Does dental fluorosis affect electric pulp test response and/or optimum probe placement site?

The placement site of electric pulp tester (EPT) probe on the tooth affects the threshold values obtained. The aim of this study was to determine and compare threshold levels and appropriate placement sites for EPT probe on fluorotic and normal teeth. Equal numbers of fluorotic and non-fluorotic maxillary central incisors of 40 subjects were assessed. The mean of three threshold readings from an EPT was taken from the labial surface at the incisal edge, incisal third, middle third and cervical third. Kruskal-Wallis and Friedman ANOVA followed by post hoc tests were used to compare threshold scores. Significantly higher thresholds were recorded for fluorotic teeth at the incisal edge and incisal third. The lowest thresholds were obtained for the incisal edge in both fluorotic and non-fluorotic teeth when compared to the cervical third. There was no statistically significant difference among corresponding test sites between the genders and age groups.

Prevalence and Reasons for Extraction of Endodontically Treated Teeth in Adult Nigerians.

AIM: Teeth extraction is an important problem in elder patients. Although some of these teeth have been endodontically treated, many of them may be subjected to extraction. The reasons for extraction are important for prevention planning in further patients. The aim of this study was to assess the prevalence and important reasons for extraction of endodontically treated teeth in adult Nigerians. MATERIALS AND METHODS: This study involved a retrospective examination of 2,000 case files in the archives of the University of Nigeria Teaching Hospital. Out of the 2,000 case files, 650 concerned endodontically treated teeth. RESULTS: The prevalence of extractions in the population was 21.5%. This was more often in the mandible (67.9%) than in the maxilla (32.1%). In both jaws, more molars were extracted (57.1%), followed by premolars (27.1%) and anterior teeth (15.7%). Extractions occurred 57.1% of times in females. However, the rate of extraction decreased with age but peaked in the 51-60 year age band. CONCLUSION: The association between age and extraction was proven. Caries, vertical root fracture and endodontic reasons accounted for the commonest cause of extraction in the mandible; while in the maxilla, endodontic reasons and cusp fracture caused extractions most often. CLINICAL SIGNIFICANCE: The reasons for extraction of endodontically treated teeth are different between maxilla and mandible.

Knowledge, diagnosis and management of dentine hypersensitivity: a national survey of dentists in Nigeria.

AIM: To assess the knowledge of Nigerian dentists regarding dentine hypersensitivity (DH) and their methods of diagnosis and management. METHODS: A cross-sectional questionnaire-based study of dentists practicing in all six geopolitical zones of Nigeria was conducted. The questionnaire focussed on participant's demography, exposure to patients with DH, knowledge-based questions, diagnosis and management of DH. Data analysis using EPI Info statistical software determined frequencies and proportions. Associations between discrete variables were assessed using the chi-square test (P ≤ 0.05). RESULTS: A total of 1,057 dentists responded; the majority (83.8%) had practiced for up to 15 years, and 92.0% reported that, on average, between one and 10 of their patients each week complained of DH. The majority (92.8%) of dentists described DH as stimulated brief pain from the tooth; 24.2% expressed that DH can be treated by altering the number of dentinal tubules. A diagnosis of DH is made by tapping (20.6%) or scratching (73.4%) the tooth. Although radical treatments, such as extraction (24.7%) and root canal therapy (34.5%), were mentioned by some, the majority identified aetiological and predisposing factors (98.8%) and provided diet (95.1%) and oral hygiene (95%) counselling as part of the management of DH. Evaluation of 36 knowledge-based questions revealed that only 1.8% of the respondents provided at least 25 correct answers. Knowledge was significantly associated with respondent age and number of years in practice (P ≤ 0.05) but was not associated with the number of patients with DH seen per week (P = 0.46). CONCLUSION: Dentists practicing in Nigeria exhibited knowledge gaps concerning DH and its diagnosis and management.

A survey of endodontic practices among dentists in Nigeria.

