Search

AIM: Aim was to systematically review behavioural aspects in the prevention and control of dental caries and periodontal diseases at individual and population level.MATERIAL & METHODS: With regard to caries, MEDLINE/PubMed was searched on three subheadings focusing on early childhood, proximal and root caries. For periodontal diseases, a meta-review on systematic reviews was performed; thus, the search strategy included specific interventions to change behaviour in order to perform a meta-review on systematic reviews. After extraction of data and conclusions, the potential risk of bias was estimated and the emerging evidence was graded.RESULTS: Regarding early childhood, proximal and root caries, 28, 6 and 0 papers, respectively, could be included, which predominantly reported on cohort studies. Regarding periodontal diseases, five systematic reviews were included. High evidence of mostly high magnitude was retrieved for behavioural interventions in early childhood caries (ECC), weak evidence for a small effect in proximal caries and an unclear effect of specific informational/motivational programmes on prevention of periodontal diseases and no evidence of root caries.CONCLUSION: Early childhood caries can be successfully prevented by population-based preventive programmes via aiming at the change in behaviour. The effect of individual specific motivational/informational interventions has not yet been clearly demonstrated neither for the prevention of caries nor for periodontal diseases.

AIM: To review the burden of caries and periodontitis in the elderly, changes with age that can explain this burden, and the vulnerability to disease of elderly populations.METHODS: An assessment of surveys in two populations was conducted. Indicators for caries were identified by updating a systematic review. Secular trends for smoking and type 2 diabetes were discussed.RESULTS: Changes in the susceptibility to periodontitis with age may be explained by exposure to pro-inflammatory conditions and changes in the healing capacity of cells and tissues. Due to accumulated periodontal destruction, the number of surfaces at risk for caries increases. The sequels of restorative treatment contribute to an increased susceptibility for caries development. Population-based surveys in the United States and Germany demonstrate a high caries experience among elderly people. A comparison of surveys demonstrates a relative improvement of periodontal health among elderly during the last few decades. Nevertheless, prevalence estimates for periodontitis remain high. Risk indicators for root caries include caries experience, the number of surfaces at risk and poor oral hygiene. Secular trends of main risk factors for periodontitis and their likely influence on the future periodontitis burden in the elderly are discussed.CONCLUSION: Caries and periodontitis burden in the elderly remain high.

Aim To review evidence for the treatments of gingival recession and root caries in older populations. Materials & Methods A systematic approach was adopted to identify reviews and articles to allow us to evaluate the treatments for gingival recession and root caries. Searches were performed in PubMed, Medline and Embase, the Cochrane trials register and bibliographies of European and World Workshops. Observations Gingival recession: We identified no articles that focussed specifically on older populations. Conversely, no evidence suggested that Miller class I and II lesions should be managed differently in older patients when compared to younger cohorts. Six systematic reviews included older patients and suggested that connective tissue grafts are the treatment of choice, alone or in combination with enamel matrix derivative. Root caries can be controlled at the population level by daily brushing with fluoride-containing toothpastes, whilst active decay may be inactivated using professional application of fluoride varnishes/solutions or self-applied high-fluoride toothpaste. Active root caries lesions that cannot be cleaned properly by the patient may be restored by minimally invasive techniques. Conclusions Gingival recession and root caries will become more prevalent as patients retain their teeth for longer. Whilst surgical (gingival recession) and non-operative approaches (root caries) currently appear to be favoured, more evidence is needed to identify the most appropriate strategies for older people.

