The impact of timing and modalities of dental prophylaxis on the risk of 5-fluorouracil-related oral mucositis in patients with head and neck cancer: a nationwide population-based cohort study.

PURPOSE: This study investigated the impact of dental prophylaxis on 5-fluorouracil (5-FU)-related oral mucositis (OM) according to the head and neck cancer (HNC) locations and treatment times. METHODS: A total of 13,969 HNC participants, including 482 5-FU-related OM subjects and 13,487 comparisons were enrolled from the Longitudinal Health Insurance Database for Catastrophic Illness Patients of Taiwan between 2000 and 2008. All subjects were stratified into subgroups based on the times to perform chlorhexidine use, scaling, and fluoride application before 5-FU administration. The dental prophylaxis related to 5-FU-related OM was estimated by multiple logistic regression and represented with odds ratio (OR) and 95% confidence interval (CI). RESULTS: Fluoride gel application and scaling significantly impacted on OM development (p < 0.001), and the joint effect of fluoride gel and scaling induced 5-FU-related OM (OR = 3.46, 95% CI = 2.39-5.01). The risk of OM was raised 2.25-fold as scaling within 3 weeks before 5-FU-related chemotherapy (95% CI = 1.81-2.81), and a 3.22-fold increased risk of OM while fluoride gel was applied during 5-FU-related treatment (95% CI = 1.46-7.13). CONCLUSION: Dental prophylaxis significantly affected 5-FU-related OM in the HNC population. A short interval between dental scaling or fluoride application and 5-FU administration may be associated with higher prevalence of OM. Scaling simultaneously combined with chlorohexidine promoted 5-FU-related OM in specific HNC patients excluding the oral cancer and nasopharyngeal cancer population. Proper timing of the prophylactic dental treatments prior to 5-FU therapy could reduce the risk to develop 5-FU-related OM.

Multiple liver abscesses caused by S treptococcus intermedius bacteremia in the setting of a routine dental cleaning.

Streptococcus intermedius is a Gram-positive cocci, normally found in the oral cavity and gastrointestinal tract. It has been associated with deep-seated purulent abscesses commonly in the brain or liver in immunocompromised patients. Here, we discuss the case of a 21-year-old immunocompetent patient that presented with septic shock in the setting of multiple pyogenic liver abscesses with positive blood cultures for S. intermedius The patient had a dental cleaning 3 months prior to admission. The abscesses resolved with ultrasound guided drainage and antibiotic therapy.

Absceso en la fosa posterior por Streptococcus intermedius tras una limpieza dental en una paciente inmunocompetente / Streptococcus intermedius posterior fossa abscess after a minor dental procedure in an immunocompetent woman

Presentamos el caso de una mujer de 52 años, sin antecedentes de interés, que fue derivada a nuestro centro tras ser diagnosticada de una lesión ocupante de espacio en el hemisferio cerebeloso derecho. La sospecha inicial era de metástasis. En la RMN cerebral, sin embargo, se apreciaba una marcada restricción en la secuencia de difusión concordante con un absceso cerebeloso. La paciente se había sometido a una limpieza dental tres semanas antes. El análisis microbiológico tras la evacuación quirúrgica de la lesión mostró la presencia de Streptococcus intermedius

A 52-year-old woman with no relevant previous medical history was diagnosticated of an infratentorial bulky cerebellar mass. The mass showed restricted diffusion on MR images, which was consistent with cerebellar abscess. The patient had undergone a minor dental procedure three weeks before. Microbiological analysis after surgical evacuation of the mass confirmed the presence of Streptococcus intermedius

Streptococcus intermedius posterior fossa abscess after a minor dental procedure in an immunocompetent woman. / Absceso en la fosa posterior por Streptococcus intermedius tras una limpieza dental en una paciente inmunocompetente.

A 52-year-old woman with no relevant previous medical history was diagnosticated of an infratentorial bulky cerebellar mass. The mass showed restricted diffusion on MR images, which was consistent with cerebellar abscess. The patient had undergone a minor dental procedure three weeks before. Microbiological analysis after surgical evacuation of the mass confirmed the presence of Streptococcus intermedius.

