Oral health and caries related microflora in children during the first three months following renal transplantation

There is little information on the oral health of children undergoing renal transplantation during the early transplant period. Methods. Twenty‐four children undergoing renal transplantation aged 4–13·2 years and their matched controls were recruited. The dmfs, dmft, DMFS and DMFT, plaque, gingivitis and gingival enlargement scores were recorded. The oral microflora was sampled and cultured for S. mutans, Lactobacllus species and Candida species. Results. There was a significantly lower mean dmfs (0·3 ± 0·9; P = 0·03), dmft (0·3 ± 0·9; P = 0·03), DMFS (2·3 ± 5·3; P = 0·01) and DMFT (1·5 ± 2·6; P = 0·02), respectively, in the transplant group. There was a significantly greater mean plaque score (14·7 ± 11) for the permanent dentition, at baseline only, compared with 90 days post‐transplantation (9·4 ± 10·4; P = 0·02). There was a significantly greater gingival enlargement score (1·8 ± 1·4; P = 0·04) 90 days post‐transplantation compared with baseline. The S. mutans and Lactobacillus counts were significantly lower both at baseline (P = 0·0001 and P = 0·004) and 90 days post‐transplantation (P = 0·02; and P = 0·05), respectively, compared with the controls. Conclusions. The transplant children had less active dental disease than the controls although gingival enlargement needs careful monitoring.     

The relationship between dental aesthetic index (DAI) and perceptions of aesthetics,function and speech amongst secondary school children in Ibadan,Nigeria

Objective. The purpose of the study was to investigate the relationship between a professionally derived index, the Dental Aesthetic Index, and some indications for orthodontic treatment as perceived by potential patients. Methods. An epidemiological survey of 614 secondary school students, 327 males (53·3%) and 287 females (46·7%) was carried out in Ibadan, Nigeria. Children aged 12–18 years (mean age, 14·9 ± 2·9 SD) were randomly selected, none of them had received previous orthodontic treatment. One examiner assessed the students using the Dental Aesthetic Index (DAI). Subjects were also asked to complete a questionnaire consisting of three questions concerning appearance, function, and speech, using a 5‐point Likert scale. Results. Weak but statistically significant correlations were found for subjective assessments of appearance of teeth and the DAI (r = 0·174; P < 0·01) and between biting/chewing and appearance of teeth (r = 0·095; P < 0·05). Statistically significant correlations were found between appearance of teeth and speech (r = 0·148; P < 0·01) and biting/chewing and speech. The last showed the strongest correlation (r = 0·268; P < 0·01). Conclusion. The study has shown weak but significant correlation between DAI and children's perceptions of the appearance of their teeth. We recommend further study involving both DAI and Index of Orthodontic Treatment Need (IOTN) for comparison in the Nigerian population.     

The efficacy of non‐narcotic analgesics on post‐operative endodontic pain: A systematic review and meta‐analysis

The objective of this review was to evaluate the efficacy of non‐narcotic analgesics including non‐steroidal anti‐inflammatory drugs (NSAIDs) and/or paracetamol in the treatment of post‐operative endodontic pain. Additionally, we aimed to examine the possible association of study covariates on the pain scores using meta‐regression analysis. An electronic search was performed in 2016. After data extraction and quality assessment of the included studies (n = 27, representing 2188 patients), meta‐analysis was performed using a random‐effect inverse variance method. Meta‐regression analysis was conducted to examine the associations between effect sizes and study‐level covariates (P < 0·05). The results showed that administration of non‐narcotic analgesic was more effective than placebo in the management of post‐operative pain, resulting in a lower pain scores with a standardised mean difference of ?0·50 (95% CI= ?0·70, ?0·30), ?0·76 (95%CI= ?0·95, ?0·56), ?1·15 (95% CI= ?1·52, ?0·78), ?0·65 (95% CI= ?1·05, ?0·26) for immediately after the procedure, 6?, 12? and 24 h post?operative follow‐ups (test for statistical heterogeneity: P = 0·000, P = 0·000, P = 0·000 and P = 0·001), respectively. Our meta‐regression analysis provided the evidence for association between some study covariates with treatment effect, each at different follow‐ups. We concluded that the clinicians can manage post‐operative endodontic pain by administration of NSAIDs and/or paracetamol. However, analgesic regimens should be considered as important determinants when prescribing a pharmacological adjuvant.     

