaerobic and facultative bacteria in the bloodstream following scaling and root planing (SRP). MATERIAL AND METHODS Forty-two patients with severe generalized chronic periodontitis (GChP) and generalized aggressive periodontitis (GAgP) were included in the study. Four samples of peripheric blood were drawn from the cubital vein at different times: Pre-treatment: immediately before the SRP procedure (T1), immediately after treatment (T2), 15 min. post-treatment (T3) and 30 min. post-treatment (T4). In order to identify the presence of microorganisms in blood, subcultures were conducted under anaerobic conditions. RESULTS 80.9% of the patients presented positive cultures after SRP and it occurred more frequently immediately after treatment; however, 19% of the patients still had microorganisms in the bloodstream 30 min. after the procedure. The periodontopathic microorganisms more frequently identified were Porphyromonas gingivalis and Micromonas micros. Campylobacter spp., Eikenella corrodens, Tannerella forsythensis, Fusobacterium spp. and Prevotella intermedia were isolated less often. Actinomyces spp. were also found frequently during bacteraemia after SRP. CONCLUSIONS SRP induced bacteraemia associated with anaerobic bacteria, especially in patients with periodontal disease.
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Affiliation(s)
- Gloria Inés Lafaurie
- Instituto UIBO (Unidad de Investigación Básica Oral), Universidad El Bosque, Bogotá, Colombia.
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Moreira RM, Feres-Filho EJ. Comparison Between Full-Mouth Scaling and Root Planing and Quadrant-Wise Basic Therapy of Aggressive Periodontitis: 6-Month Clinical Results. J Periodontol 2007; 78:1683-8. [PMID: 17760536 DOI: 10.1902/jop.2007.060354] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to test the hypothesis that there are no differences in clinical parameters in generalized aggressive periodontitis patients after full-mouth scaling and root planing (FRP) or quadrant-wise basic periodontal therapy (BPT) when combined with an antibiotic regimen. METHODS Patients were allocated randomly to BPT (N = 15; mean age: 29.5 +/- 5.7 years) or FRP (N = 15; mean age: 28.4 +/- 5.7 years). All subjects received oral hygiene instructions including the use of a 0.12% chlorhexidine mouthrinse solution twice a day for 2 months. Patients also received amoxicillin, 500 mg, and metronidazole, 250 mg, three times a day for 7 days. Probing depth (PD), clinical attachment level, visible plaque, and bleeding on probing were recorded at baseline and at 2, 4, and 6 months post-therapy. Statistically significant changes within and between groups were determined using the general linear model repeated measures procedure. RESULTS Both groups showed a significant improvement in all clinical parameters post-therapy, which was particularly evident at 2 months in the sites that had been deepest at baseline. For instance, the mean PD at sites with mean PD > or =7 mm at baseline had decreased 3.9 mm in the BPT group and 3.6 mm in the FRP group. At 6 months, the percentage of sites with PD > or =7 mm decreased from 13.2% +/- 3.2% to 0% in the BPT group and from 13.3% +/- 3.5% to 0.2% +/- 0.1% in the FRP group. No statistically significant differences were observed between groups for most clinical parameters. CONCLUSION Within the limits of the present investigation, FRP and BPT caused comparable clinical effects in aggressive periodontitis patients when an adjunctive combined antibiotic regimen was included.
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Affiliation(s)
- Rafael M Moreira
- Graduate Periodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Gazolla CM, Ribeiro A, Moysés MR, Oliveira LAM, Pereira LJ, Sallum AW. Evaluation of the incidence of preterm low birth weight in patients undergoing periodontal therapy. J Periodontol 2007; 78:842-8. [PMID: 17470017 DOI: 10.1902/jop.2007.060295] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Preterm low birth weight was reported to be related to periodontal infections that might influence the fetus-placenta complex. The aim of this study was to provide periodontal treatment for pregnant women and to evaluate if this treatment can interfere with pregnancy duration and weight of the newborn. METHODS The sample consisted of 450 pregnant women who were under prenatal care at a polyclinic in Três Corações, Brazil. Women with risk factors, such as systemic alterations (ischemic cardiopathy, hypertension, tuberculosis, diabetes, cancer, anemia, seizure, psychopathology, urinary tract infection, sexually transmitted diseases, asthma, and human immunodeficiency virus), and/or users of alcohol, tobacco, and drugs were excluded from the study. Data related to age, socioeconomic level, race, marital status, number of previous pregnancies, and previous preterm delivery also were evaluated. Initially, the sample was divided into two groups: 122 healthy patients (group 1) and 328 patients with periodontal disease (group 2). In group 2, 266 patients underwent treatment and 62 patients dropped out. After mothers gave birth, pregnancy duration and the weight of all infants were analyzed and recorded. RESULTS There was no statistical difference between the healthy and treated groups. However, there was a difference in the non-treated group, with a 79% incidence of preterm low birth weight. Educational level, previous preterm birth, and periodontal disease were related significantly to preterm delivery (P <0.001). CONCLUSION Periodontal disease was related significantly to preterm low birth weight.
