Treatment of the inflamed dental pulp.
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Administration, Topical↗
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Replantation of avulsed teeth. A review.
Time is a critical factor in successful replantation. The avulsed tooth is simply washed and replaced immediately. Where contamination with soil occurs anti-tetanus prophylaxis is given and some form of splinting is necessary for 3-4 weeks. Endodontic therapy is performed prior to replacement if there is a delay of more than two hours and where apex formation is complete it should be commenced within 10 days. Calcium hydroxide is useful as a root canal dressing and in controlling resorption. The value of immediate replacement and treatment should be publicised.
Adolescent↗
Histological studies of an adhesive paint-on restorative for cervical erosions.
A histological study of the response in the pulps of human teeth to cervical restorations made with a composite resin following etching of the enamel for 2 minutes with 50 per cent phosphoric acid showed moderate inflammation after 14 days. Three specimens showed normal structure after 98 days. Teeth restored without etching showed only slight inflammation.
Composite Resins↗
The pulp. A big issue about a little tissue.
Difficulties in correlating pulp symptomology with available histopathological and biochemical data have hampered understanding of pulp reaction to stimuli. Some of the less well known biochemical cell and tissue regulatory systems are appraised. Pathways whereby such systems could be implicated in pulp function are suggested.
Animals↗
Effect of dentine thickness on pulpal changes beneath restorative materials.
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Dental Materials↗
Keeping the pulp alive: the pharmacology and toxicology of agents applied to dentine.
Materials applied to teeth release chemicals which may diffuse through dentine to either harm or help the dental pulp. Chemical threats are minimized by material choice or by using relatively impermeable lining or base materials which are themselves of low chemical toxicity. The most probable long-term threat to the pulp in the restored tooth is bacterial, through leakage around restorations. This may be prevented by the use of treatment sequences designed to develop an effective seal. Pulpal inflammation is treated primarily by removal of the irritant cause; inflammation may also be suppressed in the very short term by corticosteroids, and its resolution aided in the longer term by zinc oxide-eugenol preparations.
Demeclocycline↗
Antibiotics and endodontics.
Antibiotics can be used as an adjunct to endodontic treatment in a number of ways--locally, systemically and prophylactically. The local or intra-canal use of antibiotics in the form of medicaments is common. However, the commercially available agents for this purpose may not be the ideal mixtures. Systemic antibiotics should be restricted to patients who have local signs of infection, malaise and elevated body temperature. Prophylactic use of antibiotics has been recommended for patients 'at risk' of infective endocarditis, in some pre-surgical situations and following avulsion and replantation of teeth. The tendency towards indiscriminate antibiotic use should be discouraged. The use of broad spectrum drugs should be restricted so that these medications remain effective in serious situations.
Anti-Bacterial Agents↗
Pulpal reactions in rat incisors to Caridex.
This study examined the in vivo effects of Caridex, a chemomechanical caries removal system, on rat pulpal tissue. Rat incisors were opened and the pulps exposed to Caridex or physiological saline and sealed with calcium hydroxide. After various time periods, teeth were extracted and examined by light microscopy. Histological evaluation revealed an almost identical response in both test and control teeth which consisted of a transient inflammatory reaction and a limited necrosis in adjacent pulp tissue. Within seven days, formation of hard tissue matrix was seen below the necrotic area and on pulpal walls. It was suggested that the high pH of Caridex may have contributed to the necrotizing effect of calcium hydroxide in adjacent pulp tissue and the formation of hard tissue matrix. Additionally, the solution is most probably bactericidal. The results suggest that the system can be used as a caries removal agent on humans without unfavourable side effects on the dental pulp.
Aminobutyrates↗
Factors associated with continuing pain in endodontics.
A survey of 100 patients referred to a specialist endodontic practice was undertaken to determine the frequency of various factors associated with continuing pain after endodontic treatment had been commenced by the patient's general dental practitioner. Information was obtained by questioning the patient, examining the tooth, reviewing information supplied by the referring dentist and by observation during subsequent treatment. There were 23 different factors associated with continuing pain--all patients had more than one factor; most (78 per cent) had four, five or six factors; the highest was 9 factors (2 per cent). The most commonly occurring factors were: lack of use of rubber dam (87 per cent), unsatisfactory temporary restorations (80 per cent), and inappropriate use of intracanal medicaments (71 per cent). The other factors were related to diagnostic or treatment errors that could have been avoided in most cases. This survey suggests that dentists need to pay more attention to basic treatment recommendations in order to predictably relieve pain when carrying out emergency endodontics.
