Antibiotics in Endodontics: a review Segura‐Egea, J. J.; Gould, K.; Şen, B. Hakan ...
International endodontic journal,
December 2017, Letnik:
50, Številka:
12
Journal Article
Recenzirano
Odprti dostop
The overuse of antibiotics and the emergence of antibiotic‐resistant bacterial strains is a global concern. This concern is also of importance in terms of the oral microbiota and the use of ...antibiotics to deal with oral and dental infections. The aim of this paper was to review the current literature on the indications and use of antibiotics and to make recommendations for their prescription in endodontic patients. Odontogenic infections, including endodontic infections, are polymicrobial, and in most cases, the prescription of antibiotics is empirical. This has led to the increasing use of broad‐spectrum antibiotics even in cases where antibiotics are not indicated, such as symptomatic irreversible pulpitis, necrotic pulps and localized acute apical abscesses. In case of discrete and localized swelling, the primary aim is to achieve drainage without additional antibiotics. Adjunctive antibiotic treatment may be necessary in the prevention of the spread of infection, in acute apical abscesses with systemic involvement and in progressive and persistent infections. Medically compromised patients are more susceptible to complication arising from odontogenic infections and antimicrobials have a more specific role in their treatment. Therefore, antibiotics should be considered in patients having systemic diseases with compromised immunity or in patients with a localized congenital or acquired altered defence capacity, such as patients with infective endocarditis, prosthetic cardiac valves or recent prosthetic joint replacement. Penicillin VK, possibly combined with metronidazole to cover anaerobic strains, is still effective in most cases. However, amoxicillin (alone or together with clavulanic acid) is recommended because of better absorption and lower risk of side effects. In case of confirmed penicillin allergy, lincosamides such as clindamycin are the drug of choice.
This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on Antibiotics in Endodontics. The statement is based on current ...scientific evidence as well as the expertise of the committee. The goal is to provide dentists and other healthcare workers with evidence‐based criteria for when to use antibiotics in the treatment of endodontic infections, traumatic injuries of the teeth, revascularization procedures in immature teeth with pulp necrosis, and in prophylaxis for medically compromised patients. It also highlights the role that dentists and others can play in preventing the overuse of antibiotics. A recent review article provides the basis for this position statement and more detailed background information (International Endodontic Journal, 2017, https://doi.org/10.1111/iej.12741). Given the dynamic nature of research in this area, this position statement will be updated at appropriate intervals.
Femoroacetabular impingement (FAI) is a common cause of hip pain and dysfunction. The purpose of this study was to report outcome 2 years after the arthroscopic treatment of FAI using validated ...outcome measurements. Two hundred and eighty‐nine patients (males = 190, females = 99) with a mean age of 37 years underwent arthroscopic surgery for FAI. Patients were included consecutively in a hip arthroscopy registry. The cohort was evaluated using online web‐based validated health‐related patient‐reported outcomes measurements, including the iHOT‐12, HAGOS, EQ‐5D, HSAS for physical activity level, VAS for overall hip function and overall satisfaction. The mean follow‐up time was 25.4 months. Pre‐operative scores compared with those obtained at follow‐up revealed statistically and clinically significant improvements (P < 0.05) for all measured outcomes; iHOT‐12 (43 vs 66), VAS for global hip function (50 vs 71), HSAS (2.9 vs 3.6), EQ‐5D index (0.58 vs 0.75), EQ‐VAS (67 vs 75) and HAGOS different subscales (56 vs 76, 51 vs 69, 60 vs 78, 40 vs 65, 29 vs 57, 33 vs 58). At the 2‐year follow‐up, 236 patients (82%) reported they were satisfied with the outcome of surgery. We conclude that arthroscopic treatment for FAI resulted in statistically and clinically significant improvements in outcome parameters.
Genotyping by sequencing along with high throughput sequencing approaches allows for the rapid development and discovery of variable markers such as microsatellites, which can be highly informative ...for population genetics. These approaches, along with combinatorial barcoding techniques and a novel genotyping protocol, were employed to examine the population structure of commercially valuable fisheries species, Nephrops norvegicus. Results suggest at least four genetically distinct groupings of the species across the sampled distribution and the presence of isolation by distance. No evidence for genetic bottlenecks were found in any population, however the genetic structure observed in this study does not correspond to current fisheries management delineations. This study is the first to apply microsatellite markers distribution-wide for this species, revealing a population structure for Nephrops norvegicus important for informing management of this widely fished species.
