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Introduction: Dental examination and stabilization are performed prior to allogeneic hematopoietic cell transplantation to decrease infection risk during neutropenia. Burden of dental disease and treatment need is not well characterized in this population., Objectives: This report describes the dental status of a cohort of patients within the Chronic Graft-versus-Host Disease Consortium and treatment rendered prior to transplant., Methods: The cohort included 486 subjects (Fred Hutchinson: n = 245; Dana-Farber: n = 241). Both centers have institutional-based dental clearance programs. Data were retrospectively abstracted from medical records by calibrated oral health specialists., Results: The median age at transplant was 55.9 years, 62.1% were male, and 88% were white. Thirteen patients were edentulous (2.7%). The mean teeth among dentate patients before clearance was 26.0 (SD, 4.6). Dental findings included untreated caries (31.2%), restorations (91.6%), endodontically treated teeth (48.1%), and dental implants (5.7%). Pretransplant procedures during clearance included endodontic therapy (3.6%; mean = 0.1 teeth), restorations (25.1%; mean = 0.7), dental prophylaxis (59.2%), scaling/root planing (5.1%), and extraction (13.2%; mean = 0.3). The mean teeth after clearance was 25.6 (SD, 5.0)., Conclusions: Retrospective analysis of pre-AlloHCT dental data in subjects at two large transplant centers identified low levels of dental need. Findings suggest high access to care., (© 2023 Wiley Periodicals LLC.)

Aim: Consumption of free sugars has been associated with chronic non-communicable diseases. The aim of the study was to investigate the effect of free-sugar consumption on gingival inflammation using a systematic review and meta-analysis based on the PICO question 'What impact does the restriction of free sugars have on the inflammation of gingival tissue?', Materials and Methods: Literature review and analyses were based on the Cochrane Handbook for Systematic Reviews of Interventions. Controlled clinical studies reporting on free-sugar interventions and gingival inflammation were included. Risk of bias was performed with ROBINS-I and ROB-2, and effect sizes were estimated with robust variance meta-regressions., Results: Of the 1777 primarily identified studies, 1768 were excluded, and 9 studies with 209 participants with gingival inflammation measures were included. Six of these studies reported on the dental plaque scores of 113 participants. Restriction of free sugars, when compared with no such restriction, was associated with statistically significantly improved gingival health scores (standard mean difference [SMD] = -0.92; 95% confidence interval [CI]: -1.43 to -0.42, p < .004; I 2 [heterogeneity] = 46.8) and a trend towards lower dental plaque scores (SMD = -0.61; 95% CI: -1.28 to 0.05, p < .07; I 2  = 41.3). The observed improvement of gingival inflammation scores with restricted consumption of free sugar was robust against various statistical imputations. No meta-regression models were feasible because of the limited number of studies. The median publication year was 1982. Risk-of-bias analysis showed a moderate risk in all studies., Conclusion: Restriction of free sugar was shown to be associated with reduced gingival inflammation. The systematic review was registered at PROSPERO (CRD 42020157914)., (© 2023 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

The aim of this study was to assess the effectiveness of fluoride varnish (FV) in reducing dentine caries at the patient, tooth, and surface levels as well as caries-related hospitalizations in preschoolers. We performed a systematic review of clinical trials of FV, alone or associated with an oral health program, compared with placebo, usual care, or no intervention. Bibliographical search included electronic searches of seven databases, registers of ongoing trials, and meeting abstracts, as well as hand searching. We performed random-effects meta-analyses and calculated confidence and prediction intervals. The search yielded 2,441 records; 20 trials were included in the review and 17 in at least one meta-analysis. Only one study had low risk of bias in all domains. We found no study reporting on caries-related hospitalizations. At the individual level, the pooled relative risk was 0.88 (95% confidence interval [CI] 0.81, 0.95); this means that in a population of preschool children with 50% caries incidence, we need to apply fluoride varnish in 17 children to avoid new caries in one child. At the tooth level, the pooled weighted mean difference was -0.30 (95% CI -0.69, 0.09) and at the surface level -0.77 (95% CI -1.23, -0.31). Considering the prediction intervals, none of the pooled estimates were statistically significant. We conclude that FV showed a modest and uncertain anticaries effect in preschoolers. Cost-effectiveness analyses are needed to assess whether FV should be adopted or abandoned by dental services., (© 2019 S. Karger AG, Basel.)

Background: Numerous studies indicate implants placed immediately after extraction or with minimally invasive procedures have excellent long-term success and survival rates. There is general agreement that implants must be stable after implant placement. This study evaluated implant stability changes from the time of implant placement to second stage (prior to restoration). Resonance frequency analysis (RFA) was determined for two commercially available units (Osstell, Osstell USA, Columbia, MD and Penguin, Penguin Integration Diagnostics, Sweden). The unit of measurement was the implant stability quotient (ISQ)., Materials and Methods: Prior to treatment patients were given medical and dental evaluations. Periapical and panogram radiographs were taken Computerized tomography images were taken for sites where adequate bone volume or quality were uncertain. Thirty patients were enrolled in this study (13 females, 17 males, mean age 73.4 years, (maximum age 90, minimum 47 year total of 38 implants were placed. One implant was lost. Computerized implant planning (Nobel Clinician) Nobel Biocar United States (Nobel Biocare, Yorba Linda, CA) was performed for all patients. Implants were placed utilizing a surgical guide. Using Resonance Frequency anal this study compared two RFA systems for determining implant stability (ISQ; Osstell and Penguin). Measurement pegs were screwed into the implants, and RFA measurements were taken at mesial, distal, lingual, and buccal implant surfaces. Stability measurements were taken at implant placement and at second stage. Clinical data and RFA measurements were recorded on data sheets. The average interval between first and second stages was 144.1 days (range 21.3) RESULTS: Average interval between implant placement and second stage was 141.1 days. One implant was lost prior to second stage. The results are based on 30 patients with 38 implants. At second stage, the RFA measures were slightly higher than first stage with a mean increase of 1.15, SE = 0.3, P-.067. The Penguin RFA values were marginally higher than Osstell (mean increase 1.10, SE = 0.64, P < .08)., Conclusions: RFA values between implant placement and second stage differed slightly between implant placement and second stage (P < 0.10). These differences were not clinically or statistically significant. At second stage, Penguin RFA values were slightly higher when compared with the Osstell device (P < 0.67). Bone quality appears to be an important factor when determining RFA readings. Type I bone had significantly higher readings when compared with other less dense bone types (P < .029) Resonance frequency evaluation data were similar for both instruments, indicating their reliability in determining implant stability. Neither instrument predicted implant failure. While subjective, Penguin was less cumbersome to utilize and the window revealing the readings was very easier to read. Further, the pegs are magnetized making insertion easy., (© 2018 Wiley Periodicals, Inc.)

