Comparative evaluation of Sapindus Mukorossi extract with 17% EDTA on smear layer removal in various parts of the tooth root

OBJECTIVES

This study aimed to compare the effectiveness of an experimental root canal irrigant and 17% Ethylene-di-amine tetra acetic acid for removal of the smear layer in the coronal, middle and apical portions of the root canal.

MATERIALS AND METHODS

Ninety human single rooted maxillary and mandibular teeth were selected for this study. The teeth were randomly divided into two experimental groups and one control group as follows: Group A (Ethanolic extract of Sapindus Mukorossi), Group B (17% EDTA), and Group C (Distilled water). The root canals of all three groups were prepared with stainless steel K-files by means of the standard step-back technique and irrigated with 5.25% sodium hypo chloride. The teeth were decoronated, following the irrigation and divided longitudinally into two-halves and visualized using scanning electron microscope (SEM) for the amount of smear layer present utilizing the three-point score system. The observations were noted both before and after the treatment. Nonparametric tests were applied for the comparison and p-value ⩽ 0.05 was considered as statistically significant.

RESULTS

It was evident from that smear layer was completely removed in coronal portion of 27 out of 30 teeth in-group A. For middle and apical areas of group A, 24 and 19 teeth showed complete smear layer removal. In-group B it was found that there were 24, 21, and 3 teeth at coronal, middle and apical, areas respectively where smear layer were completely absent. Intra group comparison showed a significant difference (p = 0.002) in smear layer removal was found for group A at coronal, middle and apical thirds. Similarly, a significant difference (p = 0.001) was also found for group B; however heavy smear layer was found among the three parts of the canal for group C.

CONCLUSIONS

Ethanolic extract of Sapindus Mukorossi have higher effectiveness in removing the smear layer from the root canal in comparison to 17% EDTA.

Treatment of dental complications in sickle cell disease

BACKGROUND

Sickle cell disease is the most common single gene disorder and the commonest haemoglobinopathy found with high prevalence in many populations across the world. Management of dental complications in people with sickle cell disease requires special consideration for three main reasons. Firstly, dental and oral tissues are affected by the blood disorder resulting in several oro-facial abnormalities. Secondly, living with a haemoglobinopathy and coping with its associated serious consequences may result in individuals neglecting their oral health care. Finally, the treatment of these oral complications must be adapted to the systemic condition and special needs of these individuals, in order not to exacerbate or deteriorate their general health. Guidelines for the treatment of dental complications in this population who require special care are unclear and even unavailable in many aspects. Hence this review was undertaken to provide a basis for clinical care by investigating and analysing the existing evidence in the literature for the treatment of dental complications in people with sickle cell disease. This is an update of a previously published review.

OBJECTIVES

To assess methods of treating dental complications in people with sickle cell disease.

SEARCH METHODS

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Review Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 01 August 2019. Additionally, we searched nine online databases (PubMed, Google Scholar, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Literature in the Health Sciences in Latin America and the Caribbean database, African Index Medicus, Index Medicus for South East Asia Region, Index Medicus for the Eastern Mediterranean Region, Indexing of Indian Medical Journals). We also searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organizations, pharmaceutical companies and researchers working in this field. Date of last search: 07 November 2019.

SELECTION CRITERIA

We searched for published or unpublished randomised controlled studies of treatments for dental complications in people with sickle cell disease.

DATA COLLECTION AND ANALYSIS

Two review authors intended to independently extract data and assess the risk of bias of the included studies using standard Cochrane methodologies; however, no studies were identified for inclusion in the review.

MAIN RESULTS

No randomised controlled studies were identified.

AUTHORS' CONCLUSIONS

This Cochrane Review did not identify any randomised controlled studies assessing interventions for the treatment of dental complications in people with sickle cell disease. There is an important need for randomised controlled studies in this area, so as to identify the most effective and safe method for treating dental complications in people with sickle cell disease.

Treatment of dental and orthodontic complications in thalassaemia

BACKGROUND

Thalassaemia is a quantitative abnormality of haemoglobin caused by mutations in genes controlling production of alpha or beta globins. Abnormally unpaired globin chains cause haemolytic anaemia by causing membrane damage and cell death within organ systems and destruction of erythroid precursors in the bone marrow. The life-long management of the general health effects of thalassaemia in affected individuals is a highly challenging issue in and of itself; and failure to deal with dental and orthodontic complications in people with thalassaemia exacerbates the public health, financial and personal burden posed by the condition. There exists a lack of evidence-based guidelines for care-seekers and providers to best deal with such dental and orthodontic complications in thalassaemia, which this review seeks to address.

OBJECTIVES

The main objective of this review was to assess different methods to treat dental and orthodontic complications in people with thalassaemia.

SEARCH METHODS

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We searched the reference lists of relevant articles and reviews.Date of last search: 01 August 2019.We also searched nine online databases (PubMed, Google Scholar, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Literature in the Health Sciences in Latin America and the Caribbean database, African Index Medicus, Index Medicus for South East Asia Region, Index Medicus for the Eastern Mediterranean Region, Indexing of Indian Medical Journals). We searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organizations, pharmaceutical companies and researchers working in this field.Date of last search: 22 July 2019.

