Root surface caries: clinical, histopathological and microbiological features and clinical implications.
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Root sections were inoculated with one of two strains of Actinomyces viscosus or a strain of Streptococcus sobrinus and then incubated for 9 days in Trypticase soy broth (TSB) containing 0.25% glucose or TSB supplemented with 0.25% sucrose (TSB+S). Lesion progression was measured from microradiographs. One section from each group was examined with a transmission electron microscope. Lesion progression was associated with a fall in the pH of the medium. However, lesion progression was not correlated with the mean 48-hour pH of the medium. In both TSB and TSB + S, lesion progression with A. viscosus was significantly greater than in the S. sobrinus group. However, the mean 48-hour pH value in TSB + S was lower than that in the S. sobrinus group. Plaque formation in TSB was, subjectively, least in the S. sobrinus group. Examination of transmission electron micrographs revealed bacteria penetrating the surfaces of the sections and extending into the lesion in the A. viscosus groups but not in the S. sobrinus group. This in vitro bacterial plaque model of root caries may be suitable for investigations of the bacterial etiology of root-surface caries and the virulence factors associated with pathogenicity.
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In order to evaluate the anticaries effects of several trace elements by combined and respective treating procedure, studies on inhibiting demineralization and improving remineralization were carried out with lanthanum, cerium and fluoride in a pH-cycling condition. The analysis of polarized microscope and electron microprobe demonstrated that the lanthanum and fluoride to an acetate buffer solutions had less severe demineralization of root surface than individual lanthanum or fluoride to the solution. The former, furthermore, precipitated a compound membrane which may be F-La(Ce)-Ca containing crystal on the root surface, and showed a better resistibility to acid. A further discussion was made from the viewpoint of crystal physiochemistry.
Caries, periodontal disease, and occlusal wear were studied in rats with short-term (one month) and long-term (12 months) untreated alloxan diabetes and in age-matched control rats. Standard laboratory diet and water were given ad libitum. Streptococcus mutans and lactobacilli were naturally occurring inhabitants of the oral bacterial flora. In short-term diabetic rats, there was less dental plaque in the gingival region of the first mandibular molar than in control rats, but the density of leukocytes in the junctional epithelium was increased. Interdentally, the gingival papillae were intact, and the prevalence of foreign material was as low as for the controls. No caries lesions were seen. The proportion of the oral flora which was lactobacilli was positively correlated with the blood glucose level. In long-term diabetic rats, there was more periodontal breakdown than in the age-matched control rats. The periodontal breakdown was always associated with large interdental impactions of foreign material. Caries was seen only in the diabetic rats and in sites with interdental impactions. The decay was shown to start in the cementum at the cemento-enamel junction. The amount of alveolar bone loss, but not the amount of dental caries, was related to the degree of hyperglycemia. Occlusal wear of the molars in long-term diabetic rats was significantly increased as compared with that in the controls.
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Minimal intervention dentistry (MID), a modern, evidence-based approach to caries management in dentate patients, uses a medical model whereby disease is controlled by the "oral physician" and an affiliated dental team. Geriatric MID helps clinicians to address the ever-increasing restorative challenges presented by older patients, including erosion, abrasion, demineralization, rampant coronal and root caries, retained roots, recurrent caries (necessitating crowns and other repairs), subgingival caries, "wet" oral environments, salivary dysfunction, disruptive behaviours, poor compliance with preventive care, high plaque levels, and financial and other restrictions on care options. The main components of a geriatric approach to MID are assessment of the risk of disease, with a focus on early detection and prevention; external and internal remineralization; use of a range of restorations, dental materials, and equipment; and surgical intervention only when required and only after disease has been controlled. This second in a series of 2 articles describes direct restorative strategies to address the challenges of geriatric caries management, including choice of material, placement of glass ionomers, sandwich technique, techniques for the management of erosion and abrasion, tunnel and slot preparations, techniques for "wet" subgingival environments, vital pulp therapy and geriatric atraumatic restorative technique.