Objective To systematically review the survival rate and incidence of complications of furcation-involved multirooted teeth following periodontal therapy after at least 5 years. Material and methods Electronic and manual searches were performed up to and including January 2008. Publication selection, data extraction and validity assessment were performed independently by three reviewers. Results Twenty-two publications met the inclusion criteria. Because of the heterogeneity of the data, a meta-analysis could not be performed. The survival rate of molars treated non-surgically was >90% after 5-9 years. The corresponding values for the different surgical procedures were: Surgical therapy: 43.1% to 96%, observation period: 5-53 years. Tunnelling procedures: 42.9% to 92.9%, observation period: 5-8 years. Surgical resective procedures including amputation(s) and hemisections: 62% to 100%, observation period: 5-13 years. Guided tissue regeneration (GTR): 83.3% to 100%, observation period: 5-12 years. The most frequent complications included caries in the furcation area after tunnelling procedures and root fractures after root-resective procedures. Conclusions Good long-term survival rates (up to 100%) of multirooted teeth with furcation involvement were obtained following various therapeutic approaches. Initial furcation involvement (Degree I) could be successfully managed by non-surgical mechanical debridement. Vertical root fractures and endodontic failures were the most frequent complications observed following resective procedures.

Background/aims: The aim of this study was to analyse the residual periodontal attachment in teeth extracted by East German dentists in order to determine a possible ‘forceps level’. Methods: Out of about 8000 extracted teeth collected from a dental waste disposal company, 500 teeth were randomly selected. After exclusion of wisdom teeth and premolars extracted for orthodontic reasons (intact teeth with attachment > 90%), coronal and root caries, fillings, pulp exposure and incomplete root fillings (based on X-rays) were registered. The periodontal ligament was stained with 1% Fuchsin Red and measured with a light microscope. Results: For intact teeth (DF = 0, periodontal disease definition I), the mean periodontal attachment (50.5% ± 16.0) was significantly lower than for teeth with carious defects or fillings (64.7% ± 18.8. unpaired t-test: p

Background: The etiology of root caries is thought to be identical to coronal caries, though root caries seem to be more complicated because of the higher susceptibility of exposed roots (dentin) by periodontal therapy to demineralization than intact enamel. This implies that mutans streptococci are the most likely pathogens in the development of root caries. Although it is known that both the numbers of mutans streptococci and the frequency of isolation in root caries lesions are negatively correlated with the distance from the gingival margin, the subgingival sulcus has not been considered a possible habitat for mutans streptococci. However, subgingival occurence of mutans streptococci in both untreated and treated periodontal patients has not been documented well in the literature.Objective: To investigate the presence and levels of mutans streptococci in the subgingival plaque of patients (n=154) in different stages of periodontal therapy. The subgingival sulcus may be a possible habitat for mutans streptococci. This localisation of mutans streptococci may be of importance in the development of root caries after periodontal surgery.Materials and methods: In this cross-sectional study, subgingival plaque samples from 154 consecutive adult periodontitis patients were tested for presence and levels of mutans streptococci and putative periodontal pathogens by anaerobic cultures. These patients were divided into 3 groups based on their stage of periodontal treatment: (1) untreated patients; (2) patients after initial periodontal therapy only; (3) patients in the maintenance phase who not underwent periodontal surgery; (4) patients after periodontal surgery.Results: The prevalence of mutans streptococci in the 4 study groups varied from 82% in untreated patients to 94% in maintenance patients. The mean proportion of mutans streptococci was 6.65% in maintenance patients versus 1.86% in untreated patients (p=0.005) and 2.51% in patients after scaling and root planing (p=0.041).Conclusions: The subgingival area is a microbial habitat for mutans streptococci that may be of importance in the development of root caries in periodontitis patients.

