The Changes in Size of Periapical Lesions after Root Canal Treatments Assessed by Digital Periapical Radiography and Cone-Beam Computed Tomography: A 2-Years Prospective Clinical Study.

Background and Objectives: There is limited information regarding comparison of long-term dynamics of periapical bone destruction estimated by digital periapical radiography (DPR) and by cone-beam computed tomography (CBCT). This study aimed to compare the radiographically assessed periapical changes of endodontically treated teeth over 2 years of follow-up and to analyse disagreements in periapical lesion size estimates around the same roots using DPR and CBCT. Materials and Methods: A total of 176 endodontically treated teeth, of 128 patients with apical periodontitis, were assessed by DPR and CBCT, at baseline and after 2 years. All periapical radiolucencies were categorised by severity (S0, S1, S2, S3) concerning their size. Descriptive statistics were used to report distribution of the radiolucencies at baseline and at follow-up, and their size transitions over 2 years. Site-specific comparison of the radiolucencies identified by two methods was performed using Z test and Pearson's chi-square test. Results: majority of the detected radiolucencies were scored as S0: 65% and 68% at baseline; 89% and 83% at follow-up, by DPR and CBCT, respectively. Site-specific score comparison showed that disagreements comprised 18% and 20% of the total number of radiolucencies detected by DPR and CBCT, respectively. There were more disagreements between DPR and CBCT within categories S1 and S2 + S3 compared to S0: at baseline, they comprised 17-33% and after two years 62-95% of all detected radiolucencies within the category. 65% of non-matching score transitions over two years occurred between S0 and S1. The CBCT-based evaluation resulted in negative treatment outcomes for 10 more root canals than the DPR-based result. Conclusions: Most remarkable disagreement between DPR and CBCT recordings was observed within the radiolucency categories S2 and S3. However, the diagnostic accuracy of both radiographic methods was questionable as it resulted in a high proportion of non-matching S0-S1 lesion transitions over 2 years.

Estimation of Caries Treatment Needs in First Permanent Molars of Lithuanian 5-6-Year-Old Children, Based on Caries Lesion Activity Assessment.

Background and Objectives: Early detection of dental caries lesions at active stages of development can facilitate their monitoring and reduce needs for restorative dental care. This study aimed to describe the prevalence and caries treatment needs in first permanent molars of pre-school children, based on a caries lesion activity assessment, and in relation to participants' ages, dental plaque levels and toothbrushing habits. Materials and Methods: Large cross-sectional dental caries survey using multistage cluster sampling was conducted among Lithuanian 4-6-year-old children attending kindergartens. For the present study purpose, all individuals presenting erupted permanent molars were selected. Thus, only 5-6-year-olds (n = 453) took part in this study. They were examined for caries by one calibrated examiner using Nyvad clinical diagnostic criteria that differentiate between active and inactive caries lesions. Dental plaque was assessed by the Silness-Löe index, and parents' reports about toothbrushing frequency were collected. Results: Overall, 41% of permanent molars were affected by caries; 6-year-olds had more caries lesions than 5-year-olds (p <0.05). Mean number of decayed and filled surfaces (DF-S) of all participants was 1.79 (SD 2.93), half of lesions were noncavitated, more than one-third were cavitated and fillings comprised less than one surface per child. Majority of lesions were active; prevalence of inactive lesions (all noncavitated) was 1% and 6% in 5- and 6-year-olds, respectively. Prevalence of active lesions increased with age; it correlated with plaque levels and with toothbrushing frequency (<0.001). Likelihood to detect active lesions was up to nine times higher in teeth with abundant plaque (odds ratio (OR) 8.73; confidence interval (CI) 5.35-14.25), and up to seven times higher in individuals brushing teeth irregularly (OR 6.88; CI 2.21-21.41). Conclusions: The obtained data indicate high treatment needs in the erupted permanent molars of the Lithuanian pre-school population and imply that caries management should primarily focus on improved biofilm removal, accompanied with regular use of fluoridated toothpaste.

Micro-Computed Tomography (Micro-CT) Evaluation of Effects of Different Rotary Glide Path Techniques on Canal Transportation and Centering in Curved Root Canals.

