Impact of treatment of rheumatoid arthritis on periodontal disease: A review.

BACKGROUND: Numerous studies support a bidirectional association between rheumatoid arthritis (RA), a chronic autoimmune degenerative inflammatory joint disease, and periodontitis, a chronic inflammatory disease caused by the immune reaction to bacteria organized in biofilms. RA and periodontitis are both multifactorial chronic inflammatory diseases that share common modifiable and non-modifiable risk factors. There is no cure for RA; treatment is based on lifestyle modifications and a variety of medications: nonsteroidal anti-inflammatory drugs (NSAID), glucocorticoids, and disease-modifying antirheumatic drugs (DMARDs, e.g., conventional synthetic DMARDs [csDMARDs]; biological DMARDs [bDMARD] and targeted synthetic DMARDs). There are molecular pathways of inflammation that are common to both RA and periodontitis. Thus, there is a potential effect of RA treatments on periodontitis. This systematic review aims to assess the impact of antirheumatic agents on periodontal conditions of patients suffering from both RA and periodontitis. METHODS: PubMed/MEDLINE, Cochrane Library, and Embase online databases were systematically explored, and a manual search was performed to identify relevant studies published until January 2023. This review is registered in the PROSPERO database (CRD42023409006). RESULTS: A total of 2827 articles were identified, and 35 fulfilled the inclusion criteria. The included studies generally show a consensus that, at normal dosage, NSAID and corticosteroids have negligible impact on periodontium. Similarly, csDMARD alone or in combination with other csDMARD demonstrated no adverse effect on periodontium. Monotherapy with bDMARD had a positive effect on periodontal pocket depths and gingival inflammation in the longitudinal studies up to 6 months but showed negligible effect on the periodontium in interventional studies with a longer follow-up (9 months and 15.1 months). However, the combination of tumor necrosis factor (TNF)-α inhibitors + methotrexate (MTX) was associated with a rise in gingival inflammation. Due to the considerable heterogeneity of the study designs, a meta-analysis could not reasonably be performed. CONCLUSION: Within the limitations of the available studies, there is evidence to suggest that bDMARD monotherapy may improve the periodontal condition of RA patients with periodontal disease to a certain extent; the concomitant medication of TNF inhibitor + MTX could worsen gingival inflammation. More data are required to understand the impact of RA therapies on periodontal health.

Guided endodontics versus conventional access cavity preparation: an ex vivo comparative study of substance loss.

BACKGROUND: To compare the outcomes of conventional access cavity preparation (CONV) versus guided endodontics (GE) for access cavity preparation in anterior teeth with pulp canal calcification (PCC) regarding root canal detection, substance loss, procedural time, and need for additional radiographs. METHODS: Extracted, sound human teeth with PCC (n = 108) were matched in pairs, divided into two groups and used to produce 18 models. An independent endodontist and a general dentist performed access cavity preparation under simulated clinical conditions on nine models each (54 teeth). The endodontist used the conventional technique and the general dentist GE. Time needed to access the root canals and the number of additional radiographs were recorded. Pre- and postoperative cone-beam computed tomography scans were obtained to measure substance loss. Statistical significance was tested by examining the overlap of 95% confidence intervals (CIs) between the groups. RESULTS: All root canals were successfully accessed by both methods. There were no significant differences in substance loss (CI: CONV 15.9-29.6 mm3 vs. GE 17.6-27.5mm3) or procedural time (CI: CONV 163.3-248.5 s vs. GE 231.9-326.8 s). However, 31 additional radiographs were required for GE compared to none for CONV. CONCLUSIONS: For access cavity preparation in teeth with PCC, both CONV by a specialist and GE by a general dentist produce good results in terms of substance loss and time requirements.

Impact of CBCT image quality on the confidence of furcation measurements.

