Stain Removal Assessment of Two Manual Toothbrushes with an Interproximal Tooth Stain Index.

OBJECTIVE: To assess a newly developed index to measure interproximal stain and evaluate the stain removal efficacy of two commercially available manual toothbrushes. METHODS: This was a randomized, examiner-blind, parallel-group, two-treatment clinical trial of two weeks' duration. Subjects qualified for the study if they had an average Modified Lobene Stain Index of ≥ 1.5 from two anterior teeth. At baseline, subjects brushed in front of a mirror for one minute under supervision. All subjects were provided with a standard 0.243% sodium fluoride dentifrice and were randomly assigned either an Oral-B Pulsar manual brush (OBP) or a Colgate Whitening manual brush (CW) to use for two weeks. Stain was reassessed after two weeks of product use. Stain measurements were conducted using the Modified Lobene Stain Index and the new Interproximal Modified Lobene Stain Index, which allows for assessment of stain in hard-to-reach areas using the same area and intensity scales as the Modified Lobene Stain Index. RESULTS: Use of the two manual brushes resulted in statistically significant reductions in surface stain relative to baseline after two weeks of use. Median stain reductions were 78% and 60% for the OBP and CW, respectively, as measured by the Modified Lobene Stain Index. The mean changes in the composite scores from baseline to week two were 1.85 and 1.57 for the two treatment groups, respectively. Statistically significant reductions from baseline were also found for the intensity and extent of stain measures (p < 0.001). Similar trends were found using the new Interproximal Modified Lobene Index. Composite median stain removal percentages versus baseline were 88% and 73% for the OBP and CW groups, respectively (p < 0.001). For the interproximal sites, a median stain removal of 92% was observed with the OBP brush and 83% reduction with the CW brush. For the gingival sites, the median stain removal percentages were 83% and 50%, respectively For the body region, a median stain removal of 100% was found for both treatment groups. No statistically significant differences were found between the two groups for the mean composite scores for either index. CONCLUSION: Both manual brushes showed effective stain removal, including interproximal hard-to-reach sites. The Interproximal Modified Lobene Stain Index gave clinically relevant results consistent with the traditional Modified Lobene Stain Index, while allowing assessment of interproximal regions.

Comparison between rapid and mixed maxillary expansion through an assessment of arch changes on dental casts.

BACKGROUND: Aim of this retrospective observational study was to compare upper and lower dental changes in patients treated with Rapid Maxillary Expansion (RME) and Mixed Maxillary Expansion (MME), assessed by dental cast analysis. METHODS: Treatment groups consisted of 42 patients: the RME group (n = 21) consisted of 13 female and 8 male subjects with the mean age of 8.8 years ± 1.37 at T0 and 9.6 years ± 1.45 at T1; the MME group (n = 21) consisted of 12 female and 9 male patients with a mean age of 8.9 years ± 2.34 at T0 and 10.5 years ± 2.08 at T1. The upper and lower arch analysis was performed on four dental bilateral landmarks, on upper and lower casts; also upper and lower arch depths were measured. The groups were compared using independent sample t-test to estimate dental changes in upper and lower arches. RESULTS: Before expansion treatment (T0), the groups were similar for all examined variables (p>0.05). In both RME and MME group, significant increments in all the variables for maxillary and mandibular arch widths were observed after treatment. No significant differences in maxillary and mandibular arch depths were observed at the end of treatment in both groups. An evaluation of the changes after RME and MME (T1) showed statistically significant differences in mandibular arch depth (p<0.001) and maxillary intercanine widths (p<0.05). Differences in maxillary arch depth and arch width measurements were not significant. CONCLUSIONS: RME and MME can be considered two effective treatment options to improve transverse arch dimensions and gain space in the dental arches. A greater lower arch expansion was observed in the MME group, which might be attributed to the "lip bumper effects" observed in the MME protocol.

Deciduous-dentition malocclusion predicts orthodontic treatment needs later: findings from a population-based birth cohort study.

