- Email: [email protected]
Indirect pulp capping
Methods.—The 19 participants (median age 14 years) had fixed orthodontic appliances and saliva densely colonized by mutans streptococci. The plaque adjacent to the brackets for their appliances was sampled to determine baseline levels. The patients’ teeth were professionally cleaned, then coated with a single application of 36% chlorhexidine varnish for 8 minutes. Recolonization levels were measured after 2 weeks in the plaque around the brackets.
of the varnish is not clinically relevant for patients with fixed orthodontic appliances and saliva highly colonized with mutans streptococci.
Clinical Significance.—Oral hygiene in teenagers, especially those in braces, may be less than ideal. The use of antimicrobials has been suggested to counteract this threat. In this study, use of a chlorhexidine varnish failed to produce a significant reduction in recolonization by mutans streptococci.
Results.—Thirty-six sites had worse (higher) scores and 64 sites had improved scores after 2 weeks. No change was detected at the other 52 sites sampled. Only 34 sites had mutans streptococci scores that were undetectable. Intraindividual differences were observed, and the degree of reinfection differed significantly between patients. Only 2 patients clearly demonstrated a suppression of the mutans streptococci count.
Attin R, Ilse A, Werner C, et al: Antimicrobial effectiveness of a highly concentrated chlorhexidine varnish treatment in teenagers with fixed orthodontic appliances. Angle Orthod 76:1022-1027, 2006
Discussion.—The single application of a chlorhexidine varnish was insufficient to suppress mutans streptococci growth over a period of 2 weeks. This indicates that use
Reprints available from R Attin, Univ of Go¨ttingen, Dept of Operative Dentistry, Robert-Koch Str 40, Go¨ttingen, Germany; e-mail: [email protected]
Pediatric Dentistry Indirect pulp capping Background.—The identification and removal of carious lesions are generally accomplished using visual and tactile examinations that assess dentin hardness. Bacteria usually remain even when all the soft dentin is removed. However, the number of cariogenic microorganisms is reduced and further progression of the lesion halted even with partial carious dentin removal. Deep carious lesions present the problem of exposing the pulp should all the carious tissue be removed. Indirect pulp capping is undertaken in these cases, which leaves a layer of carious tissue over the pulp. Calcium hydroxide (CH) liner induces pulpdentin remineralization and minimizes bacterial infection in these cases. The performance of primary molars with deep caries cavities sealed with a resin-based composite after partial removal of infected dentin at the pulpal wall was investigated. It was hypothesized that adding guttapercha (GP) over the dentin would not affect the behavior of the restoration either clinically or microbiologically. Methods.—The 20 subjects were ages 4 to 7 years and had a combined total of 42 treated teeth. In each case the treatment was incomplete excavation of the demineralized dentin, applying a layer of CH (19 sites) or GP (20 sites), and sealing with a resin-based composite for 4 to 7 months. Cavity preparation and sealing were carried out, then the dentin was assessed for color and consistency as well as microbiologic status.
242
Dental Abstracts
Results.—Most lesions were light brown immediately after the carious dentin was incompletely removed, then became dark brown after treatment. No significant difference in final color was observed between the CH and GP groups. Both groups also had soft or leathery dentin consistency immediately after incomplete dentin removal. Hard consistency was achieved in 85% of the CH group and 68.4% of the GP group. The final dentin consistency did not differ significantly between the 2 groups. The CH group had a higher number of teeth with initial soft dentin that became hard after treatment than the GP group. The initial bacterial counts of the 2 groups were similar except for Lactobacillus, which was greater in the CH group than the GP group. All viable bacteria counts were significantly reduced after treatment regardless of whether CH or GP was used. The groups did not differ from one another in microbiological status. Discussion.—The clinical and radiographic examinations of these 2 groups of patients demonstrated a 95.1% success rate. The bacterial counts declined, indicating reduced or absent metabolic activity and suggesting that the lesion was no longer growing. The remaining carious dentin had hardened in most cases, with no evidence of caries progression. Microbiological analysis demonstrated a substantial reduction in infective organisms after the sealing. The indirect pulp capping and adhesive restoration can be done in a single appointment for primary teeth.
