Oral Health Status of Outpatients with Schizophrenia in Ankara, Türkiye: A Descriptive Study. / Ayakta Tedavi Gören Sizofreni Hastalarinin Agiz Sagligi Durumu: Tanimlayici Bir Çalisma (Ankara-Türkiye).

OBJECTIVES: To evaluate the oral health status and denture treatment needs of a group of outpatients with schizophrenia. METHODS: One hundred and eighty-eight patients diagnosed with schizophrenia were evaluated. Socio-demographic characteristics, eating habits, alcohol consumption, smoking status, oral hygiene attitudes, medical status, medications and the data related to dental visit were obtained via structured questionnaire of 45 questions. Medication information were confirmed from hospital records. The DMFT score (the Total of decayed, missing and filled teeth), denture status, Community Periodontal Index of Treatment (CPITN) and attachment loss were recorded in accordance with the criteria defined by the WHO. RESULTS: The mean DMFT score was 11.1±8.6. Total number of teeth decreased, while the number of decayed teeth and DMFT scores increased with age (p<0.001). There was no relationship between the anticholinergic effects of antipsychotics and the teeth count, number of decayed, filled and missing teeth, and the DMFT scores. The CPITN assessment revealed that 71.6% of the patients had healthy periodontium, 7.4% exhibited gingival bleeding upon probing, and 21% had dental calculus. Psychotropic medication and tooth brushing habits were associated with CPITN scores. Male sex was associated with higher frequency of denture need (p<0.001), while no association was observed with the education level and antipsychotic use (p>0.001). CONCLUSION: Physicians and dentists have to work in coordination to maintain good oral health of patients with schizophrenia. Patients should be encouraged for regular dental check-ups and dentist should take utmost care of the oral hygiene maintenance.

Which is the most effective biomaterial in indirect pulp capping? 4- year comparative randomized clinical trial.

Purpose: The aim of this study is to compare the clinical outcomes of Mineral Trioxide Aggregate (MTA) and calcium hydroxide pulp capping after complete caries removal. Materials and methods: In 73 regular patients (47 women, 26 men; age 20.65±3.02 years), having at least one deep carious lesion was recruited. Following complete caries removal, the pulp was indirectly capped with either MTA(n=51) or calcium hydroxide (n =49), randomly. Final restoration with a resin-based composite in a single session was performed. Clinical parameters including pulp vitality, sensitivity to cold or heat stimulants, percussion tests and discomfort during chewing and color were recorded after 6 months, 1 year, 2- year, 3- year and 4- year. Data were analysed statistically (p<0.05). Results: After 4- year, the survival rates were 86% (for MTA), and 82.9% (for calcium hydroxide). Totally, 8 teeth from calcium hydroxide group and 7 teeth from MTA group were endodontically treated. No significant difference was detected between the groups in terms of pulp vitality (p=0.613). Grey discoloration rate was 63% in MTA group. Conclusion: Both pulp-capping materials, MTA and calcium hydroxide showed similar clinically successful performance in terms of pulp vitality in the treatment of deep dentin caries lesions after 4- year.

Effect of cavity lining on the restoration of root surface carious lesions: a split-mouth, 5-year randomized controlled clinical trial.

OBJECTIVE: To compare the clinical performance of cavities with no lining and lining with resin-modified glass ionomer (RMGIC) for the treatment of root surface carious lesions. MATERIALS AND METHODS: The study included 39 patients (mean age, 39.6 years) who visited the university hospital for the treatment of at least 2 root surface carious lesions. After caries removal, the depth, length, and height of the cavities were measured. Using a paired-tooth design and simple randomization technique, the cavities were assigned to one of two groups that were either unlined or lined with RMGIC (Glass Liner II). All cavities were restored with a nanohybrid resin-based composite (Clearfil Majesty Esthetic). One hundred restorations (50 lined, 50 unlined) were placed. Two examiners other than the operator blindly evaluated the restorations at the follow-ups according to the modified Havemann criteria for marginal adaptation, anatomic form, marginal staining, caries in the adjacent tooth structure, caries at the cavosurface margin, and tooth sensitivity. Chi-square, Fisher's exact, Mann-Whitney U, and Cochran Q tests were used for the analysis (p < 0.05). RESULTS: At the 5-year follow-up, 12 restorations were failed. However, there was no significant difference between the marginal adaptation and marginal staining of the materials (p = 0.526 and p = 0.893, respectively). Four caries lesions were detected in the adjacent tooth structure and at the cavosurface margin at the 5-year assessment. CONCLUSION: There was no significant difference in the clinical performance of the lined and unlined restorations. CLINICAL RELEVANCE: The clinical performance of both unlined and RMGIC-lined cavities at the 5-year post-restoration assessment was acceptable. TRIAL REGISTRATION: NCT03802539.

