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Biomedical subjects

A W Walls

Publications and source records attributed to A W Walls.

At least 19 recordsLinked to original sources
PubMed2001

The bonding of composite resin to moist enamel.

OBJECTIVE: To determine the effect on the bond strength of modern dentine bonding agents to etched enamel of surface contamination with water. DESIGN: Fifteen bond strength measurements were made for bonds prepared to both moist and dry etched enamel for each of three test and one control materials. RESULTS: For two materials (Scotchbond 1 and Prime and Bond 2.1) the bond strength was not affected by the presence of water on the etched enamel surface. A mean bond strength in excess of 25 MPa was achieved for both materials under all conditions. One material (Optibond Solo) showed a 30% increase in bond strength when bonds were formed under wet condition (21.10 MPa compared with 15.35 MPa). The bond strength of the control material, a conventional unfilled bonding resin, decreased markedly with aqueous contamination (9.14 MPa compared with 26.75 MPa). CONCLUSION: Etched enamel should be rehydrated routinely prior to bonding composite resin to its surface using a water displacing dentine bonding system.

Acid Etching, Dental↗
PubMed2001

Ridge augmentation using mandibular tori.

A 19-year-old female was referred by her dental practitioner for the restoration of missing maxillary lateral incisors and canines. Ridge augmentation was required. This was undertaken using mandibular tori as the sites for harvesting bone. The grafting was successful and the spaces were subsequently restored using resin-bonded bridgework. The case reports that mandibular tori provide a local and convenient source of bone for ridge augmentation procedures.

Adult↗
PubMed2001

Prevalence of impacts of dental and oral disorders and their effects on eating among older people; a national survey in Great Britain.

OBJECTIVE: The objective was to assess the prevalence, in a British population aged 65 years and older, of oral health related impacts and the effects they had on the quality of daily life and in particular on eating. METHODS: 753 free living and 202 institutionalised subjects aged 65 years and over, participating in the oral health survey of the British National Diet and Nutrition Survey (NDNS), had a dental examination and interview. Data on the impact of dental and oral disorders on the activities of daily living based upon the modified Oral Impacts on Daily Performance (OIDP) indicator were collected. RESULTS: 17% of the free living edentate participants reported that their mouth affected their pattern of daily living on a regular basis. Oral impacts levels were lowest in dentate subjects with the greatest number of teeth. For the dentate, the most common oral impacts were on eating and speaking. Impacts relating to emotional stability, sleeping, relaxing, carrying out physical activity and social contact were very infrequent, but were severe when they did occur. Among those with an impact on eating, 25% said it was severe and 42% had the impact nearly every day or in a spell of 3 or more months. Oral impacts were more prevalent among the institution sample, particularly the dentate. The impacts were associated with the inability or difficulty to eat a range of 16 common foods. CONCLUSION: This survey has shown that the oral status of older people fairly frequently affects the quality of life of older people, and in particular, the ability to eat several common types of foods.

Aged↗
PubMed2001

Clinical and behavioural risk indicators for root caries in older people.

OBJECTIVE: To investigate the clinical and behavioural factors indicating root caries risk among older people. DESIGN: Cross-sectional clinical and interview data from the National Diet and Nutrition Survey (aged 65 years and over) in Great Britain. Logistic regression models of the prevalence of root caries and linear regression models of the extent of root caries were constructed to quantify the role of a range of clinical and behavioural risk indicators, including sugars intake. SETTING: A national sample of older British adults, free-living and institutionalised. PARTICIPANTS: 462 dentate adults aged 65 years or over. RESULTS: Nine or more intakes of sugars per day more than doubled the odds of root caries being present (OR 2.2-2.4). Other clinical and behavioural factors affecting root caries included wearing a partial denture in the presence of heavy plaque deposits (OR 2.1-2.6) and infrequent tooth brushing (OR 2.8-4.1). Linear regression models showed that, amongst those that had root caries, sucking sweets in the presence of a dry mouth, poor hygiene, partial dentures and living in an institution contributed to the extent of root caries, as measured by the RCI(d). CONCLUSIONS: Of the factors open to possible clinical or behavioural intervention, frequent sugars intake, poor hygiene and partial dentures were all associated with large increases in risk.

Aged↗
PubMed2001

The relationship among dental status, nutrient intake, and nutritional status in older people.

