Sodium Hypochlorite Concentration and Postendodontic Pain - Unveiling the Optimal Balance: A Systematic Review and Meta-Analysis.

INTRODUCTION: This study systematically reviewed literature regarding the effect of different concentrations of sodium hypochlorite (NaOCl) used during root canal treatment (RCT) on postendodontic pain (PEP) and rescue analgesia. METHODS: Following registration with PROSPERO (CRD42023388916), a search was conducted using PubMed, Scopus, Web of Science, and Embase databases. Randomized controlled trials of patients receiving RCT which assessed PEP at different time intervals were included. Following data extraction and Cochrane risk of bias assessment 2, meta-analyses were performed to evaluate PEP during the first 48 hours along with rescue analgesic intake. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: Five randomized controlled trials with 674 patients were included. One study exhibited a low risk of bias, while 4 raised some concerns. Patients treated with low concentrations of NaOCl (≤3%) were significantly less likely to report PEP at 24 hours (OR = 2.32; [95% CI, 1.63-3.31]; P < .05) and 48 hours (OR = 2.49; [95% CI, 1.73-3.59]; P < .05) as compared with high concentrations of NaOCl (≥5%). Furthermore, with low concentrations of NaOCl, significantly lesser moderate-severe PEP was reported at 24 hours (OR = 2.32; [95% CI, 1.47-3.62]; P < .05) and 48 hours (OR = 2.35; [95% CI, 1.32-4.16]; P < .05) and lesser analgesia was needed (OR = 2.43; [95% CI, 1.48-4.00]; P < .05). CONCLUSIONS: While PEP can be influenced by several factors, low certainty evidence suggests that when NaOCl is used as an irrigant during RCT, PEP may be less likely with lower concentrations of NaOCl. Moderate certainty evidence indicates that lesser analgesia may be required with lower concentrations of NaOCl. These results should be cautiously interpreted.

Irrigant dynamics of a back-to-back double side-vented needle in root canals with various tapers: a computational fluid dynamics study.

Understanding the apical pressure and irrigant flow patterns in root canals is crucial for safe and effective irrigation. Therefore, this study aimed to assess the flow characteristics of irrigants in root canal models with varying tapers during final irrigation by employing various needle designs, including a back-to-back double-side-vented needle, through computational fluid dynamics. The root canal model was configured as a closed geometrical cone with a simulated apical zone (size 30) and features tapers of 4%, 6%, and 8%. Three needle types-open-ended needle (OEN), single side-vented needle (SSVN), and double side-vented needle (DSVN)-were investigated. The results indicated that for the 4% taper models, the open-ended needle generated the maximum apical pressure, followed by the double side-vented needle and the single side-vented needle. However, in the 6% and 8% tapering root canal models, the double-side-vented needle applied the lowest maximum apical pressure. Consequently, the DSVN can pose a risk for irrigant extrusion in minimally prepared canals due to heightened apical pressure. In wider canals, the DSVN exhibited lower apical pressure. The maximum irrigant replacement was observed with OEN compared to that of the closed-ended group for both flow rates. Additionally, compared with OENs, closed-ended needles exhibited nonuniform and lower shear wall stress.

Effect of bleaching on color and surface topography of teeth with enamel caries treated with resin infiltration (ICON®) and remineralization (casein phosphopeptide-amorphous calcium phosphate).

Background: Dental bleaching is not recommended on teeth with enamel caries. Aim: The study aimed to assess the efficacy of in-office bleaching on demineralized enamel managed by resin infiltration (RI) as well as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). Methodology: Forty-eight sound enamel specimens were divided into four groups based on the surface treatment performed before in-office bleaching. Group I consisted of no caries and no treatment (NT); Group II had artificial caries (AC) and NT; Group III had AC treated with RI, and Group IV had AC remineralized with CPP-ACP. Pre- and postbleaching teeth color and surface topography were evaluated using spectrophotometer and scanning electron microscope (SEM), respectively. Statistical Analysis Used: One-way analysis of variance and Tukey's post hoc test were performed for inter-group comparisons. Results: The color change postbleaching was the least in Group IV; and this was significantly less than Group I (P < 0.05) and Group II (P < 0.001). The bleaching efficiency in Group III was not significantly different from the control group. In addition, the enamel topographic changes were less in the surface-treated group. Conclusion: RI can be considered a treatment modality for teeth with enamel caries requiring tooth whitening as the bleaching efficiency was like that of sound enamel.