Efficacy of low‐level laser therapy in the treatment of TMDs: a meta‐analysis of 14 randomised controlled trials

This study was designed to evaluate the efficacy of low‐level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMDs). We searched electronic databases and references lists of relevant articles, retrieved all of the published randomised controlled trials in regard to these issues and then performed a meta‐analysis. Fourteen highly qualified RCTs reporting on a total of 454 patients, which evaluated the effectiveness of LLLT for patients suffering from TMDs were retrieved. The results indicated that LLLT was not better than placebo in reducing chronic TMD pain (weighted mean difference = ?19·39; 95% confidence interval = ?40·80–2·03; P < 0·00001; I² = 99%). However, the LLLT provided significant better functional outcomes in terms of maximum active vertical opening (MAVO) (weighted mean difference = 4·18; 95% confidence interval = 0·73–7·63; P = 0·006; I² = 73%), maximum passive vertical opening (MPVO) (weighted mean difference = 6·73; 95% confidence interval = 01·34–12·13; P = 0·06; I² = 73%), protrusion excursion (PE) (weighted mean difference = 1·81; 95% confidence interval = 0·79–2·83; P = 0·59; I² = 0%) and right lateral excursion (RLE) (weighted mean difference = 2·86; 95% confidence interval = 1·27–4·45; P = 0·01; I² = 73%). The results of our meta‐analysis have provided the best evidence on the efficacy of LLLT in the treatment of TMDs. This study indicates that using LLLT has limited efficacy in reducing pain in patients with TMDs. However, LLLT can significantly improve the functional outcomes of patients with TMDs.     

Dental health of dentists' children in Mongolia

Summary. Objectives. To describe the dental health of dentists’ children, to evaluate its association with their dentist‐parents’ background and work‐related characteristics and to compare it with that of children in the general population in Mongolia. Design. Cross‐sectional survey, questionnaire‐based data. Subjects. Dentists’ children, aged 3–13 years. Sample. All dentists (n = 250) actively practising in the capital city of Mongolia. Results. The dentists’ children's dmft ranged from 0 to 12, and DMFT from 0 to 8; 50% were caries‐free. The younger the children, the higher was their total caries experience expressed as the sum of DMFT + dmft scores (r = ?0·22; P = 0·001). Dentist‐parents’ background and work‐related factors were not associated with their children's caries status (P > 0·05). When dentists’ children were compared with their counterparts at the population level, mean dmft for 6‐year‐olds was 2·6 for (urban) dentists’ children, 6·5 for children in the urban population and 0·9 for those in rural population of equivalent age. Mean DMFT for 12‐year‐olds were 1·0, 1·8 and 1·2, respectively, in the same three groups. In general, (urban) dentists’ children in all age groups had better dental health than did their urban counterparts at the population level. Among 5–7‐year‐olds, dentists’ children had worse dental health than did their counterparts in the rural population. Conclusions. Despite the dentists’ knowledge and awareness, their children demonstrated higher rates of dental caries than expected. This suggests that Mongolian dentists may have insufficient preventive orientation. In particular, the primary dentition of younger children seems to be poorly valued. In Mongolia, dentists should have better training and education in modern methods of caries prevention and their advantages. Appreciation and care of the primary dentition need to be improved at all levels of oral health promotion in Mongolia.     

