[The Intensified Dental Preventive Programme in Rhineland-Palatinate: Investigations on first-grade school-children in 2013/2014]. / Die zahnärztliche selektive Intensivprophylaxe in Rheinland-Pfalz: Untersuchungen an Erstklässlern im Schuljahr 2013/2014.

Aim: For children and adolescents at increased risk of caries, the "Selective Intensive Prophylaxis" (SIP) programme was established in Rhineland-Palatinate in 2004, as well as in the most other German states. This study compares the results of the school dentists' evaluations of first grade school children in 2013/2014 participating in the "Selective Intensive Prophylaxis" (SIP) programme or the "Standard Programme" (SP). Methods: The d3mft/D3MFT index was recorded by school dentists according to the WHO criteria; caries was diagnosed if dentin was affected; no radiography or fiber-optic transillumination was used. The examinations were performed once under the SP and twice under the SIP. Children and parents were informed in case of a need for treatment and reminded if the did not see the family dentist. Out of the evaluated d3mft/D3MFT values, the Significant Caries Index (SiC) was calculated. Statistical computing was performed using SPSS 22.00. Results: Of all first graders, n=25 020 were evaluable for d3mft/D3MFT. Altogether n=1 164 first graders were included into the SIP in the 2013/2014 term; for n=1 002 of those, the results for both examinations were available. The caries experience of those pupils participating in the SIP was clearly higher than in the SP (41.8% naturally healthy vs. 61.7%, p<0.0001). There was significant difference between the first and second examination in the SIP, especially with respect to individual (16.0 vs. 23.0%, p<0.0001) and tooth-related (43.2 vs. 54.2%, p<0.0001) level of restoration. Conclusion: The results show that the SIP in Rhineland-Palatinate is conducted in a population with high caries experience. The significant difference concerning the dental restoration level, both individual- and teeth-related - leads to the conclusion that children frequently sought dental treatment if a need for treatment was diagnosed by the school dentist.

Effectiveness of a miswak extract-containing toothpaste on gingival inflammation: a randomized clinical trial.

OBJECTIVES: In this study, the efficacy of a miswak extract-containing toothpaste (Salvadora persica) on gingival inflammation was compared with that of a herbal and a conventional toothpaste. METHODS: Non-smoking outpatients with sulcus bleeding index (SBI) ≥25% and with periodontal pocket depths ≤3 mm were randomly selected and divided into three groups: M-group, miswak extract-containing toothpaste; P-group, herbal toothpaste; and C-group, conventional toothpaste. After instructing the patients to brush their teeth twice a day for 3 weeks with the assigned toothpaste using a flat-trimmed manual toothbrush, a thorough oral examination was performed by a calibrated examiner (EH). The primary outcome was the SBI after 21 days. Furthermore, the amount of plaque was measured by approximal plaque index (API). RESULTS: Sixty-six patients with a mean age of 57.8 ± 10.2 years were recruited and enrolled. After 3 weeks of brushing, all three patient groups showed a significant reduction in SBI. The P-group (SBI reduction: 17.1% ± 9.1) and the M-group (14.5% ± 8.1) showed the strongest effect followed by the C-group (9.4% ± 7.8). All three groups showed a significant reduction in API without significant differences between the groups. CONCLUSIONS: The use of each of the three tested toothpastes caused a significant reduction in gingival inflammation and amount of plaque. The miswak extract-containing toothpaste showed a similar effect as the herbal toothpaste and can be safely used for domestic oral hygiene in patients with gingivitis.

Catalogue of Interactive Learning Objectives to improve an Integrated Medical and Dental Curriculum.

