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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-  V    October  2007

In this Issue:

  • Editorial

  • News

  • Laughter - The best Medicine

  • www.DentistryUnited.com Ranks at Number 8 on Google

  • IDEM SINGAPORE online registration open

  • Radiation and chemotherapy induced mucositis- Part 2 - Dr.Ghazala Danish

  • Periodontics - A review ( Basics)     - Dr. Rasha Seragelden


     

Editorial :

         Advances in Dental Research  has proved that not only endocrine glands can synthesize hormones  . Specialist of the Chuvash State University A.V. Moskovsky discovered neuroendocrinal cells in the dental pulp, besides, their quantity differs in healthy and affected teeth.

         Bioactive substances perform communication between adjacent organs and cells. They achieve their target by moving in the tissues between the cells or along with the bloodstream. Therefore, there is no wonder that some cells of the pulp (the most inner soft dental tissue, where there are nerves and blood vessels) are also secreting bioactive substances.

         Subject of inquiry was the root pulp, which had been extracted by medical indication from teeth with pulpitis, periodontitis, caries and from healthy teeth. Altogether, the researchers examined 418 teeth of 294 individuals of both sexes, ageing 23 through 49. The extracted pulp was fixed to produce sections. The sections were colored by antibodies for different specific proteins, which are produced by neuroendocrine cells. Upon completion of the multi-step process, the colored proteins are seen as reddish spots in the pulp tissue.

         The pulp consists of stretched cells of the connective tissue, fibroblasts and endotheliocytes. Neuroendocrine cells differ from them by a bigger size, irregular shape and presence puce clods in the cytoplasm of, the clods often covering the nucleus. These clods are bioactive substances.There are few neuroendocrine cells in a healthy pulp, but their number increases in case of caries, acute pulpitis or periodontitis. The more developed the disease is, the more numerous such cells are, the cells being accumulated nearby the lesion focus. What is their role?

According to A.V. Moskovsky’s opinion, neuroendocrine cells of the pulp perceive information from the organism’s medium and react to it by secretion of peptide hormones. Thus, they regulate blood microcirculation, metabolism, connective tissue cell division and activity of immunocompetent cells. It is them that can regulate inflammatory processes in case of caries and pulpitis.(source)

                            Further education in Dentistry has gained its utmost importance in recent times. We @ Dentistryunited are committed to make dentists more competent professionally . We are here to offer you skill enhancement programs in the field of fixed prosthodontics , implantology , Aesthetic Dentistry  , endodontics and Orthodontics . mail us @ dentistryunited@gmail.com for program details , We have introduced new programs for less than a week time basis in Full mouth rehabilitaion  and endodontics . The programs are scheduled to be held in the Royal city of Mysore , India.

                          Together we can make dentistry better . DentistryUnited is comitted to encouragement in research. Thru Dental follicle we have been trying to promote research by  publishing research papers , review articles and news. we welcome you to send in your articles/papers to DentistryUnited@gmail.com .

             I hope you enjoy this issue.      

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 :

A young man saw an elderly couple sitting down to lunch at McDonald's. He noticed that they had ordered one meal, and an extra drink cup. As he watched, the gentleman carefully divided the hamburger in half, then counted out the fries, one for him, one for her, until each had half of them. Then he poured half of the soft drink into the extra cup and set that in front of his wife. The old man then began to eat, and his wife sat watching, with her hands folded in her lap.The young man decided to ask if they would allow him to purchase another meal for them so that they didn't have to split theirs. The old gentleman said, "Oh no. We've been married 50 years, and everything has always been and will always be shared, 50/50." The young man then asked the wife if she was going to eat, and she replied... "Not yet...It's his turn with the teeth!"
 

                                         

www.DentistryUnited.com Ranks at Number 8 on Google

                  The most visited website for dental news , www.DentistryUnited.com ranks now on Number 8 on google  for the key word "dentistry" . Click Here to see our ranking . DentistryUnited takes its eighth position among 29,000,000 websites. This is the proof thereof the popularity of Dentistryunited among dentists. We also proved information about the Universities worldwide. So next time you need to see the worldwide list of institutions offering Dental Education just logon to www.DentistryUnited.com .Added to it we also provide information about Continuing Education Programs for dentists across the planet Earth.Upcoming conferences and a link to journals along with the way  in to various dental associations is available at www.DentistryUnited.com .write us back your comments to Info @ DentistryUnited.com

 

 

 

 IDEM SINGAPORE online registration open

 

 

One of the biggest events of dentistry "IDEM" singapore now opens online registraions.The IDEM sinpgapore which is scheduled for April 4-6/2008  . Click here to register

Radiation and chemotherapy induced mucositis- Part 2

Dr.Ghazala Danish

 India

         
 

Mucosal barriers

Sucralfate, an antiulcer drug, binds to ulcerated tissue by attaching to proteins in the damaged mucosa. It forms an adhesive -like protective coating. Available in tablet form, it can be dissolved in water to make a rinse. Dyclonine or lidocaine can be added to the solution to decrease pain and can be swished and expectorated or swallowed up to six times per day.