Clinical Significance.—Demonstrated here is the validity of indirect pulp capping of extensive carious lesions in the absence of signs of pulp pathology with and without CA(OH)2. Reduced metabolic activity resulting from hermetically sealing the lesion appears to be the key.
Pinto AS, de Arau´jo FB, Franzon R, et al: Clinical and microbiological effect of calcium hydroxide protection in indirect pulp capping in primary teeth. Am J Dent 19:382-387, 2006 Reprints available from FB de Arau´jo, Dept of Pediatric Dentistry, Faculty of Dentistry, UFRGS, Rua Ramiro Barcelos, 2492, Bom Fim, Porto Alegre, Rio Grande do Sul, Brazil; e-mail: fernando.araujo@ ufrgs.br
Preventive Dentistry Pilocarpine lozenge for xerostomia Background.—Patients with xerostomia report the subjective sensation of dryness in the oral mucous membranes. The condition can develop iatrogenically after the patient undergoes radiotherapy. The effects of radiotherapy on the parenchyma of the salivary glands are dose related and permanent. Pilocarpine hydrochloride, a direct-acting cholinergic parasympathomimetic agent, directly stimulates muscarinic receptors. It can stimulate the salivary glands, is given orally, and has side effects that are tolerable for most patients. The systemic administration of pilocarpine has proved safe with dosages from 2.5 to 10 mg. Side effects were dose related but of low incidence. They included transient sweating, urinary frequency, and headache. Topical pilocarpine, given in lozenge form, would be easy to administer, stimulate salivary function mechanically, permit prolonged and increased topical contact, and may have fewer systemic effects. The efficacy and safety of pilocarpine lozenges for xerostomia symptom relief were assessed in patients with hypofunction related to radiotherapy for head and neck cancer. Methods.—Thirty-three head and neck cancer patients (mean age 51.9 years) were randomly divided into groups receiving a pilocarpine tablet, a pilocarpine hydrochloride lozenge (3 or 5 mg), or a placebo lozenge every 10 days. Patients used visual analog scales to express the improvement in clinical symptoms and salivary function before and 3 hours after treatment at each visit. Collections of whole resting saliva were obtained 1, 30, 60, 80, 120, 150, and 180 minutes after treatment. Results.—The improvements in oral dryness were 12.1% for the pilocarpine tablet, 63.6% for the 3-mg pilocarpine lozenge, 69.7% for the 5-mg pilocarpine lozenge, and 42.4% for the placebo lozenge. The difference in improvement was significantly greater with the 5-mg lozenge than the placebo lozenge, but was not significantly greater for the 3-mg lozenge. The proportion of improved responses was lower for the pilocarpine tablet group than for the placebo group. Oral comfort and speaking were improved in
all groups but did not differ significantly from the improvements in the placebo group. Whole saliva production increased for all 3 lozenge groups immediately. The maximal effect for the 3-mg and 5-mg pilocarpine lozenge groups was at 60 to 90 minutes, with a slow decline thereafter. Salivary output after placebo lozenge use was somewhat less and stable from the period of 30 to 180 minutes. After use of the pilocarpine tablet, salivary weight increased within 30 minutes, reached maximum values at 60 minutes, and slowly declined after that. The increases in whole saliva production with the 3-mg and 5-mg lozenge groups were significant compared with placebo use. The increased salivary flow accompanying use of the pilocarpine tablet was similar to that with the 3-mg and 5-mg lozenges. No notable side effects were reported. Discussion.—The use of pilocarpine produced clinically significant benefits that were much greater than the side effects or risks. Patients given the 5-mg pilocarpine lozenges had the best clinical responses. Further study with more patients is needed.
Clinical Significance.—Systemic use of pilocarpine to stimulate salivary flow is well known. Explored here is its oral administration in the form of a lozenge. Early results are encouraging. Dry mouth as a medication side effect in our aging population, in addition to postirradiation patients, makes this convenient delivery system attractive.
Taweechaisupapong S, Pesee M, Aromdee C, et al: Efficacy of pilocarpine lozenge for post-radiation xerostomia in patients with head and neck cancer. Austral Dent J 51:333-337, 2006 Reprints available from S Taweechaisupapong, Dept of Oral Diagnosis, Faculty of Dentistry, Khon Kaen Univ, Khon Kaen 40002, Thailand; e-mail: [email protected]
Volume 52
Issue 4
2007
243
of the varnish is not clinically relevant for patients with fixed orthodontic appliances and saliva highly colonized with mutans streptococci.
Clinical Significance.—Oral hygiene in teenagers, especially those in braces, may be less than ideal. The use of antimicrobials has been suggested to counteract this threat. In this study, use of a chlorhexidine varnish failed to produce a significant reduction in recolonization by mutans streptococci.
Results.—Thirty-six sites had worse (higher) scores and 64 sites had improved scores after 2 weeks. No change was detected at the other 52 sites sampled. Only 34 sites had mutans streptococci scores that were undetectable. Intraindividual differences were observed, and the degree of reinfection differed significantly between patients. Only 2 patients clearly demonstrated a suppression of the mutans streptococci count.
Attin R, Ilse A, Werner C, et al: Antimicrobial effectiveness of a highly concentrated chlorhexidine varnish treatment in teenagers with fixed orthodontic appliances. Angle Orthod 76:1022-1027, 2006
Discussion.—The single application of a chlorhexidine varnish was insufficient to suppress mutans streptococci growth over a period of 2 weeks. This indicates that use
Reprints available from R Attin, Univ of Go¨ttingen, Dept of Operative Dentistry, Robert-Koch Str 40, Go¨ttingen, Germany; e-mail: [email protected]
Pediatric Dentistry Indirect pulp capping Background.—The identification and removal of carious lesions are generally accomplished using visual and tactile examinations that assess dentin hardness. Bacteria usually remain even when all the soft dentin is removed. However, the number of cariogenic microorganisms is reduced and further progression of the lesion halted even with partial carious dentin removal. Deep carious lesions present the problem of exposing the pulp should all the carious tissue be removed. Indirect pulp capping is undertaken in these cases, which leaves a layer of carious tissue over the pulp. Calcium hydroxide (CH) liner induces pulpdentin remineralization and minimizes bacterial infection in these cases. The performance of primary molars with deep caries cavities sealed with a resin-based composite after partial removal of infected dentin at the pulpal wall was investigated. It was hypothesized that adding guttapercha (GP) over the dentin would not affect the behavior of the restoration either clinically or microbiologically. Methods.—The 20 subjects were ages 4 to 7 years and had a combined total of 42 treated teeth. In each case the treatment was incomplete excavation of the demineralized dentin, applying a layer of CH (19 sites) or GP (20 sites), and sealing with a resin-based composite for 4 to 7 months. Cavity preparation and sealing were carried out, then the dentin was assessed for color and consistency as well as microbiologic status.
242
Dental Abstracts
Results.—Most lesions were light brown immediately after the carious dentin was incompletely removed, then became dark brown after treatment. No significant difference in final color was observed between the CH and GP groups. Both groups also had soft or leathery dentin consistency immediately after incomplete dentin removal. Hard consistency was achieved in 85% of the CH group and 68.4% of the GP group. The final dentin consistency did not differ significantly between the 2 groups. The CH group had a higher number of teeth with initial soft dentin that became hard after treatment than the GP group. The initial bacterial counts of the 2 groups were similar except for Lactobacillus, which was greater in the CH group than the GP group. All viable bacteria counts were significantly reduced after treatment regardless of whether CH or GP was used. The groups did not differ from one another in microbiological status. Discussion.—The clinical and radiographic examinations of these 2 groups of patients demonstrated a 95.1% success rate. The bacterial counts declined, indicating reduced or absent metabolic activity and suggesting that the lesion was no longer growing. The remaining carious dentin had hardened in most cases, with no evidence of caries progression. Microbiological analysis demonstrated a substantial reduction in infective organisms after the sealing. The indirect pulp capping and adhesive restoration can be done in a single appointment for primary teeth.
Clinical Significance.—Demonstrated here is the validity of indirect pulp capping of extensive carious lesions in the absence of signs of pulp pathology with and without CA(OH)2. Reduced metabolic activity resulting from hermetically sealing the lesion appears to be the key.
Pinto AS, de Arau´jo FB, Franzon R, et al: Clinical and microbiological effect of calcium hydroxide protection in indirect pulp capping in primary teeth. Am J Dent 19:382-387, 2006 Reprints available from FB de Arau´jo, Dept of Pediatric Dentistry, Faculty of Dentistry, UFRGS, Rua Ramiro Barcelos, 2492, Bom Fim, Porto Alegre, Rio Grande do Sul, Brazil; e-mail: fernando.araujo@ ufrgs.br
Preventive Dentistry Pilocarpine lozenge for xerostomia Background.—Patients with xerostomia report the subjective sensation of dryness in the oral mucous membranes. The condition can develop iatrogenically after the patient undergoes radiotherapy. The effects of radiotherapy on the parenchyma of the salivary glands are dose related and permanent. Pilocarpine hydrochloride, a direct-acting cholinergic parasympathomimetic agent, directly stimulates muscarinic receptors. It can stimulate the salivary glands, is given orally, and has side effects that are tolerable for most patients. The systemic administration of pilocarpine has proved safe with dosages from 2.5 to 10 mg. Side effects were dose related but of low incidence. They included transient sweating, urinary frequency, and headache. Topical pilocarpine, given in lozenge form, would be easy to administer, stimulate salivary function mechanically, permit prolonged and increased topical contact, and may have fewer systemic effects. The efficacy and safety of pilocarpine lozenges for xerostomia symptom relief were assessed in patients with hypofunction related to radiotherapy for head and neck cancer. Methods.—Thirty-three head and neck cancer patients (mean age 51.9 years) were randomly divided into groups receiving a pilocarpine tablet, a pilocarpine hydrochloride lozenge (3 or 5 mg), or a placebo lozenge every 10 days. Patients used visual analog scales to express the improvement in clinical symptoms and salivary function before and 3 hours after treatment at each visit. Collections of whole resting saliva were obtained 1, 30, 60, 80, 120, 150, and 180 minutes after treatment. Results.—The improvements in oral dryness were 12.1% for the pilocarpine tablet, 63.6% for the 3-mg pilocarpine lozenge, 69.7% for the 5-mg pilocarpine lozenge, and 42.4% for the placebo lozenge. The difference in improvement was significantly greater with the 5-mg lozenge than the placebo lozenge, but was not significantly greater for the 3-mg lozenge. The proportion of improved responses was lower for the pilocarpine tablet group than for the placebo group. Oral comfort and speaking were improved in
all groups but did not differ significantly from the improvements in the placebo group. Whole saliva production increased for all 3 lozenge groups immediately. The maximal effect for the 3-mg and 5-mg pilocarpine lozenge groups was at 60 to 90 minutes, with a slow decline thereafter. Salivary output after placebo lozenge use was somewhat less and stable from the period of 30 to 180 minutes. After use of the pilocarpine tablet, salivary weight increased within 30 minutes, reached maximum values at 60 minutes, and slowly declined after that. The increases in whole saliva production with the 3-mg and 5-mg lozenge groups were significant compared with placebo use. The increased salivary flow accompanying use of the pilocarpine tablet was similar to that with the 3-mg and 5-mg lozenges. No notable side effects were reported. Discussion.—The use of pilocarpine produced clinically significant benefits that were much greater than the side effects or risks. Patients given the 5-mg pilocarpine lozenges had the best clinical responses. Further study with more patients is needed.
Clinical Significance.—Systemic use of pilocarpine to stimulate salivary flow is well known. Explored here is its oral administration in the form of a lozenge. Early results are encouraging. Dry mouth as a medication side effect in our aging population, in addition to postirradiation patients, makes this convenient delivery system attractive.
Taweechaisupapong S, Pesee M, Aromdee C, et al: Efficacy of pilocarpine lozenge for post-radiation xerostomia in patients with head and neck cancer. Austral Dent J 51:333-337, 2006 Reprints available from S Taweechaisupapong, Dept of Oral Diagnosis, Faculty of Dentistry, Khon Kaen Univ, Khon Kaen 40002, Thailand; e-mail: [email protected]
Volume 52
Issue 4
2007
243