The oral health of subjects over 75 yr and living independently in the southwest of Britain was assessed. The majority (80%) of the sample were edentulous, and a large proportion of both edentate and dentate subjects were using dentures. More than half of the denture wearers were using loose, very unhygienic, or structurally defective dentures. Mucosal pathoses were quite common, although most of the lesions were denture-induced stomatitis found in association with unhygienic dentures. The dentate subjects had, on average, 11 natural teeth, frequently with evidence of root caries and deep periodontal pockets or extreme bone loss. The oral health problems suggest that there is a significant need to develop effective methods of improving oral hygiene in this age group. The prosthetic treatment is related principally to denture repairs while there is a need to control root caries among the growing population of elderly dentate people.
OBJECTIVE: To investigate the oral health status of patients with nasopharyngeal carcinoma (NPC) after completion of radiotherapy. METHODS: Thirty-three NPC patients (mean age 53 +/- 10 years) who had completed head and neck radiotherapy (3.6 +/- 3.1 years post-operation) were examined. Dental caries, periodontal status and oral mucosal lesions were recorded. Stimulated whole saliva (SWS) flow rate, pH, buffer capacity and carriage rate of carcinogenic micro-organisms were assessed. Jaw opening was measured. RESULTS: Xerostomia was present in all patients, while 42% had candidiasis and 21% had limited jaw opening. The mean number of teeth present was 22, mean DMFT was 8.0, mean number of untreated root caries lesions was 1.4. Both saliva pH and buffering capacity were low while Streptococcus mutans and Lactobacillus spp. carriage were high. 52% of the patients had no dental care following radiotherapy. Although few patients expressed direct dissatisfaction, perceived level of information and of post-operative dental care was insufficient. CONCLUSIONS: Post-irradiated NPC patients constitute a high-risk group for dental root caries and oral candidiasis. The carriage rate of Streptococcus mutans and Lactobacillus spp. in this NPC patient group was the highest among findings of other similar studies. This may be related to the inadequacy of dental care after radiotherapy. Head and neck radiotherapy was not associated with periodontal disease.
OBJECTIVES: This study compared a 10% chlorhexidine varnish treatment with placebo and sham treatments for preventing dental caries in adult patients with xerostomia (dry mouth). DESIGN: The study was a multicentred, randomized, parallel group, double blind, placebo-controlled clinical trial. SETTING: All examinations and procedures were performed at Tuft's University, Boston, MA, the University of British Columbia, Vancouver, BC or the University of Western Ontario, London, ON. SUBJECTS: Subjects were adults with recent or current dental caries experience, high salivary levels of cariogenic microorganisms and low salivary flow rates. RESULTS: 236 subjects completed at least one post-treatment examination. There were 697 new carious lesions diagnosed, 446 (64%) located on coronal surfaces and 251 (36%) located on root surfaces. The mean attack rate was 0.23 surfaces/100 surfaces at risk. A treatment difference observed between the Active and Placebo groups was statistically significant for root caries increment (p = .02) and total caries increment (p = .03). A treatment difference observed between the Active and Sham groups was not statistically significant for coronal, root or total caries increment. Analysis of variance of treatment group differences was performed using mutans streptococci counts, salivary flow rates, age, sex, caries prevalence, medications, time to first event and early withdrawal as co-variables. These factors did not meaningfully alter the findings. CONCLUSIONS: The difference between the 10% chlorhexidine varnish and placebo treatments is considered to be highly clinically significant for root caries increment (41% reduction) and for total caries increment (25% reduction) but only for coronal caries increment (14%).
The aim of this study was to screen patients with fixed prosthodontic appliances that were in oral cavity for a period of 5 years or more and to assess clinically and radiologically root caries, gingival recession, pocket formation, alveolar ridge resorption, as well as gingival (GI) and plaque index (PI). The aim also was to find out the differences between materials and constructions, between abutment and non-abutment teeth, and to find out the need for replacement. A total of 260 patients and their orthopantomograms were examined, with a total of 2,265 teeth, 610 being bridge abutments and 246 being crowns. The most frequent were metal+ acrylic veneer crowns or bridges. Root caries was found under the abutments in 10-20%; however abutments with ceramic crowns had the lowest percentage of caries (p < 0.01). Alveolar ridge resorption, pocket formation deeper than 3 mm and gingival recession of various degree was found in 50% of the cases, again with the lowest percentage of ceramic-fused-to-metal appliances (p < 0.01). Pocket depth was registered in significantly higher percentage in metal-acrylic veneer appliances compared to natural teeth (p < 0.01), while there was no significant difference between metal-ceramic appliances and natural teeth (p > 0.05). Although the worst findings were recorded for metal- + acrylic veneer crowns for PI, no significant difference existed between crowns of different material or non-abutment teeth (p > 0.05). There was statistically significant difference between abutments with metal + acrylic veneer crowns, full metal crowns, metal ceramic crowns and non-abutments for GI scores. Higher percentage of scores 0 and 1 was recorded for metal ceramic crowns and non-abutments and significantly higher percentage of scores 2 and 3 was recorded for metal + acrylic veneer crowns and full metallic crowns. Almost 50% of metal-ceramic abutments had no pathologic findings. Almost 30% of the patients needed replacement, or even some abutments to be extracted and therefore a new prosthodontic appliance.
