Juan J. Segura-Egea

Diabetes mellitus, periapical inflammation and endodontic treatment outcome.

The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and systemic health is one of the most interesting aspects faced by the medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable, and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol. Key words: Apical periodontitis, diabetes mellitus, endodontics, root canal treatment.

In vitro evaluation of cytotoxicity and genotoxicity of a commercial titanium alloy for dental implantology.

Titanium and its alloys have many applications in dentistry, being used in orthodontics, endodontics, prosthetics and implantology. But the use in the biomedical field depends on its biocompatibility, as the Council Directive 93/42/EEC of 14 June 1993 concerning medical devices has established. The aim of this study was to investigate the cytotoxicity and genotoxicity of a commercial titanium/aluminium/vanadium alloy (Ti-6Al-4V) developed by an innovative sand-blast process with aluminium oxide, and nitric-acid passivation. This procedure created a material with an average surface roughness of 1.73±0.16μm with applications in dental implants. International Organization for Standardization (ISO) procedures 7405:2008 and 10993-5:2009 were used to perform the cytotoxicity tests, and bacterial and cell-mutation assays to evaluate genotoxicity. The results show that this titanium alloy (Ti-6Al-4V) was neither cytotoxic nor genotoxic in any of the tests performed. It can be concluded that this new Ti-6Al-4V material with the roughness characteristics specified shows good biocompatibility and can be considered of choice in dental implantology.

Pain associated with root canal treatment

AIM To determine the pain experienced by patients during root canal treatment and to correlate with age and gender, pulpal diagnosis, previous periapical status, dental characteristics and length of treatment. METHODOLOGY One hundred and seventy-six patients (68 men and 108 women), with ages ranged from 6 to 83 years, were randomly recruited. Patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain experienced during root canal treatment. RESULTS The mean pain level during root canal treatment was 1.2 +/- 0.8 in a VAS between 0 and 10. Fifty-four per cent of patients did not experience pain. There were no significant differences in relation to gender or age groups. Mandibular teeth had a significantly (P < 0.05) higher percentage incidence of pain in comparison with maxillary teeth. Pain was absent in 63% of anterior teeth compared with 44% in posterior ones (P < 0.01). Interventions shorter than 45 min resulted in a significantly higher percentage of pain absence (P < 0.05). Root canal treatment was significantly (P < 0.05) more painful in teeth with irreversible pulpitis and acute apical periodontitis compared to the group with necrotic pulps and chronic apical periodontitis (P = 0.049). CONCLUSIONS Root canal treatment in teeth with irreversible pulpitis and acute apical periodontitis was more painful. Age, tooth type and length of the treatment were factors associated with increased risk for pain experienced during the procedure. Knowledge of pain levels endured by patients will allow dentists to decide when to use supplemental local anaesthesia.

High prevalence of apical periodontitis amongst smokers in a sample of Spanish adults

AIM To study the prevalence of apical periodontitis in smoker and nonsmoker patients. METHODOLOGY In a cross-sectional study, the records of 180 subjects, 109 smokers and 71 nonsmokers, were examined. All participants underwent a full-mouth radiographic survey incorporating 14 periapical radiographs. The periapical region of all teeth, excluding third molars, was examined. Periapical status was assessed using the Periapical Index score. Statistical analyses were conducted using the Cohens Kappa test, analysis of variance and logistic regression. RESULTS Apical periodontitis in at least one tooth was found in 74% of smokers and in 41% of nonsmokers (P < 0.01; odds ratio = 4.2; 95% C. I. = 2.2-7.9). Amongst smoker patients 5% of the teeth had apical periodontitis, whereas in nonsmoker subjects 3% of teeth were affected (P = 0.008; odds ratio = 1.5; 95% C. I. = 1.1-2.1). The percentage of root filled teeth in smoker and nonsmoker patients was 2.5% and 1.5%, respectively (P < 0.05; odds ratio = 1.7; C. I. 95% = 1.0-2.6). CONCLUSIONS In this study population, smoking was significantly associated with a greater frequency of root canal treatment and with an increased prevalence of apical periodontitis.

