Anna Carolina Ratto Tempestini Horliana

Assessment of preemptive analgesia with ibuprofen coadministered or not with dexamethasone in third molar surgery: a randomized double-blind controlled clinical trial.

IntroductionThere is no conclusive evidence from clinical trial studies regarding preemptive analgesic interventions. Clinical trials are necessary to evaluate the efficacy of preemptive analgesic interventions already demonstrated in animal studies. Thus, it is necessary to evaluate the analgesic effect of preoperative administration of ibuprofen alone or coadministered with dexamethasone after third molar surgery.Material and methodsA randomized, double-blind, and controlled clinical trial was conducted with 94 bilateral symmetrical third molar surgeries. Preemptive analgesic medication was randomly defined: ibuprofen or placebo and ibuprofen + dexamethasone or placebo was administered to patients who served as their own control (split mouth). The variables analyzed were postoperative pain through visual analog scale (VAS), total number of rescue analgesic (TNRA), and patient satisfaction. Data were analyzed with the Mann–Whitney test.ResultsThere was no significant difference (p > 0.05) between ibuprofen and placebo for postoperative pain (VAS) and TNRA. Patients consumed less analgesics (TNRA) for dexamethasone + ibuprofen (p < 0.05) and felt more comfortable in the postoperative period after surgery (p < 0.05).DiscussionThe preemptive analgesia with ibuprofen was insufficient to inhibit central sensitization, whereas its association with dexamethasone was more effective in preventing pain in third molar surgery.

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

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

Occlusal adjustment associated with periodontal therapy—A systematic review

OBJECTIVES Occlusal adjustment as part of periodontal therapy has been controversial for years, mostly because the literature does not provide enough evidence regarding the influence of trauma from occlusion (TfO) on periodontitis. The need for occlusal adjustment in periodontal therapy is considered uncertain and requires investigation. The aim of this systematic review was to identify and analyse those studies that investigated the effects of occlusal adjustment, associated with periodontal therapy, on periodontal parameters. DATA A protocol was developed that included all aspects of a systematic review: search strategy, selection criteria, selection methods, data collection and data extraction. SOURCES A literature search was conducted using MEDLINE via PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE. STUDY SELECTION Three reviewers screened the titles and abstracts of articles according to the established criteria. Every article that indicated a possible match, or could not be excluded based on the information given in the title or abstract, was considered and evaluated. On final selection, four articles were included. CONCLUSIONS Although the selected studies suggest an association between occlusal adjustment and an improvement in periodontal parameters, their methodological issues (explored in this review) suggest the need for new trials of a higher quality. There is insufficient evidence at present to presume that occlusal adjustment is necessary to reduce the progression of periodontal disease. CLINICAL SIGNIFICANCE Although it is still not possible to determine the role of occlusal adjustment in periodontal treatment, adverse effects have not been related to occlusal adjustment. This means that the decision made by clinicians whether or not to use occlusal adjustment in conjunction with periodontal therapy hinges upon clinical evaluation, patient comfort, and tooth function.

Hyaluronidase increases the duration of mepivacaine in inferior alveolar nerve blocks.

PURPOSE To evaluate the duration of the effect of mepivacaine when hyaluronidase is injected immediately prior to the end of pulpal anesthesia. PATIENTS AND METHODS Forty bilateral, symmetrical third molar surgeries were performed in 20 healthy patients. Inferior alveolar nerve block was induced using 2.8 mL 2% mepivacaine with epinephrine. Hyaluronidase (75 turbidity-reducing units) or a placebo was injected 40 minutes after the beginning of pulpar anesthesia (randomized and double-blind trial). The duration of effect in the pulpal and gingival tissues was evaluated by response to painful electrical stimuli applied to the adjacent premolar, and by mechanical stimuli (pin prick) to the vestibular gingiva, respectively. RESULTS In both tissues, the duration of anesthetic effect with hyaluronidase was longer (P < .01) than with the placebo. CONCLUSION Hyaluronidase increases the duration of mepivacaine in inferior alveolar nerve blocks.

Comparative analysis of preemptive analgesic effect of dexamethasone and diclofenac following third molar surgery.