Background: The etiology of root caries is thought to be identical to coronal caries, though root caries seem to be more complicated because of the higher susceptibility of exposed roots (dentin) by periodontal therapy to demineralization than intact enamel. This implies that mutans streptococci are the most likely pathogens in the development of root caries. Although it is known that both the numbers of mutans streptococci and the frequency of isolation in root caries lesions are negatively correlated with the distance from the gingival margin, the subgingival sulcus has not been considered a possible habitat for mutans streptococci. However, subgingival occurence of mutans streptococci in both untreated and treated periodontal patients has not been documented well in the literature. Objective: To investigate the presence and levels of mutans streptococci in the subgingival plaque of patients (n=154) in different stages of periodontal therapy. The subgingival sulcus may be a possible habitat for mutans streptococci. This localisation of mutans streptococci may be of importance in the development of root caries after periodontal surgery. Materials and methods: In this cross-sectional study, subgingival plaque samples from 154 consecutive adult periodontitis patients were tested for presence and levels of mutans streptococci and putative periodontal pathogens by anaerobic cultures. These patients were divided into 3 groups based on their stage of periodontal treatment: (1) untreated patients; (2) patients after initial periodontal therapy only; (3) patients in the maintenance phase who not underwent periodontal surgery; (4) patients after periodontal surgery. Results: The prevalence of mutans streptococci in the 4 study groups varied from 82% in untreated patients to 94% in maintenance patients. The mean proportion of mutans streptococci was 6.65% in maintenance patients versus 1.86% in untreated patients (p=0.005) and 2.51% in patients after scaling and root planing (p=0.041). Conclusions: The subgingival area is a microbial habitat for mutans streptococci that may be of importance in the development of root caries in periodontitis patients.

Several publications have reported an increased susceptibility for root caries after periodontal therapy. It has been suggested that newly exposed roots were less resistant to cariogenic species. This study examined the hypothesis that the increased susceptibility could also be related to an intra-oral microbial shift during the initial phase of the periodontal therapy from a perio-pathogenic to a more cariogenic flora. 10 patients with severe periodontitis were followed for 8 months after thorough scaling and root planing in combination with optimal plaque control. At baseline and after 4 and 8 months, samples were taken from the saliva, the tongue dorsum and the supragingival interdental spaces. These samples were cultured both aerobically and anaerobically in order to determine the total number of colony forming units (CFU) per sample as well as the number of CFU of Streptococcus mutans and Lactobacillus species. Oral hygiene parameters were recorded at the same visits. Finally, at baseline and at the 8 months follow-up, changes in caries activity and periodontal health were registered. Although the total number of aerobic and anaerobic CFU in samples from the tongue and the saliva remained nearly constant over the entire observation period (variations within 0.5 log), significant (p< or =0.05) increases in the number of S. mutans could be detected, especially at month 8. The significant decrease in the total number of anaerobic CFU in samples from the teeth was not associated with a reduction in the number of S. mutans, so that also for this niche the relative proportion of the latter increased. The number of lactobacilli species for the different niches showed only negligible changes (within 0.5 log values), except for samples from the teeth for which a small (1 log), but statistically significant (p

To study periodontal conditions, root caries, number of lost teeth and causes for tooth loss during 11-14 years after active periodontal treatment.Sixty-four patients participated in the follow-up study. Reasons for tooth loss were identified through previous case books, radiographs and clinical photos. To identify factors contributing to tooth loss, a logistic multilevel regression analysis was used.The number of lost teeth was 211. The main reason was periodontal disease (n = 153). Due to root caries and endodontic complications, 28 and 17 teeth, respectively, were lost. Thirteen teeth were lost for other reasons. The number of teeth (p = 0.05) and prevalence of probing pocket depths, 4-6 mm (p = 0.01) at baseline, smoking (p = 0.01) and the number of visits at dental hygienists (p = 0.03) during maintenance, significantly contributed to explain the variation in tooth loss.Previously treated patients at a specialist clinic for periodontology continued to lose teeth in spite of maintenance treatments at general practitioners and dental hygienists. The main reason for tooth loss was periodontal disease. Tooth loss was significantly more prevalent among smokers than non-smokers. Tooth-related risk factors were smoking, low numbers of teeth and prevalence of periodontal pockets, 4-6 mm.

