How severe is the threat of caries to old teeth?

Caries is a bacterial infection caused by a complex interaction of biologic and behavioral factors. It is believed that caries is a major threat to teeth in old age, yet little information is available on the incidence and progress of carious lesions in elderly teeth. All too often caries is diagnosed after a visual and tactile examination of tooth structure without thought for the other factors essential to the initiation and support of an active lesion. Prospective studies have been conducted recently in Vancouver to quantify associations between the incidence of caries and many of the behavioral, bacteriologic, and physiologic factors potentially influencing oral health in old age. The results indicate that improvements in hygiene may hold the most promise for controlling this infection in an elderly population.

Submucosal root retention. A two-year clinical observation

Eight subjects had the crowns of 21 teeth surgically amputated, and the roots were covered by alveolar mucosa. At the time of surgery, 17 teeth were vital and four had received endodontic therapy. After an average 2-year-period, 12 teeth (57%) remained submerged without complications. Two roots have been extracted, three have been successfully converted to regular overdenture abutments, and the remaining four have appeared in the mouth and are still under observation. Caution is urged as to expectations of a long-term prosthetic benefit from this procedure.

A retrospective study on the maintenance and repair of implant-supported prostheses

This study reviewed the prosthodontic treatment and aftercare required by 29 patients with 32 implant-supported prostheses (12 fixed and 20 removable) placed on 107 implants. Patients were followed for 4 to 39 months. The majority of implant-supported prostheses (53%) were placed in the mandible. Visual analogue scales were used by the patients to rate their satisfaction with their prostheses and their chewing ability. Approximately one third of the patients studied required three or more relines of their existing dentures between first- and second-stage surgeries, while over half of the definitive implant-supported prostheses required a major adjustment or repair. Removable prostheses required 78% of the total repairs and accounted for 80% of those prostheses that needed repeated repairs. In general, patients were very satisfied with their implant-supported prostheses, but 17% complained of mild speech difficulties and 7% noted slight difficulty in cleaning their fixed prostheses. Overall, the short-term prosthetic management required for the implant-supported prostheses in this study was substantial, particularly with the removable prostheses, and this should be taken into account when evaluating prosthetic options.

An electronic oral health record to document, plan and educate

The University of British Columbia (UBC) in collaboration with a software developer (Planmeca Oy, Finland) created an electronic oral health record based on the principles of cognitive ergonomics rooted in the European research and development project 'ORQUEST' to guide students through medical, dental, social histories, examinations, treatment planning and progress notes. Clinicians in each dental specialty of the Faculty of Dentistry and software engineers cooperated to define the clinical content and workflow of clinical procedures in three phases: (i) development of a radiographic module, (ii) development of medical, dental, social and family histories, intra- and extra-oral examinations, progress notes and treatment planning and (iii) development of the orthodontic section accompanied by an optimisation phase to correct technical problems and clinical content issues. From a practical perspective, this EOHR enhances the clinical performance of students and the quality assurance capacity of the institution. It facilitates audits of clinical productivity and research, and it can be modified with relative ease to suit similar educational and clinical environments in either public or private healthcare settings.

A prospective study on the maintenance of implant prostheses in private practice

This study examined the adjustments, repairs, time, and costs required to maintain 69 implant prostheses in private prosthodontic practice for an average of 22 months after placement. For the removable prosthesis design, the most common adjustment was contouring the prosthesis and the most common repair was retentive component replacement. Screw tightening or fracture repair were the most frequently needed modifications for fixed implant prostheses. Each removable implant prosthesis averaged four times as many postplacement adjustments and almost twice as many repairs as did each fixed implant prosthesis, and the mean length of each maintenance appointment was also longer for removable prostheses. Mean repair costs were approximately 60% higher for the removable design.

Cost analysis of fabricating implant prostheses

This prospective study analyzed the time and costs involved in fabricating implant prostheses in private practice and the factors affecting prosthesis design. Esthetic was the most commonly reported factor influencing the decision to use a fixed or removable prosthesis, while cost was infrequently cited. The single-tooth fixed implant required the least time to fabricate and had the lowest clinical fees, while the removable bar/clip prosthesis had the highest fees and demanded the greatest amount of time to fabricate. Single-tooth fixed and individual attachment removable prostheses generated approximately half the hourly income produced by multiple-unit fixed and bar/clip removable implant prostheses, and the individual attachment design had the highest ratio of expenses to income.

Issues in the amalgam debate

This paper reviews the facts available on the biological effects of mercury released from amalgam restorations in teeth. There seems to be no doubt that mercuric vapor is released from restorations, but we do not know how much of this mercury is deposited in human tissues. There is no scientific evidence to support the belief that vapors from dental restorations either cause or exacerbate human diseases. Therefore, there is no clinical justification at present for replacing amalgam with other less durable or less predictable restorative materials.

A comparison of two methods for removing zinc oxide-eugenol provisional cement

Two methods of removing zinc oxide-eugenol (ZOE) luting cement from amalgam were compared by determining their effect on the tensile bond strength of amalgam cylinders luted together using a 4-META resin cement. The samples were examined using scanning electron microscopy and energy dispersive x-ray analysis. Results showed that mechanical cleansing with pumice leaves ZOE residue mixed with pumice, which inhibits bonding, while the bond strength of samples cleansed with a dental degreasing agent was similar to that of an uncontaminated control group.

Opinions of dentists on an integrated fixed and removable prosthodontic curriculum

Dentists in practice from 3 to 5 years who were exposed to an integrated fixed and removable prosthodontic curriculum as students at the University of British Columbia responded to a survey on the relevance of their prosthodontic education to current dental practice. The majority of the respondents reported that the integrated curriculum prepared them adequately for general dental practice, although many felt that they would have benefited from a greater emphasis on specific treatments, most notably cast metal inlays and onlays, all-ceramic restorations, and implant-supported prostheses.

The roots of dentistry in ancient China

The history of dentistry in China is closely aligned with the remarkable developments in Chinese medicine over at least six millennia. Rudimentary dental extractions were performed as early as 6000 BC, when the first signs of adornment with human teeth were described. There were actually four distinct periods of medical development in China: the Mystical Period; the Golden Period; the Controversial Period; and the Transitional Period. The Golden Period was marked by the appearance of the first textbooks to describe preventive and restorative dental techniques, as well as the first colleges. Dentistry then moved through the dark times of the Controversial Period, when war mongering stymied progress. Lasting until 1800 AD, it came to an end with the domination of Western medicine and dentistry. This paper chronicles the development of dentistry in China, revealing that it has been a part of Chinese life for a long time.

Restorative treatment for geriatric root caries

The restorative management of root caries poses many challenges to the clinician. The clinical features of root caries and current restorative techniques using new adhesive materials are discussed.