INTRODUCTION: Online learning media are increasingly being incorporated into medical and dental education. However, the coordination between obligatory and facultative teaching domains still remains unsatisfying. The Catalogue of Interactive Learning Objectives of the University Clinic of Mainz (ILKUM), aims to offer knowledge transfer for students while being mindful of their individual qualifications. Its hierarchical structure is designed according to the Association for Dental Education in Europe (ADEE) levels of competence. MATERIALS AND METHODS: The ILKUM was designed to establish a stronger interconnection between already existing and prospective learning strategies. All contents are linked to the current lectures as well as to e-learning modules, e.g., clinical case studies and OR videos. Students can conduct self-examinations regarding specific learning objectives. Since 2007, ILKUM has been developed and analyzed regarding its acceptance among dental students. RESULTS: These improved e-learning techniques foster time and location-independent access to study materials and allow an estimation of the knowledge achieved by students. Surveys of our students clearly show a large demand for upgrading ILKUM content (89%; n = 172) with integrated self-testing (89%; n = 174). In parallel to the advancement of our e-learning offering, a portion of internet-based learning is constantly rising among students. CONCLUSION: The broad acceptance and demand for the development of ILKUM show its potential. Moreover, ILKUM grants fast, topic-oriented querying of learning content without time and locale limitations as well as direct determination of the individually needed knowledge conditions. CLINICAL SIGNIFICANCE: The long-term goal of the ILKUM project is to be a sustainable, important additional modality of teaching and training for dental and medical students.

Survey of root canal irrigating solutions used in dental practices within Germany.

AIM: Irrigant usage information in relation to years of professional experience was collected from general dentists in different German federal states by means of a questionnaire. METHODOLOGY: A short survey concerning endodontic treatment and use of irrigants was mailed to 4240 dentists or delivered to 3720 dental offices as an extra page in a journal in eight German states. Detailed information concerning the most frequently used irrigants, their concentrations, the spectrum of disinfectants used in root canal treatment concepts for vital and nonvital pulps, main topics of continuing education as well as years of professional experience was collected. The statistical analysis of differences found amongst the dentists in relation to professional experience or federal state was performed using the chi-square test. RESULTS: Of a total of 7960 invitations, 1630 replies were evaluated (response rate 20.5%). The majority of the dentists (57.3%) had >20 years of professional experience, 23% had >30 years. Dentists with long-standing professional experience (20-30 years) used H2 O2 significantly more often than dentists with less experience (P < 0.001), and of the older colleagues (>30 years of professional experience), 14.6% never used NaOCl, whilst the younger colleagues almost always used it (P < 0.001). Differences were also found for the usage of irrigants amongst dentists from the various German states. CONCLUSIONS: Whilst NaOCl was used in almost all states, regional differences were found regarding the choice of additional irrigants, which were mainly determined by the irrigation protocols taught at different universities.

Braces versus Invisalign®: gingival parameters and patients' satisfaction during treatment: a cross-sectional study.

BACKGROUND: Fixed orthodontic appliances (FOA) temporarily interfere with periodontal health of patients, as the appliance complicates oral hygiene. The use of aligners in orthodontic therapy increased strongly during the last decade. In the literature, the reports about effects of aligner treatment on oral hygiene and gingival conditions are scarce. This cross-sectional study evaluated oral hygiene and patient's satisfaction during orthodontic treatment of patients with FOA or Invisalign®. METHODS: 100 patients (FOA = 50, Invisalign® = 50) were included who underwent orthodontic treatment for more than 6 months. Clinical examinations were performed to evaluate patients' periodontal condition and were compared with clinical data at the beginning of the orthodontic treatment. Oral hygiene, patients' satisfaction and dietary habits were documented by a detailed questionnaire. For statistical analysis, the Mann-Whitney U-Test and Fisher's Exact Test were used; as multiple testing was applied, a Bonferroni correction was performed. RESULTS: At the time of clinical examinations, patients with FOA were in orthodontic therapy for 12.9 ± 7.2 months, whereas patients with Invisalign® were in orthodontic therapy for 12.6 ± 7.4 months. Significantly better gingival health conditions were recorded in Invisalign® patients (GI: 0.54 ± 0.50 for FOA versus 0.35 ± 0.34 for Invisalign®; SBI: 15.2 ± 7.6 for FOA versus 7.6 ± 4.1 for Invisalign®), whereas the amount of dental plaque was also less but not significantly different (API: 37.7 % ± 21.9 for FOA versus 27.8 % ± 24.6 for Invisalign®). The evaluation of the questionnaire showed greater patients' satisfaction in patients treated with Invisalign® than with FOA. CONCLUSION: Patients treated with Invisalign® have a better periodontal health and greater satisfaction during orthodontic treatment than patients treated with FOA.

Clinical efficacy of a computerised device (STA™) and a pressure syringe (VarioJect INTRA™) for intraligamentary anaesthesia.