The aim of the study was to predict the marginal bone level at a 5-year follow-up based on the information available from an initial radiographic examination and to evaluate the precision of the prediction by comparing the predicted bone levels with those actually observed at the follow-up.In 1997, 616 randomly selected dentate individuals underwent a full-mouth radiographic survey. In 2003, 473 of those individuals (77%) participated in a second radiographic examination. Marginal bone level, caries lesions, fillings, crowns, root fillings and periapical status were recorded on all teeth. On the basis of data available from the first examination, a linear mixed model regression analysis with the tooth as the unit of analysis was used to predict the marginal bone level 5 years later.Number of teeth, smoking, and also presence of apical periodontitis and crowns were associated with bone loss and could be used as predictors of future marginal bone level.The analysis of all teeth showed that the number of tooth- and person-specific factors at the first examination influenced the prediction of the marginal bone level at the 5-year follow-up examination. However, the performance of the combined prediction model was less satisfactory.

The aim of the investigation was to study the individual susceptibility to root caries in periodontally treated patients in a long-term follow-up of 12 years. Age, plaque score, salivary counts of lactobacilli and mutans streptococci, salivary secretion rate and buffer effect, oral sugar clearance time and dietary habit index were tested as possible predictors for root caries incidence. During the whole observation period of 12 years, new root caries lesions were recorded in 24 of a total of 27 patients. In 8 of these, the root caries incidence was between 1 and 5, in 7 between 6 and 9 and in 9, 12 or more new DPS. However, the annual mean number of new DPS was rather low. 13 patients with > 5 new DFS% during the 3rd 4-year period (years 9–12) differed significantly from 14 patients with 5 new DFS% in salivary mutans streptococcus counts (p 5 new DFS% in years 9–12 than in those with 5 new DFS%. During the whole 12-year observation period, smokers had significantly more root caries than non-smokers (p < 0.05). The main conclusions from this study are (1) that root caries in this category of periodontally treated patients is a minor problem although some individuals show a high incidence, and (2) that patients at risk for development of root carties may be possible to identify by using readily available tests in addition to clinical examination and the patient's medical history.

Aim: The purpose of the present study was to evaluate in a group of periodontal maintenance patients, the effect of using a dentifrice and mouthrinse containing amine fluoride (AmF) and stannous fluoride (SnF 2 ) as compared with a dentifrice and mouthrinse both containing sodium fluoride (NaF) with regard to their root caries experience. Material: In total, 80 patients who had been treated for moderate-to-severe periodontitis agreed to participate in this study. Subjects received supportive periodontal therapy at regular intervals of 3-4 months for at least a period of 1 year. The patients were randomly divided into two groups: (1) the test group used an AmF/ SnF 2 dentifrice and mouthrinse and (2) the control group used an NaF-containing dentifrice and mouthrinse. Root caries was recorded at four sites per tooth at baseline and 24 months. Results: An increase in number of the exposed root surfaces was noted for both groups during the experimental period (p

When a binary response is observed on teeth from each subject belonging to 2 or more exposure groups, application of the usual Pearson chi2 tests is invalid, since such responses within the same subject are not independent. Consequently, special statistical methods are needed to control for the correlation among teeth (sites) within the same subject. A simple adjustment to the Pearson chi2 statistic has been proposed for comparing proportions in site-specific data. However, the required assumptions for this statistic have not yet been thoroughly addressed. These assumptions are guaranteed to hold in experimental comparisons, but may be violated in some observational studies.We investigate the conditions under which the adjusted chi2 statistic is valid and examine the performance of the adjusted chi2 statistic when these conditions are violated.Our simulation study shows that the adjusted chi2 statistic generally produces good empirical type I errors under the assumption of a common intracluster correlation coefficient. Even if the intracluster correlations are different, the adjusted statistic performs well when the groups have equal numbers of clusters (subjects).The discussion is illustrated using an observational study of caries on the roots of teeth.

