The association of parental dental anxiety and knowledge of caries preventive measures with psychological profiles and children's oral health.

AIM: As parents and caregivers are responsible for the oral health of children, their own dental anxiety may negatively impact the oral health of their children. This study aimed to assess whether parental dental anxiety and knowledge of caries preventive measures are associated with their psychological profiles and their children's oral health. METHODS: This case-control study involved parents, who were divided according to whether their children did or did not have active caries. The differences in Short version of the Dental Anxiety Inventory, and Knowledge of Caries Preventive Measures (KCPM) scores between the parents whose children have and do not have active caries was established by the Mann-Whitney U test (P < 0.05). CONCLUSION: Parental dental anxiety and knowledge of caries preventive measures are associated with the oral health of their children.

In Vitro Evaluation of the Stabilization Time of Chemical Bonds During Setting Reaction and Microhardness of Preheated Glass-Ionomer Cements.

OBJECTIVES: To evaluate the effect of preheating glass-ionomer cement (GIC) restorative materials on stabilization time (ST) of their metal carboxylate bonds and on microhardness. METHODS AND MATERIALS: Two conventional high-viscosity GICs, Ketac Universal (3M ESPE) and Equia Forte (GC), were evaluated. The thermographic camera was used to measure the temperature inside the glass-ionomer cement capsules before and after heating. The preheating of capsules was performed at 54°C for 30 seconds in a commercial device. Characterization of ST in the GICs was determined by Fourier Transform Infrared (FTIR) spectroscopy. For this, 10 samples of each material were prepared, five in the non-preheated group (control) and five with preheating. FTIR spectra were obtained 10 minutes after mixing (control group) or after heating and then every 10 minutes for 120 minutes. For the microhardness test, 20 cylindrical specimens (3 mm height x 6 mm diameter) were prepared for each material (10 preheated, 10 control). The microhardness was determined at three time intervals: 10 minutes after mixing, after the ST as detected through the FTIR part of the study, and after one week. Knoop microhardness was assessed using a diamond indenter with a 25 g load and 15 seconds dwell time. RESULTS: Ketac Universal showed an increase in temperatures of 15.7°C for powder and 3.6°C for liquid, while Equia Forte showed 16.4°C for powder and 8.5°C for liquid. FTIR spectra indicated that preheating reduced the ST for Equia Forte but increased it for Ketac Universal. Preheating increased the initial microhardness (T1) of Equia Forte. With maturation over one week, it was observed that preheating significantly improved the microhardness of both materials compared with the control specimens. CONCLUSION: Preheating influenced the ST and the microhardness of Ketac Universal and Equia Forte. The ST and microhardness of Ketac Universal increased after seven days, whereas Equia Forte showed a reduced ST and increased microhardness from the outset.

Role of carbohydrate in central fatigue: a systematic review.

Carbohydrate (CHO) depletion is linked to neuromuscular fatigue during exercise. While its role at peripheral level is relatively well understood, less is known about its impact centrally. The aim of this systematic review was to critically analyze the effects of CHO on central fatigue (CF) assessed by various neurophysiological techniques. Four databases were searched using PRISMA guidelines through February 2016. The inclusion criteria were: CHO as intervention against a placebo control, fatigue induced by prolonged exercise and assessed using neurophysiological measures [voluntary activation (VA), superimposed twitch (SIT), M-wave, electromyography], alongside maximal voluntary contraction (MVC). Seven papers were reviewed, where exercise duration lasted between 115 and 180 min. CHO improved exercise performance in three studies, whereby two of them attributed it to CF via attenuation of VA and SIT reductions, while the other indicated peripheral involvement via attenuation of M-wave reduction. Although a few studies suggest that CHO attenuates CF, data on its direct effects on neurophysiological outcome measures are limited and mixed. Generally, measures employed in these studies were inadequate to conclude central contribution to fatigue. Factors including the techniques used and the lack of controls render additional confounding factors to make definitive deductions. Future studies should employ consistent techniques and appropriate neurophysiological controls to distinguish CHO effect at central level. The use of pharmacological intervention should be incorporated to elucidate involvement of central mechanisms.

Intensity-dependent alterations in the excitability of cortical and spinal projections to the knee extensors during isometric and locomotor exercise.

