Periodontal complications with age.

The present literature review on periodontal complications in aging focuses on the diagnosis, etiology and development of periodontal complications as a complete entity. In addition, the review also focuses on some of the common systemic diseases that either may further add to periodontal complications or, as result of anti-inflammatory treatment, limit the expression of periodontal disease. There is no evidence to suggest that clinical methods to provide periodontal therapies have been developed especially for older individuals. There is evidence that aging can be associated with periodontally healthy conditions through life and with a high level of tooth retention and function. Periodontal complications that are difficult to manage are usually associated with concurrent medical diseases and complications, or with socio-economic factors that limit the ability to provide dental care for the aging population. Currently, some systemic medical conditions are managed with anti-inflammatory medications with positive effects, while slowing the progression and expression of chronic periodontitis. The lack of data from clinical studies on how to manage periodontal complications in aging is obvious.

Dental care in patients with antiphospholipid syndrome: two case reports.

Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disease that may be classified as primary or secondary. Treatment consists of oral anticoagulant, antiplatelet, and/or immunosuppressant drugs. This report describes the dental treatment of 2 women with APS and multiple dental concerns, including periodontal disease, caries, and missing teeth. The invasive dental procedures were performed in an outpatient setting with hematologic monitoring and use of local hemostatic measures. Neither interruption of anticoagulant medications nor administration of blood products was necessary. All of the procedures were performed without complications. To date, no recommendations for the dental care of patients with APS have been established, demonstrating a need to investigate the risks for bleeding and infection, among other concerns, during dental treatment of these patients.

Are sickle cell anaemia and sickle cell trait predictive factors for periodontal disease? A cohort study.

BACKGROUND AND OBJECTIVE: Periodontal diseases are associated with bacterial challenge and the host immune response, and are also modulated by genetic factors. There is evidence that sickle cell anaemia (SCA) does not represent a risk factor for periodontal diseases. However, it is still unclear whether the heterozygous condition [sickle cell trait (SCT)] is associated with periodontal diseases. SCT is a genetic condition that can cause vaso-occlusive events, which may be associated with a propensity to bacterial infections. The aim of this study was to investigate the association of SCA and SCT with periodontal diseases by evaluating clinical and radiographic characteristics. MATERIAL AND METHODS: The sample (n = 369) was selected and divided into two groups: exposed groups [HbSS (SCA genotype) and HbAS (SCT genotype) = 246] and a nonexposed group (HbAA = 123). HbAA consisted of individuals without SCA and SCT. The clinical parameters evaluated were plaque index, gingival index, calculus index, clinical probing depth, clinical attachment level, gingival recession, tooth mobility and furcation involvement. The percentage of alveolar bone loss was measured using a Schei ruler. Binomial and Poisson regressions were used to estimate correlations of interest (α = 0.05). RESULTS: None of the periodontal parameters was associated with SCA. SCT was associated with gingivitis (p = 0.041) and periodontitis (p = 0.002). Individuals with SCT had a lower plaque index (p = 0.044) but a higher calculus index (p = 0.003) and greater alveolar bone loss (p = 0.010) compared with subjects in the HbAA group. CONCLUSIONS: SCT can act as a predictor for establishment of periodontal diseases. There was no correlation between SCA and periodontal diseases.

Orthodontic Treatment in Adult Patient with Reduced Periodontium: A Case Report.

Patients presenting reduced periodontium represent a major concern for orthodontists. The purpose of this article is to present the clinical case of an adult patient who presented sequel of periodontal disease (diastemas) compromising her dental aesthetics. She was subjected to an orthodontic treatment with the application of light forces distant from the teeth with reduced periodontium. A periodontal support therapy was successfully implemented. The final stage of the treatment indicated satisfactory occlusal and periodontal characteristics.

Biomechanical considerations in mandibular incisor extraction cases.

Mandibular incisor extraction can be regarded as a valuable treatment option in certain malocclusions to obtain excellence in orthodontic results in terms of function, aesthetics and stability. This treatment alternative is indicated in clinical situations like mild to moderate class III malocclusion, mild anterior mandibular tooth size excess, periodontally compromised teeth, ectopic eruption of mandibular incisor and minimal openbite tendencies. Unlike in premolar extraction cases, space closure in mandibular incisor extraction cases is unique in which the extraction space will be in the middle of the arch. The end result of space closure in these cases should be well aligned, upright, anterior teeth with parallel roots and the goal can be achieved with the bodily tooth movement through proper application of biomechanics. The purpose of this article is to explain the biomechanics of space closure in mandibular incisor extraction cases.

