The Effect of Various Concentrations of Nitrous Oxide and Oxygen on the Hypersensitive Gag Reflex.

The purpose of this study was to compare the effectiveness of various concentrations of N2O/O2 on obtunding a hypersensitive gag reflex. We hypothesized that the administration of nitrous oxide and oxygen would obtund a hypersensitive gag reflex enough to allow a patient to tolerate the placement and holding of a digital x-ray sensor long enough to obtain a dental radiograph. Volunteers claiming to have a hypersensitive gag reflex were first screened to validate their claim and then tested by placing a size 2 digital x-ray sensor in the position for a periapical radiograph of the right mandibular molar area and holding it in place for 10 seconds. Subjects were first tested using room air only, then 30%, 50%, or 70% nitrous oxide until they were able to tolerate the sensor without gagging or discomfort. A visual analog scale was used for subjective responses, and other statistical tests were used to analyze the results. We found that for some subjects, 30% nitrous oxide was sufficient; for others, 50% was needed; and for the remainder of the subjects, 70% was sufficient to tolerate the test. Using a combination of 70% nitrous oxide and 30% oxygen allowed all patients claiming to have a hypersensitive gag reflex to tolerate the placement and holding of a digital x-ray sensor long enough to take a periapical radiograph.

Risk Factors and Prevalence of Occupational Musculoskeletal Pain among Endodontists in the United States.

INTRODUCTION: A musculoskeletal disorder (MSD) of pain, weakness, numbness, or paresthesia is a common issue for dental health care providers. The aims of this study were to (1) identify the prevalence of MSDs among endodontists in the United States, (2) to identify risk factors of MSDs among United States endodontists, and (3) to compare these findings with other published findings for dental providers. METHODS: A 24-question survey regarding the demographics, potential risk factors, and prevalence of MSDs was formulated and distributed to 5394 members of the American Association of Endodontists. Data were then analyzed using descriptive statistics and chi-square analysis to find significance at α = 0.05. RESULTS: Six hundred twenty participants responded to the survey for an overall response rate of 12%. Of the submitted surveys, 527 of them confirmed to be endodontists practicing in the United States, and all results were derived from those 527 surveys. Seventy-four percent of respondents reported having experienced MSDs in the last 12 months, and 88% reported having experienced at least 1 MSD thus far during their career. Eighty-five percent of female participants reported an MSD within the past 12 months compared with 70% of males. CONCLUSIONS: MSDs have a high prevalence among endodontists in the United States. The neck and lower back were the areas of highest MSD prevalence. Female sex and the frequent adoption of awkward postures were factors associated with significantly higher rates of reported MSDs in the last 12 months.

The Validity of Pulp Tests on Crowned Teeth: A Clinical Study.

OBJECTIVE: The aim of this study was to evaluate the sensitivity and specificity of electric pulp testing (EPT) using the bridging technique in comparison to a cold test on crowned teeth. METHODS: Thirty teeth were included in this study. Only one crowned tooth from each subject was included. The adjacent teeth served as controls. The crowned teeth were tested for pulp vitality using a bridging EPT technique and cold test. Vitality was confirmed upon access based on bleeding or lack of bleeding from detected root canal systems. The data was statistically analyzed using the McNamara test (P<0.05). RESULTS: The sensitivities of the cold test and bridging EPT were 87% and 66% respectively. Accuracy for cold and bridging EPT were 87% and 67% respectively. The cold test demonstrated a statistically significant higher accuracy and sensitivity than the bridging EPT. However, no significant difference was detected in the specificity between the two tests. CONCLUSION: Both EPT and cold test should be considered as an adjunctive diagnostic tool when determining pulp status in a crowned tooth. Pulp sensitivity tests are essential but the results should be interpreted in combination with other clinical signs/symptoms.

Regenerative Endodontics: A Systematic Analysis of the Failed Cases.

