Evaluation of acceptance and preference of topical lidocaine application versus articaine injection anesthesia after nonsurgical periodontal treatment: A randomized clinical trial.

BACKGROUND: To compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement. METHODS: Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients' preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists' preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance. RESULTS: After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentists' acceptance and preference regarding either anesthetic method studied were balanced. CONCLUSIONS: Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy.

Pyostomatitis vegetans Zahlreiche blassgelbe Punkte auf entzündlich rotem Grund.

Pyostomatitis vegetans is a disease of the gingiva and the oral mucosa with noticeable, uncommon morphology. Clinical characteristics of this rare disease and considerations regarding differential diagnosis are described. Pyostomatitis vegetans is frequently associated with chronic inflammatory bowel diseases and can, thus, give a diagnostic hint at an existing ulcerative colitis or Crohn’s disease. A therapy plan for pyostomatitis vegetans is presented, which led to remission using local treatment only. The follow-up examination after one year showed that the treatment outcome had remained stable. An unexpected clinical appearance of the gingiva with small, pale pink thickenings after therapy and at follow-up is portrayed.

Microbiota of exposed root surfaces after fluoride, chlorhexidine, and periodontal maintenance therapy: a 3-year evaluation.

BACKGROUND: Fluoride and chlorhexidine (CHX) are state-of-the-art preventive measures for remineralizing teeth and for preventing plaque accumulation. The aim of this study was to examine the effects of fluoride and CHX varnishes on root caries and microbiota located on root surfaces. METHODS: Thirty-three patients from a periodontal maintenance program, having at least one tooth with gingival recession in each quadrant, participated in this study. One tooth per quadrant was assigned randomly to the control group or to one of the test groups that were treated with fluoride varnish, 1% CHX, or 40% CHX. The varnish treatment and the tooth cleaning were repeated every 3 months. Clinical examinations were performed at baseline and once a year for 3 years. Caries status and oral hygiene indices were evaluated clinically. The total cultivable microbiota and percentage of Mutans streptococci (MS), Actinomyces (ACC), and lactobacilli (LB) were analyzed. RESULTS: Oral hygiene was improved greatly during the course of the study. The percentage of MS, ACC, and LB of the total cultivable microbiota revealed a statistically significant reduction between baseline and final examination for each of the four groups. CONCLUSION: Professional tooth cleaning alone at 3-month intervals might be as effective in reducing MS, ACC, and LB as adjunctive treatment with fluoride or chlorhexidine.

In vitro attachment of osteoblasts on contaminated rough titanium surfaces treated by Er:YAG laser.

Microbial contamination of implant surfaces inhibits formation of new osseous tissues. Biocompatibility of sandblasted large grid (SLA) surface, after previous in vitro cocultivation with Porphyromonas gingivalis and concomitant Er:YAG laser irradiation of microorganisms, was tested by attachment of newly cultured osteoblasts. A total of 36 customized titanium cubes with SLA surface were placed into human osteoblast culture for 14 days. After removal of 1 control cube, 35 other cubes were contaminated with precultured P. gingivalis (ATCC33277) and incubated in broth medium for 1 week. Ablation was carried out on 32 cubes. Each side was treated for 23.5 s with a pulsed, water-cooled laser beam. After irradiation, cubes were again placed into fresh osteoblast culture for 2 weeks. One randomly selected single side per cube was analyzed by scanning electron microscope in 22 cubes. On other 10 cubes, vitality of attached cells was tested with ethidiumbromide staining by fluorescence microscopy. Three negative controls revealed constantly adherent P. gingivalis, and no osteoblasts were detectable after P. gingivalis contamination on the surfaces. Laser-treated specimens showed newly attached osteoblasts, extending over 50-80% of the surface. Positive control cube (without bacterial contamination) showed over 80% cell coverage of the surface. Vitality of widely stretched osteoblasts was confirmed by FITC staining. Our results indicate that Er:YAG laser was effective in removing P. gingivalis and cell compounds, offering an acceptable surface for new osteoblast attachment.

[Critical assessment of microbiological diagnostics in periodontal diseases with special focus on Porphyromonas gingivalis]. / Kritische Beurteilung mikrobiologischer Diagnostik bei marginaler Parodontitis unter besonderer Berüchsichtigung von Porphyomonas gingivalis.

Periodontitis is caused by an opportunistic infection with pathogenic microorganisms of the oral biofilm. In this paper, we discuss the usefulness of microbial diagnostics with respect to the differential diagnosis or the treatment approaches of periodontal diseases. Several diagnostic techniques, based on morphological, enzymatic, cultural, genetic or antigenetic properties have been established to analyze the microbial flora. Among the bacterial species some virulent genotypes of P. gingivalis play an important role in the etiology of periodontitis. Expression of fimbriae or different proteases have been identified as potential virulence factors of this gram negative anaerobic rod. To date a characterization of virulence of specific strains or a correlation between expression of different virulence factors and distinct periodontal conditions, however, is missing. Therefore, the importance of a routine identification of P. gingivalis still needs further evaluation.