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IgG rheumatoid factor in dental periapical lesions of patients with rheumatoid disease.

To detect "hidden" IgG rheumatoid factor in tissues from dental periapical lesions, 26 rheumatoid and 14 control patients were examined by the direct immunofluorescence technique for binding of FITC-labelled IgG before and after pepsin digestion. Whereas free rheumatoid factor was detected in only 1 rheumatoid tissue before digestion with pepsin, this tissue as well as 8 other rheumatoid tissues strongly bound heat-aggregated IgG after the digestion procedure. Six of these 9 tissues also bound native IgG. In no control tissue was free rheumatoid factor detected and in only 1 was "hidden" rheumatoid factor revealed after pepsin digestion. Hence, presence of IgG rheumatoid factor correlated positively with the presence of rheumatoid disease, and evidence was established that certain features of rheumatoid inflammation occur in dental periapical lesions of many patients with rheumatoid disease.

Adult↗

Occurrence of amyloid in the teeth-supporting tissues of patients with rheumatoid diseases. An immunohistochemical study.

An investigation was carried out to determine whether amyloid could be detected in the dental periapical lesions or gingival buccal fold, or in both, of patients with rheumatoid disease but in whom amyloidosis had not been diagnosed. Tissue from the dental periapical lesions of 36 rheumatoid and 23 control patients, as well as from the gingival buccal fold of 11 of the rheumatoid and 11 of the control patients, were examined by the direct immunofluorescence technique and by polarization microscopy of sections stained with Congo red. Amyloid was observed almost 5 times more often, or in 19% of the dental periapical lesions of rheumatoid patients: it was detected by immunofluorescence in 7 rheumatoid patients and 1 control patient, and by polarization microscopy in 6 of these 7 rheumatoid patients as well as in the 1 control. Rectal biopsies performed on these 8 patients were positive in only 1 of the rheumatoid patients. Amyloid was not detected in any of the gingival biopsies. Serum samples from the rheumatoid and the control patients were tested for the presence of the nonimmunoglobulin amyloid fibril-related serum component, protein ASC. Nineteen of the 36 rheumatoid patients, including the 7 whose dental periapical lesions contained amyloid, had protein ASC in their serum.

Adult↗

Treatment of teeth with open apices using mineral trioxide aggregate.

Injuries to the dentition may ultimately result in the interruption of root development. If the pulp remains vital following trauma, this state should be maintained and root-end closure should be induced by apexogenesis. When the pulp is necrotic, the placement of an apical barrier can be utilized as an alternative to establish an environment that facilitates the closure of the apical opening. This article demonstrates the use of mineral trioxide aggregate as an apical barrier material for root-end closure in the permanent teeth of three patients.

Aluminum Compounds↗

[A comparative study of application of PCR technique and Porphyromonas gingivalis nucleic acid probe in clinical examination of apical periodontitis].

By PCR technique and Pg nucleic acid probe, the authors investigated the Pg distribution in root canal samples from patients with clinical apical periodontitis and made a comparative study of the two methods. The results showed that: 1. Pg positive rate of apical periodontitis samples by PCR examination was 74% and that of by nucleic acid probe examination was 76%, and their total coincidence rate reached 94%; 2. between comparative groups there was no significant difference (P > 0.05) in all data by two examination methods; 3. Pg was closely related with clinical symptoms of apical periodontitis such as spontaneous pain, percussion pain, fetidity and periapical abscess. This indicates that the two methods are accurate, quick and convenient and can both be used in direct examination of clinical samples.

Adolescent↗

Microbiologic and pathologic aspects of pulpal and periapical disease.

The greatest cause of endodontic and periapical pathosis is microbial infection of the pulp. Most odontogenic infections are of a polymicrobial nature. With advances in anaerobic isolation and culturing techniques, much has been learned about the presence of pathogenic organisms such as Porphyromonas and Prevotella species (formerly classified as black-pigmented Bacteroides species) in infected root canals. This review provides a summary of recent developments in endodontic microbiology, virulence factors, and host defense systems as they relate to the pathogenesis of pulpal and periapical inflammatory lesions.

Actinomyces↗

[The pathomorphology of chronic apical periodontitis].

The clinical, roentgenological and histopathological diagnoses of thirty apical processes are compared. The paper also discusses certain histopathological characteristics. As a result of these investigations, a proposal is made to modify the classification of chronic apical processes.

Chronic Disease↗

Endodontic diagnosis. Mystery or mastery?

