Dental Abstracts

Editorial Board

2012-05-01

The importance of embracing and implementing effective dental caries management

V. Kim Kutsch — 2012-05-01

In 1926, G.V. Black predicted a future for the dental profession where we would understand the histopathology of dental caries so well that we would be able to prevent it before it caused any irreversible damage to the teeth. Yet today, 85 years later, despite everything we have learned about this disease, dentists spend the majority of their clinical time actively treating and restoring the real damages caused by dental caries. Despite the dental profession’s best efforts to treat this disease, dental caries is increasing globally at alarming rates. The United States is no exception to this problem; dental caries is increasing at high rates in our youngest children, and affects people of all ages. Senior citizens are now also dealing with increasing caries rates primarily due to medication-induced xerostomia. The profession’s answer to dental caries has been the dental drill with fluoride therapies thrown is for good measure. This approach worked for a while, we have an X generation that is largely decay free, but for the next generation, this approach is clearly no longer adequate. And it’s not a problem that is going to go away, and we are not going to solve it by drilling faster, or graduating more dentists, or building more pediatric dental hospitals. We need to shift our focus from the results of the disease and focus our efforts on addressing the causes. It’s time we critically look at the evidence, how we approach this disease, and make appropriate changes.

Pursing new approaches

2012-05-01

If you wanted to start over again, would you have to go back to your college days? That’s when you made all the decisions and prepared yourself to become what you are today. But thinking back, much of what you learned in college is now outdated or even irrelevant. What about all that you learned after you graduated from college? That is probably more important and certainly more in line with current-day practice. So thoughts of starting over shouldn’t prompt an “If only I could do it again…” but rather an “I can change now.” Where do you start?

Exit strategies

2012-05-01

The time to plan for exiting your practice within 1, 5, 10, or even 20 years is today. Planning will give you peace of mind, ensure that you are more likely to sell the practice at its peak, offer the opportunity to have higher earnings between the plan’s inception and the exit time, give the staff and patients a clear path to remain with the practice, allow you to pass on the legacy of your long-term practice to a successor of your choice, give you a sort of insurance should death or disability occur, and permit you to explore multiple alternatives for the practice’s transition. Five alternatives that could be pursued were outlined.

Scans without benefit

2012-05-01

Bone scans and computed tomography (CT) scans are being done for many men with low- or medium-risk prostate cancer and for very few men who have high-risk prostate cancer. The scans tell doctors if the cancer has spread beyond the prostate, which is seldom found outside of high-risk disease. They expose men to radiation, which increases future cancer risk; offer little health benefit; and cost the health care system extra money.

John Ruskin’s dentist

2012-05-01

John Ruskin was an artist, writer, and critic in Victorian England, who has been portrayed as a highly eccentric individual (). Review of his writings reveals that he felt it important to have a good dentist in his life. However, his relationship with at least two of his dentists was also unconventional. His diary entry for July 18, 1866, remarked on the passing of his first dentist, Mr. Rogers, stating that Ruskin was “very sorry… very sad, and ill all evening.” About a week after Rogers’ death, Ruskin’s diary records his visit to Alfred James Woodhouse (), a dentist 5 years younger than Ruskin.

Leonardo Da Vinci: Mona Lisa smile

2012-05-01

Leonardo da Vinci’s masterpiece “The Mona Lisa” has been a source of much speculation regarding the subject’s enigmatic smile. Many theories have been put forward to explain it, often based on the fact that da Vinci was not only a master artist but also a mathematician, an inventor, an architect, and an anatomist. A new interpretation was suggested after a careful analysis of the smile in light of recent information about the artist, his subject, and the clinical presentation of Bell’s palsy.

Oral metastases

2012-05-01

Metastases to the mouth and jaws most often represent carcinomas and most often affect the jaw bones, especially the posterior mandible. Oral metastatic disease is usually associated with advanced disease, and affected patients frequently die within a year, often before being investigated for occult oral metastases. Even when autopsies are performed, the mouth and jaws are often not included to avoid unacceptable facial mutilation. Few studies have documented oral metastatic disease in specific geographic regions, but data indicate that there are significant geographic variations in the frequency of the types of tumors that metastasize to the mouth and jaws. A retrospective but relatively contemporary study of 38 Canadian cases was compared with data from other countries.

