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PubMed1992

Influence of teeth, alveoli, and periodontal ligaments on torsional rigidity in human mandibles.

We investigated the influence of teeth, periodontal ligaments, and alveoli on the structural integrity of human mandibles loaded in torsion. Surface bone strain was recorded from the mandibular corpus below the first molar on each of four specimens. These specimens were loaded by an external force that caused primarily torsion about the long axis of the corpus, and bone strain was recorded under the following conditions: 1) all supporting structures intact, 2) all supporting structures intact and the M1 loaded by a simulated bite force, 3) M1 removed and 4) alveolar bone of the M1 removed. For comparative purposes, experiments were also designed to investigate the effects of intermittent holes on the torsional rigidity of a baboon femur. This permitted comparison of the mechanical behavior of the mandibles with that of a more homogeneous bony member. These experiments suggest that the presence of teeth within alveoli has a measurable role in the maintenance of torsional rigidity. The condition of the periodontal ligament also appears to influence these stress-bearing capabilities. Moreover, the alveolar bone supporting the teeth also provides structural support for countering torsional loads. For the specific case of corpus twisting, the mandible does not behave as a member with open or closed sections as predicted by theoretical models. The observed magnitudes of bone strain, however, conform more closely to the predictions generated by a closed-section model.

Adult↗
PubMed1982

A case control study of Creutzfeldt-Jakob disease: association with physical injuries.

Sixty cases of Creutzfeldt-Jakob disease reported from 902 neurological clinics throughout Japan between 1975 and 1977 were examined in a retrospective case control study. Histories were obtained from patients, sex-matched neighbors, and spouses. No association was observed in either sex with five socioeconomic variables; exposures to eight species of animals; ingestion of raw meat or quadruped brains; eighteen diseases, allergies or immunizations; tooth extraction; blood transfusion; or lumbar puncture. Surgical operations within five years before disease onset were reported for 25.9% and 7.8% of male patients and pooled controls and for 24.2% and 9.6% of female patients and controls. Mechanical injuries were observed for the same period in 33.3% and 9.8% of male patients and controls and in 18.2% and 13.5% of female patients and controls. The operations and mechanical injuries varied in all groups as to body parts affected and nature of the lesions. Physical injuries including operations may be a predisposing factor to the development of Creutzfeldt-Jakob disease.

Creutzfeldt-Jakob Syndrome↗
PubMed1984

The relative analgesic efficacy of propiram fumarate, codeine, aspirin, and placebo in post-impaction dental pain.

To evaluate the analgesic efficacy of orally administered 50 mg propiram fumarate, 650 mg aspirin, 60 mg codeine phosphate, and placebo in acute post-impaction dental pain, 159 patients with moderate or severe pain were randomly allocated to the four treatments in this single-dose double-blind, stratified, parallel-group study. A research nurse questioned the patients at 1/2 hour and hourly for 6 hours after medicating. A standard format was used to question subjects about their pain intensity and relief from the starting pain. Propiram, 50 mg, produced a level of analgesia approaching that of 650 mg aspirin in peak effect, total effect, and duration of action and was statistically superior to 60 mg codeine and placebo for every measure of analgesic efficacy. Several mild adverse effects were observed; however, they appeared to be evenly distributed among the active treatments.

Adolescent↗
PubMed1992

Comparison of the efficacy and safety of ketorolac and meperidine in the relief of dental pain.

A single-dose, randomized, double-blind study of parallel design was conducted to determine the analgesic efficacy and safety of ketorolac tromethamine in patients who experience moderate or severe pain after the surgical removal of three or more third molars, one of which was a bony-impacted mandibular molar. Meperidine hydrochloride was used as the control analgesic. In this 8-hour study, assessments were made of pain intensity, pain relief, and overall rating of the medication in 145 patients, each of whom had received an intramuscular injection of 10 mg, 30 mg, or 90 mg of ketorolac, or 50 mg or 100 mg of meperidine. The summed pain intensity and total pain relief scores showed that, at 3 and 8 hours, the effectiveness of 30 mg of ketorolac was similar to that of 90 mg ketorolac and that both of these doses were significantly more efficacious than 10-mg ketorolac, 50-mg meperidine, or 100-mg meperidine. Patients who received 30 mg or 90 mg of ketorolac gave the study medication significantly higher ratings overall than did patients who received 50 mg or 100 mg of meperidine. Significantly fewer patients treated with ketorolac reported adverse events in comparison with those treated with meperidine (17% and 59%, respectively), which suggests that it possesses a better therapeutic index than meperidine. Thus, ketorolac appears to represent an important advance in analgesic therapy.

Analgesics↗
PubMed1998

Analgesic efficacy and safety of (R)- ketoprofen in postoperative dental pain.

