Xerostomia relates to the degree of asthma control.

Few studies have assessed the relationships between xerostomia and the use of inhaled corticosteroids (ICS). The main objective of this study was to investigate the prevalence of xerostomia in a respiratory outpatient clinic and its relationship with bronchial asthma and ICS use. A cross-sectional observational study of patients recruited in an outpatient setting divided them according to previous diagnoses of bronchial asthma. Data about pulmonary function, concomitant medication, medical comorbidities, Xerostomia Inventory test (XI test), and the degree of asthma control by ACT (asthma control test) were collected for each patient. A linear regression model was applied, using the XI score as dependent variable and the ACT score as independent variable. The 57 patients were divided into asthmatics (40 patients, 70.2%) and control group without asthma (17, 29.8%). The prevalence of xerostomia was 87.7% (50 patients), with no differences between the study groups or current dose of ICS. In the asthmatic group, patients with uncontrolled asthma had worse XI scores than those with partially or totally controlled asthma (30.43 ± 8.71 vs. 24.92 ± 8.08; P < 0.05). In a logistic regression model, the XI test was significantly associated to ACT scores with a moderately strong correlation (r = 0.55; P = 0.005) after adjusting for the current daily dose of ICS. Xerostomia is a common symptom in the ambulatory setting. There is a moderate relationship between the degree of asthma control and the severity of xerostomia.

Peri-implant evaluation in type 2 diabetes mellitus patients: a 3-year study.

OBJECTIVE: The aim of this study was to analyze the changes produced in peri-implant tissues in type 2 diabetes mellitus patients with different glycemia levels, measured by monitoring glycated hemoglobin A1c (HbA1c), over a period of 3 years following dental implant placement. MATERIALS AND METHODS: Sixty-seven patients were divided into four groups according to their HbA1c levels: 21 patients in Group 1 (<6); 24 patients in Group 2 (6.1-8); and 11 patients in Group 3 (8.1-10) and Group 4 (>10.1). Each patient received one implant. All implants were placed in the anterior zone of the maxilla. The variables selected to assess the general state of patients' peri-implant health were as follows: probing depth, bleeding on probing, and marginal bone loss. RESULTS: Marginal bone loss was found to increase in relation to increases in HbA1c levels. Bleeding on probing showed statistically significant differences between groups. When the peri-implant area was probed, mean levels of bleeding varied from 0.43 in Group 1 at 1 year after implant surgery to 0.62 in Group 4 (P = 0.042 between the four study groups). After the second year, greater bleeding on probing was observed in Group 4 (0.63) in comparison with groups with lower HbA1c levels. Peri-implant pocket depths presented values that were too low to be considered pathological and without statistically significant differences between the study groups. CONCLUSION: Implant therapies for diabetic patients can be predictable, providing these patients fall within controlled ranges of glycemia over time, assessed by monitoring HbA1c levels.

Marginal bone loss evaluation around immediate non-occlusal microthreaded implants placed in fresh extraction sockets in the maxilla: a 3-year study.

OBJECTIVE: To evaluate marginal bone loss over 3 years around immediate microthreaded implants placed in the maxillary anterior/esthetic zone and immediately restored with single crowns. MATERIAL AND METHODS: Seventy-one implants (with microthreads up to the platform--rough surface body and neck, internal connection and platform switching) were placed in fresh extraction sockets in the maxillary arches of 30 men and 23 women (mean age 37.85 ± 7.09 years, range 27-60). All subjects had at least 3 mm of soft tissue to allow the establishment of adequate biologic width and to reduce bone resorption. Each patient received a provisional restoration immediately after implant placement with slight occlusal contact. Mesial and distal bone height was evaluated using digital radiography on the day following implant placement (baseline) and after 1, 2, and 3 years. Primary stability was measured with resonance frequency analysis. RESULTS: No implants failed, resulting in a cumulative survival rate of 100% after 3 years. Marginal bone loss from implant collar to bone crest measured at baseline (peri-implant bone defect at the fresh extraction socket) and after 3 years was 0.86 mm ± 0.29 mm. Mesial and distal site crestal bone loss ranged from 3.42 mm ± 1.2 mm at baseline to 3.51 mm ± 1.5 mm after 3 years (P = 0.063) and from 3.38 mm ± 0.9 mm at baseline to 3.49 mm ± 0.9 mm after 3 years, respectively (P = 0.086). CONCLUSIONS: This prospective study found minimal marginal bone loss and a 100% implant survival rate over the 3-year follow-up for microthreaded immediate implants subjected to immediate non-occlusal loading.

