Database: MEDLINE <: biomedical, nursing & dental literature, 1966 - Oct 2000.> Search Strategy (You Saved Citations 1-221 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 60 from 57 keep 601-821 221 *************************** <1> UI - 90238780 AU - Thomson WM IN - Department of Health Policy and Programmes, Manawatu-Wanganui Area Health Board, Palmerston North. TI - Root surface caries--an overview of aetiology, prevalence, prevention, and management. [Review] [30 refs] SO - New Zealand Dental Journal 1990 Jan;86(383):4-9 AB - Root surface caries is a specific clinical entity which has been receiving increasing attention in recent years. It has a complex, multi-factorial aetiology, but all the causal factors, and their relative contributions, are not yet clear. There appears to be a role for one or more microbiological agents, particularly in association with a diet involving frequent ingestion of fermentable sugars. Gingival recession is almost certainly a pre-requisite for the development of root surface caries, but intra-oral, site-specific differences in prevalence confuse the picture. Figures of between 20 and over 70 percent for gross prevalence have been reported, with demonstrated attack rates of between 15 and 28 percent of susceptible surfaces being affected. Difficulties in diagnosis may limit the reliability of these figures. The prevention of root surface caries is a two-phase process; the initial emphasis is on the prevention of gingival recession, and the later approach involves measures aimed at reducing the frequency of intake of known cariogenic foodstuffs, and increasing the resistance of susceptible root surfaces with topical fluoride. Medicines which can cause dry mouth must also be examined. The treatment of root surface caries involves a range of procedures, from topical fluoride to multi-surface, glass ionomer cement restorations. [References: 30] <2> UI - 90259142 AU - Peterson DE IN - Department of Oral Diagnosis, Dental School, University of Maryland, Baltimore. TI - Pretreatment strategies for infection prevention in chemotherapy patients. [Review] [77 refs] SO - NCI Monographs 1990;(9):61-71 AB - It is important to understand the pathogenesis of acute oral infections in patients with chemotherapy-induced myelosuppression in order to develop strategies to prevent such complications. Four distinct oral sites that can either be acutely infected or contribute to acute systemic infection are the oral mucosa, dental pulp and periapical tissues, periodontium, and salivary glands. Many cytotoxic drugs can be directly stomatotoxic to replicating oral mucosa. Once mucosal integrity is affected, secondary acute infection can occur. Even without clinical ulceration, deleterious shifts in the oral microbial population can develop. Gram-negative bacilli have been identified as frequent colonizers of myelosuppressed patients, although coagulase-negative staphylococci are being recovered with increasing frequency. Strategies to prevent oral mucosal infection include reducing trauma and preventing proliferation of organisms. Dental pulpal infection is most commonly caused by extensive dental caries. Most pulpal infection is of bacterial origin and can progress to involve the periapical tissues of the involved tooth if not treated. Specific endodontic interventions will usually stabilize or eliminate the source of the infection until the patient's hematologic status returns to normal and definitive pulpal therapy can be provided. In part because acute pulpal complications in the myelosuppressed cancer patient are relatively infrequent, research on the causative organisms and the appropriate therapy of acute, systemic infection of pulpal origin has been limited. Many adults have chronic, asymptomatic periodontal disease. In its advanced stages, extensive ulceration may be present that is not clinically observable. In patients with reduced host defenses, exacerbation of preexistent periodontal disease can have systemic sequelae and is associated with elevated levels of periodontopathic organisms or pathogens typically associated with systemic infection in myelosuppressed cancer patients. Mechanical and chemical antimicrobial techniques are available to reduce prevalence and improve patient comfort and oral hygiene. Dental extractions may be indicated to eliminate the nidus of infection of either pulpal or periodontal origin in patients who are scheduled to receive myelosuppressive chemotherapy. Data indicate that such procedures may be performed without undue risk. Unlike patients who undergo bone marrow transplantation or radiotherapy, patients who receive chemotherapy do not commonly experience subjective salivary gland dysfunction. Occasionally, a transient xerostomia may occur; this condition is frequently attributed to the patient's oral habits, such as breathing through the mouth. The dessicating effect of breathing through the mouth can contribute to oral mucosal injury during function as well as provide a setting for acute infection of commensal origin. More research is needed on the effects of chemotherapy on salivary host defenses. [References: 77] <3> UI - 90241704 AU - Hutchison IL AU - Hopper C AU - Coonar HS IN - Department of Oral and Maxillofacial Surgery, St Bartholomew's Hospital, West Smithfield, London. TI - Neoplasia masquerading as periapical infection [see comments]. [Review] [32 refs] CM - Comment in: Br Dent J 1990 Jun 9;168(11):429 SO - British Dental Journal 1990 Apr 7;168(7):288-94 AB - Seven examples of neoplasia which presented as periapical radiolucencies are described. These were all initially treated for presumed periapical infection. The atypical features that should alert dentists to the possibility of a tumour presenting in this manner are: a vital tooth with minimal caries, root resorption and an irregular radiolucent outline, tooth mobility in the absence of generalised periodontal disease, regional nerve anaesthesia, and failure to respond to good endodontic therapy. All material removed at the time of apical surgery must be examined histologically to prevent neoplasia being overlooked. [References: 32] <4> UI - 90235084 AU - MacEntee MI IN - Division of Prosthodontics, Faculty of Dentistry, University of British Columbia. TI - Does the dental profession care for disabled elders? Some practical questions. [Review] [16 refs] SO - Journal / Canadian Dental Association. Journal de l Association Dentaire Canadienne 1990 Mar;56(3):215-7 AB - The information available on elderly people in Canada indicates that they are part of an expanding population with limited financial resources. Despite the many reports of disinterest in oral health among LTC residents, there is convincing evidence that people in general, regardless of age, dental status, or deteriorating general health, want help when they believe that it is available. The current inequity in dental services can be corrected, and it is the responsibility of all health providers-physicians and nurses no less than dentists-to show that oral disease, discomfort, and disfigurement, are not an inevitable consequence of old age. [References: 16] <5> UI - 90187455 AU - Rolla G AU - Saxegaard E IN - University of Oslo, Dental Faculty, Department of Pedodontics, Norway. TI - Critical evaluation of the composition and use of topical fluorides, with emphasis on the role of calcium fluoride in caries inhibition. [Review] [44 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:780-5; discussion 820-3 AB - There is evidence that a major part of the fluoride which is retained on teeth during topical application is calcium fluoride or calcium fluoride-like, and that this material is relatively stable in the mouth. This is due to surface adsorption of phosphate (HPO4(2-)) ions onto the calcium fluoride surface. Calcium fluoride releases fluoride during caries challenges due to reduced concentration of HPO4(2-) at acid pH. Normally, the fluoride released from calcium fluoride during caries challenges is subsequently built into hydroxyfluorapatite through dissolution/re-precipitation reactions. It appears likely that the formation of calcium fluoride from topical application agents should be increased and not reduced, as believed in the past. Increased deposition of calcium fluoride can be achieved with increased reaction time between fluoride and enamel, reduced pH of the solution, increased concentration, or pre-treatment with calcium. A reduction in pH of the agents is probably the most practical approach to increase the deposition of calcium fluoride during topical application, and clinical data support this contention. Calcium fluorides with various dissolution rates are formed during different procedures of topical application with fluoride, presumably due to incorporation of phosphate into the calcium fluoride crystals. [References: 44] <6> UI - 90187453 AU - Hargreaves JA IN - Faculty of Dentistry, University of Alberta, Edmonton, Canada. TI - Water fluoridation and fluoride supplementation: considerations for the future. [Review] [79 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:765-70; discussion 820-3 AB - The extensive literature on water fluoridation and fluoride supplementation is discussed, looking critically at the benefits of systemic fluoride availability in the prevention of dental caries and at the adverse factors of enamel fluorosis which can occur from the ingestion of too much fluoride during the period of tooth development. Recommendations are made for the future use of fluorides, emphasizing that water fluoridation is a safe and proven health measure which should be continued. Caution in the use of other fluoride supplementation methods is raised, especially when related to compliance and the use of fluoride supplements which are under the control of the individual. Targeting of children who would benefit from fluorides and additional preventive dental health measures is recommended. [References: 79] <7> UI - 90187452 AU - Horowitz HS TI - The future of water fluoridation and other systemic fluorides. [Review] [60 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:760-4; discussion 820-3 AB - School and community water fluoridation, salt fluoridation, and use of dietary fluoride supplements have abundant scientific support as effective caries-preventive methods. Because caries has declined greatly in many developed countries from use of topical fluorides, the absolute caries reduction will be considerably smaller when systemic fluoride methods are implemented now than it was 20 to 40 years ago. For countries with most of the population living in cities with communal water supplies, community fluoridation is the most logical approach from the standpoints of cost-effectiveness and total caries-preventive impact. In countries with a mostly rural population without central water supplies, salt fluoridation is more practical. Dietary fluoride supplements can be recommended only for regions where neither water fluoridation nor salt fluoridation is possible, or as a temporary measure. Although divergent views exist concerning the relative caries-preventive effects of pre-eruptive and post-eruptive fluoride administration, the effectiveness of systemic fluoride methods for preventing dental caries remains unchallenged. Persuasive scientific and public health arguments exist to justify implementing and sustaining their use. The future of these methods will be influenced by the findings of new clinical and epidemiological research. Social, political, economic, and educational factors will be of equal, if not greater, importance. Perceptions of the current severity of dental caries as a health problem and of risks associated with preventing the problem may affect the future uses of systemic fluorides more than will recommendations of scientists. [References: 60] <8> UI - 90187450 AU - Groeneveld A AU - Van Eck AA AU - Backer Dirks O IN - Department of Community Dental Health and Epidemiology, Netherlands Institute for Preventive Health Care, Leiden. TI - Fluoride in caries prevention: is the effect pre- or post-eruptive?. [Review] [30 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:751-5; discussion 820-3 AB - A longitudinal study of children from ages 7 to 18 showed that, if enamel lesions were included, the overall number was the same in fluoridated and non-fluoridated areas. However, a significant reducing effect of pre-eruptive fluoride could be seen in the number of dentinal lesions in a fluoridated area, provided that fluoride was also consumed post-eruptively for a considerable period of time. A precise estimation of both pre- and post-eruptive effects was obtained when teeth were classified according to their eruption time as related to the onset of water fluoridation. About 66% of the greatest reduction in pit and fissure caries came from pre-eruptive fluoride, while in smooth surfaces, this effect was reduced to 25%. In approximal surfaces, the reduction was due half to pre- and half to post-eruptive fluoride. Post-eruptive fluoride became more important with decreasing severity of caries attack. Thus, assuming a continuing decline in dental caries, the majority of such populations will benefit most from the use of topical fluorides. However, in high-risk groups, supplementation of pre-eruptive fluoride can still be of major importance. [References: 30] <9> UI - 90187449 AU - Thylstrup A IN - Department of Cariology and Endodontics, Royal Dental College, Copenhagen, Denmark. TI - Clinical evidence of the role of pre-eruptive fluoride in caries prevention. [Review] [122 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:742-50; discussion 820-3 AB - Recent clinical and laboratory evidence has suggested that systemic fluoride plays a more minor role in caries inhibition than was previously believed. This paper reviews clinical data on water fluoridation, the topical administration of fluorides, and fluoride supplements in the light of more recent understanding of the disease dental caries. Due to reduced functional usage, erupting teeth tend to accumulate plaque which has cariogenic potential. For this reason, the period from tooth emergence to the establishment of interproximal contact and full occlusion is the most critical for caries initiation. Analyses of clinical data indicate that maximum protection against caries is obtained when