Microbial analysis of bone collected during implant surgery: a clinical and laboratory study

Dental implant surgery produces bone debris which can be used to correct bone defects in the "simultaneous-augmentation" technique. However, this debris is potentially contaminated with oral bacteria. Therefore, this study examined bone debris collected during dental implant surgery in order 1) to identify the microbial contaminants and 2) to compare the effects of two different aspiration protocols on the levels of microbial contamination. Twenty-four partially dentate patients were randomly allocated into two equal groups and underwent bone collection using the Frios Bone Collector during surgery to insert two endosseous dental implants. In group S (using a stringent aspiration protocol), bone collection occurred within the surgical site only. In group NS (utilizing a non-stringent aspiration protocol), bone collection and tissue fluid control was achieved using the same suction tip. Bone samples were immediately transported for microbial analysis. Colonial and microscopic morphology, gaseous requirements and identification kits were utilized for identification of the isolated microbes. Twenty-eight species were identified including a number associated with disease, in particular, Enterococcus faecalis and Staphylococcus epidermidis as well as the anaerobes Actinomyces odontolyticus, Eubacterium sp., Prevotella intermedia, Propionibacterium propionicum and Peptostreptococcus asaccharolyticus. In group S (stringent aspiration protocol), significantly fewer organisms were found than in group NS, the non-stringent aspiration protocol (P=0.001). Gram-positive cocci dominated the isolates from both groups. It is concluded that if bone debris is collected for implantation around dental implants, it should be collected with a stringent aspiration protocol (within the surgical site only) to minimize bacterial contaminants.

Predicting population dental disease experience at a small area level using Census and health service data

BACKGROUND

Information on the dental disease patterns of child populations is required at a small area level. At present, this can be provided only by expensive whole population surveys. The aim of this study was to evaluate the ability of Census data combined with health service information to provide estimates of population dental disease experience at the small area level.

METHOD

Clinical dental data were collected from a large cross-sectional survey of 5-year-old children. A preliminary series of bivariate linear regression analyses were undertaken at ward level with the mean number of decayed, missing or filled teeth per child (dmft) as the dependent variable, and the Census and health service and lifestyle variables suspected of having a strong relationship with dmft as independent variables. This was followed by fitting a multiple linear regression model using a stepwise procedure to include independent variables that explain most of the variability in the dependent variable dmft.

RESULTS

All deprivation indicators derived from the Census showed a highly significant (p<0.001) bivariate linear relationship with ward dmft. The Jarman deprivation score gave the highest R2 value (0.45), but the Townsend index (R2=0.43) and the single Census variable 'percentage of households with no car' (R2 = 0.42) gave very similar results. The health and lifestyle indicators also showed highly significant (p<0.001) linear relationships with dmft. The R2 values were generally much lower than the deprivation-related Census variables, with the exception of the percentage of residents who smoked (R2 = 0.42). None of the health or lifestyle variables was included in the final dental disadvantage model. This model explained 51 per cent of the variability of ward dmft.

CONCLUSIONS

The results demonstrate the strong relationship between dental decay and deprivation, and all of the commonly used measures of deprivation exhibited a similar performance. For this population of young children health and health services shelf data did not improve on the ability of deprivation-related Census variables to predict population dental caries experience at a small area level.

Water fluoridation, poverty and tooth decay in 12-year-old children

AIM

To examine the influence of water fluoridation, and socio-economic deprivation on tooth decay in the permanent dentition of 12 year old children.

SETTING

The North of England, fluoridated Newcastle and non-fluoridated Liverpool. A total of 6,638 children were examined.

OUTCOME MEASURES

Multiple Regression analysis of fluoride status, mean electoral ward DMFT in 1992/93 and ward Townsend Scores from the 1991 census.

RESULTS

Social deprivation and tooth decay were significantly correlated in areas with and without water fluoridation. Multiple linear regression showed a statistically significant interaction between ward Townsend score, mean DMFT and water fluoridation, showing that the more deprived the area the greater the reduction in tooth decay. At a Townsend score of zero (the English average) there was a predicted 37% reduction in decay in 12-year-olds in fluoridated wards.

CONCLUSIONS

Tooth decay is strongly associated with social deprivation. The findings confirm that the implementation of water fluoridation has markedly reduced tooth decay in 12-year-old children and that socio-economic dental health inequalities are reduced.

Sugar, drinks, deprivation and dental caries in 14-year-old children in the north west of England in 1995

OBJECTIVES

To examine associations between dental caries and reported drink consumption.

DESIGN

A cross-sectional caries prevalence study including reported drink consumption.

SETTING

Secondary schools across the former North Western Region of England.

SUBJECTS

A random sample of 6,014, 14-year-old children.

RESULTS

The mean DMFT of the sample was 2.74. The reported mean weekly consumption of cans of carbonated drinks was 5.66, with a range of zero to 42. There was a significant gender difference in drink consumption and a significant correlation between the reported weekly consumption of cans of carbonated drinks and DMFT. Logistic regression analysis showed tea drinkers had a significantly lower DMFT than coffee drinkers and that this effect was independent of the addition of sugar and the number of cans of drink consumed. Reported use of sugar-free carbonated drinks was not associated with better dental health.

