Does having children affect women's oral health? A longitudinal study.

BACKGROUND: Many believe women's oral health deteriorates as a result of having children. If so, such associations should exist among women but not among men. The aims of this study were to investigate whether number of children is associated with experience of dental disease and tooth loss among both men and women and to examine whether this association is affected by other variables of interest. METHODS: This study used data from the Dunedin Multidisciplinary Health and Development study, a longitudinal study of 1037 individuals (48.4% female) born from April 1972 to March 1973 in Dunedin, New Zealand, who have been examined repeatedly from birth to age 45 years. RESULTS: Data were available for 437 women and 431 men. Those with low educational attainment were more likely to have more children and began having children earlier in life. Having more children was associated with experiencing more dental caries and tooth loss by age 45, but this association was dependent on the age at which the children were had. Those entering parenthood earlier in life (by age 26) had poorer dental health than those entering parenthood later in life, or those without children. There was no association between number of children and periodontal attachment loss (PAL). Low educational attainment, poor plaque control, never routine dental attendance, and smoking (for PAL) were associated with PAL, caries experience, and tooth loss. CONCLUSIONS: Social factors associated with both the timing of reproductive patterns and health behaviors influence the risk of dental disease and its management.

Psychosocial aspects of periodontal disease diagnosis and treatment: A qualitative study.

AIMS: Patient-reported outcomes have attracted interest as there has been a shift from clinician-centric endpoints. This qualitative study aimed to develop an understanding of the psychosocial impact of periodontitis and its treatment. MATERIALS AND METHODS: Fourteen adults were asked to document their experiences of untreated periodontitis and non-surgical periodontal therapy at a university clinic, using written or audio-recorded diaries. The diary data were then used as a framework for semi-structured qualitative interviews, conducted at the completion of initial non-surgical treatment. Inductive thematic content data analysis was employed. RESULTS: Three themes illustrated the detrimental impact of periodontitis: "concealment," "having a guilty conscience" and "patient comfort as paramount." These were related to a core underlying concept, "progression to a more positive outlook," which described a distinct shift in participants' attitudes and optimism after their periodontal treatment. Despite finding treatment unpleasant, the participants described profound positive influences on their social well-being, self-esteem, mood, work, relationships and outlook. CONCLUSIONS: This study illustrated the broad psychosocial impact of periodontitis. The findings suggest that the benefits of periodontal treatment extend beyond improvements in traditional biomedical indicators to those which are more relevant and desirable to patients.

Management of periodontal health in children: pediatric dentistry and periodontology interface.

The oral health of children and adolescents mirrors their general health. Because oral health care is often delivered in isolation from general health care, oral signs and symptoms do not always alert practitioners to their significance beyond the mouth. An important example of this is the association of a higher risk of dental caries and periodontal disease in children and adolescents with overweight, obesity and prediabetic conditions. Oral-health practitioners need to consider the health conditions that their patients may have. This will aid in diagnosis and alert the practitioner to oral conditions that may not resolve without general health-care intervention also. This paper reviews the more common oral conditions involving periodontal health in children and adolescents, and discusses the diagnosis of these conditions, potential associated health problems and the roles of pediatric dentistry and periodontology in the management of these conditions with the goal of children entering adulthood with healthy dentitions.

Chronic periodontitis and implant dentistry.

Dental implants are regularly placed in patients with a history of periodontitis, even though peri-implant tissues are susceptible to the same host-modulated plaque-induced factors that initiate and sustain periodontitis. This article endeavors to clarify the evidence regarding the history of periodontitis as a risk factor for implant success and survival, and the role of supportive periodontal therapy in maintaining implants for individuals with a history of periodontitis.

Quantifying the Association Between Self-Reported Diabetes and Periodontitis in the New Zealand Population.

BACKGROUND: This study aims to investigate the association between diabetes and periodontitis in the New Zealand (NZ) adult population. METHODS: Data from two NZ national surveys (N = 2,048) were analyzed to compare estimates of the strength of the association between diabetes and periodontitis using two multivariate epidemiologic approaches (cohort and matched case-control studies). This was possible because the first survey provided participants for the second survey. Periodontitis cases were identified using 14 case definitions, including six severe definitions. The cohort study identified those with diabetes in 2006/07 and those with periodontitis in 2009 to determine the patients with diabetes odds of having periodontitis, using logistic regression modeling (adjusting for smoking status, sociodemographic, and dental characteristics). The matched case-control study identified cases of severe periodontitis in 2009 and compared their 2006/07 diabetic status with that of controls (individually matched on age group, sex, and socioeconomic status). Conditional logistic regression modeling was used for the case-control study, adjusting for ethnicity, smoking status, and dental characteristics. RESULTS: Overall, 3.6% of the periodontally examined adults reported having diabetes. There was no sex difference in diabetes prevalence, but it was greater in older age groups. Depending on the definition of periodontitis used, there were different estimates of risk for periodontitis, with odds ratios ranging from 1.91 (P = 0.01) to 3.51 (P = 0.22) using the cohort study approach. Diabetes was associated with a greater risk of having periodontitis using only two of the 14 periodontitis case definitions. No association was observed using the matched case-control study. CONCLUSIONS: The diabetes-periodontitis association in the NZ population remains unclear. This study demonstrates that the determination of the strength of a putative association is method dependent.