teeth erupt into an environment with low concentrations of ionic fluoride. The similarity in caries reductions obtained in water fluoridation studies and long-term studies with topically administered fluoride regimens, including fluoride-containing dentifrices, indicates that the pre-eruptive effect of fluoride is of borderline significance relative to the more significant post-eruptive effect. Water fluoridation and topical fluoride programs are thus important measures for the control of caries at the community level. For the individual, topical application of fluoride is seen as an integral part of caries treatment aimed at arresting progressive caries. Fluoride application is thus considered a supportive therapy, in conjunction with cariogenic plaque control. Daily use of fluoridated dentifrices from tooth eruption is more efficacious than daily use of fluoride supplements from birth. [References: 122] <10> UI - 90187440 AU - Van Loveren C IN - Department of Cariology & Endodontology, Academic Center for Dentistry Amsterdam (ACTA), The Netherlands. TI - The antimicrobial action of fluoride and its role in caries inhibition. [Review] [67 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:676-81; discussion 682-3 AB - Despite a considerable amount of literature on the effects of fluoride in dental plaque, several urgent questions remain unanswered, such as: Does the inhibiting effect of fluoride on dental plaque metabolism contribute to caries prevention? Does adaptation of plaque to fluoride affect its cariogenicity? Single applications of fluoride directly to dental plaque reduced acid production. Also, fluoride dissolving from topically treated enamel reduced the acid production in covering layers of oral bacteria in vitro. The effects of both treatments were only of short duration and may not be relevant to caries prevention in vivo. In contrast, daily applications of fluoride resulted in a reduction of the acidogenicity of dental plaque even 8-12 h after the treatment. Such a reduction is likely to contribute to caries prevention. But it has to be realized that when plaque reaches saturation with respect to fluoridated calcium (phosphate) precipitates, enamel becomes insoluble and any antimicrobial effect becomes irrelevant. Still lacking are data on the antimicrobial effects of fluoride regimens normally used in home care, in weekly rinsing programs in schools, or treatments applied professionally every six months. Adaptation of Streptococcus mutans to fluoride has been suggested to reduce the cariogenic potential of the cells. In vitro-induced fluoride-resistant strains were less cariogenic in rats, and the velocity of acid production in vitro was reduced at constant pH greater than 5.5. Despite the ability of oral bacteria to adapt to fluoride, evidence of adaptation in dental plaque of normal subjects resulting in a reduced cariogenic potential has not yet been demonstrated. [References: 67] <11> UI - 90187437 AU - Hamilton IR IN - Department of Oral Biology, Faculty of Dentistry, University of Manitoba, Winnipeg, Canada. TI - Biochemical effects of fluoride on oral bacteria. [Review] [80 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:660-7; discussion 682-3 AB - Fluoride inhibition of carbohydrate metabolism by the acidogenic plaque microflora is well-established, although it has not always been appreciated that oral bacteria vary considerably in their susceptibility to fluoride. Early studies demonstrated that the F-induced reduction in acid production was due, in part, to the inhibition of the glycolytic enzyme, enolase, which converts 2-P-glycerate to P-enolpyruvate. The decreased output of PEP in the presence of F, in turn, results in the inhibition of sugar transport via the PEP phosphotransferase system (PTS). Bacterial accumulation of fluoride involves the transport of HF, a process requiring a transmembrane pH difference or pH gradient, which is generated only by metabolically active cells. The uptake of HF into the more alkaline cytoplasm results in the dissociation of HF to H+ and F- and, if allowed to continue, the accumulation of protons acidifies the cytoplasm, causing a reduction in both the proton gradient and enzyme activity. Current information indicates that in addition to enolase, F- also inhibits the membrane-bound, proton-pumping H+/ATPase, which is involved in the generation of proton gradients through the efflux of protons from the cell at the expense of ATP. Thus, fluoride has the dual action of dissipating proton gradients and preventing their generation through its action on H+/ATPase. The collapse of transmembrane proton gradient, in turn, reduces the ability of cells to transport solutes via mechanisms involving proton motive force. In spite of these known effects on the bacterial cell, there is no general agreement that the anti-microbial effects of F contribute to the anti-caries effect of fluoride.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 80] <12> UI - 90187431 AU - Ten Cate JM IN - Department of Cariology & Endodontology, Academic Center for Dentistry Amsterdam, (ACTA), The Netherlands. TI - In vitro studies on the effects of fluoride on de- and remineralization. [Review] [71 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:614-9; discussion 634-6 AB - The recent literature extensively describes the role of ambient fluoride in the de- and remineralization of dental enamel. Fluoride in sub-ppm concentrations is effective in promoting mineral deposition and inhibiting mineral dissolution. The latter phenomenon is most likely attributable to the concomitant precipitation of a fluoride-rich mineral phase which inhibits further dissolution. These fundamental processes result in an inhibition of enamel demineralization and an enhancement of enamel lesion remineralization. Alternatively, fluoride may also induce the 'arrestment' of enamel lesions. For the in vivo patterns and the effects of caries-preventive substances to be studied, de- and remineralization can best be examined with a pH-cycling system in which the pH depressions occurring in the oral environment are mimicked in a laboratory model. Such an approach has proved useful in developing optimal fluoride schemes which can be tested in animal, intraoral, and clinical studies. [References: 71] <13> UI - 90187429 AU - Arends J AU - Christoffersen J IN - Dental School, Laboratory for Materia Technica, University of Groningen, The Netherlands. TI - Nature and role of loosely bound fluoride in dental caries. [Review] [42 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:601-5; discussion 634-6 AB - This paper discusses loosely bound fluoride and its role in dental caries and prevention. Loosely bound fluoride (abbr. by Fa) is fluoride adsorbed onto enamel mineral crystallites. Several recent studies indicate that a high total level of fluoride in enamel does not guarantee protection against caries. This leads to the conclusion that a major part of fluoride present in the solid enamel is not active in prevention. The adsorption of Fa to the mineral under acidic conditions is described. Most likely there is a dynamic equilibrium between fluoride in solution and adsorbed Fa at the crystal surface interface. When the crystallite is completely covered by adsorbed Fa, there is a maximum inhibition of dissolution. The rate of dissolution of mineral depends on pH, the actual concentrations of calcium and phosphate in the liquid in contact with the crystallites, and on the fraction of the surface covered by adsorbed fluoride. The fluoride, Fs, localized in the inner part of the crystallites is relatively unimportant. "CaF2-like" material can be formed on and in enamel depending on conditions. The in vivo-formed globular "CaF2-like" material is not pure CaF2 and releases F- ions when dissolving; these ions will also be partly adsorbed as Fa in and on enamel. Presently, the amount and importance of Fa originating from in vivo-formed "CaF2-like" material are not known. The level of fluoride, Fa, necessary for strong inhibition of enamel demineralization in vitro is estimated to correspond to a fluoride concentration, FL, in the liquid phase of 1 ppm or 50 mumol/L fluoride ions.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 42] <14> UI - 90187428 AU - Chow LC IN - American Dental Association Health Foundation, Paffenbarger Research Center, National Institute of Standards and Technology, Gaithersburg, Maryland 20899. TI - Tooth-bound fluoride and dental caries. [Review] [52 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:595-600; discussion 634-6 AB - The cariostatic effects of tooth-bound fluoride reported in the recent literature are reviewed. Several treatment procedures which can increase the tooth-bound fluoride content are described. Based on this information, it is suggested that effectiveness of currently used topical fluoride treatments may be significantly increased by (1) including in the regimen a dicalcium-phosphate-dihydrate-forming treatment so that a portion of the labile fluoride is re-incorporated as tooth-bound fluoride, and (2) employing application methods which ensure the effective delivery of treatment agents to the fissures, and to approximal and cervical surfaces, where most caries occurs. [References: 52] <15> UI - 90187427 AU - White DJ AU - Nancollas GH IN - Procter & Gamble Co., Cincinnati, Ohio 45241. TI - Physical and chemical considerations of the role of firmly and loosely bound fluoride in caries prevention. [Review] [94 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:587-94; discussion 634-6 AB - Historically, there has been considerable debate concerning the roles of loosely bound (calcium fluoride) and firmly bound (fluorapatite) fluoride for caries prevention. Research now shows that fluorapatite (FAP) is a finite reaction product of enamel/apatite fluoridation with or without CaF2 formation, suggesting that CaF2 always be considered as a supplement to, rather than a substitute for, FAP formation. In the presence of low levels of fluoride in the solution phase, the crystallization of hydroxyapatite is enhanced, while the corresponding dissolution is retarded. Fluoride in the bulk FAP or CaF2 solid phase, in contrast, has limited impact on crystal growth or dissolution kinetics. Both FAP and CaF2 can provide F to the solution phase to enhance remineralization and retard demineralization of enamel HAP crystallites. The FAP provides most of this F under low pH conditions, while CaF2 provides F at neutral or lower pH. The reactivity of fluoride on sound and carious enamel differs significantly. Carious enamel acquires more fluoride, acquires it more quickly, and itself acts as a source of retained fluoride in comparison with the more limited reactivity of sound enamel. Overall, the most important question concerning fluoride reactivity relates to its efficiency in enhancing remineralization or retarding demineralization processes. This is influenced not only by the reaction products, e.g., loosely or firmly bound fluoride, but also by the nature of the enamel substrate and frequency of application of the topical fluoridating agent. Inasmuch as the reactivity of bulk HAP is dominated by surface layers of FAP material, the debate over usefulness of various fluoride reaction products solely on a chemical level is no longer critical. Instead, all factors influencing the efficiency of a fluoridating regimen must be considered in the development of improved systems for caries prevention. [References: 94] <16> UI - 90172243 AU - Cheung GS IN - Department of Conservative Dentistry, University of Hong Kong, Faculty of Dentistry. TI - Reducing marginal leakage of posterior composite resin restorations: a review of clinical techniques. [Review] [41 refs] SO - Journal of Prosthetic Dentistry 1990 Mar;63(3):286-8 AB - It has been well established that composite resin restorations have leakage at the margins. The polymerization shrinkage of the material and its inadequate adhesion to the cavity walls are the primary causes. Unlike silver amalgam restorations, which are self-sealing with age, the gap at the composite-to-tooth interface tends to persist and invite postoperative sensitivity, adverse pulp reactions, and the development of recurrent caries. Many techniques or materials have been advocated to improve the clinical adaptation of this material and to reduce marginal leakage. They limit the effect of polymerization shrinkage and/or enhance the bonding of the composite material to the tooth structure. This article reviews the clinical techniques and materials that have been suggested and are presently available to improve the marginal quality of composite resins, with special reference to posterior restorations. [References: 41] <17> UI - 90187442 AU - Fejerskov O AU - Manji F AU - Baelum V IN - Department of Oral Anatomy, Dental Pathology and Operative Dentistry, Royal Dental College, Aarhus, Denmark. TI - The nature and mechanisms of dental fluorosis in man. [Review] [87 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:692-700; discussion 721 AB - Any use of fluorides, whether systemic or topical, in caries prevention and treatment in children results in ingestion and absorption of fluoride into the blood circulation. The mineralization of teeth under formation may be affected so that dental fluorosis may occur. Dental fluorosis reflects an increasing porosity of the surface and subsurface enamel, causing the enamel to appear opaque. The clinical features represent a continuum of changes ranging from fine white opaque lines running across the tooth on all parts of the enamel to entirely chalky white teeth. In the latter cases, the enamel may be so porous (or hypomineralized) that the outer enamel breaks apart posteruptively and the exposed porous subsurface enamel becomes discolored. These changes can be classified clinically by the TF index to reflect, in an ordinal scale, the histopathological changes associated with dental fluorosis. Compared with Dean's and the TSIF index, we consider the TF index to be more precise. Recent studies on human enamel representing the entire spectrum of dental fluorosis have demonstrated a clear association between increasing TF score and increasing fluoride content of the enamel. So far, no useful data on dose (expressed in mg fluoride/kg b.w.)