Showing papers in "Journal of the American Dental Association in 2011"

Dietary Guidelines for Americans, 2010: An update

Abstract: Background The U.S. Department of Agriculture developed Dietary Guidelines for Americans, 2010, by taking into consideration evidence-based nutritional science, changes in the food supply and environmental influences. Conclusions The 2010 guidelines emphasize the importance of maintaining caloric balance to support a healthy weight and selecting nutrient-dense foods and beverages to ensure adequate nutrient intakes. Americans’ compliance with previous dietary guidelines has been poor, and the 2010 guidelines acknowledge the need for collaboration among individuals, the community, government and industry to ensure consumers’ access to and acceptance of appropriate foods. Clinical Implications As part of the greater community, the oral health practitioner will find that familiarity with the 2010 guidelines will enable him or her to assist patients in making better food choices for oral and systemic health.

Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: Executive summary of recommendations from the American Dental Association Council on Scientific Affairs

Abstract: Background This narrative review of osteonecrosis of the jaw in patients with low bone mass receiving treatment with antiresorptive agents is based on an appraisal of the literature by an advisory committee of the American Dental Association Council on Scientific Affairs. It updates the committee's 2008 advisory statement. Methods The authors searched MEDLINE for literature published between May 2008 (the end date of the last search) and February 2011. Results This report contains recommendations based on the findings of the literature search and on expert opinion that relate to general dentistry; periodontal disease management; implant placement and maintenance; oral and maxillofacial surgery; endodontics; restorative dentistry and prosthodontics; orthodontics; and C-terminal telopeptide testing and drug holidays. Conclusions The highest reliable estimate of antiresorptive agent–induced osteonecrosis of the jaw (ARONJ) prevalence is approximately 0.10 percent. Osteoporosis is responsible for considerable morbidity and mortality. Therefore, the benefit provided by antiresorptive therapy outweighs the low risk of developing osteonecrosis of the jaw. Clinical Implications An oral health program consisting of sound hygiene practices and regular dental care may be the optimal approach for lowering ARONJ risk. No validated diagnostic technique exists to determine which patients are at increased risk of developing ARONJ. Discontinuing bisphosphonate therapy may not lower the risk but may have a negative effect on low-bone-mass–treatment outcomes.

A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up.

Abstract: Background Immediate-function implants have become an accepted alternative for fixed restoration protocols in edentulous mandibles on the basis of documented high success rates. The All-on-4 concept (Nobel Biocare, Goteborg, Sweden), a surgical and prosthetic protocol for immediate function involving the use of four implants to support a fixed prosthesis in patients with completely edentulous mandibles, represents one of these protocols. The authors conducted a study to document long-term follow-up of the All-on-4 concept. Methods This longitudinal study included 245 patients with a total of 980 immediate-function implants (four per patient), all placed in the anterior region, to support fixed full-arch mandibular prostheses. The inclusion criterion was having an edentulous mandible, or a mandible with hopeless teeth, in need of fixed implant restorations. Results A total of 21 implants failed in 13 patients, giving cumulative patient-related and implant-related success rates of 94.8 percent and 98.1 percent, respectively, at five years, and 93.8 percent and 94.8 percent, respectively, with up to 10 years of follow-up. The prostheses’ survival rate was 99.2 percent with up to 10 years of follow up. Conclusions The results support the conclusion that use of the All-on-4 immediate-function implant concept in completely edentulous mandibles is viable in the long term. Clinical Implications High prosthesis survival rates can be achieved by the use of four implants to support a full-arch fixed prosthesis in the mandible.

Development of a brief and effective temporomandibular disorder pain screening questionnaire: Reliability and validity

Abstract: Background Available screening instruments for identifying temporomandibular disorders (TMDs) exhibit methodological or logistic limitations. The authors conducted a study to develop and assess the validity of a self-report instrument in screening patients for pain-related TMDs.

Evidence-based guidelines for the care and maintenance of complete dentures: A publication of the American College of Prosthodontists

Abstract: The current rates of edentulism have been estimated to be between 7 percent and 69 percent of the adult population internationally. In the United States, while the incidence of edentulism continues to decline, rapid population growth coupled with current economic conditions suggest that edentulism and conventional denture use will continue at current or higher numbers. Unfortunately, evidence-based guidelines for the care and maintenance of removable complete denture prostheses do not exist. In 2009, the American College of Prosthodontists (ACP) formed a task force to establish evidence-based guidelines for the care and maintenance of complete dentures. The task force comprised members of the ACP, the Academy of General Dentistry, the American Dental Association Council on Scientific Affairs, the American Dental Hygienists' Association, the National Association of Dental Laboratories and GlaxoSmithKline Consumer Healthcare. The review process included the assessment of over 300 abstracts and selection of over 100 articles meeting the inclusion criteria of this review. The task force reviewed synopses of the literature and formulated 15 evidence-based guidelines for denture care and maintenance. These guidelines were reviewed by clinical experts from the participating organizations and are being published in The Journal of the American Dental Association for widespread distribution to the dental community. These guidelines reflect the views of the task force.

