The depth of cure of clear versus opaque sealants as influenced by curing regimens.

BACKGROUND: The authors conducted a study to test the hypothesis that light-curing regimens affect depth of cure of clear versus opaque sealants. METHODS: The authors light-cured samples of one clear and two opaque sealants at 20 seconds, 0 millimeters; 40 seconds, 0 mm; and 40 seconds, 2.2 mm (n = 5 each). They assessed the depth of cure with Knoop hardness at 0.5-mm increments five minutes and one hour after curing. The authors used analysis of variance. RESULTS: Curing regimens and sealant types affected the depth of cure. The clear sealant maintained a greater hardness than did the opaque sealants through a depth of 3 mm (P < .001). A 20-second duration reduced the depth of cure for all sealants (P < .001). The distance from the light source did not affect the cure depth of the clear sealant (P = .34), but it reduced the cure depth of the opaque sealants (P < .05). Sealant hardness increased significantly one hour after light curing (P < .001). CONCLUSIONS: A clear sealant cured deeper than did opaque sealants. Curing duration is crucial to achieve an adequate depth of cure. A 20-second duration may not suffice. Light source distance affected the depth of cure for the opaque sealants, but not for the clear sealant with sufficient curing duration. CLINICAL IMPLICATIONS: The authors advocate a curing duration of longer than 20 seconds to ensure thorough polymerization at the interface between the sealant and tooth. Insufficient curing could contribute to failure of the sealants, especially the opaque sealants, under clinical conditions that restrict the light tip position.

Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs.

This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs. The panel addressed the following clinical questions. Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews.

Permanent tooth development in children with cleft lip and palate.

PURPOSE: The purposes of this study were to: (1) quantify and compare permanent tooth development of cleft lip and palate (CLP) patients to age- and gender-matched controls; (2) relate these findings to cleft type and severity; and (3) examine delays in individual permanent maxillary teeth related to their proximity to the cleft. METHODS: Standardized methods using panoramic radiographs were employed to stage dental development and dental age for 49 children with clefts and 49 matched controls. Data were analyzed with a mixed linear model. RESULTS: Analyses indicated a correlation between delayed permanent tooth development and CLP with an overall delay of 0.52 years (P = .02) and with boys accounting for all the delay. No differences were found between subjects with unilateral or bilateral clefts. A nonsignificant trend was noted for greater delay in subjects with clefts of the primary and secondary palates vs primary palate alone. Teeth most often affected by the delay were maxillary first and second premolars and maxillary second molars. CONCLUSIONS: While permanent tooth development is delayed in cleft lip and palate patients, this delay is: found in boys only; is independent of the cleft type and severity; and is not correlated with proximity to the cleft.

Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The panel addressed the following clinical questions: Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus. glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? TYPES OF STUDIES REVIEWED: Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews. At the panel's request, the ADA Division of Science staff conducted additional searches for clinical studies related to specific topics. The Centers for Disease Control and Prevention also provided unpublished systematic reviews that since have been accepted for publication. RESULTS: The expert panel developed clinical recommendations for each clinical question. The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions. CLINICAL IMPLICATIONS: These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. The evidence indicates that sealants can be used effectively to prevent the initiation and progression of dental caries.

Risk factors for early childhood caries in Canadian preschool children seeking care.

PURPOSE: The purpose of this study was to determine family characteristics, beliefs, and habits that contribute to early and severe caries in young children in Canada. METHODS: A survey was administered to: (1) parents of 139 children diagnosed with early childhood caries (ECC) in 5 pediatric dentistry practices in Canada over a 33-month period (group 1); and (2) parents of all normal referrals (carious and noncarious children) in one of the practices over a 3 month period (group 2). Group 2 prevented studying an exclusive or polarized population, and allowed direct comparison between children with decoy and without decoy. The survey responses were compared with caries rates in the children, determined by dental examination, to detect important correlations of family and child factors with the disease level. Chi-square and logistic regression analyses described the strength of the relationships. RESULTS: Parent responses provided information on: (1) demographics; (2) economic status; (3) birth order; (4) parental education; (5) payment methods; (6) feeding and weaning history; (7) fluoride history; (8) food habits; (9) hygiene; (10) behavior; and (11) medication use. Caries presence and severe caries was linked to: (1) leaving the bottle with a child while sleeping; (2) having problems brushing a child's teeth; (3) prolonged holding of liquids in the mouth; and (4) being Caucasian. The authors did find that bottle use in general and having a difficult child were protective influences against decay. CONCLUSIONS: The factors providing the most caries risk are: (1) being left with a bottle while sleeping; (2) parents having problems brushing the child's teeth; (3) holding liquids in the mouth for prolonged times; and (4) ethnicity.