CONCLUSIONS

Reported consumption of sugared drinks and carbonated drinks was associated with significantly higher levels of dental caries. Drinking tea was associated with lower levels of caries. Sugar-free drinks were not associated with better dental health.

Extraction of teeth over 5 years in regularly attending adults

OBJECTIVES

This prospective study was conducted to describe the incidence of tooth extraction in a group of regularly attending adults and to assess factors that are predictive of tooth loss.

METHODS

Baseline and annual incremental clinical data were obtained from 23 general dental practitioners on a group of their regularly attending, dentate adult patients over a 5-year period. The patients completed a postal questionnaire with questions relating to dental health behaviours, attitudes and knowledge, and social factors.

RESULTS

Complete clinical data were obtained from 2799 patients. Four hundred and seventy (17%) patients underwent extractions, 72% of which were posterior teeth. The majority of extractions were for reasons other than caries (79%). Bivariate analyses revealed many significant differences between patients who underwent extractions and those who did not, with respect to the clinical, social, behavioural and attitudinal variables. The logistic regression model for tooth loss included three clinical variables, number of teeth, crowns and sites with recession. Other variables in the final model included the dentist's and patient's prediction of treatment need, having sensitive teeth, having a sweet tooth, living alone and smoking. The sensitivity for the model was 0.57 with specificity 0.72.

CONCLUSIONS

This study is unique in its examination of patients and has highlighted that both clinical and other factors are important in predicting who will undergo extractions. Future investigations should assess the consequence of having extractions in terms of health benefit or detriment.

Radiomorphometric indices of the mandible in a British female population

OBJECTIVES

To examine the radiomorphometric indices of the mandible on panoramic radiographs in a population of British female patients, to identify their normal ranges and to investigate their relationships with age, detentition and social class.

METHODS

Five indices, cortical width at the gonion (GI) and below the mental foramen (MI), the panoramic mandibular index (PMI), the mandibular cortical index (MCI) and one new index (measurement of cortical width at the antegonion; AI), were measured bilaterally on 500 panoramic radiographs of females by one trained observer. The measurements were analysed for ease of application, repeatability, relationships with age, dentition and social class and interrelationships between the variables.

RESULTS

All quantitative indices (GI, MI, PMI, AI), showed a significant, negative correlation with age. MCI showed an age-related distribution. Mandibular dentition exerted a significant influence on some indices, but social class had no influence. Intra-observer repeatability of MI, PMI and AI was fair (precision < 20%) but that for GI was poor. Intra-observer agreement in MCI assessments was excellent.

CONCLUSIONS

The age-related changes in mandibular radiomorphometric indices and their variation within each age band lend support to their potential use in identification of skeletal osteopenia. However, problems with repeatability and measurement precision identified in the pilot study, notably with GI, may be a considerable obstacle to their use in general practice.

The relationship between water fluoridation and socioeconomic deprivation on tooth decay in 5-year-old children

AIM

To examine the relationship between water fluoridation, socioeconomic deprivation and tooth decay in 5-year-olds.

SETTING

10,004 children: 1,051 in naturally fluoridated Hartlepool in 1991/92, 3,816 in fluoridated Newcastle & North Tyneside and 5,137 in non-fluoridated Salford & Trafford in 1993/94.

OUTCOME MEASURES

Correlations between mean electoral ward dmft and ward Townsend Scores from the 1991 census.

RESULTS

Regardless of the level of water fluoridation significant correlations were found between deprivation and tooth decay. Multiple linear regression models for dmft showed a statistically significant interaction between ward Townsend score, and both types of water fluoridation, confirming the more deprived the area the greater the reduction in tooth decay. At a Townsend score of zero (the English average) there was a predicted 43% reduction in decay in 5-year-olds in fluoridated areas.

CONCLUSIONS

Tooth decay is strongly associated with social deprivation. The findings confirm that the implementation of water fluoridation has halved tooth decay in 5-year-old children and that the dental caries divide between rich and poor is reduced.

Predicting which adult patients will need treatment over the next year

This prospective study was conducted to determine factors important in predicting which regularly attending adult patients would receive first, restorations or extractions for any reason (receiving treatment) and, second, restorations or extractions undertaken specifically for caries (receiving treatment related to caries). Baseline and incremental clinical data were obtained from 24 general dental practitioners on a group of their regularly attending, dentate adult patients over a 12-month period. The patients completed a postal questionnaire with questions relating to dental health behaviour, attitudes, knowledge, and social factors. Complete data were obtained from 2553 patients. Thirty-one variables were identified as potential predictors for the two dependent variables receiving treatment and receiving treatment related to caries, and logistic regression models were fitted. Receiving treatment was associated with having fewer sound teeth and more anterior fillings, posterior fillings and crowns (P < 0.001). The dentist's prediction of the need for treatment related to caries and the patient's own prediction of the need for a filling were also important in the model (P < 0.001). Some of these variables, together with having received recent medical treatment and taking sugar in tea or coffee were also found to predict treatment related to caries. The model for receiving treatment related to caries was more successful at predicting the patient's individual risk but the model for receiving treatment was slightly better at classifying patients into whether or not they received treatment. It is reassuring that the common assumptions made by the dental practitioners of their patient's risk have received statistical validation.

