The clinical assessment of oral dryness is a significant predictor of salivary gland hypofunction

OBJECTIVES: To compare subjective complaints of xerostomia and salivary gland dysfunction and a clinical assessment of oral dryness with an objective measurement of salivary gland dysfunction, in a group of UK patients attending a Dry Mouth Clinic. The aim of the study was to identify signs and symptoms that may be of predictive value for salivary gland hypofunction (SGH) in clinical practice. METHODS: This prospective study investigated 214 patients who attended a Dry Mouth Clinic, held at Liverpool University Dental Hospital. Patients gave a history of xerostomia for a minimum of 6 months and were asked standardised questions to subjectively assess oral dysfunction. The oral mucosa was then clinically assessed for dryness and sialometry was performed. Unstimulated whole saliva flow rates (UFR) of < 0.2 ml min-1 were considered to be indicative of SGH. RESULTS: One or more symptoms of oral dysfunction were reported in 178 (83%) patients, in addition to xerostomia. The clinician diagnosed oral dryness in 105 patients. Objective evidence of SGH was found in 125 (58%) of patients. The clinicians' subjective assessment of oral dryness was indicative of a reduced UFR (P < 0.0001) and a significant predictor of an UFR < 0.2 ml min-1 using logistic regression analysis (odds ratio 9.6; 95% CI 4.8 and 19.3). The mean UFR of patients who reported symptoms of oral dysfunction was significantly lower than the mean UFR of patients who reported no oral dysfunction. Using logistic and multiple regression analyses, symptoms of oral dysfunction were not found to be significant predictors of either an UFR < 0.2 ml min-1 or a reduced UFR. CONCLUSIONS: The clinical assessment of oral dryness was a significant predictor of SGH, in this selected group of patients. Patients who complain of xerostomia may have additional symptoms of oral dysfunction indicative of a reduced UFR.     

Biological complications with dental implants: their prevention, diagnosis and treatment

Biofilms form on all hard non-shedding surfaces in a fluid system, i.e. both on teeth and oral implants. As a result of the bacterial challenge, the host responds by mounting a defence mechanism leading to inflammation of the soft tissues. In the dento-gingival unit, this results in the well-described lesion of gingivitis. In the implanto-mucosal unit, this inflammation is termed "mucositis". If plaque is allowed to accumulate for prolonged periods of time, experimental research has demonstrated that "mucositis" may develop into "periimplantitis" affecting the periimplant supporting bone circumferentially. Although the bony support may be lost coronally, the implant still remains osseointegrated and hence, clinically stable. This is the reason why mobility represents an insensitive, but specific diagnostic feature of "periimplantitis". More sensitive and more reliable parameters of developing and existing periimplant infections are "bleeding on probing", "probing depths" and radiographic interpretation of conventional or subtraction radiographs. Depending on the diagnosis made continuously during recall visits, a maintenance system termed Cumulative Interceptive Supportive Therapy (CIST) has been proposed.     

Esthetic outcome of implant-supported single-tooth replacements assessed by the patient and by prosthodontists

PURPOSE: The objective of this study was to assess and compare patients' and clinicians' judgments of the esthetic outcome of implant-supported single-tooth replacements. MATERIALS AND METHODS: In all, 29 patients with 41 single implant-supported crowns in the maxillary anterior region participated in the study. The esthetic outcome of the implant-supported crowns was assessed by the patients and by 5 prosthodontists by means of a questionnaire in which various esthetics-related variables were addressed and responded to using visual analogue scales. Multiple regression analyses were used to evaluate the influence of the variables on the "overall satisfaction" with the implant-supported crown. RESULTS: Most variables in the patients' assessments revealed mean values above 90% and median values close to 100%. No single factor used in the multiple regression analysis was found to influence a patient's satisfaction with appearance of the crown at a statistically significant level. The clinicians' degree of satisfaction was for all variables lower than that of the patients. In 89% of the cases the clinicians could correctly locate the single implant-supported crown. Among the variables assessed, surrounding soft tissue appearance and form of the crown had the strongest influence on the clinician's overall satisfaction with the appearance of the crown. CONCLUSION: Appreciation of the esthetic outcome of the single implant-supported crowns was rated higher by the patients than by the prosthodontists. Furthermore, factors considered by professionals to be of significance for the esthetic result of the restorative treatment may not be of decisive importance for the patient's satisfaction.     

