Is Diet a Determining Factor in the Induction of Gingival Inflammation by Dental Plaque? A Secondary Analysis of Clinical Studies.

The aim was to determine the association between plaque and gingival inflammation reported by dietary interventions. Data of four clinical studies dealing with changed nutrition and gingival examination were reanalyzed with regard to gingival inflammation (GI), plaque (PI), and bleeding on probing (BOP). Dietary changes basically involved avoiding sugar, white flour and sweetened drinks and focusing on whole foods for 4 weeks. The control groups were to maintain their usual diet. All participants had to reduce their oral hygiene efforts. Linear regression models taking the clustering of the data due to several studies into account were applied. In total, data of 92 participants (control groups: 39, test-groups 53) were reanalyzed. While both groups showed a slight increase in dental plaque, only the test groups showed a significant decrease in inflammatory parameters: GI (mean value difference End-Baseline (Δ): -0.31 (±SD 0.36)) and BOP (Δ: -15.39% (±16.07)), both p < 0.001. In the control groups, there was a constant relation between PI and GI, while the experimental group showed a decreasing relationship in GI/PI (p = 0.016), and even an inverted relationship BOP/PI under a changed diet (p = 0.031). In conclusion, diet seems to be a determining factor how the gingiva reacts towards dental plaque.

Diagnosing and recording root caries: A survey among Swiss dentists.

OBJECTIVES: Despite the increase in the root caries prevalence, little is still known about how dentists manage this condition. The present study aimed to evaluate the knowledge of dentists on diagnosing and recording root caries lesions (RCL). METHODS: The survey consisted of three domains: (1) dentists' knowledge on diagnosing, recording and managing RCL; (2) information about their current general clinical routines; and (3) their demographics. The four Swiss Universities distributed the survey via e-mail lists for alumni or professionals participating in continuing education. The data was quality checked. Construct validity, internal reliability and intraclass correlation (ICC) were assessed. RESULTS: The survey was answered by 383 dentists from 25(out of 26) cantons [mean(SD) working experience: 22.5(12) years]. The majority replied that they see less than 5 patients with RCL per week, whereas 41 have at least 5 per week, and 40 % (157 dentists) do not distinguish RCL from coronal caries in their patients' medical records. When diagnosing active RCL, tactile sensation was the most predominant criterion (n = 380), whereas color (n = 224) and visual appearance (n = 129) of the lesion were less often selected. The most often chosen risk factors for RCL were poor oral hygiene and presence of biofilm.The responses were significantly influenced by the participants' place of education, their age and working area. CONCLUSION: The present survey highlights the huge diversity in diagnosing, recording and assessing risk factors of RCL. The benefits of an appropriate diagnosis, recording and management of risk factors of RCL should be highlighted in under- and postgraduate dental education. CLINICAL SIGNIFICANCE: A great diversity in diagnosing, recording and assessing risk factors of RCL was observed, which migh strongly impact how dentists manage RCL. The study emphasizes the necessity for intensive efforts to bridge the gap between guideline recommendations and their implementation in private dental practices.

Decision making and management of root caries: A practice-based survey.

OBJECTIVES: With increasing life expectancy and improved preventive measures, teeth are retained longer, leading to a rise in prevalence of root caries lesions (RCL). However, little is known about how dentists manage this condition. The present survey aimed to evaluate the knowledge of Swiss dentists on decision making and management of RCL. METHOD: The survey evaluated dentists' knowledge, clinical routines, and demographics concerning RCL. Dentists were contacted via email and local newsletters, and 383 dentists from 25 (out of 26) cantons responded. Mann-Whitney U test, χ2 test, intraclass correlation coefficients, Spearman correlation and Chi Square were used. RESULTS: The dentists had a mean(SD) working experience of 22.5(12) years. Most dentists correctly classified an inactive (67%) and an active (81%)RCL. Although the inactive lesion did not call for restorative treatments, 61% of the dentist declared they would restore it. From the active lesion,83% would restore it. The invasive treatments leaned toward complete caries excavation with composite resin as preferred restorative material. There were significant correlations between material choice and expected success rates. Among the non-invasive options, oral hygiene instructions and (highly-)fluoridated toothpaste were favored. Most dentists declared having a recall system for such patients, with biannual follow-ups preferred. The dentists' place of education significantly influenced restorative decisions (p < 0.001), while participants' age (≥60years) impacted activity status (p = 0.048) and restorative decisions (p = 0.02). CONCLUSION: Material preferences for non-invasive or invasive management varied greatly and there were minimal differences in the management of inactive or an active RCL. Moreover, diagnosing active lesions appeared easier than diagnosing inactive ones. CLINICAL SIGNIFICANCE: Despite diverse material preferences for (non-)invasive treatments, a strong positive correlation existed between the chosen restorative material and its expected 2-year success rate. Moreover, diagnosing active lesions appeared easier than diagnosing inactive ones. The outcome emphasis the need to align guideline recommendations with their application in private dental practices.

