Treatment of chronic sialadenitis by intraductal penicillin or saline.

PURPOSE: We sought to describe the treatment of chronic sialadenitis by intraductal penicillin or saline. PATIENTS AND METHODS: The study group consisted of 32 males and 23 females with chronic submandibular sialadenitis aged 12 to 65 years and 16 males and 11 females with chronic parotitis aged 8 to 65 years who were treated by intraductal instillation of penicillin or saline. RESULTS: In the patients with submandibular sialadenitis, 44 patients treated with penicillin and 11 treated with saline became symptom free; symptoms recurred in 3 treated with penicillin, of whom 2 became symptom free after further instillations and 1 after removal of a sialolith at the ductal orifice; and follow-up of 22 patients verified that 18 treated with penicillin and 4 with saline had been symptom free for 1 to 15 years and 1 to 3 years, respectively. In the patients with parotitis, 18 patients treated with penicillin, 8 treated with saline, and 1 treated with both became symptom free; symptoms recurred in 1 treated with penicillin and 1 with saline, both of whom became symptom free after further instillations; and follow-up of 15 patients verified that 11 treated with penicillin, 3 with saline, and 1 with both had been symptom free for 1 to 14 years, 2 to 12 years, and 3 years, respectively. CONCLUSION: The intraductal instillation of penicillin or saline is a simple and surprisingly successful technique for the treatment of chronic sialadenitis.     

Oral care and sensory sensitivities in children with autism spectrum disorders

Children with autism spectrum disorders (ASD) are at high risk for oral disease. The aim of this study was to examine the contribution of sensory processing problems to challenges in receiving oral care for children with ASD. A questionnaire was sent to the parents of 206 children with disabilities to test the hypotheses that children with ASD, relative to children with other disabilities, experience greater difficulty with home‐based and professional oral care, and that these difficulties may relate in part to sensory processing problems. The results partially supported these hypotheses. Compared to children with other disabilities, those with ASD had greater behavioral difficulties and sensory sensitivities that parents believed interfered with their child’s oral care. Among children with ASD, sensory sensitivities were associated with oral care difficulties in the home and dental office, and with behavioral difficulties in the dental office. Utilizing strategies to modify the sensory environment may help facilitate oral care in children with ASD.     

Adherence of streptococci to cells infected with herpesvirus

The attachment of streptococci and staphylococci to cells infected with influenza virus has been previously reported and has been correlated with the increased incidence of these bacterial infections during flu epidemics. The present work was initiated to determine whether infection with herpes simplex virus (HSV) might lead to preferential bacterial attachment. HEp-2 cells were grown in monolayer and infected with HSV, Type I or Type II. Twenty-four hours later the cells were incubated with suspensions of various organisms, including Group A and B streptococci, Staphylococcus aureus, Propionibacterium acnes, and Candida albicans. After incubation for one hour, the cells were washed and fixed. Bacterial adherence and virus infection were assessed by scanning electron microscopy (SEM) as well as conventional light and transmission electron microscopy (TEM). Only Group A streptococci adhered to virus-infected cells, both to cells infected with HSV, Type I and those infected with HSV, Type II. SEM and TEM revealed bacteria attaching to cells with budding virus particles. Preincubation of infected cells with anti-HSV serum prevented bacterial adherence. These findings suggest that infection of oral epithelium with HSV might lead to superinfection with Group A streptococci.     

Degrees of saturation with respect to apatites in parotid saliva at various pH values

abstract — The purpose of the present work was to investigate the degrees of saturation with respect to hydroxyapatite and fluorapatite in saliva at various pH's. The data of ionic activities in parotid saliva were collected from the literature and the degrees of saturation with respect to hydroxyapatite and fluorapatite were calculated. It was found that parotid saliva was supersaturated with respect to both apatites above pH 5.5, unsaturated with respect to hydroxyapatite and concurrently supersaturated with respect to fluorapatite in the pH range 5.5–4.5, while it was unsaturated with respect to both apatites below pH 4.5. In the laboratory it has been found that when enamel is exposed to a liquid unsaturated with respect to hydroxyapatite and supersaturated with respect to fluorapatite, a caries-like lesion is developed. A liquid unsaturated with respect to both apatites leads to an erosion-like injury. It is concluded that the two chemical conditions leading to the two types of enamel lesions may both occur in the oral cavity.     

