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Panoramic radiographic examination of 704 Danish children aged 9--10 years.
Panoramic radiographs of 704 apparently health children aged 9--10 years were examined regarding anomalies and pathologic conditions in the maxillofacial area. Almost all findings were mesial to the molars. 1.7% of the children had a supernumerary tooth, 7.7% had hypodontia. Malposition of 631 permanent teeth was recorded. 42 dentigerous cysts were detected. Malformed crown or root was seen on 60 permanent teeth. Caries was found on 224 primary and 32 permanent teeth. 257 primary teeth showed atypical resorption, and 53 had a periapical inflammatory radiolucency. 20 retained roots of primary teeth were detected. 31 maxillary sinuses had an opacity. There were very few other findings.
Effect of resin/fluoride and holmium:YAG laser irradiation on the resistance to the formation of caries-like lesions.
PURPOSE: This study compared the effects of a combination of a topical application of resin/NaF mixture and holmium-doped yttrium aluminum garnet (HO:YAG) laser energy with untreated control sites for their resistance to acid destruction/mechanical challenges of root surfaces adjacent to restorative margins. MATERIALS AND METHODS: Forty-eight extracted human teeth were prepared for restorations with coronal margins in enamel and the apical margins on root surfaces. Four types of restorative materials were used. One half of the restorative/root surface margins were treated with an application of nonfilled resin/fluoride mixture and holmium-doped yttrium aluminum garnet laser irradiation; the remaining portion served as the untreated control for each tooth. Acid (10% formic) and mechanical (air sandblaster) challenges were used to test the effects of these treated sites to their controls and to other types of restorative/root surface margins. The depth of root surface loss within 0 to 2 mm apical from the restorative margins was measured and evaluated after 24, 48, and 72 hours of acid exposures. RESULTS: The measurements of tooth loss for the 24- and 48-hour acid-exposure cycles were subjected to statistical analysis (ANOVA) using a paired t test for the variables. The variables, depth of tooth surface loss for the control sites was compared with the depth of loss of the treated sites on opposing sides of each tooth. The depth of tooth surface loss for the control sites had an average mean of 0.35 (0.25) mm for the 24-hour acid exposures, with the opposing treated sides having a mean of 0.053 (0.05) mm (significant at the 0.05 level). The 48-hour acid-exposure results showed significant increased tooth loss for the control sites, but minimum additional loss on the treated sites. The control sites showed an average mean of 1.16 (0.24) mm and a mean of 0.095 (0.103) mm for the treated areas, significant at the 0.05 level. No measurements were made for the 72-hour cycle groups of composite and amalgam alloy restorations because of the loss of most of the filling materials in the control sites. The control groups of crowns showed an average mean loss of 2.06 (0.37) mm with only 0.20 (0.19) mm surface loss for the treated sites. The paired t test for variables indicated no significant differences of tooth surface loss between various types of restorative margins used in this study. CONCLUSIONS: HO:YAG laser energy irradiation after application of resin/NaF to restorative margins and adjacent areas showed a significant increased resistance to acid/mechanical destruction on cementum-dentin root surfaces. The integrity of the restorative/dentin margins were maintained after extended exposures to formic acid and mechanical challenges.
A novel multidisciplinary approach for the treatment of an intruded immature permanent incisor.
The optimal treatment for intruded permanent teeth has not yet been determined. The ideal treatment option is the one with the lowest probability of developing complications such as external root resorption and marginal bone loss. Each case should be considered individually, bearing in mind the severity of the intrusion, the stage of root development, and tooth mobility. Management of an intruded permanent tooth may consist of: (1) observation for spontaneous eruption; (2) surgical crown uncovering; (3) orthodontic extrusion (with or without prior luxation of the intruded tooth); (4) and partial surgical extrusion, immediately followed by orthodontic extrusion and surgical repositioning. The purpose of this article was to review the treatment options for intruded immature permanent incisors, and to present a new modality of an elective internal strengthening of the immature root weakened by external root resorption. A case of an intrusive luxation injury in a 7 1/2-year-old child and the resulting complications utilizing this technique is described. This is the first known report in the pediatric dentistry literature of performing an elective (preventive) internal strengthening of an immature root weakened by severe external inflammatory resorption. The child was followed for 5 years with an excellent clinical outcome. This technique should be considered for treatment of immature permanent teeth with thin cervical root dentin and external or internal root resorption due to trauma or caries.
