Effect of topical fluoride and fluoride varnish on in vitro root surface lesions.

PURPOSE: To evaluate the effect of a fluoride varnish on demineralization and remineralization of root surfaces in vitro. METHODS: 80 caries-free teeth were selected from a large pool of extracted anterior and premolar teeth from elderly patients. Acid resistant nail varnish was painted on all surfaces except for a window (l x 4 mm) on the buccal or lingual root surfaces. Teeth were randomly divided into four treatment groups: CONTROL: washed with deionized/distilled water; Daily gel: treated with Karigel-N (5,000 ppm) for 4 minutes daily; Weekly gel: treated with Karigel-N for 4 minutes weekly; and Weekly varnish: treated with Duraflor (22,600 ppm) weekly (the varnish was removed 24 hours after each application). Teeth were then placed in a cycle of demineralization (6 hours at pH 4.3) and remineralization (17 hours at pH 7.0) for 21 days. Half the specimens of each group were brushed with no dentifrice for 10 seconds twice daily. Specimens were evaluated under polarized light microscopy and contact microradiography. The depth of each lesion and width of the remineralization bands were measured. An ANOVA model was used to assess the effect of different treatments. RESULTS: The control group had the deepest lesions and the daily gel group had the shallowest lesions. The weekly varnish group was found to have significantly shallower lesions than the weekly gel group. The varnish brushing subgroup had significantly deeper lesions than varnish non-brushing subgroup (P = 0.01). Remineralization bands were detectable in most lesions. There was no significant difference in band width between different groups (F = 0.634, P = 0.594). However, a significant difference was found when remineralization bands were calculated as percentage of lesion depth between different groups (F = 4.24, P = 0.001). The varnish non-brushing subgroup had significantly higher percentage than the control group, but daily gel non-brushing had the highest percentage. Brushing was a significant factor in the varnish group. Lesions were significantly shallower in the non-brushing varnish subgroup.

Overview of the evidence for clinical interventions in pediatric dentistry.

PURPOSE: The purpose of this report was to describe the quantity of published literature and types of studies supporting the use of 4 pediatric dentistry procedures: (1) ferric sulfate pulpotomy; (2) stainless steel crowns; (3) space maintainers; and (4) atraumatic restorative technique (ART). METHODS: When available, titles and abstracts of reports written in English and published over a 36-year period (1966-2002) concerning these procedures were retrieved from MEDLINE. They were classified using a modified classification scheme that, in addition to the study designs, also considered the 4 dimensions of measuring dental outcomes. RESULTS: The quantity of available literature concerning each dental procedure varied considerably. Even though many reports were published on treatments, only a small proportion of the published literature for each procedure was found to evaluate outcomes, regardless of outcome dimension. Besides outcomes evaluations, studies on techniques, material properties, and review articles comprised a large proportion of the literature. Clinical dimension of outcomes was most commonly studied. Case series and case reports were the most frequently used study designs to report outcomes. CONCLUSIONS: The outcomes-related literature to support some of the commonly performed treatments is limited both in quantity and study types. More reports are needed to develop the evidence base to support the commonly performed procedures in pediatric dental practice. Additional analyses reporting of the literature are also needed to assess internal and external validity of the studies.

Anticipated and experienced pain associated with endodontic therapy.

BACKGROUND: The authors compared the levels of anticipated and experienced pain of patients who received endodontic therapy, or ET, with selected patient and dental characteristics. METHODS: Sensory and affective pain outcome measures (pain and unpleasantness) were evaluated by 333 adult patients immediately before and after dental school faculty or residents performed ET. Dentists provided clinical evaluations and a pulpal diagnosis for each tooth and then rated the level of their patients' pain during treatment. RESULTS: Before ET, 43 percent of all patients anticipated high outcome levels, yet only 22 percent experienced high pain levels, and only 18 percent experienced high unpleasantness levels. Outcome levels did not differ by tooth type, pulpal diagnosis, ET history or dental care attendance. Women were significantly more likely to anticipate higher pain and unpleasantness levels than were men. Experienced outcome levels, however, did not differ by sex. Anticipated and experienced outcome levels significantly decreased with increasing age. Dentists' evaluation of their patients' pain levels correlated more highly for female than for male patients. CONCLUSIONS: Pain experienced during ET often is less than anticipated. Younger people anticipate and experience higher pain levels. Women are more likely than men to anticipate, but not necessarily experience, higher pain levels. Dentists are more closely attuned to the pain experiences of their female patients. Clinical Implications. Practitioners could better prepare younger patients and female patients for ET and improve pain communication with male patients. Findings suggest that patients perceive each ET experience as new, implying that dentists should manage patients who have had ET in the past as carefully as those receiving ET for the first time.

The involvement of Iowa dentists in hospice care.

The relationships between dentist characteristics and professional education with involvement of Iowa dentists in hospice care were investigated. Using the 1999 Iowa Health Professional database, a survey requesting information regarding involvement in and training for care of hospice patients was mailed to all licensed dentists (N = 1,210). Two mailings yielded a 54.6% response rate. Of the 638 dentist respondents, the mean age was 47, 86% were male, 88% general dentists, and 295 (46%) reported providing some treatment for hospice patients. At least one dentist reported providing hospice patient care in 72 of Iowa's 99 counties. About 90% of dentists treating hospice patients were general practitioners. Males were more likely to provide treatment (p < 0.0313). Neither dentist age nor years in practice were significant predictors. Dentists were more likely to treat hospice patients in the office (IO, 40%). The most prevalent treatments were denture relines (31% IO; 71% OO), examinations (16% IO; 68% OO), and emergency treatment (12.5% IO; 53% OO). More than 86% of surveyed dentists indicated that their professional education did not adequately train them to meet the clinical, psychosocial, communication, or spiritual needs of hospice patients.