The etiology of root caries is thought to be identical to coronal caries, though root caries seem to be more complicated because of the higher susceptibility of exposed roots (dentin) by periodontal therapy to demineralization than intact enamel. This implies that mutans streptococci are the most likely pathogens in the development of root caries. Although it is known that both the numbers of mutans streptococci and the frequency of isolation in root caries lesions are negatively correlated with the distance from the gingival margin, the subgingival sulcus has not been considered a possible habitat for mutans streptococci. However, subgingival occurrence of mutans streptococci in both untreated and treated periodontal patients has not been documented well in the literature.To investigate the presence and levels of mutans streptococci in the subgingival plaque of patients (n=154) in different stages of periodontal therapy. The subgingival sulcus may be a possible habitat for mutans streptococci. This localisation of mutans streptococci may be of importance in the development of root caries after periodontal surgery.In this cross-sectional study, subgingival plaque samples from 154 consecutive adult periodontitis patients were tested for presence and levels of mutans streptococci and putative periodontal pathogens by anaerobic cultures. These patients were divided into 4 groups based on their stage of periodontal treatment: (1) untreated patients; (2) patients after initial periodontal therapy only; (3) patients in the maintenance phase who not underwent periodontal surgery; (4) patients after periodontal surgery.The prevalence of mutans streptococci in the 4 study groups varied from 82% in untreated patients to 94% in maintenance patients. The mean proportion of mutans streptococci was 6.65% in maintenance patients versus 1.86% in untreated patients (p=0.005) and 2.51% in patients after scaling and root planing (p=0.041).The subgingival area is a microbial habitat for mutans streptococci that may be of importance in the development of root caries in periodontitis patients.

Background: Sjogren's syndrome (SS) is one of the most common systemic autoimmune diseases in middle-aged women. The present study had the aim to examine the dental and periodontal condition in patients with SS in comparison with disease controls and to evaluate the influence of reduced salivary flow in the periodontal tissues. Method: We examined 24 patients with primary or secondary SS in comparison with 27 patients who had another autoimmune disease but no signs or symptoms of SS, as well as with 29 subjects who had a subjective feeling of xerostomia or xerophthalmia without exhibing an underlying disease. The clinical evaluation included examination of the oral mucosa, determination of missing, decayed and filled teeth, fixed or removable prosthetic appliances, plaque index, gingival index, probing pocket depth, probing attachment level, oral hygiene habits and frequency of dental visits. Statistical analysis was performed using the 2-tailed Fisher exact and Kruskal-Wallis tests. Results: No significant difference was found in the dental or periodontal condition of the 3 groups. The number of teeth, feelings and distal or mesial decay lesions correlated negatively with age, while the number of fixed prosthetic appliances correlated positively. The salivary flow was statistically lower in patients with SS and exhibited a negative correlation with the number of cervical decay lesions. It was also found that SS patients had better oral hygiene habits than subjects of the control groups. Conclusions: No significant difference could be detected concerning the dental and periodontal status of SS patients, compared with that of patients with other immune diseases as well as with that of controls who had subjective xerostomia.

42 very deeply fractured or otherwise damaged single roots which could not be saved by intra-alveolar transplantation only were replanted to a supragingival level after extraoral transapical elongation by either an ordinary titanium root screw (method 1) or a specially designed titanium post (TransApex, Dentatus) (method 2). After observation periods of x=73 months (method 1) and x= 34 months (method 2), 61% and 85% of the cases-respectively, were considered successful, fulfilling all 5 predefined success criteria. No other resorptions than slight surface resorptions were seen and all teeth showed very shallow pocket depths and physiological mobility, indicating that the long extraoral treatment had not caused lasting traumatic injury to the PDL cells. The most frequent complication in method 1 was periapical osteitis, indicating that the elongation system had become insufficient. On the other hand, the method showed the capacity to heal many of the pre-existing osteitis cases. Both root elongation techniques described in this report are comparatively inexpensive and safe, since the apical elongation is never extended beyond the lamina dura structure of the alveolus. Method 2 is to be preferred, however, as the specially designed through-and-through post-system which simultaneously provides apical closure, transapical elongation and coronal retention, allows treatment of even very short roots and seems to give better results.