A comparison of oral health in 70-year-old city cohorts in Umeå northern Sweden in 1981 and 1990: oral problems, dental and periodontal status.
A comparison of oral health in two different samples of 70-year-old men and women living in the city of Umeå in 1981 and 1990 showed that a higher frequency of dental visits among men could be expected in the city population in 1990 (95% CI). The frequency and pattern of reported oral problems was similar in 1981 and 1990. Total edentulousness among men and women in 1981/1990 was 31.3/21.4 and 53.5/35.7% respectively. The lower frequency in 1990 was not statistically significant on the population level. The mean number of teeth was lower in dentated men (12.8 +/- 6.0 V.S. 17.4 +/- 5.4) (p < 0.05) and women (16.9 +/- 6.3 V.S. 13.9 +/- 8.4) (n.s.) in 1990 compared with in 1981 and the functional index according to Eichner showed no difference. Thus, the lower frequency of edentulousness in 1990 mainly seemed to be the result of another distribution of about the same total amount of teeth, on more people. The bleeding index showed values around 30% in both cohorts. Both men and women showed less recurrent caries in 1990 (p < or = 0.05). Men showed a higher number of missing teeth (p < or = 0.01) and of decayed root surfaces (p < or = 0.05) in 1990. The latter might be explained by a larger exposed root surface area which was indicated by a higher frequency (n.s.) of surfaces with an attachment level > 3 mm in the cohort examined in 1990. Although, the compared 70-year-old city cohorts in Umeå examined in 1981 and 199 showed a higher frequency of dental visits and of dentated subjects, no improvement in reported oral health or dental status could be found in the 70-year-old in Umeå in 1990.
Influence of constant fluoride levels in solution on root hard tissue de- and remineralization measured by 125I absorptiometry.
To study the effect of fluoride on de- and remineralization of root hard tissue, an automatic pH-cycling caries model, simulating Stephan curves, was used for 21 days. From each of 13 unexposed human roots, four cementum/dentin blocks were prepared. Four experiments were carried out: one block from each tooth as subjected to pH cycling without and with fluoride at the concentrations of 0.02 ppm (1.0 mumol/l), 0.20 ppm (10.5 mumol/l) and 2.00 ppm (105.3 mumol/l) in the de- and remineralizing solutions, respectively. Mineral change in the specimens was monitored by 125I absorptiometry. When no fluoride was added to the solutions the change in transmission (delta T) increased continuously over 21 days, indicating loss of mineral. In the 0.02-ppm F experiment, there was a marked decrease in delta T, but almost no change in the 0.20-ppm F experiment. pH cycling with 2.00 ppm F in the solutions resulted in a gain of mineral in or most likely on the surface of the cementum/dentin blocks, indicated by a continuously decreasing delta T. The fluoride level in the solution significantly influenced the change in the mineral content of the specimens. Microradiographs of the sectioned blocks showed radiodense surface zones, varying degrees of subsurface demineralization and signs of remineralization or mineral deposition.
Dental caries among the elderly in Norway.
