Effect of Non-Surgical Periodontal Treatment on Oxidative Stress Markers in Leukocytes and Their Interaction with the Endothelium in Obese Subjects with Periodontitis: A Pilot Study.

AIM: The primary objective of this pilot study was to evaluate the effect of non-surgical periodontal treatment. The secondary aim was to evaluate the effect of dietary therapy on both parameters of oxidative stress in leukocytes and leukocyte-endothelial cell interactions in an obese population. METHODS: This was a pilot study with a before-and-after design. Forty-nine obese subjects with periodontitis were randomized by means of the minimization method and assigned to one of two groups, one of which underwent dietary therapy while the other did not. All the subjects underwent non-surgical periodontal treatment. We determined periodontal, inflammatory and oxidative stress parameters-total reactive oxygen species (ROS), superoxide production, intracellular Ca2+, mitochondrial membrane potential and superoxide dismutase (SOD) activity. We also evaluated interactions between leukocytes and endothelium cells-velocity, rolling flux and adhesion-at baseline and 12 weeks after intervention. RESULTS: Periodontal treatment improved the periodontal health of all the patients, with a reduction in serum retinol-binding protein 4 (RBP4), total superoxide production and cytosolic Ca2+ in leukocytes. In the patients undergoing dietary therapy, there were less leukocyte adhesion to the endothelium, an effect that was accompanied by a decrease in TNFα, P-selectin and total ROS and an increase in SOD activity. CONCLUSIONS: Whereas non-surgical periodontal treatment induces an improvement in leukocyte homeostasis, dietary therapy as an adjuvant reduces systemic inflammation and increases antioxidant status which, in turn, modulates leukocyte-endothelium dynamics.

Relationship Between Surgical Difficulty of Third Molar Extraction Under Local Anesthesia and the Postoperative Evolution of Clinical and Blood Parameters.

PURPOSE: To determine whether the Pederson scale is a good predictor of the surgical difficulty of third molar extraction and establish whether such surgical difficulty is directly related to the postoperative course as assessed from clinical (pain, inflammation, and trismus) and blood (C-reactive protein, interleukin-6 [IL-6], and fibrinogen) parameters. MATERIALS AND METHODS: A prospective observational study was conducted of 2 groups of patients who underwent simple or surgical third molar extraction under local anesthesia. Clinical and blood parameters and possible complications were recorded for 1 week after extraction. RESULTS: A total of 118 patients were studied. Surgical difficulty as predicted by the Pederson scale showed significant differences (P < .001) for osteotomy, sectioning of the crown, root sectioning, duration of intervention, type of closure, and number of sutures. Under conditions of equal surgical difficulty, the evolution of the groups was similar for pain and inflammation, although trismus was greater for patients subjected to surgical extraction. After the operation, marked increments were recorded in serum C-reactive protein, IL-6, and fibrinogen, although without differences among different levels of surgical difficulty. The probability of complications was similar in the routine and surgical extraction groups. The appearance of complications was the principal cause of alterations in clinical and blood parameters. CONCLUSIONS: The Pederson scale is a good predictor of the surgical difficulty of third molar removal as assessed from different clinical and blood parameters. C-reactive protein, IL-6, and fibrinogen concentrations varied considerably after the operation but were not influenced by the degree of surgical difficulty. The presence of postoperative complications was associated with a poorer evolution of clinical and blood parameters.

Current methods of sedation in dental patients - a systematic review of the literature

OBJECTIVE: The main objective of this systematic literature review is to identify the safest and most effective sedative drugs so as to ensure successful sedation with as few complications as possible. Study DESIGN: A systematic literature review of the PubMed MEDLINE database was carried out using the key words "conscious sedation", "drugs", and "dentistry". A total of 1,827 scientific articles were found, and these were narrowed down to 473 articles after applying inclusion and exclusion criteria. These 473 studies were then individually assessed for their suitability for inclusion in this literature review. RESULTS: A total of 21 studies were selected due to their rigorous study design and conduciveness to further, more exhaustive analysis. The selected studies included a total of 1,0003 patients classified as ASA I or II. Midazolam was the drug most frequently used for successful sedation in dental surgical procedures. Ketamine also proved very useful when administered intranasally, although some side effects were observed when delivered via other routes of administration. Both propofol and nitrous oxide (N2 O) are also effective sedative drugs. CONCLUSIONS: Midazolam is the drug most commonly used to induce moderate sedation in dental surgical procedures, and it is also very safe. Other sedative drugs like ketamine, dexmedetomidine and propofol have also been proven safe and effective; however, further comparative clinical studies are needed to better demonstrate which of these are the safest and most effective

