Subgingival distribution of yeast and their antifungal susceptibility in immunocompetent subjects with and without dental devices

Yeasts colonize the subgingival biofilm, which becomes a reservoir that favors their reproduction. The purpose of the present work was to determine the prevalence of yeasts of the Candida genus in the subgingival biofilm of gingivoperiodontal disease patients, including users and non-users of dental devices, and their susceptibility to fluconazole and voriconazole. Samples of subgingival pockets of immunocompetent nonsmokers showing gingivitis and periodontitis were inoculated in a differential chromogenic medium. Sixty three percent of subjects used dental devices. Yeasts were identified and susceptibility to fluconazole and voriconazole was tested following CLSI M44-A standards. The prevalence of yeasts in the subgingival biofilm was 40% CI 95% (30.5-50.3); 10% were patients who did not use dental appliances. The most frequently observed yeasts were C. albicans, and C. parapsilosis, C. dubliniensis, C. tropicalis and C. guilliermondii. Only C. dubliniensis and C. guilliermondii showed resistance to azoles. The use of dental devices significantly increased the prevalence of yeasts in periodontal pockets inpatients presenting gingivitis. It is noteworthy that non albicans Candida species, such as C. dubliniensis and C. guilliermondii, considered emerging species, which have a diminished susceptibility to antifungal agents were found in the crevicular fluid of immunocompetent patients.

Prevention of white spot lesions in orthodontic practice: a contemporary review

The development of white spot demineralization associated with fixed appliance orthodontic treatment is a significant clinical problem. Both established and experimental methods for prevention of such lesions in day-to-day clinical practice are presented and discussed.

The safety of nickel containing dental alloys

Nickel is a constituent of many dental alloys. This paper reviews mainly papers published after 1985 with regards to biological reactions to nickel in dentistry. Nickel is an allergen, but there is no evidence that individual patients are at a significant risk of developing sensitivity solely due to contact with nickel-containing dental appliances and restorations. Hypersensitivity reactions to nickel are only likely to occur with prior sensitization from non-dental contacts and even these are rare. Clinical evidence has been presented to show that small doses of nickel, e.g. from dental appliances, may induce tolerance to this allergen. The papers reviewed report low rates of release of nickel from dental alloys. Some nickel compounds, which are mildly cytotoxic, have been implicated as carcinogens by inhalation in industrial settings, but these compounds are not present in dentistry-related operations, including dental technology procedures. Nickel-containing alloys and compounds have not been associated with increased cancer risk by oral or dermal routes of exposure. It is concluded that, subject to use according to established techniques, nickel-containing dental alloys do not pose a risk to patients or members of the dental team.

An atypical lingual lesion resulting from the unhealthy habit of sucking the lower lip: clinical case study

Unhealthy oral habits may be involved in the etiology of a malocclusion, since they may affect development of the orofacial region. There is little information on the habit of sucking the lower lip, to which practitioners attribute less clinical consequences. However, lower lip sucking is a harmful habit which appears frequently in children, especially during situations requiring increased attention and mental concentration. In patients presenting lower lip sucking, strong contractions of the lower lip's orbicular's muscle and the mentalis muscle, associated with hypertonicity of the upper lip caused by sucking, has to be balanced by lingual thrusting during the act of deglutition. A case is presented in which failure to identify the habit of lower lip sucking led to an atypical lesion on the tongue, caused by the tongue's impaction against the orthodontic appliance prescribed to correct a malocclusion. The recognition and elimination of an unhealthy habit is of great importance in diagnosis and the establishment of a treatment plan, so that undesirable complications can be avoided.

Sagittal, vertical, and transverse changes consequent to maxillary molar distalization with the pendulum appliance

INTRODUCTION

The purpose of this study was to evaluate the skeletal and dental changes in patients who underwent distalization of their maxillary molars with pendulum appliances.

METHODS

The sample consisted of 31 patients (initial mean age, 14.58 years) with Angle Class II molar relationships and all permanent teeth up to the second molars. The maxillary molars were distalized with pendulum appliances for a mean period of 5.87 months. Lateral cephalograms, 45 degrees oblique radiographs, and dental casts were obtained before and after distalization. Changes produced by the pendulum appliance were analyzed with paired t tests.

RESULTS

Maxillary first molar distalization accounted for 63.5% of the space opening; mesial movement of the maxillary first premolars contributed 36.5% of the space. The mean space opening on lateral cephalograms was 7.25 mm, and the rate of molar movement was 1.23 mm per month. The mean distalization of the maxillary molars was 4.6 mm, with a mean distal crown tipping of 18.5 degrees The maxillary molars experienced expansion, with a smaller effect on the first molars than on the second molars. The pendulum appliance produced symmetrical expansion, with a rate of 1.04 mm per month on the right and 1.10 mm per month on the left.

CONCLUSIONS

The pendulum appliance is effective for distalization of the maxillary molars and the establishment of a Class I molar relationship in a relatively short time. However, caution is needed to control collateral effects, including mesial movement of the first premolars and distal tipping of the molar crowns.

Loss of a clinical attachment level in a child: differential diagnosis with aggressive periodontitis. Case report

A nine-year-old boy presented with a serious periodontal lesion caused by a rubber band that had been used to close a medial diastema. Surgery was required to remove it. The impaction of a foreign body in the periodontal space should be suspected when a clinical attachment level is lost during childhood.

Treatment of Obstructive Sleep Apnea and Hipoapnea Syndrome with oral appliances

Obstructive sleep apnea and hipoapnea syndrome (OSAHS) is a disorder that affects about 4% of the adult population, and besides the social problems associated to snoring and extreme day time sleepiness, it is preoccupying since it may cause pulmonary hypertension and cardiac failure.

Review and discussion

Through a literature review, we discuss the use of oral appliances to treat this condition, in regards of therapy effectiveness and limitations, main clinical symptoms, major occlusal side effects, rate of improvement and patient satisfaction.

Conclusions

We concluded that the use of oral appliances should be a first choice treatment for mild to moderate OSAHS, being dental, joint and muscular discomforts, hypersalivation and xerostomia, the most frequent clinical symptoms, with light occlusal side effects that normally do not bother the patients, with a good degree of improvement and high satisfaction index.

