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Query: UMLS:C0031099 (periodontitis)
 12,489 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The study examines the use of an oral antibiotic with a wide spectrum of action tested in dentistry belonging to the cephalosporin class: acetoxyethylcefuroxime. The pharmaceutical industry has succeeded in synthesising a prodrug of parenteral cephalosporin "Metoxyrinic cefuroxime sodium", thus resolving the problems presented by earlier molecules such as: scarce bioavailability, poor palatability and collateral effects at a gastroenteric level. This is a 2nd generation cephalosporin whose mechanism of action consists in the capacity to selectively block the synthesis of the peptidoglycan, a fundamental component of the cell wall of both Gram+ and Gram- bacteria. The study, which was performed in the Division of Odontostomatology of the Mauriziano Hospital in Turin, examined 59 patients suffering from some of the most commonplace dental pathologies such as: apical periodontitis-alveolitis-odontogenic abscesses-eighth teeth in dysodontiasis-maxillary cysts. The following clinical parameters were evaluated in both outpatients and those undergoing surgery: swelling, pain, lymphoadenopathy at the start of treatment, and at days 3 and 5 of treatment. A 250 mg tablet was administered every 12 hours for 5 days. Owing to the rapid resolution of symptoms and the limited collateral effects observed, the authors conclude that the drug may be regarded as the elective form of treatment.
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PMID:[The clinical evaluation of acetoxyethylcefuroxime in dentistry]. 773 83

The development of recommendations for what is acceptable clinical practice for patients with adult periodontitis is challenging. First, how much and what type of evidence is needed? This depends very much on the clinical problem, the nature of the evidence that is available, and the potential ill effects that may ensue if the effects of the treatment that is recommended are not what they are hoped to be. All treatments are applied with the implicit assumption that they do more good than harm. Treatments that are expensive, invasive, irreversible, or potentially risky, require more evidence than treatments that are not invasive, have reversible effects, and are without risk. Recall the hierarchy of types of evidence used in the AHCPR pain guidelines ranging from a meta-analysis of RCTs to uncontrolled observations in patients or expert opinion. A randomized controlled trial, or a meta-analysis of RCTs carries more weight than a much larger series of cases because of the great potential for bias when observations are made under uncontrolled conditions. One hundred poorly controlled studies do not provide evidence for optimal clinical decisions. Second, who bears the burden of proof? Certainly, any newly proposed therapy must be proven safe and effective by its proponents. But, what about treatments that have been the standard of practice, can they be grandfathered in, or must evidence be gathered for them? Given changes in understanding of mechanisms of disease pathogenesis, classification, rates of activity, and measurement of outcomes, it may be time to call all clinical dogma regarding treatment of adult periodontitis into question. Reliable evidence is not available for many of the treatments for adult periodontitis. Most of the evidence that is available was collected using methods and an underlying conceptual scheme regarding diagnosis and progression of disease that is very different from current beliefs. One could argue that even for the treatments that have been evaluated in RCTs, disease activity rates were so low by current assessment, that there was no disease to prevent or treat.
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PMID:Natural history of periodontitis and a review of technologies to prevent and treat it. 792 98

1. Porphyromonas gingivalis is one of the bacteria likely to be related to pain in periodontitis. Several enzymes isolated from P. gingivalis have been reported to have kininogenase activity. Since kinin release could be held responsible for inflammatory symptoms and pain in periodontitis, we investigated whether the inflammatory and algesic effects of a sonic extract from P. gingivalis (PGSE) could be inhibited by the potent bradykinin B2 receptor antagonist, icatibant (Hoe 140). 2. In anaesthetized rats, the subplantar injection of PGSE (0.1 and 1.0 mg) caused a dose-dependent oedema of the hind paws. The net increase of the paw volume 60 min after the injection was 23 +/- 5% and 77 +/- 12%, respectively. The oedema was rich in plasma proteins as determined by the Evans blue method. Pretreatment with icatibant (300 nmol kg-1, s.c.) significantly reduced the effect of 1.0 mg of PGSE whereas the effects of 0.1 mg of PGSE remained unaffected. 3. The subplantar injection of 1.0 mg of PGSE in unanaesthetized rats caused nociceptive behavioural responses which started about 5 min after the injection and lasted for about 10-15 min. These responses were completely prevented by pretreatment with icatibant (300 nmol kg-1, s.c.). 4. The present results show that the plasma extravasation induced by non-algesic doses of a sonic extract from P. gingivalis are caused by mechanisms other than B2 kinin receptor activation whereas inflammatory effects of algesic doses are due to the action of kinins. The pain elicited by the extract is solely mediated by kinins and can be prevented by icatibant. The bradykinin antagonist could thus have a potential for a clinical use against pain associated with periodontal inflammation.
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PMID:Anti-inflammatory and analgesic activity of the bradykinin antagonist, icatibant (Hoe 140), against an extract from Porphyromonas gingivalis. 795 58