Assessing the relationship between children's oral health status and that of their mothers.

Abstract: Background The authors conducted a study to describe the relationship between the oral health of young children and that of their mothers. Methods Using data from the Third National Health and Nutrition Examination Survey and a related birth certificate–linked file, the authors compiled a sample of 1,184 mother/child pairs for children aged 2 through 6 years. The authors performed logistic and cumulative logistic regression analyses by using children's caries experience and untreated caries status as dependent variables. They evaluated the mothers' untreated caries status and tooth loss status along with other covariates, including age, race/ethnicity and poverty status. Results Children of mothers who had high levels of untreated caries were more than three times as likely (odds ratio [OR], 3.5; 95 percent confidence interval [CI], 2.0–6.2) to have higher levels of caries experience (treated or untreated dental caries) compared with children whose mothers had no untreated caries. A similar relationship was observed between mothers' tooth loss and caries experience among their children. The children of mothers with high levels of tooth loss were more than three times as likely (OR, 3.3; 95 percent CI, 1.8–6.4) to have higher levels of caries experience compared with children of mothers with no tooth loss; for mothers with moderate tooth loss, the OR was 2.3 (95 percent CI, 1.5–3.5). Conclusions Mothers' oral health status is a strong predictor of the oral health status of their children. Practice Implications Preventive plans for children should be based on a caries risk assessment. The results of this study demonstrate that basic information obtained from the child's mother regarding her oral health status is valuable in helping the dentist determine the child's caries risk.

Dental plaque and oral health during the first 32 years of life.

Abstract: Background Studies investigating the role of dental plaque in oral disease have focused primarily on the quantity and quality of plaque at a given point in time. No large-scale epidemiologic research has been conducted regarding the continuity and change in plaque levels across the long term and the association of plaque levels with oral health. Methods The authors used data from the Dunedin Multidisciplinary Health and Development Study. Collection of dental plaque data occurred at ages 5, 9, 15, 18, 26 and 32 years by means of the Simplified Oral Hygiene Index. The authors assessed oral health outcomes when participants were aged 32 years. Results The authors identified three plaque trajectory groups (high, n=357; medium, n=450; and low; n=104) and found substantial, statistically significant differences in both caries and periodontal disease experience among those groups. For example, after the authors controlled for sex, socioeconomic status and dental visiting pattern, they found that participants in the high-plaque-trajectory group lost nearly five times more teeth owing to caries than did those in the low-plaque-trajectory group. Conclusions Across the long term, participants in the high-plaque-trajectory group were more likely to experience caries, periodontal disease and subsequent tooth loss than were those in the low- or medium-plaque-trajectory groups, and they experienced all those conditions with greater severity. Clinical Implications Improving oral health requires emphasizing long-term self-care, as well as providing broad public health and health promotion measures that promote and support oral self-care. This study's findings suggest that poor oral hygiene and smoking have a synergistic effect on periodontal disease experience.

Minimally invasive management of dental caries: Contemporary teaching of posterior resin-based composite placement in U.S. and Canadian dental schools

Abstract: Background. Resin-based composites are an increasingly popular material for restoring posterior teeth, permitting minimally invasive cavity preparations and esthetic restorations. The authors investigated current teaching of the placement of posterior resin-based composites in U.S. and Canadian dental schools. Methods. In late 2009 and early 2010, the authors, with the assistance of the Consortium of Operative Dentistry Educators (CODE), invited 67 dental schools to participate in an Internet-based survey. Results. The response rate was 73 percent. Although all schools taught the placement of resin-based composites in occlusal and most occlusoproximal cavities, eight schools (16 percent) did not teach placement of three-surface occlusoproximal resin-based composite restorations in permanent molars. Resin-based composites accounted for 49 percent of direct posterior restorations placed by dental students in 2009 and 2010, a 30 percent increase from 2005. Conclusions. Teaching placement of posterior resin-based composites continues to increase in dental schools in the United States and Canada, with predoctoral students gaining, on average, an equal amount of experience placing posterior resin-based composites and amalgams in terms of numbers of restorations. Clinical Implications. Evidence-based, up-to-date teaching programs, including those in operative dentistry, are needed to best prepare students for careers in dentistry.

