Differentiated macrophages (MØ) are the resident tissue phagocytes and sentinel cells of the inna... more Differentiated macrophages (MØ) are the resident tissue phagocytes and sentinel cells of the innate immune response. These cells are major constituents of periapical granulomas. Current studies indicate these activated cells as the source of bone-resorbing cytokines in the periapical granuloma. Periapical inflammation can be mediated by proinflammatory cytokines like interleukin 1ß (IL-1ß), tumor necrosis factor α (TNF-α), IL-6, and IL-8. Reducing the production of these cytokines may be beneficial for the treatment of periapical lesions. Oils rich in omega-3 fatty acids like docosahexaenoic acid (DHA) have been linked with anti-resorptive and bone-protective effects. The purpose of this investigation was to study the effect of DHA on the expression of these cytokines by normal and lipopolysaccharide (LPS)-treated MØ. We hypothesized that pretreatment of MØ with DHA decreases the expression of pro-inflammatory cytokines induced by LPS-treated MØ. THP-1 monocytes were cultured and differentiated into MØ. DHA was added to MØ in a dose-dependent manner. MØ samples were added to the following groups: Group 1, ethanol alone as a solvent control; Group 2, 10 µg/ml of DHA (D1); Group 3, 20 µg/ml of DHA (D2); Group 4, 10 µg/ml of DHA + LPS (DL1); Group 5, 20 µg/ml of DHA + LPS (DL2); Group 6, LPS alone. Reverse transcriptase-PCR (RT-PCR) followed by ImageJ analysis was used to measure cytokine expression. The results show that IL-1ß and TNF-α levels for DL and DHA (basal) were significantly lower than the levels in LPS alone. IL-6 was increased in the DL groups. There was no significant change for IL-8. DHA at higher concentrations may selectively decrease proinflammatory cytokine production of IL-1ß and TNF-α. More studies are needed to verify the anti-inflammatory therapeutic action of agents like DHA omega-3 fatty acids.
Many parameters must be addressed for endodontic therapy to succeed. Because conservation of toot... more Many parameters must be addressed for endodontic therapy to succeed. Because conservation of tooth structure is vital, the pulp chamber and root canal orifices should be located by using a method that is consistent yet accurate. The correlation of occlusal anatomy with the locations of the root canal orifice may aid dentists with access design. This study sought to determine if a correlation existed between occlusal surface anatomy, pulp chamber location, and root canal orifice location. This in vitro study utilized 21 human mandibular first molars. For each specimen, amalgam restorations were placed in the respective cusp tips, with gutta-percha placed in each canal at the level of the furcation. The authors made digital radiographs and occlusal photographs of each complete specimen. The samples were sectioned horizontally at the level of the cementoenamel junction (CEJ). Using a digital software program, the radiographs were superimposed with the digital photographs and correlations of pulp chamber to locate the canal orifice and occlusal surface anatomy. The authors found that the pulp chamber of the mandibular first molar lies more lingual at the level of the CEJ. In addition, the orifices were consistent in their location relative to cusp tip anatomy, a discovery that may assist dentists with the access design.
Introduction: With the recent advancement in dental treatment modalities, patients are increasing... more Introduction: With the recent advancement in dental treatment modalities, patients are increasingly faced with the dilemma of selecting between root canal treatment (RCT) and implant placement (IP). Data on the influence of demographics on the aforementioned choice appear to be limited. The purpose of this retrospective cohort study was to investigate any association between demographic attributes and patients' receipt of RCT or IP. Methods: The study sample for this computerized retrospective cohort study included 4084 dental school patients who received RCT and/or IP between 2006 and 2011. The following data were abstracted for each patient: age, sex, ethnicity, insurance status, and zip codes; the last variable was the proxy for socioeconomic status (SES). Statistical analysis included descriptive, chi-square test, and computation of odds ratios. Results: Patient age, sex, race, insurance status, and SES were significantly associated with the choice of endodontic or implant therapy. Older patients were 6 times more likely as younger ones to receive IP. Males were 1.3 times more likely as females to have received IP; whites were twice as likely as blacks for the same treatment. Insured patients were 1.6 times more likely to have received RCT compared with uninsured patients The odds of patients from high SES receiving IP was 2.4 times greater than those from low SES. Conclusions: Demographic attributes and insurance status significantly affected the receipt of RCT or IP. Clinicians need to be aware that patient demographics and/or dental insurance status play a role in treatment decisions.
The purpose of this study was to test the ability of a commercially available iodoform gutta-perc... more The purpose of this study was to test the ability of a commercially available iodoform gutta-percha, to delay infiltration of Enterococcus faecalis using a microleakage model. Seventy extracted single-rooted teeth were decoronated and biomechanically prepared using hand and rotary instruments. Thirty roots were obturated laterally with iodoform gutta-percha and another 30 with regular gutta-percha. Both groups were suspended in sterile BHI broth. An inoculum of E. faecalis suspension was placed at the coronal end of each root, incubated and replenished daily. The apical broth was observed for turbidity, indicating bacterial microleakage. Samples were observed for 32 days, and data was analyzed to compare microleakage between the two groups. The results showed no significant difference between the iodoform and regular gutta-percha samples in delaying microleakage of E. faecalis (p Ͼ 0.05).