Development of the Chinese version of the Oro‐facial Esthetic Scale

The aim of this study was to investigate the psychometric properties of the Oro‐facial Esthetic Scale among Chinese‐speaking patients. The original Oro‐facial Esthetic Scale was cross‐culturally adapted in accordance with the international standards to develop a Chinese version (OES‐C). Unlike the original Oro‐facial Esthetic Scale, the version employed in this study used a 5‐point Likert scale with items rated from unsatisfactory to most satisfactory. Psychometric evaluation included the reliability and validity of the OES‐C. The reliability of the OES‐C was determined through internal consistency and test–retest methods. The validity of OES‐C was analysed by content validity, discriminative validity, construct validity and convergent validity. The corrected item‐total correlation coefficients of the OES‐C ranged from 0·859 to 0·910. The inter‐item correlation coefficients between each two of the eight items of the OES‐C ranged from 0·766 to 0·922. The values of ICC ranged from 0·79 (95% CI = 0·54–0·98) to 0·93 (95% CI = 0·87–0·99), indicating an excellent agreement. Construct validity was proved by the presence of one‐factor structure that accounted for 83·507% of the variance and fitted well into the model. Convergent validity was confirmed by the association between OES‐C scores and self‐reported oral aesthetics and three questions from the Oral Health Impact Profile related to aesthetics (correlation coefficients ranged from ?0·830 to ?0·702, P < 0·001). OES‐C scores discriminated aesthetically impaired patients from healthy controls. This study provides preliminary evidence concerning the reliability and validity of the OES‐C. The results show that the OES‐C may be a useful tool for assessment of oro‐facial esthetics in China.     

The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: A systematic review and meta‐analysis of randomised controlled trials

Oral appliances (OAs) have demonstrated efficacy in treating obstructive sleep apnea (OSA), but many different OA devices are available. The Japanese Academy of Dental Sleep Medicine supported the use of OAs that advanced the mandible forward and limited mouth opening and suggested an evaluation of their effects in comparison with untreated or CPAP. A systematic search was undertaken in 16 April 2012. The outcome measures of interest were as follows: Apnea Hypopnea Index (AHI), lowest SpO₂, arousal index, Epworth Sleepiness Scale (ESS), the SF‐36 Health Survey. We performed this meta‐analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Five studies remained eligible after applying the exclusion criteria. Comparing OA and control appliance, OA significantly reduced the weighted mean difference (WMD) in both AHI and the arousal index (favouring OA, AHI: ?7·05 events h^?1; 95% CI, ?12·07 to ?2·03; P = 0·006, arousal index: ?6·95 events h^?1; 95% CI, ?11·75 to ?2·15; P = 0·005). OAs were significantly less effective at reducing the WMD in AHI and improving lowest SpO₂ and SF‐36 than CPAP, (favouring OA, AHI: 6·11 events h^?1; 95% CI, 3·24 to 8·98; P = 0·0001, lowest SpO₂: ?2·52%; 95% CI, ?4·81 to ?0·23; P = 0·03, SF‐36: ?1·80; 95% CI, ?3·17 to ?042; P = 0·01). Apnea Hypopnea Index and arousal index were significantly improved by OA relative to the untreated disease. Apnea Hypopnea Index, lowest SpO₂ and SF‐36 were significantly better with CPAP than with OA. The results of this study suggested that OAs improve OSA compared with untreated. CPAP appears to be more effective in improving OSA than OAs.     

