A Predictive Model for Root Caries Incidence

This study aimed to find the set of risk indicators best able to predict root caries (RC) incidence in caries-active adults utilizing data from the Xylitol for Adult Caries Trial (X-ACT). Five logistic regression models were compared with respect to their predictive performance for incident RC using data from placebo-control participants with exposed root surfaces at baseline and from two study centers with ancillary data collection (n = 155). Prediction performance was assessed from baseline variables and after including ancillary variables [smoking, diet, use of removable partial dentures (RPD), toothbrush use, income, education, and dental insurance]. A sensitivity analysis added treatment to the models for both the control and treatment participants (n = 301) to predict RC for the control participants. Forty-nine percent of the control participants had incident RC. The model including the number of follow-up years at risk, the number of root surfaces at risk, RC index, gender, race, age, and smoking resulted in the best prediction performance, having the highest AUC and lowest Brier score. The sensitivity analysis supported the primary analysis and gave slightly better performance summary measures. The set of risk indicators best able to predict RC incidence included an increased number of root surfaces at risk and increased RC index at baseline, followed by white race and nonsmoking, which were strong nonsignificant predictors. Gender, age, and increased number of follow-up years at risk, while included in the model, were also not statistically significant. The inclusion of health, diet, RPD use, toothbrush use, income, education, and dental insurance variables did not improve the prediction performance.

Role of fluoridated dentifrices in root caries formation in vitro

PURPOSE

To evaluate in vitro root caries formation in human permanent teeth and to determine the effects of commercially available dentifrices containing different amounts of fluoride, while employing a well-tested artificial caries system using an acidified gel.

METHODS

Root surfaces from caries-free human permanent teeth (n = 10) underwent debridement and fluoride-free prophylaxis. The tooth roots were sectioned into six portions, and acid-resistant varnish was placed with two sound root surface windows exposed on each tooth portion. Each portion from a single tooth was assigned to a treatment group: (1) No treatment control; (2) Denticious 5000 dentifrice (5,000 ppm F + xylitol); (3) PreviDent 5000 (5,000 ppm F); (4) AIM dentifrice (1,500 ppm F); (5) Listerine dentifrice (1,300 ppm F); and (6) Crest Regular Paste (1,500 ppm F). Tooth portions were treated with fresh dentifrice twice daily for 180 seconds, followed by fresh synthetic saliva rinsing over a 7-day period. Controls were exposed twice daily to fresh synthetic saliva rinsing over a 7-day period. In vitro root caries were created using an acidified gel (pH 4.25, 21 days). Longitudinal sections (three sections/tooth portion, 30 sections/group; 60 lesions/group) were evaluated for mean lesion depths (water imbibition, polarized light). Statistical analyses were performed using ANOVA and Duncan's Multiple Range test.

RESULTS

Mean lesion depths were 389 +/- 43 microm for No treatment - control, 223 +/- 33 microm for Denticious 5000 dentifrice, 242 +/- 42 microm for Prevident 5000, 337 +/- 29 microm for AIM dentifrice, 297 +/- 37 microm for Listerine dentifrice, and 282 +/- 34 microm for Crest Regular Paste dentifrice. All treatment groups had mean depths significantly less than the No treatment - control group (P < 0.05). Denticious 5000 and PreviDent 5000 had significantly reduced mean depth compared with the other dentifrice treatment groups (P < 0.05).

Fluoride dentifrice containing xylitol: in vitro root caries formation

PURPOSE

To evaluate the effects of experimental xylitol dentifrices with and without fluoride on in vitro root caries formation.

METHODS

Root surfaces from caries-free human permanent teeth (n = 10) underwent debridement and a fluoride-free prophylaxis. The tooth roots were sectioned into quarters, and acid-resistant varnish was placed with two sound root surface windows exposed on each tooth quarter. Each quarter from a single tooth was assigned to a treatment group: (1) No treatment control; (2) Aquafresh Advanced (0.15% F = 1,150 ppm F); (3) Experimental xylitol dentifrice without fluoride (0.45% xylitol); and (4) Diamynt fluoride dentifrice with xylitol (0.83% sodium monofluorophosphate = 1,100 ppm F and 0.20% xylitol). Tooth root quarters were treated with fresh dentifrice twice daily (3 minutes) followed by fresh synthetic saliva rinsing over a 7-day period. Controls were exposed twice daily to fresh synthetic saliva rinsing daily over a 7-day period. In vitro root caries were created using an acidified gel (pH 4.25, 21 days). Longitudinal sections (three sections/tooth quarter, 60/group) were evaluated for mean lesion depths (water inhibition, polarized light, ANOVA, DMR).

RESULTS

Mean lesion depths were 359 +/- 37 microm for the control Group; 280 +/- 28 microm for Aquafresh Advanced; 342 +/- 41 microm for the experimental xylitol dentifrice without fluoride; and 261 +/- 34 microm for Diamynt. Aquafresh Advanced and Diamynt had mean lesion depths significantly less than those for the no treatment control and the experimental xylitol without fluoride dentifrice (P< 0.05). There were minimal non-significant differences in mean lesion depths between Aquafresh Advanced and Diamynt (P > 0.05).

