Analysis of saliva for periodontal diagnosis--a review

BACKGROUND: This review examines salivary constituents as potential diagnostic tests for periodontal disease. Saliva is a fluid that is readily available and contains locally-produced microbial and host response mediators, as well as systemic (serum) markers that may prove to be an aid in the diagnosis of periodontal disease. METHODS: A medline search was conducted and the relevant literature concerning the applications of saliva for periodontal diagnosis was reviewed. RESULTS: Based on the literature, salivary markers that have been studied as potential diagnostic tests for periodontal disease include proteins of host origin (i.e., enzymes, immunoglobulins), phenotypic markers, host cells, hormones (cortisol), bacteria and bacterial products, ions and volatile compounds. CONCLUSIONS: A number of markers show promise as sensitive measures of disease and the effectiveness of therapy. At this time, host-derived enzymes and other inflammatory mediators orginating from the gingival crevice appear to hold the greatest promise as salivary diagnostic tests for periodontal disease. Longer-term longitudinal studies, however, are required to establish the relationship between specific markers and progression of periodontal disease. Furthermore, analysis of saliva may offer a cost-effective approach to assessment of periodontal disease in large populations.     

Pulpal diagnosis

Correct pulpal diagnosis is the key to all predictable endodontic treatment. It is paramount that prior to proceeding with a treatment that will affect the contents of the pulp chamber that a clinical diagnosis of the pulp and the periapical tissues is established. This diagnosis should be based on presenting symptoms, history of symptoms, diagnostic tests and clinical findings. If it is not possible to establish the diagnosis or one diagnosis is not dominant within a differential diagnosis, therapy should not be initiated until further evaluation has been performed. In this review, current knowledge on pulpal and periapical status as it pertains to diagnosis will be reviewed. Additionally, most common diagnostic tests will be presented and critically reviewed.     

Pulpal irritants

The dental pulp is characterized as a connective tissue and as such it is not considered an external tissue, yet its exposure to external stimuli is constant. This is due to a number of factors including the permeability of attrited or disrupted enamel as well as that of physiologic dentin and cementum. The pulp is extraordinarily sensitive to its external environment. Once thought to be a vestigial organ, it is now understood that the dental pulp is an important tissue whose role in the defense of the dentition may be as significant as its role in odontogenesis.     

Pulpal Tissue Inflammatory Reactions after Experimental Pulpal Exposure in Mice

Introduction

The purpose of this study was to establish a stable experimental mice pulpal inflammatory model and to evaluate inflammatory reactions of pulpal tissue after pulpal exposure.

大鼠实验性牙髓炎和根尖周炎的组织病理学观察

目的：观察大鼠牙髓在自然暴露状态下组织病理学动态过程。方法：12只Wistar大鼠磨牙开髓后旷置口腔，分别于术后3d、7d、14d分批处死大鼠，组织经HE染色进行观察和测量分析。结果：术后3d，冠髓和近根管口处根髓坏死，根尖周区出现炎症细胞；术后7d，根髓坏死继续发展，根尖周区炎症明显；术后14d，根髓几乎完全坏死，根尖周区见牙槽骨吸收。组织学测量发现，术后3d，约35．18％的牙髓发生坏死；术后14d牙髓坏死达92．23％。根尖区破坏的水平长度和垂直长度随炎症进展而增加，术后7～14d发展速度最快。结论：大鼠磨牙开髓后口髂蔚群可诱导牙髓后,口腔菌群可诱导牙髓炎．炎症随诱导时间延长而加重，最后形成根尖周炎。     

Pulpal response to dental amalgams

Abstract – The pulpal reactions to amalgams with relatively high Cu content were compared with a conventional amalgam placed in unlined cavities prepared in intact monkey teeth. After a 1-week observation period the pulpal responses from one of the Cucontaining amalgams and the conventional amalgam were of the same magnitude, whereas the two other amalgams gave more pronounced reactions. After observation periods of 1 and 2 months only one o( the amalgams with high Cu content caused more pronounced reactions than the conventional amalgam.     

Pulpal response to phosphoric acid

Abstract. The chemical treatment of tooth surfaces to improve bonding of dental materials to enamel and dentin is one of the approaches in overcoming the lack of adhesion of the available restorative materials to tooth structure. The acid etch technique is now an accepted procedure in restorative and preventive dentistry and for the direct bonding of orthodontic attachments. The pulpal response elicited by one of the conditioning agents, 50 % H₃PO₄ applied for 1 minute, was investigated in the teeth of the vervet monkey. The differences between most of the criteria used to evaluate the pulpal responses in acid-treated and control teeth at three time intervals, namely 4, 14 and 42 days, were statistically significant. These results suggest that a protective lining should be used to cover exposed dentin before etching adjacent enamel surfaces with 50 % H₃PO₄.