INTRODUCTION: Estimating orthodontic treatment need in the permanent dentition using information from the deciduous-dentition malocclusion may assist in defining the time for appropriate orthodontic intervention. Our objective was to investigate whether malocclusion in the deciduous teeth predicts orthodontic treatment need in the permanent dentition. METHODS: Two oral health studies nested in a birth cohort were carried out at ages 6 (n = 359) and 12 (n = 339) years. Open bite, crossbite, and canine malocclusion were assessed in the deciduous teeth. Orthodontic treatment need was determined in the permanent dentition using the dental esthetic index. Prevalence ratios were estimated using 2 dental esthetic index cutoff points: highly desirable/mandatory orthodontic treatment and only mandatory orthodontic treatment. We tested all combinations of the deciduous malocclusion and the outcomes, controlling for confounders. RESULTS: Children with only open bite and those with concurrent open bite and canine malocclusion were more likely to have either highly desirable/mandatory orthodontic treatment or only mandatory orthodontic treatment needs by age 12. The combination of crossbite and open bite in the deciduous teeth was associated with the highest risk of need for mandatory orthodontic treatment. CONCLUSIONS: Malocclusion in the deciduous teeth is a risk factor for orthodontic treatment need in the permanent dentition. Children with malocclusion at a young age should be monitored regularly, and caregivers may be able to better prepare for possible orthodontic treatment.

Is the value of oral health related to culture and environment, or function and aesthetics?

OBJECTIVE: To examine the disutility of tooth loss. It compared how people value their teeth in two countries which are culturally similar in order to explore the effect of culture on self-perceptions of oral health. BASIC RESEARCH DESIGN: Cross sectional study. PARTICIPANTS: Participants were recruited from subjects attending two hospitals in Turkey and in Iran. INTERVENTIONS: Nineteen descriptions of mouths with varying degrees and types of tooth loss were presented to the participants. They were shown mouth models of partially edentate dentitions and the teeth missing were explained in relation to the participants own mouth. The participants were specifically asked to consider the role their teeth played in function (chewing), communication (speech) and aesthetics (looks) along with "all the other things that make your mouth important". MAIN OUTCOME MEASURES: The participants were asked to indicate on a visual analogue scale how they would value the health of their mouth if they lost the tooth/teeth described and the resultant space was left unrestored. RESULTS: Overall 152 subjects participated, 78 in Turkey and 74 in Iran with 83 being female and 69 male. Their mean age was 29.5 years (SD 9.3), 62.5% had experienced tooth loss and 37.5% had complete (or completely restored) dentitions. Although there were no differences between the two countries in the degree of utility people attached to anterior teeth, Turkish participants attached significantly more disutility than Iranians to the loss of premolar and molar teeth (p < 0.003). CONCLUSION: Country of origin had an influence on the value placed on certain parts of the dentition and this effect is independent of the number of missing teeth, gender and age. This implies that attitudes to oral health are influenced by prevalent cultural attitudes more than by function.

An assessment of conventional and self-ligating brackets in Class I maxillary constriction patients.

OBJECTIVE: To evaluate two different treatment systems with regard to incisor position, transverse dimension changes in maxillary arch, changes in maxillary molar inclinations, clinical periodontal parameters, and pain intensity in patients with a Class I malocclusion. MATERIALS AND METHODS: Seventeen patients (with a mean age of 14.5 years) underwent orthodontic treatment with the Roth prescribed edgewise bracket systems after expanding the maxillary arch with a quad-helix appliance, and 16 patients (with a mean age of 14.8 years) underwent orthodontic treatment with the Damon 3MX bracket system. Each subject's lateral cephalometric and posteroanterior radiographs and dental casts were obtained at the beginning of the treatment and after debonding. In addition to these, the periodontal index and pain scores were taken. RESULTS: Cephalometric data showed that in both treatment systems, overjet value decreased and maxillary and mandibular incisors proclined. Posteroanterior measurements demonstrated a greater increase in the maxillary molar inclination in the Damon group. Significant increase of maxillary intercanine, interpremolar, and intermolar widths was shown in both systems. Periodontal index and pain score changes between different observation periods were the same. CONCLUSIONS: The conventional and Damon systems were found similar with regard to the incisor position, transverse dimension changes in maxillary arch, clinical periodontal parameters, and pain intensity. The only significant difference was that the Damon system inclined the maxillary molars more buccally than the conventional group.

