Calcium sulphate for control of bleeding after oral surgery in anticoagulant therapy patients.

Control of bleeding after oral surgery is mandatory in patients taking anticoagulants. There are different haemostatic measures to prevent post-surgical bleeding. The aim of the present paper is to study the use of a haemostatic agent, calcium sulphate (CaS) (P30, Ghimas, Bologna, Italy) for controlling post-surgical bleeding in a group of patients treated with warfarin therapy for thromboembolic states. Twenty teeth (12 mandibular molars, 8 maxillary molars) in 20 patients (14 male and 6 females) with a mean age of 54.3 years (±10.3 years) were included in the study. The patients were divided into 2 groups; in the study group of 10 patients calcium sulphate was used in layers to fill the socket after extraction, while for the 10 patients in the control group put a gauze with tranexamic acid was put in the extraction site immediately after extraction, and half an hour after extraction. The outcome was bleeding in subsequent days. Bleeding at post-operative day 1 was significant in 5 patients of the control group, however, in the study group treated with calcium sulfate there was no bleeding in any patient (p value 0.0055). CaS demonstrated to be a good haemostatic agent for controlling bleeding after oral surgery in patients taking anticoagulants.

An overview on periodontal changes and dental movements.

Only in recent times has been enhanced the importance of gingival crevicular fluid in periodontal health and in particular in maintaining the integrity of periodontium during application of orthodontic forces. The aim of this short review is to evaluate the importance of substances as valid biomarkers of periodontal health during orthodontic movements. A search on PubMed and Cochrane database was performed considering the literature from 2003 to 2014, using the following key words: gingival crevicular fluid, biomarkers of periodontal tissue, orthodontic movements. After abstracts screening, the full-texts of selected papers were analyzed and the papers found from the reference lists were also considered. The search focused on clinical applications documented in studies in the English language: levels of evidence included in the literature analysis were I, II and III. Literature analysis showed 28 papers that fulfilled the inclusion criteria. The conclusion is that GCF is a powerful vehicle for clinical diagnostics, since it contains different biochemical and cellular arrays in relation to different clinical situations indicative of the state of periodontal health during orthodontic treatment.

Periodontitis and cerebrovascular disease: a new novel in medicine.

The aim of this review is to determine if there is a relationship between periodontal disease and stroke. The included case-control and cohort studies mediate the incidence of stroke and periodontal disease by analyzing different parameters. A literature review was carried out in PubMed, Scopus and Embase databases using the key word "stroke" AND "periodontal disease". An amount of 932 articles came out from our research on these three databases. These articles were selected according to PRISMA criteria. The following inclusion criteria were established: studies conducted in humans, articles published in English and published in the last ten years. Exclusion criteria were: experimental studies on animals, articles published more than 10 years ago, non-English language articles, articles of non-indexed journals, and articles not directly related to the association between stroke and periodontitis. These criteria reduced the number of articles from 932 to 399. At the end, articles that appeared to be repeated in different databases have been eliminated: 254 articles remained. All these articles titles were reviewed by the authors, who decided whether or not to include them in the review. We selected an amount of 43 articles. These studies were reviewed by reading the titles and abstracts, and by finally selecting the ones with the same topic of this review. When titles or abstracts were not clear, the complete article was read. At the end 7 articles were selected. In addition, 2 systematic reviews and 1 article, cited in the discussion, and regarding the protocol used in patients suffering from cardiovascular diseases and periodontitis, were selected. The quality of these articles was evaluated through the JADAD system. In conclusion, patients with stroke have a higher prevalence of periodontitis.

The role of implant-abutment connection in preventing bacterial leakage: a review.

