International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations of these teeth are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning, and follow up are important for achieving a favorable outcome. Guidelines should assist dentists and patients in decision making and in providing the best care possible, both effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. These Guidelines represent the best current evidence based on literature search and expert opinion. The primary goal of these Guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines cover the management of fractures and luxations of permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth.

Avulsion of permanent teeth is one of the most serious dental injuries. Prompt and correct emergency management is essential for attaining the best outcome after this injury. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. It represents the current best evidence and practice based on that literature search and expert opinions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The purpose of these Guidelines is to provide clinicians with the most widely accepted and scientifically plausible approaches for the immediate or urgent care of avulsed permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition.

Traumatic injuries to the primary dentition present special problems that often require far different management when compared to that used for the permanent dentition. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The primary goal of these Guidelines is to provide clinicians with an approach for the immediate or urgent care of primary teeth injuries based on the best evidence provided by the literature and expert opinions. The IADT cannot, and does not, guarantee favorable outcomes from strict adherence to the Guidelines; however, the IADT believes their application can maximize the probability of favorable outcomes.

Root canal treatment and prevalence of apical periodontitis in a nigerian adult subpopulation: a radiographic study.

PURPOSE: To evaluate the frequency, distribution and quality of root canal treatment in an adult Nigerian subpopulation and to determine the prevalence of apical periodontitis. MATERIALS AND METHODS: The periapical status and length of root fillings of 756 patients attending Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria for the first time were evaluated using full mouth periapical radiographs. The length of the root canal filling was considered 'adequate' if it was ≤ 2 mm from the radiographic apex, 'under-filled' if it was > 2 mm short of the apex, and 'overfilled' if filling material extended beyond the radiographic apex. Periapical status was assessed using the periapical index (PAI) with teeth classified as having apical periodontitis if the score was over 2. RESULTS: Overall, 61.2% of the patients had root-filled teeth and 67.2% featured apical periodontitis. Of the 21,468 teeth examined, 12.2% had been root filled, and of these 41% exhibited apical periodontitis. The prevalence of root-filled teeth was higher in the younger patients, while the prevalence of apical periodontitis in root-filled teeth was similar between age groups. Root-treated teeth that were overfilled or were mandibular incisors had the highest prevalence of apical disease. Overfilled teeth were more prone to developing an apical radiolucency than were under-filled teeth (P < 0.001 and P < 0.05, respectively). CONCLUSIONS: The prevalences of endodontically treated teeth and apical periodontitis were within the range reported for other countries; however, a very large number of patients required treatment or retreatment.

Perception of patients with amalgam fillings about toxicity of mercury in dental amalgam.

OBJECTIVE: The objective of this study is to evaluate the awareness of patients with dental fillings about the toxicity of mercury in dental amalgam. MATERIALS AND METHODS: Adult patients having at least one amalgam filling in their mouth were recruited in the Oral Diagnosis Department of OAUTHC, Ile-Ife Dental Hospital. Participants were recruited consecutively as they report in the clinic. Data were collected using a structured questionnaire developed based on standard questions from relevant publications. They were asked to indicate the type of filling material in their mouth, ingredients of the material, previous knowledge of mercury in dental amalgam and ailments due to mercury. They were to indicate their level of agreement with filling their cavities with dental amalgam despite prior information about its mercury content. RESULTS: There were about 446 respondents analyzed; male, 194 (43.5%); female 252 (56.5%). Six (1.4%) and 21 (4.7%) respondents were primary and secondary schools students respectively; 15(3.4%) had no formal education while about 410 (91.9%) were either undergraduate or graduate. All of them had at least one amalgam filling. 249 (55%) participants know the type of filling on their teeth; 156 (34.5%) had the knowledge of the presence of mercury in dental amalgam while 26.1% believed mercury can cause problems in human beings. About 90 (19.9%) participants claimed to have heard about adverse reactions to dental amalgams and 34 (7.5%) of them have heard about people recovering from an illness after removal of their filling. The level of agreement with filling their cavities with amalgam despite prior knowledge of its mercury content was 74% while 60% was observed for allowing just any material to be placed on their teeth. CONCLUSION: Awareness of toxicity of mercury in dental amalgam was slightly low among the respondents studied. This may be suggested to be a reflection of nonexistent of global amalgam controversy in Nigeria.

Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision.

