Agreement between normative and perceived orthodontic need amongst deprived multiethnic school children in London

The Index of Orthodontic Treatment Need (IOTN) has been used in dental epidemiology and to prioritize orthodontic treatment. The aim of this paper was to use the aesthetic component (AC) of the IOTN to measure agreement between normative and perceived orthodontic need amongst school children. Three hundred and seventy-eight children aged 11-14 years, enrolled in London UK state schools participated in this survey. The study focused on three ethnic groups: white, black and South Asian. Townsend deprivation scores suggested that the children were from areas of high socio-economic deprivation. Logistic regression analysis was carried out for agreement between normative and perceived need at each threshold value. Perceived need for braces, ethnic background, social class and hours of television viewing were significant variables. Black pupils were significantly less likely to concur on normative and perceived need scores, tending to perceive less need for treatment than did the dentist. Subjects from lower social classes were significantly more likely to concur on normative and perceived need scores. In conclusion, the study showed that using the IOTN AC at various points along the scale, different influences play a significant role in agreement/disagreement between normative and perceived needs, indicating that patient-clinician agreement regards orthodontic treatment is sensitive to several cultural factors.     

A 31-year-old woman with jaw deviation and pain: Part I

J Evid Base Dent Pract 2002;2:168-74     

Acellular dermal matrix allograft in the treatment of mucogingival defects in children: illustrative case report

Mucogingival defects can occur in children and are of particular concern when orthodontic treatment is indicated. The rationale for surgical intervention is predicated on the need to repair the mucogingival defect and to establish adequate thickness of attached gingiva. The free gingival graft, usually obtained from the hard palate, is often used to increase the amount of attached gingiva. The prospect of a second surgical site, and its inherent risks and complications, which may include pain, discomfort, and bleeding, is especially undesirable in children. Important to consider is the possibility that a child may not have adequate tissue thickness at the donor site. A case report is presented utilizing the alternative soft tissue graft, Alloderm, to correct a mucogingival defect prior to orthodontic treatment. Adhering to the free gingival autograft technique, an acellular dermal matrix allograft was utilized at the graft site. The patient revealed good post-operative healing, tissue vascularization, and a healthy zone of attached gingiva at the six month follow up visit. Comparable results to the conventional autograft were obtained with less surgical time, surgical sites, and discomfort to the patient.     

Retention of sealants over carious and sound tooth surfaces

Bacteriologic and clinical studies suggest that sealants can be used therapeutically on incipient caries of the enamel. The present study was designed to explore this approach further by determining whether there is a difference in retention rates on sound or carious tooth surfaces sealed for the first time as well as resealed surfaces. A total of 1766 teeth were sealed for subjects 12-14 yr of age of which 120 were judged to be carious. Mouths were divided sagittally on a random basis and an ultraviolet light activated resin with a filler or an autopolymerizing resin without a filler was placed on contralateral surfaces of all molar and premolar teeth. The effects of sealant type, caries status, arch and tooth type on retention over a 2-yr period were tested using Mantel-Haenszel statistics. At the end of 1 yr, 88% of the teeth sealed with the autopolymerizing resin were judged to be completely intact compared to 82% of the teeth filled with the ultraviolet light resin. At the end of the second year the retention rates were 84% and 75% respectively. The retention rates for carious and sound teeth at the end of both years were almost identical. Overall, premolars had a 15% more favorable retention rate than molars. There were minimal differences between arches although maxillary premolars had approximately a 5% higher retention rate than mandibular premolars. The reverse was true for molar teeth. Retention of sealants at the end of the second year (resealed after 1 yr) was 4% less than comparable teeth sealed initially.     

The effects of a calorie-reduced diet on periodontal inflammation and disease in a non-human primate model

BACKGROUND: Low-calorie diets are commonplace for reducing body weight. However, no information is available on the effects of a reduced-calorie diet on periodontal inflammation and disease. The purpose of this study was to evaluate the clinical effects of a long-term calorie-restriction (CR) diet on periodontitis in an animal model of periodontitis. METHODS: Periodontitis was induced in 55 young, healthy, adult rhesus monkeys (Macaca mulatta) by tying 2.0 silk ligatures at the gingival margins of maxillary premolar/molar teeth. Animals on a CR diet (30% CR; N = 23) were compared to ad libitum diet controls (N = 32). Clinical measures, including the plaque index (PI), probing depth (PD), clinical attachment level (CAL), modified gingival index (GI), and bleeding on probing (BOP) were recorded at baseline and 1, 2, and 3 months after ligature placement. RESULTS: Significant effects of CR were observed on the development of inflammation and the progression of periodontal destruction in this model. Compared to controls, CR resulted in a significant reduction in ligature-induced GI (P <0.0001), BOP (P <0.0015), PD (P <0.0016), and CAL (P <0.0038). Periodontal destruction, as measured by CAL, progressed significantly more slowly in the CR animals than in the controls (P <0.001). CONCLUSIONS: These clinical findings are consistent with available evidence that CR has anti-inflammatory effects. Moreover, these experimental findings are the first observations, to the best of our knowledge, that CR dampens the inflammatory response and reduces active periodontal breakdown associated with an acute microbial challenge.     

