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PubMed2000

The effect of triphenylbismuth on the radiopacity and performance properties of compression- and injection-molded denture resins.

PURPOSE: Methods of incorporating radiopaque triphenylbismuth into an experimental compression-molded and injection-molded heat-polymerized resins were determined. The transverse flexural properties, radiopacity, and color stability of the resins containing triphenylbismuth were then compared with a commercially available, compression-molded denture resin. MATERIALS AND METHODS: Varying levels of triphenylbismuth were added to both the monomer and polymer in heat-polymerized denture resin systems to determine the level of the additive that was necessary to achieve a radiopacity similar to 0.2 mm of copper with minimum resin porosity. Specimens were then prepared by incorporating 0% or 30% wt/wt triphenylbismuth into resins. The commercially available polymethyl methacrylate resin served as a benchmark for physical property comparison, and no additive was included during its polymerization. At 30% wt/wt triphenylbismuth, resin color stability, transverse deflection, and radiopacity were evaluated using methods described in International Standards Organization Standard 4049 and American Dental Association Specification No. 12. The transverse deflection results among the resin groups were compared with a reference resin using the Kruskal-Wallis method (alpha = 0.05). RESULTS: Incorporation of triphenylbismuth into the monomer of the injection material, resulting in 30% wt/wt in the polymerized resin, produced a level of radiopacity similar to 0.2 mm copper. Although the injection-molded resin with 30% wt/wt triphenylbismuth remained translucent, the compression-molded resin was opaque, indicating excessive air-entrapment porosity. The additive caused a faint yellowing in both types of resins, but color stability was not affected. Transverse deflection of the injection-molded resin (4.5 +/- 0.5 mm) and the injection-molded resin with triphenylbismuth (3.8 +/- 1.7 mm) was greater than that of the experimental resin (3.5 +/- 0.2 mm), which was equal to the commercial resin (3.6 +/- 0.2 mm). Triphenylbismuth at 30% wt/wt significantly reduced transverse deflection for the experimental resin (2.6 +/- 0.5 mm). CONCLUSIONS: Triphenylbismuth at a final concentration of 30% wt/wt can be added to polymethyl methacrylate injection-molded resins to provide a high level of detection on chest or abdominal radiographs without adversely affecting resin color stability and transverse deflection.

Benchmarking↗
PubMedDate not supplied

Prosthodontics as a specialty private practice: net income of private practitioners.

PURPOSE: The aim of this study was to use data from a survey of prosthodontists in the US to examine average net earnings of prosthodontists in private practice. MATERIALS AND METHODS: A survey of 2500 prosthodontists in the US was used to estimate the net earnings of practicing prosthodontists. The national average net earnings of prosthodontists in private practice was estimated along with average earnings for subgroups of prosthodontists. Estimates for private practitioners by age, gender, size of practice, full-time/part-time status, practice ownership, and by type of treatment procedures rendered by the practitioner were also included. RESULTS: Average earnings for prosthodontists in private practice on a primary or secondary basis were estimated to be $215,300 and for prosthodontists who own or share in the ownership of a private practice, $233,920. Reported earnings estimates ranged from $96,160 for non-owners of a private practice and $103,350 for part-time private practitioners to $233,920 for practice owners and $275,170 for prosthodontists in practice with two prosthodontists. The average earnings of prosthodontists who are practice owners were estimated to be 35% higher than the corresponding general practitioners. CONCLUSION: Average net earnings are often used to examine the current economic health of a profession. The average net earnings of prosthodontists in private practice exceed the average net income reported by the American Dental Association for all dentists and all general practitioners and they are competitive with earnings among all specialty groups. This evaluation of the net earnings of prosthodontists shows that prosthodontics offers a competitive career opportunity for the general dentist with a personal desire to pursue advanced dental education in a specialty as a profession.

Adult↗
PubMed1986

Current status of indices of plaque.

Microbial plaque has been described by the Council on Dental Therapeutics of the American Dental Association in their recently drafted Guidelines for acceptance of products for the management of dental plaque and gingivitis. The choice of an index system to be used in plaque trials should be made in terms of the objective of the trial, the size of the population, the period of the study, and the type and extent of change anticipated. The indices currently in use estimate the quantity of plaque in terms of tooth area covered or the thickness of material in the area measured. The Silness and Loe and the modified Turesky methods have been suggested as acceptable indices for the estimation of cleansing ability.

Dental Health Surveys↗
PubMed1988

Chemotherapeutic agents for controlling plaque and gingivitis.