-response (dental fluorosis) relationships are available. In this paper, we have, therefore, re-evaluated the original data by Dean et al. (1941, 1942), Richards et al. (1967), and Butler et al. (1985) from the USA, by applying the equation of Galagan and Vermillion (1957) which permits the calculation of water intake as a function of temperature.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 87] <18> UI - 90187458 AU - Konig KG IN - Faculty of Medicine and Dentistry, University of Nijmegen, The Netherlands. TI - Feasibility of the combined use of fluorides. [Review] [29 refs] SO - Journal of Dental Research 1990 Feb;69 Spec No:801-4; discussion 820-3 AB - An increase in the number of methods of fluoride administration over and above traditional modes, while offering new caries-preventive possibilities, has also created problems. These cannot be solved by the purely scientific, objective approach, since emotional resistance to fluoride has increased in some countries in parallel to environmental pollution. In most of the highly developed countries, the decrease of caries prevalence has dramatically lowered the number of children in need of concentrated preventive programs. On the other hand, dental awareness and multiple sources of fluoride have increased the risk of chronic fluoride overdosage. Means to avoid the latter problem are discussed. In addition to community-delivered fluoridation programs, individual counseling and "tailor-made" preventive measures are of increasing importance. [References: 29] <19> UI - 90152976 AU - Stadtler P IN - Department of Operative Dentistry, University Dental Clinic, Graz, Austria. TI - Fluorides. [Review] [31 refs] SO - International Journal of Clinical Pharmacology, Therapy, & Toxicology 1990 Jan;28(1):20-6 AB - Remineralization of early lesions and inhibition of demineralization are considered to be the prevailing mechanisms of action of fluorides. For this purpose a number of preparations are available today. Before applying them, one should be aware of their concentration, correct prescription, dosage, pharmacokinetics and potential side and after-effects. [References: 31] <20> UI - 90151018 AU - Baker DP IN - Department of Obstetrics and Gynecology, Texas A & M University, College of Medicine, Temple. TI - Estrogen-replacement therapy in patients with previous endometrial carcinoma. [Review] [21 refs] SO - Comprehensive Therapy 1990 Jan;16(1):28-35 AB - For patients with previous endometrial cancer, ERT is not the accepted practice in the U.S. The therapeutic dictum that estrogen is contraindicated in patients with previous uterine adenocarcinoma is, however, not substantiated by clinical data. The relation of unopposed estrogen stimulation to endometrial hyperplasia and carcinoma, and the published studies relating ERT to endometrial cancer, have resulted in the clinical perception--and cautionary statements to that effect--that estrogen is contraindicated for patients with a history of endometrial carcinoma. The exact biologic effects of ERT on endometrial adenocarcinoma have not yet been studied adequately, however; the initial clinical data suggest that there is no increase in recurrence or mortality. In the meantime, the clinician is left with contradictory data as a basis for determining the proper management of symptomatic patients. The total impact of estrogen deficiency on the health of women and the ratio of benefits and risks of ERT are yet to be defined completely. The preponderance of evidence suggests that estrogen has a beneficial effect on the major cause of death in women, coronary heart disease, by increasing the high-density lipoprotein (HDL) fraction of cholesterol. It is established that estrogen prevents the demineralization of bone and delays the ravages of osteoporosis. No one has died from vaginal atrophy, bladder dysfunction, or hot flashes; the quality of life and marriage have been improved, however, by relieving these symptomatic conditions with ERT. Several studies have attempted to analyze with various statistical models the ratio of benefits to risks, and the majority of authors have concluded that the beneficial effect on cardiovascular disease alone clearly outweighs any known risk.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 21] <21> UI - 90125584 AU - Disney JA AU - Bohannan HM AU - Klein SP AU - Bell RM IN - School of Dentistry, University of North Carolina, Chapel Hill 27599-7450. TI - A case study in contesting the conventional wisdom: school-based fluoride mouthrinse programs in the USA. [Review] [62 refs] SO - Community Dentistry & Oral Epidemiology 1990 Feb;18(1):46-54 AB - This paper presents the events surrounding the dissemination of the results of a major preventive dentistry demonstration program designed and conducted to provide evidence of the effectiveness and actual costs of a combination of commonly used preventive procedures. It then reviews the controversy provoked when the results of that program were counter to the conventional wisdom of the day, prevailing national policy, and public health practice. An analysis of possible reasons for this reaction follows. The paper concludes with some observations about how such a situation might be approached to minimize similar controversy in the future. [References: 62] <22> UI - 90108382 AU - Bramante MA IN - Graduate School of Orthodontics, Columbia University School of Dentistry, New York, New York. TI - Controversies in orthodontics. [Review] [64 refs] SO - Dental Clinics of North America 1990 Jan;34(1):91-102 AB - Three controversial interrelated aspects of orthodontics have been reviewed: retention, the effect of third molars on lower anterior crowding, and extraction and nonextraction orthodontic treatment. Recent studies have shown that unacceptable lower anterior crowding occurs in 90 per cent of well-treated extraction cases. The implication is that nonextraction cases should be 90 per cent or higher. In view of our present general inability to identify the 10 per cent that will remain acceptable, some form of indefinite retention is advised. A literature review of the effect of third molars on lower anterior crowding finds strong opinions on both sides of the issue. Similar studies often show dissimilar conclusions, particularly when observing cases of third molar extraction or agenesis. Certainly the problem is multifactorial; however, the vast bulk of the evidence indicates that the third molars play an insignificant role in lower anterior crowding. Extraction of teeth for orthodontic treatment prior to 1900 was prevalent and indiscriminate. From the turn of the century to the mid-thirties Angle moved the specialty away from extractions to a relatively rigid nonextraction treatment philosophy. Dissatisified with relapsing Class II cases, recurrence and aggravation of crowding, and what he felt were bimaxillary full faces, Tweed and others, circa 1935, redirected the profession back to extractions with a more disciplined approach to treatment by the removal of four first premolars. Fifty years later we have found that extraction treatment and uprighting lower incisors does not prevent long-term postretention crowding and that flattened profiles are not always esthetically desirable. Earlier treatment of maxillomandibular basal discrepancies by old and new treatment philosophies and mechanics have produced more stable nonextraction corrections. Better control of leeway space and a reduction in caries has helped reduce the amount of lower anterior flaring that was seen in the nonextraction cases in the first third of the century. These reasons have moved the specialty of orthodontics to a mixed but more nonextraction-oriented approach to treatment. [References: 64] <23> UI - 91206972 AU - Theilade E TI - Advances in oral microbiology. [Review] [25 refs] SO - Annals of the Royal Australasian College of Dental Surgeons 1989 Oct;10:62-71 AB - More than 200 species of micro-organisms have been identified in the resident oral microflora colonizing teeth and oral mucosa. Their numbers and proportions are regulated by several ecological mechanisms such as antimicrobial factors in saliva and gingival fluid, intermicrobial synergism and antagonism, host diet, etc. Due to their pathogenic potential, oral micro-organisms cause dental caries, periodontal disease, mixed anaerobic infections of oral tissues, and sometimes infections in other organs. The role of specific bacteria or virulence factors in plaque-induced diseases is difficult to assess because of the microbial complexity and variability of dental plaque. Correlations have been established between Streptococcus mutans, lactobacilli and dental caries, and also between spirochaetes, certain Gram-negative rods and periodontal inflammation. The predictive value of microbiological tests as indicators of active caries or periodontal destruction is, however, too low to justify clinical use. Preventive methods such as plaque control and sugar restriction help establish a microflora compatible with oral health. [References: 25] <24> UI - 91134684 AU - Abdul-Kadir R IN - Faculty of Dentistry, University of Malaya, 59100 Kuala Lumpur. TI - Assessment of periodontal diseases in epidemiological investigations: a critical review. [Review] [60 refs] SO - Singapore Dental Journal 1989 Dec;14(1):6-12 AB - Like dental caries, epidemiological assessment of periodontal disease is important for purposes of recognizing the extent of the disease in the population as well as a basis for planning and evaluating preventive and treatment programmes. while present day measurement methods for dental caries are excellent such is not true for periodontal diseases. This paper reviews the development and usefulness of different indices for the assessment of periodontal disease and treatment needs in epidemiological investigations. [References: 60] <25> UI - 91137311 AU - Gluckman E IN - Bone Marrow Transplantation Unit, Hopital Saint Louis, Paris, France. TI - Recent trends in allogeneic bone marrow transplantation. [Review] [45 refs] SO - Clinical Transplants 1989;:123-8 AB - The indications and results of allogeneic bone marrow transplantation are well known by the analyses of European and International registries. In acute nonlymphoblastic leukemia in first CR, the disease-free survival (DFS) is 45% with a risk of relapse (RR) of 15%, in ALL in first CR the DFS is 60% with a RR of 15%, in ALL in second CR the DFS is 40% with a RR of 30%, and in CML in the chronic phase the DFS is 60%, with a RR of 20%. These results must be adjusted with other risk factors such as age, sex mismatch, disease status, CMV serology, and GvHD. The use of donors who differ from genotypically matched related donors is currently under investigation. Mismatched related transplants give disappointing results except in the case of 1 HLA mismatch. Unrelated HLA-matched donor panels have recently been established in various countries with 200 transplants performed with a DFS of approximately 40%. Researchers are currently trying to reduce the RR by intensifying the conditioning regimen or using the graft-versus-leukemia effect of allogeneic T cells, reducing GvHD by the use of monoclonal antibodies, and improving the engraftment by the use of growth factors. The recent use of cryopreserved cord blood cells for transplantation may improve the results of partially mismatched transplants in children. [References: 45] <26> UI - 90316396 AU - Maryniuk GA AU - Brunson WD TI - When to replace faulty-margin amalgam restorations: a pilot study. [Review] [27 refs] SO - General Dentistry 1989 Nov-Dec;37(6):463-7 <27> UI - 90222127 AU - Seppa L TI - Topical fluorides. [Review] [71 refs] SO - Proceedings of the Finnish Dental Society 1989;85(6):445-56 AB - Fluoride is currently conceived as acting for the most part topically, reducing dissolution and enhancing remineralization of the enamel. The introduction of small amounts of fluoride into the mouth as often as possible is therefore important. Regular use of fluoride toothpastes is the most practicable way of maintaining elevated fluoride concentrations at the plaque-enamel interface. The importance of fluoride toothpastes as the basic caries preventive method requires emphasizing. For those who need additional fluoride therapy, frequent rinsing with dilute fluoride solutions or topical applications of concentrated fluoride solutions, gels or varnishes are the commonest alternatives. None of these methods is superior to any other. Thus, choice of method depends on costs, convenience, patient acceptance and safety. [References: 71] <28> UI - 90192381 AU - Swift EJ Jr TI - Effects of glass ionomers on recurrent caries. [Review] [26 refs] SO - Operative Dentistry 1989 Winter;14(1):40-3 AB - Glass-ionomer cements slowly and continuously release fluoride ions. The studies described in this article have shown that glass ionomers can therefore reduce the incidence and severity of recurrent caries. [References: 26] <29> UI - 90146127 AU - Ettinger RL IN - Department of Prosthodontics, Dows Institute for Dental Research, College of Dentistry, University of Iowa, Iowa City 52242. TI - Management of the ageing dental patient. [Review] [68 refs] SO - Annals of the Academy of Medicine, Singapore 1989 Sep;18(5):507-15 AB - Dental care of elderly persons is very similar to that of younger persons but is often modified by a variety of age related and age associated changes. Diseases and the medications taken to treat them often have a direct effect on oral health. Clinical decision-making for the dental care of older adults can be more complex. Dental disease patterns within the ageing population seem to be changing and seem to be expressed differently resulting in more modifying factors which will require actual diagnosis and complicate treatment planning. This paper presents some definitions of geriatric patients with specific applications to dentistry. Using the available data the characteristics and needs of these patients have been described with particular reference to decision-making. Selected management issues have been discussed with particular reference to stress, communication, prevention and premedication. Some concepts in restorative care especially related to root caries were discussed. In prosthodontics the problems related to treatment have been identified and the incremental treatment technique discussed. Issues