Inequalities in Untreated Root Caries and Affordability of Dental Services among Older American Adults.

The growing geriatric population is facing numerous economic challenges and oral health changes. This study explores the relationship between affordability of dental care and untreated root caries among older American adults, and whether that relationship is independent of ethnicity and socioeconomic factors. Data from 1776 adults (65 years or older) who participated in the National Health and Nutrition Examination Survey (NHANES) were analyzed. The association between affordability of dental care and untreated root caries was assessed using logistic regression models. Findings indicated that untreated root caries occurred in 42.5% of those who could not afford dental care, and 14% of those who could afford dental care. Inability to afford dental care remained a statistically significant predictor of untreated root caries in the fully adjusted regression model (odds ratio 2.79, 95% confidence interval: 1.78, 4.39). Other statistically significant predictors were gender (male), infrequent dental visits, and current smoking. The study concludes that the inability to afford dental care was the strongest predictor of untreated root caries among older Americans. The findings highlight the problems with access to and use of much needed dental services by older adults. Policy reform should facilitate access to oral healthcare by providing an alternative coverage for dental care, or by alleviating the financial barrier imposed on older adults.

Lesões cervicais em área estética com exposição dos canais radiculares: o papel de uma abordagem multidisciplinar / Cervical lesions in the aesthetic zone with exposure of radicular canals: the role of a multidisciplinary approach

Introdução: algumas situações clínicas não se apresentam como ideais para o tratamento restaurador adequado e o profissional deve encontrar formas alternativas de acesso adequado à margem gengival. Objetivo: apresentar um caso de lesões cervicais com exposição vestibular de canais radiculares no qual a interação entre Endodontia, Odontologia Restauradora e Periodontia foi fundamental para seu sucesso. Relato de caso: o paciente apresentou lesões de cárie cervical subgengivais, com exposição dos canais radiculares dos dentes anteriores. O tratamento inicial foi realizado por meio de uma adaptação do isolamento com lençol de borracha. Após instrumentação, foi introduzida nos canais guta-percha recoberta com vaselina, para auxiliar na restauração temporária da superfície vestibular. O tratamento endodôntico e periodontal foi concluído posteriormente e os dentes foram restaurados durante a cirurgia periodontal, com resina composta. Conclusões: deve-se sempre considerar o planejamento multidisciplinar no tratamento de casos atípicos, bem como adaptar procedimentos convencionais para a abordagem de casos complexos, visando o restabelecimento da saúde, estética e função do paciente.

Caries de superficies radiculares: etiología, diagnóstico y manejo clínico / Root caries lesions: etiology, diagnosis and clinical managment

Como todas las lesiones de caries, la caries de superficies radiculares (CSR) refleja un cambio tisular continuo. Es esencial diagnosticar los síntomas antes que esas lesiones lleguen a estar cavitadas. Por la misma razón, y para poder decidir entre modalidades invasivas y no-invasivas, deberá ser perfectamente comprendida la dinámica de la formación de la lesión cariosa. Este artículo revisa la etiología, los criterios de diagnóstico y los factores de riesgo en caries de superficies radiculares, y también discute la prevención y la terapéutica, haciendo un especial énfasis en procedimientos de remineralización y en un enfoque no-invasivo de este problema.

As all caries lesions, root caries reflect a continuous tissue change. It is essential to diagnose symptoms before these lesions become cavitated. For the same reason, and in order to be able to decide between invasive and non-invasive modalities, the dynamics of the formation of the carious lesion must be perfectly understood. This paper reviews the etiology, diagnostic criteria and risk factors for root surface caries, and also discusses prevention and therapeutics, with a special emphasis on remineralization procedures and a non-invasive approach to this problem.

Gingival recession and root caries in the ageing population: a critical evaluation of treatments.

