The International Caries Consensus Collaboration undertook a consensus process and here presents clinical recommendations for carious tissue removal and managing cavitated carious lesions, including restoration, based on texture of...
moreThe International Caries Consensus Collaboration undertook a consensus process and here presents clinical recommendations for carious tissue removal and managing cavitated carious lesions, including restoration, based on texture of demineralized dentine. Dentists should manage the disease dental caries and control activity of existing cavitated lesions to preserve hard tissues and retain teeth long-term. Entering the restorative cycle should be avoided as far as possible. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal or control first. Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated. When a restoration is indicated, the priorities are as follows: preserving healthy and remineralizable tissue, achieving a restorative seal, maintaining pulpal health, and maximizing restoration success. Carious tissue is removed purely to create cond...
The purpose of this research was to conduct a cost-analysis, from a public healthcare perspective, comparing the cost and benefits of face-to-face patient examination assessments conducted by a dentist at a residential aged care facility...
moreThe purpose of this research was to conduct a cost-analysis, from a public healthcare perspective, comparing the cost and benefits of face-to-face patient examination assessments conducted by a dentist at a residential aged care facility (RACF) situated in rural areas of the Australian state of Victoria, with two teledentistry approaches utilizing virtual oral examination. The costs associated with implementing and operating the teledentistry approach were identified and measured using 2014 prices in Australian dollars. Costs were measured as direct intervention costs and programme costs. A population of 100 RACF residents was used as a basis to estimate the cost of oral examination and treatment plan development for the traditional face-to-face model vs. two teledentistry models: an asynchronous review and treatment plan preparation; and real-time communication with a remotely located oral health professional. It was estimated that if 100 residents received an asynchronous oral hea...
—This study assessed the feasibility of a teledentistry model for teleconsultation and telediagnosis in Residential Aged Care Facilities. Study feasibility was defined by the ability to develop remote treatment plans. Reliability of the...
more—This study assessed the feasibility of a teledentistry model for teleconsultation and telediagnosis in Residential Aged Care Facilities. Study feasibility was defined by the ability to develop remote treatment plans. Reliability of the remote assessments was assessed by comparing with those performed by traditional face-to-face oral examinations. An intraoral camera was operated by trained teledentistry assistants with the aim of screening residents for oral diseases and pathological conditions. The model was supported by traning and an instructional kit for the introral camera operators. The structure, content and delivery of the program, was evaluated. Residents’ views about the structure, content and delivery of the program were also evaluated. A total of 50 residents participated in this assessment. Results indicated that the proposed teledentistry approach for oral health screening is feasible and reliable as an alternative to traditional oral health examination. Residents exp...
The risks of iatrogenic actions when we apply therapies to the tooth itself, or to collateral teeth, are potentially high when combined with low sensitivity and specificity of our diagnosis tools. There are therapeutic tools, both for the...
moreThe risks of iatrogenic actions when we apply therapies to the tooth itself, or to collateral teeth, are potentially high when combined with low sensitivity and specificity of our diagnosis tools. There are therapeutic tools, both for the occlusal and proximal surfaces, in the form of infiltration products, specific inserts for cavity preparation, a fluorescent camera for magnification and early detection, and others; however, preservation of the natural tooth aesthetics also requires early detection of the carious lesion, associated with comprehensive patient care so that our therapies are perpetuated. The purpose of this article is to discuss the advantages and drawbacks of minimally invasive dental techniques, distinguishing those that preserve or reinforce the enamel and enamel-dentine structures (MIT1) from those that require minimum preparation of the dental tissues (MIT2). The discussion is rounded off by an illustration of how the natural tooth aesthetics are preserved in tw...
Objective: This study aims to assess the influence of the clinical experience of the examiner and the diagnostic threshold of the radiographic grading system on the reproducibility and diagnostic accuracy for approximal caries lesions....
moreObjective: This study aims to assess the influence of the clinical experience of the examiner and the diagnostic threshold of the radiographic grading system on the reproducibility and diagnostic accuracy for approximal caries lesions. Method: 200 standardized digital bitewing radiographs pairs were sampled from those taken during a caries clinical trial in adolescents. All radiographs were scored using the Pitts grading system, which allowed both enamel and dentine lesions to be scored at two depths and included a method for scoring caries when overlaps were present. Three experienced dentists (clinical trial radiograph reviewer, clinical trial examiner, paediatric dentist) were trained and calibrated in the grading system prior to its use. Scoring was undertaken in a dedicated room with controlled lighting, a calibrated monitor and custom-built database. Sensitivity, specificity and the area (Az) under the ROC curve were calculated at D1 (enamel) and D3 (dentine) thresholds. Conse...