Photobiomodulation as an Inflammatory Therapeutic Following Dental Prophylaxis in Canines.

Objective: The aim of this study was to determine if a single photobiomodulation treatment can reduce oral erythema and edema following routine dental prophylaxis in canines. Background: Photobiomodulation therapy has been documented to accelerate healing time through mitigation of erythema and edema in human and veterinary patients. Methods: Canine patients were randomly assigned into three groups: CG (Control, n = 9, mock gingiva treatment without irradiation), LTG (left side treated, n = 8, irradiation of left upper and lower dental arcade), and RTG (right side treated, n = 7, irradiation of right upper and lower dental arcade). Immediately following anesthetized dental prophylaxis, the canines in the RTG and LTG received four points of irradiation (GaAlInP-650 nm, continuous wave, 0.1 W, 0.2 W/cm2, 100 sec, 10 J, 20 J/cm2). Erythema and edema along the gingival surface of each dental arcade were scored 24 h after treatment by a blinded veterinary evaluator. Analysis of variance and Bonferroni correction were used for data analysis. Results: Using a composite evaluation, there was significantly lower inflammation scores for the RTG (p = 0.017) and LTG (p = 0.025) relative to the CG at the location of the lower right dental arcade. Evaluating erythema individually, a significant reduction was found in the LTG (p = 0.049) when compared with the CG for the lower left dental arcade. Conclusions: Despite the limitations in this study, the canines who received a single photobiomodulation treatment demonstrated some degree of reduction in oral inflammation and erythema following dental prophylaxis.

Routine scale and polish for periodontal health in adults.

BACKGROUND: Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even for those at low risk of developing periodontal disease. There is debate over the clinical and cost effectiveness of 'routine scaling and polishing' and the optimal frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing, or both, of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), which does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. Routine scale and polish treatments are typically provided in general dental practice settings. The technique may also be referred to as prophylaxis, professional mechanical plaque removal or periodontal instrumentation.This review updates a version published in 2013. OBJECTIVES: 1. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health.2. To determine the beneficial and harmful effects of routine scaling and polishing at different recall intervals for periodontal health.3. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health when the treatment is provided by dentists compared with dental care professionals (dental therapists or dental hygienists). SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 10 January 2018), and Embase Ovid (1980 to 10 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials of routine scale and polish treatments, with or without oral hygiene instruction, in healthy dentate adults without severe periodontitis. We excluded split-mouth trials. DATA COLLECTION AND ANALYSIS: Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (or standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data. We calculated risk ratios (RR) and 95% CIs for dichotomous data. We used a fixed-effect model for meta-analyses. We contacted study authors when necessary to obtain missing information. We rated the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included two studies with 1711 participants in the analyses. Both studies were conducted in UK general dental practices and involved adults without severe periodontitis who were regular attenders at dental appointments. One study measured outcomes at 24 months and the other at 36 months. Neither study measured adverse effects, changes in attachment level, tooth loss or halitosis.Comparison 1: routine scaling and polishing versus no scheduled scaling and polishingTwo studies compared planned, regular interval (six- and 12-monthly) scale and polish treatments versus no scheduled treatment. We found little or no difference between groups over a two- to three-year period for gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis when comparing six-monthly scale and polish treatment versus no scheduled treatment was -0.01 (95% CI -0.13 to 0.11; two trials, 1087 participants), and for 12-monthly scale and polish versus no scheduled treatment was -0.04 (95% CI -0.16 to 0.08; two trials, 1091 participants).Regular planned scale and polish treatments produced a small reduction in calculus levels over two to three years when compared with no scheduled scale and polish treatments (high-certainty evidence). The SMD for six-monthly scale and polish versus no scheduled treatment was -0.32 (95% CI -0.44 to -0.20; two trials, 1088 participants) and for 12-monthly scale and polish versus no scheduled treatment was -0.19 (95% CI -0.31 to -0.07; two trials, 1088 participants). The clinical importance of these small reductions is unclear.Participants' self-reported levels of oral cleanliness were higher when receiving six- and 12-monthly scale and polish treatments compared to no scheduled treatment, but the certainty of the evidence is low.Comparison 2: routine scaling and polishing at different recall intervalsTwo studies compared routine six-monthly scale and polish treatments versus 12-monthly treatments. We found little or no difference between groups over two to three years for the outcomes of gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis was 0.03 (95% CI -0.09 to 0.15; two trials, 1090 participants; I2 = 0%). Six- monthly scale and polish treatments produced a small reduction in calculus levels over a two- to three-year period when compared with 12-monthly treatments (SMD -0.13 (95% CI -0.25 to -0.01; 2 trials, 1086 participants; high-certainty evidence). The clinical importance of this small reduction is unclear.The comparative effects of six- and 12-monthly scale and polish treatments on patients' self-reported levels of oral cleanliness were uncertain (very low-certainty evidence).Comparison 3: routine scaling and polishing provided by dentists compared with dental care professionals (dental therapists or hygienists)No studies evaluated this comparison.The review findings in relation to costs were uncertain (very low-certainty evidence). AUTHORS' CONCLUSIONS: For adults without severe periodontitis who regularly access routine dental care, routine scale and polish treatment makes little or no difference to gingivitis, probing depths and oral health-related quality of life over two to three years follow-up when compared with no scheduled scale and polish treatments (high-certainty evidence). There may also be little or no difference in plaque levels over two years (low-certainty evidence). Routine scaling and polishing reduces calculus levels compared with no routine scaling and polishing, with six-monthly treatments reducing calculus more than 12-monthly treatments over two to three years follow-up (high-certainty evidence), although the clinical importance of these small reductions is uncertain. Available evidence on the costs of the treatments is uncertain. The studies did not assess adverse effects.

