Self-estimation of oral malodor

Bad breath (halitosis, oral malodor) is a common condition, usually the result of microbial putrefaction within the oral cavity. Often, people suffering from bad breath remain unaware of it, whereas others remain convinced that they suffer from foul oral malodor, although there is no evidence for such. The purpose of the present investigation was to determine whether objective self-measurement of oral malodors is possible. Each of 52 volunteers was asked to sample the odor from his/her mouth, tongue, and saliva. Results were compared with (i) self-assessments prior to (preconception) and following (post-measurement) self-measurements; (ii) odor judge scores; (iii) dental-measurements (plaque index, gingival index, and probing depth); (iv) volatile sulphide levels; (v) salivary cadaverine levels; and (vi) intra-oral trypsin-like activity. Among the self-measurements, only saliva self-scores yielded significant correlations with objective parameters. Despite the partial objectivity of saliva self-estimates, subsequent post-measurement self-assessments failed to correlate with objective parameters. The results suggest that (i) preconceived notions confound the ability to score one's own oral malodors in an objective fashion; and (ii) partial objectivity can be obtained in the case of saliva self-measurement, presumably because the stimulus is removed from the body proper.

Effect of parapulpal pins on conservative restoration of pulpless premolars

Conservative restoration of pulpless premolars with composite resins is indicated in specific instances. The effect of parapulpal pins on marginal leakage and fracture resistance was evaluated in this in vitro study for composite resin restorations in 80 extracted, pulpless premolars. Conservatively prepared pulpless premolars restored with composite resin were resistant to occlusal forces and parapulpal pins were effective in reducing gingival marginal microleakage. Parapulpal pins significantly improved the marginal seal of composite resin restorations in pulpless teeth when the gingival margins of the restoration were placed in dentin.

Detection of psychopathologic trends in glossodynia patients

Glossodynia affects primarily middle-aged women. Although many possible etiologies have been proposed for the syndrome, most have not been substantiated. In the present study 56 glossodynia patients were evaluated for their psychopathologic profile as reflected by the SCL-90 questionnaire. The data show that glossodynia patients present a relatively high psychopathologic profile, especially on the scales of somatization and depression. Significant correlations were found between the intensity of pain experienced by the patients and some of the SCL-90 scales (somatization, depression, anxiety, GSI and PSDI). No correlations were found between SCL-90 scores and duration of symptoms, prevalence of symptoms per day and patient's condition during the past year. Patients living alone were found to differ significantly from those living with a significant other (overall group effect significant at the 0.01 level). The data suggest that psychopathologic trends may be associated with glossodynia.

Antecedents of burning mouth syndrome (glossodynia)--recent life events vs. psychopathologic aspects

Burning mouth syndrome--BMS (also known as glossodynia, glossalgia, glossopyrosis, or oral dysesthesia)--primarily affects middle-aged women. Many possible etiologies have been proposed to account for the syndrome; most are still unsubstantiated. One possible suggested etiology involves the presence of psychological components. In this study, 45 BMS patients and 45 age-, sex-, ethnic origin-, socio-economic status-, and education-matched control subjects were evaluated for their psychopathologic profile and existence of recent life events. All subjects were requested to complete the SCL-90 questionnaire and a Recent Life Changes questionnaire. The BMS patients scored significantly higher on all SCL-90 scales except one. A MANOVA test to evaluate the overall group effect was significant at the 0.0001 level. No differences between groups were found for recent life events. The data suggest that although BMS patients are subjected to elevated psychological stress, initiation of BMS symptoms is not necessarily correlated with stressful life events.

Dental anxiety: a cause for possible misdiagnosis of tooth vitality

Fear, anxiety and anticipation of pain are prepotent emotional and cognitive mediators of pain behaviour. As pain is often used as a parameter for evaluation of tooth vitality, existing dental anxiety may occasionally lead to possible misdiagnosis. A representative case is presented in which dental anxiety led to an initial misdiagnosis of endodontic pathology.