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Affiliation(s)
- Catia M Gazolla
- Clinical Dentistry Postgraduate Program, Vale do Rio Verde University, Três Corações, MG, Brazil.
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Hodosh M, Hodosh SH, Hodosh AJ. KNO3/benzocaine/tetracaine gel use for maintenance visit pain control. Gen Dent 2007; 55:312-5. [PMID: 17682639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A 35% potassium nitrate/20% benzocaine/10% tetracaine/aqueous hydroxyethyl cellulose gel was applied to the teeth and gingiva of 100 patients prior to hygienist-administered maintenance treatments. The application effectively anesthetized the teeth and gingiva so that these maintenance treatments could be performed routinely with genuine patient comfort. As a control in this double-blind study, 100 patients received hydroxyethyl cellulose without the active agents. All patients were volunteers and chosen at random.
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Abstract
BACKGROUND Glanzmann thrombasthenia (GT) is an exceedingly rare but well-defined inherited disorder of platelet function caused by a defect in the glycoprotein IIb/IIIa complex. The association of GT with consanguinity has been noted, especially in geographic regions in which intermarriage is common. In most patients, GT is diagnosed during early infancy or before the age of 5 years. Common manifestations of this disorder are gingival hemorrhage, purpura, epistaxis, petechiae, and menorrhagia. Chronic, prolonged, untreated, or unsuccessfully treated bleeding may be life threatening. METHODS We report two female patients with GT who were referred by our hematology clinic to our periodontology department for the treatment of excessive gingival bleeding. The first patient was treated with a platelet transfusion and underwent periodontal therapy (scaling and root planing and dental polishing). The second patient, whose GT was undiagnosed at the time of her referral to our department, applied to our emergency service because of uncontrolled gingival bleeding that developed after scaling and root planing was performed by her dentist. Both patients had been called for regular dental visits. RESULTS All treated sites healed without complications. The first patient was monitored for 2 years, during which she practiced proper oral hygiene and experienced no periodontal complications. The other patient did not participate in follow-up. CONCLUSIONS Gingival bleeding is usually the first sign of most hematologic disorders, and dentists must be alert for the signs of unusual gingival bleeding. In such cases, collaboration with a hematologist is essential. Under the proper circumstances, periodontal treatment can be performed with an acceptable outcome. With proper oral hygiene, we believe that there will be no complications and no gingival bleeding.
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Affiliation(s)
- Hilal Uslu Toygar
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey.
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Kasaj A, Heib A, Willershausen B. Effectiveness of a topical salve (Dynexan) on pain sensitivity and early wound healing following nonsurgical periodontal therapy. Eur J Med Res 2007; 12:196-9. [PMID: 17513190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
The purpose of the present study was to evaluate clinically the effect of an anaesthetic gel (lidocaine 20 mg/g as active agent) on pain sensitivity and early wound healing following nonsurgical periodontal therapy. A total of 40 patients with chronic periodontitis were enrolled in this randomized, split-mouth, double-blind, placebo-controlled clinical trial. Each subject had 3 sites in each of 2 contra-lateral jaw quadrants with a probing pocket depth (PPD) of > or = 5 mm and bleeding on probing (BOP+). All experimental sites received scaling and root planing without local anesthesia followed by irrigation with sterile saline and assessment of pain sensitivity using a standardized Visual Analogue Scale (VAS). After treatment, the patients randomly received the active or placebo gel into the periodontal pockets and overall pain was again assessed immediately after debridement and after 10, 20 and 30 minutes. The VAS showed a statistically significant (p < or = 0.0001) reduction in reported pain, favoring the active gel over the placebo at all 3 different points in time. After 30 minutes the median VAS score was 0.3 in the Dynexan group as opposed to 1.7 in the placebo-treated group (p < or = 0.0001). In terms of wound healing no differences were found between the test and control sites after 1 week. The results of the study showed that the anaesthetic gel was statistically more effective than the placebo in reducing pain following nonsurgical periodontal therapy. However, in terms of early wound healing no significant differences were seen between the two treatment sites.