Inlay-retained fixed dental prostheses

2012-05-01

Among the single posterior tooth replacement options currently available are metal-ceramic, all-ceramic, and direct or indirect fiber-reinforced composite fixed dental prostheses (FDPs) and implants. The gold standard for tooth replacement is the full-coverage metal-ceramic FDP, but retention can be tenuous, soft tissues may become pigmented, and the cervical area of the abutment teeth can appear opaque or dark. If patients reject implant therapy with or without reconstructive surgery and when abutment teeth have previous restorations, minimally invasive procedures with adhesive preparations may be a better option than conventional full-coverage FDPs, for which more tooth preparation is needed. With pre-existing fillings, the dentist can limit the removal of tooth structure and maximize the retention of inlay-retained FDPs. This conservative approach allows the preservation of healthier tooth structure and makes periodontal assessment easier. Disadvantages associated with certain materials used for restorations include potential debonding and insufficient fracture resistance with high-strength pressed ceramics, and fiber exposure, delamination, and hairline microcracks in the composite veneer of fiber-reinforced composites. Yttria tetragonal zirconia polycrystal has mechanical properties that may avoid the problems seen with other materials, but zirconia cannot be etched by common etchants and may not adhere to tooth structure adequately. The clinical procedures used to place inlay-retained FDPs made from a Yttria tetragonal zirconia polycrystal framework veneered with a pressed ceramic and luted with a completely adhesive approach were outlined.

Diabetes screening

2012-05-01

Diabetes mellitus is associated with significant morbidity and mortality, yet many cases of type 2 diabetes are unrecognized and undiagnosed. Early diagnosis and institution of treatment help to prevent or mitigate complications. Prediabetes, or subdiabetic hyperglycemia, can precede type 2 diabetes but still raise the risk for heart disease, stroke, and microvascular diseases typical of persons with frank diabetes. Diabetes is also a risk factor for periodontal disease and can complicate periodontal treatment outcomes if it is poorly controlled. The preferred strategies for identifying patients with diabetes use simple methods to identify those at high risk and “opportunistic” screening during routine contact with health care systems. About 70% of US adults see a dentist at least once a year, and individuals tend to seek routine and preventive oral care more often than medical care. The National Health and Nutrition Examination Survey (NHANES) III data indicate that an algorithm using simple periodontal measures and risk factors readily known by patients may permit dentists to screen for diabetic or prediabetic individuals.

Preemptive analgesia in children

2012-05-01

Both children and their parents suffer distress when the child experiences pain during dental extractions. Using analgesics after tooth extraction can be helpful, but it may be preferable to give preoperative analgesics to eliminate pain before it is even experienced. Preemptive analgesia administration lowers postextraction pain scores in adults, but few studies have evaluated this approach for children.

Autism

2012-05-01

Autism is characterized by aberrant social behavior, impaired communication skills, repetitive behavior patterns, and unusual stereotypical pursuits. This complex neurodevelopmental disorder is generally called autism spectrum disorder, reflecting the variety and grade of features found. Persons with autism spectrum disorder may have mental retardation, developmental disabilities, and various medical and behavioral problems. The behavioral manifestations include hyperactivity, irritability, aggression, self-injury, lack of attention, and outbursts of anger, all of which make the management of these patients quite difficult and can complicate the diagnosis of orofacial pain. Possible influences of orofacial pain on autistic behavior and vice versa were investigated, along with the clinical implications of these interactions.

Antithrombotic therapy

2012-05-01

The recommended practice for patients receiving oral antithrombotic therapy who require tooth extraction is to continue the administration of a maintenance dose of warfarin and/or antiplatelet therapy. A prothrombin time–international normalized ratio (INR) between 3.0 or less and 4.0 is not associated with a higher incidence of postoperative hemorrhage whether or not the maintenance dose of warfarin is given. However, discontinuing warfarin is associated with an incidence of severe thrombosis of 0.95%, with most patients dying. Performing endoscopy after reducing or discontinuing warfarin has similar poor results and an incidence of severe thrombosis of 1.2%. Cerebral infarction incidence increases 3.4-fold when aspirin is discontinued in these patients. The complication associated with continuing antithrombotic therapy is postoperative hemorrhage, which occurs in 2% to 26% of patients, perhaps as a result of increased INR values and acute inflammation related to the tooth extraction. The onset of postoperative hemorrhage and the need for hemostatic countermeasures were evaluated retrospectively to identify factors that may contribute to the onset of bleeding.