Risk of Infective Endocarditis After Invasive Dental Treatments: Case-Only Study.

BACKGROUND: Invasive dental treatments (IDTs) can yield temporary bacteremia and have therefore been considered a potential risk factor of infective endocarditis (IE). It is hypothesized that, through the trauma caused by IDTs, bacteria gain entry to the bloodstream and may attach to abnormal heart valves or damaged heart tissue, giving rise to IE. However, the association between IDTs and IE remains controversial. The aim of this study is to estimate the association between IDTs and IE. METHODS: The data in this study were obtained from the Health Insurance Database in Taiwan. We selected 2 case-only study designs, case-crossover and self-controlled case series, to analyze the data. The advantage of these methods is that confounding factors that do not vary with time are adjusted for implicitly. In the case-crossover design, a conditional logistic regression model with exposure to IDTs was used to estimate the risks of IE following an IDT with 4, 8, 12, and 16 weeks delay, respectively. In the self-controlled case series design, a conditional Poisson regression model was used to estimate the risk of IE for the risk periods of 1 to 4, 5 to 8, 9 to 12, and 13 to 16 weeks following an IDT. RESULTS: In total, 9120 and 8181 patients with IE were included in case-crossover design and self-controlled case series design, respectively. In the case-crossover design, 277 cases and 249 controls received IDTs during the exposure period, and the odds ratio was 1.12 (95% confidence interval, 0.94-1.34) for 4 weeks. In the self-controlled case series design, we observed that 407 IEs occurred during the first 4 weeks after IDTs, and the age-adjusted incidence rate ratio was 1.14 (95% confidence interval, 1.02-1.26) for 1 to 4 weeks after IDTs. CONCLUSIONS: In both study designs, we did not observe a clinically larger risk for IE in the short periods after IDTs. We also found no association between IDTs and IE among patients with a high risk of IE. Therefore, antibiotic prophylaxis for the prevention of IE is not required for the Taiwanese population.

Transient bacteremia induced by dental cleaning is not associated with infection of central venous catheters in patients with cancer.