Pulp canal obliteration (PCO) is a sequela of tooth trauma. The dental clinician faced with this condition has to make a difficult decision. The aim of this study was to evaluate the clinical signs and symptoms associated with teeth with PCO and to assess the status of the periapical tissues using the periapical index (PAI) as an aid in making a treatment decision. The study included teeth diagnosed with PCO in patients with a history of traumatic injury to the involved teeth. Histories of associated signs and symptoms including pain, swelling and drainage from a sinus tract were elicited. Tooth color, sensibility to electric pulp testing, mobility and percussion tenderness were recorded. The periapical status was assessed using the PAI. Two hundred and seventy-six teeth were diagnosed with PCO. One hundred and fifty-seven (56.9%) and 119 (43.1%) demonstrated partial or total PCO, respectively. Yellow discoloration presented most frequently, occurring in 186 (67.4%) teeth. Sixty-two (33.3%) of these had developed periapical lesions and reacted negatively to sensibility testing. Fifty-seven (30.7%) of these teeth presented radiographically with a normal periapical appearance and reacted normally to sensibility testing, whereas 67 (36.0%) presented with small changes in the periapical bone pattern and reacted in the high normal range to sensibility testing. Teeth with PAI scores < or =2 presented with occasional spontaneous pain. Teeth with PAI scores > or =3 presented with clinical symptoms and signs ranging from pain on percussion to spontaneous pain, and slight swelling to sinus tract drainage. Based on the findings of this study, endodontic treatment should be initiated in teeth with tenderness to percussion, PAI scores > or =3 and a negative response to sensibility testing.

Prevalence and causes of fractured permanent incisors in 12-year-old suburban Nigerian schoolchildren.

The aim of the study was to assess the prevalence and causes of traumatic dental injuries to the permanent dentition of 12-year-old school children in Ile-Ife, a suburban population in the south west of Nigeria. A dental trauma cross-sectional survey was carried out through clinical examination of upper and lower permanent incisors and interviews with 415 (212 boys, 203 girls) 12-year-old children attending private and public secondary schools in Ile-Ife, in 2004/2005 by one calibrated examiner. Garcia-Godoy's classification was used. The prevalence of traumatic dental injuries was 12.8%. There was no statistical difference in the prevalence between boys and girls P > 0.05. The most common cause of injuries was falls (49.1%), followed by traffic accidents (13.2%), collision against objects or people (11.3%) and misuse of teeth 9.4%. The commonest type of injury was enamel fracture alone (9.9%), followed by enamel-dentine fracture (4.8%). Majority of the accidents occurred at home (60.4%), followed by school (26.4%). The prevalence of traumatic dental injuries was on the increase among suburban Nigerian children in Ile-Ife and it has a potential to be considered an emerging public health problem.

Dentine hypersensitivity and associated factors: a Nigerian cross-sectional study.

INTRODUCTION: Prevalence of dentine hypersensitivity (DH) may be on the increase as a result of changing lifestyles. This study aimed to assess the prevalence of DH and relative importance of associated factors in 18-35 year old Nigerians and compare to findings from a similar European study. METHODS: Following ethical approval, 1349 subjects from the six geopolitical zones in Nigeria participated in this cross sectional study. DH was clinically evaluated by cold air tooth stimulation, patient pain rating (yes/no) and investigator rated pain using the Schiff ordinal scale (0-3). Erosive tooth wear using the BEWE index was assessed. A questionnaire regarding the nature of the DH, erosive dietary intakes, tooth brushing habits and other factors was completed by patients. Bivariate analysis was conducted. RESULTS: 32.8% of patients reported pain on tooth stimulation and 32.9% scored ≥1 on Schiff scale for at least one tooth. Questionnaire reported sensitivity was 41.2%. There were statistically significant associations between Schiff score and clinically elicited DH (p < 0.001); and BEWE erosive tooth wear score and clinically elicited DH (p < 0.001). There were significant associations between DH and some oral hygiene practices such as brushing frequency, brush movement and brushing after breakfast. Fresh fruit and fruit/vegetable juice intake also showed significant association. CONCLUSION: The most important risk factors of DH for this population in Nigeria appear to be the frequency and characteristics of tooth brushing. This should be considered in its prevention and management.

An analysis of the etiological and predisposing factors related to dentin hypersensitivity.