Outcomes of topical applications of melatonin in implant dentistry: a systematic review.

BACKGROUND: Due to its antioxidant properties and its ability to detoxify free radicals, melatonin may interfere in the function of osteoclasts and thereby inhibit bone resorption. This inhibition of bone resorption may be enhanced by a reaction of indolamine in osteoclastogenesis and this may contribute to certain benefits in implantology. OBJECTIVE: This systematic literature review on the use of melatonin in implant dentistry aims to provide guidelines for clinicians. MATERIALS AND METHODS: PubMed, Science Direct, ISI Web of Knowledge, and the Cochrane base databases were used to identify articles published between 1999 and 2013 on melatonin use in implant dentistry. Ten articles were selected consisting of 9 animal research studies and 1 review article, involving 60 Beagle dogs, 57 rats, and 30 rabbits and a total of 352 implants. RESULTS: Melatonin, which is released into the saliva, has important implications in the oral cavity. To achieve dental implant stability, osseointegration involves a cascade of protein and cell apposition, vascular invasion, bone formation, and maturation. This process may be accelerated by local delivery of growth-promoting factors, as occurs with the topical application of melatonin over the implant surface. CONCLUSIONS: The experimental evidence suggests that topical applications of melatonin may be useful in oral surgery and implant dentistry, increasing bone-to-implant contact values and new bone formation, and so improving the success and long-term survival of implant treatments.

Histological, radiological and histomorphometric evaluation of immediate vs. non-immediate loading of a zirconia implant with surface treatment in a dog model.

OBJECTIVE: The aim of this study was to assess the performance of zirconia implants under immediate loading compared with delayed loading in dogs over 30-90 days. MATERIALS AND METHODS: Tooth extractions were made for the subsequent placement of dental implants at premolars P2, P3, P4 and molars M1 bilaterally in the dog mandible. Forty eight zirconia implants, 4 mm in diameter and 10 mm in length, were inserted, whose neck and body surfaces had been treated with femtosecond laser texturing; 24 implants were loaded immediately and 24 remained unloaded during the osseointegration period. Final radiographs were taken recording stability values before sacrifice at 30 or 90 days when sample removal for histological and histomorphometric analysis was performed. Bone-to-implant contact, crestal bone loss and implant stability were evaluated at these two study times. RESULTS: Bone-to-implant contact values after 30 days were 38.9% for immediately loaded implants and 32% for non-loaded implants. After 90 days, values increased to 65% for immediately loaded and 57.6% for non-loaded implants. After 30 days, there was more crestal bone lost in the non-loaded group (0.58 ± 0.28 mm) compared with the immediately loaded group (0.5 ± 0.3 mm). After 90 days, there was improved stability in both groups, but was lower in the immediately loaded group (0.5 ± 0.23 mm) compared with the non-loaded group (0.56 ± 0.28 mm). Initial implant stability values were -3.5 PTV at the moment of implant placement. Stability values after the first 30 days were -4 for immediately loaded implants and -3 for non-loaded. At 90 days, non-loaded implants showed -4.9, whereas immediately loaded showed -7.1. CONCLUSIONS: For the different parameters studied, zirconia implants treated with femtosecond laser and subjected to immediate loading showed better results compared with non-loaded implants in terms of BIC, crestal bone loss and implant stability.

Evaluation of the efficacy of a topical sialogogue spray containing malic acid 1% in elderly people with xerostomia: a double-blind, randomized clinical trial.

OBJECTIVE: The aim of this study was to evaluate the clinical efficacy of a topical sialogogue spray containing 1% malic acid for elderly people affected by xerostomia. MATERIAL AND METHODS: This research took the form of a double-blind, randomized clinical trial. Forty-one individuals (mean age: 78.7 years) with xerostomia were divided into two groups: for the first 'intervention group' (21 subjects) a topical sialogogue spray (1% malic acid) was applied, while for the second 'control group' (20 subjects), a placebo spray was applied; for both groups, the sprays were applied on demand during 2 weeks. The Xerostomia Inventory (XI) was used to evaluate xerostomia levels before and after product/placebo application. Unstimulated and stimulated salivary flows rates, before and after spray application, were measured. RESULTS: XI scores decreased significantly (clinically meaningful) from 36.4 ± 7.3 points to 29.1 ± 7.1 (p < 0.05) with an XI difference of 7.2 ± 6.1, after the combination among 1% malic acid with xylitol and fluoride application. After 2 weeks of 1% malic acid application, unstimulated and stimulated salivary flows rates increased significantly (p < 0.05). CONCLUSION: A topical sialogogue spray containing 1% malic acid improved xerostomia in an elderly population and increased unstimulated and stimulated salivary flows rates.

