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PubMed1985

Histopathology of the initial lesion of the root surface: an in vitro study.

An acidified gel system was used to produce artificial caries lesions in root surfaces. Radiopaque surface layers were found with 47% of the lesions. Demineralized bodies of the lesion and mineralized zones of banding were seen in all lesions when examined by microradiography. Cementum and dentin seemed to respond to the acid attack in a similar manner. Although artificial root lesions did not simulate natural root caries entirely, the acidified gel system resulted in a reproducible method that might give insight into initial lesion formation on root surfaces. This technique may be used for studying the physico-chemical process involved in the demineralization of root surfaces and for testing the effects of various agents in the prevention of root caries.

Aged↗
PubMed1991

Epidemiology of oral diseases.

Recent epidemiologic findings for coronal and root surface caries, enamel fluorosis, and the periodontal diseases are reviewed. Incidences of coronal caries in children have continued to decline (at an accelerated rate in some populations) during the 1980s. Two possible reasons other than fluorides for these trends are a change in providers' criteria for treatment of pit and fissure caries and the use of dental sealants. Further declines are anticipated, particularly if benefits resulting from preventive programs can be extended to lower socioeconomic groups. The study of root caries has evolved to include concerns of standardized measurement, documentation of incidence in addition to prevalence, and use of multivariate analyses to identify potential explanatory variables. Evidence supports an increase in the prevalence of enamel fluorosis, generally of the milder forms; use of fluoride supplements and toothpastes at an early age may be risk factors for this condition. The prevalence of severe periodontal disease in the general population is low. Initial assessments of risks for periodontal disease progression have identified a number of potential factors that are related to the diseases in a complex way. Significant analytic advances have been made to aid in risk-factor identification.

Child↗
PubMed1988

Microbial caries induction in the roots of human teeth in vitro.

Streptococcus mutans GS5, Lactobacillus casei DSM20011 and Actinomyces viscosus T14 produce artificial caries in the roots of extracted teeth. Roots were coated with wax leaving an 8 mm2 window exposed on the buccal surfaces, and then incubated for 8 days in the presence of the test organism, the synthetic medium being changed each day. Samples were then examined by SEM, or microradiographs were obtained from 120 microns sections. The pH at the root surface at the end of the induction averaged 4.43, 5.00 and 5.20, and the lesion depths measured on the microradiographs averaged 121, 83 and 34 microns, for Strep. mutans, L. casei and A. viscosus respectively. This relationship between pH and lesion depth confirms earlier findings. As all of these organisms can produce lesions in tooth structure, elimination of one type would probably not eliminate caries.

Actinomyces↗
PubMed1976

The relationship between cemental caries, oral hygiene status and fermentable carbohydrate intake.

Two groups of patients were evaluated for the presence of active, restored, and recurrent root surface caries. One group of 120 subjects had received treatment for moderate to severe periodontitis. The second group consisted of 124 subjects who were affected by moderate to severe periodontitis but had received no treatment. The two groups were also evaluated for amounts of recession, pocket depth, and the presence of bacterial plaque. In addition, each subject was asked to compile a record of his/her dietary intake for a seven-day period. The treated group was found to brush and floss more frequently than the untreated group and had a lower mean plaque score (45.8), than the untreated group (61.4). There was no difference in the mean plaque scores for the subgroups with and without root surface caries within either the treated groups. The prevalence of root surface caries increased through age 59 in the treated group, then diminished after age 60. In the untreated group the prevalence increased steadily with age. Analysis of the data from the dietary hisories revealed that the subjects in both the treated and the untreated groups who were affected with root surface caries had a significantly higher (P less than 0.01) number of fermentable carbohydrate exposures per week.

Adult↗
PubMedDate not supplied

Dental caries in older adults with diabetes mellitus.

The prevalence of type II diabetes mellitus increases with age. The objective of this study was to determine the prevalence of coronal and root-surface caries experience among older adults with different levels of diabetes control. Subjects were 42 community-dwelling, dentate adults aged 54-86 yrs, including 24 diabetics and 18 nondiabetic controls. Coronal and root-surface caries and restorations were evaluated. Diabetics had fewer teeth than nondiabetics, especially those with poorer glycemic control. The mean decayed/filled surface (DFS) and filled surface (FS) values were higher, and the mean decayed surface (DS) and missing surface (MS) values were lower in nondiabetics than in diabetics, and in well-controlled diabetics compared with poorly controlled diabetics. After adjusting for missing teeth, the data were expressed as a percentage of the available surfaces, and the significant differences in DFS and FS disappeared. However, the p-values for mean number of DS and MS remained very similar to those for %DS and %MS. The number of root-surface caries was higher for the diabetics than for nondiabetics, but no corresponding difference was observed between well-controlled and poorly controlled diabetics. The results of this study suggest that diabetes and poor glycemic control may not be associated with an increased prevalence of past coronal and root-surface caries experience in older adults, but there is a tendency for more active caries lesions and missing teeth.

