Flowable Urethane Dimethacrylate-Based Filler for Root Canal Obturation in Primary Molars: A Pilot SEM and microCT Assessment.

Pulpectomy in deciduous teeth involves endodontic access opening, root canal debridement and obturation with an appropriate filling material. EndoREZ (ER) is the urethane dimethacrylate-based filler, which can be used for root canal obturation in permanent and primary teeth. This observation aimed to evaluate the behavior of the ER as a filler in root canals of two primary molars after the physiological resorption process using the scanning electron microscopy (SEM) and micro-computed tomography (µCT) in second lower molars after their natural exfoliation. The SEM analysis revealed a non-uniform, porous and lacunary structure of ER, visually similar to the resorbed surface of the dentine. The µCT observations demonstrated the differences in the resorption level of the root and material surfaces. The preliminary observations suggest that ER is resorbed faster than root tissues and can therefore be a suitable material for the root canal filling in primary teeth. However, more investigations are needed to support these preliminary findings.

The impact of a prospective 4-year longitudinal school intervention for improving oral health and oral health inequalities in primary schoolchildren in Flanders-Belgium.

BACKGROUND: Oral diseases and socio-economic inequalities in children are a persisting problem. AIM: To investigate the 4-year longitudinal impact of an oral health promotion programme on oral health, knowledge, and socio-economic inequalities in primary schoolchildren. DESIGN: The intervention was carried out between 2010 and 2014 within a random sample of Flemish primary schoolchildren (born in 2002). It consisted of an annual oral health education session. ICDAS/DMFT, care level, knowledge scores, and plaque index were used as outcome variables. Being entitled to a corrective policy measure was used as social indicator. Mixed model analyses were conducted to evaluate changes over time between intervention and control group and between higher and lower social subgroups. RESULTS: A total of 1058 participants (23.8%) attended all four sessions. The intervention had a stabilizing effect on the number of decayed teeth and increased knowledge scores. No statistically different effect on the two social groups could be demonstrated. Socio-economic inequalities were present both at T0 and T4 . CONCLUSION: The oral health promotion programme had a positive impact on oral health knowledge and stabilized the number of decayed teeth. No impact on inequalities could be demonstrated, although a higher dropout rate in children with a lower social status was seen.

A reject analysis of cone-beam CTs in under-aged patients.

OBJECTIVES:: The main objective of this study was to perform a retrospective reject analysis (or audit) of 79 cone-beam CTs (CBCTs) taken in under-aged patients at the Ghent University hospital over a 2-year timespan. METHODS:: Observer agreement between two oral radiologists and two senior year Master students in Paediatric Dentistry was performed for quality, diagnostic and therapeutic value. The senior year Master Students followed appropriate modules of an online course. Descriptive and comparative statistics were performed. RESULTS:: For the oral radiologists, all intra rater reliabilities were moderate to good (Gwet's AC1 = 0.41-0.75). For the senior students in Paediatric dentistry, these varied highly from fair to very good (Gwet's AC1 = 0.28-0.95). There was a high level of disagreement between oral radiologists and students (Gwet's AC1 = 0.16-0.45) and in-between students concerning observed quality (Gwet's AC1 = 0.29). A total of 16 CBCTs (20%) was rejected, 24 images (30%) were acceptable and 39 images (50%) had an excellent quality. 50 CBCTs were perceived to have a diagnostic advantage. 13 of the images would have no influence on the therapy, according to the oral radiologists. A significant correlation was found between unacceptable quality, absence of perceived diagnostic advantage (p = 0.004, RR = 2.4) and influence on therapy (p < 0.0005, RR = 1.8). A small field of view (FOV) was positively correlated to an excellent quality of the image (p = 0.011, RR = 2.8). CONCLUSIONS:: Image quality did not reach the proposed boundary of 10% according to the European Guidelines on Radiation Protection in Dental Radiology. This is the first published audit on an overall database of under-age children for CBCT.

Oral health-related quality of life changes in children following dental treatment under general anaesthesia: a meta-analysis.