There has been a vigorous search for many years for chemical agents that could supplement or even supplant patient-dependent mechanical plaque control and thus reduce or prevent oral disease. 5 categories of agents or approaches have been considered: (1) broad spectrum antiseptics, (2) antibiotics aimed at specific bacteria, (3) single or combinations of enzymes that could modify plaque structure or activity, (4) non-enzymatic dispersing or modifying agents and (5) agents that could affect bacterial attachment. The success of these approaches can be evaluated clinically by the use of standard scoring methods for measuring plaque and gingivitis and their safety established by soft tissue and microbiologic examination. Antiseptic agents have received the bulk of the attention over the years. At present, only 2 antiseptics, the bis-biguanide, chlorhexidine gluconate (Peridex) and a combination of phenol related essential oils (Listerine), have developed sufficient supporting data in 6-month (or longer) studies to gain the approval of the Council On Dental Therapeutics of the American Dental Association. On the basis of short-term studies, cetylpyridinium chloride, zinc and copper salts, sanguinarine and octenidine warrant continued study as does stannous fluoride at an appropriate concentration. On the basis of current research, a new generation of more specific antibacterial agents that interfere with attachment to pellicle can be developed. It is hard to predict, however, that they will affect gingivitis, at least until there is more information on what specific organisms should be targeted.

Anti-Bacterial Agents↗
PubMed1988

Clinical index systems used to assess the efficacy of mouthrinses on plaque and gingivitis.

The American Dental Association's Council on Dental Therapeutics has adopted Guidelines for acceptance of chemotherapeutic products for the control of supragingival dental plaque and gingivitis. The most widely used plaque indices are the plaque index (PI) and the Turesky index. Gingivitis has usually been assessed by the Löe and Silness method, although the modified gingival index of Lobene and a bleeding index reported by Caton and Polson have also been used. To date, 2 products have been accepted by the Council as being effective in helping control supragingival plaque and gingivitis. These products were evaluated using clinical indices described in this review. The indices were selected from the many in the literature as being valid, reliable, and easily learned. Suggestions are made for criteria to be used in comparability studies.

Dental Health Surveys↗
PubMed2005

Anti-gingivitis efficacy of a stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice.

OBJECTIVE: Stannous fluoride is a broad-spectrum anti-microbial agent that has been used in dentistry as a chemical adjunct to prevent dental caries and gingivitis. The objective of this study was to assess the anti-gingivitis efficacy of a stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice relative to a negative control. METHODS: This was a randomized, 6-month, double-blind, parallel-group gingivitis study conducted according to the guidelines for evaluating chemotherapeutic products for the control of gingivitis outlined by the American Dental Association. A stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice was tested against a commercially available negative control dentifrice. Following baseline measurements, subjects received a dental prophylaxis. Subjects were then instructed to brush twice daily for 60 s using their assigned product. Oral soft-hard-tissue examinations and clinical examinations using the Modified Gingival Index, Gingival Bleeding Index, and the Turesky modification of the Quigley-Hein Plaque Index were performed at baseline, 3 and 6 months post-treatment. RESULTS: A total of 143 subjects were enrolled and 130 of them completed the 6-month study. After 6 months of product usage, the experimental group had 21.7% less gingivitis (p<0.001), 57.1% less bleeding (p<0.001), and 6.9% less plaque (p=0.01) on average compared with the negative control group. No adverse oral soft-hard-tissue effects or extrinsic tooth staining was observed in the study. CONCLUSION: The results demonstrate that use of the stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice over a 6-month period provided statistically significant reductions in gingivitis, gingival bleeding, and plaque when compared with a negative control dentifrice.

Adolescent↗
PubMed2006

Meta-analyses of studies of 0.2% delmopinol mouth rinse as an adjunct to gingival health and plaque control measures.

BACKGROUND: Delmopinol is a third-generation anti-plaque agent used as a mouthwash to reduce plaque and alleviate gingivitis. OBJECTIVE: To create an overview of the anti-plaque efficacy of 0.2% delmopinol as an adjunct to normal oral hygiene measures by meta-analysis of completed clinical trials. MATERIALS AND METHODS: Eight double-blind, parallel-group studies were identified. Study durations ranged from 8 to 24 weeks. Five studies (n=913) involved supervised rinsing; three studies (n=467) involved unsupervised rinsing. These sets of trials were analysed separately and in combination. Efficacy outcomes comprised modified plaque index, modified gingival index (MGI) and gingival bleeding on probing (BOP). RESULTS: Delmopinol 0.2% was superior to placebo for the reduction of plaque scores in both sets of studies. Effects on MGI and BOP were also better with delmopinol 0.2% than with placebo. In most instances, 95% confidence intervals were wholly in favour of delmopinol. Pooled analysis of all eight studies confirmed statistically significant effects of delmopinol 0.2% compared with placebo (p<0.00001). Delmopinol met the efficacy criteria of the American Dental Association in studies of extended duration. CONCLUSION: Delmopinol 0.2% mouthwash is effective as an adjunct measure for reducing plaque burden and indices of gingivitis, whether or not it is used under supervision.

