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PubMed2000

Oral health status of patients 5-6 years after placement of cobalt-chromium removable partial dentures.

This study is a clinical survey of cobalt-chromium (Co-Cr) removable partial denture (RPD) wearers that aimed to investigate the effects of denture wearing on oral tissues. A random sample of patients who had received their dentures 5-6 years previously from a dental teaching hospital in Hong Kong was selected. Those who had been constantly wearing the RPDs were examined by one calibrated examiner under an optimal clinical setting. The patients' dental, periodontal and mucosal status were assessed. A total of 87 patients were examined. Mucosal lesions under the Co-Cr RPDs were uncommon in this study sample. However, there was a high prevalence of plaque, gingivitis and gingival recession, especially in dento-gingival surfaces in close proximity (within 3 mm) to the dentures. Thus, there is a special need for regular oral hygiene reinforcement, scaling and prophylaxis among RPD wearers. Despite a low caries incidence in the study sample, root caries were found to be associated with contact with the RPDs (P < 0.05) but coronal caries were not. It is recommended that coverage of the exposed root surfaces by RPD components should be avoided. Also, topical fluorides should be regularly applied onto exposed root surfaces as a preventive measure.

Adult↗
PubMed1998

Caries in patients with non-insulin-dependent diabetes mellitus.

OBJECTIVE: The purpose of this study was to investigate the prevalence and risk factors of dental caries in patients with non-insulin-dependent diabetes mellitus and to determine whether these factors are associated with metabolic control and vascular complications of the disease. STUDY DESIGN: Both the occurrence of caries, acidogenic oral bacteria, and yeasts and salivary flow were studied in 25 patients with non-insulin-dependent diabetes mellitus whose diagnosis had been set 13 to 14 years earlier and in whom the metabolic evolution of the disease was well established. The patients' glycemic control was determined by means of analysis of the blood hemoglobin A1C concentration at the time of dental examination. The control group consisted of 40 nondiabetic subjects in the same age group. Decayed, missing, and filled teeth indices and numbers of surfaces with caries, filled surfaces, and root caries were determined by means of clinical dental caries examination. Stimulated salivary flow was measured, and levels of Streptococcus mutans, lactobacilli, and yeasts were analyzed. RESULTS: The median hemoglobin A1C concentration of the patients was 8.6%, which indicates poor metabolic control of diabetes. No association was found between the metabolic control of disease and dental caries. The occurrence of dental caries was not increased in the patients with non-insulin-dependent diabetes mellitus in comparison with the control subjects. The counts of acidogenic microbes and yeasts did not differ statistically significantly between the groups. There was no association of caries with the prevalence of coronary artery disease or hypertension in either the patients or the control subjects. In a stepwise logistic regression model, a salivary flow of at least 0.8 ml/min was related to the occurrence of dental caries in patients with non-insulin-dependent diabetes mellitus, whereas negligence with respect to dental care was the most important risk predictor in the control group. CONCLUSION: Our results showed no effect of diabetes on the prevalence of caries. However, the caries-protective effect of saliva was partly lost in patients with non-insulin-dependent diabetes mellitus.

Aged↗
PubMed2004

Caries-preventive effect of sodium fluoride mouthrinses: a systematic review of controlled clinical trials.

The Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on different caries-preventive methods. The aim of this article was to report the findings concerning the caries-preventive effect of fluoride mouthrinses (FMRs) in various age groups, with special reference to background fluorides. A systematic search in electronic databases for literature published between 1966 and August 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years' follow-up, and caries increment in the permanent dentition (DeltaDMFS/T) as endpoint. Out of 174 articles originally identified, 62 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A-C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF) expressed as percent. The level of evidence was based on 25 articles. The results revealed limited evidence (evidence level 3) for the caries-preventive effect (PF 29%) of daily or weekly sodium fluoride rinses compared with placebo in permanent teeth of schoolchildren and adolescents with no additional fluoride exposure and for a caries-preventive effect on root caries in older adults. Inconclusive evidence (evidence level 4) was found regarding the effect of FMRs in schoolchildren and adolescents exposed to additional fluoride sources such as daily use of fluoride toothpaste. No firm support for the use of FMRs was disclosed in a small number of studies designed for patients at caries risk. Furthermore, no association between the frequency of the rinses and prevented fraction or saved surfaces per year was found. In conclusion, this systematic review suggests that sodium fluoride mouthrinses may have an anti-caries effect in children with limited background of fluoride exposure, while its additional effect in children with daily use of fluoride toothpaste could be questioned. The need for further clinical trials to elucidate the effect of FMRs in risk patients and older adults is emphasized.

