Root canal treatment work still favored for badly damaged teeth

 

Few patients regret having a severely damaged tooth saved by a root canal filling. A University of Gothenburg thesis shows that 87 percent would choose the same treatment again, if in need, although pain and discomfort around the tooth are common.

The reason for getting a root filling is often that the soft tissue inside the tooth, the dental pulp, is inflamed or infected. The root canal treatment is carried out in stages, on several occasions. Soft parts are removed and the root canals are finally filled with a combination of a natural, rubberlike material (gutta-percha) and a kind of cement.

Despite generally good oral health, root canal treatment is still a common and necessary measure. In Sweden, as in most countries, most root canal treatments are performed by general dental practitioners in the public or private sector.

For her PhD thesis, dentist Emma Wigsten of the Institute of Odontology at Sahlgrenska Academy, University of Gothenburg, studied various aspects of root canal treatments performed in Swedish general dental practice, with the Public Dental Service in Region Västra Götaland as a base.

Molars difficult to treat

In several of the component studies in Wigsten’s compilation thesis, data on a patient group initially numbering 243 were analyzed. They had all started root canal treatment at one of the 20 public dental clinics in the region. The patients were then followed up for one to three years.

Most of the root canal treatments studied were prompted by toothache in teeth with caries and large restorations, which culminated in root fillings within a year. Molars were an exception: only just over half of the root fillings met their purpose and, as a result, many molars had to be removed (i.e. extracted).

“It seems harder to get a good result in treating the molars, despite time and resources invested. Root canal treatment is complicated: You’re working inside the tooth where you can’t see anything, and the further back you go in the mouth, the more difficult it becomes,” Wigsten says.

“Root canal treatments of molars involve significantly bigger challenges than other tooth groups. So it may be important to investigate whether root canal treatments of molars should be performed to a greater extent by dentists specializing in root canal treatment.”

Satisfaction and quality of life

Half of the patients stated that they had mild pain or discomfort from their root-filled tooth during the follow-up period of up to three years. Nevertheless, the great majority (87 percent) were satisfied. They did not regret their choice to get root canal treatment instead of a tooth extraction.

Another component study, at six public dental clinics in Region Västra Götaland, covered 85 patients in whom either root canal treatment was started or a tooth was removed. An improved health-related quality of life was observed in the patients who started root canal treatment, but not in those who underwent a tooth extraction.

“The studies show that the patients' quality of life benefited from root canal treatment. On the other hand, it’s unclear whether the treatment is cost-effective compared with tooth removal, especially where molars are concerned,” Wigsten concludes.

Title: Root Canal Treatment in a Swedish Public Dental Service: Studies of indications and results, http://hdl.handle.net/2077/68698

Oral health can be an additional, modifiable risk factor for high risk COVID-19 patients

 The correlation between poor oral health and COVID-19 severity, as well as the correlation between oral health and delayed recovery, demonstrates a potential need to consider oral health an additional risk factor for cardiac patients who may contract COVID-19. The new sub-study, examining Egyptian cardiac patients, will be presented at ACC Middle East 2021, a hybrid meeting held in partnership by the American College of Cardiology, Egyptian Society of Cardiology and the ACC Egypt Chapter on Oct. 14-15, 2021.

The oral cavity is a potential reservoir for respiratory pathogens. Previous trials have linked poor oral hygiene with increased inflammation and cardiovascular disease. According to the researchers, COVID-19 severity has also been linked to an inflammatory response.

The researchers hypothesized that increased COVID-19 severity may be linked to poor oral health status, especially in patients with cardiovascular diseases. According to the study authors, the study assessed oral health status, severity of COVID-19 symptoms, C-reactive protein (CRP) levels and duration of recovery.

“Oral tissues could act as a reservoir for SARS-CoV-2, developing a high viral load in the oral cavity. Therefore, we recommended maintenance of oral health and improving oral hygiene measures, especially during COVID-19 infection,” said Ahmed Mustafa Basuoni, MD, cardiology consultant at Cairo University and lead author of the study. “Simple measures like practicing proper oral hygiene, raising awareness of oral health importance either in relation to COVID-19 infection or systemic diseases by using media and community medicine, regular dental visits, especially in patients with CVD, and using [antimicrobial] mouthwashes [could help in] preventing or decreasing the severity of COVID-19 disease.” 

The study included 86 Egyptian heart disease patients with a confirmed COVID-19 PCR test. Using a questionnaire, researchers from Cairo University assessed oral health and COVID-19 severity. An oral health score was used to determine the effect of oral health on COVID-19. Data on CRP levels and COVID-19 PCR tests were collected via the questionnaire and confirmed via medical records. CRP levels are used to determine when there is inflammation in the body.

