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A fiber-optic setup for quantification of root surface demineralization.

A fiber-optic fluorescence observation (FOFO) technique has been developed for the quantification of demineralized root dentin. The method was tested on 40 specimens of in vitro demineralized parts of human root dentin. Fluorescein sodium salt was used as a penetrating dye. The fluorescein sodium salt was excited using light around 465 nm. The fluorescence signal around 527 nm measured for demineralized dentin was corrected for lamp output and then divided by the corrected fluorescence signal for the sound control dentin on the same root, resulting in a FOFO-value. FOFO-values correlate linearly (r = 0.91) with mineral loss measured by transverse microradiography. Therefore, it was concluded that the FOFO-technique provides a good, non-destructive measure of the severeness of in vitro demineralized human root dentin, and is applicable on bulk dentin. Future work on natural lesions in vivo will be needed to investigate the applicability of the technique in a clinical situation.

Adolescent↗

What do older adults' global self-ratings of oral health measure?

OBJECTIVE: Although global self-ratings of oral health are widely used in oral health research, the frames of reference on which older people's ratings are based are not known. This study used a quantitative approach in order to identify these referents. METHODS: Data were collected from 498 dentate subjects aged 53 years and over who took part in the second stage of a three-phase longitudinal epidemiological and sociodental study. Data were obtained by means of a personal interview and clinical oral examination and a self-complete version of the 49-item Oral Health Impact Profile (OHIP). These data were used to construct measures of oral disorders, oral symptoms, the functional and psychosocial impacts of oral disorders, health behaviours and contextual variables such as general health status, socioeconomic status and sociodemographic characteristics. Bivariate and linear regression analyses were used to identify which of these variables predicted self-ratings of oral health. RESULTS: One quarter of subjects stated that their oral health was only fair or poor. At the bivariate level most variables were associated with self-ratings of oral health. The regression model for all subjects indicated that the most important predictor of these self-ratings was the OHIP functional limitations sub-scale score. This explained 23% of the variation in the self-ratings. Six other variables entered the model and increased the R2 value to 0.36. There was some variation in the models and the influence of various factors by age and educational attainment. CONCLUSIONS: The results suggest that the referents that inform older adults' ratings of oral health are broadly similar to those that have been reported to inform their ratings of general health and differ across groups.

Age Factors↗

Oral health in the elderly with non-insulin-dependent diabetes mellitus.

The purpose of this study was to examine salivary flow rates and selected oral health parameters in 12 patients (aged 76-86 years) with non-insulin-dependent diabetes mellitus (NIDDM) and also in 20 subjects (aged 76-86 years) with NIDDM and cardiovascular diseases (CVD) and to compare them with 32 healthy controls matched for age and gender. Unstimulated salivary flow rates were lower in both groups of NIDDM patients than in the controls, although the differences were not statistically significant. Subjective oral dryness and other oral and non-oral symptoms were more frequently reported by the patients with NIDDM + CVD; however, the differences were usually non-significant. Root-surface caries was more frequently detected in the subjects with NIDDM only, although the difference among groups was not statistically significant. Periodontal treatment need, according to CPITN values, was more frequent in the subjects with NIDDM only, compared with controls or those with NIDDM + CVD, although the differences were again not statistically significant. There were no statistically significant differences in the oral health parameters of the subjects with NIDDM or NIDDM + CVD compared with those of their age- and sex-matched healthy controls.

Aged↗

Collagen mediates adhesion of Streptococcus mutans to human dentin.