Zilactin is a medicated gel that contains tannic acid and forms an occlusive film cover oral ulcerations. It must be applied to dried tissue, which often causes increased discomfort and decreases patient acceptance.

 

Analgesics

Capsiacin- found in chilli peppers acts upon nerve endings to provide temporary pain relief.

Morphine- a CNS analgesic, depresses pain impulse trnsmission. Effective in managing mucositis pain in cancer patients, but dry mouth is one of its adverse effect. It does not improve the health of the mucosa.

Fentanyl (transdermal patch)- a very potent short acting opioid, used primarily as an anesthetic. Available in a sustained release transdermal delivery system with half life of 33 hrs. Useful in patients unable to take oral medications. Patch must be changed every 3 days.

 

Growth factors

Recombinant keratinocyte growth factor- influences growth, development and repair of epidermal tissues, accelerates wound healing, increases number of stem cells that survive a dose of radiation therapy.

Fibroblastic growth factor (renifermin)- stimulates salivary gland hyperplasia and salivary gland output. Maintaining a moist oral mucosa may help reduce the severity of mucositis.

Epidermal growth factor-present in biologic fluids including saliva. Palys a role in healing damaged mucosa, less tissue damage when higher levels are present in ECF.

 

Antioxidants

Cancer chemotherapy is an oxidative process. Radiotherapy and chemotherapy generate free radical species, which require antioxidants to be neutralized. Beta-carotene has been proved useful in chemotherapy induced mucositis.

Vitamin E in combination with vitamin C- act on a cellular level by protecting the cell membrane and preventing peroxidation.

Glutamine- very important during stress. It has successfully reduced radiotherapy and chemotherapy induced mucositis by three mechanism-a) as a cellular fuel, b) as a precursor of nucleotides needed for cell regeneration, c) as a source of glutathione, which is a potent antioxidant. 4gms of powdered glutamine in oral oral rinse in a swish and swallow suspension, twice a day decreases intensity and duration of mucositis.

Glutathione- is the body’s main antioxidant. Blood levels of glutathione are reduced by radiotherapy and severe inflammation. It can be used as intraoral spray or oral dissolvable tablets.

 

Immunomodulators

Thalidomide- immunomodulatory and antiangiogenic agent, inhibits tumor necrosis factor associated with oropharyngeal ulcers. To prescribe thalidomide the practitioner must register with the System for Thalidomide Education and Prescribing Safety (STEPS) to minimize substantial risks of teratogenecity.

In the future, the control of mucositis may be found in cellular engineering and manipulation. Cytokine-stimulated neutrophils recovery using agents such as granulocyte colony stimulating factor and granulocyte macrophage colony-stimulating factors decreases the duration of mucositis either by limiting epithelial damage or by decreasing the likelihood of secondary infection and delayed healing. Transforming growth factor-beta 3 and interlukin-2 have demonstrated promising efficacy by transiently limiting the rate of basal oral epithelial growth proliferation in vitro and in vivo, thereby modifying the frequency and severity of chemotherapy-induced mucositis.

 

 

Radioprotectants

Amifostine- enhances the tolerance of normal tissues to a given dose of radiation and decreases treatment morbidity. Cytoprotective mechanism involves DNA protection, repair acceleration and antioxidant function. Prevents salivary gland injury induced by radiation, reducing xerostomia, mucositis and hematological abnormalities. Given i.v or s.c. Life threatening anaphylactoid reaction, nausea, vomiting, hypotension and hypocalcemia associated with amifostine treatment have been reported.

 

Nonpharmacological appraoch

Cryotherapy in the form of ice chips, used for 5 minutes prior to drug administration and for 25 minutes afterward, can decrease the mucositis associated with 5-fluorouracil, possibly by causing local vasoconstriction and reducing local delivery of the agent.

Low intensity laser therapy- improves wound healing and accelerates replication of cells. Low energy helium-neon laser seems to be safe, simple, atraumatic and efficient method for prevention and treatment of chemotherapy and radiotherapy induced mucositis.

