Association between longitudinal tooth fractures and visual detection methods in diagnosis.

OBJECTIVES: This study investigated the distribution of longitudinal tooth fractures (LTFs) according to the patient's age and analyzed the association between visual detection methods and the types of LTFs. METHODS: Patients with symptomatic teeth with LTFs were examined at the department of conservative dentistry in a dental hospital from September 1, 2009 to March 31, 2014. Naked eye examination, staining with a dye, operating microscopy, transillunimation, and periapical radiography were used to identify the fracture lines. Diagnostic surgery was performed to visualize the fracture line in some cases with vertical root fractures. The final diagnosis was based on the American Association of Endodontists (AAE) classification: cracked tooth, fractured cusp, split tooth, and vertical root facture. The probability density function for each type of LTF was calculated to assess the risks of LTF development according to age. The association between the detection methods and types of LTFs was identified using the association plot. RESULTS: A total of 245 teeth with LTFs were enrolled. Overall, 71.8% of LTFs was observed in patients aged 40-69 years, and 65.7% of LTFs were diagnosed as cracked teeth. The mean age in patients with cracked teeth was 49.3 years, while the mean age in patients with fractured cusps was 59.1 years. A significant association was observed between the detection method and type of LTF (p < 0.001). CONCLUSIONS: Cracked tooth was the most common type of LTF. The probability of occurrence of cracked teeth peaked in patients aged approximately 50 years, while the probability of occurrence of fractured cusps peaked in patients aged approximately 60 years. Cracked teeth were detected most often using transillumination. CLINICAL SIGNIFICANCE: LTFs occurred mostly in patients aged 40 years and older. Transillumination is useful for the diagnosis of cracked teeth.

Does Reflective Learning with Feedback Improve Dental Students' Self-Perceived Competence in Clinical Preparedness?

The value of dental students' self-assessment is often debated. The aim of this study was to explore whether reflective learning with feedback enabled dental students to more accurately assess their self-perceived levels of preparedness on dental competencies. Over 16 weeks, all third- and fourth-year students at a dental school in the Republic of Korea took part in clinical rotations that incorporated reflective learning and feedback. Following this educational intervention, they were asked to assess their perceptions of their clinical competence. The results showed that the students reported feeling most confident about performing periodontal treatment (mean 7.1 on a ten-point scale) and least confident about providing orthodontic care (mean 5.6). The fourth-year students reported feeling more confident on all the competencies than the third-year students. Their self-perceived competence in periodontal treatment and oral medicine significantly predicted the instructors' clinical evaluations. This study offered insights into determining if structured reflective learning with effective feedback helps to increase dental students' self-perceived level of clinical preparedness.

Lipoteichoic acid of Streptococcus mutans interacts with Toll-like receptor 2 through the lipid moiety for induction of inflammatory mediators in murine macrophages.

Streptococcus mutans is a pathogenic Gram-positive bacterium that is closely associated with dental caries and subsequent pulpal inflammation. Although lipoteichoic acid (LTA) is considered a major virulence factor of Gram-positive bacteria, little is known about the innate immunity to S. mutans LTA. In this study, we purified LTA from S. mutans (Sm.LTA) through n-butanol extraction, hydrophobic interaction column chromatography, and ion-exchange column chromatography to investigate its immunological properties using murine macrophages. The Sm.LTA preparation had no detectable contamination with endotoxins, proteins, or nucleic acids. Upon exposure to Sm.LTA, the murine macrophage cell-line RAW 264.7 cells produced TNF-α and nitric oxide (NO) in a dose-dependent manner. Sm.LTA preferentially bound to and activated CHO/CD14/TLR2 cells rather than CHO/CD14/TLR4 cells, which are stable transfectants expressing CD14 and TLR2 or CD14 and TLR4, respectively. Sm.LTA could not induce TNF-α or NO production in macrophages derived from TLR2-deficient mice whereas it dose-dependently induced those inflammatory mediators in wild-type macrophages. TLR2-dependent induction of NO by Sm.LTA was also confirmed in RAW 264.7 cells using specific antibodies blocking TLR2. Furthermore, Sm.LTA deacylated by alkaline hydrolysis neither stimulated TLR2 nor induced TNF-α or NO production, suggesting that Sm.LTA lipid moieties are crucial for the immuno-stimulatory activity of Sm.LTA. Unlike Staphylococcus aureus LTA, which has potent immuno-stimulating activity, Sm.LTA showed a modest induction of NO production comparable to LTAs of other oral bacteria Enterococcus faecalis and Lactobacillus plantarum. In conclusion, our results suggest that the Sm.LTA interacts with TLR2 through the lipid moiety for the induction of inflammatory mediators in macrophages.

