Association between xerostomia, oral and general health, and obesity in adults. A cross-sectional pilot study.

BACKGROUND: The objective of this study was to analyse the association between oral and general health variables and obesity indicators with the sensation of dry mouth or xerostomia as evaluated on the Xerostomia Inventory (XI). MATERIAL AND METHODS: A total of 354 randomly selected subjects participated in this cross-sectional pilot study and completed an anonymous questionnaire. Anthropometric, clinical, and xerostomic variables were evaluated. Kruskal-Wallis, ANOVA and Bonferroni test were used for multiple comparisons. ROC curves and multinomial logistic regression were used to determine the (OR) risk of xerostomia. RESULTS: A total of 30.7 % of respondents reported xerostomia based on XI. The dry mouth question, the XI taken as a "gold standard", showed a diagnostic sensitivity of 70.37 %, and a specificity of 83.27 % (AUC=0.768, p<0.001). Logistical regression showed the highest xerostomia OR was associated to patients with bad self-perceived health, 6.31 (CI 95% 2.89-13.80, p<0.001). In the model adjusted for tooth mobility, bone or respiratory diseases, and the consumption of anxiolytics and antidepressants, the OR was 3.46 (CI 95% 1.47-8.18, p=0.005). CONCLUSIONS: a high prevalence of xerostomia was found in this cross-sectional pilot study, which was significantly more frequent in women, and increased with age. Xerostomia was associated to several systemic diseases, psychological conditions, and oral functional disorders such as tooth mobility. These preliminary results can serve as the basis for developing guidelines for the application of innovative measures designed to improve the quality of life of individuals with xerostomia.

Endodontic and aesthetic management of a conoid tooth with type IIIA dens invaginatus.

BACKGROUND: Dens invaginatus is a dental developmental abnormality caused by an infolding of the enamel organ into the adjacent dental papilla before the calcification of the dental tissues. The clinical presentation of dens invaginatus varies according to its severity, from mild forms, in which we might find a deeper than normal cingulum pit, to severe cases, in which there is a pronounced infolding reaching the apical foramen. The very nature of the invagination favours the contamination from the oral environment to the pulp space and the onset of caries. Therefore, patients might present with symptoms or signs of pulpitis and/or apical periodontitis. The aim of this paper is to present the successful endodontic and restorative management of a conoid shaped upper lateral incisor, affected by dens invaginatus type IIIA. CASE REPORT: A 13-year-old girl was referred to our office for endodontic and aesthetic treatment of the right upper lateral incisor, which was asymptomatic. Clinical, radiographic and photographic examinations were performed. The diagnosis of this tooth was dens invaginatus, Oehlers type IIIA with chronic apical periodontitis. Full isolation and magnification were used to achieve correct endodontic management of the aberrant internal anatomy of the tooth. Ultrasonic tips and a combination of manual and mechanical instruments were used for cleaning and shaping. Warm vertical condensation technique was used for sealing the canal system. As the final restoration it was chosen an indirect composite crown bonded to the tooth surface with minor preparation and using an adhesive technique. Radiographic healing and satisfaction of the aesthetic needs was achieved up to 5 years from completion of treatment. CONCLUSION: This case report shows the successful outcomes of a complex case based on proper diagnosis and correct treatment strategies for arresting the progression of apical periodontitis in challenging internal anatomies, as well as the fulfillment of a young patient aesthetic needs.

The juxta-oral organ of Chievitz (organum yuxtaorale) updated: Embryology, anatomy, function and pathology.

BACKGROUND: The Chievitz's organ or juxta-oral organ is a mysterious bilateral structure, phylogenetically preserved, which develops from the mouth epithelium as an invagination that loses connection to it in the prenatal period. It is located laterally to the walls of the oral cavity in an imprecise anatomical location and receives abundant innervation from the buccal nerve. Structurally it consists of non-keratinizing squamous-like neuroepithelial cells surrounded by two layers of connective tissue with nerve fibers and different morphotypes of sensory corpuscles. Its function is completely unknown although based on its rich innervation it is assumed that works as a mechanoreceptor. METHODS: We have performed immunohistochemistry for axonal and Schwann cells, and the putative mechanoproteins ASIC2, TRPV4 and Piezo2 in sections of fetal juxta-oral organ. RESULTS: Intraparenchymatous nerve fibers and sensory corpuscles were observed as well as immunoreactivity for Piezo2 in both nerve fibers and epithelial parenchymatous cells. CONCLUSIONS: We add indirect evidence that the juxtaoral organ is a mechanoreceptor because in addition to its dense innervation, the epithelial cells and sensory nerve fibers display immunoreactivity for the mechanogated ion channel Piezo2. Based on current knowledge, the functional and clinical importance of the juxta-oral organ should be further investigated.

