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PubMedDate not supplied

Case report: dental considerations for managing a patient undergoing I-131 treatment for Graves' disease.

General dentists face many challenges when managing patients in an urgent care situation. Patients undergoing radioactive iodine therapy for Graves' disease pose a particular challenge, as they may exhibit a wide variety of symptoms during the active treatment phase. Proper management during the quarantine phase of treatment also involves a specific protocol for effective patient care.

Adult↗
PubMed1992

Effects of selected inflammatory mediators on blood flow and vascular permeability in the dental pulp.

One of the major events involving inflammatory processes is the alteration of microcirculatory hemodynamics by inflammatory mediators released from tissue components. Using modern macrocirculatory techniques, 15 mu radioisotope labeled microspheres, 133Xe washout, laser Doppler flowmetry and double isotopes, 125 and 131I-albumin, and microcirculatory methods, intravital fluorescence microscopy with FITC labeled dextran, we have examined the effects of selected mediators, e.g. 5-hydroxytryptamine (5-HT), prostaglandin E2 (PG-E2), bradykinin (BK), substance P (SP), calcitonin gene related peptide (CGRP) and histamine on blood flow and vascular permeability in the pulp of experimental animals. Surprisingly, SP and CGRP caused weak albumin leakage in the pulp, while the opposite is true in high compliance tissues, such as muscles, suggesting that the vessels in a low compliance environment, such as the pulp, may not be as permeable in response to selected mediators. Intraarterial injection of 5-HT caused a strong vasoconstriction which was mediated by 5-HT1p receptor subtype. The pulpal 5-HT receptor subtype was identified by immunocytochemistry, receptor autoradiography and functional investigations. Intravital fluorescence microscopy observations of the rat incisor preparation showed that histamine, BK and PGE2 increased permeability, whereas isoproteranol caused partial inhibition of the BK-induced increase. In an induced pulpal inflammation model using plaque extract, blood flow increased over 40% in the moderately inflamed pulp, which demonstrated severe vasodilation and polymorpholeukocyte accumulation. In the partially necrotic pulp, blood flow decreased nearly 35%. Results of this study clearly show that there is a high structural/functional correlation in pulpal microcirculation in inflammation. As demonstrated in this presentation, the effects of inflammatory mediators on pulpal microcirculatory hemodynamics are complex.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Tissue pressure and blood flow in pulpal inflammation.

The initial vascular reactions during inflammation are vasodilation and increased vessel permeability. Both these basic reactions cause increased pulpal fluid volume. In the dental pulp the inflammatory vascular reactions take place in a rigid enclosed dentin chamber, which to some extent makes the pulp vulnerable. Due to this lack of distensibility any gain in pulpal volume will necessarily increase the pulpal tissue pressure. If the tissue pressure rises to the same level as the blood pressure it will compress the pulpal vessels, thus counteracting a beneficial blood flow increase during inflammation. Using the micropuncture technique and laser Doppler flowmetry we have performed simultaneous measurements of tissue pressure and blood flow in the cat dental pulp during neurogenic inflammation. Sensory nerve stimulation caused a rise both in blood flow and tissue pressure. Our findings thus strongly suggest that the increased pulpal tissue pressure promote fluid absorption back into the blood. If, in theory, plasma proteins and other macromolecules had leaked out during sensory nerve stimulation they must have been successfully removed by lymphatics, unless the tissue pressure would have risen to the same level as the capillary blood pressure causing a fall in PBF. This was not found. On the contrary, increased blood flow was measured, even in experiments lasting for more than 8 hours. It is therefore concluded that the pulp may have a beneficial blood flow increase during inflammation in spite of simultaneously increased tissue pressure.

Animals↗
PubMed1992

Pathophysiological roles of arachidonic acid metabolites in rat dental pulp.

