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 59 from 57 keep 301-600 300 *************************** <1> UI - 96036252 AU - Bowen WH IN - Department of Dental Research, University of Rochester, New York 14642, USA. TI - Are current models for preventive programs sufficient for the needs of tomorrow?. [Review] [45 refs] SO - Advances in Dental Research 1995 Jul;9(2):77-81 AB - We can be proud of our accomplishment in the prevention of dental caries. Many children in developed countries are now caries-free; however, by age 50, fewer than 5% of the population is caries-free. The drop in the prevalence of caries among specific age groups is undoubtedly due to widespread exposure to fluorides. However, caries protection by fluorides is not absolute; if caries attack continues throughout life, the prevalence of caries will increase. All available evidence strongly suggests that ambient levels of fluoride in the mouth play a critical role in protection against caries. It is clear that novel methods of delivery, such as sustained-release technology, will be developed to enhance the protective effect of fluoride, utilizing amounts of fluoride significantly less than those currently in use. The problems of preventing dental caries in developing countries are much more severe than those facing Western countries. The prevalence of caries appears to be increasing in no small measure due to the introduction of Western diets. Administration of fluoride through conventional routes is either impractical or inordinately expensive. It appears sensible, therefore, to direct preventive measures through dietary constituents associated with caries. Fluoridation of sugars appears to be highly practical and safe way to reduce the prevalence of caries in such communities. Fluoride and iodide are currently added to salt in many parts of the world. If we are to reduce the prevalence of caries effectively in all countries and in all age groups, current methods of prevention will have to be greatly enhanced, and/or effective additional approaches will need to be developed. [References: 45] <2> UI - 96036253 AU - Fejerskov O IN - Department of Dental Pathology, Royal Dental College, Faculty of Health Sciences, Aarhus University, Denmark. TI - Strategies in the design of preventive programs. [Review] [35 refs] SO - Advances in Dental Research 1995 Jul;9(2):82-8 AB - Dental caries is mostly recorded at the cavity level only. A reduced mean number of cavities in new age cohorts is often thought of as a result of prevention of the disease, dental caries. However, what is measured is rather our success in controlling the disease in such a way that prevalence of its more severe manifestations (cavities) can be reduced in children. Caries lesions and periodontal breakdown are cumulative with age and progress steadily in all populations. Thus, caries is the predominant reason for tooth loss in almost all age groups. The low prevalence and skewed distribution of dental caries make several fluoride programs less (if at all) cost-effective. Rather than considering a "whole population strategy" as opposed to a "high-risk strategy", it is argued that they should go hand in hand. However, the high-risk strategy may appear to have an unfavorable ratio of benefits to costs. So far the available literature shows no evidence that we have tests which, with sufficient predictive power, can identify groups or individuals of "high risk". It is therefore concluded that a population strategy should be maintained and further developed with emphasis on oral hygiene, because it influences norms and behavior. More knowledge about the pathogenesis of oral disease is needed before we can develop truly cost-effective strategies for the prevention of caries and periodontal breakdown. [References: 35] <3> UI - 96036255 AU - Horowitz AM TI - The public's oral health: the gaps between what we know and what we practice. [Review] [39 refs] SO - Advances in Dental Research 1995 Jul;9(2):91-5 AB - Health for All by the Year 2000 is a theme developed in 1979 by the World Health Organization. The theme includes oral health and is being promoted throughout the world. The advances in dental research make it possible to improve oral health and, concomitantly, general health. With the appropriate use of science-based, preventive regimens, dental caries and periodontal diseases can be prevented or controlled. Further, major risk factors for oral and lip cancer are known; thus, it is possible to reduce the incidence of these diseases. Available technologies, however, are useful only when they are used by appropriate user groups as recommended. The gaps between what is known about preventing oral diseases and what is practiced are often extensive. This presentation explores differences between scientific knowledge about risk factors for oral diseases and preventive regimens and procedures, public and professional knowledge and practices, and professional support for improved oral health through the application of primary preventive procedures, often referred to as "science transfer". Barriers to the adoption of preventive regimens and practices are discussed. Strategies using health education and health promotion for narrowing these gaps are presented. [References: 39] <4> UI - 96017056 AU - Proskin HM AU - Volpe AR TI - Comparison of the anticaries efficacy of dentifrices containing fluoride as sodium fluoride or sodium monofluorophosphate. SO - American Journal of Dentistry 1995 Feb;8(1):51-8 AB - The dominance of the marketplace by dentifrices containing fluoride as sodium monofluorophosphate and sodium fluoride has given rise to great academic and commercial interest regarding the comparison of those two fluoride species. Since the 1970's, several comparative clinical trials have been conducted to investigate the relative anticaries efficacy of dentifrices containing these two agents, generally giving rise to equivocal results. Recently, attention has been turned to investigative efforts which employ information derived from the collective body of relevant comparative clinical studies available in the literature to establish an omnibus conclusion concerning this issue. Beginning with the sign test of Beiswanger & Stookey (1989), and continuing through the meta-analyses of Johnson (1993) and Proskin (1993), this line of research remains vital today. The recent publication of two studies (Marks et al, 1994; Stephen et al, 1994) previously documented in the literature only in abstract form (Conti et al, 1993; Stephen et al, 1993) has given rise to the need for the present meta-analytic reconsideration of the available data. As in the previous meta-analyses, the quantitative results obtained depended on the studies which provided data for the calculations. However, as also indicated in previously-documented meta-analyses, the clinical interpretation of the results, which was based on the guidelines published by the American Dental Association (Council on Dental Therapeutics, 1988), did not vary according to study selection.(ABSTRACT TRUNCATED AT 250 WORDS) <5> UI - 96017068 AU - Swift EJ Jr AU - Perdigao J AU - Heymann HO IN - Department of Operative Dentistry, University of North Carolina, School of Dentistry, Chapel Hill, USA. TI - Bonding to enamel and dentin: a brief history and state of the art, 1995. [Review] [216 refs] SO - Quintessence International 1995 Feb;26(2):95-110 AB - The acid-etch technique for bonding composite resins to enamel has revolutionized the practice of restorative dentistry. The ability of clinicians to bond restorative materials to enamel has fundamentally changed such diverse areas as cavity preparation, caries prevention, and esthetic treatment options. Although bonding of resin to dentin has proved to be a difficult challenge, ongoing advances are improving the reliability and predictability of dentinal adhesion. The purpose of this article is to provide a brief history of enamel and dentinal bonding, as well as an overview of the current state of the art. [References: 216] <6> UI - 95391498 AU - Jeppesen C IN - Environmental and Food Laboratory, Dyregardsvej 1, Skovlunde, Denmark. TI - Media for Aeromonas spp., Plesiomonas shigelloides and Pseudomonas spp. from food and environment. [Review] [55 refs] SO - International Journal of Food Microbiology 1995 Jun;26(1):25-41 AB - Several media are proposed particularly for the detection of Aeromonas spp. but also for Plesiomonas shigelloides and Pseudomonas spp. Some are for general purposes and others specifically for the examination of clinical, environmental or food samples. All media are selective, due to antibiotics, bile salts, dyes and other selective agents, as well as differential, primarily based on the ability of the microorganisms to ferment/not ferment carbohydrates. As with all selective media, the recovery of stressed cells is sometimes prevented and the competing flora is not always completely inhibited so that confirmatory tests need to be made on presumptive positive colonies. The choice of a specific medium for isolation of Aeromonas spp. will always depend on the type of sample to be examined and whether the investigator needs qualitative detection or quantitative recovery. The best medium for quantitative estimation of Aeromonas spp. from food and environmental samples seems to be starch ampicillin agar (SAA), though others might be recommended. There is a need for a comparative study including Rippey Cabelli agar (mA), ampicillin bile salts inositol xylose (MIX) agar, ampicillin dextrin agar (ADA), dextrin fuchsin sulphite agar (DFS) and starch glutamate ampicillin penicillin C-glucose agar (SGAP-10C) in addition to SAA. For routine analysis of environmental and food samples for P. shigelloides, spread plating on inositol brilliant green bile salts (IBB) and plesiomonas (PL) agars is recommended. For Pseudomonas spp., CFC agar permits quantitative recovery of both pigmented and non-pigmented strains from food and environmental samples, whilst at the same time inhibiting most other organisms. [References: 55] <7> UI - 95362059 AU - Gamble CL IN - Cooper Clinic Osteoporosis Center, Fort Smith, AR, USA. TI - Osteoporosis: drug and nondrug therapies for the patient at risk. [Review] [17 refs] SO - Geriatrics 1995 Aug;50(8):39-43 AB - Preventing bone loss and avoiding fractures are the most effective therapies for osteoporosis. Nondrug measures include weight-bearing exercise, adequate calcium intake, and the prevention of falls. Estrogen replacement therapy can protect bone from rapid demineralization typical of the early post-menopausal period. New research has provided more data on estrogen's safety and efficacy. Calcitonin is an option when estrogen is contraindicated. Although calcitonin requires frequent injections, it does provide some analgesic effect for patients with osteoporosis-related fracture. Fluoride and etidronate have shown promise but remain investigational due to questions about long-term effects on bone mass. Potent third-generation bisphosphonates are being studied and may be available soon. [References: 17] <8> UI - 95370901 AU - Duperon DF IN - Pediatric Dentistry, University of California at Los Angeles, School of Dentistry 90024-1668, USA. TI - Early childhood caries: a continuing dilemma. [Review] [41 refs] SO - Journal of the California Dental Association 1995 Feb;23(2):15-6, 18, 20-2 passim AB - Early childhood caries continues to be a problem in the U.S. This paper examines the progression, etiology, prevention and treatment of this condition. A suggested future direction for research and governmental action needed to combat this expensive and debilitating condition is presented. The author recognizes all that the CDA has done and is doing to help prevent this debilitating oral disease in California. [References: 41] <9> UI - 95354069 AU - Limeback H IN - University of Toronto, Faculty of dentistry, USA. TI - Toward a caries-free society--fluoride therapies for today and the next century. [Review] [33 refs] SO - Journal / Canadian Dental Association. Journal de l Association Dentaire Canadienne 1995 Jul;61(7):601-5 <10> UI - 95352330 AU - Bishop K AU - Briggs P IN - Charles Clifford Dental Hospital, Sheffield. TI - Endodontic failure--a problem from top to bottom. [Review] [12 refs] SO - British Dental Journal 1995 Jul 8;179(1):35-6 AB - Endodontically treated teeth are susceptible to bacterial contamination through exposure to oral fluids. It is crucial, therefore, that restorations placed during and after root canal therapy protect the root canal from oral contamination. This paper highlights the clinical steps necessary to reduce the risk of contamination in root-filled teeth. [References: 12] <11> UI - 95331873 AU - Tanzer JM IN - Department of Oral Diagnosis, University of Connecticut School of Dental Medicine, Farmington. TI - Xylitol chewing gum and dental caries. [Review] [170 refs] SO - International Dental Journal 1995 Feb;45(1 Suppl 1):65-76 AB - There is an extensive peer-reviewed literature on xylitol chewing gum as it pertains to effects on tooth decay in human subjects, on human dental plaque reduction, on inhibition of dental plaque acid production, on inhibition of the growth and metabolism of the mutans group of streptococci which are the prime causative agents of tooth decay, on reduction of tooth decay in experimental animals, and on xylitol's reported contribution to the remineralisation of teeth. The literature not only supports the conclusion that xylitol is non-cariogenic but it is now strongly suggestive that xylitol is caries inhibitory, that is, anti-cariogenic in human subjects, and it supplies reasonable mechanistic explanation(s). [References: 170] <12> UI - 95331874 AU - Trahan L IN - Groupe de Recherche en Ecologie Buccale, Faculte de medecine dentaire, Pavillon de medecine dentaire, Universite Laval, Quebec, Canada. TI - Xylitol: a review of its action on mutans streptococci and dental plaque--its clinical significance. [Review] [170 refs] SO - International Dental Journal 1995 Feb;45(1 Suppl 1):77-92 AB - Many mechanisms have been proposed to explain the caries preventive effect of xylitol as a total or partial dietary sugar substitute. This article reviews the current knowledge of the effect of xylitol on the microbial population