Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 2/27/2009
Article title: A 48 month survival analysis comparing sealant (Delton) with fluoride varnish (Duraphat) in 6-8 year old children
Author(s): Bravo BM, Garcia-Anillo I, Baca P, and Llodra JC
Journal: Community Dent. Oral Epidemiology
Volume (number): 25:247-50, 1997
Major topic: Compare sealant and fluoride varnish in the prevention of occlusal caries
Type of Article: Research article
Main Purpose: The purpose of this paper was to compare Delton visible light fissure sealant and Duraphat fluoride varnish in preventing occlusal caries in permanent first molars.
Materials and Methods: A 48 month clinical trial consisted of 344 children aged 6-8 years of age divided into three groups: 104 children in the sealant group, 112 children in the varnish group, and 128 children in a control group. Sealant and varnish groups were evaluated every 6 months and the sealant repaired or fluoride varnish was reapplied every 6 months. Because the sealants were maintained throughout the study and fluoride was applied throughout the study, a survival analysis was used to compare the groups as the ability to prevent dental caries regardless of the time of origin of the study.
Findings: 66 children were lost during the study period. A total of 1201 molars were part of the study. The median survival times before caries developed was 28.6 months for the control molars and the full 48 months of the study for the sealant and varnish groups. A Cox proportional hazard regression analysis allowed comparison of risk of decay over time and allowed this comparison to occur independent of time. The study shows that sealants were significantly more effective than the control (hazard ratio of 0.177); varnish was significantly more effective than the control group (hazard ratio of 0.463), and that sealants were more effective than varnish (hazard ratio of 0.382)
Key points/Summary : Sealants provide the best protection for occlusal surfaces of permanent molars when monitored and repaired every 6 months
Assessment of article: The article was difficult to read as the statistics were discussed at length while the actual data and discussion were a minimal part of the article.
Thursday, February 26, 2009
Natural History of Treatment outcomes of Permanent First Molars
Department of Pediatric Dentistry
Lutheran Medical Center
Date: 02/27/2009
Article title: Natural history of treatment outcomes of permanent first molars: A study of sealant effectiveness
Author(s): Bhuridej, Damiano, Kuthy, Flach, Kanellis, Heller, Dawson
Journal: Journal of Dentistry for Children
Volume (number): 136
Month, Year: Sept. 2005
Major topic: Sealant effectiveness
Minor topics: Caries
Type of Article: Retrospective review
Main Purpose: Compare natural progress of teeth without intervention with teeth treated with sealants.
Overview of method of research: Insurance claim data was reviewed and treatment outcome trees were generated. The source was IOWA medicaid claims from 1996-2000. The authors compared the treatments for 1st molars receiving sealant and 1st molars not sealed.
Findings:
40% of patients who routinely utilized medicaid for dental had sealants placed on their molars. 25% of all molars reviewed received some form of restorative treatment. Sealed molars were less likely to require further restorative treatment (13% vs 29%) Sealed molars had fewer endodontic treatments, crowns and extractions.
Key points/Summary :
Very few studies have utilized insurance data to retrospectively review treatment outcomes.
The Healthy People 2010 goal is to have 50% of high risk kids get sealants.
The Treatment Outcome Trees developed by the authors made for a graphical representation of the progression of teeth.
The more often a child utilizes the medicaid system, the more likely they are to receive sealants.
Not all unsealed molars required future restorative treatment (risk levels are different)
The authors suggest that outreach sealant programs could reduce restorative needs of high risk populations.
Inclusion criteria mandated that kids be enrolled in Medicaid during the entire study period and that they were seen at least 3 times during the study period.
The data can’t be generalized beyond a medicaid population.
Assessment of article: I think it’s universally accepted that sealants can reduce caries in high risk populations. The problem with this kind of research is that it quantifies the treatment--sealant, restorative, etc--into billing codes and doesn’t recognize subtle differences in treatment provided. This type of research is useful, but has a lot of limitations.
Lutheran Medical Center
Date: 02/27/2009
Article title: Natural history of treatment outcomes of permanent first molars: A study of sealant effectiveness
Author(s): Bhuridej, Damiano, Kuthy, Flach, Kanellis, Heller, Dawson
Journal: Journal of Dentistry for Children
Volume (number): 136
Month, Year: Sept. 2005
Major topic: Sealant effectiveness
Minor topics: Caries
Type of Article: Retrospective review
Main Purpose: Compare natural progress of teeth without intervention with teeth treated with sealants.
Overview of method of research: Insurance claim data was reviewed and treatment outcome trees were generated. The source was IOWA medicaid claims from 1996-2000. The authors compared the treatments for 1st molars receiving sealant and 1st molars not sealed.
Findings:
40% of patients who routinely utilized medicaid for dental had sealants placed on their molars. 25% of all molars reviewed received some form of restorative treatment. Sealed molars were less likely to require further restorative treatment (13% vs 29%) Sealed molars had fewer endodontic treatments, crowns and extractions.
Key points/Summary :
Very few studies have utilized insurance data to retrospectively review treatment outcomes.
The Healthy People 2010 goal is to have 50% of high risk kids get sealants.
The Treatment Outcome Trees developed by the authors made for a graphical representation of the progression of teeth.
The more often a child utilizes the medicaid system, the more likely they are to receive sealants.
Not all unsealed molars required future restorative treatment (risk levels are different)
The authors suggest that outreach sealant programs could reduce restorative needs of high risk populations.
Inclusion criteria mandated that kids be enrolled in Medicaid during the entire study period and that they were seen at least 3 times during the study period.
The data can’t be generalized beyond a medicaid population.
Assessment of article: I think it’s universally accepted that sealants can reduce caries in high risk populations. The problem with this kind of research is that it quantifies the treatment--sealant, restorative, etc--into billing codes and doesn’t recognize subtle differences in treatment provided. This type of research is useful, but has a lot of limitations.
The Use of Pit and Fissure Sealants
Author(s): Robert J Feigal DDS PhD and Kevin J Donly DDS MS
Journal: Pediatric Dentistry
Volume (number): 28:2
Month, Year: 2006
Major topic: everything you ever wanted to know about sealants but were too afraid to ask
Type of Article: Review
Overview of method of research: Literature Review
Findings: In the 1950’s, 60’s and 70’s, 70% of all occlusal surfaces were expected to become carious within 10 years of eruption and many of these occurred within 3 years. This supported the Council of Dental Research’s policy on universal sealant application within 3-4 years of eruption. Occlusal decay accounts for 88% of decay but only 13% of tooth surfaces. Upon review of several papers, Feigal and Donly have come up with the following recommendations concerning sealant use: Sealants are an effective although underused form of prevention when applied by a professional and proper follow up is performed. Sealant benefit is exemplified by placement on high risk surfaces and those with incipient lesions. The best evaluation of risk includes tooth morphology, clinical diagnostics, caries hx, fluoride hx and oral hygiene. Primary and permanent teeth must both be evaluated for caries and considered for sealant placement. Occlusal surfaces should be cleaned prior to placement; minimal enameloplasty techniques have also been advocated. Proper bonding will greatly improve the retention and efficacy of sealants. Glass ionomer materials can be used as transitional sealants and have shown some promise as long term sealants.
Key points/Summary: Sealants are an extremely effective method of caries prevention when performed properly, especially on high risk teeth and those with incipient lesions. Proper recall and sealant repair is essential to long term sealant success.
Assessment of article: A lot of good info.
Brian Schmid DMD
Journal: Pediatric Dentistry
Volume (number): 28:2
Month, Year: 2006
Major topic: everything you ever wanted to know about sealants but were too afraid to ask
Type of Article: Review
Overview of method of research: Literature Review
Findings: In the 1950’s, 60’s and 70’s, 70% of all occlusal surfaces were expected to become carious within 10 years of eruption and many of these occurred within 3 years. This supported the Council of Dental Research’s policy on universal sealant application within 3-4 years of eruption. Occlusal decay accounts for 88% of decay but only 13% of tooth surfaces. Upon review of several papers, Feigal and Donly have come up with the following recommendations concerning sealant use: Sealants are an effective although underused form of prevention when applied by a professional and proper follow up is performed. Sealant benefit is exemplified by placement on high risk surfaces and those with incipient lesions. The best evaluation of risk includes tooth morphology, clinical diagnostics, caries hx, fluoride hx and oral hygiene. Primary and permanent teeth must both be evaluated for caries and considered for sealant placement. Occlusal surfaces should be cleaned prior to placement; minimal enameloplasty techniques have also been advocated. Proper bonding will greatly improve the retention and efficacy of sealants. Glass ionomer materials can be used as transitional sealants and have shown some promise as long term sealants.
Key points/Summary: Sealants are an extremely effective method of caries prevention when performed properly, especially on high risk teeth and those with incipient lesions. Proper recall and sealant repair is essential to long term sealant success.
Assessment of article: A lot of good info.
Brian Schmid DMD
Microleakage at Sealant/Enamel Interface of Primary Teeth: Effect of Er:YAG Laser Ablation of Pits and Fissures
Department of Pediatric Dentistry
Lutheran Medical Center
Date: 02/27/2009
Article title: Microleakage at Sealant/Enamel Interface of Primary Teeth: Effect of Er:YAG Laser Ablation of Pits and Fissures
Author(s): Borsatto MC, et al
Journal: Journal of Dentistry for Children
Volume (number): 71:2
Month, Year: 2004
Major topic: Sealant enamel microleakage
Minor topics: etch technique and laser ablation
Type of Article: clinical study
Main Purpose: To compare microleakage of sealants using 3 etching techniques
Overview of method of research: Primary molars were split into 3 groups to have sealant placed on the occlusal surfaces. The 1st group was etched with 37% phosphoric acid, group 2 acid etch and laser preparation, and group 3 laser preparation alone.
The molars were placed in a dye solution after a round of thermal-cycling. The teeth were then sectioned and polished into .25mm strips and looked at under a microscope and analyzed with computer software for degree of dye penetration.
Findings:
Group 1 and 2 had equal levels of microleakage. Group 3, however, had almost twice the degree of microleakage.
Key points/Summary :
Sealants success depends on its ability to:
fill pits, fissures and anatomical defects
remain bonded to enamel and not allow microleakage and consequent development of caries.
Lasers have been shown to alter enamel surface anatomy--microscopically--similar to etching in both permanent and primary teeth.
It has been speculated that laser ablation could produce a similar effect to etching
All preparations experienced some degree of microleakage.
The laser and etch technique had slightly less microleakage, but it was not statistically significant.
The authors thought that although the laser “etched” the tooth surface, it was probably irregular, which might explain the leakage.
Assessment of article: Good article. I like lasers (laser-cats) and it’s good to have some articles to ground the promoters of the product.
Lutheran Medical Center
Date: 02/27/2009
Article title: Microleakage at Sealant/Enamel Interface of Primary Teeth: Effect of Er:YAG Laser Ablation of Pits and Fissures
Author(s): Borsatto MC, et al
Journal: Journal of Dentistry for Children
Volume (number): 71:2
Month, Year: 2004
Major topic: Sealant enamel microleakage
Minor topics: etch technique and laser ablation
Type of Article: clinical study
Main Purpose: To compare microleakage of sealants using 3 etching techniques
Overview of method of research: Primary molars were split into 3 groups to have sealant placed on the occlusal surfaces. The 1st group was etched with 37% phosphoric acid, group 2 acid etch and laser preparation, and group 3 laser preparation alone.
The molars were placed in a dye solution after a round of thermal-cycling. The teeth were then sectioned and polished into .25mm strips and looked at under a microscope and analyzed with computer software for degree of dye penetration.
Findings:
Group 1 and 2 had equal levels of microleakage. Group 3, however, had almost twice the degree of microleakage.
Key points/Summary :
Sealants success depends on its ability to:
fill pits, fissures and anatomical defects
remain bonded to enamel and not allow microleakage and consequent development of caries.
Lasers have been shown to alter enamel surface anatomy--microscopically--similar to etching in both permanent and primary teeth.
It has been speculated that laser ablation could produce a similar effect to etching
All preparations experienced some degree of microleakage.
The laser and etch technique had slightly less microleakage, but it was not statistically significant.
The authors thought that although the laser “etched” the tooth surface, it was probably irregular, which might explain the leakage.
Assessment of article: Good article. I like lasers (laser-cats) and it’s good to have some articles to ground the promoters of the product.
Thursday, February 19, 2009
Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro
Resident’s Name: Dan Boboia Date: 2/20/09
Article title: Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro
Author(s): Lussi A. et al
Journal: Caries Res
Volume (number): 33: 261-266
Month, Year: 1999
Major topic / Main purpose: Assess the validity of a new laser fluorescence device (Diagnodent) histologically for the detection and quantification of caries on macroscopically intact occlusal surfaces, determine optimum cut-off points for different stages of the caries process, and assess reproducibility of results.
The diagnostic approach of the Diagnodent is based on the caries-induced changes in teeth leading to an increased fluorescence at specific excitation wavelengths. The intensity of fluorescence depends on the wavelength of the light as well as the structure and condition of dental hard tissues.
Methods and Materials
105 extracted teeth with macroscopically intact occlusal surfaces were measured by a single examiner using both a laser fluorescence device and an Electronic Caries Monitor.
Teeth were examined histologically to determine specificity, sensitivity, and likelihood ratio at the D2 (caries extending through more than half of the enamel thickness) and D3 (caries involving dentin) levels.
Reproducibility of Diagnodent was determined by having 11 dentists record the different measurements at the same site on a separate set of 83 extracted molar teeth
Results
Histological examination revealed 21 teeth --- caries free, 15 teeth --- caries extending up to halfway through the enamel (D1), 31 teeth --- caries in the inner half of the enamel (D2), 28 teeth --- caries in outer half of dentin, 10 teeth --- caries extending into inner half of dentin
The laser device ranged from 72 - 87% (specificity) and 72 - 87% (sensitivity). ECM (Electronic Caries Monitor) ranged from 64 - 78 % (specificity) and 87 - 92% (sensitivity). Compare to 30% sensitivity for clinical visual methods of caries detection of macroscopically intact occlusal surfaces.
Higher specificity values for the laser at D2 and D3 levels compared to ECM
False-positive readings can occur with plaque / calculus deposits in the fissure and/or tip
Conclusions
The Diagnodent has a higher diagnostic validity than the ECM
Measurements using this device are highly reproducible (certainly higher then ECM or visual diagnosis)
This device could be a valuable tool for the longitudinal monitoring of caries and for assessing outcome of prevention
Assessment of article Good Article
Article title: Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro
Author(s): Lussi A. et al
Journal: Caries Res
Volume (number): 33: 261-266
Month, Year: 1999
Major topic / Main purpose: Assess the validity of a new laser fluorescence device (Diagnodent) histologically for the detection and quantification of caries on macroscopically intact occlusal surfaces, determine optimum cut-off points for different stages of the caries process, and assess reproducibility of results.
The diagnostic approach of the Diagnodent is based on the caries-induced changes in teeth leading to an increased fluorescence at specific excitation wavelengths. The intensity of fluorescence depends on the wavelength of the light as well as the structure and condition of dental hard tissues.
Methods and Materials
105 extracted teeth with macroscopically intact occlusal surfaces were measured by a single examiner using both a laser fluorescence device and an Electronic Caries Monitor.
Teeth were examined histologically to determine specificity, sensitivity, and likelihood ratio at the D2 (caries extending through more than half of the enamel thickness) and D3 (caries involving dentin) levels.
Reproducibility of Diagnodent was determined by having 11 dentists record the different measurements at the same site on a separate set of 83 extracted molar teeth
Results
Histological examination revealed 21 teeth --- caries free, 15 teeth --- caries extending up to halfway through the enamel (D1), 31 teeth --- caries in the inner half of the enamel (D2), 28 teeth --- caries in outer half of dentin, 10 teeth --- caries extending into inner half of dentin
The laser device ranged from 72 - 87% (specificity) and 72 - 87% (sensitivity). ECM (Electronic Caries Monitor) ranged from 64 - 78 % (specificity) and 87 - 92% (sensitivity). Compare to 30% sensitivity for clinical visual methods of caries detection of macroscopically intact occlusal surfaces.
Higher specificity values for the laser at D2 and D3 levels compared to ECM
False-positive readings can occur with plaque / calculus deposits in the fissure and/or tip
Conclusions
The Diagnodent has a higher diagnostic validity than the ECM
Measurements using this device are highly reproducible (certainly higher then ECM or visual diagnosis)
This device could be a valuable tool for the longitudinal monitoring of caries and for assessing outcome of prevention
Assessment of article Good Article
Dental Caries Diagnosis
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 2/20/2009
Article title: Dental Caries Diagnosis
Author(s): Stookey GK, Jackson RD, Zandona AGF, et al.
Journal: Dental Clinics of North America
Volume (number): 43 (4)665-678, October 1999
Major topic: Review of caries detection devices
Type of Article: Literature review
Main Purpose: The purpose of this paper was to review current and future methods of caries detection and its applications in a clinical setting. The introduction of fluoride resulted in a decline in caries and change in paradigm from treatment to early detection and prevention of treatment.
Findings: The goal of these new diagnostic methods is to detect caries in its earliest stages or monitor the dynamic process of demineralization and remineralization that occurs during caries development. Researchers are developing new tools that are sensitive enough and specific enough for accurate caries detection. These include Quantitative light-induced fluorescence (QLF), electron conductivity measurements (ECM), direct digital radiography (DDR), and digital imaging fiberoptic with transillumination (DiFOTI)
QLF- light scattering is a measure of whiteness of a carious lesion. Its use is primarily in smooth surface lesions whereby a differential in fluorescence is detected in sound vs carious enamel. Using fluorescent dyes and argon light, carious detection was improved over bitewing radiographs. Most studies evaluated interproximal lesions. The technique dye-enhanced laser fluorescence appeared to improve sensitivity and specificity. However, the presence of plaque reduced specificity. Further development led to the Diagnodent, a potable diode laser-based system. Studies comparing it to electro-conductivity measurements showed it to have higher specificity and sensitivity
ECM- The basis of ECM is that sound tooth surfaces should have little or no conductivity whereas carious or demineralized enamel should have measurable conductivity. Various studies showed a high sensitivity and specificity when saliva was removed from pit and fissures with air flow or isolation and saline flowed in groves. Airflow seems to have an effect on measurement. It is suggested that this method is an adjunct test along with other methods to determine occlusal caries
DDR- standardized radiographs have a significant degree of human variability in assisting in the diagnosis of caries. Digital radiographs have the advantage of reduced radiation, and image manipulation. However its diagnostic advantages were not statistically significant over conventional radiographs.
DiFOTI- FOTI consists of a measurement of fiberoptic light source traversing a tooth and recorded and analyzed. DiFOTI combines FOTI with a digital CCD sensor on a cameral which is analyzed on a computer. Results indicate that DiFOTI is 2x as sensitive in detecting interproximal lesins and 3x as sensitive in detecting occlusal caries as compared to conventional radiographs
Key points/Summary : No single diagnostic test is capable of early detection of all types of carious lesions. However continued research should reveal methods to reliably detect caries.
Assessment of article: Well presented article that needs an update for 2009 as there is much use and abuse of these techniques in private practice
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 2/20/2009
Article title: Dental Caries Diagnosis
Author(s): Stookey GK, Jackson RD, Zandona AGF, et al.
Journal: Dental Clinics of North America
Volume (number): 43 (4)665-678, October 1999
Major topic: Review of caries detection devices
Type of Article: Literature review
Main Purpose: The purpose of this paper was to review current and future methods of caries detection and its applications in a clinical setting. The introduction of fluoride resulted in a decline in caries and change in paradigm from treatment to early detection and prevention of treatment.