This study sought to assess setting time and sealing properties of intracanal mineral trioxide ag... more This study sought to assess setting time and sealing properties of intracanal mineral trioxide aggregate (MTA). Eighty-three extracted single-rooted human teeth were decoronated and instrumented using the crown-down technique. The apical 3.0 mm of each tooth was resected. After MTA was placed, the coronal openings of the canals were sealed with moist cotton pellets. Root samples were divided into three groups according to setting time periods of four hours, two days, or one week. Within each group, 15 samples were kept in wet gauze to provide a moist apical environment (WA) while the remaining 10 were kept in a dry apical environment (DA). After respective incubation periods, 20 samples per group (10 WA, 10 DA) were mounted in an apical broth turbidity determination chamber and incubated for 30 days. The remaining five teeth per group (WA-h) were sectioned into 3.0 mm slices and compared for MTA setting hardness using the Shore-D Hardness test. Remaining teeth served as negative and positive controls. Each sample was inoculated coronally with Enterococcus faecalis and checked daily for turbidity in apical broth. Microbial leakage was reduced significantly as setting time increased from four hours to two days or one week. There was no significant reduction in leakage when setting time was increased from two days to one week. Over the first 20 days, the DA samples showed a higher rate of leakage compared to the WA samples. The Shore-D hardness test correlated with leakage results; 93% of total setting hardness was reported at two days and one week compared to only 75% for the four-hour group. Results suggest that apical moisture may affect MTA setting time or sealing ability initially and that intracanal MTA may take up to two days to set completely.
A conducting media is necessary when using an electric pulp tester (EPT). The objective of this s... more A conducting media is necessary when using an electric pulp tester (EPT). The objective of this study was to observe differences in conductance through various media. We hypothesized that variations in current conductance through different media exist. The pulp chamber of a freshly extracted premolar was exposed, and the cathode of a voltmeter was inserted into the pulpal tissue. The anode was coupled to the EPT handpiece. The measurement taken during dry (no interface media) EPT tip-to-tooth contact was 0 V, which served as negative control. EPT tip directly touching the cathode measured 3.9V and served as positive control. A number of media readily available in the dental office were tested. Data was analyzed using single factor ANOVA. Listerine (3.3) conducted the most voltage (p Ͻ 0.5). Of nonliquids, K-Y Brand UltraGel and Crest Baking Soda & Peroxide Whitening Tartar Control toothpaste recorded significantly (p Ͻ 0.05) higher voltage readings (1.4 V).
A descriptive, cross sectional survey was developed to determine the preferences of endodontists ... more A descriptive, cross sectional survey was developed to determine the preferences of endodontists when prescribing analgesics. Eleven clinical scenarios describing common endodontic diagnoses or procedures with specified severity of pain were provided. A survey was sent to 310 AAE members and 63 responded, providing a 20% response rate. Respondents were given various choices for analgesic prescription including various dosages of ibuprofen or acetaminophen (APAP), or combination narcotic medications. Data were analyzed by 2 tests. Non-narcotics were preferred over narcotics for all clinical situations. Significantly more respondents selected ibuprofen 600 mg (4ϫ a day) regardless of the severity of preoperative or postoperative pain (p Ͻ 0.001). Educators and board-certified AAE members were less likely than nonboard certified AAE members to manage their patient's perceived severe pain with narcotic analgesics.
With proper education, dentists can gain further insight into recognizing limitations in treating... more With proper education, dentists can gain further insight into recognizing limitations in treating cases that require advanced training and advanced optics such as a dental operating microscope.
Introduction: The purpose of this study was to investigate the effects of factors associated with... more Introduction: The purpose of this study was to investigate the effects of factors associated with various coronal restorative modalities after root canal treatment (RCT) on the survival of endodontically treated teeth (ETT) and to assess the effect of time lapse between RCT and crown placement after RCT to form a tooth loss hazard model. Methods: Computerized analysis was performed for all patients who received posterior RCT from 2008 to 2016 in the graduate endodontic department. Data collected included dates of RCT, type of post-endodontic restoration, and time of extraction if extracted. Teeth that received crown after RCT were also divided into 2 groups: receiving crown before 4 months and after 4 months after RCT. Data were analyzed by using Kaplan-Meier log-rank test and Cox regression model (a = 0.05) by using SPPS Statistic 21. Results: Type of restoration after RCT significantly affected the survival of ETT (P = .001). ETT that received composite/amalgam buildup restorations were 2.29 times more likely to be extracted compared with ETT that received crown (hazard ratio, 2.29; confidence interval, 1.29-4.06; P = .005). Time of crown placement after RCT was also significantly correlated with survival rate of ETT (P = .001). Teeth that received crown 4 months after RCT were almost 3 times more likely to get extracted compared with teeth that received crown within 4 months of RCT (hazard ratio, 3.38; confidence interval, 1.56-6.33; P = .002). Conclusions: Patients may benefit by maintaining their natural dentition by timely placement of crown after RCT, which otherwise may have been extracted and replaced by implant because of any delay in crown placement.
Enterococcus faecalis has been shown to be highly resistant once established in the root canal sy... more Enterococcus faecalis has been shown to be highly resistant once established in the root canal system and may play an important role in endodontic failures. The purpose of this study was to evaluate the antimicrobial activity of four root canal sealers on E. faecalis. Seventeen blood-agar plates were inoculated with E. faecalis using the Lawn technique. Five discs were placed on each plate, four with sealers--Sealapex, Roth 811, Kerr EWT, and AH-Plus--and an ampicillin disc as the control. The plates were incubated at 37 degrees C. The zones of inhibition were measured at 24 and 48 h. Analysis using a one-way ANOVA and Tukey test showed a statistically significance difference (p < 0.05) between all four groups of sealers. Roth 811 showed the largest zone of inhibition (1.1 mm), followed by Sealapex (0.8 mm) and Kerr EWT (0.5 mm), whereas AH-Plus had no antimicrobial activity. There was no difference in the zones of inhibition between the 24- and 48-h time periods.
