Periapical Microsurgery: Assessment of Different Types of Light-emitting Diode Transilluminators in Detection of Dentinal Defects.

INTRODUCTION: This study evaluated 4 different light-emitting diode (LED) transilluminators and the impact of operator experience in the detection of dentinal defects through an ex vivo TRUEJAW surgical model (Dental Engineering Laboratories, Santa Barbara, CA). METHODS: Forty-four extracted and endodontically treated mandibular premolar teeth were evaluated. Teeth were mounted in the models followed by surgical flaps and osteotomies to expose the apical third of the roots. After apical resection, the root-end surfaces were randomly inspected for the presence or absence of dentinal defects using a dental operating microscope (DOM) at ×19.4 magnification by experienced and novice LED evaluators. The assessment was made with the DOM light and 4 masked LED transilluminators of different diameters and luminous flux. The teeth were examined outside the models to establish the ground truth. The sensitivity, specificity, and kappa and McNemar test values of each light source by examiner were calculated. RESULTS: The use of LED transilluminators improved the diagnostic sensitivity of dentinal defects when compared with the DOM light alone for both examiners. For the LED-experienced evaluator, the medium-low transilluminator had statistically significant higher sensitivity than the DOM light and the small-low and small-high transilluminators (P < .05). For the novice LED evaluator, the medium-high transilluminator had the highest sensitivity. There was a statistically significant difference between the sensitivities of the medium-low transilluminator between the examiners (P < .05). CONCLUSIONS: Within the limitations of this ex vivo surgical study, dentinal defects were more often detected with the LED transilluminators with a larger diameter and increased lumens. The operator's LED transilluminator experience was found to have a positive effect on the detection of dentinal defects using transillumination.

Effects of a national economic crisis on dental habits and checkup behaviors - a prospective cohort study.

OBJECTIVES: The effects of economic recessions on dental health behaviors and care utilization are vastly unexamined. Thus, we aimed to ascertain changes in dental health behaviors and checkup frequency from before to after the start of the 2008 Icelandic economic collapse using a nationally representative, prospective cohort - the Health and Wellbeing in Iceland cohort. METHODS: Participants in the cohort (n = 4100) were contacted first from October to December of 2007 and again from November to December of 2009. The questionnaires assessed respondent's demographics, dental behaviors (brushing, flossing), and dental checkup frequency. We present odds ratios derived from multivariate logistic regression of visiting a dentist annually after the collapse compared with before, as well as odds ratios of daily brushing and flossing habits. RESULTS: Overall, there was no strong evidence for drastic changes in dental health behaviors as from 2007 to 2009. However, employed men (odds ratio 1.29; 95% confidence interval 1.07-1.54) - as well as unemployed women (1.98; 1.00-3.92) - experienced increased odds of visiting a dentist at least annually. Additionally, men were more likely to brush (1.42; 1.05-1.93) and floss daily (1.20; 1.03-1.42) after the collapse compared with before. CONCLUSIONS: Overall, it seems as if the collapse did not have drastic negative effects on dental health behaviors of the population in Iceland. Our findings suggest that men may have opted for healthier dental health behaviors following the national economic collapse in 2008.

Prevalence of dental erosion in children: a national survey.

OBJECTIVES: To measure the prevalence of dental erosion in permanent teeth in Iceland as part of the National Oral Health Survey. METHODS: A representative, nationwide sample of 2251 Icelandic children, 20% of those aged 6, 12 and 15 year, was examined. Dental erosion was recorded for all erupted permanent teeth and graded using the modified scale of Lussi. RESULTS: Erosion was not seen in the permanent teeth of six-year-olds, but was present in 15.7% of 12-year-olds, more frequently in boys than girls (19.9% boys, 11.0% girls; P < 0.001). Among 15-year-olds, dental erosion was seen among 30.7% of subjects (38.3% boys, 22.7% girls; P < 0.001). Severity of erosion was mostly scored as grade I, with only 5.5% of 15-year-olds scored as grade II, mostly on tooth 46 (4.3%) and 36 (4.2%). For 12-year-olds, 0.9% had erosion scores of grade II mostly on tooth 46 (0.8%) and 36 (0.7%). No subjects had erosion of grade III. The most common clinical manifestation of erosion was the appearance of cup-like lesions on the cusps of lower first molars. CONCLUSIONS: Dental erosion was frequently present by the age of 12; the prevalence doubled by age 15 and was seen almost twice as often among boys than girls. Teeth most frequently showing signs of erosion were the lower first molars. The rapidly growing prevalence of erosion demonstrated by this nationwide survey emphasizes the need for further research into the aetiology of erosion and possible methods of preventing and treating this emerging dental problem.

Caries prevalence of permanent teeth: a national survey of children in Iceland using ICDAS.

