Database: MEDLINE <: biomedical, nursing & dental literature, 1966 - Oct 2000.> Search Strategy (You Saved Citations 1-300 From Set 57): ----------------------------------------------------------------------------- 1 exp Tooth demineralization/ 22628 2 demineralization.mp. 1620 3 caries.mp. 15295 4 caires.mp. 1 5 craies.mp. 0 6 careis.mp. 4 7 carise.mp. 0 8 (teeth adj3 cavit:).mp. 422 9 (tooth adj3 cavit:).mp. 217 10 (dental adj3 cavit:).mp. 276 11 (dentin adj3 cavit:).mp. 254 12 (enamel adj3 cavit:).mp. 182 13 (teeth adj3 decay:).mp. 374 14 (tooth adj3 decay:).mp. 321 15 (dental adj3 decay:).mp. 250 16 (dentin adj3 decay:).mp. 12 17 (enamel adj3 decay:).mp. 20 18 (active adj decay).mp. 9 19 (rampant adj3 decay:).mp. 14 20 (recurrent adj3 decay:).mp. 30 21 (white adj spot:).mp. 509 22 carious.mp. 2077 23 cariology.ti,ab. 56 24 (non-cavitated adj3 lesion:).mp. 15 25 (noncavitated adj3 lesion:).mp. 2 26 Tooth remineralization/ 478 27 (dental adj3 fissure:).mp. 99 28 (tooth adj3 fissure:).mp. 50 29 (teeth adj3 fissure:).mp. 98 30 caries-free.mp. 603 31 cariesfree.mp. 17 32 Cariogenic agents/ 728 33 precavit:.mp. 8 34 (filled adj3 teeth).mp. 510 35 (filled adj3 tooth).mp. 117 36 (oral adj fissure:).mp. 6 37 (tooth adj3 remineraliz:).mp. 28 38 (teeth adj3 remineraliz:).mp. 24 39 dft.mp. 413 40 dfs.mp. 1258 41 dmf:.mp. 6397 42 cariogeni:.mp. 1787 43 or/1-42 32256 44 Meta-analysis/ 3246 45 Meta-analysis.pt. 4816 46 medline.ti,ab. 5528 47 (metaanaly: or (meta adj analy$5)).ti,ab. 5931 48 overview$1.ti,ab. 21172 49 review.pt. 749371 50 (systematic adj review:).mp. 1512 51 or/44-50 767320 52 43 and 51 2481 53 limit 52 to (human and english language) 1878 54 limit 53 to yr=1980-2000 1632 55 pc.fs. 408367 56 prevent:.mp. 324526 57 54 and (55 or 56) 821 58 from 57 keep 1-300 300 *************************** <1> UI - 20242101 AU - Hanada N IN - Department of Oral Science, National Institute of Infectious Diseases, Tokyo 162-8640, Japan. nhanada@nih.go.jp TI - Current understanding of the cause of dental caries. [Review] [38 refs] SO - Japanese Journal of Infectious Diseases 2000 Feb;53(1):1-5 AB - Dental caries-associated oral streptococci are called the mutans streptococci, with Streptococcus mutans and Streptococcus sobrinus being the most prevalent caries-associated organisms in humans. Strains of the mutans streptococci are highly conserved within not only mothers and their children but also racial groups, suggesting vertical transmission of this organism within human populations. It has been found that the mother-child infection route of the mutans streptococci can be prevented by simply reducing the amount of the mutans streptococci contained in the mothers' saliva. Moreover, a chlorhexidine varnish reduces the salivary mutans streptococci by an average of 3 logs (99.9%), and moved them below detectable levels. We should attempt to eliminate the infection with the mutans streptococci among Japanese people by attempting to break the infectious chain from mothers to children. [References: 38] <2> UI - 20354174 AU - Mount GJ IN - University of Adelaide. TI - A new classification and techniques for simple restorative dentistry. [Review] [24 refs] SO - Annals of the Royal Australasian College of Dental Surgeons 1998 Oct;14:94-8 AB - It is nearly one hundred years since G. V. Black proposed a simple, five-stage classification for carious lesions based upon the site of the lesion and the type of restorative material likely to be used for restoration. In the absence of both effective preventive measures and a knowledge of remineralization his approach was essentially surgical: having identified a lesion remove it surgically, as well as all surrounding susceptible tooth structure, to prevent recurrence. Surgery is no longer regarded as the primary choice for treatment of a disease and there are many factors which suggest that this system is out of date. Preservation of natural tooth structure should be the principal aim and this is best achieved through remineralization. Remaining cavitated areas can then be restored more conservatively, thus assisting in maintaining aesthetics as well as strength in the tooth crown. If the profession is to adopt a new approach to operative dentistry it is suggested that the psychology of introducing a new classification for carious lesions is a desirable move. [References: 24] <3> UI - 20352519 AU - Newbrun E IN - University of California, San Francisco, USA. TI - Evolution of professionally applied topical fluoride therapies. [Review] [30 refs] SO - Compendium of Continuing Education in Dentistry (Jamesburg, NJ) 1999;20(1 Spec No):5-9; quiz 34 AB - Ever since researchers first realized the benefits of fluoride as an anticaries agent, they began investigating the effect of concentrated topical fluoride applications in reducing caries. Many forms of fluoride were studied, including solutions, gels or foams of sodium fluoride, stannous fluoride, organic amine fluoride, acidulated phosphate fluoride, and nonaqueous fluoride varnishes in an alcoholic solution of natural resins and difluorosilane agents covered by a polyurethane coating. All of these professionally applied topical agents have anticaries benefits, although these benefits and the ease of application vary. One trend that stands out in the evolution of professionally applied fluoride agents is the development of increasingly more user-friendly products. [References: 30] <4> UI - 20352521 AU - Seppa L IN - University of Oulu, Finland. TI - Efficacy and safety of fluoride varnishes. [Review] [29 refs] SO - Compendium of Continuing Education in Dentistry (Jamesburg, NJ) 1999;20(1 Spec No):18-26; quiz 34-5 AB - Clinical studies show that fluoride varnishes, such as Duraphat, are effective in increasing the fluoride content in the enamel and preventing caries. Varnish application is fast and easy. A professional prophylaxis before varnish application is not necessary, which decreases the application time. Patients receive significant preventive benefits with only semiannual varnish applications. Finally, and most importantly, studies show that fluoride varnishes are safe. Effectiveness, application ease, and safety give fluoride varnishes an advantage over other types of topical fluoride treatments, such as gels and rinses. [References: 29] <5> UI - 20352520 AU - Ogaard B IN - Faculty of Dentistry, University of Oslo, Norway. TI - The cariostatic mechanism of fluoride. [Review] [21 refs] SO - Compendium of Continuing Education in Dentistry (Jamesburg, NJ) 1999;20(1 Spec No):10-7; quiz 34 AB - The benefits of using fluoride to prevent caries have been known for many years, but a complete understanding of this mechanism is still being researched. The fluoride concentration in the apatitic structure of enamel does not have as significant an effect on reducing caries as a continuous presence of fluoride in the plaque liquid. Concentrated, topical fluoride agents (such as in toothpaste, fluoride mouth rinses, gels, or varnishes) have a different mechanism of fluoride protection than low-concentration applications (such as fluoridated water). In initial caries lesions and plaque, concentrated agents form globules of a calcium fluoride-like material on the enamel surface. This material is fairly insoluble, possibly because it is coated with phosphates or proteins. This mechanism explains how the topical application of a fluoride varnish, two or three times a year, can result in caries reduction. [References: 21] <6> UI - 20285140 AU - Stickler GB IN - Department of Pediatric and Adolescent Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA. TI - Are yearly physical examinations in adolescents necessary? [see comments]. CM - Comment in: J Am Board Fam Pract 2000 May-Jun;13(3):172-7 SO - Journal of the American Board of Family Practice 2000 May-Jun;13(3):172-7 AB - BACKGROUND: Recommendations regarding the frequency of routine physical examinations for adolescents have varied from one examination every 2 to 3 years to yearly evaluations. Because none of these recommendations was based on studies regarding the usefulness of such examinations, it was pertinent to review the results of published studies. METHODS: All series of routine school and preathletic examinations of adolescents published in the English literature from 1943 to 1995 were reviewed. Only reviews of examinations by physicians with or without supervised health professionals were included. RESULTS: Findings included weight, blood pressure, visual acuity, innocent heart murmurs, scoliosis, referral for further testing, and serious abnormalities unknown before examination. A total of 20,047 examinations by 12 different groups of investigators was abstracted. Only 2 adolescents had major, previously unknown findings: 1 boy was blind in one eye and the other had mitral insufficiency. Elevated blood pressures were found in 0.1% to 1.6% of adolescents. Minor findings included acne, caries, myopia, and minor orthopedic problems, but they did not prevent participation in school or sports. CONCLUSIONS: Yearly physical examinations in adolescents are not cost-effective and have practically no value in finding important pathologic conditions. This conclusion would not apply to sexually active teenagers. The value of an examination for health education or detection of mental problems has never been tested in this population. For entrance to school and camps or for sports participation, the review of a questionnaire and screening examinations by allied health providers should be the method of choice unless future studies justify repeated yearly examination of adolescents. <7> UI - 20257262 AU - Mahomed K AU - Gulmezoglu AM IN - Department of Obstetrics and Gynaecology, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe. kmahomed@healthnet.zw TI - Pyridoxine (vitamin B6) supplementation in pregnancy. [Review] [1 refs] SO - Cochrane Database of Systematic Reviews [computer file] 2000;(2):CD000179 AB - BACKGROUND: Pyridoxine (vitamin B6) contributes to the development of the central nervous system and may influence brain development and cognitive function. It may also prevent dental caries and protect the placental vascular bed. OBJECTIVES: The objective of this review was to assess the effects of vitamin B6 supplementation during pregnancy and labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials of pyridoxine administration compared to a control group. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted by two reviewers. MAIN RESULTS: One trial involving 371 women was included. Pyridoxine supplementation either as oral capsules (odds ratio 0.63, 95% confidence interval 0. 41 to 0.95) or lozenges (odds ratio 0.33, 95% confidence interval 0. 22-0.51) was associated with decreased incidence of dental decay in pregnant women. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate pyridoxine supplementation during pregnancy, although the results of one trial suggest that it may have a beneficial effect on dental decay. [References: 1] <8> UI - 20311250 AU - Iughetti L AU - Marino R AU - Bertolani MF AU - Bernasconi S IN - Department of Paediatrics, University of Modena and Reggio Emilia, Italy. TI - Oral health in children and adolescents with IDDM--a review. [Review] [39 refs] SO - Journal of Pediatric Endocrinology & Metabolism 1999;12(5 Suppl 2):603-10 AB - Children with insulin-dependent diabetes mellitus have a lower salivary flow rate, pH and buffer capacity, but a higher glucose content and peroxidase, IgA, magnesium and calcium concentration, in comparison with healthy children. Nevertheless the incidence of caries is lower than normal in diabetic children with good metabolic control. Periodontal disease usually starts at puberty as mild gingivitis with bleeding and gingival recession, and it may develop into severe periodontitis, especially in children with poor control of diabetes. Microangiopathy, impaired immune response, different bacterial microflora and collagen metabolism are involved in the pathogenesis of diabetic periodontal disease. The gingival flora is mostly composed of Gram-negative, anaerobic bacteria, while collagen has a lower solubility and is atrophic and inadequate to support the occlusion forces. For these reasons, prevention of periodontitis is important in diabetic children; they should receive oral hygiene instruction and visit a dentist at least twice a year. [References: 39] <9> UI - 20305622 AU - Martin-Iverson N AU - Pacza T AU - Phatouros A AU - Tennant M IN - School of Oral Health Sciences, University of Western Australia. TI - Indigenous Australian dental health: a brief review of caries experience. [Review] [17 refs] SO - Australian Dental Journal 2000 Mar;45(1):17-20 AB - The indigenous community in Australia is an at risk population for oral diseases such as dental caries. The majority of communities are isolated and dental services in these areas are limited. Oral hygiene standards are poor and this combined with a diet rich in refined carbohydrates has led to high incidences of dental caries. In addition, diabetes, which is related to obesity (and a diet high in sugar and fat) has been linked to increases in oral disease. Caries prevalence was found to be low in areas where fluoridation levels in the water were high. The fact that the fluoride supplementation appears to improve oral health to a significant degree suggests that implementation of fluoride treatment programmes for school children and, where viable, fluoridation of water sources would be appropriate. In addition, dental education programmes should receive high priority. As with the rest of the community, these preventive measures will result in less need for emergency dental treatment in the future, better oral health for the community and reduced financial burden on the State. It is under these circumstances that oral health planners and providers must, in consultation with the relevant community representatives, develop appropriate mechanisms to address the needs of this group. The development of strategies that integrate with the plethora of general health strategies currently being implemented is just one means of achieving improved oral health outcomes for indigenous Australians. [References: 17] <10> UI - 20305621 AU - Messer LB IN - School of Dental Science, University of Melbourne. TI - Assessing caries risk in children. [Review] [31 refs] SO - Australian Dental Journal 2000 Mar;45(1):10-6 AB - With the dramatic improvements in the oral health of children in Australia that have