INTRODUCTION: To evaluate the impact of experience whilst using different devices for intraligamentary anaesthesia, dental students tested clinical anaesthetic efficacy of a mechanical (PDL-S) and a computer-controlled (CCLAD) application system in restorative patients. MATERIAL AND METHODS: In a prospective study, 41 Patients in need of restorative treatment in lower posterior mandible were randomised into three groups (PDL-S: teeth n = 22; CCLAD: teeth n = 20; inferior alveolar nerve block (IANB): teeth n = 20). Dental last year students conducted anaesthesia and dental treatment. Primary objectives were differences in pain during treatment [numeric rating scale (NRS)] as well as in anaesthetic efficacy (complete/sufficient vs. insufficient/no effect) between PDL-S and CCLAD. Pain of injection, need for second injections, amount of anaesthetic solution and duration of local numbness were assessed. IANB as gold standard was compared to each system descriptively. RESULTS: PDL-S had a significant lower pain during treatment (P = 0.017) but a similar anaesthetic efficacy (P = 0.175) compared to the CCLAD system. Concerning pain of injection (P = 0.42), quantity of second injections (P = 0.232), amount of used solution (P = 0.073) as well as duration of local numbness (P = 0.253), no differences were seen. When comparing both periodontal ligament injection (PDL)-systems with IANB, pain rating was higher when using CCLAD. Injection pain, amount of used solution as well as soft tissue anaesthesia was less for PDL-S and CCLAD. DISCUSSION: Both PDL techniques showed a good success for dental routine treatments. Although, compared to the mechanic device, the CCLAD system might need more clinical daily experience. CONCLUSION: We recommend including specific trainings in intraligamentary anaesthesia in the dental curriculum.

In vitro and in vivo characterization of porcine acellular dermal matrix for gingival augmentation procedures.

BACKGROUND AND OBJECTIVE: Recently, porcine acellular dermal matrix (PADM) has been proposed as a possible alternative to autogenous grafts in periodontal plastic surgery. The aim of the present study was to investigate the in vitro responses of four different oral cell lines cultured on a novel PADM. Furthermore, tissue reaction to PADM was evaluated histologically after subcutaneous implantation in mice. MATERIAL AND METHODS: Human gingival fibroblasts (HGF), human osteoblast-like cells, human umbilical vein endothelial cells and human oral keratinocytes (HOK) were cultured and transferred on to the PADM. A tissue culture polystyrene surface served as the control. The viability of all tested cell lines on PADM was measured by using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide colorimetric assay and PrestoBlue(®) reagent. The ToxiLight(®) assay was performed to analyze the effect of PADM on adenylate kinase release. PADM was implanted into nude mice subcutaneously and subjected to histological analysis after 21 d. RESULTS: Using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide colorimetric assays, all tested cell lines cultured on PADM demonstrated a significant increase of viability compared to the control group (each p < 0.001) with the exception of HGF and HOK after 3 d (each p > 0.05). According to the PrestoBlue(®) analysis, all cell lines demonstrated a significant increase of viability compared to the control group at the particular points of measurement after 18 h (HGF p < 0.01; human osteoblast-like cells, human umbilical vein endothelial cells, HOK each p < 0.001). No significant cytotoxic effects of PADM on the tested cell lines could be observed, as assessed by changes in adenylate kinase release. Subcutaneous implantation of PADM into nude mice demonstrated good integration with surrounding tissues and significant revascularization of its collagen structure. CONCLUSION: Overall, the results suggest that PADM is a promising substitute for autogenous soft tissue grafts in periodontal surgery.

[Oral health conditions in women with or without occupation--results from a regional examination and survey]. / Mundgesundheit von berufstätigen und nicht berufstätigen Frauen--Ergebnisse einer regionalen Untersuchung und Umfrage.

