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                    D e n t a l    F o l l i c l e               

             The        Monthly   Dental   E-Journal                 Vol - I I      Number-  III        August  2007

In this Issue:

  • Editorial

  • News

  • Laughter - The best Medicine

  • Transcutaneous electrical nerve stimulation  -Dr.Ghazala Danish

  • History of dentistry- Dr.Rasha Seragelden

  • In Vivo Detection of Resistant Yeasts and Significance in Oropharyngeal Candidiasis (OPC) in AIDS in the Era of HAARTIn Vivo Detection of Resistant Yeasts and Significance in Oropharyngeal Candidiasis (OPC) in AIDS in the Era of HAART. -     News Report

  • A study of Minocycline HCI Microspheres with Scaling and Root Planing provesto be Significantly More Effective than SRP alone   News Report

     

Editorial :

      

Transmissible spongiform encephalopathies (TSEs) are a group of lethal degenerativ encephalopathies characterized by the appearance of microscopic vacuoles in the brain gray matter, giving a spongiform appearance with the etiologic agent being a PRION which is  a host-encoded protein termed . Prions are composed of a cell surface glycoprotein designated PrP (protease-resistant protein) .The classic example of a human TSE is the progressive brain disease Creutzfeldt-Jakob disease (CJD).

There are several well-recognized animal TSEs including bovine spongiform encephalopathy (BSE; also known as ‘‘mad cow disease’’) in cattle and scrapie in sheep and goats .

It presents as a rapidly progressive multifocal  dementia. ,up to a third of patients have nonspecific prodromal symptoms that may include insomnia, fatigue, depression, weight loss, headache, general malaise, and ill-defined pain. Over a period of weeks, there is rapid progression to akinetic mutism, with mental deterioration, myoclonus, extrapyramidal and pyramidal signs, cerebrellar ataxia, and cortical blindness leading to death ultimately. No treatment has been found so far nor any prophylaxis or method of sterlization. No direct association to dentistry has been confirmed but suseptible transmission thru infected dental instrument is under research.

The more we discover the more challenges nature poses against us.But survival of the fittest is what the entire thing about.

I hope you enjoy every bit of Dental Follicle as much as you have enjoyed it all these days.

Best,

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Yours truly

Dr. Syed Nabeel

Editor of Dental Follicle & WebMaster www.DentistryUnited.com

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News :

         

                       

Laughter - The Best Medicine :

Dentist: There goes the only woman I ever loved.
Assistant: Why don't you marry her?
Dentist: I can't afford to. She's my best patient.

                                         

Transcutaneous electrical nerve stimulation

Dr.Ghazala Danish

MDS - Oral Medicine and Radiology

Mysore , India

Introduction

Transcutaneous electrical nerve stimulation (TENS) currently is one of the most commonly used forms of electroanalgesia. Many clinical reports exist concerning the use of TENS for various types of conditions such as low back pain (LBP), myofascial and arthritic pain, sympathetically mediated pain, bladder incontinence, neurogenic pain, visceral pain, and postsurgical pain. Because many of these studies were uncontrolled, there has been ongoing debate about the degree to which TENS is more effective than placebo in reducing pain.

Historical aspects

Throughout history man has sought relief from pain by various means. Historical references to pain relieving modalities include herbs, heat and cold applications, acupuncture techniques, drugs, surgery, meditation, hypnosis and electricity. Electricity is a natural phenomenon within all types of living tissues. The brain constantly receives and integrates electrical signals indicative of all environmental (external) and bodily (internal) events including that of pain. Electrical stimulation for pain control was used in ancient Greece, 63 A.D. It was reported by Scribonius Largus pain was relieved by standing on an electrical fish at the seashore. In the 16th through the 18th century various electrostatic devices were used for headache and other pains. Benjamin Franklin was a proponent of this method for pain relief. In the 1900's a device called the electreat, along with numerous other devices were used for pain control and other quack applications such as cancer cures. Only the electreat survived into the twentieth century, but was not portable, and had limited control of the stimulus.

The first modern, patient-wearable TENS was patented in the U.S.A. on June 18, 1974. It was initially used for testing the tolerance of chronic pain patients to electrical stimulation before implantation of electrodes in the spinal cord dorsal column. The electrodes were attached to an implanted receiver, which received its power from an antenna worn on the surface of the skin. Although intended only for testing tolerance to electrical stimulation, many of the patients got so much relief from the TENS itself that they never returned for the implant.

