Cell Attachment Following Instrumentation with Titanium and Plastic Instruments, Diode Laser, and Titanium Brush on Titanium, Titanium-Zirconium, and Zirconia Surfaces

PURPOSE

The aim of this study was to evaluate the surface characteristics and gingival fibroblast adhesion of disks composed of implant and abutment materials following brief and repeated instrumentation with instruments commonly used in procedures for implant maintenance, stage-two implant surgery, and periimplantitis treatment.

MATERIALS AND METHODS

One hundred twenty disks (40 titanium, 40 titaniumzirconium, 40 zirconia) were grouped into treatment categories of instrumentation by plastic curette, titanium curette, diode microlaser, rotary titanium brush, and no treatment. Twenty strokes were applied to half of the disks in the plastic and titanium curette treatment categories, while half of the disks received 100 strokes each to simulate implant maintenance occurring on a repetitive basis. Following analysis of the disks by optical laser profilometry, disks were cultured with human gingival fibroblasts. Cell counts were conducted from scanning electron microscopy (SEM) images.

RESULTS

Differences in surface roughness across all instruments tested for zirconia disks were negligible, while both titanium disks and titaniumzirconium disks showed large differences in surface roughness across the spectrum of instruments tested. The rotary titanium brush and the titanium curette yielded the greatest overall mean surface roughness, while the plastic curette yielded the lowest mean surface roughness. The greatest mean cell counts for each disk type were as follows: titanium disks with plastic curettes, titanium-zirconium disks with titanium curettes, and zirconia disks with the diode microlaser.

CONCLUSION

Repeated instrumentation did not result in cumulative changes in surface roughness of implant materials made of titanium, titanium-zirconium, or zirconia. Instrumentation with plastic implant curettes on titanium and zirconia surfaces appeared to be more favorable than titanium implant curettes in terms of gingival fibroblast attachment on these surfaces.

Influence of clinical experience on oral health attitude and behaviour of dental students attending a Nigerian university

OBJECTIVE

To evaluate the self-reported oral health attitudes and behaviour among the clinical dental students and to compare the influence of clinical experience on oral health attitudes and behaviour among dental students at the different clinical years in the University of Benin using the modified Hiroshima University Dental Behavior Inventory (HU-DBI).

METHODS

The study involved 156 clinical dental students from the University of Benin, Benin City, Nigeria. Demographic data were obtained for age and gender from 4th, 5th and 6th year clinical students. A modified English version of HU-DBI survey consisted of 22 items with dichotomous responses (yes-no) was used in this study. Descriptive statistics was performed for age and clinical level of education. Chi-square text was applied to the percentages of responses. Tamhane's T2 post-hoc multiple comparison for pairwise comparison of the three clinical levels of students was done to determine the differences. Test significance was set at P < 0.05.

RESULTS

The response rate was 87.2%. The mean age of the respondents was 26.2 + 2.4 years. A total of 62 (39.7%) respondents were females and 94 (60.3%) males. Statistically significant differences were found among the various clinical levels of dental students for previous visit to the dentist office, visiting the dentist unless there is toothache, brushing the teeth twice daily and the prevention of gum disease with tooth brushing alone.

CONCLUSION

There was improvement in the dental students' oral health behaviour and attitudes with increasing level of dental education.

Powered versus manual toothbrushing for oral health

BACKGROUND

Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this. This is an update of a Cochrane review first published in 2003, and previously updated in 2005.

OBJECTIVES

To compare manual and powered toothbrushes in everyday use, by people of any age, in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 23 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE via OVID (1946 to 23 January 2014), EMBASE via OVID (1980 to 23 January 2014) and CINAHL via EBSCO (1980 to 23 January 2014). We searched the US National Institutes of Health Trials Register and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials of at least four weeks of unsupervised powered toothbrushing versus manual toothbrushing for oral health in children and adults.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by The Cochrane Collaboration. Random-effects models were used provided there were four or more studies included in the meta-analysis, otherwise fixed-effect models were used. Data were classed as short term (one to three months) and long term (greater than three months).

MAIN RESULTS

Fifty-six trials met the inclusion criteria; 51 trials involving 4624 participants provided data for meta-analysis. Five trials were at low risk of bias, five at high and 46 at unclear risk of bias.There is moderate quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual toothbrushes with regard to the reduction of plaque in both the short term (standardised mean difference (SMD) -0.50 (95% confidence interval (CI) -0.70 to -0.31); 40 trials, n = 2871) and long term (SMD -0.47 (95% CI -0.82 to -0.11; 14 trials, n = 978). These results correspond to an 11% reduction in plaque for the Quigley Hein index (Turesky) in the short term and 21% reduction long term. Both meta-analyses showed high levels of heterogeneity (I(2) = 83% and 86% respectively) that was not explained by the different powered toothbrush type subgroups.With regard to gingivitis, there is moderate quality evidence that powered toothbrushes again provide a statistically significant benefit when compared with manual toothbrushes both in the short term (SMD -0.43 (95% CI -0.60 to -0.25); 44 trials, n = 3345) and long term (SMD -0.21 (95% CI -0.31 to -0.12); 16 trials, n = 1645). This corresponds to a 6% and 11% reduction in gingivitis for the Löe and Silness index respectively. Both meta-analyses showed high levels of heterogeneity (I(2) = 82% and 51% respectively) that was not explained by the different powered toothbrush type subgroups.The number of trials for each type of powered toothbrush varied: side to side (10 trials), counter oscillation (five trials), rotation oscillation (27 trials), circular (two trials), ultrasonic (seven trials), ionic (four trials) and unknown (five trials). The greatest body of evidence was for rotation oscillation brushes which demonstrated a statistically significant reduction in plaque and gingivitis at both time points.

AUTHORS' CONCLUSIONS

Powered toothbrushes reduce plaque and gingivitis more than manual toothbrushing in the short and long term. The clinical importance of these findings remains unclear. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and only temporary.

Effects of two essential oil mouthrinses on 4-day supragingival plaque regrowth: a randomized cross-over study

PURPOSE

To investigate the plaque inhibiting effects of two commercially available mouthrinses containing essential oils (EO). Both products contained the same concentration of EO, but one of them did not contain ethanol.

METHODS

The study was an observer-masked, randomized, 4 x 4 Latin square cross-over design, balanced for carryover effects, involving 12 participants in a 4-day plaque regrowth model. A 0.12% chlorhexidine (CHX) rinse and a saline solution served as positive and negative controls, respectively. On Day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On Day 5, subjects were scored for disclosed plaque.

