Showing papers in "BMC Oral Health in 2015"

The International Caries Classification and Management System (ICCMS™) An Example of a Caries Management Pathway.

Abstract: The International Caries Classification and Management System (ICCMS™) is a comprehensive set of clinical protocols that address all diagnostic, preventive and restorative decisions necessary “to preserve tooth structure and restore only when indicated,” which is the mission adopted at the Temple University Caries Management Pathways workshop, in 2012 [1]. The foundation for ICCMS™ is based on extensive critical analyses, research, and clinical feedback on the best approaches to move away from the mechanical or restorative care that has been followed around the world, towards a system where prevention is emphasized, initial caries lesions are prevented from progressing (controlled), and moderate or extensive caries lesions are restored with the goal of preserving, as much as possible, natural tooth structure [2]. This chapter will describe the scientific, and clinical management protocols that have been developed over the last several years by over 70 cariologists, epidemiologists, and clinicians. While ICCMS™ is recommended as the most comprehensive pathway for caries management to achieve the desired aforementioned mission, it is important to emphasize that ICCMS™ is not the only system available today that promotes staging of the caries process and risk assessment and management [1]. The ICCMS™, in contrast to other systems, has well-developed and documented protocols for the implementation of a new model of caries management. It is based on the well-established and widely used International Caries Detection and Assessment System (ICDAS™).

Detection and diagnosis of the early caries lesion

Abstract: The purpose of this manuscript is to discuss the current available methods to detect early lesions amenable to prevention. The current evidenced-based caries understanding, based on biological concepts, involves new approaches in caries detection, assessment, and management that should include non-cavitated lesions. Even though the importance of management of non-cavitated (NC) lesions has been recognized since the early 1900 s, dental caries has been traditionally detected at the cavitation stage, and its management has focused strongly on operative treatment. Methods of detection of early carious lesions have received significant research attention over the last 20 years. The most common method of caries detection is visual-tactile. Other non-invasive techniques for detection of early caries have been developed and investigated such as Quantitative Light-induced Fluorescence (QLF), DIAGNOdent (DD), Fibre-optic Transillumination (FOTI) and Electrical Conductance (EC). Based on previous systematic reviews, the diagnosis of NCCLs might be more accurately achieved in combination of the visual method and the use of other methods such as electrical methods and QLF for monitoring purposes.

Braces versus Invisalign®: gingival parameters and patients’ satisfaction during treatment: a cross-sectional study

Abstract: Fixed orthodontic appliances (FOA) temporarily interfere with periodontal health of patients, as the appliance complicates oral hygiene. The use of aligners in orthodontic therapy increased strongly during the last decade. In the literature, the reports about effects of aligner treatment on oral hygiene and gingival conditions are scarce. This cross-sectional study evaluated oral hygiene and patient’s satisfaction during orthodontic treatment of patients with FOA or Invisalign®. 100 patients (FOA = 50, Invisalign® = 50) were included who underwent orthodontic treatment for more than 6 months. Clinical examinations were performed to evaluate patients’ periodontal condition and were compared with clinical data at the beginning of the orthodontic treatment. Oral hygiene, patients’ satisfaction and dietary habits were documented by a detailed questionnaire. For statistical analysis, the Mann–Whitney U-Test and Fisher’s Exact Test were used; as multiple testing was applied, a Bonferroni correction was performed. At the time of clinical examinations, patients with FOA were in orthodontic therapy for 12.9 ± 7.2 months, whereas patients with Invisalign® were in orthodontic therapy for 12.6 ± 7.4 months. Significantly better gingival health conditions were recorded in Invisalign® patients (GI: 0.54 ± 0.50 for FOA versus 0.35 ± 0.34 for Invisalign®; SBI: 15.2 ± 7.6 for FOA versus 7.6 ± 4.1 for Invisalign®), whereas the amount of dental plaque was also less but not significantly different (API: 37.7 % ± 21.9 for FOA versus 27.8 % ± 24.6 for Invisalign®). The evaluation of the questionnaire showed greater patients’ satisfaction in patients treated with Invisalign® than with FOA. Patients treated with Invisalign® have a better periodontal health and greater satisfaction during orthodontic treatment than patients treated with FOA.

Detection and diagnosis of periodontal conditions amenable to prevention

Abstract: Gingivitis and chronic periodontitis are highly prevalent chronic inflammatory diseases. Gingivitis affects the majority of people, and advanced periodontitis is estimated to affect 5-15% of adults. The detection and diagnosis of these common diseases is a fundamentally important component of oral health care. All patients should undergo periodontal assessment as part of routine oral examination. Periodontal screening using methods such as the Basic Periodontal Examination/Community Periodontal Index or Periodontal Screening Record should be performed for all new patients, and also on a regular basis as part of ongoing oral health care. If periodontitis is identified, full periodontal assessment is required, involving recording of full mouth probing and bleeding data, together with assessment of other relevant parameters such as plaque levels, furcation involvement, recession and tooth mobility. Radiographic assessment of alveolar bone levels is driven by the clinical situation, and is required to assess bone destruction in patients with periodontitis. Risk assessment (such as assessing diabetes status and smoking) and risk management (such as promoting smoking cessation) should form a central component of periodontal therapy. This article provides guidance to the oral health care team regarding methods and frequencies of appropriate clinical and radiographic examinations to assess periodontal status, to enable appropriate detection and diagnosis of periodontal conditions.

