Late Effects of Head and Neck Radiotherapy on Pulp Vitality Assessed by Pulse Oximetry.

INTRODUCTION: Radiation therapy (RT) of malignant tumors in the head and neck area may have damaging effects on surrounding tissues. The aim of this investigation was to evaluate the long-term effects of ionizing radiation on pulp vitality by measuring pulp oxygenation levels (%SpO2) in patients with history of RT of intraoral and oropharyngeal tumors 4-6 years after treatment. METHODS: In an experimental group RT (n = 90, history of RT) and a control group CON (n = 90, no history of RT), pulp vitality was assessed by measuring %SpO2 by using pulse oximetry and pulp sensitivity by cold thermal testing. All anterior teeth without history of endodontic therapy of the participants in group RT were measured (n = 693), regardless of the quadrant and the irradiated area. An equal number of anterior teeth were tested in group CON. RESULTS: There was no significant difference between the %SpO2 levels in group RT (92.7%; standard deviation, ± 1.83) and group CON (92.6%; standard deviation, ± 1.80). All teeth in RT and CON groups showed a positive response to the thermal test. All tested teeth were considered vital. CONCLUSIONS: Pulp %SpO2 was found to be within normal limits 4-6 years after RT. This suggests that RT may not have a long-term influence on pulp vitality, and reported short-term changes in pulpal microcirculation because of RT may be temporary.

Clinical diagnosis of pulp inflammation based on pulp oxygenation rates measured by pulse oximetry.

INTRODUCTION: The objective of this study was to investigate correlations between pulp oxygenation rates (%SpO(2)) and clinical diagnoses of reversible pulpitis (RP), irreversible pulpitis (IP), or pulp necrosis (PN). METHODS: Sixty patients who presented with a tooth with endodontic pathology were grouped according to a clinical diagnosis of either RP (n = 20), IP (n = 20), or PN (n = 20). The clinical diagnosis was based on the patient's dental history, periapical radiographs, clinical inspection, and percussion and thermal sensitivity testing. Pulse oximetry (PO) was used to determine pulp oxygenation rates. For every patient, one additional endodontically treated tooth (negative control [NC], n = 60) and one additional healthy tooth with healthy pulp status (positive control [PC], n = 60) were evaluated. Analysis of variance, the Tukey HSD test, and the Student's t test were used for statistical analysis. RESULTS: The mean %SpO(2) levels were as follows: RP: 87.4% (standard deviation [SD] ±2.46), IP: 83.1% (SD ±2.29), PN: 74.6% (SD ±1.96), PC: 92.2% (SD ±1.84), and NC: 0% (SD ±0.0). There were statistically significant differences between RP, IP, and PN compared with NC and PC and between RP, IP, and PN (all P ≤ .01). CONCLUSIONS: The evaluation of pulp oxygenation rates by PO may be a useful tool to determine the different inflammatory stages of the pulp to aid in endodontic diagnosis.

Pulp vitality in patients with intraoral and oropharyngeal malignant tumors undergoing radiation therapy assessed by pulse oximetry.

INTRODUCTION: The aim of this study was to evaluate pulp oxygenation levels (%SpO(2)) in patients with malignant intraoral and oropharyngeal tumors treated by radiotherapy (RT). METHODS: Pulp oxygenation levels were measured by pulse oximetry. Twenty patients were selected, and two teeth of each participant (n = 40) were analyzed, regardless of the quadrant and the area irradiated, at four different time points: TP1, before RT; TP2, at the beginning of RT with radiation doses between 30 and 35 Gy; TP3, at the end of RT with radiation doses between 60 and 70 Gy; and TP4, 4 to 5 months after the beginning of cancer treatment. RESULTS: Mean %SpO(2) at the different time points were 93% (TP1), 83% (TP2), 77% (TP3), and 85% (TP4). The Student's t test showed statistically significant differences between TP1 and TP2 (P < .01), TP3 (P < .01), and TP4 (P < .01). TP3 was also statistically significantly different when compared with TP2 (P < .01) and TP4 (P < .01). No statistically significant difference could be observed between TP2 and TP4. CONCLUSIONS: Because the mean %SpO(2) before RT was greater than during and after therapy and values obtained 4 to 5 months after the beginning of RT were close to the initiation of RT, pulp tissue may be able to regain normal blood flow after RT. If the changes in the microcirculation of the dental pulp were indeed transitory, preventive endodontic treatment or extraction in patients who are currently undergoing or recently received RT and who show negative signs of pulp sensitivity may not be necessary for pulpal reasons.

Microscópio odontológico para o clínico geral: a qualidade total chega aos consultórios odontológicos / The operating microscope for the general clinician: the excellence era arrives to the dental office

Desde o princípio do século, tanto a medicina como a odontologia, tem se beneficiado enormemente do uso da magnificaçäo, tendo consequentemente seus horizontes ampliados. A melhora da acuidade visual dos profissionais, conseguida principalmente através do uso intenso de magnificaçäo óptica, tem tornado parte integral dos consultórios odontológicos modernos. Através da grande tendência mundial da Micro-Odontologia, os autores usaram princípios de microcirurgia para melhorar a acuidade visual, bem como a precisäo das técnicas operatórias já existentes, para modificar e ampliar definitivamente o espectro da açäo da Odontologia moderna. Este artigo tem por objetivo fornecer um breve histórico da utilizaçäo da magnificaçäo (Microscópio Odontológico) na odontologia, uma suscinta descriçäo do Microscópio Odontológico, bem como o quanto os Cirurgiöes Dentistas podem se beneficiar desta nova tecnologia. Certamente estamos diante de uma nova era na Odontologia: a era da excelência clínica