Peri-implantitis diagnosis and treatment by New Zealand periodontists and oral maxillofacial surgeons.

OBJECTIVES: This study aimed to investigate the understanding, diagnosis and management of peri-implantitis by New Zealand periodontists and oral maxillofacial surgeons (OMFS). DESIGN: Telephone interviews (in combination with a postal and electronic survey) were conducted of all 25 periodontists and 32 OMFS listed as specialists on the New Zealand Dental Register. A seven item multi-choice and short answer questionnaire was used to investigate: their definition of peri-implantitis; the number of annual referrals received in their practice for this condition; their diagnostic, preventive and treatment strategies for peri-implantitis; and their perception of the role of general dental practitioners in its management. RESULTS: The participation rate was 84.6%. Most respondents defined peri-implantitis as a disease of multifactorial aetiology that leads to destruction of the bone supporting an implant. The average number of cases seen annually differed between periodontists (11 cases/year) and OMFS (4 cases/year). The criteria used by the respondents to diagnose peri-implantitis included increased probing depths and radiographic evidence of bone loss. Each type of specialist used mechanical debridement for treatment, but a higher proportion of OMFS performed surgical procedures as treatment. The prevention strategies used smoking cessation advice and ensuring good plaque control. All respondents agreed that peri-implantitis is an important disease that can lead to implant failure, and all acknowledged the role of general dental practitioners in diagnosis, referral for treatment and long-term implant maintenance. CONCLUSION: The definition, diagnostic criteria and management strategies used by New Zealand specialists are generally consistent with those found in the literature. No evidence-based, gold standard treatment protocol for peri-implantitis has been identified in the literature, and New Zealand specialists use a range of treatment modalities.

Periodontal diseases in an Omani adult population: a preliminary study.

BACKGROUND: Data on the periodontal status of the adult population in the Arab world are scarce. The aim of this pilot study is to assess the prevalence, extent, and severity of periodontal diseases in an adult group from Oman. METHODS: This is a cross-sectional study of 319 teachers who were randomly sampled from the list of teachers from the Muscat region schools in Oman. Dental caries, tooth loss, and periodontal attachment loss (AL) were recorded for each of the participants. A questionnaire collected data on participants' sociodemographic characteristics, dental-care characteristics, self-rated periodontal status, and self-rated well-being. RESULTS: A total of 99% of participants had at least one site with probing depth (PD) or clinical AL of ≥ 3 mm. More than one third (36%) of participants had at least one site with AL ≥ 5 mm, and 12% had at least one site with AL ≥ 6 mm; for PD, the prevalence estimates were 26% and 8%, respectively, and a gradient by age group was evident across the different thresholds. Regarding the extent of disease, 17.6% of sites had PD ≥ 3 mm, and 21% of sites had AL ≥ 3 mm. CONCLUSIONS: The prevalence, extent, and severity of periodontitis were higher than estimates reported from industrialized countries, such as Australia, New Zealand, and the United States. This is of concern, especially when considering the relatively young age of the study population. Because of this high prevalence, investigation of periodontitis in a national sample of Omanis is desirable to confirm the findings of this study.

Periodontitis among adult populations in the Arab World.

BACKGROUND: The Arab World consists of 22 countries from North and North-east Africa and the Middle East. Periodontal disease is an important global oral health burden, and is highly prevalent in developing countries. OBJECTIVES: The objective of this narrative review is to report on the recorded prevalence of periodontitis in the Arab World, and to examine the methods used in collecting the data. DATA AND SOURCES: A search of the literature was performed using the PubMed database up to September 2011 to identify articles that reported on the prevalence of periodontal disease in the 22 Arab countries. Reports kept in the World Health Organization (WHO) Global Health Data bank were also used in this review. CONCLUSION: There is a paucity of up-to-date data regarding the prevalence of periodontitis in the Arab adult population. Most relevant data are at least 10 years old. From the literature available, it is clear that there is a need for epidemiological data that are representative of the adult population from this region. Such data will enable proper development of guidelines, allocation of resources and the development of appropriate public health programmes.

Evaluating the efficiency of caries removal using an Er:YAG laser driven by fluorescence feedback control.