of dental plaque, particularly on mutans streptococci, in the light of an ecological concept of the oral environment and of the potential clinical significance. A noncariogenic commensal plaque flora constitutes the biotic component of a balanced ecosystem compatible with dental health. Dietary sugars, particularly sucrose, and sugar substitutes are abiotic environmental factors that can shift the delicate balance of the ecosystem towards a more or less cariogenic microbiota. Most dietary sugars are fermented by plaque microorganisms, favour the establishment of a cariogenic microflora and contribute to bacterial virulence. The vast majority of plaque bacteria, however, are incapable of fermenting xylitol into cariogenic acid end-products. There is no evidence that the plaque microbiota can adapt to metabolise xylitol or can be enriched with xylitol-metabolising cells even after long exposure to xylitol. Accumulated intracellularly as a non-metabolisable metabolite by mutans streptococci, xylitol inhibits its growth in vitro and reduces the amount of plaque and the number of mutans streptococci in both the plaque and saliva of xylitol consumers. When present in the oral environment xylitol not only prevents a shift of the bacterial community towards a more cariogenic microflora but also selects for a mutants population that was shown to have weakened virulence factors in preliminary in vitro experiments and in rats. Further research is needed to fully understand the clinical importance in the prevention of caries of this xylitol-selected population. [References: 170] <13> UI - 95321292 AU - Konig KG AU - Navia JM IN - University Medical Faculty, Nijmegen, Netherlands. TI - Nutritional role of sugars in oral health. [Review] [44 refs] SO - American Journal of Clinical Nutrition 1995 Jul;62(1 Suppl):275S-282S; discussion 282S-283S AB - The dental risk of dietary sugars is dependent mainly on the frequency of intake, but the prevalence of caries in a population is strongly modified by other dietary, social, and behavioral factors independent from intake of sugars. Regarding dietary factors, it must be remembered that hidden sugars in fruit as well as polysaccharides are cariogenic. The most important of the other factors is regular tooth brushing, which results in the removal of the bacterial plaque that causes caries and periodontal diseases and makes fluoride (which is contained in every advanced toothpaste) available for maintenance of the hard dental tissues and for remineralization wherever demineralization has occurred. This explains why in most highly developed countries caries prevalence has decreased markedly during the past 20 y although consumption of sugars remained high. [References: 44] <14> UI - 95318336 AU - Anusavice KJ TI - Treatment regimens in preventive and restorative dentistry. [Review] [70 refs] SO - Journal of the American Dental Association 1995 Jun;126(6):727-43 AB - Due in part to a lack of appropriate training and the incentive of adequate compensation, preventive dentistry in the United States has focused on prophylaxis and fluoride application. Dentistry must shift its attention to developing standardized protocols for "preservative dentistry"--diagnosing caries, assessing and monitoring caries risk, arresting active caries and remineralizing non-cavitated lesions. This article addresses shortcomings in preventive dentistry and proposes a plan for treatment standardization that can ensure optimum treatment and, ideally, lead to adequate compensation. [References: 70] <15> UI - 95292520 AU - Pitts NB AU - Longbottom C IN - Dental Health Services Research Unit, Dental School, University of Dundee, Scotland, UK. TI - Preventive Care Advised (PCA)/Operative Care Advised (OCA)--categorising caries by the management option. [Review] [41 refs] SO - Community Dentistry & Oral Epidemiology 1995 Feb;23(1):55-9 AB - Currently a range of systems and classifications are used by clinicians, epidemiologists and clinical research workers to sub-divide carious lesions into different grades. These systems are based on the depth of the lesion and/or the presence/absence of macroscopic cavitation. In order to improve upon the meaningfulness and comparability of such systems in the light of increasing knowledge about the disease process, lesion behaviour and caries management options, the authors propose a new system of categorisation that differentiates between lesions which normally require operative intervention and those which do not. In future, it is proposed that in addition to existing conventional criteria, diagnostic systems should also allow results to be expressed in terms of 1) lesions for which appropriate non-invasive Preventive Care Is Advised (PCA lesions) and 2) lesions for which Operative Care Is Advised (OCA lesions). Locally acceptable sub-divisions may have to be developed and agreed for certain specific applications. The adoption of this additional nomenclature and approach in the future should aid communications between the different groups involved in caries diagnosis and research. It may facilitate the dissemination of research findings, as well as helping to "drive" researchers working on caries diagnostic methods to focus on techniques which will aid in the accurate assessment of lesion activity and behaviour. Such a focus should also increase our understanding of treatment decision making and promote the development of clinical guidelines. The facility to retain existing criteria in parallel, for local and other purposes, would preserve comparability with data collected previously. [References: 41] <16> UI - 95287769 AU - Wigdor HA AU - Walsh JT Jr AU - Featherstone JD AU - Visuri SR AU - Fried D AU - Waldvogel JL IN - Ravenswood Hospital Medical Center, Wenske Laser Center, Chicago, IL 60640, USA. TI - Lasers in dentistry. [Review] [158 refs] SO - Lasers in Surgery & Medicine 1995;16(2):103-33 AB - Since the development of the ruby laser by Maiman in 1960, there has been great interest among dental practitioners, scientists, and patients to use this tool to make dental treatment more pleasant. Oral soft tissue uses are becoming more common in dental offices. The possible multiple uses of lasers in dentistry, beyond soft tissue surgery and dental composite curing, unfortunately, have not yet been realized clinically. These include replacement of the dental drill with a laser, laser dental decay prevention, and laser decay detection. The essential question is whether a laser can provide equal or improved treatment over conventional care. Safe use of lasers also must be the underlying goal of proposed or future laser therapy. With the availability and future development of different laser wavelengths and methods of pulsing, much interest is developing in this growing field. This article reviews the role of lasers in dentistry since the early 1960s, summarizes some research reports from the last few years, and proposes what the authors feel the future may hold for lasers in dentistry. [References: 158] <17> UI - 95279592 AU - Mandel ID IN - Columbia University School of Dental and Oral Surgery, New York 10032, USA. TI - Calculus update: prevalence, pathogenicity and prevention. [Review] [47 refs] SO - Journal of the American Dental Association 1995 May;126(5):573-80 AB - Does reduction of supragingival calculus provide only a cosmetic effect, or does it benefit oral health as well? The author discusses the causes and effects of calculus development and reviews methods of calculus control. [References: 47] <18> UI - 95294916 AU - Levy SM AU - Kiritsy MC AU - Warren JJ IN - Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City 52242, USA. TI - Sources of fluoride intake in children. [Review] [111 refs] SO - Journal of Public Health Dentistry 1995 Winter;55(1):39-52 AB - Wide variations in fluoride intake among children make estimating fluoride intake difficult. This paper discusses the various sources of fluoride intake among children, beginning with a review of the fluoride concentrations of water and other beverages, foods, and therapeutic fluoride products. A review of previous studies' estimates of fluoride intake from diet, dentifrice, fluoride supplements, fluoride mouthrinses, and gels, as well as total fluoride intake also is presented. Then, estimates of fluoride intake among young children of different age groups are summarized, and examples demonstrating the high level of variability of fluoride intake, both from individual sources and in total, are presented. Lastly, this paper discusses the implications of our current level of knowledge of children's fluoride intake, and presents recommendations for the use of fluoride for children in light of this current knowledge. The major recommendations are that: (1) the fluoride content of foods and beverages, particularly infant formulas and water used in their reconstitution, should continue to be monitored closely in an effort to limit excessive fluoride intake; (2) ingestion of fluoride from dentifrice by young children should be controlled, and the use of only small quantities of dentifrice by young children should be emphasized; and (3) dietary fluoride supplements should be considered a targeted preventive regimen only for those children at higher risk for dental caries and with low levels of ingested fluoride from other sources. [References: 111] <19> UI - 95300418 AU - Wahlig TM AU - Georgieff MK IN - Division of Neonatology, University of Minnesota School of Medicine, Minneapolis, USA. TI - The effects of illness on neonatal metabolism and nutritional management. [Review] [77 refs] SO - Clinics in Perinatology 1995 Mar;22(1):77-96 AB - In summary, careful attention to nutrient delivery in the IUGR infant is important to prevent and treat neonatal metabolic derangements and to improve postnatal growth. Carbohydrates are the essential fuel in the first days of life, to prevent hypoglycemia. Subsequent delivery of protein and fat helps rectify reduced muscle and fat stores and promotes weight gain. Calcium supplementation to prevent further bone demineralization and iron supplementation to replete iron stores may be necessary. Of special interest is that the neurologic outcome of these infants appears linked to the rate of catch-up growth. The rate of postnatal head growth depends on many perinatal and neonatal risk factors, and is a strong predictor of early developmental outcome in low-birthweight infants. Insufficient energy delivery beyond 2 weeks postnatal age in SGA premature infants results in failure to initiate subsequent catch-up head growth, with consequently smaller head circumferences at 1-year follow-up. [References: 77] <20> UI - 95310690 AU - Anonymous TI - Caries diagnosis and risk assessment. A review of preventive strategies and management. [Review] [72 refs] SO - Journal of the American Dental Association 1995 Jun;126 Suppl:1S-24S AB - The scientific basis for caries risk assessment, prevention and treatment on an individual patient basis requires further development, specification and continuing validation. Still, current technologies and techniques, taken together, can provide enhanced capabilities over those that have been employed traditionally. Undoubtedly, the clinical tools for carrying out these responsibilities will be refined and expanded in the future in response to the changing clinical profile of caries in the population. For example, bacteriologic testing methods have become easier and more reliable, and will become more widely used. Other effective methods to detect the early, pre-cavitation stage of caries also should become more available in the future. Practitioners will be continually challenged and responsible for evaluating the effectiveness and value of emerging technologies in their practices and in light of their patients' needs. But how can this be accomplished best? Effectiveness claims will be made for new drugs and devices that come onto the market. There are several sources of information to assist the practitioner in making such decisions. The American Dental Association acceptance programs (voluntary) and the U.S. Food and Drug Administration compliance programs (law) provide standards and guidance as to product safety and effectiveness. Without such determinations, the practitioner must judge independently product claims and clinical studies. Marketing materials by themselves (advertisements, videos, pamphlets) may not be sufficient evidence of effectiveness particularly when scientific references supporting claims either are not provided or are inadequate. Peer-reviewed scientific literature in publications of the major scientific and professional associations can be viewed as generally reliable. Changing the way dental caries is managed in clinical practice will require integrating new scientific information and technology into workable clinical procedures. Dental education and third-party reimbursement issues must be addressed also but are beyond the scope of this document. Given that disease patterns are always changing in the population, dentists need to modify practice decisions using risk assessment. Ultimately, the goal for dentistry is that adult patients also will enjoy the same low level of caries experience that many children enjoy today. [References: 72] <21> UI - 95271395 AU - Hergenroeder AC IN - Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston 77030-2399, USA. TI - Bone mineralization, hypothalamic amenorrhea, and sex steroid therapy in female adolescents and young adults. [Review] [90 refs] SO - Journal of Pediatrics 1995 May;126(5 Pt 1):683-9 AB - 1. The vast majority of bone mineralization in girls occurs by the middle of the second decade. 2. Premature bone demineralization occurs in women with hypothalamic dysfunction manifest as amenorrhea and oligomenorrhea, associated with athletics, dancing, and eating disorders. 3. In young women with amenorrhea associated with weight loss, BMD loss will be occurring soon after the amenorrhea develops. Treatment to prevent BMD loss or promote BMD accretion should begin soon, probably within 6 months after amenorrhea occurs. 