Dental Plaque↗
PubMed2000

Practices of Maryland dentists: oral cancer prevention and early detection--baseline data from 1995.

OBJECTIVES: To investigate practices and opinions of general dentists in Maryland, USA, related to oral and pharyngeal cancer prevention and early detection. DESIGN AND METHODS: A pre-tested, 34-item questionnaire, cover letter and addressed, stamped envelope were mailed in the summer, 1995, to a simple random sample of 800 members and non-members of the American Dental Association practicing in Maryland. A reminder postcard was sent 3 weeks after initial mailing; a second complete mailing to all non-respondents 6 weeks after first mailing. RESULTS: Over 90% of dentists asked about patient's current use of tobacco but only 77% assessed patient's history of tobacco use and types and amounts used. Fewer (66%) asked about present use of alcohol. Ninety percent reported providing an oral cancer examination at the initial appointment for patients 40 years of age or older; only 6% provided the examination for edentulous patients and only 40% reported palpating lymph nodes of patients 80% or more of the time. CONCLUSIONS: Dentists' reporting on providing oral cancer examinations and taking appropriate health histories are disappointing. These results call for comprehensive educational interventions in terms of changes in dental curricula and as continuing education courses especially since most dentists were interested in continuing education courses on oral cancer prevention and early detection.

Adolescent↗
PubMed2005

The effectiveness of self-performed mechanical plaque control with triclosan containing dentifrices.

OBJECTIVE: To assess the effectiveness of self-performed mechanical plaque control with triclosan (5-chloro-2-(2,4 dichlorophenoxy)phenol) containing dentifrice. SEARCH STRATEGY: An electronic search of the National Library of Medicine, Washington DC (Medline-PubMed; up to and including March 2005) was performed using specific search terms to identify clinical trials of >or=6 months in duration, which assessed the effect of various forms of plaque control in gingivitis subjects. In those trials the manual toothbrush group (frequently the control group) served to provide data for the assessment of the effectiveness of self-performed mechanical plaque control with a triclosan-containing dentifrice. The data were analysed depending on the (baseline) intervention, being either a professional oral hygiene instructions, a prophylaxis, or both. DATA COLLECTION AND ANALYSIS: Two reviewers extracted information (KPKJH and GAW). Where appropriate plaque and gingivitis data for baseline and end-trial were used to calculate weighted mean differences (WMD) with the appropriate 95% confidence intervals (CI) using a random effect models. MAIN RESULTS: Of 105 titles and abstracts, 18 trials were found suitable for clinical data were extracted. Meta-analysis were conducted. In studies (n=9) evaluating a triclosan/copolymer dentifrice, plaque control [Quigley and Hein (1962) Journal of American Dental Association, Vol. 65: pp. 26-29] was significantly improved compared with a control fluoride dentifrice, with a WMD of -0.48 (95% CI: -0.73 to -0.24). For gingival inflammation as assessed with the gingival index [Löe and Silness (1963) Acta Odontologica Scandinavica, Vol. 21: pp. 533-551] a significant WMD of -0.24 (95% CI: -0.35 to -0.13) was found. From studies (n=6) evaluating the Triclosan zinc/citrate dentifrices a small but significant WMD for plaque control [Silness and Löe (1964) Acta Odontologica Scandinavica, Vol. 22: pp. 121-135] was observed in favour of the test group as compared with the standard fluoride dentifrice formulations (WMD -0.07, 95% CI: -0.10 to 0.05). While at baseline the proportion of bleeding was comparable, at the end of the studies a significant -10.81% WMD (95% CI: -12.69 to -8.93) in favour of the triclosan/zinc citrate dentifrice was observed. CONCLUSION: This systematic review indicates, based on studies >or=6 months of duration in adults with gingivitis, that the effectiveness of self-performed mechanical plaque control with a triclosan-containing dentifrice, had a significant albeit small positive effect on the reduction of plaque and gingivitis.

Anti-Infective Agents, Local↗
PubMed1999

Two-year clinical evaluation of tooth whitening using an at-home bleaching system.