Application of short-form oral health impact profile on elderly Japanese.

OBJECTIVES: The purpose of this study was to use the oral health impact profile (OHIP-14) to evaluate the impact of oral disease on the quality of life of a group of independently-living elderly persons in an urban area of Japan. SUBJECTS: A total of 1244 participants of the Senior Citizen's College, who attended the lectures once a week. They were community-dwelling, independently-living people over 60 years of age. MEASUREMENTS: Japanese version of the short-form OHIP-14. RESULTS: Internal reliability for the 14 items overall was very high (Cronbach's alpha = 0.95). Report of 'painful aching' and 'uncomfortable to eat' were the two most highly scored items using the mean sum OHIP-14 score. A multiple logistic regression analysis indicated that the sum OHIP-14 score had significant associations with self-assessment of general health, dental status, and a perceived need for dental treatment. However, age, gender, dissatisfaction with financial status or education level was not significantly associated with the sum OHIP-14. Compared with that of other countries, the items were ranked similarly, whereas the perceived magnitudes of the problems were quite different from other population. CONCLUSIONS: The OHIP-14 in Japanese had a high internal reliability, was significantly associated with dental status and comparable ranking for items when compared with studies from other countries.

In vitro evaluation of fluoride varnish on overdenture abutments.

STATEMENT OF PROBLEM: No clinical study has evaluated the efficacy of fluoride varnish as a topical fluoride agent for the protection of overdenture abutments from dental caries. PURPOSE: This study assessed the efficacy of a fluoride varnish in protecting overdenture abutments from demineralization in an in vitro environment. MATERIAL AND METHODS: Eighty caries-free, extracted teeth were sectioned and domed immediately below the cementoenamel junction, simulating overdenture abutment preparations. Acid resistant nail varnish was painted on all surfaces except for a window (1 x 4 mm) on the prepared occlusal dentin surfaces. Teeth were randomly divided into 4 groups of 20 specimens: control, washed with deionized/distilled water; Daily Gel, treated with Karigel-N (5,000 ppm) for 4 minutes daily; Weekly Gel, treated with Karigel-N for 4 minutes weekly; and Weekly Varnish, treated with Duraflor (22,600 ppm) weekly. The varnish was removed using a blade 24 hours after each application to simulate the clinical loss of the varnish. Teeth were then placed in a cycle of demineralization (2.2 mMol/L CaCl(2)2H(2)O, 2.2 mMol/L KH(2)PO(4), and 50 mMol/L acetic acid at pH 4.3) for 6 hours and remineralization (1.5 mMol/L CaCl(2)2H(2)O, 0.9 mMol/L KH(2)PO(4), and 150 mMol/L KCl at pH 7.0 for 17 hours) for 21 days. Half the teeth in each group were brushed with no dentifrice for 10 seconds, twice daily. Teeth were sectioned at 100 +/- 10 microm buccolingually and evaluated under polarized light microscopy and contact microradiography. The depth of each lesion and the width of the remineralization bands were measured (mm). Analysis of variance models and T-tests were used to assess the effects of different treatments (alpha=.05). Duncan multiple range tests were then chosen as post hoc tests to evaluate the statistical significance of all pairwise comparisons. RESULTS: The control group had the deepest lesions (mean depth 400 +/- 39 microm). The lesions from the varnish and daily gel groups were significantly shallower than the lesions in both the control group and the weekly gel group. The remineralization bands in the varnish group were 52% wider than the control group bands. However, the daily gel group had the largest increase in band width (117% increase) compared with the control group. There were significant differences between all groups for net depth (lesion depth minus the remineralization band) (P<.0001). Daily application of fluoride gel was significantly more effective than the other treatments tested. Brushing was not a significant factor. CONCLUSION: Within the limitations of this in vitro study, treatment of overdenture abutment with various topical fluorides significantly inhibited demineralization and enhanced remineralization of cut occlusal dentin surfaces. Daily use of Karigel-N was the most effective treatment, followed by the weekly application of Duraflor varnish.

Evaluation and characteristics of "dropouts" in a longitudinal clinical study.

This paper attempts to identify characteristics of a longitudinal clinical study's "dropout" population (1974-1996) of patients using overdentures. This study included 395 subjects. Dropouts were identified as persons who did not respond to letters or telephone calls after participating in the study for up to 2 years, could not be located, or did not wish to return to the study. Participants (N=273) and Dropouts (N=84) were compared by evaluating a series of factors: sociodemographic, medical, health, and some oral health behaviors. The population was divided into two very similar cohorts for analysis based on years of recruitment: Group I (1974-1984) and Group II (1985-1993). Significant differences were found between them, including vision problems and risk of oral soft tissue problems related to medical diagnosis. Dropouts were significantly younger than Participants, had fewer hearing and vision problems, tended to brush their teeth more often and were more likely to use daily topical fluoride in their overdentures. The differences between the Dropouts and the Participants may be that younger persons are more mobile and have fewer vision and hearing problems, but this does not help predict their commitment to a study. Health behaviors such as brushing overdenture abutments or fluoride use may be more predictable but are harder to assess until persons have been study participants for some time.