in the care of older dental patients are not often related to technical problems but are issues related to what is considered appropriate care, necessary treatment, where it should be carried out and the sequence in which it should be completed. [References: 68] <30> UI - 90107246 AU - Surmont PA AU - Martens LC TI - Root surface caries: an update. [Review] [75 refs] SO - Clinical Preventive Dentistry 1989 May-Jun;11(3):14-20 AB - Root surface caries lesions will become more predominant in the future. Recently, several definitions and graduations have been suggested. Objective, epidemiologic data are still lacking. The etiologic factors of root surface caries generally are parallel to those of coronal caries. However, some nuances needed to be identified. Differences concerning the bacteriologic characteristics, the substrate, the mineral composition, and the clearance are discussed. Some patients are more likely to develop multiple lesions than others. Restorative materials with bonding abilities to dentin are the preferred materials. Fluoride applications will probably be the most effective in preventing the development of root surface caries lesions. [References: 75] <31> UI - 90115591 AU - Shaw L AU - Glenwright HD IN - Department of Children's Dentistry, University of Birmingham Dental School, UK. TI - The role of medications in dental caries formation: need for sugar-free medication for children. [Review] [14 refs] SO - Pediatrician 1989;16(3-4):153-5 AB - Most paediatric medicines are prescribed in a liquid form that includes sugar in the formulation. Accumulating evidence, on a clinical and experimental basis, shows a significant association between the intake of sucrose-based medication and an increased incidence of dental caries. Many of the children on long-term medication for chronic medical problems are particularly at risk from the consequences of developing dental caries; dental disease, sepsis or treatment procedures can put the general health or even life of the child at risk. The need to use sucrose in medications should be reassessed; medicines containing sugar should be labelled accordingly; and medical and dental professionals should be aware of potential problems related to sucrose-based medications. [References: 14] <32> UI - 90115592 AU - Krasse B IN - Department of Cariology, Faculty of Odontology, University of Goteborg, Sweden. TI - Specific microorganisms and dental caries in children. [Review] [18 refs] SO - Pediatrician 1989;16(3-4):156-60 AB - During the last decades it has been convincingly demonstrated that mutants streptococci and lactobacilli are of etiologic importance in dental caries. The knowledge has been applied in several clinical studies and the results show that microbiological examinations can be valuable adjuncts in the diagnosis, treatment and prevention of dental caries. Although dental caries has declined considerably, some children still develop high caries activity. It is important that such children are identified and given preventive treatment before they develop rampant decay. In this context pediatricians play an important role and the new microbiological knowledge can be a valuable tool. [References: 18] <33> UI - 90115593 AU - Adair SM IN - Department of Pediatric Dentistry, Eastman Dental Center, Rochester, N.Y. TI - Risks and benefits of fluoride mouthrinsing. [Review] [63 refs] SO - Pediatrician 1989;16(3-4):161-9 AB - Fluoride mouthrinses have been demonstrated in controlled clinical trials to reduce the incidence of dental caries in children by an average of 35%. This practice has been demonstrated to be a safe and effective adjunct to individual and public health preventive dental programs. The risks of fluoride mouthrinse use are primarily related to acute and chronic ingestion of fluoride, and acute ingestion of ethanol. These and other minor risks are easily controlled by adult supervision of mouthrinse use. Claims of allergic reaction or adverse behavioral reaction to food dyes in mouthrinses have not been substantiated. Recently, mouthrinses have been investigated as contributing to the risk of oral cancer, but results of retrospective studies are equivocal, especially in the light of the stronger confounding variables of alcohol consumption and tobacco use. Fluoride mouthrinses remain a safe and effective means of controlling dental decay. [References: 63] <34> UI - 90118791 AU - Bille J AU - Carstens K IN - Department of Cariology and Endodontics, Royal Dental College, Copenhagen, Denmark. TI - Approximal caries progression in 13- to 15-year-old Danish children. [Review] [22 refs] SO - Acta Odontologica Scandinavica 1989 Dec;47(6):347-54 AB - A total of 278 children aged 13 years in 1980, who lived in an area where preventive programs and professional attitudes towards restorative treatment had changed over a 10-year period, were dentally examined in 1980, 1981, and 1982. Different preventive treatments were given to the children, to decrease the variation in dental caries. The development of new lesions and the rate of progression of existing lesions were studied by means of bitewing radiographs. Ninety-four per cent of the surfaces remained unchanged. Of the surfaces diagnosed as carious at 13 years of age no progression had occurred in 63%, and 86% of enamel lesions remained within the enamel. Although caries progression was slow in this population, the variation in dental caries was only slightly altered. [References: 22] <35> UI - 90064955 AU - Greene JC AU - Louie R AU - Wycoff SJ IN - Department of Dental Public Health and Hygiene, School of Dentistry, University of California, San Francisco. TI - Preventive dentistry. I. Dental caries. [Review] [56 refs] SO - JAMA 1989 Dec 22-29;262(24):3459-63 AB - Primary care physicians and nurses have numerous opportunities to assist in the prevention of dental caries, periodontal diseases, malocclusion, trauma to the mouth and teeth, and oral cancer. This is the first of two articles that provide background for the US Preventive Services Task Force recommendations for interventions by physicians, nurses, and other clinicians to prevent these oral diseases and conditions. Physicians and other health professionals are urged to be aware of these opportunities and to take appropriate action in collaboration with the patient's dentist. [References: 56] <36> UI - 90078872 AU - Ben-Amar A IN - Section of Operative Dentistry, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel. TI - Reduction of microleakage around new amalgam restorations. [Review] [77 refs] SO - Journal of the American Dental Association 1989 Dec;119(6):725-8 AB - Microleakage is a problem of all fresh amalgam restorations and is clinically undetectable. Because microleakage may be responsible for pulp irritation, pulp inflammation, necrosis, and recurrent caries, it is essential to prevent and control it. Correct cavity margin preparations, proper amalgam manipulation, proper condensation, and burnishing can minimize microleakage in amalgam restorations. The use of conventional varnish or dentin adhesive on cavity walls before the insertion of the amalgam is the best method to reduce microleakage. Most well-manipulated and well-placed amalgams do not exhibit microleakage after a time. [References: 77] <37> UI - 90040404 AU - Horowitz HS TI - Effectiveness of school water fluoridation and dietary fluoride supplements in school-aged children. [Review] [36 refs] SO - Journal of Public Health Dentistry 1989;49(5 Spec No):290-6 AB - School water fluoridation and school-based fluoride tablet programs both have been shown in many studies to be effective in preventing dental caries. These studies indicate that school water fluoridation reduces dental decay by approximately 40 percent and school-based fluoride tablet programs by about 30 percent. However, nearly all the studies were done when the prevalence of caries among US schoolchildren was greater than it is today, which makes it difficult to assess their current effectiveness. Data from dental surveys of school-aged children conducted during the past 30 years indicate that overall caries prevalence has declined by more than 75 percent and that of approximal tooth surfaces by more than 90 percent. Recent national data indicate the difference in caries prevalence between children with lifetime residence in either fluoridated or nonfluoridated areas has also diminished, which raises questions about the cost effectiveness of initiating school-based fluoride programs for all areas. There are still groups of children, however, seriously affected by dental caries. It is safe to assume that implementation of school water fluoridation or fluoride tablet programs will result in traditionally reported benefits among these children. Ongoing school-based fluoride programs should not be discontinued until it is known what impact their cessation will have on dental disease. [References: 36] <38> UI - 90040403 AU - Newbrun E IN - Department of Stomatology, University of California, School of Dentistry, San Francisco 94143-0512. TI - Effectiveness of water fluoridation [see comments]. [Review] [72 refs] CM - Comment in: J Public Health Dent 1991 Spring;51(2):70-1 SO - Journal of Public Health Dentistry 1989;49(5 Spec No):279-89 AB - The efficacy of communal water fluoridation in reducing dental caries has been reviewed based on surveys conducted in the last decade of caries prevalence in fluoridated and nonfluoridated communities in the United States as well as in Australia, Britain, Canada, Ireland, and New Zealand. The efficacy is greatest for the deciduous dentition, with a range of 30-60 percent less caries in fluoridated communities. In the mixed dentition (ages 8 to 12), the efficacy is more variable, about 20-40 percent less caries. In adolescents (ages 14-17), it is about 15-35 percent less caries. Current data on caries prevalence in adults and seniors are extremely limited and include several populations living in communities with higher than optimal fluoride levels. For these adults and seniors, a range of 15-35 percent less caries would also apply. Viewed in toto, the current data for children, adolescents, adults and seniors show a consistently and substantially lower caries prevalence in fluoridated communities. For an accurate measurement of the efficacy of water fluoridation in reducing dental caries, it is essential that only persons with a record of continuous or long-term residency in fluoridated versus nonfluoridated areas be included in such assessments. Because of the high geographic mobility in our society and the widespread use of fluoride dentifrices, supplements, and other topical fluoride agents, such comparisons are becoming more difficult to conduct. Accordingly, the effectiveness (rather than the efficacy) of water fluoridation has decreased as the benefits of other forms of fluoride have spread to communities lacking optimal water fluoridation. [References: 72] <39> UI - 90040405 AU - Ripa LW IN - Department of Children's Dentistry, School of Dental Medicine, State University of New York, Stony Brook 11794-8701. TI - Review of the anticaries effectiveness of professionally applied and self-applied topical fluoride gels. [Review] [70 refs] SO - Journal of Public Health Dentistry 1989;49(5 Spec No):297-309 AB - Of the five types of topical fluoride gel products available in the United States, two have not been clinically tested in randomized double blind clinical trials. For those tested, the averaged results of clinical trials involving schoolchildren in fluoride-deficient communities indicate a caries reduction of approximately 26 percent from either a professional or self-administered program. A similar relative reduction can be expected from programs conducted in fluoridated communities, but the absolute caries inhibition is less. Twice-a-year professional applications are more effective than once-a-year applications, and self-applications using trays are more effective than applying the gel on a toothbrush. For subjects beyond school age, there are few clinical studies of either self-applied or professionally applied gels; however, current epidemiological evidence does not indicate a need for public health caries preventive programs for healthy employed adults. For medically compromised patients, especially those exhibiting rampant caries associated with radiation-induced xerostomia, a variety of topical gel procedures appear to be effective in limiting caries. [References: 70] <40> UI - 90040406 AU - Leverett DH IN - Department of Community Dentistry, Eastman Dental Center, Rochester, NY 14620. TI - Effectiveness of mouthrinsing with fluoride solutions in preventing coronal and root caries. [Review] [54 refs] SO - Journal of Public Health Dentistry 1989;49(5 Spec No):310-6 AB - Fluoride mouthrinses have been used extensively for the past 15 years to prevent dental caries in children. Their use has been especially widespread in organized school-based programs in the US. Nearly three dozen clinical studies of fluoride mouthrinses, both with and without placebo controls, have been reported in the literature since the early 1960s. The overwhelming majority of those studies report statistically significant caries inhibition from the use of the products. Most of the studies were published prior to the knowledge of a decline in caries prevalence during the past 30 years. Consequently, the results of those studies lacking a placebo control group have been challenged. Even randomized clinical trials with appropriate control groups appear to be reporting declining differences between test and control groups. Using a model based on annual caries increments from published studies, the conclusion is reached that future use of fluoride mouthrinses is unlikely to result in annual savings in DMF increment greater than 0.4 surfaces, regardless of age of rinsers. [References: 54] <41> UI - 90040407 AU - Weintraub JA IN - Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450. TI - The effectiveness of pit and fissure sealants. [Review] [93 refs] SO - Journal of Public Health Dentistry 1989;49(5 Spec No):317-30 AB - This review addresses two major issues related to the use of pit and fissure sealants. First, the epidemiology of occlusal caries for children and adults is examined to determine if there is a basis for administering sealant