RESULTS

Differences among treatments were highly significant (P < 0.0001), with greater plaque inhibition by CHX compared to EO rinse containing ethanol (P = 0.012), which, in turn, was significantly more effective than the rinse without ethanol and the saline (P < 0.001). The reduction in plaque regrowth seen with the EO rinse without ethanol was quite similar to that elicited by saline (P > 0.05).

3D monitoring and quality control using intraoral optical camera systems

The quality of intraoral scanning systems is steadily improving, and they are becoming easier and more reliable to operate. This opens up possibilities for routine clinical applications. A special aspect is that overlaying (superimposing) situations recorded at different times facilitates an accurate three-dimensional difference analysis. Such difference analyses can also be used to advantage in other areas of dentistry where target/actual comparisons are required. This article presents potential indications using a newly developed software, explaining the functionality of the evaluation process and the prerequisites and limitations of 3D monitoring.

[Pregnant women's oral hygiene knowledge and habits after the second millennium in South-East Hungary]

Among the predisposing agents for inflammatory periodontal lesion dental plaque is the most important, but different local and systemic factors may influence the seriousness or progression of periodontitis. Hormonal changes during pregnancy belong to the systemic aggravating factors. The aim of the present study was to assess pregnant women's oral hygiene knowledge and habits, and if these have a relationship with age, residence, educational level and profession/occupation. Questionnaires were used for the data collection. 275 pregnant women, who underwent prenatal care at the Department of Obstetrics and Gynecology in Szeged, volunteered to answer the questions. The results showed that almost all the women brushed their teeth daily, but only about one third of them used special oral hygiene tools, like dental floss. Many of the women claimed to have gingival bleeding when brushing their teeth. More then 70% visited a dentist during pregnancy. There was a significant relationship between educational level and the use of dental floss (p=0.004) and gingival bleeding (p=0.023) Oral hygiene education, dental and periodontal treatment of pregnant women need more emphasis during prenatal care.

Why do we polish? Part one

What does polishing oral hard tissues and restorations accomplish? The two parts of this review will describe the effect of polishing on various restorative materials and teeth; the development of biofilm and adherence of plaque to teeth and restorations; the effects of unpolished versus polished surfaces on gingival health and longevity of restoration; and techniques for polishing various restorative materials. A listing of available polishing materials is included in Part Two, which will appear in the July-August Northwest Dentistry.

The antibacterial and antiplaque effectiveness of mouthwashes containing cetylpyridinium chloride with and without alcohol in improving gingival health

This article briefly discusses the antibacterial action ofcetylpyridinium chloride (CPC) and its efficacy in the removal of bacterial plaque as an adjunct to the mechanical cleaning of tooth surfaces. It reviews new studies on the effectiveness of mouthwash formulations containing CPC against two common oral bacteria species and in disrupting plaque biofilms. Finally, this article reviews three clinical studies which support that the daily use of mouthwashes containing 0.075% CPC, with and without alcohol, represents a valuable complement to daily mechanical plaque control.

Dental training and changes in oral health attitudes and behaviors in Istanbul dental students

The aim of this study was to examine the changes that occur in the oral health attitudes and behaviors of dental students in Istanbul, Turkey, during their dental education. The Turkish version of the Hiroshima University-Dental Behavioral Inventory (HU-DBI) was distributed among 757 dental students at the Dental Faculty, Istanbul University. The response rate was 72 percent. Chi-square and logistic regression models were used for statistical analysis. The mean HU-DBI score of the clinical students was significantly higher than that of the preclinical students. Preclinical students significantly more often believed that it was impossible to prevent gum disease with toothbrushing alone and worried about the color of their teeth and bad breath. Most of them brushed their teeth with strong strokes, thought the condition of their teeth was getting worse despite daily toothbrushing, and would seek dental care only when symptoms arise. Clinical students more often used disclosing solutions to see how clean their teeth were and complained of bleeding gums. The variation in favorable oral health attitudes/behaviors appeared to reflect the students' educational training experience. The findings of this study highlight the relatively poor oral health behaviors of Turkish dental students, which should be improved by means of comprehensive programs that aim to promote their own dental hygiene practices and preventive oral health knowledge from the start of dental training.

Interventions for replacing missing teeth: maintaining and recovering soft tissue health around dental implants

BACKGROUND

It is important to institute an effective supportive therapy to maintain or recover soft tissue health around dental implants. Different maintenance regimens have been suggested, however it is unclear which are the most effective.

OBJECTIVES

To assess the effects of different interventions for 1) maintaining and 2) recovering soft tissue health around osseointegrated dental implants.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and to an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 2 June 2010.

SELECTION CRITERIA

All randomised controlled trials comparing agents or interventions for maintaining or recovering healthy tissues around dental implants.

DATA COLLECTION AND ANALYSIS

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using standardised mean differences for continuous data and risk ratios for dichotomous data with 95% confidence intervals.

MAIN RESULTS

Five trials compared interventions for maintaining soft tissue health around implants and a further six trials compared interventions to recover soft tissue health where there was evidence of peri-implant mucositis. No statistically significant differences were found between the effectiveness of powered versus manual toothbrushes for either maintaining or recovering soft tissue health. There was no statistically significant difference found between different types of self administered antimicrobials for maintaining soft tissue health (hyaluronic acid gel compared to chlorhexidine gel, amine fluoride/stannous fluoride mouthwash compared to chlorhexidine mouthwash) and triclosan dentifrice compared to sodium fluoride dentifrice showed no statistically significant difference in recovering soft tissue health. However chlorhexidine irrigation was more effective in reducing plaque and marginal bleeding scores compared to chlorhexidine mouthwash and Listerine mouthwash was found to be statistically significantly better than placebo with regard to reducing mean plaque scores and marginal bleeding scores. When interventions administered by dental professional were compared there was no statistically significant difference found between chlorhexidine and physiologic solutions as irrigants at second stage surgery to maintain health of soft tissues. In patients with peri-implant mucositis two trials evaluated interventions performed by dental professionals. There was no statistically significant difference between mechanical debridement followed by either minocycline or chlorhexidine gel, or between debridement with a titanium curette compared to an ultrasonic debridement tool.

