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Mild dehydration: a risk factor for dental disease?
A review of the published international literature was undertaken to investigate whether dehydration is a risk factor for dental disease. Published evidence of associations between saliva and dental disease and between saliva and dehydration was observed, but the precise nature of these associations is unclear and no evidence of a direct link between dehydration and dental disease was found. It is concluded that no direct link between dehydration and dental disease has been proven, although there is considerable circumstantial evidence to indicate that such a link exists.
Clinical performance of a resin-modified glass-ionomer and two polyacid-modified resin composites in cervical lesions restorations: 1-year follow-up.
The aim of this study was to assess the clinical performance of a resin-modified glass-ionomer cement (Vitremer) and two polyacid-modified resin composites (F2000 and Freedom) over 1 year. Nineteen patients with at least three cervical lesions were selected, providing an initial sample size of 87 restorations (29 per material), being 78 to non-carious and nine to carious lesions. Restorations were evaluated at baseline, 6 months and 1 year after placement, using modified US Public Health Service criteria: colour match, marginal discoloration, caries, anatomical form, marginal integrity and surface texture. At baseline, restorations were considered as acceptable for all criteria. At 1-year recall, 21 restorations per material were re-examined. Freedom was rated Bravo or Charlie for all the examined criteria and Vitremer earned an Alfa rating solely for the criterion caries. On the contrary, F2000 showed the best overall results, although presenting significant alteration in colour match. Statistical analysis of data was performed using chi-square and Mc Nemar tests. As to the evaluated periods, significant difference was observed solely between baseline and 1-year recall. Freedom and Vitremer were statistically different (P < 0.01) as to anatomical form and surface texture. For F2000, significant difference (P < 0.05) was noticed as to colour match and anatomical form. After 1-year follow-up, F2000 showed the most acceptable results as to the analysed criteria.
The prevalence of non-carious cervical lesions in permanent dentition.
A non-carious cervical lesion (NCCL) is the loss of hard dental tissue on the neck of the tooth, most frequently located on the vestibular plane. Causal agents are diverse and mutually interrelated. In the present study all vestibular NCCL were observed and recorded by the tooth wear index (TWI). The aim of the study was to determine the prevalence and severity of NCCL. For this purpose, 18555 teeth from the permanent dentition were examined in a population from the city of Rijeka, Croatia. Subjects were divided into six age groups. The teeth with most NCCL were the lower premolars, which also had the largest percentage of higher index levels, indicating the greater severity of the lesions. The most frequent index level was 1, and the prevalence and severity of the lesions increased with age.
Evaluation of the accuracy and reproducibility of a replication technique for the manufacture of electroconductive replicas for use in quantitative clinical dental wear studies.
This work sought to evaluate the accuracy and reproducibility of a replication process that formed electroconductive replicas from addition cured silicone impressions for the purposes of monitoring tooth surface loss. Replicas were constructed by painting the surface of impressions with one of three high silver content electroconductive paints [Electrocure (EC), RS Silver Paint (SP) and Electrolube (EB)] and, once dry, backing this up with a cyanoacrylate based gel material (Zapit) and die stone. For each paint an impression was recorded of a gauge block of known step height (1270 microm) and five impressions of the palatal surface of a laboratory standard maxillary central incisor were also recorded. All impressions were taken using an addition cured silicone impression material (President). The resultant electroconductive replicas were mapped using a computer controlled probe. This data was analysed to determine both the replica's step height and, using surface matching techniques, the reproducibility of the replication process. The mean step heights recorded were; EC=1268.43 (s.d.=12.09), SP=1267.09 (s.d. 1.77) and EB 1299.58 (s.d. 14.47). Both EC and SP recorded the step height to within 3 microm. In the repeat replication of the palatal surface of an upper central incisor SP maintained a greater constancy of surface topography (99.6%) that was statistically superior to both EC (P < 0.05) and EB (P < 0.01). The SP was therefore the preferred paint for this technique. Bearing this in mind the replication technique was both accurate and reproducible but vigilance, as to the selection of paint for the process, should be exercised so as not to affect the good accuracy and reproducibility of the technique.
A novel approach to evaluating the reproducibility of a replication technique for the manufacture of electroconductive replicas for use in quantitative clinical dental wear studies.
The assessment of the progression of tooth surface loss has until recently been limited to either the application of subjective ranking scales or visual comparison of sequential study casts. The development of quantitative measuring techniques offers the potential of greater accuracy and sensitivity. As direct intra-oral measurement is problematical such approaches often utilize impressions of the teeth, recorded at different epochs, to construct replicas for mapping and comparison. This in vitro investigation sought to determine the reproducibility of such an approach taking into account the total process chain. Two inlay cavities (one large, one small) were prepared in the palatal aspect of a plastic maxillary central incisor and restored with two flush fitting inlays. A series of impressions of this tooth were recorded, using a special tray and an addition cured light bodied silicone impression material (President, Coltene, Switzerland), with (a) both inlays in (b) both inlays out (c) large inlay out and small inlay in (d) large inlay in and small inlay out - a total of 16 impressions. Electroconductive replicas were fabricated from these and mapped using a computer controlled probe. Each series simulated wear of the tooth. A surface matching and difference detection algorithm was then used to compare each series of replicas and calculate the proportion of the surface undergoing simulated wear by a direct comparison of (a) matched to (b) or, indirectly as the summation of the results of matches of (a) with (c) and (a) with (d). The mean proportion of the surface with wear calculated directly was 26.6% (s.d.=0.6) and indirectly 26.1% (s.d. = 0.5). A one-way anova revealed no significant difference (P > 0.05). It is concluded that determining wear by this method is highly reproducible.
