Geza T. Terezhalmy

Trial of metronidazole vs. azithromycin for treatment of cyclosporine‐induced gingival overgrowth

Abstract:  Gingival overgrowth usually characterized by increased cellular growth of gingival fibroblasts appears to be multifactorial. In patients receiving CyA for more than 3 months, the incidence can approach 70% and can be attributed to pharmaceutical immunosuppression. Case reports have reported regression of overgrowth with both metronidazole and azithromycin. The goal of this study was to determine the efficacy of metronidazole and azithromycin in reducing CyA‐induced gingival overgrowth. Twenty‐five patients were included in this double‐blinded randomized study. All patients were receiving CyA as medically indicated and diagnosed with gingival overgrowth by a dentist. Patients were randomized to receive either 5‐days of azithromycin or 7‐days of metronidazole given at baseline only. The extent of gingival overgrowth was measured at 0, 2, 4, 6, 12, and 24 wk. Fourteen patients at CCF and 11 patients at CCHMC were studied. Repeated measures anova was performed to assess differences within and between groups. Gingival overgrowth at baseline was not statistically different between groups. The mean degree of gingival overgrowth after treatment was different across all time intervals (p = 0.0049) showing azithromycin to be more effective than metronidazole. Therapy with azithromycin offers an effective alternative to the management of CyA‐induced gingival overgrowth.

Clinical evaluation of brushing time and plaque removal potential of two manual toothbrushes

AIM To compare plaque removal efficacy of Oral-B CrossAction (CA) used for 1 min with an American Dental Association (ADA) manual toothbrush used for 2 or 5 min in an examiner-blind, three-treatment, six-period crossover study. MATERIALS AND METHODS After refraining from all oral hygiene procedures for 23-25 h, subjects were randomly assigned to one of nine possible six-period (visit) treatment sequences. Plaque was assessed at baseline (Rustogi Modified Navy Plaque Index). Post-brushing scores were recorded after brushing with a marketed dentifrice and the assigned toothbrush for the specified duration. The same procedure was followed at each of six subsequent visits. Clinical measurements were carried out by the same examiner. RESULTS Forty subjects completed the study. All three treatments effectively removed plaque from the whole mouth, along the gingival margin and from approximal surfaces. Whole mouth and gingival margin plaque removal scores with CA for 1 min did not differ significantly from scores with the ADA toothbrush used for 2 min. The ADA brush used for 5 min showed significantly greater whole mouth (P < 0.001) and gingival margin (P < 0.001) plaque reduction than the two other treatments. Approximal plaque removal scores did not differ between the three treatments. CONCLUSIONS Efficient plaque removal can be achieved after 1 min of brushing with CA. The amount of plaque removed did not differ significantly from that achieved with the ADA brush after 2 min of brushing. Greater whole mouth and gingival margin plaque removal scores were seen with the ADA brush after 5 min.

The effects of high frequency, low intensity ultrasound therapy on parotid flow rates

OBJECTIVES Saliva plays a critical role in maintaining oral health and comfort. Development of a single device capable of simulating salivary flow with no taste or adverse side effects is desirable. STUDY DESIGN This clinical investigation on 23 healthy volunteers with no dry mouth complaints evaluated the effectiveness of ultrasonic therapy in mechanical stimulation of the parotid gland to increase saliva flow. Stimulated and unstimulated parotid saliva was collected. Differences in mean salivary flow rates and affects of age and ethnicity were measured. RESULTS The mean difference between stimulated and unstimulated saliva flow rates was 0.009 mL/min +/- SD = 0.042, t (df = 22) = 1.27 with P = .31. There were no significant differences of age (P = .26), gender (P = .38), or race/ethnicity (P = .58) for the difference of stimulated and unstimulated conditions. CONCLUSIONS Results indicate that high-frequency low-intensity ultrasound therapy is not effective in stimulating salivary flow rates.

Dental Care of AD Patients

To provide optimal care to patients with Alzheimer’s disease (AD), health care providers must understand the disease, its treatment, and the effects that both the disease and/or its treatment may have on the patient’s quality of life. Physicians who treat patients with AD must better understand the role of adequate dental health care in improving the quality of life and not forget to initiate timely referral to oral health care providers. Oral health care providers, in turn, must develop preventive and therapeutic strategies compatible with the patient’s physical and cognitive ability to undergo and respond to dental care. Adequate dental care is a vital aspect of a patient’s well-being.