programs to different age groups. Second, the effectiveness of pit and fissure sealants in fluoridated and non-fluoridated communities is compared. Changes in effectiveness of sealant over time are evaluated in terms of percent effectiveness, complete retention, caries incidence, and reapplication rates. Based on epidemiologic evidence, sealant programs can be justified for children and young adults, but not for older age groups. Based on the literature reviewed, following one application of autopolymerized or visible-light-cured sealant, the median percent effectiveness declines from 83 percent after one year to 55 percent after seven years. Similarly, the median complete retention declines from 92 percent after one year to 66 percent after seven years. Conversely, the median percent of sealed first molars becoming carious and/or restored increases from 4 percent after one year to 31 percent after seven years. Large differences in sealant effectiveness are not apparent between studies performed in fluoridated and fluoride-deficient communities. [References: 93] <42> UI - 90007710 AU - Wei SH AU - King NM AU - Ngan PW IN - Department of Children's Dentistry and Orthodontics, University of Hong Kong, Prince Philip Dental Hospital. TI - Total child patient care--aspects of paediatric dentistry and orthodontics. [Review] [14 refs] SO - International Dental Journal 1989 Sep;39(3):163-70 AB - Various factors have combined to create a situation in which paediatric dentistry is undergoing considerable change. These include the declining prevalence of caries, the refinement of preventive measures and the rapid development of new materials and techniques. The result is a shift in emphasis away from a purely conservative, restorative approach towards a concept of total child care. This requires the practitioner to consider total treatment planning in which there will be phases of preventive, restorative and orthodontic treatment appropriate to each child patient. Correct application of these skills, modified by the application of advancing technology, will ensure that children so treated will grow to value and appreciate good dental health. [References: 14] <43> UI - 90002423 AU - Limeback H AU - Eggert FM TI - Xylitol in chewing gum: a discussion on developing CDA guidelines for the recognition of food products with dental therapeutic claims. [Review] [30 refs] SO - Journal / Canadian Dental Association. Journal de l Association Dentaire Canadienne 1989 Sep;55(9):717-9 <44> UI - 90002420 AU - Rubinoff AB AU - Latner PA AU - Pasut LA TI - Vitamin C and oral health. [Review] [24 refs] SO - Journal / Canadian Dental Association. Journal de l Association Dentaire Canadienne 1989 Sep;55(9):705-7 AB - Maintaining natural dentition is a realistic goal given today's improved caries control and attention to good oral hygiene. Expanding knowledge in the area of periodontal diseases provides further insight into health promotion practices which can be effective in preventing tooth loss. Vitamin C's role in maintaining the health of teeth and gingivae remains unchallenged. Now clinical evidence indicates that vitamin C functions in improving host defence mechanisms and is thereby implicated in preserving periodontal health. Common sense tells us that the monitoring of the vitamin C status of individuals, especially those at high risk (e.g., diabetics, smokers, elderly, etc.) for inadequate intakes, will yield positive results for periodontal health. Patient education programs that stress the importance of good nutrition, while at the same time providing practical information for the selection of a well balanced diet, are simple measures that will benefit many. [References: 24] <45> UI - 90002419 AU - Burgess RC AU - Burgess NE TI - Diet and dental caries. [Review] [54 refs] SO - Journal / Canadian Dental Association. Journal de l Association Dentaire Canadienne 1989 Sep;55(9):699-702 <46> UI - 89360121 AU - Beiswanger BB AU - Stookey GK IN - Indiana University School of Dentistry, Oral Health Research Institute, Indianapolis 46202. TI - The comparative clinical cariostatic efficacy of sodium fluoride and sodium monofluorophosphate dentifrices: a review of trials. SO - ASDC Journal of Dentistry for Children 1989 Sep-Oct;56(5):337-47 AB - This report reviews the methods and findings of published clinical studies comparing dentifrices containing sodium fluoride (NaF) and sodium monofluorophosphate (Na2PO3F) for the purpose of determining whether sodium fluoride formulations have superior cariostatic effects. Nine of ten reported trials found a numerical advantage for sodium fluoride dentifrices with highly compatible abrasive systems and the hypothesis that these two fluoride agents have equivalent cariostatic effects is rejected (p = 0.011). Therefore, the collective clinical evidence demonstrates that dentifrices containing NaF have greater cariostatic effectiveness than dentifrices containing Na2PO3F. <47> UI - 89365973 AU - Spears GF TI - Fluoride and dental caries [letter]. SO - New Zealand Dental Journal 1989 Jul;85(381):95 <48> UI - 89341107 AU - Beiswanger BB AU - Lehnhoff RW AU - Mallatt ME AU - Mau MS AU - Stookey GK IN - Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis 46202. TI - A clinical evaluation of the relative cariostatic effect of dentifrices containing sodium fluoride or sodium monofluorophosphate. [Review] [28 refs] SO - ASDC Journal of Dentistry for Children 1989 Jul-Aug;56(4):270-60 AB - A three-year clinical trial was conducted to determine whether a sodium fluoride (NaF) dentifrice had greater cariostatic effects than a sodium monofluorophosphate (Na2PO3F) dentifrice. Both dentifrices contained 1100 ppm fluoride and silica abrasive systems. A panel of 3,290 children, age 6-16, received one of the two dentifrices for ad libitum home use. The subjects were examined for caries at the baseline and after 2 and 3 years. Results were analyzed both for all children and for those children age 11 years or older at the baseline. The older children were found to have about 50 percent higher new caries increments than did the entire panel of children. In the older, caries- prone children, the subjects using the NaF product experienced significantly (15 percent and 12 percent) fewer new lesions than did the subjects using the Na2PO3F product after 2 and 3 years respectively. In the panel of all children, subjects using the NaF product had numerically, but not significantly, fewer new lesions. The results for this study, showing significantly greater cariostatic benefits in caries-prone children for a sodium fluoride dentifrice with a highly compatible system, are consistent with findings of other investigators. [References: 28] <49> UI - 89341196 AU - Johnsen D AU - Nowjack-Raymer R IN - Department of Pediatric Dentistry, School of Dentistry, Case Western Reserve University, Cleveland, Ohio 44106. TI - Baby bottle tooth decay (BBTD): issues, assessment, and an opportunity for the nutritionist. [Review] [78 refs] SO - Journal of the American Dietetic Association 1989 Aug;89(8):1112-6 AB - Baby Bottle Tooth Decay (BBTD) is a rampant form of caries affecting the maxillary incisors, and frequently the molars, that occurs before the age of 2 years and is of growing concern. BBTD is a nutritional disorder whose outcome is carious teeth. Treatment involves extensive and expensive restoration of teeth or extraction of teeth associated with physical restraint, sedation, or general anesthesia in a hospital. This review of several issues regarding BBTD includes description, etiology and pathogenesis, prevalence, background factors, treatment, timing for intervention, existing strategies, and research opportunities. The disease is of significance to the nutritionist because it is totally preventable and occurs at an age when many children have seen a nutritionist (e.g., in a WIC program) but may not have seen a dentist. The dietetic practitioner can identify children at risk, determine awareness by the parent, and establish a behavioral contract with the parent. The practitioner needs to succeed for only a brief time to prevent BBTD. [References: 78] <50> UI - 89348219 AU - Palmer CA TI - Diet and nutrition: crucial factors in the dental health of children. [Review] [95 refs] SO - World Review of Nutrition & Dietetics 1989;58:131-59 <51> UI - 89326635 AU - Widdop FT TI - Caring for the dentate elderly. [Review] [58 refs] SO - International Dental Journal 1989 Jun;39(2):85-94 AB - The proportional increase of elderly persons in most communities and increasing tooth retention among them betoken considerable change in gerodontic needs. Servicing dentate older patients will occupy progressively more practising time. This committment requires the development of somewhat different skills, knowledge and philosophy from those customarily propounded in dental teaching to date which has concentrated mostly on matters relevant to young and middle-aged persons. Dentists must become proficient in managing clinical entities of prevalence in the elderly. Xerostomia, a frequent, but often neglected symptom can have distressing consequences. Practitioners have a responsibility to detect it, analyse its likely cause or causes and select appropriate therapy. Root caries is re-emerging as a common finding. Its aetiology must be understood in order to institute effective preventive measures and treatment. Dentate elderly persons typically have heavily restored teeth subject to various iatrogenic problems. Some of the restorative work required can be provided exactly as for younger patients. However, optimum care is not necessarily the most elaborate. It is often desirable, when health or financial considerations dictate, to adopt expedients which reduce treatment extent and/or expense. Adhesive materials are extremely useful. The 'sandwich technique' for bonding composite resin to dentine via glass ionomer cement often facilitates the provision of extensive restorations in a minimally invasive fashion. Adhesive procedures can also be applied to treat attrition, mend fatigue fractures, splint teeth deficient in periodontal support, and provide simplified cosmetic treatment for elderly patients. [References: 58] <52> UI - 89314624 AU - Eccles MF TI - The problem of occlusal caries and its current management. [Review] [59 refs] SO - New Zealand Dental Journal 1989 Apr;85(380):50-5 AB - Occlusal caries has become relatively more important, due to the changing pattern of dental caries that has occurred in the developed countries of the world. Accurate diagnosis of the activity of a carious lesion is important, because arrest and remineralization are possible. Diagnosis of occlusal caries is difficult due to the morphology of the occlusal surface. Unfortunately, topical action of fluorides is thought to be making diagnosis increasingly difficult. The literature suggests that we should be examining for caries under good lighting and a dry field, the use of a blunt probe being reserved for gently removing debris from fissures to enable good visualisation. Bitewing radiography is valuable in the detection of occlusal as well as approximal caries, but good radiographic technique and careful viewing are essential. Electronic caries detection may well prove useful in the future. The traditional restorative approach to occlusal caries resulted in inconsistent treatment decisions, poor durability of restorations, and the unfortunate consequences of replacement restorations. It seems logical to take a more conservative, preventive approach in the management of dental caries. Fissure sealants should be used preventively for the caries-prone patient, and therapeutically for the suspect or early carious lesion. Where the caries has spread into dentine, as shown radiographically, then the sealant restoration may be more suitable. These techniques have been shown to be safe and effective, although careful case selection, appropriate manipulation of materials, recall, and maintenance are essential to long-term success.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 59] <53> UI - 89247893 AU - Triger DR TI - Autoimmune chronic active hepatitis and primary biliary cirrhosis. [Review] [45 refs] SO - Baillieres Clinical Gastroenterology 1989 Jan;3(1):21-38 AB - Autoimmune CAH is important to recognize, since it is highly responsive to treatment which undoubtedly prolongs life. Autoimmune CAH can rarely be cured; complete withdrawal of treatment leads to relapse in over 80% of patients. Prednisolone and azathioprine are the major drugs of choice, the former inducing remission while the latter maintains remission, either alone or in combination with prednisolone. Since both drugs are associated with substantial side-effects which tend to be dose-related, the object of treatment must be to induce and maintain remission with the minimum risk of relapse together with an acceptably low incidence of complications. Although PBC shares many features in common with autoimmune CAH, treatment of the underlying disease is generally unsuccessful. To date no drug has been shown to induce remission or to prolong survival. The main aim of treatment should be directed towards the complications of PBC, of which pruritus and osteoporosis are the two major complaints. Cholestyramine and antihistamines are the drugs of choice, but when these fail a variety of other therapies are also available, although many have only been shown to be effective on an anecdotal basis. No treatment has yet been shown to reverse the bone demineralization which occurs in PBC, but early calcium supplementation is recommended in this disorder. Osteomalacia is uncommon and can be prevented by prophylactic calcium and vitamin D supplementation in jaundiced patients. Liver transplantation is effective in treating PBC, and when successful leads to complete restoration of health with the prospects of increasingly long survival. Recurrence of PBC does not appear to be a significant problem. [References: 45] <54> UI - 89275855 AU - Taubman MA AU - Smith DJ TI - Oral immunization for the prevention of dental diseases. [Review] [49 refs] SO - Current Topics in Microbiology & Immunology 1989;146:187-95 <55> UI - 89256210 AU - De Craene GP AU - Martens LC AU - Dermaut LR AU - Surmont PA IN - Department of Pedodontics, State University of Ghent, Belgium. TI - A clinical evaluation