Journal of Dental Hygiene
Primary Dental Care
BMC Oral Health
Background: Transmission of Streptococcus mutans from mother-to-child can lead to Early Childhood Caries. A previous study identified characteristics and beliefs of general dentists about counseling pregnant women to reduce risk of infection and Early Childhood Caries. This study extends those findings with an analysis of county level factors. Methods: In 2006, we surveyed 732 general dentists in Oregon, USA about dental care for pregnant women. Survey items asked about individual and practice characteristics. In the present study we matched those data to county level factors and used multinomial logistic regression to test the effects of the factors (i.e., dentist to population ratio, percentage of female dentists, percentage of females of childbearing age, and percentage of individuals living in poverty) on counseling behavior. Results: County level factors were unrelated to counseling behavior when the models controlled for dentists' individual attitudes, beliefs, and practice level characteristics. The adjusted odds ratios for no counseling of pregnant patients (versus 100 percent counseling) were 1.1 (95% CI .8-1.7), 1.0 (1.0-1.1),1.2 (.9-1.5), and 1.1 (1.0-1.2) for dentist/population ratio, percent female dentists, percent females of childbearing age, and percent in poverty, respectively Similar results were obtained when dentists who counseled some patients were compared to those counseling 100 percent of patients. Conclusions: Community level factors do not appear to impact the individual counseling behavior of general dentists in Oregon, USA regarding the risk of maternal transmission of Early Childhood Caries.
Background: Recently, increasing importance has been placed on the social determinants of health and disease. The present study aimed to determine the prevalence of periodontal disease in Brazilian adults and identify possible relationships with social determinants. Methods: A cross-sectional study was performed using a sample of 743 adults (aged 35--49 years) living in an urban area of a large city in southeastern Brazil. The condition of the periodontium was assessed using the Community Periodontal Index (CPI) according to the diagnostic criteria established by the World Health Organization (WHO). The variables related to social determinants were collected using a structured questionnaire. A descriptive analysis of all study variables was performed. Multiple correspondence analysis was subsequently performed to identify relationships between periodontal disease and the social determinants of health. Results: The periodontal exams showed that 36.5% of adults had a healthy periodontium, 2.0% had gingival bleeding, 47.1% had calculus and 9.5% had periodontal pockets of 4--5 mm. Periodontal pockets of 6 mm or more were the worst periodontal condition found (affecting only 2.1% of the participants). The correspondence analysis enabled us to form three groups with different profiles. The first group was distinguished by the presence of bleeding (gingivitis) or a healthy periodontium. The members of this group were typically aged 35 to 39 years and had 9--12 years or more than 12 years of education. The second group consisted of subjects with calculus and periodontal pockets of 4--5 mm. The members of this group were typically white men aged 40--44 years with incomes greater than $ 300.00. The third group was distinguished by the presence of periodontal pockets of 6 mm or more. The members of this group were typically adult females, black and mixed individuals who had 8 years or less of schooling, individuals with incomes <= $ 300.00 and widowers. Conclusion: The results suggest that periodontal health is worse in the group for which the social indicators are worse. Therefore, the social determinants of health also affect the severity of periodontal disease in adults Brazilian society.
