Push-Out Bond Strength Evaluation of Glass Fiber Posts With Different Resin Cements and Application Techniques

The purpose of this study was to evaluate the push-out strength of two different adhesive cements (total etch and self-adhesive) for glass fiber post (GFP) cementation using two different techniques (microbrush and elongation tip) of cement application. In addition, this study evaluated the effect of total-etch conditioning before the use of a self-adhesive cement. Sixty premolar specimens with a single root canal were selected, endodontically treated, and shaped for GFP cementation. The specimens were randomly placed into one of six groups according to the cement and technique used: RelyX ARC (ARC): ARC + microbrush, ARC + elongation tip; RelyX Unicem (RU): RU + microbrush, RU + elongation tip; or RelyX Unicem + 37% phosphoric acid (RUE): RUE + microbrush, RUE + elongation tip. Each specimen root was cut perpendicular to the vertical axis yielding six 1.0-mm-thick sections. Push-out strength test was performed, followed by statistical analysis using three-way analysis of variance and the Games-Howell test (p<0.05). Statistically significant differences between the groups were found (p< 0.05). The cervical third of the roots had the highest mean push-out strength values, while the apical third had the lowest mean values regardless of the technique used. The elongation technique produced higher mean push-out strength values compared to the microbrush technique. The self-etch adhesive cement had the highest mean push-out strength value in all thirds. The addition of a conditioning step before the self-etch adhesive cementation appears to be effective in enhancing push-out strength with GFPs.

Evaluating a Cultural Competency Curriculum: Changes in Dental Students' Perceived Awareness, Knowledge, and Skills

In response to current and projected demographic changes in the United States, many dental schools have taken steps to increase the cultural competence of their students through various educational methods. The aim of this study was to evaluate the effectiveness of the cultural competency curriculum at Boston University Henry M. Goldman School of Dental Medicine (GSDM). The curriculum was evaluated using a pre and post design, utilizing an instrument developed for pharmacy students and modified for dental students. The questionnaire was comprised of 11 items designed to assess changes in students' awareness, knowledge, and skills in providing culturally competent care. Data were collected for two classes of second-year DMD students and first-year Advanced Standing students. The total number of returned surveys was 485, for a response rate of 79.5%. The students' post-curriculum mean scores were all higher than their pre-curriculum scores for overall cultural competence (pre 26.5±6.3 to post 29.8±7.2) and for individual subscores on awareness (pre 5.3±1.4 to post 5.5±1.5), knowledge (pre 7.2±1.9 to post 8.1±2.1), and skills (pre 14.1±4.4 to post 16.2±4.4). The improvements on all scores were statistically significant (p<0.0001), with the exception of the awareness component. This evaluation suggests that the cultural competency curriculum at GSDM has been effective in producing improvements in these students' cultural competence in the domains of knowledge and skills.

Retention and effectiveness of fissure sealants in Kuwaiti school children

OBJECTIVES

To evaluate the retention and effectiveness of fissure sealants in permanent first molars in a public programme.

METHODS

Sealant retention in permanent first molars was evaluated in 452 children aged 6-8 years in 20 primary schools under the care of the School Oral Health Programme, Kuwait-Forsyth. The sealants were placed using rubber dam or cotton roll isolation, after cleaning with pumice and rubber cup, and 15 seconds etching. Sealant retention was evaluated at one and two years and scored as complete, partial or complete loss of sealant. Caries was scored when sealant was partially or completely lost.

RESULTS

A total of 2,744 sealants were applied, with 2,324 and 2,288 sealants examined at the end of the first and second year respectively. In two years, 75% of the sealants were completely retained, 2.9% partially lost, 7.3% completely lost, and 14.8% resealed or restored. A small proportion of teeth (0.9%) were carious. Multivariate analyses showed that occlusal surfaces were 2.8 times more likely to retain a sealant than the buccal and palatal pits (95% CI 2.7-3.9, p<0.0001), and maxillary teeth were 1.3 times more likely to retain their sealant than the mandibular teeth (95% CI 1.01-1.5, p=0.04). Maxillary teeth were less likely to be carious (OR=0.6, 95% CI 0.4-0.97), p=0.03) and occlusal surfaces were 2.8 times more likely to be carious (95% CI 1.9-4.3), p<0.0001). No differences in sealant retention (p=0.24) and caries (p=0.19) were seen between teeth isolated using rubberdam or cotton roll.