[Risks and side effects of periodontitis therapy. Focus on restorative possibilities for improving esthetic defects]

The primary goal of the prophylaxis and therapy of periodontitis is the establishment and the preservation of the secondary oral health. Thereby, the main expected outcomes are the reduction of inflammation and probing pocket depths. During the healing process, some tissue shrinkage during the reparative process and healing is inevitable in most cases and leads to more or less pronounced recession. The latter can cause subsequent secondary side effects due to dentin exposure, which appear - in most cases - unwanted and negative, i. e. hypersensitivity, increased caries risk, erosion and abrasion of the exposed dentin. These pathologic conditions may also encounter esthetic and functional impairments. The aim of this article is to elucidate and discuss these potential clinical pitfalls and their minimal-invasive management, especially when using adhesive strategies using composite resin materials.

Root caries and risk profiles using the Cariogram in different periodontal disease severity groups

OBJECTIVES

To study root caries and risk profiles using the Cariogram in relation to periodontal disease severity and to analyse indicators associated with high caries risk.

MATERIAL AND METHODS

A cross-sectional examination was carried out on 112 patients with periodontal disease from two government clinics in Saudi Arabia. The investigation comprised a questionnaire, bitewing radiographs, measurement of salivary secretion rate, buffering capacity and cariogenic microorganisms, and registration of periodontal status, plaque amount and coronal and root caries/fillings (DFT and RDFT). The data were then entered into the Cariogram pedagogic model to illustrate the caries risk profiles.

RESULTS

Patients were grouped according to periodontal disease severity into one of three groups: (1) gingivitis (n = 44); (2) mild-to-moderate periodontitis (n = 33); and (3) severe periodontitis (n = 35). The prevalence of RDFT in the total sample was 17%. There were no statistically significant differences between the three groups in number of root lesions or mean 'Actual Chance to Avoid New Cavities' (Chance-AC) according to the Cariogram. Of the total sample, 22% displayed high caries risk (Chance-AC ≤ 40%). The most significant risk indicators in high caries risk patients were infrequent use of fluoride and unfavourable salivary and microbial parameters.

CONCLUSIONS

Root surface lesions and high caries risk were present in about one-fifth of the patients referred for periodontal treatment. A combination of risk indicators rather than a single one contributed to the increased risk. Caries and risk profiles were not significantly correlated with periodontal disease severity.

Comparison of visual-tactile, radiographic, and histologic diagnoses of subgingival crown margin caries- an in vitro study

The purpose of this study was to investigate the accuracy of diagnosing interproximal subgingival caries at crown margins. A total of 32 subgingival interproximal crown margin areas were examined by 10 clinicians (n = 320) using conventional diagnostic methods on extracted, crowned teeth mounted in a specially designed cast. Crown margins were located 1.5 mm below the level of the artificial gingiva. Clinical and radiographic diagnoses were compared to the histopathologic findings for each site. Both visual-tactile and radiographic evaluations revealed a weak diagnostic accuracy for interproximal subgingival crown margin caries.

A new coping for overdentures. Part 2: Preliminary results of a clinical study

The aim of this study was to evaluate a new type of coping used for overdentures. Twenty-nine patients received 60 new chairside copings prepared by 3 operators. The copings, used to anchor removable prostheses, were followed up for between 6 months and 4 years with inspection, probing, and radiographic evaluation. Five teeth (8.3%) were extracted. A few clinical problems occurred, including decementation, periodontal pathology (loss of support and bleeding on probing), subgingival decay, and root fracture. No differences were noted in the incidence of complications among the 3 operators. The study demonstrated the clinical predictability of the new copings.

Clinical evaluation of tunneled molars: a retrospective study

BACKGROUND

The main concern associated with the tunneling procedure is the development of root caries on the furcation area post-treatment. The objective of this study was to evaluate the periodontal conditions and the prevalence of root caries in tunneled molars.

METHODS

The study sample comprised 30 tunneled teeth (mean tunneling age = 3.6 years) in 18 subjects who had received periodontal treatment and were enrolled in a maintenance program that included the application of fluoride to the exposed root surfaces. Plaque index (PI), pocket depth (PD), bleeding on probing (BOP), decayed, missing, filled or sound teeth (DMFT) and demographic characteristics were assessed. Statistical analysis was performed using the Friedman and Mann-Whitney tests and multiple linear regression analyses.

RESULTS

Four teeth (13.4%) showed active root caries inside the tunnels. Six (5.4%) of the 109 root surfaces facing the furcation region (inner surfaces) were affected by carious lesions, similar to the amount of root caries observed on the outer tunnel root surfaces, where 10 (5.3%) of the 189 surfaces studied were restored (p > 0.05). The interior of the tunnels had a higher percentage of sites with PD > or =6 mm then the exterior (p > 0.05). However, the plaque indexes and BOP scores were low for both the internal and external surfaces of the tunnels. Regression analysis indicated that the only positive association with the development of caries inside the tunnels was previous root caries experience (beta = -0.671; p = 0.01).

