A placebo-controlled multi-centred evaluation of an anaesthetic gel (Oraqix) for periodontal therapy.

AIMS: Six Canadian dental schools investigated the ability of a thermosetting gel containing 25 mg/g prilocaine and 25 mg/g lidocaine as active agents to produce analgesia in periodontal pockets utilizing a randomized, double-blind, placebo-controlled study. MATERIALS AND METHODS: The study consisted of 130 patients, each of whom received the active or placebo gel in periodontal pockets in one quadrant of the mouth for 30 s prior to periodontal debridement (scaling and root planing). Pain was measured using both a 100-mm Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS). RESULTS: The median VAS pain score for the patients treated with the anaesthetic gel was 5 mm (range 0-85 mm) as opposed to 13 mm (range 0-79 mm) in the placebo-treated patients (P=0.015). There was no significant difference in the percentage of patients reporting no or mild pain (78% and 76% for the anaesthetic gel and placebo, respectively). No significant differences were seen in patient demographics, or mandible versus maxilla. CONCLUSIONS: The VAS pain scores showed that the anaesthetic gel 5% was statistically more effective than the placebo in reducing pain during periodontal debridement.

Tobacco-use cessation programs and policies at the University of Manitoba's faculty of dentistry.

The deleterious effects of tobacco use on general health and oral health are well documented. While one-third of Manitobans are current smokers, up to 79% report they want to quit. Counselling by health care professionals can help achieve quit rates of 15-20%. Yet many health professionals do not provide tobacco-use cessation counselling because they feel they are not trained to do so. In 1998, the faculty of dentistry of the University of Manitoba implemented a number of tobacco-use cessation interventions in its undergraduate curricula and general teaching clinic. The faculty has also successfully obtained the inclusion of a dental fee code for tobacco-use cessation services in the provincial fee guide and has received approval to allow dentists who have completed an approved course in tobacco-use cessation training to prescribe bupropion HCl (Zyban), in consultation with a patient's physician, to aid smoking cessation.

Cigarette smoking and periodontitis: methodology to assess the strength of evidence in support of a causal association.

Identification of the cause of the development and progression of periodontitis has received extensive attention, with notable advances over the past decade in clinical, microbiological, immunological, biochemical, and behavioral knowledge. However, it is still largely unknown which factors lead to the conversion of non-destructive forms of periodontal disease into destructive forms and disease progression. Chronic adult periodontitis is believed to be influenced by an interaction of host defense and environmental factors. Although these variables have been studied extensively, no study has employed randomized controlled prospective human or randomized controlled community intervention designs, methodologies necessary to prove a variable to be a cause of periodontitis. Owing to the absence of literature employing rigorous experimental design, this article assesses systematically observational, cross-sectional and longitudinal studies to examine the potential causal association between cigarette smoking and periodontitis. The methodology of Sir Bradford Hill's criteria for causation was used as the framework. Results suggest that cigarette smoking is causally associated with periodontitis. That is, cigarette smoking is consistently associated with an increased prevalence/severity of periodontitis and is suspected on theoretical grounds of playing a causal role. Hill's criteria provide a useful methodology to better understand the pathogenesis of periodontal diseases and may be applied to study the pathogenesis of other dental diseases as well.

Factors associated with adult periodontitis in a dental teaching clinic population.

Exposure to a number of environmental, behavioral and sociodemographic variables has been associated with increased prevalence and severity of adult periodontitis. However, it is not possible easily to identify the individuals most susceptible to this chronic disease. A case control study was conducted among a population of adults to determine what factors were associated with increased prevalence of moderate to advanced periodontitis. Clinical and radiographic data were obtained from dental charts and structured interviews were conducted by telephone to collect sociodemographic and behavioral data. Statistical modeling was completed for the total study population (35-87-year-olds) and for two age-stratified subpopulations. Significant crude disease associations were observed between periodontitis and numerous explanatory variables. However, after adjustment for age and gender, few variables remained significant. Age stratification indicated that young adults (35-54 years) were affected differently from older adults (> or =55 years) by exposures to certain variables. Young moderate smokers had a 3.15 times increased risk of periodontitis and young heavy smokers had a 7.33 times increased risk compared to never-smokers. Older single adults had a 3.07 times increased risk compared to those with partners.

Vapor emissions resulting from Nd:YAG laser interaction with tooth structure.