The cariostatic potential of cheese: cooked cheese-containing meals increase plaque calcium concentration

OBJECTIVE: Eating cheese by itself increases plaque calcium concentration - which is probably one mechanism of the well-established action of cheese in reducing experimental caries. The objective of the present study was to determine whether consumption of cheese as part of a cooked, mixed meal (ie as it is habitually consumed) is able to increase plaque calcium concentration. DESIGN: Plaque samples were obtained from 16 adult volunteers before and 5 minutes after consumption of either a 15 g cube of cheese, one of two cheese-containing test meals, or one of two control meals. Each subject tested each of the four meals on a separate occasion. Plaque calcium concentration was measured using atomic absorption spectrophotometry. RESULTS: The test meals increased plaque calcium concentrations to a significantly greater magnitude than the control meals (P < 0.05). A non-significant trend was observed towards a larger magnitude of change in plaque calcium concentration in the 8 subjects with the lowest, compared with the 8 subjects with the highest baseline concentration. CONCLUSION: The findings suggest that cheese-containing meals increase plaque calcium concentration and thus probably protect against dental caries.     

Effects of repeated scaling and root planing and/or controlled oral hygiene on the periodontal attachment level and pocket depth in beagle dogs

This study was performed to evaluate the effect of initial and/or repeated subgingival scaling with or without controlled oral hygiene on the level of periodontal attachment and pocket depth in Beagle dogs. furthermore, the effect of repeated scaling on the progression of naturally developed periodontitis was to be determined. At baseline, and at 1,6,12,24 and 36 months clinical parameters for plaquen deposits (PII), calculus (CI), gingival health (GI) periodontal attachment from the cementoenamel junction (CEJ) and pocket depth were recorded by the same examiner. Eight healthy Beagles, 3 1/2–6 years of age with moderate naturally developed periodontal desease were divided into experimental and control animals. In the experimental group, 4 dogs received a thorough scaling and root planing at the start of the experiment. thereafter the experimental dogs were subjected to daily toothbrushing and a rubber cup and pumice prophylaxis every two weeks. The remaining 4 control dogs were not subjected to any oral hygience measures. Two quadrants diagonally opposed in each animal (experimentaal and control) were scaled and root planed every six months. In the experimental group a significant increase in attachment level was maintained throughout the study. Initial scaling followed by oral hygiene reduced pocket depth singificantly and pocket reduction was maintained over the three year period. Repeated scaling did not influence the mainternance of the attachment level or the reduction in pocket depth in the experimental group. The control animals continued to lose attachment and pocket depth increased during the study. Scaling every six months without oral hygience resulted in loss of attachment and increase in pocket depth, although the rate of attachment loss was retarded. It is concluded that following initial scaling conticuous removal of bacterial plaque is essential for the maintenance of periodontal attachment. In moderate periodontal disease the levels of attachments may be maintained without surgical therapy.     

In-vivo incorporation of [3H]-proline into rabbit dental pulp collagen.

Collagen metabolism of rabbit dental pulp was studied by following the incorporation of [³H]-proline into pulp collagen. The specific activity of hydroxyproline was studied in various collagen fractions in rabbit incisor and molar teeth of different ages. The specific activity of the collagen fractions was consistently higher in incisor than in molar pulps at all ages, except for the pepsin-resistant fraction. In the molar at most ages, the pepsin-resistant fraction had a specific activity equal to, or greater than, that in the fractions solubilized by either acid or pepsin. The results demonstrate the high metabolic activity of dental pulp, and rapid incorporation of new collagen into the insoluble fibre network.     

Effect of laser irradiation on the permeability of bovine dental enamel

The transport of ionic and non-ionic compounds through bovine dental enamel was measured before and after irradiation with a carbon dioxide laser (energy density 10J/cm²). The irradiation increased the permeability of enamel rather than decreased it as postulated by other workers to explain the increased resistance to surface demineralization produced by such irradiation.