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Affiliation(s)
- A Kasaj
- Department for Operative Dentistry and Peridontology, University of Mainz, Augustusplatz 2, 55131 Mainz, Germany
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Offenbacher S, Lin D, Strauss R, McKaig R, Irving J, Barros SP, Moss K, Barrow DA, Hefti A, Beck JD. Effects of periodontal therapy during pregnancy on periodontal status, biologic parameters, and pregnancy outcomes: a pilot study. J Periodontol 2007; 77:2011-24. [PMID: 17209786 DOI: 10.1902/jop.2006.060047] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Few studies have examined the potential effects of periodontal treatment during pregnancy on pregnancy outcomes, periodontal status, and inflammatory biomarkers. METHODS A randomized, delayed-treatment, controlled pilot trial was conducted to evaluate the effects of second-trimester scaling and root planing and the use of a sonic toothbrush on the rate of preterm delivery (<37 weeks gestation). Secondary outcome measures included changes in periodontal status, levels of eight oral pathogens, levels of gingival crevicular fluid (GCF) interleukin-1beta (IL-1beta), prostaglandin E(2) (PGE(2)), 8-isoprostane (8-iso), and IL-6, and serum levels of IL-6, soluble intercellular adhesion molecule 1 (sICAM1), 8-isoprostane, soluble glycoprotein 130 (sGP130), IL-6 soluble receptor (IL-6sr), and C-reactive protein (CRP). Logistic regression models were used to test for effects of treatment on preterm delivery. Secondary outcomes were analyzed by analysis of covariance adjusting for subject baseline values. RESULTS Periodontal intervention resulted in a significantly decreased incidence odds ratio (OR) for preterm delivery (OR = 0.26; 95% confidence interval = 0.08 to 0.85), adjusting for baseline periodontal status which was unbalanced after randomization. Pregnancy without periodontal treatment was associated with significant increases in probing depths, plaque scores, GCF IL-1beta, and GCF IL-6 levels. Intervention resulted in significant improvements in clinical status (attachment level, probing depth, plaque, gingivitis, and bleeding on probing scores) and significant decreases in levels of Prevotella nigrescens and Prevotella intermedia, serum IL-6sr, and GCF IL-1beta. CONCLUSIONS Results from this pilot study (67 subjects) provide further evidence supporting the potential benefits of periodontal treatment on pregnancy outcomes. Treatment was safe, improved periodontal health, and prevented periodontal disease progression. Preliminary data show a 3.8-fold reduction in the rate of preterm delivery, a decrease in periodontal pathogen load, and a decrease in both GCF IL-1beta and serum markers of IL-6 response. However, further studies will be needed to substantiate these early findings.
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Affiliation(s)
- Steven Offenbacher
- Department of Periodontology, Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7455, USA.
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Abstract
Periodontal therapy aims at arresting periodontal infection and maintaining a healthy periodontium. The periodic mechanical removal of subgingival microbial biofilms is essential for controlling inflammatory periodontal disease. Mechanical periodontal therapy consists of scaling, root planing and gingival curettage. The sonic and ultrasonic scalers are valuable tools in the prevention of periodontal disease. The vibration of scaler tips is the main effect to remove the deposits from the dental surface, such as bacterial plaque, calculus and endotoxin. However, constant flushing activity of the lavage used to cool the tips and cavitational activity result in disruption of the weak and unattached subgingival plaque. The aim of the study was to review the safety, efficacy, role and deleterious side-effects of sonic and ultrasonic scalers in mechanical periodontal therapy.