•Genotyping by sequencing approaches highly informative for marine population management•Microsatellites group Nephrops norvegicus into four clusters across their distribution•Species genetic structure does not match current delineations of functional units•Individual populations are represented by multiple management units•New microtyper an efficient and accurate method for genotyping
Nephrops norvegicus is a commercially valuable demersal fisheries species. Relatively little is understood about this species’ population dynamics across its distribution with previous mitochondrial ...and microsatellite studies failing to identify significant population-level differentiation. In this study, sequence variation in the mitochondrial (mtDNA) D-loop was analysed from samples across the distribution range, and compared with COI sequences for this species retrieved from GenBank. Analysis of a 375 bp fragment of the D-loop revealed significant genetic differentiation between samples from the North-east Atlantic and the east Mediterranean (FST = 0.107, P < 0.001). Tau (τ), theta (θ0 and θ1) and Fu's FS values suggest the species spread between 10,500 to 19,000 ybp and subsequently expanded rapidly across the Atlantic.
Aim
To study patient‐ and tooth‐specific characteristics of teeth indicated for root canal treatment, in the public dental service of the county of Västra Götaland, Sweden.
Methodology
During a ...designated 8‐week period, general dental practitioners working at 20 different public dental clinics consecutively registered indications for undertaking root canal treatment. The patients’ subjective level of pain was also registered (visual analogue scale) at the very first appointment. The following information was retrieved from computerized dental records and radiographs: gender, age, number of remaining teeth, tooth group, previous restoration, number of restored surfaces, dental caries and tooth substance loss. Gender and age were compared using both descriptive and analytical statistics.
Results
The material comprised 243 teeth in 243 patients: 128 (52.7%) women and 115 (47.3%) men, mean age 48.3 years. Molar teeth predominated (47.7%). Most of the teeth (83.5%) had previously been restored and exhibited significant loss of tooth substance, more than a third of the crown (71.3%). Dental caries was present in 127 teeth (62.9%). Dental trauma was implicated in only seven cases (2.9%). Initial treatment was frequently undertaken at an emergency visit, for relief of symptoms (64.9%). The most commonly registered indication was pulpal necrosis with apical periodontitis (38.1%), followed by pulpitis (37.7%). Retreatment of a root filled tooth was reported in 18 teeth (7.4%).
Conclusions
In the general Public Dental Service of Sweden, root canal treatment is most frequently undertaken in molars. The primary indication is relief of symptoms. Retreatment of root filled teeth is uncommon.
Aim
Root canal treatment of teeth with necrotic pulps and apical periodontitis may be complicated by limited access to the root canals due to restorations and dystrophic calcifications. The objective ...of this study was to evaluate retrograde root canal as a primary treatment using a surgical approach as an alternative to conventional orthograde treatment.
Methodology
Patients with apical periodontitis in the anterior region of the maxilla were consecutively recruited to the study over a period of 4 years. Fifty‐seven patients met the inclusion criteria and received retrograde root canal treatment. A clinical and radiographic evaluation was made after 1 and 2 years postoperatively.
Results
Clinical and radiographically evaluation after 2 years revealed a successful outcome (as defined in this study) in 90% of the cases.
Conclusion
Retrograde root canal as a primary treatment was a reliable alternative to treat apical periodontitis on single‐ and two‐rooted teeth with limited orthograde access to the root canals in the maxilla.
Aim
To explore associations between root filled teeth, primary and secondary apical periodontitis, and levels of inflammatory markers in blood from patients with a first myocardial infarction and ...matched controls.