Aged↗
PubMed2000

Heavy metals in human primary teeth: some factors influencing the metal concentrations.

Human primary teeth have been used as indicators of heavy metal exposure for several decades, but the knowledge about the influence of factors such as tooth type and the presence of caries and roots on metal concentrations is limited. Samples of tooth powder from more than 1200 Norwegian primary teeth without fillings have been analyzed for lead, zinc and cadmium content, and 554 of them for mercury. The material represents all groups of tooth types (incisors, canines and molars), carious and non-carious teeth, and teeth with and without roots. Here we investigate how tooth group and the presence of caries and roots are related to metal concentrations in the teeth. We find that carious teeth have higher metal concentrations than non-carious teeth; the difference was statistically significant for lead, mercury and zinc. Teeth with roots have higher lead and zinc concentrations than teeth without roots. We find differences in metal concentrations between the tooth groups for lead, mercury and zinc. Significant, positive correlations are found between lead and the three other metals and between mercury and zinc. We conclude that metal concentrations in primary teeth are affected by the presence of caries and roots and by tooth group.

Cuspid↗
PubMed1992

Chlorhexidine solutions, gels and varnishes in caries prevention.

To combat dental caries, a chemical has been sought that possesses stronger antimicrobial properties than fluoride in support of its physicochemical tooth-protecting properties. These searches have led to several agents, of which chlorhexidine (CH) appears most effective. To reduce local side effects of the well-known 0.2% CH mouthwash, a 0.05% CH gluconate + 0.04% NaF solution, pH 5.9, has been developed. Use of this combination over a 2-year period resulted in a 53% reduction in caries increment and a 75% reduction in gingival bleeding, i.e. a clear duality of prevention of oral disease (Luoma et al. 1978). Staining of teeth was minimal and easily removable in about one third of the subjects. To lessen the contribution of patients, chlorhexidine gels, without but more especially with fluoride have been professionally administered. Reductions in salivary mutans streptococci after short periods of gel applications have been found to persist longer than reductions after brief periods of mouthwashing. Reductions of approximal caries increment by about 50% in children, and root surface caries in adults have been obtained through use of CH gels. The effect on root surface caries in adults was equal to that obtained through use of local fluoride applications. Dental CH varnish seems promising, especially because a very short contact time with a tooth may be sufficient to reduce mutans streptococci. No simultaneous effects against caries and gingivitis of CH gels or varnishes has been reported. Comparisons of CH solutions, gels and varnishes, with or without fluoride, in relation to their potentials for preventing oral disease in subjects at risk remain to be accomplished.

Chlorhexidine↗
PubMed1991

Degradation of bovine incisor root collagen in an in vitro caries model.

The effects of pH, ionic strength and proteinases on the destruction of bovine incisor root collagen were studied. Experiments were done with powdered and intact root specimens. Completely demineralized root powder was subjected to solutions of varying pH and ionic strength: (a) 0.1 M acetic acid, pH 4.0, (b) 0.1 M acetic acid + 0.15 M KCl, pH 4.0, (c) 0.1 M Hepes, pH 7.0 or to (d) 0.1 M Hepes + 0.15 M KCl, pH 7.0 at 37 degrees C. The surfaces of intact root specimens were exposed to 0.1 M acetic acid, pH 4.0 (which resulted in erosive lesions) or to 0.1 M lactic acid, 0.2 mM methane hydroxy diphosphonate, pH 5.0 (which produced subsurface lesions) at 37 degrees C. After incubation, the extracts were analysed for soluble collagen and the insoluble matrices were treated with trypsin at 15 degrees C to determine the denatured collagen. To estimate sensitivity to non-specific proteinases, demineralized root powder was also treated with trypsin under physiological conditions of temperature, pH and ionic strength. The denaturation and subsequent solubilization of collagen material from the fibrils could be influenced by variations in pH and ionic strength but these effects were small when compared to proteolytic degradation under physiological conditions. This supports the hypothesis that, in root caries, destruction of exposed matrix collagen depends largely on the presence and activity of proteinases.