 

Oral Care Prior to Radiation

Every patient about to receive radiation to the head and neck must under go a comprehensive dental evaluation to identify risk factors for the development of oral complications. All services required for the patient to be in optimal oral health need to be provided as well as initiation of an aggressive preventive regimen. Many patients with head and neck cancer are noncompliant with routine oral hygiene and dental care.

Ninety seven percent of dentulous patients need dental care prior to initiation of radiation. Evaluation should be done at least 3 weeks before radiation to allow adequate time for wound healing. Knowledge of the location of the radiation field and total dose of radiation are important factors in formulating a treatment plan. For example, treatment of nasopharyngeal and soft palate tumors present a decreased risk for ORN. Since the body of the mandible is generally not in the field. Therefore, it is less critical to remove mandibular molars prior to initiation of radiation. For lesions in the floor of the mouth, tongue, and tonsillar pillar, and retromolar tumors that require radiation of the major salivary glands and the body of the mandible, there is an increased risk of radiation caries and osteoradionecrosis. Practitioners need to be more aggressive about removal of questionable mandibular molars and premolars prior to radiation. If, due to the size or location of the primary tumor, the goal of radiation palliation, pre-radiation extractions may only be indicated when retention of teeth could cause discomfort. 

A thorough oral examination should be performed, including.

Ø      Full mouth radiographs and a panoramic radiograph

Ø      Identification of periodontal disease

Ø      Bleeding index

Ø      Pocket index

Ø      Tooth mobility

Ø      Assessment of oral hygiene

Ø      Assessment of the patient’s motivation to comply with the necessary preventive regimen

Ø      Identification of all restorative needs

Ø      Carious lesions

Ø      Defective restorations

Ø      Fractured teeth

Ø      Identification of periapical infections, unerupted teeth, root tips, and other pathological conditions

Ø      Preprosthetic surgical needs

Ø      Bony ostosis

Ø      Tori

Ø      Evaluation of prosthetic appliances

Ø      Proper fit and comfort

Ø      Potential sources of irritation

Ø      Removal of soft liners, which become colonized with yeast and can become a source of irritation to friable mucosa.

 

Oral care during radiation

During radiation, patients need to be monitored weekly. Palliative treatment for musositis should be give.

Use of saliva substitutes should be encouraged to lubricate dried mucosal tissues and decrease the chance of traumatic ulceration. Patients can be started on a diet of semisoft food, moistened with liquids or gravies and cautioned to avoid spicy, acidic or mechanically irritating foods. Good oral hygiene and daily fluoride use must be reinforced.

Trismus prevention exercises should be reviewed. Denture wearing should be discouraged, except for obturators.

 

Oral care after radiation therapy

Following the completion of radiation therapy, patients should be observed once or twice during the first month. Then they can be placed on a 3 to 4 month recall schedule. The goal is to prevent radiation caries and periodontal disease, decrease the risk of development of osteoradionecrosis and manage some of the chronic side effects such as xerostomia. The oral mucosa should be examined for areas of irritation or ulceration. If present, the causative agent should be identified and corrected if possible.

 

Conclusion

Review of literature has delineated a vast number of agents that have been identified as effective in prevention and treatment of mucositis in cancer patients. However, no single agent is universally effective. It is extremely important to prevent mucositis or atleast reduce its severity and complications. Any of the available methods should be thus used singly or in combination to get optimum benefit.

LIST OF REFERENCES

 

 

1)      Greenburg MS, Glich M. Burket’s Oral Medicine and Treatment, 10th ed. Noida: Gopson Papers Limited; 2003.

2)      Orad RA, Blanchaert RH. Oral Cancer. The Dentist’s Role in Diagnosis, Management, Rehabilitation and Prevention. 1st ed. London: Quintessence Publishing Co, Inc.; 2000.

3)      Velez I, Tamara LA, Mintz S. Management of oral mucositis induced by chemotherapy and radiotherapy: An update. Quintessence International, Volume 35 (2), 2004; 129-35.

4)      Barker G, Loftus L, Cuddy P, Barker B. the effects of sucralfate suspension and diphenhydramine syrup plus kaolin-pectin on radiotherapy-induced musocitis. Oral Surg Oral Med Oral Pathol 1991; 71: 288-93.

5)      Epstein JB, Moore PS. Benzydamine hydrochloride in prevention and management of pain in oral mucositis associated with radiation therapy. Oral Surg Oral Med Oral Pathol 1986; 62: 145-48.