Chemomechanical caries removal in children: an operator's and pediatric patients' responses.

BACKGROUND: This study investigated an operator's and pediatric patients' responses to chemo-mechanical caries removal (CMCR) versus the traditional method (TM) of caries removal using a handpiece and a round bur when treating dentinal-depth occlusal lesions with minimal enamel access in primary molars. METHODS: Data were collected from 50 children at baseline and before, during and after caries removal using CMCR or TM. The subjects in the CMCR group were on average younger than the subjects in the TM group and had more deep lesions. RESULTS: The operator rated CMCR as needing more clinical and technical effort and more total effort than TM. He was less satisfied with CMCR than with TM. Subjects in the CMCR group perceived the time needed for treatment as significantly longer than did the subjects in the TM group. Fear of the dentist decreased in subjects in the TM group from before to after the operative appointment, while it increased in subjects in the CMCR group. CONCLUSIONS: The authors found no direct advantage in using CMCR over using TM. CLINICAL IMPLICATIONS: CMCR cannot be recommended as an alternative to TM when treating dentinal depth occlusal lesions with minimal access in primary molars.

Chemomechanical caries removal in children: efficacy and efficiency.

BACKGROUND: The authors investigated the effectiveness of chemomechanical caries removal (CMCR) compared with the traditional method (TM) of caries removal using a round bur when treating dentinal-depth occlusal lesions with minimal enamel access in primary molars. The authors also compare CMCR with TM to determine if it had a higher efficacy and could be used more frequently without the subject's having to undergo local anesthesia. METHODS: The authors collected data from 50 children during operative appointments at which caries was removed using one of the two methods. RESULTS: Complete caries removal within 15 minutes was achieved in only 57.7 percent of the CMCR-treated teeth. In 42.3 percent of these teeth, residual caries was removed using TM. CMCR was almost eight times more time-consuming than was TM when used to excavate dentinal-depth occlusal lesions with minimal cavitation. There was no significant difference between CMCR and TM in the number of subjects who needed to undergo local anesthesia. CONCLUSIONS: The authors found no direct clinical advantage in using CMCR over using TM for treating occlusal dentinal lesions with minimal cavitation in pediatric patients.

The use of pit and fissure sealants.

This paper reviews key issues of sealant use and methodology and poses recommendations to inform the discussion toward a consensus statement by participants. A comprehensive review of sealant literature, including policy recommendations from previous conferences that reviewed best practices for sealant use, was completed. Building on previous review papers and on previous policy statements by dental and public health groups, this paper discusses key questions about sealant use in light of contemporary caries data and cost-benefit analyses. In addition, newest material advancements are reviewed to establish the next step in sealant improvement for young patients.

Remineralized dentin lesions induced by glass ionomer demonstrate increased resistance to subsequent acid challenge.

OBJECTIVE: The purpose of this study was to test the hypothesis that remineralized dentin lesions induced by glass ionomer are less vulnerable to subsequent acid challenge. METHOD AND MATERIALS: Baseline demineralized (BDe) lesions were created in 50 bovine dentin slices immersed for 3 weeks in acid solution. A resin-modified glass ionomer (RMGI) was applied to the specimens before immersion in salivalike solution to allow remineralization (Re) for 2 weeks (V2W) or 6 weeks (V6W). Resin-modifed glass ionomer was coated to block further ion release before a 3-week immersion in acid solution as a second demineralization (SDe). Control groups (C2W and C6W) were done simultaneously without RMGI. In another group, RMGI was left undisturbed (V2W+) to allow continuous ion release during SDe. Mineral content was converted from microradiographs, after BDe, Re, and SDe steps. Changes in mineral content were calculated and compared between groups. RESULTS: The remineralized surface zone was maintained after SDe, but the lesion body became deeper. Percentage of mineral loss from SDe was not significantly different between V2W and C2W (t test, P > .05). When remineralization was extended to 6 weeks, V6W showed significantly less mineral loss than C6W. Mineral loss was lowest when RMGI was not blocked (V2W+). CONCLUSION: Dentin lesions remineralized in the presence of RMGI maintained the highly mineralized surface zone when subjected to second demineralization. However, the remineralized surface zone could not prevent advance of the lesion body. The subsequent demineralization was markedly reduced by extending the remineralization period or by leaving the RMGI undisturbed to resume ion release.