Clinical Performance and Epidemiologic Aspects of Fractured Anterior Teeth Restored with a Composite Resin: A Two-Year Clinical Study.

PURPOSE: To investigate the etiologic factors, effect of age and gender on dental trauma, and to evaluate the performance of composite resin on the fractured crown of permanent anterior teeth. MATERIALS AND METHODS: Over a 2-year period, 73 permanent teeth from 51 patients with dental trauma were treated with direct composite resin restoration. Informed consent and standardized trauma forms were completed by the patient; teeth were restored with a submicron hybrid composite resin (Spectrum TPH) and respective adhesive system (Prime&Bond NT). Sixty-nine teeth were directly restored without fiber posts, while four were treated with fiber posts. Two experienced clinicians, besides the operator, evaluated each restoration at 6-, 12-, and 24-month follow-ups according to US Public Health Service (USPHS) criteria for the following characteristics: anatomical form, marginal adaptation, color match, marginal discoloration, surface roughness, and caries. Data were analyzed using the Wilcoxon Signed Rank, Kruskal-Wallis, Mann-Whitney U, and Siegel and Castellan tests. RESULTS: A total of 73 traumatized teeth in 51 patients aged from 14 to 64 years (mean age 25.47 ± 14.058 years) were assessed according to the Ellis classification and restored over a 2-year period. Crown fractures were more common in the maxilla (84.9%) and caused by falls (58.8%). At the end of 24 months, a total of ten restorations were lost. The survival rate after 24 months was 82.14%. There were statistically significant differences in marginal adaptation between the 6-, 12-, and 24-month follow-ups. Although changes in marginal discoloration over time were not significant (p = 0.194), changes in color match were significant (p = 0.029). CONCLUSION: Within the limitations of this study, direct composite restorations were accepted as clinically satisfactory.

Etiologic factors and clinical evaluation of restored fractured anterior teeth: an observational study.

PURPOSE: The aims of this study were to investigate the etiologic factors and to evaluate performance of composite resin on fractured crown in permanent anterior teeth at 6 and 12 months. SUBJECTS AND METHODS: Records from 51 patients were retrieved from a Dental School Clinic, comprising 73 fractured anterior teeth directly restored with a submicron hybrid composite (Spectrum TPH) resin and respective adhesive system (Prime and Bond NT) were evaluated. The United States Public Health Service criteria were used to assess the clinical evaluation. Data were analyzed using the Wilcoxon Signed Rank, Kruskal-Wallis, Mann-Whitney U, and Siegel and Castellan tests. RESULTS: Seventy-two maxillary incisors and one canine of 51 patients were evaluated. The patient's age at the time of therapy ranged from 14 to 64 years old (mean 25.47). Mostly observed crown fracture was seen in upper incisors (84.9%) and due to falls (58.8%). At the 6-month follow-up, one patient lost one restoration and at the 12-month, one patient lost one and one lost two restorations. A statistically significant difference was found in terms of marginal adaptation between 6 and 12 months. CONCLUSION: In this short-term observation period, remaining tooth structure was conserved and good patient compliance was achieved. Factors such as esthetic and/or cost should be considered to indicate the direct composite restorations.

Tooth loss and edentulism in the Turkish elderly.

The aim of this study was to evaluate partial and complete tooth loss and some related demographic factors, and oral health behaviors among Turkish elderly. According to recent censuses, elderly population of Turkey is rapidly growing. There is no nationwide information related to edentulism and natural teeth retention among 65-74 year-old people in Turkey. In this nationwide representative cross-sectional study, 1545 subjects aged 65-74 years were evaluated using the proportional stratified cluster sampling method. The data were collected via a structured, pre-tested face to face administered questionnaire and an oral examination. Chi-square test and binary logistic regression analyses were used to determine the significance of explanatory variables. 48.0% of elderly were edentate. The mean DMF-T was 25.8±8.5. These values were higher in women (p=0.016), older age (p<0.001) and rural individuals (p<0.001). Only 12.4% of the subjects had functional dentition. Age, visiting dentist, and health security were associated with edentulism. Female sex (OR=1.37), 70-74 age group (OR=2.08) and illiteracy (OR=3.25) were the independent factors of not having functional dentition. A reduction in edentulism in elderly may be achieved by the implementation of community programs promoting oral health for the prevention and treatment.