AIM: To review evidence for the treatments of gingival recession and root caries in older populations. MATERIALS & METHODS: A systematic approach was adopted to identify reviews and articles to allow us to evaluate the treatments for gingival recession and root caries. Searches were performed in PubMed, Medline and Embase, the Cochrane trials register and bibliographies of European and World Workshops. OBSERVATIONS: Gingival recession: We identified no articles that focussed specifically on older populations. Conversely, no evidence suggested that Miller class I and II lesions should be managed differently in older patients when compared to younger cohorts. Six systematic reviews included older patients and suggested that connective tissue grafts are the treatment of choice, alone or in combination with enamel matrix derivative. Root caries can be controlled at the population level by daily brushing with fluoride-containing toothpastes, whilst active decay may be inactivated using professional application of fluoride varnishes/solutions or self-applied high-fluoride toothpaste. Active root caries lesions that cannot be cleaned properly by the patient may be restored by minimally invasive techniques. CONCLUSIONS: Gingival recession and root caries will become more prevalent as patients retain their teeth for longer. Whilst surgical (gingival recession) and non-operative approaches (root caries) currently appear to be favoured, more evidence is needed to identify the most appropriate strategies for older people.

Clinical outcome of root caries restorations using ART and rotary techniques in institutionalized elders

Abstract The aim of this study was to compare the clinical performance of root caries restorations after a six-month period using two methods, a conventional technique with rotary instruments and an atraumatic restorative technique (ART), in an institutionalized elderly population in the city of Bogotá, Colombia. Root caries represents a multifactorial, progressive, chronic lesion with softened, irregular and darkened tissue involving the radicular surface; it is highly prevalent in the elderly, especially in those who are physically or cognitively impaired. A quasi-experimental, double-blind, longitudinal study was carried out after cluster randomization of the sample. Two different experienced dentists, previously trained, performed the restorations using each technique. After six months, two new investigators performed a blind evaluation of the condition of the restorations. The results showed a significantly higher rate of success (92.9%) using the conventional technique (p < 0.03). However, we concluded that ART may have been the preferred technique in the study population because 81% of those restorations survived or were successful during the observation period.

Root Caries in Older Adults.

Older adults are retaining an increasing number of natural teeth, and nearly half of all individuals aged 75 and older have experienced root caries. Root caries is a major cause of tooth loss in older adults, and tooth loss is the most significant negative impact on oral health-related quality of life for the elderly. The need for improved preventive efforts and treatment strategies for this population is acute.

The use of bur and laser for root caries treatment: a comparative study.

This research analyzed the influence of bur and erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser caries removal on cavity characteristics and marginal seal of composite resin restorations. One hundred and forty human dental root samples were used. After in vitro root caries induction using Streptococcus mutans, the carious lesions were removed either by a conventional technique using burs (G1=control) or by using an Er,Cr:YSGG laser (λ=2.78 µm, 20 Hz, pulse duration is approximately equal to 140 µs, noncontact mode using a 600-µm tip) with the following power outputs: G2: 1.0 W; G3: 1.25 W; G4: 1.5 W; G5: 1.75 W; G6: 2.0 W; G7: 2.25 W; G8: 2.5 W; G9: 2.75 W; G10: 3.0 W; G11: 3.25 W; G12: 3.5 W; G13: 3.75 W; and G14: 4.0 W. Samples in the 14 groups (n=10) were conditioned with Clearfil SE Bond and restored with a flowable composite. They were then thermocycled (1000 cycles) and immersed into a 2% methylene blue solution for microleakage analysis. The data were statistically compared (analysis of variance or Spearman correlation tests; p≤0.05). The lased groups showed significantly greater microleakage indexes, cavity depths, and presence of residual caries than did those of the control group. There was a strong positive correlation between residual caries and microleakage. The results indicate that Er,Cr:YSGG laser irradiation is not a good alternative to the use of burs for root caries removal since it may cause a significant loss of marginal sealing in composite resin restorations.

Forced eruption as an alternative to tooth extraction in long-term use of oral bisphosphonates: review, risks and technique.