OBJECTIVE: To conduct a meta-analysis of studies that have employed the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) instruments, to evaluate the oral health-related quality of life (OHRQoL) changes in children following dental treatment under general anaesthesia (DGA). METHOD: A systematic search of 5 databases was conducted in accordance with the PRISMA guidelines. The inclusion criteria were use of ECOHIS and COHRQoL, pre-and post-operative assessments, patients aged between 0 and 16 years, no restrictions on the follow-up period and DGA. The primary outcome measure was changes in quality of life for both the children, which was based on mean difference (MD). Twenty-two articles were included in the meta-analysis. RESULTS: A favourable outcome in OHRQoL was identified in all studies. The combined MD for ECOHIS and COHRQoL were 1.62 [95% CI 1.52-1.71; P < 0.00001; I2 = 0%] and 0.86 [95% CI 0.74-0.99; P < 0.00001; I2 = 0%], respectively, both with no evidence of heterogeneity. CONCLUSION: There is evidence to support that the OHRQoL of children was improved, with large effect size, in the short-term following DGA. CLINICAL RELEVANCE: Dental treatment under GA significantly improved the OHRQoL of children.

Socioeconomic inequalities in caries experience, care level and dental attendance in primary school children in Belgium: a cross-sectional survey.

OBJECTIVES: Oral health inequality in children is a widespread and well-documented problem in oral healthcare. However, objective and reliable methods to determine these inequalities in all oral health aspects, including both dental attendance and oral health, are rather scarce. AIMS: To explore oral health inequalities and to assess the impact of socioeconomic factors on oral health, oral health behaviour and dental compliance of primary school children. METHODS: Data collection was executed in 2014 within a sample of 2216 children in 105 primary schools in Flanders, by means of an oral examination and a validated questionnaire. Intermutual Agency database was consulted to objectively determine individuals' social state and frequency of utilisation of oral healthcare services. Underprivileged children were compared with more fortunate children for their mean DMFt, DMFs, plaque index, care index (C, restorative index (RI), treatment index (TI), knowledge and attitude. Differences in proportions for dichotomous variables (RI100%, TI100% and being a regular dental attender) were analysed. The present study was approved by the Ethics Committee of the University Hospital Ghent (2010/061). All parents signed an informed consent form prior to data collection. All schools received information about the study protocol and agreed to participate. Children requiring dental treatment or periodic recall were referred to the local dentist. RESULTS: Underprivileged children had higher D1MFT (95% CI 0.87 to 1.36), D3MT (95% CI 0.30 to 0.64), plaque scores (95% CI 0.12 to 0.23) and lower care level (p<0.02). In the low-income group, 78.4% was caries-free, compared with 88.4% for the other children. Half of the low-income children could be considered as regular dental attenders, while 12.6% did not have any dental visit during a 5-year period. CONCLUSION: Oral health, oral hygiene, oral healthcare level and dental attendance patterns are negatively affected by children's social class, leading to oral health inequalities in Belgian primary school children.

Cone-beam computed tomography in pediatric dentistry, a retrospective observational study.

OBJECTIVES: The aim of this study was to find the reasons for referral and their correlation with age, gender, field of view, and resolution for all patients under the age of 18 who underwent a cone-beam computed tomography (CBCT) scan between 1 May 2010 and 1 May 2012 in the dental out-patient clinic of the University Hospital Ghent. MATERIAL AND METHODS: From the local CBCT database, 79 pediatric patients gave their consent. Subsequently age, gender, reason for referral, external or internal referral, field of view (FOV), and resolution data were collected. Descriptive and comparative statistical analysis was performed. RESULTS: There seemed to be a correlation between orthodontic referrals and female patients. The majority of patients referred for trauma follow-up were 12 years and older. Fourteen percent of referrals were for dento-alveolar trauma, 18 % for other dento-alveolar reasons, 4 % for developing dentition-generalized, 36 % for developing dentition-localized, 10 % for endodontics, 1 % for periodontics, 16 % for surgical applications, and 1 % was for the visualization of the TMJ. Eighty percent of the CBCTs were taken at a FOV 50 × 55 mm. Larger FOV was used for surgical planning or follow-up reasons. The majority of the CBCTs was taken at a resolution of 200 µm, while a resolution of 150 µm was used for endodontic issues. From these results, a classification system for referral was developed. CONCLUSIONS: From the present study, it can be concluded that a referral pattern could be detected which was correlated with gender, age group, FOV, and resolution. These results can help practitioners make the decision to refer for CBCT when extra three dimensional imaging is expected to have a benefit in therapeutic value for a pediatric or adolescent patient. CLINICAL RELEVANCE: This study can guide dental professionals referring pediatric and adolescent patients for CBCT.