AIM: In the present study oral health conditions and oral hygiene measures of women with and without occupation were examined and compared. In addition to a dental assessment, oral hygiene measures and socio-demographic data were collected by means of a questionnaire. METHOD: A total of 415 subjects (210 women with and 205 women without occupation) with an age range of 25-65 years were enrolled in this study. All women underwent a dental assessment, including a radiographic examination (orthopanthomogram). The dental assessment comprised the number of teeth, caries frequency (DMFT index), type and frequency of restorations, quality of oral hygiene (API), degree of gingival inflammation (SBI), probing depths and the presence of recessions. In addition, a questionnaire, concerning anamnestic data and information about the familial situation, level of education and occupation, was filled in. The study was approved by the ethics commission (Rhineland-Palatinate). RESULTS: Of the women without occupation (mean age: 38.1±9.7 years) 90% were married, only 3% were heavy smokers, and only 2% had a university degree. Of the working women (mean age: 43.2 ±11 years) 73% were married, 17% were heavy smokers (> 20 cigarettes/day), and 10% had a university degree. Oral hygiene of the working women was slightly better than that in women without occupation; however, severe periodontal disease was seen more frequently in working women (15% vs. 3.3%; p<0.027). With respect to the periodontal situation, the probability of developing an aggressive periodontitis was with an odds ratio of 4.23 (95% CI: 0.77-23.17) considerably higher for the group of working women. CONCLUSION: The oral health of women with or without occupation differed slightly. These findings suggest that occupation, level of education and life style of the women have an influence on oral hygiene measures and on oral health.

The influence of enamel matrix derivative on the angiogenic activity of primary endothelial cells.

BACKGROUND AND OBJECTIVE: Angiogenesis plays a crucial role in early wound healing and tissue regeneration. Although enamel matrix derivative (EMD) has demonstrated the potential to stimulate periodontal regeneration, the biological effects of EMD on angiogenesis and underlying mechanisms have not been fully elucidated. The aim of the present study was to examine the angiogenic effects of EMD in vitro. MATERIAL AND METHODS: Human umbilical vein endothelial cells (HUVECs) were used to assess the effect of EMD on proliferation, survival, adhesion and migration. The effect of EMD on HUVEC angiogenesis was assessed by a three-dimensional sprouting assay. In order to understand the signalling mechanism of altered cell proliferation of HUVECs caused by EMD, the phosphorylation status of ERK1/2 and of the serine/threonine protein kinase Akt was analysed by western blot using phospho-specific antibodies. RESULTS: The proliferation of HUVECs was stimulated by 50 µg/mL EMD, whereas higher concentrations (≥100 µg/mL) resulted in an increased apoptotic rate. The mitogenic response to EMD was associated with the activation of ERK1/2. Enamel matrix derivative did not affect cell adhesion, but all concentrations of EMD tested (0.1-250 µg/mL) promoted migration of HUVECs. Furthermore, EMD induced capillary-like sprout formation from HUVEC spheroids in a dose-dependent manner. CONCLUSION: Our data indicate that EMD acts as a proangiogenic factor in vitro and, as such, might contribute to periodontal tissue regeneration by stimulation of vessel formation during wound healing.

Tissue reaction to sealing materials: different view at biocompatibility.

The biodegradability of root canal sealers in areas other than the root canal system is crucial to the overall success rate of endodontic treatment. The aim of the present study was to investigate, the cell and tissue reaction to GuttaFlow and AHPlus, both in vitro and in vivo. For the in vitro experiments the materials were incubated with Human Periodontal Ligament Fibroblasts and cell proliferation and cytotoxicity analyses were performed. Additional fluorescence-microscope stainings were carried out in order to visualize cell growth and morphology. For assessment of the tissue reaction to the materials a subcutaneous implantation model in Wistar rats was employed and the inflammatory response to the materials was visualized by means of general and specific histology after 6 weeks. Human gingival fibroblasts proliferation seemed to be dependent upon dental material and cultivation time. After an incubation period of 96 hrs AHPlus proved to be significantly (p<0.002) more cytotoxic than GuttaFlow, as only a small number of fibroblasts survived on AHPlus. In vivo, GuttaFlow was surrounded by a fibrous capsule and no degradation took place, while AHPlus induced a well-vascularized granulation tissue in which the material was phagocyted by macrophages. The results of this study demonstrate that a potential cytotoxic effect of a sealing material may beneficial in order to have antibacterial properties and induce self degradation when accidentally extruded over the apical foramen.

[Oral hygiene, prophylaxis and therapy in patients with inflammatory rheumatic diseases]. / Mundhygiene, Prophylaxe und Therapie bei entzündlich-rheumatischen Erkrankungen.