Pain relief by single low-level laser irradiation in orthodontic patients undergoing fixed appliance therapy

INTRODUCTION

The objective of this study was to analyze the effect of single low-level laser therapy (LLLT) irradiation on pain perception in patients having fixed appliance treatment.

METHODS

Seventy-six patients (46 women, 30 men; mean age, 23.1 years) enrolled in this single-blind study were assigned to 2 groups. The patients in group 1 (G1; 38 patients, 13 men, 25 women; mean age, 25.1 years) received a single course of LLLT (Mini Laser 2075, Helbo Photodynamic Systems GmbH & Co KG, Linz, Austria; wavelength 670 nm, power output 75 mW) for 30 seconds per banded tooth. The patients in group 2 (G2; 38 patients, 17 men, 21 women; mean age, 21.0 years) received placebo laser therapy without active laser irradiation. Pain perception was evaluated at 6, 30, and 54 hours after LLLT by self-rating with a standardized questionnaire.

RESULTS

Major differences in pain perception were found between the 2 groups. The number of patients reporting pain at 6 hours was significantly lower in G1 (n = 14) than in G2 (n = 29) (P <.05), and the differences persisted at 30 hours (G1, n = 22; G2, n = 33) (P <.05). At 54 hours, no significant differences were seen between the number of patients reporting pain (G1, n = 20; G2, n = 25), although the women had a different prevalence between G1 (n = 11) and G2 (n = 15) (P = .079). At 6, 30, and 54 hours, more than 90% of the subjects in both groups described the pain as "tearing."

CONCLUSIONS

LLLT immediately after multibanding reduced the prevalence of pain perception at 6 and 30 hours. LLLT might have positive effects in orthodontic patients not only immediately after multibanding, but also for preventing pain during treatment.

Severe external apical root resorption associated with orthodontic treatment

External apical root resorption (EARR) is frequently associated with orthodontic treatment, however, the amount of root resorption is rarely of clinical significance. Severe EARR does, however, constitute a clinically significant problem. In contrast to the vast majority of the literature pertaining to EARR, the focus of this research project was restricted to only severe cases of EARR. The purpose of this study was to test whether frequently cited treatment-related variables played a significant role in the development of severe EARR. The difference between minor and severe EARR seems unlikely to be associated with the treatment that is received, but is instead inextricably linked to the genetic makeup of the patient.

[Clinical analysis of PLI, GI and SBI in patients with fixed orthodontic appliances]

PURPOSE

The aim of the present study was to carry out a detailed analysis of the data on PLI, GI, SBI in fixed orthodontic patients.

METHODS

375 middle school students aged 12 to 15 years old were selected as control group, including 196 boys and 179 girls. 331 patients with fixed orthodontic appliances aged 12 -15 years from city were used as experimental group, including 101 boys and 230 girls without mouth-breathing. Gingival index (GI), sulcus bleeding index (SBI), and plaque index (PLI) were recorded for each individual patient six months after being with orthodontic appliances. Four upper and four lower incisors were assessed, the data of the two groups were analyzed with SPSS 10.0 software package for Student's t test.

RESULTS

It was found that there were significant higher PLI, GI and SBI values in orthodontic treated patients (P<0.01). Although there was no significantly difference in PLI value between boys and girls (P>0.05) in the experimental group, there were statistically significant higher GI and SBI values compared boys with girls (P<0.01). There were significantly higher PLI and GI values in boys' lower incisor(P<0.01). Oral health care was difficult in patients with fixed orthodontic appliances. Boys' oral hygiene was poorer than girls'.

CONCLUSION

In order to maintain periodontal health, it is very important to strengthen oral hygiene to children who receive fixed appliance, especially in boys, as well as control the level of plaque accumulation in the lower incisors.

[Aspiration and ingestion of dental instruments--diagnosis, treatment and prevention]

Aspiration and ingestion of foreign bodies of dental origin during treatment may cause a gastrointestinal and airway obstruction or perforation, and may constitute a life threatening situation. Ingestion occurs more often than aspiration and usually does not cause any clinical signs or symptoms. Most often it will spontaneously rejected from the gastrointestinal tract by peristaltic movement without any coimplication. However aspiration always requires treatment since foreign bodies there may cause inflammatory reaction and even severe obstruction and death. This article describes one case of aspiration and 3 cases of ingestion of dental instruments and materials. We discuss the diagnostic procedure: evidence of clinical signs and plain radiography, CT and the use of contrast material in case of radiolucent foreign bodies. The modern technique of endoscopy is successfully performed for diagnosis and treatment of foreign bodies in case of aspiration with minimal complications. We suggest a step by step protocol of treatment at the dental clinic in the case of ingestion/aspiration of foreign body and discuss several prevention techniques.

Changes in arch width. A 20-year longitudinal study of orthodontic treatment

The changes in the dental arch dimensions that occur as a result of growth and treatment are of interest to the orthodontist and require careful consideration during treatment planning. A greater understanding of these changes could influence the patient's expectations from treatment as well as the formulation of the treatment and retention plans by the clinician. A retrospective study of the maxillary and mandibular canine and molar arch width changes in 60 patients over 20 years was carried out. Approximately half were treated orthodontically, and measurements were made on dental casts taken at four time points during the study: 1981, 1985, 1989, and 2001. Between baseline and final follow-up, the treated group demonstrated a statistically significant increase in maxillary intercanine arch width and statistically significant decreases in maxillary intermolar and mandibular intercanine and intermolar widths. No significant changes were observed for the untreated group. When comparing the orthodontically treated group with the untreated group, there was a significantly greater increase in maxillary intercanine width and a significantly greater reduction in mandibular intercanine width in the treated group over the duration of the study. No significant difference was observed between treated and untreated groups for maxillary and mandibular intermolar width changes. Sex had no statistically significant effect on these treatment differences. Type of orthodontic treatment had no effect on arch width changes within the treated group; however, the effect of tooth extraction needs further investigation.