Prevention of prescription opioid abuse: the role of the dentist.

Abstract: Background Opioids are analgesics that have potential for misuse, abuse or addiction. Up to an estimated 23 percent of prescribed doses are used nonmedically. As prescribers of 12 percent of immediate-release (IR) opioids in the United States, dentists can minimize the potential for misuse or abuse. Methods The authors participated in a two-day meeting in March 2010 cohosted by Tufts Health Care Institute Program on Opioid Risk Management, Boston, and Tufts University School of Dental Medicine, Boston. The purpose of the meeting was to synthesize available opioid abuse literature and data from a 2010 survey regarding West Virginia dentists' analgesic prescribing practices, identify dentists' roles in prescribing opioids that are used nonmedically, highlight practices that dentists can implement and identify research gaps. Results Dentists can play a role in minimizing opioid abuse through patient education, careful patient assessment and referral for substance abuse treatment when indicated, and using tools such as prescription monitoring programs. Research is needed to determine the optimal number of doses needed to treat dental-related pain. Conclusions Dentists cannot assume that their prescribing of opioids does not affect the opioid abuse problem in the United States. The authors suggest that dentists, along with other prescribers, take steps to identify problems and minimize prescription opioid abuse through greater prescriber and patient education; use of peer-reviewed recommendations for analgesia; and, when indicated, the tailoring of the appropriate and legitimate prescribing of opioids to adequately treat pain. Practice Implications The authors encourage dentists to incorporate practical safeguards when prescribing opioids, consistently educate patients about how to secure unused opioids properly, screen patients for substance use disorders and develop a referral network for the treatment of substance use disorders.

Human papillomavirus infections in the oral mucosa.

Abstract: Background Public awareness of human papillomavirus (HPV) as the causal agent of cervical cancer and of the availability of HPV vaccines has increased. As a result, more patients are asking their dentists about oral HPV infection and its prevention by means of vaccination. Parents of pediatric dental patients also may be concerned when their children have HPV-associated oral lesions, because HPV infection still often is considered a purely sexually transmitted disease. In this review, the authors provide the latest information for dental professionals about HPV infection in the oral mucosa and in general. Types of Studies Reviewed The authors searched PubMed for all studies regarding HPV infection in the oral mucosa, and they reviewed relevant publications focusing exclusively on HPV infections of the oral cavity. In selecting studies for review, the authors made a clear distinction between studies regarding HPV infections in the mouth and those regarding HPV infection in the oropharynx or in other head and neck sites. Results HPV can infect oral mucosa. A subgroup of oral cancer clearly is associated with HPV. Oral HPV infection is transmitted sexually but also can be transmitted from mouth to mouth and vertically from an infected mother during delivery. Conclusions and Clinical Implications Persistent HPV infection in the oral mucosa might increase the risk of developing oral cancer. Regular and meticulous clinical examination is the dentist's most important tool in detecting HPV-associated changes in the oral mucosae. HPV-associated oral cancer may affect a population younger than that typically affected by HPV-independent oral cancer. Alcohol and tobacco use increase the risk of developing oral cancer, so good practice includes encouraging patients to avoid these habits. The availabel HPV vaccines cover the HPV genotypes found most commonly in the oral mucosa, but their protective effect against oral cancer remains to be elucidated.

Cuspal deflection and depth of cure in resin-based composite restorations filled by using bulk, incremental and transtooth-illumination techniques

Abstract: Background Restoration techniques affect shrinkage stress and depth of cure The authors tested cuspal deflection and depth of cure resulting from the use of different techniques (bulk, incremental, bulk/transtooth illumination) and two resin-based composites (deep curing and conventional) Methods The authors restored extracted teeth with deep-curing X-tra fil (VOCO, Cuxhaven, Germany) (by using bulk and incremental techniques) and Filtek Supreme Plus (3M ESPE, St Paul, Minn) (by using bulk, incremental and bulk/transtooth-illumination techniques) The sample size for each technique was five They determined cuspal deflections as changes in buccal and lingual surfaces before and after restoration To determine the extent of cure, they measured hardness 05 to 35 millimeters deep on the sectioned restorations Results The authors found no difference in cuspal deflection between filling techniques within the same materials ( P > 05) They found no difference in hardness for X-tra fil at any depth with either the bulk or the incremental technique ( P > 05) Filtek Supreme Plus had higher hardness values at depths of less than 15 mm with the bulk/transtooth-illumination technique, whereas the bulk technique resulted in lower hardness values at depths of 20 mm and below ( P Conclusions Cuspal deflection was not affected by filling techniques X-tra fil cured up to a depth of at least 35 mm; Filtek Supreme Plus had lower curing values below a depth of 2 mm The transtooth-illumination technique improved curing depth for restorations placed in bulk Clinical Implications When using resin-based composite restorative materials, clinicians should be more concerned about the effect of filling techniques on curing depth than about how these techniques affect shrinkage stresses

