Fluoride dentifrice containing xylitol: in vitro root caries formation.

PURPOSE: To evaluate the effects of experimental xylitol dentifrices with and without fluoride on in vitro root caries formation. METHODS: Root surfaces from caries-free human permanent teeth (n = 10) underwent debridement and a fluoride-free prophylaxis. The tooth roots were sectioned into quarters, and acid-resistant varnish was placed with two sound root surface windows exposed on each tooth quarter. Each quarter from a single tooth was assigned to a treatment group: (1) No treatment control; (2) Aquafresh Advanced (0.15% F = 1,150 ppm F); (3) Experimental xylitol dentifrice without fluoride (0.45% xylitol); and (4) Diamynt fluoride dentifrice with xylitol (0.83% sodium monofluorophosphate = 1,100 ppm F and 0.20% xylitol). Tooth root quarters were treated with fresh dentifrice twice daily (3 minutes) followed by fresh synthetic saliva rinsing over a 7-day period. Controls were exposed twice daily to fresh synthetic saliva rinsing daily over a 7-day period. In vitro root caries were created using an acidified gel (pH 4.25, 21 days). Longitudinal sections (three sections/tooth quarter, 60/group) were evaluated for mean lesion depths (water inhibition, polarized light, ANOVA, DMR). RESULTS: Mean lesion depths were 359 +/- 37 microm for the control Group; 280 +/- 28 microm for Aquafresh Advanced; 342 +/- 41 microm for the experimental xylitol dentifrice without fluoride; and 261 +/- 34 microm for Diamynt. Aquafresh Advanced and Diamynt had mean lesion depths significantly less than those for the no treatment control and the experimental xylitol without fluoride dentifrice (P< 0.05). There were minimal non-significant differences in mean lesion depths between Aquafresh Advanced and Diamynt (P > 0.05).

Living in limbo: Ethics and experience in a conversation about persistent oral lesions.

This case report presents a conversation that the authors had with a patient who is suffering from oral lichen planus and oral cancer. The reason that the authors approached the patient for an interview was to find out why he decided to enroll in an experimental study related to his oral cancer. The patient reported that it was "the waiting" that led him to enroll in this study--that is, the pressure of waiting for oral cancer to reemerge was simply unbearable, and enrolling in this experimental study enabled him to take a more proactive approach to his illness. The authors view this "waiting" as a "limbo experience" and reflect on the implications of this limbo experience for dental ethics and research ethics.

Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas.

BACKGROUND: This article presents evidence-based clinical recommendations developed by a panel convened by the American Dental Association Council on Scientific Affairs. This report addresses the potential benefits and potential risks of screening for oral squamous cell carcinomas and the use of adjunctive screening aids to visualize and detect potentially malignant and malignant oral lesions. TYPES OF STUDIES REVIEWED: The panel members conducted a systematic search of MEDLINE, identifying 332 systematic reviews and 1,499 recent clinical studies. They selected 5 systematic reviews and 4 clinical studies to use as a basis for developing recommendations. RESULTS: The panel concluded that screening by means of visual and tactile examination to detect potentially malignant and malignant lesions may result in detection of oral cancers at early stages of development, but that there is insufficient evidence to determine if screening alters disease-specific mortality in asymptomatic people seeking dental care. CLINICAL IMPLICATIONS: The panel suggested that clinicians remain alert for signs of potentially malignant lesions or early-stage cancers while performing routine visual and tactile examinations in all patients, but particularly in those who use tobacco or who consume alcohol heavily. Additional research regarding oral cancer screening and the use of adjuncts is needed.

Living in limbo: ethics and experience in a conversation about persistent oral lesions.

This case report presents a conversation that the authors had with a patient who is suffering from oral lichen planus and oral cancer. The reason that the authors approached the patient for an interview was to find out why he decided to enroll in an experimental study related to his oral cancer. The patient reported that it was "the waiting" that led him to enroll in this study--that is, the pressure of waiting for oral cancer to re-emerge was simply unbearable, and enrolling in this experimental study enabled him to take a more proactive approach to his illness. The authors view this "waiting" as a "limbo experience" and reflect on the implications of this limbo experience for dental ethics and research ethics.

