clinical

Brief summaries of current topics

relevant to everyday dental practice.

Ingrid Sevels

Clinical Abstracts

DDSBA

A Stronger Biofilm

Anti-Bacterial Approaches to Caries

Caries begins wben acids produced by bacteria dissolve
dental bard tissue. Caries is bacterially induced, yet tbe
most effective metbods for preventing caries are based on
tbe use of fluoride, whicb interferes witb dissolution and
re-precipitation of enamel and dentin and reduces bacterial metabolism and growtb. Lifestyle, buman bebaviour
and pH all contribute to tbe level of bacterial glycolysis.
Researcbers are currently assessing new metbodologies
tbat combine fluoride and anti-microbial agents to develop
and maintain a bealtbier oral biofilm. Wben fermentable
carbobydrates are consumed, tbe dental plaque pH is altered and caries may develop. Fluoride affects tbe level of

enamel saturation, but adding anti-bacterial agents

to the fluoride limits the drop of the pH hy inhihiting hacteria.
Cborbexidine (CHX) induces transient cbanges in tbe
microflora but seldom inbibits caries. Recently, a caries-inbibiting effect of 46 percent was observed for CHX delivered in rinses, gels and tootbpastes. A consensus bas not
been reacbed on tbe effectiveness of CHX.
Recent views of dental plaque as an active biofilm may
cbange tbe approacb to caries prevention, witb tbe following items being considered:
Duration and mode of delivery for anti-bacterial agents
(daily delivery tbrougb tootbpastes vs. professional administration)
Plant and natural product extracts, pbotodynamic tberapy and tbe anti-microbial peptides in saliva could keep
biofilm bealthy
Cost-effectiveness of new products
Furtber researcb is needed to develop safe anti-bacterial
agents and combine tbem witb fluoride, and to create acceptable over-tbe-counter professional products.
Adv Dent Res 21:8-12, 2009
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Ontario Dentist December 2010

Topical Physostigmine
Tbis recent cross-over and randomized study
tested tbe efficacy and appropriate dosage of
pbysostigmine, a tertiary amine tbat enbances
tbe cbolinergic tone of secretory cells, for tbe
management of dry moutb.
Twenty people witb dry moutb and byposalivation received a topical gel containing eitber
pbysostigmine (0.9, 1.8, 3.6, or 7.2mg) or a
placebo. Tbe product was applied to tbe inside
of tbe lips and distributed via tbe tongue. Feeling of dryness, saliva volumes and systemic effects were measured, witb tbe following findings:
Tbe 3.6 and 7.2mg doses of pbysostigmine
produced gastrointestinal side-effects.
At 1.8 mg, pbysostigmine gave two to tbree
bours of relief from tbe subjective feeling of
moutb dryness. No systemic effects were noted
witb tbis dosage.
Tbe response witb pbysostigmine was five
times greater tban witb tbe placebo.
Systemic drug treatments for dry moutb may
cause uncomfortable side-effects. Having a local
agent witb minimal adverse effects is attractive
to botb patient and practitioner.
Eur J Oral Sei 117:209-217, 2009

Clinical Abstracts

Hypnosis for TMD Pain

The purpose of this study was to assess the effect of hypnosis to relieve pain in the people suffering from the complexities of temporomandibular disorders (TMDs). Forty
women with TMD (mean duration 11.9 years) were randomly assigned to four 1-hour sessions of hypnotic intervention (treatment group) or simple relaxation (control
group). A numerical rating scale from 0 to 10 three times
per day was used to rate pain intensity. Psychological
symptoms, pain coping strategies, sleep disturbance and
analgesic use were also assessed. Results were as follows:
Pain levels in the hypnosis group were reduced by
more than 50 percent
None of the hypnosis group patients dropped out, but
three from the control group left because they had no
benefit from the relaxation therapy

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for pain increased from 5.2 to 10.3 in the hypnosis group
Hypnosis for TMD pain had no adverse side-effects. The effectiveness of hypnosis on pain indicates that central pain
mechanisms are involved in TMD, further supporting its
classification as a complex, multi-factorial disorder.
/ Oral Rehab 36:556-570, 2009 W.

Dr. Ingrid Sevels is a 1971 graduate of the Faculty of Dentistry,

University of Toronto. She received a BA in English and
Professional and Creative Writing in 2002, and currently
maintains a part-time clinical practice in Oakville, Ont. Dr.
Sevels may be reached at Ingrid.sg08@cogeco.ca or at
www. oakvilleden ta Icare, com.

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December 2010 Ontario Dentist

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