Oral Hygiene With Neutral Electrolyzed Water and Systemic Therapy Increases Gastric Helicobacter pylori Eradication and Reduces Recurrence.

OBJECTIVES: Helicobacter pylori gastric infection strongly correlates with gastric diseases such as chronic gastritis, functional dyspepsia, and complications such as peptic ulcers and gastric cancer. In developing countries, systemic therapies are not usually successful due to elevated antibiotic resistance. Additionally, oral H. pylori infection and periodontal disease correlate with gastric treatment failures. This study aimed to explore the effect of an integral therapy, comprising oral hygiene and concomitant systemic treatment, to increase the eradication of gastric infection and recurrences. MATERIALS AND METHODS: A prospective, randomized, four-arm, parallel-group, open-label clinical trial was conducted to investigate the efficacy of integral therapy to eradicate gastric H. pylori infection and avoid recurrences in double-positive (real-time PCR oral and gastric infection) patients. Oral hygiene involved mouthwash with neutral electrolyzed water (NEW), with or without periodontal treatment. One hundred patients were equally distributed into four groups: NS, NS-PT, NEW, and NEW-PT. All patients had concomitant systemic therapy and additionally, the following oral treatments: mouthwash with normal saline (NS), periodontal treatment and mouthwash with normal saline (NS-PT), mouthwash with NEW (NEW), and periodontal treatment and mouthwash with NEW (NEW-PT). Gastric and oral infection and symptoms were evaluated one and four months after treatments. RESULTS: Integral therapy with NEW-PT increased gastric eradication rates compared with NS or NS-PT (84%-96% vs. 20%-56%; p < 0.001). Even more, a protective effect of 81.2% (RR = 0.1877; 95% CI: 0.0658-0.5355; p = 0.0018) against recurrences and 76.6% (RR = 0.2439; 95% CI: 0.1380-0.4310; p < 0.001) against treatment failure (eradication of infection and associated symptoms) was observed in patients from the NEW and NEW-PT groups. CONCLUSIONS: Implementation of oral hygiene and systemic treatment can increase the eradication of gastric infection, associated symptoms, and recurrences. NEW is recommended as an antiseptic mouthwash due to its efficacy and short- and long-term safety.

Instrumentos rotatorios: su uso, separación y efecto en complicaciones endodónticas postoperatorias / Rotary instrumentation: usage, separation and effect on postoperative endodontic complications

El uso de instrumentos de níquel-titanio en el campo de la endodoncia ha permitido que el tratamiento de conductos se lleve a cabo de manera más predecible y eficiente. Sin embargo, a pesar de las mejoras que se han hecho en el diseño de las limas y en las aleaciones del metal, la fractura de los instrumentos rotatorios continúa siendo una complicación no deseada, problemática y frustrante. La separación de los instrumentos rotatorios se debe frecuentemente al uso incorrecto o excesivo de los mismos. Si la fractura ocurre, el paciente debe ser informado del incidente y se debe considerar el remover o no el fragmento del instrumento. El presente reporte describe un caso de seguimiento a cinco años en un molar mandibular con dos instrumentos endodónticos rotatorios separados en los conductos mesiovestibular y mesiolingual, que no afectaron de forma adversa el resultado del tratamiento.

Introduction of nickel-titanium instruments in the field of endodontics has made conventional root canal therapy more predictable and efficient. However, despite improvements in file designs and metal alloys, fracture of rotary instruments during endodontic treatment still represents a problematic, unwanted and frustrating complication. File separation often results from incorrect use or overuse of an endodontic instrument. If breakage occurs, patients should be informed about the incident and consideration should be given to whether or not to remove the fragment. This report describes a five year follow-up case of a mandibular molar with two separated endodontic rotary instruments lodged into the mesio-buccal and mesio-lingual canals which did not negatively affect the outcome of root canal treatment.