The journey beyond silos. Teaching and learning interprofessional ethics at UTHealth.

Interprofessional education and ethics education are two educational programs that blend together well, and, moreover, they are a natural fit for teaching in an academic health science center. The purpose of this paper is to describe our recent journey of developing and implementing an interprofessional ethics curriculum across the six schools of UTHealth. We provide an overview of the goals of the Campus-wide Ethics Program, which is housed in the McGovern Center for Humanities and Ethics, and we highlight certain innovative developments that are the result of the collaborative work of faculty and administrators from all six schools of UTHealth. In addition, a brief synopsis of the specific didactic and clinical courses in which ethics is a significant component is outlined for both the dental and the dental hygiene curricula. Lastly, we describe some of the recent scholarly activities that are a product of this new program. We are excited about our evolving efforts and the potential benefits of weaving interprofessional ethics within our school and across our campus. This article tells the story of our journey beyond "the silos" that are common among academic health science centers.

Fluoride-releasing orthodontic adhesives and topical fluoride effect on enamel caries formation: an in vitro study.

PURPOSE: To examine in vitro orthodontic bonding sealants combined with daily fluoride (NaF) rinse on caries-like lesion depths. METHODS: Permanent molar teeth (n = 40) were randomly divided into four treatment groups: 1: Pro-Seal, 2: Light Bond, 3: Pro-Seal with NaF rinsing, and 4: Light Bond with NaF rinsing. Orthodontic sealant material was placed on buccal surfaces of each group and surrounded by acid-resistant varnish on the buccal and a control window on the lingual. Each group underwent synthetic saliva rinsing and lesion initiation. Groups 3 and 4 were subjected to 0.05% NaF for 1 minute per day. Artificial caries were created in vitro. The specimens in each treatment group were sectioned and mean lesion depth was assessed with polarized light microscopy (water imbibition). Lesion depth was compared among the treament groups using ANOVA and Duncan's Multiple Range Test. RESULTS: The ProSeal and Light Bond treatment groups exhibited significant reductions in mean lesion depths as compared to the controls (P < 0.05). ProSeal with NaF rinsing and Light Bond with NaF rinsing treatment groups exhibited significant reductions in mean lesion depth when compared to Pro Seal and Light Bond treatment without fluoride rinsing and controls (P < 0.05). The enamel-resin interfaces of all treatment groups were intact and exhibited no caries-like lesion formation.

Recognizing the Relationship Between Disorders in the Oral Cavity and Systemic Disease.

Oral health is integral to general health. The oral cavity may harbor manifestations of systemic disease and can be the harbinger of early onset. Primary care providers (PCPs) can therefore use the oral cavity to support working diagnoses. Conversely, systemic diseases and treatments can affect oral health and require interactions between PCPs and dental providers. Acute oral manifestations of systemic disease may involve teeth and/or gums. This article reviews oral and systemic disease connections for some diseases, identifies issues that benefit patients through medical-dental collaboration, and highlights some nondental oral injuries that might confront PCPs or emergency medical providers.

A study on the efficacy and safety of combining dental surgery with tonsillectomy in pediatrics.

