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PubMed2003

Hepatocyte growth factor/scatter factor in development, inflammation and carcinogenesis: its expression and role in oral tissues.

Hepatocyte growth factor (HGF) was discovered as a potent mitogen for adult hepatocytes from the plasma of patients with fulminant hepatic failure. It is now known to be a broad-spectrum, multi-functional mitogen, motogen and morphogen. The activities of HGF are mediated through the signalling pathway of its receptor, c-Met. During tooth development, HGF is expressed in the dental papilla and c-Met is expressed in the inner enamel epithelium. The expression of HGF and c-Met indicates that HGF is involved in morphogenesis of the tooth by mediating epithelial-mesenchymal interactions. In the mature tooth, HGF expression by fibroblasts is enhanced in pulpitis and mediated through the induction of prostaglandin (PG) E(2); it is induced not only by inflammatory cytokines, but also by components of oral bacteria. Consequently, concentrations of HGF in gingival crevicular fluid (GCF) increase in periodontitis. The mitogenic and other biological activities, such as angiogenesis, of HGF contribute towards wound healing. Both HGF and c-Met are expressed in the developing tongue, and the signalling pathway of the latter is shown to be essential for myogenesis. Dysregulation of c-Met signalling is observed in carcinogenesis, but HGF also has cytotoxic activity to certain tumour cells. The reason for the discrepancy between these observations is not clear at present.

Gingiva↗
PubMed1991

Treatment considerations in a geminated maxillary lateral incisor.

A patient with anomalous maxillary lateral incisor was referred for endodontic therapy. A diagnosis of irreversible pulpitis of a geminated maxillary lateral incisor was made. The preoperative radiograph revealed an image of a single root canal but in fact the tooth had two separate and distinct root canals. Treatment considerations of this anomaly are discussed.

Adult↗
PubMed1989

Emergency pulpotomy: pain relieving effect with and without the use of sedative dressings.

Seventy-three teeth with acute irreversible pulpitis were subjected to emergency pulpotomies. After removal of the coronal portion of the pulp, a sterile cotton pellet or zinc oxide-eugenol cement was placed against the remaining pulp tissue. The cotton pellet was either dry or moistened with camphorated phenol, cresatin, eugenol, or isotonic saline. This gave six different groups of treatment following the pulpotomy. All teeth were sealed with zinc oxide-eugenol cement. By means of questionnaires, symptoms were recorded after the anesthetic effect was gone and also at 1, 7, and 30 days after treatment. A total of 70 patients (96%) reported pain relief. Three patients did not experience relief and returned for pulpectomy. After the first postoperative day, no pain was reported by any of the patients. The frequency of discomfort decreased from 11% 1 day postoperatively to 1% 30 days after the emergency treatment. There was no difference in recorded symptoms among the six treatment groups. Thus, removal of caries, pulpotomy, and sealing of the cavity apparently was a reliable means to relieve pain. The use of the various dressings did not contribute to the relief of pain.

Analgesics↗
PubMed1999

Clinical applications of mineral trioxide aggregate.

An experimental material, mineral trioxide aggregate (MTA), has recently been investigated as a potential alternative restorative material to the presently used materials in endodontics. Several in vitro and in vivo studies have shown that MTA prevents microleakage, is biocompatible, and promotes regeneration of the original tissues when it is placed in contact with the dental pulp or periradicular tissues. This article describes the clinical procedures for application of MTA in capping of pulps with reversible pulpitis, apexification, repair of root perforations nonsurgically and surgically, as well as its use as a root-end filling material.

Aluminum Compounds↗
PubMed1998

Dental sepsis.

Dental sepsis or periapical abscess formation constitutes a large percentage of dental conditions that afflict horses. Dental sepsis occurs when the pulp chamber of the tooth is exposed to the oral cavity or external environment, allowing bacterial localization with resulting infection. Although acute, primary, septic pulpitis in horses is rare, dental sepsis often results from colonization of the pulp chamber with pathogenic bacteria secondary to maleruption or impaction of teeth with secondary alveolar bone lysis, primary fractures of the tooth, mandible, or maxilla, periodontal disease, or infundibular necrosis. The sequela to pulpal infection are extensions into the periradicular tissues and mandibular or maxillary periapical abscess formation.

