Association between breast cancer chemotherapy, oral health and chronic dental infections: a pilot study.

Breast cancer has developed to become the leading type of cancer in females. For this study, 80 women were examined after chemotherapy for breast cancer and compared to 80 healthy age-matched women. This cross-sectional study comprised a dental examination with number of teeth, caries frequency (DMFT) and the presence of periodontal diseases (PSI). With the help of X-rays (OPG), the number of root canal fillings and apical lesions (LEO/LPO) were recorded. Furthermore, the education level, body mass index (BMI), smoking habits and general health conditions were recorded. All women completed questionnaires on oral health-related quality of life (OHIP-G14) and general well-being (HADS-D). To assess the influence of cancer therapy on oral health parameters, appropriate generalized linear models were fitted with disease status as main explanatory variable, adjusting for age and education. For OHIP and HADS, we additionally adjusted for number of missing teeth. The examined 160 women showed a comparable mean age (60.4 years) and an average BMI of 24.6. Cancer patients showed a higher risk for missing teeth (p < 0.001) and more apical lesions (p < 0.0041), particularly those of endodontic origin without root canal fillings (p = 0.0046), than the control women. The general well-being of cancer patients was significantly reduced with a HADS score of 9.4 for women with breast cancer compared to 5.3 for the healthy control. This study suggests that women after breast cancer chemotherapy are inclined to have a poorer oral health status with more missing teeth and apical lesions. Therefore, tightly scheduled dental recall visits should be recommended.

Photodynamic Therapy has no Adverse Effects In Vitro on Human Gingival Fibroblasts and Osteoblasts.

BACKGROUND: Invasion of periodontal pockets with persistent microorganisms and subsequent development of a biofilm are the main cause of periodontal infections. In severe cases, additional use of antibiotics to the standard therapy of scaling and root planing (SRP), is necessary, but the use of antibiotics may lead to resistance. As an alternative, the combination of SRP and adjunct photodynamic therapy (PDT) is applied in the treatment of periodontal infections to improve periodontal therapy. The aim of this study was to determine possible side effects of PDT on human gingival fibroblasts (GF) and human osteoblasts (OB). METHODS: GF and OB were either untreated or treated with methylene blue (MB) only, with MB and subsequently irradiation with a soft laser (PDT) or irradiated with a soft laser only. All cells were analyzed for viability using the MTT test, migration capacity using Boyden chambers, and the scratch wound assay. RESULTS: Viability and migration capacity of GF and OB were not affected by PDT (for GF: p = 0.48, for OB: p = 0.08 compared to control group) whereas soft laser irradiation only improved cell viability and migration and MB treatment only reduced cell viability and migration. After 72 hours of incubation of both GF and OB, the gaps were almost closed. CONCLUSIONS: In vitro, PDT did not affect viability and migration capacity of GF and OB whereas soft laser treatment only had a positive effect on GF and OB. Therefore, PDT seems to be a safe method in the treatment of periodontal infections without significant side effects.

Efficacy of photodynamic therapy as adjunct treatment of chronic periodontitis: a systematic review and meta-analysis.

Meta-analysis of treatment effects of antimicrobial photodynamic therapy (aPDT) adjunct to non-surgical scaling and root planing (SRP) in comparison to SRP alone on patients with chronic periodontitis. The meta-analysis was performed according to PRISMA statement and Cochrane Collaboration guidelines. Electronic search complemented by hand search assured a high yield of randomized controlled trials (RCTs) of aPDT as adjunct modality to SRP. Differences in probing depth (PD) and clinical attachment level (CAL) were calculated with 95% confidence intervals and pooled in a random effects model. Analysis for intra- and inter-study heterogeneity was provided by χ 2 and I 2 tests, and publication bias was checked by funnel plots. Pooled overall effects of 26 RCTs attested significant benefits of aPDT adjunct to SRP with respect to PD reduction (MD 0.37; 95% CI 0.12-0.53; P < 0.0001) and CAL gain (MD 0.33; 95% CI 0.19-0.48; P < 0.00001) after 3 and 6 months. Sensitivity analysis minimized heterogeneity of PD reduction (MD 0.21; 95% CI 0.13-0.30; P < 0.00001) and CAL gain (MD 0.36; 95% CI 0.27-0.46). aPDT adjunct to SRP provides significant PD reduction and CAL gain in treatment of chronic periodontitis. This moderate effect was found after 3 and 6 months which is short from a clinical perspective.