Mechanism of action

The currently proposed mechanisms by which TENS produces neuromodulation include the following:

  • Presynaptic inhibition in the dorsal horn of the spinal cord
  • Endogenous pain control (via endorphins, enkephalins, and dynorphins)
  • Direct inhibition of an abnormally excited nerve
  • Restoration of afferent input

The results of laboratory studies suggest that electrical stimulation delivered by a TENS unit reduces pain through nociceptive inhibition at the presynaptic level in the dorsal horn, thus limiting its central transmission. The electrical stimuli on the skin preferentially activate low- threshold myelinated nerve fibers. The afferent input from these fibers inhibits propagation of nociception carried in the small unmyelinated C fibers by blocking transmission along these fibers to the target or T cells located in the substantia gelatinosa (laminae 2 and 3) of the dorsal horn.

The mechanism of the analgesia produced by TENS is explained by the gate control theory proposed by Melzack and Wall in 1965. The gate usually is closed, inhibiting constant nociceptive transmission via C fibers from the periphery to the T cell. When painful peripheral stimulation does occur, the information carried by C fibers reaches the T cells and opens the gate, allowing pain transmission centrally to the thalamus and cortex, where it is interpreted as pain. The gate control theory postulated a mechanism by which the gate is closed again, preventing further central transmission of the nociceptive information to the cortex. The proposed mechanism for closing the gate is inhibition of the C-fiber nociception by impulses in activated myelinated fibers. TENS, therefore, blocks ascendance of nociceptive phenomena, which prevents descendent motor activity (tightening up). Also, by providing stimulating muscular contraction, the pumping action of TENS results in increased tissue perfusion.

TENS also stimulates the release of the body’s endogenous opiates. Thus TENS has neurologic, physiologic, pharmacologic psycho logic effects. Physiologic effect is the rhythmic muscle movement. The fasciculation of muscles may result in an increased circulation, decrease in oedema and decrease in resting muscle activity. Pharmacologic action is by the release of endorphins and psycho logic effect being the placebo action.

Indications for the use of TENS

  • Neurogenic pain (eg, deafferentation pain, phantom pain), sympathetically mediated pain, postherpetic neuralgia, trigeminal neuralgia, atypical facial pain, brachial plexus avulsion, pain after spinal cord injury (SCI)
  • Musculoskeletal pain: Examples of specific diagnoses include joint pain from rheumatoid arthritis and osteoarthritis, acute postoperative pain (eg, postthoracotomy), and acute posttraumatic pain. After surgery, TENS is most effective for mild-to-moderate levels of pain, and it is ineffective for severe pain. The use of TENS in chronic LBP and myofascial pain is controversial, as placebo-controlled studies fail to show statistically significant beneficial results. Uncertainty also exists about the value of TENS in tension headache.
  • Visceral pain and dysmenorrhea are other conditions in which TENS has been applied successfully.
  • Other disorders: TENS has been used successfully in patients with angina pectoris and urge incontinence, as well as in patients requiring dental anesthesia. Reports discuss use of TENS to assist patients in regaining motor function following stroke, to control nausea in patients on chemotherapy, as an opioid-sparing modality in postoperative recovery, and in postfracture pain.

 

TENS is considered a method of pain relief, and has a wide following for use in obstetric care, particularly labour. There is little data on its actual efficacy, and some obstetricians maintain that it is ineffective.

In palliative care and pain medicine, TENS units are sometimes used in an attempt to alleviate neuropathic pain (pain due to nerve damage). Although results are modest, some patients benefit from this approach.

TENS has been used successfully to treat acute and chronic pain in medicine for many years and more recently in dentistry. TENS usefulness in the treatment of myofascial pain is well-recognized. Dental electroanalgesic devices are derived from TENS technology and are useful for electroanalgesia and in dental procedures such as simple restorations and periodontal procedures.

Pain symptoms after dental treatment most commonly are referable to structures innervated by the trigeminal nerve; these structures include, but are not limited to, muscles (masseter, temporalis, lateral pterygoid, medial pterygoid), tendons (temporal) and ligaments (stylomandibular), which can be stretched to or beyond their modulus of elasticity or held in nonphysiological positions by prolonged opening. When we use TENS, we apply it over the coronoid notch, which closely approximates the level at which the trigeminal nerve exits the skull. When TENS is applied in this position, tissues innervated by the trigeminal nerve do not receive noxious sensory input and, consequently, do not develop an undesirable motor response (that is, injury is prevented).

