RESUMEN

Early childhood caries is common in Hong Kong, and parental practices on maintaining good oral health of their young children are far from satisfactory. This article reports on the effectiveness of a randomized controlled trial on family-centered oral health promotion to new parents in establishing proper feeding habits and oral hygiene practices and in reducing caries risk among 3-y-old toddlers. At baseline, pregnant mothers and their husbands were recruited and randomly allocated into 2 groups. The test group received individualized oral health education (OHE) via a behavioral and educational counseling approach while the control group received the OHE pamphlets only. Information related to the feeding habits, oral hygiene practices, and oral health of the toddlers was collected by parent-completed questionnaires and oral examination annually via home visits. A total of 580 families were recruited at baseline, and 436 toddlers were followed up when they reached 3 y old (test, n = 228; control, n = 208; follow-up rate, 75.2%). The proportions of toddlers who held food in the mouth, fell asleep when milk feeding, had prolonged use of the nursing bottle, ate before bed, and consumed a sweet snack daily were significantly lower in the test group than in the control group (all P < 0.05). Significantly higher proportions of toddlers brushed their own teeth twice daily, were brushed by their parents twice daily, and used fluoride toothpaste than in the control group (all P < 0.001). Toddlers in the test group had better oral health status with a lower level of visible plaque, Streptococcus mutans, white spot lesion, and cavitated lesion (all P < 0.05). Family-centered oral health promotion and individualized OHE for parents via a behavioral and educational counseling approach are more effective in establishing good feeding habits and parental toothbrushing practices and in decreasing the caries risk of their toddlers than the distribution of OHE pamphlets alone (ClinicalTrials.gov NCT02937194).

Asunto(s)

Caries Dental , Salud Bucal , Preescolar , Caries Dental/prevención & control , Femenino , Promoción de la Salud , Hong Kong , Humanos , Higiene Bucal/educación , Embarazo , Cepillado Dental

RESUMEN

OBJECTIVES: The objectives of this review were to identify the factors associated with root caries and to describe their relationship with the presence and extent of root caries. METHODS: A search was carried out on the PubMed, Medline, Embase, and Scopus databases for articles published between January 1990 and October 2018. Information was extracted on the factors associated with the presence or extent of decayed or filled root surfaces and/or decayed root surfaces. Factors were sorted into 6 categories: social-demographic background, general health, health behaviors, fluoride exposure, oral health habits, and oral health condition. RESULTS: The quality of the 127 identified relevant papers was assessed, and those of low methodological quality were excluded. Finally, 44 articles reporting on 40 cross-sectional studies were included. The total sample size comprised 78,183 participants from different countries around the world. Positive correlations were detected between root caries and age, gingival recession, and use of tobacco, while negative correlations were found for social position, use of fluoride toothpaste, and oral hygiene status. Mixed findings were reported for association with the number of teeth and dental visit behaviors. CONCLUSION: This systematic review found a number of factors in different categories to be associated with root caries. People who are older, of lower socioeconomic status, or tobacco users and those with more gingival recession and poorer oral hygiene have higher risk of root caries. KNOWLEDGE TRANSFER STATEMENT: This systematic review found a number of factors associated with root caries, including age, social position, exposure to fluoride, and oral hygiene status. This information helps dental public health workers and clinicians identify the groups at high risk of caries and the factors to act on for more effective prevention and management of root caries (e.g., use fluoride toothpaste and improve oral hygiene).

Asunto(s)

Caries Dental , Caries Radicular , Estudios Transversales , Humanos , Salud Bucal , Higiene Bucal

RESUMEN

OBJECTIVES: The aim of this noninferiority double-blind randomized clinical trial was to compare the effectiveness of the topical semiannual application of a 25% silver nitrate (AgNO3) solution followed by a 5% sodium fluoride (NaF) varnish with that of a 38% silver diamine fluoride (SDF) solution in arresting caries among preschool children. METHODS: Healthy 3-y-old children with active dentine carious lesions were randomly allocated to 2 groups via computer-generated random numbers. Lesions in group A received applications of a 25% AgNO3 solution followed by a 5% NaF varnish semiannually (every 6 mo). Lesions in group B received semiannual applications of a 38% SDF solution followed by a placebo varnish. A trained examiner recorded the status of caries and oral hygiene at baseline and during follow-up examinations. The examiner, children, and their caretakers were blinded to the intervention allocation. This study adopted an intention-to-treat analysis. A noninferiority test was conducted for the data analysis. Group A's noninferiority was accepted if the lower limit of the 95% CI for the difference in the mean number of arrested surfaces was >-0.5. RESULTS: A total of 1,070 children were recruited at baseline, with 535 children in each group. After 18 mo, the mean ± SD number of arrested surfaces was 3.3 ± 3.4 in group A (n = 484) and 3.2 ± 3.5 in group B (n = 476; P = 0.664). The difference in the mean number of arrested surfaces between the groups was 0.092 (95% CI, -0.322 to 0.505). Apart from black staining on the arrested lesions, no other significant side effect was observed. CONCLUSION: A semiannual application of 25% AgNO3 followed by 5% NaF is no worse than a 38% SDF in arresting dentine caries among preschool children over 18 mo. The Hong Kong Research Grants Council (GRF 17107315) funded this trial, which was registered at ClinicalTrials.gov (NCT02019160). KNOWLEDGE TRANSFER STATEMENT: This randomized clinical trial found that silver nitrate solution followed by sodium fluoride varnish is effective in arresting dentine caries among preschool children. As silver nitrate followed by sodium fluoride is a noninvasive and simple protocol, it can be an alternative strategy to manage dental caries among young children, especially in countries where silver diamine fluoride is not available.

