• Restorative Dentistry and Endodontics
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• v.24 no.1
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• pp.1-12
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• 1999

Bacterial infection of the pulp results in the development of a periapical lesion with the concomitant resorption of periapical bone. The cytokines are believed to play an important role in this matter. The purpose of this study was to find the relationship among the presence of black pigmented bacteria, the levels of cytokines(TNF-${\alpha}$, -${\beta}$, IL-$1{\beta}$, and TGF-${\beta}1$), and the amount of bone resorption in periapical and pulpal diseases. For the purpose, the patients were grouped into chronic apical pathosis, acute apical pathosis, acute pulpitis, and a healthy control group. Root canal samples were taken from periapical tissue exudates during routine endodontic treatment, and the venous blood was taken from each patients. The samples were processed to measure local and systemic levels of the cytokines using enzyme linked immunosorbent assay(ELISA). Bacterial content of Porphyromonas endodontalis, Porphyromonas gingivalis, and Prevotella nigrescens were measured by indirect immunofluorescence method and the size of the periapical lesions were measured from the radiographs. The following results were obtained: 1. The levels of bone resorptive cytokines(TNF-${\alpha}$, TNF-${\beta}$, and IL-$1{\beta}$) in exudates from acute and chronic apical pathoses were significantly higher than those from acute pulpitis and the normal pulps(p<0.05). 2. IL-$1{\beta}$ were the highest among the bone resorptive cytokines in apical pathoses. However, no statistical difference between acute and chronic lesions were found(p>0.05). 3. The levels of TGF-${\beta}1$ in exudates from acute pulpitis and chronic apical pathoses were significantly higher than those from acute apical pathoses and the normal pulps(p<0.05). However, there were no significant correlations among the levels of bone resorptive cytokines. 4. The levels of TNF-${\beta}$ in serum were significantly higher than those from the exudates while serum TGF-${\beta}1$ concentrations were significantly lower(p<0.05). 5. Exudates from the canals in which the P. nigrescens were detected showed significantly higher levels of IL-$1{\beta}$ than those from the canals without the microorganism(p<0.05). 6. There were no significant correlations among the levels of the cytokines, the amount of bone destruction, and the presence of acute and chronic symptoms(p>0.05).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.1
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• pp.85-92
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• 2000

Common dental procedures(dental extraction & minor operation) are potentially stress-inducing in many patients, especially medically compromised patients. The body's response to dental stress involves the cardiovascular system(an increase in cardiovascular workload), the respiratory organ and the endocrine system(change in metabolism). To minimize the stress to the medical risk patient, the stress reduction protocol was established. The obtained contents were as follows: (1) Recognize the patient's degree of medical risk (2) Complete medical consultation before dental therapy (3) Schedule the patient's appointment in the morning (4) Monitor and record preoperative and postoperative vital signs (5) Use psychosedation during therapy (6) Use adequate pain control during therapy (7) Short length of appointment : do not exceed the patient's limits of tolerance (8) Follow up with postoperative pain/anxiety control (9) Telephone the higher medical risk patient later on the same day that treatment was given Though the stress reduction protocol above was applied to the dental extraction in medically compromised patients with the advanced infected teeth, the final responsibility for the complications(syncope, bleeding & infection, etc.) in a patient rests with the dentist who ultimately treats him. For the prevention of postextraction complications & poor prognosis, the authors treated the advanced infected teeth with the pulp extirpation, opening drainage through the canal and complete occlusal reduction. The final extraction and wound closure were then done after $1{\sim}2$ weeks. The final prognosis was comfortable without common complications.

• Journal of Oral Medicine and Pain
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• v.34 no.1
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• pp.1-9
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• 2009

Liver transplantation is definitive treatment for the patients suffering from hepatitis, severe liver cirrhosis and liver cancer. In these patients, systemic infections under immunosuppression may occur easily. Therefore, primary object of dental treatments before liver transplantation is absolute removal of oral infection source. In addition, comprehensive dental management plan is essential for success of liver transplantation. The present study has been performed to investigate decayed, missing and filled permanent teeth index(DMFT index), degree of oral hygiene, past medical history, need of dental treatment, completion of dental treatment need and time interval between dental visit and operation date of liver transplantation in liver transplant candidates. Obtained results were as follows; 1. Decayed teeth of the patients were 2.68, missing teeth were 4.02 and filled teeth were 3.42. DMFT index was 10.12. 2. Twenty percents of patients showed moderate to severe food impactions, 42.2% of patients had moderate to heavy calculus and 37.8% of patients displayed gingival inflammation with swelling. 3. Patients needed periodontal treatments more than any other dental treatments. Periodontal treatments were needed for 88.9% of patients, operative & endodontic treatments were 46.7% of patients and 33.3% of patients needed for oral & maxillofacial surgical treatments. 4. Among 90 patients, time interval between scheduled operation date of liver transplantation and dental visit was within 2 weeks for 32.2% of patients, within 1 week for 20.0% of patients. In conclusion, most liver transplant candidates needed dental treatments for removal of potential infection sources. However because of insufficient interval between dental visit and operation date, they had taken liver transplantation procedures without comprehensive dental management. Development of preventive and comprehensive dental management program is mandatory for these patients. Cooperative interdisciplinary management will play a positive role for successful liver transplantation.