BACKGROUND: To investigate the impact of scanning parameter in cone-beam computed tomography (CBCT) images on accuracy and confidence with measurements of furcation involvement (FI) in maxillary molars. MATERIAL AND METHODS: Six half cadaver heads with present maxillary molars (n = 10) were available. CBCT scans with the fixed-parameter field of view (4 × 4 cm, 12 × 17 cm) amperage and voltage (4 mA, 90 kV) and with varying scan modes (SM), that is images/scan (IS), voxel sizes (VZ) and rotation (R), were performed using one CBCT apparatus. The images were analysed by two calibrated investigators. Horizontal FI's were measured in mm or a "through and through" destruction (FI degree III) was recorded. Each rater scored the FI measurements performed in each scan as "confident" or as "not confident". Data were statistically analysed using chi-square tests. RESULTS: The agreement between CBCT FI measurements and intra-surgical FI measurements varied according to SM (SM HiSp 180°, 0.08: kappa 0.538, CI; 95%: 0.362-0.714; SM Std. 360°, 0.25: kappa 0.698, CI; 95%: 0.534-0.861). The number of measurements scored as "confident" varied according to SM (SM Std. 360°, 0.08:52 out of 60 measurements; SM Std. 360°, 0.25:16 out of 60 measurements; p < .001). CONCLUSIONS: SM of CBCT significantly affect the confidence with FI measurements in maxillary molars.

Oral disorders in patients with newly diagnosed haematological diseases.

OBJECTIVE: This study aimed to examine saliva flow rates and prevalence of dental and periodontal diseases of patients with newly diagnosed severe haematological diseases and compare these findings with age-matched controls of normal population. METHODS: A total of 149 patients diagnosed with haematological diseases aimed to be treated with haematological stem cell transplantation between 2008 and 2018 and 154 controls were included in the study. A dental examination was performed for patients within a maximum of 6 months after diagnosis. Differences were compared in terms of the stimulated salivary flow rate (SSFR); decayed, missing and filled teeth (DMFT) index; number of teeth; caries prevalence; presence of periodontitis and acute infections. RESULTS: The mean SSFR of the patient group was significantly lower (1.1 ml/min ± 0.7 ml/min) than the mean SSFR of the controls (1.3 ml/min ± 0.5 ml/min; p = 0.004). The number of caries lesions was significantly higher in the patient group (mean ± SD, 1.1 ± 1.9) than in the control group (mean ± SD, 0.4 ± 1.2; p < 0.001). There were fewer teeth and a higher DMFT index in the patient group compared to the control group, but the differences were not significant. Acute symptomatic infections were observed in eight (5.4%) patients and in none of the controls (p < 0.01). CONCLUSIONS AND CLINICAL RELEVANCE: Oral examinations in patients with newly diagnosed severe haematological disease demonstrated a higher prevalence of caries, acute infections and lower mean SSFR compared with the controls. These findings support the recommendations for early dental examination at the time of diagnosis.

Common oral diseases, hyposalivation and survival post-HSCT, a longitudinal study.

OBJECTIVES: Haematopoietic stem cell transplantation (HSCT) recipients are at risk of side effects within the oral cavity. The purpose of this study was to examine progression of common oral diseases and hyposalivation and their associations with survival in allogeneic HSCT recipients. METHODS: Two hundred and sixty nine adult HSCT recipients treated with HSCT between 2008 and 2016 were included in this study. The associations of caries, decayed, missing, filled teeth (DMFT) index, radiological attachment loss and stimulated salivary flow rate with 6-month survival and the progression of the oral disorders within 2 years were examined. RESULTS: Forty HSCT recipients (14.8%) deceased within 6 months post-HSCT. Among the deceased recipients, hyposalivation and caries were more common pre-HSCT than in recipients who survived over 6 months (P < 0.05). HSCT recipients with hyposalivation pre-HSCT had higher risk of death (HR: 1.90, 95% CI:1.00-3.60; P = 0.044) within 6 months post-HSCT compared with recipients without hyposalivation. Hyposalivation pre-HSCT was associated with a higher DMFT index score (P < 0.05) and a smaller number of teeth (P < 0.005) 24 months post-HSCT in comparison with those without hyposalivation. CONCLUSIONS: Hyposalivation and caries were associated with a lower rate of survival in HSCT recipients. Additionally, hyposalivation predisposed to deterioration of oral health post-HSCT.

Guided Endodontics versus Conventional Access Cavity Preparation: A Comparative Study on Substance Loss Using 3-dimensional-printed Teeth.