Dentist-patient communication techniques used in the United States: The results of a national survey

Abstract: Background The authors conducted a national survey to determine the communication techniques that dentists use routinely and variations in their use. Methods American Dental Association Survey Center staff members mailed an 86-item questionnaire to a random sample of 6,300 U.S. dentists in private practice. Participants reported routine use (“most of the time” or “always”) during a typical week of 18 communication techniques, of which seven are basic techniques. The authors used analysis of variance and ordinary least squares regression models to test the association of communication, provider and practice characteristics with the number of techniques. Results Dentists routinely use an average of 7.1 of the 18 techniques and 3.1 of the seven basic techniques. Two-thirds or more of dentists used four of the techniques (hand out printed materials, speak slowly, use models or radiographs to explain, use simple language). Less than one-fourth of dentists used any of the techniques in the teach-back method or patient-friendly practice domains. A dentist’s age, race/ethnicity, education outside the United States and area of dentistry affected use. Health literacy variables (awareness, education in communication, practice-level change, outcome expectancy) and lack of time were associated with the number of techniques used. Conclusions Routine use of all of the communication techniques is low among dentists, including some techniques thought to be most effective with patients with low literacy skills. Practice Implications Professional education is needed to improve knowledge about communication techniques and to ensure that they are used effectively. A firm foundation for these efforts requires the development, evaluation and dissemination of communication guidelines for dental care professionals.

Applied behavior analysis: behavior management of children with autism spectrum disorders in dental environments

Abstract: Background There are a limited number of studies addressing behavior management techniques and procedural modifications that dentists can use to treat people with an autism spectrum disorder (ASD). Methods The authors conducted a search of the dental and behavioral analytic literature to identify management techniques that address problem behaviors exhibited by children with ASDs in dental and other health-related environments. Results Applied behavior analysis (ABA) is a science in which procedures are based on the principles of behavior through systematic experimentation. Clinicians have used ABA procedures successfully to modify socially significant behaviors of people with ASD. Basic behavior management techniques currently used in dentistry may not encourage people with cognitive and behavioral disabilities, such as ASD, to tolerate simple in-office dental procedures consistently. Instead, dental care providers often are required to use advanced behavior management techniques to complete simple in-office procedures such as prophylaxis, sealant placement and obtaining radiographs. ABA procedures can be integrated in the dental environment to manage problem behaviors often exhibited by children with an ASD. Conclusions The authors found no evidence-based procedural modifications that address the behavioral characteristics and problematic behaviors of children with an ASD in a dental environment. Further research in this area should be conducted. Clinical Implications Knowledge and in-depth understanding of behavioral principles is essential when a dentist is concerned with modifying behaviors. Using ABA procedures can help dentists manage problem behaviors effectively and systematically when performing routine dental treatment. Being knowledgeable about each patient's behavioral characteristics and the parents' level of involvement is important in the successful integration of the procedures and reduction of in-office time.

Nonfluoride caries-preventive agents: Executive summary of evidence-based clinical recommendations

Abstract: Background In this article, the authors present evidence-based clinical recommendations regarding the use of nonfluoride caries-preventive agents. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. The panel addressed several questions regarding the efficacy of nonfluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries. Types of Studies Reviewed A panel of experts convened by the ADA Council on Scientific Affairs, in collaboration with ADA Division of Science staff, conducted a MEDLINE search to identify all randomized and nonrandomized clinical studies regarding the use of nonfluoride caries-preventive agents. Results The panel reviewed evidence from 50 randomized controlled trials and 15 nonrandomized studies to assess the efficacy of various nonfluoride caries-preventive agents. Clinical Implications The panel concluded that certain non-fluoride agents may provide some benefit as adjunctive therapies in children and adults at higher risk of developing caries. These recommendations are presented as a resource for dentists to consider in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. (The full report can be accessed at "http://ebd.ada.org/ClinicalRecommendations.aspx".)