SELECTION CRITERIA

We searched for published or unpublished randomised controlled trials for treatment of dental and orthodontic complications in individuals diagnosed with thalassaemia, irrespective of phenotype, severity, age, gender and ethnic origin.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened 35,202 titles from search results. We identified four unique randomised controlled trials, of which one seemed potentially relevant. Based on closer inspection, the trial was found not to be eligible for inclusion.

MAIN RESULTS

We did not find any relevant trials for inclusion in the review.

AUTHORS' CONCLUSIONS

We were unable to draw any conclusions due to the lack of available data and trials. This review highlights the need for conducting and appropriate reporting, of high-quality randomised controlled trials investigating the effectiveness of various treatment modalities for dental and orthodontic complications in people with thalassaemia.

Managing tooth pain in general practice

Tooth pain is a common presentation in primary care, with 32.4% of Singaporeans experiencing pain from dental caries in their lifetime. Some systemic conditions can have oral presentations, and oral conditions may be associated with chronic disease. A good history and examination is key in delineating odontogenic from non-odontogenic causes of tooth pain. Primary care physicians should accurately diagnose and assess common dental conditions and make appropriate referrals to the dentist. Common non-odontogenic causes of orofacial pain can be mostly managed in primary care, but important diagnoses such as acute coronary syndrome, peritonsillar abscess and temporal arteritis must not be missed. Ibuprofen has been shown to be effacious, safe and cost-effective in managing odontogenic pain. Antibiotics are indicated when there is systemic or local spread of dental infection. Without evidence of spread, antibiotics have not been shown to reduce pain or prevent subsequent dental infections.

Tailored Dentistry: From "One Size Fits All" to Precision Dental Medicine?

Over the past 30 years and fueled by both a rapidly evolving understanding of dental diseases and technological advances in diagnostics and therapy, dentistry has been changing dramatically. Managing dental caries and carious lesions had, for nearly a century, encompassed only a small number of basic concepts that were applied to virtually all patients and lesions, namely, invasive removal of any carious tissue regardless of its activity or depth and its replacement with restorative materials (amalgams or crowns for most of the past) or tooth removal and prosthetic replacement. Grounded in a deeper understanding of the disease "caries," its management-aiming to control the causes of the disease, to slow down or alleviate existing disease, and, only as a last resort, to remove its symptoms using a bur or forceps-has become more complex and diverse. In parallel and at nearly unprecedented speed, our patients are changing, as mirrored by ongoing debates as to the demographic and, with it, the social future of most high-income countries. This article describes how these changes will have a profound future impact on how we practice dental medicine in the future. It will deduce, from both demographic and epidemiologic trends, why there is the need to apply not one but rather the whole range of existing evidence-based concepts in an individualized (personalized) manner, hence increasing the effectiveness and efficiency of dental management strategies, and also describe how these strategies should be tailored according not only to our patients (their age and risk profiles) but also to the specific tooth (or site or lesion).

Human immunodeficiency virus related discrimination in general dentistry

Objectives:

To investigate HIV related discrimination among general dentists in Jeddah, Saudi Arabia; and to list factors affecting or causing healthcare providers to discriminate people living with HIV (PLWH).

Methods:

The current study takes place in Jeddah, western Saudi Arabia. The duration for accepting all responses was between March and November, 2017. In this cross-sectional study, we used a self-administered, structured questionnaire. The sample size was 430 general dentists practicing in Jeddah, Saudi Arabia. Descriptive statistics, mean, and standard deviation were calculated. Bivariate and multivariate analysis was carried out at p<0.05 level of significance. The Statistical Package for the Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY, USA) was used for data analysis.

Results:

In our study population, the total HIV related discrimination was 67.4%. Approximately 98.1% defer PLWH to the last appointment of the day, while 84.7% refer them to specialists. Furthermore,100% reported wearing double gloves, and 94.7% where wearing protective eye shields if they encounter HIV-patient in the clinic. Male participants were found to be 23% more likely to be discriminative compared to female participants, Moreover, participants who are confident to provide both surgical and non-surgical dental treatment for PLWH were found to be 52% less likely to be discriminative towards PLWH. Also, HIV discrimination is 33% higher in the private practice compared to the governmental practice.

Conclusion:

Human immunodeficiency virus related discrimination in the study population was affected by dentists’ gender, type of practice, and self-protective attitudes.

Dental Problems in Primary Care

Oral health directly affects overall health and quality of life. More Americans lack dental insurance than medical insurance. Patients with poor oral health are more likely to have respiratory and cardiovascular diseases, adverse pregnancy outcomes, and diabetes mellitus. Early childhood caries is the most common chronic condition in American children. Certain illicit and prescription drugs increase the risk of enamel erosion and caries formation in adults. Incision and drainage is the treatment of choice for dental abscess. Risk factors for periodontal disease include smoking, diabetes, human immunodeficiency virus infection, use of certain medications, and genetic susceptibility. Patients with gingivitis typically present with swollen, erythematous gum tissue that bleeds easily with brushing or flossing. One in three children will have an injury to the primary teeth, and one in five 12-year-old children will have an injury to the permanent teeth. All dental fractures should be evaluated with imaging and managed in conjunction with a dental professional. Immediate reimplantation is the preferred treatment for avulsed permanent teeth. Primary care clinicians are well positioned to reduce rates of oral disease. Family physicians can incorporate oral health into routine practice through counseling about diet, oral hygiene, smoking cessation, and fluoride supplementation; application of fluoride varnish; and screening for dental disease.