Background: Children with low birth weight show an increased prevalence of developmental defects of enamel in the primary dentition that subsequently may predispose to early childhood caries (ECC).Focusing 6--36 months old, the purpose of this study was to assess the frequency of enamel defects in the primary dentition and identify influences of early life course factors; socio-demographics, birth weight, child's early illness episodes and mothers' perceived size of the child at birth, whilst controlling for more recent life course events in terms of current breastfeeding and oral hygiene. Methods: A cross-sectional study was conducted in the high fluoride area of Manyara, northern Tanzania including 1221 child-mother pairs who attended Reproductive and Child Health (RCH) clinics for immunization and/or growth monitoring. After the primary caregivers had completed face to face interviews at the health care facility, children underwent oral clinical examination whereby ECC and developmental defects of enamel were recorded using field criteria. All erupted teeth were examined and the enamel defects were assessed on buccal surfaces according to the modified DDE Index. Results: The prevalence of enamel defects was 33.3%. Diffuse opacities were the most common defects identified (23.1%), followed by hypoplasia (7.6%) and demarcated opacities (5.0%). The most frequently affected teeth were the upper central incisors (29.0% - 30.5%), whereas lower central incisors (4.3% to 4.5%) were least frequently affected. Multiple logistic regression analysis, adjusting for confounding the factors revealed that having normal birth weight (equal or more than 2500 g) associated with lower odds of having enamel hypoplasia [OR 0.22 (95% CI 0.1-0.7)]. No statistically significant association occurred between birth weight and diffuse opacities, demarcated opacities or combined DDE. Conclusion: Children with the history of low birth weight were more likely than their normal birth weight counterparts to present with enamel hypoplasia. In view of the frequent occurrence of enamel defects and the fact that hypoplasia may constitute a risk factor for future ECC, enamel defects should be included as a dental health indicator in epidemiological studies of children in northern Tanzania.
Background: Chepang communities are one of the most deprived ethnic communities in Nepal. According to the National Pathfinder Survey, dental caries is a highly prevalent childhood disease in Nepal. There is no data concerning the prevalence of caries along with knowledge, attitude and oral hygiene practices among Chepang schoolchildren. The objectives of this study were to 1) record the prevalence of dental caries 2) report experience of dental pain 3) evaluate knowledge, attitude and preventive practices on oral health of primary Chepang schoolchildren.MethodA cross sectional epidemiological study was conducted in 5 government Primary schools of remote Chandibhanjyang Village Development Committee (VDC) in Chitwan district. Ethical approval was taken from the Institutional Review Board within the Research Department of the Institute of Medicine (IOM) Tribhuvan University. Consent was obtained from parents for conducting clinical examination and administrating questionnaire. Permission was taken from the school principal in all schools. Data was collected using a pretested questionnaire on 131 schoolchildren aged 8-16-year- olds attending Grade 3–5. Clinical examination was conducted on 361 school children aged 5–16 –year-olds attending grade 1–5. Criteria set by the World Health Organization (1997) was used for caries diagnosis. The questionnaires, originally constructed in English and translated into Nepali were administered to the schoolchildren by the researchers. SPSS 11software was used for data analysis. Results: Caries prevalence for 5–6 –year-old was above the goals recommended by WHO and Federation of Dentistry international (FDI) of less than 50% caries free children. Caries prevalence in 5-6-year-olds was 52% and 12-13-year-olds was 41%. The mean dmft/DMFT score of 5–6 –year-olds and 12 -13-year -olds was 1.59, 0.31 and 0.52, 0.84 respectively. The DMFT scores increased with age and the d/D component constituted almost the entire dmft/DMFT index. About 31% of 8-16-year-olds school children who participated in the survey reported having suffered from oral pain. Further, the need for treatment of decayed teeth was reported at 100%. About 76% children perceived teeth as an important component of general health and 75% reported it was required to eat. A total 93% children never visited a dentist or a health care service. Out of 56% children reporting cleaning their teeth daily, only 24% reported brushing their teeth twice daily. About 86% of the children reported using toothbrush and toothpaste to clean their teeth. Although 61% children reported to have received oral health education, 82% children did not know about fluoride and its benefit on dental health. About 50% children reported bacteria as the main cause of tooth decay and 23% as not brushing teeth for gingivitis. Frequency of sugar exposure was low; 75% of children reported eating sugar rich food once daily. Conclusions: Caries prevalence of 5–6 –year- old Chepang school children is above the recommended target set by FDI/WHO. The study reported 31% schoolchildren aged 8-16-year old suffered oral pain and decayed component constituted almost the entire dmft/DMFT index. The brushing habit was reportedly low with only 24% of the children brushing twice daily. A nationwide scientifically proven, cost effective school based interventions is needed for prevention and control of caries in schoolchildren in Nepal.