The object of this study was to determine the correlation between clinical symptoms and the activity of enzymes such as collagenase, chondroitinase, and hyaluronidase produced by bacteria isolated from infected root canals. The materials examined consisted of 28 teeth with apical periodontitis from 25 patients. Bacteria producing collagenase or chondroitinase and hyaluronidase were found to be significantly related to subacute clinical symptoms involving percussion pain. The frequency of bacteria producing collagenase was higher in isolates from root canals with a radiolucent area over 5 mm in diameter than in those from canals having a radiolucent area less than 5 mm in diameter.
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PMID:Relationship between clinical symptoms and enzyme-producing bacteria isolated from infected root canals. 800 69

Bone loss in the oral cavity may occur due to many causes, including infection, systemic or local alterations in the host response, or multifactorial causes. The purpose of this article is to review our present understanding of the major causes of oral bone loss in adults, with special emphasis on two major oral diseases: periodontitis and residual ridge resorption. Periodontitis is characterized by resorption of the alveolar bone as well as loss of the soft tissue attachment to the tooth. Progressive periodontitis will result in continued alveolar bone loss and may result in tooth mobility, abscesses, and ultimately tooth loss. Although the reported prevalence may vary according to the epidemiologic study design, the 1985 National Survey of Oral Health of United States Adults indicated that 94% of female senior citizens examined demonstrated at least one site with at least 2 mm loss of attachment. Resorption of alveolar bone that occurs following tooth extraction is termed residual ridge resorption. In many cases, the denture will loosen because of the inability of the resorbed ridge to stabilize the prosthesis. In the most severe cases, the denture may impinge on the exposed mandibular nerve, resulting in pain or total inability to tolerate the prostheses. Although clear statistics on the prevalence of residual ridge resorption are not available, this boss loss may result in the need for new dentures to replace ill-fitting prostheses.
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PMID:Bone loss in the oral cavity. 812 14

It has been reported that administration of prophylactic penicillin may prevent flare-ups or other undesirable posttreatment sequelae following root canal treatment. To test this hypothesis in a prospective study, 80 patients with a diagnosis of pulp necrosis and chronic apical periodontitis were divided into three groups: group A (prophylactic penicillin, AHA recommendation), group B (placebo, same regimen), and group C (no medication). Medications and evaluations were double-blinded. Patients reported their posttreatment events including incidence of flare-ups, incidence and severity of pain/swelling, and occurrence of adverse side effects. Differences in the three groups were determined statistically using chi-square tests. The outcome showed no significant difference (p = 0.68) among the three groups. That is, administration/nonadministration of penicillin prophylactically was unrelated to posttreatment signs and symptoms following canal preparation. Incidence of flare-ups was very low (1 of 80). Occurrence of pain in the mild-moderate levels was fairly high (approximately 70% overall), but was primarily in the mild category. Overall incidence of side effects was also very low (2 of 80). Severe levels of pain/swelling and flare-up incidence were low with no difference between administration or nonadministration of antibiotics. Based on our data, using penicillin (a potentially dangerous drug) prophylactically to control posttreatment symptoms is not recommended in cases of pulp necrosis and asymptomatic periapical pathosis.
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PMID:Prophylactic penicillin: effect on posttreatment symptoms following root canal treatment of asymptomatic periapical pathosis. 826 55

This study examined the variety of obligate and facultative anaerobic bacterial species recovered from cases of acute apical periodontitis. A total of 19 root canal samples and 24 periapical granuloma samples were taken from patients suffering pain and discomfort. Bacteria were identified by applying the following techniques: culturing on various media, Gram-staining and using commercially available biochemical test strips. In addition, Prevotella intermedia and Porphyromonas endodontalis were differentiated on a molecular genetic level using species-specific oligodeoxynucleotide probes. The most frequently identified bacteria were Prevotella intermedia, Bifidobacterium spp., Streptococcus sanguis, Streptococcus milleri-group and Bacteroides spp. Obligate anaerobes occurred at a rate of 82.3%, and the average number of isolates was 6.4 per sample.
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PMID:Studies into the microbial spectrum of apical periodontitis. 862 6

