Oral health referral trigger tools for people living with HIV

This study validated and compared two different Oral Health Referral Trigger Tools in the form of brief (3‐item and 5‐item) questionnaires designed to identify people living with HIV (PLHIV) with symptoms of oral disease requiring a dental referral from other health professionals. It was composed of a self‐completed questionnaire and oral screen by a dentist of a convenience sample selected from PLHIV attending two outpatient clinics for routine nondental care for HIV infection. The dental exam was completed by a single dentist at a third location. The one hundred participants were HIV positive, predominantly male and of Caucasian origin with a mean age of 45.6 years. Both referral tools were found to be valid and had adequate sensitivity to identify HIV positive subjects at risk of oral disease and facilitate appropriate referral by nondental health professionals to dental health service. When both tools were compared the 3‐item tool proved to be a more valid and sensitive indicator which could be easily applied by nondental staff to facilitate a dental referral.     

Microleakage of Composite Restorations Bonded with Three New Dentin Bonding Agents

ABSTRACT: This report evaluates the impact of two dentin bonding techniques on microleakage of Class V restorations bonded with three new dentin bonding systems. Forty-eight extracted human premolar and molar teeth were randomly assigned to four groups for bonding with EBS Bonding System (ESPE, Seefeld, Germany); Syntac Single-Component (Ivoclar-Vivadent, Schaan, Liechtenstein); Scotchbond 1 (3M Dental Products, St. Paul, Minnesota); and a control, Prime and Bond 2.1 (Dentsply, DeTrey, Konstanz, Germany). Cavities were cut in both the buccal and lingual surfaces. The coronal half of each preparation was in enamel, and the gingival half was in cementum or dentin. The cavities were restored with composite after the application of dentin bonding agents, using two different drying techniques for each material. The teeth were stored in distilled water for 6 days at 37°C and then thermocycled. The restorations were examined microscopically for leakage, using Procion brilliant red as a marker. All groups showed microleakage at both the enamel and dentin margins. At the gingival margin, there was no significant difference between any of the experimental materials and the control for either wet bonding (Kruskal-Wallis: p .8920) or dry bonding (Kruskal-Wallis: p .9973); or between the two techniques for each material (Mann-Whitney U in all cases p > .05). Scanning electron microscopic examination confirmed that the zones of microleakage, as indicated by dye penetration, were principally resin-cohesive failures within the collagen-rich hybrid layer. Three water-based bonding agents were unable to prevent microleakage at either the enamel or dentin margins of Class V cavities regardless of which bonding technique was employed. All systems behaved equally.     

Magnetic Retention for Obturators

Prosthetic rehabilitation can be challenging in cases of maxillectomy or developmental defect. This article describes a case in which a magnetically retained, implant-supported denture was used to restore the maxilla following hemi-maxillectomy. Use of the Oral Health Impact Profile before and after treatment showed a marked diminution in the number of adverse impacts 2 weeks post-placement and during review 6 months later.     

Occlusal Changes Following Posterior Tooth Loss in Adults. Part 2. Clinical Parameters Associated with Movement of Teeth Adjacent to the Site of Posterior Tooth Loss

