Hospitalisations due to pulp and periapical conditions in Australian children from 1998-99 to 2017-18.

OBJECTIVE: To assess the demographic and time trends in hospitalisation rate for Pulp and Periapical Diseases (P&PDs) over 20-years (1998-99 to 2017-18), amongst children and adolescents (under age 19 years) in all states and territories of Australia. P&PDs are considered potentially preventable, with the possibility of them resulting in emergency presentations if timely treatment is not provided. They can result in treatment under general anaesthesia, which is costly. DESIGN: Retrospective analysis of hospitalisation for pulp and periapical diseases. SETTING: Public and private hospitals across Australia. MAIN OUTCOME MEASURES: The number of hospitalisations (measured using the number of separations or cases of hospital admission) for all pulp and periapical diseases by age-group. RESULTS: There were about 40,000 hospitalisations regarding P&PDs over the 20 years among Australian children under 19 years old. The rate of admissions ranged from means of 28.5 to 44.1 per 100,000 population. The number of admissions increased over 20 years for all children, except those younger than 4 years. Children aged 5-9 years had the highest rate of admissions and, more days in hospital per admission than other age groups. Most children only had one-day admissions. CONCLUSION: Pulp and periapical diseases hospitalisation rates have increased over two decades. Additional approaches to improve child dental health in Australia need to be considered.

Pulpal and periapical disease in crowned vital teeth: A prospective matched cohort study.

This study aimed to determine the incidence and contributing factors to pulpal and periapical disease in crowned vital teeth. Seventy-three pairs of healthy teeth were included and divided into two groups; 'crowned' and 'untreated' groups. The crowned group was prepared for full coverage crown and no treatment was carried out on the untreated group. Both groups were subjected to clinical and radiographic examination to detect endodontic signs and symptoms pre-operatively and one-week after crown cementation. Electric pulp test was also subjected to both groups, pre-operatively, after tooth preparation and before crown cementation. The incidence of pulpal and periapical disease was 6.8% and 1.4%, respectively, after tooth preparation. Factors associated with pulpal and periapical disease were exposed pulp during tooth preparation and pre-operative bone level <35%. Despite the low incidence, the occurrence of pulpal and periapical disease within a short period is noteworthy.

Chronic inflammatory periapical diseases: a Brazilian multicenter study of 10,381 cases and literature review.

The aim of this study was to investigate the epidemiological and clinical characteristics of chronic inflammatory periapical diseases in different regions of Brazil and to compare with data from the literature. A multicenter study was carried out in four Brazilian referral centers in oral diagnosis. Histopathological records were reviewed, and all cases diagnosed microscopically as periapical granuloma, radicular cyst, and periapical abscess were included. Demographic and clinical data were collected. Descriptive statistics and Pearson's chi-square test were performed. A total of 10,381 cases of chronic inflammatory periapical diseases were found (13.8% of 74,931 archived specimens) over a period of 65 years. Radicular cysts were the most common lesion (59.9%). Women (56.1%) with a mean age of 37.01 years old (range 13 to 100 ± 14.42) and people of white skin color (59.2%) were the most affected individuals by chronic inflammatory periapical diseases. The lesions were generally asymptomatic (28.1%), located in the maxilla (60.1%), and posterior region (49.8%). The radicular cysts were larger when compared to periapical granulomas (p < 0.001). The disagreement between the clinical and histopathological diagnoses was higher when the final diagnosis was a periapical granuloma (p < 0.001). Chronic inflammatory periapical diseases continue to be common lesions affecting mainly adults. This should be a consequence of the burden of untreated caries in permanent teeth. Women are more affected and radicular cyst was the most common lesion.

Chronic inflammatory periapical diseases: a Brazilian multicenter study of 10, 381 cases and literature review

Abstract The aim of this study was to investigate the epidemiological and clinical characteristics of chronic inflammatory periapical diseases in different regions of Brazil and to compare with data from the literature. A multicenter study was carried out in four Brazilian referral centers in oral diagnosis. Histopathological records were reviewed, and all cases diagnosed microscopically as periapical granuloma, radicular cyst, and periapical abscess were included. Demographic and clinical data were collected. Descriptive statistics and Pearson's chi-square test were performed. A total of 10,381 cases of chronic inflammatory periapical diseases were found (13.8% of 74,931 archived specimens) over a period of 65 years. Radicular cysts were the most common lesion (59.9%). Women (56.1%) with a mean age of 37.01 years old (range 13 to 100 ± 14.42) and people of white skin color (59.2%) were the most affected individuals by chronic inflammatory periapical diseases. The lesions were generally asymptomatic (28.1%), located in the maxilla (60.1%), and posterior region (49.8%). The radicular cysts were larger when compared to periapical granulomas (p < 0.001). The disagreement between the clinical and histopathological diagnoses was higher when the final diagnosis was a periapical granuloma (p < 0.001). Chronic inflammatory periapical diseases continue to be common lesions affecting mainly adults. This should be a consequence of the burden of untreated caries in permanent teeth. Women are more affected and radicular cyst was the most common lesion.

[A clinicopathological retrospective epidemiological analysis of benign tumors and tumor-like lesions in the oral and maxillofacial region, diagnosed at the University of Szeged, Department of Oral Medicine (1960-2014)]. / A szegedi Fogászati és Szájsebészeti Klinikán diagnosztizált, az orofacialis régiót érinto jóindulatú daganatok és daganatszeru laesiók klinikopatológiai retrospektív epidemiológiai analízise (1960­2014).