Arachidonic acid metabolism in normal rat incisor pulp was examined by measuring the conversion activity of exogenously added arachidonic acid in pulpal homogenates. It was demonstrated that the major metabolites were 12-hydroxyeicosatetraenoic acid and prostaglandin (PG) I2. Immunohistochemical studies revealed that PGI2 synthase was distributed in the pulpal blood-vessel cells, fibroblasts and odontoblasts, suggesting that PGI2 may contribute to regulating the function of these cells. When the incisor pulp was experimentally inflamed by applying lipopolysaccharide, arachidonic acid metabolism in the pulp showed overall increase. Change in the pulpal vascular permeability, which was assessed by quantifying the amount of extravasated dye, was almost parallel to the changes in PGE2 and PGI2 production. When production of the PGs was inhibited by indomethacin, the increase of vascular permeability in the inflamed pulp was also suppressed. Topically-applied PGE2 and PGI2 methyl ester abolished the suppression of increase in vascular permeability by indomethacin. These results suggest that PGE2 and PGI2 may be involved in the increase of vascular permeability in the experimental pulp inflammation. We further measured the production of leukotriene (LT) B4 in the inflamed pulp by incubating isolated pulp samples with Ca ionophore A23187, followed by radioimmunoassay. Change in LTB4 production was revealed to be almost parallel to that of neutrophil infiltration. BW755C, an inhibitor of both cyclooxygenase and lipoxygenase, reduced both LTB4 production and neutrophil infiltration. Accordingly, it was suggested that LTB4 may be involved in neutrophil infiltration in the experimental pulp inflammation.

Animals↗
PubMed1992

The effects of capsaicin on pulpal blood flow.

One of the initial events in pulpal inflammation has been characterized as neurogenic inflammation: the release of neuropeptides following excitation of sensory C-fibers by noxious stimuli which alters microcirculatory parameters, that is, vasodilation and plasma extravasation. Thus, the purpose of the study was to investigate the effect of capsaicin on pulpal blood flow (PBF) with the aim of understanding neurogenic inflammation in the dental pulp by characterizing the response of the pulpal vasculature to repeated applications of various concentrations of capsaicin. Experiments were performed on canine teeth of cats anesthetized with sodium pentobarbital. PBF was measured by the laser Doppler flowmeter following the application of capsaicin into the dentinal cavities of the canine teeth. The increases of PBF to capsaicin were 31.8 +/- 6.3% (n = 6) and 54.2 +/- 6.2% (n = 9), for 1 microM and 100 microM capsaicin, respectively. The increase of PBF peaked at about 50 sec after the capsaicin placement and the PBF returned to control level within 20 min following capsaicin removal. Four repeated applications of 1 microM capsaicin caused a small change in the peak PBF amplitude. In contrast, a second application of 100 microM capsaicin caused a significantly smaller increase of PBF than the first application (26.8 +/- 6.4% vs. 54.2 +/- 6.2%). Results of the present study show that local application of capsaicin caused the increase of PBF and that repeated capsaicin stimulations inhibited PBF responses. Smaller PBF increases in response to high concentrations of capsaicin also suggested the depletion of vasoactive substances, e.g. substance P, from the sensory nerve terminals, which appears to be dose-dependent. The PBF response to capsaicin suggests that neurogenic inflammation in the dental pulp involves capsaicin-sensitive nerve endings.

Animals↗
PubMed1992

Effects of inflammation on dental sensory nerves and vice versa.

A brief review of the normal sensory innervation of teeth is presented, especially concerning the fibers that are immunoreactive (IR) for calcitonin gene-related peptide (CGRP). Numerous CGRP-IR fibers innervate coronal dentin at sites populated by primary odontoblasts and associated pulp cells that synthesize nerve growth factor (NGF). If the primary odontoblasts and adjacent pulp cells are lost as a consequence of injury, CGRP-IR dentinal innervation is greatly reduced. The responses of CGRP-IR nerve fibers to pulpal injury are reviewed. Those reactions show that pulpal sensory nerve fibers can alter the size, shape and immunoreactivity of their terminal branches in response to different stages of inflammation and healing.

