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PubMed1995

Effect of traumatic occlusion on periapical lesions in rats.

The effect of traumatic occlusion on periapical lesions in rats was investigated histologically and histometrically. Rats were divided equally into groups A to D. Rats in group A received no treatment; in group B, rats received pulpal exposure of the left mandibular first molar; in group C, a resin plate was cemented onto the occlusal surface of the corresponding maxillary molar; and in group D, the molar pulp was exposed and the resin plate was installed. At 1 and 2 wk, compression of the periodontal ligament and inflammation were less in group D than in group B. Lesions in the periapical periodontal ligament at 1, 2, and 4 wk in group D were significantly smaller than those in group B. This study suggests that traumatic occlusion delayed the enlargement of the periapical lesions in rats.

Alveolar Bone Loss↗
PubMed1993

Correlation between thermal sensitivity and microorganisms isolated from deep carious dentin.

The correlation between thermal sensitivity and the microorganisms present in 29 deep carious lesions was studied. The numbers of lactobacilli and total Gram-positive rods in the carious lesions were found to be negatively related to the length of pain triggered by cold and heat stimulants. The presence of Gram-positive cocci and non-black-pigmented Bacteroides were positively associated with both cold and heat sensitivities. Black-pigmented Bacteroides, Streptococcus mutans, and total anaerobic colony counts were positively related to the heat sensitivity. Recovery of Fusobacterium nucleatum, Actinomyces viscosus, and enterics on the selective plates was associated with cold sensitivity. Total counts of Gram-positive cocci and Gram-negative rods on the anaerobic nonselective medium were positively related to the cold sensitivity. It appeared that teeth with low numbers of lactobacilli in the carious lesions usually responded to thermal tests with longer duration of pain. Conversely, teeth with high numbers of lactobacilli in the carious lesions usually responded with shorter duration of pain.

Bacteroides↗
PubMed1992

Microleakage--full crowns and the dental pulp.

Recent studies have described microleakage under full crowns cemented with several different cements. This study tested three different types of crown margin preparations--a chamfer, a shoulder, and a shoulder plus a bevel to determine whether or not the margin preparation could affect microleakage. All crowns were cemented with zinc phosphate cement. The crowns were tested for leakage in thermocycled dye. All crowns demonstrated significant leakage following the path of the dentinal tubules into the pulp. This could possibly be one of the causes of pulpal inflammation and even pulpal death under full crowns.

Crowns↗
PubMed1992

Endodontic interappointment flare-ups: a prospective study of incidence and related factors.

Severe pain and/or swelling following a root canal treatment appointment are serious sequelae. Information varies or is incomplete as to the incidence of these conditions and related factors. In this study, data were collected at root canal treatment appointments on demographics, pulp/periapical diagnoses, presenting symptoms, treatment procedures, and number of appointments. Patients that then experienced a flare-up (a severe problem requiring an unscheduled visit and treatment) had the correlating factors examined. Statistical determinations were by chi-square analysis with significance at 0.05 or less. Nine hundred forty-six visits resulted in an incidence of 3.17% flare-ups. Flare-ups were positively correlated with more severe presenting symptoms, pulp necrosis with painful apical pathosis, and patients on analgesics. Fewer flare-ups occurred in undergraduate patients and following obturation procedures. There was no correlation between patient demographics or systemic conditions, number of appointments, treatment procedures, or taking antibiotics.

Acute Disease↗
PubMed1990

Neurovascular interactions in the dental pulp in health and inflammation.

The two key components in pulpal inflammation are microcirculation and sensory nerve activity. With advancement of techniques they can be measured simultaneously in the same tooth. Excitation of A-delta fibers seems to have an insignificant effect on pulpal blood flow (PBF), whereas C fiber activation causes an increase in PBF. This C fiber-induced PBF increase is caused by neurokinins, especially substance P, which is released from the C fiber nerve terminals. Manipulation of PBF has varying effects on sensory nerve activity. An increase in PBF causes excitation of both A-delta and C fibers via an increase in tissue pressure, whereas flow reduction has an inhibitory effect on A-delta fibers, but no discernible effect on C fiber activity. Understanding of this complex neurovascular relationship in the pulp, especially given the fact that the pulp is in a low compliance system, is prerequisite to more comprehensive characterization of pulpal inflammation.

