Showing papers in "Journal of The Canadian Dental Association in 2000"

Examination, classification, and treatment of halitosis; clinical perspectives.

Abstract: Patients with halitosis may seek treatment from dental clinicians for their perceived oral malodour. In this article, an examination protocol, classification system and treatment needs for such patients are outlined. Physiologic halitosis, oral pathologic halitosis and pseudo-halitosis would be in the treatment realm of dental practitioners. Management may include periodontal or restorative treatment or both, as well as simple treatment measures such as instruction in oral hygiene, tongue cleaning and mouth rinsing. Psychosomatic halitosis is more difficult to diagnose and manage, and patients with this condition are often mismanaged in that they receive only treatments for genuine halitosis, even though they do not have oral malodour. A classification system can be used to identify patients with halitophobia. Additionally, a questionnaire can be used to assess the psychological condition of patients claiming to have halitosis, which enables the clinician to identify patients with psychosomatic halitosis. In understanding the different types of halitosis and the corresponding treatment needs, the dental clinician can better manage patients with this condition.

The pH of tooth-whitening products.

Abstract: Tooth whitening products may be in contact with intraoral structures for several hours or they may be used daily to whiten the teeth. Consequently, these products should have a relatively neutral pH to minimize potential damage. This study measured the pH of 26 commercially available tooth-whitening products. The pH of the different whitening products ranged from 3.67 (highly acidic) to 11.13 (highly basic). The dentist-supervised home-bleaching products had a mean pH of 6.48 (range 5.66 to 7.35). The over-the-counter whitening products had a mean pH of 8.22 (range 5.09 to 11.13), and the whitening toothpastes had a mean pH of 6.83 (range 4.22 to 8.35). The 3 in-office bleaching products had a pH between 3.67 and 6.53. One-way ANOVA showed that there was a significant difference between the 4 product categories. The most basic pH of all the products tested was 11.13 for the whitening gel of Natural White-Rapid White. The most acidic pH of all products tested was 3.67 for Opalescence Xtra 35% hydrogen peroxide in-office bleach. The Least-Squares-Means test showed that the over-the-counter category had a pH significantly different from the other categories (p < 0.05).

The periodontal disease classification system of the American Academy of Periodontology--an update.

Abstract: Until recently, the accepted standard for the classification of periodontal diseases was the one agreed upon at the 1989 World Workshop in Clinical Periodontics This classification system, however, had its weaknesses In particular, some criteria for diagnosis were unclear, disease categories overlapped, and patients did not always fit into any one category Also, too much emphasis was placed on the age of disease onset and rate of progression, which are often difficult to determine Finally, no classification for diseases limited to the gingiva existed In 1999, an International Workshop for a Classification of Periodontal Diseases and Conditions was organized by the American Academy of Periodontology to address these concerns and to revise the classification system The workshop proceedings have been published in the Annals of Periodontology The major changes to the 1989 proceedings and the rationale for these changes are summarized here In addition, the potential impact of these changes is discussed

Tobacco-associated lesions of the oral cavity: Part I. Nonmalignant lesions.

Abstract: Nonmalignant tobacco-associated lesions of the oral cavity were discussed in the first part of this two-part article. Here, we describe malignant lesions associated with tobacco use, basic biopsy principles for such lesions and intervention strategies that dental professionals may use to reduce the chances of their patients developing precancerous lesions or primary malignancies.

A review of impacted permanent maxillary cuspids--diagnosis and prevention.

Abstract: As impacted permanent maxillary cuspids occur in 1-2% of the population, the general dentist should know the signs and symptoms of this condition and the interceptive treatment. Features of buccal or palatal cuspid impaction include lack of canine bulges in the buccal sulcus indicating a lingual eruption path and possible impaction; lack of symmetry between the exfoliation and eruption of cuspids that may indicate palatal or lingual impaction; and abnormal mesiodistal location and angulation of the developing maxillary permanent cuspids on radiographs. Diagnosis of impacted cuspid teeth at age 8-10 years can significantly reduce serious ramifications, including surgical exposure and orthodontic alignment as well as root resorption of the lateral incisors. In specific cases, extraction of the primary maxillary cuspids can prevent impaction of the permanent maxillary cuspids and additional sequelae.

