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PubMed1995

Pulpotomy of carious vital teeth with periapical involvement.

Twenty-six permanent vital molars with carious pulp exposures and periapical involvement presenting as radiolucencies or radiopacities on radiographic examination, in patients aged between 10-24 years, were treated using an atraumatic surgical technique with calcium hydroxide alone. The healing was evaluated using clinical and radiographic criteria: absence of clinical symptoms, sensitivity of the radicular pulp, formation of a hard tissue barrier in the exposed area, resolution of periapical involvement and no intraradicular pathosis radiographically. Assessed by these criteria, successful results were achieved in 24 teeth. The observation period following pulpotomy treatment was 16-72 months. The favourable results of this study demonstrate that pulpotomy treatment in teeth with cariously exposed vital pulps and with periapical involvement may be an alternative treatment to root canal therapy.

Adolescent↗
PubMed1995

Studies into the microbial spectrum of apical periodontitis.

This study examined the variety of obligate and facultative anaerobic bacterial species recovered from cases of acute apical periodontitis. A total of 19 root canal samples and 24 periapical granuloma samples were taken from patients suffering pain and discomfort. Bacteria were identified by applying the following techniques: culturing on various media, Gram-staining and using commercially available biochemical test strips. In addition, Prevotella intermedia and Porphyromonas endodontalis were differentiated on a molecular genetic level using species-specific oligodeoxynucleotide probes. The most frequently identified bacteria were Prevotella intermedia, Bifidobacterium spp., Streptococcus sanguis, Streptococcus milleri-group and Bacteroides spp. Obligate anaerobes occurred at a rate of 82.3%, and the average number of isolates was 6.4 per sample.

Actinomyces↗
PubMed1996

In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline.

The aim of this study was to clarify the antibacterial effect of a mixture of ciprofloxacin, metronidazole and minocycline, with and without the addition of rifampicin, on bacteria taken from infected dentine of root canal walls. The efficacy was also determined against bacteria of carious dentine and infected pulps which may the precursory bacteria of infected root dentine. This efficacy was estimated in vitro by measuring bacterial recovery on BHI-blood agar plates in the presence or absence of the drug combination. Bacteria ranging in number from 10(2) to 10(6) occurred in samples of infected root dentine (27 cases). However, none was recovered from the samples in the presence of the drug combination at concentrations of 25 micrograms ml-1 each. The respective drug alone (10, 25, 50 and 75 micrograms ml-1) substantially decreased the bacterial recovery, but could not kill all the bacteria. Bacteria taken from carious dentine (25 cases) and infected pulps (12 cases) were also sensitive to the drug combination. These results may indicate that the bactericidal efficacy of the drug combination is sufficiently potent to eradicate bacteria from the infected dentine of root canals.

Anti-Bacterial Agents↗
PubMed2003

Lymphangiogenesis in human dental pulp.

AIM: To investigate the impact of inflammation on lymphangiogenesis in human dental pulp. METHODOLOGY: Eleven samples of dental pulp without inflammation and 11 dental pulps with moderate to intense mononuclear cell inflammatory infiltrate associated with dentine caries were selected. The streptavidin-biotin complex stain was used to detect CD31, vascular endothelial growth factor receptor-3 (VEGFR-3) and alpha-smooth muscle actin. The number of lymphatic vessels was obtained by counting the number of vessels positive for CD31 and VEGFR-3 and negative for alpha-smooth muscle actin. RESULTS: The results demonstrated that the mean number (+/-SD) of vessels positive for CD31 and VEGFR-3 (lymphatic vessels) in the group with inflammation (6.09 +/- 1.81) was statistically higher (P = 0.0123) than the mean number in the group without inflammation (3.73 +/- 2.20). CONCLUSION: Increased co-immunostaining of CD31 and VEGF-3 in vessels associated with human dental pulp inflammation occurred, which suggests lymphangiogenesis.

Actins↗
PubMed2003

Diagnosis and root canal treatment of a mandibular second premolar with three root canals.

AIM: To present a case of a mandibular second premolar with three root canals. SUMMARY: An accurate diagnosis of the morphology of the root canal system is a prerequisite for successful root canal treatment. A review of the literature reveals a low incidence of all types of premolars with three root canals. Diagnostic means such as preoperative radiographs and examination of the pulp chamber floor aid the location of root canal orifices. The diagnostic and therapeutic problems concerning premolars with unusual anatomy are described on the basis of a clinical example. A case report describes the successful treatment of a mandibular second premolar with three root canals. KEY LEARNING POINTS: Clinicians should be aware of unusual root canal anatomy in mandibular premolars. Radiographs exposed at two different horizontal angles and their careful interpretation facilitate the search of additional root canals. The use of magnification and additional lighting are recommended for the clinical examination of the pulpal floor.