Detection, evaluation, and treatment of eating disorders the role of the primary care physician.
OBJECTIVE: To describe how primary care clinicians can detect an eating disorder and identify and manage the associated medical complications. DESIGN: A review of literature from 1994 to 1999 identified by a MEDLINE search on epidemiology, diagnosis, and therapy of eating disorders, including anorexia nervosa and bulimia nervosa. MEASUREMENTS AND MAIN RESULTS: Detection requires awareness of risk factors for, and symptoms and signs of, anorexia nervosa (e.g., participation in activities valuing thinness, family history of an eating disorder, amenorrhea, lanugo hair) and bulimia nervosa (e.g., unsuccessful attempts at weight loss, history of childhood sexual abuse, family history of depression, erosion of tooth enamel from vomiting, partoid gland swelling, and gastroesophageal reflux). Providers must also remain alert for disordered eating in female athletes (the female athlete triad) and disordered eating in diabetics. Treatment requires a multidisciplinary team including a primary care practitioner, nutritionist, and mental health professional. The role of the primary care practitioner is to help determine the need for hospitalization and to manage medical complications (e.g., arrhythmias, refeeding syndrome, osteoporosis, and electrolyte abnormalities such as hypokalemia). CONCLUSION: Primary care providers have an important role in detecting and managing eating disorders.
Gastroesophageal reflux disease: New oral findings.
OBJECTIVE: The objective of this study was to investigate the effects of gastroesophageal reflux disease (GERD) on dentition, salivary function, and oral mucosa. STUDY DESIGN: Thirty-one patients with esophagitis underwent medical evaluation, which included taking their medical history, performing both an esophagogastroduodenoscopy and esophagus biopsy, and conducting a stomatologic examination. The latter consisted of an extraoral and intraoral physical examination, saliva tests (flow, buffer capacity, and pH), and biopsy and morphometry of the palatal mucosa, as well as taking a history of the patients' habits. Fourteen healthy volunteers from the same population were used as a control group. RESULTS: No relationship between GERD and changes in the oral cavity was shown by saliva tests, oral clinical examination, or histopathologic examination of the palatal mucosa. However, morphometric analysis of the palatal epithelium showed a statistically significant difference between the patients with GERD and the control group. CONCLUSIONS: GERD is associated with microscopic alterations in the palatal mucosa (epithelial atrophy and increased fibroblast number), which are only detected by morphometry.
Eating disorders: dental implications.
This article presents updated information on the 2 major eating disorders, anorexia nervosa and bulimia nervosa. Both conditions are found primarily in women. The eating disorders have significant morbidity and mortality associated with them. Patients are vulnerable to sudden death from cardiac arrhythmias. Suicide is a concern in some patients. The etiology of the eating disorders is unknown, but genetic, cultural, and psychiatric factors appear to play a role. Medical management may involve hospitalization to stabilize the patient, behavior modification, drugs, and psychotherapy. The long-term outcome of treatment is unclear at this time. The role of the dentist as a "case finder" is discussed. Also, the role of the dentist in restoring the dental and oral tissues to a healthy state in patients with eating disorders is presented.
A reliability study of clinical tooth wear measurements.
STATEMENT OF PROBLEM: Most studies examining tooth wear severity have been performed on dental casts. This indirect approach has limited applicability to dental practice because during the assessment of the casts, the identification of dentin exposure is difficult or even impossible. PURPOSE OF STUDY: The purpose of this study was to assess occlusal and incisal tooth wear clinically to determine the reliability of the assessment procedure and to establish the influence of selected relevant clinical variables (dental quadrant, tooth type, and severity of wear) on the reliability. MATERIAL AND METHODS: Forty-five volunteers (17 men, 28 women; mean age 33.7 +/- 10.7 years), 32 with temporomandibular disorders and 13 free from signs and symptoms of such disorders, were evaluated on 4 occasions. Two trained observers graded tooth wear at 2 different points in time with a 5-point ordinal scale developed for use in this study. The inter-rater and intra-rater reliability of the scale was expressed as Cohen's kappa. The influence of 2 clinical variables, dental quadrant and tooth type, on the values of kappa was tested with 1-way analysis of variance and post hoc Bonferroni tests. Probability levels of P< .05 were considered statistically significant. The influence of the final clinical variable, severity of wear, was assessed qualitatively. RESULTS: The overall values of the inter-rater and intra-rater reliability were substantial (kappa = 0.632 to 0.678). The clinical variable dental quadrant did not influence the kappa values, whereas the inter-rater reliability during the first session was better for incisors and canines than for premolars (1-way analysis of variance: F(3,23)=4.577, P=.012; post hoc Bonferroni tests: P=.030 and.036). Qualitative assessment of severity of wear indicated that the more advanced the tooth wear, the more reliably it could be graded. CONCLUSION: By means of the developed 5-point ordinal scale and within the limitations of this study, it was concluded that tooth wear can be assessed reliably in the clinical dental setting.
