A prospective study of the prevalence of periapical pathology in severely worn teeth

The aim of this article was to carry out a prospective audit on a convenience sample of all new patients referred to the toothwear clinic at Cardiff University Dental Hospital to establish the prevalence of undiagnosed periapical pathology. CLINICAL RELEVANCE: The low prevalence value for undiagnosed periapical pathology in patients with advanced toothwear suggests that, for many patients, toothwear is a slow process which allows the defence mechanisms of the pulp to counteract the effects of wear. It also questions the necessity of taking routine radiographs of teeth with wear into dentine, in the absence of clinical symptoms. This would reduce the total radiation dose delivered to the patient and preserve valuable healthcare resources.     

Tooth whitening: current status

This article reviews the history of tooth whitening and its rapid evolution and briefly discusses tooth whitening agents and protocols. The active ingredients and mode of action during the whitening process are explained. The factors affecting the speed of whitening and its final results are discussed, as well as adverse effects and safety precautions. Protocols are explained in detail, and the predicted outcomes, including those for tetracycline-stained teeth, are covered.     

Clinical effects after subgingival polishing with a non-aggressive ultrasonic device in initial therapy

OBJECTIVES: The Vector ultrasonic system provides root debridement supported by different abrasive irrigation fluids. The aim of this study was to investigate the clinical outcome of initial therapy with subgingival low-abrasive debridement. MATERIAL AND METHODS: Twenty patients, who had at least two teeth with pocket depths >5 mm in each quadrant, took part in this prospective randomized clinical study. Patients were treated in a split-mouth design as one test quadrant (1) subgingivally with Vector fluid polish (VU-H) and as three control quadrants, (2) with only supragingival polishing (PO-H), (3) with hand instruments (HI-H) performed by a hygienist and (4) with hand instruments (HI-D) performed by a dentist. At baseline, 3 and 6 months after treatment, pocket depths and attachment levels (ALs) were measured and bleeding on probing (BOP) was recorded. RESULTS: At 6-month evaluation, all groups showed an improvement in clinical parameters. No statistically significant differences in any of the investigated parameters could be observed between the Vector group and the hand scaling groups, or when comparing the results of the two different operators. CONCLUSION: This study demonstrates that Vector treatment with polishing fluid was able to reduce pocket depths and the prevalence of BOP and improve clinical AL in a similar way as scaling with curettes.     

Practice-based PREP Panel handling evaluation of a new impression mixing device and the associated material

Aims: To evaluate the handling of a new impression mixing device and the associated impression material by general dental practitioner members of the PREP Panel. Design: By means of a questionnaire, the participating practitioners recorded their views on the mixing machine and impression materials, having used these for ten weeks. Setting: UK general dental practices. Participants: General dental practitioner members of a UK practice‐based research group. Methods: A questionnaire was designed to elicit views on the performance of the mixing device and impression material under test. This was distributed to the practitioners who had used the test materials for 10 weeks and the data thereby obtained collated and presented, principally in the form of VAS scales. Outcome measures: Rating of various parameters of the mixing device and impression materials on VAS scales. Results: The Pentamix 3 machine scored well for ease of initial use [4.8 on a visual analogue scale (VAS) where 1 = very difficult to use and 5 = very easy to use]. In a range of criteria (including cleanliness, easy handling, time to fill the tray and overall convenience) the Pentamix scored highly on VAS scales. A maximum score of 5 (on a VAS where 1 = very dissatisfied and 5 = very satisfied) was achieved for reproducible mixing quality. The appreciation of the Pentamix 3 mixing machine was demonstrated by the fact that 85% (n = 11) of evaluators stated that they would recommend it to colleagues. Regarding the impression material under evaluation, 85% (n = 11) of the evaluators stated that they would recommend Impregum Quick impression materials to their colleagues. Conclusions: Within the limitations of this study, the Pentamix 3 automatic impression mixing device scored highly in this assessment, together with the impression materials assessed.     

