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Biomedical subjects

Kenneth J Anusavice

Publications and source records attributed to Kenneth J Anusavice.

At least 19 recordsLinked to original sources
PubMed2005

Mammalian cell delivery via aerosol deposition.

The objective of this study was to test the hypothesis that bovine dermal fibroblasts can survive aerosol delivery via an airbrush with mean cell survival rates greater than 50%. This technology has great implications for burn and other wound therapies, for delivery of genetically altered cells in gene therapies, and for tissue engineering with tissue scaffolds. Bovine dermal fibroblasts were suspended at a concentration of 200,000 cells/mL in Hank's Balanced Salt Solution, and delivered into six-well tissue culture plates using a Badger 100G airbrush. Cells were delivered through three nozzle diameters (312, 484, and 746 microm) at five different air pressures (41, 55, 69, 96, and 124 kPa). Nine repetitions were performed for each treatment group, and cell viability was measured using trypan blue exclusion assay. Mean cell viability ranged from 37 to 94%, and depended on the combination of nozzle diameter and delivery pressure (p < 0.0001). Linear regression analysis was used to develop a stochastic model of cell delivery viability as a function of nozzle diameter and delivery air pressure. This study demonstrates the feasibility of using an airbrush to deliver viable cells in an aerosol to a substrate.

Aerosols↗
PubMed2005

Viscoelastic finite element analysis of an all-ceramic fixed partial denture.

In recent years metal-free ceramic systems have become increasingly popular in dental practice because of their superior aesthetics, chemical durability and biocompatibility. Recently, manufacturers have proposed new dental ceramic systems that are advertised as being suitable for posterior fixed partial dentures (FPDs). Reports indicate that some of these systems have exhibited poor clinical performance. The objective of this study was to use the viscoelastic option of the ANSYS finite element program to calculate residual stresses in an all-ceramic FPD for four ceramic-ceramic combinations. A three-dimensional finite element model of the FPD was constructed from digitized scanning data and calculations were performed for four systems: (1) IPS Empress 2, a glass-veneering material, and Empress 2 core ceramic; (2) IPS Eris a low fusing fluorapatite-containing glass-veneering ceramic, and Empress 2 core ceramic; (3) IPS Empress 2 veneer and an experimental lithium-disilicate-based core ceramic; and (4) IPS Eris and an experimental lithium-disilicate-based core ceramic. The maximum residual tensile stresses in the veneer layer for these combinations are as follows: (1) 77 MPa, (2) 108 MPa, (3) 79 MPa, and (4) 100 MPa. These stresses are relatively high compared to the flexural strengths of these materials. In all cases, the maximum residual tensile stresses in the core frameworks were well below the flexural strengths of these materials. We conclude that the high residual tensile stresses in all-ceramic FPDs with a layering ceramic may place these systems in jeopardy of failure under occlusal loading in the oral cavity.

Ceramics↗
PubMed2005

Residual stresses in bilayer dental ceramics.

It is clinically observed that lithia-disilicate-based all-ceramic fixed partial dentures (FPD) can fail because of the fragmentation of the veneering material. The hypothesis of this study is that the global residual stresses within the surface of those veneered FPDs may be responsible for partial fragmentation of the veneering ceramic. Bilayer and monolithic ceramic composites were prepared using a lithia disilicate based (Li2OSiO2) glass-ceramic core and a glass veneer. A four-step fracture mechanics approach was used to analyze residual stress in bilayered all-ceramic FPDs. We found a statistically significant increase in the mean flexural strengths of bilayer specimens compared with monolithic glass specimens (p < or = 0.05). There was a statistically significant difference between the mean longitudinal and transverse indentation-induced crack sizes in bilayer specimens (p < or = 0.05), which indicates the existence of residual stress. Global residual stresses in the veneer layer, calculated using a fracture mechanics equation, were determined to be responsible for the increased strength and observed chipping, i.e., spallation in bilayer ceramic composites.

Biocompatible Materials↗
PubMed2005

Present and future approaches for the control of caries.

