Oral ulceration (Part 1).

Ulceration is probably the oral mucosal condition seen most frequently by general dental practitioners. It is almost always painful and therefore sufferers are prompt to seek advice. An important exception to this generalisation is the occurrence of oral squamous cell carcinoma, which is often painless in its early stages. Definitive diagnosis, which requires mucosal biopsy, is mandatory for any persistent area of oral ulceration.

Oral ulceration (Part 2).

Ulceration is probably the oral mucosal condition seen most frequently by general dental practitioners. It is almost always painful and therefore sufferers are prompt to seek advice. An important exception to this generalisation is the occurrence of oral squamous cell carcinoma, which is often painless in its early stages. Definitive diagnosis, which requires mucosal biopsy, is mandatory for any persistent area of oral ulceration.

Impacts of missing upper anterior teeth on daily living.

BACKGROUND: Aesthetics and function of the orofacial region are very important aspects of human life which may be affected by tooth loss and impact on the quality of life. The aim of this study was to identify the effects of anterior tooth loss on patients' quality of life and satisfaction with their dentition. METHODS: Fifty partially edentulous patients with missing anterior teeth and 50 control subjects who had no missing teeth were recruited into the study. The control subjects matched the patients by age, gender, and level of education. A Dental Impact on Daily Living questionnaire was used to assess dental impacts on daily living and satisfaction with the dentition. RESULTS: Tooth loss has a definite measurable impact on patients' daily living and satisfaction with their appearance, pain levels, oral comfort, general performance, and eating capacities (p = 0.000). Age and level of education had no effect on patients' total satisfaction with their dentition and daily living. However, females were less satisfied with appearance, general performance and eating (p = 0.003, 0.005 and 0.007 respectively) than males. There were significant correlations between the number of missing anterior teeth and patients' total satisfaction (p = 0.028) and patients satisfaction with appearance, oral comfort, general performance, and eating dimensions (p = 0.001, 0.048, 0.011 and 0.009 respectively). CONCLUSION: Tooth loss has definitive impact on patients' satisfaction with their dentition regardless of personal factors such as age, gender and level of education. The higher the number of missing teeth the lower the levels of satisfaction with the dentition and daily living.

The effects of ozone gas application on shear bond strength of orthodontic brackets to enamel.

PURPOSE: To investigate the possibility that ozone may have an adverse effect on the bond strength of orthodontic brackets and to determine the area of residual adhesive on teeth after the debonding of brackets. METHODS: 60 extracted premolars teeth were used in this study. Resin coated APC brackets (3M) were bonded according to the manufacturers' instructions. Bonded teeth were randomly divided into two groups. The teeth in Group 1 were subjected to a 10-second dosage of ozone from the HealOzone unit (Kavo) after etching and to a further 10 seconds of ozone after bonding the brackets using a 5 mm delivery cup. Teeth in Group 2 were used as a control. Debonding was carried out using a testing instrument at a cross-head speed of 1 mm/minute. RESULTS: The Mann-Whitney test revealed no significant differences in shear bond strength between the two groups (P = 0.337). The mean shear bond strength (11.66 MPa) of Group 1 (subjected to ozone) was not significantly different than the mean shear bond strength (10.88 MPa) of Group 2 (not subjected to ozone). A Pearson Chi-square test of the Adhesive Remnant Index (ARI) revealed no significant difference in residual adhesive among the groups tested.

Three-dimensional measurement of residual adhesive and enamel loss on teeth after debonding of orthodontic brackets: an in-vitro study.