When pharmacologic anesthesia is precluded: the value of hypnosis as a sole anesthetic agent in dentistry

Occasionally, a dental patient presents his/her dentist with a history of hypersensitivity to local anesthetic agents. The symptoms may include immediate reactions to the injection procedure (dizziness, shortness of breath, tachycardia, etc), or delayed reactions to the anesthetic (swelling, urticaria, etc). Although the true incidence of local anesthetic allergy is low, such a history often involves the patient's anxiety regarding the use of the drug in question, and the dentist's apprehension to treat the "problematic" patient. In such cases, hypnosis can play a major role in controlling pain and the associated distress. In the present article, the method concerning the implementation of hypnosis to induce local anesthesia is described and illustrated through case demonstrations.

Correlates of success and failure in behavior therapy for dental fear

Extreme dental fear and avoidance are universal problems, with severe adverse effects on the patient's oral health. Although behavior modification techniques were shown to be effective in the treatment of this problem, their success is by no means absolute. In the present article, the SCL-90 questionnaire was used for development of possible predictive measures for success and failure of behavior modification as a treatment for dental fear. Patients who failed in treatment through behavior modification were found to score significantly higher on the global score of Positive Symptom Distress Index (p < 0.01) and on individual subscales of somatization (p < 0.02) and psychoticism (p < 0.05) than patients who were treated successfully. The predictive value of chosen SCL-90 scales was 71%. The results suggest that use of SCL-90 may be valuable for the prediction of success and failure of behavior modification as a treatment for dental fear and avoidance.

Halitosis measurement by an industrial sulphide monitor

Previous studies have established that hydrogen sulphide and mercaptans are the primary components of halitosis (bad breath). In the present investigation, we report a simple, rapid technique for measurement of halitosis-related sulphides. The technique is based on a portable instrument generally used for environmental safety applications. Seventy-five volunteers were measured using this technique, and the results (in peak ppb hydrogen sulphide equivalents) compared with organoleptic assessment by 7 judges. A highly significant overall correlation (r = 0.603; P less than 0.001) was obtained between these 2 methods. Moreover, in most cases, the organoleptic ratings of the individual judges correlated more highly with sulphide monitor values than with one another. The simplicity of the technique suggests its use in clinical studies as well as in diagnosis and treatment of patients with this complaint.

Hypnotic induction in dentistry--coping with the fear of losing control (autonomy): a brief communication

A common cause of stress among dental patients is the patient's fear of losing control in face of the "helplessness provoking" dental situation. Although hypno-relaxation and hypnosis serve as efficient tools to aid in the administration of dental treatment to such patients, some of them may view hypnosis as a further relinquishing of control to the hypnotist and thus resist hypnotic induction, despite their willingness to try to use hypnosis for therapeutic reasons. To avoid this resistance, a "self-control" induction method is suggested that enables the patient to remain in control throughout the process. This technique minimizes the threat of losing one's autonomy and thus enables treatment of these patients.

Wedges in restorative dentistry: principles and applications

Overhanging margins of proximal restorations are a well-known, iatrogenic cause of periodontal pathology. The high incidence of such findings in Western societies should arose the concern of the dental community. However, overhanging margins represent only part of the iatrogenic problem created by the misuse of wedges in restorative procedures. Other causes include incorrect proximal contouring, inadequate contact points and under- or overfilling the restorative material. The understanding of the variables associated with wedge selection and positioning has a major role to play in the prevention of iatrogenic periodontal pathology associated with restorative procedures. It is concluded that: (i) the occlusion of the matrix band to the remaining healthy tooth structure of the gingival cavosurface line angle should be achieved solely by the correct application of the wedges; (ii) the effect of the wedges on the proximal contour and contact area should be carefully re-evaluated prior to insertion of the restorative material; (iii) various sizes and shapes of wedges and a sharp knife for carving must be readily available.

Glass ionomer cement restorations: the effects of lasing the cavity walls on marginal microleakage

Glass Ionomer cements are used in modern dentistry for various preventive purposes, one of which is the treatment of cervical caries lesions. Anticariogenic properties and the ability to bond to dentin and enamel are their main advantages. Since acid-etching of the tooth prior to glass ionomer placement is contraindicated, a "dry" defocused laser beam was used to enhance retention. The results indicate that finishing the cavity walls with a laser beam increased the marginal microleakage of the glass ionomer cement restorations. Thus, the procedure was apparently found unsuitable for clinical use.