INTRODUCTION: The aim of this systematic review was to analyze failed cases of regenerative endodontic treatment (RET) reported in the literature in terms of etiology, diagnosis, treatment protocols, signs of failure, and additional endodontic interventions. METHODS: Electronic searches were performed in PubMed, Web of Science, and ProQuest Dissertations & Theses databases. All in vivo publications in humans that reported at least 1 failed case of RET were included in this systematic review. Failed RET cases were defined in the current study as any case that required an additional endodontic intervention or extraction after the completion of the initial RET. RESULTS: A total of 28 studies that reported 67 failed cases of RET were included in this review. A total of 37 failed RET cases reported the etiology that resulted in the initiation of RET; 59% of these cases were caused by dental trauma, and 30% were caused by dens evaginatus. A total of 26 (39%) failed RET cases were detected at least 2 years after the initiation of RET. A total of 53 (79%) failed RET cases were presented with signs and/or symptoms of persistent infection. CONCLUSIONS: Persistent infection was the main presentation in 79% of failed RET cases. Furthermore, 39% of failed RET cases were identified after more than 2 years of follow-up. Future studies should include a detailed description of the etiology, preoperative variables, intraoperative protocols, and postoperative follow-up to provide a better understanding of failed cases after RET.

The Effect of Crown Lengthening on the Outcome of Endodontically Treated Posterior Teeth: 10-year Survival Analysis.

INTRODUCTION: The purpose of this study was to investigate the effect of a crown lengthening (CL) procedure and the crown-root ratio after CL on the long-term survival of endodontically treated teeth (ETT). METHODS: Permanent posterior teeth with opposing dentition that had received adequate nonsurgical root canal treatment (NSRCT) and a full-coverage crown between January 1, 2006, and January 1, 2016 were included in this retrospective study. The data collected included dates of the NSRCT, time of extraction if extracted, age, sex, location, the crown-root ratio after CL, and the presence of a lesion. All included ETT were divided into 2 groups: RESULTS: 5-year survival rates of ETT in the control and CL groups were 88.6% and 82.2%, respectively (P > .05). The 10-year survival rates of ETT in the control and CL groups were 74.5% and 51%, respectively (P < .05). ETT that received the CL procedure after NSRCT were almost 2.3 times more likely to get extracted compared with ETT that did not need the CL procedure at the 10-year follow-up (hazard ratio = 2.29, P < .05). Also, ETT with an inadequate crown-root ratio (1:1) after CL showed the lowest survival rate (40%) compared with ETT with an adequate crown-root ratio (<1:1). CONCLUSIONS: A crown-root ratio of 1:1 after osseous CL may affect the long-term survival of ETT. Despite the promising survival rate of ETT with an adequate crown-root ratio after CL, the long-term survival of NSRCT with an inadequate crown-root ratio (1:1) should be considered in the treatment planning phase. Also, it is worth mentioning that the results of the present study should be evaluated in future prospective studies.

The Effect of Lunasin on Receptor Activator of Nuclear Factor Kappa-B Ligand-mediated Osteoclast Formation from RAW 264.7 Cells.

INTRODUCTION: To date, no study has investigated the antiresorptive property of lunasin. Hence, the present study aimed to assess the ability of lunasin to inhibit the osteoclast formation using RAW 264.7 cells. We hypothesized that lunasin is able to inhibit osteoclast formation. METHODS: In the present study, the murine monocytic cell line RAW 264.7 was induced to differentiate into mature osteoclasts in the presence of recombinant receptor activator of nuclear factor kappa-B ligand. Tartrate-resistant acid phosphatase, a marker of osteoclasts, was used to identify osteoclasts. Cell lines were divided into different groups and exposed to different concentrations of 50 µmol/L, 75 µmol/L, and 100 µmol/L active and inactive lunasin. The control group was RAW 264.7 cells with receptor activator of nuclear factor kappa-B ligand. Tartrate-resistant acid phosphatase-positive cells of 3 or more nuclei, indicative of mature osteoclasts, were counted by 3 observers. The mean number of the data collected was analyzed using 1-way analysis of variance and the multiple comparison post hoc Bonferroni correction. RESULTS: There was a significant difference in the reduction of osteoclast formation in all the active lunasin groups (P < .001) compared with the control group and the inactive lunasin group (P < .001). CONCLUSIONS: Considering the suppressive effect of lunasin on osteoclastogenesis, the use of lunasin as a potential antiresorptive agent can be evaluated in future studies.