OBJECTIVE: The aim of this study was to determine the incidence of bacteremia resulting from dental cleaning and of subsequent established bloodstream infection (BSI) caused by oral microorganisms in patients with cancer with central venous catheters (CVCs). STUDY DESIGN: Twenty-six patients with cancer with CVCs and absolute neutrophil count over 1000 cells/µL received dental cleaning without antibiotic prophylaxis. Periodontal status was assessed at baseline by using the Periodontal Screening and Recording (PSR) score. Blood cultures were drawn via the CVCs at baseline, 20 minutes into cleaning, and 30 minutes and 24 hours after cleaning. Medical records were monitored for 6 months. RESULTS: Baseline blood culture results were negative in 25 patients. Nine of 25 patients (36%) had positive blood culture 20 minutes into cleaning, all associated with at least 1 microorganism typically found in the mouth. These 9 patients had significantly higher mean PSR score (3.22) compared with the other 16 (2.56; P = .035). These expected bacteremias did not persist, with blood culture results (0/25) at 30 minutes and 24 hours after cleaning showing no positivity (P = .001). There were no cases of CVC-related infection or BSI attributable to dental cleaning. CONCLUSIONS: Bacteremia resulting from dental cleaning is transient and unlikely to cause CVC-related infection or BSI in patients with absolute neutrophil count greater than 1000 cells/µL.

Management of Direct-Acting Oral Anticoagulants Surrounding Dental Procedures With Low-to-Moderate Risk of Bleeding.

The purpose of this article is to review the available evidence regarding how to safely manage direct-acting oral anticoagulant (DOAC) therapy in patients requiring dental procedures with low-to-moderate risk of bleeding. A literature search was performed using MEDLINE and PubMed. Each author performed an independent search to ensure all pertinent articles were identified. The reference sections of each article were also reviewed. Pertinent articles were evaluated by each author for inclusion. Articles were eligible for inclusion if the participants were taking DOAC therapy surrounding a dental procedure known to have low-to-moderate risk of bleeding. Studies could be prospective or retrospective and included case reports, case series, and clinical trials. Articles were excluded if they assessed dental procedures known to carry a high risk of bleeding or were review articles. Twenty-five articles were identified, 5 of which met inclusion criteria including 2 case series, 1 retrospective study, and 2 prospective trials. Variation in the management of DOAC therapy surrounding these procedures was found. Among patients undergoing low-to-moderate risk dental procedures while receiving DOAC therapy, bleeding rates were low regardless of whether the DOAC was held or continued surrounding the procedure. Documented bleeding was mild and easily controlled by local hemostatic measures. Patients can safely continue DOAC therapy surrounding these dental procedures.

Estudo da rugosidade e da morfologia superficial do esmalte de dentes decíduos submetidos a diferentes métodos profiláticos / Study of the superficial roughness of the enamel of deciduous teeth submitted to different prophylactic methods

O controle da doença cárie é um dos maiores desafios na Odontologia. O controle do biofilme, de forma mecânica pelo paciente ou pelo profissional, ainda é o melhor método preventivo Este trabalho tem como objetivo a realização de um estudo in vitro da rugosidade do esmalte de dentes decíduos submetidos a quatro métodos profiláticos diferentes. Selecionamos 32 faces proximais de dentes decíduos hígidos, que foram divididos em 4 grupos. No primeiro grupo utilizamos para o polimento mistura de pedra-pomes (SSWHITE)® e água destilada e realizamos polimento utilizando taça de borracha em caneta de baixa rotação; no segundo, pasta profilática Clinpro Prophy Paste (3M)®também com taça de borracha em caneta de baixa rotação; no terceiro jato de bicarbonato de sódio (Polident) e no quarto jato de glicina Clinpro Prophy Powder(3M). Todos os procedimentos foram realizados pelo mesmo operador, que foi calibrado na busca de reprodução de situação clínica. Em cada espécime os procedimentos foram realizados durante 10 segundos com os produtos e equipamentos determinados. Após os procedimentos profiláticos os dentes foram lavados e armazenados em água destilada até o momento das leituras. As leituras para mensuração da rugosidade superficial em micrometros foram realizadas antes e após os procedimentos profiláticos por meio do Perfilômetro Óptico Wyko NT1100 INPE. Todos os grupos provocaram um aumento do valor de Rugosidade aritmética Ra, que é a rugosidade provocada por picos e vale do esmalte de dentes decíduos, sendo que o grupo 4 do (bicarbonato) que apresentou melhores resultados por apresentar menor variação em analise estatísticas, através da ferramenta teste t-Student mostrou que não houve variação de Ra inicial entre os 4 grupos