INTRODUCTION: The aim of this in vitro study was to compare endodontic access cavities in teeth with calcified root canals prepared with the conventional technique and a guided endodontics approach regarding the detection of root canals, substance loss, and treatment duration. METHODS: Six identical sets of upper and lower jaw models were produced with 3-dimensional-printed incisors that had simulated calcified root canals. Splints for guided access preparations were fabricated based on 3-dimensional surface scans and cone-beam computed tomographic data sets. Under simulated clinical conditions, 3 operators with different levels of experience prepared access cavities on each front tooth with the conventional technique and guided endodontics (8 teeth per technique and operator). Access cavities were volumetrically assessed on postoperative cone-beam computed tomographic scans. Statistical significance was tested by examining the overlap of 95% confidence intervals (CIs). RESULTS: Canal location was successful in 10 of 24 cases (41.7%) using the conventional technique and 22 of 24 cases (91.7%) with the guided approach. The mean substance loss of the conventional access and the guided access was 49.9 mm3 (95% CI, 42.2-57.6 mm3) and 9.8 mm3 (95% CI, 6.8-12.9 mm3), respectively. The treatment lasted 21.8 minutes (95% CI, 15.9-27.7 minutes) for the conventional technique and 11.3 minutes (95% CI, 6.7-15.9 minutes) for guided endodontics. The success of the guided approach was not influenced by the experience of the operator. CONCLUSIONS: Guided endodontics allows a more predictable and expeditious location and negotiation of calcified root canals with significantly less substance loss.

Common oral diseases in allogeneic haematopoietic stem cell transplantation (HSCT) recipients pre-HSCT.

OBJECTIVES: The purpose of this study was to compare the prevalence of common oral diseases between allogeneic haematopoietic stem cell transplantation (HSCT) recipients and healthy controls. MATERIALS AND METHODS: A total of 143 adult allogeneic HSCT recipients who were treated for haematological malignancies between 2008 and 2016 were included in the study. The HSCT recipients were age and sex matched with healthy controls. A dental examination was performed on the HSCT recipients prior to HSCT. Differences in stimulated saliva flow rate (SSFR), decayed, missing and filled teeth (DMFT) index, number of teeth, number of caries lesions, and measures of current or previous periodontitis (radiological attachment loss >3 mm or probing pocket depth ≥4 mm) between HSCT recipients and controls were examined. RESULTS: Stimulated saliva flow rate, DMFT index and the number of caries lesions were poorer in the HSCT recipients pre-HSCT compared to controls (all P-values <0.05). No statistically significant differences in the measures of current or previous periodontitis were observed. CONCLUSIONS: Stimulated saliva flow rate was low and caries was common in HSCT recipients prior to HSCT. Efficient preventive strategies are important in order to maintain the oral health of these patients.

Lower Educational Level is a Risk Factor for Tooth Loss - Analysis of a Swiss Population (KREBS Project).

PURPOSE: To analyse risk factors for tooth loss in women and men seeking treatment at the University of Basel, Switzerland. MATERIALS AND METHODS: Records of patients from the pool of patients at the department were consecutively screened between January 2009 and October 2011. Gender, smoking habits, education, profession, general health status and dental variables were recorded. Tooth loss was assessed on full-mouth periapical radiographs. Gender-nested logistic regression models were applied for statistical analysis. RESULTS: The sample consisted of 161 participants (4012 teeth in total, 3988 after exclusion of third molars), 80 women and 81 men, with a mean age of 48.0 ±â€¯14.6 in women and 47.7 ±â€¯12.5 in men. There were no significant differences in smoking status between men and women. Oral clinical data revealed similar gingival inflammation (BI) and number of sites with a periodontal probing depth (PPD) ≥ 5 mm among men and women. However, oral hygiene (PI) differed between men and women, with women having better oral hygiene (p < 0.01). Tooth loss increased from the front to the molar regions. A significant risk for tooth loss was associated with decreasing educational level. Compared to advanced education, individuals with 'no school graduation' showed a significantly higher risk for tooth loss in women (OR = 3.2, p = 0.02) and men (OR = 3.6, p = 0.03). Age ≥ 50 years significantly predicted tooth loss in men only (OR 2.2, p = 0.01). CONCLUSION: The results from the present study demonstrate lower educational level as a strong risk factor for tooth loss in this Swiss cohort. The educational level may need to be considered for diagnosis and treatment planning, and particularly for patient information practices to increase the patients' understanding of the development of oral diseases leading to tooth loss.