[Family physicians' knowledge regarding oral disease treatment during pregnancy in Jiading district, Shanghai city]

PURPOSE

This study was conducted to evaluate the knowledge of family physicians regarding oral disease treatment during pregnancy in Jiading district, Shanghai city.

METHODS

A questionnaire was designed, involving the knowledge of oral health care and oral disease treatment during pregnancy. Data retrieved was entered into Excel database and analyzed using SPSS20.0 software package.

RESULTS

203 family physicians were involved in the investigation. 192 valid questionnaires were obtained in the study. 70.3% of respondents knew the safety period of oral treatment during pregnancy; 90.1% were aware of that oral diseases could lead to adverse pregnancy outcomes; 90.6% informed the clients that oral examination and treatment should be performed before pregnancy. 93.8% of the respondents supported that pregnant women need timely oral treatment. The proportions of the respondents who believed that pregnant women could receive dental caries filling and crown repair, supragingival scaling, root canal therapy, tooth extraction and subgingival scaling were 91.9%, 60.4%, 51.0%, 31.8%, and 40.1%, respectively. The proportions of the respondents holding out that pregnant women could receive local oral anesthesia and dental X-ray examination were 55.2% and 31.8%. Doctors' age, education, and technical title were the most important factors affecting their understanding (P<0.05).

CONCLUSIONS

The present study demonstrates that family doctors in Jiading district are highly aware of oral health care knowledge during pregnancy. However, there are great differences in understanding of issues related to treatment of oral diseases during pregnancy. The majority of doctors believing that pregnant women can use local anesthetic drugs with routine dental X-ray examinations have higher academic qualifications and technical titles.

Treatment options for odontogenic maxillary sinusitis: a review

OBJECTIVE

The aim of this article is to review the main treatment options for odontogenic sinusitis that are used today.

MATERIAL AND METHODS

Search on PubMed, Cochrane Library, PMC, Science Direct data bases. For a literature review search keywords were used: odontogenic sinusitis, odontogenic maxillary sinusitis treatment OR diagnosis, maxillary sinusitis of dental source OR dental origin OR etiology.

RESULTS

2886 articles were found in the databases using keywords. After duplicate citations screened, inclusion/exclusion criteria applied, excluded articles after titles, summaries and full-text reading 25 articles were included in the literature review.

CONCLUSION

Although clinical symptomatology is not conspicuous among other types of sinusitis, the odontogenic maxillary sinusitis treatment regimen is different. It consists of eliminating dental infection and management of sinusitis. The usage of Caldwell-Luc approach is limited these days and recommended only when a better access to sinus is needed, for example, removing large foreign bodies. Endoscopic sinus surgery is widely used these days to remove the inflamed sinus mucosa, foreign bodies, displaced teeth, while preserving physiological function of the sinus. Sometimes dental infection removal alone is sufficient to resolve the odontogenic maxillary sinusitis, but sometimes concomitant endoscopic sinus surgery or Caldwell-Luc approach is necessary for full resolution.

Palliative Care Dentistry: Focusing on Quality of Life

Palliative care dentistry is the management of patients with progressive, far-advanced disease for whom the oral cavity has been compromised either by disease or by treatment. The focus of care is on the immediate quality of life. Typically, the palliative care team neglects to include a dentist despite many patients under its care, including those with cancer, exhibiting oral problems such as xerostomia, candidiasis, mucositis, and loss of masticatory function. This article will discuss the oral care of patients with terminal illnesses, many of whom have oral maladies that negatively impact quality of life. Treatment options for these patients will be outlined.

Oral health considerations in anorexia and bulimia nervosa. 2. Multidisciplinary management and personalized dental care

This article outlines a comprehensive, multidisciplinary strategy for treatment of patients with anorexia and bulimia nervosa. In this approach, primary medical intervention and emergency dental care are followed by the staging of treatment phases that integrate medical care, psychotherapy, nutritional counseling, and dental management, which may encompass various treatment options for repair of damaged dentition. Emphasis is placed on prevention of further tissue damage during all phases of management and following completion of the treatment course.

The Emergency Dental Appointment: Restorative Emergencies Part 1 - Tooth Related Problems

Dental emergencies affect a large proportion of the population. While there is ample information in the literature on how to manage medical emergencies in dental practice, there is little information on common dental emergencies and how to manage them. In the UK, the 2009 Adult Dental Health Survey reported 9% of dentate adults reporting pain at their clinical examination. 1 The prevalence of non-pain related restorative dental emergencies is estimated to be higher, and will be a common presenting situation in the dental clinic. Often these unplanned events cause difficulties for dental practitioners, who are already constrained by time, to fit in these patients and manage them. Over and above this, the increasing life spans, retention of teeth into later life and finite life of dental restorations all add to the challenges encountered by the dental practitioner. Prompt and effective management of these conditions often leads to optimising patient experience, but also offers better outcomes. This two-part series provides an overview of the more common dental emergencies encountered by the dental practitioner and their management. Paper 1 focuses on the management of common tooth-related emergencies and includes non-odontogenic and odontogenic pain. Paper 2 focuses on the management of osseointegrated dental implant related emergencies.