AUTHORS' CONCLUSIONS

There was only low quality evidence for which are the most effective interventions for maintaining or recovering health of peri-implant soft tissues. The included RCTs had short follow-up periods and few subjects and although overall the risk of bias of the studies was either low or unclear, only single trials were available for each outcome. There was no reliable evidence as to which regimens are most effective for long term maintenance. This should not be interpreted as meaning that current maintenance regimens are ineffective. There was weak evidence that antibacterial mouthrinses are effective in reducing plaque and marginal bleeding around implants. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according to the CONSORT guidelines (www.consort-statement.org/).

A systematic review of dental disease in patients undergoing cancer therapy

INTRODUCTION

This purpose of this systematic review was to evaluate the literature and update our current understanding of the impact of present cancer therapies on the dental apparatus (teeth and periodontium) since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies.

REVIEW METHOD

A systematic literature search was conducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 1990 and 31 December 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of dental caries, severe gingival disease, and dental infection. Data on DMFT/dmft, DMFS/dmfs, plaque, and gingival indexes were also gathered. The level of evidence, recommendation, and guideline (if possible) were given for published preventive and management strategies.

RESULTS

Sixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n = 457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (SD, 0.25; n = 189). The GI for patients who were post-chemotherapy was 1.02 (SD, 0.15; n = 162). The weighted prevalence of dental infections/abscess during chemotherapy was reported in three studies and was 5.8%.

CONCLUSIONS

Patients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhexidine rinses are beneficial in patients who are post-radiotherapy. There continues to be lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy.

Basic oral health goals for Spain 2015/2020

AIM/OBJECTIVE

To define the basic oral health goals for Spain 2015 (children)/2020 (adults).

METHODS

The Spanish Society of Epidemiology and Oral Public Health commissioned a six-member Expert Panel, which worked over the period 2006-2007 and reached consensus according to the EuropeAid Evaluation Guidelines. The Panel's work included three meetings and a presentation at the Society's annual conference in 2007. Since each autonomous region/city in Spain has control over its health policy, only basic goals for the country as a whole were defined. The variables used to set goals were caries history and gingival health according to the World Health Organisation criteria, and tooth brushing frequency and health perception according to the European Global Oral Health Indicators Development Project.

RESULTS AND CONCLUSIONS

A total of 16 targets were defined, 8 for children and 8 for adults. For example, the number of permanent decayed, missing and filled teeth should be < 1.0 at 12 years of age by 2015, or the percentage of edentulous persons should be < 15% at 65-74-years by 2020. In order to achieve the proposed goals, the Expert Panel recommends involving all health system personnel in the maintenance and/or development of new oral health programmes and strategies.

A simplified method to develop optimal gingival contours for the single implant-supported, metal-ceramic crown in the aesthetic zone

Prosthetic replacement of the missing single maxillary central incisor with an implant-supported crown represents a profound aesthetic challenge for the restorative dentist, laboratory technician, and surgeon. In addition to the visual fidelity of color, translucency, contour, and surface texture, the proper soft tissue outline is sacrosanct to the illusion of a natural tooth. The contrast between the uniformly round shoulder of the implant and the tooth's curvilinear cementoenamel junction is particularly problematic. This clinical report demonstrates a simplified method that precisely controls the facial gingival and proximal soft tissue contours for implant-supported, metal-ceramic crowns in the aesthetic zone, using the cervical anatomy of the maxillary incisor tooth as a guide. A new role for the provisional crown that is intended to maximize the volume of keratinized tissue is also described.

Interventions for replacing missing teeth: maintaining and recovering soft tissue health around dental implants

BACKGROUND

It is important to institute an effective supportive therapy to maintain or recover soft tissue health around dental implants. Different maintenance regimens have been suggested, however it is unclear which are the most effective.

OBJECTIVES

To test the null hypotheses of no difference between different interventions (1) for maintaining healthy peri-implant soft tissues, and (2) for recovering soft tissue health, against the alternative hypothesis of a difference.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and to an internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 13 June 2007.

SELECTION CRITERIA

All randomised controlled trials comparing agents or interventions for maintaining or recovering healthy tissues around dental implants.

DATA COLLECTION AND ANALYSIS

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using standardised mean differences for continuous data and risk ratios for dichotomous data with 95% confidence intervals.

MAIN RESULTS

Eighteen RCTs were identified. Nine of these trials, which reported results from a total of 238 patients, were included. Follow ups ranged between 6 weeks and 1 year. No meta-analysis could be made since every RCT tested different interventions. Listerine mouthwash showed a reduction of 54% in plaque and 34% in marginal bleeding compared with a placebo. Two trials evaluated the efficacy of powered and sonic toothbrushes compared to manual toothbrushing and showed no statistically significant differences, though more patients liked the sonic brush. No statistical differences were found between brushing with a hyaluronic or a chlorhexidine gel, between cleaning with an etching gel or manually, between injecting a chlorhexidine or a physiologic solution inside the implant's inner part and between submucosal minocycline and a chlorhexidine gel. When an amine fluoride/stannous fluoride (AmF/SnF(2)) mouthrinse was compared with a chlorhexidine one, no statistically significant differences were found for implant failures and staining index while patients preferred and had less taste change with the AmF/SnF(2) mouthrinse. Self administered subgingival chlorhexidine irrigation resulted in statistically significantly lower plaque and marginal bleeding than a chlorhexidine mouthwash, however the mouthwash was given at a suboptimal dosage.

AUTHORS' CONCLUSIONS

There was only little reliable evidence for which are the most effective interventions for maintaining or recovering health of peri-implant soft tissues. The included RCTs had short follow-up periods and few subjects. There was not any reliable evidence for the most effective regimens for long term maintenance. This should not be interpreted as current maintenance regimens are ineffective. There was weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as an adjunct to routine oral hygiene, is effective in reducing plaque and marginal bleeding around implants. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according to the CONSORT guidelines (http://www.consort-statement.org/).

Porcelain laminate veneers: reasons for 25 years of success

This article discusses failures that could occur if meticulous attention is not given to details such as planning the case, conservative (enamel saving) preparation of teeth, proper selection of ceramics to use, proper selection of the materials and methods of cementation of these restorations, proper finishing and polishing of the restorations, and proper planning for the continuing maintenance of these restorations. Some concerns as to newer products and methods and their effect on the continued success of this modality of treatment are also addressed.

Quality of trials in a systematic review of powered toothbrushes: suggestions for future clinical trials

BACKGROUND

This study aimed to assess the quality of reports of randomized controlled trials (RCTs) comparing manual and powered toothbrushes and provide advice on how future trials might be improved.

