Higher concentration dental local anaesthetics (3% and 4%) have become more available in Australia in recent years. Benefits claimed include a faster onset of anaesthesia and improved success with injections compared to 2% solutions. Recent reports suggest that the higher concentration carries a greater risk of prolonged anaesthesia to the mandibular and particularly the lingual nerves. The literature was reviewed and those studies which demonstrated adverse effects of different concentrations of local anaesthetics were analysed. Recent cases are presented. There is an extensive international literature which confirms increased concentration of local anaesthetic does show an increased risk, by about ×6, of prolonged anaesthesia. Five case reports illustrate the impact of this complication on patients’ quality of life. Careful consideration needs to be given before using higher concentration local anaesthetic agents for mandibular and lingual blocks as lower concentration local anaesthetics are safer. If acceptable to individual patients, avoidance of block injections or any local anaesthetic for minor restorative tasks could be encouraged given the severity of the complication. It is safe to use the higher concentration agents for infiltrations away from major nerves.
Background: Previous studies have demonstrated variable effects on systemic inflammatory and immune responses following improved periodontal health. This study examined changes in serum levels of the inflammatory mediators IL-1β, IL-6, TNF-α and sICAM-1, and antibodies to Porphyromonas gingivalis, human heat shock protein (hHSP) 60 and P. gingivalis GroEL following improvement in periodontal health in high cardiovascular (CV) risk and low CV-risk patients.
Methods: Patients retrospectively selected from a longitudinal study, had undergone yearly periodontal examinations and peripheral blood collections. They had demonstrated a quantifiable improvement in periodontal health (>60% reduction in number of sites with probing depth ≥4 mm from the baseline visit) and could be classified as either high CV-risk (≥6 classical risk factors, n = 13) or low CV-risk (≤1 classical risk factor, n = 14). Serum levels of the cytokines and antibodies were measured using ELISA.
Results: For sICAM-1 and anti-P. gingivalis GroEL and anti-hHSP60 antibodies, most patients recorded decreased levels. Reductions in serum sICAM-1 levels were more notable in low CV-risk patients (p = 0.006); and reductions in levels of anti-P. gingivalis GroEL and anti-hHSP60 antibodies (p = 0.001 and 0.009 respectively) were more notable in high CV-risk patients.
Conclusions: This study found that subsequent to improved periodontal health, the anti-HSP (HSP60 and GroEL) antibody response was reduced, particularly for high CV-risk patients. sICAM-1 levels were also lowered, more so for low CV-risk patients.
Background: The aim of this study was to compare dental hospital admissions in a total state birth population of Indigenous and non-Indigenous children aged under five years in Western Australia.
Methods: Midwives’ notification data were linked to databases of deaths, admissions, birth defects and intellectual disability. Births during 1980–1995 were followed until five years of age (n = 383 665). Dental admissions were classified by ICD-9 principal diagnosis categories.
Results: There were 738 dental admissions for 665 children aged up to five years of Indigenous mothers (n = 20 921). Indigenous children comprised 6.3% of all children having a dental admission in this age group; 3.2% of children with Indigenous mothers had a dental admission compared with 2.7% of non-Indigenous children. Overall, 8.7% (n = 58) of Indigenous children with a dental admission had a birth defect and 5.5% (n = 23) had an intellectual disability (compared to 8.8% and 3.2%). Indigenous children were four times more likely to be diagnosed with oral soft tissue diseases than non-Indigenous children, and less likely to be categorized as having diseases of the dental hard tissues. Indigenous children were more likely to have a longer dental admission.
Conclusions: These analyses provide important findings regarding hospital admissions for Indigenous children. Admissions for disorders of the soft tissues are more common in Indigenous children.
Background: Platelet-rich fibrin (PRF) by Choukroun’s technique is derived from an autogenous preparation of concentrated platelets. Little is known about the effects of PRF on periodontal ligament fibroblasts (PDLFs) and the application of PRF for periodontal regeneration.
