Database: MEDLINE <: biomedical, nursing & dental literature, 1966 - Oct 2000.> Search Strategy (You Saved Citations 1-300 From Set 70): ----------------------------------------------------------------------------- 1 exp Decision support techniques/ 19211 2 exp Decision making/ 28700 3 exp Decision making, computer-assisted/ 16758 4 ((decision: or consensus) adj (making or make$1 or support 14407 or theory or trees or technique:)).mp. 5 exp "Sensitivity and specificity"/ 89544 6 Computer simulation/ 19925 7 Computer systems/ 3947 8 Computers/ 40006 9 (computer: adj5 (simulation: or system: or decision: or 23667 predict: or forecast:)).mp. 10 Forecasting/ 28594 11 Models, biological/ 101335 12 Likelihood functions/ 3382 13 exp Risk/ 227197 14 exp "Outcome assessment (health care)"/ 103983 15 or/1-14 649701 16 exp Tooth demineralization/ 22628 17 demineralization.mp. 1620 18 caries.mp. 15295 19 caires.mp. 1 20 craies.mp. 0 21 careis.mp. 4 22 carise.mp. 0 23 (teeth adj3 cavit:).mp. 422 24 (tooth adj3 cavit:).mp. 217 25 (dental adj3 cavit:).mp. 276 26 (dentin adj3 cavit:).mp. 254 27 (enamel adj3 cavit:).mp. 182 28 (teeth adj3 decay:).mp. 374 29 (tooth adj3 decay:).mp. 321 30 (dental adj3 decay:).mp. 250 31 (dentin adj3 decay:).mp. 12 32 (enamel adj3 decay:).mp. 20 33 (active adj decay).mp. 9 34 (rampant adj3 decay:).mp. 14 35 (recurrent adj3 decay:).mp. 30 36 (white adj spot:).mp. 509 37 carious.mp. 2077 38 cariology.ti,ab. 56 39 (non-cavitated adj3 lesion:).mp. 15 40 (noncavitated adj3 lesion:).mp. 2 41 Tooth remineralization/ 478 42 (dental adj3 fissure:).mp. 99 43 (tooth adj3 fissure:).mp. 50 44 (teeth adj3 fissure:).mp. 98 45 caries-free.mp. 603 46 cariesfree.mp. 17 47 Cariogenic agents/ 728 48 precavit:.mp. 8 49 (filled adj3 teeth).mp. 510 50 (filled adj3 tooth).mp. 117 51 (oral adj fissure:).mp. 6 52 (tooth adj3 remineraliz:).mp. 28 53 (teeth adj3 remineraliz:).mp. 24 54 dft.mp. 413 55 dfs.mp. 1258 56 dmf:.mp. 6397 57 cariogeni:.mp. 1787 58 or/16-57 32256 59 15 and 58 2571 60 limit 59 to (human and english language and yr=1980-2000) 2084 61 limit 60 to (infant < 1 to 23 months > or preschool child < 735 2 to 5 years > or child < 6 to 12 years >) 62 limit 60 to (adolescence < 13 to 18 years > or adult < 19 1117 to 44 years > or middle age < 45 to 64 years > or "aged < 65 and over >" or "aged, < 80 and over >") 63 61 and 62 393 64 60 not 61 1349 65 64 or 63 1742 66 (disease adj free adj (survival or patient:)).mp. 6825 67 65 not 66 1490 68 "Root caries"/ 297 69 exp "Tooth root"/ 7047 70 67 not (68 or 69) 1390 71 from 70 keep 1-300 300 72 from 70 keep 301-600 300 73 from 70 keep 601-900 300 *************************** <1> UI - 96114310 AU - Soo YS AU - Morgan MV IN - Dental Health Services, Department of Health and Community Services, Victoria. TI - Caries experience in rural Victorian adolescents. SO - Australian Dental Journal 1995 Oct;40(5):311-7 AB - An oral health status survey was conducted on 818 adolescents aged 12 to 16 years in a non-fluoridated area in rural Victoria. The prevalence and severity of dental caries experience was found to increase with age. The occlusal surface was the predominant surface affected by dental caries for all age groups. Filled surfaces represented the largest component of the DMFS index and were responsible for the increasing dental caries experience with age. Fewer fissure sealants were present with increasing age and second molars were sealed less often than the first molars. Although no difference was evident in the total caries experience between those with and without access to public dental services, a statistical difference was found to exist in unmet need between these two groups. Untreated caries levels were significantly higher in health card holders. The provision of preventive and dental treatment services to this group should be a priority in the future. <2> UI - 96230308 AU - Caliskan MK IN - Department of Endodontics, Ege University Dental Faculty, Bornova, Izmir, Turkey. TI - Pulpotomy of carious vital teeth with periapical involvement. SO - International Endodontic Journal 1995 May;28(3):172-6 AB - Twenty-six permanent vital molars with carious pulp exposures and periapical involvement presenting as radiolucencies or radiopacities on radiographic examination, in patients aged between 10-24 years, were treated using an atraumatic surgical technique with calcium hydroxide alone. The healing was evaluated using clinical and radiographic criteria: absence of clinical symptoms, sensitivity of the radicular pulp, formation of a hard tissue barrier in the exposed area, resolution of periapical involvement and no intraradicular pathosis radiographically. Assessed by these criteria, successful results were achieved in 24 teeth. The observation period following pulpotomy treatment was 16-72 months. The favourable results of this study demonstrate that pulpotomy treatment in teeth with cariously exposed vital pulps and with periapical involvement may be an alternative treatment to root canal therapy. <3> UI - 96218756 AU - Erickson RL AU - Glasspoole EA IN - 3M Dental Products Division, St. Paul, MN 55144, USA. TI - Model investigations of caries inhibition by fluoride-releasing dental materials. [Review] [63 refs] SO - Advances in Dental Research 1995 Nov;9(3):315-23; discussion 324-31 AB - Fluoride-releasing dental materials are generally believed to reduce or prevent secondary caries. The evidence for this is largely anecdotal and centers on clinical experience with silicate cements and, more recently, with glass-ionomer cements. Unfortunately, corroborating evidence from controlled clinical trials is inadequate to establish precisely how effective these materials are or under what conditions they might be effective. Even less is known about the clinical effectiveness of newer materials that, often, release less fluoride. In vitro model systems have been used to study the effects of dental materials on de/remineralization of surrounding tooth structure. Fluoride-releasing materials have been shown in these models to reduce demineralization of both enamel and dentin compared with a material that does not release fluoride. This is useful from a mechanistic standpoint, but without clinical "standards" to guide model results, it is not possible to define an acceptable level of fluoride release or the length of time such release is required. A limited number of in situ model studies has been conducted, and some fluoride dose-response information has been obtained. These models are closer to the real situation and perhaps provide the best means to define required levels of fluoride release from materials in the absence of adequate clinical information. [References: 63] <4> UI - 96218755 AU - Roberts AJ IN - Unilever Dental Research, Port Sunlight Laboratory, Bebington, Wirral, UK. TI - Role of models in assessing new agents for caries prevention--non-fluoride systems. [Review] [40 refs] SO - Advances in Dental Research 1995 Nov;9(3):304-11; discussion 312-4 AB - While fluoride is an effective anti-caries agent, the search for more effective alternative therapies continues. A wide range of non-fluoride anti-caries agents has been postulated, and this paper reviews some of the pre-clinical models that have been utilized in their evaluation and some of the pitfalls that must be avoided. Using data on the potential anti-caries efficacy of phosphopeptides obtained from casein, the caution that must be applied in extrapolating laboratory data to predict clinical performance is discussed. Evaluation strategies that focus on only one potential mode of action (e.g., inhibition of demineralization) may overestimate the true clinical efficacy which may arise from a combination of two or more effects (e.g., inhibition of demineralization and stimulation of remineralization). Although laboratory and in situ data predict anti-caries efficacy for sodium trimetaphosphate in combination with fluoride, this was not found in three-year clinical trials. A possible reason for this, the lack of suitable calibration methods, is discussed. Finally, some comments on the appropriateness of laboratory evaluation strategies are made. [References: 40] <5> UI - 96218754 AU - Faller RV IN - The Procter & Gamble Company Health Care Research Center, Mason, Ohio 45040-8006, USA. TI - The application of in situ models for evaluation of new fluoride-containing systems. [Review] [49 refs] SO - Advances in Dental Research 1995 Nov;9(3):290-9; discussion 300-3 AB - Many in situ models have assessed the anticaries potential of fluoride-containing systems (Stookey et al., 1985; Mellberg et al., 1986, 1992a,b; Corpron et al., 1986; Featherstone and Zero, 1992; Ogaard and Rolla, 1992; Stephen et al., 1992). Several models have reportedly been validated according to guidelines proposed by Proskin et all. (1992). The proposed guidelines cover only dentifrices containing sodium fluoride (NaF) or sodium monofluorophosphate (SMFP) as active ingredients. These compounds are the most widely used sources of fluoride in dentifrices, and dose-response clinical standards are available for both. Other fluoride compounds, such as amine fluoride (AmF) and stannous fluoride (SnF2), have also been proven effective in reducing caries (Muehler et al., 1957, 1958; Marthaler, 1968; Lu et al., 1980; Cahen et al., 1982). Profile standards for these fluorides were not included in the proposed guidelines, primarily due to the lack of clinical data necessary to establish a dose response for these ingredients. Criteria for demonstrating the efficacy of these ingredients, along with methods to assess new fluoride compounds, need to be established. In situ models are used to evaluate the anticaries potential of new compounds added to mouthrinses, gums, slow-release devices, etc. (Creanor et al., 1992; Manning and Edgar, 1992; Lamb et al., 1993; Toumba and Curzon, 1993; Wang et al., 1993). Ingredients are often added to dentifrices previously proven effective against caries in order to provide additional benefits of gum health, tartar control, cleaning, etc. Proposals are made regarding the in situ testing of new dentifrices containing clinically proven fluoride compounds other than NaF and SMFP, as well as alternative delivery systems, in order to assist in their evaluation. [References: 49] <6> UI - 96218753 AU - Proskin HM IN - Department of Community Dentistry, Eastman Dental Center, Rochester, New York, USA. TI - Statistical considerations related to the use of caries model systems for the determination of clinical effectiveness of therapeutic agents. SO - Advances in Dental Research 1995 Nov;9(3):270-8; discussion 279-89 AB - Caries model systems bear great promise for the eventual determination of clinical benefits of therapeutic agents without the time and expense involved in the conduct of a full-fledged clinical trial. However, before such models can routinely be applied for such purposes, there are several issues which must first be resolved, including the consideration of a number of statistical matters. These include the assessment of the validity and reliability of the models to be so used. A procedure presented by Proskin, Chilton, and Kingman provides a quantitative means by which a conclusion concerning clinical effectiveness can be derived on the basis of data obtained through the use of a model system given that certain fairly general underlying conditions prevail. The present paper provides some discussion and recommendations of the author related to statistical matters concerning the use of models, and discusses the derivation and logic of the Proskin, Chilton, and Kingman procedure. <7> UI - 96218752 AU - Marsh PD IN - Department of Microbial Pathogenicity, Centre for Applied Microbiology and Research, Salisbury, England. TI - The role of microbiology in models of dental caries. [Review] [71 refs] SO - Advances in Dental Research 1995 Nov;9(3):244-54; discussion 255-69 AB - Models of dental caries (laboratory, animal, and human in situ models) vary markedly in their microbiological complexity. Laboratory models range from mono-cultures of cariogenic species providing an acidic challenge to enamel, to the development of diverse mixed cultures growing on a habitat-simulating medium in an artificial mouth or chemostat. The latter systems are of value in determining either mechanisms of action or cause-and-effect relationships--e.g., between dietary components or antimicrobial agents and the microflora. Laboratory models have also shown that the sensitivity of oral bacteria to inhibitors is markedly reduced when growing in biofilms such as dental plaque. Animal models have proved unequivocally that caries is an infectious and transmissible disease. Their use has enabled comparisons to be made of (a) the cariogenic potential of different bacterial species, (b) the role of the diet, and (c) the effects of potential anti-caries agents. It has been claimed that no caries-protective agent currently in use has failed a rodent test. In situ human models have been designed to permit the development of "natural" plaque on standardized enamel surfaces freely exposed to the human oral environment. The microflora that develops on unadulterated surfaces is similar in composition to that found at comparable sites on vital teeth. Demineralization can be accelerated by the inoculation of additional cariogenic bacteria coupled with either intra- or extra-oral sucrose rinses. The increased realism associated with the transition from laboratory to human in situ models is countered by a reduced ability to control or manipulate the system for experimental purposes. Thus a hierarchy of tests is needed for the study of anti-caries agents, each requiring a varying degree of microbiological complexity. [References: 71] <8> UI - 96218751 AU - Hay DI IN - Department of Biochemistry, Forsyth Dental Center, Boston, MA 02115, USA. TI - Salivary factors in caries models. [Review] [42 refs] SO - Advances in Dental Research 1995 Nov;9(3):239-43 AB - Consideration of salivary factors in caries models rarely extends beyond viewing saliva as a sink or diluent for plaque metabolic products, or as a source of buffering, for neutralizing plaque acids. In reality, saliva has a complex chemistry and a wide range of biochemical activities that may significantly affect plaque chemistry and microbiology. Thus, saliva is a major source of