Randomized controlled clinical trial of the 24-months survival of composite resin restorations after one-step incomplete and complete excavation on primary teeth

OBJECTIVE

This randomized clinical trial aimed to compare the 24-months survival of composite restorations in primary molars after partial caries removal (PCR) and total caries removal (TCR).

METHODS

Forty-eight children aged 3-8 years with at least one molar with a deep carious lesion were included (PCR; n=66; TCR; n=54). For PCR, excavation was stopped when dentine with a leathery consistency was achieved; in the TCR group, total absence of carious tissue was confirmed using a blunt-tipped probe. Pulpotomy was performed in cases of pulp exposure. Success was assessed by modified USPHS criteria with Alpha and Bravo scores recorded as success.

RESULTS

Pulp exposure occurred in 1 and 15 of the teeth treated with PCR and TCR respectively (p<0.01). The restorations survival rate after 24 months was 66% (PCR) and 86% (TCR) (p=0.03). When teeth that received pulpotomy were analyzed separately, the survival rate was 92% (p=0.09). PCR performed in occlusoproximal restorations demonstrated the lowest success rate (p=0.002). PCR increases 2.90 times the probability of having a restorative failure compared to TCR (p=0.03), after adjusting for cavity type. When pulp exposure and restoration failure were considered as the outcome, there was no significant difference between the two groups (p=0.10) with success rates of 64% (PCR) and 61% (TCR).

CONCLUSION

Collectively, deciduous teeth submitted to PCR prevented pulp exposure and, consequently, more invasive treatments; otherwise, PCR yielded lower longevity for composite restoration compared to TCR, suggesting that PCR restorations need to be followed over time, especially when multi-surface restorations are involved.

CLINICAL SIGNIFICANCE

Composite restorations on carious remaining tissue require monitoring over time, especially those performed in more than one surface. Even if the restorations present shortcomings over the time, the majority of them are subject to repair, allowing more conservative approaches for teeth with deep caries lesions.

A population-based cohort study of oral health in South Brazil: The Porto Alegre Study

Few population-based cohort studies have been established in Dentistry and this is especially true for Latin America. We conducted a population-based prospective study focusing on oral health in Porto Alegre, south Brazil, and herein we describe its methodology and discuss directions for further research. The cohort was established in 2001 using a multistage probability sample of 1,465 toothed and 121 edentulous subjects. A 5-year follow-up was performed in 2006 that included 755 individuals. The main aim of this study was to determine the pattern and risk factors for periodontal disease progression and tooth loss incidence. A full-mouth protocol was used including periodontal assessments at six sites per tooth. Primary outcomes were periodontal attachment loss and tooth loss. Oral mucosal lesions, dental plaque, gingivitis, supragingival calculus, probing depths, gingival recession, and dental caries were also assessed. This is the first population-based cohort study to focus on periodontal disease in Latin America. Findings will contribute to our understanding of the epidemiology of periodontal disease and provide valuable data for the planning and implementation of preventive and therapeutic strategies.

Relationship between vascular endothelium and periodontal disease in atherosclerotic lesions: Review article

Inflammation and endothelial dysfunction are linked to the pathogenesis of atherosclerotic disease. Recent studies suggest that periodontal infection and the ensuing increase in the levels of inflammatory markers may be associated with myocardial infarction, peripheral vascular disease and cerebrovascular disease. The present article aimed at reviewing contemporary data on the pathophysiology of vascular endothelium and its association with periodontitis in the scenario of cardiovascular disease.