Dental health status may influence nutrition. The objective of this part of the National Diet and Nutrition Survey was to assess if there is a relationship between dental status in people 65 years and older and intake of certain nutrients and any link between dental status and blood-derived values of key nutrients. Random national samples of independently living subjects and those living in institutions had dental examinations, interviews, four-day food diaries, and blood and urine analyzed. In the sample living independently, intakes of most nutrients were lower in edentate than dentate subjects. Intake of non-starch polysaccharides, protein, calcium, non-heme iron, niacin, and vitamin C was significantly lower in edentate subjects. People with 21 or more teeth consumed more of most nutrients, particularly of non-starch polysaccharide. This relationship in intake was not apparent in the hematological analysis. Plasma ascorbate and plasma retinol were the only analytes significantly associated with dental status.

Aged↗
PubMed2001

Geriatric oral health issues in the United Kingdom.

The current status of geriatric oral health in the United Kingdom is influenced by an historical pattern of care prevalent during the early years of the National Health Service in 1948, when inexpensive oral health care became available to all. At that time, tooth extraction was perceived as an acceptable, and among some people a preferred, approach to oral care. This has left a legacy of edentulism among senior citizens, which affects both oral and general health, in addition to an attitude that places oral health as a low priority. This legacy is now beginning to unwind as cohorts of adults, who have benefited from low-cost dental care for the majority of their lives, are entering their senior years. Many of these young-old retain their natural teeth and have more positive attitudes towards oral health. This paper discusses the impact of this history as well the effect of income on access to care, the influence of the ageing process on adequate oral hygiene and the availability of dentists trained to treat both dentate and edentulous geriatric patients. A brief outlook for the future is also provided.

Adult↗
PubMed2000

Direct composite inlays versus conventional composite restorations: 5-year follow-up.

OBJECTIVES: To determine at 5 year follow-up the failure rate, wear rates and other aspects of clinical performance of direct composite inlays compared with conventional composite restorations placed incrementally. METHODS: 100 matched pairs of restorations were originally entered into the trial. Each pair consisted of a direct composite inlay and a conventional composite restoration made from the same material. At 5 years it was possible to recall 65 pairs, of which 54 were complete. Clinical assessments were made using USPHS criteria (indirect measurements of occlusal wear were made using Ivoclar standard dies) and annual bite wing radiographs. RESULTS: There was a trend to more failure of inlays than conventional composites (17.4 c.f. 7.5%) but this was not significant. The clinical performance of both types of restoration was similar and compared favourably with the results of studies of other materials. Secondary decay was diagnosed in only one restoration. Between 3 and 5 years there was some deterioration in cavo-marginal discoloration, marginal adaptation (occlusally) and surface roughness (occlusally). There was no apparent deterioration in colour match, proximal contact, shim stock contacts and Gingival Index. Wear rates of both types of restoration showed no significant difference and were essentially linear with a mean of 33-34 microm per year. CONCLUSIONS: Both inlays and conventional composite restorations complied with ADA specification minimum requirements for posterior composite restorations. In this study the direct inlay technique gave no clinical advantage over conventional, incremental placement.

Adult↗
PubMed2000

Using partial recording to assess tooth wear in older adults.

OBJECTIVES: To establish whether partial recording can be used for the measurement and reporting of tooth wear data in samples of adult populations, whilst maintaining the usefulness of the index. METHODS: Using whole mouth coronal tooth wear data from a large random population sample of 1200 dentate older adults in England, several different partial recording systems were investigated to establish which teeth would maintain a high level of sensitivity for the most economic use of codes and index teeth. Tooth wear data were recorded on a surface-by-surface basis on all teeth in the sample using the tooth wear index. RESULTS: Five different partial mouth recording systems were assessed, including half-mouth scoring, assessment of just upper or just lower anterior teeth, assessment of all anterior teeth and use of six index teeth. The 12 anterior teeth were the ones most often affected by moderate or severe wear, and when all 12 teeth were used as the index teeth few wear cases were missed, and all the most extensive and severe cases of coronal wear were classified as having some wear. A limited index of only six anterior teeth (three uppers and three lowers) was almost as sensitive, but allowed less flexibility when reporting the extent of coronal wear. Other systems for partial recording were less sensitive. CONCLUSIONS: Partial recording using six or 12 anterior teeth is appropriate for measuring and reporting tooth wear data in large population surveys.

Age Distribution↗
PubMed2000

Impact of treatment provision on the epidemiological recording of root caries.

