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PubMedDate not supplied

Antimicrobials in future caries control? A review with special reference to chlorhexidine treatment.

The aim of this paper was to examine recent evidence for the effect of the antibacterial approach to prevent and control caries with special reference to the use of chlorhexidine (CHX). Existing information from the mid 1990s provided limited evidence for the effectiveness of CHX gels, rinses and toothpaste in preventing caries in permanent teeth of children and adolescents. An updated literature search on CHX intervention in controlled clinical trials from 1995 to May 2003 unveiled 22 studies covering over 4,500 patients with clinical caries as end point. The vast majority (n = 21) were dealing with CHX-containing varnishes. Since the studies exhibited disparities in design, diagnosis and intervention, the findings were subgrouped with respect to caries type and localization. According to the ranking system of the Swedish Council on Technology Assessment in Health Care, the evidence for an anticaries effect of CHX varnishes was rated as inconclusive for caries-active schoolchildren and adolescents with regular fluoride exposure. Regarding fissure caries, a preventive effect of CHX varnishes was demonstrated in 4 studies out of 5 when compared to no treatment in children with low fluoride exposure. The evidence for arresting root caries in dry-mouth patients and frail elderly subjects was inconclusive. In conclusion, the evidence from the recent literature was inconclusive for the use of CHX varnishes for caries prevention in risk groups.

Anti-Infective Agents, Local↗
PubMed1990

Effect of an antimicrobial-containing varnish on root demineralisation in situ.

The effect of an antimicrobial-containing varnish on root demineralisation was investigated. The in situ demineralisation effect on the varnish, with or without the active ingredients chlorhexidine and thymol, was measured by means of microradiography in comparison with no application after a 2-week period in vivo. Furthermore, the effect of one or two applications was investigated by the 10 participants who carried sound intact roots in an appliance for four consecutive 2-week periods. In each period, different roots were mounted in the buccal flanges of a lower prosthesis, the experiment being of a randomized cross-over design. The results show that: (1) A single varnish treatment with active ingredients reduced lesion depth and mineral loss by about 77 and 82%, respectively. (2) The control varnish had no effect, and it can be concluded that antimicrobial-releasing varnishes are promising materials for root caries prevention.

Administration, Topical↗
PubMed2003

Restorative service patterns in Australia: amalgam, composite resin and glass ionomer restorations.

AIM: To examine the provision of amalgam, composite resin and glass ionomer restorations, and to assess whether these main restorative services varied by patient, visit and oral health characteristics. DESIGN: A cross-sectional survey incorporating a log of service items provided on a typical day. SETTING: Australian private general practice. METHODS: Data on services and patients were collected by a mailed survey from a random sample of dentists from each State/Territory in Australia in 1998-99 with a response rate of 71%. MAIN OUTCOME MEASURES: Rates per visit of amalgam, composite resin and glass ionomer restorations among dentate adults who had received a restoration. RESULTS: Analysis showed older patients had lower amalgam rates but higher glass ionomer rates, composite resin rates were lower at emergency visits, capital city patients had higher amalgam rates but lower composite resin rates, patients with decayed teeth had higher amalgam and composite resin rates, and use of restorative materials varied by clinical problem. CONCLUSIONS: Despite widespread use of alternative materials, amalgam rates remained high in circumstances such as replacement restorations and restorations involving more than one surface. Other restorative materials also had specific applications. Both amalgam and composite resins were provided at higher rates to patients with active caries but composite resins were also used at higher rates for aesthetic problems. Glass ionomer restorations were used at higher rates for initial and one-surface restorations, and for conditions such as root caries and dentinal sensitivity.

Adult↗
PubMed2000

Retrospective case series analysis of the factors determining immediate implant placement.

Implant placement at the time of extraction has become an acceptable treatment option. The formation of a restorative treatment plan frequently requires the removal of questionable and hopeless teeth. This retrospective case series analysis reports the reasons for tooth removal before immediate implant placement and provides a rationale for removing questionable and hopeless teeth. Root length is also analyzed as related to tooth loss. Between September 1986 and December 1998, 460 teeth were removed from 282 patients. Reasons for removal were advanced periodontal disease, endodontic complications, nonrestorable caries, roots fractures, short roots (< 14 mm in length), root resorption, and loosened posts. Implants were placed at the time of extraction. Tallies, frequency distributions, and percentages were used to determine individual and multiple reasons for extraction. For teeth with short roots, computerized measurements were made from periapical x-rays. Advanced periodontal disease and restored endodontically treated teeth with posts were the primary reasons for tooth extraction. Dental implants replaced 305 maxillary and 155 mandibular teeth.