According to the researchers, the correlation between oral health and COVID-19 severity showed a significant inverse relationship, as did the correlation between oral health with recovery period and CRP values. Poor oral health was correlated to increased values of CRP and delayed recovery, especially in patients with cardiac diseases.

“Oral health should be a part of routine history taking and examination in cardiac patients,” Basuoni said. “Lifestyle measures should be instructed to all cardiac patients regarding good oral hygiene with regular dental visits. We need to give more space in research for these risk factors which can be easily modified.”

Survey of US dentists shows high rate of opioid prescriptions despite knowledge of effective alternatives

 

- A survey of dentists in the United States finds that an overwhelming majority of those who responded believe nonsteroidal anti-inflammatory drug (NSAID)-acetaminophen combinations are as effective or more effective in managing dental pain as opioids; however, almost half say they still prescribe opioids.

The results of the survey, conducted by PharmedOut at Georgetown University Medical Center with  undergraduate students at Georgetown University School of Nursing & Health Studies, were published October 21 in The Journal of the American Dental Association.

“These results suggest that dentists are familiar with the evidence about the effectiveness of NSAID-acetaminophen medications, but their self-reported prescribing patterns demonstrate a disconnect,” says Matthew Heron, the first author who conducted the research as an undergraduate at Georgetown’s School of Nursing & Health Studies.

Previous studies find that dentists comprise 15.8% of opioid prescribers and prescribe 8.6% of opioid medications in the United States. Dentists are the highest prescribers of opioids to patients 18 years and younger.

“We know that the first exposure to opioids for many people occurs in their teens and early 20s following  common dental procedures like third molar extractions,” says Nkechi Nwokorie, who also conducted the work as an undergraduate at Georgetown. “This is a particularly vulnerable population for misuse.”

The Georgetown researchers received 291 survey responses and analyzed 269 completed surveys. Although 84% of respondents reported believing that NSAID-acetaminophen combinations are equally as effective or more effective than opioids, 43% of respondents also reported regularly prescribing opioid medications.

“This underscores the need for more education about the harms of opioids and the need for national guidelines to align clinical practice with current evidence,” concludes Adriane Fugh-Berman, MD, a professor in the departments of pharmacology & physiology, and family medicine at Georgetown University Medical Center. Fugh-Berman is also the director of PharmedOut.

Study: Heartburn drugs may have unexpected benefits on gum disease

 

The use of heartburn medication is associated with decreased severity of gum disease, according to a recent University at Buffalo study.

The research found that patients who used proton pump inhibitors (PPIs) – a class of drugs commonly prescribed to treat heartburn, acid reflux and ulcers – were more likely to have smaller probing depths in the gums (the gap between teeth and gums). When gums are healthy, they fit snuggly against the teeth. However, in the presence of harmful bacteria, the gap deepens, leading to inflammation, bone loss and periodontitis, also known as gum disease.

The findings, published last month in Clinical and Experimental Dental Research, may be linked to the side effects of PPIs, which include changes in bone metabolism and in the gut microbiome, says lead investigator Lisa M. Yerke, DDS, clinical assistant professor in the Department of Periodontics and Endodontics at the UB School of Dental Medicine.

“PPIs could potentially be used in combination with other periodontal treatments; however, additional studies are first needed to understand the underlying mechanisms behind the role PPIs play in reducing the severity of periodontitis,” says Yerke.

Additional investigators include first author and UB alumnus Bhavneet Chawla, and Robert E. Cohen, DDS, PhD, professor of periodontics and endodontics in the UB School of Dental Medicine.

The study sought to determine whether a relationship exists between PPI use and gum disease. The researchers analyzed clinical data from more than 1,000 periodontitis patients either using or not using PPIs. Probing depths were used as an indicator of periodontitis severity.

Only 14% of teeth from patients who used PPIs had probing depths of 6 millimeters or more, compared to 24% of teeth from patients who did not use the medication. And 27% of teeth from patients using PPIs had probing depths of 5 millimeters or more, compared to 40% of teeth from non-PPI users, according to the study.

The researchers theorized that PPIs’ ability to alter bone metabolism or the gut microbiome, as well as potentially impact periodontal microorganisms, may help lessen the severity of gum disease.

Additional studies are under development to determine if this relationship can be found in other populations of patients with gum disease, and to learn to what extent the relationship can be directly attributed to PPIs, says Yerke.

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JOURNAL

Clinical and Experimental Dental Research

DOI

https://doi.org/10.1002/cre2.495 

ARTICLE TITLE

Association between proton pump inhibitors and periodontal disease severity