Visible Light Curing Devices - Irradiance and Use in 302 German Dental Offices.

PURPOSE: To determine the irradiance delivered by visible-light curing (VLC) units and obtain information about the exposure times and the maintenance protocols used by dentists. MATERIALS AND METHODS: The irradiance (mW/cm2) delivered by 526 VLCs from 302 dental offices from the Rhine-Main area, Germany, was measured using an integrating sphere (IS) and a MARC patient simulator (M-PS); additional information was gathered using a survey. RESULTS: Irradiance was measured from 117 standard quartz-tungsten-halogen (QTH), 5 high-power QTH, 2 LED 1st-generation, 333 LED 2nd-generation, 61 LED 3rd-generation, and 8 plasma-arc curing (PAC) units. Depending on the measurement method, 8% (IS) or 11% (M-PS) of the VLCs delivered < 400 mW/cm2. Depending on the VLC, the shortest exposure times required to deliver a radiant exposure of 16 J/cm2 ranged from 7 to 294 s. The number of exposure cycles used by dentists when light curing a restoration ranged from 1 to 14. The shortest total exposure time used by dentists on a restoration was 5 s, the maximum was 200 s, and the median was 20 s. Of the 526 VLCs, 41% had intact, undamaged light tips. Only half of the dental offices checked the irradiance from their VLCs regularly, 97% disinfected the VLC, and 86% used eye protection. CONCLUSION: Approximately 10% of the VLCs delivered < 400 mW/cm2 and 14% of the dental offices used no form of eye protection. To achieve sufficient light curing of RBC restorations, more awareness about the VLCs used in the dental office is required.

Is there a Genotoxic Potential of Endodontic Root Materials?

BACKGROUND: Leakage of components from endodontic materials (EM) can occur in case of apical extrusion into the periapical tissue. Therefore, an important prerequisite, besides the mechanical properties of the EM, is a high biocompatibility. In the present study, we elucidated the genotoxic potential of EMs of different base composition by utilizing the -H2AX assay. METHODS: For investigation of the genotoxic potential of EM, supernatants of commercially available EM were prepared and dilutions were applied to human gingival fibroblasts. Non-toxic doses of EM were determined by cell viability assay. For the -H2AX assay, human gingival fibroblasts were incubated with predefined concentrations of the supernatants, which were found not to reduce cell viability. Hydrogen peroxide was utilized as positive control. Cells were fixed 1, 6 and 24 hours after addition of the supernatant to the medium, followed by immunostaining for -H2AX. For scoring of -H2AX foci, automated foci counting was performed in at least 80 cells per experiment and time point. The experiments were repeated at least twice. RESULTS: In contrast to hydrogen peroxide treated cells, no elevated -H2AX levels were detected in cells incubated with the EM supernatants. CONCLUSIONS: Samples treated with EM supernatants showed no elevated levels of -H2AX foci, e.g., no genotoxicity. Therefore, all types of EM seem to meet the standard to be called a biocompatible dental material in terms of genotoxicity, and, therefore, the application seems safe.

Determination of polymerization shrinkage of different composites using a photoelastic method.

