In vitro activity of amoxicillin, clindamycin, doxycycline, metronidazole, and moxifloxacin against oral Actinomyces.

Actinomyces spp have been increasingly associated with endodontic infections. However, the antimicrobial susceptibility of this genus has not been studied extensively. The objective of this study was to determine the susceptibility of oral isolates of Actinomyces naeslundii, Actinomyces gerencseriae, Actinomyces israelii, Actinomyces viscosus, and Actinomyces odontolyticus to amoxicillin, clindamycin, doxycycline, metronidazole, and moxifloxacin using in vitro assays. The minimum inhibitory concentration (MIC) of each bacterial isolate was determined by using E-test strips (AB Biodisk, Solna, Sweden). The MIC(90) was 0.19 microg/mL for amoxicillin, 0.25 microg/mL for doxycycline, 0.50 microg/mL for moxifloxacin, and 1.00 microg/mL for clindamycin. However, metronidazole was not active against any of the Actinomyces spp tested (MIC(90)>256 microg/mL).

Interdisciplinary approach to endodontic therapy for uncooperative children in a dental school environment.

The aim of this study was to describe an interdisciplinary approach for endodontic therapy of behavior-challenging children and to report the efficacy of sedation techniques for these procedures. Sedation records of thirty-two patients who received root canal treatment were reviewed. Age at treatment in months, gender, year of treatment, tooth type, status of root maturation (open or closed apex), etiological factor(s), sedation protocol, and outcome were the variables analyzed. The collected information was entered into a computerized flowchart and the data analyzed using descriptive statistics. Midazolam in combination with meperidine or hydroxyzine were the most common protocols used (46 percent and 40 percent of the cases, respectively). Only two (6 percent) treatments were aborted due to uncontrolled behavior during sedation. We conclude that cooperation between pediatric dentists and endodontists is fundamental to achieving success when providing root canal treatment for uncooperative child patients.

Antimicrobial efficacy of medicated root canal filling materials.

Bacteria remaining within the root canal system are a significant factor in endodontic failures. The aim of this in vitro study was to evaluate the antimicrobial efficacy of commercially available gutta-percha formulations against common endodontic pathogens. Standard, tetracycline, or iodoform (also called medicated gutta-percha; MGP) containing gutta-percha were tested against Actinomyces israelii, A. naeslundii, Enterococcus faecalis, and Fusobacterium nucleatum using the agar diffusion method. Resilon points and tetracycline disks/E-tests were used as negative and positive controls, respectively. Resilon did not display antimicrobial properties. Standard gutta-percha and MGP inhibited F. nucleatum and A. naeslundii, with MGP also inhibiting A. israelii. Tetracycline containing gutta-percha was found to inhibit growth from all four bacterial species tested. The results of this study suggest that the use of tetracycline containing gutta-percha as an obturation material may be useful as a complement to the cleaning and disinfection phase of root canal procedures.

Peripheral ameloblastoma: a case report and review of the literature.

Peripheral ameloblastoma is a rare, benign odontogenic tumor that histologically resembles an intraosseous ameloblastoma but develops in the soft tissues of the gingiva and mucosa and exhibits an innocuous clinical behavior. We report a case of a recurrent peripheral ameloblastoma in a 61-year-old man that presented as a painless swelling on the maxillary anterior labial attached gingiva. Clinical and histopathologic features of this lesion are discussed. The peripheral ameloblastoma should be included in the differential diagnosis of a gingival lesion clinically resembling any of the myriads of entities seen on the gingiva including a pyogenic granuloma, peripheral giant cell granuloma, or parulis/gumboil. We believe this case highlights the need for submitting excised tissue for microscopic examination.

Dentinal tubule disinfection using three calcium hydroxide formulations.

The objective of this study was to determine the antibacterial efficacy of three calcium hydroxide (CH) formulations using an in vitro model of Enterococcus faecalis dentinal tubule infection. CH mixed with water (CH), CH mixed with iodine-potassium iodide (CH+IKI), and CH mixed with iodoform and silicone oil (Metapex) were tested. Human cylindrical dentin specimens infected with E. faecalis were filled with disinfectants and incubated for 1 week. Dentin powder samples collected with ISO 018 burs showed a statistically significant reduction in E. faecalis for all three experimental groups in comparison with untreated control specimens. Statistically significant differences were also found between the three experimental groups. Metapex was the most effective dentinal tubule disinfectant, followed by CH+IKI and then CH. Similar results were observed at greater dentin tubule depths (ISO 021 burs) with the exception that intracanal treatment with CH resulted in significantly higher numbers of E. faecalis in comparison with untreated control specimens.

Improving performance on the endodontic section of the Florida Dental Licensure Examination.