Treatment of molar teeth with severe furcation involvement allows for differing therapies of which the tunneling procedure has been least studied. While subsequent root caries in furcal exposed teeth was believed a major shortcoming, successful periodontal therapy is primarily dependent upon the stability of the attachment and intrafurcal and interproximal bone. We evaluated in each of 18 subjects (10 female, 8 male) a molar tooth with deep grade II/III furcation involvement at time of presentation (T-0), to 1st post-surgical recall following a tunneling procedure (T-1), to most immediate last recall (T-2; mean time T-0 to T-2, 5.80 +/- 0.83 years). Assessments included O'Leary's plaque index (P1-I), attachment levels (AL), root caries and radiographic bone loss. The mean P1-I from T-0 to T-2 decreased 56.8% with some plaque at T-2 detected in furcations of 7/18 teeth. AL across all time periods were not significantly difference except for palatal/lingual AL which from T-0 to T-2 were significantly different. Root caries was found in only 3 teeth at T-2. Adequate radiographs were available for 8 surgically tunneled mandibular molars for analysis of 5 measurements of osseous levels i.e., the mesial and distal levels of the intrafurcal and the interproximal osseous crests, and the distal interproximal osseous crest of a mesial adjacent single-rooted reference tooth which received osseous surgery at the same time. Mean time change values (T-1 to last radiograph taken, T-2a; mean time 3.0 +/- 0.7 years) showed no significant difference among the 5 points measured.(ABSTRACT TRUNCATED AT 250 WORDS)

The rationale for periodontal treatment in this case was that inflammatory perio-dontal disease can be arrested by creating a dento-gingival anatomy which is accessible for daily plaque removal techniques and that hypermobility per se does not mandate splinting to adjacent, less mobile teeth. These principles were applied to the management of a maxillary molar with advanced furcation involvement. In order to resolve the furcation problem it was necessary to amputate the palatal and disto-buccal root which resulted in retention of the mesio-buccal root. Although this retained root was hypermobile, this was not reason in itself to justify splinting. Splinting would be necessary only if the mobility interfered with masticatory function or increased progressively. Since this would not be known until the behavior of the tooth was observed in function, the root was restored as an independent unit. The occlusion was designed so that the crown had no premature contacts in the retruded or intercuspal positions and no non-working side contacts in lateral excursion. The margins of the crown were kept supragingival. In the weeks following crown placement, no increase in mobility occurred although the tooth was in full masticatory Function. One year later there had been no change in the mobility status. It was concluded that the retained mesio-buccal root which had reduced periodontal support and a degree of hyper-mobility was capable of independent function. No periodontal breakdown occurred due to this mobility. Furthermore, efficient removal of plaque prevented recurrence of inflammatory periodontal disease and, in the presence of this plaque control, root caries did not develop after placing the crown margins in a supragingival location.

Caries development on exposed root surfaces was evaluated in 31 patients who had been subjected to surgical and/or nonsurgical periodontal treatment 8 years earlier due to advanced chronic periodontitis. Besides assessments for evaluation of the periodontal treatment, a number of examinations and tests were carried out in order to assess variables presumed to influence the root surface caries development. Both statistical and graphical analyses were carried out to test differences between groups of subjects and to evaluate the variables studied as possible risk factors for root surface caries. The variables studied were: salivary lactobacillus count, salivary Streptococcus mutans count, plaque score, salivary secretion rate, salivary buffer effect, oral sugar clearance time, dietary habits and the age of the subject. The final results support previous findings from an initial 4-year period that root surface caries occurs, though to a minor extent, in this patient category demonstrating good or excellent periodontal conditions after periodontal treatment. A positive correlation was found between the baseline and final root surface caries scores. After the second 4-year period, the salivary counts of S. mutans and lactobacilli, the plaque score and the dietary habits differed significantly between groups of subjects who had developed 0 or greater than 5 new DFS %. Root surface caries was far more prevalent when risk values of the variables studied were present than when they were absent. The important variables in this respect differed considerably between the subjects. No single variable was found to be discriminative in all subjects.