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PubMed1999

Caries activity and associated risk factors in elderly hospitalised population--15-months follow-up in French institutions.

UNLABELLED: Only a few studies have been published concerning hospitalised elderly disabled people. OBJECTIVES: 1) to investigate the oral health status of elderly French patients hospitalised in the two main geriatric hospitals of Paris. 2) to describe the respective influences of general parameters (type of hospitalisation, pathologies and medication) on oral environment parameters. 3) to analyse the influences of these oral parameters on caries activity in Long-Term Care (LTCF) and in rehabilitation facilities (RF) patients and to study the incidence and the time-course of caries in these specific population. SUBJECTS: 117 subjects (mean age = 83.0 years, SD = 7.8, range = 64 to 102 years) were examined at baseline and 32 of the 50 LTCF subjects were reexamined 15-months later. METHODS: The general parameters recorded were age, gender, type of hospitalisation, period of stay, removable prosthesis, general diseases, number of diagnoses, medications with hyposalivary side-effects. The oral environment parameters recorded were flow rate, buffer capacity, mutans streptococci and lactobacilli counts, measured at baseline by tests on stimulated saliva, and plaque index. Crown and root surfaces were recorded according to a modified caries activity index. RESULTS: Among the polypathological subjects (85.5% of the population), the number of diseases ranged from 2 to 8. The LTCF patients had a significantly higher mean number of diagnoses (3.5; SD = 1.5) than the RF patients (2.8; SD = 1.4). 76.9% of patients were taking medications with hyposalivary side-effects. The stimulated flow rate ranged from 0.02 ml/min to 5 ml/min. Its mean was significantly lower for LTCF patients (0.67 ml/min; SD = 0.51) than for RF patients (1.12 ml/min; SD = 0.89). The plaque index was significantly higher in LTCF subjects and in patients with mental diseases. At baseline, 17,442 crown and root surfaces were examined. Flow rate was related to crown caries and buffer capacity to root caries. During the 15-months follow-up, the mean number of active root surfaces was significantly increased: from 0.148 (SD = 0.116) at baseline vs. 0.250 (SD = 0.174) at the second examination. CONCLUSIONS: The strongest relationship in the present study between oral parameters and caries activity was the negative relationship between buffer capacity and active root caries. This study confirms an association between the type of hospitalisation and both salivary parameters flow rate and plaque index. This investigation illustrates the critical need for hygiene and oral care, in this elderly disabled population.

Age Factors↗
PubMed2003

Direct detection of Actinomyces spp. from infected root canals in a Chinese population: a study using PCR-based, oligonucleotide-DNA hybridization technique.

OBJECTIVES: The poor sensitivity of phenotypic identification techniques has hampered the taxonomic differentiation of Actinomyces. Hence we developed a sensitive and specific, PCR-based oligonucleotide-DNA hybridization technique to detect Actinomyces spp. and, used this method to detect these organisms in samples directly obtained from infected root canals. METHODS: A total of 32 samples from 28 Chinese patients, with primary root canal infections, aseptically exposed at the first patient visit, were studied. Whole bacterial genomic DNA was isolated directly from paper point samples. The variable regions of 16S ribosomal DNA of bacteria were amplified and labeled with digoxigenin for further hybridization and detection. A total of seven oligonucleotide probes specific for A. bovis, A. gerencseriae, A. israelii, A. meyeri, catalase-negative A. naeslundii (genospecies 1 and 2), catalase-positive A. naeslundii genospecies 2 and A. odontolyticus were used. RESULTS: 16 of the 32 teeth were infected with one or more Actinomyces species. The prevalence rates of the examined species were: A. odontolyticus 31.3%, A. meyeri 9.4%, A. naeslundii 9.4%, A. israelii 6.3% and A. gerencseriae 3.1%; no A. bovis was detected in any of the canals. Furthermore, A. odontolyticus was isolated more frequently from root canals with caries or a history of caries (Fisher's exact test: P=0.0496; Odds ratio=9.00, 95% confidence interval: 0.97-83.63), and A. naeslundii was significantly associated with traumatized teeth (Fisher's exact test: P=0.0121; Odds ratio=57.00, 95% confidence interval: 2.10-1546.90). However, no significant correlation was found between Actinomyces spp. and clinical symptoms and signs, such as pain, swelling, percussion to tenderness, sinus and periapical radiolucency. CONCLUSION: Actinomyces spp. may be important pathogens of root canal infections. A. naeslundii in particular may be related with traumatized teeth. A. odontolyticus appears to be involved in infections related to caries, exposure of dentinal tubules during cavity preparation and/or leaking restoration, but further clarification with large samples is necessary.