4. Women who recover from anorexia nervosa at a young age (< 15 years of age) can have normal total body BMD, but regional (lumbar spine and femoral neck) BMD may remain low. The longer the anorexia nervosa persists, the less likely it is that the BMD will return to normal. Girls and women with anorexia nervosa need to be rehabilitated early in the disease to maximize BMD accretion. 5. Conjugated estrogen, in doses that improve bone mineralization in postmenopausal women and in combination with medroxyprogesterone, has not been shown to improve BMD in young women with hypothalamic amenorrhea. The role of orally administered medroxyprogesterone at a dose of 10 mg per day, 10 days per month, in improving BMD in teenage girls with hypothalamic amenorrhea or oligomenorrhea remains to be established. 6. Treatment with OCP may have a beneficial effect on BMD in young women with hypothalamic amenorrhea, but this has not been established in a double-masked, randomized, controlled trial. Doing a double-masked trial using OCP will be difficult because estrogen-deficient subjects treated with OCP will be likely to have menstrual bleeding, whereas those treated with placebo will not. In addition, the risk of pregnancy in a sexually active subject, who does not know whether she is receiving OCP, is too great for some subjects. 7. Osteoporosis is a major cause of morbidity and death. Peak bone mass is a major determinant of the risk of osteoporosis, and the second decade is the critical period of peak bone mass acquisition; thus providers of health care for adolescents need to understand the factors that affect bone mineralization during this period, and advise patients accordingly. [References: 90] <22> UI - 95211688 AU - Lewis DW AU - Ismail AI TI - Periodic health examination, 1995 update: 2. Prevention of dental caries. The Canadian Task Force on the Periodic Health Examination. SO - CMAJ 1995 Mar 15;152(6):836-46 AB - OBJECTIVE: To make recommendations, based on current evidence, for practising physicians and dentists on interventions for the prevention of dental caries in their patients. OPTIONS: Systemic fluoride administration, professionally administered fluoride, use of fluoride mouth rinses, fissure sealants, oral-hygiene practices, dietary practices, identification of groups at a high risk of dental caries, and early diagnosis and treatment. OUTCOMES: Reduced prevalence of dental caries and fluorosis, longer retention of teeth and lower treatment costs. EVIDENCE: Several MEDLINE searches were conducted for articles published from January 1980 to December 1992, including relevant review articles. VALUES: Relevant clinical findings were evaluated and categorized with the use of the evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination. Recommendations were developed for each method of caries prevention, with reduced incidence of dental caries and improved prevalence of caries-free teeth given high values. BENEFITS, HARMS AND COSTS: The potential benefits of these measures in the long-term are a lower incidence of tooth decay, longer retention of teeth and prevention of fluorosis. The cost saving can be considerable for patients and insurers; however, implementation of some recommendations will be difficult, since the traditional preventive practices of dentists and dental hygienists are not easily changed. RECOMMENDATIONS: There is good evidence that the following manoeuvres are effective in preventing dental caries: use of dentifrices containing fluoride, fluoridation of drinking water, fluoride supplements for patients in areas where there is a low level (0.3 ppm or less) of fluoride in the drinking water, professionally applied topical fluoride and the use of fluoride mouth rinses for patients with very active decay or at a high risk of dental caries and selective use of professionally applied fissure sealants on permanent molar teeth. There is poor evidence that the following manoeuvres are effective in preventing dental caries: professionally applied topical fluoride and the use of fluoride mouth rinses for patients with a low risk of caries, toothbrushing (without a dentifrice containing fluoride) and flossing, cleaning of teeth by a dentist or dental hygienist before topical application of fluoride or at a dental visit and dietary counselling for the general population. There is good evidence to recommend against the use of over-the-counter fluoride mouth rinses by the general population. VALIDATION: These guidelines are compatible with those of the US Preventive Services Task Force. SPONSOR: These guidelines were developed and endorsed by the task force, which is funded by Health Canada. Major funding was provided by the Faculty of Dentistry of the University of Toronto, Toronto and the Faculty of Dentistry of Dalhousie University, Halifax. <23> UI - 95225807 AU - Manton DJ AU - Messer LB IN - University of Melbourne. TI - Pit and fissure sealants: another major cornerstone in preventive dentistry. [Review] [108 refs] SO - Australian Dental Journal 1995 Feb;40(1):22-9 AB - Despite dramatic reductions in caries in fluoridated communities, the disease continues to occur during childhood and adolescence and there is a sustained caries susceptibility of pits and fissures. Pit and fissure sealants have been available to the dental profession for the past two decades. Closely following community water fluoridation, this use of adhesive technology is now recognized as a major cornerstone of modern preventive dentistry. However, the technique appears to have been slow in implementation by the dental profession. Recent expanded utilization of sealants in the public sector, particularly in Victoria, has increased the awareness of the procedure amongst the public and is heightening demand. A review of the pertinent literature and current trends in utilization of sealants is presented. The case is made for expanded utilization of sealants in both the public and private sectors of dental health care delivery in Australia. [References: 108] <24> UI - 95205440 AU - Cherry-Peppers G AU - Sinkford JC AU - Newman ES AU - Sanders CF AU - Knight RS IN - National Health Service Corps, Rockville, Maryland 20857. TI - Primary oral health care in black Americans: an assessment of current status and future needs. [Review] [37 refs] SO - Journal of the National Medical Association 1995 Feb;87(2):136-40 AB - To improve health for all in the United States by the year 2000, dental health needs must be considered a component of total health and primary care. The failure to address dental needs has reached a crisis level, particularly in the black and underserved communities throughout the nation. Data from several nationwide studies have shown that oral disease is greater in black Americans than their white counterparts. More severe periodontal disease patterns, untreated dental decay, and earlier tooth loss were observed. Key minority subgroups received less preventive care. [References: 37] <25> UI - 95142057 AU - Navia JM IN - School of Public Health, University of Alabama at Birmingham 35294-0019. TI - A new perspective for nutrition: the health connection. [Review] [7 refs] SO - American Journal of Clinical Nutrition 1995 Feb;61(2):407S-409S AB - The science of nutrition has undergone a major transformation in its objectives and approaches because of the influence of new understanding in epidemiology of oral diseases in technically developed countries, as well as in developing countries with different environmental circumstances. Recent findings of biochemical, immunological, and molecular biology investigations related to oral tissues have also added a new health dimension to this understanding. The major challenge ahead is not only to continue to expand the available scientific information, but to recognize the role that nutrition has for oral tissues, which is no different than the one it has for other tissues and organ systems. Investigators in other fields have been incorporating these new concepts about nutrition in the planning of their research during the past decade, but this emphasis has been lacking in dental research and this needs to be corrected. Still, we have one more challenge ahead, and that is to transfer to the general public the information generated by research in our laboratories and clinics in a prudent and effective way. This will ensure that consumers will take advantage of nutrition information alongside oral health concepts to maintain good general health while preventing and controlling oral diseases. There is much work ahead to be done, but the following papers have already started to set up research guidelines for the future. [References: 7] <26> UI - 95142059 AU - Papas AS AU - Joshi A AU - Belanger AJ AU - Kent RL Jr AU - Palmer CA AU - DePaola PF IN - Tufts University School of Dental Medicine, Boston, MA 02111-1513. TI - Dietary models for root caries. [Review] [63 refs] SO - American Journal of Clinical Nutrition 1995 Feb;61(2):417S-422S AB - A stepwise multiple logistic regression was computed to assess which of the nutritional variables differentiate the healthy and diseased group of participants in the Forsyth Specialized Caries Center (n = 275). Variables considered as candidates for the model included the consumption per week of sugars, starch, cheese, fruits and fruit juices, noncariogenic foods, and dairy products. Two variables--sugars and cheese--were statistically significant by the stepwise procedure. Increased intake of sugar was associated with being in the root caries group, whereas high intake of cheese was negatively associated with root caries. Thus, cheese seems to have a protective effect after sugar intake is controlled for. Odds ratios were computed to quantify the influence of the variables. An increase of two exposures of sugar per day corresponded with an odds ratio of 1.26. The odds ratio continues to increase with sugar intake so that an increase to five exposures per day gives an odds ratio of 1.79. This model is consistent with past in vitro studies suggesting that cheese protects against caries formation when sugar intake is controlled for and that increasing frequency of sugar intake increases the odds of root caries. [References: 63] <27> UI - 95142064 AU - Hargreaves JA IN - Faculty of Dentistry, University of Alberta, Canada. TI - Discussion: diet and nutrition in dental health and disease. [Review] [23 refs] SO - American Journal of Clinical Nutrition 1995 Feb;61(2):447S-448S AB - The recognition in 1993 by the International Association of Dental Research (IADR) for the initiation of a Nutrition Research Group within the Association prompted this nutrition symposium related to diet and nutrition in health and disease. The IADR Nutrition Research Group is encouraged to collaborate with other nutritional research groups in important areas of medicine, food science technology, and agriculture to target health issues influenced by dietary choices, nutritional adequacy, and dental health status. [References: 23] <28> UI - 98245749 AU - Selnes JE AU - Sectakof PA IN - Department of Orthodontics, Faculty of Dentistry, University of Toronto. TI - Iatrogenic effects of orthodontic treatment. Part II: Demineralization. [Review] [8 refs] SO - University of Toronto Dental Journal 1994;7(1):12-4 <29> UI - 98245750 AU - Chan AR IN - Faculty of Dentistry, University of Toronto. TI - Dental caries and periodontal disease in Down's syndrome patients. [Review] [23 refs] SO - University of Toronto Dental Journal 1994;7(1):18-21 <30> UI - 98245754 AU - Limeback H IN - Preventive Dentistry, Faculty of Dentistry, University of Toronto. TI - Current recommendations for appropriate use of fluoride supplements for the prevention of dental caries. [Review] [20 refs] SO - University of Toronto Dental Journal 1994;8(1):19, 21, 23 passim <31> UI - 98186976 AU - Glass RT IN - Department of Oral Pathology, University of Oklahoma College of Dentistry, USA. TI - The ingredients of a successful snuff cessation program. [Review] [7 refs] SO - Journal - Oklahoma Dental Association 1994 Fall;85(2):20-3 AB - From the brief outline of the details so necessary for a successful snuff cessation program, it is apparent that snuff addiction is a complex and difficult issue. In the same way that some things in clinical dentistry you prefer to do and some things you prefer to refer, so it may be for your snuff addicts. By virtue of your rapport with your patient, you may be the best to treat the patient's addiction or you may want to refer the patient to an established snuff cessation program (not a cigarette cessation program). Simply telling the snuff addict not to dip is grossly inadequate. Dentists have been very successful in stemming the tide of dental caries and periodontal disease. From the knowledge gained in these prevention programs and the fact that snuff has such an impact in the mouth, the dentist is the natural health care provider to conduct successful snuff cessation programs. [References: 7] <32> UI - 98201399 AU - Miller M AU - Truhe T IN - Princeton Dental Resource Center (PDRC), USA. TI - Fluoride: an update for the year 2000. [Review] [33 refs] SO - Dentistry Today 1994 Oct;13(10):34, 36, 38-41 <33> UI - 98130179 AU - Perlus J TI - Determining recall frequency. A controversial issue. [Review] [84 refs] SO - Ontario Dentist 1994 Sep;71(7):31-5 <34> UI - 98130193 AU - Zettle K TI - The fluoridation controversy: a debate. Part I: The cons of fluoridation. [Review] [18 refs] SO - Ontario Dentist 1994 Oct;71(8):23-5, 27-8 <35> UI - 98130194 AU - Kassirer B TI - The fluoridation controversy: a debate. Part II: The pros of fluoridation. [Review] [21 refs] SO - Ontario Dentist 1994 Oct;71(8):29, 31-2 <36> UI - 96013537 AU - Liebenberg WH TI - The fissure sealant impasse [editorial]. [Review] [25 refs] SO - Quintessence International 1994 Nov;25(11):741-5 <37> UI - 95369542 AU - Kidd EA AU - Joyston-Bechal S IN - Department of Conservative Dental Surgery, United Medical and Dental School, Guy's Hospital, London. TI - Update on fissure sealants. [Review] [17 refs] SO - Dental Update 1994 Oct;21(8):323-6 AB - The pit and fissure sealants that are commercially available today are designed to prevent plaque, bacteria and carbohydrates from entering the fissures and causing caries. This article will concentrate on contemporary diagnostic problems and indications for fissure sealing. Brief mention will be made of innovations in materials and techniques. [References: 17] <38> UI - 