INTRODUCTION: In a clinicopathological retrospective epidemiological study we investigated benign tumors and tumor-like lesions located in the orofacial region, diagnosed at the Universiy of Szeged, Department of Oral Medicine. METHOD: During a 54-year period (1960-2014), 14 661 biopsies were taken. The included subjects were 7491 patients diagnosed with benign tumors and tumor-like lesions. RESULTS: The average age of patients was 55.3 years, 2823 (37.7%) patients were male and 4668 (62.3%) female. The male : female ratio was 1 : 1.65. Most of the patients included in the study were aged 51-60 (1280, 17.1%). The number of children was 1014 (13.6%) and the number of adults was 6477 (86.3%). The number of non-neoplasms was 6420 (85.7%), being significantly higher than the number of neoplasms (1071, 14.3%). Most of the lesions were of mesenchymal origin (5574, 77.4%); the number of lesions of non-mesenchymal origin was 982 (13.1%). The most prevalent type of lesions was traumatic fibroma (fibrosis): 1806 (32.4%). The most common lesion type in the group of lesions of infectious/inflammational origin was pyogenic granuloma, the number of which was 465 (8.3%). The most common cystic lesion was mucocele (805, 10.7%). Hemangioma was the most frequent lesion type among developmental anomalies with the number of 815 (14.6%). The most common location of the lesions was the lip in 2081 cases (27.8%), followed by the gingiva in 2024 cases (27.0%), bucca in 1069 cases (14.3%), tongue in 981 cases (13.1%), and the facial skin in 695 cases (9.3%). After taking biopsy, the majority of benign lesions were treated with cryo-, laser-, or combined (cryo and laser) surgery. CONCLUSION: The present computer-aided study showed that irritational fibroma was the most common orofacial benign tumor, and the lip was the most frequent location. The diagnostic classification and the methodology are considerably different in the majority of the studies, which may hinder the exact comparison with other surveys from different regions of the world. Orv Hetil. 2018; 159(37): 1516-1524.

Periapical infection may affect birth outcomes via systemic inflammation.

OBJECTIVES: Maternal dental periapical infections are associated with preterm birth and intrauterine growth restriction. This study investigates whether the association is mediated through bacterial spread from periapical lesions to placenta (direct pathway) or systemic inflammatory reaction (indirect pathway). MATERIALS AND METHODS: We compared birth outcomes in Malawian mothers with and without periapical infection. As markers of a direct pathway, we identified placental bacteria using a 16S rDNA approach and assessed histological evidence of inflammation in the placenta and amniotic membranes. We measured C-reactive protein, alpha-1-acid glycoprotein, and salivary cortisol as markers of an indirect pathway. We used regression models to associate the predictor variables with duration of pregnancy and newborn size. RESULTS: Of 1,024 women, 23.5% had periapical infection. There was no association of periapical infection with either bacterial DNA or histological inflammation in placenta or membranes. Periapical infection was associated with C-reactive protein, alpha-1-acid glycoprotein, and cortisol concentrations in a dose-dependent manner at 36 weeks. Addition of alpha-1-acid glycoprotein or cortisol concentration into regression models attenuated the association between periapical infection and pregnancy outcomes. CONCLUSION: There was no evidence of direct spread of periapical bacteria to the placenta. Periapical infections and adverse pregnancy outcomes are in part mediated through systemic inflammation.

Análise epidemiológica e imunológica em indígenas das etnias Sateré Mawé e Tikuna portadores de infecções endodônticas / Epidemiological and immunological analysis in indigenous people of the Sateré Mawé and Tikuna ethnic groups with endodontic infections