Adult↗
PubMed2005

Influence of the pulpal components on human dentine permeability in vitro.

AIM: To examine the influence of the retained pulpal components on permeability of human dentine by monitoring drug diffusion. METHODOLOGY: Twelve intact dentine discs were prepared from freshly extracted human third molars. The dentine surface on the enamel side was etched with 10% polyacrylic acid for 30 s. The drug diffusion test was carried out before and after removal of the retained pulpal components. Each dentine disc was inserted between two plastic chambers; enamel- and pulpal-side chambers, which were filled with 0.05 mol L(-1) naproxen sodium (NA) and phosphate-buffered saline (PBS), respectively. After 10 min, the solution on the pulpal-side chamber was collected to determine the concentration of NA using a spectrophotometer. To remove the retained pulpal components and residual NA, the pulp chamber of each disc was washed out with PBS and placed in an ultrasonic cleaner. After removal of these components and the residual NA, the drug diffusion test was repeated. The inner surface of the pulp chamber was observed using scanning electron microscopy (SEM) before and after the removal of the retained pulpal components. RESULTS: The amount of NA that diffused through dentine into the pulp was significantly higher after the pulp chamber was washed out with PBS (paired t-test, P < 0.05). SEM observation demonstrated the presence of the retained pulpal components, odontoblastic layer and some parts of subodontoblastic zone, covering the surface of predentine. These components were removed after the pulp chamber was washed out with PBS followed by cleaning in an ultrasonic cleaner. CONCLUSIONS: The presence of retained pulpal components had a significant influence on drug diffusion through dentine discs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

The effect of capsaicin on substance P expression in pulp tissue inflammation.

AIM: To evaluate the effect of capsaicin on substance P (SP) expression during induced inflammation in rat pulp tissue. METHODOLOGY: Radioimmunoanalysis was used to measure SP levels in 36 mandibular molar pulps taken from six Wistar rats. Twelve samples were obtained from healthy pulps and used as negative control group. Another 12 samples were obtained after inducing inflammation with mechanical pulp exposure; these were used as the positive control group. Capsaicin was infiltrated into the inferior dental nerve in the experimental group and 12 samples were obtained after mechanical pulp exposure. RESULTS: The lowest SP expression was found in mechanically exposed pulps where capsaicin pretreatment had been carried out (0.028 ng mL(-1)), followed by healthy pulps (0.302 ng mL(-1)). The highest SP expression was found in mechanically exposed pulps with no capsaicin pretreatment (124 ng mL(-1)). The Kruskal-Wallis test showed statistically significant differences between the groups (P < 0.001). CONCLUSION: Inferior dental nerve infiltration with capsaicin reduces SP expression in dental pulp tissue in rats.

Animals↗
PubMed2005

Dental pulp capping: effect of Emdogain Gel on experimentally exposed human pulps.

AIM: To investigate the effect of Emdogain Gel (Biora AB, Malmo, Sweden), consisting of a enamel matrix derivative (EMD) in a propylene glycol alginate (PGA) vehicle, on experimentally exposed human pulps and to register postoperative symptoms. METHODOLOGY: Nine pairs of contralateral premolars scheduled for extraction on orthodontic indications were included. Following a superficial pulp amputation performed with a small (016) diamond bur, either EMDgel or a mix of calcium hydroxide and sterile saline was placed at random in contact with the pulp wound. The subjects made records of symptoms and were also interviewed about pain/discomfort by a blinded examiner. After 12 weeks the teeth were extracted, prepared and subjected to light microscopic examination in which the inflammation and newly formed hard tissue in the pulp were analysed. Immunohistochemistry was performed using affinity-purified rabbit anti-EMD polyclonal antibodies. RESULTS: Postoperative symptoms were less frequent in the EMDgel-treated than in the calcium hydroxide-treated teeth, especially during the first six weeks. In the EMDgel-treated teeth, new tissue partly filled the space initially occupied by the gel and hard tissue was formed alongside the exposed dentine surfaces and in patches in the adjacent pulp tissue. EMD was detected in the areas where new hard tissue had been formed. The wound area of the EMDgel-treated teeth exhibited inflammation in the majority of the teeth whereas less inflammation was seen in the calcium hydroxide-treated teeth where the hard tissue was formed as a bridge. CONCLUSIONS: In the EMDgel-treated teeth, postoperative symptoms were less frequent and the amount and pattern of hard tissue formation were markedly different than in the teeth treated with calcium hydroxide. However, the operative procedure and the formulation with EMD in a PGA vehicle do not seem to be effective for the formation of a hard tissue barrier.