AIM: To determine the prevalence of different etiological factors of dentin hypersensitivity in patients and to provide information on their association with dentin hypersensitivity. METHODS AND MATERIALS: Twenty-nine patients (17 male, 12 female) suffering from pain of dentin hypersensitivity were recruited to participate in the study. A relevant history was taken and dentin hypersensitivity confirmed by using air-blast and tactile stimuli. RESULTS: All patients were right-handed. The left side of the mouth showed a preponderance of gingival recession, abrasion, abfraction, and erosion while more teeth on the right side showed attrition. Gingival recession and attrition were common among the molars, abrasions among the molars and premolars, abfraction among the premolars, while erosive lesions were predominantly found among the incisors. A total of 911 teeth were examined in the 29 subjects presenting with dentin hypersensitivity. The following conditions were found to be associated with the dentin hypersensitivity: 43 of 117 teeth (36.8%) with gingival recession; 41 of 99 teeth (41.4%) with attrition; 40 of 67 teeth (59.7%) with abrasion; 16 of 25 teeth (64%) with abfraction; and 32 teeth had erosive lesions all associated with hypersensitivity. CONCLUSION: Gingival recessions followed by attrition were the most commonly found etiological factors leading to dentin hypersensitivity. Erosive lesions were mostly associated with dentin hypersensitivity. A statistically significant relationship exists between dentin hypersensitivity, tooth wear lesions, and gingival recession. CLINICAL SIGNIFICANCE: This study provides clinical evidence supporting the notion of dentin hypersensitivity being a tooth wear phenomenon. Therefore, successful preventive and management strategies for sufferers of dentin hypersensitivity must take into consideration causal factors for tooth wear and gingival recession.

Short-term clinical evaluation of four desensitizing agents.

AIM: To evaluate the effectiveness of four topical desensitizing agents in providing short-term relief of dentin hypersensitivity. METHODS AND MATERIALS: One hundred sixteen hypersensitive teeth with a positive response to intraoral testing for dentin hypersensitivity were included in this study. The four desensitizing agents tested were Duraphat, 2% fluoride iontophoresis, copal varnish (CV), and Gluma Comfort Bond Plus Desensitizer. Following a specific regimen randomly determined desensitizing agents were applied in an alternating order when patients presented in a clinical setting with a complaint of hypersensitive teeth. A visual analogue scale was used to determine the degrees of hypersensitivity at three points in time. The first being just before the treatment to establish a baseline, then at 24 hours post-treatment, and the last at seven days post-treatment. Differences in the mean pain scores (MPS) between the baseline and post-treatment evaluation periods were used to determine the reduction in dentin hypersensitivity. RESULTS: At baseline the MPS for teeth treated with CV was 5.34 (SD: 2.39), Duraphat was 4.66 (SD: 1.82), Gluma was 6.03 (SD: 2.37), and iontophoresis was 5.76 (SD: 1.37). At 24 hours post-treatment the MPS for CV was 2.1 (SD: 0.95), Duraphat was 1.38 (SD;1.86), Gluma was 0.79 (SD;1.45), and iontophoresis was 1.62 (SD1.97). The reduction in dentin hypersensitivity at 24 hours (difference between baseline MPS and 24 hour MPS) was 5.28 for Gluma, 4.14 for iontophoresis, 3.28 for Duraphat, and 3.24 for CV which were all statistically significant (p<0.05). At seven days, the MPS for CV was 1.55 (SD: 1.44), Duraphat was 1.0 (SD;1.89), Gluma was 0.10 (SD;0.44), and iontophoresis was 0.3 (SD;0.98). Reduction of hypersensitivity between 24 hours and one week was 1.32 for iontophoresis, 0.69 for Gluma, 0.55 for CV, and 0.38 for Duraphat. Only the reductions for iontophoresis and Gluma were statistically significant at seven days (p<0.05). CONCLUSIONS: All agents caused a statistically significant reduction in dentin hypersensitivity within 24 hours of treatment. Gluma performed best at 24 hours while iontophoresis appeared to have an edge at seven days. Long-term studies are needed to determine why this difference exists. Dentin hypersensitivity presents as an emergency condition requiring an effective means of providing immediate relief in the clinician's treatment armamentarium.

The prevalence of dentine hypersensitivity among adult patients attending a Nigerian teaching hospital.

