Craniofacial growth disturbance is related to temporomandibular joint abnormality in patients with juvenile idiopathic arthritis, but normal facial profile was also found at the 27-year follow-up.

OBJECTIVES: To assess the long-term outcome of craniofacial morphology related to disease variables and temporomandibular joint (TMJ) involvement as demonstrated with computed tomography (CT) and magnetic resonance imaging (MRI) in adult patients with juvenile idiopathic arthritis (JIA). METHODS: Sixty of 103 patients participated in a re-examination on average 27 years after baseline. Craniofacial morphology, with emphasis on size and position of the mandible, was assessed in lateral cephalographic images and related to disease variables and TMJ involvement by CT and MRI. Definitions of craniofacial growth disturbances were based on measurements outside 2 SD from the mean of healthy adult controls. RESULTS: Sagittal craniofacial growth disturbances were found in 57% and micrognathia in 27% of the 60 patients. Of those with JIA TMJ involvement, 70% had some form of growth disturbance. Micrognathia occurred only in patients with bilateral TMJ involvement. The bilateral TMJ group had significantly different craniofacial morphology than healthy controls and patients without TMJ involvement. Growth disturbances and TMJ involvement were present in all subtypes of JIA, except for one subtype comprising one patient. Patients with growth disturbances had more severe disease than patients with normal craniofacial growth, regarding both present and previous disease activity. Unexpectedly, half of the patients without craniofacial growth disturbances also had TMJ involvement, many from before the age of 12. CONCLUSIONS: Craniofacial growth disturbances were found to be frequent in adult JIA patients, especially in those with bilateral TMJ involvement. However, growth disturbances did not always follow TMJ involvement, not even when affected early.

Effects of fluoride on caries development and progression in vivo.

The dissolution rate of calcium-fluoride-like material from the enamel surface in vivo appears to be much slower than previously thought. This could be due to adsorption of phosphate ions and/or protein molecules to the surface of the calcium-fluoride-like particles. During cariogenic challenges, the phosphate/protein coating is released, resulting in increased solubility rate of the calcium-fluoride-like material. Due to this mechanism, calcium-fluoride-like material may be a major aspect of the cariostatic mechanism of topically applied fluoride. Topically applied neutral fluoride agents are able to inhibit caries development in enamel but not completely stop lesion development. A fluoride solution at low pH has been found to be more effective in caries model studies than neutral fluoride agents, which might be due to the formation of a larger depot of calcium fluoride. Data from fluoridated areas indicate that the fluoride ion as such has a limited effect on lesion development, and a major mechanism of the cariostatic effect may be reformation of apatite (remineralization). The product of lesion consolidation (a fluoridated apatite) may have a limited effect, since intra-oral caries model studies show that even pure fluorapatite, in the form of shark enamel, demineralizes. In fissures and around orthodontic appliances, conventional fluoride agents appear to have only a small effect.

The in vivo orthodontic banding model for vital teeth and the in situ orthodontic banding model for hard-tissue slabs.

This paper presents the orthodontic banding model for vital teeth and the orthodontic in situ model for slabs of enamel, root surface, dentin, or other mineralized tissues such as shark enamel. The model for vital teeth is an in vivo model, since a crevice for plaque accumulation is created behind orthodontic bands on the buccal enamel surfaces of teeth in situ. Visible white-spot lesions are usually seen after a four-week banding period in the absence of fluoride. The microbiological flora developed behind the bands shows a similarity to that of natural caries. Microradiographic data show that the initial lesion is a softening of the enamel surface. Later, a subsurface lesion develops. A modification of the model has been developed for the use of slabs of mineralized tissues. In this model, slabs are mounted on a removable appliance. The slabs are covered with orthodontic banding material for plaque accumulation. Lesion development in enamel in the two model systems is almost identical. The benefit of the in vivo model is that caries development can be studied on vital teeth in young individuals. The model is independent of the patient's cooperation. No special diet is required, e.g., no sucrose rinsing. In the in situ model, slabs could be examined after one study period and then replaced for another period.

Intra-oral models: comparison of in situ substrates.

