Biomedical subjects

Scott S DeRossi

Publications and source records attributed to Scott S DeRossi.

16 recordsLinked to original sources

PubMed2006

The anesthetic efficacy of 4 percent articaine 1:200,000 epinephrine: two controlled clinical trials.

OBJECTIVE: The authors conducted two double-blinded, randomized, multicenter clinical trials to determine the efficacy and clinical anesthetic characteristics of 4 percent articaine hydrochloride (HCl) with 1:200,000 epinephrine (A200) as compared with those of 4 percent articaine HCl with 1:100,000 epinephrine (A100) and 4 percent articaine HCl without epinephrine (Aw/o). METHODS: During separate testing sessions, members of the authors' research team used three articaine study formulations to induce either inferior alveolar nerve block anesthesia (Trial 1) or maxillary infiltration anesthesia (Trial 2). In each trial, subjects received, in a randomized sequence, each of the three formulations to determine efficacy (success rate) and anesthetic characteristics (onset time and duration). The authors evaluated pulpal anesthesia via subjects' response to electric pulp testing (EPT). RESULTS: A total of 126 subjects were enrolled in the two studies (63 subjects in each trial). In both mandibular and maxillary trials, the success rates for inducing profound anesthesia (EPT score > 80), the mean onset times and the mean durations of anesthesia were similar for both epinephrine-containing formulations (A200 and A100). In subjects who received the formulation containing no epinephrine (Aw/o), the success rate for profound anesthesia was significantly less. CONCLUSION: These studies demonstrated that the inclusion of epinephrine in 4 percent articaine anesthetic formulations is essential for achieving profound anesthesia. The authors found that the A200 formulation provided a level of pulpal anesthesia comparable with that of the A100 formulation.

Adult↗

PubMed2005

Lichen planus, lichenoid drug reactions, and lichenoid mucositis.

Lichen planus is a common mucocutaneous disease affecting a significant portion of the general population. This article reviews the most current concepts on the epidemiology, etiology, pathogenesis, clinical presentations, and treatment of oral lichen planus, lichenoid drug reactions, and lichenoid mucositis.

Humans↗

PubMed2005

A study of benzocaine gel dosing for toothache.

OBJECTIVE: This pilot study evaluated subject compliance with a proposed OTC label with improved dosing directions for self-application of a 20% benzocaine gel for toothache pain, and assessed the methodology for evaluating efficacy in a future pivotal study of benzocaine gel. It was hypothesized that > or = 75% of subjects would apply < or = 400 mg of product (80 mg benzocaine). Exploratory analyses of efficacy were also performed. METHODOLOGY: Thirty patients with spontaneous pain of moderate or severe intensity from a single tooth due to caries, a lost restoration, or a fracture entered this randomized, parallel group, double-blind study. Before self-applying 20% benzocaine gel or placebo, patients read a label containing new dosing directions, including a picture of how much product to apply to their tooth and the surrounding gingival tissues. The amount applied was determined by weighing the tube before and after dosing. Following dosing, pain intensity and relief were recorded every five minutes through 30 minutes, then every ten minutes through 120 minutes. Responders were defined as those subjects who experienced at least a one-unit reduction in pain intensity from baseline at two consecutive time points within the first 20 minutes. Onset of meaningful relief was recorded using a stopwatch. The percentage of responders was compared using the Mantel-Haenszel test. ANOVA was employed to test for differences in Pain Relief Combined with Pain Intensity Difference (PRID), and the areas under the curve at 30, 60, 90, and 120 minutes for this measure (SPRID). Median onset and duration times were compared using the Cox proportional hazards model. Adverse events were recorded if and when they occurred. RESULTS: It was found that 86.7% of the subjects (26/30) applied < or = 375 mg of product (mean +/- SD = 327.7 +/- 276.8 mg). The benzocaine group had a significantly higher (p = 0.022) responder rate (86.7%) than the placebo group (46.7%). Significant differences in favor of the benzocaine group were also recorded for PRID at 10, 15, and 30 minutes (p < 0.05) and SPRID-30 (p = 0.037). Median onset and duration times were 8.3 minutes and > 115 minutes for the benzocaine group, >120 minutes and 5 minutes for the placebo group. There were no adverse events recorded in the study. CONCLUSION: The improved dosing directions resulted in a high percentage of subjects self-applying an appropriate amount of benzocaine gel or matching placebo. The label and study methodology appear suitable for a pivotal dose-response study in subjects with toothache pain. While the current study was not statistically powered to make firm efficacy conclusions, 20% benzocaine gel appeared more efficacious than placebo, providing a rapid onset of pain relief and a relatively long duration of action.