Adolescent↗
PubMed1996

The final pH of bacteria comprising the predominant flora on sound and carious human root and enamel surfaces.

Acidogenesis at low pH appears to be an important bacterial cariogenic trait. However, most information in this regard pertains to only a few of the acidogenic dental plaque bacteria. Therefore, the 'final' pH in sugar broth was determined for a wide variety of oral bacteria. Their source was: (1) carious material from advanced root lesions (ARL), (2) plaque from sound root surfaces of root-caries-free subjects (SRS), (3) plaque from "white spot" coronal lesions and sound coronal surfaces of caries-active subjects, and (4) plaque from sound coronal surfaces of caries-free subjects. Strains from groups 1 and 2 (ARL, 389 strains; SRS, 358 strains) were previously identified (van Houte et al., 1994) to the genus/species level and belonged to the predominant cultivable flora (PCF). Strains from groups 3 and 4 also belonged to the PCF but were not identified. All strains were placed in one of 4 final pH categories: < 4.2, 4.2-4.4, 4.4-4.6, and > or = 4.6. The main findings were: (1) ARL samples contained many strains with a final pH < 4.2 (mean percentage of 25.7). They included all strains of Lactobacillus and mutans streptococci (MS), most Bifidobacterium strains and non-mutans streptococci (non-MS), and about 20% of the Actinomyces strains. By contrast, SRS samples contained far fewer strains with a final pH < 4.2 (mean percentage of 8.4) which were nearly all non-MS. (2) Organisms with a final pH < 4.4 constituted mean percentages of 41.5 and 32.1 for the ARL and SRS samples, respectively. (3) The final pH distribution of strains in samples from coronal surfaces showed a tendency relative to caries activity (group 3 vs. group 4) similar to that for groups 1 and 2. Our findings further support the concept that increased cariogenic conditions are associated with increased proportions of organisms capable of acidogenesis at a low pH and that this shift involves organisms other than the MS and lactobacilli.

Bacteria↗
PubMedDate not supplied

Oral health knowledge, practices, and status among outpatient veterans at the VA Maryland Health Care System.

Poor oral health can have a significant impact on overall health and quality of life. Yet few studies have established the oral health needs of outpatient veterans. The purpose of this study was to assess the oral health knowledge and practices, the dental status, and the periodontal treatment needs of outpatient veterans seeking primary care services at a statewide healthcare system. Veterans were interviewed and received an oral examination by a trained examiner using NIDCR criteria for dental caries detection and the Community Periodontal Index of Treatment Needs (CPITN). The mean age of the study participants' (n = 135) was 57.7 (SD = 14.1) years. Ninety-five percent of the sample was male and 44% African-American. Untreated coronal and root caries was present in 57% and 36% of veterans, respectively. Sixty-nine participants received the periodontal examination, with 29% of them in Category III. An interpretation of these findings shows a high need for preventive and restorative oral health care among outpatient veterans receiving primary services in an integrated and comprehensive VA health care system.

Dental Care↗
PubMed1995

Clinical and historical predictors of dental caries on radiographs.

This report evaluates the efficacy of the clinical predictors of caries proposed in the USA FDA guidelines for prescribing dental radiographs. The clinical findings that best associate with the presence of any caries where a history of pain, a defective restoration, unusual calcification, and an abutment tooth for a fixed or removable prosthesis. There is a group of measures of periodontal disease that were also weakly associated with the presence of caries. The best predictors of caries extending into the dentin were the presence of clinically defective restorations, a history of pain, and signs of periodontal disease. Proximal lesions are likely to appear on teeth with defective restorations, unusual calcification or large or deep restorations. The best predictors of radiographic root caries are periodontal findings such as furcation involvement, increased mobility, a history of periodontal therapy and gingival recession. While the specificities for these findings were generally high, the sensitivities and positive predictive values were usually under 50%, and often much lower. Thus these clinical findings cannot successfully be used as exclusive criteria for ordering radiographs for caries detection. Because caries is found fairly frequently, and because we are unable to identify tooth-specific criteria with clinically useful sensitivity and specificity values, these data support the FDA panel recommendation of bitewing examinations for all new patients and at periodic intervals for recall patients.

Confidence Intervals↗
PubMed1989

The prognosis of tunnel preparations in treatment of class III furcations. A follow-up study.

