Evaluation of the Cariogram for root caries prediction.

OBJECTIVES: The aim of this study was to evaluate complete and reduced Cariogram models in predicting root caries risk in independently living older adults by comparing the caries risk assessment of the programme to observed root caries increment over a two-year period. METHODS: A prospective study recording root caries incidence was conducted on 334 dentate older adults. Data were collected on participant's medical history, fluoride exposure, and diet. Saliva samples were collected to measure salivary flow rate, buffer capacity and bacterial counts. Clinical examination was completed to record decayed, missing and filled teeth (DMFT) and also exposed, filled and decayed root surfaces (RDFS). This was repeated after 12 and 24 months. Scores were entered into the Cariogram and baseline risk category was recorded. Reduced Cariogram models were generated by omitting individual salivary variables and all salivary variables. The performance of the complete and reduced Cariogram models in predicting root caries incidence were evaluated by receiver operating characteristic (ROC) analysis. RESULTS: 280 participants were examined at two year follow up. 55.6% of those in the highest risk group developed new caries compared to 3.8% in the lowest risk group. The mean root caries increment in the highest risk group was 2.00 (SD 3.20) compared to 0.04 (SD 0.20) in the lowest risk group. The area under the ROC curve for the complete Cariogram model was 0.77 (95% CI 0.70-0.83) indicating a fair performance in predicting root caries. Omitting individual or all salivary variables did not significantly alter the predictive ability of the Cariogram. CONCLUSION: Within the limitations of this study, the Cariogram was clinically useful in identifying individuals with a high risk of developing root caries. CLINICAL SIGNIFICANCE: Identification of a caries risk assessment tool which could reliably select high-risk individuals for root caries prevention strategies would maximise the cost effectiveness of professionally delivered prevention measures.

Pragmatic treatment planning for the older dentate patient.

INTRODUCTION: Population ageing is a progressive trend in most developed nations, including Ireland. Alongside this trend, there has been a concomitant decrease in tooth loss among Irish adults (Whelton, 2007). As a result, there will be more dentate older patients presenting for care. Future treatment strategies will be based on patient demand, clinician skill set, pragmatism, future planning and cost-effectiveness. CASE REPORTS: This article presents the use of minimally invasive concepts in the management of older patients. As well as describing these principles, two cases treated by the staff and students of Cork University Dental School and Hospital are presented as examples. DISCUSSION: Older patients can be provided with good aesthetic, functional outcomes using the principles of minimally invasive dentistry. Futhermore, these treatment options are less likely to fail catastrophically in future years, resulting in tooth loss and edentulousness in advanced years when adaptation may be challenging. CONCLUSION: Treatment choices for older adults should be as evidence based an pragmatic as possible, with a view to impact of future failure.

Evaluation of Biodentine in the Restoration of Root Caries: A Randomized Controlled Trial.

There is no "gold-standard" material for the operative management of root caries. The aim of this study was to determine if the clinical performance of Biodentine would be acceptable for the restoration of root caries in older adults. A randomized controlled clinical trial was conducted comparing a calcium silicate cement (Biodentine), a high-viscosity glass ionomer cement (Fuji IX GP Extra), and a resin-modified glass ionomer cement (Fuji II LC). Of the 334 volunteers assessed for eligibility, 249 were excluded. A total of 303 lesions in 85 participants were randomized, with 151 lesions allocated to receive Biodentine, 77 to Fuji IX GP Extra, and 77 to Fuji II LC. Patients were reviewed by a calibrated dentist who was not involved in restoration placement and who was blinded to material allocation. Restorations were assessed according to a modified US Public Health Service criteria. The cumulative survival percentages after 6 mo and 1 y were 58.6% and 47.2% in the Biodentine group, 89.6% and 83.8% in the Fuji IX GP Extra group, and 89.5% and 84.9% in the Fuji II LC group, respectively. There were statistically significant differences ( χ2 test, P < 0.001) in restoration failure rates between restoration groups. There was no difference between Fuji IX GP Extra and Fuji II LC, but differences ( P < 0.001) were shown between the Fuji II GP Extra group and the Biodentine group and also between the Fuji II LC group and the Biodentine group at both time points. Based on the results of this study, Biodentine cannot be recommended for the operative management of root caries. Fuji IX GP Extra and Fuji II LC displayed similar success rates, and high-viscosity glass ionomer cement and resin-modified glass ionomer cement continue to be the best available option for the restoration of root caries ( ClinicalTrials.gov NCT01866059). Knowledge Transfer Statement: The results of this study can assist dental practitioners when selecting a restorative material for the operative management of root caries. This randomized controlled trial compared the 1-y clinical performance of a calcium silicate-based material to that of a high-viscosity glass ionomer cement and a resin-modified glass ionomer cement in the operative management of root caries. The study concluded that high-viscosity glass ionomer cement and resin-modified glass ionomer cement continue to be the best available option to dental practitioners when restoring the root surface.