Effect of Dentine Conditioning with Silver Diamine Fluoride on Wettability of Root Canal Sealers.

OBJECTIVE: To test the null hypothesis that dentine treatment with silver diamine fluoride (SDF), a potent antimicrobial agent, following use of proteolytic and chelating agents does not influence the wettability of an epoxy resin (AH Plus, Dentsply Sirona, Charlotte, NC, USA) and a tricalcium silicate sealer (BioRoot RCS, Septodont, Saint-Maur-des-Fossés, France). METHODS: Seventy-two intraradicular dentine specimens were divided into six groups based on the final irrigation solutions used: 2.5% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA) (NaOCl-EDTA) (group 1); NaOCl-EDTA-NaOCl (group 2); NaOCl-EDTA followed by 3.8% SDF, NaOCl-EDTA-SDF (group 3); NaOCl-EDTA-NaOCl-SDF (group 4); SDF (group 5) and saline (group 6). After irrigation, the specimens were divided into subgroups according to the sealer used, AH Plus or BioRoot RCS. Contact angles were measured using a contact angle analyser. The data were analysed using an independent t test, one-way analysis of variance (ANOVA) and Tamhane T2 post hoc test, with the level of significance set at P < 0.05. RESULTS: In the epoxy resin sealer group, dentine surfaces treated with only SDF showed the lowest contact angle. This was significantly less than the groups in which NaOCl was used as the final irrigant (P < 0.05). In the tricalcium silicate-based sealer group, the groups treated with SDF showed significantly greater contact angles when compared to the control group (P < 0.05). CONCLUSION: It was concluded that SDF conditioning of dentine favours the wettability of epoxy resin sealer but is detrimental to the wettability of tricalcium silicate sealer.

Validation of ageism scale for dental students in India: (Ageism Scale for Dental Students- India) - a cross sectional study.

Background: Ageism persists in many different societies as it is innate and subconscious in nature. Negative effects such as loneliness, mistreatment, and occupational discrimination are frequently present due to ageism. The dental students in our study were wary of the possible benefits of expensive dental care because ageism is rife in their field. There is no validated and reliable ageism scale to assess how dental students perceive ageism in India. The current study was carried out to validate the ageism scale for dental students in the Indian context. METHODS: This was a cross sectional analytical study carried out among both males and females in Manipal College of Dental Sciences, Mangalore in which the instrument was 27-item Ageism scale for dental students. Content validity was done by six subject experts. The final version was administered to 213 students/Residents of dental school. The factorability of data was confirmed with KMO = 0.61 and Bartlett's Test of Sphericity resulting in p < 0.001. RESULTS: Final PCA model resulted in 15 items and six components that together accounted for 70.37% of overall variance. The six components had reliability ranging from marginal 0.51 (Component 6) to a high of 0.81 (Component 3). As per the gender differences by component females showed less ageism than men in "non-compliance" (-0.9(-1.66-0.14), p<0.05) and "practitioner perspective" (1.43 (0.84, 2.03), p<0.01). Statistical significance was seen in Barriers/concerns in dental treatment of elderly where residents showed reversed (1.4 (0.41, 2.38), p<0.01). Urban group showed more ageism for component 'time restraint' (-0.79 (-1.57, -0.02), p<0.05. CONCLUSION: Preliminary validation resulted in 15 item scale with six components with acceptable validity of the ageism scale and could be further tested in large samples. This scale will help recognize ageism in Indian context and provide necessary information to make changes in the curriculum as required.

Antimicrobial efficacy of Kerr pulp canal sealer (EWT) in combination with 10% amoxicillin on Enterococcus faecalis: A confocal laser scanning microscopic study.