Adolescent↗

PubMed2004

The management of oral human papillomavirus with topical cidofovir: a case report.

Cidofovir, a purine nucleotide analog of cytosine, has showed significant promise against a number of DNA viruses. In 1997, the US Food and Drug Administration approved the use of cidofovir intravenously in the treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome. Recent studies and reports suggest that a topical form of cidofovir may be useful for treating viral cutaneous lesions recalcitrant to traditional treatments. We report the case of a 36-year-old man with human immunodeficiency virus (HIV) and recalcitrant human papillomavirus (HPV) lesions on the gingiva that were successfully treated with cidofovir gel 1%.

Administration, Topical↗

PubMed2003

Efficacy and tolerability of an intraoral benzocaine patch in the relief of spontaneous toothache pain.

OBJECTIVE: In this randomized, double-blind, placebo-controlled clinical trial, the effectiveness and tolerability of a novel intraoral benzocaine patch was evaluated in 60 patients who presented to the Dental School's emergency clinic with spontaneous toothache pain of at least a moderate intensity. METHODOLOGY: Mucoadhesive patches, containing either 12 mg of benzocaine or a matching placebo, were applied approximately two millimeters apical to the mucogingival junction of the symptomatic tooth and remained in place for 60 minutes. Pain intensity (0-4 scale) and pain relief (0-4 scale) were recorded every five minutes through 30 minutes, and then every ten minutes through the 90-minute time point. The onset times of first perceptible and meaningful relief were recorded using two stopwatches. The occurrence of adverse events was also monitored. RESULTS: While the benzocaine patches were numerically superior to the placebo patches at all time points with respect to pain relief, PID (pain intensity difference) and their summed measures (TOTPAR and SPID scores), an analysis of covariance revealed no significant differences between treatments. Survival analysis indicated that the percentage of patients reporting meaningful pain relief by 30 minutes was significantly (p < 0.05) greater in the benzocaine group than in the placebo group (77% for benzocaine and 47% for placebo). The median onset times to first perceptible and meaningful relief were 5.4 and 18.1 minutes in the benzocaine group, and 7.8 and 30.4 minutes in the placebo group. Only two side effects (headache) were reported in the entire study. CONCLUSION: Although the results of the present study were promising, further research on this novel delivery system of benzocaine is warranted to firmly establish efficacy in patients with spontaneous toothache pain.

Administration, Oral↗

PubMed2003

Burning mouth syndrome. A retrospective analysis of clinical characteristics and treatment outcomes.

Burning mouth syndrome is a condition characterized by burning sensations of the oral cavity in the absence of physical abnormalities of the mucosa or a detectable underlying medical disorder. It is a multifactorial disorder with unclear etiology, affecting predominatly middle-aged women. Multiple approaches to treatment have been described in the literature, with few controlled clinical trials regarding their efficacy. The objectives of this retrospective study were to: 1. determine the epidemiologic characteristics of BMS patients referred to an oral medicine practice; 2. determine if BMS classification correlates with response to treatment; 3. determine the efficacy of a variety of known therapies for BMS. A database was constructed from the charts of 150 consecutive patients diagnosed with BMS; and these charts were reviewed. Patients were classified according to previously published criteria for BMS. Presumed etiologies were grouped into depression/anxiety-associated; hematinic deficiencies, including iron, folate and vitamin B complex; oral habits: and idiopathic BMS. Treatment approaches were divided into seven categories: soft desensitizing appliance; tricyclic antidepressants (TCA); benzodiazepines (BZD); topical analgesics; hematinic supplements; habit awareness counseling; and multi-modal therapy (combining two or more of the above). Improvement was recorded using a zero to 100% VAS scale and classified as no relief (0%); mild (0-40%); meaningful/moderate (41-80%); and profound relief (81-100%). Burning mouth syndrome without any identifiable cause (idiopathic) was diagnosed in 33 patients (46.6%). Patients were followed up at one month (4 weeks) after the initial visit. Nine patients (12.7%) reported profound relief; 17 patients (23.9%) reported meaningful relief; 39 patients (54.9%) reported mild relief. This retrospective review showed no significant correlation between classification of BMS and response to therapy. The most effective treatment modalities were habit awareness, followed by TCAs.

