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Background: The number of older people increases globally, so is the risk of cognitive impairment. Periodontal diseases are common among older adults with significant tooth loss and periodontal problems. Thus, this review explored the periodontal disease conditions among individuals with and without dementia. Methods: Available databases such as Medline/Pubmed, Web of Science, Scopus, Cochrane Library and Embase/OVID were used in the search. Case-control studies reporting on periodontal disease and dementia parameters were selected based on PICO (Population, Intervention, Comparison and Outcomes) framework. A Newcastle-Ottawa Scale (NOS) was used to assess the quality reporting of the studies and PRISMA guideline was used for screening. Results: A total of ten studies were identified for analysis. Most studies reported higher plaque index score (PI), bleeding on probing (BoP), pocket depth (PD) and clinical attachment loss (CAL) among individuals diagnosed with dementia or Alzheimer's disease compared with clinically healthy controls or individual diagnosed without dementia. A higher prevalence of subjects with severe periodontal disease was also observed in individuals diagnosed with dementia/Alzheimer's disease. The quality of the studies was found to be moderate with lower comparability and ascertainment criteria scores. Conclusion: This qualitative analysis has shown poor periodontal health and increased inflammatory mediators in case groups compared to the control groups. Thus, more quality studies and novel intervention are warranted to reduce the impact of periodontal health on dementia globally.
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INTRODUCTION: Despite being acknowledged as the second global burden of oral disease, periodontal disease has few epidemiologic studies in the literature, particularly for developing countries. Many previous studies have assessed the relationship between periodontal disease and oral health-related quality of life (OHRQoL), with patients attending dental clinic or hospitals rather than a general population. This study attempted to fill the knowledge gap in limited information about periodontal disease and OHRQoL, with reference to a general population in a developing country. OBJECTIVES: To investigate the relationship between OHRQoL and periodontal diseases in an older population in Indonesia. METHODS: We invited 582 older people from community health centers. The 369 (63.4%) older people who agreed to participate consented to an oral health examination and a questionnaire capturing demographic, socioeconomic, behavioral, and Oral Health Impact Profile-14 (OHIP-14) data. RESULTS: Almost 75% of the older people had generalized periodontitis; 3% had healthy periodontal status; and around 22% had localized periodontitis. There was a lack of statistical evidence for an association between periodontal disease status and OHRQoL. This result was based on the appraisal of the prevalence of the impact (Odds ratio [OR], 0.95 [95% CI, 0.54 to 1.59]; P = 0.77), difference in mean severities (0.07 [95% CI, -1.66 to 1.80]; P = 0.94), and extent of the impact (P = 0.996). However, we found evidence for a relationship between tooth mobility and OHRQoL for all of the OHIP assessments, including prevalence of the impact (OR, 1.87 [95% CI, 1.16 to 3.01]; P = 0.009), difference in mean severities (-2.98 [95% CI, -4.50 to -1.45]; P < 0.001), and extent of the impact (P = 0.001). CONCLUSION: There was a lack of statistical evidence for a relationship between periodontal disease status and OHRQoL in this society. However, we found evidence that tooth mobility, as a sign of periodontal disease progression, is related to OHRQoL. KNOWLEDGE TRANSFER STATEMENT: The present study can be used by dentists, community health workers, and policy makers in Indonesia to understand the prevalence, severity, and extent of the negative impacts of periodontal disease on older people's quality of life. In addition, this study provides information about factors that might considerably affect the oral health-related quality of life in this society, such as brushing habits, dental visit, family income, DMF-T status, and subjective appraisal toward dental health.