microbial nutrients, without which bacterial acid production is diminished. Buffering by salivary bicarbonate, and base production from urea and basic amino acids and peptides, significantly affect Stephan curves. Saliva is supersaturated with respect to basic calcium phosphate salts and contains novel inhibitors of calcium phosphate precipitation, while specific salivary proteins bind calcium. It seems important to consider if this system is reflected in plaque. Saliva, with contributions from serum and bacterial constituents, provides most of the precursors for the acquired enamel pellicle, which acts to slow demineralization during caries attack. Pellicle constituents appear to influence initial bacterial colonization of tooth surfaces and, therefore, may affect the microbial composition of plaque, but their detailed effects on plaque are poorly understood. Microbial adaptations to the anti-bacterial systems also seem important but are poorly investigated. Thus, saliva possesses an array of activities that have substantial actual or potential impact on plaque and, therefore, merit consideration for inclusion in systems intended to model dental caries. [References: 42] <9> UI - 96218750 AU - Edgar WM AU - Higham SM IN - The University of Liverpool School of Dentistry, Department of Clinical Dental Sciences, UK. TI - Role of saliva in caries models. [Review] [32 refs] SO - Advances in Dental Research 1995 Nov;9(3):235-8 AB - The crucial role played by the actions of saliva in controlling the equilibrium between de- and remineralization in a cariogenic environment is demonstrated by the effects on caries incidence of salivary dysfunction and by the distribution of sites of caries predilection to those were salivary effects are restricted. However, of the several properties of saliva which may confer protective effects, it is not certain which are most important. A distinction can be made between static protective effects, which act continuously, and dynamic effects, which act during the time-course of the Stephan curve. Evidence implicates salivary buffering and sugar clearance as important dynamic effects of saliva to prevent demineralization; of these, the buffering of plaque acids may predominate. Enhanced remineralization of white spot lesions may also be regarded as dynamic protective effects of saliva. Fluoride in saliva (from dentifrices, ingesta, etc.) may promote remineralization and (especially fluoride in plaque) inhibit demineralization. The design of experiments using caries models must take into account the static and dynamic effects of saliva. Some models admit a full expression of these effects, while others may exclude them, restricting the range of investigations possible. The possibility is raised that protective effects of saliva and therapeutic agents may act cooperatively. [References: 32] <10> UI - 96218749 AU - Zero DT IN - Eastman Dental Center, Rochester, NY 14620, USA. TI - In situ caries models. [Review] [78 refs] SO - Advances in Dental Research 1995 Nov;9(3):214-30; discussion 231-4 AB - By using in situ models, we have the potential to study both fundamental aspects of the caries process as well as more applied research problems such as the effect of food on dental caries and the role of fluoride in caries prevention in human subjects without actually causing caries in the natural dentition. The key experimental parameters that need to be considered in the development of an in situ model are the characteristics of the subject panel, the physical design of the model, the type of hard tissue substrate and the method of assessing mineral status, and the study design and clinical protocol. Each parameter must be carefully considered in relation to the objectives of the research, study design requirements, ethical considerations, impact on clinical relevance, and impact on the control of variation. The major source of variation associated with in situ models should be of biological and not experimental origin. The design and conduct of proper in situ model studies require a clear understanding of the caries process, sound analytical support, and a knowledge of how to work with research subjects to achieve a high level of compliance. Given the complex nature of caries, a combination of hard tissue substrates--including sound, surface-softened lesions and subsurface lesions--may be necessary to model all aspects of caries progression and prevention successfully. Internal validation of in situ models using fluoride dose-response controls is considered to be necessary for studies evaluating the efficacy of new fluoride dentifrice formulations. [References: 78] <11> UI - 96218747 AU - White DJ IN - The Procter & Gamble Company, Mason, Ohio 45040-8006, USA. TI - The application of in vitro models to research on demineralization and remineralization of the teeth. [Review] [247 refs] SO - Advances in Dental Research 1995 Nov;9(3):175-93; discussion 194-7 AB - Progress in in vivo and in situ experimentation has led many researchers to speculate as to the relevance and importance of in vitro testing protocols in caries research. A Medline/Biosis search for the present review revealed well over 300 citations (since 1989) documenting in vitro tests associated with caries research on mineralization and fluoride reactivity. The present survey documents these recent applications of in vitro test methods in both mechanistic and 'profile' caries research. In mechanistic studies, in vitro protocols over the past five years have made possible detailed studies of dynamics occurring in mineral loss and gain from dental tissues and the reaction dynamics associated with fluoride anticaries activity. Similarly, in profile applications, in vitro protocols make possible the inexpensive and rapid--yet sensitive--assessment of F anticaries efficacy within fluoride-active systems, and these tests represent a key component of product activity confirmation. The ability to carry out single variable experiments under highly controlled conditions remains a key advantage in in vitro experimentation, and will likely drive even further utilization, as advances continue in physical-chemical and analytical techniques for substrate analysis in these protocols. Despite their advantages in vitro testing protocols have significant limitations, most particularly related to their inability to simulate the complex biological processes involved in caries. [References: 247] <12> UI - 96218746 AU - Anonymous TI - Clinical Aspects of De/Remineralization of Teeth. Proceedings of Models Conference 1994. Rochester, New York, June 11-14, 1994. SO - Advances in Dental Research 1995 Nov;9(3):169-340 <13> UI - 96218757 AU - ten Cate JM AU - Mundorff-Shrestha SA IN - Department of Cariology and Endodontology, Academic Center for Dentistry Amsterdam, The Netherlands. TI - Working Group Report 1: Laboratory models for caries (in vitro and animal models). SO - Advances in Dental Research 1995 Nov;9(3):332-4 <14> UI - 96218758 AU - Wefel JS IN - Dows Institute for Dental Research, University of Iowa, Iowa City 52242, USA. TI - Working Group Report 2: In situ caries models, saliva, microbiology, and statistical considerations. SO - Advances in Dental Research 1995 Nov;9(3):335-7 <15> UI - 96218759 AU - Cummins IN - Unilever Dental Research, Port Sunlight Laboratory, Bebington, Wirral, Merseyside, UK. TI - Working Group Report 3: Role of models in assessing new agents for caries prevention. SO - Advances in Dental Research 1995 Nov;9(3):338-9 <16> UI - 96197666 AU - Volpe AR AU - Petrone ME AU - Davies R AU - Proskin HM IN - Colgate-Palmolive Technology Center, Piscataway, NJ, USA. TI - Clinical anticaries efficacy of NaF and SMFP dentifrices: overview and resolution of the scientific controversy. [Review] [32 refs] SO - Journal of Clinical Dentistry 1995;6 Spec No:1-28 AB - Since the introduction of commercially marketed fluoride-containing dentifrices in the 1950s, the evolution of these products has seen a number of formulation changes, particularly with regard to the specific types of active fluoride agents they contain. Most currently marketed dentifrices contain one of two major fluoride compounds--sodium fluoride (NaF), or sodium monofluorophosphate (SMFP)--and much research effort has gone into continued investigations geared toward determining which, if either, of these two agents provides dentifrices with greater levels of anticaries efficacy. Historically, among clinical studies, most single-investigation attempts to resolve this issue have yielded equivocal results. During the past two years, however, renewed attempts on a larger scale have been made, including scientific symposia in Toronto, London, and Stockholm sponsored by major manufacturers of dentifrices. The conflicting conclusions derived from these undertakings have resulted in a scientific controversy as to which represents the most accurate resolution to the fluoride-comparison issue. The present paper considers processes for addressing this controversy, and identifies the key points of difference among those processes by which the three symposia arrived at their respective conclusions. An objective procedure for addressing the fluoride-comparison issue is offered, and applied to the clinical data which is currently available in the literature. The results of this analysis indicate that: 1) There is no statistically significant difference between the anticaries effectiveness of dentifrices containing fluoride as SMFP, and those containing fluoride as NaF; and 2) There is no clinically meaningful difference between the anticaries effectiveness of dentifrices containing fluoride as SMFP, and those containing fluoride as NaF. [References: 32] <17> UI - 96197677 AU - Sunden S AU - Grondahl K AU - Grondahl HG IN - Department of Oral Diagnostic Radiology, Faculty of Odontology, Goteborg University, Sweden. TI - Accuracy and precision in the radiographic diagnosis of clinical instability in Branemark dental implants. SO - Clinical Oral Implants Research 1995 Dec;6(4):220-6 AB - The aim was to evaluate accuracy and precision in the radiographic diagnosis of clinical instability in Branemark dental implants. In two clinics specialized in the Branemark osseointegration technique we identified all patients in whom lack of clinical stability of one or more fixtures had been observed during a 5-year period. Radiographs of these fixtures (n=62) were mixed with radiographs of clinically stable fixtures (n=158). Eight observers were asked to determine whether or not a perifixtural radiolucency was seen by means of a 5-point rating scale expressing the confidence with which the presence or absence of a radiolucency was determined. Receiver operator characteristic analysis was used to calculate the A(z) values and the variability in A(z) values between and within observers was determined. In addition, we evaluated the agreement in rating codes within observers between repeat examinations. The A(z) values (mean=0.844 at the first reading and 0.856 at the second) indicated that the accuracy in radiographic diagnosis of clinical fixture instability was at least as good as that associated with other radiographic tasks such as approximal caries diagnosis and diagnosis of small periodontal bone lesions. Interobserver variability was larger than intraobserver variability. Intraobserver agreement in rating codes was relatively high and less than an average of 6% of all ratings differed with two rating codes or more. Despite the relatively good diagnostic accuracy, the probability of predicting clinical fixture instability from a radiographic examination can be low in populations with a low prevalence of fixtures showing clinical instability. <18> UI - 96189699 AU - Marino R IN - School of Dental Science, University of Melbourne, Australia. TI - Should we use milk fluoridation? A review. [Review] [71 refs] SO - Bulletin of the Pan American Health Organization 1995 Dec;29(4):287-98 AB - This article presents the argument that because of several demonstrated advantages, milk fluoridation provides a valid alternative to water fluoridation when the latter is not possible. Extensive literature describing study of fluoride compounds administered with calcium-rich food, as well as clinical trials and laboratory experiments with fluoridated milk, have demonstrated its effectiveness in caries prevention. The main criticisms of milk fluoridation are decreased bioavailability of the fluoride, the cost and administrative burden involved, and (in some cases) lack of sound clinical conclusions regarding its preventive efficacy. These criticisms are reviewed in the light of evidence now available. [References: 71] <19> UI - 96179262 AU - Soikkonen KT IN - Institute of Dentistry, Department of Dental Radiology, University of Helsinki, Finland. TI - Endodontically treated teeth and periapical findings in the elderly. SO - International Endodontic Journal 1995 Jul;28(4):200-3 AB - The radiographic quality of root-canal fillings, the prevalence of periapical findings and their associations with gender and age were investigated in 133 dentate old people living at home (45 males and 88 females, aged 76, 81, and 86 years and who had endodontically treated teeth or periapical lesions. Sixteen per cent of the endodontically treated teeth (n=507) exhibited periapical lesions, compared with 4% for the teeth not endodontically treated (P<0.0001) (chi-square test). Lesions were least prevalent in association with radiographically adequate root canal fillings (10%), and most prevalent in teeth with root canal post perforation (100%). Overfilled root canals and multi-rooted teeth with one or more unfilled roots also showed a high percentage of lesions (19% and 22%, respectively). Men had more periapical lesions than women in endodontically treated teeth (P<0.001, Mann-Whitney U-test), a finding contrary to previous studies in younger subjects. There were no other statistically significant differences between the sexes or age groups, although the percentage of root-filled teeth increased with age. <20> UI - 96177076 AU - Tidehag P AU - Gunne J IN - Department of Prosthetic Dentistry, Faculty of Odontology, Umea University, Sweden. TI - A 2-year clinical follow-up study of IPS Empress ceramic inlays. SO - International Journal of Prosthodontics 1995 Sep-Oct;8(5):456-60 AB - This study evaluated the clinical quality