preventing peroxide bleach-induced pulpitis pain during tooth whitening; preventing composite and amalgam pain when used with a cavity liner; combining with a provisional cement for use in temporary crowns; and combining with polycarboxylate cement for direct and indirect pulp capping procedures to help heal pulps and prevent pulpal abscesses. Direct pulpal anesthesia is a further application. Pulpal nerves are directly impacted by anesthetic gels containing high concentrations of potassium ions. These inhibit the nerve conduction of painful stimuli in teeth by bathing the outer membranes of the pulpal nerves and depolarizing them. Only when the potassium ions dissipate can nerve conduction resume. A gel used for direct pulpal anesthesia is noninvasive and requires no needle injections of local anesthetics. The effectiveness of this gel was investigated for use during maintenance dental treatments. Methods.—The gel contains 35% KNO3, 20% benzocaine, and 10% tetracaine in aqueous hydroxyethyl cellulose. Two hundred patients ranging from 18 to 85 years of age were randomly chosen to test the gel for use during a maintenance dental appointment in this double-blinded study. The topical anesthetics anesthetized the gingiva, and the potassium anesthetized the teeth, entering into the orifices of the dentinal tubules and moving to the pulp through these circuits, eventually bathing the pulp with potassium ions. The patients were treated with either gel 1 (the KNO3-benzocaine-tetracaineaqueous hydroxyethyl cellulose product) or gel 2, consisting of the aqueous hydroxyethyl cellulose gel alone. Both gels were flavored with cinnamon No 8 and colored with DNC Red No 40, appearing identical. Two minutes after the gel was applied, participants underwent scaling, curettage, ultrasonic scaling, prophyjet, tooth polishing, flossing, and other maintenance treatments. Within 15 seconds of completing these procedures, patients completed a 5-point verbal scale of pain ratings. The 0 to 4 pain rankings were 0, none; 1, slight; 2, moderate; 3, severe; and 4, very severe. Patients also documented their subjective pain experience using a 0 to
100 mm visual analog scale (VAS) ranging from ‘‘no pain’’ to ‘‘pain as bad as it could be.’’ Results.—Based on the verbal 5-point scale, gel 1 outperformed gel 2 overwhelmingly. Ninety-one of 100 patients using gel 1 had no pain and nine had slight pain. None experienced moderate, severe, or very severe pain during the maintenance procedures. All of the patients using gel 2 reported some degree of pain. Five had slight pain, 77 moderate pain, 17 severe pain, and one very severe pain. No adverse side effects occurred with either gel. All of the patients who had used gel 1 felt their maintenance treatments were more comfortable and pleasant than any previously experienced and would use the gel at future appointments. Discussion.—Using an aqueous gel consisting of 35% KNO3, 20% benzocaine, and 10% tetracaine provided excellent pain control for patients undergoing maintenance dental procedures. The gel was applied to the teeth just before the procedures and provided pain control with excellent patient acceptance.
Clinical Significance.—Potassium ions have been shown to block neural conduction of painful stimuli. Reported here is a clinical study using a potassium/topical anesthetic preparation for maintenance visits. Patients were more comfortable than during prior experiences.
Hodosh M, Hodosh SH, Hodosh AJ: KNO3/benzocaine/tetracaine gel use for maintenance visit pain control. Gen Dent July/August 2007, pp 312-315 Reprints available from the Academy of General Dentistry. Fax your request to Jo Posselt (312/440-4261) or e-mail [email protected]
Pediatric Dentistry Mineral trioxide aggregate for primary molar pulpotomy Background.—Formocresol is the most common medicament used in pulpotomy today, but concern has arisen because of its toxicity. Soft tissues demonstrate immediate irritation when exposed to formocresol, systemic disturbances have been suggested, and there is a mutagenic and carcinogenic potential. Alternatives have been proposed previously but none achieved results better than those with formocresol. Mineral trioxide aggregate (MTA)
was approved as a therapeutic endodontic material for use in humans in 1998 and possesses many positive qualities. Among its properties are good biocompatibility, alkaline pH, high sealing capacity, ability to harden in the presence of humidity, and ability to induce bone, cement, and dentin formation. MTA is currently used in repairing perforations and furcation lesions in permanent teeth and in pulp capping, apexification, and root-end fillings in
Fig 1.—Radiograph of first and second lower left primary molar. A, 12 months after pulpotomy with MTA. B, 36 months after pulpotomy with MTA. C, 42 months after pulpotomy with MTA. Note the absence of pathology and the presence of stenosis of second molar roots and dentin bridge in distal root of the first molar. (Courtesy of Maroto M, Barberı´a E, Vera V, et al: Mineral trioxide aggregate as pulp dressing agent in pulpotomy treatment of primary molars: 42-month clinical study. Am J Dent 19:283-286, 2006.)
immature permanent teeth. Its use in primary teeth has not been studied long term. A clinical and radiographic survey of the results of MTA pulpotomies in primary molars and dentin formation in root canals was carried out over the course of 42 months (Figure 1). Methods.—The children who participated with parental consent had no systemic pathologic conditions or allergies, required a pulpotomy of previously untreated primary molars because of caries, had no clinical or radiographic indications of radicular pulp degeneration, and had primary molars that could be restored with a stainless steel crown. The 69 molars underwent pulpotomy with MTA with follow-up evaluations every 6 months for 42 months. Results.—Only one primary molar had evidence of clinical or radiographic failure. In this case an internal resorption was noted 42 months after treatment of the mesial root of a maxillary first primary molar. Most of the other primary molars demonstrated reparative dentin deposition on radiographic examination. Stenosis was seen in 82% of the canals after 24 months and in 84% after 42 months. Dentin bridges were formed in 64% of cases after 24 months and in 83% after 42 months. At the final evaluation, 11 primary molars demonstrated normal exfoliation and the underlying bicuspids erupted without any clinical or radiographic signs of pathologic processes. Two maxillary second primary molars had no signs of failure but were extracted during orthodontic treatment 30 months after pulpotomy with
MTA. Both had dentin bridge formation similar to what was observed radiographically. Discussion.—Formocresol is an effective medication for pulpotomy but has great toxic potential. MTA is biocompatible and nontoxic and proved able to maintain the teeth treated with pulpotomy in a functional state with no clinical or radiographic signs of infection or failure. The clinical success rate was 100% and the radiographic success rate was 98.5% in this study. The gray MTA used may present a reasonable alternative to formocresol in pulpotomy treatments for primary molars, but more long-term studies are advisable. Clinical Significance.—Mineral trioxide aggregate (MTA) has proven useful in perforation and furcal lesion repair as well as for pulp capping and apical sealing. In this report, MTA shows promise as a pulpotomy agent, thus avoiding the pitfalls of the traditional agent formocresol.
Maroto M, Barberı´a E, Vera V, et al: Mineral trioxide aggregate as pulp dressing agent in pulpotomy treatment of primary molars: 42-month clinical study. Am J Dent 19:283-286, 2006 Reprints available from M Maroto, Dept of Prevention, Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Complutense Univ of Madrid, Avda Complutense sn, Ciudad Universitaria, 28040 Madrid, Spain; e-mail: [email protected]
Periodontics Generalized aggressive periodontitis treatment Background.—In generalized aggressive periodontitis (GAP), the periodontal tissues are destroyed in an episodic and rapid fashion, sometimes causing rapid and early tooth loss. Standard therapy is mechanical treatment,
specifically scaling and root planing (SRP) and/or periodontal surgery, plus adjunctive antibiotics and supportive periodontal therapy. However, the widespread use of antibiotics has contributed to the development of bacterial