Personalized dentistry

2012-05-01

Dental professionals are realizing that the patient’s reaction to oral bacteria is a vital component in understanding how much tissue will be destroyed and when the process will resolve. Research links periodontal disease with other health problems such as heart and respiratory disorders, preterm and low–birth weight infants, stroke, osteoporosis, and diabetes. The management of periodontal disease must address not only general causative factors but also specific patient risk factors and responses to treatment. Inflammation plays a strong role in the initiation and progression of periodontal disease, but also relates to the individual’s overall health. In fact, periodontal health affects systemic health, and systemic health affects periodontal health. The dental hygienist and dentist play a crucial role in identifying patients at risk, managing the oral problems, and referring the patient for care of systemic medical problems.

Cone-beam CT for vertical root fracture detection

2012-05-01

Vertical root fractures (VRFs), seen in 10.9% to 12.9% of patients, can present a diagnostic challenge for clinicians. Should there be a misdiagnosis, patients may undergo invasive surgery and/or tooth extraction needlessly. The teeth most often affected are the mandibular molars and the maxillary premolars, with the highest incidence in patients aged 40 to 60 years. The possible presence of a VRF may be determined through a thorough dental history combined with the classic clinical and radiographic signs and symptoms, specifically, pain and swelling, an isolated deep periodontal pocket, and combined periapical and lateral radiolucency associated with the root. Conventional radiographs may be able to indicate a VRF directly if the x-ray beam is in the same plane as the fracture, but exploratory surgery may be needed to actually see the fracture. Should the diagnostic and prognostic assessments be equivocal, direct visualization is highly desirable. Alternative imaging techniques are needed to improve the detection of VRFs. Cone-beam computed tomography (CBCT) involves three-dimensional slice acquisition at significantly reduced radiation doses and may allow the precise visualization and assessment of VRFs in extracted teeth with clinically suspicious root fractures. The diagnostic ability of CBCT for VRF was validated in relation to surgical exploration and direct visualization of these fractures.

Osseous/cemento-osseous dysplasia of the jaws

2012-05-01

Benign fibro-osseous lesions include a range of conditions and present difficulties in diagnosis. The differential diagnosis must consider the lesion’s stage of development and possible associated entities such as osteomyelitis and simple bone cysts. Osseous dysplasia (OD) or cemento-osseous dysplasia (COD) is one of the entities included in this group of disorders. The World Health Organization has described three clinical presentations: (1) periapical OD/COD in which the lesions occur in the anterior mandible and involve only a few adjacent teeth; (2) focal OD/COD, which has a limited number of lesions in the posterior jaw quadrant but is otherwise similar to periapical OD/COD; and (3) florid OC/COD and familial gigantiform cementomas, which are more extensive forms seen bilaterally in the mandible or all jaw quadrants. Usually OD/COD affects only tooth-bearing areas of the jaws or edentulous alveolar processes. Immature lesions have no calcified material, but more mature lesions are characterized by dense, globular masses of calcified material that may be coalescent. Microscopic features alone are insufficient to make a definitive diagnosis. Instead diagnosis requires a thorough medical history, a complete intraoral examination, adequate radiographic investigation, and the application of knowledge. This can be accomplished by a general dentist who has a familiarity with the various radiographic presentations. The demographic and clinical features of OD/COD and the frequency of specific radiographic characteristics were documented.

Self-adhesive cements

2012-05-01

Adhesive systems for post cementation have been demonstrated to be effective. However, polymerization shrinkage stresses in the root canal are considerable because of the large configuration factor, and shrinkage stress cannot be controlled. Some reports found that adhesive posts are generally not preferred; others found that self-adhesive resin composites as cements for glass-fiber posts are quite desirable. For example, it is possible to combine luting and core build-up in a single stage. It was hypothesized that self-adhesive cements are as capable to sustain a load as an appropriate adhesive combined with a typical core build-up resin composite and that the load capability of self-adhesive and conventional resin composite core build-ups will be comparable after thermal cycling and mechanical loading (TCML).

