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Interactions between periodontal disease, medical diseases and immunity in the older individual.

Treatment of dental diseases such as dental decay and periodontal disease cost the United States public an estimated USD 37 billion in 1994 (2). As such, the cost of dental treatment was higher than the cost of treating eye disease, diabetes or arthritis, among others. The highly individualized,labor intensive methods used to debride, repair and replace the involved teeth account for the enormity of this expense. This expense will increase, as more people, with more teeth, are living longer. The magnitude of this problem in terms of potential dental needs isillustrated by the relative and absolute numbers of older individuals who will be dentate in 2000 compared with 1900. In 1900, about 4% of the UnitedStates population was older than 64 years of age and about 60% were edentulous, giving a total of l.2 million dentate individuals. In 2000, 1 6% of the United States population will be older than 64 years and about 25% edentulous ( 1 18, 162), giving a total of 39 million dentate individuals. Thus, over a century the number of older dentate individuals at risk of developing dental caries and periodontal disease increased by 32 times.

By Loesche WJ, Lopatin DE.|2018-08-27T21:15:02+00:00January 1st, 1998|Other|

A preliminary pilot study of treatment of thrombophilia and hypofibrinolysis and amelioration of the pain of osteonecrosis of the jaws.

OBJECTIVES:

In a preliminary pilot study of 30 treatments in 26 patients with osteonecrosis of the jaws and chronic disabling facial pain, our specific aim was to determine whether, to what degree, and how safely therapy of hypofibrinolysis and thrombophilia would ameliorate the chronic pain associated with osteonecrosis of the mandible and maxilla.

STUDY DESIGN:

Thrombophilia was treated with Coumadin (DuPont) in 10 patients; hypofibrinolysis was treated with Winstrol (Sanofi-Winthrop) in 20 patients, including 4 who had mixed thrombophilia and hypofibrinolysis and had previously been treated with Coumadin. The initial treatment period was targeted to be 4 months. Each patient was asked to keep a daily written pain-relief numeric rating score and side-effects diary and to provide a summary pain-relief numeric rating score and side effects compilation for the total treatment period.

RESULTS:

There were 4 men and 22 women in the study group; their mean age was 49 +/- 11 years. The mean onset of their osteonecrosis pain was at age 45 +/- 12 years, and the mean duration of their facial pain prior to therapy was 4.5 +/- 4.2 years. Ten patients had one or more thrombophilic traits (there were two patients with protein C deficiency, five with resistance to activated protein C and/or the mutant Factor V Leiden gene, and four with high anticardiolipin antibodies). The 10 patients who were thrombophilic were treated with Coumadin (the international normalized ratio was targeted to 2.5-3.0) for 22 +/- 9 weeks. By self-reported pain-relief numeric rating scores, 6 of the 10 patients with thrombophilia (60%) had > or = 40% pain relief, 2 (20%) had no change, and 2 (20%) had increased pain (30% and 80% worse). Nine of the 10 patients with thrombophilia (90%) had no Coumadin-related side effects; 1 patient (10%) stopped Coumadin therapy (after 28 weeks) because of nosebleeds. Winstrol (6 mg per day) was used for 16 +/- 9 weeks in 20 patients with hypofibrinolysis, some of whom had one or more hypofibrinolytic traits (10 had high levels of plasminogen activator/inhibitor activity, usually accompanied by low stimulated tissue plasminogen activator activity; 13 had high Lp[a] lipoprotein). Of these 20 patients with hypofibrinolysis, 9 patients (45%) had > or = 40% pain relief, 3 patients (15%) had 20% to 30% relief, 5 patients (25%) had no improvement, and 3 patients (15%) had increased pain (30% worse, 60% worse, and 70% worse). Six of the 20 patients with hypofibrinolysis (30%) had no Winstrol-related side effects, while 14 (70%) had side effects that could be attributed to Winstrol, including weight gain, peripheral edema, increased facial and body hair, and acne–all of which were reversed within 6 weeks of stopping Winstrol therapy.

CONCLUSIONS:

We postulate that thrombophilia and hypofibrinolysis lead to impaired venous circulation and venous hypertension of the mandible/maxilla with subsequent development of osteonecrosis and chronic facial pain. In many patients, facial pain can be ameliorated by treating the pathogenetic coagulation defects with Coumadin or Winstrol. Large, double-blind, placebo-controlled crossover studies will be required in the future to validate these preliminary results and to determine whether […]

By Glueck CJ, McMahon RE, Bouquot JE, Tracy T, Sieve-Smith L, Wang P.|2018-09-15T02:21:36+00:00January 1st, 1998|Periodontal Disease|

Systemic transfer of mercury from amalgam fillings before and after cessation of emission.

In 29 volunteers with a low amalgam load, the number of amalgam-covered tooth surfaces and the occlusal area of the fillings were determined. Concentrations of total mercury were measured in plasma and erythrocytes as well as in urine together with the excretion rate. Absorbed daily doses were estimated from intraoral Hg emission by two separate methods. The transfer of Hg from the fillings via the oral cavity and blood to urinary excretion was evaluated according to the most representative combination of parameters. This consisted of urinary excretion (1), Hg concentration in plasma (2), absorbed dose (3), and occlusal area (4). Pairwise correlation coefficients were 0.75 for parameters 1 vs 2 and 2 vs 3 and 0.49 for parameters 3 vs 4. Within 9 days after removal of the fillings, a transient increase was observed in plasma Hg levels only. This was reduced in those volunteers to whom a rubber dam had been applied during removal. Peak plasma Hg was 0.6 ng/ml on average and decreased with halftimes between 5 and 13 days. A significant decrease in Hg excretion was noted not before 100 days after removal. Being relatively insensitive to dietary mercury, the determination of total mercury in plasma and of its urinary excretion rate appears, under practical aspects, most suitable for the investigation of Hg uptake from amalgam.