Successful pulp revascularization of an autotransplantated mature premolar with fragile fracture apicoectomy and plasma rich in growth factors: a 3-year follow-up.

AIM: This case report demonstrates a positive outcome of the adjuvant use of fragile fracture (FF), which is a technique used to harvest dental pulp stem cells (DPSCs), and platelet-rich plasma (PRP) in a mandibular premolar (tooth 44) with a completely formed root that was transplanted into a surgically created socket and which maintained pulp vitality and function. SUMMARY: After virtual surgical planning, a 3D tooth replica of tooth 44 was fabricated. A surgical socket was created in the position of tooth 14; then, tooth 44 was extracted and the root dentine was abraded using a turbine diamond bur 3 mm from the apex until a circular groove was prepared around the outer circumference of the root; and then, an FF was performed without damaging the pulp tissue. PRP was placed in the socket, after which the donor tooth was inserted in the recipient area. At 2 weeks post-treatment, orthodontic traction was applied. At 3-year follow-up, the tooth had adequate alignment and was asymptomatic. Response to pulp testing was positive, and the presence of pulp canal obliteration was observed as a sign of pulpal healing. KEY LEARNING POINTS: Autotransplantation is a good alternative for replacing missing teeth, with repair of tissues and pulp revascularization. Revascularization of an autotransplanted mature tooth using the fragile fracture technique and PRP scaffold is a feasible option and might have positive effects on the long-term outcome of the procedure. Including completely formed teeth as donors in autotransplantation, maintaining vitality and their functions is an option that warrants further study.

Class I and Class II small leucine-rich proteoglycans in human cutaneous pacinian corpuscles.

Pacinian corpuscles are onion bulb-like multilayered mechanoreceptors that consist of a complicated structure of axon terminals, Schwann related cells (inner core), endoneural related cells (intermediate layer) and perineurial related cells (outer core-capsule). The cells forming those compartments are continuous and share the properties of that covering the nerve fibers. Small leucine-rich proteoglycans are major proteoglycans of the extracellular matrix and regulate collagen fibrillogenesis, cell signalling pathways and extracellular matrix assembly. Here we used immunohistochemistry to investigate the distribution of class I (biglycan, decorin, asporin, ECM2 and ECMX) and class II (fibromodulin, lumican, prolargin, keratocan and osteoadherin) small leucine-rich proteoglycans in human cutaneous Pacinian corpuscles. The distribution of these compounds was: the inner core express decorin, biglycan, lumican, fibromodulin, osteoadherin; the intermediate layer display immunoreactivity for osteoadherin; the outer core biglycan, decorin, lumican, fibromodulin and osteoadherin; and the capsule contains biglycan, decorin, fibromodulin, and lumican. Asporin, prolargin and keratocan were undetectable. These results complement our knowledge about the distribution of small leucine-rich proteoglycans in human Pacinian corpuscles, and help to understand the composition of the extracellular matrix in these sensory formations.

Dental students' knowledge regarding the indications for antibiotics in the management of endodontic infections.

AIM: To determine the knowledge of undergraduate Spanish dental students regarding the indications of systemic antibiotics in the management of endodontic infections. METHODOLOGY: The final year dental students from four Spanish dental schools were requested to answer a one-page questionnaire on the indications for systemic antibiotics in the treatment of endodontic infections. One hundred and seventy-five students were asked to participate in this research. Data were analysed using descriptive statistics and chi-square test. RESULTS: One hundred and four students (93.7%) completed satisfactorily the survey and were included in the study. The average duration of antibiotic therapy was 7.0 ± 2.0 days. All respondents chose amoxicillin as the first-choice antibiotic in patients with no medical allergies, alone (47%) or associated with clavulanic acid (53%). The first drug of choice for patients with an allergy to penicillin was clindamycin 300 mg (99%). For cases of irreversible pulpitis, up to 63% of students would prescribe antibiotics. For the scenario of a necrotic pulp, symptomatic apical periodontitis and no swelling, 44% would prescribe antibiotics. Almost 40% of students would prescribe antibiotics for necrotic pulps with asymptomatic apical periodontitis and a sinus tract. CONCLUSIONS: It is necessary for the Spanish schools of dentistry to improve students' knowledge about antibiotics and their indications in endodontics. Interactive education analysing real endodontic cases using problem-based learning would help students acquire better skills in prescribing antibiotics in pulp-periapical pathosis.