of a light-cured fissure sealant (Helioseal). [Review] [42 refs] SO - ASDC Journal of Dentistry for Children 1989 Mar-Apr;56(2):97-102 AB - The clinical success of pit and fissure sealants has been reported by several authors. In this study a white-shaded, visible-light-cured sealant was used; the results of the clinical evaluation confirmed this finding. Concerning retention rate, marginal adaptation, and the presence of secondary caries and air bubbles, good results were obtained. Data indicate that a visible- light-cured sealant (Helioseal) appears to be as good as the self-cured sealants and better than the UV-light-cured products. A comparison was also made between the invasive (PFSI) and non-invasive (PFS) application techniques; with respect to the marginal adaptation and the presence of air bubbles, better results were found for fissures that had been enlarged as a preventive measure. More longitudinal studies over a longer period of time are necessary. [References: 42] <56> UI - 89234710 AU - Nieboer C AU - de Hoop D AU - van Loenen AC AU - Langendijk PN AU - van Dijk E IN - Department of Dermatology, Free University Hospital, Amsterdam, The Netherlands. TI - Systemic therapy with fumaric acid derivates: new possibilities in the treatment of psoriasis. [Review] [28 refs] SO - Journal of the American Academy of Dermatology 1989 Apr;20(4):601-8 AB - For the past two decades fumaric acid (FA) therapy has become an increasingly popular treatment in Western Europe for psoriasis. FA therapy originally was developed by Schweckendiek and subsequently standardized by Schafer. Schafer's fumaric acid compound therapy (FACT) consists of the oral intake of dimethylfumaric acid ester (DMFAE) and several salts of monoethylfumaric acid ester (MEFAE) in combination with topical fumaric acid therapy (1% to 3% MEFAE in an ointment or FA in bathing oils) and a diet. Schafer claimed excellent results in a large number of patients. Preliminary studies by German dermatologists, however, revealed contradictory therapeutic results and serious side effects, and FA treatment was soon abandoned by dermatologists. To assess the value of FA therapy we conducted an open pilot study of 36 patients in which FACT therapy appeared to be rather effective. Thereafter, several controlled studies with MEFAE sodium in two different dosages versus placebo, and DMFAE versus placebo, were done. The results indicated that MEFAE sodium in dosages up to 240 mg daily was ineffective, whereas daily dosages of 720 mg resulted in a significant decrease in scaling and itching but did not affect extension of the eruption. DMFAE, 240 mg daily, produced a significant amelioration and prevented extension. Side effects of FA treatment were nausea, diarrhea, general malaise, and severe stomachache. Mild disturbances of liver and kidney function during treatment were observed with the 720 mg dosage of MEFAE and with the 240 mg dosage of DMFAE. Moreover, a relative lymphopenia with a selective decrease of suppressor T lymphocytes occurred in about 50% of the patients treated with DMFAE.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 28] <57> UI - 89197364 AU - Grenby TH IN - Department of Oral Medicine and Pathology, United Medical School, Guy's Hospital, London Bridge, London, UK. TI - Latest state of research on lactitol and dental caries. [Review] [29 refs] SO - International Dental Journal 1989 Mar;39(1):25-32 AB - Research on the dental properties of lactitol as a bulk sweetener to replace dietary sugar is reviewed under three headings: microbiological experiments in vitro, investigations in laboratory animals, and studies in man. Lactitol was not easily metabolized by acidogenic and polysaccharide-forming oral micro-organisms, its enamel-demineralizing potential in vitro intra-oral acid development and dental plaque formation from lactitol in man were substantially lower than from sucrose. The indications for dental health benefits are promising. [References: 29] <58> UI - 89179934 AU - McCormack-Brown KR AU - Clark BJ AU - McDermott RJ IN - Dept. of Health Sciences, Western Illinois University, Macomb, IL 61455. TI - Dental pit and fissure sealants: implications for school health personnel. [Review] [50 refs] SO - Journal of School Health 1989 Feb;59(2):69-73 AB - While tooth decay among schoolchildren has declined in recent years, 95% of all schoolchildren still experience tooth decay. School-based fluoride rinse programs have made a significant contribution to the decrease in tooth decay. Pit and fissure sealants, one other preventive dentistry measure, also fight tooth decay. A pit and fissure sealant placed on the chewing surfaces of permanent molars acts as a barrier and protects caries-prone areas of the teeth. For sealants to be effective, it is important that school health educators, nurses, and administrators have the dental health knowledge necessary to make informed decisions about school-based dental sealant programs. Examples of successful programs are discussed. [References: 50] <59> UI - 89136497 AU - Mitchell L AU - Murray JJ IN - Department of Child Dental Health, Dental School, University of Newcastle-upon-Tyne, UK. TI - Fissure sealants: a critique of their cost-effectiveness [see comments]. [Review] [52 refs] CM - Comment in: Community Dent Oral Epidemiol 1989 Aug;17(4):220 SO - Community Dentistry & Oral Epidemiology 1989 Feb;17(1):19-23 AB - Despite the large number of clinical trials demonstrating the effectiveness of fissure sealants in preventing occlusal caries, it has been suggested that the fundamental principles of cost-effectiveness have not been applied to the use of fissure sealants and there is little in the literature which allows up-to-date judgements to be made. A review of the literature suggests that whilst the limitations in design of some of the earlier fissure sealants studies make it difficult to draw firm conclusions, the results of later studies, particularly those which evaluated fissure sealants as an integral part of routine dental care, are encouraging. A number of factors including durability and tooth selection influence the economic viability of fissure sealants. These factors must be considered and controlled if sealants are to be used cost-effectively. [References: 52] <60> UI - 89140059 AU - Hastreiter RJ IN - Minnesota Department of Health, Minneapolis 55440. TI - Is 0.4% stannous fluoride gel an effective agent for the prevention of oral diseases? [see comments]. [Review] [62 refs] CM - Comment in: J Am Dent Assoc 1989 Jul;119(1):10, 12, 172-4 SO - Journal of the American Dental Association 1989 Feb;118(2):205-8 AB - Research does not support the concept that 0.4% stannous fluoride gels are the preferred preventive or treatment agents for hypersensitivity, plaque, gingivitis, or periodontitis. The only clinically proved, cost-beneficial indications for use of these materials are for the prevention of enamel decalcification in patients wearing banded orthodontic appliances and for the prevention of dental caries in patients who have had head and neck radiation therapy. Even for these applications, other fluoride products may have equal effectiveness. [References: 62] <61> UI - 89127973 AU - Brown RH TI - Fluorides and the prevention of dental caries. Part II: The case for water fluoridation. [Review] [20 refs] SO - New Zealand Dental Journal 1989 Jan;85(379):8-10 AB - The evidence is very strong that fluoridation of water, and fluorides in other forms, are the prime reasons for the enormous reduction in decay that has occurred over the past 25-30 years. These advantages must be retained. This can be done most effectively and most economically through a continuation of water fluoridation and the use of fluoride toothpaste. In nonfluoridated areas, professionally applied topical fluorides will continue to be needed, particularly within the School Dental Service, and in those adolescent and adults where the history and clinical picture suggest the individual is at risk. Without fluoride acting to enhance the resistance of the mouth, decay would certainly rise. Although advocacy for a sound diet and the use of fissure sealants is encouraged as part of caries preventive programmes, these alone will not provide adequate protection across the whole community. Fluoridation of public water supplies continues to be endorsed. [References: 20] <62> UI - 89109838 AU - Ripa LW IN - Department of Children's Dentistry, School of Dental Medicine, State University of New York, Stony Brook 11794-8701. TI - Clinical studies of high-potency fluoride dentifrices: a review. [Review] [24 refs] SO - Journal of the American Dental Association 1989 Jan;118(1):85-91 AB - A review of clinical studies indicates that increasing the fluoride content above 1,000 ppm in dentifrices containing sodium monofluorophosphate increases the mean caries reduction by approximately 12%. The results of studies testing high-potency mixed-fluoride dentifrices containing both sodium fluoride and sodium monofluorophosphate are less conclusive. [References: 24] <63> UI - 89091547 AU - Mandel ID IN - Center For Clinical Research in Dentistry, School of Dental and Oral Surgery, Columbia University, New York, New York. TI - Preventive dental services for the elderly. [Review] [33 refs] SO - Dental Clinics of North America 1989 Jan;33(1):81-90 AB - Preventive dentistry for the elderly is a two-track system: one for the haves and another for the have nots (not an uncommon duality). For those who have teeth, the major needs are prevention of new or recurrent caries and preventing further loss of supporting tissue. The strategies are essentially the same as for the younger populations, with some modification. For the have-nots, maintenance of denture function and denture hygiene becomes the counterpart. Both groups have the same needs for surveillance of soft tissue health and salivary gland function. The major challenge for the preventively oriented dentist concerned with the elderly is to develop an appreciation of the need for regular care in an age group that places a low priority on this service. This is an educational and a behavioral problem that has to be addressed by our social and behavioral scientists. The practitioner, however, has to build it into dental practice on an ongoing basis. People do not become elderly over night (although it may seem to happen that way). As people grow older, they lose the youthful sense of immortality and are very amenable to health education. We have to provide it. A well functioning dentition, artificial or, one hopes, natural, adds to well being, "quality of life" and is part of active life expectancy that to many is more important than mere survival. [References: 33] <64> UI - 89091546 AU - Navazesh M IN - Department of Geriatric Dentistry and Special Patient Care, University of Southern California School of Dentistry, Los Angeles. TI - Xerostomia in the aged. [Review] [31 refs] SO - Dental Clinics of North America 1989 Jan;33(1):75-80 AB - Xerostomia is a symptom associated with a variety of causes. Disorders in the production and transport as well as excessive depletion of saliva may lead to xerostomia. It is difficult to make any general statement about the functional significance of salivary gland changes associated with aging, as the clinical evidence is controversial and data from different studies do not encourage any uniform conclusion. Rational treatments of xerostomias may be performed casually (for example, withdrawal or exchange of drugs inhibiting salivary secretion), but will often only be practical as a symptomatic therapy. Special attention should be directed toward maintenance of adequate oral hygiene in order to prevent clinical complications such as increased dental caries, monilial infection, dysgeusia and tooth sensitivity, which are associated with xerostomia and are often observed in elderly xerostomic patients. [References: 31] <65> UI - 89091540 AU - Ship JA AU - Ship II IN - National Institute of Dental Research, Bethesda, Maryland. TI - Trends in oral health in the aging population. [Review] [30 refs] SO - Dental Clinics of North America 1989 Jan;33(1):33-42 AB - Increased survival of the natural dentition, persistence of periodontal disease, deterioration of prior dental restorations, root surface caries, and continued incidence of oral cancer represent a complex of emerging oral health problems of the aged in the United States. Additional data on the epidemiology of oral mucous membrane syndromes will help to characterize the prevalence of these diseases in the aging population as well. Improvement in the utilization and accessibility of dental services by the aging cohorts will contribute to the prevention of oral disease in the future. Combined with the substantial growth in the size of this cohort of the population and alterations in the prevalence of these oral health status indicators, changes in the need for and projected utilization of professional oral health services can continue to be anticipated. Clinical research directed toward assessment of efficacy of treatment modalities for prevention of dental disease and maintenance of dental health are essential for the projection of dental health manpower needs for the future. This should also lead to the development of appropriate academic and training programs to meet the changing needs of the elderly. [References: 30] <66> UI - 95316807 AU - Messer JG TI - An overview of dental care delivery and dental health in Northern Newfoundland and Labrador. SO - Canadian Journal of Community Dentistry 1988 Winter;3(1):45-53 <67> UI - 90373573 AU - Luoma H IN - Department of Preventive Dentistry and Cariology, University of Kuopio, Finland. TI - The role of magnesium in the aetiology and prevention of caries: some new findings and implications [see comments]. [Review] [55 refs] CM - Comment in: Magnes Res 1989 Sep;2(3):235-7 SO - Magnesium Research 1988 Dec;1(3-4):223-30 AB - While some epidemiological studies seem to indicate that a high intake of magnesium should be associated with a low prevalence of dental caries, the results of experimental studies are mainly equivocal. Magnesium is probably not bound to the apatite lattice of dental enamel or dentine, or it is bound to a small degree only. It is mainly located in the hydration layer of the apatite crystallites. In the dental caries