of 62 Empress restorations placed for 18 patients. Patients were evaluated for caries and fracture by two investigators at 7 and 26 months using the CDA quality evaluation criteria in additional to periodontal criteria. The results indicated a large number of excellent ratings for color and surface, but lower ratings for anatomic form and marginal integrity. <21> UI - 96156529 AU - Wenzel A IN - Department of Oral Radiology, Royal Dental College, University of Aarhus, Denmark. TI - Current trends in radiographic caries imaging. [Review] [149 refs] SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1995 Nov;80(5):527-39 AB - Caries prevalence, lesion site, and lesion behavior have changed over the past decade. This review looks at the impact of these changes on radiographic caries imaging. [References: 149] <22> UI - 96164930 AU - Benedetti-Panici P AU - Greggi S AU - Scambia G AU - Salerno MG AU - Baiocchi G AU - Laurelli G AU - Menichella G AU - Pierelli L AU - Foddai ML AU - Serafini R AU - et al IN - Department of Gynaecology, Catholic University, Rome, Italy. TI - Very high-dose chemotherapy with autologous peripheral stem cell support in advanced ovarian cancer. SO - European Journal of Cancer 1995 Nov;31A(12):1987-92 AB - 20 patients with stage III-IV ovarian cancer were submitted to induction chemotherapy (ICT) (40 mg/m2 cisplatin, days 1-4; 1.5 g/m2 cyclophosphamide, day 4; every 4 weeks for 2 cycles) followed by intensified CT (100 mg/m2 cisplatin, day 1; 650 mg/m2 etoposide, day 2; 1.8 g/m2 carboplatin by 24 h infusion, day 3). Haematological support consisted of autologous peripheral stem cells (APSC) and bone marrow (ABM) transplant (T) in 16 and 4 patients, respectively. All patients were evaluable for toxicity and 19 for pathological response (PR), one patient dying of systemic mycosis after ABMT. Severe (grade 3-4) non-haematological toxic effects were gastrointestinal (100%), neurological (10%) and hepatic (10%). PR was observed in 84% of patients (complete response 37%, partial response with microscopic residual disease 26%, partial response with macroscopic residual disease 21%). Five year overall survival was 60% and progression-free survival was 51% with 9 patients still disease-free (DFS). APSCT significantly reduced the duration of aplasia compared with ABMT, and toxicity was acceptable in those patients undergoing APSCT. The prolonged DFS in patients showing PCR suggests that this new approach may have a therapeutic impact. <23> UI - 96159396 AU - Holland TJ AU - Whelton H AU - O'Mullane DM AU - Creedon P IN - Oral Health Services Research Centre, University Dental School, Wilton, Cork, Ireland. TI - Evaluation of a fortnightly school-based sodium fluoride mouthrinse 4 years following its cessation. SO - Caries Research 1995;29(6):431-4 AB - The aim of this study was to investigate the effectiveness of a school-based fortnightly 0.2% sodium fluoride mouthrinse programme after children ceased to participate. The programme, which commenced at age 6 and ceased at age 12, was investigated 4 years following its cessation. Three groups of 12-year-olds and three groups of 16-year-olds were examined, i.e. children who had participated in the mouthrinse, those attending non-participating nearby schools and life-time residents of a fluoridated community. Significant differences in mean DMFT in the 12-year-olds between the mouthrinse and the control group were not found in the 16-year-old group. Mean DMFT for the mouthrinse group and those in a fluoridated community (which were the same in 12-year-olds) showed a statistically significant difference in those aged 16. Most caries found, both in 12-year-olds and in 16-year-olds, occurred on molar teeth and was found on pit and fissure surfaces. The cessation of these programmes at age 12 should be reappraised and the combination of school-based fluoride mouthrinse programmes with a fissure sealing programme is recommended. <24> UI - 96116575 AU - Gladys S AU - Van Meerbeek B AU - Inokoshi S AU - Willems G AU - Braem M AU - Lambrechts P AU - Vanherle G IN - Department of Operative Dentistry and Dental Materials, Katholieke Universeit te Leuven, UZ St Rafael, Belgium. TI - Clinical and semiquantitative marginal analysis of four tooth-coloured inlay systems at 3 years. SO - Journal of Dentistry 1995 Dec;23(6):329-38 AB - OBJECTIVES: The marginal quality of four tooth-coloured inlay systems was clinically investigated and subjected to computer-aided semiquantitative marginal analysis under scanning electron microscopy (SEM) after 3 years of clinical service. METHODS: Three of the restoration types were made using the Cerec CAD-CAM apparatus: one was milled from preformed glass ceramic blocks, and the two other inlay types were milled from preformed porcelain blocks. The fourth system was based on an experimental indirect resin composite inlay system. Each inlay type was luted with a different luting resin composite. The clinical evaluation was performed with a mirror and explorer by two clinicians separately, and the marginal analysis was conducted microscopically on replicas (SEM x 200). RESULTS: After 3 years in situ, all the restorations were clinically acceptable. No recurrent caries was observed. Marginal analysis under SEM detected a high percentage of submargination for all four systems, which suggests that their respective resin composite luting agents were all subject to wear. The percentage of marginal fractures on the enamel side as well as on the inlay side did not increase dramatically compared to the 6-month results. CONCLUSION: The first recall after 6 months of clinical service indicated how tooth-coloured inlays behave at their margins. The 3-year results confirmed the early findings, indicating that wear of resin composite lutes is important and present in all systems. The two ceramic materials showed a similar behaviour at the margins. The resin composite inlay performed better at the inlay site than at the enamel site. <25> UI - 96113470 AU - Kay EJ AU - Brickley M AU - Knill-Jones R IN - University of Dental Hospital of Manchester, U.K. TI - Restoration of approximal carious lesions--application of decision analysis. SO - Community Dentistry & Oral Epidemiology 1995 Oct;23(5):271-5 <26> UI - 96118045 AU - Hunter JM AU - Arbona SI IN - Department of Geography, Michigan State University, East Lansing 48824, USA. TI - The tooth as a marker of developing world quality of life: a field study in Guatemala. SO - Social Science & Medicine 1995 Nov;41(9):1217-40 AB - A geographical sample in a rural area of eastern Guatemala revealed widespread, premature and heavy losses of permanent teeth. Social and environmental influences that affect tooth loss include inadequate diet, refined sugar, poor oral hygiene, absence of fluoride, lack of preventive education and insufficiency of dental care services. Land hunger and family poverty are of paramount importance. Gender-based cultural differences are apparent in tooth extraction rates, and use of dentures. No one escapes visitations of severe orofacial pain that cast a blight upon the quality of rural life. Periodontal disease drives the poorest of the poor to spend disproportionately large sums on pharmaceutical pain-killers and destructive traditional medicines. Lay 'tooth-pullers' visit remote rural homes to extract teeth. Only full edentulism can bring patients permanent somatic and financial relief. Community dental health is conspicuously neglected in official policies and plans for rural development. <27> UI - 96122749 AU - Rozier RG TI - The effectiveness of community water fluoridation: beyond dummy variables for fluoride exposure [editorial; comment]. CM - Comment on: J Public Health Dent 1995 Fall;55(4):218-28 SO - Journal of Public Health Dentistry 1995 Fall;55(4):195 <28> UI - 96122750 AU - Matthias RE AU - Atchison KA AU - Lubben JE AU - De Jong F AU - Schweitzer SO IN - UCLA School of Public Policy and Social Research 90095, USA. TI - Factors affecting self-ratings of oral health. SO - Journal of Public Health Dentistry 1995 Fall;55(4):197-204 AB - OBJECTIVES: The purpose of this study is to determine the relationship of self-rated oral health to a comprehensive battery of clinical, sociodemographic, physical health, and mental health measures in a well-elderly urban population. METHODS: Results are based on telephone interviews and clinical assessments of 550 subjects over 65 years of age participating in a Los Angeles-based Medicare project during 1990. Subjects were mostly female, white (89%), with above-average income. RESULTS: Findings show that: (1) the DMF measure is not as strongly related to self-rated oral health as was a single measure of missing teeth; (2) the major predictors of self-rated oral health were "worry about teeth" and "appearance of teeth" followed by total missing teeth, race, education, and depression scores; and (3) self-rated general health is related to self-rated oral health. CONCLUSION: Self-rated oral health may be, for older adults, a better measure of "health" than of "morbidity". <29> UI - 96122757 AU - Phipps KR AU - Stevens VJ IN - Oregon Pacific AHEC, Newport 97365, USA. TI - Relative contribution of caries and periodontal disease in adult tooth loss for an HMO dental population. SO - Journal of Public Health Dentistry 1995 Fall;55(4):250-2 AB - OBJECTIVES: This study examined the reasons for tooth loss in an adult population with dental insurance. METHODS: Computerized records were used to identify Kaiser Permanente Dental Care patients aged 40-69 years who had an extraction during 1992 (n = 1,877). A random sample of 839 dental charts were reviewed. RESULTS: Slightly more than 51 percent of the teeth were extracted for periodontal disease, 35.4 percent for caries, 9.5 percent for a combination of the two, and 3.5 percent for other reasons. When considering patients as the unit of analysis, 58.4 percent of the patients had an extraction for caries, 39.9 percent for periodontal disease, 5.0 percent for both, and 2.6 percent for other reasons. CONCLUSIONS: In this population both caries and periodontal disease play a role in tooth loss. For this reason, prevention programs focusing on the prevention of both disease processes should be developed for adults. <30> UI - 96101343 AU - Abbasi AA AU - Rudman D AU - Wilson CR AU - Drinka PJ AU - Basu SN AU - Mattson DE AU - Richardson TJ IN - VA Medical Center, Section of Geriatrics, Milwaukee, WI 53295, USA. TI - Observations on nursing home residents with a history of hip fracture. SO - American Journal of the Medical Sciences 1995 Dec;310(6):229-34 AB - The authors evaluated nursing home residents with a prior history of hip fracture for osteopenia and its risk factors, and attempted to learn to what extent the residents' bone status had been considered by their primary care physicians. Thirty-one hip fracture residents in the Milwaukee VA nursing home were studied to determine their status with regard to bone mineral density of the proximal femur, and the following risk factors or predictors of osteopenia: history of smoking; history of fractures; calcium and vitamin D intake; underweight; immobility; hypogonadism; and administration of drugs that may accelerate bone demineralization. Data were also collected on the evaluation and management of the post hip fracture residents in three other nursing homes. In the Milwaukee nursing home, out of 31 hip fracture survivors, 74% had sustained a hip fracture before admission to the nursing home; 29% had a history of second fracture. In 84% of patients, there was no mention of osteopenia in the active medical problem list and, therefore, there was no intervention plan in place to improve or prevent further bone loss. Thirty-two percent were underweight, 36% were currently smoking, 55% were immobile, 64% were consuming at least one medication that might increase bone loss, calcium intake was less than 1,000 mg daily in 52%, and 66% were hypogonadal (serum testosterone level less than 300 ng/dL). Chart reviews of the hip fracture survivors at three other nursing homes revealed similar findings. Approximately 5-15% of nursing home residents are hip fracture survivors. They usually have severe osteopenia and multiple risk factors for further bone loss and future fractures.