Actinomyces↗
PubMed2005

Orthodontic extrusion of an extensively broken down anterior tooth: a clinical report.

A predictable esthetic restoration is not limited to the restored teeth; it has to include the gingival unit and its interface with the teeth involved. Failure to deliver restorations that maintain gingival health jeopardizes the success of any restorative procedure and creates potential for periodontal problems. Perforations, fractures, root resorption, or caries in the cervical area of the tooth, especially in the anterior part of the mouth, present many challenges to the clinician. Failure to place the crown margins on sound tooth material may violate the biologic width and should be considered a restorative failure. Orthodontic root extrusion or forced eruption is a well-documented clinical method for altering the relation between a nonrestorable tooth and its attachment apparatus, elevating sound tooth material from within the alveolar socket. It has some advantages over surgical crown lengthening, which is less conservative considering the sacrifice of supporting bone and the negative change in the length of the clinical crowns of both the tooth and its neighbors. This article presents a case of a maxillary right lateral incisor, extensively broken down following trauma, treated with orthodontic extrusion combined with gingival fiberotomy, without a need for a corrective surgical procedure.

Adult↗
PubMedDate not supplied

The influence of dentin adhesives on the demineralization of irradiated and non-irradiated human root dentin.

This study determined the caries-protective effects of two different dentin bonding systems (Syntac, Scotchbond) on sound and irradiated root surfaces in vitro. The root surfaces of 30 freshly extracted caries-free human molars were used. The teeth were bisected in the mesio-distal direction and all lingual halves of the teeth were irradiated. The irradiation dose of 60 Gy was fractionally applied over six weeks (2 Gy/day, 5d/wk). All halves were then coated with acid-resistant nail varnish, exposing two rectangular windows 6 mm2 each on the dentinal root surface. One window served as an untreated control, while the other was treated with one of the above mentioned dentin adhesive systems. The specimens were randomly distributed among the four experimental groups as follow: Group A: Syntac, non-irradiated; Group AR: Syntac, irradiated; Group B: Scotchbond, non-irradiated; Group BR: Scotchbond, irradiated. Subsequently, all specimens were demineralized for 14 days with acidified gel (HEC, pH 4.8, 37 degrees C). From each window, two dentinal slabs were cut. The slabs were ground to a thickness of 80 microm and submerged in water. The depth of the lesions was determined using a polarized light microscope. The non-irradiated control specimens showed lesions with an average depth of 63 microm (+/-10,2 microm). In the case of the irradiated control specimen, the lesion depth was not significantly different. In all experimental groups, the lesion depth was significantly reduced compared to the control groups. Statistical analysis revealed no significant differences between the irradiated and non-irradiated specimens. It can be concluded that demineralization of the root surface can be hampered by application of the dentin adhesive systems tested. In this study, no differences between irradiated and sound root surfaces could be detected.

Analysis of Variance↗
PubMed1991

Effect of 2-O-stearoyl glycerol-1,3-bisphosphate on in vitro demineralization of dental root surfaces.

The effect of 2-O-stearoyl glycerol-1,3-bisphosphate (Glydip) on caries lesion formation in root surfaces of sound human third molars was investigated in vitro. For this purpose parts of the root surfaces were treated with Glydip. Adjacent parts of the surfaces were not treated and served as control. Lesions were obtained by demineralization with an acetate buffer of pH 5.0. It was found that Glydip had no inhibiting effect on the rate of lesion formation. Additionally, pretreatments were performed with lauryl sulphate, a chloroform-methanol mixture, an aqueous solution of sodium hypochlorite, and collagenase prior to the treatment with Glydip to enhance the accessibility of the tissue for Glydip. None of these pretreatments or combinations of them revealed an inhibiting effect of Glydip on the rate of caries lesion formation. This result is in contrast to the effect of Glydip on the demineralization of enamel.

Acid Etching, Dental↗
PubMed2004

Effect of two-step adhesive systems on inhibition of secondary caries around fluoride-releasing resin composite restorations in root dentine.