occurred over the past two decades, the option of, and the need for, targeted prevention of dental caries for those at high risk has become apparent. Since caries is of multifactorial aetiology, the clinical outcome varies depending on which factor, or combination of factors, is prominent in a particular individual; this may be related to both age and stage of life. Tests for caries risk can assist in prediction, but clinical signs and history are as important in assessing the main cause(s) of caries in an individual. In studies involving several factors, past caries experience (especially of the first permanent molar) continues to be the best predictor of future caries in children. Despite their ready availability, tests in the form of commercial kits are still expensive; no one test is an adequate predictor of caries risk, and the specificity and sensitivity of the tests are not reliably diagnostic for an individual. There is a need for regional longitudinal risk assessment studies in which potential risk factors are identified before the onset of caries in order to maximize predictive power and then validated against subsequent caries. Caries activity may not be able to be predicted in a population with low disease prevalence. Any risk assessment strategy must be followed by appropriate preventive interventions. [References: 31] <11> UI - 20291715 AU - Beltran-Aguilar ED AU - Goldstein JW AU - Lockwood SA IN - Surveillance, Investigations and Research Branch, Division of Oral Health, Centers for Disease Control and Prevention, CDC-DOH, Chamblee, Ga. 30341, USA. TI - Fluoride varnishes. A review of their clinical use, cariostatic mechanism, efficacy and safety. [Review] [91 refs] SO - Journal of the American Dental Association 2000 May;131(5):589-96 AB - BACKGROUND: This is a review of the clinical use, cariostatic mechanism, efficacy, safety and toxicity of fluoride varnishes. TYPES OF STUDIES REVIEWED: The authors reviewed and summarized in vitro, in vivo and in situ studies; clinical trials; demonstration programs; position papers; and editorials published in English in the biomedical literature since 1966. RESULTS: Extensive laboratory research and clinical trials conducted in Europe and elsewhere show that fluoride varnishes are as efficacious as other caries-preventive agents. Fluoride varnishes are widely used in European caries-preventive programs. The U.S. Food and Drug Administration has cleared these products only as medical devices to be used as cavity liners and for the treatment of hypersensitive teeth. These products have not yet been cleared for marketing in the United States as caries-preventive agents. CLINICAL IMPLICATIONS: Three fluoride varnishes are currently available in the United States. Semiannual applications are the most proven treatment regimen. Varnishes are safe and easy to apply and set in contact with intraoral moisture. [References: 91] <12> UI - 20308805 AU - Hamilton J TI - Searching for consensus. [Review] [39 refs] SO - CDS Review 1999 Jul-Aug;:20-5 AB - Although caution is expressed by some in relying solely on caries detector dye for diagnosis until more research is done, many aspects of microdentistry are bringing exciting potential to operative dentistry. Perhaps pediatric dentists will find microdentistry the most promising because of its application for long-lasting sealants and less traumatic restorations. To dentistry's benefit, fewer injections and less frequent drilling are predicted to create a whole new generation of nonphobic adults. [References: 39] <13> UI - 20312050 AU - Cox CF AU - Hafez AA AU - Akimoto N AU - Otsuki M AU - Mills JC IN - Department of Biomaterials, University of Alabama School of Dentistry, Birmingham 35294-0007, USA. TI - Biological basis for clinical success: pulp protection and the tooth-restoration interface. [Review] [49 refs] SO - Practical Periodontics & Aesthetic Dentistry 1999 Sep;11(7):819-26; quiz 827 AB - This article provides biological and technological information that strengthens clinicians' understanding of cohesive hybridization and pulp therapy in order to support their routine use of bonding and resin systems. Utilizing cohesive systems, clinicians should experience several advantages over traditional water-soluble base and liner systems. When properly applied, cohesive hybridization of vital dentin prevents immediate postoperative hypersensitivity under all restorations and completely seals the entire tooth-restoration interface, which provides a reduction in recurrent caries. [References: 49] <14> UI - 20308790 AU - Geurtsen W AU - Garcia-Godoy F IN - Department of Conservative Dentistry & Periodontology, Medical University Hannover, Germany. Geurtsen.Werner@mh-Hannover.de TI - Bonded restorations for the prevention and treatment of the cracked-tooth syndrome. [Review] [61 refs] SO - American Journal of Dentistry 1999 Dec;12(6):266-70 AB - Several reports revealed that the cracked-tooth syndrome is a common problem in dental practice, which often results in extraction of the affected incompletely fractured teeth. Predominantly restored teeth suffer from these incomplete fractures. Therefore, it is of outstanding importance to stabilize teeth weakened due to cavity preparation. Besides full cuspal coverage by partial or full crowns, bonded restorations have been proposed for internal splinting of restored teeth. Although contradictory data have been published, there is evidence that bonded amalgam or resin-based composite restorations (RBC) do not increase fracture resistance of teeth with wide occlusal-proximal cavities to values similar to sound, unrestored controls. Indirectly fabricated RBC inlays and various ceramic inlays, however, increased fracture strength to levels as high as those of sound caries-free teeth. Therefore, it is recommended that weakened teeth with wide cavities be strengthened by full cuspal coverage with cast or ceramic restorations, by bonded ceramic inlays, or by indirectly-fabricated bonded RBC composite inlays. [References: 61] <15> UI - 20260257 AU - Mitsunaga T IN - Department of Forest Products, Faculty of Bioresources, Mie University, Tsu, Japan. TI - Anti-caries activity of bark proanthocyanidins. [Review] [33 refs] SO - Basic Life Sciences 1999;66:555-73 <16> UI - 20274759 AU - Liebenberg WH IN - wliebenb@direct.ca TI - Intentional pulp capping: a clinical perspective of the adhesive experience. [Review] [105 refs] SO - Journal of Adhesive Dentistry 1999;1(4):345-63 AB - A new standard of biocompatibility has evolved for dental tissues. This paper attempts to trace the extraordinary transformation of composite resin from dissident to healer. Intentional pulp capping is a logical progression of the adhesive era given the fact that current enamel-dentin bonding systems are biologically acceptable and potentially provide a gap-free therapeutic seal at the restorative interface. The probationary status of the adhesive pulp capping procedure is acknowledged; nevertheless, it is abundantly clear that there is a place for this treatment modality in clinical practice. PURPOSE: The objective of the accompanying pictorial essay is to give a clinical perspective of the author's experience with intentional pulp capping over the past seven years. The focus of this paper is the detailed examination of the clinical variables which influence the quality of the "seal" surrounding the exposed pulpal tissues. [References: 105] <17> UI - 20274725 AU - Deery C IN - Dental Health Services Research Unit, Dundee Dental Hospital and School, UK. c.h.deery@dundee.ac.uk TI - The economic evaluation of pit and fissure sealants. [Review] [41 refs] SO - International Journal of Paediatric Dentistry 1999 Dec;9(4):235-41 AB - This paper reviews the literature relating to the economic evaluation of sealants. Economic issues are commonly cited for lack of sealant utilization, although there are no adequate economic analyses on which to base this belief. The design of much of the existing economic literature regarding sealants is inappropriate, for example many analyses do not consider the advantages of a sound tooth in the calculation of budget. In general the recent literature supports the efficiency and the effectiveness of sealants. However, there is a need for well designed studies, examining modern materials and populations with current caries prevalence. In particular there is a need for well conducted cost-benefit analyses and cost-utility analyses, which should encompass discounting for time and sensitivity analyses. Results from such research would assist clinicians and policy makers alike, in decisions regarding the provision of care with regard to sealant provision at the individual and community level. [References: 41] <18> UI - 20274724 AU - Rolling I AU - Clausen N AU - Nyvad B AU - Sindet-Pedersen S IN - Department of Oral and Maxillo-facial Surgery, Aarhus University and University Hospital, Denmark. TI - Dental findings in three siblings with Morquio's syndrome. [Review] [23 refs] SO - International Journal of Paediatric Dentistry 1999 Sep;9(3):219-24 AB - Three siblings with Morquo's syndrome are described. Cultured fibroblasts from the youngest sibling demonstrated a total absence of N-acethylgalactosamine-6-sulphate-sulphatase whereas beta-galactocidase activity was normal, thus verifying the diagnosis of MPS-IV A. Dental features such as pointed cusps, spade-shaped incisors, thin enamel and pitted buccal surfaces were observed in all three children. Furthermore, in all three siblings the TMJ was affected with severe resorption of the head of the condyle. Histological examination of exfoliated primary molars showed a band of increased porosity following the striae of Retzius in the outer part of the enamel. These developmental disturbances were occasionally associated with minor localized defects in the enamel surface. The importance of close monitoring of dental development and regular dental care in order to prevent attrition of the teeth, loss of vertical face height and subsequent risk of TMJ dysfunction is emphasized. [References: 23] <19> UI - 20204944 AU - Wenzel A IN - Department of Oral Radiology, Royal Dental College, University of Aarhus, Denmark. awenzel@odont.au.dk TI - Digital imaging for dental caries. [Review] [88 refs] SO - Dental Clinics of North America 2000 Apr;44(2):319-38, vi AB - Laboratory studies show that digital intraoral radiography systems are as accurate as dental film for the detection of caries when a good-quality image is obtained, although more re-takes might be necessary because of positioning errors with the digital systems, particularly the charge-coupled device sensors. The phosphor plate is more comfortable for the patient than nondigital systems, and the dose can be further reduced with the storage phosphors. Cross-contamination does not pose a problem with digital systems if simple hygiene procedures are observed. [References: 88] <20> UI - 20236898 AU - Stephen KW IN - Dental Public Health Unit, University of Glasgow Dental School, Scotland. TI - Fluoride prospects for the new millennium--community and individual patient aspects. [Review] [47 refs] SO - Acta Odontologica Scandinavica 1999 Dec;57(6):352-5 AB - Over the past 2 decades, it has been suggested that with the generalized availability of fluoridated dentifrices, and coupled with a possible increased likelihood of fluorosis, the benefits of community-based fluoridation have receded. However, while this may be so for dentally motivated populations, there are convincing data to suggest that the least fortunate amongst us could still benefit from communally delivered fluoride. Furthermore, the deleterious effects of such program withdrawals have been demonstrated and, with respect to fluorosis fears, client assessment of their own fluorosis status has indicated few concerns. Alternative, centrally delivered means of fluoride dispensing, e.g. via schools, etc., although effective in the short-term, are impractical over longer time-spans. Nonetheless, at the individual level, fluoride supplements and dentifrices, in particular, are successful caries inhibitors. This is especially so if these vehicles are employed in their most effective, proven manners. Finally, fears relating to disfiguring fluorosis should be allayed, but where fluoride abuses result in mild mottling, a simple remineralizing technique obviates the need for traumatic restorative procedures. [References: 47] <21> UI - 20236895 AU - Clasen AB AU - Ogaard B IN - Department of Cariology, Faculty of Dentistry, University of Oslo, Norway. TI - Experimental intra-oral caries models in fluoride research. [Review] [81 refs] SO - Acta Odontologica Scandinavica 1999 Dec;57(6):334-41 AB - The use of experimental intra-oral caries models has increased in fluoride research. This paper focuses on the pre-clinical intra-oral models, the in situ and in vivo models, the various types, their benefits and disadvantages. Both preparation and sterilization of the hard tissue substrates can affect the substrates and therefore the results. Care needs to be taken that dentine samples are not exposed to drying and consequently shrinking during preparation and evaluation. Sterilization by gamma-radiation is at present the least tissue-damaging method. The most realistic experimental model is the in vivo model, followed by the in situ model using specimens with natural surfaces. The most accurate and direct evaluation technique for demineralization and remineralization studies is quantitative transversal microradiography, whereas confocal laser scanning microscopy (CLSM) is the most sensitive qualitative evaluation technique. Other evaluation techniques discussed are microhardness testing and the iodine permeability test. In light of the present skewed caries situation in western countries we suggest that fluoride research focuses on experimental caries models that can mimic severe cariogenic challenge. Testing of fluoride combinations and dosages that can prevent lesion development rather than promote remineralization would then be a practical consequence. [References: 81] <22> UI - 20236893 AU - ten Cate JM IN - Academic Centre for Dentistry Amsterdam (ACTA), Department of Cariology, Endodontology, Pedodontology, The Netherlands. JM.ten.Cate@acta.nl TI - Current concepts on the theories of the mechanism of action of fluoride. [Review] [32 refs] SO - Acta Odontologica Scandinavica 1999 Dec;57(6):325-9 AB - The caries-preventive effect of fluoride is mainly attributed to