Findings: The goal of these new diagnostic methods is to detect caries in its earliest stages or monitor the dynamic process of demineralization and remineralization that occurs during caries development. Researchers are developing new tools that are sensitive enough and specific enough for accurate caries detection. These include Quantitative light-induced fluorescence (QLF), electron conductivity measurements (ECM), direct digital radiography (DDR), and digital imaging fiberoptic with transillumination (DiFOTI)
QLF- light scattering is a measure of whiteness of a carious lesion. Its use is primarily in smooth surface lesions whereby a differential in fluorescence is detected in sound vs carious enamel. Using fluorescent dyes and argon light, carious detection was improved over bitewing radiographs. Most studies evaluated interproximal lesions. The technique dye-enhanced laser fluorescence appeared to improve sensitivity and specificity. However, the presence of plaque reduced specificity. Further development led to the Diagnodent, a potable diode laser-based system. Studies comparing it to electro-conductivity measurements showed it to have higher specificity and sensitivity
ECM- The basis of ECM is that sound tooth surfaces should have little or no conductivity whereas carious or demineralized enamel should have measurable conductivity. Various studies showed a high sensitivity and specificity when saliva was removed from pit and fissures with air flow or isolation and saline flowed in groves. Airflow seems to have an effect on measurement. It is suggested that this method is an adjunct test along with other methods to determine occlusal caries
DDR- standardized radiographs have a significant degree of human variability in assisting in the diagnosis of caries. Digital radiographs have the advantage of reduced radiation, and image manipulation. However its diagnostic advantages were not statistically significant over conventional radiographs.
DiFOTI- FOTI consists of a measurement of fiberoptic light source traversing a tooth and recorded and analyzed. DiFOTI combines FOTI with a digital CCD sensor on a cameral which is analyzed on a computer. Results indicate that DiFOTI is 2x as sensitive in detecting interproximal lesins and 3x as sensitive in detecting occlusal caries as compared to conventional radiographs
Key points/Summary : No single diagnostic test is capable of early detection of all types of carious lesions. However continued research should reveal methods to reliably detect caries.
Assessment of article: Well presented article that needs an update for 2009 as there is much use and abuse of these techniques in private practice
The effect of fluoridation on the occurrence of hidden caries in clinically sound occlusal surfaces
Department of Pediatric Dentistry
St Joseph Hospital
Resident’s Name: Derek Banks Date: February 27, 2009
Article title: The effect of fluoridation on the occurrence of hidden caries in clinically sound occlusal surfaces
Author(s): K Weerheijm, E Kidd, H Groen
Journal: Caries Research
Volume (number): 31:30-34
Month, Year: 1997
Major topic: Pit and fissure caries
Minor topic: Fluoride
Type of Article:
Main Purpose: To determine if the presence or absence of fluoride plays a role in "hidden" pit and fissure caries
Overview of method of research: 515 participants age 15 in 1968-1969. Some were exposed to fluoridated water since birth - the others weren't. Clinical and radiographic examinations were performed, and lesions which were not detected clinically, but showed up on bitewing radiographs were considered hidden lesions. The authors hypothesized that fluoride had something to do with the presence of these hidden lesions.
Findings: The study showed that hidden caries is not a new phenomenon and that it is not directly attributable to the presence of fluoride. Fluoride, in fact, is found to reduce caries - including hidden ones.
Key points/Summary: Can the fluoride get deep down inside the pits and fissures?
Assessment of article: Okay for it's time
Wednesday, February 18, 2009
Fluoride varnishes: should we be using them?
Author(s): Jay Vaikuntam, BDS
Journal: Pediatric Dentistry
Volume (number): 22(6)
Month, Year: 2000
Major topic: use of fluoride varnish for caries control
Minor topic(s): none
Type of Article: continuing education article
Main Purpose: to review efficacy, types and usage of fluoride varnish
Overview of method of research: review of literature
Findings: Europe and Canada use fluoride varnish as the standard of care in prevention techniques; however, fluoride varnishes are not yet approved by FDA for use as caries preventive agents and are considered cavity liners and desensitizing agents. To determine clinically applicable use of fluoride varnish, one must recognize an individual’s caries risk and then design an appropriate prevention strategy. The efficacy of fluoride varnishes as anti-caries agents has been reported to offer a 40-56% reduction in caries incidence, a 51% reversal of decalcified tooth structure and a 21-35% reduction in enamel demineralization. One study concluded that fluoride varnishes have a definite cariostatic effect on approximal caries. The authors note that NaF can settle due to its particulate manner, and so actual dosing of fluoride per child is more accurate in individualized packaging.
Contents Fl: mg/ml Package Cost/package Est. cost / application
Duraphat 5% NaF in viscous colophonium base 22.6
10 ml tube $25/tube $1.25-2.50
Duraflor 5% NaF in alcoholic resin suspension w/xylitol 22.6
10 ml tube $24-28/tube $1.00-2.00
Fluor Protector 1% difluorosilane in polyurethane base 1
1 box of 20 vials with 0.4 ml/vial $81.58/ 20 vial box $4.00
CavityShield 5% NaF in resin base 22.6
Unit doses, (0.4 ml or 0.25 ml) $24-34/ box $3.00-3.75
The three most used application regimens are: (1) one application/6 months; (2) one application/3 months; (3) three applications over a one-week period. Ultimately reapplication is necessary for fluoride varnishes to be effective. Studies have shown that plaque removal and/or professional prophy-cup cleanings are not necessary prior to varnish application; Nonetheless, proper varnish protocol is as follows: (1) prophylaxis (TB or Cup), (2) cotton roll isolation/ dry teeth; (3)dispense and apply varnish to entire surface of tooth, (4) patient instructed to avoid brushing for remainder of day and avoid eating for 2 hrs. In terms of toxicity, the potential exists but studies show that levels used are well below toxic does, even if patient consumes most of it throughout day. (Toxic dose is 5 mg/kg)
Key points/Summary: Fluoride varnishes are most effective when used on early white spot lesions with intact surface layer rather than on cavitated lesions.
Assessment of article: the article is a succinct reference on fluoride varnish
Journal: Pediatric Dentistry
Volume (number): 22(6)
Month, Year: 2000
Major topic: use of fluoride varnish for caries control
Minor topic(s): none
Type of Article: continuing education article
Main Purpose: to review efficacy, types and usage of fluoride varnish
Overview of method of research: review of literature
Findings: Europe and Canada use fluoride varnish as the standard of care in prevention techniques; however, fluoride varnishes are not yet approved by FDA for use as caries preventive agents and are considered cavity liners and desensitizing agents. To determine clinically applicable use of fluoride varnish, one must recognize an individual’s caries risk and then design an appropriate prevention strategy. The efficacy of fluoride varnishes as anti-caries agents has been reported to offer a 40-56% reduction in caries incidence, a 51% reversal of decalcified tooth structure and a 21-35% reduction in enamel demineralization. One study concluded that fluoride varnishes have a definite cariostatic effect on approximal caries. The authors note that NaF can settle due to its particulate manner, and so actual dosing of fluoride per child is more accurate in individualized packaging.
Contents Fl: mg/ml Package Cost/package Est. cost / application
Duraphat 5% NaF in viscous colophonium base 22.6
10 ml tube $25/tube $1.25-2.50
Duraflor 5% NaF in alcoholic resin suspension w/xylitol 22.6
10 ml tube $24-28/tube $1.00-2.00
Fluor Protector 1% difluorosilane in polyurethane base 1
1 box of 20 vials with 0.4 ml/vial $81.58/ 20 vial box $4.00
CavityShield 5% NaF in resin base 22.6
Unit doses, (0.4 ml or 0.25 ml) $24-34/ box $3.00-3.75
The three most used application regimens are: (1) one application/6 months; (2) one application/3 months; (3) three applications over a one-week period. Ultimately reapplication is necessary for fluoride varnishes to be effective. Studies have shown that plaque removal and/or professional prophy-cup cleanings are not necessary prior to varnish application; Nonetheless, proper varnish protocol is as follows: (1) prophylaxis (TB or Cup), (2) cotton roll isolation/ dry teeth; (3)dispense and apply varnish to entire surface of tooth, (4) patient instructed to avoid brushing for remainder of day and avoid eating for 2 hrs. In terms of toxicity, the potential exists but studies show that levels used are well below toxic does, even if patient consumes most of it throughout day. (Toxic dose is 5 mg/kg)
Key points/Summary: Fluoride varnishes are most effective when used on early white spot lesions with intact surface layer rather than on cavitated lesions.
Assessment of article: the article is a succinct reference on fluoride varnish
Caries prevention and reversal based on the caries balance
Author(s): Featherstone J
Journal: Pediatric Dentistry
Volume (number): 28:2
Month, Year: 2006
Major topic: Caries Prevention
Minor topic(s:
Type of Article: Conference Review
Main Purpose: To review the caries balance concept and use it as a guide for caries prevention
Overview of method of research: N/A
Findings: N/A
Key points/Summary : The caries process can be easily summarized as a balance between pathological factors such as cariogenic bacteria, fermentable carbohydrates, and salivary dysfunction and protective factors such as saliva components and flow, fluoride, and antibacterial therapy. Tooth morphology, oral hygiene, sealant application, and fluoride releasing dental materials are also important factors that play a role in the caries process. The goal is to reduce the pathological factors and increase the protective factors. A caries risk assessment should be done for every patient and should evaluate the following risk factors: visible cavitation or caries into dentin by radiograph, carious lesions restored in the last three years, readily visible heavy plaque on the teeth, frequent between meal snacks of fermentable carbohydrates, saliva reducing factors, fixed or removable appliances. If the patient is high risk .12% chlorhexidine gluconate mouthrinse one a day for 1 week for 6 months can be prescribed along with a high fluoride toothpaste 5,000 ppm. Fluoride varnish for children under 5 placed 3x a year has also been shown to be very effective.
Assessment of article: Very interesting article with some great ideas for us to use on our patients.
Journal: Pediatric Dentistry
Volume (number): 28:2
Month, Year: 2006
Major topic: Caries Prevention
Minor topic(s:
Type of Article: Conference Review
Main Purpose: To review the caries balance concept and use it as a guide for caries prevention
Overview of method of research: N/A
Findings: N/A
Key points/Summary : The caries process can be easily summarized as a balance between pathological factors such as cariogenic bacteria, fermentable carbohydrates, and salivary dysfunction and protective factors such as saliva components and flow, fluoride, and antibacterial therapy. Tooth morphology, oral hygiene, sealant application, and fluoride releasing dental materials are also important factors that play a role in the caries process. The goal is to reduce the pathological factors and increase the protective factors. A caries risk assessment should be done for every patient and should evaluate the following risk factors: visible cavitation or caries into dentin by radiograph, carious lesions restored in the last three years, readily visible heavy plaque on the teeth, frequent between meal snacks of fermentable carbohydrates, saliva reducing factors, fixed or removable appliances. If the patient is high risk .12% chlorhexidine gluconate mouthrinse one a day for 1 week for 6 months can be prescribed along with a high fluoride toothpaste 5,000 ppm. Fluoride varnish for children under 5 placed 3x a year has also been shown to be very effective.
Assessment of article: Very interesting article with some great ideas for us to use on our patients.
Ehlers Danlos Syndrome (EDS)
EDS is a group of inherited disorders characterized by extremely loose joints, hyper-elastic skin that bruises easily andeasily damaged blood vessels. Other symptoms include joint pain, joint dislocation, double jointedness, flat feet, easily bruised damaged and stretchy skin, soft velvety skin, easily scarred tissue, poor wound healing, premature rupture of membranes at birth and vision problems, mitral valve prolapse, and periodontal disease.
Diagnosis of EDS is based on collagen typing via skin biopsy, collagen gene mutation testing, These patients can have a normal life span and normal intelligence depending on the type. There are six types.
Type I and II are also called the Classic type affecting between 1 and 20000 and 1 in 40000 live births. Type I is an autosomal dominant disorder while type II is both autosomal dominant and recessive. Both are characterized by loose joints, elastic velvety skin, fragile skin that tears and bruises, poor wound healing. Noncancerous fibrous growths on pressure areas like the elbows and knees, hernias, and heart valve problems.
Type III EDS also called the Hypermobility type is the most common form of EDS affecting 1 in 10000-15000 live births It is an autosomal dominant condition, and is characterized by loose unstable joints, soft velvety skin, chronic degenerative joint disease, advanced premature osteoarthritis, and heart valve problems.
Type IV or the Vascular type is the most serious type affecting 1 in 250000 live births. It is a autosomal dominant disorder. It involves fragile blood vesses and ogans that are prone to rupture, and thin fragile skin. The patients facial characteristics consist of protruding eyes, thin nose and lips, sunken cheeks and small chin. Fingers and toes are the most commonly affected joints. Diagnosis is usually made by skin biopsy for defects in collagen fibers.
Type VI or the Kyphoscoliosis type is very rare autosomal recessive disorder characterized by curvature of spine, fragile eyes prone to rupture, muscle weakness, and increased risk of rupture of medium sized arteries. Diagnosis is usually made by a urinalysis showing a deficiency of procollagen lysl hdroxylase enzyme.
Type VII A and B: VII A also called the Arthrochalasis type has only been reported in 30 cases. It is an autosomal dominant disorder characterized by loose joints, stretchy skin with common dislocations of hip joints, early onset arthritis, and increased risk of bone loss and fracture. Diagnosis is aided by genetic tests of the type I collagen. VIIB also known as the dematorparesis type is autosomal recessive and affects the skin, and joints. Patients usually have short stature, delayed closure of fontanelles, a facial appearance with swollen eyelids and bluish tint to the sclera.
No definitive treatment is available to treat the disease, only palliative care for bruising joint pain and dislocations, and heart valvular disease and blood vessel aneuryisms. These patients have limited physical activity especially as it relates to contact sports. If surgery is needed, stitches are not recommended because of tearing of the skin.
Since these patients can have a normal life span, dental treatment is a concern. Many of the types list mitral valve prolapse which requires SBE prophylaxis. As a connective tissue disorder, these patients are very susceptible to periodontal disease and also delayed wound healing. Caution is advised in the placement of these patients in the dental chair and manipulation of the facial tissues because of their likelihood of fragility of the skin and membraneous tissues of the mouth.
I think these patients offer a real challenge to the dentist because of the underlying systemic connective tissue problems.
Diagnosis of EDS is based on collagen typing via skin biopsy, collagen gene mutation testing, These patients can have a normal life span and normal intelligence depending on the type. There are six types.
Type I and II are also called the Classic type affecting between 1 and 20000 and 1 in 40000 live births. Type I is an autosomal dominant disorder while type II is both autosomal dominant and recessive. Both are characterized by loose joints, elastic velvety skin, fragile skin that tears and bruises, poor wound healing. Noncancerous fibrous growths on pressure areas like the elbows and knees, hernias, and heart valve problems.
Type III EDS also called the Hypermobility type is the most common form of EDS affecting 1 in 10000-15000 live births It is an autosomal dominant condition, and is characterized by loose unstable joints, soft velvety skin, chronic degenerative joint disease, advanced premature osteoarthritis, and heart valve problems.
Type IV or the Vascular type is the most serious type affecting 1 in 250000 live births. It is a autosomal dominant disorder. It involves fragile blood vesses and ogans that are prone to rupture, and thin fragile skin. The patients facial characteristics consist of protruding eyes, thin nose and lips, sunken cheeks and small chin. Fingers and toes are the most commonly affected joints. Diagnosis is usually made by skin biopsy for defects in collagen fibers.
Type VI or the Kyphoscoliosis type is very rare autosomal recessive disorder characterized by curvature of spine, fragile eyes prone to rupture, muscle weakness, and increased risk of rupture of medium sized arteries. Diagnosis is usually made by a urinalysis showing a deficiency of procollagen lysl hdroxylase enzyme.
Type VII A and B: VII A also called the Arthrochalasis type has only been reported in 30 cases. It is an autosomal dominant disorder characterized by loose joints, stretchy skin with common dislocations of hip joints, early onset arthritis, and increased risk of bone loss and fracture. Diagnosis is aided by genetic tests of the type I collagen. VIIB also known as the dematorparesis type is autosomal recessive and affects the skin, and joints. Patients usually have short stature, delayed closure of fontanelles, a facial appearance with swollen eyelids and bluish tint to the sclera.
No definitive treatment is available to treat the disease, only palliative care for bruising joint pain and dislocations, and heart valvular disease and blood vessel aneuryisms. These patients have limited physical activity especially as it relates to contact sports. If surgery is needed, stitches are not recommended because of tearing of the skin.
Since these patients can have a normal life span, dental treatment is a concern. Many of the types list mitral valve prolapse which requires SBE prophylaxis. As a connective tissue disorder, these patients are very susceptible to periodontal disease and also delayed wound healing. Caution is advised in the placement of these patients in the dental chair and manipulation of the facial tissues because of their likelihood of fragility of the skin and membraneous tissues of the mouth.
I think these patients offer a real challenge to the dentist because of the underlying systemic connective tissue problems.
The effect of dentists’ behaviors on fear-related behaviors in children
Author(s): P Weinstein, T Getz, P Ratener, P Domoto
Journal: JADA
Volume (number): 104
Month, Year: January 1982
Major topic: Behavior Management
Minor topic(s: Effect of dentists’ behavior on fear-related behaviors
Type of Article: Behavioral Analysis
Main Purpose: Analyze effect of dentist behavior on fear-related behaviors
Overview of method of research: 25 practitioners (22 G.P.’s, 3 pediatric dentists) were observed treating patients age 3-5 y.o. Each patient was seen for at least two operative appointments for which injections would be needed. 100 total appointments were completed, for which 72 videos from 23 offices were available at completion of the study. No nitrous oxide or premedication was used. Videos were watched independently by two psychologists, a dentist, and a dental student. Behaviors were categorized as fear-related or non-fear-related based on the following criteria: Fear-related = minor and problem movement, crying, screaming, whimpering, protest, hurt, and discomfort. Non-fear-related behaviors are any behavior not listed above.
Findings: Putdowns, and ignoring the patient are likely to produce fear-related behaviors. Specific feedback is better than general feedback (e.g. not just “good job,” but “I like the way you keep your hands in your lap.”) Reassurance was less effective than one would expect (less effective than questioning for feelings), but can be okay when combined with explaining. Physical contact concurrent to explaining works well. Distraction was found to be less than effective in most cases.
Key points/Summary: “In the guidance dimension, the probability of fear-related behaviors is lowest after the use of direction and reinforcement. Findings show that specific feedback resulted in less fear-related behavior than general feedback.” “Questioning for feeling, which attempts to elicit and recognize the child’s feelings, appears to be the most effective empathic behavior.” Physical touch, e.g. patting the childs shoulder as a reassuring gesture was found to be effective as well.
Assessment of article: Very interesting.
Journal: JADA
Volume (number): 104
Month, Year: January 1982
Major topic: Behavior Management
Minor topic(s: Effect of dentists’ behavior on fear-related behaviors
Type of Article: Behavioral Analysis
Main Purpose: Analyze effect of dentist behavior on fear-related behaviors
Overview of method of research: 25 practitioners (22 G.P.’s, 3 pediatric dentists) were observed treating patients age 3-5 y.o. Each patient was seen for at least two operative appointments for which injections would be needed. 100 total appointments were completed, for which 72 videos from 23 offices were available at completion of the study. No nitrous oxide or premedication was used. Videos were watched independently by two psychologists, a dentist, and a dental student. Behaviors were categorized as fear-related or non-fear-related based on the following criteria: Fear-related = minor and problem movement, crying, screaming, whimpering, protest, hurt, and discomfort. Non-fear-related behaviors are any behavior not listed above.
