Variation in periodontal referral in 2 regions in theUK

This study investigated the periodontal referral patterns of general dental practitioners (GDPs) in Northern Ireland (NI) and North West England (NWE). A questionnaire dealing with periodontal referral was sent to all 520 GDPs registered in NI and to 274 GDPs in NWE. A usable return was made by 355 (68%) in NI and 189 (70%) in NWE. The NI dentists made significantly more periodontal referrals (median 5, range 0-80) in the year preceding the survey than those in NWE (median 2, range 0-50), p<0.001. Distance was the only factor significantly related to the referral rate in both regions with those who practised more than 25 miles from a specialist referring significantly fewer patients in both regions. In NI, there was a trend towards increased periodontal referral by GDPs who had attended more postgraduate courses; however, in NWE, this was not the case. The GDPs in NWE were significantly less likely than those in NI to refer patients with medical conditions. It is concluded that there is considerable variation in periodontal referral both within and between the 2 regions studied. It is further concluded that in many cases, non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in these regions (NI and NWE) in relation to periodontal referral. Much of the variance in referral in North West England, as in Northern Ireland, remains unexplained.     

Trends in endodontic claims in Italy

According to the scant data available in the literature, endodontic claims are common among dental professional liability cases and the second most common type of claim. This study aimed to describe the characteristics of endodontic claims in Italy and the most frequently disputed errors, and the discussion below includes consideration of ethical and medico‐legal aspects thereof. We retrospectively analysed 120 technical reports written on cases of professional malpractice in endodontics in the last 5 years. The complainant patients were males in 22.5% of the cases, while females made up the remaining 77.5%. In the dentist sample, male operators were more often involved in litigation cases (80%) than female operators. The most frequently claimed technical errors were: lack of a complete filling of root canal/s (71.7%), the perforation of tooth structure (12.7%), extrusion of sealing materials beyond the apex of the tooth (9.6%) and the fracture of an endodontic instrument (5.9%). In 1.7% of cases it was found that the expert did not make any errors performing the endodontic therapy. In only very few cases (2.7%) no therapy was considered necessary, while the most common therapeutic solution involved in endodontic misconduct was tooth extraction (53.0%). In many cases the dentist preferred to extract the endodontically undertreated tooth and substitute it prosthetically rather than trying to re‐treat it. The discrepancy between the total number of cases examined and those that eventually go to court leads us to believe that the majority of endodontic malpractice cases are resolved in out‐of‐court settlements.     

Human Herpesviridae in acute necrotizing ulcerative gingivitis in children in Nigeria

Herpesviruses have been implicated in the pathogenesis of human periodontitis. The present study investigated whether herpeasviruses are present in the lesions of acute necrotizing ulcerative gingivitis. Sixty-two Nigerian children, aged 3–14 years, were studied. Twenty-two children had acute necrotizing ulcerative gingivitis and were also malnourished, 20 exhibited no acute necrotizing ulcerative gingivitis but were malnourished, and 20 were free of acute necrotizing ulcerative gingivitis and in a good nutritional state. Polymerase chain reaction methods were used to determine the presence of human cytomegalovirus (HCMV), Epstein-Barr virus type 1 and type 2 (EBV-1, EBV-2), herpes simplex virus (HSV), human herpes virus 6 (HHV-6), human papilloma virus and human immunodeficiency virus type 1 in crevicular fluid specimens collected by paper points. Of the 22 acute necrotizing ulcerative gingivitis patients, 15 (68%) revealed viral infection and 8 (36%) viral coinfection. Thirteen (59%) acute necrotizing ulcerative gingivitis patients demonstrated HCMV, 6 (27%) EBV-1, 5 (23%) HSV and 1 (5%) HHV-6. Only 2 (10%) subjects from each group not affected by acute necrotizing ulcerative gingivitis showed viral presence, and no control subject revealed viral coinfection. These findings suggest that HCMV and possibly other herpesviruses contribute to the onset and/or progression of acute necrotizing ulcerative gingivitis in malnourished Nigerian children.     