Caries disease control is one of the greatest challenges in dentistry. The biofilm control mechanically by the patient or by the professional is still the best preventive method. This work aims to perform an in vitro study of the enamel roughness of deciduous teeth submitted to four different prophylactic methods. We selected 32 faces close to healthy deciduous teeth, which were divided into 4 groups. In the first group we used a mixture of pumice (SSWHITE) ® and distilled water polishing with rubber cup in a low rotation pen; in the second group we used Clinpro Prophy Paste (3M) ® prophylactic paste also with rubber cup in low rotation pen, in the third group the polishing with sodium bicarbonate jet (Polident) and in the fourth group with glycine jet Clinpro Prophy Powder (3M ). All procedures were performed by the same operator properly calibrated for 10 seconds with parameters controlled after the prophylactic procedures the teeth were washed and stored in distilled water until readings. The readings for measuring surface roughness in micrometers will be performed before and after the prophylactic procedures using the Wyko NT1100 INPE apparatus obtaining the Ra value. All the prophylactic methods caused an increase in the Ra value, with the bicarbonate group 4 having the best results in statistical analysis the tStudent test tool and there was no initial Ra variation among the 4 groups

Dental Prophylaxis and Osteoradionecrosis: A Population-Based Study.

The aim of this study was to investigate the association of different dental prophylactic modalities and osteoradionecrosis (ORN) and determine the risk of ORN under different timing periods of scaling, with the use chlorhexidine mouth rinse after surgery and with different strategies of fluoride gel application in head and neck cancer (HNC) participants. A cohort of 18,231 HNC participants, including 941 ORN patients and 17,290 matched control cases, were enrolled from a Longitudinal Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) in Taiwan. Based on different dental prophylactic modalities before radiotherapy, including chlorhexidine mouth rinse, scaling, and fluoride gel, all HNC subjects were stratified into different groups. The Cox proportional hazard regression was used to compare ORN incidences under different dental prophylactic modalities. The results revealed that scaling and chlorhexidine mouth rinse were significantly related to ORN risk ( P = 0.004 and P < 0.0001). Chlorhexidine mouth rinse was highly correlated to ORN occurrence (hazard ratio [HR], 1.83-2.66), as exposure increased the risk by 2.43-fold among oral cancer patients, regardless of whether they had received major oral surgery or not. Oral cancer patients receiving scaling within 2 wk before radiotherapy increased their incidence of ORN by 1.28-fold compared with patients who had not undergone scaling within 6 mo. There is no significance of fluoride application for dental prophylaxis in increasing ORN occurrence. In conclusion, dental prophylaxis before radiotherapy is strongly correlated to ORN in HNC patients. Chlorhexidine exposure and dental scaling within 2 wk before radiotherapy is significantly related to ORN risk, especially in oral cancer patients. The use of 1.1% NaF topical application did not significantly increase the risk of ORN in HNC patients. An optimal dental prophylaxis protocol to reduce ORN should concern cancer location, cautious prescription of chlorhexidine mouth rinse, and proper timing of scaling.

Pigmentações extrínsecas negras do esmalte em Odontopediatria / Pigmentos negros extrínsecos del esmalte en Odontopediatría / Extrinsic dark-pigmentation of the tooth enamel in pediatric dentistry

