The future of dental care for the elderly population

The U.S. population is aging, and the elderly are maintaining many of their natural teeth. Studies have shown that if older people have teeth, they tend to utilize dental services to a similar extent as younger cohorts. Geriatric dental care is the diagnosis, treatment, and prevention of dental and oral diseases for all older adults. A functional categorization of the aging population is more useful in dentistry than a chronological one, and 70 percent of this population, or 23.2 million people, is able to visit a dentist in his or her office. The oral health care of older adults has become more challenging because they will no longer accept extraction and dentures as a solution to complex restorative needs. This paper discusses these issues and looks at the future of geriatric dental care.     

The role of cosmetic dentistry in restoring a youthful appearance.

BACKGROUND: Dentistry is faced with a population that is getting older and keeping more of its natural teeth. Smiles show physical and esthetic signs of aging. Advances in the area of cosmetic dentistry now offer the dental profession new opportunities in conservative and esthetic restorative procedures that have the potential to reverse the signs of dental aging, thereby making patients appear younger. CASE DESCRIPTION: The physical and esthetic attributes of an aged dentition are identifiable. Tooth wear over time alters the appearance of the teeth and smile in a way that is perceptible to dentists and laypeople. Bonding and adhesive ceramic restorative procedures have the potential of reversing the esthetic manifestations of the aging process for teeth. Specific diagnostic tools, including a composite resin mock-up and construction of an incisal putty matrix, allow for previsualization of possible treatment outcomes and allow clinicians to resolve occlusal as well as esthetic treatment concerns before initiating actual treatment. CLINICAL IMPLICATIONS: The ability to make patients look younger through cosmetic enhancement of teeth and smiles has tremendous implications for the future practice of dentistry. Dentists who have the training and skills to meet the increasing demand for esthetic procedures by patients seeking to restore a youthful appearance may find an expanded role within their practices for this type of treatment.     

The importance of dental implants

Implant dentistry has evolved into the mainstream of restorative practices all over the world. Maintenance of bone after tooth loss to improve or maintain facial esthetics and improved retention, function, and performance of removable restorations are only some of the advantages for the edentulous patient. No longer are implants considered only when traditional restorations cannot be fabricated. Evidence-based reports indicate implant restorations last longer than those on teeth and the abutment teeth are at less risk of loss or complication.     

Caries decline and changing pattern of dental therapy

The most striking feature of some industrialized countries is a dramatic reduction of the prevalence of dental caries among school-aged children. As a result, teeth are being retained longer than before and it is possible that the incidence of caries--especially root caries--is increasing. It is an error of judgement that dentistry becomes simplier. With the increase of life span there will be an increase of needs for restorative dentistry in the older age groups of the population. The dentist of the future has to be a flexible practitioner who has had a broader based education.     

Conscious sedation services provided in secondary care for restorative dentistry in the UK: a survey

OBJECTIVES: To assess the views of consultants in restorative dentistry on sedation services in secondary care for restorative dentistry and their involvement in the provision of this. DESIGN: Postal questionnaire survey in the UK. SETTING: Consultants in restorative dentistry. RESULTS: There was an 80% response rate from 179 consultants. Among consultants in restorative dentistry there was a perceived need for sedation services in restorative dentistry within NHS hospitals other than for teaching purposes. Anxiety and level of trauma of dental treatment affected whether consultants felt it appropriate for patients to have such treatment under sedation. One third (48) of consultants treated patients under conscious sedation, a significant number of these held NHS posts and had graduated more recently. Of those (41) who provided treatment under conscious sedation in an NHS setting, most (38, 93%) provided treatment under intravenous sedation of whom only eight (21%) acted as operator/sedationist. Nearly all consultants (135, 94%) felt that specialist registrars in restorative dentistry should undergo some form of training in sedation. CONCLUSIONS: Although consultants in restorative dentistry recognise the need for training in and the provision of sedation in secondary care for restorative dentistry, only one third of respondents currently provide this service.     

Human enamel veneer restoration in a deciduous tooth: clinical case

Trauma to deciduous anterior teeth, frequently occur in children, and the treatment is a big challenge for the pediatric dentistry. In these cases, besides the pain and discomfort provoked by the injury, both child and parents/persons responsible were eager to reconstruct the damage, as soon as possible. In modern operative restorative dentistry, no restorative material is able to substitute for the human dental enamel in quality, color and resistance. The aim of this paper is to relate the treatment of esthetic veneer (facet) of human dental enamel in a three-year-old child after trauma that caused concussion and accentuated color alteration. Clinical results showed an efficient esthetical resolution, revealing it to be a good alternative for treatment of traumatized anterior deciduous teeth.     