the effects on demineralization/remineralization at the tooth oral fluids interface. Sub ppm levels of fluoride in saliva are effective in shifting the balance from demineralization, leading to caries, to remineralization. This is attributed to the fluoride-enhanced precipitation of calcium phosphates, and the formation of fluorhydroxyapatite in the dental tissues. Low fluoride levels are found in saliva after toothbrushing with fluoride containing dentifrices. Similar concentrations are ineffective in interfering with processes of growth and metabolism of bacteria, and also do not result in a significantly reduced dissolution of tooth mineral as a result of (firmly bound) fluoride incorporation. Comparative studies of fluoride efficacy have shown that higher concentrations in solution are needed in pH-cycling studies of dentine than in enamel to maintain the mineral balance or to induce remineralization. This is attributed to the greater solubility of the dentine and the smaller size of the dentine crystallites compared to enamel. Fluoride slow-release devices, in the form of fluoride-releasing restorative materials, may serve to increase the fluoride levels in saliva and plaque to levels at which caries can be prevented, also in high-risk patients. Research questions for the next millennium and future perspectives for fluoride applications should be found in the retention and slow release of fluoride after various combinations of fluoride treatment, the combination of fluoride and anti-microbial treatment, the individualization of caries prevention, and the combination of preventive schemes with new developments in caries diagnosis. [References: 32] <23> UI - 20215945 AU - Matear DW IN - Baycrest Department of Geriatric Dentistry, Baycrest Centre for Geriatric Care, North York, Ontario. TI - Demonstrating the need for oral health education in geriatric institutions. [Review] [67 refs] SO - Probe 1999 Mar-Apr;33(2):66-71 AB - OBJECTIVES: This review paper discusses the need for an educational component of a preventive oral health care program in geriatric institutions. The content of an education component that can improve the awareness of health care professionals in geriatric institutions with respect to the positive relationship of good oral health to good general health, thereby motivating them to provide adequate oral care, is investigated. METHODS: A literature review was conducted of the following areas: dental health education in nurse training; dental care for the elderly; prevention of dental caries, periodontal diseases and oral cancer; oral hygiene; nursing homes; long-term care facilities, and homes for the aged. The search was conducted through Medline from 1966 to 1998. RESULTS: Overall, there is little information and agreement about the content and structure of oral health education programs in geriatric institutions, although information exists with respect to the effectiveness of methods of oral hygiene and the efficacy of oral care agents. The oral health care needs of the institutionalized elderly are not being met due to health care professionals' demanding workload, a lack of knowledge of the importance of oral health care and apathy, or lack of interest, towards the practical application of oral health care principles. CONCLUSIONS: There is a need to educate all stakeholder groups, including health care professionals, in the importance of mouth care for elderly clients. Dental professionals working in geriatric care should address this need by implementing a preventive oral health care program consisting, not only of examinations and preventive care, but also of an educational component for the allied health care professionals and members of the patient's family. The ultimate goal is for the medical and dental professionals and caregivers to collaborate with an integrated approach to preventing oral disease, thereby improving overall health and quality of life for the institutionalized elderly. [References: 67] <24> UI - 20215925 AU - Duncan TB AU - Duncan WK AU - De Ball S TI - Fluoride: a review--Part II: Topical fluorides. [Review] [29 refs] SO - Mississippi Dental Association Journal 1999 1st Quarter;55(1):34-6 AB - Fluoride therapy continues to be the best defense in the battle against dental caries. The decision to utilize topical fluorides is no longer age dependent. Changing disease patterns require dentists to critically evaluate the caries risk of each patient and develop a fluoride treatment plan based upon the needs of the individual patient. A variety of professional and self-applied fluoride products are available and new fluoride delivery systems have recently entered the market. A critical review of literature, combined with an understanding of the advantages and disadvantages of each topical fluoride system will assist the dentist in selecting the product best suited for each patient. [References: 29] <25> UI - 20168176 AU - Iughetti L AU - Marino R AU - Bertolani MF AU - Bernasconi S IN - Department of Paediatrics, University of Modena and Reggio Emilia, Italy. TI - Oral health in children and adolescents with IDDM--a review. [Review] [39 refs] SO - Journal of Pediatric Endocrinology & Metabolism 1999 Sep-Oct;12(5):603-10 AB - Children with insulin-dependent diabetes mellitus have a lower salivary flow rate, pH and buffer capacity, but a higher glucose content and peroxidase, IgA, magnesium and calcium concentration, in comparison with healthy children. Nevertheless the incidence of caries is lower than normal in diabetic children with good metabolic control. Periodontal disease usually starts at puberty as mild gingivitis with bleeding and gingival recession, and it may develop into severe periodontitis, especially in children with poor control of diabetes. Microangiopathy, impaired immune response, different bacterial microflora and collagen metabolism are involved in the pathogenesis of diabetic periodontal disease. The gingival flora is mostly composed of Gram-negative, anaerobic bacteria, while collagen has a lower solubility and is atrophic and inadequate to support the occlusion forces. For these reasons, prevention of periodontitis is important in diabetic children; they should receive oral hygiene instruction and visit a dentist at least twice a year. [References: 39] <26> UI - 20162490 AU - Trevisanato SI AU - Kim YI IN - Banting and Best Institute of Medical Research, University of Toronto, ON, Canada. TI - Tea and health. [Review] [72 refs] SO - Nutrition Reviews 2000 Jan;58(1):1-10 AB - Tea is a pleasant, popular, socially accepted, economical, and safe drink that is enjoyed every day by hundreds of millions of people across all continents. Tea also provides a dietary source of biologically active compounds that help prevent a wide variety of diseases. It is the richest source of a class of antioxidants called flavonoids and contains many other beneficial compounds such as vitamins and fluoride. A growing body of evidence suggests that moderate consumption of tea may protect against several forms of cancer, cardiovascular diseases, the formation of kidney stones, bacterial infections, and dental cavities. Future research needs to define the actual magnitude of health benefits, establish the safe range of tea consumption associated with these benefits, and elucidate potential mechanisms of action. [References: 72] <27> UI - 20138338 AU - Erdem TL AU - Ozcan I AU - Ilguy D AU - Sirin S IN - Faculty of Dentistry, Department of Oral Diagnosis and Radiology, University of Istanbul, Istanbul, Turkey. tlerdem@instanbul.edu.tr TI - Hereditary sensory and autonomic neuropathy: review and a case report with dental implications. [Review] [8 refs] SO - Journal of Oral Rehabilitation 2000 Feb;27(2):180-3 AB - Hereditary sensory and autonomic neuropathy (HSAN) is a rare syndrome which is seen in early childhood. Five different types are described. Absence of pain and self-mutilation are characteristic findings of this syndrome. Teeth in the oral cavity can cause damage to the oral tissues and tongue. When it is diagnosed, there should be co-operation between dentist and neurologist. Using an oral shield prevents the biting and, thus, traumatization of the tissues can be prevented. A case report which is diagnosed as HSAN type 4 is presented and information submitted about its treatment. [References: 8] <28> UI - 20162073 AU - Frame PS AU - Sawai R AU - Bowen WH AU - Meyerowitz C IN - Tri-County Family Medicine, Cohocton, New York 14826, USA. TI - Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines. [Review] [16 refs] SO - American Journal of Preventive Medicine 2000 Feb;18(2):159-62 AB - INTRODUCTION: The purpose of this article is to compare published evidence supporting procedures to prevent dental caries and periodontal disease, in low-risk patients, with the actual preventive recommendations of practicing dentists. METHODS: Methods included (1) a survey questionnaire of general dentists practicing in western New York State concerning the preventive procedures they would recommend and at what intervals for low-risk children, young adults, and older adults; and (2) review of the published, English-language literature for evidence supporting preventive dental interventions. RESULTS: The majority of dentists surveyed recommended semiannual visits for visual examination and probing to detect caries (73% to 79%), and scaling and polishing to prevent periodontal disease (83% to 86%) for low-risk patients of all ages. Bite-wing radiographs were recommended for all age groups at annual or semiannual intervals. In-office fluoride applications were recommended for low-risk children at intervals of 6 to 12 months by 73% of dentists but were recommended for low-risk older persons by only 22% of dentists. Application of sealants to prevent pit and fissure caries was recommended for low-risk children by 22% of dentists. Literature review found no studies comparing different frequencies of dental examinations and bite-wing radiographs to determine the optimal screening interval in low-risk patients. Two studies of the effect of scaling and polishing on the prevention of periodontal disease found no benefit from more frequent than annual treatments. Although fluoride is clearly a major reason for the decline in the prevalence of dental caries, there are no studies of the incremental benefit of in-office fluoride treatments for low-risk patients exposed to fluoridated water and using fluoridated toothpaste. CONCLUSIONS: Comparative studies using outcome end points are needed to determine the optimal frequency of dental examinations and bite-wing radiographs for the early detection of caries, and of scaling and polishing to prevent periodontal disease in low-risk persons. There is no scientific evidence that dental examinations, including scaling and polishing, at 6 month intervals, as recommended by the dentists surveyed in this study, is superior to annual or less frequent examinations for low-risk populations. There is also no evidence that in-office fluoride applications offer incremental benefit over less costly methods of delivering fluoride for low-risk populations. [References: 16] <29> UI - 20174317 AU - Staehle HJ IN - Department of Operative and Preventive Dentistry, Ruprecht-Karls University, Heidelberg, Germany. hans-joergstaehle@med.uni-heidelberg.de TI - Minimally invasive restorative treatment. [Review] [30 refs] SO - Journal of Adhesive Dentistry 1999;1(3):267-84 AB - Minimally invasive restorative treatment implements need-, damage-, and risk-balanced dental care while ensuring that the ends and means are reconciled. Using examples from initial treatment of carious lesions, maintenance and correction of existing restorations, treatment of traumatic damage, and direct color and form correction of teeth, a preventively offensive and restoratively defensive treatment concept is presented. Such a concept demands of the dentist greater diagnostic efforts and more highly differentiated employment of invasive treatment methods. Demands on the patients are greater as well: they must be willing to comply with regular post-treatment examinations. In return, one receives the option of minimizing the sacrifice of maintainable hard tooth structures and avoiding extensive, large-scale dental procedures. [References: 30] <30> UI - 20146916 AU - Burt BA IN - Program in Dental Public Health, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA. bburt@umich.edu TI - The case for eliminating the use of dietary fluoride supplements for young children. [Review] [72 refs] SO - Journal of Public Health Dentistry 1999 Fall;59(4):269-74 AB - Fluoride supplements have been used for years to prevent dental caries; nevertheless, there are three reasons why their use is inappropriate today among infants and young children in the United States. Evidence for the efficacy of fluoride supplements when used from birth or soon after is weak, supplements are a risk factor for dental fluorosis, and fluoride has little preeruptive effect in caries prevention. While there are many reports on the caries-preventive efficacy of supplements, few meet standards for acceptability as clinical trials, and those that do have tested chewable tablets or lozenges under supervision in school-aged children. North American children today are exposed to fluoride from many sources--drinking water, toothpaste, gels, rinses, and in processed foods and beverages. The additional cariostatic benefits that accrue from using supplements are marginal at best, while there is strong risk of fluorosis when young children use supplements. Available evidence suggests that the public is more aware of the milder forms of fluorosis than was previously thought; thus, it is prudent for caries-preventive policies to aim to maximizing caries reductions while minimizing the risk of fluorosis. It is therefore concluded that the risks of using supplements in infants and young children outweigh the benefits. Because alternative forms of fluoride for high-risk individuals exist, fluoride supplements should no longer be used for young children in North America. [References: 72] <31> UI - 20121580 AU - Mochizuki K AU - Yonezu T AU - Yakushiji M AU - Machida Y IN - Department of Pediatric Dentistry, Tokyo Dental College, Chiba, Japan. TI - The fusion of three primary incisors: report of case. [Review] [26 refs] SO - ASDC Journal of Dentistry for Children 1999 Nov-Dec;66(6):421-5, 367 AB - The occurrence of a fusion of three primary incisors is rare. A