Background: Sealers with antimicrobial properties play an important role in endodontic therapy success especially against Enterococcus faecalis infection found in failed root canal therapy. Addition of antibiotic agents to endodontic sealers may show significant increase in their antibacterial properties both against anaerobic and aerobic microbes. The purpose of the present study was to evaluate antimicrobial efficacy of Kerr pulp canal sealer (EWT) in combination with 10% amoxicillin against E. faecalis and post-root canal treatment viability of Enterococcus faecalis on the first and seventh day. Methods: A total of 60 extracted human mandibular premolar teeth were decoronated after initial decontamination with 1% NaOCl. Root length standardized to 12 mm. Canal instrumentation was done using ProTaper Universal file system till size F2 using 5.25% NaOCl. It was then infected with a pure strain of E. faecalis for a period of four days. Obturation was done using plain sealer, (n=30) and sealer-antibiotic combination, (n=30). Half of the teeth were sectioned at 24 hours (S, SA) and other half were sectioned seven days after obturation (S7, SA7). All samples were stained with SYTO9 and propidium iodide for imaging under Confocal Laser Scanning microscope. Statistical analysis was performed with the statistical software SPSS v. 17.0 (SPSS for Windows; SPSS Inc, Chicago, IL). Data was analysed using One Way ANOVA and post hoc Tukey test to determine statistical significance with p value < 0.01 considered significant. Results: Statistically significant differences were observed in green to red ratio between group S (9.561976) and S7 (0.435418) (p < 0.01). There was no difference found between SA (mean of green to red ratio, (0.70431) and SA7 (mean of green to red ratio, 0.85184). Conclusions: Antibiotics added to the sealer effectively eradicated of E. faecalis 24 hours post-obturation. However, after seven days, plain sealer was as effective as sealer-antibiotic combination.

Effects of traditional and novel proteolytic agents on tissue dissolution and dentine microhardness.

The study aimed to evaluate the tissue-dissolving ability of papain and bromelain with respect to that of sodium hypochlorite (NaOCl) at the temperatures of 25°C and 60°C. The study also assessed the effects of these proteolytic agents on radicular dentine microhardness. Warming NaOCl, papain and bromelain solutions resulted in significant tissue dissolution at all time intervals (p < 0.001). At 60°C, bromelain showed significantly higher tissue weight loss at every time interval when compared to NaOCl (p < 0.001). All of the three organic tissue dissolvents reduced the microhardness at 1 hr when compared to their respective baseline values. The reduction in microhardness from the baseline reading was statistically significant only in the papain group at 30 min (p = 0.018) and at 60 min (p = 0.03) when compared to the control group. Hence it was concluded that bromelain exerted superior tissue dissolution action, especially when warmed, with minimal effect on dentine microhardness.

Translucency characteristics of permanent maxillary central incisor in Indian population: An analytical cross-sectional study.

Background: Understanding the optical characteristics, especially the translucency patterns (TPs) in teeth can assist clinicians in creating biomimetic restorations. Aim: This study assessed the differences in enamel TPs and the area of translucency (AOT) in the most dominant teeth of an individual's smile according to their age and gender. Materials and Methods: This cross-sectional study was conducted on 140 consented individuals. Based on the age, there were four groups with 35 subjects in each. The digital imaging method is used to classify and differentiate different TPs. The AOT was measured with the assistance of ImageJ 1.51j8 software. Statistical Analysis Used: One-way ANOVA with a post hoc test was used to test the statistical significance difference among the various age groups, and an independent t-test was used to test the variations between genders. Results: The outcome of this study showed that the AOT was the highest for the 50 and above age group as compared to other age groups (P = 0.003). Although there were variations in the TPs between the two genders, the AOT showed no significant difference. Conclusion: The area of incisal third translucency in the upper central incisors varied between different age groups. However, gender had no influence in the area of incisal translucency. Wide variations in the TPs were seen based on age and gender.

Effect of ocular dominance, clinical experience, and sex on the accuracy of shade selection.

OBJECTIVE: The study aimed to evaluate the influence of ocular dominance, clinical experience, and sex on the accuracy of visual color matching. METHOD AND MATERIALS: A total of 104 selected participants consisting of dental students and dental practitioners were allocated into two groups based on their clinical experience of using visual shade matching tabs for the selection of tooth shade. Both the inexperienced (IXP), as well as experienced participants (EXP), were then asked to correctly match the shades of five tabs (A2, A3.5, B1, C2, and D3) of a commonly used visual shade guide (Vitapan Classical shade guide, VITA Zahnfabrik) that were kept constant throughout the study. The participants documented the shade of those tabs using another set of shade guide using the right eye (left eye covered), left eye (right eye covered), as well as both eyes. Test for ocular dominance was performed using the Dolman method. The results were statistically analyzed using the chi-square test with a level of significance set at < .05. RESULTS: The percentage of correct shade matching with the monocular dominant vision (53%) was significantly better as compared to the monocular non-dominant vision (12%) (P < .001) or binocular vision (44%) (P < .05). Sex had an influence in shade selection (P = .031). However, clinical experience was an insignificant aspect in shade matching (P = .078). CONCLUSIONS: Knowing the clinician's dominant eye can be clinically relevant, as it can influence the accuracy of shade selection, irrespective of sex and clinical experience.