We investigated the role of exercise intensity and associated central motor drive in determining corticomotoneuronal excitability. Ten participants performed a series of nonfatiguing (3 s) isometric single-leg knee extensions (ISO; 10-100% of maximal voluntary contractions, MVC) and cycling bouts (30-160% peak aerobic capacity, W peak). At various exercise intensities, electrical potentials were evoked in the vastus lateralis (VL) and rectus femoris (RF) via transcranial magnetic stimulation (motor-evoked potentials, MEP), and electrical stimulation of both the cervicomedullary junction (cervicomedullary evoked potentials, CMEP) and the femoral nerve (maximal M-waves, M max). Whereas M max remained unchanged in both muscles (P > 0.40), voluntary electromyographic activity (EMG) increased in an exercise intensity-dependent manner for ISO and cycling exercise in VL and RF (both P < 0.001). During ISO exercise, MEPs and CMEPs progressively increased in VL and RF until a plateau was reached at ∼ 75% MVC; further increases in contraction intensity did not cause additional changes (P > 0.35). During cycling exercise, VL-MEPs and CMEPs progressively increased by ∼ 65% until a plateau was reached at W peak. In contrast, RF MEPs and CMEPs progressively increased by ∼ 110% throughout the tested cycling intensities without the occurrence of a plateau. Furthermore, alterations in EMG below the plateau influenced corticomotoneuronal excitability similarly between exercise modalities. In both exercise modalities, the MEP-to-CMEP ratio did not change with exercise intensity (P > 0.22). In conclusion, increases in exercise intensity and EMG facilitates the corticomotoneuronal pathway similarly in isometric knee extension and locomotor exercise until a plateau occurs at a submaximal exercise intensity. This facilitation appears to be primarily mediated by increases in excitability of the motoneuron pool.

The anatomical relationship between the roots of mandibular second molars and the inferior alveolar nerve.

AIM: To evaluate the anatomical relationship between the roots of mandibular second molars and the inferior alveolar nerve (IAN) in relation to the risk of potential nerve injury during root canal treatment. METHODOLOGY: Cone-beam computed tomography (CBCT) images from the patient record database at a dental hospital were selected. The anonymized CBCT images were reconstructed and examined in three planes (coronal, axial and sagittal) using 3D viewing software. The relationship between each root apex of mandibular second molars and the IAN was evaluated by measuring the horizontal and vertical distances from coronal CBCT sections, and the actual distance was then calculated mathematically using Pythagoras' theorem. RESULTS: In 55% of the 272 mandibular second molar roots evaluated, from a total of 134 scans, the distance between the anatomical root apex and the IAN was ≤3 mm. CONCLUSIONS: In over 50% of the cases evaluated, there was an intimate relationship between the roots of mandibular second molars and the inferior alveolar nerve (IAN). Therefore, root canal treatment of mandibular second molars may pose a more significant potential risk of IAN injury; necessary precautions should be exercised, and the prudent use of CBCT should be considered if an intimate relationship is suspected.

Apical periodontitis and the technical quality of root canal treatment in an adult sub-population in London.

AIM: To assess the prevalence of apical periodontitis (AP) and the technical quality of root canal treatment in an adult sub-population in London. METHODOLOGY: Panoramic radiographs of 136 patients who attended a dental hospital were collected. The periapical health of teeth present was assessed radiographically and the presence or absence of AP noted. The technical quality of the root canal treatment was scored as adequate or inadequate, based on the European Society of Endodontology (2006) guidelines. RESULTS: A total of 3,396 teeth were assessed; AP was detected in 4.1% of the teeth. Forty-nine percent of patients had at least one tooth with radiographic evidence of AP. The percentage of root filled teeth with AP was 38.3%. AP was significantly more frequently found in root treated, compared with non-root treated, teeth (p <0.001). In 44.3% of the cases, the technical quality of the root canal filling was inadequate. AP was detected in 14% of adequately, compared with 68.6% of inadequately, root filled teeth. There is a significant negative correlation between the technical quality of root canal treatment and the presence of AP (p <0.001). CONCLUSIONS: There was a high prevalence of AP and poor technical quality root canal treatment; a strong association between AP and root filled teeth, and between the periapical health and the technical quality of the root canal treatment. The results are consistent with previous studies using similar methodology and re-confirmed that high technical quality root canal treatment is crucial to ensure a favourable treatment outcome.

Short-interval intracortical inhibition in knee extensors during locomotor cycling.