Findings: Putdowns, and ignoring the patient are likely to produce fear-related behaviors. Specific feedback is better than general feedback (e.g. not just “good job,” but “I like the way you keep your hands in your lap.”) Reassurance was less effective than one would expect (less effective than questioning for feelings), but can be okay when combined with explaining. Physical contact concurrent to explaining works well. Distraction was found to be less than effective in most cases.
Key points/Summary: “In the guidance dimension, the probability of fear-related behaviors is lowest after the use of direction and reinforcement. Findings show that specific feedback resulted in less fear-related behavior than general feedback.” “Questioning for feeling, which attempts to elicit and recognize the child’s feelings, appears to be the most effective empathic behavior.” Physical touch, e.g. patting the childs shoulder as a reassuring gesture was found to be effective as well.
Assessment of article: Very interesting.
Crouzon Syndrome
Significant craniofacial and/or oral features:
Craniosynostosis
Hydrocephalus
Maxillary hypoplasia/mandibular prognathism
Exophthalamos secondary to shallow orbits
Ocular hypertelorism and divergent strabismus
Beaked nose appearance
Narrow ear canals resulting in hearing loss
Normal intelligence
Narrow/absent ear canals
Etiology:
Autosomal dominant genetic disorder due to mutation in FGFR2 gene. This gene provides instructions for making FGFR2 protein. Normally the FGFR2 protein is involved in signaling immature cells to become bone cells during embryonic development. When this gene is overstimulated the bones of the skull fuse prematurely.
Incidence:
1 case per 60,000
Age of Diagnosis:
At birth, diagnosis is made because of dysmorphic features
Factors that influence dental care or require dental intervention:
Overcrowding of upper teeth
Malocclusions
V-shaped maxillary dental arch
Narrow, high, or cleft palate and bifid uvula
Possibly oligodontia, macrodontia, peg-shaped and widely-spaced teeth
Associated systemic conditions:
5% of patients have acanthosis nigricans (darkened thickened skin with accentuated markings and velvety feel)
73% of patients have chronic tonsillar herniation
Factoids:
It is the most common craniosynostosis syndrome
Craniosynostosis
Hydrocephalus
Maxillary hypoplasia/mandibular prognathism
Exophthalamos secondary to shallow orbits
Ocular hypertelorism and divergent strabismus
Beaked nose appearance
Narrow ear canals resulting in hearing loss
Normal intelligence
Narrow/absent ear canals
Etiology:
Autosomal dominant genetic disorder due to mutation in FGFR2 gene. This gene provides instructions for making FGFR2 protein. Normally the FGFR2 protein is involved in signaling immature cells to become bone cells during embryonic development. When this gene is overstimulated the bones of the skull fuse prematurely.
Incidence:
1 case per 60,000
Age of Diagnosis:
At birth, diagnosis is made because of dysmorphic features
Factors that influence dental care or require dental intervention:
Overcrowding of upper teeth
Malocclusions
V-shaped maxillary dental arch
Narrow, high, or cleft palate and bifid uvula
Possibly oligodontia, macrodontia, peg-shaped and widely-spaced teeth
Associated systemic conditions:
5% of patients have acanthosis nigricans (darkened thickened skin with accentuated markings and velvety feel)
73% of patients have chronic tonsillar herniation
Factoids:
It is the most common craniosynostosis syndrome
The relationship between child temperament and early childhood caries
Author(s): Quinone R., Santos RG, Wilson S., Cross H.
Journal: Pediatric Dentistry
Volume (number): 23:1, 2001
Month, Year: 2001
Major topic: Early Childhood Caries, Temperament
Type of Article: Prospective study using an observational-correlational study design
Main Purpose: The study evaluated the relationship between temperament, like a strong tempered defiant child, and the duration of feeding habits as well as its predictive value in determining the risk for early childhood caries.
Overview of method of research: Fifty-eight healthy children, aged 1- 5 years of age with four maxillary incisors and four maxillary first primary molars were included in the study. All children were examined for the number of carious teeth and the number of carious surfaces. A second evaluator interviewed parents using a demographic survey, and a feeding practice questionnaire which asked if their child was presently being nursed or bottle fed, the duration of feeding, and the time of day that the child was being nursed or bottle fed. Attention was given to night time feeding habits. Lastly the EAS survey for emotionability (being easily distressed), Activity level (energetic), sociability (tendency to make friends) and shyness was given to a parent of the child.
Findings: Demographically, 64% of the children were Native Canadian, and 21% were Caucasian with the remainder either nonspecified or Asian. Most were low to moderate income with the majority of the lower income children representing Native Canadians. The average temperament score was moderately emotional, highly active, social and moderately shy. The average duration of feeding habits was 21.21 months with 72% reporting night time feeding. 76% had decay with 77% of the children with decay being from the Native Canadian population. Lastly the mean number of carious teeth was 3.7. These results show that shyer children and those with a greater duration of feeding habits are risk factors for ECC. However shyness and increased duration of feeding habits are independent predictors of ECC. The authors pointed out some weaknesses of the study as it relates to the data being questionnaire and survey based.
Key points/Summary: Temperament especially strong willed temperament did not predict duration of feeding habits. As noted above, shyness and duration of feeding habits independently predicted ECC levels. Also being a Native Canadian positively predicted ECC as well as low income and improper feeding practices.
Assessment of article: It was a fair article which was bogged down with statistics. The conclusions ended up disputing the hypothesis that stronger temperament correlated with poor feeding habits and thus decay. However, the findings were obvious as it relates to lower socioeconomics and improper feeding habits being risk factors for ECC
Journal: Pediatric Dentistry
Volume (number): 23:1, 2001
Month, Year: 2001
Major topic: Early Childhood Caries, Temperament
Type of Article: Prospective study using an observational-correlational study design
Main Purpose: The study evaluated the relationship between temperament, like a strong tempered defiant child, and the duration of feeding habits as well as its predictive value in determining the risk for early childhood caries.
Overview of method of research: Fifty-eight healthy children, aged 1- 5 years of age with four maxillary incisors and four maxillary first primary molars were included in the study. All children were examined for the number of carious teeth and the number of carious surfaces. A second evaluator interviewed parents using a demographic survey, and a feeding practice questionnaire which asked if their child was presently being nursed or bottle fed, the duration of feeding, and the time of day that the child was being nursed or bottle fed. Attention was given to night time feeding habits. Lastly the EAS survey for emotionability (being easily distressed), Activity level (energetic), sociability (tendency to make friends) and shyness was given to a parent of the child.
Findings: Demographically, 64% of the children were Native Canadian, and 21% were Caucasian with the remainder either nonspecified or Asian. Most were low to moderate income with the majority of the lower income children representing Native Canadians. The average temperament score was moderately emotional, highly active, social and moderately shy. The average duration of feeding habits was 21.21 months with 72% reporting night time feeding. 76% had decay with 77% of the children with decay being from the Native Canadian population. Lastly the mean number of carious teeth was 3.7. These results show that shyer children and those with a greater duration of feeding habits are risk factors for ECC. However shyness and increased duration of feeding habits are independent predictors of ECC. The authors pointed out some weaknesses of the study as it relates to the data being questionnaire and survey based.
Key points/Summary: Temperament especially strong willed temperament did not predict duration of feeding habits. As noted above, shyness and duration of feeding habits independently predicted ECC levels. Also being a Native Canadian positively predicted ECC as well as low income and improper feeding practices.
Assessment of article: It was a fair article which was bogged down with statistics. The conclusions ended up disputing the hypothesis that stronger temperament correlated with poor feeding habits and thus decay. However, the findings were obvious as it relates to lower socioeconomics and improper feeding habits being risk factors for ECC
Potential Efficacy of Chlorhexidine against Mutans Streptococci and Human Dental Caries
Author(s): C.G. Emilson
Journal: Journal of Dental Research
Volume (number): 73 (3)
Month, Year: March 1994
Major topic: Effectiveness of anti-cariogenic chemotherapeutic other than fluoride
Type of Article: Literature review
Main Purpose: To discuss the effectiveness of chemotherapeutic agents
Overview of method of research: Review of articles
Findings: Chlorhexidine has been studied for many years and has proven itself as an effective anti-cariogenic aide. Antibiotics, both topical and systemic, are the other main chemotherapeutic which has shown effectiveness in the elimination and control of dental plaque but antibiotic use for this purpose has been deemed frivolous. Chlorhexidine differs from fluoride in its main anti-cariogenic activity, namely, it is a more potent antimicrobial, while fluoride, with limited antimicrobial properties, strengthens the teeth themselves. This is the basis for this articles two main conclusions: that besides fluoride, chlorhexidine is the most effective anticariogenic chemotherapeutic and that the concomitant use of fluoride and chlorhexidine is synergistic. While fluoride does less to reduce the mutans streptococci counts in the mouth, it is more able to penetrate decalcified lesions and affect the bacteria retained there, while the chlorhexidine exerts its powerful antimicrobial effects in the macrobiotic areas of the mouth. Chlorhexidine is more effective when applied for longer, such as the use of varnish directly on teeth or placed on removable appliances and even incorporated into dental cements. Long term chlorhexidine use was equally effective when applied at home or by a dental professional. Forty % solution of chlorhexidine varnish proved to be more effective that the 10 or 20% solution. Repeated application of chlorhexidine is necessary due to its inability to eliminate mutans streptococci completely from the oral cavity. Post treatment, recolonization occurs in the pits and fissures of the molar teeth and proceeds in a posterior to anterior direction. The bacterial spread originates in the deep pits and impenetrable interproximal areas f the dentition.
Key points/Summary : Fluoride remains the chemotherapeutic agent of choice, but chlorhexidine may hold a place in the future of caries prevention, particularly as a antimicrobial adjunct to regular fluoride application.
Assessment of article: Raises a lot of good questions about chlorhexidine and was unbiased, including articles which did not support the use of chlorhexidine.
Journal: Journal of Dental Research
Volume (number): 73 (3)
Month, Year: March 1994
Major topic: Effectiveness of anti-cariogenic chemotherapeutic other than fluoride
Type of Article: Literature review
Main Purpose: To discuss the effectiveness of chemotherapeutic agents
Overview of method of research: Review of articles
Findings: Chlorhexidine has been studied for many years and has proven itself as an effective anti-cariogenic aide. Antibiotics, both topical and systemic, are the other main chemotherapeutic which has shown effectiveness in the elimination and control of dental plaque but antibiotic use for this purpose has been deemed frivolous. Chlorhexidine differs from fluoride in its main anti-cariogenic activity, namely, it is a more potent antimicrobial, while fluoride, with limited antimicrobial properties, strengthens the teeth themselves. This is the basis for this articles two main conclusions: that besides fluoride, chlorhexidine is the most effective anticariogenic chemotherapeutic and that the concomitant use of fluoride and chlorhexidine is synergistic. While fluoride does less to reduce the mutans streptococci counts in the mouth, it is more able to penetrate decalcified lesions and affect the bacteria retained there, while the chlorhexidine exerts its powerful antimicrobial effects in the macrobiotic areas of the mouth. Chlorhexidine is more effective when applied for longer, such as the use of varnish directly on teeth or placed on removable appliances and even incorporated into dental cements. Long term chlorhexidine use was equally effective when applied at home or by a dental professional. Forty % solution of chlorhexidine varnish proved to be more effective that the 10 or 20% solution. Repeated application of chlorhexidine is necessary due to its inability to eliminate mutans streptococci completely from the oral cavity. Post treatment, recolonization occurs in the pits and fissures of the molar teeth and proceeds in a posterior to anterior direction. The bacterial spread originates in the deep pits and impenetrable interproximal areas f the dentition.
Key points/Summary : Fluoride remains the chemotherapeutic agent of choice, but chlorhexidine may hold a place in the future of caries prevention, particularly as a antimicrobial adjunct to regular fluoride application.
Assessment of article: Raises a lot of good questions about chlorhexidine and was unbiased, including articles which did not support the use of chlorhexidine.
Anterior tooth trauma in the primary dentition: Incidence, classification, treatment methods and sequelae: A review of the literature
Author(s): Irwin Fried, DDS, MS; Pamela Erickson, DDS, PhD
Journal: Journal of Dentistry for Children
Volume (number): 62: 256-61
Month, Year: 1995
Major topic: dental trauma in primary dentition
Minor topic(s): none
Type of Article: Literature review/review of clinical protocol
Main Purpose: to review primary tooth trauma, encompassing incidence, classification methods, treatment modalities, follow-up scheduling, and future sequalae
Overview of method of research: Literature Review
Findings: the occurrence of traumatic injury to primary dentition has an incidence of 4-30%; One study found that 17% of cases involved the maxillary central incisor. Younger patients incur most dental injuries due to coordination and judgment levels.
Key points/Summary: fractured primary teeth are classified in the same manner as permanent teeth, first listing the tooth injury (Ellis fracture classification) and then listing a subclassification of periodontal trauma, (concussion, subluxation, luxation). The following diagnostic steps should be taken when assessing oral trauma: medical hx, neurologic eval, clinical head and neck exam, oral examination (soft & hard tissues), radiographic examination, & photo documentation. Lacerations on facial skin should be treated by a plastic surgeon. Make sure you check for normal range of jaw movements. Use saline +/o gauze to rinse away any blood clots interfering with visualization of oral soft tissues. Fracture treatment: class I – do nothing, class II – resin +/o CaOH base, class III – pulpotomy/pulpectomy, any root fractures – extract. Periodontal trauma treatment: concussion – do nothing, subluxations – leave alone unless about to exfoliate, then extract, leave intrusive luxation to reerupt unless it is impinging on permanent tooth bud, & alveolar fractures – splint for 7-10 days. Follow up schedule: 7-10 days, 3 weeks, 3 months, 6 months. At follow ups perform following: percussion, palpation, and evaluation of color change. Do not base extraction on color change. Evaluate ankylosis by dull thud/metallic sound and submergence of tooth.
Assessment of article: this is a good overview/review. It is yet another article that reinforces our need for radiographic imaging when on call at HASBRO
Journal: Journal of Dentistry for Children
Volume (number): 62: 256-61
Month, Year: 1995
Major topic: dental trauma in primary dentition
Minor topic(s): none
Type of Article: Literature review/review of clinical protocol
Main Purpose: to review primary tooth trauma, encompassing incidence, classification methods, treatment modalities, follow-up scheduling, and future sequalae
Overview of method of research: Literature Review
Findings: the occurrence of traumatic injury to primary dentition has an incidence of 4-30%; One study found that 17% of cases involved the maxillary central incisor. Younger patients incur most dental injuries due to coordination and judgment levels.
Key points/Summary: fractured primary teeth are classified in the same manner as permanent teeth, first listing the tooth injury (Ellis fracture classification) and then listing a subclassification of periodontal trauma, (concussion, subluxation, luxation). The following diagnostic steps should be taken when assessing oral trauma: medical hx, neurologic eval, clinical head and neck exam, oral examination (soft & hard tissues), radiographic examination, & photo documentation. Lacerations on facial skin should be treated by a plastic surgeon. Make sure you check for normal range of jaw movements. Use saline +/o gauze to rinse away any blood clots interfering with visualization of oral soft tissues. Fracture treatment: class I – do nothing, class II – resin +/o CaOH base, class III – pulpotomy/pulpectomy, any root fractures – extract. Periodontal trauma treatment: concussion – do nothing, subluxations – leave alone unless about to exfoliate, then extract, leave intrusive luxation to reerupt unless it is impinging on permanent tooth bud, & alveolar fractures – splint for 7-10 days. Follow up schedule: 7-10 days, 3 weeks, 3 months, 6 months. At follow ups perform following: percussion, palpation, and evaluation of color change. Do not base extraction on color change. Evaluate ankylosis by dull thud/metallic sound and submergence of tooth.
Assessment of article: this is a good overview/review. It is yet another article that reinforces our need for radiographic imaging when on call at HASBRO
Risk of fluorosis associated with infant formulas prepared with bottled water
Author(s): M Buzalaf
Journal: Journal of Dentistry for Children
Volume (number): 71:2
Month, Year: 2004
Major topic: Fluoride
Minor topic(s): Fluorosis
Type of Article: En vitro study
Main Purpose: Evaluate levels of fluoride in formulas prepared with bottled water (fluoridated or unfluoridated)
Overview of method of research: Mix different kinds of formula with different types of bottled water and measure the fluoride content. Each test was done three times to ensure accuracy of the data.
Findings: When mixed with optimally fluoridated water, infant formula contains fluoride levels that are above the recommended limit and may predispose patients to dental fluorosis.
Key points/Summary: Infant formulas may be a major risk factor for fluorosis, especially when prepared with fluoridated water. A total daily intake of fluoride between 0.05 and 0.07 mg/kg is generally regarded as optimum. When mixed with deionized water, all formulas tested provide suboptimal levels of fluoride to the patient. However, when mixed with “optimally fluoridated” water (titrated to optimal value for older patients), levels of fluoride in formula can reach levels that are double the recommended dose, and may cause dental fluorosis. Also of note, older infants (6 months and above) are most likely ingesting fluoride from other sources e.g. foods, water, juices. The author suggests giving specific guidelines to parents for optimization of fluoride levels e.g. how many bottles per day with bottled water formula, and how many from the tap/fluoridated bottled water (are we discussing this in the infant/toddler program?). The author also suggests increasing awareness of this issue in our communities e.g. pediatricians etc…
Assessment of article: Very interesting.
Journal: Journal of Dentistry for Children
Volume (number): 71:2
Month, Year: 2004
Major topic: Fluoride
Minor topic(s): Fluorosis
Type of Article: En vitro study
Main Purpose: Evaluate levels of fluoride in formulas prepared with bottled water (fluoridated or unfluoridated)
Overview of method of research: Mix different kinds of formula with different types of bottled water and measure the fluoride content. Each test was done three times to ensure accuracy of the data.
Findings: When mixed with optimally fluoridated water, infant formula contains fluoride levels that are above the recommended limit and may predispose patients to dental fluorosis.
Key points/Summary: Infant formulas may be a major risk factor for fluorosis, especially when prepared with fluoridated water. A total daily intake of fluoride between 0.05 and 0.07 mg/kg is generally regarded as optimum. When mixed with deionized water, all formulas tested provide suboptimal levels of fluoride to the patient. However, when mixed with “optimally fluoridated” water (titrated to optimal value for older patients), levels of fluoride in formula can reach levels that are double the recommended dose, and may cause dental fluorosis. Also of note, older infants (6 months and above) are most likely ingesting fluoride from other sources e.g. foods, water, juices. The author suggests giving specific guidelines to parents for optimization of fluoride levels e.g. how many bottles per day with bottled water formula, and how many from the tap/fluoridated bottled water (are we discussing this in the infant/toddler program?). The author also suggests increasing awareness of this issue in our communities e.g. pediatricians etc…
Assessment of article: Very interesting.
Policy on Use of a Caries-risk Assessment Tool (CAT) for Infants, Children, and Adolescents
Author(s): Reference Manual
Journal: Pediatric Dentistry
Volume (number): 29 (7)
Month, Year: 2008
Major topic: caries risk assessment
Minor topic(s): none
Type of Article: policy statement
Main Purpose: assessment of caries risk in modern-day pediatric dentistry
Overview of method of research: literature review
Findings: Based on the literature, previous caries experience is the best predictor of future caries in primary teeth. The earlier in infancy children are inoculated with s. mutans, the more severe the caries in primary dentition.