PURPOSE: To investigate the polymerization shrinkage stress of different low viscous bulk composites (SDR, Venus Bulk Fill, X-tra Base, Filtek Bulk Fill) in comparison to a conventional flowable composite (Filtek Supreme XTE Flow) and to high viscous bulk and conventional composites (Filtek Supreme XTE, GrandioSO, Tetric EvoCeram, Tetric EvoCeram BulkFill, Venus Diamond, Venus Pearl), as well as to an experimental composite (Ormocer) and a sonic-activated bulk fill composite (Sonicfill), by means of photoelastic investigation. METHODS: To ensure bonding of the resin composite, cylindrical cavities (Ø 4mm) in araldite B epoxide resin plates (40 × 40 × 4 mm3) were pre-treated with the Rocatec system. Embedded in araldite plates, six resin composite specimens of each material were exposed for 60 seconds from one side (Translux Power Blue, 1,000 mW/cm2). The samples were stored, light-protected and dry (23°C). Polymerization shrinkage stress data (MPa) were calculated 15 minutes, 1 and 24 hours after light exposure, based on the diameter of the isochromatic curves of first order, obtained from araldite plates. Statistical analysis was performed with the Wilcoxon-test and Bonferroni correction (P< 0.0006). RESULTS: After 15 minutes/1 hour, the mean polymerization stress values calculated were:for SDR 4.4 ± 0.1/4.4 ± 0.2 MPa; Venus Bulk Fill 4.8 ± 0.3/4.9 ± 0.3 MPa; X-tra Base 6.5 ± 0.3/6.7 ± 0.3 MPa; Filtek Bulk Fill 4.9 ± 0.3/4.9 ± 0.3 MPa; Filtek Supreme XTE Flow 8.0 ± 0.3/8.2 ± 0.2 MPa; Filtek Supreme XTE 7.1 ± 0.1/7.4 ± 0.2 MPa; GrandioSO 6.3 ± 0.4/6.3 ± 0.3 MPa; Tetric EvoCeram 4.5 ± 0.1/4.6 ± 0.1 MPa; Tetric EvoCeram BulkFill 4.9 ± 0.2/5.0 ± 0.3 MPa; Venus Diamond 3.7 ± 0.3/3.8 ± 0.3 MPa; Venus Pearl 3.9 ± 0.2/4.0 ± 0.2 MPa, Sonicfill 5.4 ± 0.2/5.6 ± 0.3 MPa; and Ormocer (experimental) 4.1 ± 0.2/4.3 ± 0.2 MPa. After 24 hours, the following mean stress values were obtained:SDR 4.7 ± 0.2 MPa; Venus Bulk Fill 5.1 ± 0.2 MPa; X-tra Base 7.2 ± 0.4 MPa; Filtek Bulk Fill 5.3 ± 0.3 MPa; Filtek Supreme XTE Flow 8.7 ± 0.3 MPa; Filtek Supreme XTE 7.9 ± 0.2 MPa; GrandioSO 7.0 ± 0.4 MPa; Tetric EvoCeram 4.9 ± 0.1 MPa; Tetric EvoCeram BulkFill 5.4 ± 0.3 MPa; Venus Diamond 4.5 ± 0.3 MPa; Venus Pearl 4.5 ± 0.3 MPa, Sonicfill 5.8 ± 0.2 MPa and Ormocer (experimental) 4.5 ± 0.2 MPa. The new and experimental resin composites showed significantly less polymerization shrinkage stress than the conventional resin composite (Filtek Supreme XTE). CLINICAL SIGNIFICANCE: Resin composite restoratives differ in their polymerization shrinkage stress development, independent of their viscosity. Some low viscosity bulkfill-restoratives generate less shrinkage stress compared to other conventional or bulk-restoratives. Practitioners should yield to the potential effect of shrinkage stress development, because this might affect marginal integrity in the clinical performance.

Root coverage with connective tissue graft associated with coronally advanced flap or tunnel technique: a randomized, double-blind, mono-centre clinical trial.

AIM: The aim of this randomized clinical trial was to compare the coronally advanced flap (CAF) with the modified microsurgical tunnel technique (MMTT) for treatment of Miller class I and II recessions. MATERIAL AND METHODS: Forty patients with 71 gingival recessions were recruited and randomly assigned to either CAF or to MMTT. In both groups, a connective tissue graft was applied. Clinical evaluations were performed after 3, 6, and 12 months. Impressions were taken and digitally scanned three-dimensionally to evaluate the quantitative soft tissue changes in the operative region. Patient satisfaction was measured with the root coverage aesthetic score (RES). RESULTS: After a period of 12 months, significant differences were not found between the two groups. Root coverage was 98.3% for CAF and 97.2% for MMTT. The evaluation of the aesthetic outcome using RES showed good results in both groups. The RES score was in accordance with subjective patient satisfaction. There was no significant difference in the amount of volumetric changes. CONCLUSIONS: CAF and MMTT with the additional use of a graft are equally successful in covering gingival recessions of Miller class I and II, with high aesthetic results. All patients indicated their willingness for further periodontal surgery.

The influence of various rehydration protocols on biomechanical properties of different acellular tissue matrices.