CONCLUSION

The results show that tunneling is a suitable technique to treat periodontal furcation lesions in individuals following a regular maintenance program.

An in vitro Study of Affected Dentin as a Risk Factor for the Development of Secondary Caries

The objective of the study was to investigate the association between the presence of residual caries (inner affected dentin) on the cavity walls of cavity preparations and the further development of secondary caries lesions. Two 2 x 5 x 2 mm cavities, one in the apical portion (A) and one in the cervical portion (C) of the root, were prepared on both the lingual (L) and buccal (B) surfaces of 18 extracted human roots. The apical cavities (AB and AL) were artificially demineralized for 30 min using a decalcifying solution, followed by staining with a caries detector dye and then excavation of irreversibly demineralized dentin, leaving behind a layer of inner carious dentin. The cervical cavities (CB and CL) remained intact with sound dentin on the cavity walls. All cavities were then restored with composite resin. Following restoration, lingual specimens (AL and CL) were completely covered by an acid-resistant varnish to prevent further demineralization. All specimens were then incubated in an in vitro microbial artificial mouth model for 3 days in order to develop secondary carious lesions. At the end of the study all specimens were processed for energy-dispersive X-ray analysis of Ca concentration adjacent to the border between dentin and restoration. Statistical analysis of Ca concentrations revealed that the presence of affected inner dentin does not increase the susceptibility to secondary caries. Therefore, it was concluded that conservative cavity preparations leaving behind affected dentin do not increase the risk of secondary caries development.

Root caries in periodontally treated patients in relation to their compliance with suggested periodontal maintenance intervals

The purpose of this study is to investigate the correlation between the degree of patient compliance with the suggested periodontal maintenance treatment intervals and the new root caries development 5 years after the completion of the active periodontal treatment. The percentage of root surfaces with new root caries was low for both the erratic and the complete compliance patient groups. Erratic compliance with the suggested maintenance intervals 5 years after the active periodontal treatment leads to greater root caries prevalence, greater percentages of patients and root surfaces with new root caries, greater root caries prevalence for smokers, and greater percentages of new defects in root surfaces with further clinical attachment loss and plaque retention. The prevention of root caries development is based on the daily plaque removal and the high patient compliance with the therapist's suggestions for periodontal maintenance intervals.

Radiation-induced root surface caries restored with glassionomer cement placed in conventional and ART cavity preparations: Results at two years

BACKGROUND

There are no published studies comparing the clinical performances of more-viscous glass-ionomer cement (GIC) restorations when placed using conventional and atraumatic restorative treatment (ART) cavity preparation methods to restore root surface caries.

METHODS

One dentist used encapsulated Fuji IX GP and Ketac-Molar to restore 72 conventional and 74 ART cavity preparations for 15 patients who had received cervicofacial radiation therapy. Two assessors evaluated the restorations at six, 12, and 24 months for retention, marginal defects and surface wear, and recurrent caries.

RESULTS

After two years, the cumulative restoration successes were 65.2 per cent for the conventional and 66.2 per cent for the ART cavity preparations, without statistical or clinical significance (P > 0.50). Restoration dislodgement accounted for 82.8 per cent and marginal defects for 17.2 per cent of all failures. There were no instances of unsatisfactory restoration wear or recurrent caries observed. Teeth with three or more restored cervical surfaces accounted for 79.3 per cent of all failures (P < 0.0001).

CONCLUSIONS

For root surface caries restored with GIC, the use of hand instruments only with the ART method was an equally effective alternative to conventional rotary instrumentation for cavity preparation. Larger restorations had higher failures, usually from dislodgement.

[Dental care of patients with leukemia]

Leukemias include a variety of acute and chronic malignant hematological diseases that require antineoplastic chemotherapy. Hematological stem cell transplantation allows an aggressive chemotherapy during which patients suffer from severe immunosuppression. Oral infections may cause serious complications during this immunosuppression. Therefore, professional diagnosis and elimination of oral infection foci must be carried out as early as possible before such treatment. Aggressive chemotherapy causes hyposalivation and as a consequence an increased risk for oral hard and soft tissue diseases. Adequate oral care before, during and after chemotherapy combined with a stem cell transplantation is necessary to prevent oral diseases and systemic complications of oral origin.

A 5-year follow-up study on the prosthetic rehabilitation of the elderly in Helsinki, Finland

In 1990, 364 elderly (76-86 years) inhabitants of Helsinki, Finland, attended a dental and oral examination study that was conducted as part of the Helsinki Aging Study. In spring 1996, these subjects were recalled for a 5-year follow-up. Between the baseline and follow-up examinations, 114 (31%) subjects had deceased (86 women and 28 men), whereas 134 had either moved, were too ill, or refused to participate in the follow-up. Follow-up examination was conducted for 113 subjects (79 women and 34 men), with the participating rate being 46%. Five subjects became edentulous during the follow-up. Of the subjects, 61% had 1-32 teeth at follow-up. In these subjects, the mean number of teeth decreased from 14.9 (+/-8.3) to 13.5 (+/-8.6) (P < 0.0001). Prosthetic status changed in 40% of the elderly dentate people: 25% received new prostheses whereas 15% lost prostheses that were not replaced. New fixed partial dentures were made in five maxillae and in nine mandibles during the follow-up. Acrylic removable partial dentures (ARPD) were most frequently used: 35% of dentate subjects had an ARPD. Subjects with removable prostheses had higher levels of salivary microbes and higher root caries incidence than those with natural teeth. Furthermore, the presence of removable prostheses at baseline, together with the male gender, was clearly associated with tooth loss during follow-up. This study indicates that fixed rather than removable prostheses should be used in elderly patients. The need for a removable denture ought to be carefully considered.