Effects of in-office and at-home bleaching on human enamel and dentin: an in vitro application of Fourier transform infrared study.

In-office and at-home bleaching techniques are widely used methods for the whitening of teeth. However, the safety of these techniques has not been clarified yet. The aim of the current study is to investigate the in-office- and at-home-bleaching-induced structural and quantitative changes in human enamel and dentin at the molecular level, under in vitro conditions. The Fourier transform mid-infrared (mid-FT-IR) spectroscopic technique was used to monitor bleaching-induced structural changes. Band frequency and intensity values of major absorptions such as amide A, amide I, phosphate (PO(4)), and carbonate (CO(3)(-2)) bands, for treatment groups and control, were measured and compared. The results revealed that both procedures have negligible effects on dentin constituents. In office-bleached enamel, in addition to demineralization, a decrease in protein and polysaccharide concentrations, mineral-to-protein ratio, and the strength of hydrogen bonds around NH groups, as well as a change in protein secondary structure were observed. The protein structure changed from beta-sheet to random coil, which is an indication of protein denaturation. However, no significant variations were observed for at-home bleached enamel. The control, at-home, and in-office bleached enamel samples were differentiated with a high accuracy using cluster analysis based on FT-IR data. This study revealed that office bleaching caused deleterious alterations in the composition and structure of enamel that significantly affected the crystallinity and mineralization of the tissue. Therefore, at-home bleaching seems to be much safer than in-office bleaching in terms of molecular variations.

Caries detection with DIAGNOdent and ultrasound.

OBJECTIVE: The objective of this study was to evaluate the repeatability of 2 nondestructive caries detection methods, ultrasound (ULS) and DIAGNOdent, for the detection of approximal caries lesions, and to evaluate 2 tips provided for the DIAGNOdent. STUDY DESIGN: White/brown-spot lesions (n = 42) were captured by a digital camera, and measured by test methods and confocal laser scanning microscope (CLSM). Intra- and inter-observer reliability, accuracy, and Cohen's kappa and Spearman's rho statistics were used. RESULTS: At DIAGNOdent, intra-observer agreements were 78.5%, 66.7% for A tip and 59.5%, 47.6% for B for 2 examiners, respectively. Accuracy of both tips was 50% for the first examiner; 45.3% for A and 47.6% for the B tip for the second examiner. All ULS measurements were accurate, reliable, and positively and significantly correlated between examiners. CONCLUSION: The A tip of the DIAGNOdent was found to be better than the B tip for the detection of enamel caries. All DIAGNOdent and ULS measurements were positive and significantly correlated for both examiners. Both methods demonstrated high repeatability and accuracy.

Oral sugar clearance and other caries-related factors of stimulated whole saliva in patients with secondary Sjögren syndrome.

OBJECTIVE: To compare oral sugar clearance, salivary flow rate, buffer capacity, salivary counts of mutans streptococci and lactobacilli in whole saliva, and root caries in subjects with secondary Sjögren syndrome with those of healthy subjects. METHOD AND MATERIALS: Twenty subjects with secondary Sjögren syndrome and 20 healthy subjects (age 30 to 55 years; all women) rinsed their mouth with a 20% sucrose solution. Before the rinse and 2, 5, 10, and 30 minutes after the rinse, 2 paper disks were soaked with saliva, 1 under the tongue and 1 in the mandibular vestibule. The salivary sucrose concentration was determined enzymatically. The clearance time and the area under the sugar clearance curve (AUC) were calculated. RESULTS: Patients with secondary Sjögren syndrome and with low salivary flow had longer sugar clearance times in the mandibular buccal vestibule and sublingual regions than did healthy individuals (P = .000 and P = .000, respectively). Significant differences of AUC values between the groups for the buccal and sublingual regions were also found (P = .000 and P = .003, respectively). CONCLUSION: Subjects with secondary Sjögren syndrome had longer sugar clearance time, related to low salivary flow, high counts of cariogenic microorganisms, and decayed and filled surfaces in the root.

