A Case Report of Tooth Wear Associated with a Patient's Inappropriate Efforts to Reduce Oral Malodor Caused by Endodontic Lesion

Here, we report a case of severe tooth wear associated with a patient's inappropriate efforts to reduce oral malodor. A 72-year-old male patient visited our breath clinic complaining of strong breath odor. Former dentists had performed periodontal treatments including scaling and root planing, but his oral malodor did not decrease. His own subsequent breath odor-reducing efforts included daily use of lemons and vinegar to reduce or mask the odor, eating and chewing hard foods to clean his teeth, and extensive tooth brushing with a hard-bristled toothbrush. Oral malodor was detected in our breath clinic by several tests, including an organoleptic test, portable sulphide monitor, and gas chromatography. Although patient's oral hygiene and periodontal condition were not poor on presentation, his teeth showed heavy wear and hypersensitiving with an unfitted restoration on tooth 16. Radiographic examination of the tooth did not reveal endodontic lesion, but when the metal crown was removed, severe pus discharge and strong malodor were observed. When this was treated, his breath odor was improved. After dental treatment and oral hygiene instruction, no further tooth wear was observed; he was not concerned about breath odor thereafter

Recovery of flow-mediated vasodilatation after repetitive measurements is involved in early vascular impairment: comparison with indices of vascular tone.

In repetitive measurements of flow-mediated dilatation (FMD), the duration of the interval between measurements remains controversial. In this pilot study, we conducted three sequential measurements of low-flow-mediated constriction (L-FMC), FMD and flow-mediated total dilation (FMTD; L-FMC+ FMD) at baseline and intervals of 15 and 60 min in 30 healthy males. FMD15, L-FMC15, and FMTD15 were significantly lower than the respective first measurements, but all indices showed full recovery at 60 min in all subjects. The baseline diameter was slightly increased at 15 min and restored at 60 min, but the maximum diameter, and the baseline and reactive flow velocity unchanged. We examined the relationship between recovery rate of FMTD at 15 min (FMTD-R) and cardio-ankle vascular index (CAVI). Univariate analysis showed moderate correlation between FMTD-R, and CAVI and L-FMC0. Patients were divided according to FMTD-R value; the low-FMTD-R group [below the median value (-26.2%)] included a significantly higher proportion of smokers and higher CAVI values than the high-FMTD-R group. The reproducibility of FMTD and FMTD-R was evaluated in another group of 25 healthy subjects. The range of variation across measurements was 1.1% for FMTD and 4.6% for FMTD-R; with intraclass correlation coefficients of 0.93 and 0.95, respectively. The present study demonstrated blunted recovery of FMD within 15 min, suggesting the need for selection of a more adequate interval between measurements to avoid underestimation of FMD in subsequent measurements. The findings demonstrated the reproducibility of FMTD-R and FMTD measurements, and that FMTD-R might be involved in arterial stiffness and early vascular impairment in the healthy subjects

FMTD and FMTD-R measurements in consecutive FMD procedures in healthy volunteers.

<p>Correlation analysis for FMTD (A) and FMTD-R (B) (p<0.01, respectively.). Bland-Altman Plots for FMTD (C) and FMTD-R (D). The dotted lines represent 1.96 ± SD.</p

Clinical characteristics of the patient population divided according to FMTD-R.

<p>Values are mean ± SD or percentage of patients.</p><p>*p<0.004, compared with the good FMTD-R group (Fisher's exact probability test).</p

Values of FMD-related indices and CAVI in the healthy subjects divided into the poor and good recovery groups based on the median FMTD-R value (-26.2%).

<p>No significant difference was observed in FMD (A), FMTD (B), and L-FMC (C) values between the two groups. CAVI values were significantly higher in the poor recovery group.</p

Brachial artery characteristics.

<p>Values are mean ± SD.</p><p>p<0.01, compared with the respective baseline measurement.</p

Correlation between FMTD-R and other FMD-related indices.

<p>Although a significant correlation between FMTD-R and L-FMC was confirmed (A), no relationship was found between FMTD-R and FMD (B) or FMTD (C). Notably, FMTD-R correlated significantly with CAVI (D).</p

Serial changes in the physiological indices of flow-mediated vasodilatation.

<p>Flow-mediated total dilation (FMTD) (A), flow-mediated dilation (FMD) (B), and low–flow-mediated constriction (L-FMC) (C) values were obtained at 15 and 60 min intervals after the measurement. All indices were blunted at 15 min and showed complete recovery at 60 min. Data are mean ± SD. *p<0.05, compared with the respective baseline measurement.</p