INTRODUCTION: The purpose of this study was to evaluate 3-dimensionally the changes on tooth surfaces after debonding orthodontic brackets and after removing residual adhesive and finishing. METHODS: Sixty premolars were randomly divided into 2 groups, and brackets were bonded according to the manufacturers' instructions. Two types of orthodontic adhesives were used: resin-modified glass ionomer cement (group 1) and resin-coated adhesive precoated brackets (group 2). The brackets were debonded on a testing machine at a cross-head speed of 1 mm per minute. Models were made of each tooth before bonding, after debonding, and after removal of residual adhesive. The models were scanned with a 3-dimensional laser scanning machine, and the scanned images were analyzed by using modified analytical software. RESULTS: The Mann-Whitney test showed significant differences in adhesive thickness and enamel loss between the 2 groups (P <.001). The mean (+/- SD) thickness for group 1 was 31.2 microm (+/- 26.5 microm), and the mean (+/- SD) thickness for group 2 was 102.7 microm (+/- 79.71 microm). The means (+/- SD) for enamel losses after cleaning and finishing the enamel surfaces were 22.8 microm (+/- 17.67 microm) for group 1 and 50.5 microm (+/- 31.27 microm) for group 2. CONCLUSIONS: Adhesive thickness and enamel loss due to orthodontic procedures can successfully be measured in vitro by using 3-dimensional laser scanning technology.

Analgesic efficacy of the cyclooxygenase-inhibiting nitric oxide donor AZD3582 in postoperative dental pain: Comparison with naproxen and rofecoxib in two randomized, double-blind, placebo-controlled studies.

OBJECTIVE: This study assessed the analgesic efficacy of single doses of 4-(nitrooxy)butyl-(2S)-2-(6-methoxy-2-naphthyl) propanoate (AZD3582) in acute postoperative dental pain after the removal of an impacted mandibular third molar (ie, wisdom tooth). METHODS: Two randomized, placebo-controlled, double-blind studies were performed. In a dose-finding study, 242 patients were randomized to AZD3582 375, 750, 1500, or 2250 mg (n = 41, 37, 42, and 41, respectively); naproxen 500 mg (n = 39); or placebo (n = 42). In a comparator study, 282 patients were randomized to AZD3582 500 mg (n = 78) or 750 mg (n = 83), rofecoxib 50 mg (n = 80), or placebo (n = 41). Primary outcomes included time to rescue medication, time to pain relief, and mean pain intensity difference (MPID), as well as safety profile. Pain was rated on a visual analog scale. RESULTS: In the dose-finding study, 52% (126/242) were women; the mean (SD) age was 25.1 (4) years, mean weight was 69.0 kg, and the mean (SD) body mass index (BMI) was 23.7 (3) kg/m2. In the comparator study, 58% (164/282) were women; the mean (SD) age was 27 (6.4) years, mean weight was 71 kg, and mean (SD) BMI was 24.2 (3) kg/m2. In the dose-finding study, the AZD3582 750-, 1500-, and 2250-mg groups were superior to placebo in the primary variables "time to rescue medication (0-8 hours)" (hazard ratios [HRs] [95% CIs], 0.17 [0.07-0.42], P < 0.003; 0.23 [0.11-0.50], P < 0.001; and 0.15 [0.06-0.36], P < 0.001, respectively), "time to meaningful pain relief" (HRs [95% CIs], 3.42 [1.87-6.25], P < 0.003; 2.49 [1.37-4.50], P < 0.003; and 3.07 [1.70-5.55], P < 0.001, respectively), and MPID (analysis of covariance [ANCOVA] least squares mean [LSM] differences [95% CIs], 25.8 [17.3-34.4], P < 0.003; 20.4 [12.1-28.7], P < 0.003; and 29.3 [20.9-37.6], P < 0.001, respectively). AZD3582 and naproxen did not show any statistically significant differences for the 3 primary variables, except that naproxen was superior to the AZD3582 375-mg dose for the variables time to meaningful pain relief (HR difference, 0.48 [95% CI, 0.29-0.78], P < 0.004) and MPID (difference in ANCOVA LSM, -10.2, [95% CI, -18.2 to -2.2], P < 0.012). The median times to meaningful pain relief were 115 minutes for AZD3582 375 mg, 66 minutes for 750 mg, 85 minutes for 1500 mg, 81 minutes for 2250 mg, and 162 minutes for placebo (P = NS, P = 0.003, P < 0.003, and P < 0.001, respectively). The median time to first rescue medication was 144 minutes for placebo, and <50% of the subjects on any of the AZD3582 doses or naproxen took rescue medication within 8 hours after dosing. In the comparator study, AZD3582 750 mg was superior to placebo in "time to rescue medication (0-24 hours)" (HR [95% CI], 0.4 [0.3-0.6], P < 0.001), "time to confirmed perceptible pain relief" (2.1 [1.1-3.8], P = 0.02), and MPID (11.9 [4.2-19.5], P = 0.002). However, inferiority of AZD3582 to rofecoxib for MPID could not be excluded (tolerance limit of 10 mm; P = NS for noninferiority testing). The median times to confirmed perceptible pain relief were 45 minutes for AZD3582 500 mg, 40 minutes for 750 mg, and 37 minutes for rofecoxib. The median times to first rescue medication were 218 minutes for AZD3582 500 mg, 365 minutes for 750 mg, 635 minutes for rofecoxib, and 90 minutes for placebo. Overall, AZD3582 was well tolerated. However, an effect on orthostatic blood pressure could not be excluded because there seemed to be more subjects with dizziness and orthostatic blood pressure reduction who were administered AZD3582 > or =750 mg. The proportions of patients with vertigo and decreased orthostatic blood pressure each group were as follows: AZD3582 500 mg, 6%; AZD3582 750 mg, 12%; rofecoxib, 3%; and placebo, 5%. CONCLUSIONS: AZD3582 750 mg had similar analgesic efficacy as equimolar doses of naproxen, but noninferiority to rofecoxib was not demonstrated.

