Critical Summary: Assessing Local Antimicrobials for Chronic Periodontitis

Critical Summary: Assessing Local Antimicrobials for Chronic Periodontitis

A new critical summary by Dr. Robert Durand shows that adjunct local antimicrobials provide statistically significant benefits over subgingival debridement alone in patients with chronic periodontitis.

This is a critical summary of Matesanz-Pérez P, et al. A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis. J Clin Periodontol. 2013;40(3):227-241.

To learn more, visit ADA Center for Evidence Based Dentistry.

Article Considers Optimal Frequency Of Dental X-Rays.

The Huffington Post (CAN) (5/28) reports on how frequently patients need to have dental X-rays. Though X-rays are an important tool for dentists in determining difficult-to-see dental decay, the Huffington Post points out that dentists should generally use the ALARA – as low as reasonably achievable – principal in prescribing X-rays. The Huffington Post also reports that “a document produced for the American Dental Association suggests that an adult with good oral health and low risk of dental problems should have x-rays taken at intervals of every 24 to 36 months.”

Dentists Recommend Replacing Toothbrush Every Three Months At Least.

YourTango (4/15, Drouillard) explores tattoos and body piercings ritualistic and symbolic meaning to those who choose to modify their body in such a way. The article notes that the American Dental Association “opposes tongue, lip or cheek piercing,” and reports that the Mayo Clinic found that 17 percent of college students with piercings “suffered a medical complication such as infection or tearing” as a result of their piercing.

ADA Does Not Recommend Oil Pulling.

In its “Health with Dr. Paula” segment, WTVM-TV Columbus, GA (4/15) reports that despite claims that “oil pulling” offers oral health benefits, “the American Dental Association cautions that because of a lack of evidence, they do not recommend oil pulling as a replacement for standard oral health care such as flossing and teeth brushing.”

Dentists Warn Of Risks Associated With Poor Dental Implant Care.

BBC News (4/14) reports that according to results published in the British Dental Journal, some dentists have warned that they are seeing an increase in peri-implantitis in patients with implants because “patients are often not aware of how to maintain them.” BBC News adds, “If an infection is allowed to take hold around an implant inserted in the gum, the jaw bone around the implant can also become affected and begin to waste away.” The dentists stress that caring for dental implants is no different than practicing regular oral hygiene, despite the perception that dental implants are indestructible, and should include regular flossing, brushing, rinsing with mouthwash, and cleanings by a dentist.

Dislodged Tooth Should Be Placed In Milk Or Patient’s Saliva In Transit To Dentist.

A CBS’ The Doctors (4/7) segment on first aid “dos and don’ts” offered patient advice on what to do if a tooth is dislodged. During the segment, Reader’s Digest editor-in-chief Liz Vaccariello discussed several first aid situations, noting that a tooth that has been knocked out should not be washed or put in any alcohol or peroxide solution. Instead, patients should place the tooth in a container with a small amount of their own saliva or milk. Moreover, during the segment host Dr. Travis Stork advised patients to “get to your dentist as soon as possible, because that tooth could literally be re-implanted and potentially survive if you do the right thing with it.”

Smokeless Tobacco Risks Noted During Oral Cancer Awareness Month.

The Bradenton (FL) Herald (4/14, Dymond) reports that while only a small percentage of dental patients still chew tobacco, about 20 percent still smoke. One local dentist “uses his charm and wit to urge patients to give up” the habits “due to the dangers of both,” especially during April, which is Oral Cancer Awareness Month. Another Florida dentist points out that three of four people she sees who say they use smokeless tobacco present with pre-cancerous lesions in their oral cavity. The Herald reports that the scale “began tipping against dipping after the 2014 death of former San Diego Padre Hall of Famer Tony Gwynn, who contracted salivary gland cancer and attributed it to his habit of using chewing tobacco.” Gwynn was 54.

        Meanwhile, also as part of Oral Cancer Awareness Month, the Athens (GA) Banner-Herald (4/13) reports that North Athens Implant and Family Dentistry is offering free oral cancer screenings through April 17. “People who use tobacco, including smoking cigarettes, and who drink alcohol heavily are at increased risk for oral cancers,” the article notes, adding that such cancers are most prevalent in people over 40.

Surgeon Recommends Regular Dental Visit To Prevent Oral Cancer.

On its website, KOMO-TV Seattle (5/22) profiles public speaker and author Robert Haase, who had successful tongue reconstruction surgery following a diagnosis of tongue cancer. His surgeon, Dr. Robert Bayles of Virginia Mason Medical Center, “said for prevention, people should follow good hygiene habits and see a dentist regularly,” as regular exams can detect oral cancers.

