Oral surgery, oral medicine, oral pathology, oral radiology and endodontics

Calcium hydroxide has been included within several materials and antimicrobial formulations that are used in a number of treatment modalities in endodontics. These include, inter-appointment intracanal medicaments, pulp-capping agents and root canal sealers. Calcium hydroxide formulations are also used during treatment of root perforations, root fractures and root resorption and have a role in dental traumatology, for example, following tooth avulsion and luxation injuries. The purpose of this paper is to review the properties and clinical applications of calcium hydroxide in endodontics and dental traumatology including its antibacterial activity, antifungal activity, effect on bacterial biofilms, the synergism between calcium hydroxide and other agents, its effects on the properties of dentine, the diffusion of hydroxyl ions through dentine and its toxicity. Pure calcium hydroxide paste has a high pH (approximately 12.5-12.8) and is classified chemically as a strong base. Its main actions are achieved through the ionic dissociation of Ca2+ and OH- ions and their effect on vital tissues, the induction of hard-tissue deposition and the antibacterial properties. The lethal effects of calcium hydroxide on bacterial cells are probably due to protein denaturation and damage to DNA and cytoplasmic membranes. It has a wide range of antimicrobial activity against common endodontic pathogens but is less effective against Enterococcus faecalis and Candida albicans. Calcium hydroxide is also an effective anti-endotoxin agent. However, its effect on microbial biofilms is controversial.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2591.2011.01886.x

Properties and applications of calcium hydroxide in endodontics and dental traumatology.

Bacteria have been implicated in the pathogenesis and progression of pulp and periapical diseases. The primary aim of endodontic treatment is to remove as many bacteria as possible from the root canal system and then to create an environment in which any remaining organisms cannot survive. This can only be achieved through the use of a combination of aseptic treatment techniques, chemomechanical preparation of the root canal, antimicrobial irrigating solutions and intracanal medicaments. The choice of which intracanal medicament to use is dependent on having an accurate diagnosis of the condition being treated, as well as a thorough knowledge of the type of organisms likely to be involved and their mechanisms of growth and survival. Since the disease is likely to have been caused by the presence of bacteria within the root canal, the use of an antimicrobial agent is essential. Many medicaments have been used in an attempt to achieve the above aims but no single preparation has been found to be completely predictable or effective. Commonly used medicaments include calcium hydroxide, antibiotics, non-phenolic biocides, phenolic biocides and iodine compounds. Each has advantages and disadvantages, and further research is required to determine which is best suited for root canal infections.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1834-7819.2007.tb00527.x

The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics

Composition and functional properties of propolis (bee glue): A review.

Oral infections caused by yeast of the genus Candida and particularly Candida albicans (oral candidoses) have been recognised throughout recorded history However, since the 1980s a clear surge of interest and associated research into these infections have occurred This has largely been due to an increased incidence of oral candidosis over this period, primarily because of the escalation in HIV-infection and the AIDS epidemic In addition, changes in medical practice leading to a greater use of invasive clinical procedures and a more widespread use of immunosuppressive therapies have also contributed to the problem Whilst oral candidosis has previously been considered to be a disease mainly of the elderly and very young, its occurrence throughout the general population is now recognised Candida are true 'opportunistic pathogens' and only instigate oral infection when there is an underlying predisposing condition in the host Treatment of these infections has continued (and in some regards continues) to be problematic because of the potential toxicity of traditional antifungal agents against host cells The problem has been compounded by the emergence of Candida species other than C albicans that have inherent resistance against traditional antifungals The aim of this review is to give the reader a contemporary overview of oral candidosis, the organisms involved, and the management strategies that are currently employed or could be utilised in the future

https://www.tandfonline.com/doi/pdf/10.3402/jom.v3i0.5771

Pathogenesis and treatment of oral candidosis

The health industry has always used natural products as an alternative, to the conventional allopathic formulations available for the treatment of various afflictions. Propolis, a natural antibiotic is a resinous yellow brown to dark brown substance that honey bees (Apismellifera) collect from tree buds, sap
flows, shrubs or other botanical sources to seal unwanted open spaces in the hive, protecting it from outside contaminants. The main chemical classes present in propolis are flavonoids, phenolics and other various aromatic compounds. Flavonoids are well known plant compounds that have
antibacterial, antifungal, antiviral, antioxidant and anti-inflammatory proprieties. Propolis has been used in dentistry for various purposes and has a promising role in future medicine as well as in dentistry. This paper is an attempt to review various applications of this compound in dentistry.