Successful Class V restorations

2012-05-01

By providing restorations that have good longevity, dentists help to limit the expansion of cavities, protect the pulp, promote satisfaction for patients, and reduce costs. Class V restorations are less durable than other restorations, with composite resin Class V restorations being particularly susceptible to failure compared with Class II composite restorations. The mode of failure can be influenced by many factors, but the causes and mechanisms of failure for restorations that fail soon after placement and those that fail after prolonged service differ. A better understanding of the factors that lead to early failure should help dental practitioners choose more reliable materials and techniques and make them aware of situations that require particular care or skill to ensure success. Class V restorations were evaluated, comparing those that failed within 2 years of placement with those that remained in place to reveal factors that influenced success or failure.

Optimal repair technique

2012-05-01

When a deficient dental restoration must be replaced, the preparation is further extended, creating a larger problem, which goes against the trend toward favoring minimally invasive approaches. Repair by partial replacement of the restoration or local extension adjacent to the existing restoration is the preferred approach, but it relies on providing sufficient attachment to the old restoration. Retention can be obtained through macromechanical, micromechanical, or chemical means. The various brands of composites used may react differently to the various repair approaches. No optimal universally applicable technique has been identified for all composite restorations. The effectiveness of various repair techniques used to bond composite to various artificially aged composites was investigated.

Moisture effects with etch-and-rinse adhesives

2012-05-01

The two-step etch-and-rinse adhesive is a widely used dentin bonding system that requires the removal of the smear layer and the superficial demineralization of the underlying dentin. This is accomplished using an acid conditioner. The demineralized dentin must then be kept moist to maintain interfibrillar porosity and permit adequate infiltration of the resin monomer. Factors affecting the adequate moisturizing of the site include operator skill and interpretation of the manufacturer’s directions, drying time, distance between tooth and air syringe, and environmental temperature. A simpler technique would be bonding to dry demineralized dentin, but the resulting bond strength has been considered inadequate. However, researchers report that the dry approach is technically feasible and may permit high bond strength if the adhesives are rubbed vigorously onto the dentin surfaces. A randomized controlled clinical trial was performed to assess the 24-month clinical performance of resin-based composites in noncarious cervical lesions in teeth restored with two etch-and-rinse adhesives applied to dry or rewetted demineralized dentin through vigorous rubbing.

Repair rather than replace

2012-05-01

Amalgam restorations are widely used because of their relative low cost, long-term cost-effectiveness, and longevity. However, these restorations can fail, usually because of secondary caries or fracture. The criteria guiding the decision to replace amalgam restorations can be subjective and poorly defined. There are available alternative treatments to replacement that avoid removing significant amounts of healthy tooth, specifically, repairing, sealing, and refinishing the restoration. The effects of the various treatments were compared in amalgam restorations scheduled for replacement.

All-ceramic materials

2012-05-01

Although porcelain-fused-to-metal (PFM) restorations accounted for about 70% of the crowns placed in the United States just a few years ago (), the percentage has now dropped to about 50% (). The decline is attributable to the increased use of all-ceramic restoration materials and a small number of resin-based composite materials. Patients now seem to be more discriminating and conscious of aesthetics than previously and want to have tooth-colored indirect restorations whenever possible. Dentists may inform patients about the greater longevity and higher strength of cast-gold alloy restorations, but many patients still want the tooth-colored ones and even request that no metal be used at all. Dentists need to be able to clearly differentiate between the alternative materials for crowns and fixed prostheses. The reasons for changing from PFM to all-ceramic restorations and specific characteristics of the various options were reviewed.

Effects on restorative materials

2012-05-01

Patients are selecting dental whitening for esthetic reasons or to eliminate intrinsic discolorations caused by fluoride, pulpal necrosis, tetracycline, smoking, or drinking beverages that stain such as tea, coffee, or red wine. The most common products used are hydrogen peroxide and carbamide peroxide. Both of these are now being studied for their effects on tooth surfaces and dental restorative materials. The changes they produce in the physical properties of dental restoratives were translated into a clinical perspective to provide practitioners with answers to patients’ questions regarding the effects of tooth bleaching.