Key points/Summary: caries risk assessment is determination of the likelihood of the incidence of caries during a certain time period. Caries risk indicators are variables that either directly cause the disease or are predictors of disease potential. A successful caries risk assessment tool will incorporate one ore more social, behavioral, mirobiologic, environmental, and clinical variables. The benefits of a CAT include: a concise assessment tool for dental and non-dental healthcare practitioners, providing evidence for periodicity of services for third-party payers.
Assessment of article: A classic article
Journal: Pediatric Dentistry
Volume (number): 29 (7)
Month, Year: 2008
Major topic: caries risk assessment
Minor topic(s): none
Type of Article: policy statement
Main Purpose: assessment of caries risk in modern-day pediatric dentistry
Overview of method of research: literature review
Findings: Based on the literature, previous caries experience is the best predictor of future caries in primary teeth. The earlier in infancy children are inoculated with s. mutans, the more severe the caries in primary dentition.
Key points/Summary: caries risk assessment is determination of the likelihood of the incidence of caries during a certain time period. Caries risk indicators are variables that either directly cause the disease or are predictors of disease potential. A successful caries risk assessment tool will incorporate one ore more social, behavioral, mirobiologic, environmental, and clinical variables. The benefits of a CAT include: a concise assessment tool for dental and non-dental healthcare practitioners, providing evidence for periodicity of services for third-party payers.
Assessment of article: A classic article
Using Anticipatory Guidance to Provide Early Dental Intervention
Author(s): Arthur J. Nowak, Paul S. Casamassimo
Journal: JADA
Volume (number): Vol. 126
Month, Year: August 1995
Major topic: early dental intervention
Minor topic(s): using anticipatory guidance to provide early dental intervention
Type of Article: Clinical Practice
Main Purpose: Developing an anticipatory guidance program for dental health.
Overview of method of research: Informative
Findings: Studies show the incidence of dental caries seem to be concentrated in about 20 to 25 percent of the U.S. child population, nursing bottle caries rates remain dramatically high among certain minority populations, and the measurement of various types and numbers of cariogenic organisms in the mouth does not correlate well with the number of carious lesions in individual children’s teeth.
Key points/Summary: Just as medicine has used anticipatory guidance to educate parents about general health issues for young children, so must the dental profession educate these same parents about children’s oral health. Dentists have continually relied on the infectious- disease model for a basic and often repetitive generic message of brushing, flossing and using fluoride. Current recommendations for anticipatory guidance in pediatric dental care are areas such as oral development, fluoride adequacy, oral hygiene and health, habits nutrition and diet and injury prevention. Anticipatory guidance forces interaction by requiring the clinician to seek information about a child’s development from the parent and by directing the clinician to develop individualized plans or strategies. The anticipatory guidance avoids repetition of the same message presented in disease-based programs. Applying anticipatory guidance to dental preventive education is an organized way for all dental providers to enjoy the attention of parents and be more successful in preventive dentistry.
Assessment of article: Good ideas and resources presented in article
Journal: JADA
Volume (number): Vol. 126
Month, Year: August 1995
Major topic: early dental intervention
Minor topic(s): using anticipatory guidance to provide early dental intervention
Type of Article: Clinical Practice
Main Purpose: Developing an anticipatory guidance program for dental health.
Overview of method of research: Informative
Findings: Studies show the incidence of dental caries seem to be concentrated in about 20 to 25 percent of the U.S. child population, nursing bottle caries rates remain dramatically high among certain minority populations, and the measurement of various types and numbers of cariogenic organisms in the mouth does not correlate well with the number of carious lesions in individual children’s teeth.
Key points/Summary: Just as medicine has used anticipatory guidance to educate parents about general health issues for young children, so must the dental profession educate these same parents about children’s oral health. Dentists have continually relied on the infectious- disease model for a basic and often repetitive generic message of brushing, flossing and using fluoride. Current recommendations for anticipatory guidance in pediatric dental care are areas such as oral development, fluoride adequacy, oral hygiene and health, habits nutrition and diet and injury prevention. Anticipatory guidance forces interaction by requiring the clinician to seek information about a child’s development from the parent and by directing the clinician to develop individualized plans or strategies. The anticipatory guidance avoids repetition of the same message presented in disease-based programs. Applying anticipatory guidance to dental preventive education is an organized way for all dental providers to enjoy the attention of parents and be more successful in preventive dentistry.
Assessment of article: Good ideas and resources presented in article
Current fluoride therapy in dentistry for children
Author(s): S Adair
Journal: Current Opinion in Dentistry
Volume (number): 1:583-591
Month, Year: 1991
Major topic: Fluoride
Minor topic(s): Fluoride
Type of Article: Literature review
Main Purpose: Review literature regarding use, implications, and complications of fluoride supplementation and application.
Overview of method of research: Review of the “current” literature.
Findings: Overall… fluoride is beneficial primarily due to its topical effects, and there are benefits to different modalities of application/supplementation.
Key points/Summary: Early studies showed a 50 to 60% decrease in the incidence of caries due to fluoridation of water. More recent studies show closer to a 20% decrease. This difference is attributed by many to the increased availability of fluoride in dentrifices and rinses. Increased levels of fluorosis have been noted even in optimally fluoridated communities, but fluorisis is usually very mild to mild. Australian study noted a 20-28% decrease in DMFS in fluoridated areas (3463 patients). Quebec showed 23% decrease in optimally fluoridated area (936 patients). In Cheshire, England 66% of children with some degree of dental fluorosis live in optimally fluoridated communities – the remaining 44% live in fluoride-deficient communities. Children with a water source containing 4.7 to 5.3 mg/L fluoride (optimal level is about 1.0 mg/L) in Israel reported 60% with either no or mild fluorosis, and 40% with moderate to severe fluorosis. Studies evaluating the preeruptive effects of fluoride gave mixed results. No difference was noted in tooth morphology, and high sucrose levels in other tests may skew results, as pH can fall below level at which fluoridated teeth are resistant to demineralization. In New Zealand, the diets of small children were analyzed for fluoride content to see if children were being overfluoridated by fluoride in public water. Results showed that even in optimally fluoridated areas, fluoride intake was within currently accepted limits of 0.05 to 0.07 mg F/kg body weight per day. Milk reduced fluoride ingestion, and a meal reduced it much more. Author notes that many physicians prescribe fluoride supplements without taking into account other sources of fluoride e.g. well water fluoride levels, dentrifices, etc… A few studies showed that ingested fluoride is very bioavailable, reporting from 60-11% absorption – so the little kiddos need close supervision if they use fluoride containing dentrifices…. They also should be able to spit well. Mouthrinses have shown some promise as well.
Assessment of article: Great. Like a Cliff’s Notes for fluoride articles…. Which would make this summary like a cliff’s notes of the cliff’s notes…. Anybody taking notes?
Journal: Current Opinion in Dentistry
Volume (number): 1:583-591
Month, Year: 1991
Major topic: Fluoride
Minor topic(s): Fluoride
Type of Article: Literature review
Main Purpose: Review literature regarding use, implications, and complications of fluoride supplementation and application.
Overview of method of research: Review of the “current” literature.
Findings: Overall… fluoride is beneficial primarily due to its topical effects, and there are benefits to different modalities of application/supplementation.
Key points/Summary: Early studies showed a 50 to 60% decrease in the incidence of caries due to fluoridation of water. More recent studies show closer to a 20% decrease. This difference is attributed by many to the increased availability of fluoride in dentrifices and rinses. Increased levels of fluorosis have been noted even in optimally fluoridated communities, but fluorisis is usually very mild to mild. Australian study noted a 20-28% decrease in DMFS in fluoridated areas (3463 patients). Quebec showed 23% decrease in optimally fluoridated area (936 patients). In Cheshire, England 66% of children with some degree of dental fluorosis live in optimally fluoridated communities – the remaining 44% live in fluoride-deficient communities. Children with a water source containing 4.7 to 5.3 mg/L fluoride (optimal level is about 1.0 mg/L) in Israel reported 60% with either no or mild fluorosis, and 40% with moderate to severe fluorosis. Studies evaluating the preeruptive effects of fluoride gave mixed results. No difference was noted in tooth morphology, and high sucrose levels in other tests may skew results, as pH can fall below level at which fluoridated teeth are resistant to demineralization. In New Zealand, the diets of small children were analyzed for fluoride content to see if children were being overfluoridated by fluoride in public water. Results showed that even in optimally fluoridated areas, fluoride intake was within currently accepted limits of 0.05 to 0.07 mg F/kg body weight per day. Milk reduced fluoride ingestion, and a meal reduced it much more. Author notes that many physicians prescribe fluoride supplements without taking into account other sources of fluoride e.g. well water fluoride levels, dentrifices, etc… A few studies showed that ingested fluoride is very bioavailable, reporting from 60-11% absorption – so the little kiddos need close supervision if they use fluoride containing dentrifices…. They also should be able to spit well. Mouthrinses have shown some promise as well.
Assessment of article: Great. Like a Cliff’s Notes for fluoride articles…. Which would make this summary like a cliff’s notes of the cliff’s notes…. Anybody taking notes?
Changes in maternal attitudes toward baby bottle tooth decay
Author(s): Kanellis, M.J. et al
Journal: Pediatric Dentistry
Volume (number): 19:1
Month, Year: 1997
Major topic: knowledge and attitudes of parents toward baby bottle tooth decay
Minor topic(s): n/a
Type of Article: research article
Main Purpose: to determine if women hearing a persuasive message about baby bottle tooth decay would process this message primarily through central or peripheral route.
Overview of method of research: 120 low-income women meeting the following qualifications were enrolled: pregnant or had a child younger than 7 months, in eastern Iowa WIC program, and at a level of literacy allowing for unassisted completion of a consent form. Participants completed a questionnaire and a pre-intervention attitudinal survey to determine knowledge of, anxieties about, and attitudes toward baby bottle tooth decay. Subjects were then randomly divided into 3 different groups: 2 experimental and one control. The two experimental groups learned about baby bottle tooth decay while the control group did not. The idea behind the two experimental groups was to evaluate if the way in which knowledge was processed affected how an individual formed an attitude, based on routes of persuasion. The two routes of persuasion are central and peripheral; persuasion through the central route occurs when careful evaluation of the message content is possible; persuasion through the peripheral route occurs when surrounding cues are influencing the person’s ability to focus on the issue being presented. Attitudes formed via the central route have been found to be more persistent and predictive of behavior. Experimental group one received their message about baby bottle tooth decay through the peripheral route of persuasion. Experimental group two received this message through the central route. Subjects then completed the same intervention attitudinal and knowledge surveys. “Change in knowledge” and “change in attitude” was then measured based on the pre and post surveys.
Findings: It was hypothesized that study participants receiving information via the central method of persuasion would demonstrate a significant increase in attitude score versus those receiving information via peripheral method. Although participants hearing about baby bottle tooth decay did show significant positive change in attitude and knowledge regarding baby bottle tooth decay versus those in the control group, there was no significant difference between the two experimental groups.
Key points/Summary: the connection between knowledge and behavior is not always easy to defined, particularly in relation to health.
Assessment of article: interesting and slightly disheartening news.
Journal: Pediatric Dentistry
Volume (number): 19:1
Month, Year: 1997
Major topic: knowledge and attitudes of parents toward baby bottle tooth decay
Minor topic(s): n/a
Type of Article: research article
Main Purpose: to determine if women hearing a persuasive message about baby bottle tooth decay would process this message primarily through central or peripheral route.
Overview of method of research: 120 low-income women meeting the following qualifications were enrolled: pregnant or had a child younger than 7 months, in eastern Iowa WIC program, and at a level of literacy allowing for unassisted completion of a consent form. Participants completed a questionnaire and a pre-intervention attitudinal survey to determine knowledge of, anxieties about, and attitudes toward baby bottle tooth decay. Subjects were then randomly divided into 3 different groups: 2 experimental and one control. The two experimental groups learned about baby bottle tooth decay while the control group did not. The idea behind the two experimental groups was to evaluate if the way in which knowledge was processed affected how an individual formed an attitude, based on routes of persuasion. The two routes of persuasion are central and peripheral; persuasion through the central route occurs when careful evaluation of the message content is possible; persuasion through the peripheral route occurs when surrounding cues are influencing the person’s ability to focus on the issue being presented. Attitudes formed via the central route have been found to be more persistent and predictive of behavior. Experimental group one received their message about baby bottle tooth decay through the peripheral route of persuasion. Experimental group two received this message through the central route. Subjects then completed the same intervention attitudinal and knowledge surveys. “Change in knowledge” and “change in attitude” was then measured based on the pre and post surveys.
Findings: It was hypothesized that study participants receiving information via the central method of persuasion would demonstrate a significant increase in attitude score versus those receiving information via peripheral method. Although participants hearing about baby bottle tooth decay did show significant positive change in attitude and knowledge regarding baby bottle tooth decay versus those in the control group, there was no significant difference between the two experimental groups.
Key points/Summary: the connection between knowledge and behavior is not always easy to defined, particularly in relation to health.
Assessment of article: interesting and slightly disheartening news.
Xylitol, Sweeteners, and Dental Caries
Author(s): Ly, K.A., Milgrom, P., Rothen, M.
Journal: Pediatric Dentistry
Volume (number): 28
Month, Year: 2006
Major topic: Provide an overview of xylitol and other polyol sweeteners and dental caries for clinicians and to discuss current applications for dental practice and potential community-based public health interventions.
Type of Article: Review
Main Purpose:
Provide an overview of xylitol and other polyol sweeteners and dental caries for clinicians and to discuss current applications for dental practice and potential community-based public health interventions.
Findings:
• Sugar alcohols have been shown to be noncariogenic and reduce the level of strep mutans (SM) in plaque and saliva. Microorganisms do not readily metabolize xylitol into energy source so its consumption has minimal effect on plaque pH. Strep mutans expends energy to break down xylitol without yielding energy in return.
• Long term habitual consumption of xylitol can select for less virulent strains which are less capable of adhering to tooth surfaces.
Xylitol Dose and Frequency
• Not fully developed.
• Study at University of Washington concluded that MS levels were reduced with increasing doses of xylitol; effect leveling off between 6.88g to 10.32g per day.
• In a second study 10.32 g per day divided in 2,3, and 4 administrations demonstrated a linear response in decreasing levels of MS in plaque and saliva.
Children at High Risk for Caries
• One study in Belize showed children with high caries rates demonstrated arrest in 9-27% of lesions.
• Another study in Estonia showed a 33-59% reduction in tooth decay in the group using xylitol candy and 54% reduction in groups using xylitol gum.
• University of Washington produced and field tested xylitol-containing popsicles, gummy bears, puddings, and sorbet. They found children readily accepted such foods when offered as part of the daily diet.
• Study in Costa Rica involving 2,630 children between 8 and 10 years old compared NaF toothpaste with and without 10% xylitol. After 3 years of brushing twice a day study showed a 12% reduction in decayed / filled lesion surfaces (DFS) and DFS-buccal surfaces.
Pregnant Women and New Mothers
• Study looked at the effects of 100% xylitol gum, chlorhexidine varnish, and fluoride varnish on the inhibition of SM transmission to newborns through their mothers. SM levels were:
o 10% in xylitol mother group
o 29% chlorhexidine mother group
o 49% in the fluoride group
o At 6 years of age the xylitol group still had the lowest SM levels compared with the other two
Conclusions
1) 6 to 10g divided into to 3-5 consumption periods per day is needed to be effective
2) Clear labeling of xylitol content in products is needed
3) A ceiling effect appears beyond the 10g dose
Assessment of article
Good article. Very informative. Excellent tables
Journal: Pediatric Dentistry
Volume (number): 28
Month, Year: 2006
Major topic: Provide an overview of xylitol and other polyol sweeteners and dental caries for clinicians and to discuss current applications for dental practice and potential community-based public health interventions.
Type of Article: Review
Main Purpose:
Provide an overview of xylitol and other polyol sweeteners and dental caries for clinicians and to discuss current applications for dental practice and potential community-based public health interventions.
Findings:
• Sugar alcohols have been shown to be noncariogenic and reduce the level of strep mutans (SM) in plaque and saliva. Microorganisms do not readily metabolize xylitol into energy source so its consumption has minimal effect on plaque pH. Strep mutans expends energy to break down xylitol without yielding energy in return.
• Long term habitual consumption of xylitol can select for less virulent strains which are less capable of adhering to tooth surfaces.
Xylitol Dose and Frequency
• Not fully developed.
• Study at University of Washington concluded that MS levels were reduced with increasing doses of xylitol; effect leveling off between 6.88g to 10.32g per day.
• In a second study 10.32 g per day divided in 2,3, and 4 administrations demonstrated a linear response in decreasing levels of MS in plaque and saliva.
Children at High Risk for Caries
• One study in Belize showed children with high caries rates demonstrated arrest in 9-27% of lesions.
• Another study in Estonia showed a 33-59% reduction in tooth decay in the group using xylitol candy and 54% reduction in groups using xylitol gum.
• University of Washington produced and field tested xylitol-containing popsicles, gummy bears, puddings, and sorbet. They found children readily accepted such foods when offered as part of the daily diet.
• Study in Costa Rica involving 2,630 children between 8 and 10 years old compared NaF toothpaste with and without 10% xylitol. After 3 years of brushing twice a day study showed a 12% reduction in decayed / filled lesion surfaces (DFS) and DFS-buccal surfaces.
Pregnant Women and New Mothers
• Study looked at the effects of 100% xylitol gum, chlorhexidine varnish, and fluoride varnish on the inhibition of SM transmission to newborns through their mothers. SM levels were:
o 10% in xylitol mother group
o 29% chlorhexidine mother group
o 49% in the fluoride group
o At 6 years of age the xylitol group still had the lowest SM levels compared with the other two
Conclusions
1) 6 to 10g divided into to 3-5 consumption periods per day is needed to be effective
2) Clear labeling of xylitol content in products is needed
3) A ceiling effect appears beyond the 10g dose
Assessment of article
Good article. Very informative. Excellent tables
Evolving Primary Pulp Therapy Techniques
Author(s): Yacobi, R., et all.