The efficacy of a topical anesthetic on pain and unpleasantness provoked by scaling of gingival pockets was investigated in 20 patients with mild chronic periodontitis. A eutectic mixture of local anesthetics (EMLA) and a placebo cream, both occluded by Orahesive Oral Bandages, were applied in a balanced, randomized, double-blind, split-mouth design, which enabled within-subject comparison of the anesthetic and the placebo in the upper and the lower jaw. Pretreatment interviews showed that approximately two-thirds of the patients considered gingival scaling to be associated with some degree of pain and unpleasantness. Pain intensity and unpleasantness were evaluated on 100-mm visual analog scales (VAS). Application of EMLA reduced both pain intensity and unpleasantness significantly compared to placebo cream. Median reductions in VAS pain intensity in the upper and lower jaw were 58.9% and 61.9%, and corresponding reductions in VAS unpleasantness were 31.9% and 25.6%, respectively. Generally, the patients accepted the anesthetic procedure well. The residual perception of pain and unpleasantness following topical anesthesia may be dependent on activation of nonanesthetized nociceptive fibers in the tooth pulp. However, the present study clearly demonstrates the efficacy of a topical anesthetic in a clinical situation, which may be recommended as a simple pharmacologic strategy to reduce pain and unpleasantness during scaling procedures.
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PMID:Efficacy of a topical anesthetic on pain and unpleasantness during scaling of gingival pockets. 863 58

Cystatins are physiological inhibitors of cysteine proteinases and widely distributed in human tissues and fluids including saliva. Cystatins S, SA, SN, and D are only found in glandular saliva and tear fluid whereas cystatin C has been detected in all tested biological fluids. Previous studies demonstrated that total cystatin activity and cystatin C concentration were highest in whole and parotid saliva of periodontitis patients compared to healthy subjects suggesting a response of the salivary glands to an inflammatory condition of the oral cavity. Based on these results we studied a possible change in the concentration of cystatin S, cystatin C, albumin, IgA, amylase activity, and cystatin activity in a whole and parotid saliva of 20 periodontitis patients as a consequence of periodontal treatment. Saliva samples were quantified for cystatins S and C, albumin, and IgA by enzyme-linked immunosorbent assay. Amylase was determined in an activity assay and total cystatin activity was measured towards pa-pain. The clinical condition of the subjects improved significantly after 6 months of periodontal therapy whereas biochemical analyses of whole and parotid saliva indicated that significant changes in salivary protein composition occurred only in whole saliva. Total cystatin activity (P < 0.05) and cystatin C concentration (P < 0.05) of whole saliva samples collected after periodontal treatment decreased to normal healthy control values. Further, concentrations of cystatin S were unchanged during the periodontal treatment process. These results suggest that other sources of cystatins than the parotid gland i.e.; other salivary glands or crevicular fluid, are involved in the decrease of total cystatin activity in whole saliva after periodontal treatment.
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PMID:Effect of periodontal treatment on the protein composition of whole and parotid saliva. 870 50

Clinico-statistical observations were made on the outpatients visiting the Department of Initial Diagnosis and Emergency, Faculty of Dentistry Hospital, Tokyo Medical and Dental University in 1986, 1987, 1989 and 1990. The following findings were obtained according to sex, age group, and chief complaints of new outpatients. Approximately 60% of the outpatients were female during the year examined. The number of outpatients tended to increase in March and to decrease during the winter. The largest number of new outpatients visiting the hospital was in the 20-24-year-old group in both males and females. In the female patients, the 50-54-year-old group had a relatively higher peak. The greatest chief complaint was tooth pain. Further, the chief complaint involving oral soft tissues was due to inflammation. The main disease diagnosed due to chief complaints was caries in the 20-29-year-old group, marginal periodontitis in the 50-59, pericoronitis of wisdom tooth in the 20-29, temporomandibular joint problem in the < or = 19 and masticatory disturbance in the 60 < or = -year-old groups.
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PMID:[4-year clinico-statistical observation of outpatients]. 923 65


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