Review article. Are bruxism and the bite causally related?

There is an increasing 'acceptance of a multicausal, non-occlusion-oriented aetiology of bruxism.'     

Are graduates as good as they used to be?

A theme runs through discussions on dental undergraduate education, that 'they are not as good as they used to be'. Based largely on anecdotal evidence, we question whether this is true. Dentistry is changing. Today's graduates are different, but not worse. Graduates must qualify with basic competencies--agreed between all those responsible for their education. We maintain that vocational trainers are teachers, just as we are, and as such they have similar responsibilities. Close liaison between training practices and dental schools is essential.     

Are standards and evidence sufficient?

The origins of standards and guidelines in medicine are traced from work in the 1970s showing that treatment variations could not be accounted for by objective differences in the disease or other conditions of patients. Guidelines based on evidence can be effective in reducing such variation and in reducing costs. However, population disparities in disease and access, as well as dramatically rising insurance costs, pose challenges. Standards based entirely on efficacy of procedures will leave unanswered important questions about diagnosis and effective allocation of resources throughout population groups.     

Caries-detector dyes--how accurate and useful are they?

Commercially available caries-detector dyes are purported to aid the dentist in differentiation of infected dentin, yet research has established that these dyes are not specific for infected dentin. They are non-specific protein dyes that stain the organic matrix of less mineralized dentin, including normal circumpulpal dentin and sound dentin in the area of the amelo-dentinal junction. A considerable body of evidence indicates that conventional tactile and optical criteria provide satisfactory assessment of caries status during cavity preparation. There is reason for concern that subsequent use of a caries-detector dye would result in unnecessary removal of sound tooth structure. The use of caries-detector dyes has also been suggested as a diagnostic aid for occlusal caries. Although diagnosis of carious dentin beneath apparently sound enamel can be challenging, there is a lack of substantive evidence supporting the use of dyes for this purpose and false positives are a significant concern. Careful visual inspection combined with bitewing radiographic diagnosis has been shown to be the most reliable diagnostic method for the presence of infected dentin requiring operative treatment.     

Managed clinical networks: what are they and how do they work?

Managed clinical networks (MCNs) play an increasingly important part in the delivery of effective healthcare. This paper describes what they are and how they work, based on the experience of MCNs in Scotland and, in particular, CleftSiS, the National Managed Clinical Network for Cleft Lip and Palate Services in Scotland. CLINICAL RELEVANCE: The basic principles of MCNs described in this paper will assist clinicians in all specialties, with the development of MCNs that modernize and integrate the delivery of effective healthcare.     

Cytotoxic effects of resin-modified orthodontic band adhesives: Are they safe?

Objective:To evaluate the cytotoxic effects of three different resin-modified orthodontic band adhesives.Materials and Methods:Three resin-modified orthodontic band adhesives (Bisco Ortho Band Paste LC™, Multi-Cure Glass Ionomer Band Cement™, and Transbond Plus Light Cure Band Adhesive™) were prepared and the samples were extracted in 3 mL of Basal Medium Eagle with 10% newborn calf serum for 24 hours. The L929 cells were plated (25,000 cells/mL) in wells of 96-well dishes and maintained in a humidified incubator for 24 hours at 37°C, 5% CO₂, and 95% air. After 24-hour incubation of the cells, the incubation medium was replaced by the immersed medium in which the samples were stored. Then L929 cells were incubated in contact with eluates for 24 hours. The cell mitochondrial activity was evaluated by the methyltetrazolium test. Twelve wells were used for each specimen, and methyltetrazolium tests were applied two times. The data were statistically analyzed using one-way analysis of variance and Tukey Honestly Significantly Different tests.Results:Results with L929 fibroblasts demonstrated that all freshly prepared resin-modified orthodontic band adhesive materials reduced vital cell numbers (P > .05), in comparison to the control group. Our data demonstrate that all materials showed significant cytotoxicity compared to the control group.Conclusions:The results indicate that all materials showed significant cytotoxicity compared to the control group, and further studies using different test methods are needed for all resin-modified orthodontic band adhesives.     