OBJECTIVES: This study evaluated the influence of different rehydration media and time periods on biomechanical and structural properties of different acellular collagen matrices (ACMs). MATERIALS AND METHODS: Specimens of three ACMs (mucoderm®, Mucograft®, Dynamatrix®) were rehydrated in saline solution (SS) or human blood for different time periods (5-60 min). ACMs under dry condition served as controls. Biomechanical properties of the ACMs after different rehydration periods were determined by means of tensile testing. ACMs' properties were further characterized using Fourier-transform-infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). RESULTS: At dry conditions, mucoderm® presented the highest tensile strength (TS) and Dynamatrix® showed the maximum elastic modulus (EM; p each ≤0.036). Rehydration in SS and blood resulted in significant TS changes of mucoderm® (p each ≤0.05). Concering EM, mucograft® showed significantly decreased values after rehydration in SS compared to Dynamatrix® and mucoderm® after 10 min (p each ≤0.024). mucoderm® hydrated for 5 min in blood displayed nearly double TS and a significantly increased EM after 60 min (p = 0.043) compared to rehydration in SS. TS and EM values of Dynamatrix® and Mucograft® were not altered following rehydration in blood versus SS (p each ≥0.053). FTIR analysis confirmed the recovery of the graft protein backbone with increased rehydration in all samples. DSC measurements revealed that tissue hydration decreased thermal stability of the investigated ACMs. CONCLUSION: Our findings demonstrated that the rehydration protocol affects the biomechanical properties of ACMs. CLINICAL RELEVANCE: Clinicians should be aware of altered handling and mechanical properties of ACMs following different rehydration protocols.

Efficacy of an aluminium triformate mouthrinse during the maintenance phase in periodontal patients: a pilot double blind randomized placebo-controlled clinical trial.

BACKGROUND: The aim of this prospective placebo-controlled pilot study was to evaluate short-term effects of a mouthrinse containing aluminium triformate (ATF) on gingival inflammation and plaque formation in periodontal patients who are in the maintenance phase. ATF has styptic (astringent) and anti-inflammatory effects. METHODS: Forty non-smoking periodontal patients with modified sulcus bleeding index (MSBI) ≥40 % were randomly divided into two groups. The participants received a masked mouthrinse (ATF or placebo) and were instructed with the rinsing protocol of 3 daily rinses during 30 s for 7 days. One blinded investigator (CE) performed all clinical examinations. The primary outcome was reduction in gingival inflammation as measured by MSBI. The secondary outcomes were reduction of the amount of plaque as measured by plaque index (PI) and approximal plaque index (API) and the occurrence of side effects. The patients were evaluated at the start and the end of the rinsing period, including the compliance of the patients. RESULTS: MSBI was reduced in both groups compared to baseline, but the ATF group showed significantly more reduction in MSBI compared to the placebo group (ATF: 17.6 %, placebo: 7.6 %, p = 0.035). ATF and placebo had no effects on dental plaque. Patients reported ATF mouthrinse not to have side effects other than oral sensation, whereas compliance of the patients was good. Almost all patients in the ATF group reported reduction of gum bleeding after 1 week of rinsing with ATF. CONCLUSIONS: This short-term pilot clinical trial is a firm basis to design a long-term controlled clinical trial to show whether ATF helps to inhibit further periodontal breakdown in maintenance patients with high MSBI. TRIAL REGISTRATION: This trial was registered in the WHO International Clinical Trials Registry Platform as DRKS00007672 , date of registration: 21/01/2015.

Dental age assessment in 6- to 14-year old German children: comparison of Cameriere and Demirjian methods.

BACKGROUND: The aim of the study was to compare two frequently used dental age estimation methods for accuracy. METHODS: A total of 479 panoramic radiographs in age groups 6-14 years from a German population were evaluated. The dental age of 268 boys and 211 girls was assessed by means of the method of Demirjian (1973) and Cameriere (2006) and compared with their actual chronological age. RESULTS: Demirjan's method showed an overestimation of dental age compared to chronological age in all age groups for boys (mean difference -0.16, p = 0.010, range -0.35 to 0.09), age group 9 showed an underestimation. Using the same method for girls (mean difference -0.18, p = 0.008, range -0.45 to 0.13), an overestimation could also be shown in all age groups except for age groups 8 and 13. Results for Cameriere's method showed for boys (mean difference 0.07, p = 0.314, range -1.38 to 3.83) in age groups 6 to 11 an overestimation, but in age groups 12 to14 an underestimation. The results for girls (mean difference 0.08, p = 0.480, range -1.55 to 4.51) showed an overestimation for age groups from 6 to 10, and an underestimation in age groups 11 to 14. CONCLUSIONS: The comparison shows an advantage of Demirjian's method for both genders. While Cameriere's method showed a higher inaccuracy in all age groups, Demirjian's method showed more appropriate results for dental age estimation of the investigated German population. To avoid errors in forensic age estimation and to prevent misidentifications for defendants in criminal processes, further studies of more precise methods for age estimation for the German population are required.