BACKGROUND The aim of this study was to evaluate the ability of different rotary glide path techniques to maintain canal anatomy by comparing canal transportation and centring abilities in curved root canals using X-ray micro-computed tomography (micro-CT). MATERIAL AND METHODS We selected 36 root canals and randomly assigned them to 3 groups. The first group was instrumented using Pathfile (PF) 1 and PF2, the second group using PF2, and the third group using a Proglider (PG) instrument. Selected tooth samples were scanned using a micro-CT system with 8-µm resolution. Centring ability and transportation were compared at 5 levels: 0.5 mm (A0) and 1 mm (A1) from apical foramen, at the point of maximum root curvature (C0), at 1 mm below it (C-), and 1 mm above it (C+). Area, ratio of areas (RA), perimeter, centroid shift, mean diameter, and ratio of diameter ratios (RDR) were assessed. RESULTS In all groups, there were no significant differences between different levels in all parameters (p>0.05). In group 1, the centroid shift was greatest at A0 and C-, and the least impact was at C0. In group 2, the biggest impacts were at C- and A0, and the smallest at C+. In group 3, the greatest impacts were at A0 and A1, and the smallest at C0. CONCLUSIONS All 3 instrument groups performed very similarly, without significant differences in canal-shaping parameters. Overall, using just PF2 instead of PF 1 and 2 created very similar shaping results, which could reduce the number of instruments needed and the cost of treatment.

Prevalence of Dental Erosion among the Young Regular Swimmers in Kaunas, Lithuania.

OBJECTIVES: To determine prevalence of dental erosion among competitive swimmers in Kaunas, the second largest city in Lithuania. MATERIAL AND METHODS: The study was designed as a cross-sectional survey, with a questionnaire and clinical examination protocols. The participants were 12 - 25 year-old swimmers regularly practicing in the swimming pools of Kaunas. Of the total of 132 participants there were 76 (12 - 17 year-old) and 56 (18 - 25 year-old) individuals; in Groups 1 and 2, respectively. Participants were examined for dental erosion, using a portable dental unit equipped with fibre-optic light, compressed air and suction, and standard dental instruments for oral inspection. Lussi index was applied for recording dental erosion. The completed questionnaires focused on the common erosion risk factors were returned by all participants. RESULTS: Dental erosion was found in 25% of the 12 - 17 year-olds, and in 50% of 18 - 25 years-olds. Mean value of the surfaces with erosion was 6.31 (SD 4.37). All eroded surfaces were evaluated as grade 1. Swimming training duration and the participants' age correlated positively (Kendall correlation, r = 0.65, P < 0.001), meaning that older swimmers had practiced for longer period. No significant correlation between occurrence of dental erosion and the analyzed risk factors (gastroesophageal reflux disease, frequent vomiting, dry mouth, regular intake of acidic medicines, carbonated drinks) was found in both study groups. CONCLUSIONS: Prevalence of dental erosion of very low degree was high among the regular swimmers in Kaunas, and was significantly related to swimmers' age.

Pathogenesis of apical periodontitis: a literature review.

OBJECTIVES: This review article discusses the host response in apical periodontitis with the main focus on cytokines, produced under this pathological condition and contributing to the degradation of periradicular tissues. The pace of research in this field has greatly accelerated in the last decade. Here we provide an analysis of studies published in this area during this period. MATERIAL AND METHODS: Literature was selected through a search of PubMed electronic database. The keywords used for search were pathogenesis of apical periodontitis cytokines, periapical granuloma cytokines, inflammatory infiltrate apical periodontitis. The search was restricted to English language articles, published from 1999 to December 2010. Additionally, a manual search in the cytokine production, cytokine functions and periapical tissue destruction in the journals and books was performed. RESULTS: In total, 97 literature sources were obtained and reviewed. The topics covered in this article include cellular composition of an inflammatory infiltrate in the periapical lesions, mechanisms of the formation of the innate and specific immune response. Studies which investigated cytokine secretion and functions were identified and cellular and molecular interactions in the course of apical periodontitis described. CONCLUSIONS: The abundance and interactions of various inflammatory and anti-inflammatory molecules can influence and alter the state and progression of the disease. Therefore, periapical inflammatory response offers a model, suited for the study of many facets of pathogenesis, biocompatibility of different materials to periapical tissues and development of novel treatment methods, based on the regulation of cytokines expression.