Adolescent↗
21st century endodontics. Part 1.
Root canal treatment techniques probably develop and change more frequently than any other area of dental practice and it can be hard for the busy general dental practitioner to keep up to date. The aim of this series of five papers is to give a thorough review of current teaching and practice. This will encompass the rationale of root canal treatment, guidance on the latest technical procedures for preparation and obturation of the entire root canal system, and consideration of how these principles may contribute to successful treatment. The series will address the following issues: diagnosis and treatment planning; root canal morphology and access; control of infection by effective isolation and anti-microbial agents; the philosophy of modern canal preparation techniques; single- or multi-visit treatment with relevant canal medication; obturation; diagnosis of failure and considerations in re-treatment. It is hoped that readers will be encouraged by the series to question their own techniques, audit their outcomes, and adopt new techniques only after careful reflection of the underlying principles involved.
Humans↗
Some aspects of equine dental radiology.
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Alveolar Process↗
Capacity of anaerobic bacteria from necrotic dental pulps to induce purulent infections.
Combinations of bacteria isolated from the root canals of teeth with necrotic pulps and periapical bone destruction were tested for their capacity to induce abscess formation and transmissible infections when inoculated subcutaneously into guinea pigs. Transmissible infections could be induced with combinations obtained from teeth with purulent apical inflammation, but not with combinations from symptomless teeth with chronic apical inflammation. All combinations which gave transmissible infections contained strains of Bacteroides melaninogenicus or B. asaccharolyticus (formerly B. melaninogenicus subsp. asaccharolyticus). The results suggest that purulent inflammation in the apical region in certain cases may be induced by specific combinations of bacteria in the root canal and that the presence of B. melaninogenicus or B. asaccharolyticus in such combinations is essential. However, with one exception, the strains needed the support of additional microorganisms to achieve pathogenicity. The results indicate that Peptostreptococcus micros was also essential. Histological sections of the lesions in the guinea pigs showed that all bacterial combinations induced acute inflammation with an accumulation of polymorphonuclear leukocytes and the formation of an abscess. However, the presence of B. melaninogenicus or B. asaccharolyticus in the combinations resulted in a failure of abscess resolution, with a gradually increaseing accumulation of polymorphonuclear leukocytes.
Animals↗
Quantitative analysis of diverse Lactobacillus species present in advanced dental caries.
Our previous analysis of 65 advanced dental caries lesions by traditional culture techniques indicated that lactobacilli were numerous in the advancing front of the progressive lesion. Production of organic acids by lactobacilli is considered to be important in causing decalcification of the dentinal matrix. The present study was undertaken to define more precisely the diversity of lactobacilli found in this environment and to quantify the major species and phylotypes relative to total load of lactobacilli by real-time PCR. Pooled DNA was amplified by PCR with Lactobacillus genus-specific primers for subsequent cloning, sequencing, and phylogenetic analysis. Based on 16S ribosomal DNA sequence comparisons, 18 different phylotypes of lactobacilli were detected, including strong representation of both novel and gastrointestinal phylotypes. Specific PCR primers were designed for nine prominent species, including Lactobacillus gasseri, L. ultunensis, L. salivarius, L. rhamnosus, L. casei, L. crispatus, L. delbrueckii, L. fermentum, and L. gallinarum. More than three different species were identified as being present in most of the dentine samples, confirming the widespread distribution and numerical importance of various Lactobacillus spp. in carious dentine. Quantification by real-time PCR revealed various proportions of the nine species colonizing carious dentine, with higher mean loads of L. gasseri and L. ultunensis than of the other prevalent species. The findings provide a basis for further characterization of the pathogenicity of Lactobacillus spp. in the context of extension of the carious lesion.
Colony Count, Microbial↗
Emergency dentistry for the general practitioner. II. Treatment of the primary conditions causing pain.
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Family Practice↗
Pulpal responses to caries and dental repair.
The dentine-pulp complex shows a broad spectrum of responses to caries of the dental tissues, which represents a summation of injury, defence and repair events taking place. The relative importance of these various events will reflect both the extent of disease activity and metabolic state of the tissues. This review examines the interplay between these events and the opportunities for tissue regeneration following caries.
Animals↗
Morphology of the nerve fibers in both normal and inflamed human dental pulp.
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Birefringence↗