Common dental and periodontal diseases: evaluation and management.

Physicians may encounter patients with dental and periodontal diseases in the context of outpatient medical practice. It is important for physicians to be aware of common dental and periodontal conditions and be able to assess for the presence and severity of these diseases. This article reviews common dental and periodontal conditions, their cardinal signs and symptoms, outpatient-setting assessment techniques, as well as common methods of treatment. Physicians detecting gross abnormalities on clinical examination should refer the patient to a dentist for further evaluation and management.

The protective effect of recombinant FomA-expressing Lactobacillus acidophilus against periodontal infection.

A number of studies have shown that the outer membrane protein FomA found in Fusobacterium nucleatum demonstrates great potential as an immune target for combating periodontitis. Lactobacillus acidophilus is a useful antigen delivery vehicle for mucosal immunisation, and previous studies by our group have shown that L. acidophilus acts as a protective factor in periodontal health. In this study, making use of the immunogenicity of FomA and the probiotic properties of L. acidophilus, we constructed a recombinant form of L. acidophilus expressing the FomA protein and detected the FomA-specific IgG in the serum and sIgA in the saliva of mice through oral administration with the recombinant strains. When serum containing FomA-specific antibodies was incubated with the F. nucleatum in vitro, the number of Porphyromonas gingivalis cells that coaggregated with the F. nucleatum cells was significantly reduced. Furthermore, a mouse gum abscess model was successfully generated, and the range of gingival abscesses in the immune mice was relatively limited compared with the control group. The level of IL-1ß in the serum and local gum tissues of the immune mice was consistently lower than in the control group. Our findings indicated that oral administration of the recombinant L. acidophilus reduced the risk of periodontal infection with P. gingivalis and F. nucleatum.

[Abscess at the implant site following apical parodontitis. Hardware-related complications of deep brain stimulation]. / Abszess in der Impulsgeneratortasche nach apikaler Parodontitis. Eine Hardware-assoziierte Komplikation nach tiefer Hirnstimulation Hardware-related complication of deep brain stimulation.

Deep brain stimulation of the subthalamic nucleus is an important treatment option for advanced stages of idiopathic Parkinson's disease, leading to significant improvement of motor symptoms in suited patients. Hardware-related complications such as technical malfunction, skin erosion, and infections however cause patient discomfort and additional expense. The patient presented here suffered a putrid infection of the impulse generator site following only local dental treatment of apical parodontitis. Therefore, prophylactic systemic antibiotic treatment is recommended for patients with implanted deep brain stimulation devices in case of operations, dental procedures, or infectious disease.

[Pain during and after root canal treatment]. / Bestrijding van pijn bij de wortelkanaalbehandeling.

Toothache can be prevented or remedied with a root canal treatment. Unfortunately a root canal treatment can also be the cause of pain. During a root canal treatment pain can be suppressed by local anesthesia, the use of the airotor, the attitude of the dentist and his communication with the patient. Afterpain has three causes: damage and iatrogenic apical periodontitis, pulpitis and continuing apical periodontitis. In this article the possible treatment of pain by a root canal treatment are extensively discussed.

Tooth loss due to periodontal abscess: a retrospective study.

This retrospective study focused on the frequency of tooth loss due to periodontal abscess among 42 patients who were treated by a single clinician over a 5- to 29-year period. A total of 114 patients were selected from the active periodontal recall schedule of a single periodontist at The University of Iowa College of Dentistry. The criteria for inclusion in the study included having a history of moderate to advanced periodontitis, being on 3 to 6 month recall periodontal maintenance care, and completion of active periodontal therapy prior to October 1987. Other parameters evaluated were age; gender; number of teeth present and missing at the initial, reevaluation, and last periodontal recall visit; initial periodontal prognosis; furcation involvement; non-surgical and surgical periodontal therapy; and reasons for tooth loss. Patients were grouped according to the number of teeth lost following active periodontal treatment into well-maintained (0 to 3), downhill (4 to 9), and extreme downhill (10 to 23) groups. Forty-two of the 114 patients were identified as having one or more periodontal abscesses. A total of 109 teeth were affected by periodontal abscess of which 49 (45%) teeth were lost and 60 (55%) were successfully maintained over an average of 12.5 years (5 to 29 years). More furcated teeth were lost than nonfurcated teeth and teeth given a hopeless prognosis were lost more consistently than those given a questionable prognosis in all groups. The frequency of periodontal abscess and tooth loss per patient was greater in the downhill and extreme downhill response groups than the well-maintained group. This suggests that teeth with a history of periodontal abscess can be treated and maintained for several years.

Protective immunity to Porphyromonas gingivalis infection in a murine model.