Prosthodontic rehabilitation for a patient with acromegaly.

Acromegaly is a condition which results from an excess of growth hormone produced by the pituitary gland after epiphyseal plate closure at puberty. The most common cause of acromegaly is a benign pituitary adenoma. Acromegaly is characterised by enlargement of the hands, feet, nose and ears; expansion of the skull and pronounced brow protrusion. From an oral standpoint, the most relevant symptoms are mandibular protrusion, spacing of the lower teeth and macroglossia. A 46 year-old patient was referred to University Dental School and Hospital by her General Dental Practitioner. The patient had been diagnosed with acromegaly and was receiving medical care from a consultant endocrinologist. The patient was partially dentate with only her lower anterior dentition remaining. She was wearing a complete upper denture but was unable to function effectively due to a lack of occlusal support. Treatment comprised non-surgical periodontal management, construction of upper and lower removable prostheses in a class III relationship and composite restorations on the remaining lower teeth.

Provision of resin bonded bridgework for a patient with microstomia secondary to scleroderma.

Scleroderma is a connective tissue disorder that can present with orofacial involvement. A 48 year-old patient presented to Cork University Dental Hospital with concerns about the appearance of her upper central incisor teeth, which had become progressively mobile in recent years. A diagnosis of localised scleroderma had been made a number of years previously by her medical practitioner and the patient reported that her scleroderma-associated microstomia had progressed significantly in recent years. Most reports of this condition advocate the use of sectional impression trays and sectional dentures to replace missing teeth. This report describes the use of resin-bonded bridgework (RBB) and discusses the possible advantages of this treatment option over those already presented in the literature.

Trends in material choice for direct restorations by final year students from University College Cork 2004-2009.

Traditionally, undergraduate students in University College Cork (UCC) have been taught to use amalgam as the first choice material for direct restoration of posterior cavities. Since 2005 the use of composite resins has replaced amalgam as the first choice material. An audit was conducted of all direct restorations placed by final year students from UCC from 2004 until 2009. Results showed that over a six year period, final year UCC dental undergraduate students placed proportionately more direct composite resin restorations and significantly fewer amalgam restorations. The need for and undergraduate exposure to, provision of amalgam restorations may have to be revisited.

Supporting career choices in dentistry.

The Cork University Dental School & Hospital, University College Cork, introduced an innovative programme in April 2011, which provided prospective dental students with an opportunity to participate in a one-day experiential workshop. The aim of the workshop was to provide students with an overview of the dental undergraduate programmes. Feedback on the workshop was exceptionally positive, and prospective students would recommend the workshop to a fellow student, as it helped to inform their decision about choosing dentistry as a first option.

Ready for practice? A study of confidence levels of final year dental students at Cardiff University and University College Cork.

AIM: The aim of this study was to describe the self-reported confidence levels of final year students at the School of Dentistry, Cardiff University and at the University Dental School & Hospital, Cork, Ireland in performing a variety of dental procedures commonly completed in primary dental care settings. METHOD: A questionnaire was distributed to 61 final year students at Cardiff and 34 final year students at Cork. Information requested related to the respondents confidence in performing a variety of routine clinical tasks, using a five-point scale (1=very little confidence, 5=very confident). Comparisons were made between the two schools, gender of the respondent, and whether or not a student intended completing a year of vocational training after graduation. RESULTS: A response rate of 74% was achieved (n=70). The greatest self-reported confidence scores were for 'scale and polish' (4.61), fissure sealants (4.54) and delivery of oral hygiene instruction (4.51). Areas with the least confidence were placement of stainless steel crowns (2.83), vital tooth bleaching (2.39) and surgical extractions (2.26). Students at Cardiff were more confident than those at Cork in performing simple extractions (Cardiff: 4.31; Cork: 3.76) and surgical extractions (Cardiff: 2.61; Cork: 1.88), whilst students in Cork were more confident in caries diagnosis (Cork: 4.24; Cardiff: 3.89) fissure sealing (Cork: 4.76; Cardiff: 4.33) and placement of preventive resin restorations (Cork: 4.68; Cardiff: 4.22). CONCLUSION: Final year students at Cardiff and Cork were most confident in simpler procedures and procedures in which they had had most clinical experience. They were least confident in more complex procedures and procedures in which they had the least clinical experience. Increased clinical time in complex procedures may help in increasing final year students' confidence in those areas.

