Six months of high-dose xylitol in high-risk caries subjects—a 2-year randomised, clinical trial

Objectives

The hypothesis was that the daily use of a high dose of a xylitol chewing gum for 6 months would reduce the increment of decayed permanent first molar surfaces (ΔD₆S) in high-risk schoolchildren after 2 years.

Methods

In this randomised, clinical trial, 204 schoolchildren with a high caries risk were assigned to two experimental groups, xylitol and non-xylitol. Caries status, salivary mutans streptococci, and lactobacilli were re-evaluated 2 years later in 74 xylitol-treated and 83 non-xylitol-treated schoolchildren. Differences in mean ?D₆S between groups registered at baseline and at follow-up were evaluated using the nonparametric Mann–Whitney U test.

Results

Outcome was the development of detectable carious lesions initial (D₁–D₂) and manifest (D₃) in the permanent first molars. In the xylitol group, the difference in proportion of children with decayed first permanent molars at baseline and follow-up was 1.43 % for manifest lesion and 2.86 % for initial lesions; while in the non-xylitol group was 10.26 % (p?<?0.01) and 16.66 % (p?<?0.01), respectively. A statistically significant difference regarding means was also observed in the non-xylitol group: the ?D₆S for manifest lesion was 0.18 (p?=?0.03) and 0.67 (p?=?0.02) for initial lesion.

Conclusion

The use of a chewing gum containing a high dose of xylitol for a period of 6 months has been shown to produce a long-term effect on caries development in high caries-risk children.

Clinical relevance

A school-based preventive programme based on 6 months’ administration of a high dose of xylitol via chewing gum proved to be efficacious in controlling caries increment in high-risk children.     

Evaluation of a preventive program aiming at children with increased caries risk using ICDAS II criteria

Objectives

A selective intensified prevention (SIP) was introduced at individual schools in deprived areas in Marburg County (Germany) in 1995. The outcome of the program was evaluated in sixth graders (mean age: 12.06 years) in comparison to a control region.

Materials and methods

Caries experience was recorded by applying International Caries Detection and Assessment System (ICDAS) II criteria. Tooth brushing habits and other independent variables were examined psychometrically. To compare the mean caries scores, non parametric tests were applied. The influence of various independent variables on caries experience was assessed by stepwise backward logistic regression analysis. The matching criteria age, gender, ethnicity and maternal education were used to parallelize the samples.

Results

ICDAS scores of 2–6 were detected uniformly more often in the control region than in the test group. Combining ICDAS scores 3–6, children from the control region (mean D_3–6MFT: 1.73) showed roughly double the caries experience compared to the test group (mean D_3–6MFT: 0.88, p?<?0.005). The D_5,6MFT score of the test group amounted to 0.50, and the corresponding value of the reference group was 0.77 (p?=?0.043). Multivariate analysis disclosed fissure sealants, early start of tooth brushing and topical fluoride application to be associated with the prevention of dental caries. High frequency of sugar intake was associated with the presence of dentine lesions.

Conclusions

The results of our study confirm the positive effect of SIP on the dental health of 12-year-old pupils living in deprived areas.

Clinical relevance

On the basis of ICDAS II, targeted preventive measures can be applied in children with increased caries risk. Frequent applications of fluoride varnish inhibit the progression of initial lesions in this group.     

Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects

Objectives

This study aimed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with oral appliance therapy.

Materials and methods

As part of a previously conducted RCT, 51 patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. At baseline and after a 2-year follow-up, dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables.

Results

Long-term use of an oral appliance resulted in small but significant dental changes compared with CPAP. In the oral appliance group, overbite and overjet decreased 1.2 (±1.1) mm and 1.5 (±1.5) mm, respectively. Furthermore, we found a significantly larger anterior–posterior change in the occlusion (?1.3?±?1.5 mm) in the oral appliance group compared to the CPAP group (?0.1?±?0.6 mm). Moreover, both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region. Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up [regression coefficient (β)?=??0.02, 95 % confidence interval (?0.04 to ?0.00)].

Conclusions

Oral appliance therapy should be considered as a lifelong treatment, and there is a risk of dental side effects to occur.

Clinical relevance

Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine.     

Auricular acupuncture effectively reduces state anxiety before dental treatment—a randomised controlled trial

Objectives

The objective of this study was to analyse whether auricular acupuncture, acupuncture at the outer ear, could reduce state anxiety before dental treatment.