AIM: Short-interval intracortical inhibition (SICI) can provide information on changes in cortical responsiveness during voluntary contractions. It is, however, unknown whether the magnitude of SICI changes throughout the cycle of rhythmic movements such as leg cycling. METHODS: The effects of four conditioning stimulus (CS) intensities, 70, 80, 90 and 95% of active motor threshold (AMT), on the magnitude of SICI were tested during three conditions: (1) activation phase of the electromyography (EMG) burst, (2) deactivation phase of the EMG burst and (3) static contractions. The three conditions were matched for EMG amplitude and test motor-evoked potential (MEP) size with reference to the vastus lateralis muscle. Responses were also recorded from rectus femoris and vastus medialis. RESULTS: short-interval cortical inhibition was weak during static knee contractions (15% reduction in control MEP) relative to previous reports during contractions in other muscle groups. SICI was abolished during the activation phase of the knee extensor EMG burst (P > 0.05), but present (approx. 90% of control MEP size) during the deactivation phase of EMG (P < 0.05). Furthermore, inhibition was elicited at a lower CS intensity during the deactivation phase of EMG during cycling than during static contractions (70 AMT vs. 90% AMT). CONCLUSION: The results suggest that the efficacy of intracortical inhibitory projections to knee extensor corticomotoneurons is particularly weak during muscle activation. A lower threshold of activation for inhibitory cells during deactivation phase of cycling EMG was evident, and there was a phasic modulation of intracortical inhibition affecting corticospinal projections to the working muscles.

Glass-ionomer cement restorative materials: a sticky subject?

Glass-ionomer cement (GIC) materials have been in clinical use since their inception 40 years ago. They have undergone several permutations to yield different categories of these materials. Although all GICs share the same generic properties, subtle differences between commercial products may occur. They have a wide range of uses such as lining, bonding, sealing, luting or restoring a tooth. In general, GICs are useful for reasons of adhesion to tooth structure, fluoride release and being tooth-coloured although their sensitivity to moisture, inherent opacity, long-term wear and strength are not as adequate as desired. They are useful in situations where they are not disadvantaged by their comparatively lower physical properties, such as where there is adequate remaining tooth structure to support the material and where they are not subject to heavy occlusal loading. The last decade has seen the use of these materials being extended. However, they are likely to retain their specific niches of clinical application.

Expansion of nanotechnology for dentistry: effect of colloidal platinum nanoparticles on dentin adhesion mediated by 4-META/MMA-TBB.

PURPOSE: To investigate the effect of Colloidal Platinum Nanoparticles (CPN) on the bond strength between dentin and 4-META/MMA-TBB resin using different concentrations of CPN. MATERIALS AND METHODS: Twenty-five extracted human third molars were stored in 0.5% chloramine T. The occlusal dentin slices were prepared by grinding occlusal surfaces of each tooth and polishing with 600-grit silicon carbide paper under running water. One control and four experimental groups (2 specimens per group) were used as follows: a) dentin surfaces treated with 10-3 solution, followed by rinsing with water and subsequently an acrylic rod bonded with hand-mixed 4META/MMA-TBB resin (Super-Bond C&B, Sun Medical) (control); b) dentin surfaces treated with 10-3 etching solution, followed by rinsing with water and application of CPN (100% or 10%) as a primer solution for 60 s and rinsed with water for 20 s, then an acrylic rod bonded with Super-Bond C&B(Etch-CPN [100% or 10%]); c) dentin surfaces treated with CPN (100% or 10%) for 60 s, rinsed with water for 20 s, followed by application of 10-3 solution, then an acrylic rod bonded with Super-Bond C&B (CPN-Etch [100% or 10%]). After storage in 37°C water, specimens were sectioned into beams (cross-sectional area: 1 mm2) for microtensile bond strength testing at a crosshead speed of 1mm/min. The data were analyzed using the Games-Howell method (p < 0.05; n = 15). RESULTS: Etch-CPN (100), CPN-Etch(100) and CPN-Etch (10) showed significantly higher bond strengths compared to the control. When using 10% CPN, the highest bond strength was demonstrated. The bond strength of 4META/MMA-TBB resin was approximately doubled by CPN application. CONCLUSION: The results of this study showed that higher bond strengths are obtained when treating dentin with a lower concentration of CPN. Further evaluation to optimize conditions such as the application time and rinsing time are required.

Effect of application time of colloidal platinum nanoparticles on the microtensile bond strength to dentin.