Factors related to gender differences in toothbrushing among Lithuanian middle-aged university employees.

BACKGROUND AND OBJECTIVES. Many previous studies showed clear gender differences in the percentages of adults reporting toothbrushing more than once a day. This study evaluated the factors determining gender differences in toothbrushing among Lithuanian middle-aged university employees. MATERIAL AND METHODS. A questionnaire survey was anonymously conducted among 35- to 44-year-old employees (n=862) of four universities in Lithuania in 2005. The response rate was 64% (n=553). Data covered toothbrushing frequency, habitual dental attendance, dental health attitudes and knowledge, and subject's background information. RESULTS. Of all respondents, 68% reported brushing their teeth more than once a day (73% of women and 49% of men, P<0.001) and 51% indicated checkup-based habitual dental attendance (54% of women and 41% of men, P=0.012). The majority reported good dental status as being important to them and poor oral health as injurious to general health. Of all respondents, 44% indicated that "Lack of time is the main reason for incomplete oral self-care" (61% of men and 40% of women, P<0.001). Logistic regression models showed that the strongest factor affecting toothbrushing frequency was the importance of good dental health to them (OR, 1.6; 95% CI, 1.1-2.4; P=0.02) among women and statement that "Poor oral health can be injurious to general health" (OR, 2.6; 95% CI, 1.2-5.5; P=0.01) and checkup-based habitual dental attendance (OR, 2.4; 95% CI, 1.0-5.9; P=0.06) among men. CONCLUSIONS. Due to different determinants affecting toothbrushing frequency among men and women, different oral health motivation programs by gender should be developed.

Antibiotic prescription for the treatment of endodontic pathology: a survey among Lithuanian dentists.

OBJECTIVE: To describe a pattern of antibiotic prescription during root canal treatment procedures based on the reports of Lithuanian general dental practitioners. MATERIALS AND METHODS: Questionnaires concerning endodontic treatment were sent to all 2850 Lithuanian dental practitioners registered on the database of the Lithuanian Dental Chamber. Only the questions containing general information and individual decisions about antibiotic prescription for endodontic treatment were selected for the analysis. RESULTS: The response rate was 53.8%. Of the 1532 responses, 1431 questionnaires received from licensed general dental practitioners were analyzed. More than 60% of the respondents reported prescribing antibiotics in cases of symptomatic apical periodontitis. Majority of the respondents (83.9%) reported symptomatic apical periodontitis with periostitis being a clear indication for the prescription of antibiotics. Nearly 2% of the respondents reported prescribing antibiotics in cases of symptomatic pulpitis. With an increasing duration of professional activity, an increase in the proportion of the respondents reporting prescription of antibiotics was observed. Amoxicillin was the most preferable antibiotic during endodontic treatment, followed by amoxicillin with clavulanic acid. An increase in reporting penicillin prescription and decline in prescribing amoxicillin and amoxicillin with clavulanic acid with regard to the increasing age of respondents was observed. CONCLUSIONS: Lithuanian dentists, particularly those with longer duration of professional activity, tended to exceed general recommendations for the antibiotics prescription in cases of endodontic infections. However, a trend toward prescription of broader spectrum antibiotics by younger dentists, compared with those with longer professional activity, was observed.

Microbial infection and its control in cases of symptomatic apical periodontitis: a review.

Apical periodontitis is an inflammation of dental periapical tissues developed as a response to colonization of microorganisms in root canal system. Etiology of periapical pathology is associated with different species of microorganisms that are not fully defined yet. The changes in the composition of root canal microbiota as well as other factors, such as host resistance to various infections and concomitant viral infection, etc., can influence development of the symptomatic apical periodontitis. Etiology of disease is reviewed in this article. The purpose of treatment of symptomatic apical periodontitis is to eliminate the infection in root canal system and to obtain relief of symptoms. It can be done by conventional root canal therapy, which can be combined with anti-inflammatory medication. Indications for antibiotic therapy in such cases are limited to particular occasions, which are considered in article. Nevertheless, findings show that usually dentists prescribe antibiotics improperly in clinical practice. It can render drugs ineffective against diseases of dental origin as well as against potentially fatal infectious diseases. Selection of antibiotics for the treatment of root canal infections is reviewed in this article. Importance of antimicrobial susceptibility testing is emphasized. There is a need for more research on microbial causes and interactions in different forms of apical periodontitis to improve diagnosis and treatment.