Dentoalveolar and skeletal changes associated with the pendulum appliance followed by fixed orthodontic treatment

INTRODUCTION

This prospective clinical study analyzed the distalization of maxillary molars achieved by the pendulum appliance and its effect on the anchorage teeth during and after fixed orthodontic treatment.

METHODS

Lateral cephalograms of 22 adolescents (15 girls, 7 boys) taken pretreatment, after distalization, after leveling and aligning, and after fixed orthodontic treatment were evaluated. The initial mean age was 14.5 years (SD = 1.80). The mean time for distalization of the maxillary molars was 5.85 months (SD = 1.82), and the total treatment time was 3.61 years (SD = 1.83).

RESULTS

The pendulum appliance moved the maxillary molars distally, but with significant distal inclination, protrusion of the anterior teeth, and increase in lower anterior facial height (LAFH) due to the clockwise mandibular rotation. After fixed orthodontic treatment, the maxillary incisors and the maxillary first premolars and first molars were returned to their pretreatment anteroposterior positions. Thus, at postdistalization, there was 2.1 mm of protrusion of the maxillary first molars, despite the anchorage reinforcement (Nance button and cervical headgear worn at night during fixed appliance therapy). However, at the end of treatment, all patients had Class I molar relationships.

CONCLUSIONS

The pendulum appliance followed by fixed orthodontic treatment corrected the Class II sagittal relationship, especially due to the dentoalveolar changes secondary to the spontaneous mandibular growth in the anterior direction during fixed appliance treatment.

Molar distalization with pendulum appliances in the mixed dentition: Effects on the position of unerupted canines and premolars

INTRODUCTION

The pendulum appliance allows for rapid molar distalization without the need for patient compliance. Its efficiency has been confirmed in a number of clinical studies. However, the potential interactions and positional changes between the deciduous molars used for dental anchorage and the erupted and unerupted permanent teeth have yet to be clarified when this appliance is used for molar distalization in the mixed dentition.

METHODS

Twenty-nine patients in the mixed dentition each received a modified pendulum appliance with a distal screw and a preactivated pendulum spring for bilateral distalization of the maxillary molars. The patients were divided into 4 groups based on dentition stages: patient group 1 (PG 1, n = 10) was in the early mixed dentition; patients had resorption of the distal root areas of the deciduous molars being used for dental anchorage, and the unerupted premolars were located at the distal margin of the deciduous molar root region. Based on radiographs taken before placement of the pendulum appliance, patient group 2 (PG 2, n = 10) was diagnosed as having a central location of the unerupted premolars. In the third group (PG 3, n = 4), the first premolars were already erupted and could be integrated into the dental anchorage, but the canines were not yet erupted. In the fourth group (PG 4, n = 5), the first premolars and both canines were fully erupted.

RESULTS

Statistical analysis of the measured results showed significant differences in the side effects between PG 1 and PG 2. In patients being treated with pendulum appliances, the anchorage quality of the deciduous molars that were already partially resorbed in the distal root area was comparatively reduced. Consequently, the mesial drift of the deciduous molars and incisors was increased, without impairing the extent and quality of the molar distalization. Anchorage loss in the supporting area had no direct impact on the sagittal position of the unerupted premolars in the early mixed dentition.

CONCLUSIONS

If permanent teeth have already started to erupt in the supporting area, additional space restrictions should be avoided in patients with critical topography, especially if there is little space for the unerupted canines. At this stage of the mixed dentition, premolar extraction or augmentation of the supporting area with extraoral headgear offers a therapeutic alternative to intraoral distalization appliances with exclusively dental anchorage.

Nickel ions release in patients with fixed orthodontic appliances

AIM

The extent to which orthodontic appliances can cause contact allergies due to nickel release is a controversial matter. Since the data provided by literature are contrasting, the Authors think that it is important to analyse nickel ions released in organic tissues by means of a plasma spectrometer.

METHODS

About 100 intact hairs were taken from 15 patients wearing fixed orthodontic appliances. The hairs had been washed 12 to 24 h before, in order to limit environmental contamination. The same procedure was carried out on a control group corresponding in sex, age and abode. The samples of hair were taken from at least 3 different scalp sites: frontal, vertex and occipital areas.

RESULTS

According to the spectrophotometric analysis of the hair, there were no differences in nickel concentrations between the test group (0.50 mg/g on average) and control group (0.64 mg/g) (*P<0.005). The mean value was reduced even further if minimum and maximum values were excluded (test group 0.46 mg/g, control group 0.52 mg/g). Even though there was a slight difference (0.14 mg/g), it showed that more nickel concentration was found in the control sample (without orthodontic appliances) to a maximum of 2.20 mg/g. This suggests that environmental contamination, in particular diet, has an influence on ion concentration. Other studies also confirm that gut absorption of nickel released in the mouth by orthodontic appliances is much lower than the absorption of nickel release through diet.

CONCLUSIONS

It can be assumed that orthodontic appliances do not release significant values of nickel to be a risk factor to the patient's health.

Quantitative measurement of speech sound distortions due to inadequate dental mounting

In this paper, the most adequate quantitative parameters are sought that reflect the dependence of speech sound distortions on the correct position of dental mountings. We suggest the Hurst fractal exponent and some parameters calculated from the Paul wavelet transform of speech sound are useful as quantitative parameters. The investigations are focussed on the alterations of the first /s/ phoneme when the patient produces the Sisyphe sound. The results will be useful to obtain a rigorous, computer assisted method to establish (design) the optimal parameters of prosthetic mounts in order to ensure best speech quality.

Iatrogenic trauma to oral tissues

BACKGROUND

Iatrogenic trauma can be defined as any trauma that has been induced by the dentist's activity, manner, or therapy. The aim of this article is to present traumatic oral tissue lesions of iatrogenic origin.

METHODS

Thirteen cases of chemical (due to ferric sulfate and formocresol), physical (due to orthodontic wires and appliances), and thermal (due to electrosurgery) injuries to the oral tissues are reported.

RESULTS

Chemical, physical, and thermal injuries in the oral, gingival, or palatinal mucosa of iatrogenic origin can exhibit various clinical features. The management of traumatic injuries is dependent on the severity of the involvement in the periodontal tissues. While, in most cases, the elimination of the offending agent and symptomatic therapy were sufficient, in severe cases, or when the injury resulted in permanent defects, periodontal surgery and regenerative therapy may be necessary.