Mouthrinse recommendation for prosthodontic patients

Different reasons can contribute to classifying dental prosthesis wearers as high-risk individuals in relation to dental biofilm accumulation. These include a past history of oral disease, age and additional retentive areas. Other common complaints include inflammation and halitosis. Moreover, prosthesis replacement and prosthetic pillar loss are generally associated with caries and periodontal disease recurrence. Therefore, the present study undertook to make a critical review of the literature, aiming at discussing the main aspects related to chemical agent prescriptions for dental prosthesis wearers. Most of the articles were selected based on relevance, methods and availability in regard to the specific subject under investigation, without considering publication year limitations. Different types of prostheses and their impact on teeth and other oral tissues were reported. It was demonstrated that there is greater biofilm buildup and increased inflammatory levels in the presence of different types of prostheses, suggesting that additional measures are required both on population-wide and individual levels in order to control these factors. Mechanical control consists of a combination of manual or electric toothbrush and toothpaste, as well as specific devices for interdental cleaning. Although many chemical agents exhibit antimicrobial benefits when used for prosthesis disinfection, only a few agents can be used safely without causing damage. Regarding the selection of antiseptics by the overall population, chlorhexidine is the most indicated in the short term and in sporadic cases. The most indicated adjuncts to overcome the deficiencies and limitations of daily mechanical biofilm control are products containing essential oils as active ingredients.

Publication rates of editorial board members in oral health journals

The aim of this study was to measure the publication rate of editorial board members in their board journals and to evaluate associated variables. We evaluated the ten highest-ranked journals according to the 5-year impact factor under 'Dentistry, Oral Surgery & Medicine' subject category for 2010, 2011, and 2012. All original research papers with at least one member of the editorial board as author were counted. Final analyses assessed associated variables such as size of the editorial board, number of papers published each year, and each journal's impact factor. Overall, there was an increase in the average number of articles published from 2010 (115.2 ± 52.2) to 2012 (134.7 ± 47.4). The number and percentage of articles published with editorial board members as authors over the three years did not follow the same pattern, with a slight decrease from 2010 to 2011 and an increase in 2012. The number of articles with editorial board members as authors was significantly higher for journals with impact factors ≥4.0. Journals with a higher impact factor and larger editorial board were associated with higher chances of editorial board members publishing in their respective journals. Participation of editorial board members as authors in publishing varies significantly among journals.

Mouthrinse recommendation for prosthodontic patients

Different reasons can contribute to classifying dental prosthesis wearers as high-risk individuals in relation to dental biofilm accumulation. These include a past history of oral disease, age and additional retentive areas. Other common complaints include inflammation and halitosis. Moreover, prosthesis replacement and prosthetic pillar loss are generally associated with caries and periodontal disease recurrence. Therefore, the present study undertook to make a critical review of the literature, aiming at discussing the main aspects related to chemical agent prescriptions for dental prosthesis wearers. Most of the articles were selected based on relevance, methods and availability in regard to the specific subject under investigation, without considering publication year limitations. Different types of prostheses and their impact on teeth and other oral tissues were reported. It was demonstrated that there is greater biofilm buildup and increased inflammatory levels in the presence of different types of prostheses, suggesting that additional measures are required both on population-wide and individual levels in order to control these factors. Mechanical control consists of a combination of manual or electric toothbrush and toothpaste, as well as specific devices for interdental cleaning. Although many chemical agents exhibit antimicrobial benefits when used for prosthesis disinfection, only a few agents can be used safely without causing damage. Regarding the selection of antiseptics by the overall population, chlorhexidine is the most indicated in the short term and in sporadic cases. The most indicated adjuncts to overcome the deficiencies and limitations of daily mechanical biofilm control are products containing essential oils as active ingredients.

Antimicrobial mouthrinse use as an adjunct method in peri-implant biofilm control