Methods

This prospective, randomised patient-blinded study with 182 patients compared anxiety before dental treatment following auricular acupuncture at the relaxation-, tranquillizer- and master cerebral points (auricular acupuncture group) versus acupuncture at sham points (finger-, shoulder- and tonsil points; sham group) and a non-intervention control group. Anxiety was assessed using the Spielberger State Trait Anxiety Inventory (German version) before auricular acupuncture and 20?min thereafter, immediately before dental treatment.

Results

Auricular acupuncture reduced state anxiety score more effectively from 54.7?±?10.8 to 46.9?±?10.4 (mean ± SD) than sham acupuncture from 51.9?±?10.2 to 48.4?±?10.0. In contrast, state anxiety in the control group increased from 51.0?±?11.7 to 54.0?±?11.6 (mean increase +3.0; CI +4.7 to +1.2). The decrease in state anxiety in both intervention groups was statistically significant (p?<?0.001) when compared to the non-intervention control group. After correcting for group differences in baseline state anxiety, the reduction in anxiety was ?7.3 score points (CI ?9.0 to ?5.6) in the auricular acupuncture group and ?3.7 score points (CI ?5.4 to ?1.9) in the sham group (p?=?0.008).

Conclusion

Auricular acupuncture, a minimally invasive method, effectively reduces state anxiety before dental treatment.

Clinical relevance

Auricular acupuncture could be an option for patients scheduled for dental treatment, who experience an uncomfortable degree of anxiety and request an acute intervention for their anxiety.     

The prevalence of root resorption of maxillary incisors caused by impacted maxillary canines

Objectives

The aim of this study was to evaluate the prevalence of root resorption of maxillary incisors caused by impacted maxillary canines using low-dose dental computed tomography and to gain additional knowledge of the underlying aetiology and the progression of root resorption.

Materials and methods

A total of 440 patients (mean age, 24.7 years) with 557 impacted maxillary canines were examined regarding their location and the occurrence of root resorption of maxillary incisors.

Results

The frequency of root resorption was 2 % of central and 7.7 % of lateral maxillary incisors. The location of the 557 impacted canines within the dental arch was palatal in 67.5 %, buccal in 15.4 % and central in 17.1 %. No significant differences could be shown with respect to the width and the shape of the dental follicle of the impacted maxillary canines and the presence of root resorption of incisors. The presence of root resorption of central (p?<?0.0001) and lateral (p?<?0.023) maxillary incisors was significantly correlated with an existing contact relationship of the impacted maxillary canines.

Conclusions

Our investigation confirms the theory of prior reports comprising a much larger patient population, hypothesising that the dental follicle of impacted maxillary canines does not cause resorption of adjacent maxillary incisors per se.

Clinical relevance

Root resorption of maxillary incisors is correlated with effects of contact of the impacted maxillary canines, and these findings should be considered in treatment planning. Our findings are consistent with other reports and may develop new treatment approaches for the treatment of this sequela.     

Herpes simplex virus reactivation and dental procedures

Objectives

Dental extraction is reported to trigger recurrent herpes labialis (RHL).

Aim

This aims to prospectively study the clinical occurrence of RHL and the oral herpes simplex virus type 1 (HSV-1) viral shedding before and 3 days after different dental procedures.

Materials and methods

Oral HSV-1 DNA was measured by real-time PCR before and 3 days after dental procedures of the inferior dentition in 57 immunocompetent patients (mean age 32.4 years) who were selected and divided into four distinct subgroups (dental inspection without anesthesia, n?=?19; dental filling under local anesthesia, n?=?14; molar extraction under local anesthesia, n?=?15; and molar extraction under general anesthesia, n?=?9) and compared to 32 healthy controls (mean age 33 years).

Results

None of the patients suffered from RHL at day 3. Oral HSV-1 DNA was detected before and after procedure in 1.7 % (1/57) and 5.3 % (3/57), respectively [dental inspection without anesthesia, 5.3 % (1/19); molar extraction under local anesthesia, 6.7 % (1/15); and molar extraction under general anesthesia, 11 % (1/9)]. None of the controls presented RHL or detectable oral HSV-1 DNA. There was no statistically significant difference between the study groups and controls.