Adolescent↗
PubMed1992

An in situ enamel section model for assessment of enamel re/demineralization potential.

An enamel-section-carrying intra-oral appliance to predict the results of double-blind anti-caries studies has been developed. Initial validation was against the F concentration effect attained in a clinical trial where three sodium monofluorophosphate (SMFP) dentifrices were used. Original appliance-based work showed significant differences in remineralization between non-F and F dentifrices, but not between different F dentifrices. However, it was shown later that acidified gel-prepared lesions were not as responsive as solution-prepared lesions to de- and remineralizing processes, and lesion remineralization rates were found to be dependent on initial lesion size. An in situ cross-over study was then repeated with use of acid-solution-created lesions, and seven volunteers completed the project. Each brushed twice daily x 2 min with either 0, 1000, or 2500 ppm F, as SMFP dentifrice. After a two-week wash-out, subjects wore the appliances for four weeks. Enamel mineral content was assessed at 0, two, and four weeks via microradiography/microdensitometry, and a statistically significant dose-response was obtained between non-F and F as well as between 1000 and 2500 ppm F pastes, i.e., as per the three-year clinical trial data. Hence, the model's suitability for pre-clinical screening was confirmed. It has also been used in caries microbiological studies, in root caries investigations, and currently in chewing gum cariogenicity experiments.

Dental Enamel↗
PubMed1994

Connective tissue graft technique assuring wide root coverage.

Gingival recession related to periodontal disease or developmental problems can result in root sensitivity, root caries, and esthetically unacceptable root exposures. Consequently, root restorations are performed that often complicate, rather than resolve, the problems created by exposed roots. This article presents a predictable procedure for root coverage on areas of wide denudation in the maxilla and the mandible.

Connective Tissue↗
PubMed2002

Mouthrinses and dental caries.

Mouthrinsing for the prevention of dental caries in children and adolescents was established as a mass prophylactic method in the 1960s and has shown average efficacy of caries reduction between 20-50%. Commonly, weekly or twice monthly rinsing procedures using neutral 0.2% NaF solutions have been used in schools or institutions in areas with low fluoride concentrations in the drinking water. Today, when dental caries has declined substantially in the western countries, and relatively few individuals are suffering from caries, the efficiency of large scale mouthrinsing is questioned and more individual approaches of caries prevention strategies are needed. For this reason individual caries risk assessments are necessary, utilising diagnostic tools with the aim of explaining the main causes of the caries disease. Therefore in high risk patients, daily mouthrinses using 0.05% NaF can be recommended combined with other selective preventive measures such as sugar restriction, improved oral hygiene, antibacterial treatments, and so forth. Mouthrinsing solutions have therefore been combined with antiplaque agents like chlorhexidine and other agents which can improve the caries preventive effect not only in high caries risk patients, including those with dry mouth problems and root caries. Other agents than sodium fluoride have been used, such as stannous and amine fluoride with proven clinical effects. However, although a series of new formulas of mouthrinses containing fluoride combined with different antiplaque agents have shown promising antibacterial and antiplaque efficacy, their long-term clinical effects are sparsely documented. Acute and chronic side effects from established and recommended mouthrinsing routines are extremely rare but ethanol containing products should not be recommended to children for long-term use or to individuals with alcohol problems. Patients with dry mouth problems should avoid mouthrinses containing high concentration of detergent components which reduce the substantivity of the agent and worsen the dry mouth effect. For the future, patients, dentists and public health officials will welcome new and safe, controlled and self-administrated mouthrinsing procedures with not only high efficacy, but also high effectivity and efficiency.

