The effects of an immediately pre-surgical chlorhexidine oral rinse on the bacterial contaminants of bone debris collected during dental implant surgery

Dental implant surgery produces bone debris that can be used in the "simultaneous augmentation" technique. Although this debris is contaminated with oral bacteria, a stringent aspiration protocol has been shown to reduce the levels of contamination. Chlorhexidine mouthrinse is a well-proven antibacterial rinse that has been shown to reduce infectious complications associated with dental implants. This study examined the effect of pre-operative rinsing with a 0.1% chlorhexidine digluconate mouthrinse on the bacterial contaminants present in collected bone debris bone (CBD). Twenty partially edentate patients were randomly allocated into equal groups and underwent bone collection using the Frios Bone Collector (FBC) during the insertion of two dental implants. In group T a pre-operative chlorhexidine rinse was used, whilst in group C sterile water was used. For both groups, a stringent bone collection protocol was used. Bone samples were immediately transported for microbial analysis. Colonial and microscopic morphology, gaseous requirements and identification kits were utilised for identification of the isolated microbes. Thirty-nine species were identified including a number associated with disease, in particular Actinomyces odontolyticus, Clostridium bifermentans, Prevotella intermedia, and Propionibacterium propionicum. Samples from group T (chlorhexidine mouthrinse) yielded significantly fewer organisms (P < 0.001) than in group C (sterile water mouthrinse). Gram-positive cocci dominated the isolates from both groups. It is concluded that if bone debris is to be used for the purpose of immediate simultaneous augmentation, a preoperative chlorhexidine mouthrinse should be utilised in conjunction with a stringent aspiration protocol to reduce further the bacterial contamination of CBD.     

Effect of magnification on locating the MB2 canal in maxillary molars

The purpose of this study was to determine if the surgical operating microscope and/or dental loupes could enhance the practitioner's ability to locate the second mesiobuccal canal (MB2) canal of maxillary molars in an in vivo, clinical setting. The participating endodontists documented 312 cases of root canal therapy on maxillary first and second molars. Participants that used the microscope or dental loupes located the MB2 canal with a frequency of 57.4% and 55.3%, respectively. Those using no magnification located the MB2 canal with a frequency of 18.2%. When no magnification was used, significantly fewer MB2 canals were located based by Chi-square analysis at p < 0.01. There was no significant difference between the use of the microscope and dental loupes in the frequency of locating the MB2 canal. When the maxillary first molars were considered separately, the frequency of MB2 canal detection for the microscope, dental loupes, and no magnification groups was 71.1%, 62.5%, and 17.2%, respectively. The results of this study show that the use of magnification in combined groups leads to a MB2 detection rate approximately three times that of the nonmagnification group and that the use of no magnification results in the location of significantly fewer MB2 canals. Based on these results, more emphasis should be placed on the importance of using magnification for locating the MB2 canal.     

Immunolocalization of urokinase and its receptor in prematurely fused cranial sutures of infants

In cranial sutural samples derived from five children with premature cranial suture fusion we have performed immunostaining for the urokinase plasminogen activator (uPA) and urokinase receptor (uPAR). We have found a strong reactivity for cell- or matrix-bound uPA and uPAR in the sutural connective tissue and associated with the osteoblasts and osteocytes lining the calvarial bone. The sutural tissue itself showed a banding with different intensity of urokinase and uPAR staining concerning connective tissue. It is proposed that the components of the plasminogen activating system are involved in tissue turnover of sutural tissue and in sutural growth.     

Metastatic transitional cell carcinoma of the urinary bladder presenting as a mandibular gingival swelling

Oral cavity metastases mostly originate from the breasts, lungs, or kidneys. Transitional cell carcinoma (TCC), the most frequent malignant tumor of the urinary bladder, rarely metastasizes to the jaws. To the best of our knowledge, only 8 cases of bladder carcinoma have been reported in the English literature to metastasize to the jawbones. A new case of mandibular metastasis of urinary bladder TCC with extension to the gingiva is presented in a 64-year-old white man. The patient was referred for a periodontal infection of the upper right first molar. The clinical examination also showed a gingival swelling located in the lower left premolar region with a hypoasthesia of the left side of the lower lip. The gingival mass was biopsied, and the microscopy showed a mandibular metastatic TCC of the urinary bladder extending to the gingiva. Periodontists should be aware that, although gingival metastases are rare, when they occur they may mimic other local benign pathological conditions.     

Jaw clenching: muscle and joint forces, optimization strategies

Realistic masticatory muscle and temporomandibular joint forces generated during bilateral jaw clenching are largely unknown. To determine which clenching directions load masticatory muscles and temporomandibular joints most heavily, we investigated muscle and joint forces based on feedback-controlled electromyograms of all jaw muscles, lines of action, geometrical data from the skull, and physiological cross-sectional areas acquired from the same individuals. To identify possible motor control strategies, we applied objective functions. The medial pterygoid turned out to be the most heavily loaded muscle for all bite directions. Biting with accentuated horizontal force components provoked the highest loading within the medial and lateral pterygoids. The largest joint forces were also found for these bite directions. Conversely, the lowest joint forces were detected during vertical biting. Additionally, joint forces with a clear posterior orientation were found. Optimization strategies with the elastic energy as objective function revealed the best fit with the calculated results.     

Use of a composite pedicled muscle flap and rhBMP-7 for mandibular reconstruction

The aim of this study was to investigate the feasibility of reconstructing critical size continuity osteoperiosteal defects of the mandible using a composite of recombinant BMP-7 contained in a bovine type-1 collagen carrier wrapped in a pedicled sterno-occipitalis muscle flap. At 3 months following surgery, bridging of the surgical defect was noted in three subjects (60%). Histologically, the induced bone regenerate showed maturation from woven to lamellar bone. Islands of cartilage were distributed throughout the defect. Replacement ossification of the degenerated muscle was a common feature in all specimens. Microradiography showed a gradual increase in the calcification of mineralized tissue from the margin to the centre of the newly generated bone. This research represents a proof of the concept that bone can be satisfactorily formed within a muscular scaffolding at the site of the created defect in a one-stage procedure.     