CONCLUSIONS

Sealant retention was high, and sealants were effective in preventing caries.

Does Medicaid improve utilization of medical and dental services and health outcomes for Medicaid-eligible children in the United States?

BACKGROUND

Data are lacking to support the contention that Medicaid services improve utilization of healthcare services and result in better health.

OBJECTIVE

To compare sociodemographic, utilization of healthcare services and health status characteristics among Medicaid-eligible children.

METHODS

The third National Health and Nutrition Examination Survey included 2821 children 2-16 years of age eligible for Medicaid. The main outcome measures are annual physician visit, annual dentist visit, general health status, oral health status, asthma (second most common childhood disease), dental caries (most common childhood disease), asthma treatment needs, and dental treatment needs. We quantified the association of these outcome measures with Medicaid insurance status and sociodemographic status using multiple logistic regression modeling, taking into account the complex survey design and sample weights.

RESULTS

Among Medicaid-eligible children, 27% were uninsured. Among uninsured Medicaid-eligible children, 62% had an annual physician visit, 32% had an annual dentist visit, 10% needed asthma treatment, and 57% needed dental treatment. Among insured Medicaid-eligible children, 81% had an annual physician visit, 39% had an annual dentist visit, 13% needed asthma treatment, and 42% needed dental treatment. After simultaneously taking into account other characteristics, uninsured Medicaid-eligible children were more likely to not have an annual physician visit (OR(NoMDvisit) = 2.21; 1.26-3.90), and to need dental treatment (OR(DentalNeed) = 1.57; 1.13-2.18).

CONCLUSIONS

This USA population-based study found disparities exist within Medicaid's services between utilization of dental and medical services. Medicaid insurance improved utilization of medical services, but did not improve the utilization of dental services. This suggests that Medicaid insurance does not improve access to dental services for poor children.

Plaque removal using a battery-powered toothbrush compared to a manual toothbrush

OBJECTIVE

To evaluate the effectiveness of battery-powered tooth brushing in removing plaque in Kuwaiti children.

METHODOLOGY

The subjects were 30 boys, aged 9-11 years. Prior to the start of the study, the children had never used a battery-powered toothbrush. At baseline, plaque accumulation was assessed for manual tooth brushing and battery-powered tooth brushing (Oral-B Kids battery-powered). All subjects then used the battery-powered toothbrush for two weeks at home. Plaque accumulation was again assessed for both manual and battery-powered tooth brushing. Plaque accumulation was assessed using the Soparkar modification of the Quigley-Hein Plaque Index. Differences in pre- and post-tooth brushing plaque, and change from baseline, were the outcome measures evaluated.

RESULTS

At baseline, there was no difference in plaque removal between battery-powered tooth brushing and manual tooth brushing, either in difference between pre- and post-tooth brushing plaque measures (p = 0.44) or in percentage change (p = 0.51). After two weeks of use, there was a statistically significant difference in plaque removal between battery-powered tooth brushing and manual tooth brushing, both in the difference between pre- and post-tooth brushing plaque measures (p = 0.01) and in percentage change (p = 0.006). Mean plaque removal by manual tooth brushing was 0.97 +/- 0.45, and mean plaque removal by battery-powered toothbrush was 1.23 +/- 0.56. Mean percentage change in plaque removal by manual tooth brushing was 33.5 +/- 16.05, and mean plaque removal by battery-powered tooth brushing was 43.0 +/- 18.82, which represented a 9.5% improvement for battery-powered tooth brushing compared to manual tooth brushing.

CONCLUSION

After two weeks use of a battery-powered toothbrush, the plaque removal was enhanced compared to baseline and to manual tooth brushing. Battery-powered tooth brushing also enhanced manual tooth brushing ability.

Sanguinaria-related leukoplakia: epidemiologic and clinicopathologic features of a recently described entity

An association between the use of Viadent toothpaste and/or mouthwash and the development of leukoplakia oral mucosal lesions has been described recently. Discontinuing the Viadent products may result in resolution of the leukoplakia, although frequently this is not the case. In order to corroborate the earlier study and to provide further insight regarding the clinical features of this process, a case-control study was conducted. A significant association was seen between the use of Viadent products and the development of oral leukoplakia. Furthermore, leukoplakias affecting sites other than the buccal vestibule also were associated with the use of these products.