The present study evaluated the long-term prognosis of tunnel preparations performed in a large number of teeth with advanced periodontal furcation defects. One hundred seven (107) patients, in which 156 teeth had been treated by tunnel preparations, were recalled for an evaluation, which was based on a questionnaire, a clinical examination, and radiographs; 102 patients attended (149 teeth = 95%). The mean observation time per tooth was 37.5 months (range 10 to 107 months). The results showed that 10 teeth (6.7%) had been extracted and 7 teeth (4.7%) hemisected. The indication for 12 of these extractions or hemisections was root caries. Among the remaining 132 teeth, 23 (15.4%) showed initial or established caries. There was no relationship between caries development and length of the observation time. Thus, approximately 75% of the teeth were still caries-free and in function. The findings demonstrated that tunnel preparations have a considerably better prognosis than previously reported and should be considered a valid treatment alternative.

Adult↗
PubMed2004

Dental caries experience in older people over time: what can the large cohort studies tell us?

BACKGROUND: Little was known of the natural history of dental caries among older adults until recently, but reports from a number of large cohort studies have now enabled better understanding of the nature and determinants of dental caries in older people. The aim of this review is to examine and compare findings from established population-based longitudinal studies of older adults in order to determine their preventive implications. METHODS: The dental literature was reviewed in order to identify reports on dental caries incidence from large, population-based dental longitudinal studies of older adults (age 50+) with at least 3 years of follow-up. RESULTS: Reports were identified from four studies (in Iowa, North Carolina, Ontario and South Australia) which met the criteria; four reports dealt with coronal caries, and five with root surface caries. When annualised, coronal and root surface caries increments were combined and compared with those reported for adolescents, the caries experience of older people over time (between 0.8 and 1.2 new surfaces affected per year) exceeded that reported from cohort studies of adolescents (between 0.4 and 1.2 surfaces per year). The only caries risk factor common to all four studies was the wearing of a partial denture (for root surface caries only). CONCLUSIONS: Older people are a caries-active group, experiencing new disease at a rate which is at least as great as that of adolescents. PRACTICE IMPLICATIONS: Dentate older people should be the target of intensive monitoring and preventive efforts at both the clinical practice and public health levels. There is no easily identifiable 'magic bullet' for preventing caries in that age group, but the use of evidence-based preventive interventions (such as fluoride) should suffice.

Adolescent↗
PubMed1993

Tobacco use: a modifiable risk factor for dental disease among the elderly.

OBJECTIVES: Because the public health literature contains few analytic studies of modifiable behavioral risk factors for dental disease among older community-dwelling populations, the New England Elders Dental Study was undertaken as an epidemiologic study of the oral health status of a representative sample of older adults living within the six New England states. METHODS: Five dentists conducted comprehensive in-home oral health examinations on 1156 community-dwelling adults aged 70 and older to determine whether lifetime use of tobacco products was a significant risk factor for tooth loss, caries, and periodontal disease. RESULTS: Among New England elders, tobacco use was more common among men (18.1%) than women (7.9%), with a combined rate of 12.3%. Further, 64.7% of men and 36.6% of women were previous tobacco users. Years of exposure to tobacco products was a statistically significant risk factor for tooth loss, coronal and root caries, and periodontal disease, regardless of other social and behavioral factors. CONCLUSIONS: Lifelong tobacco use is a modifiable risk factor for poor dental health among older adults. Dental practitioners need to intervene with all their adult patients to discourage use of tobacco products for oral as well as general preventive health care.

Aged↗
PubMed1987

The mineral solubility of human tooth roots.

Whole roots of molars that had never been exposed to the mouth were exposed to calcium and phosphate-containing buffer solutions with discrete values of pIOHA [i.e. -log(a10Ca2+ X a6PO4(3-) X a2OH-)] at various pH. From densitometric measurements on contact-microradiographs of transverse sections of the roots the rate of demineralization (Vdem) was calculated. Vdem changed non-linearly as a function of pIOHA and became zero at a pIOHA-value of 105.3 +/- 0.4; this is substantially lower than the corresponding value of 118 +/- 1 for enamel. Thus root mineral is more soluble than enamel mineral. The critical pH for root caries appears to be about 6.7, provided that the plaque fluid follows about the same pH-pIOHA- pathway as acidified saliva.

Adult↗
PubMed2004

Micro-computed tomography of a 500-year-old tooth: technical note.

