The pharmacokinetics and cardiovascular effects of high-dose articaine with 1:100,000 and 1:200,000 epinephrine

OBJECTIVES: The authors conducted a randomized, double-blind, two-way crossover clinical trial to compare the pharmacokinetics and cardiovascular effects of 11.9 milliliters of 4 percent articaine hydrochloride (HCl) plus 1:100,000 epinephrine (A100) with those of 11.9 mL of 4 percent articaine HCl plus 1:200,000 epinephrine (A200). METHODS: During two testing sessions, the authors administered injections of A100 and A200 over a seven-minute period (in one-cartridge doses unless otherwise noted): maxillary right first molar infiltration, maxillary left first molar infiltration, maxillary right first premolar infiltration, maxillary left first premolar infiltration, right inferior alveolar injection, left inferior alveolar injection, right long buccal infiltration (one-half cartridge) and left long buccal infiltration (one-half cartridge). They analyzed venous blood samples for articaine levels. They used noninvasive acoustic tonometry to measure a variety of cardiovascular parameters over a two-hour period. RESULTS: Plasma concentration curves of articaine over time were similar for both solutions, with peak concentrations and times to maximum concentration being 2,037 nanograms per milliliter and 22 minutes for A100 and 2,145 ng/mL and 22 minutes for A200. At the 10-minute point, the mean systolic blood pressure and heart rate were significantly elevated (P < .05) with A100 versus A200. CONCLUSIONS: Maximum dose recommendations for the A100 solution also can be applied to the A200 solution. A200 produces less cardiovascular stimulation than does A100. CLINICAL IMPLICATIONS: A200 is as safe as A100, and may be preferable to A100 in patients with cardiovascular disease and in those taking drugs that reportedly enhance the systemic effects of epinephrine.     

Molecular analysis of bacteria in asymptomatic and symptomatic endodontic infections

The purpose of the present study was to use terminal restriction fragment length polymorphism analysis and the 16S rRNA gene clone library to investigate the diversity of the microbiota associated with asymptomatic and symptomatic endodontic infections and to compare the bacterial community structure in these two clinical conditions. Samples were taken from asymptomatic endodontic infections associated with chronic periradicular lesions and from symptomatic infections clinically diagnosed as acute abscesses. 16S rRNA genes from DNA isolated from clinical samples were used to construct clone libraries or were subjected to terminal restriction fragment length polymorphism analysis. Sequence analysis of 186 clones revealed 42 taxa; 23 (55%) were uncultivated phylotypes, of which seven were unique to endodontic infections. Clone sequencing and terminal restriction fragment length polymorphism analysis revealed that the most commonly detected taxa were Fusobacterium nucleatum (including terminal restriction fragment types 1 and 2), Peptostreptococcus micros/Peptostreptococcus sp. oral clone AJ062/BS044/FG014, Prevotella species, Dialister species, Mogibacterium species, Lachnospiraceae oral clone 55A-34, Filifactor alocis, Megasphaera sp. oral clone CS025/BS073, and Veillonella sp. oral clone BP1-85/Veillonella dispar/V. parvula. Bacteroides-like sp. oral clone X083/Bacteroidales oral clone MCE7_20 and Dialister sp. oral clone BS016/MCE7_134 were detected only in asymptomatic teeth. On the other hand, F. nucleatum terminal restriction fragment type 2, Prevotella intermedia, Dialister pneumosintes, and some phylotypes were exclusively detected in symptomatic samples. Bacterial profiles of symptomatic endodontic infections generated by terminal restriction fragment length polymorphism analysis were clearly different from those of asymptomatic infections. Overall, the average number of terminal restriction fragments in symptomatic samples was significantly larger than in asymptomatic samples. Molecular analysis of the microbiota associated with symptomatic or asymptomatic endodontic infections indicates that the endodontic bacterial diversity is greater than previously described by culture methods and that the structure of the microbiota differ significantly between asymptomatic and symptomatic infections.     