Methods: PDLFs were derived from healthy individuals undergoing extraction for orthodontic reasons. Blood collection was carried out from healthy volunteers. PRF was obtained from a table centrifuge centrifuged at 3000 rpm for 12 minutes. The effects of PRF on PDLFs were determined by measuring the expression of phosphorylated extracellular signal-regulated protein kinase (p-ERK), osteoprotegerin (OPG) and alkaline phosphatase (ALP) activity. Moreover, we retrospectively examined the feasibility and safety of reconstructing the periodontal infrabony defects with PRF in six patients.
Results: PRF was found to increase ERK phosphorylation and OPG in PDLFs in a time-dependent manner (p < 0.05). ALP activity was also significantly upregulated by PRF (p < 0.05). Application of PRF in infrabony defects exhibited pocket reduction and clinical attachment gain after six months. Periapical radiography revealed radiographic defect filled in grafted teeth.
Conclusions: The enhancement of p-ERK, OPG and ALP expression by PRF may provide benefits for periodontal regeneration. Clinical and radiologic analysis showed that the use of PRF is an effective modality for periodontal infrabony defects.
Background: Dentine hypersensitivity occurs easily on exposed dentine. This study aimed to evaluate the effectiveness of a novel bioactive glass-containing toothpaste on dentine permeability and remineralization.
Methods: Thirty dentine discs were divided into three groups of 10 specimens each. The groups corresponded to the following brushing treatments: no brush, distilled water, and bioactive glass-containing toothpaste (Novamin). The toothpaste was applied twice a day for 7 days. Dentine permeability was measured after ethylene-diamine-tetraacetic acid (EDTA) etching, initial application, 3-day application, 7-day application and citric acid challenge, respectively. The dentine morphology was investigated using scanning electron microscopy (SEM). Attenuated total reflection Fourier transform infrared (ATR/FTIR) spectroscopy was performed to monitor the mineral variation on demineralized dentine. Qualitative information of elemental variation before and after treatments on completely demineralized dentine was detected by energy dispersive X-ray (EDX) analysis.
Results: The bioactive glass-containing toothpaste significantly reduced dentine permeability after the 7-day treatment and showed, under SEM, excellent resistance to acid challenge compared to the other groups. ATR/FTIR and EDX revealed increased mineral content after treatment with Novamin.
Conclusions: As the innovative bioactive glass-containing toothpaste occlude dentinal tubules and resist acid challenge, it may be useful for the treatment of dentine hypersensitivity and dentine remineralization.
Background: The purpose of this study was to estimate the prevalence of different genotypes of human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) in peri-implantitis and mucositis sites, and to evaluate the correlation between herpesvirus presence and clinical parameters.
Methods: A total of 80 dental implants (mean time of loading, 4.16 ± 1.8 years) were evaluated during the course of the study (30 peri-implantitis, 25 mucositis and 25 healthy peri-implant sites). The following clinical parameters were assessed: visible plaque index, bleeding on probing, suppuration and probing depth. A polymerase chain reaction (PCR) assay was used to identify the presence of different HCMV and EBV genotypes in peri-implant tissue plaque samples.
Results: HCMV-2 was detected in 53.3% and EBV-1 in 46.6% of the 30 peri-implantitis sites evaluated. By contrast, HCMV-2 was not detected in healthy periodontal sites and EBV-1 was detected in one healthy site. A statistically significant correlation was found between the presence of HCMV-2 and EBV-1 genotypes and clinical parameters of peri-implantitis.
Conclusions: The results from the present study confirmed the high prevalence of HCMV-2 and EBV-1 in the peri-implant tissue plaque of peri-implantitis sites and suggests a possible active pathogenic role of the viruses in peri-implantitis.
Background: Government subsidized dental care is provided as a community safety-net to complement the private dental sector. The aim of this study was to detail the geographic catchment characteristics of three outer metropolitan government dental clinics.
