Diabetes mellitus, periapical inflammation and endodontic treatment outcome.

The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and systemic health is one of the most interesting aspects faced by the medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable, and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol.

Periodontitis and osteoporosis: a systematic review.

BACKGROUND: Osteoporosis and periodontitis are frequent disorders that affect aging populations. It has been hypothesized that both conditions may be related. OBJECTIVE: To determine whether dental osteoporosis is a local manifestation of systemic bone loss having similar etiology and risk factors, or whether it is an independent process depending primarily on factors that cause periodontitis. METHODS: A systematic review of clinical trials assessing the relationship between osteoporosis and periodontitis was carried out. An electronic search was made based on Internet search engines, MEDLINE (from 1966 to December 2009) and the Cochrane Controlled Clinical Trials Register. RESULTS: A total of 145 studies dealing with the relationship osteoporosis-periodontitis were identified. Of them, 35 were considered suitable for selection. Studies on maxillary and/or mandible radiological findings have a positive correlation in the majority of the cases (18 positive vs. three negative), whereas the findings on clinical periodontal examination are inconclusive (six positive vs. five negative). There were ten studies in which a diagnosis of osteoporosis was made, based on the existence of non-traumatic fracture, while there were nine studies using radiographs for diagnosis, of which six studies were found to have a positive correlation. There was only one study based on a clinical periodontal examination that found a positive correlation. CONCLUSIONS: The majority of the studies suggested a relationship between osteoporosis and periodontitis. Further well-controlled studies are needed to better elucidate the inter-relationship between systemic and oral bone loss and to clarify whether dentists could usefully give an early warning for osteoporosis risk.

Nuevos procedimientos en anestesia local en odontología: el sistema Injex / New proceedings in dental anesthesia: the Injex system

Una de las circunstancias que han contribuido al desarrollo de la odontología en los últimos tiempos ha sido la mejora en las técnicas anestésicas. Sin embargo, el uso de la aguja en la mayor parte de los sistemas de anestesia dental, a pesar de ser un sistema casi indoloro, constituye un problema por la gran cantidad de pacientes que presentan fobias a la misma. Este hecho empeora cuando las poblaciones que han de ser tratadas son niños o pacientes especiales. En esta revisión bibliográfica se exponen las ventajas e inconvenientes de las técnicas anestésicas sin aguja, y se describe un nuevo sistema aparecido en el mercado español, el sistema Injex® (AU)

In the recent years, the improvement of anesthesics methods have been one of the circunstances who had contributed to the development of Odontology. In the other hand, sometimes is an important problem the employrnent of the needle in the most of anethesisc systems, because many patients present fobic situations when the needle is employed. This situation is worst when children or handicapped patients have to be treated. In this review, the advantages and mistakes of dental anesthesia without needle is exposed, and a new method developed, called Injex® , is presented (AU)

Ultrastructure of the gingiva in cardiac patients treated with or without calcium channel blockers.

OBJECTIVES: In the last few years, several studies have suggested that periodontal diseases are related to the development of atherosclerosis and its complications. Our objective was to study the ultrastructural morphology of the gingiva from cardiac patients, some of whom were treated and some not with calcium channel blockers compared to a control group. MATERIAL AND METHODS: Fifty-five patients were studied and grouped in the following way: (a) healthy group (HG) (n=12) healthy patients with at least two pockets between 3 and 5 mm; (b) cardiac group (CG) (n=12) patients with cardiac disease untreated with calcium channel blockers; (c) diltiazem group (DG) (n=13) cardiac patients treated with diltiazem; (d) nifedipine group (NG) (n=18) cardiac patients treated with nifedipine. RESULTS: Ultrastructural studies in the CG showed inflammatory cells, collagen fibers disruption and a more extended morphologically compromised fibroblast mitochondria. Morphometric studies in CG showed mitochondria that were impaired in number but increased in volume, suggesting metabolic cell suffering. In DG and NG, morphometric data were similar to HG. The presence of myofibroblasts and collagen neosynthesis was detected in DG and NG. CONCLUSIONS: Our data showed differences in the ultrastructure of the gingival fibroblasts between the studied groups; the DG and NG showed features that could be interpreted as an attempt to restore the cellular metabolic function.