Conclusion

Molar extraction increases the risk of oral HSV-1 shedding but not of RHL. Procedure-related nerve damage probably accounts for HSV reactivation.

Clinical relevance

Antiviral prophylaxis for RHL is not routinely recommended for dental procedures, regardless of a prior history of RHL.     

A randomized clinical trial on the use of medical Portland cement,MTA and calcium hydroxide in indirect pulp treatment

Objectives

Studies on indirect pulp treatment (IPT) show varying success rates of 73 to 97 %. The necessity of re-opening the cavity and the question of the optimal capping material is still under debate. The aim of this prospective in vivo study was to compare the clinical and microbiological outcomes of mineral trioxide aggregate (MTA), medical Portland cement, and calcium hydroxide on the dentin–pulp complex of permanent and primary teeth treated with two-step IPT.

Materials and methods

In 86 regular patients (51 % men; 49 % women; age 17.2 years ±13.8), one deep carious lesion each was treated with incomplete caries removal, randomly selected capping with either calcium hydroxide (n?=?31), medical Portland cement (29) or white MTA (26), and re-entry (6.3 months ±1.0). Clinical (color, humidity, and consistency of dentin) and microbiological (Lactobacilli/Mutans Strep. counts) parameters were recorded at the first and second treatment.

Results

The IPT had a high success rate of 90.3 % regardless of the material used (p?=?0.72). The arrested lesions showed consistently darker, dry, and therefore, sclerotic dentine (p?<?0.05) as well as a decrease in bacterial counts at re-entry (Lactobacilli p?=?0.01/Mutans Strep. p?=?0.07).

Conclusions

The findings of this study support the use of the IPT as a treatment for deep carious lesions preferably with non-resorbing materials such as MTA or medical Portland cement.

Clinical relevance

The findings of this study could promote the improvement of the IPT as a one-step treatment of deep carious lesions when the remaining demineralized dentin would be sealed with durable restorations.     

The Basic Erosive Wear Examination (BEWE) applied retrospectively to two studies

Objectives

A scoring method for tooth erosion is needed to enable community-based assessments. The aim of this study was to evaluate the Basic Erosive Wear Examination (BEWE) scoring method, using data previously collected from two studies.

Materials and methods

In a national survey of erosion in children and adolescents, a representative, 20 % nationwide sample of 2,251 children, aged 6, 12 and 15 years, was examined. Erosion, recorded for all surfaces of permanent teeth, was converted to a BEWE score. For a group of referred patients, erosion was scored for 351 patients and then converted to a BEWE score.

Results

From the national survey, no erosion was seen in permanent teeth of 6 years old, but was present in 12 years old (19.9 % boys, mean BEWE of 0.22; 11.0 % girls, mean BEWE of 0.079; p?<?0.001). Among 15 years old, erosion was seen in 30.7 % of subjects (38.3 % boys, mean BEWE of 1.00; 22.7 % girls, mean BEWE of 0.42; p?<?0.001). For the referred patients, the BEWE score was 9.4 for subjects with gastric reflux symptoms but 6.0 for those without symptoms (p?<?0.001).

Conclusions

The value of scoring with the BEWE methodology was clearly demonstrated, showing increasing severity of erosion between 12 and 15 years and gender differences in erosion severity. Intrinsic acid erosion clearly caused an increased BEWE score.

Clinical relevance

The BEWE scoring methodology appears valuable for assessing erosion in populations.     

Prognostic and predictive value of serum vascular endothelial growth factor (VEGF) in squamous cell carcinoma of the head and neck

Introduction

This study aimed to investigate the prognostic and predictive value of serum vascular endothelial growth factor (VEGF) in head and neck squamous cell carcinoma (HNSCC).

Method

Preoperative and 6-month postoperative serum VEGF levels were measured using a quantitative sandwich enzyme immunoassay technique in 55 consecutive patients with HNSCC and two control groups. The first control group included normal, healthy, age- and sex-matched individuals (n?=?20), while the second control group included the patients who had history of HNSCC and were free of disease for at least 5 years (n?=?25).

