Melatonin: Implications at the oral level

The strong relationship between the pineal gland and the immune system continues to establish itself more and more. In situations of a pinealectomy or in those of inhibition of the production of melatonin, a state of immunosuppression is produced which disappears when the patient receives this hormone. Likewise, melatonin counteracts the negative effects that immunosuppressive drug treatments produce over the immunity. It is due to these facts that one postulates the possibility of utilizing melatonin in primary and secondary immunodeficiency states as well as in cancerous immunotherapy. The action of this hormone over the immune system is carried out through the T-helper lymphocytes, lymphokines and also it seems through certain pituitary hormones. On the other hand, lymphokines such as Gamma-Interferon and Interleukin-2, as well as the thymus, can modulate the synthesis of melatonin at the level of the pineal gland. Without doubt, all these actions have important consequences at the time of treatment of our high-risk dental patients who have, in one way or another, an altered immunologic system. The altered immune system has direct implications in primary oral pathologies, or in others derived directly from our dental treatment.Une relation de plus en plus précise s’établit entre la glande pinéale et le système immunitaire. Dans les cas d’une pinéalectomie ou d’une inhibition de la production de mélatonine, un état d’immunodépression apparaît et qui disparaît lorsque le patient reçoit cette hormone. Par ailleurs, la mélatonine contrecarre les effets négatifs des immunodépresseurs sur l’immunité. Il en résulte que l’on peut postuler l’utilisation de la mélatonine dans les états d’immunodéficience primaire et secondaire ainsi qu’au cours de l’immunothérapie cancéreuse. L’action de cette hormone sur le système immunitaire s’exerce au travers des lymphocytes T-helper, des lymphokines et aussi semble-t-il au travers de certaines hormones hypophysaires. De plus, des lymphokines telles que l’Interferon gamma et l’Interleukine 2, aussi bien que le thymus, peuvent moduler la synthèse de la mélatonine au niveau de la glande pinéale. Sans doute, toutes ces actions possèdent d’importantes conséquences lors du traitement en dentisterie, chez nos patients à haut risque souffrant d’une manière ou d’une autre d’une altération de leur système immunitaire.Le système immunitaire altéré exerce une implication directe dans des pathologies primitives de la bouche ou dans celles qui dérivent directement de notre traitement dentaire

Pharmacological interactions of vasoconstrictors

This article is the first of a series on pharmacological interactions involving medicaments commonly prescribed and/or used in odontology: vasoconstrictors in local anaesthetics and anti-inflammatory and anti-microbial analgesics. The necessity for the odontologist to be aware of adverse reactions as a result of the pharmacological interactions is due to the increase in medicament consumption by the general population. There is a demographic change with greater life expectancy and patients have increased chronic health problems and therefore have increased medicament intake. The presence of adrenaline (epinephrine) and other vasoconstrictors in local odontological anaesthetics is beneficial in relation to the duration and depth of anaesthesia and reduces bleeding and systemic toxicity of the local anaesthetic. However, it might produce pharmacological interactions between the injected vasoconstrictors and the local anaesthetic and adrenergic medicament administered exogenically which the odontologist should be aware of, especially because of the risk of consequent adverse reactions. Therefore the importance of conducting a detailed clinical history of the general state of health and include all medicaments, legal as well as illegal, taken by the patient

Pharmacological interactions of anti-inflammatory-analgesics in odontology

In this second article we describe the more interesting pharmacological interactions in dental practice based on the prescription of analgesic narcotics, paracetamol and non-selective non-steroid anti-inflammatory drugs (NSAI) (which inhibit cyclooxigenase 1 ?COX 1- and cyclooxigenase 2 ?COX 2-) and selective NSAIs (COX 2 inhibitors). The importance of preventing the appearance of these pharmacological interactions is because these are medicaments prescribed daily in odontology for moderate pain treatment and inflammation in the oral cavity. Paracetamol can interact with warfarin and therefore care should be taken with chronic alcoholic patients. All NSAIs reduce renal blood flow and consequently are capable of reducing the efficacy of medicaments used for treating arterial hypertension, which act via a renal mechanism. Especial attention should be taken considering the risk of interaction between the antagonists of AT1 receptors of angiostensin II (ARAII) and the NSAIs

