Periodontal status of orthodontic patients and the relationship between dental aesthetic index and community periodontal index of treatment need

This prospective clinic-based study evaluated the pretreatment periodontal status of the orthodontic patients seen at the University College Hospital, Ibadan, Nigeria, and assessed the relationship between dental aesthetic index (DAI) scores and periodontal status according to community periodontal index of treatment needs (CPITN) scores. One hundred forty five patients-70 (48.3%) males and 75 (51.7%) females from 6 to 45 years (mean 15.8 +/- 7.5)-were seen. World Health Organization (WHO) guidelines were followed in the examination and reporting of the periodontal status, and DAI scores were assessed based on WHO guidelines. The chi-square test was used to determine the association between the DAI and the CPITN scores. Most patients were in the 6-15 (55.9%) or 16-25 (35.9%) age groups. Based on the WHO preferred cumulative calculations of treatment need (TN), 35.2% of the patients had TN 0, 64.9% had TN 1, 24.9% had TN 2, and only 0.7% had TN 3. The relationship between DAI scores and periodontal treatment needs was not statistically significant (P >.05). Although many patients were yet to attain the WHO goal of no more than 1 sextant affected by bleeding or calculus at the age of 15, over one third had satisfactory periodontal health.     

Comparing the In Vivo Diagnostic Accuracy of Digital Periapical Radiography with Cone-beam Computed Tomography for the Detection of Vertical Root Fracture

Introduction

The purpose of this study was to determine whether there is a difference in the in vivo diagnostic accuracy of digital radiography (DR) and cone-beam computed tomography (CBCT) imaging in the detection of vertical root fracture (VRF). The presence/absence of VRF was confirmed by visual inspection of the extracted root surface and was the reference standard against which both imaging modalities were compared.

Methods

Twenty-one unsalvageable teeth from 20 patients that had been radiographed and scanned with CBCT imaging were included in the study. The teeth were atraumatically extracted and visually inspected under a microscope to confirm the presence/absence of fracture. The widest point of each fracture was recorded using an optical coherence tomography scanner in order to quantify the size of fractures. Images were viewed under standardized conditions by 13 examiners and repeated 2 weeks later to assess their consistency.

Results

DR and CBCT imaging showed similarly poor sensitivity of 0.16 and 0.27, respectively. Both imaging modalities had similarly high specificity of 0.92 and 0.83, respectively. There was no statistical difference between the diagnostic accuracy of either imaging modality. Fracture width did not affect the detection rate of either imaging modality. Receiver operating characteristic analysis revealed mean A_z values of 0.535 and 0.552 for DR and CBCT imaging, respectively.

Conclusions

Both DR and CBCT imaging have significant limitations when detecting vertical root fractures.     

Ludwig''s Angina. The anaesthetic management of nine cases

We reviewed nine patients with Ludwig's angina who required surgical drainage over a 24-month period. This represents the largest series reported in world literature. All of these patients were managed successfully by a combination of tracheal intubation and early surgical intervention. None required tracheostomy, which is the previously recommended procedure of choice for airway management.     

Relationship between Oral Health-Related Quality of Life, Satisfaction, and Personality in Patients with Prosthetic Rehabilitations