Panoramic mandibular index as a radiomorphometric tool: an assessment of precision

OBJECTIVES

To evaluate the intra-observer repeatability and inter-observer reproducibility of the measurements used in deriving the Panoramic Mandibular Index (PMI).

METHODS

Two observers measured 21 dental panoramic radiographs independently of each other, both repeating the measurements after a period of 1 week. The measurements were then evaluated using a number of statistical methods.

RESULTS

All sets of compared measurements, both within and between observers, demonstrated significant positive correlations, with no significant difference between measurements Precision, however, was poor and variable.

CONCLUSION

The main difficulties in obtaining consistency in repeated measurements were related to individual morphology and radiodensity. In order to improve the validity of the PMI as a measure of local bone loss, repeatability of the measurements should be improved. Suggestions as to how this, might be achieved are discussed.

The prevention of failed appointments in general dental practice

AIM

To identify those patients most likely to fail to attend dental appointments.

DESIGN

Retrospective analysis of the attendance pattern of patients.

SETTING

A National Health Service practice in Kent.

SUBJECTS AND METHODS

Dental records of 1000 patients.

MAIN OUTCOME MEASURES

Data (age, gender, plaque score, treatment planned, whether the patient was exempt from charges, distance between their home and the practice) were related to attendance history.

RESULTS

34.8% of patients receiving income support and 24.8% of children failed to attend compared with 18.6% of non-exempt adults. Differences between non-exempt adults and children [per cent difference 6.2%, CI = (0.6%, 11.8%)] and for those receiving income support [per cent difference 16.2%, CI = (6.2%, 26.2%)] were significant (P < 0.05). A significant improvement in the appointment failure rate was achieved using telephone reminders.

CONCLUSIONS

Patients exempt from dental charges (mainly children and those receiving income support) were more likely to have failed to attend for their appointment. Whereas the attendance of children may be outside their control in some cases, we hypothesise that factors such as poverty in the group receiving income support may be an important influence in whether these patients feel able to attend for their appointments.

Measurement of tooth mobility in children using the periotest

This study investigated the use of the periotest for measuring tooth mobility of upper permanent incisor teeth in children. A total of 160 children, with equal numbers of boys and girls aged between 9 and 16 years had two periotest readings made on their four upper incisor teeth. In all 1,280 measurements were collected and analysed. The results showed that the second periotest readings were statistically significantly higher than the first. Periotest readings were lower for girls than boys of the same ages. The periotest may have a place as a diagnostic tool in paediatric dentistry and dental traumatology, however, further research is necessary before the periotest can be used to assist in the diagnosis and assessment of healing of traumatised teeth.

Dietary intake of micronutrient antioxidants in relation to blood levels in patients with systemic sclerosis

OBJECTIVE

To document habitual intakes of micronutrient antioxidants in patients with systemic sclerosis (SSc) in light of studies reporting subnormal levels of ascorbate and selenium in this patient group.

METHODS

Dietary intakes of vitamin C, selenium, alpha-tocopherol, beta-carotene, and sulfur amino acid precursors of glutathione were assessed using the 7 day weighed record in 12 patients with SSc and in 12 healthy control subjects. The intakes of the first 4 substances were examined in relation to plasma/serum levels, while intakes of sulfur amino acids were examined in relation to urinary inorganic sulfate.

RESULTS

Antioxidant and sulfur amino acid intakes were similar in patients and controls, although the patients had lower levels of selenium (median 74 compared to 87 milligrams in controls; p = 0.014) and of vitamin C in plasma (median 6.0 compared to 11.1 milligrams/l in controls; p = 0.08). Inorganic sulfate concentration in urine was similar in patients and controls.

CONCLUSION

Our results suggest that reduced blood levels of the water soluble antioxidants selenium and ascorbic acid in patients with SSc are not due to dietary deficiency. Other explanations must therefore be sought.

A radical view of gallstone aetiogenesis

It is proposed that gallstones stem from insufficiency of micronutrient antioxidants relative to the load of oxidants and/or oxidation-prone substrates within hepatocytes in such a way that ancillary hepatobiliary resources, including bilirubin with lactoferrin and mucin, are mobilized to combat oxidative stress but inadvertently promote lithogenesis. Aberrant activities of hepatic cytochrome P450 mono-oxygenases and of haem oxygenase are integral to this template, because differential inhibition or activation of these enzymes would help to rationalize the spectrum of human gallstone composition and also the different outcomes when animals are fed the same lithogenic diets. The hypothesis is based on a decade of work on another lithogenic disease, chronic pancreatitis. It accommodates observations on human and experimental gallstones, it is testable and, as shown by studies of chronic pancreatitis, has implications for primary disease prevention.