Methodology
Between May 2010 and February 2014, 805 patients with a first myocardial infarction and 805 controls, matched for sex, age, and postal code area, were recruited to the multicentre case–control study PAROKRANK (periodontitis and its relation to coronary artery disease). All participants underwent a physical and oral examination, as well as blood sampling. Using panoramic radiography, root filled teeth, primary apical periodontitis, and secondary apical periodontitis were assessed by three independent observers. Blood samples were analysed with enzyme‐linked immunosorbent assay method for the following inflammatory markers: interleukin‐1β (IL‐1β), IL‐2, IL‐6, IL‐8, IL‐12p70, tumour necrosis factor‐α, and high‐sensitivity C‐reactive protein (hsCRP). Additionally, white blood cell count and plasma‐fibrinogen were analysed. Associations between endodontic variables and the levels of inflammatory markers were statistically analysed with Mann–Whitney U‐test and Spearman correlation, adjusted for confounding effects of baseline factors (sex, age, myocardial infarction, current smoking, diabetes, family history of cardiovascular disease, education, marital status, and periodontal disease).
Results
Mean age of the cohort was 62 years, and 81% were males. Root fillings were present in 8.4% of the 39 978 examined teeth and were associated with higher levels of hsCRP, fibrinogen, and leukocyte count, but lower levels of IL‐2 and IL‐12p70. After adjusting for confounders, root filled teeth remained associated with higher levels of fibrinogen, but lower levels of IL‐1β, IL‐2, IL‐6, and IL‐12p70. Primary apical periodontitis was found in 1.2% of non‐root filled teeth and associated with higher levels of IL‐8 (correlation 0.06, p = .025). Secondary apical periodontitis was found in 29.6% of root filled teeth but did not relate to the levels of any of the inflammatory markers.
Conclusions
This study supports the notion that inflammation at the periapex is more than a local process and that systemic influences cannot be disregarded. Whether the observed alterations in plasma levels of inflammatory markers have any dismal effects on systemic health is presently unknown but, considering the present results, in demand of further investigation.
Abstract
Northern shrimp (Pandalus borealis) are protandrous hermaphrodites that reproduce first as males, go through a transition phase and transform to females, and then spawn as such for the rest ...of their lives. No clear consensus exists as to which factors influence the activation of the sex change process, but one possible factor is population density. Here, we investigate whether changes in stock size can influence the ogive of sex change, and use a 26-year time series (i.e. 1990–2015) of survey data on shrimp biomass from three different stocks in Iceland as a test case. Two of the stocks experienced periods of high biomass during the 1990 s, with a pronounced and prolonged depletion observed after 2000. In contrast, stock biomass of the third stock decreased only slightly during the time series. We found that the ogives of sex change of the two stocks where the biomass decreased to very low levels have changed significantly, and that shrimp now change sex at a lower size compared to earlier. Furthermore, Lmax has decreased significantly.
Aim
To investigate the 5‐year frequency of additional treatments in relation to the number of reported root filled canals in molar teeth in Sweden.
Methodology
The cohort included first and second ...molars in adult individuals who were registered with a root filling performed in 2009. Treatment codes corresponding to root fillings of teeth with from one up to four root filled canals were identified in the Swedish Social Insurance Agency database. The studied additional treatments were extraction, non‐surgical root canal retreatment and endodontic surgery during the subsequent 5 years, identified by corresponding codes for these treatments registered on these specific teeth. Differences in the frequency of additional treatments based on the number of root filled canals were analysed using chi‐square test and considered statistically significant at P < 0.05.
Results
In 2009, root fillings on a first or second molar tooth were registered in 100 720 individuals. The study included 32 901 maxillary first molars (6.4% with four root filled canals), 12 763 maxillary second molars (3.3% with four root filled canals), 37 703 mandibular first molars (19.2% with four root filled canals) and 17 353 mandibular second molars (3.7% with four root filled canals). The total frequency of additional treatments was 14.3% (n = 14 425) during the 5‐year observational period. Additional treatments were more frequent in teeth with 1–3 root filled canals compared to teeth with four root filled canals for maxillary first molars (15.2% vs. 12.7%, P = 0.002), maxillary second molars (13.8% vs. 9.1%, P = 0.007) and mandibular first molars (14.0% vs. 10.7%, P < 0.001) but not mandibular second molars (15.6% vs. 13.7%, P = 0.200).
Conclusions
Over 5 years, 85.7% of the included teeth were not registered with any additional treatments. Maxillary first and second molars and mandibular first molar teeth had a greater frequency of additional treatments when ≤3 root canals were filled compared to four canals.
PDF