Os povos indígenas compõem 305 etnias, distribuídas por todas as unidades federativas do Brasil. Esta diversidade cultural consiste em uma das maiores riquezas do país, mas, ao mesmo tempo, é também um grande desafio para a elaboração e implementação de políticas públicas específicas e diferenciadas. O objetivo deste estudo foi analisar o perfil epidemiológico de saúde bucal e a necessidade de tratamento endodôntico de indígenas das etnias SATERÉ MAWÉ, que vivem em Barreirinha-AM, e TIKUNA, residentes na zona urbana de MANAUS-AM. Após determinar a necessidade de tratamento endodôntico, este estudo comparou as respostas perirradiculares de infecções endodônticas entre membros de uma civilização ocidental, residentes em Belo Horizonte MG, e indígenas não miscigenados da etnia TIKUNA. Para a análise epidemiológica participaram do estudo 138 indivíduos, sendo 98 pertencentes à etnia TIKUNA e 40 SATERÉ-MAWE; distribuídos nos grupos etários de 7 a 50 anos ou mais. Para a analise imunológica das alterações perirradiculares das populações selecionas, coletaram-se as amostras clínicas em dentes portadores de necrose pulpar. Os indígenas da etnia Tikuna foram atendidos na Clínica de Endodontia da UNIP (Universidade Paulista), campus Manaus. Os membros da população ocidental foram atendidos nas clínicas da Faculdade de Odontologia da UFMG. As amostras foram coletadas imediatamente após a instrumentação do SCR, introduzindo-se cones absorventes nos SCR, 1 mm além do ápice radicular. Subsequentemente, as amostras foram transferidas para um tubo estéril, e mantidas na temperatura de - 70 º C até a sua análise. Utilizando-se o PCR em tempo real, avaliou-se a expressão das citocinas e quimiocinas TNF-, IL-1-, IL-9, INF-, IL-17, IL-10, CXCR-4, CCL-2/MCP-1 e CCR-6. Os resultados demonstram que, em relação à etnia SATERÉ-MAWÉ, na faixa etária de 7 a 12 anos, o CPO-d apresentou valor médio de 3.17. Comparando-se o índice CPO-d e a necessidade de tratamento endodôntico em cada uma das etnias, verificou-se que estas variáveis estão correlacionadas, uma vez que, à medida que o CPO-d aumentou, verificou-se um aumento na necessidade de tratamento endodôntico. Os molares prevaleceram dentre os os dentes mais acometidos por cárie e com necessidade de tratamento endodôntico. Quanto à análise imunológica, observou-se um aumento significativo na expressão gênica de TNF, CCL-2/MCP-1, CXCR4, e CCR6, após os procedimentos de limpeza e formatação dos SCR apenas na população ocidental. Os níveis de INF- aumentaram na 2a coleta na população indigena, enquanto, em ambas as populações, houve um aumento significativo na expressão de IL-10 e IL-17 após os procedimentos de limpeza e formataçao. Não observaram-se diferenças significativas entre as expressões de IL-1 , IL-9, e CCL4, entre a 1ª e 2ª coleta, em ambas as populações. Conclui-se que as populações indígenas encontram-se desasistidas, visto que o CPO-d de ambas as etnias se encontram acima dos padrões recomendados pela OMS, principalmente na faixa etária de 07 a 12anos. Ademais, o nível de escolaridade ainda é muito baixo nas populações indígenas analisadas, mesmo na comunidade Tikuna, situada na zona urbana de Manaus/AM. Finalmente, observaram-se padrões imunes distintos quando se comparou as respostas das comunidades ocidentais e Tikuna, sugerindo que os determinantes genéticos e ambientais devem ser mais bem avaliados no futuro.

The indigenous peoples comprise 305 ethnic groups, distributed by all the federative units of Brazil. This cultural diversity is one of the most significant assets of the country, but at the same time, it is also a great challenge for the elaboration and implementation of specific and differentiated public policies. The objective of this study was to analyse the epidemiological profile of oral health and the need for endodontic treatment of SATERÉ MAWÉ indigenous people living in Barreirinha-AM, and TIKUNA, living in the urban area of MANAUS-AM. After determining the need for endodontic treatment, this study compared the perirradicular responses of endodontic infections among members of western civilisation, living in Belo Horizonte - MG, and no - mixed indigenous TIKUNA. For the epidemiological analysis, the study consisted of 138 individuals, of whom 98 were TIKUNA ethnicity, and 40 were SATERÉ-MAWE ethnics; aged between 7 and 50 years or more. For the immunological analysis of the perirradicular alterations of the selected populations, the clinical samples were collected in teeth with pulp necrosis. The Tikuna Indians were treated at the Endodontics Clinic of UNIP (Universidade Paulista), Manaus campus. The members of the western population were attended in the clinics of the Faculty of Dentistry of UFMG. Samples were collected immediately after SCR instrumentation, introducing absorbent cones in the SCR, 1 mm beyond the root apex. Subsequently, the samples were transferred to a sterile tube and maintained at -70 ° C until analysed. Using the real-time PCR, the expression of cytokines and chemokines TNF-, IL-1-, IL-9, INF-, IL-17, IL-10, CXCR- 2 / MCP-1 and CCR-6. The results show that, concerning the ethnicity SATERÉ-MAWÉ, in the age group of 7 to 12 years, the CPO-d presented a mean value of 3.17. Comparing the CPO-d index and the need for endodontic treatment in each of the ethnicities, these variables were correlated, since, as CPO-d increased, there was an increase in the demand for endodontic treatment. The molars prevailed among the teeth most affected by caries and in need of endodontic treatment. As for the immunological analysis, a significant increase in the gene expression of TNF, CCL-2 / MCP-1, CXCR4, and CCR6 was observed after the SCR cleaning and formatting procedures only in the western population. INF- levels increased in the second collection in the Indian community, while in both people, there was a significant increase in the expression of IL-10 and IL-17 after the cleaning and shaping procedures. There were no significant differences between IL-1, IL-9, and CCL4, between the 1st and 2nd collection, in both populations. It is concluded that the indigenous people are disassociated, since the CPO-d of both ethnic groups is above the standards recommended by the WHO, especially in the age group from 07 to 12 years. Besides, the educational level is still shallow in the indigenous populations analysed, even in the Tikuna community, located in the urban area of Manaus / AM. Finally, distinct immune patterns were observed when comparing Western societies and Tikuna responses, suggesting that genetic and environmental determinants should be better evaluated in the future. Keywords: endodontic treatment, epidemiology, indigenous, cytokines, chemokines, periapical lesion.