METHODS

Studies were identified in the Cochrane systematic review of RCTs comparing powered versus manual toothbrushes. Reports were assessed against predefined criteria on the design of the studies to determine the effectiveness of the brushes in everyday home use and on their methodological quality.

RESULTS

Only 42 of 297 identified studies satisfied the inclusion criteria and were eligible for inclusion in the review. Many studies were excluded for more than one reason. Fifteen studies employed split-mouth designs that may have changed toothbrushing behavior. Of 42 included RCTs, the generation of randomization sequence was adequate in 15 trials and concealment of allocation was adequate in 16 trials. Intention-to-treat analysis was reported in only five studies. Plaque data were reported using 10 different indices and gingivitis with nine indices. Only 12 trials lasted 3 months or longer, and there were no data on the benefits of powered toothbrushes for periodontal attachment.

CONCLUSIONS

Some designs created an artificial research environment that may have undermined the findings. Authors of toothbrush trials should consider the Consolidated Standards of Reporting Trials statement. Greater standardization of the indices used is required. Trials of longer duration would enhance the evaluation of powered toothbrushes. Data on thresholds for clinically significant differences in plaque and gingivitis levels would help to determine whether oral hygiene aids provide important health benefits.

Enhancement of fluoride release from glass ionomer cement following a coating of silver fluoride

BACKGROUND

This study investigated the extent to which a coating of 10% silver fluoride (AgF) on discs of glass jonomer cements (GIGs) would enhance the release of fluoride ion into eluting solutions at varying pH.

MATERIALS AND METHODS

Forty discs each of Fuji LX, Fuji VII and of Vitrebond were prepared in a plastic mould. Twenty discs of each material were coated for 30 seconds with a 10% solution of AgF. Five discs each of coated and uncoated material were placed individually in 4m1 of differing eluant solutions. The eluant solutions comprised deionized distilled water (DDW) and three separate acetate buffered solutions at pH 7, pH 5 and pH 3. After 30 minutes the discs were removed and placed in five vials containing 4m1 of the various solutions for a further 30 minutes. This was repeated for further intervals of time up to 216 hours, and all eluant solutions were stored. Fluoride concentrations in the eluant solutions were estimated using a fluoride specific electrode, with TISAB IV as a metal ion complexing and ionic concentration adjustment agent. Cumulative fluoride release patterns were determined from the incremental data.

RESULTS

The coating of AgF greatly enhanced the level of fluoride ion release from all materials tested. Of the uncoated samples, Vitrehond released the greater concentrations of fluoride ion, followed by Fuji VII. However, cumulative levels of fluoride released from coated samples of the GICs almost matched those from coated Vitrebond.

CONCLUSIONS

It was concluded that a coating of 10% AgF on GICs and a resin modified GIC greatly enhanced the concentration of fluoride released from these materials. This finding might be applied to improving protection against recurrent caries, particularly in high caries risk patients, and in the atraumatic restorative technique (ART) of restoration placement.

The use of dental care facilities and oral health: a multilevel approach of schoolchildren in the Brazilian context

PURPOSE

To appraise the association between dental care utilisation and gingival status in the Brazilian context, controlling for covariates on socio-demographic characteristics and dentofacial anomalies (12-year-old children).

MATERIALS AND METHODS

A survey of oral health comprising 5780 schoolchildren in 35 towns of the state of São Paulo, Brazil, provided primary information regarding the assessment of the community periodontal index. The survey also provided information on socio-demographic characteristics and the dental aesthetic index of participants. The utilization of dental services was measured at the town-level, in terms of the dental care index (F/DMFT ratio). Multilevel models of logistic regression fitted the adjustment of covariates for gingival bleeding on probing and calculus.

RESULTS

Almost 32% of the children examined presented unhealthy gingival conditions, with a significantly poorer profile for boys, black children and those enrolled in public schools than for their counterparts. Several dentofacial anomalies associated with unhealthy gingival status: crowding of the incisal segments, maxillary and mandibular irregularity, antero posterior molar relation, maxillary overjet and vertical anterior openbite. Towns with a higher dental care index presented a lower proportion of children with gingival bleeding and calculus.

CONCLUSION

This study confirmed previous observations of boys, blacks and children enrolled in public schools as presenting poorer oral health status than their counterparts in the Brazilian context. The utilization of dental services was significantly associated with improved profile of gingival status of participating towns, and this association is unlikely to be due to insufficient control of confounding on socio-demographic characteristics and dentofacial anomalies.

Manual versus powered toothbrushing for oral health

BACKGROUND

Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this.

OBJECTIVES

To compare manual and powered toothbrushes in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group Trials Register (to 17/06/2004) and Central Register of Controlled Trials (The Cochrane Library Issue 2, 2004); MEDLINE (January 1966 to week 2 June 2004); EMBASE (January 1980 to week 2 2004) and CINAHL (January 1982 to week 2 June 2004). Manufacturers were contacted for additional data.

SELECTION CRITERIA

Trials were selected for the following criteria: design-random allocation of participants; participants - general public with uncompromised manual dexterity; intervention - unsupervised manual and powered toothbrushing for at least 4 weeks. Primary outcomes were the change in plaque and gingivitis over that period.

DATA COLLECTION AND ANALYSIS

Six authors independently extracted information. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using random-effects models. Potential sources of heterogeneity were examined, along with sensitivity analyses for quality and publication bias. For discussion purposes SMD was translated into percentage change.

MAIN RESULTS

Forty-two trials, involving 3855 participants, provided data. Brushes with a rotation oscillation action removed plaque and reduced gingivitis more effectively than manual brushes in the short term and reduced gingivitis scores in studies over 3 months. For plaque at 1 to 3 months the SMD was -0.43 (95% CI: -0.72 to -0.14), for gingivitis SMD -0.62 (95% CI: -0.90 to -0.34) representing an 11% difference on the Quigley Hein plaque index and a 6% reduction on the Loe and Silness gingival index. At over 3 months the SMD for plaque was -1.29 (95% CI: -2.67 to 0.08) and for gingivitis was -0.51 (-0.76 to -0.25) representing a 17% reduction on the Ainamo Bay bleeding on probing index. There was heterogeneity between the trials for the short-term follow up. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias. No other powered designs were as consistently superior to manual toothbrushes.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and temporary.

AUTHORS' CONCLUSIONS

Powered toothbrushes with a rotation oscillation action reduce plaque and gingivitis more than manual toothbrushing. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.