This article summarizes current and potential future approaches for the management of caries. Current surveys suggest that traditional "drill, fill, and bill" dentistry is still widely practiced in the United States in spite of considerable evidence that supports a minimally invasive treatment approach. Because there is a wide variability in treatment decisions on when and how to prevent new lesions, on how to arrest the progression of existing lesions, and on when and how to place initial and replacement restorations, the findings from some studies differ significantly from the results of other studies. While fluoride treatments are known to prevent a percentage of new lesions, they do not have the ability to prevent all caries lesions. Modern management of caries entails treating patients according to risk and monitoring early lesions in tooth surfaces that are not cavitated. Although we know that the dmfs score for children is a powerful predictor of caries increment in permanent teeth of these children a few years later, this score is rarely used in private practice as a measure of risk or as a measure of treatment success. Although these modern methods for caries management offer great promise for controlling the disease, they may take decades to apply in a standardized way so that the variability in treatment is reduced. However, during the next two decades, an alternative approach to caries prevention such as replacement therapy and a caries vaccine may become available as a more consistent method of controlling this disease.

Anti-Bacterial Agents↗
PubMed2004

Role of investment interaction layer on strength and toughness of ceramic laminates.

OBJECTIVES: The aim of this study was to test the hypothesis that the interaction of a core ceramic with investment material can significantly reduce the flexural strength and the fracture toughness of core/veneer ceramic laminates. METHODS: Ceramic composites were prepared from experimental core and experimental veneer and Empress 2 core and Empress 2 veneer ceramics. Four divesting techniques were used for each bilayer ceramic group. Core surfaces were etched with 1% HF solution for 15 or 30 min and grit blasted with 100 microm Al2O3 particles for 15 or 30 s. The effect of treatment on strength was analyzed statistically by means of two-way ANOVA. A linear regression graph was made for each group to analyze the relationship between flexural strength and the dimensions of critical cracks. RESULTS: The four surface divesting treatments produced no significant differences (p > 0.05) between the mean flexural strengths and the mean fracture toughnesses. However, groups with different core/veneer combinations showed statistically significant differences (p < or = 0.05) between the mean flexural strengths and between the mean fracture toughnesses. The Empress 2 core/experimental veneer combination exhibited the greatest fracture toughness values. The Empress 2 core/Empress 2 veneer combination exhibited the lowest mean fracture toughness and lowest mean flexural strength. SIGNIFICANCE: The investment interaction layer does not have a significant effect on the flexural strength and fracture toughness of the bilayer ceramic laminates for interfaces that are coherent and well bonded. However, the core/veneer combination of materials does affect the strength of bilayer ceramic laminates. The existence of global residual stress is the most likely reason for the observed strength increases.

Acid Etching, Dental↗
PubMed2004

Shear stress relaxation of dental ceramics determined from creep behavior.

OBJECTIVE: To test the hypothesis that shear stress relaxation functions of dental ceramics can be determined from creep functions measured in a beam-bending viscometer. METHODS: Stress relaxation behavior was determined from creep data for the following materials: (1) a veneering ceramic-IPS Empress2 body ceramic (E2V); (2) an experimental veneering ceramic (EXV); (3) a low expansion body porcelain-Vita VMK 68 feldspathic body porcelain (VB); (4) a high expansion body porcelain-Will Ceram feldspathic body porcelain (WCB); (5) a medium expansion opaque porcelain-Vita feldspathic opaque porcelain (VO); and (6) a high expansion opaque porcelain-Will Ceram feldspathic opaque porcelain (WCO). Laplace transform techniques were used to relate shear stress relaxation functions to creep functions for an eight-parameter, discrete viscoelastic model. Nonlinear regression analysis was performed to fit a four-term exponential relaxation function for each material at each temperature. The relaxation functions were utilized in the ANSYS finite element program to simulate creep behavior in three-point bending for each material at each temperature. RESULTS: Shear stress relaxation times at 575 degrees C ranged from 0.03 s for EXV to 195 s for WCO. SIGNIFICANCE: Knowledge of the shear relaxation functions for dental ceramics at high temperatures is required input for the viscoelastic element in the ANSYS finite element program, which can used to determine transient and residual stresses in dental prostheses during fabrication.

Aluminum Silicates↗
PubMed2004

Fracture behavior of lithia disilicate- and leucite-based ceramics.

OBJECTIVE: This study was designed to characterize the fracture behavior of ceramics and test the hypothesis that variation in strength is associated with a variation in fracture toughness. METHODS: The following four groups of 20 bar specimens (25 x 4 x 1.2 mm) were fabricated (ISO standard 6872): E1, a hot-pressed leucite-based core ceramic (IPS Empress); E2, a hot-pressed lithia-based core ceramic (IPS Empress 2); ES, a hot-pressed lithia-based core ceramic (Experimental); and GV, a glass veneer (IPS Empress2 body). Specimens were subjected to four-point flexure loading in 37 degrees C distilled water. Fractographic analysis was performed to determine the fracture origin (c) for calculation of fracture toughness (KIC). Weibull analysis of flexure strength (sigma) data was also performed. RESULTS: Differences in mean sigma and KIC were statistically significant for E1 and GV (p<0.05). These differences are associated with processing effects and composition. SIGNIFICANCE: The higher mean sigma and KIC values of E2 and ES core ceramics suggest potentially improved structural performance compared with E1 although the Weibull moduli of E1 and E2 are the same.