(ABSTRACT TRUNCATED AT 250 WORDS) <31> UI - 96095090 AU - Hildebrandt GH IN - Department of Cariology, Restorative Sciences and Endodontics, University of Michigan, Ann Arbor 48109-1078, USA. TI - Caries risk assessment and prevention for adults. SO - Journal of Dental Education 1995 Oct;59(10):972-9 <32> UI - 96095089 AU - Burgess RC IN - University of Toronto, Faculty of Dentistry, ON, Canada. TI - Assessment of caries risk factors and preventive practices. SO - Journal of Dental Education 1995 Oct;59(10):962-71 <33> UI - 96095088 AU - Stoddard JW IN - Department of Restorative Dentistry, University of Washington, Seattle 98195-7456, USA. TI - Caries risk assessment used as a determinant for caries management and prevention. SO - Journal of Dental Education 1995 Oct;59(10):957-61 <34> UI - 96095087 AU - Dodds MW AU - Suddick RP IN - Department of Community Dentistry, University of Texas Health Science Center at San Antonio 78284-7917, USA. TI - Caries risk assessment for determination of focus and intensity of prevention in a dental school clinic. SO - Journal of Dental Education 1995 Oct;59(10):945-56 <35> UI - 96095086 AU - Imfeld TN AU - Steiner M AU - Menghini GD AU - Marthaler TM IN - Department of Preventive Dentistry, Periodontology and Cariology, University of Zurich, Switzerland. TI - Prediction of future high caries increments for children in a school dental service and in private practice. SO - Journal of Dental Education 1995 Oct;59(10):941-4 <36> UI - 96095085 AU - Moss ME AU - Zero DT IN - Eastman Dental Center, Rochester, New York 14620, USA. TI - An overview of caries risk assessment, and its potential utility. [Review] [42 refs] SO - Journal of Dental Education 1995 Oct;59(10):932-40 AB - The clinical findings that dentists use to estimate the future caries activity of patients are imperfect. Almost invariably there are protective factors in patients who go on to develop clinical caries and there are risk factors that persist in patients who do not develop clinical caries. Therefore, the clinical decision process is characterized by a level of uncertainty concerning the selection of patient management strategies for caries. To the degree that information relating to caries risk assessment can reduce the amount of uncertainty associated with decisions for clinical patient care in the present, that information has utility. Dentists face many treatment decisions daily. The integration of a mechanistic understanding of caries and use of clinical data may yield useful information that will improve clinical patient management. Certain factors affect the potential utility of caries risk screening from the clinician's perspective. These can be summarized in terms of the costs and benefits of the procedures as well as the availability and appeal of alternative procedures. Factored in with these considerations are the investment history one has made toward a given procedure and the propensity for changing one's behavior. These considerations are not easily addressed at present since costs and benefits for different therapeutic approaches have been developed for only a few dental conditions. We have put forth a framework that emphasizes the clinician as the key component in the assessment of caries risk. We argue that integration of the clinician's focus with a mechanistic understanding of caries and a probabilistic, empirical appreciation for caries activity will be beneficial for patient management. These arguments remain untested and should be challenged in a research setting. We need to establish whether information derived from risk assessment procedures leads to improved clinical outcomes. We need to have a better understanding of how clinicians process clinically available risk information. We need to determine what additional risk assessment information will improve the clinician's ability to identify high-risk patients. We also need to establish whether there are differences in the usefulness of additional risk information depending on the level of experience of the clinician. [References: 42] <37> UI - 96095084 AU - Brown JP IN - Department of Community Dentistry, University of Texas Health Science Center at San Antonio 78284-7917, USA. TI - Developing clinical teaching methods for caries risk assessment: introduction to the topic and its history. SO - Journal of Dental Education 1995 Oct;59(10):928-31 <38> UI - 96077556 AU - Toyo'oka T AU - Takahashi M AU - Suzuki A AU - Ishii Y IN - Department of Analytical Chemistry, School of Pharmaceutical Sciences, University of Shizuoka, Japan. TI - Determination of free fatty acids in blood, tagged with 4-(2-carbazoylpyrrolidin-1-yl)-7-(N,N-dimethylaminosulfonyl )- 2,1,3-benzoxadiazole, by high-performance liquid chromatography with fluorescence detection. SO - Biomedical Chromatography 1995 Jul-Aug;9(4):162-70 AB - The free fatty acids in blood were determined by high performance liquid chromatography (HPLC) after pre-column tagging with 4-(2-carbazoylpyrrolidin-1-yl)- 7-(N,N-dimethylaminosulphonyl)-2,1,3-benzoxadiazole [sequence: see text] (DBD-ProCZ). The tagging conditions were optimized with palmitic acid (C16:0) and linoleic acid (C18:2) as representative free fatty acids, saturated and unsaturated, respectively. Under the mild reaction conditions of room temperature for 90 min in dimethylformamide (DMF) containing 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide hydrochloride (EDC, 0.2 M)/pyridine (2%), all the fatty acids tested were tagged with the DBD-ProCZ to produce highly fluorescent derivatives which emit light at 550 nm (excitation at 450 nm). The fluorescence wavelengths were essentially the same for all fatty acids, whereas the intensities were different for individual fatty acids. The derivatives obtained from ten free fatty acids were completely separated by reversed-phase chromatography with two isocratic elution conditions. The on-column detection limit (signal-to-noise ratio of 3) with proposed HPLC separation and fluorescence detection is in the range of 19 (palmitic acid)--176 fmol (palmitoleic acid). The free fatty acids in rat serum and human plasma were successfully determined using the present methods. <39> UI - 96123990 AU - Vandre RH AU - Webber RL IN - U.S. Army Dental Research Detachment of the Walter Reed Army Institute Research, Walter Reed AMC, Washington, DC, USA. TI - Future trends in dental radiology. [Review] [46 refs] SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1995 Oct;80(4):471-8 AB - Direct digital dental radiographic systems offer the potential to radically change the way dentists diagnose and treat dental pathoses. They offer instantaneous availability of radiographs, markedly lower patient radiation exposure, and the elimination of developing chemicals and developing equipment. The storage of dental radiographs as digital data permits their transmittal over phone lines facilitating phone consultations and may someday allow expedited authorization of treatment plans by dental insurance companies. With the use of digital subtraction radiology the dental practitioner will be able to diagnose periodontal disease progression and dental caries progression long before current techniques can detect a change. With tuned aperture computed tomography, the owner of a filmless digital system can make tomographic radiographs that allow the visualization of slices through areas of interest without having to buy additional hardware. Computer-aided diagnosis will facilitate the detection of proximal dental caries and osteoporosis, and may someday allow automated tracing of cephalometric radiographs. [References: 46] <40> UI - 96106551 AU - Lazarchik DA AU - Firestone AR AU - Heaven TJ AU - Filler SJ AU - Lussi A IN - Division of Hospital Dentistry, University of Alabama at Birmingham 35294-0007, USA. TI - Radiographic evaluation of occlusal caries: effect of training and experience. SO - Caries Research 1995;29(5):355-8 AB - The purpose of this study was to investigate what effect differing levels of didactic education and clinical experience have on the ability to diagnose occlusal caries from radiographs. Freshman and senior dental students and dental school faculty were asked to evaluate bitewing radiographs for the presence of occlusal caries and for a recommendation for restorative treatment. The agreement between histologic and radiographic diagnosis was assessed by calculating sensitivity, specificity, accuracy, and interexaminer agreement. It was concluded that dental students and faculty did differ in their abilities to evaluate radiographs for occlusal caries, and that education and clinical experience especially affected interexaminer agreement. <41> UI - 96106552 AU - Hintze H AU - Wenzel A AU - Larsen MJ IN - Department of Oral Radiology, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark. TI - Stereomicroscopy, film radiography, microradiography and naked-eye inspection of tooth sections as validation for occlusal caries diagnosis. SO - Caries Research 1995;29(5):359-63 AB - In establishing a trustworthy validation for occlusal caries lesions, various methods have been used after sectioning teeth. The aim of the present study was to compare the accuracy of four such methods: stereomicroscopy (SM), film radiography (FR), microradiography (MR) and naked-eye inspection (NEI) for the detection of caries in occlusal tooth surfaces. Further, the interobserver agreement between three observers' registrations of occlusal caries by these methods was evaluated. The material consisted of 18 unerupted third molars known to be sound with respect to caries, as they were embedded in bone prior to removal, and 20 erupted third molars with an unknown 'true state of disease'. The teeth were serially sectioned, coded and examined blindly for occlusal caries by three independent observers by the four validation methods under study. SM was demonstrated to be the only method by which all observers correctly identified all 18 unerupted teeth as sound, resulting in a specificity of 1.00. By the other three methods, 1 or more of the unerupted teeth were falsely classified as carious. In the erupted teeth, 73, 58, 52 and 32%, respectively, of the teeth were determined carious by SM, MR, NEI and FR. As it was possible by SM to detect caries in nearly three quarters of the erupted teeth and at the same time to identify all unerupted teeth as sound, this method seemed to be the most trustworthy of the validation methods under study. <42> UI - 96106553 AU - van Rijkom HM AU - Verdonschot EH IN - Department of Cariology and Endodontology, TRIKON Institute for Dental Clinical Research, University of Nijmegen, The Netherlands. TI - Factors involved in validity measurements of diagnostic tests for approximal caries--a meta-analysis. SO - Caries Research 1995;29(5):364-70 AB - In this study, a meta-analysis was performed on published validity parameters of visual inspection, radiographic examination and visual inspection upon fibreoptic transillumination (FOTI) in approximal caries diagnosis. It was the objective to investigate the influence of the diagnostic test, the study design and the validation method on reported validity. Sensitivities and specificities reported in the literature were transformed into D2 values, representing the performance of a diagnostic method above chance, or of the observer using it, in a single parameter. Dz values were neither statistically significantly different between visual inspection, radiographic examination and FOTI nor between 'weak' and 'strong' validation methods (p > 0.05). Dz values obtained from in vivo studies were significantly different from those obtained from in vitro studies (p < 0.05), indicating that study design had a significant impact on the measurement of the validity of the evaluated test for approximal caries diagnosis. <43> UI - 96106554 AU - Rudolphy MP AU - van Amerongen JP AU - Penning C AU - ten Cate JM IN - Department of Cariology and Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. TI - Grey discolouration and marginal fracture for the diagnosis of secondary caries in molars with occlusal amalgam restorations: an in vitro study. SO - Caries Research 1995;29(5):371-6 AB - Grey discolouration of the enamel around a filling and marginal fracture are often reasons to replace restorations due to suspicion of secondary caries. The aim of this study was to establish the validity of grey discolouration and marginal fracture for the diagnosis of caries at the enamel-dentine junction (EDJ) next to an amalgam filling. The occlusal surfaces of 161 extracted molars with occlusal amalgam fillings were photographed on colour slides, from which grey discolourations and marginal fracture were recorded. The size of the fracture was scored using a modified Mahler scale with six categories: score 1 = no marginal fracture (< 30 microns), score 6 = fracture width > 200 microns. Secondary caries at the EDJ was scored on radiographs of 700 micron sections of the molars. Both radiolucencies and radiopacities in dentine were scored as caries. The sensitivity of grey discolouration for detection of secondary caries was 50% and the specificity 91%. The positive and negative predictive values were 71 and 80%, respectively. Marginal fracture was evaluated at five different levels of severity. Although there was caries present more frequently at the EDJ under severely fractured margins, marginal fracture was found of little diagnostic value at all levels. Only marginal fracture at threshold level V provided a positive predictive value (50%), which was significantly higher than the caries prevalence (31%). It is concluded that width of marginal fracture, as defined by the Mahler scale, has hardly any value for the diagnosis of secondary caries. However, grey discolouration may be a useful diagnostic aid. <44> UI - 96106555 AU - Deery C AU - Fyffe HE AU - Nugent Z AU - Nuttall NM AU - Pitts NB IN - Dental Health Services Research Unit, Dental School, University of Dundee, UK. TI - The effect of placing a clear pit and fissure sealant on the validity and reproducibility of occlusal caries diagnosis. SO - Caries Research 1995;29(5):377-81 AB - The purpose of this in vitro study was to assess the validity and reproducibility of the diagnosis of fissure caries prior to and following the placement of a clear sealant. One hundred and twelve extracted molar teeth were examined by 7 experienced clinicians. Each examiner conducted four visual examinations, 2 prior to and 2 after sealing, allowing an assessment of reproducibility. The teeth were subsequently serially sectioned to provide the histological validation. After placement of a sealant, a significant (p < 0.05) loss of sensitivity was found for the diagnosis of enamel lesions and dentine lesions, but specificity was not altered. The overall reproducibility expressed by the kappa statistic was 0.60 and 0.47, before and after sealing, respectively. The examiners significantly (p < 0.001) underestimated the severity of lesions detected after sealing compared to their assessment prior to sealing. The investigation suggests that sealed surfaces require careful assessment and monitoring. <45> UI - 96106550 AU - Lussi A AU - Jaeggi T AU - Jaeggi-Scharer S IN - Department of Operative, Preventive and Pediatric Dentistry, University of Bern, School of Dental Medicine, Switzerland. TI - Prediction of the erosive potential of some beverages. SO - Caries Research 1995;29(5):349-54 AB - The aim of this study was to investigate whether the erosive potential of a beverage on human enamel can be predicted by examining the composition of the beverage. The buccal surfaces of 84 caries-free premolars were embedded in resin and polished flat. Two hundred micrometers of the enamel surface were removed. Then the slabs were divided into 14 groups and immersed for 20 min in commercially available beverages. Surface microhardness was measured before and after immersion. Further, the phosphate concentration, the fluoride concentration, the baseline pH as well as the titrated amount of base to raise the pH to 7.0 of each beverage were determined. Surface microhardness values after immersion were calculated with an equation derived in a recent study and compared with the values measured in this investigation. Apple juice showed the greatest significant decrease (p < 0.05) in surface microhardness, followed by Schweppes, Orangina and Grapefruit soft drink. The smallest decrease in surface microhardness