The prescribing of antibiotics for endodontic infections by dentists in Turkey: a comprehensive survey.

AIM: To investigate the antibiotic prescribing patterns for endodontic infections based on the reports of Turkish dentists. METHODOLOGY: A survey consisting of 20 questions on general information and 13 questions on antibiotic prescribing patterns for endodontic cases was delivered to the e-mail addresses of general dentists and specialists via the database of the Turkish Dental Association. Collected data were analysed using Mc-Nemar-Bowker Test and multivariate ordinal logistic regression tests at the significance level of 0.05. RESULTS: A total of 1007 responses were obtained from 17 827 dentists. The majority of the participants were general dental practitioners (GDP, 80%) whilst 8% were Endodontists. Gender, clinical experience, affiliations and speciality were significant risk factors for antibiotic prescription (P < 0.05). GDPs prescribed antibiotics twice as much as all specialists and members of public hospitals prescribed antibiotics three times more than specialists and clinical academics (P < 0.05). Amoxicillin with clavulanic acid was the most prescribed antibiotic (90%), followed by Ornidazole (25%). Clindamycin was the drug of choice for the patients with penicillin allergy (59%). Infection and fever control (76%), prophylaxis (44%) and avoiding swelling and trismus during endodontic treatment (26%) were the most common reasons for antibiotic prescriptions. Completing a course of prescribed antibiotics was recommended by most (75%). Infective endocarditis, immunosuppression, artificial heart valve and mitral valve prolapse were the main causes of prophylaxis in descending order. Uncontrolled and extensive use of antibiotics by patients (62%) was mentioned as the most effective reason for antibiotic resistance. Up to 10% of participants prescribed antibiotics for symptomatic irreversible pulpitis, asymptomatic apical periodontitis with or without endodontic treatment (8, 12 and 11%, respectively). Up to 20% of dentists prescribed antibiotics for symptomatic apical periodontitis when the pulp was vital or necrotic (13 and 23%, respectively). Almost one third of the participants prescribed antibiotics for symptomatic apical periodontitis of previously treated teeth with or without radiographic lesions whilst 34% prescribed antibiotics for acute apical abscess with localized swelling without systemic involvement. CONCLUSIONS: The majority of dentists reported they prescribed antibiotics inappropriately. It is necessary to improve the knowledge of dentists about antibiotics and their indications in endodontics.

Effect of dentine conditioning with phytic acid or etidronic acid on growth factor release, dental pulp stem cell migration and viability.

AIM: To investigate the effect of several chelating solutions on transforming growth factor (TGF-ß) release from dentine discs and their subsequent impact on cellular behaviour. METHODOLOGY: Human dentine discs were prepared with a standardized diameter and disinfected using 1.5% NaOCl for 5 min. The dentine discs were then exposed to 17% ethylenediaminetetraacetic acid (EDTA), 1% phytic acid (IP6), 9% etidronic acid (HEDP) or distilled water (DW). The release of transforming growth factor (TGF-ß) was quantified using ELISA. The proliferation of dental pulp stem cells (DPSCs) on the conditioned dentine discs was analysed using an MTT assay, and the cell morphology was observed by SEM. Migration of DPSCs towards the conditioned dentine discs was measured using a Transwell assay. Data for cell proliferation and migration were analysed using two-way analysis of variance with a Bonferroni post hoc test; a Kruskal-Wallis test was used for analysing TGF-ß release. RESULTS: Both HEDP and IP6 treatment triggered TGF-ß release and cell migration. The greatest TGF-ß release was observed after HEDP treatment as compared with EDTA and DW but there was no significant difference between the groups. In terms of cell migration, HEDP was more effective than EDTA (P < 0.05) whilst IP6 was similar to EDTA. Cell proliferation significantly increased with time after EDTA, DW and IP6 treatment (P < 0.05), whereas HEDP treatment did not induce cell proliferation (P > 0.05). CONCLUSIONS: IP6 and HEDP were effective chelating agents on TGF-ß release, and cell migration was as effective as EDTA.

Sealing efficacy of a single-cone root filling after post space preparation.

OBJECTIVES: The aim of the present study was to compare the sealing efficacy of root fillings made by a single-cone technique with three different sealers and a cold lateral compaction technique with an epoxy sealer. MATERIALS AND METHODS: Eighty extracted single-rooted human teeth were assigned to four experimental groups: group 1, single-cone and epoxy sealer; group 2, single-cone and calcium silicate-based sealer; group 3, single-cone and methacrylate resin-based sealer; and group 4, cold lateral compaction and epoxy sealer. Twenty extra teeth served as negative and positive controls. After preparation of a coronal post space, the sealing efficacy of the root fillings was assessed on a fluid transport setup. The results were analyzed using Kruskal-Wallis and Mann-Whitney U test. RESULTS: No fluid transport was detected for the negative controls whereas all the positive controls showed rapid fluid transport. No significant difference was detected between groups 1, 3, and 4 whereas group 2 demonstrated significantly more fluid transport than all the other experimental groups. CONCLUSIONS: Root fillings made by a single-cone technique with the epoxy or methacrylate-based sealers were as effective after post space preparation as those made by a cold lateral technique with the epoxy sealer in sealing the root canal. CLINICAL RELEVANCE: Specific root canal sealers in combination with single-cone technique represent a noteworthy alternative to the use of cold lateral compaction technique when a post space is required. The use of effective endodontic procedures with simplified technical implementation may positively affect endodontic outcome.