[Dental health and the combat readiness]

Oral diseases are still amongst the most common human ailments in the western world and in Israel. Acute dental illness may cause intense pain, malaise, nutrition impairment, disturbance and loss of operative activities. The article reviews the literature from the last two decades regarding dental classification of military service candidates, incidence of acute dental conditions and emergency treatment needs in military population, and dental preparation programs for military recruits.

[Big data in dentistry and oral medicine]

Knowledge about the extent of dental and oral diseases and needs in Israel is very limited with no official governmental body responsible for data collection. The aim of the "Dental Oral Scale (DOS) project is to measure the extent of dental and oral diseases, their risk factors, and their association with demographics and various systemic conditions. The DOS project includes demographic, dental and medical records of all patients attending IDF dental clinics in 2014, as well as a control group of patients. Records were obtained from three computerized military databases: a sociodemographic record, a medical record (Clinical Patient Record-CPR) and a dental record (Dental Patient Record-DPR). The DOS project analyses the associations between these oral-health related conditions and sociodemographic parameters as well as behavioral parameters and systemic general health-related conditions.

A review of pathogenesis, diagnosis, treatment options, and differential diagnosis of odontogenic infections: a rather mundane pathology?

Odontogenic infections are common in the dental practice and their treatment should be a standard procedure for every dentist. For optimal management of septic intraoral problems, the practitioner must understand the underlying causes and etiologies of odontogenic infections. Therefore, the purpose of this article is to outline basic inflammatory processes involved in the development of odontogenic and intraoral infections including relevant pathogens, biochemical processes mediated by pro-inflammatory molecules, the basics of abscess formation, the host response, and the clinical appearance of intraoral septic processes. Furthermore, treatment modalities of odontogenic infections and associated lesions are discussed and a brief explanation of possible complications and their management is provided.

[Not Available]

Zusammenfassung. Entzündungen und Traumata sind häufige Ursachen von akuten Schmerzen im Mund- und Gesichtsbereich. Demgegenüber stehen diagnostisch unklare und/oder therapieresistente Beschwerden, die gegebenenfalls durch psychosoziale Belastungen kompliziert werden. Das zeitliche Schmerzmuster gibt differenzialdiagnostische Hinweise. Bei kurzdauernden Schmerzattacken ist die Trigeminusneuralgie die wichtigste neurologische Differenzialdiagnose. Bei anhaltenden Mund- und Gesichtsschmerzen ist an eine Trigeminusneuropathie und an eine Myoarthropathie des Kausystems zu denken. Letztere basiert auf der Erfassung definierter Leit- und Begleitsymptome inkl. Kopfschmerzen. Die stressbedingte Kaumuskel-Anspannung (z.B. Zähnepressen und -knirschen) spielt bei der Pathogenese eine bedeutende Rolle. Diese Parafunktionen sind zentralnervös reguliert und stehen häufig in direktem Zusammenhang mit psychosozialen Belastungen. Deshalb bilden Kenntnisse des biopsychosozialen Krankheitsmodells und die Verfügbarkeit eines interdisziplinären Expertenteams die Grundlage zur adäquaten Diagnostik und Behandlung.

Quantifying Appointments, Treatment Time, Impressions, and Diagnostic Data of Cases Staffed by General Dentists and Prosthodontists in a Dental School Clinic

The aim of this retrospective study was to quantify differences between general dentists and prosthodontists regarding appointments, treatment time, impressions, and preoperative diagnostic data in teaching predoctoral clinical fixed prosthodontics. Electronic dental records (n=356) of patients treated at one dental school in academic year 2012 were randomly selected for review to obtain the following data: faculty and student demographics, number of appointments and treatment time from preparation to cementation, number of impressions made, completion of oral disease control treatment (ODCT), and presence of preoperative periapical radiographs and diagnostic casts. The results showed that ODCT was completed in 78%, preoperative radiographs were present in 76%, and diagnostic casts made in 53% of the cases reviewed. There was no statistically significant difference in number of appointments, treatment time, or number of final impressions when students were staffed by general dentists or prosthodontists. When students were supervised by multiple faculty members, there was generally an increase in treatment time and number of appointments and final impressions. Although this study found no statistically significant differences between general dentists and prosthodontists regarding the criteria evaluated, the results suggest that faculty development and calibration are needed to ensure ODCT is completed and preoperative radiographs are present prior to initiating fixed prosthodontic procedures.

Bioactive Materials in Endodontics: An Evolving Component of Clinical Dentistry

Achieving biocompatibility in a material requires an interdisciplinary approach that involves a sound knowledge of materials science, bioengineering, and biotechnology. The host microbial-material response is also critical. Endodontic treatment is a delicate procedure that must be planned and executed properly. Despite major advances in endodontic therapy in recent decades, clinicians are confronted with a complex root canal anatomy and a wide selection of endodontic filling materials that, in turn, may not be well tolerated by the periapical tissues and may evoke an immune reaction. This article discusses published reports of various bioactive materials that are used in endodontic therapy, including calcium hydroxide, mineral trioxide aggregate, a bioactive dentin substrate, calcium phosphate ceramics, and calcium phosphate cements.