Dissolution of enamel

abstract — Each of six premolars were exposed to 8 ml of a buffer, pH 5.0. The ionic activity products for FA, HA, CaHPO₄, CaF₂ and Ca₄H(PO₄)₃ were determined. It was found that the liquid phase initially was unsaturated with respect to all solid phases and that FA and HA were dissolving from the enamel. Four hours after initiation of the experiments the liquid phase was supersaturated with respect to FA while still unsaturated with respect to HA, which resulted in a precipitation of FA in the enamel and a dissolution of HA from the enamel. Teeth which had been exposed to a buffer unsaturated with respect to both FA and HA exhibited the signs of a natural erosion, while teeth exposed to a buffer supersaturated with respect to FA and unsaturated with respect to HA showed the characteristics of a caries lesion. It was found by analyzing various acidic beverages that these were unsaturated with respect to both FA and HA. By calculation it was found that saliva was unsaturated with respect to HA and supersaturated with respect to FA at a pH of between 5.5 and 4.5. It was concluded that the erosive lesion can be described as the result of a demineralization caused by a liquid phase unsaturated with respect to both HA and FA and the carious injury by a liquid phase unsaturated with respect to HA and supersaturated with respect to FA.     

Implant restoration of external resorption teeth in the esthetic zone.

PURPOSE: The purposes of this article were to review the literature for treatment of teeth with external resorption secondary to avulsive injuries and to illustrate treatment of patients with teeth following different clinical scenarios to develop a predictable course of therapy. MATERIALS AND METHODS: Cases that demonstrate treatment of teeth with external resorption following injury during the growing period, external resorption treated with a delayed approach after tooth extraction, immediate grafting of the extraction site to repair labial bone loss, and immediate implant placement with provisionalization are shown. CONCLUSION: Based on a review of the literature, the decision to place dental implants to replace teeth with external resorption can be timed depending on the location and type of the resorption, with excellent esthetic results.     

Pulp tissue reactions to a dentin bonding agent as a direct capping agent

The aim of this study was to investigate the response of human pulp tissue to a dentin bonding agent, Scotchbond Multi-Purpose Plus (SMPP), in exposed class V cavities. Sixteen human premolar teeth were mechanically exposed. Ten pulps were capped with SMPP and six teeth were capped with Dycal. The cavities were filled with a composite. After 40 days, the teeth were extracted and processed for histologic evaluation. Of the 10 teeth capped with SMPP, eight showed moderate chronic inflammation, one was severely inflamed, and one pulp had no to slight inflammation. None of the teeth capped with SMPP showed dentin bridge formation. Of the six teeth capped with Dycal, three exhibited incomplete dentin bridges associated with no to slight inflammation, and three showed no to slight inflammation, without formation of dentin bridges. Direct capping with Dycal with subsequent sealing with SMPP may show favorable results in pulp tissue. SMPP may cause inflammatory changes when applied directly to exposed pulp tissue.     

Matrix metalloproteinase levels in children with aggressive periodontitis

BACKGROUND: Matrix metalloproteinases (MMPs) are a family of host-derived proteinases reported to mediate multiple functions associated with periodontal destruction and inflammation. Most of the existing data have been gathered from adults with chronic periodontitis. The purpose of this study was to determine the MMP levels in a cohort of African American children with and without aggressive periodontitis. METHODS: Gingival crevicular fluid (GCF) was collected in a cohort of 44 African American children, 7 to 19 years of age, with and without aggressive periodontitis (AgP) and compared to healthy unrelated children and to adults with chronic periodontitis (CP). GCF volume was determined with a calibrated gingival fluid meter. The samples were assayed for MMP-1, -2, -3, -8, -9, -12, and -13 using fluorimetric substrates. RESULTS: The MMP levels from diseased sites in the subjects with AgP were statistically higher (P <0.05) in almost all instances than those associated with the unrelated controls or with the subjects with CP. MMP-8 was significantly elevated in the diseased sites of the children with AgP relative to non-diseased sites in the same children (P = 0.002), as well as the siblings, non-diseased controls, and subjects with CP (P < or =0.0001). There was no positive correlation between probing depth and any MMP level. CONCLUSIONS: MMP levels were elevated in AgP sites relative to non-diseased sites in the same subjects, in siblings, and in unrelated controls. MMPs associated with the AgP sites in children were generally elevated compared to an adult cohort with a history of CP.     