Characteristics of dental attendance among Lithuanian middle-aged university employees.

OBJECTIVE: This study aimed to evaluate and describe the dental attendance patterns and to characterize the factors that encourage preventive dental visits among 35- to 44-year-old university employees in Lithuania. MATERIAL AND METHODS: A questionnaire survey was conducted anonymously among the 35- to 44-year-old employees (n=862) of four universities in Lithuania in 2005. The response rate was 64% (n=553). Data on their most recent dental visit, habitual dental attendance, and self-reported dental health were collected. Gender, marital status, education, and income levels served as background factors. Of the respondents, 79% were women, and 82% held a university degree. RESULTS: Of all the respondents, 75% reported having their most recent dental visit within the previous 12 months; 19% indicated a preventive check-up as the reason for it (15%--self-decided visit and 4%--dentist's recall). The most common treatments received were fillings (75%), scaling and cleaning (28%), and endodontic treatment (22%). Analysis of the data about habitual dental attendance showed that preventive check-up as the main reason for attendance was more commonly reported by women (OR=1.7), among those who indicated having lost fewer teeth (OR=1.5), reported higher incomes (OR=1.4), and who indicated a shorter time interval since their most recent dental visit (OR=1.3). CONCLUSION: Dental problem seems to be a dominant reason for dental attendance in Lithuania where both dentists' and patients' behavior weakly reflects preventive orientation.

A pilot study of Er,Cr:YSGG laser therapy used as an adjunct to scaling and root planing in patients with early and moderate periodontitis.

OBJECTIVES: The study aim was to compare the results of an Er,Cr:YSGG laser therapy used in adjunct to scaling and root planing (SRP), and of SRP alone, in a small group of patients with early to moderate periodontitis. MATERIALS AND METHODS: Ten adult patients with periodontitis were treated according to split-mouth design, using Protocol A (SRP alone) or, Protocol B (Er;Cr:YSGG laser therapy combined with SRP). At baseline, and 3 months after the treatment the following periodontal parameters were evaluated: bleeding on probing (BOP), probing depth (PD), plaque index (PI). RESULTS: no statistically significant difference in plaque levels was noted before and after the treatment between the treated quadrants, however a tendency of a more pronounced decrease in plaque levels was noted in the group of laser-SRP treated teeth. After three months, 60-68% decrease of BOP-positive teeth compared to baseline status was noted in all treated quadrants, without significant difference between the treatment modes. The decrease of mean PD values was measured after three months compared to baseline: on the lingual surfaces in 'SRP" group the mean PD improvement value was 0,94+/-12, and in the laser-SRP group it was 1,96+/-11, (p<0,001); on the vestibular surfaces the mean improvement values were 0,99+/-0,14 and 2,03+/-0,11, respectively (p<0,001). CONCLUSIONS: Non-surgical periodontal therapy using both an Er;Cr:YSGG laser + SRP and SRP alone, lead to significant improvements in all the investigated clinical parameters. The combined treatment using laser as an adjunct to root scaling and planing seemed to be advantageous when compared to SRP alone, due to more efficient attachment level restoration.

Testing of the questionnaire on dental care satisfaction in a sample of adult patients visiting dental clinics at Faculty of Odontology, Kaunas University of Medicine. A pilot study.

UNLABELLED: A pilot study was conducted with the aim to test and develop a questionnaire which covers dental patients attendance, satisfaction with dental care, oral health self-evaluation, attitudes and knowledge about oral health, before applying it to a broad population. A total of 53 adult subjects (mean age 40.1) visiting Kaunas University of Medicine dental clinics, filled in the questionnaire presented by the researchers. Statement choices to define dental care satisfaction were selected from previously used instruments for similar studies in other countries. RESULTS: Major difficulties in answering questions were related to using the Likert scale response alternatives. All statements concerning dental care satisfaction with the mean Likert score value below 2.0 were decided to be indicative for the importance of characteristics. According to factor analysis and distribution of the mean scores of dental care satisfaction characteristics it was decided to include no more than 8 questions in each dimension to the final version of questionnaire. In case of equal loadings of several statements in the factor analysis, the statement with lower mean score was used. CONCLUSIONS: The use of professional terminology in questionnaire survey should be tested before applying to a broad population. The final instrument for measuring dental care satisfaction should be formed on the basis of statistical evaluation of relative importance and comparative load of different questions/statements to be included in the questionnaire.