Introduction: Most of the published literature on the management of overbite with the Invisalign appliance (Align Technology, Santa Clara, Calif) consists of case reports and case series., Methods: In this retrospective study of 120 patients, we sought to assess the nature of overbite changes with the Invisalign appliance. Records were collected from 3 practitioners, all experienced with the Invisalign technique. The patients were consecutively treated adults (>18 years old) who underwent orthodontic treatment only with the Invisalign appliance. Patients with major transverse or anteroposterior changes or extraction treatment plans were excluded. The study sample included 68 patients with normal overbites, 40 with deepbites, and 12 with open bites. Their median age was 33 years, and 70% of the patients were women., Results: Cephalometric analyses indicated that the deepbite patients had a median overbite opening of 1.5 mm, whereas the open bite patients had a median deepening of 1.5 mm. The median change for the normal overbite patients was 0.3 mm. Changes in incisor position were responsible for most of the improvements in the deepbite and open bite groups. Minimal changes in molar vertical position and mandibular plane angle were noted., Conclusions: The Invisalign appliance appears to manage the vertical dimension relatively well, and the primary mechanism is via incisor movements., (Published by Elsevier Inc.)

Periodontal diseases and dental caries are the most common diseases of humans and the main cause of tooth loss. Both diseases can lead to nutritional compromise and negative impacts upon self-esteem and quality of life. As complex chronic diseases, they share common risk factors, such as a requirement for a pathogenic plaque biofilm, yet they exhibit distinct pathophysiologies. Multiple exposures contribute to their causal pathways, and susceptibility involves risk factors that are inherited (e.g. genetic variants), and those that are acquired (e.g. socio-economic factors, biofilm load or composition, smoking, carbohydrate intake). Identification of these factors is crucial in the prevention of both diseases as well as in their management., Aim: To systematically appraise the scientific literature to identify potential risk factors for caries and periodontal diseases., Methods: One systematic review (genetic risk factors), one narrative review (role of diet and nutrition) and reference documentation for modifiable acquired risk factors common to both disease groups, formed the basis of the report., Results & Conclusions: There is moderately strong evidence for a genetic contribution to periodontal diseases and caries susceptibility, with an attributable risk estimated to be up to 50%. The genetics literature for periodontal disease is more substantial than for caries and genes associated with chronic periodontitis are the vitamin D receptor (VDR), Fc gamma receptor IIA (Fc-γRIIA) and Interleukin 10 (IL10) genes. For caries, genes involved in enamel formation (AMELX, AMBN, ENAM, TUFT, MMP20, and KLK4), salivary characteristics (AQP5), immune regulation and dietary preferences had the largest impact. No common genetic variants were found. Fermentable carbohydrates (sugars and starches) were the most relevant common dietary risk factor for both diseases, but associated mechanisms differed. In caries, the fermentation process leads to acid production and the generation of biofilm components such as Glucans. In periodontitis, glycaemia drives oxidative stress and advanced glycation end-products may also trigger a hyper inflammatory state. Micronutrient deficiencies, such as for vitamin C, vitamin D or vitamin B12, may be related to the onset and progression of both diseases. Functional foods or probiotics could be helpful in caries prevention and periodontal disease management, although evidence is limited and biological mechanisms not fully elucidated. Hyposalivation, rheumatoid arthritis, smoking/tobacco use, undiagnosed or sub-optimally controlled diabetes and obesity are common acquired risk factors for both caries and periodontal diseases., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

It has been suggested that facial traits are informative on the inherited susceptibility to tuberculosis and obesity, two current global health issues. Our aim was to compare the phenotypic characteristics of adolescents with dental markers for a concave (n=420), a convex (n=978), and a straight (n=3542) facial profile in a nationally representative sample of United States adolescents. The results show that adolescents with a concave facial profile, when compared to a straight facial profile, had an increased waist-to-height ratio (Δ, 1.1 [95% CI 0.5-1.7], p<0.003) and an increased acne prevalence (OR, 1.5 [95% CI 1.2-1.9], p<0.001). Adolescents with a convex facial profile, when compared to a straight facial profile, had an increased prevalence of tuberculosis (OR, 4.3 [95% CI 1.4-13.1], p<0.02), increased ectomorphy (Δ, 0.3 [95% CI 0.2-0.4], p<0.0001), increased left-handedness (OR, 1.4 [95% CI 1.1-1.7], p<0.007), increased color-blindness (OR, 1.7 [95% CI 1.3-2.3], p<0.004), and rhesus ee phenotype (OR, 1.3 [95% CI 1.1-1.5], p<0.008). Adolescents with a concave facial profile, when compared to a convex profile, had increased mesomorphy (Δ, 1.3 [95% CI 1.1-1.5], p<0.0001), increased endomorphy (Δ, 0.5 [95% CI 0.4-0.6], p<0.0001), lower ectomorphy (Δ, 0.5 [95% CI 0.4-0.6], p<0.0001), and lower vocabulary test scores (Δ, 2.3 [95% CI 0.8-3.8], p<0.008). It is concluded that population-based survey data confirm that distinct facial features are associated with distinct somatotypes and distinct disease susceptibilities., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Background: The authors sought to determine associations between serum vitamin D levels and dental caries in noninstitutionalized children aged 5 to 12 years in the United States., Methods: The authors used National Health and Nutrition Examination Survey, 2005-2006, data to study childhood caries and vitamin D. Vitamin D deficiency and inadequacy were defined as serum 25-hydroxyvitamin D (25[OH]D) less than 30 nanomoles per liter and between 30 and 49 nmol/L, respectively. Associations between vitamin D and caries experience (a combined measure of untreated caries or restorations) were examined after adjustment for confounders using multivariate logistic regression at a critical value of 5%. Sample weights were used to generate nationally representative estimates., Results: The overall prevalence of serum 25(OH)D less than 30 nmol/L and 25(OH)D between 30 and 49 nmol/L among 5- to 12-year-olds was 3% and 16%, respectively. Prevalence of 25(OH)D less than 30 nmol/L and 25(OH)D between 30 and 49 nmol/L among children with caries experience was 2% and 16%, respectively. Multivariate logistic regression analysis found no significant association between vitamin D and caries experience (P = .78). Furthermore, this association was not significant after adjusting for age, sex, race and ethnicity, ratio of family income to poverty threshold, and sugar consumption (P = .46)., Conclusions: The authors did not find a significant association between 25(OH)D status and caries experience in US children who participated in NHANES, 2005-2006., Practical Implications: The authors' findings do not support existing evidence of an association between caries and vitamin D., (Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate aged partially and fully edentulous patients who received dental implants and were maintained over time. Further, to determine how the partially and edentulous ageing populations (65 and above) with dental implants maintain bone levels, proper oral hygiene, and perceive benefits of dental implants., Materials and Methods: Since 1995, patients receiving dental implants have been prospectively entered into an Access-based computerized program (Triton Tacking System). Patient demographics (age, sex), bone quality, quantity, implant location, and type of surgery have been continuously entered into the database. The database was queried for patients receiving implants (first stage) between 66 and 93 years of age. Thirty-one patients were within this age group. Twenty-five patients returned to the clinic for periodontal and dental implant evaluation. The Periodontal Index was used to evaluate selected teeth in terms of probing depth, bleeding on probing, plaque accumulation, and mobility. Using NIH Image J, radiographs taken at second stage and last examination were measured for changes in interproximal bone levels. Once identified, each patient anomalously filled out an abbreviated quality of health life form. Due to small sample size, descriptive statistics were used to compare clinical findings., Results: Fifteen males ranging from 78 to 84 (mean age 84 years) years and 16 females from 66 to 93 (mean age 83 years) (age range 66-93) were contacted by phone or mail and asked to return to our office for a re-examination. For this group, the first dental implants were placed in 1996 (n = initial two implants) and continuously recorded through 2013 (n = last seven implants). Thirty-one patients received a total of 84 implants. Two patients were edentulous, and the remaining were partially edentulous. Four implants were lost. Between implant placement and 6- to 7-year interval, 13 patients with 40 implants had a cumulative survival rate of 94.6%. Of the original group (n = 33), three were deceased, two were in nursing homes, and three could not be located., Conclusions: Aged patients receiving dental implants had excellent implant survival rates, low periodontal disease index scores with minimal changes in interproximal bone levels. Results from this study indicate that patients with advanced age, in reasonably good health, have excellent implant survival rates, excellent quality of life scores, and can be maintained in good oral health., (© 2015 Wiley Periodicals, Inc.)