Numerous intra-oral caries models have been designed for clinical and mechanistic purposes. Several factors--such as human vs. bovine enamel, sound vs. demineralized tissues, lesion type, dentin vs. enamel, the severity of the cariogenic challenge, and the microflora--may influence the reactivity of the hard tissue and hence lesion development and progression. Some models use unextracted teeth and are true in vivo models, whereas in situ models are based on hard-tissue substrates in the form of slabs or sections. Models producing a moderate cariogenic challenge usually show a fluoride dose response. However, caries is increasingly becoming a problem limited to some high-risk patients and to lesions located to areas where severe challenges exist (e.g., fissures and pits). There is thus need for models that could mimic such situations. One of the requirements for intra-oral models producing severe cariogenic challenge conditions should probably be that it should be able to demineralize fluorapatite. A challenge for future caries research is to develop agents that have a better clinical effect in fissures and pits than those presently available. Because, in the past, much emphasis has been placed on remineralization of artificial lesions, more research on the demineralization process should be performed in the future, since this may give improved clinical effects. Ideally, an intra-oral caries model should take into account as many of the natural oral conditions as possible and minimize the degree of artificiality.

The effect of fluoride application on fluoride release and the antibacterial action of glass ionomers.

The aim of this study was to investigate whether the release of fluoride and the antimicrobial effect of freshly mixed glass ionomers could be prolonged by application of fluoride on aged material. Test slabs of freshly mixed and aged (14 d in water) conventional and silver glass ionomer (Ketac-Fil and Ketac-Silver, Espe, Seefeld, Germany) and composite (Silux Plus, 3M, St. Paul, MN) were fitted into the bottom of a test tube. A layer of S. mutans Ingbritt cells was centrifuged onto the test slabs, and the samples were incubated for 20 h in 1.7% sucrose solution. After the incubation, pH, F, and Ca contents of the fluid phase, and F, Mg, P, and K contents of the cells were determined. The aged glass-ionomer samples were then covered with toothpaste (0.1% F) or with fluoride gel (1.25% F), and the composite samples with fluoride gel. After being thoroughly rinsed, S. mutans cells were incubated on the samples as above. The pH fall was significantly inhibited by freshly mixed glass ionomers, and there were changes in cellular cation and phosphorus contents. Large amounts of fluoride were found in the fluid and cells. For old glass ionomers, no inhibitory effect on pH fall could be seen. Fluoride release had decreased to a low level.(ABSTRACT TRUNCATED AT 250 WORDS)

Relative cariostatic effects of KOH-soluble and KOH-insoluble fluoride in situ.

The relative cariostatic effects of fluoride as fluorapatite, CaF2, loosely-bound fluoride, or KOH-soluble fluoride are debated. The present study was carried out to investigate this further in an intra-oral caries model. Pairs of premolars extracted for orthodontic reasons were used. Enamel from one tooth of each pair was used as control (untreated). Two slabs were cut from the enamel of the other contralateral premolar. These slabs were treated with 2% NaF for 24 h. One slab was then treated with 1 mol/L KOH twice for 24 h for removal of all loosely-bound fluoride. The slabs treated with 2% NaF and then with 1 mol/L KOH would contain the KOH-insoluble fluoride. Those treated with only 2% NaF would, in addition, contain KOH-soluble fluoride. Each slab, control, KOH-insoluble F, and KOH-soluble and insoluble F was mounted on different upper removable appliances. The slabs were covered with orthodontic banding material, thus allowing space for plaque accumulation. Five individuals wore the appliance in three separate four-week periods. The slabs were analyzed by quantitative microradiography. The average mineral loss (delta Z) was 1680 +/- 1000 vol% x microns in the control teeth, 620 +/- 76 vol% x microns in the KOH-soluble and -insoluble F teeth, and 2167 +/- 1278 vol% x microns in the KOH-insoluble F teeth. The average lesion depths were 90 +/- 41 microns in the control teeth, 35.3 +/- 5.5 microns in the KOH-soluble F teeth, and 88 +/- 35 microns in the KOH-insoluble F teeth. It was concluded that only KOH-soluble fluoride reduced mineral loss and lesion depths significantly, compared with the untreated teeth.

Selection of Streptococcus mutans and lactobacilli in an intra-oral human caries model.