A novel method for volumetric assessment of tooth wear using three-dimensional reverse-engineering technology: a preliminary report.

OBJECTIVE: To describe a newly developed three-dimensional (3D) digital superimposition method for quantitative evaluation of tooth wear that occurs during orthodontic treatment. MATERIALS AND METHODS: The sample consisted of dental casts obtained from 56 patients (23 male patients and 33 female patients; mean ± standard deviation age  =  21.8 ± 5.1 years) who received orthodontic treatment with extraction of four premolars. The maxillary and mandibular dental casts taken before (T1) and after (T2) orthodontic treatments were scanned, and 3D images of the canines were constructed. The canines at T1 were superimposed with those at T2 with the best-fit method using the middle third of the labial and lingual surface as the reference area. To measure the volume of the canines, four boundary planes were constructed, and the differences in volume before and after orthodontic treatment were calculated. RESULTS: The mean volume of tooth wear of the 224 canines was 2.0 mm(3) after 35.5 months of orthodontic treatment. The volume of canine tooth wear was 2.3 ± 1.5 mm(3) in male subjects and 1.9 ± 1.2 mm(3) in female subjects. The mean wear of the upper right canines (2.4 ± 2.0 mm(3)) was significantly greater than that of the lower right canines (1.9 ± 2.6 mm(3)). CONCLUSIONS: Regional registration of teeth in 3D digital models is useful for quantitative evaluation of tooth wear in orthodontic patients. This method may also be used to assess treatment results in restorative dentistry.

Risk assessment of feline tooth resorption: a Portuguese clinical case control study.

Tooth resorption (TR) is one of the most common dental diseases in cats. Determination of risk factors has not yet been fully assessed and, to the best knowledge of the authors, this disease has never been studied in Portuguese cats. The objective of this case-control study was to determine type and distribution of TR lesions, evaluate risk factors, and establish relationships between variables in this disease. The study included data from 71 cats admitted for general anesthesia for various reasons. The cats were randomly selected. The inclusion criteria were availability of clinical history and owner permission. Cats with known oral disease were not excluded from the study. All cats received ultrasonic scaling and polishing of the teeth, a thorough oral examination, and full-mouth radiographs. A strong statistical relation was found between age and TR. The age group of 10 to 15-years showed an increased risk of 6.56 times for TR occurrence compared with the group 0 to 4-years of age. Presence of gingivitis in all index levels was related to an increased risk for TR. No relation was found between age or gingivitis index and lesion type. Mandibular third premolar and molar teeth were most commonly affected by TR, especially for type 1 lesions. Canine teeth were statistically more likely to have type 2 lesions. The trend for the canine teeth to be more affected with type 2 lesions needs further verification.

Guidelines for the assessment of the impacted maxillary canine.

UNLABELLED: Canine impactions are frequently encountered, occurring in 1.7% of the population. The aim of this paper is to provide guidance on the assessment and management of cases which present in general dental practice. Canine position is considered in four categories; canine overlap with adjacent incisor, vertical canine height, angulation to midline and position of canine root apex. Good, average and poor prognostic outcomes are considered for each category and a brief outline of their management is included. CLINICAL RELEVANCE: Canine impactions frequently present during routine examination. Appropriate recognition, investigation and referral, if necessary, are paramount to successful treatment.

Dental erosion prevalence and associated risk indicators among preschool children in Athens, Greece.

OBJECTIVES: The aims of the study were to investigate dental erosion prevalence, distribution and severity in Greek preschool children attending public kindergartens in the prefecture of Attica, Greece and to determine the effect of dental caries, oral hygiene level, socio-economic factors, dental behavior, erosion related medication and chronic illness. MATERIAL AND METHODS: A random and stratified sample of 605 Greek preschool children was clinically examined for dental erosion using the Basic Erosive Wear Examination Index (ΒΕWE). Dental caries (dmfs) and Simplified Debris Index were also recorded. The data concerning possible risk indicators were derived by a questionnaire. Zero-inflated Poisson regression was generated to test the predictive effects of the independent variables on dental erosion. RESULTS: The prevalence of dental erosion was 78.8 %, and the mean and SE of BEWE index was 3.64 ± 0.15. High monthly family income was positively related to ΒΕWE cumulative scores [RR = 1.204 (1.016-1.427)], while high maternal education level [RR = 0.872 (0.771-0.986)] and poor oral hygiene level [DI-s, RR = 0.584 (0.450-0.756)] showed a negative association. CONCLUSIONS: Dental erosion is a common oral disease in Greek preschool children in Attica, related to oral hygiene and socio-economic factors. CLINICAL RELEVANCE: Programs aimed at erosion prevention should begin at an early age for all children.