The current understanding on the role of microbiology on periodontitis causation is reviewed. An appraisal of the literature reveals several issues that have limited the attempts to investigate candidate periodontal pathogens as causes of periodontitis and confirms that only limited epidemiological evidence is available. Several aspects of the contemporary understanding on causal inference are discussed with examples for periodontitis.

Background: Reports of osteonecrosis of the jaw (ONJ) have associated this lesion to treatment with bisphosphonates (BPs) and dental procedures. In this study, we investigated the association of specific dental diagnoses and procedures with ONJ among patients with past BP use., Methods: Dentists from three practice-based research networks provided ONJ cases and controls (1:3). Data gathered from patients and dental offices with two respective standard questionnaires included demographic, medical, pharmaceutical, and dental information. Diagnoses and procedures up to 3 years prior to ONJ (prior to interview for controls) were analyzed within risk strata, defined by BP use and cancer status, using interaction terms within conditional logistic regression models., Results: We enrolled 191 ONJ cases and 573 controls from 119 dental offices. Among participants who had used only oral BP, extraction was the only dental risk factor for ONJ (odds ratio (OR) = 12, p = 0.01). Suppuration was also more prevalent in cases (18 %) than in controls (9 %), but not statistically significant (OR = 9, p = 0.06). Among participants who had not used either oral or IV BP (a majority of whom received radiation therapy to the head and neck), suppuration was the only dental risk factor for ONJ (prevalence = 34 % for cases and 8 % for controls; OR = 7, p = 0.01). The prevalence of extractions in this group was also higher, but not statistically significant (44 vs 10 %; OR = 3). Limited power precludes definitive findings among participants exposed to IV BP., Conclusions: Among patients taking oral BP, extraction was the only dental procedure associated with subsequent ONJ development, Clinical Relevance: Results of this study suggest that routine dental procedures are not associated with development of ONJ in patients exposed to BPs.

Purpose: This prospective study evaluated implant survival rates and crestal bone changes for porous oxide-coated (TiUnite, Nobel Biocare AB, Gothenburg, Sweden), parallel-walled implants., Materials and Methods: All patients receiving TiUnite (porous oxide-surfaced implants [POS]) implants were entered into a database (Triton Tracking System) starting February 1999. Survival rates were calculated from the date of implant placement and related to surgical method of placement (two-stage buried, flapless, immediate placement, immediate placement flapless, one stage), bone quality, and implant characteristics. Failed and nonfailed implants were compared with respect to changes in mean proximal bone levels and the presence of radiolucent areas around the implant apex (shadows)., Results: Four hundred nine patients received 817 porous oxide-coated implants, of which 38 failed. Using the last office visit as the censoring date, the cumulative survival date was 93%. The failure rate was independent of bone quality or quantity; implant diameter or length; and surgical method. For the 102 surviving implants, there was no significant change in the average crestal bone loss (+0.13 mm with a standard error, 0.17). For the 17 failing implants, the average crestal bone loss was -4.14 mm (standard error, 0.55). This difference between bone levels of failing and nonfailing implants was highly significant (p < .0001). There was no difference in the prevalence of radiographic shadows around failing and nonfailing implants at time of placement (p < .16)., Conclusion: Results from this prospective clinical study indicate that 7% of TiUnite surfaced implants failed for unknown reasons. Failing implants were characterized by significant bone loss but not by the presence of shadows., (© 2013 Wiley Periodicals, Inc.)

Objective: The aim of this study was to report on the failure rates of two distinct dental implant systems in a clinical practice setting., Materials and Methods: Date of implant placement and loss were entered prospectively in a data registry system. Failure rates of two commercially pure titanium implants, one with a porous oxydized surface (POS) and the other with a chemically altered surface (CAS), were assessed using a quality control chart and survival analyses., Results: A total of 860 POS and 759 CAS implants were placed. A warning of an increased failure rate of the CAS implant was identified by means of the quality control chart. Survival analyses indicated that the CAS implant failure rate was twice that of the POS implant (Hazard Ratio: 2.08; 95% CI: 1.33-3.28, P-value < 0.0012). After adjusting for alternative explanations, the CAS implant remained associated with a 95% increased failure rate (95% CI: 1.14-3.35; P-value = 0.0146). Abandoning the CAS implant and returning to a POS implant was associated with a non-significant 64% drop in the implant failure rate within less than a year (HR: 0.36; 95% CI: 0.12-1.14; P-value < 0.0826)., Conclusion: The difference between a 4% failure rate with the POS implant and an 8% failure with the CAS implant appears inconsistent with the assumption of substantial equivalence., (© 2012 John Wiley & Sons A/S.)