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Enfermedades Periodontales , Periodontitis , Movilidad Dentaria , Anciano , Humanos , Indonesia/epidemiología , Salud Bucal , Enfermedades Periodontales/epidemiología , Calidad de VidaRESUMEN
INTRODUCTION: The impact of periodontal disease on oral health-related quality of life (OHRQoL) has often been investigated from a quantitative research perspective, which is based on clinical findings and an OHRQoL questionnaire. Very few studies have examined the issue from the view of qualitative research. To our knowledge, there have been no previous qualitative studies focusing the effect of periodontal disease on OHRQoL in Indonesian older people. OBJECTIVES: To explore and understand the impact of periodontal disease on the OHRQoL of older people as a subjective reflection in relation to periodontal disease experiences. METHODS: Semi-structured interviews were conducted in a sample of 31 older people with generalized chronic periodontitis. Thematic analysis was used to identify the key issues in participants' accounts. The analysis was undertaken by 2 independent coders to ensure reliability. To achieve thematic saturation, successive interviews were undertaken until 5 sequential interviews did not bring new themes. RESULTS: Participants reported the negative effects likely related to periodontal disease. The impacts of periodontal disease were described by these older people as affecting more than pain, physical discomfort, and physical function restrictions. Periodontal disease also affected their psychological and social aspects of daily living. In addition, this study identified themes related to individual and environmental factors that may modify and personalize periodontal disease experiences. Furthermore, this study identified a misleading belief that problems related to periodontal disease were a normal part of aging, which might influence individuals' expectations toward oral health. Relatedly, participants frequently reported that the progression of tooth mobility to tooth loss was an inevitable part of the aging process. CONCLUSIONS: Periodontal disease negatively affected participants' OHRQoL. It is fundamental to understand older people's perceptions toward their periodontal disease as well as individual and environmental factors that may have an influence on their periodontal disease experiences. KNOWLEDGE TRANSFER STATEMENT: This study is a reflection of Indonesian older people's subjective periodontal disease experiences. Therefore, the present study can be used to understand older people's perceptions, attitudes, behaviors, and experiences toward periodontal disease and how this disease may affect their quality of life. This study also highlights a widespread and misleading belief that oral problems related to periodontal disease are an inevitable part of aging in this study population.
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Periodontitis Crónica , Calidad de Vida , Anciano , Humanos , Indonesia/epidemiología , Investigación Cualitativa , Calidad de Vida/psicología , Reproducibilidad de los ResultadosAsunto(s)
Caries Dental , Agua Potable , Fluorosis Dental , Australia , Fluoruración , Fluoruros , HumanosRESUMEN
OBJECTIVES: In previous studies, increasing number of teeth predicted better survival and the acute needs for dental treatment predicted mortality. We sought to investigate whether restored dentitions by various removable dental prostheses impact cardiovascular (CVD) longevity. METHODS: Kuopio Oral Health and Heart study was initiated as a cross-sectional investigation with 256 subjects with diagnosed coronary artery disease [CAD] and 250 age- and sex-matched controls without CAD in 1995-1996. The mean age of both groups was 61, 30% were females. We appended mortality follow-up records to the baseline data and formulated this 15-year follow-up study. We examined the relationship between various types of dental prostheses and cardiovascular mortality by proportional hazard regression analyses. We also explored their correlation to oral and systemic inflammatory markers such as asymptotic dental score and C-reactive protein. RESULTS: In a model adjusted for age, sex and smoking, groups having only natural teeth (NT), removable partial denture(s) [PD] and NT, a PD and a full denture [FD], and FD/FD or FD/NT demonstrated the following hazard ratios for mortality (95% confidence interval). NT both arches: 1.00 [reference]; PD and NT: 0.75 [0.22-2.56]; PD and FD: 1.99 [1.05-3.81]; and FD opposed by FD or NT: 1.71 [0.93-3.13], respectively [p for trend=0.05]. Although statistically not significant, those with PD and NT with mean a number of teeth [Nteeth] of 15.4 had better survival compared with those who had all NT [Nteeth=22.5]; while those who had FD and PD [Nteeth=6.5] had shorter longevity than those with FD/FD or FD/NT [Nteeth=3.5]. CONCLUSIONS: Although not all subgroups of dental prostheses reached significant relationship with CVD mortality, our study suggests that not only the number [quantity] of remaining teeth but their maintenance [quality] removing potential inflammatory foci, such as pericoronitis or retained root tips, may positively impact on cardiovascular survival.