Fracture resistance of endodontically restored, weakened incisors.

OBJECTIVES: To test the fracture strength of weakened bovine incisors endodontically treated with mineral trioxide aggregate (MTA), calcium phosphate bone cement (CPBC) or fibre reinforced composite (FRC) posts, and to evaluate the fracture mode. METHODS: Weakened bovine incisors (n = 75), standardized according to the dentinal wall thickness at the cervical area, were randomly assigned to one control group and three experimental groups. Unfilled teeth were assigned to group 1 (n = 20) and served as control group. Group 2 (n = 17) consisted of teeth filled with MTA. In group 3 (n = 18), the incisors were filled with CPBC and in group 4 (n = 20) with FRC posts. All specimens were subjected to load at a cross-head speed of 60 mm min(-1) until fracture occurred. The initial (IL) and final fracture (FL) loads (N) were recorded, and the failure mode among the different groups was evaluated. RESULTS: anova showed a statistically significant difference in fracture load among the groups. Tukey's test revealed a significant difference for the IL between the control group and the experimental groups with exception of the MTA group. The FL was not significantly different among the experimental groups. A high percentage of favourable fractures was seen in the FRC and CPBC groups. CONCLUSION: FRC posts and CPBC could be promising materials to strengthen non-vital structurally compromised teeth.

Educational background of Flemish dental practitioners and their perceptions of their management of dental trauma.

AIM: The aim of this study was to analyze whether any correlation existed between Flemish dental practitioner's educational background and their perceptions of their knowledge regarding emergency treatment for crown fractures and their actual expertise. METHODS: A questionnaire was distributed among 336 dental practitioners at six different locations in the country and completed prior to a lecture on dental traumatology. The response rate was 100%. The questionnaire consisted of three parts: the first part enquired about personal background, the second part requested a self-assessment of the practitioner's dental trauma education and treatment experience, and the third part tested the knowledge of the practitioner by asking for responses to different options for emergency treatment for dental trauma. RESULTS: Nearly 63% of the participants had more than 20 years of experience. Satisfaction about adequacy in basic education in dental traumatology was significantly related to the years as graduation to older graduates being less satisfied. This observation was not related to the additional education taken. Most frequently, uncomplicated crown fractures (42%) were seen more frequently than severe injuries. Concerning knowledge, a high result (67%) of incorrect answers was given for the treatment for injured immature permanent incisors. However, a high correlation was found between good knowledge of treatment and young professionals who graduated <10 years ago. Referring dental injuries for treatment was correlated with increasing level of difficulty. In the permanent dentition, however, complicated crown fractures (CCF) in immature teeth were not referred in many (66%) cases. CONCLUSION: It was observed that the knowledge of Flemish dental practitioners regarding emergency treatment for CCF is insufficient especially for the management of immature incisors.

A decision tree for the management of exposed cervical dentin (ECD) and dentin hypersensitivity (DHS).