Cytokine profile in the gingival crevicular fluid of periodontitis patients with and without type 2 diabetes: a literature review

Background: Periodontitis may occur in patients with and without type 2 diabetes (T2D). It may be hypothesized that the gingival crevicular fluid (GCF) cytokine profile in patients with periodontitis with poorly controlled T2D may differ from the GCF cytokine profile in medically healthy individuals with periodontitis. The aim was to review the cytokine profiles in the GCF of patients with periodontitis with and without T2D. Methods: Databases were searched from 1988 to August 2011 using different combinations of various keywords. Titles and abstracts of articles that satisfied the eligibility criteria were screened by the authors and checked for agreement. Only articles published in English were included. Results: Ten studies were included. Two studies reported GCF concentrations of interleukin (IL)‐6 to be higher in patients with periodontitis with T2D compared to medically healthy patients with periodontitis. Two studies showed GCF IL‐6 levels to be higher in periodontitis with T2D compared to medically healthy subjects without periodontitis. In one study GCF levels of IL‐17, IL‐23, and interferon‐γ were higher in patients with periodontitis with T2D compared to medically healthy patients with periodontitis. In one study, GCF concentrations of IL‐8 were significantly higher in patients with periodontitis with T2D compared to medically healthy individuals with periodontitis. Three studies reported GCF levels of IL‐1α to be significantly higher in patients with periodontitis with T2D compared to medically healthy individuals with periodontitis. Conclusion: The GCF cytokine profile in patients with and without T2D seems to be governed by the intensity of periodontal inflammation and the role of T2D in this regard is rather secondary.     

Effect of sanguinaria extract on established plaque and gingivitis when supragingivally delivered as a manual rinse or under pressure in an oral irrigator

Sanguinaria extract (sanguinaria) solutions were evaluated in 44 subjects in a 2-week, no oral hygiene study as a 300 micrograms/ml manual rinse, and the results compared to supragingival irrigation with 22.5 micrograms/ml sanguinaria concentration and supragingival irrigation with water. Both the manual use of sanguinaria and supragingival irrigation of dilute sanguinaria produced significantly less plaque growth than supragingival irrigation with deionized water. In terms of % changes from baseline, manual rinsing and supragingival irrigation with sanguinaria limited plaque growth to 17.7% and 24.2%, respectively, while irrigation with water had a 51.5% growth. For gingivitis, control supragingival irrigation with sanguinarine and with water were statistically different from manual rinsing with sanguinaria. Compared to baseline, the groups irrigating with sanguinaria and with water had gingivitis reductions of 68.7% and 73.3%, respectively, while manual rinsing with sanguinaria had a 29.6% reduction. The results suggest that dilute solutions of sanguinaria delivered via rinsing or supragingival irrigation are effective in controlling plaque as an additional benefit to the use of supragingival irrigation to control gingivitis. Supragingival irrigation with sanguinaria as part of a home care routine for patients with plaque and gingivitis is suggested.     

Symptoms of the cervical spine in temporomandibular and cervical spine disorders

This study was performed to assess the prevalence of signs and symptoms related to cervical spine disorders (CSD) in subgroups of patients with temporomandibular disorders (TMD) and to compare TMD patients and CSD patients with regard to the results of orthopaedic cervical spine tests. One hundred and eleven consecutive patients with TMD and 103 consecutive patients with signs and symptoms of CSD were examined. The results indicated that there is a considerable overlap in the signs and symptoms of patients with TMD and patients with CSD. Signs and symptoms on neck extension occurred more often in CSD patients than in subgroups of TMD patients. No significant differences in upper cervical extension, neck flexion, and shoulder girdle function were found between CSD patients and subgroups of patients with TMD. Patients with CSD reported neck pain during active and passive movements of the neck more often than the subgroups of patients with TMD. TMD patients and CSD patients did not differ with regard to pain on shoulder girdle function and palpation of the shoulder girdle. Logistic regression analyses showed that orthopaedic tests of the cervical spine are of minor importance in discriminating between patients with TMD and patients with CSD. It is concluded that TMD with a myogenous involvement in contrast to TMD with only an arthrogenous involvement should no longer be viewed as a local disorder of the stomatognathic system. The upper quarter, including the stomatognathic system, cervical spine, and shoulder girdle, should be evaluated in patients with more complex or persistent symptoms in the head and neck region.     