This double-blind, randomized, parallel-group study compared the analgesic efficacy and safety of single doses of (R)- ketoprofen 25 mg and 100 mg to that of acetaminophen 1,000 mg and placebo in 177 patients experiencing moderate to severe pain after surgical removal of their impacted third molars. Both (R)- ketoprofen 100 mg and acetaminophen 1,000 mg were significantly (P < 0.05) more efficacious than placebo for all summary analgesic measures. Other than a more rapid analgesic onset (45 minutes versus 60 minutes) for acetaminophen 1,000 mg, (R)- ketoprofen 100 mg and acetaminophen 1,000 mg were statistically equivalent to each other. The 25 mg dose of (R)- ketoprofen appeared to approach the analgesic threshold dose, being numerically but not statistically superior to placebo for all summary measures. There were no serious adverse events observed in this study, with the overall incidence of side effects being somewhat less in the (R)- ketoprofen groups than in the acetaminophen 1,000 mg group. (R)- Ketoprofen possesses analgesic activity and an acceptable side-effect profile in the oral surgery pain model.

Acetaminophen↗
PubMed2001

Dental health knowledge and attitudes of regularly attending mothers of high-risk, pre-school children.

AIM: The aims of this study were to discover the knowledge of and attitudes towards dental health of a group of regularly attending mothers of young children at high-risk of caries, and to evaluate their toothbrushing techniques. METHOD: As part of the baseline examination of a randomised controlled trial to test the influence of dental health counselling on the caries increment of at-risk pre-school children, 268 mothers of 334 children completed a questionnaire enquiring about their dental health knowledge and attitudes, and were also observed brushing their children's teeth. RESULTS: Although most mothers (71%) knew that they should brush their children's teeth twice a day using a small toothbrush (94%) only 52% knew that they should use only a small pea-sized amount of paste, and only 3% knew the recommended level of fluoride in toothpaste for these at-risk children. 40% of the children insisted on brushing their own teeth and 40% of the mothers brushed their children's teeth inadequately. Although three-quarters of the mothers knew that sugary foods and drinks should be consumed only at mealtimes, only 7% knew the four foods and drinks supplying most sugar to a child's diet. Although three-quarters of mothers thought that dental decay in milk teeth was very important, only half wanted their children's carious teeth restored. CONCLUSION: Knowledge, attitudes and behaviour about dental health among these regularly attending mothers of at-risk, pre-school children were superficial. Their attitudes to dental health of primary teeth were equivocal and their demonstrated brushing behaviour on the part of their children was inadequate.

Attitude to Health↗
PubMedDate not supplied

Evaluation of the analgesic efficacy of ibuprofen.

Ibuprofen is a derivative of propionic acid that was originally marketed in the United States as an antirheumatic agent in 1974. In 1979, it was approved for use as an analgesic. Of the 18 published double-blind clinical trials reviewed, only 6 were well designed. These six studies provide strong evidence that ibuprofen is effective for dental pain due to tooth extractions, dysmenorrhea and episiotomy pain. Thus, ibuprofen appears to be an effective drug for mild to moderate pain. It is as effective or more effective than aspirin, codeine or propoxyphene. Recommended initial dosage is 300 mg every six hours, increasing as needed to 400 mg every four hours. Adverse effects are relatively minor and infrequent.

Anesthesia, Dental↗
PubMed1993

Bone loss in the oral cavity.

Bone loss in the oral cavity may occur due to many causes, including infection, systemic or local alterations in the host response, or multifactorial causes. The purpose of this article is to review our present understanding of the major causes of oral bone loss in adults, with special emphasis on two major oral diseases: periodontitis and residual ridge resorption. Periodontitis is characterized by resorption of the alveolar bone as well as loss of the soft tissue attachment to the tooth. Progressive periodontitis will result in continued alveolar bone loss and may result in tooth mobility, abscesses, and ultimately tooth loss. Although the reported prevalence may vary according to the epidemiologic study design, the 1985 National Survey of Oral Health of United States Adults indicated that 94% of female senior citizens examined demonstrated at least one site with at least 2 mm loss of attachment. Resorption of alveolar bone that occurs following tooth extraction is termed residual ridge resorption. In many cases, the denture will loosen because of the inability of the resorbed ridge to stabilize the prosthesis. In the most severe cases, the denture may impinge on the exposed mandibular nerve, resulting in pain or total inability to tolerate the prostheses. Although clear statistics on the prevalence of residual ridge resorption are not available, this boss loss may result in the need for new dentures to replace ill-fitting prostheses.

Adult↗
PubMed1989

Laser dentistry: a new application of excimer laser in root canal therapy.

