Furcation-involved molar teeth - part 2: management and prognosis.

Furcation-involved molars are a common presentation in general dental practice. Teeth with increasing degrees of furcation involvement are at a higher risk of requiring extraction. This second article reviews management and prognosis of furcation-involved molar teeth. An improved understanding of how to appropriately manage these teeth can result in improved outcomes for patients.

Furcation-involved molar teeth - part 1: prevalence, classification and assessment.

Furcation-involved molars are a common presentation in general dental practice. Teeth with increasing degrees of furcation involvement are at a higher risk of requiring extraction. The assessment and management of these teeth may be complicated by difficulties in accessing the furcation for both the clinician and patient. However, with appropriate supportive therapy, these teeth have been shown to have acceptable survival rates. This first article reviews and discusses the classification, assessment and the non-surgical management of furcation-involved molar teeth. An improved understanding of how to appropriately manage these teeth can result in improved outcomes for patients.

The ability of a potassium oxalate gel strip to occlude human dentine tubules; a Novel in vitro: In situ Study.

OBJECTIVES: To determine if an oxalate strip reduced fluid flow in dentine samples and whether this reduction was maintained following a 14 day intra-oral period. METHODS: Dentine tubule fluid flow was measured by a modified Pashley cell in 40 acid-etched dentine discs 1 mm thick, diameter >10 mm, with an acquired pellicle, pre-equilibrated with Hartmann's solution and conditioned by toothbrushing, pre and post treatment (10 min) with an oxalate (3.14 %) gel strip or no treatment. One control and one test sample were exposed in-situ for 14 days to the oral environment in 20 healthy adult volunteers, and fluid flow re-measured. The appliance containing the two samples was removed for brushing with water after mealtimes when the participant brushed their teeth and for a 2 min daily soak in chlorhexidine. RESULTS: Fluid flow rate was reduced significantly immediately following treatment with the oxalate strip compared to baseline flow rate by 58 %. Following 14 days in-situ oral environment phase, a significant further reduction in fluid flow compared to baseline was identified in both control and oxalate strip treated samples, both (p < 0.0001), but the reduction was greater in the test samples, 94 % vs 87 %, p < 0.01. CONCLUSIONS: This novel investigation is the first to show fluid flow measurement using the Pashley model in dentine samples that have been housed in the mouth for 14 days. Treatment with an oxalate strip designed for dentine hypersensitivity alleviation reduced dentine fluid flow more than control providing evidence that the oxalate treatment withstood the oral environment over a prolonged time. CLINICAL SIGNIFICANCE: This study demonstrated the efficacy and durability of the oxalate precipitate over a 14 day period in achieving and maintaining dentine tubule occlusion when participants had no dietary restrictions. This demonstrates the suitability of the oxalate strip for the treatment of patients suffering from dentine hypersensitivity pain.

A randomised controlled trial to investigate the efficacy of an oxalate strip for the management of dentine hypersensitivity pain.

OBJECTIVES: To compare a 3.14% potassium oxalate strip and 8% arginine calcium carbonate toothpaste for the reduction of dentine hypersensitivity after 2 and 4 weeks. METHODS: This was an examiner-blind, parallel study in 80 healthy adults with dentine hypersensitivity (Schiff score >2) in >1 tooth. After acclimatisation, participants were randomised to the oxalate desensitising strip with fluoride toothpaste or the arginine desensitising toothpaste control which also contained fluoride. Products were applied under supervision of study staff after measuring baseline sensitivity, thereafter the strip or control toothpaste (fingertip application) was applied after 1 and 2 weeks, and teeth brushed twice-daily with the fluoride (test group) or the fluoridated arginine control toothpaste. Sensitivity was assessed following airblast (Schiff and VAS) and tactile stimuli (Yeaple probe) at baseline, 2 and 4 weeks. RESULTS: Both groups showed significant reductions from baseline in VAS, Schiff and Yeaple sensitivity scores after 2 and 4 weeks (p < 0.0005). The oxalate group had significantly lower Schiff and higher Yeaple probe scores compared to control after both time points (p < 0.0002 and p < 0.05), but while scores favoured the oxalate group, there were no significant differences in VAS. CONCLUSIONS: This study demonstrated application of a 3.14% potassium oxalate strip combined with toothbrushing with paste was more effective in pain management of dentine hypersensitivity than brushing with arginine toothpaste. CLINICAL SIGNIFICANCE: Treatment of sensitive teeth with the oxalate strip reduced dentine hypersensitivity after 2 and 4 weeks to a significantly greater degree than a positive control sensitivity toothpaste demonstrating that oxalate strips are an effective targeted treatment for dentine hypersensitivity sufferers.

Dental erosion from an excess of vitamin C.

Acid erosion of enamel is the chemical dissolution of the superficial layers of teeth without the presence of bacteria. If the presence and exposure of a demineralising agent such as vitamin C is frequent and prolonged, it can lead to significant tooth wear. This case report discusses one such presentation and as a result of the occlusal relationship, this serves to effectively demonstrate the localised effects of vitamin C-induced acid erosion. The management of localised tooth wear with composite restorations utilising the Dahl principle to replace lost tooth tissue is also reported. Clinical Relevance. Patients should be made aware of the erosive nature of chewable vitamin C tablets and their potentially harmful effects on the dentition if consumed in excess. Objective Statement. The reader should understand the clinical implications of an excessive intake of vitamin C. This demonstrates the importance of the manufacturer's instructions and the clinician's role in advising patients with regard to the correct therapeutic doses.