In an attempt to improve performance of University of Florida College of Dentistry (UFCD) graduates on the endodontic section of the Florida Dental Licensure Examination, a retrospective analysis was conducted for classes graduating between 1996 and 2003 to assess potential relationships between passing and failing performance and three factors with potential impact on "first attempt" pass rates. The three factors were clinical endodontic experience, performance on the senior mock board examination, and dialogue with representatives of the licensure examination, which resulted in modification of the endodontic section of the licensure exam. Using ANOVA, we found no differences in performance on the endodontic section of the senior mock board exam between graduates who passed the endodontic section of the dental licensure exam and those who failed this section. Furthermore, no differences were found in the mean number of clinical endodontic experiences (number of teeth treated) between graduates who passed the endodontic section of the licensure exam and those who failed. However, in 2003 following dialogue between representatives of the Florida Board of Dentistry and endodontic faculty from the two dental schools in Florida, a significant difference in senior mock board endodontic scores (p>0.05) and a significant difference in performance on the endodontic section of the licensure exam scores (p>0.005) was observed for the 2003 graduates when compared to the 2002 graduates. The mean mock board scores and the mean state board endodontic section scores were higher for the 2003 graduates. In addition, the UFCD failure rate on the endodontic section of the state board exam dropped from 34 percent in 2002 to 6 percent in 2003. The primary factors believed responsible for these improvements were a direct result of dialogue between dental school faculty and state board representatives. They include a greater appreciation by the UFCD faculty for the performance criteria used by the Board of Dentistry to evaluate procedures and a change by the board in the tooth selection criteria for the endodontic experience. The options in tooth-type used in the board exams increased from a two-rooted maxillary premolar to any anterior or premolar tooth. In conclusion, this report supports the positive benefits from ongoing discussions between dental school faculty and representatives of the state licensure board.

Coronal microleakage assessed by polymicrobial markers.

Studies have shown significant bacterial leakage following exposure of sealed root canals to artificial and natural saliva. The objective of this study was to determine contamination via bacterial migration in artificial saliva in endodontically treated teeth using different obturation techniques and sealers. A total of 144 extracted, human mandibular anterior teeth were cleaned and shaped to a #40 master apical file using hand and rotary instrumentation. One hundred and twenty teeth were divided into two experimental groups. The teeth in Group 1 were obturated with gutta-percha using lateral compaction and five different sealers, and the teeth in Group 2 were obturated with gutta-percha using thermomechanical compaction and five different sealers. The remaining 24 teeth were prepared as positive and negative controls. All specimens, except the negative controls, were inoculated every five days with Anaerobic streptococci (NCTC 9891) related to Peptostreptococcus micros and Prevotella intermedia (ATCC 25611). The contamination onset time was continuously recorded and turbid broths cultured for bacteria identification. The controls behaved as expected. Regardless of the combination between obturation techniques and different sealers, all broths became turbid during this experiment. The correlation between the obturation techniques and the sealers revealed statistical significance using ANOVA (p<0.0001), followed by the Duncan Multiple Range Test, which determined the ranking between these interactions. The combination of MicroSeal obturation technique with Ketac-Endo sealer allowed a slower rate of coronal-apical bacterial migration.

Comparison of the apical seal obtained by a dual-cure resin based cement or an epoxy resin sealer with or without the use of an acidic primer.

This study compared the apical leakage of roots obturated with gutta-percha using either a dual-cure resin based cement (Panavia F) or an epoxy-resin sealer (Thermaseal plus) with or without the application of an acidic primer (ED Primer). Eighty-six single rooted canine teeth were decoronated, cleaned, and shaped by using hand and rotary instruments, randomly divided into four groups, and obturated as follows: group A (n = 20): ED Primer applied followed by thermoplastized obturation with gutta-percha and Thermaseal Plus sealer; group B (n = 20): thermoplastized obturation with gutta-percha and Thermaseal Plus; group C (n = 20): ED primer applied followed by thermoplastized obturation with gutta-percha and Panavia F; group D (n = 20): thermoplastized obturation with gutta-percha and Panavia F. Both a negative control (n = 3; entire root coated with wax) and a positive control (n = 3; obturated with only a fitted master cone) were included in the study. Groups A, B, C, D, and the controls were immersed in molten sticky wax, leaving the apical 2-mm exposed, and quickly chilled. All teeth were immersed in 1% methylene blue dye solution for 10 days, rinsed, and sectioned longitudinally. Apical dye penetration was measured stereomicroscopically at 10-fold magnification. The analysis of variance and Duncan Multiple Range were used for result analysis. The specimens obturated with gutta-percha and an epoxy-resin sealer (with or without an acidic primer) demonstrated significantly less linear dye penetration than specimens obturated with gutta-percha and the dual-cure, resin-based cement (with or without an acidic primer).