OBJECTIVE: To determine whether micro-computed tomography (micro-CT) could be used to reconstruct ancient dental anatomy accurately and differentiate the enamel from the dentin, as well as to verify whether micro-CT could detect tooth disorders such as attrition or caries accurately. METHODS: Micro-CT imaging was performed, using a cone-beam micro-CT specimen scanner, on a 500-year-old human tooth found in a burial jar in the Cardomom Mountains in southwestern Cambodia. RESULTS: The occlusal surface of the tooth showed marked attrition, with the dentin extending close to the enamel layer on the crown. In addition to this, micro-CT images depicted calculus on the buccal surface and a cervical root caries lesion present on the distal surface. The sclerotic zone of the carious lesion (located deep in the destroyed dentin) and the dentin were effectively differentiated through excellent resolution and superior tissue contrast of the volume data set. Axial slices from apical to coronal show the carious lesion extending vertically along the dentin-enamel junction with an intact outer enamel surface. CONCLUSION: Micro-CT is a reproducible, nondestructive and highly accurate technique that can be successfully applied to the study of ancient teeth.

Cambodia↗
PubMed2000

Food starches and dental caries.

Sucrose and starches are the predominant dietary carbohydrates in modern societies. While the causal relationship between sucrose and dental caries development is indisputable, the relationship between food starch and dental caries continues to be debated and is the topic of this review. The current view of dental caries etiology suggests that in-depth evaluation of the starch-caries relationship requires the consideration of several critical cariogenic determinants: (1) the intensity (i.e., the amount and frequency) of exposure of tooth surfaces to both sugars and starches, (2) the bioavailability of the starches, (3) the nature of the microbial flora of dental plaque, (4) the pH-lowering capacity of dental plaque, and (5) the flow rate of saliva. Studies of caries in animals, human plaque pH response, and enamel/dentin demineralization leave no doubt that processed food starches in modern human diets possess a significant cariogenic potential. However, the available studies with humans do not provide unequivocal data on their actual cariogenicity. In this regard, we found it helpful to distinguish between two types of situations. The first, exemplified by our forebears, people in developing countries, and special subject groups in more modern countries, is characterized by starch consumption in combination with a low sugar intake, an eating frequency which is essentially limited to two or three meals per day, and a low-to-negligible caries activity. The second, exemplified by people in the more modern societies, e.g., urban populations, is characterized by starch consumption in combination with significantly increased sugar consumption, an eating frequency of three or more times per day, and a significantly elevated caries activity. It is in the first situation that food starches do not appear to be particularly caries-inducive. However, their contribution to caries development in the second situation is uncertain and requires further clarification. Although food starches do not appear to be particularly caries inducive in the first situation, the possibility cannot be excluded that they contribute significantly to caries activity in modern human populations. The commonly used term "dietary starch content" is misleading, since it represents a large array of single manufactured and processed foods of widely varying composition and potential cariogenicity. Hence, increased focus on the cariogenicity of single starchy foods is warranted. Other aspects of starchy foods consumption, deserving greater attention, include the bioavailability of starches in processed foods, their retentive properties, also in relation to sugars present (starches as co-cariogens), their consumption frequency, the effect of hyposalivation on their cariogenicity, and their impact on root caries. The starch-caries issue is a very complex problem, and much remains uncertain. More focused studies are needed. At present, it appears premature to consider or promote food starches in modern diets as safe for teeth.

Animals↗
PubMed1995

Effect of lactic acid and proteolytic enzymes on the release of organic matrix components from human root dentin.

The mechanisms of organic matrix breakdown in the root caries process are not well understood. Therefore, the combined and separate effects of lactic acid and proteolytic enzymes on the degradation of human dentin collagen, glycoproteins, proteoglycans and phosphoproteins were investigated in the present study. Dentin powder was pretreated with lactic acid (pH 4.0), distilled and deionized (dd) water (pH 7.0) and EDTA/guanidine HCl (pH 7.4) for 24 h. Pellets of acid- or dd water-pretreated dentin powder were washed, dried, and then treated with trypsin, bacterial or mammalian tissue collagenase, or control buffer for 3 h. The released dentin proteins were analyzed by reducing sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting to identify degraded type I collagen, proteoglycans, glycoproteins and phosphoproteins. All water and acid pretreatment and enzyme treatment groups demonstrated two collagen fragment bands with molecular weights at approximately 79 kD. Further studies showed that the 79 kD proteins from acid-pretreated dentin collagen were degraded by tissue collagenase, suggesting that endogenous collagenase may be involved in the degradation of root dentin collagen. Dentin proteoglycans were detectable in all the treatment groups by protein slot blotting. Relatively few distinct glycoproteins and proteoglycans, and no phosphoproteins were detected by immunoblotting. Results from this study suggest that both acids and proteolytic enzymes from either host or microbial origin are important in the degradation of human dentin matrix and the mechanisms involved in the release of various noncollagenous proteins may be different.