The aim of this study was to evaluate the sensitivity and specificity of electric pulp testing (E... more The aim of this study was to evaluate the sensitivity and specificity of electric pulp testing (EPT) using the bridging technique in comparison to a cold test on crowned teeth. Methods: Thirty teeth were included in this study. Only one crowned tooth from each subject was included. The adjacent teeth served as controls. The crowned teeth were tested for pulp vitality using a bridging EPT technique and cold test. Vitality was confirmed upon access based on bleeding or lack of bleeding from detected root canal systems. The data was statistically analyzed using the McNamara test (P<0.05). Results: The sensitivities of the cold test and bridging EPT were 87% and 66% respectively. Accuracy for cold and bridging EPT were 87% and 67% respectively. The cold test demonstrated a statistically significant higher accuracy and sensitivity than the bridging EPT. However, no significant difference was detected in the specificity between the two tests. Conclusion: Both EPT and cold test should be considered as an adjunctive diagnostic tool when determining pulp status in a crowned tooth. Pulp sensitivity tests are essential but the results should be interpreted in combination with other clinical signs/symptoms.
Introduction: Preeclampsia (PE) is characterized by hypertension and proteinuria after the 20th w... more Introduction: Preeclampsia (PE) is characterized by hypertension and proteinuria after the 20th week of gestation. There is an association between systemic inflammation and adverse pregnancy outcomes such as PE. Therefore, for the first time, the present study aimed to investigate the possible association between maternal apical periodontitis (AP) and PE. Methods: In this case-control study, 50 mothers who were diagnosed with PE during pregnancy were included in the experimental group. The control group consisted of 50 matched mothers with a normal course of pregnancy. The endodontic and periodontal status of all participants was reviewed using the digital panoramic radiographs that were available before pregnancy. The number of remaining teeth and the presence of AP in all teeth and endodontically treated teeth were recorded using the periapical index. Binary logistic regression was used to determine the possible association between AP and PE (a = 0.05). Results: AP in at least 1 tooth was found in 27 of the mothers who developed PE (54%) and in 16 of the control patients (32%) (odds ratio [OR] = 2.4, P < .05). Adjusted for the maternal periodontitis, number of teeth, and endodontic treatment, maternal AP was significantly associated with the occurrence of PE (P < .05; OR = 2.23; 95% confidence interval, 95% = 1.92-6.88). Conclusions: AP was significantly more prevalent in the experimental group. For the first time, this study has provided evidence that maternal AP may be a strong independent predictor of PE. Considering the high occurrence of PE, particularly in developing countries, it could be suggested that the risk of PE may be reduced through comprehensive dental examinations for detecting and treating any source of inflammation, including AP, before pregnancy.
Introduction: The aim of this systematic review was to analyze failed cases of regenerative endod... more Introduction: The aim of this systematic review was to analyze failed cases of regenerative endodontic treatment (RET) reported in the literature in terms of etiology, diagnosis, treatment protocols, signs of failure, and additional endodontic interventions. Methods: Electronic searches were performed in PubMed, Web of Science, and ProQuest Dissertations & Theses databases. All in vivo publications in humans that reported at least 1 failed case of RET were included in this systematic review. Failed RET cases were defined in the current study as any case that required an additional endodontic intervention or extraction after the completion of the initial RET. Results: A total of 28 studies that reported 67 failed cases of RET were included in this review. A total of 37 failed RET cases reported the etiology that resulted in the initiation of RET; 59% of these cases were caused by dental trauma, and 30% were caused by dens evaginatus. A total of 26 (39%) failed RET cases were detected at least 2 years after the initiation of RET. A total of 53 (79%) failed RET cases were presented with signs and/or symptoms of persistent infection. Conclusions: Persistent infection was the main presentation in 79% of failed RET cases. Furthermore, 39% of failed RET cases were identified after more than 2 years of follow-up. Future studies should include a detailed description of the etiology, preoperative variables, intraoperative protocols, and postoperative follow-up to provide a better understanding of failed cases after RET.
Introduction: The purpose of this study was to compare the cytotoxicity and cytokine expression p... more Introduction: The purpose of this study was to compare the cytotoxicity and cytokine expression profiles of EndoSequence Root Repair Material (ERRM; Brasseler, Savannah, GA) putty, ERRM flowable, and ProRoot mineral trioxide aggregate (MTA; Dentsply Tulsa Dental, Johnson City, TN) using osteoblast cells (MG-63). Methods: Four millimeters in diameter of each material was placed in the center of a 6-well culture plate, and a 2-mL suspension (10 5 cells/mL) of human osteoblasts was seeded in each well. Photomicrograph images were used to evaluate cytotoxicity as evidenced by the lack of osteoblast cell growth in relation to the materials with AH-26 (Dentsply Tulsa Dental) as the positive control. In addition, reverse-transcriptase polymerase chain reaction (RT-PCR) was used to evaluate the expression of interleukin (IL)-1b, IL-6, IL-8, and tumor necrosis factor-a (TNF-a). Cytokine expression of MG-63 cells upon lipopolysaccharide treatment was used as controls. RT-PCR results were normalized by the expression of the housekeeping gene b-actin and were used to measure cytokine expression. Statistical analysis was performed using analysis of variance. Results: Results showed that ERRM putty and MTA exhibited minimal levels of cytotoxicity; however, ERRM was slightly more cytotoxic although not statistically significant. The expression of IL-1b, IL-6, and IL-8 was detected in all samples with minimal TNF-a expression. Conclusions: We concluded that ERRM and MTA showed similar cytotoxicity and cytokine expressions.