Acetates↗
PubMed1989

Effect of topical F- solutions on caries-like lesions in root surfaces.

Topical F- solutions, NaF, SnF2, TiF4, or Fe-Al-NaF, were applied to root surfaces to examine the effect on caries-like lesions produced in vitro. Extracted premolars were treated with a solution for 10 min prior to a 20-day period in acid gel. The lesions were studied by microradiography and light microscopy, and concentration profiles of 12 elements were determined by secondary ion mass spectrometry. The results indicated that the solutions retarded the development of lesions. The greatest effect was obtained with TiF4 and SnF2 solutions. Element analyses revealed that high concentrations of F (up to 3.5%) accumulated in the outer third of the lesion and that SnF2 and TiF4 formed depots in the cementum, although both Sn and Ti also penetrated the lesion. NaF had a weaker effect on lesion formation, but induced a high F concentration in the demineralized zones. The Fe-Al-F solution affected the lesion only marginally and deposited a relatively low F concentration in the lesion, although Fe and Al penetration and depot formation were noted.

Adolescent↗
PubMed2001

Evaluation of an adjusted chi-square statistic as applied to observational studies involving clustered binary data.

A simple adjustment to the Pearson chi-square test has been proposed for comparing proportions estimated from clustered binary observations. However, the assumptions needed to assure the validity of this test have not yet been thoroughly addressed. These assumptions will hold for experimental comparisons, but could be violated for some observational comparisons. In this paper we investigate the conditions under which the adjusted chi-square statistic is valid and examine its performance when these assumptions are violated. We also introduce some alternative test statistics that do not require these assumptions. The test statistics considered are then compared through simulation and an example presented based on real data. The simulation study shows that the adjusted chi-square statistic generally produces empirical type I errors close to nominal under the assumption of a common intracluster correlation coefficient. Even if the intracluster correlations are different, the adjusted chi-square statistic performs well when the groups have equal numbers of clusters.

Chi-Square Distribution↗
PubMed1999

Quantification of root surface plaque using a new 3-D laser scanning method.

There are no published reports in the literature objectively quantifying thickness of plaque on teeth. The aim of this study was to quantify plaque on a tooth surface and assess if this quantification correlates with a clinical index of plaque from each of 51 patients. Patients were instructed not to perform any oral hygiene on the day of the assessment. The Silness and Löe plaque index was scored and replicas were scanned using a co-ordinate measuring machine (CMM) and laser scanning probe. A replica was obtained from this surface before and after toothbrushing. Plaque adjacent to the gingival margin had a mean thickness of 0.106+/-0.118 mm (mean+/-SD) whilst mean plaque thickness 250 microm from the gingival margin was 0.053+/-0.052 mm (mean+/-SD). There was a significant correlation between the plaque index and the plaque thickness (p < or = 0.002). The finding that plaque is present in the greatest amount adjacent to the gingival margin supports a previously reported hypothesis that primary root carious lesions (PRCL's) may initiate adjacent to the gingival margin. This method quantifies plaque thickness on exposed root surfaces which correlates with the plaque index as well as illustrating how the morphological characteristics of teeth, gingivae and plaque can be studied in vivo from replicas recorded.

Adult↗
PubMed1993

Marginal sealing ability of four restorative materials placed in root surfaces.

The sealing ability of four restorative materials, placed in root surface cavities, was assessed by a range of standard in vitro microleakage tests. The rank order of the severity of microleakage associated with the four materials varied with the different tests. Although differences between the performance of unlined amalgam, two different dentine-bonded composites and a glass-ionomer restorative material were detected, most were not statistically significant. None of the materials tested completely eliminated microleakage and so even those materials reported to be adhesive to dentine cannot be considered ideal in the restoration of root surface cavities.

Composite Resins↗
PubMed1996

Surgical correction of gingival recessions associated with radicular carious lesions.

In this clinical report, six cases are presented in which radicular carious lesions and gingival recessions were treated concurrently. The combined treatment included the removal of caries, radicular planing, and various surgical techniques for root coverage. Traditional procedures, as well as newer procedures, such as guided tissue regeneration, showed successful results.

Adult↗
PubMed1991

The effect of an antimicrobial releasing varnish on root demineralisation in situ. The influence of the demineralisation period.