Adolescent↗
PubMed2006

Roentgenographic in vitro investigation of frequency and location of curvatures in human maxillary premolars.

The aim of this study was to determine the location of the root canal curvature and measure the distance from the CEJ to the first curvature using in vitro methods. Extracted maxillary premolars (n = 358) were fixed and digitally radiographed using the parallel technique. Excluded from further analysis were teeth with root caries, artificial crowns, extensive fillings, or endodontic treatments. The results were descriptively analyzed and the cumulative frequencies were calculated. The median values of the distance between CEJ and first curvature were for the first right premolars 8.4 mm (buccal) and 8.5 mm (palatal), for the first left premolars 9.1 mm (buccal) and 8.9 mm (palatal). The median distances in the second premolars were 10.7 mm (right side) and 10.2 mm (left side). The results showed that a high number of maxillary premolars had a curvature with a median value of 8 mm apically from the CEJ. Our findings suggest that such measurements may be useful to consider during endodontic treatment and post insertion.

Bicuspid↗
PubMed1996

Reproducibility of clinical caries diagnoses on coronal and root surfaces.

Intra- and interexaminer reproducibility of clinical caries diagnoses was studied using 3 experienced dentists, who independently examined 20 patients twice at an interval of 2-6 weeks. The lesions were classified as one of the following four diagnoses: (1) initial active caries, (2) initial inactive caries, (3) manifest active caries, and (4) manifest inactive caries. For the various diagnoses, signs of cavitation, surface structure and discolouration were used. The reproducibility at a patient level was evaluated using intraclass correlation coefficients and at a surface level using kappa statistics. At a patient level, for the total number of lesions, the intraclass coefficients of correlation varied from 0.55 to 0.77. For the individual diagnoses, total manifest caries showed the highest coefficients of correlation, ranging from 0.73 to 0.92. At a tooth surface level, the kappa values varied from 0.29 to 0.61. The most common shift was that from any type of caries diagnosis to a diagnosis of a sound surface. There was little difference between the results for coronal and root caries and between initial and manifest lesions. Nor was there any difference for buccal + lingual surfaces only compared to all surfaces. Judging from the pattern of change in diagnosis between the repeated examinations, the main source of error seemed to be due to the fact that the lesions observed at one examination were overlooked at the other examination.

Adult↗
PubMed2006

The clinical relevance and correlation between the initial straight length to the first curvature in human second maxillary premolars.

The aim of this study was to evaluate the straight lengths of the root canal of human second maxillary premolars using standardized radiological techniques in vitro. The distances were examined starting from the cemento-enamel junction (CEJ) to the appearance of a curvature. In particular recommendations which may facilitate decision making with regard to the length of post systems after successful endodontic treatment should be available. Extracted human second maxillary premolars (n = 210) were used; teeth with root caries, artificial crowns, extensive fillings or with previous endodontic treatment were excluded from this investigation. The teeth were fixed in a specially developed device with standardized and reproducible distances and digital radiographs using the parallel technique were made. A descriptive statistical analysis and the calculation of the cumulative frequencies were made. The values for the distance starting from the CEJ to a first curvature were as follows: a) For right second premolars: median value=10.3 mm (min.: 5 mm; max.: 15.8 mm) and mean value= 10.4 SD+/- 2.6 mm; b) left second premolars: median value =10.2 mm (min.: 5 mm; max.: 17 mm) and mean value =10.3 mm SD +/-2.2 mm. Based on our data, high number of second maxillary premolars showed a curvature (30.4%) 9 mm apically from the CEJ. These findings should be taken into consideration for endodontic treatments and post insertions.

Bicuspid↗
PubMed1987

Artificial grooves on the Krapina Neanderthal teeth.

Gross and microscopic examination of the Krapina Neanderthal dental remains reveals the presence of artificial grooves along the cemento-enamel junction of 14 teeth representing ten different individuals. The grooves display distinct morphological features including their consistent location (primarily on the mesial and/or distal root walls), their troughlike appearance, striations and/or polishing in the channel, and the ridges of reactive cementum bordering the groove. These grooves occur only on erupted, permanent teeth, and except for a single occurrence on a lower I2, all are located on mandibular or maxillary P4-M3. The morphological nature of the grooves is distinct and has been used to distinguish these grooves from root caries and other pathological or natural causes. Based on the close resemblance between artificial grooves at Krapina and those which have been attributed to toothpick use in other fossil and recent populations, we argue the Krapina Neanderthals were habitually probing the interproximal dental spaces with tools.

Fossils↗