Vasoactive intestinal polypeptide (VIP) and VPAC1 receptor in adult human dental pulp in relation to caries.

OBJECTIVE: To quantitatively measure VIP levels and to qualitatively study the distribution of VIP fibres and demonstrate the presence of the VPAC1 receptor in human dental pulp from carious and non-carious adult human teeth. DESIGN: Dental pulp samples were collected from non-carious, moderately carious and grossly carious adult human teeth. VIP levels were determined using radioimmunoassay. The distribution of VIP fibres was studied using immunohistochemistry. The VPAC1 receptor protein expression was determined by Western blotting. RESULTS: VIP levels were found to be significantly elevated in the dental pulp of moderately carious compared with non-carious (p=0.0032) or grossly carious teeth (p=0.0029). The distribution of VIP fibres was similar in non-carious and carious teeth, except that nerve bundles appeared thicker in the pulp samples from carious compared with non-carious teeth. Western blotting indicated that the VPAC1 receptor proteins were detected in similar levels in pooled dental pulp samples from both carious and non-carious teeth. CONCLUSION: It is concluded that quantitative changes in the levels of VIP in human dental pulp during the caries process and the expression of VPAC1 receptor proteins in membrane extracts from carious and non-carious teeth suggests a role for VIP in modulating pulpal health and disease.

Vulnerability and presenting symptoms in burning mouth syndrome.

OBJECTIVES: To investigate if burning mouth syndrome (BMS) patients have differing health perceptions, medication, and life experiences compared with controls and to examine the role of vulnerability factors and differentiate them from the presenting symptomology in patients with BMS. STUDY DESIGN: A nonprobability convenience sample of patients presenting with BMS and age- and sex-matched controls were recruited from Queen's University, Belfast, King's College London, and Baylor College of Dentistry, Dallas. Participants completed a questionnaire to assess 9 aspects of their medical and social history, including early and past life experiences. The subjects completed the Hospital Anxiety and Depression Scale to assess current distress. RESULTS: Participants with BMS had significantly higher experiences of adverse early life experiences compared with controls. They had statistically significantly higher mean scores for anxiety and depression compared with controls. A hierarchical multiple logistic regression analysis showed that the characteristics of BMS included cancer phobia, gastro-intestinal problems, and chronic fatigue. CONCLUSION: BMS is a complex disorder. People who experience adverse life experiences may become vulnerable to developing BMS in later life.