Dietary and oral hygiene habits in children with type I diabetes mellitus related to dental caries.

UNLABELLED: The aims of the study were to evaluate differences in dietary, oral hygiene habits and social class in children with Type I diabetes mellitus (DM), compared to non-diabetics, and to investigate relationship between selected caries-risk factors and caries experience in diabetics. MATERIAL AND METHODS: 70 children with Type I DM and 70 age- and sex-matched non-diabetic controls were included in the study. Metabolic control of diabetes was categorized into well- to- moderately-controlled and poorly-controlled groups based on glycosylated haemoglobin HbA1c. The study was based on the data obtained from the questionnaire including information about dietary and oral hygiene habits, pattern of dental visits and social class. Results showed that the diabetic children had more frequent main meals and less snacking than their controls: the mean number of main meals/day was 4.33 (SD = 0.93) in the diabetics, and 2.53 (SD = 0.85) in the controls. Significantly less diabetics (43%) used sweet drinks than their controls (79%). There were no differences according to the frequency of toothbrushing as well as frequency of dental visits between the diabetics and controls, however, significantly more diabetics reported that they never used dental floss than non-diabetics. There were no significant differences in the diet, toothbrushing frequency between the diabetics with different metabolic control. Multiple logistic regression analysis showed that among caries risk associated variables only age of children (OR = 1.98; CI = 1.23-3.19) and level of metabolic control of diabetes (OR = 4.65; CI = 1.28-16.89) were statistically significantly associated with high caries experience in the diabetics. CONCLUSIONS: Frequent consumption of sweet drinks and snacks can influence caries development in children. Amongst the diabetics, the differences in caries prevalence can be explained by combination of biological and behavioral factors rather than single dietary or oral hygiene elements.

Oral hygiene in children with type I diabetes mellitus.

UNLABELLED: Oral hygiene is an important etiological factor related to oral health status in children. The aim of the study was to evaluate the oral hygiene status in children with type I diabetes mellitus (DM) and in their non-diabetic controls, and to correlate it with the health condition of the gingival tissues. MATERIALS AND METHODS: Seventy 10-15 year-old children (mean age 13.6, SD=1.6) with type I DM and 70 their age and sex-matched non-diabetic controls were included in the study. The metabolic control of DM was categorized into well- to- moderately controlled and poorly-controlled diabetes groups based on glycosylated haemoglobin HbA1c. The oral hygiene and gingival status were assessed using the Simplified Oral hygiene index OHI-S (Greene-Vermillion) and gingival index GI (Löe-Silness), respectively. Student's t, Mann-Whitney U or chi-square tests and linear regression were used in the statistical analyses. RESULTS: There were no statistically significant differences in the mean values of OHI-S between the diabetics and non-diabetics, however the mean calculus index (CI-S) was significantly higher and the mean plaque index (DI-S) was significantly lower in diabetic subjects than non-diabetics (p<0.05). The children with type I DM had significantly higher mean values of GI compared with the non-diabetic subjects (0.15, SD=0.37 and 0.05, SD=0.19 respectively) (p<0.05). Healthy gingiva was recorded in 73% diabetics, and 87% of the non-diabetics (p<0.05). The poorly controlled diabetics had higher mean gingival, plaque, calculus indices than well-moderately controlled subjects, although the differences were not statistically significant. Statistically significantly higher mean OHI-S index was found in children with poor control of diabetes compared with the well-moderately-controlled diabetics (1.39, SD=0.75 and 1.07, SD=0.53, respectively) (p<0.05). The level of gingivitis statistically significantly correlated with the levels of calculus in both study groups (p<0.001). No difference in toothbrushing habits was revealed between the study subjects. CONCLUSION: Despite similar oral hygiene habits, the children with type I DM were more prone to calculus accumulation which seemed to be a predisposing factor in development of gingivitis in these individuals.