A. Tzukert

Alveolar bone repair following extraction of impacted mandibular third molars

Bone regeneration following extraction of impacted mandibular third molars was measured on 83 preoperative and postoperative radiographs. The patient sample was divided into two age groups, 20 to 29 years and 30 to 50 years. Postoperatively, there was an average net gain of 2.15 mm in bone level. The degree of bone healing is affected primarily by age and, to a lesser extent, by the presence of generalized inflammation (periodontitis).

Prevention of infective endocarditis: not by antibiotics alone. A 7-year follow-up of 90 dental patients.

Ninety patients (thirty-nine men, fifty-one women with a mean age of 45.4 years with rheumatic heart disease or prosthetic heart valves, were subjected to a total of 1617 dental procedures, which required about 3400 patient/dentist encounters. All treatments were performed according to the protocol described in the present article. Although theory expects three to six cases of infective endocarditis cases in the described population, none of the patients have encountered the disease (p = 0.0013). A conceptual approach, as well as the protocol, is presented. Properly applied, the protocol will reduce the probability of iatrogenic and self-inflicted bacteremia, thus elevating the efficacy of the preventive process.

Development of resistant oral viridans streptococci after administration of prophylactic antibiotics: Time management in the dental treatment of patients susceptible to infective endocarditis

The American Heart Association recommends prophylactic administration of penicillin before each dental session to patients susceptible to infective endocarditis. Such preventive treatment, however, may trigger the transient appearance of penicillin-resistant bacterial strains. In order to investigate the behavior of oral streptococci, 29 healthy volunteers who did not harbor penicillin-resistant viridans streptococci received 4 gm of phenoxymethyl penicillin orally over a period of 10 hours. This amount constituted the sole dose of antibiotics administered in the entire experiment. Daily specimens of oral flora were obtained for 14 successive days from each participant and incubated aerobically with a penicillin-saturated disk for 24 hours. Viridans streptococci were considered resistant when bacterial colonies grew adjacent to the disk for 1 day or more. The study population was divided into high- and low-resistance groups, according to the individual antibiograms. Resistant viridans streptococci were already detected at 6 hours after penicillin ingestion in nine (31%) of the subjects. Six months later, oral specimens were taken from ten randomly selected participants; these specimens served as a control. The difference in bacterial resistance between the high- and low-resistance groups was significant for the duration of 9 days, as was that between the high-resistance and control groups (p less than 0.05 in both cases). In order to minimize the odds that penicillin-resistant bacterial strains will develop in patients susceptible to infective endocarditis, elective dental treatments in these persons should be scheduled in intervals of not less than 10 days.

Dental treatment for the patient on anticoagulant therapy: prothrombin time value--what difference does it make?

Thirty patients taking anticoagulants received routine dental treatment without altering their prothrombin time values. In a follow-up of 5 years, no serious complications were seen in patients with a prothrombin time value of up to 2.5. A protocol is suggested for dental treatment in these patients.

Analysis of the American Heart Association's recommendations for the prevention of infective endocarditis

A probabilistic model analyzes the American Heart Associations (AHA) recommendations for the prevention of infective endocarditis (IE) of dental origin. The model, presented in the form of a flow chart, combines available data elements with the AHA recommendations; mortality serves as the sole valued outcome and payoff measure. The analysis shows that an annual death rate of 1.36 per million population is attributable to the antibiotics administered in an attempt to prevent IE, whereas not more than 0.26 annual deaths per million are traceable to IE of dental origin. Sensitivity and threshold analyses were conducted to determine the conditions under which the recommended prophylactic policy will prove beneficial. The model suggests that the standard AHA antibiotic regimen should be exploited only in IE susceptible patients belonging to the high risk categories and that its value in moderate, low, and negligible risk patients is doubtful. When the use of antibiotics is unavoidable, oral administration is the preferable route.

The spatial distribution, intensity and unpleasantness of acute dental pain

&NA; The distribution, intensity and unpleasantness of acute dental pain were studied in 196 patients. Dental pain was classified by source according to 7 anatomical sites: dentinal, pulpal, pulpal and periapical, periapical, pericoronal, papular and periodontal. The distribution of dental pain was classified by the frequency of pain spread throughout the sample, by the extent of pain spread for a particular pain source, that is, the number of vectors of spread and by the pain reference locations in the face and head. Pain‐intensity and pain‐unpleasantness were assessed on Visual Analogue Scales. The frequency and extent of pain spread varied as a function of source. However, specific patterns of pain spread were not associated with particular pain sources. There was considerable overlap in patterns of spread between maxillary and mandibular pain sources. The frequency and extent of pain spread was correlated positively with both pain intensity and pain unpleasantness. The correlation between pain ratings and pain spread may be attributed to central mechanisms and interactions between trigeminothalamic neurons. Spatial overlap of pain from maxillary and mandibular pain sources may be due to the large receptive fields of wide dynamic range neurons, that can extend beyond one trigeminal division. These observations indicate that the spatial distribution of acute dental pain is not sufficient as a diagnostic tool for indentifying pain source.

Orofacial pain of cardiac origin

Abstract Facial pain due to cardiac anoxia has been demonstrated in three patients. Electrocardiograph and coronary angiograph changes could be associated with the facial pain. An aortocoronary bypass operation in one of the patients eliminated the facial pain. Pain of cardiac origin should be included in the differential diagnosis of orofacial pain, especially when it is associated with effort in elderly patients.

Hospital personnel with penicillin-resistantStreptococcus viridans

Abstract Penicillin is the drug of choice for the prevention of bacterial endocarditis (BE) resulting from dental treatment. The susceptibility of Streptococcus viridans to this antimicrobial agent was studied. A representative sample of hospital personnel (N = 76) was compared to a control group of seventy-six subjects who were not associated with the hospital. Twenty-four of the hospital personnel worked in wards that consume 0.13 to 1.64 (mean ± SD = 0.88 ± 0.64) gm penicillin per day per position (low consumption group = LCG) and fifty-two worked in wards that consume 2.27 to 3.67 (mean ± SD = 3.04 ± 0.55) gm penicillin per day per position (high consumption group = HCG). Antibiograms of oral isolates showed that, while 48.08% of the subjects from the HCG revealed penicillin-resistant S. viridans only 8.33% of the subjects from the LCG and 7.89% of the control group presented such results. The data presented suggest that there are subjects who may unknowingly carry penicillin-resistant S. viridans as part of their oral flora. It is therefore recommended that the preferable antibiotic used for the prevention of BE should be determined by an antibiogram.

Pulpitis and root canal therapy: Is a diagnostic radiograph of value?

Historical data and a decision-flow diagram were used to analyze the informational value to be obtained from diagnostic radiographs in cases of pulpitis. It is recommended that preoperative radiographs be relegated to the category of nonroutine procedures and that the eccentric length-measurement radiograph be used as point of reference.

A computerized decision support system for patient selection in dental education

A computerized decision support system is presented. The system is used to aid in the situation of patient selection for the purpose of dental education and utilizes the PERT/CPM methodology and decision tables. It runs on a microcomputer and written in Basic. The input is a list of patients needs, and the output is a tentative treatment plan, the chair time needed to complete the treatment, its cost, and the probability that the student will finish it on time.