An epidemiological study of a regional population of Native Americans receiving treatment from 19... more An epidemiological study of a regional population of Native Americans receiving treatment from 1991 to 2000 (n ϭ 5460) was conducted via electronic survey. The objectives were to identify factors affecting the retention of endodontically treated teeth and to determine frequencies of endodontic care. Multiple factors were assessed. Analyses utilized 2 and frequency tests. The results indicated that endodontists tend to complete most posterior teeth and retreatment cases, while generalists tended to complete anterior teeth, primary endodontic therapy, and to restore immediately. Patients with multiple systemic diseases (p ϭ 0.0225) and diabetes (p Ͻ 0.0001) experienced decreased retention of endodontically treated teeth and increased retreatment (p ϭ 0.0109) by endodontists. Patients treated by general dentists experienced increased retention for female patients (p ϭ 0.0066), immediate restoration of the treated tooth (p ϭ 0.0212), and decreased retention with a history of hypertension (p ϭ 0.0036) and diabetes (p ϭ 0.0033). This study suggests that diabetes and/or hypertension, delayed or no restoration, and increasing age, may all contribute to decreased retention of endodontically treated teeth, but that immediate postendodontic restoration may enhance retention. In the early era, very few cases of molar endodontics were completed, and one could infer that there were greater numbers of posterior teeth extracted because of this fact. This demonstrates how a combination of providers can provide a broader range of clinical endodontic services, supporting an Indian Health Service goal of providing the highest level of oral health care possible.
Introduction: To date, no study has investigated the antiresorptive property of lunasin. Hence, t... more Introduction: To date, no study has investigated the antiresorptive property of lunasin. Hence, the present study aimed to assess the ability of lunasin to inhibit the osteoclast formation using RAW 264.7 cells. We hypothesized that lunasin is able to inhibit osteoclast formation. Methods: In the present study, the murine monocytic cell line RAW 264.7 was induced to differentiate into mature osteoclasts in the presence of recombinant receptor activator of nuclear factor kappa-B ligand. Tartrate-resistant acid phosphatase, a marker of osteoclasts, was used to identify osteoclasts. Cell lines were divided into different groups and exposed to different concentrations of 50 mmol/L, 75 mmol/L, and 100 mmol/L active and inactive lunasin. The control group was RAW 264.7 cells with receptor activator of nuclear factor kappa-B ligand. Tartrate-resistant acid phosphataseÀpositive cells of 3 or more nuclei, indicative of mature osteoclasts, were counted by 3 observers. The mean number of the data collected was analyzed using 1-way analysis of variance and the multiple comparison post hoc Bonferroni correction. Results: There was a significant difference in the reduction of osteoclast formation in all the active lunasin groups (P < .001) compared with the control group and the inactive lunasin group (P < .001). Conclusions: Considering the suppressive effect of lunasin on osteoclastogenesis, the use of lunasin as a potential antiresorptive agent can be evaluated in future studies.
Introduction: Pain and anxiety control is critical in dental practice. Moderate sedation is a use... more Introduction: Pain and anxiety control is critical in dental practice. Moderate sedation is a useful adjunct in managing a variety of conditions that make it difficult or impossible for some people to undergo certain dental procedures. The purpose of this study was to analyze the sedation protocols used in 3 dental specialty programs at the Case Western Reserve University School of Dental Medicine, Cleveland, OH. Methods: A retrospective analysis was performed using dental school records of patients receiving moderate sedation in the graduate endodontic, periodontic, and oral surgery programs from January 1, 2010, to December 31, 2012. Information was gathered and the data compiled regarding the reasons for sedation, age, sex, pertinent medical conditions, American Society of Anesthesiologists physical status classifications, routes of administration, drugs, dosages, failures, complications, and other information that was recorded. Results: The reasons for the use of moderate sedation were anxiety (54%), local anesthesia failures (15%), fear of needles (15%), severe gag reflex (8%), and claustrophobia with the rubber dam (8%). The most common medical conditions were hypertension (17%), asthma (15%), and bipolar disorder (8%). Most patients were classified as American Society of Anesthesiologists class II. More women (63.1%) were treated than men (36.9%). The mean age was 45 years. Monitoring and drugs varied among the programs. The most common tooth treated in the endodontic program was the mandibular molar. Conclusions: There are differences in the moderate sedation protocols used in the endodontic, periodontic, and oral surgery programs regarding monitoring, drugs used, and record keeping.
The purpose of the present study was to evaluate the cutting efficiency of the three different ul... more The purpose of the present study was to evaluate the cutting efficiency of the three different ultrasonic tips for orthograde endodontic treatment: stainless steel, zirconium nitride-coated, and diamond-coated tips. An ultrasonic handpiece was mounted on a custom-made automated balance, and each tip repeatedly penetrated dental stone blocks to a depth of 3 mm for 10 times. The amount of time taken to penetrate 3 mm of stone was measured. The diamond-coated tips showed significantly greater cutting efficiency than either stainless steel tips or zirconium-nitride coated tips. The stainless steel tips showed initial better cutting efficiency, but over time Table 1, there is no significant difference between the cutting efficiency of the stainless steel tips and the zirconium nitride coated tips. The diamond coated tips were the only group that showed breakage in this study.
The purpose of this study was to compare the effectiveness of various concentrations of N 2 O/O 2... more The purpose of this study was to compare the effectiveness of various concentrations of N 2 O/O 2 on obtunding a hypersensitive gag reflex. We hypothesized that the administration of nitrous oxide and oxygen would obtund a hypersensitive gag reflex enough to allow a patient to tolerate the placement and holding of a digital x-ray sensor long enough to obtain a dental radiograph. Volunteers claiming to have a hypersensitive gag reflex were first screened to validate their claim and then tested by placing a size 2 digital x-ray sensor in the position for a periapical radiograph of the right mandibular molar area and holding it in place for 10 seconds. Subjects were first tested using room air only, then 30%, 50%, or 70% nitrous oxide until they were able to tolerate the sensor without gagging or discomfort. A visual analog scale was used for subjective responses, and other statistical tests were used to analyze the results. We found that for some subjects, 30% nitrous oxide was sufficient; for others, 50% was needed; and for the remainder of the subjects, 70% was sufficient to tolerate the test. Using a combination of 70% nitrous oxide and 30% oxygen allowed all patients claiming to have a hypersensitive gag reflex to tolerate the placement and holding of a digital x-ray sensor long enough to take a periapical radiograph.