PURPOSE: The purpose of this study was to determine the prevalence of dentine hypersensitivity and to examine some associated factors such as initiating stimuli among adult patients attendingthe Dental Clinic of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. MATERIALS AND METHODS: All consecutive adult patients that presented at the oral diagnosis unit over a period of 13 months, from March 2003 to March 2004, were included in the study. Relevant history, such as nature of the pain, initiating stimulus, frequency of episode, interference with eating, drinking and toothbrushing were taken. Evidence of tooth surface loss was noted. Dentine hypersensitivity was confirmed clinically by the use of air blast from the air-water jet and scratching suspected surfaces with a dental probe. RESULTS: Of the 2165 patients examined, 29 were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 1.34%. The commonest teeth affected were the molars and the commonest initiating factor was cold water. Occlusal surfaces were most affected, followed by cervical surfaces. A male predominance was observed. CONCLUSION: A lower prevalence figure was found in the present study in comparison to earlier reported studies. The prevalence of dentine hypersensitivity is slightly lower in females, with female to male ratio of 1 to 1.42. Dentine hypersensitivity resulted in more severe disturbance when drinking water than when eating or brushing.

Pulpal sequelae after trauma to anterior teeth among adult Nigerian dental patients.

BACKGROUND: Epidemiological studies show that about 11.6% to 33.0% of all boys and about 3.6% to 19.3% of all girls suffer dental trauma of varying severity before the age of 12 years. Moderate injuries to the periodontium such as concussion and subluxation are usually associated with relatively minor symptoms and hence may go unnoticed by the patient or the dentist, if consulted. Patients with these kinds of injuries present years after a traumatic accident most of the time with a single discoloured tooth. This study sets out to document the incidence of various posttraumatic sequelae of discoloured anterior teeth among adult Nigerian dental patients. METHODS: One hundred and sixty eight (168) traumatized discoloured anterior teeth in 165 patients were studied. Teeth with root canal treatment were excluded from the study. Partial obliteration was recorded when the pulp chamber or root canal was not discernible or reduced in size on radiographs, total obliteration was recorded when pulp chamber and root canal were not discernible. A retrospective diagnosis of concussion was made from patient's history of trauma to the tooth without abnormal loosening, while subluxation was made from patient's history of trauma to the tooth with abnormal loosening. RESULTS: Of the 168 traumatized discoloured anterior teeth, 47.6% and 31.6% had partial and total obliteration of the pulp canal spaces respectively, 20.8% had pulpal necrosis. Concussion and subluxation injuries resulted more in obliteration of the pulp canal space, while fracture of the teeth resulted in more pulpal necrosis (p < 0.001). Injuries sustained during the 1st and 2nd decade of life resulted more in obliteration of the pulp canal space, while injuries sustained in the 3rd decade resulted in more pulpal necrosis. CONCLUSION: Calcific metamorphosis developed more in teeth with concussion and subluxation injuries. Pulpal necrosis occurred more often in traumatized teeth including fractures.

Knowledge, diagnosis and management of dentine hypersensitivity: a national survey of dentists in Nigeria.

AIM: To assess the knowledge of Nigerian dentists regarding dentine hypersensitivity (DH) and their methods of diagnosis and management. METHODS: A cross-sectional questionnaire-based study of dentists practicing in all six geopolitical zones of Nigeria was conducted. The questionnaire focussed on participant's demography, exposure to patients with DH, knowledge-based questions, diagnosis and management of DH. Data analysis using EPI Info statistical software determined frequencies and proportions. Associations between discrete variables were assessed using the chi-square test (P ≤ 0.05). RESULTS: A total of 1,057 dentists responded; the majority (83.8%) had practiced for up to 15 years, and 92.0% reported that, on average, between one and 10 of their patients each week complained of DH. The majority (92.8%) of dentists described DH as stimulated brief pain from the tooth; 24.2% expressed that DH can be treated by altering the number of dentinal tubules. A diagnosis of DH is made by tapping (20.6%) or scratching (73.4%) the tooth. Although radical treatments, such as extraction (24.7%) and root canal therapy (34.5%), were mentioned by some, the majority identified aetiological and predisposing factors (98.8%) and provided diet (95.1%) and oral hygiene (95%) counselling as part of the management of DH. Evaluation of 36 knowledge-based questions revealed that only 1.8% of the respondents provided at least 25 correct answers. Knowledge was significantly associated with respondent age and number of years in practice (P ≤ 0.05) but was not associated with the number of patients with DH seen per week (P = 0.46). CONCLUSION: Dentists practicing in Nigeria exhibited knowledge gaps concerning DH and its diagnosis and management.

Pattern of traumatised anterior teeth among adult Nigerians and complications from late presentation.