The association between Viadent use and oral leukoplakia

Recently, leukoplakia of the maxillary vestibule was described in patients with no traditional risk factors but who had used Viadent products. We designed a case-control study to evaluate the hypothesis that Viadent users were more likely to have lesions. One hundred and forty-eight cases and controls were identified through the Section of Oral and Maxillofacial Pathology. Cases and controls were administered a questionnaire about Viadent use and other known risks. Results of crude, stratified, and logistic regression analyses showed that use of Viadent products was a risk indicator for leukoplakia (adjusted OR = 9.7, 95% CI = 4.7-21.6), with a strong dose-response relation.

Patient satisfaction with the comprehensive care model of dental care delivery

In the summer of 1997, the College of Dentistry, The Ohio State University, changed its predoctoral clinics from the traditional model to the comprehensive care (CC) model. Although the CC model is considered the better model for delivery of care, from the patient perspective it has not been previously evaluated. The purpose of this study was to compare the two dental care delivery systems--the traditional model and the CC model--using patient satisfaction. The Dental Satisfaction Questionnaire (DSQ) developed by the Rand Corporation was used to assess patient satisfaction. The questionnaire consists of nineteen items, measuring overall satisfaction and subscales of access, pain management, and quality. The questionnaire was self-administered to active and recall patients in the summers of 1997 and 1998 to evaluate satisfaction with care in the traditional and CC models respectively. The completed DSQ was returned by 119 respondents in 1997 and 116 respondents in 1998. There were no significant differences in age. gender, and self-rated general and oral health of patients using the two delivery systems. No statistically significant differences were seen in the overall Dental Satisfaction Index and the sub-scales of access, pain management, and quality of care. Statistically significant differences were observed on only two of the nineteen individual items. We conclude that there was no difference in satisfaction levels of our patients between the two dental care delivery models.

Use of fissure sealant retention as an outcome measure in a dental school setting

The purpose of this study was to describe and assess the use of fissure sealant retention as a quality measure of the delivery system for pediatric dentistry. The Pediatric Dentistry Section at the Ohio State University College of Dentistry adopted Sealant retention as a measure of quality. Sealant retention in first and second molars was evaluated at each six-month recall appointment. Sealants were categorized as satisfactory or unsatisfactory. Two hundred five sealants were evaluated between March 1998 and March 1999. The mean age of the patients at the time of sealant evaluation was 14.0 +/- 2.9. Mean sealant retention period was 29.8 +/- 23.2 months, with a range of 0.9 to 148 months. Median sealant retention period was 23.2 months. Overall, 75.6 percent of the sealed teeth were classified as satisfactory. Use of this data in making improvements is discussed. Our results indicate that the use of sealant retention is a suitable measure for quality of care in pediatric dentistry.

Access and use of specific dental services in HIV disease

OBJECTIVES

This study examined factors associated with the use of specific dental services by persons with HIV disease.

METHODS

The data were derived from 1,588 adults who participated in a series of up to six interviews as part of the AIDS Cost and Service Utilization Surveys. Use of dental services such as examinations, x-rays, cleaning, fillings, extractions, root canals, crown and bridge or dentures, and periodontal procedures were evaluated using logistic regression and generalized estimating equations were applied.

RESULTS

Multivariate analyses showed that medical insurance, an education beyond high school, income higher than $1,300 per month, high ambulatory visits, and receipt of psychological counseling were generally associated with higher service use. Blacks, those with an inpatient admission, and CD4+ cell counts less than 500 cells/microL were significantly less likely to use most types of dental services.

CONCLUSIONS

The study concludes that disparities exist in the use of several dental services similar to those seen in the general population.