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Affiliation(s)
- T Arabaci
- Department of Periodontology, Atatürk University Faculty of Dentistry, Erzurum, Turkey
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Abstract
AIM To investigate rinsing with povidone-iodine on bacteraemia caused by ultrasonic scaling. MATERIAL AND METHODS Sixty patients with gingivitis undertook a randomized, placebo-controlled trial in which 30 rinsed with 0.9% saline and 30 with 7.5% povidone-iodine for 2 min. before ultrasonic scaling of FDI teeth 31-35. Blood samples before and after 30 s and 2 min. of scaling were cultured by lysocentrifugation. RESULTS Oral bacteraemia occurred in 33.3% of the saline group and 10% of the povidone-iodine group. Regression analysis showed that rinsing with povidone-iodine was approximately 80% more effective than rinsing with saline in reducing the occurrence of bacteraemia, with a statistically significant odds ratio (OR) of 0.189 (95% confidence intervals, OR=0.043-0.827). There were 24 oral bacterial isolates in the saline group and 3 in the povidone-iodine group. Viridans streptococci comprised 11 of the isolates in the saline group and none in the povidone-iodine group. Bacteraemia magnitude was 0.1 colony-forming units/ml in the povidone-iodine subjects and 0.1-0.7 CFU/ml in the saline group. CONCLUSIONS Rinsing with 7.5% povidone-iodine reduced the incidence and magnitude of bacteraemia and eliminated viridans streptococci from such bacteraemia. Povidone-iodine rinsing may be helpful for ultrasonic scaling of gingivitis patients at risk of infective endocarditis.
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Affiliation(s)
- Martin Cherry
- Discipline of Periodontics, Faculty of Dentistry, University of Sydney, Sydney, Australia
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Szymańska J. Dental bioaerosol as an occupational hazard in a dentist's workplace. Ann Agric Environ Med 2007; 14:203-207. [PMID: 18247451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Many-year studies on aerosols as an infection vector, despite their wide range, ignored dental aerosol. All procedures performed with the use of dental unit handpieces cause the formation of aerosol and splatter which are commonly contaminated with bacteria, viruses, fungi, often also with blood. Aerosols are liquid and solid particles, 50 microm or less in diameter, suspended in air. Splatter is usually described as a mixture of air, water and/or solid substances; water droplets in splatter are from 50 microm to several millimetres in diameter and are visible to the naked eye. The most intensive aerosol and splatter emission occurs during the work of an ultrasonic scaler tip and a bur on a high-speed handpiece. Air-water aerosol produced during dental treatment procedures emerges from a patient's mouth and mixes with the surrounding air, thus influencing its composition. Because air contained in this space is the air breathed by both dentist and patient, its composition is extremely important as a potential threat to the dentist's health. According to the author, insufficient awareness of health risk, working habits, and economic factors are the reasons why dentists do not apply the available and recommended methods of protection against the influence of bioaerosol and splatter. Behaviour protecting a dentist and an assistant from the threat resulting from the influence of dental aerosol cannot be limited to isolated actions. The author, on the basis of the literature and own research, characterizes bioaerosol and splatter in a dental surgery and reviews a full range of protective measures against these risk factors.
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Affiliation(s)
- Jolanta Szymańska
- Department of Paedodontics, Medical University of Lublin, Staszica 11, 20-018 Lublin, Poland.
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Forner L, Larsen T, Kilian M, Holmstrup P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol 2006; 33:401-7. [PMID: 16677328 DOI: 10.1111/j.1600-051x.2006.00924.x] [Citation(s) in RCA: 436] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
UNLABELLED SCIENTIFIC RATIONALE FOR STUDY: Bacteremia occurs with various frequency after oral procedures. Periodontal disease may affect the incidence, magnitude, duration and bacterial spectrum of bacteremia. PRINCIPLE FINDINGS The incidence and magnitude of bacteremia after scaling was significantly higher in periodontitis than in gingivitis patients and healthy control individuals. In periodontitis patients, the magnitude of bacteremia was associated with gingival index, plaque index and number of sites with bleeding on probing, but not with probing pocket depth measurements. PRACTICAL IMPLICATIONS The prevention and treatment of periodontal diseases appear to be crucial for the prevention of bacteremia associated with oral procedures.