Amoxicillin-Loaded Sponges Made of Collagen and Poly[(methyl vinyl ether)-co-(maleic anhydride)] for Root Canal Treatment: Preparation, Characterization and In Vitro Cell Compatibility.

The difficulty of eliminating Enterococcus faecalis and other bacteria infecting dental root canals makes it desirable to develop formulations capable of sustained release of antibiotics within the canal. With this function in view, in this work we compared the mechanical, drug release and biocompatibility properties of amoxicillin-loaded collagen (CL) and CL complexed with poly[(methyl vinyl ether)-co-(maleic anhydride)] (PVMMA), with or without glutaraldehyde (GTA) or the natural product genipin (GN) as cross-linker. Collagen was not denatured by complexation with PVMMA. Only CL-PVMMA-GN sponges did not disintegrate during 7 days exposure to cell culture medium (un-cross-linked CL disintegrated within 24 h and un-cross-linked CL-PVMMA within 4 days), and CL-PVMMA-GN sponges also exhibited the most appropriate combination of mechanical properties (hardness, modulus of deformability and plasticity). CL-PVMMA-GN sponges absorbed aqueous medium faster than other cross-linked formulations, but their maximum uptake was less; and drug release from CL-PVMMA-GN sponges tended to be faster than from any other, except un-cross-linked CL-PVMMA, maximum release taking about 4 days. No formulation significantly altered the viability of L929 fibroblast-like mouse connective tissue cells, but cells growing on sponges showed signs of non-adherence. It is concluded that genipin-cross-linked CL-PVMMA sponges merit further investigation as antibiotics vehicles and aids to tissue regeneration in the dental root canal.

The corrosion of nickel-titanium rotary endodontic instruments in sodium hypochlorite.

AIM: To evaluate the corrosion resistance of nickel-titanium (NiTi) endodontic rotary instruments immersed in 5.25% sodium hypochlorite (NaOCl) solution. METHODOLOGY: The corrosion performance of NiTi instruments (S1 25 mm, ProTaper Dentsplay Maillefer, Ballaigues, Switzerland) was evaluated using commercial 5.25% NaOCl solution (pH = 12.3), and the same solution partially neutralized adding H2SO4 to reach pH = 10.1. Electrochemical measurements were carried out using a potentiostat equipped with a five-channel zero resistance ammeter (ZRA) for galvanic current measurements. The instruments were sectioned into three parts (cutting part, noncutting part and shank) and degreased with acetone and rinsing with demineralized water prior to being immersed in NaOCl solution for testing. Each set of the three parts constituted one 'virtual' instrument through the ZRA, giving access to the galvanic currents that circulate between the three parts. Nine instruments were employed to check the reproducibility of the electrochemical measurements. RESULTS: The corrosion potential (E(corr)) of the NiTi alloy reached the passive domain in approximately 20 s of immersion in the solution having a pH 10.1. After this initial period the potential remained steady, indicating that stable passivation was achieved. However, at pH 12.3 no stationary state was achieved even after 6000 s of immersion time. Thus, the alloy was not stable in this medium from a corrosion point of view. CONCLUSIONS: The corrosion resistance of NiTi alloy was enhanced by lowering the pH of NaOCl solution to 10.1, which allows the system to reach the stability domain of the passivating species TiO2 and NiO2.

Analysis of the area and length of masticatory cycles in male and female subjects.

It is difficult to determine the existence of a normal or physiological masticatory cycle, because there exists great individual diversity. This study presents some data about two parameters of masticatory cycles according to the frontal plane, i.e. the area and length of right-sided and left-sided cycles in a group of 30 young people, 18 women and 12 men. For our study the Myotronics K6-1 kinesiograph was used. It registers the magnetic field and allows us to obtain graphic recordings of the jaw movement in the three space planes. Other authors have analysed these parameters, but none of those reviewed provides information about the distribution to each side or according to the gender of sampling subjects selected for the analysis. We have tried to describe the normal morphology of the masticatory cycles and, also, establish a reference so as to provide help in the diagnosis of the functional pathology of the masticatory system.