Inflammatory disorders of the periodontium are often associated with chronic systemic diseases, which can demonstrate a reciprocal influence. Within the adult population at present, 74% of younger adults and 88% of older individuals require periodontal treatment. Due to inflammatory processes, patients with rheumatoid arthritis or other chronic polyarthritides frequently suffer from pain in the temporomandibular joint and, since finger mobility is often limited, their ability to perform oral hygiene measures is impeded. However, diligent and constant oral hygiene is of crucial importance both for maintaining a healthy periodontium and to prevent the development of caries. For their daily dental care, these patients should favor the use of electric toothbrushes, products for interdental cleaning and mouth rinses. The dentist should be informed immediately about increased and constant gingival bleeding, gingival hyperplasia, loosening or migration of teeth associated with gingival recession or other irritations in the oral cavity. Professional dental cleaning should be routinely performed at 3- to 6-month intervals in order to prevent an increase in the risk for periodontal disease.

Influence of gender and social factors on oral health, treatment degree and choice of dental restorative materials in patients from a dental school.

OBJECTIVE: The attitude towards oral health is influenced by gender, the level of education and the social background of the patients The aim of the present study was to determine a possible relationship of gender, the educational level and the oral health as well as the choice of dental restorations. METHODOLOGY: A total of 2374 outpatients (age: 18-80 years) from a University dental school were assessed. Inclusion criteria were 15 remaining teeth and good general health. In addition to anamnesis data, information concerning educational level and present occupation was collected. The dental assessment included number of teeth, endodontic treatment, type of restorations (root canal fillings, restoration materials) as well as dental panoramic radiographs (OPG). RESULTS: The female patients demonstrated a statistically significant higher percentage of restoration, more teeth with crowns and more tooth coloured fillings compared to men (P < 0.01). Patients with a higher level of education preferred more expensive restorations, whereas patients with a low level of education exhibited more inexpensive restorations. However, patients with private health insurance showed lower levels of carious lesions. CONCLUSION: The examined patients showed no significant correlation between educational level and type of dental restorations but female patients had a lower number of teeth and more restoration.

Assessment of alveolar bone loss and angular bony defects on panoramic radiographs.

The aim of the present study was to investigate the prevalence and severity of alveolar bone loss and angular bony defects in randomly selected panoramic radiographs. A total of 500 panoramic radiographs of adult patients seeking dental care were studied. The mean age of the subjects was 51 years (range 20-80). The assessments of alveolar bone levels and angular bony defects were performed by direct measurements of the distance between the cemento-enamel junction (CEJ) and bone level. The results demonstrated a gradual and significant increase in the frequency of bone loss with increasing age (p<0.05). Angular bony defects were found in 249 subjects (49.8 %) and were most frequent at the mandibular first molar. The mean depth of the angular bony defects was 6.0 mm with the greatest mean depth in the maxillary anterior area (6.8 mm). The mean mesiodistal depth of the intrabony defects was 2.44 mm, most pronounced in maxillary molars (3.1 mm). In conclusion, the study demonstrated a high prevalence of angular bony defects suitable for regenerative periodontal treatment.

Influence of apple juice on human enamel surfaces of the first and second dentition - an in vitro study.

Dental erosion caused by acidic beverages is common and occurs with increasing tendency. The aim of this in vitro study was to analyse the erosive potential of apple juice on human enamel samples from the first and second dentition. Apple-juice-containing beverages (n = 23) were selected, and pH and buffering capacity were determined. Enamel samples were prepared from impacted, surgically removed wisdom teeth (20 mm superset2) and from deciduous teeth (16 mm superset2). Prepared enamel slices were incubated with a selected apple juice (pH = 3.5) for up to 24 h; the amounts of released calcium were determined colorimetrically, and mean surface roughness (Ra) of the enamel was measured using an optical profilometric device (perthometer, Mahr, Göttingen, Germany). Controls were incubated with a 0.9 % sodium chloride solution under the same conditions (37 degrees C, humidified atmosphere of 5% CO subset2 and 95 % air). The surfaces of the enamel samples were visually examined by CLSM (Leica TCS SP2). The pH-values of the apple juices ranged from 3.3 to 4.2. Incubating the enamel slices (from both dentitions) with a selected apple juice caused a time dependent release of calcium. After 24 h, the primary dentition showed Ca-release values of 0.61 +/- 0.035 mg/ 20 mm superset2 and the second dentition of 0.41 +/- 0.085 mg/ 20 mm superset2; the surface roughness for the primary teeth was 6.8 +/- 1.09 microm and for the second dentition 6.2 +/- 0.41 microm. CLSM show structural changes on all surfaces when compared to the controls. In this in vitro study, the erosive potential of apple juice on teeth of the first and second dentition could be demonstrated. However, it must be considered that numerous modifying factors influence the human enamel surface in vivo; therefore, a direct translation from in-vitro conditions can only be done with caution.

