Age-related changes in the periodontium of pigtail monkeys

Age-related changes in the periodontia of maxillary lateral incisors were studied in the pigtail monkey (Macaca nemestrina) . Transverse sections were obtained from the crestal and apical middle third of the roots from specimens of ages 3 and 4 years (N = 2), 10 years (N = 3), and 20 years (N=3). With increasing age, the roots migrated toward the labial cortical plate, resulting in the development of a bony root prominence on the labial periosteal surface. Quantitative histomorphometric measurements in conjunction with analysis of variance were used to isolate the effects of age and section level on the parameters of interest. The areas of the alveolar socket and cementum increased significantly with age, as did cemental thickness. The width of cementum on the lingual surface was significantly greater than the width on the other surfaces, probably as a response to the labial migration of the tooth. The width and relative area of the periodontal ligament space decreased significantly with age, suggesting that the deposition of cementum proceeded at a rate slightly greater than that at which the socket was enlarging. The number of blood vessels in each quadrant of the periodontal ligament were counted, and no significant difference was found among the different age groups. There were, however, significantly more blood vessels in sections from the crestal third than in those from the apical third of the roots.     

Epilepsy and the dental management of the epileptic patient

AIM: The aim of this article is to educate oral healthcare providers on the diagnosis and treatment of epilepsy and seizure disorders. It also shows the impact of epilepsy on the oral cavity and provides suggestions on the dental management of epileptic patients. REVIEW: Epilepsy and seizure disorders affect 1.5 million Americans. The disease is caused by a number of genetic, physiologic, and infectious disorders as well as trauma. Treatment is primarily pharmaceutical but can also be surgical. The disease itself and the pharmaceutical management often have an impact on the oral cavity. Primary management considerations are the provision of good periodontal care and the restoration of the teeth with stable, strong restorations. CONCLUSIONS: With proper understanding of patients with epilepsy and seizure disorders and their medical treatment, the dental care team can safely and effectively render dental care that will benefit the patient and minimize the risk of oral health problems in the future.     

Molar Distalization with Different Pendulum Appliances: In Vitro Registration of Orthodontic Forces and Moments in the Initial Phase

Abstract. Aim: Registration of the orthodontic forces and moments acting with different types of pendulum appliance for non-compliance upper molar distalization in an in vitro study. Material and Methods: The purpose-designed test set-up comprised the following components: artificial maxilla with anchorage unit and two electrothermodynamic (ETD) molars, electronic measuring unit for temperature control and regulation, and a sensor unit with force-moment sensor, analog/digital converter and data readout unit. This set-up permitted virtually authentic simulation of in vivo conditions on the one hand and precise determination of the force systems on the other.The appliances investigated were the standard pendulum appliance with U-loop activation according to Hilgers and with uprighting activation according to Byloff, the M-pendulum with U-loop activation according to Scuzzo, and the Pendulum K with initial uprighting activation, toe-in bend and incorporated distal screw according to Kinzinger. Results and Conclusions: The effects shown by the standard pendulum appliance and the M-pendulum over a 3 mm simulated distalization increment were a marked decrease in the distally directed forces, and an increase in the intrusive and palatally directed forces as well as in the distoinclinatory, mesially inward, and palatally rotating moments.Activations in the U-loop region of the pendulum springs induced an increase in distally and buccally directed forces and in uprighting and buccally rotating moments as well as a marked rise in extrusive forces. Whereas the activation described by Hilgers led to mesially outward rotating moments, activation according to Scuzzo resulted in a further increase in the mesially inward rotating moments.In the measured standard pendulum appliances, uprighting activation at the end of the pendulum according to Byloff led to an increase in distally and buccally directed as well as in mildly intrusive forces, and to an increase in uprighting as well as in buccally and mesially outward rotating moments.With the Pendulum K according to Kinzinger, the initial toe-in bend and uprighting activation in the region of the end of the pendulum spring together with regular adjustment of the incorporated distal screw permitted virtually translatory molar distalization: constantly distalizing forces with slight intrusive, buccally directed, and rotating side effects.     

A 10-year comparative study of the incidence of third molar removal in the aging population.