Enfermedades pulpares y periapicales en estructuras dentales permanentes en pacientes con edades de seis-catorce años / Pulp and periapical diseases in permanent dental structures of patients aged six to fourteen years

Introducción: cuando las estructuras dentales permanentes tienen pulpas jóvenes e inmaduras, son más grandes y las paredes del canal radicular muy delgadas. Si estas son afectadas por alguna enfermedad pulpar o periapical, la integridad de la pulpa se ve dañada y consecuentemente el desarrollo radicular. Objetivo: identificar las enfermedades pulpares y periapicales en estructuras dentales permanentes y su grado de desarrollo según la clasificación de Patterson, de pacientes con edades de seis a catorce años. Métodos: estudio observacional descriptivo y transversal. De 357 pequeños que acudieron a la Unidad Universitaria de Inserción Social de la Universidad Autónoma de Yucatán, México, 2013, por afectaciones pulpar o periapical, 56 infantes presentaron estas, en estructuras dentales inmaduras permanentes. Los criterios de inclusión fueron: edad, estructura dentaria, enfermedades pulpares y periapicales, clasificación de Patterson para observar radiográficamente el grado de desarrollo radicular. Se proporcionó a los padres una carta de consentimiento informado, realizándoles un cuestionario con datos demográficos del niño. Al niño, se le preguntó su historia de dolor, se realizaron pruebas, exámenes clínicos y toma radiográfica. Con pruebas Ji-cuadrada se comparó la proporción de pacientes según: 1) estructura dentaria; 2) edad; 3) clasificación de Patterson; 4) enfermedad pulpar y periapical. Resultados: el 57 por ciento fueron niñas y 43 por ciento niños. El 15,69 por ciento de los infantes tuvo enfermedad pulpar y/o periapical en estructuras dentales permanentes presentándose con mayor frecuencia en el estadio 1, 2 y 3 de Patterson. Difirió significativamente (X2= 22,6429; p= 0,0004; g.l.= 5) la estructura dentaria afectada. La proporción de pacientes con enfermedad pulpar o periapical según edad difirió significativamente (X2= 30,75; p< 0,0001; g.l.= 6). La proporción de pacientes con alguna estructura dentaria permanente afectada según la clasificación de Patterson, difirió significativamente (X2= 7,75; p= 0,0208; g.l.= 2). Hubo diferencias estadísticas entre los tipos de enfermedades pulpares (X 2= 7,2; p= 0,0273; g.l.= 2), no difirió significativamente entre los tipos de enfermedades periapicales (X2= 1,4615; p=0,4815; g.l.= 2). Conclusiones: desde muy temprana edad los niños y niñas, están presentando mayor cantidad de enfermedades pulpares que periapicales en estructuras dentales permanentes aún sin terminar su desarrollo radicular, lo que pone en riesgo la conservación de sus dientes en la edad adulta, y afecta severamente el sistema estomatognático con probabilidad de padecer maloclusiones a temprana edad(AU)

Introduction: when permanent dental structures have young, immature pulps, they are bigger and their root canal walls are very thin. If they are affected by some pulp or periapical disease, damage is caused to pulp integrity and consequently to root development as well. Objective: identify pulp and periapical diseases in permanent dental structures of patients aged six to fourteen years, and their degree of development according to Patterson's classification. Methods: a cross-sectional observational descriptive study was conducted. Of the 357 children attending the Social Service University Unit at the Autonomous University of Yucatán, Mexico, in the year 2013, for pulp or periapical diseases, 56 presented them in immature permanent dental structures. The following inclusion criteria were applied: age, dental structure, pulp and periapical diseases, and Patterson's classification, to radiographically observe the degree of root development. Parents provided their informed consent in writing, and answered a questionnaire with personal details of the child. Children were asked about the antecedents of their pain, and underwent tests and clinical and radiographic examination. Chi-square tests were used to sort out the patients according to: 1) dental structure, 2) age, 3) Patterson's classification, 4) pulp and periapical disease. Results: 57 percent of the sample were girls and 43 percent were boys. 15.69 percent had pulp and/or periapical disease in permanent dental structures, with a higher prevalence of Patterson's stages 1, 2 and 3. The dental structure affected varied significantly (X2= 22.6429; p= 0.0004; g.l.= 5). The proportion of patients with pulp or periapical disease varied significantly with age (X2= 30.75; p< 0.0001; g.l.= 6). The proportion of patients with some permanent dental structure affected varied significantly according to Patterson's classification (X2= 7.75; p= 0.0208; g.l.= 2). Significant statistical differences were found between the types of pulp diseases (X2= 7.2; p= 0.0273; g.l.= 2), not between the types of periapical diseases (X2= 1.4615; p=0.4815; g.l.= 2). Conclusions: incidence of pulp diseases is higher than that of periapical diseases in very young children. These affect permanent dental structures with incomplete root development, jeopardizing tooth preservation in adult age and severely affecting the stomatognathic system with a potential for causing malocclusion at an early age(AU)