BACKGROUND: Osteonecrosis of the jaw (ONJ) is a painful condition secondary to bisphosphonate (BP) therapy. It occurs at a much higher rate in patients receiving intravenous (IV) versus oral BP treatment. BPs are prescribed in the treatment of bone diseases such as osteoporosis, multiple myeloma, cancer metastases and Paget disease. Patients' risk of developing ONJ is of concern to medical and dental teams alike and requires open communication between the disciplines. If dental surgery is indicated, it must be performed before commencement of IV BP therapy, and it should be considered for patients receiving oral BP therapy. However, the dental literature pertaining to the two therapeutic modalities stresses the low risk of ONJ's developing in patients receiving oral BP therapy (especially in the early stages) compared with that in patients receiving IV administration. CASE DESCRIPTION: The authors used forced eruption to extrude hemisected hopeless distal roots of first and second mandibular molars from within their alveolar sockets in a patient receiving long-term oral BP therapy. Just before the extraction, they placed orthodontic separating bands around the distal roots to further exfoliate the roots. This so-called bloodless extraction is an alternative treatment for patients at risk of developing ONJ. CLINICAL IMPLICATIONS: The combination of orthodontic extrusion and bloodless extraction is aimed at minimizing trauma and enhancing the health of the surrounding tissues in patients at risk of developing ONJ or when the patient refuses to undergo conventional tooth extraction.

Effect of different root caries treatments on the sealing ability of conventional glass ionomer cement restorations.

In this study we compared the microleakage of conventional glass ionomer cement (GIC) restorations following the use of different methods of root caries removal. In vitro root caries were induced in 75 human root dentin samples that were divided in five groups of 15 each according to the method used for caries removal: in group 1 spherical carbide burs at low speed were used, in group 2 a hand-held excavator was used, and in groups 3 to 5 an Er,Cr:YSGG laser was used at 2.25 W, 40.18 J/cm(2) (group 3), 2.50 W, 44.64 J/cm(2) (group 4) and 2.75 W, 49.11 J/cm(2) (group 5). The air/water cooling during irradiation was set to 55%/65% respectively. All cavities were filled with GIC. Five samples from each group were evaluated by scanning electron microscopy (SEM) and the other ten samples were thermocycled and submitted to a microleakage test. The data obtained were compared by ANOVA followed by Fisher's test (p≤0.05). Group 4 showed the lowest microleakage index (56.65 6.30; p<0.05). There were no significant differences among the other groups. On SEM images samples of groups 1 and 2 showed a more regular interface than the irradiated samples. Demineralized dentin below the restoration was observed, that was probably affected dentin. Group 4 showed the lowest microleakage values compared to the other experimental groups, so under the conditions of the present study the method that provided the lowest microleakage was the Er,Cr:YSGG laser with a power output of 2.5 W yielding an energy density of 44.64 J/cm(2).

Conservative treatment of periodontal recessions with class V-defects using gingiva-shaded composite--A systematic treatment concept.

UNLABELLED: Periodontal recessions can cause aesthetic and functional problems, especially in the anterior region or when combined with exposed crown margins. A combination of periodontal disease, recession with exposed root surface, hard-tissue defects and age emphasizes the need for treating these defects. If crown margins are exposed and surgical treatment is not possible, aesthetics and function can only be improved by replacement of the restoration. The restorative treatment option with a gingiva-shaded composite is especially valuable for dental fear patients or older patients with general or local risk factors, surgical contra-indications or Class III and IV recessions with questionable prognosis of surgery. The step-by-step-approach described in this article is an alternative, minimal-invasive treatment concept for cervical lesions in combination with all kinds of periodontal recessions, that is especially suitable for wedge-shaped defects next to exposed crown margins. CLINICAL RELEVANCE: With this treatment concept, the reader should be able to use gingiva-shaded composite for different indications, such as exposed root surfaces or crown margins in combination with recessions.

Two-year clinical performance of glass ionomer and resin composite restorations in xerostomic head- and neck-irradiated cancer patients.