AIM: To investigate the pattern of routine endodontic practices among Nigerian dentists. MATERIALS AND METHODS: This study was a questionnaire-based survey of samples of dentists in the Nigerian cities of Enugu and Benin. The self-administered questionnaire contained 25 close-ended questions with multiple choice options. The data collected included demographic details of respondents, root canal preparation techniques, irrigants and intracanal medicaments used, the number of appointments, method of working length determination, root filling techniques, cements used, and the scope of treatment performed. RESULTS: Most respondents used sodium hypochlorite as the irrigant, the step back technique for canal preparation, and lateral condensation with a zinc oxide-eugenol-based sealer for obturation. Most respondents did root canal treatment on all types of teeth and used radiographs to determine the working length 70% of the time. Most respondents followed up their patients for less than 12 months and most treated teeth with periapical areas larger than 10 mm by root canal therapy combined with apical surgery. CONCLUSION: Most Nigerian dentists use step back technique for canal preparation and lateral condensation for obturation. CLINICAL SIGNIFICANCE: Endodontic practice by Nigerian dentists differs from some established practice quality guidelines in many other countries, particularly in nonperfusion of modern techniques into practice, popularity of antibiotic use for endodontic emergencies and a high rate of perforations.

Transport media for avulsed teeth: a review.

Management protocols for avulsed teeth should include management of the pulp and periodontal ligament (PDL) cells in order to improve the long-term prognosis and survival of these teeth. The use of an inappropriate transport or storage medium potentially increases the risk of PDL cell necrosis, which can result in ankylosis and replacement resorption of the tooth root. Considering the critical role of these media, an informed choice of a suitable medium is essential for a favourable outcome. The literature regarding transport media for avulsed teeth was reviewed using PubMed/MEDLINE up to February 2010. This review outlines the common storage media that are available and highlights their specific features or problems. Although HBSS, ViaSpan and Eagle's medium have great potential to maintain the PDL cells in a viable state after avulsion, the practicalities of using these solutions, the costs and the lack of ready availability to the general public make them less than ideal. Milk remains the most convenient, cheapest and readily available solution in most situations while also being capable of keeping PDL cells alive. Hence, milk remains the storage medium of choice for avulsed teeth that cannot be replanted immediately or very soon after the avulsion.

Pain during root canal treatment: an investigation of patient modifying factors.

AIM: The study highlighted the effect of patient-related factors on levels of pain felt by subjects during root canal treatment, as well as the association between treatment duration and pain severity. MATERIALS AND METHODS: Maxillary central incisors with either necrotic pulp or irreversibly inflamed pulp, with or without preoperative pain were studied in 160 subjects aged 18 years and above. Subject's age and gender as well as pulp status and preoperative pain status were recorded. The procedure was done using a standard protocol. Visual analog scale was used to record the level of pain felt. RESULTS: Those cases with irreversible pulpitis felt higher pain. None with necrotic pulp experienced intense pain, while those in the 51 to 60 year age bands had severe, unbearable or intense pain. Mild pain was a common denominator in all age bands. Pain level increased with treatment duration. CONCLUSION: Except for age, the level of pain felt by subjects during RCT is significantly correlated with gender and pulp status. Furthermore, the experienced pain levels increased with treatment duration. CLINICAL SIGNIFICANCE: Clinicians should be prepared to make use of supplemental local anesthesia in women and in teeth with IP.

Flare-up incidence and related factors in Nigerian adults.

AIM: To determine the incidence of flare-up and the effect of age, gender, visit type, treatment duration, preoperative pain and intraoperative pain on flare-up in Nigerian adults. MATERIALS AND METHODS: A total of 175 participants, aged 18 to 60 years with a necrotic central incisor, with or without preoperative pain, participated. They received postoperative paracetamol tablets and were asked to report back if unbearable pain/swelling developed. RESULTS: A 10% flare-up rate was recorded, while none of the studied factors had a significant relationship with flare-up. CONCLUSION: The relationships between flare-up and studied related factors were not proven. CLINICAL SIGNIFICANCE: Age, gender, visit type, treatment duration, preoperative pain and intraoperative pain have no effect on flare-up incidence.

Tooth loss among Nigerians treated in teaching hospitals: a national pilot study.