The role of apical size determination and enlargement in the reduction of intracanal bacteria.

The master apical preparation size in root canal therapy is debatable despite considerable research. The present study compared file sizes that bind at the apex before and during crown-down preparation and assessed the relation between apical size and extent of intracanal bacterial load. There were 100 single-rooted teeth biomechanically prepared after inoculation with Enterococcus faecalis. Canals were preflared, and apical size was ascertained by the first file to bind (FAB) at the working length (WL). During crown-down preparation, the first crown-down file to reach the apex during instrumentation was noted (CDF). Teeth were then divided into three master apical file size groups of CDF + 1, CDF + 2, and CDF + 3. Positive controls were inoculated postinstrumentation, whereas negative controls were instrumented without inoculation (n = 5). The samples were then cultured for intracanal bacterial counts. Fifteen samples and four controls were analyzed under SEM. The data were analyzed using ANOVA, Student's t-test, and chi(2) tests. The CDF was demonstrated to be an average of four file sizes larger than the FAB (p < 0.05). There was a significant increase in the number of samples with negative cultures from CDF + 1 to CDF + 3. SEM observation revealed bacteria on dentinal walls and in tubules even in most negative canal cultures.

A correlation study of occlusal and pulp chamber anatomy: the maxillary first molar.

The success of endodontic therapy is based on a number of criteria, particularly the conservation of tooth structure. This principle requires a systematic approach to pulp chamber access. By correlating the occlusal anatomy with the location of the root canal orifice, a dentist may find a number of guidelines for improving access design. In this in vitro study, the authors evaluated 29 human maxillary first molars. Digital radiographs and digital occlusal photographs were taken of each specimen before and after decoronation at the cementoenamel junction (CEJ). The three images were superimposed on one another and evaluated for occlusal and pulpal patterns. The thickness of the pulp chamber walls of the CEJ varied, based on the circumference of individual teeth. In addition, the canal orifices at the pulp chamber floor exhibited a consistent pattern relative to the cusp tips, which may assist in access design.

A correlation study of occlusal and pulp chamber anatomy: the mandibular first molar.

Many parameters must be addressed for endodontic therapy to succeed. Because conservation of tooth structure is vital, the pulp chamber and root canal orifices should be located by using a method that is consistent yet accurate. The correlation of occlusal anatomy with the locations of the root canal orifice may aid dentists with access design. This study sought to determine if a correlation existed between occlusal surface anatomy, pulp chamber location, and root canal orifice location. This in vitro study utilized 21 human mandibular first molars. For each specimen, amalgam restorations were placed in the respective cusp tips, with gutta-percha placed in each canal at the level of the furcation. The authors made digital radiographs and occlusal photographs of each complete specimen. The samples were sectioned horizontally at the level of the cementoenamel junction (CEJ). Using a digital software program, the radiographs were superimposed with the digital photographs and correlations of pulp chamber to locate the canal orifice and occlusal surface anatomy. The authors found that the pulp chamber of the mandibular first molar lies more lingual at the level of the CEJ. In addition, the orifices were consistent in their location relative to cusp tip anatomy, a discovery that may assist dentists with the access design.

Intracanal assessment of mineral trioxide aggregate setting and sealing properties.