OBJECTIVE: The purpose of this study was to investigate the effect of two-step adhesive systems on secondary caries inhibition around fluoride-releasing materials in vitro. METHODS: Two self-etching primer systems, Clearfil SE Bond (SE) and UniFil Bond (UB), and two one-bottle systems with a total-etch wet-bonding technique, Single Bond (SB) and One-Step (OS), were used prior to placement of resin composites either with (Reactmer) or without (Z100) fluoride release. Class V cavities prepared in extracted human premolars were restored with various combinations of materials: Reactmer/SE, Reactmer/UB, Reactmer/SB, Reactmer/OS, Z100/SE, Z100/UB, Z100/SB and Z100/OS. After storage for 14 days, the restored teeth were incubated in bacterial medium containing sucrose with Streptoccus mutans for 2 weeks. Water sorption and desorption of the adhesives and fluoride release from the resins either coated with adhesive or uncoated were also determined. RESULTS: The one-bottle groups showed higher water sorption and desorption than the self-etching primer groups. Although fluoride release from the Reactmer specimens was suppressed by the adhesive coating, the one-bottle groups allowed significantly higher fluoride release than the self-etching primer groups. On microradiographs, the radio-opaque layers adjacent to the Reactmer restorations were thick and clear, while the layers adjacent to the Z100 restorations were thin and unclear. For the Reactmer restorations, the radio-opaque layers associated with the one-bottle groups were significantly thicker than for the self-etching primer groups. CONCLUSIONS: These results indicated that the use of one-bottle wet-bonding systems for bonding of fluoride-releasing resin composites to dentine may contribute to inhibit secondary caries compared to self-etching primer systems.

Bisphenol A-Glycidyl Methacrylate↗
PubMed1984

Four-year longitudinal study of the periodontal health status of overdenture patients.

Seven patients with a total of 12 roots were treated with overdentures (maxillary, mandibular, or both) and recalled at 6-month intervals for a period of 4 years. A periodontist evaluated the periodontal health status of the abutment roots after complete periodontal therapy, immediately prior to placement of the overdentures, and at all recall visits. The gingival tissues around all the abutments were slightly erythematous and edematous and bled on probing. There were no statistically significant changes in pocket depth or in apparent width of attached gingiva on an intra-arch basis. However, statistically significant changes were found on comparison between the maxillary and mandibular arches. Over the 4-year period 50% of the roots remained immobile, 25% of the roots that were initially mobile exhibited no mobility, and 25% of the roots decreased in mobility. Five of 14 roots in eight patients (35.7% of the abutment roots) developed dental caries. Periodic recalls to reinforce plaque control measures, to provide adjunctive periodontal therapy, and to correct and adjust the prostheses of patients treated with overdentures are important factors in the longterm success of this treatment modality. Biomechanically, treatment of patients with overdentures is a valid practical alternative to complete dentures.

Dental Abutments↗
PubMed2003

Concentration of selected elements in the roots and crowns of both primary and permanent teeth with caries disease.

We examined the differences between the concentrations of chemical elements in caries-changed primary teeth and permanent ones with a division into the root and the crown. The study comprised 27 children aged from 4 to 11 yr and 36 adults aged from 36 to 71 yr. We examined the elements with the total reflection X-ray fluorescence method. The lowest concentrations of calcium, manganese, strontium, lead, and copper were in the roots of primary teeth compared to the roots of permanent ones. The calcium, nickel, zinc, lead, and copper concentrations were significantly higher in the roots of primary teeth than in the roots of permanent teeth. However, the zinc concentration was higher both in the root and crown of primary teeth than in permanent teeth. On the basis of our investigations, we can conclude that the content of some elements (manganese, copper, strontium, and lead) is higher in caries permanent teeth than in primary ones. The nickel and zinc concentrations are higher in the teeth of the children than the adults. However, the content of other elements (calcium, chromium, iron) is similar in both kinds of teeth.

Adult↗
PubMed2001

Self-reported and clinical oral health in users of VA health care.