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Enfermedad de la Arteria Coronaria/mortalidad , Dentadura Completa/estadística & datos numéricos , Dentadura Parcial Removible/estadística & datos numéricos , Factores de Edad , Proteína C-Reactiva/análisis , Candidiasis Bucal/epidemiología , Estudios de Casos y Controles , Estudios Transversales , Cálculos Dentales/epidemiología , Dentición , Femenino , Finlandia/epidemiología , Estudios de Seguimiento , Humanos , Hipertensión/epidemiología , Mediadores de Inflamación/análisis , Longevidad , Masculino , Persona de Mediana Edad , Enfermedades Periodontales/epidemiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores Sexuales , Fumar/epidemiología , Infecciones Estreptocócicas/epidemiologíaRESUMEN
The population of the world is aging. A greater proportion of older people are retaining increasing numbers of natural teeth. Aging is associated with changes in oral architecture and muscle weakness, making personal oral hygiene more difficult, particularly for the oldest and most frail individuals. Furthermore, there is exposure of root dentin with its higher pH for demineralization in addition to enamel as a substrate for caries. Aging is also associated, for many in the developed world, with taking multiple medications, with the associated risk of dry mouth. These variables combine to increase caries risk in older vulnerable populations. Caries occurs on both the crowns of teeth (predominantly around existing restorations) and the exposed roots. Prevention needs to be aggressive to control disease in this combination of circumstances, with multiple strategies for limiting the damage associated with caries in this population. This paper explores the evidence that is available supporting preventive strategies, including fluorides in various forms, chlorhexidine, and calcium phosphate supplementation.
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Caries Dental/prevención & control , Fluoruros/uso terapéutico , Odontología Geriátrica/métodos , Higiene Bucal/métodos , Anciano , Anciano de 80 o más Años , Clorhexidina/uso terapéutico , Caries Dental/epidemiología , Caries Dental/terapia , Odontología Geriátrica/tendencias , Humanos , Antisépticos Bucales/uso terapéutico , Higiene Bucal/tendencias , Reino Unido/epidemiologíaRESUMEN
As people are living longer and retaining their teeth into old age, root caries is an increasingly significant problem. A minimally invasive treatment strategy, involving sealing the root caries lesion with an antibacterial resin sealant, could be highly beneficial. The aim of this study was to compare the antibacterial properties of the primers of two proprietary dentine bonding agents, Clearfil SE Bond (SE; Kuraray Medical, Japan) and Clearfil Protect Bond (PB; Kuraray Medical), which contains the antibacterial monomer methacryloyloxydodecylpyridinium bromide. Fifty-two root caries lesions were identified and randomly assigned to a primer. The lesion was cleaned, isolated, sampled with a sharp spoon excavator, a primer applied and a second sample taken. Samples were transported in fastidious anaerobe broth, vortex-dispersed and serial dilutions inoculated onto selective agars. Reduction in colony-forming units (CFU, %) after primer application was calculated for both primers for bacterial growth on each selective agar and compared to a hypothesised mean of 100% (one-sample t test, p < 0.05). No significant differences between primers were seen, indicating efficient bacterial elimination by both materials. Comparing percent reduction between SE and PB for each agar (Mann-Whitney test, p < 0.05), a significantly greater CFU reduction by PB was seen for streptococci but not other bacteria. More lesions exhibited bacterial growth and several lesions demonstrated marked bacterial growth after treatment with SE compared with PB. Therefore, PB appears to exhibit superior antimicrobial properties, particularly against streptococci. Both primers are highly antibacterial towards root caries bacteria and may therefore be suitable for minimally invasive treatment.
