Current update of chemomechanical caries removal methods.

Chemomechanical caries removal is an excellent method for minimally invasive caries excavation, and the removal agents are either sodium hypochlorite (NaOCl)- or enzyme-based. The NaOCl-based agents include GK-101, GK-101E (Caridex) and Carisolv, and the enzyme-based agents include Papacarie and the experimental material, Biosolv. This review outlines the changes in chemomechanical caries removal methods and focuses on recently published laboratory and clinical studies. The historical development, mechanism of action, excavation time and biological effects on pulp and dental hard tissues are described. Based on existing evidence, the currently available chemomechanical caries removal methods are viable alternatives to conventional rotary instrument methods. Chemomechanical methods could be extremely useful in very anxious, disabled and paediatric patients. It does seem some of these agents would still benefit from quicker excavation times in order to achieve more universal acceptance. However, as a means of conserving the caries-affected dentine, chemomechanical caries removal is possibly much more successful than conventional rotary instrumentation.

Trial of experimental toothpastes regarding quality for cleaning dentures.

The aim of this study was to evaluate the efficacy of experimental toothpastes for removing denture biofilm by means of a randomized crossover trial. Thirty volunteers brushed their dentures using a brush and four pastes: (1) Corega refreshing mint (control), (2) 0.2% chloramine T, (3) 1.0% chloramine T, and (4) 0.01% fluorosurfactant. Each paste was used for 7 days, and participants were randomized to use them according to one of four sequences. Biofilm was disclosed (neutral red) after each period, photographed, and quantified by means of a software program. All experimental toothpastes were similar to the control in terms of posttreatment biofilm coverage.

Evaluating an experimental dentifrice containing chloramine-T: a preliminary study.

PURPOSE: The aim of the present study was to evaluate the clinical efficacy of an experimental dentifrice (CH) containing an antimicrobial agent (1% chloramine-T). MATERIALS AND METHODS: A clinical, fully randomised, double-blind comparative study was designed for 30 selected patients aged 15 to 50 years, with no periodontal disease, decay or other oral diseases, good general health and the presence of dental plaque and sulcus bleeding. Baseline Turesky modified plaque index (PI) and sulcus bleeding index (SBI) were scored for all patients. Volunteers randomly received the experimental dentifrice (CH) or a commercial-brand dentifrice containing triclosan (TR). Both dentifrices were provided in identical, number-labelled tubes, and the subjects were instructed to use the supplied dentifrice only for their usual oral hygiene, three times a day for a duration of 7 days. After 7-day use of dentifrices, the PI and SBI were assessed again. The data obtained were subjected to the Kruskal­ Wallis test, followed by Dunn's post hoc test. RESULTS: After 7-day use of dentifrices, the PI scores diminished significantly for both evaluated dentifrices. The SBI values decreased significantly for both experimental and commercial-brand dentifrices. CONCLUSIONS: Both dentifrices reduced PI and SBI. By comparing the experimental and gold-standard dentifrice, it was found that there was no statistically significant difference between the PI and SBI scores after their use, suggesting that they exerted a similar effect on the oral health indexes.

In vitro and clinical evaluation of specific dentifrices for complete denture hygiene.

OBJECTIVES: To study the physical properties of two experimental dentifrices for complete denture hygiene, their effect on denture biofilm removal and antimicrobial properties by means of a clinical trial. MATERIALS AND METHODS: The experimental dentifrices comprised two compositions. One was based on the addition of 1% chloramine T (D1) and the other on the presence of 0.01% fluorosurfactant (D2). Measurements of density, pH, consistency, rheological features and abrasiveness were conducted. Sixty complete denture wearers were randomly assigned to three groups and were instructed to brush their dentures with a specific toothbrush: (1) Water (control); (2) D1; or (3) D2. Each method was used for 21 days. Denture biofilm was disclosed by a 1% neutral red solution and quantified by means of digital photos taken from the internal surface. Microbiological assessment was conducted to quantify Candida sp. and mutans streptococci. Data were evaluated by one-way anova and Tukey HSD, or Kruskal-Wallis (alpha = 0.05). RESULTS: Both dentifrices decreased biofilm coverage when compared with the control group. D1 was the most efficacious treatment to reduce mutans streptococci, whereas D2 showed an intermediate outcome (ANOVA, p < 0.040). No treatment influenced Candida albicans or non-albicans species (Kruskal-Wallis, p = 0.163 and 0.746, respectively). CONCLUSION: It can be concluded that brushing complete dentures with the experimental dentifrices tested could be effective for the removal of denture biofilm.