Treatment of dental complications in sickle cell disease

BACKGROUND

Sickle cell disease is the most common single gene disorder and the commonest haemoglobinopathy found with high prevalence in many populations across the world. Management of dental complications in people with sickle cell disease requires special consideration for three main reasons. Firstly, dental and oral tissues are affected by the blood disorder resulting in several oro-facial abnormalities. Secondly, living with a haemoglobinopathy and coping with its associated serious consequences may result in individuals neglecting their oral health care. Finally, the treatment of these oral complications must be adapted to the systemic condition and special needs of these individuals, in order not to exacerbate or deteriorate their general health.Guidelines for the treatment of dental complications in this population who require special care are unclear and even unavailable in many aspects. Hence this review was undertaken to provide a basis for clinical care by investigating and analysing the existing evidence in the literature for the treatment of dental complications in people with sickle cell disease.

OBJECTIVES

To assess methods of treating dental complications in people with sickle cell disease.

SEARCH METHODS

We searched the Cochrane Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.Date of last search: 11 April 2016.Additionally, we searched nine online databases (PubMed, Google Scholar, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Literature in the Health Sciences in Latin America and the Caribbean database, African Index Medicus, Index Medicus for South East Asia Region, Index Medicus for the Eastern Mediterranean Region, Indexing of Indian Medical Journals). We also searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organizations, pharmaceutical companies and researchers working in this field.Date of last search: 03 March 2016.

SELECTION CRITERIA

We searched for published or unpublished randomised controlled studies of treatments for dental complications in people with sickle cell disease.

DATA COLLECTION AND ANALYSIS

Two review authors intended to independently extract data and assess the risk of bias of the included studies using standard Cochrane methodologies; however, no studies were identified for inclusion in the review.

MAIN RESULTS

No randomised controlled studies were identified.

AUTHORS' CONCLUSIONS

This Cochrane review did not identify any randomised controlled studies assessing interventions for the treatment of dental complications in people with sickle cell disease. There is an important need for randomised controlled studies in this area, so as to identify the most effective and safe method for treating dental complications in people with sickle cell disease.

[Pregnancy and lactation period: Which local anesthetics and analgesics?]

The aim of this paper is to show relevant aspects of dental treatment in pregnancy. Common medication used in dental offices should be highlighted in special regard to the pregnant patient during dental treatment. The reader should gain more security in the election of the proper drugs for local anesthesia and oral analgesics. Local anaesthetics such as articain with adrenalin in a dilution of 1 : 200 000 can be used for dental treatment at any time. Paracetamol should be used as first line oral analgesic. Elective dental procedures should be postponed after delivery and after lactation period.

Criteria for admission of odontogenic infections at high risk of deep neck space infection

OBJECTIVES

Many patients with odontogenic infections are hospitalised because of the risk of deep neck space infection. The objective of this study was to identify risk factors allowing more reliable selection of patients requiring hospitalisation for both specialists and emergency physicians.

MATERIAL AND METHODS

This retrospective study was based on a cohort of 97 patients hospitalised for odontogenic infection in the Department of Otorhinolaryngology and Head and Neck Surgery of Centre hospitalier Sud Francilien, Île-de-France, from January 2008 to June 2012.

RESULTS

The majority of patients presented with dental abscess (66 patients; 68%). Nineteen patients (20%) presented with deep neck space infection. The frequency of deep neck space infection was significantly higher in patients with mandibular odontogenic infection (16/55 patients (29%) than in those with maxillary odontogenic infection (3/42 (7%); P ≤ 0.009). The incidence of deep neck space infection was significantly higher in patients with dental abscess (17/66, (26%) than in those without dental abscess (2/31 (6%); P ≤ 0.03).

CONCLUSION

In addition to the well-known classical criteria (fever, neck swelling, dyspnoea, dysphagia, trismus, leukocytosis, elevated C reactive protein (CRP)), the criteria for admission for odontogenic infection should include mandibular odontogenic infection and/or the presence of dental abscess.

[Endodontics in motion: new concepts, materials and techniques 2. The use of cone-beam computed tomography in endodontic diagnosis and treatment planning]

Systems for cone-beam computed tomography make a high-quality 3D reconstruction of dentomaxillofacial structures possible, without exposing the patient to excessive doses of radiation. Due to its 3D nature cone-beam computed tomography is superior to conventional dental radiographic imaging methods for many aspects of endodontic diagnosis and treatment planning. There are multiple indications for the use of cone-beam computed tomography scans in endodontics, including detection of periapical lesions or root fractures and the exploration of the root canal anatomy and its deviations. Depending on conditions, a judicious decision will always have to be made with regard to the radiographic technique to be applied. Primary in that respect must be the means by which the most accurate diagnostic image can be achieved with the lowest possible dose of radiation. Making a cone-beam computed tomography scan is justified only when the required diagnostic information cannot be achieved adequately using lower dose conventional dental radiographic imaging techniques.