Osseointegration can be affected by oral conditions; in particular, the micro gap at the implantabutment-connection (IAC) represents a site for dental plaque aggregation favoring bacterial leakage that can increase inflammatory cells at the level of the IAC, causing peri-implantitis. This micro gap, once early colonized, may constitute a bacterial reservoir that could subsequently contaminate fixture's surroundings and interfere with peri-implant tissues health. The aim of this review is to describe, according to the most recent literature, the different kind of implant-abutment connection and their ability to reduce bacterial leakage and thus preventing peri-implantitis. The following database were consulted: Pubmed (n=26), Scopus (n=90), Research gate (n=7) and 123 articles were found. Duplicates were excluded and after reading abstract and titles, those articles that were off topic were also excluded. The remaining ones (n=24) were assessed for full-text eligibility. We excluded 5 articles because they were case reports, 2 because there was no clear reference to the relationship between IAC and bacterial leakage and 2 because they were not pertinent to the argument. Fifteen articles were included in the review. From the review, it is clear that a relationship between the IAC and bacterial leakage exists. All the connections presented an amount of micro-gap and bacterial micro-leakage but conical and mixed connection systems seem to behave better. Moreover, both connections seem to have a better load distribution and the mixed one has anti-rotational properties, very useful during the positioning of the prosthesis.

Current concepts on cleft lip and palate etiology.

Nonsyndromic cleft lip with or without cleft palate is the most common craniofacial anomaly affecting around 1 in 700 live births worldwide. Clefts of the human face can be classified anatomically as cleft palate only (CPO), cleft lip only (CLO), cleft lip and palate (CLP) or a combined group of cleft lip with or without cleft palate (CL/P), based on different in embryologic development. These malformations have some genetic origin, in fact several association studies have been performed to obtain important information about the candidate genes; but more important are gene-environment interactions that play an increasing role in its etiology. Epidemiological studies have shown how environmental factors (alcohol, smoking, drugs), as well as possible gene-environment interactions, play an important role in the onset of the malformation. On the contrary, folic acid intake seems to have a protective effect. In this review, we analyze the role of environmental factors related to onset of cleft.

Two-way relationship between diabetes and periodontal disease: a reality or a paradigm?

Diabetes mellitus (DM) and periodontal disease (PD) are both chronic diseases. From one side, DM have an adverse effect on PD, and on the other side PD may influence DM. Systemic therapy of DM with glycaemic control, affects the progress of PD. Reversely treatment of PD combined with the administration of systemic antibiotics seems to have a double effect on diabetic patients reducing the periodontal infection and improving the glycaemic control. Inflammation, altered host responses, altered tissue homeostasis are common characteristic of both DM and PD. The potential common pathophysiologic pathways of direct or reverse relationship of DM and PD are still unknown and further in vitro and in vivo studies are needed to explore this relationship.

Why patients with cardiovascular risks go to dentists. Is there sufficient evidence of influence of periodontal therapy on cardiovascular disease?

Cardiovascular disease (CVD) is a common cause of death, representing 29% of the mortality all over the word. Estimates for 2006 show that CVD is one of the world's main cause of death, with 17.1 million death per year. More than 70 million Americans have been diagnosed with various forms of CVD, including high blood pressure, coronary artery disease (acute myocardial infarction and angina pectoris), disorders of peripheral arteries etc. There is strong evidence that periodontal disease (PD) is associated with an increased risk of CVD. In addiction many patients with CVD are also affected by PD, which can be mild or severe. The aim of this manuscript is to investigate the effects of periodontal therapy on the management of CVD. 34 randomised controlled trials and reviews were included in this manuscript to test the effects of different periodontal therapies for patients with CVD. In conclusion, we may affirm that there is some lack of knowledge on relations between PD and CVD, however there is sufficient evidence to justify a periodontal treatment to prevent CVD, in fact PD is very prevalent in middle-aged population and can have a significant impact on the cardiovascular function.

Complication in third molar extractions.

Mandibular third molars (MM3s) are responsible for pericoronitis, primary and/or secondary crowding of the dentition, odontogenic tumors and cysts, periodontal defects associated with the posterior part of mandibular second molars. Tooth extraction is indicated for prophylactic and therapeutic purpose in patients with problems caused by impacted teeth. Common postoperative complications associated with third molar extraction are alveolitis (0.5e32.5%), infection (0.9e4.2%), postoperative bleeding (0.2e1.5%), transient dysfunction of the inferior alveolar nerve (0.6e5.5%), and permanent dysfunction of the inferior alveolar nerve (0.1e0.9%). A literature review reveals number of individual case reports of accidental displacement to various anatomical locations, namely, the infratemporal fossa, pterygomandibular space, lateral pharyngeal space, submandibular space, and sublingual space.