INTRODUCTION: Caries lesions in dental hard tissues autofluoresce when exposed to light of certain wavelengths, whereas sound tissues do not, and this can be used as an in vitro histological marker for dental caries. Detection of autofluorescence is the basis of KaVo DIAGNOdent™ technology, and provides objective feedback control of laser-stimulated ablation of dental caries for the KaVo Key Laser 3™. This Er:YAG laser operates at 2940nm wavelength, and is effective at removal of infected dental hard tissues. Micro-computed tomography (micro-CT) allows the non-invasive investigation of three-dimensional structures and analysis of mineral density profiles of dentine following laser ablation. OBJECTIVE: To evaluate removal of infected, demineralised dentine by Er:YAG irradiation with a laser feedback mechanism, using micro-CT. DESIGN: 27 carious teeth (1 control) and 1 sound tooth, treated with the KaVo Key Laser 3™ using a KaVo™ non-contact 2060 handpiece at specific feedback settings, were examined using a Skyscan 1172 Micro-CT, to observe the efficiency of demineralised dentine removal. Grey scale images obtained were colour rendered to assist detection of demineralised tissue if present. RESULTS: Complete removal of demineralised tissue occurred with laser-stimulated ablation under feedback control at values of 7 and 8 when measured by micro-CT. At greater values, removal of demineralised dentine was incomplete. CONCLUSION: Examination of dental tissues by micro-CT allowed determination of the efficiency of Er:YAG laser-stimulated ablation. Feedback control of the KaVo Key Laser 3™ appeared to operate like a cut-off switch when infected dentine was eliminated, at a threshold of between 6 and 7.

Infection of apical dentin and root-end cavity disinfection.

INTRODUCTION: The purpose of this study was to assess Enterococcus faecalis penetration into the dentin of the apical 3 mm and bacterial death after the application of either chlorhexidine or laser to root-end cavities. METHODS: Root canals of 60 single-rooted teeth were prepared. In part 1, cementum was removed semicircumferentially from 21 roots, and the smear layer was removed from 15 roots using 17% EDTA/cetrimide. Teeth were inoculated and incubated with E. faecalis for 10 days, rinsed, and live/dead stained. The effect of cementum and smear on bacterial penetration was assessed by confocal laser scanning microscopy (CLSM). In part 2, 39 teeth had root ends resected and cavities ultrasonically prepared. Inoculated roots were assigned to 1 of the following 3 groups: (1) root-end cavities irrigated with 0.2 % chlorhexidine, (2) root-end cavities irradiated with a laser for 20 seconds at 1.5 W, or (3) root-end cavities that received no treatment. Roots were live/dead stained, sectioned, and examined by CLSM. The depth of the bacterial penetration and bacterial survival were compared using the Mann-Whitney U test. RESULTS: The presence of a smear layer and/or cementum did not significantly affect bacterial penetration. In root-end cavities, chlorhexidine was more effective than laser (P < .001), reducing bacterial viability by 93% versus 70% with a laser. CONCLUSIONS: E. faecalis invaded the entire width of dentin in the apical 3 mm irrespective of the smear layer and/or cementum. Chlorhexidine was more effective than laser in disinfecting root-end cavities.

A comparison of Er:YAG laser and mechanical debridement for the non-surgical treatment of chronic periodontitis: a randomized, prospective clinical study.

AIMS: To compare a monotherapy of Er:YAG laser debridement (ERL), wavelength 2940 nm, with mechanical scaling and root planing (SRP) for the treatment of chronic periodontitis using clinical and patient-centred outcomes. METHODS: Twenty-eight participants had two randomly assigned quadrants treated with ERL and two with SRP. Full-mouth plaque index, probing depth, bleeding on probing, clinical attachment level and gingival recession were recorded at baseline and 6- and 12-weeks post therapy. A questionnaire was used to assess pain, discomfort and satisfaction during and after treatment. RESULTS: Twenty-two participants completed treatment and had 6- and 12-week clinical re-evaluations. SRP provided greater mean pocket depth reduction at 6- and 12-weeks (p = 0.01 and p = 0.003 respectively), and a greater reduction in pockets ≥ 4 mm at 6 weeks only (p = 0.03) compared with ERL. SRP also resulted in a significant reduction in bleeding on probing (BOP) sites at 12 weeks compared with ERL and a statistically significant greater reduction in mean clinical attachment level (CAL) at 6- (p = 0.02) and 12-weeks (p = 0.03). Patients expressed greater satisfaction with SRP on the day of treatment but were equally satisfied subsequently. CONCLUSION: SRP resulted in a statistically significant greater short-term improvement in clinical parameters and patient satisfaction compared with ERL.

Diabetes, periodontitis, and the subgingival microbiota.

Both type 1 and type 2 diabetes have been associated with increased severity of periodontal disease for many years. More recently, the impact of periodontal disease on glycaemic control has been investigated. The role of the oral microbiota in this two-way relationship is at this stage unknown. Further studies, of a longitudinal nature and investigating a wider array of bacterial species, are required in order to conclusively determine if there is a difference in the oral microbiota of diabetics and non-diabetics and whether this difference accounts, on the one hand, for the increased severity of periodontal disease and on the other for the poorer glycaemic control seen in diabetics.