Identification and overexpression of human neutrophil alpha-defensins (human neutrophil peptides 1, 2 and 3) in squamous cell carcinomas of the human tongue.

To date, little attention has been paid to the possible role of alpha-defensins (human neutrophil peptides 1-3), HNP-1, HNP-2 and HNP-3 in innate host defence against tumour invasion. In the current study, using a single-dimensional high pressure liquid chromatography (HPLC) method for peptide separation, followed by mass spectrometry and amino acid sequencing for identification and quantitation, we report the overexpression of HNP-1, HNP-2 and HNP-3 in squamous cell carcinomas of the human tongue compared with autogenous non-tumour tissue. Using a specific antibody we show that the defensins are abundant in neutrophils infiltrating human oral squamous cell carcinoma tissue. In the context of their previously reported oncolytic activity, our results may imply a role for alpha-defensins in host defence against oral squamous cell carcinoma.

Impacts of implant treatment on daily living.

PURPOSE: This study investigated the association between satisfaction with the dentition and dental prostheses and personality profiles among patients who received implant-supported prostheses. MATERIALS AND METHODS: Patients seeking dental implant therapy were recruited for this study. A Dental Impact on Daily Living questionnaire was used to assess dental satisfaction and the effects of implant-supported prostheses on daily living. The NEO Five Factor Inventory (NEO-FFI) was used to assess participants' personality profiles. Participants completed the questionnaires before implant insertion and 3 months after rehabilitation with implant-supported prostheses. RESULTS: Eighty patients (42 men and 38 women, mean age 40.99 years) participated. Patients were more satisfied with their dentition after implant treatment. Neuroticism and conscientiousness had significant relationships with patient satisfaction and impact on daily living both before and after implant therapy. Openness and agreeableness had significant relationships with patient satisfaction and impact on daily living only after implant treatment. Extraversion had a significant relationship with patient satisfaction and impact on daily living only before treatment. After implant treatment, neuroticism was helpful in predicting total satisfaction, as well as satisfaction with appearance, pain, oral comfort, performance, and eating. Conscientiousness was helpful in predicting satisfaction with appearance, whereas openness was helpful in predicting satisfaction with pain. Before implant treatment, neuroticism was helpful in predicting total satisfaction as well as satisfaction with appearance, oral comfort, and performance. CONCLUSION: Implant-supported prostheses had positive impacts on participants' daily living and satisfaction with the dentition. Personality traits (such as neuroticism, openness, agreeableness, and consciousness) affect patients' daily living and satisfaction with implant-supported prostheses. Selected personality traits might predict patients' satisfaction with implant-supported prostheses prior to treatment.

Quantification of tooth wear: conventional vs new method using toolmakers microscope and a three-dimensional measuring technique.

OBJECTIVES: This study aimed to evaluate the reliability of a new CAD-CAM Laser scanning machine in detection of incisal tooth wear through a 6-month period and to compare the accuracy of using this new machine against measuring tooth wear using tool maker microscope and conventional tooth wear index. METHODS: Twenty participants (11 males and 9 females, mean age=22.7 years, SD=2.0) were assessed for incisal tooth wear of lower anterior teeth using Smith and Knight clinical tooth wear index (TWI) on two occasions, the study baseline and 6 months later. Stone dies for each tooth were prepared and scanned using the CAD-CAM Laser Cercon System (Cercon Smart Ceramics, DeguDent, Germany). Scanned images were printed and examined under a toolmaker microscope (Stedall-Dowding Machine Tool Company, Optique et Mecanique de Precision, Marcel Aubert SA, Switzerland) to quantify tooth wear and then the dies were directly assessed under the microscope to measure tooth wear. The Wilcoxon Signed Ranks Test was used to analyse the data. RESULTS: TWI scores for incisal edges were 0, 1, and 2 and were similar at both occasions. Scores 3 and 4 were not detected. Wear values measured by directly assessing the dies under the tool maker microscope (range=517-656microm, mean=582microm, and SD=50) were significantly more than those measured from the Cercon digital machine images (range=132-193microm, mean =165microm, and SD=27) and both showed significant differences between the two occasions. CONCLUSIONS: Measuring images obtained with Cercon digital machine under tool maker microscope allowed detection of wear progression over the 6-month period. However, measuring the dies of worn dentition directly under the tool maker microscope enabled detection of wear progression more accurately. Conventional method was the least sensitive for tooth wear quantification and was unable to identify wear progression in most cases.