PURPOSE: Few data exist on combining pediatric surgical procedures under a single general anesthetic encounter (general anesthesia). We compared perioperative outcomes of combining dental surgical procedures with tonsillectomy during one anesthetic vs separate encounters. METHODS: We classified elective tonsillectomy ± adenoidectomy and restorative dentistry as combined (group C) or separate (group S). Outcomes included anesthesia time, recovery duration, the need for overnight hospital stay, and postoperative complications. RESULTS: Patients aged 4±1 years underwent tonsillectomy and dental surgery in combination (n=7) or separately (n=27). No differences were noted in total anesthesia time (C: median: 150, interquartile range [IQR]: 99, 165 vs S: median: 109, IQR: 92, 132; 95% CI of difference in median: -58, +10 minutes; P=0.115) and total recovery time (C: median: 54, IQR: 40, 108 vs S: median: 72, IQR: 58, 109; 95% CI of difference in median: -16, +48 minutes; P=0.307). The need for overnight stay (C: 4 of 7, S: 20 of 27; P=0.394) did not differ between the groups. No postoperative complications were noted in either group. CONCLUSION: These preliminary data support the potential feasibility of combining dental procedures with tonsillectomy during a single anesthetic encounter. Such care may not only reduce costs but also limit parental work absences and increase convenience for patient families. When compared with procedures performed separately, combined procedures did not result in increased morbidity or significant changes in postoperative outcomes.

Sarcoidosis affecting the periodontium: a long-term follow-up case.

BACKGROUND: Clinical manifestations of sarcoidosis affecting the periodontium could mimic aggressive periodontitis. This case report documents the occurrence of sarcoidosis affecting the periodontium, including its clinical features, diagnosis, treatment, and 6-year follow-up. METHODS: An individual with a history of pulmonary sarcoidosis was referred for evaluation and treatment of an aggressive periodontal condition. Clinical, radiographic, and histopathologic findings supported the diagnosis of sarcoidosis affecting the periodontium. Initial treatment consisted of reinforcement of oral hygiene, scaling and root planing, chlorhexidine rinses, and periodontal maintenance. The systemic disease was managed with prednisone, alendronate, and losartan. Twelve months later, the patient returned with severe attachment loss of sudden onset and gingival recession affecting the facial right surfaces of maxillary posterior teeth. In addition, he complained of chronic pain of moderate to severe intensity involving both jaws. The affected teeth were extracted and the surrounding alveolar bone was debrided. Intraoral sarcoidosis was confirmed by histologic findings, and his medications were changed to methotrexate and hydroxychloroquine. RESULTS: The patient has been followed for 6 years with continuation of the systemic medications and periodontal maintenance every 3 to 4 months without recurrence of intraoral sarcoidosis. CONCLUSIONS: The main features of this unique periodontal presentation were pain, rapidly progressive gingival recession, and significant changes in alveolar bone density in focal areas. Careful review of medical history and close monitoring of intraoral conditions are critical for patients with a history of sarcoidosis. An intraoral biopsy is necessary to confirm a definitive diagnosis in cases with similar clinical findings.

Potential inhibition of demineralization in vitro by fluoride-releasing sealants.

BACKGROUND: The incorporation of fluoride into sealants has been viewed as a viable way to prevent pit-and-fissure caries by potential inhibition of demineralization through the release of fluoride to enamel. The authors conducted a study to examine the effect of a recently introduced fluoride-releasing sealant (ProSeal, Reliance Orthodontic Products, Itasca, Ill.) on enamel demineralization in an in vitro artificial caries system. METHODS: The authors randomly assigned 45 extracted human third molars to three treatment groups receiving either conventional sealant without fluoride (Group 1), fluoride-releasing sealant (Group 2) or glass ionomer sealant with high fluoride release (Group 3). They placed cavity preparations on the buccal surfaces of the molars and filled them with the assigned material. They placed acid-resistant varnish on the specimens' enamel surfaces to within 1 millimeter of the sealant, leaving a 1-mm rim of sound enamel available for in vitro enamel caries formation. They thermocycled the teeth (500 cycles) in artificial saliva. They subjected the teeth to an in vitro artificial caries challenge for six weeks to produce caries-like lesions in enamel adjacent to the sealant materials. The authors took longitudinal sections from each tooth, immersed them in water and examined them via polarized light microscopy to determine wall lesion frequencies. RESULTS: The mean (+/- standard deviation) lesion depths were 232 +/- 17 micrometers for Group 1, 144 +/- 21 mum for Group 2 and 128 +/- 15 mum for Group 3. The wall lesion frequency was 12 percent for Group 1 and 7 percent for both Groups 2 and 3. There was a significant difference (P < .05) among the fluoride-releasing materials versus the nonfluoride-releasing material. This study indicates that the new fluoride-releasing sealant substantially reduces the amount of enamel demineralization adjacent to the material. CONCLUSION: ProSeal provided increased demineralization inhibition compared with a conventional sealant containing no fluoride, but less than that shown by a glass ionomer sealant. CLINICAL IMPLICATIONS: ProSeal's physical properties and cariostatic effects may allow for applications beyond traditional sealant use.