Aluminum Silicates↗
PubMed2004

Creep functions of dental ceramics measured in a beam-bending viscometer.

OBJECTIVE: To characterize the high temperature viscoelastic properties of several dental ceramics by the determination of creep functions based on mid-span deflections measured in a beam-bending viscometer (BBV). METHODS: Six groups of beam specimens (58 x 5.5 x 2.5 mm) were made from the following materials: (1) IPS Empress2 body--a glass veneer ceramic (E2V); (2) an experimental glass veneer (EXV); (3) Vita VMK 68 feldspathic body porcelain--a low-expansion body porcelain (VB); (4) Will-Ceram feldspathic body porcelain--a high-expansion body porcelain (WCB); (5) Vita feldspathic opaque porcelain--a medium-expansion opaque porcelain (VO); and (6) Will-Ceram feldspathic opaque porcelain--a high-expansion opaque porcelain (WCO). Midpoint deflections for each specimen were measured in a BBV under isothermal conditions at furnace temperatures ranging from 450 to 675 degrees C. Non-linear regression and linear regression analyses were used to determine creep functions and shear viscosities, respectively, for each material at each temperature. RESULTS: The shear viscosities of each group of dental ceramics exhibited bilinear Arrhenius behavior with the slope ratios (x) ranging from 0.19 for WCB to 0.71 for EXV. At the higher temperature ranges, activation energies ranged from 363 kJ/mol for VO to 386 kJ/mol for E2V. SIGNIFICANCE: The viscoelastic properties of dental ceramics at high temperatures are important factors in understanding how residual stresses develop in all-ceramic and metal-ceramic dental restorations.

Dental Porcelain↗
PubMed2004

Work of adhesion of resin on treated lithia disilicate-based ceramic.

OBJECTIVE: This study is to test the hypothesis that chemical etching and silane coating of a ceramic surface will influence the work of adhesion (WA) of adhesive resin to dental ceramic. METHODS: A hot-pressed lithia disilicate-based ceramic was used as a model material to investigate the influence of probing media and surface treatments on WA using a dynamic contact angle analyzer. Eighty ceramic specimens were randomly divided into eight experimental groups and treated as follows: (1 and 3) as polished; (2 and 4) etched with 9.5% hydrofluoric acid (HF) for 1 min; (5) etched with 4% acidulated phosphate fluoride (APF) for 2 min; (6) silane coated; (7) etched with HF for 1 min and silane coated; (8) etched with APF for 2 min and silane coated. Advancing and receding contact angles (theta(a) and theta(r)) were measured using high purity water (gamma = 72.6 mN/m) for groups 1 and 2, and a liquid resin (gamma = 39.7) for groups 3-8 as probing liquids. RESULTS: The liquid resin medium yielded a lower WA than water. Silanization produced a significantly lower WA (p < 0.001) than non-silanated surfaces. Etching alone consistently yielded a greater WA for all surface treatments (p < 0.001). SIGNIFICANCE: The silanated ceramic surface exhibited a lower surface energy and did not enhance bonding to the liquid resin by work of adhesion.

Acid Etching, Dental↗
PubMed2003

Weibull analysis and flexural strength of hot-pressed core and veneered ceramic structures.

OBJECTIVE: To test the hypothesis that the Weibull moduli of single- and multilayer ceramics are controlled primarily by the structural reliability of the core ceramic.Methods. Seven groups of 20 bar specimens (25 x 4 x 1.2 mm) were made from the following materials: (1) IPS Empress--a hot-pressed (HP) leucite-based core ceramic; (2) IPS Empress2--a HP lithia-based core ceramic; (3 and 7) Evision--a HP lithia-based core ceramic (ES); (4) IPS Empress2 body--a glass veneer; (5) ES (1.1 mm thick) plus a glaze layer (0.1 mm); and (6) ES (0.8 mm thick) plus veneer (0.3 mm) and glaze (0.1 mm). Each specimen was subjected to four-point flexure loading at a cross-head speed of 0.5 mm/min while immersed in distilled water at 37 degrees C, except for Group 7 that was tested in a dry environment. Failure loads were recorded and the fracture surfaces were examined using SEM. ANOVA and Duncan's multiple range test were used for statistical analysis. RESULTS: No significant differences were found between the mean flexural strength values of Groups 2, 3, 5, and 6 or between Groups 1 and 4 (p>0.05). However, significant differences were found for dry (Group 7) and wet (Groups 1-6) conditions. Glazing had no significant effect on the flexural strength or Weibull modulus. The strength and Weibull modulus of the ES ceramic were similar to those of Groups 5 and 6. SIGNIFICANCE: The structural reliability of veneered core ceramic is controlled primarily by that of the core ceramic.