We report the first study of the application of excimer lasers in dentistry for the treatment of dental root canals. High-energy ultraviolet (UV) radiation emitted by an XeCl excimer laser (308 nm) and delivered through suitable optical fibers can be used to remove residual organic tissue from the canals. To this aim, UV ablation thresholds of dental tissues have been measured, showing a preferential etching of infiltrated dentin in respect to healthy dentin, at laser fluences of 0.5-1.5 J/cm2. This technique has been tested on extracted tooth samples, simulating a clinical procedure. Fibers of decreasing core diameters have been used to treat different sections of the root canal down to its apical portion, resulting in an effective, easy, and fast cleaning action. Possible advantages of excimer laser clinical applications in respect to usual procedures are also discussed.

Fiber Optic Technology↗
PubMed2004

Preoperative intravenous tramadol versus ketorolac for preventing postoperative pain after third molar surgery.

The objective of this study was to compare the analgesic efficacy of a single-dose of preoperative intravenous tramadol versus ketorolac in preventing pain after third molar surgery. Sixty-four patients undergoing elective third molar surgery were randomly assigned into one of the two groups (32 in each group): Group I received tramadol 50 mg, and Group 2 received ketorolac 30 mg intravenously preoperatively before the surgery. After injection of the study drugs, a standard intravenous sedation technique was administered and the impacted third molars were removed under local anaesthetic. The difference in postoperative pain was assessed by four primary end-points: pain intensity as measured by a 100-mm visual analogue scale hourly for 12 h, median time to rescue analgesic, postoperative acetaminophen consumption, and patient's global assessment. Throughout the 12-h investigation period, patients reported significantly lower pain intensity scores in the ketorolac versus tramadol group (P = 0.05, Mann-Whitney U-test). Patients also reported significantly longer median time to rescue analgesic (9.0 h versus 7.0 h, P = 0.007, log rank test), lesser postoperative acetaminophen consumption (P = 0.02, Mann-Whitney U-test) and better global assessment (P = 0.01, chi2 test) for the ketorolac versus tramadol group. Preoperative intravenous ketorolac 30 mg is more effective than tramadol 50 mg in the prevention of postoperative dental pain.

Acetaminophen↗
PubMed1992

Erythema nodosum of dental origin.

The association of erythema nodosum and dental infectious foci has rarely been described in the literature. This report concerns four women who developed erythema nodosum either following dental treatment associated with gingival bleeding or due to infectious dental foci. In these cases, tooth extraction, removal of dental deposits, interrupted pulp treatment, apical periodontitis, or a relicted root were identified as causes of the development of erythema nodosum. Upon admission to the hospital, these patients also presented fever and and a maximally elevated erythrocyte sedimentation rate (ESR). In all instances, surgical treatment of the dental foci and/or administration of antibiotics rapidly led to the regression of the erythema nodosum, as well as to the normalization of body temperature and ESR. The cases described indicate that antecedent dental treatment and the possible presence of infectious dental foci should be considered in the differential diagnosis of erythema nodosum when taking the patient's medical history. This approach may avoid unnecessary, possibly invasive diagnostic procedures and can lead to rapid improvement in the patient's clinical status.

Adult↗
PubMed1983

Ultrastructural study of transganglionic degeneration following dental lesions.

Transganglionic degeneration in the trigeminal main sensory nucleus (MSN) and pars interpolaris (PI) was studied in cats following dental lesions. At early survival times, three types of terminal alteration were seen in both MSN and PI: (1) flocculent degeneration, (2) neurofilamentous hyperplasia and, (3) glycogen accumulation. With longer survival times, the magnitude of these terminal alterations increases. Electron dense degeneration was only seen in the ventral half of PI. Phagocytosis of the altered terminals was also observed. The study suggests a plausible explanation for the variations observed in the CNS projection of primary afferents with degeneration and with HRP transport studies.

Animals↗
PubMed1993

Prevention of postoperative swelling and pain by dexamethasone after operative removal of impacted third molar teeth.

In a placebo-controlled double-blind study, we examined the effect of perioperative oral administration of 6 mg dexamethasone, given once 12 h before and once 12 h after osteotomy of two impacted molar teeth, on postoperative edema, limitation of jaw opening, and intensity of postoperative pain. On the first day after surgery the difference in the increase in cheek swelling was 54.3% (P < 0.001) as measured with a tape, 46% (P < 0.001) measured with a gauge in the first molar area and 29% (P < or = 0.056) by sonographic measurement of the cheek diameter in the molar area. The limitation in the jaw opening was reduced by 17.7% (P < 0.002) after dexamethasone. Pain assessed by visual analog scale was reduced by dexamethasone by 50% (P < 0.01). The amount of analgesics required postoperatively (codeine phosphate) was reduced by 37% (P = 0.02) following dexamethasone administration. Seventy-six percent of our patients preferred perioperative medication of dexamethasone.