Some strains of Streptococcus mutans were found to recognize and bind collagen type I. Binding of 125I-labeled collagen type I was specific in that collagen types I and II, but not unrelated proteins, were able to inhibit binding of the labeled ligand to bacteria. Collagen binding to S. mutans was partially reversible and involved a limited number of bacterial binding sites per cell. S. mutans UA 140 cells bound collagen type I with high affinity (Kd = 8 x 10(-8) M). The number of binding sites per cell was 4 x 10(4). Collagen-binding strains of S. mutans were found to adhere to collagen-coated surfaces as well as to pulverized root tissue. S. mutans strains that did not bind the soluble ligand were unable to adhere to these substrata. Adherence to collagen-coated surfaces could be inhibited with collagen or clostridial collagenase-derived collagen peptides. Adherence of S. mutans to dentin was enhanced by collagen types I and II but inhibited by collagen peptides. S. mutans UA 140 bound significantly less 125I-collagen type I following treatment with peptidoglycan-degrading enzymes. These enzymes released a collagen-binding protein (collagen receptor) with a relative molecular size of 16 kDa. The results of this study suggest that collagen mediates adhesion of S. mutans to dentin. This interaction may target collagen-binding strains of S. mutans to dentin in the oral cavity and may play a role in the pathogenesis of root surface caries.

Adhesins, Bacterial↗

The isolation of Actinomyces naeslundii from sound root surfaces and root carious lesions.

The isolation of Actinomyces naeslundii from sound, exposed root surfaces (n = 56) and soft and leathery root carious lesions (n = 71) was investigated. Root carious lesions were sampled after the removal of overlying plaque. Supragingival plaque or carious dentine was sampled using a sterile excavator, the samples were disaggregated and cultured on both selective and non-selective media. A. naeslundii isolates were identified to the genospecies using specific antisera. Significantly greater numbers and proportions of A. naeslundii genospecies 2 than A. naeslundii genospecies 1 were isolated from all sites sampled. There was no significant difference between the numbers and proportions of the two genospecies isolated from leathery and soft lesions. The relationship between the presence of A. naeslundii genospecies and aciduric and acidogenic organisms was investigated. Those sound exposed root surfaces from which A. naeslundii genospecies 1 and/or 2 were isolated yielded significantly lower numbers of lactobacilli and yeasts than the surfaces from which A. naeslundii were not isolated. This difference was also found in leathery lesions but not soft root carious lesions. The microflora of soft root carious lesions was found to comprise primarily gram-positive pleomorphic rods which formed 70+/-7.8% of the flora, while in plaque from exposed root surfaces and in infected dentine from leathery lesions the gram-positive pleomorphic rods represented only 35% of the flora.

Actinomyces↗

Inhibition of dentin demineralization by fluoride in vitro.

Compared with the knowledge accumulated on enamel-fluoride interactions, relatively little data is available regarding fluoride effects on dentin. This applies to both laboratory and clinical studies into the efficacy of fluoride schemes for the prevention of root surface caries. This study aimed to determine the effects of fluoride and pH on the demineralization of dentin, such as to provide information necessary to develop preventive programmes. Bovine dentin blocks were subjected to undersaturated calcium- and phosphate-containing solutions in the pH range 4.0-6.0 with fluoride added at concentrations between 0.5 and 10 ppm. Non-fluoride solutions served as controls. Mineral loss was assessed chemically and by transversal microradiography. Comparisons were made with similar studies on enamel demineralization. The results showed that demineralization of dentin depends on both pH and fluoride concentration in the demineralizing solution. Inhibition of demineralization that could be relevant from a clinical point of view was found at fluoride values 5-10 times the corresponding values for enamel. Also rapid depletion of fluoride from the solutions was observed, indicating the high uptake capacity of dentin for fluoride. Lesion depth depended on pH of the solution while the fluoride levels were associated with the surface layer, both in mineral content and depth. For dentin we propose a demineralization mechanism where acid penetrates rapidly into the tissue, presumably through the tubules, after which the released calcium and phosphate is partly trapped by the inward diffusing fluoride. This leads to the formation of a surface layer, which may even be hypermineralized compared to sound dentin.

Animals↗

Antimicrobial effect of a novel ozone- generating device on micro-organisms associated with primary root carious lesions in vitro.