Results

The mean baseline serum VEGF concentrations of the 55 patients with HNSCC and the first and the second control groups were 437.86, 42.56, and 48.03 pg/ml, respectively (P?<?0.001). After a median follow-up of 75 months, 15 patients of the study group developed recurrent disease and 40 patients remained free of disease. The mean preoperative and 6-month postoperative serum VEGF levels for the 40 patients who did not have recurrent disease were respectively 327.69 and 153.50 pg/ml compared to 731.72 and 692.96 pg/ml for the 15 patients with recurrent disease (P?<?0.001). High (≥540 pg/ml) serum VEGF level was associated with poor overall survival (P?<?0.001). Moreover, multivariate analysis showed node stage (P?<?0.001) and preoperative serum VEGF level (P?=?0.020) as significant, independent prognostic factors for overall survival.

Conclusion

Preoperative or postoperative elevated serum levels of VEGF are highly predictive for disease recurrence and are associated with poor disease-free and overall survival of patients with HNSCC.     

Fully automatic CAD design of the occlusal morphology of partial crowns compared to dental technicians' design

Objectives

The aim of this study was to compare the occlusal morphology of partial crown reconstructions made by dental technicians with reconstructions made by a fully automatic software process (biogeneric tooth model) in relation to the original natural tooth shape.

Material and methods

Stone replicas of natural teeth were measured three-dimensionally before preparing inlay and onlay cavities for ceramic restorations (n?=?5). For each preparation, five reconstructions (in total n?=?25) were made by five dental technicians. Additionally, reconstructions were calculated automatically by a software based on the biogeneric tooth model (Cerec 3D). In order to compare the two different kinds of reconstruction, an objective metrical similarity measure (shape similarity value, SSV) based on calculated volumes between compared datasets was used.

Results

In 22 of 25 cases, the reconstructions made by the CAD software were closer to the original situation than the reconstructions made by the technicians. Mean average SSV of reconstructions made by the technicians (310.2?±?78.8 μm) was significantly higher (p?<?0.05) than mean SSV of CAD reconstructions (biogeneric model) (222.0?±?47.7 μm).

Conclusions

In the design of naturally shaped occlusal inlay/onlay surfaces, a fully automatic CAD system can be at least as good as conventional wax-ups by dental technicians.

Clinical relevance

The adjustment of a dental restoration to fit the morphology of surrounding tooth structures, still presents challenges for the dentist.     

The prevalence of approximal caries in patients after fixed orthodontic treatment and in untreated subjects

Objective

The aim of this retrospective, cross-sectional study was to investigate the prevalence of approximal carious lesions in patients after fixed multibracket therapy and in subjects without orthodontics on bitewing radiographs.

Material and methods

Bitewing radiographs of 104 orthodontically treated patients with fixed multibracket appliances were compared to those of 111 untreated subjects. The individuals in both groups were between 15 and 16.25 years of age when radiographs were taken. The test group with orthodontics was recruited from the archive of the Department of Orthodontics at the University of Zürich. The untreated control group was selected randomly from 16 communities in the Canton of Zürich. The approximal surfaces of the permanent premolars and molars of all subjects were assessed by two calibrated investigators.

Results

The average number of enamel lesions in the test group after fixed orthodontic treatment was lower than in the control group (0.57 vs. 1.85, p?<?0.001). The same was found for dentin lesions (0.06 vs. 0.49, p?<?0.001). The distribution of lesions was similar in both groups.

Conclusion

Fewer approximal carious lesions were detected in the test group after fixed multibracket appliances than in the age-matched control group without orthodontic treatment.     

Effect of the treatment of root surface-adhered necrotic periodontal ligament with propolis or fluoride in delayed rat tooth replantation

Objectives

The purpose of this study was to evaluate the application of 15 % propolis and 2 % acidulated-phosphate sodium fluoride solutions on the root surface-adhered necrotic cemental periodontal ligament in delayed tooth replantation.

Materials and methods

Thirty Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. After this period, the dental papilla, enamel organ, and pulp tissue were removed, and the animals were randomly assigned to three groups: group I = immersion in saline for 10 min; group II = immersion in a 2 % acidulated-phosphate sodium fluoride solution for 10 min; and group III = immersion in a 15 % propolis and propylene glycol solution for 10 min. The root canals were filled with a calcium hydroxide paste and the teeth were replanted.

Results

Inflammatory resorption, replacement resorption, and ankylosis were observed in all groups without a statistically significant difference (p?>?0.05) among them.

Conclusions

Under the tested conditions, the application of fluoride or propolis on root surface-adhered necrotic periodontal ligament did not favor the healing process in delayed tooth replantation.     