Periodontal conditions and oral hygiene in rural population of post-war Vukovar region, Croatia in correlation to stress.

OBJECTIVE: The greatest burden of oral diseases is on the socially marginalized population, such as those living in small villages and war areas. The aim of this study was to assess the periodontal conditions of people in post-war area villages in relation to oral hygiene, habits and war stress. METHODS: The study was conducted on a sample of 282 subjects (mean age 41.5 +/- 17.8) in seven Vukovar villages using the questionnaire and clinical periodontal examination. RESULTS: Five years after the war in Croatia the population was still very poor, low educated, and had a low level of periodontal health and oral hygiene habits. The level of periodontal disease and attachment loss tended to increase with age and physical activity and decrease with education level, higher frequency of tooth brushing and toothbrush replacement, dental visits and utilisation of auxiliary devices. Subjects exposed to any kind of war stress had a significantly worse periodontal status and more excluded sextants than those who were not exposed to such stress experience (p<0.05). Better periodontal conditions were found in individuals that were refugees, than those who were in war, wounded or lost a dear person (p<0.05). Individuals who were in war rarely brushed their teeth, visited dentist and changed toothbrushes, but more frequently drank alcohol and smoked, in comparison to other groups, especially those who have not been exposed to war stress. CONCLUSIONS: Specific socio-economic and psychological conditions in post-war areas could be significant risk factors for poor periodontal conditions.

Effect of digital noise filters on diagnostic radiographs for the diagnosis of experimental root fractures.

This article discusses basic concepts of noise suppression for digital radiographs, and shows how false application of algorithms available can lead to a loss of information. Noise suppression realized with low pass convolution filters are designed to decrease strong grey level changes of neighboring pixels. Sixty-two extracted fully intact premolars were selected and treated usingthe crown-down technique to prepare them for experimental fractures. A total of 358 radiographs were taken, of which 312 images were selected with clearly visible root fractures. The selected radiographs were stored as uncompressed images and manipulated with 8 different convolution filters. A total of 2496 raw and filtered images were inspected for visible root fractures. Only the arithmetic mean filter with 5 x 5 kernel size led to a deletion of the visible fracture line in 33.3% of the inspected cases. The other filters proved to be useful for noise reduction without loss of any necessary diagnostic information. None of the filters improved the diagnostic outcome in the 46 remaining radiographs which did not show clearly visible root fractures before application of the filters.

The effectiveness of a novel optical probe in subgingival calculus detection.

OBJECTIVES: The aim of the present study was to evaluate the effectiveness of a novel optical calculus detection system under in vivo conditions. METHODS: One hundred and seventy-six tooth surfaces from 44 adult teeth that were indicated for extraction were selected for the present study. The patients were randomly assigned to one of the two experimental groups. In group A (n = 96), clinical presence or absence of subgingival calculus deposits was determined using the light-emitting diode-based optical probe (OP). In group B (n = 80), the subgingival deposits were first recorded with the OP followed by root surface debridement until no subgingival deposits could be detected by the device. Teeth were then extracted and examined under a stereomicroscope by two trained dentists (DENT 1, DENT 2) and a dental student. Results were compared with the measurements of the OP and direct visual control. RESULTS: In group A, post-extraction results revealed 89% and 90% agreement with the positive and negative OPs detection. In group B, 17% of the surfaces demonstrated even after subgingival debridement and control with the detecting device still calcified deposits in the microscopic evaluation. The highest inter-examiner agreements were observed between DENT 1 and DENT 2. CONCLUSION: It was shown that the optical detection system identifies subgingival calculus with a high efficacy and therefore, may be a support for the operator to determine the endpoint of root surface instrumentation.

Effectiveness of a topical salve (Dynexan) on pain sensitivity and early wound healing following nonsurgical periodontal therapy.