BACKGROUND: This article describes the oral health of users of Veterans Administration (VA) health care using both clinical and self-report measures, and models relationships between these measures and self-perceived oral health. METHODS: We conducted a cross-sectional study of 538 male users of VA outpatient care in the Boston area. Questionnaires assessed self-reported oral health, oral-specific health-related quality of life, health behaviors, and sociodemographic information. Clinical data were collected on oral mucosa status, number of teeth and root tips, dental caries, and periodontal treatment need. We report clinical and self-reported oral health status by age group (era of military service). We regressed models of self-perceived oral health on clinical indices and self-reported measures of the impact of oral health on daily life, adjusting for sociodemographic characteristics and health behavior. RESULTS: Among those participants aged 65 to 91 years old, 2.8%, 18.7%, and 41.5% rated their oral health as excellent, very good, or good, respectively. Among 50- to 64-year-old men, the corresponding values were 1.4%, 18.5%, and 40.4%, while among those aged 22 to 49 years old, the values were 2.3%, 17%, and 34.1%. Tooth loss was common among users of VA care; 34% of those aged 65-90 years, 28% of those aged 50-64 years, and 8% of those aged 25-49 years had no teeth. Periodontal treatment needs were uniformly high among persons with teeth; mild mucosal change was common, and 10% had root tips. Regression models showed self-perceived oral health was better in persons with more teeth and recent dental treatment, and worse with tooth mobility, coronal decay, and more medical problems. Measures of the impact of oral conditions on daily life added significantly to the amount of explained variance in self-perceived oral health. CONCLUSIONS: Clinical conditions and the impact of oral health on daily life are important determinants of self-perceived oral health.

Adult↗
PubMed1999

[Ready-made crowns in the deciduous dentition].

The following review of the literature on "prefabricated crowns for deciduous teeth" attempts to highlight the benefits and limitations of this treatment modality. The use of prefabricated crowns is indicated in the following situations: severe destruction of the clinical crown, deep approximal cavities, bilateral approximal cavities, circumferential caries, history of root canal treatment, and need for fixed space retention. Compared to amalgam restorations involving two or more surfaces, prefabricated crowns on deciduous molar teeth gave very high survival rates. They consist of a chromium-nickel-steel alloy and are reported to have an acceptable gingival tolerance profile. In contrast to the Anglo-American countries this treatment modality is quite uncommon in Germany. A probable reason for this reservation could be that many clinicians often fail to see the need for a filling in the deciduous dentition. Besides, many dentists are reluctant to use local anesthesia in children, which is inevitable in preparing and fitting a prefabricated crown. In the United States and UK dentists are less frequently confronted with this problem, as complex treatments are often carried out under nitrous oxide sedation or insufflation anesthesia. Modern filling materials have been introduced which have the potential to narrow the indications for prefabricated stainless steel crowns. Against this background, future studies are necessary to compare the survival rates of prefabricated crowns and modern filling materials.

Child↗
PubMed1991

Selectivity, efficiency, and surface characteristics of hard dental tissues ablated with ArF pulsed excimer lasers.

Lasers are finding expanding applications in the field of dentistry. Cutting in soft tissue, hard dental material ablation, caries removal, and root canal therapy are only a few examples of dental laser uses. In this article, the application of short pulse ArF excimer laser to ablation of dentin and enamel is investigated. In particular, the effect of laser pulse repetition rates (PRR) and fluence levels on the efficiency of the ablation process and on the average thermal response of ablated surfaces is investigated. Ablation of dentin was found to be considerably more efficient than the ablation of enamel and depends exponentially on the laser fluence. Both dentin and enamel surfaces showed an increase in surface temperature with repetition rate. At lower PRR, however, temperature increases are very small. Surface temperature was also found to increase with laser fluence, although this increase is very small at laser PRR of 5 Hz or less. Tissue ablation rates were found to be comparable to or better than other nanosecond lasers, and left smooth surfaces, free of thermal damage. Microscopic examination of the ablated surface shows no crack formation, charring, discoloration, or any other thermal damage. The ablated surfaces appear to be very smooth, highly polished, and glossy looking as if they were subjected to thermal melting. This observation is indeed confirmed under scanning electron microscopy (SEM), where evidence of localized melting of the tissue is observed. Furthermore, a close SEM examination of the dentin surface reveals a selectively ablated intertubular dentin, while the remaining pillar-like dentin tubules are sealed off with fused peritubular dentin. At all fluence levels and PRR, the first three to four pulses impinging on an untreated enamel surface produced unusually large plumes of debris which were different in size, texture, and fluorescence emission characteristics from the ablation products of subsequent pulses. It is believed that these different ablation characteristics are a consequence of the pulsed ArF laser's ability to selectively remove residual matter from the more resistant enamel surface.

Acid Etching, Dental↗
PubMed2000

Cytotoxic and nongenotoxic effects of phenolic compounds in human pulp cell cultures.