Journal:
Volume (number):
Month, Year:
Main Purpose:
Evaluate pulpectomies followed by zinc oxide obturation for inflamed or cariously infected vital pulps of anterior and posterior primary teeth
Method:
- Sample included 106 children (56 boys and 50 girls) mean age 3.3 years
- Pulps extirpated, canals irrigated with water and dried with air
- ZOE used to fill canals short of apex to prevent apical extrusion
- Anterior teeth restored with composite and posterior teeth restored with SSC
- Teeth evaluated clinically and post operatively at 6 and 12 months by four different pediatric dentists
- Treatment classified as a failure if one or more of the following clinical signs appeared: pain, swelling, abscess, or fistulous tract
Findings:
-89% success rate for anterior teeth at 6 months and 76% success rate at 12 months postoperatively
-92% success rate for posterior teeth at 6 months and 84% at 12 months postoperatively
-No statistically significant differences found between success rates for maxillary and mandibular teeth at either 6 month or 12 month post-op
-More underfilled teeth failed when compared to those completely filled; overfilling is not preferred to underfilling because of the foreign body reaction which may occur from extrusion of ZOE beyond the root apex
-100% of posterior teeth demonstrated clinical success results at 12 months
-84% of posterior teeth demonstrated radiographic success results at 12 months
Conclusions:
Pulpectomy technique is as effective as for primary posterior teeth as formocresol pulpotomies at 1 year
Assessment of article:
Good article
Journal:
Volume (number):
Month, Year:
Main Purpose:
Evaluate pulpectomies followed by zinc oxide obturation for inflamed or cariously infected vital pulps of anterior and posterior primary teeth
Method:
- Sample included 106 children (56 boys and 50 girls) mean age 3.3 years
- Pulps extirpated, canals irrigated with water and dried with air
- ZOE used to fill canals short of apex to prevent apical extrusion
- Anterior teeth restored with composite and posterior teeth restored with SSC
- Teeth evaluated clinically and post operatively at 6 and 12 months by four different pediatric dentists
- Treatment classified as a failure if one or more of the following clinical signs appeared: pain, swelling, abscess, or fistulous tract
Findings:
-89% success rate for anterior teeth at 6 months and 76% success rate at 12 months postoperatively
-92% success rate for posterior teeth at 6 months and 84% at 12 months postoperatively
-No statistically significant differences found between success rates for maxillary and mandibular teeth at either 6 month or 12 month post-op
-More underfilled teeth failed when compared to those completely filled; overfilling is not preferred to underfilling because of the foreign body reaction which may occur from extrusion of ZOE beyond the root apex
-100% of posterior teeth demonstrated clinical success results at 12 months
-84% of posterior teeth demonstrated radiographic success results at 12 months
Conclusions:
Pulpectomy technique is as effective as for primary posterior teeth as formocresol pulpotomies at 1 year
Assessment of article:
Good article
Risk of Enamel Fluorosis in Nonfluoridated and Optimally Fluoridated Populations
Author(s): David G. Pendrys
Journal: JADA
Volume (number): Volume 131
Month, Year: June 2000
Major topic: Fluorosis
Minor topic(s): Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations
Type of Article: case study
Main Purpose: To evaluate the impact of specific fluoride sources on the prevalence of enamel fluorosis in the population
Overview of method of research: Two groups of children 10 to 14 years of age – one group had grown up in nonfluoridated communities and one group had grown up in optimally fluoridated communities. Trained examiners measured enamel fluorosis using the Fluorosis Risk Index and measured early childhood fluoride exposure using a questionnaire completed by the parent. Author then calculated attributable risk percent estimates, or the proportion of cases of mild-to-moderate enamel fluorosis associated with exposure to specific early fluoride sources, based on logistic regression models.
Findings: Enamel fluorosis in the nonfluoridated study sample was attributed to fluoride supplementation and early tooth brushing behaviors. Enamel fluorosis in the optimally fluoridated study sample was attributed to early tooth brushing behaviors, inappropriate fluoride supplementation and the use of infant formula in the form of a powdered concentrate.
Key points/Summary: Enamel Fluorosis – is a hypomineralization of the enamel caused by the ingestion of an amount of fluoride that is above optimal levels during enamel formation. In severe forms actual breaking of enamel may occur with brown staining or pitting. By advising parents about the best early use of fluoride agents, health professionals play an important role in reducing the prevalence of clinically noticeable enamel fluorosis.
Assessment of article: Fluorosis seems to be a recurring theme from early tooth brushing behaviors. Important to inform parents a pea sized amount of toothpaste to be used only after adequate ability to spit. Usually after age two. Are our ECC study patients really not ingesting too much fluoride from the gel kam parents are applying?
Journal: JADA
Volume (number): Volume 131
Month, Year: June 2000
Major topic: Fluorosis
Minor topic(s): Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations
Type of Article: case study
Main Purpose: To evaluate the impact of specific fluoride sources on the prevalence of enamel fluorosis in the population
Overview of method of research: Two groups of children 10 to 14 years of age – one group had grown up in nonfluoridated communities and one group had grown up in optimally fluoridated communities. Trained examiners measured enamel fluorosis using the Fluorosis Risk Index and measured early childhood fluoride exposure using a questionnaire completed by the parent. Author then calculated attributable risk percent estimates, or the proportion of cases of mild-to-moderate enamel fluorosis associated with exposure to specific early fluoride sources, based on logistic regression models.
Findings: Enamel fluorosis in the nonfluoridated study sample was attributed to fluoride supplementation and early tooth brushing behaviors. Enamel fluorosis in the optimally fluoridated study sample was attributed to early tooth brushing behaviors, inappropriate fluoride supplementation and the use of infant formula in the form of a powdered concentrate.
Key points/Summary: Enamel Fluorosis – is a hypomineralization of the enamel caused by the ingestion of an amount of fluoride that is above optimal levels during enamel formation. In severe forms actual breaking of enamel may occur with brown staining or pitting. By advising parents about the best early use of fluoride agents, health professionals play an important role in reducing the prevalence of clinically noticeable enamel fluorosis.
Assessment of article: Fluorosis seems to be a recurring theme from early tooth brushing behaviors. Important to inform parents a pea sized amount of toothpaste to be used only after adequate ability to spit. Usually after age two. Are our ECC study patients really not ingesting too much fluoride from the gel kam parents are applying?
Primary molar pulp therapy—histological evaluation of failure
Author(s): Waterhouse PJ, Nunn JH, Whitworth JM, Soames JV.
Journal: International Journal of Paediatric Dentistry
Volume (number): Volume 10
Month, Year: 2000
Major topic: Pulpal histology
Minor topic(s): Formocresol vs. Calcium Hydroxide pulpotomies
Type of Article: Research article
Purpose: This paper compares the histological, clinical, and radiographic features of primary molar teeth that showed evidence of clinical and/ or radiographic failure. Further histolgical findings were described in terms of reactionary dentin deposition and internal resorption of the dentin in these involved teeth..
Overview of method of research: The study evaluated 26 female and 26 male patients aged 3.3 to 12.5 years with primary molars requiring vital pulp therapy using either 20% Buckley’s formocresol for 5 minutes or Calcium hydroxide powder. Treated teeth were assessed clinically at 1 month, 6 months, and 12 months then annually thereafter for pain, defective restorations or signs of mobility. Radiographically these teeth were also evaluated for restoration failure, periapical pathology, and resorption. In cases of clinical or readiographic failure, the six teeth that exhibited failure were extracted and five were examined histologically because one tooth fractured during extraction.
Findings: Key points/Summary: Of the 5 teeth extracted, two teeth were from the formocresol group and three teeth were from the calcium hydroxide group. The formocresol specimens showed no dentin bridge formation but showed appositional dentin formation, whereas the other teeth showed dentin bridging in 4 of the 6 canals and the remaining two canals showed appositional dentin formation. Post extraction readiographs of the five teeth revealed pulpal obliteration in 4 of the 5 teeth.
Discussion: The extracted teeth demonstrated a consistent pattern of pulpal obliteration. Interestingly in the successful cases, calcific barriers and dentin bridging were evident in less than 25% of the cases. It was suggested that this may be related to the superimposition of healthy bone and soft tissue masking the bridging inside the pulp. Histologically, the failures may show more reactionary dentin formation as a result of an attempted repair process within pulp tissue. The author suggested that coronal leakage through a leaking restoration and penetration through a porous calcific barrier may cause a clinical failure. Also a tooth that is a poor candidate for a pulpotomy, i.e. an inflamed radicular pulp lacking proper hemorrhage control may lead to failure.
Recommendations/ Conclusions: The author makes the following recommendations based on the findings of this report: 1 Periodic radiographs are needed to monitor pulp healing after vital pulp therapy. 2. If hemorrhage persists after coronal amputation then a pulpotomy is a poor choice for treatment. And 3. A well sealed restoration is essential to prevent bacterial leakage.
Assessment of article: Interesting article with little scientific merit due to the small sample size. However, recommendations are useful.
Journal: International Journal of Paediatric Dentistry
Volume (number): Volume 10
Month, Year: 2000
Major topic: Pulpal histology
Minor topic(s): Formocresol vs. Calcium Hydroxide pulpotomies
Type of Article: Research article
Purpose: This paper compares the histological, clinical, and radiographic features of primary molar teeth that showed evidence of clinical and/ or radiographic failure. Further histolgical findings were described in terms of reactionary dentin deposition and internal resorption of the dentin in these involved teeth..
Overview of method of research: The study evaluated 26 female and 26 male patients aged 3.3 to 12.5 years with primary molars requiring vital pulp therapy using either 20% Buckley’s formocresol for 5 minutes or Calcium hydroxide powder. Treated teeth were assessed clinically at 1 month, 6 months, and 12 months then annually thereafter for pain, defective restorations or signs of mobility. Radiographically these teeth were also evaluated for restoration failure, periapical pathology, and resorption. In cases of clinical or readiographic failure, the six teeth that exhibited failure were extracted and five were examined histologically because one tooth fractured during extraction.
Findings: Key points/Summary: Of the 5 teeth extracted, two teeth were from the formocresol group and three teeth were from the calcium hydroxide group. The formocresol specimens showed no dentin bridge formation but showed appositional dentin formation, whereas the other teeth showed dentin bridging in 4 of the 6 canals and the remaining two canals showed appositional dentin formation. Post extraction readiographs of the five teeth revealed pulpal obliteration in 4 of the 5 teeth.
Discussion: The extracted teeth demonstrated a consistent pattern of pulpal obliteration. Interestingly in the successful cases, calcific barriers and dentin bridging were evident in less than 25% of the cases. It was suggested that this may be related to the superimposition of healthy bone and soft tissue masking the bridging inside the pulp. Histologically, the failures may show more reactionary dentin formation as a result of an attempted repair process within pulp tissue. The author suggested that coronal leakage through a leaking restoration and penetration through a porous calcific barrier may cause a clinical failure. Also a tooth that is a poor candidate for a pulpotomy, i.e. an inflamed radicular pulp lacking proper hemorrhage control may lead to failure.
Recommendations/ Conclusions: The author makes the following recommendations based on the findings of this report: 1 Periodic radiographs are needed to monitor pulp healing after vital pulp therapy. 2. If hemorrhage persists after coronal amputation then a pulpotomy is a poor choice for treatment. And 3. A well sealed restoration is essential to prevent bacterial leakage.
Assessment of article: Interesting article with little scientific merit due to the small sample size. However, recommendations are useful.
Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report
Author(s): Eidelman E, Holan G, Fuks A.
Journal: Pediatric Dentistry
Volume (number): Volume 23, Number 1
Month, Year: January/ February 2001
Major topic: MTA pulpotomies vs. Formocresol
Minor topic(s): none
Type of Article: Research article.
Purpose: This paper evaluates clinically and radiographically the use of MTA and Fomocresol in primary molars with carious pulp exposures.
Overview of method of research: 45 primary molars from 26 children aged 5-12 years of age (mean of 6 years) were randomly assigned to a MTA group or a FC group. The selected teeth were asymptomatic with carious pulp exposures, no evidence of pulp degeneration and an ability to properly restore the teeth. The MTA group had MTA pste placed over the amputated pulp stumps after hemostasis was established. The FC group involved placing a moistened Formocresol pellet placed on the amputated pulp stumps for 5 minutes. A SSC was placed on all teeth over a ZOE base. 32 teeth in 18 children were available for follow-up from 6-30 months. The MTA group consisted of 17 molars, whereas the FC group had 15 teeth
Findings: Key points/Summary: One failure was recorded in the FC group with internal resorption at 17 months. Pulp canal obliteration was the most common finding in 9 of the 32 teeth, 2 in the FC group, and 7 in the MTA group with an average time of detection at 12 months. Almost half of the teeth were followed for only 1 year. The author discussed some advantages of MTA over FC including time of application. MTA was placed over the pulp stumps directly providing the advantage of better sealing ability and stimulating a cytokine release from bone cells to promote hard tissue formation. ZOE is an irritant to the pulp and when used with FC is in direct contact with the pulp.
Conclusion: MTA showed clinical and radiographic success as a pulpotomy medicament after a short term evaluation period.
Assessment of article: Good article which provided background information as to the advantages of MTA. However, it did not discuss the disadvantages of MTA over FC such as cost, and waste. There was some confusion as to the sample size as the paper listed the MTA sample size as 15 and then 17 in the methods and results section
Journal: Pediatric Dentistry
Volume (number): Volume 23, Number 1
Month, Year: January/ February 2001
Major topic: MTA pulpotomies vs. Formocresol
Minor topic(s): none
Type of Article: Research article.
Purpose: This paper evaluates clinically and radiographically the use of MTA and Fomocresol in primary molars with carious pulp exposures.
Overview of method of research: 45 primary molars from 26 children aged 5-12 years of age (mean of 6 years) were randomly assigned to a MTA group or a FC group. The selected teeth were asymptomatic with carious pulp exposures, no evidence of pulp degeneration and an ability to properly restore the teeth. The MTA group had MTA pste placed over the amputated pulp stumps after hemostasis was established. The FC group involved placing a moistened Formocresol pellet placed on the amputated pulp stumps for 5 minutes. A SSC was placed on all teeth over a ZOE base. 32 teeth in 18 children were available for follow-up from 6-30 months. The MTA group consisted of 17 molars, whereas the FC group had 15 teeth
Findings: Key points/Summary: One failure was recorded in the FC group with internal resorption at 17 months. Pulp canal obliteration was the most common finding in 9 of the 32 teeth, 2 in the FC group, and 7 in the MTA group with an average time of detection at 12 months. Almost half of the teeth were followed for only 1 year. The author discussed some advantages of MTA over FC including time of application. MTA was placed over the pulp stumps directly providing the advantage of better sealing ability and stimulating a cytokine release from bone cells to promote hard tissue formation. ZOE is an irritant to the pulp and when used with FC is in direct contact with the pulp.
Conclusion: MTA showed clinical and radiographic success as a pulpotomy medicament after a short term evaluation period.
Assessment of article: Good article which provided background information as to the advantages of MTA. However, it did not discuss the disadvantages of MTA over FC such as cost, and waste. There was some confusion as to the sample size as the paper listed the MTA sample size as 15 and then 17 in the methods and results section
The efficiency of Semiannual Silane Fluoride Varnish Applications: a Two year clinical study in preschool children
Author(s): Petersson L, Twetman S, Pakhomov G
Journal: Journal of Public Health Dentistry
Volume (number):
Month, Year: 1998
Major topic: Efficiency of Silane Fluoride Varnish
Minor topic(s:
Type of Article: Prospective Study
Main Purpose: To study the efficiency of Fluoride Varnish applied twice a year to preschool children
Overview of method of research: 5137 preschool children 4-5 years old where split into a fluoride varnish group and a control group. Both groups received basic preventative treatment including dietary counseling and brushing instructions. In addition the fluoride group received fluoride varnish applications 2x year for 2 years. Caries data was recorded at baseline and at one and two years.
Findings: After two years the mean caries incidence was low and there was no statistical significance between the two groups. The incidence of approximal lesions was significantly lower in the fluoride varnish group than in the control group. More caries reduction was seen in the children with the highest caries prevalence.
Key points/Summary : Children with a history of caries will benefit from fluoride varnish applied 2x a year to help reduce to incidence of approximal caries.
Assessment of article: Great article to highlight the benefit of varnish
Journal: Journal of Public Health Dentistry
Volume (number):
Month, Year: 1998
Major topic: Efficiency of Silane Fluoride Varnish
Minor topic(s:
Type of Article: Prospective Study
Main Purpose: To study the efficiency of Fluoride Varnish applied twice a year to preschool children
Overview of method of research: 5137 preschool children 4-5 years old where split into a fluoride varnish group and a control group. Both groups received basic preventative treatment including dietary counseling and brushing instructions. In addition the fluoride group received fluoride varnish applications 2x year for 2 years. Caries data was recorded at baseline and at one and two years.
Findings: After two years the mean caries incidence was low and there was no statistical significance between the two groups. The incidence of approximal lesions was significantly lower in the fluoride varnish group than in the control group. More caries reduction was seen in the children with the highest caries prevalence.
Key points/Summary : Children with a history of caries will benefit from fluoride varnish applied 2x a year to help reduce to incidence of approximal caries.
Assessment of article: Great article to highlight the benefit of varnish
Evidence-based Use of Fluoride in Contemporary Pediatric Dental Practice
Author(s): Steven M. Adair, DDS
Journal: Pediatric Dentistry
Volume (number): Volume 23, number 2
Month, Year: Conference Paper 2006
Major topic: Fluoride Treatment
Minor topic(s): Use of fluoride in pediatric dental practice
Type of Article: evidence based
Main Purpose: To review clinically evidence for the effectiveness of fluoride options and where possible, combinations of fluoride exposures, and to make recommendations to dental practitioners based on the available evidence for the use of these various approaches in contemporary practice, particularly regarding the use of multiple fluoride sources.
Overview of method of research: Literature Reviews
Findings: Therapeutic use of fluoride for children should focus on regimens that maximize topical contact, preferably in lower-dose, higher-frequency approaches. Twice-daily use of a fluoridated dentifrice for children in optimally fluoridated and fluoride-deficient communities, coupled with professional application of topical fluoride gel, foam, or varnish is currently recommended. The addition of other fluoride regimens should be based on periodic caries risk assessments, and recognizing that the additive effects of multiple fluoride modalities exhibit diminishing returns. Dentifrices with 1,500ppm F had a greater effect in the young permanent dentition than those with lower F concentrations. Higher caries reduction was found in studies in which tooth-brushing was supervised. Those who began brushing with a fluoridated toothpaste prior to age 2 had significantly more severe fluorosis.
Key points/Summary: Currently supplemental fluoride is prescribed on the basis of age, not body weight. Factors to keep in mind while recommending the use of fluoride supplementation: Assay the child’s primary drinking water supply for fluoride content. Consider delaying supplementation until after the eruption of the permanent first molars (systemic fluoride supplementation prior to this age is not strong and the highest risk for fluorosis from fluoride supplements appears to be 3-6 years old). Ensure that the parents understand the risks and benefits of fluoride supplementation. As a safety factor a maximum of 120mg of fluoride supplements should be prescribed at one time (this is a lethal dose for children under 8kg and a toxic dose for children weighing 24kg or less). No good evidence exists to support fluoride supplements for pregnant women. Recommendations for fluoride containing dentifrices: Tooth-brushing should be supervised by an adult, especially once fluoridated toothpaste use has begun, tooth-brushing with fluoridated toothpaste should be done twice daily and older children who are able to expectorate should use more than a pea-sized dab to increase their salivary fluoride levels. Recommendations for fluoride mouth rinses: Should be used one children who demonstrate the ability to swish and expectorate without swallowing (generally six and older), reserved for children who are moderate or high risk or have fixed orthodontic or prosthetic devices, alcohol free preparations should be recommended over those containing alcohol, and little benefit should be expected from fluoride mouthrinses in low-caries-risk children who are already using a fluoridated dentifrice. Recommendations for use of prescription strength fluoride gels: Recommended for patients in fluoride-deficient communities who are at high risk for caries, parents of young children should supervise placement, and application regimens should be limited to the minimum time period deemed necessary for control of dental caries. Gels are recommended for patients with SECC, rampant caries in the mixed and permanent dentition, with reduced salivary flow, wearing prosthetic or orthodontic appliances, and who may be at high risk for dental caries. Recommendations for the clinical use of fluoride gels and foams include: Use caries risk to determine need and frequency, follow pumice prophylaxis with a topical fluoride application, use properly fitted trays to reduce unwanted ingestion, and allow patient to expectorate freely after application and refrain from eating or drinking for 30 minutes following the application. Recommendations for fluoride varnish use: Current recommendation for placement of fluoride varnish at 6-month intervals, have patient refrain from eating or drinking for 30 minutes after the application and have them postpone brushing until the morning after, it appears that fluoride varnish may be superior to fluoride gels and foams in caries reduction.
Assessment of article: very informative
Journal: Pediatric Dentistry
Volume (number): Volume 23, number 2
Month, Year: Conference Paper 2006
Major topic: Fluoride Treatment
Minor topic(s): Use of fluoride in pediatric dental practice
Type of Article: evidence based
Main Purpose: To review clinically evidence for the effectiveness of fluoride options and where possible, combinations of fluoride exposures, and to make recommendations to dental practitioners based on the available evidence for the use of these various approaches in contemporary practice, particularly regarding the use of multiple fluoride sources.