OBJECTIVES: [corrected] To describe the occurrence of decayed teeth (DT), missing teeth (MT), filled teeth (FT), and the total sum score DMFT in elderly Norwegian pensioners, 67 years or more. BASIC PROCEDURES: A representative sample of 582 elderly Norwegians (12.5% receiving social care) participated in a nationwide study (46% men and 54% women). In all, 394 (68%) still had some of their own teeth. A standardized clinical examination was performed by one of the authors (BMH) using well-defined criteria. MAIN FINDINGS: Mean DT was 0.46, FT was 8.4, and DMFT was 25.4. Mean number of root remnants was 0.11. Mean DT, FT, DMFT, and root remnants for the dentate participants were 0.67, 12.4, 24.1, and 0.17, respectively. Men had significantly higher DT than women. DT decreased with increasing age. Only small differences were found in the prevalence of dentate individuals with caries between gender, age groups, geographical regions, and residence in areas of varying population density. CONCLUSION: It seems that caries is a minor problem in the Norwegian elderly population. Age and the number of remaining teeth do not have a decisive role in the development of caries. Further, there are no differences in these respects between geographical areas in Norway.
An in vitro evaluation of fluorescein penetration into natural root surface carious lesions.
In order to develop a method for detection and quantification of initial root surface carious lesions, the use of fluorescein sodium as a fluorescent dye is evaluated. The penetration depth of fluorescein sodium into human roots containing natural carious lesions was measured on approximately 130-microns-thick slices, cut in a direction perpendicular to the pulp. This depth was compared to the lesion depth that was measured on the same slice with transversal microradiography. The results indicate that fluorescein sodium in water penetrates into demineralized layers of root dentine even if a surface layer with a high mineral content is present. The penetration depth is about 1.1 times the microradiographically determined lesion depth.
Traumatically injured primary incisors: a clinical and histological study.
World-wide epidemiological studies state that from 8 percent to 30 percent of children up to 7 years of age sustain injury to primary incisors, including crown fracture, root fracture, tooth avulsion, and dental displacement, which result in malformation of permanent incisors depending upon their state of development. In this study, traumatized primary incisors were evaluated clinically and radiographically, with the following data recorded: exact or approximate time-interval of traumatic episode(s) and extraction, mobility, color change, sensitivity to percussion/palpation, swelling, sinus tract, caries, crown/root fracture, periodontal/periapical lesions, external/internal root resorption, mineralization, and obturation. Based upon the local damage and developmental age, 138 teeth were extracted, fixed in 10 percent formalin, and processed for histological evaluation according to routine methodology. Histologic findings were: the presence of varying extent of necrosis, bacteria in the area of necrosis--not in all cases--neutrophilic leukocytes, chronic inflammatory cells, pulpal calcifications, resorption/apposition, and circulatory changes. The blood pigment distinguished hemorrhage due to extraction from pathologic circulatory changes. All the described reactions varied in intensity and extent with the time interval and the assumed force of the original trauma. Physical trauma to primary teeth caused pulpal damage, which could involve periapical tissue, depending on the extent of the initial damage.
Factors which are associated with dental decay in the older individual.
OBJECTIVES: To improve reliability of salivary bacterial cultures as a surrogate for plaque levels of cariogenic bacterial species by reporting the salivary CFUs of these organisms as a function of the number of teeth. DESIGN: Cross-sectional collection of data in a convenience sample of adults over 60 years of age. SETTING: Hospital Dental clinic, University bacteriology laboratory. SUBJECTS: 523 older dentate subjects, average age 70, including 412 subjects who were in an independent living status and 111 in a dependent-living situation. MAIN OUTCOME MEASURES: Subjects were examined for decay and the presence of salivary factors including the levels of S. mutans, lactobacilli, yeast and other bacteria. The salivary levels of the bacteria were adjusted for the number of teeth in the mouth, and the resultant values were entered into multivariable logistic regression models along with clinical and other salivary parameters. RESULTS: Mutans streptococci levels reported as CFUs/ml saliva per tooth were significantly associated with coronal surface decay, and lactobacilli, reported in a similar way, were significantly associated with root surface decay. Salivary levels of yeasts, which had previously been associated with decay in this population, were no longer significant using this construct. CONCLUSIONS: This construct of reporting salivary bacteriological data as a function of tooth number and per ml saliva could improve the reliability of bacteriological data obtained in epidemiological studies investigating the role of bacteria in dental decay in the elderly.