Manifestaciones periodontales en la menopausia / Periodontol manifestations in menopause

En la menopausia la mujer se ve afectada por múltiples cambios hormonales que tienen como resultado, en algunos casos, trastornos sistémiccs, entre los que destaca la osteoporosis (debida a una pérdida de masa ósea generalizada en el organismo). En el presente trabajo se revisa el papel que la menopausia (y la osteoporosis) puede tener contribuyendo a la pérdida de masa ósea alveolar y a una alteración en el periodonto que pueda dar lugar a una pérdida de inserción periodontal. Estudiados el papel de la osteoporosis "per se", del nivel de calcio, de las alteraciones hormonales y de las alteraciones en los mediadores de la inflamación (interleukinas), se concluye que si bien parece existir cierta relación entre estos factores y el desarrollo de problemas periodontales, hoy día no se tiene datos suficientes para extraer conclusiones definitivas, por lo que se requieren más estudios sobre el tema (AU)

Hormonal changes in menopausal women frecquently develops many systemic alterations such as osteoporosis. In the present paper, menopause and its role in the development of periodontal disease and periodontal attachment loss is reviewed. Looking at the particular role of osteoporosis and calcium, hormonal, and interleukines levels in menopausal women, the relationship between periodontal disease and these factors seems to be stablished, but to improve the knowledge about this important situation, more studies should be developed in the future (AU)

The gingival inflammatory infiltrate in cardiac patients treated with calcium antagonists.

OBJECTIVES: To analyse the periodontal inflammatory infiltrates in patients with cardiac disease, some of these patients were treated with calcium antagonists (nifedipine and diltiazem) and some were not, to compare them with a healthy control group, and to evaluate the changes in the inflammatory infiltrate after periodontal treatment. MATERIAL AND METHODS: A "healthy group" (HG, n=12), a "cardiac group" (CG, n=12) without treatment with calcium antagonists, a "nifedipine group" (NG, n=18) and a "diltiazem group" (DG, n=13) were analysed. Biopsies were taken from a zone 2-3 mm below the upper part of the interproximal papillae 12-13 and 33-32 before causal periodontal treatment and after 1 year. Using haematoxylin-eosin staining, the plasma cells (P), lymphocytes (L), histiocytes (H) and polymorphonuclear cells (PMN) were counted. T and B lymphocytes were evaluated using the monoclonal antibodies anti-CD20 and anti-CD45RO. Statistical tests used: chi2 for study of the sample composition; ANOVA for comparison between groups; Student t-test and Wilcoxon test for comparison between visits; post-hoc test Bonferroni. RESULTS: When the cells were compared statistically, differences were established for L at the first visit (p<0.00001) and at the last visit (p<0.02), for the B lymphocytes (first visit p<0.0021, last visit p<0.022) and for the T lymphocytes (first visit p<0.0042, last visit p<0.0021). Between the 2 visits, HG showed significant reductions for P (p<0.01), L (p<0.045) and H (p<0.033); and the NG for L (p<0.0001). Lymphocytes showed differences in the NG with respect to the B lymphocytes (p<0.008). CONCLUSIONS: Nifedipine affects the inflammatory infiltrate with a greater number of lymphocytes (especially B) and these cells fell significantly in number after periodontal treatment.

El Decálogo de Harden como base para la programación de la asignatura de ortodoncia en la licenciatura de Odontología / Harden's Decalogue base for the programmation in ortodontics in the curricula of odontology

La Ortodoncia es una asignatura que se imparte durante el tercer y cuarto curso de la Licenciatura en Odontología. Además de ciertos problemas presentes en la población (estética, maloclusiones) que cada vez requieren una mayor atención por profesionales que tengan conocimientos adecuados de ortodoncia, la elevada carga lectiva de los curricular debe obligar a los docentes a mejorar su rendimiento, por lo que la' elaboración de una programación objetiva y dinámica pasa a ser capital. Proponemos en el presente trabajo un sistema de programación basado en el "decálogo de Harden", del que pensamos que cumple los requisitos adecuados para reflejar nuestros propósitos en esta materia (AU)

Effect of cigarette smoking on periodontal status of healthy young adults.