Changes in caries prevalence in Japan

In Japan, the mean DMFT at 12 years of age increased from 2.8 in 1957 to 5.9 in 1975. From the 1981 survey (DMFT=5.43), conversely, the mean DMFT decreased and reached 3.64 in 1993. The increase in caries prevalence can, without doubt, be explained by an increment of sugar consumption, since the intake of sugar increased after World War II and exceeded 18.25 kg/year (50 g/day) in 1965 and reached a maximum value (29.3 kg/year) in 1973 in Japan. On the other hand, the reason why the DMFT has decreased since 1981 is not clear. In many industrialized countries, a caries reduction has been achieved with acceptable fluoride exposure, although sugar consumption was still at a high level. However, fluoride usage was still limited during the last 2 decades in Japan. There is no community where fluoridated drinking water has been supplied since 1972. Fluoride tablet use was also discontinued for children in the 1970s. Fluoride mouthrinsing programs were available for only 19r of school children in 1992. Moreover, the market share of fluoridated dentifrices stayed at 10% until 1986 and became 30% only in 1988. An excellent correlation (r=0.91; P 0.01) is observed between the DMFT in 12-year-olds and per capita sugar consumption per year between 1957 and 1987 in Japan.     

Trends in socioeconomic disparities in oral health in Brazil and Sweden

Celeste RK, Nadanovsky P, Fritzell J. Trends in socioeconomic disparities in oral health in Brazil and Sweden. Community Dent Oral Epidemiol 2011; 39: 204–212. © 2010 John Wiley & Sons A/S Abstract – Objectives: To describe the dynamics of trends in socioeconomic disparities in oral health in Brazil and Sweden among adults, to assess whether trends follow expected patterns according to the inverse equity hypothesis. Methods: In Sweden, we obtained nationally representative data for the years 1968, 1974, 1981, 1991 and 2000, and in Brazil, for 16 state capitals in 1986 and in 2002. Trends in the prevalence of ‘edentulism’ and of ‘teeth in good conditions’ were described in two groups aged 35–44 with lower and higher economic standards, respectively. Results: There was an annual decline in disparities in ‘edentulism’ of 0.4 percentage points (pp) (95% CI = 0.2–0.7) in Brazil and 0.7pp (95% CI = 0.5–0.9) in Sweden, as a result of improvements in both income groups. Concerning ‘teeth in good conditions’, in Brazil, there was improvement only in the higher income group and absolute disparities have increased (0.5pp annually), while in Sweden, there was a nonsignificant decrease (0.3pp annually) with improvements in both groups. Since 1991 in Sweden and in 2002 in Brazil, our measures of socioeconomic disparities in ‘edentulism’ were not statistically significant. Trends did not differ by sex or dental visit. Conclusions: Despite improvements in both income groups and a decrease in disparities in ‘edentulism’, the poorer group in Brazil has seen no improvement in ‘teeth in good conditions’ and disparities have increased. It appears that Brazil and Sweden reflect different stages of trend for ‘teeth in good conditions’ and the same stages for ‘edentulism’, represented by the inverse equity hypothesis.     

Fluorosis in relation to fluoride levels in water in central Nigeria

Abstract– Objectives : This study was conducted to examine the prevalence of dental fluorosis in relation to fluoride levels in water among children aged 12–15 years in the states of Plateau and Bauchi, Nigeria. Methods : Children ( N =203) were examined using WHO criteria. The children were from two schools and permanent residents of the communities in which the schools are located (Tilden Fulani and Kanadap). Intra-examiner reliability for determining fluorosis scores was 80%. Results : Fluoride levels in the water ranged from 0.0–0.4 mg/L. Prevalence of dental fluorosis in the sample was 51%. Forty-one percent had very mild fluorosis, 7% had mild fluorosis and 3% had moderate to severe fluorosis. The lowest DMFT was observed in the school where the fluoride level of the water ranged between 0.0 and 0.4 mg/L, and in the group with very mild fluorosis. Conclusion : Fluoride levels in water for central Nigeria were appropriate for oral health. In the areas where the children were permanent residents, factors other than the fluoride levels of the water contributed to the severity of dental fluorosis.     

Advances in local anesthesia in dentistry

Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia.     