Oral manifestations of Diabetes Mellitus. A systematic review

Background: Diabetes Mellitus has become a global epidemic and presents many complications, usually proportional to the degree and duration of hyperglycemia. The aim of this systematic review was to investigate the different oral manifestations associated with Diabetes Mellitus. Material and Methods: A MEDLINE search for "Diabetes Mellitus and oral manifestations" was performed. A further search was conducted for "diabetes" and its individual oral manifestation. Inclusion criteria were as follows: human clinical studies with a minimum of 30 patients; studies published in relevant scientific journals between January 1998 and January 2016. Nineteen studies fulfilled the inclusion criteria and were analyzed, assessing the strength of scientific evidence according to recommendations made by the Centre for Evidence-Based Medicine, Oxford (OCEBM), which permits adequate assessment of prevalence studies. Results: A total 3,712 patients (2,084 diabetics) were included in the studies reviewed. Of the 19 studies analyzed, 4 were longitudinal studies and 15 cross-sectional studies. Periodontal disease, periapical lesions, xerostomia and taste disturbance were more prevalent among diabetic patients. An association between diabetes and caries and mucosal lesions proved positive in 5 out of 10 studies. Conclusions: Despite multiple oral manifestations associated with DM, awareness of the associations between diabetes, oral health, and general health is inadequate. It is necessary for doctors and dentists to be aware of the various oral manifestations of diabetes in order to make an early diagnosis (AU)

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Enfermedades pulpares y periapicales en estructuras dentales permanentes en pacientes con edades de seis-catorce años / Pulp and periapical diseases in permanent dental structures of patients aged six to fourteen years

Introducción: cuando las estructuras dentales permanentes tienen pulpas jóvenes e inmaduras, son más grandes y las paredes del canal radicular muy delgadas. Si estas son afectadas por alguna enfermedad pulpar o periapical, la integridad de la pulpa se ve dañada y consecuentemente el desarrollo radicular. Objetivo: identificar las enfermedades pulpares y periapicales en estructuras dentales permanentes y su grado de desarrollo según la clasificación de Patterson, de pacientes con edades de seis a catorce años. Métodos: estudio observacional descriptivo y transversal. De 357 pequeños que acudieron a la Unidad Universitaria de Inserción Social de la Universidad Autónoma de Yucatán, México, 2013, por afectaciones pulpar o periapical, 56 infantes presentaron estas, en estructuras dentales inmaduras permanentes. Los criterios de inclusión fueron: edad, estructura dentaria, enfermedades pulpares y periapicales, clasificación de Patterson para observar radiográficamente el grado de desarrollo radicular. Se proporcionó a los padres una carta de consentimiento informado, realizándoles un cuestionario con datos demográficos del niño. Al niño, se le preguntó su historia de dolor, se realizaron pruebas, exámenes clínicos y toma radiográfica. Con pruebas Ji-cuadrada se comparó la proporción de pacientes según: 1) estructura dentaria; 2) edad; 3) clasificación de Patterson; 4) enfermedad pulpar y periapical. Resultados: el 57 por ciento fueron niñas y 43 por ciento niños. El 15,69 por ciento de los infantes tuvo enfermedad pulpar y/o periapical en estructuras dentales permanentes presentándose con mayor frecuencia en el estadio 1, 2 y 3 de Patterson. Difirió significativamente (X2= 22,6429; p= 0,0004; g.l.= 5) la estructura dentaria afectada. La proporción de pacientes con enfermedad pulpar o periapical según edad difirió significativamente (X2= 30,75; p< 0,0001; g.l.= 6). La proporción de pacientes con alguna estructura dentaria permanente afectada según la clasificación de Patterson, difirió significativamente (X2= 7,75; p= 0,0208; g.l.= 2). Hubo diferencias estadísticas entre los tipos de enfermedades pulpares (X 2= 7,2; p= 0,0273; g.l.= 2), no difirió significativamente entre los tipos de enfermedades periapicales (X2= 1,4615; p=0,4815; g.l.= 2). Conclusiones: desde muy temprana edad los niños y niñas, están presentando mayor cantidad de enfermedades pulpares que periapicales en estructuras dentales permanentes aún sin terminar su desarrollo radicular, lo que pone en riesgo la conservación de sus dientes en la edad adulta, y afecta severamente el sistema estomatognático con probabilidad de padecer maloclusiones a temprana edad(AU)

Introduction: when permanent dental structures have young, immature pulps, they are bigger and their root canal walls are very thin. If they are affected by some pulp or periapical disease, damage is caused to pulp integrity and consequently to root development as well. Objective: identify pulp and periapical diseases in permanent dental structures of patients aged six to fourteen years, and their degree of development according to Patterson's classification. Methods: a cross-sectional observational descriptive study was conducted. Of the 357 children attending the Social Service University Unit at the Autonomous University of Yucatán, Mexico, in the year 2013, for pulp or periapical diseases, 56 presented them in immature permanent dental structures. The following inclusion criteria were applied: age, dental structure, pulp and periapical diseases, and Patterson's classification, to radiographically observe the degree of root development. Parents provided their informed consent in writing, and answered a questionnaire with personal details of the child. Children were asked about the antecedents of their pain, and underwent tests and clinical and radiographic examination. Chi-square tests were used to sort out the patients according to: 1) dental structure, 2) age, 3) Patterson's classification, 4) pulp and periapical disease. Results: 57 percent of the sample were girls and 43 percent were boys. 15.69 percent had pulp and/or periapical disease in permanent dental structures, with a higher prevalence of Patterson's stages 1, 2 and 3. The dental structure affected varied significantly (X2= 22.6429; p= 0.0004; g.l.= 5). The proportion of patients with pulp or periapical disease varied significantly with age (X2= 30.75; p< 0.0001; g.l.= 6). The proportion of patients with some permanent dental structure affected varied significantly according to Patterson's classification (X2= 7.75; p= 0.0208; g.l.= 2). Significant statistical differences were found between the types of pulp diseases (X2= 7.2; p= 0.0273; g.l.= 2), not between the types of periapical diseases (X2= 1.4615; p=0.4815; g.l.= 2). Conclusions: incidence of pulp diseases is higher than that of periapical diseases in very young children. These affect permanent dental structures with incomplete root development, jeopardizing tooth preservation in adult age and severely affecting the stomatognathic system with a potential for causing malocclusion at an early age(AU)

Dental health in antique population of Vinkovci - Cibalae in Croatia (3rd-5th century).