The aims of this present study were (1) to assess the antimicrobial effect of ozone from a novel ozone-generating device (Heolozone, USA) [0.052% (v/v) in air delivered at a rate of 13.33 ml.s(-1)] on primary root carious lesions (PRCLs) and (2) to evaluate the efficacy of ozone specifically on Streptococcus mutans and Streptococcus sobrinus. In study 1, 40 soft PRCLs from freshly extracted teeth were randomly divided into two groups to test the antimicrobial effect on PRCLs from exposure to ozonated water for either 10 or 20 s. Half of a lesion was removed using a sterile excavator. Subsequently, the remaining lesion was exposed to the ozonised water for a period of either 10 or 20 s (corresponding to 0. 069 or 0.138 ml of ozone, respectively). Using paired Student t tests, a significant (p<0.001) reduction (mean +/- SE) was observed in the ozone-treated groups with either a 10-second (log(10) 3.57+/-0.37) or 20-second (log(10) 3.77+/-0.42) ozone application compared with the control groups (log(10) 5.91+/-0.15 and log(10) 6.18+/-0.21, respectively). In study 2, 40 sterile saliva-coated glass beads were randomly divided into two groups for each micro-organism. One glass bead was put into each bijou bottle with 3 ml of Todd-Hewitt broth. S. mutans and S. sobrinus were inoculated anaerobically overnight. Each glass bead was then washed with 2 ml of phosphate-buffered saline. Immediately, 10 s of ozone gas was applied to each glass bead in the test groups. There was a significant (p<0.0001) reduction (mean +/- SE) in ozone-treated samples for S. mutans (log(10) 1.01+/-0.27) and S. sobrinus (log(10) 1.09+/-0.36) compared with the control samples (log(10) 3.93+/-0.07 and log(10) 4.61+/-0.13, respectively). This treatment regime is an effective, quick, conservative and simple method to kill micro-organisms in PRCLs. Ozone gas application for a period of 10 s was also capable of reducing the numbers of S. mutans and S. sobrinus on saliva-coated glass beads in vitro.

Anaerobiosis↗

Maxillary canine-to-first premolar bilateral transposition in a female with Down syndrome. A case report.

OBJECTIVE AND IMPORTANCE: To report a case of the bilateral transposition of the maxillary canines with the premolars in a 17-year-old female with Down syndrome. CLINICAL PRESENTATION AND INTERVENTION: A 17-year-old female presented with moderate mental retardation; she was short and of small stature, and she had a round cherubic face and a broad forehead. Clinical intraoral examination revealed bilateral malpositions of the maxillary canines and premolars as transposition. She had an open mouth, macroglossia and a protruding tongue. The case required the combined orthodontic and prosthetic treatment to achieve an acceptable morphologic and esthetic occlusion. However, the parents refused to accept the proposed treatment. Extractions of the roots and caries treatment were done as these were considered priority for the patient. CONCLUSION: This rare and severe positional anomaly represents an orthodontic challenge and its correction involves treatment risk and requires a great deal of control and carefully applied mechanics.

Adolescent↗

Bacterial colonization of mineralized and completely demineralized dentine in situ.

The changing environment in a developing root lesion may result in a succession of the microbial flora in the dentine. As demineralization proceeds, the collagenous matrix is exposed, which could be conducive to the growth of specific microorganisms. In this study both sound and completely demineralized dentine were placed together in the partial prothesis of 8 individuals to test whether the type of substrate influenced the composition of the bacterial flora. After 6 weeks the degradation of the collagenous matrix, the demineralization of the dentine and the microbial composition were assessed. The collagen loss varied between 0 and 69 wt%. Mineral loss from the originally sound dentine specimens ranged from virtually none to complete demineralization. Percentages of total streptococci, mutans streptococci, Actinomyces and lactobacilli isolated from both dentinal substrates did not differ significantly. The percentage of lactobacilli in the dentine specimens was positively correlated to the lesion depth. The percentage of Actinomyces species was significantly higher in both the dentine specimens that had been demineralized in vitro and those that were found to be completely demineralized in situ compared to the partially demineralized dentine specimens. In vitro, no collagenolytic activity of the predominant flora isolated from both dentinal substrates could be shown.

Actinomyces↗

Oral colonization and pathogenicity of Actinomyces israelii in gnotobiotic rats.