OBJECTIVE: To assess personal oral health care standards among frail, elderly and infirm nursing home residents prior to developing and evaluating a health promotion intervention. DESIGN: Descriptive survey, interview and clinical data. SETTING: 22 randomly selected nursing homes in the Bristol area. METHOD: 412 residents with denture(s) and/or natural teeth, and giving informed consent to the study were interviewed about dental attendance and current dental problems. A clinical examination assessed levels of oral and denture hygiene, denture-related stomatitis, gingivitis, calculus and root caries. RESULTS: Less than half the subjects (mean age 84.5 years) were ambulant. Over 70% had not seen a dentist for over 5 years, and 22% reported a current dental problem. Among denture wearers, 82% were unable to clean their dentures; staff cleaned dentures for 64%. Denture-related stomatitis affected 33%, and unhygienic dentures were worn by 95% of subjects. Among dentate subjects (mean number of teeth 11.6), 75% were unable to clean their teeth yet none received regular assistance. On average, two-thirds of each tooth surface were covered in plaque. Gingivitis was moderately severe. Calculus was present in 82% of subjects and root caries in 63% of subjects. CONCLUSIONS: Most residents required help with oral health care but many did not receive it. Residents' levels of plaque and associated dental disease were high. Staff did not effectively perform oral health care appropriate to residents' needs. Further research to evaluate an oral health care training programme for care staff is planned.
The usefulness of fluoride-releasing restorations in secondary caries prevention may be questioned because of the presence of other common sources of fluoride and because of ageing of the restorations. This study tested the hypothesis that glass-ionomer cement restorations, either aged or unaged, do not prevent secondary root caries, when fluoride dentifrice is frequently used. Sixteen volunteers wore palatal appliances in two phases of 14 days, according to a 2 x 2 crossover design. In each phase the appliance was loaded with bovine root dentine slabs restored with either glass-ionomer or resin composite, either aged or unaged. Specimens were exposed to cariogenic challenge 4 times/day and to fluoridated dentifrice 3 times/day. The fluoride content in the biofilm (FB) formed on slabs and the mineral loss (DeltaZ) around the restorations were analysed. No differences were found between restorative materials regarding the FB and the DeltaZ, for either aged (p = 0.792 and p = 0.645, respectively) or unaged (p = 1.00 and p = 0.278, respectively) groups. Under the cariogenic and fluoride dentifrice exposure conditions of this study, the glass-ionomer restoration, either aged or unaged, did not provide additional protection against secondary root caries.
As part of an evaluation of the potential of topical application of TiF4 in the prevention or arrest of root caries, the longevity of the titanium-rich glaze and the long-term retention of titanium and fluoride in exposed dentin surfaces were examined in dogs. For comparison, the effect of fluoride in combination with another cation, tin, was studied as well. Facets of exposed dentin were prepared in two beagles and treated for 1 or 4 min with either a TiF4 or an SnF2 solution (1.1 M F, native pH). After 3, 7, or 21 wk, the experimental surfaces were analyzed for fluoride, titanium, tin, and calcium using an electron microprobe. Dentin surfaces treated with TiF4 for 1 min showed fluoride concentrations ranging from less than 0.15% to 1.03%, while those treated for 4 min with SnF2 showed values from 0.22% to 1.28%. The calcium analyses revealed partial surface demineralization in one half of the SnF2-treated specimens, while this was a rare finding in the TiF4 group. The findings show that a brief application of TiF4 to exposed dentin results in approximately the same increase in fluoride content as a 4-min application of SnF2, with, however, less surface demineralization. In addition, the presence of a surface glaze may impart an added benefit to the use of TiF4 as a topical agent in the prevention of root caries.