Root caries: a periodontal perspective.

BACKGROUND AND OBJECTIVE: A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs. MATERIAL AND METHODS: The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders. RESULTS: Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking. CONCLUSION: Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.

Association of gingival recession and other factors with the presence of dentin hypersensitivity.

Dentin hypersensitivity (DH) may be present in association with gingival recession. The aim of this study was to determine quantitatively the association of gingival recession and other factors with the presence of DH. One hundred and four Japanese subjects with or without gingival recession were randomly selected. Intact canines and/or first premolars in both maxillary and mandibular quadrants were analyzed. Gingival recession was measured as a vertical length at the buccal site of the teeth. DH was recorded as an ordered categorical variable registering four increasing levels of pain after cold stimulation; from no discomfort to severe pain during and after stimulation (DH1, 2, 3, and 4). Association of DH with periodontal parameters and daily lifestyle was also investigated. Tooth-based analysis of 446 teeth from 104 subjects revealed that DH level was significantly higher in recessive teeth (1, 2, 3, and 4-8 mm) than in non-recessive teeth (0 mm). DH-positive rate in non-recessive teeth was only 18 % (DH1; 14 %, DH2; 3 %, and DH3; 1 %). Highest DH level was observed in teeth with severe recession (4-8 mm), showing DH0; 21 %, DH1; 33 %, DH2; 31 %, and DH3; 15 %. Recession-dependent increase in DH was observed, showing 18, 49, 52, 60, and 79 % DH-positive in teeth with 0, 1, 2, 3, and 4-8 mm recession, respectively. Plaque-free teeth showed a higher DH level than plaque-stained teeth, suggesting that good plaque control may be associated with the presence of DH. There were no significant differences in DH of teeth on the basis of smoking, probing depth, and bleeding on probing. Multiple logistic regression analysis revealed that gingival recession [odds ratio (OR) = 10.2, 95 % confidence interval (CI) = 5.5-18.9] and plaque deposition (OR = 0.3, 95 % CI = 0.2-0.5) were significant contributors to DH. Multilevel modeling analysis revealed that not only gingival recession and plaque deposition but also V-shaped cervical notch and tooth brushing frequency were associated with DH. These results demonstrate that the progression of gingival recession, plaque-free teeth, V-shaped cervical notch, and frequent brushing may be significant predictors of DH in canines and first premolars.

Collaborative management of a young patient with generalized aggressive periodontitis.

What are the orthodontic treatment possibilities, limitations and risks inherent in patients with periodontal disorders, particularly active periodontal disease? This case report describes the interface between orthodontics, periodontics and restorative dentistry in the management of a 25-year-old young man with generalized aggressive periodontitis.

Cervical dentin hypersensitivity: a cross-sectional investigation in Athens, Greece.

The purpose of this study was to identify the prevalence of cervical dentin hypersensitivity in a cross-sectional investigation of Greek adults. Seven hundred and sixty-seven subjects were examined. Participants were patients processed for first examination in the Clinic of Oral Diagnosis and Radiology at the Faculty of Dentistry, University of Athens. The evaluation of hypersensitivity was performed using two methods: for each tooth, the response to a) tactile stimulus and b) air-blast stimulus was measured. Additional factors such as smoking habits, oral health behaviour, consumption of acidic foods, type of toothbrush, daily use of fluoride solution and of desensitising toothpaste, gingival recession and non-carious cervical lesions were recorded and evaluated as causative factors. Descriptive statistics on the demographics of the study sample, of oral health behaviour characteristics and of oral examination findings were performed. Comparisons of these characteristics in the presence or absence of hypersensitivity were conducted with the chi-square test. Data were further analysed using multiple logistic regression modelling. Among study participants, 21·3% had at least one cervical dentin hypersensitivity reaction to the tactile stimulus, and 38·6%, to the air-blast stimulus. Multivariate analysis detected association of the hypersensitivity in tactile or air-blast stimulus with the non-carious lesions and with the gingival recessions. Additionally, a relation between hypersensitivity and air-blast stimulus with gender (female) was found. There was no association between the hypersensitivity in both of the stimuli and the level of education, smoking, consumption of acidic foods, type of toothbrush and daily use of fluoride solution or desensitising toothpaste. The overall prevalence of cervical dentin hypersensitivity in the adult population in Athens ranged from 21·3% to 38·6% depending on the type of stimuli. Cervical non-carious lesions and gingival recessions were determined as significant predictors of dentin hypersensitivity.