As pigmentações negras do esmalte se devem à coloração extrínseca e estão associadas com problemas estéticos. O objetivo é apresentar dois casos clínicos de crianças com pigmentações extrínsecas negras do esmalte dentário, com ênfase no tipo de tratamento e no acompanhamento. Trata-se de um paciente de 5 anos de idade que utilizava constantemente sulfato ferroso para tratamento de anemia por deficiência de ferro; e outro paciente de 12 anos de idade com diabetes mellitus tipo 1 e dermatomiosite. No primeiro caso observou-se a presença de pigmentações negras extrínsecas nos dentes decíduos e nos primeiros molares permanentes, principalmente nas superfícies lingual e vestibular na região cervical e terço médio, além de lesões de cárie incipientes nas superfícies oclusais dos molares e manchas brancas ativas nos primeiros molares permanentes. No segundo caso, havia pigmentações negras extrínsecas na região cervical das superfícies lisas dos dentes decíduos e permanentes. No primeiro caso, foi realizado tratamento para remoção das pigmentações negras e polimento dos dentes por meio de profilaxia profissional com creme dental abrasivo que contém pedra pomes microgranulada. Houve uma melhora no aspecto clínico a partir da segunda sessão e finalizado na quinta sessão. Para o caso 2, observou-se dificuldade na remoção de manchas pigmentadas na região cervical e risco de sangramento gengival. Uma vez que a criança necessitava de antibiótico profilático, optamos pelo controle diário de biofilme e não remoção pela profilaxia profissional, uma vez que o paciente não se queixava do impacto estético. Conclui-se que as pigmentações negras extrínsecas podem ser observadas facilmente em crianças, e ainda que haja um comprometimento estético, não traz danos à manutenção da saúde bucal. Cabe ressaltar que não está claro como sua presença na superfície dentária reduz a suscetibilidade à cárie. Além disso, a escolha do tratamento sempre deverá ser baseada no risco-benefício para o paciente(AU)

Dark enamel pigments are due to extrinsic staining and associated with aesthetic problems. The objective is to present two cases of children with black extrinsic pigmentation in the tooth enamel, with emphasis on the type of treatment and monitoring. This is a 5-year-old patient of who constantly used ferrous sulfate to treat anemia by iron deficiency, and another 12-year-old patient with type 1 diabetes and dermatomyositis. In the first case, we observed the presence of black extrinsic pigments in the primary teeth and the first permanent molars, especially in the lingual and vestibular part in the cervical region and middle third, together with incipient caries lesions on the occlusal surfaces of molars and active white spots on the first permanent molars. In the second case, there were strange black pigmentation in the cervical region of the smooth surfaces of the primary and permanent teeth. In the first case, the treatment performed was to remove black pigments and polishing the teeth by means of professional prophylaxis and using an abrasive toothpaste containing micro-granules of pumice. There was an improvement in the clinical aspect from the second session and the treatment ended at the fifth session. For the second case, we observed difficulty to remove the pigmented spots in the cervical region, together with the risk of bleeding gums. When the child needed prophylactic antibiotics, we opted for the daily control of the biofilm and it was not removed by professional cleaning, because the patient did not complain about the aesthetic impact. As conclusions, the extrinsic black pigments can be easily observed in children, and despite its aesthetic effect, it does damage oral health. It should be noted that it is unclear how their presence on the tooth surface reduces susceptibility to caries or tooth decay. In addition, the choice of treatment should always be based on the relation risk-benefit for the patient(AU)

Los pigmentos de esmalte negro se deben a la tinción extrínseca y están asociados con problemas estéticos. El objetivo es presentar dos casos clínicos de niños con pigmentaciones extrínsecas negras del esmalte dental, con énfasis en el tipo de tratamiento y el seguimiento. Se trata de un paciente de 5 años de edad, que utilizaba constantemente sulfato ferroso para el tratamiento de la anemia por deficiencia de hierro, y otro paciente de 12 años de edad con diabetes mellitus tipo 1 y dermatomiositis. En el primer caso se observó la presencia de pigmentos extrínsecos negros en los dientes primarios y los primeros molares permanentes, principalmente en la parte lingual y vestibular en la región cervical y tercio medio; además de lesiones de caries incipientes en las superficies oclusales de los molares y manchas blancas activas en los primeros molares permanentes. En el segundo caso, había pigmentaciones negras extrañas en la región cervical de las superficies lisas de los dientes primarios y permanentes. En el caso 1, se realizó el tratamiento para eliminar los pigmentos negros y el pulido de los dientes por medio de una profilaxis profesional con crema dental abrasiva que contiene microgránulos de piedra pómez. Hubo una mejora en el aspecto clínico a partir de la segunda sesión y se finalizó en la quinta sesión. Para el caso 2, se observó dificultad en la eliminación de manchas pigmentadas en la región cervical y el riesgo de sangrado de las encías. Una vez que el niño necesitaba antibióticos profilácticos, optamos por el control diario de la biopelícula y no se eliminó por la limpieza profesional, ya que el paciente no se quejaba del impacto estético. Se concluye que los pigmentos negros extrínsecos pueden observarse fácilmente en los niños, y aunque haya un efecto estético, no hace daños al mantenimiento de la salud bucal. Cabe señalar que no está claro cómo su presencia en la superficie del diente reduce susceptibilidad a la caries. Además, la elección del tratamiento siempre se debe basar en el beneficio-riesgo para el paciente(AU)

Insufficient evidence to determine the effects of routine scale and polish treatments.