95217994 AU - Scannapieco FA IN - Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo 14214, USA. TI - Saliva-bacterium interactions in oral microbial ecology. [Review] [399 refs] SO - Critical Reviews in Oral Biology & Medicine 1994;5(3-4):203-48 AB - Saliva is thought to have a significant impact on the colonization of microorganisms in the oral cavity. Salivary components may participate in this process by one of four general mechanisms: binding to microorganisms to facilitate their clearance from the oral cavity, serving as receptors in oral pellicles for microbial adhesion to host surfaces, inhibiting microbial growth or mediating microbial killing, and serving as microbial nutritional substrates. This article reviews information pertinent to the molecular interaction of salivary components with bacteria (primarily the oral streptococci and Actinomyces) and explores the implications of these interactions for oral bacterial colonization and dental plaque formation. Knowledge of the molecular mechanisms controlling bacterial colonization of the oral cavity may suggest methods to prevent not only dental plaque formation but also serious medical infections that may follow microbial colonization of the oral cavity. [References: 399] <39> UI - 95169229 AU - Nancollas GH AU - Johnsson MA IN - Department of Chemistry, State University of New York at Buffalo 14214. TI - Calculus formation and inhibition. [Review] [37 refs] SO - Advances in Dental Research 1994 Jul;8(2):307-11 AB - The formation, development, and dissolution of hard deposits such as calculus are complex processes that involve numerous calcium phosphate phases as well as the interaction of these ions with organic molecules. Although formation is determined by thermodynamic driving forces, kinetic factors are also important determinants for the precipitation of specific calcium phosphate phases. The overall process, therefore, may involve the formation of metastable intermediates which may subsequently transform into the more stable hard deposits observed in vivo. A knowledge of the kinetics of growth of both individual calcium phosphate phases and their mixtures is important for elucidating the mechanism of calculus formation. Although salivary proteins are effective inhibitors of the mineralization reactions that take place in dental plaque, once adsorbed, their conformation may change to present surfaces that catalyze the nucleation of mineral phases. The variable pH conditions in plaque, expressed in terms of free ionic concentrations, will markedly alter the supersaturations with respect to typical calcium phosphate precursor phases such as dicalcium phosphate dihydrate (DCPD) and octacalcium phosphate (OCP). Physical-chemical studies have shown that the mineralization of all the calcium phosphate phases is controlled by reactions at the surface rather than by diffusion of lattice ions through the contacting liquid phase. This makes the rates of reaction very sensitive to ions and molecules in the solution that may absorb at the active growth sites and, while not significantly incorporating into the precipitated crystal phases, markedly influences the rates of mineralization and demineralization.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 37] <40> UI - 95169227 AU - Adams D AU - Addy M IN - Department of Basic Dental Science, Dental School, Cardiff, Wales. TI - Mouthrinses. [Review] [101 refs] SO - Advances in Dental Research 1994 Jul;8(2):291-301 AB - Mouthrinses have been used for centuries for medicinal and cosmetic purposes, but it is only in recent years that the rationale behind the use of the ingredients has been subject to scientific research and clinical trials. Although Listerine held its position for many years in the vanguard of the anti-plaque agents, the advent of mouthrinses containing chlorhexidine was a major breakthrough in the research for a chemical means to prevent disease. Since that time, and especially in the past ten years, the number of formulations that claim to have anti-plaque, anti-calculus, and anti-caries activity has increased, and much emphasis has been placed on such substances as an adjunct to, or indeed to replace, conventional toothbrushing techniques. This review covers the literature on mouthrinses over the past five years, concentrating more on the anti-plaque, anti-gingivitis, and anti-calculus formulations. In the first section, the methods of conducting clinical trials of mouthrinses are discussed, and a plea is made for a greater degree of standardization of methodology with agreed acceptable levels of clinical benefit. Trials of established mouthrinses are considered, and the advantages and disadvantages of several newer formulations discussed. From the review, it appears that chlorhexidine has no equal in its effects on reduction of plaque and gingivitis, but major drawbacks lie in the taste and stain-producing problems. The pre-brushing rinse, Plax, does not have unqualified success in all trials, though the more recent European formulation may have promise. Newer rinses which inhibit bacterial adhesion to tooth surfaces also appear promising, and it is suggested that more work on combinations of active ingredients is necessary. [References: 101] <41> UI - 95169226 AU - Russell RR IN - Department of Oral Biology, Dental School, University of Newcastle, Newcastle upon Tyne, UK. TI - Control of specific plaque bacteria. [Review] [49 refs] SO - Advances in Dental Research 1994 Jul;8(2):285-90 AB - The Specific Plaque Hypothesis posits that particular bacteria are of unique importance in the etiology of dental caries and periodontal diseases, and a logical conclusion is that these bacteria should be the targets for our 'magic bullets' in devising plaque-control methods. This paper considers the development of preventive measures based on understanding of the significance of particular bacterial species and the properties of those bacteria. Knowledge of the importance of specific organisms as mediators of disease and molecular studies on the properties of potential virulence factors may reveal potential targets for inhibition, blocking by synthetic analogues, or functional inactivation by antibodies. [References: 49] <42> UI - 95169223 AU - Marsh PD IN - PHLS Centre for Applied Microbiology and Research, Salisbury, England. TI - Microbial ecology of dental plaque and its significance in health and disease. [Review] [80 refs] SO - Advances in Dental Research 1994 Jul;8(2):263-71 AB - Dental plaque forms naturally on teeth and is of benefit to the host by helping to prevent colonization by exogenous species. The bacterial composition of plaque remains relatively stable despite regular exposure to minor environmental perturbations. This stability (microbial homeostasis) is due in part to a dynamic balance of both synergistic and antagonistic microbial interactions. However, homeostasis can break down, leading to shifts in the balance of the microflora, thereby predisposing sites to disease. For example, the frequent exposure of plaque to low pH leads to inhibition of acid-sensitive species and the selection of organisms with an aciduric physiology, such as mutans streptococci and lactobacilli. Similarly, plaque accumulation around the gingival margin leads to an inflammatory host response and an increased flow of gingival crevicular fluid. The subgingival microflora shifts from being mainly Gram-positive to being comprised of increased levels of obligately anaerobic, asaccharolytic Gram-negative organisms. It is proposed that disease can be prevented or treated not only by targeting the putative pathogens but also by interfering with the processes that drive the breakdown in homeostasis. Thus, the rate of acid production following sugar intake could be reduced by fluoride, alternative sweeteners, and low concentrations of antimicrobial agents, while oxygenating or redox agents could raise the Eh of periodontal pockets and prevent the growth and metabolism of obligately anaerobic species. These views have been incorporated into a modified hypothesis (the "ecological plaque hypothesis") to explain the relationship between the plaque microflora and the host in health and disease, and to identify new strategies for disease prevention. [References: 80] <43> UI - 95169220 AU - Edgar WM AU - Higham SM AU - Manning RH IN - Department of Clinical Dental Sciences, School of Dentistry, Liverpool, England. TI - Saliva stimulation and caries prevention. [Review] [63 refs] SO - Advances in Dental Research 1994 Jul;8(2):239-45 AB - The protective role of saliva is demonstrated by the rampant caries seen in human subjects with marked salivary hypofunction, and in desalivated animals. In normal cases, however, the relationship between saliva flow and coronal or root caries experience is doubtful, and to examine the concept that stimulation of saliva might have protective effects against caries, one must look beyond a simple correlation between caries and flow rate. Protective properties of saliva which increase on stimulation include salivary clearance, buffering power, and degree of saturation with respect to tooth mineral. These benefits are maximized when saliva is stimulated after the consumption of fermentable carbohydrates, by reducing the fall in plaque pH leading to demineralization and by increasing the potential for remineralization. Plaque acid production is neutralized, and experimental lesions in enamel are remineralized, when gum is chewed to stimulate saliva after a carbohydrate intake. The pH-raising effects are more easily explained by the buffering action of the stimulated saliva than by clearance of carbohydrates. The remineralization action depends upon the presence of fluoride. These findings suggest that the protective actions of saliva can be mobilized by appropriate salivary stimulation, and that in addition to established procedures such as tooth cleaning and fluoride regimens, eating patterns which lead to saliva stimulation to increase the potential for saliva protection might be included in recommendations for caries prevention. Confirmation of this concept in clinical tests is required. [References: 63] <44> UI - 95169219 AU - Lagerlof F AU - Oliveby A IN - Department of Cariology, School of Dentistry, Karolinska Institutet, Huddinge, Sweden. TI - Caries-protective factors in saliva. [Review] [183 refs] SO - Advances in Dental Research 1994 Jul;8(2):229-38 AB - Saliva influences caries attack mainly by its rate of flow and by its content of fluoride. The salivary flow rate influences to a high degree the rate of oral and salivary clearance of bacterial substrates included in foods and snacks. This influence is site-dependent. The basal salivary fluoride concentration is low, about 1 mumol/L, independent of salivary flow rate, and not influenced by diurnal variation. After an exposure of the oral cavity to fluoride, the increased fluoride level is decreased by a process influenced mainly by the salivary flow rate and the volumes of saliva in the mouth before and after swallowing. Other less important caries-protective factors in saliva include its buffer ability, its content of calcium, inorganic phosphate, pH-increasing substances, and anti-microbial agents. [References: 183] <45> UI - 95169213 AU - Ogard B AU - Seppa L AU - Rolla G IN - Department of Orthodontics, Faculty of Dentistry, University of Oslo, Norway. TI - Professional topical fluoride applications--clinical efficacy and mechanism of action. [Review] [122 refs] SO - Advances in Dental Research 1994 Jul;8(2):190-201 AB - All currently used topical fluoride agents deposit soluble fluoride as calcium fluoride on enamel or in lesions. Calcium fluoride serves as a source of fluoride for the formation of fluorapatite. The latter phase is formed when pH drops in plaque, not during topical application. The potential for calcium fluoride formation should probably be increased in topical fluoride agents. In countries with low caries prevalence, the clinical recommendations for topical fluoride need to be reconsidered. Toothpaste is the basic fluoride regimen recommended for everybody. The need for additional fluoride supplementation depends on caries activity. There is no distinct difference in the caries-preventive effects of concentrated fluoride solutions, gels, or varnishes. Thus, the choice of method depends on costs, convenience, patient acceptance, and safety. The use of fluoride varnishes has proven to be a feasible and safe method of fluoride application. With fluoride varnishes, the amounts of fluoride exposure can be better controlled, and less chair-time is required compared with conventional solutions and gels. No dose-response effect to concentrated fluoride agents is apparent, and the benefit of frequent application is not clearly established. In individuals with the most severe cariogenic challenge, combinations of fluoride and antimicrobials may give better clinical effects than fluoride alone. [References: 122] <46> UI - 95169211 AU - O'Mullane DM IN - Oral Health Services Research Centre, University Dental School, Wilton, Cork, Ireland. TI - Systemic fluorides. [Review] [26 refs] SO - Advances in Dental Research 1994 Jul;8(2):181-4 AB - Fluoridation of domestic water supplies has been shown to be effective in reducing the prevalence of dental caries in numerous studies conducted world-wide over the last 50 years. The most widely used systemic alternative to water fluoridation is salt fluoridation, which has been found to be effective against dental caries in programs conducted in Switzerland and Hungary. Currently, fluoridated salt is sold in eight countries. Studies conducted on fluoridated milk in Scotland, Hungary, and Bulgaria have shown it to be effective against dental caries, and a number of fluoridated milk programs are currently at the planning stage. The feasibility of using fluoridated sugar in communities where alternative preventive strategies are not feasible is currently being investigated. [References: 26] <47> UI - 95169205 AU - ten Cate JM IN - Department of Cardiology and Endodontology, Academic Centre for Dentistry, Amsterdam, the Netherlands. TI - In situ models, physico-chemical aspects. [Review] [51 refs] SO - Advances in Dental Research 1994 Jul;8(2):125-33 AB - In situ (intra-oral) caries models are used for two purposes. First, they provide information about oral physiological processes. Such information helps to detail our knowledge of the oral ecosystem and to verify conclusions from in vitro experiments. Second, in situ models are utilized to test preventive agents in the phase between laboratory testing and clinical trials. Most investigations involving enamel inserts have been aimed at testing new dentifrices. The experimental designs of such studies usually do not allow one to draw conclusions on physico-chemical processes, e.g., because of single point measurements. Studies of model parameters (lesion type, lesion severity, and de/remineralization in time) constitute only a minority of the research reports. The most striking observation obtained with in situ models has been the significant differences in de/remineralization observed among individuals and, more importantly, within one individual during different time periods and between different sites in the same mouth (for review, see ten Cate et al., 1992). Regardless of this, some general findings can be inferred: During in situ demineralization, up to 62 vol% microns/day may be removed from enamel. For dentin specimens, this value may be as high as 89 vol% microns/day. For remineralization, during fluoride dentifrice treatment, a median deposition rate of 0.7%/day (for lesions with integrated mineral loss values between 2000 and 4000 vol% microns) is found. The rate of deposition seems to be correlated with the extent of the pre-formed lesion. This suggests that the number of sites (crystallite surface) available for calcium phosphate precipitation is an important parameter.