Zeroing in on the cause of your patient's facial pain

The overlapping characteristics of facial pain can make it difficult to pinpoint the cause. This article, with a handy at-a-glance table, can help.

Methadone Maintenance Therapy and the Dental Patient

Methadone is a Schedule II drug best known for its use in the treatment of opioid dependence. Dental providers should be aware of the oral and systemic effects of methadone. In patients undergoing methadone maintenance therapy, there is a higher incidence of rampant caries, xerostomia, bruxism and poor oral hygiene. A review of the pharmacology, systemic effects, drug interactions and oral manifestations is presented, as well as possible modifications to treatment and specific considerations in dental therapies.

Biomaterials in Relation to Dentistry

Dental caries remains a challenge in the improvement of oral health. It is the most common and widespread biofilm-dependent oral disease, resulting in the destruction of tooth structure by the acidic attack from cariogenic bacteria. The tooth is a heavily mineralised tissue, and both enamel and dentine can undergo demineralisation due to trauma or dietary conditions. The adult population worldwide affected by dental caries is enormous and despite significant advances in caries prevention and tooth restoration, treatments continue to pose a substantial burden to healthcare. Biomaterials play a vital role in the restoration of the diseased or damaged tooth structure and, despite providing reasonable outcomes, there are some concerns with clinical performance. Amalgam, the silver grey biomaterial that has been widely used as a restorative material in dentistry, is currently in throes of being phased out, especially with the Minimata convention and treaty being signed by a number of countries (January 2013; http://mercuryconvention.org/Convention/) that aims to control the anthropogenic release of mercury in the environment, which naturally impacts the use of amalgam, where mercury is a component. Thus, the development of alternative restoratives and restoration methods that are inexpensive, can be used under different climatic conditions, withstand storage and allow easy handling, the main prerequisites of dental biomaterials, is important. The potential for using biologically engineered tissue and consequent research to replace damaged tissues has also seen a quantum leap in the last decade. Ongoing research in regenerative treatments in dentistry includes alveolar ridge augmentation, bone tissue engineering and periodontal ligament replacement, and a future aim is bioengineering of the whole tooth. Research towards developing bioengineered teeth is well underway and identification of adult stem cell sources to make this a viable treatment is advancing; however, this topic is not in the scope of this chapter. Whilst research focuses on many different aspects, operative dentistry involves the wide use of restorative biomaterials; thus, the development of smart biomaterials to suit the current climes of minimally invasive dentistry is important. The concept of minimally invasive dentistry primarily promotes preservation of the natural tissue, and, thus, the prevention of disease or the advancement of procedures that allow early detection and interception of its progress with minimal tissue loss are of significance. This chapter presents, in brief, the current state of the art of direct restorative biomaterials and their role and future in the field of dentistry. Modern dental practice is highly reliant on the selection of appropriate materials for optimum function and benefit to the patient. Dentistry, perhaps, has the unique distinction of using the widest variety of materials, ranging from polymers, metals, ceramics, inorganic salts to composite materials. So far, aesthetics of restorative materials and their ability to perform in the harsh oral environment without undergoing changes in dimension and stability has been the major focus of materials used in dentistry. Despite advances in tissue engineering and regeneration in the field of regenerative medicine, this concept has found relatively limited application for enamel and dentine due to their limited ability to remodel, but research related to biomimetic approaches for the modification of dentine is a significant step.

Influence of Isolation Method of the Operative Field on Gingival Damage, Patients' Preference, and Restoration Retention in Noncarious Cervical Lesions

OBJECTIVES

To evaluate the retention rates, gingival damage, and patients' preferences for adhesive restorations in noncarious cervical lesions (NCCL) associated with the use of rubber dam vs cotton rolls/retraction cord isolation.

METHODS

Thirty patients having one pair of similar NCCL on opposing sides of the same arch were enrolled in this study. A total of 60 restorations were placed. In each patient one restoration was placed under rubber dam isolation (RD) using dental retainers, and the other one was placed using cotton rolls/retraction cord (CR/RC) isolation. Dental residents with more than 10 years of clinical experience restored all NCCL using the same adhesive (GO!, SDI Limited, Bayswater, Australia) and composite resin (Ice, SDI). The patients' preferences were recorded. The gingival condition (bleeding, gingival laceration, and gingival insertion level) was evaluated immediately after the restorative procedure and after one week. Gingival sensitivity was also assessed one week after the end of the restorative procedures. The clinical time required to perform each restoration was recorded. The performance of the restorations was assessed using the FDI criteria at baseline and six, 12, and 18 months after clinical service. All criteria evaluated were submitted to appropriate statistical analysis (α=0.05).

RESULTS

The retention rates of the restorations at each recall time were not affected by the isolation method (p>0.05). No significant difference between isolation methods was found in regard to patients' preferences (p=0.86), gingival bleeding (p=0.57), laceration (p=0.64), insertion (p>0.52), gingival sensitivity (p=0.52), or chairside time (p=0.77).

CONCLUSIONS

The use of CR/RC was shown to be similar to the use of RD in terms of retention rates, patient's preference, gingival damage, and chairside time for adhesive restorations in NCCL.

