QUESTIONS & ANSWERS
three days after administration of the an tibiotic; this side effect is due to the change in flora in the gastrointestinal tract, which takes time to occur. Serumsickness-type reactions can be seen as late as 10 to 15 days after therapy. John Silverio, MD, Wyeth Laboratories, Philadelphia.
Readers are invited to su b m it questions to The Journal's Questions and Answers section. Answers provided by experts are sent to questioners in advance o f publication. Questions should relate to the a rt and science o f dentistry.
Adverse reactions to penicillin Q. What is the consensus o f the best sources o f information regard ing the incidence o f adverse reactions to penicillin administered intramus cularly and orally, respectively?
The incidence of adverse reactions during oral administration of penicillin is greater than that during parenteral ad ministration. The reactions observed in the course of oral administration of pen icillin (nausea, vomiting, loose stools, urticaria), however, are less severe than those observed in the course of parenter al therapy. Anaphylactic shock, which is the only known fatal reaction to penicil lin, is much more frequently observed with parenteral administration than With oral administration. John Silverio, MD, Wyeth Laboratories, Philadelphia.
cations o f the drug per se, disregard ing, o f course, deaths caused by dis eases that were being treated with penicillin?
A. To my knowledge, the exact number of fatalities that have occurred in the course of therapy with penicillin since its introduction in the United States in the early 1940’s is not known. We would esti mate that there have been 250 to 300 fa talities during the 25 years this antibiotic has been available. John Silverio, MD, Wyeth Laboratories, Philadelphia. Q. Are there any historical or physical findings to suggest a pattern for the patients who will react ad versely to penicillin, that is, age, race, skin or hair type, past illness es, or other allergies?
Q. What are the types o f reactions that occur, that is, shock, skin rash, joint pain, and so on?
The exact percentage of each adverse reaction is not known, since papers on this matter have differed. Skin rash (urticaria) would be much more frequent than joint pain (serum-sickness-like reaction) which, in turn, is more frequent than anaphylac tic shock. Total adverse reactions range from 1% to 5 % according to most reports. John Silverio, MD, Wyeth Laboratories, Philadelphia.
Q. Since the introduction o f peni cillin in the United States, how many deaths have been caused by compli
Persons suffering from allergies (asthma, hay fever, urticaria, and so on) are more prone to have allergic reactions to penicillin than are those persons with out allergies. Age, race, and skin or hair type have no bearing on the frequency of sensitivity reactions to this antibiotic. John Silverio, MD, Wyeth Laboratories, Philadelphia.
Q. At what time do most adverse reactions to penicillin begin during penicillin therapy? A. The time depends on the type of ad verse reaction observed. For example, anaphylactic reactions appear within minutes and certainly before a half hour after administration of the antibiotic. Gastrointestinal upsets may occur two to
Q. What is the etiology o f the burn ing tongue, lips, palate, or cheeks o f older age groups who do not have anemia or allergies? Also, what is the most recognized therapy? HAROLD R . BAYNE, DDS,
Medical Arts Building, 1520 Seventh St, Moline, 111 61265.
Are you sure the patient does not have anemia? Double check with the phy sician. Pernicious anemia is a common cause. If a woman is in the postmenopaus al age, other causes may include vitamin B complex deficiency, hormonal imbal ance, emotional disturbance, or, frequent ly, a combination of them. Postclimacteric men may have the same experience. Vita min B complex deficiency is best treated by a diet rich in high quality protein, non refined carbohydrates, and a proper pro portion of preferably polyunsaturated fats. Before each meal, and there must be pro tein in every one, the patient should swal low a high potency vitamin B complex capsule, washing it down with a full glass of water. Breakfast is the most important meal of the day because any excess pro tein from dinner the night before is not stored in the body and it has to be replen ished after a lapse of so many hours. Vita min B complex breaks down protein into amino acids that are to be resynthesized into the proteins needed by the body; it is not a drug, it is a supplement to food. As the patient's condition improves and the burning mouth becomes more com fortable, the capsule before lunch is dis continued, then the one before dinner, and finally theone before breakfast. Good food provides all the vitamins we need. If the physician disapproves of a high protein diet for a particular patient, he may have valid reasons, and he will modify thé diet. Hormonal treatments should be prescribed by the physician. Cooperation between physican and dentist is essentiahfor all 17
patients with stomatopyrosis. Emotional imbalance is often improved by a person capable of establishing a good rapport with the patient, but he must know how to prompt and guide the conversation so that the patient will “ stick to the subject.” Emotional wholesomeness is the most im portant factor in the prognosis. Nothing can ruin nutritional welfare like aggrava tion and anxiety. Alfred Elfenbaum, 431 Oakdale Ave, Chicago.
