Nutritional Assessment of Denture Wearers Using Matched Electronic Dental-Health Record Data.

PURPOSE: To assess the nutritional profile of denture wearers through a retrospective cohort study using nutritional biomarkers from matched electronic dental and health record (EDR-EHR) data. MATERIALS AND METHODS: The case group (denture wearers) included matched EDR-EHR data of patients who received removable partial, complete, and implant-supported prosthodontic treatments between January 1, 2010 and December 31, 2018, study time. The control (nondenture wearers) group did not have recorded denture treatments and included patient records within 1 year of the denture index date (first date of case patients' receiving complete or partial denture) of the matching cases. The qualified patients' EDR were matched with their EHR based on the availability of laboratory reports within 2 years of receiving the dentures (index date). Nutritional biomarkers were selected from laboratory reports for complete blood count, comprehensive and basic metabolic profile, lipid, and thyroid panels. Summary statistics were performed, and general linear mixed effect models were used to evaluate the rate of change over time (slope) of nutritional biomarkers before and after the index date. Likelihood ratio tests were performed to determine the differences between dentures and controls. RESULTS: The final cohort included 10,481 matched EDR-EHR data with 3,519 denture wearers and 6,962 controls that contained laboratory results within the study time. The denture wearers' mean age was 57 ±10 years and the control group was 56 ±10 years with 55% females in both groups. Pre-post analysis among denture wearers revealed decreased serum albumin (p = 0.002), calcium (p = 0.039), creatinine (p < 0.001) during the post-index time. Hemoglobin (Hb) was higher pre-index, and was decreasing during the time period but did not change post-index (p < 0.001). Among denture wearers, completely edentulous patients had a significant decrease in serum albumin, creatinine, blood urea nitrogen (BUN), but increased estimated glomerular filtration rate (eGFR). In partially edentulous patients, total cholesterol decreased (p = 0.018) and TSH (p = 0.004), BUN (p < 0.001) increased post-index. Patients edentulous in either upper or lower arch had decreased BUN and eGFR during post-index. Compared to controls, denture wearers showed decreased serum albumin and protein (p = 0.008), serum calcium (p = 0.001), and controls showed increased Hb (p = 0.035) during post-index. CONCLUSIONS: The study results indicate nutritional biomarker variations among denture wearers suggesting a risk for undernutrition and the potential of using selected nutritional biomarkers to monitor nutritional profile.

Effect of a nano-hydroxyapatite paste on bleaching-related tooth sensitivity.

STATEMENT OF THE PROBLEM: Bleaching-related tooth sensitivity has been shown to be facilitated by the presence of enamel defects. A nano-hydroxyapatite (n-HAP) paste has been shown to repair these defects. PURPOSE OF THE STUDY: Using a randomized clinical trial, an n-HAP paste was investigated to determine its efficacy in reducing bleaching-related tooth sensitivity. METHODS AND MATERIALS: An n-HAP paste (Renamel AfterBleach, Sangi Co., Ltd., Tokyo, Japan) and a placebo (zero-HAP) were randomly assigned for use in 42 participants. A 7% hydrogen peroxide gel was used twice daily for 14 days, with use of assigned desensitizer for 5 minutes immediately following. A diary was completed daily for 4 weeks to note: use of the agents and sensitivity on a visual analog scale (VAS). Three aspects of tooth sensitivity were investigated: percentage of participants; number of days; and intensity level. Color change was assessed. RESULTS: For Groups zero-HAP and n-HAP, respectively, 51 and 29% of participants reported tooth sensitivity (p = 0.06). Days of sensitivity were 76 and 36, respectively (p = 0.001). Change in VAS score from baseline trended higher for group zero-HAP (p = 0.16). Color change was equivalent. DISCUSSION: The data trend indicated group n-HAP experienced less sensitivity over all three measures. Only the number of days of sensitivity was statistically significant. CONCLUSION: Within the limits of the study it can be concluded that the use of the n-HAP paste was associated with a statistically significant reduction in the number of days of tooth sensitivity experienced during active bleaching. CLINICAL RELEVANCE: For those using a tooth whitener without a desensitizing agent, this study indicates that a paste containing nano-hydroxyapatite crystal can effectively reduce the duration of tooth sensitivity.

Effect of bleaching on fracture toughness of resin composites.

This study determined the effect of bleaching agents on the fracture toughness of composite materials. Four nanofilled resin composites were evaluated: Filtek Supreme Plus, Tetric EvoCeram, Premise and Esthet-X. Four concentrations of bleaching agents were tested: Opalescence PF 10%, 20%, 35% and 45%. Fifty specimens of each composite conforming to ASTM guidelines for the single edge notch bar-shaped specimen were fabricated in a metal mold. The specimens were stored in artificial saliva at 37 degrees C for a minimum of 24 hours prior to exposing them to the bleaching agents. Ten specimens of each material were used as controls. Forty specimens of each brand were evenly divided into four groups for bleaching agent application (n = 10). The resin composites were bleached on both sides for 14 days. The specimens were then subjected to a three-point bending test with a crosshead speed of 0.2 mm per second. The fracture toughness (K(Ic)) was calculated. The control group K(Ic) value of Esthet-X was significantly higher than that of the other composites in the controlled groups. Bleaching agents significantly improved the fracture toughness values of Filtek Supreme Plus. The application of bleaching agents did not significantly change the fracture toughness values of the other nanofilled resin composites tested.