This study sought to assess setting time and sealing properties of intracanal mineral trioxide aggregate (MTA). Eighty-three extracted single-rooted human teeth were decoronated and instrumented using the crown-down technique. The apical 3.0 mm of each tooth was resected. After MTA was placed, the coronal openings of the canals were sealed with moist cotton pellets. Root samples were divided into three groups according to setting time periods of four hours, two days, or one week. Within each group, 15 samples were kept in wet gauze to provide a moist apical environment (WA) while the remaining 10 were kept in a dry apical environment (DA). After respective incubation periods, 20 samples per group (10 WA, 10 DA) were mounted in an apical broth turbidity determination chamber and incubated for 30 days. The remaining five teeth per group (WA-h) were sectioned into 3.0 mm slices and compared for MTA setting hardness using the Shore-D Hardness test. Remaining teeth served as negative and positive controls. Each sample was inoculated coronally with Enterococcus faecalis and checked daily for turbidity in apical broth. Microbial leakage was reduced significantly as setting time increased from four hours to two days or one week. There was no significant reduction in leakage when setting time was increased from two days to one week. Over the first 20 days, the DA samples showed a higher rate of leakage compared to the WA samples. The Shore-D hardness test correlated with leakage results; 93% of total setting hardness was reported at two days and one week compared to only 75% for the four-hour group. Results suggest that apical moisture may affect MTA setting time or sealing ability initially and that intracanal MTA may take up to two days to set completely.

Apical Periodontitis, a Predictor Variable for Preeclampsia: A Case-control Study.

INTRODUCTION: Preeclampsia (PE) is characterized by hypertension and proteinuria after the 20th week of gestation. There is an association between systemic inflammation and adverse pregnancy outcomes such as PE. Therefore, for the first time, the present study aimed to investigate the possible association between maternal apical periodontitis (AP) and PE. METHODS: In this case-control study, 50 mothers who were diagnosed with PE during pregnancy were included in the experimental group. The control group consisted of 50 matched mothers with a normal course of pregnancy. The endodontic and periodontal status of all participants was reviewed using the digital panoramic radiographs that were available before pregnancy. The number of remaining teeth and the presence of AP in all teeth and endodontically treated teeth were recorded using the periapical index. Binary logistic regression was used to determine the possible association between AP and PE (α = 0.05). RESULTS: AP in at least 1 tooth was found in 27 of the mothers who developed PE (54%) and in 16 of the control patients (32%) (odds ratio [OR] = 2.4, P < .05). Adjusted for the maternal periodontitis, number of teeth, and endodontic treatment, maternal AP was significantly associated with the occurrence of PE (P < .05; OR = 2.23; 95% confidence interval, 95% = 1.92-6.88). CONCLUSIONS: AP was significantly more prevalent in the experimental group. For the first time, this study has provided evidence that maternal AP may be a strong independent predictor of PE. Considering the high occurrence of PE, particularly in developing countries, it could be suggested that the risk of PE may be reduced through comprehensive dental examinations for detecting and treating any source of inflammation, including AP, before pregnancy.

Association between Systemic Diseases and Endodontic Outcome: A Systematic Review.

INTRODUCTION: To date, the relationships between systemic diseases and endodontic treatment outcomes remain poorly studied. Thus, the purpose of this systematic review was to evaluate the relationship between host-modifying factors and their association with endodontic outcomes. METHODS: Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies and gray literature of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers. RESULTS: Sixteen articles met the inclusion criteria with moderate to high risk of bias. There was no article with low risk of bias. Available scientific evidence remains inconclusive as to whether diabetes and/or cardiovascular disease(s) may be associated with endodontic outcomes. Human immunodeficiency virus and oral bisphosphonate did not appear to be associated with endodontic outcomes. CONCLUSIONS: Although additional well-designed longitudinal clinical studies are needed, the results of this systematic review suggest that some systemic diseases may be correlated with endodontic outcomes.

Association of End-stage Renal Disease with Radiographically and Clinically Diagnosed Apical Periodontitis: A Hospital-based Study.