AIM: The aim of this study was to identify the causes and patterns of tooth loss among Nigerian adults. BACKGROUND: Tooth loss continues to be a major problem in clinical dentistry and has received significant attention in everyday dental practice. In Nigeria there is a discernible lack of current data that would explain the reasons and patterns of tooth loss from its different geopolitical zones. METHODS AND MATERIALS: The reasons for tooth extractions during a period of 12 months were obtained from the hospital records of teaching and specialist hospitals in Nigeria's six geopolitical zones and the Federal Capital Territory (FCT). Data were analyzed using Statistical Package for the Social Sciences for Windows (SPSS) version 9.0. RESULTS: A total of 4,204 teeth were extracted from 3,431 patients. Of these teeth 52.4 percent were lost due to dental caries while 30.2 percent were removed because of periodontal disease, 5.0 percent were missing as a result of trauma, and 3.9 percent were impacted and required extraction. The remaining 8.5 percent were extracted for a variety of reasons such as orthodontic treatment, overeruption, neoplasms, supernumerary teeth, attrition, a cystic lesion, and hypoplasia. Dental caries was the most common diagnosis given for tooth loss in the South-South (79 percent), South-East (68 percent), North-East (47 percent), North-West (69 percent), and North-Central (35 percent) zones followed by periodontal disease. In contrast, periodontal disease was the most common cause of tooth loss in the South-West zone (65 percent) and in the FCT (55 percent), followed by dental caries at 22 percent and 33 percent, respectively. CONCLUSION: Although teeth were extracted based on a variety of diagnoses, dental caries was identified as the common reason cited for tooth loss in Nigeria and to a lesser extent periodontal disease. Also different reasons were given for tooth loss among the various geographical zones. CLINICAL SIGNIFICANCE: Tooth loss among Nigerians was attributed largely to dental caries and secondarily to periodontal disease. Both conditions can be prevented if diagnosed early enough and treatment is instituted in a timely manner.

Rubber dam use among a subpopulation of Nigerian dentists.

In this cross-sectional questionnaire-based study, we surveyed the attitudes toward, knowledge of, and use of rubber dams (RDs) among dentists in southern Nigeria. The questionnaire, which was distributed and collected by one of the authors, requested information on the dentists' background characteristics, attitudes, and knowledge. Data were analyzed with SPSS, and the chi-square was used to assess differences in categorical variables. A total of 100 out of 108 dentists responded (92.6% response rate). The prevalence of RD use was 18%. Dentists in the government sector used RDs more often than did dentists in the private sector. About 77% of dentists had not used RDs or were unaware of how to use them. All specialists had seen RDs, but only 56% had used one in their practice. All dentists believed in the effectiveness of RDs. We conclude that rubber dams are underutilized in this population, and that dentists need to be made aware of the possibility of rubber dam use through an awareness campaign.

Appropriate electrode placement site for electric pulp testing of anterior teeth in Nigerian adults: a clinical study.

Electric pulp testing is one of the pulp vitality tests which aid dentists in diagnosis of the pulp status. This test is technique sensitive and hence may elicit false responses. There are some concerns regarding the optimal placement of the probe tip. The threshold value (the lowest electric current at which sensation is perceived) is reached when an adequate number of nerve fibers are stimulated, so the sensation would be greatest where the density of neural distribution is the highest. The purpose of this study was to identify the optimum site for electrode placement in anterior teeth of adults, the threshold values of these teeth using an electric pulp test, and to determine the influence of sex, age, and arch on the outcome. The optimum electrode placement sites and threshold values varied with type of tooth and arch. The maxillary teeth, canines, male gender and increasing age required higher electric current to evoke a sensation, while incisal edges required lower current to evoke a sensation.

Xeroradiography: stagnated after a promising beginning? A historical review.

Various methods have been introduced for obtaining radiographs. Xeroradiography which is a method of imaging uses the xeroradiographic copying process to record images produced by diagnostic x-rays. It differs from halide film technique in that it involves neither wet chemical processing nor the use of dark room. Literature on this subject is scarce. After an initial promising beginning, this imaging method, once thought to hold the key to endodontic imaging, got stagnated. A revisit of this promising endodontic imaging system would therefore be appropriate. The purpose of this study was to review xeroradiographic technique as a roentgenographic imaging system.

Dilaceration among Nigerians: prevalence, distribution, and its relationship with trauma.

Dilaceration is the result of a developmental anomaly in which an abrupt change in the axial inclination between crown and root is observed. Its prevalence in various races is different and its association with history of trauma is controversial. This study assessed the prevalence and distribution of dilacerated teeth among Nigerians and also investigated whether there was a relation between a history of trauma and teeth that had dilaceration. A total of 465 records of adult attendees (involving 706 teeth and 256 films) were retrospectively studied. Dilacerated teeth were scored using Hamasha et al.'s criteria. Dilaceration occurred more often in the maxilla, posterior teeth and in women, though no association between a history of trauma and occurrence of dilaceration was found. Prevalence of dilaceration in the population and in all teeth was 4.5% and 2.97%, respectively. Dentists should pay detailed attention to baseline radiographs, especially in maxilla and posterior teeth.

Cracked tooth syndrome: characteristics and distribution among adults in a Nigerian teaching hospital.