two-year-old Japanese girl was brought to the pediatric dental outpatient clinic, Tokyo Dental College, to receive a caries-prevention treatment. The fused tooth consisted of the maxillary primary central incisors and right maxillary lateral incisor. Primary left lateral incisor erupted normally and the other primary teeth were erupted. The radicular pulp chambers were fused into one for three fourths of the length from the apex, and only one root. The hair and skin of the patient appeared normal and no systemic abnormality or congenital disease was noted in the medical history of the patient and her family. The occurrence of a three-tooth fusion, and no supernumerary tooth was confirmed. [References: 26] <32> UI - 20152089 AU - Wynn RL AU - Meiller TF AU - Crossley HL IN - Department of Oral Medicine and Diagnostic Sciences, Dental School, University of Maryland at Baltimore, USA. TI - Tobacco "plantibodies" for caries prevention. [Review] [25 refs] SO - General Dentistry 1999 Sep-Oct;47(5):450-4 <33> UI - 20132676 AU - Gales MA AU - Nguyen TM IN - Department of Pharmacy Practice, School of Pharmacy, Southwestern Oklahoma State University, Weatherford, USA. TI - Sorbitol compared with xylitol in prevention of dental caries. [Review] [16 refs] SO - Annals of Pharmacotherapy 2000 Jan;34(1):98-100 AB - OBJECTIVE: To summarize published data on the comparative efficacy of sorbitol and xylitol for prevention of dental caries. DATA SOURCES: Published double-blind comparative trials, using sorbitol and xylitol products, identified by MEDLINE (January 1966-December 1998) and International Pharmaceutical Abstracts (January 1970-December 1998) searches. DATA SYNTHESIS: Clinical trials generally used sorbitol and xylitol gums, which patients chewed three to five times daily for 20-40 months. Xylitol was superior to sorbitol in two longer, secondary dentition trials (30-63% reductions), but not in two primary dentition trials. CONCLUSIONS: The data suggest that xylitol-containing gums may provide superior efficacy in reducing caries rates in high-risk populations. [References: 16] <34> UI - 20113839 AU - Ismail AI AU - Sohn W IN - School of Dentistry, University of Michigan, Ann Arbor 48109-1078, USA. ismailai@umich.edu TI - A systematic review of clinical diagnostic criteria of early childhood caries. SO - Journal of Public Health Dentistry 1999 Summer;59(3):171-91 AB - OBJECTIVE: This paper reviews case definitions and clinical diagnostic criteria of early childhood caries (ECC) and severe ECC (S-ECC) in children aged 1 to 5 years old. The acronym S-ECC as used in this paper refers to nursing caries, baby bottle tooth decay, rampant caries, labial caries, maxillary anterior caries, and other terms used to refer to severe dental caries in preschool children. METHODS: A search was carried out for articles published in peer-reviewed journals and indexed in MEDLINE using the following terms: nursing caries, baby bottle tooth decay, early childhood caries, rampant caries in preschool children, labial caries, maxillary anterior caries, and nursing bottle caries. MEDLINE's MeSH terms "dental caries" and "deciduous teeth" were used to search for other relevant studies. Reports were selected if they included children 1 to 5 years of age and described diagnostic criteria or case definitions of S-ECC. Three previous reviews were searched for other relevant reports. One unpublished report was included in this review and data from NHANES III were analyzed to provide information on caries patterns in preschool children in the United States. The first author read all the abstracts from the MEDLINE search and tagged relevant reports for photocopying. He also abstracted all the information from the reports. The first author calibrated the second author, who independently read all included and excluded reports. Disagreements were resolved by consensus. RESULTS: Out of 126 studies, 32 were excluded and 94 (93 published and 1 unpublished) were included in this review. Eighty-one of the 94 published studies were cross-sectional surveys or clinical studies, 7 were case-control clinical studies, 2 studies were controlled clinical trials, and 4 were cohort or field trials. About two-thirds of the included studies did not report on calibration of examiners. Information on reliability of examiners was reported by 19 of the 94 studies. The included studies varied widely in the name used to identify S-ECC, case definitions, and diagnostic criteria. "Cavitation" was the most common criterion used to define dental caries. Several studies measured early or noncavitated carious lesions. Twenty-seven studies used the presence of 1 dmf maxillary incisor to classify a child with S-ECC. Another 23 and 9 studies defined S-ECC by the presence of 2+ or 3+ dmf maxillary incisors, respectively. Dental caries in preschool children clusters in pits and fissures and on smooth tooth surfaces of primary molars and maxillary incisors. CONCLUSIONS: This review found a wide variation in the case definitions and diagnostic criteria used to diagnose ECC or define S-ECC. Dental caries in the maxillary incisors is one of several patterns of dental caries that may occur in primary teeth of preschool children. A consensus is needed on case definitions and diagnostic criteria that can assist researchers to test preventive interventions and study the etiology and epidemiology of ECC. <35> UI - 20113834 AU - Crall JJ AU - Szlyk CI AU - Schneider DA IN - Department of Pediatric Dentistry, University of Connecticut Health Center, Farmington 06030-1610, USA. crall@nso.uchc.edu TI - Pediatric oral health performance measurement: current capabilities and future directions. SO - Journal of Public Health Dentistry 1999 Summer;59(3):136-41 AB - This paper offers an overview of performance measurement in health care, provides a synopsis of the findings and recommendations of an Oral Health Expert Panel organized by the National Committee for Quality Assurance (NCQA) under contract with the Health Care Financing Administration (HCFA), and discusses challenges and possible future directions for pediatric oral health care performance measures development. Existing performance measures for pediatric oral health care are extremely limited; however, several new measures have been proposed and are in various stages of development and testing. Measures capable of being implemented in the short-term focus on access and use of services, rely on administrative data sources, and represent refinements and enhancements of current measures. Measures proposed for future implementation focus more on the effectiveness of care, consumer assessments of care and plan performance, and the value of services provided to enrolled children. Recommendations are targeted toward high-risk children who, for the most part, are covered by public programs (e.g., Medicaid and the Children's Health Insurance Program). Nevertheless, the entire set of recommended measures is considered to be relevant to all pediatric populations and applicable to all forms of dental care coverage, including state-administered programs and commercial third party arrangements. <36> UI - 20110277 AU - Kay E AU - Locker D IN - University Dental School of Manchester, UK. TI - A systematic review of the effectiveness of health promotion aimed at improving oral health. SO - Community Dental Health 1998 Sep;15(3):132-44 AB - OBJECTIVE: To examine the quality of oral health promotion research evidence and to assess the effectiveness of health promotion, aimed at improving oral health using a systematic and scientifically defensible methodology. BASIC RESEARCH DESIGN: Systematic review of oral health promotion research evidence using electronic searching, iterative hand-searching, critical appraisal and data synthesis. CLINICAL SETTING: The settings of the primary research reviewed were clinical, community, schools or other institutions. The participants were children, the elderly, adults and people with handicaps and disabilities. INTERVENTIONS: Only studies which reported an evaluative component were included. Theoretical and purely descriptive papers were excluded. MAIN OUTCOME MEASURES: The review examined the evidence of effectiveness of oral health promotion on caries, oral hygiene, oral health related knowledge, attitudes and behaviours. RESULTS: Very few definitive conclusions about the effectiveness of oral health promotion can be drawn from the currently available evidence. Caries and periodontal disease can be controlled by regular toothbrushing with a fluoride toothpaste but a cost-effective method for reliably promoting such behaviour has not yet been established. Knowledge levels can almost always be improved by oral health promotion initiatives but whether these shifts in knowledge and attitudes can be causally related to changes in behaviour or clinical indices of disease has also not been established. CONCLUSIONS: Oral health promotion which brings about the use of fluoride is effective for reducing caries. Chairside oral health promotion has been shown to be effective more consistently than other methods of health promotion. Mass media programmes have not been shown to be effective. The quality of oral health promotion evaluation research needs to be improved. <37> UI - 20101371 AU - Steinberg D AU - Friedman M IN - Department of Oral Biology, Faculty of Dentistry, Hebrew University-Hadassah, Jerusalem, Israel. TI - Dental drug-delivery devices: local and sustained-release applications. [Review] [133 refs] SO - Critical Reviews in Therapeutic Drug Carrier Systems 1999;16(5):425-59 AB - Dental diseases are among the most prevalent illnesses in humans. Many pharmaceutical dosage forms are used to prevent and treat these diseases. Toothpastes and mouthwashes are two of the most popular dental medicaments. A local delivery application that prolongs the release of the drug in the mouth offers great advantages in preventing and treating caries and periodontal diseases. Sustained-release devices are a relatively new concept in dentistry. This paper describes several types of sustained-release devices that are available commercially or are in the premarketing stage. [References: 133] <38> UI - 20103524 AU - Petti S AU - Bossa MC AU - Tarsitani G AU - Falcolini G AU - Lumbau A AU - Campus G IN - G. Sanarelli Hygiene Institute, La Sapienza University, Rome. TI - Variables affecting salivary Streptococcus mutans counts in a cohort of 12-year-old subjects. [Review] [31 refs] SO - Minerva Stomatologica 1999 Sep;48(9):361-6 AB - BACKGROUND: Several factors such as toothbrushing, diet, acidogenic potential of the mutans streptococci strain and site of the carious lesion can modify the salivary Streptococcus mutans (Sm) counts. In the present investigation the effect of some behavioural, clinical and microbiological variables on Sm salivary counts was evaluated in a cohort of 12-year-olds. METHODS: Forty subjects were examined by two calibrated examiners (GC, AL). The number of surfaces either decayed occlusal, decayed smooth or filled and the number of bleeding sextants, (clinical index for oral hygiene) were reported. Saliva was collected using a tongue depressor and was plated onto mitis salivarius agar with bacitracin and 20% sucrose. The presumptive Sm colonies were counted and the concentrations were logarithmically transformed. One Sm strain per subject was identified and the cariogenic potential evaluated as the minimum pH value recorded, during 5 hrs of incubation in 5% sucrose solution. The children's parents or guardians completed a questionnaire concerning the frequency of toothbrushing, the consumption of sweet foods and soft drinks and at what age the children started brushing their teeth. The effect of the explanatory variables on Sm count logarithms was evaluated by stepwise multiple regression. RESULTS: The regressors with significant additional explanatory power were cariogenic potential (b = -1.335, p = 0.00001, R2 increment = 0.312), decayed smooth surfaces (b = -0.456, p = 0.009, R2 increment = 0.114) and bleeding sextants (b = -0.113, p = 0.004, R2 increment = 0.062), whereas the power of filled surfaces was marginally significant (p = 0.08). CONCLUSIONS: On the basis of these results, it is suggested that acidogenicity is not only a cariogenic factor, but also a factor promoting colonization of oral sites by Sm, especially in subjects with a high frequency of sugar consumption. [References: 31] <39> UI - 20067229 AU - Eklund SA IN - Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor 48109, USA. TI - Changing treatment patterns. SO - Journal of the American Dental Association 1999 Dec;130(12):1707-12 AB - BACKGROUND AND OVERVIEW: Patterns of clinical care are closely linked to the nature of diseases in the population. During the past decade, the nature of both dental caries and periodontitis has undergone a transformation that has implications for dental practice. Especially in younger cohorts, the overall need for extensive restorative and periodontal treatment is much reduced, compared with that of prior generations. CONCLUSIONS: Over the next several decades, there will be a slowly declining per-capita need for restorative and surgical care. The overall mix of services will continue to shift toward diagnostic and preventive services. PRACTICE IMPLICATIONS: At least in terms of today's conventional dental care, each provider in the future should be able to manage the oral health care needs of larger numbers of patients than is possible today. <40> UI - 20106769 AU - Sanchez OM AU - Childers NK IN - University of Alabama School of Dentistry, Birmingham 35294-0007, USA. TI - Anticipatory guidance in infant oral health: rationale and recommendations. [Review] [31 refs] SO - American Family Physician 2000 Jan 1;61(1):115-20, 123-4 AB - If appropriate measures are applied early enough, it may be possible to totally prevent oral disease. The American Academy of Pediatric Dentistry recommends that infants be scheduled for an initial oral evaluation within six months of the eruption of the first primary tooth but by no later than 12 months of age. The rationale for this recommendation is provided, although the recommendation itself is not universally accepted. Specific recommendations include elimination of bottles in bed, early use of soft-bristled toothbrushes (with parental supervision) and limitation of high-carbohydrate food intake after teeth have been brushed. [References: 31] <41> UI - 20101192 AU - Osborne JW AU - Lopez