6)      Stokman MA, Spijkervet FKL, Boezen HM, Schouten JP, Roodenburg JLN, Vries EGE. Preventive Intervention Possibilities in Radiotherapy- and Chemotherapy-induced Oral Mucositis: Results of Meta-analyses. J Dent Res 2006; 85 (8): 690-700.


 

Periodontics - A review ( Basics)

Dr.Rasha Seragelden

Cairo , Egypt

 

The mouth is home to more than 450 species of microorganisms. Most of these are necessary to maintain healthy teeth and gums; in fact, fewer than 5% have been linked to periodontal (gum) infections. Still, even this small number can do significant damage.

The path to gum disease has many steps, beginning with plaque formation;

 "plaque" is an invisible, sticky film that covers your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Although it is removed each time you brush, plaque can reform within 24 hours. Plaque that stays on your teeth for longer than two or three days can harden under your gum line and turn into tartar. This white substance acts as a reservoir for bacteria and makes plaque even more difficult to brush away. Tartar is bound so tightly to teeth that it can be removed only by a professional cleaning.

The longer that plaque and tartar persist, the more damage they inflict. Initially, they may just irritate and inflame the gingiva, the part of the gum around the base of your teeth. This is commonly known as gingivitis and is the mildest form of gum disease. Its trademark signs include bad breath and swollen, red, bleeding, or receding gums.

Left untreated, however, gingivitis can progress to more severe periodontitis. This final stage of gum disease occurs when ongoing gingivitis leads to the development of pockets between your gums and teeth that fill with more plaque, tartar, and bacteria. Over time, these pockets can spread under your gum tissue and cause infections that may result in tissue or tooth loss.

 

Heart disease.

Researchers have discovered that people with periodontal disease are much more likely to suffer from coronary artery disease than those without the disease.

 

Scientists have advanced several theories to explain the link between periodontal disease and heart disease. One theory holds that inflammation caused by periodontal disease leads to impaired functioning of the vascular endothelium, which contributes to arterial disease.

Still another hypothesis is based on several studies showing that periodontal infections can be correlated with increased levels of inflammatory mediators, such as fibrinogen, C-reactive protein, or cytokines, which have been correlated with increased risk of cardiovascular disease.

 

Stroke.

The presence of gum disease also may increase risk of stroke. Previous research found that the severity of gum disease is proportionally related to the amount of arterial plaque located in the carotid arteries, the two major arteries on each side of the neck that supply blood to the brain. Blockage here may reduce blood flow to the brain or advance blood clots, which can lead to a stroke. A 2005 study from the University of Minnesota found a direct link between high levels of bacteria that cause gum disease and thickness of the carotid arteries. This research stands out as the first to link atherosclerosis with the type of bacteria that causes gum disease, and not with other oral bacteria.

 

Diabetes.

 Diabetes is associated with increased risk of infection, which may include oral infections such as periodontitis. Researchers have noted that periodontal disease is a common complication of diabetes. In fact, people with type I or type II diabetes are more susceptible to severe, progressive periodontal disease than non-diabetic individuals.

Studies suggest that periodontal disease may adversely affect blood sugar control in people with diabetes. Controlling periodontal infection in diabetic individuals has been found to help improve blood sugar control, as measured by a decreased demand for insulin and decreased levels of hemoglobin A1C, a marker of long-term blood sugar control.

Measures to combat complications of diabetes, especially periodontitis and gingivitis, may be important in reducing additional systemic inflammatory burden, thus potentially preventing other conditions such as cardiovascular disease.

 

Premature and low-weight births.

New findings indicate that gum disease can affect the health of pregnant women and their unborn children. A University of Chile study found that women with gingivitis were at higher risk of delivering premature infants and low-weight babies than women with healthier gums. The likely reason is that periodontitis or gingivitis bacteria contribute to an inflammatory response of the placental membrane, which may induce

preterm labor. Periodontal treatment reduced the risk of premature and low-weight births in women with pregnancy-related gum disease.

 

Other conditions.

 Gum disease may also contribute to other physical problems. For instance, some evidence suggests that periodontal disease may contribute to lung infections like pneumonia, or may worsen chronic conditions such as emphysema.

Experts believe this may be due to oral bacteria that move into the airways of the throat and lungs. Poor oral health may also accompany poor joint health. People with moderate to severe periodontitis experience an increased risk of rheumatoid arthritis. Gum disease is also present in many patients who suffer from juvenile idiopathic arthritis.