Impact of removable dentures on oral health-related quality of life among elderly adults in Taiwan

Abstract: Background: Although the use of removable dentures can improve oral function and esthetics for elderly people, compared to those who do not wear removable dentures, those wearing removable dentures could have worse oral health related-quality of life (OHRQoL). Additional information is required to assess which factors related to denture wearing influence the OHRQoL of elderly individuals. The purpose of this study is to evaluate the association between denture wearing and OHRQoL in a sample of elderly individuals in Taiwan. Methods: The study population included 277 elderly people wearing removable dentures (mean age=76.0 years). Using face-to-face interviews, we collected data on the participants’ socio-demographic characteristics, dental care service usage (regular dental checkups, treatment during toothache, dental visits in the last year), and factors related to denture wearing (perceived oral pain, perceived loose denture, perceived oral ulcer, perceived halitosis, perceived dry mouth, and perceived total denture satisfaction scores). OHRQoL was measured using the Taiwanese version of the Geriatric Oral Health Assessment Index (GOHAI-T). The location and number of remaining natural teeth and the type of denture were also recorded. Hierarchical multiple regression analysis was performed using GOHAI-T scores as the dependent variable. Results: All the predictors together accounted for 50% of the variance in GOHAI-T scores. Further, education level, number of natural teeth, denture status, perceived loose denture, perceived oral ulcer, and perceived total denture satisfaction scores had statistically significant influences on OHRQoL. When compared with other variables, factors related to denture wearing, especially perceived total denture satisfaction scores, had the greatest impact on GOHAI-T scores. Conclusions: Of the factors analyzed in this study, denture satisfaction was the strongest predictor of OHRQoL. This suggests that denture satisfaction is useful for assessing the effect of denture treatment on the OHRQoL of elderly individuals wearing removable dentures.

Defining periodontal health

Abstract: Assessment of the periodontium has relied exclusively on a variety of physical measurements (e.g., attachment level, probing depth, bone loss, mobility, recession, degree of inflammation, etc.) in relation to various case definitions of periodontal disease. Periodontal health was often an afterthought and was simply defined as the absence of the signs and symptoms of a periodontal disease. Accordingly, these strict and sometimes disparate definitions of periodontal disease have resulted in an idealistic requirement of a pristine periodontium for periodontal health, which makes us all diseased in one way or another. Furthermore, the consequence of not having a realistic definition of health has resulted in potentially questionable recommendations. The aim of this manuscript was to assess the biological, environmental, sociological, economic, educational and psychological relationships that are germane to constructing a paradigm that defines periodontal health using a modified wellness model. The paradigm includes four cardinal characteristics, i.e., 1) a functional dentition, 2) the painless function of a dentition, 3) the stability of the periodontal attachment apparatus, and 4) the psychological and social well-being of the individual. Finally, strategies and policies that advocate periodontal health were appraised.

Anterior maxilla alveolar ridge dimension and morphology measurement by cone beam computerized tomography (CBCT) for immediate implant treatment planning

Abstract: Implants have been widely used to restore missing teeth. Limited information on applied anatomy at the anterior maxilla compromises the clinical outcome for implant placement in this region. In the current study, Cone Beam Computerized Tomography (CBCT) was used to measure alveolar ridge and buccal undercut dimension at the anterior maxilla to help develop treatment planning for immediate implant placement. CBCT scans were screened to include 51 subjects with full dentition at right maxilla. Measurements were taken at the cross sectional views in the middle of the maxillary right central incisor, lateral incisor, and canine regions. Alveolar height was measured from the alveolar crest to floor of nasal fossa. Alveolar width was measured from the buccal to palatal cortical plate at the coronal, middle, and apical third of the distance from the alveolar crest to floor of the nasal fossa. Buccal undercut location was measured from where the buccal cortical plate started dipping to a line extending at the alveolar crest that was perpendicular to the long axis of the alveolar ridge. The buccal undercut depth was measured from the deepest point of the undercut at the buccal plate to a line tangent to the buccal plate paralleling the long axis of ridge. Alveolar width increased from coronal to apical direction for each tooth. Mean alveolar widths (mm) were: central incisor, 9.55; lateral incisor, 8.30; canine, 9.62. The lateral incisor had a significantly smaller alveolar width than the other anterior teeth. No significant difference in ridge height was noted among the teeth. Undercut locations from the alveolar crest (mm) were: central incisor, 5.84; lateral incisor, 3.59; canine, 5.11. Undercut depths (mm) were: central incisor, 0.76; lateral incisor, 0.87; canine, 0.73. The percentages of teeth with buccal undercuts were: central incisor, 41 %, lateral incisor, 77 %, and canine 33 %. Male demonstrate significant larger ridge width compared with females for all three teeth. At anterior maxilla, the lateral incisor has the thinnest alveolar bone, and most frequently exhibits a buccal undercut which is the closest to alveolar ridge compared with other maxillary anterior teeth.

Clinical, microbiological, and immunological aspects of healthy versus peri-implantitis tissue in full arch reconstruction patients: a prospective cross-sectional study

Abstract: Background Due to the world-wide increase in treatments involving implant placement, the incidence of peri-implant disease is increasing. Late implant failure is the result of the inability to maintain osseointegration, whose most important cause is peri-implantitis. The aim of this study was to analyze the clinical, microbiological, and immunological aspects in the peri-implant sulcus fluid (PISF) of patients with healthy dental implants and patients with peri-implantitis.

