Pain and swelling in periapical surgery. A literature update

In recent years, periapical surgery (PS) has evolved thanks to the incorporation of technical and diagnostic advances. In PS, secondary effects such as pain and swelling occur as with all surgical procedures. The objective of the present study is to review the literature of articles published on pain and swelling during the postoperative period in periapical surgery. For this review, a search was made in Medline and of literature published in Spanish odontological journals. In the reviewed literature the maximum pain was produced during the first 24 postoperative hours and maximum swelling between the first and second day. Recent studies propose the use of corticoids and nonsteroidal anti-inflammatory drugs (NSAIDs) during the pre-and post-operative period, in order to reduce pain perception during the first postoperative week after surgery. Likewise, low-level laser therapy has been used; although with no statistically significant results being observed for the control of pain. In the majority of published studies there was no statistically significant relationship between age and sex and the postoperative symptoms. However, greater pain and swelling is observed in patients with poor oral hygiene before surgery, and higher pain in patients who smoke, and in those with pain before surgery. Surgery of anterior teeth and molars is associated with greater pain.     

Factors related to oral hygiene in persons with scleroderma

Objectives: The purpose of this study was to assess potential risk factors for the development of poor oral hygiene and increased dental caries in individuals with scleroderma. Methods: Twenty‐two subjects with scleroderma participated in this study. All subjects were examined with the Patient Hygiene Performance (PHP) Index, which assesses the extent of plaque and debris over a tooth surface. In addition, oral aperature, xerostomia and dominant upper extremity strength, motion, skin thickness, and dexterity were measured. Results: None of the subjects had good or excellent hygiene. Fifteen subjects had fair oral hygiene and seven subjects had poor oral hygiene as measured by the PHP Index. Significant differences were seen between these two groups for oral aperture, percentage of teeth with caries, skin thickness, dexterity and finger flexion. Dexterity and joint motion correlated significantly with the number of decayed surfaces and number of caries. Oral aperture correlated with the PHP Index and the number of dental caries. Conclusions: Subjects with poor oral hygiene required more time to complete manual dexterity task and had decreased hand strength and joint motion. Moreover, these same subjects had more contractures, scars, ulcers, and higher skin scores (more disease activity) than subjects in the fair hygiene group. In addition to frequent dental exam and routine cleaning, dental personnel may want to consider exercises to increase oral aperature and investigate toothbrush and dental floss selection used by persons with scleroderma.     

Tobacco smoking and dental periapical condition

The relation between smoking and apical periodontitis has been little studied to date. The aim of the present study was to investigate whether tobacco smoking might be associated with the prevalence or severity of periapical lesions. A total of 247 individuals, 81 current smokers, 63 former smokers, and 103 non-smokers participated in the study. The periapical condition was expressed as the number and percentage of radiographically detectable lesions and, in addition, as a severity index. The overall prevalence of apical periodontitis was 52% and the overall prevalence of endodontic treatment 58%. There was no significant influence of smoking on the prevalence of either apical periodontitis or endodontic treatment. The mean number (percentage) of periapical lesions per person was 1.9 (6%) in current smokers, 1.5 (4%) in former smokers, and 1.0 (3%) in non-smokers. Controlling for age, the association between smoking and periapical lesions was not statistically significant. The mean periapical severity index including all teeth, or teeth affected by periapical lesions alone, did not significantly differ between smoking groups. It is concluded that the present observations do not lend support to the assumption that tobacco smoking is associated with apical periodontitis.     

Adherence to oral hygiene and dental self-care

Nearly every person will be in need of dental treatment in his lifetime, whether purely for health causes or alternately for esthetic issues. Yet the main reasons of seeking dental treatment are in fact Caries, Gingivitis and Periodontitis. In spite of the fact that these pathologies occur due to the accumulation of Plaque around the oral cavity and teeth, they are fairly easy to prevent. Using simple techniques such as oral rinsing, flossing and brushing of the teeth, are normally sufficient for obtaining good oral health. If this is actually the case, than how is it that we are witnessing a massive spread of dental problems? How come there are so many incidents of people suffering from dental problems if the preventative care is that easy to manage? The answer lies in the concept of Adherence, referring to the cooperation of an individual with the demands of his treatment regime and the dental staff. The idea of promoting health adherence aims mainly for using medication, attending the periodic inspections and examination, and making lifestyle changes such as preventive care illustrated above. This article exemplifies how one of the current trends in Medical Psychology discipline is to enhance adherence by establishing a secure therapeutic alliance which is based upon a positive relationship between the patient and his doctor, increasing patient's confidence and sense of self-efficacy, and recruiting family members and friends to the patient's process of change. A distinctive emphasis is put on expanding the patient's knowledge about his condition, and raising awareness to the linkage between his medical (to be more specific-dental) problem and its symptoms to the implications. The most modish and putative intervention nowadays is Patient Centered, where the guiding principles used are urging the patient to be responsible for implying the treatment regime, taking active participation, and make decisions regarding his current and future status. This article illustrates, through a comprehensive literature review of theories, models and researches, the contemporary methods for promoting adherence to oral hygiene, dental Self-Care and treatment. Using the combination of a survey from a select sample of specialists in the field of Dentistry, and the conclusions inferred from studies reviewed, I was able to determine how investment in the Bio-Psycho-Social approach would improve patient satisfaction from their doctors and outcomes of the treatment, shorten the duration of treatment, consume only little resources, improve dental health of patients and prevent repetitive visits to the dentists clinics. At the same time, despite the fact that dentistry practitioners acknowledge the importance of patient's adherence and take active measures such as talks, praises, guidance and providing information, most of them don't seem to comprehend interfusion of family members or friends as an integral part of the treatment. Moreover, their overall feeling is of incompetence when regarding dealing with un-adherent patients. Therefore, maybe there is room for providing dentists and staff with seminars, conventions etc. about the latest novelties on the subject. In conclusion, enhancing dental patient's adherence to health behavior is a domain mainly under the responsibility of the dentist, but also of his staff. As elaborated in the article, the measures for doing so are: 1. Information- the dentist should guide patients about the different methods for maintaining oral hygiene, explain how proper adherence benefits positive treatment outcome, and provide a broad and informative picture of the patient's specific problem. 2. Positive rapport - the need for establishing a good relationship between the doctor and his patients is crucial for attaining effective and satisfactory treatment outcomes. No doubt that this matter depends upon the personality and character of both the doctor and the patient, but using positive verbal reinforcements, symbolic incentives (such as free toothpaste samples), support throughout the treatment, sharing the rationale behind professional decisions with the patient, and proving several treatment options to choose from, are all methods for recruiting patients to the treatment process and the implementation of health behavior change. 3. Using reminders - the dentist can suggest different ideas for preventing slips and withdrawals in the patient's behavior, mainly through dental calendars or periodic phone calls to prompt patient's persistence in their actions. In addition, it is possible of course to use family and friends as a supportive auxiliary power.     