Are temporomandibular disorders and tinnitus associated?

The current study aimed to research the prevalence of temporomandibular disorders (TMD) in patients with subjective tinnitus, as compared to controls, and the association between symptoms of TMD, tinnitus, and chronic pain. Two hundred patients were divided into two groups, according to the presence (experimental) or not (control) of subjective tinnitus. The subgroups were determined according to the RDC/TMD criteria. The Pain Pressure Threshold (PPT) values of the masseter and temporalis muscles were recorded bilaterally, and a Visual Analog Scale (VAS) was used to address subjective pain. The most prevalent TMD subgroups in the tinnitus patients (p < 0.05) were myofascial pain with limited opening (39.0%), disc displacement with reduction (44.33%), and arthralgia (53.54%). The severity of tinnitus was significantly associated with the severity of chronic pain (p = .000). The PPT values were lower (p > 0.05), while the Visual Analog Scale (VAS) was statistically higher (p = .000) for the tinnitus patients. These results suggest that an association exists between TMD and subjective tinnitus.     

Oral pyogenic granuloma—a review of 215 cases in a South Indian Teaching Hospital, Karnataka, over a period of 20?years

Introduction

Pyogenic granuloma (PG) is a solitary, benign vascular growth. The precise cause for the development of pyogenic granuloma is unknown. It is believed, however, to be an exuberant tissue response to local irritation or trauma. Up to date, few studies have been carried out among Asians, particularly on the Indian subcontinent.

Materials and methods

Biopsy services were researched from 1989 to 2009. Two hundred-fifteen histologically confirmed PGs were retrieved and retrospectively analyzed for incidence, age, gender, site distribution, clinical presentation and histopathology. These cases were also evaluated for recurrence.

Results and discussion

Pyogenic granuloma accounted for 50.35% among reactive lesions in this study with a mean age of 34.27?years and a peak incidence in the third decade of life. PG was more common in females with a greater predilection for the maxillary gingivae (50.23%). Eighteen cases occurred in pregnant women. Clinically, PG occurred more frequently as pedunculated lesions (103). Gingival irritation and inflammation due to poor oral hygiene were the major precipitating factors. Histologically, PG presented a greater number of vascular channels of varied sizes, lined with plump endothelial cells, capillary budding, and chronic inflammatory cells, namely lymphocytes and plasma cells. Recurrence was seen in 14.88% of patients, predominantly in females, especially in the maxillary anterior region.

Conclusion

Among the reactive lesions, PG had the highest incidence. The frequency of pyogenic granuloma in the southern part of India was much higher compared to other studies. Additional epidemiological research is required to understand the frequency.     

Are bruxism and the bite causally related?

In the dental profession, the belief that bruxism and dental (mal-)occlusion ('the bite') are causally related is widespread. The aim of this review was to critically assess the available literature on this topic. A PubMed search of the English-language literature, using the query 'Bruxism [Majr] AND (Dental Occlusion [Majr] OR Malocclusion [Majr])', yielded 93 articles, of which 46 papers were finally included in the present review*. Part of the included publications dealt with the possible associations between bruxism and aspects of occlusion, from which it was concluded that neither for occlusal interferences nor for factors related to the anatomy of the oro-facial skeleton, there is any evidence available that they are involved in the aetiology of bruxism. Instead, there is a growing awareness of other factors (viz. psychosocial and behavioural ones) being important in the aetiology of bruxism. Another part of the included papers assessed the possible mediating role of occlusion between bruxism and its purported consequences (e.g. tooth wear, loss of periodontal tissues, and temporomandibular pain and dysfunction). Even though most dentists agree that bruxism may have several adverse effects on the masticatory system, for none of these purported adverse effects, evidence for a mediating role of occlusion and articulation has been found to date. Hence, based on this review, it should be concluded that to date, there is no evidence whatsoever for a causal relationship between bruxism and the bite.