asthma and erosion

Resident’s Name: Joanne Lewis Date: February 19, 2010

Article title: Is there a relationship between asthma and dental erosion? A case control study

Author(s): Al-Dlaigan, Y. H., et al

Journal: International Journal of Pediatric Dentistry

Volume (number): 12

Date: 2002

Major topic: asthma and tooth erosion

Type of Article: research article

Main Purpose: to determine if there is a relationship between asthma and tooth erosion

Overview of method of research: The study consisted of 60 children divided into 3 groups as follows: group 1 – control group of 20 children with no history of asthma or other health problems. Group 2 – asthma group – 20 children with a history of asthma requiring long term medication. Group 3 – erosion group – 20 children referred due to significant erosion, no history of asthma. All children were examined clinically and classified as having low, moderate, or severe erosion. Information about medical history and dietary intake was collected for each child through a standard questionnaire. Unstimulated and stimulated saliva samples were collected from the children – the salivary pH and buffering capacity was measured. The data was analyzed using SPSS.

Findings: None of the children in the control group had severe erosion. In the asthma group, 65% had moderate and 35% had severe erosion. In the erosion group, 65% were classified as having severe erosion, with the majority of the erosion occurring on palatal surfaces, unlike in the control or asthma group. In the asthma and erosion groups there were more children who reported a history of indigestion, vomiting, heartburn and stomach problems. Dietary questions showed a high intake of soft drinks in all three groups of children; however, children in the erosion group did have a diet with more acidic components. There was no statistically significant difference noted in salivary flow rates, salivary pH, or buffering capacity between the 3 groups.

Key points/Summary: Conditions such as vomiting, heartburn, and stomach problems were more common in the erosion and asthma groups. Other studies suggest a definite association between gastroesophageal reflux and asthma. The most consistent dietary risk factor related to erosion is the consumption of soft drinks, carbonated beverages, and sports drinks.

Assessment of article: I thought this study was structured oddly and tried to look at too many variables. Results were not surprising.

02/19/2010 Treatment of children for primary acute herpetic gingivostomatitis with lactobacillus in aqueous suspension

Resident: J. Hencler Date: 02/19/2010

Article title: Treatment of children for primary acute herpetic gingivostomatitis with lactobacillus in aqueous suspension

Author(s): William F. McCord, DDS
Journal: Pediatric Dentistry: December, 1988 – V 10, #4, Pg 307-308
Major topic: Treatment of primary acute herpetic gingivostomatitis (PAHG)
Type of Article: Clinical trial

Main Purpose: To evaluate the effectiveness of a lactobacillus aqueous preparation in the treatment of PAHG.

Overview of method of research: Study was performed in a private dental office and included 15 males and 18 females ranging from 2-10 years old. Treatment prescribed for each child included a stabilized aqueous suspension of lactobacilli. Parents were instructed to have children swish 1 tsp of the medication in their mouth for as long as possible b/f swallowing and repeat 4x for 7 days.

Findings: All patients experience total relief of pain w/in 72 hrs and all symptoms including lesions and inflammation disappeared w/in 7 days.

Key points in the article discussion: Peak incidence of PAHG is around 2 yo. CC is extreme pain and soreness of the mouth so severe that the child has difficulty eating, drinking, and swallowing. One major problem associated w/ PAHG is dehydration. Results showed relief of pain and lesion healing may have occurred in a shorter period of time than with use of alternate forms of lactobacillus or when lesions remain untreated. The mechanism in which lactobacillus suspension produces a therapeutic response in patients is unknown. It is important to note that this therapeutic approach employs viable organisms of one type (lactobacillus) to combat viable organisms of another type (herpes simplex virus) by acting as a virostatic agent. There is no evidence from this study that the lactobacilli were virostatic other than clinical observation demonstrating cessation of pain, disappearance of lesions, the ability of the child to swallow more easily, the improvement of malaise, and reduction in fever.

Summary of conclusions: This clinical trial presents preliminary evidence that lactobacilli in a liquid form greatly aids in the relief of pain and other symptoms of PAHG. In this study, aqueous lactobacillus preparation showed a high degree of palatability, ease of administration, and may be useful in treating herpetic lesions.

Assessment of article: Small sample size with good results. This was a very interesting article and very easy to read. At the time it was published more research was needed on this tx regimen.

Effect of dental treatment on lung function

Brian Schmid DMD 02/19/10

Authors: Tanya Matthew BDS, Paul S Casamassamo DDS, Stephen Wilson MA PhD.
Reference: JADA Vol 129, August 1998
Main topic: lung function in asthma patients undergoing dental treatment.
Summary: 5-19% of children have some some form of bronchial asthma. The most common triggers for asthmatic attacks include: cigarette smoke, physical exercise, viral and bacterial infections, weather changes including cold temperatures, air pollutants and other allergens and also emotional stress. It has been recommended that dentists limit theur manipulatin of the hyperactive airway during fluoride treatment, radiography and use of cotton rolls. Also, prophylactic use of asthma medication. A semi-reclined or upright can also be used. It is estimated that 40% of attacks are caused by emotional stress. There are also several documented cases of allergies to dental materials, so a rubber dam is recommended to avoid exposure and particularly misting of tooth structure and restoration materials which may irritate the sensitive airway.
57 patients between 6-18 y.o. were chosen and had their lung function tested before, during, immediately post operatively and 30 minutes post operatively for prophylaxis and/or operative visits. Questionnaires were also given to their parents to determine severity of disease, control for several factors and to elucidate how their childs asthma affects their everyday life. All were scheduled after 1pm to control for Circadian changes. The mean patient was 11.8 y.o. and split almost equally for male and female. Fourteen patients (18.8%) showed a clinically significant decrease immediately post-operatively and 12 (16.2%) showed decreased lung function 30 minutes post operatively. Immediate post op and 30 minute post op lung function decrease were associated and predictive. Baseline lung function was the best predictor of post operative lung function. Since spirometry is unliklely to be performed in the dental setting, a thorough history is the best predictor of how sensitive the patient is to attacks and to distinguish common triggers. Severity of asthma and time since last hospital visit were not correlated to incidence of decreased lung function. Clinically 1 in 10 patients had decreased lung function and in this study no clinical variables pertaining to asthma were able to predict a decrease in lung function due to routine dental treatment.
Evaluation: This is a well organized study and reinforces the importance of taking good histories and applying their suggestions clinically.