Massage low back pain away

2012-05-01

Short-term help for low back pain may come in the form of massage therapy. Seattle researchers led by Daniel Cherkin, Director of Group Health Research Institute, randomly assigned 401, mostly middle-aged white women, with chronic low back pain to receive relaxation massage, structural massage, or usual medical care, including pain medications, anti-inflammatory agents, muscle relaxants, or physical therapy. Massage therapy was delivered in hour-long treatments weekly for 10 weeks. After 10 weeks, over one-third of the massage patients said their back pain was much better or gone; this was reported by only 1 in 25 patients who received standard care. Overall, those who had either relaxation or structural massage took fewer anti-inflammatory medications, were more active, and spent fewer days in bed than those receiving usual treatment. After 6 months, the massage groups still had improved function, but after 1 year, pain and function were comparable between the three groups.

Mandibular implant overdentures

2012-05-01

Half of all conventional mandibular dentures have problems with stability and retention. Implant-retained/supported mandibular overdenture (IOD) treatment is now considered a better choice than conventional dentures in many cases. Two implants have been considered the minimum needed, whether they are used with independent, unsplinted attachments or splinted together, using a cast metal bar and bar-clip attachment. Four implants plus three interconnecting bar and bar-clip attachments can also be used. The best choice for attachment mechanisms between implants and the denture base is controversial. A comparison of prosthesis performance and patient satisfaction for three mandibular IOD treatment options was conducted.

Short implants

2012-05-01

More short implants (10 mm or less) are being used for extremely resorbed posterior regions in partially edentulous patients. Previously, short implants were associated with reduced survival rates because of the diminished amount of bone-to-implant contact, because their posterior location has a poorer quality of alveolar bone, and because of a higher crown-to-implant ratio. To avoid using short implants, extremely resorbed bone can be augmented using bone-grafting techniques, but this additional surgical intervention also leads to higher patient morbidity, higher costs, and longer treatment times. New developments in implant systems and surface treatment techniques have provided better results with larger surface areas even for short implants. The clinical outcome of implants measuring <10 mm for partially edentulous patients was evaluated in a systematic review of the literature, also noting the sources of heterogeneity between studies through subgroup analysis.

Delayed presentation

2012-05-01

About 40% of patients with oral cancer are first seen with advanced disease, with the delay in coming for treatment attributable to the patient. Advanced disease requires more radical treatment and has a poorer prognosis. In addition, there is more treatment needed, more patient and caregiver distress, and worse health-related quality-of-life outcomes, along with added healthcare costs, with late presentation. The public has a generally poor awareness of oral cancer, with oral symptoms seldom seen as being an indicator of any type of cancer. Thus, patients delay seeking help and are often unconcerned about symptoms, often only changing the way they eat, using personal remedies, or simply talking to their family or friends rather than to an oral healthcare professional. Barriers to seeking treatment may hinder early reporting of symptoms. Patients who were treated for oral cancer were interviewed to help identify measures that may promote earlier presentation for care.

Copper deficiency

2012-05-01

Anemia and spinal cord damage causing severe neurological results can accompany the overuse of zinc-containing denture adhesive. This condition is preventable but the neurological damage caused is often not treatable, making it important to promptly identify and treat denture adhesive overuse. A case report demonstrated the results of overusing zinc-containing denture adhesive.

Denture stomatitis

2012-05-01

Access to dental care is improving, and individuals are able to maintain their natural dentition longer, but there is still a significant level of edentulousness, especially among the older individuals. These individuals need to use dentures for long-term, which places them at risk for developing denture stomatitis. This common disorder affects about two-thirds of complete removable denture wearers and is characterized by inflammation and erythema of the oral mucosal areas covered by the denture. Usually, the individual experiences no symptoms, but a few suffer pain, itching, or a burning sensation. Dentists see stomatitis as inflammation or swelling of the mucosal tissues on routine examination. What causes denture stomatitis remains poorly understood. It is suspected that the cause is multifactorial, with a likely association with Candida infection. The current findings relative to the etiology of denture stomatitis were collected and analyzed.