Background: Dental caries is one of the most common chronic childhood diseases affecting a large portion of children in the United States. The prevalence of childhood dental caries in Kentucky is among the highest in the nation. The purposes of this study are to (1) compare sociodemographic differences between caries and no caries groups and (2) investigate factors associated with untreated dental caries among children who visited a mobile dental clinic in South Central Kentucky. Methods: Study subjects were children aged 6 to 15 years who participated in the school-based dental sealant program through the mobile dental clinic operated by the Institute for Rural Health at Western Kentucky University between September 2006 and May 2011 (n = 2,453). Descriptive statistics were calculated for sociodemographic factors (age, gender, race/ethnicity, insurance status, and urban versus rural residential location) and caries status. We used chi-square tests to compare sociodemographic differences of children stratified by caries and no caries status as well as three levels of caries severity. We developed a logistic regression model to investigate factors associated with untreated dental caries while controlling for sociodemographic characteristics. Results: The proportion of children having untreated dental caries was 49.7% and the mean number of untreated dental caries was 2.0. The proportion of untreated dental caries was higher in older children, children with no insurance and living in rural residential locations, and caries severity was also higher in these groups. Odds ratio indicated that older ages, not having private insurance (having only public, government-sponsored insurance or no insurance at all) and rural residential location were associated with having untreated dental caries after controlling for sociodemographic characteristics of children. Conclusions: Untreated dental caries was more likely to be present in older children living in rural areas without insurance. Health interventionists may use this information and target rural children without having proper insurance in order to reduce geographic disparities in untreated dental caries in South Central Kentucky.
Background: A reform to Dental Care legislation in 2002 abolished age limits restricting adults’ use of public dental services in Finland. In the Public Dental Service (PDS) unit of Espoo, the proportion of adult patients rose from 36% to 57%. The aim of this study was to investigate heavy use of dental services by adults and its determinants. Methods: A longitudinal cohort study was undertaken based on a PDS patient register. Of all adults who attended the PDS in Espoo in 2004, those who had six or more visits (n=3,173) were assigned to the heavy user group and a comparison group of low users (n=22,820) had three or fewer dental visits. A sample of 320 patients was randomly selected from each group. Baseline information (year 2004) on age, sex, number and type of visit, oral health status and treatment provided was collected from treatment records. Each group was followed-up for five years and information on the number and types of visit was recorded for each year from 2005 to 2009. Results: Most heavy users (61.6%) became low users and only 11.2% remained chronic heavy users. Most low users (91.0%) remained low users. For heavy users, the mean number of dental visits per year (3.0) during the follow-up period was significantly lower than initially in 2004 (8.3) (p<0.001) but 74.8% of heavy users had had emergency visits compared with 21.6% of the low users (p<0.001).A third (33%) of the visitors in each group had no proper examination and treatment planning during the 5-year follow-up period and two or more examinations were provided to fewer than half of the heavy (46.1%) or low (46.5%) users.The mean number of treating dentists was 5.7 for heavy users and 3.8 for low users (p<0.001). Conclusions: Frequent emergency visits were characteristic of heavy users of dental services. Treatment planning was inadequate, probably partly due to the many dentists involved and too many patients requesting care. Better local management and continuous education are needed to ensure good quality adult dental care and to reduce heavy consumption.
Oral Health Journal Headline News
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Message from the FDI president: Dr Orlando Monteiro da Silva
Oral Health Journal Print Edition
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INTRODUCTION AND REVIEW OF THE LITERATUREOrthodontic tooth movement is dependent on changes to the local environment, including vascular changes, recruitment of inflammatory mediators and alveolar socket remodelling.1 In most instances,...
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The objective of dentistry is to retain the natural dentition as part of maintaining optimum oral health. With recent studies linking oral health to general systemic health, promoting oral health translates to improved quality of life. The...