The working practices and career satisfaction of dental therapists in New Zealand

OBJECTIVE: To describe the working practices and level of career satisfaction of dental therapists in New Zealand. DESIGN: Postal survey of dental therapists identified from the New Zealand Dental Council's dental therapy database. One mailing with one follow-up. PARTICIPANTS: Questionnaires were sent to 683 registered dental therapists. Replies were received from 566 (82.9%). OUTCOME MEASURES: Current working practice, career breaks, continuing education, career satisfaction. RESULTS: Respondents had a high career satisfaction, but were much less satisfied with their remuneration. After controlling for age and income satisfaction, therapists who felt that they were valued members of the dental community had over four times the odds of having higher overall job satisfaction. There were no differences in the mean career satisfaction scale score by age, but respondents aged 45 and over had a lower mean income satisfaction scale score than their younger counterparts (p<0.05). Older respondents were more likely to report regularly placing fissure sealants (p<0.05), participating in peer review (p<0.05), and playing a role in team management/coordination (p<0.05) than younger respondents. Most therapists (412; 82.2%) had taken at least one career break, usually for child rearing. A mean of 6.5 years (SD 5.9; range six weeks to 25 years) had been taken in career breaks. Younger therapists were more interested in moving into private practice than their older colleagues (p<0.05). More than half of respondents planned to retire from dental therapy within 10 years. CONCLUSION: Urgent action is required to improve the recruitment and retention of dental therapists in the New Zealand School Dental Service. Measures to reduce the time taken in career breaks could increase the productivity of this workforce. Remuneration and career progression are key issues; therapists need to feel that they are valued members of the dental profession.     

Antibacterial effect of chlorhexidine- containing glass ionomer cement in vivo: a pilot study

This in vivo pilot study was carried out to test the antibacterial effect of glass ionomer containing chlorhexidine (test group) in comparison to conventional glass ionomer (control group). Fifty 6- to 11-year-old children with one occlusal lesion in a molar were randomly allocated to test and control groups in a parallel-group design. The cavity walls and one half of the floor were cleaned and restored with one of the materials without dentine conditioning. The restorations were removed after 7 days. Dentine samples were taken from the cleaned (affected dentine) and noncleaned area (infected dentine) at baseline and at day 7. Samples were anaerobically and aerobically cultivated for mutans streptococci, lactobacilli and total viable bacterial count (TVC) following common laboratory procedures. ANCOVA was used to test for treatment effects. Seven days after treatment, a significant decrease in anaerobic and aerobic bacterial counts (p = 0.0001) was shown. Lower numbers of anaerobic lactobacilli (p = 0.02), TVC (p = 0.008) and aerobic lactobacilli and TVC (p = 0.03), but not of mutans streptococci, were indicated in the test group compared to the control group. A significant reduction in aerobic lactobacilli from infected dentine treated with the glass ionomer containing chlorhexidine (p = 0.05) was observed whereas in affected dentine, anaerobic mutans streptococci, lactobacilli and TVC and aerobic TVC and mutans streptococci were significantly lower in the test group 7 days after treatment (p = 0.01). We conclude that the present pilot study revealed lower microorganism counts in chlorhexidine-containing glass ionomers than in conventional glass ionomers for both affected and infected dentine over a 7-day period.     

Beta-glucuronidase activity in saliva: relationship to clinical periodontal parameters

BACKGROUND: Beta-glucuronidase (betaG) in gingival crevicular fluid (GCF), a marker of neutrophil influx into the crevicular environment, has previously been shown to be correlated with periodontal clinical parameters at individual sites (probing depth and clinical attachment level). Furthermore, elevated levels of betaG were found to be a risk factor for periodontal attachment loss. Analysis of betaG in saliva may be a measure of crevicular neutrophil influx for the whole mouth. The purpose of this cross-sectional study was to evaluate the relationship between betaG activity in saliva and periodontal clinical parameters in subjects demonstrating various levels of periodontal disease. METHODS: The study population consisted of 380 subjects (108 males and 272 females). A sample of unstimulated whole saliva and a venous blood sample were obtained from each subject, and a periodontal examination, which included measurement of probing depth (PD), attachment level (AL), and gingival index (GI) was performed. The unmodified saliva samples were frozen at -20 degrees C and analyzed for betaG activity. The blood samples were analyzed for number of white blood cells, neutrophils, monocytes, lymphocytes, and platelets. Statistical analysis was conducted to determine the association between salivary betaG activity and the whole-mouth clinical periodontal parameters, complete blood count, smoking status, and age. RESULTS: Highly significant correlations between salivary betaG activity and mean probing depth (MPD), mean gingival index (MGI), and the number of sites with probing depth > or = 5 mm were found. When subjects were divided into tertiles based on their MPD and MGI, elevated salivary betaG activity was detected in subjects in the 2 upper tertiles. Logistic regression modeling was used to determine which of the clinical or laboratory parameters were able to identify patients with at least 4 sites with PD > or = 5 mm. Salivary betaG activity > or = 100 produced an odds ratio (OR) of 3.77. In comparison, current and former smokers had an OR of 3.15 and 2.29, respectively. CONLCUSIONS: The results suggest that a significant association exists between periodontal clinical parameters and salivary betaG activity. Due to the non-invasive and simple nature of saliva collection, this association should be studied to determine its usefulness as a screening test for periodontitis, and a means of monitoring the response to treatment.