Effects of early bilateral mandibular first molar extraction on condylar and ramal vertical asymmetry

Objectives

This study aims to investigate the mandibular vertical asymmetry in a group of adult patients who had early bilateral mandibular first molar extractions.

Methods

Mandibular asymmetry index measurements (condylar, ramal, and condylar plus ramal) were made on the panoramic radiographs of a study group including 30 subjects (mean age, 18.22?±?1.30 years) and a control group of 25 subjects (mean age, 18.24?±?1.17 years). Group I comprised the control group patients with no extractions and had excellent class I relationships, no missing teeth, and slight or moderate anterior crowding. Group II included patients with a bilateral mandibular first molar teeth extracted before the age of 12 years. Student’s t test was used for the comparison of asymmetry index values between the groups. A paired t test was used to determine possible statistically significant differences between the sides for condylar, ramal, and condylar plus ramal height measurements.

Results

No group showed statistically significant side-specific differences for posterior vertical height measurements. Condylar asymmetry index (CAI), ramal asymmetry index, and condylar plus ramal asymmetry index measurements were not statistically different between the groups (p?>?0.05).

Conclusions

CAI values were significantly high when compared with the 3 % threshold value in the both groups, but comparisons between the groups were not statistically significant.

Clinical relevance

This article investigates the effects of early bilateral mandibular molar teeth extraction that has never been investigated in the literature. The present study showed that the lengths of the condylar, ramal, and condylar plus ramal height were less in the study group than in a well-matched control group of without extraction.     

An early oral health care program starting during pregnancy—a long-term study—phase V

Objectives

Objective was to analyze the effects of a long-term prevention program on dental and oral health of adolescents.

Materials and methods

The entire study was subdivided into five phases. Phase I comprised an individual preventive care during pregnancy, phase II assessed mothers and their children until the age of 3, and in phase III until the age of 6. In phase IV, 13- to 14-year-old teenagers were investigated. In phase V, 18–19-year-old adolescents were examined (18.4?±?0.4 years, n?=?26). All phases consisted of an examination, education, and treatment based on the concept of an “early oral health care promotion.” The control group consisted of randomly selected adolescents of the same age (n?=?35). The following clinical parameters were assessed: DMF-T/DMF-S, HI, PBI, PSI, and Streptococcus mutans/lactobacilli concentration in saliva.

Results

The adolescents of the prevention group revealed a share of 92.3 % caries-free dentition. Mean DMF-T was 1.4?±?2.6. The control group showed a significantly higher mean DMF-T of 3.8?±?3.2 (p?<?0.05) and revealed 71.4 % of caries-free dentition. The prevention group showed a significant lower PSI of 1.2?±?0.8 compared to the control group (2.1?±?0.4) (p?<?0.05).

Conclusion

An “early oral health care promotion” starting during pregnancy may cause a sustained and long-term improvement of the oral health of young adults.

Clinical Relevance

Prevention programs starting during pregnancy may establish an improved health behavior. Caries, periodontitis, and dietary complications in mother and child can be avoided by improving maternal oral health and by a tooth-friendly diet.     

Caries detection under composite restorations by laser fluorescence and digital radiography

Objectives

The objective of this study is to assess the potential of DIAGNOdent readings in detecting carious lesions under composite resin restorations in comparison with digital radiography.

Materials and methods

One hundred extracted third molars were visually selected: 50 with and 50 without carious lesions. Class I occlusal cavities were prepared. In the carious group, caries were left on the floor of cavities before composite resin restoration. The occlusal surface relevant to the caries position in the carious group and a counterfeit point in the non-carious group were marked for DIAGNOdent reading. Teeth were fixed in a plaster box. Digital radiographs were taken and examined by four observers. Definitive diagnosis of caries was based on a histological assessment. Diagnostic accuracy for each method was expressed by the area under the receiver operating characteristic (ROC) curve. Differences between the areas under the ROC curves were assessed using the McNemar test.

Results

The respective sensitivity (95 % confidence interval (%CI)) and specificity (95 %CI) of DIAGNOdent were 0.74 (0.66–0.83) and 0.84 (0.76–0.92). The respective average diagnostic performance values for digital radiographs assessed by four observers were 0.54 (0.36–0.72) and 0.77 (0.65–0.86). The respective ROC values for DIAGNOdent and digital radiographs based on four observers were 0.79 and 0.65. Cohen’s kappa statistic revealed a moderate to substantial agreement among interobserver reliabilities (k?=?0.60–0.77).