Case reports and cohort studies have linked bisphosphonate therapy and osteonecrosis of the jaws (ONJ), but neither causality nor specific risks for lesion development have been clearly established. We conducted a 1:3 case-control study with 3 dental practice-based research networks, using dentist questionnaires and patient interviews for collection of data on bisphosphonate therapy, demographics, co-morbidities, and dental and medical treatments. Multivariable logistic regression analyses tested associations between bisphosphonate use and other risk factors with ONJ. We enrolled 191 ONJ cases and 573 controls in 119 dental practices. Bisphosphonate use was strongly associated with ONJ (odds ratios [OR] 299.5 {95% CI 70.0-1282.7} for intravenous [IV] use and OR = 12.2 {4.3-35.0} for oral use). Risk markers included local suppuration (OR = 7.8 {1.8-34.1}), dental extraction (OR = 7.6 {2.4-24.7}), and radiation therapy (OR = 24.1 {4.9-118.4}). When cancer patients (n = 143) were excluded, bisphosphonate use (OR = 7.2 {2.1-24.7}), suppuration (OR = 11.9 {2.0-69.5}), and extractions (OR = 6.6 {1.6-26.6}) remained associated with ONJ. Higher risk of ONJ began within 2 years of bisphosphonate initiation and increased 4-fold after 2 years. Both IV and oral bisphosphonate use were strongly associated with ONJ. Duration of treatment >2 years; suppuration and dental extractions were independent risk factors for ONJ.

Destructive periodontal disease has been primarily defined and investigated as an infectious disease. The aim of this study was to systematically search for cohort studies where microbiological diagnoses were performed before the onset of destructive periodontal disease and where statistically significant associations were identified. A search was executed in PubMed. The results showed that three studies published after 2005 supported the infection hypothesis for one putative periodontal pathogen: Aggregatibacter actinomycetemcomitans. These three studies were conducted in predominantly non-Caucasian pediatric populations living in geographic areas with an elevated child-mortality rate. These studies did not obtain physical or laboratory markers of health, making it possible that A. actinomycetemcomitans was not a cause but a marker for poor environmental or systemic health. No cohort studies were identified supporting the infection hypothesis in adults, Caucasians or in a population residing in areas with child-mortality rates reflective of healthy population goals. While the possibility cannot be excluded that A. actinomycetemcomitans has an etiological role in certain specific pediatric populations, there are no cohort studies supporting an infectious etiology of destructive periodontal disease in adults., (© 2012 Eur J Oral Sci.)

Background: There are a few prospective studies reporting on new implant systems. When a new implant is brought to market, prospective trials should be carried out to determine the predictability of that system., Purpose: This prospective study evaluates implant survival, Resonance Frequency Analysis (RFA), and crestal bone level changes for a new implant system (Neoss System, Bimodal surface, Neoss Ltd, Harrogate, UK)., Materials and Methods: Seventy-six patients, 38 females (age ranging from 23 to 57 years) and 38 males (ranging in age from 17 to 85 years) received 100 Neoss implants. Patients were consecutively enrolled in the study if they were missing one or more teeth in either arch, or a single tooth was scheduled for removal and immediate implant replacement. Evaluated implants were 4, 4.5, or 5 mm wide and were 7, 9, 11, 13, or 15 mm long. A one-stage approach was followed. At first stage and prior to healing abutment placement RFA measurements were taken. Measurements were retaken at second stage. Fifty-one implants were placed for restoration of single missing teeth and 49 were for short span implant bridges., Results: The cumulative survival rate at 1- to 2-year interval was 93%. Average initial RFA measurement for all implants was 72.06, while the average final score was 72.58. These changes were not statistically significant. Changes in RFA scores for maxillary implants were insignificant. Forty-two paired mandibular RFA measurements were evaluated. Initial and final mean mandibular RAF measurements were 73.65 (SD 9.203) and 77.186 (SD 6.177), respectively. These changes were statistically significant (p = .02). Sixty-four paired radiographs were available for evaluation. Between examinations, there was an average -0.6 mm of bone loss, which was statistically significant (p = .03). On average, 4.0-mm-wide implants lost 0.1 mm of bone when compared with 5-mm-wide implants. These differences were insignificant (p = .86). Bone loss was adjusted for implant length, and tooth position and there were small, but clinically insignificant changes. Five-millimeter-wide implants lose 0.2 mm more than 4.0-mm-wide implants (p = .7). Maxillary incisors lose the least amount of bone 0.152 (p = .33)., Conclusions: The implants tested in this study had initially high RAF readings, indicating good primary stability. RFA readings for implants placed in the mandible improved from baseline and the changes were statistically significant. Marginal bone levels revealed clinically insignificant bone loss from implant installation to second stage. Loss of seven implants with initially high RFA readings is surprising., (© 2011 Wiley Periodicals, Inc.)

Subjects: The study included 230 patients (60% female) with a total of 423 wisdom tooth extractions. The patients were treated by 2 oral surgeons between July 1998 and July 2002 in the Oral and Maxillofacial Surgery Unit of the Massachusetts General Hospital in Boston, Massachusetts., Gold Standard: The authors reported that the extraction was inspected for evidence of inferior alveolar nerve (IAN) exposure under direct vision using a headlight., Diagnostic Tests: Each tooth was inspected for the presence of any of the following 5 radiographic signs:, Main Results: No IAN exposures occurred when all 5 radiographic signs were absent. Based on this study, where 189 M3 had such a radiographic presentation, we can conclude that the upper limit of the 95% confidence interval for the IAN exposure is 1.6%. None of the 5 diagnostic markers, when used in isolation, had adequate sensitivity and specificity to accurately predict an IAN nerve exposure in a clinical setting., (Copyright © 2012. Published by Mosby, Inc. All rights reserved.)

Objective: To determine the long-term safety and benefit of a new intraoral bone conduction device (SoundBite Hearing System by Sonitus Medical) for single-sided deafness (SSD)., Study Design: A multi-center, controlled, nonrandomized, prospective unblinded study of SSD patients wearing the device over a 6-month period., Settings: Ambulatory care centers typical of those where SSD patients are diagnosed and treated., Patients: Adults (N = 22) with acquired, permanent SSD and no current use of any other SSD device., Intervention: Continual daily wear of the new device for 6 months., Main Outcome Measures: Comprehensive medical, audiologic, and dental measures; aided thresholds; Abbreviated Profile of Hearing Aid Benefit scores, and an SSD questionnaire., Results: There were no related adverse events or changes in the medical or audiologic findings at the end of the trial compared with the beginning. There were no significant changes in the mean aided thresholds (p > 0.01) or the mean dental measures (p > 0.05) at 3 or 6 months compared with pretrial measures. The mean Abbreviated Profile of Hearing Aid Benefit benefit scores showed improvement (p < 0.01) for the Background Noise, Reverberation, and Ease of Communication subscales and the Global scale at 3 and 6 months. The results of the SSD questionnaire indicated that the vast majority (>90%) of the subjects reported satisfaction and improvement in a variety of areas after wearing the device long term., Conclusion: The SoundBite system is safe and continues to provide substantial benefit for SSD patients with continual daily use over a 6-month period.

