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At least 1,207 records · Page 67Linked to original sources
PubMed1976

Origin, diagnosis, and treatment of the dental manifestations of vitamin D-resistant rickets: review of the literature and report of case.

Previous discussions center on early diagnosis, initial treatment, and follow-up therapy for the patient with vitamin D-resistant rickets. Both the medical and dental aspects of treatment for these patients has a long-range effect on the normal developmental patterns. Although treatment is begun at an early age, some rachitic skeletal effects such as minor bowing of the legs and bossing of the skull will invariably be noticed. In patients with controlled rickets the alveolar processes undergo normal development, with apparent normal dental eruption. The poor development and calcification of the alveolus seen in the untreated patient leads to loss of the lamina dura and periodontal ligament of the teeth. Patients with resistant rickets possess a functional dentition, although not without inherent defects. Various degrees of fracture and attrition of enamel can be seen, and hypoplasia of dentin is nearly a universal result. Defects extending to the dentinoenamel junction have been shown in repeated cases. Cementum, because of its close relationship with dentin calcification, also appears abnormal. Pulp tissue may undergo abberations of physiology in resistant rickets, although further work in this respect is needed. With respect to the possible dental pathoses seen in this disease, the dental history of the patient with resistant rickets discussed in this report showed that several of the deciduous teeth, possibly the mandibular left second premolar and right first molar, and definitely the maxillary right second premolar and canine and the mandibular left canine had all undergone pulpal degeneration of apparently unknown causation. In the maxillary right second premolar and the mandibular left canine, enamel fractures were clinically and radiographically apparent. However, the maxillary right canine originally had an acute abscess with no defects other than normal, minimal wear facets. No causative factor for its necrosis could be found. Overt enamel fractures in the maxillary right second premolar and the mandibular left canine may have led to microexposures of the pulp with subsequent bacterial pulpal contamination. Suppuration present in several of the pulps when first entered during endodontic treatment, as well as chronic fistulas in several areas, support the conclusion that contamination by some means does indeed occur.

Abscess↗
PubMed1977

Endodontic classification.

Clinical and histopathologic findings are mixed in current endodontic classifications. A new system, based on symptomatology, may be more useful in clincial practice. The classifications are vital asymptomatic, hypersensitive dentin, inflamed-reversible, inflamed/dengenerating without area-irreversible, inflamed/degenerating with area-irreversible, necrotic without area, and necrotic with area.

Acute Disease↗
PubMed1978

Human pulpal response to citric acid cavity cleanser.

Treatment of cavities with citric acid cavity cleanser, also used as an etchant, before restoration with zinc oxide-eugenol cement, was toxic to the human dental pulp in comparison to sham-treated controls. The cleanser caused a significantly (P less than .01) greater intensity and incidence (P less than .01) of inflammation. The added insult from cleanser pretreatment caused destruction of the odontoblast processes withnin the cut dentinal tubules, and an increase in diameter of the tubules. These effects on dentin and odontoblasts probably contributed to the observed increase in adverse pulp responses.

Adolescent↗
PubMed1979

Pulpal response in rhesus monkeys to cementation agents and cleaners.

The purpose of these studies was to compare pulpal inflammatory responses induced by cementation of precision amalgam inlays with zinc phosphate cement, with and without a Hydroxyline liner, Durelon cement, and ZOE controls. Hydraulic force was induced by the inlay insertion procedure. Cavilax, water, and polyacrylic acid were compared with ZOE controls. Both studies also used untreated teeth for comparison. The use of zinc phosphate luting cement in the 48-hour inlay study was the only condition provoking moderate to severe responses. Zinc phosphate cement over Hydroxyline liner and Durelon cement in the study of inlays and Cavilax cleaner, water, and polyacrylic acid in the study of cleaners showed mild responses comparable to the ZOE control in the 48-hour and in the 45-day periods.

Acetone↗
PubMed1992

Managing local anesthesia problems in the endodontic patient.

Root canal therapy has a poor public image related to occasional and sometimes severe pain, and to dentists' inability to obtain profound anesthesia. Patients' apprehension, in combination with tissue inflammation, significantly lowers the pain threshold, which decreases the anesthetic's effectiveness. The best and also the first approach to achieving anesthesia is to administer a conventional block or infiltration. If profound anesthesia does not occur after this attempt, use a supplemental technique such as lingual infiltrations, PDL or intrapulpal injections. Because infiltrations are generally not effective, PDL and intrapulpal injections are preferred. The PDL is better than the intrapulpal injection because it is non-painful, safe and usually effective. The intrapulpal injection is limited and may be uncomfortable. Administer both the PDL and intrapulpal injections under back-pressure to achieve effective, but short-lived anesthesia. Special injection devices (for example, pressure syringes for the PDL) are not required for either technique. Two anesthetic types are useful. Administer 2 percent lidocaine with epinephrine for conventional and supplemental injections. For emergencies and long procedures, administer 0.5 percent bupivacaine with epinephrine to provide effective, long-lasting anesthesia and analgesia.

Anesthesia, Dental↗
PubMed1995

The endodontic-periodontal lesion: a rational approach to treatment.

When a periapical lesion communicates with a deep periodontal pocket, the etiology can be either endodontic or periodontal. This article clarifies the relationship between pulpal and periodontal disease and presents a systematic approach to the diagnosis and management of endodontic-periodontal lesions. It also presents a case that demonstrates the successful treatment of teeth that appear to be hopelessly diseased.

Dental Pulp Necrosis↗
PubMed1997

Pulpal response to cavity preparation by an erbium, chromium:YSGG laser-powered hydrokinetic system.