Oral health status of the elderly in a residential home in Turkey.

OBJECTIVES: To determine the oral health status and treatment needs of elderly residents of a residential home in Ankara, Turkey. BACKGROUND: Little is known about oral health problems of elderly living in the institutions. METHODS: Among 216 elderly, 193 of them were interviewed and were clinically examined according to WHO criteria. Age, gender, educational and occupational status, oral hygiene practices, dental insurance, access to dental care and systemic diseases were recorded using a structured questionnaire. Coronal and root caries, periodontal disease, dental status and related treatment needs were assessed by two calibrated dentists. RESULTS: The mean age of the subjects were 75.2 +/- 8.3 in males, 79.1 +/- 7.9 in females; 32.6% of subjects were dentate and the mean number of teeth was 3.7 +/- 7.0 (median = 0). A functional dentition was present in 7.3% of subjects (>or=20). The mean decayed, missing and filled teeth (DMFT) was 29.3 +/- 5.8 (median = 32) and mean root caries was 2.2 +/- 3.1 (median = 1.0). The major reason for tooth extraction was dental caries. Of the subjects, 20.7% had at least one untreated coronal caries and 18.1% root caries. The assessment of periodontal status according to CPI revealed that only four persons had nine healthy sextants with the score of '0'. Edentulousness was 67.4% while 11.9% of them lacked denture in both jaws. CONCLUSION: The results illustrated poor dental health and showed extremely high demand for the dental health services programmes for the elderly living in these institutions.

Shear bond strength of orthodontic brackets with 3 self-etch adhesives.

INTRODUCTION: The purpose of this study was to compare shear bond strength and mode of failure of brackets bonded with 3 self-etching products. METHODS: The products tested were (1) a recently developed, modified self-etching, 1-step adhesive system (Adper Prompt L-Pop Self Etch Adhesive, 3M, St Paul, Minn); (2) a new fluoride-releasing, antibacterial, self-etching adhesive system (Clearfil Protect Bond, Kuraray, Osaka, Japan); and (3) a fluoride-releasing, self-etching adhesive system (Transbond Plus Self Etching Primer, 3M). Thirty-six defect-free premolars were randomly divided into 3 groups (n = 12 each), and metal brackets were bonded according to the manufacturer's instructions. Brackets were debonded in shear on a universal testing machine with a crosshead speed of 1 mm per minute. RESULTS: One-way ANOVA showed a statistically significant (P < .001) difference between groups. Group 2 had the highest shear bond strength. The difference between groups 1 and 3 was not statistically significant. The Kruskal-Wallis test showed no significant differences in the ARI scores (P = .595; P < .05). CONCLUSIONS: The fluoride-releasing, antibacterial, self-etching adhesive system, Clearfil Protect Bond, produced greater shear bond strength than the other 2 products tested and could be considered for clinical use.

Shear bond strength of orthodontic brackets with newly developed antibacterial self-etch adhesive.

Because the enamel adjacent to brackets may be affected by microorganisms, an antibacterial adhesive may be a useful choice to prevent and reduce demineralization. The purpose of this in vitro study was to determine the (1) shear bond strength of a self-etch and an antibacterial self-etch adhesive for orthodontic metal brackets and (2) bond failure interface of a self-etch and an antibacterial self-etch adhesive using a modified adhesive remnant index (ARI). Twenty-four defect-free premolars were randomly assigned into two groups. The teeth received the following treatments-group 1: Transbond Plus Self-Etching Primer + Transbond XT; group 2: antibacterial dentin bonding system (ABF) + Transbond XT. All samples were stored in deionized water at 37 degrees C for 48 hours. Shear debonding tests were performed at a crosshead speed of five mm/min. The results in megapascals were (median, minimum, maximum) group 1: 8.53, 4.59, 12.63; group 2: 9.79, 4.01, 22.10, respectively. Mann-Whitney test revealed that the difference between the groups was not statistically significant (P = .2, P > .05). Failed brackets were examined by an optical microscope at 16x magnification to determine the bond failure interface using a modified ARI. The predominant mode of failure for both groups was at the bracket-adhesive interface. ABF may have sufficient mechanical properties and also an antibacterial effect that makes it a good choice for orthodontic bonding.

The in vitro performance of laser fluorescence and caries-detector dye for detecting residual carious dentin during tooth preparation.