Application of a capsaicin rinse in the treatment of burning mouth syndrome

Objective: To examine the efficacy of a new topical capsaicin presentation as an oral rinse in improving the symptoms of burning mouth syndrome (BMS).Study design: A prospective, double-blind, cross-over study was made of 30 patients with BMS. There were 7dropouts; the final study series thus comprised 23 individuals. The patients were randomized to two groups: (A)capsaicin rinse (0.02%) or (B) placebo rinse, administered during one week. After a one-week washout period, the patients were then assigned to the opposite group. Burning discomfort was scored using a visual analog scale(VAS): in the morning before starting the treatment, in the afternoon on the first day of treatment, and at the end of the week of treatment in the morning and in the afternoon. The same scoring sequence was again applied one week later with the opposite rinse. Results: The mean patient age was 72.65 ± 12.10 years, and the duration of BMS was 5.43 ± 3.23 years on average. Significant differences in VAS score were recorded in the capsaicin group between baseline in the morning (AM1)or afternoon (AA1) and the end of the week of treatment (AA7)(p=0.003 and p=0.002, respectively).Conclusion: The topical application of capsaicin may be useful in treating the discomfort of BMS, but has some limitations (AU)

Application of a capsaicin rinse in the treatment of burning mouth syndrome.

OBJECTIVE: To examine the efficacy of a new topical capsaicin presentation as an oral rinse in improving the symptoms of burning mouth syndrome (BMS). STUDY DESIGN: A prospective, double-blind, cross-over study was made of 30 patients with BMS. There were 7 dropouts; the final study series thus comprised 23 individuals. The patients were randomized to two groups: (A) capsaicin rinse (0.02%) or (B) placebo rinse, administered during one week. After a one-week washout period, the patients were then assigned to the opposite group. Burning discomfort was scored using a visual analog scale (VAS): in the morning before starting the treatment, in the afternoon on the first day of treatment, and at the end of the week of treatment in the morning and in the afternoon. The same scoring sequence was again applied one week later with the opposite rinse. RESULTS: The mean patient age was 72.65 ± 12.10 years, and the duration of BMS was 5.43 ± 3.23 years on average. Significant differences in VAS score were recorded in the capsaicin group between baseline in the morning (AM1) or afternoon (AA1) and the end of the week of treatment (AA7)(p=0.003 and p=0.002, respectively). CONCLUSION: The topical application of capsaicin may be useful in treating the discomfort of BMS, but has some limitations.

Clinical study of hemodynamic changes during extraction incontrolled hypertensive patients

Objective: To evaluate the efficacy and safety of the vasoconstrictor used in local anesthesia during dental extractionin controlled hypertensive patients.Study Design: A prospective observational study was carried out in hypertensive patients (n=97) with a meanage of 60.45±9.60 years. The following parameters were monitored at three different timepoints (before the procedure,3 minutes after local anesthesia infiltration, and 3 minutes after the operation): blood pressure (diastolicand systolic), heart rate, and oxygen saturation. Anesthesia (1-3 carpules) was provided in the form of articainewith 4% epinephrine as vasoconstrictor in one group, while another group received 3% mepivacaine withoutvasoconstrictor.Results: All patients presented primary hypertension (n= 97)(grade I in 57.7% of the cases and grade II in 42.3%).The most widely used antihypertensive drugs were angiotensin II receptor antagonists (ARA II). The only significantdifferences observed corresponded to systolic blood pressure measured before and after dental extraction inthe group of hypertensive patients anesthetized with vasoconstrictor.Conclusions: In procedures such as dental extraction, no significant hemodynamic changes in well controlledhypertensive patients are seen attributable to anesthetic use with a vasoconstrictor, when fewer than three localanesthetic carpules are administered (AU)

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