CONCLUSIONS

The skill, experience, and up-to-date knowledge of dentists are the main factors to prevent possible iatrogenic traumas. Although "To err is human," careful practice is very important for the principle "Primum non nocere" ("First do no harm").

External root resorptions and orthodontic forces: correlations and clinical consequences

Orthodontically induced root resorption is the most frequent unwanted side effect of orthodontic tooth movement that is unavoidable. This is due to the fact that both bone remodelling and root resorption are based upon a sterile inflammatory process, initiated by force application. In addition to individual factors that have a bearing on the amount of resorption, the type and magnitude of orthodontic forces play a major role. In animal and human experiments it could be shown that continuous forces, as produced by materials with pseudo- elastic characteristics, seem to produce more resorptions than discontinuous forces. Recent research shows that the magnitude of the orthodontic force up to 200cN is probably not decisive for root resorption.

Preliminary evaluation of morphological parameters of the saliva in patients undergoing orthodontic treatment

PURPOSE

In recent years, many reports have focused on clinical changes in the oral cavity of orthodontic patients, manifested in general inflammation of the mucosa. In order to better understand histopathological alterations in the mouth and the use of easily available diagnostic material, we decided to assess the morphology of salivary cells at different time points of treatment with orthodontic appliances.

MATERIAL AND METHODS

The study material included non-stimulated saliva obtained from 21 orthodontic patients and 11 healthy secondary school students (controls). After fixation in 96% ethanol the smears were stained with PAS + hematoxylin or H+E, and using the methods of May-Grünwald-Giemsa and Feulgen.

RESULTS

As revealed by the histopathological examinations of saliva smears, patients treated with intra-oral fixed orthodontic appliances showed morphological changes in oral epithelial cells and in the number of leukocytes as compared to the control group. The changes were most pronounced in the first months of treatment.

CONCLUSIONS

The preliminary data indicate that orthodontic patients develop changes in the composition and morphology of salivary cells, the intensity of which depends on the time of exposure to the appliance.

The concentration of anthranilic acid in saliva of orthodontic appliances

PURPOSE

Anthranilic acid is an important, the aromatic intermediate in the degradation of tryptophan in kynurenine pathway. This compound plays an important role in the regulation of immunological processes as well shows antibacterial activity. The aim of our study was to estimate the concentration of anthranilic acid in saliva of young patients with orthodontic apparatus. We also assessed correlation between saliva anthranilic acid concentrations and time of orthodontic treatment. For the first time we have demonstrated the enhanced concentration of anthranilic acid in saliva of young orthodontic appliances.

MATERIAL AND METHODS

The study was performed on non-stimulated, mixed saliva of patients with orthodontic appliances. The concentration of anthranilic acid and was determined by high-performance liquid chromatography.

RESULTS

The concentration of anthranilic acid was significantly higher in orthodontic patients (p = 0.043) in comparison to healthy volunteers. The mean time of orthodontic treatment was 15.0 +/- 2.03 months. We did not observe existence of correlation between anthranilic acid concentration in saliva and time of orthodontic treatment (r = -0.250; p = 0.517).

CONCLUSION

These results might indicate that anthranilic acid can be one of many factors initiating of periodontal disease in orthodontic appliances.

Three cases illustrating the potential of dental treatment as a precipitant for weight loss leading to anorexia nervosa

OBJECTIVE

This is the first published report to illustrate the potential for dental treatment to precipitate weight loss leading to anorexia nervosa.

METHOD

Documentation of history and clinical findings on three adolescents referred to a specialist eating disorder service are presented.

RESULTS

These cases illustrate that dental treatment may be precipitants of weight loss leading to anorexia nervosa.

CONCLUSION

There is a need for increased awareness of this area amongst parents of children and adolescents vulnerable to eating disorders and also their dentists.

Preliminary evaluation of saliva composition in allergic patients subjected to orthodontic treatment; morphological examination

PURPOSE

Intra-oral fixed orthodontic appliances, so frequently used in the treatment of malocclusions, may cause pathomorphological changes in the mouth and can be a potential source of antigen stimulation. Therefore, the aim of the current study was to assess the changes in salivary cells of orthodontically treated allergic patients.

MATERIAL AND METHODS

The study material was the non-stimulated saliva samples collected from 28 allergic patients subjected to orthodontic treatment with intra-oral fixed appliances and from 11 healthy secondary school students (controls). After fixation in 96% ethanol, saliva smears were stained with PAS + hematoxylin or H+E, and using the methods of May-Grünwald-Giemsa and Feulgen. The microscopic analysis was made of oral epithelial cells and inflow elements, with regard to their shape, size, the nucleus-to-cytoplasm ratio and nuclear chromatin condensation.

RESULTS

The results of preliminary investigations indicate that allergic patients with fixed orthodontic appliances exhibit changes in the morphology and composition of salivary cells as compared to control patients. Differences in the morphological picture were most pronounced in the first months of orthodontic treatment.

CONCLUSIONS

It was shown that the number and morphology of salivary cells in allergic patients altered in response to ions released from dental alloys. Thus, saliva can be used as diagnostic material.

Oral cavity status and IgE level in orthodontic patients

PURPOSE

Considering nickel release from fixed orthodontic appliances, determination of the relationship between the clinical status of the mouth, IgE level and treatment duration in orthodontic patients seems to be advisable.

MATERIAL AND METHODS

Twenty-one patients with symptoms of nickel hypersensitivity observed during treatment with fixed orthodontic appliances were separated from a group of 50 subjects, aged 11-33 years, undergoing orthodontic treatment for malocclusion. The patients were divided into two subgroups PgA and PgB.

RESULTS

The mean IgE level in PgA was 39.20 IU/ml and in PgB 210.61 IU/ml. In PgA, the majority of patients were wearing ear-rings (8/10), but not in PgB (4/11). The mean treatment duration in PgA was 21.3 +/- 4.83 months, while in PgB 14.4 +/- 2.84. There were no statistically significant differences in the symptoms indicating stomatitis between the groups of patients subjected to treatment with intra-oral appliances.