The efficacy of a topical sialogogue spray containing 1% malic acid in patients with antidepressant-induced dry mouth: a double-blind, randomized clinical trial.

BACKGROUND: One of the most important antidepressants side effects is dry mouth. The aim of this study was to evaluate the clinical efficacy of a topical sialogogue spray containing 1% malic acid on patients affected by dry mouth caused by antidepressants drug. MATERIALS AND METHODS: This research took the form of a double-blind, randomized clinical trial at Faculty of Dentistry of University of Granada (Spain). Seventy participants with antidepressant-induced dry mouth were divided into two groups: for the first "intervention group" (35 subjects) a topical sialogogue spray (1% malic acid) was applied, while for the second "control group" (35 subjects), a placebo spray was applied; for both groups, the sprays were applied on demand during 2 weeks. The dry mouth questionnaire (DMQ) was used to evaluate dry mouth symptoms before and after product/placebo application. Unstimulated and stimulated salivary flows rates, before and after application, were measured. RESULTS: Dry mouth symptoms improved after 1% malic acid topical spray application (p < .05). After 2 weeks of 1% malic acid application, unstimulated and stimulated salivary flows rates increased significantly (p < .05). CONCLUSIONS: A sialogogue spray containing 1% malic acid improved dry mouth feeling of the patients suffering antidepressant-induced dry mouth and increased unstimulated and stimulated salivary flows rates.

Effectiveness of malic acid 1% in patients with xerostomia induced by antihypertensive drugs.

OBJECTIVES: Assessing the clinical effectiveness of a topical sialogogue on spray (malic acid, 1%) in the treatment of xerostomia induced by antihypertensive drugs. STUDY DESIGN: This research has been carried out through a randomized double-blind clinical trial. 45 patients suffering from hypertensive drugs-induced xerostomia were divided into 2 groups: the first group (25 patients) received a topical sialogogue on spray (malic acid, 1%) whereas the second group (20 patients) received a placebo. Both of them were administered on demand for 2 weeks. Dry Mouth Questionnaire (DMQ) was used in order to evaluate xerostomia levels before and after product/placebo application. Unstimulated and stimulated salivary flows rates, before and after application, were measured. All the statistical analyses were performed by using SPSS software v17.0. Different DMQ scores at the earliest and final stage of the trial were analysed by using Mann-Whitney U test, whereas Student's T-test was used to analyse salivary flows. Critical p-value was established at p<0.05. RESULTS: DMQ scores increased significantly (clinical recovery) from 1.21 to 3.36 points (p<0.05) after malic acid (1%) application whereas DMQ scores increased from 1.18 to 1.34 points (p>0.05) after placebo application. After two weeks of treatment with malic acid, unstimulated salivary flow increased from 0.17 to 0.242 mL/min whereas the stimulated one increased from 0.66 to 0.92 mL/min (p<0.05). After placebo application unstimulated flow ranged from 0.152 to 0.146 mL/min and stimulated flow increased from 0.67 to 0.70 mL/min (p>0.05). CONCLUSIONS: Malic acid 1% spray improved antihypertensive-induced xerostomia and stimulated the production of saliva.

Peri-implant bone reactions to immediate implants placed at different levels in relation to crestal bone. Part II: a pilot study in dogs.

PURPOSE: The aim of the present study was to evaluate bone-to-implant contact (BIC) and bone remodeling dynamics after immediate implant placement at different levels in relation to the crestal bone with two different implant designs in beagle dogs. MATERIALS AND METHODS: The mandibular second, third and fourth premolars of six beagle dogs were extracted bilaterally and three implants were immediately placed in the hemi-arches of each dog. Randomly, three cylindrical and three tapered implants were inserted crestally (control group) or 2 mm subcrestally (test group). Both groups were treated with a minimal mucoperiosteal flap elevation approach. A gap from the buccal cortical wall to the implant was always left. Three dogs were allowed a 4-week submerged healing period and the other three an 8-week submerged healing period. The animals were sacrificed and samples were obtained. Biopsies were processed for ground sectioning. Histomorphometric analysis was carried out in order to compare BIC, de novo bone formation and bone remodeling. RESULTS: All implants osseointegrated clinically and histologically. Healing patterns examined microscopically at 4 and 8 weeks for both groups (crestal and subcrestal) yielded similar qualitative bone findings. The total BIC mean value for the crestal group was 36.48 ± 3.4% and for the subcrestal group was 41.46 ± 4.2%. The mean percentage of newly formed BIC was greater with the cylindrical implant design (46.06 ± 1.09%) than with the tapered design (33.89 ± 1.72%). There was less bone resorption in the subcrestal group (test) than crestal group (control). CONCLUSION: These findings suggest that apical positioning of the top of the implant does not jeopardize bone crest and peri-implant tissue remodeling. However, less resorption of the lingual crest may be expected when implants are placed 2 mm subcrestally. Moreover, higher BIC values were found in cylindrical implants placed subcrestally.