Aluminum Silicates↗
PubMed2003

Failure analysis of resin composite bonded to ceramic.

OBJECTIVE: To use fractographic principles to classify the mode of failure of resin composite bonded to ceramic specimens after microtensile testing. METHODS: A leucite-based ceramic (IPS Empress)-E1) and a lithia disilicate-based ceramic (IPS Empress2)-E2) were selected for the study. Fifteen blocks of E1 and E2 were polished through 1 microm alumina abrasive. The following ceramic surface treatments were applied to three blocks of each ceramic: (1) 9.5% hydrofluoric acid (HF) for 2 min; (2) 4% acidulated phosphate fluoride (APF) for 2 min; (3) Silane coating (S); (4) HF+S; (5) APF+S. An adhesive resin and a resin composite were applied to all treated surfaces and light cured. Twenty bar specimens for each group were prepared from the composite-ceramic blocks and stored in 37 degrees C distilled water for 30 days before loading to failure under tension in an Instron testing machine. Fracture surfaces were examined using scanning electron microscopy and X-ray dot mapping. Statistical analysis was performed using one-way ANOVA, Duncan's multiple range test, and Weibull analyses. RESULTS: Similar surface treatments were associated with significantly different bond strengths and modes of failures for E1 and E2. All fractures occurred within the adhesion zone. The microstructural difference between etched E1 and E2 ceramics was a major controlling factor on adhesion. SIGNIFICANCE: The quality of the bond should not be assessed based on bond strength data alone. Mode of failure and fractographic analyses should provide important information leading to predictions of clinical performance limits.

Acid Etching, Dental↗
PubMed2002

Effect of connector design on the fracture resistance of all-ceramic fixed partial dentures.

STATEMENT OF PROBLEM: Fracture of all-ceramic fixed partial dentures (FPDs) tends to occur in the connector area. PURPOSE: The objective of this study was to test the hypothesis that the radii of curvature at the connector affects the fracture resistance of 3-unit FPDs. MATERIAL AND METHODS: With the use of a standardized silicone mold, 40 three-unit FPD wax patterns were fabricated with the same dimensions and divided into 4 groups of 10 specimens per group. Each pattern was modified at the connector areas of the occlusal embrasure (OE) and the gingival embrasure (GE); 2 wax carvers with radii of curvature at their tips of 0.90 mm and 0.25 mm were used. The dimensions of the connectors were standardized with an electronic caliper to 4 +/- 0.12 mm in height and 5 +/- 0.13 mm in width. Connector designs were as follows: Design I: OE and GE 0.90 mm; Design II: OE 0.90 mm and GE 0.25 mm; Design III: OE 0.25 mm and GE 0.90 mm; and Design IV (control): OE and GE 0.25 mm. An experimental hot-pressed core ceramic was used to make the FPD frameworks, which were consequently cemented on epoxy dies with dual-polymerizing composite (Variolink II) and loaded to fracture in a universal testing machine at a crosshead speed of 0.5 mm/min. The failure load data were analyzed with analysis of variance (ANOVA; P=.05) and Duncan's test (alpha=.01). RESULTS: The mean failure loads and standard deviations were as follows: 943 +/- 151 N for Design I; 746 +/- 106 N for Design II; 944 +/- 144 N for Design III; and 673 +/- 55 N for Design IV. ANOVA revealed a significant difference (P< or = .0001) between the mean failure loads of different connector designs. The mean loads to failure for Designs I and III were significantly higher than those for Designs II and IV (Duncan's test). CONCLUSION: Within the limitations of this study and for the experimental ceramic tested, as the radius at the gingival embrasure increased from 0.25 to 0.90 mm, the mean failure load increased by 140%. The radius of curvature at the occlusal embrasure had only a minor effect on the fracture susceptibility of 3-unit FPDs.

