Awareness, knowledge and treatment decisions for erosive tooth wear: A case-based questionnaire among Danish dentists

Assessing dentists' awareness of the orthodontic-restorative interface

OBJECTIVES

Awareness of the interface between restorative and orthodontic treatments is essential for dentists to facilitate a meaningful interdisciplinary approach by integrating the knowledge and skills of different dental disciplines into patients' treatment to enhance outcomes. The aim of this study was to investigate General Dental Practitioners' (GDPs) awareness of the orthodontic-restorative interface.

METHODS

This was a mixed-method study involving the collection of a) quantitative data via a bespoke online questionnaire and b) qualitative data through open questions. A weblink was created to the questionnaire using Opinio®. The questionnaire was distributed to GDPs practising in the UK. Clinical vignette-based questions assessed GDPs awareness and the results were categorised into two groups: aware and unaware. Two months after the primary survey, respondents were sent an email with follow-up (reliability) survey. Reliability responses were compared against the primary responses to assess the repeatability using intraclass correlation coefficient. Data were analysed using independent t-test and X2 test.

RESULTS

118 complete responses were received. 63 GDPs (53.4 % [95 % CI 44 %-63 %]) demonstrated a good understanding of the orthodontic-restorative interface. These GDPs were characterised by greater age (t = 2.75, p = 0.007) and experience (t = 3.54, p < 0.001). Qualitative data showed that respondents perceived orthodontic-restorative treatments as minimally invasive and aesthetics enhancing.

CONCLUSIONS

Orthodontic-restorative treatment aids in minimal invasive dentistry. GDPs lack adequate awareness of the orthodontic-restorative interface in relation to patient care and communication with patients. More quality and structured undergraduate and postgraduate training are imperative to facilitate GDPs to understand and utilise aspects of orthodontic-restorative treatments to raise the standard of patient care. Additionally, to support these patients, the educational pathway between GDPs and specialist orthodontists is crucial.

CLINICAL SIGNIFICANCE

GDPs ability to assess and carry out orthodontic-restorative treatments would conserve natural teeth. Dependable access to orthodontic services would encourage GDPs to refer challenging cases to specialists or dentists with enhanced skills. When the circumstances call for it, patients should be given orthodontic-restorative alternatives, regardless of the potential consequences of their acceptance of the procedures.

Pomegranate extract on eroded dentin: antioxidant action, bond strength and morphology of the adhesive interface after aging

Objectives

This study aimed to evaluate the effect of pomegranate solution (Punica granatum) on eroded dentin through antioxidant action, shear bond strength (SBS) and interface morphology.

Materials and Methods

The 10% pomegranate peel extract was prepared by the lyophilization method. Punicalagin polyphenol was confirmed by high-performance liquid chromatography. Antioxidant activity was evaluated by capturing the 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical. For the SBS, 48 dentin fragments were divided into sound or eroded, and subdivided according to the pretreatment (n = 12): water or P. granatum. The surfaces were restored with self-etch adhesive and a bulk-fill resin (Ecosite; DMG). The SBS was done immediately (24 hours) and after thermal cycling + water storage (12 months). For scanning electron microscopy, 48 dentin fragments (24 sound and 24 eroded) received the same treatments as for SBS (n = 6), and they were analyzed after 24 hours and 12 months.

Results

The P. granatum had antioxidant action similar (p = 0.246) to the phenolic standard antioxidants. After 24 hours, eroded dentin had lower SBS than sound dentin (p < 0.001), regardless of the pretreatment. After 12 months, P. granatum maintained the SBS of sound dentin (13.46 ± 3.42 MPa) and eroded dentin (10.96 ± 1.90 MPa) statistically similar. The lowest values were found on eroded dentin treated with water (5.75 ± 1.65 MPa) (p < 0.001). P. granatum on eroded dentin caused peritubular demineralization and hybrid layer with resin tags.

Conclusions

The pomegranate extract had antioxidant action and preserved the adhesive interface of the eroded dentin.

Does the application of dimethyl sulfoxide improve resin bonding to eroded dentine? Four-year in vitro evaluation

OBJECTIVE

To evaluate the effect of dimethyl sulfoxide (DMSO) on the microtensile bond strength (µTBS) and nanoleakage (NL) of universal adhesives on eroded dentine, immediately and after four years of water storage.