Diabetes

2012-05-01

Diabetes affects about 35.8 million persons in the United States, with important impacts on every part of the body, including the mouth. Seven million of these persons are unaware that they have diabetes. The data indicate that there is a relationship between diabetes and oral health. However, most diabetic patients make no changes to their oral hygiene regimen after being diagnosed with this condition. The symptoms of the disease are often subtle and easy to ignore or not take seriously. Diabetes increases the probability that an individual will develop periodontal disease, but periodontitis also increases the risk of poor glycemic control in persons with diabetes. Bidirectional relationships are also found between poor glycemic control, A1C levels, blood pressure, and cholesterol levels. Persons with unstable blood glucose levels have an increased risk for serious complications related to poor oral hygiene. Reasons for not altering the oral care routine include (1) the patient is unaware of the extent of the disease and the impact on the entire body and (2) there is a general lack of knowledge in the healthcare community concerning the diabetes−oral health connection. The role of oral healthcare providers in diabetes was delineated.

Osteoporosis and periodontitis

2012-05-01

Periodontitis causes not only alveolar bone loss (ABL) but also tooth loss. Tooth loss is linked to osteoporosis as well. Older adults have high rates of periodontitis, and studies using dual X-ray absorptiometry suggest that 49% to 72% of women aged 70 years have osteoporosis. The diagnosis of osteoporosis is based on bone mass density (BMD), with a BMD 2.5 standard deviations below the average peak bone density in young adults considered indicative of osteoporosis. A Peripheral Instanteous X-ray Imaging (PIXI) calcaneus T-score (the number of standard deviations above or below the mean BMD value for young adults of the same gender) ≤1.6 is an adequate cutoff value for establishing the prevalence of osteoporosis in population studies. Probing pocket depth and clinical attachment levels are either weakly or not associated with osteoporosis, and men show no relationship between osteoporosis and periodontitis. Radiographic evidence of ABL defined by various bone loss criteria has indicated a link with osteoporosis. Relationships were sought between calcaneus PIXI T-scores defining osteoporosis and mandibular cortex characteristics on oral panoramic radiographs in older subjects and between osteoporosis and periodontitis in older persons.

Secondhand smoke

2012-05-01

Thirty percent of persons in the United States are reported to have moderate to severe periodontitis, yet the Centers for Disease Control and Prevention and the Centers for Health Statistics warn that the number of actual cases of periodontitis are underrepresented by at least 50%. Patients with periodontal disease suffer attachment loss, tooth loss, and infection, leading to problems of diminished confidence, quality of life, and self-image. Periodontal disease can be influenced by systemic disease, medication, personal oral hygiene, and genetics, but the greatest single influence is smoking, with at least 20% of the cases attributable to this habit. Studies have linked smoking to altered immune system status and poor wound healing, among other negative effects. In addition, since 1972, the Surgeon General has labeled involuntary smoking (passive or secondhand smoke) as hazardous. Nearly half of all the nonsmoking participants in the National Health and Nutrition Examination Survey 1991 to 2004 had a detectable level of exposure to passive smoke, and almost 3% of these exposed persons had moderate to severe periodontitis, not including gingivitis. Links between secondhand smoke and periodontitis were assessed.

Adjunct platelet-rich plasma

2012-05-01

Platelet-rich plasma (PRP) is an autogenous blood clot containing platelets in high concentrations. It is used clinically to support soft- and hard-tissue healing, diminish the chance of acquiring a transmissible disease, and decrease hypersensitivity reactions. PRP is acquired from the patient’s own blood and contains growth factors that improve and increase wound healing. Its uses and benefits were outlined, along with the role of the dental hygienist in using this innovative technological advance.