Progressing toward a more culturally competent approach to dental care for African American elders

This study was conducted to understand perceptions that may influence oral self-care behaviors among elderly African American adults living in an urban community. Four focus groups at two senior centers were recruited, involving a total of 25 participants. Content analysis and ethnographic summaries were used to identify themes, common concepts and language. The results indicated that although the participants recognized the advantages of routine brushing, the importance of keeping teeth clean to prevent gum disease was not widely acknowledged. On the basis of these focus groups, the authors suggest that health promotion approaches for adults who are elderly should be linked to the audience's cultural norms and perceptions regarding the benefits of oral hygiene practices.

Randomized controlled trial of pilocarpine hydrochloride for the moderation of oral mucositis during autologous blood stem cell transplantation

Pilocarpine hydrochloride has been reported to increase salivation and decrease oral mucositis in patients receiving head and neck radiotherapy, but there is only one report of its use in a cancer chemotherapy patient population. This prospective, double-blinded, randomized, placebo-controlled trial was undertaken to determine the efficacy of pilocarpine for the moderation of oral mucositis during autologous blood stem cell transplantation. Subjects were randomized to receive a 5 mg tablet of pilocarpine, or a placebo, during and following chemotherapy. Subjects were seen every other day and evaluated for gingival, oral, and oropharyngeal mucositis; nutrition; oral hygiene; eating; speaking; sleeping; pain at rest and/or with swallowing; and mouth dryness. We recorded the mean and highest scores and duration of problems, along with white blood cell counts and differentials, and the use of systemic narcotics for oral mucosal pain. We enrolled and randomized 36 subjects, and there were no statistically or clinically significant differences for the primary outcome of severity of mucositis and no clinically significant differences in any of the other outcome measures. Pilocarpine has no benefit for the moderation of the incidence, severity, or duration of mucositis in patients receiving autologous blood stem cell transplantation.

The role of keratinized tissue and attached gingiva in maintaining periodontal/peri-implant health

Although the band of keratinized tissue and attached gingiva is determined genetically, it may be affected by the presence of plaque-associated inflammation or by the action of certain mechanical interventions. This article reviews variations in the width of keratinized tissue and attached gingiva and their clinical significance regarding periodontal/peri-implant health.

Interventions for replacing missing teeth: maintaining health around dental implants

BACKGROUND

To maintain healthy tissues around dental implants it is important to institute an effective preventive regimen (supportive therapy). Different maintenance regimens have been suggested, however it is unclear which are the most effective.

OBJECTIVES

To test the null hypothesis of no difference between different interventions for maintaining healthy tissues around dental implants.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 2 February 2004.

SELECTION CRITERIA

All randomised controlled trials of oral implants comparing agents or interventions for maintaining or recovering healthy tissues around dental implants.

DATA COLLECTION AND ANALYSIS

We carried out a quality assessment of the included RCTs in duplicate and contacted the authors for missing information. We independently extracted the data in duplicate. We followed the Cochrane Oral Health Group's statistical guidelines.

MAIN RESULTS

Fourteen RCTs were identified. Five of these trials, which reported results from a total of 127 patients, were suitable for inclusion in the review. Two trials evaluated the efficacy of powered and sonic toothbrushes, respectively, when compared to manual toothbrushing and showed no statistically significant differences. One RCT compared Listerine versus placebo mouthwashes showing a reduction of 54% in plaque and 34% in marginal bleeding compared with the placebo. One trial compared self administered subgingival chlorhexidine irrigation versus chlorhexidine mouthwash. The group using chlorhexidine irrigation resulted in statistically significantly lower mean plaque scores and a marginal bleeding index than the group using chlorhexidine mouthwash, however the mouthwash was given at a suboptimal dosage. One study compared etching gel with mechanical debridement showing no statistical differences. Follow ups ranged between 6 weeks and 5 months. It was not possible to make any meta-analysis as each trial assessed different interventions.

REVIEWERS' CONCLUSIONS

There is only little reliable evidence for which are the most effective interventions for maintaining health around peri-implant tissues. There was no evidence that the use of powered or sonic toothbrushes was superior to manual toothbrushing. There is weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as adjunct to routine oral hygiene is effective in reducing plaque formation and marginal bleeding around implants. There was no evidence that phosphoric etching gel offered any clinical advantage over mechanical debridement. These findings are based on RCTs having short follow-up periods and few subjects. There is not any reliable evidence for the most effective regimens for long term maintenance. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according the CONSORT guidelines (http://www.consort-statement.org/).

Perioesthetic Approach to the Diagnosis and Treatment of Carious and Noncarious Cervical Lesions: Part II

Several classes of tooth-colored materials are available for restoring carious and noncarious cervical lesions. Included are the composite resins, which can be bonded into the cervical area to provide predictable form, function, and esthetics. Part I of this two-part report reviewed the etiology of noncarious cervical lesions and provided a series of clinical case reports showing the importance of the periodontal aspect of lesion management. In part II we present information about adhesive preparation design and esthetic restoration of the noncarious cervical lesion.

CLINICAL SIGNIFICANCE

When used with proper attention to preparation design and restoration placement and finishing, resin composites can be used to successfully restore form, function, and esthetics to defective cervical areas of teeth.

Manual versus powered toothbrushing for oral health

BACKGROUND

Specific oral bacteria, generically known as "dental plaque" are the primary cause of gingivitis (gum disease) and caries. The removal of dental plaque is thought to play a key role in the maintenance of oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this.

OBJECTIVES

To compare manual and powered toothbrushes in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register (to 22/8/02); Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to week 5 2002); EMBASE (January 1980 to week 3 July 2002) and CINAHL (January 1982 to June 2002). Manufacturers of powered toothbrushes were contacted for additional published and unpublished trials.

SELECTION CRITERIA

Trials were selected if they met the following criteria: design-random allocation of participants; participants-general public with uncompromised manual dexterity; intervention- supervised manual and powered toothbrushing for at least four weeks; primary outcomes-the change in plaque and gingivitis over that period.

DATA COLLECTION AND ANALYSIS

Six reviewers independently extracted information in duplicate. Indices for plaque and gingivitis were expressed as standardised values for each study. The effect measure for each meta-analysis was the standardised mean difference (SMD) with the appropriate 95% confidence intervals (CI) using random effect models. Potential sources of heterogeneity were examined, along with sensitivity analyses for the items assessed for quality and publication bias.