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Affiliation(s)
- Lone Forner
- Department of Periodontology, University of Copenhagen, Copenhagen, Denmark
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Forabosco A, Spinato S, Grandi T, Prini M. A comparative study between different techniques in non-surgical periodontal treatment. Minerva Stomatol 2006; 55:289-96. [PMID: 16688105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
AIM This study was carried out to compare a conventional manual instrumentation with an ultrasonic technique (Odontoson M) in scaling and root planing periodontal treatment. The effects of subgingival irrigation with 10% iodised solution in association with Odontoson M were studied. METHODS Sixty patients were selected: they were suffering from adult periodontitis, aged between 35 and 65 and non-smokers. They were randomly divided into 3 groups (Gs1, Gs2, Gs3). Gs1 was treated with curettage using Gracey curettes, Gs2 was treated with scaling and root planing using Odontoson M, while in Gs3 scaling and root planing with Odontoson M irrigated with a 10% iodised solution were performed. Clinical parameters (probing depth, bleeding on probing, dental mobility, loss of attachment level) were measured before treatment (T0), after 30 days (T1), after 90 days (T2) and after 120 days (T3). RESULTS No statistical significant differences between Gs1 and Gs2 were observed. The improvement of clinical parameters in Gs3 was greater and statistical significant differences with other groups treated were recorded. CONCLUSIONS There are no significant differences between the effectiveness of scaling and root planing with manual instruments and with Odontoson M. The 10% iodised solution used such as topic antiseptic carries out greater effects in not surgical periodontal treatments.
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Affiliation(s)
- A Forabosco
- Department of Periodontology, University of Modena and Reggio Emilia, Modena, Italy.
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Ettlin DA, Ettlin A, Bless K, Puhan M, Bernasconi C, Tillmann HC, Palla S, Gallo LM. Ibuprofen arginine for pain control during scaling and root planing: a randomized, triple-blind trial. J Clin Periodontol 2006; 33:345-50. [PMID: 16634956 DOI: 10.1111/j.1600-051x.2006.00918.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this controlled clinical trial was to investigate the analgesic efficacy and tolerability of ibuprofen arginine in patients with mild-to-moderate periodontitis during and after non-surgical periodontal treatment. METHODS This randomized, triple-blind, placebo-controlled, parallel-group trial assessed the analgesic efficacy of ibuprofen arginine (Spedifen) in patients undergoing routine periodontal scaling and root planing. 64 patients with chronic periodontitis received either 800 mg ibuprofen arginine or placebo 30 min. before treatment. Numeric pain and electronic visual analogue scales ranging from 0 to 100 were used. RESULTS The average pain levels during treatment were lower following ibuprofen arginine (quartiles: 0.5, 4.5, 11) compared with placebo (4, 16, 26), corresponding to a percentage reduction in median pain of 72% (p=0.023). The median maximum pain was 28 (inter-quartile range 10-50) following placebo and 10 (4-31) following ibuprofen arginine (p=0.065). CONCLUSIONS In patients with mild-to-moderate chronic periodontitis, ibuprofen arginine was safe and superior to placebo for alleviating pain during non-surgical periodontal treatment. Its painless administration and rapid onset of action make it well suitable for pain management in a general dental office.
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Affiliation(s)
- Dominik A Ettlin
- Center for Dental and Oral Medicine, University of Zurich, Zurich, Switzerland.
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Honda S, Inatomi Y, Yonehara T, Hashimoto Y, Hirano T, Uchino M. [A case report of streptococcus oralis meningitis after dental manipulation]. Rinsho Shinkeigaku 2006; 46:154-6. [PMID: 16619842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A 75-year-old man was admitted to our hospital because of high fever and disturbance of consciousness 4 days after dental treatment including scaling, irrigation, and oral antibiotic for dental caries without gingivitis. A lumber puncture revealed cloudy cerebrospinal fluid (CSF): it contained 984 leukocytes/mm3, 680 mg/dl of protein, 5 mg/dl of glucose (blood sugar 233 mg/dl), and Streptococcus oralis, one of common microorganisms on the gingival, was isolated from the CSF. He was successfully treated with intravenous antibiotics. The authors believe this patient's meningitis developed as a result of bacteremia after the dental scaling in the present case.