PURPOSE: Much anecdotal evidence is available on tooth positional changes following loss of an adjacent tooth, but only a few studies are available. In Part 1 of this series, supraeruption was assessed and Generalized Linear Models were made to determine the clinical parameters associated with the supraeruptive process. The models demonstrated that clinical parameters were not only associated with the extent of supraeruption, but also with the type of eruption present. This investigation of tooth positional changes adjacent to sites of posterior tooth loss attempts to provide increased understanding of the magnitude, direction, and associated features that may be helpful in decision making and treatment planning in the clinical setting. MATERIALS AND METHODS: One hundred patients with an unopposed posterior tooth, with 100 age, sex, and bone level matched controls, were drawn from patients undergoing routine restorative care at Leeds Dental Institute. Study models were scanned, and the extent of eruption, type of eruption of the unopposed tooth, the overbite, overjet, buccal occlusion, and degree of crowding in the dentition, tipping, rotation, and buccal movement of the teeth associated with the edentulous site were recorded. Generalized Linear Models were developed to examine associations between each tooth movement and patient or dental factors. RESULTS: A statistical significance in the degree of tipping of teeth both mesial and distal to the extraction site was detected between the subject and control groups. There was also a significant difference in rotation of the tooth mesial to the site. Four Generalized Linear Models were produced of the types of non-vertical movements found in teeth associated with sites of tooth loss. CONCLUSIONS: Teeth adjacent to the site of tooth loss may undergo non-vertical movements. Teeth mesial to the extraction site had a tendency to tip distally. The degree of tipping was increased in upper teeth and in subjects with a cusp-to-cusp buccal occlusion. Rotation of teeth mesial to the extraction site was more prevalent in the lower arch. Tipping of the tooth distal to the extraction site could be extreme and was found to be more prevalent in subjects with a reduced (Code 1) overbite and in the lower arch. Rotation of teeth distal to the extraction site was greater in the upper arch and was also associated with a reduced (Code 1) overbite. It also had an association with rotation of the tooth mesial to the extraction site. Models of non-vertical movement are likely to be of limited value due to overdispersion, indicating a high degree of variability within the model.     

Impact of xerostomia on oral health and quality of life among adults infected with HIV‐1

The study investigated the impact of xerostomia on oral health and quality of life (QoL) among patients infected with human immunodeficiency virus (HIV) who were attending for routine HIV monitoring in Australia. This cross‐sectional, self‐administered questionnaire survey and oral screening (OS) included 100 subjects who were HIV positive. The OS was conducted by a dentist blinded to the subject's survey responses. Xerostomia was determined by asking the subjects a single question. Subjects with xerostomia were found to have increased caries activity and poorer QoL, especially in the psychological dimensions of the oral health impact profile. Age and duration of HIV infection were associated with xerostomia. Early diagnosis of xerostomia and intervention with preventive dental care would potentially reduce caries and improve QoL among patients infected with HIV‐1. Ongoing chronic inflammation of salivary glands despite the beneficial effects of antiretroviral therapy may play a role in the etiology of xerostomia in patients infected with HIV and requires further study.     

Occlusal Changes Following Posterior Tooth Loss in Adults. Part 1: A Study of Clinical Parameters Associated with the Extent and Type of Supraeruption in Unopposed Posterior Teeth

PURPOSE: One of the barriers to restoring an edentulous space may be the supraeruption of an unopposed tooth to occupy some or all of the space needed for prosthetic replacement. The aim of this study was to determine the extent and type of supraeruption associated with unopposed posterior teeth and to investigate the relationship between these and oral and patient factors. MATERIALS AND METHODS: Diagnostic casts of 100 patients with an unopposed posterior tooth and of 100 control patients were scanned and analyzed to record the extent of supraeruption, together with other clinical parameters. The type of eruption present was defined for each subject as Periodontal Growth, Active Eruption, or Relative Wear. Generalized Linear Models were developed to examine associations between the extent and type of supraeruption and patient or dental factors. The extent of supraeruption for an individual was modeled to show association between the degree of supraeruption and clinical parameters. Three models were produced to show associations between each type of supraeruption and clinical parameters. RESULTS: The mean supraeruption for subjects was 1.68 mm (SD 0.79, range 0 to 3.99 mm) and for controls, 0.24 mm (SD 0.39, range 0 to 1.46 mm). The extent of supraeruption was statistically greater in maxillary unopposed teeth than in mandibular unopposed teeth. Supraeruption was found in 92% of subjects' unopposed teeth. CONCLUSIONS: A Generalized Linear Model could be produced to demonstrate that the clinical parameters associated with supraeruption are periodontal growth, attachment loss, and the lingual movement of the tooth distal to the extraction site. Three types of supraeruption, which may be present singly, or in combination, can be identified. Active eruption has an association with attachment loss. Periodontal growth has an inverse association with attachment loss, is more prevalent in younger patients, in the maxilla, in premolars, and in females. Relative wear has an association with increasing age and is more prevalent in unopposed mandibular teeth.