Six-year follow-up of maxillary anterior rehabilitation with forced orthodontic extrusion: achieving esthetic excellence with a multidisciplinary approach.

Orthodontic extrusion with multidisciplinary treatment can provide predictable outcomes in selected situations, reducing the costs and the adaptation times of gingival tissues after implant integration. Forced orthodontic extrusion is strongly related to interactions of teeth with their supportive periodontal tissues. This article reports a case of orthodontic extrusion of the maxillary incisors for later implant rehabilitation in a patient with periodontal disease. Slow forces were applied for 14 months. After this time, the teeth were extracted, and the implants were placed on the same day. Also in the same session, the provisional crown was fabricated for restoration of the anterior maxillary interdental papillae loss and for gingival contouring. Clinical and radiographic examinations at the 6-year follow-up showed successful tooth replacement and an improved esthetic appearance achieved by this multidisciplinary treatment. The decision to perform orthodontic extrusion for implant placement in adult patients should be multidisciplinary.

Dentine hypersensitivity--guidelines for the management of a common oral health problem.

UNLABELLED: Dentine hypersensitivity (DHS) remains a worldwide under-reported and under-managed problem, despite making some dental treatments more stressful than necessary and having a negative impact on the patient's quality of life. This article is designed to build dental professionals' confidence and remove any confusion regarding the diagnosis, prevention and treatment of sensitive teeth caused by dentine hypersensitivity in those patients known to be at risk. There is a need for simple guidelines, which can be readily applied in general practice. However, it is also obvious that one strategy cannot suit all patients. This review describes a DHS management scheme for dental professionals that is linked to management strategies targeted at three different groups of patient. These patient groups are: 1) patients with gingival recession; 2) treatment patients with toothwear lesions; and 3) patients with periodontal disease and those receiving periodontal treatment. The authors also acknowledge the role of industry as well as dental professionals in a continuing role in educating the public on the topic of sensitive teeth. It is therefore important that educational activities and materials for both dental professionals and consumers use common terminology in order to reduce the possibility for confusion. CLINICAL RELEVANCE: This review article provides practical, evidence-based guidance on the management of dentine hypersensitivity for dental professionals covering diagnosis, prevention and treatment. Sensitivity associated with gingival recession, toothwear and periodontal disease and periodontal treatment are specifically addressed in the article.

[Salvage of a tooth with necrotised periodontium, caused by endodontic use of radiosurgery. Long-term results. Case report]. / Rádiósebészeti technikával gyökérkezelt fog körül kialakult parodontális nekrózis kezelése es a fog megmentése. Hosszú távú eredmények. Esetismertetés.

Electrosurgery and radiosurgery bear certain popularity in contemporary dentistry. Nevertheless, the inadequate treatment allocation may lead to tissue necrosis. A young female patient was referred to our department following root canal treatment (RCT) by radiosurgical device. Necrotised alveolar bone, lack of keratinized gingiva and increased tooth mobility were noticed. After considering all the treatment options, we attempted to keep the tooth. Therefore, the necrotised part of the alveolar process was removed and the gingival fringe was rejuvenated alongside root surface debridement. The tooth was then splinted with glass fibre reinforced composite and appropriate RCT was completed. After ten months of improvement periodontal reconstructive surgery with deproteinized bovine bone mineral and connective tissue graft was carried out. Substantial improvement was observed at the six month reassessment, including complete healing of the gingiva. The composite splint was then removed due to discontinued mobility. The tooth and the adjacent periodontium remained stable for seven years. Nevertheless, external root resorption was recently developed that was treated with glass ionomer cement filling and regenerative periodontal surgery using enamel matrix derivative (EMD). Ultimately, the tooth is still in place providing satisfactory function and aesthetics.

Polymorphisms and haplotypes of TLR-4/9 associated with bacterial infection, gingival inflammation/recession and oral cancer.