Microbiologic changes during caries development underneath a plaque-retaining band were investigated by the use of selective media for streptococci, Streptococcus mutans, and lactobacilli. The final four-week plaque samples on 16 experimental teeth in six young subjects were assessed. Seven experimental teeth in three other subjects were sampled at baseline and after one, two, and four weeks. All 23 experimental teeth developed a white spot lesion. In the final four-week plaque samples on the lesions, S. mutans accounted for 8% and lactobacilli 0.1% of the total CFU, both being significantly higher than in plaque from unbanded control surfaces. All experimental teeth sampled during lesion formation showed consistently elevated plaque levels of S. mutans and lactobacilli in comparison with baseline and control values at weeks one, two, and four. The results demonstrated a cariogenic environment in the human mouth associated with rapid selection of aciduric bacterial species such as S. mutans and lactobacilli.

Risk factors associated with fluorosis in a non-fluoridated population in Norway.

In Norway, there is no water fluoridation and little naturally occurring fluoride in drinking water. Fluoride toothpaste is used by 95% of the population and there is a long tradition of fluoride supplement use. The purpose of this study was to record the prevalence and severity of dental fluorosis in 8-year-old children and relate this to systemic fluoride exposure (supplements and toothpaste). All children (n = 551, born 1988) in a municipality in Norway were invited to participate. Dental fluorosis on the buccal surface of the upper permanent incisors was recorded according to the Thylstrup-Fejerskov index (TF). Parents provided data on use of supplements and toothpaste. Complete data were obtained from 383 children. Sixty-seven percent of the children had used fluoride supplements regularly during childhood. At 8 months or earlier, the teeth of 26% of the children, and at age 14 months or earlier the teeth of 82%, were being brushed. Among children who used fluoride supplements regularly, periodically, seldom and not at all, 45%, 21%, 10% and 0%, respectively, had dental fluorosis. The dental fluorosis was mild (TF = 1) in 87% of the cases. Bivariate and multivariate analyses showed that, in addition to use of fluoride supplements, starting toothbrushing at an early age was associated with higher prevalence of dental fluorosis. The child's birth weight and liking for or swallowing of toothpaste did not influence the prevalence of fluorosis. Risk factors for fluorosis were use of toothpaste before the age of 14 months and regular use of fluoride supplements during childhood.

Clinical effect and mechanism of cariostatic action of fluoride-containing toothpastes: a review.

Caries reduction has been observed in certain parts of the western world. The reduction coincides with the timing of the introduction of fluoride-containing toothpastes and no other factors can explain the caries reduction. It is possible that improved oral hygiene and use of fluoride have a synergistic effect.

Dental caries and fluorides in relation to fixed orthodontic treatment: a review.

This paper reviews the cariological aspects of fixed orthodontic treatment and discusses the role played by topical fluorides. During fixed orthodontic treatment, carious lesions may occur in the form of white spots. These may constitute an aesthetic problem. The clinical management of white spot lesions remains unresolved. In order to prevent development of these lesions, the use of topical fluorides is advocated. The need for patient co-operation in the use of self-administered topical fluorides is critical. To reduce this critical need, the use of fluoride-releasing orthodontic cements is recommended. The literature suggests that calcium fluoride, which is the major reaction product on enamel during topical fluoride application, plays an important role in the cariostatic mechanism.

Anterior space relations and lower incisor alignment in 9-year-old children born in the 1960s and 1980s.

The anterior arch spaces and the effect of early loss of deciduous canines have been studied in 2 different cohorts of 9-year-old children. One group of 119 children was from Norway and consisted of 56 girls and 63 boys, and 1 group of 133 children was from Sweden and consisted of 72 girls and 61 boys. Within these cohorts, half of the children were born in the 1960s and half in the 1980s. The 1960s group has been compared with the 1980s group to look for anterior arch changes occurring during this period of time. The children who had lost a lost deciduous canine at the age of 9 years were also compared with the children with all deciduous canines remaining. Groups were compared with analysis of variance. It was found that children with a lost deciduous canine at the age of 9 years belong to a group with less available arch space and are a crowded group when compared with an earlier study. For the girls, this was also associated with larger teeth. Anterior arch space did not differ between the 1960s and the 1980s groups except for the Swedish boys, where there was less available mandibular arch space in the 1980s group. The irregularity index for the 4 mandibular incisors was increased in the 1980s group compared with the 1960s group. This could indicate a secular trend toward an increased prevalence of malocclusion in the present population.