The purpose of this study was to investigate the effect of application time of colloidal platinum nanoparticles (CPN) on bond strength. Dentin surfaces were subjected to one of the following treatments: (A) Etching with 10% citric acid-3% FeCl(3 )solution (10-3 solution); (B) Etching with 10-3 solution followed by applying CPN as a primer solution for 10, 20, 30, or 60 seconds; and (C) Priming with CPN for 10, 20, 30, or 60 seconds followed by etching with 10-3 solution. An acrylic rod was bonded to each treated dentin surface using 4-META/MMA-TBB resin. Bonded specimens were sectioned into beams for microtensile bond strength testing. In groups (B) and (C), highest bond strength was obtained when dentin surfaces were treated with CPN for 30 seconds. This meant that the CPN primer solution either enhanced the penetration of resin into dentin or the degree of conversion of 4-META/MMA-TBB resin. Within the limitations of this study, treatment with 0.1 mN CPN primer solution followed by 20 seconds of water rinsing resulted in high bond strength.

Effects of temperature on the fluoride release and recharging ability of glass ionomers.

This study investigated the effects of environmental temperature on the fluoride release and recharging ability of glass ionomers. Five disk specimens (15 mm in diameter and 1 mm thick) were made of each of the following materials: a conventional luting glass ionomer, two high viscosity restorative glass ionomers and a restorative resin-modified glass ionomer. The fluoride release of each material was measured at 4 degrees C, 37 degrees C and 55 degrees C. An additional three groups, which were made of the same materials, were stored in distilled and deionized water for 30 days and recharged in 250 ppm fluoride solution at 4 degrees C, 37 degrees C and 55 degrees C for five minutes. The fluoride re-release was measured daily from two days prior to two days after the recharging process. At all temperatures, the luting glass ionomers showed the greatest fluoride release and recharging ability, followed by the resin-modified glass ionomer, then the high viscosity glass ionomers. For each material, the fluoride release increased with increasing temperature and all glass ionomers showed greater recharging ability at higher temperatures. An increase in environmental temperature increased both the fluoride release and recharging of the glass ionomers. This may be important in developing regimes for improving the delivery of topical fluoride products.

Bonding characteristics of newly developed all-in-one adhesives.

This study evaluated the microtensile bond strength and the interfacial morphology of newer adhesives. The occlusal surfaces of extracted teeth were ground flat for random allocation to four equal groups. Resin composite was bonded to each surface using either Clearfil SE Bond [SEB], Clearfil Protect Bond [PB], G-Bond [GB], or an experimental adhesive, SSB-200 [SSB]. After storage for 24 h in water at 37 degrees C, they were sectioned into beams (cross-sectional area 1 mm(2)) for microtensile bond strength testing (muTBS) at a crosshead speed of 1 mm/min. The load at failure of each was recorded; the data were analyzed by one-way ANOVA and Games Howell tests. The surfaces of the fractured specimens were observed using SEM. For the ultra-morphology of the interface, the occlusal surfaces of four more teeth were prepared as before and a thin layer of flowable resin composite was bonded to each surface using one of the four adhesives. The mean muTBS ranged from 39.68 MPa (GB) to 64.97 MPa (SEB). There were no statistical differences between SEB and SSB, or between PB and GB (p > 0.05). The muTBS of SEB and SSB were significantly greater than that of PB and GB (p < 0.05). SEMs of the fractured surfaces revealed a mixed (cohesive/interfacial) failure. TEM examination highlighted differences in the hybrid layer; SEB had a thicker layer than the others. In conclusion, the newer all-in-one adhesives produced a thin hybrid layer but varied in their bond strengths. The 2-step self-etching adhesives do not necessarily produce higher bond strengths than that of the all-in-one systems.

Salivary contamination and bond strength of glass-ionomers to dentin.

This study evaluated the effect of salivary contamination on the shear bond strength of two highly viscous glass ionomer cements (Fuji IX GP Fast and Ketac-Molar Maxicap) to conditioned dentin and assessed the effect of cleaning the contaminated field prior to bonding. The buccal surfaces of 90 human molars and premolars were ground to expose dentin and the teeth were then set in resin. The specimens were divided into two groups for each material, then further subdivided into three groups of 15 teeth each: Group 1--uncontaminated (control), Group 2--dentin contaminated with saliva, Group 3--dentin contaminated, washed and air dried. The specimens were made by bonding the test material to dentin using a 4 mm diameter gelatin capsule. All specimens were protected with varnish and placed in distilled water at 37 degrees C for seven days prior to measuring bond strength in shear. Fractured surfaces were examined visually and by using SEM to assess mode of failure. There were no significant differences in mean shear bond strength among the three test groups for either material (ANOVA). However, shear bond strength of Fuji IX to dentin was significantly greater than Ketac-Molar (p=0.019) for all groups. Weibull analysis showed that contaminated (Group 2) specimens had a greater probability of failure at low stresses. Modes of failure were mostly cohesive for Fuji IX and adhesive/cohesive for Ketac-Molar. In conclusion, salivary contamination did not affect the mean shear bond strength of Fuji IX GP Fast and Ketac-Molar Maxicap to conditioned dentin; however, it increased the probability of failure at low stresses.