Differentiated macrophages (MØ) are the resident tissue phagocytes and sentinel cells of the inna... more Differentiated macrophages (MØ) are the resident tissue phagocytes and sentinel cells of the innate immune response. These cells are major constituents of periapical granulomas. Current studies indicate these activated cells as the source of bone-resorbing cytokines in the periapical granuloma. Periapical inflammation can be mediated by proinflammatory cytokines like interleukin 1ß (IL-1ß), tumor necrosis factor α (TNF-α), IL-6, and IL-8. Reducing the production of these cytokines may be beneficial for the treatment of periapical lesions. Oils rich in omega-3 fatty acids like docosahexaenoic acid (DHA) have been linked with anti-resorptive and bone-protective effects. The purpose of this investigation was to study the effect of DHA on the expression of these cytokines by normal and lipopolysaccharide (LPS)-treated MØ. We hypothesized that pretreatment of MØ with DHA decreases the expression of pro-inflammatory cytokines induced by LPS-treated MØ. THP-1 monocytes were cultured and differentiated into MØ. DHA was added to MØ in a dose-dependent manner. MØ samples were added to the following groups: Group 1, ethanol alone as a solvent control; Group 2, 10 µg/ml of DHA (D1); Group 3, 20 µg/ml of DHA (D2); Group 4, 10 µg/ml of DHA + LPS (DL1); Group 5, 20 µg/ml of DHA + LPS (DL2); Group 6, LPS alone. Reverse transcriptase-PCR (RT-PCR) followed by ImageJ analysis was used to measure cytokine expression. The results show that IL-1ß and TNF-α levels for DL and DHA (basal) were significantly lower than the levels in LPS alone. IL-6 was increased in the DL groups. There was no significant change for IL-8. DHA at higher concentrations may selectively decrease proinflammatory cytokine production of IL-1ß and TNF-α. More studies are needed to verify the anti-inflammatory therapeutic action of agents like DHA omega-3 fatty acids.
Many parameters must be addressed for endodontic therapy to succeed. Because conservation of toot... more Many parameters must be addressed for endodontic therapy to succeed. Because conservation of tooth structure is vital, the pulp chamber and root canal orifices should be located by using a method that is consistent yet accurate. The correlation of occlusal anatomy with the locations of the root canal orifice may aid dentists with access design. This study sought to determine if a correlation existed between occlusal surface anatomy, pulp chamber location, and root canal orifice location. This in vitro study utilized 21 human mandibular first molars. For each specimen, amalgam restorations were placed in the respective cusp tips, with gutta-percha placed in each canal at the level of the furcation. The authors made digital radiographs and occlusal photographs of each complete specimen. The samples were sectioned horizontally at the level of the cementoenamel junction (CEJ). Using a digital software program, the radiographs were superimposed with the digital photographs and correlations of pulp chamber to locate the canal orifice and occlusal surface anatomy. The authors found that the pulp chamber of the mandibular first molar lies more lingual at the level of the CEJ. In addition, the orifices were consistent in their location relative to cusp tip anatomy, a discovery that may assist dentists with the access design.
Introduction: With the recent advancement in dental treatment modalities, patients are increasing... more Introduction: With the recent advancement in dental treatment modalities, patients are increasingly faced with the dilemma of selecting between root canal treatment (RCT) and implant placement (IP). Data on the influence of demographics on the aforementioned choice appear to be limited. The purpose of this retrospective cohort study was to investigate any association between demographic attributes and patients' receipt of RCT or IP. Methods: The study sample for this computerized retrospective cohort study included 4084 dental school patients who received RCT and/or IP between 2006 and 2011. The following data were abstracted for each patient: age, sex, ethnicity, insurance status, and zip codes; the last variable was the proxy for socioeconomic status (SES). Statistical analysis included descriptive, chi-square test, and computation of odds ratios. Results: Patient age, sex, race, insurance status, and SES were significantly associated with the choice of endodontic or implant therapy. Older patients were 6 times more likely as younger ones to receive IP. Males were 1.3 times more likely as females to have received IP; whites were twice as likely as blacks for the same treatment. Insured patients were 1.6 times more likely to have received RCT compared with uninsured patients The odds of patients from high SES receiving IP was 2.4 times greater than those from low SES. Conclusions: Demographic attributes and insurance status significantly affected the receipt of RCT or IP. Clinicians need to be aware that patient demographics and/or dental insurance status play a role in treatment decisions.
The purpose of this study was to test the ability of a commercially available iodoform gutta-perc... more The purpose of this study was to test the ability of a commercially available iodoform gutta-percha, to delay infiltration of Enterococcus faecalis using a microleakage model. Seventy extracted single-rooted teeth were decoronated and biomechanically prepared using hand and rotary instruments. Thirty roots were obturated laterally with iodoform gutta-percha and another 30 with regular gutta-percha. Both groups were suspended in sterile BHI broth. An inoculum of E. faecalis suspension was placed at the coronal end of each root, incubated and replenished daily. The apical broth was observed for turbidity, indicating bacterial microleakage. Samples were observed for 32 days, and data was analyzed to compare microleakage between the two groups. The results showed no significant difference between the iodoform and regular gutta-percha samples in delaying microleakage of E. faecalis (p Ͼ 0.05).