Short-term success of osseointegrated dental implants in HIV-positive individuals: a prospective study.

PURPOSE: Except for the occasional case report, there are no studies evaluating the success rate of osseointegrated dental implants in individuals infected with the human immunodeficiency virus (HIV). This study investigated the short-term clinical outcome of implant placement in a group of HIV-positive and HIV-negative individuals who required complete dentures. METHODS AND MATERIALS: Edentulous subjects were recruited from an HIV-dedicated clinic and a dental school clinic. Two BioHorizons dental implants were placed in the anterior mandible to support an overdenture opposing a maxillary denture. Outcome measurements obtained six months after activation of implants were presence of pain, mobility, soft tissue status, and radiographic bone level. Descriptive statistics were used. RESULTS: Twenty-nine edentulous adults, including 20 HIV-positive subjects (test) and nine HIV-negative subjects (control), participated. The test group had six females, 14 males; 13 Whites, four African-Americans, and three Hispanics with a mean age of 48.9 years (range: 35-59). The mean CD4 count was 467 cells/mm3 (range: 132-948). The control group had six females, three males; seven Whites, and two Hispanics with a mean age of 65.3 years (range: 50-82). Short-term success rate was 100% for both groups. No difference in clinical outcome was found between the groups. CONCLUSION: This study demonstrated dental implants are well tolerated and have predictable outcomes for HIV-infected individuals for the duration of the study and probably over an even longer term.

In vitro caries formation in primary tooth enamel: role of argon laser irradiation and remineralizing solution treatment.

BACKGROUND: The authors evaluated the effects of argon laser (AL) diation and remineralizing solution (RS) treatment alone and in combination on carieslike lesion formation in primary tooth enamel in an in vitro study. MATERIALS AND METHODS: The authors divided 10 caries free primary tooth enamel surfaces into four segments and assigned them to one of four treatment groups: no treatment control, AL irradiation alone at 13.5 joules per square centimeters (0.270 watts, 5-millimeter beam, 10 seconds), RS treatment alone for two minutes and AL irradiation before RS treatment. The authors created in vitro caries using a modified ten Cate solution. They evaluated longitudinal sections (three per tooth segment, 30 per treatment group) for mean lesion depth. RESULTS: After lesion formation, mean lesion depths (+/- standard deviation) were 179 +/- 16 micrometers for the no treatment controls, 137 +/- 19 microm for AL irradiation alone, 87 +/- 9 microm for RS treatment alone and 68 +/- 12 microm for AL irradiation before RS treatment. All treatment groups had mean lesion depths that were significantly less than those for the matched no-treatment control group (analysis of variance [ANOVA], Duncan multiple range [DMR] test, P < .05). AL irradiation before RS treatment significantly reduced lesion depth compared with AL irradiation alone or RS treatment alone (ANOVA, DMR test, P < .05). CONCLUSIONS: The maximum reduction in lesion depth in primary tooth enamel was achieved when the RS--which contained calcium, phosphate and fluoride in a carbopol base--was combined with AL irradiation. CLINICAL IMPLICATIONS: It would appear that to improve clinical caries resistance to enamel dissolution, AL irradiation before RS treatment could be used.

Scope of practice comparison: a tool for curriculum decision making.

