What Are Direct and Indirect Pulp Caps?

An indirect pulp cap is usually done to take  the place of a root canal in very decayed teeth.  It is made when most of the decay on the permanent tooth is removed.  When a dentist finds extensive decay very close to the pulp (nerve,) the risk of the pulp exposition by the infected decay is high.  This infection will result in the need for a root canal.  In this case dentists leave the last little bit of decay in there and place a sedative temporary filling.  Usually Intermediate Restorative Material (IRM) is used as a temporary filling material until the patient is ready for a proper, more permanent restoration. 

After a few months, the temporary filling and the decay are removed.  If the tooth has no signs or symptoms of pulpal necrosis or abscess and has a good blood supply, the pulp may repair itself.  When the bulk of the nasty decay is removed and just a small part is left but is limited, it has no nourishment from the mouth, so how is this possible?  After this procedure the remaining decay can be removed without pulp exposure.

This dental procedure is not always effective, but in some cases the dentist should attempt it; it is more likely to work in a younger patient.

Unlike an indirect pulp cap, during a direct one, an actual exposure of the pulp takes place.  For the stimulation of the secondary dentin formation a medicament like Calcium hydroxide or Mineral Trioxide Aggregate (MTA) is placed inside.  With a direct pulp cap no evident decay is left, but it leads to small mechanical or traumatic exposures.

Researches proved: professional tooth scaling reduces the risk of heart attacks and strokes

Professional tooth scaling was associated with fewer heart attacks and strokes in a study from Taiwan, presented at the American Heart Association's Scientific Sessions 2011.

More than 100,000 people took part in the seven year study. Gender, age, and health conditions were all considered when accepting the participants. One half of them had their teeth professionally scarped and cleaned at least once a year, the other half had no tooth scaling.

None of the participants had a history of heart attack or stroke at the beginning of the study. Weight, smoking, and race were not adjusted in this research as they were not included in the Taiwan National Health insurance data base – the source of the information for the analysis.

A 24% lower risk of heart attack and 13% lower risk of stroke were found among people who had tooth scaling by a dentist, compared to those who had never had a dental cleaning.

Several types of the relationships were found between teeth that were regularly cared for by a dentist, and the risk of heart disease and stroke during several research studies:

• some kinds of periodontal diseases predict a degree of risk for heart attack, stroke, and heart failure
• bacterial growth caused by inflammation can lead to heart disease or stroke

According to the study, the importance of regular dental care was proven. Those with the highest incidence of gum bleeding had a 2.1% increased risk of stroke compared to those with the lowest incidence. Those with the least amount of teeth had a 2.5% increased risk of congestive heart failure compared to those with the most teeth. Those with a higher number of deepened periodontal pockets (infection of the gum around the base of the tooth) had a 53% increased risk of heart attack compared to those with the fewest pockets. In addition, people with less than 21 teeth had a 69% increased risk compared to those with the most teeth.

Mannitol Increases Effectiveness Of Dental Nerve Block Anesthesia

A necessary part of the dental process is to allow a patient to feel comfortable and pain-free during surgical and restorative dental procedures.  The most widespread local anesthetic injection for lower teeth is the inferior alveolar nerve (IAN) block.  Despite this, the rates of ineffectiveness range from 10 to 39 percent.

A study testing the efficacy of adding of mannitol to the typical anesthetic used in Ian blocks was presented by the journal “Anesthesia Progress.”

The participants were forty adult patients, who received an IAN block at each appointment at least once a week.

To compare the results of the effectiveness the standard anesthetic, lidocaine with epinephrine, was used alone and with addition of 0.5 M mannitol.  Mannitol is a sugar alcohol that occurs naturally in fruits and vegetables.  It is rapidly excreted by the kidneys and its impact is short-lived.  However, it is effective in opening the perineurial membrane.  There are studies, which show the perineurial barrier around the nerve does not allow complete diffusion of anesthetic into the nerve trunk, in cases of IAN block failure.

An enhanced permeability is provided by the addition of mannitol.  When administered concurrently it increases the success of an IAN block.

The participants’ levels of pain were measured by an electric pulp test of their mandibular teeth every 4 minutes during the 60 minutes after the injections of anesthetic in the IAN block solutions.

In conclusion the significant increased effectiveness of the anesthesia with the addition of mannitol to lidocaine with epinephrine was shown.

Surprising Hypothetical Mechanism Warrants Further Investigation

According to a recently published study, a probiotic treatment has mitigated pancreatitis in an animal model.   This leads to a new hypothesis of how probiotic's may act.

“Severe acute pancreatitis is a critical illness that is characterized by intestinal barrier dysfunction.  While it is usually self-limiting, in 20% - 30% of cases patients develop serious disease, including systemic inflammatory response syndrome, sepsis, and/or multiple organ dysfunction, which frequently cause death,” says the study.

The study was conducted by Jacoline Gerritsen, of University Medical Center, Utrecht, the Netherlands, together with her collaborators.  The team gave one group of rats probiotic on a daily basis, starting 5 days before they induced acute pancreatitis, while another set of rats received a placebo.

It turned out that in the small intestine, "commensal rat ileum bacterium" (CRIB) were “correlated with reduced severity of acute pancreatitis in animals that had been fed probiotic," according to the report.  "...these results suggest that effects of this multi-species probiotic mixture... are mediated by stimulation of a not previously described gut commensal bacterium... which protects the host from severe sepsis.”

"This research has provided new knowledge on the possible mechanisms behind probiotic action," says Gerritsen.  "In addition, it shows that bacterial species inhabiting the small intestine might be very important for health.  Up until now, medical researchers have neglected the small intestine, because it is very difficult to obtain such samples from humans."

Source: The Journal Of The American Society For Microbiology

The Capsule of Porphyromonas Gingivalis Protects Gum Disease-Causing Bacteria From Immune Response

According to recent research the capsule, Porphyromonas gingivalis, the bacterium that causes gum disease, provides stealth, boosting the bacterium's virulence.  You may have also heard it referred to as a sugar coating, as the capsule is made from sugar molecules.  These molecules do not ordinarily elicit immunity, despite the fact that it does hide the bacterium's proteins within, preventing immune response.

Gossweiler - Dentists in carmel In.
The study was led by Janina P. Lewis, of Virginia Commonwealth University, Richmond.  The scientists compared the ability of normal, and mutant bacteria that were missing the capsule.

"The mutant bacteria activated the host to a greater extent, and thus, were more easily killed by eukaryote cells," says Lewis.  "Thus, the capsule protects the bacteria and allows them to survive unnoticed in our bodies."

"Thus, anything that would interfere with generation of capsule, such as drugs interfering with the action of enzymes involved in synthesis of the sugar coat, could be used in treatment of periodontal disease, and importantly, could have broader implications for prevention of more serious diseases," added Lewis.

Source: The Journal Of The American Society For Microbiology