Pinlay to prevent and restore excessive wear in anterior teeth.
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Indirectly formed matrix for multiple composite core restorations: two clinical treatments illustrating an expanded technique.
The technique described in this report is an expansion of a previously reported intraoral procedure for directly developing a matrix for the fabrication of composite cores. The expanded method allows a matrix to be created indirectly after the involved teeth are trimmed or restored on a cast into slightly oversized crown preparations before the treatment visit. The cast may serve for both the matrix and the interim fixed restoration, enabling fabrication by the dental laboratory. A semirigid (occlusal registration) elastomeric material is used to form the matrix. The matrix is used to apply the composite and shape the cores after the abutment teeth have been prepared, pins or posts have been placed, and adhesive procedures have been implemented. The elastomeric matrix can be modified for use as the impression matrix. The described technique allows the simultaneous formation of multiple composite cores. An alternative method in which light-polymerized core composite is used with a vacuum-formed, dual-laminate transparent matrix is described and compared with the semirigid elastomeric matrix.
Dental senescence in a long-lived primate links infant survival to rainfall.
Primates tend to be long-lived, and, except for humans, most primate females are able to reproduce into old age. Although aging in most mammals is accompanied by dental senescence due to advanced wear, primates have low-crowned teeth that wear down before old age. Because tooth wear alters crown features gradually, testing whether early dental senescence causes reproductive senescence has been difficult. To identify whether and when low-crowned teeth compromise reproductive success, we used a 20-year field study of Propithecus edwardsi, a rainforest lemur from Madagascar with a maximum lifespan of >27 years. We analyzed tooth wear in three dimensions with dental topographic analysis by using Geographical Information Systems (GIS) technology. We report that tooth wear exposes compensatory shearing blades that maintain dental function for 18 years. Beyond this age, female fertility remains high; however infants survive only if lactation seasons have elevated rainfall. Therefore, low-crowned teeth accommodate wear to a point, after which reproductive success closely tracks environmental fluctuations. These results suggest a tooth wear-determined, but rainfall-mediated, onset of reproductive senescence. Additionally, our study indicates that even subtle changes in climate may affect reproductive success of rainforest species.
Reproductive fitness and tooth wear: milking as much as possible out of dental topographic analysis.
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A syndrome of dental abnormalities of sheep: I. Clinical aspects on a commercial sheep farm in the Wairarapa.
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Morphological classification of dental lesions induced by various antitumor drugs in mice.
To characterize and compare maxillary incisor lesions caused by various antitumor drugs, male BALB/c mice were given a single intravenous injection of an estimated 10% lethal dose (LD10)) of 5-fluorouracil (5-FU), adriamycin (ADR), mitomycin C (MMC), vinblastine sulfate (VBL). taxotere (TXR), irinotecan hydrochloride (CPT-11), DX-8951f, or cisplatin (CDDP). After 3, 5, 10, 15, and 60 days, the animals were sacrificed, and the maxillary incisors were examined microscopically. The dental lesions observed were classified into 4 different types on the basis of their morphological features. The lesion due to 5-FU was characterized by focal defects in the dentin, and this injury was reversible (transient dentin injury). ADR- or MMC-induced lesions were defined by abnormal structure of the apical aspect of the tooth and irregular odontogenesis, lasting for a long period (persistent apical injury). Treatment with VBL or TXR showed irregular enamel formation and abnormal dentinogenesis. Their targets were considered to be both immature and mature odontogenic cells (diffuse dental injury). Exposure to CPT-11, DX-8951f, or CDDP elicited minor reductions in a few precursor cells in the epithelial sheath on day 3, but no prominent dental abnormalities were seen thereafter (nontoxic injury). In conclusion, antitumor drugs can cause a variety of dental lesions that vary temporally and spatially, making histopathological examination of the maxillary incisor an important component of the safety assessment process for novel antitumor drugs.
Destruction of molar teeth in rats fed amino acid diets.
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Hallermann-Streiff syndrome and progeria.
Reported is an atypical, severe case of Hallermann-Streiff syndrome combined with progeria, bilateral microphthalmus, cataracts, and normal chromosome count. A plea is made for study into the teratology of abnormal chemical, metabolic, and other forces that attack the early stages of the development of the human fetus and produce multiple anomalies.