The proportion of claims filed for specific dental procedures (ADA codes # 05110, 05120, 03320, 03330, 04260, 02150) between January 1, 2000 and June 30, 2004 by Texas general practitioners participating in a preferred provider network was compared to the proportion of these procedures performed by students graduating from the three Texas dental schools during the same period. Analysis of the data revealed that Texas dental students provide class two amalgam restorations in permanent teeth (02150) at approximately the same frequency as Texas general practitioners. Both groups provide periodontal osseous surgery (04260) at an extremely low frequency (<0.02% of total procedures). Bicuspid endodontic procedures (03320) were performed at a slightly higher frequency by students (0.43% of all procedures) than by general practitioners (0.36% of all procedures), and molar endodontic procedures (03330) were performed at a slightly higher frequency by general practitioners (0.65%) than by students (0.36%). Significant discrepancies between the groups were noted for the two complete denture procedures (05110, 05120). Students provided these procedures at frequencies fifteen times (05110) and twenty-five times (05120) greater than general practitioners. Dental schools should use data provided by scope of practice analyses to help determine an appropriate breadth and depth for their educational programs.

Retrospective clinical and radiologic evaluation of nonsurgical endodontic treatment in human immunodeficiency virus (HIV) infection.

PURPOSE: This retrospective study evaluated the clinical and radiographic status of nonsurgical endodontic treatment (ET) of anterior and posterior teeth in HIV-seropositive patients. METHODS: ET was analyzed in 26 anterior and 34 posterior teeth from 54 consecutive HIV patients (gender ratio 3 Male : 1 Female, mean age 40.2 years, mean CD4 240, CD4<500 in 88%, 12 with AIDS) over a six year period with a minimum of six months follow-up. ET was evaluated as successful, questionable, or failure based upon clinical factors (palpation, mobility, sinus tract, percussion, function, infection/swelling, occlusion, symptoms) and radiographic factors (periodontal ligament space, rarefaction, lamina dura, root resorption, obturation) during post-treatment examinations with a mean follow up of 26 months. RESULTS: Clinical evaluation at follow up found ET outcome was successful in 88%, questionable in 10% (tenderness with percussion, mobility, widened ligament), and a failure in 2% (developed lesion after ET). Periapical lesions were present in 37% of cases (mean lesion size 6.2 mm). Following ET, mean lesion size (1.8 mm) had decreased by 71%. Obturation was evaluated as optimal or acceptable in 68%. Radiographic evaluation was considered successful in 80%, no change in 15%, and a failure in 5%. CONCLUSIONS: Despite obturation deficiencies and the immunocompromised state of the patients, endodontic therapy has a relatively high degree of success in the majority of HIV/AIDS patients. HIV infection and AIDS should not be considered as a contraindication to endodontic therapy in this patient population.

Utilization of Chinese Herbal Medicine for Selected Oral Conditions in Two Pediatric Populations.

PURPOSE: To characterize traditional Chinese medicine (TCM) use, emphasizing herbal remedies, for oral conditions among two Chinese pediatric populations in the United States. METHODS: 318 unique ethnic Chinese parental units in Houston and Boston with children younger than 12 years old were interviewed for themselves and their children. Questionnaire included age, gender, duration in the United States, frequency of TCM use, and the five selected oral conditions for which TCM agents might be used. RESULTS: Parents (45.6 percent) and children (19.1 percent) used TCM for oral conditions, most commonly for aphthous ulcers (64.2 percent). Most commonly used TCM agents included watermelon frost (37.4 percent), niuhuang jiedu pian (15.5 percent), and honey/propolis (9.9 percent). Chi-square tests with logistic regression (P<0.05) showed duration of U.S. residency significantly affected (P=0.002), parental TCM usage, age group (P=0.003), and birth location (P=0.02) related to child use. Parental TCM use increased child likelihood of use (P<0.0001). CONCLUSIONS: In this study, traditional Chinese medicine was widely used for oral conditions by Chinese immigrants. Factors such as duration of U.S. residency, age, birth location, and parental use affect utilization of TCM in this population. Future studies are needed to explore the therapeutic properties of the various components of TCM.