INTRODUCTION: Dentin hypersensitivity (DHS) is a problematic clinical entity that may become an increasing clinical problem for dentists to treat as a consequence of patients retaining their teeth throughout life and improved oral hygiene practices. OBJECTIVES: The aim of this review was to develop a decision tree for the management of exposed cervical dentin (ECD) and DHS. MATERIAL AND METHODS: A brief PUBMED literature search was performed on dentin hypersensitivity using "MeSH" terms, "review", and "management". In addition, some websites and local guidelines were screened. RESULTS: From this review, it became clear that all dentate patients should routinely be screened for ECD and DHS. In this respect, underdiagnosis of the condition will be avoided and the preventive management can be initiated early. CONCLUSION: A decision tree process and a flowchart for daily practice were designed which should be started up as soon as a patient present with ECD or suffers from DHS. This approach takes into account the possible improved quality of life of the patient and is further based on a hierarchy of treatment options. In this respect, active management of DHS will usually involve a combination of at-home and in-office therapies. Starting with the use of desensitizing toothpastes is strongly recommended.

Dental attendance in preschool children - a prospective study.

BACKGROUND: At present, our understanding of the use of dental care services is incomplete, certainly where preschool children are concerned. OBJECTIVES: To investigate what proportion of 3- and 5-year-olds living in Flanders (Belgium) have already visited the dentist, to describe parents' experience about their child's dental visit, and to explore factors that may have an impact on children's early dental visit. DESIGN: Data were collected from 1057 children; validated questionnaires were completed, and children were examined by trained dentist at ages 3 and 5. Logistic regression analyses were performed to explain dental attendance. RESULTS: At the age of 3, 62% and by 5 years, 21% had never visited the dentist. The first dental visit was considered a pleasant experience for the majority of children. Multivariable regression analyses revealed that children who were not first born, whose mothers had a higher educational level and whose parents had recently visited the dentist, had significantly higher odds for having visited the dentist at young age. CONCLUSIONS: Parents of young children need to be informed about and motivated for an early dental visit. Promotion campaigns should focus on firstborn children, children from less educated parents, and parents who do not regularly see a dentist.

Dental caries and dental care level (restorative index) in children with diabetes mellitus type 1.

INTRODUCTION: The aim of the study was to investigate caries experience and dental care index in diabetic children and to determine if correlation exists between caries experience and metabolic control, insulin treatment, and the duration of diabetes. MATERIALS AND METHODS: The study group consisted of 52 children and adolescents, 3-16 years of age with type 1 diabetes attending the outpatient diabetic clinic at Ghent University Hospital, Belgium. Fifty healthy subjects recruited from the paediatric dental clinic served as the control group. Caries lesions were assessed using DMF-index both at cavity and non-cavity levels. Participants and/or their guardians provided information about oral hygiene habits and dietary habits. Diabetes-related data (type, duration, insulin regimen) were collected from medical records and completed with the lab data on HbAlc. CONCLUSION: It became clear that, although children with type 1 diabetes mellitus could be expected to run a potential high caries risk taking into account the diabetes-associated biological and behavioural alterations, no significant differences were observed regarding caries experience and dental care between diabetic children and healthy controls. The level of untreated dental decay among the diabetic children is, however, considerably high, which was reflected by a significant lower dental attendance.

Comparison of curing depth of a colored polyacid-modified composite resin with different light-curing units.

OBJECTIVE: To compare the depth of cure (DoC) of a colored polyacid-modified composite resin (PAM-C) with a traditional PAM-C and a fine hybrid composite resin using different light-curing units and different radiant energies. METHOD AND MATERIALS: The DoC of the PAM-C Twinky Star (Voco, all shades), the PAM-C Glasiosite (Voco), and the composite resin Z100 (3M ESPE) shades A2 and A4 was determined using a penetrometer test method. The materials were cured in bulk using a halogen-based unit (Elipar Trilight, E = 18 J/cm2 and E = 32 J/cm2; 3M ESPE) and an LED curing unit (Elipar Freelight 2, E = 20 J/cm2; 3M ESPE) in split stainless steel molds. Immediately after curing, the height (mm) of the cured material was measured and taken as the DoC. Ranking of means was performed by Student-Newman-Keuls multiple comparison test, and statistically significant differences among mean values were detected with ANOVA. RESULTS: Mean DoC for all materials and shades varied as follows: 4.705 to 8.870 mm (E = 32 J/cm2); 3.672 to 8.050 mm (E = 20 J/cm2); and 4.090 to 7.357 mm (E = 18 J/cm2). Two-way ANOVA revealed that the DoC depended significantly (P < .001) on the shade of the material and the curing device. Moreover, there was a significant interaction (P < .001) between the latter, indicating that the effect of the energy densities differed quantitatively among the shades. CONCLUSIONS: In this study, DoC differed significantly among the materials and the shades. Twinky Star shade blue showed the highest DoC compared to Glasiosite and Z100 shades A2 and A4. The curing device with the highest energy density exhibited the highest curing depths.