The objective of the study was to compare the analgesic effectiveness of dexamethasone and diclofenac sodium administered preemptively after surgical removal of third molars. Forty-four ASA (American Society of Anesthesiologists) I patients (19 men, 35 women; 16-28 years old) randomly and double-blindly received diclofenac sodium (50 mg) or dexamethasone (8 mg) or placebo 1 h before surgery. Intensity of pain, measured with a visual analog scale (VAS), was the variable studied at different postoperative times (1 h, 2 h, 3 h, 6 h, 8 h, 12 h, 48 h, 4 d and 7 d). The total amount of rescue medication (TARM) ingested (paracetamol) was another variable of the study. The Kruskal-Wallis statistical test was used. A p value of < .05 was adopted to reject the null hypothesis. The dexamethasone group showed lower pain intensity (p < .05) than the diclofenac sodium and placebo groups (p < .05). No difference in TARM was observed among the groups (p < .05). Preemptively administered, dexamethasone was effective in controlling postoperative pain.

Anesthetic Efficacy in Irreversible Pulpitis: A Randomized Clinical Trial

Inferior alveolar nerve block has a high failure rate in the treatment of mandibular posterior teeth with irreversible pulpitis. The aim of this study was to compare the anesthetic efficacy of 4% articaine, 2% lidocaine and 2% mepivacaine, all in combination with 1:100,000 epinephrine, in patients with irreversible pulpitis of permanent mandibular molars during a pulpectomy procedure. Sixty-six volunteers from the Emergency Center of the School of Dentistry, University of São Paulo, randomly received 3.6 mL of local anesthetic as a conventional inferior alveolar nerve block (IANB). The subjective signal of lip numbness, pulpal anesthesia and absence of pain during the pulpectomy procedure were evaluated respectively, by questioning the patient, stimulation using an electric pulp tester and a verbal analogue scale. All patients reported the subjective signal of lip numbness. Regarding pulpal anesthesia success as measured with the pulp tester, the success rate was respectively 68.2% for mepivacaine, 63.6% for articaine and 63.6% for lidocaine. Regarding patients who reported no pain or mild pain during the pulpectomy, the success rate was, respectively 72.7% for mepivacaine, 63.6% for articaine and 54.5% for lidocaine. These differences were not statistically significant. Neither of the solutions resulted in 100% anesthetic success in patients with irreversible pulpitis of mandibular molars.

Assessment of the quantity of microorganisms associated with bronchiectasis in saliva, sputum and nasal lavage after periodontal treatment: a study protocol of a randomised controlled trial

Introduction The association between periodontal disease (PD) and chronic obstructive pulmonary disease (COPD) has been widely studied, with aspiration of periodontal pathogens being one of the most accepted causal mechanisms for pulmonary exacerbation. Periodontal treatment (PT) was associated with a decrease in these exacerbations. Bronchiectasis is a pulmonary disease that has many similarities to COPD; however, there are no studies correlating this condition to PD thus far. This study will evaluate if PT reduces proinflammatory cytokines in serum and saliva, as well as halitosis and the amount of microorganisms associated with exacerbation of bronchiectasis in saliva, sputum and nasal lavage 3 months after PT. Methods and analysis A total of 182 patients with PD and bronchiectasis will be randomly allocated to group 1 (positive control; scaling and root planing (SRP)+oral hygiene (OH)) or group 2 (experimental; SRP+photodynamic therapy+OH). After 3 months, samples of saliva, nasal lavage and sputum will be collected to determine the level of Pseudomonas aeruginosa, Staphylococcus aureus and Porphyromonas gingivalis by quantitative PCR. This protocol will determine the efficacy of PT in reducing the most likely niches of bronchiectasis exacerbation by comparing pre- and post-treatment microbiology samples. Furthermore, there will be assessment of oral halitosis and verification of inflammatory cytokines in serum and saliva. Ethics and dissemination This protocol has been approved by the Research Ethics Committee of Universidade Nove de Julho. Data will be published in a peer-reviewed journal. Trial registration number NCT02514226.

Inflammatory markers in gingival crevicular fluid of periodontitis patients with type 2 diabetes mellitus according to glycemic control: A pilot study.