Modern restorative management of patients with congenitally missing teeth: 4. The role of implants

In this fourth and final paper on the management of patients with congenitally missing teeth, the use of dental implants is considered. This group of patients often provides unique challenges when implant reconstruction is considered. Often a multidisciplinary approach is required involving orthodontists, oral surgeons and restorative dentists. The use of dental implant systems is a rapidly developing area of dentistry and its implications on hypodontia are discussed. This paper identifies the problems associated with a congenital absence of teeth and addresses their management in relation to the use of implants. Clinical Relevance: The use of dental implants in hypodontia patients should always be considered as a treatment option. These groups of patients, however, require careful planning, often of a multidisciplinary nature, so that the timing of the various treatment modalities is seamless.     

Improving cervical restorations: a review of materials and techniques

INTRODUCTION: There is a great variety of cervical lesions and an increased need for treatment because patients complain either about esthetics, hypersensitivity, or even food impaction. The cumulative effects of noncarious dental tissue loss are increasingly evident within any population. The prevalence of these noncarious lesions has been estimated at between 31% and 56%, with 85% of the population showing some loss of tooth structure in the cervical area. Since more elderly patients will keep their teeth for a longer time, the problems regarding the cervical areas of the teeth will increase. Therefore, the challenge for the dentist is rather substantial, since it has been shown that the longevity of these cervical restorations is not as great as that of other restorations. The purpose of this review is to summarize some facts about cervical lesions, the different tooth-colored restorative materials and their application, and the assessment of the clinical performance of these materials.     

Etched-porcelain resin-bonded onlay technique for posterior teeth.

Remarkable advances in adhesive dentistry have made it possible to strongly bond porcelain to enamel and dentin. This evolution has dramatically changed restorative dentistry and has produced a new, highly esthetic, and strong restoration--etched-porcelain resin-bonded restorations. These restorations can be placed with confidence on posterior teeth. They are virtually indistinguishable from natural tooth structure and, thus, provide additional treatment alternatives for patients who desire natural-appearing posterior teeth. Etched-porcelain resin-bonded onlays on posterior teeth not only are an excellent restorative modality for moderately broken-down teeth but also may be used to bring caries-free teeth into occlusion. The latter can be an option for stabilizing occlusion for some patients with posterior open bite due to various causes. This article presents clinical and laboratory techniques for etched-porcelain resin-bonded onlays on posterior teeth.     

Etched-Porcelain Resin-Bonded Onlay Technique for Posterior Teeth

ABSTRACT: porcelain to enamel and dentin. This evolution has dramatically changed restorative dentistry and has produced a new, highly esthetic, and strong restoration-etched-porcelain resin-bonded restorations. These restorations can be placed with confidence on posterior teeth. They are virtually indistinguishable from natural tooth structure and, thus provide additional treatment alternatives for patients who desire natural-appearing posterior teeth. Etched-porcelain resin-bonded onlays on posterior teeth not only are an excellent restorative modality for moderately broken-down teeth but also may be used to bring caries-free teeth into occlusion. The latter can be an option for stabilizing occlusion for some patients with posterior open bite due to various causes. This article presents clinical and laboratory techniques for etched-porcelain resin-bonded onlays on posterior teeth. Remarkable advances in adhesive dentistry have made it possible to strongly bond     

Iatrogenesis in the treatment of dental caries.

Traditional restorative dental treatment has many shortcomings and has not been shown to be an effective method for managing caries. In spite of this, many dentists continue to be powered by an aggressive restorative approach which, in the light of changing "rules" of operative dentistry, must now be seen as inappropriate and as a form of iatrogenesis. Many things have changed in recent years, including: the prevalence of caries; understanding of the science of the caries process; a fuller appreciation of the problems inherent in restoring teeth; cavity design; restorative materials; and the demands of patients. Dental practice needs to change very dramatically if iatrogenesis is truly to be reduced to a minimum and dentistry is to provide the sort of preventive-based care the modern consumer is increasingly realising makes most sense.     