The European Journal of Orthodontics
Recent advances in laser scanning technology provide the opportunity to examine faces in three dimensions. The aim of this prospective clinical study was to explore facial symmetry in healthy growing individuals and determine whether asymmetric changes occur during adolescent growth.
Non-invasive laser surface scanning was performed to capture facial images of 60 Caucasian Finnish adolescents (30 males and 30 females, mean 11.5 years). Facial symmetry was analysed on images obtained at the initial scanning (T1), 2.5 (T2), and 4.5 (T3) years thereafter. The final sample consisted of 39 adolescents (19 males and 20 females, mean 16 years). Three-dimensional images were processed and analysed using an in-house developed subroutine for commercial software. A mirror image was generated and superimposed on the original image to create a symmetric face and establish the midsagittal plane. The surface matching of the original face and the mirror face (amount of symmetry) was measured for the whole face, upper, middle, and lower thirds at tolerance level 0.5 mm and presented with colour maps. Three angular and 14 linear measurements were made based on 21 soft tissue landmarks, which have proven to be reliable.
The results of the Friedman test showed that facial symmetry parameters did not significantly differ over time (P > 0.05). Mann–Whitney U-test did not reveal statistically significant differences between genders at any time point (P > 0.05). Facial growth of healthy individuals during adolescence is symmetric, although further investigation on larger randomized sample is suggested.
Relapse after orthodontic tooth movement (OTM) is an undesirable outcome that involves a number of factors. This study investigated the remodelling of the alveolar bone and related periodontal structures during orthodontic relapse in rat molars. The maxillary right first molars of 35 Wistar rats were moved mesially by a fixed orthodontic appliance for 10 days and the contralateral molars served as controls. The appliances were removed and six animals killed. The molars were allowed to relapse, and the remaining animals were sacrificed at 1, 3, 5, 7, 14, and 21 days. The jaws were sectioned and stained with haematoxylin and eosin and tartrate-resistant acid phosphatase (TRAP). One day after appliance removal, the molars relapsed to a mean 62.5 per cent of the achieved OTM and then steadily relapsed to 86.1 per cent at 21 days. The number of osteoclasts situated along the alveolar bone of the first molars was highest at the end of active treatment and significantly decreased during the relapse period. In the OTM group, osteoclasts were most numerous in the pressure side of the periodontal ligament (PDL). As the molars relapsed over time, the osteoclast distribution shifted, and after 7 days of relapse, TRAP-positive cells were registered in previous pressure and tension sides of the first molars. After 21 days, these cells were concentrated in the distal parts of the PDL of all three maxillary right molars. These results indicate that orthodontic relapse in the rat model occurs rapidly and remodelling of the alveolar bone and PDL plays a central role in the relapse processes of both actively moved and adjacent teeth.
The original histological investigation that forms the basis of our present understanding of tooth movement was carried out on dogs by the Swedish dentist Carl Sandstedt at the Karolinska Institute, Stockholm. His findings were published in 1901 as a monograph in Swedish, and shortly after his death in 1904, as three articles in German entitled ‘Einige Beiträge zur Theorie der Zahnregulierung’. Sandstedt observed that the bone was deposited on the alveolar wall of the tension side with both heavy and light forces, new bone spicules following the orientation of the periodontal fibres. On the pressure side, with light forces, osteoclasts resorbed the surface of the alveolar bone, but heavy forces compressed the periodontal ligament resulting in hyalinization—the formation of localized cell-free areas. At these sites, bone removal resulted from undermining resorption by osteoclasts from adjacent marrow spaces. He also observed root resorption and commented on the centre of rotation of the teeth. No English version of Sandstedt’s research has ever been published, and in view of its importance, one of us (DB) has translated his three articles from the original German. The aim was to persuade an orthodontic journal to publish the articles in full—however, weighing-in at 21 000 words, the impracticality of this plan soon became clear. We concluded that excerpts from the text plus commentary would be the most practical solution. Where possible and without materially changing the intended meaning, we have translated the German text into something resembling contemporary English, accompanied by the original 16 figures.
