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.

Periodontal Screening and Recording (PSR) Index: precursors, utility and limitations in a clinical setting.

Periodontal disease is a widespread condition ranging from simple gingival inflammation to severe periodontal breakdown. Early detection and diagnosis are key elements in the prevention of this oral pathology. Diagnostic aids available to dentists, such as the Periodontal Screening and Recording or PSR Index, accelerate the screening of periodontal conditions. While many studies provide support for the PSR Index as a valuable tool because it is reproducible, reliable, and quick, others have suggested that it may under or overestimate existing periodontal conditions. Some authors have suggested modifications to the recording method to improve its use either for screening purposes or for monitoring the outcome of periodontal therapy. This literature review briefly describes the PSR method, and compares studies based on both PSR and its counterpart, CPITN, in order to evaluate its usefulness and establish its limitations in a clinical setting.

A 15-month evaluation of the effects of repeated subgingival minocycline in chronic adult periodontitis.

BACKGROUND: A double-blind, randomized, parallel, comparative study was designed to evaluate the long-term safety and efficacy of subgingivally administered minocycline ointment versus a vehicle control. METHODS: One hundred four patients (104) with moderate to severe adult periodontitis (34 to 64 years of age; mean 46 years) were enrolled in the study. Following scaling and root planing, patients were randomized to receive either 2% minocycline ointment or a matched vehicle control. Study medication was administered directly into the periodontal pocket with a specially designed, graduated, disposable applicator at baseline; week 2; and at months 1, 3, 6, 9, and 12. Scaling and root planing was repeated at months 6 and 12. Standard clinical variables (including probing depth and attachment level) were evaluated at baseline and at months 1, 3, 6, 9, 12, and 15. Microbiological sampling using DNA probes was done at baseline; at week 2; and at months 1, 3, 6, 9, 12, and 15. RESULTS: Both treatment groups showed significant and clinically relevant reductions in the numbers of each of the 7 microorganisms measured during the entire 15-month study period. When differences were detected, sites treated with minocycline ointment always produced statistically significantly greater reductions than sites which received the vehicle control. For initial pockets > or =5 mm, a mean reduction in probing depth of 1.9 mm was seen in the test sites, versus 1.2 mm in the control sites. Sites with a baseline probing depth > or =7 mm and bleeding index >2 showed an average of 2.5 mm reduction with minocycline versus 1.5 mm with the vehicle. Gains in attachment (0.9 mm and 1.1 mm) were observed in minocycline-treated sites, with baseline probing depth > or =5 mm and > or =7 mm, respectively, compared with 0.5 mm and 0.7 mm gain at control sites. Subgingival administration of minocycline ointment was well tolerated. CONCLUSIONS: Overall, the results demonstrate that repeated subgingival administration of minocycline ointment in the treatment of adult periodontitis is safe and leads to significant adjunctive improvement after subgingival instrumentation in both clinical and microbiologic variables over a 15-month period.

Effectiveness of salt versus glass bead sterilizers.

Microorganisms can be removed from dental instruments by various methods, including treatment in salt and glass bead sterilizers. However, no rigorous, controlled, in vivo or in vitro studies have been performed to verify the respective efficiencies of these methods. The goals of this study were to determine if the positioning of instruments at the centre or edge of a salt sterilizer results in differential sterilization effectiveness, and to compare the effectiveness of salt sterilizers relative to glass bead sterilizers. Autoclaved number 60 reamers were contaminated by plunging them to the handle in a commercial Bacillus stearothermophilus spore suspension. They were then sterilized for different periods of time and at different positions in the sterilizers. Each experiment included positive and negative controls. The results showed that better sterilization is achieved at the edge of the chamber than at the centre, and that salt sterilizers are more effective than glass bead sterilizers for a given period of time (15 seconds) in the sterilizer.

Self-reported sexual behaviors of high school juniors and seniors in North Dakota.

The period of adolescence is characterized as a time of experimentation during which adolescents may engage in adult behavior in the absence of understanding the consequences of these behaviors. The purpose of this study was to examine the self-reported sexual behaviors of late adolescent junior and senior high school students (N = 7,699). The study indicated a significantly high and disconcerting frequency of self-reported risk-taking sexual behavior.

The effects of smoking on periodontal structures: a literature review.

Periodontal disease seems to be more prevalent in smokers than in nonsmokers. Studies have reported both increases and decreases in gingival blood flow due to smoking. Smoking does not increase the presence of the periodontopathogens Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Bacteroides intermedius. Both the chemotaxis and the phagocytic capacity of the polymorphonuclear leukocytes (PMNs) harvested from smokers are lower than with those harvested from nonsmokers. Furthermore, smokers have lower IgA, IgG, IgM, and suppressor CD8 lymphocytes levels than nonsmokers. These differences between smokers and nonsmokers should be taken into account by clinicians during periodontal examinations, therapy, and the healing process.