Dental caries experience in older people over time: what can the large cohort studies tell us?

BACKGROUND

Little was known of the natural history of dental caries among older adults until recently, but reports from a number of large cohort studies have now enabled better understanding of the nature and determinants of dental caries in older people. The aim of this review is to examine and compare findings from established population-based longitudinal studies of older adults in order to determine their preventive implications.

METHODS

The dental literature was reviewed in order to identify reports on dental caries incidence from large, population-based dental longitudinal studies of older adults (age 50+) with at least 3 years of follow-up.

RESULTS

Reports were identified from four studies (in Iowa, North Carolina, Ontario and South Australia) which met the criteria; four reports dealt with coronal caries, and five with root surface caries. When annualised, coronal and root surface caries increments were combined and compared with those reported for adolescents, the caries experience of older people over time (between 0.8 and 1.2 new surfaces affected per year) exceeded that reported from cohort studies of adolescents (between 0.4 and 1.2 surfaces per year). The only caries risk factor common to all four studies was the wearing of a partial denture (for root surface caries only).

CONCLUSIONS

Older people are a caries-active group, experiencing new disease at a rate which is at least as great as that of adolescents.

PRACTICE IMPLICATIONS

Dentate older people should be the target of intensive monitoring and preventive efforts at both the clinical practice and public health levels. There is no easily identifiable 'magic bullet' for preventing caries in that age group, but the use of evidence-based preventive interventions (such as fluoride) should suffice.

Subgingival foreign body embedment in a preschool child: management with three and a half years follow-up

CASE REPORT

This is a case report of diagnosis and management of a foreign body embedded in the gingivae of a preschool child. A 3 year-old girl presented with pain, mobility and intraoral oedema of the upper left primary canine (#63). An angular, diffuse radiolucency on the mesial aspect of the primary canine was observed in the periapical radiograph and within this radiolucency, a linear radiopacity was noted in contact with the mesial surface of the root. A clinical diagnosis of severe localized periodontal involvement due to foreign body embedment was made. It was initially attempted unsuccessfully to remove the foreign body by subgingival root scaling and planning. The area was then surgically exposed. Upon flap elevation, a tubular plastic material similar to those used for the insulation of electric wires was found to encircle tightly the cervical area of the root of the primary canine, which was removed. Three months after the surgery, the gingiva of the affected tooth had attained its normal color but had started to recede for about 1 mm. One year post surgery, the gingival recession had progressed to 3 mm and a carious lesion had already developed at the denuded root surface. Three and a half years post surgery a mild inflammation of the buccal gingivae was apparent, but periodontal healing had occurred.

CONCLUSION

The dentist must always consider the possibility of a foreign body embedment in the periodontal tissues of children and be familiar to the clinical signs and symptoms as well as the proper treatment procedures.

Dentists' perceptions of trends in restorative dentistry in the UK

PURPOSE OF STUDY

To obtain responses to a questionnaire on likely trends in the clinical practice of restorative dentistry from a national sample of general dental practitioners (GDPs) who were principals of group practices in the UK.

BASIC PROCEDURES

A panel of nine experts had been convened previously to define areas of trends in restorative dentistry in the UK and to formulate these into statements. Twenty trends were identified and framed into a 22-item questionnaire based on the trend statements. The questionnaire was sent to a national sample of 2800 principal dentists in group practices. Names of principal dentists were taken from the Yellow Pages directories, a group practice being defined as at least one principal dentist and one other practitioner. Levels of agreement for questionnaire scores of > or = 70% for all segments of a statement were taken as indicating a possible trend.

MAIN FINDINGS

Of the 2800 questionnaires sent out, 1448 were returned, a return rate of 52%. Of these, 1217 questionnaires were usable, an overall response rate of 44%. Good agreement was obtained for 14 statements (64%).

PRINCIPAL CONCLUSION

The 14 trend statements that scored a level of good agreement were taken as indicating possible trends in dentistry in the UK as perceived by those GDPs who responded to the questionnaire. However, in view of the fact that the 1217 usable questionnaires received reflected the opinions of 10% of the principal dentists in group practice in the UK, this will not be representative of all principal dentists in practice. Nevertheless for the purposes of gaining some insight into trends in restorative dentistry, it could be considered to be of value.

Restoration of teeth with more-viscous glass ionomer cements following radiation-induced caries

OBJECTIVE

To assess the suitability of more-viscous conventional restorative glass ionomer cements (GICs) in a high-caries risk group of patients.