Dental caries experience in children with congenital heart disease: a case-control study

Objectives. To compare the dental health of a group of children with complex congenital heart disease with that of age and gender matched healthy controls. Design. Case‐control study. Setting. Faculty of Medicine and Odontology/Pediatric cardiology and Pedodontics, Umeå University, Sweden. Sample and Methods. All the cases and their controls lived in the county of Västerbotten in northern Sweden. Each group comprised 41 children with a mean age of 6·5 years. Data were collected from medical and dental records while all bitewing radiographs were read separately by one of the authors. Results. Children with congenital heart disease had significantly more caries in their primary teeth than the control group. The mean dmfs‐value was 5·2 ± 7·0 in the cardiac group compared to 2·2 ± 3·5 in the control group (P < 0·05). Twenty‐six of the children had all four 6‐year‐molars, and their mean DMFS‐values were 0·9 ± 1·9 in the cardiac group compared to 0·3 ± 0·6 in the control group (P > 0·05). The children with congenital heart disease had received more caries prevention based on the use of fluorides than the control group. There was a significant correlation between the number of fluoride varnish treatments and the dmfs value of the child (r = 0·411, P < 0·01). Fifty‐two per cent of the children in the cardiac group had been prescribed fluoride tablets on one or more occasions compared to 17% in the control group (P < 0·01). Number of months on digoxin medication and the dmfs‐value had a significant correlation (r = 0·368, P < 0·05). Ten of the children had been on digoxin medication between 6 and 87 months; this subgroup had a mean dmfs‐value of 10·1 ± 8·5. Conclusion. Swedish children with complex congenital heart disease have poorer dental health than healthy age and gender matched controls in spite of intensive preventive efforts. In many cases, intervention had been given when caries were present. A closer cooperation between paediatric cardiology and paediatric dentistry is needed.     

DEEP Study: does EQ‐5D‐5L measure the impacts of persistent oro‐facial pain?

The EQ‐5D‐5L is a generic quality of life (QOL) measure widely used throughout the world, which has the advantage that it allows health‐state preferences to be elicited. The aim of this study was to examine whether: a) variation in the standardised reference period for EQ‐5D‐5L from ‘today’ to ‘the last month’ had a minimal clinically meaningful difference; (b) EQ‐5D‐5L had convergent validity with a multidimensional pain measure in quantifying the impacts of pain. As part of a larger study into the effectiveness and efficiency of care pathways for persistent orofacial pain (POFP) ( http://research.ncl.ac.uk/deepstudy ), participants with POFP (n = 100) completed two versions of the EQ‐5D‐5L at the same time with different reference periods (‘today’ vs. ‘last month’). Participants also completed the first section of the West Haven–Yale Multidimensional Pain Inventory (v3) to assess convergent validity. Two‐tailed nonparametric inferential statistics, intra‐class correlation coefficients (ICC), and within‐subject change scores were used to compare the two EQ‐5D‐5L versions. Convergent validity was assessed using Spearman's rho correlation coefficients. Health‐state valuations were significantly different (P < 0·01), and there was good similarity between the two versions' ICC 0·86 (95% CI 0·79–0·91). The within‐subject mean change was 0·03 (95% CI 0·01–0·06). For convergent validity, all relationships were significant (P < 0·05) and in the expected directions. EQ‐5D‐5L demonstrates sufficient convergent validity to be used with POFP, and a change in the standard reference period may be unnecessary if a multidimensional pain measure is also used.     

Increased phosphatidylcholine concentration in saliva reduces surface tension and improves airway patency in obstructive sleep apnoea

Surface tension may have important role for maintaining upper airway patency in patients with obstructive sleep apnoea. It has been demonstrated that elevated surface tension increases the pharyngeal pressures required to reopen the upper airway following collapse. The aim of the study was to evaluate the associations between the concentrations of endogenous surfactants in saliva with indices of upper airway patency in obstructive sleep apnoea. We studied 20 male patients with obstructive sleep apnoea (age: 60·3 ± 10·3 years; BMI: 25·9 ± 4·6 kg m^?2; AHI: 41·5 ± 18·6 events h^?1). We obtained 100‐μL samples of saliva prior to overnight polysomnographic sleep study. The surface tension was determined using the pull‐off force technique. The concentration of phosphatidylcholine (PC) was evaluated by liquid chromatography‐mass spectrometry (LC‐MS/MS). Regression analysis between apnoea, hypopnoea and apnoea/hypopnoea indices and the ratio of hypopnoea time/total disordered breathing time (HT/DBT) with surface tension and PC were performed. P < 0·05 was considered significant. The mean saliva surface tension was 48·8 ± 8·0 mN m^?1 and PC concentration was 15·7 ± 11·1 nM. The surface tension was negatively correlated with the PC concentration (r = ?0·48, P = 0·03). There was a significant positive correlation between surface tension with hypopnoea index (r = 0·50, P = 0·03) and HT/DBT (r = 0·6, P = 0·006), but not apnoea or apnoea/hypopnoea index (P > 0·11). Similarly, PC concentration negatively correlated with hypopnoea index (r = ?0·45, P = 0·04) and HT/DBT (r = ?0·6, P = 0·004), but not with apnoea index or AHI (P > 0·08). An increase in salivary PC concentration may increase upper airway patency in obstructive sleep apnoea through a reduction in surface tension.     