By Halbach S, Kremers L, Willruth H, Mehl A, Welzl G, Wack FX, Hickel R, Greim H.|2018-07-22T19:59:24+00:00January 1st, 1998|Mercury|

Giving patients freedom of choice

The modern patient, however, has evolved from being a patient to being a consumer. Our patients now view dental purchases much the same way that they view other consumer purchases.

By Di Tolla MC|2019-01-05T19:43:43+00:00January 1st, 1998|Other|

SUNCT syndrome: case report and literature review.

The case of a woman with short neuralgiform paroxysmal pain of 2 years duration is described. Pain attacks were always accompanied by ipsilateral lacrimation and conjunctival injection. Standard anti-neuralgic therapy, amitriptyline and indomethacin, failed to eliminate or reduce pain. At the end of a 30-month active period the patient seemed to have gone into remission. We believe this to be a case of short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), the first reported in the dental literature and the 24th in the general medical literature. The differential diagnosis of the case and relevant literature are discussed.

By Benoliel R, Sharav Y.|2018-08-24T19:15:09+00:00January 1st, 1998|Other|

Speciation of mercury excreted in feces from individuals with amalgam fillings.

Investigators established methods for the analysis of total mercury (Hg-total), oxidized mercury and mercury bound to sulfhydryl groups (Hg-S), mercury vapor (Hg0), and mercury from amalgam particles (APs) in fecal samples. Two individuals consumed mercury as a mercury-cysteine complex mercury vapor, and mercury from amalgam particles, and the cumulative excretion of mercury in feces was followed. Investigators found that 80% of the mercury from amalgam particles and mercury bound to sulfhydryl groups was excreted, but only 40% of the mercury vapor was excreted. Speciation of mercury excreted in feces from 6 individuals with a moderate loading of amalgam fillings showed that most of the mercury originating from the fillings consisted of oxidized mercury, which was probably bound to sulfhydryl-containing compounds. The proportion of amalgam particles in fecal samples from these individuals was low, and it did not exceed 26% of the total amount of mercury excreted.

By Engqvist A, Colmsjö A, Skare I.|2018-07-20T17:59:35+00:00January 1st, 1998|Mercury|

Observations on health before and after amalgam removal.

From 1972-1993 (5 years internship and 16 years of my own practice) amalgam was by far the most prevalent dental filling material used by me (in the side tooth area). Different reasons led me to abandon use of this material in the spring of 1994. An amalgam-critical work which had appeared in the FASEB journal in 1989 (Hahn et al.) was certainly an important reason for my decision. Moreover, some of my own earlier observations (e.g. with Pat. No 2 and Pat. No 73) and the fact that alternatives to amalgam were widely available, were equally important reasons for me to discontinue using amalgam, a material I had considered highly reliable before.

By Engel P.|2018-07-20T17:48:32+00:00January 1st, 1998|Mercury|

Neuralgia-inducing cavitational osteonecrosis.

Unfortunately, the study presented was not well designed, consisting as it did of disparate clinical findings and uncontrolled treatment attempts that fail to illuminate the true nature of a controversial condition. In addition, the implied recommendations for treatment include medications that are far from innocuous and have the potential for serious side effects. Although the authors offer their own evaluation of this study, there are several problems with this work that they do not identify,

By Freedman PD, Reich RF, Steinlauf AF.|2018-08-25T17:14:28+00:00January 1st, 1998|Periodontal Disease|

Mercury in dental amalgam: a risk analysis.

With present knowledge it is impossible to estimate the risk of effects on the foetal brain induced by the mother’s exposure to mercury from amalgam. Available facts, however, do not support a dismissal of the risk. Therefore treatment of children and women of childbearing age with amalgam should be avoided. It is also recommended that use of amalgam for dental restorations in the population in general is abandoned and substituted with less toxic material, whenever this is available and affordable.

By Berlin MD.|2018-07-18T23:24:10+00:00January 1st, 1997|Mercury|

Evidence that Mercury From Silver Dental Fillings May Be an Etiological Factor in Reduced Nerve Conduction Velocity in Multiple Sclerosis.

Seven multiple sclerosis subjects had their silver dental fillings (amalgams) removed which contained approximately 50% mercury. A visual evoked response (VER) test was performed before amalgam removal. Approximately six months after amalgam removal a second VER test was performed on all subjects, and the latencies of the VER decreased significantly. The mean latency of P1 for the right and left eye combined decreased by 23.1 milliseconds (P = 0.011) and N1 for the right and left eye combined decreased by 23.1 milliseconds (P = 0.026). It was hypothesized that mercury from dental amalgam was an etiological factor in reduced nerve conduction velocity in MS subjects.

By Siblerud RL, Kienholz E.|2020-04-07T20:03:35+00:00January 1st, 1997|Mercury|

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