BACKGROUND: The objectives of this study were to determine the prevalence and pattern of traumatic dental injury (TDI) among adults presenting in a tertiary health care facility in Nigeria, the time interval between injury and presentation in the hospital, the reasons for seeking treatment, and the complications arising due to late presentation. METHODS: Information obtained from history taking and clinical examination included Patient's demographics, the when, where, and how of the injury, previous history of trauma, time elapsed between injury and presentation at the hospital, reason for seeking treatment, tooth/teeth involved, sensibility, tenderness to percussion, mobility, presence of discolouration, swelling, sinus tract, and mobility. Radiographic findings such as periapical radiolucency, pulp canal obliteration, and root resorption were also documented. TDI was classified using the Andreasen's classification. RESULTS: Out of the 2645 adult patients that attended the outpatient clinic, 184 Presented with TDI giving a prevalence of 6.96 %. Their age range and mean age were 17-69 years and 30.6 ± 11.2 years respectively. Falls accounted for most (26.4 %) of the trauma to anterior teeth followed by motor cycle accidents (18.4 %) and domestic accidents (12.9 %), while opening bottle cork accounted for 1.2 %. The most common type of injury was enamel-dentine fracture accounting for 28.8 %, followed by complicated crown fracture 18.6 %, and avulsion 11.7 %. The maxillary central incisors were the most commonly affected followed by the maxillary lateral incisors and canines. More than half (51.5 %) of the patients presented in the hospital more than 1 year after injury. Majority of patients in the age groups ≤20 and 51-60 sought treatment because of pain, while more of those in the age groups 21-30 and 31-40 sought treatment because of aesthetic considerations. Seventy three (45.3 %) of the patients presented with complications involving 138 teeth. Majority of the complications were in teeth with enamel-dentine fracture (93.4 %), followed by concussion injury (55.6 %). CONCLUSIONS: The prevalence of TDI in this study falls within previously reported figures. However, the high number of teeth developing complications may have resulted from late presentation for care.

The prevalence of dental erosion in Nigerian patients with gastro-oesophageal reflux disease.

BACKGROUND: In various people of the Western world, gastro-oesophageal reflux (GOR) has been reported to be a common problem. Various studies have also assessed the relationship between GOR and dental erosion. The authors are not aware of such studies in Nigerians. It is therefore the aims of the present study to estimate the prevalence of GOR; to estimate the prevalence of dental erosion in patients with GORD; to document the oral findings in patients diagnosed with GORD and to compare these findings with previous studies elsewhere. METHODS: A total of 225 subjects comprising of 100 volunteers and 125 patients diagnosed with GORD were involved in this study. History of gastric juice regurgitation and heartburn were recorded. Oral examination to quantify loss of tooth structure was done using the tooth wear index (TWI) designed by Smith and Knight (1984). RESULTS: Twenty patients with GORD presented with dental erosion in the maxillary anterior teeth with TWI scores ranging from 1-3. The prevalence of erosion was found to be statistically significant between GORD patients (16%) and control (5%) (p < 0.05), but not significant between endoscopic diagnostic groups (p > 0.05). CONCLUSION: The present study supports the consideration of dental erosion as the extra-oesophageal manifestation of GORD. However the association between GORD and burning mouth sensation needs more investigation.

Failures related to crowns and fixed partial dentures fabricated in a Nigerian dental school.

The purpose of this investigation was to document the failure rate and length of service of crowns and fixed partial dentures (FPDs) fabricated in a Nigerian dental school. The reasons for failure of the initial restorations and their length of service were also ascertained. Also, the numbers of retainers, pontics, and the types of restoration were recorded. Poor esthetics was the most frequent cause of failure, 66 units (40.5%); followed by fracture, 58 units (35.6%); and dental caries, 25 units (15.4%). These outcomes were contrary to findings previously reported in studies from western countries where dental caries was principally responsible for failures (22.0% to 38.0% of cases). The resin-retained FPDs had the shortest mean years of service at 2.7 years, while the three-unit metal-ceramic FPDs had the greatest longevity at 8.6 years. The overall mean years of service for replaced restorations were 5.6 years. The study found a decrease in the mean years of service as the number of units in the fixed-fixed partial dentures increased. This is in sharp contrast to previous reports where no relationship existed between length of service and the number of units in a FPD.

Dental anxiety among patients undergoing various dental treatments in a Nigerian teaching hospital.