Restoration of endodontically treated teeth with carbon fibre posts--a prospective study

Abstract: Background: A prospective study was started in 1995 to evaluate the success of carbon fibre reinforced epoxy resin (CFRR) posts used to restore endodontically treated teeth. All the teeth in the study had lost more than 50% of their coronal structure. Methods: Fifty-nine carbon fibre Composiposts cemented with Metabond and built up with Core Paste cores were placed into the teeth of 47 patients. Each tooth received a full-coverage restoration (porcelain fused to metal crown) and was followed for 6.7-45.4 months (average = 28.0 months, standard deviation = 10.7). Results: Results for 52 teeth in 42 patients were analyzed. There were no fractures. The overall failure rate was 7.7% and the cumulative survival rate was 89.6% at the end of the follow-up period. The only statistically significant finding (p = 0.04) was that posts in lower premolars were at higher risk of failure. Conclusion: CFRR posts are among the most predictable systems available today. CFRR posts in the upper anterior teeth are associated with a higher success rate and longer life than those placed in premolars, especially lower premolars. This study contributes to the growing body of evidence that supports the use of CFRR posts in the restoration of endodontically treated teeth.

Influence of composite inlay/onlay thickness on hardening of dual-cured resin cements.

Abstract: This investigation evaluated the effect of resin composite inlay/onlay thickness on the hardness of a group of eight dual-cure resin-based cements. Fourteen disc specimens measuring 6 mm in diameter and 2.5 mm thick were prepared from each of eight dual-cure cements: Adherence, Choice, Duolink, Enforce, Lute-It, Nexus, Resinomer and Variolink. Two specimens from each material were directly light-cured while the remainder of the specimens were light-cured through resin composite spacers varying in thickness from 1 mm to 6 mm. Curing through the spacers always resulted in a decrease in the Knoop hardness number. For some cements, hardness values were reduced by 50% or more when the resin composite spacer thickness was 4 mm or greater even when measurements were made one week after dual-curing. Low hardness values indicate the presence of a weak chemical-curing mechanism that may compromise cement quality in areas of the cavity not readily accessible to the curing light.

Internal derangements of the temporomandibular joint: the role of arthroscopic surgery and arthrocentesis

Abstract: Arthroscopic surgery appears to be a safe, minimally invasive and effective method for treating internal derangements of the temporomandibular joint (TMJ), reducing pain and increasing mandibular range of motion for approximately 80% of patients. Although these results are encouraging, they are largely based on retrospective, uncontrolled and short-term studies. The landmark observation that lysis and lavage in only the upper compartment of the TMJ produce successful clinical results without repositioning the disc has prompted clinicians to question the importance of disc position as a significant factor in the etiology of TMJ pain dysfunction. Although there are prospective, controlled, randomized short-term studies indicating that arthrocentesis and arthroscopic surgery have comparable success rates in the management of acute TMJ closed lock, similar long-term studies are lacking. Until they have been done, the roles of arthroscopic surgery and arthrocentesis in the management of TMJ internal derangements remain unclear.

Caries-detector dyes--how accurate and useful are they?