Orthodontic tooth movement is dependent upon the ability of mechanical forces to induce remodelling activity within the tooth-supporting alveolar bone. In view of the importance of bone resorption in mediating tooth movement, the aim of this study was to establish if alterations in the osteoclast-specific bone marker tartrate-resistant acid phosphatase (TRACP) 5b could be detected in the sera of patients undergoing orthodontic treatment. The sample consisted of 14 subjects (10 girls and 4 boys) aged 10.5–16.5 years (mean 12.6 years) being treated with fixed appliances and a distalizing headgear. Venous blood samples (3 ml) were collected from the cubital vein pre-treatment (T0) and 2, 4, and 6 months into treatment (T1–T3); serum TRACP 5b levels were quantified using a solid-phase immunofixed enzyme activity assay. When the data were pooled and treated cross-sectionally, a significant increase in immunoreactive TRACP 5b was detected at 2 months (T1) indicating increased bone resorptive activity. However, when the serum profiles of individual patients were recorded longitudinally, a very different pattern emerged, not all patients following the same trend. This is not surprising given normal anatomical variation and differences between the patients in age, gender, and mechanotherapy. Designed as a pilot to demonstrate ‘proof of principle’, this study is the first to show that the TRACP 5b isoform can be detected in the sera of patients undergoing orthodontic treatment. It further suggests that serum bone marker measurements offer a simple and minimally invasive method for correlating the findings of laboratory and animal experimentation with clinical data.
The Notch signaling pathway is a highly conserved cell signaling system present in most multicellular organisms. Osteoimmunology comprises the interplay between the immune system and bone metabolism. Osteoclasts, cells that resorb bone, play a crucial role in bone metabolism. In this review, we discuss the role of Notch signaling in osteoimmunology that is crucial for physiological bone remodeling (such as in orthodontic tooth movement, where bone remodeling is in balance) and undue non-physiological Notch signaling which results in pathological bone remodeling (such as in rheumatoid arthritis and periodontitis, where bone remodeling is out of balance) from the point view of osteoclast differentiation. A proposal is made that Notch signaling not only controls immune system reaction but also interferes with osteoclast differentiation involved in the bone remodeling process. Therefore, Notch signaling could be a promising therapeutic target at conditions that cross link the immune system with the skeletal system.
Our aim was to evaluate the long-term treatment outcome of a systematically applied orthodontic screening and early treatment strategy in a public dental health care system, with special reference to occlusal stability at least 5 years post-retention. The subjects (N = 68) belonged to one age cohort born in a Finnish rural municipality (N = 85), and they were regularly followed from 8 to 20 years. Persons with malocclusions were screened and treated according to pre-planned protocol. Treatment need was assessed according to the Dental Health Component of the Index of Orthodontic Treatment Need, and treatment outcome using the peer assessment rating (PAR) Index and Little’s Index of Irregularity. Eighty-two per cent of the treated participants were out of retention (mean 6.9 years post-retention) at age 20. Definite treatment need in the study population decreased from 37% to 3 %. In the treated group, the mean PAR improvement decreased from 65 % to 63% from age 15 to 20 years. The mean irregularity score for the mandibular incisors was 4.0 [standard deviation (SD) 2.4] and for maxillary incisors 3.7 (SD 2.1) with no significant difference between treated and not treated subjects. The results suggest that definite need for orthodontic treatment may be predominantly eliminated from the target population with a systematically implemented treatment strategy focusing on early treatment with simple appliances. Emphasis on early timing of treatments may have contributed to the good long-term stability of treatment results.
Journal of Endodontics Research
I. Miletic, S. Jukic, I. Anic, D. Z_eljezic, V. Garaj-Vrhovac, M. Osmak.School of Dentistry, University of Zagreb, Croatia.Institute for Medical Research and Occupational Health, Croatia. Aim.To study in vitro the cytotoxic and mutagenic effects of AH26 and AH Plus. Conclusion.AH26 and AH Plus were shown to be cytotoxic in larger doses, while there was no mutagenicity found in both materials on human lymphocytes in highly controlled conditions in vitro.
