determine the prevalence of Hp in the dental plaques of
asymptomatic dental hygienists and outpatients who were
attending the dental clinic for teeth cleaning. Dental and
endoscopy devices were also investigated for their possible
role in the transmission of Hp.
Methods.The dental plaques of 24 dental hygienists
who had no symptoms of infection were tested, with mea-
sures then taken to determine if the Hp could be on the
probes used. Treated probes were then used to assess Hp
in the dental plaque of 47 patients who came to the dental
clinic for teeth cleaning. To determine if other instrument
contamination was a factor, endoscopes and endoscopy
forceps were also tested for the presence of Hp.
Results.Fifty percent of the specimens collected
from the dental hygienists were positive for Hp amplified
bands. Of 2 sets of 40 randomly selected dental probes, 1
set was routinely cleaned and 1 was subjected to sonication
and sodium dodecyl sulfate. These were then tested, and 5
of the first set had Hp DNA contamination, but no contam-
ination was found in the second set. The dental hygienists
were retested with DNA-free probes, and only 3 specimens
proved positive for Hp. The uncontaminated probes also
were used to test outpatients to the clinic, of whom 25%
had plaque specimens contaminated with Hp DNA, al-
though they were Hp culture negative. Gastroendoscopy
Evidence-based findings for intracanal medicaments
Background.The primary objective of endodontic
treatment is to eliminate bacteria and sources of nutrient
supply from the root canal system, thereby doing away with
factors that support the development of apical periodonti-
tis. The increasing reliance on evidence-based practice
prompted an analysis of the endodontic literature to iden-
tify clinical studies on the antibacterial effectiveness of in-
tracanal medicaments, which are used because canals can-
not be instrumented free of bacteria.
Methods.The search for studies targeted those
dealing with calcium hydroxide, phenolic derivatives, io-
dine(potassium iodide, chlorhexidine, or formocresol
equipment subjected to glutaraldehyde disinfection was
then tested for Hp DNA, and 3 of 8 prebiopsy endoscopes
and 1 of 11 prebiopsy forceps demonstrated specific DNA
products on nPCR testing. All specimens were negative for
Hpon cultures.
Discussion.The potential sources of Hp identified in-
cluded dental plaque and medical equipment. In addition,
sample collection techniques may bias the true prevalence
of Hp in a population.
Clinical Significance.Having identified
the role of Helicobacter pylori (Hp) in gas-
tric disturbances, this study pursues the
issue of how the Hp got there in the first
place. This information may call attention to
our infection control procedures.
Al-Hawajri AAN, Keret D, Simhon A, et al: Helicobacter pylori DNA in
dental plaques, gastroscopy, and dental devices. Dig Dis Sci 49:1091-
1094, 2004
Reprints available from R Galia, Dept of Infectious Diseases, Chaim
Sheba Medical Ctr, Tel Hashomer, 52621, Israel; e-mail: galia.rahav
@sheba.health.gov.il
used as antibacterial intracanal medicaments. Applying
the final search criteria left 5 papers that evaluated calci-
um hydroxide and had a total sample size of 164 teeth.
The 5 studies carried out microbiological sampling of all
canals before instrumentation (S1), after instrumentation
and irrigation (S2), and immediately after the calcium hy-
droxide was removed (S3). Cultures positive for the
growth of microbiological agents were documented along
with the number of bacterial cells in the samples. Before
S2 sampling, the remaining sodium hypochlorite was in-
activated with sterile sodium thiosulfate, then samples of
transport fluid or saline solution were obtained on sterile
paper points.
Volume 50 Issue 3 2005 167
 Results.One hundred sixty-two of the 164 canals
were positive at S1. At S2, 101 canals (62%), with a range of
14% to 100% in the various studies, were still positive. The
S3 cultures showed detectable bacterial growth in 45 of the
164 canals (27%). Forty-five percent of the canals positive at
S1 were still positive at S2, even with the use of calcium hy-
droxide. All but 1 study showed a decline in the percentage
of teeth that had a positive culture at S3 compared with the
results at S2. The 1 dissenting study showed a dramatic in-
crease in the number of teeth with detectable growth, with
71% of teeth having a positive culture at S3 but only 14% at
S2. Culture reversals or false-positive and false-negative cul-
tures were not addressed in most of the studies. None of
the studies of other intracanal medicaments found them to
be more effective than calcium hydroxide.
Discussion.Instrumentation and irrigation seem to
have a more important antibacterial action than the use of
intracanal medicaments. Canals cannot be completely
freed of bacteria through instrumentation and irrigation,
Operative Dentistry
Successful resin-based composite tunnel restorations
Background.A conservative approach to the treat-
ment of approximal caries in premolars and molars may in-
clude tunnel restoration, in which a tunnel cavity is pre-
pared from the occlusal to the approximal surfaces with the
goal of preserving tooth substance by leaving the marginal
ridge intact. Partial and total tunnel restorations have been
undertaken, with the difference being that the approximal
enamel lesions are not removed in the partial restoration.
Glass-ionomer cement was unsuitable for the inhibition or
remineralization of enamel lesions, so the tunnel restora-
tions in which glass-ionomer cement was used had a high
failure rate previously. Currently, the bond strength of
resin-based composite with dentin adhesive is much high-
168 Dental Abstracts
but these actions are clearly more effective than antibacte-
rial medicaments alone. The best medicament available to
reduce residual microbial flora was calcium hydroxide.
Clinical Significance.Mechanical instru-
mentation and irrigation remain the gold
standard for disinfecting root canals. Un-
fortunately not all canals can be instru-
mented. Ca(OH) 2 remains the medicament
of choice for controlling contaminants.
Law A, Messer H: An evidence-based analysis of the antibacterial ef-
fectiveness of intracanal medicaments. J Endodont 30:689-694,
2004
Reprints available from A Law, 5 Killara Ave, Killara, NSW, Australia
2071; e-mail: amanda.law@bigpond.com
er, and these composites have better mechanical proper-
ties than glass-ionomer cement. It was hypothesized that
combining total tunnel restoration and resin-based com-
posite with the adhesive technique could overcome the
problems reported with tunnel restorations in past years.
The clinical performance of these total tunnel restorations
was assessed in comparison to that of Class II resin-based
composite restorations.
Methods.The 38 patients had 63 approximal carious
lesions restored. The total tunnel restorations removed all
carious dentin and approximal demineralized enamel and
left the marginal ridge intact. Access was facilitated by en-