Systematic review of conservative operative caries management strategies.
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The relationship between cavity preparation extension and restoration longevity is examined through a systemic review of the available evidence on specific conservative, operative caries-management strategies. Evidence tables are provided for three specific techniques in the permanent dentition: 1) the proximal "tunnel" restoration, 2) the proximal "box-only" restoration, and 3) the preventive resin restoration. In the primary dentition, the clinical trials involving the proximal box-only restoration, most of which involved glass-ionomer materials, are reviewed. In the permanent dentition, the evidence reveals low effectiveness for "tunnel" restorations, limited but supportive results for proximal-only restorations, and generally favorable outcomes for the occlusal composite resin-sealant restoration. The weak link in the latter is the overlying fissure sealant, which requires adequate ongoing maintenance. Conservative operative strategies in the primary dentition have not been uniformly successful, and deleterious material effects dominate restoration performance. This systematic review concludes that operative conservatism per se does not guarantee increased restoration longevity and that all restorations are vulnerable to caries recurrence, material failures, and technical deficiencies. The more successful conservative strategies are expected to enhance tooth longevity, provided concomitant caries control is effective. (+info)
Dental caries in the second millennium.
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This historical review of dental caries diagnosis and management is based on information obtained from reports published between 1839 and 1965 and forty textbooks on caries diagnosis and management published since the nineteenth century. The history of understanding of any disease or condition in humans has passed through two distinct eras. The first, which lasted until the twentieth century and may still be ongoing today, is the "observational" era. The second, which has developed and revolutionized our understanding of the causes and treatments of all diseases, is the "scientific" era. During the observational era, treatments of oral or dental problems were based on neither biological nor scientific principles. Rather, experimentation without validation was, and to a lesser extent during the last fifty years is still, common. In terms of disease management, dental practice is still in the gray years of the "restorative era" and in the midst of the "preventive era" where the emphasis would soon shift towards early detection of biological markers of diseases and prevention of their initiation and progression. This review has found that most contemporary questions on caries diagnosis and management have been debated since the middle of the nineteenth century. There is a need for a comprehensive research program to provide scientifically based information to assist dental practitioners in caries detection, diagnosis, and management. (+info)
Diagnosis of secondary caries.
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A systematic review of the diagnosis of dental caries was produced before the conference. It did not include the diagnosis of secondary or recurrent caries. This was a wise decision because what little literature exists on the subject potentially clouds the issue. Diagnosis is a mental resting place on the way to a treatment decision. A vital part of caries diagnosis is to decide whether a lesion is active and rapidly progressing or already arrested. This information is essential to plan logical management. However, lesion activity should be judged in the patient. Thus, research on the diagnosis of secondary caries must be carried out in vivo and this usually precludes histological validation. Even if such validation is possible, it has its own problems, particularly in distinguishing recurrent from residual caries. The diagnosis of secondary caries is very important since so many restorations are replaced because dentists think there is a new decay. It will be important to establish valid criteria for the diagnosis of active secondary caries, which will be facilitated by the suggestion that secondary caries is no different from primary caries except that it occurs next to a filling. This implies that it can be seen clinically and on a radiograph, next to a restoration. (+info)
Good occlusal practice in children's dentistry.
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The difference between paediatric dentistry and most other branches of dentistry is that in the child the occlusion is changing. Consequently 'Good Occlusal Practice' in children is a matter of making the right clinical decisions for the future occlusion. The clinician needs to be able to predict the influence that different treatment options will have on the occlusion when the child's development is complete. (+info)
Survey of undergraduate esthetic courses in U.S. and Canadian dental schools.
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U.S. and Canadian dental schools were surveyed regarding curriculum issues related to undergraduate dental esthetic restorative courses. A one-page survey instrument was sent to deans of academic affairs (n=59) of dental schools to complete or forward to the most appropriate faculty at their respective schools who would be knowledgeable about the esthetic restorative curriculum. Responses were received from forty-two dental schools (42/59) for a response rate of 72.9 percent. The first part of the survey asked if a specific esthetic restorative course was offered at their school, if it was mandatory or elective, and details of the course length and content. The second part of the survey asked whether selected esthetic restorative procedures were included in the curriculum. Respondents to this survey indicated that most types of esthetic restorative procedures are taught whether or not an esthetic course is included in the curriculum. (+info)
Is it time to change state and regional dental licensure board exams in response to evidence from caries research?