Pharmacological interactions of anti-microbial agents in odontology

In this third article we describe the pharmacological interactions resulting from the use of anti-microbial agents. Although the antimicrobials prescribed in odontology are generally safe they can produce interactions with other medicaments which can give rise to serious adverse reactions which are well documented in clinical studies. Antibiotics with grave and dangerous life threatening consequences are erythromycin, clarithromycin and metronidazol and the anti-fungal agents are ketoconazol and itraconazol. Regarding the capacity of the anti-microbials to reduce the efficacy of oral anti-contraceptives the clinical studies to date are inconclusive, however, it would be prudent for the oral cavity specialist to point out the risk of a possible interaction. Therefore the specialist should be aware of possible interactions as a consequence of administering an antibiotic together with other medicaments the patient may be taking

Current methods of sedation in dental patients : a systematic review of the literature

The main objective of this systematic literature review is to identify the safest and most effective sedative drugs so as to ensure successful sedation with as few complications as possible. A total of 21 studies were selected due to their rigorous study design and conduciveness to further, more exhaustive analysis. The selected studies included a total of 1,0003 patients classified as ASA I or II. Midazolam was the drug most frequently used for successful sedation in dental surgical procedures. Ketamine also proved very useful when administered intranasally, although some side effects were observed when delivered via other routes of administration. Both propofol and nitrous oxide (N2O) are also effective sedative drugs. Midazolam is the drug most commonly used to induce moderate sedation in dental surgical procedures, and it is also very safe. Other sedative drugs like ketamine, dexmedetomidine and propofol have also been proven safe and effective; however, further comparative clinical studies are needed to better demonstrate which of these are the safest and most effective

The bacteremia of dental origin and its implications in the appearance of bacterial endocarditis

Numerous systemic diseases may affect the oral cavity and vice versa,in particular severe diseases that involve the heart valve. In these cases, additional measures or a modification to our dental treatment need to be taken. We are aware of various diseases that can cause the emergence of bacterial endocarditis (BE), such as; rheumatic fever, valve lesions due to intravenous drug use, Kawasaki disease and valve surgery, among others. Due to its severity when it is not taken into account in dental treatment, we intend to show the evolution of the antimicrobial prophylaxis towards this condition. Furthermore, we intend to publish the current guidelines of institutions and societies which increasingly encourage rational antimicrobial use. In addition, we intend to examine the evidence of the possible origins of this disease during dental treatment and at the same time describe the necessary considerations that need to be taken during dental treatment

Effect of gingival application of melatonin on alkaline and acid phosphatase, osteopontin and osteocalcin in patients with diabetes and periodontal disease

Objectives: To assess the effect of topical application of melatonin to the gingiva on salivary fluid concentrations of acid phosphatase, alkaline phosphatase, osteopontin, and osteocalcin. Study Design: Cross-sectional study of 30 patients with diabetes and periodontal disease and 30 healthy subjects. Diabetic patients were treated with topical application of melatonin (1% orabase cream formula) once daily for 20 days and controls with a placebo formulation. Results: Before treatment with melatonin, diabetic patients showed significantly higher mean salivary levels of alkaline and acid phosphatase, osteopontin and osteocalcin than healthy subjects (P < 0.01). After treatment with melatonin, there was a statistically significant decrease of the gingival index (15.84± 10.3 vs 5.6 ± 5.1) and pocket depth (28.3 ± 19.5 vs 11.9 ± 9.0) (P < 0.001). Also, use of melatonin was associated with a significant reduction of the four biomarkers. Changes of salivary acid phosphatase and osteopontin correlated significantly with changes in the gingival index, whereas changes of alkaline phosphatase and osteopontin correlated significantly with changes in the pocket depth. Conclusions: Treatment with topical melatonin was associated with an improvement in the gingival index and pocket depth, a reduction in salivary concentrations of acid phosphatase, alkaline phosphatase, osteopontin and osteocalcin