Abstract: Commercially available caries-detector dyes are purported to aid the dentist in differentiation of infected dentin, yet research has established that these dyes are not specific for infected dentin. They are non-specific protein dyes that stain the organic matrix of less mineralized dentin, including normal circumpulpal dentin and sound dentin in the area of the amelo-dentinal junction. A considerable body of evidence indicates that conventional tactile and optical criteria provide satisfactory assessment of caries status during cavity preparation. There is reason for concern that subsequent use of a caries-detector dye would result in unnecessary removal of sound tooth structure. The use of caries-detector dyes has also been suggested as a diagnostic aid for occlusal caries. Although diagnosis of carious dentin beneath apparently sound enamel can be challenging, there is a lack of substantive evidence supporting the use of dyes for this purpose and false positives are a significant concern. Careful visual inspection combined with bitewing radiographic diagnosis has been shown to be the most reliable diagnostic method for the presence of infected dentin requiring operative treatment.

A Survey of Final-Year Dental, Medical and Nursing Students: Occupational Injuries and Infection Control.

Abstract: BACKGROUD: This study investigated nonsterile occupational injuries and infection control practices reported by final-year dental, medical and nursing undergraduates. Data from an anonymous, self-administered questionnaire were analyzed using ANOVA and chi-square tests. Nonsterile occupational injuries in the previous year were reported by 82% of dental, 57% of medical and 27% of nursing respondents, including one hepatitis B virus (HBV) and one human immunodeficiency virus (HIV) exposure. Although students received appropriate management for known HIV and HBV exposure, 48% of dental, 77% of medical and 59% of nursing students reporting injuries also reported no postexposure follow-up. Dental students were more aware of postexposure protocols (p < 0.001) and also reported more frequent use of gloves (p < 0.05), masks (p < 0.001) and protective eyewear (p < 0.001) than other students. Students who reported 2-handed recapping of needles had twice the number of percutaneous injuries (mean = 1.9/year) than those who avoided recapping or recapped with one hand using a device or scoop technique (p < 0.05). All dental, and 99% and 95% of medical and nursing students, respectively, reported HBV immunization; however, 6% of dental students had inadequate response (i.e., titre of antibodies to HBV surface antigen [anti-HBs].10 mIU/mL) and 13% of dental, 24% of medical and 41% of nursing students did not know whether their postimmunization anti-HBs titre was adequate. The majority of students reported occupational injuries that increase risk of exposure to pathogens. Educational interventions are required to improve postexposure follow-up, handling of sharps, use of barriers and HBV postimmunization serology.

Single-tooth replacement: bridge vs. implant-supported restoration.

Abstract: Options for restoring a single tooth include fixed partial denture, resin-bonded restoration and single-tooth implant. In this paper, we discuss the advantages and disadvantages of these methods and factors that must be considered when choosing between them for the replacement of a single tooth. Although in some cases a fixed partial denture is the most appropriate choice, implants have the advantage of allowing preservation of the integrity of sound teeth adjacent to the edentulous area.

The oral effects of smokeless tobacco.

Abstract: Smokeless tobacco use has increased rapidly in North America. This form of tobacco use has many oral effects including leukoplakia, oral cancer, loss of periodontal support (recession), and staining of teeth and composite restorations. Systemic effects such as nicotine dependence, transient hypertension and cardiovascular disease may also result from smokeless tobacco use. This paper aims to guide dental practitioners in identifying oral lesions that occur due to the use of smokeless tobacco and also offer guidelines on how to counsel patients who express a desire to stop using smokeless tobacco products.

Waterborne Biofilms and Dentistry: The Changing Face of Infection Control

Abstract: Interest in and concern about the biofilms that occur in dental equipment and waterlines have been increasing in recent years. Dental unit waterlines are ideal environments for the growth of microorganisms entering dental units from the municipal water supply. This article describes the conditions in waterline tubing that favour development of biofilms and discusses the level of risk that such microbial growth poses for both dental professionals and their patients. It is stressed that very few cases of infection have been linked directly to contamination in dental unit waterlines. Finally, potential solutions for minimizing risks are presented and discussed.

