Evaluation of the efficiency of antibiotics in treating adult patients with symptomatic apical periodontitis: A protocol for systematic review and meta-analysis.

BACKGROUND: When a person feels dental pain, it brings great discomfort and damages the quality of life. Symptomatic apical periodontitis is identified as the most frequent cause that triggers dental pain. Symptomatic apical periodontitis arises from an infection or inflammation in the pulpless root canal structure. According to clinical guidelines, the primary form of therapy for such teeth entails removing the inflammation or infection source through local surgical procedures. Presently, systemic antibiotics are recommended only for cases where there is clear indication of an infectious spread or a systemic involvement. Therefore, this study aims to assess the efficacy and level of safety of using antibiotics to treat adult symptomatic apical periodontitis patients. METHODS: The present protocol study will conduct a search on electronic databases to look for randomized controlled trials (RCTs) that have evaluated the effectiveness and safety of antibiotics when used to treat adult patients with symptomatic apical periodontitis. The databases will be search from their beginning to April 2021. The search is not bound by publication status or language restrictions. The following databases will be searched: Web of Science, PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure, and EMBASE. This study will employ ZETOC Conference Proceedings and OpenGrey to identify potential grey literature. Afterwards, 2 independent authors will select the studies, extract data from the studies, and conduct a risk assessment to check for bias. All discrepancies between the authors will be resolute via discussion involving a third independent author. The data synthesis and statistical analysis of this study will be done with the RevMan software (Version: 5.3). RESULTS: The present protocol report will provide high-quality evidence related to the efficacy and level of safety when using antibiotics to treat mature symptomatic apical periodontitis patients. CONCLUSION: The outcomes of the present study will update the evidence available for assessing the efficacy and safeness of using antibiotics to treat mature symptomatic apical periodontitis patients. ETHICS AND DISSEMINATION: This study does not require an ethical approval since individual patient data is not included in any form. REGISTRATION NUMBER: DOI 10.17605/OSF.IO/CVP8 M (https://osf.io/cvp8m/).

Conditioned fear stress increases bone resorption in apical periodontitislesions in Wistar male rats.

OBJECTIVE: Because the impact of conditioned fear stress on apical bone resorption is unknown, the aim of the current studywas to use a rat model to evaluate the impact of conditioned fear stress on the bone resorption of inflammatory apical periodontitis lesions. METHODS: Twenty-five animals were divided into two groups. They underwent a surgical procedure in the first left lower molar tooth to expose the dental pulp and induce inflammatory apical periodontitis lesions through the retention of contamination (bacterial infection) during a 56-day period. The animals in the case group were stressed daily by using electrical stimuli (1.10 mA), whereas the animals in the control group were absent from the stressful stimuli (shocks). The open field test was performed to validate the stress methodology. The jaws were removed and collected for histological and radiographic analyses. RESULTS: Stressed animals presented increased levels of bone loss and inflammatory cells in the root apex in comparison with the control group (P = 0.0001). However, no radiographic differences were observed between the groups (P > 0.05). CONCLUSIONS: Our results demonstrated that conditioned fear stress could modify a periapical lesion by increasing the size of bone loss there. Conditioned fear stress also increased the total number of inflammatory cells compared with the control group. Studies evaluating the impact of conditioned fear stress on human periapical inflammatory lesions should be encouraged.

Patients' Values Related to Treatment Options for Teeth with Apical Periodontitis.