Protection of short-time enamel erosion by different tetrafluoride compounds

OBJECTIVE: This in vitro study aimed to analyse the protective effect of differently concentrated titanium (TiF(4)), zirconium (ZrF(4)) and hafnium (HfF(4)) tetrafluoride on enamel erosion. METHODS: Polished enamel surfaces of 36 bovine crowns were covered with tape leaving 4 enamel windows each 3mm in diameter exposed. The crowns were randomly assigned to six groups (each n=6) and pretreated with 4% TiF(4), 10% TiF(4), 4% ZrF(4), 10% ZrF(4), 4% HfF(4) or 10% HfF(4) for 4 min (first window), 10 min (second window) or 15 min (third window). The fourth window of each crown was not pretreated and served as control. Erosion was performed stepwise with 1% HCl (pH 2) in five consecutive intervals of each 15 s (total 75 s). Enamel dissolution was quantified by colorimetric determination of phosphate release into the acid. For each tooth, cumulative phosphate loss of enamel pretreated with one of the tetrafluoride compounds was calculated as percentage of the respective control and statistically analysed using two-way ANOVA. RESULTS: Enamel erosion was significantly reduced by TiF(4), ZrF(4) and HfF(4) application. Cumulative phosphate loss (mean % of control, 75s erosion) after 4-15 min application was significantly lower for 4% ZrF(4) (7-11%), 10% ZrF(4) (2-6%), 4% HfF(4) (11-9%) and 10% HfF(4) (12-16%) compared to 4% TiF(4) (42-27%) and 10% TiF(4) (54-33%). Only for 4% and 10% TiF(4), phosphate loss decreased with increasing duration of application, but also increased with increasing acid intervals. CONCLUSION: TiF(4), ZrF(4) and HfF(4) might protect enamel against short-time erosion, but protection was more enhanced by ZrF(4) and HfF(4) compared to TiF(4) application overtime.     

The Periodontitis and Vascular Events (PAVE) pilot study: adverse events

BACKGROUND: During the last 15 years, a substantial number of population-based, clinical, laboratory, and animal studies have been published that reported findings on the relationship between periodontal disease and cardiovascular disease. The Periodontitis and Vascular Events (PAVE) pilot study was conducted to investigate the feasibility of a randomized secondary prevention trial to test whether treatment of periodontal disease reduces the risk for cardiovascular disease. This article describes the occurrence of adverse events during the pilot study. METHODS: The PAVE pilot study was a multicenter, randomized trial comparing periodontal therapy to community dental care. Baseline and follow-up clinic visits included a periodontal examination; blood, subgingival plaque, and crevicular fluid specimen collection; and medical and dental histories. Telephone follow-up contacts were scheduled to occur 3 months after randomization and every 6 months thereafter to assess adverse events or endpoints. RESULTS: Cardiovascular adverse events occurred with similar frequency (23 versus 24 [P = 0.85] in the community control and the treatment groups, respectively). There were 15 serious adverse events (SAEs) with a non-significantly higher percentage occurring in the community care group (6.6% versus 3.3%; P = 0.19). A time-to-event analysis of patterns of SAEs indicated that subjects in the periodontal therapy group tended to be less likely to experience an SAE over the entire 25 months of the study. CONCLUSION: For those individuals who remained in the study, it appears that provision of periodontal scaling and root planing treatment to individuals with heart disease resulted in a similar pattern of adverse events as seen in the community care group, which also received some treatment.     

