Association of removable partial denture use with oral and systemic health.

OBJECTIVES: This narrative literature review aims to consider the impact of removable partial dentures (RPDs) on oral and systemic health. DATA AND SOURCES: A review of the literature was performed using Medline/PubMed database resources up to July 2011 to identify appropriate articles that addressed the objectives of this review. This was followed by extensive hand searching using reference lists from relevant articles. CONCLUSIONS: The proportion of partially dentate adults who wear RPDs is increasing in many populations. A major public health challenge is to plan oral healthcare for this group of patients in whom avoidance of further tooth loss is of particular importance. RPDs have the potential to negatively impact on different aspects of oral health. There is clear evidence that RPDs increase plaque and gingivitis. However, RPDs have not clearly been shown to increase the risk for periodontitis. The risk for caries, particularly root caries, appears to be higher in wearers of RPDs. Regular recall is therefore essential to minimise the risk for dental caries, as well as periodontitis. There is no evidence to support a negative impact on nutritional status, though research in this area is particularly deficient. Furthermore, there are very few studies that have investigated whether RPDs have any impact on general health. From the limited literature available, it appears that RPDs can possibly improve quality of life, and this is relevant in the era of patient-centred care. Overall, further research is required to investigate the impact of RPDs on all aspects of oral and general health, nutritional status and quality of life.

Multidisciplinary management of Blepharo-Cheilo-Dontic Syndrome and the role of overdenture in dental management.

AIM: Blepharo-Cheilo-Dontic (BCD) syndrome is a rare condition characterised by abnormalities of the eyelid, lip and teeth. A 12-year-old girl with BCD syndrome presented at the Dental Hospital following referral from the multi-disciplinary cleft lip and palate clinic. She had skeletal Class III relation, with left posterior cross bite, occlusal contacts on the second permanent molars with poor oral hygiene. The permanent units missing were 15, 14, 13, 12, 11, 21, 22, 25, in the upper arch and 35, 34, 32, 44 and 45 in the lower arch. This patient presented a complex aesthetic problem, which through multi- disciplinary care resulted in a satisfactory aesthetic outcome. In this case report we present the clinical management and the role of the overdenture in her dental management.

Perceived chewing ability and intake of fruit and vegetables.

Edentulous individuals have reduced chewing ability and lower fruit and vegetable consumption compared with dentate individuals. It has been suggested that the two are causally related. However, psychosocial factors such as attitude, self-identity, and knowledge of recommendations are predictive of intake in non-edentulous persons. The aims of this study were to: determine if perceived chewing ability was predictive of fruit and vegetable intake; explore the predictive ability of knowledge, attitude, and self-identity; and compare intake between edentulous and dentate individuals. Full denture-wearing (N = 79) and dentate persons (N = 52) completed a three-day food diary. Perceived chewing ability, sociodemographic, and psychosocial factors were assessed via self-administered questionnaire. The dentate persons consumed significantly more fruit and vegetables, but differences were not significant when juices were excluded. Perceived chewing ability explained approximately 4% variance in intake. Attitude, self-identity, and knowledge explained a further approximately 20%. If the diet of denture-wearers is to be improved, psychosocial factors, as well as perceived chewing ability, must be addressed.

A randomized-controlled trial of food choices made by edentulous adults.

AIM: The aim of this study was to conduct a randomized-controlled trial to compare food choices of edentulous adults provided with implant-supported mandibular overdentures and conventional dentures. METHODS: Edentulous patients were randomly allocated to an implant group (IG) or a denture group (DG). IG subjects (n=49) were provided with conventional maxillary dentures and implant-retained mandibular overdentures. Subjects in this group refusing implants were retained using the 'intention-to-treat principle' and provided with conventional dentures. DG subjects (n=48) were provided with conventional dentures. Subjects indicated whether they consumed any of seven test foods and the level of chewing difficulty experienced. Data were collected pre-treatment and 3 months post treatment. RESULTS: IG subjects reported increased consumption of carrots, apples and nuts post-treatment (P<0.05) and decreased post-treatment difficulty in chewing apples and nuts. DG subjects reported decreased post-treatment difficulty in chewing carrots, bacon and nuts (P<0.05). Between group differences for chewing difficulty were detected for nuts that DG subjects found easier to chew than IG subjects (P=0.002). CONCLUSION: Food selection and perceived chewing difficulty improved in both groups, with no significant differences between groups. Successful rehabilitation may not result in different food selection, which may require concurrent tailored dietary interventions, but may increase available food choices.