Contraindications for the use of TENS

TENS should not be used in patients with a pacemaker (especially of the demand type), due to risk of interference and failure of their implanted device. The stimulus outputs may drive or inhibit the pacemaker.

TENS should not be used during pregnancy because it may induce premature labor.

TENS should not be applied over the carotid sinuses due to the risk of acute hypotension through a vasovagal reflex.

TENS should not be placed over the anterior neck because of possible laryngospasm due to laryngeal muscle contraction.

The electrodes should not be placed in an area of sensory impairment (eg, in cases of nerve lesions, neuropathies), where the possibility of burns exists.

Patients with histories of chronic posterior cervical neck pain or occipital headache also should not receive TENS treatment that is confined to the trigeminal region, as the untreated condition may be exacerbated.

             

A TENS unit should be used cautiously in patients with a spinal cord stimulator or intrathecal pump. TENS should also be used with caution in people with epilepsy or pregnant women (do not use over area of the uterus as the effects of electrical stimulation over the developing fetus is not known). Possible failure of these warnings can result in Ventricular fibrillation.

Apparatus

A Transcutaneous Electrical Nerve Stimulator, more commonly referred to as a TENS unit, is an electronic device that produces electrical signals used to stimulate nerves through unbroken skin. The name was coined by Dr. Charles Burton. The unit is usually connected to the skin using two or more electrodes. A typical battery-operated TENS unit consists of a pulse generator, small transformer, frequency and intensity controls, and a number of electrodes.

       A TENS unit consists of one or more electric signal generators, a battery, and a set of electrodes. The units are small and programmable, and the generators can deliver trains of stimuli with variable current strengths, pulse rates, and pulse widths. The preferred waveform is biphasic, to avoid the electrolytic and iontophoretic effects of a unidirectional current. The usual settings for the stimulus parameters used clinically are the following:

  • Amplitude - Current at low intensity, comfortable level, just above threshold
  • Pulse width (duration) - 10-1000 microseconds

Pulse rate (frequency) - 80-100 impulses per second (Hz); 0.5-10 Hz when stimulus intensity is set high.

The 3 options for the standard settings used in different therapeutic methods of TENS application include the following:

Ø      Conventional TENS has a high stimulation frequency (40-150 Hz) and low intensity, just above threshold, with the current set between 10-30 mA. The pulse duration is short (up to 50 microseconds). The onset of analgesia with this setup is virtually immediate. Pain relief lasts while the stimulus is turned on, but it usually abates when the stimulation stops. Patients customarily apply the electrodes and leave them in place all day, turning the stimulus on for approximately 30-minute intervals throughout the day. In individuals who respond well, analgesia persists for a variable time after the stimulation stops.

Ø      In acupuncture like settings, the TENS unit delivers low frequency stimulus trains at 1-10 Hz, at a high stimulus intensity, close to the tolerance limit of the patient. Although this method sometimes may be more effective than conventional TENS, it is uncomfortable, and not many patients can tolerate it. This method often is considered for patients who do not respond to conventional TENS.

Ø      Pulsed (burst) TENS uses low-intensity stimuli firing in high frequency bursts. The recurrent bursts discharge at 1-2 Hz, and the frequency of impulses within each burst is at 100 Hz. No particular advantage has been established for the pulsed method over the conventional TENS method.

Technique

A suitable cream should be used to increase conductivity from the electrode to the  skin.

The position of the electrodes on the skin determine which nerve(s) is (are) stimulated.

TENS Electrodes should never be placed:

  • On or near the eyes

  • In the mouth

  • Transcerebrally (on each temple)

  • On the front of the neck (due to the risk of acute hypotension through a vasovagal reflex)

  • On areas of numb skin/decreased sensation

  • On broken skin areas or wounds

  • On or near the Trigeminal nerve if you have a history of Herpes zoster induced Trigeminal neuralgia (Postherpetic neuralgia)

Do not turn TENS up too high as this can cause over-stimulation which may make pain worse. There should be no muscle contraction.

When TENS is used for pain control, patients are instructed to try different frequencies and intensities to find those that provide the best pain control for that individual. Optimal settings of stimulus parameters are subjective and are determined by trial and error. Electrode positioning is quite important. Usually, the electrodes are placed initially on the skin over the painful area, but other locations (eg, over cutaneous nerves, trigger points, acupuncture sites) may give comparable or even better pain relief.

Patient comfort is a very important determinant of compliance and, consequently, the overall success of treatment. The intensity of the impulse is a function of both pulse duration and amplitude. Greater pulse widths tend to be more painful. The acupuncture like method is less tolerable because the impulse intensity is higher.