Comparative reliability analyses of zirconium oxide and lithium disilicate restorations in vitro and in vivo

Abstract: Background The authors analyzed the in vitro and in vivo performance of lithium disilicate glass-ceramic (LDGC) restorations and yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP) (that is, zirconium oxide) restorations with regard to reliability, clinical performance and abrasion resistance. Methods In the in vitro study, four authors subjected samples of LDGC, Y-TZP and metal-ceramic crowns to step-stress fatigue testing. Four investigators assessed the in vivo clinical performance of LDGC and zirconium oxide–based restorations at four and seven years, respectively. In addition, one author conducted a randomized, controlled clinical trial to analyze the volumetric loss of enamel and ceramic antagonist surfaces. Results The LDGC crowns exhibited the highest fatigue load-to-failure values in the in vitro analysis. The results of the in vivo assessment showed that the clinical performance of the LDGC restorations at four years was comparable to that of the zirconium oxide–based crowns at seven years. The results of the in vivo, randomized, controlled clinical trial showed that LDGC crowns were not only resistant to wear, but also were wear friendly to enamel antagonist surfaces. Conclusions The LDGC crowns in the in vitro and in vivo studies exhibited high durability, and they were wear friendly to opposing natural dentition. Clinical Implications LDGC and zirconium oxide–based crowns are a clinically acceptable means of treating teeth that require full-coverage restorations. In addition, LDGC materials exhibit excellent clinical performance, as well as demonstrate acceptable abrasion compatibility with the opposing natural dentition.

The connection between human papillomavirus and oropharyngeal squamous cell carcinomas in the United States: Implications for dentistry

Abstract: Background Results from studies conducted in the past several years suggest that some oropharyngeal cancers, those of the base of the tongue and the tonsils, are associated with high-risk types of human papillomavirus (HPV). In this article, the authors summarize the availabel evidence regarding the epidemiology of HPV-associated oropharyngeal cancers in the United States, the availabel HPV vaccines and the implications of these for dentistry. They also examine the differences in HPV prevalence between cancers of the oral cavity and those of the oropharynx. Types of Studies Reviewed The authors searched PubMed, Web of Science, The Cochrane Library and the National Guideline Clearinghouse to identify English-language systematic reviews and meta-analyses focused on HPV-associated oropharyngeal squamous cell cancers published from January 2005 through May 2011. Results Molecular and epidemiologic evidence suggest a strong etiologic association of HPV with oropharyngeal cancers. The incidence of oropharyngeal cancers in the United States has increased between 1973 and 2007, whereas that of cancers at other head and neck sites has decreased steadily. Compared with HPV-negative cancers, HPV-positive oropharyngeal cancers are associated with certain sexual behaviors, occur more often among white men and people who do not use tobacco or alcohol, and may occur in a population younger by about four years (median ages, 52–56 years). Despite often having a later stage of diagnosis, people with HPV-positive oropharyngeal cancers have a lower risk of dying or recurrence than do those with HPV-negative cancers. The effectiveness of the HPV vaccine in preventing oropharyngeal cancers is unknown. Clinical Implications Dental health care personnel (DHCP) should be knowledgeable about the role of HPV in carcinogenesis, the association of HPV with oropharyngeal cancers and HPV vaccines, and they should be prompt in referring patients with suggestive symptoms for evaluation. DHCP can play an important role in increasing patients' knowledge about HPV and oropharyngeal cancers.

The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: A meta-analysis

Abstract: Background The authors evaluated published evidence from controlled clinical trials regarding the efficacy of two local anesthetic solutions in providing successful pulpal anesthesia. Methods The authors searched MEDLINE and Embase databases to identify peer-reviewed randomized controlled trials in which researchers directly compared articaine and lidocaine local anesthetic solutions in adult participants. They extracted study characteristics and outcomes data as a basis for meta-analysis. They completed subgroup analyses for both infiltration and mandibular inferior alveolar block anesthetic techniques. Results Articaine solutions had a probability of achieving anesthetic success superior to that of lidocaine, with an odds ratio of 2.44 (95 percent confidence interval [CI], 1.59–3.76; P P P = .009), and no difference when the authors considered only symptomatic teeth. Clinical Implications Research evidence supports using articaine versus lidocaine for achieving pulpal anesthesia when the infiltration mode of administration is used. It is premature to recommend articaine for mandibular block anesthesia in cases involving irreversible pulpitis.