Water-dependent interfacial transition zone in resin-modified glass-ionomer cement/dentin interfaces.

The function of the interfacial transition zone (absorption layer) in resin-modified glass-ionomer cements bonded to deep dentin remains obscure. This study tested the hypotheses that the absorption layer is formed only in the presence of water derived from hydrated dentin and allows for better bonding of resin-modified glass-ionomer cements to dentin. Ten percent polyacrylic acid-conditioned, hydrated, and dehydrated deep dentin specimens were bonded with 2 resin-modified glass-ionomer cements and sealed with resins to prevent environmental water gain or loss. A non-particulate absorption layer was identified over hydrated dentin only, and was clearly discernible from the hybrid layer when bonded interfaces were examined with transmission electron microscopy. This layer was relatively more resistant to dehydration stresses, and remained intact over the dentin surface after tensile testing. The absorption layer mediates better bonding of resin-modified glass-ionomer cements to deep dentin, and functions as a stress-relieving layer to reduce stresses induced by desiccation and shrinkage.

Interaction of glass-ionomer cements with moist dentin.

Glass-ionomer cements (GICs) are regarded as aqueous gels made up of polyalkenoic acid salts containing ion-leachable glass fillers. The consequence of water permeation across the GIC-dentin interface is unknown. This study used SEM, field-emission/environmental SEM (FE-ESEM), and TEM to examine the ultrastructure of GIC-bonded moist dentin. Dentin surfaces bonded with 6 auto-cured GICs were examined along the fractured GIC-dentin interfaces. Additional specimens fractured 3 mm away from the interfaces were used as controls. SEM revealed spherical bodies along GIC-dentin interfaces that resembled hollow eggshells. FE-SEM depicted similar bodies with additional solid cores. Energy-dispersive x-ray analysis and TEM showed that the spherical bodies consisted of a silicon-rich GIC phase that was absent from the air-voids in the controls. The GIC inclusions near dentin surfaces result from a continuation of the GI reaction, within air-voids of the original polyalkenoate matrix, that occurred upon water diffusion from moist dentin.

The biocompatibility of glass-ionomer cement materials. A status report for the American Journal of Dentistry.

Since their introduction in the market, some 30 yrs ago, the biocompatibility aspects of glass-ionomer cements (GICs) have been intensively studied. In general, cytotoxicity of fully set conventional preparations in previous studies was shown to be minimal. However, a resin-modified preparation proved to be cytotoxic under these conditions. This product was also observed to be mutagenic, but data in this area are sparse and difficult to interpret. There is also evidence that certain GICs exert some antibacterial properties which is claimed to be related to the fluoride release; however, the mechanisms for this fluoride release are still unclear. Pulp response studies have shown conflicting results. However, unfavorable initial reactions, if present, resolved with time if a bacterial layer under the restoration and pulp exposures were prevented. Pain reactions after cementation of cast restorations with GICs have been reported in the past but there are no such reports in the more recent literature.

Confocal and multi-photon microscopy of dental hard tissues and biomaterials.

Confocal microscopy is a technique that can be used both in the clinic and the high-resolution microscopy suite. This form of optical microscopy enables high-resolution images to be made of samples with minimum requirements for specimen preparation. Images may be made of either reflections from the sample surface or, if an immersion medium is used to optically couple the objective lens, then sub-surface images can be produced of reflective or fluorescent structures within semi transparent materials such as cells and dental hard tissues. These images are like optical sections, giving thin (> 0.35 microm) slices up to 200 microm below the surface of a mineralized tissue. The technique generates significant improvements in resolution, lying somewhere between that of conventional light microscopy and TEM/SEM. Instruments that work at video-rate allow high-speed events to be examined, such as in vivo clinical studies, cutting of dental tissues and fracture of adhesive interfaces. New dyes offer many exciting prospects for labeling changes in chemical composition in materials or biological tissues, while new imaging techniques such as multi-photon laser excitation of dyes give the potential of greater depth penetration and improved resolution. As with all new techniques the inexperienced should be aware of some of the artifacts inherent to the system. However, the widespread availability of conventional confocal microscopes should give ample opportunity for dental researchers to capitalize on this new technology.