The aim of this study was to evaluate the clinical performance of adhesive filling materials in class V cavities in xerostomic head- and neck-irradiated cancer patients, in terms of marginal adaptation, anatomical form and recurrent caries. We selected 35 high-caries-risk, post-radiation, xerostomic adults with ≥3 cervical carious lesions in the same arch. Every patient received a KetacFil (KF), PhotacFil (PF) and Herculite XRV (HX) restoration. Patients were instructed to use a neutral 1% sodium fluoride gel in custom trays, on a daily basis. After 6, 12, 18 and 24 months, the restorations were examined for material loss, marginal integrity and recurrent caries. Fluoride compliance was determined at each recall appointment and recorded as the percentage of recommended use during that interval [compliance of ≤50% = NFUs, >50% = FUs]. Only 30 patients were available for recall at 6 months, with 28 patients at 12 and 18 months, and 27 patients at 24 months. In the NFU group, differences in recurrent caries were found between KF and HX at all observation times (p < 0.05). Differences (p < 0.05) in adaptation and/or anatomical form were found between KF and PF in NFUs after 18 and 24 months. In FUs, significant differences were observed between KF and PF, and KF and HX after 6 and 12 months, between KF and HX, PF and HX after 18 and 24 months. In summary, glass ionomers (especially the conventionally setting formulation) provide clinical caries inhibition but erode easily, while composite resin provides greater structural integrity.

[Oral benefits for the elderly: results of a one-year implementation of the "Sesame" plan in Senegal]. / Prestations bucco-dentaires chez les personnes âgées: bilan d'une année d'application du plan "Sésame" au Sénégal.

Among the 650,000 persons aged 60 and over in Senegal, only 30% were receiving social security coverage, divided between the Senegalese Retirement Providence Institute and the National Retirement Fund. To fill the social demand, the government has put in place since 1 September 2006 a plan called "Sesame" which gives people aged 60 and older, free access to certain health services provided in public health. The implementation of this plan creates a lot of comments in the health community. The objectives of this study were to describe the dental benefits offered and to identify the difficulties perceived and experienced by the service provider after one year the "sesame" plan was implemented in Ouakam Health Center dental office, benchmark place of Gerontology in the Dakar North health district in Senegal. The study included two components: quantitative and qualitative terms, respectively, consisting of a retrospective study from sheets review and an interview with the health center service provider. The beneficiaries were a total of 42, mean age 68 years, including 66.7% men. Just over a third (35.7%) resided outside Ouakam. Almost 4/5 of the beneficiaries have suffered dental extractions on 1 to 10 teeth per beneficiary. The proportions of people receiving dentine treatment and curetage were respectively 4.8% and 2.4%. Qualitative data showed that the implementation of the plan was not shared between providers and beneficiaries. The "Sesame" plan is a commendable initiative to encourage and improve.

Restoration of non carious cervical tooth surface loss lesions using composite and dentin pins: report of two cases / Restauração de lesões não cariosas cervicais utilizando compósitos e pinos dentinários: relato de dois casos

OBJETIVO: Ilustrar um método alternativo para a restauração de perdas cervicais não cariosas utilizando compósitos e pinos dentinários. MÉTODO: Nos casos apresentados, extensas lesões cervicais não cariosas foram restauradas com resinas compostas e pinos dentinários, para avaliação dos resultados. RESULTADOS E CONCLUSÕES: Os pinos de dentina podem ser um suporte alternativo na restauração de dentes com grandes lesões cervicais não cariosas.

OBJECTIVE: To illustrate an alternative method for the restoration of non carious cervical tooth surface loss lesions using composite and dentin pins. METHOD: In these two cases, extensive Class V non carious cervical tooth surface lesions were restored with composite resins and dentin pins and results were evaluated. RESULT AND CONCLUSION: Dentin pins could be an alternative support in large non carious cervical lesions.

The application of ozone in dentistry: a systematic review of literature.