Dental Pulp↗
PubMed1990

Immunological aspects of chronic inflammation and repair.

Macrophages and lymphocytes play essential roles in cell-mediated mechanisms involved in chronic inflammation. During the development of specific immunity, macrophages are required to process and present antigen to immunocompetent T cells. They also serve as "accessory" cells to lymphocytes by releasing soluble factors involved in host defense. In order to carry out their role more effectively, macrophages have the property of being activated, a process that provides them with greater ability to phagocytose and kill ingested microorganisms. Activated T cells serve as key effector cells that are capable of producing lymphokines which modify the behavior of other cells. In this way, they are able to facilitate or suppress an immune response. Chronic inflammation is often associated with irreversible destruction of parenchymal tissue, and fibrous connective tissue fills the resultant defect. Proliferation of fibroblasts, collagen production, and neovascularization are enhanced by the secretion of cytokines by T cells and macrophages.

Chronic Disease↗
PubMed1990

Neuropeptides in the dental pulp: distribution, origins, and correlation.

It is known that many factors participate in the process of inflammation and pain transmission. Recently, various neuropeptides have been demonstrated in the intrapulpal nerve fibers immunobiohistochemically. These neuropeptides may play some role in the process of inflammation and transmission of pain sensation. In this presentation, the distribution, origins, and correlation of neuropeptides in the dental pulp is reviewed.

Dental Pulp↗
PubMed1990

Clinical considerations of microleakage.

Most dental materials permit the microleakage of bacteria and bacterial products from oral fluids to reach dentin. Thus, an understanding of the clinical consequences of microleakage demands that we analyze the permeability characteristics of dentin. The more dentin surface that is exposed during tooth preparation, the greater the potential for microleakage. Thicker dentin is less permeable than thin dentin. Dentin over pulp horns is more permeable than central dentin. Similarly, the dentin making up axial walls is more permeable than dentin forming the pulpal floor of cavities. Coronal dentin is much more permeable than root dentin. In addition to the number of tubules per unit area, tubule diameter, and the location of the dentin in a tooth, another extremely important variable is the presence or absence of a smear layer. When smear layers are created, grinding debris are forced into each tubule to form a smear plug. Smear plugs are usually 1- to 2-microns long but may be 10-microns long. They are much longer than the smear layer thickness and they reduce dentin permeability more than the overlying smear layer. Smear layers constitute a natural cavity liner that reduces the permeability of dentin far more than any cavity varnish. However, its presence limits the strength of dentin bonding agents because of the relatively low cohesive forces holding the smear layer together and to dentin. If it is removed, the bond strengths of dentin adhesive resins increases, but removal also increases the potential liability for pulpal inflammation if the bond is not uniformly perfect.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Cements↗
PubMed1990

Treatment of the endodontic emergency: a decade later.

A questionnaire was sent to diplomates of the American Board of Endodontics to determine changing trends in the treatment of endodontic emergencies since Dorn's survey 10 yr ago. There is a definitely greater trend toward complete instrumentation of the root canals to the apex regardless of the emergency condition than there was a decade ago. The number of respondents who leave teeth open when the pulp is nonvital has dropped dramatically in the past decade. When there is no periapical involvement, over one third of the respondents are completing treatment in one visit. A decrease in the use of classic phenolic medicaments was noted with a corresponding increase in calcium hydroxide or no medication at all.

Calcium Hydroxide↗
PubMed1991

Copper-zinc superoxide dismutase activity in normal and inflamed human dental pulp tissue.