Trigeminal nerve injury associated with injection of local anesthetics: Needle lesion or neurotoxicity?

Abstract: Background The authors used comprehensive national registry and clinical data to conduct a study of adverse drug reactions (ADRs), in particular neurosensory disturbance (NSD), associated with local anesthetics used in dentistry Methods The study included data sets of annual sales of local anesthetics (from 1995 through 2007), 292 reports to the Danish Medicines Agency, Copenhagen, Denmark, of adverse reactions to local anesthetic drugs, and a clinical sample of 115 patients with NSD associated with local anesthetics. The authors assessed lidocaine 2 percent, mepivacaine 2 percent and 3 percent, prilocaine 3 percent, and articaine 4 percent sold in cartridges. Results The study results showed a highly significant overrepresentation of NSDs associated with articaine 4 percent, in particular with mandibular blocks. Conclusions The distribution of NSDs was disproportionate to the market share of three of the four drugs in both national registry data and clinical data. These findings indicate that the main cause of injury was neurotoxicity resulting from administration of the local anesthetic rather than the needle penetration. Clinical Implications Clinicians may consider avoiding use of high-concentration (4 percent) anesthetic formulations for block anesthesia in the trigeminal area in cases in which there are viable alternatives.

Sealants and dental caries: Dentists' perspectives on evidence-based recommendations

Abstract: Background The authors conducted a study to survey the perspectives of dentists regarding the 2010 American Dental Association (ADA) recommendation to seal non-cavitated carious lesions (NCCLs) in children and young adults. Methods The authors mailed a questionnaire to a randomly selected sample of 2,400 general dentists (GDs) and pediatric dentists (PDs) in the United States. The sample was chosen by the ADA's Survey Center. The questionnaire included two photographs of NCCLs (permanent first molar and premolar) in a 12-year-old child. Respondents were provided with radiographic findings and asked to choose from several management options. Results In the absence of radiographic evidence of caries, 37.4 percent and 42.3 percent of GDs and PDs, respectively, indicated that they would seal the NCCL in the molar. For the premolar, a significantly lower percentage of GDs than of PDs indicated that they would seal the NCCL. With radiographic evidence of caries in dentin, less than 4 percent of all dentists surveyed indicated that they would seal the NCCLs, and more than 90 percent indicated that they would remove the caries and place restorations. Less than 40 percent of dentists indicated that they sealed NCCLs in their practice. Conclusions The U.S. dentists surveyed have not adopted evidence-based clinical recommendations regarding the sealing of NCCLs. Practice Implications New educational and dissemination programs should be developed regarding these evidence-based caries management approaches.

The effect of subantimicrobial-dose-doxycycline periodontal therapy on serum biomarkers of systemic inflammation: a randomized, double-masked, placebo-controlled clinical trial.

Abstract: Background Periodontitis has been reported to be associated with coronary artery disease (CAD). Research is needed to determine if therapies that improve periodontal health also reduce systemic measures of inflammation associated with both diseases.

Cementing all-ceramic restorations: recommendations for success

Abstract: Background Several all-ceramic restorative systems of various compositions, properties and indications are available to the dental practitioner. Because of the large number of systems, the dental team faces questions and decisions when choosing the appropriate system and the appropriate means of cementation. Overview The authors present a brief overview of the cementation options for various types of all-ceramic restorations. In this article, they discuss the cementation of current all-ceramic restorations and make clinical recommendations tailored to each type of ceramic. Conclusion and Clinical Implications The clinician must have a good understanding of the ceramic type to determine whether a restoration should be cemented adhesively or nonadhesively. Other variables, such as isolation and preparation design, also influence the cementation choice. Various ceramic types demand different surface treatments before cementation. Choosing and applying the appropriate surface treatment and cementation procedure will contribute to long-lasting restorations. The literature is lacking in clinical trial results that validate current in vitro data regarding cementation of all-ceramic restorations.