State anxiety and depression as factors modulating and influencing postoperative pain in dental implant surgery. A prospective clinical survey

Objetives: To determine whether preoperative state anxiety and depression modulate or influence objective and subjective postoperative pain following dental implant insertion. Study Design: Prospective, clinical study with 7-day follow-up of a sample of 105 subjects who preoperatively completed the state anxiety questionnaire (STAI-E) and Beck Depression Inventory (BDI) and postoperatively, at 2 and 7 days, recorded objective pain with the Semmes-Weinstein mechanical esthesiometer (SW test) and subjective pain with the Visual Analog Scale (VAS). Results: 85.6% and 81.5% of patients, respectively, recorded no signs of state anxiety or depression. The correlation between anxiety and depression for both maxillary bones was the lower ( P =0.02). The correlation between subjective and objective pain at 2 and 7 days, and the anatomic regions intervened, was statistically significant in the mandible at day 7 ( P <0.01), and highly significant ( P <0.001) for the other variables. The correlation between state anxiety and objective pain at day 7 was nearly statistically significant ( P =0.07). Conclusions: The correlation between state anxiety and depression, and objective and subjective pain at day 7 was not statistically significant. A strong correlation was found between objective and subjective pain in the immediate postoperative period

Effect of topical application of melatonin on serum levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in patients with type 1 or type 2 diabetes and periodontal disease

Background: The present clinical trial study was designed to assess the effect of topical application of melatonin on serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) in patients with diabetes and periodontal disease in comparison with healthy controls. Material and Methods: Serum levels of TNF-α and IL-6 were measured by enzyme-linked immunosorbent assay and CRP by nephelometry by using the proper commercial kits in 30 patients with diabetes and periodontal disease, and also in a control group of 30 healthy subjects. Periodontograms were performed using the Florida Probe®. Patients with diabetes were treated with a topical application of melatonin (1% orabase cream formula) once daily for 20 days. Healthy subjects were treated with a placebo orabase cream. Results: Patients with diabetes and periodontal disease had significantly higher mean levels of serum TNF-α, IL-6 and CRP than healthy subjects ( P < 0.001). Following topical melatonin application, there was a statistically signi - ficant decrease in the gingival index and pocket depth ( P < 0.001) as well as a significant decrease in IL-6 and CRP serum levels ( P < 0.001). Local melatonin application in patients with diabetes and periodontal disease resulted in a significant decrease in CRP and IL-6 serum levels as well as an improvement in the gingival index and pocket depth. Patients with periodontal disease had significantly higher serum CRP, IL-6 and TNF-α values by comparison with healthy subjects. Conclusions: We conclude that melatonin can modulate the inflammatory action of these molecules in periodontal patient

Bibliometric analysis of research on regenerative periodontal surgery during the last 30 years

Objectics: The evolution of research activity during the last thirty years on regenerative periodontal surgery is studied. Results: A small number of authors are highly productive with more than 10 publications on the subject each. 79,6% of authors have only produced one article on the subject. The co-authorship average is of 2,68 authors per paper, with a collaboration between 2 and 6 authors. Main journals on the field of regenerative periodontal surgery are Journal of Periodontology and Journal of Clinical Periodontology, which are ranked 14th and 1st in their category according to the Journal Citations Reports. The most used language is English, followed by Japanese and Italian, Spanish occupying the eighth position. Conclusions: A significant increase on scientific literature is observed, similar to the one Dentistry has had. A reduced number of authors account for most production. In the same token, there is a scarce professionalization of researchers in this field, where most of the authors are occasional. On the other hand, there are two very specialized journals on this topic