The Procera Abutment — The Fifth Generation Abutment for Dental Implants

Abstract: The Branemark dental implant has undergone progressive development in terms of both the implant body itself and the components connecting the implant to the prosthesis. Many screw and abutment designs have been developed, with various degrees of success. About 15 years ago, CAD (computer-assisted design)-CAM (computer-assisted manufacture) technology was introduced to dentists. More recently CAD-CAM has been used in the manufacture of abutments for implants. This article reviews currently available techniques for creating the Procera custom abutment (Nobel Biocare, Goteborg, Sweden) and outlines appropriate applications for this type of implant.

Gingival hyperplasia complicating acute myelomonocytic leukemia.

Abstract: Many systemic illnesses manifest clinical signs in the oral cavity. A remarkable case of gingival hyperplasia heralding the presence of acute myelomonocytic leukemia (AML FAB-M4) is described. The oral manifestations of acute leukemia are reviewed.

The building blocks of evidence-based dentistry.

Abstract: The practice of dentistry is becoming more complex and challenging. Changing socio-demographic patterns, patients as knowledgeable health care consumers, rapid technical advances and the information "explosion" all place greater demands on clinical decision making. The need for reliable information and the electronic revolution have come together to allow the "paradigm shift" towards evidence-based health care to progress swiftly. Evidence- based dentistry closes the gap between clinical research and real world dental practice and provides dentists with powerful tools to interpret and apply research findings. Central to evidence-based practice is the systematic litera- ture review, which synthesizes the best evidence and provides the basis for clinical practice guidelines.

Clinical management of avulsed permanent incisors using Emdogain: initial report of an investigation.

Abstract: The enamel matrix derivative Emdogain was recently approved for clinical use in a number of countries, including Canada. It has been shown to stimulate regeneration of periodontal ligament following periodontal surgery in adults. This paper reviews pertinent clinical and laboratory studies of Emdogain and describes the protocol and methods used for a longitudinal outcome study of replantation of avulsed permanent incisors in children and adolescents. Application of these methods is described in an illustrative case report of Emdogain use. This paper is meant to inform clinicians and guide those who are instituting similar investigations.

Oral and Maxillofacial Manifestations of Multiple Sclerosis

Abstract: Multiple sclerosis is a chronic demyelinating disease of the central nervous system which mostly affects young adults living in the northern hemisphere. It is a disease primarily found in temperate climates, being rare in the tropics and increasing in frequency with distance from the equator. Canada has one of the highest prevalence rates in the world. Dentists should be familiar with the clinical manifestations that affect the oral and maxillofacial areas as well as patients' general health. Three of the most frequent oro-facial symptoms include trigeminal neuralgia, trigeminal sensory neuropathy and facial palsy. Dentists should also be aware of the importance of this disease in the diagnosis, treatment and prognosis of certain oro-facial lesions or conditions. This paper reviews 2 cases of multiple sclerosis, highlights its oro-facial manifestations and discusses the dental implications of the disease.

Effects of composite thickness on the shear bond strength to dentin.

Abstract: The manufacturers of some condensable posterior composites claim that their products can be placed in bulk and light-cured in 5-mm-thick increments. This study compared the shear bond strengths of three composite resins when bonded to dentin in 2- and 5-mm-thick increments. Overall the bond strengths were adversely affected by the composite thickness (p < 0.0001). The shear bond strength of each composite tested was much lower when polymerized in a 5-mm increment than in a 2-mm increment of composite (p < or = 0.0005). The two condensable composites tested had a lower bond strength than the conventional composite when polymerized in a 5-mm bulk increment (p < or = 0.01).

Unconventional dentistry: Part IV. Unconventional dental practices and products.

Abstract: This is the fourth in a series of 5 articles providing a contemporary overview and introduction to unconventional dentistry (UD) and its correlation to unconventional medicine (UM). Several common UD and UM practices are described to familiarize practitioners with a variety of theories, practices, products and treatments that specifically apply to dentistry. This brief review is not intended as an in-depth resource.

Dental caries in Quebec adults aged 35 to 44 years.