Adolescent↗
PubMed2002

Periodontal attachment level of extractions presumably performed for periodontal reasons.

BACKGROUND/AIMS: The aim of this study was to analyse the residual periodontal attachment in teeth extracted by East German dentists in order to determine a possible 'forceps level'. METHODS: Out of about 8000 extracted teeth collected from a dental waste disposal company, 500 teeth were randomly selected. After exclusion of wisdom teeth and premolars extracted for orthodontic reasons (intact teeth with attachment > 90%), coronal and root caries, fillings, pulp exposure and incomplete root fillings (based on X-rays) were registered. The periodontal ligament was stained with 1% Fuchsin Red and measured with a light microscope. RESULTS: For intact teeth (DF = 0, periodontal disease definition I), the mean periodontal attachment (50.5% +/- 16.0) was significantly lower than for teeth with carious defects or fillings (64.7% +/- 18.8. unpaired t-test: p < 0. 00 1). There was a marked increase in frequency of extractions in intact teeth below 70% periodontal attachment and 37% were extracted at attachment levels between 50 and 69%. Teeth with pulpal involvement showed significantly different frequency distributions and mean attachment values (77.9% +/- 17.8) than the remaining teeth (periodontal disease definition II; 55,2% +/- 15.5). CONCLUSIONS: A considerable number of teeth with no or minor coronal destruction were extracted at an attachment level of 50-70%, regardless of the tooth type. The threshold for 'periodontal' extractions seem to be too low and undifferentiated, which calls for an improvement in knowledge of periodontal diagnosis and treatment.

Dental Caries↗
PubMed1992

Periodontal regenerative therapy with coverage of previously restored root surfaces: case reports.

Two case reports are presented to demonstrate a treatment that restores proper esthetics, cures hypersensitivity, and enhances periodontal support for cases of root caries or failing Class V restorations associated with gingival recessions. The procedure involves removing the existing restoration, elevating a trapezium-shaped full thickness flap, root planing to achieve a desired concave shape, and placing a barrier membrane. In both cases, satisfying clinical results have been maintained for 18 months.

Adult↗
PubMedDate not supplied

Polyol-combinant saliva stimulants and oral health in Veterans Affairs patients--an exploratory study.

An exploratory study investigated the root caries incidence in Department of Veterans Affairs patients with exposed root surfaces. For a period of six to 30 months, the subjects were systematically assigned to groups which used chewable dragees or chewing gums that contained either xylitol or sorbitol as bulk sweeteners. The mean treatment time was 1.8 years (standard deviation = 0.8). The consumption levels of both polyols was up to 8.5 g daily, used typically in five episodes during a 16-hour period. The subjects were examined every six months in connection with their standard scheduled visits at the Veterans Affairs Medical Center. The risk for a root-surface lesion in the xylitol group was only 19% of that for a surface in the sorbitol group (relative risk, 0.19; 95% confidence interval, 0.06-0.62; p < or = 0.0065). Simultaneous study in periodontal patients showed that both polyols significantly reduced the gingival index scores, and slightly (but not significantly) reduced the plaque index scores. Collectively, both studies suggest that frequent daily consumption of chewable, saliva-stimulating products containing essentially nonfermentable or slowly fermentable dietary carbohydrate sweeteners (xylitol and sorbitol) may have an oral-health-improving effect in Department of Veterans Affairs Medical Center patients. It is necessary to evaluate if these procedures would be efficacious in larger and expanded patient cohorts.

Aged↗
PubMed1993

Systemic fluorides: drops and tablets.