UNLABELLED: Review of 6 clinical distinctions: (1) Symptom: "anything under the sun." DIAGNOSIS: pulp exposure. Duplicate: clinical or radiographic pulp exposure evidence. TREATMENT: endodontics or pulp cap under strict protocol conditions. (2) Symptom: "cold." DIAGNOSIS: hyperemia. Duplicate: ice. TREATMENT: pulp protection or endodontics. (3) Symptom: "heat." DIAGNOSIS: pulpitis. Duplicate: heat. TREATMENT: pulpotomy for multirooted teeth or pulpectomy for single-rooted teeth. Schedule endodontic completion. (4) Symptom: "I recently had a toothache and now it is gone." DIAGNOSIS: necrosis. Duplicate: Electric Pulp Test and ice are negative. TREATMENT: endodontics. (5) Symptom: "I had a toothache awhile back and now it is gone." DIAGNOSIS: LEO. Duplicate: Electric Pulp Test, ice, and test cavity are negative. TREATMENT: endodontics. (6) Symptom: "It really hurts to touch my tooth." DIAGNOSIS: percussion. Duplicate: may or may not have a LEO and may or may not have cellulitis. TREATMENT: reduce occlusion, access cavity, water chew, and schedule to finish endodontics. If these tests are carefully performed, then they are objective and the doctor does not have to be in a subjective situation. A newfound sense of endodontic diagnostic mastery is experienced. Perhaps the best way to summarize the simplicity of this clinical diagnostic scheme is to quote Sherlock Holmes: "Nothing is more deceptive than the obvious."

Dental Pulp Diseases↗

Mandibular endodontic-related paresthesia.

A 57-year-old woman sought treatment for mandibular swelling (of two weeks duration), pain, and paresthesia in the region of the left canine and first premolar. The teeth had undergone endodontic therapy; in addition, they partially supported a long-span fixed partial denture. The patient was concerned about the possibility of a serious neoplastic condition. The initial panoramic radiograph demonstrated a large periapical pathology area associated with the first premolar. Eventually, both the canine and first premolar teeth were retreated, although the paresthesia did not resolve for approximately four months. A brief review of endodontic-associated paresthesia is provided, along with a description of the therapy and postoperative radiographs taken 20 months later.

Bicuspid↗

Isolation and classification of anaerobic bacteria from pulp cavities of nonvital teeth in man.

The anaerobic microflora of infected pulp cavities and chronic periapical abscesses was studied. A total of 19 infected nonvital teeth were subjected to this study. The coronal surface was swabbed with 70% ethanol to remove debris and to disinfect. Material in root canal chamber was obtained by sterilized paper points and suspended in reduced transport fluid. The samples were dispersed, diluted, and inoculated on blood agar plates. Isolates were identified by colony characteristics and cellular morphology, fermentation, indole production, nitrate reduction, gelatin digestion, urease production, ability to grow aerobically, API 20A System, and API ZYM System. Anaerobic bacteria were found in 14 pulp cavities. Anaerobic gram-negative rods, Actinomyces species, and Propionibacterium species were predominant in the root canals. Mixed infection with anaerobes and facultative anaerobes were demonstrated in most of the pulpal cavities of nonvital teeth.

Bacteria, Anaerobic↗

Surgical management of endodontic failures: indications and treatment results.

Two-hundred and twenty-four teeth with failures after conventional endodontic treatment were treated by periapical surgery by one surgeon and followed up for 1-8 years. Indications for surgery were: inaccessibility to the apical part of the root by a coronal approach due to posts, calcifications or procedural accidents. Cysts, a few acute cases and wide-open apices were also treated surgically. Healing was judged radiographically and classified into one of four healing groups: (1) complete healing, (2) incomplete healing (scar tissue); (3) uncertain healing, and (4) unsatisfactory healing. The grouping was performed separately by the oral surgeon and an endodontist. Deviating cases were then evaluated jointly, difficult cases and borderline cases were judged by an oral radiologist. Complete healing was observed for 76.6 per cent and incomplete healing (scar tissue) for 8.1 per cent of the teeth. The size of the latter group was strongly influenced by the number of cases with large preoperative rarefaction. A success/failure grouping of the material (success = complete and incomplete healing) revealed that 27 per cent of the retrofilled cases failed compared with 3.6 per cent in the orthograde group. The main conclusion is that retrofills should be avoided whenever possible.

Apicoectomy↗

[Inflammatory odontogenic lesions of the jaws].

The apical granuloma, the periapical abcess and the radicular cyst are the most frequent between the inflammatory odontogenic lesions of the jaws. These three lesions are caused by the necrosis of the pulp but are very different between each other from an histological point of view and they can correspond to different stages of the same pathological process considering the fact that from a granuloma can arise a periapical abcess or a radicular cyst and from a radicular cyst and abcess can originate. About these three pathological processes we discuss in this article the clinical, radiographical, ethiological, microscopical features, we suggest the treatment and the differential diagnosis.

Bone Resorption↗

[The relationship of pulp and periodontal disease in patients in a specialty clinic].

This paper describes an epidemiological-clinical study performed at the Iztacala School of Professional Studies, a dependency of the National Autonomous University of Mexico. Records of 2,733 patients treated over a four year period were analyzed so as to examine the relationship between pulp and periodontal diseases, both of which are extremely prevalent in the Mexican population. On the basis of results thus yielded, it was possible to make specific recommendations regarding dental care following diagnosis.

Dental Pulp Diseases↗

Odontogenic sinus tracts.

Odontogenic sinus tracts are the most common cause of a chronically draining, fixed, nodulocystic papule of the face and neck. Injury or disease of a tooth may result in a periapical abscess that subsequently dissects along the path of least resistance and erupts through the skin. If recognized early, the sinus tract usually resolves after appropriate endodontic therapy or extraction.

Adult↗