Occlusal sealant success over ten years in a private practice: comparing longevity of sealants placed by dentists, hygienists, and assistants.

PURPOSE: The purpose of this 10-year, retrospective, cohort study was to evaluate the success of permanent molar sealants by comparing the effectiveness of sealants placed by dentists, dental hygienists, and dental assistants in a private dental practice, with all operators using an identical, standardized, application technique and 4-handed dentistry. METHODS: From 810 patient records that met entry criteria, the long-term follow-up records of 3,194 permanent first molars were evaluated. Data were collected and evaluated by survival analyses methods for: (1) time to first failure (caries or restoration of the sealed surface); (2) fluoride history; (3) caries experience; (4) operator type; (5) behavior at sealant placement; (6) tooth type; (7) age at placement; and (8) patient gender. RESULTS: Cumulative survival probability for 10 years in this practice was 87%, using Kaplan Meier analyses. The factors associated with an increased risk of failure included: (1) age (P<.001); (2) dmft (P<.003); (3) no fluoride (P<.001); (4) dentist (P<.001); and (5) registered dental assistant (P<.001). While all operator groups had success rates equal to or exceeding previous studies, dentists and registered dental assistants showed 3 times and 2 times the risk of failure, respectively, compared to the registered dental hygienists. The no-fluoride group showed almost twice the risk of failure as compared to the optimal fluoride group. Behavior showed a slightly higher risk of failure that approached significance. Age and dmft were highly significant, with slight increased risk of failure. Supplemental fluoride showed a protective effect, but this was marginally significant. Gender and tooth-type were not significant in this model. Major variations in success rates were observed in the dental assistant group, with 2 individuals accounting for most of the failures. CONCLUSIONS: This study supports delegation of sealant delivery to auxiliaries, since dental assistants and dental hygienists were equal to or better than the dentists in long-term sealant effectiveness.

A snapshot of the U.S. postdoctoral pediatric dentistry faculty workforce, 2002.

This study characterizes the faculty shortage in U.S. postdoctoral pediatric dentistry (PD) education. The objectives of the study were to determine: 1) the changes in PD faculty numbers and teaching loads between 1995 and 2002 for postdoctoral PD education, 2) current faculty age and training, and 3) distribution of faculty by age. A questionnaire was sent in 2002 to fifty-four programs, of which forty-six responded (85 percent). Dental school and residency mean class sizes increased in the seven-year study period from 82.8 to 91.8 and from 6.0 to 8.5, respectively. Full- and part-time mean faculty positions increased as did vacancies, the latter growing from 15 to 38.9 and changing during the period from 5 to 10.8 percent of available positions. About one-third of programs used general dentists to teach PD, while programs using foreign-trained educators grew from 4 to 13 percent. Twenty-nine percent of full-time and 27 percent of part-time faculty are fifty-five years or older, and young entry-level faculty, age twenty-five to twenty-nine, represent only 2 percent and 5 percent of full- and part-time faculty respectively. Faculty vacancies have increased along with numbers of students and residents, and the largest segment of PD faculty is within a decade of retirement age.

Geographic distribution of pediatric dentists in private practice in the United States.

PURPOSE: The objectives of this study were to: (1) determine the geographic distribution of pediatric dentists in private practice across the United States; and (2) compare state-based pediatric dental practitioner-to-children ratios. METHODS: Enumeration of pediatric dental practitioners was derived from the American Academy of Pediatric Dentistry's 2000-01 Membership Directory by including all active and fellow members who were in private practice in the United States. Population information for the 50 states and District of Columbia was obtained from Census 2000 data available on the US Census Bureau's Web site. RESULTS: A total of 2,913 pediatric dentists were in private practice in the United States, with the largest number located in California (333), Texas (238), and New York (202), and the smallest number located in Maine (3) and North Dakota (4). There were 4.03 pediatric dental practitioners for every 100,000 US children younger than 18 years of age. Connecticut and Massachusetts had almost twice (7.7) as many pediatric dental practitioners per 100,000 children as the national average. On the other hand, Maine had only one fourth (1) the number of pediatric dental practitioners per 100,000 children as the national average. CONCLUSIONS: Marked differences exist between the various states in their pediatric dental practitioner-to-children ratio.