This study sought to assess setting time and sealing properties of intracanal mineral trioxide ag... more This study sought to assess setting time and sealing properties of intracanal mineral trioxide aggregate (MTA). Eighty-three extracted single-rooted human teeth were decoronated and instrumented using the crown-down technique. The apical 3.0 mm of each tooth was resected. After MTA was placed, the coronal openings of the canals were sealed with moist cotton pellets. Root samples were divided into three groups according to setting time periods of four hours, two days, or one week. Within each group, 15 samples were kept in wet gauze to provide a moist apical environment (WA) while the remaining 10 were kept in a dry apical environment (DA). After respective incubation periods, 20 samples per group (10 WA, 10 DA) were mounted in an apical broth turbidity determination chamber and incubated for 30 days. The remaining five teeth per group (WA-h) were sectioned into 3.0 mm slices and compared for MTA setting hardness using the Shore-D Hardness test. Remaining teeth served as negative and positive controls. Each sample was inoculated coronally with Enterococcus faecalis and checked daily for turbidity in apical broth. Microbial leakage was reduced significantly as setting time increased from four hours to two days or one week. There was no significant reduction in leakage when setting time was increased from two days to one week. Over the first 20 days, the DA samples showed a higher rate of leakage compared to the WA samples. The Shore-D hardness test correlated with leakage results; 93% of total setting hardness was reported at two days and one week compared to only 75% for the four-hour group. Results suggest that apical moisture may affect MTA setting time or sealing ability initially and that intracanal MTA may take up to two days to set completely.
A conducting media is necessary when using an electric pulp tester (EPT). The objective of this s... more A conducting media is necessary when using an electric pulp tester (EPT). The objective of this study was to observe differences in conductance through various media. We hypothesized that variations in current conductance through different media exist. The pulp chamber of a freshly extracted premolar was exposed, and the cathode of a voltmeter was inserted into the pulpal tissue. The anode was coupled to the EPT handpiece. The measurement taken during dry (no interface media) EPT tip-to-tooth contact was 0 V, which served as negative control. EPT tip directly touching the cathode measured 3.9V and served as positive control. A number of media readily available in the dental office were tested. Data was analyzed using single factor ANOVA. Listerine (3.3) conducted the most voltage (p Ͻ 0.5). Of nonliquids, K-Y Brand UltraGel and Crest Baking Soda & Peroxide Whitening Tartar Control toothpaste recorded significantly (p Ͻ 0.05) higher voltage readings (1.4 V).
A descriptive, cross sectional survey was developed to determine the preferences of endodontists ... more A descriptive, cross sectional survey was developed to determine the preferences of endodontists when prescribing analgesics. Eleven clinical scenarios describing common endodontic diagnoses or procedures with specified severity of pain were provided. A survey was sent to 310 AAE members and 63 responded, providing a 20% response rate. Respondents were given various choices for analgesic prescription including various dosages of ibuprofen or acetaminophen (APAP), or combination narcotic medications. Data were analyzed by 2 tests. Non-narcotics were preferred over narcotics for all clinical situations. Significantly more respondents selected ibuprofen 600 mg (4ϫ a day) regardless of the severity of preoperative or postoperative pain (p Ͻ 0.001). Educators and board-certified AAE members were less likely than nonboard certified AAE members to manage their patient's perceived severe pain with narcotic analgesics.
With proper education, dentists can gain further insight into recognizing limitations in treating... more With proper education, dentists can gain further insight into recognizing limitations in treating cases that require advanced training and advanced optics such as a dental operating microscope.
Introduction: The purpose of this study was to investigate the effects of factors associated with... more Introduction: The purpose of this study was to investigate the effects of factors associated with various coronal restorative modalities after root canal treatment (RCT) on the survival of endodontically treated teeth (ETT) and to assess the effect of time lapse between RCT and crown placement after RCT to form a tooth loss hazard model. Methods: Computerized analysis was performed for all patients who received posterior RCT from 2008 to 2016 in the graduate endodontic department. Data collected included dates of RCT, type of post-endodontic restoration, and time of extraction if extracted. Teeth that received crown after RCT were also divided into 2 groups: receiving crown before 4 months and after 4 months after RCT. Data were analyzed by using Kaplan-Meier log-rank test and Cox regression model (a = 0.05) by using SPPS Statistic 21. Results: Type of restoration after RCT significantly affected the survival of ETT (P = .001). ETT that received composite/amalgam buildup restorations were 2.29 times more likely to be extracted compared with ETT that received crown (hazard ratio, 2.29; confidence interval, 1.29-4.06; P = .005). Time of crown placement after RCT was also significantly correlated with survival rate of ETT (P = .001). Teeth that received crown 4 months after RCT were almost 3 times more likely to get extracted compared with teeth that received crown within 4 months of RCT (hazard ratio, 3.38; confidence interval, 1.56-6.33; P = .002). Conclusions: Patients may benefit by maintaining their natural dentition by timely placement of crown after RCT, which otherwise may have been extracted and replaced by implant because of any delay in crown placement.
Enterococcus faecalis has been shown to be highly resistant once established in the root canal sy... more Enterococcus faecalis has been shown to be highly resistant once established in the root canal system and may play an important role in endodontic failures. The purpose of this study was to evaluate the antimicrobial activity of four root canal sealers on E. faecalis. Seventeen blood-agar plates were inoculated with E. faecalis using the Lawn technique. Five discs were placed on each plate, four with sealers--Sealapex, Roth 811, Kerr EWT, and AH-Plus--and an ampicillin disc as the control. The plates were incubated at 37 degrees C. The zones of inhibition were measured at 24 and 48 h. Analysis using a one-way ANOVA and Tukey test showed a statistically significance difference (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) between all four groups of sealers. Roth 811 showed the largest zone of inhibition (1.1 mm), followed by Sealapex (0.8 mm) and Kerr EWT (0.5 mm), whereas AH-Plus had no antimicrobial activity. There was no difference in the zones of inhibition between the 24- and 48-h time periods.