Analysis of Variance↗
PubMed2002

Factors affecting enamel and ceramic wear: a literature review.

Enamel wear by ceramics may adversely affect maintenance of the vertical dimension of occlusion and can increase the potential for thermal sensitivity. In this article, factors related to the abrasion of enamel by dental ceramics are critically reviewed. Concepts of physical, microstructural, chemical, and surface characteristics of dental ceramics on wear are presented based on research published since 1950. A PubMed search for key words (wear of enamel and ceramic) was supplemented with a hand search to identify relevant peer-reviewed articles published in English. Based on the literature, it can be concluded that material factors, their proper handling, and control of the patient's intrinsic risk factors related to wear are critically important to the reduction of enamel wear by dental ceramics.

Crystallization↗
PubMed2002

Maximum clenching force of patients with moderate loss of posterior tooth support: a pilot study.

STATEMENT OF PROBLEM: Patients who have lost moderate posterior tooth support may also lose clenching force as a result of sensitivity to increased loading to the remaining teeth and possibly a loss of muscle strength, because clenching forces are limited to avoid stress to the remaining teeth. Few studies have correlated moderate posterior tooth loss with maximum clenching force. PURPOSE: The purpose of this pilot study was to test the hypothesis that moderate loss of posterior tooth support will have a significant effect on maximum clenching force. MATERIAL AND METHODS: The maximum clenching force of 44 adults, ages 28 to 76 (mean 46), with posterior tooth loss was compared with the maximum clenching force of a control group of 20 healthy full dentition adults, ages 18 to 55 (mean 30), by use of a bilateral strain-gauged transducer. The transducer consisted of 2 stainless steel plates separated by a steel sphere that balanced occlusal forces between right and left sides. Acrylic resin pads were fabricated for each patient to protect the cusps of the teeth. The overall accuracy was found to be within 2.3% of full scale over a range of 0 to 4000 N (0 to 900 lbs). The calibration reliability of the system was checked frequently by use of a dead weight of 222 N (50 lbs). Clenching forces were supported by first and second molars and second premolars when possible. The instrumentation, methods, and operator were the same for both groups. A 2-tailed Student t test (alpha=0.01) and a pooled estimate of the mean were used to determine possible statistical significance. To test for possible correlations between clenching force and lost tooth support and between clenching force and age, a linear regression correlation coefficient R was calculated. RESULTS: For the 44 subjects with posterior tooth loss, the mean clenching force was 462 N (104 lbs), with a range of 98 to 1031 N (22 to 232 lbs). This compares with a mean of 720 N (162 lbs) with a range of 244 to 1243 N (55 to 280 lbs) for the full-dentition subjects. A 2-tailed t test showed that the average difference of 258 N (58 lbs) between the 2 groups was significant (P< or =.01). There was only a moderate negative association between clenching strength and loss of mandibular tooth support (R = -0.35). Clenching force was not well correlated with age as indicated by low R values (R = 0.21, missing tooth group and R = -0.03, full dentition group). CONCLUSION: Within the limitations of this study the maximum clenching force was less (P< or =.01), by 258 N (58 lbs) on average, in subjects with moderate loss of posterior tooth support. Loss of maximum clenching force was associated with a modest negative correlation to the number of missing teeth in the mandibular arch (R = -0.35). The range of clenching force was surprisingly large for both the missing tooth (98 to 1031 N) and full dentition (244 to 1243 N) groups.

Adolescent↗
PubMed2002

Wetting characteristic of ceramic to water and adhesive resin.