The estimation of root caries prevalence and the identification of risk factors for decay depend upon the successful identification of carious lesions in epidemiological studies. Root surface restorations can either be placed to manage decay or cervical wear/sensitivity. The handling of data for restorations during epidemiological surveys is critical to the accurate assessment of caries prevalence. The objective of this study was to determine the relative frequency of dentists' placing root surface restorations according to their reason for placement. Data for 696 restorations were recorded from 35 dentists. Forty-five % of restorations were placed because of decay compared with 55% for cervical wear/sensitivity. There were no significant differences in proportion of placement of restoration with age of the patient or between regular and irregular attenders of different ages. Using these data a correction factor was developed for inclusion in the Root Caries Index (RCI) to make allowance for the proportion of restorations placed because of wear/sensitivity. When this correction factor was introduced into an existing data-set for root caries, the RCI was reduced for all groups. This reduction was greatest in regular attenders. When these data were analysed without making allowance for treatment effects, there was a significant difference in RCI between regular and irregular attenders. When the correction factor was applied to these data, this difference was eliminated.

Adult↗
PubMed2000

Oral health and nutrition in older people.

The theoretical link between foods choice and masticatory efficiency has long been established. Recent evidence has confirmed this association, demonstrating a progressive alteration in food choice with decreasing numbers of teeth, with the greatest effect being among those who are edentulous. This altered food selection results in significant differences in the hematological status for some key nutrients in the one study in which this association was investigated. This paper summarizes some of the literature relevant to diet as a risk factor for systemic disease and identifies areas where altered food choice as a consequence of reduced masticatory efficiency might be placing individuals at increased risk of life-threatening conditions, such as atherosclerosis and cancer.

Aged↗
PubMed1999

British Isles symposium on the future of dental clinical skills training.

A symposium on the future of dental clinical skills training is reported. Abstracts of the symposium presentations review the current and future use of simulation in dental education, future skills training in the creation of new dentists, equipment and methods for simulation, the transition from simulation to clinical practice and recent developments in simulation employing new technologies. The report concludes that simulation will continue to have an important, probably increasing role in dental education, and that further developments in clinical skills training should be sensitive to changing patterns of dental disease and opportunities of provide clinical instruction.

Clinical Competence↗
PubMed1999

The impact of oral health on stated ability to eat certain foods; findings from the National Diet and Nutrition Survey of Older People in Great Britain.

OBJECTIVES: To assess how the dental status of older people's mouths affected their stated ability to eat common foods. DESIGN: Cross sectional study. SUBJECTS: Survey was part of the oral health component of the nationwide British National Diet and Nutrition Survey: people aged 65 years and older. Two separate representative samples aged 65 and over: a free-living and an institutional sample. 881 free-living and 275 institution subjects had a dental exam and were interviewed about ability to eat key foods. RESULTS: Significant percentages of free-living people had difficulty or could not eat at least 4 of 16 foods, and about 1 in 5 dentate stated they had difficulty eating or could not eat raw carrots, apples, well-done steak or nuts. More of the edentate subjects stated that they had difficulty eating than the dentate. Perceived chewing ability increased with increasing numbers of natural teeth and pairs of opposing posterior teeth. Subjects reporting a sociodental impact were more likely to consider that they were unable to eat foods that required more chewing. Associations remained valid after correction for the effects of age, sex, social class and denture wearing status and region. Perceived dryness did not affect significantly the stated ease of eating most foods. There were more dietary restrictions reported by the institution sample. Some foods, such as nuts, apples and raw carrots could not be eaten easily by over half of edentate people in the institution sample. CONCLUSIONS: The stated selection of foods are substantially affected by numbers of teeth and occluding pairs of posterior teeth and presence of full dentures in significant percentages of older people.

Aged↗
PubMed1997

Allergic contact dermatitis to bisphenol-A-glycidyldimethacrylate (BIS-GMA) dental resin associated with sensitivity to epoxy resin.

A patient presented with recurrent facial dermatitis associated with dental work. Dermatology referral identified the cause as allergic contact dermatitis to the epoxy acrylate BIS-GMA. Occupationally-induced allergic contact dermatitis to epoxy resin was also demonstrated. A structurally distinct aliphatic acrylate was successfully substituted. Contact sensitivity to BIS-GMA is reviewed and the potential for epoxy sensitive patients to cross-react to BIS-GMA is discussed.

Bisphenol A-Glycidyl Methacrylate↗
PubMed1997

Wear rates of regular and tempered composites.