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 51] <48> UI - 95146354 AU - LeMaster PL AU - Connell CM IN - Department of Health Behavior and Health Education, University of Michigan, Ann Arbor 48109-2029. TI - Health education interventions among Native Americans: a review and analysis. [Review] [61 refs] SO - Health Education Quarterly 1994 Winter;21(4):521-38 AB - Relatively few health education interventions directed at preventive health behaviors and management of chronic illness among Native Americans have been reported in the literature. This article provides a selective review of health education interventions among Native Americans that address the prevention and management of chronic illnesses/conditions as well as preventive health behaviors. For each intervention included in the review, a description of its cultural relevance, sample, design, and evaluation is provided. Limitations are noted, as well as implications for research and practice. [References: 61] <49> UI - 95150441 AU - Mandel ID IN - Columbia University, School of Dental and Oral Surgery. TI - Great expectations: the impact of research on dental practice and education. Part I. [Review] [46 refs] SO - Annals of Dentistry 1994 Winter;53(2):3-9 <50> UI - 95147203 AU - McComb D IN - Department of Restorative Dentistry, Faculty of Dentistry, University of Toronto, Ont., Canada. TI - Operative dentistry considerations for the elderly. [Review] [54 refs] SO - Journal of Prosthetic Dentistry 1994 Nov;72(5):517-24 AB - As the mean age of an older dentate population increases, so does the incidence of dental caries in its primary and secondary forms. Primary and secondary root decay gingival to existing restorations are significant operative problems prevalent in the elderly. Treated root decay is prone to recurrence if the etiology is ignored. Effective, customized prevention must parallel operative intervention. The dentist today has a wider selection of techniques and materials than ever before to treat the elderly patients. Use of preventive restorative materials such as conventional and hybrid glass ionomer materials for the treatment of root decay are discussed. [References: 54] <51> UI - 95158190 AU - Seow WK AU - Shusterman S IN - University of Queensland Dental School, Brisbane, Australia. TI - Spectrum of dentin dysplasia in a family: case report and literature review. [Review] [25 refs] SO - Pediatric Dentistry 1994 Nov-Dec;16(6):437-42 AB - The dentin dysplasias (DD), which may be classified as type 1 (DD1) or type 2 (DD2), form a group of rare, inherited dentin abnormalities that are clinically distinct from dentinogenesis imperfecta. Studies of affected families may help to distinguish different types of DD and provide further insight into their etiology and clinical management. This report describes a family that showed characteristic dental features of DD1, including clinically normal crowns in both primary and permanent dentitions, and mobile teeth that may be associated with premature exfoliation. Radiographic features included calcification of the pulp with crescent-shaped, radiolucent pulp remnants, short, tapering, taurodontic roots, and many periapical pathoses that may be cysts or granulomas. A spectrum of dentin dysplasia was noted within the family. Strategies to prevent pulp and periapical infections and early exfoliation of the teeth include meticulous oral hygiene and effective caries-preventive measures. [References: 25] <52> UI - 95161354 AU - Chadwick BL IN - Department of Child Dental Health, University of Wales College of Medicine, Heath Park, Cardiff, U.K. TI - Products for prevention during orthodontics. [Review] [36 refs] SO - British Journal of Orthodontics 1994 Nov;21(4):395-8 AB - The potential for iatrogenic damage following fixed orthodontic treatment has been well documented for many years. Enamel decalcification and gingival inflammation are preventable if good practice is followed. Patients with gingivitis or active caries should not be considered for fixed orthodontics until the disease is controlled. Diet advice, oral hygiene, and topical fluorides are the basic elements of any preventive regime, and while they need to be individually tailored for each patient, fluoride mouthrinses should be routinely used by all patients with fixed appliances. The susceptibility of enamel adjacent to an orthodontic attachment remains a problem which future improvements in adhesive materials may help to address. [References: 36] <53> UI - 95134138 AU - Johnston T AU - Messer LB IN - University of Melbourne. TI - Nursing caries: literature review and report of a case managed under local anaesthesia. [Review] [52 refs] SO - Australian Dental Journal 1994 Dec;39(6):373-81 AB - Although the prevalence of dental caries in children has fallen in recent years, significant numbers of children are still treated for nursing caries. This form of rampant caries affects the primary dentition and causes rapid destruction of normally resistant surfaces. The treatment of nursing caries is multifactorial, involving the child, parents, dental team and other health care providers to ensure the restorative dental treatment is supported by parental education in caries prevention, oral hygiene and infant nutrition. This paper presents a literature review on the condition, followed by a case report of a child with nursing caries treated in the clinic under local anaesthesia. [References: 52] <54> UI - 95113551 AU - Oguntebi BR IN - Department of Endodontics, University of Florida, College of Dentistry, Gainesville 32610-0436. TI - Dentine tubule infection and endodontic therapy implications. [Review] [52 refs] SO - International Endodontic Journal 1994 Jul;27(4):218-22 AB - A critical review of the literature suggests that the microenvironment of dentinal tubules appears to favour the selection of relatively few bacterial types irrespective of the aetiology of the infection process; coronal dental caries or pulpar necrosis. These bacteria may constitute an important reservoir from which root canal infection and reinfection may occur following pulp necrosis or during and after endodontic treatment. Previous studies of this microflora have utilized microbiological culture techniques which need to be supplemented by those that allow in situ demonstration as well as identification of the bacteria. Newer treatment strategies that are designed to eliminate this microflora must include agents that can penetrate the dentinal tubules and destroy these microorganisms, since they are located in an area beyond the host defence mechanisms where they cannot be reached by systemically administered antimicrobial agents. [References: 52] <55> UI - 95085666 AU - Kleerekoper M IN - Division of Endocrinology, Wayne State University, School of Medicine, Detroit, MI 48201. TI - Non-dental tissue effects of fluoride. [Review] [44 refs] SO - Advances in Dental Research 1994 Jun;8(1):32-8 AB - The anti-caries effects of water fluoridation are well-established. The non-dental tissue effects of fluoride in drinking water, either naturally occurring or as an additive, have been too poorly studied to permit definitive conclusions to be drawn. Claims have been made that fluoride results in an increased occurrence of malignancies, particularly osteogenic sarcoma. Experimental rat data have not resolved this issue, and epidemiologic studies are equally unclear. Initial claims that fluoride offers protection against atherosclerosis remain viable, but here too, much more directed research is needed. Early studies suggested that a water fluoride content greater than 1 ppm resulted in a lower prevalence of osteoporotic fractures. Recent epidemiologic data seriously question this conclusion and raise the possibility that even this relatively low level may increase the prevalence of osteoporotic hip fractures. Other elements, including calcium and magnesium, also vary in amount as water fluoride content varies, and it has proved difficult to distinguish the independent effects of the various nutrients in water from each other. Therapeutic use of fluoride has been largely restricted to studies of its effect on the osteoporotic study, this important issue remains unresolved. This review provides an overview of these issues, focusing on the uncertainties alluded to, and attempting to develop strategies for future research. [References: 44] <56> UI - 95079479 AU - Gregory RL IN - Indiana University, School of Dentistry, Indianapolis. TI - Dental caries vaccines: science and status. [Review] [47 refs] SO - Compendium 1994 Oct;15(10):1282, 1284, 1286 passim; quiz 1294 AB - Dental caries, caused by the etiologic agent Streptococcus mutans, is considered the most common human infectious disease. Development of a vaccine has been under investigation for more than 25 years. Possible approaches include immunizing patients using an oral vaccine containing components of the causative bacterium and by intramuscular injection. Although both approaches have proved promising, several considerations have delayed further development of a vaccine. This article reviews the scientific results and status of the various vaccines. [References: 47] <57> UI - 95077789 AU - Cox CF IN - Department of Restorative Dentistry, School of Dentistry, University of Alabama, Birmingham. TI - Evaluation and treatment of bacterial microleakage. [Review] [39 refs] SO - American Journal of Dentistry 1994 Oct;7(5):293-5 AB - Recent data have shown a correlation between pulp response and material biocompatibility when microleakage is prevented. Considering vital dentin, the dentist must keep in mind that it is an extension of the pulp, presenting the first line of response to the consequences of microleakage. Healing of the dental pulp is ensured when a clinical seal is provided to prevent bacterial microleakage. Microleakage is a biological phenomenon with several important clinical implications. The affective component clinically presents as dentin postoperative hypersensitivity due to the episodic hydrodynamic fluid movement within the tubule complex. The effective component is the disease process which signals the dentin and pulp complex to respond by deposition of sclerotic and reparative dentin deposition. Uncontrolled microleakage generally produces patient pain as well as to later allow bacterial infection resulting in recurrent caries and pulp inflammation. The dynamic, permeable nature of the dentin interface allows residual bacteria to proliferate following cavity preparation. Following sterile operative procedures, bacteria have been shown to percolate into the cavosurface margin resulting in recurrent caries and pulp inflammation. This report considers biological data emphasizing the clinical necessity to provide a hermetic seal to prepared dentin to prevent both dentin hypersensitivity and pulp inflammation. [References: 39] <58> UI - 95077788 AU - Mount GJ IN - University of Adelaide, Australia. TI - Glass ionomer cements and future research. [Review] [25 refs] SO - American Journal of Dentistry 1994 Oct;7(5):286-92 AB - Once a root surface lesion has extended into tooth structure beyond the point at which it can be successfully remineralized it is necessary to carry out traditional restorative procedures. Often the extent of the lesion is difficult to define and development of a pulp exposure is an ever present risk. Access may be difficult and placement of a restorative material, such as amalgam, which requires positive condensation for correct placement, poses a problem. The principal requirement of a restoration in such a lesion is that it should completely seal the restoration/tooth interface and prevent the ingress of further bacteria or bacterial nutrients. As there will be no occlusal load, physical properties of the restorative material are not significant. As these lesions will often occur on anterior teeth it is desirable that the material be reasonably esthetic although there will be no need for a great depth of translucency. The modern trend to light curing of restorative materials facilitates placement but there are situations with these lesions where it is difficult or impossible to obtain proper access for the light and an auto cure material may be indicated. Because the patient who presents with root surface lesions is likely to pose a continuing problem, it is desirable that the restorative material have some degree of in-built protection against further demineralization. An ongoing fluoride release is very desirable. Glass ionomer cement fulfils all the above requirements and is therefore at present the material of choice. Either the original auto