Asunto(s)

Caries Dental , Fluoruro de Sodio , Cariostáticos , Preescolar , Método Doble Ciego , Humanos , Nitrato de Plata

RESUMEN

The aim of this systematic review was to address the question: Do different irrigating protocols have an impact on the dislocation resistance of mineral trioxide aggregate (MTA)-based materials? The review was performed using a well-defined search strategy in three databases (PubMed, Scopus, Web of Science) to include laboratory studies performed between January 1995 and May 2017, in accordance with PRISMA guidelines. Two reviewers analysed the papers, assessed the risk of bias and extracted data on teeth used, sample size, size of root canal preparation, type of MTA-based material, irrigants, canal filling method, storage method and duration, region of roots and the parameters of push-out testing (slice thickness, plunger dimensions and plunger loading direction), the main results and dislocation resistance values (in MPa). From 255 studies, 27 were included for full-text analysis. Eight papers that met the inclusion criteria were included in this review. There was a wide variation in dislocation resistance due to differences in irrigation sequence, time and concentration of irrigants, storage method and duration, and the parameters of push-out bond strength testing. A meta-analysis was not done but qualitative synthesis of the included studies was performed. No definitive conclusion could be drawn to evaluate the effect of irrigation protocols on dislocation resistance of MTA-based materials. Recommendations have been provided for standardized testing methods and reporting of future studies, so as to obtain clinically relevant information and to understand the effects of irrigating protocols on root canal sealers and their interactions with the dentine walls of root canals.

Asunto(s)

Compuestos de Aluminio/farmacología , Compuestos de Calcio/farmacología , Óxidos/farmacología , Irrigantes del Conducto Radicular/farmacología , Silicatos/farmacología , Pulpa Dental/citología , Dentinogénesis/fisiología , Combinación de Medicamentos , Matriz Extracelular/fisiología , Humanos , Osteoclastos/fisiología , Transducción de Señal

RESUMEN

OBJECTIVE: To compare the effectiveness of three applications of silver diammine fluoride (SDF) solution at yearly interval and three applications of SDF solution or sodium fluoride (NaF) varnish at weekly interval at baseline in arresting active caries in the primary teeth of preschool children. METHODS: Children aged 3-4 years (n = 371) who had at least one active caries lesion (ICDAS codes 3-6) in their primary teeth were randomly allocated into three groups: Group 1 - annual application of 30% SDF solution; Group 2 - three applications of 30% SDF at weekly intervals; and Group 3 - three applications of 5% NaF varnish at weekly intervals. Follow-up examinations were performed every 6 mo nths by the same masked examiner. RESULTS: After 30 months, 309 (83%) children with 1877 caries lesions remained in the study. For cavitated lesions (ICDAS code 5 or 6), the caries arrest rate of Group 1 (48%) was significantly higher than those of Group 2 (33%) and Group 3 (34%), (p < 0.001). Results of multi-level survival analysis showed that the arrest times of cavitated lesions in both SDF groups (Groups 1 and 2) were significantly shorter than that of the NaF varnish group. For moderate caries lesions without visible dentine (ICDAS code 3 or 4), the caries arrest rates were 45%, 44% and 51% in Groups 1, 2 and 3, respectively (p > 0.05). Presence of plaque on caries lesion, tooth type and tooth surface type had an influence on caries arrest. CONCLUSION: Over a 30-month period, annual applications of SDF solution is more effective than three weekly applications of NaF varnish or SDF solution at baseline in arresting active cavitated dentine caries lesions in primary teeth. CLINICAL SIGNIFICANCE: As annual application of SDF solution was found to be more effective than 3 weekly applications of NaF varnish or SDF solution at baseline in arresting active cavitated dentine caries lesions, the former application protocol is preferred for young children who are available for regular caries arrest treatment.