Great possibilities for oral rehabilitation emerged as a result of scientific consolidation, as well as a large number of dental implant applications. Along with implants appeared diseases such as mucositis and peri-implantitis, requiring management through several strategies applied at different stages. Biofilm accumulation is associated with clinical signs manifest by both tooth and implant inflammation. With this in mind, regular and complete biofilm elimination becomes essential for disease prevention and host protection. Chemical control of biofilms, as an adjuvant to mechanical oral hygiene, is fully justified by its simplicity and efficacy proven by studies based on clinical evidence. The purpose of this review was to present a consensus regarding the importance of antimicrobial mouthrinse use as an auxiliary method in chemical peri-implant biofilm control. The active ingredients of the several available mouthrinses include bis-biguanide, essential oils, phenols, quaternary ammonium compounds, oxygenating compounds, chlorine derivatives, plant extracts, fluorides, antibiotics and antimicrobial agent combinations. It was concluded that there is strong clinical evidence that at least two mouthrinses have scientifically proven efficacy against different oral biofilms, i.e., chlorhexidine digluconate and essential oils; however, 0.12% chlorhexidine digluconate presents a number of unwanted side effects and should be prescribed with caution. Chemical agents seem beneficial in controlling peri-implant inflammation, although they require further investigation. We recommend a scientifically proven antiseptic, with significant short and long term efficacy and with no unwanted side effects, for the prevention and/or treatment of peri-implant disease.

The effect of periodontal therapy on C-reactive protein, endothelial function, lipids and proinflammatory biomarkers in patients with stable coronary artery disease: study protocol for a randomized controlled trial

BACKGROUND

Scarce information exists regarding the preventive effect of periodontal treatment in the recurrence of cardiovascular events. Prevention may be achieved by targeting risk factors for recurrent coronary artery disease (CAD) in patients with previous history of cardiovascular events. The aim of this trial is to compare the effect of two periodontal treatment approaches on levels of C-reactive protein, lipids, flow-mediated dilation and serum concentrations of proinflammatory and endothelial markers in stable CAD patients with periodontitis over a period of 12 months.

METHODS/DESIGN

This is a randomized, parallel design, examiner blinded, controlled clinical trial. Individuals from both genders, 35 years of age and older, with concomitant diagnosis of CAD and periodontitis will be included. CAD will be defined as the occurrence of at least one of the following events 6 months prior to entering the trial: documented history of myocardial infarction; surgical or percutaneous myocardial revascularization and lesion >50% in at least one coronary artery assessed by angiography; presence of angina and positive noninvasive testing of ischemia. Diagnosis of periodontitis will be defined using the CDC-AAP case definition (≥2 interproximal sites with clinical attachment loss ≥6 mm and ≥1 interproximal site with probing depth ≥5 mm). Individuals will have to present at least ten teeth present to be included. One hundred individuals will be allocated to test (intensive periodontal treatment comprised by scaling and root planing) or control (community periodontal treatment consisting of one session of supragingival plaque removal only) treatment groups. Full-mouth six sites per tooth periodontal examinations and subgingival biofilm samples will be conducted at baseline, 3, 6 and 12 months after treatment. The primary outcome of this study will be C-reactive protein changes over time. Secondary outcomes include levels of total cholesterol, LDL-C, HDL-C, triglycerides, IL-1β, IL-6, TNFα, fibrinogen, ICAM-1, VCAM-1 and E-selectin. These outcomes will be assessed at all time points over 12 months. Flow-mediated dilation will be assessed at baseline, 1, 3 and 6 months after periodontal therapy.

DISCUSSION

This trial will provide new evidence regarding the effect of periodontal treatment on risk markers for recurrence of cardiovascular events in stable coronary artery disease patients.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier, NCT01609725.

Incomplete caries removal and indirect pulp capping in primary molars: a randomized controlled trial

PURPOSE

To compare the effect of incomplete caries removal (ICR) and indirect pulp capping (IPC) with calcium hydroxide (CH) or an inert material (wax) on color, consistency and contamination of the remaining dentin of primary molars.

METHODS

This double-blind, parallel-design, randomized controlled trial included 30 children presenting one primary molar with deep caries lesion. Children were randomly assigned after ICR to receive IPC with CH or wax. All teeth were then restored with resin composite. Baseline dentin color and consistency were evaluated after ICR, and dentin samples were collected for contamination analyses using scanning electron microscopy. After 3 months, restorations were removed and the three parameters were re-evaluated. In both groups, dentin became significantly darker after 3 months.