Adolescent↗
PubMed2005

Upregulation of tissue-type plasminogen activator in inflamed human dental pulps.

AIM: To compare tissue-type plasminogen activator (t-PA) expression in normal human pulp and inflamed human pulp tissue specimens. METHODOLOGY: Thirty pulpal tissue specimens (13 normal and 17 inflamed pulps) were obtained from extracted third molars. The levels of t-PA between normal pulp and inflamed pulp tissues were compared using the quantitative reverse-transcriptase polymerase chain reaction analysis. In addition, immunohistochemistry was used to identify the in situ localization of t-PA expression in pulp specimens. Wilcoxon-Mann-Whitney rank sum test was applied for the statistical analysis of the results. RESULTS: t-PA mRNA gene was found more in inflamed pulps when compared with normal pulp tissue (P<0.05). The results from immunohistochemistry demonstrated that t-PA expression was significantly higher in the inflamed pulp (P=0.025). t-PA stain was detected in the fibroblasts, inflammatory infiltrates and endothelial cells. CONCLUSIONS: t-PA expression was significantly higher in inflamed pulp tissue. t-PA may play an important role in the pathogenesis of pulpal inflammation.

Dental Pulp↗
PubMed2005

Endodontic complications after plastic restorations in general practice.

AIM: To test the hypothesis that dentine and pulp protection by conditioning-and-sealing is no less effective than using a conventional calcium hydroxide lining. METHODOLOGY: A cohort of healthy adults requiring a new or replacement restoration in a posterior tooth was recruited in six general practices. All procedures received local Ethics Committee approval. Exclusion criteria included signs and symptoms of pulp necrosis or inflammation, and patients unable to commit to a long-term trial. Cavity preparations were randomized to receive a calcium hydroxide lining or conditioning-and-sealing with a smear-removing bonding system. Choice of bulk restorative material (composite resin or amalgam) was at the discretion of the dentist. The key outcome measure was evidence of pulpal breakdown identified at unscheduled (emergency) or scheduled recall examinations. Postoperative sensitivity was recorded on 100 mm VAS at 24 h, 4 days and 7 days. Pulp status was assessed at 6, 12, 24 and 36 month recall, and at any emergency recall appointment. The relationship between pre-treatment and treatment variables and pulp breakdown was assessed by logistic regression (P = 0.05). RESULTS: A total of 602 teeth were recruited, with comparable numbers of cavities lined (288, 47.8%) or conditioned and sealed (314, 52.2%). The majority (492, 81.7%) were replacement restorations, and amalgam was the most common bulk restorative material (377, 62.6%). A total of 390 (64.8%) restored teeth were reviewed at 6 months, 307 (51%) at 12 months, 363 (60.3%) at 24 months, and 279 (46.3%) at 36 months post-restoration. Sixteen cases of pulp breakdown were identified within 36 months of restoration placement, 11 presenting as emergencies and five detected at routine recall examination. Logistic regression showed that preoperative pain, cavity treatment by lining or conditioning-and-sealing and the use of rubber dam isolation had no association with pulp breakdown. Pulp breakdown was associated with deep or pulpally exposed cavities (P < 0.001, odds ratio 7.8) and with composite rather than amalgam restorations (P = 0.001, odds ratio 2.13). Re-coding to identify teeth with pulp exposures revealed that pulpal exposure was the key determinant of adverse pulp outcomes (P < 0.0001, odds ratio 28.4) and that composite resin restorations were again more likely to be associated with pulp breakdown than amalgam (P = 0.017, odds ratio 3.92). CONCLUSIONS: Considered within the context of routine primary dental care: Dentists can be confident that pulps will be equally well protected from post-restorative breakdown up to 36 months by calcium hydroxide lining and conditioning-and-sealing with adhesive resins. Residual dentine thickness appears to be a key determinant of pulp responses after restorative dental treatment. In deep and pulpally exposed cavities in posterior teeth, composites were associated with more pulpal breakdown than amalgams.