Animals↗
PubMed1987

Clinical findings in patients with orofacial discomfort complaints.

In 113 patients with orofacial and general complaints, which they assumed were caused by galvanic currents and/or metallic restorations, clinical dental and medical examinations were performed. Most of the patients had natural teeth with dental metallic restorations. A number of dental diagnoses, such as caries, pulpitis, periapical osteitis and periodontitis, were found. However, 16% were edentulous in one or both jaws and had complete dentures. 69% had possible metal contacts. Some oral mucosal changes were observed, but they were as frequent in patients without as in those with metal contact possibility. Signs of parafunctions and functional disturbances of the masticatory system were extremely frequent. A careful oral examination in these patients thus revealed many clinical dental and oral signs that could be more-or-less related to the complaints. Because of the extremely varying symptoms reported, however, only a small proportion could be fully explained by odontological and/or medical diagnoses, and in 38% of the patients, no clear odontological diagnosis was found that could explain the complaints.

Adult↗
PubMed1988

A study of indications used for removal of the mandibular third molar.

To study the indications used for removal of the mandibular third molar, questionnaires were sent to 35 Oral Surgery Clinics in Sweden, out of which 29 clinics participated. In each clinic, the questionnaires were to be recorded for 30 patients. The indications for removal were classified into 15 groups. There were also questions about symptoms as well as eruption status for the molar being removed. The results were based on data from 870 individuals with a mean age of 27 years. More than half of the removed third molars (54%) presented no subjective symptoms. Such symptoms were more frequent in association with fully or partially erupted molars than molars completely covered by soft or bone tissue. The indication for removal was classified as prophylactic in 27% and as orthodontic in 14%. Earlier episodes of pericoronitis consisted of 1/4 of the indications and caries or pulpitis of the third molar made up 13%. Pathologic entities like cysts, tumours and root resorption were registered in less than 3% each, and were more frequent among patients 40 years of age or older.

Adolescent↗
PubMed1988

Re- and allotransplantation of teeth--an experimental study in monkeys.

In each of six monkeys one of the permanent lateral incisors with uncompleted root development was replanted. At the same time the contralateral incisors in four of the monkeys were allotransplanted by pairs. The remaining two contralateral incisors served as controls. After 4 weeks and 4 months, respectively, three monkeys were decapitated and the upper lateral incisors with adjacent periodontal tissue were examined histologically. The replanted teeth in five cases had a vital pulp. In the sixth case, however, the replanted incisor exhibited pulpitis and partial necrosis of the pulp. The periodontal membrane had a normal histologic appearance. In two cases a small area of arrested root resorption was observed. With the allotransplanted teeth the histologic appearance was altered. After 4 weeks a pronounced inflammatory reaction was observed in both the pulpal tissue and the periodontal membrane. The pulp was in most cases necrotic, and marked root resorption was observed. Most of the allotransplanted teeth were resorbed and replaced by an irregular hard tissue that resembled osteoid, which in many cases was connected with the tooth remnants by ankylosis. These results indicate that allotransplanted teeth, in contrast to replanted teeth, exhibit the characteristic features of an allograft rejection, including an inflammatory reaction and resorption.

Animals↗
PubMed2007

Teeth: malignant neoplasms in the dental pulp?

Common pathologies of the dental pulp differentiate between acute and chronic inflammatory states caused by caries or dental trauma. Inflammations of the dental pulp as a result of neoplastic alterations are generally considered non-existent. In fact, using the search phrase "dental pulp" combined with "sarcoma", "carcinoma", or "neoplasms" in PubMed when using the MeSH search mode yielded no reports on primary malignant neoplasms. However, a hand search yields clinical reports on pulpal tumours that were published over a century ago. In this Essay, the results of a hand search in historic published work are presented. Furthermore, deductive reflections are done on general tumour pathogenesis with respect to specific anatomical prerequisites of the dental pulp. Because of the restricted space in a tooth, tumour expansion will probably lead to the formation of irritation dentine by secondary odontoblasts and, subsequently, to a haemorrhage infarct of the pulp. One hypothesis states that a purported neoplasm of the dental pulp leads to a chronic appositive pulpitis and-sooner or later-will be treated likewise by root-canal treatment or extraction. Further research, including stem-cell studies, is recommended.