Overview of method of research: Literature Reviews
Findings: Therapeutic use of fluoride for children should focus on regimens that maximize topical contact, preferably in lower-dose, higher-frequency approaches. Twice-daily use of a fluoridated dentifrice for children in optimally fluoridated and fluoride-deficient communities, coupled with professional application of topical fluoride gel, foam, or varnish is currently recommended. The addition of other fluoride regimens should be based on periodic caries risk assessments, and recognizing that the additive effects of multiple fluoride modalities exhibit diminishing returns. Dentifrices with 1,500ppm F had a greater effect in the young permanent dentition than those with lower F concentrations. Higher caries reduction was found in studies in which tooth-brushing was supervised. Those who began brushing with a fluoridated toothpaste prior to age 2 had significantly more severe fluorosis.
Key points/Summary: Currently supplemental fluoride is prescribed on the basis of age, not body weight. Factors to keep in mind while recommending the use of fluoride supplementation: Assay the child’s primary drinking water supply for fluoride content. Consider delaying supplementation until after the eruption of the permanent first molars (systemic fluoride supplementation prior to this age is not strong and the highest risk for fluorosis from fluoride supplements appears to be 3-6 years old). Ensure that the parents understand the risks and benefits of fluoride supplementation. As a safety factor a maximum of 120mg of fluoride supplements should be prescribed at one time (this is a lethal dose for children under 8kg and a toxic dose for children weighing 24kg or less). No good evidence exists to support fluoride supplements for pregnant women. Recommendations for fluoride containing dentifrices: Tooth-brushing should be supervised by an adult, especially once fluoridated toothpaste use has begun, tooth-brushing with fluoridated toothpaste should be done twice daily and older children who are able to expectorate should use more than a pea-sized dab to increase their salivary fluoride levels. Recommendations for fluoride mouth rinses: Should be used one children who demonstrate the ability to swish and expectorate without swallowing (generally six and older), reserved for children who are moderate or high risk or have fixed orthodontic or prosthetic devices, alcohol free preparations should be recommended over those containing alcohol, and little benefit should be expected from fluoride mouthrinses in low-caries-risk children who are already using a fluoridated dentifrice. Recommendations for use of prescription strength fluoride gels: Recommended for patients in fluoride-deficient communities who are at high risk for caries, parents of young children should supervise placement, and application regimens should be limited to the minimum time period deemed necessary for control of dental caries. Gels are recommended for patients with SECC, rampant caries in the mixed and permanent dentition, with reduced salivary flow, wearing prosthetic or orthodontic appliances, and who may be at high risk for dental caries. Recommendations for the clinical use of fluoride gels and foams include: Use caries risk to determine need and frequency, follow pumice prophylaxis with a topical fluoride application, use properly fitted trays to reduce unwanted ingestion, and allow patient to expectorate freely after application and refrain from eating or drinking for 30 minutes following the application. Recommendations for fluoride varnish use: Current recommendation for placement of fluoride varnish at 6-month intervals, have patient refrain from eating or drinking for 30 minutes after the application and have them postpone brushing until the morning after, it appears that fluoride varnish may be superior to fluoride gels and foams in caries reduction.
Assessment of article: very informative
The case for eliminating the use of dietary fluoride supplements for young children
Author(s): Brian A. Burt BDS, MPH, PhD
Journal: Dental Public Health
Volume (number): 59:4
Month, Year: Fall 1999
Major topic: Fluoride Supplementation
Minor topic(s): Fluorosis
Type of Article: Systematic literature review
Main Purpose: To weigh risks vs. benefits of systemic fluoride supplementation
Overview of method of research: The author reviewed the current literature on the efficacy of systemic fluoride supplementation, and the literature on dental fluorosis. Studies were analyzed for both results, and strength of study (e.g. was the study designed well? Can results be considered valid and representative of all populations? Were there some factors not analyzed?)
Findings: Many of the studies that tout the efficacy of systemic fluoride supplementation either had design flaws (non-randomized, non-blinded), or attributed caries rate reduction to systemic effects when most effects may have been localized, topical effects of fluoride in the oral cavity. “Where fluoride supplements are concerned, only a handful of trials meet these (quality criteria) standards. The evidence from these trials is favorable, and is all from studies conducted with school-aged children in whom the supplement was essentially used topically by chewing or permitting slow dissolution in the mouth. It is concluded from these studies that while some preeruptive benefits are possible, the evidence for the efficacy of fluoride supplements when ingested from birth or early infancy is hardly strong enough to offset the disadvantages of such usage.” This study also analyzes the risk of fluorosis and notes that many of the studies that analyze fluorosis categorize it as mild, moderate, or severe. The author argues that in this day and age of increased focus on esthetics, is mild fluorosis an acceptable outcome? The author recommends that the range of 0.05 to 0.07 mg F/kg body weight be used as a maximum for daily fluoride intake to avoid the risk of fluorisis. He also notes that many of the prior fluoride regimens suggested do not take into account the many other avenues by which children are ingesting fluoride e.g. water, juices, toothpaste etc…
Key points/Summary: The topical effect of fluoride seems to be the most beneficial. We should be judicious in prescribing supplementation, and take into account both risks and benefits.
Assessment of article: umm….. Yep.
Journal: Dental Public Health
Volume (number): 59:4
Month, Year: Fall 1999
Major topic: Fluoride Supplementation
Minor topic(s): Fluorosis
Type of Article: Systematic literature review
Main Purpose: To weigh risks vs. benefits of systemic fluoride supplementation
Overview of method of research: The author reviewed the current literature on the efficacy of systemic fluoride supplementation, and the literature on dental fluorosis. Studies were analyzed for both results, and strength of study (e.g. was the study designed well? Can results be considered valid and representative of all populations? Were there some factors not analyzed?)
Findings: Many of the studies that tout the efficacy of systemic fluoride supplementation either had design flaws (non-randomized, non-blinded), or attributed caries rate reduction to systemic effects when most effects may have been localized, topical effects of fluoride in the oral cavity. “Where fluoride supplements are concerned, only a handful of trials meet these (quality criteria) standards. The evidence from these trials is favorable, and is all from studies conducted with school-aged children in whom the supplement was essentially used topically by chewing or permitting slow dissolution in the mouth. It is concluded from these studies that while some preeruptive benefits are possible, the evidence for the efficacy of fluoride supplements when ingested from birth or early infancy is hardly strong enough to offset the disadvantages of such usage.” This study also analyzes the risk of fluorosis and notes that many of the studies that analyze fluorosis categorize it as mild, moderate, or severe. The author argues that in this day and age of increased focus on esthetics, is mild fluorosis an acceptable outcome? The author recommends that the range of 0.05 to 0.07 mg F/kg body weight be used as a maximum for daily fluoride intake to avoid the risk of fluorisis. He also notes that many of the prior fluoride regimens suggested do not take into account the many other avenues by which children are ingesting fluoride e.g. water, juices, toothpaste etc…
Key points/Summary: The topical effect of fluoride seems to be the most beneficial. We should be judicious in prescribing supplementation, and take into account both risks and benefits.
Assessment of article: umm….. Yep.
Light-cured Calcium Hydroxide vs Formocresol in Human Primary Molar Pulpotomies: A Randomized Controlled Trial
Author(s): Derek Zurn, DDS, N. Sue Seale, DDS
Journal: Pediatric Dentistry
Volume (number): Volume 30/ No. 1
Month, Year: January/ February 2008
Major topic: Calcium Hydroxide vs Formocresol in primary pulpotomies
Type of Article: Prospective Study
Main Purpose: To compare light-cured calcium hydroxide with diluted formocresol for its success as a primary molar pulpotomy medicant
Overview of method of research: Twenty patients (thirty four pairs of teeth) were selected with at least two matching, asymptomatic, contralateral primary molars requiring vital pulpotomies. Matched teeth in each patient were randomized to receive either calcium hydroxide or Formocresol as a pulpotomy medicament. All teeth were placed with stainless steel crowns and followed clinically and radiographically for one year or greater. The radiographs were evaluated for signs of pathology.
Findings: Clinical success for calcium hydroxide and Formocresol at twelve months or less were similar at 94% success rate for calcium hydroxide and 97% for formocresol. Beyond twelve months, clinical success varied more with calcium hydroxide at 84% and formocresol at 97%. Overall combined success rates were lower for calcium hydroxide than for formocresol.
Key points/Summary: The visible light-cured form of calcium hydroxide does not result in improved clinical or radiographic findings as a primary tooth pulpotomy agent compared with formocresol. Calcium hydroxide does not seem to be a viable alternative to diluted formocresol as a pulpotomy agent.
Assessment of article: Study proves why nobody is using calcium hydroxide as a pulpotomy agent.
Journal: Pediatric Dentistry
Volume (number): Volume 30/ No. 1
Month, Year: January/ February 2008
Major topic: Calcium Hydroxide vs Formocresol in primary pulpotomies
Type of Article: Prospective Study
Main Purpose: To compare light-cured calcium hydroxide with diluted formocresol for its success as a primary molar pulpotomy medicant
Overview of method of research: Twenty patients (thirty four pairs of teeth) were selected with at least two matching, asymptomatic, contralateral primary molars requiring vital pulpotomies. Matched teeth in each patient were randomized to receive either calcium hydroxide or Formocresol as a pulpotomy medicament. All teeth were placed with stainless steel crowns and followed clinically and radiographically for one year or greater. The radiographs were evaluated for signs of pathology.
Findings: Clinical success for calcium hydroxide and Formocresol at twelve months or less were similar at 94% success rate for calcium hydroxide and 97% for formocresol. Beyond twelve months, clinical success varied more with calcium hydroxide at 84% and formocresol at 97%. Overall combined success rates were lower for calcium hydroxide than for formocresol.
Key points/Summary: The visible light-cured form of calcium hydroxide does not result in improved clinical or radiographic findings as a primary tooth pulpotomy agent compared with formocresol. Calcium hydroxide does not seem to be a viable alternative to diluted formocresol as a pulpotomy agent.
Assessment of article: Study proves why nobody is using calcium hydroxide as a pulpotomy agent.
Vital pulp therapy with new materials for primary teeth: New directions and treatment perspectives
Author(s): Fuks, A
Journal: Pediatric Dentistry
Volume (number): 30/NO3
Month, Year: May/June 2008
Major topic: Vital pulp therapy
Minor topic(s:
Type of Article: A review
Main Purpose: To review the different forms of vital pulp therapy and the different medicaments that can be used.
Overview of method of research: N/A
Findings: Indirect pulp treatment has been reported in several articles as a successful technique in primary teeth and it is now recommended as an appropriate technique in symptom-free primary teeth with deep caries as long as a proper leakage-free restoration is placed. Direct pulp capping is still not recommended for primary teeth but can be successful on immature permanent teeth. Although a recent article has shown some success with direct pulp caps in primary teeth using MTA. Pulpotomy is still the most common technique used for symptom-free cariously exposed primary molars. In 2004 the International Agency for Research on Cancer classified formaldehyde as a carcinogenic for humans. It has also been determined that there is sufficient evidence that formaldehde causes nasopharyngeal cancer in humans, and “strong but not sufficient evidence” for leukemia. Another study published stated that formaldehyde is not a potent human carcinogen if there is minimal exposure. Currently, there is no correlation between formocresol pulpotomies and cancer. Many studies have been done comparing formocresol and MTA, formocresol and ferric sulfate, and formocresol and calcium hydroxide with varying result. See chart on 214 for summaries. MTA showed better results than FC in all cases. Ferric Sulfate was comparable to FC. Calcium hydroxide had less favorable results than FC. Sodium hypochlorite has been used recently with promising results but the study had a small sample size and a short 1 year follow-up.
Key points/Summary: There are many different ways to treat vital pulps and review articles like this help us to compare the different treatment modalities available.
Assessment of article: A must read article! A quick side note: At an office visit I did recently in Las Vegas the pediatric dentists were using hydrogen peroxide as the medicament for pulpotomies and have been doing that for years and are very happy with it.
Journal: Pediatric Dentistry
Volume (number): 30/NO3
Month, Year: May/June 2008
Major topic: Vital pulp therapy
Minor topic(s:
Type of Article: A review
Main Purpose: To review the different forms of vital pulp therapy and the different medicaments that can be used.
Overview of method of research: N/A
Findings: Indirect pulp treatment has been reported in several articles as a successful technique in primary teeth and it is now recommended as an appropriate technique in symptom-free primary teeth with deep caries as long as a proper leakage-free restoration is placed. Direct pulp capping is still not recommended for primary teeth but can be successful on immature permanent teeth. Although a recent article has shown some success with direct pulp caps in primary teeth using MTA. Pulpotomy is still the most common technique used for symptom-free cariously exposed primary molars. In 2004 the International Agency for Research on Cancer classified formaldehyde as a carcinogenic for humans. It has also been determined that there is sufficient evidence that formaldehde causes nasopharyngeal cancer in humans, and “strong but not sufficient evidence” for leukemia. Another study published stated that formaldehyde is not a potent human carcinogen if there is minimal exposure. Currently, there is no correlation between formocresol pulpotomies and cancer. Many studies have been done comparing formocresol and MTA, formocresol and ferric sulfate, and formocresol and calcium hydroxide with varying result. See chart on 214 for summaries. MTA showed better results than FC in all cases. Ferric Sulfate was comparable to FC. Calcium hydroxide had less favorable results than FC. Sodium hypochlorite has been used recently with promising results but the study had a small sample size and a short 1 year follow-up.
Key points/Summary: There are many different ways to treat vital pulps and review articles like this help us to compare the different treatment modalities available.
Assessment of article: A must read article! A quick side note: At an office visit I did recently in Las Vegas the pediatric dentists were using hydrogen peroxide as the medicament for pulpotomies and have been doing that for years and are very happy with it.
Rationale for the timing of the first oral evaluation
Author(s): Arthur J Nowak DMD
Journal: Pediatric Dentistry
Volume (number): 19:1
Month, Year: 1997
Major topic: purpose of well-child dental visits
Minor topic(s): n/a
Type of Article: review article
Main Purpose: to summarize the keystones of the first oral evaluation and provide multiple literature references for further review of each topic
Overview of method of research: literature review
Findings/Key points/Summary: evidence about oral disease support the first dental visit occurring at age one; Physicians can assist by recommending that a child see a dentist by age one. Topics to be reviewed with the parent during this visit include: non-nutritive sucking, fluorosis, trauma management, anticipatory guidance, fluoride assessment, feeding management, early childhood caries, and presence of oral bacteria.
Assessment of article: keep this article close at hand when speaking to parents/friends/colleagues about the importance of the first dental visit
Journal: Pediatric Dentistry
Volume (number): 19:1
Month, Year: 1997
Major topic: purpose of well-child dental visits
Minor topic(s): n/a
Type of Article: review article
Main Purpose: to summarize the keystones of the first oral evaluation and provide multiple literature references for further review of each topic
Overview of method of research: literature review
Findings/Key points/Summary: evidence about oral disease support the first dental visit occurring at age one; Physicians can assist by recommending that a child see a dentist by age one. Topics to be reviewed with the parent during this visit include: non-nutritive sucking, fluorosis, trauma management, anticipatory guidance, fluoride assessment, feeding management, early childhood caries, and presence of oral bacteria.
Assessment of article: keep this article close at hand when speaking to parents/friends/colleagues about the importance of the first dental visit
Randomized Clinical Trial of the Effect of Prenatal Fluoride Supplements in Preventing Dental Caries
Author(s): Leverett DH, et al.
Journal: Caries Research
Volume (number): 31:174-179
Month, Year: 1997
Major topic: effect of prenatal fluoride supplements in preventing caries in the deciduous dentition
Minor topic(s): relationship between prenatal fluoride and fluorosis in children
Type of Article: clinical research article
Main Purpose: to test the hypothesis that prenatal fluoride supplementation reduced caries in children
Overview of method of research: randomized, double-blinded study; 1400 women in their first-trimester of pregnancy and living in fluoride deficient communities were randomly assigned to one of two groups: treatment and control. Fluoride-deficient was defined as less than 0.3 ppm. During the last 6 months of pregnancy, the treatment group received a 1 mg tablet of fluoride daily; during this same time period, the control group received a placebo tablet. The fluoride tablet contained 2.2 mg of sodium fluoride which yields 1 mg of active fluoride. All participants were provided with post-natal fluoride supplements. From birth until the 3rd birthday, the mothers dispensed the appropriate fluoride dosage to their children. Each child was examined at 3 years of age for DFS without radiographs. Each child was then examined at 5 years of age for DFS without radiographs. At this latter visit, the children were also examined for fluorosis. Compliance was measured using self-reported information and by recording when new supplements were requested. 20% of children were lost to follow-up b the time of the 3-year examination and an additional 15% were lost between the 3-year and 5-year examination periods.
Findings: Compliance during the prenatal period was found to be 88% adherence. There were no statistically significant differences between the two groups for caries status. Of the 798 children, 26 had mild fluorosis (using Dean’s score). The maxillary second molar was the tooth most commonly found with fluorosis. There was no statistically significant difference between the two groups for fluorosis.
Key points/Summary: prenatal fluoride does not have a strong caries-preventive effect on children; the authors do point out that the low levels of caries in both groups could be due to the high level of compliance in postnatal fluoride use.
Assessment of article: Well-constructed research article.
Journal: Caries Research
Volume (number): 31:174-179
Month, Year: 1997
Major topic: effect of prenatal fluoride supplements in preventing caries in the deciduous dentition
Minor topic(s): relationship between prenatal fluoride and fluorosis in children
Type of Article: clinical research article
Main Purpose: to test the hypothesis that prenatal fluoride supplementation reduced caries in children
Overview of method of research: randomized, double-blinded study; 1400 women in their first-trimester of pregnancy and living in fluoride deficient communities were randomly assigned to one of two groups: treatment and control. Fluoride-deficient was defined as less than 0.3 ppm. During the last 6 months of pregnancy, the treatment group received a 1 mg tablet of fluoride daily; during this same time period, the control group received a placebo tablet. The fluoride tablet contained 2.2 mg of sodium fluoride which yields 1 mg of active fluoride. All participants were provided with post-natal fluoride supplements. From birth until the 3rd birthday, the mothers dispensed the appropriate fluoride dosage to their children. Each child was examined at 3 years of age for DFS without radiographs. Each child was then examined at 5 years of age for DFS without radiographs. At this latter visit, the children were also examined for fluorosis. Compliance was measured using self-reported information and by recording when new supplements were requested. 20% of children were lost to follow-up b the time of the 3-year examination and an additional 15% were lost between the 3-year and 5-year examination periods.
Findings: Compliance during the prenatal period was found to be 88% adherence. There were no statistically significant differences between the two groups for caries status. Of the 798 children, 26 had mild fluorosis (using Dean’s score). The maxillary second molar was the tooth most commonly found with fluorosis. There was no statistically significant difference between the two groups for fluorosis.
Key points/Summary: prenatal fluoride does not have a strong caries-preventive effect on children; the authors do point out that the low levels of caries in both groups could be due to the high level of compliance in postnatal fluoride use.
Assessment of article: Well-constructed research article.
Infant Oral Health Care: A survey of general dentists, pediatric dentists, and Pediatricians in Virginia
Author(s): Brickhouse T, Unkel J, Kancitis I, Best A, Davis R
Journal: Pediatric Dentistry
Volume (number): 30/NO 2
Month, Year: Mar/ Apr 2008
Major topic: Infant oral health
Minor topic(s:
Type of Article: A survey
Main Purpose: To evaluate medical and dental providers current knowledge and experience in infant oral health.