Fracture resistance and reinforcement of immature roots with gutta percha, mineral trioxide aggregate and calcium phosphate bone cement: a standardized in vitro model.

Endodontic treatment of immature teeth is often complicated because of flaring root canals and open apices for which apexification is needed. Long-term prognosis for these teeth is surprisingly low because of cervical root fractures occurring after an impact of weak forces. In this study, an experimental model was developed to determine the fracture resistance of immature teeth and to test the hypothesis that endodontic materials succeed in reinforcing them. Compact and hollow bone cylinders from bovine femurs were used as standardized samples. In order to evaluate the experimental model, fracture resistance in both groups was evaluated by determining the ultimate force to fracture (UFF) under diametral tensile stress. Analysis of variance (ANOVA) revealed a statistically significant difference between the mean values of UFF for both groups, independently of the sampling location or subject. In a following setting, the hypothesis that obturation with gutta percha (GP), mineral trioxide aggregate (MTA), or calcium phosphate bone cement (CPBC) reinforces the hollow bone samples was investigated. Obturation resulted in a significant reinforcement for all materials, but the degree of reinforcement depended on the material. The experimental model appeared to be suitable for in vitro investigation of reinforcement and fracture resistance in a standardized way.

Knoop hardness depth profile of polyacid-modified composite resins.

OBJECTIVES: To determine the hardness versus depth profile of several polyacid-modified composite resins (PAM-Cs) as a function of shade (A2, A4) and compare the depth of cure (DoC) based on these profiles with that previously obtained with the scraping and penetrometer methods. METHOD AND MATERIALS: Samples of 6 PAM-Cs (Hytac, 3M ESPE; F2000, 3M ESPE; Glasiosite, Voco; Dyract, Dentsply DeTrey; Dyract AP, Dentsply DeTrey; Compoglass F, Vivadent) and 3 composite resins (Herculite Enamel XRV, Kerr; Z100, 3M ESPE; Durafill VS, Heraeus Kulzer) with shades A2 and A4 were light-cured in bulk in split stainless steel molds (thickness ranging from 0.5 to 3.5 mm in steps of 0.5 mm). The Knoop hardness of the irradiated top (KHN(surface)) and nonirradiated bottom (KHN(bottom)) surfaces was determined as a function of sample thickness using a microhardness tester. RESULTS: Regression analysis demonstrated that for a given material, KHN(bottom) equals KHN(surface) up to a specific depth (= DoC) depending on the material and shade and then decreases linearly with increasing depth. The decrease of the KHN per unit depth differs significantly among materials and shades. According to a regression analysis, the scraping and penetrometer methods overestimate the DoC of PAM-Cs compared to the method based on the change of the hardness indentation with depth. CONCLUSIONS: Shade A2 results in greater values of DoC than shade A4, the effect depending quantitatively on the formulation of the material. Some formulations of PAM-Cs do not reach a DoC of 2 mm, a layer recommended to be applied in the incremental technique. The DoC as determined according to ISO 4049:2000 apparently is based on a lower degree of polymerization corresponding to a KHN of 80% of the irradiated surface.

Oral implications in children with gastroesophageal reflux disease.