Oral Hygiene and Dietary Habits in Adolescents with Fixed Orthodontic Appliances: A Cross-sectional Study.

OBJECTIVES: Fixed orthodontic appliances (FOAs) may cause a temporary deterioration of oral hygiene with corresponding gingival inflammatory changes. Optimal oral hygiene and dietary changes are essential in order to avoid periodontal inflammation. The present study investigates to what extent the recommendations made by the orthodontist are followed by young patients. MATERIALS AND METHODS: A total of 67 adolescent patients with FOA were examined and interviewed. The control group consisted of 70 patients of the same age who had not undergone any orthodontic treatment. A specific questionnaire (assessing dietary habits, oral hygiene measures) was used and comprehensive oral findings along with oral hygiene status were evaluated. RESULTS: The analysis of the data showed that despite intensive oral hygiene and dietary advice in the patients with FOA, there was no change in diet or oral hygiene habits. There were significantly higher signs of gingival inflammation and amount of dental plaque in FOA patients. Nutritional recommendations and oral hygiene measures for young people with FOA were not adequately enforced. CONCLUSION: The findings indicate that frequent recalls should be scheduled with repeated reinforcement of oral hygiene and dietary modifications in FOA patients.

Penetration Potential of a Silver Diamine Fluoride Solution on Dentin Surfaces. An Ex Vivo Study.

BACKGROUND: Occurrence of open dentinal tubules as a cause of dental hypersensitivity is a very common pnenomenon in patients. The aim of this in vitro study was to assess the effect of a silver diamine fluoride solution (Ag(NH3)2 F) on human dentin samples. METHODS: A total of five fully retained wisdom teeth were selected for this study. The crowns of the teeth were separated from the roots and the occlusal enamel surface was removed. All dentin samples were treated for 60 seconds with phosphoric acid (36%) and rinsed thoroughly to remove the smear layer. Then the desensitizing agent (Riva Star, SDI; 38% Ag(NH3)2 F) was placed according to the manufacturer's instruction. Three dentin samples were prepared for element analysis using an electron beam microprobe analyzer (JEOL JXA 8900RL). The Ag concentrations in the dentin samples were measured in depths ranging from 5 to 40 µm. The other two dentin samples were vertically fractured and accordingly prepared for visualization with SEM (Zeiss DSM). RESULTS: The application of the desensitizing agent on the dentin areas demonstrated an increased Ag concentration (JEOL JXA 8900RL). On the dentin surface an Ag concentration of 1.7 weight % (? 0.7) was measured, but at a depth of 20 µm only 0.3 weight % (± 0.1) were detected. In depths greater than 40 µm the Ag concentration was below the detection limit. The SEM results showed that deposits could be found in a covering on the dentin layer and in the dentinal tubules to a depth of 20 µm. CONCLUSIONS: In this ex vivo study, the effect of silver diamine fluoride on dentin surfaces could be demonstrated. The desensitizing agent formed a film on the dentin surface and in some dentinal tubules deposits were detected. These findings can explain a certain desensitizing effect, but a direct translation to in vivo conditions can only be done with caution.

Penetration of Streptococcus sobrinus and Streptococcus sanguinis into dental enamel.