[Mycobacterium ulcerans infection treated by Rifater, pyrazynamide, Myambutol, and surgery: a case report with a 6-year follow-up]. / Infection à Mycobacterium ulcerans traitée par Rifater, pyrazynamide, Myambutol associés à la chirurgie : à propos d'un cas avec un recul de six ans.

The author reports a case of pleuritis associated with a large homolateral Buruli thorax ulcer in a nine-year old female patient, in the Democratic Republic of Congo. Smears on Ziehl-Neelsen revealed acid-alcohol-resistant bacilli. The pathological histology confirmed a Mycobacterium ulcerans infection (Buruli ulcer). The treatment was surgical (excision-dressing-grafting) associated to antibiotic therapy (Rifater, Pyrazynamide, and Myambutol). After six years of follow up, no relapse was observed.

[Comparative study of injuring action of the preparations used for chemical-mechanic removal of carious dentine].

The destruction of human serum albumin was studied under the influence of the preparations used for chemical-mechanic removal of carious dentine (GK-101 and Caricleans, gel #2) and model systems containing sodium hypochlorite and amino compounds. Control contained hydroxide and sodium chloride but not hypochlorite. The degree of albumin destruction was determined by the amount of low molecular weight fragments precipitated by phosphotungstic acid but not by trichloracetic acid. From the results of the study the conclusion was made that in order to reduce the injuring action of hypochlorite upon dental tissues and soft tissues of oral cavity it is more preferable to use systems containing the addition of neutral and basic amino compounds.

Bactericidal and cytotoxic effects of chloramine-T on wound pathogens and human fibroblasts in vitro.

OBJECTIVES: To evaluate cytotoxicity and bactericidal effects of chloramine-T. METHODS: In vitro study of various concentrations and exposure times to preparations containing human fibroblasts or 1.5 x 10 colony forming units per milliliter (CFU/mL) of 3 gram-positive bacteria-Staphylococcus aureus, methicillin-resistant S aureus, and vancomycin-resistant Enterococcus faecalis-and 2 gram-negative bacteria-Escherichia coli and Pseudomonas aeruginosa-with and without fetal bovine serum present. MAIN OUTCOME MEASURES: Percentage reduction of bacterial growth and percentage of viable fibroblasts 48 hours after exposure. RESULTS: All gram-positive growth was reduced by 95% to 100%, regardless of dose, with or without serum. E coli (gram-negative; with/without serum) was reduced 94% to 100% at antiseptic concentrations of 300 and 400 ppm. At 200 ppm, E coli growth was fully inhibited without serum present and by 50% with serum. P aeruginosa (gram-negative) was not significantly affected under any conditions. At 100 and 200 ppm, cell viability remained greater than 90% under all experimental conditions. A 300-ppm, 3-minute exposure to chloramine-T resulted in cell viability of up to 70%, with longer exposures producing lower viabilities. Serum did not affect cell viability in any condition. CONCLUSIONS: In vitro, chloramine-T at 200 ppm for 5 to 20 minutes was effective against 3 virulent gram-positive bacteria without fibroblast damage. At 300 ppm and 3 and 5 minutes, 30% of fibroblasts were damaged and 95% to 100 % of E coli were inhibited, respectively.

[An abscess of the piriforme muscle as a rare cause of sciatic neuralgia. A case report]. / Ropien miesnia gruszkowatego jako rzadka przyczyna rwy kulszowej -- opis przypadku.

The rare cause of sciatic neuralgia, an abscess in the sciatic foramen, is presented. The most common causes of sciatic neuralgia are discussed. We analyse correlations between symptoms found in a young woman and anatomical structures of the supra- and infrapiriforme foramen and their neighborhood.

Treatment of ichthyophthiriasis after malachite green. II. Earth ponds at salmonid farms.

We tested formalin, chloramine-T-formalin and Desirox-formalin, for use against white spot disease (ichthyophthiriasis) caused by Ichthyophthirius multifiliis at 3 salmonid farms (Salmo salar and S. trutta smolt reared in earth ponds). I. multifiliis disappeared from most individuals 4 to 5 wk after the first treatment (and after the first I. multifiliis were found) with all chemicals, indicating that combinations of these chemicals, and even formalin alone, can be used to lower the parasite burden in earth ponds to such a level that no mortality occurs. This was the case when the fish were treated frequently at the beginning of the infection. Treatment can be stopped once the fish have achieved immunity to ichthyophthiriasis. The developing immunity was also revealed by the distribution of ciliates in the course of the disease. At the beginning of the infection I. multifiliis individuals were randomly distributed among the fish, but after 2 to 3 wk, when all the fish were infected, ciliates had increased in numbers and were aggregated in such a way that some fish carried quite heavy burdens. However, over 60% of the fish were free of the parasites after 4 to 5 wk, and had few or no ciliates, meaning that the distribution was even more aggregated. Sea trout had fewer parasites than salmon, and they also recovered from infection earlier even though the treatments and ponds were similar, indicating variation in resistance to I. multifiliis between fish species. It was also evident that the chemicals and their concentrations must be planned carefully to suit the conditions at each farm.