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Recubrimientos Dentinarios/uso terapéutico , Caries Radicular/tratamiento farmacológico , Caries Radicular/microbiología , Streptococcus/efectos de los fármacos , Agar , Recuento de Colonia Microbiana , Medios de Cultivo , Tratamiento Restaurativo Atraumático Dental/métodos , Recubrimientos Dentinarios/química , Recubrimientos Dentinarios/farmacología , Humanos , Compuestos de Piridinio/farmacología , Compuestos de Piridinio/uso terapéutico , Cementos de Resina/farmacología , Cementos de Resina/uso terapéutico , Estadísticas no Paramétricas , Streptococcus/crecimiento & desarrolloRESUMEN
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.
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Caries Dental/etiología , Placa Dental/etiología , Dentadura Parcial Removible/efectos adversos , Gingivitis/etiología , Periodontitis/etiología , Candida albicans , Dentadura Parcial Removible/psicología , Dieta , Estado de Salud , Humanos , Lactobacillus , Estado Nutricional , Higiene Bucal , Periodontitis/microbiología , Calidad de Vida , Riesgo , Caries Radicular/etiología , Saliva/microbiología , Estomatitis Subprotética/etiología , Streptococcus mutansRESUMEN
Provision of indirect restorations is associated with more complaints and litigation than any other area of dentistry. In the third part of this series we identify possible causes of such complaints. We explore each of the stages from clinical assessment to treatment, highlighting areas which may trigger litigation when they are not addressed carefully - particularly in relation to cosmetic dentistry. The article is illustrated with clinical examples drawn from the authors' personal experience. With patients' ever-increasing expectations, the pressure to deliver quality dentistry has never been higher and will not diminish.
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Coronas , Restauración Dental Permanente/métodos , Dentadura Parcial , Consentimiento Informado/normas , Administración de la Práctica Odontológica/normas , Odontología , Diseño de Dentadura/normas , Ética Odontológica , Humanos , Mala Praxis , Educación del Paciente como Asunto , Satisfacción del Paciente , Gestión de RiesgosRESUMEN
This study examines the effect of preparing teeth with six varying convergence angles (ranging between 12 and 120 degrees) and height (1 and 2 mm) on the retention of cast gold crowns. Six groups of 4 human premolar teeth were prepared to give a flat occlusal surface in dentine with very short axial wall heights (1 or 2 mm) and variation in axial wall convergence (between 12 and 120 degrees). Impressions were recorded of the prepared teeth and custom castings made using a high copper content precious metal alloy. The castings were luted with an adhesive resin and stored in water at 37 degrees C for 24 hours prior to determining the pull-off force in an Instron Universal testing Machine at a cross head speed of 1mm min(-1). Twenty two of the twenty four tested specimens failed within the dentine of the tooth, irrespective of preparation orientation. Statistical testing using ANOVA demonstrated that there were no differences between the bond strength values for any of the preparation convergence angles or between preparations with 1 and 2 mm axial wall heights. This suggests that attachment strength of adhesively bonded castings with minimal axial wall height preparations is not influenced by the convergence angle of the preparation. The attachment strength exceeded that cohesive strength of the underlying dentine in nearly all of the adhesively luted restorations.
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Coronas , Recubrimiento Dental Adhesivo/métodos , Retención de Prótesis Dentales , Fosfatos , Cementos de Resina , Preparación Protodóncica del Diente/métodos , Análisis de Varianza , Diente Premolar , Diseño de Prótesis Dental , Fracaso de la Restauración Dental , Análisis del Estrés Dental , Aleaciones de Oro , Humanos , Resistencia a la TracciónRESUMEN
Socio-economic variations in health exist for a wide range of health outcomes, including oral health and oral-health-related quality of life (OHRQoL). Less is known regarding how socio-economic trajectories may influence oral health and OHRQoL. This study examined whether social mobility is related to the number of teeth retained by age 50 years and OHRQoL measured at the same time, using data from the Newcastle Thousand Families Study, a birth cohort established in 1947. Women remaining in the non-manual class had the greatest tooth retention. While promotion of a healthier lifestyle and continued improvements in oral hygiene throughout life appear to be the public health interventions most likely to improve oral health into middle age, there may be sub-groups of the population on which different approaches in terms of public health interventions need to be focused.