The mouse abscess model has been used extensively to demonstrate protection after challenge with periodontopathic organisms. In the present study, an outer membrane (OM) preparation of P. gingivalis ATCC 33277 was used to immunize BALB/c mice prior to challenge with live P. gingivalis organisms. This OM preparation, particularly at the highest dose level of 100 micrograms/immunization, was able to induce high levels of specific antibody and subsequent protective immunity. Protection in all immunized mice was noted by the rapid healing of the primary lesions, a low incidence of secondary lesions, and, in the highest dose group, an absence of septicemia. Non-immunized animals demonstrated a slower development as well as healing of primary lesions, with higher numbers and larger sizes of secondary lesions. Weight loss and behavior patterns such as hunched bodies, ruffled hair, and stiffness of the hind legs were particularly noted in this group. Depletion of CD4 T cells in mice prior to immunization with 100 micrograms P. gingivalis OM resulted in significantly depressed serum levels of anti-P. gingivalis antibody and an increase in the physical signs of disease compared with both the immunized and control groups. Western blot analysis demonstrated three antigen bands (63.3, 50.1, and 45.1) recognized by all immunized groups and also the control non-immunized group, although the latter recognition occurred only after challenge. A further antigen band of 36.1 kDa was recognized by sera from the highest dose group only. This study has demonstrated the ability of P. gingivalis OM to provide protection against challenge with live P. gingivalis organisms. The increased physical signs of disease seen in the CD4 depleted animals compared with the control group not only illustrate the protective role of serum antibody, but also suggest a possible role for T cell mechanisms in control of the lesion locally. The ability of specific OM antigens to provide similar protective immunity remains to be ascertained.

Diagnóstico diferencial e tratamento dos abscessos periodontal e periapical agudo / Diagnosis differential and tratment of periapical abcess and acute periodontal

Säo feitas consideraçöes clínicas quanto ao diagnóstico e tratamento dos abscessos periodontal e periapical agudo. Discuti-se os principais recursos semiotécnicos para o diagnóstico diferencial de ambas as lesöes visando o atendimento de emergência do paciente

Serial doxycycline and metronidazole in prevention of recurrent periodontitis in high-risk patients.

The efficacy of metronidazole and doxycycline in preventing recurrent periodontitis was studied in 23 patients. After treatment in the previous 7 months with either bimonthly scaling and 3 weeks of systemic doxycycline (11 subjects) or scaling and placebo (12 subjects), patients were monitored for recurrent periodontitis and were scaled every 2 months. When either a periodontal abscess or greater than 2 mm loss of gingival attachment was observed, metronidazole was administered (250 mg every 8 hours) for 10 days. In the placebo plus metronidazole group, 5 patients (42%) exhibited recurrent periodontitis after the metronidazole regimen compared with only one (9%) in the doxycycline plus metronidazole group (P less than 0.096). Subgingival plaque samples at study and healthy control sites were screened for the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Eikenella corrodens, and Fusobacterium nucleatum by immunofluorescence and for spirochetes using Ryu's stain. Presence/absence analysis of the sum of scores of the 6 individual pathogens demonstrated large reductions (P less than 0.005) in the frequency of detection of pathogens in the former doxycycline compared with the placebo plus metronidazole group at both study and control sites before and one month after metronidazole. By 7 months after metronidazole, there was no detectable difference between groups. These results indicate that prevention of recurrent periodontitis with metronidazole may be enhanced by previous treatment with doxycycline.

Randomized controlled trial of doxycycline in prevention of recurrent periodontitis in high-risk patients: antimicrobial activity and collagenase inhibition.

82 patients with a recent history of periodontal abscesses and/or loss of gingival attachment (GAL) despite active periodontal therapy were enrolled in a double-blind, randomized, placebo-controlled trial. Clinical measurements and subgingival scaling were performed every 2 months. If any site exhibited greater than or equal to 2 mm loss of GAL or a periodontal abscess, patients were administered either 100 mg Doxycycline per day for 3 weeks or placebo. During 12 months of monitoring, 55 patients exhibited recurrent active disease and were then randomly assigned to either the Doxycycline or placebo groups. Clinical measurements of GAL and microbiological culture of subgingival bacteria were made at intervals between 1 week and 7 months after completion of the drug regime. Within 7 months, 15 out of 19 patients on placebo exhibited recurrent disease compared to 13 out of 29 patients on Doxycycline, a relative risk reduction of 43% (p less than 0.05) for Doxycycline compared to placebo. Minimal inhibitory concentrations of Doxycycline for subgingival plaque samples from active sites ranged between 25-100 micrograms/ml, which are several fold higher than reported crevicular fluid concentrations for this drug. However gingival crevicular fluid collagenase was inhibited in vitro at concentrations of 5-10 micrograms/ml Doxycycline. These data indicate that Doxycycline provides significant risk reduction of recurrent periodontitis in patients with active disease.

[Complications in root canal therapy]. / Complicaties bij de kanaalbehandeling.

Several factors prior to, during and after treatment may complicate root canal therapy. In this article several of these complications are discussed together with their possible solutions to these problems.

Apexification in a nonvital tooth by control of infection.

Incomplete formation of roots in permanent dentition because of death of the pulps is fairly common. Various pastes are used in apexification procedures. It has been suggested that minimum mechanical intervention and removal of infection alone may be sufficient. A case is reported in which this was observed.