RESULTS

No cases of yellow dentin were observed after 3 months with CH compared to 33.3% of the wax cases (P < 0.05). A statistically significant difference over time was observed only for CH regarding consistency. CH stimulated a dentin hardening process in a statistically higher number of cases than wax (86.7% vs. 33.3%; P = 0.008). Contamination changed significantly over time in CH and wax without significant difference between groups. It was concluded that CH and wax arrested the carious process of the remaining carious dentin after indirect pulp capping, but CH showed superior dentin color and consistency after 3 months.

Azithromycin as an adjunctive treatment of aggressive periodontitis: radiographic findings of a 12-month randomized clinical trial

PURPOSE

To compare the 12-month radiographic outcomes following the use of azithromycin or placebo as adjuncts to non-surgical periodontal treatment of AgP.

METHODS

17 aggressive periodontitis (AgP) subjects 13-26 years old were randomly assigned to receive scaling and root planing (SRP) with systemic azithromycin or placebo. Standardized radiographs were taken at baseline and 12 months postoperatively. Recall visits consisting of oral prophylaxis and oral hygiene instructions were performed during the 12 months. Digital image subtraction analysis and linear bone measurements were conducted by a blinded and calibrated examiner. Student t-tests were used for within and between-groups comparisons. ANCOVA was applied for between-group comparisons of changes in linear bone level adjusting for baseline values.

RESULTS

There were significant gains in linear bone levels in the azithromycin (0.55 +/- 0.10 mm) and placebo (0.42 +/- 0.07 mm) groups between the baseline and 12-month postoperative visits. There were also significant gains in bone density in the two treatment groups. No significant differences were observed between the two treatments in the amount of linear bone gain or bone density during the follow-up period. The use of azithromycin as an adjunct to SRP in the treatment of AgP did not result in significant radiographic bone level changes compared to placebo.

Factors associated with changes in self-reported dentifrice consumption in a brazilian group from 1996 and 2009

The aim of the study was to determine factors associated with changes in self-reported dentifrice consumption in an urban population group over 13 years. This study evaluated two surveys of 671 and 688 households sampled in the urban area of a city from Southern Brazil in 1996 and 2009, respectively. The mother of the family was asked to answer a structured questionnaire about demographics, socioeconomic and behavioral variables. The primary outcome was obtained by questioning "how long does a dentifrice tube last in your house?" The cut-off point of duration was less than 1 month. It was used to determine high consumption of dentifrice (HCD). Associations between HCD and independent variables were evaluated by multivariable Poisson regression. There was a significant decrease of 20% (81.2% to 61.2%) in the prevalence of HCD between 1996 and 2009, resulting in a crude annual decrease of 1.54%. Mother's age, family income, dental assistance, mother's brushing frequency and number of household members that use a toothbrush were significantly associated with HCD independent from the year of survey. The prevalence ratio (PR) of HCD for the year of survey was 0.75, indicating an overall decrease of 25% in the probability of HCD from 1996 to 2009. Probabilities of HCD also decreased over the 13 years among the strata of education, number of household members and reason for choice of dentifrice. It may be concluded that the factors associated with the observed decrease were higher educational levels, larger number of household members and reasons for choosing a dentifrice related to preventive/therapeutic effects.

Pattern and rate of progression of periodontal attachment loss in an urban population of South Brazil: a 5-years population-based prospective study

AIM

The aim of this 5-years longitudinal study was to investigate the pattern and rate of periodontal attachment loss (PAL) progression in an urban population in South Brazil.

METHODS

In 2001, a multistage probability sampling strategy was used to derive a representative sample of 1,465 dentate individuals from Porto Alegre, Brazil. Five years later, 697 dentate individuals (294M/403F, mean age: 37.9 ± 13.3) were available for follow-up. PAL was assessed by calibrated examiners using a full-mouth protocol. Estimates of proximal PAL progression and standard errors (SE) are reported.