Prevalence, and early childhood caries risk indicators in preschool children in suburban Nigeria

Abstract: Early Childhood Caries (ECC) is defined as the presence of caries lesion in an primary tooth in children below the age of 71 months. It is a significant public health problem with consequences for the growth and development of affected children. The objective of this study was to determine the prevalence and ECC risk indicators in a suburban population in Nigeria. The data of 497 children aged 6 months to 71 months who were recruited through a household survey conducted in Ile-Ife, Nigeria was analysed for prevalence of ECC and risk indicators. Information on children’s ages, sex, socioeconomic status, tooth brushing habits, sugary snacks consumption, use of fluoridated toothpaste, birth rank, infant-feeding practices, breastfeeding practices, maternal age at childbirth, and maternal knowledge of oral health was obtained. Children’s oral hygiene and caries status was also determined. Risk factors associated with ECC were determined using logistic regression analysis. Thirty-three (6.6 %) children had ECC. Four (0.8 %) had severe ECC. The four risk indicators for ECC were the child’s gender, mothers’ knowledge of oral health, consumption of sugary snacks in between meals more than three times a day, and the child’s oral hygiene status. Females (PR: −0.06; 95 % CI: −0.01– -0.01; p = 0.02), and children with mothers who had good knowledge of oral health (PR: −0.06; 95 % CI: −0.11––0.008; p = 0.02) were less likely to have ECC. Children who consumed sugary snacks in between meals three times a day or more (PR: 0.05; CI: 0.003 – 0.01; P = 0.04) and children with fair oral hygiene (PR: 0.05; 95 % CI: 0.005–0.10; p = 0.03) were more likely to have ECC. The prevalence of ECC in the study population was low. Promoting good oral hygiene practices and enhancingmothers’ knowledge of oral health may help reduce further, the risk for ECC in the study population.

Prevalence and association of self-reported anxiety, pain, and oral parafunctional habits with temporomandibular disorders in Japanese children and adolescents: a cross-sectional survey

Abstract: Associations between temporomandibular disorder (TMD) and psychological variables, pain conditions, and daily activities have been reported more commonly in middle-aged individuals than in children. However, to determine factor-specific preventive programs for TMD, it is important to evaluate the associations between multiple factors and TMD symptoms during childhood. The aim of this study was to assess the relationship between TMD symptoms and other orofacial pain conditions, daily activities, and trait anxiety in a population-based cross-sectional survey of Japanese children and adolescents. A total of 1,415 subjects (11–15 years old) self-reported their TMD symptoms, headache, neck pain, and toothache, and completed questionnaire scales that assessed 15 daily activities. Trait anxiety was assessed using the State Trait Anxiety Inventory for Children-Trait (STAIC-T) scale. Subjects were dichotomized into a TMD group or control group, based on whether they reported at least 1 TMD symptom: the TMD group (≥1 TMD symptom, n = 182) and the control group (no TMD symptoms, n = 1,233). Data were analyzed using the chi-square test and multivariate logistic regression analysis. The prevalence rates for headache and neck pain were significantly higher in the TMD group than in the control group (44.0% vs. 24.7% and 54.4% vs. 30.0%, respectively; both P < 0.001). The odds ratios for TMD symptoms in subjects with neck pain and frequent diurnal clenching were 2.08 (P < 0.001) and 3.69 (P = 0.011), respectively. Moreover, high STAIC-T scores were weakly associated with TMD symptoms. In this young Japanese population, TMD symptoms were associated with other orofacial pain conditions, particularly neck pain, although they were only weakly associated with trait anxiety. Diurnal clenching was strongly associated with TMD symptoms. Health professionals should carefully consider these factors when developing appropriate management strategies for TMD in children and adolescents.

Physical properties and biocompatibility of an injectable calcium-silicate-based root canal sealer: in vitro and in vivo study

Abstract: The aim of this study was to investigate the physical properties and biological effects of an experimentally developed injectable premixed calcium-silicate root canal sealer (Endoseal) in comparison with mineral trioxide aggregate (MTA) and a resin-based sealer (AHplus). The pH, solubility, dimensional change, flow, and radiopacity of the materials were evaluated. Biocompatibility was evaluated on the basis of cell morphology and a viability test using MC3T3-E1 cells. For evaluate inflammatory reaction, the tested sealers were implanted into dorsal subcutaneous connective tissue of Sprague Dawley rats. After 7 days, the implants with the surrounding tissue were retrieved, and histological evaluation was performed. Endoseal showed high alkalinity similar to that of MTA. The solubility of the tested materials was similar. The dimensional change and flow of Endoseal was significantly higher than that of other materials (P < 0.05). The radiopacity of Endoseal was lower than that of AHplus (P < 0.05). The biocompatibility was similar to those of MTA. Inflammatory reaction of Endoseal was similar with that of MTA, but lower than that of AHplus (P < 0.05). The present study indicates that Endoseal has favorable physical properties and biocompatibility. Therefore, we suggest that Endoseal has the potential to be used as a predictable root canal sealer.

Establishing oral health promoting behaviours in children – parents’ views on barriers, facilitators and professional support: a qualitative study

Abstract: Background The prevention of childhood dental caries relies on adherence to key behaviours, including twice daily tooth brushing with fluoride toothpaste and reducing the consumption of sugary foods and drinks. The aim of this qualitative study was to explore parents’ perceptions of barriers and facilitators that influence these oral health behaviours in children. A further objective was to explore parents’ views on limitations and opportunities for professional support to promote children’s oral health. Methods Six focus group interviews were conducted, including a total of 39 parents of 7-year old children, who were recruited from paediatric dental centres in The Netherlands. Interviews were held with Dutch parents of low and high socioeconomic status and parents from Turkish and Moroccan origin. Focus group interviews were conducted on the basis of a pre-tested semi-structured interview guide and topic list. Content analysis was employed to analyse the data. Results Analysis of interview transcripts identified many influences on children’s oral health behaviours, operating at child, family and community levels. Perceived influences on children’s tooth brushing behaviour were primarily located within the direct family environment, including parental knowledge, perceived importance and parental confidence in tooth brushing, locus of control, role modelling, parental monitoring and supervision, parenting strategies and tooth brushing routines and habituation. The consumption of sugary foods and drinks was influenced by both the direct family environment and factors external to the family, including the school, the social environment, commercials and television, supermarkets and affordability of foods. Parents raised several suggestions for professional oral health support, which included the provision of clear and consistent oral health information using a positive approach, dietary regulations at school and a multidisciplinary approach among dental professionals, child health centres and other institutions in providing parental support. Conclusion In conclusion, this qualitative study provided detail regarding parental views on the influences on children oral health behaviours and their opinions on what further support is needed to promote children’s dental health. Parents’ suggestions for professional oral health support can guide the development or improvement of caries preventive interventions.