BACKGROUND: It has been shown that tobacco is a significant risk factor for periodontal disease; however, there have been few studies on young populations where problems of general health can be discounted. The purpose of this study was to examine the influence of tobacco consumption on the periodontal condition of a young, healthy population. METHODS: The study population consisted of 304 young Caucasian males (average age 19.38 +/- 0.72 years) entering the Armed Forces. All the subjects completed a self-administered questionnaire on age, oral hygiene habits, previous dental examinations, and quantity and length of tobacco use. The periodontal examination consisted of the plaque index (PI); periodontal bleeding index (PBI); probing depth (PD); and clinical attachment level (CAL). One- and 2-way ANOVA was used to compare data recorded between smokers and non-smokers. RESULTS: Forty-six percent of subjects reported that they brushed their teeth at least once a day, but only 13% visited a dentist at least once a year. Over half (53%) were habitual smokers, 43% smoking between 5 and 20 cigarettes per day; 39% of the smokers had been smoking for less than 5 years. Mean PI was 31.24 +/- 14.88 (27.19 +/- 15.93 for smokers and 35.78 +/- 12.17 for non-smokers), with significant differences between non-smokers and those who smoked 5 to 20 cigarettes per day (26.85 +/- 16.11, P<0.0001). Mean PBI was 42.29 +/- 8.43 (non-smokers 44.67 +/- 6.53 and smokers 40.17 +/- 9.46). Significant differences were found between the PBI of the non-smokers and of those who smoked 5 to 20 cigarettes per day (39.90 +/- 9.64, P <0.0001). There were also differences in the PBI between those who brushed their teeth once (40.53 +/- 9.61) and twice (44.86 +/- 5.9) a day (P<0.0001). Mean PD was 1.62 +/- 0.43 mm (non-smokers 1.56 +/- 0.36 and smokers 1.68 +/- 0.49). Deeper probing depths were recorded among smokers than among non-smokers, with statistically significant differences (P<0.049); statistically significant differences were also found between those who attended (1.49 +/- 0.50) and those who did not attend (1.65 +/- 0.42) regular dental check-ups (P<0.031). Mean CAL 1.75 +/- 0.41 (non-smokers 1.64 +/- 0.32 and smokers 1.82 +/- 0.44). CONCLUSIONS: It may be concluded that, even at such an early age, tobacco consumption affects the periodontal health. It is necessary to inform young smokers of the risk of tobacco use regarding periodontal health.

The influence of general health and socio-cultural variables on the periodontal condition of pregnant women.

BACKGROUND: There has been speculation as to whether hormonal changes during pregnancy or pre-existing conditions of general, oral, and dental health and socio-cultural background have a greater impact on the development of periodontal disease during pregnancy. METHODS: This study evaluates the periodontal status of 130 pregnant women (plaque index, bleeding index, probing depth, and clinical attachment level) and its relationship to demographic (age, professional level, education, and urban or rural residence) and clinical variables (gestation period, previous pregnancy, health status, previous live births, previous periodontal maintenance). The hospital in which the study was conducted was selected during a prior pilot study. All records were compiled by the same trained examiner with a calibrated manual probe. Statistical tests used were ANOVA and ANCOVA. RESULTS: Results showed a mean plaque index of 58.7+/-2.79%, which increased with statistical significance when the professional level was lower (P <0.014), education was lower (P <0.01), previous periodontal maintenance was less frequent (P <0.00001) and patients lived in rural areas (P <0.0003). The mean bleeding index was 68.8+/-2.44% and was significant in relation to lower professional level (P <0.025), less frequent previous periodontal maintenance (P <0.029), and an urban residence (P <0.0011). A mean clinical attachment level of 0.84+/-0.65 mm was observed and was related significantly with age (26 to 30 years) (P <0.001) and the third trimester of gestation period (P <0.0025). The mean probing depth was 1.71+/-0.3 mm, which related significantly with age (36 to 42 years) (P <0.0002), lower professional level (P <0.0013), rural residence (P <0.0025), 2 or more previous live births (P <0.0001), and non-attendance for previous periodontal maintenance (P <0.0023). Using ANCOVA testing and adjusting by age, the differences relating to previous live births disappeared. CONCLUSIONS: Gingivitis due to accumulation of plaque was the most characteristic periodontal condition in this sample and was related to professional level, level of education, and previous periodontal maintenance. These results illustrate the importance of establishing periodontal preventive measures for pregnant women, even though their demographic and clinical characteristics do not differ from those of the general population.