Effect of surface treatment on the dislocation resistance of prefabricated esthetic fiber posts bonded with self-adhesive resin cement: A systematic review and meta-analysis.

BACKGROUND: This systematic review aimed to determine the presence of any in vitro proof to validate the utilization of surface treatments to advance the bond strength of fiber posts to intraradicular dentin with self-adhesive resin cements. METHODOLOGY: Laboratory studies that assessed the push-out or pull-out bond strength of the prefabricated esthetic posts whose surface was treated with either chemical or physical treatment or a combination and bonded using self-adhesive resin cement within root canal model were included for this systematic review. The review began after obtaining the registration number from the International Prospective Register of Systematic Reviews (PROSPERO ID-CRD42020165009). Study reporting was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant articles were identified using a literature database search in Web of Science, Scopus, PubMed, and EBSCO. Besides this, handsearch was also done to ensure complete capture of the articles. RESULTS: Fifteen articles were then selected and included in this study, out of which four were excluded for meta-analysis due to usage of the artificial substrate. It was shown that an additional step of surface treatment of esthetic fiber post did not result in significant improvement in dislocation resistance. Assessment of risk of bias categorized the available research into high risk and medium risk. The results showed heterogeneity. CONCLUSION: The use of additional steps such as chemical, mechanical, or a combination of post surface treatment does not have any added benefit. However, the results must be interpreted with caution due to methodological shortcomings.

Effect of blood contamination and various hemostatic procedures on the push-out bond strength of Biodentine when used for furcation perforation repair.

BACKGROUND: Perforations in the furcation area are common procedural accidents that can impact the outcome of treatment. There are many bioactive materials available to repair these defects. AIM: The purpose of this study was to determine and compare the effect of 25% aluminum chloride solution, 20% ferric sulfate solution, and a 980-nm diode laser, when used for hemostasis, on the dislocation resistance of Biodentine placed to repair furcation perforation. MATERIALS AND METHODS: This in vitro study was conducted on fifty extracted human permanent mandibular molars, with ten teeth in each group. The stimulated perforations were contaminated with blood, except for one group. The contaminated groups were either treated with aluminum chloride, ferric sulfate, diode laser, or none at all. All the perforations were restored with Biodentine and tested for push-out bond strength. STATISTICAL ANALYSIS USED: One-way analysis of variance and Tukey's HSD post hoc test were applied with a level of significance set at 0.05. RESULTS: The dislocation resistance of Biodentine was found to be highest when aluminum chloride or diode laser was used for arresting bleeding. In contrast, the ferric sulfate group gave the lowest value for push-out bond strength (P < 0.05). CONCLUSIONS: According to the present study, the use of ferric sulfate as a hemostatic agent showed a negative effect on the bond strength of the calcium silicate cement to dentin. Furthermore, Biodentine performed better when diode laser and aluminum chloride were used for hemostasis.

Camostat mesylate against SARS-CoV-2 and COVID-19-Rationale, dosing and safety.

The coronavirus responsible for COVID-19, SARS-CoV-2, utilizes a viral membrane spike protein for host cell entry. For the virus to engage in host membrane fusion, SARS-CoV-2 utilizes the human transmembrane surface protease, TMPRSS2, to cleave and activate the spike protein. Camostat mesylate, an orally available well-known serine protease inhibitor, is a potent inhibitor of TMPRSS2 and has been hypothesized as a potential antiviral drug against COVID-19. In vitro human cell and animal studies have shown that camostat mesylate inhibits virus-cell membrane fusion and hence viral replication. In mice, camostat mesylate treatment during acute infection with influenza, also dependent on TMPRSS2, leads to a reduced viral load. The decreased viral load may be associated with an improved patient outcome. Because camostat mesylate is administered as an oral drug, it may be used in outpatients as well as inpatients at all disease stages of SARS-CoV-2 infection if it is shown to be an effective antiviral agent. Clinical trials are currently ongoing to test whether this well-known drug could be repurposed and utilized to combat the current pandemic. In the following, we will review current knowledge on camostat mesylate mode of action, potential benefits as an antiviral agent and ongoing clinical trials.