CONCLUSIONS

The immunologic profile of the patient plays a key role in the choice of the type of appliance used to treat abnormalities of the masticatory organ. Determination of IgE is necessary in the case of allergy-positive history.

[Resorption of root cement studied with resorption indices]

PURPOSE

The aim of this work was to assess the influence of orthodontic treatment with fixed thin wire appliances on hard tissues of the tooth.

MATERIAL AND METHODS

The effect of mechanical forces from the fixed appliance on root cement was studied during and after orthodontic treatment. Root cement was examined microscopically following extraction of the affected tooth.

RESULTS

The study group comprised 35 patients who underwent pantomography because of possible root resorption during orthopedic treatment. Reduced root length was noted in 30 patients (85.7%). In most cases, apical resorption was noticed in upper (84.3%) and lower central incisors (61.4%).

CONCLUSIONS

The results of the it can be seen on photographs from the optical microscope that root cement reacted differently to forces of traumatic occlusion. Resorptive loss reached as far as the dentine border.

Effects of preoperative ibuprofen and naproxen sodium on orthodontic pain

Three experimental groups of 20 patients each, all of whom were to undergo fixed orthodontic treatment, were enrolled in this prospective study. Group 1 was given a placebo, group 2 was given 400 mg ibuprofen, and group 3 was given 550 mg naproxen sodium. All the patients received only one dose that was given one hour before archwire placement. All patients were asked to complete a questionnaire concerning the pain perceived after archwire placement. The questionnaire was in the form of a seven-page booklet that contained 100-mm horizontal Visual Analogue Scale on which the patient marked the degree of discomfort at the indicated time periods. The patients were instructed to make a check on the scale at each time interval to represent the perceived severity of pain during each of four activities, ie, chewing, biting, fitting back teeth together, and fitting front teeth together. Incidence and severity of pain were recorded by the patient at two hours, six hours, nighttime on the day of appointment, 24 hours after the appointment, and two days, three days, and seven days after bonding. The results revealed that patients taking 550 mg naproxen sodium one hour before archwire placement had significantly lower levels of pain at two hours, six hours, and nighttime after adjustment than patients taking placebo or ibuprofen. However, the use of additional postoperative doses was recommended to control orthodontic pain completely.

Prevention of enamel demineralization: An in-vitro study using light-cured filled sealant

INTRODUCTION

Enamel demineralization is an undesirable side effect of orthodontic treatment with fixed appliances. The purpose of this in-vitro study was to evaluate the efficacy of applying a light-cured filled sealant onto the buccal tooth surfaces to prevent demineralization.

METHODS

Fifty extracted human third molars were allocated to 1 of 5 groups: (1) enamel surface untreated (control); (2) surface etched; (3) fluoride varnish applied; (4) enamel etched and coated with a light-cured, unfilled sealant (control sealant); and (5) enamel etched and coated with a light-cured, filled sealant (Pro Seal, Reliance Orthodontic Products, Itasca, Ill). The enamel surface of each specimen was brushed for 15,000 strokes with nonfluoride toothpaste slurry with a piston-action brushing machine under a standardized load. All samples were then cycled for 14 days through a daily procedure of demineralization for 6 hours and remineralization for 17 hours. Then the teeth were sectioned and evaluated quantitatively by cross-sectional microhardness testing.

RESULTS

Demineralization in the Pro Seal group was significantly less (P < .05) than in the other groups. Teeth treated with fluoride varnish exhibited 30% less demineralization than the control teeth, the enamel-etched teeth, and the teeth treated with a light-cured, unfilled sealant (P < .05).

CONCLUSIONS

Pro Seal can be considered for use as a preventive method to reduce enamel demineralization adjacent to orthodontic attachments, particularly in patients who exhibit poor compliance with oral hygiene and home fluoride use.

The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances: A systematic review

INTRODUCTION

Decalcification is a significant problem during fixed orthodontic treatment. Topical Fluorides can reduce or eliminate the problem, but the relative effectiveness of different treatments or combinations of topical fluoride preparations is unknown. This systematic review was undertaken to determine the effectiveness of topical fluoride preparations in preventing decalcification during fixed orthodontic treatment.

METHODS

A wide search of published and unpublished material in any language was undertaken by using general and specialist databases; key dental journals were searched by hand. Predefined inclusion criteria based on objective outcome measures of decalcification, duration of treatment, presence of a comparison group, and study design were applied to determine study selection. Included studies were double extracted onto pre-designed data extraction sheets.

RESULTS AND CONCLUSIONS

By screening titles and abstracts, we identified 143 articles; after the inclusion criteria were applied, 7 reports (of 6 studies) remained. Differences in the methodologies and reporting made statistical analysis impossible. However, the use of topical fluorides in addition to fluoride toothpaste reduced the incidence of decalcification in populations with both fluoridated and non-fluoridated water supplies. Different preparations and formats appear to decrease decalcification, but there was no evidence that any 1 method was superior. There was some evidence that the potency of fluoride preparations might be important.

Characterization of nickel-induced allergic contact stomatitis associated with fixed orthodontic appliances

INTRODUCTION

In some orthodontic patients, an oral inflammatory response is induced by corrosion of orthodontic appliances and subsequent nickel release. This inflammatory response is manifested as stomatitis (nickel-induced allergic contact stomatitis [NiACS]). The etiology and diagnosis of NiACS are difficult to determine. The purpose of this retrospective analysis was to investigate the roles of age, sex, previous allergic history, and time of exposure to fixed orthodontic appliances in the etiopathogeny of NiACS.

METHODS

Forty-four orthodontic patients (range, 10-44 years) were divided into 2 groups, depending on their NiACS clinical manifestations.

RESULTS

Young patients, especially females with a history of allergic reactions, had a greater predisposition to NiACS clinical manifestations; time of exposure to orthodontic appliances was not a significant factor.

CONCLUSIONS

A previous allergic reaction should be considered a predictive factor of NiACS clinical manifestations and should be noted in the patient's medical history.