PURPOSE: The study goal was to evaluate the incidence of patients older than 40 years who required third molar removal. PATIENTS AND METHODS: Two prospective 5-year studies were compared over a 10-year period of 1992 to 1997 and 1997 to 2002. The study was initiated to evaluate how the large increase in the older population with longer life expectancies is reflected in the third molar population. RESULTS: In 1997, 10.5% of patients requiring third molar surgery were 40 years or older. In 2002, 17.3% of patients were 40 years or older. CONCLUSIONS: It is well known that patients 40 years and older have increased risk in removal of third molars. It is concluded that 1 patient in 5 in the high-risk category is in a very high risk category. The risk to patients and to the profession can be dramatically reduced by considering early removal of abnormal third molars.     

Recalibration improves inter-examiner reliability of TMD examination

OBJECTIVE: The purpose of this study was to assess whether recalibration of examiners would improve the reliability of gathering clinical findings and related diagnoses of temporomandibular disorders (TMD) in accordance with the Research Diagnostic Criteria for TMD (RDC/TMD). MATERIAL AND METHODS: Two clinicians independently examined a total of 48 symptomatic and asymptomatic subjects according to the RDC/TMD on two occasions: examination 1 (E1). Aarhus, Denmark (n=24; 18 female, ages 18-59 years); examination 2 (E2). Malm?, Sweden (n=24; 18 female, ages 18-86 years). The clinicians were calibrated in the use of the RDC/TMD Axis-I examination on the day before E1. Six months later, they were recalibrated on the day before E2. Intra-class correlation coefficients (ICCs) were used to examine the inter-examiner reliability of the two clinicians on the two occasions (E1, E2). RESULTS: The intra-class correlation coefficients of vertical range of jaw motion differed little between E1 and E2. At E2, all other examination components consistently improved in reliability relative to E1. Similar improvements were seen for the frequently occurring RDC/TMD clinical diagnoses: Ia. Myofascial pain [ICC = 0.83 (E1) and 1.00 (E2)], IIa. Disk displacement with reduction [ICC = 0.26 (E1) and 0.64 (E2)], and IIIa. Arthralgia [ICC = 0.16 (E1) and 0.73 (E2)]. CONCLUSION: Recalibration considerably improved inter-examiner reliability for assessing RDC/TMD clinical variables and diagnoses, which are critically dependent on reliable assessment of clinical signs; improvement was most marked when initial inter-examiner reliability was low. Final inter-examiner reliabilities after recalibration were all associated with acceptable to excellent levels.     

The hyoid bone in malay infants with cleft lip and palate.

OBJECTIVE: To compare morphological and positional variations of the hyoid bone in unoperated infants with cleft lip and palate (CL/P) with those in noncleft infants. DESIGN: Retrospective, cross sectional. PATIENTS AND METHODS: Three-dimensional computed tomography scans were obtained from 29 unoperated CL/P infants of Malay origin aged between 0 and 12 months and from 12 noncleft infants in the same age range. Observations were made and measurements were obtained with a software package developed at the Australian Craniofacial Unit. The sizes of the hyoid bones and the position of the hyoid body and epiglottis in relation to the cervical spine were measured. Anatomical anomalies of the hyoid and prevalence of aspiration pneumonia were also documented. RESULTS: The hyoid bones and epiglottis were found to be located more inferiorly in CL/P infants compared with the noncleft infants. Also, 17% (5/29) of the CL/P infants had nonossified hyoid bodies. CONCLUSION: The results suggest that there are differences in the location and genesis of the hyoid bone in infants with CL/P that warrant further investigation.     

Secondary caries in crowned teeth: correlation of clinical and radiographic findings

STATEMENT OF PROBLEM: The diagnostic value of radiographs for interproximal caries detection on nonrestored teeth is well investigated. However, little is known about the use of radiographs in the diagnosis of secondary caries localized at crown margins. PURPOSE: The aim of this study was to correlate clinical findings with regard to secondary caries with the findings of a radiographic evaluation. MATERIALS AND METHODS: One hundred randomly selected patients who underwent restorations with fixed prostheses and were exhibiting at least one secondary carious lesion were included in the study. A total of 820 restorations (test group, 730 interproximal surfaces of 365 single crowns and 910 interproximal surfaces of 455 fixed partial denture retainer crowns) and 1024 interproximal surfaces of 512 nonrestored teeth (control group) were investigated clinically, with the use of modified California Dental Association criteria, and radiographically for interproximal carious lesions. The extension of the lesions was rated to be initial (with no cavitation), early (with cavitation limited to orthodentin), or deep (with cavitation). The data were statistically analyzed for normal distribution, and the frequency of the findings was calculated in absolute numbers and as a percentage. Statistically significant differences were determined by use of the chi(2) test (P<.05). A linear regression model was applied for the correlation between the percentage of secondary caries and the duration of the crowns in situ. RESULTS: Secondary caries was diagnosed clinically in 11.2% of 1640 interproximal surfaces but only in 8.3% radiographically. In contrast, the frequency of interproximal carious lesions diagnosed clinically in nonrestored teeth increased with the use of radiographs from 3.3% to 4.1%. CONCLUSION: Within the limits of this study, the results confirm that radiographs improve the diagnostic sensitivity for interproximal caries in nonrestored teeth. However, for the diagnosis of secondary caries in crowned teeth, the clinical examination is more reliable than the radiographic evaluation.     

