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LETTERS: David R Moles Dental abscesses have increased most among poorer people BMJ 2008; 336: 1323 [Full text]

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Dental abscess increase

Rodney t. Williams   (13 June 2008)

Diseases of the periapical area

Eduardo M. Curbeira Hernández MSc MDD, Eduardo E. Castillo-Betancourt MSc MDD, Juana Hernández-Fernández MSc, Edita Solano-López MSc, Manuel Martinez-Corcho MSc MD   (6 July 2008)

Dental abscess increase 13 June 2008
Rodney t. Williams, retired general dental practitioner LL18 6HR Send response to journal: Re: Dental abscess increase	The increase in the number of dental abscess patients seen in hospitals may well be caused by the fact that general anaesthesia is no longer used in general dental practice. It is extremely difficult if not impossble,to treat an acute abscess with local anaesthetic agents, nor is is it surgically desireable R.Williams Dyserth,N.Wales LL18 6HR Competing interests: None declared
Diseases of the periapical area 6 July 2008
Eduardo M. Curbeira Hernández MSc MDD, Dentistry Department Gustavo Aldereguia Lima University Hospital. Cienfuegos. Cuba, Eduardo E. Castillo-Betancourt MSc MDD, Juana Hernández-Fernández MSc, Edita Solano-López MSc, Manuel Martinez-Corcho MSc MD Send response to journal: Re: Diseases of the periapical area	Generally when trauma or deep dental caries make teeth die, the chamber of the pulp and the radicular ducts change into necrotic tissue. This degenerated tissue with or without bacteria cause a periapical irritation. The organism then intends to fight against this irritation throughout an inflammatory response with two forms of reaction according to the nature, magnitude, and intensity of outer stimuli. The first one is necrosis, aggression and the second one slow and repeated hyperplasia. Periapical disease, so spread in our environment is preceded by gangrene of the pulp. The toxic product of the pulpit decomposition such as putrescine and cadaverine, ammonia, fatty substances and others exert an irritating action upon the periapical tissues. In the case of gangrenes, apart from the above mentioned substances, there are also micro organisms, toxins and enzymes. When the periapical tissues are affected by these micro organisms, toxins and toxic substances, they react in different forms. Some disorders appear in a short period of time accompanied by well defined symptoms, others develop slowly and progressively and generally they appear asymptomatically. In terms of management, it is important to take into account that when there is a dysfunction, it reduces the repairing capacity of the periodontal tissue. All its tissues suffer in the same way since it constitutes a functional unit when it is interfered in its defensive resource. These defensive resources are superior to the vulvar ones. The histopathology of periodontal tissue is similar to the tissue of the pulp, differing only in the ending of the processes because it is going to be influenced by the site and the circumstances in which the lesion takes place, remarking in the apical periodontal tissue changes from the acute to the chronic forms or worsening these chronic states which can return the process to a normal phase, hence, to the restoration of the affected tissues. Most of the process that occur in the pulp cause death due to its own histological and anatomical characteristics and because it is enclosed within a rigid cavity. References: 1. Moles D. R Epidemic of dental abscesses? BMJ 2008;336:1323 (14 June), doi:10.1136/bmj.39605.430243.3A 2. Harty, P.F. ENDODONCIA en la práctica clínica. 4ta. Edición.Ed. McGraw-Hill Interamericana. London. 1999. Competing interests: None declared