Microguided Endodontics: Accuracy of a Miniaturized Technique for Apically Extended Access Cavity Preparation in Anterior Teeth.

INTRODUCTION: The aim of this study was to assess the accuracy of guided endodontics in mandibular anterior teeth by using miniaturized instruments. This technique is designed to treat teeth with pulp canal calcifications and narrow roots by using a printed template that guides a bur to the calcified root canal. METHODS: Sixty sound mandibular anterior teeth were used in 10 mandibular models. Preoperative surface and cone-beam computed tomography scans were matched by using the coDiagnostix software. Virtual planning was performed for the access cavities, and templates were used for guidance. The templates were produced by a three-dimensional printer. Two operators performed the access cavities. A postoperative cone-beam computed tomography scan was superimposed on the virtual plan, and the deviation was measured in 3 dimensions and angles. Descriptive statistical analyses were performed, and 95% confidence intervals were calculated for both operators and each measured aspect. RESULTS: The deviations between the planned- and prepared-access cavities were low, with means ranging from 0.12 to 0.13 mm for different aspects at the base of the bur and 0.12 to 0.34 mm at the tip of the bur. The mean of angle deviation was 1.59°. A considerable overlap of the 95% confidence intervals indicated no significant difference between the operators. The mean treatment time, including planning and preparation, was approximately 10 minutes per tooth. CONCLUSIONS: Microguided endodontics provides an accurate, fast, and operator-independent technique for the preparation of apically extended access cavities in teeth with narrow roots such as mandibular incisors.

Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up.

OBJECTIVE: Determination of accessibility, time needed and outcome of endodontic treatment of teeth with calcified root canals in a sample of elderly participants in a private practice limited to endodontics. BACKGROUND: Due to demographic changes, gerodontology is becoming more and more important, also in the field of endodontology. Elderly patients can show up with severe calcifications of root canals. Root canal treatment, when needed, can be very challenging in these cases. Only few data exist about the treatment of calcified root canals and its outcome, especially in an elderly population. MATERIALS AND METHODS: Forty-one participants (median age: 72 years) needing a root canal treatment were included. The total number of treated teeth was 41 with 114 negotiated root canals. A specialist limited to endodontics performed the treatment in a private practice. Outcome was assessed by applying the periapical index score on the basis of recall radiographs provided by the referring dentists. Likewise, time required to localise the root canals was measured. RESULTS: All root canals have been detected using the operating microscope, and full working length could be established in 90% of the cases. Success rate was 80% after an observation time of 3 years. In three of five teeth, root canals could be localised within 15 min. CONCLUSION: Calcified root canals of older people treated in this study were all accessible within a maximum of 60 min. The success rate after a follow-up of 3 years was 80%.

Excess cement and the risk of peri-implant disease - a systematic review.

OBJECTIVE: The aim of this systematic review was to assess the role of excess cement as risk indicator for peri-implant diseases. MATERIAL AND METHODS: A systematic literature search with the keywords peri-implant disease, peri-implant mucositis, peri-implantitis, excess cement, cemented, and screw-retained restorations was performed for articles published by June 2016 using MEDLINE and EMBASE electronic databases, complemented by hand searching. RESULTS: The included 26 publications referring to 21 study groups were published between 1999 and 2016 and comprised 945 subjects with 1010 cemented implant restorations in 10 prospective and eight retrospective studies and eight case reports/series with pronounced heterogeneity of the study designs. Prevalence of peri-implant diseases varied between 1.9% and 75% of the implants with cemented restorations, with proportions of 33-100% associated with excess cement. In publications including early follow-ups and regular recall intervals, peri-implant disease was mostly detected at an early stage. Cofactors, such as type of abutment (standardized or individualized) and cementum medium used, did not have a significant influence, while higher prevalence of peri-implant diseases was found with immediate loading or cementation subsequent to reentry, and with cemented vs. screw-retained restorations. CONCLUSIONS: Excess cement was identified as a possible risk indicator for peri-implant diseases and was more frequently observed with soft tissue healing periods shorter than 4 weeks. To reduce the risk of peri-implant disease associated with excess cement, a crown margin at the level of the mucosal margin providing sufficient access is recommendable, and soft tissue maturation and early follow-ups after restoration placement should be assured.