Fluoride and fluorosis

2012-05-01

Prevalence of dental caries has been substantially reduced primarily because of the widespread use of systemic and topical fluorides. Topical formulations are much more popular than fluoride tablets, with fluoride toothpastes being the most widespread form of usage. The beneficial effects of topical fluoride agents have been widely documented, although differing fluoride concentrations are often not evaluated specifically. Topical fluorides carry the drawback of dental fluorosis, which is hypomineralization of enamel because of the ingestion of excessive amounts of fluoride by young children whose teeth are developing. Young children regularly ingest fluoride toothpaste inadvertently and this, combined with drinking fluoridated water, can produce fluorosis. Mild forms do not present a public health danger, but severe forms have aesthetic implications, especially when the upper anterior teeth are involved. The beneficial and harmful effects of topical fluoride therapies must be balanced. Two Cochrane Reviews were presented to determine the relative effectiveness of different concentrations of fluoride toothpastes in preventing dental caries in children and adolescents and to assess the relationship between using topical fluorides in young children and the risk of developing fluorosis.

Adding calcium phosphate

2012-05-01

Fluoride-containing dentifrices and mouth rinses are able to diminish the caries experience in randomized controlled clinical trials. Fluoride’s mechanism of action involves fluoride ions promoting the formation of fluorapatite or fluorohydroxyapatite in the presence of calcium and phosphate ions. Calcium and phosphate come from saliva, dissolved tooth structure, and gingival crevicular fluid and are essential to the remineralization process. Combining calcium phosphate and fluoride ions in oral care products has not been possible because they react with one another. To overcome this incompatibility, two calcium phosphate technologies have been developed. The first is casein phosphopeptide−stabilized amorphous calcium phosphate (CPP-ACP) delivered in Tooth Mousse or MI Paste containing CPP-ACP, Tooth Mousse Plus, or MI Paste Plus containing CPP-ACP plus 900-ppm fluoride. The CPP stabilizes the ACP phase and delivers bioavailable calcium, phosphate, and fluoride ions to the surface of the tooth to promote remineralization. The second is functionalized tricalcium phosphate, in which tricalcium phosphate particles are ball-milled with sodium lauryl sulfate, which is delivered in a tooth crème with sodium fluoride called Clinpro. The efficacies of these new calcium phosphate technologies plus fluoride were compared with those of conventional fluoride products.

Industry sponsorship

2012-05-01

The question was posed whether scientific articles funded in part or whole by implant companies are likely to report lower annual failure rates with implants than articles not sponsored by this industry. Data were obtained from Medline and the Cochrane Database of systematic reviews, along with hand searches of 12 dental journals. Five systematic reviews were analyzed, with 41 trials chosen for assessment.

Dental liners with amalgam

2012-05-01

Dental amalgams cannot bond to dental tissue, leaving a gap that can attract a buildup of waste products of the dental amalgam. Microleakage from the tooth and restoration interface may contribute to symptoms experienced by patients after amalgam restorations are placed, such as postoperative sensitivity. The effectiveness of various dental liners used under amalgam restorations was investigated.

Ceramic veneers

2012-05-01

Patients are demanding improved esthetics in tooth restorations, which has led to the use of ceramic laminate veneers to enhance their smile. Clinical survival rates for ceramic veneers are about 93% after 15 years, a reflection of conservation of tooth structure, reliable bonding to enamel, good esthetics, and color stability. Factors that affect long-term survival include tooth surface, ceramic thickness, type of cement used, tooth morphology, aberrant function, and geometry of the preparation. Preparation designs fall into four types: window preparations, which are limited to the labial surface; feathered incisal edge preparations that are extended to the incisal margin but lack a definite finish line; incisal shoulder finish line preparations; and overlapped incisal edge preparations, which include a palatal chamfer. A shoulder finish line may be needed to prevent the occurrence of a ceramic laminate veneer and enamel margin with a thin edge. This shoulder finish line reduces stress concentration in the ceramic veneer. The addition of the palatal chamfer is controversial, with no consistent evidence to support its usefulness. Tooth preparation with ceramic laminate veneers can be challenging, necessitating the removal of healthy tooth structure to allow an esthetic match to adjacent teeth. Worn dentition restorations can present the same challenges relative to thinning of the enamel. The fracture resistance associated with various preparation designs and the amount of existing tooth structure was investigated.

Stroke and chewing

2012-05-01

Nearly half of all stroke patients demonstrate a hemisyndrome with facial palsy involving impaired orofacial function. The kind and severity of chewing dysfunction and bite force impairment after stroke have not been quantified, but about 20% of stroke patients become malnourished related to dysphagia and chewing difficulties. The oral health-related quality of life may also suffer if chewing efficiency is diminished. It was hypothesized that maximum voluntary bite force, lip strength, and chewing efficiency will be impaired in stroke patients suffering from hemisyndrome and facial palsy.