MAIN RESULTS

Twenty-nine trials, involving 2,547 participants, provided data for the meta-analysis. Brushes that worked with a rotation oscillation action removed more plaque and reduced gingivitis more effectively than manual brushes in the short and long term. For plaque at one to three months the SMD was -0.44 (95% CI: -0.66 to -0.21), for gingivitis SMD -0.44 (95% CI: -0.72, -0.15). These represented an 11% reduction on the Quigley Hein plaque index and a 6% reduction on the Löe and Silness gingival index. At over three months the effects were SMD for plaque -1.15 (95% CI: -2.02,-0.29) and SMD for gingivitis -0.51 (95% CI: -0.76, -0.25). These represented a 7% reduction on the Quigley Hein Plaque Index and a 17% reduction on the Ainamo Bay Bleeding on Probing Gingival Index. The heterogeneity found in these meta-analyses for short term trials was caused by one trial that had exceptionally low standard deviations. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias. No other powered brush designs were consistently superior to manual toothbrushes. In these trials, data on cost, reliability and side effects were inconsistently reported. Those side effects that were reported on in the trials were localised and temporary.

REVIEWER'S CONCLUSIONS

Powered toothbrushes with a rotation oscillation action achieve a modest reduction in plaque and gingivitis compared to manual toothbrushing. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.

[Epulis during pregnancy]

Epulis is a hyperplastic lesion, which originates from the buccal mucosa and mainly from gingival tissues. It is characterised by several histologic types, of which the prevalent type during pregnancy is the granulomatous type, which is composed mainly of capillary vessels and endothelial proliferation. This lesion is referred to as "pregnancy tumor". The true prevalence of this lesion during pregnancy is unknown, though its peak incidence is during the third decade of life--compatible with pregnancy age. Furthermore, epulis is more prevalent among women than men (1:4-7). Normally, epulis appear on the frontal part of the maxilla during the third trimester. The lesion usually causes no symptoms apart from its very presence. Etiologic factors are improper maintenance of oral hygiene which lead to chronic gingivitis and high gingival levels of active progesterone which acts in a yet unindefined mechanism. Treatment includes firstly removal of irritating factors and secondly surgical conservative excision of the lesion.

Long-term results of supportive periodontal therapy (SPT) in HIV-seropositive and HIV-seronegative patients

AIM

The aim of the present study was to investigate the long-term results of periodontal supportive therapy in HIV-seropositive and HIV-seronegative patients.

MATERIAL AND METHODS

Baseline examination of 18 HIV-seropositive patients (14 males and four females, median age of 29.7 years) revealed the following periodontal diagnoses: eight patients with linear gingival erythema, four patients with necrotizing periodontitis, five patients with conventional gingivitis and one patient with chronic periodontitis. In the HIV-seronegative group, out of 16 patients (12 males and four females, median age 35.5 years), one patient presented with conventional gingivitis and 15 patients with chronic periodontitis. Periodontal therapy and maintenance care consisted of supra- and subgingival removal of plaque and calculus and instruction in oral hygiene. Based on the individual patient's needs, the mechanical therapy was repeated.

RESULTS

In the test group, the mean maintenance period was 22.7 +/- 9.4 months (range 11.0-37.4) and in the control group, 48.9 +/- 32.0 months (range 9.3-110.8). In the test group, the mean PlI (1.1 +/- 0.8) remained at the same level (1.1 +/- 0.5; p = 0.73, Wilcoxon sign rank test, p < 0.05) throughout the observation period, the mean GI was reduced from 1.6 +/- 0.5 to 1.4 +/- 0.4 (p = 0.18), the mean PPD was reduced from 2.9 +/- 0.3 to 2.8 +/- 0.2 (p = 0.15) and the mean PAL (3.1 +/- 0.5) remained unaltered as well (3.1 +/- 0.4; p = 0.83). None of these differences was statistically significant. In the control group, PPD (3.0 +/- 0.4) and PAL (3.0 +/- 0.5) were significantly reduced: PPD = 2.7 +/- 0.2 (p = 0.0003) and PAL = 2.9 +/- 0.5 (p = 0.0034).

CONCLUSION

In HIV-seropositive patients, attachment level can be maintained. However, oral hygiene and compliance are the key factors for this.

[Effect of metabolic control in type I diabetes patients and its association with periodontal disease]

OBJECTIVE

To compare the frequency of periodontal disease in type 1 diabetes mellitus patients with and without metabolic control, having a control group of healthy patients.

MATERIAL AND METHODS

A prolective cross sectional study with simple random sampling was carried out; patients were divided in three groups: A). Forty healthy subjects, B). Twenty diabetic patients with metabolic control, and C). Twenty diabetic patients without metabolic control. The diabetic subjects were evaluated with glycosylated hemoglobin (GHb) to determine the glucose control; clinical periodontal evaluations were performed for all teeth in each subject and following indexes were included: Plaque, gingival, mobility, probing depth, attachment level, bleeding on probing, and marginal bone loss.

RESULTS

The imbalance of glucose of subjects with diabetes mellitus type 1 was associated with more frequency of periodontal disease (p < 0.05).

CONCLUSION

The population of type 1 diabetes mellitus with imbalance of glucose showed association with periodontal disease.

Laser irradiation inhibition of open gingival embrasure space after orthodontic treatment

The purpose of this study was to investigate the inhibitory effect of low-energy laser irradiation on an incidence of open gingival embrasure space after orthodontic treatment. The patient was a 20-year, 7-month-old Japanese female with an Angle Class I malocclusion and crowding in the mandible. Treatment consisted of extraction of maxillary and mandibular first premolars and use of the Edgewise technique. A Ga-Al-As diode laser was used to irradiate an area of 0.5 cm2 at the labial and lingual gingival papilla between the canines. The time of exposure was 6 minutes for 3 days, carried out between the relevelling and en masse stages of movement. The total energy corresponding to 6 minutes of exposure varied from 1.90 J/cm2. There was no further evidence of open gingival embrasure space, except at the mandibular central incisor. Further: an improvement in the gingival inflammation caused by a periodontal disease was observed, and periodontal pocket depth was maintained. These results suggest that low-energy laser irradiation may inhibit the incidence of open gingival embrasure space after orthodontic treatment.

Interventions for replacing missing teeth: maintaining and re-establishing healthy tissues around dental implants

BACKGROUND

To maintain healthy tissues around oral implants it is important to institute an effective preventive regimen (supportive therapy) and when a pathologic condition of the tissue around implants is diagnosed, an intervention should be initiated as soon as possible. Different maintenance regimens and treatment strategies for failing implants have been suggested, however it is unclear which are the most effective.