Orbital Cellulitis of Odontogenic Origin

Odontogenic orbital cellulitis, although uncommon, has the potential to cause severe vision loss if unsuspected and untreated. Compared to non-odontogenic bacteriology, odontogenic orbital abscesses typically feature a heavy mixed growth with anaerobic organisms. We review the literature and discuss the case of a 26-year-old male who presented with anaerobic orbital cellulitis for treatment.

Dental Management of Patients with Dementia in Primary Dental Care

Dementia is an umbrella term for a set of symptoms that include memory loss, changes in mood and problems with reasoning, attention and communication. It is a progressive condition and there is ample evidence that oral health declines as the severity of dementia increases. Most of this decline is attributable to the effects of cognitive impairment on oral hygiene capability and/or acceptance of help from others in supporting oral hygiene. Factors such as altered salivary flow, taste change, use of high-energy food supplements and syrup-based medications also contribute to the risk of oral and dental diseases. In its role as part of the wider health and social care network, the primary dental care team can make an important contribution to securing the oral health of people living with dementia.

Dental infection and dermatological diseases: analysis of ninety-two patients and review of the literature

Dental disease has long been proposed as a potential causative agent in certain dermatological diseases. However, literature data on this association are scarce. The aim of this retrospective study was to evaluate dental status in 92 patients with various dermatological diseases who were referred to our Department for elimination of dental disease and to assess the relationship between dental infection and dermatological diseases. Dermatological conditions due to which patients were referred were alopecia, urticaria, eczematoid dermatitis, psoriasis, edema, etc. Out of 92 patients, 42 (45.7%) patients were referred for further dental treatment, while the remaining 50 (54.3%) patients had no observable dental pathology. None of the patients reported improvement following dental treatment. Based on the results of this study, we might conclude that dental infection does not play any role in the development of dermatological disease.

[Healing Dental and Oral Problems by Remedies of Animal and of Human Origin]

Use of matierials of animal or human origin in dentistry (and generally in medicine) these days is regarded as an unusal way of intervention. However in earlier times, different tissues, parts, products and organs of animals were frequently used in healing. Some of these methods were rooted in magical thinking. As analogical treatments--based on similarity or analogy--e.g. powder of horn or teeth of pike was used for the treatment of decayed teeth and different worms, maggots, veenies were applied against "toothworm". By difficult eruption of primary teeth bone marrow or brain mixed with cockridge-blood and goatmilk was a widely used medicine. Butter and honey were able to help the growing of teeth, as well. Parts of frog (fe: flippers) were also components of curing materials. Egg as the symbol of life was often an ingredient of medicaments. For the treatment of inflamed gum different animal materials were used, like chin and teeth of wolf, pike, crayfish, milk, honey, human saliva etc. Animal or human stools, mucks (containing enzymes) did one's bit in healing of oral and dental illnesses and were applied as fomentation or swathing. Placing a leech on the inflamed face was a common procedure in the past even as the use of earwax in lipnook. In our days tissues, parts or products of animals (or human beings) usually never allowed to get into contact with the body of patients. It's a much safer routine, at the same time however a precious traditional knowledge vanishes forever.

Oral manifestations of HIV disease: A review

The HIV/AIDS pandemic continues to plague the world. Evaluation of oral health status is important at every stage in the management of HIV disease. Oral health services and professionals can contribute effectively to the control of HIV/AIDS through health education, patient care, infection control and surveillance. Dental professionals have an important task of determining accurate diagnosis of oral manifestations and choosing proper treatment for each case. This review provides information on HIV associated orofacial lesions, their clinical presentation and up to date treatment strategies.

Reasons for patients' visits in the dental offices of Cracow in the years 2005-2006 and 2013-2014

INTRODUCTION

Caries is a serious health problem affecting the Polish population, mostly due to a low level of health awareness, which is reflected in irregular check-ups and a tendency for patients to visit the dentist only when they are already experiencing pain.

OBJECTIVE OF THE STUDY

to compare patients' reasons for visiting dental offices and the treatment they received during the years 2005-2006 and 2013-2014.

MATERIAL AND METHODS

Data was obtained from 495 medical files stored in 4 randomly selected dental offices in Cracow. Information was gathered on age, sex, place of residence, reasons for visiting the dentist, referrals, frequency of dental visits and procedures performed.

RESULTS

The study showed that women visited dental offices more frequently (56%) than men. The participants were aged between 1 and 91. The majority of the patients lived in large towns or cities (81.6%). Approximately 50% of the patients visited a dental office once a month. The study showed a significant increase in one-time visits (from 18.5% to 30.6%). The most frequent motivation for visiting a dental office was to receive conservative treatment, while the least common reasons were prophylaxis and tooth injuries.

CONCLUSIONS

Throughout the period under review, changes occurred in the profile of the patients who visited dental offices during these periods. One alarming trend was the significant increase in the number of patients who visited dental offices only once (12%). The main reason why patients visited dental offices did not change--more than 60% came to have caries treated but often after a single visit they did not continue the treatment despite needing to do so.