Dental procedures and subsequent prosthetic joint infections: Findings from the medicare current beneficiary survey

Abstract: Background The publication of the 2009 American Academy of Orthopedic Surgeons’ (AAOS’) guidelines for antibiotic prophylaxis after joint replacement (arthroplasty) has renewed debate concerning appropriate prophylaxis for dental patients. The authors examined an administrative data set to assess whether dental procedures were associated with prosthetic joint infections (PJIs). Methods Using data for the years 1997 through 2006 from the Medicare Current Beneficiary Survey (MCBS), the authors identified participants who had undergone total joint arthroplasty and those who had experienced a PJI. They explored associations between dental procedures and subsequent PJIs by using time-to-event analyses (N = 1,000). A nested case-control study included case participants who had had PJIs (n = 42) and matched control participants who had had total arthroplasty but had no PJIs (n = 126). The authors calculated hazard ratios (HRs) and odds ratios (ORs). Results Control participants (people without PJIs) were more likely than were case participants (those with PJIs) to have undergone an invasive dental procedure, though this trend was not statistically significant in either the time-to-event analysis (HR = 0.78; 95 percent confidence interval [CI], 0.18–3.39) or the case-control analysis (OR = 0.56; 95 percent CI, 0.18–1.74). Only four of 42 case participants had undergone an invasive dental procedure in the 90 days before the infection occurred. Consideration of all dental procedures yielded similar results. Conclusions Dental procedures were not associated significantly with subsequent risk for PJIs, although this study's power was somewhat low. The clinical importance of prophylactic antibiotics in dentistry for patients who have undergone joint arthroplasty, therefore, may be questioned. Clinical Implications These results support the view that the 2009 AAOS Information Statement on antibiotic prophylaxis for people with prosthetic joints should be reconsidered for patients in that population who are receiving oral health care.

The use of the mandibular infiltration anesthetic technique in adults

Abstract: Background The author describes the use of the infiltration anesthetic technique to anesthetize mandibular teeth in adults and explores its mechanism of action. Methods The author reviewed articles describing randomized controlled trials of the mandibular infiltration anesthetic technique in healthy participants. Results The author found that using the mandibular infiltration anesthetic technique can produce anesthesia in adult mandibular teeth. The success was dose dependent and the choice of anesthetic solution was significant; 4 percent articaine with 1:100,000 epinephrine was more effective than 2 percent lidocaine with 1:100,000 epinephrine. Combining buccal and lingual infiltrations increased success in the mandibular incisor region. The success of the mechanism of infiltration of anesthetic at the mandibular first molar appeared to depend on the mental foramen. Conclusions The mandibular infiltration anesthetic technique is an effective method of anesthetizing mandibular incisors. Four percent articaine with epinephrine appears to be the preferred solution. Clinical Implications The choice of anesthetic solution is important when using the infiltration anesthetic technique in the adult mandible.

Angled Implant Abutments: A Practical Application of Available Knowledge

Abstract: Background When dental implants are not placed parallel to adjacent teeth or contiguous implants, the clinician can use angled abutments to achieve proper restorative contours However, increased stresses on implants and bone have been associated with use of angled abutments In this regard, there are unresolved issues concerning implant survival and potential prosthetic complications that can arise when angled abutments are used to align prosthetic positions Types of Studies Reviewed The authors searched the dental literature for clinical trials that appraised the survival rate and complications (biological and technical) associated with pros-theses that are supported by angled abutments Results The results of photoelastic stress assessments, finite element analysis and strain-gauge studies indicated that increased abutment angulations result in the placement of a greater amount of stress on prostheses and the surrounding bone than that associated with straight abutments However, survival studies did not demonstrate a significant decrease of prostheses' longevity associated with angled abutments Furthermore, there was no additional bone loss adjacent to implants that supported angled abutments compared with straight abutments, and angled abutments did not manifest an increased incidence of screw loosening Clinical Implications The use of angled abutments facilitates paralleling nonaligned implants, thereby making prosthesis fabrication easier These abutments also can aid the clinician in avoiding anatomical structures when placing the implants In addition, use of angled abutments can reduce treatment time, fees and the need to perform guided bone regeneration procedures

Knowledge and beliefs regarding oral health among pregnant women

Abstract: Background Racial or ethnic and economic disparities exist in terms of oral diseases among pregnant women and children The authors hypothesized that women of a racial or ethnic minority have less oral health knowledge than do women not of a racial or ethnic minority Therefore, the authors conducted a study to assess and compare maternal oral health knowledge and beliefs and to determine if maternal race and ethnicity or other maternal factors contributed to women’s knowledge or beliefs

Alternative mandibular nerve block techniques: A review of the Gow-Gates and Akinosi-Vazirani closed-mouth mandibular nerve block techniques