Impact of tooth wear on daily living.

PURPOSE: The aim of this study was to identify the effects of tooth wear on patients' quality of life and satisfaction with their dentition. MATERIALS AND METHODS: Seventy-six tooth wear patients and 76 control subjects were recruited for the study. A Dental Impact on Daily Living questionnaire was used to assess the affect of tooth wear on daily living and satisfaction with the dentition. An ordinal scale was used to assess the severity of tooth wear in a patient cohort. RESULTS: The results showed that tooth wear has a measurable impact on patients' satisfaction with their appearance, pain levels, oral comfort, general performance, and chewing and eating capacity (P < .001). CONCLUSION: Tooth wear has an impact on patients' satisfaction with their dentition regardless of tooth wear severity or personal factors.

Caries-induced changes in the expression of pulpal neuropeptide Y.

Recent evidence suggests that the sympathetic nervous system may have a role in modulating neurogenic inflammation and bone remodelling. Neuropeptide Y (NPY) is a well-characterized neuropeptide transmitter in the peripheral sympathetic nervous system. NPY is known to be present in human dental pulp; however, quantitative data on NPY levels in pulpal health and disease in an adult population remain to be determined. The aims of the current study were to assess, quantitatively, NPY levels by radioimmunoassay and confirm the distribution of NPY fibres by immunocytochemistry in carious and non-carious adult human pulp tissue. Our results suggest changes in the levels and distribution of NPY in human dental pulp during the caries process, with significantly higher levels of NPY in carious compared with non-carious adult human teeth. Within the carious samples studied, our finding, that NPY levels were significantly elevated in mild/moderate caries, concurs with the hypothesis that NPY could have a modulatory role in pulpal inflammation and in reparative dentine formation.

A comparative study of the efficacy of Aphtheal in the management of recurrent minor aphthous ulceration.

BACKGROUND: Recurrent minor aphthous ulceration (RAU) is a common condition which is multifactorial in origin. METHODS: This study, firstly, aimed to treat the prodromal stage of RAU with Aphtheal (5% amlexanox paste) to determine if ulcer development could be prevented. A second arm of the study investigated treatment of RAU with Aphtheal once ulceration had developed. Ulcer duration, ulcer size and associated pain were measured. Both groups of subjects had previously undergone a no-treatment run-in period to establish these parameters over an untreated episode of ulceration. RESULTS: By day 3, only 35% of the prodromal group had developed an ulcer compared with 97% of the ulcer group (P < 0.001). In the treated ulcer group only 66% had an ulcer present by day 3. Treatment at the onset of prodromal symptoms reduced the maximum ulcer size score by 84% (P < 0.01), extent of ulceration by 88% (P < 0.01), maximum pain score by 69% (P < 0.01) and extent of pain by 85% (P < 0.01) compared to no treatment. CONCLUSION: Treatment with Aphtheal at the onset of prodromal RAU symptoms can prevent progression to ulcer development and significantly reduced symptoms if ulcers do develop.

Thermal changes observed at implant sites during internal and external irrigation.