METHODS

Sixty-four sound human molars were distributed into 16 groups according to (1) Dentine surface (sound and eroded dentine); (2) dimethyl sulfoxide application (with or without); (3) Application mode (etch-and-rinse or self-etch) and (4) Storage time (immediate and four years). One mild universal adhesive was used (Scotchbond Universal). The restoration was then performed with a composite resin and the specimens were sectioned into resin-dentine bonded sticks. Resin-dentine bonded sticks were tested (immediately and after four years of water storage) for µTBS (0.5 mm/min) or used to assess NL. Data on μTBS and NL were analyzed using four-way ANOVA and Tukey's test (α = 0.05).

RESULTS

Only the 3-way cross-product interaction 'substrate vs DMSO vs time' was statistically significant (p = 0.007). Eroded dentine showed a lower mean of µTBS and a higher mean of NL values than sound dentine. However, when DMSO was applied, no significant decrease of μTBS or NL values was observed after four years of water storage, regardless of adhesive strategies, or dentine evaluated, when compared to immediate results.

SIGNIFICANCE

Water-based DMSO pre-treatments not only prevent degradation of MDP-containing simplified adhesives but also serve as a potential alternative to improve long-term bonding properties to eroded dentine. The versatility of using a single pre-treatment for both self-etch or etch-and-rinse bonding to eroded dentin may facilitate future clinical applications.

Tooth Wear Evaluation System (TWES) 2.0-Reliability of diagnosis with and without computer-assisted evaluation

BACKGROUND

Tooth wear is a multifactorial process, leading to the loss of dental hard tissues. Therefore, it is important to detect the level of tooth wear at an early stage, so monitoring can be initiated. The Tooth Wear Evaluation System (TWES) enables such a multistage diagnosis of tooth wear. The further developed TWES 2.0 contains a complete taxonomy of tooth wear, but its reliability has not yet been validated.

OBJECTIVES

The aim of the study was to examine in a randomised controlled trial (RCT) whether diagnoses made based on the TWES 2.0 are reproducible and whether this reproducibility is also achieved with computer-assisted diagnostics.

METHODS

44 dental students received extensive training in TWES 2.0 assessment and taxonomy. The students each evaluated at least 10 (of the present 14) anonymised patient cases using gypsum models and high-resolution intra-oral photographs according to TWES 2.0. One half initially evaluated on paper; the other half used dedicated software (CMDfact / CMDbrux). After half of the patient cases (5), the evaluation methods were switched (AB/BA crossover design). The diagnoses were then evaluated for agreement with the predefined sample solution.

RESULTS

Evaluation of agreement with the sample solution according to Cohen's kappa indicated a value of 0.46 for manual (traditional) evaluation; and 0.44 for computer-assisted evaluation. Evaluation of agreement between examiners was 0.38 for manual and 0.48 for computer-assisted evaluation (Fleiss' kappa).

CONCLUSION

The results of this study proved that the taxonomy of the TWES 2.0 has acceptable reliability and can thus be used by dentists. Accordingly, the system can be learned quickly even by untrained practitioners. Comparable results are achieved with computer-assisted evaluation.

Nutrition Care Practices of Dietitians and Oral Health Professionals for Oral Health Conditions: A Scoping Review

BACKGROUND

Oral health conditions, such as dental caries, pose a substantial burden worldwide. Although there are many risk factors for poor oral health, diet is often implicated as a cause of these issues. The purpose of this scoping review was to identify and map studies that have captured information on the "real-world" nutrition care practices of oral health professionals (OHPs) and dietitians to optimize oral health, and specifically the dentition and periodontium.

METHODS

A search of peer-reviewed articles was conducted using MEDLINE, CINAHL, and Embase. Articles that addressed the review objective and met the following criteria were included: English language, published since 2000, and study conducted in a high-income country.

RESULTS

Overall, 70 articles were included. Most articles reported on cross-sectional survey studies and provided self-reported data on OHP practices; few articles reported on dietitians. Most articles reported only general/unspecific information on assessment and intervention practices, such as dietary analysis, nutrition counselling, and diet advice, and lacked specific information about the care provided, such as the dietary assessment tools used, type of information provided, and time spent on these activities. Barriers to the provision of nutrition care by OHPs were common and included time and lack of remuneration. Few studies reported on collaboration between dietitians and OHPs.

CONCLUSIONS

Several studies have captured self-reported information on nutrition care practices of OHPs related to oral health; however, there is limited information available on the details of the care provided. Few studies have examined the practices of dietitians.