[Denture stomatitis: etiology and clinical considerations]. / La stomatite prothétique: étiologie et considérations cliniques.

Wearing removable dental prosthesis causes an alteration in the oral microflora. For certain individuals, this new environment is responsible for the development of a particular condition: prosthetic stomatitis. This article reviews the pertinent literature regarding the main predisposing factors causing the disease. It targets the different risk groups and identifies the proposed mechanism for the proliferation of Candida albicans on the palatal side of the prosthesis. Various treatments depending on the severity of the disease are also mentioned.

[Subgingival irrigation: a heresy?]. / L'irrigation sous-gingivale, une hérésie?

Bacteria are the principal causal factor for gingivitis and adult periodontitis. This article is a review of the pertinent literature regarding subgingival irrigation with antimicrobial agents. Furthermore, the clinical significance of this technique is evaluated. In order for the antimicrobial agent to reach the base of the periodontal pocket, the canula must be placed at least 3.0 mm subgingivally. Subgingival irrigation offers no added antimicrobial effect over root scaling alone, but may extend the therapeutic effect of scaling. The effect of subgingival irrigation is none the less temporary. Subgingival irrigation must be regarded as an alternative treatment for gingivitis and adult periodontitis when root scaling alone is not sufficient.

Specific serum IgA titres as realistic indicators of treatment prognoses.

Some patients with adult periodontitis (AP), as defined by the American Academy of Periodontology, experience better healing than others after scaling and root planing. It is well documented that AP evolves by exacerbation and remission stages and that treatment during one of these stages influences the healing of periodontal pockets. Antibodies directed against major periodontal pathogens involved in AP could be used as indicators of active tissue destruction in AP. The levels of anti-Porphyromonas gingivalis (Pg) antibodies in the sera, saliva and crevicular fluid of ten patients with moderate AP were determined before and after root planing. The results suggest that testing serum IgA levels before scaling and root planing could help improve treatment prognoses.

The reliability of the Periotron 6000 in the presence of plaque.

The aim of this study was to evaluate if the presence of supragingival plaque can influence measurements of gingival crevicular fluid flow (CFF) taken with the Periotron 6000 unit. Sixty-seven experimental sites and 67 contralateral control sites were randomly chosen. Crevicular fluid was collected on a filter paper strip for 15 seconds and the CFF was measured using the Periotron 6000 unit: CFF1. The supragingival plaque was removed from the experimental site with a Gracey curette and the plaque index (PI) was estimated. Five minutes later, a second CFF measurement was taken: CFF2. On the control tooth, the plaque was not removed, and the PI was established after the second CFF measurement. There was no significant difference between the CFF1 and the CFF2 values for the control teeth. In the experimental teeth, a PI of 3.0 increased the CFF1 (pre-plaque removal) compared to the CFF2 (post-plaque removal) value by 20.6 Periotron units (PU) (p = 0.0004). A PI of 2.0 caused a 7.3 PU increase (p = 0.0370). There were no significant changes for a PI of 1.0 or 0. In this type of experimental protocol, the results also indicated that CFF differences were not affected by the gingival index (GI) for either the experimental or control groups. These results indicate that large amounts of supragingival plaque can significantly elevate CFF measurements, as determined by the Periotron 6000 unit.

The effect of supragingival plaque on crevicular fluid measurements.

The purpose of this investigation was to evaluate the influence that supragingival plaque may have on the measurement of crevicular fluid flow (CFF) when it is quantified by the use of a filter paper strip and a Periotron 6000 measuring unit. The study involved 51 human subjects from each of whom an experimental tooth was randomly chosen and a CFF measurement recorded. The quantity of crevicular fluid was collected on filter paper strips placed subgingivally at the entrance to the sulcus for 15 seconds. Any supragingival plaque was then removed, following which a second measurement of the CFF was recorded after 5 minutes. Changes in the CFF were correlated with the plaque index at the experimental site and were shown to be significantly affected by the presence as well as the quantity of supragingival plaque. It was demonstrated that measuring the CFF in the presence of supragingival plaque was not reliable.

The effects of spiramycin and/or scaling on advanced periodontitis in humans.

It has long been questioned whether antibiotics, used as a supplement to traditional therapy, provide any lasting benefit in the treatment of chronic periodontitis. This study was designed to evaluate Spiramycin as an adjunct to scaling and root planing in the treatment of advanced chronic periodontitis. In total, 193 patients with advanced periodontitis were recruited in seven centres using selection criteria previously described. After undergoing thorough scaling and root planing, all patients randomly received either Spiramycin, 1,500,000 international units, twice per day (IU, bid) for 14 days (96 patients), or a visually-identical placebo capsule (97 patients). The clinical parameters measured were plaque index, crevicular fluid level, probing depths, bleeding on probing and attachment level changes. Data was recorded at baseline, two-, eight-, 12- and 24-weeks visits. A total of 189 patients completed the study (96 placebo, 93 Spiramycin). Statistically significant differences in probing depth, favoring Spiramycin, were seen at two weeks (p < 0.0125), eight weeks (p < 0.0020), 12 weeks (p < 0.0032) and 24 weeks (p < 0.0075). Spiramycin also produced a significant improvement in attachment level at 12 weeks (p < 0.0146). All other clinical parameters showed no difference between drug and placebo. This study shows that Spiramycin, as an adjunct to thorough scaling and root planing, provides a statistically significant improvement in probing depths for up to 24 weeks when compared with scaling and root planing alone. Both longer studies and microbiologic evaluations are necessary to determine whether a more lasting benefit is possible.