Radiographic study of ethnic variation in alveolar bone height among New Zealand dental students.

BACKGROUND: The aim of this study was to determine anatomical variations in the radiographic distance between the cemento-enamel junction and the alveolar crest with respect to ethnic heritage and gender in New Zealand dental students. METHODS: Digitized bitewing films of 123 second-year New Zealand dental students were examined with a computer imaging program on a desktop computer screen. The race of parents and grandparents was obtained by questionnaire. RESULTS: The mean distance from the cemento-enamel junction to the alveolar crest across the sample was 0.97 mm. Eighteen (14.6%) of the participants had measurements >2 mm, of whom 17 were Asians. Asians had a significantly larger mean distance than did non-Asians (1.10 mm compared to 0.83 mm; P <0.001). Gender was not a significant variable. CONCLUSIONS: Students of Asian origin had a significantly greater distance between the cemento-enamel junction and the alveolar crest. It remains to be determined whether this is anatomical or disease related.

Prevalence and risk of traumatic gingival recession following elective lip piercing.

The aims of this study were to evaluate the prevalence, risk and odds ratios of gingival recession defects associated with elective lip piercing and wearing of stud jewelry, and to attempt to identify risk factors that might permit the incidence of recession and its severity to be predicted, using Miller's classification. Ninety-one subjects with lip piercing and labrets were evaluated with regard to gender, age, smoking history, orthodontic history, and labret characteristics. An age-matched group of 54 individuals without peri-oral piercing provided the control. Gingival recession was recorded on teeth opposing a labret in 68.13% of pierced subjects. By contrast, only 22.2% of unpierced individuals demonstrated recession. The odds ratio between pierced and control groups indicates a likelihood of recession 7.5 times greater in a pierced individual wearing a labret than in an unpierced individual. Logistical regression analysis showed that age, gender, smoking and labret configuration did not significantly influence the development of recession. Furthermore, an illustrative example indicates that piercing and provision of a labret might typically increase the risk of recession occurring from 34.4% (pre-piercing) to 80.8 %. Recession severity was greater in the pierced group, with Miller's class 2 and 3 defects observed in 18.7% of the pierced but not at all in the unpierced group. Ordinal regression identified previous orthodontic treatment as the only significant predictor of Miller's grade. We concluded that a clear link exists between lip piercing, labret use and gingival recession. Belief that labret placement and configuration can be modified to provide protection is unfounded.

Drug-associated gingival enlargement: case report and review of aetiology, management and evidence-based outcomes of treatment.

"Gingival enlargement" is the term now used to describe medication-related gingival overgrowth or gingival hyperplasia (AAP, 2004), a condition commonly induced by three main classes of drugs: anticonvulsants, antihypertensive calcium antagonists and the immunosuppressant cyclosporin. It is important that the health practitioner is aware of the potential aetiologic agents and characteristic features in order to be able to accurately diagnose and successfully manage patients who present with a condition such as outlined in the following case presentation.

Dental implant use in New Zealand in 2004.

OBJECTIVE: To investigate the characteristics of dental implant providers in New Zealand, to evaluate providers' dental implant treatment strategies, and to determine the nature of barriers to implant usage in New Zealand. DESIGN: A postal survey questionnaire was sent to all registered dentists in New Zealand (N=1590). METHOD: Data were analyzed with the SPSS statistical package. RESULTS: Replies were received from 1005 (63.2 percent) of the surveyed dentists. The majority of dentists (76.2 percent) are interested in dental implants and promote them in their practices. Implant dentistry is performed by 49.5 percent of the respondents, with the prosthodontic aspects of implant dentistry are performed by 79.5 percent of these dentists, while the surgical stage is referred to specialists in 89.0 percent of the cases. The greatest barrier to dental implant treatment is cost. Implant dentistry is most often provided when there is financial support from ACC. CONCLUSIONS: The extent of dental implant use in New Zealand is still relatively limited. Dentists understand the benefits of dental implant therapy, but the perceived expense of treatment prevents optimal utilization.

Elective lip piercing and gingival recession: case report.

Elective oral piercing as a form of ornamentation or self-expression appears to be gaining popularity in New Zealand and around the world. Several reports of the dangers associated with this practice appear in the dental and medical literature. This report presents a case of rapid, severe gingival recession in a previously periodontally-healthy young female, arising from trauma due to her lip piercing. The aetiology, diagnosis and treatment of her condition are outlined, as well as criteria for the dental community to consider when evaluating patients with facial piercing. The report highlights some of the dangers associated with oral piercing and raises questions concerning potential risk factors for such trauma.