Attitudes of final-year dental students to bleaching of vital and non-vital teeth in Cardiff, Cork, and Malmö.

The aim of this study was to determine attitudes of final-year dental students in Cardiff, Cork and Malmö towards tooth whitening. Following receipt of ethical approval, pre-piloted questionnaires were distributed to final-year dental students in Cork, Cardiff, and Malmö as close as possible to graduation. The questionnaire sought information relating to various opinions and attitudes towards the use of bleaching techniques including safety of bleaching, confidence in the provision of bleaching, recommendations to patients, teaching received, awareness of restrictions on the use of bleaching products and management of simulated clinical scenarios. Eighty three per cent (n = 116) of questionnaires were returned. Cork dental students had the most didactic teaching (2-h vital, 1-h non-vital bleaching) compared to Cardiff or Malmö students (0 h each). More Cork students regarded bleaching as safe (76%, n = 28) than Cardiff (70%, n = 32) or Malmö (36%, n = 12) students. More than 50% of Cork students feel they know enough about bleaching to provide it in practice, significantly more than Cardiff (< 25%) or Malmö (< 25%) students. The majority of students would provide vital bleaching after qualification (100% (n = 37) Cork; 82% (n = 27) Malmö; 76% (n = 35) Cardiff). In simulated clinical scenarios, more Cork students would propose bleaching treatments (89%n = 33) than Malmö (64%n = 21) or Cardiff (48%n= 22) students. Variations exist in the attitudes and approaches of three European dental schools towards bleaching. Dental students need to be best prepared to meet the needs of their future patients.

Toothwear and the older patient.

Toothwear is commonly observed in dentate older patients and may be physiological or pathological in nature. Toothwear can be caused by abrasion, attrition, erosion or a combination of aetiologies. Where treatment is required, a number of options exist, including the use of adhesive materials and fixed and removable prosthodontics.

Endodontic treatment completion following emergency pulpectomy.

AIM: Emergency pulpectomy is frequently performed to relieve pain experienced by patients following acute episodes of endodontic pain, or to limit the risks of infection or possible root resorption following traumatic pulpal exposures. The aim of this study was to examine subsequent patient attendance for completion of root canal treatment following pulpectomy procedures in a dental emergency unit. METHODS: The treatment records of 574 patients who had each received an emergency pulpectomy at the Casualty Clinic of the University Dental School and Hospital, Cork, Ireland were reviewed. The influence of age, gender, etiology, tooth type, and month in which the pulpectomy was performed on subsequent completion of endodontic treatment was examined. RESULTS: Of 574 patients, 39% (n = 224) returned to have endodontic treatment completed, 11% (n = 63) returned to have the tooth extracted, and 50% (n = 287) did not return for completion of the endodontic treatment. Cases were monitored up to five years following pulpectomy. Using a multinomial regression model, tooth type, etiology, and month in which the treatment was performed were found to be statistically significant predictors (p < 0.05) of endodontic treatment completion in the Cork University Dental School and Hospital. CONCLUSIONS: Proper patient selection and pre-treatment counseling are important considerations when planning emergency pulpectomies to avoid inappropriate use of resources and manpower.

Fluoridation and tooth wear in Irish adults.

The aim of this study was to determine the prevalence of tooth wear in adults in Ireland and its relationship with water fluoridation. The National Survey of Adult Oral Health was conducted in 2000/2001. Tooth wear was determined using a partial mouth examination assessing the upper and lower anterior teeth. A total of 2456 subjects were examined. In this survey, increasing levels and severity of tooth wear were associated with ageing. Men were more affected by tooth wear and were more likely to be affected by severe tooth wear than women. It was found that age, and gender were significant predictors of tooth wear (P < 0.01). Overall, there was no significant relationship between fluoridation and tooth wear in this study.

Effect of pre-heating on the viscosity and microhardness of a resin composite.