Determining replacement teeth position for the implant-retained prosthesis in the edentulous patient

A pleasing final appearance is vitally important for patients who undergo extensive oral rehabilitation. This applies equally to the fields of orthodontics, restorative, prosthetic, and implant dentistry. In the field of removable prostheses there are biometric guides that aid in the replacement of teeth especially when the anatomical ridges are severely resorbed. These guides should be considered when planning the appearance and function of prostheses. This paper suggests that in view of the fact that unfavourable placement of implant fixtures is not easily rectified, knowledge of biometric guides can be critical in the treatment planning of the implant supported prosthesis especially when there are large resorbed edentulous spans.     

Minimal intervention dentistry--a review. FDI Commission Project 1-97

The concept of minimal intervention dentistry has evolved as a consequence of our increased understanding of the caries process and the development of adhesive restorative materials. It is now recognised that demineralised but noncavitated enamel and dentine can be 'healed', and that the surgical approach to the treatment of a caries lesion along with 'extension for prevention' as proposed by G V Black is no longer tenable. This paper gives an overview of the concepts of minimal intervention dentistry, describes suggested techniques for a minimally invasive operative approach, and reviews clinical studies which have been carried out in this area.     

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??The dentogingival complex damages of anterior teeth with biological width infringed by unfitting restorations set difficult problems for both the restorative dentists and the periodontal dentists. Periodontal treatment??crowns restored again??is not the right concept of restorative dentistry. Outcomes of periodontal surgery can be more predictable and effective based on esthetics. Meanwhile??a constant challenge for clinicians and technicians come out accordingly. In this study??therapeutic principle and operative procedure was summarized by combined scientific literature and the experience of our team.     

Biologic Perspectives in Restorative Treatment

One of the primary goals of a long term successful restorative therapy is to establish a physiologic periodontal climate that facilitates the maintenance of periodontal health. The contemporary clinician has a host of alternatives for the restoration of teeth. It is now possible to mimic nature and provide restorations that defy detection but the most challenging procedure in clinical dentistry is fabricating a restoration in gingival harmony. Periodontal health is the basis of all restorative dentistry. Because periodontal disease is a major cause of tooth loss in adults, the clinician must be aware of the biological variables relevant to restorative therapy, basic concepts and clinical modes of therapy available, to be able to develop an appropriate diagnosis and treatment plan. A natural looking prosthesis within a healthy periodontium should represent the ultimate goal. This article addresses the interactions between periodontal tissues and restorative procedures. It reviews the essentials of soft tissue management inherent in restorative dentistry that will increase the probability of a successful restoration.     

Short and sticky options in the treatment of the partially dentate patient

As we move into the twenty-first century, patterns of dental disease in adults are changing. Surveys of adult dental health indicate that more people are keeping their teeth for longer in life. In many cases, the ravages of dental disease and the cumulative effect of a lifetime of restorative dentistry lead to gradual tooth loss. For many of these patients, restoration of a complete dentition may not be feasible nor desirable. In recent years, functionally oriented treatment planning has become acceptable in light of recent research findings. Using this approach, treatment efforts and resources are directed principally at retaining the 'strategic' part of the dentition in the long term, ie, the anterior and premolar teeth. This paper describes, with the aid of treated cases, a means of combining a shortened dental arch strategy with resin bonded bridgework. With the aid of recent research in this area of clinical practice, some suggestions as to the use of the technique are also described.     

An assessment of rubber dam usage amongst specialists in paediatric dentistry practising within the UK

OBJECTIVE: Rubber dam is recommended by the British Society of Paediatric Dentistry (BSPD) for various restorative and endodontic procedures. To date, there has been no report of actual usage of rubber dam within the speciality of paediatric dentistry. The aim of this study was to assess the usage of rubber dam amongst paediatric dentistry specialists within the UK. METHODS: A postal questionnaire was distributed to all practitioners registered on the UK General Dental Council's 2004 specialist list in paediatric dentistry. RESULTS: Data were available for 162 questionnaires (a 75% response rate), and of these, 85% of respondents worked in the National Health Service (NHS), 4% were private practitioners and the remainder had a mixed NHS/private practice. Regarding the benefits of rubber dam, 65% and 52% of respondents quoted patient safety and moisture control, respectively. Perceived difficulties of dam usage were lack of patient cooperation and the non-necessity for a particular treatment, as quoted in 64% and 36% of the completed questionnaires, respectively. The most common modes of isolation for anterior and posterior teeth were Dry Dam(R) (58%), and clamp and dam (80%), respectively. CONCLUSION: Current BSPD guidelines recommend rubber dam usage for many restorative procedures; however, it would appear that there is wide variability in the application, as well as under-use, of rubber dam.     