PURPOSE: The purpose of this study was to evaluate the 2-year effectiveness of a carbamide peroxide at-home bleaching gel used to provide tooth lightening treatment. MATERIAL AND METHODS: Twenty-nine patients participated in the original study, during which they treated their maxillary teeth with a 10% carbamide peroxide gel nightly for 2 weeks. Shades were determined before and after treatment by comparison with a Vita shade guide. Twenty-four patients (a recall rate of 83%) were recalled for evaluation 2 years after the initial bleaching treatment. The shade of the maxillary incisors was evaluated and compared with shades before, immediately after, and at 6 months and 2 years after initial treatment. Data were analyzed using a repeated-measures analysis of variance. RESULTS: At 2 years after bleaching with a 10% carbamide peroxide gel, the median shade was D2, a six-increment difference from the baseline median of D3. Twenty of 24 patients (83.3%) had a shade change of two or more units, which is the threshold value for bleaching efficacy using American Dental Association guidelines. The lightening result remained statistically significant (p < .0001) at 2 years. CLINICAL SIGNIFICANCE: Although some reversal of the lightening effect occurs over time following the original bleaching treatment, loss of the lighter color appears to be gradual for most patients. Although the longevity of the lightening effect remains to be determined, this clinical trial indicates that the majority of patients have a satisfactory result 2 years after treatment.

Adult↗
PubMed2003

Clinical evaluation of a 3% hydrogen peroxide tooth-whitening gel.

PURPOSE: The purpose of this randomized double-blind investigation was to clinically evaluate the effectiveness of a commercially available 3% hydrogen peroxide tooth-whitening material (ADS Tooth Whitening Gel, Applied Dental Sciences, Inc., Lee, MA). The material was used over 2 weeks in a dentist-supervised, patient-applied application. MATERIALS AND METHODS: The evaluation was carried out in accordance with American Dental Association (ADA) Council on Scientific Affairs Acceptance Program Guidelines for Home-Use Tooth Whitening Products (May 1998). Sixty-five participants were randomized into two groups (active and placebo) for a double-blind, placebo-controlled study. A custom application tray, scalloped without reservoirs, was fabricated for each participant. Tooth shades were documented by matching with the Vita shade guide ordered according to value and assigned a numeric ranking from 1 to 16, darkest to lightest. Participants were supplied with the treatment solutions to use in the application tray. Duration of active treatment was 30 minutes 3 times a day for 2 weeks. Participants were evaluated at baseline, 1 week and 2 weeks treatment, and 12 and 26 weeks post-treatment. The statistical analysis used at each time point to determine the difference between the active and placebo groups based on the change in value was the two-sample t-test. Plaque and soft tissue indices were also recorded. RESULTS: The teeth treated with 3% hydrogen peroxide were significantly lighter at 2, 12, and 26 weeks (p < or = .0140, .0004, and .0001, respectively) compared with the placebo group. The mean shade change was 4.2 Vita shade tabs at 2 weeks. At 26 weeks (6 months), the degree of whitening was 4.1 tabs.

Adult↗
PubMed1991

On-site screening for urinary Hg concentrations and correlation with glomerular and renal tubular function.

At the American Dental Association 1985 and 1986 Annual Sessions, an on-site screening for mercury was conducted as part of the Health Screening Program (HSP) to identify dentists having elevated urinary mercury concentrations. The data generated from this study were used to examine the relationship between elevated urinary mercury exposure and kidney dysfunction. Kidney dysfunction was assessed by measurement of serum and urine beta 2 microglobulin concentrations, serum creatinine, and creatinine clearance. The mean values found for urinary mercury were 5.8 micrograms Hg/L and 7.6 micrograms Hg/L for 1985 and 1986, respectively. Urinary mercury concentrations for this population were found to fall within the range of not detected to 115 micrograms Hg/L. Of the total number of participants assayed in 1985 and 1986, roughly 10 percent of the sample exhibited elevated mercury concentrations above 20 micrograms Hg/L. An analysis of the clinical markers indicated no clear relationship between elevated urinary mercury concentrations and kidney dysfunction. In addition to mercury testing, all dentists who participated in the 1985 and 1986 HSP were issued a questionnaire soliciting information as to their professional exposure. Those participants who were identified as having elevated urinary mercury concentrations in the 1985 HSP were issued a followup questionnaire that addressed psychological and neuropsychological symptoms. From these questionnaires three significant relationships were found. These relationships were associated with mercury/amalgam handling and skin contact, the number of amalgams placed by the dentist, and the number of hours of practice per week. The reported absence of a clear relationship between urinary mercury concentrations and potential kidney dysfunction is in agreement with other findings at the mercury concentrations tested.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

A national survey of dental protocols for the patient with a cardiac transplant.