The amount of output current depends on the combined impedance of the electrodes, skin, and tissues. With repetitive electrical stimuli applied to the same location on the skin, the skin impedance is reduced, which could result in greater current flow as stimulation continues. A constant current stimulator, therefore, is preferred to minimize sudden uncontrolled fluctuations of current intensity related to changes in impedance. An electroconductive gel applied between the electrode and skin serves to minimize the skin impedance. Skin irritation can occur in as many as 33% of patients, at least in part, due to drying out of the electrode gel. Patients need to be instructed in the use and care of TENS equipment, with particular attention to the electrodes.

Literature on the use of TENS in a variety of medical conditions reports a wide range of outcomes, from very positive to negative effectiveness. Generally, TENS provides initial relief of pain in 70-80% of patients, but the success rate decreases after a few months or longer to around 20-30%. To exclude a false-negative response, a trial of TENS for at least 1 hour should be given to confirm potential benefit from subsequent continuous use.

The time from the start of stimulation to the onset of analgesia varies from almost immediate to hours (on average 20-30 minutes in over 75% of patients and 1 hour in 95% of patients). The duration of analgesia also varies considerably, continuing only for the duration of stimulation in some patients and providing considerable prolonged poststimulation relief in others. The same TENS protocol may have different degrees of antinociception in acute experimental pain compared with chronic clinical pain in patients with chronic LBP.

Techniques and dental indications

Patients for whom TENS use would be indicated include those who, during the 24 hours after dental treatment, have had symptoms such as difficulty in opening their mouths, or muscular pain or headaches after dental appointments that last from 30 minutes to two hours. Typically, these patients report having had masticatory muscle pain with or without trismus that persists for at least 48 hours. On examination, it is found that the masseter muscles or temporalis muscles usually are tender and that the measured interincisal opening is reduced by 50 percent or more. When this is identified in patient’s who meet the use criteria, TENS can be used as a prophylactic measure for subsequent treatment.

A wide variety of TENS units are available, and even electroanalgesic units can be used for this purpose. A typical TENS unit can be used quickly and easily by following these steps:

Ø      Cleanse the surfaces over the coronoid notches bilaterally with alcohol wipes to remove makeup and facial oils. Then dry the areas with clean pieces of gauze.

Ø      Apply self-adherent electrode patches over the cleansed areas.

Ø      Make sure the TENS unit’s amplitude controls are set to the "off" position.

Ø      Attach the electrode leads from the patch to the TENS unit. If a dual-channel machine is used, it does not matter which channel is selected.

Ø      Set the timer to C (continuous) and the mode selector to C (conventional).

Ø      Adjust the controls to a high bandwidth and relatively high frequency.

Ø      Switch on the appropriate channel and slowly adjust the amplitude control until the patient feels a gentle pulsing sensation.

Ø      Adjust pulse width and pulse rate so they are comfortable for the patient. If one side of the patient’s head has had more difficulty in the past than the other and the patient reports less stimulation on that side, switch the leads.

Ø      Proceed with the dental procedure in the normal manner.

Ø      At completion of the procedure, turn off the unit, disconnect the leads and remove the electrode patches from the patient.


It is not necessary to have the patient wear the TENS beyond the duration of the appointment. When using this technique, muscle relaxants and other attempts at pain control are not needed. This technique as a safe, relatively inexpensive way of preventing posttreatment discomfort caused by prolonged dental treatment. The technique has been uniformly successful and results in patients who more readily accept dental treatment.  

Temporomandibular joint-myofascial pain dysfunction syndrome (TMJ-MPDS) treatment apparatus and methodology employs a transcutaneous electronic wave to suppress pain associated with TMJ-MPDS. A first positive contact electrode is placed at the pain site and a second positive contact electrode is placed at the contra-lateral temporomandibular joint; and a negative contact electrode is placed at the web of the ipsilateral hand. An electronic current wave comprising relatively high frequency pulses with a low frequency amplitude modulation is then applied between the first to the second electrodes.

Complications

Medical complications arising from use of TENS are rare; however, skin irritation is a frequent problem and often is due partly to the drying out of the electrodes. Sometimes individuals react to the tape used to secure the electrodes. Skin irritation is minimized by using self-adhesive disposable electrodes and repositioning them slightly for repeated applications.

Newer modalities

A variety of newer transcutaneous or percutaneous electrical stimulation modalities recently have emerged.