Methods: Three outer metropolitan dental clinics with the greatest number of geocoded triage patients were selected for the study. In total these three facilities had 5742 patients over the 12-week period with 2010 at clinic A, 1278 at clinic B and 2454 at clinic C. Cumulative proportions of patients’ residential address locations at distances were calculated; there was close correlation between the three clinics. A best fit curve with a correlation coefficient of 0.998 was developed.
Results: In summary, approximately 50% of patients were within 6 km of the clinic and 75% were within 10 km.
Conclusions: This study has critical outcomes for the planning of future services in developing a network model for care. The data presented will assist in the development of more evidence-based approaches to planning new service network structures.
Background: The aim of this study was to evaluate enamel remineralization and the acquisition of acid resistance by using sugar-free chewing gum containing fluoride extracted from green tea.
Methods: Forty-five volunteers participated in a crossover, double-blind study and wore intraoral appliances with human demineralized enamel. Subjects chewed fluoride chewing gum (FCG: 50 μg fluoride) or placebo gum. Remineralization and acid resistance were evaluated using the mineral change value (ΔZ, in vol%·μm). Fluoride concentrations in saliva and remineralized enamel were analysed.
Results: The peak salivary fluoride concentration was 3.93 ± 1.28 ppm (mean ± SD). The elevated salivary fluoride concentration resulted in a higher fluoride concentration of 656 ± 95 ppm in the remineralized region versus 159 ± 26 ppm for placebo gum (p < 0.001). After remineralization, the ΔZ of the FCG group was higher than that of the placebo gum group. After an acid challenge, ΔZ of the FCG group was lower than the placebo gum group. Both ΔZ were statistically significant.
Conclusions: FCG produced a superior level of remineralization and acid resistance, as compared to the placebo gum. The in situ results suggest that regular use of FCG is useful for preventing dental caries.
Background: The use of all-in-one resin-based adhesives in clinical practice has continued to increase. The aim of this study was to evaluate retention and marginal staining of a HEMA-free all-in-one adhesive Go! (SDI, Australia) and Ice resin composite in non-carious cervical lesions (NCCLs).
Methods: Forty-one restorations were placed in 13 patients (age range 44–72 years). Human Ethics Committee approval from the University of Melbourne and Dental Health Services Victoria was obtained. Restorations were bonded and placed according to the manufacturer’s instructions. Enamel etching was performed on NCCL margins after cleaning with pumice and water. Patients were recalled at six months and one, two and three years. Restorations were evaluated for retention and marginal staining, and photographic records of restorations were obtained.
Results: At three years, six patients were available for recall with 23 restoration sites reviewed. At the six-month recall, three restorations had been lost, with a further two lost at two years. At three years, an overall cumulative retention rate of 85% was calculated using survival analysis. Fifteen of the 23 restorations showed slight marginal staining.
Conclusions: At three years, the overall retention rate of 85% indicates a satisfactory result for this new adhesive. Marginal staining was regarded as minimal.
Background: This study aimed to review the survival of bone grafting procedures, performed by surgical trainees and assess factors affecting survival of these bone grafts as an adjunct to implant rehabilitation.
Methods: Data were collected from patients between 2003 and 2009 receiving bone grafting. Graft failure was defined as any complete or partial graft loss, graft which had to be removed or regrafted, or was unable to have an implant placed. Implant survival rates were not assessed in this study.
Results: Seventy-five patients received 86 bone grafts over a period of 7 years. Overall graft survival was 87.3% with 7 complete graft failures (8.1%) and 3 partial graft failures (4.6%). All failed grafts were of the block graft type, predominately in the anterior maxilla. The main reason for failure was secondary infection. Other complications occurred in about 27% of patients. Factors significantly increasing the risk of graft failure included use of bone block augmentation (p = 0.001), mixed autogenous/bone substitute grafts (p = 0.007) and diabetes mellitus (p = 0.006). Smoking was not found to affect graft survival.
Conclusions: Good results were found in a series of patients treated in an oral and maxillofacial training programme. Care should be taken in regards to planning block grafts in diabetic patients.