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Salud Bucal , Movilidad Social , Factores de Edad , Consumo de Bebidas Alcohólicas/epidemiología , Estudios de Cohortes , Escolaridad , Inglaterra/epidemiología , Femenino , Promoción de la Salud , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Ocupaciones , Higiene Bucal , Calidad de Vida , Estudios Retrospectivos , Factores Sexuales , Fumar/epidemiología , Pérdida de Diente/epidemiologíaRESUMEN
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.
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Dentadura Completa/psicología , Conducta Alimentaria/psicología , Preferencias Alimentarias/psicología , Arcada Edéntula/psicología , Masticación , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Conducta de Elección , Registros de Dieta , Ingestión de Alimentos/psicología , Femenino , Frutas , Conocimientos, Actitudes y Práctica en Salud , Humanos , Arcada Edéntula/rehabilitación , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Psicología , Autoimagen , Autoevaluación (Psicología) , VerdurasRESUMEN
The volumetric contraction of a variety of luting agents, including Panavia 21, All-Bond C&B Cement, Superbond., Variolink and zinc phosphate cement, was assessed and compared using a minimal transducer The contraction among the materials tested was determined from the post-gel linear displacement of a deflecting coverslip resting on 4 silicone rubber spacers between which a mixed material was centrally located. Finally, the rate and duration of shrinkage over a period of 60 minutes from the moment of rigid contraction for all materials were investigated, and the final shrinkage values among the materials tested were compared. The analysis of variance showed that there were highly significant differences (P< 0.001) between the materials and the mean of each group was significantly different from that of any of the other groups (Tukey's test). Superbond produced the highest values of the final polymerisation shrinkage, followed by All bond C&B, Variolink, Panavia 21 and zinc phosphate cement respectively. Also, there was a marked variation in the overall magnitude of shrinkage (from 1.34% to 4.62%) among the materials tested. The method used to measure the polymerisation shrinkage in the present study was shown to be a precise measure in that it produced consistent and reproducible results. It can also offer the ability to observe the development of polymerisation shrinkage against time, during the post-gelation phase, for a range of chemically-cured resin materials.
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Cementación/métodos , Coronas , Cementos Dentales/química , Dentadura Parcial , Compuestos de Boro/química , Recubrimiento Dental Adhesivo , Humanos , Ensayo de Materiales , Metacrilatos/química , Metilmetacrilatos/química , Fosfatos/química , Polímeros/química , Cementos de Resina/química , Propiedades de Superficie , Factores de Tiempo , Transductores , Cemento de Fosfato de Zinc/químicaRESUMEN
The film thickness and rheological properties [viscosity and tan sigma], of different resin based crown and bridge luting agents, including Panavia 21, Superbond, All Bond C&B Cement, Variolink were compared with zinc phosphate cement. A modification of the method in ISO 9917 (1991) and a controlled stress rheometer were used to monitor the changes in the film thickness and rheological properties respectively. For each material, the film thickness and rheological characteristics were determined at 60s after start of mixing and then made at regular intervals until immediately before the material was set. For the initial film thickness, the difference among the values for Varionk, Superbond and zinc phosphate cement was not significant (P>0.05), and less than 25microm. The values for All Bond C&B Cement and Panavia 21 were at least twice that of the other materials tested. All Bond C&B Cement produced the highest film thickness value at both the initial period and at 240s. Regarding viscosity, Superbond had the lowest initial value but the highest value at 240s. Variolink gave the highest initial value of viscosity, but the differences in the initial values among the other materials were small. During the whole period of testing, zinc phosphate cement gave the highest values of tan sigma, and Panavia 21 showed no significant change in any of the measured properties. The methods were able to distinguish the behaviour of different cement materials. Some resin cements produce larger than optimal values of film thickness and in some cases this is related to a rapid increase in viscosity after mixing. It is expected that differences in the ability of cements to form thin films will affect the seating of cemented restorations.