El uso de un gel a base de papaína en odontopediatría: un caso clínico / The use of a papain-based gel in pediatric dentistry: a clinical case

La caries dental es una infección bacteriana multifactorial crónica que determina la destrucción localizada de los tejidos dentarios mineralizados. El tratamiento tradicional para la remoción de la caries incluye el uso de fresas adaptadas a motores de baja y/o alta revolución, de manera de obtener una cavidad lista para recibir el material restaurador. Con el objeto de disminuir todos los inconvenientes de la tradicional remoción de caries, fue desarrollado un método de remoción química y mecánica, donde el gel ablanda la dentina infectada, preservando a máximo el tejido dentario sano. Con la finalidad de promover la utilización de este sistema, incluso en trabajos de campo y en Salud Pública, este nuevo producto, totalmente nacional, a base de papaína y cloramina, fue desarrollado y denominado Papacarie(R). Debido a su facilidad de utilización, tanto como a sus propiedades antiinflamatorias y antimicrobianas, fue elegido este método para la remoción del tejido cariado. El objetivo del presente trabajo fue describir la técnica de utilización del Papacárie(R) en pacientes odontopediátricos en un caso clínico (AU)

Papain gel: a new chemo-mechanical caries removal agent.

The chemo-mechanical caries removal method has been a solution for treatment of patients seeking alternatives to conventional methods. Among different kinds of chemo-mechanical caries removal systems, Papacarie--a papain gel--was found to be easy to manipulate, simple and cheap, as well as effective in removing infected tissues.

Acute columnaris infection in channel catfish, Ictalurus punctatus (Rafinesque): efficacy of practical treatments for warmwater aquaculture ponds.

Columnaris disease was induced in channel catfish, Ictalurus punctatus (Rafinesque), by bath exposure to four highly virulent isolates of Flavobacterium columnare. In untreated controls, mortality began 20 h after exposure and reached 100% by 48 h. Mortality in channel catfish given antibiotic treatments with oxytetracycline or a combination of sulphadimethoxine and ormetoprim in feed prior to bacterial challenge was zero with all four strains of F. columnare. Diquat (Zeneca Agricultural Products, Wilmington, DE, USA) was the most effective bath treatment; mortality with all four strains was zero. With potassium permanganate, chloramine-T, hydrogen peroxide and copper sulphate, bath treatment efficacy varied significantly among strains (P = 0.0346) and among treatments (P = 0.0033). Bath treatments with chloramine-T and potassium permanganate significantly reduced (P < 0.05) mortality from 100 to 75 and 69%, respectively, but copper sulphate and hydrogen peroxide treatments were not effective. Based on our results, oral antibiotics prevented columnaris disease but, of the bath treatments, only Diquat produced a dramatic reduction in the mortality of acutely infected fish. Diquat is labelled for aquatic use as an herbicide in the USA but in large ponds it is prohibitively expensive.

Tolerability and efficacy of N-chlorotaurine in comparison with chloramine T for the treatment of chronic leg ulcers with a purulent coating: a randomized phase II study.

BACKGROUND: The well-known active chlorine compound chloramine T (CAT) with broad-spectrum antimicrobial activity is in common therapeutic use for leg ulcers with purulent coatings; however, this treatment is painful. The tolerability of the less aggressive N-chlorotaurine (NCT), an endogenous compound also produced in vivo by stimulated human granulocytes, could be superior. OBJECTIVES: To assess the tolerability and efficacy of NCT in the cleaning of purulent coatings in chronic leg ulcers in comparison with CAT. METHODS: In a double-blind, randomized phase IIb clinical study 40 patients were treated for a median of 7 days (range 3-14) with a 1% aqueous solution of either NCT (20 subjects) or CAT (20 subjects) by twice-daily application of dressings soaked in the test solutions. Criteria for evaluation of tolerability were intensity and duration of pain caused by the ulcer therapy and scores of tissue toxicity (necrosis, granulation tissue and re-epithelialization). Therapeutic efficacy was graded as scores of intensity of purulent coating of the ulcers. RESULTS: The concentration tolerated in vitro by human epidermoid carcinoma cells was at least 10-fold higher for NCT (0.01%) compared with CAT (0.0001-0.001%). There was significantly less pain caused by NCT compared with CAT (P < 0.05) on days 1 and 4 and a trend for a shorter duration of pain (P = 0.093). The scores of intensity of coating improved without difference in both treatment groups, whereas granulation and re-epithelialization appeared earlier in the NCT group (P < 0.05). Non-quantitative microbiological cultures from ulcer smears revealed persistence of colonization by bacterial species in approximately half of both treatment groups. CONCLUSIONS: Both active chlorine compounds were helpful in reducing purulent coatings. Because of its lower toxicity and better tolerability, NCT is of advantage in the treatment of leg ulcers.