INTRODUCTION: This study aimed to explore patients' values when selecting treatment for a tooth with apical periodontitis (AP), namely retention via root canal treatment (RCT) and extraction without replacement or replacement with implant-supported crowns or fixed or removable partial prostheses. METHODS: Through 2 surveys of patients (800 university patients and 200 community patients, response rate = 43%) and dentists (498 Ontario endodontists, periodontists, prosthodontists, oral and maxillofacial surgeons, response rate = 40% and 1983 Ontario general dentists, response rate = 15%), the importance of values that might be considered important to patients when selecting treatment options for a tooth with AP were recorded. Chi-square and Kendall's tau tests were used to respectively compare the importance rating frequency by each surveyed group and its correlation to their demographic variables (P ≤ .05). RESULTS: Patients considered communication and trust (94%), tooth retention (90%), esthetic outcome (84% regardless of location), cost (83%), longevity (83%), and preoperative pain (81%) as the most important decision values. Dentists overrated the importance of patients' previous experience with the treatment options (94% vs. 72%), dental insurance (90% vs. 70%), and intraoperative pain (79% vs. 60%) while underestimating the importance of maintenance cost (60% vs. 79%). CONCLUSIONS: Dentists should respect patients' views about esthetic outcome, longevity, and cost associated with treatment options for a tooth with AP. In particular, this survey highlights the value of communication and trust between patient and dentist and preservation of the natural tooth through RCT over implant-supported crown replacement when planning treatment for a tooth with AP.

Clinical decision making for a tooth with apical periodontitis: the patients' preferred level of participation.

INTRODUCTION: To effectively engage patients in clinical decisions regarding the management of teeth with apical periodontitis (AP), there is a need to explore patients' perspectives on the decision-making process. This study surveyed patients for their preferred level of participation in making treatment decisions for a tooth with AP. METHODS: Data were collected through a mail-out survey of 800 University of Toronto Faculty of Dentistry patients, complemented by a convenience sample of 200 patients from 10 community practices. The Control Preferences Scale was used to evaluate the patients' preferences for active, collaborative, or passive participation in treatment decisions for a tooth with AP. Using bivariate and logistic regression analyses, the Gelberg-Andersen Behavioral Model for Vulnerable Populations was applied to the Control Preferences Scale questions to understand the influential factors (P ≤ .05). RESULTS: Among 434 of 1,000 respondents, 44%, 40%, and 16% preferred an active, collaborative, and passive participation, respectively. Logistic regression showed a significant association (P ≤ .025) between participants' higher education and preference for active participation compared with a collaborative role. Also, immigrant status was significantly associated with preference for passive participation (P = .025). CONCLUSIONS: The majority of patients valued an active or collaborative participation in deciding treatment for a tooth with AP. This pattern implied a preference for a patient-centered practice mode that emphasizes patient autonomy in decision making.

A survey of patients' preferences for the treatment of teeth with apical periodontitis.

INTRODUCTION: This research aimed to investigate the preference of patients in Toronto, Canada for management of a tooth affected by painful apical periodontitis when considering its retention via root canal treatment (RCT) and its extraction followed by no replacement, replacement with an implant-supported crown, fixed, or removable partial prostheses. METHODS: Data were collected through a mail-out survey of the University of Toronto Faculty of Dentistry patients, which was complemented by a convenience sample of patients in 10 community practices in Toronto (n = 1000, response rate = 43%). Participants were asked to select their general preference for anterior and posterior teeth with apical periodontitis between saving the tooth or extraction and their specific preference for tooth retention via RCT or extraction. By using bivariate and logistic regression analyses, we applied the Gelberg-Andersen Behavioral Model for Vulnerable Populations to the preference questions to understand the influential factors (P ≤ .05). RESULTS: Participants' specific preference for tooth retention via RCT was slightly but significantly lower than their general preference (anterior tooth, 93.7% versus 97.2%; posterior tooth, 83.8% versus 89.6%; P < .005). Higher annual income, previous RCT, functional dentition, good/excellent self-rated oral health, and regular dental visits were associated with higher preferences for tooth retention in response to different questions. CONCLUSIONS: The high preference for retaining a tooth in general was moderated by the specific consideration of RCT to retain the tooth. When RCT and extraction are viable options, patients should be advised about the treatment options in an impartial manner and encouraged to communicate their preferences.

Quality of life after microscopic periradicular surgery using two different incision techniques: a randomized clinical study.