Reference strains of A. israelii were orally implanted in germ-free rats after multiple inoculations. Early colonization was associated with areas of interdental hair and bedding impactions. Largest populations of organisms were isolated from teeth, as compared to the tongue, cheek, or palate. Examination of molar teeth with the scanning electron microscope revealed bacterial accumulations in the occlusal fissures, but not on smooth or approximal surfaces. Extensive plaque formation after 100-150 d was accompanied by root-surface caries and bacterial invasion of the pulp. There was no evidence of bacterial penetration of the dentin underlying surface enamel.

Actinomyces↗

Clinical status of ten dentin adhesive systems.

Laboratory testing of dentin adhesive systems still requires corroboration by long-term clinical trials for their ultimate clinical effectiveness to be validated. The objective of this clinical investigation was to evaluate, retrospectively, the clinical effectiveness of earlier-investigated dentin adhesive systems (Scotchbond, Gluma, Clearfil New Bond, Scotchbond 2, Tenure, and Tripton), and to compare their clinical results with those obtained with four modern total-etch adhesive systems (Bayer exp. 1 and 2, Clearfil Liner Bond System, and Scotchbond Multi-Purpose). In total, 1177 Class V cervical lesions in the teeth of 346 patients were restored following two cavity designs: In Group A, enamel was neither beveled nor intentionally etched, as per ADA guidelines; in Group B, adjacent enamel was beveled and conditioned. Clinical retention rates definitely indicated the improved clinical efficacy of the newest dentin adhesives over the earlier systems. With regard to adhesion strategy, adhesive systems that removed the smear layer and concurrently demineralized the dentin surface layer performed clinically better than systems that modified the disorderly layer of smear debris without complete removal. Hybridization by resin interdiffusion into the exposed dentinal collagen layer, combined with attachment of resin tags into the opened dentin tubules, appeared to be essential for reliable dentin bonding but might be insufficient by itself. The additional formation of an elastic bonding area as a polymerization shrinkage absorber and the use of a microfine restorative composite apparently guaranteed an efficient clinical result. The perfect one-year retention recorded for Clearfil Liner Bond System and Scotchbond Multi-Purpose must be confirmed at later recalls.

Clinical Trials as Topic↗

Evaluating diagnostic tests.

The presentations at this conference will discuss new technologies and rapid scientific developments that have resulted in new diagnostic tests for periodontal disease, musculoskeletal imaging, temporomandibular joint dysfunctions, and incipient coronal and root dental caries. However, for many of these claims, there has been insufficient scientific support regarding the sensitivity and specificity of the tests, or their ability to predict the percent of cases in which the disease or condition progresses to the next state of development. Research is needed that will yield the basic diagnostic parameters of new diagnostic tests, i.e., their accuracy, precision, sensitivity, specificity, positive predictive value, and negative predictive value. The purpose and methods for calculating each of these measures are described in this paper. Five questions are then presented that will need to be addressed in future research regarding new diagnostic tests: (1) Does the scientific theory of the test fit with our current body of knowledge? (2) Have the efficacy parameters of the test been reliably determined? (3) How does the test affect clinical decision-making? (4) Does using the test improve the patient's health? and (5) Is the added expense of the test justified by increased effectiveness or by avoiding other health expenditures?

Diagnosis, Oral↗

Parkinson's disease and oral care.

Parkinson's disease is a relatively common, progressive, neurological disorder. Its key features of resting tremor, bradykinesia, akinesia, restricted mobility and postural instability militate against independence for daily living, mobility, good nutrition and oral health. The successful management of the disease requires a multi-disciplinary approach in which the dietician, speech therapist, nurse and dental staff are pivotal members of the care team.

Deglutition Disorders↗

Dentists' perceptions of trends in restorative dentistry in the UK.