The near red-pulsed erbium, chromium:yttrium-scandium-gallium-garnet laser hydrokinetic system, or Er,Cr:YSGG laser HKS, is effective in cutting dental hard tissues. In this longitudinal study, the authors studied the continuously erupting open-apex incisors of New Zealand albino rabbits and the constricted apex teeth of beagles to determine the effects of HKS-produced lesions at various energy levels and of preparations produced by a tapered fissure bur on dental pulp. No pulpal inflammatory responses could be identified either immediately or 30 days after surgery in HKS preparations that removed enamel and dentin without pulp exposure.

Aluminum Silicates↗
PubMed2000

Postoperative pulpal and repair responses.

BACKGROUND: Each year in the United States, the success of 10 million surgically restored carious lesions depends on a favorable tertiary dentin repair response to preparation, restoration and patient factor variables. The authors investigated the relationship between these variables and dentinal response. METHODS: Standardized rectangular Class V restoration preparations were cut into the buccal dentin of intact first or second premolars of 27 patients without exposing the pulp and were restored. The patients were between 9 and 17 years of age. The treated teeth were scheduled for extraction for orthodontic reasons. After tooth extraction, the tertiary dentin was analyzed histomorphometrically. RESULTS: The area of tertiary reactionary dentin was found to be correlated using linear regression analysis of variance with restoration residual dentin thickness (P = .0024), age of the patient (P = .0045), restoration floor surface area (P = .0266) and restoration width (P = .0415). The authors did not find a correlation with the premolar position (P = .0594), sex of the patient (P = .650), pulpal inflammatory reaction (P = .613) or the time elapsed since surgery (P = .531). Restoration with zinc oxide eugenol was found to negatively influence tertiary dentin matrix secretion (post hoc analysis of variance, P = .030). CONCLUSIONS: The age of a patient at treatment, the choice of restorative material and the size of the restoration preparation are all factors that can positively or negatively affect the pulpal repair response. CLINICAL IMPLICATIONS: Age of the patient affects dentin repair capacity and may be a factor in treatment planning decisions. Minimizing the cutting of dentin, especially the width and base of the preparation, reduces the probability of recurrent pulpal complications.

Adolescent↗
PubMed2001

Restorative pulpal and repair responses.

BACKGROUND: Each year, about 90 million new restorations are placed in the United States and 200 million are replaced. Controversy surrounds the pulpal reactions and frequency of bacterial microleakage associated with common restorative materials. The authors investigated and compared pulpal reactions to different types of restorative materials. METHODS: Two hundred seventy-two teeth with standardized rectangular Class V unexposed cavities were restored with resin-based composite bonded to dentin; resin-based composite bonded to enamel; resin-modified glass ionomers, or RMGI; amalgam lined with zinc polycarboxylate, or ZnPC; amalgam lined with calcium hydroxide, or Ca(OH)2; or zinc oxide-eugenol, or ZnOE. Teeth were extracted for orthodontic reasons between 20 and 381 days later. The authors categorized pulpal responses according to standards set by the Federation Dentaire Internationale and the International Organization for Standardization. Bacteria were detected using Brown-Brenn-stained sections. Pulpal responses were evaluated using histomorphometric analysis and analysis of variance statistics. RESULTS: The results showed that RMGI was the best material for preventing bacterial microleakage, and resin-based composite bonded to enamel was the worst. In regard to minimizing pulpal inflammatory activity, ZnOE was the best material and resin-based composite bonded to enamel was the worst. In terms of maximizing odontoblast survival beneath deep cavity preparations, Ca(OH)2, was the best material and RMGI was the worst. CONCLUSIONS: The results show that bacterial microleakage, pulpal injury and repair responses varied widely with different restorative materials. CLINICAL IMPLICATIONS: The authors recommend that RMGI be used to restore teeth with cavities that are shallow to moderate in depth, with the floor of deep cavities being lined with Ca(OH)2 before the teeth are restored with RMGI.

Adolescent↗
PubMed2002

Anticipated and experienced pain associated with endodontic therapy.

BACKGROUND: The authors compared the levels of anticipated and experienced pain of patients who received endodontic therapy, or ET, with selected patient and dental characteristics. METHODS: Sensory and affective pain outcome measures (pain and unpleasantness) were evaluated by 333 adult patients immediately before and after dental school faculty or residents performed ET. Dentists provided clinical evaluations and a pulpal diagnosis for each tooth and then rated the level of their patients' pain during treatment. RESULTS: Before ET, 43 percent of all patients anticipated high outcome levels, yet only 22 percent experienced high pain levels, and only 18 percent experienced high unpleasantness levels. Outcome levels did not differ by tooth type, pulpal diagnosis, ET history or dental care attendance. Women were significantly more likely to anticipate higher pain and unpleasantness levels than were men. Experienced outcome levels, however, did not differ by sex. Anticipated and experienced outcome levels significantly decreased with increasing age. Dentists' evaluation of their patients' pain levels correlated more highly for female than for male patients. CONCLUSIONS: Pain experienced during ET often is less than anticipated. Younger people anticipate and experience higher pain levels. Women are more likely than men to anticipate, but not necessarily experience, higher pain levels. Dentists are more closely attuned to the pain experiences of their female patients. Clinical Implications. Practitioners could better prepare younger patients and female patients for ET and improve pain communication with male patients. Findings suggest that patients perceive each ET experience as new, implying that dentists should manage patients who have had ET in the past as carefully as those receiving ET for the first time.

Adolescent↗