Components of patient satisfaction with a dental restorative visit: results from the Dental Practice-Based Research Network.

BACKGROUND: The authors conducted a study to identify components of patient satisfaction with restorative dental care and to test the hypothesis that certain dentist, patient and procedure factors are associated with patient satisfaction. METHODS: Practitioner-investigators (P-Is) from 197 practices in The Dental Practice-Based Research Network (DPBRN) recruited consecutively seen patients who had defective permanent-tooth restorations that were replaced or repaired. At the end of the treatment visit, P-Is asked each participant to complete a satisfaction survey and mail it directly to a DPBRN regional coordinator. RESULTS: Analysis of the results of 5,879 satisfaction surveys revealed three satisfaction components: interpersonal relationship-comfort factors, material choice-value factors and sensory-evaluative factors. Satisfaction was highest among patients who received care in a private practice model, whose restorations were repaired rather than replaced and whose restored teeth were not molars. CONCLUSION: These data suggest that a patient's judgments of a dentist's skills and quality of care are based on personal interactions with the dentist, the level of comfort the patient perceives while receiving care and any experience of posttreatment sensitivity in the treated tooth. These conclusions have direct implications for management of patient care before, during and after the procedure. PRACTICE IMPLICATIONS: By taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the service provided, thereby enabling themselves to focus on what each patient values most.

Transmigration of impacted canines: prevalence, management and implications on tooth structure and pulp vitality of adjacent teeth.

The aim of this study was to estimate the prevalence of transmigrant canines in a sample of panoramic radiographs of a random Greek population, to classify them and evaluate clinically and radiographically all the implications for adjacent teeth. Panoramic radiographs of 3,586 patients retrieved from eight private practices between 1998 and 2009, were examined. Panoramic radiographs with extracted canines were not included in this study. An impacted canine was considered to be transmigrant when at least part of its length had crossed the midline. Six radiographs exhibited transmigrant canines (0.17% of the total sample of panoramic radiographs), of which four were mandibular and two maxillary. Canine transmigration is a rare phenomenon in Greek population. The impact of transmigrant canines on adjacent teeth varied from inclination, calcific metamorphosis and root resorption to no effect. Orthodontic therapy was the treatment of choice for two of the cases, while in the remaining cases the patients were scheduled for periodic recalls. Clinical and radiographic evaluation and early diagnosis are crucial aids in proper treatment planning.

The problem with an epidemiological index for dental erosion.

This article reviews and discusses the difficulties posed by the application of epidemiological indices for the measurement of dental erosion. It covers several aspects of index design.

Treatment of posterior crossbite comparing 2 appliances: a community-based trial.

INTRODUCTION: The aim of this community-based trial was to compare the effectiveness of the quad-helix appliance and removable plates for treating posterior crossbite. METHODS: Ninety-nine patients were randomly divided into 3 groups: quad-helix, expansion plate, and untreated. All subjects were in the mixed dentition, had posterior crosssbite, no sucking habits, no previous orthodontic treatment, and no Class III malocclusion. The following aspects were evaluated: posterior crossbite correction, maxillary and mandibular intermolar and intercanine expansions, length of treatment, cost-benefit analysis, success rate, and number of complications. RESULTS: The length of treatment and the costs were higher in the expansion plate group than in the quad-helix group. The success rates were similar for the quad-helix and the expansion plate groups, and the number of complications was higher in the quad-helix group. No self-correction was observed in the untreated group, and relapses occurred in both experimental groups. CONCLUSIONS: The average treatment time was significantly shorter and 11% less expensive than in the quad-helix group, making it the more cost-effective choice for treatment.

In-vitro assessment of the forces generated by lingual fixed retainers.