Characterization of bacteria isolated from human root surface carious lesions.
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In vitro secondary caries inhibition around fluoride releasing materials.
Objectives of the study were to compare the capacity of fluoride releasing materials to inhibit in vitro caries formation and to measure the width and height of the inhibition zones. Box-shaped cavities were prepared on bovine root dentine and restored with Fuji II, Fuji II LC. Vitremer, or Clearfil Liner Bond II system with a fluoride releasing composite. After immersion in a buffered demineralizing solution of 50 mmol/L acetic acid adjusted to pH 4.5 for 3 days, longitudinal sections were cut and imbibed in quinoline for analysis under a polarized light microscope (PLM). The contours of the lesions and inhibition zones were traced and their depth, width and height calculated. The data were analyzed by one-way ANOVA and Fisher's PLSD test at 95% level of confidence. The polarized light microscopy results showed a distinct inhibition zone adjacent to both conventional and resin-modified glass ionomer cements; however, it was not observed around the adhesive resin system. The width and height of this inhibition zone were significantly greater for Fuji II than for Fuji II LC and Vitremer. An inhibition zone was not observed adjacent to the adhesive resin system with fluoride releasing composite. The resin-modified glass ionomer cements produced less protection against in vitro secondary caries formation than the conventional glass ionomer cement. The recent bonding system that releases fluoride failed to produce an inhibition zone along the cavity wall adjacent to the restoration.
Dental status and treatment needs of a New Zealand institutionalised elderly population.
A survey of 359 elderly residents of rest homes and geriatric hospitals in the Manawatu and Horowhenua districts showed that approximately two-thirds were aged 80 or over, and 19.5 percent were dentate, with a mean 13.3 teeth per dentate subject. A mean of 4.6 teeth per dentate subject had caries of either the crown or root, or both. Older males had substantially higher extraction requirements than other subjects. The periodontal needs of the sample were generally low and dominated by the need for calculus removal.
[Overdentures covering natural roots. The use of chlorhexidine gel].
To prevent caries and periodontal disease in overdenture abutment teeth, daily application of chlorhexidine gel is recommended. In order to get insight into the use of the gel, 29 overdenture wearing patients were interviewed. In addition the patients were requested to show the use of the gel. It was concluded that at any time the patients were instructed about the use of the gel. Nevertheless, a majority of the patients did not use the gel daily and in accordance with the instructions given. Application of the gel in the abutment depressions of the overdenture appeared to be a heavy task.
Oral manifestations of patients with Marfan syndrome: a case-control study.
OBJECTIVE: The purpose of this study was to conduct a complete analysis of the oral abnormalities of patients with Marfan syndrome. STUDY DESIGN: Twenty three patients with Marfan syndrome and 69 healthy controls were studied. The subjects were screened for cariologic and periodontal alterations, as well as structural defects of enamel and dentin. Data analysis was performed by using the t test, the chi-square test, and regression models. RESULTS: Patients aged 0 to 17 years were significantly at risk for caries. Local hypoplastic enamel spots were more frequent in Marfan syndrome and could be related to caries history of the deciduous dentition. Root deformity, abnormal pulp shape, and pulpal inclusions were a frequent finding in patients with Marfan syndrome. Calculus and gingival indices were significantly higher in the study group as well. CONCLUSIONS: This study shows the importance of early diagnosis of oral anomalies and timely treatment of dental problems in Marfan syndrome. A series of therapeutic guidelines to be integrated in treatment strategies is proposed.
Effects of chlorhexidine on the bacterial colonization and degradation of dentin and completely demineralized dentin in situ.