Dental health and treatment needs in people with leprosy in China

OBJECTIVES

To evaluate the dental health status and treatment needs of people affected by leprosy in China, and provide a basis for the development of national or regional dental health programmes to cover the treatment needs of this population.

DESIGN

A cross-sectional study with 613 former leprosy patients was carried out in six leprosy villages, in three provinces in China (Nanjing, Taixing and Jiangyan in Jiangsu Province, Hanzhong and Shangluo in Shanxi Province and Yongzhou in Hunan Province). A questionnaire about demographic and clinical data was used. The World Health Organization's (WHO) basic methods were used to determine the tooth-based treatment needs. Periodontal status was determined by using the Community Periodontal Index of Treatment Needs (CPITN). In addition, prosthetic normative needs were assessed.

RESULTS

Among the 613 people affected by leprosy, there were 472 people (77%) who had never visited a dentist and 172 people (28.1%) had never brushed their teeth; 302 (49.3%) brushed their teeth once a day. However, there were 267 people (43.6%) who thought their dental health was at an average level and 108 (17.6%) thought they had good dental health. 55.6% of the subjects required dental fillings, 32.7% required pulp care and restoration, and 71.1% required extraction. On CPITN, 23.2% of the subjects scored 2, 28.6% scored three and 48.0% scored four, showing that these people required systematic periodontal treatment. In addition, 84.5% of the subjects needed normative prosthetic treatment.

CONCLUSIONS

Most of the subjects with leprosy in this study lacked self-care knowledge on dental health, and especially self-awareness of dental conditions. Normative treatment needs of people affected by leprosy were very high. This result calls for improved oral health education and oral health care in people with leprosy. Oral health education might preferably be integrated into already existing leprosy rehabilitation programs.

The significance of ecstasy use to dental practice

3,4 Methylenedioxymethampetamine (MDMA), commonly known as ecstasy, is an illicit drug used by individuals seeking mood enhancement. Ecstasy's pharmacology, systemic, oral and dental manifestations are presented. Use of this drug is not limited to a particular socioeconomic class and, as such, all practicing dentists must be aware of both the intra-oral effects of this drug and any possible alterations to dental treatment that might become necessary. Dental manifestations include bruxism, increased incidence of caries, xerostomia and oral ulcers.

Factors affecting treatment planning decisions for compromised anterior teeth

The purpose of this study was to identify the factors that create differences in opinion between dental professionals when treatment planning for a patient whose problem is limited to one or more maxillary incisors. A series of computer-generated scenarios was created in which anterior teeth were compromised for various reasons. The cases were used to survey a diverse group of practitioners regarding whether to treat or extract a tooth under the given circumstances. The results indicated that numerous patient-associated factors had statistically significant effects on the decision-making process. These included the patient's age, root length, root morphology, periodontal status, history of prior endodontic treatment, presence of posts, and size of periapical radiolucencies. The data also showed that a clinician's educational background had a dramatic impact on his or her treatment recommendation.

Management of dental infections by medical practitioners

BACKGROUND

Patients with dental infections frequently present to primary care practitioners such as emergency physicians or general practitioners. It is important for these healthcare professionals to understand how to assess and treat such conditions, including when to refer and to whom.

OBJECTIVE

This article aims to cover basic principles of managing patients with dental infections who present to emergency departments or general practice surgeries.

DISCUSSION

Maxillofacial surgeons frequently see serious cases of facial and neck infections that can easily be prevented if appropriately managed early.

Proposal for clinical classification of multifactorial noncarious cervical lesions

Noncarious cervical lesions often present with overlapping symptoms and have a multifactorial etiology. The dimensions of the lesion axially (depth) and occlusogingivally (width), along with the orientation of the walls of the lesion to each other (angle), are the 3 factors that can be quantified to classify the lesion and assess its progress over time. This article analyzes these factors and proposes a simple classification system based upon the clinical appearance of the lesion in order to derive simple, therapeutic, treatment-based classifications.

A rare case of canine anomaly - a possible algorithm for treating it

Canine transmigration is a very rare dental anomaly in which an unerupted mandibular canine migrates, crossing the mandibular midline. This unusual condition is most often diagnosed by chance during a routine X-ray examination. The most common clinical signs announcing the presence of this anomaly are over-retention of the deciduous canine and the absence of permanent canine from the dental arch after its physiological period of eruption. In this paper, we present a clinical case, 10-year-old boy, who was diagnosed with mandibular right canine transmigration at three years after the start of orthodontic treatment, during which we were expecting the eruption of mandibular canines. The orthopantomograph revealed the mandibular right canine to be in a horizontal position under the apices of the incisors - type 2 transmigration pattern classified by Mupparapu (2002). Based on cone-beam computer tomography examination, we recommended a surgical exposure of the canine and orthodontic alignment. Due to the risk of root resorption of the mandibular right lateral incisor during orthodontic movement phase of canine transmigrated to the dental arch, we decided to align the mandibular right canine in a transposition, between the two mandibular right incisors. Then we resorted to adapting the mandibular right lateral incisor coronary morphology to simulate a canine and also to reshaping the canine coronary morphology to resemble a lateral incisor. This therapeutic approach allowed us to restore morphologically and functionally the mandibular dento-alveolar arch, preserving the entire dental system.