Localization of SOST/sclerostin in cementocytes in vivo and in mineralizing periodontal ligament cells in vitro

Jäger A, Götz W, Lossdörfer S, Rath‐Deschner B. Localization of SOST/sclerostin in cementocytes in vivo and in mineralizing periodontal ligament cells in vitro. J Periodont Res 2009; doi: 10.1111/j.1600‐0765.2009.01227.x. © 2009 John Wiley & Sons A/S Background and Objective: Cementum and bone are rather similar hard tissues, and osteocytes and cementocytes, together with their canalicular network, share many morphological and cell biological characteristics. However, there is no clear evidence that cementocytes have a function in tissue homeostasis of cementum comparable to that of osteocytes in bone. Recent studies have established an important role for the secreted glycoprotein sclerostin, the product of the SOST gene, as an osteocyte‐derived signal to control bone remodelling. In this study, we investigated the expression of sclerostin in cementocytes in vivo as well as the expression of SOST and sclerostin in periodontal ligament cell cultures following induction of mineralization. Material and Method: Immunolocalization of sclerostin was performed in decalcified histological sections of mouse and human teeth and alveolar bone. Additionally, periodontal ligament cells from human donors were cultured in osteogenic conditions, namely in the presence of dexamethasone, ascorbic acid and β‐glycerophosphate, for up to 3 wk. The induction of calcified nodules was visualized by von Kossa stain. SOST mRNA was detected by real‐time PCR, and the presence of sclerostin was verified using immunohistochemistry and western blots. Results: Expression of sclerostin was demonstrated in osteocytes of mouse and human alveolar bone. Distinct immunolocalization in the cementocytes was shown. In periodontal ligament cultures, following mineralization treatment, increasing levels of SOST mRNA as well as of sclerostin protein could be verified. Conclusion: The identification of SOST/sclerostin in cementocytes and mineralizing periodontal ligament cells adds to our understanding of the biology of the periodontium, but the functional meaning of these findings can only be unravelled after additional in vitro and in vivo studies.     

基于颌骨和股骨差异的动物实验中种植体骨结合影响因素

颌骨和股骨是基础研究中常用的构建骨缺损或植入种植体的部位。越来越多的研究指出,颌骨和股骨二者在胚胎发育及生长、组织形态学结构以及骨代谢等方面存在较大差异。文献复习结果表明与股骨相比,颌骨的骨膜内成骨方式可能具有更优的成骨能力,同时其内的干细胞增殖能力更强,成骨分化能力更好;但颌骨组织结构的规律性欠佳,成骨细胞成骨矿化能力稍弱,免疫细胞对细胞因子更敏感,这些可能是导致动物实验中颌骨与股骨种植体骨结合存在差异的原因,但其具体机制尚未阐明。     

Patient Recall in Advanced Education in Prosthodontics Programs in the United States

Purpose: This study surveyed program directors of Advanced Education Programs in Prosthodontics (AEPP) in the United States to determine the extent, type, incidence, and perceived effectiveness of implemented recall systems. Material and Methods: Surveys were sent to AEPP directors across the United States to assess their program's recall protocol. This survey first identified whether an active recall program existed. For programs with recall systems, rigor in promoting ongoing oral health was surveyed by focusing on recall frequency, patient tracking protocol, involved personnel, interaction with other university departments, provided clinical procedures, and therapy completion protocol. Whether the directors perceived that their recall system was successful was also investigated. Results: Thirty‐three of 46 programs responded, giving a response rate of 72%. Of these 33 programs, only 21 (64%) had an active recall system, although 30 (91%) believed recall to be important. Twelve (57%) directors with recall programs considered their system to be effective. Conclusions: Prosthodontic program directors felt their program's recall effectiveness could be improved. Due to the numerous potential benefits of an active recall system, AEPPs should consider implementing or enhancing their recall programs. Further studies are indicated to determine specific criteria that describe an effective recall system for prosthodontic programs within the context of patient health promotion, program curriculum, and financial ramifications.     

Changes in tooth position in humans in relation to arterial blood pressure

The three-dimensional physiological tooth movement synchronized with the heartbeat is called periodontal pulsation. This study utilized a computer-assisted amorphous sensor to evaluate the relation between tooth position and arterial blood pressure, and also between the amplitude of periodontal pulsation and arterial blood pressure. The measuring device consisted of a small magnet attached to the tooth and an amorphous sensor that was used to detect displacement of the tooth without actually contacting it. The sample consisted of the upper left central incisors of six healthy Japanese volunteers. The three measuring points for each tooth were on the labial surface. The cold-pressor test was used as an autonomic nerve stimulus that induces an increase in blood pressure and heart rate. Periodontal pulsation, electrocardiogram, blood pressure and heart rate were recorded simultaneously during a 1 min pre-test relaxation, a 2 min cold-pressor test and a 1 min recovery. The results showed significant correlations between tooth position and mean blood pressure in five of the six volunteers and between tooth position and pulse pressure in four. Moreover, it was confirmed that tooth position shifted in the labial direction in conjunction with an increase of the mean blood pressure induced by cold stimulation. Significant correlations were found between the amplitude of periodontal pulsation and pulse pressure in four of the volunteers. These findings suggest that in humans tooth position might be affected by the force of blood pressure transmitted through periodontal vessels and that the amplitude of periodontal pulsation tends to reflect changes of pulse pressure rather than changes in mean blood pressure.     