Home versus in-office bleaching

2012-05-01

The clinical performance of vital bleaching techniques was studied in individuals older than 18 years of age who had small or no restorations in labial surfaces, no tooth sensitivity, and teeth shades A2 or darker using the VITA shade guide. The 90 subjects were randomly divided into three groups, receiving either some form of in-home or in-office bleaching. Follow-up lasted 16 weeks. A split-mouth design was chosen. The treatments applied were G-1, comparing home bleaching supervised by professionals (HB) with in-office bleaching using light irradiation (OBL); G-2, comparing OBL with in-office bleaching without light irradiation (OB); and G-3, comparing HB alone with HB plus a single session of OBL (HB+OBL). Degree of shading was measured both subjectively and objectively. Two examiners subjectively compared the shade of the six front maxillary teeth with a VITA Classical guide. Color was assessed objectively using a spectrophotometer, yielding a score that combines brightness and hue.

Headache associations

2012-05-01

Clinically, temporomandibular joint (TMJ) region disturbances have been related to the etiology, frequency, intensity, and chronicity of headache. Strong correlations exist between headache and temporomandibular disorders (TMDs), but the etiology of TMD remains unclear. However, treatment of headache patients who have malocclusion with occlusal splints tends to alleviate the problem. Both migraine headache and tension-type headache (TTH) have been associated with TMD. Few studies document these relationships; therefore, an investigation was undertaken to identify links, or the absence thereof, between occlusal interferences; parafunction; TMD; physiologic, muscular, or prosthodontic factors; and headache.

Computer-Aided Design/Manufacturing versus directly fabricated restorations

2012-05-01

Most computer-aided design/manufacturing (CAD/CAM) technologies still require veneering of zirconia frames and substructures and other procedures, taking a while to be completed. As a consequence, temporary restorations must be fabricated on the prepared abutment teeth until the final fixed partial denture (FPD) is ready. These temporary restorations protect the prepared tooth structure, pulp, and surrounding periodontal tissues; maintain oral function such as mastication and phonation; and contribute to esthetics. An overimpression technique and resin-based temporary crown and FPD materials are used to fabricate the temporaries chairside. They may be in place for more than 2 weeks, so they must have sufficient mechanical strength to withstand functional loads. Their mechanical strength, surface texture, and precise fit may be compromised during the chairside preparation procedures, such mixing and filling the over impression. CAD/CAM technologies using resin-based blanks cured under optimal conditions reportedly reduce chairside time and produce superior temporary restorations in terms of mechanical strength. The mechanical strength of directly fabricated temporary three-unit FPDs was compared with the strength of identical CAD/CAM-fabricated FPDs milled using blanks under optimal conditions.

Dental Abstracts

Editorial Board

Table of Contents

The importance of embracing and implementing effective dental caries management

Pursing new approaches

Exit strategies

Scans without benefit

John Ruskin’s dentist

Leonardo Da Vinci: Mona Lisa smile

Oral metastases

Inlay-retained fixed dental prostheses

Diabetes screening

Preemptive analgesia in children

Autism

Antithrombotic therapy

Personalized dentistry

Cone-beam CT for vertical root fracture detection

Osseous/cemento-osseous dysplasia of the jaws

Self-adhesive cements

Successful Class V restorations

Optimal repair technique

Moisture effects with etch-and-rinse adhesives

Repair rather than replace

All-ceramic materials

Effects on restorative materials

Massage low back pain away

Mandibular implant overdentures

Short implants

Delayed presentation

Copper deficiency

Denture stomatitis

Diabetes

Osteoporosis and periodontitis

Secondhand smoke

Adjunct platelet-rich plasma

Fluoride and fluorosis

Adding calcium phosphate

Industry sponsorship

Dental liners with amalgam

Ceramic veneers

Stroke and chewing

Home versus in-office bleaching

Headache associations

Computer-Aided Design/Manufacturing versus directly fabricated restorations