Asunto(s)

Caries Dental/tratamiento farmacológico , Fluoruros Tópicos/administración & dosificación , Fluoruros Tópicos/uso terapéutico , Cariostáticos/uso terapéutico , Preescolar , Caries Dental/patología , Dentina/efectos de los fármacos , Dentina/patología , Femenino , Hong Kong , Humanos , Modelos Logísticos , Masculino , Compuestos de Amonio Cuaternario/uso terapéutico , Análisis de Regresión , Compuestos de Plata/uso terapéutico , Fluoruro de Sodio/uso terapéutico , Análisis de Supervivencia , Diente Primario/efectos de los fármacos

RESUMEN

This randomized clinical trial aimed to compare the adverse effects and parental satisfaction following the different regimes of silver diamine fluoride (SDF) treatment among preschool children. A total of 888 preschool children who had active dentin caries received different SDF application regimes: group 1, 12% SDF applied annually; group 2, 12% SDF applied semiannually; group 3, 38% SDF applied annually; and group 4, 38% SDF applied semiannually. Information on adverse effects-including tooth or gum pain, gum swelling, gum bleaching, and systemic toxicity-was collected through a parent-reported questionnaire within 1 wk after every SDF or placebo application. Information of parental satisfaction on children's dental appearance was collected at baseline and 30-mo examination. At the 30 mo, 799 children (90%) remained in the study. No acute systemic illness or major adverse effect was reported. No differences of all minor adverse effects among the 4 groups were found ( P > 0.05). Overall, prevalence of tooth and gum pain as perceived by patients and reported by parents was 6.6%, while gum swelling and gum bleaching were 2.8% and 4.7%, respectively. Blackening of carious lesions was common among all groups, with 36.7%, 49.5%, 65.6% and 76.3% in groups 1 to 4, respectively (χ2 test, P < 0.001). The proportion of parents who were satisfied with their children's dental appearance in groups 1 to 4 was as follows: 67.6%, 61.5%, 70.8%, and 62.3%, respectively (χ2 test, P > 0.05). Based on parental reporting, SDF does not cause acute systemic illness. Tooth or gum pain, gum swelling, and gum bleaching were uncommon and not significantly different among the study groups. Parental satisfaction with children's dental appearance was similar among all groups. The use of SDF following the study protocol for caries arrest is safe for preschool children. Collecting information on parental satisfaction and adverse effects is beneficial for dental professionals when deciding to adopt SDF treatment for preschool children (ClinicalTrials.gov NCT02385474).

Asunto(s)

Cariostáticos/efectos adversos , Caries Dental/prevención & control , Compuestos de Amonio Cuaternario/efectos adversos , Compuestos de Plata/efectos adversos , Preescolar , Femenino , Fluoruros Tópicos/efectos adversos , Hong Kong , Humanos , Masculino , Dimensión del Dolor , Encuestas y Cuestionarios , Diente Primario

RESUMEN

This 30-mo randomized clinical trial compared the effectiveness of 2 concentrations (12% or 38%) of silver diamine fluoride (SDF) and 2 periodicity of application (once or twice a year) in arresting cavitated dentin caries in primary teeth. Children aged 3 to 4 y who had at least 1 active cavitated caries lesion were enrolled and randomly allocated into 4 groups for intervention. Group 1 had 12% SDF applied annually (every 12 mo), group 2 had 12% SDF applied semiannually (every 6 mo), group 3 had 38% SDF applied annually, and group 4 had 38% SDF applied semiannually. Clinical examinations were performed semiannually in kindergarten by a single examiner to investigate whether the SDF-treated caries became arrested. A total of 888 children with 4,220 decayed tooth surfaces received SDF application at baseline, and 799 (90.0%) children with 3,790 surfaces (89.8%) were evaluated at the 30-mo examination. The caries arrest rates were 55.2%, 58.6%, 66.9%, and 75.7% for groups 1, 2, 3, and 4, respectively ( P < 0.001). Caries treated with 38% SDF had a higher chance of becoming arrested than those treated with 12% SDF (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.51-2.60, P < 0.001). The interaction between frequency of SDF application and visible plaque index (VPI) score was significant ( P = 0.017). Among those children who received annual SDF application, children with a higher VPI score had a lower chance to have their caries become arrested (OR, 0.59, 95% CI, 0.49-0.72). In conclusion, SDF at a concentration of 38% is more effective than that of 12% in arresting active caries in primary teeth. For children with poor oral hygiene, caries arrest rate of SDF treatment can be increased by increasing the frequency of application from annually to semiannually ( ClinicalTrials.gov NCT02385474).

Asunto(s)

Cariostáticos/administración & dosificación , Caries Dental/prevención & control , Compuestos de Amonio Cuaternario/administración & dosificación , Compuestos de Plata/administración & dosificación , Preescolar , Femenino , Fluoruros Tópicos/administración & dosificación , Hong Kong , Humanos , Masculino , Diente Primario , Resultado del Tratamiento