Howell M IN - Department of Restorative Dentistry, University of Colorado, Denver 80262, USA. john.osborne@uchsc.edu TI - Marshall H. Webb and extension for prevention: a literature review. [Review] [48 refs] SO - Quintessence International 1999 Jun;30(6):399-403 AB - Dr Marshall Webb (1844-1883), author, lecturer, debater, clinician, inventor, and dentist extraordinaire, was a decade ahead of others in putting forth a concept of "extension for prevention." One hundred twenty years ago, he was one of the best known, most advanced, and highly regarded dentists in the world. His pioneering work in cardiology, preventive dentistry, ethics, and prevention of recurrent decay raised the standards of what we call operative or conservative dentistry, but he is almost unknown now. However, his concept of conservative tooth preparation could be applied today. [References: 48] <42> UI - 20101038 AU - Stephen M IN - New York University, USA. TI - The role of diet, fluoride and saliva in caries prevention. [Review] [12 refs] SO - Journal of the Indian Society of Pedodontics & Preventive Dentistry 1997 Dec;15(4):109-13 AB - Saliva is rich in calcium and phosphates, facilitating remineralization of early carious lesions. There is evidence that remineralization is associated with an increase in the size of enamel crystals and a consequent increase in resistance to caries. The contribution of sucrose to the implantation, colonization and metabolic activities of cariogenic bacteria has been clearly established, and has led to the search for sucrose substitutes. Recent report from Australia and the United States of America have reconfirmed the safety and efficacy of fluoride in preventing dental caries. The use of fluoride in various forms thus remains the cornerstone of most caries prevention programme. [References: 12] <43> UI - 20046074 AU - Johnson BS IN - Department of Restorative/Hospital Dentistry, University of Washington School of Dentistry, Seattle, USA. TI - Principles and practice of antibiotic therapy. [Review] [42 refs] SO - Infectious Disease Clinics of North America 1999 Dec;13(4):851-70, vi-vii AB - The oral cavity and surrounding structures harbor an extremely complex array of microorganisms. As a result, when structures become acutely or chronically infected, diseases can present very differently. Surgical and pharmacologic management decisions become equally complex, depending on the source site of the infection and the areas to which it spreads. This article first reviews the various domains of the oral and maxillofacial structures, and then reviews each class of antibiotics, describing how the antibiotics are likely to be used. [References: 42] <44> UI - 20060145 AU - Bergman MA TI - The clinical performance of ceramic inlays: a review. [Review] [128 refs] SO - Australian Dental Journal 1999 Sep;44(3):157-68 AB - The availability of improved ceramic materials, bonding techniques, new technology and issues of amalgam safety have led to a revival of interest in ceramic inlays in dentistry over the past ten years. Clinical studies have been carried out during this time using various evaluation techniques to assess the clinical performance of these restorations. In this paper, recent clinical studies are examined and a review of the current state of knowledge regarding the clinical performance and survival statistics of ceramic inlays is presented. The major problems associated with ceramic inlay therapy appear to be fracture, hypersensitivity, degree of fit, maintenance of marginal integrity, microleakage, bond failures and cement wear. Other areas which also affect the clinical performance of ceramic inlays are ceramic wear, opposing tooth wear, plaque accumulation, gingivitis, secondary caries, colour stability, anatomic form and radiopacity. Recommendations based on the findings of clinical studies are also presented and whilst no specific material or technique has been shown to be clearly superior, certain principles which predispose to success can be identified. When compared with other forms of aesthetic intracoronal restorations, ceramic inlays perform well. However, their high cost and extreme technique sensitivity would appear to restrict their use to certain limited clinical situations. [References: 128] <45> UI - 20067063 AU - Holmgren CJ AU - Frencken JE IN - Faculty of Dentistry, The University of Hong Kong, Hong Kong. holmgren@club-internet.fr TI - Painting the future for ART. [Review] [20 refs] SO - Community Dentistry & Oral Epidemiology 1999 Dec;27(6):449-53 AB - The objective of this paper is to review recent research and developments with respect to the atraumatic restorative treatment (ART) approach and to outline future areas of research and development. Areas identified as requiring further investigation include the evaluation of: ART restorations for longer than 3 years duration using recognised evaluation criteria, multi-surface ART restorations, ART restorations in primary teeth and ART sealants. In addition, the possibility and potential dangers of caries remaining after cavity cleaning with hand instruments must be investigated and the findings balanced against the known damage to sound tooth tissue caused by more routine cavity preparation techniques. New bioactive restorative materials which offer the possibility of healing dentinal caries lesions should be developed and evaluated. Finally, behavioural and educational aspects of the ART approach should be investigated. [References: 20] <46> UI - 20067062 AU - Anusavice KJ IN - Department of Dental Biomaterials, University of Florida, Gainesville 32610-0446, USA. kanusavice@dental.ufl.edu TI - Does ART have a place in preservative dentistry?. [Review] [17 refs] SO - Community Dentistry & Oral Epidemiology 1999 Dec;27(6):442-8 AB - The ART technique consists of hand excavating carious tissue and placing a highly viscous glass ionomer cement as a restoration material and as a sealant. Although the results of several studies are promising, the retention rates of these restorations for primary teeth are not impressive. Materials and methods that yield greater success rates are needed to improve long-term caries management outcomes. In principle, ART should yield outcomes similar to those associated with preservative dentistry, including the potential for minimal surgical intervention, conservation of sound tooth structure, avoidance of pain and need for local anesthetic injections, reduced risk for subsequent endodontics and tooth extraction, and increased survival time of the affected teeth. The ideal direct-filling ART material would be biocompatible and tooth colored; "forgiving" in its handling properties; insensitive to moisture or desiccation; hardenable without special equipment; able to form stable bonds to enamel and dentin; able to seal marginal gaps against bacteria; capable of releasing fluoride or remineralization and antibacterial agents when demineralization is most likely; and resistant to chemical attack. The highly viscous glass ionomer materials currently used for ART meet several of this criteria, though they may be deficient in their ability to seal marginal gaps against bacteria and in their sensitivity to desiccation. Furthermore, although they release fluoride over the lifetime of the restoration, this fluoride release alone may not prevent caries progression in all cases. It is necessary for cases of high caries risk to use chlorhexidine in conjunction with fluoride to achieve caries arrest and remineralization of adjacent areas of the affected teeth. Thus, while the ART technique offers some benefits in restoring function and reducing the rate of caries progression, it is unlikely that current materials will be able to arrest caries progression completely in high-risk persons. [References: 17] <47> UI - 20067061 AU - Weerheijm KL AU - Groen HJ IN - Department of Cariology Endodontology Pedodontology, ACTA, Amsterdam, The Netherlands. k.weerheijm@acta.nl TI - The residual caries dilemma. [Review] [33 refs] SO - Community Dentistry & Oral Epidemiology 1999 Dec;27(6):436-41 AB - Restorative dentistry is based on the assumption that bacterial infection of demineralized dentine should prompt operative intervention. One of the concepts of practical dentistry is to create a favourable environment for caries arrest with minimal operative intervention. The progress of remaining primary caries is key to any discussion of this concept. This discussion is important for the atraumatic restorative treatment (ART) approach, since the removal of all carious dentine is sometimes difficult using hand instruments only. In this paper the results of possible measures to guard against the effects of residual carious and its consequences are reviewed, in order to obtain an impression of the justification for (in)complete excavation of occlusal dentinal caries. Three types of measure are considered: isolating the caries process from the oral environment, excavating the carious dentine, and using a cariostatic filling material. Each of these measures contributes to the arrest of the caries process. However, none of these measures can arrest this process by itself. A combination of all three seems necessary. It is concluded that although residual caries does not seem to be the criterion for rerestoration, one has to strive for as complete caries removal as possible. If this cannot be fulfilled the sealing capacities of the filling material seem to be more important than its cariostatic properties. [References: 33] <48> UI - 99365535 AU - Warren JJ AU - Levy SM IN - Department of Preventive & Community Dentistry, College of Dentistry, University of Iowa, USA. TI - A review of fluoride dentifrice related to dental fluorosis. [Review] [53 refs] SO - Pediatric Dentistry 1999 Jul-Aug;21(4):265-71 AB - Introduced to the commercial market 40 years ago, fluoride dentifrice now accounts for nearly all dentifrice purchased in the United States. During this same time, the prevalence and severity of dental caries has declined while dental fluorosis prevalence has increased. While the caries decline can be largely attributed to widespread fluoride dentifrice use, as well as many other sources of fluoride, several recent studies have attributed much of the increase in fluorosis prevalence to early use of fluoride dentifrice. This paper reviews these studies, as well as the efficacy of fluoride dentifrices with lower fluoride concentrations. Finally, recommendations regarding fluoride dentifrice to maintain caries prevention and reduce the risk of dental fluorosis are presented. [References: 53] <49> UI - 99346238 AU - Harris PJ AU - Ferguson LR IN - School of Biological Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand. l.ferguson@auckland.ac.nz TI - Dietary fibres may protect or enhance carcinogenesis. [Review] [120 refs] SO - Mutation Research 1999 Jul 15;443(1-2):95-110 AB - Dietary fibre (DF) is widely considered to protect against cancer, especially colorectal cancer. However, a large prospective epidemiological study has shown no apparent effect of DF intake on the development of colorectal cancer. We suggest that this may be because the term DF represents a wide range of materials, some able to protect, but some able to enhance carcinogenesis. This is consistent with data from animal carcinogenesis experiments. Most of the DF in western diets is in the form of plant cell walls, but these vary in their composition and it is unlikely that all types are protective. The few data available indicate that plant cell walls containing suberin or lignin may be the most protective, although they are present in only small amounts in food plants. DFs are also added to foods. These include components obtained from plant cell walls, such as pectins, as well as soluble DFs from other sources. In general, animal carcinogenesis experiments indicate that soluble DFs do not protect and some may enhance carcinogenesis. Few human intervention studies have been done on DF or sources of DF, with the exception of wheat bran, a good source of DF, which has been shown to protect. Possible mechanisms whereby DF may enhance carcinogenesis are discussed. In addition to DFs, resistant starches and non-digestible oligosaccharides are added to foods; these, like DF, escape digestion in the small intestine. However, so far only a few animal carcinogenesis experiments have been reported using these materials, and no human intervention studies. We believe caution should be exercised in the addition of such materials to food. Copyright 1999 Elsevier Science B.V. [References: 120] <50> UI - 99372132 AU - Kurtzweil P TI - Dental more gentle with painless 'drillings' and matching fillings. [Review] [0 refs] SO - FDA Consumer 1999 May-Jun;33(3):18-22 <51> UI - 99309944 AU - Weinberg MA AU - Bral M IN - Department of Periodontics, New York University College of Dentistry, NY 10010, USA. TI - Laboratory animal models in periodontology. [Review] [50 refs] SO - Journal of Clinical Periodontology 1999 Jun;26(6):335-40 AB - Animal models are needed to objectively evaluate the pathogenesis of human periodontal diseases and its various treatment modalities. Selection of the appropriate animal model depends on the similarity of the periodontium and the nature of the disease to that of humans. The more commonly used animal models for studying the pathogenesis of periodontal disease, use of implants and guided tissue regeneration have been dogs and nonhuman primates. Periodontal disease in rodents has not been found to be as closely related to the human varieties. Rats and hamsters are best suited for caries and calculus research. Ferrets may be a promising new model for studying periodontal disease and calculus formation. Variables unique to each animal species are manifested by a wide range of clinical and histopathological features. Different species have distinct diets, habits, life spans, tissue structures, host defense mechanisms and genetic traits. This article describes the diversity seen in animal models used to study microbiological, immunological, and clinical features of periodontal disease and its prevention and treatment. [References: 50] <52> UI - 99325251 AU - Sainsbury D IN - Westmead Hospital Dental Clinical School, Westmead Hospital, New South Wales, Australia. TI - Drug addiction and dental care. [Review] [12 refs] SO - New Zealand Dental Journal 1999 Jun;95(420):58-61 AB - Patients who are addicted to drugs, or are being treated for drug addiction, present a variety of management