The aim of this study was to evaluate the sensitivity and specificity of electric pulp testing (E... more The aim of this study was to evaluate the sensitivity and specificity of electric pulp testing (EPT) using the bridging technique in comparison to a cold test on crowned teeth. Methods: Thirty teeth were included in this study. Only one crowned tooth from each subject was included. The adjacent teeth served as controls. The crowned teeth were tested for pulp vitality using a bridging EPT technique and cold test. Vitality was confirmed upon access based on bleeding or lack of bleeding from detected root canal systems. The data was statistically analyzed using the McNamara test (P<0.05). Results: The sensitivities of the cold test and bridging EPT were 87% and 66% respectively. Accuracy for cold and bridging EPT were 87% and 67% respectively. The cold test demonstrated a statistically significant higher accuracy and sensitivity than the bridging EPT. However, no significant difference was detected in the specificity between the two tests. Conclusion: Both EPT and cold test should be considered as an adjunctive diagnostic tool when determining pulp status in a crowned tooth. Pulp sensitivity tests are essential but the results should be interpreted in combination with other clinical signs/symptoms.
Introduction: Preeclampsia (PE) is characterized by hypertension and proteinuria after the 20th w... more Introduction: Preeclampsia (PE) is characterized by hypertension and proteinuria after the 20th week of gestation. There is an association between systemic inflammation and adverse pregnancy outcomes such as PE. Therefore, for the first time, the present study aimed to investigate the possible association between maternal apical periodontitis (AP) and PE. Methods: In this case-control study, 50 mothers who were diagnosed with PE during pregnancy were included in the experimental group. The control group consisted of 50 matched mothers with a normal course of pregnancy. The endodontic and periodontal status of all participants was reviewed using the digital panoramic radiographs that were available before pregnancy. The number of remaining teeth and the presence of AP in all teeth and endodontically treated teeth were recorded using the periapical index. Binary logistic regression was used to determine the possible association between AP and PE (a = 0.05). Results: AP in at least 1 tooth was found in 27 of the mothers who developed PE (54%) and in 16 of the control patients (32%) (odds ratio [OR] = 2.4, P < .05). Adjusted for the maternal periodontitis, number of teeth, and endodontic treatment, maternal AP was significantly associated with the occurrence of PE (P < .05; OR = 2.23; 95% confidence interval, 95% = 1.92-6.88). Conclusions: AP was significantly more prevalent in the experimental group. For the first time, this study has provided evidence that maternal AP may be a strong independent predictor of PE. Considering the high occurrence of PE, particularly in developing countries, it could be suggested that the risk of PE may be reduced through comprehensive dental examinations for detecting and treating any source of inflammation, including AP, before pregnancy.
Introduction: The aim of this systematic review was to analyze failed cases of regenerative endod... more Introduction: The aim of this systematic review was to analyze failed cases of regenerative endodontic treatment (RET) reported in the literature in terms of etiology, diagnosis, treatment protocols, signs of failure, and additional endodontic interventions. Methods: Electronic searches were performed in PubMed, Web of Science, and ProQuest Dissertations & Theses databases. All in vivo publications in humans that reported at least 1 failed case of RET were included in this systematic review. Failed RET cases were defined in the current study as any case that required an additional endodontic intervention or extraction after the completion of the initial RET. Results: A total of 28 studies that reported 67 failed cases of RET were included in this review. A total of 37 failed RET cases reported the etiology that resulted in the initiation of RET; 59% of these cases were caused by dental trauma, and 30% were caused by dens evaginatus. A total of 26 (39%) failed RET cases were detected at least 2 years after the initiation of RET. A total of 53 (79%) failed RET cases were presented with signs and/or symptoms of persistent infection. Conclusions: Persistent infection was the main presentation in 79% of failed RET cases. Furthermore, 39% of failed RET cases were identified after more than 2 years of follow-up. Future studies should include a detailed description of the etiology, preoperative variables, intraoperative protocols, and postoperative follow-up to provide a better understanding of failed cases after RET.
Introduction: The purpose of this study was to compare the cytotoxicity and cytokine expression p... more Introduction: The purpose of this study was to compare the cytotoxicity and cytokine expression profiles of EndoSequence Root Repair Material (ERRM; Brasseler, Savannah, GA) putty, ERRM flowable, and ProRoot mineral trioxide aggregate (MTA; Dentsply Tulsa Dental, Johnson City, TN) using osteoblast cells (MG-63). Methods: Four millimeters in diameter of each material was placed in the center of a 6-well culture plate, and a 2-mL suspension (10 5 cells/mL) of human osteoblasts was seeded in each well. Photomicrograph images were used to evaluate cytotoxicity as evidenced by the lack of osteoblast cell growth in relation to the materials with AH-26 (Dentsply Tulsa Dental) as the positive control. In addition, reverse-transcriptase polymerase chain reaction (RT-PCR) was used to evaluate the expression of interleukin (IL)-1b, IL-6, IL-8, and tumor necrosis factor-a (TNF-a). Cytokine expression of MG-63 cells upon lipopolysaccharide treatment was used as controls. RT-PCR results were normalized by the expression of the housekeeping gene b-actin and were used to measure cytokine expression. Statistical analysis was performed using analysis of variance. Results: Results showed that ERRM putty and MTA exhibited minimal levels of cytotoxicity; however, ERRM was slightly more cytotoxic although not statistically significant. The expression of IL-1b, IL-6, and IL-8 was detected in all samples with minimal TNF-a expression. Conclusions: We concluded that ERRM and MTA showed similar cytotoxicity and cytokine expressions.