This study highlighted the characteristics and distribution of cracked tooth syndrome (CTS) and the associated factors in adult attendees in the University of Nigeria Teaching Hospital. Three hundred seventy patients aged 18 years to 77 years with CTS-like conditions were included and studied over 12 months. The following information was recorded: suspected tooth and the dental arch, restorative status of the tooth, age and sex of the patient, results of bite test and transillumination, and the pulpal and periapical status of the tooth. CTS was seen most often in the 41 to 50 years age band (36.4%), in molars (63.6%), and in the maxillary arch (51.5%). Also, it was more frequent in men (55.8%). About 82% of CTS occurred in amalgam-restored teeth. All cases had a positive response to the bite test and a normal response to the electric pulp test. Only 10% gave a positive history of masticatory accident as against none with history of bruxism habits. It was concluded that patients with unexplained pain in a vital, amalgam-restored tooth (especially in maxillary molars), with or without a history of a masticatory accident, may have a cracked or fractured tooth.

The application of tooth temperature measurement in endodontic diagnosis: a review.

Teeth with vital pulp are those with an adequate vascular supply, so the circulatory status, and not sensitivity response of the pulp tissue, has been proposed to assess pulp vitality. Some experimental methods have been used to assess this; one of them is the measurement of tooth temperature, which may indicate the pulp vasculature. Some authors have found no differences between the temperatures of teeth with vital and nonvital pulp; however, others found that teeth with nonvital pulp have lower temperatures than teeth with vital pulp. Temperature measurement as a diagnostic procedure has been described with the use of thermocouple, thermistors, infrared thermography, and cholesteric liquid crystals. Many factors may influence the results of the temperature measurement procedure. For creating controlled conditions, each patient should be examined in a thermologic environment. Patients should be asked to refrain from smoking and eating/drinking for 60 minutes before the procedure. The room should be insulated and draft free, and the temperature should be maintained at 20 degrees C. It is desirable to have them lie down or sit with adequate support for the head. The use of a rubber dam is also advocated. Tooth temperature measurement as a diagnostic procedure is reviewed to include description of devices for the test, associated factors, and value of the test.

Dental anxiety among patients undergoing various dental treatments in a Nigerian teaching hospital.

The aim of the present study is to evaluate the levels of dental anxiety among patients undergoing various dental treatments and to compare the anxiety levels with those of similar studies conducted with subjects from different socio-cultural backgrounds. Dental anxiety was evaluated by the administration of a questionnaire based on the Corah's Dental Anxiety Scale (DAS). Student t-test and analysis of variance (ANOVA) with Bonferoni correction was employed to compare the mean DAS scores. Females recorded higher total DAS scores than males (7.49 +/- 2.96 and 7.16 +/- 3.44, respectively). Patients in the 24-34 year age group showed the highest total DAS scores (8.25 +/- 3.20) followed by the <24 year age group. The total DAS scores for age groups 35-39 and >50 years differ significantly from those of age groups <24 and 24-34 years. The highest DAS score was recorded for root canal therapy (9.30 +/- 2.84) followed by extraction. The level of dental anxiety among this study population is lower than those reported elsewhere. The observed avoidance of dental treatment among Nigerians, despite the seemingly low mean DAS scores, may be related to dental anxiety. The authors are, however, of the opinion poor dental awareness may be a contributory factor.

Endodontic flare-ups: comparison of incidence between single and multiple visit procedures in patients attending a Nigerian teaching hospital.

BACKGROUND: Until recently the most accepted technique of doing root canal treatment stresses multiple visit procedure. Most schools also concentrated upon teaching the multi-visit concept. However, it has now been reported that the procedure of single visit treatment is advocated by at least 70% of schools in all geographical areas. It was therefore the aims of the present study to find the incidence of post-obturation flare-ups following single and multiple visit endodontic treatment procedures, and to establish the relationship between pre-operative and post-obturation pain in patients referred for endodontic therapy in a Nigerian teaching Hospital. METHODS: Data collected included pulp vitality status, the presence or absence of pre-operative, inter-appointment and post-obturation pain. Pain was recorded as none, slight, or moderate/severe. Flare-ups were defined as either patient's report of pain not controlled with over the counter medication or as increasing swelling. The patients were recalled at three specific post-obturation periods, 1st, 7th and 30th day. The presence or absence of pain, or the appropriate degree of pain was recorded for each recall visits and the interval between visits. The compiled data were analysed using chi-square where applicable. P level