The purpose of the present study was to evaluate clinically the effect of an anaesthetic gel (lidocaine 20 mg/g as active agent) on pain sensitivity and early wound healing following nonsurgical periodontal therapy. A total of 40 patients with chronic periodontitis were enrolled in this randomized, split-mouth, double-blind, placebo-controlled clinical trial. Each subject had 3 sites in each of 2 contra-lateral jaw quadrants with a probing pocket depth (PPD) of > or = 5 mm and bleeding on probing (BOP+). All experimental sites received scaling and root planing without local anesthesia followed by irrigation with sterile saline and assessment of pain sensitivity using a standardized Visual Analogue Scale (VAS). After treatment, the patients randomly received the active or placebo gel into the periodontal pockets and overall pain was again assessed immediately after debridement and after 10, 20 and 30 minutes. The VAS showed a statistically significant (p < or = 0.0001) reduction in reported pain, favoring the active gel over the placebo at all 3 different points in time. After 30 minutes the median VAS score was 0.3 in the Dynexan group as opposed to 1.7 in the placebo-treated group (p < or = 0.0001). In terms of wound healing no differences were found between the test and control sites after 1 week. The results of the study showed that the anaesthetic gel was statistically more effective than the placebo in reducing pain following nonsurgical periodontal therapy. However, in terms of early wound healing no significant differences were seen between the two treatment sites.

Correlation between oral health and body mass index (BMI) in 2071 primary school pupils.

High weight and obesity represent risk factors for numerous diseases. Correlations between body mass index (BMI) and carious lesions have also been described. In the present study, a possible association between caries prevalence and high weight ranges were examined in 2071 primary school pupils (51.8 % girls, 48.2 % boys), aged 6 to 10 years. A dental examination including the assessment of carious lesions (df-t + DF-T) was followed by measurements of height and weight in order to determine the BMI. The evaluation showed that 6.8 % of the elementary school children were underweight, 76.4 % had a normal weight, and 10.5 % were overweight and 6.3 % obese. Underweight children showed healthy teeth in 50 % of the cases, 47.4 % with normal weight showed naturally healthy teeth, while overweight and obese children displayed naturally healthy teeth in 41.5 % and 38.3 % of the cases, respectively. In primary school pupils, a significant association between the caries frequency and the BMI was found. A low BMI showed a correlation with the absence of carious lesions (p < 0.0001), and a high BMI was linked to a high number of caries lesions (df-t + DF-T values; p = 0.0021). However, no gender-related differences, regarding the prevalence rates for high weight and obesity, could be established. The significant correlation between the BMI and caries frequency persisted even after adjustment to the age of the children.

Effect of an oily calcium hydroxide suspension (Osteoinductal) on human periodontal fibroblasts. An in vitro study.

The efficacy of an oily calcium hydroxide suspension (Osteoinductal) as an adjunct to periodontal regenerative therapy has been demonstrated in recent clinical and histological studies. However, little is known about the molecular mechanisms in vitro, particularly, about the effect of oily calcium hydroxide paste on periodontal ligament (PDL) cells. Therefore the aim of the present study was to analyze the mitogenic response of cultured PDL cells to Osteoinductal in comparison to calcium hydroxide and enamel matrix derivative (EMD) in vitro. Human periodontal ligament cells were derived from a third molar extracted for orthodontic reasons and incubated in the presence of Osteoinductal, calcium hydroxide, EMD, phosphate-buffered saline plus 10% glycerol (PBS) or standard culture medium for 15 and 60 minutes. The mitogenic response of the PDL cells was determined by Western Blot with antibodies specific for extracellular signal-related kinase (ERK)1/2 as well as the activated, tyrosine-phosphorylated form of ERK1/2 (p-ERK). Relative phosphorylation of ERK1/2 was normalized to total ERK1/2 levels by densitometry. Cell proliferation was measured after 1, 3 and 8 days using a Neubauer haemocytometer to determine the total cell number. Results demonstrated that the mitogenic response to Osteoinductal, calcium hydroxide and enamel matrix derivative was associated with the activation of ERK1/2 and was more pronounced as compared to PBS and standard culture medium treated cells. Although Osteoinductal and calcium hydroxide activated mitosis and caused phosphorylation of ERK1/2 in PDL cells, its effects were less pronounced as compared to EMD. Furthermore EMD exhibited the highest proliferative response in comparison to Osteoinductal, calcium hydroxide and the negative control after one, three and eight days. In conclusion, our data indicate that Osteoinductal enhances the mitogenic response of human PDL cells by activation of ERK1/2 and increases cell proliferation, however, it is inferior in comparison to EMD.