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Affiliation(s)
- Shoji Honda
- Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital
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Takas D, Tellefsen G, Johannsen G. Pain relief after scaling and rootplaning by monochromatic phototherapy (Biolight). Swed Dent J 2006; 30:69-75. [PMID: 16878682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The present clinical trial was designed to evaluate pain relief after scaling and rootplaning treatment, of patients with periodontal disease, by the use of monochromatic phototherapy (Mpht) (Biolight) vs. placebo. 20 randomly selected patients, 35-75 years of age, with at least ten tooth pockets, with probing depths > or = 5mm, equally shared between at least two opposite quadrants were chosen. Patients using anti-inflammatory drugs or painkillers were excluded. Scaling and rootplaning under local anaesthesia was performed by a dental hygienist, on randomly selected quadrants in all patients. Additional treatment with placebo or monochromatic phototherapy was given to the patients. The patients registered pain on a Visual Analogue Scale (VAS) (100 mm) on two occasions, the first after the effect of the local anaesthetic had worn off and the second 24 hours post-treatment. The results showed that, no pain relief could be obtained after monochromatic phototherapy compared to placebo.
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Abstract
BACKGROUND The development of soft tissue cervicofacial emphysema after dental treatment is a rare complication, with few descriptions in the dermatologic literature. It is usually restricted to only moderate local swelling. However, spread of larger amounts of air into deeper spaces may sometimes cause serious complications, including airway compromise due to accumulation of air in the retropharyngeal space, pneumomediastinum, and pneumopericardium. Fatal air embolism and soft tissue infections through dissemination of oral flora microorganisms along the emphysematous tracts have also been described. Therefore, early recognition is important, but the unfamiliarity of dermatologists with this condition often causes diagnostic problems. Important differential diagnoses include angioedema, soft tissue infections, and hematoma. OBSERVATIONS We describe 2 patients with different severity of the emphysema and airway compromise, representing the wide spectrum of its clinical expression. Our first case was remarkable, because the emphysema was massive and extended far into deep spaces, including the orbita, mediastinum, and pleural cavity. The present case is only the third report of pneumothorax associated with dental treatment published to date. The patient's condition was initially misdiagnosed and treated as angioedema. CONCLUSIONS Dermatologists should be aware that soft tissue emphysema can cause acute swelling of the cervicofacial region after dental procedures. Angioedema is an important differential diagnosis, because it may be caused by the use of nonsteroidal anti-inflammatory drugs or local anesthetics, which are often administered during dental treatments.
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Affiliation(s)
- Julia Frühauf
- Department of Dermatology, Medical University of Graz, Graz, Austria
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Abstract
BACKGROUND Patient discomfort is one reason for poor compliance with supportive periodontal therapy (SPT). The aim of this study was to compare the levels of discomfort during SPT, using the Vector system and treatment with a conventional ultrasonic scaler. METHODS Forty-six patients with an SPT programme were debrided using both the Vector system and a conventional piezo-electric scaler (Sirona) in a split mouth design. A visual analogue scale was used to evaluate of pain scores upon completion of treatment. A verbal response scale(VRS) was used to assess discomfort, vibration and noise associated with the scaling system, as well as the volume and taste of the coolant used by these systems. RESULTS Patients instrumented with the Vector system experienced approximately half the amount of pain compared with the conventional ultrasonic scaling system. The VRS showed that the Vector system caused less discomfort than the conventional ultrasonic scaling system when assessed for pain, vibration, noise and volume of coolant. These findings were all statistically significant. There was, however, no statistically significant difference between the two systems when assessed for taste. CONCLUSION During SPT the Vector system caused reduced discomforting sensations compared with conventional methods and may be useful in improving compliance with SPT programmes.
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Affiliation(s)
- A Hoffman
- Department of Dentistry, University of Queensland, Brisbane, Australia
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44
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Abstract
INTRODUCTION Transient bacteraemias are frequently detected following dental manipulation. Infective endocarditis (IE) can arise in susceptible individuals and antibiotic prophylaxis is routinely performed for certain procedures considered to be "at risk" of IE. Evidence is emerging that periodontal disease may be a significant risk factor for the development of certain systemic diseases such as cardiovascular disease. These systemic conditions could be initiated or detrimentally influenced by the repeated entry of bacteria into the bloodstream. MATERIALS AND METHODS The present study comprised a single blind parallel study of 2 weeks duration. A baseline blood sample was obtained from 30 volunteers with untreated periodontal disease following which a periodontal probing depth chart was collected. A further blood sample was taken following this procedure, and each subject was recalled 2 weeks later. A blood sample was collected, the subject carried out toothbrushing and a further blood sample taken. Full-mouth ultrasonic scaling was then performed and a final blood sample taken. Blood samples were analysed for bacteraemia using conventional microbiological culture and polymerase chain reaction (PCR) using universal bacterial primers that target the 16S ribosomal RNA gene of the vast majority of bacteria. RESULTS Using culture methods, the incidence of bacteraemias was as follows: following ultrasonic scaling (13%), periodontal probing (20%) and toothbrushing (3%). PCR analysis revealed bacteraemia incidences following ultrasonic scaling, periodontal probing and toothbrushing of 23%, 16% and 13%, respectively. CONCLUSION These findings suggest that detectable dental bacteraemias induced by periodontal procedures are at a lower level than previously reported.