cure cement or the newer dual cure materials will provide a complete marginal seal with a continuing fluoride release throughout the life of the restoration and both varieties are sufficiently esthetic to be entirely acceptable. [References: 25] <59> UI - 95077786 AU - Donly KJ IN - Department of Pediatric Dentistry, College of Dentistry, University of Iowa, Iowa City. TI - Enamel and dentin demineralization inhibition of fluoride-releasing materials. [Review] [36 refs] SO - American Journal of Dentistry 1994 Oct;7(5):275-8 AB - Fluoride-releasing dental restorative materials may provide an additional benefit in preventive dentistry. Although not currently available in the United States, a fluoride-releasing amalgam has demonstrated recurrent caries inhibition at enamel and dentin restoration margins. Likewise, both chemical-cured and light-cured glass ionomer cements have demonstrated caries inhibition at enamel and dentin restoration margins. Fluoride-releasing resin composites have also consistently demonstrated recurrent caries inhibition at enamel margins, yet there are conflicting results whether caries inhibition occurs at dentin margins. Preliminary studies indicate that glass ionomer cement and fluoride-releasing resin composite have synergistic effects with fluoride rinses and fluoridated dentifrices, in the remineralization of incipient enamel caries. The materials may act as a fluoride delivery system. Upon exposure to additional external fluoride, the material surface undergoes an increase in fluoride. This fluoride is subsequently released and has demonstrated demineralization inhibition and even remineralization at adjacent tooth structure. Clinical research to evaluate these fluoride-releasing restorative materials may provide further information for clinical recommendations. [References: 36] <60> UI - 95077785 AU - Featherstone JD IN - Department of Oral Sciences, Eastman Dental Center, Rochester, New York. TI - Fluoride, remineralization and root caries. [Review] [26 refs] SO - American Journal of Dentistry 1994 Oct;7(5):271-4 AB - This paper reviews the probable mechanism of dental caries and the role of fluoride in the inhibition or reversal of that process. The initial stages of root caries are comparable to enamel caries, being the acid dissolution of mineral resulting from acids generated by bacterial metabolism. The fermentation of carbohydrates by oral bacteria including mutans streptococci and lactobacilli initiate the root caries process, removing mineral from among the organic matrix which is primarily composed of collagen. Subsequent to this demineralization, the organic material can be further broken down by bacterial enzymes. Fluoride inhibits mineral loss during the acid dissolution process and enhances remineralization in a similar manner to that which occurs in dental enamel. [References: 26] <61> UI - 95077783 AU - Wefel JS IN - Dows Institute for Dental Research, College of Dentistry, University of Iowa, Iowa City. TI - Root caries histopathology and chemistry. [Review] [29 refs] SO - American Journal of Dentistry 1994 Oct;7(5):261-5 AB - This paper reviews the histopathology of root surface caries, and the effect of fluoride on the root caries process. The root caries process may be defined as a dynamic equilibrium similar to enamel caries. The caries process produced acid demineralization in exposed root surfaces and resulted in a lesion body when viewed in the light microscope. A relatively intact surface layer was not always present unless root caries was observed. In the absence of fluoride, a significant surface layer was left devoid of mineral but with intact collagen. Fluoride helped to prevent lesion formation and produced radiodense banding within the lesions in in vitro models. Remineralization occurred on the remaining mineral and not on the collagen matrix devoid of mineral. The conversion of active to inactive root caries requires the formation of a mineralized layer and implies the loss of surface tissues and contour in the clinical situation. [References: 29] <62> UI - 95071754 AU - Holloway PJ AU - Joyston-Bechal S IN - University of Manchester. TI - How should we use dietary fluoride supplements? [see comments]. [Review] [11 refs] CM - Comment in: Br Dent J 1995 May 6;178(9):326 SO - British Dental Journal 1994 Nov 5;177(9):318-20 AB - Since January 1993 general dental practitioners have been able to prescribe dietary fluoride supplements in the form of drops or tablets for their child patients within the conditions of service of the General Dental Service. Many GDPs may already have taken advantage of this to the benefit of their patients. However, in recent years more evidence has become available about the impact of such fluoride supplements on the teeth. [References: 11] <63> UI - 95067586 AU - Lokshin MF IN - University of Missouri-Columbia School of Medicine. TI - Preventive oral health care: a review for family physicians [see comments]. [Review] [30 refs] CM - Comment in: Am Fam Physician 1994 Dec;50(8):1626, 1632, 1635 SO - American Family Physician 1994 Dec;50(8):1677-84, 1687 AB - Good oral health is essential for both good nutrition and systemic health, in addition to the ability to taste, chew, swallow and speak. Oral diseases include dental caries, periodontal disease, oral mucosal alterations, precancerous lesions and cancer, and oral trauma. Dental caries can be prevented through good oral hygiene and regular professional cleaning, a healthy, low-sugar diet and the use of fluoride and dental sealants. Periodontal disease can be delayed by brushing with fluoride and obtaining professional scaling. Antibacterial mouthwashes may also be helpful. Careful denture cleaning and regular observation for medication side effects can decrease periodontal disease. Tobacco is the most common cause of cancerous oral lesions. Trauma can be avoided by wearing proper protective gear during contact sports and while riding bicycles and motorcycles. Persons in lower income and educational groups have a higher risk of poor oral health. Regular attention to this area by family physicians will decrease the chance of oral disease in patients. [References: 30] <64> UI - 95052244 AU - Anonymous TI - Position of the American Dietetic Association: the impact of fluoride on dental health. [Review] [26 refs] SO - Journal of the American Dietetic Association 1994 Dec;94(12):1428-31 <65> UI - 95051923 AU - Levitch LC AU - Bader JD AU - Shugars DA AU - Heymann HO IN - Department of Operative Dentistry, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450. TI - Non-carious cervical lesions. [Review] [104 refs] SO - Journal of Dentistry 1994 Aug;22(4):195-207 AB - Non-carious cervical lesions are commonly encountered in clinical practice and present in a variety of forms. A knowledge of the aetiology of these lesions is important for preventing further lesions, halting progression of lesions already present, and determining appropriate treatment. The most commonly cited aetiological factors thought to lead to the development of cervical lesions are erosion, abrasion and tooth flexure. Evidence supports a multifactorial aetiology for non-carious cervical lesions. The purpose of this paper is to review the evidence for each of these aetiological factors as it relates to the development of non-carious cervical lesions. Specific features of cervical lesions linked to these factors, including their morphology, location, prevalence and distribution by age and sex will be discussed. Suggestions for future research into the cause and prevention of non-carious cervical lesions will be presented. [References: 104] <66> UI - 95038904 AU - Marino R IN - University of Melbourne, School of Dental Science, Australia. TI - Oral health of the elderly: reality, myth, and perspective. [Review] [26 refs] SO - Bulletin of the Pan American Health Organization 1994 Sep;28(3):202-10 AB - As life expectancy increases, and with it both the relative and absolute numbers of individuals age 60 and older, oro-dental health services face new challenges. This article explores the status of geriatric dental care in Latin America through a bibliographic review of epidemiologic studies included in the MEDLINE and LILACS systems, as well as PAHO studies on this subject. The areas addressed are the elderly's oro-dental health status, perceptions of their own oro-dental health, and frequency of dental service use. The review gives special attention to the critical state of oro-dental health among Latin America's elderly population, which exhibits high prevalences of caries-related tooth loss and total loss of dentition. The review revealed a scarcity of data relating to periodontal health and the health status of buccal soft tissues in the elderly population. It also found that elderly survey subjects tended to perceive their own oro-dental health in a manner inconsistent with clinical observations. According to several survey-based studies, most of those surveyed felt their oro-dental health was good or very good with few or no chewing problems. Regarding service utilization, many of those interviewed indicated they had not seen a dentist during the 6 months preceding the study. In view of the health, social, and psychologic consequences of the current situation for the elderly and the oral health services' potential for improving this population's quality of life, it is strongly recommended that appropriate and effective oro-dental health care programs oriented to this age group be developed. [References: 26] <67> UI - 95048826 AU - Shellis RP AU - Duckworth RM IN - MRC Dental Group, Dental Hospital and School, Bristol, UK. TI - Studies on the cariostatic mechanisms of fluoride. [Review] [124 refs] SO - International Dental Journal 1994 Jun;44(3 Suppl 1):263-73 AB - This paper reviews mechanisms underlying the caries-preventive effects of fluoride, with special reference to factors which govern the efficacy of topical treatments. Fluoride reduces demineralisation in several ways: by reducing bacterial acid production and acidurance; by reducing the equilibrium solubility of apatite; and by the fluoridation of apatite crystal surfaces, reducing the dissolution rate, whether or not there is reduced solubility of the bulk mineral. On available evidence, the last seems to be the most important effect. The effect depends upon the presence of sufficiently high, dissolved fluoride concentrations to maintain the surface fluoridation. The provision of dissolved fluoride is the key to successful therapy, especially topical treatments. Fluoride also promotes remineralisation even at low concentrations, thus slowing or preventing overall mineral loss. The formation of intra-oral fluoride reservoirs capable of supplying ions for a prolonged period is crucial to the success of topical treatments. Such reservoirs include calcium fluoride, formed mainly at tooth surfaces, and fluoride associated with organic components of plaque and oral soft tissues. The patterns of fluoride clearance from intraoral reservoirs are discussed. Fluoride may be present in dentifrices as the fluoride ion (F-) or as the monofluorophosphate ion (FPO3(2-)). It is concluded that the efficacy of FPO3(2-) probably depends on enzymic hydrolysis to F-. Monofluorophosphate appears to be retained less well in intra-oral fluoride reservoirs and reasons for this are discussed. [References: 124] <68> UI - 95048825 AU - O'Mullane DM IN - Oral Health Services Research Centre, University Dental School, Wilton Cork, Ireland. TI - Introduction and rationale for the use of fluoride for caries prevention. [Review] [34 refs] SO - International Dental Journal 1994 Jun;44(3 Suppl 1):257-61 AB - Following the original work of Dean et al. showing the link between fluoride levels in the drinking water and the prevalence of dental fluorosis and dental caries, different strategies aimed at maximising the benefits of fluorides for communities and for individuals have been developed during the last 50 years. The effectiveness of fluoridated salt, fluoride mouthrinses, toothpastes, supplements, gels and varnishes has been extensively investigated in laboratory and human clinical studies. The research effort on the different fluoride strategies has not been confined to measuring effectiveness; other areas which have been extensively investigated include the method of action and metabolism of fluorides. As a result of this research effort it is now possible to adopt a more rational approach to the use of fluorides for caries prevention at community level and for individual patients. [References: 34] <69> UI - 95010960 AU - Tesini DA AU - Fenton SJ IN - Tufts University School of Dental Medicine, Boston, Massachusetts. TI - Oral health needs of persons with physical or mental disabilities. [Review] [42 refs] SO - Dental Clinics of North America 1994 Jul;38(3):483-98 AB - Dentists who examine the needs of their patient population will recognize that the oral health concerns of persons with physical or mental disabilities demand more of their knowledge and skills than any other segment of their practice. To deliver quality, comprehensive care, the clinician must be updated on prevention and treatment techniques. A reference table in this article focuses on awareness of medical issues and oral conditions and the associations and interactions between them. Access to care for persons with disabilities is discussed also. [References: 42] <70> UI - 95017834 AU - Herod EL TI - The use of milk as a saliva substitute. [Review] [40 refs] SO - Journal of Public Health Dentistry 1994 Summer;54(3):184-9 AB - Xerostomia, a clinical manifestation of salivary gland dysfunction, affects many people. These individuals frequently sip liquids to alleviate the discomforts associated with hyposalivation. Milk appears to have many of the chemical and physical properties of a good saliva substitute. Besides the obvious benefit of providing moisture and lubrication for the dehydrated mucosa, milk buffers oral acids, reduces enamel solubility, and contributes to enamel remineralization. These anticariogenic factors are generally attributed to the high calcium and phosphate content along with the milk phosphoproteins that strongly adsorb to enamel. Patients with xerostomia frequently have difficulty in obtaining