The influence of a structured telephone call on orthodontic pain and anxiety

INTRODUCTION

This purpose of this study was to examine the effects of a structured telephone call after orthodontic appliance placement on self-reported pain and anxiety.

METHODS

One hundred-fifty orthodontic patients were randomly assigned to 1 of 3 groups and matched for age, sex, and ethnicity. The subjects completed baseline questionnaires to assess their levels of pain (on a 100-mm visual analog scale) and anxiety (Spielberger's State-Trait Anxiety Inventory) before orthodontic treatment. After the initial archwires were placed, all subjects completed the pain questionnaire and state-anxiety inventory at the same time daily for 1 week. One group also received a structured telephone call demonstrating care and reassurance; the second group received an attention-only telephone call, thanking them for participating in the study; the third group served as a control.

RESULTS

Although both telephone groups reported significantly less pain (P = .005) and state-anxiety (P = .033) than the control group, there was no difference between the 2 telephone groups (P > .12 for pain; P > .81 for state-anxiety).

CONCLUSIONS

A telephone call from a health-care provider reduced patients' self-reported pain and anxiety; the content of the telephone call was not important.

A prospective long-term study of signs and symptoms of temporomandibular disorders in patients who received orthodontic treatment in childhood

This investigation analyzed the influence of orthodontic treatment performed in childhood on the long-term development of signs and symptoms of temporomandibular disorders (TMDs). The original sample consisted of 50 consecutive patients (27 girls and 23 boys) with different morphological malocclusions, who were to receive orthodontic treatment. Their mean age at start of treatment was 12.9 years. Seventeen (range 15-18) years after completion of orthodontic treatment, 40 former patients (89% of the traced subjects) completed and returned a questionnaire, and 31 subjects (69% of the traced subjects) were also examined clinically. A great majority of the participants were pleased with the result of the orthodontic treatment. Relapses of morphological malocclusions were very uncommon. The prevalence of signs and symptoms of TMD was low both before and after the active phase of orthodontic treatment, as well as at the long-term follow-up after 15 to 18 years. The incidence per year of manifest TMD requiring treatment was approximately 1%. The result of the present investigation supports the opinion that orthodontic treatment in childhood does not entail an increased risk to develop either signs or symptoms of TMD later in life.

A clinical evaluation of titanium miniplates as anchors for orthodontic treatment

INTRODUCTION

The purpose of this clinical study was to evaluate the stability of titanium miniplates used as anchorage for orthodontic treatment.

METHODS

Seventeen patients with a total of 68 miniplates were enrolled. The miniplate placement sites were evenly divided between the maxilla and mandible. The patients underwent distal movements of the molars with miniplate anchorage to correct anterior crossbite or crowding without extracting the premolars.

RESULTS

The posttreatment clinical examination showed that 5 miniplates, all in the mandible, failed before the end of treatment-a 7% failure rate.

CONCLUSIONS

Further studies, perhaps with titanium miniplates of a different design, might be necessary to identify important factors for decreasing the incidence of complications when miniplates are used for orthodontic anchorage.

Pain control during fixed orthodontic appliance therapy

The control of pain during orthodontic treatment is of great interest to both clinicians and patients. However, there has been limited research into the control of this pain, and there is no standard of care for controlling this discomfort. This prospective study determines the pain sequelae in fixed orthodontic treatment and evaluates comparatively the analgesic effects of nonsteroidal anti-inflammatory drugs for the control of this pain. One hundred and fifty orthodontic patients who were to have teeth bonded in at least one arch were randomly assigned to one of six groups: (1) placebo/placebo, (2) ibuprofen/ibuprofen, (3) flurbiprofen/flurbiprofen, (4) acetaminophen/acetaminophen, (5) naproxen sodium/naproxen sodium, and (6) aspirin/aspirin. The pain evaluations were made during chewing, biting, fitting the front teeth, and fitting the back teeth using a 100-mm visual analogue scale (VAS) for seven days. All the analgesics succeeded in decreasing the pain levels compared with the placebo group. However, naproxen sodium and aspirin groups showed the lowest pain values, and the acetaminophen group showed VAS results similar to those of the two analgesics.

Archwire ligation techniques, microbial colonization, and periodontal status in orthodontically treated patients

Fixed or removable orthodontic appliances impede the maintenance of oral hygiene and result in plaque accumulation. Plaque retention surrounding orthodontic appliances leads to enamel demineralization caused by organic acids produced by bacteria in the dental plaque. Many studies have evaluated the effects of fixed orthodontic appliances on microbial flora and periodontal status, but only a few have evaluated the method of ligation as an additional factor. The aim of this study was to determine the changes in microbial flora and periodontal status after orthodontic bonding and to determine whether two different archwire ligation techniques affect these changes. A total of 21 orthodontic patients scheduled for fixed orthodontic treatment were selected for this split-mouth study. Two commonly used auxiliaries (elastomeric rings and ligature wires) for tying archwires were tested. Microbial and periodontal records were obtained before bonding (T0), one week later (T1), and five weeks after bonding (T2). Paired t-test and Wilcoxon signed rank test were used to compare the groups statistically. Although, teeth ligated with elastomeric rings exhibited slightly greater numbers of microorganisms than teeth ligated with steel ligature wires, the differences were not statistically significant and could be ignored. The two archwire ligation techniques showed no significant differences in the gingival index, bonded bracket plaque index, or pocket depths of the bonded teeth. However, teeth ligated with elastomeric rings were more prone to bleeding. Therefore, elastomeric ring use is not recommended in patients with poor oral hygiene.

Recolonization of mutans steptococci on teeth with orthodontic appliances after antimicrobial therapy

The aim of the present study was to compare the recolonization pattern of mutans streptococci on densely colonized teeth with and without fixed orthodontic appliances after treatment with a 40 per cent chlorhexidine (CHX) varnish (EC 40, Explore). Healthy subjects free of carious lesions requiring fixed orthodontic appliance treatment but with high bacterial mutans streptococci saliva counts were recruited (n = 10). For baseline registration, plaque from buccal sites was sampled and cultivated on Dentocult strips. Following professional tooth cleaning, CHX varnish was applied to all teeth for 8 minutes. Subsequently, orthodontic brackets and bands were inserted in either the upper or lower arch. Eight weeks after varnish application the degree of recolonization with mutans streptococci was reassessed on the buccal sites. Statistical analysis showed that recolonization with mutans streptococci was significantly higher (P < 0.05) on teeth with orthodontic appliances. The results indicate that the use of fixed orthodontic appliances creates artificial environments suitable for the proliferation of mutans streptococci after CHX varnish suppression.