Acid Etching, Dental↗
PubMed2006

Incidence and antimicrobial susceptibility of Porphyromonas gingivalis isolated from mixed endodontic infections.

AIM: To investigate the prevalence of Porphyromonas gingivalis in root canals of infected teeth with periapical abscesses and to investigate the antimicrobial susceptibility of this species to some frequently prescribed antibiotics. METHODOLOGY: Samples were obtained from 70 root canals of abscessed teeth. Microbial sampling, isolation and bacterial identification were accomplished using appropriate culture methods for anaerobic species. The antimicrobial susceptibility of the 20 strains of P. gingivalis isolated was determined by using the E-test. The antimicrobial agents tested were amoxicillin, amoxicillin + clavulanate, azythromycin, benzylpenicillin, cephaclor, clindamycin, erythromycin, metronidazole and tetracycline. RESULTS: A total of 352 individual strains, belonging to 69 different species, were isolated. Eighty three percent of the strains were strict anaerobes and 47.5% of the isolated bacteria were Gram-negative. Porphyromonas gingivalis was found in 20 root canals and was most frequently found in symptomatic cases. Statistically, the presence of P. gingivalis was related to purulent exudates and pain on palpation (both P < 0.05). All P. gingivalis strains were sensitive to amoxicillin, amoxicillin + clavulanate, cephaclor, clindamycin, benzylpenicyllin, metronidazole and tetracycline. The lowest range of minimum inhibitory concentration (MIC) (0.026-0.125 microg mL(-1)) was observed against amoxicillin + clavulanate and clindamycin. The lowest MIC 90 was observed against clindamycin (0.064 microg mL(-1)). One strain was resistant to erythromycin and eight strains were resistant to azythromycin. CONCLUSION: Porphyromonas gingivalis pathogen is isolated with frequency from root canals of infected teeth with periapical abscesses. Amoxicillin, as well as amoxicillin-clavulanic acid and benzylpenicillin were effective against P. gingivalis.

Adolescent↗
PubMed2006

Delayed type allergic reaction following the use of nonlatex rubber dam during endodontic treatment.

AIM: To describe the development of a delayed type allergic reaction 24 h following the use of nonlatex rubber dam during endodontic treatment. The symptoms were alleviated with adequate medication; however, the patient rejected any further analysis. SUMMARY: In recent years, allergic reactions because of latex rubber dam and gloves have received more attention. Nonlatex products are advocated in clinical use in cases where the patient presents an allergic background. Although rare, adverse reactions may be encountered even with these products. In this article, a very rare case is presented in which a patient developed signs of allergy 24 h after the utilization of nonlatex rubber dam and gloves during endodontic treatment. Signs including visible redness on the mucosa, submucosal oedema and desquamation in the vestibular mucosa were observed. With proper medication, the signs and symptoms were alleviated. Although the patient was referred to an allergy specialist for patch testing, she did not accept any further analysis. KEY LEARNING POINTS: This case emphasizes the necessity of precautions during the management of latex-allergic patients in clinical practice. The unusual response encountered in this patient does not undermine the usefulness of nonlatex rubber dam and gloves in sensitive individuals.

Dermatitis, Allergic Contact↗
PubMed2006

Referred pain: a confusing case of differential diagnosis between two teeth presenting with endo-perio problems.

AIM: A case of a patient with a confusing referred pain is reported that emphasizes the importance of providing a differential diagnosis in order to avoid inappropriate treatment. SUMMARY: This article describes the management of a patient presenting with a combined endo-perio problem that was apparently treated adequately. After a short period of time, the reappearance of mild pain was misdiagnosed. The situation was more complicated when multiple diagnostic procedures were attempted and inadequate therapies were tried consecutively. When the true differential diagnosis was established and appropriate treatment provided, the symptoms disappeared and normal function returned. Diagnosis of teeth with necrotic pulps may be difficult to establish with possible reasons including inconclusive and poorly localized symptoms and signs. The situation can be further complicated if other teeth developing endodontic or combined endo-perio problems occur simultaneously as this may lead to misdiagnosis and treatment of the wrong tooth.

Adult↗
PubMed2006

Root canal treatment in Denmark is most often carried out in carious vital molar teeth and retreatments are rare.