Attitudes and practice in the provision of removable partial dentures.

OBJECTIVE: To identify the factors shaping the pattern of removable partial denture (RPD) provision by dentists in England. Design Cross sectional survey of general dental practitioners. METHODS: Details of current practice and provision, influences, attitudes and demographic details were collected using a self-completion questionnaire mailed to general dental practitioners identified through the Dental Practice Board register. RESULTS: Three hundred and eighty-five questionnaires were returned by general dental practitioners from 62 health authorities throughout England. The most important factor reported as influencing both the GDP's decision to provide a partial denture and its subsequent success was patient desire to have a partial denture. Constructing the denture from cobalt chrome, advising the patient on aftercare, making time available to make minor adjustments and being responsible for design were all factors dentists associated with success of a RPD. However, for a number of dentists there was a reported divergence between knowledge and practice. CONCLUSION: Overall it is clear that provision of partial dentures continues to be patient led. However, the decision making process is also influenced by a number of factors including time, cost and the NHS fee structure.

Time to survival for the restoration of the shortened lower dental arch.

Removable partial dentures may adversely affect remaining tissues and have a low prevalence of use. This randomized controlled trial was designed to compare the time to survival of cantilever resin-bonded fixed partial dentures and conventional removable partial dentures to restore shortened lower dental arches. We randomly allocated 25 male and 35 female patients (median age, 67 years) to fixed or removable partial denture groups of 30 persons, matched for age and sex. Survival of the prostheses was assessed, based on listed criteria, at each review or when problems arose. Although the removable partial denture group required rather more maintenance visits, the difference in survival rates was not statistically significant (hazard ratio = 0.59, with 95% CI 0.27, 1.29). In the absence of significant differences in five-year survival, the reported advantages of fixed partial dentures, including reduced maintenance frequency, offer positive support for the use of resin-bonded fixed partial dentures.

Survival of resin-bonded bridgework provided for post-orthodontic hypodontia patients with missing maxillary lateral incisors.

OBJECTIVE: To analyse the clinical performance and factors influencing the survival of resin-bonded bridgework provided for hypodontia patients with missing maxillary lateral incisors, following orthodontic treatment to open, maintain or redistribute the missing tooth space. DESIGN: A retrospective analysis of patients treated at a single centre using case notes with all patients invited for review to corroborate findings. SETTING: Departments of Orthodontics, Child Dental Health and Restorative Dentistry, Newcastle upon Tyne Dental Hospital and School. SUBJECTS AND METHODS: Between 1989-2000, 59 suitable hypodontia patients were identified of whom 45 had complete records. For these patients 73 resin-bonded bridges (RBBs) were provided. Following invitation, 24 patients attended for a review appointment. The survival of the RBBs, grade of operator providing treatment, duration of post-orthodontic retention, the influence of design, presence of pontic contact in static and dynamic excursions, and the effect of habits were assessed. Life table, Kaplan-Meier and Cox regression analysis were carried out for the 73 RBBs with complete records. A separate analysis of the RBBs provided for patients who attended for the invited review did not show a higher failure rate than those patients who did not attend. Therefore both sets of data were combined. RESULTS: Of the 73 RBBs provided, 30 had debonded on at least one occasion (41.1%), six of these debonds were due to trauma (20%). The mean survival time of all the restorations was 59.3 months, with a median survival time of 59 months. Senior members of staff (Consultant, Senior Lecturer or Specialist Trainee) provided most restorations (n = 39) and achieved the highest mean survival of 72.6 months and median survival time of 100+ months. RBBs provided by junior staff and students had significantly lower survival times (p <0.05) compared with senior staff. Risk of failure was 3.9 times greater with junior staff and 2.5 times greater with students (p = 0.01 and p = 0.02, respectively). Analysis of all the other factors investigated showed no statistical difference in survival times or in hazard ratios. Analysis of fixed/fixed versus cantilevered bridges was limited by the number of fixed/fixed bridges (n = 11), and only two cantilevered bridges with multiple abutments were provided; both failed within one month. CONCLUSION: RBBs provided for post-orthodontic hypodontia patients with missing maxillary lateral incisors can for many patients be an acceptable and definitive restoration. Experienced staff achieved the best results, but why this should be was not explained by the individual factors analysed in this study.