RESUMEN

Dental root caries is a common disease among elders. More efforts on preventing this disease are needed. Silver diammine fluoride (SDF) is known to prevent dental caries in primary teeth. However, clinical evidence of its efficacy in preventing root surface caries is limited. This clinical trial aimed to compare the effectiveness of SDF in preventing root caries among elders in a water fluoridated area. A total of 323 elders who had at least 5 teeth with exposed root surfaces and who had self-care ability were randomly allocated into 3 intervention groups: group 1 (placebo control), annual application of tonic water; group 2, annual application of SDF solution; group 3, annual application of SDF solution, immediately followed by potassium iodide (KI) solution. Oral hygiene instructions and fluoride toothpaste were provided to all subjects. Status of dental root surface was assessed every 6 mo by the same independent examiner. After 30 mo, 257 (79.6%) elders were reviewed. The mean numbers of root surface with new caries experience in the control, SDF, and SDF/KI groups were 1.1, 0.4, and 0.5, respectively (analysis of variance, P < 0.001). Scheffe's multiple comparison showed that elders who received placebo developed more new root caries lesions ( P < 0.05), while the difference between the SDF and SDF/KI groups was not statistically significant ( P > 0.05). Moreover, elders who had higher visible plaque index scores at 30-mo examination (analysis of covariance, P < 0.001) and those who had higher baseline DMFT scores (analysis of covariance, P = 0.005) developed more new root caries. It is concluded that annual application of SDF or SDF/KI solution is effective in preventing root caries among community-dwelling elders in a fluoridated area ( ClinicalTrials.gov NCT02360124). Knowledge Transfer Statement: Annual topical application of silver diammine fluoride or silver diammine fluoride / potassium iodide solution is effective in preventing dental root surface caries among community-dwelling elders in a fluoridated area.

RESUMEN

OBJECTIVES: To investigate the effectiveness of silver diammine fluoride (SDF) solution application in arresting dental root caries and to assess the color of arrested caries lesions. METHODS: This study was conducted in elderly centers in Hong Kong. A total of 83 elders with 157 root surfaces with active caries lesion were randomly allocated into 3 groups: Gp1 (placebo control)-annual application of soda water; Gp2-annual application of SDF solution; Gp3-annual application of SDF solution immediately followed by potassium iodide (KI) solution. Color of the arrested root caries lesion was assessed with reference to PANTONE color plates and classified into one of the followings: yellow (7401U); light brown (1245U); dark brown (4635U); and black (Black U). Status of root surfaces was assessed every 6 months by the same independent examiner. RESULTS: After 30 months, 100 (64%) of the included root caries lesions were reviewed. The arrest rates of root caries were 45%, 90%, and 93% in Gp1 (control), Gp2 (SDF) and Gp3 (SDF/KI), respectively (χ(2) test, p<0.001). Pairwise comparisons showed elders in the control group had a lower proportion of the active root caries changed to arrested (p<0.001) and the proportions of root caries being arrested in the SDF and SDF/KI groups were not significantly different (p>0.05). The distributions of arrested caries lesions by color were not significantly different between the SDF and SDF/KI groups (χ(2) test, p>0.05). CONCLUSIONS: Application of SDF solution, with or without application of KI afterwards, is effective in arresting root caries among elders in a water fluoridated area. In the long term, blackening of arrested root caries is not reduced by immediate application of KI after the application of SDF. CLINICAL SIGNIFICANCE: In a water fluoridated area, annual application of SDF solution or SDF/KI solution can arrest dental root caries in elders. In the long term, application of KI does not reduce the blackening of arrested caries lesions caused by SDF.

Asunto(s)

Caries Radicular , Amoníaco , Cariostáticos , Fluoruros , Humanos , Vida Independiente , Compuestos de Amonio Cuaternario , Compuestos de Plata

RESUMEN

Different regimens of silver diamine fluoride (SDF) have been used to manage early childhood caries. So far, there is limited information regarding the concentrations and frequency of applications for effective caries control in primary teeth. This study aimed to compare the efficacy of 2 commercially available SDF solutions at preprepared concentrations of 38% and 12% when applied annually or biannually over 18 mo in arresting dentine caries in primary teeth. This randomized double-blinded clinical trial recruited kindergarten children aged 3 to 4 y who had at least 1 tooth with dentine caries. The children were randomly allocated to receive 4 treatment protocols: group 1, annual application of 12% SDF; group 2, biannual application of 12% SDF; group 3, annual application of 38% SDF; and group 4, biannual application of 38% SDF. Clinical examinations at 6-mo intervals were conducted to assess whether active carious lesions became arrested. Information on the children's background and oral hygiene habits was collected through a parental questionnaire at baseline and follow-up examinations. A total of 888 children with 4,220 dentine carious tooth surfaces received treatment at baseline. After 18 mo, 831 children (94%) were examined. The caries arrest rates were 50%, 55%, 64%, and 74% for groups 1, 2, 3, and 4, respectively (P < 0.001). Lesions treated with SDF biannual application had a higher chance of becoming arrested compared with those receiving SDF annual application (odds ratio, 1.33; 95% confidence interval, 1.04-1.71; P = 0.025). The interaction between concentration and lesion site was statistically significant (P < 0.001). Compared with 12% SDF, the use of 38% SDF increased a chance of becoming arrested (P < 0.05), except lesions on occlusal surfaces. Based on the 18-mo results, SDF is more effective in arresting dentin caries in the primary teeth of preschool children at 38% concentration than 12% concentration and when applied biannually rather than annually. Knowledge Transfer Statement: The results of this study can be used by clinicians and dental public health professionals when deciding which concentrations and frequency of application of silver diamine fluoride solution should be adopted for arresting dentine caries. With consideration of caries arrest treatment with silver diamine fluoride, which is painless, simple, and low cost, this information could lead to more appropriate therapeutic decisions for caries control in young children or those who lack access to affordable conventional dental care.