Efficacy of a new chemical device to minimize microbial contamination along implant-abutment connection: an in vitro study.

Osseointegrated dental implants showed elevated success rates on the long-term treatment in the last ten years. However, the risk of peri-implantitis and implant failure is the main complication of implantology. The presence of a micro gap at the implant-abutment connection (IAC) allows microorganisms to penetrate and colonize the inner part of the implant leading to biofilm accumulation and consequently to peri-implantitis development. Some chemical devices (CD) has been studied to reduce bacterial penetration at IAC level but no one have been demonstrated to be effective for this purpose. Aim of the present study is to evaluate the effectiveness of a new chemical formulation STCX-1, placed in the internal part of dental implants for killing bacteria present in the IAC. To identify the antibacterial power of SXTC-1 at interface between implant-abutment connection, the passage of genetically modified Escherichia coli across IAC was evaluated. A total of eight implants were used (Edierre Implant System, Edierre SpA, Genova, Italy). The inner side of four out of the eight implants were firstly contaminated with few microliters of pure bacteria, subsequently were treated with SXTC-1 for few second and finally, the antibacterial was replaced with Lysogeny Broth (LB) and antibiotics without bacteria. The remaining four implants were not treated with SXTC-1 and just filled with LB with antibiotics. Bacteria viability was determined by measuring their Optical Density (OD) at 600nm. The analysis revealed that, in untreated implants, bacteria grew (internally and externally) for the first 48 hours, but subsequently they started to dye. In treated implants, instead, bacteria grew just in the space surrounding the device suggesting that, even if bacteria were able to get into, they immediately died thanks to the presence of SXTC-1. The STCX-1 liquid formulation have been demonstrated to be an adjuvant CD effective for prevention of of bacterial colonization at IAC level.

Prevalence of HIV-related oral manifestations and their association with HAART and CD4+ T cell count: a review.

HIV infection is one of the major health problem of the last decades. This disease causes a chronic infection that can lead to acquired immunodeficiency syndrome (AIDS). According to the Global AIDS update, released in 2016 by HIV department of World Health Organization (WHO) and by the Joint United Nations Program on HIV/AIDS (UNAIDS), at the end of 2015, 36.7 million people were infected by HIV: 34.9 million of these were adults and 1.8 million were children under 15 years of age. The same report shows that during 2015, 2.1 million of new infection cases have occurred all over the world and about 1.1 million people have died for HIV. The aim of this short review is to up-date of the main HIV-related oral manifestations and their correlation with HAART (Highly Active Antiretroviral Therapy) and CD4+ T-cell count. Despite that more than 20 years have elapsed, this classification still remains valid: even today, group 1 lesions are found in the majority of HIV-positive patients with oral manifestations. Group 1 includes the following conditions: oral candidiasis (pseudomembranous candidiasis, erythematous candidiasis, angle cheilitis), oral hairy leukoplakia, periodontal diseases (necrotizing gingivitis, necrotizing periodontitis, linear gingival erythema), Kaposi’s sarcoma, and non-Hodgkin’s lymphoma. Melanotic hyperpigmentation, HSV infection and HPV infection, which are included in group 2, are also common. Oral candidiasis, oral hairy leukoplakia, Kaposi’s sarcoma and HSV infection are the lesions that have seen the major drop in their incidence after the HAART introduction. The increase in CD4+ T-cell count is not significantly correlated to the decrease of every type of oral lesions, but it is statistically significant only in relation to oral candidiasis (p-value less than 0.001). Oral lesions are an important sign of immunodepression and with the introduction of HAART their incidence has strongly decreased, particularly in urban areas. Nevertheless, developing countries still have a high prevalence of these manifestations because of the persistence of many risk factors, like the difficulty to access treatment, poor oral hygiene, low socioeconomic status and late diagnosis.