BACKGROUND: The expression and SNPs of innate immunity genes TLR-4/9 for bacterial infection, gingival inflammation/gingival recession (GIGR), and oral squamous cell carcinoma (OSCC) are largely unknown. PATIENTS AND METHOD: 235 specimens (120 OSCC cases, among which 85 cases with either Porphyromonas gingivalis, Fusobacterium nucleatum or Treponema denticola infection and GIGR) and 115 healthy controls were used to know the expression and polymorphisms (TLR-4: N1:rs10759931, N2:rs11536889, N3:rs1927911, N4:rs4986790; TLR-9: N5:rs5743836, N6:rs352140, N7:rs187084 and N8:rs352139) of TLR-4/9 by western blot, RT-PCR, and allele-specific (AS)-PCR followed by sequencing. RESULTS: Increased TLR-4/9 mRNA/protein expression, bacterial infection (BI) and GIGR were associated with OSCC incidence. One of the three BI and GIGR was observed in 70.83% of OSCC cases, whereas all the HC used were free from any of these three BI/GIGR. The N3: CT-genotype (Odds Ratio hereafter as O.R.=1.811, p = 0.0338), TT-genotype (O.R.=3.094, p = 0.0124), 'T'-allele (O.R.=1.821, p = 0.003), N4: AG-genotype (O.R.=2.015, p = 0.0222) and 'G'-allele (O.R.=1.86, p = 0.018) of TLR-4 as well as the N5: CC-genotype (O.R.=3.939, p = 0.0017), 'C'-allele (O.R.=1.839, p = 0.0042), N6: AA-genotype (O.R.=2.195, p = 0.0234), 'A'-allele (O.R.=1.569, p = 0.0163), N7: TC-genotype (O.R.=2.083, p = 0.0136), CC-genotype (O.R.=2.984, p = 0.003) and 'C'-allele (O.R.=1.885, p = 0.0008) of TLR-9 were associated with increased OSCC risk. Similarly, the N2:'C'-allele (O.R.=1.615, p = 0.0382), N3: TT-genotype (O.R.=2.829, p = 0.0336), 'T'-allele (O.R.=1.742, p = 0.0115), N4: AG-genotype (O.R.=2.221, p = 0.0147) and 'G'-allele (O.R.=1.890, p = 0.0238) of TLR-4 as well as the N5: CC-genotype (O.R.=2.830, p = 0.031), N6: AA-genotype (O.R.=2.6, p = 0.0122) and 'A'-allele (O.R.=1.746, p = 0.0064), N7:CC-genotype (O.R.2.706, p = 0.0111) and 'C'-allele (O.R. 1.774, p = 0.0055) of TLR-9 were correlated with GIGR and BI. TLR-4 (N1-N2-N3-N4: A-C-T-A (O.R.=2.1, p = 0.0069) and TLR-9 (N5-N6-N7-N8: T-A-C-A (O.R.=2.019, p = 0.0263); C-A-C-A (O.R.=6.0, p = 0.0084); C-A-C-G (O.R.=4.957, p = 0.0452) haplotypes were linked with OSCC vulnerability, while the TLR-4 (N1-N2-N3-N4: G-C-C-A (O.R.=0.5752, p = 0.0131) and TLR-9 (N5-N6-N7-N8: T-G-T-A (O.R.=0.5438, p = 0.0314); T-G-T-G (O.R.=0.5241, p = 0.036) haplotypes offered protection. CONCLUSION: TLR-4/9 expression, polymorphisms, and BI-induced GIGR could increase OSCC risk. This may be used in pathogenesis and oral cancer prediction.

Regenerative periodontal therapy of infrabony defects using minimally invasive surgery and a collagen-enriched bovine-derived xenograft: a 1-year prospective study on clinical and aesthetic outcome.