Animals↗
PubMedDate not supplied

Mandibular second molar with C-shaped canal morphology and five canals: report of a case.

This article reviews a case involving endodontic treatment of a mandibular second molar with C-shaped canal morphology and five separate canals. The C-shaped canal variation of morphology is unusual and can lead to difficulties during treatment. Preoperative radiographs are limited in their ability to detect this entity; for a favorable treatment outcome, knowledge of the C-shaped canal's existence and morphology is essential.

Adult↗
PubMed1995

Tooth sensitivity associated with the use of luting cements.

Luting Cements are still a source of frustration to the dentist. None of the cements currently available satisfies everyone, including the patient. The problems encountered when trying to obtain adhesion to a wet substance such as dentin are well-known (Christensen, 1994). The cause of postcementation sensitivity continues to a perplexing problem.

Crowns↗
PubMed2004

Aetiology, classification and pathogenesis of pulp and periapical disease.

At present, the majority of the treatments that are performed in the clinic are due to disease entities involving the dental pulp and periapex. Dental pulp is a richly vascularized and innervated tissue, enclosed by surrounding tissues that are incapable of expanding, such as dentin. It has terminal blood flow and small-gauge circulatory access the periapex. All of these characteristics severely constrain the defensive capacity of the pulp tissue when faced with the different aggressions it may be subjected to. Pulp tissue can also be affected by a retrograde infection, arising from the secondary canaliculi, from the periodontal ligament or from the apex during the course of periodontitis. Due to the fact that periapical disease is almost inevitably preceded by pulp disease, we shall begin by describing the causes of pulp disease and will then proceed to a discussion of the causes of periapical disease. The course of illness and classification of these pathological entities will depend on the aetiology involved. We will analyse pulp necrosis and pulp degeneration that are capable of triggering reversible apical periodontitis or irreversible apical periodontitis.

Dental Pulp Necrosis↗
PubMed1992

Effect of acid etching on the dental pulp in adhesive composite restorations.

Pulpal response to marginal enamel etching or both enamel and dentine etching with 37% phosphoric acid for adhesive composite restorations was studied in the teeth of the Japanese monkey (Macaca fuscata). Dentine etching irritated the pulp and caused moderate to severe initial changes along the odontoblastic layer at 3 days. When no bacteria were present along the cavity walls, the subsequent pulpal reactions at 30 and 90 days decreased with time and large amounts of irritation dentine were formed. These inflammatory reactions were less than those caused by enamel etching only, or zinc oxide/eugenol cement. Significant correlation (P less than 0.01) was found between the intensity of the inflammatory reactions and the degree of bacterial infection. The pulpal irritation caused by acid etching of dentine for composite restorations is transitory only when the fillings have a good marginal seal and wall adaptation.

Acid Etching, Dental↗
PubMed2005

[Association between Bacteroides forsythus in the infected root canals and clinical symptoms of chronic apical periodontitis].

OBJECTIVE: To investigate the distribution of Bacteroides forsythus in root canals with chronic apical periodontitis and to determine its associations with clinical symptoms. METHODS: Thirty-eight tooth root canals from 31 subjects were studied with a 16S rDNA-directed polymerase chain reaction (PCR). These teeth were classified into symptomatic and asymptomatic groups according to the clinical symptoms and signs, including spontaneous pain, percussion pain, sinus tract and swelling, respectively. RESULTS: Ten of the 38 root canal samples were positive for B. forsythus. The prevalence of B. forsythus was 26.3% for 38 root canals, 45.5% for spontaneous pain group, 39.1% for percussion pain group, 29.4% for sinus tract group, 42.9% for swelling group, respectively. Significant positive associations were observed between B. forsythus in infected root canals and the spontaneous pain, percussion pain, and swelling of apical periodontitis, respectively (OR=infinity, 9, 12; P<0.05). There was no significant association between B. forsythus and sinus tract of apical periodontitis (OR=1.33). CONCLUSION: B. forsythus colonized in the infected root canals. It is the putative pathogen of apical periodontitis.