Abstract: Background: The purpose of this study was to assess the prevalence of dental caries in Quebec adults aged 35 to 44. Methods: A stratified sample was used. The participation rate was 77% for the questionnaire and 44.5% for the oral examination. A total of 2,110 people were examined. The World Health Organization’s caries criteria were used. Examiner agreement with gold standard dentist was excellent at the end of the nine-day training session (Kappa index > 0.8). Results: The level of caries experience is very high in Quebec adults aged 35 to 44. Almost half of dental surfaces (65 of 148) have been affected. These surfaces are mostly missing (39.3) or filled (23.9). However, there were 1.8 decayed surfaces in need of treatment per adult, and more than half the people (55.5%) had no untreated decayed surfaces. Almost three-quarters of decayed surfaces were present in only 14% of the people; lower family income and lower education are risk factors.

Comparing characteristics of Canadians who visited dentists and physicians during 1993/94: a secondary analysis.

Abstract: Unlike medical care, dental services are not included in Canada's universal system of health care. Using the data from the 1994 National Population Health Survey, we estimate the proportion of the population aged 12 and older visiting dentists and physicians in 1993/94 and compare the factors that influence the use of dentists' and physicians' services. Overall, 52.4% of Canadians made one or more visits to a dentist and 78.4% visited a physician. Logistic regression analysis indicates that whereas visiting a family physician is more likely to occur for people who are ill (generally, on medications or needing help with daily living) or pregnant, visiting a dentist is more likely to occur for young, healthy, wealthy and highly educated people. Future dental health policy needs better information on health status linked to use of services.

Comparing characteristics of Canadians who visited dentists and physicians during 1993/94

Abstract: Unlike medical care, dental services are not included in Canada's universal system of health care. Using the data from the 1994 National Population Health Survey, we estimate the proportion of the population aged 12 and older visiting dentists and physicians in 1993/94 and compare the factors that influence the use of dentists' and physicians' services. Overall, 52.4% of Canadians made one or more visits to a dentist and 78.4% visited a physician. Logistic regression analysis indicates that whereas visiting a family physician is more likely to occur for people who are ill (generally, on medications or needing help with daily living) or pregnant, visiting a dentist is more likely to occur for young, healthy, wealthy and highly educated people. Future dental health policy needs better information on health status linked to use of services.

A modified technique for direct, fibre-reinforced, resin-bonded bridges: clinical case reports.

Abstract: This article presents new modifications to the clinical technique of fabricating directly applied resin-bonded fibre-reinforced bridges. Torsional and flexural strength is achieved by means of a reinforced polyethylene fibre ribbon substructure surrounded by laminated layers of microhybrid and microfilled resins. The modifications provide a simple method for creating a better pontic-ridge relation and improved overall esthetics. Early clinical experience suggests that this technique has the potential to give patients a relatively conservative, esthetic and periodontally noninvasive alternative for anterior tooth replacement.

Unusual palatal presentation of oral psoriasis.

Abstract: Oral lesions of psoriasis are rare clinical observations Report on oral psoriasis that are well documented show no consistent lesion pattern The oral lesions range in type from red plaques to white plaques to ulcers In this report, an unusual palatal presentation of oral psoriasis with red serpiginous concentric arcs is described The diagnosis of intraoral psoriasis is supported by clinical and microscopic findings

Unconventional dentistry: Part I. Introduction.

Abstract: This is the first in a series of five articles providing a contemporary overview and introduction to unconventional (alternative) dentistry (UD) and correlation with unconventional (alternative) medicine (UM). UD is analogous to and conceptually inseparable from UM. Dentists should learn about UD and UM and be aware of evidence on the safety and effectiveness of treatments and procedures. While being skeptical of promotions, dentists should be able to accept and encompass science-based advances and reject unproven and disproven methods. Incorporating selected unconventional methods with conventional dentistry in selected patients for specific purposes may be useful to both patients and dentists. Improved education in critical thinking, research, science, medicine, behaviour, communication and patient management is needed.

