Understanding measurement of dental diseases and research participation in practice set-up

Longevity of acrylic and cobalt-chromium removable partial dentures-A ten-year retrospective survival analysis of 1246 denture-wearing patients

OBJECTIVES

to assess the survival rates of removable partial dentures (RPDs) and identify factors impacting their longevity.

METHODS

electronic health records were retrieved of patients aged ≥18 who received RPDs between 2010 - 2021 with a follow-up of ≥ three months. Data extracted included demographics, medical history, dental charting, periodontal screening and recording scores, prostheses details and related interventions, including new dentures/denture remakes, and maintenance. Multivariate Mixed-Effect Cox regression was performed to identify potential RPD survival risk factors. Reduced model selection was reached using a backward step-down by comparing the performance of these multivariable models using the ANOVA test.

RESULTS

1893 RPDs from 1246 patients were included, with a median follow-up of 21.8 months (range from 3 to 131.3 months). Three hundred and twelve patients received a maxillary RPD, 460 received a mandibular RPD, and the remaining 474 patients received both maxillary and mandibular RPDs. Metal-based RPDs had a median survival of 73 months (95%CI: 70 - 82) versus 45 months (95% CI: 37-67) for acrylic ones. Multivariable mixed effects Cox model showed that the lifespans of RPDs were longer amongst patients receiving more maintenance care within three months [Hazards Ratio (HR)=0.89 (0.83, 0.96)] and after three months [HR=0.53 (0.46, 0.61)] of denture delivery, patients wearing both maxillary and mandibular RPDs [HR=0.67 (0.52, 0.87)], and patients receiving metal-based RPDs [HR=0.31 (0.23, 0.42)].

CONCLUSIONS

Metal-based dentures, dual arch restoration, and increased maintenance positively impact the survival of RPDs.

CLINICAL SIGNIFICANCE

Adapting consent and warranty practices is advised to reflect RPD performance variations.

The Association between Lead Exposure and Dental Caries: A Systematic Review

INTRODUCTION

Dental caries has declined over the years, but it remains a major public health issue. This review aimed to investigate the association between lead (Pb) and caries experience in either deciduous or permanent teeth.

METHODS

A comprehensive search of PubMed, Embase, and Google Scholar was conducted to identify relevant studies published up until December 2022. Included were human observational studies that investigated the association between Pb exposure and dental caries. The review adhered to the PRISMA guideline.

RESULTS

Sixteen studies were included in this review, with nine focusing on deciduous teeth, thirteen on permanent teeth, and six examining both types of teeth. Most of the studies (5 of 6) found a positive association between blood lead (PbB) levels and caries in deciduous teeth, while the findings for permanent teeth were less conclusive, with only 3 of 10 studies finding an association. One of the two studies assessing salivary lead levels found a weak association for permanent teeth. All four studies that measured Pb concentration from teeth found a positive association for both deciduous and permanent teeth.

CONCLUSION

Many published studies have indicated a positive association between Pb exposure and caries experience in deciduous dentition. Children with elevated PbB level should be considered having higher caries experience. Due to lack of consensus on measurement and examination technique, there remains insufficient evidence to make any definitive conclusions, especially in permanent dentition, and so more studies are warranted.

Impact of gastroplasty on salivary characteristics, dental health status and oral sensory aspects: a controlled clinical study

BACKGROUND

Saliva is a non-invasive source of biomarkers useful in the study of different pathophysiological conditions. The qualitative and quantitative study of saliva, as well as the assessment of oral health, can be particularly useful for a better understanding of obesity due to its importance in the food oral perception and ingestion.

OBJECTIVES

To evaluate the effect of treatment of morbid obesity (dietary counselling versus gastroplasty) on salivary characteristics, oral sensory perception and dental health in a controlled study.

METHODS

73 adults (60 females; 19-59 years) with morbid obesity were divided in: Control group (CG; n=34) followed-up during a 6-months dietary program, and Gastroplasty group (GG; n=39) evaluated immediately before, 3, and 6 months after gastroplasty. Dietary habits, Oral Health Impact Profile and xerostomia complaints were investigated by interview. The clinical examination included anthropometric and caries experience evaluation. Salivary flow rate, buffering capacity, total protein and alpha-amylase levels, and sensitivity for the 4 basic tastes were assessed. Two-way mixed model and sign test were applied.

RESULTS

Physical and clinical aspects did not differ between groups in the beginning of the study, and GG showed a rapid weight loss after surgery (p<0.001). An improvement in most of the dietary aspects was observed, especially in the GG. A worsening in the dental health status was observed over time in both groups, with an increase in the number of filled and decayed teeth. CG showed a better oral health-related quality of life, while xerostomia complains increased in GG after gastroplasty. Salivary flow rate remained stable in both groups, but a decrease in buffering capacity, total protein, and alpha-amylase activity was observed in GG after 6-months; taste sensitivity increased from baseline to 6-months in GG (p<0.05).

CONCLUSION

After 6-months of follow-up, patients undergoing gastroplasty presented an improvement in dietary habits and taste sensitivity. However, changes in saliva composition and a worsening in dental health status and xerostomia complaints were also observed.

Restoration of posterior teeth in clinical practice: evidence base for choosing amalgam versus composite

This article reviews the current use of amalgam versus resin composite in posterior restorations and the evidence-base for choosing between these two treatment options. While much research has been published on the issue of the clinical use of amalgam versus resin composite, there are several issues that limit the true evidence-base on the subject. Furthermore, while the majority of published studies on posterior composites would seem to indicate equivalent clinical performance of resin composite to amalgam restorations, the studies that should be weighted much more heavily (randomized controlled trials) do not support the slant of the rest of the literature. As part of an evidence-based approach to private practice, clinicians need to be aware of the levels of evidence in the literature and need to properly inform patients of the true clinical outcomes that are associated with the use of amalgam versus resin composite for posterior restorations, so that patients are themselves making informed decisions about their dental care.