Identification of the rhamnose-sensitive adhesin of Capnocytophaga ochracea ATCC 33596

The coaggregation of the Gram-negative microorganism Capnocytophaga ochracea ATCC 33596 with several Gram-positive bacteria, including streptococci, actinomyces and rothia, is mediated by rhamnose-sensitive adhesin(s). In the present study, MAbs against the C. ochracea adhesin(s) were prepared. These antibodies inhibited all the rhamnose-sensitive interactions, indicating that they recognize epitopes at or near the rhamnose binding site of the adhesin. The monoclonals served as probes in immunoblot analysis and recognized a polypeptide of Mr 155 K present in the wild-type organism but absent in a coaggregation defective mutant. It is concluded that the rhamnose-sensitive interactions of C. ochracea are mediated by a 155 K Mr polypeptide present on its outer surface.

Effect of adhesive antibiotic TA on plaque and gingivitis in man

The adhesive antibiotic TA was applied to the dento-gingival junction of 8 human volunteers, suffering from moderate to severe gingivitis. 2 diametrically opposed quadrants of the mouth received 4 applications of 0.1 mg TA, while the other 2 quadrants were treated with a placebo and served as controls. The plaque index, gingival index and bleeding index were scored periodically for 2 weeks and in 4 patients for up to 30 days. The TA-treated quadrants showed a rapid decrease in all 3 indices following 2 treatments. A further improvement was observed with the 3rd and 4th treatments. 30 days after the onset of the experiment and 23 days after the last application, the indices were still considerably lower than the initial values.

Effect of the birth process on the neonatal line in primary tooth enamel

The neonatal line is a histologic landmark in primary tooth enamel corresponding to the event of birth. The average width of the neonatal line (NNL) in primary tooth enamel of 147 children was measured. In children with normal birth histories the width of the NNL was found to be 11.9 +/- 4.8 microns. It was wider (18.6 +/- 5.7 microns) in children born by difficult operative delivery and thinner (7.6 +/- 1.5 microns) in children born by Caesarean section. The data suggest that concomitant with the change from intrauterine to extrauterine environment, the birth process itself also contributes to the width of the NNL.

The plastic cap--an improved technique for impression taking

An improved impression technique is described using a plastic, transparent, flexible cap in combination with silicone impression materials. The technique can easily be applied at the chairside by the clinician and provides a solution to some of the present problems in impression with minimal trauma to the surrounding tissues.

Repair of an overcontoured cemented crown

A method for retracting gingival tissue to allow recontouring of crown surfaces and removal of overhanging margins has been presented.

Cell surface hydrophobicity of Actinobacillus actinomycetemcomitans Y4

Oral bacteria colonize the dento-gingival tissues in a selective manner. Hydrophobic reactions have been suggested as one of the major mechanisms of adhesion. Hydrophobicity of Actinobacillus actinomycetemcomitans Y4 (Aa) cells was studied in vitro using adherence to the liquid hydrocarbon, octane. Adherence of Aa cells to octane varied from 60-90%, depending on the medium in which they were grown, age of the culture and the buffer in which the assay was carried out. These data suggest that Aa is a hydrophobic bacterium, the hydrophobicity of which is expressed to a varying degree, and may have a rôle in its adherence to oral tissues.

Separation of amphipathic proteins based on adsorption to hexadecane:water interfaces

A method is proposed for the relatively simple and rapid separation of amphipathic biopolymers, based on adsorption onto and desorption from the surface of hexadecane droplets. Adsorption to the hexadecane:water interface was carried out by mixing hexadecane with aqueous protein solutions at room temperature. Desorption was performed by consecutive solidification and melting of the liquid hydrocarbon (m.p. 18 degrees C), resulting in coalescence of the droplets and reappearance of the desorbed moiety in the bulk aqueous phase. Of interest was the observation that lysozyme remains enzymatically active following this procedure.