PL9The HPV-genital (and oral?) infections – how are we standing now?

Sub-epithelial vesiculobullous disorders are mainly chronic autoimmune disorders arising from reactions against components of hemidesmosomes or basement membranes of the basement membrane zone of stratified squamous epithelia. Non-immune disorders involving these components typically have a genetic basis: the prime example is epidermolysis bullosa. The term immune-mediated sub-epithelial blistering diseases (IMSEBD) have been used for the acquired forms. Mucous membrane pemphigoid (MMP) is the most common IMSEBD but a number of variants exist. All sub-epithelial vesiculobullous disorders produce clinical pictures of blistering and erosions. Therefore the diagnosis must be confirmed by perilesional biopsy with immunostaining, sometimes with other investigations. No single treatment regimen reliably controls all disorders. The main treatments available are anti-inflammatory and/or immunosuppressive. There is only a weak evidence base: clinical trials of treatments are few, most include patients with heterogeneous entities, few include more than a limited number of patients, and thus reliable data from randomized controlled trials are unavailable. Currently, apart from improving oral hygiene, immunomodulatory therapy is typically used to control the oral lesions of MMP. The immunological differences within the disorders might account for significant differences in responses to therapy. It is not known if the specific subsets of MMP respond to different agents.     

OC9Successful use of mycophenolate mofetil in combination with minocycline in a woman with severe predominantly oral mucous membrane pemphigoid: a case report

Introduction  A wide variety of topical and systemic therapies are proposed for the treatment of symptomatic erosive or ulcerative oral lichen planus (OLP). The calcineurin inhibitor tacrolimus has been shown to be an effective means of treating OLP recalcitrant to other therapies. More recently, pimecrolimus has also been suggested to be of benefit in the treatment of such disease.
Case Summary  A 50-year-old male with a 7-year history of histopathologically proven erosive OLP had been treated with a wide variety of topical and systemic therapies, including tacrolimus ointment. Despite this his condition remained problematic with frequent episodes of severe erosive disease predominantly affecting the buccal mucosa bilaterally. Clinical examination revealed extensive intra-oral erosive disease, particularly affecting the right buccal mucosa. Twice daily topical application of 1% pimecrolimus ointment (Elidel®) was instituted. This resulted in resolution of his symptoms and a significant improvement in the clinical appearance of his oral lesions within a 2-month period.
Conclusion  Topical pimecrolimus may be an effective therapy for symptomatic erosive or ulcerative OLP recalcitrant to other topical and systemic therapies, including topical tacrolimus. There is a need for appropriate studies to establish the efficacy of pimecrolimus for the treatment of OLP and to ascertain whether topical calcineurin inhibitors increase the malignant potential of OLP.     

Mechanical properties of visible light-cured resins reinforced with hydroxyapatite for dental restoration.

OBJECTIVES: The purpose of this study was to measure and analyze the mechanical properties of several composite materials designed for dental restoration. METHODS: The materials were composed of a visible light-curing monomer mixture (either Bis-GMA+TEGDMA or Bis-GMA+HEMA) as a matrix and hydroxyapatite (either microscopic or nanoscopic particles) as a reinforcing filler. The surface of the hydroxyapatite particles was modified by using a coupling agent (citric, malic, acrylic or methacrylic acid). Five specimens of 14 different composites were prepared for each mechanical test: flexural strength, Young's modulus and Vickers hardness. Mean values and standard deviations were calculated, and ANOVA and Student Newman Keuls multiple comparison tests were applied (P < 0.05). RESULTS: The addition of 50-60 wt% of hydroxyapatite particles to the unfilled monomer mixtures led to the increase of both Young's modulus and surface hardness of the material, while the flexural strength decreased. In general, when microscopic instead of nanoscopic hydroxyapatite was used as a reinforcing filler, mechanical properties were favored. The mechanical properties were also improved by adding citric, acrylic or methacrylic acid as a coupling agent. CONCLUSIONS: An adequate surface modification of the hydroxyapatite particles conferred enhanced mechanical properties to the final dental composite. Microscopic-hydroxyapatite particles are preferred to nanoscopic ones.     