Variation in torus palatinus prevalence in Norway

The variation in lorus palatinus (TP) prevalence was investigated among a total of 2010 denial patients over 10 yr of age native to two different regions in Norway, the Lofoten Islands in northern Norway and the Gudbrandsdalen valley, an inland area in the southeastern part of the country. The two groups were presumed to belong to the same Caucasian stock, but were extremes with regard to the fish-to-meat ratio of the diet, which was 3:1 in Lofoten and 1:3 in Gudbrandsdalen, respectively representing a soft type of diet, and a tough type requiring greater muscular forces during mastication. The study revealed: 1) the prevalence of TP was higher among women than men; 2) TP seemed likely to arise from a multifactorial liability, with part of the genetic factors residing on the X chromosome; 3) the prevalence of TP appeared to be higher among natives of Lofoten, who consume the softer food, than among natives of Gudbrandsdalen, the higher prevalence being hypothesized to have some connection with nutrient substances present in saltwater fish, possibly Ω3 polyunsaturaled fatty acids and vitamin D; and 4) TP seemed to be a dynamic phenomenon capable of growth and subject to resorption remodeling.     

Dental findings in high-fluoride areas in Ethiopia

A survey comprising 478 children aged 6-7 years and 13-14 years was conducted in high-fluoride areas (Wonji, 12.4 parts/10(6) F- and Awassa, 3.5 parts/10 F-) in the Rift Valley in Ethiopia. Dental fluorosis was found in 99% of the 6-7-year-old groups. Very mild to moderate fluorosis dominated in the primary teeth and moderate to severe fluorosis in the permanent teeth. All 13-14-year-old children born in Awassa of Wonji had fluorosis, mainly in the moderate to severe form. Eighty-four percent of the 13-14-year-old children not born in the area had fluorosis, mainly in the very mild form. The most severe fluorosis was seen in the last erupting teeth, but moderate fluorosis was also seen in primary incisors, indicating placental transfer of fluorides. Teeth with moderate and severe fluorosis more frequently had dental caries than teeth with no or very mild and mild fluorosis. The average DMFT was 2.46 +/- 2.34 in Wonji and 1.69 +/- 1.88 in Awassa. The average dft was 0.32 +/- 0.80 in Wonji and 0.40 +/- 0.96 in Awassa. Gingivitis was seen in 97% of the children and the average OHI-S was 1.94 +/- 0.71.     

Trends in postgraduated education in general dentistry

The explosion of knowledge coupled with a more diversified society have led to a new set of demands on dentists. For more than 20 years, dental educators and the profession have been concerned about the pressure on the university to ensure that every new graduate is full competent to enter a dental practice independently and successfully. This paper reviews some of the innovations which are being employed to attempt to deal with these concerns. There is no one formula that can answer these concerns. Postgraduate training in general dentistry is becoming more widespread and may need further investigation. The main focus of this paper is on trends in formal advanced postgraduate training in general dentistry.     

Fluoride in still bottled water in Australia

Background: This study measured the fluoride content in a range of still bottled waters available in Australia. Increasing decay rates in children have prompted speculation that bottled water consumption may be impacting on dental caries rates. International studies have demonstrated that the fluoride levels in bottled water are often negligible, however there is little information about the fluoride content of still bottled water in Australia. Methods: One hundred different brands (300 samples) of still bottled water were obtained in Australia and tested using ion chromatography and an ion‐selective electrode method. Results: The tested fluoride levels ranged from <0.1 to 1.6 mg/L. Nine per cent of the samples reported fluoride levels within the range recommended for reticulated water in Australia, providing a dental health benefit. One per cent of samples recorded fluoride values greater than this range, from 1.2 to 1.6 mg/L. The majority of samples (91%) recorded fluoride levels below 0.6 mg/L. Conclusions: Better information about the fluoride levels in bottled water is of value, particularly for communities lacking access to a fluoridated drinking water supply.