To investigate the displacement of Biodentine(™) following cementation of stainless steel crowns (SSC) with glass-ionomer cement (GIC) on plastic deciduous teeth prepared for pulpotomy. Twenty plastic teeth with prepared occlusal cavities...
moreTo investigate the displacement of Biodentine(™) following cementation of stainless steel crowns (SSC) with glass-ionomer cement (GIC) on plastic deciduous teeth prepared for pulpotomy. Twenty plastic teeth with prepared occlusal cavities were divided into four groups and had Biodentine(™) placed as a mock pulpotomy agent. The pulp chamber was filled with freshly mixed Biodentine(™) then a GIC-loaded SSC was seated on the tooth using a standardized seating force for periods of: 1 min (Group 1); 2 min (Group 2), 3 min (Group 3) and 6 min (Group 4) after mixing. After 24 h at 37°C and 90% humidity, the crowns were sectioned mesio-distally and standardized digital photographs taken. Image analysis software was used to determine the ratio of the surface area of displaced Biodentine(™) relative to the surface area of the pulp chamber. The thinnest section of the remaining Biodentine(™) was measured. The lowest values of Biodentine(™) displacement and the highest values of remaining Biode...
Odontogenic cysts are often encountered in the paediatric and adolescent population, dentigerous cyst being the most common. The current report aims to raise the awareness of paediatric dentists about the management of this condition. The...
moreOdontogenic cysts are often encountered in the paediatric and adolescent population, dentigerous cyst being the most common. The current report aims to raise the awareness of paediatric dentists about the management of this condition. The current report presents a case of a healthy 14 year-old boy with an odontogenic cyst involving two displaced mandibular premolars. The cyst was enucleated surgically and the two premolars were preserved. The diagnosis was a dentigerous cyst. At 4, 12 and 20 months there was substantial bone healing and non-assisted eruption of the premolars. A less invasive approach when treating odontogenic cysts in children and adolescents is recommended when possible to preserve the permanent teeth involved.
Reduced bond strengths of resin composites to hypomineralised enamel increase restorative failure. To investigate if the adhesion of resin composite to hypomineralised enamel can be improved by pre-treatments: resin infiltration,...
moreReduced bond strengths of resin composites to hypomineralised enamel increase restorative failure. To investigate if the adhesion of resin composite to hypomineralised enamel can be improved by pre-treatments: resin infiltration, oxidative pre-treatment followed by a resin infiltration, or oxidative pre-treatment. Twenty-one enamel specimens in each of five Groups: 1) Normal enamel; 2) Hypomineralised enamel; 3) Hypomineralised enamel pre-treated with a resin infiltrant, (Icon(®)); 4) Hypomineralised enamel pre-treated with 5.25% sodium hypochlorite then treatment with resin infiltrant; 5) Hypomineralised enamel pre-treated with 5.25% sodium hypochlorite. A resin composite rod was bonded to each specimen using Clearfil™ SE bond as the adhesive (hereafter termed 'routine bonding'), then subjected to microshear bond strength (MSBS) testing. Overall, the mean MSBS between the five groups differed significantly (P = 0.001). Pre-treatment of hypomineralised enamel with 5.25% sodium hypochlorite with or without subsequent resin infiltration in Groups 4 and 5 prior to routine bonding resulted in increased mean MSBS compared to Groups 2 and 3, with mean MSBS values not differing significantly when compared to routine bonding to normal enamel. Increased bond strength of resin composite to hypomineralised enamel was obtained by pre-treatment of hypomineralised enamel specimens with 5.25% sodium hypochlorite with or without subsequent resin infiltration.
Demarcated hypomineralization lesions are not uncommon in second primary molars. Data on the prevalence of hypomineralized second primary molars (HSPM) are scarce. To investigate the prevalence of HSPM, assess the relationship between...
moreDemarcated hypomineralization lesions are not uncommon in second primary molars. Data on the prevalence of hypomineralized second primary molars (HSPM) are scarce. To investigate the prevalence of HSPM, assess the relationship between HSPM and first permanent molars previously diagnosed with demarcated lesions and to determine the severity of HSPM in relation to dental caries severity. A cluster sample of 809, 7- to 9-year-old children was examined. The scoring criteria proposed by the European Academy of Paediatric Dentistry for hypomineralization in permanent dentition were adapted to score HSPMs. The International Caries Detection and Assessment System was used to assess caries status in the second primary molar of the children diagnosed with demarcated defects. The examination was carried out in schools by a calibrated dentist. Of the children examined, 53 (6.6%) had hypomineralization defects in at least one second primary molar. Combinations of affected first permanent and second primary molars were reported in 21 (39.6%) of cases. Severe carious lesions were found mostly in teeth with enamel breakdown. The prevalence of HSPM was 6.6%. Over one-third of affected second primary molars were associated with demarcated lesions in the first permanent molars. The chance of severe caries increased with the increase in the demarcated lesion severity.