PURPOSE OF REVIEW: To emphasize oral complications in children with gastroesophageal reflux disease. Interest of pediatricians to conduct an orodental examination or to include a dental examination performed by a dentist should be encouraged, as dental erosion, for instance, may be present in these children. RECENT FINDINGS: Dental caries, dental erosion, mucosal lesions and oral bacterial load have been studied extensively in children with gastroesophageal reflux disease, but there is no sound consensus about the impact of gastroesophageal reflux disease on oral health parameters. SUMMARY: Gastroesophageal reflux and oral health deserve to be better understood and recognized by medical staff, pediatricians in particular. Literature on this subject contains many case reports and some cross-sectional studies, resulting in confusing conclusions for clinicians and researchers. Dental caries, dental erosion, mucosal lesions and oral bacterial load are the most frequently studied items in these kinds of study. Dental erosion seems to be an oral finding that should be studied in depth in these children, as conflicting results have been reported in literature, the latter being the result of the use of different indexes to collect clinical data.

Relative curing degree of polyacid-modified and conventional resin composites determined by surface Knoop hardness.

OBJECTIVES: The aim of the present study was to investigate the relative curing degree at a depth of 2 mm of several polyacid-modified composites (PAM-Cs) as a function of shade. METHODS: The Knoop hardness of the irradiated top and non-irradiated bottom surfaces of 2 mm thick samples of the PAM-Cs Hytac, F2000, Glasiosite, Dyract, Dyract AP, and Compoglass F and of the resin composites Z100, Herculite Enamel XRV, and Durafill VS, were determined for shades A2 and A4. RESULTS: The top and bottom hardness of F2000 and Glasiosite ranged between that of the two composites Herculite and Z100. Compoglass, Dyract and Dyract AP had a lower top and bottom hardness than the hybrid composites, but higher than that of the microfilled composite Durafill. The top hardness of Hytac compared with that of the first group, whereas the bottom hardness compared with the second group. The bottom-to-top KHN ratio reflecting the relative curing degree at a depth of 2 mm was less than 80% for the two shades of Hytac and Compoglass as well as for the A4 shade of Dyract AP and Herculite. SIGNIFICANCE: A hard top surface of a PAM-C is not an indication of adequate in depth polymerization. Shade A2 results in significantly greater values for the curing degree compared to shade A4, the effect depending quantitatively on the formulation of the material. Some formulations of PAM-C do not reach an adequate curing degree at a depth of 2 mm so that it is recommended to apply the incremental technique even in box-only cavities with layers of maximum 2 mm.

Review: The physiology of saliva and transfer of drugs into saliva.

Although saliva or oral fluid "lacks the drama of blood, the sincerity of sweat and the emotional appeal of tears", quoting Mandel in 1990 [I.D. Mandel, The diagnostic uses of saliva, J. Oral Pathol. Med. 19 (1990) 119-125], it is now meeting the demand for inexpensive, non-invasive and easy-to-use diagnostic aids for oral and systemic diseases, drug monitoring and detection of illicit use of drugs of abuse, including alcohol. As the salivary secretion is a reflex response controlled by both parasympathetic and sympathetic secretomotor nerves, it can be influenced by several stimuli. Moreover, patients taking medication which influences either the central nervous system or the peripheral nervous system, or medication which mimic the latter as a side effect, will have an altered salivary composition and salivary volume. Patients suffering from certain systemic diseases may present the same salivary alterations. The circadian rhythm determines both the volume of saliva that will and can be secreted and the salivary electrolyte concentrations. Dietary influences and the patient's age also have an impact on composition and volume of saliva. The latter implies a wide variation in composition both inter- and intra-individually. Sampling must therefore be performed under standardized conditions. The greatest advantage, when compared to blood sample collection, is that saliva is readily accessible and collectible. Consequently, it can be used in clinically difficult situations, such as in children, handicapped and anxious patients, where blood sampling could be a difficult act to perform.

Oral health in prevalent types of Ehlers-Danlos syndromes.

