Anaesthetic efficacy of 4% articaine compared with 2% mepivacaine: a randomized, double-blind, crossover clinical trial.

The aim of this study was to evaluate the clinical efficacy of 4% articaine (Ar4) compared to 2% mepivacaine (Me2), both in combination with 1:100,000 epinephrine, in a unique soft tissue model. This was a randomized, double-blind, crossover clinical trial. The anaesthetic was applied to the lower lip using a computerized local delivery system. The following were evaluated: blood flow, thermal sensation, pressure and proprioception, extent of anaesthesia, gradual elimination, and the final duration of the effect of the anaesthesia. Seventy-two volunteers completed all parts of the study. Significant differences, which indicated better effectiveness of Me2 compared to Ar4, were observed in the following tests: reduction in blood flow (larger in the Me2 group); anaesthetized area at 30min (larger in the Me2 group); pressure tests; temperature tests after 20min; fine and discriminatory proprioception tests after 20min. The volunteers' perception of anaesthesia at 30, 40, 50, and 60min was superior for Me2 at all recorded time points. The duration of anaesthesia was also superior for Me2. The overall performance of Me2 was superior to Ar4, implying that Me2 provides a more effective anaesthesia in terms of depth, extent, and duration.

Clinical evaluation of chlorhexidine for the control of dental biofilm in children with special needs.

OBJECTIVE: The aim of the present study was to assess two vehicles and forms of the in-home administration of chlorhexidine for the control of dental biofilm in children with special needs. BASIC RESEARCH DESIGN: Twenty-nine children aged seven to 12 years (mixed dentition phase) participated in the study. A double-blind, placebo-controlled, cross-over clinical trial was carried out with the following treatment groups: 1 - 0.12% chlorhexidine gel (CG); 2 - placebo gel (PG); 3 - 0.12% chlorhexidine spray (CS); 4 - placebo spray (PS). Ten-day experiment periods were separated by 15-day washout intervals. MAIN OUTCOME MEASURES: The parameters evaluated were plaque, gingival bleeding, and preferences of parents/caregivers. RESULTS: The initial conditions were similar in each phase of the experiment (p > 0.05). The treatments with chlorhexidine (gel and spray) achieved a significant reduction (p < 0.0001) in plaque and bleeding. The placebo treatments did not achieve significant differences (p > 0.05). The parents/caregivers preferred the administration of chlorhexidine in spray form. CONCLUSIONS: The topical administration of chlorhexidine associated to tooth brushing led to a reduction in dental biofilm and gingival bleeding in children with special needs. Administration in spray form proved easier and was preferred by parents/caregivers.

Clinical evaluation of three toothbrush models tested by schoolchildren.

AIM: The aim of this single-blind cross-over study was to compare the performance of three different toothbrush models in the control of dental biofilm and maintaining a healthy gingival condition. METHODS: Twenty-seven schoolchildren (aged 9-10 years) participated in the study. Three toothbrushes with different bristle arrangements were used: T1 - bristles on the same plane, straight arrangement; T2 - bristles on different planes, straight arrangement; T3 - bristles on different planes, straight and circular arrangement. The participants were then randomly divided into three groups for brushing with one of the three toothbrushes. Each experimental period lasted 15 days each, with three daily brushings and a 7-day washout interval was used between periods. The oral hygiene and gingival bleeding indices were recorded by a single, calibrated examiner blind to the brush used. Bristle wear was measured with a digital calliper at the end of each period. The data were analysed using parametric (anova and Student's t-test) and non-parametric (Cochran's Q and McNemar) tests. RESULTS: The toothbrushes achieved similar results (P>0.05) for the clinical parameters investigated. The three models exhibited a similar degree of bristle wear (P>0.05). CONCLUSION: The arrangement of the bristles had little influence over the removal of biofilm and gingival conditions. Thus, there is no clinical justification for replacing conventional toothbrushes with more expensive models.

Molar furcation entrance and its relation to the width of curette blades used in periodontal mechanical therapy.

AIM: The purpose of this research was to evaluate molar furcation entrances and the width of periodontal curette blades used in periodontal instrumentation. MATERIALS AND METHODS: One hundred extracted molars (50 upper and 50 lower) were analysed. The furcation entrances were measured using orthodontic wires of different predetermined diameters: 0.4, 0.5, 0.6, 0.7, 0.8 and 0.9 mm. McCall 17-18, Gracey 5-6 and Gracey 5-6 mini-five curette blades were measured at their anterior (AT), middle (MT) and posterior (PT) thirds by a single trained investigator, through the use of a digital caliper. RESULTS: The results showed significant differences (P < 0.0001) in relation to furcation entrances. The buccal upper molar furcations showed the narrowest dimensions. In relation to the blade diameter, significant differences among the instruments were found for their MT and PT (P < 0.0001), but not for the AT (P = 0.183). Significant differences were found among curette manufacturers. Nineteen per cent of evaluated furcations presented entrances <0.60 mm and 75% of the blades at their AT presented width >0.60 mm. CONCLUSIONS: These findings demonstrated that some molar furcation entrances could not be adequately instrumented with the tested curettes. The use of other hand instruments, such as periodontal files, rotating instruments and ultrasonic devices should be taken into consideration during periodontal therapy.

Severe necrotizing stomatitis and osteomyelitis after chemotherapy for acute leukaemia.

BACKGROUND: Leukaemia is a malignant neoplasm characterized by clonal proliferation of white blood cells within the bone marrow. Despite an increase in the white blood cell count, the leukaemic leukocytes are non-functional. The oral complications arising in leukaemic patients can be attributed to the direct and indirect effects of immunosuppressive chemotherapy. METHODS: This case report describes severe maxillary and mandibular necrotizing stomatitis and osteomyelitis in a young female patient after chemotherapy for acute leukaemia. On physical examination, the patient presented malnourished with pale skin, cervical lymphadenitis, frequent fever and generalized pain. The intra-oral clinical examination found halitosis, multiple ulcers, necrotizing stomatitis and osteomyelitis located in the maxillary and mandibular regions. The necrotizing stomatitis and osteomyelitis were treated locally with atraumatic removal of the necrotized tissues. The patient received a daily preventive protocol consisting of oral hygiene care, including twice daily brushing, and mouthrinses with a solution of chlorhexidine. She was also treated with systemic metronidazole and amoxicillin for 21 days. RESULTS: During the course of management the patient's oral condition improved with some re-epithelialization being noted. However, severe alveolar bone destruction remained evident. Thirty-two months after presentation of the initial symptoms, the patient died due to complications related to leukaemia recurrence (haemorrhage, sepsis and respiratory distress syndrome). CONCLUSIONS: Dental monitoring during cancer treatment is imperative in order to emphasize the importance of dental plaque control and the maintenance of a healthy periodontal condition throughout medical treatment.