Overview of method of research: 300 randomly selected pediatricians, 300 randomly selected general dentists, and all the pediatric dentists in Virginia (122) were sent surveys consisting of 17 questions regarding routine infant oral health care protocol. Demographic data was also obtained.
Findings: 379 surveys were obtained 128 general dentists, 121 pediatricians, 93 pediatric dentists. 55% of general dentists report not treating children 0-36 months. 74% of pediatric dentists report that children should be seen by their dentist within the first year, and only 12% of general dentists and 5% of pediatricians recommend this. (this is written differently in the chart on page 149). 77% of general dentists, 75% of pediatricians, and 80% of pediatric dentists responded that both dentists and pediatricians are responsible for infant oral health care.
Key points/Summary: More education is needed in both the medical and dental communities about infant oral health care.
Assessment of article: Great article would like to see it done in more states besides Virginia.
Journal: Pediatric Dentistry
Volume (number): 30/NO 2
Month, Year: Mar/ Apr 2008
Major topic: Infant oral health
Minor topic(s:
Type of Article: A survey
Main Purpose: To evaluate medical and dental providers current knowledge and experience in infant oral health.
Overview of method of research: 300 randomly selected pediatricians, 300 randomly selected general dentists, and all the pediatric dentists in Virginia (122) were sent surveys consisting of 17 questions regarding routine infant oral health care protocol. Demographic data was also obtained.
Findings: 379 surveys were obtained 128 general dentists, 121 pediatricians, 93 pediatric dentists. 55% of general dentists report not treating children 0-36 months. 74% of pediatric dentists report that children should be seen by their dentist within the first year, and only 12% of general dentists and 5% of pediatricians recommend this. (this is written differently in the chart on page 149). 77% of general dentists, 75% of pediatricians, and 80% of pediatric dentists responded that both dentists and pediatricians are responsible for infant oral health care.
Key points/Summary: More education is needed in both the medical and dental communities about infant oral health care.
Assessment of article: Great article would like to see it done in more states besides Virginia.
A Survey of Primary Tooth Pulp Therapy as Taught in US Dental Schools and Practiced by Diplomats of the American Board of Pediatric Dentistry
Author(s): Bryan Dunston, DDS; James A. Coll, DMD, MS
Journal: Pediatric Dentistry
Volume (number): 30(1)
Month, Year: Jan / Feb 2008
Major topic: current pulp therapy practice
Minor topic(s):
Type of Article: research – survey
Main Purpose: to repeat a 1997 survey of current pulp therapy practice and to compare results.
Overview of method of research: The Primosch et al survey of 1997 was replicated. The survey was sent to all 56 US dental school pediatric dentistry departments and to ABPD diplomats. The predoctoral program directors were asked to complete the survey according to the department’s philosophy on primary tooth pulp therapy. The diplomats were asked to complete the survey according to their philosophy for pulp therapy in primary teeth. The survey contained 27 questions and was divided into 2 parts. Part I was designed to ascertain which primary tooth pulp therapies were taught in predoctoral pediatric dental programs or used in practice by the diplomats. Part II presented various clinical scenarios for pulp therapy in primary teeth.
Findings: In 2005 significantly more directors taught and diplomats practiced the use of glass ionomer cement for IPT, and not re-entering a tooth after placing an IPC. Conversely, significantly fewer directors taught and diplomats practiced the use of calcium hydroxide base and ZOE base for IPT. Calcium hydroxide remained the base of choice for direct pulp caps, but more predoctoral pediatric dental programs gave students the choice of CaOH or glass ionomer cement as a base for DPC in primary teeth in 2005 as compared to 1997. For pulpotomies, in 2005 significantly more dental schools taught and diplomats used ferric sulfate compared to 1997, although formocresol remained the medicament of choice. ZOE remained the base of choice from 1997 to 2005. For pulpectomies, hand instruments remained the debridement method of choice from 1997 to 2005, and sodium hypochlorite continued to be preferred canal irrigant from 1997 to 2005. ZOE remained the material of choice for obturation of root canals in 2005, but significantly more diplomats and directors advocated other filler pastes such as CaOH and iodoform than in 1997. Significantly fewer diplomats and directors used or taught 2-appointment pulpectomies compared to 1997 directors.
Key points/Summary: The increase in the teaching of IPT in 2005 may reflect the mounting evidence showing IPT success rates of greater than 90%. However, there is no reimbursement code for IPT. There is also evidence that a 1-appointment IPT is highly successful. The AAPD guidelines endorse CaOH, ZOE, and glass ionomer cement for IPT’s, but the shift to GI may reflect using the GI cement for SSC’s as a 1-step cement and IPT liner. The AAPD guidelines state that DPC is indicated only for small mechanical or traumatic exposures. This study shows there is an increasing trend to teach and use DPC. In 2005 there was a large decrease in the teaching of formocresol for pulpotomy, and a trend toward ferric sulfate. This shift may have occurred due to rising concerns over systemic distribution of formocresol. In the clinical scenarios, there were some disagreements over pulp therapy in 2 cases: uncontrolled bleeding during pulpotomy and a primary molar with a sinus tract. Some directors and diplomats are not applying the AAPD pulp therapy guidelines. Significantly fewer diplomats and directors advocated 2-appointment pulpectomy technique; many studies have shown that 1-appointment pulpectomies have high clinical success rates.
Assessment of article: Interesting to know what people are doing out there.
Journal: Pediatric Dentistry
Volume (number): 30(1)
Month, Year: Jan / Feb 2008
Major topic: current pulp therapy practice
Minor topic(s):
Type of Article: research – survey
Main Purpose: to repeat a 1997 survey of current pulp therapy practice and to compare results.
Overview of method of research: The Primosch et al survey of 1997 was replicated. The survey was sent to all 56 US dental school pediatric dentistry departments and to ABPD diplomats. The predoctoral program directors were asked to complete the survey according to the department’s philosophy on primary tooth pulp therapy. The diplomats were asked to complete the survey according to their philosophy for pulp therapy in primary teeth. The survey contained 27 questions and was divided into 2 parts. Part I was designed to ascertain which primary tooth pulp therapies were taught in predoctoral pediatric dental programs or used in practice by the diplomats. Part II presented various clinical scenarios for pulp therapy in primary teeth.
Findings: In 2005 significantly more directors taught and diplomats practiced the use of glass ionomer cement for IPT, and not re-entering a tooth after placing an IPC. Conversely, significantly fewer directors taught and diplomats practiced the use of calcium hydroxide base and ZOE base for IPT. Calcium hydroxide remained the base of choice for direct pulp caps, but more predoctoral pediatric dental programs gave students the choice of CaOH or glass ionomer cement as a base for DPC in primary teeth in 2005 as compared to 1997. For pulpotomies, in 2005 significantly more dental schools taught and diplomats used ferric sulfate compared to 1997, although formocresol remained the medicament of choice. ZOE remained the base of choice from 1997 to 2005. For pulpectomies, hand instruments remained the debridement method of choice from 1997 to 2005, and sodium hypochlorite continued to be preferred canal irrigant from 1997 to 2005. ZOE remained the material of choice for obturation of root canals in 2005, but significantly more diplomats and directors advocated other filler pastes such as CaOH and iodoform than in 1997. Significantly fewer diplomats and directors used or taught 2-appointment pulpectomies compared to 1997 directors.
Key points/Summary: The increase in the teaching of IPT in 2005 may reflect the mounting evidence showing IPT success rates of greater than 90%. However, there is no reimbursement code for IPT. There is also evidence that a 1-appointment IPT is highly successful. The AAPD guidelines endorse CaOH, ZOE, and glass ionomer cement for IPT’s, but the shift to GI may reflect using the GI cement for SSC’s as a 1-step cement and IPT liner. The AAPD guidelines state that DPC is indicated only for small mechanical or traumatic exposures. This study shows there is an increasing trend to teach and use DPC. In 2005 there was a large decrease in the teaching of formocresol for pulpotomy, and a trend toward ferric sulfate. This shift may have occurred due to rising concerns over systemic distribution of formocresol. In the clinical scenarios, there were some disagreements over pulp therapy in 2 cases: uncontrolled bleeding during pulpotomy and a primary molar with a sinus tract. Some directors and diplomats are not applying the AAPD pulp therapy guidelines. Significantly fewer diplomats and directors advocated 2-appointment pulpectomy technique; many studies have shown that 1-appointment pulpectomies have high clinical success rates.
Assessment of article: Interesting to know what people are doing out there.
Caries Risk Assessment Practices Among Texas Pediatric Dentists
Author(s): Trueblood R. Kerins CA., and Seale NS
Journal: Pediatric Dentistry
Volume (number): Volume 30, Number 1
Month, Year: January, February 2008
Major topic: Caries Risk Assessment in private practice
Minor topic(s): none
Type of Article: Survey
Purpose: This paper evaluates how caries risk assessment is practiced by Texas pediatric dentists. It further determines if the practice is doing a CRA, if they are documenting the CRA, who is performing the CRA, and if the practitioner believes continuing education in CRA is needed.
Overview of method of research: A 20 question survey was sent to all 204 members of the TX Academy of pediatric dentistry which asked demographic information about the practitioner and the practice as well as specific questions regarding the use of CRA in practice.
Findings: Key points/Summary: Sixty two percent of the surveys were returned. The most common risk factors for decay were diet, caries history, and SES. Most dentists provided oral hygiene instruction, and education to patients about dietary risk factors during a typical recall appointment. Only 2/3rds placed sealants for prevention, with 17% providing fluoride testing and less than 2% used salivary flow testing or bacterial testing during recall appointments. The types of preventive treatments used in the dental practices included sealants (92%), fluoride treatments (92%), detailed oral hygiene instruction (87%), increased recall frequency (76%),, and diet counseling (65%). Chemotherapy i.e. chlorhexidine rinses and xylitol are used less commonly in practice. It was interesting to note that the most common risk factor was diet, yet 67% felt it was important to discuss at a recall visit, and 16% never provided diet counseling at a recall visit. Caries risk assessment was mainly performed by verbal questions (69%), while 39% reported using both verbal and written CRA’s. However most reported documenting preventive treatment recommendations in the chart. It was noted that in 76% of the practices that multiple people whether hygienists, assistants, or dentists completed the CRA on the patients.
Conclusions: The author found that there was a need for a more detailed CRA, a more customized treatment plan based on the findings of the CRA, and lastly, better documentation of the caries risk status of the pediatric patient.
Assessment of article: Nonscientific article illustrating the need for a more standardized method of implementing a CRA in pediatric dental practice. Good article pointing out our deficiencies in private practice.
Journal: Pediatric Dentistry
Volume (number): Volume 30, Number 1
Month, Year: January, February 2008
Major topic: Caries Risk Assessment in private practice
Minor topic(s): none
Type of Article: Survey
Purpose: This paper evaluates how caries risk assessment is practiced by Texas pediatric dentists. It further determines if the practice is doing a CRA, if they are documenting the CRA, who is performing the CRA, and if the practitioner believes continuing education in CRA is needed.
Overview of method of research: A 20 question survey was sent to all 204 members of the TX Academy of pediatric dentistry which asked demographic information about the practitioner and the practice as well as specific questions regarding the use of CRA in practice.
Findings: Key points/Summary: Sixty two percent of the surveys were returned. The most common risk factors for decay were diet, caries history, and SES. Most dentists provided oral hygiene instruction, and education to patients about dietary risk factors during a typical recall appointment. Only 2/3rds placed sealants for prevention, with 17% providing fluoride testing and less than 2% used salivary flow testing or bacterial testing during recall appointments. The types of preventive treatments used in the dental practices included sealants (92%), fluoride treatments (92%), detailed oral hygiene instruction (87%), increased recall frequency (76%),, and diet counseling (65%). Chemotherapy i.e. chlorhexidine rinses and xylitol are used less commonly in practice. It was interesting to note that the most common risk factor was diet, yet 67% felt it was important to discuss at a recall visit, and 16% never provided diet counseling at a recall visit. Caries risk assessment was mainly performed by verbal questions (69%), while 39% reported using both verbal and written CRA’s. However most reported documenting preventive treatment recommendations in the chart. It was noted that in 76% of the practices that multiple people whether hygienists, assistants, or dentists completed the CRA on the patients.
Conclusions: The author found that there was a need for a more detailed CRA, a more customized treatment plan based on the findings of the CRA, and lastly, better documentation of the caries risk status of the pediatric patient.
Assessment of article: Nonscientific article illustrating the need for a more standardized method of implementing a CRA in pediatric dental practice. Good article pointing out our deficiencies in private practice.
“New Age” Pulp Therapy: Personal Thoughts on a Hot Debate
Author(s): Paula Jane Waterhouse
Journal: Pediatric Dentistry
Volume (number): 30, #3
Month, Year: May/June 2008
Major topic: Vital pulp therapy and use of formocresol
Minor topics:
Type of Article: A review
Main Purpose: To review reasons against the use of formaldehyde-containing preparations in dental care of children
Findings:
Contrary to the idea that primary tooth pulps present a more pronounced inflammatory reaction compared with permanent teeth, recent data has demonstrated equality in dentitions for the degree of vasodilation and angiogenesis in response to a caries insult. Primary teeth have a good potential for tissue repair and healing. In light of these recent findings approaches to pulp therapy need to be updated.
54% of the 184 surveyed British pediatric dentists expressed concern over the safety of formocresol
Although the amount of formocresol used in practice is small (20% dilution of Buckley’s formocresol) further research is needed to investigate effects on both patient and clinicians over long-term use in a clinical setting. Currently there is nothing published related to the possible levels formaldehyde and cresol vapor in the dental working environment.
Formaldehyde passes into tissues such as mucous membranes readily but uptake into skin is poor. Tricresol is said to decrease the solubility and diffusion of formaldehyde, thereby reducing movement out of the root canal. However, because tricresol can disrupt cell membrane lipid components some fear potentiation of local caustic effects of formaldehyde could occur.
Formaldehyde is an irritant to the eyes and respiratory tract in amounts as low as 0.1ppm in some humans. Workers exposed to chronic levels of 0.2-2ppm exhibit mild epithelial lesions. In a 2005 incident a 1-ounce spill of Buckley’s formocresol caused a dental clinic to close for the rest of the day and 10 individuals required emergency room treatment for breathing difficulty. The UK’s Health and Safety executive branch states that there is “increased concern” for the carcinogenic potential of formaldehyde in humans, particularly in relation to nasopharyngeal cancer, but data falls short of producing conclusive evidence.
Alternative techniques for vital pulp therapy of irreversibly inflamed teeth may not be as successful as formocresol. In this area further research is needed if we are to move away from the use of formocresol.
Current UK guidelines reflect a shift away from the use of formocresol, however it remains listed as a medicament option.
Key points/Summary: Although there is an obvious emphasis on moving away from the use of formocresol in pediatric dentistry an adequate alternative must be found before this occurs.
Assessment of article: Fair article. Good superficial review of the negative aspects of using formocresol. Would have liked to see more substance.
Journal: Pediatric Dentistry
Volume (number): 30, #3
Month, Year: May/June 2008
Major topic: Vital pulp therapy and use of formocresol
Minor topics:
Type of Article: A review
Main Purpose: To review reasons against the use of formaldehyde-containing preparations in dental care of children
Findings:
Contrary to the idea that primary tooth pulps present a more pronounced inflammatory reaction compared with permanent teeth, recent data has demonstrated equality in dentitions for the degree of vasodilation and angiogenesis in response to a caries insult. Primary teeth have a good potential for tissue repair and healing. In light of these recent findings approaches to pulp therapy need to be updated.
54% of the 184 surveyed British pediatric dentists expressed concern over the safety of formocresol
Although the amount of formocresol used in practice is small (20% dilution of Buckley’s formocresol) further research is needed to investigate effects on both patient and clinicians over long-term use in a clinical setting. Currently there is nothing published related to the possible levels formaldehyde and cresol vapor in the dental working environment.
Formaldehyde passes into tissues such as mucous membranes readily but uptake into skin is poor. Tricresol is said to decrease the solubility and diffusion of formaldehyde, thereby reducing movement out of the root canal. However, because tricresol can disrupt cell membrane lipid components some fear potentiation of local caustic effects of formaldehyde could occur.
Formaldehyde is an irritant to the eyes and respiratory tract in amounts as low as 0.1ppm in some humans. Workers exposed to chronic levels of 0.2-2ppm exhibit mild epithelial lesions. In a 2005 incident a 1-ounce spill of Buckley’s formocresol caused a dental clinic to close for the rest of the day and 10 individuals required emergency room treatment for breathing difficulty. The UK’s Health and Safety executive branch states that there is “increased concern” for the carcinogenic potential of formaldehyde in humans, particularly in relation to nasopharyngeal cancer, but data falls short of producing conclusive evidence.
Alternative techniques for vital pulp therapy of irreversibly inflamed teeth may not be as successful as formocresol. In this area further research is needed if we are to move away from the use of formocresol.
Current UK guidelines reflect a shift away from the use of formocresol, however it remains listed as a medicament option.
Key points/Summary: Although there is an obvious emphasis on moving away from the use of formocresol in pediatric dentistry an adequate alternative must be found before this occurs.
Assessment of article: Fair article. Good superficial review of the negative aspects of using formocresol. Would have liked to see more substance.
Determining the Prevalence and Risk factors for Early Childhood Caries in a Community Dental Health Clinic
Author(s): Schroth, R.J., Cheba, V.
Journal: Pediatric Dentistry
Volume (number): 29
Month, Year: 2007
Major topic: Prevalence of ECC among patients at a community dental clinic (Mount Carmel Dental Clinic) in Winnipeg, Manitoba
Minor topics: Summarize trends among those patients
Type of Article: Chart Review / Retrospective
Main Purpose:
1) Determine prevalence of ECC among young children accessing dental services at a community dental clinic
2) Identify factors associated with ECC
3) Determine % of patients who received treatment for ECC in the clinic and the number referred to a specialist
Overview of method of research:
Review of 834 charts
Study population comprised of children younger then 72 months who attended the clinic between 1991 and 2004
Data collection form used contained the following:
1) household and family characteristics
2) dental visitation status
3) childhood issues
4) demographics
10% of all charts reviewed again to check for reliability of variables collected
Findings:
• 71% of patients had ECC
• 53% of the subjects were male
• 70% of patients belonged to families consisting of 4 or more persons, 80% of children had at least 1 other sibling
• Average family income $1,481 Canadian dollars
• Average age of first dental visit was 50 months (only 5 children seen by dentist around 1 year)
• 19% were referred to another provider
Conclusions
1) Majority of preschool children attending Mount Carmel Clinic had ECC
2) Factors significantly associated with ECC on logistic regression analysis include: sex of child, low monthly household income, residing with both parents, history of failed dental visits, first dental visit at no earlier then 24 months of age
3) Efforts should me made to follow current recommendations for first dental visit by 12 months of age
Assessment of article
Good article.