OBJECTIVES

To test the null hypothesis of no difference between different interventions for maintaining or re-establishing healthy tissues around dental implants.

SEARCH STRATEGY

The Cochrane Oral Health Group Specialised Register, The Cochrane Controlled Trials Register, MEDLINE and EMBASE were searched. Hand searching included several dental journals. In addition, authors of all identified trials, fifty-five oral implant manufacturers and two extensive personal libraries (ME and AJ) were consulted.

SELECTION CRITERIA

All randomised controlled trials of oral implants comparing agents or interventions for maintaining or re-establishing healthy tissues around dental implants.

DATA COLLECTION AND ANALYSIS

Data were independently extracted, in duplicate, by two reviewers (ME & HW). Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed.

MAIN RESULTS

Nine RCTs were identified. Five of these trials, which reported results from a total of 127 patients, were suitable for inclusion in the review.

REVIEWER'S CONCLUSIONS

There is only a little reliable evidence for which are the most effective interventions for maintaining health around peri-implant tissues. There was no evidence that the use of powered or sonic toothbrushes was superior to manual toothbrushing. There is a weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as adjunct to routine oral hygiene is effective in reducing plaque formation and marginal bleeding around implants. There was no evidence that phosphoric etching gel offered any clinical advantage over mechanical debridement. These findings are based on RCTs having short follow-up periods and few subjects. There is not any reliable evidence for the most effective regimens for long-term maintenance. For the treatment of failing implants (peri-implantitis) there is not any reliable evidence for preferring one therapeutic regimen over another. More RCTs should be conducted in this area. In particular, there is a definite need for trials investigating which is the most effective approach for the treatment of peri-implantitis and for trials with longer follow-up for maintenance. Such trials should be reported according the CONSORT guidelines (http://www.consort-statement.org/).

Itraconazole prophylaxis for invasive gingival aspergillosis in neutropenic patients with acute leukemia

BACKGROUND

Due to an increasing number of leukemic patients with invasive gingival aspergillosis during neutropenia (neutrophils <500 cells/microl for >10 days), we evaluated the efficacy of oral itraconazole prophylaxis for preventing this invasive infection at our hospital.

METHODS

This was a retrospective, non-randomized study to analyze the onset of identified invasive gingival aspergillosis among 536 patients with acute leukemia at risk due to the presence of neutropenia from 1991 to 1998. Patients received itraconazole capsules 100 mg/day prophylactically between April 1994 and December 1996, and 200 mg/day between January 1997 and December 1998. Itraconazole serum levels at day 10 were measured in some patients.

RESULTS

In the 39 months prior to April 1994 without itraconazole prophylaxis, 15 cases of invasive gingival aspergillosis were detected in 192 high risk patients with 469 episodes of neutropenia (7.8% of the high risk patients). Between April 1994 and December 1996, using itraconazole prophylaxis at 100 mg/day, there was a dramatic decrease in the infections resulting in 3 of 198 high risk patients with 511 episodes of neutropenia (1.5% of the high risk patients). Furthermore, between January 1997 and December 1998, using itraconazole prophylaxis at 200 mg/day, no cases of the infection were observed in the 146 high risk patients with 380 episodes of neutropenia. The incidence of invasive gingival aspergillosis was significantly lower among patients administered itraconazole than among those without itraconazole (100 mg/day; P = 0.006 and 200 mg/day; P = 0.001). The mean itraconazole serum level in 20 patients receiving 100 mg/day was 71.78 ng/mL and in 16 patients receiving 200 mg/day was 202.67 ng/ml.

CONCLUSIONS

These findings suggest that oral itraconazole could be effective for preventing invasive gingival aspergillosis in neutropenic patients with acute leukemia and warrants further randomized investigation.

Influence of oral health attitude of mothers on the gingival health of their school age children

We investigated the influence of mothers' oral health attitudes on their children's gingival health level, in 257 pairs of mothers and children from an elementary school in Hiroshima. The Oral Rating Index for Children (ORI-C) was used for the gingival health examination, and the Hiroshima University Dental Behavioral Inventory (HU-DBI) was used to assess the oral health attitude of each mother. Subjects in mother and child pairs were divided into a lower grade group (L-group) (grades 1-3), and upper grade group (U-group) (grades 4-6). Gingival health i L-group children was 3.42 times higher in those whose mothers noticed plaque, and 2.68 times higher in those who received dental check-ups. However, ORI-C scores were not correlated to HU-DBI scores in the U-group. We concluded that the gingival health of children could be significantly influenced by the oral health attitude of their mothers up to approximately ten years of age.

Clinical periodontal findings and microflora profiles in children with chronic neutropenia under supervised oral hygiene

BACKGROUND

This is the first known case report that used a polymerase chain reaction (PCR)-based method to help identify the oral microflora in patients with chronic neutropenia. In this study, we report clinical periodontal findings and microflora profiles of 2 children, 1 with severe congenital neutropenia (SCN, Kostmann type) and 1 with cyclic neutropenia (CN).

METHODS

The SCN patient had severe gingivitis, whereas the patient with CN had mild gingivitis in the gingival margins. Monthly oral cleaning instruction and review were performed without subsequent periodontal therapy. Oral hygiene conditions remained satisfactory and visible plaque was scarce, despite the persistence of mild gingivitis. Under supervised oral hygiene, we examined the presence of periodontal pathogens from patient plaque samples.

RESULTS

By a PCR-based method, Prevotella nigrescens, Bacteroides forsythus, Campylobacter rectus, and Capnocytophaga gingivalis were detected in the SCN patient and P. intermedia, C. rectus, C. gingivalis, and C. sputigena in the CN patient, suggesting the existence of periodontal pathogens. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, and C. ochracea were not found in either patient.

CONCLUSIONS

Use of 1% povidone iodine solution and local antibiotic application under supervised oral hygiene were helpful to improve gingival conditions in patients with chronic neutropenia.