Transcutaneous neuromuscular electrical stimulation can improve swallowing function in patients with dysphagia caused by non‐stroke diseases: a meta‐analysis

There is still debate over whether the effect of transcutaneous neuromuscular electrical stimulation (NMES) in dysphagia rehabilitation is superior to traditional therapy (TT). The purpose of this meta‐analysis was to assess the overall efficacy by comparing the two treatment protocols. Published medical studies in the English language were obtained by comprehensive searches of the Medline, Cochrane and EMBASE databases from January 1966 to December 2011. Studies that compared the efficacy of treatment and clinical outcomes of NMES versus TT in dysphagia rehabilitation were assessed. Two reviewers independently performed data extraction. Data assessing swallowing function improvement were extracted as scores on the Swallowing Function Scale as the change from baseline (change scores). Seven studies were eligible for inclusion, including 291 patients, 175 of whom received NMES and 116 of whom received TT. Of the seven studies, there were two randomised controlled trials, one multicentre randomised controlled trial and four clinical controlled trials. The change scores on the Swallowing Function Scale of patients with dysphagia treated with NMES were significantly higher compared with patients treated with TT [standardised mean difference (SMD) = 0·77, 95% confidence interval (CI): 0·13 to 1·41, P = 0·02]. However, subgroup analysis according to aetiology showed that there were no differences between NMES and TT in dysphagia post‐stroke (SMD = 0·78, 95% CI: ?0·22 to 1·78, P = 0·13, 4 studies, 175 patients). No studies reported complications of NMES. NMES is more effective for treatment of adult dysphagia patients of variable aetiologies than TT. However, in patients with dysphagia post‐stroke, the effectiveness was comparable.     

Oral sensorial complaints,salivary flow rate and mucosal lesions in the institutionalized elderly

Summary The aims of this study were to determine the prevalence of oral sensorial complaints, salivary flow rate and oral mucosal lesions in the institutionalized and non‐institutionalized elderly. The study included 280 institutionalized and 61 non‐ institutionalized elderly people. Dry mouth, burning mouth sensations, taste disturbances, salivary flow rate and oral mucosal lesions were assessed and compared between groups. A greater number of the institutionalized elderly had dry mouth (P = 0·001) and taste disturbance (P = 0·035) compared to non‐institutionalized elderly. The institutionalized elderly also had significantly lower salivary flow rate (P < 0·0001). Positive correlation was found between salivary flow rate and perception of dry mouth in the institutionalized elderly (r_s = 0·26; P < 0·05), as well as in the non‐institutionalized elderly (r_s = 0·35; P < 0·05). Moreover, positive correlation was observed between salivary flow rate and the sensation of burning mouth in the institutionalized elderly (r_s = 0·13; P < 0·05) and non‐institutionalized elderly (r_s = 0·31; P < 0·05). The number of institutionalized elderly people with oral mucosal diseases was higher compared with non‐institutionalized ones (P = 0·01). The most common oral mucosal lesions in both groups were related to wearing dentures. It can be concluded that the institutionalized elderly are significantly affected with oral sensorial complaints, including dry mouth and taste disturbance, as well as decreased salivary flow rate and oral mucosal diseases compared with the non‐institutionalized elderly.     