Influence of bonding agent composition on flexural properties of an Ultra-High Molecular Weight Polyethylene Fiber-Reinforced Composite

This study evaluated the influence of seven commercially available bonding agents on the flexural properties of an Ultra High Molecular Weight Polyethylene (UHMWPE) Fiber-Reinforced Composite (FRC). Nine groups (n=10 per group) of flexural strength specimens were prepared from an indirect composite reinforced with UHMWPE fiber and cured according to manufacturers' instructions (Groups A to I). Group I was a fiber-reinforced negative control without any bonding agent resination. A tenth group (Group J) was a positive control group prepared using indirect composite alone. The fiber reinforcement material for Groups A to H was resinated with one of the seven different bonding agents. Group H used the same bonding agent as for Group G specimens. However, the fiber was silanized before bonding agent application for Group G specimens. Specimens were stored wet for 24 hours at 37 degrees C before measuring flexural strength and modulus in three-point bend at a crosshead speed of 1 mm/minute. Scanning Electron Microscopy (SEM) was employed to assess the fiber-resin interface of representative samples. The mean (SD) flexural strength of the test groups impregnated by the bonding agents ranged from 169 (37) to 266 (39) MPa. Statistical analysis of the flexural strength data using one-way ANOVA revealed significant (p<0.05) differences between the test groups. There was catastrophic fiber/composite failure in the positive control group that had a mean flexural strength of 75 (8) MPa. Silane pre-treatment of UHMWPE fiber before impregnation with the bonding agent significantly reduced the flexural strength (p<0.05).     

Oral cancer. Practical prevention and early detection for the dental team

Approximately 2,000 patients a year are diagnosed with oral cancer in New York State. In an effort to control this deadly disease, Governor George Pataki has taken a leadership role in the United States by mandating and funding training for dentists in the prevention and early detection of oral cancer. The purpose of this article is to highlight the epidemiology of oral cancer, to show how the dental profession can contribute to the health of the citizens of New York State, and to provide practical guidelines for both tobacco cessation intervention and utilization of existing technology for the early detection of oral cancer and precancerous conditions in the general dental practice setting.     

Relationship between bilateral condylar bone change and mandibular morphology: a study using morphometry

This study was undertaken to evaluate the relationship between bilateral condylar bone change (BCBC) and mandibular morphology. Thirty Japanese women with BCBC as diagnosed from computed tomographic scans were compared to 2 control groups: 26 Class I and 25 Class II Japanese women. All cephalograms were traced and scanned, and 14 homologous landmarks were digitized. Coordinates were used for cephalometric analysis, Procrustes analysis, Euclidean distance matrix analysis (EDMA), and thin-plate spline (TPS) analysis. Comparison of the cephalometric data for the BCBC and Class I groups revealed significant shrinkage in the condylar process and ramus height, in addition to a shorter body length. The centroid size showed that BCBC mean geometric forms were smaller than those of Class I and Class II. The landmark morphology of the BCBC group differed from both Class I and Class II, as shown by the residuals (P < .001). EDMA showed expansion of infradentale-pogonion (9.9%) and along the anterior slope height of the condyle (28.6%), while the posterior slope height decreased (21.6%). The vertical ramus height (gonioncondylion) also decreased by 11.8% in comparison to Class I. Compared to Class II, BCBC ramus height was shorter by 8.9%, condylar width decreased 13.7%, and the posterior condylar slope was 22% shorter. TPS analysis showed increased antegonial notching, a vertically expanded symphysis, and a collapsed and more horizontal condyle in the BCBC group. The combination of the above methods was very helpful in assessing mandibular morphology and showed that BCBC might be related not only to changes in the condyle, but may dictate changes in the rest of the mandible as well.