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Affiliation(s)
- Denis F Kinane
- University of Louisville School of Dentistry, Louisville, KY 40292, USA.
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46
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Abstract
OBJECTIVES The aim of this study was to clinically detect the immediate effect of root instrumentation with curettes and ultrasonic scalers on clinical attachment level. MATERIAL AND METHODS Twelve subjects with moderate chronic periodontitis, presenting probing depths of 3.5-6.5 mm on anterior teeth, upper and/or lower, were selected. Teeth were randomly assigned to one of the following groups: US group--scaled with an ultrasonic scaler; and CC group--scaled and planed with 5-6 Gracey curettes. The selected teeth were probed with a computerized electronic probe, guided by an occlusal stent and subjected to scaling and root planing. Immediately following instrumentation, teeth were probed again. The difference between relative attachment level (RAL) immediately before and after instrumentation was considered trauma from instrumentation. RESULTS Intra-group analysis revealed statistically significant differences between RAL immediately before and after instrumentation in both groups (0.77+/-0.51 for US group; and 0.73+/-0.41 for CC group, p<0.0001). However, inter-group analysis did not show statistically significant difference in trauma from instrumentation caused by the two different instruments (p=0.816). CONCLUSIONS Within the limits of this study, it was concluded that root instrumentation causes a mean immediate attachment loss of 0.75 mm, and that instrumentation with either curettes or ultrasonic scalers do not seem to reduce significantly the trauma from of instrumentation produced.
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Affiliation(s)
- Renato Vasconcelos Alves
- Department of Prosthodontics and Periodontics, Division of Periodontics, School of Dentistry at Piracicaba (UNICAMP), São Paulo CEP 13414-903, Brazil
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47
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Rühling A, Bernhardt O, Kocher T. Subgingival debridement with a teflon-coated sonic scaler insert in comparison to conventional instruments and assessment of substance removal on extracted teeth. Quintessence Int 2005; 36:446-52. [PMID: 15954250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Previous studies have shown that endotoxins are located on the periodontally diseased root cementum and not within it. To what extent a Teflon-tubed sonic scaler was capable of removing bacterial deposits in comparison to conventional scaling instruments, and the resulting root surface roughness and root surface topography, were recently assessed. The objective of the present study was to evaluate how much root cementum is removed with these instruments. METHODS AND MATERIALS Eighty-two teeth were treated subgingivally on one approximal site either with a Teflon-coated sonic scaler insert (tSS), a Gracey curette, a conventional sonic scaler (SS), a piezoelectric ultrasonic scaler insert (US), or an oscillating Periotor insert (PT) before extraction. The untreated site served as control. The width and length of cementum removal were compared histomorphometrically. Nonparametric analyses were carried out for statistical comparison. RESULTS The US, PT, and tSS inserts removed less substance than the curettes or SS inserts. The cementum removed was 40 microm for root surfaces treated with the curette or SS, 30 microm for those treated with US, 20 microm for PT, and 17 microm for tSS. CONCLUSION The Teflon-coated sonic scaler inserts can be a reasonable choice for gentle maintenance treatment of compliant patients with good plaque control, and little or no subgingival deposits.
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Affiliation(s)
- Andreas Rühling
- Department of Restorative Dentistry and Periodontology, School of Dentistry, University of Kiel, Germany.