Background: Type 2 diabetes mellitus (T2DM) and periodontitis are inflammatory conditions with a bidirectional association. This pilot study aimed to evaluate whether T2DM and glycemic control interfere in inflammatory markers profiles in gingival crevicular fluid (GCF) in periodontitis patients. Materials and Methods: Fourteen diabetic periodontitis patients were enrolled in this study, seven with adequate glycemic control (glycated hemoglobin [HbA1c] <8.0%) (DMA + P) and seven with inadequate control (HbA1c ≥8.0%) (DMI + P). Seven chronic periodontitis patients without diabetes formed the control group (P). GCF was obtained from diseased sites (probing depth >6 mm) of an entirely hemiarch, pooled and cytokines levels determined using multiplex beads immunoassay. Clinical periodontal parameters were analyzed by Mann-Whitney test and levels of cytokines by Kruskal-Wallis and Dunns multiple comparison tests with confidence level of 95% (P < 0.05). Results: Cytokines profile of GCF obtained from deep periodontal pockets presented high levels of inflammatory cytokines, and there were no statistical differences between levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-α according to presence of diabetes or percentage of HbA1c among the groups, despite groups with T2DM and periodontitis exhibit higher levels of PD. Conclusion: Within the limitations of this study, inflammatory mediators in GCF are dependent to the local response and do not correlate with the diabetic status.

Antimicrobial Photodynamic Therapy as a Co-adjuvant in Endodontic Treatment of Deciduous Teeth: Case Series

To assure the success of endodontic treatment, the root canal must be completely decontaminated. Thus, some methods have been researched in an attempt to effectively eliminate microorganisms from the interior of the root canal system. Among them is conventional endodontic therapy in conjunction with photodynamic therapy (PDT). Five anterior deciduous teeth were treated endodontically with the conventional technique and PDT. For PDT, 0.005% methylene blue was used as a photosensitizer and a 660 nm laser. After the conventional endodontic therapy, the photosensitizer was applied inside the root canal, 3 min of pre‐irradiation time, and then, the laser was applied for 40s with an energy of 4J. Afterward, the canal was irrigated with saline solution and the sealing material of the root canal was placed. The microbiological analysis of the samples was collected before and after the treatments were performed. Observing the results obtained in this case series, which showed a bacterial reduction from 37.57% to 100%, and the clear difficulty in the success of endodontic treatment of deciduous teeth, antimicrobial photodynamic therapy can be considered an alternative of easy application that does not generate microbial resistance, to act as a support in the decontamination of the root canals.

Influence of Nd:YAG laser on the penetration of a bioceramic root canal sealer into dentinal tubules: A confocal analysis

Objective The aim of this in vitro study, is to evaluate the penetration of a bioceramic root canal sealer into dentinal tubules at 3 mm and 5 mm from the apex after Nd:YAG laser irradiation. Methods Forty freshly extracted human mandibular premolars were prepared using Reciproc® and irrigated with 17% ethylenediaminetetraacetic acid (EDTA). Teeth were divided into 4 groups: group 1, obturated with control sealer (AH Plus®); group 2, obturated with bioceramic sealer (Endosequence BC Sealer®); group 3, Nd:YAG laser + control sealer (AH Plus®); and group 4, Nd:YAG laser + bioceramic sealer (Endosequence BC Sealer®). The samples were transversely sectioned 3 mm and 5 mm from the apex and examined using confocal laser scanning microscopy. Two parameters were measured: 1) sealer penetration into dentinal tubules of the root canal and 2) sealer penetration into the perimeter of the root canal walls. Results Penetration analysis showed that bioceramic sealer had a higher penetration at depths of 3 and 5 mm than that of the control sealer, regardless of laser use (p <0.05). Perimeter analysis showed that there was no difference between both sealers at a depth of 3 mm (p <0.05), regardless of laser use. At a depth of 5 mm, bioceramic sealer and laser showed a greater perimeter of penetration (p <0.05) than the control sealer. Conclusion The use of Nd:YAG laser did not compromise the penetration of bioceramic sealer into dentinal tubules of root canals at 3 mm and 5 mm from the apex.