OBJECTIVES: The Icelandic Oral Health Survey aimed to obtain new national data on the oral health of Icelandic children and teenagers. METHODS: A representative stratified random cluster sample of 2251 Icelandic children in first, seventh and 10th grade, aged approximately 6-, 12- and 15-years old was examined for caries prevalence using the ICDAS criteria. Bite-wing digital radiographs were obtained for the children in 7th and 10th grade. RESULTS: D(3)MFT scores by visual examination of 6-, 12- and 15-year olds were 0.12, 1.43 and 2.78 respectively but when including radiographs, the D(3)MFT rose to 2.11 at 12 years and 4.25 at 15 years. The Significant Caries Index, SiC, by visual examination for 12 and 15 y was 3.7 and 6.7 respectively but was 4.7 for 12 y and 8.9 for 15 y with radiographs. In all age groups and at most disease levels, caries was active in the majority of the lesions (58-100%). The percentage of children with no visually detectable caries at D(3)/D(1) level was 93%/74% for 6 years, 48%/22% for 12 years and 35%/16% for 15 years. When radiographs were included the percentage reduced to 34%/15% for 12 years and 20%/6% for 15 years. Approximately 80% of 12- and 15-year-olds had at least one of their first molars sealed, with the mean number of sealed first molars being 2.2 among 12 y and 2.0 among 15 y. CONCLUSIONS: Caries levels were higher than expected in this national survey and further away from the goals of the National Health Plan for 2010 than anticipated. Caries distribution was skewed with more than half of the children having low caries scores but a wide distribution of caries experience was seen among the remaining population.

Dental health of patients with Parkinson's disease in Iceland.

The oral and dental health of patients with Parkinson's disease (PD) has not been well documented and the findings are conflicting. Patients with PD were invited to take part in a clinical and radiographic examination together with a comparison control group of persons who were a spouse or family member. Subjects (n = 67) and controls (n = 55) were examined and compared. Subjects with PD had more missing teeth, caries, dental plaque, and poorer periodontal health. Counts of cariogenic bacteria in saliva were significantly higher for subjects with PD. They did not consume more sweets or sugar, did not brush less frequently, used dental floss more than controls, and visited the dentist at least as often. Salivary flow levels were comparable between subjects with PD and controls. The lack of muscular control may explain the poorer oral health of patients with PD. Dentists and patients with PD may be reluctant to embark on complex dental procedures, and this may explain the increased number of missing teeth in persons with PD in this study.

Development of occlusal traits and dental arch space from adolescence to adulthood: a 25-year follow-up study of 245 untreated subjects.

INTRODUCTION: The purpose of this study was to examine longitudinally the development of specific occlusal traits and space conditions in an Icelandic sample. METHODS: The sample comprised 245 adolescents examined clinically in the late mixed or permanent dentition and again 25 years later. All subjects were orthodontically untreated, and all had the full complement of teeth at both examinations. RESULTS: A significant increase in the prevalence of mandibular anterior crowding and mesial molar relationships and a decrease in the prevalence of excessive overjet and maxillary anterior spacing were seen. The persistence of malocclusion traits ranged from 17.9% to 53.4% for maxillary anterior spacing and crowding, mandibular spacing, overjet, overbite, and distal molar occlusion, whereas anterior mandibular crowding and molar crossbite were still found in 72.7% and 75.0%, respectively, at the second examination. Normal occlusal traits and space conditions at adolescence stayed mostly unchanged, with the exception of 11.2% of the subjects, who developed mandibular anterior crowding between the first and second examinations. CONCLUSIONS: Deterioration of normal occlusal traits and space relationships was uncommon in this study, whereas self-correction of malocclusion traits and space anomalies was relatively frequent.

Dental erosion in Icelandic teenagers in relation to dietary and lifestyle factors.

High consumption of fruit juices and carbonated drinks has been related to dental erosion. Teenage male Icelanders consume about 800 ml of carbonated drinks per day on average and this corresponds with the main age group and gender of patients seen with erosion. This study examined the prevalence of dental erosion in 15-year-old children in Reykjavík and looked at the association between erosion and some lifestyle factors in a case-control study drawn from the same sample. A 20% sample of the 15-year-cohort population (n = 278) was selected. Dental erosion was classified by location and severity (1 = enamel erosion; 2 = dentine erosion; 3 = severe dentine erosion) and was seen in 21.6% of subjects (68.3% male; 72% scored as grade 1; 23% grade 2; 5% grade 3). Control subjects were the first healthy subjects examined after a case subject had beens diagnosed. In the case-control study, information was gathered by multiple-choice questionnaire on symptoms of gastric reflux, tooth sensitivity, some lifestyle and dietar-factors. Several lifestyle and dietary factors, previously shown to be significantly related to dental caries in Icelandic teenagers, showed no significant relationship to tooth erosion. Although dietary factors are probably important in causing erosion, dietary recall questionnaires did not help in discovering individuals likely to develop erosion.