RESUMEN

OBJECTIVES: To describe the characteristics of patients who visited halitosis clinic and to investigate the factors that may associate with halitosis. MATERIALS AND METHODS: Nine hundred and eleven patients, who visited halitosis clinic for consultations, underwent organoleptic tests and volatile sulfur compound (VSC) measurements with a portable sulfide monitor. The oral health of patients, including dental caries, oral hygiene, and gingival inflammation status, was assessed. Questionnaires were used to obtain information on demographics, oral hygiene practices, and dietary habits. RESULTS: Of the 911 patients, more females than males visited the clinic. Patients' age ranged from 18 to 82 years (mean ± s.d.: 40.8 ± 14.1). Almost 30% of patients had complained of halitosis for over 5 years before looking into treatments. Approximately half of the patients self-perceived that they were unable to get close to others. Around 77% of patients had halitosis. Results of multiple logistic regressions for organoleptic scores and VSC values showed that tongue coating and tongue scraping were significantly associated with halitosis (P < 0.05). CONCLUSIONS: Among these Chinese patients, over three-quarters of patients had halitosis, and negative impacts on social communications were observed. Tongue coating was the most important factor responsible for halitosis.

Asunto(s)

Halitosis/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Adulto Joven

RESUMEN

OBJECTIVE: The study investigated the experience of orofacial pain (OFP) symptoms and associated disability and psychosocial impact in community dwelling and institutionalized elderly people in Hong Kong. METHODS: A community-based cross-sectional survey involving elders aged 60 years and above. Participants were recruited at social centres for the elderly and homes for the aged throughout Hong Kong. Elders who reported OFP symptoms in the previous four weeks took part. Standard questions were asked about OFP conditions in the previous month and the Manchester Orofacial Pain Disability Scale (MOPDS), the Oral Health Impact Profile (OHIP-14) and the General Health Questionnaire (GHQ-12) were administered. The MOPDS was translated and validated for use in Chinese elders. RESULTS: 200 community dwelling and 200 institutionalized elders participated. Toothache was the most common symptom (62.0%) and burning sensation in the tongue was least common (0.5%). The distribution of pain symptoms, pain duration and severity and pain ratings were similar in both groups. The MOPDS (Chinese elders version) had good reliability and construct validity. The MOPDS and OHIP-14 summary scores was significantly higher in the institutionalized elderly (p < 0.001 and p < 0.013, respectively). Psychological distress (GHQ-12 score > or = 4) was more common among the institutionalized elderly (11%) than the community dwelling elderly (4.0%, p = 0.002). CONCLUSIONS: Orofacial pain symptoms were associated with significant disability and had a detrimental impact on psychological distress level and quality of life, particularly in the institutionalized elderly. There is a need to improve access to professional care and health-related outreach services generally for elderly people in Hong Kong.

Asunto(s)

Dolor Facial/psicología , Vida Independiente , Institucionalización , Calidad de Vida , Estrés Psicológico/psicología , Anciano , Anciano de 80 o más Años , Analgésicos/uso terapéutico , Síndrome de Boca Ardiente/psicología , Estudios Transversales , Escolaridad , Femenino , Hogares para Ancianos , Hong Kong , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Aceptación de la Atención de Salud , Autocuidado , Seguridad Social , Trastornos de la Articulación Temporomandibular/psicología , Factores de Tiempo , Enfermedades de la Lengua/psicología , Odontalgia/psicología

RESUMEN

BACKGROUND: Longitudinal study to investigate how the dental caries in primary teeth progress with increasing age is still lacking. Aims. To describe the development of new caries over 2years and to identify risk factors that can predict new caries development. DESIGN: A random sample of preschool children aged 3-4years was surveyed and followed up when they reached 5-6years of age in Hong Kong. Dental caries status was assessed using the dmft index. Negative binomial regression was performed to investigate the factors collected at baseline that could predict the caries increment over 2years. RESULTS: Totally 358 children attended both examinations. The mean caries increment over 2years was 0.9. Results of the negative binomial regression showed that children who used nursing bottles during sleep when they were young (P=0.013), whose toothbrushing began after 12months (P=0.005), who took snack once or more daily (P<0.001), and whose parents had 9 or fewer years of education attainment (P=0.002) had significantly higher caries increment. CONCLUSIONS: New caries development of Hong Kong preschool children was low. Children's feeding, snaking and brushing habits, and parents' education attainment were the significant predictors for new caries development of preschool children.