Cephalometric variables as predictors of Class II treatment outcome

Cephalometric analysis of skeletodental features is accepted as an integral part of orthodontic diagnosis and treatment planning. This assumes that diagnostic cephalometric variables affect prognosis and thus help reduce malocclusion severity, which is the aim of orthodontic treatment. The aim of this study was to assess the predictive value of 41 commonly used cephalometric parameters with regard to pretreatment severity and treatment outcomes. Pretreatment severity was assessed by using the Peer Assessment Rating (PAR) occlusal index, an instrument that has been shown to be valid and reliable. Treatment outcomes consisted of (1) posttreatment malocclusion severity (post-PAR), (2) relative improvement (percent PAR reduction), and (3) treatment duration. Complete records, including cephalograms, of 223 treated Class II cases were analyzed by means of separate multiple linear regression models. Each of the outcome variables and the pretreatment severity served as the respective dependent variables, and the cephalometric parameters served as the independent or predictor variables. The cephalometric parameters explained 39.2% of the pretreatment severity variance, 17. 9% of posttreatment severity variance, 15.7% of relative treatment improvement variance, and 20.0% of treatment duration variance.

Risk factors for dental fluorosis: a review of the recent literature

The decline in dental caries prevalence and incidence in developed countries over the last two decades is considered to be largely due to the widespread use of fluoride. Simultaneously, with the decline in caries, an increase in the prevalence of dental fluorosis has been noticed. The increase is in the mild and very mild forms of fluorosis, and is proportionally greater in non-fluoridated areas than in fluoridated areas. This is because of the increase in the mean fluoride intake from all sources since the 1940s. The increase in fluorosis prevalence prompted numerous studies on risk factors for fluorosis. As a result the literature over the last two decades has also reported numerous studies with differing and confusing results. This paper describes for the clinician the condition and summarizes the recent literature on the risk factors for fluorosis. Only well conducted studies evaluating risk factors or indicators and quantifying the risk for dental fluorosis from the 1980s through the 1990s time period were included in this review. Four major risk factors were consistently identified: use of fluoridated drinking water, fluoride supplements, fluoride toothpaste, and infant formulas before the age of six years.

A comparison of oral health in elderly populations seeking and not seeking dental care

The General Oral Health Assessment Index (GOHAI) has been recommended for use as an outcome measure in the evaluation of dental treatment. This study was designed to assess the ability of the GOHAI in the evaluation of differences in those actively seeking dental care compared with those not seeking care. GOHAI was self-administered to two samples of elderly individuals, over 65 years of age, in the Columbus, OH, area. The first sample was ambulatory individuals living in a nursing home in Columbus, and the second sample consisted of patients accessing dental care at The Ohio State University (OSU) dental school clinics. Other variables used in this study were age, gender, self-rated oral and general health, and use of prostheses. Overall mean GOHAI score in the nursing home respondents was significantly higher (32.1 +/- 3.0) when compared with that of dental patients (mean, 30.4 +/- 3.9, p = 0.01). Mean GOHAI scores for all categories of variables used were consistently higher (better) in the nursing home respondents than for the dental patients. Results of this study show that self-assessed oral health measured by the GOHAI was higher for those individuals not seeking dental care than for those actively seeking dental care. The GOHAI is sensitive as an outcome measure in differentiating between individuals actively seeking care and those not seeking care.

Factors associated with utilization of care for oral lesions in HIV disease

OBJECTIVES

The purpose of this study was to examine factors associated with utilization of care for oral lesions in people with HIV disease.

STUDY DESIGN

The data were derived from 1424 adults who participated in a series of up to 4 interviews as part of the AIDS Cost and Service Utilization Survey. Treatment for thrush, oral sores, and other conditions was evaluated through use of logistic regression, with generalized estimating equations being applied.

RESULTS

In all, 9.1% of those in the study sample reported being treated. After adjusting for CD4 cell count and other variables, regression analyses indicated that blacks (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.32-0.91) and Hispanics (OR, 0.59; 95% CI, 0.36-0.98) had significantly lower odds of reporting being treated. Respondents with more than a high school education (OR, 1.64; 95% CI, 1.08-2.51), clinical trial participants (OR, 1.92; 95% CI, 1.27-2.90), and those receiving counseling (OR, 2.22; 95% CI, 1.60-3.09) were more likely to report being treated.

CONCLUSIONS

Utilization of care for oral lesions is very low. Educational and racial differences exist among those respondents who received care for HIV-associated oral lesions.