process it is preferentially dissolved together with the carbonate of the mineral phase. It is not known to what extent feasible dietary changes can modify tooth magnesium content during pre-eruptive tooth development. Animal experiments indicate that the elevation of dietary magnesium alone after tooth eruption has no definite capacity to modify the occurrence of dental caries. When fed in combination with small fluoride supplements in the diet magnesium and fluoride may support each other in preventing various calcium salt imbalances such as dental caries, arteriosclerosis and nephrocalcinosis. Although some recent in vitro findings indicate that extra magnesium in the fluid environment of cariogenic streptococci may protect them against the inhibitory action of fluoride, such magnesium changes do not seem possible in the human mouth under present or envisaged dietary conditions. [References: 55] <68> UI - 90125443 AU - Swift EJ Jr TI - Fluoride-containing restorative materials. [Review] [48 refs] SO - Clinical Preventive Dentistry 1988 Nov-Dec;10(6):19-24 <69> UI - 89354455 AU - Levy SM TI - The epidemiology and prevention of dental caries in adults. [Review] [72 refs] SO - Compendium - Supplement 1988;(11):S390-8 <70> UI - 89354451 AU - Ripa LW TI - Effect of type of fluoride compound and fluoride concentration on the caries inhibition of dentifrices. [Review] [28 refs] SO - Compendium - Supplement 1988;(11):S365-70 <71> UI - 89335176 AU - Johnsen DC TI - Baby bottle tooth decay: a preventable health problem in infants. [Review] [51 refs] SO - Update in Pediatric Dentistry 1988 Nov;2(1):1-4, 6-7 <72> UI - 89250155 AU - Yasin-Harnekar S TI - Nursing caries. A review. [Review] [43 refs] SO - Clinical Preventive Dentistry 1988 Mar-Apr;10(2):3-8 <73> UI - 89256544 AU - Kureishi A AU - Chow AW IN - Division of Infectious Disease, University of British Columbia, Vancouver, Canada. TI - The tender tooth. Dentoalveolar, pericoronal, and periodontal infections. [Review] [42 refs] SO - Infectious Disease Clinics of North America 1988 Mar;2(1):163-82 AB - Dental caries and periodontal disease are the most common afflictions of the tooth. These infectious diseases cause considerable pain and discomfort and ultimately loss of the tooth. Apart from local effects, these infections may extend beyond natural barriers and result in complications that can vary in severity from the excruciating pain of acute pulpitis to life-threatening infections of the deep fascial spaces of the head and neck. In this article, the clinical and pathologic features of dental caries, pulpitis, periapical abscess, pericoronitis, and periodontal infections are discussed as well as prevention and treatment of infections involving the tooth, with emphasis on endocarditis prophylaxis. [References: 42] <74> UI - 89233313 AU - Shah N TI - Fluorides in dental health: recent concepts. [Review] [36 refs] SO - Indian Journal of Pediatrics 1988 Sep-Oct;55(5):693-701 <75> UI - 89108636 AU - Koch G IN - Institute for Postgraduate Dental Education, Jonkoping, Sweden. TI - Importance of early determination of caries risk. [Review] [6 refs] SO - International Dental Journal 1988 Dec;38(4):203-10 AB - Even if the preventive programmes against dental disease in place today were to be highly successful there would still be individuals developing large numbers of carious lesions. It is therefore important to find methods to detect early those individuals who are prone to develop caries and then to institute special preventive programmes for them. The importance of such systems will increase when the general level of dental health improves. Then the high-caries group will require a proportionally larger part of the total dental care provided. The number of false-positive decisions will increase as the proportion of high caries risk individuals decreases. To a certain extent, this will mean that the application of specifically designed and expensive preventive programmes for predicted high-risk individuals will result in a low cost-effectiveness ratio. In a clinical study the possibility of predicting high caries risk pre-school children was analysed. [References: 6] <76> UI - 89108640 AU - Beck JD AU - Kohout F AU - Hunt RJ IN - Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450. TI - Identification of high caries risk adults: attitudes, social factors and diseases. [Review] [27 refs] SO - International Dental Journal 1988 Dec;38(4):231-8 AB - Since agent, host and environmental factors have been associated with caries, the development of multivariate risk assessment models is warranted. This process comprises the identification of risk factors, the development and testing of risk models, assessment and targeting. Work-in-progress by the authors in delineating oral, social/behavioural and medical risk factors for root caries in older adults shows that regression models explain 48 per cent of the variance in root caries scores for males and 47 per cent for females. Discriminant analyses using the risk factors identified in the regressions differentiated between people who did and did not get root caries during an 18-month period. The sensitivity of the predictions for men was 0.75 and the specificity was 0.79. For women, the sensitivity was 0.79 and the specificity was 0.83. These results suggest that it will be possible to develop a clinically useful risk assessment model. Future studies should include data on oral risk factors, such as micro-organisms present, salivary flow and buffering capacity, that can be added to the multivariate model. [References: 27] <77> UI - 89078526 AU - Klein JP AU - Scholler M IN - Unite de Recherches U 157, Institut National de la Sante et de la Recherche Medicale, Faculte de Chirurgie Dentaire, Strasbourg, France. TI - Recent advances in the development of a Streptococcus mutans vaccine. [Review] [70 refs] SO - European Journal of Epidemiology 1988 Dec;4(4):419-25 <78> UI - 89058007 AU - Sims DS Jr AU - Cavanagh PR AU - Ulbrecht JS IN - Center for Locomotion Studies, Pennsylvania State University, University Park 16802. TI - Risk factors in the diabetic foot. Recognition and management. [Review] [117 refs] SO - Physical Therapy 1988 Dec;68(12):1887-902 AB - The most frequently reported diabetic foot complication is plantar ulceration. Neuropathic fractures occur less often than plantar ulcers but usually result in major structural deformities of the feet. The primary risk factors for plantar ulceration are believed to be loss of protective sensation and the presence of high plantar pressures. Principal etiologic factors in the development of neuropathic fractures are hypothesized to be loss of protective sensation and bone demineralization. Major diabetic foot injuries are preventable by the use of comprehensive screening examinations and patient education. Patients at highest risk of injury should be seen more frequently and receive more extensive therapy. Successful management of plantar ulcerations is dependent on reduction of pressures under the foot and control of infection. Neuropathic fractures require long-term immobilization to promote healing followed by careful monitoring after removal of casts to prevent reinjury. Future research needs include prospective studies on risk factors and validation of treatment techniques. [References: 117] <79> UI - 89026263 AU - Mellberg JR TI - Remineralization. A status report for the American Journal of Dentistry. Part II. [Review] [43 refs] SO - American Journal of Dentistry 1988 Apr;1(2):85-9 <80> UI - 89026480 AU - Crawford PJ TI - Sealant restorations (preventive resin restorations). An addition to the NHS armamentarium. [Review] [22 refs] SO - British Dental Journal 1988 Oct 8;165(7):250-3 <81> UI - 89032671 AU - Anonymous TI - Review of methods of identification of high caries risk groups and individuals. Federation Dentaire Internationale Technical Report No. 31. [Review] [143 refs] SO - International Dental Journal 1988 Sep;38(3):177-89 AB - The search for methods of predicting dental caries activity began during the last century. The purpose of this review was to update the report on methods of caries prediction which resulted from the 1977 workshop, sponsored by the National Institutes of Health, Washington, DC, and also to identify the methods most likely to provide effective prediction of caries risk which should be given high priority in future research. The factors that need to be considered in assessing the value of a method of predicting caries risk are the correlation coefficient between the predictions and the final caries scores and in particular an assessment of the ability of the method to recognize subjects who will develop caries (sensitivity) and to exclude those who will not (specificity). The predictive power of the method should also be known. There is, however, the risk that when predictive tests are applied to a population with decreasing caries prevalence the number classified as false positive could be increased. This may limit the cost-effectiveness of preventive technique. The requirements of a good method of predicting dental caries are that the method should be simple, inexpensive and rapid and should identify subjects who will become diseased and exclude subjects who will remain healthy. To date, a wide variety of factors have been considered in the search for an effective method of predicting caries risk, but only a few have had some success. Certain epidemiological methods have shown reasonable sensitivity but less specificity. Measures in this category include specific indicator surfaces and DMFT increment in the previous year. Among the more useful specific tests have been mutans streptococci and lactobacillus counts and measurement of saliva buffering capacity. Other methods that show some promise include the physical measurement of incipient carious lesions of enamel. The measurement of possible determinants of a multifactorial disease is extremely difficult and regardless of which single method has been tried the authors have usually concluded that it is difficult to develop a reliable method of identifying caries susceptible individuals from the method. To a lesser extent the same conclusions have been applied to methods for identifying risk groups. There does, however, appear to have been little research in which a combination of tests or methods have been used, particularly combinations of tests that involve different scientific disciplines.(ABSTRACT TRUNCATED AT 400 WORDS) [References: 143] <82> UI - 89036895 AU - Burt BA AU - Beltran ED IN - Program in Dental Public Health, School of Public Health, University of Michigan, Ann Arbor 48109-2029. TI - Water fluoridation: a response to critics in Australia and New Zealand [see comments]. [Review] [64 refs] CM - Comment in: J Public Health Dent 1989 Summer;49(3):131-7 SO - Journal of Public Health Dentistry 1988 Fall;48(4):214-9 AB - Recent questions about the effectiveness of water fluoridation have come from Diesendorf in Australia and Colquhoun in New Zealand. This report examines the arguments of both authors in detail and finds errors in each. Diesendorf employed an outdated view of how fluoride exerts its anticariogenic action and took a number of quotations out of context. Colquhoun's data are questionable. Neither author has produced evidence to challenge the established safety and effectiveness of water fluoridation. [References: 64] <83> UI - 89036898 AU - Beltran ED AU - Burt BA IN - Program in Dental Public Health, School of Public Health, University of Michigan, Ann Arbor 48109-2029. TI - The pre- and posteruptive effects of fluoride in the caries decline. [Review] [145 refs] SO - Journal of Public Health Dentistry 1988 Fall;48(4):233-40 AB - The widespread availability of fluoride from many sources is accepted as a major reason for the caries decline among children in developed countries. There is still controversy, however, about its principal mode of action. This article reviews the evidence on fluoride's preeruptive and posteruptive effects, and suggests reasons for its continuing role in the caries decline. Early fluoridation studies accepted that fluoride acted preruptively through incorporation into developing enamel; but further research could not explain why fluoride levels were not clearly higher in enamel exposed to fluoride, nor why there were no clear correlations between caries experience and enamel fluoride concentration. Instead, considerable evidence suggests that fluoride acts mainly, though not entirely, through posteruptive remineralization of demineralized enamel. Caries experience has declined in nonfluoridated as well as in fluoridated areas, though DMF scores are still consistently lower in fluoridated areas. Posteruptive remineralization effects are seen from fluoridated drinking water as well as with fluoride from other sources. The continuing caries decline, beyond the level suggested by early fluoridation field trials, can be attributed either to more efficient remineralization or to long-term, intraoral ecological change, or to both. [References: 145] <84> UI - 89040729 AU - Brown RH TI - Fluoride and the prevention of dental caries. Part I: The role of fluoride in the decline of caries [see comments]. [Review] [65 refs] CM - Comment in: N Z Dent J 1989 Apr;85(380):63-5 SO - New Zealand Dental Journal 1988 Oct;84(378):103-8 <85> UI - 89032668 AU - Lange DE IN - Department of Periodontology, School of Dental Medicine, University of Munster, FRG. TI - The practical approach to improved oral hygiene. [Review] [31 refs] SO - International Dental Journal 1988 Sep;38(3):154-62 AB - It is possible to preserve or restore oral health and to avoid or treat the two plaque diseases, caries and periodontitis. These two diseases are extremely closely correlated with oral hygiene status. The patient's understanding of oral structures and his or her interest in preserving or restoring healthy teeth and gums depends on instruction and motivation. There is, unfortunately, no scientifically based method of reliably motivating every patient. A person's ability to be motivated is substantially moulded by his social position, intelligence, personality and attitude to his body and health. The techniques and methods illustrated are intended to stimulate and activate appropriate attitudes. A standard of oral hygiene that helps to