https://eprints.manipal.edu/1932/1/14._Int_J_Med_and_Med_Sci,_2010_proplis_use.pdf

Propolis and its potential uses in oral health

Background: Permanent teeth pulp exposures have traditionally been treated with calcium hydroxide pulp capping. The aim of this study was to investigate the response of human pulp tissue which were mechanically exposed to a new material, Propolis and compare it with two existing and commonly used pulp capping agents (mineral trioxide aggregate and Dycal). Methods: Thirty-six intact human premolars were mechanically exposed. Teeth were divided into six groups of 6 teeth each and were capped with Propolis, mineral trioxide aggregate and Dycal. Final restoration was done with posterior composite resin using light cured glass ionomer cement as a liner. The teeth were then extracted on the 15th or the 45th day and processed for histological evaluation. Results: Differences in inflammatory response and dentine bridge formation of the exposed pulp to the three different materials were statistically calculated using chi-square test and were found to be non-significant. There was more pulp inflammation in teeth treated with Dycal than with Propolis and MTA on the 15th as well as on the 45th day. Propolis and MTA showed bridge formation in more teeth, and the bridges were in closer proximity to pulp capping material than teeth treated with Dycal on the 45th day. Conclusions: The response of pulps to Propolis as a pulp capping agent was comparable to MTA and Dycal.

https://eprints.manipal.edu/2485/1/12.ADJ'10_propolis_cappin.pdf

A comparative histological analysis of human pulp following direct pulp capping with Propolis, mineral trioxide aggregate and Dycal.

Asthma is a chronic inflammatory condition that causes the airways to constrict and produce excess mucus, making breathing difficult. It is characterized by the obstruction of airflow which is variable over a short period of time. This condition is reversible, either spontaneously or can be controlled with the help of drugs. Asthma medication comprises bronchodilators, corticosteroids and anticholinergic drugs. Most of these drugs are inhaled using various forms of inhalers or nebulizers. The effect of these drugs on oral health is the subject of debate among dental practitioners. Patients taking asthma medication may be at risk of dental caries, dental erosion, periodontal diseases and oral candidiasis. Hence, patients with bronchial asthma on medication should receive special prophylactic attention. This article reviews the correlation between asthma and oral health, and suggests various measures to counter possible oral health problems related to asthma.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1834-7819.2010.01226.x

Asthma and oral health: a review

Supernumerary paramolars are the rare anomalies of the maxillofacial complex. These are more common in the maxilla than in the mandible. This article reviews the etiology, frequency, classification, complications, diagnosis and management of supernumerary teeth (bilateral maxillary paramolars)

Management of supernumerary teeth.

Background: The common recovery of Candida albicans and Enterococcus faecalis from failed root canals of teeth in which previous treatment has failed is notable. These organisms have been shown to be resistant to antimicrobial action of calcium hydroxide but are sensitive to chlorhexidine gluconate. The aim of the present in vitro study was to investigate the antimicrobial efficacy of calcium hydroxide paste, 2% chlorhexidine gel and their combination against Candida albicans and Enterococcus faecalis. Methods: Inoculae of these organisms were used to make lawn cultures on Sabouraud’s dextrose agar and blood agar plates. Wells were prepared with these lawn cultures and filled with calcium hydroxide paste, 2% chlorhexidine gel and their combination. The agar plates were kept overnight for incubation at 37˚C and the zone of inhibition was examined after 24 and 72 hours. Results: The results suggest that 2% chlorhexidine gel alone is more effective at 72 hours than calcium hydroxide paste alone or in combination with 2% chlorhexidine gel against both the organisms, even though calcium hydroxide showed better antifungal efficacy against Candida albicans at 24 hours. Conclusion: In failed root canal treatments, 2% chlorhexidine gel may be a more effective intracanal medicament than calcium hydroxide paste or their combination against Candida albicans and Enterococcus faecalis.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1834-7819.2007.tb00475.x

Kundabala M

Papers

Propolis and its potential uses in oral health

A comparative histological analysis of human pulp following direct pulp capping with Propolis, mineral trioxide aggregate and Dycal.

Asthma and oral health: a review

Management of supernumerary teeth.

Antimicrobial action of calcium hydroxide, chlorhexidine and their combination on endodontic pathogens.