Quintessence International, 09/2022

Periodontal disease has been associated with various systemic diseases including kidney disease. However, a causal relationship is yet to be established. One possible association is that periodontitis may cause an increased inflammatory response in kidney disease patients which in turn destroys endothelial vasculature. This may contribute to development of risk factors of kidney disease such as diabetic neuropathy and cardiovascular events leading the progression and mortality in kidney disease patients. The role of periodontal inflammation driving kidney disease is still under investigation. This review article highlights the role of periodontal inflammation in the development and progression of kidney disease. It is crucial that dental practitioners and nephrologists understand the association between periodontal and kidney disease. Early periodontal screening and educating patients about the importance of good oral hygiene may play an important role in prevention of progression of kidney disease. Keywords: inflammation, kidney disease, periodontitis

Objectives: This study was conducted to elucidate the link of site-specific, tooth-related, and patient-associated factors with bleeding on pocket probing (BOPP) and the impact of scaling and root planing over these factors. Method and materials: This cross-sectional study comprised of 50 untreated periodontitis patients and 50 periodontitis patients who had received scaling and root planing in the last 6 to 12 months and were on supportive periodontal therapy. Multilevel modeling was applied to data, with BOPP being the dichotomous outcome variable. Variables that revealed a significant association with BOPP in multilevel modeling were analyzed further to find the influence of the treatment group (untreated periodontitis and treated periodontitis) on the association between predictor variables and BOPP. Results: Odds ratio (OR) for BOPP in untreated periodontitis versus treated periodontitis was 1.493, and in molars versus anterior teeth this was 1.439. Untreated periodontitis had an OR of 3.500 compared to treated periodontitis, in anterior teeth with Plaque Index 0. This was 2.795 and 7.734 in treated periodontitis and 5.106 and 12.762 in untreated periodontitis at Plaque Index 1 and 2, respectively. Bleeding on marginal probing had an OR of 6.984 for BOPP. Bleeding on marginal probing negative sites had higher OR in untreated periodontitis irrespective of the probing pocket depth. Conclusion: Plaque control is more effective in controlling periodontal inflammation after scaling and root planing. The probability of BOPP in the absence of bleeding on marginal probing is higher in untreated patients. The scope of influence of marginal inflammation on periodontal inflammation in shallow pockets is more in untreated periodontitis as compared to treated periodontitis; however, the trend reverses in deep pockets. Keywords: inflammation, molars, odds ratio, periodontitis, root planing

Objectives: Doxycycline hyclate is a controlled-release doxycycline polymer which can locally be applied. This study aimed to assess the effects of the prophylactic application of doxycycline hyclate at the implant–abutment interface on the short-term outcomes of implant therapy. Method and materials: The present split-mouth randomized clinical trial included 20 subjects who received two mandibular implants bilaterally (40 implants in total). In the test side (n = 20), doxycycline hyclate was injected at the implant–abutment interface at the time of delivery of final prosthesis. No intervention was performed for the control side (n = 20). The marginal bone level on mesial and distal implant surfaces, bleeding on probing, pocket probing depth, and incidence of peri-implant mucositis were recorded at baseline and after 3, 6, and 12 months. Results: Significant differences were found between the test and control sites, all favoring the test group, for marginal bone level changes at mesial and distal implant surfaces as well as for changes in pocket probing depth after 6 and 12 months. Furthermore, the numbers of implants with bleeding on probing and risk of developing peri-implant mucositis were significantly greater in the control group compared to the test group at 3-months, 6-months, and 12-months following baseline. Conclusions: Within the limitations of this study, it can be concluded that prophylactic application of doxycycline hyclate at the implant–abutment interface results in reduced crestal bone resorption and pocket probing depth levels. In addition, it reduces the risk of developing peri-implant mucositis. Keywords: dental implants, doxycycline, peri-implantitis, peri-implant mucositis, randomized controlled trials, treatment outcome

Objectives: To evaluate the effect of kinesiology tape application after mandibular third molar extraction. Method and materials: Patients with mandibular third molar extraction indications were divided into three groups. The patients in group 1 had kinesiology tape applied after tooth extraction, the patients in group 2 were given an ice pack and intermittent cryotherapy within 24 h of the operation, and the patients in group 3 were not given any additional intervention. All patients were followed up, and the postoperative swelling, pain, mouth opening limitation, and quality of life were recorded and evaluated. Comments on the intervention methods from patients were also collected. Results: Compared to group 3, groups 1 and 2 showed a significant reduction in postoperative swelling, pain, and limitation of mouth opening, and improvement of quality of life. There was no significant difference between groups 1 and 2 in each index, but the patients in group 1 reported fewer problems than those in group 2. Conclusions: The application of kinesiology tape was helpful in reducing the postoperative inflammatory symptoms of mandibular third molar extraction and improved the patients’ postoperative quality of life. These results suggest that kinesiology tape can be used as an auxiliary treatment to cryotherapy or as an alternative intervention after mandibular third molar extraction. Keywords: cryotherapy, inflammatory symptoms, kinesiology tape, mandibular third molar, quality of life

Two nasal foreign bodies were discovered by a dental practitioner on a routine radiographic examination of a 15-year-old autistic patient. Going over past radiographs, one of the nasal foreign bodies was detected in a radiograph performed 2 years previously. No nasal complaints or other clues to the problem were apparent. The patient was referred to the emergency room, and the foreign bodies were removed by an Ear Nose and Throat specialist, under general anesthesia. This paper reviews the diagnosis and treatment of nasal foreign bodies, and highlights the important role of the dental practitioner in the proper detection and diagnosis, prompt referral for management, and reduction in related complications. Keywords: accidental finding, case-report/series, foreign body, nasal discharge, radiography, radiology