INTRODUCTION: The aim of this article was to assess the effect of wire adaptation on the lingual surfaces of mandibular anterior teeth with 3 types of lingual retainers on the development of vertical and labiolingual forces. METHODS: Ten retainers (canine to canine) were constructed from each of the following wires: Wildcat 0.0195-in heat-treated 3-strand twist-flex wire (GAC, Bohemia, NY); Penta-one 0.0215-in 6-strand as received; and Penta-one 0.0215-in 6-strand after heat treatment at 350°C for 4 minutes (both, Masel Orthodontics, Carlsbad, Calif). The retainers were bonded on each tooth of an acrylic resin model, and the model was installed in the Orthodontic Measurement and Simulation System. The vertical and labiolingual forces generated were measured for wire displacements up to 0.2 mm in 0.02-mm increments. RESULTS: Wire displacement of 0.2 mm exerted forces as high as 1 N on the teeth. In the vertical direction, the highest force levels were recorded for the as-received Penta-one 0.0215-in and the lowest from its heat-treated counterpart. In the horizontal plane, the as-received Penta-one 0.0215-in exerted the highest forces. CONCLUSIONS: The forces recorded from the lingual retainer wires during 0.2-mm simulated intrusion-extrusion and buccal-lingual movements might generate high forces that exceed 1 N and be large enough to produce unwanted tooth movement during retention. The only significant determinant of the generated forces was the amount of wire displacement and not the type of wire used in this study.

Little's irregularity index: photographic assessment vs study model assessment.

INTRODUCTION: The aim of this study was to investigate whether photographic images are accurate and reliable to assess Little's irregularity index (LII) compared with study model measurements. METHODS: Ten plastic models with different levels of incisor irregularity were photographed occlusally at 9 angulations ranging from 70° to 110° on 3 occasions. Clinical occlusal photographs and study models of 72 dental arches were selected from 16 patients participating in a study of incisor alignment. LII was measured from the models by using digital calipers and from the digital images with ImageJ software (Rasband WS, National Institutes of Health, Bethesda, Md; http://rsb.info.nih.gov/ij/, 1997-2006). RESULTS: Photographs of the plastic models and the direct measurements of the models showed high levels of reliability and repeatability (intraclass correlation coefficients [ICC], 0.999 and 0.983). Validity was shown by the limits of agreement between the plastic models and the photographs at 90°, 70°, and 110°, which were -0.2621 to 0.9547, -0.1961 to 1.3205, and -0.7399 to 2.0405, respectively, and the ICC were 0.993, 0.983, and 0.969, respectively. The intraexaminer and interexaminer ICC for the clinical photographs were 0.997 and 0.987, and intraexaminer agreement for the study models was 0.995. The limits of agreement and the ICC between the photographic method and study model method were -1.9656 to 1.2861 and 0.986. CONCLUSIONS: LII can be measured from photographs with good reliability and repeatability. The limits of agreement indicate that, for the mean value of a group of subjects, the photographic method is valid, but care is needed in interpreting an individual measurement.

The dental health of three-year-old children in Greater Glasgow, Scotland.

OBJECTIVE: To report on the dental health of three-year-old children in Greater Glasgow, and to examine the amount of dental caries associated with deprivation in this young age group. DESIGN: Dental inspections in nursery schools. SUBJECTS AND METHODS: The national inspection programme using BASCD criteria was extended to include an additional group of nursery attending three-year-olds in Greater Glasgow in 2006/7 and 2007/8. Caries experience was analysed by logistic regression models and ROC plots. RESULTS: Fourteen percent of this population was sampled in 2006/7 and 19% in 2007/8 (usable data n = 1,711 in 2006/7, 2,428 in 2007/8). Mean d(3)mft was 1.1 in 2006/7 and 1.0 in 2007/8. The prevalence of caries experience was 26% in 2006/7 and 25% in 2007/8 (33% and 32%, respectively, for children in deprived areas). The adjusted odds-ratio for caries experience for children living in the most deprived areas was 2.90 (2.31, 3.64), p <0.001. There was a high rate of caries in the upper anterior teeth. CONCLUSION: It was feasible to conduct large scale caries surveys of three-year-olds in a nursery setting. Poor dental health and inequality commence early in life. Caries prevention should be targeted toward deprived families from birth.