Evaluation of the dental curriculum at the University of Basel. Does the Master of Dental Medicine adequately prepare for the professional practice?

The present study reports the results of a structured survey of graduates intending to evaluate the education at the Dental School of the University of Basel in the years from 2006 to 2014. In addition, dentists and practice owners supervising graduates from Basel in daily clinical routine or hiring them as assistant dentists were questioned. The aims of the current survey were (1) to analyze own subjective experiences, (2) to assess potential differences between the cohorts prior to and after the implementation of the Bologna reform, (3) to compare the rating regarding theoretical knowledge and practical skills, and (4) to disclose potential for improvement. It was found that according to both their own assessment and the rating of the practice owners, graduates possess the basic dental expertise. The alumni rated their theoretical knowledge higher than their clinical practical skills and indicated a potential for intensification in the fields of dental surgery and implantology. When comparing the cohorts who had completed their studies according to the old (until 2010) and new study regulations, there were only minor differences; the own skills related to patient information about treatments were better rated by alumni who had been trained according to the new study regulations. The curriculum leading to the Master of Dental Medicine at the University of Basel fundamentally prepares graduates for the professional activity, but the additional acquisition of clinical experience in daily practice is indispensable.

Influence of time, toothpaste and saliva in the retention of Streptococcus mutans and Streptococcus sanguinis on different toothbrushes

Objectives: The intraoral transmission of cariogenic and periodontopathogenic species seems to be facilitated by contaminated toothbrushes and other oral hygiene devices. The aim of this investigation was to analyze the in vitro retention and survival rate of Streptococcus mutans and Streptococcus sanguinis on different toothbrushes. The impacts of human saliva and antimicrobial toothpaste on these parameters were further evaluated. Material and Methods: Part I: Four toothbrushes (Colgate 360°, Curaprox CS5460 ultra soft, elmex InterX, Trisa Flexible Head3) were contaminated by S. mutans DSM 20523 or S. sanguinis DSM 20068 suspensions for three minutes. Bacteria were removed from the toothbrushes after either three minutes (T0) or 24 hours (T24) of dry storage and grown on Columbia blood agar plates for the quantification of colony-forming units (CFUs). Part II: The effects of saliva from a caries-active or a caries-inactive person and of toothpaste containing 0.12% chlorhexidine digluconate were also tested. Results: Part I: After three minutes of dry storage, approximately one percent of the bacteria were still detectable on the toothbrushes. After 24 hours, S. sanguinis exhibited a more pronounced decrease in viable cell numbers compared with S. mutans but the differences were not significant (Kruskal-Wallis test, p>0.05). Part II: The addition of human saliva from a caries-active or caries-inactive person slightly increased the retention of both streptococcal species at T0. The use of toothpaste had no influence on the amount of viable streptococci at T0, but it reduced the microbial load after 24 hours of storage. There were only slight nonsignificant differences (p>0.05) between the four toothbrushes. Conclusions: In vitro bacterial retention and survival of S. sanguinis and S. mutans on different toothbrushes occurred. Within the limitations of this study, the use of human saliva or an antimicrobial toothpaste ...

Treatment of periodontal-endodontic lesions--a systematic review.

BACKGROUND: The treatment of periodontal-endodontic lesions is challenging due to the involvement of both periodontal and endodontic tissues. OBJECTIVE: To evaluate the treatment options and outcomes of periodontal-endodontic lesions. MATERIAL AND METHODS: A systematic literature search was performed for articles published by 12 May 2013 using electronic databases and hand search. Two reviewers conducted the study selection, data collection and validity assessment. The PRISMA criteria were applied. From 1087 titles identified by the search strategy, five studies and 18 case reports were included. RESULTS: Clinical studies and case reports were published from the years 1981 to 2012. A pronounced heterogeneity exists among studies regarding applied treatment protocols and quality of reporting. In all clinical studies, comprising 111 teeth, a non-surgical root canal treatment (RCT) was performed as initial treatment step. Non-surgical and/or a surgical periodontal therapy was applied in some studies without re-evaluation of the endodontic healing. Probing pocket depth reductions were reported in all included studies, comprising the data from 80 teeth at follow-up. CONCLUSIONS: A sequential treatment with root canal treatment as a first treatment step appears to be reasonable. An adequate time for tissue healing is suggested prior to re-evaluation.