Screening for common oral diseases.

Abstract: Screening is a method used for the detection of a disease at a point in its natural history when it is not yet symptomatic. The ability to screen for a particular disease is contingent on the disease having a detectable pre-clinical phase that is long enough to permit its early detection. The logic of screening rests upon the assumption that early detection of disease may allow for interventions that alter its natural course, thereby halting disease progress and preventing the onset of adverse outcomes. In this sense, the aim of screening is generally secondary prevention. Beyond altering the course of disease, there are additional considerations that must be addressed whenever a screening strategy is proposed. The benefits that may be obtained in terms of improved health must be balanced against a variety of other factors, including cost (e.g. equipment, manpower), ethical issues (e.g. labelling of individuals who screen positive), the efficacy of interventions (e.g. effect on quality of life), and side effects (e.g. does early detection do more harm than good?). The advantages of implementing generalized screening programs for human diseases are numerous and often selfevident. Beyond the primary benefit of improving the overall health of the population, early detection in the pre-clinical phase followed by preventative measures to arrest disease progress should yield several secondary benefits, including less patient time spent with the health care professional, more time for the health care professional to treat other patients, and cost savings for patients and third-party providers (i.e., governments and insurance companies). While there are successful examples of screening for medical disorders (e.g., phenylketonuria, breast cancer, cervical cancer), routine screening programs have not been implemented for relatively common oral diseases observed in general dental practice, such as caries, periodontal disease and oral cancer. Early detection would likely reduce the morbidity associated with dental caries and periodontal disease (e.g., pain, halitosis, gingival recession,1 gingival bleeding,1 tooth loss,2 compromised oral function), and the mortality associated with oral cancer. Furthermore, valid methods already exist for the screening of these oral diseases, in accordance with the principles outlined by Wilson and Junger3 in 1968 for the World Health Organization (see sidebar). So what explains the lack of routine screening programs? I would suggest that nonmethodological factors are responsible, and propose to briefly examine these factors at two levels: screening at the dental office and screening in the general population.

An evaluation of sampling and laboratory procedures for determination of heterotrophic plate counts in dental unit waterlines.

Abstract: Background: The high numbers of heterotrophic microorganisms that have been cultured from dental unit waterlines (DUWs) have raised concern that this water may exceed suggested limits for heterotrophic plate counts (HPCs). The main purpose of this investigation was to examine HPC variability in DUWs and to examine in detail the effect of laboratory processing of water samples on HPC values. Methods: Water samples were collected from dental offices either at the beginning of or during the clinic day and were transported to the laboratory, where they were analyzed. Results: Measuring HPC levels within an office would involve testing all units, because significant differences were found between units connected to the same municipal water supply. Within a unit, the average microbial count from high-speed lines was approximately twice the average count from air/water lines. The laboratory processing of water samples significantly affected the numbers of heterotrophic microorganisms that were recovered. Incubation temperature, time and media, as well as neutralization of residual chlorine, all had significant effects on the HPC values. However, no significant differences in microbial counts were found between samples plated with the spread plate method on R2A agar and those plated with the pour plate method with Plate Count Agar. Conclusions: Dental organizations have suggested target limits in terms of numbers of heterotrophic microorganisms recovered in water from dental units, but standards for laboratory handling must be established as well. A protocol for sample collection and laboratory handling is proposed.

Periodontal medicine: a new paradigm.

Abstract: Recent evidence indicates that we need to change how we think about the etiology and pathogenesis of periodontal disease. Although bacteria are a necessary factor in the equation, the reaction of the host’s immuno-inflammatory system is responsible for most of the destruction found in periodontal disease. Thus, it makes sense that a number of environmental and acquired factors may modify a patient’s risk of developing periodontal disease. This paper reviews the scientific evidence for a number of these risk factors including age, genetics, smoking, diabetes mellitus, stress and osteoporosis.