In the preparation of osseointegrated dental implant sites, the use of bone drilling with conventional external irrigation has been shown to be thermally non-injurious to bovine bone, when employed as a model for dental implantology. The use of internal irrigation drilling systems is promoted on the basis of improved delivery of coolant to the bone/drill interface, which should subsequently improve local debridement and cooling, and therefore reduce thermal insults to the bone. The aim of this bovine model study was to compare the temperatures that were generated with external and internal irrigation systems during bone preparation for dental implants. A constant drill load of 1.7 kg was applied throughout the drilling procedures via a drilling rig. The burs that were used for both irrigation methods were a 2 mm twist drill for cutting the channel and a 3.25 mm drill for trephining this channel. The principal recorded parameter was the change in temperature generated via the drilling procedure. The 2 mm twist drills produced a maximum change in temperature of only 3.0 degrees C and 3.1 degrees C for the internal and external irrigation systems, respectively. Maximum changes for the 3.25 mm drills were 1.34 degrees C and 1.62 degrees C, respectively. Using the t-test, no statistical benefit was observed for one irrigant delivery system over the other. The clinical benefit of using the more expensive internal irrigation systems is therefore deemed unjustifiable, on the grounds that these systems do not appear to reduce the thermal challenge to the bone over and above that of simple flood irrigation.

Quantitative analysis of substance P, neurokinin A and calcitonin gene-related peptide in gingival crevicular fluid associated with painful human teeth.

The aim of this study was to investigate the presence of substance P (SP), neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) in the gingival crevicular fluid of teeth diagnosed with pain of pulpal origin compared with clinically healthy teeth, and to detect any changes in the levels of these neuropeptides in gingival crevicular fluid after removal of the pulp from the painful teeth. Gingival crevicular fluid was collected at baseline from one interproximal site at a painful and a non-painful contralateral tooth from 54 adult patients. Sampling was repeated after 1 wk in a subset of 21 subjects. Samples were analysed for SP, NKA, and CGRP using radioimmunoassay. The mean levels of SP and NKA were significantly higher in gingival crevicular fluid from painful teeth compared with non-painful teeth. The level of SP in the GCF of painful teeth fell significantly 1 wk after pulpectomy. In contralateral teeth, there were no significant differences in the levels of SP and NKA after 1 wk. It is concluded that SP and NKA are present in significantly greater amounts in the GCF of painful teeth compared with healthy teeth.

Changes in vasoactive intestinal peptide in gingival crevicular fluid in response to periodontal treatment.

AIMS: To evaluate the role of the anti-inflammatory neuropeptide vasoactive intestinal peptide (VIP) in periodontal health and disease and to determine the effects of periodontal treatment, resulting in a return to periodontal health, on the levels of VIP in gingival crevicular fluid (GCF). METHODS: At baseline, 10 subjects with periodontitis (nine females, one male, mean age 43.0, SD 7.3) started a course of non-surgical periodontal treatment. Clinical indices were measured at one periodontitis and one clinically healthy site at an initial visit and at 8 weeks after the completion of treatment in each subject. A 30-s sample of GCF was collected from each test site using perio paper strips. The volume of GCF was measured and each sample subsequently analysed for VIP by radioimmunoassay. One healthy site was sampled from each member of a control group (10 females, mean age 29.9, SD 8.2 years) with clinically healthy gingiva and no periodontitis. RESULTS: The clinical condition of all periodontitis sites improved as a result of periodontal treatment. The levels of VIP (pg/30 s sample) in periodontitis-affected sites fell significantly from 302.0 (SD 181.2) at the initial visit to 78.0 (54.4) after treatment, p = 0.007. The reduction in the concentration of VIP (pg/ micro L) in GCF from 524.3 (322.3) to 280.8 (280.2) was not statistically significant. The levels of VIP in clinically healthy sites fell from 115.5.5 (74.3) to 77.8 (32.3), n.s. and the concentration changed little from 883.8 (652.1) to 628.7 (323.3), n.s. There were substantially smaller amounts of VIP (25.8, SD 12.8) pg in healthy sites sampled from control subjects. CONCLUSIONS: VIP is present in GCF in greater quantities in periodontitis-affected than clinically healthy sites. In addition, the reduction in inflammation resulting from effective periodontal treatment is associated with a reduction in the levels of VIP in gingival crevicular fluid.