Inferior alveolar nerve injury resulting from overextension of an endodontic sealer: non-surgical management using the GABA analogue pregabalin

AIM   To describe a case of endodontic sealer (AH Plus) penetration within the mandibular canal after root canal treatment with resolution of pain and paraesthesia after a non-surgical approach, including treatment with prednisone and pregabalin. SUMMARY   A 37-year-old woman underwent root canal treatment of the left mandibular second molar tooth. Postoperative periapical radiographs revealed the presence of radiopaque canal sealer in the mandibular canal. The day after, the patient reported severe pain in the tooth and paraesthesia/anaesthesia in the region innervated by the left inferior alveolar and mental nerve. Diagnosis of injury to the inferior alveolar nerve because of extrusion of AH Plus was established. The non-surgical management included 1 mg kg(-1) per day prednisone, two times per day, in a regimen on a daily basis, and 150 mg per day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. One month after the incident, the signs and symptoms were gone. KEY LEARNING POINTS This case illustrates the care required when performing root canal treatment, especially when the root apices are in close proximity to the inferior alveolar nerve canal. The complete resolution of paraesthesia and the control of pain achieved in the present case suggests that a non-surgical approach combining prednisone and pregabalin is a good option in the management of the inferior alveolar when it is contacted by extruded root filling material.

Frequency and distribution of root-filled teeth and apical periodontitis in an adult population of Barcelona, Spain.

AIM  To determine the prevalence of apical periodontitis (AP) and the frequency of root canal treatment in a sample of Spanish adults. DESIGN  A descriptive cross-sectional study. SETTING  Barcelona, Spain. PARTICIPANTS  A total of 397 adult subjects, 49% males and 51% females. METHODS  Digital panoramic radiographs were used. Periapical status was scored according to the periapical index. Results were analysed statistically using the chi-squared test and logistic regression. RESULTS  Radiographic signs of AP in one or more teeth were found in 135 patients (34%). The prevalence of AP was significantly higher in males (42.3%) than females (26.1%) [odds ratio (OR)=2.1; 95% confidence interval (95% CI)= 1.4-3.2; P= 0.0007]. At least one root-filled tooth (RFT) was found in 233 patients (59%). Twenty-six per cent of subjects with RFT had at least one RFT with AP. The prevalence of AP increased with age (P < 0.05). Patients with RFT showed a higher prevalence of AP (42%) relative to patients without RFT (23%) (OR = 2.4; 95% CI = 1.5-3.7; P = 0.00013). Adjusting for age, gender and teeth number, endodontic status remained significantly associated with periapical status (OR = 2.3; 95% CI = 1.4-3.6; P = 0.0005). CONCLUSIONS  Both the prevalence of AP and the frequency of root canal treatment are high among Spanish adults. AP affects more frequently RFT relative to untreated teeth. Patients with one or more RFT have a greater likelihood of having AP than patients without RFT.

Antibiotic use by members of the Spanish Endodontic Society.

INTRODUCTION The purpose of this study was to determine the prescribing habits of active members of the Spanish Endodontic Society (AEDE) with regard to antibiotics. METHODS A one-page questionnaire was sent to the active members of the AEDE. Of the 508 surveys mailed, 158 surveys were returned, and 140 were found to be usable. The overall response rate was 31.1%. The data were analyzed by using descriptive statistics and chi-square tests of independence. RESULTS The average duration of antibiotic therapy was 6.8 +/- 1.8 days. In patients with no medical allergies, most of the responders (86.1%) selected amoxicillin as the first-choice antibiotic, alone (44.3%) or associated with clavulanate (41.8%); metronidazole-spiramycin and clindamycin were prescribed by 7.6% and 3.7% of the respondents. The first drug of choice for patients with an allergy to penicillins was clindamycin 300 mg (63.2%) followed by metronidazole-spiramycin (23.7%). For cases of irreversible pulpitis, 40.0% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis, and no swelling, 52.9% prescribed antibiotics. Almost 21.5% prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract. CONCLUSIONS For the most part, the majority of the members of the AEDE were selecting the appropriate antibiotic for use in orofacial infections, but there are still many who are prescribing antibiotics inappropriately. The use of antibiotics for minor infections, or in some cases in patients without infections, could be a major contributor to the world problem of antimicrobial resistance.