Associations between dental anxiety, sense of coherence, oral health-related quality of life and health behaviour - a national Swedish cross-sectional survey

Abstract: Dental anxiety (DA) is a common condition associated with avoidance of dental care and subsequent health-related and psychosocial outcomes, in what has been described as the vicious circle of DA. Also, recent studies have found an association between the psychosocial concept of sense of coherence (SOC) and DA. More studies are needed to verify the relationship between DA and SOC, especially using population-based samples. There is also a need for studies including factors related to the vicious circle of DA, such as oral health-related quality of life (OHRQoL), in order to further establish the correlates of DA in the general population. Therefore, the aim of this study was to investigate the relationship between DA and SOC, OHRQoL and health-related behaviour in the general Swedish population. The survey included a randomly selected sample of the adult Swedish population (N = 3500, age 19 – 96 years.). Data was collected by means of telephone interviews. Dental anxiety was measured with a single question. The SOC measure consisted of three questions conceptualising the dimensions of the SOC: comprehensibility, manageability and meaningfulness. The data collection also included the five-item version of the Oral Health Impact Profile (OHIP-5), as a measure of OHRQoL, as well as questions on oral health-related behaviour and socioeconomic status. Statistical analyses were made with descriptive statistics and inference testing using Chi-square, t – test and logistic regression. High DA was associated with low OHRQoL, irregular dental care and smoking. There was a statistically significant relationship between the SOC and DA in the bivariate, but not in the multivariate, analyses. Dental anxiety was not associated with oral health-related behaviour or socioeconomic status. This cross-sectional national survey gives support to the significant associations between high dental anxiety, avoidance of dental care and health-related outcomes, which may further reinforce the model of a vicious circle of dental anxiety. The results further indicate a weak relationship between dental anxiety and sense of coherence.

Shaping ability of ProTaper Universal, WaveOne and ProTaper Next in simulated L-shaped and S-shaped root canals

Abstract: The purpose of this study was to compare the shaping ability of the ProTaper Universal (PTU; Dentsply Maillefer, Ballaigues, Switzerland), WaveOne (WO; Dentsply Maillefer) and ProTaper Next (PTN; Dentsply Maillefer) in simulated L-shaped and S-shaped root canals respectively. 30 simulated L-shaped and 30 simulated S-shaped root canals in resin blocks were employed and randomly divided into 3 groups (n = 10), respectively. The canals were prepared to a tip size 25 using PTU, WO or PTN: PTU F2 (taper 0.08 over the first 3 mm from apical tip), WO Primary (taper 0.08 over the first 3 mm from apical tip), and PTN X2 (taper 0.06 over the first 3 mm from apical tip). Photos of the simulated root canals were taken pre- and postinstrumentation. The 2 layers were superimposed after a series of image processing and 10 points were selected from apical constriction with 1 mm interval. And then the central axis transportation and straightened curvature were measured with software of image analysis. In simulated L-shaped root canals, PTU and PTN caused less transportation than WO at curved section (P < 0.05), and PTN caused the least transportation at apical constriction (P < 0.05). Moreover, PTN maintained the canal curvature best among the 3 groups (P < 0.05). But PTN produced more transportation at straight section compared with PTU and WO (P < 0.05). In simulated S-shaped root canals, PTN preserved the coronal curvature best (P < 0.05), but there was no significant difference in apical curvature since all the files straightened the curvature obviously. PTN showed a better shaping ability than PTU and WO at the curved section of root canals, and PTN maintained the best apical constriction. But all the files had a tendency to straighten the apical curvature in multi-curved canals.

Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study

Abstract: The aim of this retrospective study was to evaluate the survival of dental implants placed after ablative surgery, in patients affected by oral cancer treated with or without radiotherapy. We collected data for 34 subjects (22 females, 12 males; mean age: 51 ± 19) with malignant oral tumors who had been treated with ablative surgery and received dental implant rehabilitation between 2007 and 2012. Postoperative radiation therapy (less than 50 Gy) was delivered before implant placement in 12 patients. A total of 144 titanium implants were placed, at a minimum interval of 12 months, in irradiated and non-irradiated residual bone. Implant loss was dependent on the position and location of the implants (P = 0.05–0.1). Moreover, implant survival was dependent on whether the patient had received radiotherapy. This result was highly statistically significant (P < 0.01). Whether the implant was loaded is another highly significant (P < 0.01) factor determining survival. We observed significantly better outcomes when the implant was not loaded until at least 6 months after placement. Although the retrospective design of this study could be affected by selection and information biases, we conclude that a delayed loading protocol will give the best chance of implant osseointegration, stability and, ultimately, effective dental rehabilitation.

Severe early childhood caries and social determinants in three-year-old children from Northern Thailand: a birth cohort study

Abstract: The purpose of this study was to investigate the prevalence and social risk factors of severe early childhood caries in three-year-old children in Northern Thailand, using a birth-cohort study The data utilized in this study were from the prospective cohort study of Thai children (PCTC) from the 28 to 38 weeks gestational age until the children reached the age of 36 months (N = 597) in Mueang Nan district, Northern Thailand. Questionnaires were administered at different time points and dental examination was conducted at the age of 3 years of the child. 44.1 % of the 3 year old children had S-ECC. In multivariate logistic regression analysis, environmental factors (the use of rain or well water as drinking water, no schooling of mother of child, being male), and risk behaviour (sleeping with a bottle at 30 months) were associated with S-ECC. Further, in bivariate analysis, psychological distress in the mother, lack of spousal relationship support, suckle to sleep when going to bed, introduction of soft drinks at 12 months, having had more frequently sweet food, and less than daily tooth brushing before 30 months were associated with S-ECC. A very high rate of S-ECC was observed, and oral health may be influenced by social factors.