METHODS

Fifteen adult patients with radiation-induced caries were treated at a dental hospital by one dentist. Two encapsulated aesthetic GICs were used in each patient to restore 146 carious lesions in the exposed dentine and cementum of 93 teeth. The restorations were assessed directly over two years for their retention, secondary caries, anatomic form, marginal integrity, marginal discolouration, and surface texture.

RESULTS

Both GICs were placed in similar sized cavities (P = 0.63). After two years, although 30.0% of Ketac-Molar Aplicap and 12.5% of Fuji IX GP restorations had been lost (P = 0.01), there were no instances of secondary caries. The remaining GICs showed ongoing marginal deterioration, but there were very few instances where this required the repair or replacement of the restorations. No restorations failed from surface erosion.

CONCLUSIONS

In these high-caries risk patients the placement of more-viscous GICs appeared to prevent secondary caries, even when the restorations were subsequently lost.

Dental caries: risk assessment and treatment solutions for an elderly population

Caries remains one of the top three most common infectious diseases in the world today. Although caries prevalence decreased markedly in children and in adults up to age 40 between 1975 and 2000, the overall risk for caries in older age groups (45 to 64, 65 to 84, and > 85 years of age) has not decreased appreciably. In fact, the risk for caries in individuals 70 years of age and older has increased. The increase in restorative work needed between 1990 and 2030 will be highest in adults over the age of 44 years. Root caries prevalence and the number of restored teeth will be greatest in the elderly population. Approximately 30% of individuals over the age of 65 will have no permanent teeth. It is also apparent that additional caries risk factors are associated with a significant proportion of the older population, including reduced saliva flow, inadequate oral hygiene, frequent sugar intake, Asian ethnicity, and the presence of partial dentures. The principles of modern caries management focus on risk assessment, risk reduction, monitoring noncavitated carious lesions, and the assignment of specific treatment options according to risk. Because a relatively high proportion of elderly patients will remain at high risk for caries, therapeutic regimens for managing caries as an infectious disease must focus on the use of antibacterial treatment; high-fluoride dentifrices; supplementary low-dose, high-frequency fluoride rinses; patient education; and shorter recall intervals.

Aging successfully: oral health for the prime of life

Aging is a worldwide phenomena. More adults, particularly those in developed countries, are living longer and healthier lives. The average US life expectancy was 47 years in 1900; by 2000, it had increased to 74 years. As the population ages, the number of adults with acute and chronic illnesses increases. The use of medications also increases with age. People over 65 years of age make up about 12% of the US population, but they consume 30% of all prescription medications, many of which can have a negative impact on oral health. Although tooth loss is declining in US adults, the need for various types of dental services in the adult population continues to increase. Data on the use of dental services has shown that dental visits by older adults correlate with the presence of teeth, not age. Research on the epidemiology of periodontal disease in older adults suggests that the disease in older adults is probably not due to greater susceptibility but, instead, the result of cumulative disease progression over time. Data on root caries has shown that exposed root surfaces, in combination with compromised health status and the use of multiple medications, can increase an older adult's risk for root caries. Oral candidiasis commonly occurs in immunocompromised individuals of any age, but in older adults, nursing home residents are particularly susceptible. Oral cancer is a disease of older adults, with a median age of 64 at diagnosis. Tobacco and alcohol use are the most common risk factors. Mental or physical impairments, such as dementing illnesses, or impaired dexterity as a result of arthritis or stroke, can impair an adult's ability to perform adequate oral self-care. Preventing oral diseases in older adults requires an understanding of the risk factors for oral diseases and how these risk factors change over time. Of particular concern are nursing home residents, who remain the most vulnerable of elders. Incorporating preventive oral health strategies into dental treatment and nursing home care will play a critical role in maintaining oral health for a lifetime. Oral health education of family, caregivers, and nursing home staff is essential if oral diseases are to be avoided later in life.

A clinical comparison of glass ionomer, resin-modified glass ionomer and resin composite restorations in the treatment of cervical caries in xerostomic head and neck radiation patients

Controversy exists as to whether there is less secondary caries at the margins of glass ionomer restorations compared with other materials that do not release fluoride. This study examined the incidence of secondary caries for three types of restorative materials in Class V restorations in xerostomic patients. The study group consisted of 45 high caries-risk adult patients who had undergone head and neck irradiation for the treatment of cancer. All were substantially xerostomic and in need of at least three restorations in the same arch. Every patient received a restoration with each of the test materials, a conventional glass ionomer (GI), a resin modified glass ionomer (RMGI) and a resin composite (C). Patients were instructed in the daily use of a neutral pH sodium fluoride gel in custom trays. Recall appointments were made at 6, 12, 18 and 24 months, and the restorations were examined for material loss, marginal integrity and recurrent caries at the restoration margin. Fluoride compliance was determined at each recall period and recorded as the percentage of recommended use during that interval. Patients were categorized at the end of the study as fluoride non-users if their average compliance was 50% or less. Those with greater than 50% compliance were categorized as fluoride users. In the latter group, no recurrent caries was found for any of the restorations, whereas a material-dependent incidence of recurrent caries was found in the fluoride non-user group. None of the GI, one RMGI and eight C restorations failed due to recurrent caries. For the fluoride non-user patients, Fishers exact test (p=0.05) showed no statistical difference between GI and RMGI but statistical differences were found among those materials and resin composite at each recall period. Recurrent caries reductions for GI and RMGI relative to C were greater than 80% in xerostomic patients not using topical fluoride supplementation.