Is the Schneiderian membrane thickness affected by periodontal disease? A cone beam computed tomography-based extended case series.

OBJECTIVE: The aim was to assess the thickness of Schneiderian membranes (SM) in patients with advanced periodontal disease. METHODS: 17 dentate patients (DG) scheduled for periodontal surgery on maxillary molars were consecutively recruited and cone beam computed tomographies performed for preoperative diagnosis. Twenty-one patients (EG) requiring cone beam computed tomography-based planning of implant placement in the edentulous posterior maxilla served as controls. RESULTS: Schneiderian membrane thickness measured from cone beam computed tomography was significantly greater in the dentate group compared to the edentulous group, both in the first (p = 0.028) and second (p < 0.001) molar position. In the dentate group, clinical signs of periodontal destruction (increased probing pocket depth or furcation involvement) were not associated with Schneiderian membrane thickness. Additional findings, such as periapical lesions (p = 0.008), and the distance between root tips and maxillary sinus revealed a significant association (p = 0.036) with Schneiderian membrane thickness. CONCLUSION: In molar regions with periodontal destruction, Schneiderian membrane thickening occurred, particularly in combination with small bone layers above the root tips or periapical lesions.

Biologic width dimensions--a systematic review.

BACKGROUND: Consideration of the biologic width in restorative dentistry seems to be important for maintaining periodontal health. OBJECTIVE: To evaluate the dimensions of the biologic width in humans. MATERIALS AND METHODS: A systematic literature search was performed for publications published by 28 September 2012 using five different electronic databases; this search was complemented by a manual search. Two reviewers conducted the study selection, data collection, and validity assessment. The PRISMA criteria were applied. From 615 titles identified by the search strategy, 14 publications were included and six were suitable for meta-analyses. RESULTS: Included studies were published from the years 1924 to 2012. They differed with regard to measurements of the biologic width. Mean values of the biologic width obtained from two meta-analyses ranged from 2.15 to 2.30 mm, but large intra- and inter-individual variances (subject sample range: 0.2 - 6.73 mm) were observed. The tooth type and site, the presence of a restoration and periodontal diseases/surgery affected the dimensions of the biologic width. Pronounced heterogeneity among studies regarding methods and outcome measures exists. CONCLUSIONS: No universal dimension of the biologic width appears to exist. Establishment of periodontal health is suggested prior to the assessment of the biologic width within reconstructive dentistry.

Is smoking a predictor of apical periodontitis?

OBJECTIVES: To evaluate the association between cigarette smoking and the frequency of apical periodontitis in female and male patients seeking treatment at the University of Basel (KREBS Project). MATERIALS AND METHODS: This cohort study included full-mouth periapical radiographs of 161 subjects, including 66 current smokers, 28 former smokers and 67 [corrected] individuals who had never smoked. The periapical region of all teeth was radiographically evaluated using the Periapical Index (PAI) score. Generalised linear mixed-effects models using the logit link were performed. RESULTS: The frequency of apical periodontitis differed based on gender and smoking status. Current male cigarette smokers with <10 or ≥10 pack years showed frequencies of apical periodontitis of 7.9 % and 7.5 %, [corrceted] respectively, compared to 4.1 % [corrected] in individuals who had never smoked. The corresponding data for female smokers were 5.8 % and 7.4 % [corrected] in smokers with <10 or ≥10 pack years, respectively, versus 5.2 % in individuals who had never smoked. The factors "prevalent coronal restoration" (p < 0.001), "prevalent root canal treatment" (p < 0.001) and "quality of root canal filling" (p < 0.001) were significant predictors for apical periodontitis. After adjustment for quality of root canal filling cigarette smoking was not associated with apical periodontitis in current female and male smokers with <10 or ≥10 pack years (p > 0.05). CONCLUSION: Smoking status did not predict apical periodontitis in females and males in this sample group. CLINICAL RELEVANCE: With respect to quality of root canal filling, tobacco use may not be a significant predictor for apical periodontitis.