proper nutrition due to problems associated with lubricating, masticating, tasting, and swallowing food. Milk is a food with high nutritional quality that would certainly benefit most patients with xerostomia. Because of the nutritional, anticariogenic, and moisturizing properties of milk, patients with xerostomia may find milk of value as a saliva substitute to help reduce the oral health problems associated with hyposalivation. [References: 40] <71> UI - 95024592 AU - Liebenberg WH TI - Extended fissure sealants: an adjunctive aid in the prevention of demineralization around orthodontic bands. [Review] [78 refs] SO - Quintessence International 1994 May;25(5):303-12 AB - Banding of molars is still the attachment mode of choice to the majority of clinical orthodontists. One of the acknowledged hazards of orthodontic treatment continues to be the presence of clinically detectable areas of enamel demineralization following the removal of orthodontic appliances. Factors that contribute to this demineralization include inaccurate adaptation of the bands and breakdown of the seal as a consequence of the inadequate bonding strength of the cements and their solubility in oral fluids. Traditional cleaning methods limit adequate plaque control to those areas gingival and incisal to the cemented bands. The iatrogenically created defective band-tooth interface areas pose particular problems, because the ingress of food particles and bacterial plaque make these areas prone to demineralization. A technique is introduced whereby fissure sealant is extended to cover the entire occlusal perimeter, effectively sealing the band-tooth circumferential interface. This technique represents an additional method of prophylaxis against the demineralization that can accompany orthodontic intervention. [References: 78] <72> UI - 94349742 AU - Riordan PJ AU - FitzGerald PE IN - Dental Services, Dental School, University of Western Australia, Perth. TI - Outcome measures in split mouth caries trials and their statistical evaluation [see comments]. [Review] [37 refs] CM - Comment in: Community Dent Oral Epidemiol 1998 Apr;26(2):80-3; discussion 84 SO - Community Dentistry & Oral Epidemiology 1994 Jun;22(3):192-7 AB - The split mouth study design in trials of fissure sealants and restorative materials neatly controls for confounding by many of the variables associated with poor retention of sealants and occurrence of dental caries. Traditionally, the outcome measures used in split mouth trials have been material retention, (per cent) effectiveness and net gain. A survey of the literature revealed that a large proportion of split mouth studies report no statistical evaluation of outcome measures. In those studies in which statistical evaluation had been conducted, McNemar's X2 was the test most frequently used. This statistic is appropriate for comparing differences between "success" and "failure" tooth pairs (or "positives" and "negatives" in split mouth terminology) but it cannot evaluate directly effectiveness and net gain. The distributions of effectiveness and net gain are different and it would be desirable to estimate confidence intervals for them. In this paper, we consider these statistics, suggest methods by which confidence intervals may be calculated, and provide examples of the calculations. We demonstrate the close relationship between effectiveness (as used in split mouth trials) and relative effect and relative risk (as used in general epidemiological analysis) and recommend that relative risk should be the preferred outcome measure for split mouth trials. Whatever outcome measure is chosen in split mouth trials should always be subjected to statistical evaluation, preferably by the calculation of confidence intervals. [References: 37] <73> UI - 94377933 AU - Imfeld TN IN - Department of Preventive Dentistry, Periodontology and Cariology, University of Zurich. TI - Clinical caries studies with polyalcohols. A literature review. [Review] [23 refs] SO - Schweizer Monatsschrift fur Zahnmedizin 1994;104(8):941-5 AB - Polyalcohols represent the most important group of sugar substitutes. Those most widely used in products advertising dental benefits compared to their sucrose containing homologues are sorbitol, mannitol (hexitols), xylitol (pentitol), maltitol, lactitol (12-carbon polyols), Lycasin (hydrogenated starch hydrolysate) and Palatinit (mixture of two 12-carbon polyols). All these polyalcohols have been proven to be non-cariogenic or extremely low cariogenic in rat caries experimentation, and some of them also in human clinical caries studies. They have also been shown to be non-acidogenic or hypoacidogenic in plaque pH telemetry. The low or non-cariogenicity of the above polyols can be termed a "passive" feature, because it is based on the fact that they are not, or only poorly and very slowly, fermented by the oral flora. More recent research, however, has also propagated "active", i.e. bacteriostatic and/or cariostatic properties of xylitol or mixtures of xylitol with other sugar substitutes. Such claims have not yet been substantiated in human caries trials. [References: 23] <74> UI - 94365795 AU - Jendresen MD AU - Allen EP AU - Bayne SC AU - Donovan TE AU - Hansson TL AU - Klooster J AU - Kois JC TI - Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. [Review] [348 refs] SO - Journal of Prosthetic Dentistry 1994 Jul;72(1):39-77 <75> UI - 94349738 AU - Ismail AI IN - Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada. TI - Fluoride supplements: current effectiveness, side effects, and recommendations. [Review] [81 refs] SO - Community Dentistry & Oral Epidemiology 1994 Jun;22(3):164-72 AB - A critical review of the literature was conducted to determine the current effectiveness of fluoride supplements in caries prevention and their role as risk factors for dental fluorosis. Use of fluoride supplements by young children is idiosyncratic and all of the studies which investigated the effectiveness of this regimen suffered from a significant drop in the number of participants receiving daily supplements. The scientific evidence supports the efficacy of fluoride supplements in caries prevention but there is weaker support for their effectiveness. Fluoride supplements are a risk factor for dental fluorosis, though their contribution to the increase in fluorosis prevalence is less than that of water fluoridation and fluoridated dentifrices because of their more limited and shorter use. There is also evidence that fluoride supplements are used inappropriately in fluoridated areas. The availability of optimal levels of fluorides in beverages in non-fluoridated communities raises the question of whether fluoride supplements are needed in the 1990s, and whether it is time to consider the total fluoride intake not only from water but also from foods, beverages, and dentifrices, when recommending supplements. A re-evaluation of the need for and dosage schedules of fluoride supplements is warranted. [References: 81] <76> UI - 94349736 AU - Lewis DW AU - Banting DW IN - Department of Community Dentistry, University of Toronto, Ontario, Canada. TI - Water fluoridation: current effectiveness and dental fluorosis. [Review] [34 refs] SO - Community Dentistry & Oral Epidemiology 1994 Jun;22(3):153-8 AB - This paper reviewed the literature on the evidence for water fluoridation's effectiveness under current conditions of multiple fluoride use at recommended and at reduced concentrations, the extent of dental fluorosis at different fluoride concentrations, and the "halo" effect of water fluoridation. Using the relative difference in dental caries between communities with low and optimal water fluoride as an indicator, the effectiveness of water fluoridation has decreased over time as the use of other fluorides has increased. Thus the effectiveness of water fluoridation alone cannot now be determined. Compared to the early fluoridation studies, the differences in dental caries and fluorosis prevalence between fluoridated and non-fluoridated areas have markedly narrowed. Both the prevalence and severity of dental fluorosis have increased since 1945; however, the portion of fluorosis due to water fluoridation is now less (40%) than that attributed to other fluoride sources (60%). Research also suggests that the "halo" effect of community water fluoridation may result in a significantly greater intake of fluoride for people in non-fluoridated communities. This review recognized that since water fluoridation has unique advantages from the perspectives of distribution, equity, compliance and cost-effectiveness over other fluoride technologies, it remains as the fundamental base for caries prevention. The increasingly greater contribution that other sources of fluoride make to dental fluorosis suggests that these sources of fluoride, many of which are used on an elective basis, should be more closely examined for needed changes. [References: 34] <77> UI - 94349737 AU - Johnston DW IN - Division of Community Dentistry, Faculty of Dentistry, University of Western Ontario, London, Canada. TI - Current status of professionally applied topical fluorides. [Review] [57 refs] SO - Community Dentistry & Oral Epidemiology 1994 Jun;22(3):159-63 AB - The literature was reviewed to establish the current effectiveness of professionally applied topical fluorides in the prevention of dental caries and to determine the risk of chronic and acute fluoride ingestion from their use. Use of professionally applied topical fluorides by moderate to high risk children and adults is supported by existing research. Although many of the studies are dated, there is sufficient evidence to support their continued use. Professionally applied topical fluorides are not a risk factor for dental fluorosis, though they have been implicated in acute reactions. The precautions needed to minimize fluoride intake are discussed. [References: 57] <78> UI - 94349739 AU - Levy SM IN - Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City. TI - Review of fluoride exposures and ingestion. [Review] [98 refs] SO - Community Dentistry & Oral Epidemiology 1994 Jun;22(3):173-80 AB - The literature on fluoride intake/ingestion was reviewed critically to determine the current exposure to fluorides for children living in non-fluoridated and fluoridated areas in North America. Fluoride from all sources except mouthrinses and professionally applied topical fluorides was considered, including ingestion from foods and beverages, as well as intake from the use of fluoride dentifrice and dietary fluoride supplements. Data from all of these sources were used to produce estimates of mean daily ingestion. Studies consistently have identified substantial variation in ingestion among individuals. These analyses demonstrated that a substantial proportion of individuals had exposure or ingestion well beyond that of the mean for each source, and often 10-20% received up to several times as much exposure as the mean. Some children probably ingest sufficient fluoride from a single source to exceed the "optimal" fluoride intake recommended from all sources, and are therefore at increased risk of fluorosis. This review highlighted the substantial variation and complexity of fluoride ingestion. Appropriate consideration of these aspects is warranted in efforts to ensure a margin of safety favoring dental caries prevention while limiting objectionable fluorosis. [References: 98] <79> UI - 94344491 AU - Ghebremeskel K AU - Crawford MA IN - Institute of Brain Chemistry & Human Nutrition, Queen Elizabeth Hospital for Children, London, UK. TI - Nutrition and health in relation to food production and processing. [Review] [88 refs] SO - Nutrition & Health 1994;9(4):237-53 AB - Intensive animal rearing, manipulation of crop production and food processing have altered the qualitative and quantitative balance of nutrients of foods consumed by Western society. This change, to which the physiology and biochemistry of man may not be presently adapted to, is thought to be responsible for the chronic diseases that are rampant in the Industrialised Western Countries. Agriculture production and food processing practices, dietary habits and lifestyle of the West is being fostered without any appraisal of the health implications by most developing countries. Consequently, a rising trend in the incidences of obesity, diabetes, high blood pressure, cardiovascular diseases, dental decay and appendicitis is apparent. Mediterranean countries are adopting the agriculture and food practices of northern Europe as the result of the harmonisation of European food and agriculture policy. It is predicted that the low incidence of morbidity and mortality from coronary heart disease, stroke, diabetes and breast and colon cancer of the Mediterranean countries would rise to the high northern European level in the foreseeable future. Most of these chronic diseases are lifestyle related and are preventable. This can be realised by tackling the root problem which is food production and processing practices and not by dispensing designer drugs or opening more hospital beds. [References: 88] <80> UI - 94341936 AU - Wilson M IN - Department of Microbiology, Institute of Dental Surgery, University of London, UK. TI - Bactericidal effect of laser light and its potential use in the treatment of plaque-related diseases. [Review] [37 refs] SO - International Dental Journal 1994 Apr;44(2):181-9 AB - Chemical antibacterial agents are increasingly being used in prophylactic and therapeutic regimes for plaque-related diseases. As these agents can be rendered ineffective by the development of resistance in the target organisms there is a need to develop alternative antimicrobial approaches. Light from high-power lasers is known to be bactericidal and investigations have shown that it is effective against organisms implicated in caries and inflammatory periodontal diseases. However, the adverse effects of such light on dental hard tissues argue against its use solely as an antibacterial agent. Although light from low-power lasers has no adverse effect on bacterial viability, bacteria can be sensitised to killing by such light by prior treatment with a chemical photosensitising agent. Lethal photosensitisation of a wide range of cariogenic and periodontopathogenic bacteria