Abstract: Background and Overview The limited success rate of the standard inferior alveolar nerve block (IANB) has led to the development of alternative approaches for providing mandibular anesthesia Two techniques, the Gow-Gates mandibular nerve block and the Akinosi-Vazirani closed-mouth mandibular nerve block, are reliable alternatives to the traditional IANB The Gow-Gates technique requires the patient's mouth to be open wide, and the dentist aims to administer local anesthetic just anterior to the neck of the condyle in proximity to the mandibular branch of the trigeminal nerve after its exit from the foramen ovale The Akinosi-Vazirani technique requires the patient's mouth to be closed, and the dentist aims to fill the pterygomandibular space with local anesthetic Conclusion Both techniques are indicated for any type of dentistry performed in the mandibular arch, but they are particularly advantageous when the patient has a history of standard IANB failure owing to anatomical variability or accessory innervation Clinical Implications Having the skill to perform these alternative anesthetic techniques increases dentists' ability to provide successful local anesthesia consistently for all procedures in mandibular teeth

Alternative treatments to replacement of defective amalgam restorations: results of a seven-year clinical study.

Abstract: Background The authors conducted a prospective cohort clinical study to investigate the effectiveness of alternative treatments to the replacement of defective amalgam restorations. Methods Fifty patients aged 21 through 77 years (mean age, 56 years) with 113 defective amalgam restorations that were diagnosed during treatment planning participated in the study. The authors assigned each tooth to one of five treatment groups: repair with amalgam (n = 20), sealing of defective margins (n = 23), refinishing (n = 23), replacement (n = 22) or no treatment (n = 25). The replacement and no-treatment groups served as comparison groups, and the authors assigned 47 teeth randomly to these groups. Two clinicians examined the restorations before and after the assigned treatment and at subsequent recall visits by using modified U.S. Public Health Service criteria including marginal adaptation, anatomic form, occlusal and proximal contact, postoperative sensitivity and secondary caries. Results The clinicians examined 94 restorations (83 percent) at the one-year recall visit, 74 (65 percent) at the two-year recall visit and 54 (48 percent) at the seven-year recall visit. They observed most of the downgraded and failed restorations after the first two years of clinical service. Conclusions The study results show that some degree of degradation occurred in all treatment groups, including the replacement group, at the seven-year recall examination, with no significant failure rate. The results support the repair of defective amalgam restorations as an alternative to replacement. Furthermore, the study findings show that in future controlled clinical trials, all teeth may receive random assignment. Clinical Implications The study findings support repair rather than replacement of amalgam restorations with localized defects. Randomized controlled trials are needed to confirm these findings.

Dental patients’ self-reports of xerostomia and associated risk factors

Abstract: Background Most studies regarding xerostomia focus on elderly people. Therefore, the authors conducted a study of dental patients 18 years or older to determine the prevalence of self-reported xerostomia and associated risk factors. Methods The authors sent a total of 2,200 questionnaires to four dental clinics to assess patients' self-reported xerostomia. They also collected sociodemographic data and information regarding personal behavior. They used logistic regression models to estimate odds ratios (OR) and 95 percent confidence intervals (CI) to explore the relationship between self-reported xerostomia and risk factors that reasonably might be expected to be associated with self-reported xerostomia. Results The overall prevalence of xerostomia in participants was 7 percent. Participants with burning-mouth sensations were associated with having higher odds of experiencing dry mouth (OR, 2.1; 95 percent CI, 0.9–5.2). Participants 51 years or older were significantly more likely to report having dry mouth than were younger participants ( P Conclusion The authors found that medication use and age were highly significant risk factors for dental patients reporting xerostomia. Clinical Implications Clinicians should interview their patients carefully regarding their use of medications and provide proper oral health care to improve xerostomia resulting from medication use.

All-ceramic restorations in different indications: a case series.

Abstract: Background Encompassing a vast array of materials, today's all-ceramic systems are suitable for a large range of indications in almost all areas of fixed restorative dentistry. Methods The authors describe five clinical cases involving different indications to illustrate the use of different ceramic materials and combinations of materials. They describe the collaboration between the dentist and dental technician for single-tooth restorations and for complex cases, including all stages of the restorative procedures from treatment planning with an analytic wax-up to the selection of appropriate materials, tooth preparation and cementation. Results The patients described experienced significant functional and esthetic improvement, even those who had severely discolored teeth. This was possible because the authors executed the working steps in a strictly synchronized manner and selected the restorative materials carefully to meet the specific needs of each patient. Conclusions All-ceramic systems have expanded the range of restorative treatment options significantly; at the same time, their handling has been simplified substantially. The use of lithium disilicate glass-ceramic–and zirconium oxide–based frameworks along with an identical veneering ceramic enables the dental care professional to cover almost all indications in fixed prosthodontics while achieving the same esthetic results.