Background: Previous studies regarding general anaesthesia related morbidity and mortality rates for dental surgery have taken the form of a retrospective survey. The Australian and New Zealand College of Anaesthetists also do not record morbidity and mortality for dental/oral and maxillofacial procedures. The aim of this study was to document the clinical incidents requiring transfer to another hospital and mortality.
Methods: Records from patients transferred to another hospital after having treatment under general anaesthesia performed at the Royal Dental Hospital of Melbourne between 1 January 2005 and 31 December 2009 were prospectively reviewed.
Results: There were 17 557 general anaesthesia procedures performed during the review period, including paediatric, special needs and minor oral and maxillofacial surgery procedures. The incidence of morbidity requiring transfer to a hospital with overnight stay facilities was 0.13%. There were no cases of mortality recorded. The most common complication was low oxygen saturation.
Conclusions: The low incidence of morbidity seen is most likely attributed to the safety of modern anaesthesia and appropriate patient selection. Dentists and dental specialists performing general anaesthesia procedures should be aware of the complications that arise so that informed consent can be obtained. This study also provides a benchmark for general anaesthesia morbidity/mortality for dental procedures.
Background: Treatment planning for dental implants involves the assessment of patient-related risk factors prior to formulation of a treatment plan. The aim of this review was to assess relevant literature and provide evidence-based information on the successful surgical placement of dental implants.
Methods: An electronic search of Medline, PubMed and the Cochrane Databases of Systematic Reviews was undertaken using a combination of MeSH terms and keywords. A handsearch was also performed and cross-referenced with articles cited in papers selected. The primary study parameter was implant failure.
Results: Forty-three studies were selected based on specific inclusion criteria. Many studies contain confounding variables, numbers in subcategories are often too small for meaningful statistical analysis, and follow-up times vary and are often short-term.
Conclusions: There are many risk factors which the clinician is required to know and understand to advise patients, and consider in planning and treatment provision. Consistent evidence exists to show an increased failure rate with smokers, a history of radiotherapy and local bone quality and quantity. Weaker evidence exists to show a higher incidence of peri-implant disease in patients with a history of periodontitis-related tooth loss. Lack of evidence precludes definitive guidelines for patients with autoimmune disorders where expert opinion recommends caution. Osteoporotic patients show acceptable survival rates; however patients on oral bisphosphonates show a small incidence but high morbidity from osteonecrosis of the jaw. Emerging evidence suggests that there is a correlation between genetic traits and disruption of osseointegration.
Background: Juvenile paradental cysts typically occur on the buccal aspect of mandibular first and second molars in children aged 6 to 11 years. The cysts may be treated by enucleation, with or without extraction of the involved teeth, or by marsupialization. This report demonstrates the success of a conservative surgical technique (marsupialization) and good outcomes in five juvenile paradental cyst cases.
Methods: Five patients (two males, three females) with a mean age of 8.4 years, complaining of mandibular buccal swelling around the molars, underwent marsupialization of radiolucent lesions involving partially or fully erupted permanent first molars. Clinical, radiographic and histological characteristics led to diagnoses of juvenile paradental cysts.
Results: The surgical procedures were simple to perform and resulted in complete remission of the lesions with no complications. The mean follow-up time was 2.8 years. No recurrences were observed, the related teeth developed normally, and complete periodontal healing was achieved.
Conclusions: The surgical marsupialization of juvenile paradental cysts achieved good outcomes without compromising the development of related teeth, and thus may be considered an appropriate treatment for paediatric patients.
Langerhans’ cell histiocytosis (LCH) is a rare disease where different organs and systems may be affected. Oral involvement generally consists of mucosal ulceration associated with lesions of the underlying bone. Many reports exist about the misdiagnosis of this disease. Various symptoms may lead the clinician to an incorrect diagnosis, especially with multiple organ involvement. Oral manifestations are common, and dentists should be aware of this disease and evaluate intraoral findings accordingly. This study presents an LCH case characterized by oral mucosal ulcerations with no involvement of the underlying bone. A definitive diagnosis was made by open biopsy from the oral mucosa.