that was significant resulted from Fendant and Isostar orange. The mean absolute deviation of the calculated to the effective erosion was 7.1%, it ranged between 14.6% (apple juice) and 1.6% (Fendant). The data suggest the possibility of predicting erosion caused by a beverage with an accuracy of 7%. This information can be of value in the prevention of dental erosion. <46> UI - 96116625 AU - Pendrys DG IN - Department of Behavioral Sciences and Community Health, School of Dental Medicine, University of Connecticut Health Center, Farmington 06030, USA. TI - Risk of fluorosis in a fluoridated population. Implications for the dentist and hygienist. SO - Journal of the American Dental Association 1995 Dec;126(12):1617-24 AB - The prevalence of enamel fluorosis has increased in optimally fluoridated areas in recent years. This has led to efforts to identify the cause or causes and to make recommendations that seek to maintain the caries-preventive effectiveness of fluoride use while minimizing the risk of fluorosis. In this study, the author estimated the potential direct impact that dental practitioners could have on reducing the amount of enamel fluorosis in U.S. children. The findings suggest that dental practitioners could have an important impact on reducing the prevalence of enamel fluorosis by guiding the public toward the most appropriate use of fluoride products. <47> UI - 96062745 AU - Maupome G AU - Hernandez-Guerrero JC AU - Garcia-Luna M AU - Trejo-Alvarado A AU - Hernandez-Perez M AU - Diez-de-Bonilla J IN - Department of Epidemiology, Universidad Nacional Autonoma de Mexico, Facultad de Odontologia, Coyoacan, Mexico. TI - In vivo diagnostic assessment of dentinal caries utilizing acid red and povidone-iodine dyes. SO - Operative Dentistry 1995 May-Jun;20(3):119-22 AB - In order to compare the clinical utilization of diagnostic dyes to identify carious dentin, the present in vivo study compared two caries-detector dyes, acid red (1% acid red in propylene glycol wt/wt) and povidone-iodine (8% povidone-iodine in water wt/vol). A total of 221 cavities prepared by 19 senior dental students under the supervision of two teachers at the Universidad Nacional Autonoma de Mexico Dental School were used. Dyes were applied double-blind under standardized conditions to at least two teeth of the same patient. Data were analyzed using the Mantel-Haenszel chi-square test and a test of proportions. Results showed that molars or premolars did not appear to be positively stained more frequently by one dye or another. Also, 36.7% of teeth tested positive to either one of the two dyes. Prudent utilization of either acid red or povidone-iodine appeared to be equally useful in assisting clinical decisions concerning cavity size while restoring dentinal lesions. However, povidone-iodine may be preferred in clinical settings where acid red is expensive and/or difficult to obtain. Further research is necessary to establish accurately the mechanism of staining by povidone-iodine. <48> UI - 96036318 AU - Zacharia MA AU - Munshi AK IN - Department of Pedodontics and Preventive Children's Dentistry, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, India. TI - Microbiological assessment of dentin stained with a caries detector dye. SO - Journal of Clinical Pediatric Dentistry 1995 Winter;19(2):111-5 AB - The purpose of this study was to assess microbiologically the efficacy of 1% acid red in propylene glycol dye to stain carious dentin. Thirty teeth with primary carious lesions involving dentin were chosen. Cavity preparation using the conventional visual and tactile criteria was done and the dye was applied to the prepared cavity. Dentin samples were collected, from carious dentin prior to cavity preparation, dye stained areas and unstained areas. The total colony forming units (CFU) in each sample were then assessed microbiologically. The results showed a highly significant difference in the total colony forming units in dye stained and dye unstained dentin samples. The 1% acid red dye in propylene glycol dye was found to be effective as an adjunctive aid in the diagnosis of carious dentin. <49> UI - 96037069 AU - Larsson B AU - Johansson I AU - Hallmans G AU - Ericson T IN - Department of Cariology, Research University of Umea, Sweden. TI - Relationship between dental caries and risk factors for atherosclerosis in Swedish adolescents?. SO - Community Dentistry & Oral Epidemiology 1995 Aug;23(4):205-10 AB - In an earlier study on a selected group of adolescents with high caries prevalence we found dietary habits that resembled those considered to promote the development of atherosclerosis. In the present study we have compared DMF-score with factors traditionally associated with the risk for development cardiovascular diseases (CVD). All 15-yr-olds living in an urban community in Northern Sweden 1987-1989 were included. Medical variables related to the risk of developing CVD were evaluated in groups of adolescents with various levels of manifest caries expressed as decayed and filled surfaces (DFS). The proportion of individuals with no medical risk factor at an unfavorable level was significantly higher in a caries free than in a high-caries (DFS > or = 9) group. Adolescents with two or more medical factors reaching unfavorable levels had a significantly higher caries score than the group with no factor at unfavorable level. A significant positive correlation was found for the whole group between DFS-score and relative body weight (body mass index) in an univariate correlation test as well as multiple linear regression analysis. The hypothesis that high caries score can be an indicator for unfavorable levels of traditional risk factors for CVD is not contradicted by the results in the present study but supported by the observed covariation with BMI. We therefore suggest that dietary counseling to adolescents with a high caries score in combination with a moderate obesity can be of advantage in reducing the caries risk as well as the risk for development of CVD at higher ages. <50> UI - 96072478 AU - Fontana M IN - Oral Health Research Institute, Indianapolis, Indiana 46202, USA. TI - Secondary caries: relation with current criteria used to replace restorations. [Review] [156 refs] SO - General Dentistry 1995 Mar-Apr;43(2):143-54; quiz 155-6 <51> UI - 96045998 AU - Loe H IN - Department of Periodontology, School of Dental Medicine, University of Connecticut Health Center, Farmington 06030-1710, USA. TI - Changing paradigms in restorative dentistry. [Review] [37 refs] SO - Journal of the American College of Dentists 1995 Fall;62(3):31-6 AB - Dramatic improvements in oral health have occurred during the last twenty years. Success is most noticeable in children and young adults, but also extends to the general population. The impact from declining disease rates, improved restorative materials and techniques, new diagnostics and treatments, a broad array of preventives, and better ways to deliver products and services to the public are demonstrated in the decline in the number of restorative procedures performed each year, including a 40% decline in the use of amalgam over the last eleven years. The new paradigm for restorative dentistry calls for an increasingly conservative approach to treatment. The question now is not primarily whether amalgam, composite, or any other material will fill a cavity. The real issue is to make the distinction between caries as a disease and caries as a lesion. Treating caries as a disease requires a new approach to patient management. A diagnosis of caries requires that a patient risk profile be established. We can no longer be limited in our efforts to merely restore the individual tooth surface. This paper discusses the need to cure disease and restore the total integrity of our patients' oral health. [References: 37] <52> UI - 96046017 AU - Brantley CF AU - Bader JD AU - Shugars DA AU - Nesbit SP IN - Advanced Education in General Dentistry program, Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill 27599-7450, USA. TI - Does the cycle of rerestoration lead to larger restorations?. SO - Journal of the American Dental Association 1995 Oct;126(10):1407-13 AB - The common practice of rerestoring teeth has been termed the "cycle of rerestoration." Some researchers and clinicians have speculated that this cycle results in teeth receiving progressively larger restorations. In this study involving 1,337 decisions to replace existing restorations in posterior teeth, the authors noted that 70 percent of all recommendations resulted in an increased number of restored surfaces. This observed increase in restoration size raises questions about the effects of the rerestoration cycle on the health of a tooth and suggests that practitioners should attempt to avoid premature rerestoration since it could hasten the cycle. <53> UI - 96021510 AU - Vaarkamp J AU - ten Bosch JJ AU - Verdonschot EH IN - TRIKON, Department of Cariology and Endodontology, Faculty of Medical Sciences, University of Nijmegen, The Netherlands. TI - Light propagation through teeth containing simulated caries lesions. SO - Physics in Medicine & Biology 1995 Aug;40(8):1375-87 AB - The methods currently utilized in dentistry to detect caries lesions have their limitations and alternatives are being investigated. A promising option is tooth transillumination which is based on an increase of light scattering or light absorption in the affected tissue region. In this study transillumination applied to detect approximal caries lesions was investigated using premolar teeth containing simulated caries lesions. Cavities were drilled at the approximal surface and filled with light absorbing and light scattering fluids in different dye and particle concentrations to model successive stages of lesion progress. For light absorbing cavities the extinction as function of the decadic absorption coefficient measured at the occlusal surface could be approximated by the Lambert-Beer law (r = 0.98 +/- 0.01). For light scattering cavities the extinction as a function of the decadic reduced scatter coefficient wad fitted to a straight line (r = 0.98 +/- 0.03) for mu's (lambda = 633 nm) < 1.25 mm-1. For higher reduced decadic scatter coefficients the curves levelled off due to multiple scattering. In addition, the contribution of the dentinal cavity part to the radiance change induced by the total cavity was estimated. For light absorbing cavities illuminated with red light the average contribution was 10.5 (SD 4.2)% and for those illuminated with green light it was 1.4 (SD 0.9)%, indicating that the radiance change caused by a caries lesion is mainly determined by the enamel lesion part. <54> UI - 96062740 AU - Kidd EA IN - Department of Conservative Dental Surgery, Guy's and St. Thomas's Medical and Dental School, London, England. TI - The use of diet analysis and advice in the management of dental caries in adult patients. SO - Operative Dentistry 1995 May-Jun;20(3):86-93 <55> UI - 96037996 AU - Addy M IN - Division of Restorative Dentistry, Dental School, Bristol, UK. TI - Evaluation of clinical trials of agents and procedures to prevent caries and periodontal disease: choosing products and recommending procedures. [Review] [57 refs] SO - International Dental Journal 1995 Jun;45(3):185-96 AB - The prevention of caries, gingivitis and periodontal diseases has been, and still is, a major objective for the dental profession. A large number of products are available to the general public, either over the counter or on prescription, formulated to prevent these diseases. Formulations are also used by professionals for the prevention and treatment of dental diseases. In recommending or using agents for prevention or therapy it is necessary for the practitioner to appreciate whether proof of efficacy is established. Preventive or therapeutic roles of formulations are frequently confused and there is a need to define the often misleading terminology used to describe products. Guidelines are required to enable the dental professional to understand research data and what constitutes proof of efficacy for preventive and/or therapeutic formulations. The guidelines should describe the research methodologies used today, including study design and analysis, ethics, the format of research papers and the relevance of laboratory data to clinical efficacy. [References: 57] <56> UI - 96024989 AU - Dibdin GH AU - Dawes C AU - Macpherson LM IN - MRC Dental Group, Dental School, Bristol, United Kingdom. TI - Computer modeling of the effects of chewing sugar-free and sucrose-containing gums on the pH changes in dental plaque associated with a cariogenic challenge at different intra-oral sites. SO - Journal of Dental Research 1995 Aug;74(8):1482-8 AB - Variation in salivary access to different intra-oral sites is an important factor in the site-dependence of dental caries. This study explored, theoretically, how access is modified by chewing sugar-free and sugar-containing gums. A finite difference computer model, described elsewhere, was used. This allowed for diffusion and/or reaction of substrate, acid product, salivary buffers, and fixed-acid groups. Site-dependent saliva/plaque exchange was modeled in terms of a 100-microns-thick salivary film covering the plaque (a) flowing directly from the salivary ducts, (b) flowing from the intra-oral salivary pool, or (c) exchanging with the pool. Computed flow-velocities or rates of exchange were based on previous intra-oral measurements. The model was also tested against an in vitro study conducted by two of the authors. In addition, the three proposed models of saliva/plaque interaction were compared, and the effect of salivary film thickness investigate. Results suggested that: (1) although sugar-free gum chewed during a cariogenic challenge causes a rapid rise in plaque pH, sucrose-containing gums cause the pH, after a temporary rise resulting from increased salivary flow, to stay low for an extended period; (2) the computer model reproduced in vitro tests reasonably well; (3) although the three models of the plaque/saliva interaction start from different assumptions, two lead to closely related predictions; and (4) increasing the assumed salivary film thickness by a large amount (e.g., from 50 to 200 microns) caused no change in modeled Stephan curves, as long as these changes were accompanied by