  • Interferential current therapy (IFC) is based on summation of 2 alternating current signals of slightly different frequency. The resultant current consists of cyclical modulation of amplitude, based on the difference in frequency between the 2 signals. When the signals are in phase, they summate to an amplitude sufficient to stimulate, but no stimulation occurs when they are out of phase. The beat frequency of IFC is equal to the difference in the frequencies of the 2 signals. For example, the beat frequency and, hence, the stimulation rate of a dual channel IFC unit with signals set at 4200 and 4100 Hz is 100 Hz.
  • IFC therapy can deliver higher currents than TENS. IFC can use 2, 4, or 6 applicators, arranged in either the same plane for use on regions such as the back or in different planes in complex regions (eg, the shoulder).
  • Percutaneous electrical nerve stimulation (PENS) combines advantages of both electroacupuncture and TENS. Rather than using surface electrodes, PENS uses acupuncturelike needle probes as electrodes, placed at dermatomal levels corresponding to local pathology. The main advantage of PENS over TENS is that it bypasses the local skin resistance and delivers electrical stimuli at the precisely desired level in close proximity to the nerve endings located in soft tissue, muscle, or periosteum.

 

History of dentistry

Dr.Rasha Seragelden

Cairo , Egypt

          Is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to human being

The first dental school, the Baltimore College of Dental Surgery, opened in Baltimore, Maryland in 1840. Harvard Dental School was the first dental school to affiliate with a university in 1867 (renamed Harvard School of Dental Medicine in 1940.)

A 4200 year old dentist Iy Mry's chamber in Saqqarra, Egypt ( ref: Dental Follicle Vol 1 Issue 12 , May- 2007)

It is agreed that the oldest of those civilizations that knew something of dentistry was Egypt. The earliest indication of any such knowledge, in Egypt is found in the Edwin Smith Surgical Papyrus, interpreted by Dr. Breasted, the Director of the Oriental Institute of Chicago, and by him. It is dated in the 17th century B.C., even if the original author's first manuscript was produced at least a thousand years earlier, between 2500 and 3000 B.C. It contains detailed directions for the treatment of wounds about the mouth, but no mention is made of restoring lost teeth resulting from these or similar injuries. The hard tissues of the mouth were in general considered untreatable, if we are to judge from a case report from the above Papyrus in which a fracture of the mandible is described. In closing his discussion this ancient Egyptian surgeon says: "One having a fracture of the mandible over which a wound has been inflicted and he has fever from it, it is an ailment not to be treated." The surgery mentioned in this papyrus was most likely the war-time surgery of a physician who was following an army. In times of peace, however, it is reasonable to believe that many minor dental ills were treated.

Dental instruments illustrated in Peter Lowe’s Discourse on the Art of Chirurgerie.

 

In a mandible of an Egyptian from the Old Kingdom (3000-2500 B.C.) described by Hootin,we have evidence of minor oral surgery, and in a later papyrus dating, it is believed, from 1550 B.C., we find many prescriptions for dental maladies, but in all the ancient Egyptian medical and dental writings no mention is made of mechanical dental appliances.

Schmidt, Virshow, Mummery, and other competent authorities on ancient Egyptian mummies find no trace of restorative dental art among the Egyptians, and contrary to the beliefs of various writers detached archaeological specimens of Egyptian prosthetic dentistry do not seem to exist. Whether there was a religious prejudice against artificial teeth or against the burying of them with the mummy we do not know, but "it is hard to believe" says Guerini, "that so refined and ingenious a people as the Egyptians should not have found the means of remedying the deformity resulting from the loss of one or more front teeth."

Evidence has been found of teeth having been drilled dating back 9,000 years. [ The people of the Indus Valley Civilization, even from the early Harappan periods (c. 3300 BC), had knowledge of medicine and dentistry. A physical anthropologist that examined exhumed bodies from that time period, Professor Andrea Cucina from the University of Missouri-Columbia, made the discovery when he was cleaning the teeth from one of the men. Stone age people in India and Pakistan were using dental drills made of flint 9,000 years ago.

Some information contained in the Edwin Smith Papyrus dates as early as 3000 BC and includes the treatment of several dental ailments.  Hammurabi's Code contains some references to dental procedures and fees. The Ebers papyrus also discusses similar treatments. Examining the remains of some ancient Egyptians and Greco-Romans reveal early attempts at dental prosthetics and surgery.