Caries in exposed root surfaces is becoming a significant problem in dentistry. Varnish applications have interesting preventive possibilities against root caries. The effect of such a varnish, containing two antimicrobials, was studied on the demineralisation of roots with a twofold aim. Firstly, the efficacy of the varnish was investigated in situ as a function of the demineralisation period. Ten participants wore sound intact roots treated with the varnish in an intra oral appliance for 2, 4 and 6 weeks. Secondly, the effect of the varnish on root demineralisation after removal of the varnish was measured. The results showed that the reduction, in demineralization of about 80% after 2 weeks, decreased in magnitude with the length of the in situ demineralisation period. After 4 weeks there was no longer statistically significant difference compared with untreated roots. The acid attack by plaque was, however, substantial in this model; after 6 weeks in situ untreated roots were so strongly demineralised that microradiography was no longer possible anymore. In the second experiment in which the varnish was removed 2 days after application there was a trend toward a reduction of about 30% in root demineralisation after 2 weeks. This was not statistically significant when compared with no application.

Adult↗
PubMed1999

Chewing tobacco use and dental caries among U.S. men.

BACKGROUND: Chewing tobacco has high levels of sugars and may be cariogenic, but few studies have investigated such an association. This study examined the relationship between chewing tobacco use and dental caries among U.S. adult men. METHODS: Participants in the Third National Health and Nutrition Examination Survey conducted from 1988 to 1994 were interviewed about tobacco use and examined by dentists. The authors included in their analysis dentate men 18 years of age or older. They calculated the mean number of decayed or filled permanent teeth, or DFT, and decayed or filled coronal tooth surfaces, or DFS, as well as the mean number and percentage of decayed or filled root surfaces, or RDFS, and decayed root surfaces, or RDS, by tobacco-use status. They used multiple logistic regression to examine the association between chewing tobacco use and root-surface caries. RESULTS: Men who currently used only chewing tobacco had a higher adjusted mean number of DFT than did those who currently used only snuff, only cigarettes or more than one form of tobacco or who never used tobacco. Mean DFS also was higher among chewing tobacco users than among those who used only snuff, only cigarettes or more than one form of tobacco. Chewing tobacco users had a higher mean RDFS and RDS than did the users of other forms of tobacco or nonusers. Current users of chewing tobacco were more than four times as likely as those who never used tobacco to have one or more RDFS or RDS, with a dose-response relationship between number of packages used per week and odds of having root-surface caries. CONCLUSIONS: In addition to its established role as a carcinogen, chewing tobacco may be a risk factor in the development of root-surface caries and, to a lesser extent, coronal caries. This may be due to high sugar content, increased gingival recession and enhanced collagenase activity. CLINICAL IMPLICATIONS: Interventions by dentists and other members of the oral health care team to prevent tobacco use and help users quit can reduce the risk of developing oral and systemic disease.

Adolescent↗
PubMedDate not supplied

Effect of fluoridated milk on progression of root surface lesions in vitro under pH cycling conditions.

The aim of this study was to assess the effect of milk with 0, 2.5 or 5 ppm F on progression and remineralization of caries-like root surface lesions using a pH cycling model. The root surface lesions were created utilizing a partially saturated lactic acid buffer at pH 4.6. Longitudinal sections were cut through the lesion and analyzed using polarized light microscopy (PLM) and microradiography (MRG). The sections were then coated with an acid resistant varnish, except the outer natural surface that would be exposed to water, milk or fluoridated milk and cycled in a de- and remineralizing system for 2 weeks. The lesions were characterized again by PLM and MRG after treatment. A significant reduction in lesion progression was found by PLM and MRG after treatment with either non-fluoridated or fluoridated milk when compared to the control group. Using quantitative MRG, mineral change and distribution in the lesions were recorded. A possible protective effect of fluoridated milk on root surface caries was supported by a reduction in the progression of the lesions and an increase in the mineral within the lesion.

Analysis of Variance↗
PubMed1993

Association between untreated caries and age, gender and dental attendance in adults.

The aim of the study was to examine the association between untreated caries on the crown and root of the tooth with the age, gender and dental attendance in a group of adult. Six general practitioners in the Greater Manchester area agreed to take part. Over a 6-week period they collected clinical and personal data on 270 of their adult patients. No association was found between the mean number of coronal surfaces with caries and age; however, there was more root caries in people over 55 yr. More recurrent caries associated with a restoration was diagnosed than primary caries. There were proportionally more female than male regular attenders, and once attendance has been taken into account there were no gender differences for either coronal or root caries. Both coronal and root caries were associated with attendance, with irregular attenders experiencing more. Irregular attenders were three and a half times more likely to have caries on the root surfaces than regular attenders.

Adult↗