Biological response to porcine xenograft implants: an experimental study in rabbits.

PURPOSE: The aim of this study was to evaluate the effect of a new porcine biomaterial and collagen paste in 20 New Zealand rabbits. MATERIALS AND METHODS: Forty implants using a porcine xenograft made up of 80% corticocancellous collagenated bone particles of ≤300 µm in size were placed in the proximal metaphyseal area of both tibiae. Four periods of time were formed: 1h, 5, 8, and 15 months. After implantation, an anteroposterior and lateral radiological study was carried out. Samples were sectioned at 5 µm and stained using hematoxylin-eosin, Masson's trichromic, and Gordon-Switt reticulin stains. RESULTS: These results confirmed the biocompatibility of this porcine biomaterial-collagen paste; only a few, occasional macrophages and scattered lymphocytes were observed. No fibrosis was observed between the implants and the bone. Moreover, the material was osteoconductive acting as a "scaffold" for bone cells, and there was a progressive increase in bone growth in and around the implants. CONCLUSION: This new porcine biomaterial-collagen paste seemed to be biocompatible, bioresorbable, and osteoconductive.

Crestal bone loss evaluation in osseotite expanded platform implants: a 5-year study.

OBJECTIVE: The aim of this prospective clinical study was to evaluate the survival rates at 5 years of expanded platform implants placed in the anterior zone of the maxilla and immediately restored with single crowns. MATERIALS AND METHODS: Implants incorporating the platform-switching concept were placed in fresh extraction sockets in the maxillary arch, with each patient receiving a provisional restoration immediately after implant placement. After 15 days, final screwed restorations were inserted. Mesial and distal bone heights were evaluated using digital radiography on the day following implant placement and at 1, 3, 6, 9, 12, 24, 36 months and 5 years. Primary stability was measured with resonance frequency analysis (RFA) using the Osstell Mentor device. Sixty-four implants were placed in 32 men and 32 women ranging in age between 29 and 60 (mean: 39.64 ± 5.16 years). RESULTS: Mean mesial bone loss was 0.08 mm (SD 0.42). Mean distal bone loss was 0.14 mm (SD 0.56). Over the course of the 5 years, the mean RFA value was 72.5 ± 3.1 SD. CONCLUSION: The platform-switched implants remained stable over the course of 5 years and had an overall survival rate of 97.1%.

Experimental model of bone response to xenografts of bovine origin (Endobon): a radiological and histomorphometric study.

OBJECTIVE: To carry out a radiological and histomorphometric evaluation of bone response to bovine bone implants inserted in rabbits' tibiae. MATERIALS AND METHODS: Twenty New Zealand rabbits weighing 3900-4500 g were used. Twenty bovine bone implants (Endobon) in granulated form of 500-1000 µm granulometry were inserted in the proximal metaphyseal area of the animals' right tibia and 20 control areas were located in the proximal metaphyseal area. Following implantation, the animals were sacrificed in four groups of five, after 1 month, 2 months, 3 months and 4 months, respectively. Anteroposterior and lateral radiographs were taken. Samples were sectioned at 5 µm and stained using Hematoxylin-Eosin and Masson's trichromic. RESULTS: After 4 months, radiological images showed complete repair of the bone defects. No healed or residual bone alterations attributable to the presence of the implant were observed. Histomorphometric analysis at 4 months showed the presence of a higher density of newly formed bone with mean values for new bone, residual graft material and non-mineralized connective tissue of 22.8 ± 1.5%, 39.4 ± 2.3% and 37.7 ± 2.5%. There were no statistically significant differences in the length of cortical formation with bovine bone, 98.8 ± 1.1%, compared with the control group, 99.1 ± 0.7%, at the end of the study period. CONCLUSIONS: The biomaterial used in the study was shown to be biocompatible, osteoconductive and non-resorbable and as such a possible bone substitute that does not interfere with normal reparative bone processes.