T. Attin, F. Paque, F. Ajam & A. M. Lennon Department of Operative Dentistry, Preventive Dentistry and Periodontology, Georg-August Universitat Gottingen, Gottingen, Germany. Internal bleaching procedures such as the walking bleach technique can be used for whitening of discoloured root-filled teeth. The walking bleach technique is performed by application of a paste consisting of sodium perborate-(tetrahydrate) and distilled water (3% H2O2), respectively, in the pulp chamber. Following a critical review of the scientific literature, heating of the mixture is contra-indicated as the risk of external cervical resorption and the formation of chemical radicals is increased by application of heat. An intracoronal dressing using 30% H2O2 should not be used in order to reduce the risk of inducing cervical resorption. This review provides advice based on the current literature and discusses how the walking bleach technique can lead to successful whitening of non-vital root-filled teeth without the risks of side-effects.
S. Huumonen, M. Lenander-Lumikari, A. Sigurdsson & D. Orstavik NIOM, Scandinavian Institute of Dental Materials, Haslum, Norway. University of Turku, Finland.University of North Carolina at Chapel Hill, USA. Aim.To assess the treatment results up to 1 year after endodontic treatment of apical periodontitis using a silicone-based sealer in comparison with Grossmanâs sealer, and to compare the results at 3 months after treatment with the 12-month follow-up to assess the prognostic value of a 3-month control. Results and conclusions.Average PAI scores decreased from 3.43 at start to 2.21 at 12 months for Grossmanâs sealer and from 3.40 to 2.26 for the silicon based material. No significant difference between the groups at start or any of the follow ups was seen. The 3-monthcontrolwas adequate in establishing significant healing in both groups. The improvement of the periapical condition continued at the12-monthexamination.
B. Martin, G. Zelada, P.Varela, J. G. Bahillo, F. Magaan, S. Ahn & C. RodriguezDivision of Dental Pathology and Therapeutics, Department of Stomatology, School of Dentistry, University of Santiago de Compostela, Spain.Department of Computation, Faculty of Computer Science, University of A Coruna, Spain. Aim.To evaluate the effect of rotational speed and the angle and radius of curvature of root canals on the fracture of two types of nickel-titanium rotary instruments: K3 and ProTaper. Conclusions.Instrument fracture was associated with rotational speed and the angle of curvature of the canal.
M. Bernath & J. Szabo.Department of Dentistry and Oral Surgery, Faculty of Medicine, Pecs University, Pecs, Hungary. Aim.To analyse the type and degree of inflammatory reaction initiated by four sealers. Conclusions.The present study has demonstrated that sealers with different chemical compositions initiate different types of inflammatory reactions. The study revealed a good biocompatibility of Apexit and Grossmanâs sealers and emphasized that root canal filling confined to the canal is an important factor in reducing periapical inflammation.
P. G. Satchell, J. L. Gutmann & D. E.Witherspoon.Private Practice Limited to Endodontics, Houston, USA.Private Practice Limited to Endodontics, Dallas, USA.Private Practice Limited to Endodontics, Plano, Texas, USA. Apoptosis plays an important role in many aspects of endodontics, yet there is a paucity of information in this regard in the endodontic literature. Apoptosis is a single deletion of scattered cells by fragmentation into membrane- bound particles that are phagocytosed by other cells. It is a key process in the embryological development of the tooth, periodontal ligament and supporting oral tissue in the progression of oral disease, bone resorption, immunological response and inflammation, and in wound healing and certain pharmacological effects. The understanding of the ability of clinical materials to induce or inhibit apoptosis and the investigation of apoptosis as it relates to the pathogenesis of pulpal and periradicular pathology may eventually lead to new treatment approaches for the endodontist. The purpose of this review is to familiarize the clinical endodontist with current knowledge on apoptosis as it relates to the pulp and periradicular tissues.