Craniofacial and oral manifestations of trichorhinophalangeal syndrome type I (Giedion's syndrome): a case report.

A case of trichorhinophalangeal syndrome type I (Giedion's syndrome) is presented and discussed. Pathologic alterations, including oral and facial manifestations, and the clinical history of this unusual condition are described. The case is compared with others reported in the literature.

A clinical assessment of the effectiveness of a mouthwash based on triclosan and on Zea mays L used as supplements to brushing.

The effectiveness of a mouthwash based on triclosan in combatting plaque and gingivitis was compared with a mouthwash based on nonsaponifiable maize germ (Zea mays L). Both were used to supplement conventional mechanical oral hygiene. The study was carried out under double-blind conditions with a negative control (a placebo) and a positive control (a mouthwash based on chlorhexidine). After a period of 14 days to allow the Plaque Index and Gingival Index to standardize, the 43 subjects who formed the sample were examined weekly for 3 weeks. During the study, five subjects were excluded because they did not meet the criteria for selection for the study. Although the mouthwash based on triclosan reduced the Plaque Index by 7.3% in comparison with the placebo negative control (a less marked effect than that of chlorhexidine, which achieved an 8.43% reduction), it had scarcely any effect on the Gingival Index. The mouthwash based on Zea mays L had no beneficial action on the Plaque Index, which increased slightly, but it led to an improvement in the Gingival Index (7.17% in comparison with the placebo).

Dental health among institutionalized psychiatric patients in Spain.

This study assessed the dental health of an institutionalized psychiatric population in Spain. The study population was composed of 347 males and 218 females with a mean age of 58.0. The mean length of hospitalization was 26.1 years. The largest proportion of the patients (62%) was diagnosed as having schizophrenia. All subjects were taking psychotropic drugs, with a mean number of 2.1 medications. The sample was examined according to the WHO dental criteria. The DMFT index demonstrated the mean number of carious teeth to be 7.9; missing teeth, 17.0; and filled teeth, 0.0. The DMFT index increased significantly with the patient's age and length of hospitalization. Female and demented patients had significantly higher DMFT scores. These findings suggest that institutionalized patients with mental illness in Spain have extensive untreated dental disease.

[Dental treatment under general anesthesia offered at the Hospital Pediátrico Universitario de Puerto Rico during the years 1989-1994]. / Tratamiento odontológico bajo anestesia general ofrecido por el Hospital Pediátrico Universitario de Puerto Rico durante los años 1989-1994.

One hundred and fourteen mentally retarded (MR) and non-mentally retarded (NMR) patients were divided into two groups and categorized according to the condition presented. Age, sex, and type of procedure performed were recorded for each patient. On the MR group 32% were over 17 years of age. On the NMR group 51% were under 6 years of age. The sex distribution was similar in both groups. Exodontia was the most frequently performed dental procedure. The MR group was composed of those who presented only mental retardation (42%), cerebral palsy (17%), epilepsy (15%), syndromes (7%), endocrinopathies (7%), hydrocephalus (5%) and other conditions (7%). The NMR group was composed of those who presented cardiopathy (7%), bottle syndrome (42%), hemotopathy (11%), maxillofacial disorders (24%) and other conditions (16%).

Evaluation of gingival and periodontal conditions following causal periodontal treatment in patients treated with nifedipine and diltiazem.