DATA SOURCES: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the metaRegister of Controlled Trials and the US National Institutes of Health Clinical Trials Register. STUDY SELECTION: Randomised controlled trials (excluding split mouth) of routine scale and polish treatments with and without OHI in healthy dentate adults without severe periodontitis. DATA EXTRACTION AND SYNTHESIS: Study assessment, data extraction and risk of bias assessment were carried out independently by two reviewers. Mean and standardised mean differences were calculated when different scales were reported. Fixed effects models were used as there were only a small number of studies. RESULTS: Three studies involving a total of 837 patients, and all considered to be at unclear risk of bias were included. No studies reported any adverse effects. Only one trial (conducted in general practice) provided data comparing scale and polish versus no scale and polish. It found no evidence to claim or refute benefit for scale and polish treatments for the outcomes of gingivitis, calculus and plaque. Two studies, both at unclear risk of bias, compared routine scale and polish provided at different time intervals. When comparing six with 12 months there was insufficient evidence to determine a difference for gingivitis at 24 months. There were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals, in particular between three and 12 months for the outcome of gingivitis at 24 months, with OHI, MD -0.14 (95% CI -0.23 to -0.05; P value = 0.003) and without OHI MD -0.21 (95% CI -0.30 to -0.12; P value < 0.001) (mean per patient measured on 0-3 scale), based on one study. There was some evidence of a reduction in calculus. This body of evidence was assessed as of low quality.One study provided data for the comparison of scale and polish treatment with and without OHI. There was a reduction in gingivitis for the 12-month scale and polish treatment when assessed at 24 months MD -0.14 (95% CI -0.22 to -0.06) in favour of including OHI. There were also significant reductions in plaque for both three and 12-month scale and polish treatments when OHI was included. The body of evidence was once again assessed as of low quality. CONCLUSIONS: There is insufficient evidence to determine the effects of routine scale and polish treatments. High quality trials conducted in general dental practice settings with sufficiently long follow-up periods (five years or more) are required to address the objectives of this review.

Dissemination of periodontal pathogens in the bloodstream after periodontal procedures: a systematic review.

BACKGROUND: To date, there is no compilation of evidence-based information associating bacteremia and periodontal procedures. This systematic review aims to assess magnitude, duration, prevalence and nature of bacteremia caused by periodontal procedures. STUDY DESIGN: Systematic Review. TYPES OF STUDIES REVIEWED: MEDLINE, EMBASE and LILACS databases were searched in duplicate through August, 2013 without language restriction. Observational studies were included if blood samples were collected before, during or after periodontal procedures of patients with periodontitis. The methodological quality was assessed in duplicate using the modified Newcastle-Ottawa scale (NOS). RESULTS: Search strategy identified 509 potentially eligible articles and nine were included. Only four studies demonstrated high methodological quality, whereas five were of medium or low methodological quality. The study characteristics were considered too heterogeneous to conduct a meta-analysis. Among 219 analyzed patients, 106 (49.4%) had positive bacteremia. More frequent bacteria were S. viridans, A. actinomycetemcomitans P. gingivalis, M. micros and species Streptococcus and Actinomyces, although identification methods of microbiologic assays were different among studies. CLINICAL IMPLICATIONS: Although half of the patients presented positive bacteremia after periodontal procedures, accurate results regarding the magnitude, duration and nature of bacteremia could not be confidentially assessed.

Routine scale and polish for periodontal health in adults.