UNLABELLED: The Neodymium:yttrium aluminum garnet (Nd:YAG) dental laser has been cleared by the United States Food and Drug Administration (FDA) for marketing in intraoral soft tissue treatment. The efficacy and safety of the Nd:YAG laser in the treatment of hard dental tissue as well as the effects of dental irradiation on the pulp and periodontium have been investigated. Odors resulting from laser irradiation have been reported, but the nature and toxicity of associated decomposition vapors is unknown and the health consequences of their inhalation have not yet been studied. OBJECTIVES: The purpose of this in vitro study was to identify vapors emitted during interaction of the Nd:YAG laser with carious human enamel and dentin and sound enamel and dentin coated with organic ink. METHODS: Vapor emissions were collected from prepared sections of extracted human teeth receiving laser irradiation of 100 mJ and 10 Hz for a duration of 1, 10, or 60 s. Emissions were collected by means of charcoal absorption tubes, and subsequently analyzed using a Gas Chromatograph equipped with Mass Selective (GC/MS) and Flame Ionization Detectors to identify the chemical constituents of the vapors. RESULTS: No compounds were identified in Nd:YAG laser-treated caries, enamel and dentin. No volatile vapors were identified from samples of tooth materials exposed to the laser for 1 or 10 s. Camphor was positively identified in the test sample which consisted of India ink-coated dentin and the reference sample of India ink-coated glass beads, both exposed to the laser for 60 s. 2,5-norbornadiene was tentatively identified in these samples. The Threshold Limit Value (TLV) of camphor is 2 ppm with a Lethal Dose Level (LDLo) of 50 mg/kg (human oral), while the TLV and LDLo of 2,5-norbornadiene is unknown. SIGNIFICANCE: Occupational and public health safety measures are discussed in this article. Further research is needed to quantify the compounds produced and to determine their toxicity to patients and to dental care providers.

Are community health interventions evaluated appropriately? A review of six journals.

OBJECTIVES: To determine if Randomized Controlled Trial (RCT) methodology was used appropriately in community health, we: (1) determined the proportion of non-randomized studies that should have been RCTs, and (2) assessed the quality of the RCTs. METHODS: The 1992 issues of six community health journals were manually searched. Intervention studies were analyzed. Studies that did not use randomization were analyzed for feasibility and practicality of RCT methods; RCTs were analyzed for quality using a checklist. RCTs were compared with community health RCTs from The New England Journal of Medicine. The proportion of studies meeting each criterion was determined. RESULTS: Fourteen percent of 603 studies were interventions and 4% were RCTs. Of those not using randomization, 42% should have. Mean RCT scores were significantly lower for the community health journals than for The New England Journal of Medicine. Many criteria important to quality scored poorly. CONCLUSIONS: RCTs are underused and lack methodologic rigor in community health. Conclusions regarding the effectiveness of interventions are therefore suspect.

The effectiveness of the Nd:YAG laser in the treatment of dental hypersensitivity.

Dentin hypersensitivity is one of the most painful and least predictably treated chronic conditions in dentistry. The effectiveness of laser therapy in the reduction of dentin hypersensitivity and its effects on pulpal vitality were studied. Nineteen subjects participated in the randomized, double-blind study, and were followed up for three months. Two sites were treated. One received helium neon (He:Ne) laser treatment and the other received He:Ne plus Nd:YAG (He:Ne+Nd:YAG) laser treatment. Laser treatment consisted of 30 millijoules (mJ) to 100 mJ per pulse, at 10 pulses per second (pps) in increments of 10-40 seconds each over a total treatment time of less than two minutes, without local anesthesia. Hypersensitivity was assessed by mechanical stimulus (using a sharp explorer), and thermal stimulus (using a blast of cold air from a dental syringe). Pulpal vitality was measured using an electrical stimulus. The results indicate that immediately following laser treatment and for three months thereafter, the subjects' perceived level of discomfort decreased. He:Ne treatment reduced dentin hypersensitivity to air by 63 per cent and to mechanical stimulation by 61 per cent over three months. The He:Ne + Nd:YAG treatment reduced dentin sensitivity to air by 58 per cent and to mechanical stimulation by 61 per cent. All teeth remained vital after laser treatment, with no adverse reactions or complications. He:Ne and He:Ne + Nd:YAG laser treatment can be used to reduce dentin hypersensitivity without detrimental pulpal effects.

Localized juvenile periodontitis: a case analysis and rational approach to treatment.

This case involves a 14-year-old female patient affected with localized juvenile periodontitis. Treatment consisted of periodontal flap surgery in conjunction with tetracycline therapy. A successful result was obtained and maintained. The case depicts the fact that in many instances localized juvenile periodontitis can be treated with confidence and a high degree of predictability. It should also be noted that, like all treatment modalities, the treatment of this disease as discussed in this case is not the panacea and will undergo considerable changes in the future; however, in light of current knowledge, this combined treatment approach appears to be effective in LJP patients.

The relationship between gingival tissue temperatures and various indicators of gingival inflammation.

IN PERIODONTICS there is a need for objective measurements in monitoring disease processes and in assessing the effectiveness of treatment. The purpose of this study was to compare gingival temperatures with indicators of gingival inflammation in order to examine the application of temperature as a diagnostic aid. In six patients the temperature of interproximal sulcular tissue was measured and compared with bleeding upon probing, crevicular fluid flow, pocket depth, plaque accumulation and calculus formation. The results show significantly higher temperatures with bleeding upon probing and with the presence of dental plaque and calculus. Temperature increase correlated with increase in crevicular fluid flow, but a relationship to pocket depth is not clear. The thermocouple microprobe is a very sensitive instrument. The method used is noninvasive, safe and efficient. It can be concluded from our data that differences in gingival temperature reflect not only a regional tissue variability but also can indicate an inflammatory state.