Adult↗

PubMed2003

Desquamative gingivitis: early presenting symptom of mucocutaneous disease.

Desquamation of the gingiva is a sign that may be encountered in clinical practice. Various diseases can affect the gingival tissues. Mild desquamation that is localized may be associated with mechanical irritation or induced by trauma. Moderate to severe generalized desquamation associated with ulceration and erythema may be indicative of a more serious systemic condition. Although often overlooked, mucocutaneous diseases frequently present with gingival desquamation as an early presenting symptom. The most common mucocutaneous diseases that affect the oral cavity are lichen planus, pemphigus, and mucous membrane pemphigoid. This article reviews the etiology, signs and symptoms, and therapies for these disorders. Increased knowledge of mucocutaneous diseases can help the clinician recognize these disorders and enable the patient to receive appropriate therapy.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2003

Mucous membrane pemphigoid. Update for the general practitioner.

A common patient complaint that may be encountered in practice is desquamation of oral tissue. Moderate-to-severe, generalized oral desquamation associated with ulceration and erythema could be associated with systemic mucocutaneous disease. Systemic mucocutaneous diseases that affect the oral cavity include lichen planus, pemphigus and mucous membrane pemphigoid. This article will review the etiology, clinical presentation and management of mucous membrane pemphigoid.

Diagnosis, Differential↗

PubMed2002

Antibiotics and oral contraceptives.

With the exception of rifampin-like drugs, there is a lack of scientific evidence supporting the ability of commonly prescribed antibiotics, including all those routinely employed in outpatient dentistry, to either reduce blood levels and/or the effectiveness of oral contraceptives. To date, all clinical trials studying the effects of concomitant antibiotic therapy (with the exception of rifampin and rifabutin) have failed to demonstrate an interaction. Like all drugs, oral contraceptives are not 100% effective with the failure rate in the typical United States population reported to be as high as 3%. It is thus possible that the case reports of unintended pregnancies during antibiotic therapy may simply represent the normal failure rate of these drugs. Considering that both drug classes are prescribed frequently to women of childbearing potential, one would expect a much higher rate of oral contraceptive failure in this group of patients if a true drug:drug interaction existed. On the other hand, if the interaction does exist but is a relatively rare event, occurring in, say, 1 in 5000 women, clinical studies such as those described in this article would not detect the interaction. The pharmacokinetic studies of simultaneous antibiotic and oral contraceptive ingestion, and the retrospective studies of pregnancy rates among oral contraceptive users exposed to antibiotics, all suffer from one potential common weakness, i.e., their relatively small sample size. Sample sizes in the pharmacokinetic trials ranged from 7 to 24 participants, whereas the largest retrospective study of pregnancy rates still evaluated less than 800 total contraceptive users. Still, the incidence of such a rare interaction would not differ from the accepted normal failure rate of oral contraceptive therapy. The medico-legal ramifications of what looks like at best a rare interaction remains somewhat "murky." On one hand, we have medico-legal experts advising the profession to exercise caution and warn all oral contraceptive users of a potential reduction in efficacy during antibiotic therapy. These opinions are not evidence-based and rely heavily on one or two legal proceedings that cannot even be substantiated. On the other hand, there is one recently published legal proceeding in which the outcome was in favor of the oral surgeon. There is clearly a need for additional scientific research in oral contraceptive users that incorporates larger sample sizes, different time courses (prophylactic use versus standard 7-10 day use versus extended use), and different delivery systems (systemic administration versus local-controlled delivery) of antibiotic therapy. Though experts on this topic still recommend informing oral contraceptive users of the potential for a rare interaction, and for clinicians to advise them to employ additional barrier techniques of birth control during antibiotic therapy and for at least 1 week beyond the last dose [40], it is hoped that a set of guidelines regarding this controversy will eventually be published that is evidence-based, and not solely the results of anecdotal reports, expert opinions, and legal proceedings.