Adolescent↗
PubMed2005

Current concepts in vital pulpotomies in primary teeth.

Vital pulpotomies in primary teeth are performed to maintain the vitality of the pulp and to hold the tooth until it can be normally exfoliated. There exists much controversy surrounding the issue of pulpotomy agents, and the ideal pulp dressing material has not yet been identified. Therefore, it seems that formocresol will still be the first choice for pulpotomies in primary teeth until such agent is identified.

Aluminum Compounds↗
PubMed2005

[Clinical evaluation of two types of NiTi rotary instruments in preparation of root canals].

OBJECTIVE: To evaluate clinical effects of two types of nickel-titanium rotary instruments in preparation of molars' root canals. METHODS: 100 molars with pupal and periapical involvement were instrumented by Protaper and Hero642 files with crown-down technique. All teeth were obturated with lateral condensation method. Straightening of canal curvature was determined. The efficiency of preparation and obturation was analyzed with radiograph before, during and after operation. RESULTS: The operating time of each NiTi group was short. The two NiTi rotary instruments could achieve continuously tapered root canal shape. The curvature of the canal reduced by -4.02 degrees +/- 2.80 degrees with Protaper and 1.72 degrees with Hero642 (P < 0.001). Five pieces of Protaper with broken, whereas no Hero642 was broken (P < 0.05). CONCLUSIONS: Protaper, Hero642 files showed good shaping ability and improved predictability in root canal obturation. Protaper can lessen canal curvature more significantly. Hero642 files are easy to operate and not easy to separate.

Adult↗
PubMedDate not supplied

Response of human pulp capped with a bonding agent after bleeding control with hemostatic agents.

PURPOSE: This study evaluated the response of human pulps capped with a bonding agent after bleeding control with different hemostatic agents. MATERIAL AND METHODS: Twenty-five Class II cavities were prepared in 25 caries-free human premolars scheduled for extraction due to orthodontic treatment. The pulp exposures were performed on the occlusal floor. The teeth were randomly divided into five groups. Groups 1-4 were capped with an adhesive system after hemostasis with different agents: Group 1--saline solution; 2--ferric sulfate; 3--2.5% NaOCl; 4--Ca(OH)2 solution. In Group 5, after hemostasis with saline solution, the pulp was capped with calcium hydroxide (control group). Then, ScotchBond Multi Purpose Plus was applied and the resin composite Z-100 placed incrementally according to the manufacturers' directions. After 60 days, the teeth were extracted and processed for light microscopic examination (HE) and the groups were categorized in a histological score system. The data were subjected to a non-parametric test (alpha=0.05). RESULTS: Overall, the histological features showed that the pulp response from Groups 1 through 4 was inferior to the response from Group 5, where dentin bridging occurred. In all groups, where the adhesive system was used for capping, the pulp response varied from an acute inflammatory, with varying degrees, to necrosis. No dentin bridge was formed after adhesive capping.

Adolescent↗
PubMed2004

[Radiographic evaluation of the quality of root canal filling in a dental teaching hospital].

OBJECTIVE: To evaluate the quality of root canal filling performed by dentists and advanced dental trainees (ADTs) and the current level of continuing education in a dental teaching hospital. METHODS: 2 043 cases, randomly completed by six dentists and eight ADTs over half a year, were divided into two groups. The quality of root canal filling was analyzed radiographically. RESULTS: The overall percentage of the adequate root filling was 49.6%. The percentages of the adequate teeth filling and root canals filling (59.9%; 63.9%) by dentists were significantly higher than those (40.1%; 47.4%) by ADTs. In addition, the frequency of the adequate root canals filling by ADTs in the last two months (57.8%) was significantly higher than that in the first two months (40.0%), and the adequate filling rate by ADTs during the last two months was close to that by dentists. CONCLUSIONS: The quality of root canal filling performed by dentists was adequate. There was a substantial improvement for ADTs in filling quality after six months training.

Dental Pulp Cavity↗