Clinical trial of a self-etching adhesive for sealant application: success at 24 months with Prompt L-Pop.

PURPOSE: To evaluate the 2-year clinical sealant success when using Prompt L-Pop (3M-ESPE), the first self-etching adhesive, as the sole etching and adhesive step prior to sealant placement. METHODS: Patients ages 7-13 years with matched pairs of permanent molars needing sealants were enrolled into an ongoing clinical study of sealant success. First and/or second permanent molars were randomly assigned to control (sealant only after phosphoric acid etch) or Prompt plus sealant groups in a split-mouth, matched pair study design. Standard methods were used for sealant (Delton, Dentsply) placement, except for the Prompt group in which the self-etching adhesive was brushed on the surface, air thinned, followed by immediate placement of the sealant and polymerization. All sealants were placed using appropriate cotton-roll isolation and a dental assistant. Sealant scoring was done at 24 months using strict clinical criteria for failure, previously published, and photos of the sealed surfaces were archived on video. RESULTS: Percentages of sealants scored as successful (no significant loss of material or need for repair) through 24 months were: (a) Occlusal sealants: Control = 61%, versus Prompt = 61%; (b) Bu/Lingual sealants: Control = 54%, versus Prompt = 62%; McNemar's Chi Square tests indicate no difference in success between the Prompt sealants and their matched controls (P > 0.80). Time of placement for sealants, timed from start of the etch step through polymerization, averaged 3.1 minutes for Control and 1.8 minutes for Prompt. We conclude that Prompt L-Pop self-etching adhesive is effective in bonding sealant to enamel and that the simplified method dramatically shortens treatment time and treatment complexity.

Indirect pulp treatment of primary posterior teeth: a retrospective study.

PURPOSE: This study was performed to assess retrospectively the clinical and radiographic success of indirect pulp treatment (IPT) on primary posterior teeth, and to compare the influence of caries risk, skills of the operator, and restorative material on the success of IPT. METHODS: A retrospective review of records of patients treated with IPT in the pediatric dental clinic at The University of Michigan, School of Dentistry from July 1993 through July 1999 was completed in January 2000. Two hundred fifty-five records with IPT were reviewed, from which 132 patients met the inclusion criteria, with 187 primary posterior teeth treated with an IPT. The patients were followed clinically and radiographically for a time ranging between 2 weeks to 73 months. Data were analyzed using survival analysis methods. RESULTS: The success of IPT was 95% (178/187 teeth), with only 9 failures. The 1-year probability of survival of each tooth was estimated to be 96% using an exponential survival model. The use of a base over a calcium hydroxide liner significantly increased the success rate of IPT (P = .0095). The use of a stainless steel crown (SSC) after an IPT was significantly more successful than the use of an amalgam (P=.026). IPT performed on primary first molars failed more frequently than on second primary molars (P = .045). There was no significant difference between maxillary and mandibular primary molars. CONCLUSIONS: Indirect pulp treatment is a successful technique and should be considered as an alternative pulp therapy procedure in deeply carious primary posterior teeth. The use of a base over the liner in addition to a SSC dramatically increases the success of an IPT.

The use of pit and fissure sealants.

This paper reviews key issues of sealant use and methodology and poses recommendations to inform the discussion toward a consensus statement by participants. A comprehensive review of sealant literature, including policy recommendations from previous conferences that reviewed best practices for sealant use, was completed. Building on the review paper by Simonsen and on previous policy statements by dental and public health groups, this paper discusses key questions about sealant use in light of contemporary caries data and cost-benefit analyses. In addition, newest material advancements are reviewed to establish the next step in sealant improvement for young patients.

Preventing the transfer of Streptococcus mutans from primary molars to permanent first molars using chlorhexidine.