Information regarding the presence of the free radical scavenging (inactivating, dismutating) enzyme superoxide dismutase in human dental pulp was sought. Free radicals, such as the superoxide anion radical (O2-) and the hydroxyl anion radical (OH.), are powerful biological oxidants produced by phagocytes during the normal tissue response to injury and infection. Also produced is hydrogen peroxide (H2O2), an aggressive oxygen species formed by the reaction of superoxide with itself, i.e., a dismutation in which one molecule of O2- is oxidized by the other. These three reactive oxygen intermediates serve as part of the normal host biological defense mechanism for the inactivation of microorganisms and the breakdown of their toxic products. Both normal and inflamed dental pulps were assayed for the presence of this enzyme. Superoxide dismutase activity was identified in the normal pulpal tissues. There was a slight decrease in activity with age. In the inflamed pulpal tissues, enzyme activity was markedly and significantly increased in comparison to that in the normal tissues. These observations indicate that human dental pulp possesses an endogenous defense mechanism designed to protect the tissue components (cells and matrix) from the toxic effects of the reactive oxygen intermediates. In this regard, the inflammatory response of this specialized and somewhat isolated (compartmentalized) tissue is not unlike that seen in other connective tissues.

Adult↗
PubMed1991

Human polymorphonuclear granule components: relative levels detected by a modified enzyme-linked immunosorbent assay in normal and inflamed dental pulps.

Lysosomal granules of polymorphonuclear leukocytes (PMN's) contain proteolytic enzymes and other components important in the regulation of inflammation and the elimination of bacteria or debris associated with pulp disease. However, PMN lysosomal degranulation is nonspecific and can result in destruction of healthy connective tissue adjacent to the areas of damaged or infected tissue. For this study a modified enzyme-linked immunosorbent assay was used to detect the human PMN lysosomal granule products: elastase, cathepsin G, and lactoferrin. Evaluation of 55 pulp samples yielded a statistically significant difference (p less than 0.05) among the levels of elastase and lactoferrin in normal and moderate to severely inflamed pulps. Although cathepsin G levels were increased, there was no statistical significance (p greater than 0.05) among groups. The results indicate that a modified enzyme-linked immunosorbent assay technique can be used to measure PMN lysosomal granule components in dental pulp tissues. Additionally, elastase and lactoferrin levels appear to be valid diagnostic markers of advanced dental pulp disease.

Biomarkers↗
PubMed1991

Endodontic therapy in a mandibular second bicuspid with four canals.

Success in endodontic therapy often depends on the removal of the critical concentration of pulp tissue or necrotic debris within the root canal system. The best method to ensure this objective is to locate and instrument all of the canals in the root of the tooth. Therefore, a thorough knowledge of root canal morphology is essential to reduce the chances of failure. The purpose of this article is to report a case of mandibular second bicuspid with four distinct canals.

Bicuspid↗
PubMed1991

Natural modifiers of the inflammatory process in the human dental pulp.

Concentrations of the protease inhibitors alpha 1-antitrypsin and alpha 2-macroglobulin were determined in normal and inflamed human dental pulps. Carious pulpal exposure which is associated with polymorphonuclear leukocyte infiltration and release of lysosomal enzymes was chosen as the point of verifiable inflammatory activity in the pulp. Normal samples were collected from nondiseased third molar teeth treatment planned for extraction and inflamed human pulps were collected from teeth with deep carious lesions. One half of each sample was assayed for concentration of protease inhibitors by enzyme-linked immunosorbent assay and the remaining half was examined histologically to verify the clinical diagnosis and categorize the extent of the inflammatory process. alpha 1-Antitrypsin and alpha 2-macroglobulin were detected in normal and inflamed human dental pulps in the nanogram per milliliter range. Statistically significant differences were found in the concentrations of alpha 2-macroglobulin (p less than 0.01) in moderate to severe inflammation versus normal pulp categories and between mildly inflamed pulps and moderate to severely inflamed pulps (p less than 0.05). Although differences in concentrations of alpha 1-antitrypsin were seen between inflamed and normal pulps, the differences were not statistically significant. The presence of these two protease inhibitors in the human dental pulp tissue and the increase in their concentration in acute inflammation indicates that these proteins play a role in the pathogenesis of pulpal inflammatory disease.

Adolescent↗
PubMed1991

Determination and relationship of C-reactive protein in human dental pulps and in serum.