Pain and discomfort experienced after placement of a conventional or a superelastic NiTi aligning archwire. A randomized clinical trial.

Two nickel-titanium arch-wire types commonly used for initial tooth alignment were compared with regard to the pain/discomfort patients experience during the initial phase of tooth movement. The two arch wires used were a superelastic nickel-titanium alloy, 0.014 inch Sentalloy, Light (GAC International Inc. Central Islip, NY, USA) and a 0.014 inch Nitinol (Unitek, Monrovia, CA, USA), a conventional nickel-titanium aligning archwire. One hundred and twenty-eight consecutive patients attending an orthodontic university clinic and 2 private practices for routine placement of a fixed appliance were randomly assigned one of these 2 initial arch wires. Assessments of pain/discomfort were made daily by means of a 100 mm visual analog scale (VAS) over the first 7-day period after bonding. On the first day, recordings were made every hour for the first 11 hours. The results showed that the level of discomfort increased continuously every hour after the insertion of either a Sentalloy or a Nitinol as first arch wires, with a peak in the first night, remaining high on the second day and decreasing thereafter to baseline level after 7 days. During the first 10 hours it was apparent that the pain/discomfort experienced after placement of a Sentalloy was less than that found with the Nitinol archwire, although a significant difference could be found at 4 hours only. No significant gender-specific differences were found in either archwire group. A significant difference between the upper and lower dental arches was observed during the first 11 hours after placement of either a Sentalloy or a Nitinol arch wire, with the lower arch having the higher pain experience.

The effect of long-term water storage on the tensile strength of orthodontic brackets bonded with resin-reinforced glass-ionomer cements.

The purpose of this study was to evaluate in vitro the effect of water storage on the tensile bond strength of orthodontic brackets bonded with Vitremer and Fuji II LC resin-reinforced glass-ionomer cements. Seventy-two extracted human premolars were randomly divided into 6 groups and the bonding strengths of the resin-reinforced glass-ionomer cements were compared to control groups bonded with Concise composite resin at 24 hours and 9 months. The brackets were bonded on prepared teeth and a tensile load was applied to dislodge the brackets held in a special device from Lloyd 1000R testing machine. The effects of duration of water exposure, type of bonding material and interaction between long-term water exposure and type of bonding material on the bonding strength were described using the Weibull regression model. The mean tensile bond strength of resin-reinforced glass-ionomers after 24 hours water storage was significantly lower than the mean of the control samples. The results of this study showed no effect of water exposure on the tensile bond strength of brackets bonded with Vitremer glass-ionomer cement. The mean bonding strength of brackets bonded with Fuji II LC without enamel pre-conditioning significantly increased after 9-months water storage as compared to Fuji samples exposed to water for 24 hours. The results of this investigation allow to conclude: 1. Long-term water storage had not decreased the bond strength of resin-reinforced glass-ionomers applied as orthodontic adhesives, 2. Weibull regression model is an adequate and flexible tool to evaluate the bonding properties of dental materials.

Antimicrobial effect of a chlorhexidine-thymol varnish (Cervitec) in orthodontic patients. A prospective, randomized clinical trial.

The aim of the present investigation was to study the effect of combined application of a fluoride varnish (Fluor Protector) and an antimicrobial varnish (Cervitec) on the oral microflora, caries and gingival condition in patients receiving treatment with fixed orthodontic appliances. A total of 198 individuals (12 to 15 years old), scheduled for fixed orthodontic treatment, were randomized into 2 groups. Prior to bonding, the Cervitec and the control group received one application with Cervitec or a placebo every week for 3 weeks, respectively. In the Cervitec group. Fluor Protector was applied at bonding and Cervitec at the next visit, 6 weeks later. Each varnish was then applied every 12 weeks for 24 weeks. In the control group, the fluoride varnish was applied only at bonding and every 12 weeks. The Visible Plaque Index (VPI), the Gingival Bleeding Index (GBI), the White Spot Lesion Index (WSL) and the level of mutans streptococci in plaque and saliva were recorded 3 weeks prior to bonding and after 24 weeks. At bonding and after 12 weeks, only VPI, GPI, plaque and salivary mutans streptococcus counts were recorded. During the 3-week prebonding period, the mean VPI, GBI and mutans streptococci in plaque decreased in both groups. At bonding, the mean level of mutans streptococci in plaque was significantly lower in the Cervitec group than in the control group. The mean level of mutans streptococci was significantly lower after 12 weeks' bonding in the Cervitec group than in the control group. No effects on the other parameters were found during the 24 weeks.