Treating root-surface caries

This article summarizes the effectiveness of restorative materials used to restore root surfaces, the mechanisms by which these materials reduce caries, and placement techniques for restoring root-surface lesions. Patients may be classified into low, medium, and high caries risk groups for root caries, and specific dental restorative material recommendations are made for each category. Effective plaque control, xylitol-containing chewing gums, antimicrobial agents, fluoride-releasing restorative materials, topically applied fluoride, and fluoride-containing toothpastes provide maximum protection for the high caries risk patient.

Clinical and behavioural risk indicators for root caries in older people

OBJECTIVE

To investigate the clinical and behavioural factors indicating root caries risk among older people.

DESIGN

Cross-sectional clinical and interview data from the National Diet and Nutrition Survey (aged 65 years and over) in Great Britain. Logistic regression models of the prevalence of root caries and linear regression models of the extent of root caries were constructed to quantify the role of a range of clinical and behavioural risk indicators, including sugars intake.

SETTING

A national sample of older British adults, free-living and institutionalised.

PARTICIPANTS

462 dentate adults aged 65 years or over.

RESULTS

Nine or more intakes of sugars per day more than doubled the odds of root caries being present (OR 2.2-2.4). Other clinical and behavioural factors affecting root caries included wearing a partial denture in the presence of heavy plaque deposits (OR 2.1-2.6) and infrequent tooth brushing (OR 2.8-4.1). Linear regression models showed that, amongst those that had root caries, sucking sweets in the presence of a dry mouth, poor hygiene, partial dentures and living in an institution contributed to the extent of root caries, as measured by the RCI(d).

CONCLUSIONS

Of the factors open to possible clinical or behavioural intervention, frequent sugars intake, poor hygiene and partial dentures were all associated with large increases in risk.

Gingival recession-its significance and management

OBJECTIVES

To review the prevalence and current concepts of the mechanisms and aetiology of gingival recession and present the principles of assessment and management of the patient with gingival recession.

DATA AND SOURCES

The literature was searched for review and original research papers relating prevalence, mechanisms, aetiology, assessment, and treatment of gingival recession using Medline and manual tracing of references cited in key papers otherwise not elicited.

STUDY SELECTION

Studies with gingival recession as focus and pertinent to key aspects of review.

RESULTS

Gingival recession is a common condition and its extent and prevalence increase with age. Many factors including trauma and periodontal disease have a role in its aetiology. The patient may develop signs and symptoms including pain from exposed dentine, root caries and aesthetic concerns. Management of gingival recession requires thorough patient assessment, identification of aetiological factors, and recording and monitoring of the extent and severity of the condition. Treatment should be directed at prevention of further progression and the control of symptoms and disease. The patient's aesthetic concerns should be appreciated. Surgical treatment of recession may be indicated to cover exposed root surfaces. Many surgical techniques have been described with varied reported clinical effectiveness.

CONCLUSIONS

Gingival recession should be thoroughly assessed and evaluated in order to offer the most suitable management.

Type 1 diabetes mellitus and oral health: assessment of coronal and root caries

OBJECTIVES

The oral health of a large cohort of adult insulin-dependent diabetic patients (Type 1), diagnosed 24 years previously with juvenile onset, was comprehensively assessed. This paper describes the prevalence of coronal and root caries in this adult Type 1 diabetic population and evaluates demographic, dietary, behavioral, physiologic, salivary and medical variables associated with decayed and filled surfaces in the crown (DFS) or root (RDFS).

METHODS

Type 1 diabetes mellitus subjects participating in this oral health evaluation had been monitored for 6-8 years as participants in the University of Pittsburgh, Department of Epidemiology, longitudinal study of medical complications associated with diabetes. Four hundred and six diabetic subjects received a comprehensive oral health examination during one of their regularly scheduled medical visits. Oral assessments included coronal and root caries, missing teeth, edentulism, periodontal status, soft tissue pathologies, salivary function and health behaviors. Sixteen diabetic subjects and one control subject were edentulous. Coronal and root caries data from the remaining 390 dentate diabetic subjects were compared with 202 dentate nondiabetic control subjects.

RESULTS

The adult Type 1 diabetic subjects were not found to have significantly higher DFS rates as compared with our control subjects or published age-adjusted NHANES III findings. Both control and diabetic subjects had low decayed to filled tooth surface ratios. A linear regression model evaluated possible associations with coronal decayed and filled tooth surfaces (DFS) within the diabetic population. Significant factors included older age, women, fewer missing teeth, more frequent use of dental floss, more frequent visits to the dentist during the last 12 months, and diabetic nephropathy. The prevalence of RDFS was higher in the diabetic subjects as compared to recruited control subjects. Neither dietary behaviors nor glycemic control were found to contribute to coronal or root caries.