C-reactive protein (CRP), an acute phase protein synthesized by the liver, increases in serum as much as 3000 times above its normal level in response to acute inflammation. The purpose of this study was to determine whether CRP levels in dental pulps could be correlated with the histological disease status of the pulp and with systemic blood levels of CRP. Inflamed and necrotic pulps were extirpated during routine endodontic therapy. Normal pulps were removed from extracted, intact third molars. One half of each pulp specimen was placed in formalin for histological study; the other half was frozen for immunological study. A serum sample was obtained from each patient at the end of the dental visit. CRP levels were determined by the enzyme-linked immunosorbent assay. Pulps were categorized histologically as normal, inflamed, inflamed/necrotic, or necrotic. The correlation between CRP levels of pulp and serum was not significant. CRP levels of normal pulps differed significantly only from inflamed pulps (p less than 0.05, Dunnett). This increase in CRP appears to be a local phenomenon resulting from the interaction of CRP with various inflammatory mediators in the pulp.

C-Reactive Protein↗
PubMed1990

Inflammatory resorption caused by an adjacent necrotic tooth.

A case history is presented with a large periapical lesion and a perforating resorption defect on a cuspid. Endodontic therapy was performed, presuming that the necrotic cuspid caused the inflammatory response. No radiographic healing was evident 18 months after endodontic therapy. Considerable healing was demonstrated 6 months later, following the extraction of an adjacent tooth with prior root canal therapy. It was concluded that the failing root canal therapy of the extracted tooth was the primary factor leading to the inflammatory lesion, the resorptive perforation of the adjacent tooth, and its pulpal necrosis. It has not been reported prior that inflammatory resorption can result from the pulpal necrosis of an adjacent tooth.

Adult↗
PubMed1991

Bacteria in the apical 5 mm of infected root canals.

Ten freshly extracted teeth which had carious pulpal exposures and periapical lesions contiguous with the root apex were placed inside an anaerobic chamber and the apical 5 mm of the root canals cultured. In addition to anaerobic incubation, duplicate cultures were incubated aerobically. Fifty strains of bacteria from the 10 root canals were isolated and identified. The most prominent bacteria cultured from the 10 root canals were Actinomyces, Lactobacillus, black-pigmented Bacteroides, Peptostreptococcus, nonpigmented Bacteroides, Veillonella, Enterococcus faecalis, Fusobacterium nucleatum, and Streptococcus mutans. Of the 50 bacterial isolates, 34 (68%) were strict anaerobes. This study demonstrates the presence of predominantly anaerobic bacteria in the apical 5 mm of infected root canals in teeth with carious pulpal exposures and periapical lesions.

Bacteria, Anaerobic↗
PubMed1991

An ultrastructural and immunohistochemical study of human dental pulp: identification of Weibel-Palade bodies and von Willebrand factor in pulp endothelial cells.

Special and specific immunohistochemical techniques as well as routine transmission electron microscopy were used to identify the presence of von Willebrand factor (vWF), a blood clotting factor essential to normal hemostasis, and Weibel-Palade bodies (WPB's), respectively, in the endothelial cells lining the blood vessels from both normal and inflamed human pulpal tissues. In human endothelial cells, WPB's are peculiar and specialized organelles which store vWF. All classes of blood vessels (capillaries, arterioles, arteries, venules, and veins) were vWF positive. The fine structural studies showed similar results with regard to the presence of WPB's. Interestingly, morphometric analyses conducted on the same tissues using either light or transmission electron microscopy showed that significantly more vWF-positive blood vessels were seen in the inflamed tissues. In agreement with the latter observation, transmission electron microscopy showed that more vascular endothelial cells contained WPB's in the inflamed tissues when compared with the normal tissues. From this it appears that during pulpal inflammation, the cascade of events associated with hemostasis may be activated with the increased synthesis and release of vWF by endothelial cells.

Dental Pulp↗
PubMed1991

Histology and lysosomal cytochemistry of the postsurgically inflamed dental pulp after topical application of steroids. I. Histological study.

The purpose of this study was to histologically investigate steroid effects on the dental pulp. Three steroid preparations, hydrocortisone, betamethasone and triamcinolone, were locally applied to the exposed pulp tissue in rat incisor after pulpectomy. After 24 h, the effects on the tissues were assessed by light microscopy. The results showed that topical application of corticosteroids as an intracanal medicament reduced inflammatory changes in the pulp as compared with controls. Furthermore, triamcinolone and betamethasone demonstrated more potent anti-inflammatory effects than did hydrocortisone.

Administration, Topical↗