Obesity is a major risk factor towards the development of obstructive sleep apnea, while significant weight loss (both conservatively managed and surgically assisted) has a variable effect upon its severity. Differences in the effect of...
moreObesity is a major risk factor towards the development of obstructive sleep apnea, while significant weight loss (both conservatively managed and surgically assisted) has a variable effect upon its severity. Differences in the effect of weight loss on obstructive sleep apnea may be due to underlying craniofacial characteristics. To determine whether craniofacial characteristics can predict OSA treatment response to significant weight loss. We analyzed craniofacial measurements from lateral cephalograms performed at baseline on 57 patients enrolled in a previously reported 2-year randomized clinical weight loss trial (laparoscopic adjustable gastric band surgery versus conservatively [dietician and very low calorie diet] treated). Group mean weight loss was ∼ 13% (mean weight loss 131 to 114 kg), with corresponding reduction in mean apnea hypopnea index (AHI) from 61 to 41 events/h. Computer assisted lateral cephalogram analysis was undertaken by three trained staff blinded to treatm...
This study aimed to compare and contrast in vitro six methods to determine the most accurate method for detecting approximal carious lesions in primary molars. Extracted primary molars (n = 140) were stored in 0.02% chlorhexidine solution...
moreThis study aimed to compare and contrast in vitro six methods to determine the most accurate method for detecting approximal carious lesions in primary molars. Extracted primary molars (n = 140) were stored in 0.02% chlorhexidine solution and mounted in light-cured resin in pairs. The six carious lesion detection methods used by the three examiners to assess approximal carious lesions were visual inspection, digital radiography, two transillumination lights (SDI and NSK), and two laser fluorescence instruments (CDD and DDP). Five damaged teeth were discarded. The teeth (n = 135) were sectioned, serially ground, and examined under light microscopy using Downer's histological (HST) criteria as the gold standard. Intra- and inter-examiner reliability, agreement with HST, specificity, sensitivity, receiver operating characteristic (ROC) curves, and areas under the curve were calculated. This study found visual inspection to be the most accurate method when validated by histology. Transillumination with NSK light had the highest specificity, and digital radiography had the highest sensitivity for detecting enamel and/or dentinal carious lesions. Combining specificity and sensitivity into the area under ROC curves, enamel plus dentinal lesions were detected most accurately by visual inspection followed by digital radiography; dentinal lesions were detected most accurately by digital radiography followed by visual inspection. None of the four newly developed methods can be recommended as suitable replacements for visual inspection and digital radiography in detecting carious lesions on approximal surfaces of primary molars, and further developmental work is needed.
Molar incisor hypomineralisation (MIH) is a problematic condition with several characteristics for which infiltrant resins could theoretically improve clinical outcomes. To investigate whether caries infiltrant resin can penetrate...
moreMolar incisor hypomineralisation (MIH) is a problematic condition with several characteristics for which infiltrant resins could theoretically improve clinical outcomes. To investigate whether caries infiltrant resin can penetrate MIH-affected enamel. Molar incisor hypomineralisation lesions (n = 21) were infiltrated using either the standard protocol or with the addition of a sodium hypochlorite (NaOCl) irrigation step. Lesions were sectioned and examined microscopically for infiltrant penetration before undergoing Vickers hardness testing. The surfaces of several lesions were also examined using scanning electron microscopy (SEM). Infiltrant resin could penetrate MIH lesions; however, the pattern was erratic. Two lesions were confined to inner enamel, and no infiltration occurred. On average, the resin penetrated to a depth of 0.67 ± 0.39 mm and 23.1 ± 15.2% of the area of the lesion. Microhardness increased in areas of resin penetration by 1.0 ± 0.7 GPa representing a proportional increase of 2.2 ± 2.5 times. There were no significant differences in results based on either the infiltration protocol or the type of MIH lesion. Caries infiltrant resin is capable of penetrating MIH enamel lesions; however, the pattern, extent, and change in hardness produced are currently unpredictable.
Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has been shown to remineralize enamel subsurface lesions in situ. The aim of this study was to investigate the effects of CPP-ACP in a fruit-flavoured sugar-free chewing gum...
moreCasein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has been shown to remineralize enamel subsurface lesions in situ. The aim of this study was to investigate the effects of CPP-ACP in a fruit-flavoured sugar-free chewing gum containing citric acid on enamel remineralization, and acid resistance of the remineralized enamel, using an in situ remineralization model. The study utilized a double-blind, randomized, crossover design with three treatments: (i) sugar-free gum (2 pellets) containing 20 mg citric acid and 18.8 mg CPP-ACP, (ii) sugar-free gum containing 20 mg citric acid alone, (iii) sugar-free gum not containing CPP-ACP or citric acid. Ten subjects were instructed to wear removable palatal appliances, with 4 half-slab insets of human enamel containing demineralized subsurface lesions and to chew gum (2 pellets) for 20 min 4 times per day for 14 days. At the completion of each treatment the enamel half-slabs were removed and half of the remineralized lesion treated wit...