Squamous cell cancer of the buccal mucosa in young adults

BACKGROUND: Squamous cell carcinoma of the buccal mucosa is predominantly a cancer of elderly people and is seen rarely in young adults. Although many aetiological factors have been postulated, tobacco alone has been implicated as the main factor in the aetiology of such cancers at any age. PATIENTS AND METHODS: A retrospective analysis of 46 patients with cancer of the buccal mucosa who were under the age of 35 years at the time of presentation was made to evaluate their survival and predictors of survival. The details were extracted from the computerised records and case records of the Regional Cancer Centre, Trivandrum, India. These were analysed with particular emphasis on risk factors, clinical extent, and treatment. Survival was analysed by the Kaplan-Meier method, and differences in survival were compared using the log-rank test. RESULTS: The male:female ratio was 6.7:1. Almost all the patients (n = 42, 91%) used either tobacco or alcohol, with tobacco chewing being the most common. The 3 and 5 years disease-free survival were 72 and 61%, respectively. Non-smokers and patients with an advanced T stage at presentation had significantly worse prognoses.     

Penetration of a bonding agent into De- and remineralized enamel in vitro

PURPOSE: To evaluate bonding penetration into different enamel substrates. MATERIALS AND METHODS: Ten extracted human molars were mesiodistally sectioned. Buccal and lingual enamel surfaces were divided into four equal areas using sticky wax. The central two areas of each tooth (n = 20) were demineralized for 12 weeks using an acidic gel (pH 4.8). The lateral areas served as controls. After demineralization, ten specimens were remineralized in a saliva substitute for three weeks. An amine fluoride solution (Elmex Fluid) was applied on one half of each specimen before acid etching. After etching for 120 s, an enamel-bonding agent (Heliobond) containing 0.1% rhodamine was applied onto test and control areas, and was light cured for 60 s. Subsequently, the specimens were sectioned and tag length was determined using a confocal laser scanning microscope (CLSM). Results were statistically compared with ANOVA followed by Scheffe's and Bonferroni/Dunn post hoc tests. RESULTS: With a mean penetration depth of 68 +/- 22 microm, tags in demineralized enamel were significantly longer than in other groups (p < or = 0.01). Penetration decreased significantly in remineralized areas or when fluoride was used (p < or = 0.01), but was still significantly deeper than in control sites (p < or = 0.01). CONCLUSION: Penetration of an unfilled resin into enamel was considerably influenced by the degree of dental hard tissue mineralization. Penetration was increased in demineralized enamel; however, remineralized enamel also allowed good penetration of the bonding agent.     

A randomized clinical trial comparing enamel matrix derivative and membrane treatment of buccal Class II furcation involvement in mandibular molars. Part I: Study design and results for primary outcomes

BACKGROUND: The objective of this multicenter, randomized trial was to compare enamel matrix derivative (EMD; test) with barrier membranes (control) for the treatment of mandibular buccal Class II furcation defects. METHODS: Forty-five patients with 90 comparable defects on contralateral molars were included. Defects were randomly assigned to EMD or bioabsorbable barrier membrane; the contralateral defect received the alternative treatment. Assessments at baseline and 8 and 14 months included gingival margin levels, probing depths, bleeding on probing, vertical attachment levels, and vertical bone sounding from a stent at five buccal sites/ tooth. Defect dimensions were recorded at surgery and during reentry at 14 months. Change of open horizontal furcation depth was the primary outcome variable. Adverse reactions and patient perceptions were also noted. RESULTS: Both treatment modalities led to significant clinical improvements. The median reduction of open horizontal furcation depth was 2.8 mm with the corresponding interquartile interval (1.5 mm, 3.5 mm) at test sites compared with 1.8 mm (1.0 mm, 2.8 mm) at control sites. The Hodges-Lehmann estimator of the advantage (reduction test versus control) was 0.75 mm (95% confidence interval [CI]: 0.125 mm, 1.375 mm, P = 0.033, Wilcoxon). The frequency of complete furcation closure was 8/45 (test) and 3/45 (control); partial closure, 27/45 in both groups; no change, 9/45 and 11/45, respectively; and deterioration, 1/45 and 4/45, respectively. The frequency of no pain or no swelling at 1 week post-surgery was 62% and 44%, respectively, at the test sites and 12% and 6% at the control sites. CONCLUSION: There was a significantly greater reduction in horizontal furcation depth and a comparatively lower incidence of postoperative pain/swelling following enamel matrix derivative compared to membrane therapy.