Anti-Bacterial Agents↗

PubMedDate not supplied

Oral lichen planus. Update for the general practitioner.

There are a variety of dermatologic disorders that commonly present in the oral cavity. Among these is lichen planus which may affect the oral mucous membranes. Dentists need to be familiar with the clinical presentations of this disease. This article will review the common signs and symptoms of oral lichen planus, and will discuss the tools and criteria used to diagnose this disorder. We will also described the modalities available to clinicians to treat this disease.

Administration, Topical↗

PubMedDate not supplied

Pemphigus: update for the general practitioner.

Pemphigus is a dermatologic disease that can affect both the skin and mucous membranes. Pemphigus affects the oral cavity; the most common form of the disease that is observed clinically is pemphigus vulgaris. Oral lesions may precede skin lesions; therefore, it is imperative that clinicians are aware of the clinical signs and symptoms of this disorder. This article will review the etiology, symptomatology, diagnostic tools, and treatments available to diagnose and manage this disease.

Glucocorticoids↗

PubMedDate not supplied

Burning mouth syndrome: a guide for the general practitioner.

A commonly misdiagnosed condition, burning mouth syndrome (BMS) is characterized by burning sensations of the oral cavity in the absence of physical abnormalities of the oral mucosa. BMS affects middle-aged women predominantly. This condition has a multifactorial etiology, although several conditions have been associated with BMS, including depression/anxiety, hematinic deficiencies (iron, folate, and vitamin B complex), oral habits such as tongue thrusting and bruxism, and idiopathic BMS. Multiple approaches to treatment have been described in the literature, although few controlled clinical trials have been designed to determine their efficacy. This article examines BMS, its related factors, and treatment options available to the general dentist.

Burning Mouth Syndrome↗

PubMedDate not supplied

Temporomandibular disorders and fibromyalgia: comorbid conditions?

Temporomandibular disorders (TMDs) and fibromyalgia (FM) are two clinical conditions prevalent in today's society. Many individuals suffer from chronic pain in various muscle groups, including the muscles of mastication. Previously, TMDs and FM were thought to be separate, unrelated clinical entities. New research has shown a possible link between the two conditions; this article sheds light on possible correlations between them.

Fibromyalgia↗

PubMedDate not supplied

Temporomandibular joint disc disfigurement and abnormal thickening of the posterior band.

Temporomandibular joint (TMJ) disc disfigurement is a common finding associated with various stages of disc displacement and injury. However, in most cases, the clinical diagnosis of disc displacement without reduction may not be readily apparent due to either a delay in patient presentation or lack of early imaging of the disc. The case of a 22-year-old woman with a history of TMJ disorder, seeking treatment for a history of unilateral posterior open bite and bilateral jaw pain, is described.

Adult↗

PubMedDate not supplied

Herpes simplex and varicella-zoster infections: clinical and laboratory diagnosis.

One of a dentist's most common diagnostic challenges is determining the cause of vesiculo-ulcerative disorders of the oral cavity. The most common etiology of oral vesicles is herpes simplex virus (HSV) infection. Varicella-zoster virus (VZV) is a less common etiology of vesicles in the oral cavity. Dentists often are able to differentiate these two viruses based on the clinical presentation of infectious symptoms; however, further laboratory testing is required to identify herpetically induced vesiculo-ulcerative lesions definitively. This article reviews the basic clinical signs and symptoms of HSV and VZV infection and describes the various laboratory tests that can determine the definitive etiology of the vesiculo-ulcerative disorder.

Cytodiagnosis↗

PubMedDate not supplied

A review of adverse oral reactions to systemic medications.

There is no debate that oral health and general well-being are inextricably bound. Many commonly prescribed medications have associated dental and oral manifestations that often are nonspecific and can vary in significance. This article reviews many common oral manifestations of systemic drugs, including the clinical manifestations, diagnosis, and treatment of these conditions.

Drug-Related Side Effects and Adverse Reactions↗