Dental Pulp Diseases↗
PubMed2005

Facial cellulitis arising from dens evaginatus: a case report.

Dens evaginatus is a developmental anomaly that produces a tubercle on the occlusal surface of a tooth. It is found most frequently in the mandibular premolars. The occlusal tubercle easily causes occlusal interferences. Attrition or fracture of the tubercle can lead to pulpitis, pulp necrosis, periapical pathosis, and periapical infection. This case report illustrates the treatment of facial cellulitis arising from dens evaginatus with open apex. Calcium hydroxide was used for the apexification procedure. One year after canal obturation, radiography revealed no apical pathosis and the apical seal was evident.

Adult↗
PubMed2006

Microbiological evaluation of photo-activated disinfection in endodontics (an in vivo study).

OBJECTIVE: To determine the microbiological effect of photoactivated disinfection (PAD) as an adjunct to normal root canal disinfection in vivo. DESIGN: A randomised trial carried out in general dental practice. SUBJECTS AND METHODS: Patients presenting with symptoms of irreversible pulpitis or periradicular periodontitis requiring endodontic therapy were selected at random. A microbiological sample of the canal was taken on accessing the canal, after conventional endodontic therapy, and finally after the PAD process (photosensitiser and light) had been carried out on the prepared canal. All three samples from each canal were plated within 30 minutes of sampling and cultured anaerobically for five days. Growth of viable bacteria was recorded for each sample to determine bacterial load. RESULTS: Thirty of the 32 canals were included in the results. Cultures from the remaining two did not reach the laboratory within the target time during which viability was sustained. Of the remaining 30, 10 canals were negative to culture. These were either one of the canals in multi rooted teeth where the others were infected or where a pre-treatment with a poly-antibiotic paste had been applied to hyperaemic vital tissue. Sixteen of the remainder were negative to culture after conventional endodontic therapy. Three of the four which had remained infected cultured negative after the PAD process. In the one canal where culturable bacteria were still present, a review of the light delivery system showed a fracture in the fibre reducing the effective light output by 90%. CONCLUSIONS: The PAD system offers a means of destroying bacteria remaining after using conventional irrigants in endodontic therapy.

Adolescent↗
PubMed2006

Dental caries affects body weight, growth and quality of life in pre-school children.

The effect of a relatively common chronic disease, severe dental caries, affects young childrens' growth and well-being. Treating dental caries in pre-school children would increase growth rates and the quality of life of millions of children. Severe untreated dental caries is common in pre-school children in many countries. Children with severe caries weighed less than controls, and after treatment of decayed teeth there was more rapid weight gain and improvements in their quality of life. This may be due to dietary intake improving because pain affected the quantity and variety of food eaten, and second, chronic inflammation from caries related pulpitis and abscesses is known to suppress growth through a metabolic pathway and to reduce haemoglobin as a result of depressed erythrocyte production.

Body Weight↗
PubMed2005

Formocresol and ferric sulfate have similar success rates in primary molar pulpotomy. In carious primary molars does a pulpotomy performed with ferric sulphate, compared with formocresol, result in greater clinical/radiographic success?

DATA SOURCES: Medline Ovid Library, the Cochrane Library, PubMed, Embase, Science Citation Index (SCI) and System for Information on Grey Literature in Europe (SIGLE). STUDY SELECTION: Reviews, full reports, or research abstracts of prospective, retrospective, comparative, and/or radiographic studies were included, while case reports and letters were excluded. DATA EXTRACTION AND SYNTHESIS: A total of 13 studies (three randomized clinical trials and 10 clinical trials) contributed to the meta-analysis, one randomized clinical trial and one clinical trial were analyzed by the direct technique, and all 13 trials were analyzed by the indirect technique. Data from trials were divided into clinical and radiographic data, and separate statistical analyses were conducted using the direct technique. Odds ratios (ORs) were used to compare the relative success of ferric sulphate and formocresol. Data homogeneity was tested using the chi(2)-test of consistency on the ORs for each trial. RESULTS: Clinical data indicated that ferric sulphate was significantly more successful than formocresol (OR=1.95; CI=1.01-3.80). Radiographic data indicated no difference between medicaments (OR=0.90; CI=0.58-1.39). Medicaments did not differ with t-tests of clinical (P>0.10) and radiographic (P>0.50) data. CONCLUSIONS: In human carious primary molars with reversible coronal pulpitis, pulpotomies performed with either formocresol or ferric sulphate are likely to have similar clinical/radiographic success.