Conclusions

There were no statistically significant differences between DIAGNOdent and digital radiographs for the detection of dental caries under composite restoration (p value?>?0.05).

Clinical relevance

DIAGNOdent was developed to detect caries on occlusal surfaces and was tested for caries adjacent to filling materials. This study demonstrated the use of DIAGNOdent in detecting caries under old composite restorations.     

Effects of high-fluoride dentifrice (5,000-ppm) on caries-related plaque and salivary variables

Objectives

The aim of the present study was to measure the effects of a 5,000-ppm F toothpaste on caries-related factors in dental plaque and saliva.

Materials and methods

A 6-week clinical trial was designed with a total of 34 participants, of which 26 completed the study. The participants were assessed on four visits, 2 weeks apart. Sampling of approximal fluid for fluoride analysis and approximal plaque for organic acid analysis was performed. Chair-side tests were performed to register the lactic acid production rate on the tongue using Clinpro? Cario L-Pop?, approximal plaque pH using the pH “strip method” and salivary buffer capacity and counts of cariogenic microorganisms using CRT Buffer® and CRT Bacteria®.

Results

Six weeks’ use of 5,000-ppm fluoridated (F) toothpaste significantly increased the approximal fluid F concentration (p?<?0.05). There was a significant decrease in lactic acid production rate on the tongue assessed by Clinpro? (p?<?0.05). This was accompanied by changes in interproximal plaque acidogenicity, including significant reductions in AUC_5.7, AUC_6.2 and maximum pH fall and an increase in minimum pH (p?<?0.05). A significant increase in the salivary buffer capacity and a reduction in the salivary mutans streptococci were observed (p?<?0.05).

Conclusion

The present study demonstrates the ability of 5,000-ppm F toothpaste to modify caries-related factors in dental plaque and saliva.

Clinical relevance

The 5,000-ppm F toothpaste could be regarded as a possible effective regimen against caries in the near future.     

Evaluation of the long-term storage stability of saliva as a source of human DNA

Objectives

The objectives of this paper are to determine the storage stability of saliva at 37 °C over an 18-month period, and its influence on the DNA yield, purity, PCR protocols and genotyping efficacy.

Materials and methods

Of the 60 participants, blood samples were obtained from 10 and saliva from 50. Samples were subjected to different storage conditions: DNA extracted immediately; DNA extracted following storage at 37 °C for 1, 6, 12 and 18 months. Subsequently, DNA yield, OD_260/280 and OD_260/230 ratios were measured. The isolated DNA was used to amplify exons 0–7 of the RUNX2 gene and subsequently sequenced. Furthermore, 25 SNPs were genotyped.

Results

The mean DNA yield, OD_260/280 and OD_260/230 ratios obtained from blood were 67.4 ng/μl, 1.8?±?0.05 and 1.8?±?0.4 respectively. DNA yield obtained from saliva was significantly higher than blood (p?<?0.0001), ranging from 97.4 to 125.8 ng/μl while the OD_260/280 ratio ranged from 1.8?±?0.13 to 1.9?±?0.1. The success rates for the 25 SNPs ranged from 98 to 100 % for blood and 96–99 % for saliva samples with the genotype frequencies in Hardy–Weinberg equilibrium (>0.01).

Conclusions

Saliva can be stored at 37 °C for 18 months without compromising its quality and ability to endure genetic analyses.

Clinical relevance

Saliva is a viable source of human DNA to facilitate the feasibility of large-scale genetic studies.     

Assessment of smoking behaviour in a dental setting: a 1-year follow-up study using self-reported questionnaire data and exhaled carbon monoxide levels

Objectives

This study analyses the changes in smoking habits over the course of 1 year in a group of patients referred to an oral medicine unit.

Materials and methods

Smoking history and behaviour were analysed at baseline and after 1 year based on a self-reported questionnaire and on exhaled carbon monoxide levels [in parts per million (ppm)]. During the initial examination, all smokers underwent tobacco use prevention and cessation counselling.