Asunto(s)

Susceptibilidad a Caries Dentarias , Caries Dental/epidemiología , Conducta Alimentaria , Higiene Bucal/estadística & datos numéricos , Diente Primario/patología , Niño , Preescolar , Índice CPO , Caries Dental/patología , Caries Dental/prevención & control , Femenino , Hong Kong , Humanos , Estudios Longitudinales , Masculino , Salud Bucal/estadística & datos numéricos , Estudios Prospectivos , Factores Socioeconómicos , Cepillado Dental/estadística & datos numéricos

RESUMEN

AIM: The aim of this study is to examine the survival distributions of primary root canal treatment using interval-censored data and to assess the factors affecting the outcome of primary root canal treatment, in terms of periapical healing and tooth survival. MATERIALS AND METHODS: About one tenth of primary root canal treatment performed between January 1981 and December 1994 in a dental teaching hospital were systematically sampled for inclusion in this study. Information about the patients' personal particulars, medical history, pre-operative status, treatment details, and previous review status of the treated teeth, were obtained from dental records. Patients were recalled for examination clinically and radiographically. Treatment outcomes were categorized according to the status for periapical healing and tooth survival. The event time was interval-censored and subjected to survival analysis using the Weibull accelerated failure time model. RESULTS: A total of 889 teeth were suitable for analysis. Survival curves of both outcome measures (periapical healing and tooth survival) declined in a non-linear fashion with time. Median survival of the treated teeth was 119 months (periapical healing) and 252 months (tooth survival). Age, tooth type, pre-operative periapical status, occlusion, type of final restoration, and condition of the tooth/restoration margin were significant factors affecting both periapical healing and tooth survival. Apical extent and homogeneity of root canal fillings had a significant impact towards periapical healing (p < 0.05), but not tooth survival. CONCLUSION: The longevity of treated teeth based on tooth survival was considerably greater than that of periapical healing. Both outcome measures were affected by a number of socio-demographic, pre-, intra-, and post-operative factors. CLINICAL RELEVANCE: Root canal-treated teeth may continue to function for a considerable period of time even though there may be radiographic periapical lesion present. Decision for extraction may be due to reasons other than a failure of the periapical tissues to heal.

Asunto(s)

Tratamiento del Conducto Radicular/estadística & datos numéricos , Adulto , Factores de Edad , Caries Dental/diagnóstico por imagen , Adaptación Marginal Dental , Oclusión Dental , Cavidad Pulpar/diagnóstico por imagen , Restauración Dental Permanente/clasificación , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Dinámicas no Lineales , Periodontitis Periapical/diagnóstico por imagen , Periodontitis Periapical/terapia , Tejido Periapical/diagnóstico por imagen , Radiografía de Mordida Lateral , Radiografía Dental Digital , Retratamiento , Estudios Retrospectivos , Materiales de Obturación del Conducto Radicular/normas , Obturación del Conducto Radicular/normas , Análisis de Supervivencia , Pérdida de Diente/clasificación , Diente no Vital/diagnóstico por imagen , Resultado del Tratamiento , Cicatrización de Heridas/fisiología

RESUMEN

OBJECTIVES: The objective of this study was to explore the clinical and socio-demographic factors influencing oral health-related quality of life (OHRQoL) of the Chinese elderly. METHODS: Two urban districts in Binzhou, Shandong Province, Eastern China were selected and 300 elders aged 60-80 years were recruited. The study subjects completed a structured questionnaire in an interview and underwent a clinical examination. The questionnaire included questions on socio-economic information and a Putonghua version of the General Oral Health Assessment Index (GOHAI) which had been validated for use in Chinese elders to evaluate their OHRQoL. Clinical examination was performed using the criteria recommended by the World Health Organization. Tooth status, periodontal health status, loss of attachment (LOA), and number of occluding tooth pairs were recorded. Duplicate examinations were conducted on 10% of the subjects. RESULTS: The mean GOHAI score of the subjects was 46.0 (SD 8.5). Result of an ANCOVA showed that subjects who were older, had no root caries, had no tooth with LOA > or = 6mm, or had more occluding pairs had higher GOHAI scores indicating better OHRQoL. CONCLUSION: The OHRQoL of the study elders was fair and was influenced by age and a number of clinical factors. With limited resources and dental manpower in China, higher priority should be given to the elders who are relatively younger, who have or are at high risk of developing root caries and advanced periodontal diseases, and who have few occluding tooth pairs.

