A prospective randomized trial on efficacy of antibiotic prophylaxis in asymptomatic teeth with pulpal necrosis and associated periapical pathosis.

A recent study from a private endodontic practice compared "prophylactic" antibiotic (high-dose, 1-day) regimens of penicillin V and erythromycin (base or stearate) for patients who had asymptomatic teeth with pulpal necrosis and associated periapical radiolucent lesions (PN/PL). A 2.2% flare-up incidence was found, with no statistically significant differences for penicillin (0.0%), base (2.9%), and stearate (3.8%). No hypersensitivity responses occurred, and gastrointestinal side effects were found primarily with the erythromycins (12.4%). To ascertain whether or not similar results would occur with student operators in a dental school clinic population, the current study was undertaken. One-hundred ninety-five patients with quiescent PN/PL were randomly given either penicillin V or erythromycin (base or stearate). A 2.6% flare-up incidence was found, with no statistically significant differences for penicillin (3.1%), base (1.5%), and stearate (3.1%). No hypersensitivity responses occurred, and GI side effects were found primarily with the erythromycins (17.7%). As can be seen, the results were very similar to those of the recent endodontic practice study. Hence, it can be concluded that the results of the previous endodontic practice study were not unique to any one clinician or method. A comparison was also made between the "prophylactic" penicillin group of the current study and the placebo control group of our previous dental school clinic, student operator study (in which the methods, population, and regimen were almost identical to those of the current study). The results showed that the "prophylactic" penicillin group had significant fewer flare-ups and non-flare-up-associated swelling and pain than did the placebo group. In view of these findings and those from studies from the literature in which "prophylactic" antibiotics were not used, it is our opinion that the antibiotic regimens used in the current study should be a component of clinical endodontic therapy for quiescent PN/PL.

Infectious flare-ups and serious sequelae following endodontic treatment: a prospective randomized trial on efficacy of antibiotic prophylaxis in cases of asymptomatic pulpal-periapical lesions.

Without peritreatment antibiotics, infectious flare-ups (about 15% incidence) and serious sequelae follow endodontic treatment of asymptomatic teeth with necrotic pulps and associated periapical lesions. Antibiotics administered after endodontic treatment (4-day regimen) reduce the flare-up incidence to about 2%, but hypersensitivity responses, sensitization, resistant microbes, and drug-taking compliance are potential problems. To ascertain whether a specific prophylactic antibiotic (high-dose, 1-day regimen) would preferentially maintain this low flare-up incidence while overcoming antibiotic-related problems, 315 patients with quiescent pulpal necrosis and an associated periapical lesion were randomly given either penicillin V or erythromycin (base or stearate). Evaluations of flare-up after endodontic treatment were done at 1 day, 1 week, and 2 months. A 2.2% flare-up incidence was found, with no statistically significant differences for penicillin (0.0%), base (2.9%), and stearate (3.8%). No hypersensitivity responses occurred. Gastrointestinal side effects were found primarily with the erythromycins (12.4%). A comparative analysis of the data from our first study (no peritreatment antibiotics) and the pooled data from our last two investigations (including the current trial) showed that peritreatment antibiotic coverage significantly reduced flare-ups and serious sequelae after endodontic treatment (p less than 0.001).

Stress, relaxation, and saliva: a pilot study involving endodontic patients.

Thirty-four endodontic patients completed dental anxiety questionnaires and had saliva samples taken prior to and at the conclusion of their initial endodontic treatment. Pain and anxiety were managed with local anesthesia, nitrous oxide--oxygen psychosedation, hypnosis, and meditation, either alone or in combination. For most patients, by the conclusion of the treatment, anxiety had decreased, salivary volume had increased, and salivary protein was reduced. Meditation and hypnosis, either alone or in combination with local anesthesia, were most effective in anxiety reduction as measured by questionnaire and/or salivary changes.

Stress, relaxation and saliva: a follow-up study involving clinical endodontic patients.

Dentally induced stress and relaxation-induced anxiety reduction recently have been correlated with salivary changes in private patients treated by a solo endodontist. Hypnosis was shown to be more effective than local anesthesia in anxiety reduction. Dental students and clinic patients were employed in this study in an attempt to replicate the previous findings. One additional salivary variable (pH) was examined. Twenty-nine endodontic clinic patients were treated, each by a different dental student. The patients completed dental anxiety questionnaires and had salivary samples taken prior to, and at the conclusion of, their initial endodontic treatments. Pain and anxiety were managed using local anesthesia, hypnosis, or nitrous oxide-oxygen, either alone or in combination. There were significant anxiety-reduction changes by the conclusion of the visits (p less than 0.001) as measured by increased salivary volume, increased salivary translucency, reduced salivary protein, increased salivary pH and reduced questionnaire-determined anxiety level. Hypnosis and nitrous oxide-oxygen were significantly more effective (p less than 0.05) than local anesthesia in anxiety reduction as measured by salivary changes and questionnaires. It can be concluded that saliva is an easily obtained fluid that can be used to determine levels of stress and relaxation.

A physiological and subjective evaluation of meditation, hypnosis, and relaxation.

Ss were monitored for respiratory rate, pulse rate, blood pressure, skin resistance, EEG activity, and muscle activity. They were monitored during the alert state, meditation (TM or simple word type), hypnosis (relaxation and task types), and relaxation. Ss gave a verbal comparative evaluation of each state. The results showed significantly better relaxation responses for the relaxation states (relaxation, relaxation-hypnosis, meditation) than for the alert state. There were no significant differences between the relaxation states except for the measure "muscle activity" in which meditation was significantly better than the other relaxation states. Overall, there were significant differences between task-hypnosis and relaxation-hypnosis. No significant differences were found between TM and simple word meditation. For the subjective measures, relaxation-hypnosis and meditation were significantly better than relaxation, but no significant differences were found between meditation and relaxation-hypnosis.