has been demonstrated using light from a helium/neon or gallium aluminium arsenide laser in conjunction with a dye such as toluidine blue or aluminium disulphonated phthalocyanine as a photosensitiser. The advantages of the technique are that killing is achieved in very short periods of time (< 60 s), resistance development in the target bacteria would be unlikely and damage to adjacent host tissues can be avoided. This approach may be a useful alternative to antibiotics and antiseptics in eliminating cariogenic and periodontopathogenic bacteria from disease lesions. [References: 37] <81> UI - 94324257 AU - Birkhed D IN - Department of Cariology, Faculty of Odontology, University of Goteborg, Sweden. TI - Cariologic aspects of xylitol and its use in chewing gum: a review. [Review] [102 refs] SO - Acta Odontologica Scandinavica 1994 Apr;52(2):116-27 AB - Several studies indicate that xylitol is not metabolized to acids either in pure cultures of oral microorganisms in vitro or in dental plaque in vivo. Chronic consumption of xylitol-sweetened chewing gum resulted in reduction of dental plaque, suppression of mutans streptococci, and reduced adhesiveness of plaque. So far, four field studies with regimens including chewing gum and other xylitol-containing products and four clinical trials have been carried out. All of the latter studies showed that a daily intake of two to three pieces of xylitol gum resulted in a defined reduction of caries. There are indications that regular and prolonged use of xylitol chewing gum may have a caries-preventive effect. [References: 102] <82> UI - 94332848 AU - Mealey BL AU - Semba SE AU - Hallmon WW IN - Department of Periodontics, Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas. TI - The head and neck radiotherapy patient: Part 2--Management of oral complications. [Review] [57 refs] SO - Compendium 1994 Apr;15(4):442, 444, 446-52 passim; quiz 458 AB - As the incidence of head and neck cancer increases and the use of high-dose radiation treatment rises, the dentist will be called on to treat a wide variety of radiation-induced oral maladies. Treatment planning for radiotherapy patients begins immediately after tumor diagnosis and is directed first and foremost toward prevention of oral complications. In the event such complications occur, the dentist must be familiar with available treatment regimens for managing these conditions and preventing future deterioration in oral health. [References: 57] <83> UI - 94338921 AU - Wright JT AU - Fine JD IN - Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill 27599. TI - Hereditary epidermolysis bullosa. [Review] [27 refs] SO - Seminars in Dermatology 1994 Jun;13(2):102-7 AB - Epidermolysis bullosa (EB) is a diverse group of disorders having blister formation as their common feature. Tissue separation occurs at variable depths in the skin and/or mucosa depending on the specific EB type. Marked oral involvement of the soft and hard tissues can produce potentially devastating alterations, with oral tissue fragility and blistering common to all EB types. Oral debilitation resulting from soft tissue scarring is limited primarily to the recessive dystrophic EB subtypes. Individuals with generalized recessive dystrophic EB typically have microstomia, obliteration of the oral vestibule, and ankyloglossia. Generalized enamel hypoplasia appears to be limited to junctional EB, whereas rampant dental caries afflicts many individuals having either junctional or generalized recessive dystrophic EB. Although systemic treatment remains primarily palliative, it is possible to prevent destruction and subsequent loss of the dentition through appropriate interventions and dental therapy. The severely affected soft and/or hard tissues frequently seen in patients having generalized recessive dystrophic and junctional EB often require aggressive dental intervention to maintain optimal oral health. Even the most severely affected individuals with EB can retain their dentition through the use of modern dental restorative techniques delivered using general anesthesia. [References: 27] <84> UI - 94336450 AU - Margolis MQ AU - Hunt RJ AU - Vann WF Jr AU - Stewart PW IN - Department of pediatric dentistry, School of Dentistry, University of North Carolina, Chapel Hill. TI - Distribution of primary tooth caries in first-grade children from two nonfluoridated US communities. [Review] [25 refs] SO - Pediatric Dentistry 1994 May-Jun;16(3):200-5 AB - In a prospective longitudinal study, 1099 first grade children from Aiken, South Carolina, and 1086 children from Portland, Maine, were examined annually for 3 years. Caries prevalence and dmfs incidence were determined. The mean dmfs in Portland children was 2.9. In Aiken, white children had a mean dmfs of 8.4, and black children had a mean dmfs of 10.2. The mean 3-year primary tooth caries increment was 1.5 surfaces in the Portland cohort 3.3 surfaces in the Aiken white cohort and 2.8 surfaces in the Aiken black cohort. These increments were divided evenly between interproximal and fissure surfaces. Twenty percent of the children in Portland had 75% of the caries; in Aiken, 20% of the children had 60% of the caries. This distribution suggests a high-risk group that could be targeted for aggressive caries prevention efforts if risk factors can be identified. [References: 25] <85> UI - 94305647 AU - Ravald N IN - Specialist Clinic for Periodontics, Public Dental Service, Linkoping, Sweden. TI - Root surface caries. [Review] [97 refs] SO - Current Opinion in Periodontology 1994;:78-86 AB - Epidemiologic studies have shown that root surface caries are present worldwide. The prevalence and incidence of root surface caries differ widely among different populations but also among individuals within the same group. Differences in diagnostic criterias and reporting of data substantially influence epidemiologic data. The prevalence of decayed and filled root surfaces generally increases with age. However, age per se is not considered to be the main reason for caries development on root surfaces. The same main factors as for coronal caries, ie, cariogenic microorganisms, diet, saliva, and fluoride exposure, seem to play important roles in root caries development. Due to different anatomy, histology, and chemical composition of the tissues, there may be a higher risk of caries development on root surfaces than on coronal surfaces. In treatment of root surface caries, a causative treatment strategy should be determined. Prevention and treatment should focus on oral hygiene, fluoride exposure, and restriction of intake frequency of foods containing sugars or other easily fermentable carbohydrates. [References: 97] <86> UI - 94304523 AU - Proskin HM AU - Volpe AR TI - Meta-analysis in dental research: a paradigm for performance and interpretation. SO - Journal of Clinical Dentistry 1994;5(1):19-26 AB - Applications of meta-analysis have begun to appear with some regularity in the dental research literature. Recently, a meta-analysis played a high-profile role in the ongoing academic debate concerning the relative anticaries efficacy of dentifrices containing fluoride as sodium fluoride and as sodium monofluorophosphate, engendering a controversy concerning the methodology employed. This has given rise to the need for a careful consideration of the principles involved in the meta-analytic process to provide a basis of understanding upon which such controversies may be resolved. The present report endeavors to meet this need by enumerating the steps involved in a meta-analysis, and contrasting them with the analogous steps in the more widely-understood "usual" inferential process, bringing to light both the similarities and differences between these two types of analyses. Within this context, the conflicting meta-analyses associated with the current controversy are discussed and compared, and the source of the difference between them is readily identified. This process reaffirms the need for close collaboration between statisticians and other scientists in the performance of a meta-analysis, and the value of such close collaboration in the evaluation and interpretation of a meta-analysis performed by others, as well. <87> UI - 94317523 AU - Thabet MA AU - Truchina O AU - Chan JC TI - X-linked hypophosphatemia: molecular biology and treatment controversies. [Review] [15 refs] SO - Chung-Hua Min Kuo Hsiao Erh Ko i Hsueh Hui Tsa Chih 1994 May-Jun;35(3):180-7 AB - X-linked hypophosphatemia, currently one of the most prevalent varieties of familiar rickets, is attributed to renal phosphate wasting secondary to a gene defect localized to X p22 chromosomal region. The proximal tubular phosphate reabsorption defect is associated with blunted 1,25-dihydroxyvitamin D synthesis to hypophosphatemia or parathyroid hormone administration. It is characterized clinically by hypophosphatemia, growth retardation, and rickets especially in male patients. As the affected patients mature, pseudofractures, skeletal deformities, osteomalacic bone pain, progressive ankylosis, and dental caries occur, which may be alleviated and even prevented with adequate medical therapy. Long term treatment combines phosphate supplementation with calcitriol, augmented occasionally by diuretics. Hypercalcemia, hyperparathyroidism, and nephrocalcinosis are potential complications which require careful monitoring and continued investigations. The use of recombinant human growth hormone to augment renal tubular reabsorption of phosphate and to promote linear growth remains to be examined in well controlled, clinical trials. [References: 15] <88> UI - 94315409 AU - Heifetz SB IN - Department of Dental Medicine and Public Health, USC School of Dentistry, Los Angeles, CA 90089-0641. TI - Fluorides for the elderly. [Review] [54 refs] SO - Journal of the California Dental Association 1994 Mar;22(3):49-54 AB - With the current decline in the rate of dental caries among school children, the elderly now have the higher rate of decayed coronal surfaces in addition to being susceptible to root caries. The most effective strategy that the profession can take is twofold: thoroughly assess the level of caries risk of the elderly individual, and institute recognized measures of fluoride therapy commensurate with the defined risk. This review article describes risk indicators characteristic of the elderly patient and offers specific fluoride regimens for low, moderate and high risk subjects. [References: 54] <89> UI - 94292277 AU - Rolla G AU - Ellingsen JE IN - Dental Faculty, University of Oslo, Norway. TI - Clinical effects and possible mechanisms of action of stannous fluoride. [Review] [37 refs] SO - International Dental Journal 1994 Feb;44(1 Suppl 1):99-105 AB - Stannous fluoride was frequently used as a vehicle for fluoride in preparations used in caries prophylaxis in the 1960s and 1970s. At present it is not much used, although extensive research during the last two decades has established that stannous fluoride possesses several interesting properties which demonstrate that it deserves to be used in the prophylaxis against both gingivitis and caries. In the following, a review of the clinical properties of stannous fluoride is presented, together with a discussion of its merits compared with other fluoride vehicles in current use. [References: 37] <90> UI - 94292263 AU - Retief DH IN - Department of Biomaterials, University of Alabama School of Dentistry, UAB Station, Birmingham 35294. TI - Do adhesives prevent microleakage?. [Review] [59 refs] SO - International Dental Journal 1994 Feb;44(1):19-26 AB - All the polymeric composite restorative resins shrink during polymerisation resulting in the development of tensile and/or shear stresses at the tooth/restoration interface. The major part of the contraction stresses develops within 15 minutes after the initiation of polymerisation but with the light activated resins it occurs within seconds after irradiation. The tensile stresses may disrupt the adhesive bonding of the restorative system to the cavity walls resulting in microleakage at the tooth/restoration interface. The properties of the restorative resins which include polymerisation shrinkage during hardening, differences in the coefficients of thermal expansion of the tooth and the restoration, and water sorption of the restoration on exposure to the oral environment, play an important role in determining the marginal gap dimensions and hence microleakage. Microleakage at the enamel/restoration interface has been eliminated by the acid etch technique provided that adequate enamel thickness is present. Microleakage at the dentine/restoration interface, however, is much more difficult to eliminate. None of the dentinal bonding restorative systems eliminates microleakage at the gingival margins of restorations that extend to or beyond the cementum/enamel junction. Microleakage is reduced by using an incremental restorative technique but is increased when the restored teeth are subjected to masticatory stress or occlusal loading. None of the dentinal bonding systems prevents the development of marginal gaps at the dentine/restoration interface when evaluated 10 minutes after placement of the restorations but hygroscopic expansion resulting from water or saline immersion results in a significant reduction in marginal gap dimensions. An increase in the cavosurface margins reduces marginal gap dimensions but it is not dependent on cavity depth.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 59] <91> UI - 94259922 AU - Horsted-Bindslev P IN - Department of Oral Anatomy, Dental Pathology and Operative Dentistry, Faculty of Health Sciences, University of Aarhus, Denmark. TI - Fluoride release from alternative restorative materials. [Review] [31 refs] SO - Journal of Dentistry 1994;22 Suppl 1:S17-20 AB - Numerous laboratory studies have been performed to evaluate the fluoride releasing capacity of different restorative materials. The studies have comprised release of fluoride, uptake of fluoride in the dental hard tissues and the inhibitory effect on demineralization. The present paper discusses the results from and the clinical relevance of the laboratory studies especially as regards the glass ionomer materials and resin composites. [References: 31] <92> UI - 94273010 AU - Gal