Roman city Cibalae (Vinkovci) - the birthplace of Roman emperors Valentinian I and Valens was a very well developed urban ares in the late antique what was evidenced by numerous archaeological findings. The aim of this paper is to get insight in dental health of antique population of Cibalae. One hundred individuals with 2041 teeth dated to 3rd - 5th century AD have been analyzed for caries, antemortem tooth loss, periapical diseases and tooth wear. Prevalence of antemortem tooth loss was 4.3% in males, 5.2% in females. Prevalence of caries per tooth was 8.4% in males, 7.0% in females. Compared to other Croatian antique sites, ancient inhabitants of Roman Cibalae had rather good dental health with low caries prevalence and no gender differences. Statistically significant difference was found between males in females in the prevalence of periapical lesions and degree of tooth wear. Periapical lesions were found only in males.

Reasons for Apical Surgery Treatment in an Underserved New York City Population.

Endodontic retreatment often involves remaking restorations. The total cost may steer the treatment towards surgery. The aim of this study was to retrospectively record the reasons for performing apical surgery in an economically deprived patient population. The clinical reasons (59%) for apical surgery were most common, but the nonclinical (financial) reasons (41%) emerged as a major cause. The finding that 41% of the apicoectomies were performed because of nonclinical constraints is a high figure and may not reflect the situation generally. Still, economic factors potentially play a major role in the selection of surgical versus nonsurgical endodontic retreatment.

Association between diabetes and the prevalence of radiolucent periapical lesions in root-filled teeth: systematic review and meta-analysis.

INTRODUCTION: The question of whether diabetes mellitus can influence the outcome of root canal treatment (RCT) remains unclear. The aim of this systematic review and meta-analysis was to analyze scientific available evidence on the association between diabetes and the presence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT). METHODS: The review question was as follows: in adult patients who had endodontically treated teeth, does the absence or presence of diabetes result in an increase in the prevalence of RPL associated to RFT? A systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, and Scopus search was conducted using the following MeSH and keywords: Diabetes Mellitus OR Diabetes OR Diabetic OR Hyperglycemia, AND Endodontics, Periapical Periodontitis, Periapical Diseases, Apical Periodontitis, Periradicular Lesion, Periapical Radiolucency, Radiolucent Periapical Lesion, Root Canal Treatment, Root Canal Preparation, Root Canal Therapy, Root Filled Teeth, Endodontically Treated Teeth. Seven studies reporting data on the prevalence of RPL associated to RFT both in diabetic and control subjects were included. RESULTS: After the study selection, seven epidemiological studies fulfilled the inclusion criteria, representing data from 1593 root canal treatments, 1011 in non-diabetic control subjects, and 582 in diabetic patients. The calculated pooled odds ratio (OR = 1.42; 95 % CL = 1.11-1.80; p = 0.0058) indicates that diabetic patients have higher prevalence of RFT with RPLs than controls. CONCLUSION: Available scientific evidence indicates that diabetes is significantly associated to higher prevalence of periapical radiolucencies in endodontically treated teeth, being an important putative pre-operative prognostic factor in RCT. CLINICAL RELEVANCE: Taking into account that diabetes is the third most prevalent chronic medical condition among dental patients, endodontic providers should be aware of the relationship between the outcome of endodontic treatment and diabetes.

Prevalence of root canal treatment and periapical radiolucency in elders: a systematic review.

INTRODUCTION: Neither the prevalence of periapical radiolucency (PARL), a surrogate for disease, nor the prevalence of non-surgical root canal treatment (NSRCT) in elders have been subjected to systematic review. The purpose of this study was to conduct systematic review and meta-analysis of the prevalence of PARL and NSRCT in elders. METHODS: Inclusion/exclusion criteria were used for defined searches in MEDLINE and Cochrane CENTRAL. Title lists were scanned and abstracts read to determine utility; articles meeting the criteria were analyzed. Weighted mean percentages were calculated for prevalence of PARL, NSRCT, and PARL in both teeth with and without NSRCT. RESULTS: Defined searching produced 3576 titles; 29 prevalence articles were included. Patient samples mostly represented modern populations from countries with very high human development indices. Meta-analyses were performed on up to 74 000 elders' teeth. For those aged 65+, the prevalence of all teeth with NSRCT was extremely high, 21%; the prevalence of all teeth with PARL was quite high, 7%; the prevalence of PARL in NSRCT teeth was high, 25%; and the prevalence of PARL in untreated teeth was surprisingly high, 4%. In elders, the prevalence of NSRCT and PARL separately increased with age; whereas, PARL in NSRCT teeth decreased with age. CONCLUSIONS: In comparison to general adult populations, elders had: a much higher prevalence of NSRCT, a higher prevalence of PARL, a lower prevalence of PARL in NSRCT teeth, and a higher prevalence of PARL in untreated teeth. Teeth saved through NSRCT were preferentially retained by elders.