Case reports and cohort studies have linked bisphosphonate therapy and osteonecrosis of the jaws (ONJ), but neither causality nor specific risks for lesion development have been clearly established. We conducted a 1:3 case-control study with three dental Practice-based Research Networks, using dentist questionnaires and patient interviews for collection of data on bisphosphonate therapy, demographics, co-morbidities, and dental and medical treatments. Multivariable logistic regression analyses tested associations between bisphosphonate use and other risk factors with ONJ. We enrolled 191 ONJ cases and 573 controls in 119 dental practices. Bisphosphonate use was strongly associated with ONJ (odds ratios [OR] 299.5 {95%CI 70.0-1282.7} for intravenous [IV] use and OR = 12.2 {4.3-35.0} for oral use). Risk markers included local suppuration (OR = 7.8 {1.8-34.1}), dental extraction (OR = 7.6 {2.4-24.7}), and radiation therapy (OR = 24.1 {4.9-118.4}). When cancer patients (n = 143) were excluded, bisphosphonate use (OR = 7.2 {2.1-24.7}), suppuration (OR = 11.9 {2.0-69.5}), and extractions (OR = 6.6 {1.6-26.6}) remained associated with ONJ. Higher risk of ONJ began within 2 years of bisphosphonate initiation and increased four-fold after 2 years. Both IV and oral bisphosphonate use were strongly associated with ONJ. Duration of treatment > 2 years; suppuration and dental extractions were independent risk factors for ONJ.

Introduction: Anterior open-bite (AOB) treatment is considered challenging because of difficulties in determining and addressing etiologic factors and the potential for relapse in the vertical dimension after treatment. In this review, we compiled evidence on the long-term stability of the major therapeutic interventions for correcting AOB. Our objective was to review and compile evidence for the stability of surgical and nonsurgical therapies for AOB malocclusion. Our data sources were PubMed, EMBASE, Cochrane Library, limited gray literature search, and hand searching., Methods: A search was performed of the electronic health literature on the stability of AOB after treatment. Hand searching of major orthodontic journals and limited gray literature searching was also performed, and all pertinent abstracts were reviewed for inclusion. Full articles were retrieved for abstracts or titles that met the initial inclusion criteria or lacked sufficient detail for immediate exclusion. Studies accepted for analysis were reviewed and their relevant data retrieved for pooling. The long-term stability estimates were pooled into nonsurgical and surgical groups, and summary statistics were generated., Results: One hundred five abstracts met the initial search criteria, and 21 articles were included in final analyses. Rejected articles failed to exhibit follow-up times of 12 months or more, did not include measurements of overbite (OB), or did not meet inclusion criteria. All included articles were divided into a surgical group (SX) with a mean age of 23.3 years and a nonsurgical group (NSX) with a mean age of 16.4 years. All studies were case series. Random-effects statistical models were used to pool the mean OB measures before and after treatment and also at the long-term follow-up. The pretreatment adjusted means of OB were -2.8 mm for the SX and -2.5 mm for the NSX. AOB closures up to +1.6 mm (SX) and +1.4 mm (NSX) were achieved. Relapse in the SX group during the mean 3.5 years of follow-up reduced the OB to +1.3 mm; the NSX group relapsed to +0.8 mm in the mean 3.2 years of follow-up. Pooled results indicated reasonable stability of both the SX (82%) and NSX (75%) treatments of AOB measured by positive OB at 12 or more months after the treatment interventions., Conclusions: In the included case series publications, success of both the SX and NSX treatments of AOB appeared to be greater than 75%. Because the SX and the NSX were examined in different studies and applied to different clinical populations, no direct assessment of comparative effectiveness was possible. The pooled results should be viewed with caution because of the lack of within-study control groups and the variability among studies., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Objective: The auditory deficits of Single Sided Deafness (SSD) can be treated effectively with a novel device, SoundBite, that delivers sound by applying imperceptible vibratory signals to the teeth (hereafter referred to as an intra-oral hearing device). The intra-oral hearing device is placed around two maxillary teeth and is similar to a small partial denture or retainer. The goal of this study was to report how this removable hearing device affects the oral structures., Methods: Twenty-two SSD patients wearing an intra-oral hearing device were enrolled in a prospective study for six months. Differences (delta) between the device-anchoring teeth and the equivalent contralateral non-device teeth were evaluated with four dental parameters using a paired t-test. Hearing thresholds were evaluated as a function of alveolar bone support using linear regression., Results: Compared to the non-device teeth, the hearing device teeth did not exhibit any increased recession (delta = 0.1 mm, p-value = 0.48), increased pocket depth (delta = 0.0 mm, p-value = 0.48), increased root resorption (delta = 4%, p-value = 0.43), or increased alveolar bone loss (delta = 0.0 %, p-value = 0.43). There was no association between the amount of alveolar support and hearing thresholds (delta = 0.2, p-value = 0.34)., Conclusion: The intra-oral component of the hearing device did not adversely affect the dental structures of the subjects in this trial.

Objective: Compare GHb among people with diabetes who have and have not received periodontal care., Research Design and Methods: This cross-sectional study linked 5 years of electronic medical record and dental insurance data for dually insured patients with diabetes, ages 40-70 years (n = 5,103). We assessed the association between annual mean GHb (%) and periodontal care (a proxy for periodontitis) defined using claim codes. Among patients who received periodontal care, we assessed the association between GHb and periodontal treatment intensity. We determined associations using linear regression adjusted for potential confounders and tested for effect modification by age, sex, insulin use, diabetes severity, BMI, and smoking., Results: Mean GHb was 7.66%; 38% of participants received periodontal care during the 5 years. After multivariate adjustment, patients who received periodontal care had a GHb level 0.08 percentage points higher than patients who did not (P = 0.02). In stratified analyses, the association was present for women (0.18 percentage points higher GHb with periodontal care, P < 0.001) but not significant for men (0.008 percentage points lower, P = 0.86). In patients who received periodontal care, those with one, and with two or more, surgical treatments had GHb 0.25 (P = 0.04) and 0.36 (P = 0.002) percentage points lower, respectively, than patients without periodontal surgeries., Conclusions: This population-based cross-sectional study showed small associations between periodontal care (a proxy for periodontitis) and higher GHb. Well-controlled longitudinal studies or clinical trials are needed to evaluate causality and temporal trends. Sub-analyses suggest that further investigation of this association among women, and by intensity of periodontal treatment, may be of interest.