Purpose: This study investigated the relationship between oral health‐related quality of life, satisfaction with dentition, and personality profiles among patients with fixed and/or removable prosthetic rehabilitations. Materials and Methods: Thirty‐seven patients (13 males, 24 females; mean age 37.6 ± 13.3 years) with fitted prosthetic rehabilitations and 37 controls who matched the patients by age and gender were recruited into the study. The Dental Impact on Daily Living (DIDL) questionnaire was used to assess dental impacts on daily living and satisfaction with the dentition. The Oral Health Impact Profile (OHIP) was used to measure self‐reported discomfort, disability, and dysfunction caused by oral conditions. Oral health‐related quality of life was assessed by the United Kingdom Oral Health‐Related Quality of Life (OHQoL‐UK) measure. Moreover, the NEO five‐factor inventory was used to assess participants’ personality profiles. Results: Prosthetic factors had no relationship to the DIDL, OHIP, and OHQoL‐UK scores. Patients with the least oral health impacts had better oral health‐related quality of life (p= 0.023, r =–0.37), higher levels of total satisfaction, and satisfaction with appearance, pain, oral comfort, general performance, and eating (p < 0.05, r =–0.79, –0.35, –0.59, –0.56, –0.58, and –0.50, respectively). Patients with better oral health‐related quality of life (QoL) had higher total satisfaction, satisfaction with oral comfort, general performance, and eating (p < 0.05, r = 0.34, 0.39, 0.33, and 0.37, respectively). Patients with lower neuroticism scores had less oral health impact (p= 0.006, r = 0.44), better oral health‐related QoL (p= 0.032, r =–0.35), higher total satisfaction, satisfaction with appearance, pain, oral comfort, and eating (p < 0.05, r =–0.58, –0.35, –0.33, –0.39, and –0.35, respectively). Conclusion: Patients’ satisfaction with their dentition and prosthetic rehabilitations has positive effects on oral health‐related QoL and oral health impacts and improves patients’ daily living and dental perceptions. Neuroticism might influence and predict patients’ satisfaction with their dentition, oral health impacts, and oral health‐related QoL. Satisfaction with the dentition might predict a patient's level of neuroticism.     

Risk of Implant Failure and Marginal Bone Loss in Subjects with a History of Periodontitis: A Systematic Review and Meta‐Analysis

Background: A number of studies have suggested that implant failure and associated bone loss is greater in subjects with a history of periodontitis. Purpose: To evaluate the risk for marginal bone loss around implants and implant failure in subjects with a history of periodontitis compared with periodontally healthy subjects in studies with a minimum 3‐year follow‐up. Materials and Methods: Data sources: The MEDLINE, EMBASE, and PubMed databases and relevant journals were searched up to July 1, 2008, with restriction to English language. Review Methods: Prospective and retrospective longitudinal observational clinical studies comparing periodontal/peri‐implant variables among subjects with periodontitis and subjects who were periodontally healthy were included. Screening of studies, quality assessment, and data extraction were conducted independently and in duplicate. Clarification of missing and unclear information was not sought. Outcome measures were: implant survival/failure, peri‐implant parameters, changes in radiographic marginal bone level, probing pocket depth, and gingival index. Results: Seventeen potential studies were identified and six studies were accepted comparing patients with periodontitis and periodontally healthy patients treated with implants. Five studies were eligible for meta‐analysis of implant survival and four studies were eligible for meta‐analysis of bone loss around implants. The odds ratio for implant survival was significantly in favor of periodontally healthy patients (3.02, 95% confidence intervals 1.12–8.15). A random effects model showed more marginal bone loss in periodontitis subjects compared with periodontally healthy subjects (standard mean difference 0.61, 95% confidence interval 0.14–1.09). Conclusions: Within the limitations of the heterogenous studies available, a moderate level of evidence indicates that periodontitis subjects were at significantly higher risk for implant failure and greater marginal bone loss as compared with periodontally healthy subjects. Prospective observational studies with subject‐based designs are recommended.     

Supervised toothbrushing and oral health education program in Kuwait for children and young adults with Down syndrome

The authors report on the effectiveness of a school-based, supervised toothbrushing program among a group of 112 children with Down syndrome in Kuwait. The study involved 45 boys and 67 girls, who ranged in age from 11–22 years (mean, 14.8 years). The participants had moderate mental retardation and attended one of two special needs schools. Plaque was scored according to the Silness and Loe plaque index and gingivitis according to the Loe and Silness gingival index. Supervised toothbrushing and dental health education sessions were conducted twice a week. The program was evaluated at the end of three months. The mean plaque score decreased from 1.93 to 0.95 (p < 0.001), and the mean gingival score from 2.00 to 0.83 (p < 0.001). This three-month supervised toothbrushing program was effective in reducing plaque and gingivitis scores, but the key to long-term success of the program is sustaining the children's motivation to make oral hygiene a part of their daily life.