Prevalencia de enfermedades pulpares y periapicales en pacientes geriátricos: Mérida, Yucatán, México / Prevalence of pulpal and periapical disease among geriatric patients in Mérida, Yucatán, Mexico

Introducción: las consideraciones médicas, psicológicas y biológicas en la población de personas mayores es una responsabilidad social que todo profesional deberá atender con sumo cuidado, ya que este grupo etario es más susceptible a presentar diversas enfermedades, entre las que se encuentran las pulpares y las periapicales. Objetivo: determinar la prevalencia de enfermedades pulpares y periapicales en pacientes de 60 y más años de edad en pacientes geriátricos de la Facultad de Odontología de la Universidad Autónoma de Yucatán, México. Métodos: estudio descriptivo, prospectivo, transversal y observacional. El universo estuvo constituido por los pacientes que acudieron a la Clínica de Admisión de la Facultad de Odontología de la Universidad Autónoma de Yucatán, México durante el periodo comprendido de agosto a diciembre de 2012. La muestra fue de 74 paciente de 60 y más años de edad, con alguna afección pulpar o periapical, que aceptaron participar en el estudio. Se les realizó: entrevista por medio de un formulario de historia odontológica que permitió al paciente describir su experiencia de dolor de un modo organizado, breve y descriptivo; examen clínico y pruebas pulpares: térmicas, percusión y palpación; estudio radiográfico. Se utilizó estadística descriptiva y pruebas chi cuadrado. Resultados: se revisaron 108 órganos dentarios. El 41,67 pr ciento (n= 45) presentó patologías pulpares: 22,22 por ciento (n= 10) pulpitis reversible, 57,78 por ciento (n= 26) pulpitis irreversible y 20 por ciento (n= 9) necrosis pulpar. El 58,33 por ciento (n= 63) patologías periapicales: 42,85 por ciento (n= 27) periodontitis apical aguda, 15,87 por ciento (n= 10) periodontitis apical crónica, 1,58 por ciento (n= 1) quiste apical, 27 por ciento (n= 17) absceso apical agudo y 12,70 por ciento (n= 8) absceso apical crónico. Conclusión: no se obtuvo diferencias significativas entre el número de dientes que presentaron enfermedades pulpares y el número de dientes que presentaron enfermedades periapicales en este grupo etario(AU)

Introduction: medical, psychological and biological factors should be carefully considered by health professionals when dealing with elderly patients, for this age group is more prone to a number of conditions, among them pulpal and periapical disease. Objective: determine the prevalence of pulpal and periapical disease among patients aged 60 and over attending the School of Dentistry of the Autonomous University of Yucatán, Mexico. Methods: a descriptive cross-sectional observational prospective study was conducted. The study universe was composed of the patients attending the Outpatient Clinic at the School of Dentistry of the Autonomous University of Yucatán, Mexico, from August to December 2012. The sample was 74 patients aged 60 and over with some pulpal or periapical condition who accepted to participate in the study. An interview was conducted based on a dental history form allowing patients to describe their pain experience in a brief, descriptive, organized manner. Clinical examination was performed, as well as pulpal tests: thermal, percussion and palpation, and a radiographic study. Analysis was based on descriptive statistics and chi square tests. Results: 108 dental organs were examined. 41.67 percent (n= 45) presented the following pulpal pathologies: reversible pulpitis 22.22 percent (n= 10), irreversible pulpitis 57.78 percent (n= 26) and pulp necrosis 20 percent (n= 9). 58.33 percent (n= 63) presented the following periapical pathologies: acute apical periodontitis 42.85 percent (n= 27), chronic apical periodontitis 15.87 percent (n= 10), apical cyst 1.58 percent (n= 1), acute apical abscess 27 percent (n= 17) and chronic apical abscess 12.70 percent (n= 8). Conclusion: no significant differences were found between the number of teeth with pulpal disease and the number of teeth with periapical disease in this age group(AU)

[Clinical analysis for systemic complications of patients in the dental emergency room].

OBJECTIVE: To analyze the clinical features of oral emergency patients in general health, and to guide the oral emergency patients in the treatment, and prevention of accidents. METHODS: The retrospective study was performed on the day visits to the emergency department in Peking University School and Hospital of Stomatology from February to November 2013.The basic information of the newly diagnosed adult, their overall health status, American society of anesthesiologists(ASA) classification and oral diagnosis information were analyzed and summarized. RESULTS: The cardiovascular and cerebrovascular diseases(6.4%), hypertension(13.4%), endocrine system diseases(4.2%)were most common in the patients. With the increase of age, the associated systemic diseases had increased in number and in ASA classification. Periapical disease(24.6%), dental pulp disease(24.4%), and periodontal disease(18.0%) accounted for about 2/3. CONCLUSION: The general health status of patients with oral emergency worsened with the increase of age. Oral surgeons should make risk assessment before treatment. ASA classification system can help doctors predict the patient risk, take corresponding measures in advance, and help to reduce the occurrence of accidents.

