Dental India
News/Discussions in the web on Periodontics
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1. The importance of dry mouth as an etiologic agent in caries and periodontal disease.
2. Future uses of the tetracycline family of drugs
3. Artridox and Playdough
4. Infections linked to clogged arteries
5. Laboratory-fabricated, acrylic resin cylinders for fixed,
provisional implant restorations
6. Salivary Histatin 5 Is an Inhibitor of Both Host and Bacterial Enzymes
Implicated in Periodontal Disease - Infection and Immunity
7. Jones on Dental Technology: Technology versus the dental laboratory
8 Ohio Citizen Action wants beryllium banned in dentistry
9 Health effects of modified tobacco products uncertain; greater scrutiny needed
10 Infectious disease a concern in coming century
1. The importance of dry mouth as an etiologic agent in caries and
periodontal disease.
While cleaning out my old mail I came across this important piece of literature
which Shirley Gutkowski posted for us way back in March last year.
I thought it would be worth posting again because it points out the importance of
dry mouth as an etiologic agent in caries and periodontal disease.
Add what we know about the large amounts of immunoglobulinA in the saliva
(keeps bacterium from adhering), and it reminds one how important it is to note
this in out patients so we can take steps to counter the problem. Obviously,
the saliva substitutes that are promoted are fine for alleviating the
discomfort of xerostomia, but don't have the therapeutic potential of real saliva.
(I'm not sure, but I imagine the fluoride lozenges that Shirley knows more about,
tend to promote salivation and would be better than sugary mints for that purpose)
Review of the main causes of dry mouth problem:
1. Medications (many,, many) including virtually all anti-depressants
2. Recreational drugs
3. Surgery and radiation therapy
4. Systemic diseases
File this with information useful for knowing what's important for
total patient management, in my opinion.
Dr. Larry
Subject: [RDH] Abstract: Remineralization and Saliva
How it works
: Dent Clin North Am 1999 Oct;43(4):579-97 Related Articles, Books
Saliva and dental caries. Dowd FJ
Department of Pharmacology, Creighton, University School of Medicine, Omaha,
Nebraska, USA. fdowd@creighton.edu
A study of saliva and its tooth-protective components reveals at least four
important functions of saliva: (1) buffering ability, (2) a cleansing effect,
(3) antibacterial action, and (4) maintenance of a saliva supersaturated in
calcium phosphate. Several salivary constituents subserve one or more of
these functions. Research has yielded important information about organic and
inorganic secretory products. It is also clear that saliva as a unique
biologic fluid has to be considered in its entirety to account fully for its
effects on teeth. Saliva is greater then the sum of its parts. One reason for
this is that salivary components display redundancy of function, each often
having more than one function. This redundancy, however, does not imply that
proteins that share functional roles all contribute to the same degree. For
instance, when comparing proteins that inhibit calcium phosphate
precipitation, statherin and acidic proline-rich proteins are most potent,
whereas histatins, cystatins, and mucins appear to play lesser roles. The
complex interaction between proteins is another major factor contributing to
saliva's function. In this regard, heterotypic complexes of various proteins
have been shown to form on hydroxyapatite. Mucin binding to other salivary
proteins, including proline-rich proteins, histatins, cystatins, and
statherin, is well documented. The complexes, whether adsorbed to the tooth
surface or in saliva, have important implications for bacterial clearance,
selective bacterial aggregation on the tooth surface, and control of
mineralization and demineralization. Finally, proteolytic activity of saliva
generates numerous products whose biologic activities are often different
from their parent compounds. Fluoride is another important component of
saliva that is discussed separately in other articles in this issue. The
ability of saliva to deliver fluoride to the tooth surface constantly makes
salivary fluoride an important player in caries protection largely by
promoting remineralization and reducing demineralization. Some key properties
of salivary components discussed in this article are listed in Table 1.
Saliva is well adapted to protection against dental caries. Saliva's
buffering capability; the ability of the saliva to wash the tooth surface, to
clear bacteria, and to control demineralization and mineralization; saliva's
antibacterial activities; and perhaps other mechanisms all contribute to its
essential role in the health of teeth. The fact that the protective function
of saliva can be overwhelmed by bacterial action indicates the importance of
prevention and therapy as in other infectious diseases. The knowledge of
functional properties of saliva as well as those of its separate components
may permit a better assessment of dental caries susceptibility. Future
research is essential to characterize more fully salivary components and
their interactions and how these affect the caries process. With such
knowledge, the use of modified oral molecules as therapeutic agents may
become a reality. Equally intriguing is the prospect of influencing the
secretion of salivary components by greater knowledge and control over the
secretory processes responsible for the delivery of those components.
2. Future uses of the tetracycline family of drugs
Check out this amazing story about future uses of the
tetracycline family of drugs. To think just a few years ago we
were all excited about tetracycline fibers. We are going to be
seeing many scientific advances in our lifetime!
Pat Buss RDH
New uses for an old drug: Rebirth of the tetracyclines To read the
entire news article, visit
http://www.e-dental.com/read/sp20010222/397559
3. Artridox and Playdough
Laurie:
Hi Mira,
Dr. Larry is correct, the deeper the pocket, the more retention you get with
the Atridox. You would not use in pockets less than 5 mm. One frustrating
point with using Atridox is if you have a patient that bleeds easily. The
Atridox gets sticky and gummy. We generally did placement within a month
after a maintenance visit hoping to reduce bleeding enough to avoid this
situation. If we felt that the patient would still bleed alot after a month,
we would schedule the Atridox appointment with LA. Otherwise we performed the
procedure without local.
Larry replies:
You can use cycroanalate glue (spelling?) just like the glue used to hold down
the tetracycline fibers in the past. I don't blame you for wanting to avoid
the perio pak. Many or probably most periodontists now avoid that perio pak as
often as possible after surgical procedures also.
You don't have to use perio dressing with Atridox. I just went to a meeting on
it 2 weeks ago. The rep stated that as long as you get a good 3 days of meds
in the pocket you are covered because it releases so well and that no dressing
or "glue" was needed. We use it in our office and the only real problem is not
pulling it out of the pocket with the syringe. You also DO NOT have to pack it
into the pocket with any instrument either. Just mix well and inject into the
site but remember to back the syringe tip out as you inject.
Lisa from NY writes
I have found that if you pack the stuff into the pocket, you don't need the
cyanoacrylate (crazy glue) or the perio pack.
It just stays put if the pt. does not floss, etc., in that area for 10 days.
Pontic replies
Artridox(spelling) can easly be handled with a piece of celluloid
strip placed on the syringe tip and inject to your haerts content.
THen when you remove the tip place the prongs of a pair of cotton
pliers between of the barrell of the tip and pull the tip out. the
artridox stays in place the celluloid piece falls off in about ten
seconds. - Pontic
Laurie writes
I used Atridox in an office I worked for previously and we did not place any
type of dressing over the area. Most of the antibiotic dissolves between 3-4
days. I generally tell patients not to use any type of interdental aid for at
least 7days and to avoid eating any type of foods that may possibly get stuck
where the Atridox was placed. The only time I had any problems with the
Atridox falling out was if I overpacked the area. Learning curve. More isn't
always better. We liked the results we got with the product. I hope you give
it a try.
Mira writes
Atridox has recently arrived in Canada. Still quibbling with the
Dental Association as to whether we DH's can even use it. (Don't
that just make ya spittin' mad! Another case for self-reguation
ASAP.) But they haven't officially said that we *can't".
Anyway, I watched the video. It seemed to me that the more root
morphology there was and the deeper the pocket...the more chance of
good retention for 3-4 days.
If anyone has any practical tips it would be much appreciated. I was
only given a chance at one squirt into a typodont so I am going to
have to troubleshoot on the fly.
We don't have perio chips in Canada either. We got a bootlegged box
of them once and I threw them into some 7 - 10mm pockets and got 2-
3mm improvement on this patient. I was shocked. Any comments on
perio chips?
Larry replies
Hi all you Atridox users,
Exactly, retention depends on pkt depth, morphology of pocket etc.
It's especially nice in furcations. Great bactericidal effect in an area that is
difficult access for debridement and tends to haror bacteria. And that is where
retention is best when the substance goes into and through a furcation.
Larry
PS IF they don't let you place it in Canada, they are just harming the patient.
How could they justify the restriction?
Sent: Thursday, February 22, 2001 10:46 PM
Subject: [Periodontal] Atridox and Playdough
Shirley Gutkowski writes
Well, I had an eye opening experience last night. I finally got to
see a video on Atridox application and guess what I saw at the end.
A huge blob of periodontal dressing. I graduated in 1986 with my
first DH degree and I have NEVER seen a dressing, nor have I handeled
a dressing, nor do I ever, ever want to tell a patient that I'm going
to put one on. I don't even know how to mix it, I don't know
anything at all about it. So, Atridox is off my list. Anyone else?
I'm going to wait for that Arestin, I've waited this long for an
alternative to Perio Chip, I can wait a little longer.
Janet writes:
We don't use periodontal dressing when we use Atridox.
February 28, 2001
4. Infections linked to clogged arteries - ADA News
Common, chronic bacterial infections, including lung and urinary tract infections,
as well as gum disease, may increase the risk of atherosclerosis, a build-up of
fatty plaques in the arteries that could lead to heart attack, study findings suggest...
http://www.ada.org
February 22, 2001
5. Laboratory-fabricated, acrylic resin cylinders for fixed, provisional implant
restorations - Journal of Prosthodontics
Commercially produced provisional cylinders are commonly used during fabrication of fixed,
provisional implant restorations. A procedure is presented for the fabrication of fixed,
provisional implant restorations using laboratory-fabricated, autopolymerizing acrylic
resin cylinders. These cylinders offer a number of advantages over commercially
produced cylinders and may reduce the treatment cost of implant prosthodontics.
http://www.jprosthodontics.org
February 20, 2001
6. Salivary Histatin 5 Is an Inhibitor of Both Host and Bacterial Enzymes Implicated
in Periodontal Disease - Infection and Immunity
One of the salient features of periodontitis and gingivitis is the increase in the levels
of bacterial and host-derived proteolytic enzymes in oral inflammatory exudates...
http://iai.asm.org
7 Jones on Dental Technology: Technology versus the dental laboratory
In recent years, technological advances in dental products, especially in Computer
Automated Design/Computer Automated Manufacturing (CAD/CAM) systems, have allowed
dentists to create single tooth restorations in their own practices.
Now some dentists are predicting that this new technology will greatly lessen
their need for dental laboratories. For more, visit here...
http://www.e-dental.com
8 Ohio Citizen Action wants beryllium banned in dentistry
Ohio Citizen Action recently released a report showing dental lab employees are working
with a deadly metal and likely have little knowledge of its toxicity. The group says that
some dental laboratory suppliers are withholding life-saving information from the workers
handling beryllium. For more, visit here...
http://www.e-dental.com
9 Health effects of modified tobacco products uncertain; greater scrutiny needed
Pharmaceutical and modified tobacco products designed to reduce the health risks of
smoking cannot yet be proved to reduce tobacco-related disease, says a new report
from the Institute of Medicine. Products developed to lessen the risk of disease by
reducing exposure to toxic chemicals are scientifically feasible, but in the absence
of rigorous research, no one knows if these products decrease the incidence of
tobacco-related disease or actually increase it by encouraging smoking.
For more, visit here...
http://www.e-dental.com
10 Infectious disease a concern in coming century: NIAID director - ADA News
Infectious disease is the second leading cause of death worldwide and will become a
major focus for health policy makers and world leaders in the 21st century, according
to the director of the National Institute of Allergy and Infectious Diseases
http://www.ada.org