PURPOSE OF STUDY: To obtain responses to a questionnaire on likely trends in the clinical practice of restorative dentistry from a national sample of general dental practitioners (GDPs) who were principals of group practices in the UK. BASIC PROCEDURES: A panel of nine experts had been convened previously to define areas of trends in restorative dentistry in the UK and to formulate these into statements. Twenty trends were identified and framed into a 22-item questionnaire based on the trend statements. The questionnaire was sent to a national sample of 2800 principal dentists in group practices. Names of principal dentists were taken from the Yellow Pages directories, a group practice being defined as at least one principal dentist and one other practitioner. Levels of agreement for questionnaire scores of > or = 70% for all segments of a statement were taken as indicating a possible trend. MAIN FINDINGS: Of the 2800 questionnaires sent out, 1448 were returned, a return rate of 52%. Of these, 1217 questionnaires were usable, an overall response rate of 44%. Good agreement was obtained for 14 statements (64%). PRINCIPAL CONCLUSION: The 14 trend statements that scored a level of good agreement were taken as indicating possible trends in dentistry in the UK as perceived by those GDPs who responded to the questionnaire. However, in view of the fact that the 1217 usable questionnaires received reflected the opinions of 10% of the principal dentists in group practice in the UK, this will not be representative of all principal dentists in practice. Nevertheless for the purposes of gaining some insight into trends in restorative dentistry, it could be considered to be of value.

Adolescent↗

The inevitable maladies of the mature dentition.

Patients who are in their mature years should be advised about the numerous ways in which teeth and supporting structures degenerate in the later years of life. This knowledge will allow patients to make special efforts to prevent, reduce, eliminate or treat the oral problems associated with aging.

Aged↗

Visualization of the human periodontium using serial thin section contact radiography.

A method is described to produce radiographs of thin sections of human teeth and periodontal structures. These high resolution contact x-rays allow for visualization of the microscopic details of the mineralized components of these tissues in a dimension heretofore not examined. Twenty-five blocks of human jaws containing teeth affected by periodontal disease were obtained from cadavers. Sagittal, transverse and cross-sectional serial slices were cut using a rotary instrument (1500 rpm) with a water-cooled 3-inch jewelers slot saw. Five hundred-micron sections were made of jaw specimens containing 2 or 3 teeth. The radiographs were taken with a Faxitron low voltage x-ray machine on Kodak-Ortho, Type 3 film. Films were exposed at a distance of 12 inches from the x-ray source at 35 kVp and 1.0 mA for 3 minutes with the specimen in direct contact with the film. Spatial representation of the internal structure of the alveolar bone was obtained using this technique and the detailed anatomy of the vascular channels within the cancellous and cortical compartments of the jaws was studied. Mineralization patterns of plaque and calculus, calcifications in the periodontal ligament, pulp calcifications, accessory root canals, caries and detailed structural changes in the enamel and cementum were also viewed on these films with the aid of microscopy. Magnifications of up to 30 times were used without excessive image distortion resulting from film grain.

Alveolar Process↗

Synergistic effect of pyrophosphate and sodium dodecyl sulfate on periodontal pathogens.

Our previous studies have shown that pyrophosphate (PPi), the anticalculus component of tartar-control dentifrices, inhibits the growth of organisms associated with coronal and root surface caries. The purposes of this investigation were to: 1) determine if periodontal pathogens are similarly susceptible to the growth-inhibitory properties of PPi; and 2) determine if combinations of pyrophosphate-sodium dodecyl sulfate (PPi-SDS) inhibit growth synergistically. Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, Eikenella corrodens, and Campylobacter rectus (formerly Wolinella recta) were cultured in appropriate enriched media under anaerobic conditions. Inhibition assays were performed in tubes containing media supplemented with PPi and/or SDS. A range of concentrations of PPi and SDS in 2-fold increments was employed, with each concentration assayed in triplicate. Minimal inhibitory concentration (MIC) analyses revealed all of the bacteria were susceptible to PPi and SDS, with MICs of 0.67% (25 mM) and 0.01% w/v respectively. Combination studies with PPi-SDS showed much greater growth inhibition against P. gingivalis and A. actinomycetemcomitans than achieved with the agents individually. Determination of fractional inhibitory concentration indices indicated a synergistic growth-inhibitory effect. Under the constraints of the conditions employed, these studies demonstrate the efficacy of PPi-SDS combinations in inhibiting the growth of periodontal pathogens. It is conceivable that these compounds may have clinical benefit as a subgingival irrigant.

Aggregatibacter actinomycetemcomitans↗