PURPOSE: The purpose of this study was to determine if the application of 1% chlorhexidine-containing wax on primary molars during the period of eruption of the first permanent molars could prevent the transfer of certain oral flora, namely Streptococcus mutans, to the permanent molars. METHODS: Fourteen children with a mean age of 6.5 years (7 males and 7 females) were assigned into two groups: a chlorhexidine group (n=9) in which 1% chlorhexidine-containing wax was painted on primary molars on one side of the mouth; and a placebo wax group (n=5) in which a similar wax, but without chlorhexidine, was painted on primary molars on the other side of the mouth. Baseline saliva samples and pooled plaque samples from the primary molars on both sides of the dentition were obtained from the two treatment groups. Following treatment, plaque samples from the occlusal fissures of the first permanent molars on both sides of the dentition were obtained. The levels of S.mutans and other members of the oral flora on the treated sides (chlorhexidine or placebo) were compared with those on the untreated sides. RESULTS: The results showed that the proportions of S.mutans to S.sanguinis were significantly lower in the chlorhexidine-treated sides compared to the untreated (P=0.04) and in the chlorhexidine-treated patients compared to placebo (P=0.029). CONCLUSIONS: Since lower mutans to sanguinis ratios have been associated with lower caries experience, treating primary molars with 1% chlorhexidine wax during eruption of permanent first molars may be a simple means for shifting the fissure flora of the permanent molars towards a more favorable balance.

Microleakage of a new improved glass ionomer restorative material in primary and permanent teeth.

PURPOSE: The objective of this study was to assess the microleakage of the new conventional glass ionomer, Fuji IXgp in comparison to another conventional glass ionomer (Fuji II), a resin modified glass ionomer (Vitremer) and a composite resin (TPH) in primary and permanent teeth. METHODS: Twenty-five extracted human premolars and 13 primary molars were used. Preparations were made on the center of the buccal and lingual aspects of the premolars (Group A) and the mesio buccal and disto buccal surface as well as the mesio lingual and disto lingual surface of the primary molars (Group B). Each group was randomly divided into five subgroups of 10 specimens each and restored with a different material following the manufacturer's recommendations. Restorations were subjected to thermocycling followed by microleakage evaluation using 50% silver nitrate and computerized image analysis. RESULTS: Two factor analysis of variance revealed a significant main effect of material (P<0.001), a trend toward a main effect of tooth type (P=0.082) and a significant interaction term P=0.016. Materials were a source of difference, so a one-way ANOVA test was used for both primary and permanent teeth together and for each individual group of teeth. Differences were further examined with a multi-variate analysis using the Scheffe' test for both groups of teeth and each individual group of teeth. Each group of teeth restored with the same material was then analyzed with an Independent Samples t-test which showed that conventional glass ionomer (Fuji II) had more leakage than all other groups (P<0.01). In addition TPH showed more microleakage in primary teeth (P<0.02) and Fuji II showed more microleakage in permanent teeth (P<0.02). CONCLUSIONS: Fuji IXgp behaved similarly to the composite (TPH) and to the resin modified glass ionomer (Vitremer). This is a promising result for this material that is targeted for application in conjunction with the Atraumatic Restorative Technique and minimal intervention treatments.

Avaliaçäo in vitro da microinfiltraçäo na interface/esmalte sob a influência de contaminaçäo, emprego de "primer"e tipo de selante / In vitro evaluation of sealant microleakage under the influence of contamination, use of primer type of sealant

Este estudo avaliou, in vitro, a microinfiltraçäo na interface selante/esmalte sob a influência de contaminaçäo do meio (saliva), emprego de "primer" (Tenure - DEn-Mat) e tipo de selante (Concise Light Cured White Sealant - 3M; Fluroshield - Caulk/Dentsply). Os resultados foram obtidos a partir de medidas lineares, utilizando-se um sistema computadorizado de imagens digitalizadas (IMAGE PLUS). Pôde-se concluir que a contaminaçäo salivar e utilizaçäo de "primer" atuaram de maneira diversa nas diferentes etapas do procedimento clínico; os selantes comportaram-se de maneira semelhante quando submetidos às mesmas condiçöes; o emprego do "primer" favoreceu o escoamento do selante Fluroshield (Caulk/dentsply) nos sulcos e pôde ser observado maior número de bolhas com esse material