Chemomechanical caries removal: a comprehensive review of the literature.

Compared to the past, caries removal has become more efficient, however inherent fundamental drawbacks of the drilling approach have remained: unpleasantness to patients, need for local anesthesia, and potential adverse effects to the pulp due to heat and pressure. Chemomechanical caries removal, introduced almost three decades ago, was claimed to be a non-invasive alternative for the removal of carious dentine. In essence, the technique involved applying a solution onto the decayed dentinal tissue, allowing it to soften it, and, finally, scraping it off with blunt hand instruments. The partially degraded collagen in carious dentine was chlorinated by chemomechanical caries removal solutions. This chlorination affected the secondary and/or quaternary structure of collagen, by disrupting hydrogen bonding. Carious material removal was thus facilitated. The purpose of this paper is to perform a comprehensive review of the literature regarding chemomechanical caries removal, including the most recently available product, the initial reports on which warrant renewed interest in the approach.

Pathology associated with an aquareovirus in captive juvenile Atlantic halibut Hippoglossus hippoglossus and an experimental treatment strategy for a concurrent bacterial infection.

A large-scale mortality of larval and juvenile halibut Hippoglossus hippoglossus occurred at a semi-commercial halibut farm in Atlantic Canada. Investigation of the cause revealed aquareovirus particles in necrotic liver tissue of affected fish. Cytopathic effect on CHSE-214 cell lines occurred from all fish cultured for viruses, and the viral morphology of the particles in culture was consistent with that observed in necrotic host tissue. The virus was placed in the family of Reoviridae, genus Aquareovirus based on morphology and RT-PCR results. Multifocal hepatocellular necrosis was a consistent finding in all fish as well as acute necrosis of proximal renal tubules. Concurrent bacterial infections were present in some specimens. Fish experimentally treated with oxytetracycline or a combination of oxytetracycline and chloramine-T had a significantly lower mortality rate than untreated fish. Fish treated with chloramine-T alone had a significantly elevated mortality rate compared to controls. Despite supportive medical therapy, mortality levels in treated and untreated groups remained elevated, supporting the hypothesis that the primary pathogen was of viral origin. This is the first report of elevated mortalities in Atlantic halibut associated with an aquareovirus.

Drugs in salmonid aquaculture--a review.

In contrast to mammalian therapeutics, the use of pharmaceutical substances is rather limited in fish. It is basically restricted to anaesthetic agents and anti-infective agents for parasitic and microbial diseases. Anaesthetic agents are used primarily in fish farm and laboratory settings to provide analgesia and immobilization of fish for minor procedures. The anti-infective agents are used for controlling diseases and the choice of drug depends on efficacy, ease of application, human safety, target animal safety including stress to the fish, environmental impact, regulatory approval, costs, and implications for marketing the fish. In this article, the major drugs used in salmonids in North America and Europe will be reviewed and some insight into future directions for drug development and use for the salmonid industry will be introduced. The mechanisms of action, pharmacokinetics, side effects, and uses of the drugs are emphasized.

Effects of formalin, chloramine-T, and low salinity dip on the behavior and hemolymph biochemistry of the American lobster.

The purpose of this research was to investigate the salinity and formalin sensitivity of a ciliate parasite (Anophryoides haemophila) of the American lobster (Homarus americanus), and to examine the target-animal (lobster) safety of chemical-bath treatments involving low salinity, formalin, or chloramine-T that could be used to control this parasite in lobster pounds. "Bumper car" disease, caused by An. haemophila, is an important concern to lobster pound operators in eastern North America, because of the implicated lobster mortality rate and the general lack of preventive and therapeutic intervention regimes. We determined, using an in vitro method, that formalin at 50 mg/L, or low salinity at 8.0 parts per thousand (ppt) for 1 hour killed 100% of the parasites. When healthy lobsters were exposed to formalin at 200 mg/L, there were no negative behavioral responses and no significant differences in a panel of hemolymph biochemical indices. Similar results occurred when lobsters were exposed to chloramine-T, a common finfish therapeutic agent for topical bacteria and protozoa, at 10 mg/L for 1 hour. The low salinity treatment (8.0 ppt) resulted in significant adverse changes in lobster behavior and biochemical indices; however, these changes did not persist for more than 1 week after treatment ended. Although these treatments are unlikely to kill parasites that have already invaded the lobster carapace, they should be effective in reducing parasite loads on the gill and carapace surface of the lobster and in the environment of the impoundment housing.