Adhesion to eroded enamel and dentin: systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review and meta-analysis was to compare the bond strength between eroded and sound permanent enamel and dentin and to assess whether bonding performance (immediate and after aging) differs between etch&rinse and self-etch adhesives and can be improved by surface pretreatment prior to bonding.

METHODS

Electronic databases (PubMed, Scopus, Embase, Web of Science, CENTRAL, LILACS, BBO) were searched by two reviewers. Random-effect meta-analyses were performed to compare bond strength to sound and eroded dental hard tissues without and with surface pretreatment prior to bonding, respectively. The effect of adhesive mode (etch&rinse vs. self-etch) and aging (immediate vs. aged) was compared using subgroup analyses. Statistical heterogeneity was assessed using Cochran's Q and I²-statistic. Funnel plots and Egger's regression intercept tests were used to evaluate publication bias. Quality and risk of bias of included studies were also assessed.

RESULTS

Fourty-seven studies (45 in vitro, 2 in situ) were included in the systematic review and meta-analyses. Erosion impairs bond strength to dentin (p < 0.001; mean difference: -10.2 MPa [95%CI: -11.9 to -8.6 MPa]), but not to enamel (p = 0.260). Surface pretreatment measures removing or stabilizing the collagenous matrix can improve dentin bond strength (maximum mean difference: +12.4 MPa). Etch&rinse and self-etch adhesives did not perform significantly different on eroded enamel (p = 0.208) and dentin (p = 0.353). The majority of studies (32 of 47) presented a medium risk of bias.

SIGNIFICANCE

Data from in vitro and in situ studies showed that erosion impairs dentin bonding of etch&rinse and self-etch adhesives and makes surface pretreatment prior to bonding of composite restorations necessary.

Genetic Aspects of Dental Erosive Wear and Dental Caries

Objectives

The present review aims to give an overview of the literature focusing on novel genetic aspects of dental erosion and dental caries. Once the tooth erupts into the oral cavity, the regenerative capability of enamel is fundamentally limited due to the loss of dental epithelium during eruption. The susceptibility or resistance to dental erosion and caries is presumably a result of environmental, phenotypic, and/or genetic influence. Even though it is evident that individuals frequently exposing their teeth to acid and sugar are at high risk of developing dental erosion and caries, the findings exclusively based on these factors are elusive. Data resources and study selection. The present review was based on data collected from the National Library of Medicine database with different combinations of the following terms: "tooth," "dental," "dentin," "enamel," "erosion," "erosive wear," "caries," "decay," "gene," and "genetic." A total of forty-six studies met the inclusion criteria. Data were extracted by one reviewer and verified by another.

Conclusion

The high prevalence of erosion and caries among certain groups, and observations that not all individuals appearing to be at risk develop these lesions, has sparked research on identifying genetic effects to these conditions. A connection of genome-wide and candidate gene studies has increased considerably in the literature. This review reveals largely varying success among studies, demonstrating the difficulties of developing the study with adequate sample sizes and durable phenotype definitions that permit enough statistical power to identify genetic contributors.

Awareness, knowledge and treatment decisions for erosive tooth wear: A case-based questionnaire among Danish dentists

OBJECTIVE

To examine the knowledge and experience of erosive tooth wear (ETW) among Danish dental practitioners and, based on two cases, explore their treatment decisions.

METHODS

We sent a validated questionnaire electronically to all active members of The Danish Dental Association and The Association of Public Health Dentists in Denmark. The questionnaire had two parts; the first focused on scoring, recordkeeping, knowledge and experience of ETW. The second part presented two patients with different severity of erosive lesions to explore the dentists preventive and restorative treatment decisions.

RESULTS

We received 442 answers from 4,490 potentially eligible dentists in Denmark (response rate 9.8%). The majority (78%) was female and the median age was 44 years. Nearly all respondents (97%) registered ETW in the charts and 49% recorded "always" or "often" the patients' diet history, most commonly with aid of interviews. The respondents perceived the prevalence of ETW to be higher today than 10-15 years ago and male patients (15-25 years) appeared more affected than females. The majority (82%) thought that they usually found the probable cause of the condition with carbonated beverages being the most common factor. The treatment included dietary guidance, soft tooth brushing with non-abrasive fluoride toothpaste, topical fluoride applications and direct composite restorations.

CONCLUSION

The majority of Danish dentists taking part of this survey had adopted a minimally invasive approach for the management of erosive tooth wear in young adults. There was however room for improvements in diagnosis, scoring and case documentation.