Inferior alveolar nerve paresthesia after overfilling of endodontic sealer into the mandibular canal.

The present study describes a case of endodontic sealer (AH Plus) penetration within and along the mandibular canal from the periapical zone of a lower second molar after endodontic treatment. The clinical manifestations comprised anesthesia of the left side of the lower lip, paresthesia and anesthesia of the gums in the third quadrant, and paresthesia and anesthesia of the left mental nerve, appearing immediately after endodontic treatment. The paresthesia and anesthesia of the lip and gums were seen to decrease, but the mental nerve paresthesia and anesthesia persisted after 3.5 years. This case illustrates the need to expend great care with all endodontic techniques when performing nonsurgical root canal therapy, especially when the root apices are in close proximity to vital anatomic structures such as the inferior alveolar canal.

Pattern of antibiotic prescription in the management of endodontic infections amongst Spanish oral surgeons

AIM To identify antibiotic prescription practices in the treatment of endodontic infections amongst Spanish oral surgeons. METHODOLOGY Members of the Spanish Oral Surgery Society (SECIB) were surveyed on antibiotic prescription on six different pulpal and periapical diagnoses. A total of 200 questionnaires were delivered with 127 returned (64%). RESULTS The average duration of antibiotic therapy was 7.0 +/- 1.0 days. Ninety five percent of respondents selected amoxicillin as the first choice antibiotic in patients with no medical allergies, alone (34%) or associated to clavulanate (61%). The first drug of choice for patients with an allergy to penicillins was clindamycin 300 mg (65%), followed by azithromycin (15%) and metronidazole-spiramycin (13%). For cases of irreversible pulpitis, 86% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis and no swelling, 71% prescribed antibiotics. Almost 60% of respondents prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract; in this clinical situation, odontologists prescribed more frequently antibiotics compared to stomatologists (P = 0.0080; odds ratio = 8.0; C. I. 95% = 1.7-37.1). CONCLUSIONS The majority of the members of the SECIB were selecting the appropriate antibiotic for use in endodontic infections, but there are still many who are prescribing antibiotics inappropriately. The use of antibiotics for minor infections, or in some cases in patients without infections, could be a major contributor to the world problem of antimicrobial resistance.

Hypertension and Dental Periapical Condition

INTRODUCTION The purpose of this study was to investigate the prevalence of apical periodontitis and endodontic treatment in hypertensive patients and control subjects without hypertension. METHODS In a cross-sectional study, the records of 40 hypertensive patients and 51 control subjects were examined. Periapical status of all teeth was assessed by using the periapical index score. RESULTS Apical periodontitis in 1 or more teeth was found in 75% of hypertensive patients and in 61% of control subjects (P = .15; odds ratio, 1.94; 95% confidence interval, 0.78-4.81). One or more root-filled teeth were found in 45% and 39% of hypertensive and control subjects, respectively (P > .0.5). Among hypertensive patients 5.2% of the teeth had apical periodontitis, whereas in the control subjects 4.2% of teeth were affected (P > .05). The percentages of root-filled teeth in the study and control groups were 3.1% and 1.8%, respectively (P > .05). Among hypertensive patients 65% of root-filled teeth had apical periodontitis, whereas in the control subjects 43% of the root-filled teeth were associated with apical periodontitis (P > .05). CONCLUSIONS The prevalence of apical periodontitis and endodontic treatment was not significantly different in hypertensive patients compared with control subjects without hypertension.