AIM: To evaluate the clinical and aesthetic outcome of regenerative periodontal therapy (RPT) using minimally invasive surgery and a collagen-enriched bovine-derived xenograft (1); to identify risk factors for failure (clinical attachment level (CAL) gain ≤ 1 mm) and advanced gingival recession (REC) increase (>1 mm) (2). MATERIAL AND METHODS: Ninety-five non-smoking patients, with ≤ 25% full-mouth plaque and bleeding presenting ≥ 6 months after initial periodontal therapy with ≥ 1 isolated inter-dental infrabony defect were recruited. Patients were consecutively treated by the same clinician using minimally invasive surgery and a collagen-enriched bovine-derived xenograft. Clinical, radiographic and aesthetic data were collected before surgery and up to 1 year. Multivariate analyses were used to identify risk factors for failure and advanced REC increase. RESULTS: Eighty-four patients (39 men, 45 women; mean age 53) complied and demonstrated mean probing depth (PD) of 7.8 mm, CAL of 10.0 mm and defect depth of 5.2 mm before surgery. At 1 year, postsurgery mean PD reduction was 3.5 mm (range 0.0-8.0), CAL gain was 3.1 mm (range 0.0-7.0) and radiographic defect fill was 53% (range 0-100). Forty-nine percentage showed ≥ 4 mm CAL gain, whereas 15% were considered failures. Mean inter-dental and midfacial REC increase was 0.3 mm (range-2.0-2.0) and 0.5 mm (range-1.5-2.0) respectively. Midfacial REC increase and contour deterioration contributed most to a small, yet significant reduction in the Pink Esthetic Score from 10.06 to 9.42 (p = 0.002). Risk factors for failure included defects with a non-supportive anatomy (OR: ≥ 10.4), plaque (OR: 14.7) and complication(s) (OR: 12.0). Risk factors for advanced midfacial REC increase included defects with a non-supportive anatomy (OR: 58.8) and a thin-scalloped gingival biotype (OR: 76.9). CONCLUSIONS: RPT using minimally invasive surgery and a collagen-enriched bovine-derived xenograft demonstrated favourable clinical outcome after 1 year, even though soft tissue aesthetics could not be fully preserved. Defects with a non-supporting anatomy may be at risk for failure and advanced midfacial recession.

The relationship between osteoporosis and periodontitis in women aged 45-70 years.

OBJECTIVE: To explore the possible relationship between the osteoporotic condition and the severity of periodontitis in women aged 45-70 years. MATERIALS AND METHODS: Ninety women with generalized chronic periodontitis, aged 45-70 years, were studied. Areal bone mineral density (BMDa) was assessed using standardized dual energy X-ray absorptiometry (normal: T-score ≥ -1, osteopenic: -2.5 ≤ T-score <-1, osteoporotic: T-score < -2.5). Gingival index (GI), bleeding on probing, clinical attachment loss (CAL), probing pocket depth and gingival recession (GR) were recorded. Periodontitis severity was represented by CAL. Menopausal condition and smoking were documented. RESULTS: Mean GI, bleeding on probing, CAL and GR were significantly greater for osteoporotic women than women with normal BMDa (P = 0.002, P = 0.01, P = 0.04, respectively). Osteopenic women and women with normal BMDa significantly differed in mean GI (P = 0.02). The associations found between osteoporotic women and women with normal BMDa and the associations found between osteopenic women and women with normal BMDa existed even after adjusting for smoking and menopausal status. CONCLUSION: Subjects with osteoporosis (OPR) presented with greater CAL than the subjects with normal BMDa, which suggests a greater severity of periodontitis. Subjects with OPR had greater GR than the subjects with normal BMDa. Subjects with osteopenia and subjects with normal BMDa did not differ in CAL, which might suggest that the early diagnosis of reduced BMDa, prior to the establishment of a significant negative impact on the periodontal tissues, might be important. Smoking and menopausal status did not alter these associations.

An analysis of the aetiology, prevalence and clinical features of dentine hypersensitivity in a general dental population.

AIM: Dentine hypersensitivity may be defined as pain arising from exposed dentine typically in response to chemical, thermal or osmotic stimuli that cannot be explained as a rising from any other form of dental defect or pathology. The aim to this cross-sectional study was to determine prevalence of dentine hypersensitivity (DH) and to examine some associated etiological factors in a study of patients visiting general dental practitioners in Turkey. PATIENTS AND METHODS: A total of 1368 patients were examined for the presence of cervical dentine hypersensitivity by means of a questionnaire and intraoral tests by (air and probe stimuli). The patients have at least two different quadrants which have sensitive teeth with sound exposed cervical dentin on the facial surface were included the study. RESULTS: A total of 285 teeth were diagnosed as having dentine hypersensitivity in 73 patients, giving an overall prevalence figure for dentine hypersensitivity of 5.3%. 40-49 years age group was the cohort with the greatest number of subjects with DH and females had more predilection than males. Upper premolars were most affected and the commonest initiating factor was cold drinks. Subjects who smoked did not have more sensitive teeth on average than subjects who did not smoke (p > 0.05). Approximately half of the patients reported DH for a duration of within 1-3 days. The commonest etiological factor with the sensitive teeth was the gingival recession. CONCLUSIONS: The prevalence of dentine sensitivity in this sample was lower compared to studies carried out previously in different populations both general practice and hospital clinics. Further larger scale studies are required to assess its prevalence in Turkish population.