OBJECTIVES: (1) To systematically review the clinical application and remineralization potentials of ozone in dentistry; (2) To summarize the available in vitro applications of ozone in dentistry. SOURCES: Ovid MEDLINE, CINAHL, etc. (up to April 2007). STUDY SELECTION: In vitro or in vivo English language publications, original studies, and reviews were included. Conference papers, abstracts, and posters were excluded. RESULTS: In vitro: Good evidence of ozone biocompatibility with human oral epithelial cells, gingival fibroblast, and periodontal cells; Conflicting evidence of antimicrobial efficacy of ozone but some evidence that ozone is effective in removing the microorganisms from dental unit water lines, the oral cavity, and dentures; Conflicting evidence for the application of ozone in endodontics; Insufficient evidence for the application of ozone in oral surgery and implantology; Good evidence of the prophylactic application of ozone in restorative dentistry prior to etching and the placement of dental sealants and restorations. In vivo: Despite the promising in vitro evidence, the clinical application of ozone in dentistry (so far in management of dental and root caries) has not achieved a strong level of efficacy and cost-effectiveness. CONCLUSIONS: While laboratory studies suggest a promising potential of ozone in dentistry, this has not been fully realised in clinical studies to date. More well designed and conducted double-blind randomised clinical trials with adequate sample size, limited or no loss to follow up, and carefully standardised methods of measurement and analyses are needed to evaluate the possible use of ozone as a treatment modality in dentistry.

Scapholunate dislocation: a rare occupational hazard.

Dentists and their assistants are at risk of physical injuries during dental operations. The most common injuries are musculoskeletal. The need to work in a fixed working position using continuous repetitive movements can predispose dentists to wrist ache, lower backache, and neckache. We encountered a rare case of scapholunate dislocation with ligamentous injury, an unusual complication of extraction of teeth.

Laser-fluoride effect on root demineralization.

Although the individual cariostatic effects of laser and fluoride have been shown, the combined effect of CO(2) laser and fluoride on root demineralization remains uncertain and was the main aim of this study. By using a pH-cycling system and Polarized Light Microscopy, we demonstrated the synergistic effect of fluoride combined with CO(2) laser treatment on reducing root demineralization. The mean lesion depths (in microm) for each group were 160 +/- 14 (Control), 113 +/- 8 (Laser treatment alone), 111 +/- 6 (Fluoride treatment alone), and 25 +/- 7 (Fluoride followed by laser treatment). A significant laser-enhanced fluoride uptake, characterized by the ToF-SIMS analysis, was revealed by the 37% and 400% increments in loosely and firmly bound fluorides (both p < 0.002) in laser-irradiated areas, compared with the non-irradiated controls. In conclusion, there is a significant synergistic effect of combined CO(2) laser and fluoride treatment on the inhibition of root demineralization, possibly due to laser-enhanced fluoride uptake in the root.

Connective tissue grafting on resin ionomer in localized gingival recession.

BACKGROUND: One of the main objectives of periodontal reconstructive surgery is the coverage of exposed roots that occur due to gingival recession. On some occasions, where a caries, root resorption, or amalgam restoration exists on the exposed root surface, the treatment planning becomes more complex. This case report describes the use of a subepithelial connective tissue graft (SCTG) on a resin ionomer-restored root surface to treat gingival recession that is complicated with the above-mentioned handicaps. METHODS: An amalgam restoration and carious lesion were removed following full-thickness flap reflection, and the cavity was restored with glass ionomer cement. An SCTG was placed onto the restoration, and the flap was coronally positioned. A porcelain crown restoration was performed 9 months after surgery. RESULTS: At 3-, 6-, and 9-month follow-ups, probing depths were reduced and gain in attachment level was obtained with no clinical signs of inflammation in gingiva. Monthly periodontal controls revealed that creeping attachment had occurred on the restoration during the follow-up periods. CONCLUSION: This single case report serves as a good example to show that SCTG can be successfully performed to treat gingival recession associated with a glass ionomer-restored root surface.

Epidemiologia e desenvolvimento das cáries radiculares: revisão de literatura / Epidemiology and development of root caries: a literature review

Com os programas de prevenção à cárie dentária, a população está mantendo maior número de dentes até idades mais avançadas. Estes ficam sujeitos a alterações fisiológicas e patológicas da cavidade bucal, como alterações do fluxo salivar, capacidade tampão da saliva e/ou exposição radicular por retração da margem gengival. As superfícies radiculares expostas, devido à sua composição química, são mais susceptíveis ao desenvolvimento da cárie, assim, o diagnóstico e o tratamento das lesões instaladas e a prevenção de futuras torna-se extremamente importante. O objetivo deste trabalho é discutir os fatores associados ao desenvolvimento da cárie radicular, bem como sua distribuição nas populações com mais de 40 anos.