AIM: To study the reasons given by a representative sample of Danish general dental practitioners (GDPs) for undertaking root canal treatment and, to investigate their confidence in performing root canal treatment on molar teeth. METHODOLOGY: A questionnaire was sent to 600 Danish GDPs randomly selected from the roster of the Danish Dental Association. They were asked to recall various factors about their experience of the last root filling they completed, including the reason for treatment and the pulp diagnosis. Self-assessments on 100-mm visual analogue scales (VAS) were reported concerning the confidence in performing root canal treatment of a molar. End-point definitions were 'very easy' (0) and 'very difficult' (100), respectively. Time reports of molar treatments were given in categorized groups. RESULTS: The most frequent reason for performing root canal treatment was caries within the tooth involved (55%). The majority of treatments involved teeth with vital pulps (54%). Retreatments were carried out in 2% of the cases. The confidence in performing root canal treatment varied but was relatively high, expressed as VAS-values below 50. The creation of an aseptic working field was regarded as the most difficult procedure followed by root canal preparation. Fifty-six percent of the responders stated a time frame of 46-75 min to complete root filling in a molar tooth. CONCLUSIONS: Root canal treatment in Denmark was reported to be undertaken most often because of caries. Treatment was typically performed in molar teeth with vital pulp. Even though apical periodontitis was frequently noted in root filled teeth, retreatments were rare. From a subjective perspective root canal treatment was not considered to be very difficult and was carried out relatively rapidly.

Analysis of Variance↗
PubMed2006

Cytokine-induced prostaglandin E2 production and cyclooxygenase-2 expression in dental pulp cells: downstream calcium signalling via activation of prostaglandin EP receptor.

AIM: To determine whether (i) proinflammatory cytokines stimulate prostaglandin E(2) (PGE(2)) production and cyclooxygenase (COX) gene expression in dental pulp cells, and (ii) pulp cells that express different prostaglandin E(2) receptor (EP) isoforms and their activation by PGE(2) leads to downstream Ca(2+) signalling. METHODOLOGY: Cultured human dental pulp cells were exposed to interleukin (IL)-1beta and tumour necrotic factor-alpha (TNF-alpha). The expression of COX-1 and COX-2 was measured with reverse transcriptase-polymerase chain reaction (RT-PCR). The production of PGE(2) was measured using an enzyme-linked immunosorbent assay. Expression of prostaglandin EP receptor isoforms was studied by RT-PCR, whereas fura-2 fluorescence was used to measure calcium mobilization. The Kruskal-Wallis test and Wilcoxon sum rank test with Bonferroni correction were used for statistical analysis. RESULTS: Interleukin-1beta and TNF-alpha stimulate PGE(2) production of human dental pulp cells (P < 0.05). IL-1beta stimulated the COX-2 but not COX-1 mRNA expression. Pulp cells express mainly EP2, EP3 and EP1 receptors as analysed by RT-PCR. PGE(2) (0.25-2 micromol L(-1)) stimulated the Ca(2+) mobilization as indicated by increase in fura-2 fluorescence. CONCLUSIONS: Interleukin-1beta and TNF-alpha may stimulate PGE(2) production in dental pulp cells. Activation of prostaglandin EP receptors in dental pulp cells by PGE(2) may induce Ca(2+) signalling to regulate cellular biological activity during inflammation.

Calcium Signaling↗
PubMed2006

Immunocytochemical investigation of immune cells within human primary and permanent tooth pulp.

AIM: The aim of this study was to determine whether there are any differences in the number and distribution of immune cells within human primary and permanent tooth pulp, both in health and disease. DESIGN: The research took the form of a quantitative immunocytochemical study. One hundred and twenty-four mandibular first permanent molars and second primary molars were obtained from children requiring dental extractions under general anaesthesia. Following exodontia, 10-microm-thick frozen pulp sections were processed for indirect immunofluorescence. Triple-labelling regimes were employed using combinations of the following: (1) protein gene product 9.5, a general neuronal marker; (2) leucocyte common antigen (LCA); and (3) Ulex europaeus I lectin, a marker of vascular endothelium. Image analysis was then used to determine the percentage area of immunostaining for LCA. RESULTS: Leucocytes were significantly more abundant in the pulp horn and mid-coronal region of intact and carious primary teeth, as compared to permanent teeth (P < 0.05, anova). Both dentitions demonstrated the presence of well-localized inflammatory cell infiltrates and marked aborization of pulpal nerves in areas of dense leucocyte accumulation. CONCLUSIONS: Primary and permanent tooth pulps appear to have a similar potential to mount inflammatory responses to gross caries The management of the compromised primary tooth pulp needs to be reappraised in the light of these findings.

Adolescent↗