Comparison of periodontal disease in patients with clefts of palate and patients with unilateral clefts of lip, palate, and alveolus.

OBJECTIVE: Long-term health of the stomatognathic system as well as esthetic aspects are the therapeutic goals in patients with orofacial clefts. The aim of this study was to analyze the periodontal condition of patients with cleft palate (CP) and cleft lip, palate, and alveolus (CLP) and to determine the differing degrees and localization of periodontal disease. DESIGN: In 30 patients with unilateral cleft lip, palate, and alveolus and 30 patients with cleft palate (CP), periodontal lesions were identified and classified according to the Community Periodontal Index of Treatment Needs (CPITN) and pathological mobility of teeth was noted. The state of oral hygiene was recorded by the Approximal Plaque Index. RESULTS: In general, poor oral hygiene was found in all patients. Patients with CLP were classified as CPITN code 0 in 0%, codes 1 and 2 in 7%, code 3 in 43%, and code 4 in 50% of cases. Patients with cleft palate showed code 0 in 0%, codes 1 and 2 in 30%, code 3 in 45%, and code 4 in 25% of cases. In this study, periodontal disease was found in patients with cleft palate to a similar extent to that in the general population, whereas patients with cleft lip, palate, and alveolus had a predisposition to deep periodontal destruction of teeth adjacent to the cleft. The registration of pathological mobility of teeth and resulting loss of attachment corresponded to the periodontal disease classification according to the CPITN. CONCLUSION: A critical periodontal situation was found in patients with unilateral cleft lip, palate, and alveolus. In contrast, patients with cleft palate exhibited a similar periodontal situation to that found in the general population, with additional damage that may be attributed to orthodontic treatment.     

Periodontal disease in patients with cleft palate and patients with unilateral and bilateral clefts of lip, palate, and alveolus

BACKGROUND: Long-term health of the stomatognathic system, as well as esthetics, is the therapeutic goal in patients with facial clefts. The aim of this study was to analyze the periodontal situation of patients with cleft palate (CP) and cleft lip, palate, and alveolus (CLPA) to elicit the differing degrees and localization of periodontal disease. METHODS: In 30 patients with unilateral cleft lip, palate, and alveolus (UCLPA), 30 patients with cleft palate (CP), and 20 patients with bilateral cleft lip, palate, and alveolus (BCLPA), the gingival situation was identified and classified according to the sulcus bleeding index (SBI). Periodontal attachment loss and pathological loosening of teeth were noted for identification of periodontal lesions. The state of oral hygiene was recorded by the approximal plaque index (API). RESULTS: In general, poor oral hygiene was found in all patients. The SBI showed a high incidence of gingivitis in patients with cleft lip, palate, and alveolus. Patients with cleft palate had a minor extent of sulcus bleeding. Periodontal disease was found to a similar extent to that in the general population in patients with cleft palate, whereas patients with cleft lip, palate, and alveolus had a predisposition to deep periodontal destruction of teeth adjacent to the cleft. The registration of pathological loosening of teeth, a result of attachment loss, corresponded to the degree of periodontal disease shown by the attachment loss. CONCLUSIONS: A critical periodontal situation was found in patients with unilateral and bilateral cleft lip, palate, and alveolus, ultimately leading to tooth loss in the front tooth region. In contrast, patients with cleft palate exhibited periodontal situations similar to that found in the general population with additional damage, which may be attributed to orthodontic treatment.     