Asunto(s)

Cuidado Dental para Ancianos , Salud Bucal , Calidad de Vida , Anciano , Anciano de 80 o más Años , Análisis de Varianza , China/epidemiología , Índice CPO , Escolaridad , Femenino , Prioridades en Salud , Indicadores de Salud , Humanos , Renta , Masculino , Persona de Mediana Edad , Pérdida de la Inserción Periodontal/epidemiología , Pérdida de la Inserción Periodontal/psicología , Caries Radicular/epidemiología , Caries Radicular/psicología , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Pérdida de Diente/epidemiología , Pérdida de Diente/psicología , Población Urbana

RESUMEN

OBJECTIVES: The aims of this study were to investigate trends in oral health in a cohort from late childhood through adolescence to early adulthood and to describe how the oral health of young adults was affected by their family sociodemographic characteristics, oral health status, and utilization of dental services during adolescence using life course approach. METHODS: A cohort of 638 students was followed from late childhood (12 years old) through adolescence (15 years old) to early adulthood (18 years old) in Hong Kong. Dental examinations included the assessment of caries experience (DMFT score) and periodontal conditions (Community Periodontal Index, CPI) according to WHO criteria. Information on utilization of dental services, parental education attainment, and monthly household income was collected. Path analyses were performed to investigate oral health trends and the relationships between oral health (DMFT scores and highest CPI values) at age 18 years and the sociodemographic characteristics at age 12 years, oral health, and utilization of dental services during adolescence. RESULTS: In 2004 and 2007, 395 (62%) and 324 (51%) subjects of the original sample were followed up when they reached the age of 15 and 18 years, respectively. The mean DMFT score gradually increased from 0.62 at age 12 to 1.52 at age 18 (P < 0.001). The proportion of subjects with calculus or shallow periodontal pockets (highest CPI score 2 or 3) also increased with age, from 58% at age 12 to 96% at age 18 (P < 0.001). The oral health trend path models showed that DMFT score and highest CPI value at age 18 years were positively associated with DMFT score and highest CPI value at younger ages (P < 0.05). Results of the two extended path models showed that household income had positive effect on the utilization of dental services (ß > 0.29, P < 0.05) and the utilization of dental services had positive effect on DMFT score (ß > 0.12, P < 0.05) but not for highest CPI value (P > 0.05). However, parental education attainment had no significant effect on either DMFT score or highest CPI value (P > 0.05). CONCLUSIONS: Oral health status had become worse from childhood to early adulthood in the study cohort. Economic circumstance of the subjects was found to be positively related to their utilization of dental services and through this contributed to the subjects' caries experience. Oral health at younger ages was positively associated with succeeding oral health conditions.

Asunto(s)

Salud Bucal , Adolescente , Niño , Índice CPO , Atención Odontológica/estadística & datos numéricos , Caries Dental/epidemiología , Encuestas de Salud Bucal , Escolaridad , Hong Kong , Humanos , Renta , Estudios Longitudinales , Masculino , Enfermedades Periodontales/epidemiología , Factores Socioeconómicos

RESUMEN

BACKGROUND: The aim of this study was to explore the relationship between early childhood caries (ECC) and relevant socio-economic, behavioural and biological experiences in the life course of children. METHODS: A cross-sectional study of 2-year-old children was analysed. A questionnaire collected socio-economic and behavioural data during the first two years of the participants' life. Caries experience was recorded at the level of cavitation and oral hygiene was assessed using the Visible Plaque Index (VPI). Microbiological investigation collected information on colony-forming units (CFU) of Streptococcus mutans (S. mutans). The outcome was ECC. Bivariate and multiple logistic regression analyses were performed. RESULTS: The study included 394 children, with 109 having ECC and 285 being caries-free. The mean decayed, missing and filled primary teeth (dmft) score of the ECC group was 3.65 ± 3.12, with decayed teeth making up 100% of the score. The results of the final logistic regression analysis showed that ECC was significantly associated with the mother's schooling at child's birth [<12 years vs. ≥12 years, OR = 1.80], VPI score [>60% vs. 0-20%, OR = 5.71], and S. mutans [≥10(5) CFU/ml vs. 0 CFU/ml, OR = 3.80]. CONCLUSIONS: Social, behavioural and biological factors during the life course of 2-year-old children in southern China are associated with the development of ECC.

Asunto(s)

Caries Dental/etiología , Adulto , Carga Bacteriana , Peso al Nacer , Preescolar , China , Estudios Transversales , Índice CPO , Parto Obstétrico , Caries Dental/microbiología , Hipoplasia del Esmalte Dental/patología , Índice de Placa Dental , Escolaridad , Conducta Alimentaria , Métodos de Alimentación , Femenino , Edad Gestacional , Indicadores de Salud , Humanos , Masculino , Edad Materna , Estado Nutricional , Ocupaciones , Higiene Bucal , Padres/educación , Edad Paterna , Factores Socioeconómicos , Streptococcus mutans/aislamiento & purificación , Diente Primario/patología , Adulto Joven

RESUMEN

This concise review presents two Cochrane Reviews undertaken to determine: (1) the relative effectiveness of fluoride toothpastes of different concentrations in preventing dental caries in children and adolescents; and (2) the relationship between the use of topical fluorides in young children and their risk of developing dental fluorosis. To determine the relative effectiveness of fluoride toothpastes of different concentrations, we undertook a network meta-analysis utilizing both direct and indirect comparisons from randomized controlled trials (RCTs). The review examining fluorosis included evidence from experimental and observational studies. The findings of the reviews confirm the benefits of using fluoride toothpaste, when compared with placebo, in preventing caries in children and adolescents, but only significantly for fluoride concentrations of 1000 ppm and above. The relative caries-preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration. However, there is weak, unreliable evidence that starting the use of fluoride toothpaste in children under 12 months of age may be associated with an increased risk of fluorosis. The decision of what fluoride levels to use for children under 6 years should be balanced between the risk of developing dental caries and that of mild fluorosis.