OBJECTIVES: One of the reasons for using composite inlays is that restorations can be tempered. Composites tempered with heat and light have, at least initially, an enhanced degree of cure which, it is claimed, improves their physical properties, including wear resistance. The aim of this study was to compare the wear rates of a selection of composites in their regular and tempered conditions. METHODS: Two hybrid composites (Brilliant Dentin, Coltène; Occlusin, ICI) and a microfilled material (Heliomolar, Ivoclar-Vivadent) were chosen to provide a variety of filler particle and resin systems. Regular composites were cured normally with light while tempered composites were given an additional 8 min secondary cure at 120 degrees C in the Coltène DI500 heat and light oven. Specimens of an amalgam (Dispersalloy, Johnson & Johnson) and a heat/pressure cured composite (Isosit, Ivoclar-Vivadent) were used for comparison. The specimens were stored for either 7 days or 1 year to determine if prolonged water storage affected wear rate. Wear testing was carried out in a two-body wear machine using a steatite abrader as an enamel substitute. ANOVA was used to test the effects on wear rate of tempering, storage time and type of material. RESULTS: Significant differences were found in wear rate between materials (p < 0.001), but not for tempering or prolonged storage time. CONCLUSION: These findings agree with clinical studies which have shown that tempering has little or no influence on the occlusal wear of composite inlays.

Acrylic Resins↗
PubMed1997

Clinical factors related to reported satisfaction with oral function amongst dentate older adults in England.

This paper aims to identify the features of a natural dentition, specifically the number and distribution of teeth, which are important for oral satisfaction and freedom from eating problems in the elderly. Data were gathered on the dental condition, satisfaction and function of 1211 dentate adults aged 60 years or over, randomly sampled from three areas in England. Multiple logistic regression was used to identify the clinical factors which contribute to satisfaction with aesthetics and the ability to bite and chew. Satisfaction with biting and chewing was influenced by specific reported eating problems, dry month and increasing age. The presence of these eating problems was related to a complex series of factors describing the number and distribution of teeth and dentures, and some variables describing symptoms and disease. Having 21 or more natural teeth and no removable partial dentures (odds ratio 3.2), 2 or more posterior contacting pairs of teeth (odds ratio 1.7), and few anterior spaces were important factors related to the absence of eating problems. Unfilled anterior spaces (odds ratio 3.9), and widespread caries and periodontal disease were associated with aesthetic dissatisfaction. Many of the principles of shortened dental arch are consistent with good function and satisfaction in the elderly.

Aged↗
PubMed1997

Partial dentures as an independent indicator of root caries risk in a group of older adults.

OBJECTIVES: To estimate the independent association between the wearing of removable partial dentures (RPD) and the presence of root caries in a population of older adults. DESIGN: Multivariate logistic regression modeling of root caries prevalence using different measures of root caries as dependent variables. The model included measures of disease history as indicators of historical risk. SETTING: Data collected in the field from three areas of England. SUBJECTS: Random sample of adults aged 60 years and over, drawn from lists of patients registered with general medical practitioners. INTERVENTION: Field measurements of a range of oral health variables including oral disease, disease history, oral status and various social and demographic measures. MAIN OUTCOME MEASURES: The presence of root caries, unsound and sound root restorations. RESULTS: Of the five different models of root caries prevalence which were used, RPDs featured as an independent risk indicator for root surface caries in the three which were related to the presence of untreated disease. The odds ratios for the contribution made by RPDs were all over 1.6, and when considered alone was in excess of 2 in one model. These models were generally well fitting. RPDs did not feature as a risk indicator in the two models which related only to the presence of root surface restorations. CONCLUSIONS: In this study, where RPDs were present, the odds of untreated disease being present increased substantially.

Age Factors↗
PubMed1997

Strategies to improve the quality of oral health care for frail and dependent older people.

The dental profile of the population of most industrialised countries is changing. For the first time in at least a century most elderly people in the United Kingdom will soon have some of their own natural teeth. This could be beneficial for the frail and dependent elderly, as natural teeth are associated with greater dietary freedom of choice and good nutrition. There may also be problems including high levels of dental disease associated with poor hygiene and diet. New data from a national oral health survey in Great Britain is presented. The few dentate elderly people in institutions at the moment have poor hygiene and high levels of dental decay. If these problems persist as dentate younger generations get older, the burden of care will be substantial. Many dental problems in elderly people are preventable or would benefit from early intervention. Strategies to approach these problems are presented.

Aged↗