INTRODUCTION: The present study aimed to evaluate the prevalence of apical periodontitis (AP) and endodontic treatment in patients with end-stage renal disease (ESRD) as compared with patients with no history of ESRD. METHODS: In this cross-sectional study, 40 patients diagnosed with nondiabetic ESRD were included. The control group consisted of 40 age-matched and sex-matched healthy individuals. Digital panoramic radiographs were exposed on patients in both the experimental and control groups. The number of remaining teeth and the prevalence of nonsurgical and/or surgical root canal treatment were evaluated. Also, the presence of AP in all teeth and endodontically treated teeth (ETT) was recorded using the periapical index. Logistic regression was used to determine the possible association between ESRD and AP. RESULTS: AP in at least 1 tooth was found in 29 of the patients with ESRD (73%) and in 16 of the control patients (40%) (odds ratio [OR] = 3.9, P < .05). In 21 (52%) patients with ESRD in the experimental group, at least 1 ETT was diagnosed with AP. In the control group, 11 (28%) individuals had AP affecting at least 1 of the ETT (OR = 2.9, P < .05). Adjusted for the number of teeth and endodontic treatment, ESRD was significantly associated with the presence of AP (P < .05; OR = 2.6; 95% confidence interval, 1.43-4.8). Also, the number of teeth with AP was significantly associated with the urea serum level in the experimental group (P < .05, ß coefficient = 4.35). CONCLUSION: AP was significantly more prevalent in the experimental group. This may suggest that ESRD could possibly alter the pathogenesis of AP. However, these findings do not confirm the presence of any cause-and-effect relationship between these conditions. Also, considering the modifying effect of AP on urea serum level, the treatment of AP could be incorporated in the treatment planning of patients with ESRD.

The Influence of Periodontal Status on Endodontically Treated Teeth: 9-year Survival Analysis.

INTRODUCTION: The aim of this study was to investigate the effect of periodontal status at the time of nonsurgical root canal treatment (NSRCT) on the survival rate of endodontically treated teeth (ETT). METHODS: In this retrospective investigation, molars that received NSRCT in an advanced specialty education program in endodontics from 2009 through 2017 were initially recruited. After the application of inclusion and exclusion criteria, 315 teeth were included in the study. Inclusion criteria were ETT with an acceptable quality of NSRCT; ETT that received an adequate crown within 3 months after NSRCT; and ETT with complete periodontal charting before NSRCT including pocket depths, clinical attachment loss, and bone loss. The periodontal status of all included teeth was assessed based on American Academy of Periodontology guidelines. All included ETT were divided into 3 groups as follows: healthy group, mild periodontitis, and moderate periodontitis. The survival rate of ETT was analyzed using univariate Kaplan-Meier and log-rank tests for differences between groups (P < .05). A Cox regression model was used to assess the effect of independent variables on the survival rate. RESULTS: Teeth that were diagnosed with mild periodontitis were almost 2 times more likely to be extracted compared with ETT diagnosed with normal periodontium at the time of NSRCT (odds ratio [OR] = 1.9, P < .05). This increased risk of tooth loss was 3.1 (OR = 3.1, P < .05) for ETT diagnosed with moderate periodontitis. Smokers were twice as likely to have tooth loss compared with nonsmokers (OR = 2.2, P < .05). CONCLUSIONS: Patients' periodontal health, being 1 of the prognostic determinants of the outcome of NSRCT, requires attention before and subsequent to NSRCT. This may improve the survival of ETT and help patients maintain their natural dentition.

The Effect of the Dental Operating Microscope on the Outcome of Nonsurgical Root Canal Treatment: A Retrospective Case-control Study.