Actions of melatonin mixed with collagenized porcine bone versus porcine bone only on osteointegration of dental implants.

This study evaluated the effect of the topical application of melatonin mixed with collagenized porcine bone on the osteointegration on the rough discrete calcium deposit (DCD) surface implants in Beagle dogs 3 months after their insertion. In preparation for subsequent insertion of dental implants, lower molars were extracted from 12 Beagle dogs. Each mandible received two parallel wall expanded platform implants with a DCD surface of 4 mm in diameter and 10 mm in length. The implants were randomly assigned to the distal sites on each mandible in the molar area and the gaps were filled with 5 mg lyophilized powdered melatonin and porcine bone and collagenized porcine bone alone. Ten histological sections per implant were obtained for histomorphometric studies. After a 4-wk treatment period, melatonin plus porcine bone significantly increased the perimeter of bone that was in direct contact with the treated implants (P < 0.0001), bone density (P < 0.0001), and new bone formation (P < 0.0001) in comparison with porcine bone alone around the implants. Melatonin plus collagenized porcine bone on DCD surface may act as a biomimetic agent in the placement of endo-osseous dental implants and enhance the osteointegration. Melatonin combined with porcine bone on DCD implants reveals more bone in implant contact at 12 wk (84.5 +/- 1.5%) compared with porcine bone alone treated area (67.17 +/- 1.2%).

Melatonin stimulates the growth of new bone around implants in the tibia of rabbits.

This study evaluated the effect of the topical application of melatonin in accelerating bone formation associated with implants 2 months after their application to the tibiae of rabbits. Twenty New Zealand rabbits were used. Twenty implants treated with melatonin and 20 control implants without melatonin were placed in the proximal metaphyseal area of each tibia. Studies of new bone formation were subsequently made at 15, 30, 45 and 60 days. Cortical width and cortical length of new bone formation were measured. Following implantation, an anteroposterior and lateral radiologic study was carried out. Collected samples were sectioned at 5 µm and stained using hematoxylin-eosin, Masson's trichromic and Gordon-Switt reticulin stains. After a 60 day treatment period, melatonin increased the length of cortical bone (95.13±0.42%) versus that around control implants (62.91±1.45%). Related to the perimeter of cortical bone of the tibiae, melatonin induced new bone 88.35±1.56% versus 60.20±1.67% in the control implants. Melatonin regenerated the width and length of cortical bone around implants in tibiae of rabbits more quickly than around control implants without the addition of melatonin.

Orthodontic management in patients with haemophilia. About two clinical cases.

The most common congenital bleeding disorder is haemophilia. It is a pathology inherited and caused by a defective or an absence of the coagulation factors, so that haemophiliacs cannot form an efficient clot. These patients have been treated with fear in the dental profession without having achieved the goals and ideals most appropriate according to the requirements of each case, which is demonstrated in the little existing literature available. However, they are currently treated as healthy orthodontic patients thanks to the advances in orthodontics. We present the cases of two brothers with mild classical haemophilia, who were treated by Mc Namara's disjunctor. The emphasis is on importance of interconsultation with the haematologist, prevention and oral hygiene, and that of the beneficial effect of orthodontic.

Melatonin plus porcine bone on discrete calcium deposit implant surface stimulates osteointegration in dental implants.

The aim of this study was to evaluate the effect of the topical application of melatonin mixed with collagenized porcine bone to accelerate the osteointegration on the rough discrete calcium deposit (DCD) surface implants in Beagle dogs 3 months after their insertion. In preparation for subsequent insertion of dental implants, lower premolars and molars were extracted from 12 Beagle dogs. Each mandible received three parallel wall implants with discrete calcium deposit (DCD) surface of 4 mm in diameter and 10 mm in length. The implants were randomly assigned to the distal sites on each side of the mandible in three groups: group I implants alone, group II implants with melatonin and group III implants with melatonin and porcine bone. Prior to implanting, 5 mg lyophylized powdered melatonin was applied to one bone hole at each side of the mandible. None was applied at the control sites. Ten histological sections per implant were obtained for histomorphometric studies. After a 4-wk treatment period, melatonin significantly increased the perimeter of bone that was in direct contact with the treated implants (P < 0.0001), bone density (P < 0.0001), new bone formation (P < 0.0001) in comparison with control implants. Topical application of melatonin on DCD surface may act as a biomimetic agent in the placement of endo-osseous dental implants and enhance the osteointegration. Melatonin combined with porcine bone on DCD implants reveals more bone to implant contact at 12 wk (84.5 +/- 1.5%) compared with melatonin treated (75.1 +/- 1.4%) and nonmelatonin treated surface implants (64 +/- 1.4%).