AIM: To monitor the quality of life of patients after periradicular surgery when two different flap designs were used. METHODOLOGY: Forty patients with teeth having a periradicular lesion of endodontic origin were included according to specific selection criteria. Patients were randomly assigned to two groups. In one group a sulcular incision (SI) with complete papilla mobilization was made, and in the other group a papilla-base incision (PBI) was used. Periradicular surgery was performed using a surgical microscope. Parameters related to life quality were recorded daily in the first week post-surgery using a questionnaire. Pain was evaluated with a 0-100 visual analog scale (VAS). Other symptoms (swelling, bleeding and nausea), plus functions (chewing, speaking, sleeping, daily routine and work) were assessed using a five-point scale. Analgesic intake was recorded. Fisher's test and unpaired t-test were used to assess the difference between groups. RESULTS: The VAS score for pain, and the scores for swelling, chewing and phonetic impairment, peaked on days 1 and 2 postoperatively. A significant difference in favour of the PBI group was found for chewing and swelling in the first 4 days. Starting from day 3 post-surgery, the PBI group reported a significantly more rapid decrease in pain levels and analgesics use than the SI group (P < 0.05). The other parameters were similar in the two groups. CONCLUSIONS: The papilla-base incision technique may be preferred as reduction of pain levels, swelling and drug intake were more rapid in the first week postoperatively compared with cases in which a sulcular incision was used.

Socio-economic risk indicators for apical periodontitis.

OBJECTIVE: The aim of this study was to reveal possible socio-economic risk indicators for apical periodontitis. MATERIAL AND METHODS: In 1992-93 a representative sample of women in Göteborg, Sweden, aged 38-84 years, participated in a medical and dental survey (n=981) which included dental and medical examinations and dental radiographic examination (OP). The dependent variable was apical periodontitis (AP=0, AP>0). The independent variables were age, number of teeth, number of restored teeth, number of root-filled teeth, number of teeth with carious lesions, satisfactory masticatory function, and dental esthetics as crude measures of self-reported dental health, dental anxiety, time elapsed since last visit to a dental office, regular dental visiting habits, smoking, alcohol habits, and marital status. A subjective evaluation of economy, health and life situation (acceptable or poor) was accounted for as socio-economic variables. The oldest age group, women born 1908, and edentulous individuals were omitted, leaving 844 subjects for analysis. Statistical analysis included multivariate logistic regression, chi-squared test, and independent t-test for comparison of group characteristics (AP=0 vs AP>0). RESULTS: For socio-economic variables there was a significant association between acceptable health and apical periodontitis (OR=1.72 (CI=1.09-2.70)). For oral-related variables, root-filled teeth (OR=1.17 (CI=1.10-1.23)) and teeth with carious lesions (OR=1.48 (CI=1.19-1.85)) were predictive of apical periodontitis. CONCLUSIONS: In the present study, socio-economic variables and dental visiting habits did not appear to have obvious implications for periapical health, whereas root-filled teeth and carious lesions were associated with apical periodontitis.

Apical periodontitis and related factors in an adult Lithuanian population.

OBJECTIVES: The objectives of this investigation were to study determinants of apical periodontitis among Lithuanians who were 35 to 44 years old and to study possible associations between apical periodontitis, relevant general diseases, and perceived general health. STUDY DESIGN: Information was collected from a randomly selected sample, consisting of 147 individuals from Vilnius, Lithuania. Aspects of oral and general health, health-related habits and attitudes, and social parameters were used as independent variables, with various aspects of apical periodontitis as the dependent variable. Associations were tested by regression analysis. RESULTS: Apical periodontitis was highly prevalent in this Lithuanian population. Oral health-related variables showed the strongest association with apical periodontitis. Decayed and filled teeth scores were found to be strongly associated with periapical disease, and sound teeth were strongly associated with periapical health. In addition, behavioral variables were found to be important disease determinants. CONCLUSIONS: Apical periodontitis appeared to be an oral health problem closely related to dental caries. No association could be detected between general diseases and apical periodontitis, but an association between perceived general health and apical periodontitis was demonstrated.