The effect of pre-heating resin composite on pre-cured viscosity and post-cured surface hardness was evaluated. Groups of uncured specimens were heated to 60 degrees C and compared with control groups (24 degrees C) with respect to viscosity and surface hardness. Mean (SD) viscosities of the pre-heated specimens (n = 15) were in the range of 285 (13)-377 (11) (Pa) compared with 642 (35)-800 (23) (Pa) at ambient temperature. There was a statistically significant difference between the two groups (P < 0.001). Mean (SD) Vickers microhardness (VHN) of the pre-heated group (n = 15) was 68.6 (2.3) for the top surface and 68.7 (1.8) for the bottom surface measured at 24 h post curing (specimen thickness = 1.5 mm). The corresponding values for the room temperature group were 60.6 (1.4) and 59.0 (3.5). There was a statistically significant difference between corresponding measurements taken at the top and bottom for the pre-heated and room temperature groups (P < 0.001). There was no significant difference between top and bottom measurements within each group. Pre-heating resin composite reduces its pre-cured viscosity and enhances its subsequent surface hardness. These effects may translate as easier placement together with an increased degree of polymerization and depth-of-cure.

Case report: Presentation of lacrimo-auriculodento- digital (LADD) syndrome in a young female patient.

BACKGROUND: Lacrimo-auriculo-dento-digital (LADD) syndrome (OMIM #149730) is an autosomal-dominant congenital disorder that can be caused by heterozygous mutations in the tyrosine kinase domains of the genes encoding fibroblast growth factor receptors 2 (FGFR2) and 3 (FGFR3), and has been found in association with a mutation in the FGF10 gene, which encodes an Fgfr ligand. Clinical signs vary, but the condition is characterised by involvement of the lacrimal and salivary systems, cup-shaped ears, hearing loss and dental abnormalities. Additional features may include involvement of the hands and feet with other body systems particularly the kidneys. CASE REPORT: Previous literature on the subject has been reviewed and this case is the first presentation of LADD syndrome in the Republic of Ireland, as a sporadic case in a 12-year-old girl who exhibited a range of dental and digital anomalies. TREATMENT: Her general medical practitioner managed her medical care whilst her oral care necessitated a multidisciplinary approach involving restorative and orthodontic elements. FOLLOW-UP: The initial restorative phase of treatment has successfully improved the appearance of the patient's anterior teeth using direct resin composite build-ups.

Technical quality of root canal fillings performed in a dental school and the associated retention of root-filled teeth: a clinical follow-up study over a 5-year period.

The aim of this study was to examine the technical quality of root canal fillings performed in a dental school and to investigate the associated effect on the survival/retention of root-filled teeth. A review of case notes of patients who had root canal treatment performed in the department of Restorative Dentistry, University Dental School and Hospital, Cork, Ireland was carried out. The technical quality of the root canal filling was described according to its relationship with the radiographic apex on a post-treatment radiograph. Tooth status at review was defined as 'tooth present' or 'tooth absent' based on the presence or absence of the root-filled tooth recorded in the treatment records at a review appointment following placement of the root canal filling. One hundred and forty-eight teeth (129 patients) were considered. Of these, 69.6% (n = 103) were of acceptable technical quality, 23.6% (n = 35) were under-extended, and 6.8% (n = 10) were overextended. An increased number of intra-treatment radiographs to confirm the relationship of the canal preparation to the radiographic apex and operator experience were significant predictors of adequate root canal fillings (P < 0.05). Eighty-three per cent (n = 123) of teeth were present at a review appointment held an average of 40 months following completion of treatment (12-60 months). The technical quality of the root canal filling was the only significant factor in predicting tooth survival (P < 0.05), while the presence of pre-treatment periapical pathology had no significant effect on survival of the root-filled tooth. Determination and maintenance of the working length of the canal system is an important feature in producing good quality root canal fillings, which in turn, is associated with increased likelihood of survival/retention of root-filled teeth.

Attitudes of final year dental students to the use of rubber dam.

AIM: To investigate the attitudes of final year dental students in Wales and Ireland to the use of rubber dam. METHODS: A pre-piloted questionnaire was distributed to final year dental students in Cardiff and Cork Dental Schools in January 2008. Information sought included attitudes to, and the current and anticipated use of, rubber dam for a variety of operative and endodontic treatments. RESULTS: Of 93 questionnaires distributed, 87 were completed and returned (response rate = 94%; Cardiff: 89%, n = 51; Cork: 100%, n = 36). Rubber dam was routinely used by 98% of respondents (n = 85) on adult patients, but only 32% of respondents (n = 28) had used rubber dam on child patients (P < 0.05). Rubber dam was never used by 75% of respondents (n = 65) when placing posterior amalgam restorations, and by 21% of respondents (n = 18) when placing anterior composite restorations. Rubber dam was used by 98% of the respondents (n = 85) when performing root canal treatments. Sixty-two per cent of respondents (n = 54) believed their use of rubber dam would decrease once leaving the dental school. CONCLUSION: Whilst dental students believe that rubber dam is relevant to clinical dentistry, there are negative perceptions associated with its use amongst dental students. More than half of those questioned predicted their use of rubber dam would decrease once in independent practice. Greater emphasis should be placed on the advantages of using rubber dam in clinical dentistry whilst at dental school.