Evaluation of indirect pulp capping using pozzolan-based cement (ENDOCEM-Zr®) and mineral trioxide aggregate - A randomized controlled trial.

BACKGROUND: Pulp capping should always be considered as the primary treatment of choice for teeth without irreversible pulpitis in lesions approaching dental pulp. The predictability of vital pulp therapy has improved with the introduction of newer bioceramic materials. AIM: The purpose of this randomized controlled trial was to compare the outcomes of mineral trioxide aggregate (MTA) (Angelus, Londrina, Brazil) and a pozzolan-based cement (ENDOCEM-Zr® [Maruchi, Wonju, Korea]) as an indirect pulp capping (IPC) material. MATERIALS AND METHODS: IPC was performed in forty patients who were randomly divided into ENDOCEM-Zr® and MTA groups. The outcome was assessed using clinical and radiographic tests at different time intervals. The prognostic factors on the outcome of IPC were also evaluated. RESULTS AND CONCLUSIONS: The success rate of ENDOCEM-Zr® and MTA groups was 94.7% and 89.4%, respectively. The results were not statistically significant. Binary logical regression showed that the age of the patient and the status of the pulp before treatment were deciding variables for the outcome of the study. Therefore, it was concluded from the study that the evaluated pozzolan-based cement could be used as an alternative to MTA because of its faster setting time and lower discoloration potential. In addition, pulp capping should be performed with caution in individuals above 40 years and in teeth with reversible pulpitis.

Effect of silver diamine fluoride-potassium iodide and 2% chlorhexidine gluconate cavity cleansers on the bond strength and microleakage of resin-modified glass ionomer cement.

BACKGROUND: Disinfection of the prepared cavity can be a crucial step in the longevity of restorations. The objective of this study was to compare the antimicrobial action (AMA) of silver diamine fluoride-potassium iodide combination (SDF-KI) with 2% chlorhexidine gluconate (CHX) and to compare the alteration in bond strength and microleakage while using SDF-KI and CHX as cavity cleansers in resin-modified glass ionomer cement (RMGIC) restorations. MATERIALS AND METHODS: Samples were grouped as follows: Group 1: Polyacrylic acid (PAA), Group 2: CHX, Group 3: SDF-KI, and Group 4: Distilled water (CTRL). AMA was assessed by measuring the zone of inhibition of the above-mentioned materials by dispensing them into the punch hole prepared on agar plates with an inoculum of Streptococcus mutans. For assessing the effect of the cavity cleansers on the bond strength of RMGIC, they were applied to the dentinal samples prepared from freshly extracted noncarious molars. After the surface was treated, cylindrical restoration of RMGIC was placed and allowed to set. The shear bond strength was then evaluated using a universal testing machine. Rhodamine-B dye penetration was viewed under a fluorescent microscope to evaluate the microleakage of RMGIC following surface treatment of the standardized cavities prepared on the cervical third of freshly extracted noncarious premolars. RESULTS: SDF-KI (34 ± 0.8 mm) showed potent AMA followed by CHX (23.9 ± 0.7 mm) and PAA (12.7 ± 0.8 mm). SDF-KI showed a drastic increase in the bond strength when compared to the PAA, CHX, and CTRL groups. Although the application of SDF-KI showed the least microleakage among all the groups, it was not statistically significant. CONCLUSION: The application of SDF-KI and CHX is useful against S. mutans in an in vitro study. Although SDF-KI group showed the least microleakage among the groups, it was not statistically significant. SDF-KI application has shown a drastic increase in the bond strength of RMGIC although further research is required for the suitable reasoning of the phenomenon.

Divergent Synthesis of Cyclopropane-Containing Lead-Like Compounds, Fragments and Building Blocks through a Cobalt Catalyzed Cyclopropanation of Phenyl Vinyl Sulfide.