Experimental tooth movement upregulates preproenkephalin mRNA in the rat trigeminal nucleus caudalis and oralis

Levels of preproenkephalin mRNA expression in trigeminal subnucleus complex by noxious tooth movement stimuli were examined using in situ hybridization. At 24 h, preproenkephalin mRNA expression was significantly upregulated in the ipsilateral trigeminal subnucleus caudalis (P<0.05), and in the subnucleus oralis (P<0.05). These findings suggested that enkephalinergic inhibitory systems could be activated during tooth movement, and that subnucleus oralis may be involved in modulation of the nociception, as well as the subnucleus caudalis.

Gingival enlargement and resolution during and after orthodontic treatment

Gingival enlargement (GE) is a condition that commonly develops during orthodontic treatment. Thirty adolescent subjects with clinically significant GE were analyzed at pre-orthodontic treatment (T1), when the appliances were removed (T2), and 3 to 12 months after (T3). The mean GE decreased from T2 to T3, but was significantly higher on T3 than T1 (p<.05). It may be concluded that complete resolution of GE developed during orthodontic treatment is not always attained after removal of the fixed appliances.

Snoring and obstructive sleep apnea: compliance with oral appliance therapy

OBJECTIVE

To assess the effectiveness of oral appliances in clinical practice.

DESIGN

Survey of 110 subjects.

SETTING

Hospital-based dental practice.

METHODS

Questionnaire.

MAIN OUTCOME MEASURES

Compliance and control of sleepiness and snoring.

RESULTS

Fifty-seven percent of respondents were compliant with therapy, reporting control of sleepiness and snoring.

CONCLUSIONS

More than 50% of those on oral appliance therapy reported continued use after at least 18 months.

Effect of 0.4% stannous fluoride gel on Streptococci mutans in relation to elastomeric rings and steel ligatures in orthodontic patients

BACKGROUND

Patients with fixed orthodontic appliances often experience an absolute increase in the number of Streptococci mutans colony-forming units (cfu). The aim of this investigation was to study the development of biofilm and S. mutans cfu in connection with stainless steel ligatures and elastomeric rings in orthodontic patients treated with and without 0.4% stannous fluoride gel (SFG).

MATERIAL

Forty-seven patients were divided into 2 groups: those treated with 0.4% SFG for 4 minutes (experimental) and those without 0.4% SFG (control). In each patient, elastomeric rings were used for ligation on 1 side of the dental arch midline, and stainless steel ligatures were used on the opposite side. Saliva samples were collected before and after appliance placement. At 15 and 30 days after appliance placement, biofilm samples from the stainless steel ligatures and the elastomeric rings were collected and subjected to microbiologic procedures and scanning electron microscopy (SEM) analysis.

RESULTS

The numbers of S. mutans cfu in the saliva and biofilm were not statistically different between the teeth fitted with elastomeric rings and stainless steel ligatures, or between the experimental and control groups. SEM analysis showed biofilm formation on both ligature ties.

CONCLUSIONS

Topical application of 0.4% SFG in orthodontic patients with elastomeric rings or stainless steel ligatures does not cause a significant decrease in S. mutans cfu in the saliva and biofilm.

Patient discomfort: a comparison between lingual and labial fixed appliances

This study was undertaken to determine the discomfort differences between patients treated with lingual and labial orthodontic brackets. The study sample consisted of two groups of 30 adolescent patients. Group LI was treated with lingual appliances, and group LA was treated with labial appliances. After three months of treatment, each patient completed a seven-part survey with 12 questions, evaluating intraoral discomfort; tongue-lip-cheek soreness; eating, speech, and oral care difficulties; adaptation period; and general problems. In the LI group, tongue soreness and speech difficulties were significantly greater (P < .001) than in the LA group, whereas cheek (P < .001) and lip (P < .05) soreness were greater in group LA than in group LI. No statistically significant differences were found between the groups in reported intraoral discomfort and eating and oral care difficulties, but adhering of food particles was greater (P < .05) in the LI group. In this study, speech difficulty was the most severe problem for the lingual group. All patients in the LA group and 76.7% of the patients in the LI group reported that the problem was solved at the end of 30 days. However, 23.3% of the LI group claimed that at the end of three months they were still having a problem while speaking. Even the maximum adaptation period was longer in the LI group (90 days) than in the LA group (30 days). General evaluation of this study suggested that after the initial discomfort period, only a small percentage (10%) of lingual orthodontic patients reported some hindrance because of their treatment.

Dental Therapy for Obstructive Sleep Apnea

This article reviews the history of dental therapy as it has led up to currently available options for the treatment of sleep-related breathing disorders with an emphasis on oral appliance therapy. Over the last 20 years and in particular the last 5 to 7 years the contribution as well as the effectiveness of oral appliances has impacted the treatment of sleep apnea and at the same time provides an alternative for many patients. The focus here is to examine oral appliances and the role they have as it may be delivered by the dentist with an interest as well as the expertise in dental sleep medicine.

Plaque and Gingivitis Reduction in Patients Undergoing Orthodontic Treatment with Fixed Appliances?Comparison of Toothbrushes and Interdental Cleaning Aids

AIM

Comparison of the efficacy of different oral cleaning devices to improve dental hygiene in patients with multibracket appliances.