Long-term outcome after treatment of temporomandibular joint osteoarthritis with exercise and manual therapy

In a previous study, exercise and manual therapy demonstrated a 90% success rate in patients with osteoarthrosis of the temporomandibular joints in the short-term. The aim of this follow-up study was to assess the long-term effect of these treatment modalities. Seventeen patients were evaluated. All patients suffered from osteoarthrosis of the temporomandibular joints with pain in the temporomandibular joint at baseline and were treated successfully in a prior short-term study. The parameters were pain at rest and at chewing, impairment in daily life, and mouth opening. At follow-up, 11 patients (65%) experienced no pain and 13 patients (76%) had no pain at rest (Fisher's Exact Test: p<0.02). Thirteen patients (76%) had a normal incisal edge clearance, and ten patients (59%) felt no impairment due to the disease (Fisher's Exact Test: p=0.01). Thirteen patients (76%), who had been treated once successfully, have not needed treatment within the three years after cessation of their therapy. Exercise therapy is an effective tool to treat osteoarthrosis of the temporomandibular joints.     

Short-term anti-plaque effect of two chlorhexidine varnishes

BACKGROUND: Chlorhexidine (CHX) varnishes have been mainly used for the prevention of caries in high-risk populations. Reports regarding their anti-plaque effect on a clinical level are limited to non-existing as opposed to their microbiological impact on plaque formation. AIM: The aim of this preliminary investigation was to evaluate the anti-plaque effect of two CHX varnishes applied on sound enamel in relation to a positive control, a negative control and to one another. METHODS: Sixteen healthy subjects volunteered for this randomized-controlled, single-blind, four-treatment-four-period crossover-designed clinical trial. A 3-day plaque re-growth model was used to determine de novo plaque accumulation following CHX rinsing, Cervitec application, EC40 application and no therapy. The amount of plaque was measured using the Quigley and Hein plaque index and "automatic image analysis" (AIA). RESULTS AND CONCLUSIONS: Varnish treatment resulted in significantly higher plaque levels than CHX rinsing irrespective of the varnish that was used (p< or =0.002), implying that the latter is likely to remain the gold standard as an anti-plaque agent. However, highly significant differences were also found in favour of both varnish systems when compared with no therapy (p<0.001), which indicates that varnish treatment is an effective means of inhibiting plaque formation in a short time span. Cervitec exhibited slightly, yet significantly, higher plaque levels in comparison with EC40 as determined by AIA (p=0.006). Large-scale trials with a longer observation period are necessary to substantiate these results.     

Attitudes toward patient safety standards in U.S. dental schools: a pilot study

The objective of this study was to assess the patient safety culture among students, staff, and faculty in seven U.S. dental school clinics when compared to those from a similar study in twenty U.S. hospitals. A survey on patient safety culture developed by the Agency for Healthcare Research and Quality (AHRQ) was used to measure attitudes towards patient safety by anonymous faculty, students, and support staff members who work in the clinics of seven U.S. dental schools. This survey instrument was also administered to staff at twenty U.S. hospitals. In three of the twelve sections of the survey (Overall Perceptions of Safety, Management Support for Patient Safety, and Teamwork Across Units), dental school personnel responses rated above the hospital benchmark results. In Section 2 (Frequency of Adverse Events Reported) and Section 4 (Organizational Learning/ Continuous Improvement), average dental school responses were below those recorded for hospital personnel. The overall score from the twelve sections of the survey indicated that patient safety attitudes of dental school participants were higher than those of their hospital counterparts.