To assess current practice of dental protocols for the patient with a cardiac transplant, a 19-question survey was designed and distributed to all general practice and oral surgery residency programs accredited by the American Dental Association. Analysis of the survey demonstrates a great amount of variability in the protocols used in this field. With the discovery of cyclosporine in 1976 by Borel, organ transplantation surgery has become increasingly common. This is especially true of heart transplantation. Success rates have increased dramatically in recent years; they are now documented at 81% at 1 year, 74% at 2 years, and 50% at 5 years. The two primary causes of death after cardiac transplantation are organ rejection and infection. Cyclosporine and azathioprine have improved the delicate balance between preventing organ rejection and encouraging infections. However, numerous bacterial infections, viral infections, and fungal infections may originate in the mouth and become life-threatening problems. For this reason, dentists must be members of the cardiac transplant teams and a nationally accepted dental protocol should be devised to ensure proper patient care.

Dental Care for Persons with Disabilities↗
PubMed2000

Microbial biofilm formation and contamination of dental-unit water systems in general dental practice.

Dental-unit water systems (DUWS) harbor bacterial biofilms, which may serve as a haven for pathogens. The aim of this study was to investigate the microbial load of water from DUWS in general dental practices and the biofouling of DUWS tubing. Water and tube samples were taken from 55 dental surgeries in southwestern England. Contamination was determined by viable counts on environmentally selective, clinically selective, and pathogen-selective media, and biofouling was determined by using microscopic and image analysis techniques. Microbial loading ranged from 500 to 10(5) CFU. ml(-1); in 95% of DUWS water samples, it exceeded European Union drinking water guidelines and in 83% it exceeded American Dental Association DUWS standards. Among visible bacteria, 68% were viable by BacLight staining, but only 5% of this "viable by BacLight" fraction produced colonies on agar plates. Legionella pneumophila, Mycobacterium spp., Candida spp., and Pseudomonas spp. were detected in one, five, two, and nine different surgeries, respectively. Presumptive oral streptococci and Fusobacterium spp. were detected in four and one surgeries, respectively, suggesting back siphonage and failure of antiretraction devices. Hepatitis B virus was never detected. Decontamination strategies (5 of 55 surgeries) significantly reduced biofilm coverage but significantly increased microbial numbers in the water phase (in both cases, P < 0.05). Microbial loads were not significantly different in DUWS fed with soft, hard, deionized, or distilled water or in different DUWS (main, tank, or bottle fed). Microbiologically, no DUWS can be considered "cleaner" than others. DUWS deliver water to patients with microbial levels exceeding those considered safe for drinking water.

Bacteria↗
PubMed1987

Cost-effectiveness analysis of periodontal disease control.

Cost-effectiveness analysis was used to evaluate alternative methods of periodontal disease control. The alternatives considered included non-surgical and surgical procedures as well as the use of antimicrobial agents. Data on costs were obtained from American Dental Association publications of average charges for periodontal services. The concept of quality-adjusted tooth-years (QATYs) was developed to provide an outcome measure which could be compared across treatments. The conclusions of this analysis are as follows: (1) Conservative non-surgical treatments for periodontal disease control not only have costs lower than surgical alternatives, as would be expected, but also maximize expected quality-adjusted tooth-years over a wide range of estimates; (2) antimicrobial therapy used as an adjunct to non-surgical treatment is likely to be both effective and cost-effective; and (3) quality of tooth-years is a critical consideration in the determination of outcome of periodontal treatment. For example, when tooth-years are not adjusted for quality, differences between treatments are diminished, and surgical treatment becomes as good as or better than more conservative treatments for some levels of disease severity.

Alveoloplasty↗
PubMed1994

Effects of creep value and occlusal force on marginal adaptation of amalgam filling.

Creep of amalgam is thought to be a factor determining poor marginal adaptation. Clarification of the relationship between creep of amalgam in the cavity and creep value (American Dental Association specification no. 1; ADA #1) is essential to an understanding of the mechanism of marginal fracture and service life. However, only elastic stress analyses of amalgam in a cavity have been reported in the dental field. Therefore, the creep of amalgam in a class I cavity was simulated by an axisymmetric elastic creep finite-element method. The stress and time dependencies of the creep rate of amalgam were incorporated into this calculation. Creep values of 1.0 and 3.0% (ADA #1) were selected as amalgam properties. When the occlusal force on the amalgam filling was assumed in the vertical direction along the axis of the tooth, the rate of extrusion and rate of opening of the gap at the cavity margin were revealed by the simulation. The computed results show that the gap and extrusion were developed in direct proportion of the creep value and proportionally with the square of the occlusal force. Simulated results are in agreement with clinical findings of the service lives of restorations, i.e., a poor adaptation to the margin can be seen for 4-to-10-year-old amalgam fillings.

Bite Force↗