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48
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Abstract
BACKGROUND Sonic scalers have an elliptical and piezoceramic ultrasonic scalers a linear oscillation pattern. Thus, a sonic scaler "hammers" the tooth surface, irrespective of its alignment to the tooth, whereas a piezoceramic ultrasonic scaler may oscillate parallel to the tooth surface and gently remove calculus if the alignment is correct. The aim of this study was to measure pain on a visual analogue scale (VAS) during removal of supragingival calculus on mandibular incisors with a sonic or an ultrasonic scaler. MATERIAL AND METHODS Seventy-four periodontally healthy subjects with supragingival calculus on the mandibular incisors were treated with both a sonic and a piezoceramic ultrasonic scaler in a split-mouth design. The sequence of instrument application and allocation of instruments to jaw side were randomized. Patient comfort was assessed with a VAS after treatment. RESULTS The VAS results did not show any difference between the two instrumentation modalities. CONCLUSION For calculus removal during prophylaxis the type of power-driven instrument does not seem to have an impact on perceived pain. This means that the oscillation pattern does not influence the pain experience.
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Affiliation(s)
- T Kocher
- Dental School, University of Greifswald, Germany.
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49
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Abstract
BACKGROUND A recently introduced piezo-driven ultrasonic device (Vector) generates longitudinal oscillations. As a result, the instrument tip moves parallel to the tooth surface. By avoiding vertical oscillations, maintenance treatment with the Vector device should be less painful than treatment with conventional systems. We investigated whether patients perceive treatment with the Vector device as less painful than with a conventional ultrasonic device, and whether the clinical efficacy of the Vector device is comparable with that of the conventional ultrasonic device in maintenance patients. MATERIAL AND METHODS Thirty-eight maintenance patients with moderate to advanced periodontal disease took part in this prospective, randomized controlled clinical study. Each patients had to have at least two teeth with probing depths of >4 mm. They were treated either with Dentsply (n=22) at a reduced power setting or with the Vector device (n=16). The observation period was 6 months. Probing pocket depth, attachment level, and bleeding upon probing were assessed at six sites on each treated tooth by a blinded investigator Patient were asked to report perceived pain during instrumentation with a visual analog scale immediately after treatment, in the evening of the treatment day, and in the evenings 1 and 2 days after treatment. RESULTS Bleeding on probing, probing depth, and attachment level improved in both instrumentation groups from baseline to month 6; however, there was no difference between the two instrumentation modalities. The patients perceived treatment with neither instrument as unpleasant, and their perception of pain intensity both during instrumentation and on the following days did not differ. CONCLUSION In maintenance therapy, clinical efficacy of the vector device is comparable with that of conventional ultrasonic device. It makes no difference whether the ultrasonic device at a reduced power setting or the Vector device is used, since patients perceive both instruments as causing very little pain.
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Affiliation(s)
- Thomas Kocher
- Unit of Periodontology, School of Dentistry, University of Greifswald, Greifswald, Germany.
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50
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van Steenberghe D, Garmyn P, Geers L, Hendrickx E, Maréchal M, Huizar K, Kristofferson A, Meyer-Rosberg K, Vandenhoven G. Patients' experience of pain and discomfort during instrumentation in the diagnosis and non-surgical treatment of periodontitis. J Periodontol 2005; 75:1465-70. [PMID: 15633322 DOI: 10.1902/jop.2004.75.11.1465] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The present multicenter study aimed to survey the patients' experiences in relation to the diagnosis and non-surgical treatment of periodontitis according to current treatment routine. METHODS Patients (N = 268) treated for plaque-related periodontitis were enrolled in two groups: group 1 received primary probing of pocket depths (PD 1) and/or primary scaling and root planing (SRP 1); group 2 consisted of patients who were scheduled in the different centers for recall PD/scaling/subgingival instrumentation. Data collection included a full periodontal status, anesthesia employed, procedure time, and patient self-completed questionnaires to assess their previous and current experience of pain and discomfort during anesthesia and periodontal treatment. RESULTS Ninety percent of the patients received infiltration anesthesia during primary SRP, compared to only 2% during recall scaling/instrumentation and none during PD. Many patients (40% in SRP group 1 and 52% in the recall scaling/instrumentation group) were most bothered by the scaling procedure, while others (35% in the primary SRP patients) by the anesthetic injection. Painful experiences during previous primary PD and present SRP were highly correlated (r = 0.6). CONCLUSIONS From these results, it is evident that subgingival instrumentation causes pain and discomfort, an aspect that should be considered in periodontal therapy. Unfortunately, the use of local infiltration anesthesia to reduce pain is in itself a cause of discomfort. Attractive alternatives for anesthetic applications are much needed.
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Affiliation(s)
- Daniel van Steenberghe
- Department of Periodontology, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium.
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