Effect of preparation mode on Class II resin composite repair

Complete removal of failed posterior resin composite fillings is time-expensive and involves the risk of removing sound tooth substance. In any case of failure within the composite material, intra-oral repair would be favourable. This in vitro study was conducted to examine the effect of different preparation and bonding modes on integrity of repaired restorations. Forty-eight direct Class II resin composite restorations (Syntac Classic/Tetric Ceram) were placed in extracted human third molars. The specimens were stored for 365 days and then replaced partially by removing the central part of the proximal box with all margins located in composite. The partial repairs were placed with the same materials after pre-treatment with a silicon carbide bur and Syntac Classic (n = 8). Preparation modes have been (i) box-only parallel, (ii) box-only with undercuts, (iii) box with undercuts and additional occlusal retention. The repairs were performed either with (i) Tetric Ceram or with (ii) Tetric Flow as thin lining covered with Tetric Ceram. Before and after thermomechanical loading (100 000 cycles of 50 N and 2500 cycles between +5 and +55 degrees C in an artificial mouth), marginal quality between aged and freshly applied composite was evaluated by SEM at x200 magnification and microleakage was observed by light microscopy at x50 magnification. Box-only preparations exhibited a better fatigue resistance than preparations with additional occlusal retention. This observation was independent from the presence of undercuts (P < 0.05). An intermediary layer of flowable resin composite tended to result in better marginal quality, however, not being statistically significant.     

A laboratory study of glass ionomer cement as a retrograde root-filling material

This laboratory study investigated the use of various glass ionomer cements for retrograde root filling from the point of view of sealing qualities, ion release and ease of application. The sealing qualities of the material were tested by dye penetration and microscopic and SEM examination. Fluoride and silver ion release tests showed an initial loss of these two ions from the glass ionomer cement. A modified system for mixing and application was developed. Dye penetration did not differ from that of controls using vertically condensed gutta-percha. Glass ionomer cement is possibly a clinical alternative for the sealing of retrograde cavities; however, the silver-reinforced materials may cause tissue irritation from release of silver ions and their corrosion products.     

The cost of endodontic procedures in a French university hospital

Clinical costs have become an important consideration in dental schools, and have been the subject of several recent studies. In order to determine the actual costs of endodontic procedures, we have attempted to identify the various components of root canal therapy. The present study is based on findings in a university hospital functioning within the context of the French health care system. A questionnaire was used to survey the major factors entering into the achievement of the clinical procedure. The endodontic treatments were performed on 100 1st or 2nd molars, by undergraduate students. The survey involves fixed, variable, direct and indirect costs, and takes into consideration the reimbursements made by the French health care system. Findings indicate that all procedures show an appreciable deficit with a significant difference between initial treatment and retreatment. The analysis of the survey questionnaire findings enables us to offer some recommendations in the area of undergraduate education, as well.     

Prevalence and classification of HIV-associated oral lesions

OBJECTIVES: An International Workshop addressed the prevalence and classification of HIV/AIDS associated oral lesions.
DESIGN: Five questions provided the framework for discussion and literature review. What is the prevalence of oral lesions in children and adults? Should the accepted classification of HIV-related oral lesions be modified in the light of recent findings? Why is there a gender difference in the prevalence of oral lesions in developed and developing countries? Are there unusual lesions present in developing countries? Is there any association between modes of transmission and the prevalence of oral lesions?
RESULTS: Workshop discussion emphasized the urgent need for assistance in the development of expertise to obtain accurate global prevalence data for HIV-associated oral lesions. Oral candidiasis has been consistently reported as the most prevalent HIV-associated oral lesion in all ages. Penicilliosis marneffei, a newly described fungal infection, has emerged in South-east Asia. Oral hairy leukoplakia and Kaposi's sarcoma appear to be associated with male gender and male-to-male HIV transmission risk behaviours. These lesions occur only rarely in children.
CONCLUSIONS: Additional prevalence data are needed from developing countries prior to substantially altering the 1993 ECC/WHO Classification of oral lesions associated with adult HIV infection. The workshop confirmed current oral disease diagnostic criteria.     

Acute necrotizing ulcerative gingivitis in a case of systemic lupus erythematosus

Presented is an unusually severe case of acute necrotizing ulcerative gingivitis (ANUG) in association with systemic lupus erythematosus (SLE), in which the patient was observed to slough a considerable amount of attached gingival tissues and eventually to lose a number of teeth and supporting bone. The usual limited and treatable nature of ANUG is reviewed, and attention is directed to the mechanisms by which SLE and therapeutic amounts of steroids can contribute to the increased severity of the oral disease.     