The aim of this pilot study was to assess the difference in virulence of acidogenic and aciduric oral streptococci in an in vitro caries model using their penetration depths into dental enamel. 30 caries-free extracted molars from 11- to 16-year-olds were cleaned ultrasonically for 1 min with de-ionized water and, after air-drying, embedded in epoxy resin. After 8-h of setting at room temperature, the specimens were ground on the buccal side with SiC-paper 1200 (particle size 13-16 µm). Enamel was removed in circular areas sized 3 mm in diameter; the mean depth of removed enamel was 230 ± 60 µm. 15 specimens each were incubated anaerobically under standardized conditions with 24 h-cultures of Streptococcus sanguinis 9S or Streptococcus sobrinus OMZ 176 in Balmelli broth at 37 ± 2 °C; the pH-values of the broths were measured at the beginning and end of each incubation cycle. After 2, 4, 6, 8, and 10 weeks 3 teeth each were fixed in 2.5% glutaraldehyde in cacodylate buffer for 24 h, washed 3× and dehydrated 30-60min by sequential washes through a series of 30-100% graded ethanol. The teeth were cut in half longitudinally; afterward, two slits were made to obtain fracture surfaces in the infected area. After critical-point-drying the fragments were gold-sputtered and viewed in a scanning electron microscope at magnifications of ×20-20,000. After 10 weeks of incubation, penetration of S. sanguinis of 11.13 ± 24.04 µm below the break edges into the enamel was observed. The invasion of S. sobrinus reached depths of 87.53 ± 76.34 µm. The difference was statistically significant (paired t test: p = 0.033). The experimental penetration depths emphasize the importance of S. sanguinis versus S. sobrinus in the context of the extended ecological plaque hypothesis.

Effect of thermocycling with or without 1 year of water storage on retentive strengths of luting cements for zirconia crowns.

STATEMENT OF PROBLEM: Bond stability between zirconia crowns and luting cement and between cement and dentin is a main concern; however, only limited evidence is available as to its longevity. PURPOSE: The purpose of this in vitro study was to measure the retentive strengths of 7 self-adhesive cements (RelyX Unicem Aplicap, RelyX Unicem Clicker, RelyX Unicem 2 Automix, iCEM, Maxcem Elite, Bifix SE, SpeedCem), 2 adhesive cements with self-etch primers (Panavia 21, SEcure), 1 glass ionomer cement (Ketac Cem), 1 resin-modified glass ionomer cement (Meron Plus), and 1 zinc phosphate cement for luting zirconia crowns (LAVA) to extracted teeth after thermocycling with or without 1 year of water storage. MATERIAL AND METHODS: Two-hundred-forty extracted human molars (2 treatments; n=10 per cement) were prepared in a standardized manner. All cements were used according to the manufacturers' recommendations. The intaglios of the crowns were treated with airborne-particle abrasion. After thermocycling (×5000, 5°C/55°C) with or without 1 year of water storage, the cemented ceramic crowns were removed by using a Zwick universal testing device. Statistical analyses were done with the Wilcoxon rank sum and the 2-independent-samples Kolmogorov-Smirnov test. RESULTS: Median retentive strengths [MPa] for specimens thermocycled only/thermocycled with 1 year of water storage were as follows: Panavia 21: 1.7/2.5, SEcure: 3.0/3.0, RelyX Unicem Aplicap: 3.1/3.4, RelyX Unicem Clicker: 4.1/4.2, RelyX Unicem 2 Automix: 3.8/3.1, iCEM: 2.3/2.7, Maxcem Elite: 3.0/3.2, Bifix SE: 1.7/1.7, SpeedCem: 1.3/1.6, Meron Plus: 3.1/2.7, Ketac Cem: 1.4/1.4, and zinc phosphate cement: 1.1/1.6. Statistically significant differences were found only among specimens thermocycled only or thermocycled with 1-year water storage (P<.001). CONCLUSIONS: Significant differences in retentive strengths were observed among cements after thermocycling only or thermocycling with 1 year of water storage, but not for the effect of the additional 1 year of water storage.

Traumatic dental injuries in a university hospital: a four-year retrospective study.

BACKGROUND: Traumatic dental injuries present complex injuries of the dentoalveolar system. Aim of this study was to investigate the frequency and patterns of traumatic dental injuries in a University dental emergency service over four years. METHODS: A retrospective investigation on all dental trauma patients presenting at the dental emergency service of the University Medical Center Mainz, Germany between 01/2010 and 12/2013 was conducted. Demographic data, the cause and type of trauma and the initial therapy were analyzed. RESULTS: Out of 16,301 patients, 1,305 patients (8 %; average age 14.7 years ±15.7; 60.1 % male, 39.9 % female) came due to trauma. 63.9 % of the traumas occurred on weekends. The most frequent reason for injuries was falls (54.6 %). No correlation could be found between the cause and the kind of trauma. In 48.6 % of the cases only one tooth was involved, in 33.5 % two. The permanent dentition was traumatized in 56.6 % of cases, the deciduous teeth in 41.1 %. The most frequently affected tooth was the central upper incisor (61.0 %). Hard-tissue injuries were significantly more frequent in the permanent dentition, while periodontal injuries were seen significantly more often in the deciduous dentition. CONCLUSION: Eight percent of all patients seeking help at the dental emergency service presented with trauma, meaning that dental traumatology is one of the major topics in emergencies. To improve the quality of care, further public education, expert knowledge among dental professionals and a well-structured emergency service are necessary.