RESULTS

Fifty-six per cent (SE: 1.9) and 36% (SE: 1.8) of subjects showed PAL progression ≥3 mm affecting ≥2 and ≥4 teeth respectively. PAL progression ≥3 mm was mostly localized affecting 3.8 (SE: 0.2) teeth and 5.7 (SE: 0.3) sites. Annual PAL progression was, on average, 0.3 mm (SE: 0.01). Significant differences in PAL progression were observed according to age, gender, race and socioeconomic status. PAL progression increased with age reaching the highest progression rate in the 40-49 years cohort, and then decreased in older age groups. PAL progression was consistently higher among males and non-Whites than females and whites.

CONCLUSION

A large proportion of this urban Brazilian sample was affected by PAL progression underscoring the need for health promotion initiatives aiming at preventing progression of destructive periodontal disease.

Consumo de dentifrício e fatores associados em um grupo populacional brasileiro

Este estudo transversal avaliou o consumo de dentifrício fluoretado e fatores associados em Passo Fundo, Rio Grande do Sul, Brasil. Seiscentos e oitenta e oito domicílios foram selecionados. Um questionário estruturado foi respondido pela mãe para obter dados demográficos, hábitos e consumo de dentifrício. O consumo foi avaliado por intermédio da duração de um tubo de dentifrício e considerado baixo (duração > 1 mês) e alto (duração < 1 mês). Modelos de regressão logística avaliaram a associação do consumo com variáveis independentes. Foi observado que 61,2% dos domicílios apresentaram alto consumo de dentifrício. No modelo multivariado, idade da mãe > 50 anos (OR = 1.62; IC95% 1,02-2,61), frequência de escovação da mãe (OR = 2,53; IC95%: 1,53-4,16), número de moradores que utilizam escova (OR = 5,69; IC95%: 3,68-8,81) e motivo cosmético para escolha do dentifrício (OR = 1,64; IC95%:1,03-2,61) representaram maior chance de alto consumo de dentifrício. Conclui-se que a maioria dos domicílios apresenta consumo elevado de dentifrício, associado com idade e frequência de escovação da mãe, número de moradores e motivos de escolha.

Proposal for the teaching of the chemical control of supragingival biofilm

The mechanical control of supragingival biofilm is accepted as one of the most important measures to treat and prevent dental caries and periodontal diseases. Nevertheless, maintaining dental surfaces biofilm-free is not an easy task. In this regard, chemical agents, mainly in the form of mouthwashes, have been studied to help overcome the difficulties involved in the mechanical control of biofilm. The aim of this paper was to discuss proposals for the teaching of supragingival chemical control (SCC) in order to improve dentists' knowledge regarding this clinical issue. Firstly, the literature regarding the efficacy of antiseptics is presented, clearly showing that chemical agents are clinically effective in the reduction of biofilm and gingival inflammation when used as adjuvant agents to mechanical control. Thus, it is suggested that the content related to SCC be included in the curricular grid of dental schools. Secondly, some essential topics are recommended to be included in the teaching of SCC as follows: skills and competencies expected of a graduate dentist regarding SCC; how to include this content in the curricular grid; teaching-learning tools and techniques to be employed; and program content.

Professional toothbrushing as a method for diagnosing gingivitis in 3- to 6-year-old preschool children

PURPOSE

The aim of the present crossover study was to evaluate professional toothbrushing as a method for diagnosing gingivitis in children.

MATERIALS AND METHODS

Thirty-four preschool children who had gingival bleeding > or = 10% and without proximal restorations/carious lesions were included in the study. Examinations comprised two gingival indices recorded at a 15-min interval, in the following sequences: the Ainamo and Bay gingival bleeding index (GBI1) followed by the brushing index (BI2) and vice versa (BI1-GBI2). Half of the children started the study in the first sequence and the other half in the second. After a 3- to 4-day washout period, the indices were again recorded with individuals changing the sequences. Data analysis considered GBI as the gold standard, and sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were also calculated.