Denture relinings Q. Occasionally during the past years, I have sent a complete den ture to be relined which com es back with a milky white appearance, es pecially on the buccal and labial sur faces. The difference from the nor mal color o f the acrylic resin is no ticeable, and it may happen to one denture and not to another made o f the same type acrylic resin. I suggested to my laboratory man that the color was caused by water seepage, but he thinks it is caused by something in the patient’s mouth that reacts when the denture is processed. R. S. C O O PER , DDS,
Suite 413, Citizens Bank Building, Paducah, Ky.
A. I agree with your suggested cause for the milky appearance of the denture. To minimize the effect of the water transfer, the flasked denture that is relined should not be heated higher than 165 F for sev eral hours if a heat-curing resin is used as the relining material. A cold-curing acryl ic resin would be better as a relining ma terial since the temperature of the denture is raised only slightly by the heat given off while the denture is cured. The higher the temperature at which the denture is heated in the flask, the greater should be the amount of blanching and the greater the amount of warpage. A vinyl-acrylic denture base is more susceptible to blanching than an acrylic denture base. If a vinyl-acrylic denture is reflasked, it should be covered with tin foil, a special flasking material should be
18 ■ JADA, Vol. 77, July 1968
used, or the denture should be rebased in stead of being relined. George Paffenbarger, senior research associate, National Bureau of Standards, Washington, DC 20234.
Stained teeth Q. I would like to know if there is any way o f improving the appear ance and esthetics o f teeth with mot tled enamel other than that o f plac ing crowns on the teeth. I have heard that this condition can be treated by use o f Superoxol and Pyrozone to bleach the teeth. Would bleaching o f the teeth with these or other chem icals cause the enamel to be defec tive? LYNN HARNER, DDS, 4Q1 First National Bank Bldg, D odge City, Kan 67801.
hours after the treatment. This procedure is repeated in one week” the number of appointments will depend on the amount of stain present in the teeth. If the patient feels any discomfort from the heat during the treatment, the opera tor is applying the heat longer than the required time. The rest period should then be lengthened and the heating period shortened. Some patients respond to treatment more readily than others, and a definite change is seen after the first few treat ments. As the treatment progresses, the solution has to penetrate deeper into the tooth to remove the deep stain and the result is less noticeable. Photographs should be taken before treatment so that the patient can see the progress that has been made. Charles F. Bouschor, department of operative dentistry, Baylor University College of Dentistry, 800 Hall St, Dallas 75226.
Fluorine stain can be permanently re moved from the teeth without damage to the enamel or pulp of a tooth. There are several technics that are used, but the most successful method uses a mixture of five parts of Superoxol and one part of ether. A rubber dam is placed over the six anterior teeth that are to be treated to pre vent the solutjon from coming in contact with the tissue. A cotton roll saturated with the solution is held in place by means of ligatures, or the cotton roM is held in place over the teeth to be bleached by use of articulating paper forceps. Heat is ap plied to the saturated cotton roll by use of a slight amount of pressure for about four seconds, removed for about four sec onds, applied again, and removed. This procedure continues for 20 to 30 minutes, with the cotton roll being continually sat urated. The heating method should raise the temperature to 150-160 F to activate the solution to cause it to penetrate the fluorine stain. After the treatment and with the rubber dam still in place, the operating light is placed about 18 inches from the teeth for 20 minutes to acceler ate the bleaching process. The maximum amount of bleaching occurs about two
Q. What information do you have on Sofdent 27 manufactured by the National Patent Development Corp? R O BERT M O R R IS, DDS.
The Council on Dental Materials and Devices has not evaluated this specific resilient relining material but has re viewed the literature regarding such ma terials. The Council has not been able to obtain adequate data from the National Patent Development Corporation to sup port the many claims that have been made for Sofdent 27. The Council is of the opin ion that such materials should only be recommended for temporary use and should not be considered as permanent or to be used in all dentures. In other words, the Council is of the opinion that this type of material should only be used for prob lem cases. It is suggested that the material be used on an experimental basis and only be used in patients who will be closely ob served over a period of tim e to determine the usefulness of the material. John W. Stanford, PhD, secretary, Council on Dental Materials and Devices.