Periodontal infection profiles in type 1 diabetes

OBJECTIVES: We investigated the levels of subgingival plaque bacteria and serum IgG responses in patients with type 1 diabetes and non-diabetic controls of comparable periodontal status. MATERIAL AND METHODS: Fifty type 1 diabetes patients (mean duration 20.3 years, range 6-41) were age-and gender-matched with 50 non-diabetic individuals with similar levels of periodontal disease. Full-mouth clinical periodontal status was recorded, and eight plaque samples/person were collected and analysed by checkerboard hybridization with respect to 12 species. Homologous serum IgG titres were assessed by checkerboard immunoblotting. In a sub-sample of pairs, serum cytokines and selected markers of cardiovascular risk were assessed using multiplex technology. RESULTS: Among the investigated species, only levels of Eubacterium nodatum were found to be higher in diabetic patients, while none of the IgG titres differed between the groups, both before and after adjustments for microbial load. Patients with diabetes had significantly higher serum levels of soluble E-selectin (p=0.04), vascular cell adhesion molecule-1 (VCAM-1; p=0.0008), adiponectin (p=0.01) and lower levels of plasminogen activator inhibitor-1 (PAI-1; p=0.02). CONCLUSIONS: After controlling for the severity of periodontal disease, patients with type 1 diabetes and non-diabetic controls showed comparable subgingival infection patterns and serum antibody responses.     

Evidence for the cardioprotective effects of omega-3 Fatty acids

OBJECTIVE: To review available literature regarding the cardiovascular effects of marine-derived Omega-3 fatty acids and evaluate the benefit of these fatty acids in the prevention of coronary heart disease. DATA SOURCES: Biomedical literature accessed through a MEDLINE search (1966-April 2002). Search terms included fish oil, omega-3 fatty acid, sudden death, hypertriglyceridemia, myocardial infarction, and mortality. DATA SYNTHESIS: Following an early 1970's observational investigation that Omega-3 fatty acids may reduce the occurrence of myocardial infarction-related deaths in Greenland Eskimos, additional trials have been conducted that support this finding. Epidemiologic and clinical trial data suggest that Omega-3 fatty acids may reduce the risk of cardiovascular-related death by 29-52%. In addition, the risk of sudden cardiac death was found to be reduced by 45-81%. Possible mechanisms for these beneficial effects include antiarrhythmic properties, improved endothelial function, antiinflammatory action, and reductions in serum triglyceride concentrations. Omega-3 Fatty acids are fairly well tolerated; potential adverse effects include bloating and gastrointestinal distress, "fishy taste" in the mouth, hyperglycemia, increased risk of bleeding, and a slight increase in low-density-lipoprotein cholesterol. CONCLUSIONS: Omega-3 Fatty acids may be beneficial and should be considered in patients with documented coronary heart disease. They may be particularly beneficial for patients with risk factors for sudden cardiac death.     

Cenesthopathy in adolescence: An appraisal of diagnostic overlaps along the anxiety–hypochondriasis–psychosis spectrum

Objective

To discuss the diagnostic validity of unusual bodily perceptions along the spectrum from age-specific, often transitory and normal, to pathological phenomena in adolescence to hypochondriasis and finally to psychosis.

Methods

Critical literature review of the cornerstone diagnostic groups along the spectrum embracing anxiety and cenesthopathy in adolescence, hypochondriasis, and cenesthopathy and psychosis, followed by a discussion of the diagnostic overlaps along this spectrum.

Results

The review highlights significant overlaps between the diagnostic cornerstones. It is apparent that adolescents with unusual bodily perceptions may conceptually qualify for more than one diagnostic group along the spectrum. To determine whether cenesthopathies in adolescence mirror emerging psychosis, a number of issues need to be considered, i.e. age and mode of onset, gender, level of functioning and drug use. The role of overvalued ideas at the border between hypochondriasis and psychosis must be considered.

Conclusion

As unusual bodily symptoms may in some instances meet formal psychosis risk criteria, a narrow understanding of these symptoms may lead to both inappropriate application of the new DSM-5 attenuated psychosis syndrome and of treatment selection. On the other hand, the possibility of a psychotic dimension of unusual bodily symptoms in adolescents must always be considered as most severe expression of the cenesthopathy spectrum.