appropriate reductions in film velocity, in accord, theoretically, with the practical clearance data. <57> UI - 96004688 AU - Chong BS IN - Department of Conservative Dental Surgery, United Medical and Dental Schools, Guy's Hospital, London, England. TI - Coronal leakage and treatment failure. SO - Journal of Endodontics 1995 Mar;21(3):159-60 AB - This report presents a case in which undiagnosed coronal leakage resulted in failure in the endodontic management of a tooth. Coronal leakage occurred during root canal treatment as a result of the presence of deficient composite resin fillings and secondary caries. Despite repeated visits of cleaning and dressing, the canal continued to be contaminated and symptoms persisted. On referral, the reason for treatment failure was diagnosed. The tooth was successfully treated by the replacement of the deficient fillings, after the elimination of underlying caries. Symptoms resolved enabling the completion of the root canal treatment. <58> UI - 96003031 AU - Bader JD AU - Shugars DA IN - Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. TI - Variation in dentists' clinical decisions. [Review] [67 refs] SO - Journal of Public Health Dentistry 1995 Summer;55(3):181-8 AB - OBJECTIVES: The first comprehensive review of the recent literature regarding variation in dentists' clinical treatment decisions is presented. METHODS: Variation among dentists in the clinical decisions they make as well as the methods used for assessing this variation are examined at three levels of aggregation of clinical decisions: the dental practice (or dentist), the patient, and the individual tooth. RESULTS: The extent to which differences in dentists' clinical decisions have been examined is limited. Studies are particularly sparse at the level of the dental practice, where the aggregate of dentists' treatment decisions is reflected. Further, the methods and measures used to assess variation tend to be different across studies, making quantification of variation difficult. Nevertheless, the available information reflects substantial variation in measures such as rates of provision of specific procedures; cost and numbers of procedures recommended for specific patients; and diagnoses, intervention decisions, and treatment selections for individual teeth. CONCLUSIONS: Even when differences in patients are controlled, variation in dentists' clinical decisions is ubiquitous. While its consequences remain undetermined, the variation in basic clinical decisions such as caries diagnosis signals the need to consider the extent to which the appropriateness of care is affected. [References: 67] <59> UI - 96036258 AU - O'Mullane D IN - WHO Collaborating Centre for Oral Health Services Research, University Dental School, Ireland. TI - Can prevention eliminate caries?. [Review] [24 refs] SO - Advances in Dental Research 1995 Jul;9(2):106-9 AB - There are four main factors involved in the carious process: at-risk tooth structure, plaque flora, fermentable carbohydrates, and time. Based on our knowledge of the carious process, four main preventive strategies have been developed over the years, namely, fluorides, fissure sealing, dietary choice, and plaque control. Fluorides are having a major impact on smooth-surface caries; hence, strategies combining fluorides and fissure sealing are very effective. However, use of fissure sealing is still problematic. Changing dietary practices with a view to reducing dental caries seems to be having little impact on a global scale. Plaque control, as practiced routinely by the majority of people, is not sufficient to result in caries reductions. Deprivation and poverty are strongly associated with high caries levels. Although the preventive strategies currently available are likely to result in lower caries levels for many, for logistical reasons and because of factors associated with deprivation and poverty, caries is likely to remain a major public health problem in most communities for the foreseeable future. [References: 24] <60> UI - 96036270 AU - Bergmann KE AU - Bergmann RL IN - Department of Pediatrics, Virchow-Klinikum Humboldt University, Berlin, Germany. TI - Salt fluoridation and general health. [Review] [42 refs] SO - Advances in Dental Research 1995 Jul;9(2):138-43 AB - Salt fluoridation is a systemic form of fluoride supplementation, leaving it to the consumer whether he wants fluoride supplements or not, but thereafter not requiring special dependability for daily compliance. Most German drinking water has low fluoride concentrations. The estimated fluoride intake in German children is between 100 and 300 micrograms/day, and in adults, between 400 and 600 micrograms/day. Male subjects have higher mean intakes than females. From 70 to 90% of the salt intake of 10 to 13.5 g/day in German adults comes from commercially prepared foods. This leaves about 1 to 4 g of salt to be added as table salt at the individual level and to become the source of supplementary fluoride. To increase fluoride intake by at least 500 micrograms/d, and to prevent an additional intake of more than 3000 micrograms/day, it may be necessary to have salt at a fluoride level of around 500 micrograms/g or to include one commercial food to be prepared with fluoridated salt, e.g., bread. A salt fluoride concentration of 250 micrograms/g does not present a risk of dental fluorosis. However, clear recommendations about systemic fluoride supplementation must be given as long as there are fluoride tablets, fluoride-rich mineral waters, and fluoridated table salt available simultaneously. Persons at risk for hypertension from salt consumption require different means of fluoride supplementation. By and large, in areas of low drinking water fluoride, fluoridated table salt has the potential to become a means of systemic supplementation comparable with drinking water fluoridation. [References: 42] <61> UI - 96036252 AU - Bowen WH IN - Department of Dental Research, University of Rochester, New York 14642, USA. TI - Are current models for preventive programs sufficient for the needs of tomorrow?. [Review] [45 refs] SO - Advances in Dental Research 1995 Jul;9(2):77-81 AB - We can be proud of our accomplishment in the prevention of dental caries. Many children in developed countries are now caries-free; however, by age 50, fewer than 5% of the population is caries-free. The drop in the prevalence of caries among specific age groups is undoubtedly due to widespread exposure to fluorides. However, caries protection by fluorides is not absolute; if caries attack continues throughout life, the prevalence of caries will increase. All available evidence strongly suggests that ambient levels of fluoride in the mouth play a critical role in protection against caries. It is clear that novel methods of delivery, such as sustained-release technology, will be developed to enhance the protective effect of fluoride, utilizing amounts of fluoride significantly less than those currently in use. The problems of preventing dental caries in developing countries are much more severe than those facing Western countries. The prevalence of caries appears to be increasing in no small measure due to the introduction of Western diets. Administration of fluoride through conventional routes is either impractical or inordinately expensive. It appears sensible, therefore, to direct preventive measures through dietary constituents associated with caries. Fluoridation of sugars appears to be highly practical and safe way to reduce the prevalence of caries in such communities. Fluoride and iodide are currently added to salt in many parts of the world. If we are to reduce the prevalence of caries effectively in all countries and in all age groups, current methods of prevention will have to be greatly enhanced, and/or effective additional approaches will need to be developed. [References: 45] <62> UI - 96036253 AU - Fejerskov O IN - Department of Dental Pathology, Royal Dental College, Faculty of Health Sciences, Aarhus University, Denmark. TI - Strategies in the design of preventive programs. [Review] [35 refs] SO - Advances in Dental Research 1995 Jul;9(2):82-8 AB - Dental caries is mostly recorded at the cavity level only. A reduced mean number of cavities in new age cohorts is often thought of as a result of prevention of the disease, dental caries. However, what is measured is rather our success in controlling the disease in such a way that prevalence of its more severe manifestations (cavities) can be reduced in children. Caries lesions and periodontal breakdown are cumulative with age and progress steadily in all populations. Thus, caries is the predominant reason for tooth loss in almost all age groups. The low prevalence and skewed distribution of dental caries make several fluoride programs less (if at all) cost-effective. Rather than considering a "whole population strategy" as opposed to a "high-risk strategy", it is argued that they should go hand in hand. However, the high-risk strategy may appear to have an unfavorable ratio of benefits to costs. So far the available literature shows no evidence that we have tests which, with sufficient predictive power, can identify groups or individuals of "high risk". It is therefore concluded that a population strategy should be maintained and further developed with emphasis on oral hygiene, because it influences norms and behavior. More knowledge about the pathogenesis of oral disease is needed before we can develop truly cost-effective strategies for the prevention of caries and periodontal breakdown. [References: 35] <63> UI - 96017041 AU - Wilson NH AU - Wilson MA IN - Department of Restorative Dentistry, University Dental Hospital, United Kingdom. TI - The outcome of a clinical trial of a dentin bonding system. Justice or injustice?. SO - American Journal of Dentistry 1995 Apr;8(2):99-102 AB - PURPOSE: To review the findings and to question the outcome of a clinical evaluation of a dentin bonding system. MATERIALS AND METHODS: The study was a split mouth, single blind (to patient), randomised within patient, clinical trial of Tripton used in conjunction with Opalux and the ultrafine compact-filled, experimental visible light cured resin composite M221784 (ICI Dental) in the restoration of mixed (enamel/dentin), caries free buccal-surface cervical lesions in vital, permanent canine and premolar teeth. The design of the trial was based on the then current American Dental Association (ADA) Clinical Protocol Guidelines for Dentin and Enamel Adhesive Materials. Restorations were placed as dictated by a predetermined randomised number scheme with each patient recruited to the study receiving at least one pair of matched restorations, comprising one restoration of each resin composite. RESULTS: The study reported was discontinued at 1 year subsequent to a 17% loss rate between 6 and 12 months after placement, with most of the restorations lost having been placed in what has subsequently become shown to be relatively unfavorable situations. It is suggested that the outcome of clinical trials of the type considered may warrant review in the light of new knowledge and understanding, and that regulatory bodies setting clinical protocol guidelines must give careful consideration as to whether the criteria for this type of trial should be more restrictive or required to include a representative range of clinically relevant situations. <64> UI - 96036304 AU - Aranda M AU - Garcia-Godoy F IN - Department of Pediatric Dentistry, University of Texas Health Science Center, San Antonio, Texas, USA. TI - Clinical evaluation of the retention and wear of a light-cured pit and fissure glass ionomer sealant. SO - Journal of Clinical Pediatric Dentistry 1995 Summer;19(4):273-7 AB - The purpose of this study was to evaluate the 12-month retention and wear of an experimental light-cured glass ionomer for pit and fissure sealing. A total of 25 patients 7-14 years-old were selected from the Pediatric Dentistry Clinic at the University of Texas Health Science Center at San Antonio. The patients resided in areas without fluoridated water. Each tooth was isolated with cotton rolls, dried with oil-free compressed air and GC Dentin Conditioner applied with a small disposable brush to the pits and fissures for 20 seconds. The teeth were rinsed with water and gently air dried using an air/water syringe. The teeth were not desiccated. GC experimental glass ionomer for pit and fissures was used. The powder/liquid ratio was dispensed at 1.4 gm/1.0 gm (one level spoonful of powder to one drop of liquid). The powder was mixed for 15-20 seconds. An explorer was used to apply the mixed sealant to the tooth and teased into all pits and fissures. The sealant was then cured for 20 seconds. Occlusion was corrected after the sealant was light-cured. Immediately, a color slide and a vinyl polysiloxane impressions were taken. The impressions were poured in epoxy resin. Color slides, impressions and epoxy models were also made at 3, 6, 9 and 12-month recalls. A total of 95 sealants were placed and follow-up for 12 months. The results showed that with the clinical visual inspection all sealants were present at 3 and 6 months postoperatively. At 12 months, only 20% of the sealants were clinically evident.(ABSTRACT TRUNCATED AT 250 WORDS) <65> UI - 96012679 AU - White SC AU - Atchison KA AU - Hewlett ER AU - Flack VF IN - UCLA Schools of Dentistry, Section of Oral Radiology, USA. TI - Efficacy of FDA guidelines for prescribing radiographs to detect dental and intraosseous conditions. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1995 Jul;80(1):108-14 AB - OBJECTIVES. This study compared the FDA guidelines for ordering dental radiographs to a conventional full-mouth examination for the detection of intraosseous disease and conditions affecting teeth other than caries. STUDY DESIGN. We examined 490 patients and selected posterior bite-wing and periapical views as indicated by the patient's signs or symptoms. We compared the radiographic findings with the use of this selected set of radiographs to those from a full-mouth set of radiographs to determine the rates of missed disease when the FDA guidelines were used. RESULTS. The most commonly missed intraosseous findings were osteosclerosis, unerupted teeth, periapical radiolucencies, and primary root tips. Periapical radiolucencies that were most probably periapical cemental dysplasia were missed in six patients. The most commonly missed dental findings were resorbed roots and pulp stones. Three instances of dens in dente were missed. CONCLUSIONS. When we used the FDA guidelines, the number of missed intraosseous and dental conditions was small and most likely inconsequential given the range of variability in dental diagnosis and treatment. <66> UI - 96056121 AU - Molander B AU - Ahlqwist M AU - Grondahl HG IN - Department of Oral Diagnostic Radiology, Goteborg University, Sweden. TI - Panoramic and restrictive intraoral radiography in comprehensive oral radiographic diagnosis. SO - European Journal of Oral Sciences 1995 Aug;103(4):191-8 AB - It has been suggested that information from the panoramic radiograph makes it possible to appropriately select supplementary intraoral radiographs to achieve a comprehensive examination of teeth and surrounding bone with less patient dose but no significant information loss. Number of intraoral radiographs selected, information loss and monetary costs with such a procedure was evaluated in 40 patients. Results show that, on average, 5.1 intraoral radiographs were selected to supplement the panoramic radiograph. Of these, 3.1 contained information different from that in the panoramic radiograph but 2.0 did not. An additional 3.4 ought to have been taken to reach the result of the 'gold standard' achieved from a simultaneous evaluation by two expert observers of panoramic radiographs and full mouth surveys with intraoral radiographs. Sensitivity for the combined use of panoramic and supplementary intraoral radiographs was high (80-96%, depending on type of teeth) as regards periapical lesions and marginal bone loss but low for caries (42-96%). Specificity was high for periapical lesions and caries (95-97%) but low for marginal bone loss (50-92%). In Sweden, patient costs become almost the same for a combination of panoramic radiography and 8.5 intraoral radiographs as for a full mouth survey comprising 20 intraoral radiographs. The radiation dose reduction is 40-50% considering that the dose from a panoramic radiograph approximately corresponds to 2-4 intraoral radiographs.(ABSTRACT TRUNCATED AT 250 WORDS) <67> UI - 95396132 AU - Tang Y AU - Norcia AM IN - Smith-Kettlewell Eye Research Institute, San Francisco, CA 94115, USA. TI - Application of adaptive filtering to steady-state evoked response. SO - Medical & Biological Engineering & Computing 1995 May;33(3 Spec No):391-5 AB - A new method to detect steady-state evoked potentials (EPs) is presented. The technique is based on a two-weight recursive least squares (RLS) adaptive filter and the Tcirc2 statistic. Simulations with known sinusoids buried in Gaussian noise and in EEG noise indicate that the adaptive filter can detect signals at 3 or 4 times lower signal-to-noise ratios that the discrete Fourier transform (DFT). Qualitatively similar results were obtained with human visual evoked potential recordings. <68> UI - 95376479 AU - Brickley M AU - Kay E AU - Shepherd J IN - Department of Oral Surgery, Medicine and Pathology, University of Wales College of Medicine, Cardiff, UK. TI - Public health aspects of third molar surgery. The effect of surgeons' treatment thresholds on efficiency and effectiveness. SO - Community Dental Health 1995 Jun;12(2):70-6 AB - Disease associated with third molars is being recognised increasingly as a public health problem in terms both of rising incidence and of appropriate use of resources. Since minor alterations in treatment philosophy can have a substantial impact on the efficiency and effectiveness of oral surgery services, this study examines the sensitivity and specificity of oral surgeons' decisions and uses Receiver Operator Characteristics (ROC) analysis to investigate their ability to detect and make appropriate judgements about teeth which need extraction according to established criteria. The study shows that the seniority of the surgeon making the treatment decisions had no significant effect on the decisions made and also demonstrated wide variations between the treatment plans made by individual clinicians. It is clear from this study that if an efficient and effective service for the treatment of third molar disease is to be commissioned, policy decisions about criteria for intervention must be made by health service purchasing authorities, adhered to by secondary care providers, and shared with the primary care practitioners who refer patients for treatment. <69> UI - 95401467 AU - Lewandrowski KU AU - Tomford WW AU - Yeadon A AU - Deutsch TF AU - Mankin HJ AU - Uhthoff HK IN - Orthopaedic Research Laboratories, Massachusetts General Hospital, Boston 02114, USA. TI - Flexural rigidity in partially demineralized diaphyseal bone grafts. SO - Clinical Orthopaedics & Related Research 1995 Aug;(317):254-62 AB - Control of biomechanical properties of demineralized diaphyseal bone allografts is required for their clinical application. Therefore, the changes in flexural rigidity in human fibulae were investigated as a function of the demineralization depth using a nondestructive bending test. Starting at the facies medialis, the flexural rigidity was determined in 24 planes at 15 degrees sequential angular increments, which allowed data collection around the circumference of the bone. Test bones included 4 pairs of left and right human fibulae and 15 single fibulae. The elliptical distribution of the flexural rigidity of left and right fibulae and single fibulae before and after demineralization was compared. The stiffness index and the area ratio were defined as parameters to describe the mechanical status of the test bones. Results show that the rigidity of diaphyseal bones is strongly dependent on the reduction of their cortical thickness by demineralization. A mathematical model allowing prediction of the reduction of the rigidity of diaphyseal bone grafts as a function of the demineralization depth is presented. <70> UI - 95406831 AU - Swedberg Y IN - Department of Pedodontics, Faculty of Odontology, Goteborg, Sweden. TI - Dental time study results in relation to a model for a dental health related patient group system. SO - Swedish Dental Journal 1995;19(3):109-18 AB - Using a time study method, dental care treatment resources were studied concerning different caries groups of children and adolescents 3-19 years of age. The results were applied to a model for a dental health related patient group system as a tool for presenting the dental care situation. Quality assurance aspects of a dental health related patient group system, adapted for use in general dental care, had led to a suggested model system: "Dental Visiting Groups" (DVG). The DVG system takes into consideration the fact that dental care was performed by three dental care-giving personnel groups--dentists, dental hygienists and dental assistants--giving dental care in three main areas of dental procedures: diagnostic, prevention and intervention. The DVG system implied a model of Swedish dentistry in change, and presented the relationships among the dental health related patient groups, the three main areas of dental procedures, and the tasks of the dental care-givers. Applied over time, the DVG system illustrated the efficiency of the dental care model used. <71> UI - 95405934 AU - Schlagenhauf U AU - Pommerencke K AU - Weiger R IN - Department of Conservative Dentistry, School of Dental Medicine, University of Tubingen, Germany. TI - Influence of toothbrushing, eating and smoking on Dentocult SM Strip mutans test scores. SO - Oral Microbiology & Immunology 1995 Apr;10(2):98-101 AB - The Dentocult SM Strip mutans test (D-SM, Vivadent) is a popular method for estimating salivary mutans streptococci and is clinically used for the detection of potential caries risk patients. The influence of toothbrushing, eating and smoking on the reliability of D-SM test scores was assessed in 30 subjects aged 21-39 years. All experiments were performed 24 h after professional tooth cleaning in the morning of 3 consecutive days. On day 1 immediately before and 30 min after toothbrushing, D-SM tests were taken and total salivary colony-forming units per ml were determined. Following the same protocol, the influence of a standardized breakfast and of smoking was evaluated on day 2 and on day 3 respectively. Although all parameters significantly decreased the salivary colony-forming units per ml, only the standardized breakfast induced significant changes in the D-SM test results. Eating therefore should be avoided prior to the performance of the D-SM test. <72> UI - 95361462 AU - Amstutz RD AU - Rozier RG IN - Directorate of Health Care Studies and Clinical Investigation, AMEDD Center & School, Ft. Sam Houston, Texas 78234-6060, USA. TI - Community risk indicators for dental caries in school children: an ecologic study. SO - Community Dentistry & Oral Epidemiology 1995 Jun;23(3):129-37 AB - A statewide survey of NC schoolchildren found wide variation in dental caries prevalence among sampled classrooms. This study examined factors associated with this variation using classrooms as a surrogate for the larger community, in order to identify community risk indicators (CRI). In all, 172 classrooms (3400 students) in Grades K-6 were available for analysis. Initially, 56 sociodemographic, environmental, health system, and clinical factors were evaluated for their association with caries prevalence (K-3: average dfs + DMFS; 4-6: average DMFS) using univariate and bivariate analyses. Of these, 21 factors met our criteria for evaluation using WLS multivariate regression. For Grades K-3 (n = 108), population density, parental education, and coastal residence were negatively associated with caries scores, while age, and medical and dental, Medicaid expenditures were positive. For Grades 4--6 (n = 64), age and fs:dfs ratio were positively associated with caries scores while population density, population:dentist ratio, and years of natural fluoride exposure were negative. CRIs for both models, when compared to individual models, explained a substantial portion of the variation in caries prevalence, 31% for Grades K-3 and 51% for Grades 4-6. Results suggest that a risk assessment model based on community rather than individual variables is feasible and further refinement may reveal factors useful in identifying high risk communities. <73> UI - 95361464 AU - Szpunar SM AU - Eklund SA AU - Burt BA IN - Program in Dental Public Health, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA. TI - Sugar consumption and caries risk in schoolchildren with low caries experience. SO - Community Dentistry & Oral Epidemiology 1995 Jun;23(3):142-6 AB - This paper assesses the risk from sugar consumption in a population of school children with low caries experience. It relates eight different measures of sugar consumption to the occurrence of any DMFS increment, and, separately, to approximal and pit-and-fissure DMFS. The data are from a 3-yr longitudinal study of 429 children, initially aged 11-15, residing in non-fluoridated rural communities in Michigan, USA. All children completed at least three dietary interviews, were present for baseline and final dental examinations, and had a parent or guardian provide questionnaire information on residence history, use of fluoride and dental services, and family history. Results indicated that a higher proportion of total energy intake from sugars increased the probability of caries on all surfaces, and a higher total intake of sugars was also associated with total caries increment. No relationship, however, was found between DMFS increment and the frequency of eating high sugar foods. Each additional 5 g of daily sugars intake was associated with a 1% increase in the probability of developing caries, and those whose energy intake from sugars was 1 SD above the mean had 2.0 times the risk of developing approximal caries than did children whose energy intake from sugars was 1 SD below the mean. <74> UI - 95361465 AU - Weissenbach M AU - Chau N AU - Benamghar L AU - Lion C AU - Schwartz F AU - Vadot J IN - Faculte de Chirurgie Dentaire, Nancy, France. TI - Oral health in adolescents from a small French town. SO - Community Dentistry & Oral Epidemiology 1995 Jun;23(3):147-54 AB - In France, caries are more prevalent in rural areas than in large cities. This study analyzed the relationship between number of oral health indices and some known risk factors (toothbrushing, sugar consumption, saliva components) and sociodemographic factors in adolescents from a small town. The sample included 112 children aged 12-14 in the north-east of France. School marks was found to be better linked with dental caries indices than the socio-occupational category of parents: gingival index (GI), DMFS, DMFT and caries severity (CS) significantly increased with decreasing school marks; oral plaque was related to socio-occupational of parents. The analysis using the regression method showed that the variance explained by the various factors studied was modest (between 23 and 30%) for GI, initial caries sites (IS), DS, DMFS, DMFT and CS, and was small for plaque (5%) and calculus (3%). This would be due in part to the wide dispersion of these indices. The sex had a non-significant regression coefficient for all oral health indices investigated. For GI, only mutans streptococci (MS) and plaque had a significant regression coefficient. Calculus was explained by any factor considered. Only MS had a significant part in plaque. IS was explained by MS, toothbrushing and age. For DS, only toothbrushing, MS and sweet drinks during meals had a significant part. DMFS and DMFT were explained only by MS and age. CS was explained by MS, age, salivary buffer pH, salivary flow rate, and toothbrushing. <75> UI - 95362059 AU - Gamble CL IN - Cooper Clinic Osteoporosis Center, Fort Smith, AR, USA. TI - Osteoporosis: drug and nondrug therapies for the patient at risk. [Review] [17 refs] SO - Geriatrics 1995 Aug;50(8):39-43 AB - Preventing bone loss and avoiding fractures are the most effective therapies for osteoporosis. Nondrug measures include weight-bearing exercise, adequate calcium intake, and the prevention of falls. Estrogen replacement therapy can protect bone from rapid demineralization typical of the early post-menopausal period. New research has provided more data on estrogen's