Limitations include:
• Missing data on family income, total family size, medical conditions, parental employment status
• Difficulty deciphering providers progress notes; differing chart documentation habits of the providers; format of charts changed during the period under review
• Charting errors
• Difficulty in establishing cause and effect relationship
Journal: Pediatric Dentistry
Volume (number): 29
Month, Year: 2007
Major topic: Prevalence of ECC among patients at a community dental clinic (Mount Carmel Dental Clinic) in Winnipeg, Manitoba
Minor topics: Summarize trends among those patients
Type of Article: Chart Review / Retrospective
Main Purpose:
1) Determine prevalence of ECC among young children accessing dental services at a community dental clinic
2) Identify factors associated with ECC
3) Determine % of patients who received treatment for ECC in the clinic and the number referred to a specialist
Overview of method of research:
Review of 834 charts
Study population comprised of children younger then 72 months who attended the clinic between 1991 and 2004
Data collection form used contained the following:
1) household and family characteristics
2) dental visitation status
3) childhood issues
4) demographics
10% of all charts reviewed again to check for reliability of variables collected
Findings:
• 71% of patients had ECC
• 53% of the subjects were male
• 70% of patients belonged to families consisting of 4 or more persons, 80% of children had at least 1 other sibling
• Average family income $1,481 Canadian dollars
• Average age of first dental visit was 50 months (only 5 children seen by dentist around 1 year)
• 19% were referred to another provider
Conclusions
1) Majority of preschool children attending Mount Carmel Clinic had ECC
2) Factors significantly associated with ECC on logistic regression analysis include: sex of child, low monthly household income, residing with both parents, history of failed dental visits, first dental visit at no earlier then 24 months of age
3) Efforts should me made to follow current recommendations for first dental visit by 12 months of age
Assessment of article
Good article.
Limitations include:
• Missing data on family income, total family size, medical conditions, parental employment status
• Difficulty deciphering providers progress notes; differing chart documentation habits of the providers; format of charts changed during the period under review
• Charting errors
• Difficulty in establishing cause and effect relationship
Regerneration Potential of the Young Permanent Tooth: What Does the Future Hold?
Author(s): Hargreaves KM, Giesler, T, Henry M, Wang Y.
Journal: Pediatric Dentistry
Volume (number): Volume 30, Number 3
Month, Year: May/June 08
Major topic: Regeneration of Pulp
Minor topic(s): none
Type of Article: Literature Review
Purpose: This article reviews the literature as it relates to biologically based endodontic therapies like pulp revascularization and regeneration of a vital pulp/ dentin complex. The author discusses a format for future research into this area of endodontics.
Findings: Several parameters have been established in the literature to promote regeneration of the pulp. (1) It is more effective in immature teeth with wide open apices. (2) Instrumentation and bleach irrigation is inadequate to create needed conditions for revascularization of a necrotic tooth. Most cases used NaOCl (bleach) as an irrigant to cleanse the pulp chamber and root. (3) Calcium hydroxide prevents revascularization. (4) The triple antibiotic paste consisting of Ciprofloxacin, Metronidazole, and Minocycline effectively disinfects an infected necrotic pulp and promotes revascularization. A blood clot is then stimulated to provide a protein scaffold allowing tissue ingrowth into the pulp. As a result these studies show continued thickening of the dentinal walls and apical closure. In summary, these case reports can act as a foundation to generate future prospective clinical trials.
The author continues with a discussion of three components of tissue engineering as it relates to the pulp. Mesenchymal progenitor cells from the dental pulp, apical papilla or elsewhere can develop into odontoblastic cells. However the origin and type of cells remain unknown as the tissue in human teeth has not been evaluated histologically. A clot acts as a scaffold which is necessary to stimulate differentiation of these undifferentiated stem cells and provide a nutrient filled environment to facilitate growth. The author discusses platelet rich plasma as a substance that contains growth factors and forms a fibrin matrix for pulp regeneration. The last component are signaling molecules like growth factors and other substances that can stimulate cell proliferation and direct cell differentiation into odontoblasts/ osteoblasts, etc Examples of signaling molecules include dexamethosone or EDTA.
Future paths of exploration for regeneration of pulp tissue were mentioned. Instead of gene tranfection or growth of artificial teeth, the authors suggest focusing on finding signaling molecules at the apex of the tooth and then designing a scaffold for proliferation
Assessment of article: Good article from a symposium given by AAPD
Journal: Pediatric Dentistry
Volume (number): Volume 30, Number 3
Month, Year: May/June 08
Major topic: Regeneration of Pulp
Minor topic(s): none
Type of Article: Literature Review
Purpose: This article reviews the literature as it relates to biologically based endodontic therapies like pulp revascularization and regeneration of a vital pulp/ dentin complex. The author discusses a format for future research into this area of endodontics.
Findings: Several parameters have been established in the literature to promote regeneration of the pulp. (1) It is more effective in immature teeth with wide open apices. (2) Instrumentation and bleach irrigation is inadequate to create needed conditions for revascularization of a necrotic tooth. Most cases used NaOCl (bleach) as an irrigant to cleanse the pulp chamber and root. (3) Calcium hydroxide prevents revascularization. (4) The triple antibiotic paste consisting of Ciprofloxacin, Metronidazole, and Minocycline effectively disinfects an infected necrotic pulp and promotes revascularization. A blood clot is then stimulated to provide a protein scaffold allowing tissue ingrowth into the pulp. As a result these studies show continued thickening of the dentinal walls and apical closure. In summary, these case reports can act as a foundation to generate future prospective clinical trials.
The author continues with a discussion of three components of tissue engineering as it relates to the pulp. Mesenchymal progenitor cells from the dental pulp, apical papilla or elsewhere can develop into odontoblastic cells. However the origin and type of cells remain unknown as the tissue in human teeth has not been evaluated histologically. A clot acts as a scaffold which is necessary to stimulate differentiation of these undifferentiated stem cells and provide a nutrient filled environment to facilitate growth. The author discusses platelet rich plasma as a substance that contains growth factors and forms a fibrin matrix for pulp regeneration. The last component are signaling molecules like growth factors and other substances that can stimulate cell proliferation and direct cell differentiation into odontoblasts/ osteoblasts, etc Examples of signaling molecules include dexamethosone or EDTA.
Future paths of exploration for regeneration of pulp tissue were mentioned. Instead of gene tranfection or growth of artificial teeth, the authors suggest focusing on finding signaling molecules at the apex of the tooth and then designing a scaffold for proliferation
Assessment of article: Good article from a symposium given by AAPD
The influence of restorative material on the survival rate of restorations in primary molars
Author(s): Anastasios G. Papathanasiou, DDS, MDSc, MRCD(C), et al
Journal: Pediatric Dentistry
Volume (number): 16(4)
Month, Year: July/August 1994
Major topic: Longevity of restorations in primary molars
Type of Article: study
Main Purpose: To examine the survival rate of restorations placed in primary molars.
Overview of method of research: 128 patients with data on 604 restorations met the criteria to be included in the final sample. The restorative materials used in the study were preformed crowns, amalgam, composite, and glass ionomer. Each restoration could have one of 3 possible fates: failed, withdrawn (patient was lost to follow-up or the tooth naturally exfoliated) or censored (the tooth survived intact to the censor date). It was estimated that LA was used on 90% of the restorations and rubber-dam on 60%. The survival time of a restoration was an estimate of the number of months between the placement of a restoration and when it was terminated (once one of the fates could be attributed).
Findings: A higher frequency of failed restorations was observed in the GI and composite group, while a higher frequency of withdrawn restorations was observed in the SSC and amalgam group. For SSC and amalgam restorations, the mean survival time was more than 5 years and the 5-year survival estimate values were 68% for SSC and 60% for amalgam. The mean survival time was 32 months for composite and 12 months for GI. The difference in survival rate success was small in the first year of study, but increased as the restorations were followed for a longer period of time.
Key points/Summary: The order of the survival rate of the restorations, from highest to lowest, was SSC, amalgam, composite, and GI.
Assessment of article: Written 15 years ago – this knowledge seems pretty standard now.
Journal: Pediatric Dentistry
Volume (number): 16(4)
Month, Year: July/August 1994
Major topic: Longevity of restorations in primary molars
Type of Article: study
Main Purpose: To examine the survival rate of restorations placed in primary molars.
Overview of method of research: 128 patients with data on 604 restorations met the criteria to be included in the final sample. The restorative materials used in the study were preformed crowns, amalgam, composite, and glass ionomer. Each restoration could have one of 3 possible fates: failed, withdrawn (patient was lost to follow-up or the tooth naturally exfoliated) or censored (the tooth survived intact to the censor date). It was estimated that LA was used on 90% of the restorations and rubber-dam on 60%. The survival time of a restoration was an estimate of the number of months between the placement of a restoration and when it was terminated (once one of the fates could be attributed).
Findings: A higher frequency of failed restorations was observed in the GI and composite group, while a higher frequency of withdrawn restorations was observed in the SSC and amalgam group. For SSC and amalgam restorations, the mean survival time was more than 5 years and the 5-year survival estimate values were 68% for SSC and 60% for amalgam. The mean survival time was 32 months for composite and 12 months for GI. The difference in survival rate success was small in the first year of study, but increased as the restorations were followed for a longer period of time.
Key points/Summary: The order of the survival rate of the restorations, from highest to lowest, was SSC, amalgam, composite, and GI.
Assessment of article: Written 15 years ago – this knowledge seems pretty standard now.
Pulpal Status of Hypomineralized Permanent Molars
Author(s): Helen D. Rodd, BDS, PhD, et al
Journal: Pediatric Dentistry
Volume (number): 29(6)
Month, Year: Nov/Dec 2007
Major topic: Pulpal status of hypomineralized teeth
Type of Article: Scientific / research
Main Purpose: To determine the pulpal status of hypomineralized permanent first molars.
Overview of method of research: 25 sound and 19 hypomineralized permanent first molars were obtained from children requiring dental extractions under general anesthesia as part of an orthodontic treatment plan. Carious hypomineralized molars were excluded from the study. A total of 44 children, with a mean age of 9.4 years, provided the experimental teeth for the study. Only 1 tooth was collected from each child. Prior to tooth removal, children were interviewed to ascertain a simple pain history for both sound and hypomineralized teeth. The pulp sections were processed and immunostaining was performed using an indirect immunofluorescence method. Three different fields were subject to quantitative analysis: 1.) the MB pulp horn 2.) the occlusal subodontoblastic region between the 2 pulp horns and 3.) the midcoronal pulp region. The pulp sections were analyzed for pulpal innervation, pulpal vascularity, and the presence of immune cells.
Findings: Of the 19 hypomineralized samples, 6 had reportedly been sensitive, 5 had been asymptomatic, and for the remaining 8, a valid history could not be obtained. The pulp horn was the most densely innervated region and in the hypomineralized teeth there was evidence of an overall increase in neural density within the pulp horn and the occlusal subodontoblastic region. There was a marked increase in leukocyte common antigen-immunoreactive cells within the pulps of hypomineralized teeth exhibiting enamel loss. There were no significant differences in vascularity between sound and hypomineralized samples.
Key points/Summary: Some noncarious hypomineralized molars have an underlying pulpal inflammation. This histological presentation (increase in pulpal innervation, immune cell accumulation) is similar to that of carious permanent first molars in children of a similar age group. This may explain why children with hypomineralized teeth continue to experience pain with dental procedures even after the administration of local anesthetic.
Assessment of article: Thorough science, small sample size.
Journal: Pediatric Dentistry
Volume (number): 29(6)
Month, Year: Nov/Dec 2007
Major topic: Pulpal status of hypomineralized teeth
Type of Article: Scientific / research
Main Purpose: To determine the pulpal status of hypomineralized permanent first molars.
Overview of method of research: 25 sound and 19 hypomineralized permanent first molars were obtained from children requiring dental extractions under general anesthesia as part of an orthodontic treatment plan. Carious hypomineralized molars were excluded from the study. A total of 44 children, with a mean age of 9.4 years, provided the experimental teeth for the study. Only 1 tooth was collected from each child. Prior to tooth removal, children were interviewed to ascertain a simple pain history for both sound and hypomineralized teeth. The pulp sections were processed and immunostaining was performed using an indirect immunofluorescence method. Three different fields were subject to quantitative analysis: 1.) the MB pulp horn 2.) the occlusal subodontoblastic region between the 2 pulp horns and 3.) the midcoronal pulp region. The pulp sections were analyzed for pulpal innervation, pulpal vascularity, and the presence of immune cells.
Findings: Of the 19 hypomineralized samples, 6 had reportedly been sensitive, 5 had been asymptomatic, and for the remaining 8, a valid history could not be obtained. The pulp horn was the most densely innervated region and in the hypomineralized teeth there was evidence of an overall increase in neural density within the pulp horn and the occlusal subodontoblastic region. There was a marked increase in leukocyte common antigen-immunoreactive cells within the pulps of hypomineralized teeth exhibiting enamel loss. There were no significant differences in vascularity between sound and hypomineralized samples.
Key points/Summary: Some noncarious hypomineralized molars have an underlying pulpal inflammation. This histological presentation (increase in pulpal innervation, immune cell accumulation) is similar to that of carious permanent first molars in children of a similar age group. This may explain why children with hypomineralized teeth continue to experience pain with dental procedures even after the administration of local anesthetic.
Assessment of article: Thorough science, small sample size.
Composite rebonding to stainless steel metal using different bonding agents
Author(s): T Al-Shalan, M Till, R Feigal
Journal: AAPD Journal
Volume (number): 19:4
Month, Year: 1997
Major topic: Crowns and Alloys
Minor topic(s): Rebonding to SSC’s
Type of Article: In Vitro Study
Main Purpose: Test tensile strength of different bonding agents when used to rebond composite to stainless steel
Overview of method of research: Each bonding agent used on non-mechanically prepared and mechanically repaired metal strips, composite cured to strip, and Ingstron machine used to test tensile strengths.
Findings: Composite can be bonded effectively to SS metal using a bonding agent. Bond strength of all rebonding systems was greater than the original commercially produced bond. Highest bond strength = Caulk’s, lowest = Ellman. No significant difference was found between mechanically prepared and unprepared groups.
Key points/Summary : We can rebond to our SSC’s if the facing comes off! No need to use silane, just etch, bond, and composite. No need to prepare surface – it just needs to be clean. The only trick around here is finding a composite shade that is opaque enough to match the NuSmile facing material.
Assessment of article: Good summary.
Journal: AAPD Journal
Volume (number): 19:4
Month, Year: 1997
Major topic: Crowns and Alloys
Minor topic(s): Rebonding to SSC’s
Type of Article: In Vitro Study
Main Purpose: Test tensile strength of different bonding agents when used to rebond composite to stainless steel
Overview of method of research: Each bonding agent used on non-mechanically prepared and mechanically repaired metal strips, composite cured to strip, and Ingstron machine used to test tensile strengths.
Findings: Composite can be bonded effectively to SS metal using a bonding agent. Bond strength of all rebonding systems was greater than the original commercially produced bond. Highest bond strength = Caulk’s, lowest = Ellman. No significant difference was found between mechanically prepared and unprepared groups.
Key points/Summary : We can rebond to our SSC’s if the facing comes off! No need to use silane, just etch, bond, and composite. No need to prepare surface – it just needs to be clean. The only trick around here is finding a composite shade that is opaque enough to match the NuSmile facing material.
Assessment of article: Good summary.
A Clinical and Microbiological Study of Deep Carious Lesions during Stepwise Excavation Using Long Treatment Intervals.
Author(s): Bjorndal L, Larsen T, Thylstrup A.
Journal: Caries Res
Volume (number): Volume 31: 411-7
Month, Year: 1997
Major topic: Bacterial status of deep carious lesions after stepwise excavation
Minor topic(s): none
Type of Article: Research Study.
Purpose: This study evaluates stepwise excavation of deep carious lesions in terms of clinical and microbiological parameters. More specifically the study examines changes in bacterial flora before and after final excavation and determines if there is a relationship between bacteria and dentin characteristics.
Methods: 31 teeth with deep caries were included with 18 having decay covering over 1/3rd of the crown and 13 with decay covering less than or equal to 1/3rd of crown. All pulps tested vital and no teeth had a history of spontaneous or provoked pain. Treatment consisted of a first step of removal of central caries and superficial removal of the necrotic and demineralized dentin and complete removal of surrounding demineralized dentin. After two separate intervals of time, either 6-9 months or 9-12 months, the temporary restorations were removed and samples were taken. The clinical data evaluated color of dentin, consistency, and moisture at first excavation, after removal of the temporary restoration, and after final excavation. Microbiological data was obtained from the peripheral excavated hard dentin, the central demineralized dentin before final excavation, and after final excavation.
Findings: General characteristics of the dentin include the following: Dentin classified as very soft or soft was always wet after first excavation and that after the treatment interval, the dentin became dry prior to final excavation. The dentin became darker, harder, and drier after the treatment time. Also in general, cases which had light yellow color after final excavation had no bacterial growth while 7 of 8 dentin samples with light brown color and 2 of 4 with dark brown color had bacterial growth. Black staining in 1 tooth had the highest bacterial counts. Overall, there was a significant reduction (104 ) in bacterial counts (CFU’s) during the interval of temporary restoration. This initial step in stepwise excavation had a major impact in decreasing the bacteria in the tooth. In previous studies aggressive caries removal which may lead to a pulp exposure is not necessary, only removal of the central carious biomass, superficial parts of demineralized dentin and complete excavation of peripheral dentin is necessary
Conclusion: Stepwise excavation of deep carious lesions is an appropriate treatment for teeth with deep caries. The study also showed the relevance for microbiological studies in determining if bacteria survive in clinically excavated lesions.
Assessment of Article: Good scientific article demonstrating that it is acceptable to leave caries in teeth that do not exhibit signs and symptoms of pulpitis because the bacteria will diminish in a well sealed restoration.
Journal: Caries Res
Volume (number): Volume 31: 411-7
Month, Year: 1997
Major topic: Bacterial status of deep carious lesions after stepwise excavation
Minor topic(s): none
Type of Article: Research Study.
Purpose: This study evaluates stepwise excavation of deep carious lesions in terms of clinical and microbiological parameters. More specifically the study examines changes in bacterial flora before and after final excavation and determines if there is a relationship between bacteria and dentin characteristics.
Methods: 31 teeth with deep caries were included with 18 having decay covering over 1/3rd of the crown and 13 with decay covering less than or equal to 1/3rd of crown. All pulps tested vital and no teeth had a history of spontaneous or provoked pain. Treatment consisted of a first step of removal of central caries and superficial removal of the necrotic and demineralized dentin and complete removal of surrounding demineralized dentin. After two separate intervals of time, either 6-9 months or 9-12 months, the temporary restorations were removed and samples were taken. The clinical data evaluated color of dentin, consistency, and moisture at first excavation, after removal of the temporary restoration, and after final excavation. Microbiological data was obtained from the peripheral excavated hard dentin, the central demineralized dentin before final excavation, and after final excavation.
Findings: General characteristics of the dentin include the following: Dentin classified as very soft or soft was always wet after first excavation and that after the treatment interval, the dentin became dry prior to final excavation. The dentin became darker, harder, and drier after the treatment time. Also in general, cases which had light yellow color after final excavation had no bacterial growth while 7 of 8 dentin samples with light brown color and 2 of 4 with dark brown color had bacterial growth. Black staining in 1 tooth had the highest bacterial counts. Overall, there was a significant reduction (104 ) in bacterial counts (CFU’s) during the interval of temporary restoration. This initial step in stepwise excavation had a major impact in decreasing the bacteria in the tooth. In previous studies aggressive caries removal which may lead to a pulp exposure is not necessary, only removal of the central carious biomass, superficial parts of demineralized dentin and complete excavation of peripheral dentin is necessary
Conclusion: Stepwise excavation of deep carious lesions is an appropriate treatment for teeth with deep caries. The study also showed the relevance for microbiological studies in determining if bacteria survive in clinically excavated lesions.
Assessment of Article: Good scientific article demonstrating that it is acceptable to leave caries in teeth that do not exhibit signs and symptoms of pulpitis because the bacteria will diminish in a well sealed restoration.
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