Non-surgical treatment of dentin caries in preschool children – systematic review

Abstract: Background: Untreated dentin caries in primary teeth is commonly found in preschool children worldwide. Recently, the use of simple non-surgical approaches to manage the situation has been advocated. The aim of the study was to systematically review and evaluate the literature on effectiveness of non-surgical methods in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children. Methods: A systematic search of the main electronic databases (Pubmed, Cochrane Collaboration, EMBASE) was conducted to identify peer reviewed papers published in English in the years 1947–2014. Keywords and MeSH terms used in the search were “dental caries”, “primary dentition” and various non-surgical treatments (fluoride, sealant, resin infiltration, xylitol, chlorhexidine, CPP-ACP, ozone, etc.). The inclusion criteria were clinical studies conducted in children under 6 years old, and reported findings on caries arrest or caries progression in primary teeth. Retrieved papers were read by two reviewers independently to assess suitability for inclusion, and the final decision was made by consensus. Quality of the included studies was assessed and data were extracted for analysis. Results: The search identified 323 papers for screening. Among these, 290 papers did not satisfy the study inclusion criteria. Consequently, 33 full papers were retrieved and reviewed. Finally, 4 studies were included. Three studies reported that topical applications of silver diammine fluoride (SDF) solution could arrest dentin caries in preschool children. One study supported that having a daily toothbrushing exercise in kindergarten using toothpaste with 1000 ppm fluoride could stabilize the caries situation in young children. Conclusions: There is limited evidence to support the effectiveness of SDF applications or daily toothbrushing with fluoride toothpaste in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children. More well-designed randomized controlled trials are required to confirm these findings.

The effect of motivational interviewing on oral healthcare knowledge, attitudes and behaviour of parents and caregivers of preschool children: an exploratory cluster randomised controlled study

Abstract: Motivational Interviewing (MI) has been used across primary healthcare and been shown to be effective in reducing the prevalence of early childhood caries (ECC) in preschool children. This study aimed to compare the effect of MI, in contrast to traditional dental health education (DHE), on oral health knowledge, attitudes, beliefs and behaviours among parents and caregivers of preschool children in Trinidad. The design of this exploratory study included a cluster randomised controlled trial and semi-structured focus groups. Six preschools (79 parents and caregivers) in Eastern Trinidad were randomly assigned to a test or control group (3 preschools in each group). Parents and caregivers in the test-group (n = 25) received a talk on dental health using an MI approach and the control-group (n = 54) received a talk using traditional DHE. Both groups received additional, written dental health information. The MI group also received two telephone call follow-ups as part of the MI protocol. Both groups were given questionnaires before the talks and four months later. Question items included oral health knowledge, beliefs, attitudes, brushing behaviour, oral health self-efficacy, oral health fatalism and a specific instrument to asses ‘readiness for change’, the Readiness Assessment of Parents Concerning Infant Dental Decay (RAPIDD). Participants in the test-group were also invited to take part in a focus group to share their views on the dental health talk. At four month follow-up, knowledge items on fluoride use, tooth brushing, dietary practice and dental attendance increased in both the test (DHE + MI) and control (DHE) groups ((p < 0.05, Chi Square test). In the test-group there were increases in mean child tooth brushing frequency and reduction in oral health fatalism (p < 0.05 t-test). Findings from a thematic analysis of the focus group suggested that the MI talk and telephone follow-up were well accepted and helpful in supporting parent and caregiver efforts to improve oral health practices for their preschool children. In this exploratory controlled study there was some evidence that using an MI approach when delivering oral health information had a positive effect on parent/ caregiver oral health knowledge, attitudes and behaviours compared to traditional DHE. There is need for further research involving the use of brief-counselling techniques in this Caribbean population.

Effect of probiotic chewing tablets on early childhood caries – a randomized controlled trial

Abstract: To evaluate the effect of probiotic chewing tablets on early childhood caries development in preschool children living in a low socioeconomic multicultural area. The investigation employed a randomized double-blind placebo-controlled design. The study group consisted of 138 healthy 2-3-year-old children that were consecutively recruited after informed parental consent. After enrollment, they were randomized to a test or a placebo group. The parents of the test group were instructed to give their child one chewing tablet per day containing three strains of live probiotic bacteria (ProBiora3®) and the placebo group got identical tablets without bacteria. The duration was one year and the prevalence and increment of initial and manifest caries lesions was examined at baseline and follow-up. All parents were thoroughly instructed to brush the teeth of their off-springs twice daily with fluoride toothpaste. The groups were balanced at baseline and the attrition rate was 20 %. Around 2/3 of the children in both groups reported an acceptable compliance. The caries increment (Δds) was significantly lower in the test group when compared with the placebo group, 0.2 vs. 0.8 (p < 0.05). The risk reduction was 0.47 (95 % CI 0.24–0.98) and the number needed to treat close to five. No differences were displayed between the groups concerning presence of visible plaque or bleeding-on-brushing. No side effects were reported. The results suggested that early childhood caries development could be reduced through administration of these probiotic chewing tablets as adjunct to daily use of fluoride toothpaste in preschool children. Further studies on a possible dose–response relationship seem justified ClinicalTrials.gov Identifier: NCT01720771 . First received: October 31, 2012.