Upper left 2nd molar RCT or Implant

I have been getting different answers by two of my personal dentists (both general DDS) on treatment of my upper left 2nd molar that has sensitivity. Planning ahead I have asked my uncle (DDS, doesn't do implants) and he said that he normally doesn't do RCT on upper 2nd molar because of location and multi canals. My normal doctor said she will refer me out if I want an implant, but can do a RCT. Is this odd? My uncle's not willingness to do RCT. Is it a sign that a Endo should do it? Can general DDS do implant upper 2nd molar?

Before determining treatment, one must  determine the pulp status of the tooth. How many seconds does the  pain to cold linger after ice is put on it then removed? If 3-5 seconds try a desensitizing toothpaste that has 5% Potasium Nitrate, if pain lingers 15-20 seconds the pulp is dying and a root canal or extraction can be done. If the dentists you have seen have not properly tested the tooth ( hot, cold, Elec Pulp Test, percussion, Xray) have them do these tests or see an endodontist who should do them as a standard routine. Once you know that the tooth pulp needs treatment you can decide RCT vs Extraction then decide if you want to replace #15 or not. Good Luck

Skipping Dental Visits, Preventive Health Check-Ups May Prove Expensive

US News & World Report (4/8, Pant) covers five scenarios in which being overly frugal may cost more in the long run. One of those cases is when it comes to a patient’s health, as it “might be tempting to skip a doctor’s appointment or forgo getting your teeth cleaned at the dentist.” However, avoiding preventive care “is ‘false savings,’” since “catching an illness or treating an injury early on is better for your net worth and your well-being,” US News reports. “Visit the doctor and the dentist,” the article says.

ADA Does Not Recommend Oil Pulling.

LiveScience (5/21) reports on oil pulling, noting that the ADA does not recommend oil pulling “as either a supplementary oral hygiene practice, or as a replacement for standard oral health behaviors” due to “a ‘lack of science.’” The ADA “criticizes existing studies” on oil pulling “as ‘unreliable’ for a number of reasons.” LiveScience adds that “possibly the greatest risk of oil pulling is using it to replace time-tested treatments,” though other heath risks are also significant. For instance, Harvard Medical School “found that one out of five Ayurvedic herbal medical products produced in South Asia and available in Boston South Asian grocery stores contains potentially harmful levels of lead, mercury and/or arsenic,” and the ADA “also reported that oil pulling could cause lipoid pneumonia,” diarrhea or stomach upset.

Considers Causes Of Tooth Sensitivity.

Citing ADA spokesperson Dr. Matt Messina extensively, TIME (5/21) reports on why people suffer from tooth sensitivity. Citing Dr. Messina, TIME reports that short-lived cold-induced pain may not be cause for alarm, “but if the pain is persistent and confined to a specific tooth or area of your mouth,” it may be an indicator of a micro-crack, a degraded filling, or a cavity, all of which require a dentist’s attention. If a person has sensitivities to cold, hot and biting pressure “we could also be talking about some sort of infection in the tooth,” Dr. Messina said. Sensitivity may be the result of issues with the gums, as “brushing too forcefully, chewing tobacco or allowing the buildup of plaque can all cause your gums to “run away” from your teeth, resulting in temperature sensitivity, Messina says.” Dr. Messina also said, “The solutions are often simple, but only if we address the problem early.”

ADA Consumer Advisor Discusses Methods For Avoiding Halitosis.

Drawing on comments from ADA consumer advisor and dentist Dr. Sally J. Cram, Men’s Journal (5/7) reports on ways to avoid halitosis. Namely, Men’s Journal reports that Dr. Cram advises patients maintain proper oral hygiene, use a soft bristle toothbrush, use fluoride toothpaste, eat a diet rich in greens, and scrape or brush the tongue. Regarding toothpaste, Dr. Cram said, “It’s also very important to chose toothpastes that have the American Dental Association Seal of Acceptance. This shows that it has been evaluated by someone other than the manufacturer and is safe and effective.”

Prevention, Dental Visits Key To Maintaining Oral Health.

WTVT-TV Tampa, FL (5/7, Chmura) reports on five steps people should take in order to improve and maintain their oral health. “According to a list of prices posted by the American Dental Association, fillings average more than $100 while crowns top $1,000,” although dentists “say those expensive trips could be avoided if only we would do a better job caring for our teeth,” WTVT reports. The steps the article advises include brushing for two minutes twice a day, using a soft-bristle brush, using correct brushing technique, and flossing at least once per day “to prevent an ugly, painful, time-consuming, and likely expensive alternative.”

Study Highlights Need To Rinse, Replace Toothbrush.

Women’s Health (5/5) reports that a study from researchers at the University of Manchester found that “the average toothbrush can contain 10 million or more bacteria,” including E.coli and Staph. The article reports that the study illuminates the importance of properly rinsing and storing one’s toothbrush, as well as replacing it at the proper interval. The article cites American Dental Association spokesperson and dentist Dr. Maria Lopez Howell, who explained that people should rinse their brush thoroughly after use, replace it when the bristles become frayed or after three months of use, and to store it in an upright position “in a spot that gets enough air for it to dry between brushings.”