Historically, dental extractions have been used to treat a variety of illnesses. During the Middle Ages and through the 19th century, dentistry was not a profession into itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth, which not only resulted in the alleviation of pain, but often cured a variety of ailments linked with chronic tooth infection. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican (resembling a pelican's beak) which was used through the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century.[citation needed]

An image from 1300s (A.D.) England depicting a dentist extracting a tooth with forceps

It is said that the 17th century French physician Pierre Fauchard started dentistry science as we know it today, hence he was named "the father of modern dentistry". Among many of his developments were, the extensive use of dental prosthesis, introducing dental fillings as treatment for dental caries and stating that sugar derivate acids like tartaric acid were responsible for dental decay.

 

 


In Vivo Detection of Resistant Yeasts and Significance in Oropharyngeal Candidiasis (OPC) in AIDS in the Era of HAARTIn Vivo Detection of Resistant Yeasts and Significance in Oropharyngeal Candidiasis (OPC) in AIDS in the Era of HAART.

 


 

CHICAGO, IL  -- Preliminary results from an ongoing study suggest that oral colonization with drug-resistant yeast species occurs frequently in patients receiving highly active antiretroviral therapy (HAART), researchers said here at the 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).

Poster presentation was done by Ana C. Vallor, PhD, Research Fellow in Medicine and Infectious Diseases, and  Spencer W. Redding, DDS, Chairman of Dental Diagnostic Science, both of University of Texas Health Science Center, San Antonio, Texas.

Seven patients (21%) were found to carry fluconazole-resistant yeast species after oral rinse samples were analyzed with molecular diagnostic methods. This resistance was found in multiple yeast species, including C. albicans, C. glabrata, C. tropicalis, and C. dubliniensis."These methods could be useful in the rapid detection of colonizing resistant yeasts in patients at risk for invasive candidiasis,"  said the conclusion in the poster.

 

 

 A study of Minocycline HCI Microspheres with Scaling and Root Planing provesto be   Significantly More Effective than SRP alone        
 

A new study "Minocycline HCI Microspheres reduce red-complex bacteria in periodontal disease therapy "published this month (August? 2007)in the Journal of Periodontology shows that a combination of ARESTIN® (minocycline hydrochloride) Microspheres 1 mg, plus scaling and root planing (SRP) is significantly more effective than SRP alone in controlling periodontal disease. Study results indicate clearly that when ARESTIN® is placed at the time of initial SRP, clinical markers of disease are reduced, such as pocket depth, inflammation, and bleeding on probing, thus creating an environment where healing has occurred.

The study measured the antimicrobial effectiveness of using ARESTIN® to treat periodontal pathogens, also called red complex bacteria (RCB)  Viz...Porphyromonas gingivalis, Tannerella forsynthensis, and Treponema denticola, that play a primary role in periodontal infection. When administered in conjunction with SRP, ARESTIN® significantly reduced the proportion of these disease-causing bacteria by 29percent more than SRP alone and showed nearly twice the reduction in levels of these periodontal pathogens. Additionally, ARESTIN® patients maintained relative levels of periodontal pathogens normally seen in healthy patients, while the SRP only patients did not.ARESTIN® plus SRP also significantly decreased pocket bleeding by 79 percent, more than SRP alone.

 A combination of ARESTIN® and SRP led to positive changes in clinical attachment level (CAL) and overall reduction of periodontal disease.The mean gain in CAL for subjects receiving both treatments was 45 percent greater than in those treated with PDR alone (1.16 mm as opposed to 0.80 mm, respectively). Regarding pocket depth reduction (PDR), subjects treated with ARESTIN® and SRP experienced average reductions that were 37 percent greater than those observed in SRP-only groups (1.38 mm vs 1.01 mm, respectively). These findings suggest that the combination of ARESTIN and SRP is more effective in targeting bacteria that grow to a greater density in deeper pockets, such as the red complex strain, than SRP alone.locally delivered ARESTIN exhibited surprising specificity of action in being directed almost entirely toward inhibition of bacteria generally considered periodontal pathogens with little inhibitory effect on other species.

OraPharma, Inc. is a specialty oral healthcare company that discovers, develops, and commercializes products that maintain and restore oral health. ARESTIN® (minocycline hydrochloride) Microspheres, 1 mg (www.arestin.com) is indicated as an adjunct to scaling and root planing procedures for reduction of pocket depth in patients with adult periodontitis. OSSIX® PLUS (resorbable collagen membrane) is used in guided bone regeneration (GBR) and guided tissue regeneration (GTR) procedures. For more information about OraPharma and its products, visit www.orapharma.com.