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State and regional board exams represent the final gateway to dental licensure. One would expect that the requirements for licensure would reflect procedures that are beneficial to each patient's oral health and that are consistent with the teachings of most dental schools. We conducted an Internet survey to determine whether Class 2 tooth preparations based on caries lesions whose radiolucencies were confined to enamel were allowed for state and regional exams. Information obtained for 46 of the 50 states revealed that 33 of the states (72%) allowed teeth with either an E1 or E2 lesion to be restored. Seventeen of these states allowed teeth with an E1 lesion to be restored. Only 12 of the 46 states (26%) covered by these boards did not allow teeth with E1 or E2 lesions to be surgically treated. In contrast, a recent report indicates that only 30% of dental schools permit teeth with enamel lesions to be restored to satisfy clinical requirements and competencies. (+info)
Prevalence and antibiotic resistance profile of mercury-resistant oral bacteria from children with and without mercury amalgam fillings.
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Genes encoding resistance to mercury and to antibiotics are often carried on the same mobile genetic element and so it is possible that mercury-containing dental materials may select for bacteria resistant to mercury and to antibiotics. The main aim of this study was to determine whether the prevalence of Hg-resistant oral bacteria was greater in children with mercury amalgam fillings than in those without. A secondary aim was to determine whether the Hg-resistant isolates were also antibiotic resistant. Bacteria in dental plaque and saliva from 41 children with amalgam fillings and 42 children without such fillings were screened for mercury resistance by cultivation on a HgCl(2)-containing medium. Surviving organisms were identified and their susceptibility to mercury and to several antibiotics was determined. Seventy-eight per cent and 74% of children in the amalgam group and amalgam-free group, respectively, harboured Hg-resistant bacteria; this difference was not statistically significant. Nor was there any significant difference between the groups in terms of the proportions of Hg-resistant bacteria in the oral microflora of the children. Of Hg-resistant bacteria, 88% and 92% from the amalgam group and the amalgam-free group, respectively, were streptococci; 41% and 33% were resistant to at least one antibiotic, most frequently tetracycline. The results of this study show that there was no significant difference between children with amalgam fillings and those without such fillings with regard to the prevalence, or the proportion, of Hg-resistant bacteria in their oral microflora. The study also found that Hg-resistant bacteria were common in children regardless of whether or not they had amalgam fillings and that many of these organisms were also resistant to antibiotics. (+info)
Elderly Canadians residing in long-term care hospitals: Part I. Medical and dental status.
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BACKGROUND: Oral diseases and conditions have been identified as a significant problem for elderly residents of long-term care (LTC) hospitals in developed countries, yet little recent information is available for the Canadian population. OBJECTIVE: To describe the medical, dietary, oral microbial, oral hygiene and dental status of elderly Canadians living in LTC hospitals in Vancouver and surrounding communities. METHODS: A sample of 369 elderly dentate hospital residents (mean age 83.9 years, 281 women [76.2%]) were examined, and their medical status and medications, oral status and type of hospital were documented. Oral hygiene practices and diet (specifically intake of refined carbohydrates) were evaluated. Subjects with xerostomia and subjects taking medications with hyposalivary side effects were identified, and salivary Streptococcus mutans and Lactobacillus were cultured. RESULTS: The mean plaque index was 1.3; men had a higher plaque index than women and residents of extended care hospitals had a higher plaque index than those in intermediate care hospitals. The mean bacterial score per millilitre of saliva was 9.7 105 colony-forming units (CFU) for Streptococcus mutans and 1.6 105 CFU for Lactobacillus. On average, each subject had 6.3 sound teeth, and 9.3 teeth had been restored. CONCLUSIONS: Although almost half of the subjects had visited a dental office in their community within the past 5 years, the elderly hospital residents in this study had few remaining teeth and suffered from poor oral hygiene. Prevention strategies (such as diet, oral hygiene and antimicrobial agents) rather than dental interventions (such as restorations and extractions) alone may be needed to control oral diseases in this susceptible population. (+info)