INTRODUCTION: The aim of the current investigation was to assess the effect of the use of a dental operating microscope on the outcome of nonsurgical root canal treatment (NS RCT) while treating the mesiobuccal (MB) root of the maxillary first molar. METHODS: This retrospective investigation included endodontically treated maxillary first molars (ETMs) with apparent adequate previous NS RCT and restorations referred for endodontic retreatment at the endodontic graduate clinic. Inclusion criteria were ETMs that were diagnosed with irreversible pulpitis and normal periapical tissues before the initial NS RCT and ETMs that presented with a minimum of 1 identifiable periapical lesion (PAR) at 1 of the roots at the time of retreatment. One hundred ninety-five ETMs were included and divided into 2 groups: (1) the initial NS RCT had been performed using a microscope (n = 83) and (2) NS RCT had been performed without the use of a microscope (n = 112). Data extracted were whether the second MB (MB2) canal was located initially and the presence of an MB PAR at the time of retreatment. Data were statistically analyzed using binary logistic regression (α = 0.05). RESULTS: The MB root was 3 times more likely to present with a PAR at the time of retreatment if the initial NS RCT was performed without the use of a microscope (P < .05, odds ratio = 3.1). There was a significant association between a missed MB2 canal and an MB PAR in the group in which the initial NS RCT was performed without the use of a microscope (P < .05, odds ratio = 5.1). However, in cases in which the initial NS RCT was performed using a microscope, a missed MB2 canal was not associated with the presence of an MB PAR. CONCLUSIONS: With proper education, dentists can gain further insight into recognizing limitations in treating cases that require advanced training and advanced optics such as a microscope. Based on this strategy, it would appear that the outcome of NS RCT can be improved.

The Association between the Anatomic Landmarks of the Pulp Chamber Floor and the Prevalence of Middle Mesial Canals in Mandibular First Molars: An In Vivo Analysis.

INTRODUCTION: The present study aimed to determine the incidence and anatomic variation of the middle mesial (MM) canal in mandibular permanent first molars using cone-beam computed tomographic imaging and to evaluate the association between the presence of MM canals and anatomic landmarks of the pulp chamber floor in the mesial root. METHODS: In this in vivo cross-sectional study, 210 CBCT scans of mandibular fist molars from 210 patients were included. CBCT scans were evaluated in 3 sections, and the following data were collected for further analysis: identification of the MM canal, the distance between the mesiobuccal (MB) and mesiolingual (ML) orifices, the presence of any isthmus between the MB and ML orifices, and the MB and ML root canal system (RCS) configurations. Binary logistic regression was performed to assess the effect of pulp floor anatomic characteristics as an independent variable on the outcome variable (the presence of an MM canal). RESULTS: The overall prevalence of the identification of an MM canal regardless of age was 14.7%. Mandibular first molars with an isthmus between the MB and ML RCS configurations were almost 5 times more likely to show an MM canal (P < .05, odds ratio [OR] = 4.9). The MB-ML intraorifice distance was inversely associated with the presence of an MM canal (P < .05, OR = 0.73). Patients less than 42 years old were 4 times more likely to have an MM canal in their CBCT scans compared with patients older than 42 years old (P < .05, OR = 3.9). CONCLUSIONS: The suggested anatomic landmarks of the pulp chamber floor could act as a reliable predictive factor for the presence of an MM canal. This knowledge of anatomic clues may serve to better direct endodontists in locating an MM canal, which could prevent excessive removal of tooth structures.

Comparison of IL-1ß, TNF-α, hBD-2, and hBD-3 Expression in the Dental Pulp of Smokers Versus Nonsmokers.