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Cementación , Coronas , Cementos de Resina , Cemento de Fosfato de Zinc , Análisis de Varianza , Compuestos de Boro , Resinas Compuestas , Fuerza Compresiva , Análisis del Estrés Dental , Ensayo de Materiales , Metacrilatos , Metilmetacrilatos , Fosfatos , Reología , Resistencia al Corte , ViscosidadRESUMEN
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.
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Consejo , Dentadura Completa , Conducta Alimentaria , Boca Edéntula/fisiopatología , Fenómenos Fisiológicos de la Nutrición , Anciano , Anciano de 80 o más Años , Registros de Dieta , Femenino , Frutas , Humanos , Masculino , Masticación , Persona de Mediana Edad , Encuestas y Cuestionarios , VerdurasRESUMEN
In this study, the prevalence of root caries in a sample of Japanese elders was investigated along with various aetiological factors. Two hundred and eighty-seven independently living elderly people over the age of 60 years were examined for the prevalence of active, inactive, and filled root lesions as well as the number of teeth. General health, oral status and brushing habits were surveyed, and salivary flow was determined in terms of flow rate and subjective feeling of dry mouth during eating. About 39% of the subjects had one or more decayed roots and 53.3% had at least one decayed or filled lesion. Root caries was seen most frequently on canine teeth followed by the first premolar. The number of decayed or filled lesions increased with increasing number of residual teeth (Kruskal-Wallis test, P = 0.033), however, there was no association between the proportion of teeth with root decay and the number of teeth. For subjects with 20 or more teeth, the number of decayed roots is likely to be lower in subjects who reported brushing frequently (P = 0.058), and higher in subjects with low salivary flow (P = 0.059) or subjective feeling of dry mouth (P = 0.052) (Chi-squared). The presence of decayed lesions is likely to be related to dry mouth (P = 0.057, odds ratio 3.13) and brushing frequency (P = 0.088, odds ratio 1.76) (Multiple logistic regression analysis). The results indicate a high frequency of root surface caries in this Japanese community-dwelling older population. Oral hygiene status and low salivary flow or perceived dry mouth were potential risk factors for disease.
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Caries Radicular/epidemiología , Distribución por Edad , Anciano , Encuestas de Salud Bucal , Restauración Dental Permanente , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Salivación , Distribución por Sexo , Pérdida de DienteRESUMEN
The relative contributions of factors operating in fetal life, childhood, and adulthood to the risk of disease in middle age have become important research issues, but self-perceived oral health has rarely been considered in this context. This study investigated the impact of risk factors operating throughout life on self-perceived oral health, according to the Oral Health Impact Profile (OHIP), at age 50 yrs in 305 individuals from the Newcastle Thousand Families cohort. Factors from early and adult life contributed to the OHIP scores, but in men, self-perceived oral health was mostly explained by factors operating early in life. In women, the number of teeth retained in adulthood had a more prominent impact. Lifecourse influences on oral-health-related quality of life appear different for men and women, which may have implications for the effectiveness of public health interventions and health promotion.