OBJECTIVE: The aim of this in vitro study was to compare the performance of a laser fluorescence device (DIAGNOdent) and a caries-detector dye for detecting residual dentinal caries. METHODS AND MATERIALS: Forty extracted human molar teeth with deep dentinal carious lesions on their approximal surfaces were used for the study. The caries were removed by a new chemomechanical system, Carisolv. Three independent observers checked all cavities for residual caries using caries-detector dye and DIAGNOdent. The presence or absence of residual caries was verified using polarized light microscopy as the gold standard. Three observers recorded two different measurements at the same site after 2 weeks to determine intra- and interexaminer reproducibility of the DIAGNOdent. RESULTS: Average kappa values of 0.61 for interexaminer reproducibility and 0.94 for intraexaminer reproducibility were determined. The specificity of caries-detector dye was found to be 100% and the specificity of the DIAGNOdent was 86%. CONCLUSION: Although DIAGNOdent showed greater sensitivity than caries-detector dye (P < .05), low sensitivity values for each diagnostic system may lead to teeth with residual caries being undetected. Therefore, it might be advisable to reconsider the criteria for detecting residual caries during tooth preparation.

Use of laser fluorescence in monitoring the durability and cariostatic effects of fluoride and chlorhexidine varnishes on occlusal caries: a clinical study.

OBJECTIVE: The aim of this study was to compare the effectiveness and caries-preventive effects of a fluoride varnish (Fluor Protector; 0.1% fluoride) and a chlorhexidine varnish (Cervitec; 1% chlorhexidine and 1% thymol) on initial caries of occlusal fissures and to monitor the durability of the varnishes by the use of a fluorescence system, DIAGNOdent (Dd). METHOD AND MATERIALS: Nineteen subjects underwent professional tooth cleaning at the beginning of the study. Afterward, fluorescence measurements (baseline) were obtained from 56 test sites and 28 control sites on the central fossae of molars. Each subject had Fluor Protector and Cervitec application on randomly assigned experimental teeth, and applications were followed by Dd measurements. Measurements were repeated after 1 and 6 months. RESULTS: There was an increase in fluorescence values immediately after application of varnish in the two test groups. One month after varnish application, Dd scores for group Fluor Protector were not significantly different from Dd scores obtained immediately after application (P = .108), whereas Dd scores for group Cervitec decreased significantly (P = .007). For both test groups, there was a significant decrease between the values obtained immediately after application and those acquired after 6 months. There was also a significant decrease between 1 month and 6 months for test groups and a slight but significant increase for the control group (P = .011). No significant difference was found between the Fluor Protector and Cervitec groups after 6 months. CONCLUSION: It was concluded that the Dd system may be used to monitor the existence of these two varnishes.

Bonding to enamel and dentin using self-etching adhesive systems.

OBJECTIVES: This study investigated the effectiveness of three different dentin adhesive systems on the adhesion of resin composite to both dentin and enamel. METHOD AND MATERIALS: The flat dentin and enamel surfaces of 60 extracted human molar teeth were exposed by wet grinding with 600-grit silicon carbide paper. One total-etch self-priming adhesive system (Prime & Bond NT), one two-step self-etching primer adhesive system (Clearfil SE Bond), and one "all-in-one" self-etching adhesive system (Prompt L-Pop) were evaluated. Each bonding system was applied according to the manufacturer's instructions and followed by composite (TPH Spectrum) application. Twenty-four hours after bonding, the teeth were subjected to shear testing. There were 10 replicates for each group. RESULTS: Prompt L-Pop exhibited significantly higher bond strength values to enamel (27 +/- 4.2 MPa) than all other groups. There were no statistically significant differences for shear bond strength to dentin among adhesives. Prompt L-Pop showed the statistically significantly higher bond strength to enamel than dentin. There were no statistically significant differences between the enamel and dentin bond strengths of Clearfil SE Bond and Prime & Bond NT. CONCLUSIONS: The self-etching adhesive systems produced high bond strengths to human coronal dentin and ground enamel surfaces. These materials seem to be very promising for further clinical applications, and the results are very encouraging for the clinical success of these simplified adhesive systems. The self-etching adhesive systems produced even better bond strengths to both enamel and dentin than conventional total-etch systems, especially the "all-in-one" system, which produced the highest bond strength to enamel.