A randomized controlled trial of implant-retained mandibular overdentures.

Evidence from randomized clinical trials of implant-retained overdentures is very limited at the present time. The aim of this study was to compare implant-retained mandibular overdentures and conventional complete dentures in a randomized controlled trial (RCT). Our a priori hypothesis was that implant-retained mandibular overdentures would be significantly better than conventional complete dentures. Edentulous patients (n = 118) were randomly allocated to either an Implant Group (n = 62) or a Denture Group (n = 56). Patients completed the Oral Health Impact Profile (OHIP) and a denture satisfaction scale pre-treatment and three months post-treatment. Upon completion of treatment, both groups reported improvement (p < 0.001, Wilcoxon Ranks Sum test) in oral-health-related quality of life and denture satisfaction. There were no significant post-treatment differences between the groups, but a treatment effect may be masked by application of "intention to treat" analysis. The OHIP change scores were significantly greater for patients receiving implants than for those who refused them.

Nutrition counseling increases fruit and vegetable intake in the edentulous.

Edentulous denture-wearers eat fewer fruits and vegetables than do comparable dentate individuals. Improved chewing ability with new dentures has resulted in little dietary improvement, suggesting that dietary intervention is necessary. The objective of this randomized controlled trial was to have a positive impact upon dietary behavior of patients receiving replacement complete dentures through a tailored dietary intervention. Readiness to change diet (Stage of Change), intake of fruits, vegetables, and nutrients, and chewing ability were assessed pre-and 6 weeks post-intervention. The intervention group (n = 30) received two dietary counseling sessions; the control group (n = 28) received current standard care. Perceived chewing ability significantly increased in both groups. There was significantly more movement from pre-action into action Stages of Change in the intervention group, who had a greater increase in fruit/vegetable consumption (+209 g/d) than did the control group (+26 g/d) (P = 0.001). Tailored dietary intervention contemporaneous with replacement dentures can positively change dietary behavior.

A quantitative study of enamel acid etch patterns on surfaces used for retention of resin-bonded fixed prostheses.

This study investigated the quality of in vivo etch patterns on the bonding surfaces of 46 abutment teeth following acid etching with 37% phosphoric acid for 30 seconds. Two-stage putty and light bodied addition cured silicone impressions of the etched lingual surfaces were used to form replicas that were then viewed using the scanning electron microscope. Over 69% of the lingual bonding surface area of incisors, canine and premolars were unetched, 16% barely etched, 7% etched and less than 2% ideally etched. There was no significant difference in the quality of etch between different tooth types. There was a significantly greater proportion of poorly etched enamel towards the cervical margin in comparison with the occlusal half. This may have implications in retention of resin bonded bridges.

"Bridging the gap." Should the training of dental technicians be linked with that of the dental undergraduate?

OBJECTIVES: Improving communication and collaboration between members of the dental team is important to the long term aim of improving the quality of dental care for patients. For example, closer integration between trainee dental technicians and undergraduate dental students during their courses of training should both help to develop their own skills and foster an improved level of communication and understanding between these members of the dental team. The purpose of this study was to ascertain the number of dental teaching hospitals in Great Britain and Ireland currently involved with the training of dental technicians, and to find out how many of these bring trainee technician and undergraduate dental students together at some time during training as a matter of policy. METHODS: Action research was carried out in the form of a linking exercise in the Newcastle upon Tyne Dental Hospital. This involved second year trainee dental technicians and third year undergraduate dental students working together to provide complete dentures for a patient within the formal undergraduate course in complete denture construction. The trainee technicians also attended a series of lectures relevant to this course alongside undergraduate dental students. RESULTS: The main findings revealed that although a number of dental teaching hospitals were involved with the training of dental technicians and had encouraged links between undergraduate dental students and trainee technicians, few had formalised these links in any way. CONCLUSION: The outcomes of the linking exercise were evaluated by means of focus groups, observations and semi-structured interviews. Results indicated that both the trainee dental technician and the undergraduate dental student benefited to some extent from closer collaboration during training.

The interdisciplinary management of hypodontia: the relationship between an interdisciplinary team and the general dental practitioner.