Comportamiento de urgencias estomatológicas, Hospital Faustino Pérez, 2009 / Stomatologic emergencies behavior, Hospital Faustino Pérez, 2009

Introducción: las urgencias dentales, además de causar signos y síntomas, producen complicaciones que afectan la salud general de los pacientes, por lo que se requiere de atención priorizada, apoyo psicológico y maniobras no traumáticas. Objetivo: determinar el comportamiento de las urgencias estomatológicas. Materiales y métodos: se realizó un estudio observacional, descriptivo y transversal en la consulta de Estomatología del Hospital “Faustino Pérez” de Matanzas en el periodo marzo-diciembre del 2009. El universo estuvo constituido por 533 pacientes que asistieron a la consulta de Estomatología y que presentaron diferentes tipos de urgencias estomatológicas, los cuales se caracterizaron, según variables sociodemográficas y clínicas. Se realizó un interrogatorio minucioso y un examen bucal a cada paciente en el sillón dental y se confeccionó la historia clínica individual de Estomatología. Los datos se recopilaron de forma manual. Para su análisis se emplearon medidas de frecuencias absolutas y relativas. Se tuvo en cuenta el consentimiento informado. Resultados: el 59,5 por ciento de los pacientes con urgencias estomatológicas correspondió al sexo masculino y fue el más representado, los pacientes de 35 a 59 años constituyeron el 32,5 por ciento y predominaron los trabajadores. Conclusiones: el absceso dentoalveolar agudo fue la forma clínica más frecuente dentro de los trastornos pulpares y periapicales en el grupo de edad de 35 a 59 años y en el sexo femenino(AU)

Background: stomatologic emergencies, in addition to causing signs and symptoms, produce complications affecting the patients general health status, so they require prioritized care, psychological support and no-traumatic actions. Aim: to determine the stomatologic emergencies behavior. Material and methods: we carried out a cross-sectional, descriptive, observational study in the Stomatologic consultation of the Hospital “Faustino Perez” of Matanzas in the period March-December 2009. The universe was formed by 533 patients who attended the Stomatologic consultation having different kinds of stomatologic emergencies that were characterized according to clinical and social variables. Each patient was carefully questioned; a buccal examination was carried out to each of them and the Stomatologic individual historical record was filled out. Data were compiled manually. For their analysis we used absolute and relative frequency measures. The informed consent was taken into account.Results: 59,5 percent of the patients with stomatologic emergencies were male, the most represented gender. The patients aged 35-59 years were 32,5 percent, and workers predominated. Conclusions: the acute dental alveolar abscess was the most frequent clinical form among the pulp and periapical disorders in the 35-59 years age group and in the female gender(AU)

Assessment of the nonoperated root after apical surgery of the other root in mandibular molars: a 5-year follow-up study.

INTRODUCTION: If a surgical approach is chosen to treat a multirooted tooth affected by persistent periapical pathosis, usually only the affected roots are operated on. The present study assessed the periapical status of the nonoperated root 5 years after apical surgery of the other root in mandibular molars. METHODS: Patients treated with apical surgery of mandibular molars with a follow-up of 5 years were selected. Patient-related and clinical parameters (sex, age, smoking, symptoms, and signs of infection) before surgery were recorded. Preoperative intraoral periapical radiographs and radiographs 5 years after surgery were examined. The following data were collected: tooth, operated root, type and quality of the coronal restoration, marginal bone level, length and homogeneity of the root canal filling, presence of a post/screw, periapical index (PAI) of each root, and radiographic healing of the operated root. The presence of apical pathosis of the nonoperated root was analyzed statistically in relation to the recorded variables. RESULTS: Thirty-seven patients fulfilled the inclusion criteria. Signs of periapical pathosis in the nonoperated root 5 years after surgery (PAI ≥ 3) could be observed in only 3 cases (8.1%). Therefore, statistical analysis in relation to the variables was not possible. The PAI of the nonoperated root before surgery had a weak correlation with signs of apical pathosis 5 years after surgery. CONCLUSIONS: Nonoperated roots rarely developed signs of new apical pathosis 5 years after apical surgery of the other root in mandibular molars. It appears reasonable to resect and fill only roots with a radiographically evident periapical lesion.

Radiolucent periapical lesions and bone mineral density in post-menopausal women.

PURPOSE: To investigate the relationship between radiolucent periapical lesions and bone mineral density in post-menopausal women. MATERIAL AND METHODS: Seventy-five post-menopausal women were recruited for the study. Bone mineral density was measured using dual-energy X-ray absorptiometry. Three groups were established: healthy bone group, osteopenic group and osteoporotic group. Periapical radiolucencies were diagnosed on the basis of examination of digital panoramic radiographs. Statistical analysis was carried out using anova and chi-squared tests, and logistic regression analysis. RESULTS: In both the osteopenic and osteoporotic groups, 25% of women showed at least one periapical radiolucency, whereas this was only 7.4% in the healthy bone group (odds ratio = 4.2; p = 0.061). After multivariate logistic regression analysis adjusting for covariates (age, number of teeth, number of root-filled teeth and number of teeth with coronal restorations), a marginally significant association was evident between bone mineral density and the presence of periapical radiolucencies (odds ratio = 1.9; CI 95% = 1.0-3.8; p = 0.050). CONCLUSIONS: After adjusting for covariates, low bone mineral density is marginally associated with a higher frequency of radiolucent periapical lesions.

Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings, socio-demographics status, habits and laboratory data - seeking an association.

OBJECTIVE: The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status. METHOD: One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment. RESULTS: The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001). CONCLUSIONS: The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection.