Dentistry Journal — Open Access Journal

This review discusses the techniques and uses of atraumatic restorative treatment (ART) and interim therapeutic restoration (ITR) and states the differences between these two approaches. ART and ITR are similar approaches and are performed using the same material, but they differ in the purpose of their use. ART is used in cases when there are obstacles to reaching dental care units and has been proven to have high success rates in primary and permanent dentitions. ITR is used as a temporary restoration that will be replaced with a more definitive one. ITR is used in cases when the ideal dental treatment cannot be performed. Conventional glass polyalkenoate (ionomer) restorative cement (GIC) is the material of choice that has been used for ART and ITR. This is because of its fluoride release properties, including its ability to bond to enamel and dentine, its pulpal biocompatibility, and its ease of manipulation. High-viscosity glass ionomer performed better than low and medium-viscosity glass ionomer in ART. Combining GIC with conditioner, as well as the use of a chemo-mechanical approach, improved the success rate of ART. Both ATR and ITR are acceptable strategies, with success rates comparable to the traditional treatment methods. Full article

The applications of computer-guided technologies for three-dimensional image analysis provide a unique opportunity to quantify the morphological dimensional changes of the face in a practical and convenient way. Symmetry of the nasolabial area is one of the main factors of facial attractiveness as well as being the main objective of the treatment of cleft lip and palate (CLP). Technological advances in computer-guided visualization modes and their applications to three-dimensional stereophotogrammetry provide more practical opportunities and alternatives for facial analysis. Each study, however, uses different protocols for the acquisition and analysis of three-dimensional images. In addition, each study identifies different anthropometric points and calculates linear and angular measurements with overlapping protocols. Therefore, it is appropriate to define a standardization of the three-dimensional analysis of CLP patients to compare the studies of different research centers. The aim of this report is to propose a protocol to standardize the acquisition and analysis of three-dimensional images to evaluate the three-dimensional changes in the nasolabial area in cleft lip and palate patients undergoing pre-surgical nasoalveolar molding (PNAM). Full article

Passive irrigation is an efficient method for a successful endodontic treatment. During sonic activation biocompatible polymer tips are used to activate irrigants. Compared to ultrasonic activation with metallic tips, polymer tips have the advantage of a reduced risk of fracture and minimise dentine damage. Hence, two polymers, polyether ether ketones (PEEK) and polyamide (PA6), were identified for the manufacturing of novel irrigation tips. The chemical resistance against the irrigants ethylenediaminetetraacetic acid (EDTA) 20%, chlorhexidine gluconate (CHX) 2% and sodium hypochlorite (NaOCl) 5.25% was analysed. Using microindentation, the change of hardness, elasticity, surface roughness and appearance of the polymers was determined. PA6 had a high absorption of irrigant compared to PEEK. PEEK was resistant to the investigated irrigants and showed no significant alteration of surface and mechanical properties, whereas PA6 slightly increased its hardness, elastic modulus and surface roughness during long-term exposure at 37 °C. However, PA6 tips seem to be a promising disposable product due to the material’s high deformability and low manufacturing costs. Particularly with regard to structural-dynamic properties and high chemical resistance, PEEK can be considered as a material for reusable irrigation tips. Full article

During insertion of dental implants, measurement of dynamic parameters such as the torque-depth curve integral or insertion energy might convey more information about primary stability than traditional static parameters such as the insertion or removal torque. However, the relationship between these dynamic parameters, bone density, and implant geometry is not well understood. The aim of this investigation was to compare static and dynamic implant stability measurements concerning three different implant designs when implants were inserted into bovine bone ribs and dynamic parameters were collected using an instantaneous torque measuring implant motor. Standard implant osteotomies were created in segments of bovine ribs. After measuring the bone density using the implant motor, 10 cylindrical, 10 hybrid tapered-cylindrical, and 10 modified cylindrical implants were placed, and their primary stability was assessed by measuring the torque–depth curve integral, along with insertion and removal torque. The relationship between these quantities, bone density, and implant geometry was investigated by means of regression and covariance analysis. The regression lines describing the relationship between the torque–depth integral and bone density differed significantly from those describing the relationship between insertion torque, removal torque, and bone density for all three designs. The torque–depth curve integral provides different information about immediate primary stability than insertion and removal torque and in certain clinical conditions might be more reliable than these static parameters for assessing implant primary stability. Further research should be carried out to investigate the findings of the present study. Full article

The aim of the study was to test the validity of the Malocclusion Impact Questionnaire (MIQ) in a NZ sample and to evaluate possible cross-cultural differences in MIQ data between a NZ and a UK sample. A cross-sectional, non-random sample of young people, aged 10–16 years, attending their first appointment at the orthodontic clinic of New Zealand’s National Centre for Dentistry were asked to complete a questionnaire. This consisted of the 17 item MIQ, the short form CPQ_11-14-ISF16 and two global questions. Some basic demographic and clinical data were collected. Sixty-six participants completed the questionnaire; however, the data for 2 were excluded due to the number of incomplete responses. MIQ was found to have excellent internal consistency (Cronbach’s alpha 0.924), good construct validity (Spearman’s rho, 0.661 global Q1 ‘Overall, how much do your teeth bother you?’; 0.583 global Q2 ‘Overall, how much do your teeth affect your life?’). MIQ also demonstrated good criterion validity with CPQ_11-14-ISF16 (Pearson rho, 0.625). The Rasch analysis confirmed that the questionnaire performed similarly and there was no differential item functioning between the two populations. The main differences between the samples were that the young people in NZ were less concerned about their malocclusion and reported lower item-impact scores compared with the young people in the UK. Full article

Traumatic dental injuries (TDI) in childhood are fairly commonplace, with a reported prevalence of up to 30% worldwide. These injuries can have significant impacts on patients, their families and dental professionals; however, this area is currently underrepresented within paediatric oral health research. The psychosocial impacts of traumatic injury are personal to each patient and should be addressed as part of a holistic treatment plan. A review of the current evidence base shows that children who have suffered a traumatic injury to the dentition report worse oral-health-related quality of life. They are also more likely to suffer decreased self-esteem due to their appearance, especially where the injury is not effectively managed. Society (including other children) often judges poorly those with obvious dental disease or anomaly, and with the rising use of social media, these judgements can be made by even greater audiences. There is currently a paucity of qualitative research in this topic to explore the negative psychosocial impacts of dental trauma in greater detail. Although there is growing evidence for the benefit of treatment in improving children’s wellbeing following a TDI, the field of paediatric dental traumatology still has much to learn about young patients’ perspectives, experiences and values. Full article

Antibiotics are widely used in dental caries and another dental related issues, both for therapeutic and prophylactic reasons. Unfortunately, in recent years the use of antibiotics has been accompanied by the rapid emergence antimicrobial resistance. Dental caries and periodontal diseases are historically known as the top oral health burden in both developing and developed nations affecting around 20–50% of the population of this planet and the uppermost reason for tooth loss. Dental surgeons and family practitioners frequently prescribed antimicrobials for their patients as outpatient care. Several studies reported that antibiotics are often irrationally- and overprescribed in dental diseases which is the basis of antimicrobial resistance. The aim of this review is to evaluate the use of antibiotics in dental diseases. Almost certainly the promotion of primary oral health care (POHC) in primary health care program especially among the least and middle-income countries (LMIC) may be the answer to ensure and promote rational dental care. Full article

Nickel and chromium ions released from fixed orthodontic appliances may act as allergens. This study aimed to systematically review the effect of fixed orthodontic treatment on salivary levels of these ions by doing a meta-analysis on cross-sectional and cohort studies. The Web of Science, Scopus, Cochrane Library, and PubMed databases were searched for articles on salivary profile of nickel or chromium in patients under fixed orthodontic treatment published from January 1983 to October 2017. A random-effect meta-analysis was done using Review Manager 5.3 to calculate mean difference (MD) and 95% confidence interval (CI), and the quality of questionnaire was evaluated by the Newcastle–Ottawa scale. Fourteen studies were included and analyzed in this meta-analysis. Salivary nickel level was higher in periods of 10 min or less (MD = −11.5 µg/L, 95% CI = −16.92 to −6.07; P < 0.0001) and one day (MD = −1.38 µg/L, 95% CI = −1.97 to −0.80; P < 0.00001) after initiation of treatment compared to baseline (before the insertion of appliance). Salivary chromium level was higher in periods of one day (MD = −6.25 µg/L, 95% CI = −12.00 to −0.49; P = 0.03) and one week (MD = −2.07 µg/L, 95% CI = −3.88 to −0.26; P = 0.03) after the initiation of treatment compared to baseline. Corrosion of fixed orthodontic appliances leads to elevated salivary nickel and chromium concentrations early after initiation of orthodontic treatment. Randomized clinical trials controlling for factors affecting the saliva composition are recommended on a higher number of patients and among different ethnicities. Full article

Bioactive polyphenol components of cranberry (Vaccinium macrocarpon) are known to have virulence attenuating effects against several cariogenic virulence properties responsible for dental caries pathogenesis. In particular, cranberry A-type proanthocyanidins and flavonols have demonstrated potent inhibitory effects against cariogenic virulence targets such as bacterial acidogenicity, aciduricity, glucan synthesis, and hydrophobicity. Cranberry phenols have the ability to disrupt these cariogenic virulence properties without being bactericidal, a key quality essential for retaining the benefits of the symbiotic resident oral microbiome and preventing the emergence of resistant microbes. This review discusses the cariostatic mechanisms of specific cranberry phytochemicals and their potential use as therapeutic agents against cariogenic bacteria in the prevention and control of dental caries. Full article

Comparing oral health-related quality of life (OHRQoL) measures can facilitate selecting the most appropriate one for a particular research question/setting. Three child OHRQoL measures Child Perceptions Questionnaire (CPQ_11–14), the Child Oral Health Impact Profile (COHIP) and the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) were used with 335 10- to 13-year-old participants in a supervised tooth-brushing programme in New Zealand. The use of global questions enabled their validity to be examined. Assessments were conducted at baseline and after 12 months. All three measures had acceptable internal consistency reliability. There were moderate, positive correlations among their scores, and all showed differences in the impact of dental caries on OHRQoL, with children with the highest caries experience having the highest scale scores. Effect sizes were used to assess meaningful change. The CPQ_11–14 and the CARIES-QC showed meaningful change. The COHIP-SF score showed no meaningful change. Among children reporting improved OHRQoL, baseline and follow-up scores differed significantly for the CPQ_11–14 and CARIES-QC measures, although not for the COHIP-SF. The three scales were broadly similar in their conceptual basis, reliability and validity, but responsiveness of the COHIP-SF was questionable, and the need to compute two different scores for the CARIES-QC meant that its administrative burden was considerably greater than for the other two measures. Replication and use of alternative approaches to measuring meaningful change are suggested. Full article

An association between periodontal disease and cancer has been established in recent studies, but no common etiology has been identified in the hopes of reducing the global burden of these non-communicable diseases. This perspective article hypothesizes that the determinant mediating the association of periodontal disease with cancer is dysregulated phosphate metabolism. Phosphate, an essential dietary micronutrient, is dysregulated in chronic kidney disease, and both cancer and periodontal disease are associated with chronic kidney disease. Reviewed evidence includes the association between phosphate toxicity and cancer development, and the association between periodontal disease and chronic kidney disease-mineral and bone disorder includes conditions such as ectopic calcification and bone resorption, which may be indirectly related to periodontal disease. Dental calculus in periodontal disease contains calcium phosphate crystals that are deposited from excess calcium and phosphate in saliva. Alveolar bone resorption may be linked systemically to release of parathyroid hormone in response to hypocalcemia induced by hyperphosphatemia. More research is needed to examine the role of dysregulated phosphate metabolism in periodontal disease. Full article

Amelogenesis imperfecta (AI) is a hereditary developmental disorder affecting the enamel of teeth. Affected patients present with tooth hypersensitivity, rapid tooth wear, or fractures of enamel as well as alterations in color and shape, all of which compromise esthetic appearance and masticatory function. Chronic conditions in childhood severely impact the whole family, affecting normal family routines and/or increasing the family’s financial burden. The aim of this study was to explore experiences and the impact on daily life of being a parent to a child with severe forms of amelogenesis imperfecta. Parents of children and adolescents with AI participated in an interview with a psychologist. The transcribed interviews were analyzed using thematic analysis. The parents talked about several concerns about having a child with AI. Four main themes emerged from the interviews: Feelings associated with passing on a hereditary disorder, knowledge decreases stress, unfamiliarity with the diagnosis, and psychosocial stress. In these main categories we identified several subthemes. Feelings associated with passing on a hereditary disorder included the subtheme of guilt/shame; knowledge decreases stress included knowledge about diagnosis in the family and support from dental health care professionals; Unfamiliarity with diagnosis included missed diagnosis, fear of not getting correct treatment, and insufficient pain control; finally, the subtheme Psychosocial stress included fear of child being bullied and emergency dental visits. The findings show that parents of children with severe amelogenesis imperfecta report similar experiences as do parents of children with other chronic and rare diseases. Full article

Background: This study was done to evaluate the prevalence and contributory factors of early childhood caries (ECC) and severe ECC (S-ECC) among preschool children of Kindergartens and Early Childhood Centres in Trinidad and Tobago. Methods: A cross-sectional study was carried out involving 342 preschool children aged 3 to 5 years. The school staff distributed a structured questionnaire to the children to be completed by the mother. Clinical examinations were conducted by calibrated examiners. Statistical significance was set at p < 0.05 in all analyses. Results: The prevalence of ECC and S-ECC was 50.3% and 52.3%, respectively. Dietary and oral hygiene factors particularly with bottle feeding and high plaque levels were major contributors to dental caries in this population. Conclusion: ECC and S-ECC are significant issues that occur in preschool children in Trinidad and Tobago. The development of ECC and S-ECC can be attributed to certain environmental factors like dietary habits and oral hygiene practices. Early dental assessment, broad-based oral health education programmes, increased parental/guardian engagement during oral hygiene practices and greater access to facilities for early childhood caries prevention and management can help alleviate the problems of ECC and S-ECC in this population. Full article

Diagnosis of oral white lesions might be quite challenging. This review article aimed to introduce a decision tree for oral white lesions according to their clinical features. General search engines and specialized databases including PubMed, PubMed Central, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “mouth disease”, “oral keratosis”, “oral leukokeratosis”, and “oral leukoplakia”. Related English-language articles published since 2000 to 2017, including reviews, meta-analyses, and original papers (randomized or nonrandomized clinical trials; prospective or retrospective cohort studies), case reports, and case series about oral diseases were appraised. Upon compilation of data, oral white lesions were categorized into two major groups according to their nature of development: Congenital or acquired lesions and four subgroups: Lesions which can be scraped off or not and lesions with the special pattern or not. In total, more than 20 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by a stepwise progression method. Full article

This study aimed to evaluate microhardness of a dentifrice containing fluoride and arginine compared to a positive control (fluoride only) and a negative control (no fluoride) on sound and demineralized bovine enamel surfaces. Specimens were randomly assigned to different treatments that included daily pH cycling and brushing three times a day with one of the following dentifrices (n = 8): Neutraçucar (arginine and fluoride), Colgate Total 12 (fluoride) and My First Colgate (no fluoride). Enamel carious lesions were artificially created one week before the beginning of these treatments (demineralized bovine enamel (DE) groups). The same groups were also tested in sound enamel (sound bovine enamel (SE) groups). Microhardness was measured at baseline and after one, two, and five weeks of treatment using a Knoop indenter. Statistical analysis involved two-way Analysis of Variance (ANOVA) and Tukey’s test. After five weeks, both Total 12 and Neutraçucar had increased the microhardness of DE specimens (p < 0.05). Only Neutraçucar had increased the microhardness of the sound enamel after five weeks of treatment. Thus, it could be concluded that arginine-based dentifrices increase the microhardness of sound and demineralized bovine enamel surfaces. Full article

Dentigerous cysts are one of the most prevalent types of odontogenic cysts and are associated with the crown of an unerupted tooth, especially of the mandibular third molar. In this study, the characteristics of a dentigerous cyst developed around a mandibular third molar on panoramic radiographs were investigated. The panoramic images of 257 consecutive dentigerous cyst cases associated with a mandibular third molar were analyzed. The mean age of the patients was 45.9 ± 13.3 years. The size of the cyst did not significantly correlate to the age of the patient. The unilocular type (89.1%) and the crown side type (68.5%) were significant. The associated mandibular third molars had a high frequency of class III (64.6%) and position B (48.3%) in Pell and Gregory classification and of horizontal position (36.3%) in angulation. Dentigerous cysts were thought to originate and grow commonly around deeply impacted third molars. The associated third molar with dentigerous cyst tends to have a mesial inclination. Dentigerous cysts do not appear to develop gradually after the crown formation has finished, but arise at various periods randomly. Full article

Background: Prisoners have poorer dental health than non-prison populations. It is known that the prison environment can promote health and thus, policies, including access to dental care, are in place to promote health during imprisonment. Aim: Our aim was to conduct an oral health and psychosocial needs survey to identify the factors associated with accessing prison dental services in Scotland. Methods: A convenience sample of offenders from a male maximum security prison, a women’s prison, and a young offenders’ institution was gathered. A questionnaire examined the demography, prison experience, dental anxiety, oral health-related quality of life, and reported attendance of dental services. A dental examination was conducted using the International Caries Detection and Assessment System to diagnose obvious decay. A hierarchical logistic regression analysis was performed. Results: 342 prisoners participated. When missing data were excluded, the final sample was 259. The regression analysis showed the following: Model 1 characterized the offenders by demography and prison experience, explaining 19% of the variance. Model 2 showed that an offender was 36% more likely to attend dental services for every unit change in the 5-point ranking scale of ‘feeling irritable with people because of teeth, mouth, or dentures’, explaining an additional 7% of the variance. Model 3 explained 35% of the variance, (i.e., an additional 9%) and was adopted as the final model to characterize offenders who access dental services when in prison. An offender who reported accessing prison dental services was 3.28 times more likely to be male. For each increase in the year of an offender’s age, the offender was 5% more likely to access prison dental services. An 11% greater chance of accessing prison dental services for every experience of remand was also found. An offender was 32% more likely to access prison dental services for each increased level of irritability, and there was a 2 times higher likelihood of emergency dental services’ attendance. There was a 19% lower chance of accessing prison dental services for each additional tooth affected by decay and a 13% greater chance of accessing prison dental services for each unit increase in missing teeth. Conclusions: In conclusion, this investigation identified factors associated with access to prison dental services in Scotland. The role of accessibility factors, such as the oral health impact of irritability, appeared to increase perceptions of dental need and promote dental services’ attendance. Full article

Young homeless people make up nearly one-third of those experiencing homelessness. The need to provide an educative approach, to strengthen social interacting, and construct new knowledge to increase social inclusivity, is required. The aim of this qualitative exploration was to use critical consciousness as an educative tool, to co-design, implement, and evaluate a series of oral health and health pedagogical workshops to strengthen social engagement and to construct new health knowledge, with, and for, homeless young people and their service providers. An action research design permitted the simultaneous development, implementation, and evaluation of the pedagogical workshop program. A Non-Governmental Organization (NGO), providing supported accommodation for young homeless people, acted as the partner organization. Thirteen young people and five staff members from this NGO participated and co-designed eight workshops. Qualitative data collection included unstructured post-intervention interviews together with verbatim quotes from the group discussions during the workshops and from the post-workshop questionnaires. The qualitative analysis was informed by content analysis to permit the emergence of key themes from the data. The two themes were: 1. ‘trust building and collective engaging’ and 2. ‘constructing knowledge and developing skills’. Theme 1 highlighted engagement with the service provider, illustrating the transformation of the young people’s relationships, strengthening of their social interacting, and enabling their critical reflexive thinking on sensitive issues present in the homelessness trajectory. Theme 2 illustrated the young people’s ability to share, lend, and encode their new health information and convert it into an understandable and useable form. This new comprehension permitted their behavior change and social interaction. These findings provide an approach to increase young people’s knowledge, health literacy, and strengthen their social interacting to support community action. Full article

Objective assessments of oral hygiene are important to prevent oral and systemic diseases. Two objective assessment tests are available to assess oral hygiene; (1) the adenosine triphosphate (ATP) + adenosine monophosphate (AMP) swab test, which incorporates a luciferase assay and (2) a bacteria count using the dielectrophoretic impedance measurement (DEPIM) method. In this study, we compared the two tests using a subjective visual assessment by professional clinicians and investigated the clinical significance of these tests. Twenty-seven young participants (mean age 26.3 ± 3.2 years) and twenty-seven older participants (mean age 75.1 ± 5.9 years) were recruited. Oral bacteria were sampled from three areas, including the tongue dorsum, the buccal mucosa, and the faucal mucosa, and saliva was obtained using a cotton swab. The amount of ATP + AMP and the number of bacteria were measured by each specific apparatus. Additionally, one examiner assessed the overall condition of oral hygiene using the visual analog scale (VAS). In the ATP + AMP swab test, the means were highest in saliva. For the bacteria count, the means were higher in the tongue dorsum and saliva and lower in the faucal and buccal mucosa. The results of the subjective assessment of oral hygiene indicated that the VAS-value was 3.78 ± 0.97 for the young group and 3.35 ± 0.81 for the older group. No significant difference was observed between the two groups. Additionally, no significant relationship between the values of the ATP + AMP swab test and the bacteria count was found for any of the four sample sites. In the older group, the subjective assessment of oral hygiene was significantly correlated with the values of the ATP + AMP swab test (multiple correlation coefficient = 0.723, p = 0.002). In conclusion, the values provided by the ATP + AMP swab test were not always correlated to the bacteria count. The results of this study suggest that the subjective assessment of oral hygiene was more highly correlated with the results of the ATP + AMP swab test, as compared to the bacterial count assay. Full article