Dental fluorosis and caries experience in relation to three different drinking water fluoride levels in South Africa

Objectives. The purpose of this study was to determine the relationship between caries experience, degree of fluorosis and different concentrations of fluoride in the drinking water of children. Sample and methods. The study included 282 children aged 10–15 years, who lived continuously since birth in three different naturally fluoridated areas (Leeu Gamka, 3·0; Kuboes 0·48 and Sanddrif 0·19 p.p.m. F), with virtually no dental care or any fluoride therapy. The teeth of the children were examined for caries using the DMFT index according to the WHO criteria and for fluorosis, using Dean’s criteria according to the WHO guidelines. Results. The prevalence of fluorosis (scores 2, 3, 4 and 5) among the school children was 47% in Sanddrif, 50% in Kuboes and 95% in Leeu Gamka. Almost half the children in the two low fluoride areas had no fluorosis (scores 0 and 1), whereas only 5% in Leeu Gamka had no fluorosis. Of the children in Sanddrif, 42·5% had very mild/mild (scores 2 and 3) fluorosis, 44·3% in Kuboes and 34·1% in Leeu Gamka. Except for one individual in Kuboes, severe fluorosis (score 5) was only observed in the high fluoride area in 30% of the children. According to the Bonferroni adaptation for multiple comparisons, the degree of fluorosis in Leeu Gamka differed significantly from both those of Sanddrif and Kuboes. The mean DMFT for the children in Sanddrif and Kuboes was similar (1·64 ± 0·30 and 1·54 ± 0·24, respectively) but the caries experience of Leeu Gamka (1·98 ± 0·22) was significantly higher (P < 0·05) than that of both the other two areas. A strong positive correlation (P < 0·05) was found between the caries experience and the fluorosis scores of children in the high fluoride area (Leeu Gamka) but no correlation could be found in the other two areas. Significantly (P < 0·01) more children had decayed teeth in the high F area (Leeu Gamka) than in the other two areas. Conclusion. The results suggest a positive association between high F levels in the drinking water and dental caries. Furthermore, a low caries experience and no difference in DMFT and fluorosis between the two low fluoride areas were found.     

Turned versus anodised dental implants: a meta‐analysis

The aim of this meta‐analysis was to test the null hypothesis of no difference in the implant failure rates, marginal bone loss (MBL)and post‐operative infection for patients being rehabilitated by turned versus anodised‐surface implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in November 2015. Eligibility criteria included clinical human studies, either randomised or not. Thirty‐eight publications were included. The results suggest a risk ratio of 2·82 (95% CI 1·95–4·06, P < 0·00001) for failure of turned implants, when compared to anodised‐surface implants. Sensitivity analyses showed similar results when only the studies inserting implants in maxillae or mandibles were pooled. There were no statistically significant effects of turned implants on the MBL (mean difference‐MD 0·02, 95%CI ?0·16–0·20; P = 0·82) in comparison to anodised implants. The results of a meta‐regression considering the follow‐up period as a covariate suggested an increase of the MD with the increase in the follow‐up time (MD increase 0·012 mm year^?1), however, without a statistical significance (P = 0·813). Due to lack of satisfactory information, meta‐analysis for the outcome ‘post‐operative infection’ was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.     