Comment↗
PubMed2001

Detection of Slackia exigua, Mogibacterium timidum and Eubacterium saphenum from pulpal and periradicular samples using the Polymerase Chain Reaction (PCR) method.

AIM: The purpose of this study was to detect Slackia exigua from root canal samples using a sensitive PCR amplification method. Mogibacterium timidum and Eubacterium saphenum were also included because of their culture-difficult properties. METHODOLOGY: The species-specific PCR primers were prepared according to 16S rDNA sequence analysis data, and confirmed to be effective for PCR amplification as species-specific, respectively. A total of 36 clinical samples were obtained during the first visit of root canal treatment. RESULTS: The sensitivity of detection was a minimum of 10 organisms for S. exigua and five organisms for M. timidum and E. saphenum, respectively. In seven cases of pulpitis, Sexigua was detected in two cases (29%), and M. timidum in two cases (29%), but E. saphenum was not detected. In 17 cases of root canal treatment, S. exigua was detected in seven cases (41%), M. timidum in 12 cases (71%) and E. saphenum in four cases (24%). In 12 cases of root canal retreatment, S. exigua was detected in three cases (25%), M. timidum in three cases (25%) and E. saphenum in two cases (17%). CONCLUSIONS: S. exigua, M. timidum and E. saphenum were present in root canal systems, and may be associated with pulpal and periradicular pathosis.

Actinomycetales Infections↗
PubMed2002

Nociceptive behaviour induced by dental application of irritants to rat incisors: a new model for tooth inflammatory pain.

Animal models simulating acute human pulpitis are still lacking. The rat incisors present a particular situation where most of their innervation is considered to be unmyelinated and concentrated mainly in the tooth pulp. This study reports on a new model for dental pain induced by inflammatory agents applied to the tooth pulps of incisors. In different groups of rats, artificial crowns were fixed on the lower incisors, after cutting 1-2mm of their distal extremities. A volume of 7-10 microl of solutions of saline, capsaicin (1-10mg/ml) or formalin (2.5% or 5%) was injected in the crown cavity, and the nociceptive behaviour was quantitated following a devised scoring method of four scales. Intradental application of capsaicin produced nociceptive scores in the form of one plateau for 1-2h depending on the concentration used. Similar results were obtained with intradental application of formalin 2.5%. The one plateau of nociceptive scores obtained with formalin contrasts with the biphasic aspect of nociceptive behaviour described with the intradermal formalin test. This discrepancy could be attributed to a difference in the types of afferent fibres involved in each situation. Pretreatment with morphine (2 mg/kg) attenuated, in a naloxone-reversible manner, the nociceptive behaviour observed following intradental application of capsaicin. Pretreatment with meloxicam (a cyclo-oxygenase-2 inhibitor) exerted a less pronounced attenuation of the nociceptive scores when compared with morphine. These results provide evidence for the validity of the described model for the simulation of tooth pulp inflammatory pain in awake animals.

Analgesics, Opioid↗
PubMed2001

The effects of noxious dental heating on the jaw-opening reflex and trigeminal Fos expression in the ferret.

