The effect of fluoride and strontium application on dentin: in vivo and in vitro studies.

The effectiveness of topical 2% sodium fluoride applied with and without 10% strontium chloride pretreatment was compared in patients complaining of tooth hypersensitivity. In addition the radiopacity of 2% sodium fluoride and 25% strontium chloride treated dentin was studied in vitro. Reduction of sensitivity to cold and mechanical stimuli was evaluated during a period of 3 months by pain scoring in the exposed cervical dentin of homologous teeth on the two sides of the jaws. There was a significant decrease in the sensitivity of the exposed cervical dentin after treatment with sodium fluoride solution with or without pretreatment with strontium chloride solution. At the end of the experimental period the combined strontium and fluoride treatment was found to be more effective than that of fluoride alone in reducing sensitivity to cold. The increase in radiodensity of dentin samples immersed in strontium chloride was statistically significant, while there was no significant increase in density for the samples immersed in sodium fluoride solutions. A mineralization process is possibly the effective means by which fluoride or strontium diminishes sensitivity of dentin.     

MSX1 and TGFB3 contribute to clefting in South America

MSX1 and TGFB3 have been proposed as genes in which mutations may contribute to non-syndromic forms of oral clefts; however, an interaction between these genes has not been described. The present study attempts to detect transmission distortion of MSX1 and TGFB3 in 217 South American children from their respective mothers. With transmission disequilibrium test analysis, cleft lip with/without cleft palate, cleft lip with palate plus cleft palate only, and all datasets combined showed evidence of association with MSX1 (p = 0.004, p = 0.037, and p = 0.001, respectively). With likelihood ratio test analysis, "cleft lip only" showed association with MSX1 (p = 0.04) and "cleft palate only" with TGFB3 (p = 0.02). A joint analysis of MSX1 and TGFB3 suggested that there may be an interaction between these two loci to increase cleft susceptibility. These results suggest that MSX1 and TGFB3 mutations make a contribution to clefts in South American populations.     

Incidence of penetration of a blood vessel during inferior alveolar nerve block

Aspiration of the syringe after the needle had been placed in position for an inferior alveolar nerve block (but before the anaesthetic solution was injected) in 250 patients showed that the tip of the needle was in a blood vessel in 49 (20%). Aspiration of blood was significantly more common in patients aged 9-19 years than in all others (P=0.04).     

Postoperative complaints following impacted mandibular third molar surgery in Ile-Ife, Nigeria.

An investigation into the pattern of complaints lodged by patients after impacted mandibular third molar surgery was done in a Nigerian teaching hospital over a period of 3 years. One hundred and twenty seven records were retrieved. Pericoronitis (71.2%), pulpitis (17.6%) and periodontitis (11.2%) were the reasons for surgery. No third molar surgery was done for prophylactic or orthodontic reasons. Sixty-one complaints were lodged by 49 (38.6%) patients on day 1, and 37 complaints by 35 patients on day 7. These complaints were verified by the findings of the examining clinician. Pain, swelling and trismus were the commonest complaints. A significant association (P = 0.042) was found between patients' complaints on the first postoperative day and the drug combination given. Similarly, there was a significant relationship (P = 0.0055) between the type of analgesics prescribed and the presence of postoperative pain. No significant relationship was however found between the complaints and patients' age, indication for extraction, impaction type and method of impacted tooth removal. Although the findings of this retrospective study are limited in their comparability, they suggest the need for an appraisal of pain management in patients undergoing mandibular third molar surgery in our hospital. Consequently, there should be a reduction in complaint rate thereby making selective review appointment on the first postoperative day feasible.     

The effect of acid etching on vascular diameter of pulp-vessels in rat incisor (vitalmicroscopic study)

Conditioning agents used on dentin with composite materials are biologically active and may have deleterious effects on the pulpal microcirculation. No data are available on the immediate vascular effect of etching materials applied on a constant thin pulpal dentin. In this study the authors examined whether the application of 36% phosphoric acid (Conditioner 36, 15 seconds) or itakonic acid with 10% maleic acid (NRC Non-Rinse Conditioner, 20 seconds), as recommended by the manufacturers, alters the blood circulation in the pulp of the rat's lower incisors. The effect of prolonged etching time (60 seconds) was also assessed (Conditioner 36). The application of saline served as the untreated control. The technique of vitalmicroscopy was used on the first lower incisor of 40 (10-10 in each group) male Sprague-Dawley rats (weighing 350 +/- 8 g SE) to record the changes in vessel diameter prior to and at 5, 15, 30 and 60 minutes after the test materials were administered on the dentin. In the control rats, the vessel diameter was stable during the entire experiment. Acid conditioning as recommended by the manufacturers tended to cause vasodilatation, though these alterations were statistically not significant when compared to the control group (ANOVA, p > 0.05). After prolonged etching time (Conditioner 36, 60 seconds) significant vasoconstriction (-14.4 +/- 6.13; -10.59 +/- 4.2; -11.96 +/- 6.75; -5.49 +/- 5.78%) was observed (ANOVA, p < 0.05). In this group, stasis developed in pulpal blood circulation in 40% of rats (Cochran's-Q test, p < 0.05), gas-bubble formation was observed in 30% and the disappearance of the pulpal wall occurred in 20%. These results suggest that exposition time with acid is crucial to the pulpal microcirculation. That is, acid conditioning applied as indicated (for 15-20 seconds) onto a very thin layer of dentin only slightly affects the blood supply to the dental pulp; however, prolonged etching time (for 60 seconds) results in immediate failure of microcirculation in the dental pulp of rats.     

Glandular odontogenic cyst: a challenge in diagnosis and treatment

The present review analyzes the accumulated data from all cases of glandular odontogenic cyst (GOC) reported in the English language literature. In the 20 years since it was first described, 111 cases have been reported, an incidence of 0.2% of odontogenic cysts. The age range is 14-75, mean 45.7, with a M/F ratio of 1.3:1. GOC has a predilection for the mandible (70%), affecting both anterior and posterior areas. It is typically radiolucent, well defined, either unilocular (53.8%) or multilocular (46.2%). Frequent perforation (61%) and of thinning of cortical plates (24.4%) indicate aggressiveness. Sufficient follow-up indicates that 30% of cases can recur. Treatment by enucleation or curettage carries the highest risk for recurrence, especially in large and multilocular lesions. Peripheral osteoectomy or marginal resection can eliminate the risk. Defined criteria for microscopic diagnosis are described, which in addition to Ki67 and p53 can help in differentiating GOC from lesions with histological similarities (cysts with mucous metaplasia, botryoid and surgical ciliated cysts, low-grade mucoepidermoid carcinoma). Definite diagnosis may not be possible in small incisional biopsies due to the focal presentation of characteristic features required for diagnosis. There is now evidence to support an odontogenic rather than a sialogenic origin.