[The Bambuí Project: a population-based study of factors associated with regular utilization of dental services in adults]

A cross-sectional study was conducted in Bambuí, Minas Gerais, to identify factors associated with regular use of dental services. Participants were interviewed with a structured questionnaire and previously validated questions. 999/1,221 (81.8%) randomly selected individuals aged > 18 years participated in the Bambuí dental survey. Of these, 654 out of 656 individuals who had at least one natural tooth and had visited a dentist during their lifetime participated in the study. Results adjusted by multiple logistic regression showed that regular use of dental services was significantly related to having > 8 and 4-7 years of schooling (OR = 9.90; 95% CI = 2.90-33.77 and OR = 3.87; 95% CI = 1.11-13.51, respectively), having a preference for restorative treatment rather than extraction (OR = 4.91; 95% CI = 2.23-10.79), having no present need of dental treatment (OR = 4.87; 95% CI = 3.17-7.49), and belief that visiting the dentist prevents tooth decay and gum disease (OR = 1.73; 95% CI = 1.13-2.65). The results show that regular use of dental services was related to factors distributed in the Andersen and Newman model (1973) explaining use of dentistry services.

Outcomes assessment an intervention strategy to improve parental compliance to follow-up evaluations after treatment of early childhood caries using general anesthesia in a Medicaid population

Young children from low-income families are at risk for the development of early childhood caries (ECC) that can progress to severe oral disease. Treatment of this condition often requires extensive rehabilitation using general anesthesia in an ambulatory care facility. These children, presenting with neglected oral health, frequently face major obstacles to accessing dental care in a timely manner. Recently, several retrospective studies reported poor follow-up compliance (return for recall evaluations) in children treated for ECC using general anesthesia (GA). The purpose of this study was to provide a prospective analysis of an intervention strategy aimed at improving follow-up compliance in this population. Results of the analysis suggested that the insertion of an additional pre-operative consultation appointment failed to improve significantly compliance to follow-up evaluations or change parental dental health knowledge and preventive practices. Patient variables studied also failed to discriminate influences on predicting compliant behavior. Although retreatment (relapse) was prevalent among those patients who complied with follow-up evaluations, a statistically significant improvement in plaque, gingival, and mutans streptococci scores were demonstrated, following the degree of aggressive restorative treatment typically provided using general anesthesia. These findings are contrary to those reported from conventional restorative therapy and might reflect a beneficial outcome of an aggressive restorative approach. Further investigation is required to identify an intervention strategy that improves follow-up compliance and reduces the costly ravages of dental neglect in young children from low-income families.

Relationship between gingival health and dental caries in children aged 7-12 years

The purpose of this study was to investigate the relationship between gingival health and dental caries in elementary school children in Japan. The subjects were 474 children aged 7 to 12 years who attended dental check-ups at an elementary school. The Oral Rating Index for Children, which consists of five categories (+2, +1, 0, -1, -2), was used to rate the findings of the gingival health examination. The dental examination was performed using the WHO caries diagnostic criteria for DMFT. Children were divided into three groups: a healthier group (H-group) made up of those scoring +2 (excellent) or +1 (good), an equivocal group (E-group) made up of those scoring 0, and a gingival less-healthy group (L-group) made up of those scoring -2 (very poor) or -1 (poor). Overall percentages for the H-group, E-group and L-group were 48.3%, 21.5% and 30.2%, respectively. The number in the L-group increased with increasing age. The mean scores of the DT and DMFT in the H-group were significantly lower than those in the L-group (p < 0.01 and p < 0.05, respectively). The results suggest that oral hygiene instruction should be given to children in order to motivate self-care, not only to avoid dental caries but also to prevent gingivitis.

Tissue preservation and maintenance of optimum esthetics: a clinical report

Today, most tooth replacement in the esthetic zone is done using implants placed in a delayed surgical protocol. Unfortunately, this delay can result in loss of both hard and soft tissue during the healing period, necessitating guided tissue regeneration techniques at the time of implant placement. Recent developments with tapered implants have facilitated predictable immediate implant placement, preserving the osseous structure surrounding the socket. Further developments with custom healing abutments can preserve the crestal soft tissues, including the papillae. This article reviews techniques that provide for the preservation of both bone and soft tissue while enhancing the esthetic results around implants.

Public knowledge of the prevention of dental decay and gum diseases

In 1992, a mail survey was conducted among South Australians aged 10 years and older to assess the knowledge of prevention of dental caries and gum diseases and to explore its variation by sociodemographic factors. The survey provided 838 completed questionnaires. Questions were asked on perceptions of importance of a number of preventive measures, the main purpose of water fluoridation and sources of information. Respondents rated four myths for preventing dental caries as the most important: 97 per cent rated regular tooth brushing; 87 per cent rated regular dental visits; 85 per cent rated calcium in the diet; and 78 per cent rated eating fibrous foods as definitely or probably important. Only 56 per cent of respondents rated drinking water with fluoride as definitely or probably important for preventing dental caries, and only half (50.2 per cent) identified the main purpose of water fluoridation as the prevention of decay. Respondents rated regular tooth brushing (96 per cent) and regular dental visits (87 per cent) as important for the prevention of gum diseases. However, the myth of massaging the gums was rated as important by 67 per cent. Higher percentages of females, older adults and those with lower educational attainment rated the myths for preventing caries as important. Younger people were less able to specify the main purpose for fluoridation of water supplies. The persistence of myths and the low rating of the importance of scientifically efficacious measures are major challenges for oral health promotion.

[The importance of periodontal evaluation in orthodontics]

The orthodontist is in fact a periodontal-therapist since his aim is to move the teeth with and through the periodontal tissues. It is most important for the orthodontist to be able to determine at the initial clinical examination what are the various periodontal risk factors. When the pathology is obvious with inflammation, periodontal pockets, gingival hyperplasia, edema of the papillae, gingival recessions, the need for periodontal treatment is manifest. But many times, the periodontal evaluation is complicated by the presence of slight variations of the quality of the marginal tissue that represent a risk of developing periodontal defects during the orthodontic treatment. The aim of this presentation is to put forward the importance of the periodontal evaluation during the initial examination of the patient so that, if necessary, an adequate periodontal therapy can be initiated to stabilize the periodontal tissues and thus improves the esthetical outcome.

Recent research on calculus

This paper discusses the different types of calcium phosphate in calculus and the role of plaque pH in controlling calcium phosphate precipitation (calculus) or dissolution (caries). There is great site-specificity of deposition of supragingival but not subgingival calculus, with highest amounts of the former being present on the lingual aspects of the mandibular anterior teeth. This may be because the plaque there is most alkaline as that region has the highest salivary film velocity and the lowest salivary sugar concentration during consumption of sugar-containing food and drinks. The importance of calculus removal for good gingival health is emphasised.