The influence of partial implant‐supported restorations on chewing side preference

Summary This study aimed at determining whether the individual’s chewing side preference is affected by local effects, produced by the presence of implant‐supported restorations. The test group included 81 patients with partial implant‐supported prosthesis. The control group included 108 subjects with no implants. All subjects went through a series of laterality tests for chewing and tasks (hand, foot, eye and ear) side preference. The preferred chewing side (PCS) was determined by observing the first stroke of the chewing cycle during chewing a gum. A positive and significant correlation between the chewing side preference and the subject’s sidedness during the different tasks was examined, by performing four Phi correlation tests for: chewing and handedness(r = 0·54; P < 0·001); chewing and footedness (r = 0·49; P < 0·001); chewing and eyedness (r = 0·65; P < 0·001) and chewing and earedness (r = 0·66, P < 0·001). Of the subjects, 78·3% preferred the right side for chewing, 19·1% preferred the left and 2·1% had no clear side preference. There was no statistical difference in chewing side preference distribution between genders. The distribution of chewing side preference was not significantly affected by the location of missing teeth or implants. In conclusion, implant placement will not affect PCS. Therefore, information on chewing side preference should be part of the routine preoperative examination for implant‐supported restorations to provide a better treatment plan in those cases that the implant‐supported restoration will be on the PCS.     

Piroxicam and laser phototherapy in the treatment of TMJ arthralgia: a double‐blind randomised controlled trial

This study aimed to evaluate the efficacy of piroxicam associated with low‐level laser therapy compared with single therapies in 32 patients presenting temporomandibular joint arthralgia in a random and double‐blind research design. The sample, divided into laser + piroxicam, laser + placebo piroxicam and placebo laser + piroxicam groups, was submitted to the treatment with infrared laser (830 nm, 100 mW, 28 s, 100 J cm^?2) at 10 temporomandibular joint and muscle points on each side during four sessions concomitant to take one capsule a day of piroxicam 20 mg during 10 days. The treatment was evaluated throughout four sessions and 30 days follow‐up through visual analogue scale (VAS), maximum mouth opening and joint and muscle (temporal and masseter) pain on palpation. The results showed that all the study groups had a significant improvement in the VAS scores (P < 0·05), and there were no significant group differences. Piroxicam was effective in the reduction of joint and muscle pain on palpation (P < 0·05) and showed the lowest temporal pain (P = 0·02) at the 30‐day follow‐up. The combination of low‐level laser therapy and piroxicam was not more effective than single therapies in the treatment of temporomandibular joint arthralgia. The use of piroxicam was more effective in the following 30 days.     

Long‐term tooth loss in periodontally compromised but treated patients according to the type of prosthodontic treatment. A retrospective study

If prosthodontic treatment is considered after periodontal therapy, the questions arise i) does prosthodontic treatment affect the treatment outcome of the dentition in general and ii) which type of prosthesis is related to best treatment outcome of abutment teeth? Our goal was to compare long‐term tooth loss after comprehensive periodontal therapy in patients with or without prosthodontic treatment. Ninety patients' charts with a total of 1937 teeth who had received comprehensive periodontal treatment 5–17 years ago by the same periodontist were retrospectively evaluated. Sixty‐five patients received fixed dental prostheses (FDP; n = 29) and/or removable partial dentures anchored with clips (RPDC; n = 25) or double crowns (RPDD; n = 25). Twenty‐five patients were also periodontally compromised but treated without prosthodontic treatment and served as a control group. A total of 317 teeth and 70 abutment teeth were lost during 9·7 ± 4·1 years of observation. Thereof, 273 teeth and 48 abutment teeth were lost due to periodontal reasons. Mean tooth loss amounted to 1·2 ± 1·5 (controls) and 4·4 ± 3·4 (partial dentures). Abutment tooth loss was 0·4 ± 1·1 (FDP), 1·0 ± 1·2 (RPDC) and 1·3 ± 1·0 (RPDD). Poisson regressions identified prosthodontic treatment, age, socio‐economic status, diabetes mellitus, mean initial bone loss and aggressive periodontitis as factors significantly contributing to tooth loss. Age, diabetes and non‐compliance contributed to abutment tooth loss. Not considering biomechanical factors, patients with prosthodontic reconstructions under long‐term supportive periodontal therapy were at higher risk for further tooth loss than patients without prostheses. Not only the type of partial denture but also the patient‐related risk factors were associated with abutment tooth loss.     