Objective: To evaluate the effects of zinc oxide–eugenol, calcium hydroxide, and mineral trioxide aggregate as base materials on the clinical and radiographic success of ferric sulfate pulpotomies in primary molars. Method and materials: Following hemostasis with 15.5% ferric sulfate, 105 teeth were randomly allocated to three groups: Group 1, zinc oxide–eugenol; Group 2, calcium hydroxide; and Group 3, mineral trioxide aggregate. All teeth were restored with stainless-steel crowns. Clinical and radiographic examinations were conducted at 6, 12, 18, and 24 months. Results: After 24 months, clinical success rates for Groups 1 to 3 were 97.1% (34/35 teeth), 94.2% (33/35 teeth), and 97.1% (34/35 teeth), respectively (P > .05). Radiographic success rates were 65.7% (23/35 teeth), 65.7% (23/35 teeth), and 77.1% (27/35 teeth), respectively (P > .05). Internal resorption was the most observed radiographic finding (15/105 teeth). Conclusions: The choice of zinc oxide–eugenol, calcium hydroxide, and mineral trioxide aggregate, as base materials, did not affect the clinical and radiographic success of ferric sulfate pulpotomies in primary teeth. Keywords: calcium hydroxide, ferric sulfate, mineral trioxide aggregate, primary teeth, pulpotomy, stainless steel crown, zinc oxide–eugenol

This paper is based on lean principles and how they can apply to dental offices for general dental practitioners and specialists. In addition, this paper highlights how to identify and eliminate waste. This information provides value to the process in a dental office, establishing a platform and roadmap for lean thinking and how these principles can be utilized further in health care for reliable, efficient, and sustainable clinical outcomes. Keywords: kaizen, lean, practice management

Objective: Dental anxiety (DA) is a frequent and widespread phenomenon worldwide. There are few studies that have discussed the preoperative intervention of dental anxiety. The aim of this study was to explore the clinical efficacy of an online intervention to improve understanding and reduce dental anxiety in patients with transcrestal sinus floor elevation (TSFE) and to explore the correlation between patients’ understanding and dental anxiety, pain perception, and satisfaction. Method and materials: This prospective randomized controlled trial enrolled patients who underwent TSFE and simultaneous implant placement. Patients were randomly allocated to the preoperative online intervention group (test group) and the non-online intervention group (control group). Two patient interview topic guide questionnaires were utilized to assess the extent and source of patients’ understanding of the treatment process after a consultation at the hospital (T1) and prior to the surgery (T2). The preoperative dental anxiety was also assessed using the modified Corah dental anxiety scale (MDAS) at T1 and T2. All patients used the visual analog scale to describe their pain perception and satisfaction with the treatment process immediately after surgery (T3). A correlation analysis was performed to analyze the interrelationship between patient understanding, dental anxiety, pain perception, and satisfaction. Results: At T1, both groups were homogenous in their knowledge of the TSFE procedure and preoperative dental anxiety. At T2, the test group showed a better understanding of the TSFE procedure and lower preoperative dental anxiety than that of T1 and the control group at T2. Pain perception was significantly lower in the test group than in the control group at T3. Patients in the test group expressed significantly greater satisfaction with the treatment process than the control test group. There was a negative correlation between patients’ understanding and preoperative dental anxiety. A positive correlation between preoperative dental anxiety and pain perception was found with a significant difference. Patients’ satisfaction was positively correlated with understanding and negatively correlated with pain perception. Conclusions: Preoperative online intervention effectively increased patients’ understanding of the treatment process. This resulted in decreased preoperative dental anxiety, decreased pain perception, and greater postoperative satisfaction from patients who underwent TSFE. Clinical relevance: Online medical care can be considered as an auxiliary tool to improve the effect of implant surgery. Keywords: dental anxiety, follow-up, implant, internet-based intervention, sinus floor augmentation

Objective: Chlorhexidine is the gold standard for chemical biofilm control in dentistry. As with all therapeutic agents, side effects should be considered, which may include allergic reactions. The present review focused on the allergy-causing potential of dental CHX mouthrinses. Method and materials: Four databases were searched for systematic reviews related to chlorhexidine and dentistry (MEDLINE, Embase, Web of Science, and Scopus). Original papers available in the identified studies and meta-analyses were individually screened for allergy by both authors. Results: An initial 804 studies were identified, of which 46 systematic reviews and the original papers described therein were ultimately analyzed. Only two reviews explicitly addressed the topic of allergy. In a total of 194 original studies and a total of 9,698 patients, no allergies were reported. In 44 control studies, the topic was touched upon, but only in connection with the inclusion and exclusion criteria and possible contraindications. Conclusions: The topic of “allergy” regarding chlorhexidine application as a mouth rinse in dentistry seems to be omnipresent. Nevertheless, true allergies to chlorhexidine in dentistry appear to be low to nonexistent. Precautions, however, should still be taken in practice and further studies should be envisaged, especially in patients with an alleged history of chlorhexidine contact allergy. (Quintessence Int 2022;53:808–814; doi: 10.3290/j.qi.b2841913 based on an original publication (in German) in Parodontologie 2022;33(1):59–69) Keywords: allergy, chlorhexidine, mouthrinse, review