Fluoride and enamel solubility

abstract — The present paper deals with the solubility of enamel and the influence of fluoride on the degree of saturation with respect to hydroxyapatite. Enamel surfaces were exposed to 8 ml buffer at various pH values. The buffers were analyzed at suitable intervals for calcium, phosphate, fluoride and pH and the ionic activity products for fluorapatite, hydroxyapatite, calcium fluoride, brushite and octacalcium phosphate were calculated. It was found that the buffers were supersaturated with respect to fluorapatite and remained unsaturated with respect to the other salts investigated. Under these conditions fluorapatite was formed while hydroxyapatite dissolved, the system thus tending toward equilibrium at which the liquid phase is saturated concurrently with respect to both apatites. It is suggested that at least a part of the solubility reducing effect of fluoride is due to fluoride rendering the liquid phase supersaturated with respect to fluorapatite. This results in formation of fluorapatite, rendering the liquid phase unsaturated with respect to hydroxyapatite.     

Craniofacial complex specificities in five men with sex reversal syndrome

In order to clarify the role of sex chromosome constitution in craniofacial growth control, we compared craniofacial morphology of men with sex reversal syndrome (46, XX) with the morphology of normal men, Klinefelter's syndrome and normal women, using cephalometric measurements. Due to physical resemblance between men with 46, XX karyotype and men with 47, XXY karyotype, cephalometric analysis comprised parametres which had already been found to be specific for Klinefelter's syndrome, i.e. cranial base length and flexion, maxillary and mandibular base length, jaw position in relation to cranial base and sagittal jaw relationship. Linear measurements showed reduction of about 10% in maxillary base length in 46, XX men in relation to normal men. Mandibular base in men with sex reversal syndrome was also shortened for about 10% in relation to both normal men and Klinefelter's syndrome. Cranial base flexion in men with Klinefelter's syndrome and in men with sex reversal syndrome showed similarity. The basal angle was found to be more acute, for about 4 degrees , in comparison to individuals with normal karyotype. Unlike in men with Klinefelter's syndrome, mandibular and maxillary prognathism were not registered in men with sex reversal syndrome.     

Recurrent aphthous ulcers in association with HIV infection. Description of ulcer types and analysis of T-lymphocyte subsets.

This study was conducted to characterize the recurrent aphthous ulcers (RAU) found in association with human immunodeficiency virus (HIV) infection, to examine evidence for increased severity of the ulcers with HIV disease, and to determine whether increased severity is associated with abnormalities of peripheral blood lymphocyte subsets. Seventy-five HIV-seropositive patients with RAU were followed for up to 2 years, and lymphocyte subsets were analyzed in 42. Minor, herpetiform, and major ulcer types were seen, but unexpectedly, 66% of the patients had the usually uncommon herpetiform and major types. These types were temporally associated with symptomatic HIV disease. Patients with major RAU were significantly more immunosuppressed than those with minor or herpetiform RAU in that they had fewer CD4 and CD8 lymphocytes (p less than 0.05). The lesion of RAU is considered to represent a local breakdown in immunoregulation. The systemic immune imbalance seen with HIV disease may amplify the local defect and lead to more severe ulcers.     

Visible light cured resin. Chronological change in mechanical properties of matrix resin immersed in MeOH

Monomer composition was examined to improve durability of matrix resin of visible light cured composite resin. As a monomer, five kinds of cyclophosphazene monomers, two kinds of commercial monomers and a mixture of commercial monomers were prepared to the visible light cured resins. The mechanical properties of these set products were examined with time after immersion in MeOH, an aging accelerating solvent. Compressive strength of the resins using cyclophosphazene monomers tended to decrease with time, but it increased in accordance with the increase of the number of polymerization group. Compressive strength of the resins using commercial monomers tended to decrease, but that using the BMPEPP monomer tended to increase with time. Yield point of the resins with the cyclophosphazene monomer 4 PN-(EMA)8 tended to increase with the time but that of the resins with other cases monomers decreased. The yield point of all three resins made using commercial monomers tended to decrease with time, but the rate of decrease was small for BMPEPP monomer. Compressive elastic modulus of the resins using cyclophosphazene monomers tended to increase with time when the number of polymerization group was 6-8, while it decreased when the number was 4-5. When commercial monomers were used, it tended to decrease with time, but the rate of decrease was small for the BMPEPP monomer. Transverse strength of the resins using cyclophosphazene monomers showed a tendency to decrease with time. When a commercial monomer was used, cracks appeared in the Bis-GMA+Tri-EDMA monomer after 7 days, and with the other two monomers, the transverse strength tended to decrease with time, though the rate of decrease was small for the BMPEPP monomer. Transverse elastic modulus tended to decrease with time, but the rate of decrease was small for the BMPEPP monomer.     

Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision

Abstract –  Pulp canal obliteration (PCO) is a sequela of tooth trauma. The dental clinician faced with this condition has to make a difficult decision. The aim of this study was to evaluate the clinical signs and symptoms associated with teeth with PCO and to assess the status of the periapical tissues using the periapical index (PAI) as an aid in making a treatment decision. The study included teeth diagnosed with PCO in patients with a history of traumatic injury to the involved teeth. Histories of associated signs and symptoms including pain, swelling and drainage from a sinus tract were elicited. Tooth color, sensibility to electric pulp testing, mobility and percussion tenderness were recorded. The periapical status was assessed using the PAI. Two hundred and seventy-six teeth were diagnosed with PCO. One hundred and fifty-seven (56.9%) and 119 (43.1%) demonstrated partial or total PCO, respectively. Yellow discoloration presented most frequently, occurring in 186 (67.4%) teeth. Sixty-two (33.3%) of these had developed periapical lesions and reacted negatively to sensibility testing. Fifty-seven (30.7%) of these teeth presented radiographically with a normal periapical appearance and reacted normally to sensibility testing, whereas 67 (36.0%) presented with small changes in the periapical bone pattern and reacted in the high normal range to sensibility testing. Teeth with PAI scores ≤2 presented with occasional spontaneous pain. Teeth with PAI scores ≥3 presented with clinical symptoms and signs ranging from pain on percussion to spontaneous pain, and slight swelling to sinus tract drainage. Based on the findings of this study, endodontic treatment should be initiated in teeth with tenderness to percussion, PAI scores ≥3 and a negative response to sensibility testing.     

The preparedness of dental professionals to treat persons with disabling conditions in long-term care facility and community settings

A survey was conducted of 300 state long-term care facilities to determine prior training and needs for further instruction of dental staff in the management of patients in this setting. In addition, dental practitioners in two states, Missouri and Washington, were surveyed with respect to their qualifications and availability to treat persons with disabling conditions in the community. A large proportion of dentists who work in long-term care facilities reported a lack of formal preparation for their area of dental practice. Many community dentists who stated a willingness to treat persons with disabling conditions also appeared to be inadequately prepared. Responses to the Missouri and Washington surveys were generally similar; apparent differences with respect to experience may have been caused by variation in survey criteria. Positive effects of training are beginning to carry over into practice. Larger numbers of recent graduates reported training and expressed willingness to treat patients with disabling conditions compared with dentists who have been in practice longer. Dentists with training and extensive experience probably best reflect available dental resources for persons with disabling conditions in the community.     

Multidimensional evaluation of craniomandibular dysfunction. I: Symptoms and correlates

To standardize clinical history taking, a comprehensive anamnestic questionnaire was developed (Screen). Screen includes questions about (i) pain, (ii) other symptoms of CMD, (iii) correlates of CMD, (iv) psychosocial factors, and (v) general health. Variables discriminating between subgroups of clinical cases and controls were described successively. This study was performed to assess whether subgroups of patients with signs and symptoms of craniomandibular dysfunction (CMD), and a control group of dental patients with and without signs and symptoms of CMD, can be characterized by differential report of signs and symptoms of CMD, as reported in Screen. Results indicate that Screen can be used to discriminate between (i) subgroups of subjects with signs or symptoms of CMD (both clinical cases and controls) and controls without signs or symptoms of CMD; (ii) subgroups of clinical cases and controls with signs and/or symptoms of CMD; and (iii) patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component. Differences between patients and controls are interpreted with regard to the correct classification of patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component, and with regard to the subjective treatment need for CMD. The results of logistic regression analyses indicate that subsets of items of Screen correctly classified up to 80% of patients with myogenous or arthrogenous CMD. Implications for further research were discussed.