Purpose: To investigate prevalence and severity of gingivitis in representative American adults., Methods: Subjects (1,000) in Loma Linda, California; Seattle, Washington; and Boston, Massachusetts were examined for Löe-Silness Gingivitis Index (GI). Mann-Whitney rank sum test was used to determine significances in the GI between genders. The data among study sites and races were compared using the Kruskal-Wallis one-way ANOVA on ranks. The correlation of the GI and age was examined by the Spearman rank order correlation. Age differences among three sites were analyzed using the one-way ANOVA., Results: The race composition of the subjects (mean age 37.9) approximated to the 2004 U.S. Census data. The overall average GI was 1.055. Only 6.1% of subjects showed mean GI<0.50; most (93.9%) were > or = 0.50, with 55.7% > or = 1.00. There was a significant correlation (P<0.001) between the age and GI. The males' GI was significantly higher (P<0.001) than the females'; African-Americans showed a significantly higher GI (P<0.05) than other races except for the Native-Americans.

Disasters surrounding medical drugs and devices that led to public outcries for regulation have led to both legislation and the recognition that all sources of evidence are not equal in terms of reliability. Randomized controlled trials provide more reliable evidence than case-series, and human studies provide more reliable evidence than animal studies. In evidence-based medicine, different hierarchies have been created to grade the reliability of evidence. This report provides a brief review of the evidence-pyramid.

Two contradictory hypotheses on the role of dietary carbohydrates in health and disease shape how dental-systemic associations are regarded. On one side, Cleave and Yudkin postulated that excessive dietary fermentable carbohydrate intake led-in the absence of dental interventions such as fluorides-first to dental diseases and then to systemic diseases. Under this hypothesis, dental and systemic diseases shared-as a common cause-a diet of excess fermentable carbohydrates. Dental diseases were regarded as an alarm bell for future systemic diseases, and restricting carbohydrate intake prevented both dental and systemic diseases. On the opposite side, Keys postulated the lipid hypothesis: that excessive dietary lipid intake caused systemic diseases. Keys advocated a diet high in fermentable carbohydrate for the benefit of general health, and dental diseases became regarded as local dietary side effects. Because general health takes precedence over dental health when it comes to dietary recommendations, dental diseases became viewed as local infections; interventions such as fluorides, sealants, oral hygiene, antimicrobials, and dental fillings became synonymous with maintaining dental health, and carbohydrates were no longer considered as a common cause for dental-systemic diseases. These opposing dietary hypotheses have increasingly been put to the test in clinical trials. The emerging trial results favor Cleave-Yudkin's hypothesis and may affect preventive approaches for dental and systemic diseases.

Background: The placement of implants using a minimally invasive flapless approach has the potential to reduce operative bleeding and postoperative discomfort and minimize crestal bone loss. This article presents follow-up data on a prospective clinical study of implants placed using a flapless procedure., Methods: The original study reported on 57 patients (33 female patients with an age range of 24 to 86 years; 24 male patients with an age range of 27 to 81 years) recruited from three clinical centers (Tucson, Arizona; Gothenburg, Sweden; and Tel Aviv, Israel) who received 79 implants. After an average of 3 years and 8 months, the patients were contacted and invited to return to their respective clinics for reexamination. Thirty-seven patients with 52 implants returned for a follow-up examination; the remaining 20 patients (27 implants) were not available for reexamination and were considered study drop-outs., Results: The cumulative survival rate at the 3- to 4-year follow-up examination remains at 98.7%, reflecting the loss of one implant. The mean probing depth at abutment connection was 2.2 mm, as reported in the initial study (examination 2 at approximately 2 years postplacement); it was 2.4 mm at the 3- to 4-year second follow-up examination. This change was not clinically or statistically significant. Bleeding score changes also were not significant between the two intervals. The average crestal bone level was -0.7 mm at examination 2 and -0.8 mm at examination 3, a change that approached significance (P <0.06)., Conclusions: Minimally invasive flapless surgery offers patients the possibility of high implant predictability with clinically insignificant crestal bone loss for up to 4 years. Proper diagnosis and treatment planning are key factors in achieving predictable outcomes.

Systemic antibiotics have been recommended for the treatment of destructive periodontal disease. Our goal was to relate antibiotic use for medical or dental reasons to subsequent tooth loss in a cohort of 12,631 persons with destructive periodontal disease. After adjustment for age, smoking, and other confounders, the dispensing of antibiotics for 1-13 days, 14-20 days, or 21 or more days was not associated with reduced tooth loss [Adjusted rate ratio (RR) = 1.0; 95% Confidence Interval (CI) = 0.8-1.1; RR = 1.2; 95% CI = 0.9-1.4, and RR =1.2, 95% CI =1.0-1.3, respectively]. Numerous subgroup analyses were consistent with these overall null findings, with two exceptions: Longer courses of tetracyclines were associated with reduced tooth loss among persons receiving periodontal care, and penicillin was associated with reduced tooth loss among persons with more severe disease. Long-term, larger randomized trials are needed to provide evidence that antibiotics reduce tooth loss when used in the management of destructive periodontal disease.

Three different types of systematic experiments are powerful tools to evaluate whether the low-level evidence on cause and effect indeed translates into tangible outcomes in humans. The evidence pyramid forms the core of evidence-based dentistry that allows grading the evidence.

Translating basic science evidence into clinical trials is particularly challenging.

Background: The authors describe an educational program designed to prepare practicing dentists to engage in practice-based research in their practices--a trend receiving more emphasis and funding from the National Institute of Dental and Craniofacial Research (NIDCR)., Methods: The Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT), an NIDCR-funded network of which the authors are members, developed a one-day educational program to educate practitioners in principles of good clinical research. The program has four components built around the following questions: "What is the question?"; "What are the options?"; "How do you evaluate the evidence?"; and "How do you conduct a study?", Results: The intensive one-day program initially offered in early 2006, which concluded with applications of research principles to research topics of interest to practitioners, was well-received. Despite their admission that the research methodology by itself was not of great interest, the dentists recognized the importance of the background material in equipping them to conduct quality studies in their practices., Conclusions: Dentists interested in participating in practice-based research view training in research methodology as helpful to becoming better practitioner-investigators. The PRECEDENT training program seemed to reinforce their interest., Practice Implications: As dentistry evolves to become more evidence-based, more and more of the evidence will come from practice-based research. This training program prepares practicing dentists to become engaged in this trend.