Quality of root canal fillings performed by undergraduate dental students on single-rooted teeth.

INTRODUCTION: Root canal therapy is an accepted and successful form of tooth conservation. Educational guidelines require dental schools to ensure that their graduates are competent on graduation at performing root canal therapy. The aim of this investigation was to assess the technical quality of root canal fillings placed by undergraduate students in single-rooted teeth. MATERIALS AND METHODS: A total of 100 radiographs of root canal fillings placed by undergraduate students in single-rooted teeth were examined under even illumination in a darkened room using x2 magnification. These were graded as 'adequate', where the root canal filling was within 2 mm of the radiographic apex, 'under-filled', where the root canal filling was >2 mm from the radiographic apex, and 'over-filled', where the root canal filling was extruded beyond the radiographic apex. The presence of voids, fractured instruments, and root perforations were also noted. RESULTS: All teeth were obturated with gutta-percha and sealer (Roth Cement), using a cold lateral condensation technique. Of 100 teeth, 10% (n = 10) had voids. Of the remainder, 70% (n = 63) were judged to be 'acceptable', 21% (n = 19) were 'under-filled', and 9% (n = 8) were 'over-filled'. There was no evidence of fractured instruments or root perforations in any root filling examined. CONCLUSIONS: The quality of root canal fillings placed in single-rooted teeth by undergraduate dental students at the University Dental School and Hospital, Cork was acceptable (63% of root fillings placed in single rooted teeth were graded as 'adequate'). The probable reasons for this are multi-factorial, but may be linked to the amount of pre-clinical and clinical teaching in endodontics at the University Dental School and Hospital, Cork. It should be remembered that factors other than radiographic quality/evidence must be considered when determining the outcome of root canal therapy.

Fluoride-containing restorative materials.

Dental practitioners are exposed to an increasing number of dental materials, which claim the benefits of fluoride release. The purpose of this paper is to critically review the literature of these materials. Glass ionomers, resin modified glass ionomers, compomers, resin composites, fissure sealants and amalgam are discussed. It is clear that a long-term measurable release of fluoride can be observed from certain restorative materials, in vitro, particularly glass ionomer cement, resin modified glass ionomer cement, fluoridated cements, fluoridated dental amalgam and certain fissure sealants. In general, the rate of fluoride release is not constant but exhibits a relatively rapid initial rate, which decreases with time. However, the fluoride release profiles may be dependent on specific formulation and on experimental design and sampling methods. These materials may feature greater longevity, a reduced incidence of marginal failure, an elevated concentration of fluoride in contingent plaque, together with an antibacterial action when compared with non-fluoride releasing materials. In addition, fluoride-releasing materials may perform better in caries inhibition in artificial caries model studies than non-fluoridated materials. While any, or all, of these anti-cariogenic effects may be associated with fluoride release, a direct relationship between fluoride release profiles and such effects has not been determined in vivo.

The strengthening mechanism of resin cements on porcelain surfaces.

All-ceramic crowns bonded with resin cements have increased performance, and two theories have been proposed. Marquis (1992) suggested that the resin modified defects by crack healing, while Nathanson (1993) proposed that resin polymerization shrinkage strengthened porcelains. Both theories imply a sensitivity of strengthening to defect size. The hypothesis tested was that resin strength enhancement is independent of defect severity. We ground 200 porcelain discs to remove imperfections and indented 120 to create a large defect. Discs were tested dry, wet, and after being coated with 75-100 microm of resin cement in bi-axial flexure. Disc strength with and without indentations was increased significantly when coated with 2 resin cements. Both cements significantly increased the strength independent of defect population, and the hypothesis was accepted. It is proposed that the combination of surface pre-treatment and cement moved the fracture origin from the porcelain/cement interface to the cement surface, consistent with resin strength enhancement independent of defect severity.