Gingival recession associated with noncarious cervical lesions: combined periodontal-restorative approach and the treatment of long-term esthetic complications.

Buccal gingival recession is a prevalent problem in populations with a high standard of oral hygiene and is often associated with noncarious cervical lesions (NCCLs), leading to the need for a combined periodontal-restorative approach for better esthetic and functional results. In the literature, resin-modified glass ionomer (RMGI) restorations associated with periodontal surgery have been shown to achieve significant root coverage and reduction of dentin sensitivity; however, changes to the color of some of those restorations have been observed, which could compromise esthetics. Therefore, the aim of the present case report is to describe and discuss the current understanding of treatment for a gingival recession associated with an NCCL with a periodontal-restorative approach, and to describe treatment of RMGI color alteration problems two years after treatment.

Effect of bioactive glasses used as dentin desensitizers on the dentin-pulp complex in rats.

Bioactive glasses have been recommended for the occlusion of dentinal tubules in treating cervical dentin hypersensitivity. This study evaluates an in vivo model of dentin exposure, and tests the efficacy of bioglass treatments. Thirty male Wistar rats received gingival recession surgery on the upper left first molar. The treatments were applied over the surface of the exposed dentin every 4 days for 28 days. The groups were as follows: Naive; Gingival recession; Cavity varnish; Biosilicate®; Strontium bioglass; and Potassium bioglass. Changes in the dentin-pulp complex, and the presence of substance P, were evaluated through hematoxylin-eosin and immunohistochemical staining. The groups had similar results. Teeth with exposed dentinal tubules in rats showed a typical pattern in the dentin-pulp complex and immunotracing for substance P. The materials did not cause pulp damage. The effects of gingival recession and open dentinal tubules on pulp tissue require further clarification.

The effect of chlorhexidine varnish on root caries: a systematic review.

OBJECTIVE: The aim of this study was to systematically review the present literature on the effect of chlorhexidine varnish (CHX-V) on root caries. MATERIALS AND METHODS: The MEDLINE-PubMed, the Cochrane-CENTRAL and EMBASE databases were searched through December 2010 to identify any appropriate studies. Root caries incidence and root caries activity were selected as outcome variables. RESULTS: An independent screening of the unique titles and abstracts of 24 MEDLINE-PubMed, 14 Cochrane-CENTRAL and 18 EMBASE papers resulted in 6 publications that met the eligibility criteria. Data extraction provided no conclusive evidence that the application of CHX-V is effective in patients when regular professional oral prophylaxis is performed. If effective, the 40% CHX-V was found to provide a benefit over a control or fluoride varnish. CHX-V at lower concentrations (1 and 10%) may provide protection against root caries in high-risk patients (such as geriatric and xerostomia patients) in the absence of regular professional oral prophylaxis. CONCLUSION: Within the limitations of this review, it may be concluded that in the absence of regular professional tooth cleaning and oral hygiene instructions, CHX-V may provide a beneficial effect in patients in need of special care. The strength of this recommendation is graded as 'weak'.

Dentine hypersensitivity in a private practice patient population in Australia.

Although dentine hypersensitivity (DH) has been widely investigated, studies based on randomly selected general practice populations are scarce. This study aimed to examine the intra-oral distribution of DH and its association with age, sex, symptoms, stimuli, pre-disposing factors and management strategies in a private practice patient population in Australia. A randomly selected sample of 800 Australian private dental practice dentists was invited to participate in a questionnaire-based survey. A log diary about the total number of patients seen during a typical week in practice and the details of patients with DH were recorded. The details included teeth and sites involved with DH and the age and sex of people affected, symptoms, stimuli, pre-disposing factors and management strategies. The prevalence of DH was 9·1% among patients seen over the typical week with 2·3 teeth/person and 1·2 surfaces/tooth affected. Women (60·7%) were more affected than men (39·3%) whilst 30- to 49 -year-olds (48·8%) were the most common among those affected. Premolars (36·5%) and buccal surfaces (54·8%), respectively, were the most commonly affected teeth and tooth sites. Although cold stimulation (80·1%) was the commonest stimulus, dietary acid was the only stimulus that was significantly associated with DH. Gingival recession and erosion emerged as significant pre-disposing factors, whereas using desensitising toothpastes was the most important management strategy. The findings suggested that dietary acid, gingival recession and erosion were significantly associated with DH, while desensitising toothpastes was the key management strategy used for DH in this patient population.