Cariostatic effect of a light-cured, resin-reinforced glass-ionomer for bonding orthodontic brackets in vivo. A combined study using microradiography and confocal laser scanning microscopy.

The aim of this study was to evaluate in vivo the cariostatic potential of the resin-reinforced glass-ionomer (Vitremer core build-up restorative; 3M Dental Product Division) when used as a bonding agent for orthodontic brackets. The mineral distribution and topography of the enamel surface adjacent to the bracket base was determined by quantitative microradiography (TMR) and confocal laser scanning microscopy (CLSM). The study was designed in split-mouth technique using 9 pairs of premolars to be extracted for orthodontic reasons. One tooth of each pair was bonded with the resin-reinforced glass-ionomer, and the control contralateral premolar with the non-fluoridated composite (Concise, 3M Dental Products Division). After 4 weeks all teeth were extracted and stored until analysis. The lesion depths and mineral loss values in enamel adjacent to brackets bonded with Vitremer were significantly lower than in teeth bonded with the composite, indicating that the resin-reinforced glass-ionomers significantly reduced caries lesion development in vivo. CLSM images show a severe cariogenic challenge around orthodontic brackets and support TMR measurements.

The cariostatic mechanism of fluoride.

The benefits of using fluoride to prevent caries have been known for many years, but a complete understanding of this mechanism is still being researched. The fluoride concentration in the apatitic structure of enamel does not have as significant an effect on reducing caries as a continuous presence of fluoride in the plaque liquid. Concentrated, topical fluoride agents (such as in toothpaste, fluoride mouth rinses, gels, or varnishes) have a different mechanism of fluoride protection than low-concentration applications (such as fluoridated water). In initial caries lesions and plaque, concentrated agents form globules of a calcium fluoride-like material on the enamel surface. This material is fairly insoluble, possibly because it is coated with phosphates or proteins. This mechanism explains how the topical application of a fluoride varnish, two or three times a year, can result in caries reduction.

Relationship between disease course in the temporomandibular joints and mandibular growth rotation in patients with juvenile idiopathic arthritis followed from childhood to adulthood.

OBJECTIVE: To investigate the relationship between radiographic JIA disease course in the TMJs and mandibular growth rotation, compared with growth in healthy individuals. METHODS: From a larger series of JIA patients followed from childhood to adulthood, 26 were included; 11 without and 15 with bilateral radiographic TMJ involvement. Joint morphology and function were assessed at baseline, 2-, 4-, 6- and 27 years follow-up. Mandibular growth rotation (anterior, posterior or none) was assessed from cephalometric evaluations at childhood and adulthood, with observations from 16 healthy individuals as controls. TMJ disease course and mandibular growth rotation were assessed independently and their relationship analysed. Non-parametric statistical methods were applied to test differences between groups. RESULTS: In the normal TMJ group of JIA patients the joint morphology was similar at the follow-ups and all patients had good function both in childhood and in adulthood. The mandibular growth rotation was similar to that of healthy controls, i.e. predominantly in anterior direction. In the abnormal TMJ group different JIA TMJ disease courses were observed and associated with changes in the mandibular growth rotation (p = 0.007).Progressing JIA TMJ disease course was related to posterior mandibular growth rotation and improving disease course to anterior mandibular growth rotation. CONCLUSION: A relationship was found between JIA disease course in the TMJs and mandibular growth rotation, suggesting that a favourable growth could be regained in patients with improvement in TMJ morphology and/or TMJ function. To confirm this, further research on larger patient series is needed.

A prospective, randomized clinical study on the effects of an amine fluoride/stannous fluoride toothpaste/mouthrinse on plaque, gingivitis and initial caries lesion development in orthodontic patients.