issues when they attend for dental care. A number of factors are related to the treatment planning and clinical management. Dentists should be aware of these factors in order to manage these patients sensitively and effectively. Important management issues include medical problems associated with drug abuse, dental problems and how drug abuse and its subsequent treatment affect the dentition, behavioural disorders, pain management, and control of cross-infection. People who have recovered from chemical dependency to opiates have special needs, especially in pain management. Establishing a good pre-treatment rapport with the patient will assist the dentist in reducing the need for postoperative analgesics, and will encourage this group of patients to return and obtain needed dental care. The more dental practitioners know about types and patterns of drug abuse and recovery programmes, the more safely this group of patients with special needs can be managed. [References: 12] <53> UI - 99276692 AU - Wizemann TM AU - Adamou JE AU - Langermann S IN - MedImmune, Inc., Gaithersburg, Maryland 20878, USA. TI - Adhesins as targets for vaccine development. [Review] [66 refs] SO - Emerging Infectious Diseases 1999 May-Jun;5(3):395-403 AB - Blocking the primary stages of infection, namely bacterial attachment to host cell receptors and colonization of the mucosal surface, may be the most effective strategy to prevent bacterial infections. Bacterial attachment usually involves an interaction between a bacterial surface protein called an adhesin and the host cell receptor. Recent preclinical vaccine studies with the FimH adhesin (derived from uropathogenic Escherichia coli) have confirmed that antibodies elicited against an adhesin can impede colonization, block infection, and prevent disease. The studies indicate that prophylactic vaccination with adhesins can block bacterial infections. With recent advances in the identification, characterization, and isolation of other adhesins, similar approaches are being explored to prevent infections, from otitis media and dental caries to pneumonia and sepsis. [References: 66] <54> UI - 99203930 AU - Gear AJ AU - Suber F AU - Neal JG AU - Nguyen WD AU - Edlich RF IN - Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908, USA. TI - New assistive technology for passive standing. [Review] [14 refs] SO - Journal of Burn Care & Rehabilitation 1999 Mar-Apr;20(2):164-9 AB - The anesthetic skin of patients with spinal cord injuries makes these patients a high-risk population for burn injuries. Innovations in rehabilitation engineering can now provide the disabled with mechanical devices that allow for passive standing. Passive standing has been shown to counteract many of the effects of chronic immobilization and spinal cord injury, including bone demineralization, urinary calculi, cardiovascular instability, and reduced joint range of motion and muscular tone. This article will describe several unique assistive devices that allow for passive standing and an improvement in daily living for people with disabilities. [References: 14] <55> UI - 99184733 AU - Riordan PJ IN - Perth Dental Hospital and Community Dental Services, Australia. riordan@q-net.net.au TI - Fluoride supplements for young children: an analysis of the literature focusing on benefits and risks. [Review] [71 refs] SO - Community Dentistry & Oral Epidemiology 1999 Feb;27(1):72-83 AB - The use of fluoride supplements to prevent caries has been advised for more than 100 years, but serious promotion of this strategy occurred only after the effectiveness of water fluoridation was established, in the late 1950s and 1960s. Although the effectiveness of fluoride supplements was apparently endorsed by many small clinical studies, closer examination of the experimental conditions of these, their methods and the analysis of their results undermined confidence in their findings. It is likely that confounding resulted in spurious conclusions in many of them. More modern, well-conducted clinical trials of supplements suggest that today, in children also exposed to fluoride from other sources such as toothpaste, the marginal effect of fluoride supplements is very small. There is evidence that fluoride lozenges, designed to maximise any local effect, may have a small caries preventive effect, particularly in deciduous teeth. Overall, poor compliance makes fluoride supplements a poor public health measure. Supplement use by young children is associated with a substantial risk of dental fluorosis. Fluorosis is an issue about which the public is becoming concerned in several countries and this concern, if translated into opposition to all fluoride use, could jeopardise the most successful caries preventive aid we have. The potential for dental fluorosis, concern about the public's reaction to this, the poor effectiveness of supplements and the public's poor compliance with their use are persuasive arguments for a radical reduction in the use of supplements by young children. Recent changes in fluoride dosage schedules and deferment of the age of commencing the use of supplements, implemented in many countries, have followed from these concerns. Supplements formulated as lozenges maximise topical exposure of enamel to fluoride and such products may offer older children and some adults a way of maintaining an elevated fluoride level in saliva at times when toothbrushing is not practical. [References: 71] <56> UI - 99184732 AU - Limeback H IN - Faculty of Dentistry, University of Toronto, Ontario, Canada. hlimeback@dental.utoronto.ca TI - A re-examination of the pre-eruptive and post-eruptive mechanism of the anti-caries effects of fluoride: is there any anti-caries benefit from swallowing fluoride?. [Review] [35 refs] SO - Community Dentistry & Oral Epidemiology 1999 Feb;27(1):62-71 AB - The belief that fluoridated water reduces caries incidence by half stems from years of fluoridation studies where the caries rates of people in various fluoridated and non-fluoridated communities were compared. By their nature, the water fluoridation trials were not able to distinguish between the topical effects of the fluoride in the water and the systemic effects of the fluoride that is inevitably swallowed and incorporated into developing teeth. Some attempts have been made to estimate the contribution of systemic fluoride to the control of dental caries but researchers are discovering that the topical effects of fluoride are likely to mask any benefits that ingesting fluoride might have. In this updated review of the pre-eruptive vs. post-eruptive benefits of fluoride in the prevention of dental caries, a re-examination of the literature, which is often cited to support the notion that swallowing fluoride, either in water or in pill form, was done in recognition of the mounting evidence for the topical mechanism as being the primary mechanism for the prevention of dental caries. Maximum benefits from exposing newly erupted teeth to topical fluoride in the oral cavity may have been seriously under-estimated. This has obvious implications for the use of systemic fluorides to prevent dental caries and forces everyone working in the field to examine more closely the risks and benefits of fluoride in all its delivery forms. [References: 35] <57> UI - 99184728 AU - Featherstone JD IN - Department of Restorative Dentistry, University of California at San Francisco, 94143, USA. jdbf@itsa.ucsf.edu TI - Prevention and reversal of dental caries: role of low level fluoride. [Review] [75 refs] SO - Community Dentistry & Oral Epidemiology 1999 Feb;27(1):31-40 AB - Dental caries is a bacterially based disease that progresses when acid produced by bacterial action on dietary fermentable carbohydrates diffuses into the tooth and dissolves the mineral, that is, demineralization. Pathological factors including acidogenic bacteria (mutans streptococci and lactobacilli), salivary dysfunction, and dietary carbohydrates are related to caries progression. Protective factors which include salivary calcium, phosphate and proteins, salivary flow, and fluoride in saliva can balance, prevent or reverse dental caries. Fluoride works primarily via topical mechanisms which include (1) inhibition of demineralization at the crystal surfaces inside the tooth, (2) enhancement of remineralization at the crystal surfaces (the resulting remineralized layer is very resistant to acid attack), and (3) inhibition of bacterial enzymes. Fluoride in drinking water and in fluoride-containing products reduces tooth decay via these mechanisms. Low but slightly elevated levels of fluoride in saliva and plaque provided from these sources help prevent and reverse caries by inhibiting demineralization and enhancing remineralization. The level of fluoride incorporated into dental mineral by systemic ingestion is insufficient to play a significant role in caries prevention. The effect of systemically ingested fluoride on caries is minimal. Fluoride "supplements" can be best used as a topical delivery system by sucking or chewing tablets or lozenges prior to ingestion. [References: 75] <58> UI - 99184727 AU - Limeback H IN - Preventive Dentistry, University of Toronto, Ontario, Canada. hlimeback@dental.utoronto.ca TI - Appropriate use of fluoride supplements for the prevention of dental caries. Consensus Conference of the Canadian Dental Association. Toronto, Canada, 28-29 November 1997. Introduction. [Review] [22 refs] SO - Community Dentistry & Oral Epidemiology 1999 Feb;27(1):27-30 <59> UI - 99174968 AU - Allolio B AU - Lehmann R IN - Medizinische Universitatsklinik, Wurzburg, Germany. TI - Drinking water fluoridation and bone. [Review] [76 refs] SO - Experimental & Clinical Endocrinology & Diabetes 1999;107(1):12-20 AB - Drinking water fluoridation has an established role in the prevention of dental caries, but may also positively or negatively affect bone. In bone fluoride is incorporated into hydroxylapatite to form the less soluble fluoroapatite. In higher concentrations fluoride stimulates osteoblast activity leading to an increase in cancellous bone mass. As optimal drinking water fluoridation (1 mg/l) is widely used, it is of great interest, whether long-term exposition to artificial water fluoridation has any impact on bone strength, bone mass, and -- most importantly -- fracture rate. Animal studies suggest a biphasic pattern of the effect of drinking water fluoridation on bone strength with a peak strength at a bone fluoride content of 1200 ppm followed by a decline at higher concentrations eventually leading to impaired bone quality. These changes are not paralleled by changes in bone mass suggesting that fluoride concentrations remain below the threshold level required for activation of osteoblast activity. Accordingly, in most epidemiological studies in humans bone mass was not altered by optimal drinking water fluoridation. In contrast, studies on the effect on hip fracture rate gave conflicting results ranging from an increased fracture incidence to no effect, and to a decreased fracture rate. As only ecological studies have been performed, they may be biased by unknown confounding factors -- the so-called ecological fallacy. However, the combined results of these studies indicate that any increase or decrease in fracture rate is likely to be small. It has been calculated that appropriately designed cohort studies to solve the problem require a sample size of >400,000 subjects. Such studies will not be performed in the foreseeable future. Future investigations in humans should, therefore, concentrate on the effect of long-term drinking water fluoridation on bone fluoride content and bone strength. [References: 76] <60> UI - 99183256 AU - Jones G AU - Riley M AU - Couper D AU - Dwyer T IN - Menzies Centre for Population Health Research, Tasmania. G.Jones@utas.edu.au TI - Water fluoridation, bone mass and fracture: a quantitative overview of the literature. SO - Australian & New Zealand Journal of Public Health 1999 Feb;23(1):34-40 AB - OBJECTIVE: To use the technique of meta-analysis to address the following research questions: Is water fluoridation associated with altered fracture risk at a population level and are the differences between studies consistent with confounding or chance variation between studies? METHOD: The data sources utilised were Medline 1966-97, reviews and bibliographies. The search terms were fluoridation, bone mass and/or fracture. We included all observational studies published in English relating water fluoridation to bone mass and/or fracture in the initial assessment. RESULTS: Water fluoridation had no evident effect on fracture risk (RR 1.02, 95% CI 0.96-1.09, n = 18 studies). There was marked heterogeneity between studies which could be explained, in part, by the combination of gender, urbanicity and study quality (R2 0.25, p = 0.05, weighted analysis). CONCLUSIONS: Water fluoridation both at levels aimed at preventing dental caries and, possibly, at higher naturally occurring levels appears to have little effect on fracture risk, either protective or deleterious, at a population level. The small effect on bone mass seen in studies performed at the individual level is consistent with this finding. Variation between studies is also likely to be due to differences in the distribution of other recognised fracture risk factors between different populations. Confirmation of these findings is required in large studies performed at the individual level. <61> UI - 99194111 AU - Newman HN IN - Department of Periodontology, Eastman Dental Institute for Oral Health Care Sciences, University College London, University of London, United Kingdom. TI - Attrition, eruption, and the periodontium. [Review] [56 refs] SO - Journal of Dental Research 1999 Mar;78(3):730-4 AB - Features of natural masticatory function, of physiological attrition, both occlusal and approximal, and of continuing tooth eruption in adult life need to be borne in mind in considering how the chronic inflammatory periodontal diseases and dental caries have become so widespread. Evidence is reviewed showing that teeth continue to erupt in adulthood, that natural masticatory function prevented plaque accumulation at the approximal risk site of onset of both CIPDs and caries, that epithelial attachment to cementum may be physiological, and that periodontal attachment studies must be age-related. [References: 56] <62> UI - 99220705 AU - Hajishengallis G AU - Michalek SM IN - Department of Oral Biology, University of