Mary C. Crowley

A Clinical Study of the Treatment of Root Canal and Periapical Infections with Penicillin

Some preliminary clinical work was done at Michigan in which penicillin was used in the treatment of infected root canals, first in solution in physiological salt solution (5000 u. per c.c.) and later by use of absorbent points which had been saturated with 1000 u. of penicillin each. Results in a small series were unsatisfactory as compared to results obtained with commonly used drugs. Therefore, it was felt that if penicillin were to be used successfully some method must be found by which a large quantity of penicillin could be used in the tooth in a form that would slowly release penicillin over an extended period. After some study it was found that by using a paste made up with penicillin, calcium carbonate and physiological salt solution it was possible to incorporate from 5000 to 10,000 units in the average root canal and pulp chamber and that the penicillin was slowly released over a period ranging up to 96 hours. This was confirmed by recovering absorbent points from penicillin-treated root canals after 24, 48, 72 and 96 hour intervals. These points were then placed in 5% blood agar plates with beef infusion broth base inoculated with a culture of Streptococcus dysgalactiae, an organism extremely sensitive to penicillin, as determined by Kakavas and Scott (10). After incubation for 48 hours it was found that all points showed significant areas of inhibited growth in the agar, thus indicating that effective quantities of penicillin were present up to 96 hours. The clinical phase of this study was carried out by treatment of root canal cases in the clinic by exactly the same procedure as that routinely used, except for the substitution of penicillin for camphorated p. monochlorophenol or other commonly used drugs. Special precaution was taken to completely dry the canals of solution of sodium hypochlorite which is routinely used at each appointment for washing the root canals, since it would tend to inactivate the penicillin.

Penicillin Sensitivity of Streptococci Isolated from Root Canal Infections and the Normal Mouth

Many workers have shown that certain strains of supposed penicillin-sensitive bacteria may be resistant to penicillin. Since a clinical study of the effect of penicillin in infected root canals was contemplated it was thought desirable to ascertain the sensitivity of individual strains of streptococci, which are the organisms commonly isolated from infected root canals. At the same time it was decided to determine the reactions to penicillin of streptococci from saliva of normal mouths. As it has been presumed that the streptococci causing root canal infections are usually derived from the saliva, the reactions of streptococci from the two sites might lead to some information on their relationship. Material from infected root canals was inoculated into beef infusion semi-solid agar, containing ascitic fluid. The cultures after incubation at 37.50C. for 36-48 hours were plated out on 2% blood agar. Single colonies of streptococci were then transferred to other blood agar plates to be studied. The reaction on blood was determined, and the streptococci classified as hemolytic, viridans or anhemolyticus. No other method or classification was attempted, since the viridans and anhemolytic types form such heterogenous groups that it was not thought expedient at this time to attempt further classification. The hemolytic group of streptococci are recovered in only 2% of infected root canals. Streptococci from saliva were obtained from individuals who had no mouth infections. The saliva after collection was diluted with physiological salt solution, so that discrete colonies grew when streaked on blood agar. Single colonies were transferred to blood agar for study. No difficulty was encountered in identifying viridans type of streptococci, but difficulty was encountered with hemolytic and anhemolytic types of streptococci. It was noticed that colonies which had been picked as hemolytic types after replating, were anhemolytic in type; or that the anhemolytic type was hemolytic. At first it was thought that errors had been made in identifying colonies, but it happened so frequently, and after further precautions had been taken that we realized that we were dealing with dissociated strains, which had to be replated several times to obtain pure phase cultures. This particular problem is to be investigated in the near future. Tryptose broth (1) containing 5% ascitic fluid, and penicillin sodium was used to carry out the penicillin sensitivity tests. Strains were tested in 0.03 U, 0.5 U. and 8 U. of penicillin per c.c. of broth. A positive control was made in the

Effect of Certain Mouthwashes on the Number of Oral Bacteria

The purpose of this study was to determine the duration of the inhibitory effect of some of the popular mouthwashes on the oral bacteria. All of the preparations used with the exception of one, Azochloramid, were bought in the open market. Azochloramid is a new preparation and was supplied to us by the manufacturer. Two experiments were carried out. In the first, Pepsodent, Lavoris, and Hexylresorcinol were diluted 1:1 with water, while Azochloramid was made up by dissolving one tablet in 50 cc. of water. This dilution of the first four products named was used because all of the manufacturers of these products advertise that dilutions of that strength can be used, as well as weaker dilutions. Since these were preliminary tests, we used the greater concentration which should be the most efficacious. Tests were made on six individuals, but not all mouthwashes were used on all individuals. In the second experiment, Azochloramid-1 tablet in 50 cc. of water, Chlorozene-1 tablet dissolved in 125 cc. water, Zonite-1:10 dilution and Pepsodent-1: 3 dilution were used. Tests were made on two individuals, one of whom (M. C.) had been tested in Experiment I. The methods of sampling were identical in both experiments and were the same as reported in a previous publication. Briefly, samples were collected by brushing the teeth and then rinsing both mouth and toothbrush with N/300 NaOH. This material was sprayed through an atomizer especially devised to break up the larger clumps. The volume of the sprayed material was made up to 20 cc. withN/300 NaOH and 0.01 cc. portions smeared out on a glass slide, stained by

The dentist's responsibility in the management of the patient with rheumatic heart disease

Abstract The management of the “cardiac” requires certain fundamental knowledge and the need for closer cooperation between the physician and dentist. This discussion limits consideration specifically to the management of the patient with rheumatic heart disease. Bacteremias have been shown frequently to follow manipulation and trauma of surgical procedures, especially following the extraction of teeth. From such a bacteremia the patient with valvular heart disease (usually resulting from rheumatic fever) may develop subacute bacterial endocarditis as a result of the localization of bacteria on previously damaged heart valves. The prophylactic use of sulfathiazole, if given in doses sufficient to raise the blood levels above 4 mg. per 100 c.c., reduces markedly the incidence of positive blood cultures. It is in a large part the dentists responsibility to manage the patient with valvular heart disease by treatment with sulfonamides. It is thought that prophylactic premedication with sulfathiazole may prevent the individual with valvular heart disease from developing a subacute bacterial endocarditis.