INTRODUCTION: To date, the endodontic literature lacks research on the effect of smoking on cytokine and defensin expression in the dental pulp. Therefore, the aim of this study was to investigate the expression of interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, human beta defensin (hBD)-2 and hBD-3 in the dental pulp of smokers and compare them with nonsmokers. We hypothesized that cytokine and defensin expression would be reduced in smokers as compared with nonsmokers. METHODS: Thirty-two smokers and 37 nonsmokers with endodontic pulpal diagnoses of normal, symptomatic irreversible pulpitis and asymptomatic irreversible pulpitis were included in this cross-sectional study. Samples from pulp chambers were collected and stored in phosphate-buffered saline at -80°C. Luminex was used to measure IL-1ß and TNF-α levels. The levels of hBD-2 and hBD-3 were measured using enzyme-linked immunosorbent assay. Marker levels were normalized to protein concentrations and data were analyzed using Kruskal-Wallis test, Mann-Whitney U test, and 2-way analysis of variance (α = 0.05). RESULTS: Pulpal concentrations of TNF-α and hBD-2 were significantly lower among smokers (P < .01), whereas no significant difference was observed for IL-1ß, or hBD-3. Two-way analysis of covariance revealed that smoking status (P < .001), not endodontic diagnosis (pulpal status), significantly affected TNF-α and hBD-2 levels. CONCLUSIONS: This study reported that smokers are immunologically deficient in TNF-α and hBD-2, suggesting that dental pulps of smokers possess limited defense mechanisms, affecting their endodontic prognosis and indicating a cause for their reported inferior outcome.

Evaluation of cutting efficiency of ultrasonic tips used in orthograde endodontic treatment.

The purpose of the present study was to evaluate the cutting efficiency of the three different ultrasonic tips for orthograde endodontic treatment: stainless steel, zirconium nitride-coated, and diamond-coated tips. An ultrasonic handpiece was mounted on a custom-made automated balance, and each tip repeatedly penetrated dental stone blocks to a depth of 3 mm for 10 times. The amount of time taken to penetrate 3 mm of stone was measured. The diamond-coated tips showed significantly greater cutting efficiency than either stainless steel tips or zirconium-nitride coated tips. The stainless steel tips showed initial better cutting efficiency, but over time , there is no significant difference between the cutting efficiency of the stainless steel tips and the zirconium nitride coated tips. The diamond coated tips were the only group that showed breakage in this study.

Endodontic treatment in an American Indian population: a 10-year retrospective study.

An epidemiological study of a regional population of Native Americans receiving treatment from 1991 to 2000 (n = 5460) was conducted via electronic survey. The objectives were to identify factors affecting the retention of endodontically treated teeth and to determine frequencies of endodontic care. Multiple factors were assessed. Analyses utilized chi(2) and frequency tests. The results indicated that endodontists tend to complete most posterior teeth and retreatment cases, while generalists tended to complete anterior teeth, primary endodontic therapy, and to restore immediately. Patients with multiple systemic diseases (p = 0.0225) and diabetes (p < 0.0001) experienced decreased retention of endodontically treated teeth and increased retreatment (p = 0.0109) by endodontists. Patients treated by general dentists experienced increased retention for female patients (p = 0.0066), immediate restoration of the treated tooth (p = 0.0212), and decreased retention with a history of hypertension (p = 0.0036) and diabetes (p = 0.0033). This study suggests that diabetes and/or hypertension, delayed or no restoration, and increasing age, may all contribute to decreased retention of endodontically treated teeth, but that immediate postendodontic restoration may enhance retention. In the early era, very few cases of molar endodontics were completed, and one could infer that there were greater numbers of posterior teeth extracted because of this fact. This demonstrates how a combination of providers can provide a broader range of clinical endodontic services, supporting an Indian Health Service goal of providing the highest level of oral health care possible.

An analysis of current analgesic preferences for endodontic pain management.

A descriptive, cross sectional survey was developed to determine the preferences of endodontists when prescribing analgesics. Eleven clinical scenarios describing common endodontic diagnoses or procedures with specified severity of pain were provided. A survey was sent to 310 AAE members and 63 responded, providing a 20% response rate. Respondents were given various choices for analgesic prescription including various dosages of ibuprofen or acetaminophen (APAP), or combination narcotic medications. Data were analyzed by chi2 tests. Non-narcotics were preferred over narcotics for all clinical situations. Significantly more respondents selected ibuprofen 600 mg (4x a day) regardless of the severity of preoperative or postoperative pain (p<0.001). Educators and board-certified AAE members were less likely than nonboard certified AAE members to manage their patient's perceived severe pain with narcotic analgesics.