[Minocycline]. / La minocycline.

Periodontal diseases are bacterial infections and antimicrobial agents appear to offer great potential in their treatment and prevention. One such chemotherapeutic agent is minocycline. The aim of this paper is to review the literature on this antibiotic concerning in vitro and in vivo studies, its pharmacokinetics and secondary effects.

Effectiveness of soft laser treatment in periodontal surgery.

The aim of this study was to determine the analgesic, anti-inflammatory and healing effects of soft-laser treatment in a double-blind crossover study of periodontal post-surgical patients. For each patient, mucogingival procedures were required on contralateral sides of the mouth for similar problems. Twenty-eight patients had a total of 28 pairs of surgical procedures performed. Prior to surgery, a complete examination was carried out, scaling and root planing were performed, and oral hygiene instructions were given. Following surgery on both sides of the mouth, one site was lased and a placebo procedure was carried out on the other site. The patients evaluated pain three times a day for one week (modified McGill pain scale). An inflammatory index (Loe and Silness Index) was ascertained at days 7 and 14 for both sides of the mouth. A healing score (Landry, Turnbull, Howley Index) was evaluated at days 7 and 14. For both surgical procedures, the assessments were carried out in the same manner. Univariate and multivariate analyses of variance were performed for all parameters. The results showed no significant differences in the gingival index, healing index and pain reduction when the soft laser treatment was compared to the placebo operation. These results suggest that soft laser (As-Ga and He-Ne) treatments may not be a useful adjunct after certain periodontal surgical procedures.

[Treatment of dentin hypersensitivity: a retrospective and comparative study of two therapeutic approaches]. / Le traitement de l'hypersensibilité dentinaire: une étude rétrospective et comparative de deux approches thérapeutiques.

Stimulation on exposed dentine at the enamo-dentinal junction is often painful and uncomfortable for the affected patient. Two hundred and forty-four subjects suffering from dentinal sensitivity, aged from 18 to 48 years old, were treated with two types of desensitizing agent. In this study, we used sodium fluoride (Duraflor) and calcium hydroxide (Dycal catalyst). The desensitizing agent is first applied on the exposed dentine and then burnished, without local anaesthesia, until all sensitivity has disappeared. After the first session, 100% of the subjects were desensitized. All subjects were seen 1, 2, 3, 6, 13 and 26 weeks after the first application. After 6 months, 94% of the subjects treated with calcium hydroxide (Dycal) and 87% of those treated with sodium fluoride (Duraflor) were still desensitized. This difference is statistically significant at alpha = 0.01 (Anova test). In conclusion, our study reveals that both calcium hydroxide (Dycal) and sodium fluoride (Duraflor) are effective in the treatment of dentinal hypersensitivity. A slight significant advantage in using calcium hydroxide is also noted.

[Disinfectants and sterilizants for dental instruments]. / Les désinfectants et stérilisants pour instruments dentaires.

A comparative study of ten (10) products recommended for disinfection and/or sterilization of dental instruments is detailed. Four (4) out of fourteen (14) characteristics have been evaluated, namely corrosive power, monthly cost, odor and availability.

The reliability of type-token ratios for the oral language of school age children.

This study investigated the alternate forms reliability of four type-token ratios (TTRs) of oral language samples obtained from 52 elementary school children (9 through 12 years of age). The four TTRs included the basic type-token ratio, the corrected type-token ratio, the root type-token ratio, and the bilogarithmic type-token ratio. Language samples of 600 words were segmented into 50-word, 100-word, and 200-word samples. Within each TTR measure, there were no significant differences among the means for samples of the same size, but all means for a given sample size differed significantly from the means of all other sample sizes. Further, for samples of the same size the reliability coefficients calculated for each TTR measure were neither consistent nor significant. These findings indicate that under the conditions of the present study TTRs are not comparable when calculated for different sample sizes ranging from 50 to 600 words, and further, that they are not reliable measures of the language performance of individual elementary school children from regular classrooms for language samples of 50 to 200 words.

["Infection control of laboratory items" a myth?]. / Le "contrôle de l'infection des items de laboratoire" est-il un mythe?

Impression materials and impression trays must be cleaned and disinfected before being used and adjusted in the mouth, or sent to the laboratory. This article reviews some of the practical recommendations for dental offices and laboratories.