The effects of 0.2% chlorhexidine on selected plaque microorganisms were studied in an intraoral dentin caries model. In 8 individuals wearing partial dentures, sound and completely demineralized dentin specimens were placed consecutively in 2 periods of 4 weeks, respectively. Throughout the experimental period, the specimens were treated 2 x daily with 0.2% chlorhexidine; control specimens were treated with water. Plaque accumulation on the specimens was left undisturbed. No protection against demineralization of the dentin or degradation of the dentin collagen by the chlorhexidine treatment was observed. The chlorhexidine treatment did not result in a reduction of the total cultivable flora when compared with the control specimens. A significant reduction of mutans streptococci and total streptococci recovered from completely demineralized dentin treated with chlorhexidine was observed, but the proportions of Actinomyces and lactobacilli were not affected significantly. It is speculated that areas of exposed roots, which are difficult to reach by oral hygiene measurements, such as approximal surfaces, will not be protected by a 0.2% chlorhexidine mouthrinse against the caries process.
Comparison of three intra-oral storage phosphor systems using subjective image quality.
OBJECTIVE: To compare the subjective image quality of three intra-oral storage phosphor systems. METHODS: DenOptix (Dentsply/Gendex, Chicago, IL, USA), Digora (Soredex, Helsinki, Finland), and CD-Dent (DigiDent Digital Imaging Technologies, Nesher, Israel) were compared. Two different imaging plates (IPs), BAS300 and HR300 (Fuji Photo Film Co., Tokyo, Japan) were used with the DenOptix system. The specimen was the maxilla and surrounding soft tissues of an adult cadaver. Imaging was at 70 kVp and 8 mA with a focus-detector distance of 38 cm using an optical bench. The exposure times were varied and a panel of five dentists independently evaluated the images produced with each system/IP receptor for seven features; proximal caries, gingival soft tissues, cortical bone, root canal space, root apices, periodontal ligament space and endodontic instrument clarity on a three-interval confidence scale. The best three exposures were chosen according to the highest scores for each system. These images were re-read in random order a total of 10 times. Pair-wise comparisons were made by use of odd's ratio analysis. A 95% confidence interval was applied. RESULTS: Images made with the DenOptix system/BAS IP combination were perceived to have the best overall image quality. The DenOptix/HR IP combination and Digora were rated almost equally in second place. The DigiDent system was ranked inferior. The Digora was considered to be the best for demonstrating gingival soft tissues (P < 0.05) and the DenOptix/HR300 combination the best for clarity of endodontic instruments (P < 0.05). CONCLUSIONS: While the DenOptix/BAS 300 combination was rated highest overall, the ranking of image quality by modality was found to be task-dependent. Digora was rated best for demonstrating gingival soft tissues.
A finite element analysis of ferrule design on restoration resistance and distribution of stress within a root.
AIM: To analyse the effect of ferrule height upon the mechanical resistance and stress distribution within a root to explain variations in the pattern of root fracture. METHODOLOGY: An extracted, intact, caries free, maxillary right central incisor was scanned by laser and then reconstructed on a computer to produce a model of the tooth and associated periodontal ligament. A simulated post/core/crown restoration was constructed on conventional tooth preparations with various ferrules. The crown was loaded with a simulated 500 N force and the simulated displacement of components and the tensile and compressive stress within the tooth structure were recorded. RESULTS: Without a ferrule preparation, the simulated crown tilted to the labial and rotated distally. With increasing ferrule height the displacement and rotation of the crown reduced in conventional and crown-lengthening models with maximum reduction occurring when the ferrule height reached 1.5 mm. In ferrule models, higher levels of tensile stress developed in internal (by a factor of 8) and mid-root palatal (by a factor of 90) dentine at the cervical margin of the preparation. With an increase in ferrule height, the area of tensile stress within the palatal mid-dentine expanded towards the cervical margin. Similar patterns and stress values were recorded for the crown-lengthening models. CONCLUSION: The study confirms that a ferrule increases the mechanical resistance of a post/core/crown restoration. However a ferrule creates a larger area of palatal dentine under tensile stress that may be a favourable condition for a crack to develop. Crown-lengthening did not alter the levels or pattern of stress within compared with conventional ferrule preparations.