Evaluation of the Association of Chewing Function and Oral Health-Related Quality of Life in a Population of Individuals Aged ≥ 45 Years and Residing in Communities in Switzerland: A Cross-Sectional Study.

PURPOSE: To analyse the association of masticatory performance and oral health-related quality of life in a representative population of individuals residing in communities in Switzerland aged ≥ 45 years. MATERIALS AND METHODS: In total, 100 subjects completed two dedicated and validated questionnaires on their demographic data and the Geriatric Oral Health Assessment Index. A mixing ability test was performed for assessing masticatory performance. The qualitative analysis of the test was performed by categorizing the images into five categories, while the quantitative analysis was performed via a validated custom-made software. RESULTS: Sixty-six samples could be analysed. Participants younger than 65 years of age showed significantly less frequent chewing deficiencies (17%) compared to those 65 years and older (50%, p < 0.01). However, retired participants had chewing deficiencies significantly more frequently (8%) compared to workers (51%, p < 0.01). A statistically significant positive association of having chewing deficiency was found between employment status (p < 0.01) and the presence of restorations (p = 0.04), while GOHAI did not show any statistically significant association. Overall, the enrolled subjects displayed moderate chewing function. Masticatory performance was positively associated with the number of present restorations. CONCLUSIONS: The enrolled subjects residing in communities in Switzerland aged ≥ 45 years displayed moderate chewing function. Their masticatory performance was positively associated with the number of present restorations but not associated with oral health related quality of life (GOHAI).

[Risk analysis Erosive Tooth Wear (ETW): checklist for a quick assessment of the risk factors for ETW in the dental practice]. / Risikoanalyse Erosive Tooth Wear (ETW): Checkliste zur schnellen Bewertung der Risikofaktoren für ETW in der Zahnarztpraxis.

Erosive Tooth Wear (ETW) is the loss of tooth structure without bacterial involvement. As the resulting loss of tooth structure is irreversible, an early evaluation of the multifactorial etiology, accurate diagnosis and regular follow-up are essential. The ETW is dynamic and its progression should be continuously monitored. A risk analysis table was developed to systematically record risk factors for ETW (Fig. 2). This allows ETW management to be integrated more efficiently into clinical practice and the progression to be documented over the years. If ETW is assumed, the risk analysis should be performed and updated at least every two years. In the assessment, risk-promoting and risk-inhibiting factors are marked, added together and compared. If the negative factors pre-dominate, measures should be taken to minimize the risk for ETW. The main purpose of the risk analysis is therefore to evaluate the individual etiology, coun-teract negative factors, promote positive factors and prevent progression.

Longevity of posterior direct versus indirect composite restorations: A systematic review and meta-analysis.

OBJECTIVES: The goal of this systemic review and meta-analysis was to compare the longevity of direct and indirect composite restorations in posterior teeth. DATA: Randomized controlled trials (RCT) investigating direct and indirect composite restorations in permanent posterior teeth. SOURCES: Three electronic databases (PubMed, CENTRAL (Cochrane) and Embase) were screened. No language or time restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Risk of bias and level of evidence was graded using Risk of Bias 2.0 tool and Grade Profiler 3.6. RESULTS: A total of 3056 articles were found by electronic databases. Finally, five RCTs were selected. Overall, 627 restorations of which 323 were direct and 304 indirect composite restorations have been placed in 279 patients (age: 28-81 years). The highest annual failure rates (AFR) were found for indirect restorations ranging from 0 % to 15.5 %. Lower AFR were found for direct restorations ranging from 0 % to 5.4 %. The most frequent failures were found to be chipping and fracture of the restoration followed by caries. Meta-analysis revealed that the failure rate for direct restorations was significantly lower than for indirect restorations (Risk Ratio (RR) [95 %CI] = 0.61 [0.47; 0.79]; very low level of evidence). Furthermore, all studies showed a high risk of bias. CONCLUSION: Direct and indirect composite restorations can be recommended for large class II cavities including cusp coverage in posterior teeth for single tooth restoration. Meta-analysis revealed significantly lower relative risk to fail for direct composite restorations than for indirect restorations but results are with high risk of basis.