Previous studies have established that the activation of peripheral nociceptors alters the central processing of nociceptive stimuli. In this study, we examined whether noxious heating of the dental pulp enhances the nociceptive jaw-opening reflex (JOR) and the expression of the immediate early gene c-fos in chloral hydrate/pentobarbital-anesthetized ferrets. We hypothesized that the application of noxious heat to the dental pulp, a procedure that evokes a preferential activation of pulpal C-fibers, will enhance JOR responses to electrical stimulation of the tooth pulp and that this enhanced response will be associated with the expression of Fos protein in discrete regions of the trigeminal nucleus. Consistent with our predictions, we observed that noxious heat conditioning enhanced the JOR as indicated by an increase in the magnitude of the signal averaged digastric electromyogram response evoked by electrical stimuli applied to either a heat-conditioned maxillary canine or the contralateral nonconditioned canine. The enhancement in JOR responses was independent of temporal summation of the electrical stimulus for test stimuli delivered at either 1.0 or 0.1 Hz. Sensitization of the JOR was associated with an increase in the number of immunohistochemically identified Fos-positive nuclei in trigeminal caudalis (Vc) and the transition zone between trigeminal interpolaris and caudalis (Vi/Vc) ipsilateral to the site of stimulation compared with sham stimulated animals. These findings suggest that neuronal populations in Vc and Vi/Vc play a role in the enhanced reflex responses to tooth pulp stimulation and may contribute to the pain and hyperalgesia associated with a symptomatic pulpitis.

Journal Article↗
PubMed1984

The pathogenesis of excessive wear in the deciduous teeth of sheep.

The teeth and various supporting and ancillary tissues were examined post mortem from two flocks of sheep, one of which had previously shown high deciduous incisor wear. Sheep were killed in groups selected on clinical signs at equivalent ages from birth to 116 weeks of age. At the end of this time the lengths of clinical crowns of the remaining deciduous incisor teeth in the high wear flock were not measurable, whereas the other flock had up to 5.5 mm in visible crown. Using the cingulum as a marker, measurements were made from extracted teeth of the attrition of the crown and size of the root. The tooth root did not grow substantially longer after the 13th week of the sheep;s life. Wear facets were just visible in some sheep at six weeks. More rapid wear occurred three times in the high wear flock. The first of these was relatively small and occurred between the 13th and 27th week of age in I1 and I2. The second was larger and occurred between the 38th and 57th week of age in the winter/spring period. A third period of wear, which was not measured from the cingulum, because this structure had by then been worn away, was seen in the remaining deciduous teeth between the ages of 91 and 110 weeks of age, i.e., during the second winter and spring. In the low wear flock the first of these periods of wear did not occur, the second was of shorter duration and smaller size, and the third equivocal. Eruption of the teeth after the 6th week was principally passive. There was no difference in the degree of wear of the molar teeth from the two flocks. Histological examination showed that the wear was compensated for by the deposition of reparative dentine in the pulp cavity. This usually gave the appearance of an ordered process. However, when wear was excessively rapid, a different, less orderly form of reparative dentine was laid down. In a few cases the reparative process was not fast enough, and a connection developed between the mouth and the pulp causing pulpitis. There was no histological evidence that the supportive tissues of the teeth, or the upper dental pad, contributed to the excessive wear.

Journal Article↗
PubMed2003

Preparation of root canal orifices by Er:YAG laser irradiation: in vitro and clinical observations.

OBJECTIVE: The purpose of the present study was to evaluate the effectiveness of Er:YAG laser irradiation for preparation of root canal orifices in extracted human teeth and several clinical cases. BACKGROUND DATA: Few studies with sufficient data have been conducted in this area. MATERIALS AND METHODS: Orifices of 42 extracted human teeth were prepared by conventional methods using a Peeso reamer or Er:YAG laser device at 250 mJ/pulse and 8 Hz. In the clinical study, the orifices of 11 teeth from 11 patients with irreversible pulpitis were prepared by Er:YAG laser irradiation at 160 mJ/pulse and 8 Hz. Teeth were carefully irradiated using non-contact methods. Evaluation was performed by visual inspection, stereoscopy, radiography, and scanning electron microscopy (SEM). In addition, the efficiency of using the Er:YAG laser was evaluated. RESULTS: In the in vitro study, canal orifices were clearly exposed by laser irradiation in all specimens. In 31 of 36 teeth (86%), orifices were successfully prepared without ledge formation or perforation. SEM observations revealed that irradiated surfaces were slightly rough and scaly, but essentially free from debris and smear layer. In the clinical study, orifices were successfully prepared in 10 of 11 teeth (91%), and no ledge formation or perforation was observed. CONCLUSION: These results suggest that the preparation of root canal orifices by Er:YAG laser irradiation may be useful in most cases, if appropriate parameters are selected.

Adult↗