Fluoride drops and tablets are effective caries-inhibiting agents which exercise their benefit through mainly topical means. Results of caries trials in which drops or tablets were used in the home vary from excellent to poor, depending on the compliance rates of both parents and offspring. Delivery in schools has also produced reductions of > 80%, and as poor as 20%, again possibly dependent on teacher vigilance. The pre-natal controversy re fluoride tablet benefits has only recently been tested under a true double-blind protocol and resulted in a non-significant effect, although the trend was in favour of those whose mothers had taken F- tablets during pregnancy. Hence, while at the individual level, the slow intra-oral dissolution of fluoride tablets can be of great benefit for coronal caries in children, adolescents, and possibly medically compromised adults (with or without root caries), their contribution on a community basis cannot readily be compared with that of water or salt fluoridation. Although fluoride tablets have been held responsible for an increase in fluorosis prevalence, data which were assessed blind now exist to show that a daily dosage of 0.25 mg fluoride from birth is not associated with dental fluorosis, if additional fluoride products are not used injudiciously over the same period.

Administration, Oral↗
PubMed1996

Caries prevention. A continued need worldwide.

This paper provides a global perspective of the changing prevalence, severity, distribution and pattern of dental caries. The prevalence of caries in children and adolescents has declined in most developed countries and it is now a minority of young people who experience most of the disease. All forms of caries have reduced in prevalence but pits and fissures are the surfaces most frequently involved. The caries experience and levels of edentulousness in the adult populations of developed countries have also declined. The prevalence of caries in adults is remarkably constant with age but in older subjects root caries is becoming more prevalent. However, in many developing countries the prevalence of caries in young children is high and is increasing in those populations who are adopting a cariogenic diet. In countries such as Kenya and China, caries is the major cause of tooth loss but levels of edentulousness are low. There are considerable variations in disease levels between and within countries and it is evident that lower socio-economic and certain racial groups exhibit high levels of dental caries. It is essential to sustain the benefit of fluoride to those already receiving it and encourage the use of appropriate and effective strategies and products by those who are not. Water and salt fluoridation should be implemented where deemed feasible and the use of a clinically proven and affordable fluoride toothpaste should be encouraged.

Adolescent↗
PubMed1994

Fluorides for the elderly.

With the current decline in the rate of dental caries among school children, the elderly now have the higher rate of decayed coronal surfaces in addition to being susceptible to root caries. The most effective strategy that the profession can take is twofold: thoroughly assess the level of caries risk of the elderly individual, and institute recognized measures of fluoride therapy commensurate with the defined risk. This review article describes risk indicators characteristic of the elderly patient and offers specific fluoride regimens for low, moderate and high risk subjects.

Aged↗
PubMed1997

Do root lesions tend to develop in the same people who develop coronal lesions?

OBJECTIVES: The three purposes of this study are to: (1) describe the relationship between the prevalence of coronal caries and root caries; (2) describe the relationship between the three-year incidence of coronal caries and root caries; and (3) if the two conditions are associated, develop a multiple regression model that identifies characteristics distinguishing people who had increments of both root caries and coronal caries from people who had increments of either coronal caries or root caries, or who had no new caries. METHODS: Dental examinations and interviews were conducted in the homes of a randomly selected, stratified sample of people over the age of 65 years in five North Carolina counties. The relationships between coronal and root D and DF were analyzed through contingency table analyses, and ordinal logistic regression was used to identify characteristics that differentiated people who had both coronal and root D over the three years from people who had either coronal or root D and people who had no new disease. RESULTS: Evidence of root and coronal caries in whites was much more likely to be in the form of fillings, while for blacks, it was more likely to be in the form of untreated decay. Prevalence rates of coronal and root D and DF were significantly associated for both blacks and whites. Incidence rates based on DF indicated that root and coronal caries were not associated in whites, but were associated in blacks. People more likely to experience both types of caries had more gingival recession at baseline, greater average attachment loss over the three years, and lactobacilli at baseline. In addition, the presence of Porphymonas gingivalis at three years was important for whites. CONCLUSIONS: It appears that coronal and root caries do tend to appear together in the same individuals, but fillings attenuate that relationship. The impact of dental treatment on the epidemiology of dental caries appears to be considerable and calls into question whether the F component of the caries index is related to disease as defined by epidemiologic criteria.

Aged↗
PubMed1999

The effect of periodontal therapy on the number of cariogenic bacteria in different intra-oral niches.