Introduction: The high prevalence of orthodontic treatment in young people makes the associated radiation to the head and neck of potential public-health significance. In this study, we estimated secular changes (1963-2003) in age-specific organ doses associated with orthodontic care and collective organ doses in the United States in 1999., Methods: A survey of radiographic records at 1 university clinic was combined with published estimates to provide organ-specific radiation doses. Collective organ doses were estimated from the 1999 US Nationwide Evaluation of X-ray Trends and published orthodontic utilization surveys., Results: Before 1992, orthodontic care in a university setting was associated with mean doses of 7.0 milligrays (mGy) to the thyroid, 0.8 mGy to the red bone marrow, 2.7 mGy to the brain, 13.2 mGy to the salivary glands, and 5.1 mGy to the bone. After 1992, the doses decreased to 2.8 mGy to the thyroid, 0.3 mGy to the red bone marrow, 0.7 mGy to the brain, 6.2 mGy to the saliva glands, and 2.4 mGy to the bone. Around 1999, the collective doses associated with orthodontic care in the United States in patients less than 19 years of age were 400 Gy to the red bone marrow and 3800 Gy to the thyroid., Conclusions: Orthodontic care, in part due to its high prevalence, potentially contributes significantly to the diagnostic radiation burden in those less than 19 years old in the United States.

Background and Objective: The purpose of this study was to assess the oral health-related quality of life of patients presenting to a periodontal specialist by means of six questions, and to assess the perceived oral health by means of one question. Self-assessments of oral health were associated with clinical characteristics., Material and Methods: Logistic regression models were used to associate self-assessments with clinical characteristics in a cross-sectional study., Results: On the six-item questionnaire, close to 20% (295/1480) of the patients reported that teeth, gums or dentures had an impact fairly often or very often on one or more items (eating, relaxing, avoiding going out, feeling self-conscious, pain or discomfort). On the single question requesting a self-assessment of oral health, 42% (628/1468) rated their oral health as fair or poor. Both common oral health-related quality of life problems and worse perceived oral health were associated with having more than eight teeth with>5 mm periodontal pockets (odds ratio=1.45, 95% confidence interval=1.01-2.08; and odds ratio=2.83, 95% confidence interval=2.08-3.84, respectively), compared with patients who had fewer than three teeth with>5 mm periodontal pockets., Conclusion: Oral health-related problems in patients presenting to a periodontal specialist office negatively affect their quality of life. If some of the findings of this study can be confirmed in other studies, it could change the perception of chronic periodontitis as a silent disease.

For health care planning and policy, it is important to determine whether socio-economic disparities in edentulism, an ultimate marker of oral health, have improved over time. The aim of this study was to investigate the socio-economic disparities in edentulism between 1972 and 2001. Representative samples of the United States population, 25-74 years old, were obtained from NHANES I (1972), III (1991), and 1999-2002. Differences in the edentulism prevalence between high and low socio-economic positions (SEP) were compared. Differences in edentulism prevalence remained stable over approximately three decades (p = 0.480), being 10.6 percentage points in 1972, 12.1 percentage points in 1991, and 11.3 percentage points in 2001. Exploratory subgroup analyses suggested that disparities decreased for those individuals reporting a dental visit in the prior year and those reporting never having smoked. In conclusion, the absolute prevalence difference in edentulism between low and high socio-economic positions has remained unchanged over the last three decades.

The Trial to Enhance Elderly Teeth Health (TEETH) was designed to test the impact of regular rinsing with a 0.12% chlorhexidine (CHX) solution on tooth loss, and the causes of tooth loss (caries, periodontal disease and trauma) were also investigated. This paper reports on the effectiveness of a 0.12% CHX solution for controlling caries using a tooth surface (coronal and root) survival analysis. A total of 1,101 low income elders in Seattle (United States) and Vancouver (Canada), aged 60-75 years, were recruited for a double-blind clinical trial and assigned to either a CHX (n = 550) or a placebo (n = 551) mouth rinse. Subjects alternated between daily rinsing for 1 month, followed by weekly rinsing for 5 months. All sound coronal and root surfaces at baseline were followed annually for up to 5 years. At each follow-up examination, those tooth surfaces with caries, restored, or extracted were scored as 'carious'. The hazard ratio associated with CHX for a sound surface to become filled, decayed, or extracted was 0.87 for coronal surfaces (95% confidence interval: 0.71-1.14, p = 0.20) and 0.91 for root surfaces (95% confidence interval: 0.73-1.14, p = 0.41). These findings suggest that regular rinsing with CHX does not have a substantial effect on the preservation of sound tooth structure in older adults., (Copyright 2007 S. Karger AG, Basel.)

Background: Flapless surgery requires penetration of the alveolar mucosa and bone without reflection of mucoperiosteal flaps. Do these techniques force gingival tissue or foreign materials into osteotomies? If so, do such tissues or materials interfere with osseointegration? A proof-of-principle study using a canine model attempted to answer these questions., Methods: Five young adult Hound Labrador mongrel dogs received implants with a moderately roughened surface by anodic oxidation using flapless or conventional one-stage (control) surgery in contralateral jaw quadrants. The implants were placed into the osteotomies, and the international stability quotient (ISQ) was recorded using resonance frequency analysis. These measurements were repeated following a 3-month healing interval when the animals were euthanized, and implants and surrounding tissues were retrieved and processed for histologic analysis., Results: The implants were stable upon insertion and demonstrated increased stability at 3 months without significant differences between surgical protocols. The histologic evaluation showed high bone-implant contact (flapless surgery: 54.7% +/- 8.4%; control: 52.2% +/- 13.0%; P >0.05) without evidence of gingival tissue or foreign body inclusions. There were no significant differences in marginal bone levels between the surgical protocols. Post-insertion and at 3 months, ISQ values depended on the amount of torque delivered. Immediately post-insertion, for every 1-unit increase in torque value, the ISQ increased by 0.3 (95% confidence interval: 0.1 to 0.4; P = 0.0043). Three months postoperatively, for every one-unit increase in torque the ISQ value decreased 0.2 (95% confidence interval: -0.4 to -0.1; P = 0.0012). The effect of torque on ISQ values was independent of treatment effects and remained significant after adjustment for treatment., Conclusions: The results suggest that implants placed without flap reflection remain stable and exhibit clinically relevant osseointegration similar to when implants are placed with flapped procedures. Greater torque at implant placement resulted in less implant stability at 3 months.

Obtaining lifetime diagnostic radiation histories in head and neck cancer studies is often challenging due to the almost universal lack of centralized registries on X-ray utilization in medicine and dentistry. Both the common nature of orthodontics and the young age at which orthodontics typically occurs make it important to quantify what diagnostic radiographs are typically taken during orthodontic therapy. The aim of this study was to assess the number and type of radiographic films associated with one episode of orthodontic therapy in an educational setting. Charts stored in an orthodontic clinic at one academic setting were randomly sampled, and the type and number of radiographic examinations were tallied for the 325 individuals who were in orthodontic therapy for at least one year. Being under orthodontic therapy for one or more years was associated with a median number of seven extra-oral radiographs and twenty-four intra-oral radiographic films. The extra-oral radiographs included three panoramic radiographs and three cephalometric radiographs. Less than 10 percent of the variability was explained by factors such as age, gender, calendar year, surgical orthodontic therapy, and duration of therapy. Head and neck cancer etiology studies should take into account the ionizing radiation during episodes of orthodontic care. The substantial variability in radiographic practices in orthodontics could be reduced by research into clinical utility and by establishing guidelines.