Administration, Oral↗
PubMed1992

In vitro formation of mineralized nodules by periodontal ligament cells from the rat.

The purposes of this study were to determine whether periodontal ligament (PDL) cells are capable of producing mineralized nodules in vitro and to analyze ultrastructural features of the nodules. Rat PDL cells were obtained from coagulum in the socket at 2 days after tooth extraction and cultured at confluence in standard medium containing Dulbecco's Modified Eagle's Medium supplemented with 10% FBS and antibiotics. To test mineralized nodule formation, cells were further cultured for an additional 3 weeks in the standard medium containing (1) ascorbic acid (50 micrograms/ml) and sodium beta-glycerophosphate (10 mM), (2) ascorbic acid, sodium beta-glycerophosphate, and dexamethasone (5 microM), or (3) ascorbic acid alone. Cells were then fixed in 2.5% glutaraldehyde, postfixed in 1% OsO4, and prepared for light and electron microscopy. Three-dimensional nodules containing mineralized matrices were formed only when the cells were cultured in the presence of ascorbic acid and dexamethasone. They were composed of multilayered fibroblasts (up to 13 layers), and highly organized collagen fibrils with 64 nm cross-banding patterns between the cell layers. The fibroblasts in the nodules exhibited an elongated shape with a high degree of cytoplasmic polarity throughout the nodule, and have the morphological features of PDL fibroblasts as seen in vivo. Mineral deposition with needle-like crystals was initiated on collagen fibrils located in intercellular spaces of the upper cell layers and became increasingly heavier towards the bottom half of the nodules. X-ray microanalysis and electron diffraction analysis confirmed that mineral deposition contained calcium and phosphate in the form of immature hydroxyapatite.(ABSTRACT TRUNCATED AT 250 WORDS)

Alkaline Phosphatase↗
PubMed1995

Synthesis of noncollagenous extracellular matrix proteins during development of mineralized nodules by rat periodontal ligament cells in vitro.

To characterize the mineralized nodules produced by rat periodontal ligament (PDL) cells in vitro, we have studied the synthesis and distribution of mineralized tissue proteins at various stages of nodule formation. PDL cells were obtained from coagulum in the socket at 2 days after tooth extraction and cultured in Dulbecco's Modified Eagles Medium (DMEM) containing 10% fetal bovine serum and antibiotics. Confluent cells were grown in the presence of ascorbic acid (50 micrograms/ml), dexamethasone (5 microM), and beta-glycerophosphate (10 mM) for 3 weeks. Four stages showing distinct morphological characteristics during development of mineralized nodules were identified. Protein synthesis and deposition of proteins into the matrix were studied during these stages by metabolic labeling with [35S]methionine for 24 hours. Large quantities of SPARC (secreted protein, acidic and rich in cysteine) were synthesized by confluent cells but decreased during the progress of mineralized nodule formation. Two forms of osteopontin (OPN) (67 kDa and 61 kDa) were synthesized in comparable quantities by confluent cells; OPN and bone sialoprotein (BSP) were induced by dexamethasone and represented the major proteins in the mineralized matrix. The 67 kDa form of OPN was the predominant species in the mineralized matrix. Both OPN and BSP were localized by immunogold electron microscopy on globular as well as fused electron-dense structures at sites of tissue mineralization.

Animals↗
PubMed1977

Influence of transcutaneous nerve stimulation (TNS) on acute pain.

Using transcutaneous nerve stimulation (TNS) simple surgical procedures such as tooth extractions and nerve biopsies can be performed without the usual anesthetics. Estimation of threshold and suprathreshold intensities of painful electrical stimuli show no significant change during TNS. Only the threshold for non-painful electrical stimuli is slightly increased. Cortical potentials evoked by electrical peripheral nerve stimulation are not significantly modulated by TNS. Latencies of the early components 0, I--III are unchanged, the amplitudes only slightly reduced. These observations are in contradiction to the 'gate-control' theory of pain.

Acute Disease↗
PubMed1985

Familial occurrence of dermatomyositis and progressive scleroderma after injection of a local anaesthetic for dental treatment.

In an 11-year-old boy severe dermatomyositis occurred a few days after injection in the jaw of a local anaesthetic of the amide type for tooth extraction. The patient's grandmother was affected by progressive scleroderma at the age of 34 years, also after injection of a local anaesthetic for dental treatment. Both cases are discussed with special reference to the immuno-genetic aspects of the origin of dermatomyositis.

Adult↗