Results

Of the initial group of 121 patients, 98 were examined at the follow-up visit. At the baseline examination, 33 patients (33.67 %) indicated that they were current smokers. One year later, 14 patients (42.24 % out of the 33 smokers of the initial examination) indicated that they had attempted to stop smoking at least once over the follow-up period and 15.15 % (5 patients) had quit smoking. The mean number of cigarettes smoked per day by current smokers decreased from 13.10 to 12.18 (p?=?0.04). The exhaled CO level measurements showed very good correlation with a Spearman's coefficient 0.9880 for the initial visit, and 0.9909 for the follow-up examination. For current smokers, the consumption of one additional cigarette per day elevated the CO measurements by 0.77 ppm (p?<?0.0001) at the baseline examination and by 0.84 ppm (p?<?0.0001) at the 1-year follow-up.

Conclusions

In oral health care, where smoking cessation is an important aspect of the treatment strategy, the measurement of exhaled carbon monoxide shows a very good correlation with a self-reported smoking habit.

Clinical relevance

Measurement of exhaled carbon monoxide is a non-invasive, simple and objective measurement technique for documenting and monitoring smoking cessation and reduction.     

Vomer flap for hard palate repair is related to favorable maxillary growth in unilateral cleft lip and palate

Objective

Vomer flap repair is assumed to improve maxillary growth because of reduced scarring in growth-sensitive areas of the palate. Our aim was to evaluate whether facial growth in patients with unilateral cleft lip and palate was significantly affected by the technique of hard palate repair (vomer flap versus two-flap).

Materials and methods

For this retrospective longitudinal study, we analyzed 334 cephalometric radiographs from 95 patients with nonsyndromic complete unilateral cleft lip and palate who underwent hard palate repair by two different techniques (vomer flap versus two-flap). Clinical notes were reviewed to record treatment histories. Cephalometry was used to determine facial morphology and growth rate. The associations among facial morphology at age 20, facial growth rate, and technique of hard palate repair were assessed using generalized estimating equation analysis.

Results

The hard palate repair technique significantly influenced protrusion of the maxilla (SNA: β?=??3.5°, 95 % CI?=??5.2-1.7; p?=?0.001) and the anteroposterior jaw relation (ANB: β?=??4.2°, 95 % CI?=??6.4-1.9; p?=?0.001; Wits: β?=??5.7 mm, 95 % CI?=??9.6-1.2; p?=?0.01) at age 20, and their growth rates (SNA p?=?0.001, ANB p?<?0.01, and Wits p?=?0.02).

Conclusions

The results suggest that in patients with unilateral cleft lip and palate, vomer flap repair has a smaller adverse effect than two-flap on growth of the maxilla. This effect on maxillary growth is on the anteroposterior development of the alveolar maxilla and is progressive with age. We now perform hard palate closure with vomer flap followed by soft palate closure using Furlow palatoplasty.

Clinical relevance

These findings may improve treatment outcome by modifying the treatment protocol for patients with unilateral cleft lip and palate.     

Volume reduction of cystic lesions after surgical decompression: a computerised three-dimensional computed tomographic evaluation

Objectives

This study was performed to evaluate the three-dimensional radiographic variation in mandibular odontogenic cystic lesions after decompression.

Materials and methods

Pre- and post-decompression computed tomography (CT) evaluations in 20 patients affected by keratocysts (n?=?10), dentigerous cysts (n?=?9) and ameloblastoma (n?=?1) were analysed using software designed for three-dimensional measurement of volumes; the results were correlated with treatment duration, age, sex and histological type.

Results

The mean (range) decompression time was 5.70 (3–12)?months. The mean (SD) pre- and post-decompression volumes were 9.50 (7.74) and 4.65 (4.34)?cm³, respectively (P?<?0.001), with a mean (SD) reduction of 49.86 % (19.34 %). The volume reduction was positively correlated with the duration of decompression (P?<?0.001), whereas no correlations with other variables were found (P?=?0.2357). The median monthly reduction in cyst volume was 11.34 % (mean, 13.52 %; range, 4.45–30.43 %) (P?<?0.001).

Conclusions

This three-dimensional CT investigation demonstrated the effectiveness of decompression in the treatment of mandibular odontogenic cystic lesions and showed a positive correlation between the duration of treatment and volume reduction.

Clinical relevance

Decompression treatment, which is simple to perform and generally well-accepted by patients, is a reliable method to considerably reduce the volume of mandibular odontogenic cystic lesions before surgical removal. Extended decompression time seems to improve results of the reduction process.