Alabama, Birmingham 35294-2170, USA. TI - Current status of a mucosal vaccine against dental caries. [Review] [262 refs] SO - Oral Microbiology & Immunology 1999 Feb;14(1):1-20 AB - The evidence of a specific bacterial cause of dental caries and of the function of the salivary glands as an effector site of the mucosal immune system has provided a scientific basis for the development of a vaccine against this highly prevalent and costly oral disease. Research efforts towards developing an effective and safe caries vaccine have been facilitated by progress in molecular biology, with the cloning and functional characterization of virulence factors from mutans streptococci, the principal causative agent of dental caries, and advancements in mucosal immunology, including the development of sophisticated antigen delivery systems and adjuvants that stimulate the induction of salivary immunoglobulin A antibody responses. Cell-surface fibrillar proteins, which mediate adherence to the salivary pellicle, and glucosyltransferase enzymes, which synthesize adhesive glucans and allow microbial accumulation, are virulence components of mutans streptococci, and primary candidates for a human caries vaccine. Infants, representing the primary target population for a caries vaccine, become mucosally immunocompetent and secrete salivary immunoglobulin A antibodies during the first weeks after birth, whereas mutans streptococci colonize the tooth surfaces at a discrete time period that extends around 26 months of life. Therefore, immunization when infants are about one year old may establish effective immunity against an ensuing colonization attempts by mutans streptococci. The present review critically evaluates recent progress in this field of dental research and attempts to stress the protective potential as well as limitations of caries immunization. [References: 262] <63> UI - 99150725 AU - Kilpatrick N TI - Oral health for the preschool child [editorial] [see comments]. [Review] [16 refs] CM - Comment in: Med J Aust 1999 May 3;170(9):455-6 SO - Medical Journal of Australia 1999 Jan 4;170(1):6-7 <64> UI - 99151918 AU - Randall RC AU - Wilson NH IN - Restorative Dentistry, Manchester University Turner Dental School, United Kingdom. TI - Glass-ionomer restoratives: a systematic review of a secondary caries treatment effect. [Review] [76 refs] SO - Journal of Dental Research 1999 Feb;78(2):628-37 AB - It is generally accepted that glass ionomers inhibit secondary caries in vivo, and data from in vitro studies support this effect. The aim of this review was a systematic assessment, from the literature, of clinical evidence for the ability of glass-ionomer restoratives to inhibit secondary caries at the restoration margin. Inclusion and exclusion criteria for selection of the review papers were established prior to commencement of the literature search. Papers which conformed to these criteria, and reported on secondary caries as an outcome, were selected (N = 52). Primary and secondary lists of systematic criteria for use in the assessment of the papers were drawn up. The primary list of 14 criteria was applied to each paper. No paper fulfilled all these criteria, necessitating the use of the secondary measures: (i) a prospective study and (ii) use of an appropriate control. This yielded 28 papers. Tabulation of these papers by occurrence of secondary caries in the glass-ionomer or control groups demonstrated an even distribution between positive and negative outcomes. Valid evidence is considered to be best obtained from randomized, controlled studies of sufficient sample size. No conclusive evidence for or against a treatment effect of inhibition of secondary caries by the glass-ionomer restoratives was obtained from the systematic review. There is a need for appraisal of the methods currently adopted for the clinical evaluation of glass-ionomer restorative materials, and for further development of the methodology to support future systematic reviews. [References: 76] <65> UI - 99431115 AU - Wyne AH IN - Tawam Hospital Dental Center, Al-Ain, United Arab Emirates. TI - Early childhood caries: nomenclature and case definition. [Review] [10 refs] SO - Community Dentistry & Oral Epidemiology 1999 Oct;27(5):313-5 AB - A fruitless debate so far has continued to find an ideal name for early childhood caries (ECC), one which could encompass all its risk factors and express the possible seriousness and rampant nature of the problem. It should be simultaneously comprehensible to the dental profession, medical personnel and the general public. However, it is hard to find an example of a multifactorial disease where the name alone indicates its etiology, signs, symptoms, and prevention. It is time for us as a dental profession to accept the responsibility to educate ourselves, our medical colleagues and the public about ECC, and stop hoping that a perfect name for ECC will do the job for us. A similar situation exists regarding the case definition of ECC. To find a single definition of ECC based on number of lesions, teeth involved and age of the affected children is an unrealistic goal. Therefore, a classification of ECC and a case definition for each type is proposed. [References: 10] <66> UI - 20020814 AU - Clarkson BH IN - School of Dentistry, University of Michigan, Ann Arbor, USA. briclar@umich.edu TI - Introduction to cariology. SO - Dental Clinics of North America 1999 Oct;43(4):569-78, v AB - This article examines the discipline of cariology. A brief history is presented, and an overview of the origin and management of caries is discussed. This article frames the picture that the other authors in this issue paint. <67> UI - 20020815 AU - Dowd FJ IN - Department of Pharmacology, Creighton, University School of Medicine, Omaha, Nebraska, USA. fdowd@creighton.edu TI - Saliva and dental caries. [Review] [84 refs] SO - Dental Clinics of North America 1999 Oct;43(4):579-97 AB - A study of saliva and its tooth-protective components reveals at least four important functions of saliva: (1) buffering ability, (2) a cleansing effect, (3) antibacterial action, and (4) maintenance of a saliva supersaturated in calcium phosphate. Several salivary constituents subserve one or more of these functions. Research has yielded important information about organic and inorganic secretory products. It is also clear that saliva as a unique biologic fluid has to be considered in its entirety to account fully for its effects on teeth. Saliva is greater then the sum of its parts. One reason for this is that salivary components display redundancy of function, each often having more than one function. This redundancy, however, does not imply that proteins that share functional roles all contribute to the same degree. For instance, when comparing proteins that inhibit calcium phosphate precipitation, statherin and acidic proline-rich proteins are most potent, whereas histatins, cystatins, and mucins appear to play lesser roles. The complex interaction between proteins is another major factor contributing to saliva's function. In this regard, heterotypic complexes of various proteins have been shown to form on hydroxyapatite. Mucin binding to other salivary proteins, including proline-rich proteins, histatins, cystatins, and statherin, is well documented. The complexes, whether adsorbed to the tooth surface or in saliva, have important implications for bacterial clearance, selective bacterial aggregation on the tooth surface, and control of mineralization and demineralization. Finally, proteolytic activity of saliva generates numerous products whose biologic activities are often different from their parent compounds. Fluoride is another important component of saliva that is discussed separately in other articles in this issue. The ability of saliva to deliver fluoride to the tooth surface constantly makes salivary fluoride an important player in caries protection largely by promoting remineralization and reducing demineralization. Some key properties of salivary components discussed in this article are listed in Table 1. Saliva is well adapted to protection against dental caries. Saliva's buffering capability; the ability of the saliva to wash the tooth surface, to clear bacteria, and to control demineralization and mineralization; saliva's antibacterial activities; and perhaps other mechanisms all contribute to its essential role in the health of teeth. The fact that the protective function of saliva can be overwhelmed by bacterial action indicates the importance of prevention and therapy as in other infectious diseases. The knowledge of functional properties of saliva as well as those of its separate components may permit a better assessment of dental caries susceptibility. Future research is essential to characterize more fully salivary components and their interactions and how these affect the caries process. With such knowledge, the use of modified oral molecules as therapeutic agents may become a reality. Equally intriguing is the prospect of influencing the secretion of salivary components by greater knowledge and control over the secretory processes responsible for the delivery of those components. [References: 84] <68> UI - 20020816 AU - Marsh PD IN - Division of Oral Biology, Leeds Dental Institute, United Kingdom. phil.marsh@camr.org.uk TI - Microbiologic aspects of dental plaque and dental caries. [Review] [23 refs] SO - Dental Clinics of North America 1999 Oct;43(4):599-614, v-vi AB - Dental plaque is an example of a microbial biofilm with a diverse microbial composition; it is found naturally on teeth and confers advantages to the host, for example, by preventing colonization by exogenous, and often pathogenic, micro-organisms. In individuals with a high frequency sugar diet, or with a severely compromised saliva flow, the levels of potentially cariogenic bacteria (acid-producing and acid-tolerating species) can increase beyond those compatible with enamel health. This article discusses antimicrobial strategies to control dental caries, including; reducing plaque levels, in general or specific cariogenic bacteria in particular, by antiplaque or antimicrobial agents; reducing bacterial acid production by replacing fermentable carbohydrates in the diet with sugar substitutes, or by interfering with bacterial metabolism with fluoride or antimicrobial agents. [References: 23] <69> UI - 20020817 AU - Jensen ME IN - mjensen@skypoint.com TI - Diet and dental caries. [Review] [59 refs] SO - Dental Clinics of North America 1999 Oct;43(4):615-33 AB - Dental caries is a diet-related disease that continues to be a problem for certain dental patients. Frequent consumption of fermentable carbohydrates that have low oral clearance rates increases the risk for enamel caries and perhaps is even more dangerous for root surfaces. Highly acidogenic snack foods should be consumed at mealtimes to reduce the risk, and between-meal snacks should be either nonacidogenic (such as xylitol products) or hypoacidogenic (such as sorbitol and HSH products). Cheeses present a naturally occurring situation that may provide anticariogenic effects from the diet. Certain additives as well as sugar substitutes show great promise for the provision of between-meal snack foods that reduce the risk of dental caries. The dental team should thoroughly understand the relationship of diet to caries and conscientiously apply that knowledge to educate the patients in general as well as counsel specific high-risk individuals. Further emphasis should be placed on the acquisition of sound scientific data for counseling caries patients concerning diet and dental caries. [References: 59] <70> UI - 20020818 AU - Zero DT IN - Eastman Department of Dentistry, University of Rochester School of Medicine and Dentistry, New York, USA. DZero@iusd.iupui.edu TI - Dental caries process. [Review] [89 refs] SO - Dental Clinics of North America 1999 Oct;43(4):635-64 AB - The boundaries of caries diagnosis and caries intervention are changing. Dentists currently use visual, tactical, and radiographic information to detect relatively advanced changes in the dental hard tissues. The clinical management of dental caries has been primarily directed at the treatment of the consequences of the disease process by placing restorations and not at curing the disease. Using emerging technology, dentists will be able to detect incipient dental caries (demineralization) at an earlier stage than the clinically visible white spot. Dental caries is a dynamic process, which in its early stages is reversible and even in its more advanced stages can be arrested. The widespread use of fluoride has dramatically reduced the prevalence of dental caries and the rate of the progression of carious lesions. These changes permit dentists to adopt more conservative management strategies directed at the prevention and cure of dental caries. [References: 89] <71> UI - 20020821 AU - Warren JJ AU - Levy SM IN - Department of Preventive and Community Dentistry, University of Iowa, College of Dentistry, Iowa City, USA. john-warren@uiowa.edu TI - Systemic fluoride. Sources, amounts, and effects of ingestion. [Review] [106 refs] SO - Dental Clinics of North America 1999 Oct;43(4):695-711 AB - Fluoride may be ingested from a variety of sources, including many foods and beverages. Fluoride intake varies greatly among individuals and is dependent on dietary constituents and use of fluoride products. Although ingestion of toxic amounts of fluoride is rare, the prevalence of dental fluorosis has increased in North America, suggesting that the levels of fluoride ingestion need to be closely monitored. Care should be taken to avoid excessive ingestion of fluoride dentifrice by preschool-aged children by placement of a small, pea-sized quantity on the tooth-brush. Dietary fluoride supplements should be considered a targeted, preventive procedure only for those at elevated caries risk, and before prescribing them, careful consideration should be given to other fluoride sources, including home and child-care water supplies, foods, and beverages. [References: 106] <72> UI - 20020822 AU - ten Cate JM AU - van Loveren C IN - Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. TI - Fluoride mechanisms. [Review] [116 refs] SO - Dental Clinics of North America 1999 Oct;43(4):713-42, vii AB - This article discusses fluoride mechanisms in relation to dental caries. The authors specifically address firmly bound versus loosely bound fluoride; different fluoride active ingredients; fluoride