The aim of the present study is to evaluate the levels of dental anxiety among patients undergoing various dental treatments and to compare the anxiety levels with those of similar studies conducted with subjects from different socio-cultural backgrounds. Dental anxiety was evaluated by the administration of a questionnaire based on the Corah's Dental Anxiety Scale (DAS). Student t-test and analysis of variance (ANOVA) with Bonferoni correction was employed to compare the mean DAS scores. Females recorded higher total DAS scores than males (7.49 +/- 2.96 and 7.16 +/- 3.44, respectively). Patients in the 24-34 year age group showed the highest total DAS scores (8.25 +/- 3.20) followed by the <24 year age group. The total DAS scores for age groups 35-39 and >50 years differ significantly from those of age groups <24 and 24-34 years. The highest DAS score was recorded for root canal therapy (9.30 +/- 2.84) followed by extraction. The level of dental anxiety among this study population is lower than those reported elsewhere. The observed avoidance of dental treatment among Nigerians, despite the seemingly low mean DAS scores, may be related to dental anxiety. The authors are, however, of the opinion poor dental awareness may be a contributory factor.

Endodontic flare-ups: comparison of incidence between single and multiple visit procedures in patients attending a Nigerian teaching hospital.

BACKGROUND: Until recently the most accepted technique of doing root canal treatment stresses multiple visit procedure. Most schools also concentrated upon teaching the multi-visit concept. However, it has now been reported that the procedure of single visit treatment is advocated by at least 70% of schools in all geographical areas. It was therefore the aims of the present study to find the incidence of post-obturation flare-ups following single and multiple visit endodontic treatment procedures, and to establish the relationship between pre-operative and post-obturation pain in patients referred for endodontic therapy in a Nigerian teaching Hospital. METHODS: Data collected included pulp vitality status, the presence or absence of pre-operative, inter-appointment and post-obturation pain. Pain was recorded as none, slight, or moderate/severe. Flare-ups were defined as either patient's report of pain not controlled with over the counter medication or as increasing swelling. The patients were recalled at three specific post-obturation periods, 1st, 7th and 30th day. The presence or absence of pain, or the appropriate degree of pain was recorded for each recall visits and the interval between visits. The compiled data were analysed using chi-square where applicable. P level

Restoration of endodontically treated teeth: a review.

The concept of restoring a pulpless tooth with post, core and/or crown is based on the belief that the root-filled tooth becomes brittle as a result of loss of moisture content. However, recent studies revealed that the moisture content of a root-filled tooth is not significantly different from that of a vital tooth. A survey of dentist' philosophies and techniques of restoring pulpless tooth conducted in the United States of America (U.S.A.) revealed that approximately 50 per cent of the respondents believed that a post would reinforce an endodontically treated tooth, while other studies reported no statistically significant advantage to reinforcing the teeth. Therefore, the concept that all anterior teeth that have received root canal therapy require posts and crowns is not supported by recent studies. But the access cavity for the root canal treatment should be as conservative as possible so that the tooth is not weakened unnecessarily. Based on a review of the literature, this article intends to provide a guideline for the restoration of endodontically treated teeth.

Comparison of pattern of failure of resin composite restorations in non-carious cervical lesions with and without occlusal wear facets.

OBJECTIVES: Many studies have reported the clinical problems associated with resin composite restorations in NCCLs. None has compared these clinical problems in NCCLs with and without occlusal wear facets. The present study sets out to determine the proportion of NCCLs that presents occlusal wear facets, and to compare the failure pattern of resin composite restorations in NCCLs with and without occlusal wear facets. METHODS: Teeth with NCCLs were classified into two groups, those with and without occlusal wear facets. Both groups were restored using micro hybrid resin composite. The restorations were evaluated at the end of 2 years concerning post-operative sensitivity, retention, marginal integrity, marginal discolouration, wear, and secondary caries, using the USPHS criteria. Statistical analysis compared the ratings of each criterion between the two groups using Pearson's χ(2) or Fisher's exact test. RESULTS: About one-third (33.8%) of teeth with NCCLs presented with occlusal wear facets, more NCCLs with occlusal wear facets in mandibular teeth (44.7%) than maxillary teeth (24.5%). Retention rate of composite resin restorations in NCCLs with and without occlusal wear facets was 63.9% and 74.4% respectively at the end of 2 years. More marginal discolouration and defects were observed in restorations in NCCLs with occlusal wear facets, the differences were not statistically significant (p>0.05). CONCLUSIONS: The decline in ratings of marginal discolouration and defects, and the lower retention rate of restorations in NCCLs with occlusal wear facets may support the role of occlusal stress and tooth flexure as a cause of failure of restorations in NCCLs. CLINICAL SIGNIFICANCE: The ability to distinguish between stress induced lesions (with occlusal wear facets) and other cervical lesions will have important ramifications for the success of their restorations because they are not subjected to the same physical forces that are responsible for the deterioration of the restoration.