Early childhood caries in Switzerland: a marker of social inequalities

Abstract: Early childhood caries (ECC) is a marker of social inequalities worldwide because disadvantaged children are more likely to develop caries than their peers. This study aimed to define the ECC prevalence among children living in French-speaking Switzerland, where data on this topic were scarce, and to assess whether ECC was an early marker of social inequalities in this country. The study took place between 2010 and 2012 in the primary care facility of Lausanne Children’s Hospital. We clinically screened 856 children from 36 to 71 months old for ECC, and their caregivers (parents or legal guardians) filled in a questionnaire including items on socioeconomic background (education, occupation, income, literacy and immigration status), dental care and dietary habits. Prevalence rates, prevalence ratios and logistic regressions were calculated. The overall ECC prevalence was 24.8 %. ECC was less frequent among children from higher socioeconomic backgrounds than children from lower ones (prevalence ratios ≤ 0.58). This study reported a worrying prevalence rate of ECC among children from 36 to 71 months old, living in French-speaking Switzerland. ECC appears to be a good marker of social inequalities as disadvantaged children, whether from Swiss or immigrant backgrounds, were more likely to have caries than their less disadvantaged peers. Specific preventive interventions regarding ECC are needed for all disadvantaged children, whether immigrants or Swiss.

Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: five-year results from a double-blind, randomized controlled trial

Abstract: The aim of this study was to compare the 5-year survival and success rates of 3.3 mm dental implants either made from titanium-zirconium (TiZr) alloy or from Grade IV titanium (Ti Grade IV) in mandibular implant-based removable overdentures. The core study had a follow-up period of 36 months and was designed as a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann Bone Level implants (diameter 3.3 mm, SLActive®), one of TiZr (test) and one of Ti Grade IV (control), in the interforaminal region. This follow-up study recruited patients from the core study and evaluated the plaque and sulcus bleeding indices, radiographic crestal bone level, as well as implant survival and success 60 months after implant placement. Of the 91 patients who initially received implants, 75 completed the 36 month follow-up and 49 were available for the 60 month examination. Two patients were excluded so that a total of 47 patients with an average age of 72 ± 8 years were analysed. The characteristics and 36-month performance of the present study cohort did not differ from the non-included initial participants (p > 0.05). In the period since the 36-month follow-up examination, no implant was lost. The cumulative implant survival rate was 98.9 % for the TiZr group and 97.8 % for the Ti Grade IV group. Crestal bone level changes at 60 months were not different in the test and control group (TiZr −0.60 ± 0.69 mm and Ti Grade IV −0.61 ± 0.83 mm; p = 0.96). The cumulative implant success rate after 60 months was 95.8 and 92.6 % for TiZr and Ti Grade IV, respectively. After 60 months, the positive outcomes of the 36 month results for TiZr and Ti Grade IV implants were confirmed, with no significant differences with regard to crestal bone level change, clinical parameters and survival or success rates. TiZr implants performed equally well compared to conventional Ti Grade IV 3.3 mm diameter-reduced implants for mandibular removable overdentures. Registered on www.clinicaltrials.gov: NCT01878331

Clinical consequences of untreated dental caries in German 5- and 8-year-olds

Abstract: About half of all carious lesions in primary teeth of German 6- to 7-year-old children remain untreated, but no data regarding the clinical consequences of untreated dental caries are available. Therefore, this cross-sectional observational study aimed to assess the prevalence and experience of caries and odontogenic infections in the primary dentition of 5- and 8-year-old German children. Dental examinations were performed in 5-year-old pre-school children (n = 496) and in 8-year-old primary school children (n = 608) living in the Westphalian Ennepe-Ruhr district. Schools and preschools were selected by sociodemographic criteria including size, area, ownership, socio-economic status. Caries was recorded according to WHO criteria (1997). The Lorenz curves were used to display the polarisation of dental caries. Caries pattern in 5-year-olds was categorized by Wyne’s (1997) definition of early childhood caries (ECC). Odontogenic infections as clinical consequence of untreated dental caries were assessed by the pufa index. The ‘untreated caries-pufa ratio’ was calculated, and the Spearman’s rank correlation coefficient (ρ) was used for evaluating the correlation between dmft and pufa scores. Categorical data were compared between groups using the chi-square test and continuous data were analysed by t-test. Caries prevalence and experience in the primary dentition was 26.2 %/0.9 ± 2.0 dmft in 5-year-olds and 48.8 %/2.1 ± 2.8 dmft in 8-year-olds. ECC type I (22 %) was the prevalent caries pattern in 5-year-olds. About 30 % of the tooth decay was treated (5y: 29.7 %/8y: 39.3 %). The Lorenz curves showed a strong caries polarisation on 20 % of the children. Pufa prevalence and experience was 4.4 %/0.1 ± 0.5 pufa in 5-year-olds and 16.6 %/0.3 ± 0.9 pufa in 8-year-olds. In 5-year-olds 14.2 % and in 8-year-olds 34.2 % of the d-component had progressed mainly to the pulp. A significant correlation between dmft and pufa scores exists in both age groups (5y: ρ = 0.399; 8y: ρ = 0.499). First deciduous molars were most frequently affected by odontogenic infections, presenting virtually all pufa scores (>95 %). Prevalence and experience of odontogenic infections and the untreated caries-pufa ratio were increasing from the younger to the elder children. Dmft and pufa scores in primary teeth predict a higher caries risk in permanent teeth. The pufa index highlights relevant information for decision makers to develop effective oral health care programs for children at high risk for caries.

Issues arising following a referral and subsequent wait for extraction under general anaesthetic: impact on children.

Abstract: Background Untreated caries in young children can result in a referral for extraction in hospital under general anaesthetic (GA). This study aims to explore the impact of caries during the ensuing wait for GA on children resident in the North West of England.