The effects of growth hormone on the initial bone formation around implants.

PURPOSE: The aim of this study was to evaluate the effect of the topical application of growth hormone on the osseointegration of dental implants in beagle dogs 14 days after placement. MATERIALS AND METHODS: Maxillary and mandibular premolars and molars were extracted from 12 beagle dogs. Two months later, each mandible received cylindric screw-type implants of 3.25 mm in diameter and 10 mm in length. The implants were randomly assigned to the mesial and distal sites on each side of the mandible. Prior to implantation, lyophilized powdered growth hormone was applied to one osteotomy on each side of the mandible. No growth hormone was applied at the control sites. Eight histologic sections per implant were obtained for histomorphometric analysis. RESULTS: After a 2-week treatment period, the growth hormone-treated sites showed significant (P < .0001) increases in the perimeter of bone that was in direct contact with the treated implants (40.19% +/- 2.51%), total peri-implant area (P < .001) (69.57% +/- 3.53%), and new bone formation (P < .0001) (35.18% +/- 0.31%), in comparison to control implants (25.05% +/- 2.43%, 53.40% +/- 4.58%, and 28.65% +/- 1.92%, respectively). There was no significant increase in interthread bone in growth hormone-treated implants (27.92% +/- 3.31%) in comparison to control implants (25.08% +/- 3.47%) (P > .05). CONCLUSION: Topical application of growth hormone may act as a bone stimulant in the placement of endosseous dental implants.

Pharmacological interactions of vasoconstrictors.

This article is the first of a series on pharmacological interactions involving medicaments commonly prescribed and/or used in odontology: vasoconstrictors in local anaesthetics and anti-inflammatory and anti-microbial analgesics. The necessity for the odontologist to be aware of adverse reactions as a result of the pharmacological interactions is due to the increase in medicament consumption by the general population. There is a demographic change with greater life expectancy and patients have increased chronic health problems and therefore have increased medicament intake. The presence of adrenaline (epinephrine) and other vasoconstrictors in local odontological anaesthetics is beneficial in relation to the duration and depth of anaesthesia and reduces bleeding and systemic toxicity of the local anaesthetic. However, it might produce pharmacological interactions between the injected vasoconstrictors and the local anaesthetic and adrenergic medicament administered exogenically which the odontologist should be aware of, especially because of the risk of consequent adverse reactions. Therefore the importance of conducting a detailed clinical history of the general state of health and include all medicaments, legal as well as illegal, taken by the patient.

Pharmacological interactions of anti-inflammatory-analgesics in odontology.

In this second article we describe the more interesting pharmacological interactions in dental practice based on the prescription of analgesic narcotics, paracetamol and non-selective non-steroid anti-inflammatory drugs (NSAI) (which inhibit cyclooxigenase 1 -COX 1- and cyclooxigenase 2 -COX 2-) and selective NSAIs (COX 2 inhibitors). The importance of preventing the appearance of these pharmacological interactions is because these are medicaments prescribed daily in odontology for moderate pain treatment and inflammation in the oral cavity. Paracetamol can interact with warfarin and therefore care should be taken with chronic alcoholic patients. All NSAIs reduce renal blood flow and consequently are capable of reducing the efficacy of medicaments used for treating arterial hypertension, which act via a renal mechanism. Especial attention should be taken considering the risk of interaction between the antagonists of AT1 receptors of angiostensin II (ARAII) and the NSAIs.

Pharmacological interactions of anti-microbial agents in odontology.

In this third article we describe the pharmacological interactions resulting from the use of anti-microbial agents. Although the antimicrobials prescribed in odontology are generally safe they can produce interactions with other medicaments which can give rise to serious adverse reactions which are well documented in clinical studies. Antibiotics with grave and dangerous life threatening consequences are erythromycin, clarithromycin and metronidazol and the anti-fungal agents are ketoconazol and itraconazol. Regarding the capacity of the anti-microbials to reduce the efficacy of oral anti-contraceptives the clinical studies to date are inconclusive, however, it would be prudent for the oral cavity specialist to point out the risk of a possible interaction. Therefore the specialist should be aware of possible interactions as a consequence of administering an antibiotic together with other medicaments the patient may be taking.