The influence of methylprednisolone on post-operative swelling following oral surgery

This study compares the influence of methylprednisolone with that of a placebo on post-operative pain and swelling, and on healing. Twenty patients undergoing the removal of symmetrically placed bilateral lower third molar teeth under local analgesia by the same operator one side at a time were used. In each individual patient, for one side 40 mg methylprednisolone (Solumedrone Upjohn Limited) was given intravenously immediately preoperatively and for the other side a placebo was given on a double-blind random basis. The results showed that the mean post-operative swelling at 24 hours was reduced by 56% (p = .0003) when methylprednisolone was used compared with the opposite side of the same patient when the placebo was used. The severity of pain also was reduced over the first day but healing was similar for each side. Sixteen patients indicated a preference for the overall post-operative course when methylprednisolone was used.     

Susceptibility to chlorhexidine of plaque streptococci after two years oral chlorhexidine hygiene

The purpose of the present study was to examine if streptococci, isolated from human dental plaque in experimental subjects having practiced 2 years daily oral chlorhexidine hygiene, showed any difference in susceptibility to chlorhexidine compared to plaque streptococci isolated from a control group. The minimal inhibitory concentrations (MIC) of chlorhexidine were determined using the broth dilution test tube method. From an 18 h culture of each strain in brain heart infusion, 0.2 ml were inoculated into 5 ml brain heart infusion with added chlorhexidine to final concentrations of 0, 0.5, 1, 2, 4, 8, 16, 32, and 64 μg per ml. Three months later identical tests were performed. In both tests strains of Streptococcus mutans, Streptococcus milleri and Streptococcus salivarius were found to be the most susceptible to chlorhexidine, showing MIC around 4 μg chlorhexidine per ml. Strains resembling S. milleri appeared slightly less susceptible than strains identified as S. milleri . The majority of the S. sanguis strains had MIC ranging from 8 to 16 μg per ml. This species was slightly more susceptible than a group of streptococci intermediary to S. sanguis and S. mitior , while the susceptibility of the S. mitior strains ranged from 4 to more than 64 μg per ml. A difference in susceptibility to chlorhexidine between strains isolated from the chlorhexidine group and the control group was only observed for S. sanguis . Strains of this species isolated from the chlorhexidine group showed higher MIC than did strains isolated from the control group.     

Oral hygiene practices, smoking habit, and self-perceived oral malodor among dental students

The aims of this study were to determine the prevalence of oral hygiene practices and halitosis among undergraduate students from King Saud University, College of Dentistry. A self-administered questionnaire was distributed among all 481 students; 263 male and 218 female students. A questionnaire was developed to assess the self-reported perception of oral breath, awareness of bad breath, timing of bad breath, treatment received for bad breath, oral hygiene practices, caries and bleeding gums, dryness of the mouth, smoking and tea drinking habits, and tongue coating. The response rate was 77%. Forty four percent of male and 32% of female students reported the self-perception of breath odor. Self-treatment was sought by 12% male and 22% female. Six percent of males and 4% of females experienced bad breath interference at their work. Seventy-eight percent of male and 62% of female students experienced bad breath after waking up. Brushing was prevalent among 81% of male and 99% of female students. Both miswak (chewing sticks) and tooth brushing were used by 53% male and 83% female students. Fifty seven percent of male students and 44% of female students reported caries. Bleeding gingiva was experienced by 26% of males and 14% of females. Dry mouth was common among 14% of males and 17% of females, while smoking was prevalent among 13% of males and 2% of females. Tea drinking was common among 44% of males and 37% of females, while tongue coating was equally common among both males and females (21% and 20%), respectively. The results indicate female students had better oral hygiene practices, significantly less self-reported oral bad breath, and smoked less compared to male students. There was no difference in tongue coating among male and female students. Further research is needed to examine oral malodor clinically and objectively by the standard procedures available. Students should be motivated to be a health symbol and keeping their mouths free from oral malodor.