Objective: To investigate whether measures of obesity are associated with periodontitis., Design: A case-control study., Setting: A nationally representative sample using data from the Third National Health and Nutrition Examination Survey., Participants: The sample included 2452 nonsmokers, aged 13 to 21 years, who received a periodontal examination and had complete information for age, sex, and smoking habits., Main Exposures: Skinfold thickness, weight, and waist circumference were examined as independent variables in logistic regression models. Final models were adjusted for sex, race/ethnicity, poverty index ratio, last dental visit, and self-reported calcium intake., Main Outcome Measures: Cases were subjects with the presence of 1 or more periodontal sites with both a loss of tissue attachment of 3 mm and a probing depth of 3 mm (n = 111). Subjects who did not meet these criteria were classified as controls (n = 2341)., Results: Total body weight and waist circumference were associated with periodontitis, but the association varied by age. Adolescents aged 13 to 16 years were not at increased risk of chronic periodontitis, while adolescents aged 17 to 21 years had an increased risk per 1-kg increase in body weight (adjusted odds ratio, 1.06 [95% confidence interval, 1.01-1.09]). Similarly, adolescents aged 13 to 16 years were not at increased risk for periodontal disease, while adolescents aged 17 to 21 years were at an increased risk of periodontal disease per 1-cm increase in waist circumference (adjusted odds ratio, 1.05 [95% confidence interval, 1.01-1.08])., Conclusion: Periodontitis may follow patterns similar to other chronic conditions that originate early in life and are related to central adiposity.

Background: Individuals with increased oral health awareness may also have increased general health awareness, and vice versa. Such associations between oral and general health awareness has the potential to induce spurious associations in oral epidemiological research., Objective: To assess the extent to which oral self-care patterns and general health awareness are confounded, we investigated the association between flossing and obesity, two lifestyle factors that are unlikely to be causally related., Methods: A cross-sectional study of 1497 individuals presenting for an initial periodontal exam by the specialist. Self-reported flossing behaviors and body mass index (BMI) categories were related using logistic regression models., Results: After adjustment for confounding variables, lack of daily flossing was associated in a dose-dependent way with morbid obesity (odds ratio (OR), 20.3; 95% confidence interval (CI), 2.7-154.0), obesity (OR, 2.1; 95% CI, 1.5-2.9), and being overweight (OR, 1.7; 95% CI, 1.3-2.2). When restricting to never smokers, a significant relationship between obesity and lack of flossing remained., Conclusion: The strong associations between two causally unrelated oral and general lifestyle characteristics indicate that simplistic epidemiologic methodology is unlikely to provide insights into causal mechanisms of oral diseases or oral-systemic relationships.

Objectives: We report the development and psychometric evaluation of short forms of the Oral Health Impact Profile German version (OHIP-G) - an instrument to assess oral health-related quality of life (OHRQoL)., Methods: A five-item short form was developed using best subset regression in 2050 subjects from a national survey. Two 14-item versions were derived from English-language short forms and a 21-item version from previous factor analytic work. A second sample from the general population (n = 163) and a sample of clinical patients with temporomandibular disorders (TMD; n = 175) were used to investigate validity and internal consistency. Test-retest reliability was evaluated in 30 prosthodontic patients before treatment. Responsiveness was assessed in 67 patients treated for their TMD pain., Results: Associations between short form summary scores and self-report of oral health and four oral disorders in the general population and in TMD patients were interpreted as support for convergent/groups validity. The instruments' responsiveness (effect measures of 0.55-0.98), test-retest reliability (intraclass correlation coefficients: 0.72-0.87), and internal consistency (Cronbach's alpha: 0.65-0.92) were sufficient., Conclusions: Sufficient discriminative and evaluative psychometric properties of short forms of the OHIP-G make the instruments suitable to assess OHRQoL in cross-sectional as well as longitudinal studies.

Background: The thyroid is among the more radiosensitive organs in the body. The goal of this study was twofold: (1) to evaluate age-related changes in what is exposed to ionizing radiation in the neck area, and (2) to assess thyroid shield presence in cephalometric radiographs, Methods: Cephalometric radiographs at one academic setting were sampled and neck exposure was related to calendar year and patient's gender and age., Results: In the absence of shields, children have more vertebrae exposed than adults (p < 0.0001) and females have more neck tissue exposed inferior to the hyoid bone than males (p < 0.0001). The hyoid bone-porion distance increased with age (p <0.01). Thyroid shields were visible in 19% of the radiographs and depended strongly on the calendar year during which patient was seen (p-value <0.0001). Compared to adults, children were less likely to wear thyroid shields, particularly between 1973 and 1990 (1.8% versus 7.3% -p-value < 0.05) and between 2001 and 2003 (7.1% versus 42.9% -p-value < 0.05)., Conclusion: In the absence of a thyroid shield, children have more neck structure exposed to radiation than adults. In agreement with other reports, thyroid shield utilization in this study was low, particularly in children.

Background: Statins have anti-inflammatory and bone stimulating properties that may positively affect chronic periodontitis. Our objective in this study was to evaluate whether statin use by chronic periodontitis patients had a beneficial impact on tooth loss., Methods: In a retrospective cohort study (N patients = 1,021; mean follow-up = 7.1 years), dental records were merged with pharmacy data. Any statin use during 3 years, statin use during each of 3 consecutive years (regular use), and any statin use during the first 3 years after the initial periodontal exam were evaluated as predictors of tooth loss using negative binomial regression models with adjustment for potential confounding factors., Results: Any statin use during 3 years was not associated with tooth loss rate in the year subsequent to the 3-year period (rate ratio [RR] = 1.00; 95% confidence interval [CI] = 0.56 to 1.81). Regular statin use during 3 years was associated with a non-significant 37% reduced tooth loss rate in the year subsequent to the 3-year period (RR = 0.63; 95% CI = 0.32 to 1.25). Any statin use during the first 3 years after the initial periodontal exam was associated with a 48% decreased tooth loss rate in year 4 and subsequent years (RR = 0.52; 95% CI = 0.29 to 0.95)., Conclusions: Our findings were mixed for an association of statin use with reduced tooth loss in chronic periodontitis patients. Lack of control for some potential confounders, particularly smoking, and evaluation of different patterns of statin usage hamper the interpretation of the results. Exploration of these findings in additional epidemiological studies may be worthwhile.