Towards microbiome transplant as a therapy for periodontitis: an exploratory study of periodontitis microbial signature contrasted by oral health, caries and edentulism

Abstract: Conventional periodontal therapy aims at controlling supra- and subgingival biofilms. Although periodontal therapy was shown to improve periodontal health, it does not completely arrest the disease. Almost all subjects compliant with periodontal maintenance continue to experience progressive clinical attachment loss and a fraction of them loses teeth. An oral microbial transplant may be a new alternative for treating periodontitis (inspired by fecal transplant). First, it must be established that microbiomes of oral health and periodontitis are distinct. In that case, the health-associated microbiome could be introduced into the oral cavity of periodontitis patients. This relates to the goals of our study: (i) to assess if microbial communities of the entire oral cavity of subjects with periodontitis were different from or oral health contrasted by microbiotas of caries and edentulism patients; (ii) to test in vitro if safe concentration of sodium hypochlorite could be used for initial eradication of the original oral microbiota followed by a safe neutralization of the hypochlorite prior transplantation. Sixteen systemically healthy white adults with clinical signs of one of the following oral conditions were enrolled: periodontitis, established caries, edentulism, and oral health. Oral biofilm samples were collected from sub- and supra-gingival sites, and oral mucosae. DNA was extracted and 16S rRNA genes were amplified. Amplicons from the same patient were pooled, sequenced and quantified. Volunteer’s oral plaque was treated with saline, 16 mM NaOCl and NaOCl neutralized by ascorbate buffer followed by plating on blood agar. Ordination plots of rRNA gene abundances revealed distinct groupings for the oral microbiomes of subjects with periodontitis, edentulism, or oral health. The oral microbiome in subjects with periodontitis showed the greatest diversity harboring 29 bacterial species at significantly higher abundance compared to subjects with the other assessed conditions. Healthy subjects had significantly higher abundance in 10 microbial species compared to the other conditions. NaOCl showed strong antimicrobial properties; nontoxic ascorbate was capable of neutralizing the hypochlorite. Distinct oral microbial signatures were found in subjects with periodontitis, edentulism, or oral health. This finding opens up a potential for a new therapy, whereby a health-related entire oral microbial community would be transplanted to the diseased patient.

Systematic review of patient safety interventions in dentistry

Abstract: The concept of patient safety in dentistry is in its infancy, with little knowledge about the effectiveness of tools or interventions developed to improve patient safety or to minimise the occurrence of adverse events. The aim of this qualitative systematic review was to search the academic and grey literature to identify and assess tools or interventions used in dental care settings to maintain or improve patient safety. All study designs were included from all dental care settings. Outcome measures were: patient safety, harm prevention, risk minimization, patient satisfaction and patient acceptability, professional acceptability, efficacy, cost-effectiveness and efficiency. Quality assessments were performed on the included studies based on CASP tools. Further analysis was undertaken to discover whether any of the tools had been trialled or verified by the authors, or by subsequent authors. Following abstract screening, and initial qualitative synthesis, nine studies were found to meet the inclusion criteria with 31 being excluded following initial analysis. Tools identified included: checklists (4 studies), reporting systems (3), the use of electronic notes (1) and trigger tools (1). Grey literature searching did not identify any further appropriate studies. In terms of study design, there were observational studies including audit cycles (5 studies), epidemiological studies (3) and prospective cluster randomised clinical trials (1). The quality of the studies varied and none of their outcomes were verified by other researchers. The tools identified have the potential to be used for measuring and improving patient safety in dentistry, with two surgical safety checklists demonstrating a reduction in erroneous dental extractions to nil following their introduction. Reporting systems provide epidemiological data, however, it is not known whether they lead to any improvement in patient safety. The one study on trigger tools demonstrates a 50 % positive predictive value for safety incidents. It is not clear as to what impact the introduction of electronic guidelines has on patient safety outcomes. This systematic review finds that the only interventions in dentistry that reduce or minimise adverse events are surgical safety checklists. We believe this to be the first systematic review in this field; it demonstrates the need for further research into patient safety in dentistry across several domains: epidemiological, conceptual understanding and patient and practitioner involvement.

Comparison of intraoral radiography and cone-beam computed tomography for the detection of periodontal defects: an in vitro study

Abstract: This study aimed to compare the diagnostic accuracy of cone-beam computed tomography (CBCT) unit with digital intraoral radiography technique for detecting periodontal defects. The study material comprised 12 dry skulls with maxilla and mandible. Artificial defects (dehiscence, tunnel, and fenestration) were created on anterior, premolar and molar teeth separately using burs. In total 14 dehiscences, 13 fenestrations, eight tunnel and 16 without periodontal defect were used in the study. These were randomly created on dry skulls. Each teeth with and without defects were images at various vertical angles using each of the following modalities: a Planmeca Promax Cone Beam CT and a Digora photostimulable phosphor plates. Specificity and sensitivity for assessing periodontal defects by each radiographic technique were calculated. Chi-square statistics were used to evaluate differences between modalities. Kappa statistics assessed the agreement between observers. Results were considered significant at P < 0.05. The kappa values for inter-observer agreement between observers ranged between 0.78 and 0.96 for the CBCT, and 0.43 and 0.72 of intraoral images. The Kappa values for detecting defects on anterior teeth was the least, following premolar and molar teeth both CBCT and intraoral imaging. CBCT has the highest sensitivity and diagnostic accuracy for detecting various periodontal defects among the radiographic modalities examined.