Odontogenic Infections: A 1-year Retrospective Study.

OBJECTIVES: The purpose of this study was to analyze the prevalence, demographic patterns and management of odontogenic infections in patients undergoing treatment in an outpatient dental emergency service of a university hospital. MATERIALS AND METHODS: In a retrospective study of the year 2012, all patients suffering from odontogenic infections were included. Demographic data, diagnosis and the conducted treatment were analyzed. Odontogenic infections were defined as pulpitis, apical and marginal periodontitis, abscesses and pericoronitis. RESULTS: A total of 2,058 out of 4,209 emergency patients suffered from odontogenic infections. The majority (45.0%) had an apical periodontitis, 20.8% abscesses, 17.3% a marginal periodontitis, 16.3% a pulpitis and 5.8% a pericoronitis. Mean age was 37.5 ± 17.0 years standard deviation (SD) (1.2-96.4). Most patients were 20 to 29 years (24.6%), followed by the age group of 30 to 39 year old patients (21.0%). Males were affected more frequently (55.5%) than females (45.5%). Most of the patients (64.5%) of the patients received a dental or surgical treatment. Antibiotics were prescribed in 31.7% of cases. Amoxicillin was the most common prescribed antibiotic (54.5%). CONCLUSION: Odontogenic infections represent one of the main reasons for consulting the emergency service. Due to the high number of cases and the severe complications, dentists have to be familiar with the surgical management of odontogenic infections as well as the appropriate use of antibiotics. CLINICAL SIGNIFICANCE: Nearly half of all patients who sought, treatment in the emergency service had an odontogenic infectious disease. This should be considered for the organization and planning of the service.

In vitro study on dental erosion caused by different vinegar varieties using an electron microprobe.

BACKGROUND: Among health-conscious individuals, including vegetarians, salads dressed with vinegar are frequently consumed. Dental erosion can also be caused by an acidic diet, and occurs with increasing tendency. The aim of this study was to analyze the erosive potential of vinegar varieties on human enamel samples. METHODS: A total of 30 vinegar varieties were selected. Enamel samples were prepared from human wisdom teeth, and the specially prepared enamel slices were incubated with 5 selected vinegars (Bio vinegar, pH = 3.1; raspberry vinegar, pH = 2.7; Condimento Balsamico, pH = 3.95; Ortalli Bianco Modena, pH = 2.7; Vinaigre de Jerez, pH = 2.9) for up to 8 hours. Controls were incubated with a 0.9% sodium chloride solution. The quantitative analysis of CaO, P2O5, F, MgO, Cl, and O in the enamel samples (incubation: 4, 8 hours) in various depths ranging from 7.5 - 105 microm was carried out using an electron probe micro-analyser (Jeol JXA 8900RL). Linear mixed models were fitted to analyze statistically relevant differences between the different vinegars at various depth levels. RESULTS: Incubating the enamel slices with the selected vinegars caused a release of minerals, which was dependent on time and type of vinegar. The vinegar Ortalli Bianco Modena led to a slight loss (1%) of the mineral CaO in a depth up to 20 microm, while the loss of minerals caused by raspberry vinegar in a depth of up to 30 microm was about 20% (4 hours). The greatest loss of the minerals was detected for the Bio Vinegar. After 8 hours incubation, a loss of minerals of about 20% in a depth of 45 microm and in a depth of 60 microm of 16% could be observed. Both, the Bio Vinegar and the raspberry vinegar led to a significantly higher loss of minerals (p < 0.0001) than all other tested vinegars. CONCLUSIONS: In this in vitro study, the erosive potential of different vinegar varieties on human enamel samples could be demonstrated. However, it must be considered that numerous modifying factors influence the enamel surface in vivo; therefore, a direct translation to in vitro conditions can only be done with caution.

Association between chronic periodontal and apical inflammation and acute myocardial infarction.

