A microbiological study of pre- and postoperative apicoectomy sites.

There is little information on the microbiology of periapical lesions, and no data on the residual microbial flora in the periapex, if any, after apicoectomy procedures. Hence, 64 patients treated by apicoectomy procedures were prospectively studied to assess the bacterial flora in the periapex and to evaluate the residual bacteria in postoperative apicoectomy sites. Of the 64 lesions studied, 14 (22%) were sterile and 50 (78%) yielded bacteria preoperatively. Bacteria could be recovered from 28 (56%) of the latter lesions after apicoectomy and curettage. A total of 105 bacterial strains was isolated from 50 lesions, yielding a range of 1-4 (mean 2.1) species per sample. The isolates comprised 84 (80%) facultative anaerobes and 21 (20%) strict anaerobes. A polymicrobial growth was obtained from 39 lesions whilst 11 lesions yielded pure cultures. On detailed microbiological analyses of 29 lesions, 40% of the isolates were identified as alpha-haemolytic streptococci, half of which were Streptococcus sanguis; anaerobic streptococci were the predominant anaerobes. None of the organisms or group(s) of organisms emerged as recalcitrant colonisers which were difficult to dislodge after surgical debridement. These data indicate that the majority of periapical lesions harbour a variety of flora which cannot be eradicated despite thorough apicoectomy procedures.

Use of anorganic bone in periapical defects following apical surgery--a prospective trial.

Anorganic bovine bone has been used previously to obturate bony defects following apical surgery with some reported success. However, no prospective trial has been carried out. We present the results of our trial showing that the placement of anorganic bovine bone (BIO-OSS) in defects created by apical surgery is contraindicated.

Comparison of two techniques for sedation in dental surgery.

Forty-eight patients were randomised to receive sedation of outpatient dental surgery with midazolam. Sedation was given using the Verrill technique (24 patients) and the Glasgow Dental Hospital technique (24 patients). The differences in recovery and patient acceptability were assessed. There was no statistical difference in mean recovery times between the two groups. Memory function was examined using the Warrington memory test. Fewer patients in the Verrill group recalled the injection of local anaesthetic but they demonstrated memory defects 4 hours after sedation for words and 3 hours for faces. The Glasgow Dental Hospital group demonstrated memory defects for words up to 2 hours following sedation, but not for faces at any time. Thirty-eight patients would have dental surgery again with similar sedation. The dental surgeon found conditions for surgery inadequate in two patients. In view of the shorter duration of amnesia we recommend the Glasgow Dental Hospital technique.

Memory function after i.v. midazolam or inhalation of isoflurane for sedation during dental surgery.

Memory function was assessed with a recognition memory test in 40 dental patients before and after sedation with i.v. midazolam or inhalation of isoflurane. The two groups were comparable, but there was a significant impairment of memory (P less than 0.001) at the time of discharge for both words and faces after midazolam, but not after isoflurane.

Comparison of i.v. sedation with midazolam and inhalation sedation with isoflurane in dental outpatients.

I.v. midazolam was compared with inhalation sedation using isoflurane in 80 dental outpatients. Preoperative anxiety was comparable in both groups and decreased after operation to similar values. The dental surgeon and the patients rated the techniques as equally satisfactory. Midazolam produced faster induction of sedation (P less than 0.001) and more amnesia for the injection of local analgesic (P less than 0.001), whereas isoflurane produced more euphoria (P less than 0.01) and quicker recovery (P less than 0.001). The incidence of postoperative side effects was similar in the two groups.

Staphylococcal sub-mandibular lymphadenitis in childhood.

Thirteen cases of staphylococcal sub-mandibular lymphadenitis in children are presented and the diagnosis and treatment are discussed. All but one of the strains of Staphylococcus aureus isolated were resistant to penicillin, while the converse was true for erythromycin. Epidemic strains of Staphylococcus aureus were not found when bacteriophage typing was carried out on isolates from seven of the 13 patients.