This paper will illustrate how the general dental practitioner can provide care for patients with hypodontia. It will demonstrate how an interdisciplinary team works for hypodontia patients and, in particular, for those with severe hypodontia.

The role of magnets in the management of unerupted teeth in children and adolescents.

This case report describes the use of magnets in the management of teeth that fail to erupt. Eight children aged between 10 and 15 years were treated. Magnetic traction was applied to two premolars and six molars. Seven teeth (one premolar and six molars) erupted successfully (mean treatment time with magnetic traction: 7.5 months). One premolar failed to erupt; serial radiographic assessment over a 9-month period revealed no evidence of movement and so the magnetic fixture was removed. Histological evaluation of tissue samples taken from around the fixture revealed no evidence of abnormal pathology.

The interdisciplinary management of hypodontia: restorative dentistry.

This paper considers the role of restorative dentistry in the management of hypodontia. The paper describes the general restorative considerations common to patients with hypodontia and illustrates the variety of restorative techniques available in the restorative management of hypodontia and oligodontia.

The interdisciplinary management of hypodontia: background and role of paediatric dentistry.

This paper is the first of a series on the comprehensive management of young people with hypodontia. The paper looks at the background to the condition, the possible aetiological factors, the prevalence of hypodontia and other related conditions. Lastly there is consideration of the role of the paediatric dentist in interdisciplinary management of the affected child and adolescent patient.

Caries incidence following restoration of shortened lower dental arches in a randomized controlled trial.

CONTEXT: Removable partial dentures used to restore the shortened lower dental arch may adversely affect the remaining natural teeth and are associated with a low prevalence of use. OBJECTIVE: To report the findings for caries incidence 2 years after restoration of lower shortened arches with bilateral cantilever resin-bonded bridges (RBBs) and conventional partial dentures (RPDs). DESIGN: Randomised controlled trial. SETTING: Secondary care PATIENTS: 25 male and 35 female subjects of median age 67 years. were randomly allocated to 'bridge' and 'denture' treatment groups of 30 patients each matched for age and sex. Caries incidence was recorded during dental examinations 3 months, 1 and 2 years after insertion of new lower prostheses. INTERVENTIONS: Cantilever RBBs and conventional RPDs with cast metal frameworks. RESULTS: There was a highly significant difference in the frequency of new caries lesions, 11 and 51 in the bridge and denture groups respectively (P < 0.01). 20 out of 27 bridge patients and 9 of 23 denture patients had no caries experience. Multivariate modeling identified treatment group as the only significant predictor of caries occurrence. CONCLUSIONS: Two years after restoration of lower shortened arches for an elderly sample of patients, there was a significantly greater incidence of new and recurrent caries lesions in subjects restored with RPDs compared with cantilever RBBs.

Computing facilities available to final-year students at 3 UK dental schools in 1997/8: their use, and students' attitudes to information technology.

OBJECTIVE: To identify computer facilities available in 3 dental schools where 3 different approaches to the use of technology-based learning material have been adopted and assess dental students' perception of their own computer skills and their attitudes towards information technology. DESIGN: Multicentre cross sectional by questionnaire. SUBJECTS: All 181 dental students in their final year of study (1997-8). RESULTS: The overall participation rate was 80%. There were no differences between schools in the students' self assessment of their IT skills but only 1/3 regarded themselves as competent in basic skills and nearly 50% of students in all 3 schools felt that insufficient IT training had been provided to enable them to follow their course without difficulty. There were significant differences between schools in most of the other areas examined which reflect the different ways in which IT can be used to support the dental course. CONCLUSIONS: 1. Students value IT as an educational tool. 2. Their awareness of the relevance of a knowledge of information technology for their future careers remains generally low. 3. There is a need to provide effective instruction in IT skills for those dental students who do not acquire these during secondary education.

Evaluation of a computer-assisted learning programme on the oro-facial signs of child physical abuse (non-accidental injury) by general dental practitioners.

A computer-assisted learning programme with tutorials and self assessment multiple choice questions has been developed. One hundred and two general dental practitioners were asked to evaluate the programme. Over 80% of respondents felt that the programme was easy to use, contained an appropriate level of supporting information, and had improved their knowledge of non-accidental injury. All users of the programme felt that it was a better way of learning than video, audio tapes, and journals or books on the subject. It is concluded that CAL programmes are worthwhile for providing continuing professional education for general dental practitioners.