Probe penetration in relation to the connective tissue attachment level: influence of tine shape and probing force

Abstract. Previous research has shown that probing force and probe tine shape influence the clinically assessed probing depth. The purpose of the present study was to investigate the effect of tine shape and probing force on probe penetration, in relation to the microscopically assessed attachment level in untreated periodontal disease. In 22 patients, scheduled for partial or full mouth tooth extraction and no history of periodontal treatment, 135 teeth were selected. At mesial and distal sites of the teeth reference marks were cut. Three probe tines, mounted in a modified Florida Probe® handpiece, were tested: a tapered, a parallel and a bail-ended; tip-diameter 0.5 mm. The three tines were distributed at random over the sites. At each site increasing probing forces of 0.10 N, 0.15 N, 0.20 N, 0.25 N were used. After extraction, the teeth were cleaned and stained for connective tissue fiber attachment. The distance between the reference mark and the attachment level was determined using a stereomicroscope. The results showed that the parallel and ball-ended tine measured significantly beyond the microscopically assessed attachment level at all force levels; with increasing forces, the parallel tine measured 0.96 to 1.38 mm and the ball-ended tine 0.73 to 1.06 mm deeper. The tapered tine did not deviate significantly from the microscopic values at the forces of 0.15. 0.20 and 0.25 N. It can be concluded that for the optimal assessment of the attachment level in inflamed periodontal conditions, a tapered probe with a tip diameter of 0.5 mm and exerting a probing force of 0.25 N may be most suitable.     

Volumetric polymerization shrinkage of resin composites under simulated intraoral temperature and humidity conditions

This study measured the volumetric shrinkage of resin composites polymerized under temperature and humidity conditions simulating the oral cavity and compared them to those occurring under ambient room conditions. Small, semispherical specimens of a microhybrid (Z100), microfill (Filtek A110) and flowable microhybrid (4 Seasons Flow) resin composite were manually formed and light activated for 40 seconds using a halogen light-curing unit (Spectrum Curing Light). The volumetric polymerization shrinkage of 10 specimens of each brand of resin composite was measured using a drop shape analysis unit (Drop Shape Analysis System, model DSA10 Mk2) under each of two temperature/relative humidity conditions: room conditions (22 +/- 2 degrees C and 60 +/- 5%) and those simulating intraoral conditions (35 degrees C and 92 +/- 5%). Mean volumetric shrinkage values were calculated for each resin composite and the data were analyzed using two-way analysis of variance and t-test (a=0.05) to determine if significant differences existed between the amount of volumetric polymerization shrinkage that occurred under ambient room conditions and that which occurred under simulated intraoral conditions. Mean volumetric shrinkage values measured for the resin composites were: 2.26 +/- 0.04% (ambient) and 2.61 +/- 0.04% (intraoral) for Z100; 1.96 +/- 0.04% (ambient) and 2.28 +/- 0.04% (intraoral) for Filtek A110 and 4.53 +/- 0.06% (ambient) and 5.34 +/- 0.05% (intraoral) for 4 Seasons Flow. For each resin composite, statistical analysis indicated that the amount of volumetric shrinkage measured under simulated intraoral conditions was significantly greater than what was measured under ambient room conditions (p<0.0001).     

Pyoderma gangrenosum--case report

We report the case of a woman of 34 years who had ulcerative colitis and atypical pyoderma gangrenosum. The pyoderma gangrenosum responded to conservative treatment.     

Prevalence of missing posterior teeth and intraarticular temporomandibular disorders.

STATEMENT OF PROBLEM: The association between missing mandibular posterior teeth and the development of intraarticular temporomandibular disorders (TMDs) remains unclear. PURPOSE: The purpose of this study was to evaluate the prevalence of missing mandibular posterior teeth and intraarticular TMDs in a mixed population of asymptomatic subjects and symptomatic TMD patients. MATERIAL AND METHODS: Eighty-two asymptomatic volunteers and 263 symptomatic TMD patients were included in this study. Asymptomatic volunteers completed a subjective questionnaire and underwent clinical examination to document the absence of TMD signs and symptoms. All symptomatic subjects had localized jaw joint pain and pain on movement or when eating. The number of missing mandibular bicuspid and molar teeth (excluding third molars) in each subject was recorded, and magnetic resonance images were made to document the presence or absence of disk displacement in the temporomandibular joints. Subjects were divided into 4 groups: group 1 = asymptomatic, normal magnetic resonance imaging result; group 2 = asymptomatic, disk displacement; group 3 = symptomatic, normal magnetic resonance imaging result; and group 4 = symptomatic, disk displacement. Collected data were analyzed with chi-square tests (P<.05) with no adjustment for multiple comparisons. RESULTS: A positive association between missing mandibular posterior teeth and the presence of disk displacement was found. CONCLUSION: The literature does not suggest that replacement of missing posterior teeth prevents the development of TMDs. However, missing mandibular posterior teeth may accelerate the development of degenerative joint disease.