SUBJECTS AND METHODS

In a single-blind four-way crossover clinical trial, the following toothbrushes and cleaning aids were tested over 6 months to determine their efficacy in removing plaque and preventing gingivitis: the (A) manual interX short brush-head toothbrush (elmex), the (B) Sonic Speed SR-100E sonic toothbrush (Water Pik), the (C) Sonic Speed toothbrush in conjunction with the electric interdental cleaning device Flosser FL-110 (Water Pik), and (D) the Sonic Speed sonic toothbrush in conjunction with multi-floss 3-phase dental floss (elmex). Forty patients were randomly split up into four groups. Each group brushed their teeth for 4 weeks using cleaning aids/combinations A, B, C or D in different orders. The trial organization was controlled by a computer system that also assisted in recording the modified Quigley Hein Index (mQHI) and Papillary Bleeding Index (PBI) every two weeks using voice control.

RESULTS

Initial improvement was observed with all cleaning aids/combinations, but after 4 weeks of application, conditions deteriorated again--except one. After 4 weeks of application, only cleaning involving the combined use of the sonic toothbrush and the Flosser FL-110 (C) was found to be significantly more effective than cleaning with the manual toothbrush (A), and that was mainly attributed to the flosser. In patients with good oral hygiene (mQHI(initial) < or = 1.4), no improvement was observed with any of the cleaning aids (A-D).

CONCLUSIONS

Plaque and gingivitis can be reduced--especially in patients with poor oral hygiene (mQHI(initial) > or = 1.5)-by using an interdental cleaning aid. In the long run, the Flosser FL-110 is more effective than multi-floss 3-phase dental floss.

Caries Prevalence Measured with QLF after Treatment with Fixed Orthodontic Appliances: Influencing Factors

Caries prevalence on the buccal surfaces of teeth in orthodontic patients was determined with QLF and visual examination immediately after removal of fixed appliances. The number of lesions found by QLF far outnumbered that found by visual examination, but the distribution pattern was similar. 97% of all subjects and on average 30% of the buccal surfaces in a person were affected. On average, in males 40% of surfaces and in females 22% showed white spots (p < 0.01). Caries prevalence was lower (p < 0.01) in incisors and cuspids than in molars and premolars. A positive correlation with caries prevalence was found for the bleeding scores 6 weeks after debonding and lactobacillus counts before debonding. Mutans streptococci counts, age, treatment duration, socioeconomic status and dietary habits showed no correlation with caries prevalence.

The effect of fixed orthodontic appliances on the oral carriage of Candida species and Enterobacteriaceae

The aim of this investigation was to evaluate the prevalence of Candida and Enterobacteriaceae in a group of adolescents during fixed orthodontic appliance (FOA) therapy. The experimental group was recruited from a larger sample of orthodontic patients who were clinically examined once to obtain baseline data before active treatment. The group comprised 27 subjects; 13 males, 14 females (mean age 15.5 +/- 2.3 years). Thereafter, the experimental group was examined three times during a 3 month follow-up period after insertion of the FOA. The whole mouth plaque score was obtained, and the oral cavity was then sampled for Candida species and Enterobacteriaceae using three different microbiological culture techniques, namely the oral rinse, pooled plaque and the imprint culture.A significant increase in candidal numbers was observed after FOA insertion when the imprint technique was used (P < 0.001), although the overall candidal prevalence rates obtained using the oral rinse and pooled plaque techniques did not demonstrate such a change. The predominant Candida species isolated was C. albicans and the number of coliform carriers significantly increased after the insertion of a FOA, as detected by the oral rinse (P < 0.05) and the pooled plaque (P < 0.05) techniques. In total, eight coliform species were isolated following FOA therapy compared with the three species isolated before insertion of the appliance. The results also revealed a significant increase in plaque index due to the introduction of a FOA. Taken together, these data imply that insertion of a FOA is likely to promote oral carriage of Candida and coliform species. Furthermore, it appears that routine oral hygiene instruction and information on appliance hygiene given to these patients may not necessarily reduce plaque accumulation and possible attendant effects. Further work with a larger cohort is required to confirm these findings.

Nickel and cobalt hypersensitivity reaction before and after orthodontic therapy in children

Nickel and cobalt are major components of alloys used in orthodontics. The objectives of this cross-sectional study was to determine the prevalence of a nickel hypersensitivity reaction before and after orthodontic treatment with conventional stainless steel brackets and wires. The total sample consisted of 82 patients (55 females, and 27 males) from the Orthodontic Department at the Faculty of Dentistry, Süleyman Demirel University. A patch test and a questionnaire were used to evaluate hypersensitivity to these metals. The statistical analysis was carried out using Fisher's exact X(2) (2 x 2) test. The prevalence of nickel allergy was found to be higher in females than males (14.55% in females, 0% in males), and the prevalence of cobalt allergy was found to be 9.76% (7.27% in females, 14.81% in males). Orthodontic treatment with conventional stainless steel alloys does not appear to have an allergenic effect on the gingival and oral health of the patient. A family history of an allergy to these metals or the use of metallic objects in contact with the skin do not characterize nickel and cobalt hypersensitivity. This suggests orthodontic therapy with conventional stainless steel appliances does not initiate or aggravate a nickel hypersensitivity reaction. There was no association between the before treatment and after treatment to a nickel and cobalt hypersensitivity reaction.

Typing of Mutans Streptococci by Arbitrarily Primed PCR in Patients Undergoing Orthodontic Treatment

The aim of this study was to clarify the genotypic stability of mutans streptococci (MS) longitudinally during orthodontic treatment. Plaque samples were obtained from the supragingival smooth surface of the upper right teeth at four stages: prior to and after 1, 3 and 6 months of orthodontic treatment. Levels of total viable count, total streptococci and MS in dental plaque of 17 patients were recorded. Streptococci isolated from dental plaque samples were identified as MS on the basis of their morphological and biochemical properties. DNA was prepared from 713 strains of MS and the strains were then identified with polymerase chain reaction (PCR) again. Arbitrarily primed PCR (AP-PCR) fingerprinting was applied in determining the genotypes of MS. The results indicated that levels of total viable count, total streptococci and MS increased significantly after the fixed appliances were bonded. A maximum of 3 different genotypes were found in an individual. All the genotypes were found again after the application of the fixed appliances in 17 patients. A new AP-PCR typing pattern was found after the application of fixed appliances for 1 month in patient 1. That strain was not detected either prior to or after 3, or 6 months of treatment. The result indicated that the MS clones were very stable during orthodontic treatment.