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.     

Knowledge and practice of behavioral management principles among dentists treating adults with learning disabilities

This study investigated U.K. dentists’ knowledge and practice of behavioral management principles (BMPs) as applied to adults with learning disabilities (AWLD). A postal questionnaire enquired into the dentists’ experience in managing AWLD, utilization of behavioral management techniques, and knowledge of BMPs. The response rate was 41% (N = 53). Two groups were investigated: specialists (dentists registered on the Special Care Dentistry specialists’ list, n = 37) and nonspecialists (dentists not on the list, n = 16). Although specialists treated more AWLD than nonspecialists, both groups of dentists reported they felt highly confident in managing AWLD. However, all dentists’ knowledge of the principles of nonpharmacological BMPs was low. Specialists had a tendency to use a greater range of nonpharmacological behavioral management techniques compared to non‐specialists. These results suggest that dental team members need more training in the theory and practice of BMPs, which might lead to less reliance on costly pharmacological interventions and a clinical experience that is more respectful of the dignity and independence of AWLD.     

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.     

Effect of Distance on the Power Density from Two Light Guides

Purpose: This study determined the effect of distance on the power density from standard and Turbo light guides (Demetron/Kerr, Danbury, Connecticut). Materials and Methods: Power density was measured from 0 to 10 mm away from the tip of standard 8‐mm curved light guides and 13/8‐mm Turbo curved light guides. To determine the effect of distance on power density, a polynomial regression line was fitted. The Kolmogorov‐Smirnov (K‐S) statistic and the Wilcoxon rank sum (WR) tests were used to determine if there was a difference in the rate at which the power density decreased for the standard and Turbo light guides as the distance from the tip increased. Photographs of the light dispersion from each tip were also taken. Results: At 0 mm, the mean (± SD) power density from the two standard light guides was 743 ± 6.1 mW/cm² and from the four Turbo light guides was 1128 ± 22.1 mW/cm². As the distance from the tip of the light‐guide tip increased, the power density decreased, but the rate of decrease was greater from the Turbo light guides than from the standard light guides. At 6 mm the power density from the standard light guides fell to 372 mW/cm² (50% of the original value) and the power density from the Turbo light guides fell to 263 mW/cm² (23% of the original value). Both the K‐S statistic and the WR sum test indicated that the distribution of light intensities was significantly different from the two light guides (WR p‐value = .0246, K‐S p‐value < .0001). The two estimated polynomials intersected at 3.66 mm, and the 95% prediction intervals intersected at about 2.8 and 4.8 mm. Therefore, beyond 5 mm away from the tip of the light guide, the standard light guides gave higher power density readings than the Turbo light guides. Photographs showed that the light dispersed at a wider angle from the Turbo light guides than from the standard light guide. CLINICAL SIGNIFICANCE The design of the light guide of a light curing unit affects light dispersion, power density, and ultimately the dentist's ability to properly cure composite. For these reasons, manufacturers should report the power density at the tip of the light guide and 6 mm from the tip of the light guide, since significant differences exist between light guide designs.