The effect of antiseptic solutions on microorganisms in venous leg ulcers.

The effect on the microbial ulcer flora of wet gauze dressings soaked in antiseptic solutions used for desloughing leg ulcers is not known. Quantitative cultures were therefore performed in 45 venous leg ulcers, before application and after 15 minutes' treatment with gauze dressings with four different antiseptic solutions: aluminium acetotartrate (Alsol) 1%, potassium permanganate 0.015%, acetic acid 0.25% and chloramine 0.25%. The percentage of ulcers with each type of microorganism did not differ before and after application of the antiseptic solutions. Staphylococcus aureus was found in 79% of the ulcers, gram-negative rods in 39%, S. epidermidis in 21%, Proteus spp in 21%, Pseudomonas spp in 14% and fungi in none. Potassium permanganate reduced the mean number of bacteria per ulcer from 4.4 x 10(6) to 0.9 x 10(6) (ns), chloramine from 2.7 x 10(6) to 2.2 x 10(6) (ns), Alsol from 1.2 x 10(7) to 3.5 x 10(6) (ns) and acetic acid from 6.3 x 10(6) to 2.6 x 10(5) (p = 0.007). S. aureus was reduced by acetic acid (p = 0.002), gram-negative rods by both chloramine (p = 0.03) and acetic acid (p = 0.03). The number of Pseudomonas, Proteus, S. epidermidis and Streptococcus haemolyticus group G was not reduced significantly (p > 0.05) by any of the solutions.

Detoxification of endotoxin-contaminated titanium and hydroxyapatite-coated surfaces utilizing various chemotherapeutic and mechanical modalities.

The surgical repair of the ailing implant may be complicated by the surface effects of pathogenic bacteria and their products. This study evaluated the ability of various chemotherapeutic modalities to detoxify endotoxin-contaminated titanium alloy and hydroxyapatite-coated test strips. Grit-blasted titanium alloy and hydroxyapatite-coated test strips were contaminated with purified outer membranes of Escherichia coli labeled with radioactive 14C. The titanium alloy strips were treated with citric acid, stannous fluoride, tetracycline HCl, chlorhexidine gluconate, hydrogen peroxide, chloramine T, sterile water, a plastic sonic scaler tip, and an air-powder abrasive unit. Hydroxyapatite-coated strips were treated with chloramine T, citric acid, or burnished with sterile water on cotton pellets. Residual lipopolysaccharide levels were measured by liquid scintillation spectrometry. The air-powder abrasive unit removed significantly greater amounts of lipopolysaccharide than all other treatment modalities on titanium samples (P < 0.05). A 60-second burnish with sterile water was able to remove significant amounts of lipopolysaccharide when compared with untreated controls (P < 0.05). Citric acid was superior in the removal of lipopolysaccharide from hydroxyapatite-coated surfaces when compared with the controls or chloramine T (P < 0.01). Detoxification of an implant infected surface may be beneficial when surgical repair of the ailing implant is indicated.

Chloramine-T solutions: effect on wound healing in guinea pigs.

An evaluation of the wound-healing and disinfectant activities of chloramine-T (Chlorazene) used in hydrotherapy whirlpools was studied in a guinea pig cutaneous wound model. Standard microbiologic methods were used to determine the bacteriocidal activity of Chlorazene in cultures containing up to 2.03 x 10(6) colony-forming units per milliliter of Pseudomonas aeruginosa. Full-thickness skin wounds in 40 guinea pigs were inoculated with Pseudomonas aeruginosa and all animals allowed to recover from anesthesia. Twenty-four hours later, animals were placed in water only or water containing Chlorazene (300ppm) for 20 minutes. This procedure was repeated daily for up to seven days after inoculation of wounded skin. Rate of wound epithelialization and number of infected wounds were determined. Large reductions in numbers of cultured organisms were observed after treatment with Chlorazene. No differences in rate of wound healing could be determined in water- or Chlorazene-treated animals. Chlorazene-treated wounds contained fewer pseudomonas organisms than water-treated controls on postinoculation days five and six. These results confirm that Chlorazene is an effective water disinfectant. Data also indicate that in the concentration used, Chlorazene does not affect the rate of wound healing.