and demineralization and remineralization; fluoride slow-release devices and F-releasing dental materials; antimicrobial effects of fluoride; the uptake of fluoride by oral bacteria; inhibition of enolase, protein-intruding ATPase and sugar transport; the various aspects of plaque as it relates to fluoride; and the rational use of fluoride. [References: 116] <73> UI - 20020823 AU - Kidd EA IN - Division of Conservative Dentistry, Dental School of Guy's and King's and St Thomas' Hospital, London, England. TI - Caries management. [Review] [55 refs] SO - Dental Clinics of North America 1999 Oct;43(4):743-64 AB - This article has attempted to gather up the evidence presented in the rest of this issue to give dentists a practical overview of the management of the carious process. The major points are that a caries risk assessment is not only logical, it is achievable; management of caries is by preventive treatment, but operative dentistry has a role to play; in the final analysis, it is the patient who manages caries. [References: 55] <74> UI - 20000609 AU - Chandan RC IN - Global Technologies, Inc., New Brighton, MN 55112-5307, USA. TI - Enhancing market value of milk by adding cultures. [Review] [81 refs] SO - Journal of Dairy Science 1999 Oct;82(10):2245-56 AB - Fluid milk and several dairy products are an excellent medium to generate an array of products that fit into the current consumer demand for health-driven foods. Several technologies associated with culture addition, fermentation, or both are available for creating an assortment of flavors and textures in milk products. It appears that accentuating the positive attributes of inherent milk constituents, incorporating health-promoting cultures, and offering a variety of flavors and textures to the consumer could enhance milk consumption. Recent advances in probiotic research show much promise in new product development of functional foods based on milk. Several scientifically sound clinical studies have verified some of the anecdotal reports of the past. Among the reported beneficial effects of consuming certain strains of cultures, or their metabolites, or both are enhanced immune response, balancing of colonic microbiota, vaccine adjuvant effect, reduction of fecal enzymes implicated in cancer initiation, treatment of diarrhea associated with travel, antibiotic therapy, control of rotavirus and Clostridium difficile, control of ulcers related to Helicobacter pylori, reduction of serum cholesterol, antagonism against food-borne pathogens and tooth decay organisms, and amelioration of lactose malabsorption symptoms. The mode of action in most cases seems to involve modulation of ecosystem of the gastrointestinal tract of the host. Several strains belonging to genera Enterococcus, Lactobacillus, and Bifidobacterium, which have desirable clinical benefits, are now available. They are being incorporated in yogurts, dairy snacks, breakfast foods, drinks, refrigerated desserts, cheeses, spreads, frozen desserts, and unfermented sweet cultured milk. [References: 81] <75> UI - 99407419 AU - Kidd EA IN - Medical School, Guy's Hospital, King's College, University of London. TI - Assessment of caries risk. [Review] [30 refs] SO - Dental Update 1998 Nov;25(9):385-90 AB - This paper examines the importance of caries risk assessment, identifies relevant risk factors, including clinical evidence, which has been considered to be the best predictor of caries risk. [References: 30] <76> UI - 99407416 AU - Ellwood RP AU - Blinkhorn AS AU - Davies RM IN - Dental Health Unit, Turner Dental School. TI - Fluoride: how to maximize the benefits and minimize the risks. [Review] [42 refs] SO - Dental Update 1998 Nov;25(9):365-72 AB - This article reviews current thinking on the rational use of fluoride for the safe and effective prevention of dental caries, so that benefits may be maximized and risks minimized. [References: 42] <77> UI - 99407389 AU - de Soet JJ AU - de Graaff J IN - Department of Oral Microbiology, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. TI - Microbiology of carious lesions. [Review] [12 refs] SO - Dental Update 1998 Oct;25(8):319-24 AB - Dental caries is a process in which the enamel, and later the dentine, is demineralized by acids produced by bacterial fermentation of carbohydrates. The main indicator bacteria in this process are mutans streptococci and lactobacilli. This article discusses how monitoring of patients' salivary levels of these organisms can help in prevention and treatment of caries in different patient populations. [References: 12] <78> UI - 99407410 AU - Walshaw PR AU - McComb D IN - Restorative Department, Faculty of Dentistry, University of Toronto. TI - Microscopic features of clinically successful dentine bonding. [Review] [30 refs] SO - Dental Update 1998 Sep;25(7):281-6 AB - Clinical success with resin-based bonding systems depends upon meticulous attention to detail at each stage of the bonding process. Cavity margins placed in enamel wherever possible and etched for at least 15 to 30 seconds will ensure a reliable peripheral seal. Dentine conditioning should be brief--a maximum of 15 seconds for surface demineralization only. Diffusion of primers into the full extent of dentinal demineralization is enhanced by application of multiple coats. Any solvent or moisture remaining on a primed dentine surface will prevent adaptation of bonding resin, resulting in non-attachment. Adhesive bonding resin provides a valuable elastic intermediate layer for absorption of stresses of polymerization shrinkage--but it should be of uniform thickness and not air-thinned. Incremental insertion of resin composite will reduce polymerization stresses and ensure a fully cured restoration. [References: 30] <79> UI - 99314430 AU - Osborne JW AU - Summitt JB IN - Department of Restorative Dentistry, School of Dentistry, University of Colorado Health Science Center, Denver 80282, USA. TI - Extension for prevention: is it relevant today?. [Review] [53 refs] SO - American Journal of Dentistry 1998 Aug;11(4):189-96 AB - Extension for prevention has been an integral part of dentistry for over 100 years. Because this concept advocated the removal of sound tooth structure, it was not totally accepted at the turn of the century. The advent of the gold casting catapulted extension for prevention into general acceptance. In 1883, Webb presented a concept of "prevention of extension of decay". This concept advocated a proximal cavity preparation extending toward the buccal and lingual aspects of the tooth so that contact with adjacent teeth would not be at the margins. The separation of the margins, along with proper restoration contours, was thought to promote natural cleansing of the embrasures with saliva and fluids in the diet. GV Black's 1891 idea of "extension for prevention" was to provide extension of the preparation to the facial and lingual line angles in order to bring about "self-cleansing" margins via food excursion. Black's concept also included extending preparations through fissures to allow cavosurface margins to be on non-fissured enamel. Black integrated the extension of the proximal margins with his concept of an occlusal isthmus for a Class II amalgam preparation one-third the faciolingual width of the occlusal surface. Challenges to this concept of extension for prevention were immediate; and, by the 1950's, narrower, more conservative preparations were seen by a few as being more effective in preserving teeth. Not only occlusal width was reassessed, but the need to routinely extend proximal margins to the buccal and lingual line angles was also questioned. By the mid-1960's and early 1970's a more conservative approach to amalgam preparation was advocated and was being taught in some dental schools. Today, a standardized outline form should not be used or taught as a principle of cavity preparation. In areas where fissure caries has necessitated a preparation extending into dentin, a composite resin or dental amalgam restoration should be placed, and a fissure sealant should be used to protect remaining susceptible fissures from carious attack. This current form of the concept of extension for prevention, which is supported by clinical research, preserves sound tooth structure that, using outdated concepts, would have been cut away. Placing proximal margins in sound tooth structure that just clears an adjacent tooth is also strongly advocated. Sound enamel margins in certain areas may occasionally be left in contact with adjacent teeth for amalgam preparations. For Class II preparations for composite resin, facial or lingual proximal bevels will usually suffice to separate the margins from the adjacent tooth to allow finishing and polishing at the margins. Preventing unnecessary extension and allowing sounder tooth structure to remain is one important aspect of helping patients to maintain their teeth for their lifetimes. [References: 53] <80> UI - 99300469 AU - Ewoldsen N AU - Herwig L IN - Department of Adult Restorative Dentistry, College of Dentistry, University of Nebraska Medical Center, Lincoln, USA. TI - Decay-inhibiting restorative materials: past and present. [Review] [27 refs] SO - Compendium of Continuing Education in Dentistry (Jamesburg, NJ) 1998 Oct;19(10):981-4, 986, 988 passim; quiz 992 AB - Clear differences exist in the fluoride release characteristics and setting reactions of glass-ionomer cements and compomers. Differences in decay inhibition associated with specific materials are less clear. Furthermore, resin added to glass ionomer cement formulations and acids added to composite resins make it difficult to distinguish composite resins from compomers and glass ionomer cements, all of which have reported fluoride release. Optimal fluoride release from a dental restorative depends on several conditions, including oral flora, saliva, diet, mineral content of the dental tissues, and marginal seal of the restoration. Presently, in vitro and in vivo studies suggest that materials which behave similarly to silicate cements in their setting reactions and hydration characteristics will behave as decay-inhibiting restoratives. Until optimal fluoride release from dental restoratives can be quantified, dental clinicians are encouraged to consider clinical outcomes as the best test for decay inhibition. Nearly a century of clinical findings support the anticariogenicity of silicate cements. This article reviews fluoride release and anticariogenicity of restorative materials using silicate cement as a model with a well-defined mechanism for preventing secondary caries. The behavior of newer materials is compared to silicate cement for predicting decay inhibition. [References: 27] <81> UI - 99193226 AU - Smith PJ AU - Moffatt ME IN - Department of Community Health Sciences, Winnipeg, Manitoba, Canada. TI - Baby-bottle tooth decay: are we on the right track?. [Review] [60 refs] SO - International Journal of Circumpolar Health 1998;57 Suppl 1:155-62 AB - The baby-bottle tooth decay (BBTD) risk factor literature was critically assessed for strength of evidence, and the prevention literature for the identification of which risk factors are being addressed. "Inappropriate" feeding practices (non-nutritive sucking, prolonged bottle/breast feeding, nap-time feeding) are believed to cause BBTD. The association of these practices with BBTD is inconsistent and the strength of association varies greatly. These practices increase exposure to lactose, a cariogenic carbohydrate, but the current causation model fails to explain why the majority of children with these risk factors do not develop BBTD. The association of BBTD with low socioeconomic status is stronger and more consistent. Prevention has focused almost exclusively on education directed at changing the postnatal feeding practices despite the fact that teeth begin formation in utero. Prenatal deficiencies of calcium and vitamin D can lead to enamel defects, and enamel defects in turn predispose teeth to caries. Baby-bottle tooth decay is especially prevalent in Aboriginal people, for whom studies have consistently reported diets deficient in vitamin D and calcium. BBTD may be a consequence of the poor socioeconomic conditions and malnutrition. Perhaps more attention should be given to primary prevention. [References: 60] <82> UI - 99254498 AU - Gibson G IN - Special Care Dental Clinics, VA North Texas Health Care System, Dallas, USA. TI - Identifying and treating xerostomia in restorative patients. [Review] [39 refs] SO - Journal of Esthetic Dentistry 1998;10(5):253-64 AB - Inadequate saliva can have devastating consequences for a patient, including oral discomfort, rampant caries, increased candida infections, and desiccation of restorative and esthetic dental treatment. Diagnosis of the cause of xerostomia is imperative to treating the condition, and multiple causes should be considered. Treatment options for xerostomia consists of treatment for hyposalivation, palliative and preventive care to combat the results of long-term dry mouth. Treatment of xerostomia should be based on the etiologic factors of the disease, with prevention of further oral destruction and comfort being the primary goals of treatment. [References: 39] <83> UI - 99254497 AU - Fedele DJ AU - Sheets CG IN - VA Maryland Health Care System, USA. TI - Issues in the treatment of root caries in older adults. [Review] [19 refs] SO - Journal of Esthetic Dentistry 1998;10(5):243-52 AB - Increased life expectancy, improvements in tooth retention, and higher expectations about oral health will continue to result in an increased demand for esthetic restorative dental care. Using demographics as a predictor of future dental treatment needs, root caries may be one of the most significant patient management issues of the next decade. Root caries also can present the clinician with challenging restorative problems. The best treatment option is determined by the lesion, the caries rate, the condition of the patient, and the esthetic requirement or desire. Material selection is critical for successful restoration of root caries. The treatment of root caries also should include methods for the prevention of future lesions. Although caries risk assessment is not a perfected science, models can assist in estimating caries risk and then guide the clinician toward the most suitable preventive approach. [References: 19] <84> UI - 99235922 AU - Livingston HM AU - Dellinger TM AU - Holder R IN - Restorative Department, University of