Asunto(s)

Cariostáticos/administración & dosificación , Caries Dental/prevención & control , Fluoruros/administración & dosificación , Fluorosis Dental/etiología , Pastas de Dientes/química , Adolescente , Factores de Edad , Cariostáticos/efectos adversos , Cariostáticos/uso terapéutico , Niño , Preescolar , Índice CPO , Relación Dosis-Respuesta a Droga , Fluoruros/efectos adversos , Fluoruros/uso terapéutico , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Pastas de Dientes/efectos adversos , Pastas de Dientes/uso terapéutico

RESUMEN

A prospective study of all lower third molar surgery performed in the outpatient extraction clinic of a teaching dental hospital was conducted from January 1998 through October 2005 to determine the incidence of subsequent neurosensory deficit due to inferior alveolar nerve (IAN) and lingual nerve (LN) injury, to examine possible contributing risk factors and to describe the pattern of recovery. 3595 patients were included (61% female, 39% male; age range, 14-82 years). Of the 4338 lower third molar extractions performed by various grades of operators, 0.35% developed IAN deficit and 0.69% developed LN deficit. Distoangular impaction was found to increase the risk of LN deficit significantly (p<0.001). Depth of impaction was related to the risk of IAN deficit (p<0.001). Undergraduates caused more LN deficits (p<0.001). Sex, age, raising of a lingual flap, protection of LN with a retractor, removal of distolingual cortex, tooth sectioning and difficulty in tooth elevation were not significantly related to IAN or LN injury. Postoperative recovery from IAN and LN deficits was noted most significantly at 3 and 6 months, respectively. By the end of the follow-up period, 67% of IAN deficits and 72% of LN deficits had recovered completely.

Asunto(s)

Traumatismos del Nervio Lingual , Tercer Molar/cirugía , Complicaciones Posoperatorias/epidemiología , Recuperación de la Función/fisiología , Trastornos Somatosensoriales/epidemiología , Extracción Dental/estadística & datos numéricos , Diente Impactado/cirugía , Traumatismos del Nervio Trigémino , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Educación de Posgrado en Odontología/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Internado y Residencia/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Osteotomía/estadística & datos numéricos , Estudios Prospectivos , Factores de Riesgo , Factores Sexuales , Cirugía Bucal/educación , Colgajos Quirúrgicos/estadística & datos numéricos , Adulto Joven

RESUMEN

The study investigated the experience of widespread pain (WP) symptoms and psychological distress in southern Chinese with orofacial pain (OFP). A community-based, cross-sectional case-control study involving people aged 35-70 registered with the Hospital Authority/University of Hong Kong Family Medicine Clinic served as the sampling frame. People with recent OFP symptoms and a group without OFP took part. Standard questions were asked about OFP conditions in the previous month. Psychological status was evaluated through depression, and non-specific physical symptoms (NPS) scores were measured with depression and somatization sub-scales of the Symptom Checklist-90. Widespread pain was determined using body outline drawings to identify painful sites prior to a standard clinical examination. Two hundred people with OFP and 200 without OFP participated. Compared with 5.0% in the comparison group (P = 0.005), 13.5% of participants with OFP had WP (OFP/WP). Multiple OFP symptoms were more common in the OFP/WP sub-group than the OFP sub-group without WP (OFP/No WP) (P < 0.002). Sixty-three percent of the OFP/WP sub-group had moderate/severe depression scores compared with 26.0% in the OFP/No WP sub-group (P < 0.001). When pain items were included and excluded, 92.6% and 88.9% of the OFP/WP sub-group had moderate/severe NPS scores, respectively compared with 68.5% and 65.0% in the OFP/No WP sub-group (P = 0.004). Co-morbid WP occurred relatively often in southern Chinese with OFP. Psychological distress was common in OFP sufferers, particularly those with WP. A multidisciplinary approach to treatment including cognitive/behavioural therapy should be considered in Chinese people with OFP as part of a WP pattern.

Asunto(s)

Dolor Facial/psicología , Dolor/psicología , Trastornos Somatomorfos/psicología , Estrés Psicológico/psicología , Adulto , Anciano , Estudios de Casos y Controles , China , Enfermedad Crónica , Costo de Enfermedad , Estudios Transversales , Depresión/complicaciones , Depresión/psicología , Dolor Facial/complicaciones , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Dolor/complicaciones , Trastornos Somatomorfos/complicaciones , Estrés Psicológico/complicaciones