Faculty Bibliography

The dental management of a liver transplant patient requires ar awareness of the problems associated with controlling infection bleeding and pain. Consultation with the patient's physician is most important. Laboratory tests to determine liver function, complete blood count (CBC)-including white blood cells and platelets-and clotting ability (international normalized ratio (INR)) are a necessity. In the case report presented here, the dentist, in consultation with the patient's physician, outlines a dental management plan that includes the need for antibiotic prophylaxis and delineates the types of antibiotics, analgesics and local anesthetics that may be used.

DesignProspective nested case-control study.Case/control selectionFrom a cohort of 1423 Patents age 18 and older undergoing dental extractions at a public dental clinic in Chile examined at four days post-extraction. Eighty cases of alveolar osteitis were identified. Eighty matched controls were selected from the cohort at random.Data analysisEight predictor variables (risk factors), namely patient gender, hygiene, tooth location, previous surgical site infection, traumatic extraction, systemic diseases, alcohol consumption and tobacco use were considered. A binary regression logistic analysis was performed to determine significant associations.ResultsThe overall incidence of alveolar osteitis was 6.14%. Logistic regression analysis after adjustment showed a statistically significant association between three variables and the development of alveolar osteitis; previous surgical site infection (odds ratio [OR], 3.3; 95% CI, 1.4 to 7.7), traumatic extraction (OR, 13.1; 95% CI, 5.4 to 31.7) and smoking of tobacco after extraction (OR, 3.5; 95% CI, 1.3 to 9.0).ConclusionsPrevious surgical site infection, traumatic extraction and tobacco smoking are associated with an increased risk of alveolar osteitis.

BACKGROUND: The objectives of this randomized comparative effectiveness study conducted by members of the Practitioners Engaged in Applied Research and Learning (PEARL) Network were to determine whether using a resin-modified glass ionomer (RMGI) liner reduces postoperative hypersensitivity (POH) in dentin-bonded Class I and Class II resin-based composite (RBC) restorations, as well as to identify other factors (putative risk factors) associated with increased POH. METHODS: PEARL Network practitioner-investigators (P-Is) (n = 28) were trained to assess sensitivity determination, enamel and dentin caries activity rankings, evaluation for sleep bruxism, and materials and techniques used. The P-Is enrolled 341 participants who had hypersensitive posterior lesions. Participants were randomly assigned to receive an RBC restoration with or without an RMGI liner before P-Is applied a one-step, self-etching bonding agent. P-Is conducted sensitivity evaluations at baseline, at one and four weeks after treatment, and at all visits according to patient-reported outcomes. RESULTS: P-Is collected complete data regarding 347 restorations (339 participants) at baseline, with 341 (98 percent) (333 participants) recalled at four weeks. Treatment groups were balanced across baseline characteristics and measures. RBC restorations with or without an RMGI liner had the same one-week and four-week POH outcomes, as measured clinically (by means of cold or air stimulation) and according to patient-reported outcomes. CONCLUSIONS: Use of an RMGI liner did not reduce clinically measured or patient-reported POH in moderate-depth Class I and Class II restorations. Cold and air clinical stimulation findings were similar between groups. Practical Implications. The time, effort and expense involved in placing an RMGI liner in these moderate-depth RBC restorations may be unnecessary, as the representative liner used did not improve hypersensitivity outcomes.

BACKGROUND: The Practitioners Engaged in Applied Research and Learning (PEARL) Network conducted a three-armed randomized clinical study to determine the comparative effectiveness of three treatments for hypersensitive noncarious cervical lesions (NCCLs): use of a potassium nitrate dentifrice for treatment of hypersensitivity, placement of a resin-based composite restoration and placement of a sealant. METHODS: Seventeen trained practitioner-investigators (P-Is) in the PEARL Network enrolled participants (N = 304) with hypersensitive posterior NCCLs who met enrollment criteria. Participants were assigned to treatments randomly. Evaluations were conducted at baseline and at one, three and six months thereafter. Primary outcomes were the reduction or elimination of hypersensitivity as measured clinically and by means of patient-reported outcomes. RESULTS: Lesion depth and pretreatment sensitivity (mean, 5.3 on a 0- to 10-point scale) were balanced across treatments, as was sleep bruxism (present in 42.2 percent of participants). The six-month participant recall rate was 99 percent. Treatments significantly reduced mean sensitivity (P < .01), with the sealant and restoration groups displaying a significantly higher reduction (P < .01) than did the dentifrice group. The dentifrice group's mean (standard deviation) sensitivity at six months was 2.1 (2.1); those of the sealant and restoration groups were 1.0 (1.6) and 0.8 (1.4), respectively. Patient-reported sensitivity (to cold being most pronounced) paralleled clinical measurements at each evaluation. CONCLUSIONS: Sealing and restoration treatments were effective overall in reducing NCCL hypersensitivity. The potassium nitrate dentifrice reduced sensitivity with increasing effectiveness through six months but not to the degree offered by the other treatments. Practical Implications. Sealant or restoration placement is an effective method of immediately reducing NCCL sensitivity. Although a potassium nitrate dentifrice did reduce sensitivity slowly across six months, at no time was the reduction commensurate with that of sealants or restorations.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Antagonistic interactions between sodium hypochlorite, chlorhexidine, EDTA, and citric acid. Rossi-Fedele G, Dovgramaci EJ, Guastalli AR, Steier L, Figueiredo JA. J Endod 2012 Apr;38(4):426-31. REVIEWER: Analia Veitz-Keenan, DDS PURPOSE/QUESTION: To find evidence of the unwanted effects after the chemical combination between sodium hypochlorite, chlorhexidine, and the chelating agents EDTA and citric acid used in endodontic therapy SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Literature review LEVEL OF EVIDENCE: Level 3: Other evidence STRENGTH OF RECOMMENDATION GRADE: Grade C: Consensus, disease-oriented evidence, usual practice, expert opinion, or case series for studies of diagnosis, treatment, prevention, or screening.