Determinants of caries prevalence and severity in higher SES Indian children

OBJECTIVES

Recent epidemiological studies in the economically developing countries show that the prevalence and severity of dental caries has increased with industrialization and exposure of these populations to western diets. The aim of this study was to quantify the caries experience, and identify determinants associated with caries, in a population which has a higher socio-economic status (SES), and is the most westernized in India.

BASIC RESEARCH DESIGN

The study site was Goa, a former Portuguese colony, which became part of India in 1961. Data came from a cross-sectional survey of 1,189 seventh grade children in private schools, consisting of a clinical dental examination and a self-administered questionnaire to their parents.

MAIN OUTCOME MEASURES

The study used the cavitated/non-cavitated criteria to score for caries, the TF index for fluorosis, and the Silness and Loe index for plaque.

RESULTS

The mean age of the children was 12.2 years. The proportion of children caries-free in the permanent dentition was 22.2%. The mean DMFT and DMFS in the study group were 2.78 and 4.20, respectively. The decayed component accounted for over 87% of the DMFT, DMFS, dft, and dfs. Results of the crude, stratified, and multivariate regression analyses showed that poor oral hygiene, mother's highest level of education, use of fluoride toothpaste before the age of six years, and higher frequency of tooth brushing were risk indicators of caries prevalence and severity.

CONCLUSION

The findings suggest that risk indicators of caries in this study population were similar to those in developed countries.

Oral hygiene as a risk indicator of enamel and dentin caries

Dental researchers have postulated that the risk factors for enamel and dentin caries may not be the same. A review of the literature ascertained that data to support this theory are lacking.

OBJECTIVES

To evaluate the risk indicators of enamel and dentin caries of the permanent dentition in a study group who had limited access to fluorides and made limited use of dental services.

METHODS

The study was conducted in Goa, India. Data came from a cross-sectional survey of 1189 seventh grade children, which consisted of a clinical dental examination and a self-administered questionnaire to their parents. The cavitated and non-cavitated criteria were used to score for caries, and the Silness-Loe index for plaque.

RESULTS

The mean age of the children was 12.2 years. The percentage of children caries free in the permanent dentition was 22.2%, the mean+/-s for dmfs, enamel and dentin lesions were 4.20+/-5.10, 2.59+/-2.89 and 1.61+/-3.30 respectively, and the mean plaque score was 1.00+/-0.48. Results of regression analyses showed that the risk indicators of prevalence and severity of caries differed depending on lesion type. The only variable that was consistently a risk indicator of presence and severity of both dentin and enamel caries was poor oral hygiene. Mother's highest level of education and presence of fluorosis were also risk indicators of enamel and dentin caries. The presence of decayed primary teeth was a risk indicator of enamel caries; and fluorosis severity, use of fluoride toothpaste at the time of the survey, and toothbrushing frequency were risk indicators of dentin caries. The observed caries-oral hygiene association seen is explored further.

Fluorosis risk from early exposure to fluoride toothpaste

Swallowed fluoride toothpaste in the early years of life has been postulated to be a risk factor for fluorosis, but the epidemiological evidence is weakened by the fact that most of the relevant studies were done in developed countries where an individual is exposed to multiple sources of fluoride.

OBJECTIVES

To quantify the risk of fluorosis from fluoride toothpaste in a population whose only potential source of fluoride was fluoride toothpaste.

METHODS

Case-control analyses were conducted to test the hypothesis that fluoride toothpaste use before the age of 6 years increased an individual's risk of fluorosis. Data came from a cross-sectional clinical dental examination of schoolchildren and a self-administered questionnaire to their parents. The study was conducted in Goa, India. The study group consisted of 1189 seventh grade children with a mean age of 12.2 years.

RESULTS

The prevalence of fluorosis was 12.9% using the TF index. Results of the crude, stratified, and logistic regression analyses showed that use of fluoride toothpaste before the age of 6 years was a risk indicator for fluorosis (OR 1.83, 95% CI 1.05-3.15). Among children with fluorosis, beginning brushing before the age of 2 years increased the severity of fluorosis significantly (P<0.001). Other factors associated with the use of fluoride toothpaste, such as eating or swallowing fluoride toothpaste and higher frequency of use, did not show a statistically significant increased risk for prevalence or severity of fluorosis.

CONCLUSIONS

Fluoride toothpaste use before the age of 6 years is a risk indicator for fluorosis in this study population.