CONCLUSIONS

Factors associated with presence of coronal and root caries and fillings are discussed. Possible causes and implications for the association between DFS and diabetic nephropathy are provided.

Caries preventive knowledge and practices among dental hygienists

PURPOSE

The aim of this study was to determine the knowledge, opinions, and practices of dental hygienists in the areas of dental caries etiology and prevention.

METHODS

A pretested, validated 35-question survey instrument was mailed to a one percent national, stratified random sample of dental hygienists in the United States (n = 960) in October 1996. Four complete mailings of the instrument resulted in a 67% response rate, of which 77% were useable (n = 498). Respondents were asked if they agreed or disagreed with statements on caries etiology and preventive procedures, and also asked to rate the effectiveness of procedures for preventing dental caries in children and adults. Data were analyzed using descriptive statistics, t-tests, and ANOVA.

RESULTS

Overall level of knowledge of caries etiology and preventive procedures was low. More than 40% of subjects did not recognize that remineralization is the most important mechanism of action of fluoride, and fewer than 50% recognized that dental caries is a chronic infectious disease. Analysis of four factors thought to be related to knowledge and practice showed that younger graduates, more recent graduates, and ADHA members were more knowledgeable about the effectiveness of caries preventive procedures for children (p < .01). Although an overwhelming majority correctly agreed that adults benefit from fluoride and that root caries is an emerging problem, this knowledge was inconsistent with practice (p = .02). Fewer than 35% reported that they provide fluoride to adults of any age, or they wait until the disease is present. For children and adults who did receive fluoride treatments, a one-minute application of an APF gel or foam was most often provided.

CONCLUSIONS

Correct information about the etiology and prevention of dental caries is a predisposing factor to making informed decisions. Overall, respondents overrated the effectiveness of flossing and toothbrushing while underrating the effectiveness of fluorides. In the majority of cases, efficiency rather than efficacy was given priority when providing a topical fluoride treatment. An improved understanding of dental caries etiology and the scientific evidence for appropriate caries preventive procedures will allow dental hygienists to prevent and manage this disease better.

Relationships between medication intake, complaints of dry mouth, salivary flow rate and composition, and the rate of tooth demineralization in situ

The aim of this study was to describe the relationships between the rate of tooth demineralisation and medication intake, subjective feeling of dry mouth, saliva flow, saliva composition and the salivary level of lactobacilli. The study group consisted of 28 subjects that were divided into three groups according to their unstimulated whole saliva flow rate. Group 1 had an unstimulated saliva low rate < or =0.16 ml/min (n=10), group 2 had one from 0.17--0.30 ml/min (n=9), and group 3 had one >0.30 ml/min (n=9). The rate of tooth demineralization was determined as mineral loss assessed by quantitative microradiography of human root surfaces, exposed to the oral environment for 62 days in situ. The unstimulated and stimulated saliva flow rates, pH, bicarbonate, calcium, phosphate, and protein concentrations, as well as the degree of saturation of saliva with hydroxyapatite and the saliva buffer capacity were determined. The results showed that almost all subjects developed demineralization, albeit at highly varying rates. Eighty-five percent of the subjects in group 1, 33% of the subjects in group 2, and 0% of the subjects in group 3 developed mineral loss above the mean mineral loss for all the root surfaces in this experiment. Futhermore, group 1 differed significantly from groups 2 and 3 in having a higher medication intake, a more pronounced feeling of dry mouth, lower stimulated saliva flow rate, lower stimulated bicarbonate concentration, lower unstimulated and stimulated compositional outputs (bicarbonate, calcium, phosphate, and protein), and a higher Lactobacillus level. The best explanatory variable for high mineral loss in this study was a low unstimulated saliva flow rate. In conclusion, our results suggest that an unstimulated salivary flow rate < or =0.16 ml/min as described by Navazesh et al. (1992), is a better indicator of increased caries risk due to impaired salivation, than the currently accepted definition of hyposalivation (unstimulated saliva flow rate < or =0.10 ml/min), which relates to the function of the salivary glands (Sreebny, 1992).

In vitro evaluation of secondary caries development in enamel and root dentin around luted metallic restoration

Materials that release fluoride have been recommended for patients with high caries risk, but there is no conclusive evidence of their effect on fixed prostheses abutments. This study evaluated the influence of a resin-modified glass-ionomer cement on in vitro caries development in enamel and root dentin around metallic restoration. The cervical portion of 12 human third molars were sectioned in four blocks that were randomly divided into four Groups (n = 12; 1 block from each tooth/group): ZP (restoration + zinc phosphate cement), GI (restoration + resin-modified glass-ionomer cement), C1 (no restoration and no pH cycling), and C2 (no restoration and pH cycling). In ZP and GI, metallic restorations were luted at the crown-root junction. ZP, GI and C2 were submitted to a pH-cycling model. All blocks were sectioned, embedded and polished. Enamel and root dentin demineralization were evaluated through cross-sectional microhardness Knoop measures at 20 to 80 microns of depth (from the outer surface) and at 20 to 220 microns of distance from the cavity margins. Mineral loss values were calculated from Knoop hardness numbers. Data were analyzed by ANOVA, Tukey's test and regression analysis. Groups ZP, GI and C2 showed demineralization in relation to C1, which was more superficial in enamel than in root dentin. In root dentin, mineral loss in ZP and GI was smaller than in C2. Distance from the cavity margins was not significant. There was no difference between resin-modified glass-ionomer cement and zinc phosphate cement regarding artificial secondary caries development in both dental substrates.