The aim of this study was to examine the effect of combined use of a toothpaste/mouthrinse containing amine fluoride/stannous fluoride (AmF/SnF2; meridol) on the development of white spot lesions, plaque, and gingivitis on maxillary anterior teeth in orthodontic patients. A prospective, randomized, double-blind study with 115 orthodontic patients (42 males and 73 females, average age 14.4 years, drop outs 18) was designed. Group A (50) brushed twice daily with an AmF/SnF2 toothpaste (1400 ppm F) and rinsed every evening with an AmF/SnF2 solution (250 ppm F). Group B (47) brushed twice daily with a sodium fluoride (NaF) toothpaste (1400 ppm F) and rinsed every evening with a NaF solution (250 ppm F). Visible plaque index (VPI), gingival bleeding index (GBI) and white spot lesion index (WSL) were recorded on the six maxillary anterior teeth at bonding and after debonding, and evaluated with t tests. In group A no significant differences between bonding and debonding were recorded for WSL (1.02 +/- 0.08 versus 1.05 +/- 0.13, P = 0.14), VPI (0.10 +/- 0.21 versus 0.12 +/- 0.21, P = 0.66) or GBI (0.13 +/- 0.21 versus 0.16 +/- 0.22, P = 0.47), whereas statistically significant differences were found in group B between bonding and debonding for WSL (1.00 +/- 0.02 versus 1.08 +/- 0.17, P = 0.01), VPI (0.06 +/- 0.13 versus 0.17 +/- 0.25, P = 0.01) and GBI (0.06 +/- 0.12 versus 0.16 +/- 0.21, P = 0.01). The increase in lesions on the upper anterior teeth was 4.3 per cent in group A and 7.2 per cent in group B. It was concluded that the combined use of an AmF/SnF2 toothpaste/mouthrinse had a slightly more inhibitory effect on white spot lesion development, plaque and gingivitis on maxillary anterior teeth during fixed orthodontic treatment compared with NaF.

The protective effect of TiF4, SnF2 and NaF on erosion of enamel by hydrochloric acid in vitro measured by white light interferometry.

The purpose of this in vitro study was to compare the protective effect of TiF4, SnF2 and NaF (all 0.5 M F) on the development of erosion-like lesions in human dental enamel. Four enamel specimens from each of 6 extracted molars were polished and embedded in epoxy resin. The enamel surfaces of 3 specimens from each tooth were treated with the different fluoride solutions for 2 min. Following fluoride treatments, the specimens were immersed in 0.01 M HCl (pH 2.0), for 2, 4 and 6 min in order to mimic a gastric reflux situation. One specimen from each tooth was used as a control and was only exposed to acid. The etching depths (in micrometres) after 6 min were: TiF4 0.8 (SD 0.8), SnF2 3.5 (SD 0.7), NaF 5.3 (SD 0.4), and 7.0 (SD 0.3) for the control specimens. Compared to the control, TiF(4) protected the enamel surface from acid attack almost completely (88%), while SnF2 reduced the etch depth after 6 min by 50% and NaF by 25%.

[Dummy- and finger-sucking habits among 5-year old children. An investigation of frequency and effect on the dentition and occlusion]. / Smokk- og fingersugingsvaner hos 5-åringer. En underslkelse av forekomst og virkning på tannstilling og okklusjon.

Dummy- and finger-sucking habits were investigated among 60 5 year olds, born in 1982. The children were living in Raufoss, a small rural community in eastern part of Norway. Information about the sucking habits was obtained from their parents by means of questionnaires. The position of the teeth and the occlusion were registered by an orthodontist. Total prevalence of sucking habits was 63%. Thirty-seven percent, had used a dummy and 30% had been or were still finger-suckers. Two children had both used a dummy and sucked their fingers. This is a significant lower total prevalence of sucking habits than recorded in recent Swedish and Danish studies (1-8), but comparable with a Swedish study from 1971 (9). Most dummy-suckers had broken their habits at 3-4 years of age, while the finger-suckers were still active at 5 years of age. Finger-sucking had the largest impact on the position of the front teeth. The finger-suckers had significantly larger overjet and smaller overbite, more proclined upper incisors and retroclined lower incisors than dummy-suckers and those without any sucking habit. The only measurable effect of previous dummy-sucking of 5 years of age was a more open position of the lips and a smaller overbite. Otherwise, no significant effect on the occlusion was observed in any of the dummy- or fingersuckers.