Cyclopropanes provide important design elements in medicinal chemistry and are widely present in drug compounds. Here we describe a strategy and extensive synthetic studies for the preparation of a diverse collection of cyclopropane-containing lead-like compounds, fragments and building blocks exploiting a single precursor. The bifunctional cyclopropane (E/Z)-ethyl 2-(phenylsulfanyl)-cyclopropane-1-carboxylate was designed to allow derivatization through the ester and sulfide functionalities to topologically varied compounds designed to fit in desirable chemical space for drug discovery. A cobalt-catalyzed cyclopropanation of phenyl vinyl sulfide affords these scaffolds on multigram scale. Divergent, orthogonal derivatization is achieved through hydrolysis, reduction, amidation and oxidation reactions as well as sulfoxide-magnesium exchange/functionalization. The cyclopropyl Grignard reagent formed from sulfoxide exchange is stable at 0 °C for > 2 h, which enables trapping with various electrophiles and Pd-catalyzed Negishi cross-coupling reactions. The library prepared, as well as a further virtual elaboration, is analyzed against parameters of lipophilicity (ALog P), MW and molecular shape by using the LLAMA (Lead-Likeness and Molecular Analysis) software, to illustrate the success in generating lead-like compounds and fragments.

Effect of various dentin disinfection protocols on the bond strength of resin modified glass ionomer restorative material.

BACKGROUND: Disinfection of dentin surface prior to any restorative therapy is important for the longevity of the treatment rendered. However, these dentin disinfection methods should itself not interfere with the adhesion of the restorative material. Therefore the aim of this study was to determine the effect of various dentin disinfection protocols on the shear bond strength (SBS) of resin modified glass ionomer cement (RMGIC). MATERIAL AND METHODS: The occlusal surface of 40 extracted premolars were trimmed to obtain a flat dentinal surface and was randomly divided into four groups. CTRL was the control group; NaOCl was 1% sodium hypochlorite disinfection group; CHX was 2% chlorhexidine disinfection group; and PAD was the photo-activated disinfection group. Then a predetermined dimension of RMGIC was bonded to the pre-treated dentin surfaces. Following this, each sample was tested for SBS using universal testing machine at a crosshead speed of 0.5mm/min. RESULTS: Among the test groups, CHX showed the least reduction in SBS and NaOCl the highest reduction in SBS as compared to the control group. PAD on the other hand showed significantly lower SBS than CTRL and CHX groups, but the values were higher than the NaOCl group. CONCLUSIONS: Thus, it could be concluded from the present study that use of chlorhexidine based dentin disinfection does interfere with the adhesion of RMGIC. However, photo-activated disinfection should be done with caution. Moreover, sodium hypochlorite based disinfectants should be avoided prior to the use of RMGIC. Key words:Chlorhexidine, Dentin disinfection, Photo-activated disinfection, Resin modified glass ionomer cement, Shear bond strength, Sodium hypochlorite.

Concept of Minimally Invasive Indirect Veneers.

Minimally invasive indirect veneers (MIIV) are ultrathin porcelain veneers that can be cemented onto labial surfaces after no or minimal tooth preparation. The benefits of no or minimal veneer preparation are conservation of tooth structure, absence of postoperative sensitivity, bonding to enamel, minimal flexural stresses, no need for provisionals and improved patient acceptance. However, no or minimal preparation veneers should be considered only after thorough functional and aesthetic evaluation. The article presented here illustrates a case of diastema closure using MIIV, to highlight the importance of treatment planning for achieving good results.

Resurrecting an unsalvageable lower incisor with a mono-block approach.

Contemporary techniques, as well as the availability of bioactive and adhesive materials in endodontics, have helped revivifying teeth that were deemed hopeless. These newer materials and techniques would enable the clinician: (a) to predictably stop microbial activity (b) to achieve a total corono-apical fluid tight seal and (c) to strengthen mutilated teeth by obtaining intra-radicular reinforcement through mono-block effect. This case report demonstrates the successful treatment of a mutilated anterior tooth with the use of bioactive and adhesive materials to obtain a total seal and mono-block effect. This article also shows the use of a simple method in the placement of root filling cement into the root canal.

Medication-related dental erosion: a review.

Dental erosion has become a major problem that affects the long-term health of the dentition. Among the various potential causes for erosive tooth wear, the different drugs prescribed for patients may be overlooked. Several therapeutic medications can directly or indirectly be associated with dental erosion. It is the responsibility of oral health providers to make both patients and colleagues aware of drugs that may contribute to this condition. Therefore, the purpose of this discussion is to provide an overview of the various therapeutic medications that can be related to tooth erosion. The authors also include precautionary measures-summarized as The 9 Rs-to avoid or at least reduce medication-induced erosion.