Number of teeth and risk of root caries

OBJECTIVE

This study aimed to investigate the association between number of natural teeth and prevalence of root caries.

DESIGN

A cross-sectional design was adopted. A stratified multi-stage purposive sampling method was used to select a wide range of elderly people from all social classes, educational levels and sexes. Data was collected through interviews and clinical examinations.

SETTING

Urban area in Chiang Mai-Thailand.

PARTICIPANTS

549 elderly dentate aged 60-74 years.

MAIN OUTCOME MEASURES

Teeth with decay and filled roots (DF-T).

RESULTS

The prevalence of root caries was 18.2% with a mean DF-T of 0.58 (S.D. 2.02). Results of multiple logistic regression showed that number of teeth, DMF-S scores, sex, and socio economic factors were statistically significantly associated with root caries (P < 0.05). Adjusted odds ratios demonstrated a 14% increase in the chance of having root caries when the number of teeth increased one unit. Similarly, a 3% increase was observed for each unit increase in the DMF-S scores (p < 0.001). Being male, having more than four years of education and earning more than 1500 baht/month increased the chances of root caries by 76%, 139% and 85% respectively (p < 0.001). Recession and age were not statistically significantly associated with root caries.

CONCLUSIONS

Having more teeth, higher DMF-S scores, earning more than 1500 baht/month, having more than 4 years of education and being male increased the likelihood of having root caries.

[Root caries in patients in periodontal follow-up care. Prevalence and risk factors]

The aim of this cross-sectional study was to investigate the prevalence and several risk indicators of root cariës in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11-22 years ago. These patients were part of a routine 3-6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffer capacity, S. mutans counts and Lactobacilli were also scored. From the total of 45 subjects, 37 patients (82%) showed root lesions (root caries and/or fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 lesions per patient (range 0-19) in the present study. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibular sites; 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with > 106 S. mutans/ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross-sectional study in periodontal maintenance patients indicate that: root cariës can be regarded as a complication in periodontal maintenance patients, that the individual number of root lesions correlate with individual dental plaque score, that a high number of root lesions is associated with counts of salivary S. mutans, and that no relation between root cariës and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygiëne instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high-risk patients.

Take two dentists: a tale of root caries

Take two dentists, whose practices are about as different as they could possibly be, who both have a healthy respect for root caries. Our paper will start by describing these two practices and then review the literature to show what is known about the management of root caries. The paper ends by returning to the two dentists, who describe how the research reviewed in the literature may affect their work.

Parkinson's disease and oral care

Parkinson's disease is a relatively common, progressive, neurological disorder. Its key features of resting tremor, bradykinesia, akinesia, restricted mobility and postural instability militate against independence for daily living, mobility, good nutrition and oral health. The successful management of the disease requires a multi-disciplinary approach in which the dietician, speech therapist, nurse and dental staff are pivotal members of the care team.

Root caries among Benghazi patients

A total of 420 Benghazi patients were clinically examined for root caries. Root caries was not limited to older patients and the proportion of root caries among young adults was similar to that of the older age groups. Most of the lesions were located proximally and underneath restorations rather than labially or lingually. Our results may serve as baseline data for further studies on root caries in the Libyan Arab Jamahiriya.

[The dynamics of pH, free calcium and total proteins in root plaque fluid and their relationships to the cariogenic potential]

OBJECTIVE

To enhance knowledge of root caries by analysis of the dynamics of dental plaque fluids on root surface and their relationships with the caries history.

METHODS

The pH, free calcium and total proteins of dental plaque fluids on sound root surfaces were analyzed before and after the sucrose challenge. Subjects were either root caries-free (RCF) or caries-positive (RCP).

RESULTS

After a sucrose challenge, the pH of plaque fluids dropped significantly and the concentration of free calcium increased significantly. There were no statistical differences in pH (RCF group 6.24 +/- 0.74, RCP group 5.96 +/- 0.70) and free calcium [RCF group (0.60 +/- 0.46) mmol/L, RCP group (0.89 +/- 0.54) mmol/L] between RCF and RCP group before sucrose challenge. Following sucrose exposure, pH (5.14 +/- 0.19) and free calcium [(1.73 +/- 0.74) mmol/L] in RCP group were significantly lower than RCP group [(pH 5.28 +/- 0.16), free calcium (2.73 +/- 1.25) mmol/L]. No interrelationship has been found between the amount of total proteins and free calcium. Components (contents, change trend) in root plaque were strongly related to that in coronal plaque.

CONCLUSIONS

The process of root caries may be consistent to coronal caries regarding to the acid production of bacteria after a sucrose challenge. Plaque compositions show a stronger cariogenic potential in RCP group.