Dental visits, oral hygiene behaviour, and orthodontic treatment in Switzerland.

Since the first survey in 1992/93, the Swiss Health Survey (SHS) has been repeated every 5 years (1997, 2002 and 2007). In the present study, dental visits (dental care utilisation within the last 12 months), oral hygiene measures and the frequency of orthodontic treatments in the Swiss population in 2002 were examined and dental visits were compared with the years 1992/93, 1997 and 2007. Weighted data were analysed regarding different sociodemographic factors. From 1992 to 2002, dental visits among the 15-74-year-old declined continuously (1992/93: 70%, 1997: 66%, 2002: 63%), whereas in 2007 a slight increase (66%) was documented. In the survey from 2002, a large proportion (74%) of the population stated to clean their teeth or prostheses several times a day, predominantly with a manual toothbrush, whereas 28% applied an electric toothbrush and almost half of the respondents also used dental floss or toothpicks. Fewer visits and less intensive oral hygiene measures were observed among the elderly, men, weak social strata, smokers, persons with more than 8 missing teeth and in the group with removable dentures. Almost a quarter of the population had orthodontic treatment with the highest proportion among the 15-24-year-old (56%).

Does three-dimensional imaging offer a financial benefit for treating maxillary molars with furcation involvement? A pilot clinical case series.

AIM: To assess the financial benefit of cone beam computed tomography (CBCT) for the treatment options of maxillary molars including periodontal surgery and extraction followed by implant placement. MATERIAL AND METHODS: Twelve patients with generalized chronic periodontitis were recruited, and CBCT was performed in maxillary molars (n = 22) with clinical furcation involvement and increased probing pocket depths. Treatment recommendations were either based on conventional periodontal diagnostics (clinical examinations and periapical radiographs), or based on the additional CBCT data. Clinical recommendations comprised a minimal (e.g. supportive periodontal treatment) and a maximal invasive therapy (e.g. extraction and implant placement), and these were compared with CBCT-based recommendations. According to the Swiss dental tariff structure, the probabilities of saving costs or time, and the numbers needed to treat were analysed with an empirical cumulative distribution function. RESULTS: Average cost reduction from CBCT amounted to CHF 915 ± 1470 and saved 136 ± 217 min. Greatest reductions were found with maximal invasive clinically based treatment decisions (CHF 1566 ± 1840), particularly for second molars (CHF 2485 ± 2226). To compensate CBCT costs, 1.7 subjects were needed to treat to at least break even. CONCLUSIONS: Data from CBCT facilitated a reduction in treatment costs and time for periodontally involved maxillary molars in Switzerland. Based on these cost analyses, however, CBCT as additional diagnostic measure is justified only when more invasive therapies are planned.

Does a clinician's sex influence treatment decisions?

PURPOSE: As more women are entering health professions, the health care system is becoming more feminized. This investigation evaluated gender differences in clinicians' treatment preferences and decision making in a complex treatment situation. MATERIALS AND METHODS: A questionnaire was developed containing clinical cases and statements to assess practitioners' opinions on treatment of periodontally involved maxillary molars and implant therapy with sinus grafting. Data were analyzed with respect to the clinicians' sex, and an overall logistic regression was performed to further investigate possible influences of age, office location, and specialty. RESULTS: Three hundred forty questionnaires were evaluated (response rate: 35.1%). The mean age of female respondents (37%) was 42 years, and the mean age of male respondents was 46 years. Significantly fewer women reported performing implant placement (35% vs 63%), sinus grafting (16% vs 43%), and periodontal surgery (57% vs 68%). Female practitioners tended to refer more patients to specialists. Participants favored sinus grafting more often for their spouses than for themselves. Apart from a preference for regenerative periodontal surgery among women, no gender differences were observed for treatment decisions or views on general statements related to implant preference, tooth maintenance, or conventional reconstructive therapies. CONCLUSIONS: With similar expert knowledge, treatment decisions were made irrespective of sex. While the majority of male care providers performed complex therapies themselves, female clinicians referred more patients to specialists.