BACKGROUND: The Ehlers-Danlos syndromes (EDS) comprise a heterogenous group of heritable disorders of connective tissue, characterized by joint hypermobility, skin hyperextensibility and tissue fragility. Most EDS types are caused by mutations in genes encoding different types of collagen or enzymes, essential for normal processing of collagen. METHODS: Oral health was assessed in 31 subjects with EDS (16 with hypermobility EDS, nine with classical EDS and six with vascular EDS), including signs and symptoms of temporomandibular disorders (TMD), alterations of dental hard tissues, oral mucosa and periodontium, and was compared with matched controls. RESULTS: All EDS subjects were symptomatic for TMD and reported recurrent temporomandibular joint (TMJ) dislocations. Abnormal pulp shape (13%) and pulp calcification (78%) were observed in subjects affected with classical EDS. Caries experience was higher in EDS compared with controls and was related to poor oral hygiene, influenced by increased mucosal fragility and restraint of (wrist) joint mobility. The overall periodontal status in EDS was poor, with 62% of EDS subjects presenting high periodontal treatment needs (community periodontal index for treatment need, CPITN = II). CONCLUSION: Oral health may be severely compromised in EDS as a result of specific alterations of collagen in orofacial structures. When considering dental treatment in EDS, a number of tissue responses (mucosa, periodontium, pulp) and precautions (TMJ dislocation) should be anticipated.

Generalized joint hypermobility and temporomandibular disorders: inherited connective tissue disease as a model with maximum expression.

AIMS: To study the relationship between generalized joint hypermobility (GJH) and temporomandibular disorders (TMD) by assessing prevalence and patient characteristics of TMD in a population of patients with maximum expression of GJH as a symptom of inherited connective tissue disease. In addition, diagnostic reliability of a series of clinical signs indicative of temporomandibular joint (TMJ) hypermobility was tested. METHODS: The study sample consisted of 42 subjects with GJH, 24 with Marfan syndrome and 18 with Ehlers-Danlos syndrome. A subgroup of 27 individuals was selected by age (> or = 18 yrs) and was compared to 40 controls with TMD and normal peripheral joint mobility. TMD diagnoses were assigned to each subject according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: In the GJH sample (n = 42), 71.4% of the subjects were symptomatic for TMD. Of those, 13.3% had sought treatment. A myofascial pain diagnosis was made in 69%, disc dislocation with reduction was diagnosed in 85.7%, and TMJ arthralgia in 61.9%. Multiple TMD diagnoses were assigned in 69% of the subjects; of these, 57% had 3 or more subgroup diagnoses. Joint noises (P < .01) and recurrent TMJ dislocations (P < .01) were a frequent finding in adult GJH subjects (n = 27) compared to controls, with symptomatic GJH subjects presenting more and more prolonged dislocation events than asymptomatic subjects (P < .001). TMJ hypermobility signs were expressed significantly more often in GJH compared to controls with TMD and normal joint mobility. CONCLUSION: This study indicates a positive relationship between GJH and TMD.

Effect of a neutral citrate solution on the fluoride release of conventional restorative glass ionomer cements.

OBJECTIVES: This study investigates the effect of a neutral citrate solution on the fluoride release of 10 acid-base setting glass ionomer cements during 140 days at 37 degrees C. METHODS: Five disks of 10 acid-base setting restorative glass ionomers were prepared according to the manufacturer's instructions. These specimens were immersed individually in 25 ml of a 0.01 mol/l citrate solution with pH = 7. Over 140 days, the solutions were regularly renewed and the fluoride concentration eluted during each period was determined with a combined fluoride ion selective electrode. RESULTS: The cumulative fluoride release was the result of an initial high release that ceased after some time and a long-term of low fluoride release. The long-term fluoride release was higher in neutral citrate solution than in water. For some formulations the short-term fluoride release also was higher in neutral citrate solution than in water suggesting that the polysalt matrix composition could be important in this respect. SIGNIFICANCE: The fluoride release process is due not only to a loss of relatively loosely bound fluoride in the cement matrix, but also to the release of strongly bounded fluoride inducing a long-term fluoride release. The effect of citrate on the fluoride release process may increase depending on the acid (polyacrylic acid versus copolymers of polyacrylic acid) used for the polysalt formation in the hardening cement. Depending on the competition between the polyacrylate anion and the citrate anion for the metal cation extraction the fluoride release process may be retarded.