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Acontecimientos que Cambian la Vida , Persona de Mediana Edad/fisiología , Salud Bucal , Calidad de Vida , Inglaterra , Femenino , Humanos , Masculino , Autoevaluación (Psicología) , Factores Sexuales , Perfil de Impacto de Enfermedad , Clase Social , Encuestas y Cuestionarios , Pérdida de Diente/psicologíaRESUMEN
AIM: To test the hypothesis that dentine and pulp protection by conditioning-and-sealing is no less effective than using a conventional calcium hydroxide lining. METHODOLOGY: A cohort of healthy adults requiring a new or replacement restoration in a posterior tooth was recruited in six general practices. All procedures received local Ethics Committee approval. Exclusion criteria included signs and symptoms of pulp necrosis or inflammation, and patients unable to commit to a long-term trial. Cavity preparations were randomized to receive a calcium hydroxide lining or conditioning-and-sealing with a smear-removing bonding system. Choice of bulk restorative material (composite resin or amalgam) was at the discretion of the dentist. The key outcome measure was evidence of pulpal breakdown identified at unscheduled (emergency) or scheduled recall examinations. Postoperative sensitivity was recorded on 100 mm VAS at 24 h, 4 days and 7 days. Pulp status was assessed at 6, 12, 24 and 36 month recall, and at any emergency recall appointment. The relationship between pre-treatment and treatment variables and pulp breakdown was assessed by logistic regression (P = 0.05). RESULTS: A total of 602 teeth were recruited, with comparable numbers of cavities lined (288, 47.8%) or conditioned and sealed (314, 52.2%). The majority (492, 81.7%) were replacement restorations, and amalgam was the most common bulk restorative material (377, 62.6%). A total of 390 (64.8%) restored teeth were reviewed at 6 months, 307 (51%) at 12 months, 363 (60.3%) at 24 months, and 279 (46.3%) at 36 months post-restoration. Sixteen cases of pulp breakdown were identified within 36 months of restoration placement, 11 presenting as emergencies and five detected at routine recall examination. Logistic regression showed that preoperative pain, cavity treatment by lining or conditioning-and-sealing and the use of rubber dam isolation had no association with pulp breakdown. Pulp breakdown was associated with deep or pulpally exposed cavities (P < 0.001, odds ratio 7.8) and with composite rather than amalgam restorations (P = 0.001, odds ratio 2.13). Re-coding to identify teeth with pulp exposures revealed that pulpal exposure was the key determinant of adverse pulp outcomes (P < 0.0001, odds ratio 28.4) and that composite resin restorations were again more likely to be associated with pulp breakdown than amalgam (P = 0.017, odds ratio 3.92). CONCLUSIONS: Considered within the context of routine primary dental care: Dentists can be confident that pulps will be equally well protected from post-restorative breakdown up to 36 months by calcium hydroxide lining and conditioning-and-sealing with adhesive resins. Residual dentine thickness appears to be a key determinant of pulp responses after restorative dental treatment. In deep and pulpally exposed cavities in posterior teeth, composites were associated with more pulpal breakdown than amalgams.
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Resinas Compuestas/efectos adversos , Exposición de la Pulpa Dental/etiología , Necrosis de la Pulpa Dental/etiología , Restauración Dental Permanente/efectos adversos , Pulpitis/etiología , Grabado Ácido Dental , Adulto , Hidróxido de Calcio , Amalgama Dental , Recubrimiento de la Cavidad Dental , Restauración Dental Permanente/métodos , Recubrimientos Dentinarios , Femenino , Odontología General , Humanos , Modelos Logísticos , Masculino , Oportunidad Relativa , Método Simple CiegoRESUMEN
A dentin primer containing the antibacterial monomer 12-methacryloyloxydodecylpyridinium bromide (MDPB) has been shown to penetrate and kill the bacteria in artificially demineralized dentin. We hypothesized that an experimental adhesive system, which incorporates the MDPB-containing primer, would be effective in inhibiting the progression of root caries in vitro. Artificial caries lesions were prepared by either an acid-gel or a Streptococcus mutans culture technique on the roots of extracted human teeth. The progression of these lesions after the application of the experimental or proprietary adhesive system was examined. Further demineralization was completely prevented by the experimental adhesive system, while lesions managed with the proprietary materials showed limited ability to inhibit further demineralization. We conclude that the experimental adhesive system can inhibit the progression of root-surface caries in vitro, through a combination of its antimicrobial activity and sealing of the demineralized dentin.