BACKGROUND: Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing or both of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), that does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. OBJECTIVES: The objectives were: 1) to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; 2) to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; 3) to compare the effects of routine scaling and polishing with or without oral hygiene instruction (OHI) on periodontal health; and 4) to compare the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health. SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 15 July 2013), CENTRAL (The Cochrane Library 2013, Issue 6), MEDLINE via OVID (1946 to 15 July 2013) and EMBASE via OVID (1980 to 15 July 2013). We searched the metaRegister of Controlled Trials and the US National Institutes of Health Clinical Trials Register (clinicaltrials.gov) for ongoing and completed studies to July 2013. There were no restrictions regarding language or date of publication. SELECTION CRITERIA: Randomised controlled trials of routine scale and polish treatments (excluding split-mouth trials) with and without OHI in healthy dentate adults, without severe periodontitis. DATA COLLECTION AND ANALYSIS: Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data and, where results were meta-analysed, we used a fixed-effect model as there were fewer than four studies. Study authors were contacted where possible and where deemed necessary for missing information. MAIN RESULTS: Three studies were included in this review with 836 participants included in the analyses. All three studies are assessed as at unclear risk of bias. The numerical results are only presented here for the primary outcome gingivitis. There were no useable data presented in the studies for the outcomes of attachment change and tooth loss. No studies reported any adverse effects.- Objective 1: Scale and polish versus no scale and polish Only one trial provided data for the comparison between scale and polish versus no scale and polish. This study was conducted in general practice and compared both six-monthly and 12-monthly scale and polish treatments with no treatment. This study showed no evidence to claim or refute benefit for scale and polish treatments for the outcomes of gingivitis, calculus and plaque. The MD for six-monthly scale and polish, for the percentage of index teeth with bleeding at 24 months was -2% (95% CI -10% to 6%; P value = 0.65), with 40% of the sites in the control group with bleeding. The MD for 12-monthly scale and polish was -1% (95% CI -9% to 7%; P value = 0.82). The body of evidence was assessed as of low quality.- Objective 2: Scale and polish at different time intervals Two studies, both at unclear risk of bias, compared routine scale and polish provided at different time intervals. When comparing six with 12 months there was insufficient evidence to determine a difference for gingivitis at 24 months SMD -0.08 (95% CI -0.27 to 0.10). There were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals, in particular between three and 12 months for the outcome of gingivitis at 24 months, with OHI, MD -0.14 (95% CI -0.23 to -0.05; P value = 0.003) and without OHI MD -0.21 (95% CI -0.30 to -0.12; P value < 0.001) (mean per patient measured on 0-3 scale), based on one study. There was some evidence of a reduction in calculus. This body of evidence was assessed as of low quality.- Objective 3: Scale and polish with and without OHIOne study provided data for the comparison of scale and polish treatment with and without OHI. There was a reduction in gingivitis for the 12-month scale and polish treatment when assessed at 24 months MD -0.14 (95% CI -0.22 to -0.06) in favour of including OHI. There were also significant reductions in plaque for both three and 12-month scale and polish treatments when OHI was included. The body of evidence was once again assessed as of low quality.- Objective 4: Scale and polish provided by a dentist compared with a dental care professionalNo studies were found which compared the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health. AUTHORS' CONCLUSIONS: There is insufficient evidence to determine the effects of routine scale and polish treatments. High quality trials conducted in general dental practice settings with sufficiently long follow-up periods (five years or more) are required to address the objectives of this review.

The impact of Prasugrel, a new anti-platelet agent, on dental care of patients.

With increasing usage of Prasugrel (Effient), a new and highly efficient antiplatelet agent, in the management of cardiovascular events, the potential for bleeding complications has also increased. This is further compounded by the lack of a reversal agent, therefore poses a problem for clinicians engaged in oral invasive procedures. A case in which a patient taking daily Prasugrel suffered significantly prolonged bleeding following dental cleaning is reported. Local measures were used to achieve hemostasis. It is prudent to consult the prescribing physician about the risk of Prasugrel-induced bleeding, the potential for recurrence of cardiovascular events with disruption of medication, and the appropriate management strategy in advance of planned oral invasive procedures. Local measures are the first line of approach for management of hemostatic complications associated with Prasugrel, and patients should be referred to specialized centers if local approach fails. As more data become available, further evidence-based guidelines can be established.