safety and efficacy. Calcitonin is an option when estrogen is contraindicated. Although calcitonin requires frequent injections, it does provide some analgesic effect for patients with osteoporosis-related fracture. Fluoride and etidronate have shown promise but remain investigational due to questions about long-term effects on bone mass. Potent third-generation bisphosphonates are being studied and may be available soon. [References: 17] <76> UI - 95366386 AU - Swerdlow CD AU - Davie S AU - Kass RM AU - Chen PS AU - Hwang C AU - Mandel WJ AU - Gang ES AU - Raissi S AU - Peter CT IN - Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA. TI - Optimal electrode configuration for pectoral transvenous implantable defibrillator without an active can. SO - American Journal of Cardiology 1995 Aug 15;76(5):370-4 AB - A new 83 cm3 implantable cardioverter-defibrillator (ICD) designed for pectoral implantation has been implanted most frequently using right ventricular and superior vena cava (RV-->SVC) electrodes; a patch electrode (RV-->patch + SVC) has been added when necessary to decrease the defibrillation threshold (DFT). The goal of this prospective study was to compare biphasic waveform DFTs for 3 electrode configurations: RV-->patch, RV-->SVC, and RV-->patch + SVC in 25 consecutive patients. The patch was positioned in a left retro-pectoral pocket, and the SVC electrode was positioned with the tip at the junction of the SVC and innominate vein. In the first 15 patients, all 3 electrode configurations were tested in random order; in the last 10 patients, only the RV-->patch and RV-->patch + SVC configurations were tested. In the first 15 patients, the stored-energy DFT for the RV-->SVC configuration (15.2 +/- 7.7 J) was higher (p < 0.001) than the DFT for the RV-->patch configuration (11.3 +/- 6.2 J) and the RV-->patch + SVC configuration (10.0 +/- 5.8 J). For all 25 patients, the DFT was lower for the RV-->patch + SVC configuration (9.7 +/- 5.1 J) than for the RV-->patch configuration (12.4 +/- 6.6 J, p = 0.005). The pathway resistance was highest for the RV-->patch configuration (72 +/- 9 omega), lower for the RV-->SVC configuration (63 +/- 6 omega, p < 0.01), and lowest for the RV-->patch + SVC configuration (46 +/- 3 omega, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) <77> UI - 95373382 AU - May H AU - Reader R AU - Murphy S AU - Khaw KT IN - Clinical Gerontology Unit, Addenbrooke's Hospital, Cambridge. TI - Self-reported tooth loss and bone mineral density in older men and women. SO - Age & Ageing 1995 May;24(3):217-21 AB - It has been reported that postmenopausal women with osteoporosis have a higher than expected number of dentures and fewer teeth than women without osteoporosis. The relationship between self-reported tooth loss and bone mineral density (BMD) at the hip and spine in 608 men and 874 women, aged 65-76 years, was examined in a cross-sectional study. BMD was measured using dual X-ray absorptiometry. Twenty-four per cent of men and 27% of women had no natural teeth. There was a consistent decrease in BMD with increasing numbers of teeth lost in men. This relationship was independent of age, body mass index and smoking habit (trochanter r = -0.14, p < 0.0005; Ward's triangle r = -0.1, p < 0.005; and lumbar spine r = -0.07, p < 0.05) with between 5% and 9% difference in mean BMD at various sites between men who had all their teeth and men who had no teeth. There was no significant association between self-reported tooth loss and BMD in women. Tooth loss is associated with lower BMD in men; this relationship is less consistent in women. <78> UI - 95355687 AU - Duncan RC AU - Heaven T AU - Weems RA AU - Firestone AR AU - Greer DF AU - Patel JR IN - Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, USA. TI - Using computers to diagnose and plan treatment of approximal caries. Detected in radiographs. SO - Journal of the American Dental Association 1995 Jul;126(7):873-82 AB - Two of the authors developed a computer-based software system that is capable of diagnosing approximal caries and making decisions about restorative care. The system was compared with decisions made by a group of experienced clinicians. The results indicate that the clinician viewers overall correctly identified a similar number of surfaces as the software, but from viewer to viewer, there was more variability in the number of surfaces identified correctly than in those identified correctly by the software users. Software packages such as this have the potential to raise overall accuracy by increasing the consistency of treatment decisions over time. <79> UI - 95352330 AU - Bishop K AU - Briggs P IN - Charles Clifford Dental Hospital, Sheffield. TI - Endodontic failure--a problem from top to bottom. [Review] [12 refs] SO - British Dental Journal 1995 Jul 8;179(1):35-6 AB - Endodontically treated teeth are susceptible to bacterial contamination through exposure to oral fluids. It is crucial, therefore, that restorations placed during and after root canal therapy protect the root canal from oral contamination. This paper highlights the clinical steps necessary to reduce the risk of contamination in root-filled teeth. [References: 12] <80> UI - 95336962 AU - Zucca E AU - Roggero E AU - Pinotti G AU - Pedrinis E AU - Cappella C AU - Venco A AU - Cavalli F IN - Servizio Oncologico Cantonale, Ospedale San Giovanni, Bellinzona, Switzerland. TI - Patterns of survival in mantle cell lymphoma. SO - Annals of Oncology 1995 Mar;6(3):257-62 AB - BACKGROUND: The term mantle cell lymphoma (MCL) describes a subtype of non-Hodgkin's lymphoma that includes those lymphomas previously defined as centrocytic lymphoma, intermediate lymphocytic lymphoma, and mantle zone lymphoma. Since MCL has only recently been recognised as a distinct entity, the clinical literature is sparse and very little information is available about its treatment. PATIENTS AND METHODS: We retrospectively attempted to analyse the clinical features and outcome of 65 patients with mantle cell lymphoma (MCL) treated from 1979 to 1993 at two institutions in the same geographic area. Univariate (Log-rank test) and multivariate (Cox regression) analyses of the major prognostic factors were performed. RESULTS: At the time of analysis the median follow-up was 49 months. Median age was 64 years with a range of 27-85 years. The male to female ratio was 2:1. Forty-seven patients (72%) had stage IV at presentation and 20 (31%) had B-symptoms at presentation. The patients usually presented with generalised adenopathy (78% of cases) and bone marrow involvement (58%). Serum LDH were analysed at diagnosis in 61 patients and found to be elevated in 30%. beta 2-Microglobulin was determined at presentation in 42 patients and was higher than normal in 54% of them. In comparison with the other subtypes of NHLs in our series, MCL appears to have a very poor survival pattern. The median overall survival was 42 months. The CR rate was 51% with a median DFS of 44 months. Good performance status, normal LDH, normal beta 2-microglobulin, younger age (< 65 years), and a low prognostic risk according to the International Index were significantly associated (p < 0.05) with a better outcome. CONCLUSIONS: The characteristics of the patients in this study appear to be in general agreement with those in most of the previously reported series except for the somewhat lower rate of bone marrow infiltration observed in this series. Despite the limitations of a retrospective analysis and the lack of randomization between the treatment options, this study seems to suggest a survival advantage with anthracycline-containing regimens in some patients with MCL. However, this benefit was evident only for the patients with favourable International Index prognostic scores (i.e., low- and to low-intermediate-risk disease) who may already have a better prognosis. Patients with intermediate-high and high-risk disease according to the International Index have a poor prognosis regardless of the type of therapy given. <81> UI - 95332537 AU - Mertz-Fairhurst EJ AU - Adair SM AU - Sams DR AU - Curtis JW Jr AU - Ergle JW AU - Hawkins KI AU - Mackert JR Jr AU - O'Dell NL AU - Richards EE AU - Rueggeberg F AU - et al IN - Department of Oral Rehabilitation, School of Dentistry, The Medical College of Georgia, Augusta 30912, USA. TI - Cariostatic and ultraconservative sealed restorations: nine-year results among children and adults. SO - ASDC Journal of Dentistry for Children 1995 Mar-Apr;62(2):97-107 AB - The objective of this clinical study was to evaluate the long-term efficacy of placing sealed posterior composite restorations for arresting active caries. The tooth preparation for this bonded and sealed restoration was limited to placing a bevel in the enamel only, without the removal of the carious lesion. The radiographic and clinical performance of these ultraconservative sealed composite restorations placed over caries (CompS/C) was compared over a period of nine years with: 1) ultraconservative, localized sealed amalgam (AGS) restorations with no extension for prevention, and 2) traditional, unsealed amalgam restorations (AGU) with the usual extension for prevention outline form. Sealant retention with > 50 percent to 100 percent of the margins occurred in 64 percent of CompS/C and 82.5 percent of AGS restorations. After nine years the cumulative failure rates were 16 percent for CompS/C, 2.5 percent for AGS, and 17.1 percent for AGU restorations. Thus, the clinical performance of CompS/C restorations was slightly superior to that of the traditional AGU restorations. The AGS restorations were definitely superior to the traditional AGU restorations and to the CompS/C restorations in both children and adults alike. Complete sealant retention over CompS/C and AGS restorations was equivalent between children and adults (P = 0.14 and 0.74, respectively). A higher percentage of open margins in CompS/C restorations was seen, however, in children (17.4 percent) than adults (1.94 percent). This study has shown that Class I caries can be arrested by the CompS/C restoration. <82> UI - 95338943 AU - Dagenais ME AU - Clark BG IN - Montreal General Hospital, McGill University, Quebec, Canada. TI - Receiver operating characteristics of RadioVisioGraphy. SO - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics 1995 Feb;79(2):238-45 AB - The diagnostic utility of intra-oral images obtained from the RVG second generation digital imaging system are compared with standard film images with the use of receiver operating characteristic analysis. Ten phantoms were constructed, each with 8 extracted teeth that had 12 approximal surfaces per phantom with holes drilled randomly to simulate approximal caries. Three images of each phantom were tested: a conventional film image, a thermal paper print, and a screen image. The images were rated by 26 dentists at separate sessions according to their confidence in the visibility of the simulated caries. A series of receiver operating characteristics curves were computed from the resulting 3120 decisions that indicate consistently greater success at detection of the holes on the film images. A full statistical analysis is given, and recommendations are made with respect to the use of this unit. <83> UI - 95321292 AU - Konig KG AU - Navia JM IN - University Medical Faculty, Nijmegen, Netherlands. TI - Nutritional role of sugars in oral health. [Review] [44 refs] SO - American Journal of Clinical Nutrition 1995 Jul;62(1 Suppl):275S-282S; discussion 282S-283S AB - The dental risk of dietary sugars is dependent mainly on the frequency of intake, but the prevalence of caries in a population is strongly modified by other dietary, social, and behavioral factors independent from intake of sugars. Regarding dietary factors, it must be remembered that hidden sugars in fruit as well as polysaccharides are cariogenic. The most important of the other factors is regular tooth brushing, which results in the removal of the bacterial plaque that causes caries and periodontal diseases and makes fluoride (which is contained in every advanced toothpaste) available for maintenance of the hard dental tissues and for remineralization wherever demineralization has occurred. This explains why in most highly developed countries caries prevalence has decreased markedly during the past 20 y although consumption of sugars remained high. [References: 44] <84> UI - 95318336 AU - Anusavice KJ TI - Treatment regimens in preventive and restorative dentistry. [Review] [70 refs] SO - Journal of the American Dental Association 1995 Jun;126(6):727-43 AB - Due in part to a lack of appropriate training and the incentive of adequate compensation, preventive dentistry in the United States has focused on prophylaxis and fluoride application. Dentistry must shift its attention to developing standardized protocols for "preservative dentistry"--diagnosing caries, assessing and monitoring caries risk, arresting active caries and remineralizing non-cavitated lesions. This article addresses shortcomings in preventive dentistry and proposes a plan for treatment standardization that can ensure optimum treatment and, ideally, lead to adequate compensation. [References: 70] <85> UI - 95294913 AU - Rozier RG TI - A new era for community water fluoridation? Achievements after one-half century and challenges ahead [editorial]. SO - Journal of Public Health Dentistry 1995 Winter;55(1):3-5 <86> UI - 95294918 AU - Horowitz HS TI - Commentary on and recommendations for the proper uses of fluoride. SO - Journal of Public Health Dentistry 1995 Winter;55(1):57-62 AB - Fluorosis has been associated with the fluoride concentration of drinking water, use of dietary fluoride supplements, early use of dentifrices, and prolonged use of infant formula. The literature, however, does not show associations between fluorosis and use of fluoride mouthrinses, professionally applied fluorides, bottled waters, carbonated beverages, and juices. It is unwise to issue laundry lists of items that may be implicated as problem-causing when, in fact, they may not be. Although usually classified without fluorosis, children in Dean's "questionable" category would be classified with the condition if the TFI or TSIF were used. Accordingly, Dean, in 1942, really reported only 52.8 percent of children without fluorosis in Kewanee, a community with 0.9 ppm fluoride