The midwifery initiated oral health-dental service protocol: an intervention to improve oral health outcomes for pregnant women

Abstract: Evidence is emerging that women’s poor oral health and health practices during pregnancy are associated with poor oral health in their children and potentially an increased risk of pre-term or low-birth weight infants. The Midwifery Initiated Oral Health-Dental Service (MIOH-DS) trial is a three arm multicentre randomised controlled trial which will recruit women from three metropolitan hospitals aimed at improving women’s oral health and service access and indirectly reducing perinatal morbidity. All three arms of the trial will deliver oral health promotion material, although a midwife oral assessment and referral to private/public/health fund dental services pathway (Intervention Group 1) and the midwife oral assessment and referral to local free public dental services pathway (Intervention Group 2) will be compared to the control group of oral health promotional material only. Midwives will undergo specific oral health education and competency testing to undertake this novel intervention. This efficacy trial will promote a new partnership between midwives and dentists focused on enhancing the oral health of women and their infants. Should the intervention be found effective, this intervention, with existing on-line educational program for midwives, can be easily transferred into practice for large metropolitan health services within and beyond Australia. Further cost-benefit analysis is proposed to inform national health policy. Australian New Zealand Clinical Trials Registry ACTRN12612001271897 .

Early results of low-level laser application for masticatory muscle pain: a double-blind randomized clinical study

Abstract: To evaluate the effect of Low Level Laser (LLL) application at the points of greatest pain in patients with chronic masticatory muscle pain. A total number of 30 (21 women, 9 men, with a mean age of 39.2) were selected after the diagnosis of MPDS according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD). The patients were randomly divided into three groups; laser group I (n = 10); patients received the LLL at the point of greatest pain, laser group II (n = 10); patients received LLL at pre-established points in the effected muscles and placebo group (n = 10). LLL and placebo were applied three times per week, for a total of 12 sessions. Mandibular mobility was examined, masticator muscles tenderness were assessed and PPT values were obtained. Subjective pain levels were evaluated using VAS. The measurements performed before the treatment and after the completion of the therapy. Descriptive statistics (mean, standard deviation, and frequency) Student’s t-test, Mann–Whitney U-test and paired-sample t-tests were used for analysis. In both laser groups, there was a statically significant reduction in PPT values of the muscles, number of muscles without any pain on palpation increased significantly, mandibular movements’ ranges were improved. Laser group I demonstrated statistically better results than the Laser group II in all of the measured values. Plasebo group did not show any statistically difference in any of the measured values. LLLT can be accepted as an alternative treatment modality in the management of masticatory muscle pain and direct irradiation seems to effect better. Current Controlled Trials ISRCTN31085 , Date of registration 28/08/20145.

Is there a place for Tooth Mousse® in the prevention and treatment of early dental caries? A systematic review

Abstract: It is important for Dental Professionals to consider the evidence for the effectiveness of the preventive strategies used to maintain good oral health and reduce the risk of caries in their patients. Whilst many of the traditional preventive activities, including the recommendation and use of fluoride products and the placement of fissure sealants have a wealth of clinical evidence to support their use, some of the newer preventive agents have a more limited evidence base. In order to investigate the level of scientific support behind one such technology, a systematic literature review was carried out to assess the effectiveness of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) in the prevention and treatment of early dental caries. A broad search strategy using Medline via OvidSP and EMBASE was performed in order to capture all published studies to related Casein Phosphopeptide-Amorphous Calcium Phosphate. In addition to the above searches the terms “CPP ACP” and “casein phosphopeptide amorphous calcium phosphate” were searched using PREMEDLINE and the Cochrane Central Register of Controlled Trials. Inclusion criteria were clinical trials of participants of any age, comparing the use of Tooth Mousse® (MI Paste®) or Tooth Mousse Plus® (MI Paste Plus®) to a routine oral care regimen and reporting recognised clinical outcome measures for early caries lesions. Only research studies in English were selected. 7576 articles were identified, but the majority were duplicates. Once these were removed 172 articles were inspected and the focus on ‘CPP-ACP formulations of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) resulted in 29 articles being selected, and of these 12 studies met the inclusion criteria and were considered acceptable for the systematic review. The overall findings of this review did not show any significant benefits of using Tooth Mousse® (MI Paste®) products over brushing with a fluoride toothpaste for the prevention of early dental caries. With regard to the regression of white spot lesions in orthodontic patients there is a tendency towards a benefit for the use of Tooth Mousse® (MI Paste®) but the quality of evidence is limited. There is a lack of evidence to support the use of Tooth Mousse Plus® (MI Paste Plus®) over Tooth Mousse® (MI Paste®) at this time. This review suggests that further well-designed randomized controlled trials are required prior to the widespread recommendation of Tooth Mousse® products for the prevention and treatment of early dental caries in the general population.

Longitudinal study of dental caries incidence associated with Streptococcus mutans and Streptococcus sobrinus in patients with intellectual disabilities

Abstract: Mutans streptococci (Streptococcus mutans and S. sobrinus) are considered to be major etiologic agents of dental caries. Using a polymerase chain reaction method, we detected those bacteria from 145 outpatients (6–30 years old) with intellectual disabilities (ID) and their presence was compared with the incidence of dental caries. Plaque samples were collected from all erupted tooth sites in subjects with a sterile toothbrush. A dental examination was performed to determine the number of decayed and filled teeth (DFT score) in permanent dentition using the WHO caries diagnostic criteria. A Mann–Whitney U-test was employed to compare the caries scores between combinations of the bacteria, and with a Wilcoxon rank test used to compare caries scores between the baseline and after 1 year. Among all subjects, S. mutans and S. sobrinus were possessed by 78.7 and 83.5 %, respectively, while 13.1 % were positive for S. mutans alone, 17.9 % for S. sobrinus alone, and 65.6 % for both organisms, with 3.4 % were negative for both. The mean DFT score of subjects positive for both S. mutans and S. sobrinus at after 1 year was significantly higher than that of those positive for S. mutans alone (P < 0.01). The increase in caries increment was also significantly greater in subjects with both bacteria detected (P < 0.001). Our results indicate that patients with ID harboring both S. mutans and S. sobrinus have a significantly higher incidence of dental caries than those with S. mutans alone.