Evidence from epidemiologic studies suggests that periodontal diseases may exert a weak to moderate influence on the severity and course of coronary heart disease. The aim of this study was to investigate whether an association between chronic oral infections and the presence of an acute myocardial infarction (AMI) exists. A total of 248 patients after AMI and 249 healthy controls were recruited for this study. The oral assessment included caries frequency (DMFT indices), number of teeth, probing pocket depths, bleeding on probing, clinical attachment level, as well as radiographs to diagnose apical lesions. The medical examination included a blood analysis, e.g. the determination of the serum concentration of C-reactive protein (CRP). The data analysis showed statistically significant differences between AMI patients and the controls with regard to number of missing teeth (p = 0.001), DMFT index (p = 0.001) and presence of apical lesions of endodontic origin (p = 0.001). Logistic regression showed that the probability of having lesions of endodontic origin was with an odds ratio of 1.54 (95% CI 1.10-2.16; p = 0.012) considerably higher in the AMI patient group. Likewise, the AMI patients had with an odds ratio of 1.21 (95% CI 1.14-1.28; p < 0.001) a higher number of missing teeth. The data from the blood analysis, in particular the CRP values, showed no significant correlation with the number of apical lesions. The results of the present study underline that patients, who have experienced a myocardial infarction, had more missing teeth and a higher number of inflammatory processes, especially of endodontic origin, than healthy patients.

Multiple resistance to betalactam antibiotics, azithromycin or moxifloxacin in implant associated bacteria.

BACKGROUND: Antibiotics are more and more frequently prescribed in dentistry for prevention and treatment of oral diseases. Bacterial resistance to these agents is clearly increasing, including even previously susceptible micro-organisms and true pathogens. The aim of the present investigation was to examine resistant bacterial strains with respect to possible multiple antibiotic resistance. METHODS: In a previous investigation, implant-associated bacteria were tested first as mixed cultures and again as pure isolates (n = 138) for resistance to one of five antibiotics (ampicillin/AM, ampicillin + sulbactam/AB, azithromycin/AZ, penicillin/PG, moxifloxacin/MX) using the Etest. The resistance of most of the pure isolates was lower than in mixed culture, but 31.2% had retained their original resistance. Subsequently, all 138 isolates were tested for resistance or susceptibility to the other four antibiotics, again using the Etest. RESULTS: 27.6% (38/138) of the isolates retained their original antibiotic resistance and were resistant to at least one other antibiotic (MIC > or = 128 microg/mL for AB, AM or AZ, > or = 32 microg/mL PG, > or = 24 microg/mL MX). 2.2% (3/138) strains had lost their original antibiotic resistance, but were resistant to at least one other antibiotic (MIC > 128 microg/mL for AB, AM, or AZ, > or = 32 microg/mL PG, > or = 24 microg/mL MX). CONCLUSIONS: Some of the isolates belonging to the implant-associated microflora were multi-resistant, even though the patients had not received any antibiotics six weeks prior to the sampling. The exact mechanisms that lead to multiple resistance need to be examined in further studies.

Clinical parameters and aMMP-8-concentrations in gingival crevicular fluid in pregnancy gingivitis.

BACKGROUND: During pregnancy hormonal changes may increase the risk for developing gingivitis. The aim of this study was to evaluate the signs of gingival inflammation and the enzyme activity of matrix metalloproteinase-8 (aMMP-8) in the gingival crevicular fluid of pregnant women. METHODS: After approval by the ethics commission, a total of 40 volunteers participated in the study; group 1 (n = 20, age: 32 +/- 4 years) with pregnant women, and group 2 (n = 20, age: 30 +/- 10 years) with age-matched non-pregnant women as controls. After obtaining anamnestic data, the dental examination included assessment of oral hygiene, gingival inflammation, probing pocket depth, and recession. Gingival crevicular fluid was collected from both groups. A quantitative determination of aMMP-8 concentrations in the gingival crevicular fluid samples was performed. RESULTS: The aMMP-8 values of group 1 were higher (median 6.25 ng/mL aMMP-8 eluate) compared with group 2 (median 3.88 ng/mL aMMP-8 eluate), but the difference was not statistically significant (p = 0.265). Group 1 showed significantly increased probing pocket depths (p = 0.001). Gingival inflammation was present in 80% of the pregnant women, but only in 40% of the control subjects. CONCLUSIONS: It was shown that during pregnancy changes related to periodontal health could be observed. Higher aMMP-8 values, elevated probing pocket depths, and an increase of gingival inflammation could be detected in comparison with non-pregnant women.