STATEMENT OF PROBLEM: Maximum wetting of ceramic by adhesive resin is required to achieve optimal adhesion of the resin to ceramic. It is unknown whether the adhesion of the resin to the ceramic is affected by the surface topography and wetting by water or the adhesive resin. PURPOSE: This study was designed to characterize the effect of surface topography on the wetting of ceramics by water and adhesive resin. MATERIALS AND METHODS: Three materials, a veneering ceramic, Eris (ERV), and 2 core ceramics, Empress 1 core ceramic (E1C) and an experimental core ceramic (EXC), were used. Four surface-roughening procedures were used. They included polishing through 1200-grit SiC paper (P), air abrasion with 50 microm Al(2)O(3) (A), etching with 5% hydrofluoric acid gel (E), and a combination of airborne particle abrasion and etching (A/E). Forty bar specimens (15 x 10 x 1.5 mm) were prepared from each material (N=120). Twelve groups of 10 specimens each were prepared for the 4 surface-roughening procedures. Advancing (theta(A)) and receding (theta(R)) contact angles were measured with a CAHN Dynamic Contact Analyzer, on the basis of the Wilhelmy plate technique, with water and adhesive resin. The work of adhesion (W(A)) by the probing media was calculated by use of advancing contact angle data. The data were analyzed by t testing, analysis of variance, and Duncan's tests (alpha=0.05) to determine the statistical significance of differences in the contact angles between ceramic and water or resin as a function of surface roughening. RESULTS: In general, the mean theta(A) values were higher than the mean theta(R) values except for groups of E or A/E specimens with water used as a probing medium. E and A/E treatments yielded the lowest contact angle values, followed by A and P treatments (P<.001). The E1C exhibited the highest mean contact angles, whereas EXC exhibited the lowest mean contact angle except for the theta(R) with resin. The corresponding values for ERV were between those of E1C and EXC except for theta(R) values with resin. The resin medium yielded higher mean contact angles than the water medium for the same surfaces. W(A) ranged from 62.9 to 145.2 mJ/m(2). CONCLUSIONS: Within the limitations of this study, etching or a combination of air abrasion and etching were comparably effective in increasing the surface area for bonding. The most wettable surface as measured by the resin medium was EXC, followed by ERV and E1C.

Acid Etching, Dental↗
PubMed2002

Influence of tab and disk design on shade matching of dental porcelain.

STATEMENT OF PROBLEM: Given the complexity of tooth color, the variations of shade within each tooth, and translucency, it is difficult to view only one small area and select a shade match for restorations. PURPOSE: This study tested the effect of specimen design on porcelain shade matching, hypothesizing that flat disks would be matched to one another with more accuracy than tooth-shaped tabs to tabs. MATERIALS AND METHODS: All testing was conducted in a Macbeth SpectraLight booth with D65 illumination. Seventy-three senior dental students (25 women and 48 men; mean age, 27 years) were asked to match selected Vita porcelain disks and Vita shade tabs to like specimens. The design order, namely matching tabs or disks first, was alternated for each observer. The specimens were handed to the observer individually. No time limit for matching was imposed, although each observer was given explicit instructions related to the observation and handling of the specimens. Upon completion of the matching exercises, each student received his or her standardized test results and reviewed the matching results. The time for testing and review was approximately 20 minutes per observer. An analysis of variance, with gender and order as 2 factors that could affect matching scores, was performed (P <.05). RESULTS: The mean matching scores were 78.4% for disks and 73.6% for tabs (P=.119). Female observers matched 76.5% of the disks and 77.5% of the tabs, whereas male observers matched 79.4% of the disks and 71.6% of the tabs (P=.054). Matching disks before tabs yielded equivalent levels of shade matching (disks, 77.6%; tabs, 77.1%). When tabs were matched first, the scores were as follows: disks, 79.8%, and tabs, 67.3% (P=.010). CONCLUSIONS: Within the limitations of this study, there was no significant difference in shade-matching accuracy between the 2 shapes, although the order of design matching resulted in a difference in shade-matching ability. When tabs were matched first and disks second, improved matching was evident on the second test. The reverse was not true; no learning was demonstrated when the tabs were matched after the disks.

Adult↗
PubMed2002

Dental caries: risk assessment and treatment solutions for an elderly population.

Caries remains one of the top three most common infectious diseases in the world today. Although caries prevalence decreased markedly in children and in adults up to age 40 between 1975 and 2000, the overall risk for caries in older age groups (45 to 64, 65 to 84, and > 85 years of age) has not decreased appreciably. In fact, the risk for caries in individuals 70 years of age and older has increased. The increase in restorative work needed between 1990 and 2030 will be highest in adults over the age of 44 years. Root caries prevalence and the number of restored teeth will be greatest in the elderly population. Approximately 30% of individuals over the age of 65 will have no permanent teeth. It is also apparent that additional caries risk factors are associated with a significant proportion of the older population, including reduced saliva flow, inadequate oral hygiene, frequent sugar intake, Asian ethnicity, and the presence of partial dentures. The principles of modern caries management focus on risk assessment, risk reduction, monitoring noncavitated carious lesions, and the assignment of specific treatment options according to risk. Because a relatively high proportion of elderly patients will remain at high risk for caries, therapeutic regimens for managing caries as an infectious disease must focus on the use of antibacterial treatment; high-fluoride dentifrices; supplementary low-dose, high-frequency fluoride rinses; patient education; and shorter recall intervals.

Adolescent↗