DESIGN: Randomised controlled trial. INTERVENTION: Patients from hospital waiting lists who had been edentulous for at least two years and required replacement of conventional dentures were recruited. Baseline quality of life and satisfaction measures were taken and all patients were provided with new conventional complete dentures (CCDs) that they wore for three months, at which point they were reassessed using the same measures. Patients were then randomly assigned either to continue with CCDs (control) or to have implant-retained overdentures (IODs) made (test group). The control group was assessed after a further three months (six months after receiving CCDs). The test group was assessed three months after receiving IODs. OUTCOME MEASURE: The outcome measures used were the Oral Health Impact Profile-49 (OHIP-49) Denture Satisfaction Questionnaire (DSQ) and the Schedule for the Evaluation of Individual Quality of Life (SEIQoL). RESULTS: Three months after receiving CCDs patients reported significant improvements in satisfaction and quality of life (P < 0.05). However no further improvements were seen in the control group at six months for any measure. Following placement of IODs the test groups had significant additional improvements in the functional limitation, physical pain, psychological discomfort, physical disability, social disability, psychological disability and handicap scales of the OHIP and on 10 of the 11 scales of the Denture Satisfaction Questionnaire (P < 0.05, ANOVA). CONCLUSIONS: The findings show that, controlling for expectancy bias and variability in baseline levels, IODs significantly increase patient satisfaction, dental function and quality of life over and above those achieved with good quality CCDs.

DesignRandomised controlled trial.InterventionPatients with a validated history of at least three episodes of idiopathic recurrent aphthous stomatitis were randomised to either a once-daily multivitamin containing 100% of the U.S. reference daily intake (RDI) of essential vitamins or a placebo for at least one year.Outcome measureNumber of new RAS episodes, mouth pain, normalcy of diet and medication compliance.ResultsThere were no significant differences in mean number of new RAS episodes between the multivitamin (4.19 episodes) and placebo (4.60 episodes) groups. Mean duration of new episodes was similar for the two groups at 8.66 days for multivitamin group and 8.99 days for placebo(P = .60). There were no differences with other measures.ConclusionsDaily multivitamin supplementation, with the RDI of essential vitamins, did not result in a reduction in the number or duration of RAS episodes.

DESIGN: Randomised controlled trial (RCT). INTERVENTION: One hundred and sixty patients participating in a RCT in which they were randomised to multivitamins (n=81) or placebo (n=79) completed ulcer diaries and a weekly telephone survey by calling an automated interactive voice response (IVR) system. Stressful events were quantified using the validated Recent Life Changes Questionnaire (RLCQ) and were classified as mental or physical stressors. OUTCOME MEASURE: Onset and duration of RAS episodes RESULTS: Stressful life events were significantly associated with the onset of RAS episodes (P < 0.001), but not with the duration of the RAS episodes. Experiencing a stressful life event increased the odds of an RAS episode by almost three times (OR = 2.72; 95% CI = 2.04-3.62). When controlled for each other, mental stressors had a larger effect (OR = 3.46, 95% CI = 2.54- 4.72) than physical stressors (OR = 1.44; 95% CI = 1.04- 1.99) on the occurrence of RAS episodes. RAS episodes did not occur more frequently or last longer with increasing stress severity. CONCLUSIONS: In patients with a history of RAS, stressful events may mediate changes involved in the initiation of new RAS episodes. Mental stressors are more strongly associated with RAS episodes than physical stressors.

The dental management of a liver transplant patient requires an awareness of the problems associated with controlling infection, bleeding and pain. Consultation with the patient's physician is most important. Laboratory tests to determine liver function, complete blood count (CBC)-including white blood cells and platelets-and clotting ability (international normalized ratio [INR]) are a necessity. In the case report presented here, the dentist, in consultation with the patient's physician, outlines a dental management plan that includes the need for antibiotic prophylaxis and delineates the types of antibiotics, analgesics and local anesthetics that may be used.