Phenolic compounds are widely used in clinical dentistry as sedatives for the dental pulp, as disinfectants for caries, and as root canal medications. The pathobiological effects of various phenolic compounds on human dental pulp fibroblasts were investigated with Hoechst 33258 fluorescence assay and DNA precipitation assay. All phenolic compounds showed cytotoxicity in Hoechst 33258 fluorescence assay by inhibiting cellular DNA in a concentration-dependent manner. The 50% inhibition concentrations required to decrease the cellular DNA contents by guaiacol, phenol, eugenol, and thymol were 9.8, 4.5, 0.9, and 0.5 mM, respectively. However these phenolic compounds did not cause DNA single-strand breaks in cultured human pulp fibroblasts. These results indicate that phenolic compounds are cytotoxic agents but are without genotoxic effects on human pulp fibroblasts in vitro. However care should be taken to reduce the possibility of pulpal as well as periapical irritations from inadvertent extrusion of these substances in clinical usage.

Bisbenzimidazole↗
PubMed1993

Topical application of fluorides on teeth. New concepts of mechanisms of interaction.

Prevention of caries in exposed root surfaces constitutes an important clinical problem. It is thus important that clinicians involved with periodontology have an insight into fluoride prophylaxis. The understanding of the cariostatic mechanism of fluoride has improved during recent years. The aim of the present review is to give a short account of the present concept. Calcium fluoride appears to be the only product which is formed on enamel, dentin or cementum during brief topical treatments with fluoride or use of toothpaste containing fluoride. This calcium fluoride is stable in the oral environment; this is contrary to what was believed until recently. The calcium fluoride constitutes a pH-dependent reservoir of fluoride which releases fluoride when pH drops. The practical consequences of this concept is discussed.

Calcium Fluoride↗
PubMed1989

Oral health status and dental needs in a geriatric institutionalized population in Paris.

One hundred and forty-two residents of a geriatric hospital in France were given an oral exam and interviewed by questionnaire regarding their backgrounds, physical health and oral hygiene habits. The residents suffered from many systemic diseases and drug intake was relatively high. Over fifty percent reported mouth dryness, especially at waking. Twenty-three percent stated that they never brushed their teeth and the demand for dental services was low. Edentulousness was similar to those rates reported in Israel and the U.S. The majority of prostheses were rated by examiners as unacceptable and there were significant amounts of root and cervical caries in spite of the relatively high level of oral health care provided by the staff.

Aged↗
PubMed2004

Asymptotic dental score and prevalent coronary heart disease.

BACKGROUND: Oral infections have been postulated to produce cytokines that may contribute to the pathogenesis of coronary heart disease (CHD). We hypothesized that by estimating the combined production of inflammatory mediators attributable to several oral pathologies, we might be able to explain CHD with better precision. METHODS AND RESULTS: A total of 256 consecutive Finnish cardiac patients from Kuopio University Hospital with angiographically confirmed CHD and 250 age-, gender-, and residence-matched noncardiac patients (controls) were recruited. All dental factors expected to generate inflammatory mediators, including pericoronitis, dental caries, dentate status, root remnants, and gingivitis, were examined, and an asymptotic dental score (ADS) was developed by logistic regression analyses with an appropriate weighting scheme according to the likelihood ratio. We validated the explanatory ability of ADS by comparing it to that of the Total Dental Index and examining whether the ADS was associated with known predictors of CHD. A model that included ADS, C-reactive protein, HDL, and fibrinogen offered an explanatory ability that equaled or exceeded that of the Framingham heart score (C statistic=0.82 versus 0.80). When ADS was removed from this model, the C-statistic decreased to 0.77, which indicates that the ADS was a significant contributor to the explanatory ability of a logistic model. CONCLUSIONS: ADS may be useful as a prescreening tool to promote proactive cardiac evaluation among individuals without overt symptoms of CHD. However, additional prospective study is needed to validate the use of an oral health score as a predictor of incident CHD.

Coronary Disease↗
PubMed1998

Forced eruption: a multidisciplinary approach for form, function, and biologic predictability.

There are several treatment options for patients with coronal fractures, subgingival caries perforations, and root resorption. Frequently, forced eruption is not considered, although in many cases of single-rooted teeth, forced eruption is the "gold standard" for producing an esthetic result without jeopardizing periodontal support for adjacent teeth. Sufficient tooth length, achieved through forced eruption, ensures the periodontal health of the "biologic width" and crown margin and thus a successful restorative outcome.

Adult↗