The evolving impact of aging America on dental practice

American dentistry has recognized for a quarter century that the growth in the proportion of elderly in the population is impacting on the profession. Multiple articles in the professional literature have speculated on the ways in which this change will be manifested. Data and projections from earlier articles are revisited and five trends are offered to guide professionals as they position their practices for the coming years. The increase in number and proportion of elderly in dental practices stems from successes in preventing and controlling infectious diseases during the last century. The trend has not peaked but will continue for at least two more decades. Retention of teeth into advanced age has resulted from emerging and improved preventive and restorative dental advances directed at children and adults beginning mid-century, and dental utilization studies confirm the elderly are seeking dental care at an unprecedented and growing rate. Chronic disease and infirmity that accompany advanced age make dental care more challenging for this group. Dentists and their staff will need to continuously undertake educational opportunities that will foster and maintain their facility in providing care to the elderly. They will need to do this because Americans of advanced age are becoming the dominant age group seeking, and able to pay for, sophisticated dental services. The blend of those services is shifting away from removable prostheses to a rising demand for restorative, periodontic, and endodontic care. Root caries, in particular, will be a growing challenge to both providers and patients. There is mounting evidence oral disease impacts endocrine, cardiovascular, and pulmonary health, particularly in frail elders, and will likely provide many elderly additional stimuli to seek dental care. Providers who seek an alternative approach for delivering their services will find growing demand for and satisfaction with traveling to patients, rather than the other way around.     

Minimally Invasive Dentistry--concepts and techniques in cariology

The concept 'Minimally Invasive Dentistry' can be defined as maximal preservation of healthy dental structures. Within cariology, this concept includes the use of all available information and techniques ranging from accurate diagnosis of caries, caries risk assessment and prevention, to technical procedures in repairing restorations. Dentists are currently spending more than half their time replacing old restorations. The main reasons for restoration failures are secondary caries and fractures, factors that are generally not addressed in the technical process of replacing a restoration. Prevailing concepts on minimally invasive dentistry seem to be 'product or technique-motivated', challenging one technique or product with another, rather than focusing on a general concept. New knowledge of caries progression rates has also led to substantial modification of restorative intervention thresholds and further handling of the disease. New diagnostic tools for caries lesion detection, caries risk assessment and focused preventive treatments have decreased the need for early restorative interventions. In parallel to this, new techniques for cutting teeth and removing decay have evolved. This paper focuses on describing minimally invasive dentistry in cariology from a conceptual perspective, relating to clinical caries diagnosis, restorative intervention thresholds and operative procedures, with special reference to survival of tunnel and slot restorations and to repair vs. replacement of defective restorations.     

Dental materials in pediatric dentistry.

Dental materials for the restorative armamentarium in pediatric dental care continue to improve in esthetics and function. This review describes the application of some contemporary materials and concepts. Fluoride-releasing glass ionomers are appropriate for use as luting cements and as liners and bases. The glass ionomer cements have minimal solubility in oral fluids and possess the capability of inhibiting secondary caries. Amalgam and composite resin are effective for class II restorations, although amalgam placement is considerably less time consuming and less technique sensitive. Composite resins, particularly more highly filled resins, are appropriate for anterior restorative care. The use of ceramic glass inserts may provide strength and decrease restorative time for composite resin restorations in the future. When planning treatment for pediatric dental patients, each patient and restorative material to be used should be evaluated on an individual basis, in order to provide appropriate care within each material's limitations. Pediatric restorative dentistry involves the use of many materials. As materials improve in durability, strength, esthetics, and anticariogenic properties, the concepts of contemporary pediatric restorative dentistry change. Certainly, the traditional principles of restorative dentistry remain practical and significant in the practice of dentistry. Although these traditional concepts are extremely relevant, newer materials allow for modifications to be made during treatment planning in restorative dentistry. This review presents some newer materials and concepts and their applications in current pediatric restorative dentistry.