RESULTS

The overall mean value of gingival bleeding at the first examination was 18.85 +/- 9.24%. Validation of toothbrushing performed after GBI (BI2) resulted in values for SE, SP, PPV and NPV of 0.59 (95% CI, 0.55 to 0.63), 0.92 (95% CI, 0.91 to 0.93), 0.64 (95% CI, 0.60 to 0.69) and 0.90 (95% CI, 0.89 to 0.92), respectively. BI performed before GBI (BI1) resulted in similar SE, SP, PPV and NPV. Percentage agreement of GBI1-BI2 and BI1-GBI2 was 83.5% and 85.9%, respectively.

CONCLUSIONS

Professional toothbrushing can be suggested as a method for the diagnosis of gingival inflammatory status in children, especially as an indicator of gingival health.

Effect of tongue cleansing on morning oral malodour in periodontally healthy individuals

PURPOSE

The aim of this randomised single-blind, cross-over trial was to assess the effect of tongue cleansing on morning oral malodour in periodontally healthy subjects.

MATERIALS AND METHODS

Ten systemically healthy non-smoker subjects (6 males, 4 females), 24-38 years of age, completed two 4-day periods of oral hygiene cessation with a 7-day wash-out period. In one of these test periods, subjects were instructed to clean their tongues with a tongue scraper 2-3 times a day. Participants presented at least 20 teeth, without cavities, overhanging restorations/prostheses or periodontitis, and had no history of previous periodontal therapy or use of antibiotics in the 3 months prior to the study. Volatile sulphur compounds (VSC; Interscan Halimeter) and organoleptic scores were measured in exhaled mouth air once a day, early in the morning, by one examiner. Comparisons were performed using Wilcoxon's signed rank test and Friedman's test (alpha = 0.05).

RESULTS

VSC levels at baseline were 206.3 ppb (SD 139.8) and 191.4 ppb (SD 127.7) for periods of usage and non-usage of the scraper respectively (p > 0.05). VSC levels did not change significantly during the 4 days, independent of tongue cleansing (Friedman, p > 0.05). Only at day 3 did the use of the tongue scraper lead to a significantly lower level of VSC compared with controls (131.1 ppb and 199.3 ppb respectively). No significant differences in organoleptic scores were observed between groups at baseline. During the whole experimental period, there were also no significant changes in organoleptic scores when individuals used or did not use the tongue scraper.

CONCLUSION

Tongue cleansing with a scraper was unable to prevent morning oral malodour in the absence of tooth cleaning in periodontally healthy individuals.

Association between psychosocial factors and periodontitis: a case-control study

OBJECTIVE

This case-control study investigated the association between life events, anxiety, and depression with periodontitis.

METHODOLOGY

The study counted with 165 individuals, both sexes, 35-60 years of age. Case group included 96 individuals suffering from periodontal disease; and in control group 69 subjects with no history of periodontitis. Clinical examinations were performed by a single examiner. Psychological assessment included four inventories: Life Events Scale, Beck Anxiety Inventory, State-Trait Anxiety Inventory and Beck Depression Inventory. Bivariate and multivariate logistic regression analyses were performed to compare cases and controls.

RESULTS

Mean probing depth and clinical attachment level were 3.44+/-0.80 and 4.01+/-1.61 in the case group and 1.96+/-0.19 and 0.95+/-0.50 in the control group, respectively (p<0.05). Positive association of periodontitis with age (odds ratio (OR)=1.15 95% confidence interval (CI): 1.06-1.24), male gender (OR=2.71, CI: 1.13-6.49), smoking (OR=6.05, CI: 1.67-21.94) and educational level (OR=6.49, CI: 1.14-36.95) was confirmed. Bivariate analysis did not demonstrate significant mean differences in life events, anxiety symptoms, trait or state of anxiety, or depression symptoms between cases and controls. Multivariate logistic regression, controlling for confounding factors, demonstrated no significant association between psychosocial factors and periodontal disease.

CONCLUSIONS

Within the limits of this study it is possible to conclude that there was no significant association between periodontitis and the psychosocial factors analysed.