Heavy metal analysis of ortho MTA and ProRoot MTA.

INTRODUCTION: Recently, several kinds of mineral trioxide aggregate (MTA)-based products have been introduced in endodontics. Ortho MTA (BioMTA, Seoul, Republic of Korea) is one of those products, which was developed for retrograde filling, perforation repair, orthograde root canal obturation, and direct pulp capping. The inclusion of heavy metals in MTA-based materials is of concern because they come into direct contact with hard and soft tissues. The aim of this study was to investigate and compare the levels of arsenic (As), chromium (Cr), hexavalent chromium (Cr(6+)), and lead (Pb) in Ortho MTA and ProRoot MTA. METHODS: One gram of each MTA was digested using a mixture of hydrochloric and nitric acids and filtered. The As, Cr, and Pb in the resulting filtrates were analyzed by inductively coupled plasma-optical emission spectrometry. The level of Cr(6+) was measured by the methods suggested in the Korean Standard L 5221. The results were statistically analyzed using the Mann-Whitney U test. RESULTS: The concentration of As in ProRoot MTA was 1.16 ppm, but As was not detected in Ortho MTA. Cr(6+) and Pb were not detected in either MTA. Ortho MTA contained significantly less Cr than ProRoot MTA (P < .05). CONCLUSIONS: Ortho MTA and ProRoot MTA meet the ISO specification 9917-1 regarding the safety limits of As and Pb and are safe biomaterials when the purity of As, Cr(6+), and Pb is considered.

Identification of Porphyromonas gingivalis lipopolysaccharide-binding proteins in human saliva.

Porphyromonas gingivalis causes periodontal diseases and its lipopolysaccharide (LPS) is considered as a major virulence factor responsible for pathogenesis. Since initial recognition of P. gingivalis LPS (Pg.LPS) in the oral cavity might be crucial for the host response, we identified Pg.LPS-binding proteins (Pg.LPS-BPs) using Pg.LPS-immobilized beads and a high-resolution mass spectrometry. LPS purified from P. gingivalis was conjugated onto N-hydroxysuccinimidyl-Sepharose(®) 4 Fast Flow beads. Notably, Pg.LPS-conjugated beads could stimulate Toll-like receptor 2 (TLR2) as determined by a TLR2-depdendent reporter expression system using CHO/CD14/TLR2. In addition, the Pg.LPS-conjugated beads induced the production of inflammatory mediators such as nitric oxide and interferon-gamma-inducible protein-10 in the macrophage cell-line, RAW 264.7. These results imply that Pg.LPS retained its immunological properties during the conjugation process. Then, the Pg.LPS-conjugated beads were mixed with a pool of saliva obtained from nine human subjects to capture Pg.LPS-BPs and molecular identities were determined by LTQ-Orbitrap hybrid fourier transform mass spectrometry. Pg.LPS-BPs captured at high frequencies included alpha-amylase, cystatin, prolactin-inducible protein, lysozyme C, immunoglobulin components, serum albumin, lipocalin-1, and submaxillary gland androgen-regulated protein 3B. These proteins are known to be involved in bacterial adhesion and colonization, anti-microbial functions or modulation of immune responses.