An epidemiological study of a regional population of Native Americans receiving treatment from 19... more An epidemiological study of a regional population of Native Americans receiving treatment from 1991 to 2000 (n ϭ 5460) was conducted via electronic survey. The objectives were to identify factors affecting the retention of endodontically treated teeth and to determine frequencies of endodontic care. Multiple factors were assessed. Analyses utilized 2 and frequency tests. The results indicated that endodontists tend to complete most posterior teeth and retreatment cases, while generalists tended to complete anterior teeth, primary endodontic therapy, and to restore immediately. Patients with multiple systemic diseases (p ϭ 0.0225) and diabetes (p Ͻ 0.0001) experienced decreased retention of endodontically treated teeth and increased retreatment (p ϭ 0.0109) by endodontists. Patients treated by general dentists experienced increased retention for female patients (p ϭ 0.0066), immediate restoration of the treated tooth (p ϭ 0.0212), and decreased retention with a history of hypertension (p ϭ 0.0036) and diabetes (p ϭ 0.0033). This study suggests that diabetes and/or hypertension, delayed or no restoration, and increasing age, may all contribute to decreased retention of endodontically treated teeth, but that immediate postendodontic restoration may enhance retention. In the early era, very few cases of molar endodontics were completed, and one could infer that there were greater numbers of posterior teeth extracted because of this fact. This demonstrates how a combination of providers can provide a broader range of clinical endodontic services, supporting an Indian Health Service goal of providing the highest level of oral health care possible.
Introduction: To date, no study has investigated the antiresorptive property of lunasin. Hence, t... more Introduction: To date, no study has investigated the antiresorptive property of lunasin. Hence, the present study aimed to assess the ability of lunasin to inhibit the osteoclast formation using RAW 264.7 cells. We hypothesized that lunasin is able to inhibit osteoclast formation. Methods: In the present study, the murine monocytic cell line RAW 264.7 was induced to differentiate into mature osteoclasts in the presence of recombinant receptor activator of nuclear factor kappa-B ligand. Tartrate-resistant acid phosphatase, a marker of osteoclasts, was used to identify osteoclasts. Cell lines were divided into different groups and exposed to different concentrations of 50 mmol/L, 75 mmol/L, and 100 mmol/L active and inactive lunasin. The control group was RAW 264.7 cells with receptor activator of nuclear factor kappa-B ligand. Tartrate-resistant acid phosphataseÀpositive cells of 3 or more nuclei, indicative of mature osteoclasts, were counted by 3 observers. The mean number of the data collected was analyzed using 1-way analysis of variance and the multiple comparison post hoc Bonferroni correction. Results: There was a significant difference in the reduction of osteoclast formation in all the active lunasin groups (P < .001) compared with the control group and the inactive lunasin group (P < .001). Conclusions: Considering the suppressive effect of lunasin on osteoclastogenesis, the use of lunasin as a potential antiresorptive agent can be evaluated in future studies.
Introduction: Pain and anxiety control is critical in dental practice. Moderate sedation is a use... more Introduction: Pain and anxiety control is critical in dental practice. Moderate sedation is a useful adjunct in managing a variety of conditions that make it difficult or impossible for some people to undergo certain dental procedures. The purpose of this study was to analyze the sedation protocols used in 3 dental specialty programs at the Case Western Reserve University School of Dental Medicine, Cleveland, OH. Methods: A retrospective analysis was performed using dental school records of patients receiving moderate sedation in the graduate endodontic, periodontic, and oral surgery programs from January 1, 2010, to December 31, 2012. Information was gathered and the data compiled regarding the reasons for sedation, age, sex, pertinent medical conditions, American Society of Anesthesiologists physical status classifications, routes of administration, drugs, dosages, failures, complications, and other information that was recorded. Results: The reasons for the use of moderate sedation were anxiety (54%), local anesthesia failures (15%), fear of needles (15%), severe gag reflex (8%), and claustrophobia with the rubber dam (8%). The most common medical conditions were hypertension (17%), asthma (15%), and bipolar disorder (8%). Most patients were classified as American Society of Anesthesiologists class II. More women (63.1%) were treated than men (36.9%). The mean age was 45 years. Monitoring and drugs varied among the programs. The most common tooth treated in the endodontic program was the mandibular molar. Conclusions: There are differences in the moderate sedation protocols used in the endodontic, periodontic, and oral surgery programs regarding monitoring, drugs used, and record keeping.
The purpose of the present study was to evaluate the cutting efficiency of the three different ul... more The purpose of the present study was to evaluate the cutting efficiency of the three different ultrasonic tips for orthograde endodontic treatment: stainless steel, zirconium nitride-coated, and diamond-coated tips. An ultrasonic handpiece was mounted on a custom-made automated balance, and each tip repeatedly penetrated dental stone blocks to a depth of 3 mm for 10 times. The amount of time taken to penetrate 3 mm of stone was measured. The diamond-coated tips showed significantly greater cutting efficiency than either stainless steel tips or zirconium-nitride coated tips. The stainless steel tips showed initial better cutting efficiency, but over time Table 1, there is no significant difference between the cutting efficiency of the stainless steel tips and the zirconium nitride coated tips. The diamond coated tips were the only group that showed breakage in this study.
The purpose of this study was to compare the effectiveness of various concentrations of N 2 O/O 2... more The purpose of this study was to compare the effectiveness of various concentrations of N 2 O/O 2 on obtunding a hypersensitive gag reflex. We hypothesized that the administration of nitrous oxide and oxygen would obtund a hypersensitive gag reflex enough to allow a patient to tolerate the placement and holding of a digital x-ray sensor long enough to obtain a dental radiograph. Volunteers claiming to have a hypersensitive gag reflex were first screened to validate their claim and then tested by placing a size 2 digital x-ray sensor in the position for a periapical radiograph of the right mandibular molar area and holding it in place for 10 seconds. Subjects were first tested using room air only, then 30%, 50%, or 70% nitrous oxide until they were able to tolerate the sensor without gagging or discomfort. A visual analog scale was used for subjective responses, and other statistical tests were used to analyze the results. We found that for some subjects, 30% nitrous oxide was sufficient; for others, 50% was needed; and for the remainder of the subjects, 70% was sufficient to tolerate the test. Using a combination of 70% nitrous oxide and 30% oxygen allowed all patients claiming to have a hypersensitive gag reflex to tolerate the placement and holding of a digital x-ray sensor long enough to take a periapical radiograph.
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