It is established that phenytoin, cyclosporin and some calcium antagonists produce gingival overgrowth, but it is not known how this condition may respond to causal periodontal treatment. In order to find out, a longitudinal study was carried out, over a year, comparing a group of patients who were given nifedipine (NG, n = 18) and another group who were given diltiazem (DG, n = 13) with 2 others: one comprised cardiopathic patients who took no calcium antagonists (CG, n = 12) and the other contained patients who were medically healthy, with moderate periodontitis (HG, n = 12). On their basal visit, they were examined and instructed in oral hygiene, and then given causal periodontal treatment, being seen again at 4 and 8 months, when hygiene instructions were reinforced. They were seen for the last time at 12 months, when they were again examined. Groups NG and DG, on their basal visit, showed larger gum size than groups HG and CG, which was statistically significant; on their final visit, these differences remained only at the interproximal level. The number of patients with gingival overgrowth-taking the average of group HG as a minimal value-was much higher in groups CG (92%), DG (100%) and NG (89%) on the basal visit; on the final visit, the differences remained only in groups DG (85%) and NG (83%). The probing pocket depth reduction was much greater in groups HG and CG than in DG and NG, basically due to a greater gaining on clinical attachment level. The % of sites in which the pocket depth improved by more than 2 mm was 39.8% in HG, 54.5% in CG, 23.7% in DG and 28.7% in NG. The % of sites where the attachment gain by more than 2 mm was 46.2% in HG, 55.5% in CG, 22.8% in DG and 21.4% in NG. The amount of plaque and bleeding on probing, which was similar in all groups on the basal visit, decreased throughout the study, especially between the basal and 2nd visit in groups HG and CG. We have demonstrated that patients that take nifedipine and diltiazem show a larger gum size and their response to causal periodontal treatment is poorer than in the healthy and the cardiac groups.

[The current status in obtaining a license for the practice of dentistry in the European Union and the United States of America]. / Estado actual de la obtención de la licencia para el ejercicio de la odontología en la Unión Europea y en los Estados Unidos de Norteamérica.

Present regulations on the issuance of dental licenses are very different between the United States of America and the European Community. Two different mechanisms attempt to arrive at the fairest possible solution: licenses controlled by either national and/or local examinations in the United States, and licensing by credentials in the European Community. Both are compared and discussed.

Clinical assessment of gingival size among patients treated with diltiazem.

Gingival overgrowth induced by nifedipine has been extensively reported. This finding, however, does not apply to gingival size changes caused by other calcium antagonists such as diltiazem. We studied the gingiva of 13 subjects with ischemic cardiopathy who had been treated with diltiazem and established two control groups: (1) a healthy group of 12 patients and (2) a group of 10 patients with ischemic cardiopathy and concomitant treatment similar to that applied to the diltiazem group except that they had not been administered any type of calcium antagonists. The size of the gingiva around the six anterior teeth was measured on plaster models of the upper and lower jaws. Significantly higher scores of the size of the gingiva were found when patients treated with diltiazem were compared with the patients in the other two groups (p < 0.05) gingiva were found when patients treated with diltiazem were compared with the patients in the other two groups (p < 0.05) and also when interproximal (p < 0.05) and vestibular (p < 0.05) sites were considered. We did not observe any significant difference in the plaque index of each group (p < 0.05); only bleeding after probing was found statistically different between the diltiazem and the nondiltiazem groups.

Clinical assessment of gingival hyperplasia in patients treated with nifedipine.

Gingival hyperplasia caused by the use of nifedipine has been extensively reported. In this paper, the gingiva of 18 patients suffering from cardiopathy and treated with nifedipine were compared with those of 10 patients with cardiac disorders who had not been treated with calcium antagonists and with a no-treatment group of 12 patients. Nifedipine produced gingival hyperplasia, although patients who had not been treated with calcium antagonists also had mild hyperplasia. Hyperplasia first appeared in the interproximal areas, an observation which may be important for early detection. There was a direct correlation between the degree of hyperplasia and the bacterial plaque score. When we studied the influence of administration time and dose of nifedipine with the degree of hyperplasia, no statistically significant differences were found.