Recognition of patient‐reported impairment in oral aesthetics

The objectives of this study were to investigate the degree of effective recognition by professionals of patient‐estimated oral aesthetic impairment and the most reliable aspects in such recognition. Participants consisted of 95 patients with partial dentition in need of prosthodontic replacements. The oral aesthetics was professionally evaluated using the Prosthetic Esthetic Index (PEI), compiling 13 aesthetic aspects and an overall evaluation. The patient‐reported impairment was evaluated using the Oral Health Impact Profile Aesthetic (OHIP‐Aes) and the Oral Esthetic Scale (OES). Background variables were as follows: gender, age, work situation, education level, marital status, number and location of teeth, wearing a removable dental prosthesis (RDP) and smile line. A significant correlation was found between the overall professional evaluation and the OHIP‐Aes score (R = 0·43, P < 0·05), the OES score (R = 0·46, P < 0·05) and the overall patient evaluation (0·35, P < 0·05). Correlations of the 13 specific aspects of the PEI with the patient‐reported evaluations were generally small to moderate: the aspect ‘discoloration of the teeth’ showed the highest correlation. The multivariate analyses showed that up to 57% of the patient‐reported impairment could be explained by the professionally evaluated oral aesthetic in combination with background variables. Discoloration of the teeth was the greatest explanatory variable, but also dental arch symmetry, and position and colour of the teeth were significant aspects. A high percentage of the patient‐reported aesthetic impairment can be recognised by the professionals. The most reliable aspect is discoloration of the teeth, but also dental arch symmetry, and the position and colour of the teeth are important for recognising the aesthetic impairment.     

Evaluating the masticatory function after mandibulectomy with colour‐changing chewing gum

The aim of this study was to clarify the usefulness of colour‐changing gum in evaluating masticatory performance after mandibulectomy. Thirty‐nine patients who underwent mandibulectomy between 1982 and 2010 at Kobe University Hospital were recruited in this study. There were 21 male and 18 female subjects with a mean age of 64·7 years (range: 12–89 years) at the time of surgery. The participants included six patients who underwent marginal mandibulectomy, 21 patients who underwent segmental mandibulectomy and 12 patients who underwent hemimandibulectomy. The masticatory function was evaluated using colour‐changing chewing gum, gummy jelly and a modified Sato's questionnaire. In all cases, the data were obtained more than 3 months after completing the patient's final prosthesis. The colour‐changing gum scores correlated with both the gummy jelly scores (r = 0·634, P < 0·001) and the total scores of the modified Sato's questionnaire (r = 0·537, P < 0·001). In conclusion, colour‐changing gum is a useful item for evaluating masticatory performance after mandibulectomy.     

Evaluation of masticatory function after maxillectomy using a colour‐changing chewing gum

The purpose of this study was to identify the risk factors associated with the masticatory dysfunction after maxillectomy using a colour‐changing chewing gum. Thirty‐nine patients who underwent maxillectomy between January 2002 and May 2010 in the Department of Kobe University Hospital were recruited for this study. There were 20 male and 19 female subjects, with a median age of 73·3 years (range of 44–90) at the time of surgery. The intra‐oral conditions after maxillectomy were classified by HS classification, and the masticatory function was evaluated by a colour‐changing chewing gum and the results of a modified Sato's questionnaire. The scores of the colour‐changing gum were closely correlated with the scores of the modified Sato's questionnaire (r = 0·661, P < 0·01). A logistic regression analysis with the outcome variable of the gum test <4 demonstrated that significant predictors for the masticatory dysfunction were the number of anchor teeth ≤2 and a soft palate defect. A colour‐changing gum was found to be useful for evaluating the post‐operative masticatory function, and it was important to conserve the anchor teeth and the soft palate to avoid masticatory dysfunction.