prevent caries and periodontitis can be achieved only by the dental team in dental practice and not by collective measures. [References: 31] <86> UI - 88290069 AU - Makinen KK AU - Isokangas P IN - School of Dentistry, University of Michigan, Ann Arbor 48109. TI - Relationship between carbohydrate sweeteners and oral diseases. [Review] [162 refs] SO - Progress in Food & Nutrition Science 1988;12(1):73-109 AB - Dental caries and periodontal disease are wide-spread oral illnesses whose etiology is intimately associated with the consumption of carbohydrate sweeteners. Since dental caries is multifactorial in nature, it is reasonable to assume that there is no single method, usable in the foreseeable future, which would lead to its eradication. Consequently, any new caries preventive measures must function coherently with those currently in use, so that the concerted action of all methods would lead to the best cariostatic effect. Strict restriction of sucrose intake without suggestion of alternatives is not realistic. This fact has given rise to attempts to replace sucrose, especially in products consumed between meals, with sweeteners that are less cariogenic. Human clinical trials and several animal experiments have shown promising clinical results obtained by replacing sucrose with certain sugar alcohols (polyols). Among the sugar alcohols, the best results so far have been obtained with xylitol, which is chemically a pentitol containing five carbon atoms. Chewing gums containing xylitol have been shown to be strong instruments against caries in caries-active age-groups and in high-risk subjects. More research is needed to assess the ability of mixtures of xylitol with sorbitol, palatinit, maltitol, other sugar alcohols, and intense sweeteners to prevent oral plaque diseases. Although thorough clinical trials on the relationship between carbohydrate sweeteners and periodontal diseases have not been performed, the available data indicate that dietary polyols may have a restricted dampening effect on periodontal and gingival inflammations. [References: 162] <87> UI - 88302785 AU - Moss SJ IN - Department of Pedadontics, New York University's College of Dentistry, New York City. TI - Preventive techniques in infant dental care. SO - Nurse Practitioner 1988 Jul;13(7):37-8, 40, 45, passim AB - Dental caries is the most prevalent disease among young people in the United States today. Yet, most parents don't realize that early dental care is the best insurance against adult dental disease. Because prevention should begin at birth, long before the first dental visit, nurse practitioners can play an important role in educating parents about the need for early attention to their children's dental health. This article presents to the nurse practitioner an overview of preventive dental techniques, including the effectiveness and application of fluorides, the value of early and regular oral cleaning habits and the importance of early and regular consultations with health care professionals. <88> UI - 88276643 AU - Smith GE TI - Tooth decay in the developing world: could a vaccine help prevent cavities?. [Review] [43 refs] SO - Perspectives in Biology & Medicine 1988 Spring;31(3):440-53 <89> UI - 88237437 AU - Bar A TI - Caries prevention with xylitol. A review of the scientific evidence. [Review] [148 refs] SO - World Review of Nutrition & Dietetics 1988;55:183-209 <90> UI - 88242872 AU - Bral M AU - Brownstein CN IN - Department of Periodontics, New York University College of Dentistry. TI - Antimicrobial agents in the prevention and treatment of periodontal diseases. [Review] [192 refs] SO - Dental Clinics of North America 1988 Apr;32(2):217-41 AB - It has been estimated that there are more than 400 diseases affecting the oral cavity. In terms of prevalence, however, the major public health problems are caries and periodontal disease. Although these two destructive entities are completely different in many respects, they share a common denominator: the initial lesions are brought about by an aggregate of bacteria known as plaque. This article discusses chemical control of plaque in the treatment of gingivitis and antimicrobial control of subgingival plaque in the treatment of periodontitis. The authors address the use of antibiotics in the treatment of localized juvenile periodontitis, the ideal properties of antiplaque agents, and adjunctive subgingival application of antimicrobial agents. [References: 192] <91> UI - 88225558 AU - Schroder K TI - Caries prevention: an overview of the Legislative Action Packet. SO - Dental Hygiene 1988 Mar;62(3):116, 149-50 <92> UI - 88204982 AU - Smith GE TI - Fluoride and fluoridation. [Review] [148 refs] SO - Social Science & Medicine 1988;26(4):451-62 AB - To date, many of the ways of controlling tooth decay involve the use of fluorides. Either systemically via fluoridated water and tablets, or, topically, with fluoride-containing toothpaste and mouthrinses. There is now evidence that the prevalence of dental caries is declining in communities with unfluoridated water, as well as in those with fluoridated water. This phenomenon may be related to an increase of fluoride in the food chain; the unintentional ingestion of fluoride-containing dental health products; and the increasing contamination of the total environment with fluoride emissions and solid wastes from many industries. The apparent usefulness of fluoride as a preventive against dental caries does not mean that unnecessary exposure to the element should be tolerated. Fluoride at very low concentrations is phytotoxic and harmful to livestock; and in man, excessive intakes of fluoride over many years may lead to a well-defined disorder--skeletal fluorosis. In addition, a number of recent studies have suggested that fluoride may be genotoxic. [References: 148] <93> UI - 88166060 AU - Proctor VA AU - Cunningham FE IN - Department of Animal Science and Industry, Kansas State University, Manhattan. TI - The chemistry of lysozyme and its use as a food preservative and a pharmaceutical. [Review] [240 refs] SO - Critical Reviews in Food Science & Nutrition 1988;26(4):359-95 AB - The chemistry and use of lysozyme as a food preservative and a pharmaceutical are reviewed. Lysozyme inhibits the growth of deleterious organisms, thus prolonging shelf life. Chemicals used to improve the preservative effect of lysozyme and those that inhibit the enzyme are discussed, along with the stability of lysozyme in various chemical environments. Lysozyme has been used to preserve fresh fruits and vegetables, tofu bean curd, seafoods, meats and sausages, potato salad, cooked burdock with soy sauce, and varieties of semihard cheeses such as Edam, Gouda, and some Italian cheeses. Lysozyme added to infant-feeding formulas makes them more closely resemble human milk. Lysozyme has been used clinically in the treatment of periodontitis, administered in chewing gum, and implemented to prevent tooth decay. It has also been administered to patients suffering from cancer for its analgesic effect and has been used as a potentiating agent in antibiotic therapy. [References: 240] <94> UI - 89185383 AU - Pitts NB AU - Longbottom C TI - Temporary tooth separation with special reference to the diagnosis and preventive management of equivocal approximal carious lesions. [Review] [66 refs] SO - Quintessence International 1987 Aug;18(8):563-73 <95> UI - 89125345 AU - Rawls HR IN - Gillette Company, Boston, MA 02106. TI - Fluoride-releasing acrylics. [Review] [41 refs] SO - Journal of Biomaterials Applications 1987 Jan;1(3):382-405 AB - There are numerous examples in dentistry where demineralization, or even frank caries, develops near or in association with restorative or prosthetic materials. Leaking cavity margins and demineralization under bite splints are two examples. A slow-release source of fluoride could help to prevent these problems and provide added protection throughout the mouth. For this purpose a family of fluoride-releasing resins has been developed for use in various adhesive applications, and also for preparing temporary crowns and removable acrylic devices. These materials contain fluoride ions held to covalently bound positive charge sites within the polymer network. Release is by a diffusion/exchange mechanism in which anions from oral fluids diffuse to the charge sites and exchange with fluoride. Fluoride then diffuses to the surface and is released into solution. This method of release allows for the retention of adequate physical properties and is capable of a linear release rate for terms ranging from days to years. [References: 41] <96> UI - 88224509 AU - Matis BA TI - The implementation of pit and fissure sealants. Lessons in information transfer about preventive dentistry. [Review] [24 refs] SO - Dental School Quarterly - University of Texas Health Science Center at San Antonio 1987;3(2):7-10 <97> UI - 88149785 AU - Hillman JD AU - Socransky SS TI - Replacement therapy of the prevention of dental disease. [Review] [86 refs] SO - Advances in Dental Research 1987 Oct;1(1):119-25 <98> UI - 88160220 AU - Walker AR TI - Perplexities and controversies on diet and dental caries. [Review] [133 refs] SO - World Review of Nutrition & Dietetics 1987;54:174-200 <99> UI - 88115973 AU - Weintraub JA AU - Burt BA TI - Prevention of dental caries by the use of pit-and-fissure sealants. [Review] [84 refs] SO - Journal of Public Health Policy 1987 Winter;8(4):542-60 <100> UI - 88109031 AU - Evans RW AU - Lo EC AU - Lind OP TI - Changes in dental health in Hong Kong after 25 years of water fluoridation. [Review] [28 refs] SO - Community Dental Health 1987 Dec;4(4):383-94 <101> UI - 88099547 AU - Hurd DD IN - Department of Medicine, University of Minnesota, Minneapolis 55455. TI - Allogeneic and autologous bone marrow transplantation for acute nonlymphocytic leukemia. [Review] [105 refs] SO - Seminars in Oncology 1987 Dec;14(4):407-15 AB - Current results show that 50% of young patients with ANLL who undergo allogeneic BMT experience prolonged DFS and may be cured. Encouraging results with high-dose chemo/radiotherapy and autologous BMT are likewise being reported. In addition, some studies using intensive postremission treatment without BMT have shown results comparable to many transplant series. As better ways of preventing GVHD are found, the morbidity and mortality of allogeneic BMT should be reduced and the benefits of transplantation for curing patients with ANLL should be increased. However, the applicability of allogeneic BMT will remain limited due to the availability of compatible donors whether related or unrelated. Further studies are needed in the use of postremission intensive therapy with and without autologous bone marrow support. However, results to date should engender the same degree of enthusiastic optimism that followed the early reports of improved outcome with allogeneic BMT when applied to first remission patients. [References: 105] <102> UI - 88079570 AU - Yanover LR TI - Root surface caries. Epidemiology, etiology and control. [Review] [87 refs] SO - Journal / Canadian Dental Association. Journal de l Association Dentaire Canadienne 1987 Nov;53(11):839-42 <103> UI - 88058848 AU - de Bruyn H AU - Arends J IN - Dental School, State University Groningen, The Netherlands. TI - Fluoride varnishes--a review. [Review] [78 refs] SO - Journal de Biologie Buccale 1987 Jun;15(2):71-82 AB - Fluoride varnishes were developed as alternatives to the conventional topical applications, mainly to prolong contact time between fluoride and teeth. Two marketed products, Duraphat and Fluor Protector, have been extensively tested and are generally accepted for clinical use. In this overview of fluoride varnishes the state of the art of both products is presented. Fluoride uptake, demineralization inhibition and caries prevention induced by varnish applications are discussed. In general it is concluded that varnishes are toxicologically safe, easy to use, and possess excellent cariostatic properties. When re-applied regularly, twice a year, and combined with normal oral hygiene procedures they are topical fluoride agents with very good caries preventive properties. [References: 78] <104> UI - 88033933 AU - Glenn FB AU - Glenn WD 3d TI - Optimum dosage for prenatal fluoride supplementation (PNF): Part IX. [Review] [46 refs] SO - ASDC Journal of Dentistry for Children 1987 Nov-Dec;54(6):445-50 AB - There exists such a wide margin of safety for prenatal fluoride in regard to fluorosis that 2 mg/day can be used as a simplified prenatal fluoride dosage in all areas, regardless of whether they are fluoridated. Any prenatal fluoride dosage between 1 and 4 mg/day is better than no prenatal fluoride at all. [References: 46] <105> UI - 88039787 AU - Westrich BJ IN - Department of Food Science and Human Nutrition, Washington State University, Pullman 99164-2032. TI - Effect of physical activity on skeletal integrity and its implications for calcium requirement studies. [Review] [38 refs] SO - Nutrition & Health 1987;5(1-2):53-60 AB - A major task confronting those who establish calcium recommendations is the determination of a minimum level of calcium intake that will promote bone mineralization and/or reduce bone demineralization sufficiently to aid in the prevention of osteoporosis. The evidence reviewed here indicates that physical activity plays a primary role in the maintenance of skeletal integrity. Thus, to obtain data on calcium recommendations that are relevant to the general population, it is essential that calcium requirement studies use subjects whose physical activity profile is representative of the general population. [References: 38] <106> UI - 88014038 AU - Shaw JH IN - Department of Nutrition, Harvard School of Dental Medicine, Boston, MA. TI - Causes and control of dental caries. [Review] [108 refs] SO - New England Journal of Medicine 1987 Oct 15;317(16):996-1004 <107> UI - 87309349 AU - Saloum FS AU - Sondhi A TI - Preventing enamel decalcification after orthodontic treatment. [Review] [55 refs] SO - Journal of the American Dental Association 1987 Aug;115(2):257-61 AB - As enamel decalcification can occur in conjunction with orthodontic treatment, suggestions are offered for ways to prevent this condition from manifesting. A review of the literature shows the problem is widespread. Preventive programs must be