Several publications have reported an increased susceptibility for root caries after periodontal therapy. It has been suggested that newly exposed roots were less resistant to cariogenic species. This study examined the hypothesis that the increased susceptibility could also be related to an intra-oral microbial shift during the initial phase of the periodontal therapy from a perio-pathogenic to a more cariogenic flora. 10 patients with severe periodontitis were followed for 8 months after thorough scaling and root planing in combination with optimal plaque control. At baseline and after 4 and 8 months, samples were taken from the saliva, the tongue dorsum and the supragingival interdental spaces. These samples were cultured both aerobically and anaerobically in order to determine the total number of colony forming units (CFU) per sample as well as the number of CFU of Streptococcus mutans and Lactobacillus species. Oral hygiene parameters were recorded at the same visits. Finally, at baseline and at the 8 months follow-up, changes in caries activity and periodontal health were registered. Although the total number of aerobic and anaerobic CFU in samples from the tongue and the saliva remained nearly constant over the entire observation period (variations within 0.5 log), significant (p< or =0.05) increases in the number of S. mutans could be detected, especially at month 8. The significant decrease in the total number of anaerobic CFU in samples from the teeth was not associated with a reduction in the number of S. mutans, so that also for this niche the relative proportion of the latter increased. The number of lactobacilli species for the different niches showed only negligible changes (within 0.5 log values), except for samples from the teeth for which a small (1 log), but statistically significant (p<0.01), reduction could be detected. The periodontal conditions improved for all patients, but the caries activity could not be arrested. These findings seem to indicate that the increased caries susceptibility after periodontal therapy might partially be explained by a significant increase in the number of S. mutans due to ecological changes within the oral cavity. The clinical consequence of this observation would be to advocate a more strict caries preventive program during initial periodontal therapy.

Adult↗
PubMed1997

Effects of collagenase on root demineralization.

The role of proteolytic enzymes in the root caries process remains unclear. The aim of this study was to investigate collagenase activity during tooth root demineralization and remineralization in an in vitro demineralization/remineralization pH-cycling model, Human tooth roots were subjected to pH cycling (alternating demineralization and remineralization) in one of two different time cycles for five days. Collagenase at 90, 180, or 360 micrograms per root was placed into either the demineralizing solution or the remineralizing solution in the pH-cycling system. The effects of additional exposure to collagenase before or after pH cycling were also studied. After the exposure, thin sections of the roots were examined histologically by polarized light microscopy. Changes of calcium and phosphate in the solutions were analyzed chemically. Surface erosion occurred only in the groups where collagenase was contained in the remineralizing solution and in which the root samples were exposed to severe demineralization. However, no differences among the control and experimental groups were found in calcium and phosphate changes in the pH-cycling solutions. These findings suggest that collagenase works during the remineralizing phase and predominantly attacks the organic matrix of the root after demineralization. Additional exposure to collagenase before or after pH cycling did not increase surface erosion except for exposure to collagenase in the absence of phosphate following pH cycling.

Calcium↗
PubMed1994

Caries experience, treatment needs and treatment supplied among an adult Israeli population.

Information on coronal and root caries in an Israeli adult population including treatment needs has never been conducted. A sample of 2,931 adults ranging in age from 20 to 65 were selected for this longitudinal survey. The sample included both city and kibbutzim dwellers. All examinations were performed by one experienced epidemiologist utilizing the method of Radike for coronal caries. A method outlined by the National Institutes of Health was utilized for scoring of root surface recession and caries. Results indicate a 6.94 decayed and filled teeth (DF-T) mean score for the coronal caries experience and a 2.48 missing teeth (M-T) score. The total decayed and filled surfaces (DF-S) score for the examined population was 11.91. Root DF-S was found to be 1.10 among males and 0.99 among females with a total mean of 1.04. Premolars were found to have more crowns than other teeth, while molars had the highest missing score (1.53). DF-S score of 6.78 was indicated for molars, in addition to a high missing surfaces (M-S) value of 7.63 for molars. Main obstacles to dental care are lack of knowledge and financial barriers. These findings recognize an immediate need for public educational programs and regular professional care in order to increase public awareness of their dental status, encourage improved primary prevention, and seek secondary and tertiary care.

Adult↗